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320 patients with primary hyperaldosteronism (Conn syndrome) were operated on. All patients had primary adrenal aldosteromas. Authors conclude that only about 10% of such patients require a long-term preoperative preparation with spironolactons, antihypertensive and potassium. The choice of general anesthetics and muscle relaxants does not influence the course of anesthesia, time of artificial lung ventilation and extubation. Authors emphasize that traditional and laparoscopic aldosteromectomy should not be opposed. A mini-invasive approach through the partly resected XI rib was used in 320 patients with neither postoperative major complications, nor lethality. PMID:19365382
Chernyshev, V N; Skladchikova, T Iu; Chernysheva, N I
High plasma levels of homocysteine are associated with an increased risk for thromboembolic events. Neuraxial anesthesia techniques may be relatively contra- indicated in anticoagulated patients, and nitrous oxide may exacerbate the condi- tion by inhibiting the conversion of homocysteine to methionine. We describe the anesthetic implications and management of a patient with hyperhomocysteinemia undergoing an nonemergent cesarean delivery. (Anesth Analg
German E. Luzardo; Rachel A. Karlnoski; Brooke Williams; Devanand Mangar; Enrico M. Camporesi
We describe the successful anestheticmanagement of a patient with stiff-person syndrome (SPS) undergoing a right inguinal hernia repair, using a somatic paravertebral block supplemented with conscious sedation. We also present the implications of general anesthesia in patients with SPS. The use of regional anesthetictechniques in patients with SPS has the advantage of avoiding exposure to muscle relaxants. The
Nabil Elkassabany; John E. Tetzlaff; Maged Argalious
Aplastic anemia is a rare heterogeneous disorder of hematopoietic stem cells causing pancytopenia and marrow hypoplasia with the depletion of all types of blood cells. This results in anemia, neutropenia and thrombocytopenia, which pose a challenge to both surgical and anestheticmanagement of such cases. We report a child with aplastic anemia who sustained traumatic ulcer on the arm and underwent split-thickness skin grafting under general anesthesia. There are only two case reports on anesthetic considerations in aplastic anemia patients in the literature. The anestheticmanagement is challenging because of the rarity of the disease, associated pancytopenia and immunosuppression.
Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anestheticmanagement of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the level of L2-L3. The anesthetic implications of the various aspects of spinocerebellar degeneration are discussed.
Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anestheticmanagement of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the level of L2-L3. The anesthetic implications of the various aspects of spinocerebellar degeneration are discussed. PMID:21772692
\\u000a As longevity increases for patients with spinal cord injuries (SCI), operative procedures are often necessary to further rehabilitation,\\u000a control pain, evaluate urinary dysfunction, maintain skin integrity and reverse further neurologic degeneration. Increasingly,\\u000a SCI women are completing pregnancies. Considerations for anestheticmanagement of patients with chronic SCI include avoiding\\u000a autonomic hyperreflexia and hyperkalemia-related to succinylcholine, preventing exacerbations of pulmonary dysfunction and
Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circulation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anestheticmanagement. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.
Zhou, Yang-feng; Zhu, Shao-jun; Zhu, Sheng-mei; An, Xiao-xia
Schwannomas are rare and slow-growing neurogenic tumors for which surgery is the standard of care. However, the anestheticmanagement of these tumors can be challenging. This case report describes the anestheticmanagement of a patient who underwent carotid endarterectomy and excision of a presumed carotid body tumor. Histopathologic examination showed that the excised tissue was a schwannoma, which in this location can mimic a carotid body tumor. The relevant literature is also reviewed.
Schwannomas are rare and slow-growing neurogenic tumors for which surgery is the standard of care. However, the anestheticmanagement of these tumors can be challenging. This case report describes the anestheticmanagement of a patient who underwent carotid endarterectomy and excision of a presumed carotid body tumor. Histopathologic examination showed that the excised tissue was a schwannoma, which in this location can mimic a carotid body tumor. The relevant literature is also reviewed. PMID:23754924
Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery. PMID:23972747
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
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.
A new technique to study the dynamics of in vivo distribution of regional anesthetics is described. Five hundred microcuries of technetium-99m diethylenetriaminepentaacetic acid (DTPA) added to the anesthetic in a syringe prior to injection allows both dynamic and static imaging to assess the initial distribution of the injected anesthetic. Superimposed bone scans or transmission scans help delineate anatomy. The radionuclide-anesthetic flow study is a simple, safe technique to investigate both the spread of regional anesthetics and the factors that affect it. PMID:3528416
Bauman, J M; Middaugh, R E; Cawthon, M A; Hartshorne, M F; Menk, E J; Baysinger, C
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 anestheticmanagement 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
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 anesthetictechnique 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 anestheticmanagement 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
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 anesthetictechnique 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 anestheticmanagement of a 51-year-old patient with Huntington's chorea admitted for an emergency operation. PMID:23560194
Kang, Jong-Man; Chung, Jun-Young; Han, Jin Hee; Kim, Yung-Suk; Lee, Bong Jae; Yi, Jae-Woo
\\u000a Abstract\\u000a Purpose To report the anestheticmanagement of a patient with carnitine palmitoyltransferase II deficiency who presented for labour\\u000a and delivery.\\u000a \\u000a \\u000a \\u000a Clinical features A 30-yr-old primiparous woman with known carnitine palmitoyltransferase II deficiency and a past history of exercise induced\\u000a muscle pain, weakness and myoglobinuria presented in active labour. Management consisted of an early epidural for labour and\\u000a continuous dextrose infusion with
The Montgomery silicone t-tube used for post-procedural tracheal stenosis has advantage of acting as both stent and tracheostomy tube. The anestheticmanagement of patient with t-tube in situ poses a challenge. Safe management of such patients requires careful planning. We describe anestheticmanagement for direct laryngoscopy of a patient with t-tube in situ.
