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1

Pollution of Ambient Air by Volatile Anesthetics: A Comparison of Four Anesthetic Management Techniques.  

National Technical Information Service (NTIS)

Chronic exposure to waste anesthetic gas (WAG) may lead to health problems. The purpose of this study was to compare WAG concentrations resulting from four combinations of FGF and vaporizer settings during a simulated intravenous induction where the anest...

J. C. Barberio J. D. Bolt W. J. Craig P. N. Austin

2005-01-01

2

Anesthetic Management for Wingspan Stent  

PubMed Central

Background The bare metal self-expanding Wingspan stent (Boston Scientific, Natick, MA) was approved by the Food and Drug Administration under the Humanitarian Device Exemption in August 2005 for patients with intracranial atherosclerotic disease (ICAD) who are refractory to medical therapy. Relatively low rates of periprocedural morbidity and mortality have been reported. Methods After receiving institutional review board approval, we conducted a retrospective chart review to examine the anesthetic management and perioperative mortality and morbidity for all Wingspan stent insertions performed at our institution from 2005 to 2007. Results A total of 72 patients with a history of intracranial stenosis had angioplasty and Wingspan stent insertion: 34 male and 38 female, with an average age of 64 ± 11.6 years. Preoperative systolic blood pressure was 200 ± 45 mmHg, and diastolic blood pressure was 100 ± 23 mmHg. All patients received general anesthesia for stent insertion. Five patients died (6.9%), 4 had perioperative stroke (5.5%), and 9 had recurrent stenosis (12.5%). Conclusions Anesthetic management for Wingspan stent insertion for ICAD is challenging. Maintenance of hemodynamic stability with optimum brain perfusion during the stent deployment is crucial to patient safety. A prospective study is warranted to assess the optimal anesthetic choice during Wingspan stent insertion.

Farag, Ehab; Abd-Elsayed, Alaa; Anderson, Michael; Abdelmalak, Joseph; Schubert, Armin

2012-01-01

3

[Anesthetic management of surgery in term and preterm infants].  

PubMed

The physiology of the preterm and term neonate is characterized by a high metabolic rate, limited pulmonary, cardiac and thermoregulatory reserve and decreased renal function. Multisystem immaturity creates important developmental differences in drug administration and response when compared to older children. Specific monitoring techniques are required because the neonate is not physically accessible to the anesthetist during the operation. This contribution reviews the specific pathophysiological characteristics of the newborn with relevance to anesthesia and also provides robust guidelines for the anesthetic management of the most frequent non-cardiac procedures which need surgery during the neonatal period. Consideration will also be given to the anesthetic management of very low birth-weight infants with anesthetic key issues such as avoiding hyperoxia, keeping hemodynamic parameters as stable as possible and preventing hypothermia. PMID:16804683

Breschan, C; Likar, R

2006-10-01

4

Common medical illnesses that affect anesthesia and their anesthetic management.  

PubMed

Patients undergoing an office-based anesthetic require a thorough preoperative evaluation to identify medical illnesses and undertake appropriate investigations or studies. This article addresses common medical illnesses seen in oral surgery offices and provides insight into their anesthetic management, concentrating on open-airway office-based anesthesia. PMID:23870148

Agarwal, Ravi; Porter, Michael H; Obeid, George

2013-08-01

5

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

PubMed

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

Kato, Yoshiko

2014-01-01

6

[Successful anesthetic management of three patients with cardiac dysfunction for non-cardiac surgery using olprinone hydrochloride].  

PubMed

Non-cardiac surgery presents significant risks to patients with cardiac dysfunction. The relative safety of different anesthetic techniques has been studied without mentioning any clear indication. The depression of myocardial contractility by anesthetic agents limits their use in patients with cardiac dysfunction, especially for induction of anesthesia. We used olprinone hydrochloride perioperatively in the anesthetic management of three patients. In all cases, anesthetic induction, intraoperative course and the postoperative period proceeded uneventfully. We consider that perioperative use of continuous olprinone hydrochloride infusion may be suitable for patients with cardiac dysfunction for non-cardiac surgery. PMID:16026056

Arai, Takero; Cho, Tamihiro; Enomoto, Sumie; Ichiki, Akemi; Kase, Sachiko; Sato, Eiru; Tsuchida, Misa; Kuno, Yuichiro; Inoue, Hisashi; Okuda, Yasuhisa

2005-07-01

7

Anesthetic management of an infant for aortopexy  

PubMed Central

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

Kumar, Shruti; Gupta, Richa; Wadhawan, Sonia

2013-01-01

8

Anesthetic management of an infant for aortopexy.  

PubMed

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

Kumar, Shruti; Gupta, Richa; Wadhawan, Sonia

2013-04-01

9

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

PubMed Central

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

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

2014-01-01

10

[Anesthetic management of a child with fibrodysplasia ossificans progressiva (FOP)].  

PubMed

General anesthesia was successfully performed in a 9-year-old boy with FOP. FOP is a very rare inherited disease of the connective tissue, characterized by progressive heterotopic ossification of skeletal muscles, tendons, and ligaments. Trauma and invasive medical procedures can induce heterotopic ossification. Anesthetic concerns for FOP patients include particular attention to airway management and susceptibility to respiratory complications. Regarding the airway management in general anesthesia, excessive stretching of the jaw and extension of the head may lead to the ankylosis of the temporo-mandibular joint and the neck stiffness. Ankylosis of the costvertebral joints induces restrictive ventilatory impairment, which causes atelectasis and lung infection in the perioperative period. Relating to anesthetic management for a child with FOP, anesthesiologists should keep in mind the prevention of exacerbation of the symptoms and subsequent impairment of activities of daily living postoperatively. PMID:24063139

Okubo, Haruka; Hara, Koji; Sata, Takeyoshi

2013-09-01

11

Anesthetic management of a patient with Huntington's chorea -A case report-  

PubMed Central

Huntington's chorea is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia and psychiatric disturbances. The best anesthetic technique is yet to be established for these patients with increased risk of aspiration due to involvement of pharyngeal muscles and an exaggerated response to sodium thiopental and succinylcholine. The primary goal in general anesthesia for these patients is to provide airway protection and a rapid and safe recovery. We report the anesthetic management of a 51-year-old patient with Huntington's chorea admitted for an emergency operation.

Kang, Jong-Man; Chung, Jun-Young; Han, Jin Hee; Kim, Yung-Suk; Lee, Bong Jae

2013-01-01

12

Anesthetic management of the patient with amyotrophic lateral sclerosis.  

PubMed

Amyotrophic lateral sclerosis (ALS), with an incidence of 1.5-2.5 for 100 000 per year, is a rare but rapid progression neuromuscular degeneration disorder that poses unique perioperatively challenges to clinical anesthesiologists. The progressive degeneration of motor neurons causes a constellation of symptoms, including muscular weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Therapeutic and experimental treatments, including riluzole, beta lactams, methylcobalamin, dexpramipexole, antiepileptics, antioxidant agents, neutrophin, antiinflammatory agents, and antiapoptosis drugs, are described. Newer therapies, such as neural stem cells and diaphragmatic pacing, are presented. Because of the inherent muscle weakness and associated respiratory insufficiency, certain precautions must be utilized during anesthetic care of ALS patients. In particular, certain neuromuscular agents are contraindicated and anesthetics that leave the body more rapidly present logical and attractive options in this population. A solid understanding of the disease process, therapeutic interventions, and anesthesia considerations are all paramount for the successful management of a patient with ALS in the perioperative setting. PMID:23728364

Prabhakar, Amit; Owen, Christopher Paul; Kaye, Alan David

2013-12-01

13

[Anesthetic management for repair of Ebstein's anomaly with WPW syndrome].  

PubMed

Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with Wolff-Parkinson-White (WPW) syndrome. We report the perioperative management of 3 patients (a 34-year-old man, a 5-month-old boy and a 5-year-old girl) with Ebstein's anomaly associated with WPW syndrome. Anesthetic managements for valvuloplasty of the tricuspid valve and ablation of accessory pathway in 3 patients were successfully accomplished with a combination of fentanyl, sevoflurane, and midazolam. The management of Ebstein's anomaly is based on its severity. The major concerns with anesthesia for children with Ebstein's anomaly include decreased cardiac output, right-to-left atrial level shunting with cyanosis, and the propensity for atrial tachyarrhythmias. We conclude that perioperative management of arrhythmia and evaluation of residual tricuspid regurgitation using transesophageal echocardiography are essential. PMID:19364004

Nakamura, Tomoka; Kawahito, Shinji; Kawano, Hiroaki; Okada, Tsuyoshi; Kitahata, Hiroshi; Oshita, Shuzo

2009-04-01

14

Anesthetic management of electrophysiological procedures for heart failure.  

PubMed

Recent advances in EP enabled significant improvement in the care for cardiac patient. Implantation of PMs or ICDs, CRT, and RFA of tachyarrhythmias represent EP procedures that significantly improve quality of life and outcome in selected patient populations. The complexity of the procedure and the off-site EP laboratory environment create a new, challenging scenario for the anesthesiologist. A complex medical history and a current physical status of a patient presenting for a procedure must be carefully weighed in when discussing the options of anesthesia care. The roles of individual anesthetics and anesthesia techniques need to be further evaluated to facilitate the procedure and optimize patient care. PMID:22735718

Drabek, Tomas; N?mec, Jan

2012-01-01

15

Anesthetic management of a patient with bicuspid aortic valve and Hashimoto's thyroiditis posted for abdominal hysterectomy.  

PubMed

Bicuspid aortic valve is the most common birth defect affecting the heart and is present in 1-2% of the population. The abnormal valve structure leads to turbulent flow, fibrosis, calcification, and aortic stenosis. Aortic stenosis increases perioperative morbidity and mortality. Anesthetic techniques that reduce systemic vascular resistance (regional neuraxial techniques) must be used with extreme caution. Hashimoto's disease or chronic thyroiditis or autoimmune thyroiditis is the most common cause of hypothyroidism in adults. Regional anesthesia is preferred in patients with hypothyroidism as recovery from general anesthesia may be delayed by hypothermia, respiratory depression, or slow drug biotransformation. This is a case report of anesthetic management of a middle-aged female with co-existing aortic stenosis, hypothyroidism, and fibroid uterus posted for abdominal hysterectomy. PMID:23603628

Holyachi, Renuka; Patil, Basavaraj; Karigar, Shivanand L

2012-01-01

16

Peripartum anesthetic management of a patient with brittle cornea syndrome.  

PubMed

Brittle cornea syndrome (BCS) is a rare autosomal recessive disease that affects the connective tissue. The syndrome is caused by genetic changes in the 4.7-Mb interval between the D16S3423 and D16S3425 markers on the 16q24 chromosome and mutations in the Zinc-Finger 469 gene (ZNF469). BCS is characterized by thin and fragile cornea that tends to perforate spontaneously or as a result of minor trauma to the eye. In addition, the patient usually suffers from hearing loss, mental retardation, hyperextensibility of skin and joints, as well as varying degrees of scoliosis. This phenotypical expression presents an interesting challenge to anesthetic care. We briefly present the perioperative management of a patient with BCS who underwent three cesarean sections. PMID:21258811

Ioscovich, A; Grisaru-Granovsky, S; Halpern, S; Shapiro, Y

2011-03-01

17

[Anesthetic management of a patient with amyotrophic lateral sclerosis (ALS)].  

PubMed

A 63-year-old man suffering from amyotrophic lateral sclerosis (ALS) was scheduled for a surgery of rectal cancer. Anesthetic management was planned aiming early recovery from anesthesia and reduction of muscle relaxant administration. Orotracheal intubation was carried out by intravenous administration of a comparatively large dose propofol (3 mg.kg-1) and sevoflurane as high as 5%. Adequate muscle relaxation was obtained throughout the operation by inhalation of 2-3% sevoflurane and single intravenous administration of vecuronium 1 mg. A combination of propofol and sevoflurane is a successful choice to eliminate effects of anesthesia early after surgery and also to reduce the amount of a muscle relaxant used. PMID:12166283

Mishima, Yasunori; Katsuki, Shiho; Sawada, Maiko; Sato, Teruyuki; Hiraki, Teruyuki; Kano, Tatsuhiko

2002-07-01

18

Anesthetic management in a patient with Kindler's syndrome.  

PubMed

A 35-year-old male with pan-anterior urethral stricture was scheduled to undergo perineal urethrostomy. He was a known case of Kindler's syndrome since infancy. He was having a history of blister formation, extensive poikiloderma and progressive cutaneous atrophy since childhood. He had a tendency of trauma-induced blisters with clear or hemorrhagic contents that healed with scarring. The fingers were sclerodermiform with dystrophic nails and inability to completely clench the fist. Airway examination revealed thyromental distance of 7 cm with limited neck extension, limited mouth opening and mallampatti class III with a fixed large tongue. He was reported as grade IV Cormack and Lehane laryngoscopic on previous anesthesia exposure. We described the anesthetic management of such case on guidelines for epidermolysis bullosa. In the operating room, an 18-G cannula was secured in the right upper limb using Coban(™) Wrap. The T-piece of the cannula was than inserted into the slit and the tape was wrapped around the extremity. The ECG electrodes were placed on the limbs and fixed with Coban(™). Noninvasive blood pressure cuff was applied over the wrap after wrapping the arm with Webril(®) cotton. Oral fiberoptic tracheal intubation was done after lubricating the laryngoscope generously with a water-based lubricant with 7-mm endotracheal tube. Surgery proceeded without any complication. After reversing the residual neuromuscular block, trachea was extubated once the patient became awake. He was kept in the postanesthesia care unit for 2 hours and then shifted to urology ward. PMID:22144935

Solanki, Sohan Lal; Jain, Amit; Bhukal, Ishwar; Samanta, Sukhen

2011-10-01

19

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

PubMed Central

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

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

2014-01-01

20

Local anesthetic wound infiltration for pain management after periacetabular osteotomy  

PubMed Central

Background and purpose To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postoperative analgesia after PAO. Patients and methods We performed a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT00815503) in 53 patients undergoing PAO to evaluate the effect of local anesthetic infiltration on postoperative pain and on postoperative opioid consumption. All subjects received intraoperative infiltration followed by 5 postoperative injections in 10-hour intervals through a multi-holed catheter placed at the surgical site. 26 patients received ropivacaine and 27 received saline. The intervention period was 2 days and the observational period was 4 days. All subjects received patient-controlled opioid analgesia without any restrictions on the total daily dose. Pain was assessed at specific postoperative time points and the daily opioid usage was registered. Results Infiltration with 75 mL (150 mg) of ropivacaine did not reduce postoperative pain or opioid requirements during the first 4 days. Interpretation The clinical importance of ropivacaine as single component in postoperative treatment of pain is questionable, and we are planning further studies to explore the potential of LIA in larger volume—and also a multimodal regimen—to treat pain in this category of patients.

2014-01-01

21

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

PubMed Central

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

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

2012-01-01

22

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

PubMed Central

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

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

2014-01-01

23

The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy-assisted vaginal hysterectomy  

Microsoft Academic Search

BackgroundSurgical stress can induce postoperative systemic leukocytic alterations, including leukocytosis, neutrophilia, or lymphopenia. The present study investigated whether the anesthetic technique could affect the leukocytic alterations, including neutrophil-to-lymphocyte (N\\/L) ratio, after gynecologic laparoscopy.

Won Ho Kim; Hyun Seung Jin; Justin Sangwook Ko; Tae Soo Hahm; Sangmin Maria Lee; Hyun Sung Cho; Myung Hee Kim

2011-01-01

24

Anesthetic Concerns of Space Flight  

NASA Technical Reports Server (NTRS)

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

Norfleet, William T.

1999-01-01

25

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

PubMed

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

Zheng, Hui; Zhang, Yan-Rong

2012-11-01

26

Risk Management Status of Waste Anesthetic Gases Using ECRI Institute Standards  

PubMed Central

Background The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees’ health. Methods: A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute (Emergency Care Research Institute) was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds. Results: Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level. Conclusion: The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered.

Asefzadeh, S; Raeisi, AR; Mousavi, A

2012-01-01

27

Anesthetic management of a child with Langer-Giedion (TRPS II) syndrome.  

PubMed

We describe the anesthetic and perioperative management of a child with Langer-Giedion syndrome (trichorhinophalangeal syndrome type II). This is a very rare genetic syndrome caused by 8q chromosome deletion. The clinical features of this syndrome include craniofacial and urogenital abnormities, variable postnatal growth deficiency with mental retardation, multiple exostoses, hyperflexible joints, and recurrent respiratory tract infections. Potential perioperative problems are highlighted. PMID:19685136

Michalek, Pavel; Doherty, John T; Vesela, Michaela Michalkova

2009-01-01

28

[Anesthetic management in endotracheo-bronchial surgery for central bronchial and tracheal tumors].  

PubMed

The article summarizes the experience of anesthetic management in rigid bronchoscopy endobronchial surgery. Induction intravenous anesthesia followed by high tidal-volume mechanical ventilation proved to be more effective, than inhalation anesthesia with injector or high-frequency ventilation, although these methods are safe and effective in patients with compensated respiratory failure. The use of controlled hypotonia with mean arterial pressure of 60-70 mm Hg leads to decrease of blood loss and hypoxemia prevention without impairment of hemodynamics. PMID:22629836

Arsen'ev, A I; Vedenin, Ia O; Barchuk, A S; Duanevski?, I V; Nefedov, A O; Barchuk, A A; Gagua, K É; Aristidov, N Iu; Kanaev, S V; Tarkov, S A; Dolgopol'ski?, M N

2012-01-01

29

Anesthetic Management of the Patient With Low Ejection Fraction.  

PubMed

The number of patients with heart failure presenting for surgery continues to rise, and anesthesiologists are increasingly being called upon to provide quality, safe care in the operating room for patients with low ejection fraction (EF). Perioperative goals in the management of these patients include maintaining forward flow, promoting inotropy without inducing or exacerbating ischemia, and returning patients to their preoperative level of function after surgery. Oftentimes, these goals can be met with pharmacologic support, including the use of calcium channel blockers, phosphodiesterase inhibitors, and novel agents, such as nesiritide and levosimendan. Many patients with diminished EF have implantable cardioverter-defibrillators (ICDs) in place. These devices can be complex to manage, and concern often arises regarding electromagnetic interference from monopolar cautery. Although simply placing a magnet on the device will often disable the antitachycardia interventions of an ICD, this is not always the case. The safest way to manage an ICD in the perioperative period is to interrogate and reprogram the device before and after surgery. Another helpful device in dealing with patients with low EF, particularly those in acute cardiogenic shock, is the intra-aortic balloon pump. These devices can serve a critical role in managing patients who have inadequate responses to pharmacologic therapy or in whom vasopressor and inotropic support are suboptimal because of concerns for increasing myocardial work. With full understanding of available pharmacologic agents, and an appreciation of the capabilities of ICDs and intra-aortic balloon pumps, anesthesiologists will be better equipped to meet the perioperative needs of the patient with low EF. PMID:23344107

Chua, Jason Han; Nguyen, Rudolph

2013-01-23

30

Laparoscopic Cortical Sparing Adrenalectomy for Pediatric Bilateral Pheochromocytoma: Anesthetic Management  

PubMed Central

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

Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

2014-01-01

31

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

PubMed

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

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

2006-12-01

32

Technique for repeated collection of cerebrospinal fluid from cisterna magna of anesthetized strain 13 guinea pigs.  

PubMed

To study biochemical changes in cerebrospinal fluid (CSF), we developed a reliable technique for repeated collection of CSF in anesthetized strain 13 guinea pigs. The animal's head was mounted in a stereotaxic instrument with ventral tilt at 30 degrees, and cisternal puncture was made with an L-shaped, 23-gauge needle through the shaved skin. Clear CSF was collected in a 1-ml syringe surrounded by crushed ice. Each collection procedure lasted for 3 min, and three consecutive collections produced about 0.2 ml of CSF. Sampling was repeated at 3-hr intervals. With intravenous saline infusion (10 ml/kg.hr), a total volume of 0.6-1.0 ml of CSF was collected over 6 to 12 hr. Animals maintained a mean blood pressure, heart rate, and minute volume, with few changes during CSF sampling for the entire collection. PMID:1871150

Liu, C T; Guo, Z M

1991-09-01

33

Anesthetic management of a patient with obstructive prosthetic aortic valve dysfunction: a case report  

PubMed Central

We present a 55-year-old female patient who underwent burr-hole drainage due to chronic subdural hematoma, with obstructive prosthetic aortic valve dysfunction. Anesthetic management of a patient with severe obstructive prosthetic aortic valve dysfunction can be challenging. Similar considerations should be given to patients with aortic stenosis with an additional emphasis on thrombotic complication due to discontinuation of anticoagulation, which may further jeopardize the valve dysfunction. This case emphasizes the importance of a comprehensive understanding of the etiology and hemodynamic consequences of obstructive prosthetic valve dysfunction and the adequacy of anticoagulation for patients undergoing noncardiac surgery even after a successful valve replacement.

Lee, Bo Ra; Lee, Jeong-Rim

2014-01-01

34

[Anesthetic management of a patient with carnitine palmitoyltransferase deficiency with a history of rhabdomyolysis].  

PubMed

Carnitine palmitoyltransferase (CPT) makes the fatty acids available through beta-oxidation. Deficiency of CPT causes difficulties of muscle cells to metabolize fatty acid. In affected patients, exercise, fast for a prolonged period, and stress, lead to exhaustion of the store of glucose in the body, and rhabdomyolysis may occur, since muscle can not utilize fatty acid as an alternative energy source. Therefore, anesthetic management of CPT deficiency needs infusion of glucose continuously, avoiding the use of the drugs that cause rhabdomyolysis and suppressing the surgical stress. A 67-year-old man, who had previous history of rhabdmyolysis during the postoperative period, and diagnosed CPT deficiency was scheduled for total gastrectomy. General anesthesia was induced with remifentanil, thiamylal and rocuronium after epidural catheter insertion. During surgery, general anesthesia was maintained with remifentanil, sevoflurane, and blood glucose was monitored frequently, with continuous glucose infusion. No complications occurred during anesthesia and perioperative course was uneventful. PMID:23544345

Nakamura, Sayaka; Sugita, Michiko; Nakahara, Eriko; Yamamoto, Tatsuo

2013-03-01

35

[Anesthetic management of total hysterectomy in a patient with pulmonary thromboembolism].  

PubMed

We report anesthetic management of a 38-year-old woman with pulmonary thromboembolism for total hysterectomy. She had been taking oral contraceptives for adenomyosis of the uterus. She had thrombi in the arteries from pulmonary trunk to bilateral main pulmonary arteries. Thrombolytic and anticoagulant therapies did not decrease the thrombi. Removal of the swollen uterus suspected to be the origin of the thrombi, rather than thromboembolectomy, was scheduled. Cannulation for percutaneous cardiopulmonary support was set up just in case of hemodynamic derangement, before the surgery. Cardiac contraction was evaluated with transesophageal echocardiography during the surgery. There was no untoward perioperative event. Pulmonary thromboembolectomy was not done because the postoperative CT revealed shrinkage of the pulmonary thrombi after anticoagulation treatment. PMID:23814995

Okuda, Tomomi; Shigematsu, Kenji; Nitahara, Keiichi; Nakayama, Naomi; Miyamoto, Shingo; Higa, Kazuo

2013-06-01

36

Comparison of noninvasive blood pressure measurement techniques via the coccygeal artery in anesthetized cheetahs (Acinonyx jubatus).  

PubMed

Two indirect blood pressure measurement techniques, Doppler (DOP) sphygmomanometry and oscillometry, applied at the ventral coccygeal artery were compared with simultaneous direct blood pressure measurements at the dorsal pedal artery in 10 anesthetized, captive cheetahs (Acinonyx jubatus). The DOP method was moderately accurate, with relatively little bias (mean difference 3.8 mmHg) and 88.6% of the DOP systolic arterial pressure measurements being within 10 mmHg of the direct systolic arterial measurement. With the oscillometric (OM) method, 89.2% of the mean arterial pressure measurements were within 10 mmHg of the direct measurement and had the least bias (mean difference 2.3 mmHg), 80.7% of the systolic measurements were within 10 mmHg of the direct measurement and had the second least bias (mean difference 2.3 mmHg), and 59% of the diastolic measurements were within 10 mmHg of the direct measurement and had significant bias (mean difference 7.3 mmHg). However, DOP showed relatively poor precision (SD 11.2 mmHg) compared with OM systolic (SD 8.0 mmHg), diastolic (SD 8.6 mmHg), and mean (SD 5.7 mmHg). Both techniques showed a linear relationship with the direct technique measurements over a wide range of blood pressures. The DOP method tended to underestimate systolic measurements below 160 mmHg and overestimate systolic measurements above 160 mmHg. The OM method tended to underestimate mean pressures below 160 mm Hg, overestimate mean pressures above 160 mmHg, underestimate systolic pressures below 170 mmHg, overestimate systolic pressures above 170 mmHg, and underestimate diastolic pressures throughout the measured blood pressure range. Indirect blood pressure measurement using the ventral coccygeal artery, particularly when using an OM device for mean and systolic arterial pressure, may be useful in the clinical assessment of cheetahs when monitoring trends over time, but caution should be taken when interpreting individual values. PMID:24450051

Sadler, Ryan A; Hall, Natalie H; Kass, Philip H; Citino, Scott B

2013-12-01

37

Anesthetic management for a patient with severe mento-sternal contracture: difficult airway and scarce venous access -A case report-  

PubMed Central

There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.

Lee, Hye-Kyoung; Yim, Ji-Yeon; Kang, Im-Hong

2013-01-01

38

Technique for Repeated Collection of Cerebrospinal Fluid from Cisterna Magna of Anesthetized Strain 13 Guinea Pigs. (Reannouncement with New Availability Information).  

National Technical Information Service (NTIS)

To study biochemical changes in cerebrospinal fluid (CSF), we developed a reliable technique for repeated collection of CSF in anesthetized strain 13 guinea pigs. The animal's head was mounted in a stereotaxic instrument with ventral tilt at 30, and ciste...

C. T. Liu Z. M. Guo

1991-01-01

39

Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series.  

PubMed

Peroral endoscopic myotomy (POEM) is a newly developed, less invasive treatment for esophageal achalasia that requires general anesthesia under positive pressure ventilation. In this retrospective case series, we describe the anesthetic management of 28 consecutive patients who underwent POEM for esophageal achalasia. Anesthesia was maintained with sevoflurane and remifentanil under positive pressure ventilation through a tracheal tube. Retained contents in the esophagus were evacuated just before anesthesia induction to prevent regurgitation into the trachea. The POEM procedure was performed using an orally inserted flexible fiberscope. Elevation of end-tidal carbon dioxide after initiating esophageal carbon dioxide insufflation was observed in all patients and was treated by minute adjustments to the ventilation volume. Scopolamine butylbromide-induced tachycardia in one patient was treated with landiolol hydrochloride, which is a short-acting beta 1-selective blocker. Minor subcutaneous emphysema around the neck was observed in one patient. POEM was successfully completed, and tracheas were extubated immediately after the procedure in all patients. Our findings suggest that prevention of aspiration pneumonia during anesthesia induction, preparation for carbon dioxide insufflation-related complications, and treatment of scopolamine butylbromide-induced tachycardia play important roles in safe anesthesia management of POEM for esophageal achalasia. PMID:24185834

Tanaka, Eriko; Murata, Hiroaki; Minami, Hitomi; Sumikawa, Koji

2014-06-01

40

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

PubMed Central

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.

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

2012-01-01

41

Evaluation of common anesthetic and analgesic techniques for tail biopsy in mice.  

PubMed

Tail biopsy in mice is a common procedure in genetically modified mouse colonies. We evaluated the anesthetic and analgesic effects of various agents commonly used to mitigate pain after tail biopsy. We used a hot-water immersion assay to evaluate the analgesic effects of isoflurane, ice-cold ethanol, ethyl chloride, buprenorphine, and 2-point local nerve blocks before studying their effects on mice receiving tail biopsies. Mice treated with ethyl chloride spray, isoflurane and buprenorphine, and 2-point local nerve blocks demonstrated increased tail-flick latency compared with that of untreated mice. When we evaluated the behavior of adult and preweanling mice after tail biopsy, untreated mice demonstrated behavioral changes immediately after tail biopsy that lasted 30 to 60 min before returning to normal. The use of isoflurane, isoflurane and buprenorphine, buprenorphine, 2-point nerve block, or ethyl chloride spray in adult mice did not significantly improve their behavioral response to tail biopsy. Similarly, the use of buprenorphine and ethyl chloride spray in preweanling mice did not improve their behavioral response to tail biopsy compared with that of the untreated group. However, immersion in bupivacaine for 30 s after tail biopsy decreased tail grooming behavior during the first 30 min after tail biopsy. The anesthetic and analgesic regimens tested provide little benefit in adult and preweanling mice. Given that tail biopsy results in pain that lasts 30 to 60 min, investigators should carefully consider the appropriate anesthetic or analgesic regimen to incorporate into tail-biopsy procedures for mice. PMID:23294888

Jones, Carissa P; Carver, Scott; Kendall, Lon V

2012-11-01

42

Controlling Waste Anesthetic Gases.  

National Technical Information Service (NTIS)

This technical report provides Bioenvironmental Engineers (BEEs) with information to effectively manage potential waste anesthetic gas hazards. It supplements Air Force Occupational Safety and Health (AFOSH) Standard 48-8, Controlling Exposures to Hazardo...

E. J. Primeau

1994-01-01

43

[Anesthetic management of a 1.7-kg premature infant undergoing thoracoscopic thoracic duct ligation].  

PubMed

We report successful anesthetic management of a 1.7-kg premature infant who underwent thoracoscopic thoracic duct ligation under general anesthesia. She was born at 30 weeks gestation with birth weight of 1,546 g and was suffering from respiratory distress due to persistent right chylothorax for two months after birth. Chest tube drainage, fasting and intrapleural fibrin glue did not reduce her right chylothorax. Thoracoscopic thoracic duct ligation was scheduled on her day 64 under general anesthesia. The tracheal tube end was placed in the midtrachea and carbon dioxide was insufflated into the operative side of the thorax. During thoracoscopy her left lung was ventilated with the right lung pressed with spatulaes, but her respiratory status did not deteriorate so much despite of unilateral ventilation. We speculate that, due to massive right chylothorax, her pulmonary blood flow had already shifted to the left lung, therefore intraoperative substantial left unilateral lung ventilation exerted minimal effect on her respiratory status. The operation was successful and she was weaned from the ventilator on the following day. PMID:16231777

Watanabe, Kanako; Miyamoto, Yoshikazu; Kinouchi, Keiko; Kagawa, Kiyokazu; Kitamura, Seiji

2005-10-01

44

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

PubMed

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

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

2014-06-01

45

[Anesthetic management for surgery of giant coronary aneurysms complicated with Churg-Strauss syndrome].  

PubMed

Few cases of Churg-Strauss syndrome (CSS) complicated by giant coronary aneurysms (CAs)have been reported thus far. We report a case of CSS in a 60-year-old man who underwent surgery for giant CAs, and was managed with anesthetics. The patient developed acute myocardial infarction, and was diagnosed with giant CAs in the right coronary artery (RCA, 11 cm) and circumflex artery (3 cm). The CA in RCA was communicating with the right ventricle. He had a history of pericardiectomy for pericarditis caused by the CSS and developed thrombocytopenia due to consumptive coagulopathy within the CAs. An operation, including ligation and excision of the CAs, and coronary artery bypass grafting was performed under general anesthesia and cardiopulmonary bypass. There was massive hemorrhage followed by hemodynamic instability while detaching the tight pericardial adhesion and fragile surface of the CAs. Massive transfusion was required along with inotropes administration and intraaortic balloon support. In this case, determination of the appropriate surgical timing was difficult because symptoms of the CSS became worse followed by rapid enlargement of the CAs, myocardial infarction, and thrombocytopenia. Steroids were administered for treating CSS, and the blood transfusion was sufficient. However, it was difficult to control the hemorrhage and maintain hemodynamic stability. PMID:24783616

Kido, Koji; Tokuda, Rui; Suzuki, Tomofumi; Hanashiro, Ako; Kobashigawa, Teruyo; Mayama, Takashi; Kamikawa, Michie

2014-04-01

46

Severe post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique.  

