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1

Anesthetic Techniques and Cancer Recurrence after Surgery  

PubMed Central

Many of the most common anesthetics are used in surgical oncology, yet effects on cancer cells are still not known. Anesthesia technique could differentially affect cancer recurrence in oncologic patients undergoing surgery, due to immunosuppression, stimulation of angiogenesis, and dissemination of residual cancer cells. Data support the use of intravenous anesthetics, such as propofol anesthesia, thanks to antitumoral protective effects inhibiting cyclooxygenase 2 and prostaglandins E2 in cancer cells, and stimulation of immunity response; a restriction in the use of volatile anesthetics; restriction in the use of opioids as they suppress humoral and cellular immunity, and their chronic use favors angiogenesis and development of metastases; use of locoregional anesthesia compared with general anesthesia, as locoregional appears to reduce cancer recurrence after surgery. However, these findings must be interpreted cautiously as there is no evidence that simple changes in the practice of anesthesia can have a positive impact on postsurgical survival of cancer patients. PMID:24683330

D'Arrigo, Maria G.; Triolo, Stefania; Mondello, Stefania; La Torre, Domenico

2014-01-01

2

Anesthetic management of a horse with traumatic pneumothorax  

PubMed Central

A traumatic pneumothorax and severe hemorrhage were present in a mare with a large thoracic wall defect, lung perforation, and multiple rib fractures. General anesthesia was induced to allow surgical exploration. We describe the anesthetic technique, and discuss the management of the ventilatory, hemodynamic, and metabolic disturbances encountered. PMID:23204585

Chesnel, Maud-Aline; Aprea, Francesco; Clutton, R. Eddie

2012-01-01

3

[Do anesthetic techniques influence postoperative outcomes? Part II].  

PubMed

The knowledge of the influence of anesthetic techniques in postoperative outcomes has opened a large field of research in recent years. In this second part, we review some of the major controversies arising from the literature on the impact of anesthetic techniques on postoperative outcomes in 6 areas: postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes, and resources utilization. The development of protective and preventive anesthetic strategies against short and long-term postoperative complications will probably occupy an important role in our daily anesthetic practice. Dynamic postoperative pain control has been confirmed as one of the basic requirements of accelerated postoperative recovery programs ("fast-track surgery"), and it is also a preventive factor for development of chronic postoperative pain. The weight of anesthetic technique on postoperative immunosuppression is to be defined. The potential influence of anesthesia on cancer recurrence, is a highly controversial area of research. The classic pattern of perioperative fluid therapy may increase postoperative complications. On the other hand, the maintenance of normoglycemia and normothermia was associated with a decreased postoperative morbidity. The high volume of surgical procedures means that the adequacy of human, organizational and technological resources have a major impact on overall costs. PMID:23099035

Esteve, N; Valdivia, J; Ferrer, A; Mora, C; Ribera, H; Garrido, P

2013-02-01

4

[Anesthetic management for patients with mitochondrial disease].  

PubMed

Mitochondrial diseases are caused by a decrease in ATP production due to mutations of mitochondrial or mitochondria-related nuclear DNA. Their effects are likely to appear in tissues with a high energy demand, including skeletal muscle, nervous, and cardiovascular systems. Cardiac manifestations of mitochondrial diseases can be divided into cardiomyopathies, which are primarily hypertrophic and dilated cardiomyopathies, and electropathies, which are primarily conduction system disease and ventricular pre-excitation. The first principle of anesthesia for patients with mitochondrial diseases is to avoid any additional burden on the already declined metabolic functions. Appropriate oxygenation, minimization of the oxygen demand, stable cardiovascular management, maintenance of a normal blood glucose level and body temperature, and effective perioperative pain control are of importance. Most anesthetics have been reported to reduce mitochondrial functions, and although enhancement of the sensitivity and prolongation of the duration of action have been reported, they are clinically used with no major problems. Detailed preoperative evaluation of the disease condition and careful intraoperative monitoring are important for the prevention of perioperative complications. PMID:24558931

Imai, Yousuke; Yamada, Yoshitsugu

2014-01-01

5

Anesthetic management during cardiopulmonary bypass: a systematic review.  

PubMed

Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist responsible for providing the 3 most basic facets of any anesthetic: amnesia, analgesia, and muscle relaxation. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. Similarly, CPB causes pharmacodynamic alterations that impact anesthetic efficacy. The clinical significance of these alterations represents a "moving target" as practice evolves and the technology of CPB circuitry advances. In addition, perfusionists choose, modify, and maintain the CPB circuitry and membrane oxygenator. Thus, their significance may not be fully appreciated by the anesthesiologist. These issues have a profound impact on the anesthetic state of the patient. The delivery and maintenance of anesthesia during CPB present unique challenges. The perfusionist may be directly responsible for the delivery of anesthetic during CPB, a situation unique to the cardiac suite. In addition, monitors of anesthetic depth-assessment of clinical signs, hemodynamic indicators, the bispectral index monitor, end-tidal anesthetic concentration, or twitch monitoring-are often absent, unreliable, or directly impacted by the unique pathophysiology associated with CPB. The magnitude of these challenges is reflected in the higher incidence of intraoperative awareness during cardiac surgery. Further complicating matters are the lack of specific clinical guidelines and varying international policies regarding medical device specifications that add further layers of complexity and introduce practice variability both within institutions and among nations. We performed a systematic survey of the literature to identify where anesthetic practice during CPB is evidence based (or not), identify gaps in the literature to guide future investigations, and explore the implications of evolving surgical practice, perfusion techniques, and national policies that impact amnesia, analgesia, and muscle relaxation during CPB. PMID:25790208

Barry, Aaron E; Chaney, Mark A; London, Martin J

2015-04-01

6

Effect of Opiates, Anesthetic Techniques, and Other Perioperative Factors on Surgical Cancer Patients  

PubMed Central

Background Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. Methods This article presents an evidence-based review of the influence of opioids and anesthetic technique on the immune system in the context of cancer recurrence. The review focuses on the field of regional anesthesia and the setting of surgical oncologic procedures. The method for perioperative pain management and the technique of anesthesia chosen for patients in cancer surgery were explored. Results General anesthetics have been indicated to suppress both cell-mediated immunity and humoral immunity. Evidence suggests that intravenous opioids suppress the immune system. However, the mechanisms by which anesthetics and analgesics inhibit the immune system are not understood. Compared with the alternatives, regional analgesia offers reduced blood loss and superior postoperative analgesia. Because of these advantages, the use of regional analgesia has increased in oncologic surgeries. Conclusion Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery. PMID:24940132

Kaye, Alan David; Patel, Nayan; Bueno, Franklin Rivera; Hymel, Brad; Vadivelu, Nalini; Kodumudi, Gopal; Urman, Richard D.

2014-01-01

7

Anesthetic management of an infant for aortopexy  

PubMed Central

Tracheomalacia is a rare condition characterized by weakness of tracheobronchial cartilaginous bridges. Severe weakness results in tracheal collapse during inspiration, obstructing normal airflow. Tracheomalacia may also be associated with esophageal atresia, tracheoesophageal fistula, and gastroesophageal reflux. Aortopexy is an established surgical procedure for treatment of severe tracheomalacia. A 2-month-old boy was scheduled for aortopexy. He had already undergone repair of tracheoesophageal fistula and had failed multiple attempts at extubation. Intraoperative flexible fiberoptic bronchoscopy was performed to guide the amount and direction of aortopexy for assuring the most effective tracheal decompression. Since tracheomalacia is best assessed in a spontaneously breathing patient, it was an anesthetic challenge to maintain an adequate depth of anesthesia while allowing the patient to breathe spontaneously. Throughout the intraoperative period, SpO2 remained ?96%. Following the procedure, the trachea was extubated and patient was able to breathe normally. PMID:23878453

Kumar, Shruti; Gupta, Richa; Wadhawan, Sonia

2013-01-01

8

Anesthetic management of a patient with Kimura's disease for superficial parotidectomy  

PubMed Central

Kimura's disease is a rare form of chronic eosinophilic inflammatory disease with vascular proliferation involving salivary gland, skin, lymph node, and kidney. Important anesthetic concerns include increased surgical bleeding due to its vascular nature, airway involvement by the mass leading to a possible difficult airway, allergic symptoms associated with high eosinophil count and elevated IgE level and nephrotic syndrome due to involvement of kidney by the inflammatory process. There is paucity of information in the literature on the anesthetic management of Kimura's disease. We describe the anesthesia technique and review the literature of such a case posted for superficial parotidectomy. PMID:21897514

Baidya, Dalim Kumar; Chhabra, Anjolie; Raj, Ravi

2011-01-01

9

Anesthetic management of a patient with aortocaval fistula.  

PubMed

Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm (AAA), and patients with an aortocaval fistula show multiple symptoms. We report an 87-year-old man who was diagnosed as having an AAA with aortocaval fistula and who developed refractory hypotension after induction of anesthesia. Following a phenylephrine injection for slight hypotension induced by anesthetic induction, he developed severe hypotension and bradycardia, and his skin became cyanotic. Vasopressor agents had no immediate effect on the hypotension, but blood pressure gradually increased in about 30 min with continuous infusion of dopamine and noradrenaline. Transesophageal echocardiography (TEE) showed right ventricle (RV) hypokinesis and massive tricuspid regurgitation (TR). Central venous pressure (CVP) showed a remarkably high value. After the repair of the aortocaval fistula, the hemodynamics became stable, RV motion was improved, TR was reduced, and CVP became normal. Anesthetic management of the repair of an aortocaval fistula is very difficult. The hemodynamics changed dramatically throughout anesthesia in our patient with this disorder, even though low-dose anesthetics were used. For the successful treatment of this disorder, preparation for the operation is required before the induction of anesthesia, and urgent closure of the fistula is necessary after the induction of anesthesia. TEE is a useful tool for monitoring hemodynamics in such patients. PMID:19234833

Morikawa, Keiko; Setoguchi, Hidekazu; Yoshino, Jun; Motoyama, Masaiwa; Makizono, Reiko; Yokoo, Tomoka; Suemori, Yasuhiko; Tanaka, Hiroyuki; Takahashi, Shosuke

2009-01-01

10

Anesthetic management of a child with Hunter's syndrome  

PubMed Central

Hunter's syndrome is a member of a group of recessively inherited metabolic disorders termed mucopolysaccharidoses, caused by deficiency of lysosomal enzymes required for degradation of mucopolysaccharides or glycosaminoglycans, leading to accumulation of partially degraded glycosaminoglycans in various tissues. This leads to various anatomical abnormalities and systemic involvement, posing a challenge to an anesthetist. We present the anesthetic management of a 4-year old child with Hunter's disease with anticipated difficult airway, who presented for adenotonsillectomy and repair of umbilical and inguinal hernia. PMID:22557757

Kaur, Jasmeet; Swami, Adarsh C; Kumar, Amit; Lata, Sneh

2012-01-01

11

Anesthetic and dental management of a child with IMAGe syndrome.  

PubMed

IMAGe syndrome (OMIM 300290) is a rare multisystem disorder that has a broad phenotypic presentation. Though variable, this disorder mainly consists of Intrauterine growth retardation, Metaphyseal dysplasia, Adrenal hypoplasia congenita, and Genital abnormalities. Patients with IMAGe syndrome present as an uncommon yet important challenge for dentists and anesthesiologists due to their wide range of dysmorphic facial features, adrenal insufficiency, electrolyte imbalances, and need for steroid replacement. The purpose of this case report is to describe the successful anesthetic management of a pediatric patient diagnosed with IMAGe syndrome who presented for full mouth dental rehabilitation. PMID:25517553

Lindemeyer, Rochelle G; Rashewsky, Stephanie E; Louie, Phillip J; Schleelein, Laura

2014-01-01

12

Anesthetic management of a parturient with glioma brain for cesarean section immediately followed by craniotomy.  

PubMed

The anesthetic management of a parturient with an intracranial tumor can be quite challenging for the anesthetist as it requires a fine balance of both maternal and fetal safety. The literature pertaining to anesthetic management of such cases is limited. We describe the anesthetic management and peri-operative concerns of this unusual case of a parturient aged 25 years with 8 months amenorrhea and a high grade glioma in the left temporo-parietal region who underwent cesarean section under general anesthesia immediately followed by craniotomy. Anesthetic management was tailored keeping in mind maternal safety and fetal considerations. PMID:25190951

Khurana, Tina; Taneja, Bharti; Saxena, Kirti N

2014-07-01

13

Congenital lobar emphysema: A modified approach to anesthetic management  

PubMed Central

Congenital lobar emphysema (CLE) is a potentially reversible, though life-threatening cause of respiratory distress in neonates. It is a rare developmental anomaly of the lower respiratory tract. A 10-month-old child presented with fever, cough and difficulty in breathing. Respiratory system examination revealed tachypnea with intercostal retraction, decreased breath sounds over the left upper lobe and room air saturation of 95%. Chest radiograph and computed tomography showed hyperinflated left upper zones with mediastinal shift. Left thoracotomy, followed by left upper lobectomy was performed under general anesthesia with one lung ventilation. Oxygen saturation, blood pressure, electrocardiogram and capnogram were continuously monitored. During anesthesia, conventionally positive pressure ventilation is avoided until the diseased lobe is isolated, however we adopted gentle manual ventilation maintaining the airway pressure before thoracotomy as described by Coté and Payne et al. Successful anesthetic management of CLE can be achieved by proper understanding of pathophysiology, good perioperative monitoring, and adopting novel management strategies. PMID:25624651

Nandihalli, Malathi C.; Thammaiah, Srinivas H.; Kotekar, Nalini; Putran, Prashanth R.

2015-01-01

14

[Current aspects of anesthetic management in urological patients].  

PubMed

Patients with coronary stents should take clopidogrel and acetylsalicylic acid for 4 weeks or 12 months after stenting. Stopping this medication early, e.g., for surgery, results in a 90-fold increase in the patient's risk for myocardial infarction from stent thrombosis. The mortality due to perioperative acute coronary syndrome clearly exceeds that due to perioperative bleeding complications. If oral medication resulting in platelet inhibition has to be paused "bridging" with short-acting, intravenous GPIIb/IIIa antagonists is possible. In recent years perioperative beta-blockade has been recommended for patients with high coronary vascular risk, and recently also for those with medium or low risk. Current studies, however, indicate that patients on beta-blockers have increased perioperative mortality because of bradycardia, hypotension, and anemia. Therefore, anemia and hypotension should be rigorously avoided.Anesthetic management may have an influence on the postoperative course of cancer. Combined epidural-general anesthesia provides a benefit by minimizing the use of systemic opioids and volatile anesthetics. Presumably, this and a decreased response to surgical stress increase the ability of the patient's immune system to deal with cancer dissemination and micrometastasis. PMID:20721526

Groll, O; Peters, J

2010-09-01

15

Epidermolysis bullosa, dental and anesthetic management: a case report.  

PubMed

Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist. PMID:25191665

Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza

2014-09-01

16

[Anesthetic management of a patient with Swyer-James syndrome].  

PubMed

Swyer-James syndrome (SJS) shows the constellation of radiographic findings of a small, hyper lucent lung, with an ipsilateral, diminished peripheral vasculature, air trapping, and a lack of peripheral fill on bronchography. We report a case of 70-year-old woman with SJS who underwent pulmonary resection of the normal side lung for lung tumor. Because of this syndrome, we could predict the hypoxia during one-lung ventilation. In fact, about ten minutes after beginning of one-lung ventilation, Sp(O2) decreased from 100% to 90%. As we could not improve the hypoxia in spite of increasing FI(O2), O2 administration to the operating side lung was started. Sp(O2) recovered after O2 administration. For anesthetic management of a patient with SJS in the normal-side-lung, it is essential to prevent the hypoxia during one-lung ventilation. PMID:20960909

Kishi, Nobuyuki; Kawasaki, Takashi; Miyazaki, Yuya; Sata, Takeyoshi

2010-10-01

17

Epidermolysis Bullosa, Dental and Anesthetic Management: A Case Report  

PubMed Central

Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist. PMID:25191665

Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza

2014-01-01

18

Dextrocardia and ventricular septal defect with situs inversus: Anesthetic implications and management  

PubMed Central

The patients with complicated congenital heart diseases are reaching adulthood with advances in corrective surgeries and medical management. Impact of anesthetic agents on complex cardiac and extra cardiac anomalies and presence of previous palliative procedures can be a challenge for the anesthesiologist perioperatively, while these patients present for cardiac/noncardiac surgeries. We report the perioperative management of a patient with ventricular septal defect, dextrocardia, pulmonary hypertension, and situs inversus who underwent a successful hernioplasty and hydrocelectomy with a combined spinal epidural anesthesia. This discussion relates to the anesthetic management in such conditions with a special reference to Kartagener's syndrome.

Abraham, Betsy; Shivanna, Shivakumar; Tejesh, C. A.

2012-01-01

19

Anesthetic management of a patient with aortocaval fistula  

Microsoft Academic Search

Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm (AAA), and patients with an aortocaval fistula\\u000a show multiple symptoms. We report an 87-year-old man who was diagnosed as having an AAA with aortocaval fistula and who developed\\u000a refractory hypotension after induction of anesthesia. Following a phenylephrine injection for slight hypotension induced by\\u000a anesthetic induction, he developed severe hypotension

Keiko Morikawa; Hidekazu Setoguchi; Jun Yoshino; Masaiwa Motoyama; Reiko Makizono; Tomoka Yokoo; Yasuhiko Suemori; Hiroyuki Tanaka; Shosuke Takahashi

2009-01-01

20

Anesthetic management of descending thoracic aortobifemoral bypass for aortoiliac occlusive disease: Our experience  

PubMed Central

Background: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients. Methods: Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 ?g/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O2 + N2 O (30:70). Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line. Results: In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well. Conclusion: The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to maintain the myocardial oxygen supply demand ratio. PMID:24665249

Saiyed, Anjum; Meena, Reema; Verma, Indu; Vyas, C. K.

2014-01-01

21

Effects of general and spinal anesthetic techniques on endothelial adhesion molecules in cesarean section  

PubMed Central

Background The aim of this study was to investigate the effects of anesthetic techniques used during general anesthesia (GA) and spinal anesthesia (SA) on endothelial adhesion molecules in the fetal circulation of healthy parturients undergoing elective cesarean section. Methods Patients were randomly assigned to either the general anesthesia (n = 20) or spinal anesthesia (n = 20) group. Maternal and cord blood neopterin, sE-selectin, and sL-selectin levels were measured in both groups. Results Cord blood neopterin concentrations in the SA group were not different from those in the GA group, but maternal neopterin levels in the SA group were different from those in the GA group. Maternal blood levels of sE-selectin and sL-selectin were not different between the two groups. Similarly, the cord blood levels of sE-selectin and sL-selectin were not different between the two groups. We found an increased inflammatory process in the fetal circulation depending on the anesthetic method used. Conclusions These results indicate the effects of general and spinal anesthetic techniques on serum sL-selectin, sE-selectin, and neopterin levels in neonates and parturients undergoing elective cesarean section. sE-selectin and neopterin concentrations and leukocyte counts were higher in the fetal circulation than in the maternal circulation during both GA and SA. PMID:24910728

Purtuloglu, Tar?k; Akgul, Emin Ozgur; Oztosun, Muzaffer; Honca, Tevfik; Sizlan, Ali; Agilli, Mehmet; Aydin, ?brahim; Yetim, Memduh; Aydin, Fevzi Nuri; Yaman, Halil

2014-01-01

22

Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences.  

PubMed

Transcatheter aortic valve implantation is an emergent technique for high risk patients with aortic stenosis. Transcatheter aortic valve implantation poses significant challenges about its management, due to the procedure itself (i.e. the passage of large stiff sheaths in diseased vessels, the valve dilatation and the prosthesis positioning during a partial cardiac standstill) and the population of elder and high-risk patients who undergo the implantation. Retrograde transfemoral approach is the most popular procedure and a great number of cases is reported. Nevertheless, there is not a consensus regarding the intraoperative anesthesiological strategies, which vary in the different Centers. Sedation plus local anesthesia or general anesthesia are both valid alternatives and can be applied according to patient's characteristics and procedural instances. Most groups started the implantation program with a general anesthesia; indeed, it offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of potential complications, through the use of the transesophageal echocardiography. However, after the initial experiences, many groups began to employ routinely sedation plus local anesthesia for transcatheter aortic valve implantation and their procedural and periprocedural success demonstrates that it is feasible, with many possible advantages. Many aspects about perioperative anesthetic management for transcatheter aortic valve implantation are still to be defined. Aim of this work is to clarify the different management strategies through a review of the available literature published in pubmed till June 2011. PMID:23440259

Ruggeri, L; Gerli, C; Franco, A; Barile, L; Magnano di San Lio, M S; Villari, N; Zangrillo, A

2012-01-01

23

Anesthetic management for foramen magnum decompression in a patient with Morquio syndrome: a case report.  

PubMed

Morquio syndrome is a hereditary mucopolysaccharide disorder presenting with an abnormality of the craniocervical junction from childhood. We describe an adult patient who presented with Morquio syndrome who had subglottic narrowing of the airway, restrictive pulmonary disease, and mild mitral regurgitation and trivial aortic regurgitation. The anesthetic management of this patient for atlantoaxial stabilization is presented. PMID:20517622

Geetha, Lakshminarsimhaiah; Radhakrishnan, Muthuchellappan; Raghavendra, Biligiri Sridhar; Rao, G S Umamaheswara; Indira Devi, Bhagavatula

2010-08-01

24

Anesthetic management of Shah–Waardenburg syndrome: Experience of two cases and review of literature  

PubMed Central

Waardenburg syndrome (WS) is a rare autosomally inherited and genetically heterogeneous disorder of neural crest cell development. Literature regarding the anesthetic management of these cases is limited. We present 2 cases of Shah–Waardenburg syndrome and discuss them in the context of review of previously published cases. PMID:22754447

Ambi, Uday S.; Adarsh, E. S.; Hatti, Ramesh; Samalad, Vijaymahantesh

2012-01-01

25

Anesthetic management of a pregnant woman undergoing laparoscopic surgery for pheochromocytoma -A case report-.  

PubMed

Pheochromocytoma is a rare catecholamine producing tumor. Anesthetic management for the resection of pheochromocytoma is hard and challenging issue to anesthesiologist, because of its potentially lethal cardiovascular complications. It becomes more complicated when the patient is pregnant. Clinicians must keep the safety of both mother and fetus in mind. The timing of surgery for pheochromocytoma in pregnancy is very important for the maternal and fetal safety and depends on the gestational age when diagnosis is made, clinical response to medical treatment, the surgical accessibility of the tumor, and the presence of fetal distress. We report anesthetic experience of a laparoscopic resection for pheochromocytoma in 25th week gestational woman. PMID:23646250

Doo, A Ram; Kim, Deokkyu; Cha, Kyoung-Nam; Han, Young Jin; Kim, Dong-Chan

2013-04-01

26

Anesthetic Concerns of Space Flight  

NASA Technical Reports Server (NTRS)

Anesthesiologists are acutely aware of the fact that, although a given surgical procedure may be relatively simple, the required anesthetic care is, in certain cases, extremely complex. This principle is particularly evident when one ponders the difficulties involved in providing even basic anesthetic care in microgravity. In this issue some of these difficulties through the evaluation of airway management techniques during water immersion are confronted, a simulation of the gravito-inertial conditions of space flight. As prelude for this paper, I would like to outline some of the challenges to be overcome before surgical, anesthetic, and critical care can be delivered beyond our home planet.

Norfleet, William T.

1999-01-01

27

Laparoscopic colectomy in an adult with single ventricle physiology: Anesthetic implications and management.  

PubMed

Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes. PMID:25849703

Zach, Kelly J; Ramakrishna, Harish; Chandrasekaran, Krishnashwamy; Weis, Ricardo A

2015-01-01

28

Anesthetic management of tongue reduction in a case of Beckwith-Wiedemann syndrome  

PubMed Central

Anesthesia for partial glossectomy in a premature child with Beckwith-Wiedemann syndrome presents as a unique challenge to the Anesthesiologist. Airway management in patients presenting with macroglossia is especially significant and requires meticulous preparation and pre-operative assessment. This report delineates the anesthetic concerns such as an anticipated difficult airway due to a large tongue, prematurity, hypoglycemia and an oral cavity surgery and their management. PMID:25425786

Batra, Meenu; Valecha, Umesh K.

2014-01-01

29

Anesthetic management of tongue reduction in a case of Beckwith-Wiedemann syndrome.  

PubMed

Anesthesia for partial glossectomy in a premature child with Beckwith-Wiedemann syndrome presents as a unique challenge to the Anesthesiologist. Airway management in patients presenting with macroglossia is especially significant and requires meticulous preparation and pre-operative assessment. This report delineates the anesthetic concerns such as an anticipated difficult airway due to a large tongue, prematurity, hypoglycemia and an oral cavity surgery and their management. PMID:25425786

Batra, Meenu; Valecha, Umesh K

2014-10-01

30

Anesthetic management of a patient presenting with eclampsia  

PubMed Central

Eclampsia is one of the most common emergencies encountered by anesthesiologists which involve a safe journey of two lives. The definition, etiology, pathophysiology, treatment guidelines along with a special reference to management of labour pain and caesarean section are discussed. Eclampsia is commonly faced challenging case in our day to day anaesthesia practice,but less is discussed in our anaesthesia text books. Lot of controversies with regard to fluid management and monitoring still remain unanswered

Parthasarathy, S.; Kumar, V. R. Hemanth; Sripriya, R.; Ravishankar, M.

2013-01-01

31

Successful anesthetic management of a large supraglottic cyst  

PubMed Central

Excision of a huge-sized supraglottic mass nearly obstructing the airway passage is a real challenge to anesthesiologists. Upper airway obstruction due to neoplasm in supraglottic region is traditionally managed by preoperative tracheostomy. However, such a common procedure can potentially have an impact on long-term outcome. PMID:25191207

Wagh, Harshal D.

2014-01-01

32

Laparoscopic Cortical Sparing Adrenalectomy for Pediatric Bilateral Pheochromocytoma: Anesthetic Management  

PubMed Central

Introduction: Pheochromocytoma is a catecholamine-secreting tumor, which is seen rarely in children. These tumors predominantly secrete norepinephrine and epinephrine. They might be familial and associated with hereditary tumors such as Von Hippel-Lindau syndrome and multiple endocrine neoplasia type II. Case Presentation: The child might present with a spectrum of clinical manifestation including hypertension, headache, visual disturbances, and behavioral problems. A meticulous preoperative preparation is essential for a stable intraoperative and postoperative outcome Conclusions: We described successful perioperative management of a child who underwent bilateral laparoscopic cortical sparing adrenalectomy and a repeated surgery for the residual tumor removal. PMID:24790902

Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

2014-01-01

33

Motor impairment following blockade of the infraorbital nerve: implications for the use of anesthetization techniques in speech research.  

PubMed

Infraorbital nerve blocks were performed bilaterally in three subjects as a partial test of the hypothesis that some portion of the motor innervation to the facial muscles is provided in the trigeminal nerve. To ascertain the influence of this anesthetic procedure, the magnitude and rate of upper lip displacement (for speech and nonspeech tasks), the magnitude and rate of upper lip depression force, and diadochokinetic rate were transduced and recorded, both pre- and postanesthesia. All measures, along with bilateral muscle action potentials from orbicularis oris superior obtained for all force and displacement tasks, were reduced in magnitude as a function of the anesthetic condition. These findings, along with results from previous speech anesthetic studies, were interpreted to suggest that anesthesia of the infraorbital nerve produces measurable, if not substantial motor weakness in the supraoral musculature. The implications for previous studies, where anesthesia techniques have been employed, are discussed. PMID:1271798

Abbs, J H; Folkins, J W; Sivarajan, M

1976-03-01

34

Anesthetic management for cesarean delivery of a parturient with impetigo herpetiformis.  

PubMed

Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges. PMID:25611605

Duffield, Adrienne T; Smith, Kathleen A

2013-10-01

35

Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome  

PubMed Central

Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia. PMID:25191983

Hase, Yuri; Kamekura, Nobuhito; Fujisawa, Toshiaki; Fukushima, Kazuaki

2014-01-01

36

[Anesthetic management for robot assisted off-pump construction of composite graft using the da Vinci surgical system].  

PubMed

Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered "minimally invasive, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined. PMID:20169956

Takanashi, Yoko; Hamano, Hiroko; Miyata, Kazuto; Matsumoto, Shouhei; Isshiki, Atushi

2010-02-01

37

Scientometrics of anesthetic drugs and their techniques of administration, 1984–2013  

PubMed Central

The aim of this study was to assess progress in the field of anesthetic drugs over the past 30 years using scientometric indices: popularity indices (general and specific), representing the proportion of articles on a drug relative to all articles in the field of anesthetics (general index) or the subfield of a specific class of anesthetics (specific index); index of change, representing the degree of growth in publications on a topic from one period to the next; index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed; and index of ultimate success, representing a publication outcome when a new drug takes the place of a common drug previously used for the same purpose. Publications on 58 topics were assessed during six 5-year periods from 1984 to 2013. Our analysis showed that during 2009–2013, out of seven anesthetics with a high general popularity index (?2.0), only two were introduced after 1980, ie, the inhaled anesthetic sevoflurane and the local anesthetic ropivacaine; however, only sevoflurane had a high index of expectations (12.1). Among anesthetic adjuncts, in 2009–2013, only one agent, sugammadex, had both an extremely high index of change (>100) and a high index of expectations (25.0), reflecting the novelty of its mechanism of action. The index of ultimate success was positive with three anesthetics, ie, lidocaine, isoflurane, and propofol, all of which were introduced much longer than 30 years ago. For the past 30 years, there were no new anesthetics that have produced changes in scientometric indices indicating real progress. PMID:25525336

Vlassakov, Kamen V; Kissin, Igor

2014-01-01

38

The incidence of complex regional pain syndrome after fasciectomy for Dupuytren's contracture: a prospective observational study of four anesthetic techniques.  

PubMed

The development of complex regional pain syndrome (CRPS) is not an uncommon complication after Dupuytren's surgery. Despite increasing research interest, little is known regarding which patients are at increased risk for developing CRPS and what is the optimal perioperative treatment strategy for preventing the occurrence of this disease after surgery. We prospectively evaluated the use of four anesthetic techniques (general anesthesia, axillary block, and IV regional anesthesia [IVRA] with lidocaine with or without clonidine) for patients undergoing fasciectomy for Dupuytren's contracture. All patients were followed in the Pain Management Center at 1, 3, and 12 mo postoperatively by a blinded physician to evaluate the presence of CRPS. Significantly (P < 0.01) more patients developed postoperative CRPS in the general anesthesia group (n = 25; 24%) and the IVRA lidocaine group (n = 12; 25%) compared with either the axillary block group (n = 5; 5%) or the IVRA lidocaine and clonidine group (n = 3; 6%). We conclude that axillary block or IVRA with clonidine offers a significant advantage for decreasing the incidence of CRPS compared with either IVRA with lidocaine alone or general anesthesia for patients undergoing Dupuytren's surgery. PMID:16428550

Reuben, Scott S; Pristas, Rene; Dixon, Duane; Faruqi, Shameema; Madabhushi, Lakshmi; Wenner, Steven

2006-02-01

39

Anesthetic management for resection of para-aortic paraganglioma and unexpected aortic resection: A case report  

PubMed Central

Paragangliomas account for 15–20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has a high mortality rate due to hypertension and challenging anesthetic management. The present report is of a case of the successful management of paraganglioma resection with unexpected aortic resection. The patient presented for paraganglioma resection. The blood pressure (BP) was well controlled with ? blockade followed by ? blockade prior to surgery. The patient was under general anesthesia, with multiple intravenous lines, catheters and an arterial line. Induction was achieved by the administration of narcotic and volatile agents. During the procedure, the aorta was found to require resection in order to complete the tumor resection. The BP changed markedly with clamping and unclamping, tumor vein ligation and tumor resection. The increased BP due to catecholamine release and unclamping was controlled with phentolamine, nitroprusside, esmolol and labetolol. Drops in BP due to tumor vein ligation and clamping were managed with norepinephrine and vasopressin. With close communication and monitoring, the surgery on the patient was successfully completed and the patient was discharged days later in a hemodynamically stable condition. The diagnosis was further confirmed by pathology. This was a challenging case of paraganglioma resection with unexpected aortic resection. The success achieved suggests that the resection of paraganglioma and an aortic segment requires delicate anesthetic management. The key are ? blockade and ? blockade as necessary to control BP pre-operatively, frequent communication between the anesthesiologist and surgeons, intra-operative intervention in excess catecholamine release with phentolamine, nitroprusside and labetalol prior to tumor removal, and vasopressin for catecholamine deficiency when clamping or subsequent to tumor removal. It is a delicately orchestrated process requiring team work.

WANG, CHERYL; RICHMOND, ROBERT; ELDESOUKI, ENAS

2015-01-01

40

Anesthetic management of patient with systemic lupus erythematosus and thrombocytopenia for vaginal hysterectomy  

PubMed Central

We report a case of a female having systemic lupus erythematosus, who was on steroid therapy and was scheduled for vaginal hysterectomy. She presented with breathlessness on mild exertion, a characteristic facial malar rash, and a platelet count 56,000 cells/cu mm. The patient was given a subarachnoid block with 2.8 ml 0.5% bupivacaine heavy in L3–L4 intervertebral space. Inj. Hydrocortisone 25 mg was given I.V. intraoperatively and repeated every 6 hours for 24 hours. Anesthetic management included considerations of systemic organ involvement, thrombocytopenia, and perioperative steroid replacement. Spinal block can be given with platelet count > 50,000/cumm. Strict asepsis should be maintained for invasive procedures. Maintenance of normothermia decreases the impact of Raynaud's phenomenon.

Chauhan, Gaurav; Gupta, Kapil; Kashyap, Chandni; Nayar, Pavan

2013-01-01

41

Epidural block for obstetrics: Comparison of bolus injection of local anesthetic with gravity flow technique  

Microsoft Academic Search

Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.Design: Prospective, randomized study.Setting: Teaching hospital.Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.Interventions: After identification of the epidural space with pulsations of

Shaul Cohen; David Amar

1997-01-01

42

[Anesthetic management of a patient implanted with a CRT-P device undergoing laparoscopic nephrectomy].  

PubMed

A 76-year-old man implanted with a CRT-P device (cardiac resynchronization therapy pacemaker) was diagnosed with renal tumor by chance. Right laparoscopic nephrectomy was performed under general and epidural anesthesia. Urologists were going to use a monopolar electrocautery during the operation. Before beginning the operation, we converted his pacing mode from DDD to DOO with a precordial magnet because electrocautery has the potential for causing device reset. His blood pressure and heart rate were stable during DOO mode. When the former CRT-P, for example InSync8040 (Medtronic) which we reported in 2009, was converted from DDD mode to DOO mode, the optimal atrioventricular (AV) delay had become invalid in DOO mode. In this case, new device Syncra (Medtronic) which had been marketed in March 2011 was implanted. DOO mode could be used keeping the optimal AV delay and right ventricular-left ventricular delay and the effect of cardiac resynchronization was valid. New CRT-P could be managed as single chamber or double chamber pacemaker. Recently in Japan, CRT becomes more common and operations in the patients implanted with CRT-P or CRT-D (CRT with defibrillation) will become more frequent. CRT will require attention for anesthetic management. PMID:22991819

Takimoto, Kayo; Nishijima, Kaoru; Kin, Fuminobu; Atsuta, Jun; Takase, Yuri; Ono, Mayu; Hashimoto, Norio

2012-08-01

43

Anesthetic management for percutaneous computed tomography-guided radiofrequency ablation of reninoma: a case report  

PubMed Central

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension. PMID:25664160

Gil, Nam-Su; Han, Jeong Yeol; Ok, Seong-Ho; Shin, Il-Woo; Lee, Heon Keun; Chung, Young-Kyun

2015-01-01

44

Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine.  

PubMed

A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing - remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia. PMID:25191198

Sethi, Sameer; Kapil, Sonia

2014-07-01

45

Anesthetic management for percutaneous computed tomography-guided radiofrequency ablation of reninoma: a case report.  

PubMed

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension. PMID:25664160

Gil, Nam-Su; Han, Jeong Yeol; Ok, Seong-Ho; Shin, Il-Woo; Lee, Heon Keun; Chung, Young-Kyun; Sohn, Ju-Tae

2015-02-01

46

[Anesthetic management for abdominoperineal resection of the rectum in a patient with superior vena cava syndrome].  

PubMed

Since superior vena cava syndrome (SVCs) causes ntracranial hypertension and edema of the upper respiratory tract close attention should be paid to brain circulatory dysfunction and obstruction of the upper airway. A male patient with SVCs and complete obstruction of the bilateral internal jugular veins was scheduled for abdominoperineal resection of the rectum under general anesthesia To evaluate the brain circuation, we monitored the external jugular venous pressure and regional saturation of oxygen (rSO) by INVOS® in the cerebral frontal cortex. If the external ugular venous pressure would rise above 20 mmHg, we planned to change the horizontal supine position to a head up position and then remove blood from the external jugular vein. Fortunately, since the external jugular venous pressure was maintained within 20 mmHg, and since no great decreases in rSO2 occurred during surgery, we did not change the patient's position or remove blood from the patient. The surgical procedure was completed uneventfully, and pharyngoarngeal edema was not seen. He did not show any neurological deficits after surgery. From experience of khis patient, we concluded that monitoring of external cigular venous pressure and rSO2 is useful for anesthetic management in patints with SVCs. PMID:25693351

Yoshiyama, Yuki; Kawamata, Tomoyuki; Sugiyama, Daisuke; Kawamata, Mikito

2014-10-01

47

[Anesthetic management of a hemophilia A patient with HIV infection: a case report].  

PubMed

A 40-year-old male with hemophilia A was scheduled for right total knee arthroplasty. He was HIV positive probably due to receiving infected blood products previously. We performed the pharmacokinetic study of factor VIII in advance, which showed the increased factor VIII activity 1.6% by an injection of one unit. kg-1 of factor VIII and the half-life of about 16 hours. To keep the factor VIII activity over 100% in the perioperative period, 3000 units of recombinant factor VIII was injected one hour before the induction of anesthesia followed by continuous infusion at 125 units per hour. The factor VIII activity before the induction was 110.6%. The operation was successful and there was no sign of bleeding tendency. The factor VIII activity after the operation, however, was unexpectedly low (73.1%), and it was necessary to increase the infusion rate to 150 units per hour. The factor VIII activity was kept over 80% until POD 7 with the continuous infusion and over 60% until POD 21 with intermittent administration. Factor VIII was discontinued on POD 21 without any sign of bleeding tendency after the postoperative rehabilitation. Although this patient was HIV positive, his immune system was well controlled with HAART and there was no difficulty in the anesthetic management. To prevent accidental infection to the medical staff, we again recognized the importance of standard precautions. PMID:12649880

Bougaki, Masahiko; Tomioka, Toshiya; Hanaoka, Kazuo

2003-02-01

48

Anesthetic management in a patient with giant growing teratoma syndrome: a case report  

PubMed Central

Introduction Growing teratoma syndrome is a rare occurrence with an ovarian tumor. Anesthesia has been reported to be difficult in cases of growing teratoma syndrome of the cystic type due to the pressure exerted by the tumor. However, there have been no similar reports with the solid mass type. Here, we report our experience of anesthesia in a case of growing teratoma syndrome of the solid type. Case presentation The patient was a 30-year-old Japanese woman who had been diagnosed with an ovarian immature teratoma at age 12 and had undergone surgery and chemotherapy. However, she dropped out of treatment. She presented to our hospital with a 40cm giant solid mass and severe respiratory failure, and was scheduled for an operation. We determined that we could not obtain a sufficient tidal volume without spontaneous respiration. Therefore, we chose to perform awake intubation and not to use a muscle relaxant before the operation. At the start of the operation, when muscle relaxant was first administered, we could not obtain a sufficient tidal volume. An abdominal midline incision was performed immediately and her tidal volume recovered. Her resected tumor weighed 10.5kg. After removal of her tumor, her tidal volume was maintained at a level consistent with that under spontaneous respiration to avoid occurrence of re-expansion pulmonary edema. Conclusions We performed successful anesthetic management of a case of growing teratoma syndrome with a giant abdominal tumor. Respiratory management was achieved by avoiding use of a muscle relaxant before the operation to maintain spontaneous respiration and by maintaining a relatively low tidal volume, similar to that during spontaneous respiration preoperatively, after removal of the tumor to prevent re-expansion pulmonary edema. PMID:24467840

2014-01-01

49

Laser Scar Management Technique  

PubMed Central

Background and Aims: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. Methods: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. Results and Conclusions: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual. PMID:24511202

Ohshiro, Toshio; Sasaki, Katsumi

2013-01-01

50

Pre-operative anesthetic assessment of patients with rheumatoid arthritis.  

PubMed

The management and surgical interventions of problems directly or indirectly arising from rheumatoid arthritis vary drastically. Anesthesiologists and rheumatologists should be aware of the peculiarities of the anesthetic preoperative assessment of these patients, including the assessment of possible disorders of the airways, in addition to the intra-operative management and analysis of relevant pharmacological parameters. It is critical that the anesthetist is familiar with the peculiarities of the disease and the specific characteristics of drugs used in its treatment: thus, he/she will be able to plan the best possible anesthetic technique for the surgery in question, offering safety and comfort to his/her patient. It is up to the rheumatologist to know the procedure to which the patient will be submitted to and be aware of the most appropriate anesthetic technique in each case. This will allow a better interaction between the rheumatologist and the anesthesiologist in the pre-anesthetic evaluation, through the sharing of relevant information on the articular and systemic involvement by the disease that might interfere with preoperative and intraoperative management. Furthermore, the information on the pre-anesthetic assessment and the choice of anesthetic technique will enable the rheumatologist to clarify any doubts that his/her patient and family may have, as well as to guide them as to whether or not the medications in use should be maintained, and eventually about the need for a supplemental dose of corticosteroid. The objective of this review is to acquaint the rheumatologist with key concepts related to the anesthetic preoperative assessment of patients diagnosed with RA, mainly including general notions that dictate the choice of the anesthetic technique. PMID:25054599

Aires, Rodrigo Barbosa; de Carvalho, Jozélio Freire; da Mota, Licia Maria Henrique

2014-01-01

51

Anesthetic management of emergent laparoscopic bilateral adrenalectomy in a patient with a life-threatening cortisol crisis.  

PubMed

Cushing syndrome may rarely present with life-threatening hypercortisolism, manifested by hypertension, hypokalemia, hyperglycemia, and edema. If medical treatment proves ineffective in ameliorating the symptoms, emergent rescue adrenalectomy may be the only way to relieve the crisis. We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident. PMID:25611000

Sharma, Ankur; Subramaniam, Rajeshwari; Misra, Mahesh; Joshiraj, Bandi; Krishnan, Gopi; Varma, Prerna; Kishore, Shyam

2015-01-15

52

Anesthetic considerations in diabetic patients. Part II: intraoperative and postoperative management of patients with diabetes mellitus  

Microsoft Academic Search

Some studies have reported that tight glycemic control in diabetic patients undergoing major surgery improves perioperative\\u000a morbidity and mortality rates. Recently, however, large randomized studies have shown such control increases the mortality\\u000a rate, since aggressive glycemic control induces more frequent incidences of hypoglycemia. Diabetic patients have cerebral\\u000a complications during the perioperative period more often than their nondiabetic counterparts. Further, anesthetic

Yuji Kadoi

2010-01-01

53

Anesthetic Management for Implantation of the Jarvik 2000??? Left Ventricular Assist System  

Microsoft Academic Search

TheJarvik2000Heart™isaleftventricularassistdevice that produces continuous nonpulsatile axial flow by means of a single, rotating, vaned impeller. Anesthetic and perioperative considerations of the Jarvik 2000 Heart™ differ from those of conventional assist de- vices. The Jarvik 2000 is implanted within the left ven- tricle through a left thoracotomy, which is aided by left lung isolation. A brief period of cardiopulmonary by- pass

Nancy A. Nussmeier; Charles B. Probert; Douglas Hirsch; John R. Cooper; Igor D. Gregoric; Timothy J. Myers; O. H. Frazier

2003-01-01

54

Anesthetic management of comprehensive dental restoration in a child with glutaric aciduria type 1 using volatile sevoflurane.  

PubMed

Glutaric aciduria type 1 (GA1) is a rare, inherited mitochondrial disorder that results from deficiency of mitochondrial glutaryl-CoA dehydrogenase. Most patients develop neurological dysfunction early in life, which leads to severe disabilities. We present a 37-month-old girl with GA1 manifested as macrocephaly and hypotonia who received comprehensive dental restoration surgery under general anesthesia with sevoflurane. She was placed on specialized fluid management during a preoperative fasting period and anesthesia was administered without complications. All the physiological parameters, including glucose and lactate blood levels and arterial blood gas were carefully monitored and maintained within normal range perioperatively. Strategies for anesthetic management should include prevention of pulmonary aspiration, dehydration, hyperthermia and catabolic state, adequate analgesia to minimize surgical stress, and avoidance of prolonged neuromuscular blockade. We administered general anesthesia with sevoflurane uneventfully, which was well tolerated by our patient with GA1. Additionally, communication with a pediatric geneticist and surgeons should be undertaken to formulate a comprehensive anesthetic strategy in these patients. PMID:25107500

Teng, Wei-Nung; Lin, Su-Man; Niu, Dau-Ming; Kuo, Yi-Min; Chan, Kwok-Hon; Sung, Chun-Sung

2014-10-01

55

Anesthetic management of an 8-month-old infant with osteogenesis imperfecta undergoing liver transplantation: a case report  

PubMed Central

Anesthetic management of pediatric liver transplantation in a patient with osteogenesis imperfecta (OI) requires tough decisions and comprehensive considerations of the cascade of effects that may arise and the required monitoring. Total intravenous anesthesia (TIVA) with propofol and remifentanil was chosen as the main anesthetic strategy. Malignant hyperthermia (MH), skeletal fragility, anhepatic phase during liver transplantation, uncertainties of TIVA in children, and propofol infusion syndrome were considered and monitored. There were no adverse events during the operation. Despite meticulous precautions with regard to the risk of MH, there was an episode of high fever (40?) in the ICU a few hours after the operation, which was initially feared as MH. Fortunately, MH was ruled out as the fever subsided soon after hydration and antipyretics were given. Although the delivery of supportive care and the administration of dantrolene are the core principles in the management of MH, perioperative fever does not always mean a MH in patients at risk for MH, and other common causes of fever should also be considered. PMID:25006373

Lee, Jiwon; Kim, Anna; Yoo, Seokha; Shin, Seung-Yeon; Kang, Sun-Hye; Jeong, Jinyoung; Yoo, Yongjae

2014-01-01

56

GENERATIVE RISK MANAGEMENT TECHNIQUES  

Microsoft Academic Search

ABSTRACT 'Generative' technique,is a term adopted,from James Reason's work in the risk area. In terms of the Engineers Australia Safety Case Guidelines online paradigm model, it generally refers to the \\

Gaye E Francis; Richard M Robinson

57

Epidermolysis bullosa dystrophica polydysplastica. A case of anesthetic management in oral surgery.  