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 anestheticmanagement 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
Tracheoesophageal fistula (TEF) in adults occurs as a result of trauma, malignancy, cuff-induced tracheal necrosis from prolonged mechanical ventilation, traumatic endotracheal intubation, foreign body ingestion, prolonged presence of rigid nasogastric tube, and surgical complication. Anestheticmanagement for repair of TEF is a challenge. Challenges include difficulties in oxygenation or ventilation resulting from placement of endotracheal tube in or above the fistula; large fistula defect causing loss of tidal volume with subsequent gastric dilatation, atelactasis, and maintenance of one lung ventilation. The most common cause of acquired nonmalignant TEF is postintubation fistula, which develops after prolonged intubation for ventilatory support. Acquired TEF, which occurs after prolonged intubation, usually develops after 12-200 days of mechanical ventilation, with a mean of 42 days. We present a rare case of TEF that developed after 7 days of intubation. It was a difficult case to be diagnosed as patient had a history of polytrauma, followed by emergency intubation and both these conditions can contribute to tracheobronchial injury. PMID:22345958
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 anestheticmanagement 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.
Objective: To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients.Research Methods and Procedures: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book
Roman Schumann; Stephanie B. Jones; Vilma E. Ortiz; Kathleen Connor; Istvan Pulai; Edwin T. Ozawa; Alan M. Harvey; Daniel B. Carr
PURPOSE: Local anesthetic is often used for perioperative pain control. Thrombin serves as a carrying medium for sustained release of antibiotics, chemotherapy, and growth factors. We tested the hypothesis that local anesthetic pain relief can be prolonged with the adjunct use of thrombin. METHODS: A prospective single-blinded clinical study was performed. Patients undergoing elective hand surgery inclusive of carpal tunnel release, excision of ganglion cyst, trigger finger release, and excision of mucous cyst under local block were enlisted. Before closure, patients received 1 of the following combinations: (1) control with oral analgesics, (2) 5 mL of 2% xylocaine, (3) 5 mL of 0.5% bupivacaine, (4) 2.5 mL of 2% xylocaine with 2.5 mL of 0.5% bupivacaine (XB), (5) thrombin with 5 mL of 2% xylocaine (XT), (6) thrombin with 5 mL of 0.5% bupivacaine (BT), and (7) thrombin with 2.5 mL of 2% xylocaine and 2.5 mL of 0.5% bupivacaine (XBT). There were 7 patients in each group, and patient demographics were similar between groups. Outcome measures included postanesthesia care unit (PACU) time, pain level, and number of pain pills required. RESULTS: Compared with oral analgesics alone, mean (SD) postoperative pain levels were reduced by 33.3% (8.9%) by xylocaine, 69.1% (8.7%) by bupivacaine, and 45.7% (9.4%) by XB. When thrombin was added, pain levels were further reduced by 69.9% by XT (P < 0.001), 23.1% by BT (P = 0.071), and 50.5% by XBT (P < 0.001) compared with their nonthrombin counterparts. In addition, PACU time was decreased by 34.8% by XT (P = 0.003) and 19.7% by XBT (P = 0.013) compared with xylocaine and XB, respectively. However, there was no difference in total pain pills needed between xylocaine, bupivacaine, and XB when administered with and without thrombin. CONCLUSIONS: The addition of topical thrombin to local anesthetic at the end of elective hand surgery provides for sustained postoperative pain control. Patients in this study who received thrombin and local anesthetic before wound closure had lower pain levels and were discharged from the PACU sooner than those who received local anesthetic alone. LEVEL OF EVIDENCE: Therapeutic level 2. PMID:23241808
Haddock, Nicholas T; Weinstein, Andrew L; Sinno, Sammy; Chiu, David T W
We describe successful anestheticmanagement of three morbidly obese patients, using inhalation induction with high concentrations of sevoflurane. In morbidly obese patients, reduced airway space of the pharynx can cause upper airway obstruction after the induction of general anesthesia and may explain difficult mask ventilation. For these patients, careful airway management is essential during the anesthetic induction. In inhalation induction with sevoflurane, the incidence of transient apnea is lower and the control over depth of anesthesia is easier as compared with intravenous induction. Therefore, sevoflurane may be an excellent induction agent in morbidly obese patients with a potentially difficult airway. PMID:16026064
Arthrogryposis multiplex congenita is a rare disease, characterized by non-progressive, multiple joint contractures since birth. Anesthetic issues include difficult intravenous access, difficult airway management and regional anesthesia. We report the anestheticmanagement of a six-day-old neonate presenting to the emergency with features of intestinal obstruction, who was detected for the first time to have arthrogryposis multiplex congenita. General anesthesia along with caudal analgesia for peroperative and postoperative pain relief was used. There was an episode of intraoperative hyperthermia, which was tackled successfully. The child had an uneventful post-anesthesia recovery.
