Sample records for anesthetic management techniques

  1. Anesthetic Management of Patients with Intracranial Aneurysms

    PubMed Central

    Abd-Elsayed, Alaa A.; Wehby, Anthony S.; Farag, Ehab

    2014-01-01

    Background Stroke is a leading cause of death and disability worldwide. Aneurysmal subarachnoid hemorrhage (aSAH), a significant cause of hemorrhagic stroke, continues to have poor prognosis. Early diagnosis and treatment are key to improving outcomes. Subarachnoid hemorrhage (SAH) and aSAH are often accompanied by multiple comorbidities, making anesthetic management of these patients complex. Methods This article summarizes the goals of anesthetic management of patients with cerebral aneurysm, including preoperative considerations, intraoperative management, and postoperative considerations. Results Hemodynamic monitoring is an important aspect of management. Use nicardipine, labetalol, and esmolol to avoid increases in blood pressure that may cause aneurysm rupture, and avoid low blood pressure as this may decrease cerebral perfusion pressure. Nimodipine is recommended for vasospasm prophylaxis in all patients with aSAH. The hypertension arm of Triple H therapy (hypertension, hypervolemia, hemodilution) is the most important to improve cerebral perfusion. Erythropoietin has shown some promise in lowering the incidence of vasospasm and delayed cerebral ischemia. Albumin is the preferred colloid. Conclusion Anesthetic management of patients with aSAH and SAH is a complex endeavor. Careful consideration of individual patient status, optimal techniques, and the safest evidence-based methods are the best options for successfully treating these life-altering conditions. PMID:25249809

  2. Anesthetic management of super-morbidly obese parturients for cesarean delivery with a double neuraxial catheter technique: a case series.

    PubMed

    Polin, C M; Hale, B; Mauritz, A A; Habib, A S; Jones, C A; Strouch, Z Y; Dominguez, J E

    2015-08-01

    Parturients with super-morbid obesity, defined as body mass index greater than 50kg/m(2), represent a growing segment of patients who require anesthetic care for labor and delivery. Severe obesity and its comorbid conditions place the parturient and fetus at greater risk for pregnancy complications and cesarean delivery, as well as surgical and anesthetic complications. The surgical approach for cesarean delivery in these patients may require a supra-umbilical vertical midline incision due to a large pannus. The dense T4-level of spinal anesthesia can cause difficulties with ventilation for the obese patient during the procedure, which can be prolonged. Patients also may have respiratory complications in the postoperative period due to pain from the incision. We describe the anesthetic management of three parturients with body mass index ranging from 73 to 95kg/m(2) who had a cesarean delivery via a supra-umbilical vertical midline incision. Continuous lumbar spinal and low thoracic epidural catheters were placed in each patient for intraoperative anesthesia and postoperative analgesia, respectively. Continuous spinal catheters were dosed with incremental bupivacaine boluses to achieve surgical anesthesia. In one case, the patient required respiratory support with non-invasive positive pressure ventilation. Two cases were complicated by intraoperative hemorrhage. All patients had satisfactory postoperative analgesia with a thoracic epidural infusion. None suffered postoperative respiratory complications or postdural puncture headache. The use of a continuous lumbar spinal catheter and a low thoracic epidural provides several advantages in the anesthetic management of super-morbidly obese parturients for cesarean delivery. PMID:25936783

  3. Child with aplastic anemia: Anesthetic management

    PubMed Central

    Kaur, Manpreet; Gupta, Babita; Sharma, Aanchal; Sharma, Sanjeev

    2012-01-01

    Aplastic anemia is a rare heterogeneous disorder of hematopoietic stem cells causing pancytopenia and marrow hypoplasia with the depletion of all types of blood cells. This results in anemia, neutropenia and thrombocytopenia, which pose a challenge to both surgical and anesthetic management of such cases. We report a child with aplastic anemia who sustained traumatic ulcer on the arm and underwent split-thickness skin grafting under general anesthesia. There are only two case reports on anesthetic considerations in aplastic anemia patients in the literature. The anesthetic management is challenging because of the rarity of the disease, associated pancytopenia and immunosuppression. PMID:23162410

  4. Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report

    Microsoft Academic Search

    Demet Coskun; Ahmet Mahli; Zerrin Yilmaz; Pelin Cizmeci

    2008-01-01

    INTRODUCTION: The choice of anesthetic technique for Caesarean section of a pregnant woman with cerebral arteriovenous malformation (AVM) is made to maintain a stable cardiovascular system, but due to the rarity of this condition, no definitive guidelines exist. CASE PRESENTATION: We report the case of anesthetic management of Caesarean section of a pregnant woman with cerebral AVM (grade V). After

  5. Anesthetic Management of a Child with Mitochondrial Neurogastrointestinal Encephalopathy

    PubMed Central

    Casarez, Vianey Q.; Zavala, Acsa M.; Owusu-Agyemang, Pascal; Hagan, Katherine

    2015-01-01

    Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder associated with deficiency of thymidine phosphorylase (TP). Associated manifestations include visual and hearing impairments, peripheral neuropathies, leukoencephalopathy, and malnutrition from concomitant gastrointestinal dysmotility and pseudoobstruction. Given the altered metabolic state in these patients, specific consideration of medication selection is advised. This case report will describe the anesthetic management used in a 10-year-old girl with MNGIE. She had multiple anesthetics while undergoing allogeneic hematopoietic stem cell transplantation. This case report will discuss the successful repeated use of the same anesthetic in this pediatric patient, with the avoidance of volatile anesthetic agents, propofol, and muscle relaxant.

  6. Dexmedetomidine for anesthetic management of anterior mediastinal mass

    Microsoft Academic Search

    Basem Abdelmalak; Nicholas Marcanthony; Joseph Abdelmalak; Michael S. Machuzak; Thomas R. Gildea; D. John Doyle

    2010-01-01

    Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management\\u000a of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who\\u000a presented with a 10 × 9 × 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome.\\u000a He had severe obstruction of the

  7. [Anesthetic management of patients with arrhythmogenic right ventricular cardiomyopathy].

    PubMed

    Kato, Yoshiko

    2014-01-01

    Arrhythmogenic right ventricular cardiomyopathy is a genetic cardiomyopathy characterized by replacement of right ventricular myocardium by fibrofatty infiltrates, leading to significant ventricular arrhythmias with sudden death and right ventricular dysfunction. Elective operations should be postponed, until the arrhythmias and myocardial function are well tolerated. There has been no guideline on the anesthetic management of this serious, despite rare, disease and there are a few reports of the patients undergoing operation under either general or regional anesthesia. The most important issue of the anesthetic management is to avoid excessive sympathetic stimulation, especially beta stimulation which can easily induce life-threatening arrhythmias. Also, it is better to avoid adrenalin as an adjunct to the local anesthetics. Anesthetic maintenance was performed with volatile anesthetics except halothane, opiates, muscle relaxants except pancuronium and intravenous anesthetics including propofol, ketamine and benzodiazepines. Invasive monitoring of arterial blood pressure and central venous pressure is recommended and transesophageal echocardiography, if available, provides diagnostic information for an intraoperative cardiac event. It is essential to apply alpha-adrenergic agonists instead of beta-agonists for intraoperative hemodynamic support. The arrhythmias should be managed with beta-blockers or amiodarone. Adequate control of postoperative analgesia and nausea/vomiting is also important to suppress sympathetic activities. PMID:24558930

  8. Supraclavicular block as a sole anesthetic technique in craniopagus twins.

    PubMed

    Schleelein, Laura E; Perate, Alison R; Ganesh, Arjunan

    2013-01-01

    This is the first report in the literature of a sole regional anesthetic for adult craniopagus twins using a supraclavicular block for an elbow incision and drainage/bursa excision procedure. It demonstrates that for these complex medical patients, a total regional anesthesia technique is preferable when possible. There are several known general anesthetic complications in these patients. Anesthetic crossover between the twins can occur and may be variable; furthermore, the incidence and severity of the crossover effects of different anesthetics vary. Positioning of the twins can be difficult with both regional and general anesthesia. However, with regional anesthesia, the twins can position themselves and report any discomfort, which could go unnoticed under general anesthesia, leading to other complications. Craniopagus twins have a high likelihood of a difficult airway due to anatomy or positioning difficulties, which is avoided by regional anesthesia. This case emphasizes the unique challenges that these patients pose and the ability of regional anesthesia to help avoid the pitfalls of general anesthesia in these patients. PMID:23759707

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

    PubMed Central

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

    2014-01-01

    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

  10. Description and evaluation of an intraoral cervical plexus anesthetic technique.

    PubMed

    Bitner, Daniel P; Uzbelger Feldman, Daniel; Axx, Kevin; Albandar, Jasim M

    2015-07-01

    Unsuccessful anesthesia of the inferior alveolar nerve (IAN) may be due to supplementary innervations of mandibular molars from other branches, namely the cervical plexus (CP). The purpose of this prospective, randomized, double-blind, controlled trial was to determine the effectiveness of an intraoral cervical plexus anesthetic technique (ICPAT) in mandibular molars with symptomatic irreversible pulpitis (SIR) when the IAN and lingual nerve (LN) blocks failed, and to provide a description of the technique. Forty patients diagnosed with SIR received IAN and LN block anesthesia prior to treatment. After clinical signs of anesthesia, patients were subjected to an electrical pulp test (EPT) at 2-min cycles for 10 min post-injection. The anesthesia was considered unsuccessful if there was a positive EPT response ten minutes following profound lip numbness. The experimental group (n?=?20) were administered 2% Lidocaine with 1:100,000 epinephrine using the ICPAT. The control group (n?=?20) were administered 0.9% sterile saline using the ICPAT. Success was defined as no response on two consecutive readings from an EPT. In the experimental group, 60% of subjects showed successful anesthesia, whereas none of the subjects in the control group had successful anesthesia. A multiple logistic regression analysis showed that the anesthesia success rate using the ICPAT method was significantly higher (P?anesthetic technique for mandibular molars with SIR in subjects whom the IAN and LN blocks do not provide adequate anesthesia. Clin. Anat. 28:608-613, 2015. © 2015 Wiley Periodicals, Inc. PMID:25864872

  11. Effects of gas flow management on postintubation end-tidal anesthetic concentration and operating room pollution

    Microsoft Academic Search

    Daniel Siker; Juraj Sprung; Eduardo Escorcia; Robert Koch; Milan Vukcevich

    1997-01-01

    Study Objective: To study how different anesthetic practices during the transition from anesthetic delivery by mask to endotracheal intubation affect end-tidal postintubation anesthetic concentration and operating room (OR) pollution.Design: Prospective study.Setting: Anesthesia research laboratory.Measurements and Main Results: We studied four gas flow management practices: practice vaporizer off, only the anesthetic vaporizer was turned off: all off, oxygen (O2), nitrous oxide

  12. [Anesthetic management for nasal foreign body removal in children].

    PubMed

    Tonozaki, Takuya; Nishikawa, Kohki; Tsuchiya, Shigeo; Shimodate, Yuki; Yamakage, Michiaki

    2014-11-01

    Migration of a foreign body into the nasal cavity accidentally occurred in three children aged 2 yr. All procedures for removal were performed under general anesthesia. Two patients underwent slow anesthetic induction with sevoflurane and their tracheas were intubated under spontaneous breathing without neuromuscular blocking agents. One patient underwent rapid sequence induction with cricoid pressure to prevent aspiration. Anesthetic courses of the three patients were stable, and the foreign bodies were successfully removed without any complications. Since a nasal foreign body can cause occurrence of its aspiration into the trachea due to crying or reduction of muscle tone, special attention should be paid for safe management of the airway and/or anesthesia throughout the procedure. PMID:25731058

  13. Ehlers-Danlos syndrome: complications and solutions concerning anesthetic management.

    PubMed

    Johnston, Barrett A; Occhipinti, Kaitlin E; Baluch, Amir; Kaye, Alan D

    2006-10-01

    Ehlers-Danlos syndrome is an inherited disorder that results in dysfunctional collagen bundles. These dysfunctional collagen bundles are most noticeable in tissues rich with collagen fibers--skin, vessels, GI, and ligaments. Until gene therapy advancements can correct the underlying gene mutations causing faulty collagen, the mainstay of treatment is prevention of traumatic injury. The success of anesthetic management in patients with EDS requires and understanding of the role of collagen in the various tissues of the body. Collagen-rich tissue fragility, skin hyperextensibility, joint hypermobility, hematoma formation and cardiovascular disease are just some of the complications that need to be accounted for before every anesthetic procedure involving EDS patients. Anesthesiologists should be keenly that any physical manipulation of EDS patients incurs risks of trauma. PMID:17263273

  14. Epidermolysis Bullosa, Dental and Anesthetic Management: A Case Report

    PubMed Central

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

    2014-01-01

    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

  15. Pulmonary endarterectomy: Part II. Operation, anesthetic management, and postoperative care.

    PubMed

    Banks, Dalia A; Pretorius, Gert Victor D; Kerr, Kim M; Manecke, Gerard R

    2014-12-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary thromboembolic hypertension remains underdiagnosed. It is imperative that all patients with pulmonary hypertension (PH) be screened for the presence of CTEPH since this form of PH is potentially curable with pulmonary endarterectomy (PEA) surgery. The success of this procedure depends greatly on the collaboration of a multidisciplinary team approach that includes pulmonary medicine, cardiothoracic surgery, and cardiac anesthesiology. This review, based on the experience of more than 3000 pulmonary endarterectomy surgeries, is divided into 2 parts. Part I focuses on the clinical history and pathophysiology, diagnostic workup, and intraoperative echocardiography. Part II focuses on the surgical approach, anesthetic management, postoperative care, and complications. PMID:25005856

  16. Early presentation of postintubation tracheoesophageal fistula: Perioperative anesthetic management

    PubMed Central

    Kaur, Depinder; Anand, Saurabh; Sharma, Prakash; Kumar, Ashwini

    2012-01-01

    Tracheoesophageal fistula (TEF) in adults occurs as a result of trauma, malignancy, cuff-induced tracheal necrosis from prolonged mechanical ventilation, traumatic endotracheal intubation, foreign body ingestion, prolonged presence of rigid nasogastric tube, and surgical complication. Anesthetic management for repair of TEF is a challenge. Challenges include difficulties in oxygenation or ventilation resulting from placement of endotracheal tube in or above the fistula; large fistula defect causing loss of tidal volume with subsequent gastric dilatation, atelactasis, and maintenance of one lung ventilation. The most common cause of acquired nonmalignant TEF is postintubation fistula, which develops after prolonged intubation for ventilatory support. Acquired TEF, which occurs after prolonged intubation, usually develops after 12–200 days of mechanical ventilation, with a mean of 42 days. We present a rare case of TEF that developed after 7 days of intubation. It was a difficult case to be diagnosed as patient had a history of polytrauma, followed by emergency intubation and both these conditions can contribute to tracheobronchial injury. PMID:22345958

  17. [Anesthetic management of a patient with Mulvihill-Smith syndrome].

    PubMed

    Kuribayashi, Junya; Yamada, Tatsuya; Morisaki, Hiroshi; Takeda, Junzo

    2007-07-01

    Mulvihill-Smith syndrome is a rare disease that belongs to progeroid syndromes. This syndrome is characterized by a senile face with an underdeveloped lower half, short stature, microcephaly, multiple pigmented nevi, immunodeficiency, hearing loss, and high-pitched voice. We report anesthetic management of a 27-year-old woman, 138 cm and 27 kg, with this syndrome, who underwent removal of mandibular cyst, partial resection of tongue and keratoplasty. Anesthesia was induced with fentanyl, propofol and vecuronium. There was difficulty in maintaining adequate ventilation with a face mask for children, and we used a mask for infants. Her Cormack grade was rated 3 but her trachea could be intubated assisted by BURP procedure. Anesthesia was maintained with sevoflurane, nitrous oxide and oxygen supplemented with fentanyl. The changes of blood pressure during anesthesia were extraordinary, suggesting the presence of advanced arteriosclerosis. The postoperative course was uneventful, with stable hemodynamics, and the patient was discharged from the hospital on 9th postoperative day. Anesthesia for Mulvihill-Smith syndrome should be performed with caution for the potential risk of difficult airway and unstable hemodynamics. PMID:17633848

  18. Thoracic Epidural Anesthesia Combined with General Anesthesia: The Preferred Anesthetic Technique for Thoracic Surgery

    Microsoft Academic Search

    Vera Von Dossow; Martin Welte; Ulrich Zaune; Eike Martin; Michael Walter; Wolfgang J. Kox; Claudia D. Spies

    2001-01-01

    Thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) as well as total-IV anesthesia (TIVA) are both established anesthetic managements for thoracic surgery. We compared them with respect to hypoxic pulmonary vasoconstriction, shunt fraction and oxygenation during one-lung ventilation. Fifty pa- tients, ASA physical status II-III undergoing pulmo- nary resection were randomly allocated to two groups. In the TIVA group,

  19. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass

    PubMed Central

    Chaudhary, Kapil; Gupta, Anshu; Wadhawan, Sonia; Jain, Divya; Bhadoria, Poonam

    2012-01-01

    Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy. PMID:22557753

  20. Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses

    PubMed Central

    Bruins, Benjamin B.; Mirza, Natasha; Gomez, Ernest; Atkins, Joshua H.

    2015-01-01

    A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5?mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube. PMID:26090238

  1. Update on Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery, 2004–2007

    Microsoft Academic Search

    Roman Schumann; Stephanie B. Jones; Bronwyn Cooper; Scott D. Kelley; Mark Vanden Bosch; Vilma E. Ortiz; Kathleen A. Connor; Michael D. Kaufman; Alan M. Harvey; Daniel B. Carr

    2009-01-01

    To reevaluate and update evidence-based best practice recommendations published in 2004 for anesthetic perioperative care and pain management in weight loss surgery (WLS), we performed a systematic search of English-language literature on anesthetic perioperative care and pain management in WLS published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. We identified relevant abstracts by using key

  2. Case report: Anesthetic management for sequential Cesarean delivery and laminectomy

    Microsoft Academic Search

    Arif Al-areibi; Lynn Coveney; Sudha Singh; Sandra Katsiris

    2007-01-01

    Purpose  To describe the anesthetic considerations for a nearterm parturient with progressive cauda equina syndrome who required Cesarean\\u000a delivery followed immediately by decompression lumbar discectomy and laminectomy in the prone position.\\u000a \\u000a \\u000a \\u000a Clinical features  A 33-yr-old woman presented at 35 weeks gestation with severe L5-S1 disc herniation causing motor and sensory neuronal dysfunction\\u000a in the lower limbs accompanied by bowel and bladder dysfunction.

  3. Anesthetic management of carotid body tumor excision: A case report and brief review

    PubMed Central

    Karigar, Shivanand L.; Kunakeri, Sangamesh; Shetti, Akshaya N.

    2014-01-01

    Carotid body tumor (CBT) is a rare tumor, which arises at bifurcation of carotid artery from chemoreceptor cells. These cells sense the partial pressure of oxygen and carbon dioxide from the blood. Hence, carotid body plays an important role in the control of ventilation during hypoxia, hypercapnia, and acidosis. The tumor arising from these cells is benign and has tendency to turn out malignant. This tumor is found in persons who live at high altitudes. Removal of tumor poses several anesthetic challenges and perioperative morbidity or mortality. We report successful anesthetic management of CBT excision. PMID:25886240

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

    PubMed Central

    Batra, Meenu; Valecha, Umesh K.

    2014-01-01

    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

  5. Anesthetic management of spinal muscle atrophy type II in a parturient

    PubMed Central

    Bollag, Laurent; Kent, Christopher; Richebé, Philippe; Landau, Ruth

    2011-01-01

    We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature. PMID:22915887

  6. [The development of chemical narcotic and related anesthetic techniques in modern times].

    PubMed

    Zheng, Hui; Zhang, Yan-Rong

    2012-11-01

    Before the 19(th) century, ether and nitrous oxide were synthesized. However, they were just used as a kind of enjoyable things at night gatherings for their hypnotic and analgesic effect. In the 19(th) century, ether and nitrous oxide came into use in clinical anesthesia. Thereafter, more and more chemical narcotics were synthesized and applied to clinical anesthesia. In 1872, chloroform was injected into man's vein for anesthesia. In the 20(th) century, along with many kinds of barbiturates being synthesized, intravenous anesthesia got much development and application. At the same time, related techniques of anesthesia also improved. In the early 19(th) century, open inhalation anesthesia was often used. In 1900, there came a new anesthesia method by blowing into the windpipe through the cut of throat. Later on, the technique of endotracheal anesthesia and artificial respiration anesthesia (1908), the anesthetic instrument of endotracheal intubation and laryngeal mask and laryngoscope were invented. In the mid 19(th) century, the appearance of injection syringe and cocaine made local anesthesia possible. In 1880, local anesthesia also became successful. Thereafter, a variety of local anesthetic drugs were synthesized and applied, companying with various techniques of local anesthesia such as subarachnoid anesthesia (1900), sacral anesthesia (1901), epidural block (1903), plexus block (1902) and so on. In order to control the depth of anesthesia and respiration effectively, people attempted a lot so that anesthesia machine (1910), improved endotracheal anesthesia (1921), cryogenic technique (1902), controlled hypotension (1940s) and artificial hibernation (1950) came into being. PMID:23363851

  7. Anesthetic management of a parturient with spinal muscular atrophy type II.

    PubMed

    Maruotti, Giuseppe Maria; Anfora, Rita; Scanni, Emilio; Rispoli, Marco; Mazzarelli, Laura Letizia; Napolitano, Raffaele; Morlando, Maddalena; Sarno, Laura; Milanes, Giovanna Mallia; Simioli, Stefania; Migliucci, Annalisa; Martinelli, Pasquale; Mastronardi, Pasquale

    2012-11-01

    In the past, pregnancy was contraindicated in patients with spinal muscular atrophy. Recently, more cases are occurring because of improvement in survival and functional status. The goals for anesthetic management of these patients include satisfactory anesthesia during surgery and excellent postoperative analgesia with minimal compromise of respiratory function. Spinal anesthesia may be considered contraindicated due to spinal deformities, but successful spinal anesthesia was performed in a 37 year old parturient following magnetic resonance imaging of the spine. PMID:22999982

  8. Anesthetic management for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons

    Microsoft Academic Search

    Shinju Obara; Masayuki Nakagawa; Shinichiro Takahashi; Masahiko Akatu; Tsuyoshi Isosu; Masahiro Murakawa

    2009-01-01

    We report on the anesthetic management of a 69-year-old female Jehovah’s Witness undergoing cardiopulmonary bypass to replace\\u000a the ascending aorta; the patient refused transfusion of stored autologous or allogeneic blood products for religious reasons.\\u000a The strategy involved preoperative hematopoiesis with recombinant human erythropoietin and iron, intraoperative acute normovolemic\\u000a hemodilution, the use of a cell-saver system, administration of high-dose tranexamic acid,

  9. Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience

    PubMed Central

    Zhong, He-Jiang; Li, Hong; Du, Zhi-Yong; Huan, He; Yang, Tian-De; Qi, Yue-Yong

    2013-01-01

    Objective: To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. Methodology: Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby’s side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results: All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery. PMID:24353566

  10. A method for quantifying insulin sensitivity in vivo in the anesthetized rat : the euglycemic insulin clamp technique

    E-print Network

    Paris-Sud XI, Université de

    A method for quantifying insulin sensitivity in vivo in the anesthetized rat : the euglycemic insulin clamp technique coupled with isotopic measurement of glucose turnover Anne-Françoise BURNOL, place Marcelin-Berthelot, 75231 Paris Cedex 05, France. Summary. The euglycemic insulin clamp technique

  11. Successful anesthetic management of a large supraglottic cyst.

    PubMed

    Wagh, Harshal D

    2014-07-01

    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

  12. Successful anesthetic management of a large supraglottic cyst

    PubMed Central

    Wagh, Harshal D.

    2014-01-01

    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

  13. [Successful anesthetic management of three patients receiving pheochromocytoma resection using extremely high-dose remifentanil infusion].

    PubMed

    Shimoyama, Yuko; Masuda, Rikuo; Suzuki, Takashi; Serada, Kazuyuki

    2010-10-01

    We describe three consecutive cases of successful anesthetic management for pheochromocytoma resection under balanced anesthesia with sevoflurane inhalation and extremely high-dose remifentanil infusion. This case series aimed to examine whether the aggressive dosing of remifentanil, exerting both depressor and bradycardic actions with short durations, is applicable for hemodynamic control during pheochromocytoma resection. The remifentanil infusion rate was set to maintain the systolic arterial pressure below 150 mmHg and heart rate below 100 beats x min(-1). In 2 of 3 cases, intraoperative hemodynamics were controlled by titrated remifentanil infusion with up to 2 and 3 microg x kg(-1) min(-1) in each case, without additional vasoactive agents. In another case, since adequate antihypertensive control was ineffective despite incremental remifentanil infusion to a maximum of 5 microg x kg(-1) x min(-1) supplemented with repeated boluses of 200 microg remifentanil, a total of 2.4 mg of nicardipine as a depressor was needed. Ephedrine 12 mg was employed following tumor removal. This anesthetic regimen thus allowed minimal or no concomitant use of depressors during tumor manipulation and vasopressors following tumor removal. In conclusion, the liberal use of remifentanil for the anesthetic management of pheochromocytoma resection appears to be simple, safe and effective. PMID:20960893

  14. Difficulties in anesthetic management of patients with micrognathia: report of a patient with Stickler syndrome.

    PubMed

    Küçükyavuz, Zuhal; Ozkaynak, Ozkan; Tüzüner, Ay?egül Mine; Ki?ni?çi, Reha

    2006-12-01

    Stickler syndrome is an autosomal dominant multisystem disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate and a "moon-shaped" appearance. Progressive myopia and retinal degeneration are frequent. It is estimated that one third of all Pierre Robin patients have Stickler syndrome. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist considerable problems when mask ventilation or endotracheal intubation is attempted. In this case report the difficulties in anesthetic management of patients with micrognathia and repeated anesthetic courses of a child with Stickler syndrome are presented. It is vital to detect the syndrome in early stages so that adequate counseling and treatment may be given to avoid the potentially irreversible and disabling consequences. PMID:17138163

  15. Laparoscopic Cortical Sparing Adrenalectomy for Pediatric Bilateral Pheochromocytoma: Anesthetic Management

    PubMed Central

    Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

    2014-01-01

    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

  16. Comparison of the efficacy of two anesthetic techniques of mandibular primary first molar: A randomized clinical trial

    PubMed Central

    Tudeshchoie, Davood Ghasemi; Rozbahany, Neda Ahmadi; Hajiahmadi, Maryam; Jabarifar, Ebrahim

    2013-01-01

    Background: The most common technique to anesthetize mandibular primary teeth is inferior alveolar (I.A) nerve block injection which induces a relatively sustained anesthesia and in turn may potentially traumatize soft-tissues. Therefore, the need of having an alternative technique of anesthesia with a shorter term but the same efficacy is reasonable. The aim of this study was a comparison of the efficacy of two anesthetic techniques of mandibular primary first molar. Materials and Methods: In this randomized crossover clinical trial, 40 children with ages ranged from 5 years to 8 years whose mandibular primary first molars were eligible for pulpotomy, were selected and divided randomly into two groups. The right and left mandibular first molars of group A were anesthetized with infiltration and I. A nerve block techniques in the first and second sessions respectively. The left and right mandibular first molars of group B were anesthetized with I.A nerve block and infiltration techniques in the first and second sessions respectively. The severity of pain were measured and recorded according to sound-eye-motor scale by a certain person. Data was analyzed using Wilcoxon Signed Rank and Mann-Whitney U tests (P > 0.05). Results: The severity of pain was lower in infiltration technique versus I.A nerve block. There were no significant differences between the severities of pain on pulpal exposure of two techniques. Conclusion: It seems that infiltration technique is more favorable to anesthetize the mandibular primary first molar compared to I.A nerve block. PMID:24348619

  17. Anesthetic management of two cases of Beckwith-Wiedemann syndrome.

    PubMed

    Kimura, Yoshinobu; Kamada, Yasuhiro; Kimura, Saori

    2008-01-01

    Two cases of children with Beckwith-Wiedemann syndrome are presented. This syndrome consists of various abnormalities, including macroglossia, visceromegaly, omphalocele, and gigantism. These abnormalities frequently require operative correction during the neonatal period. We anesthesiologists should make plans for difficult airway managements in patients with this syndrome. Our two patients also showed larger sized tracheas than those estimated by their age and height. A cuffed tube, though still controversial, has recently been used in children. We recommend using a cuffed tube in patients with this syndrome, because the appropriate tracheal size may not be predictable, tracheal intubation might be difficult, and risks incurred during changing of a tracheal tube should be avoided. PMID:18306025

  18. Availability of Anesthetic Effect Monitoring: Utilization, Intraoperative Management and Time to Extubation in Liver Transplantation

    Microsoft Academic Search

    R. Schumann; J. Hudcova; I. Bonney; M. S. Cepeda

    2010-01-01

    Titration of volatile anesthetics to anesthetic effect monitoring using the bispectral index (BIS) has been shown to decrease anesthetic requirements and facilitate recovery from anesthesia unrelated to liver transplantation (OLT). To determine whether availability of such monitoring influences its utilization pattern and affect anesthetic care and outcomes in OLT, we conducted a retrospective analysis in recipients with and without such

  19. Anesthetic management for separation of thoracopagus twins with complex congenital heart disease: a case report.

    PubMed

    Seo, Misook; Chung, In-Sun; Karm, Myong-Hwan; Oh, Ji Mi; Shin, Won-Jung

    2015-06-01

    Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration. PMID:26045935

  20. Anesthetic management for separation of thoracopagus twins with complex congenital heart disease: a case report

    PubMed Central

    Seo, Misook; Chung, In-Sun; Karm, Myong-Hwan; Oh, Ji Mi

    2015-01-01

    Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.

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

    PubMed

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

    2010-02-01

    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

  2. A Multidisciplinary Approach to Anesthetic Management of a Parturient with Severe Aortic Stenosis

    PubMed Central

    Tyagaraj, Kalpana; Gutman, David A.; Belliveau, Lynn; Sadiq, Adnan; Feierman, Dennis E.

    2015-01-01

    In order to optimize anesthetic management and avoid adverse maternal and fetal outcomes, a clear understanding of the changes in cardiovascular physiology that occur during pregnancy is paramount. The effects of normal gestation on the cardiovascular system are particularly significant in a parturient with cardiac valvular pathology. We present a case of a 27-year-old G2P0 at 37 weeks with a past medical history of diabetes, macrosomia, congenital bicuspid aortic valve with severe stenosis (valve area 0.7?cm2) who was scheduled for elective C-section. A multidisciplinary discussion involving cardiologists, cardiac surgeons, obstetric surgeons, neonatal intensivists, perfusion staff, anesthesiologists, and nursing staff was held to formulate a plan for the perioperative management of this parturient. Also, contingency plans were formulated and discussed with the care providers, in the event of acute decompensation of the mother and baby and possible need for emergency aortic valvuloplasty and/or aortic valve replacement. PMID:26090237

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

    PubMed Central

    WANG, CHERYL; RICHMOND, ROBERT; ELDESOUKI, ENAS

    2015-01-01

    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. PMID:25780466

  4. Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

    PubMed

    Kowalczyk, Micha?; Nestorowicz, Andrzej; Stachurska, Katarzyna; Fija?kowska, Anna; St??ka, Janusz

    2015-06-01

    Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications. PMID:25943997

  5. [Anesthetic management for a patient with chronic expanding hematoma of the thorax associated with respiratory failure].

    PubMed

    Kurotaki, Kenji; Yoshida, Akiko; Ito, Yosuke; Nagaya, Kei

    2015-01-01

    Chronic expanding hematoma (CEH) of the thorax is an intractable disease which induces long-standing growing hematoma after tuberculosis or thoracic surgery. It causes respiratory failure and heart failure by compressing the mediastinum. A 68-year-old man with a history of tuberculosis during childhood had suffered from progressive exertional dyspnea for 20 years. Because a huge hematoma occupying whole right thoracic cavity compressed the heart and the trachea to the left, he was scheduled for extrapleural pneumonectomy. Bronchial arterial embolization was performed preoperatively to prevent hemoptysis and reduce intraoperative blood loss. There was no problem in the airway management using a double lumen endotracheal tube. However, severe hypotension and a decrease in cardiac index were observed due to excessive bleeding, leading to total blood loss of 11,000 g. In addition, surgical manipulation caused abrupt severe hypotension. Monitoring of arterial pressure-based cardiac output and deep body temperature was useful for the hemodynamic management during the operation. The successful postoperative course resulted in remarkable improvement of Huge-Jones dyspnea criteria from IV to II. In the anesthetic management of CEH precautions should be taken against the excessive intraoperative bleeding and abrupt hemodynamic changes. PMID:25868208

  6. [Anesthetic management for a pediatric patient of Klippel-Trenaunay syndrome with giant head by hydrocephalus].

    PubMed

    Hoshijima, Hiroshi; Takeuchi, Risa; Tsukamoto, Masanori; Ogawa, Saori; Iwase, Yoshinori; Matsumoto, Nobuyuki

    2012-12-01

    Klippel-Trenaunay syndrome (KTS) is a rare disorder associated with the triad of 1) capillary vascular malformation, 2) varicose veins and/or venous malformation, 3) and soft tissue and/or bony hypertrophy. A six-month old, 6.0-kg-weight male pediatric patient was scheduled for ventriculo-peritoneal shunt operation for hydrocephalus caused by obstructive aqueductus cerebri. At the age of three months, he was diagnosed as KTS by extensive capillary vascular malformation and soft tissue hypertrophy of the right leg. Physical examination showed prominent vascular malformation over his anterior thoracic and abdominal wall, and soft tissue hypertrophy was only on his right leg. Simultaneously, he was complicated with congenital hydrocephalus because of obstructive aqueductus cerebri. His head and skull were enlarged and his head measurement reached 55 cm (chest measurement 32 cm). Anesthetic management of KTS patients should be prepared with blood transfusion against massive hemorrhage and hypovolemic shock. Furthermore, KTS patients should be always considered to have airway difficulty due to the soft tissue hypertrophy, upper and airway hemangiomas. Therefore, we planned safer tracheal intubation following practice guidelines for management of the difficult airway. PMID:23362775

  7. Comparison of invasive and oscillometric blood pressure measurement techniques in anesthetized camelids

    PubMed Central

    Aarnes, Turi K.; Hubbell, John A.E.; Lerche, Phillip; Bednarski, Richard M.

    2012-01-01

    This study assessed the accuracy of the oscillometric method for arterial blood pressure (ABP) monitoring in anesthetized camelids. Twenty camelids were anesthetized and systolic ABP (SABP), mean ABP (MABP), and diastolic ABP (DABP) were measured directly and using the oscillometric method. The mean difference between SABP measurements was ?9.9 ± 21.9 mmHg with a range of ?76 to 54 mmHg, and the 95% limits of agreement (LOA) were ?33 to 53 mmHg. The difference between DABP measurements was ?1.8 ± 15.6 mmHg with a range of ?81 to 36 mmHg, and the 95% LOA were ?32 to 29 mmHg. The difference between MABP measurements was ?2.9 ± 17.0 mmHg with a range of ?81 to 36 mmHg, and the 95% LOA were ?30 to 36 mmHg. Accurate ABP monitoring in anesthetized camelids cannot be accomplished using the oscillometric method. PMID:23372197

  8. Bronchoscopic lung volume reduction in patients with severe emphysema: anesthetic management.

    PubMed

    Hillier, James E; Toma, Tudor P; Gillbe, Charles E

    2004-12-01

    Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. Its objective is to achieve the same improvements in lung function and exercise tolerance as lung volume reduction surgery while avoiding the surgical morbidity and mortality. We describe the anesthetic experience in a series of seven patients who underwent a total of eight procedures (one patient underwent a second procedure on the contralateral side). The technique used was one of total IV anesthesia using remifentanil and propofol, with a ventilatory strategy aimed at avoiding gas trapping and dynamic hyperinflation. To achieve this pressure, limited ventilation with a prolonged expiratory phase was provided by a Draeger Evita 2 ventilator. This technique resulted in intraoperative hypercapnia (Paco(2) 6.75 kPa) compared with baseline values (median Paco(2) 5.1 kPa; P < 0.05), but 2 h postoperatively the arterial partial pressure of CO(2) was returning to baseline (median Paco(2) 5.6 kPa; P < 0.01 compared with intraoperative data). There were no deaths or admissions to the intensive care unit after the procedure. One patient developed a pneumothorax that required drainage, three patients had acute exacerbations of chronic obstructive pulmonary disease, and one patient developed a cough that resolved spontaneously. Total hospital stay did not exceed 5 days for any of these patients. PMID:15562041

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

    PubMed

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

    2014-10-01

    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

  10. [Anesthetic management of a patient with osteogenesis imperfecta combined with mandibular defect].

    PubMed

    Tsukamoto, Masanori; Hirokawa, Jun; Sako, Saori; Fujiwara, Shigeki; Yokoyama, Takeshi

    2014-06-01

    Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by an excessive tendency to bone fractures and retarded growth. We report an anesthetic management of the patient with OI who has the history of vertebral bone fracture by coughing. A 44-year-old female underwent mandibular resection and reconstruction with a metal instrument due to ossifying fibroma 35 years ago. Since then, she had undergone mandibular resection and shaving the instrument several times because of recurrence of the tumor and/or fracture of the instrument. This time, some parts of the instrument were removed under general anesthesia since it had exposed from the skin. Difficulty in mask ventilation and intubation was predicted due to the defect of mandible and some muscles supporting the tongue and the pharynx. Awake fiber-optic nasotracheal intubation, therefore, was performed in consideration of airway obstruction. Dexmedetomidine was administered to reduce the risk of bone fracture in addition to low doses of midazolam and fentanyl. Considering incomplete respiration after extubation, the tracheal tube was extubated after inserting the tube exchanger into the trachea through the tube. The tube exchanger was pulled out after confirming spontaneous respiration and upper airway patency. The patient was cooperative, and respiratory and hemodynamic conditions were stable throughout. PMID:24979864

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

    PubMed

    Sethi, Sameer; Kapil, Sonia

    2014-07-01

    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

  12. The twin block: a simple technique to block both the masseteric and the anterior deep temporal nerves with one anesthetic injection.

    PubMed

    Quek, Samuel; Young, Andrew; Subramanian, Gayathri

    2014-09-01

    The objective of this article is to describe a new technique to anesthetize the masseter muscle and the temporalis muscle using a single extraoral approach. The block targets both the masseteric and the deep temporal nerves as they leave the infratemporal fossa to innervate the deep surfaces of their respective muscles. PMID:24703404

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

    PubMed Central

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

    2014-01-01

    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

  14. Anesthetic implications of epilepsy, status epilepticus, and epilepsy surgery.

    PubMed

    Kofke, W A; Tempelhoff, R; Dasheiff, R M

    1997-10-01

    Epilepsy is a clinical paroxysmal disorder of recurring seizures, excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. Seizures have been and are thought to arise as a result of abnormalities in (a) neural circuits, (b) excitation/inhibition balance, (c) potassium, and (d) genetic abnormalities. Therapy for epilepsy is either medical, entailing the use of a variety of antiepileptic drugs, or surgical. An urgent approach to seizure control is indicated when status epilepticus occurs. When all standard therapy fails, general anesthesia can be used to control status epilepticus. Surgery is an option in the treatment of epilepsy and requires extensive preoperative evaluation. The primary concerns for the neuroanesthesiologist anesthetizing the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with antiepileptic drugs. Proconvulsant and anticonvulsant properties have been reported for nearly every anesthetic. If seizure spikes are to be evoked during seizure surgery, then light anesthesia with a proconvulsant anesthetic is used. Conscious analgesia can be used for awake seizure surgery. However, if electrocorticography is not planned, then a general anticonvulsant anesthetic maintenance regimen is used. The latter technique also may be useful in patients whose anesthetic management is complicated by an incidental history of epilepsy. PMID:9339409

  15. Anesthetic management in pediatric liver transplantation: a comparison of deceased or live donor liver transplantations

    Microsoft Academic Search

    Isik Alper; Sezgin Ulukaya

    2010-01-01

    Purpose  Pediatric liver transplantations (LT) are becoming increasingly more common in the treatment of a child with end-stage liver\\u000a disease. The aim of this study was to evaluate the perioperative anesthetic experience of pediatric patients undergoing deceased\\u000a and live donor liver transplantations.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We performed a chart review of 164 patients between December 1997 and February 2009 in a retrospective cohort study

  16. [Successful anesthetic management of laparoscopic rectopexy using rocuronium and sugammadex in a patient with Becker muscular dystrophy].

    PubMed

    Yamaguchi, Satoshi; Ohno, Giichiro; Kitamura, Jiro

    2014-10-01

    A 70-year-old man with Becker muscular dystrophy (BMD) underwent laparoscopic rectopexy under general anesthesia. For anesthetic induction, we administered total 0.6 mg · kg-1 of rocuronium with titration. Eight minutes later, train-of-four (TOF) count reached to 0 and the patient was intubated smoothly. One hundred and five minutes later, TOF ratio recovered to 100% and we administered rocuronium 10 mg additionally. Surgery was finished without any problems 95 minutes after thereafter. TOF ratio was 45% and we administered sugammadex 3 mg · kg-1, reversing neuromuscular blockade to TOF ratio 100% within 1.5 minute. The patient awoke clearly and respiratory condition was good. He was extubated without remaining neuromuscular blockade. Postoperative course was stable and there was no serious adverse effect on his muscular function intra- and post-operatively. In conclusion, rocuronium and sugammadex can be used safely and effectively in general anesthetic management for patients with muscular dystrophy. However, as the onset times and durations of these agents can be longer, we should administer these agents with titration carefully under periodic neuromuscular monitoring. PMID:25693344

  17. [Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium].

    PubMed

    Wakimoto, Masahiro; Nagata, Hirofumi; Kumagai, Motoi; Miyata, Michiko; Iwabuchi, Yohko; Suzuki, Kenji

    2012-06-01

    We experienced an anesthetic management with rocuronium and neurostimulator for a surgical patient with amyotrophic lateral sclerosis. A 61-year-old man was scheduled for intrathecal baclofen pump implantation as treatment for his spasticity under general anesthesia. After oxygenation and totally intravenous induction with propofol and remifentanil, we administered 10 mg of rocuronium repeatedly monitoring with neurostimulator. When dosage of rocuronium reached 20 mg, train-of-four count reached 1 and his trachea was intubated without coughing or moving. Anesthesia was maintained intravenously. Train-of-four ratio recovered to 95%, 22 minutes after the first administration of rocuronium. Operation was accomplished uneventfully with no additional rocuronium. Bispectral index value recovered to 98 and the patient awoke and breathed spontaneously 19 minutes after termination of administration of anesthetic agents. We could confirm his stable and adequate respiration and trachea was extubated without reversal of rocuronium. In the postanesthesia care unit, he showed no discomfort and was returned to the ward. His symptoms did not deteriorate postoperatively and he was discharged on the 36th postoperative day. PMID:22746022

  18. Dynamic file management techniques

    Microsoft Academic Search

    Mihnd B. Deshpande; Richard B. Bunt

    1988-01-01

    Consideration of the dynamic characteristics of file referencing behavior provides an appropriate basis for the design of effective algorithms for the management of a hierarchical file system. Several algorithms are proposed, based on similar algorithms in the memory referencing context. Trace-driven simulation experiments were conducted to assess the performance implications of these approaches. The results of these experiments show that

  19. [Anesthetic management of a patient with Klippel-Trenaunay syndrome undergoing caesarean section].

    PubMed

    Hayamizu, Kengo; Yamaura, Ken; Hayamizu, Mariko; Kandabashi, Tadashi; Hoka, Sumio

    2012-08-01

    Klippel-Trenaunay syndrome (KTS) is characterized by capillary and venous malformation and hypertrophy of bone and soft tissues. A 29-year-old primigravida, who had been diagnosed of KTS by her hemangiomas and varicosities in the right leg, pubic area, rectum, vagina and lower abdominal area, was scheduled to receive caesarean section at 37 weeks gestation because vaginal delivery might cause hemorrhagic complications and extension of the venous lesions. Regional anesthesia was avoided because of the possible injuries of unknown venous malformations or varicose veins in the epidural or spinal space. The cesarean section was performed under general anesthesia uneventfully and an infant was delivered normally. There were no complications such as massive hemorrhage, disseminated intravascular coagulation and deep venous thrombosis in the perioperative period. Careful anesthetic considerations for the prevention of hemorrhagic and thrombotic complications are necessary for cesarean section in a patient with KTS. PMID:22991821

  20. Effects of Different Anesthetic Techniques on Serum Leptin, C-reactive Protein, and Cortisol Concentrations in Anorectal Surgery

    PubMed Central

    Buyukkocak, Unase; Daphan, Cagatay; Caglayan, Osman; Aydinuraz, Kuzey; Kaya, Tahsin; Saygun, Oral; Agalar, Fatih

    2006-01-01

    Aim To compare the effects of intratracheal general anesthesia (ITGA) and regional (saddle block) anesthesia on leptin, C-reactive protein (CRP), and cortisol blood concentrations during anorectal surgery. Methods Fifty-eight patients suffering from hemorrhoidal disease, pilonidal sinus, anal fissure, or anal fistula were included the study. Patients were randomly assigned into one of the two groups (n?=?29). Patients in one group received ITGA. After thiopental and fentanyl induction, vecuronium was used as a muscle relaxant. Anesthesia was maintained with sevoflurane. In the other group we applied saddle block, injecting hyperbaric bupivacaine into the subarachnoid space, through the L3-L4 intervertebral space, in the sitting position. Blood samples were collected for leptin, CRP, and cortisol analysis before the induction of anesthesia at 3 and 24 hours postoperatively. Results Preoperative leptin, CRP, and cortisol concentrations were comparable between the groups. There was no significant difference in postoperative levels of leptin and CRP in both groups. Although not significant, leptin and CRP concentrations were lower in the saddle block group at three hours postoperatively (mean?±?SD, 6.95?±?8.59 and 6.02?±?12.25, respectively) than in the ITGA group (mean?±?SD, 9.04?±?9.89 and 8.40?±?15.75, respectively). During early postoperative period, cortisol increased slightly in the ITGA group and remained at similar level in the saddle block group, but later decreased in both groups. Cortisol levels in the saddle block group were significantly lower than in the ITGA group at 3 hours postoperatively (343.7?±?329.6 vs 611.4?±?569.8; P?=?0.034). Conclusion Saddle block, a regional anesthetic technique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative period. PMID:17167859

  1. [Anesthetic management of a patient with stiff-person syndrome undergoing thymectomy].