PubMed

Severe post-burn contractures in the neck often cause anatomical distortion and restriction of neck movements, resulting in varying degrees of difficulty in airway management. Any mode of anesthesia that may obviate the need for imperative airway control may be desirable in such situations in which a difficult airway may be anticipated. Here we present one such situation where tumescent local anesthesia was employed to manage a case of severe post-burn neck contractures posted for contracture release and split-skin grafting. The other benefits of this method were minimal blood loss and excellent postoperative analgesia. In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management. PMID:21986719

Prasad, Mukesh Kumar; Puneet, Pulak; Rani, Kanchan; Shree, Divya

2012-02-01

47

Technical communication: inhaled anesthetic agent-vaporizer mismatch: management in settings with limited resources: don't try this at home.  

PubMed

Agent-specific vaporizers minimize opportunities for error and evidence our specialty's commitment to patient safety as a general principle. End-tidal anesthetic gas concentration monitoring is a useful adjunct whenever inhaled anesthetics are used in operating rooms. Due to their expense and required maintenance, end-tidal anesthetic gas monitors are not commonly used in developing nations. Unfortunately, in resource-constrained environments, situations may arise in which inhaled anesthetic agent-vaporizer mismatch may be necessary in the absence of end-tidal anesthetic gas monitoring. Rather than merely censure such practice as a threat to safety, we believe that certain anesthetic agent-vaporizer mismatch situations can be safely managed providing patients with predictable inspired anesthetic gas concentrations while minimizing errors. We present an approach based on mathematical models and tested in an artificial lung model. Mismatching of inhaled agent and vaporizer is a dangerous practice and should not be performed unless it is absolutely necessary. Such situations may arise in remote locations where neither end-tidal anesthetic gas monitoring nor vaporizer-specific agent is available. We hope our article provides guidance in such situations. PMID:23558837

Adler, Adam C; Connelly, Neil Roy; Ankam, Abistanand; Raghunathan, Karthik

2013-06-01

48

[An activated charcoal filter for eliminating volatile anesthetics. A contribution to the management of malignant hyperthermia].  

PubMed

Anesthesia machines may not be contaminated with anesthetic vapors when a patient susceptible to malignant hyperthermia (MHS) is to be anesthetized. A clean machine may not always be available, and recommended protocols for preparing a contaminated machine are cumbersome and time-consuming. We suggest the use of an activated charcoal filter that is easily assembled from spare parts available in many anesthesiology departments (Fig. 2). It consists of an HME container (Servo-Humidifier 150, Siemens-Elema), a sieve set from an anesthesia circuit (7a/8-ISO, Dräger, Lübeck), and grained activated charcoal (2.5 mm, Merck, Darmstadt). All parts are autoclavable. The filter adsorbs anesthetic vapors quantitatively (Fig. 3) without affecting humidity, nitrous oxide concentration, or circuit resistance. Storage of such a filter may obviate the need to keep a clean anesthesia machine available for MHS patients. PMID:2635839

Jantzen, J P; Eck, J; Kleemann, P P

1989-11-01

49

Regional anesthetic techniques are an alternative to general anesthesia for infants with Pompe's disease.  

PubMed

Pompe's disease or glycogen storage disease type II is a genetic disorder affecting skeletal and cardiac muscle. The infantile form is associated with gross hypertrophic cardiomegaly and death in the early years. General anesthesia is associated with potential major morbidity in these patients. We present our experience of regional anesthetic blocks used in five patients with the infantile form of glycogen storage disease type II with and without sedation for 11 surgical procedures during a clinical trial of replacement therapy for this condition. Both femoral nerve blockade and caudal epidural blockade were used with good result. The relative merits of the type of block are discussed in addition to the choice of sedation and risks of general anesthesia. The avoidance of general anesthesia in the newly presenting patient with Pompe's disease may reduce potential morbidity until enzyme replacement has been established. PMID:17564654

Walker, Robert W M; Briggs, Geraint; Bruce, James; Fletcher, Joan; Wraith, E D

2007-07-01

50

The Effect of Anesthetic Technique on Recovery After Orthognathic Surgery: A Retrospective Audit  

PubMed Central

We audited the recovery characteristics of 51 patients who had undergone orthognathic maxillofacial surgery at a single center. Patients whose anesthesia had been maintained with intravenous propofol and remifentanil (n ?=? 21) had significantly higher pain scores during the first 4 hours after surgery than those whose anesthesia was maintained with volatile inhalational agents and longer-acting opioids (n ?=? 30) (P ?=? .016). There was a nonsignificant trend towards shorter recovery times in the former group, while there were no differences in early postoperative opioid usage, hemodynamic parameters, or postoperative nausea and vomiting . Given that our data were collected retrospectively and without the ability to control for potential confounders, we interpret the results with caution. Notwithstanding these limitations, we believe this is the first report comparing the effects of different opioid-based anesthetic regimens on early recovery from orthognathic surgery, and we believe this report may be used as the starting point for a controlled study.

Chegini, Soudeh; Johnston, Kevin D; Kalantzis, Athanasios; Dhariwal, Daljit K

2012-01-01

51

[Anesthetic management for a patient with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome].  

PubMed

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, described by McCarty et al., is a form of "seronegative rheumatoid arthritis" characterized by an acute-onset polyarthritis with pitting edema of the dorsum of both hands and/or both feet. The syndrome is prevalent in elderly men, completely remitted with a small dose of steroid over a relatively short period, and has a benign clinical course. We describe a case of RS3PE syndrome in a 61-year-old man undergoing a lobectomy of the lung and discuss anesthetic management for the syndrome. PMID:15500108

Terada, Tadanori; Ishimura, Hiroshi; Iwagaki, Tamao; Aoyama, Kazuyoshi; Takenaka, Ichiro; Kadoya, Tatsuo

2004-09-01

52

Republished: society for neuroscience in anesthesiology and critical care expert consensus statement: anesthetic management of endovascular treatment for acute ischemic stroke*.  

PubMed

Literature on the anesthetic management of endovascular treatment of acute ischemic stroke (AIS) is limited. Anesthetic management during these procedures is still mostly dependent on individual or institutional preferences. Thus, the Society of Neuroscience in Anesthesiology and Critical Care (SNACC) created a task force to provide expert consensus recommendations on anesthetic management of endovascular treatment of AIS. The task force conducted a systematic literature review (up to August 2012). Because of the limited number of research articles relating to this subject, the task force solicited opinions from experts in this area. The task force created a draft consensus statement based on the available data. Classes of recommendations and levels of evidence were assigned to articles specifically addressing anesthetic management during endovascular treatment of stroke using the standard American Heart Association evidence rating scheme. The draft consensus statement was reviewed by the Task Force, SNACC Executive Committee and representatives of Society of NeuroInterventional Surgery (SNIS) and Neurocritical Care Society (NCS) reaching consensus on the final document. For this consensus statement the anesthetic management of endovascular treatment of AIS was subdivided into 12 topics. Each topic includes a summary of available data followed by recommendations. This consensus statement is intended for use by individuals involved in the care of patients with acute ischemic stroke, such as anesthesiologists, interventional neuroradiologists, neurologists, neurointensivists and neurosurgeons. PMID:25070964

Talke, Pekka O; Sharma, Deepak; Heyer, Eric J; Bergese, Sergio D; Blackham, Kristine A; Stevens, Robert D

2014-08-01

53

Anesthetic management of a patient with congenital insensitivity to pain: a case report.  

PubMed

Pain protects the body from damaging effects of harmful stimuli. Congenital insensitivity to pain is a rare inherited disorder characterized by diminished or absent sensitivity to pain, touch, and pressure that leads to frequent trauma and self-mutilation. The disorder is part of the hereditary sensory and autonomic neuropathy (HSAN) family, in which 5 types have been recognized. Research and case reports of anesthetic risks and analgesic needs of these patients is limited due to the infrequent nature of the disorder. Recommendations for anesthesia include modification of intraoperative opioid requirements, use of anesthetics to ensure cooperation and immobility, and intraoperative temperature monitoring. It is imperative for anesthesia providers to understand which type of HSAN their patient experiences and to conduct a thorough preoperative interview because a different interpretation of sensory loss may occur in each HSAN category. This article reports the case of a patient with HSAN type 2 who presented for knee arthroscopy. PMID:24354073

Parrott, Laura M

2013-10-01

54

Postoperative pain management after spinal fusion surgery: an analysis of the efficacy of continuous infusion of local anesthetics.  

PubMed

Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery. PMID:24436846

Reynolds, Richard A K; Legakis, Julie E; Tweedie, Jillian; Chung, Youngkey; Ren, Emily J; Bevier, Patricia A; Thomas, Ronald L; Thomas, Suresh T

2013-03-01

55

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

PubMed

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

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

2014-06-01

56

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

PubMed Central

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

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

2014-01-01

57

Innovative Techniques for Management Development.  

ERIC Educational Resources Information Center

Innovative training techniques intorduced in response to change in internal structure and external environment of organizations have produced positive results in their management's productivity and effectiveness. A four-year study has been conducted on the use of innovative training techniques by Vanderbilt University's Graduate School or…

Verda, Dominic J.

58

CO 2 -ventilatory response of the anesthetized rat by rebreathing technique  

Microsoft Academic Search

The ventilatory response to CO2 in rats under sodium pentobarbital anesthesia has been measured using the rebreathing technique. The animal rebreathed through a tracheal cannula for a period of 4 min from an apparatus of 200–400 ml capacity, containing 5–6% CO2 in O2.\\u000a

Fumiaki Hayashi; Akio Yoshida; Yasuichiro Fukuda; Yoshiyuki Honda

1982-01-01

59

Anesthetic neurotoxicity.  

PubMed

All routinely utilized sedatives and anesthetics have been found neurotoxic in a wide variety of animal species, including non-human primates. Neurotoxic effects observed in animals include histologic evidence for apoptotic neuronal cell death and subsequent learning and memory impairment. Several cohort studies in neonates with significant comorbidities requiring surgical procedures early in life have also demonstrated abnormal neurodevelopmental outcomes. This article provides an overview of the currently available data from both animal experiments and human clinical studies regarding the effects of sedatives and anesthetics on the developing brain. PMID:24491654

Lin, Erica P; Soriano, Sulpicio G; Loepke, Andreas W

2014-03-01

60

The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique.  

PubMed

Both end-inspiratory (EIO) and end-expiratory (EEO) occlusions have been used to measure the strength of the Hering-Breuer inflation reflex (HBIR) in infants. The purpose of this study was to compare both techniques in anesthetized infants. In each infant, HBIR activity was calculated as the relative prolongation of expiratory and inspiratory time during EIO and EEO, respectively. Respiratory drive was assessed from the change in airway pressure during inspiratory effort against the occlusion, both at a fixed time interval of 100 ms (P0.1) and a fixed proportion (10%) of the occluded inspiratory time (P10%). Twenty-two infants [age 14.3 +/- 6. 4 (SD) mo] were studied. No HBIR activity was present during EIO [-11.8 +/- 15.9 (SD) %]. By contrast, there was significant, albeit weak, reflex activity during EEO [HBIR: 27.2 +/- 17.4%]. A strong HBIR (up to 310%) was elicited in six of seven infants in whom EIO was repeated after lung inflation. P0.1 was similar during both types of occlusions, whereas mean +/- SD P10% was lower during EEO than during EIO: 0.198 +/- 0.09 vs. 0.367 +/- 0.15 kPa, respectively (P < 0.01). These data suggest a difference in the central integration of stretch receptor activity in infants during anesthesia compared with during sleep. PMID:9516215

Brown, K; Stocks, J; Aun, C; Rabbette, P S

1998-04-01

61

Anesthetic management of primary hyperparathyroidism: A role rarely noticed and appreciated so far  

PubMed Central

Endocrine surgeries have been on the rise for the last few years. During surgery, endocrine disorders present unique challenges to the endocrinologist and to the attending anesthesiologist. The endocrine, electrolyte and metabolic disturbances resulting from such disorders can have a profound effect on the normal human physiological milieu. Surgery of parathyroid glands is no exception and is associated with a multiple challenges during pre-, intra-, and post-operative period. Pre-op examination and optimization is essential so as to prevent any intra-op or post-op complications. The most striking electrolyte disturbance during parathyroid surgery is the imbalance of calcium levels in the body and the main emphasis during the entire peri-operative period revolves around the maintenance of normal serum calcium levels. The present article review in depth the various anesthetic considerations and implications during parathyroid surgery with an emphasis on pre-op preparation for elective and emergency surgery.

Bajwa, Sukhminder Jit Singh; Sehgal, Vishal

2013-01-01

62

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

PubMed Central

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

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

2014-01-01

63

Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture.  

PubMed

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem. PMID:23287087

Maxwell, Bryan G; Harrington, Katherine B; Kelly, Nate E

2013-01-01

64

[Successful anesthetic management of patients with poor ventricular function using the phosphodiesterase III inhibitor, olprinone, during major cardiovascular procedures].  

PubMed

We administered olprinone, a newly developed phosphodiesterase III inhibitor, commencing before induction of general anesthesia to patients with poor ventricular function during major cardiovascular procedures. Case 1 patient underwent off-pump CABG for acute myocardial infarction. Although he was in a shock state, olprinone improved the contractility of viable myocardium, increased the cardiac index, and decreased the pulmonary artery pressure. Case 2 patient underwent off-pump CABG for unstable angina. Olprinone significantly increased the cardiac index and the mixed venous oxygen saturation. Case 3 patient underwent graft replacement for rupture of a dissected descending aorta. Although he showed ischemic cardiomyopathy with diffuse hypokinetic left ventricle, olprinone drastically improved the contractility of the heart. Olprinone was very effective for improving ventricular dysfunction; its institution prior to induction of anesthesia made successful anesthetic management possible without resorting to a mechanical assist device like the intra-aortic balloon pump. PMID:15011421

Chang, Kyung-ho; Ogawa, Makoto; Bougaki, Masahiko; Sugano, Takayuki; Hanaoka, Kazuo

2004-02-01

65

Anesthetic management including extracorporeal membrane oxygenation therapy of liver transplant recipient with life-threatening hypoxemia -a case report-  

PubMed Central

We present a rare case of successful anesthetic management for a patient who had refractory hypoxia during liver transplantation (LT) with intraoperative veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support. A 49 year-old female patient underwent living donor LT. After reperfusion of the grafted liver, graft congestion and massive oozing developed. Thus it was decided to reoperate with a temporary gauze packing. However, the patient's condition deteriorated with azotemia and severe hypoxemia. VV ECMO with continuous renal replacement therapy was started 24 hours before secondary LT and maintained during secondary LT. VV ECMO was weaned 32 hours after secondary LT. This case indicates that not only after the LT but also before and during LT, VV ECMO can be a treatment option for the patient with end-stage liver disease combined with respiratory failure when there is the possibility of lung recovery.

Yoo, Chan Seon; Shin, Young Hee; Ko, Justin Sangwook; Gwak, Mi Sook

2013-01-01

66

Aerospace management techniques: Commercial and governmental applications  

NASA Technical Reports Server (NTRS)

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

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

1971-01-01

67

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

PubMed Central

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.

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

2006-01-01

68

[Anesthetic management of six patients with surgically repaired tetralogy of Fallot undergoing the second intra-cardiac surgery].  

PubMed

In Japan, more than 9,000 patients with congenital heart disease reach adulthood every year with improved medical treatment, and perioperative encounter with patients requiring the second intra-cardiac operation in adulthood is more often. Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease, and long-term prognosis is good. Therefore, we have more chances to care the postoperarive adult patients with TOF. This is a retrospective study in 6 patients with TOF who underwent the second intra-cardiac operation in adulthood from 2008 to 2012. Among the six patients, six had pulmonary valve replacement; four had tricuspid valve replacements or valvuloplastys; four had ventricular septal defect closures; two had right ventricular outflow tract obstruction releases; one had aortic valve replacement; and three had cryoablations. Right ventricular end-diastolic volume was 194.1 +/- 83.5 ml x m(-2) (mean +/- SD), and right ventricular ejection fraction was 38.2 +/- 4.8%. The factors which influence the anesthetic management were as follows: right cardiac failure by abnormality of the pulmonary valve; residual disease and deuteropathy of two or more combination; the risks associated with the second open chest surgery such as long operative time and severe bleeding. Perioperative management of an adult with congenital heart disease requires full understanding of its pathophysiology such as congenital heart disease, adult-specific complications, and the second open chest surgery. PMID:24783598

Adachi, Koko; Kurosawa, Shin; Kameyama, Eri; Nakata, Yohko

2014-04-01

69

Bus Fleet Management Techniques Guide. Final Report.  

National Technical Information Service (NTIS)

The purpose of the Bus Fleet Management Techniques Guide is to provide transit maintenance managers with methods that they can use to derive information for maintenance planning and fleet management. The Guide covers three basic areas: (1) statistical ana...

A. R. Cook T. H. Maze U. Dutta

1985-01-01

70

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

PubMed Central

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.

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

2012-01-01

71

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

PubMed Central

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

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

2014-01-01

72

Anesthetic management of a patient undergoing liver transplantation who had previous coronary artery bypass grafting using an in situ right gastroepiploic artery  

Microsoft Academic Search

We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous\\u000a coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained\\u000a with 1.5% isoflurane in air\\/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing\\u000a pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter

Hiroaki Murata; Haruka Inoue; Koji Sumikawa

2010-01-01

73

Anesthetic management for subtotal gastrectomy in a patient with paramyotonia congenita.  

PubMed

We performed anesthesia for a subtotal gastrectomy in a 70-year-old female patient with paramyotonia congenita (PC). She had been diagnosed with PC at the age of 47 years by electromyogram analysis. Several points to consider have been revealed regarding the management of anesthesia in patients with PC. In this patient, anesthesia was safely maintained using sevoflurane and nitrous oxide together with concomitant epidural anesthesia using mepivacaine. Efforts should be made to prevent perioperative attacks of muscle weakness when planning anesthesia for patients with this kind of disorder. Specifically, refraining from the use of muscle relaxants, care with regard to the composition of infusion fluids during operations, and the maintenance of body temperature are required for anesthesia. In addition, postoperative pain management using a continuous epidural block proved to be a useful method. PMID:18008119

Kaneda, Toru; Iwahashi, Michiyo; Suzuki, Toshiyasu

2007-01-01

74

Anesthetic management for subtotal gastrectomy in a patient with paramyotonia congenita  

Microsoft Academic Search

We performed anesthesia for a subtotal gastrectomy in a 70-year-old female patient with paramyotonia congenita (PC). She had\\u000a been diagnosed with PC at the age of 47 years by electromyogram analysis. Several points to consider have been revealed regarding\\u000a the management of anesthesia in patients with PC. In this patient, anesthesia was safely maintained using sevoflurane and\\u000a nitrous oxide together

Toru Kaneda; Michiyo Iwahashi; Toshiyasu Suzuki

2007-01-01

75

Managing the untoward anesthetic event in an oral and maxillofacial surgery practice.  

PubMed

The safe and efficient use of outpatient surgical anesthesia modalities is a significant part of the training and expertise of the oral and maxillofacial surgeon. Although adverse outcomes are rare, they can have considerable traumatic psychological and professional consequences for the surgeon involved. The goal of this article is to develop guidelines to educate the doctor, the second victim, on how to manage a bad outcome and how to navigate through a difficult and arduous process. PMID:23870150

Kaltman, Steven I; Ragan, Michael; Borges, Osbel

2013-08-01

76

Anesthetic management in patients suspected of Creutzfeldt-Jakob disease -A case report-  

PubMed Central

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder in which accumulation of the pathogenic prion protein induces neuronal damage and results in distinct pathologic features. This abnormal prion is an infectious protein and resistant to methods of sterilization currently being used. Therefore, management of definite, or suspected CJD patients requires additional precautions. We report our experience of a patient who had undergone brain biopsy for suspected of CJD. The patient was confirmed to have sporadic CJD.

In, Chi Bum; Choi, Young Sil; Park, Eun Young; Chang, Dong Jin; Choi, Hyun; Moon, Hyun Soo

2011-01-01

77

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

PubMed Central

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

Gyanesh, Prakhar; Dhiraaj, Sanjay

2013-01-01

78

Laparoscopic surgery--anesthetic implications.  

PubMed

Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. The efficacy of laparoscopic appendectomy and hemicolectomy has been recently evaluated. However, there have been no prospective randomized studies to date comparing laparoscopic with traditional laparotomy techniques. The physiological effects of prolonged pneumoperitoneum and the longer duration of surgery with the laparoscopic techniques are of concern. The application of laparoscopic inguinal hernia repair may be limited because, unlike traditional surgical hepair, general anesthesia is required and concerns have been expressed about the duration of surgery and the possibility of hernia recurrence. Notwithstanding case reports and series describing successful diaphragmatic and hiatus hernia repair using a laparoscopic surgical technique, the frequently encountered complications of cervical surgical emphysema, pneumothorax, and pneumomediastinum, attributed to passage of insufflating gas through weak points or defects in the diaphragm, must be of major concern. Anesthesiologists must maintain a high index of suspicion for these potential complication and must undertake appropriate monitoring. If there is clinical evidence of a tension pneumothorax, immediate chest tube decompression is indicated. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiological changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for upper abdominal laparoscopic procedures is most frequently limited to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal anti-inflammatory agents has reduced postoperative nausea and vomiting following laparoscopic cholecystectomy. The use of nitrous oxide during laparoscopic procedures remains controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gall-bladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists should thus be prepared to recommend deflation of the pneumoperitoneum and possibly conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties arise during the procedure. PMID:7831596

Cunningham, A J

1994-11-01

79

Anesthetic and airway management of a child with a large upper-lip hemangioma  

PubMed Central

An 11-month-old male child weighing 8 kg was brought to the plastic surgery out-patient department by his parents with chief complaints of sudden increase in size of a swelling over the upper lip and difficulty in feeding for the last 7 days. It was diagnosed as a case of hemangioma of the upper lip. All the routine and special investigations including coagulation profile of the child were normal. The child was planned for ablation of feeding vessels along with intralesional steroid injection. Airway management of the child posed the challenge for us as the size and site of the lesion carried the risk of difficult intubation and possible risk of extensive hemorrhage. All the requisite equipment for difficult airway management was made ready. We were able to intubate the child with miller number-2 blade from the left angle of mouth without putting much pressure on the swelling. The surgical and postoperative period was uneventful and the child was discharged the next day to be followed up after 2 weeks.

Bajwa, Sukhminderjit Singh; Panda, Aparajita; Bajwa, Sukhwinder Kaur; Singh, Amarjit; Parmar, S. S.; Singh, Kanwalpreet

2011-01-01

80

[Anesthetic management of a patient with moyamoya disease undergoing mitral valve repair].  

PubMed

Moyamoya disease is the result of progressive steno-occlusive changes in the internal carotid arteries followed by formation of bilateral abnormal vascular networks. The disease may present with cerebral ischemia causing cerebral hemorrhage in the perioperative period. There are few reports of cardiac surgeries in patients with moyamoya disease, and the management during cardiopulmonary bypass for moyamoya disease has not been established. We gave general anesthesia for mitral valve plasty in patient with the moyamoya disease. A 52-year-old woman underwent mitral valve plasty. She had been diagnosed with moyamoya disease and during the cardiopulmonary bypass, we used alpha-stat blood gas management with mild hypothermia, and maintained PaCO2 around 40 mmHg. We maintained the perfusion flow of CPB above 3.0 l x min(-1) x m(-2) and the mean perfusion pressure above 70 mmHg. In addition, we used the pulsatile perfusion assist with intraaortic balloon pumping to maintain cerebral circulation. Postoperative course was uneventful without apparent neurologic deficit, and she was discharged from hospital on 10th postoperative day. PMID:24724448

Ishikawa, Saki; Yamada, Tatsuya; Sakaguchi, Ryota; Hatori, Eiki; Morisaki, Hiroshi

2014-03-01

81

Anesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB).  

PubMed

Over the last decade, TECAB has matured into a reproducible technique associated with low incidence of both mortality and morbidity, as well as superior quality of life, when compared with open CABG surgery. However, TECAB also is associated with important and specific challenges for the anesthesiology team, particularly with regard to the physiologic stresses of OLV, placement of special catheters, and induced capnothorax. As the technology supporting robotic surgery evolves and familiarity with, and confidence in, TECAB increases, the authors anticipate increasingly widespread use of these procedures in an increasingly fragile and problematic patient population who will require the support of a skilled and vigilant anesthesiology team. PMID:23672862

Deshpande, Seema P; Lehr, Eric; Odonkor, Patrick; Bonatti, Johannes O; Kalangie, Maudy; Zimrin, David A; Grigore, Alina M

2013-06-01

82

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

PubMed Central

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

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

2010-01-01

83

[Anesthetic management of a patient with 8 trisomy mosaic combined with cerebral palsy].  

PubMed

We administered general anesthesia for a patient with 8 trisomy mosaic and cerebral palsy. Constitutional 8 trisomy mosaic has been associated with syndromic dysmorphology, corneal opacities, leukemia and trophoblastic disease. In Japan only 4 reports of general anesthesia related with 8 trisomy were found. This patient was a 24-year-old woman (140 cm, 35 kg), with mental retardation, poor body development and severe scoliosis. Since she suffered from repeated serious asthma and pneumonia since childhood, tracheotomy was performed at the age of 9. Epileptic seizures were also seen and antiepileptics were prescribed. This time, general anesthesia was scheduled for the extraction of a maxillary cyst. Anesthesia was induced slowly with sevoflurane from the tracheotomy, followed by rocuronium 25 mg i.v., and maintained with sevoflurane 1.5-2 % and remifentanil 0.05-0.2 microg x kg(-1) x min(-1) Throughout the operation, BIS score fluctuated between 40-60, and stable anesthesia was maintained. We reversed the rocuronium with sugammadex 140 mg promptly. The 8 trisomy mosaic patient is known to have various complications related to circulation and respiration. Careful management is necessary in anesthesia for an 8 trisomy patient. PMID:24783618

Matsuda, Kazuko; Yakushiji, Tsutomu; Ryo, Jyunkei; Higashimoto, Soken; Sasaki, Kotatsu

2014-04-01

84

[Anesthetic management of a patient with non-bullous congenital ichthyosiform erythroderma].  

PubMed

Non-bullous congenital ichthyosiform erythroderma is a disorder in the cornification of the skin, histopathologically characterized by hyperkeratosis. Previous reports mentioned that the fixation of endotracheal tubes and ECG electrodes to the skin was likely to be infirm in the patients with this disorder, and that the patients' body temperatures were easily affected by the environment. A 3-year-old girl with non-bullous congenital ichthyosiform erythroderma underwent two operations separately under general anesthesia. We used Hollister Skin Gel to fix the endotracheal tube. This gel helped prevent the irritation associated with the application and removal of adhesives. The patient became severely hypothermic during the first operation. Fortunately, the intraoperative body temperature could be maintained at a normal level during the second operation with the use of a forced-air warming system. Careful perioperative consideration is required for the fixation of endotracheal tubes and the management of body temperature in patients with non-bullous congenital ichthyosiform erythroderma. PMID:14733087

Kubota, Ryo; Miyake, Nanae; Nakayama, Hideto; Arita, Hideko; Hanaoka, Kazuo

2003-12-01

85

Ventilation and anesthetic approaches for rigid bronchoscopy.  

PubMed

Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra-short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications. PMID:24635585

Pathak, Vikas; Welsby, Ian; Mahmood, Kamran; Wahidi, Momen; MacIntyre, Neil; Shofer, Scott

2014-05-01

86

Bus Fleet Management Principles and Techniques.  

National Technical Information Service (NTIS)

The purpose of the monograph is to demonstrate principles, methods, and techniques that should permit the better management of bus fleets through the systematic use of maintenance records and data. The materials presented will assist the fleet manager in ...

T. H. Maze

1987-01-01

87

Techniques for Managing a Computer Classroom.  

ERIC Educational Resources Information Center

Some techniques for managing the classroom and teaching programing that have worked well are described. Hardware placement and use, classroom management, instructional recommendations, and programing ideas are each discussed. (MNS)

Sedran, Mary Ann

1985-01-01

88

FOUND: A Technique for Teaching Management Concepts.  

ERIC Educational Resources Information Center

Describes a technique used to teach theories of management: family simulation. Students created and described a family, its environment, and resources and used this scenario for practical applications of management concepts, such as decision making and decision trees. (SK)

Linck, Sandra Taliaferro

1982-01-01

89

Classroom Management Techniques and Student Discipline.  

ERIC Educational Resources Information Center

This paper reviews concepts and research findings on classroom management techniques and explores how these techniques are related to student discipline strategies. The first section surveys descriptive and experimental research recently accumulated on classroom management practice, concentrating on strategies for monitoring and guiding classroom…

Doyle, Walter

90

Systems management techniques and problems  

NASA Technical Reports Server (NTRS)

Report is reviewed which discusses history and trends of systems management, its basic principles, and nature of problems that lend themselves to systems approach. Report discusses systems engineering as applied to weapons acquisition, ecology, patient monitoring, and retail merchandise operations.

1971-01-01

91

Techniques for Improving Cash Management.  

ERIC Educational Resources Information Center

This article deals with several techniques for regulating cash inflow and outflow and investing surplus cash for short periods of time. The techniques are: (1) consolidating checking accounts, (2) determining surplus cash by examining bank balances in conjunction with the cash book, (3) selecting a minimum bank balance, (4) investing a greater…

Lykins, Ronald G.

1973-01-01

92

Anesthetic management for resection of hepatic paraganglioma metastatic from the donor organ in an orthotopic liver transplant recipient: a case report.  

PubMed

This is a case report of the anesthetic management for the hepatic resection of a metastatic paraganglioma in a patient with a history of prior orthotopic liver transplantation. Of interest, the metastatic paraganglioma originated from the donor organ. The patient is an 80-year-old woman with multiple medical problems including a history of cryptogenic cirrhosis who underwent successful orthotopic liver transplantation 9 years prior. She later presented with signs and symptoms of catecholamine excess suggestive of a catecholamine-producing tumor (paraganglioma or pheochromocytoma). Elevated urine catecholamine levels and radiographic evidence of a paraganglioma in the transplanted liver metastatic from the donor organ confirmed the diagnosis. Radiofrequency ablation of the tumor and surgical resection was previously attempted without success. We describe the anesthetic management for the successful resection of the metastatic hepatic paraganglioma, which was complicated by profound intraoperative hypertension and hypotension that necessitated the use of multiple vasoactive infusions, extensive surgical blood loss requiring blood transfusion, and difficult glycemic control in an insulin-dependent diabetic patient. The postoperative course is also described. This unique case presented the anesthesia team with challenges specific to both surgery for hepatic resection as well as for catecholamine-secreting tumors. We are not aware of any reports of paragangliomas of either donor or recipient origin involving a transplanted liver, making this the first such report to the best of our knowledge. PMID:23498826

Sharma, S; Wray, C; Nourmand, H

2013-03-01

93

[Anesthetic management for children undergoing magnetic resonance imaging (MRI) at Department of Anesthesia and ICU, National Center for Child Health and Development (NCCHD)].  