Transcatheter aortic valve implantation is an emergent technique for high risk patients with aortic stenosis. Transcatheter aortic valve implantation poses significant challenges about its management, due to the procedure itself (i.e. the passage of large stiff sheaths in diseased vessels, the valve dilatation and the prosthesis positioning during a partial cardiac standstill) and the population of elder and high-risk patients who undergo the implantation. Retrograde transfemoral approach is the most popular procedure and a great number of cases is reported. Nevertheless, there is not a consensus regarding the intraoperative anesthesiological strategies, which vary in the different Centers. Sedation plus local anesthesia or general anesthesia are both valid alternatives and can be applied according to patient's characteristics and procedural instances. Most groups started the implantation program with a general anesthesia; indeed, it offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of potential complications, through the use of the transesophageal echocardiography. However, after the initial experiences, many groups began to employ routinely sedation plus local anesthesia for transcatheter aortic valve implantation and their procedural and periprocedural success demonstrates that it is feasible, with many possible advantages. Many aspects about perioperative anestheticmanagement for transcatheter aortic valve implantation are still to be defined. Aim of this work is to clarify the different management strategies through a review of the available literature published in pubmed till June 2011. PMID:23440259
Ruggeri, L; Gerli, C; Franco, A; Barile, L; Magnano di San Lio, M S; Villari, N; Zangrillo, A
Morquio syndrome is a hereditary mucopolysaccharide disorder presenting with an abnormality of the craniocervical junction from childhood. We describe an adult patient who presented with Morquio syndrome who had subglottic narrowing of the airway, restrictive pulmonary disease, and mild mitral regurgitation and trivial aortic regurgitation. The anestheticmanagement of this patient for atlantoaxial stabilization is presented. PMID:20517622
Geetha, Lakshminarsimhaiah; Radhakrishnan, Muthuchellappan; Raghavendra, Biligiri Sridhar; Rao, G S Umamaheswara; Indira Devi, Bhagavatula
We describe the successful anestheticmanagement of a 14-year-old child, a corrected case of transposition of great vessels in childhood and presently with residual atrial septal defect, peripheral cyanosis, and neurological deficit of lower limb presented for tendoachillis lengthening.
Pheochromocytoma is a rare catecholamine producing tumor. Anestheticmanagement for the resection of pheochromocytoma is hard and challenging issue to anesthesiologist, because of its potentially lethal cardiovascular complications. It becomes more complicated when the patient is pregnant. Clinicians must keep the safety of both mother and fetus in mind. The timing of surgery for pheochromocytoma in pregnancy is very important for the maternal and fetal safety and depends on the gestational age when diagnosis is made, clinical response to medical treatment, the surgical accessibility of the tumor, and the presence of fetal distress. We report anesthetic experience of a laparoscopic resection for pheochromocytoma in 25th week gestational woman.
Doo, A Ram; Cha, Kyoung-Nam; Han, Young Jin; Kim, Dong-Chan
We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature.
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.
Morquio syndrome is a hereditary mucopolysaccharide disorder presenting with an abnormality of the craniocervical junction\\u000a from childhood. We describe an adult patient who presented with Morquio syndrome who had subglottic narrowing of the airway,\\u000a restrictive pulmonary disease, and mild mitral regurgitation and trivial aortic regurgitation. The anestheticmanagement of\\u000a this patient for atlantoaxial stabilization is presented.
Lakshminarsimhaiah Geetha; Muthuchellappan Radhakrishnan; Biligiri Sridhar Raghavendra; G. S. Umamaheswara Rao; Bhagavatula Indira Devi
Topical anesthetics are increasingly important, as the number of outpatient surgeries for dermatologic problems in infants and children is steadily growing. This noninvasive modality of anesthetic delivery in conjunction with a reassuring environment may minimize the discomfort of otherwise painful procedures. Since the 1880s, when cocaine was first used as a topical ophthalmologic anesthetic, many ester-and amide-based local anesthetics have been developed for a variety of simple and complex procedures. The pediatric dermatologist's arsenal of topical anesthetic preparations is increasing with the development of novel vehicles of transdermal delivery and the use of anesthetics in combination. Eutectic mixture of local anesthetics is currently the most frequently prescribed topical agent, though the use of ELA-max, another lidocaine-containing preparation, is gaining momentum, especially in the neonatal population. Amethocaine, tetracaine, iontophoresis, and the S-caine patch, a product on the horizon for use in the pediatric population, also are included in this discussion. PMID:11717557
To improve the quality of life of patients suffering from spinal cord injury, "Catheterizable cecostomy" operation have recently been carried out. In the procedure, cathetelizable stoma is opened and patients are able to control the excretion by injecting enema solution through the stoma. Although operations are usually performed under general anesthesia with tracheal intubation, special considerations sometimes need to be taken for airway management. In such cases, we select spinal anesthesia. Because the surgery is achieved on a fixed charge, efficiency of pre-operative assessment should be done for the cost-cutting with shortening of perioperative period. Diseases including hypertension, diabetes mellitus, etc., must be controlled before admission to the hospital. With these considerations, proper pre-operative assessment can be made. PMID:16491905
For religious reasons, Jehovah's Witnesses do not accept homologous blood transfusions. Instead, they request alternative medical care that does not involve such transfusions. A 58-year-old woman, a Jehovah's Witness, was scheduled for pancreaticoduodenectomy for pancreatic carcinoma under general and epidural anesthesia. She presented with hemoglobin (Hb) concentration of 10.3 g x dl(-1) and hematocrit (Ht) of 31.5% preoperatively. She was fully informed about the risk of cardiac arrest and postoperative complications without blood transfusion, and consented to the bloodless surgery with infusion of colloid solutions; albumin and hydroxyethylated starch, and intraoperative, salvaged, autologous blood transfusion. She submitted a signed letter, absolutely refusing homologous blood transfusion and releasing the hospital from any liability. The general anesthesia was induced using fentanyl, propofol, and vecuronium, and maintained with sevoflurane and vecuronium in combination with epidural anesthesia using lidocaine and fentanyl. An autologous blood transfusion device was prepared for use in the event of massive intraoperative hemorrhage. The pancreaticoduodenectomy and cholecystectomy were performed without the necessity of starting the intraoperative, salvaged, autotransfusion. The volume of intraoperative hemorrhage was 1,108 ml. Lactated Ringer's solution 3,300 ml, physiological saline 200 ml, and hydroxyethylated starch 500 ml were infused during the operation. Although her postoperative Hb and Ht dropped to 8.7 g x dl(-1) and 26.8%, respectively, no transfusion was performed. Anesthesiologists should respect the demands of Jehovah's Witnesses, and should attempt to manage surgery without transfusion. PMID:21485112