    PubMed

    Tadokoro, Takahiro; Yamashita, Soichiro; Ishigaki, Maiko; Takahashi, Shinji; Tanaka, Makoto

    2012-02-01

    Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. After epidural catheterization for the postoperative analgesia, general anesthesia was induced and maintained with continuous remifentanil infusion and propofol with target controlled infusion. With train-of-four ratio (TOFR) monitoring by stimulating the ulnar nerve, her trachea was intubated after 0.6mg x kg(-1) of rocuronium intravenous administration. Since then, additional rocuronium was not given for 4 hours. After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia. PMID:22413445

  2. [Anesthetic management for thymectomy in a patient with stiff-person syndrome].

    PubMed

    Nakamura, Taketo; Oda, Yutaka; Matsushita, Mitsuji; Mori, Takashi; Ikeshita, Kazutoshi; Asada, Akira

    2007-10-01

    Stiff-person syndrome is an autoimmune disease characterized by muscle rigidity accompanied by decreased respiratory function. We report a patient with this syndrome who underwent thymectomy under general anesthesia. A 79-year-old woman complaining of increasing muscle rigidity over the past four months was transferred to this hospital. Marked speech disturbance and dysphagia were observed on admission. The diagnosis of stiff-person syndrome was made based on an increase in serum anti-glutamic acid decarboxylase antibody level and thymoma in the anterior mediastinum. Following alleviation of muscle rigidity by high-dose gamma-globulin, thymectomy was scheduled. General anesthesia was given with propofol, fentanyl and epidural ropivacaine. Propofol was continuously infused to maintain BIS below 60 and vecuronium was intermittently administered when muscle contraction was observed in response to electrical stimulation of the ulnar nerve. Despite full recovery of muscle contractility following surgery, tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. One hour after admission to ICU, the tracheal tube was removed, with no marked changes in respiratory condition thereafter. Since many anesthetics are respiratory suppressants that can delay the recovery of respiratory function, careful monitoring of respiratory condition is required postoperatively. PMID:17966628

  3. Pregnancy with co-morbidities: Anesthetic aspects during operative intervention

    PubMed Central

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

    2013-01-01

    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. PMID:25885972

  4. Aerospace management techniques: Commercial and governmental applications

    NASA Technical Reports Server (NTRS)

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

    1971-01-01

    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.

  5. Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery

    PubMed Central

    2014-01-01

    A 60 years old chinese male scheduled for a removal of an intracardiac mass occupying majority of right ventricular space, right ventricular outflow tract and pulmonary artery. The giant cardiac mass was later diagnosed pathologically as metastatic liposarcoma. The patient had a history of surgical removal of myxoid liposarcoma from his left thigh many years ago. It is extremely rare for liposarcoma to metastatize to right ventricle and pulmonary artery. The anesthetic management of the surgical procedure to remove this kind of intracardiac mass poses significant challenges to anesthesia providers. Our patient developed refractory hypotension after induction of general anesthesia which necessitated urgent cardiopulmonary bypass. The surgical procedure was successful and the patient recovered from the surgery and was discharged home without significant complication. Accurate preoperative diagnosis and assessment of patient’s functional status, appropriate preoperative volume status, emergency cardiopulmonary bypass readiness, smooth and gentle induction of general anesthesia with less myocardial depressing agent, and closely monitoring patient’s vitals and hemodynamic parameters are imperative in managing this kind of patients. PMID:24655329

  6. Local Anesthetic-Induced Cardiac Toxicity: A Survey of Contemporary Practice Strategies Among Academic Anesthesiology Departments

    Microsoft Academic Search

    William Corcoran; John Butterworth; Robert S. Weller; Jonathan C. Beck; J. C. Gerancher; Timothy T. Houle; Leanne Groban

    2006-01-01

    Though new local anesthetics (LA), effective test-dosing, and new regional anesthetic techniques may have improved the safety of regional anesthesia, the optimal management plan for LA-induced cardiac toxicity remains uncertain. Accordingly, we evaluated current approaches to LA cardiotoxicity among aca- demic anesthesiology departments in the United States. A 19-question survey regarding regional anesthesia practices and approaches to LA cardiac toxicity

  7. Anesthetic management during Cesarean section in a woman with residual Arnold–Chiari malformation Type I, cervical kyphosis, and syringomyelia

    PubMed Central

    Ghaly, Ramsis F.; Candido, Kenneth D.; Sauer, Ruben; Knezevic, Nebojsa Nick

    2012-01-01

    Background: Type I Arnold–Chiari malformation (ACM) has an adult onset and consists of a downward displacement of the cerebellar tonsils and the medulla through the foramen magnum. There is paucity of literature on the anesthetic management during pregnancy of residual ACM Type I, with cervical xyphosis and persistent syringomyelia. Case Description: A 34-year-old woman with surgically corrected ACM Type I presented for Cesarean delivery. A recent MRI demonstrated worsening of cervical xyphosis after several laminectomies and residual syringomyelia besides syringopleural shunt. Awake fiberoptic intubation was performed under generous topical anesthesia to minimize head and neck movement during endotracheal intubation. We used a multimodal general anesthesia without neuromuscular blockade. The neck was maintained in a neutral position. Following delivery, the patient completely recovered in post-anesthesia care unit (PACU), with no headache and no exacerbation or worsening of neurological function. Conclusions: The present case demonstrates that patients with partially corrected ACM, syringomyelia, cervical kyphosis, and difficult intubation undergoing Cesarean delivery require an interdisciplinary team approach, diligent preparation, and skilled physicians. PMID:22439117

  8. Anesthetic management of toxic epidermal necrolysis: report of three adult cases

    Microsoft Academic Search

    Sara F Rabito; Shameem Sultana; Tadeusz S Konefal; Kenneth D Candido

    2001-01-01

    Toxic epidermal necrolysis is a rare but acute life-threatening syndrome in which the epidermis blisters and peels in large sheets. In general, patients with this syndrome are managed as severe second-degree burn patients, but special consideration should be given to mucous membrane involvement that reduces fluid intake and worsens the fluid deficit, systemic involvement that makes these patients hemodynamically unstable,

  9. Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report.

    PubMed

    Choleva, Abbie J

    2011-12-01

    The ex utero intrapartum treatment (EXIT) procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date. Recent advances in prenatal diagnosis of fetal congenital malformations, in particular, abnormalities involving the fetal airway, have allowed for the development of the EXIT strategy to convert potentially catastrophic situations during fetal delivery to a controlled environment. Indications for the EXIT procedure have expanded to a variety of congenital abnormalities, including fetal neck masses, lung or mediastinal tumors, congenital high airway obstruction syndrome, conjoined twin separation, and acute respiratory distress syndrome requiring transitioning from EXIT to extracorporeal membrane oxygen transitioning. Various considerations must be managed by the anesthesia provider during the EXIT procedure to ensure positive maternal and fetal outcomes. Careful attention to achieving adequate uterine relaxation, maintaining maternal blood pressure, avoiding placental abruption, prioritizing fetal airway establishment, and providing return of uterine tone when indicated are examples of these considerations. In this case report, a parturient presented for an EXIT procedure secondary to fetal cystic hygroma. PMID:22400417

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

    PubMed

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

    2010-12-01

    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

  11. Effect on thermoregulatory responses in patients undergoing a tympanoplasty in accordance to the anesthetic techniques during PEEP: a comparison between inhalation anesthesia with desflurane and TIVA

    PubMed Central

    Jung, Ki Tae; Kim, Sang Hun; Lee, Hyun Young; Jung, Jong Dal; Yu, Byung Sik; Lim, Kyung Joon; So, Keum Young; Lee, Ju Young

    2014-01-01

    Background It has been known that positive end-expiratory pressure (PEEP) increases the vasoconstriction threshold by baroreceptor unloading. We compared the effect on the thermoregulatory responses according to anesthetic techniques between an inhalation anesthesia with desflurane and a total intravenous anesthesia (TIVA) with propofol and reminfentanil when PEEP was applied in patients undergoing tympanoplasty. Methods Forty-six patients with a scheduled tympanoplasty were enrolled and the patients were divided in two study groups. Desflurane was used as an inhalation anesthetic in group 1 (n = 22), while TIVA with propofol and remifentanil was used in group 2 (n = 24). PEEP was applied by 5 cmH2O in both groups and an ambient temperature was maintained at 22-24? during surgery. The core temperature and the difference of skin temperature between forearm and fingertip were monitored for about 180 minutes before and after the induction of general anesthesia. Results The final core temperature was significantly higher in group 2 (35.4 ± 0.7?) than in group 1 (34.9 ± 0.5?). Peripheral thermoregulatory vasoconstriction was found in 5 subjects (23%) in group 1 and in 21 subjects (88%) in group 2. The time taken for reaching the thermoregulatory vasoconstriction threshold was 151.4 ± 19.7 minutes in group 1 and 88.9 ± 14.4 minutes in group 2. Conclusions When PEEP will be applied, anesthesia with TIVA may have more advantages in core temperature preservation than an inhalation anesthesia with desflurane. PMID:25097736

  12. Anesthetic Management of a Jehovah's Witness Child for Repair of a Large Ventricular Septal Defect Involving Cardio-Pulmonary-Bypass

    Microsoft Academic Search

    Axen Rafael; Aarti Sharma

    Surgical management of a Jehovah's Witness child is medically and ethically challenging. Surgeries involving cardio-pulmonary-bypass are even more challenging as the need for requirement of blood transfusion could be higher. By modifying surgical techniques, charting out careful preoperative preparation, meticulous intraoperative and postoperative management, need for the blood transfusion can be avoided. In our case report we present a 15-month-old

  13. [Anesthetic management using auto-transfusion and hypothermia for massive bleeding].

    PubMed

    Ishizawa, Michi; Matsumoto, Sonoko; Tajima, Keiko; Konishi, Ruriko; Itsuhata, Hiromasa M

    2012-08-01

    A 51-year-old woman was scheduled for emergency enterectomy and vascular repair under general anesthesia for active bleeding from internal iliac artery caused by repeated radiotherapy for cervical cancer and subsequent hypovolemic shock. For the first two hours of operation, the blood loss exceeded 6,000 ml and the hemoglobin level decreased to a low of 3.8 g x dl(-1) despite administration of 38 units of packed red cells. Intraoperative blood salvage was used in order to minimize further loss of hemoglobin. Mild hypothermia technique was also introduced to prevent brain ischemia. Total bleeding volume was approximately 10,000 ml, and total transfused volume was 8,740 ml. No neurological deficit and no systemic infection were found during the postoperative course. Although clinical risks of cell salvage in patients undergoing surgery for malignant tumor remain controversial, we conclude intraoperative blood salvage using Cell Saver could be utilized as a life-saving means and mild hypothermia might have been efficacious for protecting the brain from ischemia in our case. PMID:22991815

  14. Endoscopic third ventriculostomy: anesthetic implications.

    PubMed

    El-Dawlatly, A A

    2004-06-01

    Endoscopic third ventriculostomy (ETV) is one of the recent neurosurgical advances for the treatment of obstructive hydrocephalus. There has been number of publications, which have established the role of ETV in neurosurgical practice, particularly in hydrocephalus. ETV has developed into a therapeutic alternative to shunting for the management of patients with non-communicating hydrocephalus. This procedure requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation via neural structures to access the floor of the third ventricle. This discussion will focus on the anesthetic implications during ETV. PMID:15343430

  15. Anesthetic Consideration for Neurointerventional Procedures

    PubMed Central

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

    2014-01-01

    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

  16. Successful anesthetic management in a child after traumatic rupture of left main bronchus by a single-lumen cuffed-endotracheal tube.

    PubMed

    Elgendy, Hamed; Jilani, Tariq

    2014-01-01

    Tracheobronchial injury (TBI) may lead to catastrophe if remains undetected or managed improperly. The incidence of TBI is less in children as compared with adults due to their pliable chest wall. Its clinical manifestations include persistent pneumothorax, cervical subcutaneous emphysema, pneumomediastinum, cyanosis, and respiratory insufficiency. The recommended airway management is to intubate the healthy bronchus with a single-lumen or double-lumen endotracheal tube (ET) and bypassing the injured side. We report successful anesthetic management of traumatic rupture of the left main bronchus in a child by using a single-lumen cuffed-ET. Many factors affect the outcome of such injuries and include the extent of the lesion, the resulting pulmonary status, the adequacy of surgical reconstruction. More severe injury may require lobectomy or pneumonectomy. Early diagnosis and proper management result in good functional outcome. PMID:25281627

  17. QUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES AND TOOLS*

    E-print Network

    Embrechts, Paul

    of dependencies and stress scenarios · Integrated Risk Management c 2004 (A. Dias and P. Embrechts) 7 #12;THEQUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES AND TOOLS* Paul Embrechts Department of Mathematics ETH Zurich www.math.ethz.ch/~embrechts #12;QUANTITATIVE RISK MANAGEMENT: CONCEPTS, TECHNIQUES

  18. Anesthetic consideration for descending thoracic aortic aneurysm repair.

    PubMed

    Kahn, Ronald A; Stone, Marc E; Moskowitz, David M

    2007-09-01

    Anesthesia for surgery of the aorta poses some of the most difficult challenges for anesthesiologists. Major hemodynamic and physiologic stresses and sophisticated techniques of extracorporeal support are superimposed on patients with complex medical disease states. In this review, etiologies, natural history, and surgical techniques of thoracic aortic aneurysm are presented. Anesthetic considerations are discussed in detail, including the management of distal perfusion using partial cardiopulmonary bypass. Considerations of spinal cord protection, including management of proximal hypertension, cerebral spinal fluid drainage, and pharmacological therapies, are presented. PMID:17711972

  19. Management Styles and Techniques: People.

    ERIC Educational Resources Information Center

    DeLoach, Marva L.; And Others

    1987-01-01

    Three articles discuss management of library technical processes personnel. The first article focuses on the employer employee relationship and communication; the second explores management trends, including participative decision making, personnel evaluation, management by objectives, and the collegial system; and the third focuses on the…

  20. Applying Knowledge Management techniques for building corporate

    E-print Network

    Watson, Ian

    Applying Knowledge Management techniques for building corporate memories Ian Watson AI-CBR Computer-based reasoning and knowledge management... www.ai-cbr.org ...coincidentally I've just written a book about this... ...plug the book!!! www.ai-cbr.org Outline · Talk about ­ Knowledge ­ Knowledge management ­ Why CBR

  1. Comparison of pain intensity of anterior middle superior alveolar injection with infiltration anesthetic technique in maxillary periodontal surgery

    PubMed Central

    Shirmohammadi, Adileh; Lafzi, Ardeshir; Kashefimehr, Atabak; Malek, Sepideh

    2012-01-01

    Purpose The aim of the present clinical trial was to compare pain during injection of anterior middle superior alveolar (AMSA) technique with that of infiltration injection technique in the maxilla in periodontal flap surgeries of patients referring to the Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences. Methods Twenty subjects with an age range of 20 to 40 years were selected for the present study. One side of the maxilla was randomly selected as the test side and the other as the control side using a flip of a coin. AMSA technique was used on the test side and infiltration technique was used on the control side for anesthesia. On both sides 2% lidocaine containing 1:80,000 epinephrine was used for anesthesia. The operator obtained the visual analogue scale for each patient immediately after the injection and immediately after surgery. Data was analyzed using descriptive statistical methods (frequency percentages, means and standard deviations) and Wilcoxon's test using SPSS ver. 13 (SPSS Inc.). Statistical significance was defined at P<0.05. Results There were no statistically significant differences in pain during injection between the two techniques (P=0.856). There were statistically significant differences in postoperative pain between the two injection techniques (P=0.024). Conclusions Postoperative pain in AMSA injection technique was less than that in the infiltration technique. Therefore, the AMSA technique is preferable in the periodontal surgeries for the anesthesia of palatal tissues given the fact that it has other advantages, too. PMID:22586522

  2. Water Losses Management and Techniques

    Microsoft Academic Search

    F. Mendaza; L. Lazzarin; H. Lorenze; H. Lee; M. Farley; H. Esko; K. Johnson; M. Rapinat; P. Dohnal; R. McKenzie; D. Weimer; S. K. S. Lai; E. Somos; S. Davis; F. Martinez

    Since the 1991 IWSA International Report on 'Unaccounted for Water and the Economics of Leak Detection', the topic of management of water losses in distribution systems has received increased attention. This International Report seeks to present an overview of the 'state of the art' in management of Water Losses, based on the Reports prepared by National Rapporteurs, the recent recommendations

  3. Anesthetic considerations for robotic surgery

    PubMed Central

    2014-01-01

    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

  4. Anesthetics Drug Pharmacodynamics

    Microsoft Academic Search

    P. Bischoff; G. Schneider; E. Kochs

    Anesthesia cannot be defined in an unambiguous manner. The essential components of general anesthesia are absence of consciousness\\u000a and pain. This translates into two particular qualities: (1) sedation and hypnosis, i.e., mental blockade and (2) analgesia\\/antinociception,\\u000a i.e., sensory blockade. Anesthetic actions on these two subcomponents are difficult to separate. On the one hand, very few\\u000a anesthetics act exclusively on one

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

    Microsoft Academic Search

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

    2006-01-01

    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

  6. Techniques and methods for uncertainty management

    Microsoft Academic Search

    J. Kwakkel; S. Cunningham

    2008-01-01

    Uncertainty is inherent in modern day strategic planning. However, there is little consensus in how to define uncertainty, what its characteristics are, and how we should relate these characteristics to the appropriate treatment or management of uncertainty. One way of identifying the different meanings of uncertainty and the techniques used for treating it, is to survey the usage of the

  7. 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

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

    2014-01-01

    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

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

    PubMed

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

    2014-10-01

    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

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed Central

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

    2015-01-01

    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

  11. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease. PMID:10604786

  12. Management Science Techniques for Consultants (MSTC)

    NSDL National Science Digital Library

    Trick, Michael A.

    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.

  13. Management Science Techniques for Consultants (MSTC)

    NSDL National Science Digital Library

    Trick, Michael A.

    1998-01-01

    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.

  14. A primer on local anesthetics for plastic surgery.

    PubMed

    Armstrong, Kevin

    2013-10-01

    This article provides some insight into the basic science and concepts relevant to the use of local anesthetics by clinicians in the management of their patients, including a brief history of the development of local anesthetics and their physical properties, effectiveness, uses, limitations, and safety considerations. A generalized overview of the mechanism of action is also provided. The molecular detail of local anesthetics and voltage-gated ion channels can form the basis of understanding of (1) future developments in this area, and (2) toxicity. Most of the peer-reviewed literature related to this topic stems from work in adult humans and animals. PMID:24093648

  15. Distraction, exposure therapy, counterconditioning, and topical anesthetic for acute pain management during needle sticks in children with intellectual and developmental disabilities.

    PubMed

    Slifer, Keith J; Hankinson, Jessica C; Zettler, Melissa A; Frutchey, Robin A; Hendricks, Melissa C; Ward, Cynthia M; Reesman, Jennifer

    2011-08-01

    A behavior therapy approach for obtaining cooperation during needle sticks was provided to 8 pediatric patients with intellectual and developmental disabilities. Therapy was provided during mock needle sticks. Hand lotion was applied to simulate topical anesthetic. Distracting activities established relaxation while needle stick materials were gradually introduced. Positive reinforcement was provided for cooperation. Behavioral distress was ignored, blocked, or redirected. After cooperating with mock needle sticks, needle sites were prepared with topical anesthetic (EMLA), then therapists and medical staff implemented the behavioral protocol while completing the actual needle stick(s). Observational measures of cooperation and interfering were obtained. Results were replicated across 8 children and evaluated using paired samples t tests. Initially, all children were uncooperative with needle sticks. With treatment, behavioral distress decreased, and patients cooperated with mock and actual needle sticks. Results support the effectiveness of behavior therapy for promoting cooperation in children with intellectual and developmental disabilities during needle sticks. PMID:21357197

  16. Application of nanogel systems in the administration of local anesthetics

    PubMed Central

    Tan, Jeremy PK; Tan, Maureen BH; Tam, Michael KC

    2010-01-01

    Nanogels are robust nanoparticles that could be used to deliver active drug compounds in controlled drug delivery applications. This review discusses the design, synthesis, loading, and release of local anesthetics using polymeric nanoparticles produced via various types of polymerization techniques. The strategy of using layer-by-layer approach to control the burst release of procaine hydrochloride (PrHy; a local anesthetic drug of the amino ester group) is described and discussed. PMID:22915875

  17. Data Management Techniques for Acoustical Planetary Data

    NASA Astrophysics Data System (ADS)

    Eichelberger, Hans; Prattes, Gustav; Schwingenschuh, Konrad; Tokano, T.; Jernej, I.; Stachel, Manfred; Besser, B. P.; Aydogar, Oe.

    We discuss data management techniques for acoustical data obtained from future atmospheric planetary in-situ probes with the aim of event oriented scientific analysis. The immediate objec-tive is the localisation (acoustic wave telescope) and characterisation of acoustic phenomena of atmospheres and surfaces, e.g. in the frame of the proposed NASA/ESA Titan Saturn System Mission (TSSM) with the Acoustic Sensor Package (ACU) multi-microphone array. Contrary to huge amounts of source data obtained through the electromagnetic windows, acoustical sig-nals are seldom recorded and few files exist. One example is pressure sensor data from the instrument HASI/PWA during Huygens descent, mission Cassini-Huygens. Nevertheless, a lot of acoustic point and noise sources, e.g. caused by rain, drizzle or wind abound in Titan's atmosphere. In almost all cases, due to limitations in telemetry rate, a careful strategy for onboard event handling and data reduction -the first step in data management -has to be selected, e.g. sampling rates in kHz range or averaging in the frequency domain. This pre-processing together with complementary investigations at the space segment directly influences the scientific data return in terms of long-term continuous or short-term event based studies. The database at the ground segment with science data and metadata entries after final calibra-tion has to support the combined investigations with other instruments. This second step in data management fully explores the acoustic environment of planetary atmospheres in terms of background noise and spacecraft generated disturbances, location and characterisation of source regions and correlation between the experiments. Currently we're running databases for magnetic field data from various ground-based and satellite related experiments, historical balloon data included. Comparisons of data between experiments are possible. This framework based on dependability considerations with several different attributes, among them reliability, availability, integrity, and is suitable for extension to acoustical data. Terrestrial measurements from laboratory and open air test sites support the interpretation of scientific data and are connected to the database.

  18. Efficient Integration of Data Mining Techniques in Database Management Systems

    E-print Network

    Paris-Sud XI, Université de

    Efficient Integration of Data Mining Techniques in Database Management Systems Fadila Bentayeb J- ing data mining techniques, and more particularly super- vised machine learning algorithms, to large. Keywords: Databases, Data mining, Supervised ma- chine learning, Decision trees, Contingency table, Per

  19. Opioid induced hyperalgesia in anesthetic settings

    PubMed Central

    Lee, Hyeon Jeong

    2014-01-01

    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

  20. Group decision-making techniques for natural resource management applications

    USGS Publications Warehouse

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

    1992-01-01

    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.

  1. Techniques for Wetlands Construction and Management

    E-print Network

    Locke, Shawn; Frentress, C.; Cathey, James; Mason, C.; Hirsch, R.; Wagner, M.

    2007-09-04

    Wetlands are important ecosystems that contain a vast array of plants and animals. Wetlands perform a variety of vital functions, such as purifying water. This publication explains the role of wetlands and how to construct and manage them....

  2. Altered states: psychedelics and anesthetics.

    PubMed

    Icaza, Eduardo E; Mashour, George A

    2013-12-01

    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

  3. New techniques and devices for difficult airway management.

    PubMed

    Shirgoska, Biljana; Netkovski, Jane

    2012-09-01

    The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine. PMID:23330414

  4. Terminal area arrival management concepts using tactical merge management techniques

    Microsoft Academic Search

    Aslaug Haraldsdottir; Janet King; Julien Scharl

    2010-01-01

    This paper describes operational concept options for 4D trajectory-based arrival management in the terminal area, using Flight Management Systems (FMS) capable of Area Navigation (RNAV), Required Navigation Performance (RNP), Vertical Navigation (VNAV), as well as Required Time of Arrival (RTA) and airplane-based Interval Management (IM). Furthermore, it is assumed that the ATM automation system provides support to the controller to

  5. Project management techniques for highly integrated programs

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

    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.

  6. Interference management techniques in large-scale wireless networks 

    E-print Network

    Luo, Yi

    2015-06-29

    In this thesis, advanced interference management techniques are designed and evaluated for large-scale wireless networks with realistic assumptions, such as signal propagation loss, random node distribution and ...

  7. Supporting knowledge management: A selection of methods and techniques

    Microsoft Academic Search

    Rob van der Spek; Robert de Hoog

    1997-01-01

    Carrying out knowledge management effectively requires support from a repertoire of methods, techniques and tools. This paper provides a selection of those methods. They are described according to a conceptual framework that sees knowledge management as consisting of four activities that are performed sequentially. These activities are Review, Conceptualize, Reflect and Act. For each activity some methods are discussed while

  8. Computationally Simple Battery Management Techniques for Wireless Nodes

    E-print Network

    Sarkar, Saswati

    Computationally Simple Battery Management Techniques for Wireless Nodes Maria Adamou 1 and Saswati In this paper, we investigate di#11;erent battery management policies for a wireless node. The goal is to increase the lifetime of a node by exploiting its battery characteristics. We have presented a framework

  9. Applying selected quality management techniques to diagnose delivery time variability

    Microsoft Academic Search

    Michael Bernon; Paul Haggett

    2011-01-01

    Purpose – This research seeks to identify and apply techniques that can be used in a supply chain context to diagnose the causes of variability in delivery lead time. Design\\/methodology\\/approach – A literature review was conducted and a number of quality management (QM), techniques were selected as candidates for diagnosing delivery time variability. A case study of the application of

  10. Capitalizing on Stress Management Techniques in Developmental Classes.

    ERIC Educational Resources Information Center

    Price, Elsa C.

    Mastering stress management techniques can help college developmental class educators protect themselves from burnout. These techniques can also be taught to students in developmental classes to enable them to maximize the benefits from these classes. This paper outlines the causes of stress, identifies stressors, describes responses to stress,…

  11. Techniques for Wetlands Construction and Management 

    E-print Network

    Locke, Shawn; Frentress, C.; Cathey, James; Mason, C.; Hirsch, R.; Wagner, M.

    2007-09-04

    materials production of extractable raw materials genetic resources source for unique biological materials and products recreation opportunities for recreational activities cultural aspects opportunities for non-commercial use (i.e., aesthetic, artistic... of the land. Wetland restoration techniques seek to alter an existing site by returning it to a set of pre- vious conditions. Usually, some idea of the characteristics of the earlier wetland condi- tions is desirable when applying restoration activities...

  12. Taking bitewing radiographs in preschoolers using behavior management techniques.

    PubMed

    Kaakko, T; Riedy, C A; Nakai, Y; Domoto, P; Weinstein, P; Milgrom, P

    1999-01-01

    Radiographs are essential diagnostic tools to enable dentists to make adequate decisions and treatment plans. Treatment plans for young children, however, are quite often based on no or less than ideal radiographs. Getting successful bitewing radiographs from young children demands both behavior management techniques and adequate equipment. This report reviews the literature, and presents a modified technique of taking radiographs in young children. The technique was successfully used with 156 three-to-five-year-old children from Yakima County, Washington. Behavioral management of the children employed several techniques: building rapport, tell-show-do, modeling, positive reinforcement and increasing the child's sense of control. The equipment and placement technique were designed to be as atraumatic as possible. Positive experiences in the dental office often enhance a child's future cooperation. The techniques presented are simple to learn and use in treating very young children. PMID:10631887

  13. Role of signal transduction in anesthetic action. Alpha 2 adrenergic agonists.

    PubMed

    Maze, M; Regan, J W

    1991-01-01

    The molecular mechanism for general anesthetic action is not known. The alpha 2 adrenergic agonists represent a novel class of "anesthetic-like" agent because of their selectivity for receptor binding sites and because the transmembrane signaling systems mediating their biologic responses in non-CNS systems are known. We have begun to characterize the signal transduction pathway involved in the anesthetic-like action of the alpha 2 adrenergic agonists. The alpha 2 adrenergic agonists potently decrease both central noradrenergic neurotransmission and halothane anesthetic requirements (MAC). Since MAC is only reduced by 30-40% when noradrenergic neurotransmission is totally abolished and since the reduction in MAC with the highly selective alpha 2 adrenergic agonists exceeds 90%, factors in addition to noradrenergic neurotransmission must be contributing to the anesthetic action of the alpha 2 agonists. Studies with the superselective alpha 2 agonist dexmedetomidine confirmed this, as the alpha 2 agonist could still reduce the MAC for halothane in rats depleted of their central norepinephrine stores. The profound reduction in anesthetic requirements with dexmedetomidine raised the possibility that alpha 2 adrenergic agonists may be considered an anesthetic hypnotic agent by itself. This sole anesthetic hypnotic response was established together with the confirmation that a central alpha 2 adrenoceptor mediated this action. Subsequently, data using molecular biologic techniques suggested that the alpha 2 C4 isoreceptor was the probable receptor that mediated the anesthetic response. We further explored the postreceptor effector mechanism for the signal transduction pathway for alpha 2 anesthetic action and identified the participation of two other molecular components, namely, a pertussis-toxin-sensitive G protein and a 4-aminopyridine-sensitive ion channel. Whether the signal transduction pathway for alpha 2 anesthetic action mediates the further response to other non-alpha 2 anesthetic agents needs to be defined. PMID:1711813

  14. Anesthetic Challenges in Robotic-assisted Urologic Surgery

    PubMed Central

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

    2013-01-01

    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

  15. Managing difficult polyps: techniques and pitfalls

    PubMed Central

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

    2013-01-01

    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

  16. Clustering techniques for personal photo album management

    NASA Astrophysics Data System (ADS)

    Ardizzone, Edoardo; La Cascia, Marco; Morana, Marco; Vella, Filippo

    2009-10-01

    We propose a novel approach for the automatic representation of pictures achieving a more effective organization of personal photo albums. Images are analyzed and described in multiple representation spaces, namely, faces, background, and time of capture. Faces are automatically detected, rectified, and represented, projecting the face itself in a common low-dimensional eigenspace. Backgrounds are represented with low-level visual features based on an RGB histogram and Gabor filter bank. Faces, time, and background information of each image in the collection is automatically organized using a mean-shift clustering technique. Given the particular domain of personal photo libraries, where most of the pictures contain faces of a relatively small number of different individuals, clusters tend to be semantically significant besides containing visually similar data. We report experimental results based on a data set of about 1000 images where automatic detection and rectification of faces lead to approximately 400 faces. Significance of clustering has been evaluated, and results are very encouraging.

  17. Automated NDT techniques in radioactive waste management

    SciTech Connect

    Barna, B.A.; Brown, B.W.; Anderson, B.C.

    1983-01-01

    The prime NDT method selected for characterization of the waste is real-time x-radiography (RTR). An RTR system specifically designed for the TRU waste inspection is currently being used to develop the best techniques for waste certification. It is based on a standard 420 kV constant potential x-ray machine with a rare-earth fluorescing screen (gadolinium oxysulfide) functioning as an image converter. The low-light-level image produced on the screen is picked up by a CCTV camera with an image intensifier coupled to a plumbicon imaging tube. The system was designed for automated waste container handling and translation. Image analysis is not currently automated, although the CCTV image is digitized to allow signal averaging and edge enhancement through digital filtering. The digitized image is available through an IEEE 488 I/O port for more sophisticated computerized analysis.

  18. Anesthetic premedication: new horizons of an old practice.

    PubMed

    Sheen, Michael J; Chang, Fang-Lin; Ho, Shung-Tai

    2014-09-01

    The practice of anesthetic premedication embarked upon soon after ether and chloroform were introduced as general anesthetics in the middle of the 19(th) century. By applying opioids and anticholinergics before surgery, the surgical patients could achieve a less anxious state, and more importantly, they would acquire a smoother course during the tedious and dangerous induction stage. Premedication with opioids and anticholinergics was not a routine practice in the 20(th) century when intravenous anesthetics were primarily used as induction agents that significantly shorten the induction time. The current practice of anesthetic premedication has evolved into a generalized scheme that incorporates several aspects of patient care: decreasing preoperative anxiety, dampening intraoperative noxious stimulus and its associated neuroendocrinological changes, and minimizing postoperative adverse effects of anesthesia and surgery. Rational use of premedication in modern anesthesia practice should be justified by individual needs, the types of surgery, and the anesthetic agents and techniques used. In this article, we will provide our readers with updated information about premedication of surgical patients with a focus on the recent application of second generation serotonin type 3 antagonist, antidepressants, and anticonvulsants. PMID:25304317

  19. Hoshin Kanri: a technique for strategic quality management.

    PubMed

    Tennant, C; Roberts, P A

    2000-01-01

    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

  20. An Intelligent Content Discovery Technique for Health Portal Content Management

    PubMed Central

    2014-01-01

    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

  1. Genotoxicity of Anesthetics Evaluated In Vivo (Animals)

    PubMed Central

    Braz, Mariana G.; Karahalil, Bensu

    2015-01-01

    The anesthesia has been improved all over the years. However, it can have impact on health, in both patients and animals anesthetized, as well as professionals exposed to inhaled anesthetics. There is continuing effort to understand the possible effects of anesthetics at molecular levels. Knowing the effects of anesthetic agents on genetic material could be a valuable basic support to better understand the possible mechanisms of these agents. Thus, the purpose of this review is to provide an overview on the genotoxic potential, evaluated in animal models, of many anesthetics that have already been used and those currently used in anesthesia. PMID:26199936

  2. [Endogenous anesthetic depressions (psychopathology and typology)].

    PubMed

    Baranov, P A

    2011-01-01

    The psychopathological structure of anesthetic depressions was studied in 80 patients with progredient schizophrenia. Three variants of anesthetic depression were distinguished, viz, anxiety anesthesia with agitation, sensorial psychic anesthesia, and multiple depersonalization symptoms; melancholic anesthesia with the depressive triad, self-reproach ideas and sensorial ideatory psychic anesthesia; anesthesia proper with ideatory psychic anesthesia as the main or sole manifestation of depression. The study revealed transitions of these variants in the structure of schizophrenic episodes from anxiety anesthetic to melancholic anesthetic and further on to purely anesthetic ones. The latter type of depression proved refractory to antidepressive therapy and tended to persist for a long time. PMID:21674918

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

    PubMed

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

    2011-03-01

    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

  4. Stress-busters Tips and techniques for managing stress and

    E-print Network

    California at Santa Cruz, University of

    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

  5. Power Modeling and Thermal Management Techniques for Manycores

    E-print Network

    Simunic, Tajana

    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

  6. Nonlethal Techniques for Managing Predation: Primary and Secondary Repellents

    Microsoft Academic Search

    JOHN A. SHIVIK; ADRIAN TREVES; PEGGY CALLAHAN

    2003-01-01

    Conservation biology requires the development of practical tools and techniques to minimize con- flicts arising from human modification of ecosystems. We applied behavioral theory of primary and secondary repellents to predator management by using aversive stimulus devices (electronic training collars) and dis- ruptive stimulus devices (behavior-contingent audio and visual repellents) in a multipredator ( Canis lupus, Haliaeetus leucocephalus, Ursus spp.)

  7. Knowledge Management Techniques for Know-How Transfer Systems Design.

    E-print Network

    Paris-Sud XI, Université de

    Knowledge Management Techniques for Know-How Transfer Systems Design. The case of an Oil Company through Knowledge and Innovation, World Scientific Publishing Company Pte Ltd, Feb 2007, ISBN 13 978-981-270-451-1, pp 15-34 Summary This paper presents a research in progress on the use of knowledge engineering

  8. A Study of Approximate Data Management Techniques for Sensor Networks

    E-print Network

    Martin, Ralph R.

    in a number of places, for instance during measurement acquisition by sensor de- vices or in data propagationA Study of Approximate Data Management Techniques for Sensor Networks Adonis Skordylis, Niki,niki,alexandre @dcs.bbk.ac.uk Abstract -- Recent developments in sensor network technology have enabled

  9. Using Powerpoint Animations to Teach Operations Management Techniques and Concepts

    ERIC Educational Resources Information Center

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

    2014-01-01

    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…

  10. Management Organization Systems Technique; A Management System for Higher Education--Instruction.

    ERIC Educational Resources Information Center

    Wayne County Community Coll., Detroit, MI.

    Instruction is the focus of the final pamphlet in a six-part series describing the Management Organization Systems Technique (MOST). The system was designed at Wayne County Community College to determine the goals and objectives of the college and assist management in their attainment and evaluation. The instruction component of the system takes…

  11. Dexmedetomidine as the primary anesthetic agent during cardiac surgery in an infant with a family history of malignant hyperthermia

    PubMed Central

    Naguib, Aymen; McKee, Chris; Phillips, Alistair; Tobias, Joseph D.

    2011-01-01

    Malignant hyperthermia (MH) is an acute hypermetabolic crisis triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When providing anesthetic care for MH-susceptible agents, a total intravenous anesthetic (TIVA) technique is frequently chosen. When choosing the components for TIVA, several options exist including the combination of propofol or dexmedetomidine with an opioid. We present our experience with the use of dexmedetomidine as a key component of the anesthetic regimen in a 5-month-old infant with a family history of MH. Previous reports of the use of dexmedetomidine in MH-susceptible patients are reviewed and its benefits in such patients discussed. PMID:22144934

  12. Risk Management Techniques and Practice Workshop Workshop Report

    SciTech Connect

    Quinn, T; Zosel, M

    2008-12-02

    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.

  13. Mechanisms revealed through general anesthetic photolabeling.

    PubMed

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

    2014-03-01

    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

  14. New MPLS network management techniques based on adaptive learning.

    PubMed

    Anjali, Tricha; Scoglio, Caterina; de Oliveira, Jaudelice Cavalcante

    2005-09-01

    The combined use of the differentiated services (DiffServ) and multiprotocol label switching (MPLS) technologies is envisioned to provide guaranteed quality of service (QoS) for multimedia traffic in IP networks, while effectively using network resources. These networks need to be managed adaptively to cope with the changing network conditions and provide satisfactory QoS. An efficient strategy is to map the traffic from different DiffServ classes of service on separate label switched paths (LSPs), which leads to distinct layers of MPLS networks corresponding to each DiffServ class. In this paper, three aspects of the management of such a layered MPLS network are discussed. In particular, an optimal technique for the setup of LSPs, capacity allocation of the LSPs and LSP routing are presented. The presented techniques are based on measurement of the network state to adapt the network configuration to changing traffic conditions. PMID:16252830

  15. Surface Water Quality as Affected by Sugarcane Residue Management Techniques

    Microsoft Academic Search

    Theophilus K. Udeigwe; Jim J. Wang; Howard P. Viator; Lewis Gaston

    2010-01-01

    This study evaluated the impacts of three sugarcane residue management techniques, namely postharvest burning of residue (BR),\\u000a shredding of residue (SR), and full postharvest retention of residue (RR), on the water quality of surface runoff from February\\u000a 2006 to September 2007 in Iberia, LA. Total runoff volumes recorded were 58,418, 57,923, and 46,578 L for the BR, SR, and\\u000a RR treatments,

  16. Inhaled Anesthetics Do Not Combine to Produce Synergistic Effects Regarding Minimum Alveolar Anesthetic Concentration in Rats

    Microsoft Academic Search

    Edmond I Eger II; Michael Tang; Mark Liao; Michael J. Laster; Ken Solt; Pamela Flood; Andrew Jenkins; Douglas Raines; Jan F. Hendrickx; Steven L. Shafer; Tanifuji Yasumasa; James M. Sonner

    2008-01-01

    BACKGROUND: We hypothesized that pairs of inhaled anesthetics having divergent potencies (one acting weakly at minimum alveolar anesthetic concentration (MAC); one acting strongly at MAC) on specific receptors\\/channels might act synergisti- cally, and that such deviations from additivity would support the notion that anesthetics act on multiple sites to produce anesthesia. METHODS: Accordingly, we studied the additivity of MAC for

  17. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...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...

  18. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...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...

  19. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...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...

  20. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...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...

  1. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...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...

  2. Placental transfer of local anesthetics.

    PubMed

    Yurth, D A

    1982-02-01

    All the presently used local anesthetic agents in the increasingly popular modalities of obstetric regional anesthesia cross the placenta readily, governed only by two factors that the anesthesiologist has any control over (1) dosage and timing of doses and (2) uterine blood flow as it relates to the development of fetal acidosis. Uptake of a given dose of local agent from the epidural or caudal spaces may be limited with the addition of epinephrine to some extent with some drugs, but this is of little real value in the two safest drugs--bupivacaine and 2-chloroprocaine. At the doses and in the manner presently recommended, fetal intoxication with local anesthetic agent during maternal epidural analgesia should not occur in the absence of either direct intravascular injection, severe maternal hepatic disorder, marked fetal prematurity or postmaturity. The usual precautions in the exercise of regional anesthesia when applied to obstetrics render it very safe, if not the safest form of anesthesia-analgesia available. PMID:7039931

  3. A dynamic slack management technique for real-time distributed embedded systems 

    E-print Network

    Acharya, Subrata

    2006-04-12

    This work presents a novel slack management technique, the Service Rate Based Slack Distribution Technique, for dynamic real-time distributed embedded systems targeting the reduction and management of energy consumption. Energy minimization...

  4. A dynamic slack management technique for real-time distributed embedded systems

    E-print Network

    Acharya, Subrata

    2006-04-12

    This work presents a novel slack management technique, the Service Rate Based Slack Distribution Technique, for dynamic real-time distributed embedded systems targeting the reduction and management of energy consumption. Energy minimization...

  5. Transcatheter aortic valve implantation: anesthetic considerations.

    PubMed

    Billings, Frederic T; Kodali, Susheel K; Shanewise, Jack S

    2009-05-01

    Aortic valvular stenosis remains the most common debilitating valvular heart lesion. Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. AV implantation treats aortic stenosis without subjecting patients to sternotomy, cardiopulmonary bypass (CPB), and aorta cross-clamping. This transcatheter procedure is performed via puncture of the left ventricular (LV) apex or percutaneously, via the femoral artery or vein. Patients undergo general anesthesia, intense hemodynamic manipulation, and transesophageal echocardiography (TEE). To elucidate the role of the anesthesiologist in the management of transcatheter AV implantation, we review the literature and provide our experience, focusing on anesthetic care, intraoperative events, TEE, and perioperative complications. Two approaches to the aortic annulus are performed today: transfemoral retrograde and transapical antegrade. Iliac artery size and tortuosity, aortic arch atheroma, and pathology in the area of the (LV) apex help determine the preferred approach in each patient. A general anesthetic is tailored to achieve extubation after procedure completion, whereas IV access and pharmacological support allow for emergent sternotomy and initiation of CPB. Rapid ventricular pacing and cessation of mechanical ventilation interrupts cardiac ejection and minimizes heart translocation during valvuloplasty and prosthesis implantation. Although these maneuvers facilitate exact prosthesis positioning within the native annulus, they promote hypotension and arrhythmia. Vasopressor administration before pacing and cardioversion may restore adequate hemodynamics. TEE determines annulus size, aortic pathology, ventricular function, and mitral regurgitation. TEE and fluoroscopy are used for positioning the introducer catheter within the aortic annulus. The prosthesis, crimped on a valvuloplasty balloon catheter, is implanted by inflation. TEE immediately measures aortic regurgitation and assesses for aortic dissection. After repair of femoral vessels or LV apex, patients are allowed to emerge and assessed for extubation. Observed and published complications include aortic regurgitation, prosthesis embolization, mitral valve disruption, hemorrhage, aortic dissection, CPB, stroke, and death. Transcatheter AV implantation relies on intraoperative hemodynamic manipulation for success. Transfemoral and transapical approaches pose unique management challenges, but both require rapid ventricular pacing, the management of hypotension and arrhythmias during beating-heart valve implantation, and TEE. Anesthesiologists will care for debilitated patients with aortic stenosis receiving transcatheter AV implantation. PMID:19372319

  6. Sodium channels as targets for volatile anesthetics.

    PubMed

    Herold, Karl F; Hemmings, Hugh C

    2012-01-01

    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

  7. Evaluation of Segmentation Techniques for Inventory Management in Large Scale Multi-Item Inventory Systems1

    E-print Network

    Rossetti, Manuel D.