PubMed

We present here anesthetic management for children undergoing MRI at the Department of Anesthesia in NCCHD. Remaining motionless in the scanner of MRI is extremely important for data integrity because motion will blur the image. In patients who cannot remain still and in small children, general anesthesia or sedation is required for MRI. The MRI room is different from the conventional operating room as follows; the MRI machine emits the large sound continuously: the MRI room is the powerful magnetic field and the generation of radio frequency emissions necessitate the use of special equipment to provide continuous patient monitoring: the temperature in the MRI room is kept at 23 degrees to maintain the MRI machine: the patients positioned at the restricted area during the MRI scanning are hard to be accessed. We describe two cases of anesthetic management for children undergoing MRI by using propofol and in these cases we found that it should be better to follow the conventional setting for general anesthesia including monitoring system. Some hospitals encountered with serious complications such as cardiac arrest during MRI scanning under general anesthesia/sedation. MRI scanning under general anesthesia/sedation has a high risk due to the environment, indicating that we should be careful about the safety of the patients. PMID:23984586

Kubota, Kazumasa; Itoh, Sukeyuki; Kondo, Yoichi; Kasuya, Shugo; Fukayama, Haruhisa; Suzuki, Yasuyuki

2013-08-01

94

Environmental Implications of Anesthetic Gases  

PubMed Central

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

Yasny, Jeffrey S.; White, Jennifer

2012-01-01

95

Development of a Management Techniques Inventory.  

National Technical Information Service (NTIS)

The primary purpose of this investigation was to design and employ an inventory to collect information from a sample of Navy managers describing their perceptions of various leadership techniques. A secondary purpose was to assess the inventory itself, us...

L. A. Broedling W. Githens J. Riedel

1977-01-01

96

Anesthetic management of a patient undergoing liver transplantation who had previous coronary artery bypass grafting using an in situ right gastroepiploic artery.  

PubMed

We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained with 1.5% isoflurane in air/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter to prepare for intraoperative severe bradyarrhythmia. Olprinone and nicorandil were continuously infused to prevent decrease in coronary arterial blood flow and the collapse of cardiac function. Avoiding disruption of circulation to coronary arteries through injury or spasm of the RGEA graft and preparing for cardiac insufficiency during liver transplantation of a patient with previous CABG using an in situ RGEA is critical. PMID:20191293

Murata, Hiroaki; Inoue, Haruka; Sumikawa, Koji

2010-04-01

97

Multilevel nerve stimulator-guided paravertebral block as a sole anesthetic technique for breast cancer surgery in morbidly obese patients.  

PubMed

In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ?30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. All patients were hemodynamically stable during the operation, and no complications were noted. Patients stayed 69 min on average in the PACU and were discharged within 2 days. Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia. PMID:21748373

Naja, Zoher M; Naccache, Nicole; Ziade, Fouad; El-Rajab, Mariam; Itani, Taha; Baraka, Anis

2011-10-01

98

General Anesthetics: A Comparative Review of Pharmacodynamics  

PubMed Central

General anesthetics, in addition to eliminating the perception of stimuli, profound physiologic effects in other systems including the cardiovascular and respiratory systems. A thorough knowledge of the pharmacodynamics and pharmacokinetics of each agents as well as an understanding of the patient's physiologic reserve will allow the anesthetist to reasonably predict the response to a given drug. The ability to forecast patient responses imparts control over an anesthetic technique which contributes to the overall safety of the procesure. This paper reviews pharmacodynamics of general anesthetic agents commonly used in dentistry

Milam, Stephen B.

1984-01-01

99

Management Techniques for New Teacher Education Content  

ERIC Educational Resources Information Center

Reports some of the educational innovations and management techniques currently being utilized in the University of Northern Iowa's Department of Industrial Technology. These include new content classification elements, a common core program based on these elements, open-space laboratories, team teaching, differentiated staffing, and a variety of…

Rudisill, Alvin E.

1978-01-01

100

Is there any difference in anesthetic management of different post-OLT stage patients undergoing nontransplant organ surgery?  

Microsoft Academic Search

BACKGROUND: Little information is available about anesthesia management of nontransplant organ surgery of recipients after adult liver transplantation. The aim of this study was to discuss the anesthesia management of recipients for different stages after liver transplantation. METHODS: The medical records of 16 patients were reviewed after OLT scheduled for elective nontransplant organ surgery at our institution from September 2002

Zhi-Ying Feng; Jian Zhang; Sheng-Mei Zhu; Shu-Sen Zheng

2006-01-01

101

The Role of Different Anesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children: A Prospective, Double-Blinded, and Randomized Study  

PubMed Central

Objectives Our goal was to evaluate the role of three anesthetic techniques in altering the stress response in children undergoing surgery for repair of congenital heart diseases utilizing cardiopulmonary bypass in the setting of fast tracking or early tracheal extubation. Furthermore, we wanted to evaluate the correlation between blunting the stress response and the perioperative clinical outcomes. Design Prospective, randomized, double-blinded study. Setting Single center from December 2008 to May of 2011. Patients Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied between ages 30 days to 3 years old who were scheduled to undergo repair for a ventricular septal defect, atrioventricular septal defect, or Tetralogy of Fallot. Methods Children undergoing surgical repair of congenital heart disease were randomized to receive low-dose fentanyl (10 mcg/kg; low-dose fentanyl), high-dose fentanyl (25mcg/kg; high-dose fentanyl), or low-dose fentanyl plus dexmedetomidine (as a 1 mcg/kg loading dose followed by infusion at 0.5mcg/kg/hr until separation from cardiopulmonary bypass. In addition, patients received a volatile anesthetic agent as needed to maintain hemodynamic stability. Blood samples were tested for metabolic, hormonal and cytokine markers at baseline, after sternotomy, after the start of cardiopulmonary bypass, at the end of the procedure and at 24 hours postoperatively. Measurements and Main Results Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied. Subjects in the low-dose fentanyl plus placebo group had significantly higher levels of adrenocorticotropic hormone, cortisol, glucose, lactate, and epinephrine during the study period. The lowest levels of stress markers were seen in the high-dose fentanyl plus placebo group both over time (adrenocorticotropic hormone, p = 0.01; glucose, p = 0.007) and at individual time points (cortisol and lactate at the end of surgery, epinephrine poststernotomy; p < 0.05). Subjects in the low-dose fentanyl plus dexmedetomidine group had lower lactate levels at the end of surgery compared with the low-dose fentanyl plus placebo group (p < 0.05). Although there were no statistically significant differences in plasma cytokine levels between the three groups, the low-dose fentanyl plus placebo group had significantly higher interleukin-6:interleukin-10 ratio at 24 hours postoperatively (p < 0.0001). In addition, when compared with the low-dose fentanyl plus placebo group, the low-dose fentanyl plus dexmedetomidine group showed lower norepinephrine level from baseline at poststernotomy, after start of cardiopulmonary bypass, and end of surgery (p ? 0.05). Subjects in the low-dose fentanyl plus placebo group had more postoperative narcotic requirement (p = 0.004), higher prothrombin time (p ? 0.03), and more postoperative chest tube output (p < 0.05). Success of fast tracking was not significantly different between groups (low-dose fentanyl plus placebo 75%, high-dose fentanyl plus placebo 82%, low-dose fentanyl plus dexmedetomidine 93%; p = 0.39). Conclusions The use of low-dose fentanyl was associated with the greatest stress response, most coagulopathy, and highest transfusion requirement among our cohorts. Higher dose fentanyl demonstrated more favorable blunting of the stress response. When compared with low-dose fentanyl alone, the addition of dexmedetomidine improved the blunting of the stress response, while achieving better postoperative pain control.

Naguib, Aymen N.; Tobias, Joseph D.; Hall, Mark W.; Cismowski, Mary J.; Miao, Yongjie; Barry, N'Diris; Preston, Thomas; Galantowicz, Mark; Hoffman, Timothy M.

2013-01-01

102

Local Anesthetic Microencapsulation.  

National Technical Information Service (NTIS)

Local anesthetics have been microencapsulated using a biodegradable ploymer, polylactids. Lidocaine base and hydrochlorides of lidocaine, etidocaine and bupivacaine were coated with various quantities of polymer and the microcapsules sieved into various s...

D. L. Williams E. S. Nuwayser J. H. Kerrigan D. E. Creeden W. A. Nucefora

1983-01-01

103

Anesthetic considerations for robotic surgery  

PubMed Central

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

2014-01-01

104

Anesthetic management of a patient with Henoch-Schonlein purpura for drainage of cervical lymphadenitis: A case report  

PubMed Central

Henoch-Schonlein purpura (HSP) is a multisystem disease and immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. We report successful management of a 6-year-old patient with HSP for drainage of cervical lymphadenitis.

Hasija, Neha; Taxak, Susheela; Bhardwaj, Mamta; Vashist, Kirti

2014-01-01

105

Anesthetic management of a patient with Henoch-Schonlein purpura for drainage of cervical lymphadenitis: A case report.  

PubMed

Henoch-Schonlein purpura (HSP) is a multisystem disease and immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. We report successful management of a 6-year-old patient with HSP for drainage of cervical lymphadenitis. PMID:24843348

Hasija, Neha; Taxak, Susheela; Bhardwaj, Mamta; Vashist, Kirti

2014-04-01

106

Neurometric assessment of intraoperative anesthetic  

DOEpatents

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

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

1998-01-01

107

Neurometric assessment of intraoperative anesthetic  

DOEpatents

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

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

1998-07-07

108

Recent advances in perioperative anesthetic management update on the role of vasopressin and its effects on outcomes.  

PubMed

The vasoconstrictive and antidiuretic physiologic properties of vasopressin (antidiuretic hormone) have long been known. Until recently however, vasopressin was mostly used for diabetes insipidus and noctournal enuresis. This review summarizes the growing body of evidence regarding the perioperative use of vasopressin and its analogues in the management of certain forms of cardiovascular collapse. Physiologically, vasopressin is involved in regulating osmotic, volemic, and cardiovascular homeostasis. It acts via several specific vasopressin receptors that are variably distributed in the heart, kidneys and vasculature etc. Under normal conditions, its antidiuretic effect predominates and vasopressin only induces vasoconstriction at high concentrations. Regarding catecholamine-resistant vasodilatory shock, current evidence suggests that with adequate volume resuscitation, exogenous vasopressin in low "physiologic" doses (0.01-0.04 units/min) safely supports mean arterial pressure without adversely affecting myocardial function and splanchnic circulation. One possible explanation is that metabolic acidosis impairs the function of alpha-adrenergic (but not vasopressin) receptors, thus diminishing the response to catecholamines. Although there is yet no clear cut mortality benefit, vasopressin is now recommended as a second-line agent in septic shock for its catecholamine-sparing effect and as an alternative to epinephrine in cardiopulmonary resuscitation. It has also demonstrated efficacy in ameliorating vasoplegia after cardiopulmonary bypass as well as perioperative hypotension in patients on renin-angiotensin system antagionists preoperatively. In summary, accumulating clinical experience and formal studies indicate that vasopressin has a role in restoring vascular tone in refractory vasodilatory shock states with minimal adverse effects provided that euvolemia is assured. PMID:22762470

Udeh, Chiedozie I; Diaz-Gómez, J L; Anthony, D; Satyapriya, A; Perez-Protto, S; Hata, J S

2012-01-01

109

Inhaled anesthetics in horses.  

PubMed

Inhaled agents represent an important and useful class of drugs for equine anesthesia. This article reviews the ether-type anesthetics in contemporary use, their uptake and elimination, their mechanisms of action, and their desirable and undesirable effects in horses. PMID:23498046

Brosnan, Robert J

2013-04-01

110

Anesthetic implications for robot-assisted transaxillary thyroid and parathyroid surgery: a report of twenty cases.  

PubMed

Gasless transaxillary robot-assisted endoscopic thyroid surgery has recently been proposed and developed in South Korea and the United States. Perianesthetic implications and their evolution for 20 patients scheduled to undergo this innovative surgical technique are presented. The anesthetic considerations focus on the length of surgery due to the learning curve, the risk of the ipsilateral arm posture, and postoperative pain evaluation and management. PMID:24012492

Boccara, Gilles; Guenoun, Thierry; Aidan, Patrick

2013-09-01

111

Data Management Techniques for Acoustical Planetary Data  

NASA Astrophysics Data System (ADS)

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.

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

112

Emergency airway management: common ventilation techniques.  

PubMed

Maintaining a patient's airway and facilitating breathing are the main priorities during any emergency situation in which breathing is compromised. The key to safe management of an airway is thorough assessment, primarily to ensure the airway is patent. In an emergency situation, a bag-valve-mask may be the most effective way to assist ventilation. If ventilation is required for prolonged periods in an emergency situation, then endotracheal intubation should be performed. This involves the placement of a cuffed, endotracheal tube in the trachea, through which ventilation is maintained. Each tracheal intubation event should be anticipated as a potentially difficult intubation. Longer term ventilatory support may be achieved by the use of mechanical ventilators, which are designed to assist the movement of gases (air) into and out of a patient's lungs, while minimising the work and effort of breathing. This article provides nurses with an overview of the techniques and equipment that is most often used within emergency and intensive care units to maintain the patency of a patient's airway and provide ventilatory support. PMID:23588011

Higginson, Ray; Parry, Andy

113

Management Styles and Techniques: Literature Survey.  

ERIC Educational Resources Information Center

This review of management literature relevant to library technical services operations concentrates on materials published since 1980. Categories of management literature reviewed include budget and finance, personnel, library automation, space, and time. More than 70 references are listed. (CLB)

Stenstrom, Patricia F.

1987-01-01

114

Groundwater Management Using Control Analysis and Multiple-Objective Techniques.  

National Technical Information Service (NTIS)

The overall objective of the project was to develop mathematical optimization techniques, theory and models which are applicable in the management of groundwater systems. The motivation for the research was to improve the analytical techniques that can be...

J. P. Dauer

1984-01-01

115

Fault Management Techniques in Human Spaceflight Operations  

NASA Technical Reports Server (NTRS)

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

O'Hagan, Brian; Crocker, Alan

2006-01-01

116

MIC Technique: Managing Interpersonal Conflict. A Unit in Conflict Management Communication Skills.  

ERIC Educational Resources Information Center

Classroom techniques associated with conflict management and the six stages in the Managing Interpersonal Conflict (MIC) technique that can be used in basic interpersonal communication courses are outlined in this paper. Before presenting information on the MIC technique, the paper discusses the use of Jay Hall's Conflict Management Survey (which…

Weider-Hatfield, Deborah

117

Flexible and Adaptable Buffer Management Techniques for Database Management Systems  

Microsoft Academic Search

The problem of buffer management in database management systems is concerned with theefficient main memory allocation and management for answering database queries. Previous workson buffer allocation are based either exclusively on the availability of buffers at runtime or on theaccess patterns of queries. In this paper, we first propose a unified approach for buffer allocation inwhich both of these considerations

Christos Faloutsos; Raymond T. Ng; Timos K. Sellis

1995-01-01

118

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

PubMed

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

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

2011-08-01

119

Research and Development Management: Concepts and Techniques.  

National Technical Information Service (NTIS)

The volume contains the views of the management experts as they try to apply the principles of the management sciences to the problems of research institutions in India. This book is divided into four chapters. The first chapter is a collection of papers ...

1974-01-01

120

Data mining techniques for customer relationship management  

Microsoft Academic Search

Advancements in technology have made relationship marketing a reality in recent years. Technologies such as data warehousing, data mining, and campaign management software have made customer relationship management a new area where firms can gain a competitive advantage. Particularly through data mining—the extraction of hidden predictive information from large databases—organizations can identify valuable customers, predict future behaviors, and enable firms

Chris Rygielski; Jyun-Cheng Wang; David C. Yen

2002-01-01

121

ISWHM: Tools and Techniques for Software and System Health Management  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

122

[Local anesthetic procedures in dermatology: Part 1: principles].  

PubMed

Most dermatologic surgery is performed under local anesthesia. The choice of the type of anesthesia depends on the age, ability to cooperate and comorbidities of the patient. Anesthetics of the amide type are generally preferred for local infiltration. A solid anatomic background is required to perform effective peripheral nerve blocks. If the methods of action, toxic effects and potential drug interactions are considered, then local anesthetics have a low risk of complications. One must also not overlook the need for regular training in managing anesthetic emergencies for the entire operating room team, especially with the increasing age of our patients. PMID:22273997

Dill-Müller, D

2012-01-01

123

Anesthetic considerations of central airway obstruction  

PubMed Central

Central airway obstruction (CAO) is a serious presentation of lung cancer and associated chest diseases. It presents a real challenge to the anesthesiologist because usually the patient admitted to the hospital as an emergency case with high grade dyspnea scheduled to undergo rigid bronchoscopy for diagnostic and possible therapeutic interventions. In this case report, we described the anesthetic management of a patient who was admitted to our hospital with CAO.

El-Dawlatly, Abdelazeem; Alnassar, Sami; Abodonya, Ahmed; Almutlaq, Nada; Hajjar, Waseem

2011-01-01

124

Optimization Techniques for College Financial Aid Managers  

ERIC Educational Resources Information Center

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

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

2010-01-01

125

Waste Anesthetic Gases: Occupational Hazards in Hospitals.  

National Technical Information Service (NTIS)

Waste anesthetic gases are small amounts of volatile anesthetic gases that leak from the patient's anesthetic breathing circuit into the air of operating rooms during delivery of anesthesia. These gases may also be exhaled by patients recovering from anes...

2007-01-01

126

Automated NDT Techniques in Radioactive Waste Management.  

National Technical Information Service (NTIS)

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 ...

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

1983-01-01

127

Parental acceptance of pediatric dentistry behavior management techniques  

Microsoft Academic Search

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

Marilyn Goodwin Murphy; J. Bernard Machen

1984-01-01

128

Penile replantation, complication management, and technique refinement.  

PubMed

We describe a case of complete guillotine-type penile amputation at the proximal penile shaft. The blood flow was established 10 h after trauma. Circulation in the replanted penis was quite good but there was progressive prepuce necrosis after the hematoma. Cosmetic and urinary outcome was good 6 weeks later. The repair of deep dorsal penile vessels helps in corpus tissue healing and glans circulation. The blood supply from the corpus tissue is sufficient for the survival of the replanted penis even when the repaired dorsal vessels were occluded. Surgical pitfalls in replantation procedures and complication management are discussed. PMID:18286649

Chou, Erh-Kang; Tai, Yu-Tzu; Wu, Chao-I; Lin, Meng-Shi; Chen, Hsin-Han; Chang, Sophia Chia-Ning

2008-01-01

129

Behavior Management Techniques in Predoctoral and Postdoctoral Pediatric Dentistry Programs.  

ERIC Educational Resources Information Center

A survey determined the extent to which selected pediatric dental behavior management techniques are taught both didactically and clinically in 46 predoctoral and 45 postdoctoral programs. Results and trends are reported within the four categories of sedation, restraint, parental presence, and communications behavior management. (GLR)

Belanger, Gary K.; Tilliss, Terri S.

1993-01-01

130

Coping Styles as Mediators of Teachers' Classroom Management Techniques  

ERIC Educational Resources Information Center

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

Lewis, Ramon; Roache, Joel; Romi, Shlomo

2011-01-01

131

Automated NDT techniques in radioactive waste management  

Microsoft Academic Search

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.

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

1983-01-01

132

Communication action for case managers. Techniques to manage conflict.  

PubMed

The art of communication can facilitate case management in an optimum sense. It can also create conflict issues if handled inappropriately. In this article, the authors explore the basic tenets of the communication process. On this basic foundation, conflict and approaches to conflict resolution are explored. Specifically, Kare Anderson's Triangle Talk model is used in conjunction with a specific case that demonstrates the potential for positive communication outcomes. The model offers three principles, which are discussed individually. Good communication skills are a prime component of therapy and case management. It is important to the case outcome that the communication is done well. However, it is unusual for health care providers to have specialized training in the skills of conflict negotiation. The authors offer the reader an opportunity to apply what is presented in this article in a self-study module at the end. PMID:9526394

Marino, T Y; Kahnoski, B

1998-01-01

133

Management of posteriorly dislocated introcular lens: a new technique.  

PubMed

Many surgical techniques have been described in the management of posteriorly dislocated intraocular lens (IOLs). Lifting the IOL off the retina is a critical step during the surgical procedure. We describe a new simple and effective technique using an extrusion cannula that offers many advantages to lift the IOL in a safer and more controlled way. PMID:11371099

Santos, A; Roig-Melo, E A

2001-01-01

134

A communications-based technique for interdisciplinary design team management  

Microsoft Academic Search

A technique for interdisciplinary design team management that focuses on information processing and communication between team members is presented. A cognitive model of communication-related failure mechanisms of design groups is developed. Strategies for defining and assigning subtasks among individuals or subgroups that are based on the communications model are described. A technique for evaluating the expected effectiveness of a design

Michael J. Safoutin; Deborah L. Thurston

1993-01-01

135

Automated NDT techniques in radioactive waste management  

SciTech Connect

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.

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

1983-01-01

136

Altered states: psychedelics and anesthetics.  

PubMed

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

Icaza, Eduardo E; Mashour, George A

2013-12-01

137

Hoshin Kanri: a technique for strategic quality management.  

PubMed

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

Tennant, C; Roberts, P A

2000-01-01

138

Information Management and Process Improvement Using Data Mining Techniques  

Microsoft Academic Search

This paper describes a computer component manufacturing scenario which concentrates on the application of data mining techniques\\u000a to improve information management and process improvement within a manufacturing scenario. The case study involved, relates\\u000a to an engineering component manufacturing company with a consortium of several plant outlets in various geographical locations\\u000a world-wide. Currently, data, information and knowledge management, transparency and communication

Mervi Ranta; T. M. Scott; Martti Mäntylä

2000-01-01

139

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

PubMed Central

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

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

2014-01-01

140

Application of optimisation techniques in groundwater quantity and quality management  

Microsoft Academic Search

This paper presents the state-of-the-art on application of optimisation techniques in groundwater quality and quantity management.\\u000a In order to solve optimisation-based groundwater management models, researchers have used various mathematical programming\\u000a techniques such as linear programming (LP), nonlinear programming (NLP), mixed-integer programming (MIP), optimal control\\u000a theory-based mathematical programming, differential dynamic programming (DDP), stochastic programming (SP), combinatorial\\u000a optimisation (CO), and multiple objective

Amlan Das; Bithin Datta

2001-01-01

141

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

NASA Astrophysics Data System (ADS)

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

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

2003-10-01

142

Using Powerpoint Animations to Teach Operations Management Techniques and Concepts  

ERIC Educational Resources Information Center

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

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

2014-01-01

143

Efficient integration of data mining techniques in database management systems  

Microsoft Academic Search

We propose a new approach for applying data mining techniques, and more particularly supervised machine learning algorithms, to large databases, in acceptable response times. This goal is achieved by integrating these algorithms within a database management system. We are thus only limited by disk capacity, and not by available main memory. However, the disk accesses that are necessary to scan

Fadila Bentayeb; J. Darmont; C. Udrea

2004-01-01

144

Nonlethal Techniques for Managing Predation: Primary and Secondary Repellents  

Microsoft Academic Search

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.)

JOHN A. SHIVIK; ADRIAN TREVES; PEGGY CALLAHAN

2003-01-01

145

COMRADE data management system storage and retrieval techniques  

Microsoft Academic Search

The design of a data management software system involves the consolidation of a balanced set of individual techniques. Today's third generation computers provide the resources for the storage of large, complex sets of data, and for the rapid retrieval of that data. Random-access mass storage devices will store millions of bits of information, and central processors have instruction execution times

Ann Ellis Bandurski; Michael A. Wallace

1973-01-01

146

Management of petrous bone cholesteatoma: open versus obliterative techniques.  

PubMed

The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on obliterative or closed techniques in large cholesteatomas. A retrospective study was performed from July 1977 to September 2007 at the Tertiary referral cranial base center. Thirty-five patients were treated for PBC through different surgical approaches, and in 25 cases (72%) the surgical cavity was obliterated with a muscle flap. Four patients (11%) had a long-term recurrence. These patients received an open technique and after surgical re-exploration using a closed technique they had no recurrence. There were no recurrences in patients who underwent an obliterative technique and they received periodic MRI controls. The facial function after surgery was acceptable (71% of patients had House-Brackmann grades I to III). PBC is a complex pathology and presents difficulties in its diagnosis and treatment. Surgical technique should be suitable for removing the pathology and preventing damage to structures such as the facial nerve or great vessels. Obliterative techniques, where possible, are at least as safe as open cavity procedures and they have fewer postoperative complications; however, regular follow-up with CT and MRI is mandatory. PMID:20680639

Alvarez, Fernando López; Gómez, Justo R; Bernardo, Ma Jesús; Suárez, Carlos

2011-01-01

147

A new nonsurgical technique for managing zipper injuries.  

PubMed

Zipper injuries are highly distressing to patients and often difficult to manage. Several management techniques are described in the literature. Many are complex and laborious, requiring sophisticated instruments in skilled hands, or even rely on a formal operation. This new technique involves the release of entrapped penile skin from a zipper by cutting the zipper tape and teeth immediately superior and inferior to the zipper connector and using a needle holder to pull the zipper apparatus apart following the application of lubrication and appropriate use of local analgesia. This novel technique is quick, nontraumatic and requires readily available equipment. It has been used successfully in two patients who were ineligible for a circumcision. PMID:23995667

Lukacs, Szilveszter; Tschobotko, Benjamin; Mazaris, Evangelos

2014-08-01

148

Risk Management Techniques and Practice Workshop Workshop Report  

SciTech Connect

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

Quinn, T; Zosel, M

2008-12-02

149

Behavior management conference panel I report--Rationale for behavior management techniques in pediatric dentistry.  

PubMed

Panel I comprised of pediatric dentists, an attorney, child psychologists, parents, a specialist in early childhood education, and a pediatrician. The purpose of this panel was to discuss: (1) 8 questions that dealt with the appropriateness and effectiveness of current behavior management techniques; (2) the scientific support for those techniques; and (3) the role of the pediatric dentist in managing the difficult child. Issues of cultural diversity, access to care, and parental attitudes toward behavior management were also explored. Nonpediatric dentist members of the panel offered insights into how other health care professionals view the behavior management techniques used by pediatric dentists. The panel sought input from the conference attendees as part of its deliberations. The major recommendations of the panel included: (1) re-evaluate the definitions of child behavior in the dental setting, including definitions of appropriate behavior; (2) develop training in effective communication with parents for pediatric dentists and their staffs; (3) seek further information on the impact that changing parental attitudes towards behavior management techniques may have on the quality and accessibility of treatment; and (4) conduct research in specific areas of behavior management, particularly in communicative techniques. PMID:15132280

Adair, Steven M

2004-01-01

150

Obstetric use of nitroglycerin: Anesthetic implications  

PubMed Central

Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min) used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration.

Saroa, Richa; Sachan, Shikha; Palta, Sanjeev; Gombar, Satinder; Sahai, Nitika

2013-01-01

151

A prosthetic management technique for osteopetrosis affecting the maxilla.  

PubMed

Bony anatomical anomalies can complicate the construction and successful wearing of removable prostheses. Osteopetrosis is a group of diseases that affect the growth and continuous remodelling of bone which in turn can result in gross irregular alveolar bone morphology. This paper describes the management of a patient with this problem and emphasises the challenges in constructing a successful complete maxillary removable prosthesis. The utilisation of a flexible base plate material as an alternative to traditional materials will be highlighted. Irregular bony morphology is a recognised potential obstacle to the successful construction of removable prostheses. In most cases the problem can be overcome but in extreme and less common circumstances, management of these features can be more problematic. This paper describes a technique used to manage extreme alveolar irregularity which may perhaps be applied to those problems more commonly encountered in every day clinical practice but are less extreme then those described in this paper. PMID:17645071

Dewan, Karun; Bishop, Karl; Hollisey-Mclean, David

2007-06-01

152

Risk Management Techniques and Practice Workshop Workshop Report  

Microsoft Academic Search

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

T Quinn; M Zosel

2008-01-01

153

Anesthetic cartridge system under evaluation.  

PubMed

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

Cooley, R L; Lubow, R M

1981-01-01

154

Anesthetic Cartridge System Under Evaluation  

PubMed Central

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

Cooley, Robert L.; Lubow, Richard M.

1981-01-01

155

The effects of perineal management techniques on labor complications  

PubMed Central

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

Fahami, Fariba; Shokoohi, Zohreh; Kianpour, Mariam

2012-01-01

156

Mobility management techniques for the next-generation wireless networks  

NASA Astrophysics Data System (ADS)

The tremendous demands from social market are pushing the booming development of mobile communications faster than ever before, leading to plenty of new advanced techniques emerging. With the converging of mobile and wireless communications with Internet services, the boundary between mobile personal telecommunications and wireless computer networks is disappearing. Wireless networks of the next generation need the support of all the advances on new architectures, standards, and protocols. Mobility management is an important issue in the area of mobile communications, which can be best solved at the network layer. One of the key features of the next generation wireless networks is all-IP infrastructure. This paper discusses the mobility management schemes for the next generation mobile networks through extending IP's functions with mobility support. A global hierarchical framework model for the mobility management of wireless networks is presented, in which the mobility management is divided into two complementary tasks: macro mobility and micro mobility. As the macro mobility solution, a basic principle of Mobile IP is introduced, together with the optimal schemes and the advances in IPv6. The disadvantages of the Mobile IP on solving the micro mobility problem are analyzed, on the basis of which three main proposals are discussed as the micro mobility solutions for mobile communications, including Hierarchical Mobile IP (HMIP), Cellular IP, and Handoff-Aware Wireless Access Internet Infrastructure (HAWAII). A unified model is also described in which the different micro mobility solutions can coexist simultaneously in mobile networks.

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

2001-10-01

157

Neuronal Preconditioning by Inhalational Anesthetics  

PubMed Central

Background Ischemic preconditioning is an important intrinsic mechanism for neuroprotection. Preconditioning can also be achieved by exposure of neurons to K+ channel–opening drugs that act on adenosine triphosphate–sensitive K+ (KATP) channels. However, these agents do not readily cross the blood–brain barrier. Inhalational anesthetics which easily partition into brain have been shown to precondition various tissues. Here, the authors explore the neuronal preconditioning effect of modern inhalational anesthetics and investigate their effects on KATP channels. Methods Neuronal–glial cocultures were exposed to inhalational anesthetics in a preconditioning paradigm, followed by oxygen–glucose deprivation. Increased cell survival due to preconditioning was quantified with the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide reduction test. Recombinant plasmalemmal KATP channels of the main neuronal type (Kir6.2/SUR1) were expressed in HEK293 cells, and the effects of anesthetics were evaluated in whole cell patch clamp recordings. Results Both sevoflurane and the noble gas xenon preconditioned neurons at clinically used concentrations. The effect of sevoflurane was independent of KATP channel activation, whereas the effect of xenon required the opening of plasmalemmal KATP channels. Recombinant KATP channels were activated by xenon but inhibited by halogenated volatiles. Modulation of mitochondrial K-ATP channels did not affect the activity of KATP channels, thus ruling out an indirect effect of volatiles via mitochondrial channels. Conclusions The preconditioning properties of halogenated volatiles cannot be explained by their effect on KATP channels, whereas xenon preconditioning clearly involves the activation of these channels. Therefore, xenon might mimic the intrinsic mechanism of ischemic preconditioning most closely. This, together with its good safety profile, might suggest xenon as a viable neuroprotective agent in the clinical setting.