PubMed

Epidermolysis bullosa dystrophica is a rare disease that affects the skin and mucous membranes. Manifest at birth, it is characterized by poor dentition, esophageal strictures, syndactyly, and severe chronic anemia. Our 12-year-old patient required extensive dental treatment which necessitated overcoming problems of anesthesia as well as developing a technique of management that provided maximum safety and a minimum of discomfort. Transmission electron microscopy of sections of the gingiva revealed possible degenerative collagen fibers and an interrupted basement membrance. Anchoring fibrils normally found in the connective tissue beneath the epithelium were absent. PMID:266679

Album, M M; Gaisin, A; Lee, K W; Buck, B E; Sharrar, W G; Gill, F M

1977-06-01

58

Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report  

PubMed Central

An 18-year-old male with a Fontan circulation underwent excision of a pheochromocytoma after conversion from laparoscopic surgery. The pneumoperitoneum established for laparoscopic surgery may have adverse effects on the Fontan circulation, because it increases the intra-abdominal pressure (IAP), intra-thoracic pressure, pulmonary vascular resistance, and systemic vascular resistance (SVR), and decreases cardiac preload and cardiac output. Meticulous monitoring is also required during carbon dioxide exsufflation, because a rapid decrease in IAP can provoke hemodynamic deterioration by decreasing venous return and SVR. Furthermore, catecholamines released by the pheochromocytoma can worsen the hemodynamic status of Fontan circulation during surgery. Therefore, sophisticated intraoperative anesthetic care is required during laparoscopic pheochromocytoma excision in patients with a Fontan circulation. PMID:24729851

Lee, Hyung-Chul; Nam, Karam; Lee, Ji-Hyun; Park, Yong-Hee; Kim, Hee-Soo; Kim, Chong-Sung

2014-01-01

59

Aerospace management techniques: Commercial and governmental applications  

NASA Technical Reports Server (NTRS)

A guidebook for managers and administrators is presented as a source of useful information on new management methods in business, industry, and government. The major topics discussed include: actual and potential applications of aerospace management techniques to commercial and governmental organizations; aerospace management techniques and their use within the aerospace sector; and the aerospace sector's application of innovative management techniques.

Milliken, J. G.; Morrison, E. J.

1971-01-01

60

Pregnancy with co-morbidities: Anesthetic aspects during operative intervention  

PubMed Central

The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries.

Bajwa, Sukhminder Jit Singh; Bajwa, Sukhwinder Kaur; Ghuman, Gagandeep Singh

2013-01-01

61

Anesthetic considerations in myofibrillar myopathy.  

PubMed

Myofibrillar myopathy (MFM) is a relatively newly recognized genetic disease that leads to progressive muscle deterioration. MFM has a varied phenotypic presentation and impacts cardiac, skeletal, and smooth muscles. Affected individuals are at increased risk of respiratory failure, significant cardiac conduction abnormalities, cardiomyopathy, and sudden cardiac death. In addition, significant skeletal muscle involvement is common, which may lead to contractures, respiratory insufficiency, and airway compromise as the disease progresses. This study is the first report of anesthetic management of a patient with MFM. We report multiple anesthetic encounters of a child with genetically confirmed BAG3-myopathy, a subtype of MFM with severe childhood disease onset. A review of the anesthetic implications of the disease is provided, with specific exploration of possible susceptibility to malignant hyperthermia, rhabdomyolysis, and sensitivity to other anesthetic agents. PMID:25216331

Latham, Gregory J; Lopez, Grace

2015-03-01

62

Anesthetic management in parturients with chronic kidney disease undergoing elective Caesarean delivery: Our experience of nine cases  

PubMed Central

In this retrospective study, we describe the anesthetic management and its implications in parturients with chronic kidney disease (CKD; n = 9), who underwent elective caesarean delivery. Nine parturients with CKD of various etiologies, who underwent elective Caesarean delivery, were included in this study. Spinal anest-hesia was administered in all parturients with normal coagulation profile through a 25-gauze spinal needle (Quincke) with 0.5% (H) bupivacaine in L2-3 space and T6 level was achieved. Hemodynamics and side effects such as nausea, vomiting, headache, and backache were record. The mean age was 28.22 ± 4.43 years. The mean levels of serum creatinine and serum potassium were 2.78 ± 1.29 mg/dl and 4.11 ± 0.46 meq/l, respectively. Mean baseline values of systolic blood pressure, diastolic blood pressure, and pulse rate were higher which decreased after spinal anesthesia. However, the incidence of hypotension, which required mephentermine treatment, was 11.1%. One patient had symptoms of nausea and vomiting/dizziness at the time of hypotension, which disappeared after treatment with 5 mg of intravenous mephentermine. Baseline value of PR remained high throughout the operation. Parturients with CKD with normal coagulation profile remained hemodynamically stable under spinal anesthesia with minimal side effects. However, a large number of studies are required to determine the safety of spinal anesthesia in this setting. PMID:24574626

Modi, M. P.; Vora, K. S.; Parikh, G. P.; Shah, V. R.; Misra, V. V.; Jasani, A. F.

2014-01-01

63

School Business Management Techniques: A Compendium.  

ERIC Educational Resources Information Center

The intent of this document is to describe approximately 30 management science and organizational behavioral techniques with practical applications in school business management. Each technique is described by the mechanics of using the technique, specific applications of the technique, and requirements and constraints in the use of the technique.…

Cresswell, Anthony; And Others

64

Anesthetic management of the trigeminocardiac reflex during mesiodens removal-a case report.  

PubMed

We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed. PMID:17352528

Webb, Michael D; Unkel, John H

2007-01-01

65

Anesthetic Management of the Trigeminocardiac Reflex During Mesiodens Removal—A Case Report  

PubMed Central

We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed. PMID:17352528

Webb, Michael D; Unkel, John H

2007-01-01

66

Anesthetic management of a patient with hemophilia A with spontaneous acute subdural hematoma.  

PubMed

Intracranial hemorrhage in patients with hemophilia is associated with high mortality and sequelae. We report the case of 50-year-old man with Hemophilia A, who presented with spontaneous acute subdural hematoma and underwent craniotomy for clot evacuation. The patient received Factor VIII infusions perioperatively along with other measures to decrease blood loss. The patient presented with signs of high intracranial tension and received 3% saline intraoperatively and postoperatively to prevent brain edema. Recommendations for perioperative preparation and management of hemophilia, especially in the setting of emergency major surgery are reviewed. PMID:23494075

Gyanesh, Prakhar; Dhiraaj, Sanjay

2013-01-01

67

Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-  

PubMed Central

In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized. PMID:21286425

Lee, Jung Min; Byon, Hyo-Jin; Kim, Hee-Soo; Kim, Chong Sung

2010-01-01

68

[Anesthetic management of a patient with hemophilia B during scoliosis surgery].  

PubMed

Posterior spinal fusion for scoliosis was planned in a 14-year-old male patient with hemophilia B. Preoperative examination showed factor IX activity of 8.4% with no inhibitor development. A perioperative dosage schedule was prepared after examining the pharmacokinetics of recombinant coagulation factor IX in order to maintain levels of perioperative factor IX activity at < or = 80% for the first 6 days (days 0-6), and > or = 40% for days 7-14 postoperatively. The dose of recombinant coagulation factor IX was adjusted to maintain factor IX activity above 80%, while measuring coagulation activity every hour during the surgery. The patient showed a favorable course without hemorrhagic tendency. We could safely manage anesthesia without requiring allogeneic blood transfusion. PMID:24228466

Makino, Shohei; Nomura, Yuki; Kabara, Shizuko; Takatsuji, Saeko; Kagawa, Tetsuro

2013-10-01

69

QUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES AND TOOLS*  

E-print Network

QUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES AND TOOLS* Paul Embrechts Department of Mathematics ETH Zurich www.math.ethz.ch/~embrechts #12;QUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES Theorems of Quantitative Risk Management · PE's Desert-Island Copula · Example 1: Credit Risk · Example 2

Embrechts, Paul

70

Management Styles and Techniques: Time.  

ERIC Educational Resources Information Center

Discusses strategies to improve individuals' use of time and personal satisfaction through time management. The 126-item bibliography includes citations for time management in general and special sections for career development, family and parenting, women, and home management. (CLB)

Matthews, Priscilla J.

1987-01-01

71

Anesthetic Consideration for Neurointerventional Procedures  

PubMed Central

Interventional neuroradiology (INR) has been a rapidly expanding and advancing clinical area during the past few decades. As the complexity and diversity of INR procedures increases, the demand for anesthesia also increases. Anesthesia for interventional neuroradiology is a challenge for the anesthesiologist due to the unfamiliar working environment which the anesthesiologist must consider, as well as the unique neuro-interventional components. This review provides an overview of the anesthetic options and specific consideration of the anesthesia requirements for each procedure. We also introduce the anesthetic management for interventional neuroradiology performed in our medical institution. PMID:25426301

Joung, Kyung Woon; Yang, Ku Hyun; Shin, Won Jung; Song, Myung Hee; Ham, Kyungdon; Jung, Seung Chul; Lee, Deok Hee

2014-01-01

72

Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report  

PubMed Central

Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis. PMID:25368787

Park, Sang-hee; Min, Too Jae; Kim, Woon Young; Kim, Jae Hwan; Park, Young Cheol

2014-01-01

73

Environmental implications of anesthetic gases.  

PubMed

For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment. PMID:23241038

Yasny, Jeffrey S; White, Jennifer

2012-01-01

74

The Performance Effects of Process Management Techniques  

Microsoft Academic Search

This paper provides exploratory evidence on the cross-sectional association between process management techniques and two profit measures: return on assets and return on sales. Using a sample of firms in two industries (automotive and computer) and four countries (Canada, Germany, Japan, and the United States), we find that certain process management techniques improve profitability while others have little effect on

Christopher D. Ittner; David F. Larcker

1997-01-01

75

CUMULATIVE SUM TECHNIQUES IN ATM TRAFFIC MANAGEMENT  

E-print Network

calls. Effective ATM traffic management requires knowl­ edge of when traffic conditions change. For traffic management, sequential algorithms have the potential to give quicker detection of changes. NonCUMULATIVE SUM TECHNIQUES IN ATM TRAFFIC MANAGEMENT R. A. Vesilo School of MPCE, Macquarie

Vesilo, Rein

76

Benefit and risks of local anesthetics in infants and children.  

PubMed

Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent. PMID:12269841

Gunter, Joel B

2002-01-01

77

A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block  

PubMed Central

Background Fractured neck of femur generally requires operative fixation and is a common cause of admission to hospital. The combination of femoral nerve block and spinal anesthesia is a common anesthetic technique used to facilitate the surgical procedure. The optimal disposition of local anesthetic (LA) relative the femoral nerve (FN) has not been defined. Our hypothesis was: that the deposition of LA relative to the FN influences the quality of analgesia for positioning of the patient for performance of spinal anesthesia. The primary outcome was verbal rating (VRS) pain scores 0–10 assessed immediately after positioning the patient to perform spinal anesthesia. Methods With Institutional ethical approval and having obtained written informed consent from each, 52 patients were studied. The study was registered with ClinicalTrials.gov (NCT01527812). Patients were randomly allocated to undergo to one of three groups namely: intention to deposit lidocaine 2% (15 ml) i. above (Group A), ii. below (Group B), iii. circumferential (Group C) to the FN. A blinded observer assessed i. the sensory nerve block (cold) in the areas of the terminal branches of the FN and ii. VRS pain scores on passive movement from block completion at 5 minutes intervals for 30 minutes. Immediately after positioning the patient for spinal anesthesia, VRS pain scores were recorded. Results Pain VRS scores during positioning were similar in the three groups [Above group/Below group/Circumferential group: 2(0–9)/0(0–10)/3(0–10), median(range), p:0.32]. The block was deemed to have failed in 20%, 47% and 12% in the Above group, Below group and Circumferential group respectively. The median number of needle passes was greater in the Circumferential group compared with the Above group (p:0.009). Patient satisfaction was greatest in the Circumferential group [mean satisfaction scores were 83.5(19.8)/88.1(20.5)/93.8(12.3), [mean(SD), p=0.04] in the Above, Below and Circumferential groups respectively. Conclusions We conclude that there is no clinical advantage to attempting to deposit LA circumferential to the femoral nerve (relative to depositing LA either above or below the nerve), during femoral nerve block in this setting. PMID:24460975

2014-01-01

78

The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery  

PubMed Central

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1), 30?min after tourniquet inflation (t2), immediately before (t3), and 5?min (t4), 15?min (t5), 30?min (t6), 1?h (t7), 2?h (t8), and 6?h (t9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t2–t9 and t2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S at t2–t8 and t2–t9. IMA levels in Group T were significantly lower than those in Group S at t2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion. PMID:24701585

Ko?ucu, Müge; Co?kun, ?lker; Eroglu, Ahmet; Kutanis, Dilek; Mente?e, Ahmet; Karahan, S. Caner; Baki, Emre; Kerimo?lu, Servet; Topbas, Murat

2014-01-01

79

(Low-level radioactive waste management techniques)  

Microsoft Academic Search

The US team consisting of representatives of Oak Ridge National Laboratory (ORNL), Savannah River plant (SRP), Idaho National Engineering Laboratory (INEL), and the Department of Energy, Oak Ridge Operations participated in a training program on French low-level radioactive waste (LLW) management techniques. Training in the rigorous waste characterization, acceptance and certification procedures required in France was provided at Agence Nationale

S. D. Van Hoesen; J. M. Kennerly; L. C. Williams; W. N. Lingle; M. S. Peters; G. R. Darnell; Du Pont de Nemours

1988-01-01

80

Anesthetic considerations for robotic surgery  

PubMed Central

Recently, demand for minimally invasive surgery has increased greatly. As a result, robot-assisted techniques have gained in popularity, because they overcome several of the shortcomings of conventional laparoscopic techniques. However, robotic surgery may require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel, which may go against the conservative nature of anesthesia care. Anesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to offer better anesthetic care and promote patient safety. PMID:24567806

2014-01-01

81

The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren???s Contracture: A Prospective Observational Study of Four Anesthetic Techniques  

Microsoft Academic Search

The development of complex regional pain syndrome (CRPS) is not an uncommon complication after Du- puytren's surgery. Despite increasing research interest, little is known regarding which patients are at increased risk for developing CRPS and what is the optimal periop- erative treatment strategy for preventing the occurrence of this disease after surgery. We prospectively evaluated the use of four anesthetic

Scott S. Reuben; Rene Pristas; Duane Dixon; Shameema Faruqi; Lakshmi Madabhushi; Steven Wenner

2006-01-01

82

Anesthetic management of patient with systemic lupus erythematosus and antiphospholipid antibodies syndrome for laparoscopic nephrectomy and cholecystectomy  

PubMed Central

We report a case of a female having systemic lupus erythematosus and antiphospholipid antibodies syndrome, who was on immunosuppressant therapy. We discussed the preoperative evaluation and perioperative management who underwent nephrectomy and cholecystectomy. PMID:25558207

Khokhar, Rashid Saeed; Baaj, Jumana; Al-Saeed, Abdulhamid; Sheraz, Motasim

2015-01-01

83

Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature  

PubMed Central

Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course.

Ranjan, R. V.; Ramachandran, T. R.; Manikandan, S.; John, Roshan

2015-01-01

84

Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature.  

PubMed

Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course. PMID:25886439

Ranjan, R V; Ramachandran, T R; Manikandan, S; John, Roshan

2015-01-01

85

Perioperative anesthetic management of a patient with biliary atresia, situs inversus totalis, and kartegener syndrome for hepatobiliary surgery  

PubMed Central

Patients with genetic disorders associated with multiple congenital anomalies present unique challenges to the anesthesiologist. We report the successful perioperative management of a child with biliary atresia, situs inversus totalis, and Kartegener syndrome scheduled for corrective biliary surgery. We recommend that patients with multiple congenital anomalies need to be thoroughly and cautiously evaluated. The perioperative management should be individualized based on associated anomalies along with appropriate monitoring. PMID:21772694

Garg, Rakesh; Goila, Ajay; Sood, Rajesh; Pawar, Mridula; Borthakur, Biplob

2011-01-01

86

Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report  

PubMed Central

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach. PMID:25368788

Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Jeon, Young-Tae; Hwang, Jung-won

2014-01-01

87

Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report.  

PubMed

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach. PMID:25368788

Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Park, Hee-Pyoung; Jeon, Young-Tae; Hwang, Jung-Won

2014-10-01

88

Sudden Tracheal Collapse during EGD and Subsequent Anesthetic Management with Dexmedetomidine-Ketamine in a Patient with Achalasia and Tracheomalacia  

PubMed Central

We present a patient who experienced airway obstruction during an elective esophagogastroduodenoscopy (EGD) under anesthesia secondary to previously undiagnosed tracheomalacia. Physiology of airway obstruction with forced breathing maneuvers is discussed along with the potential advantages of dexmedetomidine-ketamine sedation for management of patients with achalasia undergoing outpatient endoscopic procedures. PMID:22606385

Atkins, Joshua H.; Mandel, Jeff E.; Metz, David C.

2011-01-01

89

Neurometric assessment of intraoperative anesthetic  

DOEpatents

The present invention is a method and apparatus for collecting EEG data, reducing the EEG data into coefficients, and correlating those coefficients with a depth of unconsciousness or anesthetic depth, and which obtains a bounded first derivative of anesthetic depth to indicate trends. The present invention provides a developed artificial neural network based method capable of continuously analyzing EEG data to discriminate between awake and anesthetized states in an individual and continuously monitoring anesthetic depth trends in real-time. The present invention enables an anesthesiologist to respond immediately to changes in anesthetic depth of the patient during surgery and to administer the correct amount of anesthetic. 7 figs.

Kangas, L.J.; Keller, P.E.

1998-07-07

90

Neurometric assessment of intraoperative anesthetic  

DOEpatents

The present invention is a method and apparatus for collecting EEG data, reducing the EEG data into coefficients, and correlating those coefficients with a depth of unconsciousness or anesthetic depth, and which obtains a bounded first derivative of anesthetic depth to indicate trends. The present invention provides a developed artificial neural network based method capable of continuously analyzing EEG data to discriminate between awake and anesthetized states in an individual and continuously monitoring anesthetic depth trends in real-time. The present invention enables an anesthesiologist to respond immediately to changes in anesthetic depth of the patient during surgery and to administer the correct amount of anesthetic.

Kangas, Lars J. (West Richland, WA); Keller, Paul E. (Richland., WA)

1998-01-01

91

Anesthetic considerations on adrenal gland surgery.  

PubMed

Adrenal gland surgery needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, and surgeon. The indications for adrenal gland surgery include hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors present to the anesthesiologist unique challenges requiring good preoperative evaluation, perioperative hemodynamic control, corrections of all electrolytes and metabolic abnormalities, a detailed and careful anesthetic strategy, overall knowledge about the specific diseases, control and maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will focus on the endocrine issues, as well as on the above-mentioned aspects of anesthetic management during hormone secreting adrenal gland tumor resection. PMID:25368694

Domi, Rudin; Sula, Hektor; Kaci, Myzafer; Paparisto, Sokol; Bodeci, Artan; Xhemali, Astrit

2015-01-01

92

Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.  

PubMed

Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS. PMID:20075534

Rawat, S K S; Mehta, Yatin; Vats, Mayank; Mishra, Yugal; Khurana, Poonam; Trehan, Naresh

2010-01-01

93

Laser technique in management of laryngomalacia  

NASA Astrophysics Data System (ADS)

Laryngomalacia is the most common cause of newborn stridor. Management can usually be accomplished without surgery. When surgery is necessary, the carbon dioxide (CO2) laser plays an essential role in enabling precise, hemostatic dissection. The authors present their application of the CO2 laser with microspot control for laser correction of laryngomalacia, with emphasis upon the use of the Boston University suspension system to achieve external suspension of the larynx and the bivalved laryngoscope to achieve tissue distension. Review of indications, technique and results is shared to detail the utility of the CO2 laser in supraglottoplasty.

Shah, Udayan K.; McGuirt, William F., Jr.; Wetmore, Ralph F.; Healy, Gerald B.

1998-07-01

94

Management Science Techniques for Consultants (MSTC)  

NSDL National Science Digital Library

Michael Trick, Associate Professor of Industrial Administration at Carnegie-Mellon University, has designed a course to give consultants (and others who want to improve their quantitative skills) an introduction to a variety of useful techniques in management science, with an emphasis on practicality. The course covers sensitivity analysis, solving large problems, integer programming, heuristic decision-making, genetic algorithms/neural networks, relaxations, network models, data envelopment analysis, scenario optimization and multiple objective decision making. In addition to the class notes, the site also contains the homework for the class.

Trick, Michael A.

1998-01-01

95

Management Science Techniques for Consultants (MSTC)  

NSDL National Science Digital Library

Michael Trick, Associate Professor of Industrial Administration at Carnegie-Mellon University, has designed a course to give consultants (and others who want to improve their quantitative skills) an introduction to a variety of useful techniques in management science, with an emphasis on practicality. The course covers sensitivity analysis, solving large problems, integer programming, heuristic decision-making, genetic algorithms/neural networks, relaxations, network models, data envelopment analysis, scenario optimization and multiple objective decision making. In addition to the class notes, the site also contains the homework for the class.

Trick, Michael A.

96

Articaine - the best choice of local anesthetic in contemporary dentistry.  

PubMed

Local anesthesia forms the foundation of pain control techniques in clinical dentistry. Within the rich local anesthetic drugs available in dentistry for the prevention and management of pain 4% articaine solutions achieve highest level of anesthetic potency and lowest systemic toxicity in all clinical situations, prior to its superlative physicochemical characteristics and the pharmacological profile. These are - low lipid solubility, high plasma protein binding rate, fast metabolization, fast elimination half time; low blood level. Articaine inactivates in both ways: in the liver and the blood serum. It has good spreading through tissues. Thus, articaine seems to be the local anesthetic of first choice in tissues with suppurative inflammation, for adults, children (over 4), elderly, pregnant women, breastfeeding women, patients suffering from hepatic disorders and renal function impairment. In Articaine solutions (1: 200,000) epinephrine is in low concentration, thus in patients at high risk adverse responses are maximally decreased. In these patients articaine should be used with careful consideration of risk/benefit ratio. Articaine solutions must not be used in persons who are allergic or hypersensitive to sulphite, due to content of Sodium metabisulfite as vasoconstrictor's antioxidant in it. Incidence of serious adverse effects related to dental anesthesia with articaine is very low. Toxic reactions are usually due to an inadvertent intravascular injection or use of excessive dose. To avoid overdoses maximum recommendation dose (MRD) must not be exceeded and aspiration test always performed prior all LA injections. In these article we introduce new graphs providing a quick and effect way to determine maximum LA dose. If the overdose reactions develop, adherence to the basic step of emergency management with end to a successful outcome in virtually all cases. PMID:21346262

Nizharadze, N; Mamaladze, M; Chipashvili, N; Vadachkoria, D

2011-01-01

97

Hepatotoxicity of Halogenated Inhalational Anesthetics  

PubMed Central

Context: Halogenated inhalational anesthetics are currently the most common drugs used for the induction and maintenance of general anesthesia. Postoperative hepatic injury has been reported after exposure to these agents. Based on much evidence, mechanism of liver toxicity is more likely to be immunoallergic. The objective of this review study was to assess available studies on hepatotoxicity of these anesthetics. Evidence Acquisition: We searched PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and the Cochrane Database using the following keywords: “inhalational Anesthetics” and “liver injury”; “inhalational anesthetics” and “hepatotoxicity”; “volatile anesthetics” and “liver injury”; “volatile anesthetics” and hepatotoxicity for the period of 1966 to 2013. Fifty two studies were included in this work. Results: All halogenated inhalational anesthetics are associated with liver injury. Halothane, enflurane, isoflurane and desflurane are metabolized through the metabolic pathway involving cytochrome P-450 2E1 (CYP2E1) and produce trifluoroacetylated components; some of which may be immunogenic. The severity of hepatotoxicity is associated with the degree by which they undergo hepatic metabolism by this cytochrome. However, liver toxicity is highly unlikely from sevoflurane as is not metabolized to trifluoroacetyl compounds. Conclusions: Hepatotoxicity of halogenated inhalational anesthetics has been well documented in available literature. Halothane-induced liver injury was extensively acknowledged; however, the next generation halogenated anesthetics have different molecular structures and associated with less hepatotoxicity. Although anesthesia-induced hepatitis is not a common occurrence, we must consider the association between this disorder and the use of halogenated anesthetics. PMID:25593732

Safari, Saeid; Motavaf, Mahsa; Seyed Siamdoust, Seyed Alireza; Alavian, Seyed Moayed

2014-01-01

98

Respiratory anesthetic emergencies in oral and maxillofacial surgery.  

PubMed

Respiratory anesthetic emergencies are the most common complications encountered during the administration of anesthesia in both the adult and pediatric populations. Regardless of the depth of anesthesia, a thorough review of the patients' health history, including the past medical history, edication list, prior anesthesia history, and complex physical examination, is critical in the promotion of safety in the oral and maxillofacial surgery office. The effective management of respiratory anesthetic emergencies includes both strong didactic and clinical skills. PMID:23706929

Gesek, Daniel J

2013-08-01

99

Fault Management Techniques in Human Spaceflight Operations  

NASA Technical Reports Server (NTRS)

This paper discusses human spaceflight fault management operations. Fault detection and response capabilities available in current US human spaceflight programs Space Shuttle and International Space Station are described while emphasizing system design impacts on operational techniques and constraints. Preflight and inflight processes along with products used to anticipate, mitigate and respond to failures are introduced. Examples of operational products used to support failure responses are presented. Possible improvements in the state of the art, as well as prioritization and success criteria for their implementation are proposed. This paper describes how the architecture of a command and control system impacts operations in areas such as the required fault response times, automated vs. manual fault responses, use of workarounds, etc. The architecture includes the use of redundancy at the system and software function level, software capabilities, use of intelligent or autonomous systems, number and severity of software defects, etc. This in turn drives which Caution and Warning (C&W) events should be annunciated, C&W event classification, operator display designs, crew training, flight control team training, and procedure development. Other factors impacting operations are the complexity of a system, skills needed to understand and operate a system, and the use of commonality vs. optimized solutions for software and responses. Fault detection, annunciation, safing responses, and recovery capabilities are explored using real examples to uncover underlying philosophies and constraints. These factors directly impact operations in that the crew and flight control team need to understand what happened, why it happened, what the system is doing, and what, if any, corrective actions they need to perform. If a fault results in multiple C&W events, or if several faults occur simultaneously, the root cause(s) of the fault(s), as well as their vehicle-wide impacts, must be determined in order to maintain situational awareness. This allows both automated and manual recovery operations to focus on the real cause of the fault(s). An appropriate balance must be struck between correcting the root cause failure and addressing the impacts of that fault on other vehicle components. Lastly, this paper presents a strategy for using lessons learned to improve the software, displays, and procedures in addition to determining what is a candidate for automation. Enabling technologies and techniques are identified to promote system evolution from one that requires manual fault responses to one that uses automation and autonomy where they are most effective. These considerations include the value in correcting software defects in a timely manner, automation of repetitive tasks, making time critical responses autonomous, etc. The paper recommends the appropriate use of intelligent systems to determine the root causes of faults and correctly identify separate unrelated faults.

O'Hagan, Brian; Crocker, Alan

2006-01-01

100

ADAPTING DATABASE IMPLEMENTATION TECHNIQUES TO MANAGE VERY LARGE KNOWLEDGE BASES  

Microsoft Academic Search

The management of very large knowledge bases presupposes efficient and robust implementation techniques, sophisticated user interfaces and tools to support knowledge acquisition, validation and evolution. This paper examines the problem of efficiently implementing a knowledge base management system by adopting database techniques. In particular, the paper describes algorithms for designing logical and physical storage schemes and for processing efficiently queries

John Mylopoulos; Vinay K. Chaudhri; Dimitris Plexousakis; Thodoros Topaloglou

1993-01-01

101

Group decision-making techniques for natural resource management applications  

USGS Publications Warehouse

This report is an introduction to decision analysis and problem-solving techniques for professionals in natural resource management. Although these managers are often called upon to make complex decisions, their training in the natural sciences seldom provides exposure to the decision-making tools developed in management science. Our purpose is to being to fill this gap. We present a general analysis of the pitfalls of group problem solving, and suggestions for improved interactions followed by the specific techniques. Selected techniques are illustrated. The material is easy to understand and apply without previous training or excessive study and is applicable to natural resource management issues.

Coughlan, Beth A.K.; Armour, Carl L.

1992-01-01

102

Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices  

PubMed Central

Background In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions. Methods This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis. Results Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon’s, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. Conclusion This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support may be beneficial. PMID:25328382

Jefferis, Joanna Mary; Clarke, Michael Patrick; Taylor, John-Paul; Brittain, Katie Rhian

2014-01-01

103

ISWHM: Tools and Techniques for Software and System Health Management  

NASA Technical Reports Server (NTRS)

This presentation presents status and results of research on Software Health Management done within the NRA "ISWHM: Tools and Techniques for Software and System Health Management." Topics include: Ingredients of a Guidance, Navigation, and Control System (GN and C); Selected GN and C Testbed example; Health Management of major ingredients; ISWHM testbed architecture; and Conclusions and next Steps.

Schumann, Johann; Mengshoel, Ole J.; Darwiche, Adnan

2010-01-01

104

Efficient Integration of Data Mining Techniques in Database Management Systems  

E-print Network

Efficient Integration of Data Mining Techniques in Database Management Systems Fadila Bentayeb J a Database Management System. We are thus only limited by disk capacity, and not by available main memory- posed. They consist in integrating data mining meth- ods in Database Management Systems (DBMSs) [3

Paris-Sud XI, Université de

105

Opioid induced hyperalgesia in anesthetic settings  

PubMed Central

Pain is difficult to investigate and difficult to treat, in part, because of problems in quantification and assessment. The use of opioids, combined with classic anesthetics to maintain hemodynamic stability by controlling responses to intraoperative painful events has gained significant popularity in the anesthetic field. However, several side effects profiles concerning perioperative use of opioid have been published. Over the past two decades, many concerns have arisen with respect to opioid-induced hyperalgesia (OIH), which is the paradoxical effect wherein opioid usage may decrease pain thresholds and increase atypical pain unrelated to the original, preexisting pain. This brief review focuses on the evidence, mechanisms, and modulatory and pharmacologic management of OIH in order to elaborate on the clinical implication of OIH. PMID:25473457

Lee, Hyeon Jeong

2014-01-01

106

Implementing cutting plane management and selection techniques  

E-print Network

sophisticated cut management is indispensable. In this paper, we ... tion algorithm in the Mops (Mathematical OPtimization System) MIP solver. Furthermore, we ...... Savelsbergh. An updated mixed integer programming library: MIPLIB 3.0.

2012-12-20

107

Managed pressure drilling techniques and tools  

E-print Network

these problems, the economics of drilling the wells will improve, thus enabling the industry to drill wells that were previously uneconomical. Managed pressure drilling (MPD) is a new technology that enables a driller to more precisely control annular pressures...

Martin, Matthew Daniel

2006-08-16

108

Project management techniques for highly integrated programs  

NASA Technical Reports Server (NTRS)

The management and control of a representative, highly integrated high-technology project, in the X-29A aircraft flight test project is addressed. The X-29A research aircraft required the development and integration of eight distinct technologies in one aircraft. The project management system developed for the X-29A flight test program focuses on the dynamic interactions and the the intercommunication among components of the system. The insights gained from the new conceptual framework permitted subordination of departments to more functional units of decisionmaking, information processing, and communication networks. These processes were used to develop a project management system for the X-29A around the information flows that minimized the effects inherent in sampled-data systems and exploited the closed-loop multivariable nature of highly integrated projects.

Stewart, J. F.; Bauer, C. A.

1983-01-01

109

Mounier-Kuhn Syndrome: Anesthetic Experience  

PubMed Central

Mounier Kuhn syndrome, or congenital tracheobronchomegaly, is an under diagnosed clinical entity with peculiar anatomical and physiological features making anesthetic care challenging. A 58-year-old chronic smoker with history of recurrent pneumonia and bronchiectasis presented for septoplasty. Thoracic imaging revealed a dilated trachea and main bronchi, tracheal and bronchial diverticuli, and chronic bronchiectasis with mediastinal lymphadenopathy. An 8.5 cuffed endotracheal tube (ETT) proved too big for his glottic aperture. An 8.0 cuffed ETT with wet gauze packing yielding an adequate seal. Postoperative continuous positive airway pressure to prevent airway collapse followed awake extubation. Anesthetic concerns include grossly enlarged and weakened airways, inefficient cough mechanisms, presence of tracheal diverticuli, and post operative tracheal collapse. Anesthetic planning includes management of endotracheal cuff size. Small size yields air leak and ineffective ventilation. Large size may lead to mucosal damage. Tube dislodgement, copious secretions, chance of expiratory collapse due to the abnormally dilated and thin airways, and post operative monitoring all must be considered. PMID:22606408

Ushakumari, Deepu Sasikumaran; Grewal, Navneet; Green, Michael

2012-01-01

110

Optimization Techniques for College Financial Aid Managers  

ERIC Educational Resources Information Center

In the context of a theoretical model of expected profit maximization, this paper shows how historic institutional data can be used to assist enrollment managers in determining the level of financial aid for students with varying demographic and quality characteristics. Optimal tuition pricing in conjunction with empirical estimation of…

Bosshardt, Donald I.; Lichtenstein, Larry; Palumbo, George; Zaporowski, Mark P.

2010-01-01

111

Advanced interference management techniques for future wireless networks   

E-print Network

In this thesis, we design advanced interference management techniques for future wireless networks under the availability of perfect and imperfect channel state information (CSI). We do so by considering a generalized ...

Razavi, Seyed Morteza

2014-06-30

112

Altered states: psychedelics and anesthetics.  

PubMed

The psychedelic experience has been reported since antiquity, but there is relatively little known about the underlying neural mechanisms. A recent neuroimaging study on psilocybin revealed a pattern of decreased cerebral blood flow and functional disconnections that is surprisingly similar to that caused by various anesthetics. In this article, the authors review historical examples of psychedelic experiences induced by general anesthetics and then contrast the mechanisms by which these two drug classes generate altered states of consciousness. PMID:24061599

Icaza, Eduardo E; Mashour, George A

2013-12-01

113

Management of petrous bone cholesteatoma: open versus obliterative techniques  

Microsoft Academic Search

The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention\\u000a to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results\\u000a of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on\\u000a obliterative or closed techniques in

Fernando López Álvarez; Justo R. Gómez; Ma Jesús Bernardo; Carlos Suárez

2011-01-01

114

Parental acceptance of pediatric dentistry behavior management techniques  

Microsoft Academic Search

The purpose of this study was to assess the attitudes of parents toward behavior management techniques employed in pediatric dentistry. Sixty-seven parents viewed videotaped segments of actual treatment of three- to five-year-old children with whom the following behavior management techniques were used successfully: general anesthesia, Papoose Board ®a , sedation, hand-over- mouth exercise (HOME), physical restraint by the dentist, physical

Marilyn Goodwin Murphy; J. Bernard Machen

1984-01-01

115

Coping Styles as Mediators of Teachers' Classroom Management Techniques  

ERIC Educational Resources Information Center

This study reports the relationships between coping styles of Australian teachers and the classroom based classroom management techniques they use to cope with student misbehaviour. There is great interest internationally in improving educational systems by upgrading the quality of teachers' classroom management. However, the relationship between…

Lewis, Ramon; Roache, Joel; Romi, Shlomo

2011-01-01

116

Circulation Sampling as a Technique for Library Media Program Management.  

ERIC Educational Resources Information Center

Discusses sampling of circulation data as a technique for library media program management. Highlights include random and purposive sampling techniques; studies of circulation samples; factors affecting circulation patterns; guidelines for sampling circulation statistics over shorter time periods; and an example using statistics gathered from an…

Garland, Kathleen

1992-01-01

117

Anesthetic implications of a partial molar pregnancy and associated complications.  

PubMed

In the United States, molar pregnancy occurs between 1 in 1,200 and 1 in 2,500 pregnancies. The critical nature of complications associated with a molar pregnancy requires advanced perioperative anesthetic management. This case report details the perioperative events of a 34-year-old gravida 5, para 3, with a partial molar pregnancy who underwent general anesthesia for a dilatation and curettage procedure, following therapeutic termination of a coexisting fetus at 18 weeks' gestation. Her initial presentation, anesthetic and operative management, and postoperative course are described clearly. The medical and anesthetic interventions required for treatment of molar pregnancy are reviewed. Of molar pregnancies, 80% are uncomplicated and follow an unremarkable course. However, for the remaining 20%, complications can be severe and may lead to substantial morbidity and mortality in otherwise healthy women. PMID:11759139

Celeski, D; Micho, J; Walters, L

2001-02-01

118

Managing difficult polyps: techniques and pitfalls  

PubMed Central

There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that ‘difficult polyp’ is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach. PMID:24714799

Tholoor, Shareef; Tsagkournis, Orestis; Basford, Peter; Bhandari, Pradeep

2013-01-01

119

Anesthetic Management for Lower Limb Fracture in Severe Aortic Valve Stenosis and Fat Embolism: A Case Report and Review of Literature  

PubMed Central

Introduction: Anesthesia in severe aortic stenosis, which describes a valve surface area less than 1 cm2, can result in rapid clinical deterioration and patient mortality. These patients may require treatment for aortic stenosis before any surgical intervention. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk, but in emergency situations, it is important to determine which kind of anesthesia technique has the lowest risk for these patients, without any cardiac intervention. Case Presentation: In this case report, we present a patient who had tibia and fibula fractures and a symptomatic severe critical aortic stenosis which was diagnosed during a preoperative visit. The patient had exertional dyspnea, palpitations and fainting history, but he had not received any medical therapy before the present admission. During hospitalization and preoperative evaluation, a fat embolism occurred and the patient was admitted to the intensive care unit. Immediately after his recovery, we successfully managed the tibia and fibula fracture fixation without any cardiac intervention. Conclusions: Our anesthesia method was sciatic and femoral nerve block under double ultrasonic and nerve stimulator guidance. PMID:24910815

Rokhtabnak, Faranak; Zamani, Mohammad Mahdi; Kholdebarin, Alireza; Pournajafian, Alireza; Ghodraty, Mohammad Reza

2014-01-01

120

Dynamic characteristics of the cutaneous vasodilator response to a local external pressure application detected by the laser Doppler flowmetry technique on anesthetized rats  

NASA Astrophysics Data System (ADS)

The laser Doppler flowmetry technique has recently been used to report a significant transient increase of the cutaneous blood flow signal when a local non-noxious pressure is applied progressively on the skin (11.1 Pa/s). The present work analyses the dynamic characteristics of this vasodilatory reflex response on anaesthetised rats. A de-noising algorithm using wavelets is proposed to obtain accurate values of these dynamic characteristics. The blood flow peak and the time to reach this peak are computed on the de-noised recordings. The results show that the mean time to reach the peak of perfusion is 85.3 s (time t = 0 at the beginning of the pressure application). The mean peak value is 188.3 arbitrary units (a.u.), whereas the mean value of the perfusion before the pressure application is 113.4 a.u. The mean minimum value obtained at the end of the experiment is 60.7 a.u. This latter value is, on the average, reached 841.3 s after the beginning of the pressure application. The comparison of the dynamic characteristics, computed with the de-noising algorithm on signals obtained in other situations, will give a better understanding on some cutaneous lesions such as those present on diabetic people.

Humeau, Anne; Koitka, Audrey; Saumet, Jean-Louis; L'Huillier, Jean-Pierre

2003-10-01

121

Application of scenario technique in flood risk management.  

PubMed

It is now commonly accepted that the management of flood risks has to be fulfilled within an integrated framework. About two decades ago flood risk was managed from a limited perspective predominantly by means of structural measures aimed at flood control. In contrast integrated flood risk management incorporates the complete management cycle consisting of the phases prevention, protection and preparedness. In theory it is a well described concept. In the stage of implementation, however, there is often a lack of support although a consistent policy framework exists. Consequently, the degree of implementation must be rated as inadequate in many cases. In particular this refers to the elements which focus on preparedness and prevention. The study to which this paper refers emphasises the means and potentials of scenario technique to foster the implementation of potentially appropriate measures and new societal arrangements when applied in the framework of integrated flood risk management. A literature review is carried out to reveal the state-of-the-art and the specific problem framework within which scenario technique is generally being applied. Subsequently, it is demonstrated that scenario technique is transferable to a policy making process in flood risk management that is integrated, sustainable and interactive. The study concludes with a recommendation for three applications in which the implementation of measures of flood damage prevention and preparedness is supported by scenario technique. PMID:17851209

Winterscheid, A

2007-01-01

122

Impaired thalamocortical connectivity in humans during general-anesthetic-induced unconsciousness  

Microsoft Academic Search

Whereas converging lines of evidence suggest that anesthetic-induced unconsciousness may result from disruption of functional interactions within neural networks involving the thalamus and cerebral cortex, the effects anesthetics have on human thalamocortical connectivity remain unexamined with current neuroimaging techniques. To address this issue we retrospectively analyzed positron emission tomography data from 11 volunteers scanned for regional cerebral glucose utilization (rCMRglu)

Nathan S White; Michael T Alkire

2003-01-01

123

Hoshin Kanri: a technique for strategic quality management.  

PubMed

This paper describes a technique for Strategic Quality Management (SQM), known as Hoshin Kanri, which has been operated as a management system in many Japanese companies since the 1960s. It represents a core aspect of Japanese companies' management systems, and is stated as: the means by which the overall control system and Total Quality Management (TQM) are deployed. Hoshin Kanri is not particularly unique in its concept of establishing and tracking individual goals and objectives, but the manner in which the objectives and the means to achieve them are developed and deployed is. The problem with applying the concept of Strategic Quality Management (SQM) using Hoshin Kanri, is that it can tend to challenge the traditional authoritarian strategic planning models, which have become the paradigms of modern business. Yet Hoshin Kanri provides an appropriate tool for declaration of the strategic vision for the business while integrating goals and targets in a single holistic model. There have been various adaptations of Hoshin Kanri to align the technique to Western thinking and management approaches, yet outside Japan its significance has gone largely unreported. It is proposed that Hoshin Kanri is an effective methodology for SQM, which has a number of benefits over the more conventional planning techniques. The benefits of Hoshin Kanri as a tool for Strategic Quality Management (SQM) compared to conventional planning systems include: integration of strategic objectives with tactical daily management, the application of the plan-do-check-act cycle to business process management, parallel planning and execution methodology, company wide approach, improvements in communication, increased consensus and buy-in to goal setting, and cross-functional-management integration. PMID:11797824

Tennant, C; Roberts, P A

2000-01-01

124

New patents on topical anesthetics.  

PubMed

Anesthesia is defined as a total or partial loss of sensation and it may be general, local or topical, depending on the method of drug administration and area of the body affected. General anesthesia is a reversible state of unconsciousness produced by anesthetic agents, characterized by amnesia, muscle relaxation and loss of sensitivity to pain of the whole body. General anesthetic drugs can be classified into two main groups according to their predominant molecular pharmacological effects: volatile and intravenous agents. Local anesthesia produce a reversible loss of sensation in a portion of the body and it reversibly block impulse conduction along nerve axons and other excitable membrane. All local anesthetics (LA) are membrane stabilizing drugs; they reversibly decrease the rate of depolarization and repolarization of excitable membranes. They act mainly by inhibiting sodium influx through sodium-specific ion channels in the neuronal cell membrane, in particular the voltage-gated sodium channels. When the influx of sodium is interrupted, an action potential cannot arise and signal conduction is inhibited. The main local anesthetic (LA) agents for skin anesthesia are benzocaine (aminoester), prilocaine and lidocaine (aminoamides) which are commercially available as gels, ointments and creams (benzocaine and eutectic mixture of lidocaine and prilocaine) or as a bioadhesive (lidocaine) with different compositions (vehicles and excipients) for adults or pediatric use. Topical anesthetics decrease anxiety, pain and discomfort during cutaneous procedures and provide effective analgesia with rapid onset, prolonged duration and minimal side effects. This article outlines the different classes of topical anesthetics available and gives an overview of the mechanism of action, metabolism of each different class, of the possible complications that can occur because of their use and their possible treatment options and new patents. PMID:24832168

Cantisani, Carmen; Macaluso, Laura; Frascani, Federica; Paolino, Giovanni; D'Andrea, Vito; Richetta, Antonio G; Calvieri, Stefano

2014-01-01

125

Anesthetic Challenges in Robotic-assisted Urologic Surgery  

PubMed Central

Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and limited access to the patient, all present anesthetic management challenges in urologic surgery. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce surgical and anesthetic complications. PMID:24659914

Hsu, Richard L; Kaye, Alan D; Urman, Richard D

2013-01-01

126

An Intelligent Content Discovery Technique for Health Portal Content Management  

PubMed Central

Background Continuous content management of health information portals is a feature vital for its sustainability and widespread acceptance. Knowledge and experience of a domain expert is essential for content management in the health domain. The rate of generation of online health resources is exponential and thereby manual examination for relevance to a specific topic and audience is a formidable challenge for domain experts. Intelligent content discovery for effective content management is a less researched topic. An existing expert-endorsed content repository can provide the necessary leverage to automatically identify relevant resources and evaluate qualitative metrics. Objective This paper reports on the design research towards an intelligent technique for automated content discovery and ranking for health information portals. The proposed technique aims to improve efficiency of the current mostly manual process of portal content management by utilising an existing expert-endorsed content repository as a supporting base and a benchmark to evaluate the suitability of new content Methods A model for content management was established based on a field study of potential users. The proposed technique is integral to this content management model and executes in several phases (ie, query construction, content search, text analytics and fuzzy multi-criteria ranking). The construction of multi-dimensional search queries with input from Wordnet, the use of multi-word and single-word terms as representative semantics for text analytics and the use of fuzzy multi-criteria ranking for subjective evaluation of quality metrics are original contributions reported in this paper. Results The feasibility of the proposed technique was examined with experiments conducted on an actual health information portal, the BCKOnline portal. Both intermediary and final results generated by the technique are presented in the paper and these help to establish benefits of the technique and its contribution towards effective content management. Conclusions The prevalence of large numbers of online health resources is a key obstacle for domain experts involved in content management of health information portals and websites. The proposed technique has proven successful at search and identification of resources and the measurement of their relevance. It can be used to support the domain expert in content management and thereby ensure the health portal is up-to-date and current. PMID:25654440

2014-01-01

127

Ondansetron Exhibits the Properties of a Local Anesthetic  

Microsoft Academic Search

PM. The blockade started im- mediately when OND was applied to the cell body us- ing a fast perfusion system, reached a plateau within 15 s, and recovered to the control level within 30 s after washout of the OND-containing solution. Because this is a known property of local anesthetics, we used the tail-flick technique to verify this effect in

Jiang Hong Ye; Wui Chiu Mui; Jun Ren; Thurman E. Hunt; Wen-Hsien Wu; Vlasta K. Zbuzek

1997-01-01

128

Pediatric epilepsy surgery: anesthetic considerations.  