    1 Evaluation of Segmentation Techniques for Inventory Management in Large Scale Multi of experiments was performed. The analysis indicates that these new techniques can improve inventory management of the National Science Foundation. #12;3 Evaluation of Segmentation Techniques for Inventory Management in Large

  8. Botulinum toxin injection techniques for the management of adult spasticity.

    PubMed

    Walker, Heather W; Lee, Michael Y; Bahroo, Laxman B; Hedera, Peter; Charles, David

    2015-04-01

    Spasticity is often experienced by individuals with injury or illness of the central nervous system from etiologies such as stroke, spinal cord injury, brain injury, multiple sclerosis, or other neurologic conditions. Although spasticity may provide benefits in some patients, it more often leads to complications negatively impacting the patient. Nonpharmacologic treatment options often do not provide long-term reduction of spasticity, and systemic interventions, such as oral medications, can have intolerable side effects. The use of botulinum neurotoxin injections is one option for management of focal spasticity. Several localization techniques are available to physicians that allow for identification of the selected target muscles. These methods include anatomic localization in isolation or in conjunction with electromyography guidance, electrical stimulation guidance, or ultrasound guidance. This article will focus on further description of each of these techniques in relation to the treatment of adult spasticity and will discuss the advantages and disadvantages of each technique, as well as review the literature comparing the techniques. PMID:25305369

  9. Cleft lift procedure for pilonidal disease: technique and perioperative management.

    PubMed

    Favuzza, J; Brand, M; Francescatti, A; Orkin, B

    2015-08-01

    Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition. Herein, we describe the etiology of pilonidal disease and our technique for definitive management of pilonidal disease using the cleft lift procedure. In this paper, we present our method of performing the cleft lift procedure for pilonidal disease including perioperative management and surgical technique. We have used the cleft lift procedure in nearly 200 patients with pilonidal disease, in both primary and salvage procedures settings. It has been equally successful in both settings with a high rate of success. It results in a closed wound with relatively minimal discomfort and straightforward wound care. We have described our current approach to recurrent and complex pilonidal disease using the cleft lift procedure. Once learned, the cleft lift procedure is a straightforward and highly successful solution to a chronic and challenging condition. PMID:26165209

  10. Volatile anesthetic-induced preconditioning.

    PubMed

    Swyers, T; Redford, D; Larson, D F

    2014-01-01

    The myocardium has an innate ability to protect itself from ischemic events. This protection occurs when the myocardium is exposed to a brief ischemic period prior to a more extreme ischemic event. This is termed ischemic preconditioning. Ischemic preconditioning induces a series of molecular pathways that protect the cardiac myocyte; first, for a period of 1-6 hours (early preconditioning) and, also, for a second period from 24-72 hours (delayed phase). The early preconditioning is mediated by the release of adenosine which induces a protective signal that is related to the mitochondrial KATP channel activation and activation of the ?-opioid and bradykinin receptors. The delayed phase is related to the induction of inducible nitric oxide synthase, superoxide dismutase and heat-shock proteins. Indirect evidence indicates that O2-derived free radicals are involved in the delayed phase, as noted in the early preconditioning phase. Applying ischemic preconditioning to clinical practice can be dangerous and difficult to implement in a controlled fashion. However, recent studies have shown that the use of volatile anesthetics, such as sevoflurane, isoflurane and desflurane, can mimic the early phase of ischemic preconditioning through a multi-pathway signaling of mitochondrial KATP channels. This important finding can easily be applied to clinical practice for patients undergoing surgery. It can also be significantly important for patients undergoing off-pump cardiac bypass surgery or cardiac bypass surgery where there is no cross-clamp or cardioplegia used where the probability of myocardial ischemia is greatly increased. This report will, therefore, discuss the mechanism, safety and efficacy of volatile anesthetics as inducers of cardiac preconditioning. PMID:24002781

  11. New equipment and techniques for airway management in trauma.

    PubMed

    Smith, C E; Dejoy, S J

    2001-04-01

    A patent, unobstructed airway is fundamental in the care of the trauma patient, and is most often obtained by placing a cuffed tube in the trachea. The presence of shock, respiratory distress, a full stomach, maxillofacial trauma, neck hematoma, laryngeal disruption, cervical spine instability, and head injury all combine to increase tracheal intubation difficulty in the trauma patient. Complications resulting from intubation difficulties include brain injury, aspiration, trauma to the airway, and death. The use of devices such as the gum-elastic bougie, McCoy laryngoscope, flexible and rigid fiberscopes, intubating laryngeal mask, light wand, and techniques such as rapid-sequence intubation, manual in-line axial stabilization, retrograde intubation, and cricothyroidotomy, enhance the ability to obtain a definitive airway safely. The management of the failed airway includes calling for assistance, optimal two-person bag-mask ventilation, and the use of the laryngeal mask airway, Combitube, or surgical airway. The simulation of airway management using realistic simulator tools (e.g. full-scale simulators, virtual reality airway simulators) is a promising modality for teaching physicians and advanced life support personnel emergency airway management skills. PMID:17016402

  12. Introducing Risk Management Techniques Within Project Based Software Engineering Courses

    NASA Astrophysics Data System (ADS)

    Port, Daniel; Boehm, Barry

    2002-03-01

    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.

  13. Benzocaine as an anesthetic for striped bass

    USGS Publications Warehouse

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

    1991-01-01

    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.

  14. Volatile Anesthetics and AKI: Risks, Mechanisms, and a Potential Therapeutic Window

    PubMed Central

    Fukazawa, Kyota

    2014-01-01

    AKI is a major clinical problem with extremely high mortality and morbidity. Kidney hypoxia or ischemia-reperfusion injury inevitably occurs during surgery involving renal or aortic vascular occlusion and is one of the leading causes of perioperative AKI. Despite the growing incidence and tremendous clinical and financial burden of AKI, there is currently no effective therapy for this condition. The pathophysiology of AKI is orchestrated by renal tubular and endothelial cell necrosis and apoptosis, leukocyte infiltration, and the production and release of proinflammatory cytokines and reactive oxygen species. Effective management strategies require multimodal inhibition of these injury processes. Despite the past theoretical concerns about the nephrotoxic effects of several clinically utilized volatile anesthetics, recent studies suggest that modern halogenated volatile anesthetics induce potent anti-inflammatory, antinecrotic, and antiapoptotic effects that protect against ischemic AKI. Therefore, the renal protective properties of volatile anesthetics may provide clinically useful therapeutic intervention to treat and/or prevent perioperative AKI. In this review, we outline the history of volatile anesthetics and their effect on kidney function, briefly review the studies on volatile anesthetic-induced renal protection, and summarize the basic cellular mechanisms of volatile anesthetic-mediated protection against ischemic AKI. PMID:24511126

  15. Local Anesthetics: A Century of Progress

    PubMed Central

    Yagiela, John A.

    1985-01-01

    One century after the clinical introduction of cocaine, local anesthesia remains the most important method of pain control in dentistry. Many local anesthetics have been marketed since 1884, and it is likely that attempts to produce drugs that enhance anesthetic efficacy, reduce systemic and local toxicity, and increase nociceptive selectivity, will continue. In addition, new methods of drug administration have been and will be developed to achieve these goals. Of fundamental importance to such improvements are investigations into the pharmacology of drugs with local anesthetic activity and anatomical and physiologic studies pertaining to the reasons why local anesthetics sometimes fail to achieve desired results. This paper reviews recent advances in our understanding of these drugs and their clinical use. ImagesFig. 1 PMID:2408504

  16. Active resource control and management techniques for programmable ATM switches

    NASA Astrophysics Data System (ADS)

    Houatra, Drissa

    2001-07-01

    With the increased demand on quality-of-service (QoS) guarantees, the methods used to design network elements are changing. Service models such as integrated services (IntServ), differentiated services (DiffServ), asynchronous transfer mode (ATM) service classes or multi protocol label switching (MPLS) resulted in research activities dealing with network QoS requirements. However, protocols based on many of these service models have limited implementations. Some of the reasons of these limitations are inadequate network interfaces and node services. With the development of programmable and active networks, it is possible to implement protocols and node service components that better meet the specifications of service models. This paper presents active resource control and management techniques for the realization of QoS guarantees on ATM networks. Using programmable ATM switch interfaces, we propose a set of mechanisms for the control and management of accesses to resources available at an ATM switch. The principal objective of the proposed mechanisms is to enable the implementation of flexible node and network service supports with QoS requirements, while maintaining the consistency and the integrity of resources available at nodes.

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

    PubMed

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

    2015-02-01

    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

  18. Microscopy on anesthetized worms Reagents needed

    E-print Network

    Lamitina, Todd

    Microscopy on anesthetized worms Reagents needed · Vacuum grease syringe · M9 + 5 mM Na Azide (3µl of M9/NaAzide in a watchglass slide 2. Pick 5-10 worms off an NGM plate and into the azide into the square. 6. Pick anesthetized worms onto the slide and gently overlay them with a 22 x 22 mm coverslip. 7

  19. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique

    PubMed Central

    Kyriazanos, Ioannis D.; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5–3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of “intentional open abdomen” was described and both clinical entities share common pathophysiological and clinical pathways (“postoperative open abdominal wall”). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as “frozen abdomen,” where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the “Coliseum technique” for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of “malignant” frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair. PMID:26064759

  20. Anesthetic efficacy of the supplemental X-tip intraosseous injection using 4% articaine with 1:100,000 adrenaline in patients with irreversible pulpitis: An in vivo study

    PubMed Central

    Bhuyan, Atool Chandra; Latha, Satheesh Sasidharan; Jain, Shefali; Kataki, Rubi

    2014-01-01

    Introduction: Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist–patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. Aim: The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. Materials and Methods: X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. Results: The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. Conclusion: When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25506137

  1. Technical management techniques for identification and control of industrial safety and pollution hazards

    NASA Technical Reports Server (NTRS)

    Campbell, R.; Dyer, M. K.; Hoard, E. G.; Little, D. G.; Taylor, A. C.

    1972-01-01

    Constructive recommendations are suggested for pollution problems from offshore energy resources industries on outer continental shelf. Technical management techniques for pollution identification and control offer possible applications to space engineering and management.

  2. Does local anesthetic stereoselectivity or structure predict myocardial depression in anesthetized canines?

    Microsoft Academic Search

    Leanne Groban; Dwight D. Deal; Jason C. Vernon; Robert L. James; John Butterworth

    2002-01-01

    Background and Objectives: It is unclear whether the susceptibility to myocardial depression from an accidental intravascular local anesthetic (LA) administration is associated with LA stereoselectivity or structure. By using direct left ventricular pressure monitoring and echocardiographic indices of contractile function in anesthetized, ventilated dogs, we compared the cardiac depressant effects of bupivacaine, ropivacaine, levobupivacaine, and lidocaine. Methods: Open-chest dogs were

  3. Percutaneous endoscopic gastrostomy: Indications, technique, complications and management

    PubMed Central

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

    2014-01-01

    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

  4. Methionine 286 in transmembrane domain 3 of the GABA A receptor ? subunit controls a binding cavity for propofol and other alkylphenol general anesthetics

    Microsoft Academic Search

    M. D. Krasowski; K. Nishikawa; N. Nikolaeva; A. Lin; N. L. Harrison

    2001-01-01

    ?-Aminobutyric acid type A (GABAA) receptors are an important target for general anesthetics in the central nervous system. Site-directed mutagenesis techniques have identified amino acid residues that are important for the positive modulation of GABAA receptors by general anesthetics. In the present study, we investigate the role of an amino acid residue in transmembrane (TM) domain 3 of the GABAA

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

    ERIC Educational Resources Information Center

    Moshavi, Dan

    2001-01-01

    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)

  6. Recovery Profiles from Dexmedetomidine as a General Anesthetic Adjuvant in Patients Undergoing Lower Abdominal Surgery

    Microsoft Academic Search

    Norimasa Ohtani; Kotaro Kida; Kazuhiro Shoji; Yutaka Yasui; Eiji Masaki

    2008-01-01

    BACKGROUND: Dexmedetomidine induces less change in hemodynamic values dur- ing the extubation period. This drug may be useful in anesthetic management requiring smooth emergence from anesthesia. We sought to determine the effects of co-administration of dexmedetomidine on the recovery profiles from sevoflurane and propofol, which usually provide safe and rapid recovery when administered alone. METHODS: Sixty patients undergoing lower abdominal

  7. Hypersensitive reactions to local dental anesthetics and patient information: critical review of a drug leaflet

    PubMed Central

    Simonet, Daniel

    2011-01-01

    This paper discusses the case of a patient who experienced adverse reactions to a local anesthetic. It reviews symptoms of adverse reactions, possible causes, patient management, and alternative anesthesia modes. The second part of the paper discusses the product leaflet information and the associated legal issues. PMID:22915891

  8. Methods and techniques specific to human resource management

    Microsoft Academic Search

    Ovidiu NICOLESCU

    2009-01-01

    The first part of the study presents the contextual and conceptual novelty elements concerning human resources on which this human resource management approach relies. The conceptual novelty element is represented by the comprehensive approach of human resource management (MRU), focused on the relationships of the organisation with internal and external human stakeholders, not limiting to the traditional approach, managers subordonees.

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

    PubMed

    Redshaw, Charlotte; Stewart, Catherine

    2014-11-01

    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

  10. Management of Jehovah's Witness patients for scoliosis surgery: the use of platelet and plasmapheresis

    Microsoft Academic Search

    Amira M. Safwat; John A. Reitan; Daniel Benson

    1997-01-01

    Four patients whose religious beliefs prohibited accepting blood during surgery for scoliosis were anesthetized and managed successfully using plateletpheresis and plasmapheresis. Blood losses were replaced with crystalloid and hetastarch solutions. In addition, a moderate hypotensive technique was used to minimize surgical blood loss. Postoperatively, the patients received iron therapy and\\/or erythropoietin. Three of these patients had an uncomplicated postoperative course;

  11. Efficacy of Intra-articular Local Anesthetics in Total Knee Arthroplasty.

    PubMed

    Fang, Rui; Liu, Zhenfeng; Alijiang, Asila; Jia, Heng; Deng, Yingjie; Song, Yucheng; Meng, Qingcai

    2015-07-01

    Pain management after total knee arthroplasty (TKA) remains among the most important challenges for patients with TKA. Intra-articular local anesthetic has been shown to reduce postoperative pain following TKA. However, studies report conflicting results. This meta-analysis evaluated the efficacy and safety of single-dose intra-articular local anesthetics for pain control after TKA. Databases (Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, and Chinese Biomedical Databases) were searched to identify randomized, controlled trials comparing local anesthetic with placebo in patients undergoing TKA. Data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed with the use of the Cochrane Collaboration's tool for assessing the risk of bias by 2 observers. Relative risk, standardized mean difference, and corresponding 95% confidence interval were calculated. Seventeen trials met the inclusion criteria, for a total of 1338 participants. The results showed that, compared with the placebo group, the single local anesthetic group had a significant lower pain score with rest at 4, 8, 24, and 48 hours; less opioid consumption at 24, 48, and 72 hours postoperatively; and greater range of motion at 24, 48, and 72 hours. There were no significant differences between the 2 groups in length of hospital stay, nausea and vomiting, pruritus, sedation, or deep venous thrombosis. The study findings showed that pain relief after TKA was significantly better with intra-articular local anesthetic than with placebo. [Orthopedics. 2015; 38(7):e573-e581.]. PMID:26186318

  12. The selection of risk management techniques using case-based reasoning

    Microsoft Academic Search

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

    2010-01-01

    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

  13. An Adaptive Radio Access Network Resource Management Technique for a HSDPA Network

    Microsoft Academic Search

    Xinzhi Yan; Jamil Y. Khan; Brendan Jones

    2007-01-01

    This paper presents an adaptive bandwidth management technique to improve the transmission efficiency of a high speed downlink packet access (HSDPA) network by adaptively allocating radio access network resources. The radio access network resources are allocated based on the air interface demand. The proposed bandwidth management technique is evaluated by an analytical and a simulation model. Both analytical and simulation

  14. Field use of isoflurane as an inhalant anesthetic in the American marten (Martes americana).

    PubMed

    Desmarchelier, Marion; Cheveau, Marianne; Imbeau, Louis; Lair, Stéphane

    2007-10-01

    We evaluated the effectiveness and practicality of using isoflurane as an inhalation anesthetic with oxygen as a gas carrier for American martens (Martes americana) in a field setting. Sixty-eight martens were trapped in the Waswanipi Cree Model Forest (Québec, Canada) from October to November 2005 and anesthetized with isoflurane in 100% oxygen (1 l/min) using a face mask. Induction setting of isoflurane was 3% for all animals. Mean (+/-SD) length of induction was 1.8+/-1.2 min. Maintenance isoflurane settings ranged from 1% to 4%. Procedures lasted an average of 16.4+/-7.1 min and were uneventful. Length of recovery, defined as the interval between the end of the procedure and animal release, was short (6.3+/-2.8 min), and well below reported lengths of recovery using injectable anesthetics (>/=70 min). As compared to open drop administration of isoflurane described in previous studies, the use of an anesthesia machine prevents the risk of potential fatal anesthetic overdose. We conclude that among anesthesia techniques currently available, isoflurane with oxygen as a gas carrier is a safe and useful field anesthetic in martens, when issues with equipment portability can be overcome. PMID:17984268

  15. Anticoagulant and antithrombotic drugs in pregnancy: what are the anesthetic implications for labor and cesarean delivery?

    Microsoft Academic Search

    A J Butwick; B Carvalho

    2011-01-01

    Neuraxial anesthetic techniques are commonly used during the peripartum period to provide effective pain relief for labor and anesthesia during cesarean delivery. Major neurologic complications are rare after neuraxial anesthesia; however, spinal hematoma is associated with catastrophic neurologic outcomes (including lower-limb paralysis). Anticoagulant and antithrombotic drugs can increase the risk of spinal hematoma after neuraxial anesthesia, and better understanding of

  16. Advances in vegetation management for power line corridor monitoring using aerial remote sensing techniques

    Microsoft Academic Search

    Zhengrong Li; Rodney Walker; Ross Hayward; Luis Mejias

    2010-01-01

    This paper presents a comprehensive discussion of vegetation management approaches in power line corridors\\u000abased on aerial remote sensing techniques. We address three\\u000aissues 1) strategies for risk management in power line corridors, 2) selection of suitable platforms and sensor suite for data collection and 3) the progress in automated data processing techniques for vegetation management. We present initial results

  17. Undiagnosed catecholamine-secreting paraganglioma and coexisting carcinoid in a patient with MH susceptibility: an unusual anesthetic challenge.

    PubMed

    Hudcova, Jana; Schumann, Roman

    2007-01-01

    The management of a patient with two undiagnosed neuroendocrine tumors and possible malignant hyperthermia (MH) susceptibility poses a unique challenge to the anesthesiologist. We describe a total intravenous anesthetic including an alpha 2-agonist infusion combined with epidurally administered bupivacaine for intra- and postoperative pain management. Alpha 2-agonists may offer improved intraoperative hemodynamic management in patients with catecholamine-secreting tumors and reduce the total dose needed for intravenous anesthetics such as propofol. The latter mechanism may be useful to avert the risk of the propofol infusion syndrome occurring as a consequence of a high cumulative dose following its prolonged administration. PMID:17285421

  18. The local anesthetic activity of saxitoxin alone and with vasoconstrictor and local anesthetic agents.

    PubMed

    Adams, H J; Blair, M R; Takman, B H

    1976-12-01

    STX (saxitoxin), alone and with various vasoconstrictor and local anesthetic agents, was evaluated for its ability to produce topical anesthesia on the rabbit cornea, peripheral nerve block in the rat, and epidural anesthesia in the dog. High frequency and long duration of block can be attained if sufficiently high concentrations of STX are used, although latency is long and the doses used may produce systemic toxicity. Frequency of satisfactory blocks and mean duration of block can be increased and systemic toxicity reduced if STX is administered with a vasoconstrictor agent. Conventional local anesthetic agents also enhance the nerve blocking activity of STX. When appropriate concentrations of STX, vasoconstrictor and local anesthetic agents are used, systemic toxic effects are not manifested and the blocks produced exhibit the rapid onset and high frequency of block characteristic of the local anesthetic agent and the remarkably long duration of STX. PMID:1015924

  19. Stress management techniques: Are they all equivalent, or do they have specific effects?

    Microsoft Academic Search

    Paul M. Lehrer; Richard Carr; Deepa Sargunaraj; Robert L. Woolfolk

    1994-01-01

    This article evaluates the hypothesis that various stress management techniques have specific effects. Studies comparing various techniques are reviewed, as well as previous literature reviews evaluating the effects of individual techniques. There is evidence that cognitively oriented methods have specific cognitive effects, that specific autonomic effects result from autonomically oriented methods, and that specific muscular effects are produced by muscularly

  20. Comparison of subarachnoid anesthetic effect of emulsified volatile anesthetics in rats

    PubMed Central

    Guo, Jiao; Zhou, Cheng; Liang, Peng; Huang, Han; Li, Fengshan; Chen, Xiangdong; Liu, Jin

    2014-01-01

    Spinal cord is an important target of volatile anesthetics in particular for the effect of immobility. Intrathecal injection of volatile anesthetics has been found to produce subarachnoid anesthesia. The present study was designed to compare spinal anesthetic effects of emulsified volatile anesthetics, and to investigate the correlation between their spinal effects and general effect of immobility. In this study, halothane, isoflurane, enflurane and sevoflurane were emulsified by 30% Intralipid. These emulsified volatile anesthetics were intravenously and intrathecally injected, respectively. ED50 of general anesthesia and EC50 of spinal anesthesia were determined. The durations of general and spinal anesthesia were recorded. Correlation analysis was applied to evaluate the anesthetic potency of volatile anesthetics between their spinal and general effects. ED50 of general anesthesia induced by emulsified halothane, isoflurane, enflurane and sevoflurane were 0.41 ± 0.07, 0.54 ± 0.07, 0.74 ± 0.11 and 0.78 ± 0.08 mmol/kg, respectively, with significant correlation to their inhaled MAC (R2 = 0.8620, P = 0.047). For intrathecal injection, EC50 of spinal anesthesia induced by emulsified halothane, isoflurane, enflurane and sevoflurane were 0.35, 0.27, 0.33 and 0.26 mol/L, respectively, which could be predicted by the product of inhaled MAC and olive oil/gas partition coefficients (R2 = 0.9627, P = 0.013). In conclusion, potency and efficacy of the four emulsified volatile anesthetics in spinal anesthesia were similar and could be predicted by the product of inhaled MAC and olive oil/gas partition coefficients (MAC × olive oil/gas partition coefficients). PMID:25674241

  1. Comparison of subarachnoid anesthetic effect of emulsified volatile anesthetics in rats.

    PubMed

    Guo, Jiao; Zhou, Cheng; Liang, Peng; Huang, Han; Li, Fengshan; Chen, Xiangdong; Liu, Jin

    2014-01-01

    Spinal cord is an important target of volatile anesthetics in particular for the effect of immobility. Intrathecal injection of volatile anesthetics has been found to produce subarachnoid anesthesia. The present study was designed to compare spinal anesthetic effects of emulsified volatile anesthetics, and to investigate the correlation between their spinal effects and general effect of immobility. In this study, halothane, isoflurane, enflurane and sevoflurane were emulsified by 30% Intralipid. These emulsified volatile anesthetics were intravenously and intrathecally injected, respectively. ED50 of general anesthesia and EC50 of spinal anesthesia were determined. The durations of general and spinal anesthesia were recorded. Correlation analysis was applied to evaluate the anesthetic potency of volatile anesthetics between their spinal and general effects. ED50 of general anesthesia induced by emulsified halothane, isoflurane, enflurane and sevoflurane were 0.41 ± 0.07, 0.54 ± 0.07, 0.74 ± 0.11 and 0.78 ± 0.08 mmol/kg, respectively, with significant correlation to their inhaled MAC (R(2) = 0.8620, P = 0.047). For intrathecal injection, EC50 of spinal anesthesia induced by emulsified halothane, isoflurane, enflurane and sevoflurane were 0.35, 0.27, 0.33 and 0.26 mol/L, respectively, which could be predicted by the product of inhaled MAC and olive oil/gas partition coefficients (R(2) = 0.9627, P = 0.013). In conclusion, potency and efficacy of the four emulsified volatile anesthetics in spinal anesthesia were similar and could be predicted by the product of inhaled MAC and olive oil/gas partition coefficients (MAC × olive oil/gas partition coefficients). PMID:25674241

  2. Study of systems and techniques for data base management

    NASA Technical Reports Server (NTRS)

    1976-01-01

    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.

  3. Intrinsic organization of the anesthetized brain.

    PubMed

    Liang, Zhifeng; King, Jean; Zhang, Nanyin

    2012-07-25

    The neural mechanism of unconsciousness has been a major unsolved question in neuroscience despite its vital role in brain states like coma and anesthesia. The existing literature suggests that neural connections, information integration, and conscious states are closely related. Indeed, alterations in several important neural circuitries and networks during unconscious conditions have been reported. However, how the whole-brain network is topologically reorganized to support different patterns of information transfer during unconscious states remains unknown. Here we directly compared whole-brain neural networks in awake and anesthetized states in rodents. Consistent with our previous report, the awake rat brain was organized in a nontrivial manner and conserved fundamental topological properties in a way similar to the human brain. Strikingly, these topological features were well maintained in the anesthetized brain. Local neural networks in the anesthetized brain were reorganized with altered local network properties. The connectional strength between brain regions was also considerably different between the awake and anesthetized conditions. Interestingly, we found that long-distance connections were not preferentially reduced in the anesthetized condition, arguing against the hypothesis that loss of long-distance connections is characteristic to unconsciousness. These findings collectively show that the integrity of the whole-brain network can be conserved between widely dissimilar physiologic states while local neural networks can flexibly adapt to new conditions. They also illustrate that the governing principles of intrinsic brain organization might represent fundamental characteristics of the healthy brain. With the unique spatial and temporal scales of resting-state fMRI, this study has opened a new avenue for understanding the neural mechanism of (un)consciousness. PMID:22836253

  4. Anesthetic Cardioprotection: The Role of Adenosine

    PubMed Central

    Bonney, Stephanie; Hughes, Kelly; Eckle, Tobias

    2014-01-01

    Brief periods of cardiac ischemia and reperfusion exert a protective effect against subsequent longer ischemic periods, a phenomenon coined ischemic preconditioning. Similar, repeated brief episodes of coronary occlusion and reperfusion at the onset of reperfusion, called post-conditioning, dramatically reduce infarct sizes. Interestingly, both effects can be achieved by the administration of any volatile anesthetic. In fact, cardio-protection by volatile anesthetics is an older phenomenon than ischemic pre- or post-conditioning. Although the mechanism through which anesthetics can mimic ischemic pre- or post-conditioning is still unknown, adenosine generation and signaling are the most redundant triggers in ischemic pre- or postconditioning. In fact, adenosine signaling has been implicated in isoflurane-mediated cardioprotection. Adenosine acts via four receptors designated as A1, A2a, A2b, and A3. Cardioprotection has been associated with all subtypes, although the role of each remains controversial. Much of the controversy stems from the abundance of receptor agonists and antagonists that are, in fact, capable of interacting with multiple receptor subtypes. Recently, more specific receptor agonists and new genetic animal models have become available paving way towards new discoveries. As such, the adenosine A2b receptor was shown to be the only 1 of the adenosine receptors whose cardiac expression is induced by ischemia in both mice and humans and whose function is implicated in ischemic pre- or post-conditioning. In the current review, we will focus on adenosine signaling in the context of anesthetic cardioprotection and will highlight new discoveries, which could lead to new therapeutic concepts to treat myocardial ischemia using anesthetic preconditioning. PMID:24502579

  5. Integrating RFID technique to design mobile handheld inventory management system

    NASA Astrophysics Data System (ADS)

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

    2008-04-01

    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.

  6. Methods and Techniques of Quality Management for ICT Audit Processes

    E-print Network

    Popa, Marius

    2012-01-01

    In modern organizations, Information and Communication Technologies are used to support the organizations' activities. To manage the quality of the organization processes, audit processes are implemented. Also, the audit processes can aim the quality of ICT systems themselves because their involvement in organization processes. The paper investigates the ways in which a quality management can be applied for audit processes in order to obtain a high level of quality for the audit recommendations.

  7. The Effect of Intravenous Anesthetics on Ischemia-Reperfusion Injury

    PubMed Central

    2014-01-01

    The effects of intravenous anesthetics on ischemia-reperfusion injury (IRI) have been investigated in both animals and clinical studies. The protective effects and the dosages of the intravenous anesthetics on IRI were discussed in this paper. The prevention of the tissue injury after the IRI was demonstrated with intravenous anesthetics in some studies. In the future, the studies should be focused on the dosage of the anesthetics related to diminishing the tissue injuries. Further studies might be required in order to investigate the effects of the anesthetics on molecular levels. PMID:24527458

  8. Applying total quality management techniques to improve software development.

    PubMed

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

    1998-01-01

    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

  9. Using Data Mining Techniques on Fleet Management System

    Microsoft Academic Search

    Chang-Yi Chen; Tien-Yin Chou; Ching-Yun Mu; Bing-Jean Lee; Magesh Chandramouli; Hsien Chao

    Traditional transportation vendors not only strive to deliver cargo securely and accurately to customers on time, but also consider reducing the operation cost and flexibly dispatching vehicles as well as staff. Thus, how to raise the competitive advantage is the big challenge for the transportation industry. Because the online vehicle tracking system can accumulate enormous records of vehicle operations management

  10. Pipeline integration of neuro and fuzzy cache management techniques

    Microsoft Academic Search

    O. Hammami

    1997-01-01

    We propose a neuro fuzzy control of cache memories and analyzes the integration of related fuzzy and neural hardware components in the architecture of a pipelined processor. This fuzzy and neural hardware is used to support on-chip cache management operations

  11. 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 ...

  12. Application of KDD Techniques in Managing Sport Facilities

    Microsoft Academic Search

    Hou Bin; Zha Jing; Liu Junmei; Luo Jian

    2008-01-01

    This paper is dedicated to come up with theoretical expressions of increasing demand for Knowledge discovery in databases (KDD) in management of digital sport facility in the context of which, China is on the verge of Beijing Olympic Games. And it presents a number of aspects for rethinking the concerns involving the process in order to realize the close relationship

  13. Seven Management Techniques that Move Cow-Calf Producers towards Profitability

    E-print Network

    Posey, R. Daniel

    2005-06-09

    has limited sources of "on the ranch revenue: the selling of weaned offspring and the selling of culled animals (bulls, cows and replacement heifers). However, adopting management techniques for better reproductive efficiency, increasing production...

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

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

    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.

  15. Seven Management Techniques that Move Cow-Calf Producers towards Profitability 

    E-print Network

    Posey, R. Daniel

    2005-06-09

    has limited sources of "on the ranch revenue: the selling of weaned offspring and the selling of culled animals (bulls, cows and replacement heifers). However, adopting management techniques for better reproductive efficiency, increasing production...

  16. PKC independent inhibition of voltage gated calcium channels by volatile anesthetics in freshly isolated vascular myocytes from the aorta

    PubMed Central

    Fanchaouy, Mohammed; Cubano, Luis; Maldonado, Hector; Bychkov, Rostislav

    2013-01-01

    In this study we used barium currents through voltage gated L-type calcium channels (recorded in freshly isolated cells with a conventional patch-clamp technique) to elucidate the cellular action mechanism for volatile anesthetics. It was found that halothane and isoflurane inhibited (dose-dependently and voltage independently) Ba2+ currents through voltage gated Ca2+ channels. Half maximal inhibitions occurred at 0.64 ± 0.07 mM and 0.86 ± 0.1 mM. The Hill slope value was 2 for both volatile anesthetics, suggesting the presence of more than one interaction site. Current inhibition by volatile anesthetics was prominent over the whole voltage range without changes in the peak of the current voltage relationship. Intracellular infusion of the GDPßS (100 ?M) together with staurosporine (200 nM) did not prevent the inhibitory effect of volatile anesthetics. Unlike pharmacological Ca2+ channel blockers, volatile anesthetics blocked Ca2+ channel currents at resting membrane potentials. In other words, halothane and isoflurane induced an `initial block'. After the first 4 to 7 control pulses, the cells were left unstimulated and anesthetics were applied. The first depolarization after the pause evoked a Ca2+ channel current whose amplitude was reduced to 41 ± 3.4% and to 57 ± 4.2% of control values. In an analysis of the steady-state inactivation curve for voltage dependence, volatile anesthetics induced a negative shift of the 50% inactivation of the calcium channels. By contrast, the steepness factor characterizing the voltage sensitivity of the channels was unaffected. Unitary L-type Ca2+ channels blockade occurred under cell-attached configuration, suggesting a possible action of volatile anesthetics from within the intracellular space or from the part of the channel inside the lipid bilayer. PMID:23948226

  17. Risk Management Technique for design and operation of facilities and equipment

    NASA Technical Reports Server (NTRS)

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

    1975-01-01

    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.

  18. Attitudes of Contemporary Parents Toward Behavior Management Techniques Used in Pediatric Dentistry

    Microsoft Academic Search

    Jonathan J. Eaton; Dennis J. McTigue; Henry W. Fields; F. Michael Beck

    2005-01-01

    Purpose: The objective of this study was to examine parental attitudes toward behavior management techniques currently used in pediatric dentistry. Methods: Fifty-five parents viewed videotaped scenes of 8 behavior management tech- niques being used during actual pediatric dental treatment. The 8 techniques shown were: (1) tell-show-do; (2) nitrous oxide sedation; (3) passive restraint; (4) voice control; (5) hand-over-mouth; (6) oral

  19. Local Toxicity from Local Anesthetic Polymeric Microparticles

    PubMed Central

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

    2013-01-01

    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

  20. Techniques for Multicore Thermal Management: Classification and New Exploration

    E-print Network

    Martonosi, Margaret

    - proposed approaches. In other parts of the space, however, we propose novel thermal control techniques controller and an outer control loop to decide process migrations. This policy avoids all thermal emergen as with aggregate thermal limits. This paper begins by dividing the CMP thermal design space into a taxonomy

  1. A Guaranteed Scheduling Technique to Manage Students' Procrastination.

    ERIC Educational Resources Information Center

    Ottens, Allan J.

    1982-01-01

    Describes some clinical observations of procrastinating and procrastinators and addresses how these observations have led to the development of a guaranteed scheduling technique (GST) to treat procrastination. Discusses the elements of GST and its implementation. Initial student reactions to GST have been favorable. (Author/RC)

  2. 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...

  3. Charles bonnet syndrome, management with simple behavioral technique

    PubMed Central

    Issa, Baba Awoye; Yussuf, Abdullahi Dasliva

    2013-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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,…

  5. Managing Age Discrimination: An Examination of the Techniques Used when Seeking Employment

    ERIC Educational Resources Information Center

    Berger, Ellie D.

    2009-01-01

    Purpose: This article examines the age-related management techniques used by older workers in their search for employment. Design and Methods: Data are drawn from interviews with individuals aged 45-65 years (N = 30). Results: Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination.…

  6. Knowledge management in organizations: examining the interaction between technologies, techniques, and people

    Microsoft Academic Search

    Ganesh D. Bhatt

    2001-01-01

    Argues that the knowledge management process can be categorized into knowledge creation, knowledge validation, knowledge presentation, knowledge distribution, and knowledge application activities. To capitalize on knowledge, an organization must be swift in balancing its knowledge management activities. In general, such a balancing act requires changes in organizational culture, technologies, and techniques. A number of organizations believe that by focusing exclusively

  7. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    ERIC Educational Resources Information Center

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  8. Uncertainty Management for Diagnostics and Prognostics of Batteries using Bayesian Techniques

    Microsoft Academic Search

    Bhaskar Saha; K. Goebel

    2008-01-01

    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

  9. Use of Knowledge Management Techniques to Improve Network Engineering Capabilities

    Microsoft Academic Search

    Robert F. Clemens; Paul G. Seelman; Richard L. Knopman; Hoi Y. Chong

    2004-01-01

    Business requirements, e-government initiatives, and recent legislation such as the Clinger-Cohen Act are all driving federal agencies to standardize and consolidate existing telecommunication networks, better control networking costs, and deploy more advanced network services. At the same time, federal customers are increasingly looking to outsource network services and to move toward performance-based, managed-service contracts centered on service- level agreements. Those

  10. Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: A systematic review

    PubMed Central

    Yadav, Seema

    2015-01-01

    Aim: To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental infiltration (SI) technique when used for pulpal anesthesia of mandibular posterior teeth with irreversible pulpitis during endodontic treatment. Settings and Design: The study follows a longitudinal study design involving original research. Materials and Methods: Electronic databases were systematically searched for randomized controlled clinical studies. Studies were selected by predefined inclusion and exclusion criteria. Statistical Analysis Used and Result: The statistical analysis used was based on the results of the original research. All the included studies showed that there is the difference in the values comparing the two techniques, but the data are not statistically significantly different. Conclusion: Based on this review, the better anesthetic efficacy of the SI was observed.

  11. A new intelligent digital right management technique for E-learning content

    Microsoft Academic Search

    Hien D. Thai

    2008-01-01

    The digitalization of e-learning sources makes it an easy target for frauds, conterfeiting and content stealing. In this paper we present a new technique to deal with the security problems of e-learning content, its authentication and digital right management. The proposed technique is done by inserting a digital logo image, which serves as watermark signals, in the audio stream of

  12. Ohio researcher garners $287k DOE grant to better techniques for measuring, managing

    E-print Network

    Calyam, Prasad

    the performance of the next generation of computer networks. Prasad Calyam, Ph.D., a senior systems developerOhio researcher garners $287k DOE grant to devise better techniques for measuring, managing network and the Ohio Academic Resources Network to devise new, more effective techniques that will improve

  13. Application of data mining techniques in customer relationship management: A literature review and classification

    Microsoft Academic Search

    E. W. T. Ngai; Li Xiu; D. C. K. Chau

    2009-01-01

    Despite the importance of data mining techniques to customer relationship management (CRM), there is a lack of a comprehensive literature review and a classification scheme for it. This is the first identifiable academic literature review of the application of data mining techniques to CRM. It provides an academic database of literature between the period of 2000–2006 covering 24 journals and

  14. Effects of management techniques on the establishment of eucalypt seedlings on farmland: a review

    Microsoft Academic Search

    Sonia Graham; Heather M. McGinness; Deborah A. O’Connell

    2009-01-01

    Research into the effects of seven management techniques on survival and growth of eucalypt seedlings planted on farmland\\u000a is reviewed. The techniques include: pre- and post-planting weed control; soil cultivation; fertiliser; mulch; tree guards\\/shelters;\\u000a and irrigation. The initial and ongoing effects of each technique are discussed—including the effects of timing, type and\\u000a quantity. Consideration is given to site, species and

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

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    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…

  16. Statistical and Economic Techniques for Site-specific Nematode Management.

    PubMed

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

    2014-03-01

    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

  17. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas.

    PubMed

    Oh, Taemin; Nagasawa, Daniel T; Fong, Brendan M; Trang, Andy; Gopen, Quinton; Parsa, Andrew T; Yang, Isaac

    2012-09-01

    Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection. PMID:22937857

  18. Arthroscopic management of tibial plateau fractures: special techniques.

    PubMed

    Perez Carro, L

    1997-04-01

    Arthroscopic assessment and treatment of tibial plateau fractures has gained popularity in recent years. This article describes some maneuvers to facilitate the management of these fractures with the arthroscope. We use a 14-mm rounded curved periosteal elevator to manipulate fragments within the joint instead of using a probe. To facilitate visualization of fractures, we describe the use of loop sutures around the meniscus to retract the meniscus when there is a tear in the meniscus. We suggest the use of the arthroscope for directly viewing the interosseous space to be sure that any internal fixation devices remain outside the articular space. The use of these tactics will allow a faster, more accurate reduction with less radiation exposure in patients with displaced tibial plateau fractures. PMID:9127091

  19. Thermal Management Techniques for Oil-Free Turbomachinery Systems

    NASA Technical Reports Server (NTRS)

    Radil, Kevin; DellaCorte, Chris; Zeszotek, Michelle

    2006-01-01

    Tests were performed to evaluate three different methods of utilizing air to provide thermal management control for compliant journal foil air bearings. The effectiveness of the methods was based on bearing bulk temperature and axial thermal gradient reductions during air delivery. The first method utilized direct impingement of air on the inner surface of a hollow test journal during operation. The second, less indirect method achieved heat removal by blowing air inside the test journal to simulate air flowing axially through a hollow, rotating shaft. The third method emulated the most common approach to removing heat by forcing air axially through the bearing s support structure. Internal bearing temperatures were measured with three, type K thermocouples embedded in the bearing that measured general internal temperatures and axial thermal gradients. Testing was performed in a 1 atm, 260 C ambient environment with the bearing operating at 60 krpm and supporting a load of 222 N. Air volumetric flows of 0.06, 0.11, and 0.17 cubic meters per minute at approximately 150 to 200 C were used. The tests indicate that all three methods provide thermal management but at different levels of effectiveness. Axial cooling of the bearing support structure had a greater effect on bulk temperature for each air flow and demonstrated that the thermal gradients could be influenced by the directionality of the air flow. Direct air impingement on the journal's inside surface provided uniform reductions in both bulk temperature and thermal gradients. Similar to the direct method, indirect journal cooling had a uniform cooling effect on both bulk temperatures and thermal gradients but was the least effective of the three methods.

  20. Molecular Mechanism of Inhibition of Firefly Luminescence by Local Anesthetics

    Microsoft Academic Search

    Issaku Ueda; Hiroshi Kamaya; Henry Eyring

    1976-01-01

    The kinetics of the action of local anesthetics upon firefly luciferin and luciferase systems is presented. Clinical concentrations of local anesthetics inhibited this ATP-induced luminescence in a dose-dependent manner. From the effects of temperature and pH upon the inhibitory action of the local anesthetics, it is concluded that hydrophobic ligand-enzyme interaction is the predominant cause of the inhibition, but hydrophilic

  1. Tips for Managing Time Time management refers to a range of skills, tools and techniques used to manage your time.

    E-print Network

    Westfall, Peter H.

    and have more free time. Below are tips to help you manage your time effectively and efficiently: Tip #1 to manage your time. Time management is essential to effectively accomplish tasks, goals, assignments and projects. Managing your time can help you meet deadlines, feel in control, achieve more, balance your life

  2. A Unitary Anesthetic Binding Site at High Resolution

    SciTech Connect

    L Vedula; G Brannigan; N Economou; J Xi; M Hall; R Liu; M Rossi; W Dailey; K Grasty; et. al.

    2011-12-31

    Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABA{sub A} receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology methods advance to the point of being able to deal with systems such as the GABA{sub A} receptor, it will be necessary to use more tractable surrogates to probe the molecular details of anesthetic recognition. We have previously shown that recognition of inhalational general anesthetics by the model protein apoferritin closely mirrors recognition by more complex and clinically relevant protein targets; here we show that apoferritin also binds propofol and related GABAergic anesthetics, and that the same binding site mediates recognition of both inhalational and injectable anesthetics. Apoferritin binding affinities for a series of propofol analogs were found to be strongly correlated with the ability to potentiate GABA responses at GABA{sub A} receptors, validating this model system for injectable anesthetics. High resolution x-ray crystal structures reveal that, despite the presence of hydrogen bond donors and acceptors, anesthetic recognition is mediated largely by van der Waals forces and the hydrophobic effect. Molecular dynamics simulations indicate that the ligands undergo considerable fluctuations about their equilibrium positions. Finally, apoferritin displays both structural and dynamic responses to anesthetic binding, which may mimic changes elicited by anesthetics in physiologic targets like ion channels.

  3. A Unitary Anesthetic-Binding Site at High Resolution

    SciTech Connect

    Vedula, L.; Brannigan, G; Economou, N; Xi, J; Hall, M; Liu, R; Rossi, M; Dailey, W; Grasty, K; et. al.