Preeclampsia is a pregnancy-associated illness affecting multiple organ systems. Symptoms typically occur after the 20th week of gestation and consist of hypertension (>140/90 mmHg) and proteinuria (>300 mg/day). It is one of the leading causes of premature birth worldwide and early diagnosis and treatment are essential for both fetal and maternal health. Therapy is aimed at lowering blood pressure sufficiently to prevent the most severe complications such as intracranial hemorrhages. At the same time attention must be paid to the possible untoward effects of blood pressure medications on uteroplacental perfusion and fetal well being. Magnesium is the cornerstone for both prevention and control of eclamptic cerebrovascular events. In cases of severe preeclampsia and eclampsia prompt delivery is indicated, often carried out by Cesarean section (>34 weeks of gestation). Compared to general anesthesia, regional anesthesia techniques offer certain advantages to both mother and fetus and in the absence of contraindications are the methods of choice. PMID:18209976
Titration of volatile anesthetics to anesthetic effect monitoring using the bispectral index (BIS) has been shown to decrease anesthetic requirements and facilitate recovery from anesthesia unrelated to liver transplantation (OLT). To determine whether availability of such monitoring influences its utilization pattern and affect anesthetic care and outcomes in OLT, we conducted a retrospective analysis in recipients with and without such
The author report anestheticmanagement of an elderly patient with untreated polycythemia vera undergoing hip joint fracture surgery. Hydroxycarbamide was administered for erythrocytosis and thrombocytosis before surgery. Antithrombotic treatment with warfarin, aspirin and physical therapy, was continued during perioperative period. Surgery was performed under general anesthesia with hematocrit below 50% and platelet below 500 thousand x microl(-1). Hypovolemia was avoided to prevent hemoconcentration. No complication occurred perioperatively, although a high proportion of patients with polycythemia vera are complicated with vascular occlusion and major hemorrhage. PMID:23431903
Background Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process. Methods/design This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey’s HSD procedure for post hoc contrasts. Discussion If simple maneuvers of ventilation or anesthetictechnique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position. Trial registration NCT01535274
The paper summarizes a 5-year experience of evaluating the safety of anestheticmanagement of patients with thermal lesions treated at the department of thermal lesions of Vishnevsky's Institute of Surgery, Russia's Academy of Medical Sciences. Regular internal auditings, based on the principles of registering the critical incidents, the course of 1473 general anesthesia managements was analyzed in 168 patients. The conclusion is that the introduction of protocols of anestheticmanagement as well as a regular monitoring over meeting the fixed targets cut the total frequency of critical incidents from 2.85 to 1.19 as estimated per one general anesthesia. Finally the authors suggest a concept whose essence in that the operation of the modern anesthesiology department must be based on a scientifically substantiated technology of anestheticmanagement. PMID:15314867
Marfan syndrome is an autosomal dominant heritable disorder of the connective tissue that involves primarily the skeletal, ocular, and cardiovascular systems. Turner syndrome is a genetic disorder resulting from partial or complete X chromosome monosomy. We report the anestheticmanagement of a case of Marfan-Turner syndrome, which is the first such case to appear in the literature to our knowledge. A 3 year old ASA III girl was scheduled to undergo minor plastic surgery. She had a short webbed neck, prognathism, micrognathia, low-set ears, and a high palate. Her anterior and posterior facial heights were long. She had growth retardation, pectus excavatum, and joint laxity. She also had high-degree mitral insufficiency, mitral valve prolapse, and an atrial septal defect. After sevoflurane induction, the airway was secured using a size 2 LMA without any difficulty in the spontaneously breathing patient. Her blood pressure was within normal limits, no arrthymia occurred, and anesthesia was uneventful. Special care should be given to syndromic patients. Prior medical evaluations and any prior anesthetic history can help to focus preoperative evaluations and planning. Preoperatively targeting relevant organ systems, any anatomic or laboratory abnormalities that can be optimized, and perioperative airway management are all key to a successful outcome. PMID:22349745
We describe the anestheticmanagement of a patient with severe myasthenia gravis and tracheal stenosis; the patient was scheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several difficulties for anestheticmanagement. The airway is shared; therefore, any complications are also shared by the anesthesiologist and bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that anesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in a case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence for choosing one approach to general anesthesia over another for bronchoscopy. Careful preoperative planning and experience in airway management and jet ventilation are crucial to prevent an adverse outcome and obtain favorable results.
Experience in the anesthetic and surgical management of 25 patients with myasthenia gravis is recorded. These are subdivided into two groups: those operated on during the period 1950-1958 and those operated on during the period 1959-1964. The purpose of this paper is to indicate improvement in mortality and morbidity due to three major advances: (1) use of the decamethonium diagnostic test in a myasthenia gravis clinic; (2) improvements in assessment and management of respiratory insufficiency; and (3) avoidance of anticholinesterase treatment in the immediate and early postoperative recovery period. Fourteen patients with myasthenia gravis, including five with thymoma and two who were refractory to medication, were in the second (1959-1964) group. There were no deaths and no myasthenic or cholinergic crises. Three prophylactic tracheostomies were performed. No emergency bronchoscopies or tracheostomies were required.
Jenkins, Leonard C.; Chang, Jone; Saxton, George D.