PubMed

Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. This article provides anesthesiologists with an overview of seizures in the pediatric population, including evaluation, medical treatment, surgical options, and the anesthetic implications of caring for this special population. PMID:22901606

Koh, Jeffrey L; Egan, Brian; McGraw, Terrence

2012-06-01

129

Local anesthetic intolerance due to metabisulfite.  

PubMed

The case of a 40-year-old woman with severe edema of the face and neck after the injection of a local dental anesthetic is presented. The reaction is attributed to the presence of sodium metabisulfite, and antioxidant, in the local anesthetic. Both the anesthetic and the sodium metabisulfite gave a delayed positive patch-test response. PMID:2706960

Dooms-Goossens, A; de Alam, A G; Degreef, H; Kochuyt, A

1989-02-01

130

New technique for the management of vesicorectal fistulas  

SciTech Connect

We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.

Leifer, G.; Jacobs, W.H.

1988-08-01

131

Power Modeling and Thermal Management Techniques for Manycores  

E-print Network

Power Modeling and Thermal Management Techniques for Manycores Rajib Nath Computer Science number of cores in manycore archi- tectures, along with technology scaling, results in high power in such processors, we need an accurate online estimate of the power consumption. In this paper, we present the first

Simunic, Tajana

132

Using Powerpoint Animations to Teach Operations Management Techniques and Concepts  

ERIC Educational Resources Information Center

This article examines the value of using complex animated PowerPoint presentations to teach operations management techniques and concepts. To provide context, literature covering the use of PowerPoint animations in business education is briefly reviewed. The specific animations employed in this study are identified and their expected benefits to…

Treleven, Mark D.; Penlesky, Richard J.; Callarman, Thomas E.; Watts, Charles A.; Bragg, Daniel J.

2014-01-01

133

The Appraisal Interview: Management Techniques for Evaluating Teachers.  

ERIC Educational Resources Information Center

Discusses roles appropriate for the principal and the teacher during the appraisal interview that follows the principal's observations and assessment of the teacher's job performance. Suggests techniques drawn from management theory for principals' use in enhancing communication, the key to making the appraisal interview mutually beneficial. (PGD)

Sadler, Norma J.

1982-01-01

134

Stress-busters Tips and techniques for managing stress and  

E-print Network

Stress-busters Tips and techniques for managing stress and introducing relaxation into your life UCSC Counseling & Psychological Services What is stress? Stress is the physiological and psychological semester or new job can bring on stress. We are all under stress every day. A certain amount of stress

California at Santa Cruz, University of

135

The proposed mechanism of action during different pain management techniques on expression of cytolytic molecule perforin in patients after colorectal cancer surgery.  

PubMed

The postoperative period is accompanied with neuroendocrine, metabolic and immune alteration which is caused by tissue damage, anesthesia, postoperative pain and psychological stress. Postoperative pain contributes to dysfunction of immune response as a result of interaction between central nervous and immune system. The postoperatively activated hypotalamo-pituitary-adrenocortical axis, sympathic and parasympathic nerve systems are important modulators of immune response. According to bidirectional communication of immune and nervous system, appropriate postoperative pain management could affect immune response in postoperative period. Although the postoperative suppression of immune response has been reported, a very little are known about the influences of different pain management techniques on cytotoxic function of immune cells in patients with colorectal cancer in early postoperative period. Perforin is a cytotoxic molecule expressed by activated lymphocytes which has a crucial role in elimination of tumor cells and virus-infected cells, mostly during the effector's phase of immune response. Immune compromise during the postoperative period could affect the healing processes, incidence of postoperative infections and rate and size of tumor metastases disseminated during operation. The pharmacological management of postoperative pain in patients with malignancies uses very different analgesic techniques whose possible influence on cytotoxic functions of immune cells are still understood poor. For decades the most common way of treating postoperative pain after colorectal cancer surgery was intravenous analgesia with opiods. In the last decade many investigations pointed out that opiods can also contribute to postoperative suppression of immune response. Epidural analgesia is a regional anesthesia technique that acts directly on the origin of pain impulses and pain relief can be achieved with small doses of opiods combined with local anesthetics. Local anesthetics potentate analgesic properties of opiods but per se are also acting as antiinflammatory drugs. Afferent neural blockade by epidural analgesia attenuates neuroendocrine stress response. We propose that epidural analgesia could be more convenient that intravenous analgesia in maintenance of immunological homeostasis that is altered by surgical stress, tumor growth and pain. PMID:21195559

Golubovic, S; Golubovic, V; Sotosek-Tokmadzic, V; Sustic, A; Petkovic, M; Bacic, D; Mrakovcic-Sutic, I

2011-03-01

136

Anesthetic Cartridge System Under Evaluation  

PubMed Central

The problem of glass breakage in the local anesthetic cartridge system was evaluated under laboratory conditions with a mechanical testing machine. The anticipated breakage of the glass did not occur with any frequency, as the rubber stopper produced more uniform failures of the system. The glass cartridge appeared to be quite reliable and resistant to breakage. Local anesthetics have been used for many years to provide patients temporary freedom from pain. Local anesthetic solutions are in wide use in both dentistry and medicine and are the most frequently used drugs in dentistry. Various estimates place the number of injections at approximately one half million daily or 125 million injections per year. These drugs and the armamentarium necessary to administer them have proven to be safe and reliable. Only rarely are there reports of sensitivity to the anesthetic solution or breakage of needles.. Sterility of the solutions has not been a problem as they are carefully processed and evaluated at the factory. Although there are sporadic reports of loss of sterility, this has been attributed to the reuse of the anesthetic cartridges on more than one patient. Monheim states “The success of the cartridge system in dentistry has been due to the sincerity, honesty, and high standards of the manufacturers in giving the profession a near-perfect product.” However, on occassion a glass cartridge will break or shatter when inserting the harpoon into the rubber stopper or even during injection. Cooley et al reported on eye injuries occurring in the dental office, one of which was due to glass from a local anesthetic cartridge that exploded and propelled particles into the patient's eye. Forrest evaluated syringes, needles, and cartridges and reported that one brand (made in Britain) fractured more often than any other, but that the fracture rate was too low to be of any consequence. It is apparent that glass cartridges will fracture or burst from time to time. This study evaluates the cartridge system with carefully controlled laboratory procedures. The cartridges were tested under various pressures and conditions in an attempt to determine the causes of failure and when such failure may be anticipated. ImagesFigure 1Figure 2Figure 3Figure 4Figure 9Figure 10 PMID:6939350

Cooley, Robert L.; Lubow, Richard M.

1981-01-01

137

The worm sheds light on anesthetic mechanisms.  

PubMed

One hundred and sixty five years have passed since the first documented use of volatile anesthetics to aid in surgery, but we have yet to understand the underlying mechanism of action of these drugs. There is no question that, in vitro, volatile anesthetics can affect the function of numerous neuronal and non-neuronal proteins. In fact, volatile anesthetics are capable of binding such diverse proteins as albumin and bacterial luciferase. The promiscuity of volatile anesthetic binding makes it difficult to determine which proteins are modulated by anesthetics to cause the state of anesthesia. Consequently, despite a great deal of in vitro data, the fundamental physiological process that volatile anesthetics perturb to effect neuronal silencing is not yet identified. Recently, data has increasingly indicated that membrane leak channels may play a role in the anesthetic response. Here we comment on the use of optogenetics to further support such a model. PMID:23730538

Singaram, Vinod K; Morgan, Philip G; Sedensky, Margaret M

2012-01-01

138

Prevention of local anesthetic systemic toxicity.  

PubMed

Although new drugs and techniques may improve outcomes when unintended high blood levels of local anesthetics occur, the primary focus of daily practice should remain the prevention of such events. Although adoption of no single "safety step" will reliably prevent systemic toxicity, the combination of several procedures seems to have reduced the frequency of systemic toxicity since 1981. These include the use of minimum effective doses, careful aspiration, and incremental injection, coupled with the use of intravascular markers when large doses are used. Epinephrine remains the most widely used and studied marker, but its reliability is impaired in the face of beta-blockade, anesthesia, advanced age, and active labor. As an alternative, the use of subtoxic doses of local anesthetics themselves can produce subjective symptoms in unpremedicated patients. Fentanyl has also been confirmed to produce sedation in pregnant women when used as an alternative. The use of ultrasound observation of needle placement and injection may be useful, but has also been reported as not completely reliable. Constant vigilance and suspicion are still needed along with a combination of as many of these safety steps as practical. PMID:20216035

Mulroy, Michael F; Hejtmanek, Michael R

2010-01-01

139

Risk Management Techniques and Practice Workshop Workshop Report  

SciTech Connect

At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk Management Techniques and Practice (RMTAP) workshop held September 18-19 at the Hotel Nikko in San Francisco. The purpose of the workshop, which was sponsored by the SC/Advanced Scientific Computing Research (ASCR) program and the National Nuclear Security Administration (NNSA)/Advanced Simulation and Computing (ASC) program, was to assess current and emerging techniques, practices, and lessons learned for effectively identifying, understanding, managing, and mitigating the risks associated with acquiring leading-edge computing systems at high-performance computing centers (HPCCs). Representatives from fifteen high-performance computing (HPC) organizations, four HPC vendor partners, and three government agencies attended the workshop. The overall workshop findings were: (1) Standard risk management techniques and tools are in the aggregate applicable to projects at HPCCs and are commonly employed by the HPC community; (2) HPC projects have characteristics that necessitate a tailoring of the standard risk management practices; (3) All HPCC acquisition projects can benefit by employing risk management, but the specific choice of risk management processes and tools is less important to the success of the project; (4) The special relationship between the HPCCs and HPC vendors must be reflected in the risk management strategy; (5) Best practices findings include developing a prioritized risk register with special attention to the top risks, establishing a practice of regular meetings and status updates with the platform partner, supporting regular and open reviews that engage the interests and expertise of a wide range of staff and stakeholders, and documenting and sharing the acquisition/build/deployment experience; and (6) Top risk categories include system scaling issues, request for proposal/contract and acceptance testing, and vendor technical or business problems. HPC, by its very nature, is an exercise in multi-level risk management. Every aspect of stewarding HPCCs into the petascale era, from identification of the program drivers to the details of procurement actions and simulation environment component deployments, represents unprecedented challenges and requires effective risk management. The fundamental purpose of this workshop was to go beyond risk management processes as such and learn how to weave effective risk management practices, techniques, and methods into all aspects of migrating HPCCs into the next generation of leadership computing systems. This workshop was a follow-on to the Petascale System Integration Workshop hosted by Lawrence Berkeley National Laboratory (LBNL)/NERSC last year. It was intended to leverage and extend the risk management experience of the participants by looking for common best practices and unique processes that have been especially successful. This workshop assessed the effectiveness of tools and techniques that are or could be helpful in HPCC risk management, with a special emphasis on how practice meets process. As the saying goes: 'In theory, there is no difference between theory and practice. In practice there is'. Finally, the workshop brought together a network of experts who shared information as technology moves into the petascale era and beyond.

Quinn, T; Zosel, M

2008-12-02

140

Following the north star: radial marker lines help preserve anatomic landmarks after local injection of anesthetic.  

PubMed

Injection of local anesthetic can result in distortion of local anatomic architecture. "Following the North Star" is a technique that uses radial markings to aid in better preservation of surgical landmarks. PMID:25556891

Krakowski, Andrew C; Admani, Shehla; Eichenfield, Lawrence F

2015-03-01

141

Volatile anesthetics affect nutrient availability in yeast.  

PubMed Central

Volatile anesthetics affect all cells and tissues tested, but their mechanisms and sites of action remain unknown. To gain insight into the cellular activities of anesthetics, we have isolated genes that, when overexpressed, render Saccharomyces cerevisiae resistant to the volatile anesthetic isoflurane. One of these genes, WAK3/TAT1, encodes a permease that transports amino acids including leucine and tryptophan, for which our wild-type strain is auxotrophic. This suggests that availability of amino acids may play a key role in anesthetic response. Multiple lines of evidence support this proposal: (i) Deletion or overexpression of permeases that transport leucine and/or tryptophan alters anesthetic response; (ii) prototrophic strains are anesthetic resistant; (iii) altered concentrations of leucine and tryptophan in the medium affect anesthetic response; and (iv) uptake of leucine and tryptophan is inhibited during anesthetic exposure. Not all amino acids are critical for this response since we find that overexpression of the lysine permease does not affect anesthetic sensitivity. These findings are consistent with models in which anesthetics have a physiologically important effect on availability of specific amino acids by altering function of their permeases. In addition, we show that there is a relationship between nutrient availability and ubiquitin metabolism in this response. PMID:12072454

Palmer, Laura K; Wolfe, Darren; Keeley, Jessica L; Keil, Ralph L

2002-01-01

142

Exploring microsolvation of the anesthetic propofol.  

PubMed

Propofol (2,6-diisopropylphenol) is a broadly used general anesthetic. By combining spectroscopic techniques such as 1- and 2-color REMPI, UV/UV hole burning, infrared ion-dip spectroscopy (IRIDS) obtained under cooled and isolated conditions with high-level ab initio calculations, detailed information on the molecular structure of propofol and on its interactions with water can be obtained. Four isomers are found for the bare propofol, while only three are detected for the monohydrated species and two for propofol·(H(2)O)(2). The isopropyl groups do not completely block the OH solvation site, but reduce considerably the strength of the hydrogen bonds between propofol and water. Such results may explain the high mobility of propofol in the GABA(A) active site, where it cannot form a strong hydrogen bond with the tyrosine residue. PMID:22358320

Leon, Iker; Cocinero, Emilio J; Millán, Judith; Jaeqx, Sander; Rijs, Anouk M; Lesarri, Alberto; Castaño, Fernando; Fernández, José A

2012-04-01

143

Mechanisms revealed through general anesthetic photolabeling.  

PubMed

General anesthetic photolabels are used to reveal molecular targets and molecular binding sites of anesthetic ligands. After identification, the relevance of anesthetic substrates or binding sites can be tested in biological systems. Halothane and photoactive analogs of isoflurane, propofol, etomidate, neurosteroids, anthracene, and long chain alcohols have been used in anesthetic photolabeling experiments. Interrogated protein targets include the nicotinic acetylcholine receptor, GABAA receptor, tubulin, leukocyte function-associated antigen-1, and protein kinase C. In this review, we summarize insights revealed by photolabeling these targets, as well as general features of anesthetics, such as their propensity to partition to mitochondria and bind voltage-dependent anion channels. The theory of anesthetic photolabel design and the experimental application of photoactive ligands are also discussed. PMID:24563623

Weiser, Brian P; Woll, Kellie A; Dailey, William P; Eckenhoff, Roderic G

2014-03-01

144

The effects of perineal management techniques on labor complications  

PubMed Central

Background: Many women suffer from perineal trauma during the normal vaginal delivery. Perineal trauma is mainly associated with pain and complications after the childbirth. Perineal management techniques can play a significant role in perineal trauma reduction. This study aimed to compare the effects of perineal management techniques (hands-off technique, Ritgen maneuver and perineal massage using a lubricant during delivery) on the labor complications. Materials and Methods: This quasi-experimental clinical trial was conducted on 99 primiparous women who referred to Daran Hospital, Isfahan, Iran for normal vaginal delivery in 2009. The subjects were selected using a convenient method and randomly assigned to three groups of Ritgen maneuver, hands-off technique and perineal massage with lubricant. A questionnaire was used to determine the demographic characteristics of the participants and complications after birth. The short form of McGill Pain Questionnaire and the visual analogue scale for pain were also employed. The incidence and degree of perineal tears were evaluated immediately after delivery. Moreover, the incidence and severity of perineal pain were assessed 24 hours and also 6 weeks after delivery. Findings: In the Ritgen maneuver group, the frequency of tears, the relative frequency of tear degrees, the severity of perineal pain 24 hours after delivery and the frequency of pain and perineal pain severity 6 weeks after delivery were significantly different from the other two methods. Conclusions: Hands-off technique during parturition of the neonate's head was associated with fewer complications after delivery. It was even better than perineal massage during the parturition. PMID:23493441

Fahami, Fariba; Shokoohi, Zohreh; Kianpour, Mariam

2012-01-01

145

Effect of isolation stress on anesthetic requirement in mice  

Microsoft Academic Search

Many studies have measured anesthetic requirements in order to determine anesthetic potency. The measurements in mice have been used to clarify anesthetic mechanisms, using the index for loss of righting reflex (LORR) [1] and the tail-flick test. However, many factors can affect anesthetic requirements [2]. Researchers have found widely divergent values for anesthetic requirements of mice. Male mice by nature

Hiroyuki Nakao; Tetsuro Uefuji; Mitsuko Mori; Keiko Tanaka

2003-01-01

146

Venom extraction from anesthetized Florida cottonmouths, Agkistrodon piscivorus conanti, using a portable nerve stimulator.  

PubMed

Florida cottonmouth snakes (Agkistrodon piscivorus conanti) were anesthetized with the injectable anesthetic propofol, and venom expulsion was induced with a commercially available human nerve stimulator. We observed rapid anesthetic induction with strong correlation between animal mass and both propofol dose and induction time. We also found a positive correlation between venom yield and animal mass. The method we describe produced consistent venom extraction, maximized yield by completely emptying the glands, potentially reduced animal stress by reducing time of conscious physical restraint, and decreased the likelihood of human envenomation. This technique could also be used in remote field locations. PMID:19647760

McCleary, Ryan J R; Heard, Darryl J

2010-01-01

147

Application of fisheries-management techniques to assessing impacts  

SciTech Connect

Monitoring methods used in fisheries-management assessments were examined and their potential applicability in confirmatory impact monitoring were evaluated using case studies from selected nuclear power plants. A report on Task I of the project examined the application of Catch-Per-Unit-Effort (CPUE) techniques in monitoring programs at riverine, large lake and ocean sites. Included in this final report is an examination of CPUE data for the Oconee Nuclear Plant on Lake Keowee, a reservoir site. This report also presents a summary of results obtained over the life of the project and guidelines for designing and implementing data collection programs and for data analysis and interpretation. Analysis of monitoring data from Lake Keowee confirmed findings from previous analyses of surveys at nuclear power plants on large lakes, rivers and coastal sites. CPUE techniques as applied to these monitoring programs do not provide data necessary to separate changes induced by plant operation from naturally occurring changes.

McKenzie, D.H.; Simmons, M.A.; Skalski, J.R.

1983-01-01

148

Neurotoxic effects of local anesthetics on the mouse neuroblastoma NB2a cell line.  

PubMed

Local anesthetics are used clinically for peripheral nerve blocks, epidural anesthesia, spinal anesthesia and pain management; large concentrations, continuous application and long exposure time can cause neurotoxicity. The mechanism of neurotoxicity caused by local anesthetics is unclear. Neurite outgrowth and apoptosis can be used to evaluate neurotoxic effects. Mouse neuroblastoma cells were induced to differentiate and generate neurites in the presence of local anesthetics. The culture medium was removed and replaced with serum-free medium plus 20 ?l combinations of epidermal growth factor and fibroblast growth factor containing tetracaine, prilocaine, lidocaine or procaine at concentrations of 1, 10, 25, or 100 ?l prior to neurite measurement. Cell viability, iNOS, eNOS and apoptosis were evaluated. Local anesthetics produced toxic effects by neurite inhibition at low concentrations and by apoptosis at high concentrations. There was an inverse relation between local anesthetic concentrations and cell viability. Comparison of different local anesthetics showed toxicity, as assessed by cell viability and apoptotic potency, in the following order: tetracaine > prilocaine > lidocaine > procaine. Procaine was the least neurotoxic local anesthetic and because it is short-acting, may be preferred for pain prevention during short procedures. PMID:25539050

Mete, M; Aydemir, I; Tuglu, I M; Selcuki, M

2015-04-01

149

Influence of Anesthetic Regimens on Intestinal Absorption in Rats  

Microsoft Academic Search

We compared the influence of anesthetic regimens using urethane (U), pentobarbital (P), ether (E), and ketamine\\/midazolam (K) on the intestinal absorption of several probes using a single-pass per-fusion technique in rats. The selected probes were D-glucose (1 mM) for the resistance of the unstirred water layer (UWL), D-glucose (100 mM) for the capacity of carrier-mediated D-glucose transport, L-glucose, and urea

Hiroaki Yuasa; Kenji Matsuda; Jun Watanabe

1993-01-01

150

GENERAL ARTICLES Minimum Alveolar Anesthetic Concentration of Fluorinated  

E-print Network

GENERAL ARTICLES Minimum Alveolar Anesthetic Concentration of Fluorinated Alkanols in Rats of conventional inhaled anesthetics correlates inversely with lipophilicity: minimum alveolar anesthetic concen.65 atm. MAC is the minimum alveolar concentration of an- esthetic required to eliminate movement

Hudlicky, Tomas

151

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping... § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

2014-10-01

152

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping... § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

2011-10-01

153

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping... § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

2012-10-01

154

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping... § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

2010-10-01

155

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping... § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

2013-10-01

156

Modification of cardiac Na+ channels by batrachotoxin: effects on gating, kinetics, and local anesthetic binding.  

PubMed Central

The purpose of the present study was to examine the characteristics of Na+ channel modification by batrachotoxin (BTX) in cardiac cells, including changes in channel gating and kinetics as well as susceptibility to block by local anesthetic agents. We used the whole cell configuration of the patch clamp technique to measure Na+ current in guinea pig myocytes. Extracellular Na+ concentration and temperature were lowered (5-10 mM, 17 degrees C) in order to maintain good voltage control. Our results demonstrated that 1) BTX modifies cardiac INa, causing a substantial steady-state (noninactivating) component of INa, 2) modification of cardiac Na+ channels by BTX shifts activation to more negative potentials and reduces both maximal gNa and selectivity for Na+; 3) binding of BTX to its receptor in the cardiac Na+ channel reduces the affinity of local anesthetics for their binding site; and 4) BTX-modified channels show use-dependent block by local anesthetics. The reduced blocking potency of local anesthetics for BTX-modified Na+ channels probably results from an allosteric interaction between BTX and local anesthetics for their respective binding sites in the Na+ channel. Our observations that use-dependent block by local anesthetics persists in BTX-modified Na+ channels suggest that this form of extra block can occur in the virtual absence of the inactivated state. Thus, the development of use-dependent block appears to rely primarily on local anesthetic binding to activated Na+ channels under these conditions. PMID:8396458

Wasserstrom, J A; Liberty, K; Kelly, J; Santucci, P; Myers, M

1993-01-01

157

Overview of Coal Bed Methane Best Management Practices and Mitigation Techniques Using Geospatial Techniques  

NASA Astrophysics Data System (ADS)

During the second half of the 1990's, Coalbed Methane (CBM) production increased dramatically nationwide to represent a significant new source of income and natural gas for many independent and established producers. Matching these soaring production rates during this period were advancements in Geographical Information System (GIS) technologies generating terra-bytes of new data for the oil & gas industry. Coupled to these accelerating initiatives are many environmental concerns relating to produced water management and impacts to surface and groundwater resources. It is these concerns that have prompted the conceptualization of research sponsored by the U.S. DOE for the development of Best Management Practices (BMP) and mitigation strategies utilizing GIS technologies for efficient environmental protection in conjunction with effective production of coal bed methane. This has been accomplished by developing a framework to take advantage of a combination of investigative field research joined with leading edge GIS technologies for the creation of environmentally characterized regions of study. This paper will provide a summary of coal bed methane best management practices and mitigation strategies as well as the use of an Internet-Based GIS application for geospatial analysis relative coal bed methane development and evaluation of various mitigation techniques and best management practices. Case studies from various basins will be presented and discussed. An update regarding current activities pertaining to ongoing developments of best practices, including produced water beneficial use alternatives, for coal bed methane nationally will be discussed.

Arthur, J. D.

2003-12-01

158

Introducing Risk Management Techniques Within Project Based Software Engineering Courses  

NASA Astrophysics Data System (ADS)

In 1996, USC switched its core two-semester software engineering course from a hypothetical-project, homework-and-exam course based on the Bloom taxonomy of educational objectives (knowledge, comprehension, application, analysis, synthesis, and evaluation). The revised course is a real-client team-project course based on the CRESST model of learning objectives (content understanding, problem solving, collaboration, communication, and self-regulation). We used the CRESST cognitive demands analysis to determine the necessary student skills required for software risk management and the other major project activities, and have been refining the approach over the last 5 years of experience, including revised versions for one-semester undergraduate and graduate project course at Columbia. This paper summarizes our experiences in evolving the risk management aspects of the project course. These have helped us mature more general techniques such as risk-driven specifications, domain-specific simplifier and complicator lists, and the schedule as an independent variable (SAIV) process model. The largely positive results in terms of review of pass / fail rates, client evaluations, product adoption rates, and hiring manager feedback are summarized as well.

Port, Daniel; Boehm, Barry

2002-03-01

159

Gum chewing during pre-anesthetic fasting.  

PubMed

Many ad hoc fasting guidelines for pre-anesthetic patients prohibit gum chewing. We find no evidence that gum chewing during pre-anesthetic fasting increases the volume or acidity of gastric juice in a manner that increases risk, nor that the occasional associated unreported swallowing of gum risks subsequent aspiration. On the contrary, there is evidence that gum chewing promotes gastrointestinal motility and physiologic gastric emptying. Recommendations against pre-anesthetic gum chewing do not withstand scrutiny and miss an opportunity to enhance comfort and sense of wellbeing for patients awaiting anesthesia. Gum chewing during the pre-anesthetic nil per os (NPO) period would also permit the development of gum-delivered premedications and should be permitted in children old enough to chew gum safely. Gum chewing should cease when sedatives are given and all patients should be instructed to remove any chewing gum from the mouth immediately prior to anesthetic induction. PMID:22171675

Poulton, Thomas J

2012-03-01

160

Sodium channels as targets for volatile anesthetics.  

PubMed

The molecular mechanisms of modern inhaled anesthetics are still poorly understood although they are widely used in clinical settings. Considerable evidence supports effects on membrane proteins including ligand- and voltage-gated ion channels of excitable cells. Na(+) channels are crucial to action potential initiation and propagation, and represent potential targets for volatile anesthetic effects on central nervous system depression. Inhibition of presynaptic Na(+) channels leads to reduced neurotransmitter release at the synapse and could therefore contribute to the mechanisms by which volatile anesthetics produce their characteristic end points: amnesia, unconsciousness, and immobility. Early studies on crayfish and squid giant axon showed inhibition of Na(+) currents by volatile anesthetics at high concentrations. Subsequent studies using native neuronal preparations and heterologous expression systems with various mammalian Na(+) channel isoforms implicated inhibition of presynaptic Na(+) channels in anesthetic actions at clinical concentrations. Volatile anesthetics reduce peak Na(+) current (I(Na)) and shift the voltage of half-maximal steady-state inactivation (h(?)) toward more negative potentials, thus stabilizing the fast-inactivated state. Furthermore recovery from fast-inactivation is slowed, together with enhanced use-dependent block during pulse train protocols. These effects can depress presynaptic excitability, depolarization and Ca(2+) entry, and ultimately reduce transmitter release. This reduction in transmitter release is more potent for glutamatergic compared to GABAergic terminals. Involvement of Na(+) channel inhibition in mediating the immobility caused by volatile anesthetics has been demonstrated in animal studies, in which intrathecal infusion of the Na(+) channel blocker tetrodotoxin increases volatile anesthetic potency, whereas infusion of the Na(+) channels agonist veratridine reduces anesthetic potency. These studies indicate that inhibition of presynaptic Na(+) channels by volatile anesthetics is involved in mediating some of their effects. PMID:22479247

Herold, Karl F; Hemmings, Hugh C

2012-01-01

161

Fish discards management: pollution levels and best available removal techniques.  

PubMed

Fish discards and by-catch issues are highly topical subjects that are permanently under a social focus. Two main approaches are being considered to address this discard problem: reducing the by-catch and increasing by-catch utilization. Interest in increased by-catch valorization may arise from a greater demand for fish products, such as the development of new markets for previously discarded species, the use of low-value specimens for aquaculture or the creation of value-added fish products for the food, pharmaceutical or cosmetic industries. However, contaminants present in fish discards may be transferred to their valorized products, leading to possible long-term bioaccumulation and subsequent adverse health effects. In this valorization framework, the aim is to promote responsible and sustainable management of marine resources. The pollutant levels in catches from European fisheries and the best available decontamination techniques for marine valorized discards/by-products are compiled and analyzed in this work. PMID:22542692

Antelo, Luis T; Lopes, Carla; Franco-Uría, Amaya; Alonso, Antonio A

2012-07-01

162

Architectural Techniques For Managing Non-volatile Caches  

SciTech Connect

As chip power dissipation becomes a critical challenge in scaling processor performance, computer architects are forced to fundamentally rethink the design of modern processors and hence, the chip-design industry is now at a major inflection point in its hardware roadmap. The high leakage power and low density of SRAM poses serious obstacles in its use for designing large on-chip caches and for this reason, researchers are exploring non-volatile memory (NVM) devices, such as spin torque transfer RAM, phase change RAM and resistive RAM. However, since NVMs are not strictly superior to SRAM, effective architectural techniques are required for making them a universal memory solution. This book discusses techniques for designing processor caches using NVM devices. It presents algorithms and architectures for improving their energy efficiency, performance and lifetime. It also provides both qualitative and quantitative evaluation to help the reader gain insights and motivate them to explore further. This book will be highly useful for beginners as well as veterans in computer architecture, chip designers, product managers and technical marketing professionals.

Mittal, Sparsh [ORNL] ORNL

2013-01-01

163

Benzocaine as an anesthetic for striped bass  

USGS Publications Warehouse

Benzocaine was tested as an anesthetic on juvenile and mature adult striped bass (Morone saxatilis ). Concentrations of 55 mg/L at 22 degree C to 80 mg/L at 11 degree C effectively anesthetized fish in about 3 min. Recovery was more rapid as temperature increased. Fish survived concentrations of twice the effective concentration and exposure times up to 60 min at the effective concentration. Striped bass required higher concentrations for anesthetization than had been previously demonstrated for salmonid fishes, but safety margins for both concentration and exposure time were wider than for the salmonids.

Gilderhus, Philip A.; Lemm, Carol A.; Woods, L. Curry, III

1991-01-01

164

A Review of Software Risk Management for Selection of Best Tools and Techniques  

Microsoft Academic Search

The aim of this research paper is to study risk management system and to find some tools and techniques recommended by different journals and articles. We have gone through different approaches in context of risk management. We have taken risk management paradigm introduced by Software Engineering Institute as our standard to analyze different techniques and tools. Different features have been

Khan Olid Bin Mannan

2008-01-01

165

Applying Data Mining Techniques to Address Disaster Information Management Challenges on Mobile Devices  

E-print Network

Applying Data Mining Techniques to Address Disaster Information Management Challenges on Mobile Management and Disaster Recovery techniques are national priorities in the wake of man-made and nature and managing information plays an important role in business recovery efforts after disaster event

Chen, Shu-Ching

166

The legal status of informed consent for behavior management techniques in pediatric dentistry  

Microsoft Academic Search

The use of various nonpharmacologic behavior management techniques is an integral part of pediatric dental practice. These techniques enjoy broad-based acceptance within the profession, but until recently there has been little syste~natic attempt to ascertain the opinion of parents on the issue of behavior management. New findings suggest that many parents do not approve of the more commonly used management

Patricia P. Hagan; John P. Hagan; J. Bernard Machen

1984-01-01

167

The Nerf Ball: A Useful Technique for Management Education and Practice  

ERIC Educational Resources Information Center

This paper describes a technique the first author imported from management practice to (a) develop students' meeting management skills, (b) improve students' listening skills and conflict management abilities and (c) encourage student participation and create a supportive learning environment. The technique uses a tangible prop (i.e., a Nerf ball)…

Archer, Bill; Lockwood, Chris A.; Anderson, Joe S.

2006-01-01

168

[Anesthesiological management of awake craniotomy : Asleep-awake-asleep technique or without sedation].  

PubMed

Awake craniotomy is indicated in deep brain stimulation (DBS) for treatment of certain movement disorders, such as in Parkinson disease patients or in the surgery of brain tumors in close vicinity to the language area. The standard procedure is the asleep-awake-asleep technique where general anesthesia or analgosedation is intermittently interrupted for neurological testing. In DBS the intraoperative improvement of symptoms, stereotactic navigation and microelectrode reading guide to the optimal position. In brain tumor resection, reversible functional impairments during electrical stimulation on the brain surface (brain mapping) show the exact individual position of eloquent or motoric areas that should be protected.The anesthesiology procedures used are very variable. It is a balancing act between overdosing of anesthetics with impairment of respiration and alertness and underdosing with pain, strain and stress for the patient. For the asleep-awake-asleep technique high acceptance but also frequent and partly severe complications have been reported. The psychological stress for the patient can be immense. Obviously, a feeling of being left alone and being at someone's mercy is not adequately treated by drugs and performance of the neurological tests is undoubtedly better and more reliable with less pharmacological impairment. Cranial nerve blocks can reduce the amount of anesthetics as they provide analgesia of the scalp more efficiently than local infiltration. With these nerve blocks, a strong therapeutic relationship and a specific communication, sedatives can be avoided and the need for opioids markedly reduced or abolished. The suggestive communication promotes for instance dissociation to an inner safe refuge, as well as reframing of disturbing noises and sensations. Each of the methods applied for awake craniotomy can profit from the principles of this awake-awake-awake technique. PMID:25421054

Seemann, M; Zech, N; Graf, B; Hansen, E

2015-02-01

169

Anesthetic considerations in acute spinal cord trauma  

PubMed Central

Patients with actual or potential spinal cord injury (SCI) are frequently seen at adult trauma centers, and a large number of these patients require operative intervention. All polytrauma patients should be assumed to have an SCI until proven otherwise. Pre-hospital providers should take adequate measures to immobilize the spine for all trauma patients at the site of the accident. Stabilization of the spine facilitates the treatment of other major injuries both in and outside the hospital. The presiding goal of perioperative management is to prevent iatrogenic deterioration of existing injury and limit the development of secondary injury whilst providing overall organ support, which may be adversely affected by the injury. This review article explores the anesthetic implications of the patient with acute SCI. A comprehensive literature search of Medline, Embase, Cochrane database of systematic reviews, conference proceedings and internet sites for relevant literature was performed. Reference lists of relevant published articles were also examined. Searches were carried out in October 2010 and there were no restrictions by study design or country of origin. Publication date of included studies was limited to 1990–2010. PMID:22096772

Dooney, Neil; Dagal, Armagan

2011-01-01

170

SYSTEMIC TOXIC REACTIONS TO LOCAL ANESTHETICS  

PubMed Central

The topical use of anesthetic agents involves an element of risk. Systemic toxic reactions are rare, but they do occur and may result in death. When a reaction occurs from a topical application, it usually progresses rapidly to respiratory and cardiovascular collapse, and thus therapy must be instituted with more haste to avoid deaths. Fatal systemic toxic reactions from topically administered anesthetic drugs are, in effect, usually not due to well informed use of the drug but to misuse owing to less than complete understanding of absorption. Emphasis is placed on the causes, prophylaxis and treatment of severe systemic toxic reactions which follow the topical application of local anesthetic drugs. If systemic toxic reactions resulting from a safe dose of a local anesthetic agent are correctly treated, there will usually follow an uneventful recovery rather than a catastrophe. PMID:13343009

Moore, Daniel C.; Green, John

1956-01-01

171

A Simple Swap Technique and Enhanced GTT Location Database Management Kuo-Hsing Chiang Nirmala Shenoy  

E-print Network

A Simple Swap Technique and Enhanced GTT Location Database Management Scheme Kuo-Hsing Chiang and provides comparison results with other location database management schemes. The performance results be divided into two categories: Location Database Management (LDM) and Location Area Management (LAM). LDM

Shenoy, Nirmala

172

Local Anesthetics Induce Human Renal Cell Apoptosis  

Microsoft Academic Search

Renal cell apoptosis contributes significantly to the pathogenesis of acute renal failure. Local anesthetics induce apoptosis in neuronal and lymphocytic cell lines. We examined the effects of chronic (48 h) local anesthetic treatment (lidocaine, bupivacaine and tetracaine) on human proximal tubular (HK-2) cells. Apoptosis induction was assessed by detecting poly(ADP)-ribose polymerase fragmentation, caspase activation, terminal deoxynucleotidyl transferase biotin-dUTP nick end

H. Thomas Lee; Hua Xu; Cory D. Siegel; Igor E. Krichevsky

2003-01-01

173

Anesthetics, immune cells, and immune responses  

Microsoft Academic Search

General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the\\u000a immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress\\u000a such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated\\u000a with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on

Shin Kurosawa; Masato Kato

2008-01-01

174

Percutaneous endoscopic gastrostomy: Indications, technique, complications and management  

PubMed Central

Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system. PMID:24976711

Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T

2014-01-01

175

"Yes and...": Introducing Improvisational Theatre Techniques to the Management Classroom.  

ERIC Educational Resources Information Center

Describes two improvisation exercises that use organizational contexts to reinforce management theory and build management skills. Outlines rules for improv, including active listening and "yes, and" (never denying information). (SK)

Moshavi, Dan

2001-01-01

176

This module aims to provide students with an understanding of the underlying principles of Software Project Management, and of established techniques for the management of software projects. By introducing students to key concepts and techniques  

E-print Network

Project Management, and of established techniques for the management of software projects. By introducing to the principled management of software projects, both tactically and at the more strategic level of measurement, estimation, experimentation and data analysis Project management: planning; scheduling

Oxford, University of

177

An Interactive Context-aware Power Management Technique for Optimizing Sensor Network Lifetime  

E-print Network

Wisconsin, USA measuring several key limnological variables. coral reef ecologists [18], [19] showsAn Interactive Context-aware Power Management Technique for Optimizing Sensor Network Lifetime management technique that adapts sampling rate as a function of both application-level context (e.g., user

Simunic, Tajana

178

The selection of risk management techniques using case-based reasoning  

Microsoft Academic Search

Risk needs to be managed at every stage of a construction project and by all organisations involved. Although there is a wide range of techniques available, numerous studies have shown that practitioners rely only on a few techniques. The research presented in this paper has developed a framework for breaking down risk management problems. Assessing 179 examples in the literature

Doug R. Forbes; Simon D. Smith; R. Malcolm W. Horner

2010-01-01

179

Study on the metadata management system technique structure driven by requirements in geosciences data clearinghouse  

Microsoft Academic Search

Metadata and its relative techniques have been widely used in distributed data resources management and sharing. According to the requirements of geosciences data sharing, traditional metadata management models driven by techniques are not suitable to geosciences clearinghouse thoroughly. Geosciences data supermarket idea is proposed referring to the supermarket's services features (e.g., open, quick, considerate, etc.). As the most important infrastructure

Juanle Wang; Shuang Li; Yunqiang Zhu

2005-01-01

180

[Intravenous regional anesthesia with long-acting local anesthetics. An update].  

PubMed

Intravenous regional anesthesia is a widely used technique for brief surgical interventions, primarily on the upper limbs and less frequently, on the lower limbs. It began being used at the beginning of the 20th century, when Bier injected procaine as a local anesthetic. The technique to accomplish anesthesia has not changed much since then, although different drugs, particularly long-acting local anesthetics, such as ropivacaine and levobupivacaine in low concentrations, were introduced. Additionally, drugs like opioids, muscle relaxants, paracetamol, neostigmine, magnesium, ketamine, clonidine, and ketorolac, have all been investigated as adjuncts to intravenous regional anesthesia, and were found to be fairly useful in terms of an increased onset of operative anesthesia and longer lasting perioperative analgesia. The present article provides an overview of current knowledge with emphasis on long-acting local anesthetic drugs. PMID:24156887

Atanassoff, P G; Lobato, A; Aguilar, J L

2014-02-01

181

[Dose limits for local anesthetics. Recommendations based on toxicologic and pharmacokinetic data].  

PubMed

Since Heinrich Braun added adrenaline to cocaine (and later also to procaine) in 1903 to allow clinical use of this local anesthetic, "limiting dosages" for local anesthetics have been "recommended" with no reference to the technique of administration, on the assumption that adrenaline will lower the toxicity of the local anesthetic used. However, the limiting dosages determined up to now do not take account of important pharmacokinetic and toxicological data: (1) The dependence of blood levels measured on the technique of regional anesthesia and (2) the raised toxicity of a local anesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation that differs according to the technique of local anesthesia is suggested for (A) subcutaneous injection, (B) injection in regions of high absorption, (C) single injection (perineural, e.g. plexus), (D) protracted injection (catheter, combined techniques), (E) injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic). This sequential categorization also underscores the need for selection of appropriate techniques as well as for concomitant monitoring referred to the technique of administration and to the expected and the possible plasma level curve.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1822598

Niesel, H C; Kaiser, H

1991-08-01

182

Knowledge Management for Distributed Agile Processes: Models, Techniques, and Infrastructure  

Microsoft Academic Search

This report summarizes presentations and discussions of the IEEE WETICE 2003 Workshop on Knowledge Management for Distributed Agile Processes. The main goals of the workshop were to bring together practitioners and researchers from the areas of Knowledge Management and Agile Processes from different domains to discuss the current state of ongoing research efforts and to share practical experiences with adaptation

Harald Holz; Grigori Melnik; Martin Schaaf

2003-01-01

183

Contents and Techniques of Management Development Programs for Women  

ERIC Educational Resources Information Center

Male and female executives were examined in terms of managerial style, perceived training needs, major job functions, and behavioral characteristics in three pilot programs focusing on management training for women. Held at the University of Maine, Orono, the programs adapted existing management education materials to female roles and viewpoints.…

Aplander, Guvenc G.; Gutmann, Jean E.

1976-01-01

184

Long-acting local anesthetics in dentistry.  

PubMed Central

Long-acting local anesthetics have proved to be effective for the suppression of both intraoperative and postoperative pain. They are useful for lengthy dental treatments and for prevention of severe pain following many types of surgical procedures. Although the currently available long-acting local anesthetics for dentistry have minimal side effects in the doses usually employed, there are potential problems. Bupivacaine, for example, can cause significant cardiac depressant and dysrhythmogenic responses. Etidocaine has less pronounced effects on the cardiovascular system, but its use may be associated with inadequate control of intraoperative bleeding. A new long-acting local anesthetic, ropivacaine, appears to offer advantages over either of the currently used long-acting agents. PMID:1308373

Sisk, A. L.

1992-01-01

185

Knowledge about local anesthetics in odontology students.  

PubMed

The purpose of the study was to identify the level of knowledge of local anesthetics frequently used in the surgical clinic by third and fourth year dental students in daily practice. The importance of pharmacology in dental practice in underscored by potential drug toxicity. The study was performed with 244 third and fourth grade career dental students (CDS). Eleven items regarding the knowledge over local anesthetics at the clinic; i.e., the appropriate doses, possible toxic effects and side effects were examined. The reference questionnaire which is in a validation process, is a way to evaluate student knowledge about most drugs used in odontology practice such as: NSAIDs, antibiotics and local anesthetics. The results were found to be unsatisfactory with a high percentage of students failing (less than six of eleven items correct). We conclude that determination of practice knowledge is an essential step in informing the institution about cognitive deficiencies identified in order to plan learning solutions. PMID:22128439

Guzmán Alvarez, Rodrigo; Campos Sepúlveda, Alfonso Efraín; Martínez González, Adrian Alejandro

2009-01-01

186

Successful management of difficult airway in an adult patient of Goldenhar syndrome.  