    2009-01-01

    Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABAA receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology methods advance to the point of being able to deal with systems such as the GABA{sub A} receptor, it will be necessary to use more tractable surrogates to probe the molecular details of anesthetic recognition. We have previously shown that recognition of inhalational general anesthetics by the model protein apoferritin closely mirrors recognition by more complex and clinically relevant protein targets; here we show that apoferritin also binds propofol and related GABAergic anesthetics, and that the same binding site mediates recognition of both inhalational and injectable anesthetics. Apoferritin binding affinities for a series of propofol analogs were found to be strongly correlated with the ability to potentiate GABA responses at GABA{sub A} receptors, validating this model system for injectable anesthetics. High resolution x-ray crystal structures reveal that, despite the presence of hydrogen bond donors and acceptors, anesthetic recognition is mediated largely by van der Waals forces and the hydrophobic effect. Molecular dynamics simulations indicate that the ligands undergo considerable fluctuations about their equilibrium positions. Finally, apoferritin displays both structural and dynamic responses to anesthetic binding, which may mimic changes elicited by anesthetics in physiologic targets like ion channels.

  4. A Unitary Anesthetic Binding Site at High Resolution

    SciTech Connect

    Vedula, L. Sangeetha; Brannigan, Grace; Economou, Nicoleta J.; Xi, Jin; Hall, Michael A.; Liu, Renyu; Rossi, Matthew J.; Dailey, William P.; Grasty, Kimberly C.; Klein, Michael L.; Eckenhoff, Roderic G.; Loll, Patrick J.; (Drexel-MED); (UPENN)

    2009-10-21

    Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABA{sub A} receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology methods advance to the point of being able to deal with systems such as the GABA{sub A} receptor, it will be necessary to use more tractable surrogates to probe the molecular details of anesthetic recognition. We have previously shown that recognition of inhalational general anesthetics by the model protein apoferritin closely mirrors recognition by more complex and clinically relevant protein targets; here we show that apoferritin also binds propofol and related GABAergic anesthetics, and that the same binding site mediates recognition of both inhalational and injectable anesthetics. Apoferritin binding affinities for a series of propofol analogs were found to be strongly correlated with the ability to potentiate GABA responses at GABA{sub A} receptors, validating this model system for injectable anesthetics. High resolution x-ray crystal structures reveal that, despite the presence of hydrogen bond donors and acceptors, anesthetic recognition is mediated largely by van der Waals forces and the hydrophobic effect. Molecular dynamics simulations indicate that the ligands undergo considerable fluctuations about their equilibrium positions. Finally, apoferritin displays both structural and dynamic responses to anesthetic binding, which may mimic changes elicited by anesthetics in physiologic targets like ion channels.

  5. [Surgical technique in the management of undescenced testis (author's transl)].

    PubMed

    Müller, E

    1976-11-15

    In cases of retentio abdominalis or inguinalis and of ectopic testis, surgery is performed about the 2nd year of life. Essentials of the operating technique are: incision of the skin must not be parallel to the spermatic cord; testes and spermatic cord must be mobilized without trauma; ideally a biopsy of the testis should be taken; any pulling of the spermatic cord and torsion of it during fixation of the testis should be avoided. If initial tensionfree placement of the testis in the scrotum is impossible, the operation should be carried out in 2 sessions with an interval of 6-12 months. In 241 cases of children operated on from 1972-1975 with 308 total operations, the author observed 2 recurrences and 1 deep infection (scrotal abscess). PMID:11375

  6. An ultrasound-guided technique for axillary brachial plexus nerve block in rabbits.

    PubMed

    Fonseca, Carla; Server, Anna; Esteves, Marielle; Barastegui, David; Rosal, Marta; Fontecha, Cesar G; Soldado, Francisco

    2015-04-21

    Regional anesthesia techniques, such as nerve blocks, are routinely used in humans and can contribute to multimodal approaches to pain management in research animals. Ultrasound guidance is an emerging aspect of regional anesthesia that has the potential to optimize local delivery and distribution of anesthetic agents, thereby reducing the amounts of these agents that must be administered. The authors developed an ultrasound-guided technique for effective block of the axillary brachial plexus in rabbits. They used this technique to carry out nerve block in 14 rabbits. The procedure was accomplished in a relatively short amount of time and achieved successful nerve block in all rabbits with no adverse effects. Sonographic visualization of the distribution of the local anesthetic ropivacaine led to administration of smaller anesthetic doses in eight of the rabbits without affecting the duration of nerve block. The authors conclude that their technique is feasible and safe and provides effective analgesia of the thoracic limb in rabbits. They recommend that this technique be integrated into multimodal approaches to pain management in rabbits undergoing thoracic limb surgery. PMID:25897939

  7. Food aversion conditioned in anesthetized sheep.

    PubMed

    Provenza, F D; Lynch, J J; Nolan, J V

    1994-03-01

    We discovered that a food aversion could be conditioned in anesthetized sheep. Sheep were allowed to eat a familiar food (alfalfa-grain pellets) for 30 min, and 90 min later they were given either an intraruminal (IR) injection of water (C), an IR injection of LiCl (L), anesthesia followed by an IR injection of water (A), or anesthesia followed by an IR injection of LiCl (A+L). Induction of anesthesia was by an intravenous injection of pentobarbitone sodium, and maintenance of deep anesthesia was by halothane. Sheep were maintained in deep anesthesia for 2 h to ensure that the effects of LiCl on the acquisition of a food aversion, which occur within about 1 h, were completed before they awakened. When tested 5 days later, sheep that received LiCl (treatments L and A+L) consumed less alfalfa-grain pellets than sheep that did not receive LiCl (treatments C and A) (241 g vs. 306 g; p = 0.057). Intake of sheep that were anesthetized (treatments A and A+L) did not differ from that of sheep that were not anesthetized (treatments C and L) (295 g vs. 252 g; p = 0.183). Nor was there an interaction between LiCl and anesthesia (p = 0.423). Thus, we conclude that changes in preferences for foods caused by postingestive feedback occur automatically every time food is ingested (i.e., they are noncognitive), and the kind and amount of feedback is a function of the match between the food's chemical characteristics and its ability to meet the animal's current demands for nutrients. PMID:8190757

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

    PubMed

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

    2014-01-01

    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

  9. [Exposure to anesthetic gases: risk and prevention].

    PubMed

    Stoklov, M; Trouiller, P; Stieglitz, P; Lamalle, Y; Vincent, F; Perdrix, A; Marka, C; de Gaudemaris, R; Mallion, J M; Faure, J

    1983-09-01

    Several studies published during the last fifteen years seem to demonstrate that major risks, i.e. congenital malformations in the offspring and increased rate of spontaneous abortions, are associated with occupational exposure to anesthetic gases (halothane and nitrous oxide) in operating rooms. In view of the severity of the potential risk, we have: 1) analyzed risk factors in the light of epidermiologic and experimental studies; 2) determined the threshold levels of air pollution for these risk factors; 3) analyzed the situation in the Grenoble Hospital and the means of dealing with it. PMID:6312577

  10. Anesthetic Implications of Robotic Gynecologic Surgery

    PubMed Central

    McLarney, J Thomas; Rose, Gregory L

    2011-01-01

    Surgery using robotic techniques is becoming more and more common. One of the specialties at the fore-front of robotic surgery has been gynecology, much like it was at the fore-front a generation ago in bringing laparoscopy into the operating room. New considerations have been noted and new techniques have been learned on both sides of the drape in order to ensure a successful outcome for the patient undergoing robotic gynecologic surgery. The purpose of this article is to bring, to light the concerns facing the anesthesiologist in regards to robotic procedures. We discuss the problems facing anesthesiologists, when a patient is experiencing both intraabdominal insufflation and steep Trendelenburg position, and also the intraoperative management of such a patient.

  11. Anesthesia techniques in complex spine surgery.

    PubMed

    Ornstein, Eugene; Berko, Robert

    2006-07-01

    The safe performance of complex spine surgery requires the close collaboration of the anesthesiology and surgical teams. The avoidance of medical and anesthetic complications depends on the appropriate preoperative medical evaluation, patient positioning, selection and administration of anesthetic agents, management of intraoperative fluid status, emergence from anesthesia, and administration of postoperative analgesia. PMID:16876022

  12. Prevention and management of postoperative nausea and vomiting: a look at complementary techniques.

    PubMed

    Mamaril, Myrna E; Windle, Pamela E; Burkard, Joseph F

    2006-12-01

    Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV. PMID:17169750

  13. Airway management in patients with subglottic stenosis: experience at an academic institution.

    PubMed

    Knights, Richard M; Clements, Stephan; Jewell, Elizabeth; Tremper, Kevin; Healy, David

    2013-12-01

    We describe a pilot study investigating the airway techniques used in the anesthetic management of subglottic stenosis. We searched the electronic clinical information database of the University of Michigan Health System for cases of subglottic stenosis in patients undergoing surgery. Demographics, airway techniques, incidence of hypoxemia, and technique failure were extracted from 159 records. A lower incidence of hypoxemia was found between the 4 most commonly used techniques and the less common techniques. We detected no difference in outcome between individual techniques. This study suggests a larger prospective multicenter study is required to further investigate these outcomes in patients with subglottic stenosis. PMID:24257385

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

    PubMed

    Ozyigit, Gokhan; Gultekin, Melis

    2014-08-10

    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

  15. Tricyclic antidepressants as long-acting local anesthetics

    Microsoft Academic Search

    Yukari Sudoh; Elaine Elliott Cahoon; Peter Gerner; Ging Kuo Wang

    2003-01-01

    Amitriptyline, nortriptyline, imipramine, doxepin, desipramine, protriptyline, trimipramine, and maprotiline are tricyclic antidepressants (TCAs) used orally in treating major depressive disorders. Recent studies showed that amitriptyline is more potent in blocking the sciatic nerve functions in vivo by local injection than bupivacaine, a long-acting local anesthetic. We therefore tested whether various TCAs could likewise act as local anesthetics in vivo after

  16. High throughput modular chambers for rapid evaluation of anesthetic sensitivity

    Microsoft Academic Search

    Yi Sun; Jingqiu Chen; Gregory Pruckmayr; James E Baumgardner; David M Eckmann; Roderic G Eckenhoff; Max B Kelz

    2006-01-01

    BACKGROUND: Anesthetic sensitivity is determined by the interaction of multiple genes. Hence, a dissection of genetic contributors would be aided by precise and high throughput behavioral screens. Traditionally, anesthetic phenotyping has addressed only induction of anesthesia, evaluated with dose-response curves, while ignoring potentially important data on emergence from anesthesia. METHODS: We designed and built a controlled environment apparatus to permit

  17. Occupational Exposure of Veterinarians to Waste Anesthetic Gases

    Microsoft Academic Search

    David Lionel Potts; Bobby F. Craft

    1988-01-01

    An evaluation of anesthetic waste gas exposures was conducted in small private practice animal clinics throughout the Salt Lake Valley. The two most frequently used anesthetic gases, methoxyflurane and halothane, were chosen to be studied. Exposures during 38 surgeries were studied in a total of 10 facilities involving 13 veterinarians. Veterinarian breathing zones were sampled on a real-time basis with

  18. Generalized trace-back techniques for survivor memory management in the Viterbi algorithm

    Microsoft Academic Search

    Robert Cypher; C. Bernard Shung

    1993-01-01

    The trace-back technique is an effective approach for survivor memory management in the Viterbi algorithm. It is especially attractive when the number of states in the trellis is large, in which case the register exchange approach is impractical due to the area required for wiring. Previous descriptions of the trace-back technique have assumed either one or two trace-back pointers and

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

    Microsoft Academic Search

    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

    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

  20. Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection.

    PubMed Central

    Lee, Shelly; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

    2004-01-01

    The purpose of this prospective, randomized, blinded study was to determine the anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection using the computer-assisted Wand Plus injection system versus a conventional syringe. The authors, using a crossover design, randomly administered in a blind manner 2 AMSA injections utilizing the computer-assisted injection system and a conventional syringe to 40 subjects during 2 separate appointments. A pulp tester was used to test for anesthesia, in 4-minute cycles for 60 minutes, of the central and lateral incisors, canine, and first and second premolars. Anesthesia was considered successful when 2 consecutive no responses (80 readings) with the pulp tester were obtained. For all teeth, except the central incisor, the use of the computer-assisted injection system was significantly (P < .05) more likely to result in pulpal anesthesia than the use of the conventional syringe technique. For the computer-assisted injection system, successful pulpal anesthesia ranged from 35 to 58%, and for the conventional syringe, successful pulpal anesthesia ranged from 20 to 42%. For both techniques, the onset of pulpal anesthesia was slow, and duration of pulpal anesthesia declined steadily over 60 minutes. We conclude that although the AMSA injection using the computer-assisted injection system was more successful than the conventional syringe technique, the rather modest to low success rates, slow onset, and declining duration of pulpal anesthesia over 60 minutes would not ensure predictable pulpal anesthesia from the second premolar to the central incisor. PMID:15497297

  1. Intravenous lipid emulsion for treatment of local anesthetic toxicity

    PubMed Central

    Kosh, M Caroline; Miller, April D; Michels, Jill E

    2010-01-01

    Clinical question Is intravenous lipid emulsion a safe and effective therapy for the reversal and treatment of local anesthetic toxicity? Results Systematic reviews, human case reports, and experimental animal studies have demonstrated the efficacy of intravenous lipid emulsion therapy in successfully reversing cardiac arrhythmias, cardiac arrest, and cardiac collapse seen with severe systemic local anesthetic toxicity. There are fewer data to support treatment of neurologic toxicities associated with local anesthetics. Implementation Intravenous lipid emulsion 20% should be available whenever patients receive large doses of local anesthetics in operating rooms and emergency departments. Various dosing protocols have been published in the medical literature. Although the dosing protocols are based on low-level evidence, a lack of major adverse events makes lipid emulsion an appropriate therapy for treating cardiotoxic symptoms induced by local anesthetics. PMID:20957136

  2. Anesthetic effect of EMLA occluded with Orahesive oral bandages on oral mucosa. A placebo-controlled study.

    PubMed Central

    Svensson, P.; Petersen, J. K.

    1992-01-01

    The efficiency of a topical anesthetic occluded with Orahesive Oral Bandage was investigated. Experimental pain was provoked by needle insertions into two palatal test areas in 20 healthy subjects. Pain, estimated on a 100-mm visual analogue scale (VAS), decreased significantly from 23.5 mm to 10.5 mm at the greater palatine foramen and from 51.5 mm to 35.0 mm at the incisive foramen after application of a eutectic mixture of local anesthetics (EMLA). No significant change in pain perception was obtained after placebo application. The EMLA cream and the Orahesive Oral Bandages were well accepted by the subjects, as only two out of 20 subjects experienced slight gagging reflexes and only three considered the taste unpleasant. No other adverse reactions were observed. Occlusion of topical anesthetics seems to be a useful technique for achieving superficial mucosal anesthesia. Images Figure 1 PMID:1308377

  3. Liquid General Anesthetics Lower Critical Temperatures in Plasma Membrane Vesicles

    PubMed Central

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

    2013-01-01

    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

  4. Response of Vegetation and Endangered Waterbirds to Habitat Management Techniques at Kealia Pond National Wildlife Refuge

    E-print Network

    National Wildlife Refuge By James Andrew Rader A thesis submitted in partial fulfillment Waterbirds to Habitat Management Techniques at Kealia Pond National Wildlife Refuge This thesis is approved the endangered waterbirds of Hawai'i. To the staff of Kealia Pond National Wildlife Refuge, thank you

  5. A survey of design techniques for system-level dynamic power management

    Microsoft Academic Search

    Luca Benini; Alessandro Bogliolo; Giovanni De Micheli

    2000-01-01

    Dynamic power management (DPM) is a design methodology for dynamically reconfiguring systems to provide the requested services and performance levels with a minimum number of active components or a minimum load on such com- ponents. DPM encompasses a set of techniques that achieves energy-efficient computation by selectively turning off (or re- ducing the performance of) system components when they are

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

    E-print Network

    Simunic, Tajana

    sensor data and system specifications (battery and solar panel specs, sensing and communication costsAn Interactive Context-aware Power Management Technique for Optimizing Sensor Network Lifetime problem in sensor networks equipped with renewable energy sources is deciding how do you allocate energy

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

    ERIC Educational Resources Information Center

    Mah, Janet W. T.; Johnston, Charlotte

    2012-01-01

    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…

  8. A Cache Management Strategy to Replace Wear Leveling Techniques for Embedded Flash Memory

    E-print Network

    Brest, Université de

    memories are falling drastically due to market growth and fabrication process mastering while researchA Cache Management Strategy to Replace Wear Leveling Techniques for Embedded Flash Memory Jalil memories are becoming the most important storage media in mobile computing and tend to be less confined

  9. Science Classroom Management Techniques Using Graphing Calculator Technology: A Collaborative Team Action Research Approach.

    ERIC Educational Resources Information Center

    Saurino, Dan R.; Bouma, Amy; Gunnoe, Brenda

    This study evaluates the use of graphing calculators in the science classroom within the context of a collaborative action research approach. A class of diversified middle-class students (n=650) defined by teachers and administrators as "above average" were studied. Initially, information was gathered on current classroom management techniques as…

  10. How to Develop Teacher Center Management Techniques. The How To Series.

    ERIC Educational Resources Information Center

    Bover, Ronald; And Others

    This booklet is designed to assist the teacher center director in the development of an effective and efficient staff team and subsequently an effective teacher center. It outlines successful management techniques and relates them to the specific needs of a teacher center staff. Guidelines are presented for: collaborative inservice activities…

  11. PDE Estimation Techniques for Advanced Battery Management Systems -Part I: SOC Estimation

    E-print Network

    Krstic, Miroslav

    PDE Estimation Techniques for Advanced Battery Management Systems - Part I: SOC Estimation S. J examine a new battery state-of-charge (SOC) estimation algorithm based upon the backstepping method This paper investigates a Li-ion battery state-of-charge (SOC) estimation algorithm based upon

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

    ERIC Educational Resources Information Center

    Otani, Akira

    1989-01-01

    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…

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed Central

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

    2006-01-01

    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

  15. Clinical review: Management of difficult airways

    PubMed Central

    Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway. PMID:17184555

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

    PubMed

    Gerardi, Debra

    2004-01-01

    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

  17. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  18. Modeling anesthetic developmental neurotoxicity using human stem cells

    PubMed Central

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

    2013-01-01

    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

  19. Challenges Encountered Using Ophthalmic Anesthetics in Space Medicine

    NASA Technical Reports Server (NTRS)

    Bayuse, T.; Law, J.; Alexander, D.; Moynihan, S.; LeBlanc, C.; Langford, K.; Magalhaes, L.

    2015-01-01

    On orbit, ophthalmic anesthetics are used for tonometry and off-nominal corneal examinations. Proparacaine has been flown traditionally. However, the manufacturers recently changed its storage requirements from room temperature storage to refrigerated storage to preserve stability and prolong the shelf-life. Since refrigeration on orbit is not readily available and there were stability concerns about flying proparacaine unrefrigerated, tetracaine was selected as an alternative ophthalmic anesthetic in 2013. We will discuss the challenges encountered flying and using these anesthetics on the International Space Station.

  20. Models and mechanisms of local anesthetic cardiac toxicity: a review.

    PubMed

    Butterworth, John F

    2010-01-01

    Cardiovascular collapse, even death, may occur after intoxication with bupivacaine or related amide local anesthetic agents. The problem has been studied in myriad laboratories for more than 20 years. Nevertheless, there is consensus neither regarding which animal model best mimics this clinical catastrophe nor as to which ion channel, enzyme, or other local anesthetic binding site represents the point of initiation for the process. This review aimed to define the various credible mechanisms that have been proposed to explain cardiovascular collapse and death after administration of local anesthetics, particularly after bupivacaine and related agents. PMID:20301823

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

    NASA Astrophysics Data System (ADS)

    Raiman, Laura B.

    1992-12-01

    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 .

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

    NASA Technical Reports Server (NTRS)

    Raiman, Laura B.

    1992-01-01

    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 .

  3. Quality assurance of imaging techniques used in the clinical management of osteoporosis.

    PubMed

    Guglielmi, G; Damilakis, J; Solomou, G; Bazzocchi, A

    2012-12-01

    Recent advances in the densitometric and imaging techniques involved in the management of osteoporosis are associated with increasing accuracy and precision as well as with higher exposure to ionising radiation. Therefore, special attention to quality assurance (QA) procedures is needed in this field. The development of effective and efficient QA programmes is mandatory to guarantee optimal image quality while reducing radiation exposure levels to the ALARA principle (as low as reasonably achievable). In this review article, the basic QA procedures are discussed for the techniques applied to everyday clinical practice. PMID:23090242

  4. Volatile anesthetics and endogenous cannabinoid anandamide have additive and independent inhibitory effects on ?7-nicotinic acetylcholine receptor-mediated responses in Xenopus oocytes

    PubMed Central

    Jackson, Shelley N.; Sachin, Singhal K.; Woods, Amina S.; Morales, Marisela; Shippenberg, Toni; Zhang, Li; Oz, Murat

    2008-01-01

    In earlier studies, the volatile anesthetics and the endogenous cannabinoid anandamide have been shown to inhibit the function of ?7-nicotinic acetylcholine receptors. In the present study, interactions between the effects of volatile anesthetics and anandamide on the function of ?7-nicotinic acetylcholine receptors expressed in Xenopus oocytes were investigated using the two-electrode voltage-clamp technique. Anandamide and volatile anesthetics isoflurane and halothane inhibited currents evoked with acetylcholine (100 ?M) in a reversible and concentration-dependent manner. Coapplication of anandamide and volatile anesthetics caused a significantly greater inhibition of ?7-nicotinic acetylcholine receptor function than anandamide or volatile anesthetics alone. Analyses of oocytes by matrix-assisted laser desorption/ionization mass spectroscopy indicated that volatile anesthetics did not alter the lipid profile of oocytes. Results of studies with chimeric ?7-nicotinic acetylcholine -5-HT3 receptors comprised of the N-terminal domain of the ?7-nicotinic acetylcholine receptor and the transmembrane and carboxyl-terminal domains of 5-HT3 receptors suggest that while isoflurane inhibition of the ?7-nicotinic acetylcholine receptor is likely to involve the N-terminal region of the receptor, the site of action for anandamide involves transmembrane and carboxyl-terminal domains of the receptors. These data indicate that endocannabinoids and isoflurane have additive inhibitory effects on ?7-nicotinic acetylcholine receptor function through allosteric binding sites located on the distinct regions of the receptor. PMID:18242598

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

    PubMed Central

    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

    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

  6. Anesthetic state modulates excitability but not spectral tuning or neural discrimination in single auditory midbrain neurons

    PubMed Central

    Schumacher, Joseph W.; Schneider, David M.

    2011-01-01

    The majority of sensory physiology experiments have used anesthesia to facilitate the recording of neural activity. Current techniques allow researchers to study sensory function in the context of varying behavioral states. To reconcile results across multiple behavioral and anesthetic states, it is important to consider how and to what extent anesthesia plays a role in shaping neural response properties. The role of anesthesia has been the subject of much debate, but the extent to which sensory coding properties are altered by anesthesia has yet to be fully defined. In this study we asked how urethane, an anesthetic commonly used for avian and mammalian sensory physiology, affects the coding of complex communication vocalizations (songs) and simple artificial stimuli in the songbird auditory midbrain. We measured spontaneous and song-driven spike rates, spectrotemporal receptive fields, and neural discriminability from responses to songs in single auditory midbrain neurons. In the same neurons, we recorded responses to pure tone stimuli ranging in frequency and intensity. Finally, we assessed the effect of urethane on population-level representations of birdsong. Results showed that intrinsic neural excitability is significantly depressed by urethane but that spectral tuning, single neuron discriminability, and population representations of song do not differ significantly between unanesthetized and anesthetized animals. PMID:21543752

  7. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 868.6100 Section 868.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...cabinet, table, or tray is a device intended to store anesthetic equipment and drugs. The device is usually constructed to...

  8. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 868.6100 Section 868.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...cabinet, table, or tray is a device intended to store anesthetic equipment and drugs. The device is usually constructed to...

  9. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 868.6100 Section 868.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...cabinet, table, or tray is a device intended to store anesthetic equipment and drugs. The device is usually constructed to...

  10. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 868.6100 Section 868.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...cabinet, table, or tray is a device intended to store anesthetic equipment and drugs. The device is usually constructed to...

  11. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 868.6100 Section 868.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...cabinet, table, or tray is a device intended to store anesthetic equipment and drugs. The device is usually constructed to...

  12. The Role of Anesthetic Drugs in Liver Apoptosis

    PubMed Central

    Dabbagh, Ali; Rajaei, Samira

    2013-01-01

    Context The modern practice of anesthesia is highly dependent ona group of anesthetic drugs which many of them are metabolized in the liver. Evidence Acquisition The liver, of course, usually tolerates this burden. However, this is not always an unbroken rule. Anesthetic induced apoptosis has gained great concern during the last years; especially considering the neurologic system. Results However, we have evidence that there is some concern regarding their effects on the liver cells. Fortunately not all the anesthetics are blamed and even some could be used safely, based on the available evidence. Conclusions Besides, there are some novel agents, yet under research, which could affect the future of anesthetic agents' fate regarding their hepatic effects. PMID:24069040

  13. Top-down mechanisms of anesthetic-induced unconsciousness

    PubMed Central

    Mashour, George A.

    2014-01-01

    The question of how structurally and pharmacologically diverse general anesthetics disrupt consciousness has persisted since the nineteenth century. There has traditionally been a significant focus on “bottom-up” mechanisms of anesthetic action, in terms of sensory processing, arousal systems, and structural scales. However, recent evidence suggests that the neural mechanisms of anesthetic-induced unconsciousness may involve a “top-down” process, which parallels current perspectives on the neurobiology of conscious experience itself. This article considers various arguments for top-down mechanisms of anesthetic-induced unconsciousness, with a focus on sensory processing and sleep-wake networks. Furthermore, recent theoretical work is discussed to highlight the possibility that top-down explanations may be causally sufficient, even assuming critical bottom-up events. PMID:25002838

  14. Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

    PubMed Central

    Srivastava, Divya; Dhiraaj, Sanjay

    2013-01-01

    Appropriate airway management is an essential part of anesthesiologist's role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed. PMID:23717240

  15. Investigative and management techniques for cement kiln dust and pulp and paper process wastes

    SciTech Connect

    Peters, C.S. [RMT, Inc., Okemos, MI (United States)

    1998-12-31

    Knowledge of the characteristics of industrial process wastes allows for some innovative and cost savings techniques for investigating and managing these wastes over conventional methods. This paper explores examples of some of these techniques employed on cement kiln dust (CKD) and pulp and paper mill process waste. Similar to Portland Cement, unleached CKD contains free lime and sources of reactive silica and/or alumina. Thus, it can set up in the presence of water. Properly moisture-conditioned CKD has been successfully used in Michigan as a landfill liner and cover material on closures of old CKD piles and newly permitted fills. However, CKD also contains high concentrations of soluble salts and when improperly managed can generate a leachate with high total dissolved solid concentrations. Surface and downhole geophysical methods employing electromagnetic conductivity have proven effective in delineating the horizontal and vertical extent of groundwater plumes caused by releases of CKD leachate.

  16. Operative Management of a Sacral Gunshot Injury via Minimally Invasive Techniques and Instrumentation

    PubMed Central

    Shen, Francis Hao-Tso

    2013-01-01

    Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation. PMID:23508557

  17. Solubility of Haloether Anesthetics in Human and Animal Blood

    PubMed Central

    Soares, Joao H. N.; Brosnan, Robert J.; Fukushima, Fabíola B.; Hodges, Joanne; Liu, Hong

    2012-01-01

    Background Anesthetic blood solubility predicts pharmacokinetics for inhaled agents and is essential for determination of blood anesthetic concentrations from end-tidal gas concentrations using Henry’s Law. Though used to model anesthetic effects in humans, there are limited interspecies solubility comparisons that include modern haloethers. This study aimed to measure hematocrit-adjusted blood:gas anesthetic partition coefficients (?B:G) for desflurane, sevoflurane, isoflurane, and methoxyflurane in humans and animals. Methods Whole blood was collected from 20 rats, 8 horses, and 4 each of cats, cattle, humans, dogs, goats, pigs, rabbits, and sheep. Plasma or cell volume was removed to adjust all samples to a packed cell volume of 40%. A single agent calibration gas headspace was added to blood in a glass syringe and was mixed and equilibrated at 37°C for 2 hours. Agent concentrations in the calibration gas and syringe headspace were measured using gas chromatography. Anesthetic solubility in saline, citrate-phosphate-dextrose-adenine, and olive oil were similarly measured. Results Except for goats, all animal species had at least one ?B:G measurement that differed significantly from humans. For each agent, ?B:G positively correlated with serum triglyceride concentrations, but this only explained 25% of interspecies variability. Desflurane was significantly less soluble in blood than sevoflurane in some species (e.g., humans) but not in others (e.g., rabbits). Conclusions Anesthetic partition coefficients differ significantly between humans and most animals for haloether anesthetics. Because of their similar ?B:G values, goats may be a better animal model for inhaled anesthetic pharmacokinetics in people. PMID:22510863

  18. Local anesthetic systemic toxicity (LAST) – Should we not be concerned?

    PubMed Central

    Goyal, Rakhee; Shukla, R.N.

    2012-01-01

    Local anesthetics are one of the most commonly used drugs in the field of medicine. Yet little is known about the systemic toxicity that can occur with their overdose. In the last few years, a lot of research has taken place understanding the etiology of the Local anesthetics systemic toxicity (LAST) and the role of lipid emulsion in treating it. There is a need to increase the awareness about LAST and establish a protocol to treat any serious neuro or cardiotoxicity. PMID:24532907

  19. [Severe local anesthetic intoxication in an infant undergoing circumcision].

    PubMed

    Doye, E; Desgranges, F-P; Stamm, D; de Queiroz, M; Valla, F V; Javouhey, E

    2015-03-01

    Local anesthetic intoxication is an uncommon complication of regional anesthesia. We report the case of a 4-month-old infant who presented with generalized tonic-clonic seizure complicated by cardiac arrest secondary to a severe intoxication to local anesthesia. These complications were observed after a bilateral dorsal penile nerve block with lidocaine for circumcision in a non-hospital setting. This report emphasizes the potential risk of local anesthetic systemic toxicity in such circumstances and describes its treatment. PMID:25482996

  20. [Soft-tissue management in primary knee arthroplasty: common techniques, navigation and force-sensing devices].

    PubMed

    Schmidt, F; Lampe, F; Elfring, R; Nebelung, S; Mumme, T; Andereya, S; Radermacher, K; Niethard, F U; Müller-Rath, R

    2007-01-01

    Soft-tissue management is essential for the outcome in total knee arthroplasty. In combination with osseous resections and component positioning, correction of the underlying ligamentous dysbalance should yield a stable joint throughout the flexion arc. Different "philosophies" with regard to technique, timing and tactics in ligament balancing are described. So far, surgeons have not been provided with standardised devices that allow the objective measurement of this complex issue. Moreover, knowledge concerning the "ideal" soft-tissue stability following knee arthroplasty is still sparse. As part of the scientific project "OrthoMIT" (minimal invasive orthopaedic therapy) an approach to combine conventional soft-tissue management with navigation and force-sensing devices should be realized technically. The aim is to develop an instrument for the objective measurement of soft-tissue management in scientific and clinical applications. PMID:17939070

  1. The fluorinated anesthetic halothane as a potential NMR biologic probe.

    PubMed

    Burt, C T; Moore, R R; Roberts, M F; Brady, T J

    1984-12-11

    Fluorinated anesthetics such as halothane preferentially partition into hydrophobic environments such as cell membranes. The 19F-NMR spectrum of halothane in a rat adenocarcinoma (with known altered lipid metabolism and membrane composition) shows an altered chemical shift pattern compared to the anesthetic in normal tissue. In eight tumor samples examined, the 19F-NMR spectra exhibit two distinct resonances, compared to a single resonance observed in normal tissues. This is explained by an enhanced or altered hydrophobic component in the tumor tissue giving rise to two discrete halothane environments. Another fluorinated anesthetic, isoflurane, shows similar behavior in distinguishing normal from diseased tissue. Given the large chemical shift range of fluorine and the inherent sensitivity of this nucleus, 19F-NMR spectra of fluorinated anesthetics can also be used to follow anesthetic degradation by the liver. The ability of fluorinated anesthetics to discriminate tissues and to monitor metabolic processes is potentially useful for in vivo 19F-NMR surface coil and imaging studies. PMID:6509092

  2. Anesthetics target interfacial transmembrane sites in nicotinic acetylcholine receptors.

    PubMed

    Forman, Stuart A; Chiara, David C; Miller, Keith W

    2015-09-01

    General anesthetics are a heterogeneous group of small amphiphilic ligands that interact weakly at multiple allosteric sites on many pentameric ligand gated ion channels (pLGICs), resulting in either inhibition, potentiation of channel activity, or both. Allosteric principles imply that modulator sites must change configuration and ligand affinity during receptor state transitions. Thus, general anesthetics and related compounds are useful both as state-dependent probes of receptor structure and as potentially selective modulators of pLGIC functions. This review focuses on general anesthetic sites in nicotinic acetylcholine receptors, which were among the first anesthetic-sensitive pLGIC experimental models studied, with particular focus on sites formed by transmembrane domain elements. Structural models place many of these sites at interfaces between two or more pLGIC transmembrane helices both within subunits and between adjacent subunits, and between transmembrane helices and either lipids (the lipid-protein interface) or water (i.e. the ion channel). A single general anesthetic may bind at multiple allosteric sites in pLGICs, producing a net effect of either inhibition (e.g. blocking the ion channel) or enhanced channel gating (e.g. inter-subunit sites). Other general anesthetic sites identified by photolabeling or crystallography are tentatively linked to functional effects, including intra-subunit helix bundle sites and the lipid-protein interface. This article is part of the Special Issue entitled 'The Nicotinic Acetylcholine Receptor: From Molecular Biology to Cognition'. PMID:25316107

  3. Comparative efficacy of 16 anesthetic chemicals on rainbow trout

    USGS Publications Warehouse

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

    1987-01-01

    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.

  4. The role of Volatile Anesthetics in Cardioprotection: a systematic review.

    PubMed

    Van Allen, Nicole R; Krafft, Paul R; Leitzke, Arthur S; Applegate, Richard L; Tang, Jiping; Zhang, John H

    2012-01-01

    This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery. PMID:22929111

  5. The role of Volatile Anesthetics in Cardioprotection: a systematic review

    PubMed Central

    2012-01-01

    This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery. PMID:22929111

  6. Bubbles, Gating, and Anesthetics in Ion Channels

    PubMed Central

    Roth, Roland; Gillespie, Dirk; Nonner, Wolfgang; Eisenberg, Robert E.

    2008-01-01

    We suggest that bubbles are the bistable hydrophobic gates responsible for the on-off transitions of single channel currents. In this view, many types of channels gate by the same physical mechanism—dewetting by capillary evaporation—but different types of channels use different sensors to modulate hydrophobic properties of the channel wall and thereby trigger and control bubbles and gating. Spontaneous emptying of channels has been seen in many simulations. Because of the physics involved, such phase transitions are inherently sensitive, unstable threshold phenomena that are difficult to simulate reproducibly and thus convincingly. We present a thermodynamic analysis of a bubble gate using morphometric density functional theory of classical (not quantum) mechanics. Thermodynamic analysis of phase transitions is generally more reproducible and less sensitive to details than simulations. Anesthetic actions of inert gases—and their interactions with hydrostatic pressure (e.g., nitrogen narcosis)—can be easily understood by actions on bubbles. A general theory of gas anesthesia may involve bubbles in channels. Only experiments can show whether, or when, or which channels actually use bubbles as hydrophobic gates: direct observation of bubbles in channels is needed. Existing experiments show thin gas layers on hydrophobic surfaces in water and suggest that bubbles nearly exist in bulk water. PMID:18234836

  7. Is fentanyl an anesthetic in the dog?

    PubMed

    Bailey, P L; Port, J D; McJames, S; Reinersman, L; Stanley, T H

    1987-06-01

    The authors used the absence of vocalization and movement during application of a hemostat clamped to the first ratchet at the base of the tail as an indication of anesthesia for evaluation of the anesthetic properties of fentanyl in the dog. Eighty-six unpremedicated, unrestrained, untrained mongrel dogs were given one of eight doses of fentanyl citrate (125, 250, 500, 750, 1000, 1500, 2000, and 3000 micrograms/kg) as a single intravenous bolus injection. Dogs breathed spontaneously without oxygen supplementation. Anesthesia was assessed every 5 min until absence of anesthesia was recorded for two consecutive evaluations. Venous plasma samples were obtained in two or three dogs receiving each of the doses of fentanyl 5 min after fentanyl injection and again when application of the tail clamp elicited either vocalization or movement (positive response). Fentanyl resulted in recumbency in all animals except two receiving 125 micrograms/kg. Although all doses of fentanyl produced anesthesia in at least one animal 5 min after injection, the duration of anesthesia was short, responses unpredictable, and anesthesia achieved in all animals only with a dose of 3000 micrograms/kg. Increasing doses of fentanyl resulted in higher plasma fentanyl concentrations 5 min after injection and at the time of the first positive response to tail clamp but there was great variability. All doses of fentanyl caused statistically significant decreases in heart and respiratory rates but none produced apnea or a PaCO2 higher than 67 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3107433

  8. Lung transplantation: perioperative pharmacology and anesthetic considerations.

    PubMed

    Rodrigues, Eduardo S; Ramakrishna, Harish; Pajaro, Octavio E

    2015-01-01

    In the past two decades, lung transplantation has become an increasingly important surgical option for the patient with end stage lung disease. Compared with the other solid organ transplants (heart, liver and kidney), lung transplantation carries immense clinical and logistic challenges; long-term organ viability is particularly problematic, with an expected five-year mortality of 40-50%. The number of lung transplants performed in the U.S. has been increasing steadily since 1988, when UNOS (United Network for Organ Sharing) started recording statistical data. In that year, 33 cases of lung transplantation were performed. As of today, a total of 23,815 lung transplants have been performed, and the largest number of yearly lung transplants (n=1,822) was performed in 2009. From appropriate patient selection, to optimal organ selection, surgical procedure, and immediate and long-term postoperative care, the medical process involves multiple healthcare providers and requires a very well-organized and committed healthcare system to achieve optimal surgical results. Understanding the pharmacology involved in the care of the lung transplant patient is of utmost importance to achieve appropriate organ preservation, immunosuppression, hemodynamic stability, and adequate anesthetic depth, while avoiding drug toxicity and side effects. The purpose of this review is to summarize the pharmacokinetics and pharmacodynamics of the medications most commonly administered to this patient population, throughout the perioperative period. PMID:24521190

  9. Management of old Tendo Achilles injury by surgical reconstruction with Lindholm technique.

    PubMed

    Choudhury, A I; Datta, N K; Kaiser, S; Tarafder, W H; Das, K P; Ahammed, S

    2010-04-01

    This prospective study was carried out in the department of orthopaedic surgery, Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2007. Main aim of this study was to improve the power of planter flexion by reconstructive method with Lindholm technique to prevent walking disability. We had a study on 21 patients whose age range was 7 to 58 years. Mean age 34.19 years. Out of 21 cases male were 18(85.75%) and female were 3(14.25%). Chronocity of Tendo Achilles injury on average 2.64 (SD+/-1.08 month). Final clinical outcome of 21 cases 18 (85.75%) patients were satisfactory and 3(14.25%) were unsatisfactory. Lindholm technique is a good method of treatment for the management of Tendo Achilles injury was evident from this study. In Bangladesh toilet pan injury was more common. All patients were treated by surgical method of reconstruction by Lindholm technique. PMID:20395914

  10. Laparoscopic Nephroureterectomy and Management of the Distal Ureter: A Review of Current Techniques and Outcomes

    PubMed Central

    Viprakasit, Davis P.; Macejko, Amanda M.; Nadler, Robert B.

    2009-01-01

    Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference. Our analysis of the literature reflects equivalent cancer control between LPN and OPN at intermediate follow-up with significantly improved perioperative morbidity following LPN. Several methods for bladder cuff excision have been advocated, however, no individual technique for management of the distal ureter proved superior. Overall, complete en-bloc resection with minimal disruption of the urinary tract should be optimized to maintain oncologic outcomes. Longer follow-up and prospective studies are needed to fully evaluate these techniques. PMID:19148293

  11. Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy?

    PubMed

    Phé, Véronique; Cussenot, Olivier; Bitker, Marc-Olivier; Rouprêt, Morgan

    2011-07-01

    Study Type - Therapy (case series) Level of Evidence?4 What's known on the subject? and What does the study add? The resection of the distal ureter and its orifice is an oncological principle during radical nephroureterectomy which is based on the fact that it represents a part of the urinary tract exposed to a considerable risk of recurrence. After removal of the proximal part it is hardly possible to image or approach it by endoscopy during follow-up. Recent publications on survival after nephroureterectomy do not allow the conclusion that removal of distal ureter and bladder cuff are useless. Several techniques of distal ureter removal have been described but they are not equivalent in term of oncological safety. •?The standard treatment of upper urinary tract urothelial carcinomas (UUT-UCs) must obey oncological principles, which consist of a complete en bloc resection of the kidney and the ureter, as well as excision of a bladder cuff to avoid tumour seeding. •?The open technique is the 'gold standard' of treatment to which all other techniques developed are necessarily compared, and various surgical procedures have been described. •?The laparoscopic stapling technique maintains a closed system but risks leaving behind the ureteric and bladder cuff segments. •?Transvesical laparoscopic detachment and ligation is a valid approach from an oncological stance but is technically difficult. The major inconvenience of the transurethral resection of the ureteric orifice and intussusception techniques is the potential for tumour seeding. •?Management of the distal ureter via the robot-assisted laparoscopic method is technically feasible, but outcomes from these procedures are still preliminary. •?Therefore, prospective comparative studies with more thorough explorations of these techniques are needed to solve the dilemma of the management of the distal ureter during nephroureterectomy. However, bladder cuff excision should remain the standard of care irrespective of the stage of the disease. PMID:21070580

  12. Effect of psychological management techniques on specific item score change during the management of dental fear in children.

    PubMed

    Folayan, Morenike Oluwatoyin; Fatusi, Adesegun

    2005-01-01

    The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). However, no statistically significant dijfference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). PMID:16161400

  13. Advanced technologies and devices for inhalational anesthetic drug dosing.

    PubMed

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

    2008-01-01

    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

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

    SciTech Connect

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

    1980-04-01

    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.

  15. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    PubMed

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities. PMID:20217253

  16. The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review

    PubMed Central

    Ibrahim, Fatimah; Thio, Tzer Hwai Gilbert; Faisal, Tarig; Neuman, Michael

    2015-01-01

    This paper reviews a number of biomedical engineering approaches to help aid in the detection and treatment of tropical diseases such as dengue, malaria, cholera, schistosomiasis, lymphatic filariasis, ebola, leprosy, leishmaniasis, and American trypanosomiasis (Chagas). Many different forms of non-invasive approaches such as ultrasound, echocardiography and electrocardiography, bioelectrical impedance, optical detection, simplified and rapid serological tests such as lab-on-chip and micro-/nano-fluidic platforms and medical support systems such as artificial intelligence clinical support systems are discussed. The paper also reviewed the novel clinical diagnosis and management systems using artificial intelligence and bioelectrical impedance techniques for dengue clinical applications. PMID:25806872

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

    PubMed Central

    Hains, Guy

    2002-01-01

    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

  18. Novel technique in managing bronchobiliary fistula in adults: Endobronchial embolization using silicone spigots in 2 cases

    PubMed Central

    Kostopanagiotou, Kostas; George, Robert S.; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2015-01-01

    Bronchobiliary fistula (BBF) can complicate most hepatic pathologies. This is a challenging group of patients, especially when surgery is precluded. The bronchoscopic application of silicon spigots is a recognized technique for the treatment of massive hemoptysis and the management of patients with bronchopleural fistula following lung resection. Their role in the treatment of BBF has never been described. In this paper we report the successful embolization using silicon spigots in two patients with BBF secondary to malignant disease, when all surgical options were exhausted. PMID:25593611

  19. The application of biomedical engineering techniques to the diagnosis and management of tropical diseases: a review.

    PubMed

    Ibrahim, Fatimah; Thio, Tzer Hwai Gilbert; Faisal, Tarig; Neuman, Michael

    2015-01-01

    This paper reviews a number of biomedical engineering approaches to help aid in the detection and treatment of tropical diseases such as dengue, malaria, cholera, schistosomiasis, lymphatic filariasis, ebola, leprosy, leishmaniasis, and American trypanosomiasis (Chagas). Many different forms of non-invasive approaches such as ultrasound, echocardiography and electrocardiography, bioelectrical impedance, optical detection, simplified and rapid serological tests such as lab-on-chip and micro-/nano-fluidic platforms and medical support systems such as artificial intelligence clinical support systems are discussed. The paper also reviewed the novel clinical diagnosis and management systems using artificial intelligence and bioelectrical impedance techniques for dengue clinical applications. PMID:25806872

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

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

    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.