We report anestheticmanagement of a 5-year-old girl for corpus callosotomy indicated for the treatment of intractable epilepsy. The procedure mandated intraoperative monitoring of evoked potentials and electrocorticogram. During the first half of the surgery until the corpus callosum was exposed, anesthesia was maintained with continuous infusion of propofol. Motor and somatosensory evoked potentials were monitored and diagnosed as intact throughout the procedure, with no epileptic activity observed in 32-lead electrocorticogram. Then propofol infusion was replaced with the inhalation of sevoflurane, 2.0% in air/oxygen mixture, which induced epileptic spike-and-wave activities, synchronized between the hemispheres, in electrocorticogram. After the completion of corpus callosotomy, we observed interhemispheric desynchronization of epileptic activities indicating successful surgical intervention. The patient emerged from anesthesia uneventfully with no neurological deficits, and thereafter with decreased incidence of generalized epileptic episodes. We suggest that such switch of anesthetic agents between propofol and sevoflurane should be helpful in intraoperative electrophysiological monitoring for ascertaining both functional preservation and successful intervention during epileptic surgery. PMID:16715915
Living donor transplantation is an accepted clinical practice in select transplant centers in Western countries to increase the availability of organs, while is standard practice in East Asian transplant programs. Living-donor right hepatic lobe resection is a particularly risky operation, with two mandatory outcomes: no serious complications for the donor, and an optimal graft-recipient body weight ratio. The use of robotic surgery has increased worldwide thanks to its minimally invasive approach, and is now becoming suitable for living donor procurement. From the anesthetic point of view, robotic surgery reveals itself to be extremely challenging, and requires diverse capacities in teamwork and planning of anestheticmanagement. We report what we believe is the first case of anestheticmanagement of a totally robotic right lobe resection in a living donor, and describe the steps taken by the anesthetists, in concert with the surgical team, to ensure delivery of the safest patient care. PMID:23877865
Local anesthetics are widely used in the practice of medicine, particularly within the field of interventional radiology. When used properly, these agents are safe and effective in preventing procedural pain and treating postprocedural pain. The clinician should be aware of proper dosing regimens, techniques, and applications and the methods of preventing and treating complications of systemic toxicity, allergy, and methemoglobinemia. This review provides an introduction to the pharmacology and optimal use of local anesthetics and current strategies for minimizing and managing their potential risks. PMID:21146999
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, anestheticmanagement 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
We experienced the anestheticmanagement of a child with epidermolysis bullosa undergoing esophageal dilatation. Anesthesia was induced with oxygen/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was with a lubricated laryngoscope blade using vecuronium 0.1 mg x kg(-1) and fentanyl 0.1 microg x kg(-1). To avoid friction and shearing forces on the skin, endotracheal tube was tied with a tape without adhesion and fixed around the neck. We removed adhesive parts of pulse-oximetry probe and electrocardiogram electrodes, then attached to the patient's skin covered with Vaseline. Peripheral venous access was secured in the left ankle and sutured. These methods were effective to avoid new blisters and to keep patient safe. PMID:16541788
We report anestheticmanagement 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
In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) issued a practice advisory on local anesthetic systemic toxicity (LAST). The executive summary of this work contained a document that was intended to serve as a checklist for the management of LAST. Based on testing the checklist during a simulated episode of LAST, ASRA has issued an updated version that should replace the previous 2010 version. Electronic copies of the ASRA Checklist, suitable for lamination and inclusion in a local anesthetic toxicity kit, are available from the ASRA Web site (www.asra.com). PMID:22189574
Neal, Joseph M; Mulroy, Michael F; Weinberg, Guy L
Purpose The practice of regional anesthesia has been revitalized of late with the popularization of ultrasound-guided techniques.\\u000a Advocates must be vigilant for the effects of unintentionally high blood levels of local anesthetic. Systemic local anesthetic\\u000a toxicity, though rare, is a potentially devastating occurrence. This narrative review summarizes the effects of local anesthetic\\u000a toxicity. We highlight how these toxic effects have motivated
There are many problems in the anestheticmanagement 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.
Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.Design: Prospective, randomized study.Setting: Teaching hospital.Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.Interventions: After identification of the epidural space with pulsations of
|This volume addresses five of the critical areas of school business management: planning, organizational management, personnel management, controlling, and directing. The various chapters describe a variety of techniques and processes for getting people to perform effectively in meeting organizational goals. The first section focuses on planning…
The symposium papers in this document describe specific applications of research managementtechniques currently being used by research and development organizations. Topics of the papers are based on subjects practicing R & D managers have found important in the management of research. Although the symposium was not specifically designed to…
Klippel-Trenaunay syndrome (KTS) is a rare disorder associated with the triad of 1) capillary vascular malformation, 2) varicose veins and/or venous malformation, 3) and soft tissue and/or bony hypertrophy. A six-month old, 6.0-kg-weight male pediatric patient was scheduled for ventriculo-peritoneal shunt operation for hydrocephalus caused by obstructive aqueductus cerebri. At the age of three months, he was diagnosed as KTS by extensive capillary vascular malformation and soft tissue hypertrophy of the right leg. Physical examination showed prominent vascular malformation over his anterior thoracic and abdominal wall, and soft tissue hypertrophy was only on his right leg. Simultaneously, he was complicated with congenital hydrocephalus because of obstructive aqueductus cerebri. His head and skull were enlarged and his head measurement reached 55 cm (chest measurement 32 cm). Anestheticmanagement of KTS patients should be prepared with blood transfusion against massive hemorrhage and hypovolemic shock. Furthermore, KTS patients should be always considered to have airway difficulty due to the soft tissue hypertrophy, upper and airway hemangiomas. Therefore, we planned safer tracheal intubation following practice guidelines for management of the difficult airway. PMID:23362775
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.