PubMed

The present case emphasizes on the increasing difficulty in management of patients with Goldenhar syndrome as they age. Fiberoptic intubation using high dose dexmedetomidine along with local anesthetics is a safe technique for securing the airway in a difficult situation, even if the patient dose not cooperates for awake procedure. A16-year-old Goldenhar patient with multiple facial deformities was scheduled for correction of hollowness of right cheek and was successfully managed with high dose dexmedetomidine infusion along with local anesthetics to facilitate fiberoptic intubation with no untoward side-effects. PMID:25538532

Sahni, Neeru; Bhatia, Nidhi

2014-11-01

187

Successful management of difficult airway in an adult patient of Goldenhar syndrome  

PubMed Central

The present case emphasizes on the increasing difficulty in management of patients with Goldenhar syndrome as they age. Fiberoptic intubation using high dose dexmedetomidine along with local anesthetics is a safe technique for securing the airway in a difficult situation, even if the patient dose not cooperates for awake procedure. A16-year-old Goldenhar patient with multiple facial deformities was scheduled for correction of hollowness of right cheek and was successfully managed with high dose dexmedetomidine infusion along with local anesthetics to facilitate fiberoptic intubation with no untoward side-effects. PMID:25538532

Sahni, Neeru; Bhatia, Nidhi

2014-01-01

188

Effects of Volatile Aromatic Anesthetics on Voltage-Gated Na+ Channels Expressed in Xenopus Oocytes  

PubMed Central

Background Many inhaled anesthetics inhibit voltage-gated sodium channels at clinically relevant concentrations, and suppression of neurotransmitter release by these agents results, at least partly, from decreased presynaptic sodium channel activity. Volatile aromatic anesthetics can inhibit N-methyl-D-aspartate (NMDA) receptor function and enhance ?-amino butyric acid A (GABAA) receptor function, but these effects depend strongly on the chemical properties of the aromatic ompounds. The present study tested whether diverse aromatic anesthetics consistently inhibit sodium channel function. Methods We studied the effect of eight aromatic anesthetics on Nav1.2 sodium channels with ?1 subunits, using whole-cell, two-electrode voltage-clamp techniques in Xenopus oocytes. Results All aromatic anesthetics inhibited INa (sodium currents) at a holding potential which produce half-maximal current (V1/2) (partial depolarization); inhibition was modest with 1,3,5-trifluorobenzene (8 ± 2%), pentafluorobenzene (13 ± 2%), and hexafluorobenzene (13 ± 2%), but greater with benzene (37 ± 2%), fluorobenzene (39 ± 2%), 1,2-difluorobenzene (48 ± 2%), 1,4-difluorobenzene (31 ± 3%), and 1,2,4-trifluorobenzene (33 ± 1%). Such dichotomous effects were noted by others for NMDA and GABAA receptors. Parallel, but much smaller inhibition, was found for INa at a holding potential which produced near maximal current (?90 mV) (VH-90), and hexafluorobenzene caused small (6 ± 1%) potentiation of this current. These changes in sodium channel function were correlated with effectiveness for inhibiting NMDA receptors, with lipid solubility of the compounds, with molecular volume, and with cation-? interactions. Conclusion Aromatic compounds vary in their actions on the kinetics of sodium channel gating and this may underlie their variable inhibition. The range of inhibition produced by MAC concentrations of inhaled anesthetics indicates that sodium channel inhibition may underlie the action of some of these anesthetics but not others. PMID:18931215

Horishita, Takafumi; Eger, Edmond I; Harris, R. Adron

2008-01-01

189

Study of systems and techniques for data base management  

NASA Technical Reports Server (NTRS)

Data management areas were studied to identify pertinent problems and issues that will affect future NASA data users in terms of performance and cost. Specific topics discussed include the identifications of potential NASA data users other than those normally discussed, consideration affecting the clustering of minicomputers, low cost computer system for information retrieval and analysis, the testing of minicomputer based data base management systems, ongoing work related to the use of dedicated systems for data base management, and the problems of data interchange among a community of NASA data users.

1976-01-01

190

Anesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review.  

PubMed

Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. The reports on rhabdomyolysis secondary to anesthesia appear to be due to inadequate supply of carbohydrate not volatile agents. Catabolism must be avoided with minimal fasting, glucose infusions based on age and weight, and attenuation of emotional and physical stress. General anesthesia appears to be protective of stress-induced catabolism and may offer benefits in children and anxious patients over regional anesthesia. Propofol has not been demonstrated to be harmful in VLCADD but is presented in an emulsion containing very long-chain fatty acids which can cause organ lipidosis and itself can inhibit mitochondrial fatty acid metabolism. It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication. PMID:25069536

Redshaw, Charlotte; Stewart, Catherine

2014-11-01

191

Integrating RFID technique to design mobile handheld inventory management system  

NASA Astrophysics Data System (ADS)

An RFID-based mobile handheld inventory management system is proposed in this paper. Differing from the manual inventory management method, the proposed system works on the personal digital assistant (PDA) with an RFID reader. The system identifies electronic tags on the properties and checks the property information in the back-end database server through a ubiquitous wireless network. The system also provides a set of functions to manage the back-end inventory database and assigns different levels of access privilege according to various user categories. In the back-end database server, to prevent improper or illegal accesses, the server not only stores the inventory database and user privilege information, but also keeps track of the user activities in the server including the login and logout time and location, the records of database accessing, and every modification of the tables. Some experimental results are presented to verify the applicability of the integrated RFID-based mobile handheld inventory management system.

Huang, Yo-Ping; Yen, Wei; Chen, Shih-Chung

2008-04-01

192

Comparative techniques for nuclear fuel cycle waste management systems.  

SciTech Connect

A safety assessment approach for the evaluation of predisposal waste management systems is described and applied to selected facilities in the light water reactor (LWR) once-through fuel cycle and a potential coprocessed UO/sub 2/-PuO/sub 2/ fuel cycle. This approach includes a scoping analysis on pretreatment waste streams and a more detailed analysis on proposed waste management processes. The primary evaluation parameters used in this study include radiation exposures to the public from radionuclide releases from normal operations and potential accidents, occupational radiation exposure from normal operations, and capital and operating costs. On an overall basis, the waste management aspects of the two fuel cycles examined are quite similar. On an individual facility basis, the fuel coprocessing plant has the largest waste management impact.

Pelto, P.J.; Voss, J.W.

1979-09-01

193

Sonographically guided anesthetic injection of anterior scalene muscle for investigation of neurogenic thoracic outlet syndrome  

Microsoft Academic Search

Objective  To describe the technique and complications of sonographically guided anesthetic injection of the anterior scalene muscle\\u000a in patients being investigated for neurogenic thoracic outlet syndrome.\\u000a \\u000a \\u000a \\u000a Material and methods  Subjects were identified via a retrospective review of medical records. For the procedure a 25-gauge needle was introduced\\u000a into the anterior scalene muscle under real-time ultrasound guidance followed by injection of local anesthetic.

Martin Torriani; Rajiv Gupta; Dean M. Donahue

2009-01-01

194

Toolbox Safety Talk Waste Anesthetic Gas (WAG)  

E-print Network

room temperatures, and may dissipate before any attempts to clean up or collect the liquid into the surrounding room during medical or research procedures are considered waste anesthetic gas (WAG). These gases to WAG and Cornell EHS has an established WAG Program to monitor exposures and protect workers. · Cornell

Pawlowski, Wojtek

195

Applying total quality management techniques to improve software development.  

PubMed

Total Quality Management (TQM) is a new management philosophy and a set of guiding principles that represent the basis of a continuously improving organization. This paper sheds light on the application of TQM concepts for software development. A fieldwork study was conducted on a Lebanese software development firm and its customers to determine the major problems affecting the organization's operation and to assess the level of adoption of TQM concepts. Detailed questionnaires were prepared and handed out to the firm's managers, programmers, and customers. The results of the study indicate many deficiencies in applying TQM concepts, especially in the areas of planning, defining customer requirements, teamwork, relationship with suppliers, and adopting standards and performance measures. One of the major consequences of these deficiencies is considerably increased programming errors and delays in delivery. Recommendations on achieving quality are discussed. PMID:10589453

Mezher, T; Assem Abdul Malak, M; el-Medawar, H

1998-01-01

196

Anesthetic Requirement is Increased in Redheads  

PubMed Central

Background: Age and body temperature alter inhalational anesthetic requirement; however, no human genotype is associated with inhalational anesthetic requirement. There is an anecdotal impression that anesthetic requirement is increased in redheads. Furthermore, red hair results from distinct mutations of the melanocortin-1 receptor. We thus tested the hypothesis that the requirement for the volatile anesthetic desflurane is greater in natural redhead than in dark-haired women. Methods: We studied healthy women with bright red (n=10) or dark (n=10) hair. Blood was sampled for subsequent analyses of melanocortin-1 receptor alleles. Anesthesia was induced with sevoflurane and maintained with desflurane randomly set at an end-tidal concentration between 5.5 and 7.5%. After an equilibration period, a noxious electrical stimulation (100 Hz, 70 mA) was transmitted through bilateral intradermal needles. If the volunteer moved in response to stimulation, desflurane was increased by 0.5%; otherwise it was decreased by 0.5%. This was continued until volunteers “crossed-over” from movement to non-movement (or vice versa) four times. Individual logistic regression curves were used to determine desflurane requirement (P50). Desflurane requirements in the two groups were compared using Mann-Whitney nonparametric two-sample test; P < 0.05 was considered statistically significant. Results: The desflurane requirement in redheads (6.2 volume-percent [95% CI, 5.9 - 6.5]) was significantly greater than in dark-haired women (5.2 volume-percent [4.9 – 5.5], P = 0.0004). Nine of 10 redheads were either homozygous or compound heterozygotes for mutations on the melanocortin-1 receptor gene. Conclusions: Red hair appears to be a distinct phenotype linked to anesthetic requirement in humans that can also be traced to a specific genotype. PMID:15277908

Liem, Edwin B.; Lin, Chun–Ming; Suleman, Mohammad–Irfan; Doufas, Anthony G.; Gregg, Ronald G.; Veauthier, Jacqueline M.; Loyd, Gary

2005-01-01

197

Case Management and Rehabilitation Counseling: Procedures and Techniques. Fourth Edition  

ERIC Educational Resources Information Center

"Case Management and Rehabilitation Counseling" discusses procedures that are useful to rehabilitation professionals working in many settings. Specifically, this book reviews the finer points relating to diagnosing, arranging services, monitoring program outcomes, arranging for placement, planning for accommodations, ethical decision making,…

Roessler, Richard T.; Rubin, Stanford E.

2006-01-01

198

Behavior Management and Socialization Techniques for Severely Emotionally Disturbed Children.  

ERIC Educational Resources Information Center

Described is a structured approach to managing behavior and increasing socialization skills of severely disturbed children in primary and adolescent classrooms. It is noted that manual signing accompanied by verbalization, gesture, and physical assisting is used to communicate behavioral expectations in the primary class; while in the adolescent…

Newman, Rebecca

199

Techniques to Enhancing Sustainable Nutrient and Irrigation Management for Potatoes  

Technology Transfer Automated Retrieval System (TEKTRAN)

Two aspects of nutrient and irrigation best management practices (BMP) in relation to sustainable agricultural production systems described in this paper are: (i) application of crop simulation model for decision support system; and (ii) real-time, automated measurement of soil water content to aid ...

200

Laparoscopic management of interstitial pregnancy: the "purse-string" technique.  

PubMed

We report five cases of interstitial pregnancy, treated between 2004 and 2010, to evaluate surgical and obstetric outcome of laparoscopic cornual resection with a "purse-string" technique. A hemostatic suture was passed at the base of the mass in a purse-string fashion prior to resection, to minimize intraoperative blood loss. Subsequent pregnancies were analysed, with a mean follow-up time of 48 months. The mean operating time was 39 min and mean blood loss 47 mL. Three of four patients who desired children delivered at term uneventfully. Laparoscopic cornual resection with a "purse-string" technique appears to be useful for treatment of early interstitial pregnancy. The technique ensures effective and safe treatment, with satisfactory obstetric outcome. PMID:22548702

Cucinella, Gaspare; Rotolo, Stefano; Calagna, Gloria; Granese, Roberta; Agrusa, Antonino; Perino, Antonio

2012-08-01

201

Using supply chain management techniques to make wind plant and energy storage operation more profitable  

E-print Network

Our research demonstrates that supply chain management techniques can improve the incremental gross profits of wind plant and storage operations by up to five times. Using Monte-Carlo simulation we create and test scenarios ...

Saran, Prashant

2009-01-01

202

Proceedings of the National Conference on Energy Resource Management. Volume 1: Techniques, Procedures and Data Bases  

NASA Technical Reports Server (NTRS)

Topics dealing with the integration of remotely sensed data with geographic information system for application in energy resources management are discussed. Associated remote sensing and image analysis techniques are also addressed.

Brumfield, J. O. (editor); Schiffman, Y. M. (editor)

1982-01-01

203

Risk Management Technique for design and operation of facilities and equipment  

NASA Technical Reports Server (NTRS)

The Risk Management System collects information from engineering, operating, and management personnel to identify potentially hazardous conditions. This information is used in risk analysis, problem resolution, and contingency planning. The resulting hazard accountability system enables management to monitor all identified hazards. Data from this system are examined in project reviews so that management can decide to eliminate or accept these risks. This technique is particularly effective in improving the management of risks in large, complex, high-energy facilities. These improvements are needed for increased cooperation among industry, regulatory agencies, and the public.

Fedor, O. H.; Parsons, W. N.; Coutinho, J. De S.

1975-01-01

204

Charles bonnet syndrome, management with simple behavioral technique  

PubMed Central

Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus. PMID:23546356

Issa, Baba Awoye; Yussuf, Abdullahi Dasliva

2013-01-01

205

Management of bi-canalicular block: A novel technique.  

PubMed

Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. Conjunctivodacryocystorhinostomy with Lester's Jones tube is considered as the standard treatment in such cases. Alternatively, these patients can be managed by retrograde intubation dacryocystorhinostomy with medial canthoplasty. We herein describe the modification of retrograde bicanalicular intubation, combined with medial canthoplasty (monopedicle flap) which gives good cosmetic results. PMID:23960322

Meena, Manju; Naik, Milind; Honavar, Santosh G

2013-01-01

206

Management of bi-canalicular block: A novel technique  

PubMed Central

Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. Conjunctivodacryocystorhinostomy with Lester's Jones tube is considered as the standard treatment in such cases. Alternatively, these patients can be managed by retrograde intubation dacryocystorhinostomy with medial canthoplasty. We herein describe the modification of retrograde bicanalicular intubation, combined with medial canthoplasty (monopedicle flap) which gives good cosmetic results. PMID:23960322

Meena, Manju; Naik, Milind; Honavar, Santosh G.

2013-01-01

207

A GUIDE TO AERATION/CIRCULATION TECHNIQUES FOR LAKE MANAGEMENT  

EPA Science Inventory

The application of aeration/circulation techniques to lakes are reviewed from a theoretical and practical viewpoint. The effect of destratification on algal production is related to the mixed depth with the use of a mathematical model. Procedures are given to determine air requir...

208

Mobility management techniques for the next-generation wireless networks  

Microsoft Academic Search

The tremendous demands from social market are pushing the booming development of mobile communications faster than ever before, leading to plenty of new advanced techniques emerging. With the converging of mobile and wireless communications with Internet services, the boundary between mobile personal telecommunications and wireless computer networks is disappearing. Wireless networks of the next generation need the support of all

Junzhao Sun; Douglas P. Howie; Jaakko J. Sauvola

2001-01-01

209

Management of hypospadias cripples with two-staged Bracka's technique.  

PubMed

Patients labelled as 'hypospadias cripples' pose a challenge to reconstructive surgeons because of the complexity of the problem and limited options for reconstruction. The two-staged Bracka method is a versatile technique that is relatively easy to learn and applicable in difficult cases of salvage hypospadias. Over a period of 8 years, we applied this technique to 100 patients with hypospadias cripples who had previously undergone multiple (3-16) procedures. In the first stage, a full-thickness graft of skin or buccal mucosa was used for urethral plate reconstruction after release of chordee. Stage II was carried out at least 6 months after the first procedure. Meatal opening at the tip of the glans was achieved in 94 patients, straightening of the penis in 96 and proper urinary stream in 92 patients. Fistula formation occurred in nine patients. In our opinion, the two-staged Bracka technique is a useful strategy to deal with the myriad abnormalities encountered in crippled hypospadias. This technique not only creates a neourethra successfully, but also gives the penis a near-normal shape and appearance. PMID:20359973

Gill, Nauman Ahmad; Hameed, Abdul

2011-01-01

210

Vascular tracers alter hemodynamics and airway pressure in anesthetized sheep  

SciTech Connect

The technique of vascular labeling was developed to mark sites of increased microvascular permeability. We used the vascular labeling technique in anesthetized sheep and found that hemodynamics and airway pressure were adversely affected by intraarterial infusions of two vascular tracers. Monastral blue (nine sheep) immediately caused systemic arterial hypotension, pulmonary arterial hypertension, and bronchoconstriction. All three physiological responses were partially blocked by a cyclooxygenase inhibitor (indomethacin) but not by an H1-antihistamine (chlorpheniramine). Colloidal gold (nine sheep) caused immediate, but less dramatic, pulmonary arterial hypertension which was not attenuated by the blocking agents. We conclude that these two vascular tracers caused detrimental physiological side effects in sheep at the usual doses used to label injured microvessels in other species.

Albertine, K.H.; Staub, N.C.

1986-11-01

211

Use of the critical chain project management technique at NASA, Langley Research Center  

Microsoft Academic Search

Although the term critical chain project management is relatively new, it is an evolutionary project management technique and not a revolutionary one. A CCPM schedule continues to rely upon the establishment of a PERT network, the assignment of duration and resources - people, equipment or funds - to each task in that network, as well as the creation of project

A. G. Hagemann

2001-01-01

212

The Impact of Teachers' Aggressive Management Techniques on Students' Attitudes to Schoolwork  

ERIC Educational Resources Information Center

Previous studies have shown that teachers' aggressive classroom management impacts negatively on students. The authors compared student reaction to teachers' use of aggressive management techniques in Australia, China, and Israel. Reactions included distraction negativity toward teachers and perceptions that teachers' responses were unjustified,…

Romi, Shlomo; Lewis, Ramon; Roache, Joel; Riley, Philip

2011-01-01

213

Techniques and results in the management of multiple ventricular septal defects  

Microsoft Academic Search

Objective: The management of patients with multiple ventricular septal defects remains controversial. Primary closure, interventional catheter techniques, and palliative surgery all may have a role, and specific management guidelines remain undefined. Methods: We reviewed the records of all 33 patients with multiple ventricular septal defects undergoing repair between January 1988 and October 1996. Pulmonary artery hypertension was present in 21

Tetsuya Kitagawa; Lucian A. Durham; Ralph S. Mosca; Edward L. Bove

1998-01-01

214

Retrograde submucosal tunneling technique for management of complete esophageal obstruction.  

PubMed

Complete esophageal obstruction is a challenging problem that is not amendable to standard dilation techniques. Multiple endoscopic techniques as well as radical surgical procedures have been developed with the goal of restoring a patent esophageal lumen. In patients with complete esophageal obstruction, an antegrade-retrograde technique has been described, but this generally depends on the ability to transilluminate across the stricture. Successful transillumination allows for safe direct puncture across the stricture, followed by dilation. In long-segment strictures (greater than 2-3 cm), transillumination may not be possible. We report a case of a 63 year-old woman who developed a complete esophageal obstruction from radiation therapy (RT) for hypopharyngeal squamous cell carcinoma. She did have enteral access via a percutaneous endoscopic gastrostomy (PEG) tube which had been placed prior to beginning RT. A combined antegrade (through the mouth) and retrograde (through PEG site) approach was done, but transillumination across the stricture failed. Fluoroscopy demonstrated a 4 cm long stricture. The creation of a submucosal tunnel from the retrograde direction decreased the stricture length to 15 mm and transillumination was achieved. This allowed safe puncture of the stricture, placement of a guidewire, then successful dilation. The patient can now tolerate soft foods and maintain her weight. Submucosal tunneling can be used to achieve transillumination for the combined antegrade-retrograde approach to complete esophageal obstruction. PMID:22874710

Babich, Jay P; Diehl, David L; Entrup, Michael H

2012-08-01

215

Lean Manufacturing – An Advanced Manufacturing Technique in Modern Operations Management  

E-print Network

With ever shrinkage time to market, companies are constantly seeking new ways of producing customized parts cost efficiently. Could this be done without restoring to the traditional manufacturing process? This is the age of new manufacturing. With accelerating technological changes as increasing competition at both local and global market place, only those companies, which are both flexible and agile, will survive in the future. The dawn of new century begins with it, new rules of competitions, and concepts such as supply chain management, flexible manufacturing and lean organizations have become preconditions for companies that seek to compete in the long term.

Dr. Debasish Basak; Md. Tarique Haider; Abhinav Kumar Shrivastava

216

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems  

SciTech Connect

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Nijs, Els L. F., E-mail: nijs@email.chop.ed [University of Pennsylvania, Department of Clinical Radiology, Children's Hospital of Philadelphia (United States); Cahill, Anne Marie, E-mail: cahill@email.chop.ed [University of Pennsylvania, Department of Radiology, Children's Hospital of Philadelphia (United States)

2010-12-15

217

Novel surgical technique for the management of partial cryptophthalmos  

PubMed Central

We report a case of a 2-month-old baby with bilateral nonsyndromic partial cryptophthalmos presenting with upper eyelid incomplete development and fusion to the cornea with resultant inability to close the eyes. He was managed successfully with bilateral upper lid reconstruction with composite graft using maternal skin and oral mucous membrane, amniotic membrane, and donor scleral graft. After this one stage surgery, lids were well-formed, and the patient was able to close both eyes, thus achieving good anatomical, functional, and cosmetic outcome. PMID:25494255

Murthy, Ramesh; Gupta, Himika

2014-01-01

218

Optimising Asset Management Decision Making and Budgeting Using Risk Management Techniques  

Microsoft Academic Search

The management, maintenance and operation of major infrastructure assets involves long (whole-of-life), complex processes\\u000a in which there is always a considerable uncertainty for the manager of those assets. The level of uncertainty of asset performance,\\u000a cost of operation and market competitiveness depends on risk management measures that are put in place (whether or not they\\u000a are recognised as risk management

Adam Aspinall; Peter Trueman

219

Substation based data interpretation techniques for improved power system management  

SciTech Connect

There is now considerable pressure on electric utilities to operate their systems in the most efficient manner possible and to provide increased quality of service to customers. This pressure, coupled with the decreasing availability of reserve margins dictates that there is a requirement for comprehensive system operation support through, among other things, the provision of quality information relating to the behavior of the primary and secondary systems. This paper will show how the data available within modern substation control and management systems can be exploited in a cost-effective manner, through the implementation of advanced substation functions in an open systems environment. Certain functions which are presently carried out at the control center could be distributed (or partially distributed) to the substation. These functions may provide the utility staff with quality information, which can in turn be used to satisfy the objectives of increasing quality and security of supply, in addition to optimizing the utility`s information, maintenance and asset management functions.

Booth, C.; McDonald, J.R. [Univ. of Strathclyde, Glasgow (United Kingdom). Centre for Electrical Power Engineering] [Univ. of Strathclyde, Glasgow (United Kingdom). Centre for Electrical Power Engineering; Laycock, W.J.

1997-04-01

220

Achieving Management Skills. Project TEAMS. (Techniques and Education for Achieving Management Skills).  

ERIC Educational Resources Information Center

Prepared as part of Platte Technical Community College's project to help managers and supervisors develop practical, up-to-date managerial skills in a relatively short time, this instructional workbook provides information and exercises applicable to on-the-job situations. Unit I focuses on time management, the causes and management of stress, and…

Platte Technical Community Coll., Columbus, NE.

221

Anesthetic gases and occupationally exposed workers.  

PubMed

The aim of this study is to estimate whether the occupational exposure to low dose anesthetic gases could cause alterations of blood parameters in health care workers. 119 exposed subjects and 184 not exposed controls were included in the study. Each worker underwent the complete blood count test (CBC), proteinaemia, leukocyte count, serum lipids, liver and kidney blood markers. The liver blood markers show statistically significant differences in health care workers compared with controls (p<0.05), a statistically significant decrease in neutrophils and an increase of lymphocytes in health care workers compared with controls (p<0.05). The prevalence of values outside the range for GPT, GGT, total bilirubin, lymphocytes and neutrophils was statistically significant in health care workers compared with controls (p<0.05). The results suggest that occupational exposure to low dose anesthetic gases could influence some haematochemical hepatic and hematopoietic parameters in exposed health care workers. PMID:24374387

Casale, Teodorico; Caciari, Tiziana; Rosati, Maria Valeria; Gioffrè, Pier Agostino; Schifano, Maria Pia; Capozzella, Assunta; Pimpinella, Benedetta; Tomei, Gianfranco; Tomei, Francesco

2014-01-01

222

Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications.  

PubMed

Hypoxic pulmonary vasoconstriction (HPV) represents a fundamental difference between the pulmonary and systemic circulations. HPV is active in utero, reducing pulmonary blood flow, and in adults helps to match regional ventilation and perfusion although it has little effect in healthy lungs. Many factors affect HPV including pH or PCO2, cardiac output, and several drugs, including antihypertensives. In patients with lung pathology and any patient having one-lung ventilation, HPV contributes to maintaining oxygenation, so anesthesiologists should be aware of the effects of anesthesia on this protective reflex. Intravenous anesthetic drugs have little effect on HPV, but it is attenuated by inhaled anesthetics, although less so with newer agents. The reflex is biphasic, and once the second phase becomes active after about an hour of hypoxia, this pulmonary vasoconstriction takes hours to reverse when normoxia returns. This has significant clinical implications for repeated periods of one-lung ventilation. PMID:25587641

Lumb, Andrew B; Slinger, Peter

2015-04-01

223

Statistical and Economic Techniques for Site-specific Nematode Management  

PubMed Central

Recent advances in precision agriculture technologies and spatial statistics allow realistic, site-specific estimation of nematode damage to field crops and provide a platform for the site-specific delivery of nematicides within individual fields. This paper reviews the spatial statistical techniques that model correlations among neighboring observations and develop a spatial economic analysis to determine the potential of site-specific nematicide application. The spatial econometric methodology applied in the context of site-specific crop yield response contributes to closing the gap between data analysis and realistic site-specific nematicide recommendations and helps to provide a practical method of site-specifically controlling nematodes. PMID:24643451

Liu, Zheng; Griffin, Terry; Kirkpatrick, Terrence L.

2014-01-01

224

Statistical and Economic Techniques for Site-specific Nematode Management.  

PubMed

Recent advances in precision agriculture technologies and spatial statistics allow realistic, site-specific estimation of nematode damage to field crops and provide a platform for the site-specific delivery of nematicides within individual fields. This paper reviews the spatial statistical techniques that model correlations among neighboring observations and develop a spatial economic analysis to determine the potential of site-specific nematicide application. The spatial econometric methodology applied in the context of site-specific crop yield response contributes to closing the gap between data analysis and realistic site-specific nematicide recommendations and helps to provide a practical method of site-specifically controlling nematodes. PMID:24643451

Liu, Zheng; Griffin, Terry; Kirkpatrick, Terrence L

2014-03-01

225

Local Toxicity from Local Anesthetic Polymeric Microparticles  

PubMed Central

Background Local tissue injury from sustained release formulations for local anesthetics can be severe. There is considerable variability in reporting of that injury. We investigated the influence of the intrinsic myotoxicity of the encapsulated local anesthetic (lidocaine, low; bupivacaine, high) on tissue reaction in rats. Methods Cytotoxicity from a range of lidocaine and bupivacaine concentrations was measured in C2C12 myotubes over 6 days. Rats were given sciatic nerve blocks with 4 microparticulate formulations of lidocaine and bupivacaine: 10% (w/w) lidocaine poly-lactic-co-glycolic acid (PLGA), 10% (w/w) bupivacaine PLGA, 50% (w/w) lidocaine PLGA, and 50% (w/w) bupivacaine PLGA. Effectiveness of nerve blockade was assessed by a modified hotplate test and weight-bearing measurements. Myotoxicity was scored in histologic sections of injection sites. Bupivacaine and lidocaine release kinetics from the particles were measured. Results Median sensory blockade duration for 50% (w/w) lidocaine was 255 (90–540) min versus 840 (277–1215) min for 50% (w/w) bupivacaine (P=0.056). All microparticulate formulations resulted in myotoxicity. The choice of local anesthetic did not influence the severity of myotoxicity. Median myotoxicity scores for 50% (w/w) lidocaine compared to 50% (w/w) bupivacaine at 4 days was 3.4 (2.1–4.2) vs. 3.3 (2.9–3.5)(P=0.44) and at 14 days 1.9 (1.8–2.4) versus 1.7 (1.3–1.9)(P=0.23) respictively. Conclusions Lidocaine and bupivacaine PLGA microspheres resulted in similar degrees of myotoxicity, irrespective of drug loading. Intrinsic myotoxicity did not predict tissue injury from sustained release of these anesthetics. Caution is warranted in the use of such devices near muscle and nerve. PMID:23460564

McAlvin, J. Brian; Reznor, Gally; Shankarappa, Sahadev A.; Stefanescu, Cristina F.; Kohane, Daniel S.

2013-01-01

226

Concussion-Assessment and -Management Techniques Used by Athletic Trainers  

PubMed Central

Context: Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients. Objective: To assess current clinical concussion diagnostic and return-to-participation practices among ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A link to the survey was sent randomly to a convenience sample of 3222 members of the National Athletic Trainers' Association. A total of 1053 (32.7%) certified ATs (experience as an AT = 11.2 ± 9.1 years) responded to the survey. Intervention(s): Prospective participants received electronic correspondence informing them of the purpose of the study and providing a link to the Web-based survey instrument. A reminder e-mail was sent approximately 6 weeks later, and the survey remained online for a total of 8 weeks. Main Outcome Measure(s): We collected information on the annual number of concussions assessed and tools employed to diagnose, manage, and safely return an athlete to participation. Descriptive statistics were computed for each variable. Results: Participants reported observing 10.7 ± 11.0 concussions per year. Clinical examination (n = 743, 70.6%) was the most commonly reported means for evaluating and diagnosing concussion. Less than half of our respondents employed the Standardized Assessment of Concussion (n = 467, 44.3%), any variation of the Romberg test (n = 461, 43.8%), and computerized neuropsychological testing (n = 459, 43.6%). Clinical examination (n = 773, 73.4%), return-to-participation guidelines (n = 713, 67.7%), physician recommendation (n = 660, 62.7%), or player self-report (n = 447, 42.5%) contributed to the return-to-participation decisions of ATs. Only 20.8% (n = 219) of ATs reported using all 3 recommended domains of the concussion battery. Conclusions: Our study demonstrated a growth in the number of ATs incorporating objective clinical measures of concussion as a part of their concussion management. Conversely, fewer ATs reported using a standard clinical examination in their concussion assessment. These findings suggest ATs must continue to increase their use of both objective concussion assessment tools and the standard clinical examination. PMID:24143906

Lynall, Robert C.; Laudner, Kevin G.; Mihalik, Jason P.; Stanek, Justin M.

2013-01-01

227

Informing Parents about the Pharmacological and Invasive Behavior Management Techniques Used in Pediatric Dentistry  

PubMed Central

Background and aims. Parental acceptance and consent are important parameters in selecting the required behavior management technique during pediatric dental treatment. The present study sought to assess the effect of three different informing methods on the parental acceptance, consent and concern regarding the pharmacological and invasive behavior management techniques used in pediatric dentistry. Materials and methods. Ninety mothers of 3-6-year-old uncooperative children were selected and randomly assigned to three study groups. The parents in each group were initially asked to answer three questions related to their levels of ‘acceptance’,‘consent’, and ‘concern’ toward the five behavior management techniques. Then, the information about the techniques was presented through a piece of writing in group I, verbal presentation in group II and showing a film in group III. At last, the parents answered the same three questions again. Score changes were analyzed by using ANOVA, correlations, Mann-Whitney U and Kruskal-Wallis methods. Results. There were no statistically significant differences in score changes of parental acceptance, consent and concern between the three groups, overall and in relation to each behaviour management technique (P > 0.05). Mothers with aca-demic education revealed more statistically significant concern following presentation of information by film (P < 0.05). Conclusion. None of the presentation methods had a significant preference over the others; in selecting the behavioral management techniques, it is advisable to observe individual factors, such as the level of education of the mothers. PMID:25093053

Paryab, Mehrysa; Afshar, Hossein; Mohammadi, Razie

2014-01-01

228

Arthroscopic management of tibial plateau fractures: surgical technique.  

PubMed

Tibial plateau fractures are serious articular fractures that are challenging to treat. Arthroscopy-assisted percutaneous fixation is the treatment of choice in Schatzker types 1, 2, 3, and 4 fractures, as it ensures optimal reduction and stable fixation consistent with early mobilisation. The most reliable fixation method seems to be percutaneous cannulated screw fixation, which is less invasive than open plate fixation. In complex proximal tibial fractures, arthroscopy may allow an evaluation of articular fracture reduction, thereby obviating the need for extensive arthrotomy. Complementary stable fixation is crucial and should allow early mobilisation to reap the benefits of the arthroscopic assistance. This article aims to review the technical points that are useful to the successful video-assisted management of tibial plateau fractures. PMID:23347755

Burdin, G

2013-02-01

229

Applying nondestructive remote sensing techniques to hazardous waste management  

SciTech Connect

The ever-increasing concern of property owners, potential property owners, real estate lawyers, and all others associated with the selling and purchasing of such properties, has led to an overwhelming demand for accurate, efficient, and economical site assessment programs. The overriding concern for the majority of these individuals is the possibility of underground storage tanks (UST's), waste deposits, and/or contaminated subsurface soils that may be located at the site. Depending on the nature of the purchase, the location or confirmation of buried waste will be a deciding factor in the decision to purchase toe proposed property. Due to the overwhelming cost of remediation of contaminated sites, and these costs being the sole responsibility of the property owner, it is imperative that the existence and amount of any subsurface contaminants be known prior to the purchase of the property. The recent introduction of two testing techniques has led to a viable solution for dependable, cost effective location and characterization of underground waste deposits. This testing procedure uses infrared thermography as a primary testing method and ground penetrating radar as a secondary investigation technique. Both technologies have been proven effective in numerous nondestructive testing (NDT) applications for many years. However, few companies have fused these technologies to incorporate data results and the testing advantages of each technology for locating and characterizing subsurface waste sites. This method of data fusion has proven to be accurate and cost-effective for gaining detailed information pertaining to subsurface conditions of both large and small sites.

Weil, G.J.; Graf, R.J. (EnTech Engineering, Inc., St. Louis, MO (United States))

1994-12-01

230

Modification of local anesthetic toxicity by vasoconstrictors.  

PubMed Central

We studied the effects of epinephrine or levonordefrin on the toxicity (convulsions) and lethality of four local anesthetics in mice. Appropriate doses of procaine, lidocaine, tetracaine or bupivacaine--either alone or in combination with 15 mcg/kg epinephrine or levonordefrin--were injected intravenously into the tail vein of male mice. Dose-response curves were constructed from the data obtained, and the CD50 and LD50 values for each local anesthetic alone and in combination with each of the vasoconstrictors were calculated by probit analysis. Both epinephrine and levonordefrin decreased the toxicity and lethality of procaine with respect to dose. Epinephrine, but not levonordefrin, increased the toxicity and lethality of bupivacaine as well as the lethality of tetracaine. Neither vasoconstrictor significantly affected the toxicity of lidocaine in mice but in rats epinephrine markedly increased lidocaine's lethality under identical conditions. Tight physical restraint decreased the LD50 values of all four local anesthetics and eliminated any modifying effect of the vasoconstrictor. PMID:2700426

Taylor, S. E.; Dorris, R. L.

1989-01-01

231

Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia.  

PubMed

Peripheral nerve catheters (PNCs) and local infiltration analgesia (LIA) represent valuable options for controlling perioperative pain. PNCs have been increasingly utilized to provide both surgical anesthesia and prolonged postoperative analgesia for a wide variety of procedures. PNCs can be more technically challenging to place than typical single-injection nerve blocks (SINB), and familiarity with the indications, contraindications, relevant anatomy, and appropriate technical skills is a prerequisite for the placement of any PNC. PNCs include risks of peripheral nerve injury, damage to adjacent anatomic structures, local anesthetic toxicity, intravascular injection, risks associated with motor block, risks of unnoticed injury to the insensate limb, and risks of sedation associated with PNC placement. In addition to these common risks, there are specific risks unique to each PNC insertion site. LIA strategies have emerged that seek to provide the benefit of targeted local anesthesia while minimizing collateral motor block and increasing the applicability of durable local anesthesia beyond the extremities. LIA involves the injection and/or infusion of a local anesthetic near the site of surgical incision to provide targeted analgesia. A wide variety of techniques have been described, including single-injection intraoperative wound infiltration, indwelling wound infusion catheters, and the recent high-volume LIA technique associated with joint replacement surgery. The efficacy of these techniques varies depending on specific procedures and anatomic locations. The recent incorporation of ultra-long-acting liposomal bupivacaine preparations has the potential to dramatically increase the utility of single-injection LIA. LIA represents a promising yet under-investigated method of postoperative pain control. PMID:24815966

Merritt, Christopher K; Mariano, Edward R; Kaye, Alan David; Lissauer, Jonathan; Mancuso, Kenneth; Prabhakar, Amit; Urman, Richard D

2014-03-01

232

Anesthetic Considerations in Robotic-Assisted Gynecologic Surgery  

PubMed Central

Background Robotic-assisted surgery has evolved over the past 2 decades with constantly improving technology that assists surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and lack of direct access to the patient all present management challenges in gynecologic surgery. Patient positioning requirements can have significant physiologic effects and can result in many complications. Methods This review focuses on the anesthetic and surgical implications of robot-assisted technology in gynecologic surgery. Conclusion Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce complications. PMID:24358000

Kaye, Alan D.; Vadivelu, Nalini; Ahuja, Nitin; Mitra, Sukanya; Silasi, Dan; Urman, Richard D.

2013-01-01

233

Investment, regulation, and uncertainty: managing new plant breeding techniques.  

PubMed

As with any technological innovation, time refines the technology, improving upon the original version of the innovative product. The initial GM crops had single traits for either herbicide tolerance or insect resistance. Current varieties have both of these traits stacked together and in many cases other abiotic and biotic traits have also been stacked. This innovation requires investment. While this is relatively straight forward, certain conditions need to exist such that investments can be facilitated. The principle requirement for investment is that regulatory frameworks render consistent and timely decisions. If the certainty of regulatory outcomes weakens, the potential for changes in investment patterns increases.   This article provides a summary background to the leading plant breeding technologies that are either currently being used to develop new crop varieties or are in the pipeline to be applied to plant breeding within the next few years. Challenges for existing regulatory systems are highlighted. Utilizing an option value approach from investment literature, an assessment of uncertainty regarding the regulatory approval for these varying techniques is undertaken. This research highlights which technology development options have the greatest degree of uncertainty and hence, which ones might be expected to see an investment decline. PMID:24499745

Smyth, Stuart J; McDonald, Jillian; Falck-Zepeda, Jose

2014-01-01

234

New adjustable suture technique for managing eyelid ptosis.  

PubMed

The challenge of accurately predicting eyelid height after levator surgery for ptosis is a well-known problem even in competent hands. It is always better to correct an unfavorable postoperative result without surgical intervention, and thus spare the patient another involved procedure. The author describes a new adjustable suture technique that ensures a secure connection between the levator muscle and the tarsus, and allows easy postoperative adjustment of lid height. The suture design consists of an inner and an outer loop in a configuration that resembles a paper clip. When the suture is tightened, the inner loop approximates the distal part of the levator muscle to the tarsal plate, bringing the tissues into secure contact. When tightened further, the outer loop is activated and it approximates the more proximal part of the levator muscle to the tarsus as much as desired to achieve the proper eyelid height. When the sutures are tightened, the levator muscle shortens by folding on itself like the pleats of an accordion. Using this method, muscle slack is reduced as the tissue is folded on itself several times. PMID:11756841

Borman, H

2001-12-01

235

Physiologic and anesthetic considerations in octogenarians undergoing laparoscopic partial nephrectomy.  

PubMed

The number of small renal tumors detected is increasing as imaging becomes both more available and advanced, and as the population ages, with a greater proportion of patients in their 80s emerging with small and treatable renal tumors. The technique of laparoscopic partial nephrectomy is emerging and becoming ever more popular in some centers, and is potentially a safer alternative for the elderly due to improved postoperative pain, shorter hospital stay with faster return to preoperative activities, and lower rates of morbidity and mortality. We present a systematic review of the physiologic and anesthetic considerations in octogenarians undergoing the procedure, highlighting special considerations and the need for expertise throughout the multidisciplinary team when dealing with these patients, in order to minimize risk and optimize outcome. PMID:23671402

Todd, Elizabeth; Vasdev, Nikhil; Soomro, Naeem A

2013-01-01

236

Anesthetic Diffusion Through Lipid Membranes Depends on the Protonation Rate  

PubMed Central

Hundreds of substances possess anesthetic action. However, despite decades of research and tests, a golden rule is required to reconcile the diverse hypothesis behind anesthesia. What makes an anesthetic to be local or general in the first place? The specific targets on proteins, the solubility in lipids, the diffusivity, potency, action time? Here we show that there could be a new player equally or even more important to disentangle the riddle: the protonation rate. Indeed, such rate modulates the diffusion speed of anesthetics into lipid membranes; low protonation rates enhance the diffusion for local anesthetics while high ones reduce it. We show also that there is a pH and membrane phase dependence on the local anesthetic diffusion across multiple lipid bilayers. Based on our findings we incorporate a new clue that may advance our understanding of the anesthetic phenomenon. PMID:25520016

Pérez-Isidoro, Rosendo; Sierra-Valdez, F. J.; Ruiz-Suárez, J. C.

2014-01-01

237

Macroscopic and macromolecular specificity of alkylphenol anesthetics for neuronal substrates.  

PubMed

We used a photoactive general anesthetic called meta-azi-propofol (AziPm) to test the selectivity and specificity of alkylphenol anesthetic binding in mammalian brain. Photolabeling of rat brain sections with [(3)H]AziPm revealed widespread but heterogeneous ligand distribution, with [(3)H]AziPm preferentially binding to synapse-dense areas compared to areas composed largely of cell bodies or myelin. With [(3)H]AziPm and propofol, we determined that alkylphenol general anesthetics bind selectively and specifically to multiple synaptic protein targets. In contrast, the alkylphenol anesthetics do not bind to specific sites on abundant phospholipids or cholesterol, although [(3)H]AziPm shows selectivity for photolabeling phosphatidylethanolamines. Together, our experiments suggest that alkylphenol anesthetic substrates are widespread in number and distribution, similar to those of volatile general anesthetics, and that multi-target mechanisms likely underlie their pharmacology. PMID:25853337

Weiser, Brian P; Hall, Michael A; Weinbren, Nathan L; Woll, Kellie A; Dailey, William P; Eckenhoff, Maryellen F; Eckenhoff, Roderic G

2015-01-01

238

Interaction of anesthetics with neurotransmitter release machinery proteins  

PubMed Central

General anesthetics produce anesthesia by depressing central nervous system activity. Activation of inhibitory GABAA receptors plays a central role in the action of many clinically relevant general anesthetics. Even so, there is growing evidence that anesthetics can act at a presynaptic locus to inhibit neurotransmitter release. Our own data identified the neurotransmitter release machinery as a target for anesthetic action. In the present study, we sought to examine the site of anesthetic action more closely. Exocytosis was stimulated by directly elevating the intracellular Ca2+ concentration at neurotransmitter release sites, thereby bypassing anesthetic effects on channels and receptors, allowing anesthetic effects on the neurotransmitter release machinery to be examined in isolation. Three different PC12 cell lines, which had the expression of different release machinery proteins stably suppressed by RNA interference, were used in these studies. Interestingly, there was still significant neurotransmitter release when these knockdown PC12 cells were stimulated. We have previously shown that etomidate, isoflurane, and propofol all inhibited the neurotransmitter release machinery in wild-type PC12 cells. In the present study, we show that knocking down synaptotagmin I completely prevented etomidate from inhibiting neurotransmitter release. Synaptotagmin I knockdown also diminished the inhibition produced by propofol and isoflurane, but the magnitude of the effect was not as large. Knockdown of SNAP-25 and SNAP-23 expression also changed the ability of these three anesthetics to inhibit neurotransmitter release. Our results suggest that general anesthetics inhibit the neurotransmitter release machinery by interacting with multiple SNARE and SNARE-associated proteins. PMID:23136341

McMillan, Kyle; Pike, Carolyn M.; Cahill, Anne L.; Herring, Bruce E.; Wang, Qiang; Fox, Aaron P.

2013-01-01

239

Accidental injection of sodium hypochlorite instead of local anesthetic in a patient scheduled for endodontic procedure  

PubMed Central

We present here a case of tissue destruction and paresthesia following the accidental injection of sodium hypochlorite instead of local anesthetic in a patient scheduled for endodontic procedure. The accident was managed by the local injection of steroid, debridement of necrotic tissue, daily dressings and medications. Wound healing was satisfactory at the end of 1 month. An extra-oral scar and a small area of paresthesia persisted even after 5 years.

Waknis, Pushkar Prakash; Deshpande, Aditya Sunil; Sabhlok, Samrat

2012-01-01

240

Current role of modern radiotherapy techniques in the management of breast cancer  

PubMed Central

Breast cancer is the most common type of malignancy in females. Advances in systemic therapies and radiotherapy (RT) provided long survival rates in breast cancer patients. RT has a major role in the management of breast cancer. During the past 15 years several developments took place in the field of imaging and irradiation techniques, intensity modulated RT, hypofractionation and partial-breast irradiation. Currently, improvements in the RT technology allow us a subsequent decrease in the treatment-related complications such as fibrosis and long-term cardiac toxicity while improving the loco-regional control rates and cosmetic results. Thus, it is crucial that modern radiotherapy techniques should be carried out with maximum care and efficiency. Several randomized trials provided evidence for the feasibility of modern radiotherapy techniques in the management of breast cancer. However, the role of modern radiotherapy techniques in the management of breast cancer will continue to be defined by the mature results of randomized trials. Current review will provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer. PMID:25114857

Ozyigit, Gokhan; Gultekin, Melis

2014-01-01

241

A hollow definitive obturator fabrication technique for management of partial maxillectomy  

PubMed Central

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis. PMID:23236579

Patil, Smita Pravinkumar

2012-01-01

242

Anesthetic considerations in Sheldon-Hall syndrome.  

PubMed

Arthrogryposis is characterized by multiple, nonprogressive joint contractures which may be caused by maternal disorders such as oligohydramnios as well as fetal akinesia resulting from primary disorders of muscle, connective tissue, or neurologic tissue. Its prevalence is about 1 : 3000. Distal arthrogryposis (DA) is a heterogenous group of genetic disorders with a characteristic flexion of the joints of the hands and feet divided into different types with additional features. Sheldon-Hall Syndrome (SHS), also known as distal arthrogryposis type 2A (DA2A), has some nonorthopedic features of specific importance to anesthetic care. PMID:24829975

Anderson, Thomas Anthony; Kasser, James R; Holzman, Robert S

2014-05-01

243

Mimosa pudica, Dionaea muscipula and anesthetics.  