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

    PubMed

    Delitala, G

    2000-01-01

    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

  2. Laparoscopic antegrade sphincterotomy. A new technique for the management of complex choledocholithiasis.

    PubMed Central

    Curet, M J; Pitcher, D E; Martin, D T; Zucker, K A

    1995-01-01

    OBJECTIVE: Laparoscopic antegrade sphincterotomy represents a new technique that expands the ability of the surgeon to manage complex choledocholithiasis at the time of laparoscopic cholecystectomy. The authors describe their experience with six patients with cholelithiasis and complex common bile duct stone disease who underwent successful laparoscopic cholecystectomy and antegrade sphincterotomies. SUMMARY BACKGROUND DATA: Patients with complex choledocholithiasis have represented a technical challenge to the minimally invasive surgeon. Recently, a laparoscopic technique of antegrade biliary sphincterotomy has been reported by DePaulo in Brazil. This technique has been successful at clearing the common bile duct at the time of laparoscopic cholecystectomy. METHODS: Laparoscopic antegrade sphincterotomy was performed in six patients with multiple common bile duct stones. A standard endoscopic sphincterotome was introduced antegrade via the cystic duct or common bile duct and guided through the ampulla. A side-viewing duodenoscope was used to confirm proper positioning of the sphincterotome. Then a blended current was applied until the sphincterotomy was complete. RESULTS: There was no mortality or morbidity associated with laparoscopic antegrade sphincterotomy. The mean additional operative time to complete laparoscopic antegrade sphincterotomy was 19 minutes. Three of the six patients were noted to have transient, asymptomatic elevation in serum amylase levels immediately after surgery (average 252 international units/L; normal < 115), which normalized within 72 hours. The mean postoperative hospital stay was 2.9 days. At a mean follow-up of 5 months (range 1 to 10 months), five patients remain asymptomatic. One individual with acquired immune deficiency syndrome had persistent symptoms, and a diagnosis of cytomegalovirus pancreatitis was eventually made. CONCLUSIONS: Laparoscopic antegrade sphincterotomy appears to be a safe and effective technique for the management of complex biliary tract disease. Images Figure 1. Figure 2. Figure 4.,Figure 5.,Figure 6. PMID:7857142

  3. The sterile-male-release technique in Great Lakes sea lamprey management

    USGS Publications Warehouse

    Twohey, M.B.; Heinrich, J.W.; Seelye, J.G.; Fredricks, K.T.; Bergstedt, R.A.; Kaye, C.A.; Scholefield, R.J.; McDonald, R.B.; Christie, G.C.

    2003-01-01

    The implementation of a sterile-male-release technique from 1991 through 1999 and evaluation of its effectiveness in the Great Lakes sea lamprey (Petromyzon marinus) management program is reviewed. Male sea lampreys were injected with the chemosterilant bisazir (P,P-bis(1-aziridinyl)-N- methylphosphinothioic amide) using a robotic device. Quality assurance testing indicated the device delivered a consistent and effective dose of bisazir. Viability of embryos in an untreated control group was 64% compared to 1% in a treatment group. A task force developed nine hypotheses to guide implementation and evaluation of the technique. An annual average of 26,000 male sea lampreys was harvested from as many as 17 Great Lakes tributaries for use in the technique. An annual average of 16,100 sterilized males was released into 33 tributaries of Lake Superior to achieve a theoretical 59% reduction in larval production during 1991 to 1996. The average number of sterile males released in the St. Marys River increased from 4,000 during 1991 to 1996 to 20,100 during 1997 to 1999. The theoretical reduction in reproduction when combined with trapping was 57% during 1991 to 1996 and 86% during 1997 to 1999. Evaluation studies demonstrated that sterilized males were competitive and reduced production of larvae in streams. Field studies and simulation models suggest reductions in reproduction will result in fewer recruits, but there is risk of periodic high recruitment events independent of sterile-male release. Strategies to reduce reproduction will be most reliable when low densities of reproducing females are achieved. Expansion of the technique is limited by access to additional males for sterilization. Sterile-male release and other alternative controls are important in delivering integrated pest management and in reducing reliance on pesticides.

  4. The sterile-male-release technique in Great Lakes sea lamprey management

    USGS Publications Warehouse

    Twohey, Michael B.; Heinrich, John W.; Seelye, James G.; Fredricks, Kim T.; Bergstedt, Roger A.; Kaye, Cheryl A.; Scholefield, Ron J.; McDonald, Rodney B.; Christie, Gavin C.

    2003-01-01

    The implementation of a sterile-male-release technique from 1991 through 1999 and evaluation of its effectiveness in the Great Lakes sea lamprey (Petromyzon marinus) management program is reviewed. Male sea lampreys were injected with the chemosterilant bisazir (P,P-bis(1-aziridinyl)-N-methylphosphinothioic amide) using a robotic device. Quality assurance testing indicated the device delivered a consistent and effective dose of bisazir. Viability of embryos in an untreated control group was 64% compared to 1% in a treatment group. A task force developed nine hypotheses to guide implementation and evaluation of the technique. An annual average of 26,000 male sea lampreys was harvested from as many as 17 Great Lakes tributaries for use in the technique. An annual average of 16,100 sterilized males was released into 33 tributaries of Lake Superior to achieve a theoretical 59% reduction in larval production during 1991 to 1996. The average number of sterile males released in the St. Marys River increased from 4,000 during 1991 to 1996 to 20,100 during 1997 to 1999. The theoretical reduction in reproduction when combined with trapping was 57% during 1991 to 1996 and 86% during 1997 to 1999. Evaluation studies demonstrated that sterilized males were competitive and reduced production of larvae in streams. Field studies and simulation models suggest reductions in reproduction will result in fewer recruits, but there is risk of periodic high recruitment events independent of sterile-male release. Strategies to reduce reproduction will be most reliable when low densities of reproducing females are achieved. Expansion of the technique is limited by access to additional males for sterilization. Sterile-male release and other alternative controls are important in delivering integrated pest management and in reducing reliance on pesticides.

  5. Anesthetic management of a pediatric patient on a ketogenic diet.

    PubMed

    Ichikawa, Junko; Nishiyama, Keiko; Ozaki, Kyoko; Ikeda, Misako; Takii, Yoshitaka; Ozaki, Makoto

    2006-01-01

    There are several specific considerations regarding seizure control during the perioperative period in patients who have been placed on a ketogenic diet (KD). A KD is high in fat and low in protein and carbohydrates and has a long history of use for the treatment of intractable seizures in children. Maintaining therapeutic ketosis and modifying the acid-base balance are particularly important for preventing seizures in patients on a KD. We report changes in the biochemical parameters of a patient with double cortex syndrome who was on a KD and who had been scheduled for the treatment of dental caries under sevoflurane anesthesia and acetate Ringer administration. Inhalation induction with a high concentration of sevoflurane should be reconsidered in view of recent reports describing the epileptogenic potential of sevoflurane. PMID:16633775

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

    PubMed

    Carrié, Sabrina; Anderson, Thomas Anthony

    2015-05-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

    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.

  8. The cardiotoxicity of local anesthetics: the place of ropivacaine.

    PubMed

    Graf, B M

    2001-08-01

    Central and regional block procedures have a well-defined role as safe and effective methods in modern anesthesia and analgesia with long-acting local anesthetics. Recent studies have shown that the incidence of intoxication by these drugs is a rare but catastrophic event. As classic neuronal sodium channel inhibitors, local anesthetics block peripheral fast voltage-gated sodium channels on neuronal axons, and these drugs have a particularly high level of activity in the CNS and the cardiovascular system. CNS-toxicity follows a two-stage process, whereby at lower concentrations inhibitory neurons are blocked first resulting in generalized convulsions, and at higher concentrations a global CNS depression can be seen. Although seizures are an impressive clinical syndrome, they can often be treated safely without permanent damage. More important is the cardiotoxicity of these drugs, which can be divided into indirect cerebrally mediated and a direct myocardial component. Like CNS-toxicity in general, indirect cardiotoxicity demonstrates an initial stimulating effect, followed by a depressive component at higher concentrations. Direct myocardial actions are comprised of negative chronotropic, dromotropic and inotropic effects. For dromotropy, stereoselectivity was found. The S-(-)-isomers of the longacting local anesthetics were less delayed compared to racemic mixtures and the R-(+)-enantiomers. For inotropy, no stereospecific depression of this parameter was noted between isomers of ropivacaine or bupivacaine, but bupivacaine produced a significantly greater depression of LV pressure than ropivacaine, mepivacaine, or lidocaine. Pharmacokinetic differences in lipophilicity of local anesthetics correlate well with the depression mitochondrial ATP-synthesis in fast metabolizing cells. Intracellular ATP-level may be involved in contractility and resuscitation of cardiomyocytes, as be proven by in-vitro and in-vivo data. Therefore the use of pure optical S-(-)-isomers of local anesthetics may help to reduce these rare but catastrophic events. Presently, ropivacaine appears to be the safest long-acting local anesthetic. PMID:11895138

  9. Commercial anesthetic-respiratory gas monitor utilizing Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Gregonis, Donald E.; Van Wagenen, Richard A.; Coleman, D.; Mitchell, John R.

    1990-11-01

    A commercial gas monitor which utilizes Raman Spectroscopy has been developed to monitor anesthetic and respiratory gases in the hospital operating room. The instrument measures all molecular gases administered by the anesthesiologist in real time with fast response of breath waveform. These gases include carbon dioxide, nitrous oxide, oxygen, nitrogen and various volatile halogenated organic anesthetics, e.g. halothane, isoflurane, enflurane, sevoflurane and desflurane. The key feature of this instrument which allows it to produce adequate Raman signals with a low cost argon ion laser is measuring these gases inside the laser resonant cavity.

  10. Detection of volatile and soluble general anesthetics using a fluorescence-based fiber optic sensor: recent progress in chemical sensitivity and noise sources

    NASA Astrophysics Data System (ADS)

    Yager, Paul; Abrams, Susan B.

    1992-04-01

    A fiber optic sensor for general anesthetics based on the phase transition of immobilized phospholipid vesicles is under development. Current work centers on evaluating the sensor response to different anesthetics and instrumentation design. The fluorescence of laurdan- doped liposomes is found to respond linearly to the infusible anesthetics thiopental sodium and Propofol. Preliminary experiments have been performed to determine sources of noise in the optical and electronic components of the sensor as it is now configured. One potential noise source is the liposome sample at the fiber tip; photobleaching and thermal fluctuations due to heating by the illuminating 360 nm radiation can affect measurement of the anesthetic level. Heating of the sample is a factor at high illumination levels, but photobleaching, which reduces the signal intensity, does not alter the intensity ratio upon which the anesthetic concentration measurement is based. Optical microscopy of fiber tips embedded in liposomes allows direct observation of the light intensity near the tip of the fiber despite the extreme turbidity of the suspension. Light intensity drops to less than 10% of its maximum intensity at the fiber tip within 300 micrometers . Further use of this technique should allow monitoring the effects of photobleaching on the spatial distribution of the liposomes responsible for the measured optical signal.

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

    PubMed

    Shuker, Sabri T

    2013-07-01

    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

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

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

    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.

  13. [What do we know about anesthetic mechanisms?: hypnosis, unresponsiveness to surgical incision and amnesia].

    PubMed

    Eckle, V-S; Hucklenbruch, C; Todorovic, S M

    2009-11-01

    Despite the increase of molecular knowledge in anesthesia research over the past decades there is still ongoing discussion about the mechanisms of anesthesia. This article focuses on presenting anesthetic sensitive ligand and voltage gated ion channels. The impact on anesthetic modulated ion channels is summarized for clinically commonly used anesthetics isoflurane, propofol and ketamine. Furthermore, the anesthetic features hypnosis, unresponsiveness to surgical incision and amnesia and their putative relevant anatomical sites in the central nervous system are briefly introduced. PMID:19760252

  14. Evaluating the Effect of Three Water Management Techniques on Tomato Crop

    PubMed Central

    Elnesr, Mohammad Nabil; Alazba, Abdurrahman Ali; Zein El-Abedein, Assem Ibrahim; El-Adl, Mahmoud Maher

    2015-01-01

    The effects of three water management techniques were evaluated on subsurface drip irrigated tomatoes. The three techniques were the intermittent flow (3 pulses), the dual-lateral drip system (two lateral lines per row, at 15 and 25cm below soil surface), and the physical barrier (buried at 30 cm below soil surface). Field experiments were established for two successive seasons. Water movement in soil was monitored using continuously logging capacitance probes up to 60 cm depth. The results showed that the dual lateral technique positively increased the yield up to 50%, water use efficiency up to 54%, while the intermittent application improved some of the quality measures (fruit size, TSS, and Vitamin C), not the quantity of the yield that decreased in one season, and not affected in the other. The physical barrier has no significant effect on any of the important growth measures. The soil water patterns showed that the dual lateral method lead to uniform wetting pattern with depth up to 45 cm, the physical barrier appeared to increase lateral and upward water movement, while the intermittent application kept the wetting pattern at higher moisture level for longer time. The cost analysis showed also that the economic treatments were the dual lateral followed by the intermittent technique, while the physical barrier is not economical. The study recommends researching the effect of the dual lateral method on the root growth and performance. The intermittent application may be recommended to improve tomato quality but not quantity. The physical barrier is not recommended unless in high permeable soils. PMID:26057380

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

    PubMed Central

    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

    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

  16. Efficacy of Benzocaine as an Anesthetic for Sahnonid Fishes

    Microsoft Academic Search

    Philip A. Gilderhus

    1989-01-01

    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.

  17. Selective inhibition of monoamine neurotransmitter transporters by synthetic local anesthetics

    Microsoft Academic Search

    Tomoyuki Sato; Shigeo Kitayama; Chieko Mitsuhata; Tetsurou Ikeda; Katsuya Morita; Toshihiro Dohi

    2000-01-01

    Synthetic local anesthetics (LAs) have been found to have cocaine-like characteristics with some psychotomimetic action, possibly through monoaminergic neurotransmission. To gain insight into the relation between LA action and monoamine transporters, we investigated the effect of synthetic LAs on neurotransmitter transporters, including monoamine transporters. We used cloned transporter cDNAs and examined transient functional expression in COS cells and stable expression

  18. Phospholipase C activation by anesthetics decreases membrane-cytoskeleton adhesion.

    PubMed

    Raucher, D; Sheetz, M P

    2001-10-01

    Many different amphiphilic compounds cause an increase in the fluid-phase endocytosis rates of cells in parallel with a decrease in membrane-cytoskeleton adhesion. These compounds, however, do not share a common chemical structure, which leaves the mechanism and even site of action unknown. One possible mechanism of action is through an alteration of inositol lipid metabolism by modifying the cytoplasmic surface of the plasma membrane bilayer. By comparing permeable amphiphilic amines used as local anesthetics with their impermeable analogs, we find that access to the cytoplasmic surface is necessary to increase endocytosis rate and decrease membrane-cytoskeleton adhesion. In parallel, we find that the level of phosphatidylinositol 4,5-bisphosphate (PIP(2)) in the plasma membrane is decreased and cytoplasmic Ca(2+) is increased only by permeable amines. The time course of both the decrease in plasma membrane PIP(2) and the rise in Ca(2+) parallels the decrease in cytoskeleton-membrane adhesion. Inositol labeling shows that phosphatidylinositol-4-phosphate levels are increased by the permeable anesthetics, indicating that lipid turnover is increased. Consistent with previous observations, phospholipase C (PLC) inhibitors block anesthetic effects on the PIP(2) and cytoplasmic Ca(2+) levels, as well as the drop in adhesion. Therefore, we suggest that PLC activity is increased by amine anesthetics at the cytoplasmic surface of the plasma membrane, which results in a decrease in membrane-cytoskeleton adhesion. PMID:11707527

  19. Antiproliferative actions of inhalational anesthetics: comparisons to the valproate teratogen.

    PubMed

    O'Leary, G; Bacon, C L; Odumeru, O; Fagan, C; Fitzpatrick, T; Gallagher, H C; Moriarty, D C; Regan, C M

    2000-02-01

    The antiproliferative potential of the volatile anesthetics isoflurane, enflurane and sevoflurane was determined and compared to the valproate teratogen. The in vitro system employed, a G1 phase proliferative arrest endpoint in C6 glioma, has served previously to discriminate agents with known teratogenic potential in vivo. Based on estimated IC(50) values that were within twice the estimated minimum aveolar concentration value, the rank antiproliferative potency of the inhalational anesthetics employed was isoflurane=enflurane>sevoflurane. Flow cytometric analysis of growth-arrested cell populations failed to reveal specific accumulation in any cell cycle phase and the lack of a G1 phase-specific effect was confirmed by the absence of a transient, time-dependent sialylation event in synchronized cells. The antiproliferative mechanism of volatile anesthetics, and valproate, was mediated at hydrophobic binding sites, as increasing the hydration sphere of the drug-micelle complex, using the hygroscopic qualities of the dimethylsulfoxide vehicle, completely reversed this effect. Our findings suggest inhalational anesthetics lack the specific in vitro characteristics of the valproate teratogen. PMID:10708904

  20. Impact of Volatile Anesthetics on Oxidative Stress and Inflammation

    PubMed Central

    Lee, Yoon-Mi; Song, Byeng Chun; Yeum, Kyung-Jin

    2015-01-01

    The safety of anesthesia, which is an important step for surgery, can be determined by its impact on oxidative stress and inflammation. The effects of volatile anesthetics such as isoflurane and sevoflurane on oxidative stress and inflammation are reviewed in various (1) cell lines, (2) rodents, and (3) human studies. Isoflurane and sevoflurane are reported to have antioxidant and anti-inflammatory effects in all cells with exception of neuronal cell lines. In addition, various animal studies have indicated that isoflurane and sevoflurane were not only safe but also reduced oxidative stress and inflammation in rodent models. In human studies, oxidative stress, inflammation, and DNA damage were not affected by isoflurane and sevoflurane in patients undergoing minor incision surgeries. On the other hand, elevated oxidative stress, inflammation, and DNA damage have been observed in patients undergoing major surgeries such as abdominal and orthopedic surgeries, hysterectomy, cholecystectomy, and thoracotomy. Although impact of anesthetics on oxidative stress and inflammation is still not clear due to the variations of patients' health conditions, types of surgery and the quantities of anesthetics, isoflurane, and sevoflurane can be considered safe anesthetics with respect to their effect on oxidative stress and inflammation in subjects undergoing minor surgery. Continuous effort evaluating the safety of anesthesia in various aspects is required.

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

    USGS Publications Warehouse

    2012-01-01

    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.

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

    PubMed

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

    2013-03-01

    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

  3. Arthrogryposis multiplex congenita: An anesthetic challenge

    PubMed Central

    Pujari, Vinayak Seenappa; Shivanna, Shivakumar; Anandaswamy, Tejesh C.; Manjunath, A. C.

    2012-01-01

    Children with arthrogryposis multiplex congenita often require multiple orthopedic corrective procedures. We present a case of a child with arthrogryposis multiplex congenita posted for contracture release of both lower limbs that were successfully managed with total intravenous anesthesia and caudal epidural analgesia with Bupernorphine as an additive. PMID:25885508

  4. Influence of local anesthetics on molecular organization in phosphatidylethanolamine membranes

    SciTech Connect

    Kelusky, E.C.; Smith, I.C.

    1984-09-01

    The influence of the local anesthetics tetracaine (TTC) and procaine (PRC) on bilayers of specifically deuterated phosphatidylethanolamines (PE) has been studied by /sup 2/H and /sup 31/P NMR. Dimyristoylphosphatidylethanolamines (DMPE), deuterated at positions 2, 4, and 14 of the sn-2 chain, position 2 of the sn-1 chain, and in the ethanolamine headgroup, were mixed 1:1 with a semisynthetic egg PE and the effect of measured quantities of TTC and PRC on the /sup 2/H quadrupole splittings, spin-lattice relaxation times, and /sup 31/P chemical shift anisotropy were observed. Experiments were performed at pH 5.5, when the anesthetics are primarily charged, and at pH 9.5, when they are uncharged. Tetracaine was observed to disorder the hydrocarbon region of the bilayer and to induce a conformational change in the PE headgroup. Conversely, procaine had little or no effect on the hydrocarbon region and induced only a small change in the headgroup. These conformational changes and disordering effects, when adjusted for anesthetic partitioning, are essentially independent of the charge on the anesthetic. However, at pH 5.5 and low TTC/PE molar ratios (less than 0.1), the /sup 2/H NMR spectra showed two lipid environments--one corresponding to free PE and the other to PE in contact with TTC. Continued addition of TTC resulted in the eventual disappearance of the free PE signal and the corresponding growth of the signal from PE in contact with TTC. At pH 9.5, when TTC is uncharged, only one signal is observed. In mixtures of PE and phosphatidylserine, a conformational change in the headgroup was noted which was similar to that seen in the pure PE; however, there was no evidence for slow lateral diffusion of the anesthetics.

  5. Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective

    PubMed Central

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

    2015-01-01

    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

  6. Assessment of frequent cutting as a plant-community management technique in power-line corridors

    NASA Astrophysics Data System (ADS)

    Luken, James O.; Hinton, Andrew C.; Baker, Douglas G.

    1991-05-01

    Repeated cutting of vegetation at or near ground level in power-line corridors is a common practice for inhibiting tree growth and regeneration. However, few data exist on long-term community responses. In this study, we sampled 20 northern Kentucky power-line corridors and compared their seedling and sapling communities to the edges and interiors of adjacent undisturbed forests. Mean seedling and sapling density in corridors was roughly twice that of adjacent undisturbed forest interiors, suggesting that repeated cutting is not a viable method of inhibiting tree regeneration. Corridor communities were dominated by Robinia pseudoacacia (black locust) and Fraxinus americana (white ash), but ordinations indicated strong similaritties among communities in corridors and adjacent forests. Many of the tree species found in adjacent forests, with the exception of a few shade-tolerant species, had highest seedling and sapling densities in corridors. Stump or root sprouting by many species appears to regenerate forests quickly after cutting. However, disturbed soil and detritus accumulations caused by management crews and their equipment may also create a large variety of microsites for seedling establishment. Because repeated cutting selects for dominance by species with highest sprout growth rates, it should not be used as the sole management technique. It may instead be used to alter the vigor, stature, and stored reserves of trees so that herbicides or other methods of tree control can be used more efficiently.

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

    NSDL National Science Digital Library

    Stephens, Matthew P.

    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.

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

    SciTech Connect

    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

    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.

  9. Catheter fixation and ligation: a simple technique for ventriculostomy management following endovascular stenting.

    PubMed

    Sweeney, Justin M; Vasan, Rohit; van Loveren, Harry R; Youssef, A Samy; Agazzi, Siviero

    2013-05-01

    The object of this study was to describe a unique method of managing ventriculostomy catheters in patients on antithrombotic therapy following endovascular treatment of ruptured intracranial aneurysms. The authors retrospectively reviewed 3 cases in which a unique method of ventriculostomy management was used to successfully avoid catheter-related hemorrhage while the patient was on dual antiplatelet therapy. In this setting, ventriculostomy catheters are left in place and fixed to the calvarium with titanium straps effectively ligating them. The catheter is divided and the distal end is removed. The proximal end can be directly connected to a distal shunt system during this stage or at a later date if necessary. The method described in this report provided a variety of management options for patients requiring external ventricular drainage for subarachnoid hemorrhage. No patient suffered catheter-related hemorrhage. This preliminary report demonstrates a safe and effective method for discontinuing external ventricular drainage and/or placing a ventriculoperitoneal shunt in the setting of active coagulopathy or antithrombotic therapy. The technique avoids both the risk of hemorrhage related to catheter removal and reinsertion and the thromboembolic risks associated with the reversal of antithrombotic therapy. Some aneurysm centers have avoided the use of stent-assisted coiling in cases of ruptured aneurysms to circumvent ventriculostomy-related complications; however, the method described herein should allow continued use of this important treatment option in ruptured aneurysm cases. Further investigation in a larger cohort with long-term follow-up is necessary to define the associated risks of infection using this method. PMID:23472845

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

    E-print Network

    Siddiqui, Talha, 1969-

    2005-01-01

    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 ...

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

    PubMed Central

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

    2013-01-01

    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

  12. Managing complex processing of medical image sequences by program supervision techniques

    NASA Astrophysics Data System (ADS)

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

    1997-05-01

    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.

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

    PubMed

    Das, Sudeb; Kundu, Malay Kumar

    2012-10-01

    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

  14. A New Technique in Management of Pilonidal Sinus, a University Teaching Hospital Experience

    PubMed Central

    Aldaqal, Saleh M.; Kensarah, Ahmed A.; Alhabboubi, Mostafa; Ashy, Abdulrahman A.

    2013-01-01

    This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H202) and primary closure, or excision without closure, or excision after injection of H202 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H202 without closure was the lowest (1.8%) with P-value < 0.005, and the mean duration of healing was 30.7 days with P-value < 0.005. We recommend using excision after injection of H202 without closure in management of PNS. Injection of H202 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate. PMID:24229013

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

    PubMed Central

    Kamel, Ihab; Trehan, Gaurav; Barnette, Rodger

    2015-01-01

    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

  16. The impact of different management techniques on carbon balance of a pine stand after windthrow

    NASA Astrophysics Data System (ADS)

    Ziemblinska, Klaudia; Urbaniak, Marek; Merbold, Lutz; Chojnicki, Bogdan H.; Olejnik, Janusz

    2015-04-01

    Forest ecosystems cover approximately 1/3 of the global land area (and 29.8% in Poland). Since forests are constantly exposed to various types of disturbances - both natural and anthropogenic such as fires, wind, insects outbreaks or clear cuts - it is important to investigate the impact of such damages on the carbon dynamics. This becomes even more important due to the fact that future climate change will most likely result in a higher frequency and intensity of extreme climatic events. Even though wind damages cause large disturbances to forests only few places in the world exist where continuous measurements of carbon exchange (CO2) in windthrown sites are carried out. Besides the opportunity to assess the carbon dynamics following wind disturbance, there is an additional possibility of evaluating differences in post windthrow forest management practices. To fill this knowledge gap we set up two measuring stations in north-western Poland in the 500ha area of pine forest damaged by tornado in July 2012, to assess the impact of such disturbance on CO2 and H2O exchange by use of Eddy Covariance (EC) technique (Tlen I and Tlen II). Both sites are characterized by similar climatic as well as soil conditions and are located 3km from each other. While at the site Tlen I all biomass (coarse and fine woody debris were collected together with stumps) was removed and ploughed thereafter, at Tlen II only trunks and main branches were taken out from the site without ploughing. Total harvested biomass per hectare, as derived from local forest inventory, were almost 18 % higher at Tlen I than Tlen II site (where uprooted stumps were left to decompose). First analysis of the eddy covariance data shows that both sites are significant carbon sources. Emissions of carbon dioxide from the non-ploughed site (Tlen II) are higher than from the ploughed site (Tlen I). Both sites released more than 8.1 t of CO2 per ha during a three month time period (mid July to mid August 2014) after being prepared for reforestation as described above . Future analysis and continuation of the measurements will help to answer the following remaining questions: How does the carbon flux change in time at both sites? When does either system reach a compensation point (NEP0)? How large are the differences in CO2 loss between both sites? Which management technique appears to be more "carbon friendly" (less CO2 released to the atmosphere per decade). If these questions are answered they will allow to adapt current post-windthrow management activities and provide potential mitigation abilities in disturbed forest ecosystems.

  17. System design and power management for ultra low energy applications using energy harvesting techniques

    NASA Astrophysics Data System (ADS)

    Shao, Hui

    Micro-systems with features of tiny volume and wireless communications are developed for different applications. To prolong devices' lifetime, energy harvesting techniques which use environmental energy as the power source are proposed. Although the amount of environmental energy is theoretically infinite, it is usually unstable and the instantaneous power available is limited. To utilize the environmental energy efficiently, power management circuits have to be built to track the unstable energy status and extract maximum power from the energy transducer. In this work, we use solar energy as an example and demonstrate the design of power management circuit for micro-systems that use energy harvesting techniques. An inductor-less solar power management system was proposed and built. The system targets to operate in all lighting environments. When the light intensity is low, a charge pump is used to step up the output voltage from the photovoltaic cell. Meanwhile, charge pump switching frequency can be auto-adjusted to transfer maximum solar power to the load. Another power management circuit was proposed and designed for solar energy harvesting systems. It is based on single inductor dual-input dual-output DC-DC converter. The converter clamps photovoltaic cells to a point where maximum solar power is extracted. At the same time, it generates a stable output voltage to power the load. Also, the converter schedules energy utilization among different energy sources and consumers. The single inductor implementation can reduce the devices' volume and cost. For devices that have very stringent volume requirement, it may not be possible to have built-in battery, and the load is powered by environmental energy only. To cater for the source characteristic, power management is executed in the load side. A charge based computation methodology was proposed where the load operation is controlled by the source energy status. Moreover, a control strategy was derived to improve system performance. For applications that are powered by environmental energy, the load circuits should utilize the energy efficiently. The energy consumption of the load should be minimized so that the environmental energy source can support more load operations. It has been demonstrated that minimum energy consumption for digital circuits occurs when operating the circuits in subthreshold region. In this work, we also looked at the energy-efficient circuit design based on sub-threshold logics. In particular we investigated the design of proper interfaces between the sub-threshold logics and other high voltage blocks in the system. A multi-stage sub-threshold level converter was designed to up-shift the sub-threshold voltage. It functions robustly for sub-threshold input, and the energy consumption is small. The multi-stage structure helps to increase the slew rate of the output and thus reduce the short-circuit current of the logic gates driven by the level converter.

  18. Hybrid Run-time Power Management Technique for Real-time Embedded System with Voltage Scalable Processor

    Microsoft Academic Search

    Minyoung Kim; Soonhoi Ha

    2001-01-01

    This paper presents a new run-time power management technique for real-time embedded systems which consist of a voltage scalable processor and power controllable peripheral devices. We have observed that there exist significant trade-offs in terms of energy consumption between the Dynamic Power Management (DPM) scheme and the Dynamic Voltage Scaling (DVS) scheme over a wide range of system operating conditions.

  19. General anesthetics inhibit gap junction communication in cultured organotypic hippocampal slices.

    PubMed

    Wentlandt, Kirsten; Samoilova, Marina; Carlen, Peter L; El Beheiry, Hossam

    2006-06-01

    Gap junctions are protein channels that directly connect the cytosol of neighboring cells, thus forming electrical synapses and promoting synchronous neuronal activities. Such activities lead to the initiation and propagation of electroencephalogram oscillations implicated in cognition and consciousness. In this study, we investigated the effects of propofol, thiopental, and halothane on gap junction communication in cultured organotypic hippocampal slices by recovery of fluorescence after photo bleaching (FRAP) technique and electrophysiological recordings. Propofol 15 microM and thiopental 10 microM attenuated gap junction communication in slice cultures by 46.7% +/- 4.5% and 48.8% +/- 5.5%, respectively, as measured by FRAP. Smaller concentrations of propofol 5 microM and thiopental 2 microM did not change gap junction coupling. Accompanying the decreased gap junction communication, hippocampus slice cultures exposed to propofol 15 microM and thiopental 10 microM were found to have reduced electrophysiologic spontaneous discharges and primary after discharges evoked by a tetanic train of 50 Hz for 2 s. On the other hand, halothane 0.64 mM, a concentration slightly larger than twice its minimum alveolar concentration had no effect on gap junction coupling while halothane 2.8 mM blocked FRAP by 70%. The current study illustrates that anesthetic concentrations of propofol and thiopental, but not halothane, attenuate gap junction communication in cultured hippocampal slices. Suppression of gap junction function could compound the mechanisms of anesthetic actions. PMID:16717311

  20. Pain Control after Total Knee Arthroplasty: Comparing Intra-Articular Local Anesthetic Injection with Femoral Nerve Block

    PubMed Central

    Kao, Shengchin; Lee, Hungchen; Cheng, Chihwen; Lin, Chingfeng; Tsai, Hsini

    2015-01-01

    Background. Direct intra-articular injection of low doses of local anesthetic (IALA) after closure of the joint capsule remains controversial for pain control after total knee arthroplasty (TKA). Methods. A retrospective study comparing patients receiving IALA with high doses (0.5% bupivacaine 60?mL) of local anesthetics or FNB in addition to intravenous patient-controlled analgesia with opioids for pain management after TKA was conducted. The primary end point was to compare the analgesic efficacy and early ambulation between the two groups. Results. No significant differences between the two groups in pain intensity, cumulative opioid consumption, incidences of opioid-related side effects, the time interval from the end of operation to the first time the patient could walk assisted with a walker postoperatively, and postoperative hospital stay were identified. Three patients in the IALA group but none in the FNB group walked within 12 hours after the end of operation. Summary. IALA with high doses of local anesthetics provides comparable analgesic efficacy as single-shot FNB after TKA and might be associated with earlier ambulation than FNB postoperatively. PMID:26064937

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

    PubMed

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

    2007-03-22

    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

  2. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.

    2015-01-01

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients with axial or discogenic pain in the lumbar spine after excluding facet joint and SI Joint pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back pain with a potential superiority for a lumbar interlaminar approach over a caudal approach. PMID:25678838

  3. Integrating Customer Relationship Management and Project Lifecycle Management using Information Technology Infrastructure Library Techniques to Improve Service Delivery

    E-print Network

    Millet, Sabbas

    2008-05-16

    , for her support through the late nights. Without her support and advice, this journey would have taken longer - much longer. #12;Glossary Acronyms List AEM#7;Audit Error Manager#7;#7;CAD#7;Change Audit Document#7;#7;CI#7;Configuration Item#7;#7;CMDB#7...;Configuration Management Database#7;#7;CMS#7;Configuration Management System#7;#7;CRM#7;Customer Relationship Management#7;#7;DMAIC#7;Define Measure Analyze Improve Control#7;#7;IMM#7;Information Mirroring Model#7;#7;ISO#7;International Standards Organization#7;#7...

  4. Filtering and prediction techniques for model-based prognosis and uncertainty management

    Microsoft Academic Search

    Liang Tang; J. DeCastro; Greg Kacprzynski; Kai Goebel; George Vachtsevanos

    2010-01-01

    Managing and reducing prognostic uncertainty is of significant importance to the success of PHM applications. The focus of prognosis uncertainty management is to identify and manage the reducible uncertainties by applying available data using appropriate uncertainty management algorithms. Particularly for dynamic model-based systems, opportunities exist to apply nonlinear filtering to provide a systematic way of dealing with the propagation of

  5. Investigative and management techniques for cement kiln dust and pulp and paper mill process wastes

    SciTech Connect

    Peters, C.S. [RMT, Inc., Okemos, MI (United States)

    1997-12-31

    Knowledge of the characteristics of industrial process wastes allows for some innovative and cost savings techniques for investigating and managing these wastes over conventional methods. This paper explores examples of some of these techniques employed on cement kiln dust (CKD) and pulp and paper mill process waste. Similar to Portland Cement, unleached CKD contains free lime and sources of reactive silica and/or alumina. Thus, it can set up in the presence of water. Properly moisture conditioned CKD has been successfully used in Michigan as a landfill liner and cover material on closures of old CKD piles and newly permitted fills. In addition to its pozzolanic properties, CKD contains high concentrations of soluble salts, generating a leachate with high total dissolved solids concentrations. Surface and downhole geophysical methods employing electromagnetic conductivity have proven effective in delineating the horizontal and vertical extent of groundwater plumes. At one paper mill in Alabama where dewatered filter cake had been placed in a lined solid waste facility, liquids that had migrated to the surface due to excessive gas pressures caused unstable working conditions at the surface. Large, vertical french drains and a horizontal drainage blanket consisting of geogrid and sand constructed over the existing waste resulted in dewatering and a substantial increase in waste stability, allowing a vertical expansion to proceed. At a kraft mill in the southeastern US, a geotechnical investigation of a lime mud pond revealed that the stability of the unit would increase by construction of an overlying dike, thereby allowing a vertical expansion to proceed. Finally, laboratory testing and modeling of the behavior of paper mill sludges indicates that they can be used as a landfill cover with permeabilities equivalent to or better than compacted clay.

  6. Effect of certain anesthetic agents on mallard ducks

    USGS Publications Warehouse

    Cline, D.R.; Greenwood, R.J.

    1972-01-01

    Four anesthetic agents used in human or veterinary medicine and 3 experimental anesthetic preparations were evaluated for effectiveness in inducing narcosis when administered orally to game-farm mallard ducks (Anas platyrhynchos).Tribromoethanol was the only compound to satisfy criteria of initial tests. Mean duration of the induction, immobilization, and recovery periods was 2.4 minutes, 8.7 minutes, and 1.3 hours, respectively, at the median effective dosage for immobilization (ED50; 100 mg./kg. of body weight). The median lethal dosage (LD50) was 400 mg./kg. of body weight.Tribromoethanol was also tested on mallards during the reproductive season. Effects on the hatchability of eggs or the survival of young were not detected.

  7. Management of postoperative swallowing dysfunction after ependymoma surgery

    Microsoft Academic Search

    Jerome W. Thompson; Lisa Newman; Frederick A. Boop; Robert A. Sanford

    2009-01-01

    Purpose  This study aims to share a new postoperative care technique team approach for the management of children after they have recovered\\u000a from the anesthetic and has passed through the immediate postoperative period of a day or so from their posterior fossa ependymoma\\u000a surgery.\\u000a \\u000a \\u000a \\u000a Methods  A team approach was developed consisting of a neurosurgeon, an otolaryngologist, an intensivist, and a speech pathologist\\/swallowing

  8. Advanced Technologies and Devices for Inhalational Anesthetic Drug Dosing

    Microsoft Academic Search

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

    Technological advances in micromechanics, optical sensing, and computing have led to innovative and reliable concepts of precise\\u000a dosing and sensing of modern volatile anesthetics. Mixing of saturated desflurane flow with fresh gas flow (FGF) requires\\u000a differential pressure sensing between the two circuits for precise delivery. The medical gas xenon is administered most economically\\u000a in a closed circuit breathing system. Sensing

  9. Advanced Characterization Techniques for Defining Vineyard Management Zones Susan Hubbard*1,2, Yoram Rubin*1, and Phil Freese*3

    E-print Network

    Rubin, Yoram

    Advanced Characterization Techniques for Defining Vineyard Management Zones Susan Hubbard*1@lbl.gov II. SOIL WATER CONTENT ESTIMATION AT THE MONDAVI VINEYARD USING GPR GROUNDWAVE DATA Surface Ground and subsequently to estimate soil water content within vineyard sites in a non-invasive and manner and with high

  10. Airway Management and Endoscopic Treatment of Subglottic and Tracheal Stenosis: The Laryngeal Mask Airway Technique

    PubMed Central

    Vorasubin, Nopawan; Vira, Darshni; Jamal, Nausheen; Chhetri, Dinesh K.

    2015-01-01

    Objectives The objective is to present clinical outcomes of subglottic and tracheal stenosis treated by flexible bronchoscopic delivery of carbon dioxide (CO2) laser via laryngeal mask airway (LMA). Methods All consecutive, nontracheotomy dependent cases of subglottic and tracheal stenosis treated endoscopically over a 4-year period were retrospectively reviewed. The surgical approach consisted of radial incisions using a flexible fiber-based CO2 laser, balloon dilation, and topical application of mitomycin C. Ventilation during the procedure occurred through the LMA, and the CO2 laser fiber was delivered through the working channel of a flexible bronchoscope passed through the LMA. Number of dilations, period between dilations, and operative times were reviewed. Results Eleven patients who underwent airway intervention during the study period were identified. Average follow-up was 28 months. Etiologies of airway stenosis included intubation injury (6), idiopathic (4), or autoimmune disease (1), requiring an average of 1.3, 1.5, and 3 dilations, respectively. Average operative time was 67 minutes. Autoimmune etiology correlated with more frequent dilations. Conclusion LMA is an effective way to manage ventilation while simultaneously allowing unencumbered flexible bronchoscopic access for laser surgery, balloon dilation, and mitomycin C application for airway stenosis. Long-term success in treating stenosis is achievable using this technique. PMID:24671485

  11. Review article: Neurotoxicity of anesthetic drugs in the developing brain.

    PubMed

    Stratmann, Greg

    2011-11-01

    Anesthesia kills neurons in the brain of infantile animals, including primates, and causes permanent and progressive neurocognitive decline. The anesthesia community and regulatory authorities alike are concerned that is also true in humans. In this review, I summarize what we currently know about the risks of pediatric anesthesia to long-term cognitive function. If anesthesia is discovered to cause cognitive decline in humans, we need to know how to prevent and treat it. Prevention requires knowledge of the mechanisms of anesthesia-induced cognitive decline. This review gives an overview of some of the mechanisms that have been proposed for anesthesia-induced cognitive decline and discusses possible treatment options. If anesthesia induces cognitive decline in humans, we need to know what type and duration of anesthetic is safe, and which, if any, is not safe. This review discusses early results of comparative animal studies of anesthetic neurotoxicity. Until we know if and how pediatric anesthesia affects cognition in humans, a change in anesthetic practice would be premature, not guided by evidence of better alternatives, and therefore potentially dangerous. The SmartTots initiative jointly supported by the International Anesthesia Research Society and the Food and Drug Administration aims to fund research designed to shed light on these issues that are of high priority to the anesthesia community and the public alike and therefore deserves the full support of these interest groups. PMID:21965351

  12. [Influences of general anesthetics on the developing mammalian brain].

    PubMed

    Miyamoto, Yoshikazu

    2011-05-01

    Recently, almost all kinds of general anesthetics currently used in human clinical anesthesia, have been shown to exert neurodegenerative effects such as apoptosis of neuronal cells during the rapid synaptogenesis of immature mammalian brains, and later neurocognitive impairment. There are several drugs or strategies to reduce this phenomenon such as alpha(2) agonist, xenon, melatonin, lithium, hypothermia and erythropoietin, but their safety and efficacy should be investigated much further. Some human studies have shown that surgery under general anesthesia in infancy is one of the risk factors of the impairment of neurocognitive function, but others including Dutch twin study have shown that it is not. Larger-sized prospective randomized studies in human such as SAFEKIDS (http://www.iars.org/safekids/) to ascertain if current clinical practice of general anesthesia impairs neurocognitive development of human neonates and infants, are expected. They will also clarify what kind of anesthetics and anesthetic strategies may be the risk factors of neurocognitive impairment in human neonates and infants. PMID:21626864

  13. Interactions of anesthetics with the membrane-water interface

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

    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.

  14. Interaction of local anesthetics with the K+ channel pore domain

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

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

    2011-01-01

    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

  16. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below.

  17. Update on local anesthetics: focus on levobupivacaine

    PubMed Central

    Burlacu, Crina L; Buggy, Donal J

    2008-01-01

    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

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

    Microsoft Academic Search

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

    2012-01-01

    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 interventions could influence these dimensions of student well-being. Specifically, the authors examined the impact of stress

  19. Integration of Knowledge Discovery techniques in the Quality Management model to achieve higher target quality

    Microsoft Academic Search

    F. Ansari Ch; Christian Sassenberg; Madjid Fathi; Ralf Montino

    2009-01-01

    Improving the quality of products is an important issue in the modern business world. Traditional approaches of Quality Management (QM) are not adequate to fulfil the demands on target quality of products. This study reveals that synergetic approaches based on the integration of Knowledge Management (KM) in Total Quality Management (TQM) have a direct impact on enhancing the quality of

  20. Summary of Transportation Management System for costal ships using Satellite Packet Communication techniques

    Microsoft Academic Search

    Takeyuki ONO; Harumi MIZOKAMI

    This paper introduces the development of the transportation management system, which realizes effective transportation by integrating sea and land. The transportation management system serves the transportation status to the transportation management companies, cargo owners, carriers, consignees, etc. on the basis of the data from mobiles installed on such as ships and lorries, for the improvement of safety and efficiency of

  1. The Effects of Clonidine Premedication on Sevoflurane Requirements and Anesthetic Induction Time

    Microsoft Academic Search

    Shinichi Inomata; Yuichi Yaguchi; Hidenori Toyooka

    1999-01-01

    We assessed the effects of oral clonidine preanesthetic medication (4.5 mg\\/kg) on the vital capacity rapid- inhalation anesthetic induction time (VCRII time) and minimum alveolar anesthetic concentration (MAC) to prevent a response to a verbal command in 50% of pa- tients (MAC-Awake) by its hypnotic effect, and on MAC-Skin incision for the analgesic effect in patients anesthetized with sevoflurane. We

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

    Microsoft Academic Search

    Takafumi Horishita; Edmond I. Eger; R Adron Harris

    2008-01-01

    BACKGROUND: Many inhaled anesthetics inhibit voltage-gated sodium channels at clinically relevant concentrations, and suppression of neurotransmitter release by these anesthetics 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 receptor function, but these effects depend strongly on the chemical properties of the aromatic compounds.