Bantel, Carsten; Maze, Mervyn; Trapp, Stefan

2010-01-01

158

Flexible use and technique extension of logistics management  

NASA Astrophysics Data System (ADS)

As we all know, the origin of modern logistics was in the United States, developed in Japan, became mature in Europe, and expanded in China. This is a historical development of the modern logistics recognized track. Due to China's economic and technological development, and with the construction of Shanghai International Shipping Center and Shanghai Yangshan International Deepwater development, China's modern logistics industry will attain a leap-forward development of a strong pace, and will also catch up with developed countries in the Western modern logistics level. In this paper, the author explores the flexibility of China's modern logistics management techniques to extend the use, and has certain practical and guidance significances.

Xiong, Furong

2011-10-01

159

Application of fisheries-management techniques to assessing impacts  

SciTech Connect

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

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

1983-01-01

160

A Bifid Mandibular Nerve as a Possible Cause of Anesthetic Deficiency in the Mandible.  

National Technical Information Service (NTIS)

The failure to achieve complete mandibular anesthesia is a problem that occurs in as high as 20% of all cases. The explanations vary from faulty anesthetic solutions to faulty technique, to anatomic or physiologic variations. Accessory nerve innervation f...

P. S. Grover L. Lorton

1982-01-01

161

Introducing Risk Management Techniques Within Project Based Software Engineering Courses  

NASA Astrophysics Data System (ADS)

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

Port, Daniel; Boehm, Barry

2002-03-01

162

Distributed cluster management techniques for unattended ground sensor networks  

NASA Astrophysics Data System (ADS)

Smart Sensor Networks are becoming important target detection and tracking tools. The challenging problems in such networks include the sensor fusion, data management and communication schemes. This work discusses techniques used to distribute sensor management and multi-target tracking responsibilities across an ad hoc, self-healing cluster of sensor nodes. Although miniaturized computing resources possess the ability to host complex tracking and data fusion algorithms, there still exist inherent bandwidth constraints on the RF channel. Therefore, special attention is placed on the reduction of node-to-node communications within the cluster by minimizing unsolicited messaging, and distributing the sensor fusion and tracking tasks onto local portions of the network. Several challenging problems are addressed in this work including track initialization and conflict resolution, track ownership handling, and communication control optimization. Emphasis is also placed on increasing the overall robustness of the sensor cluster through independent decision capabilities on all sensor nodes. Track initiation is performed using collaborative sensing within a neighborhood of sensor nodes, allowing each node to independently determine if initial track ownership should be assumed. This autonomous track initiation prevents the formation of duplicate tracks while eliminating the need for a central "management" node to assign tracking responsibilities. Track update is performed as an ownership node requests sensor reports from neighboring nodes based on track error covariance and the neighboring nodes geo-positional location. Track ownership is periodically recomputed using propagated track states to determine which sensing node provides the desired coverage characteristics. High fidelity multi-target simulation results are presented, indicating the distribution of sensor management and tracking capabilities to not only reduce communication bandwidth consumption, but to also simplify multi-target tracking within the cluster.

Essawy, Magdi A.; Stelzig, Chad A.; Bevington, James E.; Minor, Sharon

2005-05-01

163

Ischemia-Reperfusion Injury and Volatile Anesthetics  

PubMed Central

Ischemia-reperfusion injury (IRI) is induced as a result of reentry of the blood and oxygen to ischemic tissue. Antioxidant and some other drugs have protective effect on IRI. In many surgeries and clinical conditions IRI is counteract inevitable. Some anesthetic agents may have a protective role in this procedure. It is known that inhalational anesthetics possess protective effects against IRI. In this review the mechanism of preventive effects of volatile anesthetics and different ischemia-reperfusion models are discussed.

Erturk, Engin

2014-01-01

164

Computer-Aided Risk Management Research on Construction Techniques  

Microsoft Academic Search

With the rapid development of economic and technology in China, structural forms are becoming more and more complicated, which requires more rigorous construction technology and construction management. However, the risk management in our country is still in its infancy, and managers are short of awareness of risks and lack of ability to manage risks. Study on risk management methods mode

Zheng Qizhen; Tang Yu; Zhang Lei; Wu Tan

2009-01-01

165

Risk in Fire Management Decisionmaking: Techniques and Criteria.  

National Technical Information Service (NTIS)

In the past, decisionmaking in wildland fire management generally has not included a full consideration of the risk and uncertainty that is inherent in evaluating alternatives. Fire management policies in some Federal land management agencies now require ...

G. Blattenberger W. F. Hyde T. J. Mills

1984-01-01

166

Novel high sensitivity thermal managed eclipse Z-scan technique  

NASA Astrophysics Data System (ADS)

The field of Nonlinear Optics has provided many techniques to characterize photonic materials. The Z-scan method is a well estabileshed technique that exploits front wave distortions of the light beam to determine the nonlinear properties of optical materials. Several variations of the methods have been developed, as the eclipse Z-scan that can provide up to two orders of magnitude higher sensitivity than the original Z-scan set-up. We report a new variation of the Z-scan method to characterize the third-order optical nonlinearity of photonic materials. By exploiting the combination of the eclipse Z-scan with thermal nonlinearity management, we demonstrate an improvement in sensitivity and flexibility of the method to simultaneously characterize the thermal and nonthermal nonlinearity of optical materials. The method is demonstrated by measuring the nonlinear refractive index in CS2, SiO2 and H2O as standard materials, and also of a biomaterial, the amino acid Tryptophan in water solution, using the same experimental set up based on a femtosecond Ti-saphire laser operating at 76MHz repetition rate.

Gomes, Anderson S. L.; Falcão Filho, Edilson L.; de Araújo, Cid B.; Rativa, Diego; de Araujo, Renato E.

2007-03-01

167

46 CFR 111.105-37 - Flammable anesthetics.  

Code of Federal Regulations, 2010 CFR

... 2009-10-01 false Flammable anesthetics. 111.105-37 Section 111.105-37...Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA...

2009-10-01

168

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

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Anesthetic cabinet, table, or tray. 868...DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a...

2010-04-01

169

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

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Anesthetic cabinet, table, or tray. 868...DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a...

2009-04-01

170

46 CFR 147.105 - Anesthetics, drugs, and medicines.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

171

Anesthetic management for patients with perforation peritonitis  

PubMed Central

Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential.

Sharma, Kiran; Kumar, Mritunjay; Batra, Upma Bhatia

2013-01-01

172

[Anesthetic management of a patient with adrenoleukodystrophy].  

PubMed

Adrenoleukodystrophy (ALD) is a genetic disorder with demyelination of the central nervous system and adrenal insufficiency. A 24-year-old man with ALD was scheduled for dental treatment under general anesthesia. He was diagnosted as having ALD at the age of 5. Past medical history included recurrent cervical cellulitis, adrenal insufficiency, mental retardation, muscle weakness and seizure disorder. General anesthesia was induced using betamethasone as a steroid cover, sevoflurane and nitrous oxide-oxygen and maintained with sevoflurane and nitrous oxide-oxygen. Nasal intubation was performed without using a muscle relaxant. Patients with ALD cannot metabolize very long chain fatty acid, so we did not use propofol containing long chain fatty acid. Operation and anesthesia were uneventful. There were no complications during and after anesthesia. PMID:24558940

Shinohara, Maki; Hirose, Yohsuke; Boku, Aiji; Kimura, Keiji Richard; Morimoto, Yoshinari; Niwa, Hitoshi

2014-01-01

173

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

Microsoft Academic Search

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

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

1984-01-01

174

Differential modulation of human N-methyl-D-aspartate receptors by structurally diverse general anesthetics.  

PubMed

N-Methyl-d-aspartate (NMDA) receptors have a presumed role in excitatory synaptic transmission and nociceptive 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 quantitative comparisons of the NMDA receptor inhibitory potencies of inhaled anesthetics. In the present study, we sought to fill this void by defining, using the two-electrode voltage-clamp technique, the extent to which diverse clinical and aromatic inhaled anesthetics inhibit the NR1/NR2B subtype of the human NMDA receptor expressed in Xenopus laevis oocytes. At 1 minimum alveolar anesthetic concentration (MAC), anesthetic compounds reversibly inhibited NMDA receptor currents by 12 +/- 6% to 74 +/- 6%. These results demonstrate that equianesthetic concentrations of inhaled anesthetics can differ considerably in the extent to which they inhibit NMDA receptors. Such differences may be useful for defining the role that this receptor plays in producing the in vivo actions of general anesthetics. PMID:16632818

Solt, Ken; Eger, Edmond I; Raines, Douglas E

2006-05-01

175

Sodium channels as targets for volatile anesthetics.  

PubMed

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

Herold, Karl F; Hemmings, Hugh C

2012-01-01

176

Sodium Channels as Targets for Volatile Anesthetics  

PubMed Central

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 (INa) 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 Ca2+ 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.

Herold, Karl F.; Hemmings Jr., Hugh C.

2012-01-01

177

Percutaneous endoscopic gastrostomy: Indications, technique, complications and management  

PubMed Central

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

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

2014-01-01

178

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

NASA Technical Reports Server (NTRS)

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.

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

1972-01-01

179

Integration of Risk Management Techniques into Outdoor Adventure Program Design.  

ERIC Educational Resources Information Center

This paper is designed to acquaint the outdoor professional with the risk management decision making process required for the operation and management of outdoor adventure activities. The document examines the programming implications of fear in adventure activities; the risk management process in adventure programming; a definition of an…

Bruner, Eric V.

180

Are volatile anesthetics neuroprotective or neurotoxic?  

PubMed Central

Volatile anesthetics are one class of the most commonly used drugs. However, the mechanisms for these drugs to induce anesthesia are not fully understood and have been under intensive investigation. Two other effects of these anesthetics on the central nervous system, volatile anesthetics-induced neuroprotection and neurotoxicity, currently are hot research fields. Although data from animal studies for these two effects are extensive and convincing, clinical data for volatile anesthetics-induced neuroprotection are relatively weak. There is essentially lack of evidence to suggest volatile anesthetics-induced neurotoxicity in humans. In this regard, the contribution of general anesthesia/anesthetics to postoperative cognitive decline, a clinical entity whose existence has been supported by substantial evidence, also has not been established. This paper will be focused on reviewing the evidence, especially the clinical evidence, for volatile anesthetics-induced neuroprotection and neurotoxicity. Efforts will be devoted to facilitating the understanding of the two seemingly contradictory effects of these important drugs on the brain.

2012-01-01

181

Anesthetics and red blood cell rheology  

NASA Astrophysics Data System (ADS)

There are many conditions where it is useful for anesthetists to have a knowledge of blood rheology. Blood rheology plays an important role in numerous clinical situations. Hemorheologic changes may significantly affect the induction and recovery times with anesthetic agents. But also, hemorheologic factors are directly or indirectly affected by many anesthetic agents or their metabolites. In this review, the blood rheology with special emphasis on its application in anesthesiology, the importance hemorheological parameters in anesthesiology and also the effect of some anesthetic substances on red blood cell rheology were presented.

Aydogan, Burcu; Aydogan, Sami

2014-05-01

182

Anesthetic considerations in acute spinal cord trauma  

PubMed Central

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

Dooney, Neil; Dagal, Armagan

2011-01-01

183

Anesthetic Exposure and Health of Dental Personnel.  

National Technical Information Service (NTIS)

An epidemiologic survey was conducted to determine possible health hazards in the dental profession, with particular attention being given to the results of exposure to anesthetic gases. The survey contacted 30,650 dentists and 30,547 chairside assistants...

E. N. Cohen

1980-01-01

184

Dishabituation of mesencephalic reticular neurons by anesthetics.  

PubMed

To determine whether neuronal firing is affected by anesthetics, the behavior of neurons in the mesencephalic reticular formation in response to repetitive somatosensory stimulation at 2/sec was studied during wakefulness and during nitrous oxide, halothane, and thiopental anesthesia in the cat. With clinical doses of the three anesthetics there were simultaneous blockades of both initial facilitation (28 of 32) and subsequent habituation (31 of 32) of the evoked responses in a majority of the mesencephalic reticular formation neurons. This dishabituation phenomenon was most prominent with thiopental and least prominent with nitrous oxide. Thus, it is suggested that progressive inactivation of not only the facilitatory process but also the inhibitory process in the neuronal activities of the mesencephalic reticular formation is associated with the so-called "anesthetic state" produced by these three anesthetics. PMID:197860

Shimoji, K; Matsuki, M; Shimizu, H; Maruyama, Y; Aida, S

1977-10-01

185

SYSTEMIC TOXIC REACTIONS TO LOCAL ANESTHETICS  

PubMed Central

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

Moore, Daniel C.; Green, John

1956-01-01

186

Anesthetic effects in Alzheimer transgenic mouse models.  

PubMed

Research has improved the diagnosis of Alzheimer's disease, and at earlier stages, but effective therapy continues to be elusive. Current effort is focused on delay. Environmental factors are thought to interact with genetics to modulate the progression of the disease, and one such environmental factor is exposure to general anesthetics. The possibility that some anesthetic effects have long-term consequences is of general interest and concern. The difficulty of studying a chronic, age-related disease in humans combined with the fact that anesthetics are rarely given without surgery, has led to a focus on animal models. Transgenic mouse models have been developed to mimic the hallmarks of Alzheimer's disease, including amyloid beta accumulation (plaque), neurofibrillary tangles, and cognitive dysfunction. While none of the models recapitulate the human disease with high fidelity, they allow a first look at anesthetic-Alzheimer interactions in a reasonable time frame. In studies found to date, none have concluded that anesthetics alone cause a significant change in cognitive decline, but rather an acceleration in Alzheimer neuropathology. Further studies are required to define the best anesthetic paradigm for our elderly population to mitigate changes in neuropathology and potentially cognition. PMID:22705294

Tang, Junxia X; Eckenhoff, Maryellen F

2013-12-01

187

Kinetics of anesthetic-induced conformational transitions in a four-alpha-helix bundle protein.  

PubMed

Inhaled anesthetics are thought to alter the conformational states of Cys-loop ligand-gated ion channels (LGICs) by binding within discrete cavities that are lined by portions of four alpha-helical transmembrane domains. Because Cys-loop LGICs are complex molecules that are notoriously difficult to express and purify, scaled-down models have been used to better understand the basic molecular mechanisms of anesthetic action. In this study, stopped-flow fluorescence spectroscopy was used to define the kinetics with which inhaled anesthetics interact with (Aalpha(2)-L1M/L38M)(2), a four-alpha-helix bundle protein that was designed to model anesthetic binding sites on Cys-loop LGICs. Stopped-flow fluorescence traces obtained upon mixing (Aalpha(2)-L1M/L38M)(2) with halothane revealed immediate, fast, and slow components of quenching. The immediate component, which occurred within the mixing time of the spectrofluorimeter, was attributed to direct quenching of tryptophan fluorescence upon halothane binding to (Aalpha(2)-L1M/L38M)(2). This was followed by a biexponential fluorescence decay containing fast and slow components, reflecting anesthetic-induced conformational transitions. Fluorescence traces obtained in studies using sevoflurane, isoflurane, and desflurane, which poorly quench tryptophan fluorescence, did not contain the immediate component. However, these anesthetics did produce the fast and slow components, indicating that they also alter the conformation of (Aalpha(2)-L1M/L38M)(2). Cyclopropane, an anesthetic that acts with unusually low potency on Cys-loop LGICs, acted with low apparent potency on (Aalpha(2)-L1M/L38M)(2). These results suggest that four-alpha-helix bundle proteins may be useful models of in vivo sites of action that allow the use of a wide range of techniques to better understand how anesthetic binding leads to changes in protein structure and function. PMID:16445285

Solt, Ken; Johansson, Jonas S; Raines, Douglas E

2006-02-01

188

Molecular properties important for inhaled anesthetic action on human 5-HT3A receptors.  

PubMed

Although inhaled anesthetics have diverse effects on 5-hydroxytryptamine type 3 (5-HT3A) receptors, the mechanism accounting for this diversity is not understood. Studies have shown that modulation of 5-HT3A receptor currents by n-alcohols depends on molecular volume, suggesting that steric interactions between n-alcohols and their binding sites define their action on this receptor. Electrostatic interactions also play an important role in anesthetic action on other ligand-gated receptors. We aimed to determine the contribution of molecular volume and electrostatics in defining volatile anesthetic actions on 5-HT3A receptors. Human 5-HT3A receptors were expressed in, and recorded from, Xenopus oocytes using the two-electrode voltage-clamp technique. The effects of a range of volatile anesthetics, n-alcohols, and nonhalogenated alkanes on submaximal serotonin-evoked peak currents, and full serotonin concentration-response curves were defined. Volatile anesthetics and n-alcohols, but not alkanes, smaller than 0.120 nm3 enhanced submaximal serotonin-evoked peak currents whereas all larger agents reduced currents. Most compounds tested inhibited maximal serotonin-evoked peak currents to varying degrees. However, only agents smaller than 0.120 nm3 shifted the 5-HT3A receptor's serotonin concentration-response curve to the left, whereas larger anesthetics shifted them to the right. Modulation of human 5-HT3A-mediated currents by volatile anesthetics exhibits a dependence on molecular volume consistent with the n-alcohols, suggesting that both classes of agents may enhance 5-HT3A receptor function via the same mechanism. Furthermore, the enhancing but not inhibiting effects of anesthetic compounds on 5-HT3A receptor currents are modulated by electrostatic interactions. PMID:15920198

Stevens, Renna J N; Rüsch, Dirk; Davies, Paul A; Raines, Douglas E

2005-06-01

189

Differential Effects of Anesthetics on Cocaine's Pharmacokinetic and Pharmacodynamic Effects in Brain  

PubMed Central

Most studies of cocaine’s effects on brain activity in laboratory animals are preformed under anesthesia, which could potentially affect the physiological responses to cocaine. Here we assessed the effects of two commonly used anesthetics (?-chloralose and isofluorane) on the effects of acute cocaine (1 mg/kg iv) on cerebral-blood-flow (CBF), cerebral-blood-volume (CBV), and tissue-hemoglobin-oxygenation (StO2) using optical techniques and cocaine’s pharmacokinetics and binding in the rat brain using PET and [11C]cocaine. We showed that acute cocaine at a dose abused by cocaine abusers decreased CBF, CBV and StO2 in rats anesthetized with isoflurane, whereas it increased these parameters in rats anesthetized with ?-chloralose. Importantly, in isoflurane-anesthetized animals cocaine-induced changes in CBF and StO2 were coupled whereas for ?-chloralose these measures were uncoupled. Moreover, the clearance of [11]cocaine from brain was faster for isoflurance (peak-half-clearance 15.8±2.8 min) than for ?-chloralose (27.5±0.6 min) and the ratio of the specific to non-specific binding of [11C]cocaine in brain was higher for isoflurane (3.37 ± 0.32) than for ?-chloralose anesthetized rats (2.24 ± 0.4). For both anesthetics cocaine induced changes in CBF followed the fast uptake of [11C]cocaine in brain (peaking at ~ 2.5–4 minutes) but only for isoflurane did the duration of the CBV and StO2 changes correspond to the rate of [11C]cocaine’s clearance from the brain. These results demonstrate that anesthetics influence cocaine’s hemodynamic and metabolic changes in brain and its binding and pharmacokinetics, which highlights the need to better understand the interactions between anesthetics and pharmacological challenges in brain functional imaging studies.

Du, Congwu; Tully, Melissa; Volkow, Nora. D.; Schiffer, Wynne K; Yu, Mei; Luo, Zhongchi; Koretsky, Alan P.; Benveniste, Helene

2009-01-01

190

Integrating RFID technique to design mobile handheld inventory management system  

NASA Astrophysics Data System (ADS)

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

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

2008-05-01

191

Using Smart Growth Techniques as Stormwater Best Management Practices.  

National Technical Information Service (NTIS)

The goal of this document is to help communities that have adopted smart growth policies and plans recognize the water benefits of those smart growth techniques and suggest ways to integrate those policies into stormwater planning and compliance. Taking c...

L. Nisenson

2005-01-01

192

Distributed power-management techniques for wireless network video systems  

Microsoft Academic Search

Wireless sensor networks operating on limited energy resources need to be power efficient to extend the system lifetime. This is especially challenging for video sensor networks due to the large volumes of data they need to process in short periods of time. Towards this end, this paper proposes two coordinated power management policies for video sensor networks. These policies are

Nicholas H. Zamora; Jung-chun Kao; Radu Marculescu

2007-01-01

193

Control of bovine neonatal diarrhoea by management techniques  

Microsoft Academic Search

A four year study of bovine neonatal mortality on 34 dairy farms and an agricultural institute's calf unit showed that 280 (3.2 per cent) of 8752 calves died mainly from diarrhoea and, or , septicaemia. The relationship between management methods and mortality rates were studied at the calf unit. When infection rates were kept low by good standards of hygiene

HA Bakheit; HJ Greene

1981-01-01

194

Management Science/Industrial Engineering Techniques to Reduce Food Costs.  

ERIC Educational Resources Information Center

This paper examines the contributions of Industrial Engineering and Management Science toward reduction in the cost of production and distribution of food. Food processing firms were requested to respond to a questionnaire which asked for examples of their use of various operations research tools and information on the number of operations…

Greenberg, Murray

195

The effects of anesthetics on tumor progression  

PubMed Central

More and more cancer patients receive surgery and chronic pain control. Cell-mediated immunosuppression from surgical stress renders perioperative period a vulnerable period for tumor metastasis. Retrospective studies suggest that regional anesthesia reduces the risk of tumor metastasis and recurrence. This benefit may be due to the attenuation of immunosuppression by regional anesthesia. On the other hand, accumulating evidence points to a direct role of anesthetics in tumor progression. A variety of malignancies exhibit increased activity of voltage-gated sodium channels. Blockade of these channels by local anesthetics may help inhibit tumor progression. Opioids promote angiogenesis, cancer cell proliferation and metastasis. It will be interesting to examine the therapeutic potential of peripheral opioid antagonists against malignancy. Volatile anesthetics are organ-protective against hypoxia, however; this very protective mechanism may lead to tumor growth and poor prognosis. In this review, we examine the direct effects of anesthetics in tumor progression in hope that a thorough understanding will help to select the optimal anesthetic regimens for better outcomes in cancer patients.

Mao, Lifang; Lin, Suizhen; Lin, Jun

2013-01-01

196

Issues identification and management: the state-of-the-art of methods and techniques. Final report  

SciTech Connect

Issues management has taken hold in business, government, and industry planning as a means to identify and track emerging trends, concerns, and issues likely to affect an organization in the next few years. Issues management blends future research, environmental scanning, and long-range planning to help address issues early, constructively, and positively. This study reviews the state-of-the-art in issues management, drawing on discussions with issues managers in corporations and trade associations, professional futurists, and issues management specialists. The report discusses the usefulness of issues management and identifies strengths and weaknesses of various approaches, with examples from ongoing issues management operations and advice from experienced issues managers. The report evaluates methods and techniques used in issues management, including surveys, conversational Delphi, decision support systems, scanning, content analysis, and computer-assisted techniques. Reviews of 25 techniques provide practical information on capital and labor costs, track record, expertise needed, availability of external support services, relevance to issues management, scope of use, start up time, data base and computer requirements, application to strategic planning, and doability and usability in an advisory framework. The report identifies information sources and outlines a prototypical approach to establishing an issues management capability in an organization.

Coates, V.T.; Coates, J.F.; Jarratt, J.; Heinz, L.

1985-07-01

197

[Anesthetic considerations in sickle cell anemia: a case report].  

PubMed

Sickle cell anemia is the most common hemoglobinopathy. Advances in therapeutic techniques and anesthetic procedures have led to a considerable increase in the success of surgical procedures in these patients. We report the case of a 16-year-old black boy diagnosed with sickle cell anemia and beta-thalassemia who presented with chronic osteomyelitis of the tibia. He was scheduled for debridement of the lesion and musculocutaneous flap repair. We emphasize the importance of communication between anesthesiologists, surgeons, and hematologists in the perioperative period in order to determine the risk of complications and anticipate them. PMID:19725348

Fernández-Meré, L A; Sopena-Zubiría, L A; Alvarez-Blanco, M

2009-01-01

198

Volatile anesthetics-induced neuroinflammatory and anti-inflammatory responses  

PubMed Central

Volatile anesthetics have been the major anesthetics used clinically for more than 150 years. They provide all components of general anesthesia and are easy to be applied and monitored with modern equipment and technology. In addition to having anesthetic property, volatile anesthetics have multiple other effects. Many studies have clearly shown that volatile anesthetics can reduce systemic and local inflammatory responses induced by various stimuli in humans and animals. On the other hand, recent animal studies have shown that volatile anesthetics may induce mild neuroinflammation. These dual effects on inflammation may have significant biological implications and are briefly reviewed here.

2013-01-01

199

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

PubMed

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

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

2014-02-01

200

Management of internal resorption of central incisor using hybrid technique.  

PubMed

Internal inflammatory root resorption is characterised by progressive destruction of intraradicular dentin and dentinal tubules along the root canal wall. A number of theories have been proposed as a possible cause for internal resorption. It is usually asymptomatic and detected during routine radiographic investigations. Prompt diagnosis and early management of such defects is essential to maintain the integrity of the tooth. Non-surgical and surgical methods are the two main strategies involved in the management of internal resorption. The non-surgical method is usually preferred, but in cases of extensive resorption with external root perforation, surgical intervention has been advocated. The present case illustrates repair of perforating internal resorption by hybrid method, using mineral trioxide aggregate and gutta-percha, following surgical exposure. After a 10-month follow-up, no clinical and radiographic abnormalities were observed. Additionally, there was also marked reduction in periodontal pocket depth. PMID:24473420

Gayathri, Prabakaran; Pandey, Ramesh Kumar; Jain, Eesha

2014-01-01

201

Improved outage management techniques for better plant availability  

SciTech Connect

To maintain high availability of nuclear generating units is one of the most important management objectives. The duration of outages-whether planned or unplanned-is the main parameter impacting on plant availability, but the planned outages, and essentially the refueling outages, are the most important in this respect, and they also have a heavy impact on the economics of plant operation. The following factors influence the duration of the outages: (1) modifications; (2) preventive maintenance operations; and (3) corrective maintenance operations of generic faults. In this paper, the authors examine how the outage management organization of Electricite de France (EdF) plants is tending to optimize the solutions to the above-mentioned points.

Bemer, J.P.

1989-01-01

202

Project management tools and techniques in high-technology SMEs  

Microsoft Academic Search

Purpose – This paper aims to examine the use of project management practices in small high-technology firms and to identify what contributes to project success. Design\\/methodology\\/approach – The results presented in this paper are based on a survey of Irish high-technology small-to medium-sized enterprises (SMEs). A questionnaire was distributed to over 200 organisations via e-mail and a response rate of

Alan Murphy; Ann Ledwith

2007-01-01

203

Development of automated power system management techniques. [spacecraft design  

NASA Technical Reports Server (NTRS)

The basic approach in the automated power system management (APSM) implementation is to use one central microprocessor for the overall power system supervision and several local microprocessors dedicated to one or more major subassemblies to perform simple monitoring and control functions. Communication between the central and each local processor is through a dedicated two-wire network employing serial data transfer. The block diagrams of the processors, the data bus characteristics, and the software functions and organization are presented.

Imamura, M. S.; Moser, R. L.; Skelly, L. A.; Weiner, H.

1978-01-01

204

From anesthetic mechanisms research to drug discovery.  

PubMed

The ability to render patients insensible and amnesic to remarkably invasive procedures that are uncomfortable to watch, let alone experience, has been rightly designated as one of the greatest medical discoveries of all time. General anesthesia, introduced formally in the mid-nineteenth century, is now delivered to approximately 40 million patients every year in the United States alone. Given its central role in health care, it is indeed extraordinary how poorly we understand anesthesia and anesthetics. In fact, definitions are at best operational and convey little understanding of the underlying neurobiology, while the hypothetical mechanisms are surprisingly superficial. Worse, there is growing concern that the anesthetic drugs in current use, especially the inhaled anesthetics, have durable adverse effects on cognition. PMID:18449184

Eckenhoff, Rg; Zheng, W; Kelz, Mb

2008-07-01

205

Techniques and data structures for parallel resource management  

SciTech Connect

This thesis contributes to parallel resource management in two ways. First considered is management of system state for computation structures consisting of arrays of computations that differed only in indexing parameters. Simple decompositions of the externally visible state into simultaneously updatable components are proposed. Second considered is management of system state for weakened priority queues. The two priority structures proposed, a concurrent heap and a software banyan, were found to be efficient and effective. In addition, the author contributed in the area of language tools for computations that utilize predefined abstract-data-type implementations. A mechanism for abstract data type definition is presented. To promote simultaneity of update, a significant extension of the linguistic construct of path expressions is defined and used as a basis for defining implementation of sequencing within abstract data types. The main advantage of using extended path expressions is that, in addition to synchronization requirements, binding of activities to object decompositions may be specified, along with runtime consistency checking, while leaving the object implementation to the underlying system.

Biswas, J.

1987-01-01

206

Dispersion and Brillouin Managed HNLFs by Strain Control Techniques  

Microsoft Academic Search

In this paper, we investigated a chromatic dispersion and Brillouin gain spectrum (BGS) control in highly nonlinear fibers (HNLFs). Downsized HNLFs (DS-HNLFs) with specific mechanical properties are effective to realize novel applications using a strain applied to the fibers. We experimentally demonstrated the zero dispersion wavelength (??0) and the BGS tuning of the DS-HNLFs by the strain control technique. In

Masanori Takahashi; Masateru Tadakuma; Takeshi Yagi

2010-01-01

207

Regional environmental analysis and management: New techniques for current problems  

NASA Technical Reports Server (NTRS)

Advances in data acquisition and processing procedures for regional environmental analysis are discussed. Automated and semi-automated techniques employing Earth Resources Technology Satellite data and conventional data sources are presented. Experiences are summarized. The ERTS computer compatible tapes provide a very complete and flexible record of earth resources data and represent a viable medium to enhance regional environmental analysis research.

Honea, R. B.; Paludan, C. T. N.

1974-01-01

208

The Critical Incident Technique in Library and Information Management Research.  

ERIC Educational Resources Information Center

Focuses on the application of the Critical Incident Technique (CIT) in three studies at the Department of Information and Communications, Manchester Metropolitan University, United Kingdom. Examines staff-development needs as a key element in change in higher education; decision-making practices in small- to medium-size libraries; and development…

Fisher, Shelagh; Oulton, Tony

1999-01-01

209

A Guaranteed Scheduling Technique to Manage Students' Procrastination.  

ERIC Educational Resources Information Center

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)

Ottens, Allan J.

1982-01-01

210

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...

211

Goal-Oriented Communication: A CBO Technique with High Management Payback.  

ERIC Educational Resources Information Center

Discusses communication by objectives, a strategy that extends management by objectives techniques into the area of communication to strengthen ties between decision making and decision communicating. Discusses its classroom application. (FL)

Myrsiades, Linda S.

1984-01-01

212

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

?-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

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

2001-01-01

213

Anesthetic experience using total intravenous anesthesia in a patient with Isaacs' syndrome -A case report-  

PubMed Central

We report on an anesthetic experience with a 74-year-old female with Isaacs' syndrome, who underwent elective surgery for open rotator cuff repair. Isaacs' syndrome is a rare peripheral motor neuron disorder with clinical manifestations such as involuntary muscle twitching, cramps, mild weakness and increased sweating. To avoid prolonged neuromuscular blockade, the patient was observed with neuromuscular monitoring during total intravenous anesthesia with propofol, remifentanil, and atracurium. No adverse events were observed during the anesthetic management, and the patient recovered smoothly from the neuromuscular blockade. We describe the clinical characteristics of Isaacs' syndrome and its specific considerations in anesthesia.