PubMed

Some studies showed that anesthetics reduce the response of physical stimuli in Mimosa pudica and in Venus Flytrap (Dionaea muscipula), peculiar plants that have the ability to respond to touch stimuli. In this research we tested the effects of ketamine, lidocaine, diethyl ether, and amlodipine on the movements of Mimosa pudica and Venus Flytrap. With a literature review, we tried to bring elements to theorize about the interaction of these substances with these plants. The angular displacement in Mimosa´s petiole and in Dionaea leaves is what was measured to compare the drugs group with control groups. PMID:22899087

De Luccia, Thiago Paes de Barros

2012-09-01

244

Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain  

Microsoft Academic Search

Background: The evidence-based practice guidelines for the management of chronic spinal pain with interventional techniques were developed to provide recommendations to clinicians in the United States. Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidence-based approach, with broad representation of

Mark V. Boswell; Andrea M. Trescot; Sukdeb Datta; David M. Schultz; Hans C. Hansen; Salahadin Abdi; Nalini Sehgal; Rinoo V. Shah; Vijay Singh; Ramsin M. Benyamin; Vikram B. Patel; Ricardo M. Buenaventura; James D. Colson; Harold J. Cordner; Richard S. Epter; Joseph F. Jasper; Elmer E. Dunbar; Sairam L. Atluri; Richard C. Bowman; Timothy R. Deer; John Swicegood; Peter S. Staats; Howard S. Smith; Allen W. Burton; David S. Kloth; James Giordano; Laxmaiah Manchikanti

2007-01-01

245

Hypothermia attenuates NO production in anesthetized rats with endotoxemia.  

PubMed

Sepsis is often associated with upregulation of nitric oxide production and fever, and it is common to control an excessive febrile response with antipyretic therapy and external cooling. Our aim was to evaluate the effect of hypothermia on NO production in a model of septic shock. Rats were anesthetized, ventilated, and instrumented for hemodynamic monitoring and divided into four groups. Normothermic controls (NC) received saline intravenously and were maintained at 37 °C. Hypothermic controls (HC) received saline but were allowed to become hypothermic. Normothermic endotoxic (NE) received Escherichia Coli lipopolysaccharides (LPS) intravenously to induce endotoxic shock and was maintained at 37 °C. Hypothermic endotoxic (HE) received LPS intravenously and was allowed to become hypothermic. Exhaled NO (NOe) was measured from mixed expired gas at time zero and every 30 min, for 5 h. After injection of LPS, NOe increased substantially in the NE group (700 ± 24 ppb), but increased only to 25 ± 2 ppb in the HE group. NOe increased to 90 ± 3 ppb in the NC group, and to 17.6 ± 3.1 ppb in the HC group after 5 h (P < 0.05), whilst blood pressure remained stable. In the HE group, blood pressure fell immediately after injection of the LPS, but thereafter remained stable despite the rise in NOe. In the NE group, the blood pressure fell gradually, and the animals became hypotensive. During the natural course of endotoxemia in anesthetized rats, allowing severe hypothermia to ensue by not actively managing temperature and hemodynamics resulted in significantly reduced expired NO concentrations, lung injury, and prolonged survival. The clinical benefits of such a finding currently remain unclear and merit further investigation. PMID:24722817

Hakim, T S; Pedoto, A; Nandi, J; Bosco, G; Rubini, A; Mangar, D; Paoli, A; Camporesi, E M

2014-07-01

246

The role of magnetic resonance techniques in understanding and managing multiple sclerosis  

Microsoft Academic Search

Summary Magnetic resonance (MR) techniques have had a major impact in the last 10-15 years in understanding and managing multiple sclerosis. This review summarizes the current uses of MR in multiple sclerosis, based on the proceedings of a recent international workshop, under four headings: (i) technical issues; (ii) role in diagnosis; (iii) natural history studies in understanding the disease; (iv)

D. H. Miller; R. I. Grossman; S. C. Reingold; H. F. McFarland

1998-01-01

247

Cultural Variations in Mothers' Acceptance of and Intent to Use Behavioral Child Management Techniques  

ERIC Educational Resources Information Center

We examined cultural differences in mothers' acceptance of and intent to use behavioral parenting techniques for managing disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences. A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to…

Mah, Janet W. T.; Johnston, Charlotte

2012-01-01

248

Management of Giant Cell Tumour Radius in a Three Year old Child with an Improvised Technique  

PubMed Central

Giant cell tumours of immature skeleton have a very low incidence and epi-metaphyseal location. We are presenting giant cell tumour distal radius in a skeletally immature patient; an uncontained defect with a large soft tissue component which was managed by wide excision and reconstruction with an improvised technique. PMID:25654002

Puri, Ajay; Gulia, Ashish; Sharma, Seema; Verma, Amit K

2014-01-01

249

Parental Attitude toward Behavioral Management Techniques in Dental Practice with Schoolchildren in Kuwait  

Microsoft Academic Search

Objective: The objective of this study was to evaluate the parental attitude toward different management techniques used during dental treatment of schoolchildren in Kuwait. Subjects and Methods: One hundred and eighteen parents who accompanied their children to the clinics of Hawally School Oral Health Program in Kuwait participated in this study. The parents viewed a videotape which showed scenes of

Saleh Muhammad; Maddi Shyama; Sabiha A. Al-Mutawa

2011-01-01

250

Adding Angle of Arrival Modality to Basic RSS Location Management Techniques  

E-print Network

Adding Angle of Arrival Modality to Basic RSS Location Management Techniques Eiman Elnahrawy, John and a Bayesian network that combines both angle-of-arrival (AoA) and Received Signal Strength (RSS). After-based ultrasound. Approaches that use such an infrastructure and measured Received Signal Strength (RSS

Martin, Richard P.

251

Using the Critical Incident Technique for Triangulation and Elaboration of Communication Management Competencies  

ERIC Educational Resources Information Center

This paper presents the findings from research using the critical incident technique to identify the use of key competencies for communication management practitioners. Qualitative data was generated from 202 critical incidents reported by 710 respondents. We also present a brief summary of the quantitative data, which identified two superordinate…

Brunton, Margaret Ann; Jeffrey, Lynn Maud

2010-01-01

252

Research on the Integration Interface Techniques for Library Management System and Campus Smart Card System  

Microsoft Academic Search

Library management system and campus card systems are all specialized systems with great maturity. For the integration of these systems, a system integration interface technique based on the third-party interface gateway provided by campus card system is proposed. By deploying an IC card mediator program on the terminal machines for book borrowing, the mediator program will communicate with the gateway

Peng Hongying

2009-01-01

253

Suburban residents’ criteria for evaluating contraception and other deer management techniques  

Microsoft Academic Search

Contraception has been advocated increasingly by residents of urban and suburban areas as an appropriate technique for managing local deer herds. Although knowledge about the technical aspects of contraception is increasing among professionals, little study of citizens’ attitudes toward and beliefs about contraception has occurred to date. We explored residents’ attitudes toward contraception in Irondequoit, New York. We identified the

T. Bruce Lauber; Barbara A. Knuth

2000-01-01

254

Increasing Acceptance of Behavioral Child Management Techniques: What Do Parents Say?  

ERIC Educational Resources Information Center

Consumers' willingness to accept treatments is an important concern of clinicians and clinical researchers, particularly when treating children. However, few studies have directly asked parents to give reasons for accepting or refusing treatments. In the current study, 82 parents read descriptions of six behavioral child management techniques,…

Pemberton, Joy R.; Borrego, Joaquin

2007-01-01

255

Selected contribution: effect of volatile anesthetics on cADP-ribose-induced Ca(2+) release system.  

PubMed

Volatile anesthetics have multiple actions on intracellular Ca(2+) homeostasis, including activation of the ryanodine channel (RyR) and sensitization of this channel to agonists such as caffeine and ryanodine. Recently it has been described that the nucleotide cADP-ribose (cADPR) is the endogenous regulator of the RyR in many mammalian cells, and cADPR has been proposed to be a second messenger in many signaling pathways. I investigated the effect of volatile anesthetics on the cADPR signaling system, using sea urchin egg homogenates as a model of intracellular Ca(2+) stores. Ca(2+) uptake and release were monitored in sea urchin egg homogenates by using the fluo-3 fluorescence technique. Activity of the ADP-ribosyl cyclase was monitored by using a fluorometric method using nicotinamide guanine dinucleotide as a substrate. Halothane in concentrations up to 800 microM did not induce Ca(2+) release by itself in sea urchin egg homogenates. However, halothane potentiates the Ca(2+) release mediated by agonists of the ryanodine channel, such as ryanodine. Furthermore, other volatile anesthetics such as isoflurane and sevoflurane had no effect. Halothane also potentiated the activation of the ryanodine channel mediated by the endogenous nucleotide cADPR. The half-maximal concentration for cADPR-induced Ca(2+) release was decreased about three times by addition of 800 microM halothane. The reverse was also true: addition of subthreshold concentrations of cADPR sensitized the homogenates to halothane. In contrast, all the volatile anesthetics used had no effect on the activity of the enzyme that synthesizes cADPR. I propose that the complex effect of volatile anesthetics on intracellular Ca(2+) homeostasis may involve modulation of the cADPR signaling system. PMID:11408471

Chini, E N

2001-07-01

256

Resistance Management Techniques of Milton H. Erickson, M.D.: An Application to Nonhypnotic Mental Health Counseling.  

ERIC Educational Resources Information Center

Delineates five selected hypnotically based techniques of client resistance management pioneered by Milton H. Erickson: acceptance; paradoxical encouragement; reframing; displacement; dissociation. Explains how techniques can be applied to nonhypnotic mental health counseling. Discusses relevant clinical, theoretical, and empirical issues related…

Otani, Akira

1989-01-01

257

Investigation of energy management strategies for photovoltaic systems - An analysis technique  

NASA Technical Reports Server (NTRS)

Progress is reported in formulating energy management strategies for stand-alone PV systems, developing an analytical tool that can be used to investigate these strategies, applying this tool to determine the proper control algorithms and control variables (controller inputs and outputs) for a range of applications, and quantifying the relative performance and economics when compared to systems that do not apply energy management. The analysis technique developed may be broadly applied to a variety of systems to determine the most appropriate energy management strategies, control variables and algorithms. The only inputs required are statistical distributions for stochastic energy inputs and outputs of the system and the system's device characteristics (efficiency and ratings). Although the formulation was originally driven by stand-alone PV system needs, the techniques are also applicable to hybrid and grid connected systems.

Cull, R. C.; Eltimsahy, A. H.

1982-01-01

258

Regional Cerebral Blood Flow and BOLD Responses in Conscious and Anesthetized Rats Under Basal and Hypercapnic Conditions: Implications for Functional MRI Studies  

Microsoft Academic Search

Anesthetics, widely used in magnetic resonance imaging (MRI) studies to avoid movement artifacts, could have profound effects on cerebral blood flow (CBF) and cerebrovascular coupling relative to the awake condition. Quantitative CBF and tissue oxygenation (blood oxygen level–dependent [BOLD]) were measured, using the continuous arterial-spin-labeling technique with echo-planar-imaging acquisition, in awake and anesthetized (2% isoflurane) rats under basal and hypercapnic

Kenneth M. Sicard; Qiang Shen; Mathew E. Brevard; Ross Sullivan; Craig F. Ferris; Jean A. King; Timothy Q. Duong

2003-01-01

259

Mobility based key management technique for multicast security in mobile ad hoc networks.  

PubMed

In MANET multicasting, forward and backward secrecy result in increased packet drop rate owing to mobility. Frequent rekeying causes large message overhead which increases energy consumption and end-to-end delay. Particularly, the prevailing group key management techniques cause frequent mobility and disconnections. So there is a need to design a multicast key management technique to overcome these problems. In this paper, we propose the mobility based key management technique for multicast security in MANET. Initially, the nodes are categorized according to their stability index which is estimated based on the link availability and mobility. A multicast tree is constructed such that for every weak node, there is a strong parent node. A session key-based encryption technique is utilized to transmit a multicast data. The rekeying process is performed periodically by the initiator node. The rekeying interval is fixed depending on the node category so that this technique greatly minimizes the rekeying overhead. By simulation results, we show that our proposed approach reduces the packet drop rate and improves the data confidentiality. PMID:25834838

Madhusudhanan, B; Chitra, S; Rajan, C

2015-01-01

260

Mobility Based Key Management Technique for Multicast Security in Mobile Ad Hoc Networks  

PubMed Central

In MANET multicasting, forward and backward secrecy result in increased packet drop rate owing to mobility. Frequent rekeying causes large message overhead which increases energy consumption and end-to-end delay. Particularly, the prevailing group key management techniques cause frequent mobility and disconnections. So there is a need to design a multicast key management technique to overcome these problems. In this paper, we propose the mobility based key management technique for multicast security in MANET. Initially, the nodes are categorized according to their stability index which is estimated based on the link availability and mobility. A multicast tree is constructed such that for every weak node, there is a strong parent node. A session key-based encryption technique is utilized to transmit a multicast data. The rekeying process is performed periodically by the initiator node. The rekeying interval is fixed depending on the node category so that this technique greatly minimizes the rekeying overhead. By simulation results, we show that our proposed approach reduces the packet drop rate and improves the data confidentiality. PMID:25834838

Madhusudhanan, B.; Chitra, S.; Rajan, C.

2015-01-01

261

Acute toxic methemoglobinemia caused by a topical anesthetic  

Microsoft Academic Search

A case is presented in which respiratory distress resulted from the production of methemoglobin Following application of topical benzocaine to a child's oral mucous membrane. Modern local anesthetics are among the safest of ad- ministered agents, with few reported cases of morbidity or mortality. The use of topically applied local anesthetic agents is important in the atraumatic administration of regional

Sanford L. Klein; Robert A. Nustad; Stephen E. Feinberg; Raymond J. Fonseca

1983-01-01

262

Using mediation techniques to manage conflict and create healthy work environments.  

PubMed

Healthcare organizations must find ways for managing conflict and developing effective working relationships to create healthy work environments. The effects of unresolved conflict on clinical outcomes, staff retention, and the financial health of the organization lead to many unnecessary costs that divert resources from clinical care. The complexity of delivering critical care services makes conflict resolution difficult. Developing collaborative working relationships helps to manage conflict in complex environments. Working relationships are based on the ability to deal with differences. Dealing with differences requires skill development and techniques for balancing interests and communicating effectively. Techniques used by mediators are effective for resolving disputes and developing working relationships. With practice, these techniques are easily transferable to the clinical setting. Listening for understanding, reframing, elevating the definition of the problem, and forming clear agreements can foster working relationships, decrease the level of conflict, and create healthy work environments that benefit patients and professionals. PMID:15461035

Gerardi, Debra

2004-01-01

263

Liquid General Anesthetics Lower Critical Temperatures in Plasma Membrane Vesicles  

PubMed Central

A large and diverse array of small hydrophobic molecules induce general anesthesia. Their efficacy as anesthetics has been shown to correlate both with their affinity for a hydrophobic environment and with their potency in inhibiting certain ligand-gated ion channels. In this study we explore the effects that n-alcohols and other liquid anesthetics have on the two-dimensional miscibility critical point observed in cell-derived giant plasma membrane vesicles (GPMVs). We show that anesthetics depress the critical temperature (Tc) of these GPMVs without strongly altering the ratio of the two liquid phases found below Tc. The magnitude of this affect is consistent across n-alcohols when their concentration is rescaled by the median anesthetic concentration (AC50) for tadpole anesthesia, but not when plotted against the overall concentration in solution. At AC50 we see a 4°C downward shift in Tc, much larger than is typically seen in the main chain transition at these anesthetic concentrations. GPMV miscibility critical temperatures are also lowered to a similar extent by propofol, phenylethanol, and isopropanol when added at anesthetic concentrations, but not by tetradecanol or 2,6 diterbutylphenol, two structural analogs of general anesthetics that are hydrophobic but have no anesthetic potency. We propose that liquid general anesthetics provide an experimental tool for lowering critical temperatures in plasma membranes of intact cells, which we predict will reduce lipid-mediated heterogeneity in a way that is complimentary to increasing or decreasing cholesterol. Also, several possible implications of our results are discussed in the context of current models of anesthetic action on ligand-gated ion channels. PMID:24359747

Gray, Ellyn; Karslake, Joshua; Machta, Benjamin B.; Veatch, Sarah L.

2013-01-01

264

A retrospective analysis of anesthetic experience in 2917 patients posted for cleft lip and palate repair  

PubMed Central

Context: Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children. Aim: to study the perioperative anesthetic complications in poor children with cleft abnormalities. Settings and Design: Retrospective analysis. Materials and Methods: This retrospective audit was conducted on 2917 patients of smile train project under going general anesthesia for cleft lip and palate from January 2007 to December 2010. Demographic, pre-anesthetic status, anesthetic management and anesthesia complications were recorded. Chi-square test was used to assess the relation between patient factors and occurrence of complications. Results: Of the 3044, we were able to procure complete data of 2917 patients. Most of children presented with anemia 251 (35%), 202 (29%) had eosinophilia while 184 (26%) had upper respiratory tract infection. The incidence of perioperative complications was 8.19% of which 33.7% critical incidents occurred during the induction time. The most common complication was laryngospasm 77 (40.9%) followed by difficult intubation 64 (30.9%). There was no mortality. Conclusion: Since these procedures do not characterize an emergency, most of the perioperative complications can be prevented by following the routine installed by the institute and smile train protocols.

Jindal, Parul; Khurana, Gurjeet; Gupta, Deepali; Sharma, J. P.

2013-01-01

265

Implementation of quality improvement techniques for management and technical processes in the ACRV project  

NASA Astrophysics Data System (ADS)

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Raiman, Laura B.

1992-12-01

266

Implementation of quality improvement techniques for management and technical processes in the ACRV project  

NASA Technical Reports Server (NTRS)

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Raiman, Laura B.

1992-01-01

267

Monolayers of a Model Anesthetic-Binding Membrane Protein: Formation, Characterization, and Halothane-Binding Affinity  

PubMed Central

hbAP0 is a model membrane protein designed to possess an anesthetic-binding cavity in its hydrophilic domain and a cation channel in its hydrophobic domain. Grazing incidence x-ray diffraction shows that hbAP0 forms four-helix bundles that are vectorially oriented within Langmuir monolayers at the air-water interface. Single monolayers of hbAP0 on alkylated solid substrates would provide an optimal system for detailed structural and dynamical studies of anesthetic-peptide interaction via x-ray and neutron scattering and polarized spectroscopic techniques. Langmuir-Blodgett and Langmuir-Schaeffer deposition and self-assembly techniques were used to form single monolayer films of the vectorially oriented peptide hbAP0 via both chemisorption and physisorption onto suitably alkylated solid substrates. The films were characterized by ultraviolet absorption, ellipsometry, circular dichroism, and polarized Fourier transform infrared spectroscopy. The ?-helical secondary structure of the peptide was retained in the films. Under certain conditions, the average orientation of the helical axis was inclined relative to the plane of the substrate, approaching perpendicular in some cases. The halothane-binding affinity of the vectorially oriented hbAP0 peptide in the single monolayers, with the volatile anesthetic introduced into the moist vapor environment of the monolayer, was found to be similar to that for the detergent-solubilized peptide. PMID:16473900

Churbanova, Inna Y.; Tronin, Andrey; Strzalka, Joseph; Gog, Thomas; Kuzmenko, Ivan; Johansson, Jonas S.; Blasie, J. Kent

2006-01-01

268

Modeling anesthetic developmental neurotoxicity using human stem cells  

PubMed Central

Mounting pre-clinical evidence in rodents and non-human primates has demonstrated that prolonged exposure of developing animals to general anesthetics can induce widespread neuronal cell death followed by long-term memory and learning disabilities. In vitro experimental evidence from cultured neonatal animal neurons confirmed the in vivo findings. However, there is no direct clinical evidence of the detrimental effects of anesthetics in human fetuses, infants, or children. Development of an in vitro neurogenesis system using human stem cells has opened up avenues of research for advancing our understanding of human brain development and the issues relevant to anesthetic-induced developmental toxicity in human neuronal lineages. Recent studies from our group, as well as other groups, showed that isoflurane influences human neural stem cell proliferation and neurogenesis, while ketamine induces neuroapoptosis. Application of this high throughput in vitro stem cell neurogenesis approach is a major stride toward assuring the safety of anesthetic agents in young children. This in vitro human model allows us to (1) screen the toxic effects of various anesthetics under controlled conditions during intense neuronal growth, (2) find the trigger for the anesthetic-induced catastrophic chain of toxic events, and (3) develop prevention strategies to avoid this toxic effect. In this paper, we reviewed the current findings in anesthetic-induced neurotoxicity studies, specifically focusing on the in vitro human stem cell model. PMID:23859832

Bai, Xiaowen; Twaroski, Danielle; Bosnjak, Zeljko J.

2013-01-01

269

Pain fiber anesthetic reduces brainstem Fos after tooth extraction.  

PubMed

We recently demonstrated that pain-sensing neurons in the trigeminal system can be selectively anesthetized by co-application of QX-314 with the TRPV1 receptor agonist, capsaicin (QX cocktail). Here we examined whether this new anesthetic strategy can block the neuronal changes in the brainstem following molar tooth extraction in the rat. Adult male Sprague-Dawley rats received infiltration injection of anesthetic 10 min prior to lower molar tooth extraction. Neuronal activation was determined by immunohistochemistry for the proto-oncogene protein c-Fos in transverse sections of the trigeminal subnucleus caudalis (Sp5C). After tooth extraction, c-Fos-like immunoreactivity (Fos-LI) detected in the dorsomedial region of bilateral Sp5C was highest at 2 hrs (p < .01 vs. naïve ipsilateral) and declined to pre-injury levels by 8 hrs. Pre-administration of the QX cocktail significantly reduced to sham levels Fos-LI examined 2 hrs after tooth extraction; reduced Fos-LI was also observed with the conventional local anesthetic lidocaine. Pulpal anesthesia by infiltration injection was confirmed by inhibition of the jaw-opening reflex in response to electrical tooth pulp stimulation. Our results suggest that the QX cocktail anesthetic is effective in reducing neuronal activation following tooth extraction. Thus, a selective pain fiber 'nociceptive anesthetic' strategy may provide an effective local anesthetic option for dental patients in the clinic. PMID:24056223

Badral, B; Davies, A J; Kim, Y H; Ahn, J S; Hong, S D; Chung, G; Kim, J S; Oh, S B

2013-11-01

270

Seven Management Techniques that Move Cow-Calf Producers towards Profitability  

E-print Network

) Conduct breeding soundness examinations on all bulls every year. 2) Palpate and remove all non-producers. 3) Maintain cows in moderate body condition score at calving. 4) Appreciate the hidden values of vaccinations against reproductive diseases... reasons for this timing: ? Pregnancy status can be determined easily. ? Scheduling is made easier for other management techniques like deworming, vaccinating, health evaluations and culling due to failure to reproduce that also must...

Posey, R. Daniel

2005-06-09

271

Power minimization techniques on distributed real-time systems by global and local slack management  

Microsoft Academic Search

Recently, a static power management with parallelism (P-SPM) technique has been proposed to reduce the energy consumption of distributed systems to execute a set of real-time dependent tasks [7]. The authors claimed that the proposed P-SPM outperforms other known methods in energy reduction. However, how to take advantage of the local static slack for further energy optimization remains as an

Shaoxiong Hua; Gang Qu

2005-01-01

272

Power minimization techniques on distributed real-time systems by global and local slack management  

Microsoft Academic Search

Recently, a static power management with parallelism (P-SPM) technique has been proposed to reduce the energy consumption of distributed systems to execute a set of real-time dependent tasks (Mishra et al., 2003). The authors claimed that the proposed P-SPM outperforms other known methods in energy reduction. However, how to take advantage of the local static slack for further energy optimization

Shaoxiong Hua; Gang Qu

2005-01-01

273

Management of pulp canal obliteration using the Modified-Tip instrument technique  

PubMed Central

The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 – 24% and its management can be quite challenging for the practitioner. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This case report deals with such a case using the modified tip instrument technique to gain access and negotiate the canal to the apex followed by conventional root canal preparation and obturation.

Siddiqui, Shoaib Haider

2014-01-01

274

Uncertainty Management for Diagnostics and Prognostics of Batteries using Bayesian Techniques  

NASA Technical Reports Server (NTRS)

Uncertainty management has always been the key hurdle faced by diagnostics and prognostics algorithms. A Bayesian treatment of this problem provides an elegant and theoretically sound approach to the modern Condition- Based Maintenance (CBM)/Prognostic Health Management (PHM) paradigm. The application of the Bayesian techniques to regression and classification in the form of Relevance Vector Machine (RVM), and to state estimation as in Particle Filters (PF), provides a powerful tool to integrate the diagnosis and prognosis of battery health. The RVM, which is a Bayesian treatment of the Support Vector Machine (SVM), is used for model identification, while the PF framework uses the learnt model, statistical estimates of noise and anticipated operational conditions to provide estimates of remaining useful life (RUL) in the form of a probability density function (PDF). This type of prognostics generates a significant value addition to the management of any operation involving electrical systems.

Saha, Bhaskar; Goebel, kai

2007-01-01

275

Innovative Techniques for Estimating Illegal Activities in a Human-Wildlife-Management Conflict  

PubMed Central

Effective management of biological resources is contingent upon stakeholder compliance with rules. With respect to disease management, partial compliance can undermine attempts to control diseases within human and wildlife populations. Estimating non-compliance is notoriously problematic as rule-breakers may be disinclined to admit to transgressions. However, reliable estimates of rule-breaking are critical to policy design. The European badger (Meles meles) is considered an important vector in the transmission and maintenance of bovine tuberculosis (bTB) in cattle herds. Land managers in high bTB prevalence areas of the UK can cull badgers under license. However, badgers are also known to be killed illegally. The extent of illegal badger killing is currently unknown. Herein we report on the application of three innovative techniques (Randomized Response Technique (RRT); projective questioning (PQ); brief implicit association test (BIAT)) for investigating illegal badger killing by livestock farmers across Wales. RRT estimated that 10.4% of farmers killed badgers in the 12 months preceding the study. Projective questioning responses and implicit associations relate to farmers' badger killing behavior reported via RRT. Studies evaluating the efficacy of mammal vector culling and vaccination programs should incorporate estimates of non-compliance. Mitigating the conflict concerning badgers as a vector of bTB requires cross-disciplinary scientific research, departure from deep-rooted positions, and the political will to implement evidence-based management. PMID:23341973

Cross, Paul; St. John, Freya A. V.; Khan, Saira; Petroczi, Andrea

2013-01-01

276

Interaction of Local Anesthetics with Biomembranes Consisting of Phospholipids and Cholesterol: Mechanistic and Clinical Implications for Anesthetic and Cardiotoxic Effects  

PubMed Central

Despite a long history in medical and dental application, the molecular mechanism and precise site of action are still arguable for local anesthetics. Their effects are considered to be induced by acting on functional proteins, on membrane lipids, or on both. Local anesthetics primarily interact with sodium channels embedded in cell membranes to reduce the excitability of nerve cells and cardiomyocytes or produce a malfunction of the cardiovascular system. However, the membrane protein-interacting theory cannot explain all of the pharmacological and toxicological features of local anesthetics. The administered drug molecules must diffuse through the lipid barriers of nerve sheaths and penetrate into or across the lipid bilayers of cell membranes to reach the acting site on transmembrane proteins. Amphiphilic local anesthetics interact hydrophobically and electrostatically with lipid bilayers and modify their physicochemical property, with the direct inhibition of membrane functions, and with the resultant alteration of the membrane lipid environments surrounding transmembrane proteins and the subsequent protein conformational change, leading to the inhibition of channel functions. We review recent studies on the interaction of local anesthetics with biomembranes consisting of phospholipids and cholesterol. Understanding the membrane interactivity of local anesthetics would provide novel insights into their anesthetic and cardiotoxic effects. PMID:24174934

2013-01-01

277

Benzocaine-loaded polymeric nanocapsules: study of the anesthetic activities.  

PubMed

This paper describes a comparison of different polymeric nanocapsules (NCs) prepared with the polymers poly(D,L-lactide-co-glycolide), poly(L-lactide) (PLA), and poly(?-caprolactone) and used as carrier systems for the local anesthetic (LA) benzocaine (BZC). The systems were characterized and their anesthetic activities investigated. The results showed particle size distributions with polydispersity indices below 0.135, average diameters up to 120 nm, zeta potentials up to -30 mV, and entrapment efficiencies around 70%. Formulations of BZC using the polymeric NCs presented slower release profiles, compared with that of free BZC. Slowest release (release constant, k = 0.0016 min(-1)) was obtained using the PLA NC system. Pharmacological evaluation showed that encapsulation of BZC in PLA NCs prolonged its anesthetic action. This new formulation could potentially be used in future applications involving the gradual release of local anesthetics (LAs). PMID:22105694

De Melo, Nathalie Ferreira Silva; De Araújo, Daniele Ribeiro; Grillo, Renato; Moraes, Carolina Morales; De Matos, Angélica Prado; de Paula, Eneida; Rosa, André Henrique; Fraceto, Leonardo Fernandes

2012-03-01

278

Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation?  

Microsoft Academic Search

Background: Chronically compromised uterine perfusion may lead to placental insufficiency and subsequent intrauterine growth restriction (IUGR). Various therapeutic approaches (e.g. vasodilators, low-dose aspirin, intravenous glucose infusion, and hemodilution) are often of limited efficacy. Local anesthetics have been shown to improve placental blood flow in pre-eclamptic women. We hypothesized that epidural administration of local anesthetics might improve outcome in IUGR independent

D. Strümper; F. Louwen; M. E. Durieux; H. F. Gramke; J. Stuessel; D. Marcus-Soekarman; H. Van Aken; M. A. E. Marcus

2005-01-01

279

Isoflurane as an Inhalation Anesthetic for Muskrats (Ondatra zibethicus)  

Microsoft Academic Search

The effectiveness of isoflurane as an inhalation anesthetic for muskrats (Ondatra zibethicus) was evaluated. Thirty muskrats were anesthetized in an enclosed chamber using 10 ml of isoflurane in Carlton County, Minnesota (USA), from 27 September to 24 October 1994. Mean (±SE) induction time for adults, juveniles, and kits was 20.6 ± 2.9, 21.5 ± 2.4, and 16.9 ± 5.3 mm,

Jerrold L. Belant

280

Oxindole-3-spiropyrrolidines and -piperidines. Synthesis and local anesthetic activity.  

PubMed

The synthesis and local anesthetic properties of five 1-dealkyloxindole-3-spiropyrrolidines and six 1-dealkyloxindole-3-spiropiperidines are described. The compounds studied include members of all five possible positional isomers of the two classes of spirooxindoles; all showed local anesthetic activity by the rat sciatic nerve block method. The coincidence of the least variability in the relative positions of basic nitrogen, amide carbonyl, and aromatic ring (compounds 1 and 6) with lowest normalized toxicity is noteworthy. PMID:940109

Kornet, M J; Thio, A P

1976-07-01

281

General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture  

PubMed Central

Background Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. Methods Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. Results Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV. Conclusions MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition. PMID:24101954

Lee, Kyoungkyun; Yon, Jun Heum; Kim, Kye-Min; Kim, Mun-Cheol; Lee, Woo Yong; Lee, Sangseok; Lim, Yun-Hee; Nam, Sang Hyun; Choi, Young Woong; Kim, Hoon

2013-01-01

282

Qualitative evaluation of coronary flow during anesthetic induction using thallium-201 perfusion scans  

SciTech Connect

Qualitative distribution of coronary flow using thallium-201 perfusion scans immediately postintubation was studied in 22 patients scheduled for elective coronary artery bypass surgery. Ten patients received a thiopental (4 mg/kg) and halothane induction. Twelve patients received a fentanyl (100 micrograms/kg) induction. Baseline thallium-201 perfusion scans were performed 24 h prior to surgery. These scans were compared with the scans performed postintubation. A thallium-positive scan was accepted as evidence of relative hypoperfusion. Baseline hemodynamic and ECG data were obtained prior to induction of anesthesia. These data were compared with the data obtained postintubation. Ten patients developed postintubation thallium-perfusion scan defects (thallium-positive scan), even though there was no statistical difference between their baseline hemodynamics and hemodynamics at the time of intubation. There was no difference in the incidence of thallium-positive scans between those patients anesthetized by fentanyl and those patients anesthetized with thiopental-halothane. The authors conclude that relative hypoperfusion, and possibly ischemia, occurred in 45% of patients studied, despite stable hemodynamics, and that the incidence of these events was the same with two different anesthetic techniques.

Kleinman, B.; Henkin, R.E.; Glisson, S.N.; el-Etr, A.A.; Bakhos, M.; Sullivan, H.J.; Montoya, A.; Pifarre, R.

1986-02-01

283

Comparative efficacy of 16 anesthetic chemicals on rainbow trout  

USGS Publications Warehouse

Presently there are no legally registered fish anesthetics that allow for the release of fish or use of the fish for food soon after they have been anesthetized. MS-222 (tricaine), the only anesthetic registered for use on fish in the United States, cannot be used within 21 d of harvesting the fish for food. As the start in a search for an anesthetic that can be used with little or no withdrawal period, we tested the efficacy of 16 chemicals as anesthetics on rainbow trout Salmo gairdneri. Efficacy was defined by the fish (1) becoming handleable (quiet enough to be manipulated and handled readily) in 3 min or less, (2) recovering in 10 min or less, and (3) showing no mortality after 15 min in the anesthetic solution. Four chemicals--MS-222, quinaldine sulfate, benzocaine, and 2-phenoxyethanol--met these criteria for efficacy. Chemicals that yielded excessive induction or recovery times or caused excessive mortality were methylpentynol, chlorobutanol, etomidate, metomidate, Piscaine, propanidid, carbon dioxide, nicotine, salt, Halothane, Metofane, and Biotal. Because carbon dioxide leaves no residues and requires no withdrawal period, it may be an acceptable alternative for fishery workers who can tolerate somewhat shallower anesthesia and longer induction and recovery times.

Gilderhus, P.A.; Marking, L.L.

1987-01-01

284

Topical Ocular Anesthetic Abuse Among Iranian Welders: Time for Action  

PubMed Central

Purpose: The purpose of this study is to estimate the prevalence of topical ocular anesthetic abuse among welders in Iran and suggest public health solutions for this issue. Methods: In this cross-sectional study, 390 welders were randomly recruited and queried on the use of anesthetic drops. A questionnaire was administered through structured one-on-one interviews conducted by the first author. Results: A total of 314 welders (80.5%) declared that they had used topical anesthetics at least once during their working lives. Almost 90% of them stated a preference for self-treatment over seeking help from a physician due to cultural and financial reasons. The most commonly used topical anesthetic was tetracaine. Most of the subjects (97.4%) had obtained the drugs from pharmacies without a prescription. Conclusions: The prevalence of topical ocular anesthetic abuse among welders in Iran is alarmingly high and may partially be due to cultural issues. Although most physicians are aware that topical anesthetics should only be used as a diagnostic tool, there is a crucial need to re-emphasize the ocular risks associated with chronic use of these medications. Educational programs for both physicians and the public are necessary to address the problem. PMID:24339685

Sharifi, Ali; Sharifi, Hamid; Karamouzian, Mohammad; Mokhtari, Mahmoud; Esmaeili, Hamidreza Hosein; Nejad, Afshin Sarafi; Rahmatian, Mohammad

2013-01-01

285

Effects of anesthetic compounds on responses of earthworms to electrostimulation.  

PubMed

Earthworms play an important role in biomedical research, and some surgical procedures require anesthesia. Anesthetic treatments used so far usually induce convulsive body movements connected with extrusion of coelomocyte-containing coelomic fluid that may affect experimental results. Extensive movements connected with the expulsion of coelomic fluid are exploited by immunologists as a method of harvesting immunocompetent coelomocytes from worms subjected to mild electrostimulation (4.5V). The aim of the investigations was to find anesthetic drugs without unintentional coelomocyte depletion. Experiments were performed on adult specimens of Dendrobaena veneta, the coelomocytes of which consist of amoebocytes and riboflavin-storing eleocytes. Earthworm mobility was filmed and extrusion of coelomocytes was quantified by detection of eleocyte-derived riboflavin in immersion fluid. Treatments included earthworms (1) immersed either in physiological saline (controls) or in a solution of one of the tested anesthetic drugs; (2) electrostimulated immediately after anesthesia, and (3) electrostimulated a second time after a 1-hour recovery period. The well-established fish and amphibian anesthetic agent MS-222 induced coelomocyte expulsion. In contrast, solutions of the mammalian local anesthetic drug, prilocaine hydrochloride (0.25-0.5%, 5-10 min) caused temporal earthworm immobilization followed by recovery, thus showing utility as an efficient earthworm anesthetic. PMID:25134346

Podolak-Machowska, Agnieszka; Kostecka, Joanna; Librowski, Tadeusz; Santocki, Michal; Bigaj, Janusz; Plytycz, Barbara

2014-01-01

286

A Model Membrane Protein for Binding Volatile Anesthetics  

PubMed Central

Earlier work demonstrated that a water-soluble four-helix bundle protein designed with a cavity in its nonpolar core is capable of binding the volatile anesthetic halothane with near-physiological affinity (0.7 mM Kd). To create a more relevant, model membrane protein receptor for studying the physicochemical specificity of anesthetic binding, we have synthesized a new protein that builds on the anesthetic-binding, hydrophilic four-helix bundle and incorporates a hydrophobic domain capable of ion-channel activity, resulting in an amphiphilic four-helix bundle that forms stable monolayers at the air/water interface. The affinity of the cavity within the core of the bundle for volatile anesthetic binding is decreased by a factor of 4–3.1 mM Kd as compared to its water-soluble counterpart. Nevertheless, the absence of the cavity within the otherwise identical amphiphilic peptide significantly decreases its affinity for halothane similar to its water-soluble counterpart. Specular x-ray reflectivity shows that the amphiphilic protein orients vectorially in Langmuir monolayers at higher surface pressure with its long axis perpendicular to the interface, and that it possesses a length consistent with its design. This provides a successful starting template for probing the nature of the anesthetic-peptide interaction, as well as a potential model system in structure/function correlation for understanding the anesthetic binding mechanism. PMID:15465862

Ye, Shixin; Strzalka, Joseph; Churbanova, Inna Y.; Zheng, Songyan; Johansson, Jonas S.; Blasie, J. Kent

2004-01-01

287

[Effect of anesthetics on malignant tumor cells (A review)].  

PubMed

The influence of surgery and anesthesia on aspects of malignant tumor has received considerable attention in recent years. It is suggested that in vitro studies, clinically available anesthetics, such as intravenous anesthetics, local anesthetics and opioids have, more or less, possible antitumor potential against human malignant tumor cells. Although natural killer (NK) cells play an important role in tumor and metastasis surveillance, the reported effects of the anesthetics on the NK cell activity in human are controversial. Animal studies indicate that the neuroendocrine stress response to the surgery suppresses the immune function, particularly NK cell cytotoxicity, and increases the metastatic burden under inhalational anesthesia alone. Moreover, animal studies indicate that the addition of spinal block and optimum postoperative analgesia independently reduce the metastatic burden by blocking the stress response under inhalational anesthesia alone. Considering inconclusive results, especially in human, about evaluating the influence of anesthetics on malignant tumor, further studies in basic and clinical settings are required to study the effects of anesthetics on malignant tumor. PMID:19860222

Nagasaka, Hiroshi; Ohno, Seika; Kobayashi, Katsue; Sakagami, Hiroshi

2009-10-01

288

Failure detection and fault management techniques for flush airdata sensing systems  

NASA Technical Reports Server (NTRS)

Methods based on chi-squared analysis are presented for detecting system and individual-port failures in the high-angle-of-attack flush airdata sensing system on the NASA F-18 High Alpha Research Vehicle. The HI-FADS hardware is introduced, and the aerodynamic model describes measured pressure in terms of dynamic pressure, angle of attack, angle of sideslip, and static pressure. Chi-squared analysis is described in the presentation of the concept for failure detection and fault management which includes nominal, iteration, and fault-management modes. A matrix of pressure orifices arranged in concentric circles on the nose of the aircraft indicate the parameters which are applied to the regression algorithms. The sensing techniques are applied to the F-18 flight data, and two examples are given of the computed angle-of-attack time histories. The failure-detection and fault-management techniques permit the matrix to be multiply redundant, and the chi-squared analysis is shown to be useful in the detection of failures.

Whitmore, Stephen A.; Moes, Timothy R.; Leondes, Cornelius T.

1992-01-01

289

Low level waste management: a compilation of models and monitoring techniques. Volume 1  

SciTech Connect

In support of the National Low-Level Waste (LLW) Management Research and Development Program being carried out at Oak Ridge National Laboratory, Science Applications, Inc., conducted a survey of models and monitoring techniques associated with the transport of radionuclides and other chemical species from LLW burial sites. As a result of this survey, approximately 350 models were identified. For each model the purpose and a brief description are presented. To the extent possible, a point of contact and reference material are identified. The models are organized into six technical categories: atmospheric transport, dosimetry, food chain, groundwater transport, soil transport, and surface water transport. About 4% of the models identified covered other aspects of LLW management and are placed in a miscellaneous category. A preliminary assessment of all these models was performed to determine their ability to analyze the transport of other chemical species. The models that appeared to be applicable are identified. A brief survey of the state-of-the-art techniques employed to monitor LLW burial sites is also presented, along with a very brief discussion of up-to-date burial techniques.

Mosier, J.E.; Fowler, J.R.; Barton, C.J. (comps.)

1980-04-01

290

Laparoscopic endoloop technique – A novel approach of managing iatrogenic caecal perforation and literature review  

PubMed Central

Introduction An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality. We present a 4 min and 50 s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation. Presentation of case Our patient presented with an acute abdomen following endoscopic polypectomy. At surgery, the site of caecal perforation was close to the appendicular base with devitalization tissue, secondary to diathermy usage. The hallmark of safety within this novel technique included fresh healthy tissue margins within the endoloop (detachable snare ligation) and ensuring no ischemic tissue was gathered. Complete freeing of the appendix and meso-appendicular base was required and securing three endoloops proximal to the site of perforation. The post-operative course was uneventful. Discussion The World Society of Emergency Surgery (WSES) 2013 guidelines suggested an early laparoscopic approach is a safe and effective treatment for colonoscopy-related colonic perforation. There are no national guidelines and the management is dictated by the clinical condition of the patient, co-morbidity, size and site of perforation as well as the scale of bowel preparation, and surgical experience. Conclusion The endoloop technique described, undertaken during a laparoscopy is a novel approach. It is a simple and effective method, reminding clinicians to adapt techniques when necessary. Nevertheless, it is only limited to perforations around the appendicular base. PMID:25723744

Merali, N.; Hussain, A.

2015-01-01

291

Management of Idiopathic Clubfoot by Ponseti Technique in Children Presenting After One Year of Age.  

PubMed

We conducted a study to determine the effectiveness of the Ponseti technique in the management of idiopathic congenital clubfoot in patients older than 1 year of age. A total of 19 patients with 28 clubfeet (16 males [84.2%], 3 females [15.8%]) were included in the present study. The mean age at presentation was 2.7 (range 1 to 3.5) years. The results of treatment using the Ponseti technique were evaluated using the Pirani and Dimeglio scoring systems. The mean precorrection total Pirani score was 4.84 (range 3.5 to 5.5) and the mean precorrection Dimeglio score was 12.96 (range 10 to 14). The mean postcorrection total Pirani score was 0.55 (range 0 to 1), and the mean postcorrection Dimeglio score was 2.32 (range 2 to 3). These differences were statistically significant (p < .001 and p < .001, respectively). In 92.8% of the feet, satisfactory correction of the deformity was achieved. The mean number of casts applied was 8 (range 5 to 12). All but 1 (3.6%) of the clubfeet required tenotomy to achieve correction. The mean follow-up duration was 2.7 (range 1.5 to 3.5) years. We have concluded that the Ponseti technique is an effective method for the management of idiopathic congenital clubfoot, even in toddlers. PMID:25128311

Faizan, Mohammad; Jilani, Latif Zafar; Abbas, Mazhar; Zahid, Mohammad; Asif, Naiyer

2014-08-12

292

Linking Spatial Variations in Water Quality with Water and Land Management using Multivariate Techniques.  

PubMed

Most studies using multivariate techniques for pollution source evaluation are conducted in free-flowing rivers with distinct point and nonpoint sources. This study expanded on previous research to a managed "canal" system discharging into the Indian River Lagoon, Florida, where water and land management is the single most important anthropogenic factor influencing water quality. Hydrometric and land use data of four drainage basins were uniquely integrated into the analysis of 25 yr of monthly water quality data collected at seven stations to determine the impact of water and land management on the spatial variability of water quality. Cluster analysis (CA) classified seven monitoring stations into four groups (CA groups). All water quality parameters identified by discriminant analysis showed distinct spatial patterns among the four CA groups. Two-step principal component analysis/factor analysis (PCA/FA) was conducted with (i) water quality data alone and (ii) water quality data in conjunction with rainfall, flow, and land use data. The results indicated that PCA/FA of water quality data alone was unable to identify factors associated with management activities. The addition of hydrometric and land use data into PCA/FA revealed close associations of nutrients and color with land management and storm-water retention in pasture and citrus lands; total suspended solids, turbidity, and NO + NO with flow and Lake Okeechobee releases; specific conductivity with supplemental irrigation supply; and dissolved O with wetland preservation. The practical implication emphasizes the importance of basin-specific land and water management for ongoing pollutant loading reduction and ecosystem restoration programs. PMID:25602661

Wan, Yongshan; Qian, Yun; Migliaccio, Kati White; Li, Yuncong; Conrad, Cecilia

2014-03-01

293

Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System  

NASA Astrophysics Data System (ADS)

This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.

Ram Prabhakar, J.; Ragavan, K.

2013-07-01

294

[Pilon fractures : Part 2: Repositioning and stabilization technique and complication management].  