  3. E-Nose System for Anesthetic Dose Level Detection using Artificial Neural Network

    Microsoft Academic Search

    Hamdi Melih Saraoglu; Burçak Edin

    2007-01-01

    In this study, an E-Nose system was realized for the anesthetic dose level prediction. For this purpose, sevoflurane anesthetic\\u000a agent was measured using the E-Nose system implemented with sensor array of quartz crystal microbalances (QCM). In surgeries,\\u000a anesthetic agents are given to the patients with carrier gases of oxygen (O2) and nitrous oxide (N2O). Frequency changes on QCM sensors to

  4. Loss of Anatomical Landmarks with Eutectic Mixture of Local Anesthetic Cream for Neonatal Male Circumcision

    PubMed Central

    Plank, Rebeca M.; Kubiak, David W.; Abdullahi, Rasak Bamidele; Ndubuka, Nnamdi; Nkgau, Maggie M.; Dapaah-Siakwan, Fredrick; Powis, Kathleen M.; Lockman, Shahin

    2012-01-01

    We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare. PMID:23102766

  5. Post-anesthetic pulmonary edema in two horses.

    PubMed

    Kaartinen, M Johanna; Pang, Daniel S J; Cuvelliez, Sophie G

    2010-03-01

    CASE 1: A two-year old, 462 kg Standard bred horse was anesthetized for arthroscopy and castration. During anesthesia, hyperemia of the mucosal membranes and urticaria were noticed. During 5 hours of anesthesia subcutaneous edema of the eyelids and neck region developed. In the recovery box, the orotracheal (OT) tube was left in situ and secured in place with tape. Following initial attempts to stand, the horse became highly agitated and signs consistent with pulmonary edema developed subsequently. Arterial hypoxemia (PaO(2): 3.7 kPa [28 mmHg]) and hypocapnia (PaCO(2): 3.1 kPa [23 mmHg]) were confirmed. Oxygen and furosemide were administered. The horse was assisted to standing with a sling. Therapy continued with bilateral intra-nasal oxygen insufflation. Ancillary medical therapy included flunixin meglumine, penicillin, gentamycin and dimethylsulfoxide. Following 7 hours of treatment the arterial oxygen tensions began to increase towards normal values. CASE 2: An 11-year old, 528 kg Paint horse was anesthetized for surgery of a submandibular mass. The 4-hour anesthetic period was unremarkable. The OT tube was left in situ for the recovery. During recovery, the horse was slightly agitated and stood after three attempts. Clinical signs consistent with pulmonary edema and arterial hypoxemia (PaO(2): 5 kPa [37.5 mmHg]) subsequently developed following extubation. Respiratory signs resolved with medical therapy, including unilateral nasal oxygen insufflation, furosemide, flunixin meglumine and dimethylsulfoxide. The diagnosis of pulmonary edema in these horses was made by clinical signs and arterial blood-gas analysis. While pulmonary radiographs were not taken to confirm the diagnosis, the clinical signs following anesthesia support the diagnosis in both cases. The etiology of pulmonary edema was most likely multifactorial. PMID:20230564

  6. Attenuation of sympathoadrenal responses and anesthetic requirement by dexmedetomidine

    PubMed Central

    Laha, Arpita; Ghosh, Sarmila; Sarkar, Susanta

    2013-01-01

    Context: During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. Dexmedetomidine attenuates the hemodynamic response to endotracheal intubation and reduces anesthetic requirement. Aims: The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 ?g/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation and need for anesthetic agent. Materials and Methods: Fifty patients scheduled for elective major surgery were randomized into two groups each having twenty five patients-dexmedetomidine group (Group 1) and control group (Group 2). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and Ramsay sedation score were recorded at 1, 2 and 5 min after completion of administration of study drug. Fentanyl 2 ?g/kg was administered to all patients and propofol was given until loss of verbal contact. Intubation was facilitated with vecuronium 0.1 mg/kg i.v. Anesthesia was maintained with oxygen (O2) and nitrous oxide (N2O) 33%: 67% and isoflurane. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) was noted at 1 min, 2 min and 5 min after intubation. Statistical Analysis Used: For statistical analysis of the clinical data obtained, the analysis of variances (ANOVA) with paired t-test was used. Results: Pretreatment with dexmedetomidine 1 ug/kg attenuated, but did not totally abolish the cardiovascular and catecholamine responses to tracheal intubation after induction of anesthesia. In our present study, HR, SBP, DBP all increased after intubation at 1, 2, 3 and 5 min in both the groups, but the rise was significantly less in the dexmedetomidine group. Requirement of propofol was significantly less in the dexmedetomidine group. Conclusions: Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses during laryngoscopy, and reduced anesthetic requirements. PMID:25885723

  7. Extended release local anesthetic agents in a postoperative arthritic pain model.

    PubMed

    Ickowicz, Diana E; Golovanevski, Ludmila; Haze, Amir; Domb, Abraham J; Weiniger, Carolyn F

    2014-01-01

    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

  8. Anesthetic and analgesic practices in Avicenna's Canon of Medicine.

    PubMed

    Aziz, E; Nathan, B; McKeever, J

    2000-01-01

    Anesthetic and analgesic practices during the Middle Ages and the Renaissance are presented from a translation of the relevant sections of the Canon of Medicine by Avicenna (980-1037) one of the most widely read and authoritative textbooks of the period. Avicenna described tracheotomy, oropharyngeal intubation and a method for clearing upper airway secretions for the treatment of stridor and respiratory distress. He also identified certain plants with pharmacological action such as mandragora or nightshade, opium and henbane and gives various recipes for inducing both anesthesia and analgesia before surgery. PMID:10794127

  9. Antihistaminics, local anesthetics, and other amines as antiviral agents.

    PubMed Central

    Miller, D K; Lenard, J

    1981-01-01

    A number of lipophilic amines of diverse chemical structure, including antihistaminics, local anesthetics, and chloroquine, were found to exhibit similar kinetics in inhibiting the infection of BHK cells by vesicular stomatitis virus. The inhibition occurred prior to both primary and secondary RNA transcription but following transfer from the cell surface to an intracellular site, presumed to be the lysosomes. A similar inhibition, by these agents, of infection by Sendai, influenza strain WSN, and Semliki Forest viruses suggested a lysosomal involvement in infection by these viruses as well. PMID:6115382

  10. A 1 V multi-threshold voltage CMOS DSP with an efficient power management technique for mobile phone application

    Microsoft Academic Search

    S. Mutoh; S. Shigematsu; Y. Matsuya; H. Fukuda; J. Yamada

    1996-01-01

    A low-power digital signal processor (DSP) is the key component for battery-driven mobile phone equipment since a vast amount of data needs to be processed for multimedia use. Reduced supply voltage is a direct approach to power reduction. This 1 V DSPLSI with 26 MOPS and 1.1 mW\\/MOPS performance adopts a multi-threshold-voltage CMOS (MTCMOS) technique. A small embedded power-management processor

  11. Surgical management of melanoma-in-situ using a staged marginal and central excision technique.

    PubMed

    Möller, Mecker G; Pappas-Politis, Effie; Zager, Jonathan S; Santiago, Luis A; Yu, Daohai; Prakash, Amy; Kinal, Adam; Clark, Graham S; Zhu, Weiwei; Puleo, Christopher A; Glass, L Frank; Messina, Jane L; Sondak, Vernon K; Cruse, C Wayne

    2009-06-01

    Melanoma-in-situ (MIS) represents 45% of all melanomas. The margins of MIS are often poorly defined with extensive subclinical disease. Standard fusiform excision with 5-mm margins results in positive margins in up to a third of cases. To decrease the incidence of involved margins, we use a staged excision approach for MIS. First, patients undergo excision under local anesthesia of a 2- to 3-mm "contoured" rim of tissue optimally 5 mm beyond the visible extent of the lesion. Formalin-fixed paraffin-embedded en face sections from this excision are then evaluated, if necessary with the aid of immunohistochemical stains. Any positive margins are further excised. When all margins are negative, the central area is then excised and reconstructed. A total of 61 patients with MIS or lentigo maligna melanoma underwent staged contoured excisions from 2004 to 2007 at Moffitt Cancer Center. We analyzed data only from patients with MIS of the head and neck. Patients with known invasive melanoma or non-head and neck primary disease were excluded. Demographics, tumor characteristics, margin status, number of stages, and type of reconstruction and recurrences were evaluated. Forty-nine patients with MIS of the head and neck, 28 (57%) male and 21 (43%) female, 42 to 88-years-old (median 72; mean 70), underwent staged contoured margin excision before definitive central tumor excision and reconstruction. The final surgical defect size ranged from 2 to 130 cm(2) (median 16 cm(2)). Twelve patients (24%) required reexcision of at least one margin; the median number of reexcisions was 1 (range 1-2). There seemed to be a positive association between lesion size and margin status (as well as number of excisions needed to clear the margin). Unsuspected invasive melanoma was found in the central specimen in six patients (12%). Even small tumors could have unsuspected invasive melanoma: invasive cancer was seen in 4 (21%) of 19 tumors < or =2 cm in greatest dimension and 2 (7%) of 30 > 2 cm, respectively. Surgical defects were reconstructed with flaps in 18 (37%), full-thickness grafts in 20 (41%), and split-thickness grafts in 10 patients (20%). Median time from first margin excision to completion/final reconstruction was 7 days (range 7-63 days). No local recurrences have been reported at a median follow-up of 14 months (range 1-36 months). This technique allows for careful margin analysis and subsequent central tumor excision with simultaneous reconstruction. This approach minimizes the need for a second major operation, which would have been necessary in 24% of our patients if treated by a one-stage excisional approach. It is noteworthy that 12% of MIS patients had invasive melanoma in the final excision specimen. This reinforces the importance of adequate full-thickness biopsies of suspicious pigmented lesions before any type of surgical management. With short follow-up, local control has been achieved by this technique in 100% of cases. PMID:19050971

  12. Binding Site and Affinity Prediction of General Anesthetics to Protein Targets Using Docking

    PubMed Central

    Liu, Renyu; Perez-Aguilar, Jose Manuel; Liang, David; Saven, Jeffery G.

    2012-01-01

    Background The protein targets for general anesthetics remain unclear. A tool to predict anesthetic binding for potential binding targets is needed. In this study, we explore whether a computational method, AutoDock, could serve as such a tool. Methods High-resolution crystal data of water soluble proteins (cytochrome C, apoferritin and human serum albumin), and a membrane protein (a pentameric ligand-gated ion channel from Gloeobacter violaceus, GLIC) were used. Isothermal titration calorimetry (ITC) experiments were performed to determine anesthetic affinity in solution conditions for apoferritin. Docking calculations were performed using DockingServer with the Lamarckian genetic algorithm and the Solis and Wets local search method (https://www.dockingserver.com/web). Twenty general anesthetics were docked into apoferritin. The predicted binding constants are compared with those obtained from ITC experiments for potential correlations. In the case of apoferritin, details of the binding site and their interactions were compared with recent co-crystallization data. Docking calculations for six general anesthetics currently used in clinical settings (isoflurane, sevoflurane, desflurane, halothane, propofol, and etomidate) with known EC50 were also performed in all tested proteins. The binding constants derived from docking experiments were compared with known EC50s and octanol/water partition coefficients for the six general anesthetics. Results All 20 general anesthetics docked unambiguously into the anesthetic binding site identified in the crystal structure of apoferritin. The binding constants for 20 anesthetics obtained from the docking calculations correlate significantly with those obtained from ITC experiments (p=0.04). In the case of GLIC, the identified anesthetic binding sites in the crystal structure are among the docking predicted binding sites, but not the top ranked site. Docking calculations suggest a most probable binding site located in the extracellular domain of GLIC. The predicted affinities correlated significantly with the known EC50s for the six commonly used anesthetics in GLIC for the site identified in the experimental crystal data (p=0.006). However, predicted affinities in apoferritin, human serum albumin, and cytochrome C did not correlate with these six anesthetics’ known experimental EC50s. A weak correlation between the predicted affinities and the octanol/water partition coefficients was observed for the sites in GLIC. Conclusion We demonstrated that anesthetic binding sites and relative affinities can be predicted using docking calculations in an automatic docking server (Autodock) for both water soluble and membrane proteins. Correlation of predicted affinity and EC50 for six commonly used general anesthetics was only observed in GLIC, a member of a protein family relevant to anesthetic mechanism. PMID:22392968

  13. Spatial and temporal expression of c-Fos protein in the spinal cord of anesthetized rat induced by subcutaneous bee venom injection

    Microsoft Academic Search

    Ceng Luo; Jun Chen; Hui-Li Li; Ji-Shuo Li

    1998-01-01

    In order to study central neuronal components involved in subcutaneous (s.c.) bee venom-induced persistent pain (a new tonic pain model), we use Fos immunostaining technique to study the spatial and temporal patterns of neuronal activity in the spinal cord of anesthetized rats. Following intraplantar bee venom injection, Fos-like immunoreactive (ir) neurons were only seen from L1 to S3 rostrocaudally with

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

    Microsoft Academic Search

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

    2004-01-01

    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

  15. Ketamine hydrochloride as sole anesthetic for open liver biopsy.

    PubMed

    Abu Khalaf, A; Takrouri, M; Toukan, A; Abu Khalaf, M; Amr, S

    1988-10-01

    We evaluated the use of ketamine as sole anesthetic agent for open liver biopsy, with particular reference to its effect on liver function and hepatotoxicity and its effect on cardiovascular stability and respiration. From 386 patients who underwent liver biopsy at Jordan University Hospital, 12 had open liver biopsy because of contra-indications for closed needle biopsy. The surgical procedure consisted of a small right paramedian incision allowing inspection of the liver surface and a wedge and needle biopsy. Ketamine HCl was used in a dose of 2 mg/kg I.V. with supplemental doses as necessary. No significant fluctuations in cardio-respiratory vital signs were observed. Muscle rigidity and respiratory tagging movements necessitated addition of a muscle relaxant and artificial ventilation in three patients. Six patients reported dreams, two of which were described as nightmares. There was no liver function decompensation, or significant bilirubin or transaminase elevations in the week following the biopsy. Ketamine is a safe anesthetic to use for open liver biopsy in patients with underlying liver disease, although poor muscle relaxation and nightmares may be significant side effects. PMID:3211082

  16. Formulation of an antispasmodic drug as a topical local anesthetic.

    PubMed

    Abdel-Hamid, Sameh M; Abdel-Hady, S E; El-Shamy, A A; El-Dessouky, H F

    2006-12-01

    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

  17. 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...

  18. FIELD USE OF ISOFLURANE AS AN INHALANT ANESTHETIC IN THE AMERICAN MARTEN (MARTES AMERICANA)

    Microsoft Academic Search

    Marion Desmarchelier; Marianne Cheveau; Louis Imbeau; Stephane Lair

    2007-01-01

    We evaluated the effectiveness and practicality of using isoflurane as an inhalation anesthetic with oxygen as a gas carrier for American martens (Martes americana) in a field setting. Sixty-eight martens were trapped in the Waswanipi Cree Model Forest (Quebec, Canada) from October to November 2005 and anesthetized with isoflurane in 100% oxygen (1 l\\/min) using a face mask. Induction setting

  19. Ambulatory Anorectal Surgery under Perianal Anesthetics Infiltration: Analysis of 222 Cases

    Microsoft Academic Search

    Varut Lohsiriwat; Darin Lohsiriwat

    Objective: To assess the safety and early postoperative results of ambulatory anorectal surgery using perianal anesthetics infiltration. Material and Method: This retrospective study included 222 elective ambulatory anorectal surgical patients under perianal anesthetics infiltration between March 2002 and September 2005. Perioperative pain, post- operative complications, and surgical outcomes were analyzed. Results: The patients were 122 males and 100 females aged

  20. A Comparison of the Electrocardiographic Cardiotoxic Effects of Racemic Bupivacaine, Levobupivacaine, and Ropivacaine in Anesthetized Swine

    Microsoft Academic Search

    Stuart G. Morrison; Javier J. Dominguez; Philippe Frascarolo; Sebastian Reiz

    2000-01-01

    We sought, in this observer-blinded study, to deter- mine the lethal dose for each of the local anesthetics levobupivacaine (L), racemic bupivacaine (B), and ropi- vacaine (R), and to compare their respective effects on the QRS interval of the precordial electrocardiograph after intracoronary injection. Anesthetized swine were instrumented with a left anterior descending artery cor- onary angiography catheter and injected

  1. Anesthetics act in quantum channels in brain microtubules to prevent consciousness.

    PubMed

    Craddock, Travis J A; Hameroff, Stuart R; Ayoub, Ahmed T; Klobukowski, Mariusz; Tuszynski, Jack A

    2015-01-01

    The mechanism by which anesthetic gases selectively prevent consciousness and memory (sparing non-conscious brain functions) remains unknown. At the turn of the 20(th) century Meyer and Overton showed that potency of structurally dissimilar anesthetic gas molecules correlated precisely over many orders of magnitude with one factor, solubility in a non-polar, 'hydrophobic' medium akin to olive oil. In the 1980s Franks and Lieb showed anesthetics acted in such a medium within proteins, suggesting post-synaptic membrane receptors. But anesthetic studies on such proteins yielded only confusing results. In recent years Eckenhoff and colleagues have found anesthetic action in microtubules, cytoskeletal polymers of the protein tubulin inside brain neurons. 'Quantum mobility' in microtubules has been proposed to mediate consciousness. Through molecular modeling we have previously shown: (1) olive oil-like non-polar, hydrophobic quantum mobility pathways ('quantum channels') of tryptophan rings in tubulin, (2) binding of anesthetic gas molecules in these channels, and (3) capabilities for ?-electron resonant energy transfer, or exciton hopping, among tryptophan aromatic rings in quantum channels, similar to photosynthesis protein quantum coherence. Here, we show anesthetic molecules can impair ?-resonance energy transfer and exciton hopping in tubulin quantum channels, and thus account for selective action of anesthetics on consciousness and memory. PMID:25714379

  2. A Double-Edged Sword: Volatile Anesthetic Effects on the Neonatal Brain

    PubMed Central

    Chiao, Sunny; Zuo, Zhiyi

    2014-01-01

    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

  3. Effects of the fish anesthetic, clove oil (eugenol), on coral health and growth

    Microsoft Academic Search

    S. E. Boyer; J. S. White; A. C. Stier; C. W. Osenberg

    2009-01-01

    Ecological research within coral reefs often requires the use of anesthetics to immobilize organisms. It is therefore important to consider the effect of these chemicals on the surrounding flora and fauna, particularly to the corals themselves. We quantified the effects of clove oil, a commonly used fish anesthetic, on the growth and occurrence of bleaching in three species of corals:

  4. Quantitative assay for epinephrine in dental anesthetic solutions by capillary electrophoresis

    E-print Network

    Chen, David D.Y.

    Quantitative assay for epinephrine in dental anesthetic solutions by capillary electrophoresis in capillary electrophoresis. The concentration detection limit for epinephrine is about 5.0 3 1027 M (90 ng ml, linearity, accuracy and specificity. Keywords: Capillary electrophoresis; epinephrine; dental anesthetic

  5. Homology Modeling of a Human Glycine Alpha 1 Receptor Reveals a Plausible Anesthetic Binding Site

    E-print Network

    Brutlag, Doug

    . Mutations within glycine and GABA receptors have demonstrated that possible sites of anesthetic action exist within the transmembrane domains of the ligand-gated ion channels. Most receptor proteins of biologicalHomology Modeling of a Human Glycine Alpha 1 Receptor Reveals a Plausible Anesthetic Binding Site

  6. Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia

    Microsoft Academic Search

    Kenneth D. Candido; Alon P. Winnie; Ahmed H. Ghaleb; Maher W. Fattouh; Carlo D. Franco

    2002-01-01

    Background and Objectives: Buprenorphine added to local anesthetic solutions for supraclavicular block was found to triple postoperative analgesia duration in a previous study when compared with local anesthetic block alone. That study, however, did not control for potentially confounding factors, such as the possibility that buprenorphine was affecting analgesia through intramuscular absorption or via a spinal mechanism. To specifically delineate

  7. Potential for a silicon probe in a Raman spectroscopic general-anesthetic sensor

    NASA Astrophysics Data System (ADS)

    Parnell, Julie R.; Yager, Paul

    1996-04-01

    Currently there is no direct method for measuring anesthetic levels in blood or tissue. Efforts are underway to develop a Raman spectroscopy-based sensor for general anesthetics using a polymeric probe. Signal enhancement, needed because of the inherently weak Raman signal, can be obtained by absorption of anesthetics into and recirculation of photons within the probe. Commercially available photopolymerizable silicones might have potential in the development of such probes since they are conducive to ring formation. Before attempting this, however, it is necessary to understand how the interfering silicone peaks will affect the signal-to-noise ratio of the anesthetic peaks and, ultimately, the sensor's detection limit. To this end, studies were performed on liquid anesthetics in silicon oil. The anesthetic C-H stretch peaks near 3000 cm-1 were obscured by those of the silicone. However, detection limits of 1.2, 1.5, and 1.2 MAC were observed for halothane, isoflurane, and enflurane, respectively, by monitoring a lower wavenumber region (900 - 1300 cm-1). In addition, 0 - 5 MAC mixtures of anesthetics were studied. PLS predictive models generated from MSC- corrected validation spectra predicted anesthetic levels relatively well for these mixtures (R2 equals 0.969, 0.984, and 0.979 for halothane, isoflurane, and enflurane, respectively); differences of 1 MAC were discernable.

  8. Inhibitory effects of anesthetics and ethanol on muscarinic receptors expressed in Xenopus oocytes

    Microsoft Academic Search

    Kouichiro Minami; Todd W Vanderah; Makiko Minami; R. Adron Harris

    1997-01-01

    Anesthetics (and ethanol) are known to produce amnesia as well as immobilization. Recent identification of a nonimmobilizing (nonanesthetic) agent (F6 or 1,2-dichlorohexafluorocyclobutane) that impairs learning and memory suggests that distinct mechanisms may be responsible for these two actions of anesthetic agents. Muscarinic receptors are believed to play a role in memory and learning, and we asked if a specific subtype

  9. Classical Deception Techniques and Perception Management vs. the Four Strategies of Information Warfare

    Microsoft Academic Search

    C. Kopp

    The use of deception techniques for intelligence operations, strategic and tactical deception in war, politics, business and media manipulation is well established and well documented. This paper analyses established deception techniques in the context of the four canonical strategies of Information Warfare, to establish an information theoretical and game theoretical framework for future modelling and analysis.

  10. Empirical and statistical analysis of risk analysis-driven techniques for threat management

    Microsoft Academic Search

    Koen Buyens; Bart De Win; Wouter Joosen

    2007-01-01

    Abstract One of the challenges of secure software construction (and maintenance) is to get control over the multitude of threats in order to focus mitigation efforts on the most rel- evant ones. Risk analysis is one class of techniques for achieving threat reduction, but few studies are available that evaluate the quality of these techniques. In this paper, a selected

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

    E-print Network

    Fisher, Cameron (Cameron Ardell Mayhew)

    2014-01-01

    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, ...

  12. Attitudes Toward Patient Management Problems as a Self-Assessment Technique in Dermatology

    ERIC Educational Resources Information Center

    Ramsay, David L.; And Others

    1977-01-01

    Patient management problems were found to be favorable methods of self-assessment by an overwhelming majority of practicing dermatologists and those in training, regardless of the type of practice or the number of years in practice. (LBH)

  13. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...their habitats, and/or providing recreation opportunities. (f) Inventory and assessment of biological resources. (g) Applied research that targets specific biological information or management needs. (h) Development of...

  14. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...their habitats, and/or providing recreation opportunities. (f) Inventory and assessment of biological resources. (g) Applied research that targets specific biological information or management needs. (h) Development of...

  15. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...their habitats, and/or providing recreation opportunities. (f) Inventory and assessment of biological resources. (g) Applied research that targets specific biological information or management needs. (h) Development of...

  16. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...their habitats, and/or providing recreation opportunities. (f) Inventory and assessment of biological resources. (g) Applied research that targets specific biological information or management needs. (h) Development of...

  17. Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy.

    PubMed

    Wright, G Paul; Mitchell, Eric J; McClure, Amanda M; Onesti, Jill K; Moyo, Steven C; Brown, Alexander R; Peshkepija, Andi; Scott, Geoffrey L; Chung, Mathew H

    2015-02-01

    Many techniques for laparoscopic appendectomy have been proposed with few comparative studies. We performed a retrospective review of all patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from 2006 to 2011. Techniques were: (1) transection of the mesoappendix and appendix with a single staple line (SSL); (2) transection of the mesoappendix and appendix with multiple staple lines (MSL); and (3) transection of the mesoappendix with ultrasonic shears and the appendix with a single staple line (USSL). A total of 565 cases were reviewed (149 SSL, 259 MSL, and 157 USSL). Patients treated with the SSL technique had decreased operative duration (P<0.001) and length of stay (P=0.003) despite equivalent disease presentations. Multivariate analysis demonstrated decreased operative duration with the SSL technique (P=0.001). Use of a SSL for transection of the mesoappendix and appendix is both a safe and efficient technique that results in reduced operative duration with excellent surgical outcomes. PMID:24752160

  18. Dynamic resource management technique with advance reservation over QoS-provisioned networks

    NASA Astrophysics Data System (ADS)

    Yi, DongHoon; Kim, JongWon

    2002-09-01

    Works on QoS-enabled IP networks have led to two distinct approaches: the integrated service (IntServ) and the differentiated service (DiffServ) architectures. To address the tradeoff between service guarantee and scalability, a resource manager (a.k.a. bandwidth broker: BB) can be employed to complement the IntServ/RSVP with the DiffServ in the pursuit of end-to-end QoS. One major component of the resource manager is a decision mechanism for resource allocation, which enables hosts to request per-flow, quantifiable resources along the end-to-end path and to obtain feedback regarding the acceptance. However, most of existing resource manager implementations are still adopting the decision mechanism that makes a decision on the immediate availability of resources, especially bandwidth. Considering the variations in the demand over the time, we can easily expect some level of inefficiency due to this in terms of resource utilization and management. Thus, we are investigating the methods to support the request scheduling and advance reservation for the dynamic resource management. We use a time slot manager to ensure that the committed resources never exceed a specified limit and to predict the unused (but reserved) bandwidth. Network simulations are conducted to evaluate the enhanced performance of the proposed mechanism (i.e., with respect to the acceptance rate, the resource utilization, and others).

  19. Anesthetic inhibition of firefly luciferase, a protein model for general anesthesia, does not exhibit pressure reversal.

    PubMed Central

    Moss, G W; Lieb, W R; Franks, N P

    1991-01-01

    The surprising observation that pressures of the order of 150 atmospheres can restore consciousness to an anesthetized animal has long been central to theories of the molecular mechanisms underlying general anesthesia. We have constructed a high-pressure gas chamber to test for "pressure reversal" of the best available protein model of general anesthetic target sites: the pure enzyme firefly luciferase, which accounts extremely well for animal potencies (over a 100,000-fold range). We found no significant pressure reversal for a variety of anesthetics of differing size and polarity. It thus appears that either firefly luciferase is not an adequate model for general anesthetic target sites or that pressure and anesthetics act at different molecular sites in the central nervous system. PMID:1777560

  20. Different techniques for management of common bile duct stones: a single centre experience.

    PubMed

    El Wakil, Mohamed Reda M; Abdelkader, Nadia A; Salem, Hossam El-Deen M; Halima Abo, Ahmed Samir

    2014-12-01

    Local experience on the combined technique of endoscopic sphincterotomy followed by endo: scopic balloon dilation is scarce. This study clarified whether this crombined technique will offer any advantages, with respect to therapeutic outcome and complications rate, as compared with endoscopic sphincterotomy (ES) and endoscopic balloon dilatation (EBD) alone for the extraction of large and/or multiple common bile duct stones. For a total of 76 patients, extraction of large and/or multiple common bile duct (CBD) stones during endoscopic retrograde cholangiopancreatography was performed. According to the used technique, they were categorized into 3 groups; Endoscopic sphincterotomy, endoscopic balloon dilatation or combined technique. The success rate of complete stone removal and the incidence of procedure-related complications were compared among the three groups. Success rate after one session was recorded to be comparable among the three groups. Relative Risk Ratio assessment of success rate after single session among the three groups showed no statistically significant difference. Regarding bleeding, only 3 (10%) cases were recorded in the ES group with no cases in the, other 2 groups. No significant difference was noted among the three groups regarding other complication. The combined technique of ES followed by EBD is an effective and safe technique enables extraction of multiple and/or relatively large stones. It could be a reasonable alternative option when standard techniques are inadequate to remove bile duct stones. PMID:25643496

  1. Inhibition of Firefly Luciferase by General Anesthetics: Effect on In Vitro and In Vivo Bioluminescence Imaging

    PubMed Central

    Keyaerts, Marleen; Remory, Isabel; Caveliers, Vicky; Breckpot, Karine; Bos, Tomas J.; Poelaert, Jan; Bossuyt, Axel; Lahoutte, Tony

    2012-01-01

    Bioluminescence imaging is routinely performed in anesthetized mice. Often isoflurane anesthesia is used because of its ease of use and fast induction/recovery. However, general anesthetics have been described as important inhibitors of the luciferase enzyme reaction. Aim To investigate frequently used mouse anesthetics for their direct effect on the luciferase reaction, both in vitro and in vivo. Materials and Methods isoflurane, sevoflurane, desflurane, ketamine, xylazine, medetomidine, pentobarbital and avertin were tested in vitro on luciferase-expressing intact cells, and for non-volatile anesthetics on intact cells and cell lysates. In vivo, isoflurane was compared to unanesthetized animals and different anesthetics. Differences in maximal photon emission and time-to-peak photon emission were analyzed. Results All volatile anesthetics showed a clear inhibitory effect on the luciferase activity of 50% at physiological concentrations. Avertin had a stronger inhibitory effect of 80%. For ketamine and xylazine, increased photon emission was observed in intact cells, but this was not present in cell lysate assays, and was most likely due to cell toxicity and increased cell membrane permeability. In vivo, the highest signal intensities were measured in unanesthetized mice and pentobarbital anesthetized mice, followed by avertin. Isoflurane and ketamine/medetomidine anesthetized mice showed the lowest photon emission (40% of unanesthetized), with significantly longer time-to-peak than unanesthetized, pentobarbital or avertin-anesthetized mice. We conclude that, although strong inhibitory effects of anesthetics are present in vitro, their effect on in vivo BLI quantification is mainly due to their hemodynamic effects on mice and only to a lesser extent due to the direct inhibitory effect. PMID:22253879

  2. Effects of Anesthetics on the Renal Sympathetic Response to Anaphylactic Hypotension in Rats

    PubMed Central

    Wang, Mofei; Kuda, Yuhichi; Kurata, Yasutaka; Shibamoto, Toshishige

    2014-01-01

    The autonomic nervous system plays an important role in rat anaphylactic hypotension. It is well known that sympathetic nerve activity and cardiovascular function are affected by anesthetics. However, the effects of different types of anesthesia on the efferent renal sympathetic nerve activity (RSNA) during anaphylactic hypotension remain unknown. Therefore, we determined the renal sympathetic responses to anaphylactic hypotension in anesthetized and conscious rats and the roles of baroreceptors in these responses. Sprague-Dawley rats were randomly allocated to anesthetic groups that were given pentobarbital, urethane, or ketamine-xylazine and to a conscious group. The rats were sensitized using subcutaneously injected ovalbumin. The systemic arterial pressure (SAP), RSNA and heart rate (HR) were measured. The effects of sinoaortic baroreceptor denervation on RSNA during anaphylaxis were determined in pentobarbital-anesthetized and conscious rats. In all of the sensitized rats, the RSNA increased and SAP decreased after antigen injection. At the early phase within 35 min of the antigen injection, the antigen-induced sympathoexcitation in the conscious rats was significantly greater than that in the anesthetized rats. Anaphylactic hypotension was attenuated in the conscious rats compared to the anesthetized rats. The anesthetic-induced suppression of SAP and RSNA was greater in the order ketamine-xylazine >urethane?=?pentobarbital. Indeed, in the rats treated with ketamine-xylazine, RSNA did not increase until 40 min, and SAP remained at low levels after the antigen injection. The baroreceptor reflex, as evaluated by increases in RSNA and HR in response to the decrease in SAP induced by sodium nitroprusside (SNP), was suppressed in the anesthetized rats compared with the conscious rats. Consistent with this finding, baroreceptor denervation attenuated the excitatory responses of RSNA to anaphylaxis in the conscious rats but not in the pentobarbital-anesthetized rats. RSNA was increased markedly in conscious rats during anaphylactic hypotension. Anesthetics attenuated this antigen-induced renal sympathoexcitation through the suppression of baroreceptor function. PMID:25423366

  3. Modulation of the general anesthetic sensitivity of a protein: a transition between two forms of firefly luciferase.

    PubMed Central

    Moss, G W; Franks, N P; Lieb, W R

    1991-01-01

    The activities of most proteins are relatively insensitive to general anesthetics. A notable exception is firefly luciferase, whose sensitivity to a wide range of anesthetic agents closely parallels that of whole animals. We have now found that this sensitivity can be controlled by ATP. The enzyme is insensitive at low (microM) concentrations of ATP and very sensitive at high (mM) concentrations. The differential sensitivity varies from anesthetic to anesthetic, being greatest (about a 100-fold difference) for molecules with large apolar segments. This suggests that anesthetic sensitivity is modulated by changes in the hydrophobicity of the anesthetic-binding pocket. Parallel changes in the binding of the substrate firefly luciferin, for which anesthetics compete, indicate that anesthetics bind at the same site as the luciferin substrate. These changes in the nature of the binding pocket modify not only the sensitivity to anesthetics but also the position of the "cutoff" in the homologous series of primary alcohol anesthetics; the cutoff position can vary from octanol to pentadecanol, depending upon the concentration of ATP. Our results suggest that particularly sensitive anesthetic target sites in the central nervous system may possess anesthetic-binding pockets whose polarities are regulated by neuromodulatory agents. PMID:1986359

  4. Adaptive techniques for leakage power management in L2 cache peripheral circuits

    Microsoft Academic Search

    Houman Homayoun; Alexander V. Veidenbaum; Jean-luc Gaudiot

    2008-01-01

    Recent studies indicate that a considerable amount of an L2 cache leakage power is dissipated in its peripheral circuits, e.g., decoders, word-lines and I\\/O drivers. In addition, L2 cache is becoming larger, thus increasing the leakage power. This paper proposes two adaptive architectural techniques (ADM and ASM) to reduce leakage in the L2 cache peripheral circuits. The adaptive techniques use

  5. Prevention of musculoskeletal disorders within management systems: A scoping review of practices, approaches, and techniques.

    PubMed

    Yazdani, Amin; Neumann, W Patrick; Imbeau, Daniel; Bigelow, Philip; Pagell, Mark; Wells, Richard

    2015-11-01

    The purpose of this study was to identify and summarize the current research evidence on approaches to preventing musculoskeletal disorders (MSD) within Occupational Health and Safety Management Systems (OHSMS). Databases in business, engineering, and health and safety were searched and 718 potentially relevant publications were identified and examined for their relevance. Twenty-one papers met the selection criteria and were subjected to thematic analysis. There was very little literature describing the integration of MSD risk assessment and prevention into management systems. This lack of information may isolate MSD prevention, leading to difficulties in preventing these disorders at an organizational level. The findings of this review argue for further research to integrate MSD prevention into management systems and to evaluate the effectiveness of the approach. PMID:26154224

  6. Influence of anesthetic variables on short-term and overall survival rates in cats undergoing renal transplantation surgery.

    PubMed

    Snell, William; Aronson, Lillian; Phillips, Heidi; Beale, Lynne; Larenza Menzies, M Paula

    2015-08-01

    Objective-To identify factors associated with short-term (30-day) and overall survival rates in cats that underwent renal transplantation surgery (RTS). Design-Retrospective cohort study. Animals-94 cats that underwent RTS from 1998 through 2010. Procedures-Data obtained from the medical records pertinent to RTS included cat signalment; anesthetic agents, techniques, and timings; supportive treatment; perioperative physiologic findings; and surgery and warm ischemia times. Associations with short-term and overall survival rates were investigated. Results-Median survival time was 653 days (range, 2 to 4,580 days). Prolonged anesthesia (median, 300 minutes; range, 225 to 445 minutes) reduced overall survival rate but did not influence short-term survival rate. No associations were identified between survival rates and anesthetic agent used, amount and type of fluid administered IV, physiologic abnormalities, and blood product administration. All cats that received ?-opioid receptor antagonists at anesthetic recovery to reverse the effects of ?-opioid receptor agonists survived for at least 30 days. High Hct at the end of anesthesia was also associated with an increase in short-term survival rate. Two cats had an intraoperative hemoglobin oxygen saturation < 90%, and both died within 7 days after surgery. Cats > 12 years old had a lower overall survival rate than did younger cats. Conclusions and Clinical Relevance-Minimization of total anesthesia time, reversal of ?-opioid receptor agonists at the end of anesthesia, and prevention of intraoperative decreases in blood oxygen saturation and postoperative decreases in Hct appeared to help maximize postsurgical survival time in cats undergoing RTS. PMID:26176726

  7. The use of modelling and reuse techniques in the development of water management systems in basins with limited water resources.

    PubMed

    Gabbrielli, E

    2004-01-01

    Drawing on experiences in New South Wales from 1950 to 1980 in modeling and re-use techniques in the development of desalination technology and its application in fresh water production for potable use, the paper describes how Australia realized its responsibilities in developing participative and sustainable approaches to land use and water resources management. An analysis of the lessons from the operation of the Bayswater zero-discharge power station significantly contributed to the debate on sustainable approaches, highlighting that no management policy of a water basin can be implemented without a model based on reliable data from all sectors (including the environment), and no management model can be implemented without the participation of all stakeholders. These ideals were reflected in the conception and establishment of the Murray-Darling Basin Commission. The Commission succeeded in bringing together all major stakeholders in this huge basin, though it took more than 15 years to do so. While widely recognized as one of the most advanced and successful experiences in integrated management of a drainage basin, it has still not achieved the reversal of many unsustainable agricultural practices, giving a clear indication of the difficulties and time required for producing sustainable solutions. PMID:15195414

  8. Management induced organic matter differentiation in grassland and arable soil: a study using pyrolysis techniques

    Microsoft Academic Search

    Klaas G. J. Nierop; Mirjam M. Pulleman; Joke C. Y. Marinissen

    2001-01-01

    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

  9. Management induced organic matter differentiation in grassland and arable soil: a study using pyrolysis techniques

    Microsoft Academic Search

    K. G. J. Nierop; M. M. Pulleman; J. C. Y. Marinissen

    2005-01-01

    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

  10. Managing Construction Operations Visually: 3-D Techniques for Complex Topography and Restricted Visibility

    ERIC Educational Resources Information Center

    Rodriguez, Walter; Opdenbosh, Augusto; Santamaria, Juan Carlos

    2006-01-01

    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…

  11. Improving Student Understanding of Operations Management Techniques through a Rolling Reinforcement Strategy.

    ERIC Educational Resources Information Center

    Mukherjee, Arup

    2002-01-01

    Operations management problems were taught to 41 students with same-day reinforcement and to 67 with rolling reinforcement (a day after teaching). Rolling reinforcement resulted in 71.4% mean score compared to 55.4%. Use of two reinforcements had a positive but not significant impact. More reinforcement helped significantly more students achieve…

  12. Self-optimized radio resource management techniques for LTE-A local area deployments

    Microsoft Academic Search

    Claudio Stocchi; Nicola Marchetti; Neeli Rashmi Prasad

    2011-01-01

    O ne of the most promising solutions to improve the performance of wireless networks is the extensive deployment of small size cells, such as femtocells. The expected uncoordinated femtocells deployment makes the Inter-Cell Interference (ICI) management a very critical issue, since it is the most limiting factor in such a scenario, in particular for users in bad conditions. This paper

  13. Evaluating Disease Management Program Effectiveness: An Introduction to the Bootstrap Technique

    Microsoft Academic Search

    Ariel Linden; John L. Adams; Nancy Roberts

    2005-01-01

    Disease management (DM) program evaluations are somewhat limited in scope because of typically small sample sizes comprising important subsets of the treated population. Identifying subsets of the data that have differing results from the aggregate of the whole program can lend insight into where, when, and how the program achieves its results. Additionally, there is a very limited set of

  14. Objectives for a Training Concept to Enhance Situation Awareness and Threat Management Techniques

    Microsoft Academic Search

    Hans-Juergen Hoermann; Jessy Lamers; Marian Schuver-van-Blanken

    Summary ESSAI - Enhanced Safety through Situation Awareness Integration in training - is an ongoing project supported by the European Community (DG-TREN). The goals of the project are two-fold: First, factors and strategies for effective Situation Awareness (SA) and Threat Management (TM) are identified by means of flight -crew surveys and analysis of accident and incident scenarios. Second, training solutions

  15. Feature Extraction Techniques for Measuring Piñon and Juniper Tree Cover and Density, and Comparison with Field-Based Management Surveys

    NASA Astrophysics Data System (ADS)

    Madsen, Matthew D.; Zvirzdin, Daniel L.; Davis, Bracken D.; Petersen, Steven L.; Roundy, Bruce A.

    2011-05-01

    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.

  16. Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution?

    PubMed

    Best, Corliss A; Best, Alyssa A; Best, Timothy J; Hamilton, Danielle A

    2015-01-01

    The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery. PMID:26090348

  17. Cardiovascular effects of Adonis aestivalis in anesthetized sheep.

    PubMed

    Maham, Masoud; Sarrafzadeh-Rezaei, Farshid

    2014-01-01

    Adonis aestivalis (summer pheasant-eye) is an annual plant with a crimson flower, distributed in southern Europe and Asia. The plant has large buttercup-like blossoms and soft, fern-like leaves. It blooms in spring and is often found as a weed in cereal fields. Like other Adonis spp., the plant produces cardiac glycosides. It is used in remedies for mild weakness of the heart, especially when accompanied by nervous complaints. Cardiovascular and toxic effects of a hydroalcoholic extract from the aerial parts of A. aestivalis were investigated in sheep and mice. Six male sheep were anesthetized with sodium pentobarbital and arterial blood pressure was measured with a transducer connected to the left femoral artery. Heart rate and electrocardiogram (ECG) were registered from lead base-apex ECG derivatives connected to a Powerlab recorder. Three successive equal doses (75 mg kg(-1)) of the hydroalcoholic extract of A. aestivalis intravenously administered to anesthetized sheep. Adonis aestivalis extract induced a significant bradycardia and hypotension in sheep. Various ECG abnormalities in sheep included sinus arrhythmia, shortened and depressed S-T interval, and absence of P wave and flattened or inverted T wave. In addition, ventricular arrhythmias, bradyarrhythmias, atrioventricular block, ventricular premature beats, ventricular tachycardia and ventricular fibrillation have also been observed. The acute intraperitoneal toxicity (LD50) of the extract in mice was 2150 mg kg(-1). In conclusion, bradycardia and ECG alterations induced by the extract could explain the justification of traditional use of the of Adonis aestivalis in treating cardiovascular insufficiency. PMID:25568718

  18. Intraspinal techniques for pain management in cancer patients: a systematic review

    Microsoft Academic Search

    Jeff Myers; Vincent Chan; Virginia Jarvis; Cindy Walker-Dilks

    2010-01-01

    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

  19. Digital compensation of cross-phase modulation distortions using perturbation technique for dispersion-managed fiber-optic systems.

    PubMed

    Liang, Xiaojun; Kumar, Shiva; Shao, Jing; Malekiha, Mahdi; Plant, David V

    2014-08-25

    A digital compensation scheme based on a perturbation theory for mitigation of cross-phase modulation (XPM) distortions is developed for dispersion-managed fiber-optic communication systems. It is a receiver-side scheme that uses a hard-decision unit to estimate data for the calculation of XPM fields using the perturbation technique. The intra-channel nonlinear distortions are removed by intra-channel digital backward propagation (DBP) based on split-step Fourier scheme before the hard-decision unit. The perturbation technique is shown to be effective in mitigating XPM distortions. However, wrong estimations in the hard-decision unit result in performance degradation. A hard-decision correction method is proposed to correct the wrong estimations. Numerical simulations show that the hybrid compensation scheme with DBP for dispersion and intra-channel nonlinear impairments compensation and the perturbation technique for XPM compensation brings up to 3.7 dBQ and 1.7 dBQ improvements as compared with the schemes of linear compensation only and intra-channel DBP, respectively. The perturbation technique for XPM compensation requires only one-stage (or two-stage when hard-decision correction is applied) compensation and symbol-rate signal processing. PMID:25321268

  20. Anesthetics and high-pressure interaction upon elastic properties of a polymer membrane.

    PubMed Central

    Kamaya, H; Suezaki, Y; Ueda, I; Eyring, H

    1981-01-01

    Anesthetics expand cell membranes, and high pressures (about 10-15 MPa) antagonize the anesthetic action. It is also known that inhalation anesthetics expand elastomer membranes. The mechanism of pressure antagonism of anesthetic action on membrane expansion was investigated in the present study with Silastic membranes. Halothane increased the length of Silastic membrane (0.14% per kPa), with an accompanying decrease of Young's modulus (3.7.10(5) Newton/m2 per kPa). High pressure decreased the length of the membrane and increased Young's modulus. The magnitudes of the pressure effect on the length and Young's modulus of the Silastic membrane in the presence of the anesthetic were not identical with those observed in the absence of the anesthetic. In the presence of halothane at pressures common to clinical applications, the bulk modulus of the membrane decreased about 4.6-4.0%. These results suggest that the effects of pressure and anesthetic upon the elastomer may not be completely independent of each other. PMID:6943557

  1. A rare case of delayed subarachnoid anesthetic blockade effects in a 103-year-old female patient

    PubMed Central

    Ghaly, Ramsis F.; Anantamongkol, Utchariya; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: The elderly represent a unique challenge for the effects of regional anesthesia, and very few cases of block onset delay have been described. Their delayed response is attributed to a number of factors that include: Physiologic deterioration, musculoskeletal contractures, degenerative joint disease, autonomic regulatory dysfunction, cognitive dysfunction, altered pharmacokinetics, and pharmacodynamics of local anesthetics and adjuvants. Case Description: In this report we present the rare case of 45-min delay between the administration and onset of action of a subarachnoid blockade in a 103-year-old female, who was scheduled for left hip pinning, for repair of a femoral neck fracture. Patient received an injection of hyperbaric bupivacaine, 1.5 ml of 0.75% (11.25 mg), with 15 mcg of fentanyl into the subarachnoidal space and underwent the surgical procedure without complications. Conclusions: Delayed responses to subarachnoid anesthesia can be expected in extremely elderly patients. Anesthetic procedures should be monitored and managed on a case-by-case basis.