Kim, Young Mi; Lee, Sang Hoon; Han, Cheol Sig; Choi, Eun Mi; Choi, Young Ryong

2013-01-01

214

Optimising Asset Management Decision Making and Budgeting Using Risk Management Techniques  

Microsoft Academic Search

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

Adam Aspinall; Peter Trueman

215

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

SciTech Connect

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

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

2010-12-15

216

Color management and calibration techniques at the University of Arizona  

NASA Astrophysics Data System (ADS)

At the University of Arizona a research project is underway which addresses consistent color and gray-scale reproduction for digital color displays used in medical image interpretation. Now the University of Arizona can enter the field of ICC Profiling and Color Management. A color calibration facility was developed from ground up. Color calibration is presented for three color LCDs as is color accuracy. A PR670 Spectroradiometer was used to correct for errors of the pucks. A method was used to calculate the color accuracy and the ?E values.

Hashmi, Syed F.; Roehrig, Hans; Krupinski, Elizabeth A.

2011-09-01

217

Managing golf injuries: technique and equipment changes that aid treatment.  

PubMed

Proper golf technique and equipment and preventive measures can minimize golf-related injuries of the back, shoulders, elbows, and hands and wrists. Rotating the shoulder and hip a similar amount during the backswing and keeping the spine vertical during the follow-through can reduce lumbar spine strain. A rigid back support may lower the risk of vertebral compression fracture in osteoporotic patients. Shortening the backswing can decrease pressure on a degenerative acromioclavicular joint. Therapy for 'golfer's elbow' includes medial counterforce bracing, larger club grips, and graphite shafts. Treatments for wrist and hand disorders include proper swing and grip technique and larger, softer grips. Diagnosis of the easy-to-miss fracture of the hook of the hamate may require tomogram, CT, or MRI. PMID:20086732

Metz, J P

1999-07-01

218

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

ERIC Educational Resources Information Center

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

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

2011-01-01

219

Applying data mining techniques to address disaster information management challenges on mobile devices  

Microsoft Academic Search

The improvement of Crisis Management and Disaster Recovery techniques are national priorities in the wake of man-made and nature inflicted calamities of the last decade. Our prior work has demonstrated that the efficiency of sharing and managing information plays an important role in business recovery efforts after disaster event. With the proliferation of smart phones and wireless tablets, professionals who

Li Zheng; Chao Shen; Liang Tang; Tao Li; Steve Luis; Shu-Ching Chen

2011-01-01

220

Improved Task Management Techniques for Enforcing EDF Scheduling on Recurring Tasks  

Microsoft Academic Search

The management of tasks is an essential requirement in most real-time and embedded systems, but invariably leads to unwanted CPU overheads. This paper is concerned with task management in real-time and embedded systems employing the Earliest Deadline First (EDF) scheduling algorithm. Currently, the best known techniques to manage EDF scheduling lead to overheads with complexity O(log n), where n is

Michael Short

2010-01-01

221

CAPITAL MANAGEMENT TECHNIQUES IN DEVELOPING COUNTRIES: AN ASSESSMENT OF EXPERIENCES FROM THE 1990S AND LESSONS FROM THE FUTURE  

Microsoft Academic Search

This paper uses the term, capital management techniques, to refer to two complementary (and often overlapping) types of financial policies: policies that govern international private capital flows and those that enforce prudential management of domestic financial institutions. The paper shows that regimes of capital management take diverse forms and are multi-faceted. The paper also shows that capital management techniques can

Gerald EPSTEIN; Ilene GRABEL; JOMO K. S

2004-01-01

222

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

PubMed Central

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

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

2008-01-01

223

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

Microsoft Academic Search

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;

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

1997-01-01

224

Teaching management of the unexpected birth: application of multimodal techniques.  

PubMed

The ability to safely manage birth in the emergency department is a competency for emergency nurse practitioner practice. However, it is difficult to ensure that students receive enough practice with this low-frequency event. To meet this need, we created a learning environment combining readings, skills videos, lecture, practice with models, simulation, and debriefing to assist students in providing safe care to women giving birth in the emergency department. This program, which includes a high-fidelity, low-technology simulation, has been successfully implemented with excellent results. The realistic nature of the simulations, use of recently graduated nurse-midwives as the simulated patients, and group interactions during the births were keys to this successful simulation experience. When paired with appropriate preparation, simulation of an unexpected birth in the emergency department promotes confidence and safe practice among advanced practice nursing students. PMID:24487267

Wilbeck, Jennifer; Phillippi, Julia; Schorn, Mavis

2014-01-01

225

Development of analytical techniques for risk management training. Final report  

SciTech Connect

The project developed an orderly, systematic framework for rail mass transit system fire safety analysis. The engineering method is a new risk management tool which will provide a cost effective means to evaluate fire safety systems. The most important feature of this method is the identification of: New areas of research needs for rail mass transit systems; an ability for cost/benefit analysis of fire safety intervention methods; and an improved means of comparing the effectiveness of fire safety measures used by different transit systems. This type of engineering methodology has proved effective in the fire safety design and analysis of buildings and ships and will prove highly beneficial to the fire safety analysis and design of rail mass transit systems.

Barnett, J.R.

1992-10-01

226

Arthroscopic management of tibial plateau fractures: special techniques.  

PubMed

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

Perez Carro, L

1997-04-01

227

Thermal Management Techniques for Oil-Free Turbomachinery Systems  

NASA Technical Reports Server (NTRS)

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.

Radil, Kevin; DellaCorte, Chris; Zeszotek, Michelle

2006-01-01

228

Statistical and Economic Techniques for Site-specific Nematode Management  

PubMed Central

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

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

2014-01-01

229

Statistical and Economic Techniques for Site-specific Nematode Management.  

PubMed

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

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

2014-03-01

230

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas.  

PubMed

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

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

2012-09-01

231

Anode water removal: A water management and diagnostic technique for solid polymer fuel cells  

Microsoft Academic Search

A water management technique has been developed for solid polymer electrolyte fuel cells which demonstrates both performance and diagnostic benefits. Through this technique a substantial proportion of the water in the cathode can be removed via the anode fuel stream. This is accomplished by imparting a water concentration gradient through the polymer membrane, thereby increasing the back diffusion rate of

H. H. Voss; D. P. Wilkinson; P. G. Pickup; M. C. Johnson; V. Basura

1995-01-01

232

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

Microsoft Academic Search

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

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

2009-01-01

233

Flight test configuration for verifying inertial sensor redundancy management techniques  

NASA Technical Reports Server (NTRS)

The Redundant Strapdown Inertial Measurement Unit presently tested in flight configuration consists of a semioctahedral array of four dynamically tuned, two-degree-of-freedom (TDOF) gyros and four TDOF accelerometers which can provide dual, fail-operational performance for integrated avionics systems. Attention is given to the multilevel algorithm used for the detection and isolation of three ranges of sensor failure in an integrated avionics context. A technique for the generation of accelerometer and gyro error thresholds which is sensitive to dynamic sensor errors and separation effects is presented, together with simulation results. Emphasis is placed on the ensuring of highly reliable data for flight control/navigation functions, while minimizing false or missed alarms.

Bryant, W. H.; Morrell, F. R.; Bailey, M. L.

1984-01-01

234

Non-conventional caries management techniques for children show promise.  

PubMed

DesignSecondary care-based, three-arm parallel-group, randomised controlled trial.InterventionChildren aged three to eight years old with at least one primary molar tooth with caries into dentine involving two dental surfaces were randomised to either; conventional restoration (CR) with local anaesthesia, Hall technique (HT) or non-restorative caries treatment (NRCT) with no local anaesthetic. Only one tooth per child was included and parents were present during treatment.Outcome measureChild's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (five-point Likert scales).ResultsOne hundred and sixty-nine children (96 boys and 73 girls) were randomised; 52 received HT; 52 NRCT and 65 CR. Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated 'very low' or 'low' in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12). NRCT and HT were 'very easy' or 'easy' to perform for >77% of dentists, compared to 50% in CR group (P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort (P = 0.46, CI = 0.45 to 0.48).ConclusionsDentists reported more negative behaviour in the CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar. PMID:24971854

Thillainathan, Sharaniya; Duane, Brett

2014-06-01

235

Anesthetic Requirement is Increased in Redheads  

PubMed Central

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

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

2005-01-01

236

Improvement of the Management and Administration of Education Systems Through the Use of Modern Management Methods and Techniques.  

ERIC Educational Resources Information Center

The number and diversity of the parameters involved in the organization of modern education make it necessary to employ modern management methods and techniques to optimize decisions about the organization and improve the use of available material and financial resources. To accomplish these goals, a systems approach is advisable. A model of any…

Barbulescu, Constantin

237

Flow management techniques for base and afterbody drag reduction  

NASA Astrophysics Data System (ADS)

The problem of turbulent base flows and the drag associated with it have been of significant interest in missile as well as fighter aircraft design. Numerous studies in the literature have been devoted to aspects of reducing base drag on two-dimensional as well as on axisymmetric bodies. This paper presents a review of the developments that have taken place on the use of passive techniques or devices for axisymmetric base and net afterbody drag reduction in the absence of jet flow at the base. In particular, the paper discusses the effectiveness of base cavities, ventilated cavities, locked vortex afterbodies, multi-step afterbodies and afterbodies employing a non-axisymmetric boat-tailing concept for base and net drag reduction in different speed regimes. The broad features of the flow and the likely fluid-dynamical mechanisms associated with the device leading to base drag reduction are highlighted. Flight-test results assessing the effectiveness of some of the devices are compared with data from wind tunnels. The present survey indicates that base and net afterbody drag reduction of considerable engineering significance in aerospace applications can be achieved by various passive devices even when the (unmanipulated) base flow is not characterised by vortex shedding.

Viswanath, P. R.

238

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

PubMed

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

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

2014-01-01

239

Effective management of medical information through ROI-lossless fragile image watermarking technique.  

PubMed

In this article, we have proposed a blind, fragile and Region of Interest (ROI) lossless medical image watermarking (MIW) technique, providing an all-in-one solution tool to various medical data distribution and management issues like security, content authentication, safe archiving, controlled access retrieval, and captioning. The proposed scheme combines lossless data compression and encryption technique to embed electronic health record (EHR)/DICOM metadata, image hash, indexing keyword, doctor identification code and tamper localization information in the medical images. Extensive experiments (both subjective and objective) were carried out to evaluate performance of the proposed MIW technique. The findings offer suggestive evidence that the proposed MIW scheme is an effective all-in-one solution tool to various issues of medical information management domain. Moreover, given its relative simplicity, the proposed scheme can be applied to the medical images to serve in many medical applications concerned with privacy protection, safety, and management. PMID:23816251

Das, Sudeb; Kundu, Malay Kumar

2013-09-01

240

A Security Event Management Framework Using Wavelet and Data-Mining Technique  

Microsoft Academic Search

As the rapid increase of network security events, network security monitoring and management on network behavior become more and more focused in the fields of computer science. This paper develops a kind of network security management framework using collection, analysis and integration, event-correlation and scenario-analysis technique to process the raw data gathered from hybrid network. Data-mining and wavelet technology are

Lan Liu; Zhitang Li; Ling Xu; Huajun Chen

2006-01-01

241

A novel technique for endoscopic management of stones in a continent urinary reservoir.  

PubMed

Urinary stones are a well-established complication of lower urinary tract reconstruction in children and can be managed through an open, percutaneous, or transurethral endoscopic approach for their surgical removal. For children with no urethral access, it is not generally advised to pursue an endoscopic approach through a catheterizable channel. In this study, we describe a safe and effective technique for the endoscopic management of stones through a catheterizable channel in a child with a continent urinary reservoir. PMID:24726150

Vasudevan, Vinaya; Strine, Andrew C; Kaefer, Martin

2014-06-01

242

A Study of the Applicability of Scientific Management Techniques for the Administration of Small, Private Church-Related Colleges.  

ERIC Educational Resources Information Center

Experiences with various modern management techniques and practices in selected small, private church-related colleges were studied. For comparative purposes, practices in public colleges and universities were also assessed. Management techniques used in small companies were identified through review of the literature and the management seminars…

Ferguson, Albert S.

243

Local Toxicity from Local Anesthetic Polymeric Microparticles  

PubMed Central

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

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

2013-01-01

244

Technique for planning and managing industrial growth from the air-quality standpoint  

SciTech Connect

A technique has been developed for summing modeled air quality impacts from many sources onto a common grid. The computed concentration fields can come from any air quality model provided the same period of meteorology is used. At present the computed concentration fields from EPA models CRSTER and ISC can be overlayed onto the grid. The current area of application is for a 100 km by 100 km area but could be expanded to any management unit. Discussed will be current application of the technique and potential uses in planning and managing industrial growth.

Allwine, K.J.

1981-03-23

245

Postoperative management after hepatic resection  

PubMed Central

Hepatic resection has become the mainstay of treatment for both primary and certain secondary malignancies. Outcomes after hepatic resection have significantly improved with advances in surgical and anesthetic techniques and perioperative care. Metabolic and functional changes after hepatic resection are unique and cause significant challenges in management. In-depth understanding of hepatic physiology is essential to properly address the postoperative issues. Strategies implemented in the postoperative period to improve outcomes include adequate nutritional support, proper glycemic control, and interventions to reduce postoperative infectious complications among several others. This review article focuses on the major postoperative issues after hepatic resection and presents the current management.

Wrighton, Lindsay J.; O'Bosky, Karen R.; Namm, Jukes P.

2012-01-01

246

Networkcentric healthcare: applying the tools, techniques and strategies of knowledge management to create superior healthcare operations.  

PubMed

The proliferation of Information Computer and Communication Technologies (IC2T) throughout the business environment has led to exponentially increasing amounts of data and information. Although these technologies were implemented to enhance and facilitate superior decision-making, the reality is information overload. Knowledge Management (KM) is a recent management technique designed to make sense of this information chaos. Critical to knowledge management is the application of IC2T. This paper discusses how effective and efficient healthcare operations can ensue through the adoption of a networkcentric healthcare perspective that is grounded in process-oriented knowledge generation and enabled through World Healthcare Information Grid (WHIG). PMID:18048258

von Lubitz, Dag; Wickramasinghe, Nilmini

2006-01-01

247

A hollow definitive obturator fabrication technique for management of partial maxillectomy  

PubMed Central

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

Patil, Smita Pravinkumar

2012-01-01

248

Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia.  

PubMed

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

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

2014-03-01

249

A Mobility Management Technique with Simple Handover Prediction for 3G LTE Systems  

Microsoft Academic Search

Fast and seamless handover are also weighty issues in 3G LTE systems. Although cross-layer optimization and mobility prediction are well-known techniques for obtaining that goal, they have not been accepted in 3G or 3G LTE systems yet due to their insufficient cost\\/performance ratio. In order to overcome that problem, this paper proposes a mobility management technique which uses simple handover

Tae-hyong Kim; Qi-ping Yang; Jae-hyoung Lee; Soon-gi Park; Yeon-seung Shin

2007-01-01

250

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

Microsoft Academic Search

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

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

2007-01-01

251

An Experimental Test of a Craving Management Technique for Adolescents in Substance-abuse Treatment  

Microsoft Academic Search

This paper describes an experiment designed to test an imagery-based craving management technique with a sample of adolescents\\u000a diagnosed with substance-use disorders. Seventy adolescents between the ages of 14 and 18 (41 males) were recruited through\\u000a two substance-abuse treatment programs. The experimental procedure involved stimulating craving using a previously tested\\u000a imagery technique and then administering a newly developed procedure for

Paul Florsheim; Sarah Heavin; Stephen Tiffany; Peter Colvin; Regina Hiraoka

2008-01-01

252

Craniosynostosis: Esthetic protocol in open technique  

PubMed Central

Introduction: The past two decades have seen advances relative to the treatment of patients with craniosynostosis in the areas of resorbable fixation, imaging, and both intraoperative and perioperative management. The purpose of this study is to present open cranial vault reshaping techniques and anesthetic protocol used at Louisiana State University Health - Shreveport, USA. Materials and Methods: The surgical procedure of choice was single-stage open cranial vault reshaping with barrel-staving and orbital bandeau advancement as needed for supra-orbital rim deficiencies. Results: The outcomes of single-stage cranial vault reshaping with selective postoperative dynamic orthotics yielded symmetrical and consistent clinical results with only three children out of over 100 cases requiring later surgical correction. Discussion: Our review of techniques provides a safe protocol for management of craniosynostosis with symmetrical clinical head shape. The techniques presented here are aimed at improving the multidisciplinary management of these patients.

Ghali, Ghali E.; Zakhary, George

2013-01-01

253

Preventive Analgesia by Local Anesthetics: The Reduction of Postoperative Pain by Peripheral Nerve Blocks and Intravenous Drugs  

PubMed Central

The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

Barreveld, Antje; Witte, Jurgen; Chahal, Harkirat; Durieux, Marcel E.; Strichartz, Gary

2012-01-01

254

A Bandwidth Management Technique for Hierarchical Storage in Large-Scale Multimedia Servers  

Microsoft Academic Search

Using magnetic disks as a cache for tertiary storage has been shown to be an effective way to address the high stor- age costs of large-scale multimedia servers. We investigat e a technique for managing the bandwidth of such a hierar- chical storage design. In existing schemes, all data items are treated equally; and the same I\\/O rate is used

James Zijun Wang; Kien A. Hua

1997-01-01

255

Incubation Alone Is Adequate as a Culturing Technique for Cardiac Rhythm Management Devices?  

PubMed Central

There exist no standardized methods for culturing cardiac rhythm management devices. To identify the most optimal culturing method, we compared various techniques that comprise vortex, sonication, and incubation or combinations thereof. Incubation alone yielded bacterial colony counts similar to those of other culturing combinations and is the least labor-intensive.

Viola, George M.; Mansouri, Mohammad D.; Nasir, Nadim; Darouiche, Rabih O.

2009-01-01

256

SWOT ANALYSIS TECHNIQUE AS A QUANTITATIVE TOOL FOR ADAPTIVE MANAGEMENT ON TRANSBOUNDARY RIVER BASINS  

Microsoft Academic Search

Most conflicts between countries, originate from issues regarding the quantity and quality of shared water resources. During the last decades, many tools and models for river basin management have been developed according to the international and European law, conventions and other agreements. The proposed methodology is a quantitative outlook of the popular SWOT analysis. The technique suggested in this article

Christina Mitsiani

257

Increasing the Productivity of Urban Expressways: Combining TSM (Transportation Systems Management) Techniques and Transit Improvements.  

National Technical Information Service (NTIS)

This is the second phase of a two-part study, which summarizes an analysis of Transportation Systems Management (TSM) and other low capital cost techniques to increase the productivity of urban expressways and streets in dense, built-up areas. Using CORSI...

J. F. Kain G. R. Fauth

1979-01-01

258

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

ERIC Educational Resources Information Center

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

Brunton, Margaret Ann; Jeffrey, Lynn Maud

2010-01-01

259

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

NASA Technical Reports Server (NTRS)

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

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

1982-01-01

260

Anesthetic experience of a patient with relapsing polychondritis -A case report-  

PubMed Central

Relapsing polychondritis is a rare disease characterized by progressive inflammation and destruction of cartilaginous structures such as ears, nose, and tracheolaryngeal structures. As a result, tracheolaryngeal involvement makes anesthetic management a challenge. Anesthetic management of a patient with relapsing polychondritis may encounter airway problems caused by severe tracheal stenosis. We present the case of a 60-year-old woman with relapsing polychondritis who underwent wedge resection of the stomach under epidural analgesia. Thoracic epidural blockade of the T4-10 dermatome was achieved by epidural injection of 7 ml of 0.75% ropivacaine and 50 µg of fentanyl. The patient was tolerable during the operation. We suggest that epidural analgesia may be an alternative to general anesthesia for patients with relapsing polychondritis undergoing upper abdominal surgery.

Kim, In Ki; Kim, Min Soo; Shin, Yang-Sik

2012-01-01

261

Anesthetic experience of a patient with relapsing polychondritis -A case report-.  

PubMed

Relapsing polychondritis is a rare disease characterized by progressive inflammation and destruction of cartilaginous structures such as ears, nose, and tracheolaryngeal structures. As a result, tracheolaryngeal involvement makes anesthetic management a challenge. Anesthetic management of a patient with relapsing polychondritis may encounter airway problems caused by severe tracheal stenosis. We present the case of a 60-year-old woman with relapsing polychondritis who underwent wedge resection of the stomach under epidural analgesia. Thoracic epidural blockade of the T4-10 dermatome was achieved by epidural injection of 7 ml of 0.75% ropivacaine and 50 µg of fentanyl. The patient was tolerable during the operation. We suggest that epidural analgesia may be an alternative to general anesthesia for patients with relapsing polychondritis undergoing upper abdominal surgery. PMID:23198044

Kim, In Ki; Kim, Min Soo; Choi, Yong Seon; Shin, Yang-Sik

2012-11-01

262

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

ERIC Educational Resources Information Center

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

Otani, Akira

1989-01-01

263

Anesthetic implications of emergent Cesarean section in a parturient with Noonan syndrome and bacterial endocarditis.  

PubMed

Noonan syndrome is a relatively common genetically transmitted disorder characterized by facial, cardiac, and musculoskeletal abnormalities. The management of a 27 year old woman with Noonan syndrome at 23 weeks' gestation, presenting with premature labor, who required an emergent Cesarean section for placental abruption, is discussed. In addition to Noonan syndrome, this patient had bacterial endocarditis involving the mitral and aortic valves. The anesthetic implications of Noonan syndrome and endocarditis during pregnancy are presented. PMID:23965213

Chase, Charles J; Holak, Elena J; Pagel, Paul S

2013-08-01

264

A Unitary Anesthetic Binding Site at High Resolution  

SciTech Connect

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.

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

265

A Unitary Anesthetic Binding Site at High Resolution  

SciTech Connect

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.

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

2011-12-31

266

Mimosa pudica, Dionaea muscipula and anesthetics.  

PubMed

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

De Luccia, Thiago Paes de Barros

2012-09-01

267

Mimosa pudica, Dionaea muscipula and anesthetics  

PubMed Central

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

De Luccia, Thiago Paes de Barros

2012-01-01

268

Surgical and anesthetic considerations of laryngeal saccular cyst: a case report  

PubMed Central

Introduction Supraglottic laryngeal cysts are benign, uncommon lesions that have the potential to cause airway compromise. Case Presentation We present a case of a 46-year-old Caucasian woman who was scheduled for excision of a large neck growth (saccular cyst) and was managed successfully. There was thorough consideration regarding anesthetic and surgical management. Steps taken led to a successful excision with no recurrence during follow up. Conclusion This case was an opportunity to consider the challenges in the airway management associated with such cysts and provided reassurance that excision of these cysts is associated with a good post-operative outcome.

2011-01-01

269

A novel technique of otic barotrauma management using modified intravenous cannulae.  

PubMed

This article provides the first detailed description and systematic evaluation of the management of otic barotrauma using modified intravenous cannulae. A 24-gauge IC cannula was modified as a tool for tympanostomy tube placement and middle ear ventilation. The medical records of 271 ears of 156 adult patients (median age 49 years) who underwent this procedure were reviewed retrospectively. Hundred and ninty-one tubes were placed for otalgia because of hyperbaric oxygen therapy, 58 tubes were inserted for air travel prophylaxis and 22 tubes were placed for management of otic barotrauma post-flight. All the patients who had this procedure for prophylaxis experienced regular otic barotrauma symptoms during air travel prior to tube placement. All patients were reviewed 6 weeks (range 2-9 weeks) post-procedure. This technique of otic barotrauma management worked effectively in 99 % of treated patients. On follow-up, 88 % of tubes were found to be extruded and non-extruded tubes were removed in clinic without any anaesthesia. 99.6 % of tympanic membrane had healed completely and spontaneously without sequelae. Given the safety, effectiveness, low risk of complications associated with this novel tympanostomy technique, it provided a simple yet effective therapeutic option for the management of otic barotrauma. Finally, this technique can be easily applied in all health settings as it only requires medical supplies readily available in hospitals, therefore there is no additional cost. PMID:23208527

Zhang, Qi; Banks, Catherine; Choroomi, Sim; Kertesz, Thomas

2013-09-01

270

Hypothermia attenuates NO production in anesthetized rats with endotoxemia.  

PubMed

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

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

2014-07-01

271

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

NASA Technical Reports Server (NTRS)

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

Raiman, Laura B.

1992-01-01

272

Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.  

PubMed

Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication. PMID:23827172

Luo, Chao-Bao; Lai, Yen-Jun; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

2013-09-01

273

Benefits of Liver Transplantation Surgical Techniques in the Management of Extensive Retroperitoneal Tumors  

Microsoft Academic Search

Background  The potential for massive hemorrhage imposes additional challenge in the management of retroperitoneal tumors. This report\\u000a details technical considerations for the management of upper retroperitoneal tumors using principles of liver transplantation.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review of patients who underwent surgery for extensive retroperitoneal tumors using techniques for liver\\u000a transplantation from December 2002 to November 2007 was done.\\u000a \\u000a \\u000a \\u000a Results  Twenty-four patients (14

Marcelo E. Facciuto; Manoj K. Singh; Juan P. Rocca; Caroline Rochon; Manuel I. Rodriguez Davalos; Majid Eshghi; David M. Schwalb; Muhammad Choudhury; Patricia A. Sheiner

2008-01-01

274

Reaction of Local Anesthetics with Phospholipids  

PubMed Central

Local anesthetics (LA) have been found to interact with phospholipids and lipids extracted from nerve and muscle. This reaction is demonstrated by: (a) Inhibition by LA of phospholipid (and tissue lipid) facilitated transport of calcium from a methanol: water phase into chloroform. This action is dependent upon the cationic form of the LA. (b) LA increase the electrical resistance of "membranes" prepared by impregnating Millipore filters with cephalin:cholesterol or tissue lipid extracts and bathed with NaCl or KCl solutions. (c) LA coagulate aqueous dispersions of cephalin, phosphatidyl serine, phosphatidyl ethanolamine, and inositide, an action shared by calcium. The order of potency in coagulating cephalin sols is tetracaine > calcium > butacaine > procaine. Na+ and K+ do not coagulate phospholipid dispersions at 0.1 M concentration and antagonize the effect of Ca2+. (d) LA produce a marked fall in the pH of cephalin sols equivalent to that produced by calcium, (e) Ca2+ and LA form 1:2 molar complexes with phospholipids probably by ion-ion and ion-induced polar type of binding at the phosphate groups of the lipid. It is suggested that such reactions with cell membrane phospholipids may underlie inhibitory effects of LA on cellular ion fluxes and provide a chemical basis for anesthetic action.

Feinstein, Maurice B.

1964-01-01

275

Anesthetic considerations in a parturient with oral-facial-digital syndrome and repaired tetralogy of Fallot with left ventricular dysfunction.  

PubMed

Oral-Facial-Digital syndrome or Mohr syndrome is a rare congenital disorder characterized by malformations of face, oral cavity, laryngeal structures, trachea, and digits, muscular-skeletal abnormalities, and congenital cardiac defects. In this case report, we describe the anesthetic management of a parturient with Oral-Facial-Digital syndrome type II and repaired tetralogy of Fallot with left ventricular dysfunction. PMID:24631061

McKinnie, J E; Abdullah, A N; Ramanathan, J

2014-05-01

276

The diagnosis and management of pre-invasive breast disease: The role of new diagnostic techniques  

PubMed Central

In recent years we have seen significantly increased use of minimally invasive diagnostic techniques in the management of breast disease. There is wide recognition of fine needle aspiration and core biopsy as the principal diagnostic methods. However, concerns exist regarding their reliability. This article provides a brief overview of the major diagnostic issues related to use of fine needle aspiration, core biopsy and ductal lavage. It summarizes areas of use for each technique, outlines the main diagnostic pitfalls and their causes, and provides a perspective on future developments in the field.

Nerurkar, Ashutosh; Osin, Peter

2003-01-01

277

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

PubMed Central

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.

Srivastava, Divya; Dhiraaj, Sanjay

2013-01-01

278

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

PubMed

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

Srivastava, Divya; Dhiraaj, Sanjay

2013-01-01

279

Uncertainty Management for Diagnostics and Prognostics of Batteries using Bayesian Techniques  

NASA Technical Reports Server (NTRS)

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

Saha, Bhaskar; Goebel, kai

2007-01-01

280

77 FR 16537 - Grant of Authority for Subzone Status Piramal Critical Care, Inc., (Inhalation Anesthetics...  

Federal Register 2010, 2011, 2012, 2013

...Critical Care, Inc., (Inhalation Anesthetics), Bethlehem, PA Pursuant to its authority...special-purpose subzone at the inhalation anesthetic manufacturing and distribution facilities...manufacturing and distribution of inhalation anesthetics at the facilities of Piramal...

2012-03-21

281

High throughput modular chambers for rapid evaluation of anesthetic sensitivity  

Microsoft Academic Search

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

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

2006-01-01

282

Techniques in the prevention and management of seromas after breast surgery.  

PubMed

Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention of seroma formation following breast surgery, evaluating the different methodologies used. Although prevention is the best strategy, seromata remain problematic and we consider their management. The principle findings were that prevention is key to the management of seromata. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants and innovative measures of managing the axilla, among others. The evidence demonstrated that a combination of quilting and drains significantly reduces the incidence and volumes of seromata. These effects are sustained by minimizing use of electrocautery, alongside increasing frequencies of axillary sentinel lymph node biopsies and node sampling. The efficacy data on fibrin sealants is inconclusive and consequently should not be routinely used alone or accompanied by quilting sutures. Clinically significant seromas deemed 'symptomatic' by patients and complicating infected seromas should be aspirated. There are limited data on the recommended treatment of established seromas with a paucity of high-quality studies and further research involving randomized trials are indicated. PMID:24941989

H Turner, E Jane; Benson, John R; Winters, Zoë E

2014-05-01

283

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

PubMed Central

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

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

2013-01-01

284

Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials  

Microsoft Academic Search

Background\\/purpose  With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception\\u000a has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the\\u000a use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of\\u000a this systematic review was

Arman Kahokehr; Tarik Sammour; Mattias Soop; Andrew G. Hill

2010-01-01

285

Physical therapy modalities and rehabilitation techniques in the management of neuropathic pain.  

PubMed

Neuropathic pain is an important problem because of its complex natural history, unclear etiology, and poor response to standard physical therapy agents. It causes severe disability unrelated to its etiology. The primary goals of the management of neuropathic pain are to detect the underlying cause, to define the differential diagnosis and eliminate risk factors, and to reduce the pain. The physician should also know the functional and psychologic conditions of the patient. Therefore, a multimodal management plan in neuropathic pain is essential. This review aimed to reflect a diverse point of view about various physical therapy modalities and rehabilitation techniques. Physical therapy modalities and rehabilitation techniques are important options and must be considered when pharmacotherapy alone is not sufficient. In addition, psychosocial support and cognitive behavioral therapy could also be taken into consideration. It has been suggested that the importance of pain rehabilitation techniques will increase in time and these will take a larger part in the management of neuropathic pain. However, it is now early to comment on these methods because of the lack of adequate publications. PMID:24322437

Akyuz, Gulseren; Kenis, Ozge

2014-03-01

286

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

PubMed Central

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.

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

2004-01-01

287

Early anesthetic exposure and long-term cognitive impairment.  