PubMed

The management of complex pilon fractures with soft tissue injuries has seen many trends, with changes toward staged protocols of temporary external fixation followed by delayed open reduction and internal fixation (ORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques and special implants, the benefits of negative pressure wound sealing and early "fix and flap" efforts to reconstruct soft tissue defects. Reduction and fixation must involve cautious management and careful handling of soft tissue in order to minimize the well-known complications of this difficult fracture. With these changes, the rate of soft tissue complications, infections and non-unions has decreased. The target remains the anatomical reconstruction of the articular surface as well as the geometric integrity of the distal tibia and fibula. Currently it is still unclear how much articular anatomy and perfection in reduction is needed as the radiographic results do not always correlate with the clinical results. PMID:25673229

Krettek, C; Bachmann, S

2015-02-01

295

Advanced technologies and devices for inhalational anesthetic drug dosing.  

PubMed

Technological advances in micromechanics, optical sensing, and computing have led to innovative and reliable concepts of precise dosing and sensing of modern volatile anesthetics. Mixing of saturated desflurane flow with fresh gas flow (FGF) requires differential pressure sensing between the two circuits for precise delivery. The medical gas xenon is administered most economically in a closed circuit breathing system. Sensing of xenon in the breathing system is achieved with miniaturized and unique gas detector systems. Innovative sensing principles such as thermal conductivity and sound velocity are applied. The combination of direct injection of volatile anesthetics and low-flow in a closed circuit system requires simultaneous sensing of the inhaled and exhaled gas concentrations. When anesthetic conserving devices are used for sedation with volatile anesthetics, regular gas concentration monitoring is advised. High minimal alveolar concentration (MAC) of some anesthetics and low-flow conditions bear the risk of hypoxic gas delivery. Oxygen sensing based on paramagnetic thermal transduction has become the choice when long lifetime and one-time calibration are required. Compact design of beam splitters, infrared filters, and detectors have led to multiple spectra detector systems that fit in thimble-sized housings. Response times of less than 500 ms allow systems to distinguish inhaled from exhaled gas concentrations. The compact gas detector systems are a prerequisite to provide "quantitative anesthesia" in closed circuit feedback-controlled breathing systems. Advanced anesthesia devices in closed circuit mode employ multiple feedback systems. Multiple feedbacks include controls of volume, concentrations of anesthetics, and concentration of oxygen with a corresponding safety system. In the ideal case, the feedback system delivers precisely what the patient is consuming. In this chapter, we introduce advanced technologies and device concepts for delivering inhalational anesthetic drugs. First, modern vaporizers are described with special attention to the particularities of delivering desflurane. Delivery of xenon is presented, followed by a discussion of direct injection of volatile anesthetics and of a device designed to conserve anesthetic drugs. Next, innovative sensing technologies are presented for reliable control and precise metering of the delivered volatile anesthetics. Finally, we discuss the technical challenges of automatic control in low-flow and closed circuit breathing systems in anesthesia. PMID:18175104

Meyer, J-U; Kullik, G; Wruck, N; Kück, K; Manigel, J

2008-01-01

296

Considerations and techniques for incorporating remotely sensed imagery into the land resource management process.  

NASA Technical Reports Server (NTRS)

Development of a scheme for utilizing remote sensing technology in an operational program for regional land use planning and land resource management program applications. The scheme utilizes remote sensing imagery as one of several potential inputs to derive desired and necessary data, and considers several alternative approaches to the expansion and/or reduction and analysis of data, using automated data handling techniques. Within this scheme is a five-stage program development which includes: (1) preliminary coordination, (2) interpretation and encoding, (3) creation of data base files, (4) data analysis and generation of desired products, and (5) applications.

Brooner, W. G.; Nichols, D. A.

1972-01-01

297

Incorporating Piaget's theories into behavior management techniques for the child dental patient.  

PubMed

This presentation reviews psychologist Jean Piaget's contributions to knowledge of cognitive development in children, relating it to behavior management techniques. Piaget theorized that children's knowledge about reality is realized by touching and observing; he termed this constructivism. He recognized that there are stages of development in knowledge acquisition. Practitioners should try to stimulate these needs to develop a positive dental experience. Another Piaget model is egocentrism, wherein a child views the world subjectively. The dentist should let the child patient know what's going on and have an active part in treatment. PMID:11199558

Delitala, G

2000-01-01

298

Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques  

PubMed Central

Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor's office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. ImagesFigure 7

Hains, Guy

2002-01-01

299

The effect of local anesthetic on quality of recovery characteristics following dental rehabilitation under general anesthesia in children.  

PubMed

This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug (NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA). Twenty-seven healthy children aged 3-5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3-5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4-6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3-5.5 years. PMID:20020791

Townsend, Janice A; Ganzberg, Steven; Thikkurissy, S

2009-01-01

300

“Diamond” mammoplasty as a part of conservative management of breast cancer: Description of a new technique  

PubMed Central

INTRODUCTION Oncoplastic surgery is an integral part of current surgical treatment of breast cancer. Superior breast quadrant is a forgiving tumor location that often allows the conservation of the breast with simple mammoplastic manoeuvres. In this report, we describe a novel modification of the classic level I mammoplasty. PRESENTATION OF CASE A 49 years patient had an ill-defined carcinoma at the 12 o’clock position that necessitated a generous tumorectomy. A diamond shaped incision was done over the tumor area and the nipple-areola complex. Peri-areolar skin was de-epithelialized and the tumorectomy was completed down to the pectoral plane. The incision was closed in a star-like shape around the areola leading to natural appearance of the breast and a limited visible suture line. DISCUSSION We suggest that the described technique offered an advantage over the classic omega mastopexy or the round-block technique and provided a versatile technique for oncologic management and mastopexy. CONCLUSION The presented technique may be considered when performing level I mammoplasty. PMID:22466110

Hussein, Osama; El-Khodary, Tawfik

2012-01-01

301

Biological rhythms related to metabolism in Japanese Shorthorn cattle under varying environments and management techniques.  

PubMed

Plasma insulin (INS), thyroxin (T4 ), glucose (GLU), non-esterified fatty acid (NEFA), blood urea nitrogen (BUN), rectal temperature (RT) and eating behavior were evaluated in Japanese Shorthorn cattle under varying external environments and management techniques. Serial blood collection and assessments of RT and eating behavior were performed over 48 h in the spring, summer, autumn and winter in four female cattle reared under either free-stall and ad libitum feeding (FA) conditions or tie-stall and restricted feeding (TR) conditions. Cycle patterns for each parameter were examined using spectral analysis, and correlations between parameters were investigated using cross-spectral analysis. Rhythms for all parameters, except eating behavior and T4 , did not differ significantly among the varied external environments and between management techniques, although seasonal differences in the concentration or value of parameters were observed. An approximate 3- or 4-h rhythm cycle detected in T4 , GLU, NEFA, BUN, and RT might be the common metabolic rhythm. Under both conditions, the metabolite levels showed strong correlations with eating behavior. Moreover, GLU positively correlated with INS at lag time of 0 h, as did eating behavior and RT. PMID:23607269

Ogino, Mizuna; Matsuura, Akihiro; Yamazaki, Atusi; Irimajiri, Mami; Takahashi, Hideyuki; Komatsu, Tokushi; Kushibiki, Shiro; Shingu, Hiroyuki; Kasuya, Etsuko; Hasegawa, Yoshihisa; Hodate, Koichi

2013-06-01

302

Plasma cortisol and prolactin secretion rhythms in cattle under varying external environments and management techniques.  

PubMed

The secretion rhythms of plasma cortisol (CORT) and prolactin (PRL), hormones related to stress responsiveness and biological rhythm and controlled by light and temperature, were investigated under varying external environments and different management techniques. Serial blood samples were collected from female cattle reared in free-stall and freely fed (FF) conditions (n = 4) or in tie-stall and restricted feeding (RF) conditions (hay and concentrate twice daily, n = 4). Plasma CORT and PRL concentrations, eating behavior, and environmental parameters were analyzed. Cyclic patterns for each parameter were examined using spectral analysis, and correlations between CORT, PRL and other parameters were investigated using cross-spectral analysis. Under FF conditions, CORT secretion was not related to the lighting intensity and eating behavior. However, under RF conditions, the CORT secretion rhythm showed a distinct correlation with lighting intensity and eating behavior. Under FF conditions, the PRL secretion rhythm was similar in all seasons. However, under RF conditions, the PRL rhythm oscillated with high frequency in summer and low frequency in winter, indicating a seasonal change in rhythm. The present study demonstrates that hormone secretion rhythms change under different environments and management techniques. PMID:23829645

Ogino, Mizuna; Matsuura, Akihiro; Yamazaki, Atusi; Irimajiri, Mami; Suzuki, Yoshihiro; Kushibiki, Shiro; Singu, Hroyuki; Kasuya, Etsuko; Hasegawa, Yoshihisa; Hodate, Koichi

2014-01-01

303

Reliability and Efficacy of Water Use Estimation Techniques and their Impact on Water Management and Policy  

NASA Astrophysics Data System (ADS)

Estimating how much water is being used by various water users is key to effective management and optimal utilization of groundwater resources. This is especially true for aquifers like the Ogallala that are severely stressed and display depleting trends over the last many years. The High Plains Underground Water Conservation District (HPWD) is the largest and oldest of the Texas water conservation districts, and oversees approximately 1.7 million irrigated acres. Water users within the 16 counties that comprise the HPWD draw from the Ogallala extensively. The HPWD has recently proposed flow-meters as well as various 'alternative methods' for water users to report water usage. Alternative methods include using a) site specific energy conversion factors to convert total amount of energy used (for pumping stations) to water pumped, b) reporting nozzle package (on center pivot irrigation systems) specifications and hours of usage, and c) reporting concentrated animal feeding operations (CAFOs). The focus of this project was to evaluate the reliability and effectiveness for each of these water use estimation techniques for regulatory purposes. Reliability and effectiveness of direct flow-metering devices was also addressed. Findings indicate that due to site-specific variability and hydrogeologic heterogeneity, alternative methods for estimating water use can have significant uncertainties associated with water use estimates. The impact of these uncertainties on overall water usage, conservation, and management was also evaluated. The findings were communicated to the Stakeholder Advisory Group and the Water Conservation District with guidelines and recommendations on how best to implement the various techniques.

Singh, A.; Deeds, N.; Kelley, V.

2012-12-01

304

Developing Critical Thinking and Interpersonal Skills in a Services Marketing Course Employing Total Quality Management Concepts and Techniques  

Microsoft Academic Search

This article posits that total quality management (TQM) techniques can assist educators in developing critical thinking and interpersonal skills in a services marketing course. Literature addressing pedagogical deficiencies in U.S. business schools is reviewed, and key points regarding services marketing are highlighted. TQM techniques are then linked to teaching exercises conducted in a services marketing class.

John R. Ronchetto; Tom A. Buckles

1994-01-01

305

A closed-loop anesthetic delivery system for real-time control of burst suppression  

NASA Astrophysics Data System (ADS)

Objective. There is growing interest in using closed-loop anesthetic delivery (CLAD) systems to automate control of brain states (sedation, unconsciousness and antinociception) in patients receiving anesthesia care. The accuracy and reliability of these systems can be improved by using as control signals electroencephalogram (EEG) markers for which the neurophysiological links to the anesthetic-induced brain states are well established. Burst suppression, in which bursts of electrical activity alternate with periods of quiescence or suppression, is a well-known, readily discernible EEG marker of profound brain inactivation and unconsciousness. This pattern is commonly maintained when anesthetics are administered to produce a medically-induced coma for cerebral protection in patients suffering from brain injuries or to arrest brain activity in patients having uncontrollable seizures. Although the coma may be required for several hours or days, drug infusion rates are managed inefficiently by manual adjustment. Our objective is to design a CLAD system for burst suppression control to automate management of medically-induced coma. Approach. We establish a CLAD system to control burst suppression consisting of: a two-dimensional linear system model relating the anesthetic brain level to the EEG dynamics; a new control signal, the burst suppression probability (BSP) defining the instantaneous probability of suppression; the BSP filter, a state-space algorithm to estimate the BSP from EEG recordings; a proportional-integral controller; and a system identification procedure to estimate the model and controller parameters. Main results. We demonstrate reliable performance of our system in simulation studies of burst suppression control using both propofol and etomidate in rodent experiments based on Vijn and Sneyd, and in human experiments based on the Schnider pharmacokinetic model for propofol. Using propofol, we further demonstrate that our control system reliably tracks changing target levels of burst suppression in simulated human subjects across different epidemiological profiles. Significance. Our results give new insights into CLAD system design and suggest a control-theory framework to automate second-to-second control of burst suppression for management of medically-induced coma.

Liberman, Max Y.; Ching, ShiNung; Chemali, Jessica; Brown, Emery N.

2013-08-01

306

Molecular genetic analysis of volatile-anesthetic action.  

PubMed Central

The mechanism(s) and site(s) of action of volatile inhaled anesthetics are unknown in spite of the clinical use of these agents for more than 150 years. In the present study, the model eukaryote Saccharomyces cerevisiae was used to investigate the action of anesthetic agents because of its powerful molecular genetics. It was found that growth of yeast cells is inhibited by the five common volatile anesthetics tested (isoflurane, halothane, enflurane, sevoflurane, and methoxyflurane). Growth inhibition by the agents is relatively rapid and reversible. The potency of these compounds as yeast growth inhibitors directly correlates with their lipophilicity as is predicted by the Meyer-Overton relationship, which directly correlates anesthetic potency of agents and their lipophilicity. The effects of isoflurane on yeast cells were characterized in the most detail. Yeast cells survive at least 48 h in a concentration of isoflurane that inhibits colony formation. Mutants resistant to the growth-inhibitory effects of isoflurane are readily selected. The gene identified by one of these mutations, zzz4-1, has been cloned and characterized. The predicted ZZZ4 gene product has extensive homology to phospholipase A2-activating protein, a GO effector protein of mice. Both zzz4-1 and a deletion of ZZZ4 confer resistance to all five of the agents tested, suggesting that signal transduction may be involved in the response of these cells to volatile anesthetics. PMID:8668160

Keil, R L; Wolfe, D; Reiner, T; Peterson, C J; Riley, J L

1996-01-01

307

Anesthetic management of a patient with isovaleric acidemia.  

PubMed

A 3-year-old male with isovaleric acidemia presented for dental rehabilitation under general anesthesia. In times of stress, such as in the perioperative period, patients with isovaleric acidemia are at greater risk for morbidity and mortality from disordered metabolism, including glucose disturbances, hyperammonemia, hypocalcemia, and non-anion gap metabolic acidosis. Communication between the anesthesiology, dental, and endocrine teams allowed for safe and successful care of the patient. PMID:25642957

Lam, Humphrey; Kiberenge, Roy; Nguyen, Thanh; Sobey, Jenna Helmer; Austin, Thomas

2015-02-01

308

Anesthesia and Management of Anesthetic Complications of Laparoscopic Urological Surgery  

Microsoft Academic Search

\\u000a Patients undergoing laparoscopic urological surgery are subjected by definition to non-physiological trespass that threatens\\u000a to destabilize their homeostasis. Consequently, the anesthesiologist needs to take an active role in the process from the\\u000a outset and must work closely with the surgical team in order to bring the patient through the operation without adverse outcome.\\u000a This coordinated effort involves preoperative patient evaluation,

Philip Lebowitz; Mahesan Richards; Christopher Bryan-Brown

309

[Anesthetic management of an adult patient with tracheobronchomalacia].  

PubMed

General anesthesia was successfully performed in an 86-year-old woman with severe tracheobronchomalacia Tracheobronchomalacia in adult is a very rare disease, characterized by weakness of the trachea and bronchi, causing luminal narrowing during expiration. The patient had laparoscopic cholecystectomy. We used propofol, remifentanil, and rocuronium for induction of anesthesia. For maintenance of anesthesia, oxygen, air, propofol, fentanyl, and remifentanil were used. After the end of operation, we used sugammadex to reverse neuromuscular blockade by rocuronium. The patient showed spontaneous breathing and good awareness, and we extubated. The patient did well, and was discharged from the hospital 3 days after the operation. In this case, no special care such as postoperative CPAP was necessary, but normally, general anesthesia for a patient with tracheobronchomalacia requires attention. We gave general anesthesia satisfactorily in a patient with tracheobronchomalacia. PMID:25199324

Sogo, Daigo; Nakazawa, Tadashi; Nishio, Wataru; Fukukita, Kunio

2014-08-01

310

Anesthetic management of a case of armored brain  

PubMed Central

Armored brain is condition, which occurs due to calcification in a chronic subdural hematoma (SDH). Here, we are reporting a case of armored brain due to chronic SDH as a complication of vetriculoperitoneal shunt (VP shunt). Patient had undergone major surgery for removal of calcified hematoma. VP shunt is a simple surgery, but can lead to catastrophic complications like this. In this report, we had described this condition and its aspects. PMID:25558206

Gupta, Surender Kumar; Pandia, Mihir Prakash

2015-01-01

311

Software Health Management: A Short Review of Challenges and Existing Techniques  

NASA Technical Reports Server (NTRS)

Modern spacecraft (as well as most other complex mechanisms like aircraft, automobiles, and chemical plants) rely more and more on software, to a point where software failures have caused severe accidents and loss of missions. Software failures during a manned mission can cause loss of life, so there are severe requirements to make the software as safe and reliable as possible. Typically, verification and validation (V&V) has the task of making sure that all software errors are found before the software is deployed and that it always conforms to the requirements. Experience, however, shows that this gold standard of error-free software cannot be reached in practice. Even if the software alone is free of glitches, its interoperation with the hardware (e.g., with sensors or actuators) can cause problems. Unexpected operational conditions or changes in the environment may ultimately cause a software system to fail. Is there a way to surmount this problem? In most modern aircraft and many automobiles, hardware such as central electrical, mechanical, and hydraulic components are monitored by IVHM (Integrated Vehicle Health Management) systems. These systems can recognize, isolate, and identify faults and failures, both those that already occurred as well as imminent ones. With the help of diagnostics and prognostics, appropriate mitigation strategies can be selected (replacement or repair, switch to redundant systems, etc.). In this short paper, we discuss some challenges and promising techniques for software health management (SWHM). In particular, we identify unique challenges for preventing software failure in systems which involve both software and hardware components. We then present our classifications of techniques related to SWHM. These classifications are performed based on dimensions of interest to both developers and users of the techniques, and hopefully provide a map for dealing with software faults and failures.

Pipatsrisawat, Knot; Darwiche, Adnan; Mengshoel, Ole J.; Schumann, Johann

2009-01-01

312

Interrami intraoral fixation technique for severe mandibular rifle fragmented bullet injury management.  

PubMed

Interrami intraoral Kirschner wire fixation technique is presented for the reduction, stabilization, and immobilization of a pulverized and avulsed lower jaw caused by rifle fragmented bullet injuries. This indirect mandibular war injury fixation technique was tolerated by the patients and tissue more than any indirect external fixation. In addition, it is easier than open reduction using large bone plates for disrupted ballistics mandibular injury defects. An interrami intraoral fixation is appropriate for severely disrupted mandibular hard and soft tissues, and has been adapted in cases of mass casualties and limited resources. Benefits of use include limited hospital beds and fewer follow-up visits. Rifle fragmented bullet injuries need more attention for several reasons: not only because of the higher mortality and devastating nature of the injuries, but also because these injuries are responsible for an unreported type of bullet biomechanism wounding in the craniofacial region. In turn, this necessitates specialized victim management. The survival rates depend on immediate proper execution of airway, breathing, and circulation, which become more complicated as it relates to airway compromise and oropharyngeal hemorrhage resuscitation. Survival is predicated on the implementation of feasible, sensible, life-saving techniques that are applied at the appropriate time. PMID:23851763

Shuker, Sabri T

2013-07-01

313

Inhaled Anesthetics Promote Albumin Dimerization through Reciprocal Exchange of Subdomains  

PubMed Central

Inhaled anesthetics affect protein-protein interaction, but the mechanisms underlying these effects are still poorly understood. We examined the impact of sevoflurane and isoflurane on the dimerization of human serum albumin (HSA), a protein with anesthetic binding sites that are well characterized. Intrinsic fluorescence emission was analyzed for spectral shifting and self-quenching, and control first derivatives (spectral responses to changes in HSA concentration) were compared against those obtained from samples treated with sevoflurane or isoflurane. Sevoflurane increased dimer-dependent self-quenching and both decreased oligomer-dependent spectral shifting, suggesting that inhaled anesthetics promoted HSA dimerization. Size exclusion chromatography and polarization data were consistent with these observations. The data support the proposed model of a reciprocal exchange of subdomains to form an HSA dimer. The open-ended exchange of subdomains, which we propose occuring in HSA oligomers, was inhibited by sevoflurane and isoflurane. PMID:21188076

Pieters, Benjamin J.; Fibuch, Eugene E.; Eklund, Joshua D.; Seidler, Norbert W.

2010-01-01

314

Double blind randomised controlled trial of two different breathing techniques in the management of asthma  

PubMed Central

Background Previous studies have shown that breathing techniques reduce short acting ?2 agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non?specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. Methods After a 2?week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30?weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Results Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p?=?0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p<0.0001) and ICS dose was reduced by 50% (p<0.0001; p>0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Conclusion Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non?specific upper body exercises. PMID:16517572

Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic?Anticevich, S Z; Thien, F C K; Jenkins, C R

2006-01-01

315

Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series.  

PubMed

Status asthmaticus is an acute, intractable asthma attack refractory to standard interventions that can lead to progressive respiratory failure. Successful management requires a fundamental understanding of the disease process, its clinical presentation, and proper evaluation. Treatment must be instituted early and is aimed at reversing the airway inflammation, bronchoconstriction, and hyper-reactivity that often lead to lower airway obstruction, impaired ventilation, and oxygenation. Most patients are effectively treated with standard therapy including beta2-adrenergic agonists and corticosteroids. Others necessitate adjunctive therapies and escalation to noninvasive ventilation or intubation. We will review the pathophysiology, evaluation, and treatment options for pediatric patients presenting with status asthmaticus with a particular focus on refractory status asthmaticus treated with volatile anesthetics. In addition, we include a proven approach to the management of these patients in the critical care setting, which requires close coordination between critical care and anesthesia providers. We present a case series of three patients, two of which have the longest reported cases of continuous isoflurane use in status asthmaticus. This series was obtained from a retrospective chart review and highlights the efficacy of the volatile anesthetic, isoflurane, in three pediatric patients with refractory life-threatening status asthmaticus. PMID:25580870

Carrié, Sabrina; Anderson, Thomas Anthony

2015-05-01

316

How American dentists helped pioneer oxygenation of general anesthetics worldwide.  

PubMed

Dentists Horace Wells and later William Morton introduced the world to general anesthesia with nitrous oxide and ether, respectively. During the latter half of the 1800s, some of their colleagues actually redefined anesthetic gas mixtures as ones including either room air or oxygen as a carrier gas. American dentists pioneered America's first series of bubble-through anesthetic vaporizers as well as early efforts in anesthesia literature and education. By the end of the 19th Century, America's leading dental supplier, S.S. White, was mass-producing an anesthesia apparatus which combined oxygen with nitrous oxide--a template or catalyst for the design of anesthesia machines worldwide. PMID:20222218

Bause, George S

2009-01-01

317

The interaction of local anesthetics with lipid membranes.  

PubMed

Molecular Dynamic Simulations are performed to evaluate the interaction of lidocaine, procaine and tetracaine with a lipid membrane. The main interest is to evaluate the structural changes produced by these local anesthetics in the bilayers. Penetration trajectories, interaction energies, entropy changes and an order parameter are calculated to quantify the destabilization of the lipid configurations. We show that such structural parameters give important information to understand how anesthetic agents influence the structure of plasma membranes. Graphic processing units (GPUs) are used in our simulations. PMID:25181454

Zapata-Morin, Patricio A; Sierra-Valdez, F J; Ruiz-Suárez, J C

2014-09-01

318

Management of brain AVM procedural hemorrhagic complication by the "security" catheter technique.  

PubMed

Since the introduction of Onyx as a liquid embolic agent for the treatment of brain arteriovenous malformation (AVM), higher endovascular cure rates have been achieved. This may be partially attributed to its non-adhesive property, which allows longer intranidal progression of the embolic agent before solidification. However, Onyx reflux around the microcatheter can form a highly viscous plug, thereby constraining the microcatheter during its retrieval. Also, during the maneuver, arterial stretching can lead to vascular rupture and result in acute bleeding, a potentially fatal complication that demands immediate treatment. This report describes a new treatment strategy for the rapid management of such a complication. The technique consists of the placement of a second microcatheter about 2 cm proximal to the AVM nidus in the same artery containing the intranidal microcatheter. After conclusion of embolization, if rupture occurs during intranidal microcatheter retrieval, the second microcatheter that is already in place can promptly be used to control the bleeding. PMID:22633041

Abud, Daniel Giansante; Abud, Thiago Giansante; Nakiri, Guilherme Seizem

2013-03-01

319

Western pond turtle: Biology, sampling techniques, inventory and monitoring, conservation, and management: Northwest Fauna No. 7  

USGS Publications Warehouse

One of only two native, freshwater turtle species in the western United States, western pond turtles are declining in portions of their original range. Declines are mostly due to habitat loss, introduction of non-native species, pollution, and lack of connectivity among populations. USGS zoologist R. Bruce Bury and colleagues from the U.S. Forest Service, California State University, and other agencies compiled and edited a new review and field manual of this charismatic species. Objectives were to determine its current distribution and abundance, summarize and evaluate population features, review techniques to detect population and habitat changes, and improve monitoring for long-term trends. Methods described in the manual should improve consistency, efficiency, and accuracy of survey data, resulting in improved management and conservation efforts.

2012-01-01

320

Assessment of the best available wastewater management techniques for a textile mill: cost and benefit analysis.  

PubMed

In the present study, several water recovery and end-of-pipe wastewater treatment alternatives were evaluated towards the evaluation of Best Available Techniques (BATs) for the management of wastewaters from a denim textile mill in accordance with the European Union's Integrated Pollution Prevention and Control (IPPC) Directive. For this purpose, an assessment that translates the key environmental aspects into a quantitative measure of environmental performance and also financial analysis was performed for each of the alternatives. The alternatives considered for water recovery from dyeing wastewaters were nanofiltration (NF) with coagulation and/or microfiltration (MF) pre-treatment, ozonation or peroxone and Fenton oxidation. On the other hand, for the end-of-pipe treatment of the mill's mixed wastewater, ozonation, Fenton oxidation, membrane bioreactor (MBR) and activated sludge (AS) process followed by membrane filtration technologies were evaluated. The results have indicated that membrane filtration process with the least environmental impacts is the BAT for water recovery. On the other side, MBR technology has appeared as the BAT for the end-of-pipe treatment of the mill's mixed wastewater. A technical and financial comparison of these two BAT alternatives revealed that water recovery via membrane filtration from dyeing wastewaters is selected as the BAT for the water and wastewater management in the mill. PMID:20182075

Dogan, Bugce; Kerestecioglu, Merih; Yetis, Ulku

2010-01-01

321

Educating the Business Process Managers of the Future: The Six Sigma Techniques  

NSDL National Science Digital Library

Six Sigma is a strategy designed to improve efficiency in manufacturing and business processes. Its basic focus is to decrease defect, improve overall quality, reduce cost and increase profit in production. Modern operations managers recognize the tremendous advantage of applying innovative and advanced techniques that would increase productivity and customer satisfaction. Tomorrows managers are being educated at universities today. Implementing business processes analysis and improvement methodologies should be considered an important component of this education. Six Sigma methodology offers a comprehensive body of knowledge to aid with such process improvements.This paper suggests a road map for implementation of a graduate course in Six Sigma. Students would start by acquiring the basic cognitive skills and mastering the necessary underlying concepts and theories. These theories are then put into practice through a project selection and execution. Finally, students would be prepared to offer recommendations and suggestions for the selected business on manufacturing processes.As with any instructional and curriculum material, a course in Six Sigma methodology should also provide a means of assessing outcomes and student learning. This paper will present and discuss these issues and should be of great interest to those educators who wish to offer instructions on this topic.

Stephens, Matthew P.

322

Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies  

SciTech Connect

As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

2011-11-15

323

The Limits of Corporate Social Responsibility: Techniques of Neutralization, Stakeholder Management and Political CSR  

PubMed Central

Since scholarly interest in corporate social responsibility (CSR) has primarily focused on the synergies between social and economic performance, our understanding of how (and the conditions under which) companies use CSR to produce policy outcomes that work against public welfare has remained comparatively under-developed. In particular, little is known about how corporate decision-makers privately reconcile the conflicts between public and private interests, even though this is likely to be relevant to understanding the limitations of CSR as a means of aligning business activity with the broader public interest. This study addresses this issue using internal tobacco industry documents to explore British-American Tobacco’s (BAT) thinking on CSR and its effects on the company’s CSR Programme. The article presents a three-stage model of CSR development, based on Sykes and Matza’s theory of techniques of neutralization, which links together: how BAT managers made sense of the company’s declining political authority in the mid-1990s; how they subsequently justified the use of CSR as a tool of stakeholder management aimed at diffusing the political impact of public health advocates by breaking up political constituencies working towards evidence-based tobacco regulation; and how CSR works ideologically to shape stakeholders’ perceptions of the relative merits of competing approaches to tobacco control. Our analysis has three implications for research and practice. First, it underlines the importance of approaching corporate managers’ public comments on CSR critically and situating them in their economic, political and historical contexts. Second, it illustrates the importance of focusing on the political aims and effects of CSR. Third, by showing how CSR practices are used to stymie evidence-based government regulation, the article underlines the importance of highlighting and developing matrices to assess the negative social impacts of CSR. PMID:23997379

Gilmore, Anna; Collin, Jeff; Holden, Chris; Lee, Kelley

2013-01-01

324

The Limits of Corporate Social Responsibility: Techniques of Neutralization, Stakeholder Management and Political CSR.  

PubMed

Since scholarly interest in corporate social responsibility (CSR) has primarily focused on the synergies between social and economic performance, our understanding of how (and the conditions under which) companies use CSR to produce policy outcomes that work against public welfare has remained comparatively under-developed. In particular, little is known about how corporate decision-makers privately reconcile the conflicts between public and private interests, even though this is likely to be relevant to understanding the limitations of CSR as a means of aligning business activity with the broader public interest. This study addresses this issue using internal tobacco industry documents to explore British-American Tobacco's (BAT) thinking on CSR and its effects on the company's CSR Programme. The article presents a three-stage model of CSR development, based on Sykes and Matza's theory of techniques of neutralization, which links together: how BAT managers made sense of the company's declining political authority in the mid-1990s; how they subsequently justified the use of CSR as a tool of stakeholder management aimed at diffusing the political impact of public health advocates by breaking up political constituencies working towards evidence-based tobacco regulation; and how CSR works ideologically to shape stakeholders' perceptions of the relative merits of competing approaches to tobacco control. Our analysis has three implications for research and practice. First, it underlines the importance of approaching corporate managers' public comments on CSR critically and situating them in their economic, political and historical contexts. Second, it illustrates the importance of focusing on the political aims and effects of CSR. Third, by showing how CSR practices are used to stymie evidence-based government regulation, the article underlines the importance of highlighting and developing matrices to assess the negative social impacts of CSR. PMID:23997379

Fooks, Gary; Gilmore, Anna; Collin, Jeff; Holden, Chris; Lee, Kelley

2013-01-01

325

75 FR 876 - Anesthetic and Life Support Drugs Advisory Committee; Cancellation  

Federal Register 2010, 2011, 2012, 2013, 2014

...Administration [Docket No. FDA-2009-N-0664] Anesthetic and Life Support Drugs Advisory Committee; Cancellation AGENCY: Food...SUMMARY: The meeting of the Anesthetic and Life Support Drugs Advisory Committee scheduled for January 28,...

2010-01-06

326

Organizational structure : management techniques and lessons learned in aligning technical and program management resources in engineering-intensive organizations  

E-print Network

The roles of systems engineering, program and project management, and engineering management are continuously blurred and challenged in complex engineering organizations. The demands made of each of these functions can ...

Siddiqui, Talha, 1969-

2005-01-01

327

Effective management of medical information through a novel blind watermarking technique.  

PubMed

Medical Data Management (MDM) domain consists of various issues of medical information like authentication, security, privacy, retrieval and storage etc. Medical Image Watermarking (MIW) techniques have recently emerged as a leading technology to solve the problems associated with MDM. This paper proposes a blind, Contourlet Transform (CNT) based MIW scheme, robust to high JPEG and JPEG2000 compression and simultaneously capable of addressing a range of MDM issues like medical information security, content authentication, safe archiving and controlled access retrieval etc. It also provides a way for effective data communication along with automated medical personnel teaching. The original medical image is first decomposed by CNT. The Low pass subband is used to embed the watermark in such a way that enables the proposed method to extract the embedded watermark in a blind manner. Inverse CNT is then applied to get the watermarked image. Extensive experiments were carried out and the performance of the proposed scheme is evaluated through both subjective and quantitative measures. The experimental results and comparisons, confirm the effectiveness and efficiency of the proposed technique in the MDM paradigm. PMID:22327385

Das, Sudeb; Kundu, Malay Kumar

2012-10-01

328

Managing complex processing of medical image sequences by program supervision techniques  

NASA Astrophysics Data System (ADS)

Our objective is to offer clinicians wider access to evolving medical image processing (MIP) techniques, crucial to improve assessment and quantification of physiological processes, but difficult to handle for non-specialists in MIP. Based on artificial intelligence techniques, our approach consists in the development of a knowledge-based program supervision system, automating the management of MIP libraries. It comprises a library of programs, a knowledge base capturing the expertise about programs and data and a supervision engine. It selects, organizes and executes the appropriate MIP programs given a goal to achieve and a data set, with dynamic feedback based on the results obtained. It also advises users in the development of new procedures chaining MIP programs.. We have experimented the approach for an application of factor analysis of medical image sequences as a means of predicting the response of osteosarcoma to chemotherapy, with both MRI and NM dynamic image sequences. As a result our program supervision system frees clinical end-users from performing tasks outside their competence, permitting them to concentrate on clinical issues. Therefore our approach enables a better exploitation of possibilities offered by MIP and higher quality results, both in terms of robustness and reliability.

Crubezy, Monica; Aubry, Florent; Moisan, Sabine; Chameroy, Virginie; Thonnat, Monique; Di Paola, Robert

1997-05-01

329

[Local anesthetics--maximum recommended doses].  

PubMed

"Maximum doses" determined up to now do not take account of such important pharmacokinetic and toxicological data as: 1) the dependence of blood levels measured on the technique of regional anaesthesia, 2) and the raised toxicity of a local anaesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation differs according to the technique of local anaesthesia for A: subcutaneous injection, B: injection in regions of high absorption, C: single injection (perineural, e.g. plexus), D: protracted injection (catheter, combined techniques), E: injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic). This sequential categorization also underscores the need to select appropriate techniques as well as concomitant monitoring according to the technique of administration and to the expected and possible plasma level curve. The "maximum recommended doses" (in mg) of mepivacaine for use with the above five different techniques of regional anaesthesia are (doses together with the vasoconstrictor adrenaline are in brackets): A: 400 (500), B: 200, C: 400 (500), D: 500, E: 1-25 ml; those for lidocaine: A: 400 (500), B: 200, C: 400 (500), D: 500, E: 1-25 ml, for prilocaine: A: 600, B: 300, C: 600, D: 700, E: 1-25 ml, for bupivacaine: A: 150, B: 75, C: 150, D: 200, E: 1-25 ml, for etidocaine: A: 300, B: 150, C: 300, D: 300, E: up to 25 ml (no spinal anaesthesia). These "recommended maximum doses" are low for zones of raised absorption and higher for techniques of protracted injection. For prilocaine, bupivacaine and etidocaine, the "maximum recommended doses" are the same regardless of whether or not the solutions contain adrenaline. The preparation containing adrenaline is limited by the total adrenaline content (0.25 mg). The dose spectrum must be specified for all injections carried out close to the spinal cord because of the specific risk: even very tiny volumes can have an intensive effect and they involve high risks. The values specified for techniques C and D also restrict the overall dose for the techniques specified under E when high doses are necessary. The amount of the repetition dose of bupivacaine can be reliably given as 30 mg/h. Recommended maximum doses given here relate to normal conditions (70 kg body weight). They must be varied individually depending on the body weight and condition of the patient. Recommended maximum doses are of orientative significance, they do not constitute a maximum dose. There is no quantitative limit for ropivaccine because the recommended techniques do not allow higher volumes of this long acting local anaesthetic. PMID:9324365

Niesel, H C

1997-01-01

330

Effects of some anesthetic agents on skin microcirculation evaluated by laser Doppler perfusion imaging in mice  

PubMed Central

Background Anesthetic agents alter microcirculation, influencing tissue oxygenation and delivery of vital substrates. Laser Doppler perfusion imaging is a widespread technique in the field of microvascular research that can evaluate noninvasively and in real time the effects of environmental conditions, physical manipulations, diseases and treatments on peripheral perfusion. This study aims to evaluate laser Doppler perfusion imaging as a means to detect changes in skin microcirculation induced by some popular anesthetic agents in a murine model. Twenty-four age- and gender-matched healthy CD1 mice were examined by laser Doppler perfusion imaging. The skin microcirculatory response was measured at the level of plantar surfaces during isoflurane anesthesia with or without subsequent dexmedetomidine or acepromazine. At the end of the procedure, dexmedetomidine was reversed by atipamezole administration. Results In all mice, skin blood flow under isoflurane anesthesia did not show significant differences over time (P = 0.1). The serial perfusion pattern and values following acepromazine or dexmedetomidine administration differed significantly (P < 0.05). Conclusions We standardized a reliable laser Doppler perfusion imaging protocol to non-invasively assess changes in skin microcirculation induced by anesthesia in mice, considering the advantages and drawbacks of this technique and its translational value. PMID:24341447

2013-01-01

331

Concentrations of anesthetics across the water-membrane interface; the Meyer-Overton hypothesis revisited  

NASA Technical Reports Server (NTRS)

The free energies of transferring a variety of anesthetic and nonanesthetic compounds across water-oil and water-membrane interfaces were obtained using computer simulations. Anesthetics exhibit greatly enhanced concentrations at these interfaces, compared to nonanesthetics. The substitution of the interfacial solubilites of the anesthetics for their bulk lipid solubilities in the Meyer-Overton relation, was found to give a better correlation, indicating that the potency of an anesthetic is directly proportional to its solubility at the interface.

Pohorille, A.; Wilson, M. A.; New, M. H.; Chipot, C.

1998-01-01

332

Is Chemical Incompatibility Responsible for Chondrocyte Death Induced by Local Anesthetics?  

Microsoft Academic Search

Background: Chondrolysis associated with intra-articular administration of local anesthetics has been attributed to chondrocyte death induced by the local anesthetics. The mechanism of how the local anesthetics cause chondrocyte death is not clear.Purpose: This study was conducted to determine whether and how the local anesthetics cause chondrocyte death.Study Design: Controlled laboratory study.Methods: Bovine articular chondrocytes in suspension culture were treated

Michael T. Bogatch; David G. Ferachi; Bart Kyle; Sam Popinchalk; Melanie H. Howell; Dongxia Ge; Zongbing You; Felix H. Savoie

2010-01-01

333

Efficacy of Benzocaine as an Anesthetic for Sahnonid Fishes  

Microsoft Academic Search

Benzocaine was tested in the laboratory to determine the effective concentrations for anesthetizing juvenile chinook salmon Oncorhynchus tshawytscha and rainbow trout O. mykiss (formerly Salmo gairdneri). Tests were conducted at three water temperatures, in waters ranging from very soft to very hard, and with groups of rainbow trout from 5 to 47 cm long and chinook salmon 20 cm long.

Philip A. Gilderhus

1989-01-01

334

Isoflurane as an inhalation anesthetic for muskrats (Ondatra zibethicus).  

PubMed

The effectiveness of isoflurane as an inhalation anesthetic for muskrats (Ondatra zibethicus) was evaluated. Thirty muskrats were anesthetized in an enclosed chamber using 10 ml of isoflurane in Carlton County, Minnesota (USA), from 27 September to 24 October 1994. Mean (+/- SE) induction time for adults, juveniles, and kits was 20.6 +/- 2.9, 21.5 +/- 2.4, and 16.9 +/- 5.3 min, respectively (P = 0.77). Respective mean arousal times for adults, juveniles, and kits were 5.1 +/- 0.5, 5.7 +/- 0.7, and 5.7 +/- 0.6 min (P = 0.78). Heart rate, respiration rate, and body temperature were similar among age classes (P = 0.08 to 0.58). Mortality (3.3%) was comparable to that of other inhalation anesthetics. No short-term adverse effects were observed in recaptured individuals. Isoflurane is a safe and effective inhalation anesthetic for muskrats, although prolonged induction may limit its use in field studies. PMID:8592396

Belant, J L

1995-10-01

335

Anesthetic effect of 4-styrylpyridine on lamprey and fish  

USGS Publications Warehouse

The anestheticp roperty of 4-styrylpyridine (4-SP) on fish and lamprey was first noticed during chemical screening search of a selective toxicant for larval lamprey (Applegate, Howell, Hall, and Smith, 1957). To assess the possible value of the compound as an anesthetic, we later conducted the experiments reviewed in this report.

Howell, John H.; Thomas, Paul M.

1964-01-01

336

Minimally Painful Local Anesthetic Injection for Cleft Lip/Nasal Repair in Grown Patients  

PubMed Central

Introduction: There has been a recent interest in injecting large body and face areas with local anesthetic in a minimally painful manner. The method includes adherence to minimal pain injection details as well feedback from the patient who counts the number of times he feels pain during the injection process. This article describes the successes and limitations of this technique as applied to primary cleft lip/nasal repair in grown patients. Methods: Thirty-two primary cleft lip patients were injected with local anesthesia by 3 surgeons and then underwent surgical correction of their deformity. At the beginning of the injection of the local anesthetic, patients were instructed to clearly inform the injector each and every time they felt pain during the entire injection process. Results: The average patient felt pain only 1.6 times during the injection process. This included the first sting of the first 27-gauge needle poke. The only pain that 51% of the patients felt was that first poke of the first needle; 24% of the patients only felt pain twice during the whole injection process. The worst pain score occurred in a patient who felt pain 6 times during the injection process. Ninety-one percent of the patients felt no pain at all after the injection of the local anesthetic and did not require a top-up. Conclusion: It is possible to successfully and reliably inject local anesthesia in a minimally painful manner for cleft lip and nasal repair in the fully grown cleft patient. PMID:25289364

Price, Christopher; Wong, Alison L.; Chokotho, Tilinde

2014-01-01

337

Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective  

PubMed Central

Perioperative cerebral damage can result in various clinical sequela ranging from minor neurocognitive deficits to catastrophic neurological morbidity with permanent impairment and death. The goal of neuroprotective treatments is to reduce the clinical effects of cerebral damage through two major mechanisms: increased tolerance of neurological tissue to ischemia and changes in intra-cellular responses to energy supply deprivation. In this review, we present the clinical evidence of intravenous anesthetics on perioperative neuroprotection, and we also provide a critical perspective for future studies. The neuroprotective efficacy of the intravenous anesthetics thiopental, propofol and etomidate is unproven. Lidocaine may be neuroprotective in non-diabetic patients who have undergoing cardiac surgery with cardiopulmonary bypass (CBP) or with a 48-hour infusion, but conclusive data are lacking. There are several limitations of clinical studies that evaluate postoperative cognitive dysfunction (POCD), including difficulties in identifying patients at high-risk and a lack of consensus for defining the “gold-standard” neuropsychological testing. Although a battery of neurocognitive tests remains the primary method for diagnosing POCD, recent evidence suggests a role for novel biomarkers and neuroimaging to preemptively identify patients more susceptible to cognitive decline in the perioperative period. Current evidence, while inconclusive, suggest that intravenous anesthetics may be both neuroprotective and neurotoxic in the perioperative period. A critical analysis on data recorded from randomized control trials (RCTs) is essential in identifying patients who may benefit or be harmed by a particular anesthetic. RCTs will also contribute to defining methodologies for future studies on the neuroprotective effects of intravenous anesthetics. PMID:24669972

Bilotta, Federico; Stazi, Elisabetta; Zlotnik, Alexander; Gruenbaum, Shaun E.; Rosa, Giovanni

2015-01-01

338

Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract versus lower tract approach.  

PubMed

The optimal management approach for children with ureterocele and complete pyeloureteral duplication, especially in the setting of high-grade ipsilateral vesicoureteral reflux, remains unclear. Trends in surgical management reflect a shift from single-stage open reconstruction toward conservative management and minimally invasive approaches. This article reviews lower tract approaches (endoscopic ureterocele incision and ipsilateral ureteroureterostomy), and upper tract approaches (ureterocele moiety heminephrectomy) in terms of selected operative techniques, patient selection, published outcomes, postoperative care, and follow-up. Current data support endoscopic puncture as a safe and effective treatment of symptomatic children with single-system intravesical ureteroceles. PMID:25455173

Timberlake, Matthew D; Corbett, Sean T

2015-02-01

339

Simultaneous determination of local anesthetics including ester-type anesthetics in human plasma and urine by gas chromatography–mass spectrometry with solid-phase extraction  

Microsoft Academic Search

The present study describes the simultaneous determination of seven different kinds of local anesthetics and one metabolite by GC–MS with solid-state extraction: Mepivacaine, propitocaine, lidocaine, procaine (an ester-type local anesthetics), cocaine, tetracaine (an ester-type local anesthetics), dibucaine (Dib) and monoethylglycinexylidide (a metabolite of lidocaine) were clearly separated from each other and simultaneously determined by GC–MS using a DB-1 open tubular

Tohru Ohshima; Tatsunori Takayasu

1999-01-01

340

Assessment of alternative management techniques of tank bottom petroleum sludge in Oman.  