  2. IEEE COMMUNICATIONS SURVEYS & TUTORIALS, ACCEPTED FOR PUBLICATION 1 Energy Management Techniques in

    E-print Network

    Hand, Steven

    alternative left at the moment to extend the battery life of mobile phones is reducing the power consumption the battery life of mobile handhelds to few hours of operation. The research community, and operating system and hardware vendors found interesting optimisations and techniques to extend the battery life of mobile phones

  3. Disruptive Behavior: Three Techniques To Use in Your Classroom. CEC Mini-Library: Classroom Management.

    ERIC Educational Resources Information Center

    Cipani, Ennio

    The purpose of this manual is to provide teachers and other instructional personnel with an understanding of disruptive behavior and effective techniques to use in dealing with children who are disruptive in the classroom. An introductory chapter describes and defines disruptive behavior, explains possible by-products of disruptive behavior, and…

  4. The pouch and tunnel technique for management of multiple gingival recession defects

    PubMed Central

    Dani, Sneha; Dhage, Aditi; Gundannavar, Gayatri

    2014-01-01

    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

  5. Use of Formative Classroom Assessment Techniques in a Project Management Course

    ERIC Educational Resources Information Center

    Purcell, Bernice M.

    2014-01-01

    Formative assessment is considered to be an evaluation technique that informs the instructor of the level of student learning, giving evidence when it may be necessary for the instructor to make a change in delivery based upon the results. Several theories of formative assessment exist, all which propound the importance of feedback to the student.…

  6. Tools and Techniques for Evaluating the Effects of Maintenance Resource Management (MRM) in Air Safety

    NASA Technical Reports Server (NTRS)

    Taylor, James C.

    2002-01-01

    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.

  7. I, S, T, and J Grading Techniques for Es, Ns, Fs, and Ps: Insights from the MBTI on Managing the Grading Process

    ERIC Educational Resources Information Center

    Fornaciari, Charles J.; Lund Dean, Kathy

    2013-01-01

    Most instructors at least occasionally experience grading student work as a frustrating, time-consuming task. The Myers-Briggs Type Indicator (MBTI) instrument can be a powerful self-awareness tool for management educators seeking to enhance their grading techniques. Evidence suggests that many management professors prefer Extraversion (E),…

  8. Application of clustering techniques for the characterization of macroinvertebrate communities to support river restoration management

    Microsoft Academic Search

    V. Adriaenssens; P. F. M. Verdonschot; P. L. M. Goethals; N. De Pauw

    2007-01-01

    The European Water Framework Directive prescribes that the development of a river assessment system should be based on an\\u000a ecological typology taking the biological reference conditions of each river type as a starting point. Aside from this assessment,\\u000a water managers responsible for river restoration actions also need to know the steering environmental factors to meet these\\u000a reference conditions for biological

  9. Adoption of Pollution Prevention Techniques: The Role of Management Systems and Regulatory Pressures

    Microsoft Academic Search

    Madhu Khanna; George Deltas; Donna Ramirez Harrington

    2009-01-01

    This paper investigates the extent to which firm level technological change that reduces unregulated emissions is driven by\\u000a regulatory pressures, and firms’ technological and organizational capabilities. Using a treatment effects model with panel\\u000a data for a sample of S&P 500 firms over the period 1994–1996, we find that organizational change in the form of Total Quality\\u000a Environmental Management leads firms

  10. A hypothesis on the origin and evolution of the response to inhaled anesthetics

    PubMed Central

    2009-01-01

    An evolutionary narrative explaining why organisms respond to inhaled anesthetics is proposed. It is conjectured that organisms today respond to inhaled anesthetics because their ion channels are sensitive to inhaled anesthetics by virtue of common descent from ancestral, anesthetic-sensitive ion channels in one-celled organisms (i.e., that the response to anesthetics did not arise as an adaptation of the nervous system, but rather of ion channels that preceded the origin of multicellularity). This sensitivity may have been refined by ongoing selection at synapses in multicellular organisms. In particular, it is hypothesized that (1) the beneficial trait that was selected for in one-celled organisms was the coordinated response of ion channels to compounds that were present in the environment which influenced the conformational equilibrium of ion channels (2) that this coordinated response prevented the deleterious consequences of entry of positive charges into the cell, thereby increasing the fitness of the organism (3) that these compounds (which may have included organic anions, cations, and zwitterions as well as uncharged compounds) mimicked inhaled anesthetics in that they were interfacially active, and modulated ion channel function by altering bilayer properties coupled to channel function. The proposed hypothesis is consistent with known properties of inhaled anesthetics. In addition, it leads to testable experimental predictions of nonvolatile compounds having anesthetic-like modulatory effects on ion channels and in animals, including that of endogenous compounds that may modulate ion channel function in health and disease. The latter included metabolites which are elevated in some types of end stage organ failure, and genetic metabolic diseases. Several of these predictions have been tested and proved to be correct. Implications A hypothesis for the origin and evolution of the response to inhaled anesthetics is offered, and experimental predictions of this theory are made. PMID:18713893

  11. FaceTime(®) for teaching ultrasound-guided anesthetic procedures in remote place.

    PubMed

    Miyashita, Tetsuya; Iketani, Yasuhiro; Nagamine, Yusuke; Goto, Takahisa

    2014-04-01

    In isolated area in Japan, only one anesthesiologist must often do new anesthetic techniques such as ultrasound-guided procedures without receiving any teaching. One solution to this problem may involve teleanesthesia, by which experienced anesthesiologists teach novices in remote places, by utilizing information communication technologies. FaceTime™ (Apple, USA), which provides 120p of the resolution and 30 frames per second (fps) is an application of free visual communications using iPod Touch™, iPhone™ or iPad™ (Apple, USA). We investigated the delay time, the loss of the frames and the picture quality of iPad (as the device in the teaching site) in combination with iPod Touch, iPhone4 or iPhone5 (as the device in the isolated site) during FaceTime. At the operating rooms in Sado General Hospital (SGH) located in Sado Island (population; approximately 60,000), Japan, an anesthesiologist prepared 3 mobile devices (iPod Touch, iPhone4 or iPhone5). He called the other anesthesiologist at Yokohama City University Hospital (YCUH; approximately 300 km apart) by FaceTime using 1 of 3 mobile devices. The anesthesiologist at YCUH received the FaceTime call using iPad. After the connection was established, the display of the same cervical ultrasound image at SGH was sent to YCUH to evaluate the distinctness visually. Then we measured the delay time of every second (n = 60) and the loss of the frames (total frames = 30 fps × 60 s = 1,800) in each device for a minute. P < 0.01 was statistically significant. The quality of the pictures on the iPad display sent from iPhone5 was distinctly the best visually. The delay time of iPhone5 was significantly longer than the others (iPod Touch; 0.14 ± 0.02 s, iPhone4; 0.13 ± 0.02 s, iPhone5; 0.19 ± 0.03 s), but clinically acceptable. The loss of the frames of iPhone5 (20; 1.1%) was significantly less than the others (iPhone4; 900, 50.0%, iPod Touch; 902, 50.1%). To teach anesthetic techniques in remote place by FaceTime, iPhone5 as the devise in isolate site was optimum compared with iPod Touch and iPhone4. PMID:24222344

  12. [Perioperative management of off-pump CABG for a 93-year-old man].

    PubMed

    Yara, Miki; Tomino, Mikiko; Miyata, Kazuto; Ishida, Yusuke; Saiki, Iwao; Seta, Nayuko; Hara, Naomi; Uchino, Hiroyuki

    2014-10-01

    In recent years, the aging population has been growing, and the operative techniques and anesthetic methods have advanced. With these developments and medical support, the number of operations on very elderly patients has been increasing. We report the perioperative management of off-pump CABG for a 93-year-old man. When the heart was displaced during the operation, hypotension was induced and a marked reduction of his bispectral index (BIS) to "1" appeared. During the perioperative period, the patient developed delirium that was difficult to manage, but he was discharged from the hospital without any complications on POD 21. As part of the perioperative management, intraoperative cerebral circulatory management with attention to cerebral perfusion and prevention of postoperative delirium is crucial. PMID:25693348

  13. A review of local anesthetic cardiotoxicity and treatment with lipid emulsion

    PubMed Central

    Bourne, Emma; Wright, Christine; Royse, Colin

    2010-01-01

    Cardiovascular collapse from accidental local anesthetic toxicity is a rare but catastrophic complication of regional anesthesia. The long-acting amide local anesthetics bupivacaine, levobupivacaine and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the chance discovery that lipid emulsion may improve the chance of successful resuscitation has lead to recommendations that it should be available in every location where regional anesthesia is performed. This review will outline the mechanisms of local anesthetic toxicity and the rationale for lipid emulsion therapy. PMID:22915863

  14. Applications notice. [application of space techniques to earth resources, environment management, and space processing

    NASA Technical Reports Server (NTRS)

    1978-01-01

    The discipline programs of the Space and Terrestrial (S&T) Applications Program are described and examples of research areas of current interest are given. Application of space techniques to improve conditions on earth are summarized. Discipline programs discussed include: resource observations; environmental observations; communications; materials processing in space; and applications systems/information systems. Format information on submission of unsolicited proposals for research related to the S&T Applications Program are given.

  15. Application of Modern Tools and Techniques for Mine Safety & Disaster Management

    NASA Astrophysics Data System (ADS)

    Kumar, Dheeraj

    2015-06-01

    The implementation of novel systems and adoption of improvised equipment in mines help mining companies in two important ways: enhanced mine productivity and improved worker safety. There is a substantial need for adoption of state-of-the-art automation technologies in the mines to ensure the safety and to protect health of mine workers. With the advent of new autonomous equipment used in the mine, the inefficiencies are reduced by limiting human inconsistencies and error. The desired increase in productivity at a mine can sometimes be achieved by changing only a few simple variables. Significant developments have been made in the areas of surface and underground communication, robotics, smart sensors, tracking systems, mine gas monitoring systems and ground movements etc. Advancement in information technology in the form of internet, GIS, remote sensing, satellite communication, etc. have proved to be important tools for hazard reduction and disaster management. This paper is mainly focused on issues pertaining to mine safety and disaster management and some of the recent innovations in the mine automations that could be deployed in mines for safe mining operations and for avoiding any unforeseen mine disaster.

  16. [The effects of low dose clonidine on perioperative hemodynamics and anesthetic requirements in elderly patients].

    PubMed

    Masuda, T; Kondo, A; Akazawa, T; Kitahata, H; Nakahara, T

    1995-05-01

    The effects of clonidine, alpha 2-adrenergic receptor agonist, on perioperative hemodynamics and anesthetic requirements were studied in randomized 20 elderly patients without hypertension (ASA I-II) scheduled for elective abdominal surgery under general anesthesia. The control group (n = 10) was premedicated with oral diazepam 0.1 mg.kg-1 90 min prior to arrival in the operating room. The clonidine group (n = 10), in addition, received clonidine approximately 2.5 micrograms.kg-1 orally at the same time. Anesthesia was induced with fentanyl 2 micrograms.kg-1 and thiamylal 4 mg.kg-1. Vecuronium 0.15 mg.kg-1 following 0.01 mg.kg-1 priming dose was used to facilitate endotracheal intubation. Anesthesia was maintained with isoflurane in 50% nitrous oxide-oxygen and supplementary fentanyl. Clonidine effectively attenuated the cardiovascular response associated with laryngoscopy and tracheal intubation. Intraoperative variability of heart rate was significantly lower in patients receiving clonidine compared with controls. No significant differences in the requirements of either isoflurane or narcotic supplementation were observed between the two groups. We conclude that a low dose clonidine is a useful adjunct in the management of elderly patients without producing side effects. PMID:7609294

  17. Combining sediment source tracing techniques with traditional monitoring to assess the impact of improved land management on catchment sediment yields

    NASA Astrophysics Data System (ADS)

    Minella, Jean P. G.; Walling, Des E.; Merten, Gustavo H.

    2008-01-01

    SummaryThis paper aims to demonstrate the potential value of combining sediment source tracing techniques with traditional monitoring approaches, when documenting the impact of improved land management on catchment sediment yields. It reports the results of an investigation undertaken in a small (1.19 km 2) agricultural catchment in southern Brazil, which was monitored before and after the implementation of improved land management practices. Attention focussed on 50 storm events that occurred between May 2002 and March 2006 and which reflected the behaviour of the catchment during the pre-change, transition and post-change periods. Improved land management, involving minimum-till cultivation and the maintenance of good crop cover, was introduced in early 2003. The traditional monitoring provided a basis for evaluating the changes in storm runoff volume, storm hydrograph peak and storm-period sediment load and mean suspended sediment concentration. The results indicate that both storm runoff volumes and peak flows associated with a given amount of rainfall provided evidence of a significant decrease after the introduction of improved land management. Storm-period sediment loads showed a similar reduction, with a reduction by as much as 80% for low magnitude events and of ca. 40% for events of intermediate magnitude. However, there was no significant change in mean suspended sediment concentrations, indicating that the reductions in sediment load were primarily the result of the reduced storm runoff volume. Sediment source fingerprinting was used to explore the changes in the relative and absolute contributions to the storm sediment loads from the three key sources, namely the surface of the fields under crops, the unpaved roads and the stream channels. A comparison of the load-weighted mean contributions for the pre- and post-treatment periods indicated that the contribution from the field surfaces and unpaved roads decreased from 63% and 36% to 54% and 24%, respectively, whereas the contribution from the stream channels increased from ca. 2% to 22%. By relating the absolute amounts of sediment mobilised from each individual source group to variables representing the runoff and precipitation associated with the events, it was possible to identify changes in the response of the individual sediment sources to the changes in land management that occurred within the catchment. Sediment mobilisation from the stream channel during individual events increased substantially over the whole range of flows after the introduction of improved land management in the study catchment, whereas the amounts of sediment mobilised from the surfaces of the fields and the unpaved roads showed a significant decrease during events of low and intermediate magnitude. The short monitoring period associated with the study, coupled with inter-annual variations in rainfall, necessarily limit the scope and rigour of the study reported, but it is seen to provide a useful demonstration of how the coupling of sediment source tracing with more traditional monitoring techniques can provide an improved understanding of the impact of improved management practices on the sediment response of a catchment, as well as important information to inform the design and implementation of effective sediment management and control measures.

  18. Usability Evaluation of an Online, Tailored Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients Incorporating Behavior Change Techniques

    PubMed Central

    Moser, Albine; van der Weijden, Trudy; Nagykaldi, Zsolt; de Vries, Hein; Tange, Huibert

    2013-01-01

    Background An eHealth intervention using computer tailored technology including several behavior change techniques was developed to support the self-management of chronic obstructive pulmonary disease patients. Objective The goal of this study was to evaluate and improve the usability of the eHealth intervention. Methods We conducted a usability evaluation with 8 chronic obstructive pulmonary disease patients, with a mixed methods design. We improved the usability through iterative cycles of evaluation and adaptation. Participants were asked to think aloud during the evaluation sessions. Participants then completed a semi-structured interview. The sessions were observed and recorded. Descriptive statistics and content analysis were used to uncover usability issues. Results Areas for improvement were layout, navigation, and content. Most issues could be solved within 3 iterations of improvement. Overall, participants found the program easy to use. The length of the program urged us to further analyze the appreciation of behavior change techniques. Some were perceived as helpful and easy to use, while others evoked frustration. Conclusions The usability study identified several issues for improvement, confirming the need for usability evaluation during the development of eHealth interventions. The uncovered strengths and limitations of behavior change techniques may lead to optimization of eHealth interventions, but further insight is needed. PMID:23612363

  19. Innovations of surgical techniques for the management of inferior vena cava tumor thrombus of renal cell carcinoma.

    PubMed

    Yuan, S M

    2014-09-01

    Surgery for renal cell carcinoma with inferior vena cava thrombus is challenging. Cardiopulmonary bypass and deep hypothermic circulatory arrest significantly decreased the morbidity and mortality but associated with considerable postoperative complications. Debates still exist in one- or two-stage operations on which of the cardiac and urologic parts should be performed first. Modified maneuvers with main pulmonary artery clamping, vena cystoscope, transesophageal echocardiographic incorporation, and inferior vena cava interruptions are good for reduced perioperative morbidities. Surgical innovations have greatly facilitated the resection of renal cell carcinoma and inferior vena cava involvement. The advantages have been remarkable in less trauma, more cosmetic advantages, shorter hospital stay, and quicker recovery over the conventional open surgery with or without the use of bypass techniques. Such procedures have brought about improved long-term survivals. However, novel minimally invasive techniques such as robotic-assisted and hybrid approaches remain to gain further popularity in larger patient population. This article aims at a collection of the innovations of the surgical techniques in relation to the management of inferior vena cava tumor thrombus. PMID:25072132

  20. Complete Submuscular Breast Augmentation: 650 Cases Managed Using an Alternative Surgical Technique

    Microsoft Academic Search

    Hans Hendricks

    2007-01-01

    Background  An alternative complete submuscular surgical technique for primary breast augmentation is presented. Since 1998, the author\\u000a has refined the procedure for total submuscular placement of textured silicone gel implants, with good results for more than\\u000a 650 patients.\\u000a \\u000a \\u000a \\u000a Methods  The submuscular plane is accessed via a semicircular periareolar incision. Round or anatomic implants are placed beneath the\\u000a pectoralis major and external oblique

  1. Safety and Efficacy of Various Combinations of Injectable Anesthetics in BALB/c Mice

    PubMed Central

    Buitrago, Sandra; Martin, Thomas E; Tetens-Woodring, Joanne; Belicha-Villanueva, Alan; Wilding, Gregory E

    2008-01-01

    Four combinations of drugs—ketamine–xylazine, ketamine–xylazine–acepromazine (KXA), ketamine–xylazine–buprenorphine, and ketamine–xylazine–carprofen—were compared for their ability to produce anesthesia in BALB/c mice. Induction time, anesthetic duration, blood pressure, pulse rate, and time to recovery were recorded. The anesthesia induced by each anesthetic combination was assessed by using reflex responses to standardized stimuli. The KXA combination produced stable physiologic parameters and was associated with the longest duration of anesthesia (40 ± 8 min); immobility was produced in all other groups (38 ± 5 min), but a surgical plane of anesthesia could not be confirmed. All anesthetic protocols produced significant hypotension. No deaths occurred. We recommend KXA as a safe and reliable anesthetic for mice requiring a surgical plane of anesthesia. PMID:18210992

  2. Effectiveness of 20% benzocaine as a topical anesthetic for intraoral injections.

    PubMed Central

    Nusstein, John M.; Beck, Mike

    2003-01-01

    The use of topical anesthetics has been advocated prior to the administration of various types of anesthetic injections. Reported results have varied between studies. The purpose of this study was to compare the effectiveness of 20% benzocaine in reducing the pain of needle insertion during maxillary posterior and anterior infiltration and inferior alveolar nerve block injections. In this retrospective study, 1080 patients received 2336 injections using a 27-gauge needle. Topical anesthetic was applied prior to 720 of the injections. Patients rated pain of needle insertion using a 0-4 pain scale. Logistic regression analysis showed no differences in pain ratings between topical and no topical groups for the inferior alveolar nerve block and posterior maxillary infiltration injections. The use of topical anesthetic did reduce the pain of needle insertion with the maxillary anterior injections (P = .0041). PMID:14959903

  3. 75 FR 876 - Anesthetic and Life Support Drugs Advisory Committee; Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-06

    ...Anesthetic and Life Support Drugs Advisory Committee scheduled...Kalyani Bhatt, Center for Drug Evaluation and Research (HFD-21), Food and Drug Administration, 5600 Fishers Lane (for express delivery, 5630 Fishers Lane, rm....

  4. ENHANCED SUSCEPTIBILITY TO KINDLING BY CHLORDIMEFORM MAY BE MEDIATED BY ALOCAL ANESTHETIC ACTION

    EPA Science Inventory

    The formamidine pesticides amitraz and chlordimeform have recently been shown to be potent proconvulsants (Gilbert 1988). wo main neuroactive prosperities have been identified as mediators of formamidine neurotoxicity, -2 adrenergic agonism and local anesthetic actions. hese two ...

  5. Development of minimally invasive techniques for management of medically-complicated obesity.

    PubMed

    Rashti, Farzin; Gupta, Ekta; Ebrahimi, Suzan; Shope, Timothy R; Koch, Timothy R; Gostout, Christopher J

    2014-10-01

    The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss. PMID:25309074

  6. Development of minimally invasive techniques for management of medically-complicated obesity

    PubMed Central

    Rashti, Farzin; Gupta, Ekta; Ebrahimi, Suzan; Shope, Timothy R; Koch, Timothy R; Gostout, Christopher J

    2014-01-01

    The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss. PMID:25309074

  7. Massage Therapy Techniques as Pain Management for Erythromelalgia: A Case Report

    PubMed Central

    Dicks, Krista; Rizek, Philippe

    2010-01-01

    Background Erythromelalgia is characterized by temperature-dependent redness, pain, and warmth in one or more extremities. It may be a primary disease, or it may occur secondarily because of underlying illness. It is a chronic, debilitating condition often resistant to medical treatment. Purpose The present report evaluates massage as a complementary therapy to reduce pain and other symptoms associated with erythromelalgia. Participant A 31-year-old female with a long-standing history of erythromelalgia bilaterally in the lower extremities presented with complaints of acute pain exacerbation, anxiety, decreased quality of sleep, and difficulty with activities of daily living for prolonged periods of time. She had no previous experience with massage therapy or any other complementary therapies. Intervention Massage therapy was introduced over the course of 9 treatments, each 1 hour in duration, using various massage therapy techniques, remedial exercise, and recommended home care. Results In this patient with erythromelalgia, effleurage and petrissage as massage therapy techniques provided temporary pain relief in the lower extremities and long-term benefits that relieved anxiety, which improved restorative sleep and increased the patient’s participation in activities of daily living. Conclusions For this treatment protocol, therapist observation and patient feedback suggest that massage therapy may lead to a state of increased relaxation, decreased stress, decreased muscle tension, and improved sleep. These positive effects may have an indirect role in the ability of the patient to cope with erythromelalgia day to day. PMID:21589683

  8. [Management of the buried bumper syndrome: a new minimally invasive technique--the push method].

    PubMed

    Müller-Gerbes, D; Aymaz, S; Dormann, A J

    2009-11-01

    The so-called buried bumper syndrome is characterised by a pathological alteration of the percutaneous endoscopic gastrostomy (PEG) in the form of a tissue overgrowth of the internal bumper of the tube. A lack of mobilisation of the tube and/or continuous traction on the PEG causes the bumper to be impacted by stomach mucosa. The consequence is a local chronic inflammatory process that may result in the occlusion of the feeding tube. As of now, different therapeutic methods exist: the surgical technique based on common laparotomy, the local invasive removal by cutting along the tube and inner flange from the outside and pulling it out (pull method) and the endoscopic recovery from inside the stomach. The authors have developed and evaluated a new endoscopic, minimally invasive technique (push method). In eight of nine patients the inner bumper could be freed by cutting with a papillotome which is brought into the stomach through the shortened PEG from the outside while maintaining endoscopic control. Afterwards the bumper is pushed to the inside with a dilatator and the patients are provided with a balloon system using the persisting stoma. The subsequent healing process proved to yield no further complications. PMID:19899022

  9. Lidocaine Cyclodextrin complex Ophthalmic Drop, a New Topical Anesthetic Choice

    PubMed Central

    Sabermoghadam Ranjbar, AA; Rajabi, O; Salari, R; Ashraf, H

    2012-01-01

    Background Topical anesthesia is a safe and cost-effective method considered as the first-choice in many procedures. Due to the physiological characteristics of eye, most of the local anesthetics cannot efficiently penetrate through the conjunctiva deep to tenon. The aim of this pilot study was to find a new form of lidocaine to give a sufficient level of anesthesia. Methods: Lidocaine Cyclodextrin complex ophthalmic drop was produced and its pharmacological properties were studied [tested] in standard temperature and pressure. 30 patients (18 males, 12 females) with the mean age of 30.68±8.02 years enrolled in this clinical trial. All the patients were fully informed and signed the ethics committee consent forms. The patients were given tetracaine drop as the anesthetic: 3 drops separated 2 minute apart 10 min before the intervention. If we achieved a sufficient level of anesthesia, the procedure was done after. If the patient could not tolerate the procedure, the method was changed to lidocaine drop (administered after wash-out period like the first drop).The last option was conventional injection method if the patient could not tolerate the procedure with the second method either.We used this type of anesthesia for conventional procedures such as forced duction test, symblepharon, pterygium, and disport injection into extra-ocular muscles. All the procedures were done by one surgeon in a university hospital. We used a 0 to 10 visual analogue scale for pain and two 0 to 4 patient and physician satisfaction scales designed for this study. Results The mean pain score was 7.53±0.90 in group 1 and 3.03±1.83 in group 2 (P=0.00). Patient and surgeon satisfaction in group 1 were 1.33±0.48 and 1.40±0.56 respectively; while 3.23±1.00 and 3.56±0.77 for group 2 (P=0.00). Tetracaine drop could not induce sufficient anesthesia for none of the patients. Cyclodextrin based lidocaine drop was successful except For two patients for whom we changed the anesthesia to Sub-conjunctival injection method. Conclusion Our newly manufactured cyclodextrin based lidocaine eye drop could successfully induce sufficient anesthesia for 28 of 30 patients. Further studies with larger sample sizes are now being designed to find more clinical evidence about this method. PMID:23115719

  10. Specificity of stimulus-evoked fMRI responses in the mouse: the influence of systemic physiological changes associated with innocuous stimulation under four different anesthetics.

    PubMed

    Schroeter, Aileen; Schlegel, Felix; Seuwen, Aline; Grandjean, Joanes; Rudin, Markus

    2014-07-01

    Functional magnetic resonance (fMRI) in mice has become an attractive tool for mechanistic studies, for characterizing models of human disease, and for evaluation of novel therapies. Yet, controlling the physiological state of mice is challenging, but nevertheless important as changes in cardiovascular parameters might affect the hemodynamic readout which constitutes the basics of the fMRI signal. In contrast to rats, fMRI studies in mice report less robust brain activation of rather widespread character to innocuous sensory stimulation. Anesthesia is known to influence the characteristics of the fMRI signal. To evaluate modulatory effects imposed by the anesthesia on stimulus-evoked fMRI responses, we compared blood oxygenation level dependent (BOLD) and cerebral blood volume (CBV) signal changes to electrical hindpaw stimulation using the four commonly used anesthetics isoflurane, medetomidine, propofol and urethane. fMRI measurements were complemented by assessing systemic physiological parameters throughout the experiment. Unilateral stimulation of the hindpaw elicited widespread fMRI responses in the mouse brain displaying a bilateral pattern irrespective of the anesthetic used. Analysis of magnitude and temporal profile of BOLD and CBV signals indicated anesthesia-specific modulation of cerebral hemodynamic responses and differences observed for the four anesthetics could be largely explained by their known effects on animal physiology. Strikingly, independent of the anesthetic used our results reveal that fMRI responses are influenced by stimulus-induced cardiovascular changes, which indicate an arousal response, even to innocuous stimulation. This may mask specific fMRI signal associated to the stimulus. Hence, studying the processing of peripheral input in mice using fMRI techniques constitutes a major challenge and adapted paradigms and/or alternative fMRI readouts should also be considered when studying sensory processing in mice. PMID:24495809

  11. Anesthetic gases and global warming: Potentials, prevention and future of anesthesia

    PubMed Central

    Gadani, Hina; Vyas, Arun

    2011-01-01

    Global warming refers to an average increase in the earth?s temperature, which in turn causes changes in climate. A warmer earth may lead to changes in rainfall patterns, a rise in sea level, and a wide range of impacts on plants, wildlife, and humans. Greenhouse gases make the earth warmer by trapping energy inside the atmosphere. Greenhouse gases are any gas that absorbs infrared radiation in the atmosphere and include: water vapor, carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), halogenated fluorocarbons (HCFCs), ozone (O3), perfluorinated carbons (PFCs), and hydrofluorocarbons (HFCs). Hazardous chemicals enter the air we breathe as a result of dozens of activities carried out during a typical day at a healthcare facility like processing lab samples, burning fossil fuels etc. We sometimes forget that anesthetic agents are also greenhouse gases (GHGs). Anesthetic agents used today are volatile halogenated ethers and the common carrier gas nitrous oxide known to be aggressive GHGs. With less than 5% of the total delivered halogenated anesthetic being metabolized by the patient, the vast majority of the anesthetic is routinely vented to the atmosphere through the operating room scavenging system. The global warming potential (GWP) of a halogenated anesthetic is up to 2,000 times greater than CO2. Global warming potentials are used to compare the strength of different GHGs to trap heat in the atmosphere relative to that of CO2. Here we discuss about the GWP of anesthetic gases, preventive measures to decrease the global warming effects of anesthetic gases and Xenon, a newer anesthetic gas for the future of anesthesia. PMID:25885293

  12. The effects of various anesthetics on tissue levels of fructose-2,6-bisphosphate in rats.

    PubMed

    Kasten, T; Colliver, J A; Montrey, R D; Dunaway, G A

    1990-07-01

    We report that the short-term use of various anesthetic agents prior to decapitation causes alteration of the levels of fructose-2,6-bisphosphate in kidney, brain, heart, muscle, and liver. These data indicate that even light anesthesia can not be used when levels of this metabolite are to be determined. Also, it appears that the use of any of these anesthetics can profoundly alter glucose utilization in many tissues. PMID:2166868

  13. Local anesthetic effect of tramadol, metoclopramide, and lidocaine following intradermal injection

    Microsoft Academic Search

    Wei-Wu Pang; Martin S. Mok; Da-Peng Chang; Min-Ho Huang

    1998-01-01

    Background and Objectives. We observed clinically that tramadol and metoclopramide appear to have local anesthetic action. Tramadol is a central-acting analgesic. Metoclopramide is a commonly used antiemetic. The local anesthetic effect of tramadol in reducing propofol injection pain has never been mentioned, although it was speculated with metoclopramide. Methods. We conducted a double-blind, placebo-controlled study by injecting tramadol or metoclopramide

  14. The Anesthetic Effects of Etomidate: Species-Specific Interaction with ?2-Adrenoceptors

    Microsoft Academic Search

    Andrea Paris; Lutz Hein; Marc Brede; Philipp-Alexander Brand; Jens Scholz; Peter H. Tonner

    2007-01-01

    BACKGROUND: The IV anesthetic, etomidate, has structural and clinical similarities to specific 2-adrenoceptor agonists such as dexmedetomidine. We investigated whether the sedative effects of etomidate may be mediated by 2-adrenoceptors. METHODS: The anesthetic potency of etomidate (1-20 M) was determined in Xenopus laevis tadpoles in the absence and presence of the specific 2-adrenoceptor antagonist atipamezole (10 M). Anesthesia was defined

  15. Effect of volatile anesthetics on endogenous tryptophan, 5-hydroxytryptophan and 5-hydroxytryptamine in rat lung

    Microsoft Academic Search

    Annette Parent-Ermini I; Ruben R. Ben-Harari

    1990-01-01

    Volatile anesthetics inhibit the pulmonary inactivation of 5-hydroxytryptamine (5-HT) possibly via an effect on endogenous\\u000a lung 5-HT. The consequent higher systemic arterial 5-HT concentrations may predispose the heart to dysrhythmias. The direct\\u000a effect of the anesthetics on endogenous 5-HT, its metabolites, and precursors in the isolated ventilated perfused rat lung\\u000a was determined by high-pressure liquid chromatography. Halothane (0.45, 1.4, and

  16. Interactions between local anesthetics and lipid dispersions studied with liposome electrokinetic capillary chromatography

    Microsoft Academic Search

    Jaana Muhonen; Juha M. Holopainen; Susanne K. Wiedmer

    2009-01-01

    In the case of local anesthetic intoxication, intravenous administration of lipid-based Intralipid dispersion (Fresenius Kabi) can be used for the entrapment of hydrophobic drugs. Our long-term aim is to develop a sensitive, efficient, and non-harmful lipid-based formulation to specifically trap harmful substances. In this study liposome electrokinetic capillary chromatography (LEKC) was used to study the interactions between local anesthetics and

  17. Differential Modulation of Human N-Methyl-d-Aspartate Receptors by Structurally Diverse General Anesthetics

    Microsoft Academic Search

    Ken Solt; Edmond I Eger II; Douglas E. Raines

    2006-01-01

    N-Methyl-d-aspartate (NMDA) receptors have a pre- sumed role in excitatory synaptic transmission and no- ciceptive pathways. Although previous studies have found that inhaled anesthetics inhibit NMDA receptor- mediated currents at clinically relevant concentrations, the use of different experimental protocols, receptor subtypes, and\\/or tissue sources confounds quantita- tive comparisons of the NMDA receptor inhibitory po- tencies of inhaled anesthetics. In the

  18. Drug binding to the acetylcholine receptor: Nitroxide analogs of phencyclidine and a local anesthetic

    SciTech Connect

    Palma, A.L.

    1988-01-01

    The interaction of noncompetitive inhibitors (NCIs) with Torpedo californica native nicotinic acetylcholine receptor (nAChR) membranes was examined primarily by the technique of electron paramagnetic resonance (EPR) spectroscopy. The goal of this work being to define some of the physical characteristics for the site(s) of association between an NCI and the nAChR membrane. A nitroxide labeled analog of a quaternary amine local anesthetic, 2-(N,N-dimethyl-N-4-(2,2,6,6-tetramethylpiperidinoxyl)amino)-ethyl 4-hexyloxybenzoate iodide (C6SLMeI), displays a strongly immobilized EPR component when added to nAChR membranes in the presence of carbamylcholine (carb). To further this work, a nitroxide labeled analog of phencyclidine (PCP), a potent NCI, was synthesized. 4-phenyl-4-(1-piperidinyl)-2,2,6,6-tetramethylpiperidinoxyl (PPT) exhibited one-third the potency of PCP in inhibiting nAChR mediated ion flux, and from competition binding studies with ({sup 3}H)PCP displayed a K{sub D} of 0.21 {mu}M towards a carb desensitized nAChR and a K{sub 0.5} of 18 {mu}M for a resting {alpha}-bungarotoxin treated nAChR.

  19. The Role of Molecular Structure in the Crystal Polymorphism of Local Anesthetic Drugs: Crystal Polymorphism of Local Anesthetic Drugs, Part X

    Microsoft Academic Search

    Andrea C. Schmidt

    2005-01-01

    \\u000a Purpose  This report is the résumé of a comprehensive investigation on the solid-state properties and the crystal polymorphism of the\\u000a structurally homogenous class of local anesthetic drugs. The goal is to explore the relationship between crystal polymorphism\\u000a and molecular structural features.\\u000a \\u000a \\u000a \\u000a Methods  A salt form (mostly the hydrochloride) as well as the free base of 24 local anesthetics has been characterized by

  20. Modified Whale's tail technique for the management of bone-defect in anterior teeth

    PubMed Central

    Kuriakose, Anu; Ambooken, Majo; Jacob, Jayan; John, Priya

    2015-01-01

    The purpose of this case report is to describe the efficacy of a modified Whale's tail technique to achieve primary closure and thereby aid in regeneration of an interdental osseous defect between maxillary central incisors complicated by an aberrant frenal attachment. A healthy 32-year-old female patient reported with the complaint of spacing between her upper front teeth. Clinical examination revealed an aberrant frenum extending into the interdental papilla in relation to the central incisors. There was a 6 mm periodontal pocket in relation to the mesiopalatal aspect of maxillary left central incisor. Intraoral periapical radiograph showed vertical bone loss in relation to mesial aspect of maxillary left central incisor. A modified Whale's tail flap was employed to access the area. The defect was filled with an alloplastic graft. Six months postoperative review showed complete elimination of the pocket along with radiographic bone fill of the defect. PMID:25810604

  1. Symposium on the management of inguinal hernias: 4. The Shouldice technique: a canon in hernia repair

    PubMed Central

    Bendavid, Robert

    1997-01-01

    Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantages: the presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use. PMID:9194781

  2. Elevation of protective autophagy as a potential way for preventing developmental neurotoxicity of general anesthetics.

    PubMed

    Li, Guohui; Yu, Buwei

    2014-02-01

    Numerous animal studies have demonstrated that commonly used general anesthetics could cause cognitive impairment in the developing brain. However, the underlying mechanism remains unclear. Recently it is reported that autophagy activation can ameliorate developmental neurotoxicity of ethanol, which is the same GABAA agonist and NMDA antagonist as general anesthetics. We thus intend to propose the possible role of autophagy in the developmental neurotoxicity of general anesthetics. Oxidative stress and neuronal apoptosis can activate autophagy, while autophagy conversely alleviates their levels in the neuron. Crosstalk among neuronal apoptosis, oxidative stress and autophagy resembles the Yin-Yang relationship in Chinese philosophy. Neuronal apoptosis and oxidative stress represent destroyable Yin, while autophagy symbols protective Yang. The destroyable Yin and protective Yang promote and counteract each other. We hypothesize that the destroyable Yin (neuronal apoptosis and oxidative stress injury) prevails over protective Yang (autophagy) when developing brain exposes to general anesthetics. Elevating protective Yang autophagy potentially reverses the neurotoxicity of general anesthetics. Once this hypothesis is proved, it will provide a new perspective to understand the developmental neurotoxicity of general anesthetics and a new way to prevent it. PMID:24359684

  3. New procedure to synthesize silver nanoparticles and their interaction with local anesthetics

    PubMed Central

    Mocanu, Aurora; Pasca, Roxana Diana; Tomoaia, Gheorghe; Garbo, Corina; Frangopol, Petre T; Horovitz, Ossi; Tomoaia-Cotisel, Maria

    2013-01-01

    Silver nanoparticles (AgNPs) were prepared in aqueous colloid dispersions by the reduction of Ag+ with glucose in alkaline medium. Tetraethyl orthosilicate and L-asparagine were added as stabilizers of NPs. The AgNPs were characterized, and their interaction with three local anesthetics (procaine, dibucaine, or tetracaine) was investigated. Optical spectra show the characteristic absorption band of AgNPs, due to surface plasmon resonance. Modifications in the position and shape of this band reflect the self-assembly of metal NPs mediated by anesthetic molecules and the progress in time of the aggregation process. Zeta-potential measuring was applied in order to characterize the electrostatic stability of the NPs. The size and shape of the AgNPs, as well as the features of the assemblies formed by their association in the presence of anesthetics, were evidenced by transmission electron microscopy images. Atomic force microscopy images showed the characteristics of the films of AgNPs deposited on glass support. The effect of the anesthetics could be described in terms of electrostatic forces between the negatively charged AgNPs and the anesthetic molecules, existing also in their cationic form at the working pH. But also hydrophobic and hydrogen bonding interactions between the coated nanoparticles and anesthetics molecular species should be considered. PMID:24143090

  4. MicroRNAs: New Players in Anesthetic-Induced Developmental Neurotoxicity

    PubMed Central

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

    2015-01-01

    Growing evidence demonstrates that prolonged exposure to general anesthetics during brain development induces widespread neuronal cell death followed by long-term memory and learning disabilities in animal models. These studies have raised serious concerns about the safety of anesthetic use in pregnant women and young children. However, the underlying mechanisms of anesthetic-induced neurotoxicity are complex and are not well understood. MicroRNAs are endogenous, small, non-coding RNAs that have been implicated to play important roles in many different disease processes by negatively regulating target gene expression. A possible role for microRNAs in anesthetic-induced developmental neurotoxicity has recently been identified, suggesting that microRNA-based signaling might be a novel target for preventing the neurotoxicity. Here we provide an overview of anesthetic-induced developmental neurotoxicity and focus on the role of microRNAs in the neurotoxicity observed in both human stem cell-derived neuron and animal models. Aberrant expression of some microRNAs has been shown to be involved in anesthetic-induced developmental neurotoxicity, revealing the potential of microRNAs as therapeutic or preventive targets against the toxicity.

  5. Volatile anesthetics inhibit sodium channels without altering bulk lipid bilayer properties

    PubMed Central

    Sanford, R. Lea; Lee, William; Schultz, Margaret F.; Ingólfsson, Helgi I.