PubMed

Several lines of evidence from clinical cohort studies and animal studies have shown that early exposure to anesthetics is a significant risk factor for later development of learning disabilities. However, the underlying molecular mechanism is unclear. Recent studies have indicated that hippocampal neurogenesis and synaptogenesis may be involved in the mechanisms by which early anesthetic exposure produces long-term cognitive impairment. It is possible that synaptic scaffolding protein postsynaptic density-95 (PSD-95) PDZ (PSD 95/Discs large/Zona occludens-1) domain-mediated protein-protein interactions are involved in the regulation of neurogenesis and synaptogenesis in the central nervous system. PDZ domain-mediated protein-protein interactions are disrupted by clinically relevant concentrations of inhaled anesthetics. It will help us understand the molecular mechanism underlying anesthetic-induced long-term cognitive dysfunction if we can demonstrate the role of synaptic PDZ interactions in early anesthetic exposure-produced long-term cognitive impairment. PMID:24520525

Tao, Feng

2011-12-20

288

Interaction of local anesthetics with phospholipids in Langmuir monolayers  

NASA Astrophysics Data System (ADS)

We have used epifluorescence microscopy to study the interactions of two local anesthetics of the ``caine'' family (tetracaine and dibucaine), with Langmuir monolayers of the phospholipid dipalmitoylphosphatidylcholine (DPPC). These results show that incorporation of either dibucaine or tetracaine causes significant changes in the domain shapes of the liquid condensed phase in monolayers. In particular, at low pH, where the charged cationic form of the local anesthetics predominates, local anesthetic: DPPC monolayers formed significantly less compact liquid condensed domains with highly ramified shapes, compared to DPPC-only controls. For high pH values at which both local anesthetics are electrically neutral, the liquid condensed domains in mixed monolayers resembled that of DPPC-only controls, indicating that these effects have their origins in electrostatic interactions between the local anesthetics and the phospholipid headgroups. Epifluorescence images obtained using the intrinsic fluorescence of dibucaine indicated that dibucaine partitions into both the liquid condensed and liquid expanded phases.

Kane, Suzanne Amador; Floyd, Samuel D.

2000-12-01

289

How do I do it: Continuous local anesthetic infusion for children with spinal dysraphism undergoing major reconstruction of the lower urinary tract.  

PubMed

Postoperative pain control is a fundamental aspect of contemporary pediatric surgery. While many options for analgesia are available to the general patient population, choices are limited for individuals with spinal dysraphism who undergo major urologic procedures. Continuous infusion of local anesthetics has been shown to improve postoperative pain scores and decreases the need for systemic analgesia. We present our technique for continuous local anesthetic infusion utilizing readily available equipment with limited additional cost. PMID:24613391

Wild, T T; Chalmers, D J; Bielsky, A; Wilcox, D T

2014-04-01

290

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

PubMed

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

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

2013-12-01

291

Liquid General Anesthetics Lower Critical Temperatures in Plasma Membrane Vesicles  

NASA Astrophysics Data System (ADS)

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. Here 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{\\deg}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.

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

2013-12-01

292

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy  

PubMed Central

Background: Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. Materials and Methods: A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. Results: A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median (range) of 2 (1-3) doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median (range) number of doses of acetaminophen in the first 24 h was also 2 (1-3). There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Conclusion: Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

Kumar, Anoop; Wilson, Graham A. M.; Engelhardt, Thomas E.

2014-01-01

293

The Use of a Uniquely Designed Anesthetic Scavenging Hood to Reduce Operating Room Anesthetic Gas Contamination During General Anesthesia  

Microsoft Academic Search

Numerous studies have suggested that chronic expo- sure to trace levels of anesthetic gas is harmful to oper- ating room (OR) personnel. In the delivery of pediatric general anesthesia, an uncuffed endotracheal tube (ETT) is normally used which can result in considerable volatile anesthetic and nitrous oxide contamination of the OR. In this report, we present a method to reduce

Moeen K. Panni; Stephen B. Corn

2002-01-01

294

Remote sensing techniques for conservation and management of natural vegetation ecosystems  

NASA Technical Reports Server (NTRS)

The importance of using remote sensing techniques, in the visible and near-infrared ranges, for mapping, inventory, conservation and management of natural ecosystems is discussed. Some examples realized in Brazil or other countries are given to evaluate the products from orbital platform (MSS and RBV imagery of LANDSAT) and aerial level (photography) for ecosystems study. The maximum quantitative and qualitative information which can be obtained from each sensor, at different level, are discussed. Based on the developed experiments it is concluded that the remote sensing technique is a useful tool in mapping vegetation units, estimating biomass, forecasting and evaluation of fire damage, disease detection, deforestation mapping and change detection in land-use. In addition, remote sensing techniques can be used in controling implantation and planning natural/artificial regeneration.

Parada, N. D. J. (principal investigator); Verdesio, J. J.; Dossantos, J. R.

1981-01-01

295

Inhaled anesthetics and immobility: mechanisms, mysteries, and minimum alveolar anesthetic concentration.  

PubMed

Studies using molecular modeling, genetic engineering, neurophysiology/pharmacology, and whole animals have advanced our understanding of where and how inhaled anesthetics act to produce immobility (minimum alveolar anesthetic concentration; MAC) by actions on the spinal cord. Numerous ligand- and voltage-gated channels might plausibly mediate MAC, and specific amino acid sites in certain receptors present likely candidates for mediation. However, in vivo studies to date suggest that several channels or receptors may not be mediators (e.g., gamma-aminobutyric acid A, acetylcholine, potassium, 5-hydroxytryptamine-3, opioids, and alpha(2)-adrenergic), whereas other receptors/channels (e.g., glycine, N-methyl-D-aspartate, and sodium) remain credible candidates. PMID:12933393

Sonner, James M; Antognini, Joseph F; Dutton, Robert C; Flood, Pamela; Gray, Andrew T; Harris, R Adron; Homanics, Gregg E; Kendig, Joan; Orser, Beverley; Raines, Douglas E; Rampil, Ira J; Trudell, James; Vissel, Bryce; Eger, Edmond I

2003-09-01

296

Submucosal anoderm-preserving hemorrhoidectomy revisited: a modified technique for the surgical management of hemorrhoidal crisis.  

PubMed

Submucosal hemorrhoidectomy (Parks' procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction. PMID:24165256

Theodoropoulos, George E; Michalopoulos, Nikolaos V; Linardoutsos, Dimitrios; Flessas, Ioannis; Tsamis, Dimitrios; Zografos, George

2013-11-01

297

Respiratory reflexes in the anesthetized miniature swine.  

PubMed

To assess the suitability of the miniature swine for studies of the control of breathing we evaluated the response of these animals to commonly used respiratory stimuli. Hanford miniature pigs were anesthetized with alpha chloralose and allowed to breathe spontaneously. Rapid lung inflations induced a prolonged expiratory pause proportional to load. Mechanical stimulation of the upper airways induced coughing. Central venous injections of C-fiber stimulants produced bradycardia, hypotension with apnea and/or rapid shallow breathing. CO2 rebreathing increased ventilation primarily through an increase in tidal volume; inspiratory time was not changed. Bilateral vagotomy caused a slower, deeper pattern of breathing, and significantly attenuated the ventilatory response to CO2; all other reflexes were abolished by vagotomy. Cooling the vagus nerves caused reversible blockade of the cough, inflation and C-fiber mediated reflexes in that order. We conclude that the pig can serve as a useful animal in which to study the control of breathing. PMID:3120264

Adams, L; Schneider, D A; Schertel, E R; Strong, E B; Green, J F

1987-12-01

298

[Anesthetic maintenance of renal transplantation in children].  

PubMed

For many children with severe renal excretory dysfunction, renal transplantation is the sole method of life prolongation. The purpose of the investigation was to analyze the specific features of anesthetic maintenance of transplantation of related and cadaver kidney at 1 to 5 years. The investigation involved a detailed analysis of the specific features of 101 anesthesias made in children aged 1 to 16 years (mean 9.6+/-4.87 years) during transplantation of kidneys from corpses and apparently healthy relatives. The duration of surgery and anesthesia was 5.6+/-1.00 and 7.6+/-1.42 hours, respectively. Operations were made under balanced general anesthesia using a low-flow inhalational isoflurane or sevoflurane (0.5-2.0 MAC) technology. After inclusion of a graft into the bloodstream, a plasmapheresis procedure was initiated in 1-1.5 circulating blood volumes. All the children underwent invasive hemodynamic monitoring: the radial artery and internal jugular vein were catheterized. In 19 cases, the pulmonary artery was catheterized using a Swan-Ganz catheter. In children, the initial period of anesthesia during renal transplantation was marked by a drastic hemodynamic instability tended for hypotension and significant tachycardia in the presence of marked hypovolemia (central venous pressure = 0+/-2.0 mm Hg). The major component of infusion therapy was freshly frozen plasma (up to 50% of the volume). Inclusion of a cold renal graft into systemic circulation and washout of residues of preservative solution and necrobiolysis products from it were accompanied by a 0.5-1.3 degrees C temperature reduction and progression of metabolic acidosis. Safe and successful anesthetic maintenance of renal transplantation in children requires an obligatory informative invasive hemodynamic monitoring, continuous laboratory screening, and knowledge of stage-specific features. Continuous plasmapheresis by means of a plasma filter is preferred. PMID:19105257

Biriulina, N Iu; Ushakova, I A; Vabishchevich, A V

2008-01-01

299

A clinical comparison of pain perception and extent of area anesthetized by Wand® and a traditional syringe  

PubMed Central

Background: In the contemporary dental practice, alleviation of pain is the most important factor to ameliorate patient's condition and to gain one's confidence towards the skills of the operator. Such confidence aids to the ultimate success of the treatment procedures. Aims and Objectives: This study compares the pain response of a group of 10 subjects to the Wand® with the response to traditional syringe injections and also compares the extent of the area anesthetized. Materials and Methods: 10 subjects were selected for the study and 20 injections were given contralaterally to them, 10 with Wand®, and rest with the traditional aspirating syringe. Each subject received 2 injections on the palate, Left side with Wand® (test) and Right side with Traditional syringe (control). All injections were given by the same investigator without the use of topical anesthetic spray/gel. Pain perception levels were recorded with a visual analogue scale. Also the extent of area anesthetized with a single palatal injection was assessed by probing. Results: The results showed injections with the syringe were more painful than injections with the Wand® in 2 of 10 subjects. Also the extent of the area anesthetized by both the techniques was similar except in 2 patients. Conclusion: The Wand® results in less painful injections; however, mean ratings of pain for both the groups, were mostly below the annoying level of pain. Also, the areas covered by the anesthetic effect of both the injections were comparatively similar.

Shah, Meet; Shivaswamy, Sumanth; Jain, Sanjay; Tambwekar, Sonal

2012-01-01

300

Failure detection and fault management techniques for flush airdata sensing systems  

NASA Technical Reports Server (NTRS)

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

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

1992-01-01

301

Modeling anesthetic developmental neurotoxicity using human stem cells  

PubMed Central

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

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

2013-01-01

302

Pain fiber anesthetic reduces brainstem Fos after tooth extraction.  

PubMed

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

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

2013-11-01

303

Induced Changes in Protein Receptors Conferring Resistance to Anesthetics  

PubMed Central

Purpose of review While general anesthetics have been provided effectively for many years, their exact molecular underpinnings remain relatively unknown. In this manuscript, we discuss the recent findings associated with resistance to anesthetic effects as a way of shedding light on these mechanisms. Recent findings The original theories of anesthetic action based upon their effects on cellular membranes have given way to specific theories concerning direct effects on ion channel proteins. These molecular targets are intimately involved in the conduct of neuronal signaling within the central nervous system and are thought to be essential in the modulation of conscious states. It is the lack of a thorough understanding of unperturbed consciousness that fosters great difficulty in understanding how anesthetics alter this conscious state. However, one very fruitful line of analysis in the quest for such answers lies in the examination of both in vitro and in vivo ion channel systems which seem to maintain variable levels of resistance to anesthetics. Summary Information about the possible targets and molecular nature of anesthetic action is being derived from studies of anesthetic resistance in GABA receptors, tandem pore potassium channels, and an apparently wide variety of protein systems within the nematode, C. elegans

Bertaccini, Edward J.; Trudell, James R.

2014-01-01

304

Scientific or rule-of-thumb techniques of ground-water management--Which will prevail?  

USGS Publications Warehouse

Emphasis in ground-water development, once directed largely to quantitatively minor (but sociologically vital) service of human and stock needs, is shifting: aquifers are treated as possible regulating reservoirs managed conjunctively with surface water. Too, emphasis on reducing stream pollution is stimulating interest in aquifers as possible waste-storage media. Such management of aquifers requires vast amounts of data plus a much better understanding of aquifer-system behavior than now exists. Implicit in this deficiency of knowledge is a need for much new research, lest aquifers be managed according to ineffective rule-of-thumb standards, or even abandoned as unmanageable. The geohydrologist's task is to define both internal and boundary characteristics of aquifer systems. Stratigraphy is a primary determinant of these characteristics, but stratigraphically minor features may make aquifers transcend stratigraphic boundaries. For example, a structurally insignificant fracture may carry more water than a major fault; a minor stratigraphic discontinuity may be a major hydrologic boundary. Hence, there is a need for ways of defining aquifer boundaries and quantifying aquifer and confining-bed characteristics that are very different from ordinary stratigraphic techniques. Among critical needs are techniques for measuring crossbed permeability; for extrapolating and interpolating point data on direction and magnitude of permeability in defining aquifer geometry; and for accurately measuring geochemical properties of water and aquifer material, and interpreting those measurements in terms of source of water, rate of movement, and waste-sorbing capacities of aquifers and of confining beds--in general, techniques adequate for predicting aquifer response to imposed forces whether static, hydraulic, thermal, or chemical. Only when such predictions can be made routinely can aquifer characteristics be inserted into a master model that incorporates both the hydrologic and the socioeconomic facts necessary to intelligent social actions involving water.

McGuinness, Charles Lee

1969-01-01

305

Inhalational anesthetics activate two-pore-domain background K+ channels.  

PubMed

Volatile anesthetics produce safe, reversible unconsciousness, amnesia and analgesia via hyperpolarization of mammalian neurons. In molluscan pacemaker neurons, they activate an inhibitory synaptic K+ current (IKAn), proposed to be important in general anesthesia. Here we show that TASK and TREK-1, two recently cloned mammalian two-P-domain K+ channels similar to IKAn in biophysical properties, are activated by volatile general anesthetics. Chloroform, diethyl ether, halothane and isoflurane activated TREK-1, whereas only halothane and isoflurane activated TASK. Carboxy (C)-terminal regions were critical for anesthetic activation in both channels. Thus both TREK-1 and TASK are possibly important target sites for these agents. PMID:10321245

Patel, A J; Honoré, E; Lesage, F; Fink, M; Romey, G; Lazdunski, M

1999-05-01

306

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

NASA Technical Reports Server (NTRS)

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

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

1972-01-01

307

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

PubMed

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

Delitala, G

2000-01-01

308

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

USGS Publications Warehouse

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.

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

309

The "incidental anesthetic" -- an opportunity for the endoscopic correction of vesicoureteral reflux in children  

PubMed Central

Introduction: The endoscopic management of vesicoureteral reflux (VUR) with subureteric injection (STING) has become more popular. The low morbidity associated with the STING procedure has led to some authors advocating its use as a first-line therapy. Many parents are uncomfortable with this procedure being performed in children because of the potential morbidity associated with general anesthesia. We present an alternative without added anesthetic morbidity: offering the parents a STING when their child is undergoing an anesthetic for another surgical indication. Methods: We reviewed the records of 10 children who underwent incidental dextranomer/hyaluronic acid copolymer (DHA) injection over a 2-year period. Results: We considered the treatment outcome after a single STING procedure to be successful in 8 (80%) patients and a failure in 2 (20%). Distribution of VUR grade, according to the highest grade per patient, was high in 5 (50%) patients, moderate in 3 (30%) and low in 2 (20%). We observed no complications. Conclusion: The idea of performing STING in children under incidental anesthetic introduces yet another possibility in the paradigm of VUR care. Though the long-term efficacy of DHA remains to be determined, this option reduces the potential morbidity of DHA as first-line therapy while favourably altering the cost benefit.

Tamarkina, Elena; El-Sherbiny, Mohammed; Jednak, Roman; Capolicchio, John-Paul

2009-01-01

310

Structural Basis for the Inhibition of Firefly Luciferase by a General Anesthetic  

Microsoft Academic Search

The firefly luciferase enzyme from Photinus pyralis is probably the best-characterized model system for studying anesthetic-protein interactions. It binds a diverse range of general anesthetics over a large potency range, displays a sensitivity to anesthetics that is very similar to that found in animals, and has an anesthetic sensitivity that can be modulated by one of its substrates (ATP). In

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

1998-01-01

311

The use of quality management tools and techniques in ISO 9001:2000 certified companies: the Greek case  

Microsoft Academic Search

Purpose – The purpose of this paper is to examine the level of use of quality management tools and techniques as well as employees' training in ISO 9001:2000 certified companies. Design\\/methodology\\/approach – A research project was carried out in 370 Greek companies, using the questionnaire method. The selected companies have been implementing a quality management system in accordance with the

Christos Fotopoulos; Evagelos Psomas

2009-01-01

312

Management of giant omphalocele in a premature low-birth-weight neonate utilizing a bedside sequential clamping technique without prosthesis  

Microsoft Academic Search

Management of giant omphalocele in a full-term neonate is a challenging clinical situation. Even more challenging is giant omphalocele in a premature low-birth-weight infant. The authors describe a successful staged noninvasive technique for the management of giant omphalocele in a premature, low-birth-weight neonate without the use of prosthetic material until delayed primary closure could be attempted.

Richard J Hendrickson; David A Partrick; Joseph S Janik

2003-01-01

313

Top-down mechanisms of anesthetic-induced unconsciousness  

PubMed Central

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.

Mashour, George A.

2014-01-01

314

Anesthetic Efficacy of the Intraosseous Injection in Irreversible Pulpitis.  

National Technical Information Service (NTIS)

The purpose of this study was to evaluate the anesthetic efficacy of an intraosseous injection in teeth diagnosed with irreversible pulpitis. Fifty-one healthy human subjects with symptomatic maxillary or mandibular posterior teeth diagnosed with irrevers...

J. M. Nusstein

1995-01-01

315

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

NASA Astrophysics Data System (ADS)

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

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

2012-12-01

316

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

Microsoft Academic Search

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

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

2005-01-01

317

Non-Immobilizing Inhalational Anesthetic-Like Compounds  

Microsoft Academic Search

Nonimmobilizing, inhalational anesthetic-like compounds are experimental agents developed as a tool to investigate the mechanism\\u000a of action of general anesthetics. Clinically used for more than 150 years, general anesthesia has until now defied all attempts\\u000a to formulate a theory of its mechanisms that would link, in an uninterrupted logical chain, observations on the molecular\\u000a level—via effects on the cellular and

M. Perouansky

318

Solubility of Haloether Anesthetics in Human and Animal Blood  

PubMed Central

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.

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

2012-01-01

319

Centrally administered ghrelin activates cardiac vagal nerve in anesthetized rabbits.  

PubMed

Although central ghrelin has cardioprotective effect through inhibiting sympathetic nerve activity, the effects of central ghrelin on cardiac vagal nerve remain unknown. We investigated the effects of centrally administered ghrelin on cardiac autonomic nerve activities using microdialysis technique. A microdialysis probe was implanted in the right atrial wall adjacent to the sinoatrial node of an anesthetized rabbit and was perfused with Ringer's solution containing a cholinesterase inhibitor, eserine. After injection of ghrelin (1 nmol) into the right lateral cerebral ventricle, norepinephrine (NE) and acetylcholine (ACh) concentrations in the dialysate samples were measured as indices of NE and ACh release from nerve endings to the sinoatrial node using high-performance liquid chromatography. Heart rate was 270±4 bpm at baseline and decreased gradually after ghrelin injection to 234±9 bpm (P<0.01) at 60-80 min, followed by gradual recovery. Dialysate ACh concentration was 5.5±0.8 nM at baseline and increased gradually after ghrelin injection to 8.8±1.2 nM (P<0.01) at 60-80 min; the concentration started to decrease gradually from 100 to 120 min after injection reaching 5.6±0.8 nM at 160-180 min. Central ghrelin did not change mean arterial pressure or dialysate NE concentration. The elevated dialysate ACh concentration declined rapidly after transection of cervical vagal nerves. These results indicate that centrally administered ghrelin activates cardiac vagal nerve. PMID:21543266

Shimizu, Shuji; Akiyama, Tsuyoshi; Kawada, Toru; Sonobe, Takashi; Kamiya, Atsunori; Shishido, Toshiaki; Tokudome, Takeshi; Hosoda, Hiroshi; Shirai, Mikiyasu; Kangawa, Kenji; Sugimachi, Masaru

2011-07-01

320

Water solvent and local anesthetics: A computational study  

NASA Astrophysics Data System (ADS)

There are various experimental studies regarding the toxicity and the time of action of local anesthetics, which contain general insights about their pharmacological and physicochemical properties. Although a detailed microscopic analysis of the local anesthetics would contribute to understanding these properties, there are relatively few theoretical studies about these molecules. In this article, we present the results from calculations performed for three local anesthetics: tetracaine, procaine, and lidocaine, both in their charged and uncharged forms, in aqueous environment. We have used the density functional theory and molecular dynamics simulations to study the structural characteristics of these compounds. The radial distribution function g(r) was used to examine the structure of water molecules surrounding different regions of the local anesthetics. We demonstrated the nonhomogeneous character of the anesthetics with respect to their affinity to water solvent molecules as well as the modifications in their affinity to water caused by changes in their charge state. We also observed that the biological potency of the anesthetics is more related to the behavior of specific groups within the molecule, which are responsible for the interaction with the lipid phase of membranes, rather than the general properties of the molecule as a whole.

Bernardi, R. C.; Gomes, D. E. B.; Pascutti, P. G.; Ito, A. S.; Taft, C. A.; Ota, A. T.

321

Comparative efficacy of 16 anesthetic chemicals on rainbow trout  

USGS Publications Warehouse

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

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

1987-01-01

322

Suturing techniques and postoperative management in penetrating keratoplasty in the United Kingdom  

PubMed Central

Aims To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom. Methods A postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts. Results In all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%). In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal. Conclusion This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.

Lee, Richard MH; Lam, Fook Chang; Georgiou, Tassos; Paul, Bobby; Then, Kong Yong; Mavrikakis, Ioannis; Avadhanam, Venkata S; Liu, Christopher SC

2012-01-01

323

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

PubMed Central

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.

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

2008-01-01

324

Blood glucose control during selective arterial stimulation and venous sampling for localization of focal hyperinsulinism lesions in anesthetized children.  

PubMed

Surgical management of congenital hyperinsulinism is improved by accurate localization of small, focal dysregulated pancreatic lesions using the arterial stimulation and venous sampling (ASVS) test, which can demonstrate increased hepatic venous insulin concentrations after selective arterial injections of calcium. However, anesthesia-related increases in blood glucose can induce insulin secretion, making it difficult to interpret ASVS test data. In this retrospective study, we examined the effect of anesthetic interventions on blood glucose concentrations in 68 children undergoing ASVS testing. We considered only the glucose concentrations observed before calcium stimulation in the final analysis. The choice of drugs for induction (sevoflurane, propofol, or thiopentone), maintenance inhaled anesthetics (sevoflurane, desflurane, or isoflurane), and the use of caudal epidural bupivacaine were not associated with significant differences in the mean blood glucose concentration before ASVS. However, patients receiving remifentanil infusions had smaller mean glucose concentrations (80 +/- 18 versus 100 +/- 44 mg x dl(-1), P = 0.01). These concentrations were also significantly smaller if tracheal intubation was delayed for at least 10 min after induction while patients received inhaled anesthetics via a face mask along with remifentanil infusions (79 +/- 14 for delayed intubation versus 95 +/- 39 mg x dl(-1) for early intubation, respectively, P = 0.03). The percentage increase in glucose concentrations from preintubation values was significantly smaller in these subjects (3.7% +/- 21.9% for delayed intubation versus 31.7% +/- 60.4% for early intubation, P = 0.02). We conclude that the anesthetic management protocol for these patients should include the use of remifentanil infusions and the administration of inhaled anesthetics and remifentanil infusions for a minimum of 10 min to establish a deep plane of anesthesia before tracheal intubation. PMID:15385347

Cucchiaro, Giovanni; Markowitz, Scott D; Kaye, Robin; Adzick, N Scott; Litman, Ronald S; Stanley, Charles A; Watcha, Mehernoor F

2004-10-01

325

The effect of sub-anesthetic and anesthetic ketamine on water maze memory acquisition, consolidation and retrieval.  

PubMed

Ketamine, a non-selective inhibitor of NMDA (N-methyl-D-aspartate) channels is used in anesthetic or sub-anesthetic doses to induce analgesia, amnesia, to suppress fear, anxiety and depression. Although the ketamine's effect on memory acquisition is known, its effects on other aspects of memory are controversial. Morris water maze is a task which assesses spatial learning and memory. This study was aimed to assess the ketamine's differential effect on water maze memory acquisition, consolidation and retrieval. Male Sprague-Dawley rats (250-350 g) were trained in water maze single training session. 24h later a probe trial which was consisted of a single trial without platform was done. To assess the effect of ketamine on water maze memory acquisition it was administered before training; to assess its effect on memory consolidation it was administered immediately after training and to assess its effect on memory retrieval it was injected before probe trial. Ketamine both in sub-anesthetic and anesthetic doses impaired water maze memory acquisition, its anesthetic dose but not sub-anesthetic dose impaired memory consolidation and on retrieval stage, both doses deteriorated memory retrieval. It seems that NMDA receptor activity is not just necessary during water maze memory acquisition but also their post-learning reactivation is required to maintain memory consolidation and retrieval. PMID:22209880

Moosavi, Maryam; Yadollahi Khales, Golnaz; Rastegar, Karim; Zarifkar, Asadollah

2012-02-29

326

[Anesthetic management of a patient with paroxysmal nocturnal hemoglobinuria].  

PubMed

A 34-year-old man with paroxysmal nocturnal hemoglobinuria (PNH) was scheduled for emergency laparotomy. PNH is an acquired disorder of stem cells, and the common manifestations are complement mediated hemolytic anemia and deep venous thrombosis. Perioperative hemolysis occurs under the activation of complement induced by stress such as acidosis, infection, and insufficient pain control. Activation of complement secondary leads to platelet aggregation and hypercoagulability. We administrated remifentanil for the pain control during the operation and fentanyl after the operation. We avoided hypoventilation and dehydration to prevent acidosis. Washed red blood cells were given to reduce the chance of complement activation and we administrated low molecular weight heparin up to the seventh postoperative day to prevent deep venous thrombosis. The perioperative course was uneventful without complication. PMID:22860310

Hano, Kimitaka

2012-07-01

327

Anesthetic management of a pediatric patient on a ketogenic diet  

Microsoft Academic Search

There are several specific considerations regarding seizure control during the perioperative period in patients who have been\\u000a 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\\u000a the treatment of intractable seizures in children. Maintaining therapeutic ketosis and modifying the acid–base balance are\\u000a particularly

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

2006-01-01

328

Peripartum anesthetic management of a patient with brittle cornea syndrome  

Microsoft Academic Search

Brittle cornea syndrome (BCS) is a rare autosomol recessive disease that affects the connective tissue. The syndrome is caused\\u000a by genetic changes in the 4.7-Mb interval between the D16S3423 and D16S3425 markers on the 16q24 chromosome and mutations\\u000a in the Zinc-Finger 469 gene (ZNF469). BCS is characterized by thin and fragile cornea that tends to perforate spontaneously\\u000a or as a

A. Ioscovich; S. Grisaru-Granovsky; S. Halpern; Y. Shapiro

2011-01-01

329

APPLICATION OF SPACE TECHNIQUES TO THE INTEGRATED MANAGEMENT OF WATER RESOURCES: THE ASTIMWR PROJECT Remote Sensing for Water Management  

Microsoft Academic Search

Earth Observation (EO) data are an important source of information to support decisions and actions related to the management of water resources. Nevertheless, water managers often face many difficulties to access such information, because the existing computer tools for handling EO data are designed for Remote Sensing (RS) and Geographical Information System (GIS) experts and not for water resources managers.

S. MONTESINOS; L. DE STEFANO

330

A comparative study on various statistical techniques predicting ozone concentrations: implications to environmental management.  

PubMed

The objective of the present work is to compare various techniques for modeling the dependence of the tropospheric ozone concentrations on several meteorological and pollutant parameters. The study focuses on two different sites in the metropolitan area of Athens, Greece; one in the city centre and another one in the suburbs. It is found that although simple Linear Regression Analysis fails to construct accurate equations due to the existence of multicollinearity among the independent variables, still various combinations of a Multivariate Method (PCA) and Stepwise Regression Analysis manage to produce equations free of the multicollinearity issue. The derived formulas are validated and prove to have R(2) values in the order of 0.8 approximately. However, the equations are found to be unsuccessful in case of severe episodes. For this reason, a new procedure is followed for estimating the ozone values in case of episodes exclusively. The new R(2) value is estimated to be 0.9, approximately. PMID:18306048

Paschalidou, A K; Kassomenos, P A; Bartzokas, A

2009-01-01

331

Project planning and management techniques of the fast-paced TMX-Upgrade construction  

SciTech Connect

The Tandem Mirror Experiment-Upgrade (TMX-Upgrade) construction will be completed in 18 months at a total cost of $14.5 million. This paper describes the project planning and the management techniques used to complete the TMX-Upgrade within its allocated cost and schedule. In the planning stages of a project, before approval of the proposal, we define major project objectives, create a work breakdown structure (WBS), detail a technical description for each level of the WBS, and provide detailed bottoms-up cost estimates and summary schedules. In the operating phase, which continues throughout the project, we establish budget and schedule baselines. The reporting phase includes The Department of Energy (DOE) reviews of project status at monthly, quarterly, and semiannual intervals. These reports include cost, schedule, manpower, major procurement, and technical status information.

Seberger, C.D.; Chargin, A.K.

1981-10-26

332

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

USGS Publications Warehouse

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

2012-01-01

333

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

NSDL National Science Digital Library

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

Stephens, Matthew P.; Torres, Patricio A.

2010-03-19

334

Application of capillary fluid management techniques to the design of a phase separating microgravity bioreactor  

NASA Technical Reports Server (NTRS)

Manned space missions require the development of compact, efficient, and reliable life support systems. A number of aqueous biological conversion processes are associated with bioregenerative life support systems. Vessels, or bioreactors, capable of supporting these processes in microgravity must be developed. An annular flow bioreactor has been conceived. It has the potential to incorporate containment, phase separation, gas exchange, and illumination into a single vessel. The bioreactor utilizes capillary fluid management techniques and is configured as a cylindrical tube in which a two-phase liquid-gas flow is maintained. Vanes placed around the inner perimeter enhance capillary forces and cause the liquid phase to attach and flow along the interior surface of the tube. No physical barrier is required to complete phase separation. It is shown analytically that liquid film thickness is limited only by vane geometry and that an annular flow bioreactor capable of managing 284 liters would occupy 0.7 cubic m, less than half the volume of a Spacelab experiment rack.

Finger, Barry W.; Neville, Gale E., Jr.; Sager, John C.

1993-01-01

335

Application of capillary fluid management techniques to the design of a phase separating microgravity bioreactor  

SciTech Connect

Manned space missions require the development of compact, efficient, and reliable life support systems. A number of aqueous biological conversion processes are associated with bioregenerative life support systems. Vessels, or bioreactors, capable of supporting these processes in microgravity must be developed. An annular flow bioreactor has been conceived. It has the potential to incorporate containment, phase separation, gas exchange, and illumination into a single vessel. The bioreactor utilizes capillary fluid management techniques and is configured as a cylindrical tube in which a two-phase liquid-gas flow is maintained. Vanes placed around the inner perimeter enhance capillary forces and cause the liquid phase to attach and flow along the interior surface of the tube. No physical barrier is required to complete phase separation. It is shown analytically that liquid film thickness is limited only by vane geometry and that an annular flow bioreactor capable of managing 284 liters would occupy 0.7 cubic m, less than half the volume of a Spacelab experiment rack.