PubMed

This paper investigated several options for environmentally acceptable management techniques of tank bottom oily sludge. In particular, we tested the applicability of managing the sludge by three options: (1) as a fuel supplement; (2) in solidification; (3) as a road material. Environmental testing included determination of heavy metals concentration; toxic organics concentration and radiological properties. The assessment of tank bottom sludge as a fuel supplement included various properties such as proximate analysis, ultimate analysis and energy content. Solidified sludge mixtures and road application sludge mixtures were subjected to leaching using the toxicity characteristic leaching procedure (TCLP). Tank bottom sludge was characterized as having higher concentrations of lead, zinc, and mercury, but lower concentrations of nickel, copper and chromium in comparison with values reported in the literature. Natural occurring radioactive minerals (NORM) activity values obtained on different sludge samples were very low or negligible compared to a NORM standard value of 100Bq/g. The fuel assessment results indicate that the heating values, the carbon content and the ash content of the sludge samples are comparable with bituminous coal, sewage sludge, meat and bone meal and petroleum coke/coal mixture, but lower than those in car tyres and petroleum coke. The nitrogen content is lower than those fuels mentioned above, while the sulfur content seems comparable with bituminous coal, petroleum coke and a petroleum coke/coal mixture. The apparent lack of leachability of metals from solidification and road material sludge applications suggests that toxic metals and organics introduced to these applications are not readily attacked by weak acid solutions and would not be expected to migrate or dissolved into the water. Thus, in-terms of trace metals and organics, the suggested sludge applications would not be considered hazardous as defined by the TCLP leaching procedure. PMID:16959405

Al-Futaisi, Ahmed; Jamrah, Ahmad; Yaghi, Basma; Taha, Ramzi

2007-03-22

341

Treatment of hemorrhagic radiation-induced proctopathy with a 4% formalin application under perianal anesthetic infiltration  

PubMed Central

AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application. METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications. RESULTS: Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application. CONCLUSION: A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective. PMID:23946599

Samalavicius, Narimantas Evaldas; Dulskas, Audrius; Kilius, Alfredas; Petrulis, Kestutis; Norkus, Darius; Burneckis, Arvydas; Valuckas, Konstantinas Povilas

2013-01-01

342

Biomechanical evaluation of a toggle pin technique for management of coxofemoral luxation.  

PubMed

Toggle pin stabilization is an accepted technique for the management of coxofemoral (CF) luxation in dogs. The purpose of this study was to determine, in vitro, the respective contributions of several aspects of toggle pin repair to the overall stability of fixation. Factors evaluated were the manner and frequency with which toggle pins oriented on insertion, effect of orientation on toggle pin strength, effect of suture type on ligament prosthesis strength and load sustained by the fixation, and comparison of repair using a modified toggle design to that of capsulorrhaphy. When placed in cadavers using standard technique, conventional toggle pins were found to orient significantly more frequently in one of two possible positions. Mechanical testing of fixations performed in experimentally luxated cadaver hips demonstrated a high (12/20) incidence of toggle pin failure using the conventional implant in the most common orientation. When tested alone, toggle pins were weakest mechanically in this orientation. Rotating the implant 180 degrees increased mean load to failure by 249%. There was no significant difference in load sustained by conventional toggle fixations using No. 2 braided polyester versus 50 lb test monofilament nylon as the suture ligament prosthesis. However, the higher stiffness of the polyester suture may be more favorable for use in this application. Fixation using a toggle rod designed to allow evaluation of construct stability when failure of the toggle is eliminated resulted in an increase in maximum load sustained before luxation (47% of the intact control hips). This load was not significantly different than the resistance to luxation afforded by capsulorrhaphy. This study suggests that when implanting conventional toggle pins, consideration should be given to ensuring placement in the strongest orientation. PMID:7839588

Flynn, M F; Edmiston, D N; Roe, S C; Richardson, D C; DeYoung, D J; Abrams, C F

1994-01-01

343

Topical Anesthetics and Office-Based Procedures  

Microsoft Academic Search

\\u000a Minor procedures performed by the primary care practitioner are a source of pain and anxiety for children and their families.\\u000a This includes procedures such as injections, veni-puncture, and bladder catheterizations. A paradigm which includes developmentally\\u000a appropriate preparation, distraction, topical and local anesthesia, and complementary techniques will make the child more\\u000a comfortable, calm the parent, and allow the procedure to be

William T. Zempsky; Neil L. Schechter

344

Intralipid Therapy for Inadvertent Peripheral Nervous System Blockade Resulting from Local Anesthetic Overdose  

PubMed Central

Although local anesthetics have an acceptable safety profile, significant morbidity and mortality have been associated with their use. Inadvertent intravascular injection of local anesthetics and/or the use of excessive doses have been the most frequent causes of local anesthetic systemic toxicity (LAST). Furthermore, excessive doses of local anesthetics injected locally into the tissues may lead to inadvertent peripheral nerve infiltration and blockade. Successful treatment of LAST with intralipid has been reported. We describe a case of local anesthetic overdose that resulted in LAST and in unintentional blockade of peripheral nerves of the lower extremity; both effects completely resolved with administration of intralipid. PMID:25767725

Kamel, Ihab; Trehan, Gaurav; Barnette, Rodger

2015-01-01

345

Student Well-Being Interventions: The Effects of Stress Management Techniques and Gratitude Journaling in the Management Education Classroom  

ERIC Educational Resources Information Center

Student well-being in the management classroom is of concern to both educators and managers. Well-being is conceptualized here as students' reduction in stress, enhanced experienced meaning and engagement in the classroom, and, ultimately, heightened satisfaction with life. The authors investigated whether purposeful semester-long classroom…

Flinchbaugh, Carol L.; Moore, E. Whitney G.; Chang, Young K.; May, Douglas R.

2012-01-01

346

Management of metastatic malignant thymoma with advanced radiation and chemotherapy techniques: report of a rare case.  

PubMed

Malignant thymomas are rare epithelial neoplasms of the anterior superior mediastinum that are typically invasive in nature and have a higher risk of relapse that may ultimately lead to death. Here we report a case of an advanced malignant thymoma that was successfully treated with neoadjuvant chemotherapy followed by surgical resection and subsequently with advanced and novel radiation therapy techniques. A 65-year-old male was diagnosed with a stage IV malignant thymoma with multiple metastatic lesions involving the left peripheral lung and pericardium. Initial neoadjuvant chemotherapy with a cisplatin-based regimen resulted in a partial response allowing the inoperable tumor to become operable. Following surgical resection of the residual disease, the tumor recurred within a year. The patient then underwent a course of targeted three-dimensional intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). Five years after radiation therapy, the localized soft tissue thickening at the left upper lung anterior pleural space had resolved. Seven years after radiation therapy the tumor mass had completely resolved. No recurrences were seen and the patient is well even 8 years after IMRT/IGRT with a favorable outcome. Chemotherapy with targeted three-dimensional IMRT/IGRT should be considered the primary modality for the management of advanced malignant thymoma patients. PMID:25778007

D'Andrea, Mark A; Reddy, G Kesava

2015-12-01

347

Fuzzy logic resource manager: multi-agent techniques, fuzzy rules, strategies, and fuzzy decision tree structure  

NASA Astrophysics Data System (ADS)

Modern naval battleforces generally include many different platforms each with onboard sensors such as radar, ESM, and communications. The sharing of information measured by local sensors via communication links across the battlegroup should allow for optimal or near optimal decisions. A fuzzy logic algorithm has been developed that automatically allocates electronic attack (EA) resources in real-time. The fuzzy logic approach allows the direct incorporation of expertise allowing decisions to be made based on these rules. Genetic algorithm based optimization is conducted to determine the form of the membership functions for the fuzzy root concepts. The resource manager is made up of five parts, the isolated platform model, the multi-platform model, the communication model, the fuzzy parameter selection tree and the fuzzy strategy tree. Automatic determination of fuzzy decision tree structure using a genetic program, an algorithm that creates other computer programs is discussed. A comparison to a tree obtained using a genetic program and one constructed based on expertise is made. The automatic discovery through genetic algorithms of multi-platform techniques, rules and strategies is discussed. Two new multi-platform power allocation algorithms based on fuzzy number theory and linear and nonlinear programming are introduced. Methods of validating the algorithms are examined.

Smith, James F., III

2002-07-01

348

Development of Fuzzy Logic-Based Lead Acid Battery Management Techniques with Applications to 42V Systems  

E-print Network

Development of Fuzzy Logic-Based Lead Acid Battery Management Techniques with Applications to 42V developing patented fuzzy logic-based technology [1-3] for estimating the state-of-charge (SOC) and state on changing battery conditions. Finally, the fuzzy logic methodology lends itself well to rapid system design

Singh, Pritpal

349

Enhancing Learning Management Systems Utility for Blind Students: A Task-Oriented, User-Centered, Multi-Method Evaluation Technique  

ERIC Educational Resources Information Center

This paper presents a novel task-oriented, user-centered, multi-method evaluation (TUME) technique and shows how it is useful in providing a more complete, practical and solution-oriented assessment of the accessibility and usability of Learning Management Systems (LMS) for blind and visually impaired (BVI) students. Novel components of TUME…

Babu, Rakesh; Singh, Rahul

2013-01-01

350

Structural basis for the inhibition of firefly luciferase by a general anesthetic.  

PubMed Central

The firefly luciferase enzyme from Photinus pyralis is probably the best-characterized model system for studying anesthetic-protein interactions. It binds a diverse range of general anesthetics over a large potency range, displays a sensitivity to anesthetics that is very similar to that found in animals, and has an anesthetic sensitivity that can be modulated by one of its substrates (ATP). In this paper we describe the properties of bromoform acting as a general anesthetic (in Rana temporaria tadpoles) and as an inhibitor of the firefly luciferase enzyme at high and low ATP concentrations. In addition, we describe the crystal structure of the low-ATP form of the luciferase enzyme in the presence of bromoform at 2.2-A resolution. These results provide a structural basis for understanding the anesthetic inhibition of the enzyme, as well as an explanation for the ATP modulation of its anesthetic sensitivity. PMID:9788915

Franks, N P; Jenkins, A; Conti, E; Lieb, W R; Brick, P

1998-01-01

351

Postsurgical Candida albicans Infections Associated with an Extrinsically Contaminated Intravenous Anesthetic Agent  

PubMed Central

From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hospital developed Candida albicans fungemia or endophthalmitis. The case patients’ surgeries were clustered on two days. To identify risk factors for C. albicans infections, we conducted a cohort study comparing these 4 patients with 67 control patients who had surgeries on the same days but did not acquire C. albicans infections. The participation of anesthesiologist 9 (relative risk [RR], undefined; P < 0.001) and receipt of intravenous propofol, an anesthetic agent without preservative, which was administered by an infusion pump (RR, 8.8; P = 0.048) were identified as risk factors for C. albicans infections. The anesthetic had been recently introduced in the hospital. Hand cultures of 8 of 14 (57%) anesthesiologists were positive for Candida species; one yielded C. albicans. Anesthesiologist 9 was the only one to use stored syringes of propofol in the infusion pump and to reuse propofol syringes. DNA fingerprinting with a digoxigenin-labeled C. albicans repetitive element 2 probe and electrophoretic karyotyping showed two distinct banding patterns among patient isolates. We hypothesize that extrinsic contamination of propofol by anesthesiologist 9 likely resulted in C. albicans infections. These data suggest that strict aseptic techniques must be used when preparing and administering propofol. PMID:10203494

McNeil, Michael M.; Lasker, Brent A.; Lott, Timothy J.; Jarvis, William R.

1999-01-01

352

Variability in anesthetic care for total knee arthroplasty: an analysis from the anesthesia quality institute.  

PubMed

Anesthetic practice utilization and related characteristics of total knee arthroplasties (TKAs) are understudied. The research team sought to characterize anesthesia practice patterns by utilizing National Anesthesia Clinical Outcomes Registry data of the Anesthesia Quality Institute. The proportions of primary TKAs performed between January 2010 and June 2013 using general anesthesia (GA), neuraxial anesthesia (NA), and regional anesthesia (RA) were determined. Utilization of anesthesia types was analyzed using anesthesiologist and patient characteristics and facility type. In all, 108 625 eligible TKAs were identified; 10.9%, 31.3%, and 57.9% were performed under RA, NA, and GA, respectively. Patients receiving RA had higher median age and higher frequency of American Society of Anesthesiology score ?3 compared with those receiving other anesthesia types under study. Relative to GA (45.0%), when NA or RA were used, the anesthesiologist was more frequently board certified (75.5% and 62.1%, respectively; P < .0001). Anesthetic technique differences for TKAs exist, with variability associated with patient and provider characteristics. PMID:24627358

Fleischut, Peter M; Eskreis-Winkler, Jonathan M; Gaber-Baylis, Licia K; Giambrone, Gregory P; Faggiani, Susan L; Dutton, Richard P; Memtsoudis, Stavros G

2015-03-01

353

A model for performance management in real properties using statistical techniques  

E-print Network

Within Real Property Portfolio Management. there is a conscious search for new methodologies to improve building management practice, particularly for facilities in use. An approach in this direction is realized by the ...

Deolalikar, Jyoti

1989-01-01

354

Local Anesthetics Induce Apoptosis in Human Thyroid Cancer Cells through the Mitogen-Activated Protein Kinase Pathway  

PubMed Central

Local anesthetics are frequently used in fine-needle aspiration of thyroid lesions and locoregional control of persistent or recurrent thyroid cancer. Recent evidence suggests that local anesthetics have a broad spectrum of effects including inhibition of cell proliferation and induction of apoptosis in neuronal and other types of cells. In this study, we demonstrated that treatment with lidocaine and bupivacaine resulted in decreased cell viability and colony formation of both 8505C and K1 cells in a dose-dependent manner. Lidocaine and bupivacaine induced apoptosis, and necrosis in high concentrations, as determined by flow cytometry. Lidocaine and bupivacaine caused disruption of mitochondrial membrane potential and release of cytochrome c, accompanied by activation of caspase 3 and 7, PARP cleavage, and induction of a higher ratio of Bax/Bcl-2. Based on microarray and pathway analysis, apoptosis is the prominent transcriptional change common to lidocaine and bupivacaine treatment. Furthermore, lidocaine and bupivacaine attenuated extracellular signal-regulated kinase 1/2 (ERK1/2) activity and induced activation of p38 mitogen-activated protein kinase (MAPK) and c-jun N-terminal kinase. Pharmacological inhibitors of MAPK/ERK kinase and p38 MAPK suppressed caspase 3 activation and PARP cleavage. Taken together, our results for the first time demonstrate the cytotoxic effects of local anesthetics on thyroid cancer cells and implicate the MAPK pathways as an important mechanism. Our findings have potential clinical relevance in that the use of local anesthetics may confer previously unrecognized benefits in the management of patients with thyroid cancer. PMID:24586874

Chang, Yuan-Ching; Hsu, Yi-Chiung; Liu, Chien-Liang; Huang, Shih-Yuan; Hu, Meng-Chun; Cheng, Shih-Ping

2014-01-01

355

Efficacy of benzocaine as an anesthetic for salmonid fishes  

USGS Publications Warehouse

Benzocaine was tested in the laboratory to determine the effective concentrations for anesthetizing juvenile chinook salmon Oncorhynchus tshawytscha an rainbow trout O. mykiss (formerly Salmo gairdneri ). Tests were conducted at three water temperatures, in waters ranging from very soft to very hard, and with groups of rainbow trout from 5 to 47 cm long and chinook salmon 20 cm long. Effective concentrations were defined as those that rendered the fish fully handleable in 3 min or less, allowed recovery of most fish within 10 min, and caused no mortality after 15-min exposures. Concentrations of 25-45 mg/L anesthetized both species over the entire range of conditions tested. Although efficacy was essentially unrelated to species or water quality, it was related to water temperature and size of fish; the concentrations of benzocaine required were highest at the lowest water temperature and for the largest fish.

Gilderhus, P.A.

1989-01-01

356

The Enrollment Problem: Proven Management Techniques. American Council on Education/Macmillan Series on Higher Education.  

ERIC Educational Resources Information Center

A tested approach to college enrollment management is presented that offers a system to assess and develop options for researching, maintaining, or improving enrollment goals. The new approach, the Enrollment Management Matrix, consists of three dimensions: (1) key variables in enrollment management (institutional product, data and information,…

Ingersoll, Ronald J.

357

Integrating operational and financial perspectives using yield management techniques: an add-on matrix model  

Microsoft Academic Search

Yield management (YM) tends to emphasize revenue management, which is understandable, given the capital intensive nature of the hotel industry. To evaluate these strategies profitability or return must be assessed, together with management performance or efficiency, in the context of the level of risk to which the investment is subjected. Provides a two-step matrix model with which hotel owners and

Bernard J. McEvoy

1997-01-01

358

Mechanisms and management of an incomplete epidural block for cesarean section.  

PubMed

Epidural blockade is an important option for anesthesia in parturients undergoing abdominal delivery. Despite the multiple benefits of this method, there is at least one significant downside--a relatively high occurrence of unsatisfactory anesthesia that requires intervention. Depending on the presumed mechanism of epidural block failure and other clinically relevant factors (e.g., timing of diagnosis, urgency of the procedure, and so forth), certain effective measures are recommended to successfully manage this demanding situation. In general, it is important to make every effort to make the pre-existing epidural effective or replace it with another regional technique, because overall, regional anesthesia is associated with significantly lower maternal mortality. It is important to identify a dysfunctional epidural block preoperatively before a maximum volume of local anesthetic has been administered. If catheter manipulation does not produce substantial improvement, and there is no time constraint, it is safe and reasonable to replace the epidural catheter. However, risks associated with excessive volume of local anesthetic should be kept in mind. Additional epidural injections or a second catheter placement might be considered under special circumstances. Single-shot spinal anesthesia after a failed epidural may provide fast onset and reliable surgical anesthesia. Available data, although limited and contradictory, suggest the possibility of unpredictably high or total spinal anesthesia. Many authors, however, believe that appropriate precautions and modifications in technique make this a safe alternative. These modifications include limiting the amount of epidural local anesthetic administered when diagnosing a nonfunctioning epidural and decreasing the dose of intrathecal local anesthetic by 20% to 30%. If there is no documented block when the spinal is inserted, and more than 30 minutes have passed from the last epidural dose, it is probably safe to use a normal dose of local anesthetic. Continuous spinal anesthesia with a macro catheter might be a dependable alternative, particularly if large amounts of local anesthetic have already been used or the patient's airway is a cause for concern. Although there are no reports of combined spinal epidural anesthesia being used in this context, it would appear to be an attractive alternative. It allows the anesthesiologist to give smaller doses intrathecally, while still offering the flexibility of augmenting the block if needed. When inadequate epidural block becomes apparent during surgery there are limited alternatives. Depending on the origin and the pattern of inadequate anesthesia, options may include psychological support, supplementation with a variety of inhalational and intravenous agents, and local anesthetic infiltration. Induction of general anesthesia is typically left as a backup option, but must be strongly considered if the patient continues to have pain/discomfort. PMID:12698831

Portnoy, Dmitry; Vadhera, Rakesh B

2003-03-01

359

Using palaeoecological techniques to inform contemporary hydrological management of a peatland  

NASA Astrophysics Data System (ADS)

Realization of the economic and environmental value of upland peatlands has led both public and private organizations to implement 'restoration' schemes. The word 'restore' implies that we seek to reverse adverse effects that have occurred and return the ecosystem to a pre-disturbance state. Restoration schemes in UK upland peatlands focus on the objectives of raising the water table through blocking drainage channels and gullies and re-vegetating bare areas of peat that are prone to erosion. The target is often the reinstatement of Sphagnum as a significant part of the peatland flora as this will produce an accumulating peat system. Restoration of a peatland implies that we have knowledge of its previous ecological history from which we can attain a restoration blueprint but restoration schemes often take little, if any, account of the ecological history of the site. This study is an example of how palaeoecological techniques have been employed at a UK upland catchment with findings to support the peatland restoration schemes. The study combined an extensive stratigraphic survey of the catchment and a detailed core-based analysis. Macrofossil, testate amoebae, humification and charcoal analysis were employed to determine the historical representation of Sphagnum at the site, the changes in water-table level, the degree of decomposition and also burning history. Stratigraphic survey and core results show that Sphagnum has played a significant role in parts but not all of the catchment, persisting in the main core until late 19th century. They also demonstrate that the loss of Sphagnum and subsequent abundance of Calluna vulgaris is coincident with evidence of wildfire. Continued absence of Sphagnum and abundance of Calluna vulgaris is coincident with further, less intense, burning likely due to grouse moor management. The 3000 year old record from the main core demonstrates the importance of historical climate change in changing water-table levels, vegetation, and degree of decomposition. There is little doubt that when faced with designing and implementing a 'restoration' plan for a site land managers will be able to make much more informed decisions if the ecological history of the site is investigated. At this site encouraging Sphagnum growth is shown to be valid. If this restoration aim is to be successful the removal of prescribed burning is probably required.

Blundell, Antony; Holden, Joseph

2014-05-01

360

Interactions of Local Anesthetics with Voltage-gated Na + Channels  

Microsoft Academic Search

Voltage-gated Na+ channels are dynamic transmembrane proteins responsible for the rising phase of the action potential in excitable membranes. Local anesthetics (LAs) and structurally related antiarrhythmic and anticonvulsant compounds target specific sites in voltage-gated Na+ channels to block Na+ currents, thus reducing excitability in neuronal, cardiac, or central nervous tissue. A high-affinity LA block is produced by binding to open

C. Nau; G. K. Wang

2004-01-01

361

Analyses of the electroencephalograms of normal anesthetized cats  

E-print Network

December 1972 Major Subject: Veterinary Medicine and Surgery ANALYSES OF THE ELECTROENCEPHALOGRAMS OF NORMAL ANESTHETIZED CATS A Thesis BONNIE VERYLE GUSTAFSON Approved as to style and content by: . c'6 C arrman o Committee He d D p rtment Member... position as Instructor in the Department of Veterinary Surgery and Radiology with the University of Minnesota for one year. In September, 1969, she came to Texas AaN University as an Instructor in the Department of Veterinary Anatomy. Currently she...

Gustafson, Bonnie Veryle

1972-01-01

362

The Effect of Altered Physiological States on Intravenous Anesthetics  

Microsoft Academic Search

This chapter begins with the rationale for the intense interest in how altered physiologic states change the effect seen following\\u000a administration of similar doses of intravenous anesthetic drugs. It then traces the development of two types of pharmacokinetic\\u000a models that have been used to understand the relationship between pharmacokinetics and cardiovascular physiology. Physiologic\\u000a pharmacokinetic models are constructed from detailed knowledge

T. K. Henthorn

363

Albumin extravasation rates in tissues of anesthetized and unanesthetized rats  

SciTech Connect

Bovine serum albumin (BSA) labeled with /sup 131/I was injected intravenously in chronically prepared, unanesthetized rats and into pentobarbital-anesthetized rats that had received 2 ml 5% BSA to help sustain plasma volume. Initial uptake rates (clearances) in skin, skeletal muscles, diaphragm, and heart (left ventricle) were measured over 1 h. BSA labeled with /sup 125/I was injected terminally to correct for intravascular /sup 131/I-BSA. Observed clearances were in the following order in both groups of animals: heart much greater than diaphragm approximately equal to skin greater than resting skeletal muscles. Differences between unanesthetized and anesthetized animals were small and inconsistently directed. Our results suggest that the lower albumin clearances reported in the literature for anesthetized rats are not the result of their immobility or any direct effect of anesthesia on albumin transport in these tissues. The lower transport rates appear to result indirectly from changes produced by anesthesia and/or surgery in controllable parameters such as plasma volume and intravascular protein mass.

Renkin, E.M.; Joyner, W.L.; Gustafson-Sgro, M.; Plopper, G.; Sibley, L.

1989-05-01

364

Interaction of local anesthetics with the K+ channel pore domain  

PubMed Central

Local anesthetics and related drugs block ionic currents of Na+, K+ and Ca2+ conducted across the cell membrane by voltage-dependent ion channels. Many of these drugs bind in the permeation pathway, occlude the pore and stop ion movement. However channel-blocking drugs have also been associated with decreased membrane stability of certain tetrameric K+ channels, similar to the destabilization of channel function observed at low extracellular K+ concentration. Such drug-dependent stability may result from electrostatic repulsion of K+ from the selectivity filter by a cationic drug molecule bound in the central cavity of the channel. In this study we used the pore domain of the KcsA K+ channel protein to test this hypothesis experimentally with a biochemical assay of tetramer stability and theoretically by computational simulation of local anesthetic docking to the central cavity. We find that two common local anesthetics, lidocaine and tetracaine, promote thermal dissociation of the KcsA tetramer in a K+-dependent fashion. Docking simulations of these drugs with open, open-inactivated and closed crystal structures of KcsA yield many energetically favorable drug-channel complexes characterized by nonbonded attraction to pore-lining residues and electrostatic repulsion of K+. The results suggest that binding of cationic drugs to the inner cavity can reduce tetramer stability of K+ channels. PMID:23545989

Gray, Noel W.; Zhorov, Boris S.; Moczydlowski, Edward G.

2013-01-01

365

Anesthetic-related maternal mortality, 1954 to 1985.  

PubMed

This is a population-based study of the safety of obstetrical anesthesia in the Commonwealth of Massachusetts between 1954 and 1985. We used data collected by the state Committee on Maternal Mortality, which was founded in 1941. There were a total of 37 maternal deaths during the study period due to anesthetic-related complications. During the same time period, there were 886 maternal deaths. Thus, anesthetic-related mortality comprised 4.2% of all deaths, and the mortality rate was 1.5 per 100,000 live births between 1955 and 1964, 1.5 per 100,000 live births between 1965 and 1974, and 0.4 per 100,000 live births between 1975 and 1984. In the first decade of this study, aspiration during administration of a mask anesthetic was the primary cause of death. During the second decade, cardiovascular collapse associated with regional anesthesia was the primary cause of death. During the last decade of this study, all deaths were associated with general endotracheal anesthesia. As a result of this study and having identified the changes in the standard of care in Massachusetts that led to the reduction in maternal mortality, we offer recommendations to further improve the safety of anesthesia for childbirth in this country. PMID:2627406

Sachs, B P; Oriol, N E; Ostheimer, G W; Weiss, J B; Driscoll, S; Acker, D; Brown, D A; Jewett, J F

1989-01-01

366

Interactions of anesthetics with the membrane-water interface  

NASA Technical Reports Server (NTRS)

Although the potency of conventional anesthetics correlates with lipophilicity, an affinity to water also is essential. It was recently found that compounds with very low affinities to water do not produce anesthesia regardless of their lipophilicity. This finding implies that clinical anesthesia might arise because of interactions at molecular sites near the interface of neuronal membranes with the aqueous environment and, therefore, might require increased concentrations of anesthetic molecules at membrane interfaces. As an initial test of this hypothesis, we calculated in molecular dynamics simulations the free energy profiles for the transfer of anesthetic 1,1,2-trifluoroethane and nonanesthetic perfluoroethane across water-membrane and water-hexane interfaces. Consistent with the hypothesis, it was found that trifluoroethane, but not perfluoroethane, exhibits a free energy minimum and, therefore, increased concentrations at both interfaces. The transfer of trifluoroethane from water to the nonpolar hexane or interior of the membrane is accompanied by a considerable, solvent-induced shift in the conformational equilibrium around the C-C bond.

Pohorille, A.; Cieplak, P.; Wilson, M. A.

1996-01-01

367

Anesthetic keratopathy presenting as bilateral Mooren-like ulcers  

PubMed Central

This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren’s ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept®), after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects. PMID:23118524

Khakshoor, Hamid; Moshirfar, Majid; Simpson, Rachel G; Gharaee, Hamid; Vejdani, Amir H; Christiansen, Steven M; Edmonds, Jason N; Behunin, Nicholas L

2012-01-01

368

Quality management systems for fruit fly (Diptera: Tephritidae) sterile insect technique  

SciTech Connect

The papers presented in this issue are focused on developing and validating procedures to improve the overall quality of sterile fruit flies for use in area-wide integrated pest management (AW-IPM) programs with a sterile insect technique (SIT) component. The group was coordinated and partially funded by the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, Vienna, Austria, under a five-year Coordinated Research Project (CRP) on 'Quality Assurance in Mass-Reared and Released Fruit Flies for Use in SIT Programmes'. Participants in the CRP from 16 countries came from both basic and applied fields of expertise to ensure that appropriate and relevant procedures were developed. A variety of studies was undertaken to develop protocols to assess strain compatibility and to improve colonization procedures and strain management. Specific studies addressed issues related to insect nutrition, irradiation protocols, field dispersal and survival, field cage behavior assessments, and enhancement of mating competitiveness. The main objective was to increase the efficiency of operational fruit fly programs using sterile insects and to reduce their cost. Many of the protocols developed or improved during the CRP will be incorporated into the international quality control manual for sterile tephritid fruit flies, standardizing key components of the production, sterilization, shipment, handling, and release of sterile insects. (author) [Spanish] Los articulos presentados en este numero se enfocan en el desarrollo y la validacion de procedimientos para mejorar la calidad total de moscas de las frutas esteriles para su uso en programas de manejo integrado de plagas en donde la tecnica del insecto esteril (TIE) es uno de los componentes clave. El grupo fue coordinado y parcialmente financiado por la Division Conjunta de Tecnicas Nucleares para la Alimentacion y la Agricultura de la FAO/OIEA, Viena, Austria, por un periodo de cinco anos bajo el proyecto de Investigacion Coordinada (PIC) sobre 'el Aseguramiento de la Calidad de Moscas de las Frutas Criadas y Liberadas para su Uso en Programas de TIE'. Los participantes en el PIC representan 16 paises con experiencia en campos de investigacion basica y aplicada. Para asegurar que los procedimientos desarrollados fueran apropiados y pertinentes, se realizaron una variedad de estudios para el desarrollo de protocolos para evaluar la compatibilidad y para mejorar los procedimientos de colonizacion y manejo de cepas salvajes. Estudios especificos trataron asuntos relacionados con la nutricion de insectos, los protocolos de irradiacion, la dispersion y supervivencia en el campo, evaluacion del comportamiento en jaulas de campo, y el mejoramiento de la competitividad sexual. Los objetivos fundamentales fueron el aumentar la eficiencia y reducir los costos de los programas operacionales de control de moscas de las frutas donde TIE es utilizada. Muchos de los protocolos desarrollados o mejorados durante el PIC seran incorporados en el Manual Internacional de Control de Calidad para Moscas Estriles de la familia Tephritidae, para estandarizar componentes claves como la produccion, esterilizacion, envio, manejo y liberacion de insectos esteriles. (author)

Caceres, C.; Robinson, A. [Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, Agency's Laboratories, A-2444 Seibersdorf (Austria); McInnis, D. [USDA-ARS USPBARC, 2727 Woodlawn Drive, Honolulu, HI 96720 (United States); Shelly, T. [USDA/APHIS/CPHST, 41-650 Ahiki St. Waimanalo, HI 96795 (United States); Jang, E. [USDA-ARS USPBARC, P.O. Box 4459, Hilo, HI 96720 (United States); Hendrichs, J. [Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, Wagramerstrasse 5. P.O. Box 100, A-1400 Vienna (Austria)

2007-03-15

369

Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus  

PubMed Central

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes. PMID:25152601

Rollan, Antonio; Arab, Juan Pablo; Camargo, M Constanza; Candia, Roberto; Harris, Paul; Ferreccio, Catterina; Rabkin, Charles S; Gana, Juan Cristóbal; Cortés, Pablo; Herrero, Rolando; Durán, Luisa; García, Apolinaria; Toledo, Claudio; Espino, Alberto; Lustig, Nicole; Sarfatis, Alberto; Figueroa, Catalina; Torres, Javier; Riquelme, Arnoldo

2014-01-01

370

Deep Arteriovenous Malformations in the Basal Ganglia, Thalamus, and Insula: Microsurgical Management, Techniques, and Results  

PubMed Central

Background Arteriovenous malformations (AVMs) in the basal ganglia, thalamus, and insula are considered inoperable given their depth, eloquence, and limited surgical exposure. While many neurosurgeons opt for radiosurgery or observation, others have challenged the belief that deep AVMs are inoperable. Further discussion of patient selection, technique, and multimodality management is needed. Objective To describe and discuss the technical considerations of microsurgical resection for deep-seated AVMs. Methods Patients with deep AVMs who underwent surgery during a 14-year period were reviewed using a prospective AVM registry. Results Microsurgery was performed in 48 patients with AVMs in the basal ganglia (n=10), thalamus (n=13), or insula (n=25). The most common Spetzler-Martin grade was III- (68%). Surgical approaches included transsylvian (67%), transcallosal (19%), and transcortical (15%). Complete resection was achieved in 34 patients (71%), and patients with incomplete resection were treated with radiosurgery. Forty-five patients (94%) were improved or unchanged (mean follow-up 1.6 years). Conclusion This experience advances the notion that select deep AVMs may be operable lesions. Patients were highly selected for small size, hemorrhagic presentation, young age, and compactness – factors embodied in the Spetzler-Martin and Supplementary grading systems. Overall, 10 different approaches were used, exploiting direct, transcortical corridors created by hemorrhage or maximizing anatomical corridors through subarachnoid spaces and ventricles that minimize brain transgression. The same cautious attitude exercised in selecting patients for surgery was also exercised in deciding extent of resection, opting for incomplete resection and radiosurgery more than with other AVMs to prioritize neurological outcomes. PMID:23728451

Potts, Matthew B.; Young, William L.; Lawton, Michael T.

2014-01-01

371

Foreign body removal with repair of iatrogenic tracheo-bronchial tear repair: An anesthetic challenge  

PubMed Central

Foreign body aspiration into the airway is common in the pediatric age group and its anesthetic management is a challenge. Iatrogenic tracheo-bronchial injury further worsens the situation. Flexible pediatric fiberscope is the gold standard for securing the airway in cases of airway injury. We present a case of a 7-year-old girl who presented to the hospital with signs and symptoms of foreign body aspiration and suspected tracheo-bronchial tree injury. The impacted foreign body was removed by rigid bronchoscopy and the presence of a tracheo-bronchial tear was confirmed. To repair the airway tear, thoracotomy was planned necessitating one lung ventilation. A pediatric flexible fiberscope was not available, so left endobronchial intubation for one lung ventilation was done with the help of an airway exchange catheter using a rigid bronchoscope as a conduit. Subsequent intra-operative and post-operative period were uneventful. PMID:22096291

Lahori, Vikram Uday; Aggarwal, Shipra; Simick, Pemala; Dharmavaram, Sudhindra

2011-01-01

372

Update on local anesthetics: focus on levobupivacaine  

PubMed Central

In recent years levobupivacaine, the pure S (?)-enantiomer of bupivacaine, emerged as a safer alternative for regional anesthesia than its racemic parent. It demonstrated less affinity and strength of depressant effects onto myocardial and central nervous vital centers in pharmacodynamic studies, and a superior pharmacokinetic profile. Clinically, levobupivacaine is well tolerated in a variety of regional anesthesia techniques both after bolus administration and continuous postoperative infusion. Reports of toxicity with levobupivacaine are scarce and occasional toxic symptoms are usually reversible with minimal treatment with no fatal outcome. Yet, levobupivacaine has not entirely replaced bupivacaine in clinical practice. In anesthesia and analgesia practice, levobupivacaine and bupivacaine produce comparable surgical sensory block with similar adverse side effects, and equal labor pain control with comparable maternal and fetal outcome. The equipotency of the two drugs has been recently questioned, prompting clinicians to increase the dose of levobupivacaine in an attempt to ensure adequate anesthesia and analgesia and offsetting, therefore, the advantages of less motor block with levobupivacaine. In this review we aim to discuss the pharmacological essentials of the safer profile of levobupivacaine, and analyze the evidence regarding the current clinical indications. PMID:18728849

Burlacu, Crina L; Buggy, Donal J

2008-01-01

373

Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report  

PubMed Central

The history of complete denture impression procedures has been influenced largely by the development of impression materials from which new techniques and ideas arose. The purpose of this study was to compare the retention of complete dentures made by using different impression techniques like conventional, admixed, all green, and functional techniques. The results showed that there was significant difference in retention between the six techniques where functional technique showed the highest mean value of retention followed by elastomeric, all green, and admixed, while cocktail and green stick compound showed the lowest mean value. However, on clinical examination, the retention produced by the six techniques was satisfactory. PMID:25180105

Yadav, Bhupender; Jayna, Manisha; Yadav, Harish; Suri, Shrey; Phogat, Shefali; Madan, Reshu

2014-01-01

374

Evolution of interventional techniques.  

PubMed

Regional anesthesia techniques are used in pain treatment for more than a century. Although its use for acute pain conditions, such as intraoperative, postoperative and traumatic pain, is very well accepted, its use for the chronic pain syndromes is still lacking a consensus among the practitioners. The interventional techniques, which are mostly originated from the regional anesthetic techniques, have gained an increasing interest for the treatment of chronic pain syndromes during the last few decades. In this review, the development and clinical aspects of epidural injections, epiduroscopy, facet denervaion, intradiscal applications, vertebroplasty, sympathetic neurolysis, and central and peripheral continuous infusion techniques are discussed. PMID:15382002

Raj, P Prithvi

2004-07-01

375

Surgical Technique for Treatment of Recalcitrant Adductor Longus Tendinopathy  

PubMed Central

Chronic groin pain in the athlete can be a difficult problem to manage. Adductor dysfunction is the most common cause of groin pain in athletes, with the adductor longus being the tendon most commonly involved. The most reproducible finding for adductor longus tendinopathy is tenderness along the tendon with passive abduction and resisted hip adduction in extension. Magnetic resonance imaging and injection of a corticosteroid and anesthetic into the proximal muscle-tendon junction are both helpful in confirming the diagnosis. Nonoperative treatment may consist of protected weight bearing, ice application, ultrasonography, electrical stimulation, and gentle stretching with progressive strengthening. However, nonoperative management is not always successful. In these instances, surgical treatment can be quite effective. We present the indications, surgical technique, and rehabilitation protocol of adductor tenotomy for chronic tendinopathy. This can prove a useful tool for the treatment of recalcitrant groin pain attributable to the adductor longus. PMID:24904780

Gill, Thomas J.; Carroll, Kaitlin M.; Makani, Amun; Wall, Andrew J.; Dumont, Guillaume D.; Cohn, Randy M.

2014-01-01

376

Ventral inlay buccal mucosal graft urethroplasty: A novel surgical technique for the management of urethral stricture disease  

PubMed Central

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures. PMID:25685305

Terlecki, Ryan Patrick

2015-01-01

377

Ventral inlay buccal mucosal graft urethroplasty: A novel surgical technique for the management of urethral stricture disease.  

PubMed

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures. PMID:25685305

Kovell, Robert Caleb; Terlecki, Ryan Patrick

2015-02-01

378

Increasing Personal and Organizational Effectiveness. Treatise No. 4: "Time Management Techniques."  

ERIC Educational Resources Information Center

The ways in which time is utilized can be enhanced through careful management. The time to be allocated to various activities and objectives should be planned on a weekly basis in light of consciously set priorities. Commonly used but rarely useful strategies for time management include working faster and working longer, both of which lead to…

New Mexico Research and Study Council, Albuquerque.

379

Is the adoption of Strategic Management Accounting techniques really “strategy-driven”? Evidence from a survey  

Microsoft Academic Search

Several different approaches to Strategic Management Accounting (SMA) can be found in the literature of management ac counting since Simmonds (1981) coined the term. However, there is a little survey research about SMA practice, with the exception of the studies of Guilding et al. (2000) and Cravens & Guilding (2001). The paper aims to enrich the fragmented knowledge on t

Lino Cinquini; Andrea Tenucci

2007-01-01

380

Xenon and Other Volatile Anesthetics Change Domain Structure in Model Lipid Raft Membranes  

PubMed Central

Inhalation anesthetics have been in clinical use for over 160 years, but the molecular mechanisms of action continue to be investigated. Direct interactions with ion channels received much attention after it was found that anesthetics do not change the structure of homogeneous model membranes. However, it was recently found that halothane, a prototypical anesthetic, changes domain structure of a binary lipid membrane. The noble gas xenon is an excellent anesthetic and provides a pivotal test of the generality of this finding, extended to ternary lipid raft mixtures. We report that xenon and conventional anesthetics change the domain equilibrium in two canonical ternary lipid raft mixtures. These findings demonstrate a membrane-mediated mechanism whereby inhalation anesthetics can affect the lipid environment of trans-membrane proteins. PMID:24299622

Weinrich, Michael; Worcester, David L.

2014-01-01

381

Temperature and humidity of the DrÄger Cato anesthetic machine circuit  

Microsoft Academic Search

Purpose. The DrÄger Cato anesthetic machine (DrÄger, LÜbeck, Germany) effectively humidifies and warms anesthetic gases, because it has a built-in hotplate to heat the breathing system, and expired gas passes through the CO 2 absorbent three times during one breath. In the present study, we measured the temperature and absolute humidity (AH) of the anesthetic circuit in the DrÄger Cato

Hiroki Wada; Hideyuki Higuchi; Shinya Arimura

2003-01-01

382

Use of Behavioral Change Techniques in Web-Based Self-Management Programs for Type 2 Diabetes Patients: Systematic Review  

PubMed Central

Background Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes. Objective We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes. Methods Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes. Results We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters. Conclusions A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately. PMID:24334230

de Wit, Maartje; Cleijne, Wilmy HJJ; Snoek, Frank J

2013-01-01

383

Topical anesthetic preparations for rigid and flexible endoscopy: a meta-analysis.  

PubMed

Transnasal endoscopy can cause pain or discomfort for the patient. Topical anesthetic has been used in an attempt to reduce this. However, there is no consensus on whether topical anesthetic is effective in optimizing patient experience during the procedure. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of topical anesthetic on pain and comfort outcomes during endoscopy. Two authors independently searched the databases from inception to September 2013. Studies comparing topical anesthetic with placebo where the outcomes of interest were pain, comfort, or side effect outcomes were included. Sufficient data for meta-analysis were retrieved for ten trials with a total of 837 patients. The evidence suggests that local anesthetic alone or in combination with a vasoconstrictor is beneficial to patients' pain [standardized mean difference (SMD) = -0.21; p = 0.045] and comfort (SMD = -0.51; p < 0.001) outcomes when performing transnasal endoscopy. However, the topical anesthetic caused unpleasant sensation with respect to an unpleasant taste (SMD = 0.77; p < 0.001). In addition, there was no significant difference between a topical anesthetic spray and cotton type in pain and discomfort values. Applying topical anesthetic during transnasal endoscopy could reduce pain and discomfort. The spray and cotton type methods of topical anesthetic preparation showed no significant difference in terms of pain and discomfort during the procedure. However, further trials with good research methodology should be conducted to confirm our results. PMID:24682602

Hwang, Se Hwan; Park, Chan-Soon; Kim, Byung Guk; Cho, Jin Hee; Kang, Jun Myung

2015-02-01

384

Cost\\/benefit analyses of a new battery pack management technique for telecommunication applications: future directions with fuel cell\\/battery systems  

Microsoft Academic Search

A new approach to battery pack and fuel cell management, the battery health manager-BHM™ and the fuel cell health manager-FCHM™, both cell-based techniques that manage power supplies without disrupting operations, was described at INTELEC 2002. Using the BHM, each cell (or module) in a battery pack can be cycled to up to a full-load discharge, and then smart charged, in

W. A. Adams; James D. Blair; Kathryn R. Bullock; C. L. Gardner; Laishui Li

2004-01-01

385

USE OF THE MODIFIED TOGGLE PIN TECHNIQUE FOR MANAGEMENT OF COXOFEMORAL LUXATION IN DOGS: A REVIEW OF LITERATURE AND A REPORT OF TWO CASES  

Microsoft Academic Search

Use of the modified toggle pin technique for management of coxofemoral luxation in dogs: A review of literature and a report of two cases. The surgical technique described in this paper is a modification of toggle pin stabilization, which is an intracapsular reduction technique for displaced hip. The modification involves a different prosthesis to replace the ligament of the head

R. Hõim; V. Andrianov; A. Lenzner

386

The Timing of Acupuncture Stimulation Does Not Influence Anesthetic Requirement  

PubMed Central

Studies suggest that acupuncture is more effective when induced before induction of general anesthesia than afterwards. We tested the hypothesis that electro-acupuncture initiated 30 minutes before induction reduces anesthetic requirement more than acupuncture initiated after induction. Seven volunteers were each anesthetized with desflurane on 3 study days. Needles were inserted percutaneously at 4 acupuncture points thought to produce analgesia in the upper abdominal area and provide generalized sedative and analgesic effects: Zusanli (St36), Sanyinjiao (Sp6), Liangqiu (St34), and Hegu (LI4). Needles were stimulated at 2-Hz and 10-Hz, with frequencies alternating at two-second intervals. On Preinduction day, electro-acupuncture was started 30 minutes before induction of anesthesia and maintained throughout the study. On At-induction day, needles were positioned before induction of anesthesia, but electro-acupuncture stimulation was not initiated until after induction. On Control day, electrodes were positioned near the acupoints, but needles were not inserted. Noxious electrical stimulation was administered via 25-G needles on the upper abdomen (70 mA, 100 Hz, 10 seconds). Desflurane concentration was increased 0.5% when movement occurred and decreased 0.5% when it did not. These up-and-down sequences continued until volunteers crossed from movement to no-movement 4 times. The P50 of logistic regression identified desflurane requirement. Desflurane requirement was similar on the Control (5.2±0.6%, mean±SD), Preinduction (5.0±0.8%), and At-induction (4.7±0.3%, P=0.125) days. This type of acupuncture is thus unlikely to facilitate general anesthesia or decrease the need for anesthetic drugs. PMID:15673863

Chernyak, Grigory; Sengupta, Papiya; Lenhardt, Rainer; Liem, Edwin; Doufas, Anthony G.; Sessler, Daniel I.; Akça, Ozan

2005-01-01

387

Central antitussive effect of codeine in the anesthetized rabbit  

PubMed Central

Background Codeine represents a commonly used drug to suppress cough. Central antitussive effect of codeine has been confirmed in a number of animal studies. However, available data related to antitussive activity of codeine in rabbits are very limited. Objective We investigated the effects of codeine on cough, single expiratory responses (expiration-like reflex) induced by mechanical tracheo-bronchial stimulation, and on the sneeze reflex in the anesthetized rabbit. Materials and methods Twenty pentobarbitone anesthetized spontaneously breathing rabbits were used for the study. Increasing doses of codeine (codeinum dihydrogenphosphate, Interpharm) were injected intravenously (iv); 0, 0.15, 0.76, and 3.78 mg/kg of codeine dissolved in saline, 0.25 ml/kg) or intracerebroventricularly (icv); 0, 0.015, 0.076, and 0.378 mg/kg of codeine dissolved in artificial cerebrospinal fluid, 0.033 ml/kg. Results Both iv and icv injections of codeine led to a dose-dependent reduction of coughing provoked by tracheo-bronchial stimulation; however, the doses differed substantially. The effective cumulative dose for a 50% reduction in the number of coughs was 3.9 and 0.11 mg/kg after iv and icv administration of codeine, respectively; representing about 35-fold higher efficacy of the icv route. The numbers of expiration-like responses and sneeze reflex responses remained unchanged. Conclusions The study confirmed the central antitussive effect of codeine, but showed a low sensitivity of sneeze and expiration reflex to codeine. We validated the experimental model of an anesthetized rabbit for studies on central antitussive action. PMID:21147648

2010-01-01

388

Development of prilocaine gels for enhanced local anesthetic action.  