    2014-01-01

    Although general anesthetics are clinically important and widely used, their molecular mechanisms of action remain poorly understood. Volatile anesthetics such as isoflurane (ISO) are thought to alter neuronal function by depressing excitatory and facilitating inhibitory neurotransmission through direct interactions with specific protein targets, including voltage-gated sodium channels (Nav). Many anesthetics alter lipid bilayer properties, suggesting that ion channel function might also be altered indirectly through effects on the lipid bilayer. We compared the effects of ISO and of a series of fluorobenzene (FB) model volatile anesthetics on Nav function and lipid bilayer properties. We examined the effects of these agents on Nav in neuronal cells using whole-cell electrophysiology, and on lipid bilayer properties using a gramicidin-based fluorescence assay, which is a functional assay for detecting changes in lipid bilayer properties sensed by a bilayer-spanning ion channel. At clinically relevant concentrations (defined by the minimum alveolar concentration), both the FBs and ISO produced prepulse-dependent inhibition of Nav and shifted the voltage dependence of inactivation toward more hyperpolarized potentials without affecting lipid bilayer properties, as sensed by gramicidin channels. Only at supra-anesthetic (toxic) concentrations did ISO alter lipid bilayer properties. These results suggest that clinically relevant concentrations of volatile anesthetics alter Nav function through direct interactions with the channel protein with little, if any, contribution from changes in bulk lipid bilayer properties. Our findings further suggest that changes in lipid bilayer properties are not involved in clinical anesthesia. PMID:25385786

  6. Two open access, high-quality datasets from anesthetic records

    PubMed Central

    Newton-Wade, Vanessa; Harrison, Michael J; Merry, Alan F

    2013-01-01

    Objective To provide a set of high-quality time-series physiologic and event data from anesthetic cases formatted in an easy-to-use structure. Materials and methods With ethics committee approval, data from surgical operations under general anesthesia were collected, including physiologic data, drug administrations, events, and clinicians' comments. These data were de-identified, formatted in a combined CSV/XML structure and made publicly available. Results Two separate datasets were collected containing physiologic time-series data and time-stamped events for 34 patients. For 20 patients, the data included 400 physiologic signals collected over 20?h, 274 events, and 597 drug administrations. For 14 patients, the data included 23 physiologic signals collected over 69?h, with 286 time stamped comments. Discussion Data reuse potentially saves significant time and financial costs. However, there are few high-quality repositories for accessible physiologic data and clinical interventions from surgical cases. De-identifying records assists with overcoming problems of privacy and storing the data in a format which is easily manipulated with computing resources facilitates access by the wider research community. It is hoped that additional high-quality data will be added. Future work includes developing tools to explore and visualize the data more efficiently, and establishing quality control measures. Conclusion An approach to collecting and storing high-quality datasets from surgical operations under anesthesia such that they can be easily accessed by others for use in research has been demonstrated. PMID:22865672

  7. “Robo-Tripping”: Dextromethorphan Abuse and its Anesthetic Implications

    PubMed Central

    Linn, Kelly A; Long, Micah T; Pagel, Paul S

    2014-01-01

    Introduction: We describe a patient scheduled for elective surgery who regularly consumed approximately 12 to 15 times the maximum recommended daily dose of dextromethorphan. We describe the clinical pharmacology of dextromethorphan and discuss its anesthetic implications. Case Presentation: A 30-year-old man with a history of a nasal fracture was scheduled to undergo an elective septorhinoplasty. He reported daily consumption of large quantities (1440 to 1800 mg) of dextromethorphan for six years. He was previously treated for dextromethorphan dependency on several occasions with urine dextromethorphan levels exceeding 2000 ng/mL. He described marked dissociative effects when abusing the drug, but had abstained from use for 48 hours before his elective surgery. Considering that dextromethorphan has a relatively short half-life and that the patient did not suffer major withdrawal symptoms after voluntarily discontinuing the drug, the authors proceeded with the case while recognizing that the drug has significant neuropsychiatric and sympathetic nervous system stimulant effects resulting from its actions as a N-methyl-D-aspartate receptor antagonist. Conclusions: Anesthesiologists need to be aware of dextromethorphan’s clinical pharmacology because recreational abuse of the drug has become increasingly common in adolescents and young adults. PMID:25793175

  8. Central administration of nicotine suppresses tracheobronchial cough in anesthetized cats.

    PubMed

    Poliacek, I; Rose, M J; Pitts, T E; Mortensen, A; Corrie, L W; Davenport, P W; Bolser, D C

    2015-02-01

    We tested the hypothesis that nicotine, which acts peripherally to promote coughing, might inhibit reflex cough at a central site. Nicotine was administered via the vertebral artery [intra-arterial (ia)] to the brain stem circulation and by microinjections into a restricted area of the caudal ventral respiratory column in 33 pentobarbital anesthetized, spontaneously breathing cats. The number of coughs induced by mechanical stimulation of the tracheobronchial airways; amplitudes of the diaphragm, abdominal muscle, and laryngeal muscles EMGs; and several temporal characteristics of cough were analyzed after administration of nicotine and compared with those during control and recovery period. (-)Nicotine (ia) reduced cough number, cough expiratory efforts, blood pressure, and heart rate in a dose-dependent manner. (-)Nicotine did not alter temporal characteristics of the cough motor pattern. Pretreatment with mecamylamine prevented the effect of (-)nicotine on blood pressure and heart rate, but did not block the antitussive action of this drug. (+)Nicotine was less potent than (-)nicotine for inhibition of cough. Microinjections of (-)nicotine into the caudal ventral respiratory column produced similar inhibitory effects on cough as administration of this isomer by the ia route. Mecamylamine microinjected in the region just before nicotine did not significantly reduce the cough suppressant effect of nicotine. Nicotinic acetylcholine receptors significantly modulate functions of brain stem and in particular caudal ventral respiratory column neurons involved in expression of the tracheobronchial cough reflex by a mecamylamine-insensitive mechanism. PMID:25477349

  9. Central effects of clozapine in regulating micturition in anesthetized rats

    PubMed Central

    Vera, Pedro L; Miranda-Sousa, Alejandro J; Ordorica, Raul C; Nadelhaft, Irving

    2002-01-01

    Background We previously showed that systemic administration of the atypical neuroleptic clozapine in the rat altered a number of urodynamic variables and inhibited the external urethral sphincter. Since clozapine acts at several receptor types both at the periphery and the central nervous system, the site of action remained uncertain. Therefore, the purpose of this study was to determine the effects of central administration of clozapine on the bladder and the external urethral sphincter during cystometry and to examine differences in spinal versus supraspinal administration. We extended our observations by delivering clozapine centrally in anesthetized rats instrumented with either an intrathecal (L6-S1 spinal segment) or an intracerebroventricular (lateral ventricle) catheter. Results Clozapine decreased micturition volume and increased residual volume possibly by acting at a supraspinal site. Expulsion time and amplitude of the high frequency oscillations were reduced by clozapine possibly by acting at a spinal site. Bladder capacity was increased after central clozapine but probably due to a peripheral effect. Clozapine acting at spinal and supraspinal sites increased pressure threshold. Contraction time and peak pressure were not affected by clozapine. The EMG from the external urethral sphincter was also reduced following clozapine centrally and suggests a spinal and a supraspinal site of action. Conclusions The results from the present study suggest that spinal and supraspinal central sites mediate clozapine's action in inhibiting expulsion parameters and the external urethral sphincter of the rat. Therefore, the reduction in the voiding efficiency observed after clozapine appears to be mediated by spinal and supraspinal sites. PMID:11884246

  10. Extended duration local anesthetic agent in a rat paw model.

    PubMed

    Ickowicz, D E; Golovanevski, L; Domb, A J; Weiniger, C F

    2014-07-01

    Encapsulated local anesthetics extend postoperative analgesic effect following site-directed nerve injection; potentially reducing postoperative complications. Our study aim was to investigate efficacy of our improved extended duration formulation - 15% bupivacaine in poly(DL-lactic acid co castor oil) 3:7 synthesized by ring opening polymerization. In vitro, around 70% of bupivacaine was released from the p(DLLA-CO) 3:7 after 10 days. A single injection of the optimal formulation of 15% bupivacaine-polymer or plain (0.5%) bupivacaine (control), was injected via a 22G needle beside the sciatic nerve of Sprague-Dawley rats under anesthesia; followed (in some animals) by a 1cm longitudinal incision through the skin and fascia of the paw area. Behavioral tests for sensory and motor block assessment were done using Hargreave's hot plate score, von Frey filaments and rearing count. The 15% bupivacaine formulation significantly prolonged sensory block duration up to at least 48 h. Following surgery, motor block was observed for 48 h following administration of bupivacaine-polymer formulation and rearing was reduced (returning to baseline after 48 h). No significant differences in mechanical nociceptive response were observed. The optimized bupivacaine-polymer formulation prolonged duration of local anesthesia effect in our animal model up to at least 48 h. PMID:24726301

  11. Performance of computed tomographic colonography improved by total quality management techniques

    NASA Astrophysics Data System (ADS)

    Garry, John L.; Reed, Judd E.; Johnson, C. Daniel

    2000-04-01

    Our institution has been using an internally developed system for the analysis of Computed Tomographic Colonography (CTC) since 1994. This system has gone through several major revisions during that period. Careful application of 'total quality management' (TQM) principles have been utilized to enhance such aspects of performance as patient comfort, latency between examination and reporting of results, capability and reliability of 'picture archive system' (PACS) and network components, as well as reliability of results. CTC is now being practiced at our institution for clinical screening and research applications. To date, 1500 patients have been scanned. On an average day, six patients are scanned for research and/or clinical purposes. Research patient data remain on the CTC workstation for future analysis by the Radiologists while clinical patient data are analyzed as soon as the data have been received at the CTC workstation. An enlarged dynamic axial stack augmented by multiple interactive, off axis reformatted and perspective volume rendered endoluminal views have proven to be the most effective reading mode. Well over 1000 patient scans have been analyzed utilizing this specific protocol. When compared to corresponding patient BE and/or Colonoscopy procedures, CTC findings of potential cancers and polyps have compared very favorably.

  12. Pain management in newborns.

    PubMed

    Hall, Richard W; Anand, Kanwaljeet J S

    2014-12-01

    As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns. PMID:25459780

  13. Transrectal ultrasound – Techniques and outcomes in the management of intestinal endometriosis

    PubMed Central

    Rossini, Lucio G.B.; Ribeiro, Paulo A.A.G.; Rodrigues, Francisco C.M.; Filippi, Sheila S.; Zago, Rodrigo de R.; Schneider, Nutianne C.; Okawa, Luciano; Klug, Wilmar A.

    2012-01-01

    The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration. PMID:24949332

  14. Geospatial Techniques for Efficient Conservation and Management of Surface Water for Irrigation in Joganbedi Village, Khargone District, Madhya Pradesh, India

    NASA Astrophysics Data System (ADS)

    Singh, A. M.; Chauhan, A. S.; Aggarwal, D.

    2014-11-01

    The study aimed at developing improved methods based on remote sensing and GIS techniques to increase cultivated area under irrigation. Landuse / landcover mapping was considered as the key component to prioritize locations for constructing appropriate recharge structures. Joganbedi scheme was proposed for this study. Joganbedi is situated 13 km. from Khargone, district Khargone, Madhya Pradesh, India. Command area of the proposed scheme lies in Beda sub-basin which is a tributary of the Narmada River. This area is of hard rock terrain and is occupied by the Deccan basalt. The main objective of the study was surface water conservation and management via multi-spectral information resulting from remotely sensed data to increase irrigation. High resolution GeoEye1 stereo images were used for generation of DEM, contour, landuse/landcover mapping, lineaments and drainage mapping. DEM was used for canal alignment. and further, contours were used to determine catchment, submergence /FRL, and command areas. Landuse/landcover statistics of submergence area helped to identify different land classes within the study area. These parameters are required for scheme planning. Additionally, rainfall data, maximum drawdown level, and dam height were collected as supporting parameters. The study concludes that landuse/landcover mapping is useful in identification of surface water conservation and management plan for irrigation purpose. It also proves that implementation of Joganbedi scheme will increase the cultivated area under irrigation, facilitate the farmers for multi season cropping and help in improving their economic condition.

  15. Management of Post-orthodontic White Spot Lesions and Subsequent Enamel Discoloration with Two Microabrasion Techniques

    PubMed Central

    Jahanbin, Arezoo; Ameri, Hamideh; Shahabi, Mostafa; Ghazi, Ala

    2015-01-01

    Statement of the Problem Demineralization of enamel adjacent to orthodontic appliances frequently occurs, commonly due to insufficient oral hygiene. Purpose The aim of this study was to compare two microabrasion techniques on improving the white spot lesions as well as subsequent enamel discoloration. Materials and Method Sixty extracted premolar teeth without caries and hypoplasia were selected for this study. White spot lesions were artificially induced on the buccal surface of each tooth. Teeth were randomly assigned to three treatment groups, each treated with pumice powder as the control, microabrasion with 18% HCl, and microabrasion with 37% H3PO4. Subsequently, the three groups were daily immersed for five minutes in a tea-coffee solution for a period of one week. Colorimetric evaluation was done before and after formation of white spot lesions, after microabrasion, and after immersion in the colored solution; then the color differences (?E) were calculated. Statistical analysis was performed by multiple measurement analysis and the Tukey’s test. Results This study showed that ?E between the stages of white spot formation and microabrasion for H3PO4 was more than other groups and for the pumice powder group it was less than the others. Furthermore, there was a significant difference between ?E of the three study groups (p= 0.017). Additionally, ?E after placing the teeth in the colored solution and microabrasion was the highest for the HCl group and the lowest for the pumice powder group. There was also a significant difference between the three groups (p= 0.000). Conclusion Pumice powder alone had similar effects as 18% HCl on removing the white spot lesions. Nevertheless, 18% HCl makes the enamel susceptible for subsequent color staining more than the other microabrasion methods.

  16. A modified surgical technique in the management of eyelid burns: a case series

    PubMed Central

    2011-01-01

    Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid. PMID:21843322

  17. An Experimental Test of Buffer Utility as a Technique for Managing Pool-Breeding Amphibians

    PubMed Central

    Veysey Powell, Jessica S.; Babbitt, Kimberly J.

    2015-01-01

    Vegetated buffers are used extensively to manage wetland-dependent wildlife. Despite widespread application, buffer utility has not been experimentally validated for most species. To address this gap, we conducted a six-year, landscape-scale experiment, testing how buffers of different widths affect the demographic structure of two amphibian species at 11 ephemeral pools in a working forest of the northeastern U.S. We randomly assigned each pool to one of three treatments (i.e., reference, 100m buffer, 30m buffer) and clearcut to create buffers. We captured all spotted salamanders and wood frogs breeding in each pool and examined the impacts of treatment and hydroperiod on breeding-population abundance, sex ratio, and recapture rate. The negative effects of clearcutting tended to increase as forest-buffer width decreased and be strongest for salamanders and when other stressors were present (e.g., at short-hydroperiod pools). Recapture rates were reduced in the 30m, but not 100m, treatment. Throughout the experiment for frogs, and during the first year post-cut for salamanders, the predicted mean proportion of recaptured adults in the 30m treatment was only 62% and 40%, respectively, of that in the reference treatment. Frog sex ratio and abundance did not differ across treatments, but salamander sex ratios were increasingly male-biased in both cut treatments. By the final year, there were on average, only about 40% and 65% as many females predicted in the 100m and 30m treatments, respectively, compared to the first year. Breeding salamanders at short-hydroperiod pools were about 10% as abundant in the 100m versus reference treatment. Our study demonstrates that buffers partially mitigate the impacts of habitat disturbance on wetland-dependent amphibians, but buffer width and hydroperiod critically mediate that process. We provide the first experimental evidence showing that 30-m-wide buffers may be insufficient for maintaining resilient breeding populations of pool-dependent amphibians, at least during the first six years post-disturbance. PMID:26196129

  18. Anesthetic efficacy of metomidate and comparison of plasma cortisol responses to tricaine methanesulfonate, quinaldine and clove oil anesthetized channel catfish Ictalurus punctatus

    Microsoft Academic Search

    Brian C Small

    2003-01-01

    The present experiments were designed to determine the efficacy of metomidate hydrochloride as an alternative anesthetic with potential cortisol blocking properties for channel catfish Ictalurus punctatus. Channel catfish (75 g) were exposed to concentrations of metomidate ranging from 0.5 to 16 ppm for a period of 60 min. At 16-ppm metomidate, mortality occurred in 65% of the catfish. No mortalities

  19. [Anaesthetic management of a child with hemoglobinopathy].

    PubMed

    Rhondali, O; Pouyau, A; Bonnard, C; Chassard, D

    2013-12-01

    Perioperative management of a child with sickle-cell disease requires close collaboration between hematologist, surgeon and anesthetist. The level of preoperative preparation must consider both the surgical risk and the impact of the disease. Preoperative hydration and blood transfusion are the most important part of preoperative management. Anesthetic technique is not as important as preoperative preparation, management of stress and anxiety, and optimization of intraoperative physiological parameters (oxygenation, acid-base balance, tissue perfusion, normothermia). Pain management must be optimal for these children with increased needs of analgesic. Preoperative assessment of a child with thalassemia must include evaluation of the impact of chronic hemolytic anemia and iron overload induced by repeated transfusions. The most important factor in the management of a child with glucose-6-phosphate dehydrogenase deficiency is to avoid exposure to oxidative stressors. Outpatients should be informed of the risk of hemolytic crisis, and free hemoglobin in the urine should lead to discontinuation of drugs associated with hemolysis and to maintenance of urine output to prevent acute renal failure. PMID:24246659

  20. Anesthetic effects of propofol in the healthy human brain: functional imaging evidence.

    PubMed

    Song, Xiao-xing; Yu, Bu-wei

    2015-04-01

    Functional imaging methods, including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. Recent imaging studies using fMRI and PET techniques have demonstrated the regional effects of propofol on the brain. However, the pharmacological mechanism of the action of propofol in the intact human central nervous system is unclear. To explore the possible action targets of propofol in the human brain, a systematic review of the literature was performed. The literature search was performed with limiting factors of "propofol," "functional imaging," "positron emission tomography", and "functional magnetic resonance imaging" from 1966 to July 2013 (using Medline, EMBASE, CINAHL and hand searches of references). Studies meeting the inclusion criteria were reviewed and critiqued for the purpose of this literature research. Eighteen researches meeting the inclusion criteria were reviewed in terms of the appropriateness of valuation technique. In the unconscious state, propofol sharply reduces the regional glucose metabolism rate (rGMR) and regional cerebral blood flow (rCBF) in all brain regions, particularly in the thalamus. However, GMR, such as in the occipital, temporal, and frontal lobes, was obviously decreased at a sedative dosage of propofol, whereas, changes in the thalamus were not obvious. Using fMRI, several studies observed a decrease of connectivity of the thalamus versus an increase of connectivity within the pons of the brainstem during propofol-induced mild sedation. During deep sedation, propofol preserves cortical sensory reactivity, the specific thalamocortical network is moderately affected, whereas the nonspecific thalamocortical network is severely suppressed. In contrast, several recent fMRI studies are consistent on the systemic decreased effects of propofol in the frontoparietal network. Accumulating evidence suggest that propofol-induced unconsciousness is associated with a global metabolic and vascular depression in the human brain and especially with a significant reduction in the thalamocortical network and the frontoparietal network. PMID:25056258

  1. A Robust Decision-Making Technique for Water Management under Decadal Scale Climate Variability

    NASA Astrophysics Data System (ADS)

    Callihan, L.; Zagona, E. A.; Rajagopalan, B.

    2013-12-01

    Robust decision making, a flexible and dynamic approach to managing water resources in light of deep uncertainties associated with climate variability at inter-annual to decadal time scales, is an analytical framework that detects when a system is in or approaching a vulnerable state. It provides decision makers the opportunity to implement strategies that both address the vulnerabilities and perform well over a wide range of plausible future scenarios. A strategy that performs acceptably over a wide range of possible future states is not likely to be optimal with respect to the actual future state. The degree of success--the ability to avoid vulnerable states and operate efficiently--thus depends on the skill in projecting future states and the ability to select the most efficient strategies to address vulnerabilities. This research develops a robust decision making framework that incorporates new methods of decadal scale projections with selection of efficient strategies. Previous approaches to water resources planning under inter-annual climate variability combining skillful seasonal flow forecasts with climatology for subsequent years are not skillful for medium term (i.e. decadal scale) projections as decision makers are not able to plan adequately to avoid vulnerabilities. We address this need by integrating skillful decadal scale streamflow projections into the robust decision making framework and making the probability distribution of this projection available to the decision making logic. The range of possible future hydrologic scenarios can be defined using a variety of nonparametric methods. Once defined, an ensemble projection of decadal flow scenarios are generated from a wavelet-based spectral K-nearest-neighbor resampling approach using historical and paleo-reconstructed data. This method has been shown to generate skillful medium term projections with a rich variety of natural variability. The current state of the system in combination with the probability distribution of the projected flow ensembles enables the selection of appropriate decision options. This process is repeated for each year of the planning horizon--resulting in system outcomes that can be evaluated on their performance and resiliency. The research utilizes the RiverSMART suite of software modeling and analysis tools developed under the Bureau of Reclamation's WaterSMART initiative and built around the RiverWare modeling environment. A case study is developed for the Gunnison and Upper Colorado River Basins. The ability to mitigate vulnerability using the framework is gauged by system performance indicators that measure the ability of the system to meet various water demands (i.e. agriculture, environmental flows, hydropower etc.). Options and strategies for addressing vulnerabilities include measures such as conservation, reallocation and adjustments to operational policy. In addition to being able to mitigate vulnerabilities, options and strategies are evaluated based on benefits, costs and reliability. Flow ensembles are also simulated to incorporate mean and variance from climate change projections for the planning horizon and the above robust decision-making framework is applied to evaluate its performance under changing climate.

  2. NMR resolved multiple anesthetic binding sites in the TM domains of the ?4?2 nAChR

    PubMed Central

    Bondarenko, Vasyl; Mowrey, David; Liu, Lu Tian; Xu, Yan; Tang, Pei

    2012-01-01

    The ?4?2 nicotinic acetylcholine receptor (nAChR) has significant roles in nervous system function and disease. It is also a molecular target of general anesthetics. Anesthetics inhibit the ?4?2 nAChR at clinically relevant concentrations, but their binding sites in ?4?2 remain unclear. The recently determined NMR structures of the ?4?2 nAChR transmembrane (TM) domains provide valuable frameworks for identifying the binding sites. In this study, we performed solution NMR experiments on the ?4?2 TM domains in the absence and presence of halothane and ketamine. Both anesthetics were found in an intra-subunit cavity near the extracellular end of the 2 transmembrane helices, homologous to a common anesthetic binding site observed in X-ray structures of anesthetic-bound GLIC (Nury, et. al. 2011). Halothane, but not ketamine, was also found in cavities adjacent to the common anesthetic site at the interface of ?4 and ?2. In addition, both anesthetics bound to cavities near the ion selectivity filter at the intracellular end of the TM domains. Anesthetic binding induced profound changes in protein conformational exchanges. A number of residues, close to or remote from the binding sites, showed resonance signal splitting from single to double peaks, signifying that anesthetics decreased conformation exchange rates. It was also evident that anesthetics shifted population of two conformations. Altogether, the study comprehensively resolved anesthetic binding sites in the ?4?2 nAChR. Furthermore, the study provided compelling experimental evidence of anesthetic-induced changes in protein dynamics, especially near regions of the hydrophobic gate and ion selectivity filter that directly regulate channel functions. PMID:23000369

  3. Efficacy and Safety of 5 Anesthetics in Adult Zebrafish (Danio rerio)

    PubMed Central

    Collymore, Chereen; Tolwani, Angela; Lieggi, Christine; Rasmussen, Skye

    2014-01-01

    Although the safety and efficacy of tricaine methanesulfonate (MS222) for anesthesia of fish are well established, other anesthetics used less commonly in fish have been less extensively evaluated. Therefore, we compared gradual cooling, lidocaine hydrochloride (300, 325, and 350 mg/L), metomidate hydrochloride (2, 4, 6, 8, and 10 mg/L), and isoflurane (0.5 mL/L) with MS222 (150 mg/L) for anesthesia of adult zebrafish. The efficacy and safety of each agent was evaluated by observing loss of equilibrium, slowing of opercular movement, response to tail-fin pinch, recovery time, and anesthesia-associated mortality rates. At 15 min after anesthetic recovery, we used a novel-tank test to evaluate whether anesthetic exposure influenced short-term anxiety-like behavior. Behavioral parameters measured included latency to enter and number of transitions to the upper half of the tank, number of erratic movements, and number of freezing bouts. Behavior after anesthesia was unaltered regardless of the anesthetic used. Efficacy and safety differed among the anesthetics evaluated. Gradual cooling was useful for short procedures requiring immobilization only, but all instrumentation and surfaces that come in contact with fish must be maintained at approximately 10 °C. MS222 and lidocaine hydrochloride at 325 mg/L were effective as anesthetic agents for surgical procedures in adult zebrafish, but isoflurane and high-dose lidocaine hydrochloride were unsuitable as sole anesthetic agents due to high (30%) mortality rates. Although MS222 remains the best choice for generating a surgical plane of anesthesia, metomidate hydrochloride and gradual cooling were useful for sedation and immobilization for nonpainful procedures. PMID:24602548

  4. General anesthetics selectively modulate glutamatergic and dopaminergic signaling via site-specific phosphorylation in vivo.

    PubMed

    Snyder, Gretchen L; Galdi, Stacey; Hendrick, Joseph P; Hemmings, Hugh C

    2007-10-01

    Isoflurane, propofol and ketamine are representative general anesthetics with distinct molecular mechanisms of action that have neuroprotective properties in models of excitotoxic ischemic damage. We characterized the effects of these agents on neuronal glutamate and dopamine signaling by profiling drug-induced changes in brain intracellular protein phosphorylation in vivo to test the hypothesis that they affect common downstream effectors. Anesthetic-treated and control mice were killed instantly by focused microwave irradiation, frontal cortex and striatum were removed, and the phosphorylation profile of specific neuronal signaling proteins was analyzed by immunoblotting with a panel of phospho-specific antibodies. At anesthetic doses that produced loss of righting reflex, isoflurane, propofol, and ketamine all reduced phosphorylation of the activating residue T183 of ERK2 (but not of ERK1); S897 of the NR1 NMDA receptor subunit; and S831 (but not S845) of the GluR1 AMPA receptor subunit in cerebral cortex. At sub-anesthetic doses, these drugs only reduced phosphorylation of ERK2. Isoflurane and ketamine also reduced phosphorylation of spinophilin at S94, but oppositely regulated phosphorylation of presynaptic (tyrosine hydroxylase) and postsynaptic (DARPP-32) markers of dopaminergic neurotransmission in striatum. These data reveal both shared and agent-specific actions of CNS depressant drugs on critical intracellular protein phosphorylation signaling pathways that integrate multiple second messenger systems. Reduced phosphorylation of ionotropic glutamate receptors by all three anesthetics indicates depression of normal glutamatergic synaptic transmission and reduced potential excitotoxicity. This novel approach indicates a role for phosphorylation-mediated down-regulation of glutamatergic synaptic transmission by general anesthetics and identifies specific in vivo targets for focused evaluation of anesthetic mechanisms. PMID:17826804

  5. Hypnotic Hypersensitivity to Volatile Anesthetics and Dexmedetomidine in Dopamine ?-Hydroxylase Knockout Mice

    PubMed Central

    Hu, Frances Y.; Hanna, George M.; Han, Wei; Mardini, Feras; Thomas, Steven A.; Wyner, Abraham J.; Kelz, Max B.

    2012-01-01

    BACKGROUND Multiple lines of evidence suggest that the adrenergic system can modulate sensitivity to anesthetic-induced immobility and anesthetic-induced hypnosis as well. However, several considerations prevent the conclusion that the endogenous adrenergic ligands norepinephrine and epinephrine alter anesthetic sensitivity. METHODS Using dopamine ?-hydroxylase (Dbh?/?) mice genetically engineered to lack the adrenergic ligands and their siblings with normal adrenergic levels, we test the contribution of the adrenergic ligands upon volatile anesthetic induction and emergence. Moreover, we investigate the effects of intravenous dexmedetomidine in adrenergic-deficient mice and their siblings using both righting reflex and processed electroencephalographic measures of anesthetic hypnosis. RESULTS We demonstrate that the loss of norepinephrine and epinephrine and not other neuromodulators copackaged in adrenergic neurons is sufficient to cause hypersensitivity to induction of volatile anesthesia. However, the most profound effect of adrenergic deficiency is retarding emergence from anesthesia, which takes two to three times as long in Dbh?/? mice for sevoflurane, isoflurane, and halothane. Having shown that Dbh?/? mice are hypersensitive to volatile anesthetics, we further demonstrate that their hypnotic hypersensitivity persists at multiple doses of dexmedetomidine. Dbh?/? mice exhibit up to 67% shorter latencies to loss of righting reflex and up to 545% longer durations of dexmedetomidine-induced general anesthesia. Central rescue of adrenergic signaling restores control-like dexmedetomidine sensitivity. A novel continuous electroencephalographic analysis illustrates that the longer duration of dexmedetomidine-induced hypnosis is not due to a motor confound, but occurs because of impaired anesthetic emergence. CONCLUSIONS Adrenergic signaling is essential for normal emergence from general anesthesia. Dexmedetomidine-induced general anesthesia does not depend upon inhibition of adrenergic neurotransmission. PMID:23042227

  6. Management

    Microsoft Academic Search

    Michael Cotta-Schönberg

    2000-01-01

    The area of management is a naturally fertile ground for theory making, development of models and ... fads! Moreover, gurus, consultant firms, and publishers alike have vested interests in keeping the management mill going. Finally, our political lords and masters regularly come up with new trendy demands on public managers. So, it is no wonder that library managers may sometimes

  7. Discrete change in volatile anesthetic sensitivity in mice with inactivated tandem pore potassium channel TRESK

    PubMed Central

    Chae, Yun Jeong; Zhang, Jianan; Au, Paul; Sabbadini, Marta; Xie, Guo-Xi; Yost, C. Spencer

    2010-01-01

    Backgrcound We investigated the role of tandem pore domain potassium channel (K2P) TRESK in neurobehavioral function and volatile anesthetic sensitivity in genetically modified mice. Methods Exon III of the mouse TRESK gene locus was deleted by homologous recombination using a targeting vector. The genotype of bred mice (wildtype, knockout or heterozygote) was determined using the polymerase chain reaction. Morphologic and behavioral evaluations of TRESK knockout mice were compared to wildtype littermates. Sensitivity of bred mice to isoflurane, halothane, sevoflurane and desflurane were studied by determining the minimum alveolar concentration preventing movement to tail clamping in 50% of each genotype. Results TRESK knockout mice had normal development and behavior except for decreased number of inactive periods and increased thermal pain sensitivity (20% decrease in latency with hot plate test). TRESK knockout mice showed a statistically significant 8% increase in isoflurane minimum alveolar concentration compared to wildtype littermates; sensitivity to other volatile anesthetics was not significantly different. Spontaneous mortality of TRESK knockout mice following initial anesthesia testing was nearly threefold higher than that of wildtype littermates. Conclusions TRESK alone is not critical for baseline central nervous system function but may contribute to the action of volatile anesthetics. The inhomogenous change in anesthetic sensitivity corroborates findings in other K2P knockout mice and supports the idea that the mechanism of volatile anesthetic action involves multiple targets. Although it was not shown in this study, a compensatory effect by other K2P channels may also contribute to these observations. PMID:21042202

  8. ?2-Adrenergic Stimulation of the Ventrolateral Preoptic Nucleus Destabilizes the Anesthetic State

    PubMed Central

    McCarren, Hilary S.; Chalifoux, Michael R.; Han, Bo; Moore, Jason T.; Meng, Qing Cheng; Baron-Hionis, Nina; Sedigh-Sarvestani, Madineh; Contreras, Diego; Beck, Sheryl G.

    2014-01-01

    The sleep-promoting ventrolateral preoptic nucleus (VLPO) shares reciprocal inhibitory inputs with wake–active neuronal nuclei, including the locus ceruleus. Electrophysiologically, sleep-promoting neurons in the VLPO are directly depolarized by the general anesthetic isoflurane and hyperpolarized by norepinephrine, a wake-promoting neurotransmitter. However, the integration of these competing influences on the VLPO, a sleep- and anesthetic-active structure, has yet to be evaluated in either brain slices in vitro or the intact organism. Single-cell multiplex RT-PCR conducted on both isoflurane-activated, putative sleep-promoting VLPO neurons and neighboring, state-indifferent VLPO neurons in mouse brain slices revealed widespread expression of ?2A-, ?2B- and ?2C-adrenergic receptors in both populations. Indeed, both norepinephrine and the highly selective ?2 agonist dexmedetomidine each reversed the VLPO depolarization induced by isoflurane in slices in vitro. When microinjected directly into the VLPO of a mouse lightly anesthetized with isoflurane, dexmedetomidine increased behavioral arousal and reduced the depressant effects of isoflurane on barrel cortex somatosensory-evoked potentials but failed to elicit spectral changes in spontaneous EEG. Based on these observations, we conclude that local modulation of ?-adrenergic activity in the VLPO destabilizes, but does not fully antagonize, the anesthetic state, thus priming the brain for anesthetic emergence. PMID:25471576

  9. Inhalation anesthesiology and volatile liquid anesthetics: focus on isoflurane, desflurane, and sevoflurane.

    PubMed

    Sakai, Eileen M; Connolly, Lois A; Klauck, James A

    2005-12-01

    Clinical pharmacists rarely are involved in the selection and dosing of anesthetic agents. However, when practicing evidence-based medicine in a cost-conscious health care system, optimizing drug therapy is imperative in all areas. Thus, we provide general information on anesthesiology, including the different types of breathing systems and the components of anesthesia machines. Modern inhalation anesthetics that are predominantly used in clinical practice include one gas--nitrous oxide--and new volatile liquid agents--isoflurane, desflurane, and sevoflurane. Desflurane and sevoflurane are the low-soluble inhalation anesthetics, and they offer some clinical advantages over isoflurane, such as fast induction and faster recovery with long procedures. However, efficient use of isoflurane can match the speed of induction and recovery of the other agents in certain cases. In addition, the patient characteristics, duration and type of procedure, type of breathing system, and efficiency in monitoring must be considered when selecting the most optimal therapy for each patient. Maximizing the clinical advantages of these agents while minimizing the waste of an institution's operating room and pharmacy budget requires an understanding of the characteristics, pharmacokinetics, and pharmacodynamics of these anesthetic agents and the collaborated effort from both the anesthesia and pharmacy departments. An anesthetic agent algorithm is provided as a sample decision-process tree for selecting among isoflurane, desflurane, and sevoflurane. PMID:16305297

  10. ?2-Adrenergic stimulation of the ventrolateral preoptic nucleus destabilizes the anesthetic state.

    PubMed

    McCarren, Hilary S; Chalifoux, Michael R; Han, Bo; Moore, Jason T; Meng, Qing Cheng; Baron-Hionis, Nina; Sedigh-Sarvestani, Madineh; Contreras, Diego; Beck, Sheryl G; Kelz, Max B

    2014-12-01

    The sleep-promoting ventrolateral preoptic nucleus (VLPO) shares reciprocal inhibitory inputs with wake-active neuronal nuclei, including the locus ceruleus. Electrophysiologically, sleep-promoting neurons in the VLPO are directly depolarized by the general anesthetic isoflurane and hyperpolarized by norepinephrine, a wake-promoting neurotransmitter. However, the integration of these competing influences on the VLPO, a sleep- and anesthetic-active structure, has yet to be evaluated in either brain slices in vitro or the intact organism. Single-cell multiplex RT-PCR conducted on both isoflurane-activated, putative sleep-promoting VLPO neurons and neighboring, state-indifferent VLPO neurons in mouse brain slices revealed widespread expression of ?2A-, ?2B- and ?2C-adrenergic receptors in both populations. Indeed, both norepinephrine and the highly selective ?2 agonist dexmedetomidine each reversed the VLPO depolarization induced by isoflurane in slices in vitro. When microinjected directly into the VLPO of a mouse lightly anesthetized with isoflurane, dexmedetomidine increased behavioral arousal and reduced the depressant effects of isoflurane on barrel cortex somatosensory-evoked potentials but failed to elicit spectral changes in spontaneous EEG. Based on these observations, we conclude that local modulation of ?-adrenergic activity in the VLPO destabilizes, but does not fully antagonize, the anesthetic state, thus priming the brain for anesthetic emergence. PMID:25471576

  11. The AmeriFlux Data Activity and Data System: An Evolving Collection of Data Management Techniques, Tools, Products and Services

    SciTech Connect

    Boden, Thomas A [ORNL; Krassovski, Misha B [ORNL; Yang, Bai [ORNL

    2013-01-01

    The Carbon Dioxide Information Analysis Center (CDIAC) at Oak Ridge National Laboratory (ORNL), USA has provided scientific data management support for the U.S. Department of Energy and international climate change science since 1982. Over this period, climate change science has expanded from research focusing on basic understanding of geochemical cycles, particularly the carbon cycle, to integrated research addressing climate change impacts, vulnerability, adaptation, and mitigation. Interests in climate change data and information worldwide have grown remarkably and, as a result, so have demands and expectations for CDIAC s data systems. To meet the growing demands, CDIAC s strategy has been to design flexible data systems using proven technologies blended with new, evolving technologies and standards. CDIAC development teams are multidisciplinary and include computer science and information technology expertise, but also scientific expertise necessary to address data quality and documentation issues and to identify data products and system capabilities needed by climate change scientists. CDIAC has learned there is rarely a single commercial tool or product readily available to satisfy long-term scientific data system requirements (i.e., one size does not fit all and the breadth and diversity of environmental data are often too complex for easy use with commercial products) and typically deploys a variety of tools and data products in an effort to provide credible data freely to users worldwide. Like many scientific data management applications, CDIAC s data systems are highly customized to satisfy specific scientific usage requirements (e.g., developing data products specific for model use) but are also designed to be flexible and interoperable to take advantage of new software engineering techniques, standards (e.g., metadata standards) and tools and to support future Earth system data efforts (e.g., ocean acidification). CDIAC has provided data management support for numerous long-term measurement projects crucial to climate change science. One current example is the AmeriFlux measurement network. AmeriFlux provides continuous measurements from forests, grasslands, wetlands, and croplands in North, Central, and South America and offers important insight about carbon cycling in terrestrial ecosystems. We share our approaches in satisfying the challenges of delivering AmeriFlux data worldwide to benefit others with similar challenges handling climate change data, further heighten awareness and use of an outstanding ecological data resource, and highlight expanded software engineering applications being used for climate change measurement data.

  12. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy

    Microsoft Academic Search

    Hiroshi Aono; Akio Takeda; Stephen D. Tarver; Hiroshi Goto

    1998-01-01

    Study Objective: To evaluate and compare the stress hormone responses during laparoscopic cholecystectomy during general anesthesia, general anesthesia supplemented by fentanyl, and general anesthesia combined with epidural anesthesia.Design: Prospective, randomized clinical study.Setting: Operating rooms at a municipal hospital.Patients: 52 ASA physical status I and II patients.Interventions: Anesthesia was induced slowly with sevoflurane and nitrous oxide (N2O) in oxygen (O2) by

  13. Diversity in soil bacterial communities structure in four high-altitude vineyards cultivated using different soil management techniques

    NASA Astrophysics Data System (ADS)

    Opsi, Francesca; Landa, Blanca; Zecca, Odoardo; Biddoccu, Marcella; Barmaz, Andrea; Cavallo, Eugenio

    2014-05-01

    Some of the major wine producing countries are located in the Mediterranean regions, where viticulture represents one of the most widespread cultivations with economic and social importance. The area devoted to vineyards can also expand to mountain and steep slope zones, often characterized by small-scale high quality wine production, where viticulture contributes to the sustainable development from the ecological and environmental point of view. Farming practices adopted in sloping vineyards have the purpose to improve the soil physicochemical but also biological properties to avoid the degradation of the soil characteristics and resulting problems such as soil erosion and organic matter losses. A preliminary study was conducted during 2013 in four commercial vineyards located in Aosta Valley (north-western Italy), within a small area located in the adjacent municipalities of Chambave and Saint-Denis in order to minimize soil variability. Two sites have been identified on the lower (about 600 m asl) and higher (about 750 m asl) zone of the slope, each of which consist of two vineyards managed since at least ten years with different soil management techniques: grass cover and chemical weed control. The four experimental soils had a sandy loam texture with abundant skeleton, and were characterized by a slightly alkaline reaction. The organic matter content was greater in the lower zone (2.4%) than in the upper (1.5%), without specific differences between treatments. The low values of the C:N ratio reported (on average 6.2) reveal the increased organic matter mineralization; furthermore the CEC values were rather low, typical of loose soils. Soil microbiota are critical for the maintenance of soil health and quality, playing an important role in agricultural soil ecosystems. A 16S rDNA pyrosequencing approach was used for investigating differences, abundance and diversity in bacterial community structure of the four studied vineyards. Data from pyrosequencing detected, after removing low-quality sequences, a total of 40900 sequences with 10000 on average per vineyard location. Most abundant bacterial phyla were Proteobacteria (36%), followed by Actinobacteria (26%) and Acidobacteria (15%), with a trend to have higher Proteobacteria or Actinobacteria levels in the higher and lower zone of the slope, respectively and higher number of Acidobacteria when herbicide was used to control the weeds. Results from ? diversity and ? diversity indices indicated that there are differences in bacterial structure among the sampled altitudes and between the tested soil management systems, in that order. Multivariate analyses are being conducted to identify soil physicochemical factors that could be used, with additional data that will be collected and analyzed in the following year, as an indicator of the different vineyards management systems and which specific microbial groups, if any, could be correlated with those managements.

  14. Utilising Recent Advancements in Techniques for the Analysis of Incomplete Multivariate Data to Improve the Data Quality Management of Current Academic Research

    Microsoft Academic Search

    David J. Fogarty; John Blake

    2002-01-01

    This paper discusses the importance of managing data quality in academic research in its relation to satisfying the customer. This focus is on the data completeness objectivedimension of data quality in relation to recent advancements which have been made in the development of methods for analysing incomplete multivariate data. An overview and comparison of the traditional techniques with the recent

  15. The use of GIS and remote sensing techniques as tools for managing nature reserves: the case of Kakum National Park in Ghana

    Microsoft Academic Search

    Y. A. Twumasi

    2001-01-01

    Failing prices in export commodities especially in sub-Saharan Africa has compelled countries like Ghana to explore its forests and wildlife reserves for foreign exchange. The forests are now under constant threat from fire, drought and the activities of local community groups. The management of these forest reserves thus faces severe problems. Current techniques for monitoring the forests in Ghana are

  16. Mechanisms for vasopressin effects on intraocular pressure in anesthetized rats

    NASA Technical Reports Server (NTRS)

    Balaban, C. D.; Palm, D. E.; Shikher, V.; Searles, R. V.; Keil, L. C.; Severs, W. B.

    1997-01-01

    Continuous intracameral infusions of a balanced salt solution (0.175 microliter min-1) have been reported to raise intraocular pressure (IOP) in anesthetized rats. Palm et al. (1995) previously reported that this effect was attenuated significantly by inclusion of arginine-vasopressin (AVP, 10 ng 0.175 microliter-1) in the infusate. This study used experimental and computer simulation methods to investigate factors underlying these changes in IOP. First, constant intracameral infusions of artificial cerebrospinal fluid (aCSF) at different fixed rates (0.049-0.35 microliter min-1) were used to estimate the outflow resistance. Secondly, IOP responses were measured during an 2 hr intracameral infusion of either aCSF or AVP that was the sum of a small constant component (0.05 microliter min-1) and a larger periodic component (0.25 microliter min-1, cycling for 4 min on, then 4 min off); the mean infusion rate was 0.175 microliter min-1. As shown previously for 0.175 microliter min-1 constant infusions, the periodic aCSF infusion induced a significant rise in IOP that was attenuated by AVP administration. Complex demodulation analysis and the estimated gain parameter of a second order transfer function fit to the periodic responses indicated that outflow resistance increased significantly during the infusions in both aCSF and AVP groups, but that the indices of resistance did not differ significantly between aCSF and AVP infused eyes. This finding implies that changes in outflow resistance do not explain the difference in IOP responses to intracameral aCSF and AVP. The two responses differed significantly, though, in damping factors, such that the aCSF responses were considerably more underdamped than the AVP responses. It is hypothesized that aCSF-induced increase in IOP reflects both (1) a small component reflecting increased outflow resistance and (2) a larger non-resistive component. Since the non-resistive component is insensitive to pretreatment with acetazolamide, it is suggested that the aCSF-induced elevation in IOP reflects primarily vascular perfusion changes that are reduced by local vasoconstrictor actions of AVP. The latter mechanism likely maintains vascular perfusion of the globe when intraocular hypertension develops.

  17. p-(4-Azipentyl)-propofol: A Potent Photoreactive General Anesthetic Derivative of Propofol

    PubMed Central

    Stewart, Deirdre S.; Savechenkov, Pavel Y.; Dostalova, Zuzana; Chiara, David C.; Ge, Rile; Raines, Douglas E.; Cohne, Jonathan B.; Forman, Stuart A.; Bruzik, Karol S.; Miller, Keith W.

    2013-01-01

    We synthesized 2,6-Diisopropyl-4-[3-(3-methyl-3H-diazirin-3-yl)-propyl]-phenol (p-(4-azipentyl)-propofol), or p-4-AziC5-Pro, a novel photoactivable derivative of the general anesthetic propofol. p-4-AziC5-Pro has an anesthetic potency similar to propofol. Like propofol, the compound potentiates inhibitory GABAA receptor current responses and allosterically modulates binding to both agonist and benzodiazepine sites, assayed on heterologously expressed GABAA receptors. p-4-AziC5-Pro inhibits excitatory current responses of nACh receptors expressed in Xenopus oocytes and photoincorporates into native nACh receptor-enriched Torpedo membranes. Thus p-4-AziC5-Pro is a functional general anesthetic that both modulates and photoincorporates into Cys-loop ligand-gated ion channels, making it an excellent candidate for use in identifying propofol binding sites. PMID:22029276

  18. The role of dendritic signaling in the anesthetic suppression of consciousness.

    PubMed

    Meyer, Kaspar

    2015-06-01

    Despite considerable progress in the identification of the molecular targets of general anesthetics, it remains unclear how these drugs affect the brain at the systems level to suppress consciousness. According to recent proposals, anesthetics may achieve this feat by interfering with corticocortical top-down processes, that is, by interrupting information flow from association to early sensory cortices. Such a view entails two immediate questions. First, at which anatomical site, and by virtue of which physiological mechanism, do anesthetics interfere with top-down signals? Second, why does a breakdown of top-down signaling cause unconsciousness? While an answer to the first question can be gleaned from emerging neurophysiological evidence on dendritic signaling in cortical pyramidal neurons, a response to the second is offered by increasingly popular theoretical frameworks that place the element of prediction at the heart of conscious perception. PMID:25901843

  19. Bupivacaine and other amide local anesthetics inhibit the hydrolysis of chloroprocaine by human serum.

    PubMed

    Lalka, D; Vicuna, N; Burrow, S R; Jones, D J; Ludden, T M; Haegele, K D; McNay, J L

    1978-01-01

    The rate of hydrolysis of chloroprocaine by human serum was studied in the presence and absence of a number of aminde local anesthetics and their metabolites. Bupivacaine (2.4 microgram/ml) and etidocaine (2.3 microgram/ml) caused 38% and 21% inhibition respectively of the rate of chloroprocaine hydrolysis. Circulating concentrations of these drugs have been reported in this range by several investigators following epidural doses of 150 to 400 mg of either drug. Mepivacaine, lidocaine, and two lidocaine metabolites (glycine xylidide and monoethylglycine xylidide) were only inhibitory at levels much greater than those seen in blood following the usual local anesthetic doses of the parent compounds. Since serum is an important site of chloroprocaine metabolism in man, the probability of chloroprocaine intoxication may be increased when it is administered with local anesthetics such as bupivacaine and etidocaine. PMID:568420

  20. Comparative cardiovascular effects of four fishery anesthetics in spinally transected rainbow trout, Oncorhynchus mykiss

    USGS Publications Warehouse

    Fredricks, K.T.; Gingerich, W.H.; Fater, D.C.

    1993-01-01

    1. We compared the effects of four anesthetics on heart rate, dorsal and ventral aortic blood pressure, and electrocardiograms of rainbow trout (Oncorhynchus mykiss). 1. Exposure to the local anesthetics tricaine methanesulfonate (MS-222) and benzocaine hydrochloride (BZH) produced minimal cardiovascular alterations. Mean dorsal aortic pressure (DAP) decreased during exposure to MS-222, and mean DAP and mean ventral aortic pressure (VAP) increased 15% during recovery from BZH. 3. Exposure to the general anesthetic 2-phenoxyethanol (2-PE) or the hypnotic agent etomidate (ET) dramatically decreased heart rate and blood pressures and altered EKG patterns. 4. During recovery, VAP and DAP increased above baseline for an extended period. Heart rate and EKG patterns rapidly returned to normal.