Finger, B.W.; Neville, G.E. Jr.; Sager, J.C.

1993-12-31

336

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

SciTech Connect

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

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

2011-11-15

337

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

PubMed Central

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

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

2013-01-01

338

In situ neutron imaging technique for evaluation of water management systems in operating PEM fuel cells  

NASA Astrophysics Data System (ADS)

This paper explores the method of neutron imaging as an experimental tool to perform in situ non-destructive analysis on an operating polymer electrolyte membrane hydrogen fuel cell. Neutrons are ideal for the imaging of hydrogen fuel cells because of their sensitivity to hydrogen-containing compounds such as water. This research focused on using imaging techniques to develop methods for testing and evaluating the water management system of a fuel cell. A real-time radiography dataset consisting of 1000 images at 2-s intervals was used to create a movie which showed water production, transport, and removal throughout the cell. This dataset was also analyzed to quantify and calculate the amount of water present in the cell at any time and masking techniques were used to differentiate between water in the cell flow channels and in the gas diffusion layer. Additionally, a tomography dataset allowed for the creation of a digital 3-dimensional (3-D) reconstruction of the dry cell which can be analyzed for structural defects.

Satija, R.; Jacobson, D. L.; Arif, M.; Werner, S. A.

339

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

PubMed

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

Das, Sudeb; Kundu, Malay Kumar

2012-10-01

340

Managing complex processing of medical image sequences by program supervision techniques  

NASA Astrophysics Data System (ADS)

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

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

1997-05-01

341

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

NASA Astrophysics Data System (ADS)

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

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

2013-08-01

342

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

NASA Astrophysics Data System (ADS)

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.

Shao, Hui

343

Anesthetics interfere with the polarization of developing cortical neurons  

PubMed Central

Numerous studies from the clinical and preclinical literature indicate that general anesthetic agents have toxic effects on the developing brain, but the mechanism of this toxicity is still unknown. Previous studies have focused on the effects of anesthetics on cell survival, dendrite elaboration, and synapse formation, but little attention has been paid to possible effects of anesthetics on the developing axon. Using dissociated mouse cortical neurons in culture, we found that isoflurane delays the acquisition of neuronal polarity by interfering with axon specification. The magnitude of this effect is dependent on isoflurane concentration and exposure time over clinically relevant ranges, and it is neither a precursor to nor the result of neuronal cell death. Propofol also appears to interfere with the acquisition of neuronal polarity, but the mechanism does not require activity at GABAA receptors. Rather, the delay in axon specification likely results from a slowing of the extension of pre-polarized neurites. The effect is not unique to isoflurane as propofol also appears to interfere with the acquisition of neuronal polarity. These findings demonstrate that anesthetics may interfere with brain development via effects on axon growth and specification, thus introducing a new potential target in the search for mechanisms of pediatric anesthetic neurotoxicity.

Mintz, C. David; Smith, Sarah C.; Barrett, Kendall M.S.; Benson, Deanna L.

2012-01-01

344

Influence of hemostatic agents upon the outcome of periapical surgery: Dressings with anesthetic and vasoconstrictor or aluminum chloride  

PubMed Central

Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl™). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05). Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant. Key words:Aluminum chloride, bleeding control, hemostasis, periapical surgery, outcome.

Penarrocha-Diago, Maria; Maestre-Ferrin, Laura; Penarrocha-Oltra, David; von Arx, Thomas

2013-01-01

345

Comparison of alternative scoring techniques when assessing decision maker's multi-objective preferences in natural resource management.  

PubMed

A popular way to assess a decision maker's preferences in multi-objective natural resource management is to ask the decision maker to compare alternative management plans pairwisely in the ratio scale. Several numerical scoring techniques have been proposed for the ratio scale comparisons, but the performance of the alternative techniques is not fully understood. At the same time, the choice of scoring technique potentially impacts the description of the decision maker's preferences and therefore the actual management decisions. In this paper, the regression model for the ratio scale pairwise comparisons is used, and the differences between the alternative scoring techniques are studied based on two different viewpoints. The first idea is to interpret the scoring techniques as fixed models and then compare them under fixed numerical scaling. The applicability of several potential decision-making strategies is discussed in this context. The second idea is to parameterise the scoring techniques and then compare them under optimal scaling. This was possible in an artificial experiment, where the true values of the alternatives are known. The results supported the use of a geometric scoring technique. Also, the importance of assessing an appropriate scale parameter of the geometric progression is pointed out. PMID:17123701

Leskinen, Pekka

2007-10-01

346

Inhaled Anesthetics Promote Albumin Dimerization through Reciprocal Exchange of Subdomains  

PubMed Central

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

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

2010-01-01

347

Anesthetics and excitatory/inhibitory responses of midbrain reticular neurons.  

PubMed

The effects of nitrous oxide, halothane, ether, isoflurane, thiopental, and thiamylal on the excitatory as well as inhibitory responses of single neurons in the midbrain reticular formation (MRF), believed to be one of the most important sites for the regulation of wakefulness, were studied by long-term, extracellular microelectrode recording in cats and rats. All anesthetics except nitrous oxide suppressed the excitatory responses of MRF neurons evoked by somatosensory stimulation. The inhibitory responses markedly were potentiated by both barbiturates but variously affected by other inhalation anesthetics. Blockade of the inhibitory responses (disinhibition) was observed more frequently with the inhalation agents during the light state of anesthesia. Thus, suppression of excitatory responses is likely to be a general feature of the anesthetic state in terms of the behavior of MRF neurons. Further, potentiation of the inhibitory responses might be characteristic of barbiturate anesthesia. PMID:6465598

Shimoji, K; Fujioka, H; Fukazawa, T; Hashiba, M; Maruyama, Y

1984-08-01

348

Inhaled Anesthetics Promote Albumin Dimerization through Reciprocal Exchange of Subdomains.  

PubMed

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

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

2010-01-01

349

Optical link upgrade by dispersion and nonlinearity management technique realized by compensating optical cable coiled around of fiber optic closure  

NASA Astrophysics Data System (ADS)

We represent results of numerical simulations for upgrade of optical link with SMF by using the DDMS technique based on application of compensating optical cable coiled around of optical closure. We propose this technique for minimization land cost. Nonlinearity management for decreasing of quasi-solitons interaction is considered. Based on NLSE the model of optical link regeneration section with dispersion and nonlinearity management is described. The NLSE was solved numerically. Estimated values for optical system performance were derived by taking into account the amplified spontaneous emission noise, parameters of dispersion map deviations, and the interaction of quasi-solitons.

Burdin, Vladimir A.; Bourdine, Anton V.; Volkov, Kirill A.

2012-01-01

350

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

ERIC Educational Resources Information Center

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

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

2012-01-01

351

Development of kinetic analysis technique for PACS management and a screening examination in dynamic radiography  

NASA Astrophysics Data System (ADS)

The purpose of this study was to develop of kinetic analysis method for PACS management and computer-aided diagnosis. We obtained dynamic chest radiographs (512x512, 8bit, 4fps, and 1344x1344, 12bit, 3fps) of five healthy volunteers during respiration using an I.I. system twice, and one healthy volunteer using dynamic FPD system. Optical flows of images were obtained using customized block matching technique, and were divided into a direction, and transformed into the RGB color. Density was determined by the sum pixel length of movement during respiration phase. The made new static image was defined as the "kinetic map". The evaluation of patient's collation was performed with a template matching to the three colors. The same person's each correlation value and similar-coefficient which is defined in this study were statistically significant high (P<0.01). We used the artificial neural network (ANN) for the judgment of the same person. Five volunteers were divided into two groups, three volunteers and two volunteers became a training signal and unknown signal. Correlation value and similar-coefficient was used for the input signal, and ANN was designed so that the same person's probability might be outputted. The average of the specificity of the unknown signal obtained 98.2%. The kinetic map including the imitation tumor was used for the simulation. The tumor was detected by temporal subtraction of kinetic map, and then the superior sensitivity was obtained. Our analysis method was useful in risk management and computer-aided diagnosis.

Tsuchiya, Yuichiro; Kodera, Yoshie

2005-04-01

352

[A study of waste anesthetic gases monitoring and working environmental controls in hospital operating rooms].  

PubMed

There are hazardous factors threatening health care workers, and many hazardous chemical substances have been reported in operating rooms, central supply facilities, laboratories and so on. In Japan, little attention has been paid to exposure to these chemicals and to working environmental controls. Waste anesthetic gases are chemicals concerned, and we conducted environmental monitoring continuously and measured exposure to nitrous oxide, isoflurane and sevoflurane in operating rooms, and examined working environmental controls. The average environmental concentrations of nitrous oxide were about 400 ppm in anesthetists' working areas, and about 180 ppm in surgeons' and instrument nurses' working areas under unscavenged conditions. Under scavenged conditions, environmental concentrations were 70-190 ppm in anesthetists' zones, and 70-90 ppm in surgeons' and instrument nurses' zones. Even under scavenged conditions, operating room personnel are presumed to be exposed to high concentrations of nitrous oxide above ACGIH's TLV and NIOSH's REL. The level of exposure of isoflurane and sevoflurane was 2-4 ppm. Managing general ventilation system and airflow direction, working area under scavenged system, environmental concentration levels of nitrous oxide could be reduced to 20-30 ppm. In order to control occupational exposure to anesthetic gases, it is not sufficient to merely adapt scavenging systems in operating rooms. Working environmental control and occupational hygiene management should be required. PMID:9138776

Koda, S; Kumagaj, S; Toyoto, M; Yasuda, N; Ohara, H

1997-01-01

353

Commercial anesthetic-respiratory gas monitor utilizing Raman spectroscopy  

NASA Astrophysics Data System (ADS)

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.

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

1990-11-01

354

Nonepileptic seizures following general anesthetics: a report of five cases.  

PubMed

Five patients who developed seizures following a general anesthetic are described. It is not possible to determine retrospectively whether or not the initial attacks were definitely epileptic, but these patients all subsequently received a diagnosis of psychological nonepileptic convulsions/seizures (also known as pseudoseizures, psychogenic nonepileptic seizures, and nonepileptic attack disorder) established by video/EEG telemetry or ictal EEG recordings. In two cases there was evidence of concurrent epilepsy. We suggest that nonepileptic seizures may develop following postanesthetic seizures and that a psychogenic basis for seizures occurring after general anesthetics needs to be considered. PMID:15582852

Lichter, Ida; Goldstein, Laura H; Toone, Brian K; Mellers, John D C

2004-12-01

355

Characterization of in-cylinder techniques for thermal management of diesel aftertreatment  

SciTech Connect

One challenge in meeting emission regulations with catalytic aftertreatment systems is maintaining the proper catalyst temperatures that enable the catalytic devices to perform the emissions reduction. In this study, in-cylinder techniques are used to actively control the temperature of a catalyzed diesel particulate filter (DPF) in order to raise the DPF temperature to induce particulate oxidation. The performance of four strategies is compared for two different starting DPF temperatures (150 C and 300 C) on a 4-cylinder, 1.7-liter diesel engine. The four strategies include: (1) addition of extra fuel injection early in the combustion cycle for all four cylinders, (2) addition of extra fuel injection late in the combustion cycle for all four cylinders, (3) operating one-cylinder with extra fuel injection early in the combustion cycle, and (4) operating one-cylinder with extra fuel injection late in the combustion cycle. In cases (3) and (4), the cylinder operating with extra fuel injection is changed frequently to avoid oil dilution complications. In addition to the in-cylinder strategies, an in-pipe fuel addition technique for thermal management was studied for comparison. Results show that at starting temperatures above 300 C, late cycle injection strategies that cause temperature rise from exotherms created by unburned fuel components result in higher temperature rise for a given fuel penalty. At the low temperature of 150 C, early injection strategies that create temperature rise from both combustion and light reductant exotherms are preferred due to the inability of the catalyst to oxidize unburned fuel from late injection strategies.

Parks, II, James E [ORNL; Huff, Shean P [ORNL; Kass, Michael D [ORNL; Storey, John Morse [ORNL

2007-01-01

356

General anesthetic-induced channel gating enhancement of 5-hydroxytryptamine type 3 receptors depends on receptor subunit composition.  

PubMed

5-Hydroxytryptamine (serotonin) (5-HT) type 3 (5-HT(3)) receptors are members of an anesthetic-sensitive superfamily of Cys-loop ligand-gated ion channels that can be formed as homomeric 5-HT(3A) or heteromeric 5-HT(3AB) receptors. When the efficacious agonist 5-HT is used, the inhaled anesthetics halothane and chloroform (at clinically relevant concentrations) significantly reduce the agonist EC(50) for 5-HT(3A) receptors but not for 5-HT(3AB) receptors. In the present study, we used dopamine (DA), a highly inefficacious agonist for 5-HT(3) receptors, to determine whether the difference in sensitivity between 5-HT(3A) and 5-HT(3AB) receptors to the potentiating effects of halothane and chloroform is due to differential modulation of agonist affinity, channel gating, or both. Using the two-electrode voltage-clamp technique with 5-HT(3A) and 5-HT(3AB) receptors expressed in Xenopus oocytes, we found that chloroform and halothane enhanced currents evoked by receptor-saturating concentrations of DA for both receptor subtypes in a concentration-dependent manner but that the magnitude of enhancement was substantially greater for 5-HT(3A) receptors than for 5-HT(3AB) receptors. Isoflurane induced only a small enhancement of currents evoked by receptor-saturating concentrations of DA for 5-HT(3A) receptors and no enhancement for 5-HT(3AB) receptors. For both receptor subtypes, none of the three test anesthetics significantly altered the agonist EC(50) for DA, implying that these anesthetics do not affect agonist binding affinity. Our results show that chloroform, halothane, and (to a much lesser degree) isoflurane enhance channel gating for 5-HT(3A) receptors and that the incorporation of 5-HT(3B) subunits to produce heteromeric 5-HT(3AB) receptors markedly attenuates the ability of these anesthetics to enhance channel gating. PMID:16081679

Solt, Ken; Stevens, Renna J; Davies, Paul A; Raines, Douglas E

2005-11-01

357

Does Anesthetic Additivity Imply a Similar Molecular Mechanism of Anesthetic Action at N-Methyl-d-Aspartate Receptors?  

PubMed Central

Background Isoflurane and carbon dioxide (CO2) negatively modulate N-methyl-D-aspartate (NMDA) receptors, but via different mechanisms. Isoflurane is a competitive antagonist at the NMDA receptor glycine binding site, whereas CO2 inhibits NMDA receptor current through extracellular acidification. Isoflurane and CO2 exhibit additive minimum alveolar concentration effects in rats, but we hypothesized that they would not additively inhibit NMDA receptor currents in vitro because they act at different molecular sites. Methods NMDA receptors were expressed in frog oocytes and studied using two-electrode voltage clamp techniques. A glycine concentration-response for NMDA was measured in the presence and absence of CO2. Concentration-response curves for isoflurane, H+, CO2, and ketamine as a function of NMDA inhibition were measured, and a Hill equation was used to calculate the EC50 for each compound. Results Binary drug combinations containing ½ EC50 were additive if NMDA current inhibition was not statistically different from 50%. The ½ EC50 binary drug combinations decreased the percent baseline NMDA receptor current as follows (mean±SD, n=5–6 oocytes each): CO2+H+ (51±5%), CO2+isoflurane (54±5%), H++isoflurane (51±3%), CO2+ketamine (67±8%), H++ketamine (64±2%). Conclusions In contrast to our hypothesis, NMDA receptor inhibition by CO2 and isoflurane is additive. Possibly, CO2 acidification modulates a pH-sensitive loop on the NMDA receptor that in turn alters glycine binding affinity on the GluN1 subunit. However, ketamine plus either CO2 or H+ synergistically inhibits NMDA receptor currents. Drugs acting via different mechanisms can thus exhibit additive or synergistic receptor effects. Additivity may not robustly indicate commonality between molecular anesthetic mechanisms.

Brosnan, Robert J.; Pham, Trung L.

2011-01-01

358

Neuroendoscopical management of intracranial lesions: application of endovascular stent for cystoventriculostomy (New Technique)  

PubMed Central

Abstract: Background: Neuroendoscopic system is the best choice for detection and assessment of intracranial cysts and intraventricular tumors and cysts. There are some reasons and features for neuroendoscopy to be the number-one option for these dysfunctions such as entrapment of cerebrospinal fluid (CSF) inside the arachnoid cysts, location of intraventricular tumors within the CSF, and generally any ventricular enlargement because of CSF pathway obstruction. These features provide optimal space for visualization and working by neuroendoscopy. However, in the context of recent technologies such as robotic assisted neuroendoscopy and frameless stereotactic based neuroendoscopy, the ventricular enlargement is no longer an essential prerequisite for neuroendoscopy practice. This study presents an overview of history and current advancement of neuroendoscopy as a safe and effective management modality for the treatment of a variety of intracranial disorders, its indications and limitations which underpin fundamental basis of modern neurosurgery. Furthermore, we present our new technique for the treatment of intracranial arachnoid cyst using endovascular stent for patency maintenance of opening pathway. Keywords: Neuroendoscopy, Arachnoid cyst, Endoscope, Intraventricular lesions, Endovascular stent

Ghorbani, Mohammad; Ramak Hashemi, Mahmoud; Mollahosseini, Reza; Azar, Maziar

2012-01-01

359

Surgical management of brainstem cavernomas: selection of approaches and microsurgical techniques.  

PubMed

This study reviewed surgical experience with brainstem cavernomas in an attempt to define optimal surgical approaches and risks associated with surgical management. Clinical courses were retrospectively reviewed for 36 consecutive patients (12 men, 24 women; mean age, 42 years) who underwent microsurgical resection of brainstem cavernomas between 1996 and 2006. Medical records, surgical records, and neuroimaging examinations were evaluated. All 36 patients presented with > or =1 hemorrhage from the cavernomas and preoperatively displayed some neurological symptoms. Surgical approach was midline suboccipital for 16 pontine and/or medullary cavernomas under the floor of the fourth ventricle, retrosigmoid for 10 lateral mesencephalic, pontine, and/or medullary cavernomas, occipital transtentorial for 2 thalamomesencephalic and 3 mesencephalic cavernomas, combined petrosal for 2 pontine cavernomas, and other for 3 cavernomas. Complete resection according to postoperative magnetic resonance imaging was achieved in 33 of 36 patients. No mortality was encountered in this study. New neurological deficit occurred in the early postoperative period for 18 patients, but was transient in 15 of these. Neurological state as of final follow-up was improved in 16 patients (44%), unchanged in 17 (47%), and worsened in 3 (8%) compared with preoperatively. In conclusion, symptomatic brainstem cavernomas should be considered for surgical treatment. Careful selection of the optimal operative approach and a meticulous microsurgical technique are mandatory. PMID:20358241

Ohue, Shiro; Fukushima, Takanori; Kumon, Yoshiaki; Ohnishi, Takanori; Friedman, Allan H

2010-07-01

360

Prioritization of water management for sustainability using hydrologic simulation model and multicriteria decision making techniques.  

PubMed

The objective of this study is to develop an alternative evaluation index (AEI) in order to determine the priorities of a range of alternatives using both the hydrological simulation program in FORTRAN (HSPF) and multicriteria decision making (MCDM) techniques. In order to formulate the HSPF model, sensitivity analyses of water quantity (peak discharge and total volume) and quality (BOD peak concentrations and total loads) are conducted and a number of critical parameters were selected. To achieve a more precise simulation, the study watershed is divided into four regions for calibration and verification according to landuse, location, slope, and climate data. All evaluation criteria were selected using the Driver-Pressure-State-Impact-Response (DPSIR) model, a sustainability evaluation concept. The Analytic Hierarchy Process is used to estimate the weights of the criteria and the effects of water quantity and quality were quantified by HSPF simulation. In addition, AEIs that reflected residents' preferences for management objectives are proposed in order to induce the stakeholder to participate in the decision making process. PMID:19062153

Chung, Eun-Sung; Lee, Kil Seong

2009-03-01

361

Geophysical techniques for the Radioactive Waste Management Complex Subsurface Disposal Area  

SciTech Connect

During the early years of the Idaho National Engineering Laboratory (INEL), 1954 through 1970, approximately two million cubic feet of transuranic (TRU) waste, principally consisting of plutonium-contaminated materials, was buried in the Subsurface Disposal Area (SDA) of the Radioactive Waste Management Complex (RWMC). This waste was later found to also contain various solvents such as carbon tetrachloride. Since 1970 the TRU waste received at the RWMC has been retrievably stored on above-grade asphalt pads at the Transuranic Storage Area (TSA) adjacent to the SDA. This report uses literature searches, discussions with experts, and trips to developmental facilities to compare various geophysical methods. The methods evaluated include resistivity, electromagnetic induction (EM), ground penetrating radar (GPR), seismic, magnetics, gravity, radioactivity, shallo-temperature surveys, muon/borehole tomography, thermal infrared, and geothermometry. The study determined that the most promising methods for satisfying the SDA/RWMC objectives are GPR, resistivity or EM, magnetics, and some form of borehole profiling. These techniques are described in Section 2.0. Brief descriptions of methods that were determined to be inadequate for SDA use are given in Appendix A. 32 refs., 9 figs., 3 tabs.

Brown, R.M.; Quintana, B.J.

1988-11-01

362

The minimum alveolar anesthetic concentration of 2-, 3-, and 4-alcohols and ketones in rats: relevance to anesthetic mechanisms.  

PubMed

The Meyer-Overton hypothesis predicts that anesthetic potency correlates inversely with lipophilicity; e.g., MAC times the olive oil/gas partition coefficient equals a constant of approximately 1.82 +/- 0.56 atm (mean +/- sd) for conventional inhaled anesthetics. MAC is the minimum alveolar concentration of anesthetic required to eliminate movement in response to a noxious stimulus in 50% of subjects. In contrast to conventional inhaled anesthetics, MAC times the olive oil/gas partition coefficient for normal alcohols from methanol through octanol equals a constant one tenth as large as that for conventional inhaled anesthetics. The alcohol (C-OH) group causes a great affinity of alcohols to water, and the C-OH may tether the alcohol at the hydrophobic-hydrophilic interface where anesthetics are thought to act. We hypothesized that the position of the C-OH group determined potency, perhaps by governing the maximum extent to which the acyl portion of the molecule might extend into a hydrophobic phase. Using the same reasoning, we added studies of ketones with similar numbers of carbon atoms between the C=O group and the terminal methyl group. The results for both alcohols and ketones showed the predicted correlation, but the correlation was no better than that with carbon chain length regardless of the placement of the oxygen. The oil/gas partition coefficient predicted potency as well as, or better than, either chain length or oxygen placement. Hydrophilicity, as indicated by the saline/gas partition coefficient, also seemed to influence potency. PMID:16632820

Won, Albert; Oh, Irene; Liao, Mark; Sonner, James M; Harris, R Adron; Laster, Michael J; Brosnan, Robert; Trudell, James R; Eger, Edmond I

2006-05-01

363

Comparison of Three Anesthetics for Chinchilla.  

National Technical Information Service (NTIS)

Anesthesia techniques which successfully induce surgical anesthesia in Chinchilla villidera are described and compared. Two injectables, ketamine-acepromazine and ketamine-xylazine, are compared to halothane-nitrous oxide administered by mask only and the...

C. E. Hargett C. S. Landon I. M. Gautier I. W. McConnell M. Carrier

1988-01-01

364

75 FR 39032 - Anesthetic and Life Support Drugs Advisory Committee; Notice of Meeting  

Federal Register 2010, 2011, 2012, 2013

...Drug Administration [Docket No. FDA-2010-N-0001] Anesthetic and Life Support Drugs Advisory Committee; Notice of Meeting...The meeting will be open to the public. Name of Committee: Anesthetic and Life Support Drugs Advisory Committee. General...

2010-07-07

365

Investigation of Network Enterprise Risk Management Techniques to Support Military Net-Centric Operations.  

National Technical Information Service (NTIS)

System security and information assurance requirements and specifications incorporated into the architectural design of a network enterprise must be driven by an adaptable and evolving network enterprise risk management plan. Network Risk Management must ...

J. F. Teply

2009-01-01

366

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

ERIC Educational Resources Information Center

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

Babu, Rakesh; Singh, Rahul

2013-01-01

367

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve.  

PubMed

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant. PMID:24814928

Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio

2014-07-01

368

Selection and application of risk management tools and techniques for build-operate-transfer projects  

Microsoft Academic Search

Construction projects are risky. However, the characteristics of the risk highly depend on the type of procurement being adopted for managing the project. A build-operate-transfer (BOT) project is recognized as one of the most risky project schemes. There are instances of project failure where a BOT scheme was employed. Ineffective rts are increasingly being managed using various risk management tools

Prasanta Kumar Dey; Stephen O. Ogunlana

2004-01-01

369

Performance Analysis of Management Techniques for SONET/SDH Telecommunications Networks.  

National Technical Information Service (NTIS)

The performance of network management tools for SONET/SDH networks subject to the load conditions is studied and discussed in this thesis. Specifically, a SONET network which consists of four CISCO ONS 15454s, managed by a CISCO Transport Manager, is set ...

H. P. Ng

2005-01-01

370

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

NASA Technical Reports Server (NTRS)

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

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

1998-01-01

371

Anesthetic experience using total intra-venous anesthesia for a patient with Wolf-Hirschhorn syndrome -A case report-  

PubMed Central

We present here the case of a 33-month-old male patient with Wolf-Hirschhorn syndrome (WHS) and who underwent tympanoplasty and myringotomy. WHS is caused by a rare chromosomal abnormality, which is the deletion of the short arm of chromosome number 4. The typical craniofacial features of WHS patients such as micrognathia, microcephaly and the muscular weakness can make using neuromuscular blocking agents and performing intubation difficult. Moreover, there are a few previous case reports showing that malignant hyperthermia occurred during and after an operation in which the anesthesia was done with inhalation agents, so special anesthetic care is needed when operating on a WHS patient. By carefully intubating the patient and using total intravenous anesthesia, we performed successful anesthesia without any complications. We describe here the anesthetic management of a WHS patient and we review the relevant literature.

Choi, Jae Ho; Park, Young Cheol; Kim, Woon Young; Lee, Yoon-Sook

2011-01-01

372

Limbic System Participates in Mediating the Effects of General Anesthetics  

Microsoft Academic Search

In a previous study, we reported that inactivation of the medial septum or the hippocampus by muscimol, a GABAA receptor agonist, potentiated the effects of a general anesthetic. In this study, we further investigated whether other structures that are connected to the septohippocampal system are involved in mediating general anesthesia. In freely behaving rats, muscimol (0.25 ?g) or saline was

Jingyi Ma; L Stan Leung

2006-01-01

373

Theories of the Mechanism of Action of Inhalation Anesthetics.  

National Technical Information Service (NTIS)

Multiple theories have been formulated to explain the mechanism of action of inhalation anesthetics. The literature has been reviewed from the introduction of ether anesthesia in 1846 up to the present date. A concise table of theories has been compiled f...

C. Petty

1969-01-01

374

Differential General Anesthetic Effects on Microglial Cytokine Expression  

PubMed Central

Post-operative cognitive dysfunction has been widely observed, especially in older patients. An association of post-operative cognitive dysfunction with the neurodegenerative diseases, such as Alzheimer's disease, has been suggested. Neuroinflammation contributes to Alzheimer pathology, through elevated pro-inflammatory cytokines and microglial activation in the CNS leading to neuronal damage, synaptic disruption and ultimately cognitive dysfunction. We compare the effects of three different, clinically-used, anesthetics on microglial activation with, and without, the prototypical inflammatory trigger, lipopolysaccharide (LPS). Microglial BV-2 cell cultures were first exposed to isoflurane, sevoflurane (each at 2 concentrations) or propofol for 6 h, and cytokine levels measured in lysates and media. The same experiments were repeated after 1 h LPS pre-treatment. We found; 1) anesthetics alone have either no or only a small effect on cytokine expression; 2) LPS provoked a large increase in microglia cytokine expression; 3) the inhaled anesthetics either had no effect on LPS-evoked responses or enhanced it; 4) propofol nearly eliminated the LPS pro-inflammatory cytokine response and improved cell survival as reflected by lactate dehydrogenase release. These data suggest that propofol may be a preferred anesthetic when it is desirable to minimize neuroinflammation.

Ye, Xuefei; Lian, Qingquan; Eckenhoff, Maryellen F.; Eckenhoff, Roderic G.; Pan, Jonathan Z.

2013-01-01

375

Differential general anesthetic effects on microglial cytokine expression.  

PubMed

Post-operative cognitive dysfunction has been widely observed, especially in older patients. An association of post-operative cognitive dysfunction with the neurodegenerative diseases, such as Alzheimer's disease, has been suggested. Neuroinflammation contributes to Alzheimer pathology, through elevated pro-inflammatory cytokines and microglial activation in the CNS leading to neuronal damage, synaptic disruption and ultimately cognitive dysfunction. We compare the effects of three different, clinically-used, anesthetics on microglial activation with, and without, the prototypical inflammatory trigger, lipopolysaccharide (LPS). Microglial BV-2 cell cultures were first exposed to isoflurane, sevoflurane (each at 2 concentrations) or propofol for 6 h, and cytokine levels measured in lysates and media. The same experiments were repeated after 1 h LPS pre-treatment. We found; 1) anesthetics alone have either no or only a small effect on cytokine expression; 2) LPS provoked a large increase in microglia cytokine expression; 3) the inhaled anesthetics either had no effect on LPS-evoked responses or enhanced it; 4) propofol nearly eliminated the LPS pro-inflammatory cytokine response and improved cell survival as reflected by lactate dehydrogenase release. These data suggest that propofol may be a preferred anesthetic when it is desirable to minimize neuroinflammation. PMID:23382826

Ye, Xuefei; Lian, Qingquan; Eckenhoff, Maryellen F; Eckenhoff, Roderic G; Pan, Jonathan Z

2013-01-01

376

Anesthetic effect of 4-styrylpyridine on lamprey and fish  

USGS Publications Warehouse

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

Howell, John H.; Thomas, Paul M.

1964-01-01

377

'Butamben, a specific local anesthetic and aspecific ion channel modulator'  

Microsoft Academic Search

Butamben is a local anesthetic with some unusual characteristics. Epidural application in the form of a suspension leads to long-term selective pain suppression, leaving the motor system intact. The mechanism behind this selective behavior is not understood. In order to see whether this selectivity can be traced back to a selective action on ion channels, the effect of butamben was

Jeroen Petrus Beekwilder

2008-01-01

378

Intrathecal local anesthetic distribution with the new Spinocath catheter  

Microsoft Academic Search

Background and Objectives. Microcatheters have been linked in some cases to the development of cauda equina syndrome, which may be further traced to the maldistribution of the local anesthetic. A long injection time via the microcatheters contributes to the inadequate mixing. With the new Spinocath catheter, considerably shorter injection times can be achieved due to larger internal size. This study

Dietmar Holst; Michael Möllmann; Eberhard Scheuch; Konrad Meissner; Michael Wendt

1998-01-01

379

Cardioprotection with Volatile Anesthetics: Mechanisms and Clinical Implications  

Microsoft Academic Search

Cardiac surgery and some noncardiac procedures are associated with a significant risk of perioperative car- diac morbid events. Experimental data indicate that clinical concentrations of volatile general anesthetics protectthemyocardiumfromischemiaandreperfusion injury, as shown by decreased infarct size and a more rapid recovery of contractile function on reperfusion. Theseanestheticsmayalsomediateprotectiveeffectsin

Stefan G. De Hert; Franco Turani; Sanjiv Mathur; David F. Stowe

2005-01-01

380

Isoflurane Waste Anesthetic Gas Concentrations Associated with the Open-Drop Method  

PubMed Central

The open-drop technique is used frequently for anesthetic delivery to small rodents. Operator exposure to waste anesthetic gas (WAG) is a potential occupational hazard if this method is used without WAG scavenging. This study was conducted to determine whether administration of isoflurane by the open-drop technique without exposure controls generates significant WAG concentrations. We placed 0.1, 0.2, or 0.3 ml of liquid isoflurane into screw-top 500 or 1000 ml glass jars. WAG concentration was measured at the opening of the container and 20 and 40 cm from the opening, a distance at which users likely would operate, at 1, 2, or 3 min WAG was measured by using a portable infrared gas analyzer. Mean WAG concentrations at the vessel opening were as high as 662 ± 168 ppm with a 500 ml jar and 122 ± 87 ppm with a 1000 ml jar. At operator levels, WAG concentrations were always at or near 0 ppm. For measurements made at the vessel opening, time was the only factor that significantly affected WAG concentration when using the 500 ml jar. Neither time nor liquid volume were significant factors when using 1000 ml jar. At all liquid volumes and time points, the WAG concentration associated with using the 500 ml container was marginally to significantly greater than that for the 1000 ml jar.