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
A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention. Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently. PMID:16719602
Titration of volatile anesthetics to anesthetic effect monitoring using the bispectral index (BIS) has been shown to decrease anesthetic requirements and facilitate recovery from anesthesia unrelated to liver transplantation (OLT). To determine whether availability of such monitoring influences its utilization pattern and affect anesthetic care and outcomes in OLT, we conducted a retrospective analysis in recipients with and without such monitoring. We evaluated annual BIS utilization over a period of 7 years, and compared 41 BIS-monitored patients to 42 controls. All received an isoflurane/air/oxygen and opioid-based anesthetic with planned postoperative ventilation. Data collection included age, body mass index (BMI), gender, Model for End-stage Liver Disease (MELD) score, and time to extubation (TtE). Mean preanhepatic, anhepatic, and postanhepatic end-tidal isoflurane concentrations were compared, as well as BIS values for each phase of OLT using the Kruskal-Wallis and Wilcoxon signed-rank tests, respectively. The use of anesthetic effect monitoring when available increased steadily from 15% of cases in the first year to almost 93% by year 7. There was no significant difference in age, gender, BMI, MELD, or TtE between groups. The BIS group received less inhalational anesthetic during each phase of OLT compared to the control group. However, this difference was statistically significant only during the anhepatic phase (P = .026), and was clinically not impressive. Within the BIS group, the mean BIS value was 38.74 ± 5.25 (mean ± standard deviation), and there was no difference for the BIS value between different transplant phases. Availability of anesthetic effect monitoring as an optional monitoring tool during OLT results in its increasing utilization by anesthesia care teams over time. However, unless integrated into an intraoperative algorithm and an early extubation protocol for fast tracking of OLT recipients, this utilization does not appear to provide a clinical benefit but instead drives cost. PMID:21168738
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
The anesthetic implications of Joubert syndrome in an infant who required cardiac surgery using cardiopulmonary bypass (CPB) is presented. Children with Joubert syndrome present with central apnea due to malformations in the midbrain and cerebellum. These patients have a marked sensitivity to opioids. The use of dexmedetomidine along with remifentanil was effective in this case. PMID:23965207
Some studies have reported that tight glycemic control in diabetic patients undergoing major surgery improves perioperative\\u000a morbidity and mortality rates. Recently, however, large randomized studies have shown such control increases the mortality\\u000a rate, since aggressive glycemic control induces more frequent incidences of hypoglycemia. Diabetic patients have cerebral\\u000a complications during the perioperative period more often than their nondiabetic counterparts. Further, anesthetic
Kearns-Sayre syndrome (KSS) is a rare mitochondrial myopathy and often involves cardiac conduction abnormality and muscle weakness. We report a patient with KSS who had an implantable cardioverter-defibrillator (ICD) implanted during general anesthesia with propofol and nitrous oxide (N2O). These anesthetics did not show any effects on respiration, cardiac conduction, or neuromuscular transmission in this case. The surgery was performed
ObjectivesTo determine the effectiveness of a novel technique of administering local anesthesia for extensive prostate biopsy. Little reported experience with local anesthesia for extensive prostate biopsy methods is available.
A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6–16 years). The study also explored whether young patients can be taught and can use hypnosis independently
Klippel-Trenaunay syndrome (KTS) is characterized by capillary and venous malformation and hypertrophy of bone and soft tissues. A 29-year-old primigravida, who had been diagnosed of KTS by her hemangiomas and varicosities in the right leg, pubic area, rectum, vagina and lower abdominal area, was scheduled to receive caesarean section at 37 weeks gestation because vaginal delivery might cause hemorrhagic complications and extension of the venous lesions. Regional anesthesia was avoided because of the possible injuries of unknown venous malformations or varicose veins in the epidural or spinal space. The cesarean section was performed under general anesthesia uneventfully and an infant was delivered normally. There were no complications such as massive hemorrhage, disseminated intravascular coagulation and deep venous thrombosis in the perioperative period. Careful anesthetic considerations for the prevention of hemorrhagic and thrombotic complications are necessary for cesarean section in a patient with KTS. PMID:22991821
Guillain-Barré syndrome is an acute inflammatory demyelinating polyradiculopathy characterized by progressive motor weakness, areflexia, and ascending paralysis. Guillain-Barré syndrome is extremely rare in pregnant patients, and there are no established guidelines for delivery or safest anesthetic methods. We report a Cesarean delivery in the case of a 32-year old woman who was diagnosed with Guillain-Barré syndrome 18 weeks into gestation. Tracheostomy was performed due to progressive respiratory muscle weakness and respiratory failure, and ventilator support was required in the intensive care unit. The respiratory difficulty was exacerbated by the growth of the fetus, necessitating emergency Cesarean delivery. The delivery was successfully performed under general anesthesia, and the patient recovered without neurological sequelae.
We present a rare case of successful anestheticmanagement 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
We present a rare case of successful anestheticmanagement 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. PMID:24023999
Yoo, Chan Seon; Shin, Young Hee; Ko, Justin Sangwook; Gwak, Mi Sook; Kim, Gaab Soo
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 anestheticmanagement 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
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 anesthetictechnique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative period.
A contingency management framework, which focuses on the usefulness of a managementtechnique when applied to a particular problem, served as the basis for this study. About 500 Navy middle management problems were identified, analyzed, and systematically...
L. M. Doherty S. L. Dockstader B. Feher R. L. Holzbach
Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. After epidural catheterization for the postoperative analgesia, general anesthesia was induced and maintained with continuous remifentanil infusion and propofol with target controlled infusion. With train-of-four ratio (TOFR) monitoring by stimulating the ulnar nerve, her trachea was intubated after 0.6mg x kg(-1) of rocuronium intravenous administration. Since then, additional rocuronium was not given for 4 hours. After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia. PMID:22413445
Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.
This paper approaches the problem of office activities management from the databases viewpoint. Database alerting techniques are developed to serve the purpose of office activities management. A conceptual framework for office information system design is...