PubMed

Prilocaine, one of local anesthetics, has been used for regional pain relief. When applied as an ointments or creams, it is hard to expect their effects to last for long time, because they are easily removed by wetting, movement and contacting. For more comfortable and better application, we developed a prilocaine gel system using a bioadhesive polymer, carboxymethyl cellulose (CMC). For suitable bioadhesion, the bioadhesive force of various polymers was tested using an auto-peeling tester. The bioadhesive force of various types of CMC such as 100MC, 150MC and 300MC, was 0.0264, 0.0461 and 0.0824 N, at 1.5% concentration, respectively. The CMC-300MC gels showed the most suitable bioadhesive forces. The effect of drug concentration on drug release was studied from the prepared 1.5% CMC gels using a synthetic cellulose membrane at 37 ± 0.5°C. As the concentration of drug increased, the drug release increased. The effects of temperature on drug release from the 1.0% prilocaine gels were evaluated at 27, 32, 37 and 42°C. As the temperature of the drug gels increased, drug release increased. The enhancing effects of penetration enhancers such as pyrrolidones, non-ionic surfactants, fatty acids and propylene glycol derivatives were studied. Among the enhancers used, polyoxyethylene 2-oleyl ether was superior. The anesthetic effects were studied by a tail flick analgesic meter. In the rat tailflick test, 1.0% prilocaine gels containing polyoxyethylene 2-oleyl ether showed the most prolonged local analgesic effects. The results support the view that prilocaine gels with enhanced local anesthetic action could be developed using CMC bioadhesive polymer. PMID:22864742

Kang, Chung; Shin, Sang-Chul

2012-07-01

389

Laterally positioned flap-revised technique along with platelet rich fibrin in the management of Miller class II gingival recession  

PubMed Central

Gingival recession is a complex phenomenon that may present numerous therapeutic challenges to the clinician. The laterally positioned flap is commonly used to cover isolated, denuded roots that have adequate donor tissue laterally and vestibular depth. Various modifications in laterally sliding flap have been proposed in order to avoid the reported undesirable results on the donor teeth. Recently, use of growth factors has been proposed in combination with surgical techniques. This article highlights the use of laterally positioned pedicle flap-revised technique as a modification of laterally sliding flap technique along with autologous suspension of growth factors, platelet rich fibrin membrane (PRF) for the management of localized Miller class-II gingival recession. After 6 months of follow-up, the clinical condition was stable with 80% root coverage and satisfactory gingival tissue healing at both donor and recipient site with no signs of inflammation. An excellent esthetical outcome was achieved and the patient was satisfied with case resolution. PMID:23946748

Singh, Jagmohan; Bharti, Vipin

2013-01-01

390

New techniques in project portfolio management don't stifle innovation with excessive phasing and gates  

E-print Network

Managing multiple ideas, candidate initiatives and in-flight projects across diverse business units is a large challenge for major organizations. Overseeing global demand for projects as well as resource needs, risks, ...

Fisher, Cameron (Cameron Ardell Mayhew)

2014-01-01

391

Gas Sensor for Volatile Anesthetic Agents Based on Raman Scattering  

NASA Astrophysics Data System (ADS)

Continuous monitoring of respiratory and anesthetic gases during a surgery is of vital importance for the patient safety. Commonly the gas composition is determined by gas chromatography or a combination of IR-spectroscopy and electrochemical sensors. This study presents a concept for an optical sensor based on spontaneous Raman scattering which offers several advantages compared to established systems. All essential components can be detected simultaneously, no sample preparation is necessary and it provides fast response times. To reach the performance of a commonly used gas monitor signal gain has to be increased e.g. by using a multi pass setup.

Schlüter, Sebastian; Popovska-Leipertz, Nadejda; Seeger, Thomas; Leipertz, Alfred

392

Dose-response anesthetic effects of ketamine in the chicken.  

PubMed

Forty-six chickens were anesthetized with ketamine given IV at 12 dosages ranging from 1 to 160 mg/kg. The median effective dose (ED50) for greater than or equal to 15 minutes' anesthesia was 14 mg/kg. The median lethal dose (LD50) was 67.9 mg/kg. Analgesia adequate for doing major surgical operation was generally not apparent in chickens given doses less than 60 mg/kg. Side effects included muscle tremors which were unrelated to painful stimulation and flapping of wings which was common during recovery from anesthesia. PMID:6711982

McGrath, C J; Lee, J C; Campbell, V L

1984-03-01

393

Exploiting intelligent systems techniques within an autonomous regional active network management system  

Microsoft Academic Search

This paper discusses AuRA-NMS, an autonomous regional active network management system currently being developed in the UK through a partnership between several UK universities, two distribution network operators (DNO) and ABB. The scope of control to be undertaken by AuRA-NMS includes: automatic restoration, voltage control, power flow management and implementation of network performance optimisation strategies. Part of the scientific aims

Euan M. Davidson; Stephen D. J. McArthur; M. J. Dolan; James R. McDonald

2009-01-01

394

Extended release local anesthetic agents in a postoperative arthritic pain model.  

PubMed

Local anesthetics play an important role in postoperative pain management in orthopedic joint procedures. The aim of this study was to determine the effect of an intraoperative extra-articular injection of poly(DL-lactic acid co castor oil 3:7), p(DLLA:CO) 3:7 loaded with 15% bupivacaine, for postoperative analgesia following knee arthroplasty. Prolonged release local anesthetic formulation was synthesized by mixing p(DLLA:CO) 3:7 with bupivacaine base. Under anesthesia, the knee joint of Sprague-Dawley rats was exposed, a hole drilled in the femoral trochlea. 0.2 mL of either 15% polymer-bupivacaine formulation or plain bupivacaine (control) was injected locally and compared with a nonsurgery control group. Mechanical hyperalgesia was determined by counting the vocalizations and leg withdrawal after joint squeezing. Behavioral assessments over a day postoperative period revealed a reduction in rearing and ambulation in an open-field apparatus in animals of both experimental groups compared with the nonsurgery control. The vocalizations during the hyperalgesia test increased compared with the control at 24 h. At 48 h, 3.667 ± 0.5138, p = 0.0076 vocalizations were recorded for the plain bupivacaine group versus 1.417 ± 0.5138, p < 0.0001 in the 15% polymer-bupivacaine formulation. Bupivacaine encapsulated in p(DLLA:CO) 3:7 extended the duration of the analgesia compared with plain drug in rats and could represent effective postoperative analgesic in orthopedic joint procedures. PMID:24258384

Ickowicz, Diana E; Golovanevski, Ludmila; Haze, Amir; Domb, Abraham J; Weiniger, Carolyn F

2014-01-01

395

Dual effect of local anesthetics on the function of excitable rod outer segment disk membrane  

SciTech Connect

The effects of local anesthetics and a divalent cation, Ca2+, on the function of rhodopsin were estimated from the measurements of light-induced proton uptake. The light-induced proton uptake by rhodopsin in the rod outer segment disk membrane was enhanced at lower pH (4) but depressed at higher pHs (6 to 8) by the tertiary amine local anesthetics lidocaine, bupivacaine, tetracaine, and dibucaine. The order of local anesthetic-induced depression of the proton uptake followed that of their clinical anesthetic potencies. The depression of the proton uptake versus the concentration of the uncharged form of local anesthetic nearly describes the same curve for small and large dose of added anesthetic. Furthermore, a neutral local anesthetic, benzocaine, depressed the proton uptake at all pHs between 4 and 7. These results indicate that the depression of the proton uptake is due to the effect of only the uncharged form. It is hypothesized that the uncharged form of local anesthetics interacts hydrophobically with the rhodopsin in the disk membrane. The dual effect of local anesthetics on the proton uptake, on the other hand, suggests that the activation of the function of rhodopsin may be caused by the charged form. There was no significant change in the light-induced proton uptake by rhodopsin when 1 mM of Ca2+ was introduced into the disk membrane at varying pHs in the absence or presence of local anesthetics. This fact indicates that Ca2+ ion does not influence the diprotonating process of metarhodopsin; neither does it interfere with the local anesthetic-induced changes in the rhodopsin molecule.

Mashimo, T.; Abe, K.; Yoshiya, I.

1986-04-01

396

Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair?  

PubMed Central

Background Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP). Methods We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded. Results: On arrival in the recovery room, the pain score of the TAP group (4.33 ± 1.83) was found to be significantly lower than that of the control group (5.73 ± 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups. Conclusions TAP block following local infiltration had a clinical advantage only in the recovery room. PMID:25558340

Kim, Mun Gyu; Ok, Si Young; Kim, Sang Ho; Lee, Se-Jin; Park, Sun Young; Yoo, Jae-Hwa; Cho, Ana; Hur, Kyung Yul; Kim, Myung Jin

2014-01-01

397

Evaluation of exposures of hospital employees to anesthetic gases  

SciTech Connect

Hospital employees who work in hospital operating and recovery rooms are often exposed to a number of anesthetic gases. There is evidence to support the belief that such exposures have led to higher rates of miscarriages and spontaneous abortions of pregnancies among women directly exposed to these gases than among women not exposed. Most of the studies assessing exposure levels were conducted prior to the widespread use of scavenging systems. Air sampling was conducted in hospital operatories and recovery rooms of three large hospitals to assess the current exposure levels in these areas and determine the effectiveness of these systems in reducing exposures to fluoride-containing anesthetic gases. It was determined that recovery-room personnel are exposed to levels of anesthesia gases that often approach and exceed the recommended Threshold Limit Value-Time Weighted Average (TLV-TWA) of 2.0 ppm. Recovery-room personnel do not have the protection from exposure provided by scavenging systems in operating rooms. Operating-room personnel were exposed to anesthesia gas levels above the TLV-TWA only when patients were masked, or connected and disconnected from the scavenging systems. Recovery-room personnel also need to be protected from exposure to anesthesia gases by a scavenging system.

Lambeth, J.D.

1988-01-01

398

Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere  

NASA Astrophysics Data System (ADS)

Modern halogenated inhalation anesthetics undergo little metabolization during clinical application and evaporate almost completely to the atmosphere. Based on their first measurements in a range of environments, from urban areas to the pristine Antarctic environment, we detect a rapid accumulation and ubiquitous presence of isoflurane, desflurane, and sevoflurane in the global atmosphere. Over the past decade, their abundances in the atmosphere have increased to global mean mole fractions in 2014 of 0.097ppt, 0.30ppt, and 0.13ppt (parts per trillion, 10-12, in dry air), respectively. Emissions of these long-lived greenhouse gases inferred from the observations suggest a global combined release to the atmosphere of 3.1 ± 0.6 million t CO2 equivalent in 2014 of which ?80% stems from desflurane. We also report on halothane, a previously widely used anesthetic. Its global mean mole fraction has declined to 9.2ppq (parts per quadrillion, 10-15) by 2014. However, the inferred present usage is still 280 ±120t yr-1.

Vollmer, Martin K.; Rhee, Tae Siek; Rigby, Matt; Hofstetter, Doris; Hill, Matthias; Schoenenberger, Fabian; Reimann, Stefan

2015-03-01

399

Inhibition of murine cardiomyocyte respiration by amine local anesthetics.  

PubMed

The hydrophobic amino acyl amide-linked local anesthetics (e.g., lidocaine and bupivacaine) impose potent cardiac toxicity and direct mitochondrial dysfunction. To investigate these adverse events, an in vitro system was employed to measure their effects on O2 consumption (cellular respiration) by murine myocardium. Specimens were collected from the ventricular myocardium and immediately immersed in ice-cold Krebs-Henseleit buffer saturated with 95 % O2:5 % CO2. O2 concentration was determined as a function of time from the phosphorescence decay rates of Pd(II)-meso-tetra-(4-sulfonatophenyl)-tetrabenzoporphyrin. Myocardial O2 consumption was linear with time (zero-order kinetics); its rate (k, in ?M O2 min(-1)), thus, was the negative of the slope of [O2] vs. time. Cyanide inhibited O2 consumption, confirming the oxidation occurred in the respiratory chain. Lidocaine and bupivacaine produced immediate and sustained inhibition of cellular respiration at plasma concentrations of the drugs (low micromolar range). Bupivacaine was twice as potent as lidocaine. The inhibition was dose-dependent, saturating at concentrations ?30 ?M. At saturating doses, lidocaine produced ~20 % inhibition and bupivacaine ~40 % inhibition. Cellular ATP was also decreased in the presence of 30 ?M lidocaine or bupivacaine. The studied amines inhibited myocardial cellular respiration. This effect is consistent with their known adverse events on mitochondrial function. The described approach allows accurate assessments and comparisons of the toxic effects of local anesthetics on heart tissue bioenergetics. PMID:24254523

Aburawi, Elhadi H; Souid, Abdul-Kader

2014-12-01

400

Formulation of an antispasmodic drug as a topical local anesthetic.  

PubMed

Mebeverine hydrochloride, a spasmolytic agent on GIT smooth muscles, was reported to have a local anesthetic effect. Thus, it was desired in this study to formulate mebeverine HCl into a gel that could be used locally in the treatment of different oral painful conditions. Poloxamer 407 (P-407) was used as the base for this gel. Different additives were used to enhance drug release from the preparation while others were used to enhance the residence time for the preparation. Different formulae were characterized in terms of drug release and mucoadhesion. The formula which has shown the best compromise between the aforementioned parameters was selected for clinical evaluation in comparison to Lidocaine HCl gel and rheologically examined. The best drug release enhancer was cetrimide (0.005%, w/w), while hydroxypropylcellulose (0.5%, w/w) as a mucoadhesive additive has shown the best compromise between fast drug release and mucoadhesion. The gel formula (G) has shown a better pain reduction efficiency (p=0.0078) and longer duration (p=0.0313) than Lidocaine HCl gel. Histopathological examination has shown no change in the inflammatory cells count of rat oral mucosa. Therefore, it could be concluded that (G) is very promising as a local anesthetic preparation for the treatment of different oral painful conditions. PMID:16935442

Abdel-Hamid, Sameh M; Abdel-Hady, S E; El-Shamy, A A; El-Dessouky, H F

2006-12-01

401

Management of thyroid nodules: scanning techniques, thyroid suppressive therapy, and fine needle aspiration  

Microsoft Academic Search

For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features. Other visualization techniques can be used including isotope scanning (radioiodine, 99m technetium, 241 americium fluorescence, 131 cesium, 67 gallium, 75 selenomethionine, 201 thallium, 32 phosphorus, 99m Tc-bleomycin, 197 mercury, 133 xenon), thermography, x-ray techniques (plain films, computed tomographic scan, xeroradiography, chest x-ray barium swallow,

Michael W. Ashcraft; Andre J. Van Herle

1981-01-01

402

Endovascular Management of Visceral Artery Pseudoaneurysms: Transcatheter Coil Embolization Using the Isolation Technique  

SciTech Connect

PurposeTo describe our experiences with treatment of visceral artery pseudoaneurysms (VAPA) by transcatheter coil embolization using an isolation technique and to propose indications for treating VAPA with this method.Materials and MethodsWe treated 37 patients with VAPA endovascularly: There were 15 pancreaticoduodenal arcade, 10 hepatic, 5 renal, 3 splenic, and 1 each left gastric, gastroepiploic, adrenal, and superior mesenteric artery pseudoaneurysms. Preprocedure computed tomography (CT) and/or angiographic studies confirmed the presence of VAPA in all 37 patients. Using the isolation technique, we embolized vessels at sites distal and proximal to the pseudoaneurysm.ResultsTranscatheter coil embolization with the isolation technique was technically successful in 33 (89%) of 37 patients, and angiogram confirmed the complete disappearance of the VAPA in 32 patients. No major complications occurred during the procedures. In a patient with a pancreaticoduodenal arcade artery pseudoaneurysm, we were unable to control hemorrhage. In 30 of 32 patients who recovered after transcatheter coil embolization using the isolation technique, follow-up CT scan showed no flow in VAPA; they survived without rebleeding. Two of the 32 patients (6%) with confirmed complete disappearance of VAPA on angiogram and CT scan obtained the day after the procedure manifested rebleeding during follow-up.ConclusionTranscatheter coil embolization using the isolation technique is an effective alternative treatment in patients with VAPA. In combination with coil embolization, the isolation technique is particularly useful in patients whose pseudoaneurysms present surgical difficulties.

Ikeda, Osamu, E-mail: osamu-3643ik@do9.enjoy.ne.jp; Nakasone, Yutaka; Tamura, Yoshitaka; Yamashita, Yasuyuki [Kumamoto University, Graduate School of Medical and Pharmaceutical Sciences, Department of Diagnostic Radiology (Japan)

2010-12-15

403

Modern surgical techniques for management of soft tissue sarcomas involving the spine: Outcomes and complications.  

PubMed

Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions. J. Surg. Oncol. 2015 111:580-586. © 2014 Wiley Periodicals, Inc. PMID:25413665

Mattei, Tobias A; Teles, Alisson R; Mendel, Ehud

2015-04-01

404

The effect of stress management training on stress and depression in women with depression disorders: Using cognitive-behavioral techniques  

PubMed Central

Background: The present study aimed to investigate the effect of stress management training through cognitive-behavioral techniques on stress, social adaptability and depression in women with depression disorders. Materials and Methods: In this study, 40 patients diagnosed with depression who had referred to psychiatry and consultation clinics of Isfahan were randomly selected and assigned to intervention and control groups (20 patients in each group). The intervention group received eight 90-min sessions of stress training through cognitive–behavioral techniques. Data collection tools included Cooper's stress questionnaire, Bell's social adaptability questionnaire and Hamilton's depression scale questionnaire. The participants completed the questionnaires before the intervention and 1 month after the same. Data analysis was performed using covariance analysis. Results: Based on the results, considering variables of stress, social adaptability and depression, the equal variance hypothesis was confirmed. The relationship between pre- and post-test scores on stress, social adaptability and depression was statistically significant (P < 0.001). The modified mean difference was F = 12.45, P < 0.001 on stress; F = 6.88, P < 0.01 on social adaptability; and F = 5.36, P < 0.02 on depression, all of which were significant. Conclusion: Stress management training through cognitive behavioral techniques can play a main role in depression reduction and development of social adaptability through modifying inappropriate social information-processing patterns. PMID:25077163

Abbasian, Farahzad; Najimi, Arash; Meftagh, Sayyed Davood; Ghasemi, Gholamreza; Afshar, Hamid

2014-01-01

405

Allozyme electrophoresis still represents a powerful technique in the management of coral reefs  

Microsoft Academic Search

Understanding genetic variability and gene flow between populations of scleractinian corals separated by one to several hundred kilometers is crucially important as we head into a century of climate change in which an understanding of the connectivity of populations is a critically important question in management. Genetic methods that directly use molecular variance in the DNA should offer greater precision

Tyrone Ridgway

2005-01-01

406

IEEE COMMUNICATIONS SURVEYS & TUTORIALS, ACCEPTED FOR PUBLICATION 1 Energy Management Techniques in  

E-print Network

efficiently is paramount in modern smartphones. The diverse range of wireless interfaces and sen- sors devices and applications, wireless interfaces and sensors management, and finally the benefits such as location-aware services and mobile social networks. However, those applications can potentially reduce

Hand, Steven

407

Implementing Bottleneck Management Techniques and Establishing Quality of Sort Relationships to Improve Terminal Processing Capacity  

E-print Network

concept of "Factory Physics," Goldratt's Theory of Constraints (TOC) and tools from Lean Manufacturing of a terminal system can be gained by adopting a manufacturing systems management approach. This enables use in the manufacturing environment. This work focused on improving terminal performance by adapting the Hopp & Spearman

Barkan, Christopher P.L.

408

Management induced organic matter differentiation in grassland and arable soil: a study using pyrolysis techniques  

Microsoft Academic Search

Differences in agricultural management and land use lead to differences in soil structure, soil organic matter (SOM) dynamics and composition. We investigated the SOM composition at three depth layers in a permanent pasture (PP), an organic arable (OA) and a conventional arable (CA) field within one soil series in marine loam deposits in The Netherlands. Both arable fields were in

Klaas G. J. Nierop; Mirjam M. Pulleman; Joke C. Y. Marinissen

2001-01-01

409

Management induced organic matter differentiation in grassland and arable soil: a study using pyrolysis techniques  

Microsoft Academic Search

Differences in agricultural management and land use lead to differences in soil structure, soil organic matter (SOM) dynamics and composition. We investigated the SOM composition at three depth layers in a permanent pasture (PP), an organic arable (OA) and a conventional arable (CA) ®eld within one soil series in marine loam deposits in The Netherlands. Both arable fields were in

K. G. J. Nierop; M. M. Pulleman; J. C. Y. Marinissen

2005-01-01

410

Managing Construction Operations Visually: 3-D Techniques for Complex Topography and Restricted Visibility  

ERIC Educational Resources Information Center

Visual information is vital in planning and managing construction operations, particularly, where there is complex terrain topography and salvage operations with limited accessibility and visibility. From visually-assessing site operations and preventing equipment collisions to simulating material handling activities to supervising remotes sites…

Rodriguez, Walter; Opdenbosh, Augusto; Santamaria, Juan Carlos

2006-01-01

411

Community Profiling: From Technique to Reflective Practice in Community Engagement for Natural Resource Management  

Microsoft Academic Search

Community profiling is a tool that aims to help practitioners collect and make use of varied data to understand the diversity of stakeholders and issues in communities where they are delivering natural resource management programs. This paper will discuss some of the problems experienced with community profiling and propose a shift in the way in which this tool is used.

Sonya Love; Lucia Boxelaar; Josette ODonnell; Julie Francis

2007-01-01

412

Response of Vegetation and Endangered Waterbirds to Habitat Management Techniques at Kealia Pond National Wildlife Refuge  

E-print Network

would like to express my gratitude to my family and friends for the support and encouragement throughout Koshorek, for all her support and help in developing my ideas. I will forever be indebted for all her love encouragement to pursue my interests in wetland and waterfowl management. I also appreciate the prospect

413

Methodological note A review of operations management studies using scale development techniques  

Microsoft Academic Search

Operations management research is beginning to focus on the development and use of reliable and valid scales. OM scale development efforts and scale development in organizational behavior and psychology are compared. Major differences include the fact that OM research tended, until recently, to be theoretical and, when applied, tended to use the firm as a unit of measure. OM research,

Rhonda L. Hensley

414

Community Profiling: From Technique to Reflective Practice in Community Engagement for Natural Resource Management  

ERIC Educational Resources Information Center

Community profiling is a tool that aims to help practitioners collect and make use of varied data to understand the diversity of stakeholders and issues in communities where they are delivering natural resource management programs. This paper will discuss some of the problems experienced with community profiling and propose a shift in the way in…

Love, Sonya; Boxelaar, Lucia; O'Donnell, Josette; Francis, Julie

2007-01-01

415

Exploring the Degree of Support by PMOs for New Project Management Techniques and Methods  

ERIC Educational Resources Information Center

An organization tends to seek out the best set of practices in order to achieve project success. Many organizations are implementing a Project Management Office (PMO) to serve as a central post for organizing and disseminating best practices. The PMO responsibilities in part is to examine all practices, old and new, to best determine which…

Lopez, Kathleen P.

2012-01-01

416

The use of structured data analysis as a construction management research tool: 1. The technique  

Microsoft Academic Search

It is argued in this paper that the flow of data between members of a construction project team is both critical and time-consuming. If progress is to continue in important areas of construction management and engineering that involve dataflow or transfer — such as information technology, computer-aided design and manufacture, robotics and expert systems — the recording and identification of

Norman Fisher

1990-01-01

417

Use of Case Study Methods in Human Resource Management, Development, and Training Courses: Strategies and Techniques  

ERIC Educational Resources Information Center

This paper will study some of the problems associated with case studies and make recommendations using standard and innovative methodologies effectively. Human resource management (HRM) and resource development cases provide context for analysis and decision-making designs in different industries. In most HRM development and training courses…

Maxwell, James R.; Gilberti, Anthony F.; Mupinga, Davison M.

2006-01-01

418

Application and comparison of two modelling techniques for hospital bed management  

Microsoft Academic Search

The use of the bed occupancy management and planning system (BOMPS) and the Sorensen multi-phased bed model were used to assess the implications of a hospital expanding its emergency facility. BOMPS flow modelling generates resource utilisation data dependent on the best visual and statistical fit between mixed exponential equations and time of bed occupancy; the Sorensen model creates models based

Mark Mackay; Peter H Millard

1999-01-01

419

Comparison of functional activation in the temporal lobe of awake and anesthetized monkeys , H. Merkle2  

E-print Network

the fMRI responses of awake and anesthetized monkeys to the same movie stimulus at 7T. We are interested. Methods Experiments were done on a vertical 7T Bruker Biospec in awake and anesthetized monkeys (macaca in the awake animal, the high SNR and higher BOLD signal at 7T and the anesthesia protocol allow us to also

Jegelka, Stefanie

420

Channel Opening by Anesthetics and GABA Induces Similar Changes in the GABAA Receptor M2 Segment  

PubMed Central

For many general anesthetics, their molecular basis of action involves interactions with GABAA receptors. Anesthetics produce concentration-dependent effects on GABAA receptors. Low concentrations potentiate submaximal GABA-induced currents. Higher concentrations directly activate the receptors. Functional effects of anesthetics have been characterized, but little is known about the conformational changes they induce. We probed anesthetic-induced conformational changes in the M2 membrane-spanning, channel-lining segment using disulfide trapping between engineered cysteines. Previously, we showed that oxidation by copper phenanthroline in the presence of GABA of the M2 6? cysteine mutants, ?1T261C?1T256C and ?1?1T256C resulted in formation of an intersubunit disulfide bond between the adjacent ?-subunits that significantly increased the channels' spontaneous open probability. Oxidation in GABA's absence had no effect. We examined the effect on ?1T261C?1T256C and on ?1?1T256C of oxidation by copper phenanthroline in the presence of potentiating and directly activating concentrations of the general anesthetics propofol, pentobarbital, and isoflurane. Oxidation in the presence of potentiating concentration of anesthetics had little effect. Oxidation in the presence of directly activating anesthetic concentrations significantly increased the channels' spontaneous open probability. We infer that activation by anesthetics and GABA induces a similar conformational change at the M2 segment 6? position that is related to channel opening. PMID:17293408

Rosen, Ayelet; Bali, Moez; Horenstein, Jeffrey; Akabas, Myles H.

2007-01-01

421

A Double-Edged Sword: Volatile Anesthetic Effects on the Neonatal Brain  

PubMed Central

The use of volatile anesthetics, a group of general anesthetics, is an exceedingly common practice. These anesthetics may have neuroprotective effects. Over the last decade, anesthetic induced neurotoxicity in pediatric populations has gained a certain notoriety based on pre-clinical cell and animal studies demonstrating that general anesthetics may induce neurotoxicity, including neuroapoptosis, neurodegeneration, and long-term neurocognitive and behavioral deficits. With hundreds of millions of people having surgery under general anesthesia worldwide, and roughly six million children annually in the U.S. alone, the importance of clearly defining toxic or protective effects of general anesthetics cannot be overstated. Yet, with our expanding body of knowledge, we have come to learn that perhaps not all volatile anesthetics have the same pharmacological profiles; certain ones may have a more favorable neurotoxic profile and may actually exhibit neuroprotection in specific populations and situations. Thus far, very few clinical studies exist, and have not yet been convincing enough to alter our practice. This review will provide an update on current data regarding volatile anesthetic induced neurotoxicity and neuroprotection in neonatal and infant populations. In addition, this paper will discuss ongoing studies and the trajectory of further research over the coming years. PMID:24961761

Chiao, Sunny; Zuo, Zhiyi

2014-01-01

422

A Comparison of Hamster Anesthetics and Their Effect on Mosquito Blood Feeding  

Technology Transfer Automated Retrieval System (TEKTRAN)

Hamsters or mice are often anesthetized when they are used as the hosts for insect feeding experiments. An experiment was done to determine if there was a difference in mosquito blood feeding success when fed on hamsters anesthetized using two commonly used protocols. The number of blood-fed females...

423

Feature Extraction Techniques for Measuring Piñon and Juniper Tree Cover and Density, and Comparison with Field-Based Management Surveys  

NASA Astrophysics Data System (ADS)

Western North America is experiencing a dramatic expansion of piñon ( Pinus spp.) and juniper ( Juniperus spp.) (P-J) trees into shrub-steppe communities. Feature extracted data acquired from remotely sensed imagery can help managers rapidly and accurately assess this land cover change in order to manage rangeland ecosystems at a landscape-scale. The objectives of this study were to: (1) develop an effective and efficient method for accurately quantifying P-J tree canopy cover and density directly from high resolution photographs and (2) compare feature-extracted data to typical in-situ datasets used by land managers. Tree cover was extracted from aerial-photography using Feature Analyst®. Tree density was calculated as the sum of the total number of individual polygons (trees) within the tree cover output file after isolation using a negative buffer post-processing technique. Feature-extracted data were compared to ground reference measurements from Utah's Division of Wildlife Resources Range Trend Project (DWR-RTP). We found that the proposed feature-extraction techniques used for measuring cover and density were highly correlated to ground reference and DWR-RTP datasets. Feature-extracted measurements of cover generally showed a near 1:1 relationship to these data, while tree density was underestimated; however, after calibration for juvenile trees, a near 1:1 relationship was realized. Feature-extraction techniques used in this study provide an efficient method for assessing important rangeland indicators, including: density, cover, and extent of P-J tree encroachment. Correlations found between field and feature-extracted data provide evidence to support extrapolation between the two approaches when assessing woodland encroachment.

Madsen, Matthew D.; Zvirzdin, Daniel L.; Davis, Bracken D.; Petersen, Steven L.; Roundy, Bruce A.

2011-05-01

424

Web based collaborative decision making in flood risk management: Application of TOPSIS and visualisation techniques for ranking of alternatives  

NASA Astrophysics Data System (ADS)

Development of flood risk management (FRM) plans is ideally carried out in a participatory process with relevant stakeholders. Integrating stakeholders knowledge and information in the decision making process creates trust amongst decision makers and stakeholders that often leads to a successful implementation of measures. Stakeholder participation however does not come without challenges and hindrances (e.g. limitation of resources, spatial distribution and interest to participate). The most challenging type of participation is Collaborative decision making (CDM). A web-based mobile or computer-aided environment offers an innovative approach to address these challenges and hindrances. Moreover, this also enhances participation. Different phases or steps of a CDM process are addressing relevant management objectives, identify scenarios and sets of proposed alternatives, individually rank these alternatives in order of preference and present an aggregated rank to view the groups position. In individual ranking, formulation of judgement should combine scientific facts with stakeholders' beliefs and attitudes. This paper presents a developed web-based CDM framework and its implementation, highlighting the application of a Muti-Criteria Decision Making (MCDM) method for individual ranking of alternative, the method Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) with Fuzzy logic. Moreover, an innovative visualisation technique for stakeholders' group ranking is also presented. Case studies are the Alster catchment (Hamburg, Germany) and Cranbrook catchment, (London, UK). A series of stakeholders' workshops was done to test and evaluate the environments. It shows that the TOPSIS method provides a close representation of the stakeholders' preferences regarding the measures and alternatives. Overall the evaluation shows that web-based environments can address the challenges and hindrances and it enhances participation in flood risk management. The web-based environment was developed within the DIANE-CM project (Decentralised Integrated Analysis and Enhancement of Awareness through Collaborative Modelling and Management of Flood Risk) of the 2nd ERANET CRUE funding initiative.

Evers, Mariele; Almoradie, Adrian; Jonoski, Andreja

2014-05-01

425

Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration.  

PubMed

For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features. Other visualization techniques can be used including isotope scanning (radioiodine, 99m technetium, 241 americium fluorescence, 131 cesium, 67 gallium, 75 selenomethionine, 201 thallium, 32 phosphorus, 99m Tc-bleomycin, 197 mercury, 133 xenon), thermography, x-ray techniques (plain films, computed tomographic scan, xeroradiography, chest x-ray barium swallow, lymphography, angiography), and thyroid hormone suppression. Needle biopsy can be done by core biopsy (Vim-Silverman and drill biopsy), large needle biopsy for histologic processing and fine needle aspiration for cytologic interpretation. The latter is the safest, most reliable, and most cost-effective technique currently available to differentiate between benign and malignant thyroidal disease and has great promise for the future. PMID:6163751

Ashcraft, M W; Van Herle, A J

1981-01-01

426

Intraspinal techniques for pain management in cancer patients: a systematic review  

Microsoft Academic Search

Purpose  This systematic review outlines current evidence regarding the effectiveness of intraspinal techniques for cancer pain and\\u000a addresses practical implementation issues.\\u000a \\u000a \\u000a \\u000a Methods  A search of electronic databases identified systematic reviews and randomized controlled trials (RCTs) evaluating the effectiveness\\u000a of intraspinal techniques in the setting of cancer pain. An environmental scan was completed via the internet to identify\\u000a practice guidelines and resource documents

Jeff Myers; Vincent Chan; Virginia Jarvis; Cindy Walker-Dilks

2010-01-01

427

Tools and Techniques for Evaluating the Effects of Maintenance Resource Management (MRM) in Air Safety  

NASA Technical Reports Server (NTRS)

This research project was designed as part of a larger effort to help Human Factors (HF) implementers, and others in the aviation maintenance community, understand, evaluate, and validate the impact of Maintenance Resource Management (MRM) training programs, and other MRM interventions; on participant attitudes, opinions, behaviors, and ultimately on enhanced safety performance. It includes research and development of evaluation methodology as well as examination of psychological constructs and correlates of maintainer performance. In particular, during 2001, three issues were addressed. First a prototype process for measuring performance was developed and used. Second an automated calculator was developed to aid the HF implementer user in analyzing and evaluating local survey data. These results include being automatically compared with the experience from all MRM programs studied since 1991. Third the core survey (the Maintenance Resource Management Technical Operations Questionnaire, or 'MRM/TOQ') was further developed and tested to include topics of added relevance to the industry.

Taylor, James C.

2002-01-01

428

Toward high efficiency ultra-thin CIGSe based solar cells using light management techniques  

NASA Astrophysics Data System (ADS)

This study addresses the potential of different approaches to improve the generated current density in ultrathin Cu(In,Ga)Se2 (CIGSe) based solar cells down to 0.1 ?m. Advanced photon management, involving both absorption enhancement and reflection reduction in the absorber, is studied. In this contribution, the three main approaches used are: - The reduction of the CIGSe thickness by chemical etching which combines thickness reduction and smoothing effect on the absorber. - Optical management by front contact engineering and by the replacement of the back contact by the "lift-off" of CIGSe layer from the Mo layer and the deposition of a new reflective back contact. - Application of plasmonic structures to CIGSe solar cells enabling light confinement at the subwavelength scale.

Naghavi, Negar; Jehl, Zacharie; Donsanti, Frederique; Guillemoles, Jean-François; Gérard, Isabelle; Bouttemy, Muriel; Etcheberry, Arnaud; Pelouard, Jean-Luc; Collin, Stéphane; Colin, Clément; Péré-Laperne, Nicolas; Dahan, Nir; Greffet, Jean-Jacques; Morel, Boris; Djebbour, Zakaria; Darga, Arouna; Mencaraglia, Denis; Voorwinden, Georg; Dimmler, Bernhard; Powalla, Micheal; Lincot, Daniel

2012-02-01

429

NPACI Rocks: Tools and Techniques for Easily Deploying Manageable Linux Clusters  

Microsoft Academic Search

SUMMARY High-performance computing clusters (commodity hardware with low-latency, high- bandwidth interconnects) based on Linux, are rapidly becoming the dominant computing platform for a wide range of scientific disciplines. Yet, straightforward software installation, maintenance, and health monitoring for large-scale clusters has been a consistent and nagging problem for non-cluster experts. The NPACI Rocks distribution takes a fresh perspective on management and

Philip M. Papadopoulos; Mason J. Katz; Greg Bruno

2001-01-01

430

Surgical management of peptic ulcer disease today – indication, technique and outcome  

Microsoft Academic Search

Aims: The current surgical management of peptic ulcer disease and its outcome have been reviewed. Results: Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation,\\u000a a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in\\u000a the large majority of cases, and definitive

T. T. Zittel; E. C. Jehle; H. D. Becker

2000-01-01

431

A Dynamic Slack Management Technique for Real-Time System with Precedence and Resource Constraints  

Microsoft Academic Search

\\u000a Energy consumption is a critical design issue in embedded systems, especially in battery-operated systems. Dynamic Voltage\\u000a Scaling and Dynamic Frequency Scaling allow us to adjust supply voltage and processor frequency to adapt to the workload demand\\u000a for better energy management. For a set of real-time tasks with precedence and resource constraints executing on a distributed\\u000a embedded system, we propose a

Santhi Baskaran; Perumal Thambidurai

432

Increased volatile anesthetic requirement in short-sleeping Drosophila mutants  

PubMed Central

Background Anesthesia and sleep share physiological and behavioral similarities. The anesthetic requirement of the recently identified Drosophila mutant minisleeper and other Drosophila mutants was investigated. Methods Sleep and wakefulness were determined by measuring activity of individual wild-type and mutant flies. Based on the response of the flies at different concentrations of the volatile anesthetics isoflurane and sevoflurane, concentration-response curves were generated and EC50 values were calculated. Results The average amount of daily sleep in wild-type Drosophila (n=64) was 965 ±15 minutes and 1022 ± 29 in na[har38] p>0.05; n=32) (mean ± SEM, all p compared to wild-type and other shaker alleles). Shmns flies slept 584 ±13 minutes (n=64, p<0.01), Sh102 412 ± 22 minutes (n=32, p<0.01) and Sh120 782 ± 25 minutes (n=32, p<0.01). The EC50 values for isoflurane were 0.706 (95% confidence interval 0.649 to 0.764, n=661) and for sevoflurane 1.298 (1.180 to 1.416, n=522) in wild-type Drosophila, 1.599 (1.527 to 1.671, n=308) and 2.329 (2.177 to 2.482, n=282) in Sh102, 1.306 (1.212 to 1.400, n=393) and 2.013 (1.868 to 2.158, n=550) in Shmns, 0.957 (0.860 to 1.054, n=297) and 1.619 (1.508 to 1.731, n=386) in Sh120, and 0.6154 (0.581 to 0.649, n=360; p<0.05) and 0.9339 (0.823 to 1.041, n= 274) in na[har38], respectively (all p<0.01). Conclusions A single-gene mutation in Drosophila that causes an extreme reduction in daily sleep is responsible for a significant increase in the requirement of volatile anesthetics. This suggests that a single gene mutation affects both sleep behavior and anesthesia and sedation. PMID:19164958

Weber, Bernd; Schaper, Christian; Bushey, Daniel; Rohlfs, Marko; Steinfath, Markus; Tononi, Giulio; Cirelli, Chiara; Scholz, Jens; Bein, Berthold

2009-01-01

433

Organizational Behavior Change: The Effectiveness of Behavior Modification Techniques with and without Participatory Management.  

ERIC Educational Resources Information Center

This study examines a naturally occurring experiment in a large urban hospital faced with budget cuts, in which departments were ordered to reduce employees' overtime without jeopardizing service quality. The study focuses on two departments that chose to use behavior modification techniques. In one department (Radiology) the intervention combined…

Sweeney, Mary M.; Goldstein, Marc B.

434

Management of infected non-union of the proximal femur: a combination of therapeutic techniques.  

PubMed

A challenging case of a nonunion of the proximal femur complicated by infection attributed to microbial and fungal pathogens requiring a combination of novel surgical techniques to achieve eradication of infection, preservation of the native hip joint, and restoration of function. PMID:25441579

Goff, Thomas A J; Kanakaris, Nikolaos K

2014-12-01

435

Mapping Vegetation and Anthropogenic Disturbances in Southern Ecuador with Remote Sensing Techniques: Implications for Park Management  

Microsoft Academic Search

Protected areas in the Ecuadorian highlands have been threatened recently by increasingly severe anthropogenic disturbances. Given both the biodiversity and spatial heterogeneity of Andean ecosystems, geographers should develop reliable methods for mapping these areas. While remote sensing techniques have rarely been applied to studies of tropical montane landscapes, these tools have the potential to provide useful maps of vegetation and

Philip L. Keating

436

The pouch and tunnel technique for management of multiple gingival recession defects.  

PubMed

The desire for improved esthetics has increased tremendously over the years. Periodontal plastic surgery deals with regenerative procedures designed to restore form, function and enhance esthetics. The aim of this study was to evaluate the effectiveness of subepithelial connective tissue graft using pouch and tunnel technique as root coverage procedure. Three patients corresponding to a total of 8 sites participated in the study. Maxillary teeth with miller's class I gingival recession were included in the study. All the sites were treated using subepithelial connective tissue graft using pouch and tunneling technique. Patients were followed up for a period of 6 months and 1 year. All the treated teeth showed 100% root coverage at the end of 6 months and 1 year. Gingival recession is a common occurrence and its prevalence increases with age. It can lead to clinical problems, diminished cosmetic appeal and hence esthetic concern. There are various techniques for root coverage. Subepithelial connective tissue graft has shown the best predictability (95%) of root coverage in Millers class I & II cases. This technique preserves the intermediate papilla, accelerates the initial wound healing & also applies less traction. Due to minimal trauma at the recipient site, this procedure may be advantageous in treatment of recession as compared to other treatment modalities. PMID:25624637

Dani, Sneha; Dhage, Aditi; Gundannavar, Gayatri

2014-01-01

437

The pouch and tunnel technique for management of multiple gingival recession defects  

PubMed Central

The desire for improved esthetics has increased tremendously over the years. Periodontal plastic surgery deals with regenerative procedures designed to restore form, function and enhance esthetics. The aim of this study was to evaluate the effectiveness of subepithelial connective tissue graft using pouch and tunnel technique as root coverage procedure. Three patients corresponding to a total of 8 sites participated in the study. Maxillary teeth with miller's class I gingival recession were included in the study. All the sites were treated using subepithelial connective tissue graft using pouch and tunneling technique. Patients were followed up for a period of 6 months and 1 year. All the treated teeth showed 100% root coverage at the end of 6 months and 1 year. Gingival recession is a common occurrence and its prevalence increases with age. It can lead to clinical problems, diminished cosmetic appeal and hence esthetic concern. There are various techniques for root coverage. Subepithelial connective tissue graft has shown the best predictability (95%) of root coverage in Millers class I & II cases. This technique preserves the intermediate papilla, accelerates the initial wound healing & also applies less traction. Due to minimal trauma at the recipient site, this procedure may be advantageous in treatment of recession as compared to other treatment modalities. PMID:25624637

Dani, Sneha; Dhage, Aditi; Gundannavar, Gayatri

2014-01-01

438

Vis-A-Plan /visualize a plan/ management technique provides performance-time scale  

NASA Technical Reports Server (NTRS)

Vis-A-Plan is a bar-charting technique for representing and evaluating project activities on a performance-time basis. This rectilinear method presents the logic diagram of a project as a series of horizontal time bars. It may be used supplementary to PERT or independently.

Ranck, N. H.

1967-01-01

439

Yoga Breathing Techniques: Implications for Stress Management, Health, and Psychophysiological Research  

Microsoft Academic Search

Understanding and application of various respiratory practices are impeded by the many interacting physiological and psychological variables. Yoga techniques may offer insights into useful breathing practices and control of important variables. This review integrates relevant data from (a) the psychophysiological\\/psychological literature, (b) the physiological\\/medical literature, and (c) studies of yoga. The available data indicate that yogic slow breathing practices promote

James E. Kennedy

440

Tools for selecting appropriate risk management techniques in the built environment  

Microsoft Academic Search

The built environment is full of uncertainty which leads to risk. The literature shows that there is a wide range of techniques available to deal with risk; however numerous studies have shown that only a relatively small number are used in practice. One reason for this small number is a lack of knowledge of the circumstances in which they can

Doug Forbes; Simon Smith; Malcolm Horner

2008-01-01

441

Application of DSM techniques and renewable energy devises for peak load management  

Microsoft Academic Search

The growth of industries is very essential for the growth of any nation. Industries are mainly depending on electrical energy, but unfortunately the sources for electrical energy are depleting and hence the gap between the supplier and the load is continuously increasing. The work presented in this paper gives the results of application of a few DSM techniques along with

P. Ravibabu; K. Venkatesh; T. Swetha; S. F. Kodad; B. V. Sankar Ram

2008-01-01

442

Humor As a Management Technique: Its Impact on School Culture and Climate.  

ERIC Educational Resources Information Center

Ways in which humor is used as an administrative technique are explored in this paper, with a focus on its impact on school culture. Case study methodology is based on interviews with two principals and five staff members at a Tennessee high school. Following a review of transcript excerpts, the principal's use of humor is viewed through four…

Williams, Ronny A.; Clouse, R. Wilburn

443

The effects of volatile anesthetics on synaptic and extrasynaptic GABA-induced neurotransmission.  

PubMed

Examination of volatile anesthetic actions at single synapses provides more direct information by reducing interference by surrounding tissue and extrasynaptic modulation. We examined how volatile anesthetics modulate GABA release by measuring spontaneous or miniature GABA-induced inhibitory postsynaptic currents (mIPSCs, sIPSCs) or by measuring action potential-evoked IPSCs (eIPSCs) at individual synapses. Halothane increased both the amplitude and frequency of sIPSCs. Isoflurane and enflurane increased mIPSC frequency while sevoflurane had no effect. These anesthetics did not alter mIPSC amplitudes. Halothane increased the amplitude of eIPSCs, with a decrease in failure rate (Rf) and paired-pulse ratio. In contrast, isoflurane and enflurane decreased the eIPSC amplitud