Taylor, Douglas K; Mook, Deborah M

2009-01-01

381

Using palaeoecological techniques to inform contemporary hydrological management of a peatland  

NASA Astrophysics Data System (ADS)

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

Blundell, Antony; Holden, Joseph

2014-05-01

382

Assessing the local anesthetic effect of five essential oil constituents.  

PubMed

We studied the effects of five monoterpenoids, viz. 1,8-cineole, fenchone, linalool, p-cymene and ?-pinene, on the sciatic nerve fibers of the frog Rana ridibunda (Pallas, 1771) and compared them to that of lidocaine, a standard local anesthetic. The isolated sciatic nerve, with its perineurium intact, was placed in a three-chambered recording bath, which allowed us to monitor the compound action potentials (CAP), stable in amplitude, for over 2 days. The half-vitality time (IT(50)), which is the time required for the amplitude of the CAP to decrease to 50% of its control value, was 53.5 ± 0.9 h for a nerve incubated in normal saline at 26.0 °C. The IT(50) values for nerves incubated in saline with p-cymene, 1,8-cineole, or ?-pinene, at 30.0 mM, were 19.9 ± 0.4, 32.9 ± 0.5, and 31.0 ± 0.3 hours, respectively. As the IT(50) value for 30.0 mM lidocaine, a standard local anesthetic, was 1.6 ± 0.3 min under the same conditions, these three compounds cannot be considered as having a local anesthetic effect. The IT(50) values for 30.0 mM linalool and fenchone were 5.7 ± 0.6 and 15.4 ± 1.1 min, respectively; they were significantly, but not markedly different from the respective value for lidocaine. These results combined with the fast inhibition of the CAP and its fast recovery after the removal of either linalool or fenchone indicate a local anesthetic activity of the two compounds. Linalool retained this activity even at lower concentrations of 15.0 and 7.5 mM. The local anesthetic effects of lidocaine and linalool were concentration-dependent; this was not the case for fenchone, which had a relatively strong local anesthetic activity at 30.0 mM, but was entirely inactive at 25.0 mM. On the basis of the effects of the five monoterpenoids on the electrophysiological properties of the sciatic nerve fibers of the frog, we conclude that, whereas 1,8-cineole, p-cymene and ?-pinene cause only minor effects, linalool and fenchone exhibit acute local anesthetic activity. PMID:20506076

Zalachoras, Ioannis; Kagiava, Alexia; Vokou, Despoina; Theophilidis, George

2010-10-01

383

Are One or Two Dangerous? Lidocaine and Topical Anesthetic Exposures in Children  

Microsoft Academic Search

Topical anesthetics are found in a variety of prescription and non-prescription preparations, from teething gels to hemorrhoid creams. In 2003, there were 8576 exposures to local\\/topical anesthetics reported to the American Association of Poison Control Centers, with 67% of cases in the age group younger than 6 years old. This report reviews the available literature involving topical anesthetic exposures in

Liesl A. Curtis; Teresa Sullivan Dolan; H. Edward Seibert

2009-01-01

384

Flushing induction chambers used for rodent anesthesia to reduce waste anesthetic gas  

Microsoft Academic Search

Anesthetic induction chambers used for medical research are a substantial source of waste anesthetic gas (WAG). Ideally, any generated waste gas should be actively vented away from personnel operating the chamber by either a ventilated hood or snorkel. Unfortunately, the ideal environment for anesthetizing rodents is not always available. In an effort to create a safer environment, the authors designed

Janet Wolforth; Melissa C. Dyson

2011-01-01

385

Advanced InSAR techniques for the management and characterization of geothermal resources  

NASA Astrophysics Data System (ADS)

InSAR is a remote sensing tool that has applications in both geothermal exploitation and in the management of producing fields. The technique has developed rapidly in recent years and the most evolved algorithms, now capable of providing precise ground movement measurements with unprecedented spatial density over large areas, allow the monitoring of the effects of fluid injection and extraction on surface deformation and the detection of active faults. Multi-interferogram approaches have been used at several geothermal sites in different stages of development. SqueeSAR™, which represents the latest breakthrough in InSAR technology, provides a significant increase in the spatial density of measurement points by exploiting signal returns from both point-like and distributed scatterers. Furthermore, recent satellite radar sensors have a higher spatial resolution (down to 1 m), as well as a higher temporal frequency of image acquisitions (down to a few days). The coupling of the new algorithm with this new generation of satellites provides a valuable tool for monitoring the different phases of geothermal production and in support of the decision making process. Some examples from the US are presented here: the first case study involves the use of InSAR within a suite of tools for exploration of the San Emidio geothermal field in Nevada. This project aimed to develop geophysical techniques to identify and map large aperture fractures for the placement of new production/exploration wells. The second and third examples examine two zones in California: the Salton Sea area, where multi-interferogram InSAR provided an overview of surface deformation at a producing geothermal reservoir. Surface deformation in this area was complex, and the added detail provided insight into the interplay of tectonics and production activities. Additional InSAR studies have also been carried out at the Geysers field in order to evaluate the behavior of an Enhanced Geothermal System (EGS) in response to high rates of water injection, with a strong interest in researching induced seismicity and ground deformation. These studies, along with the continuing developments in radar satellite technology and in the field of InSAR, show considerable promise for the future monitoring of geothermal production facilities.

Bellotti, F.; Falorni, G.; Morgan, J.; Rucci, A.; Ferretti, A.

2012-04-01

386

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

SciTech Connect

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

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

2007-03-15

387

Sensor failure detection and management scheme for pressure probes using Kalman filtering technique  

NASA Astrophysics Data System (ADS)

For high performance, high angle of attack fighter aircraft, accurate and high fidelity airdata parameters are crucial for the flight control system. At high angle of attack, where small changes in angle of attack can greatly influence aerodynamic properties of the aircraft, the problem of flight control augmentation is extremely complicated. In this flight regime, it is critical that accurate measurements of airdata parameters including angle of attack, angle of sideslip and dynamic pressure are made available for use by the flight augmentation system. But at high angle of attack, it is difficult to measure airdata accurately using conventional intrusive sensing devices, because of upstream vortices and flow separation. To overcome this difficulty, a non-intrusive Flush Airdata Sensing system (FADS) has been developed. The FADS is a simple hardware item with the basic fixture being a hemispherical or conical cap mounted at the nose of the fuselage. A number of small holes are drilled around the cap in annular rings. The pressure at each hole is measured by pressure transducers and related to airdata parameters by a non-linear aerodynamic model derived from potential flow. A 7-hole pressure probe, proposed by the DLR for implementation on an advanced experimental fighter aircraft for airdata measurements at high angle of attack, has redundant measurements in angle of attack, angle of side slip and dynamic pressure to ensure control system augmentation at high angle of attack, in spite of some pressure sensor failure or malfunctioning. Such a system requires an algorithm which detects pressure sensor failure and performs fault management in real time. In this report, a concept for an algorithm using a recursive Kalman filtering technique has been proposed and developed. The algorithm is tested on a 5 hole pressure probe which is used in experimental flights of C-160 Transall aircraft.

Kumar, N. Shantha

1995-06-01

388

Refinements in the technique of 'awake' electrical nerve stimulation in the management of chronic low ulnar nerve injuries.  

PubMed

The standard technique in the management of chronic low ulnar nerve injuries includes excision of the neuroma and reconstruction using sural nerve grafts in the fully anaesthetised patient. It has been shown that using this standard technique, disappointing results may be observed and that significant improvement in results could be obtained if intra-operative matching of sensory and motor fascicles is performed. This study reports on eight patients with chronic ulnar nerve injuries managed using the technique of electrical fascicular orientation and sural nerve grafting. In all patients, intra-operative electrical stimulation of the fascicles in the proximal stump was done in the awake state. Several refinements in technique are described including detailing pre-operative patient education, anaesthetic considerations and in the technique of nerve dissection. Assessment was done using a sensory grading system mainly based on static two-point discrimination and a motor grading system based on intrinsic muscle function and key pinch power. At final follow up satisfactory sensory (S3+ or S4) and motor (M3 or M4) recovery was obtained in almost all cases. It was concluded that intra-operative electrical fascicular orientation was reliable and that our refinements in the technique ensured better communication with the patient during surgery, resulted in a smoother awakening without apprehension, and provided an easier nerve dissection with preservation of the blood supply of the distal nerve segment. PMID:15488501

Al-Qattan, M M

2004-11-01

389

Vasopressin: Its current role in anesthetic practice  

PubMed Central

Vasopressin or antidiuretic hormone is a potent endogenous hormone, which is responsible for regulating plasma osmolality and volume. In high concentrations, it also raises blood pressure by inducing moderate vasoconstriction. It acts as a neurotransmitter in the brain to control circadian rhythm, thermoregulation and adrenocorticotropic hormone release. The therapeutic use of vasopressin has become increasingly important in the critical care environment in the management of cranial diabetes insipidus, bleeding abnormalities, esophageal variceal hemorrhage, asystolic cardiac arrest and septic shock. After 10 years of ongoing research, vasopressin has grown to a potential component as a vasopressor agent of the anesthesiologist's armamentarium in the treatment of cardiac arrest and severe shock states.

Mitra, Jayanta K.; Roy, Jayeeta; Sengupta, Saikat

2011-01-01

390

Solid waste management in European countries: a review of systems analysis techniques.  

PubMed

In the past few decades, solid waste management systems in Europe have involved complex and multi-faceted trade-offs among a plethora of technological alternatives, economic instruments, and regulatory frameworks. These changes resulted in various environmental, economic, social, and regulatory impacts in waste management practices which not only complicate regional policy analysis, but also reshape the paradigm of global sustainable development. Systems analysis, a discipline that harmonizes these integrated solid waste management strategies, has been uniquely providing interdisciplinary support for decision making in this area. Systems engineering models and system assessment tools, both of which enrich the analytical framework of waste management, were designed specifically to handle particular types of problems. Though how to smooth out the barriers toward achieving appropriate systems synthesis and integration of these models and tools to aid in the solid waste management schemes prevalent in European countries still remains somewhat uncertain. This paper conducts a thorough literature review of models and tools illuminating possible overlapped boundaries in waste management practices in European countries and encompassing the pros and cons of waste management practices in each member state of the European Union. Whereas the Southern European Union (EU) countries need to develop further measures to implement more integrated solid waste management and reach EU directives, the Central EU countries need models and tools with which to rationalize their technological choices and management strategies. Nevertheless, considering systems analysis models and tools in a synergistic way would certainly provide opportunities to develop better solid waste management strategies leading to conformity with current standards and foster future perspectives for both the waste management industry and government agencies in European Union. PMID:21194829

Pires, Ana; Martinho, Graça; Chang, Ni-Bin

2011-04-01

391

Management by Objectives. Module Number Three of Policy/Program Analysis and Evaluation Techniques, Package VI.  

ERIC Educational Resources Information Center

This packet contains the materials necessary for presentation of the third of ten modules that comprise a portion of the National Training and Development Service Urban Management Curriculum Development Project. The management by objectives module presents a framework for identifying, integrating, monitoring, and evaluating the goals and…

Zody, Richard E.

392

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

ERIC Educational Resources Information Center

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

New Mexico Research and Study Council, Albuquerque.

393

Local anesthetic and negative chronotropic effects of diltiazem on canine cardiac Purkinje fibers.  

PubMed

The electrophysiologic effects of diltiazem, a drug with antianginal, antihypertensive, and antiarrhythmic actions, were studied on transmembrane action potentials recorded from isolated canine cardiac tissues by means of standard microelectrode techniques. Recordings were made from normal canine cardiac Purkinje fibers in major false tendons, from normal Purkinje fibers partially depolarized by treatment with Tyrode's solution containing 7 mmol/L potassium chloride, from subendocardial Purkinje fibers of the left ventricle of normal hearts, and from subendocardial ventricular muscle preparations. Diltiazem, 1 and 2 mumol/L, exerted local anesthetic effects and decreased the action potential plateau duration in normal Purkinje fibers. In contrast, diltiazem, 1 mumol/L, did not affect the action potentials of potassium-depolarized Purkinje fibers, subendocardial Purkinje fibers, or ventricular muscle cells. Diltiazem, 1 and 2 mumol/L, did not decrease normal or high potential automaticity or catecholamine-enhanced high potential automaticity in canine Purkinje fibers with maximum diastolic potentials greater than -80 mV. In contrast, diltiazem, 1 mumol/L, rapidly terminated low potential automaticity in barium-treated Purkinje fibers with maximum diastolic potentials of -40 to -60 mV. The local anesthetic effects of diltiazem, as well as the effect on low potential automaticity, can explain the antiarrhythmic effects of the drug. PMID:2729055

Dangman, K H; Ziam, S; Miura, D S

1989-06-01

394

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

PubMed

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

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

2006-06-01

395

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

Microsoft Academic Search

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

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

1996-01-01

396

Posterior Sternoclavicular Dislocations: A Brief Review and Technique for Closed Management of a Rare But Serious Injury  

PubMed Central

Posterior sternoclavicular dislocations are rare but serious injuries. The proximity of the medial clavicle to the vital structures of the mediastinum warrants caution with management of the injury. Radiographs are the initial imaging test, though computed tomography and magnetic resonance imaging are essential for diagnosis and preoperative planning. This paper presents an efficient diagnostic approach and effective technique of closed reduction of posterior sternoclavicular dislocations with a brief review of open and closed reduction procedures.

Deren, Matthew E.; Behrens, Steve B.; Vopat, Bryan G.; Blaine, Theodore A.

2014-01-01

397

Effect of certain anesthetic agents on mallard ducks  

USGS Publications Warehouse

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.

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

1972-01-01

398

[Ocular side effects of added sympathomimetics in local anesthetics].  

PubMed

In facial dermatosurgery, the addition of sympathomimetics to local anesthetics produces a desirable topical effect as they provide an almost bloodless operation field due to temporary vasoconstriction. In an 87-year-old woman, who had lost her left sight owing to a meningoma, we removed a basal-cell carcinoma from the right side of her nose. The local anesthetic applied contained noradrenaline at a concentration of 1:50,000. After the operation, the patient complained of a headache and a transitory loss of sight. We suppose that noradrenaline reached the arteria centralis retinae via arterial periorbital anastomoses, thus causing a vasoconstriction of this artery. As far as dermatosurgery of the middle and upper face is concerned, patients with severe vision disorders should be considered as a risk group; in local anesthesia of those patients an addition of sympathomimetics should be avoided. PMID:2389592

Häberle, M; Fischer, H

1990-06-01

399

Local Anesthetic Inhibits Hyperpolarization-Activated Cationic Currents  

PubMed Central

Systemic administration of local anesthetics has beneficial perioperative properties and an anesthetic-sparing and antiarrhythmic effect, although the detailed mechanisms of these actions remain unclear. In the present study, we investigated the effects of a local anesthetic, lidocaine, on hyperpolarization-activated and cyclic nucleotide-gated (HCN) channels that contribute to the pacemaker currents in rhythmically oscillating cells of the heart and brain. Voltage-clamp recordings were used to examine the properties of cloned HCN subunit currents expressed in Xenopus laevis oocytes and human embryonic kidney (HEK) 293 cells under control condition and lidocaine administration. Lidocaine inhibited HCN1, HCN2, HCN1-HCN2, and HCN4 channel currents at 100 ?M in both oocytes and/or HEK 293 cells; it caused a decrease in both tonic and maximal current (?30–50% inhibition) and slowed current activation kinetics for all subunits. In addition, lidocaine evoked a hyperpolarizing shift in half-activation voltage (?V1/2 of ??10 to ?14 mV), but only for HCN1 and HCN1-HCN2 channels. By fitting concentration-response data to logistic functions, we estimated half-maximal (EC50) concentrations of lidocaine of ?30 to 40 ?M for the shift in V1/2 observed with HCN1 and HCN1-HCN2; for inhibition of current amplitude, calculated EC50 values were ?50 to 70 ?M for HCN1, HCN2, and HCN1-HCN2 channels. A lidocaine metabolite, monoethylglycinexylidide (100 ?M), had similar inhibitory actions on HCN channels. These results indicate that lidocaine potently inhibits HCN channel subunits in dose-dependent manner over a concentration range relevant for systemic application. The ability of local anesthetics to modulate Ih in central neurons may contribute to central nervous system depression, whereas effects on If in cardiac pacemaker cells may contribute to the antiarrhythmic and/or cardiovascular toxic action.

Meng, Qing-tao; Xia, Zhong-yuan; Liu, Jin; Bayliss, Douglas A.

2011-01-01

400

Study of the polymorphic behaviour of some local anesthetic drugs  

Microsoft Academic Search

The local anesthetic drug tetracaine hydrochloride is described in the Europ. Pharmacopea with a melting point of 148°C or\\u000a with a range of 134 to 147°C due to the melting points of two other forms. The polymorphic behaviour of tetracaine hydrochloride\\u000a has been studied by using thermal treatments, storage at 92% r.h., crystallizations and equilibrations with saturated solutions.\\u000a Samples were

D. Giron; M. Draghi; C. Goldbronn; S. Pfeffer; P. Piechon

1997-01-01

401

[Perioperative management for esophagectomy].  

PubMed

Esophagetomy is considered as one of the most invasive surgical procedures. Despite marked advances in surgical techniques, anesthetic management and intensive care, the morbidity and mortality remain still high compared with the other types of surgery. Excessive inflammatory response after surgery induces over-production of inflammatory cytokines, leading to the development of vital organ failures. Anesthesiologists should pay much attention to perioperative management of patients undergoing esophagectomy since they are potentially at high risks of respiratory and cardiovascular complications caused by excessive stress with cervical, thoracic and abdominal procedures. During surgery, many interventions such as effective epidural anesthesia, restrictive fluid management, lung protective strategy, maintenance of hemodynamic stability and steroid therapy should be considered. Perioperative respiratory management including early extubation, intensive physical therapy, early mobilization and rehabilitation with enteral nutrition are all important to prevent postoperative complications and to shorten the length of hospital stay. However, some patients need longer-term mechanical ventilation due to preoperative respiratory dysfunction and reduced cough reflex by surgical manipulations. A multimodal treatment is warranted to improve the outcomes after esophagectomy. PMID:24864570

Suzuki, Takeshi; Morisaki, Hiroshi

2014-05-01

402

Traffic management techniques to face the effects of intrinsic delays in geostationary satellite networks  

Microsoft Academic Search

A new scheme for the management of real-time traffic over high-latency broadband satellite networks is described. Early studies on this topic have been reported by Iera, Molinaro and Marano (see IEEE J. Select Areas Commun.,, vol.18, p.2393-2403, 2000), with reference to an integrated terrestrial-satellite platform. In this paper, further enhancement is introduced into the traffic management scheme with a view

Antonio Iera; Antonella Molinaro; Salvatore Marano

2002-01-01

403

Promoting Public Transport Using Marketing Techniques in Mobility Management and Verifying their Quantitative Effects  

Microsoft Academic Search

Mobility management (MM) is a transportation management policy that uses “soft” measures to attempt to reduce car use and\\u000a promote sustainable transportation modes such as public transport, bicycles, and walking. Using communication and other means,\\u000a MM induces voluntarily change towards more sustainable transportation modes. We implemented MM marketing to promote an experimental\\u000a community bus service. This project had two components:

Ayako Taniguchi; Satoshi Fujii

2007-01-01

404

Interaction of local anesthetics with the K+ channel pore domain  

PubMed Central

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

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

2013-01-01

405

Effect of anesthetics on bending elasticity of lipid membranes  

NASA Astrophysics Data System (ADS)

Change in physical and chemical properties of bio-membranes is of great interest for understanding the mechanism of anesthetic action on membranes. Hypothetically the anesthetic alters the lipid membrane structure (promoting pore formation across membranes or at least switching transmembrane channels) and therefore the biophysical properties of the membrane. We have used neutron spin echo (NSE) spectroscopy to study the effect of anesthetic molecule, lidocaine, on the bending elasticity (BE) of lipid membranes. BE of lipid bilayers made of (1,2-Dimyristoyl-sn-Glycero-3-Phosphocholine) DMPC and 1,2-Dipalmitoyl-sn-Glycero-3-Phosphocholine (DPPC) have been measured at different temperatures and different in the fluid (L?) phase. Using Zilman-Granek theory the BE were obtained from the decay of the NSE intermediate scattering function. We have found that in the presence of lidocaine the BE of DMPC and DPPC bilayers increases. The results were correlated with those from differential scanning calorimetry. Increase in the lidocaine concentration leads to decrease in the liquid/crystalline transition temperature.

Yi, Zheng; Michihiro, Nagao; Bossev, Dobrin

2008-03-01

406

Interactions of anesthetics with the membrane-water interface  

NASA Astrophysics Data System (ADS)

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

Pohorille, Andrew; Cieplak, Piotr; Wilson, Michael A.

1996-04-01

407

Albumin extravasation rates in tissues of anesthetized and unanesthetized rats  

SciTech Connect

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

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

1989-05-01

408

Neuropathological Sequelae of Developmental Exposure to Antiepileptic and Anesthetic Drugs  

PubMed Central

Glutamate (Glu) and ?-aminobutyric acid (GABA) are major neurotransmitters in the mammalian brain which regulate brain development at molecular, cellular, and systems level. Sedative, anesthetic, and antiepileptic drugs (AEDs) interact with glutamate and GABA receptors to produce their desired effects. The question is posed whether such interference with glutamatergic and GABAergic neurotransmission may exert undesired, and perhaps even detrimental effects on human brain development. Preclinical research in rodents and non-human primates has provided extensive evidence that sedative, anesthetic, and AEDs can trigger suicide of neurons and oligodendroglia, suppress neurogenesis, and inhibit normal synapse development and sculpting. Behavioral correlates in rodents and non-human primates consist of long-lasting cognitive impairment. Retrospective clinical studies in humans exposed to anesthetics or AEDs in utero, during infancy or early childhood have delivered conflicting but concerning results in terms of a correlation between drug exposure and impaired neurodevelopmental outcomes. Prospective studies are currently ongoing. This review provides a short overview of the current state of knowledge on this topic.

Turski, Christopher Andreas; Ikonomidou, Chrysanthy

2012-01-01

409

Anesthetic drug development: Novel drugs and new approaches  

PubMed Central

The ideal sedative–hypnotic drug would be a rapidly titratable intravenous agent with a high therapeutic index and minimal side effects. The current efforts to develop such agents are primarily focused on modifying the structures of existing drugs to improve their pharmacodynamic and pharmacokinetic properties. Drugs currently under development using this rational design approach include analogues of midazolam, propofol, and etomidate, such as remimazolam, PF0713, and cyclopropyl methoxycarbonyl-etomidate (MOC-etomidate), respectively. An alternative approach involves the rapid screening of large libraries of molecules for activity in structural or phenotypic assays that approximate anesthetic and target receptor interactions. Such high-throughput screening offers the potential for identifying completely novel classes of drugs. Anesthetic drug development is experiencing a resurgence of interest because there are new demands on our clinical practice that can be met, at least in part, with better agents. The goal of this review is to provide the reader with a glimpse of the novel anesthetic drugs and new developmental approaches that lie on the horizon.

Chitilian, Hovig V.; Eckenhoff, Roderic G.; Raines, Douglas E.

2013-01-01

410

Interactions of anesthetics with the membrane-water interface  

NASA Technical Reports Server (NTRS)

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

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

1996-01-01

411

Management of the patient with a large anterior mediastinal mass: recurring myths  

Microsoft Academic Search

Purpose of review This editorial review summarizes the current anesthetic management of patients with anterior mediastinal masses. Recent findings With increased appreciation of the correct intraoperative management of these cases severe intraoperative respiratory or cardiovascular collapse is less likely to occur during general anesthesia. Maintenance of spontaneous ventilation is the anesthetic goal whenever possible. Major life-threatening complications now occur more

Peter Slinger; Cengiz Karsli

2007-01-01

412

Anesthetic Effectiveness of the Supplemental Intraligamentary Injection, Administered with a Computer-Controlled Local Anesthetic Delivery System, in Patients with Irreversible Pulpitis  

Microsoft Academic Search

The purpose of this study was to determine the anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Fifty-four emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had

John Nusstein; Elizabeth Claffey; Al Reader; Mike Beck; Joel Weaver

2005-01-01

413

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

Microsoft Academic Search

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

Koen Buyens; Bart De Win; Wouter Joosen

2007-01-01

414

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

PubMed Central

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

Singh, Jagmohan; Bharti, Vipin

2013-01-01

415

Relative potencies of volatile anesthetics in altering the kinetics of ion channels in BC3H1 cells.  

PubMed

Single channel recording techniques have been used to study effects of the volatile anesthetics enflurane, halothane, isoflurane and methoxyflurane, and the gaseous agent nitrous oxide, on the properties of nicotinic channels activated by acetylcholine. Single channel currents activated by 250 nM acetylcholine were recorded from cell-attached patches of BC3H1 mouse tumor cells grown in culture. All of the potent volatile agents shortened the duration of individual opening events and caused openings to appear grouped together in bursts. The slower time constant of channel open-time distributions was decreased 50% by approximately 0.22% enflurane (0.12 mM), 0.25% isoflurane (0.10 mM), 0.30% halothane (0.16 mM), 0.076% methoxyflurane (0.21 mM) or 80% nitrous oxide (20 mM) at room temperature. Even when values were corrected to 37 degrees C, the concentrations required to decrease channel open time are less than clinical dosages. Anesthetic potency in altering channel properties was directly related to both clinical potency and lipid solubility, although those agents with greater clinical potencies required relatively higher concentrations to reduce channel open time. Results are interpreted in terms of a simple sequential channel blocking model, a sequential blocking model in which anesthetics also enhance the rate at which open channels normally close, and a cyclic blocking model in which blocked channels may close directly without having to pass back through the open state. All of the agents appeared to act in a qualitatively similar fashion and no differences were found that could account for the differing clinical profiles of the volatile anesthetics. PMID:7562508

Wachtel, R E

1995-09-01

416

Characterization of In-Cylinder Techniques for Thermal Management of Diesel Aftertreatment.  

National Technical Information Service (NTIS)

One challenge in meeting emission regulations with catalytic aftertreatment systems is maintaining the proper catalyst temperatures that enable the catalytic devices to perform the emissions reduction. In this study, in-cylinder techniques are used to act...

J. E. Parks J. M. Storey M. D. Kass S. P. Huff

2007-01-01

417

Surgical Technique for Treatment of Recalcitrant Adductor Longus Tendinopathy  

PubMed Central

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

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

2014-01-01

418

Surgical technique for treatment of recalcitrant adductor longus tendinopathy.  

PubMed

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

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

2014-04-01

419

Time series analysis and forecasting techniques for municipal solid waste management  

Microsoft Academic Search

Successful planning and operation of a solid waste management system depends on municipal solid waste (MSW) generation process knowledge and on accurate predictions of solid waste quantities produced. Conventional analysis and prediction models are based on demographic and socioeconomic factors. However, this kind of analysis is related to mean generation data. Dynamic MSW generation analysis can be done using time

J. Navarro-Esbr??; E. Diamadopoulos; D. Ginestar

2002-01-01

420

Improving Student Understanding of Operations Management Techniques through a Rolling Reinforcement Strategy.  

ERIC Educational Resources Information Center

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…

Mukherjee, Arup

2002-01-01

421

Harnessing Your Projects: Using Project Management Techniques and Basecamp in Libraries  

Microsoft Academic Search

It seems that our libraries are in a constant state of change. We review the reference collection, move periodicals, renovate libraries, develop new website, and create tutorials. All of which represent change, all of which are projects, and all of which can be overwhelming if not managed properly. The main points of this webcast will be to help librarians understand

Barbara Lewis

2011-01-01

422

Managing Construction Operations Visually: 3-D Techniques for Complex Topography and Restricted Visibility  

ERIC Educational Resources Information Center

Visual information is vital in planning and managing construction operations, particularly, where there is complex terrain topography and salvage operations with limited accessibility and visibility. From visually-assessing site operations and preventing equipment collisions to simulating material handling activities to supervising remotes sites…

Rodriguez, Walter; Opdenbosh, Augusto; Santamaria, Juan Carlos

2006-01-01

423

Use of Case Study Methods in Human Resource Management, Development, and Training Courses: Strategies and Techniques  

ERIC Educational Resources Information Center

This paper will study some of the problems associated with case studies and make recommendations using standard and innovative methodologies effectively. Human resource management (HRM) and resource development cases provide context for analysis and decision-making designs in different industries. In most HRM development and training courses…

Maxwell, James R.; Gilberti, Anthony F.; Mupinga, Davison M.

2006-01-01

424

Geophysical techniques for the Radioactive Waste Management Complex Subsurface Disposal Area  

Microsoft Academic Search

During the early years of the Idaho National Engineering Laboratory (INEL), 1954 through 1970, approximately two million cubic feet of transuranic (TRU) waste, principally consisting of plutonium-contaminated materials, was buried in the Subsurface Disposal Area (SDA) of the Radioactive Waste Management Complex (RWMC). This waste was later found to also contain various solvents such as carbon tetrachloride. Since 1970 the

R. M. Brown; B. J. Quintana

1988-01-01

425

Strategies and Techniques: Reusable Artifacts for the Construction of Database Management Systems  

Microsoft Academic Search

Abstraction, selection, and integration of reusable artifacts are still open problems in re- use-based software construction. We investigate how these problems can be solved for one sample domain of system software: database management systems. We propose dimen- sions for functional subdomains where different design choices are to be made. Strategies are the design choices for dimensions; their application leads to

Andreas Geppert; Klaus R. Dittrich

1995-01-01

426

FINANCIAL ANALYSIS AND WORKING CAPITAL MANAGEMENT TECHNIQUES USED BY SMALL MANUFACTURERS: SURVEY AND ANALYSIS  

Microsoft Academic Search

This article summarized the responses of 103 small manufacturers to a mail questionnaire survey sent to the chief financial officer of 477 firms located in the southern region of the U.S. The major thrust of the paper was to provide insight into the importance of and utilization of financial analysis and working capital management concepts by small manufacturers. Findings from

Morris Lamberson

427

Activation and measurement of free whisking in the lightly anesthetized rodent.  

PubMed

The rodent vibrissa system is a widely used experimental model of active sensation and motor control. Vibrissa-based touch in rodents involves stereotypic, rhythmic sweeping of the vibrissae as the animal explores its environment. Although pharmacologically induced rhythmic movements have long been used to understand the neural circuitry that underlies a variety of rhythmic behaviors, including locomotion, digestion and ingestion, these techniques have not been available for active sensory movements such as whisking. However, recent work that delineated the location of the central pattern generator for whisking has enabled pharmac