A laryngeal mask airway (LMA) and epidural analgesia were used for anestheticmanagement of microwave coagulo-necrotic therapy for multiple hepatoma in a 76-year-old male with a giant bulla and liver cirrhosis. Since bleeding times, PT and APTT were within normal limits, an epidural catheter was inserted between Th9 and 10 interspaces in operating room. After preoxygenation, general anesthesia was induced with propofol 120 mg. After insertion of a LMA, anesthesia was maintained under spontaneous breathing with sevoflurane (1-1.5%) in about 45% oxygen and nitrogen. During the operation, 2% lidocaine was injected continuously into the epidural space. Continuous epidural injection of 2% lidocaine was found to be very effective for obtaining abdominal muscle relaxation and perioperative pain management. Postoperative chest X ray did not show any signs of rupture of the giant bulla, and any neurological abnormalities due to the epidural hematoma were not encountered. We could reduce the risk of rupture of a giant bulla during general anesthesia using a LMA and epidural analgesia. PMID:11452473
Nozaki, K; Endou, A; Sakurai, K; Takahata, O; Iwasaki, H
Background: An infant with a large subglottic papilloma that caused severe respiratory distress needed anesthesia during resection of the papilloma. Aims: We planned an approach to the airway management this infant that we thought would be successful. Methods: We used three main tactics in managing the airway – inhaled sevoflurane, intravenous fentanyl and the patient's resumed spontaneous breathing. We also allowed the otolaryngologist to quickly resect some of the papilloma before intubation. Results: Our patient's airway was managed successfully, and the papilloma was removed. Conclusions: Management of the airway in a small child with obstruction can be aided by inducing anesthesia with sevoflurane, deepening anesthesia with intravenous fentanyl, and allowing the patient to resume spontaneous breathing.
We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed. PMID:17352528
We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed.
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 anestheticmanagement 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.
We studied the utility of Vigileo monitor for grasping hemodynamics with a patient in a state of anaphylactic shock. The stroke volume variation (SVV) predicts fluid responsiveness of normal cases. In the anaphylactic shock resulting from biased blood distribution, not only blood pressure but also pulse pressure markedly decreased within a couple of minutes. SVV is calculated from the standard deviation of pulse pressure. Therefore the SVV could be overestimated during anaphylactic shock. A former version of Vigileo monitor underestimated the arterial pressure-based cardiac output (APCO) due to the underrating of a single stroke volume (SV) in a range of systemic vascular resistance (SVR) below 800 dyne x sec(-1) x cm(-5). The version 3.02 Vigileo monitor allowed for more accurate estimation of SV because its new algorithm was able to revise the apparently low SVR derived from the arterial waveform characteristics and hence provided more realistic SV and APCO values. It was thus concluded that this ver. 3.02 is useful for anestheticmanagement of the anaphylactic case. PMID:23479933
Purpose A postoperative decrease in the gastric emptying (GE) rate may delay the early start of oral feeding and alter the bioavailability\\u000a of orally administered drugs. The aim of this study was to compare the effect on early gastric emptying between two anesthetic\\u000a techniques.\\u000a \\u000a \\u000a \\u000a Methods Fifty patients (age, 19–69 years) undergoing day-case laparascopic cholecystectomy were randomly assigned to received either\\u000a total intravenous
Jakob Walldén; Sven-Egron Thörn; Åsa Lövqvist; Lisbeth Wattwil; Magnus Wattwil
The incidence and potential for serious adverse drug reactions (SADRs) in anesthesia are high due to the narrow therapeutic indices of anesthetic and analgesic drugs and high interindividual variability in drug responses. Genetic factors contribute to a majority of these SADRs. Pharmacogenetics (PG), the study of genetic effects on drug action, is strongly related to the field of anesthesia; historically, succinylcholine apnea and malignant hyperthermia were among the first PG disorders reported. Recent years have strengthened this affiliation with an emerging wide base of knowledge of the effects of genetic variations on the pharmacodynamics and pharmacokinetics of anesthetic drugs. Here, we review the history of anesthetic PG, the important genes influencing enzymes involved in anesthetic drug metabolism, the influence of genotypic expression and the potential ramifications of recent discoveries on the practice of clinical anesthesia. Epigenetics and functional genomics are also discussed. The article also addresses various critical deficits in our current knowledge of PG related to anesthesia that account for the minimal clinical translation of the findings in this area in the present time. The review concludes that in addition to enhanced data generation facilitated by rapidly evolving genetic techniques, robust clinical study designs in a large sample and sound statistical analyses are essential prerequisites for the successful clinical implementation of research findings to individual perioperative care for every patient. PMID:22432844
Chidambaran, Vidya; Ngamprasertwong, Pornswan; Vinks, Alexander A; Sadhasivam, Senthilkumar
A 42-year-old man with dilated cardiomyopathy and rheumatic mitral stenosis underwent mitral valve replacement. Prior intravascular fluid administration and infusion of dopamine and dobutamine stabilized hemodynamics during the induction of anesthesia. High-dose fentanyl at pre-cardiopulmonary bypass period and circulatory assist with milrinone and intraaortic balloon pumping after the bypass enabled us to obtain stable hemodynamics. Preoperative dobutamine stress test provided us the effective information for circulatory management in this patient. PMID:10402817
Kurokawa, S; Fujihara, H; Tobita, T; Fukuda, S; Shimoji, K
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
Knowledge integration (KI) and knowledge management (KM) techniques are being recognized as key to i mproved competitiveness in industry. These principles and techniques enable retention, sharing and systematic application of critical knowledge across geographic and temporal expanses. Five case studies of the application of KI\\/KM techniques are described in the context of a university research group including students at all
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
In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized. PMID:21286425
Lee, Jung Min; Byon, Hyo-Jin; Kim, Jin-Tae; Kim, Hee-Soo; Kim, Chong Sung
Esophageal atresia is a rare condition (1:2,500-4,500), incompatible with life, and a surgical emergency in the neonatal period. It is associated with prematurity in 30% of cases, and to congenital abnormalities in 50% of cases, especially cardiac anomalies. Major congenital heart diseases and low weight are independent predictors of mortality and critical perioperative events. The aim of this article is to describe the most significant anaesthetic challenges presented in a case of a term neonate undergoing emergency surgery after being diagnosed with esophageal atresia, tracheoesophageal fistula type iiib/C, and imperforate anus. The major priorities during the anaesthetic management consist of establishing a safe airway and effective pulmonary ventilation that minimises air leakage to the upper digestive tract. PMID:23260992
Blázquez, E; Laguillo, J L; Ariza, M A; Avilez, T S; López-Millán, J M
Though new local anesthetics (LA), effective test-dosing, and new regional anesthetictechniques may have improved the safety of regional anesthesia, the optimal management plan for LA-induced cardiac toxicity remains uncertain. Accordingly, we evaluated current approaches to LA cardiotoxicity among aca- demic anesthesiology departments in the United States. A 19-question survey regarding regional anesthesia practices and approaches to LA cardiac toxicity
William Corcoran; John Butterworth; Robert S. Weller; Jonathan C. Beck; J. C. Gerancher; Timothy T. Houle; Leanne Groban
A 51-year-old woman was scheduled for emergency enterectomy and vascular repair under general anesthesia for active bleeding from internal iliac artery caused by repeated radiotherapy for cervical cancer and subsequent hypovolemic shock. For the first two hours of operation, the blood loss exceeded 6,000 ml and the hemoglobin level decreased to a low of 3.8 g x dl(-1) despite administration of 38 units of packed red cells. Intraoperative blood salvage was used in order to minimize further loss of hemoglobin. Mild hypothermia technique was also introduced to prevent brain ischemia. Total bleeding volume was approximately 10,000 ml, and total transfused volume was 8,740 ml. No neurological deficit and no systemic infection were found during the postoperative course. Although clinical risks of cell salvage in patients undergoing surgery for malignant tumor remain controversial, we conclude intraoperative blood salvage using Cell Saver could be utilized as a life-saving means and mild hypothermia might have been efficacious for protecting the brain from ischemia in our case. PMID:22991815
Despite of various neurophysiologic monitoring methods under general anesthesia, functional mapping at awake state during brain surgery is helpful for conservation of speech and motor function. But, awake craniotomy in children or adolescents is worrisome considering their emotional friabilities. We present our experience on anestheticmanagement for awake craniotomy in an adolescent patient. The patient was 16 years old male who would undergo awake craniotomy for removal of brain tumor. Scalp nerve block was done with local anesthetics and we infused propofol and remifentanil with target controlled infusion. The patient endured well and was cooperative before scalp suture, but when surgeon sutured scalp, he complained of pain and was suddenly agitated. We decided change to general anesthesia. Neurosurgeon did full neurologic examinations and there was no neurologic deficit except facial palsy of right side. Facial palsy had improved with time.
Sung, Bohyun; Park, Jin-Woo; Byon, Hyo-Jin; Kim, Jin-Tae; Kim, Chong Sung
Although run-time reconfigurable systems have been shown to achieve very high performance, the speedups over traditional microprocessor systems are limited by the cost of configuration of the hardware. In this paper, we explore the idea of configuration caching, and create some of the first cache management algorithms for reconfigurable systems. We present techniques to carefully manage the configurations present on
The director of a not-for-profit nursery school adapted the adult stress managementtechniques of exercise and relaxation for use with 3- to 5-year-old children. Specifically, children were taught visualization techniques and yoga exercises involving deep breathing. The goal of the practicum was to rechannel children's negative stress-related…
The obese patient presents many challenges to both anesthesiologist and surgeon. A good understanding of the pathophysiologic effects of obesity and its anesthetic implications in the surgical setting is critical. The anesthesiologist must recognize increased risks and comorbidities inherent to the obese patient and manage accordingly, optimizing multisystem function in the perioperative period that leads to successful outcomes. Addressed from an organ systems approach, the purpose of this review is to provide surgical specialists with an overview of the anesthetic considerations of obesity. Minimally invasive surgery for the obese patient affords improved analgesia, postoperative pulmonary function, and shorter recovery times at the expense of a more challenging intraoperative anesthetic course. The physiologic effects of laparoscopy are discussed in detail. Although laparoscopy's physiologic effects on various organ systems are well recognized, techniques provide means for compensation and reversing such effects, thereby preserving good patient outcomes. PMID:23204937
One of the biggest problems in complicated and high-performance SoC design is management of energy and\\/or power consumption.\\u000a In this chapter, we present energy managementtechniques in system design including HW and SW, SoC architecture and logic\\u000a design. Dynamic power consumption is the major factor of energy consumption in the current CMOS digital circuits. The dynamic\\u000a power consumption is affected
\\u000a With the aging population and an increase in health problems such as obesity, diabetes, and coronary artery disease, the perioperative\\u000a management and induction of general anesthesia in such patients, while providing cardiovascular stability, continues to offer\\u000a both challenges and new developments in this field. These developments include new anesthesia medications, medical equipment\\u000a and\\/or surgical technology, and anesthetic and surgical techniques.
Local anesthetics are widely used in the practice of medicine, particularly within the field of interventional radiology. When used properly, these agents are safe and effective in preventing procedural pain and treating postprocedural pain. The clinician should be aware of proper dosing regimens, techniques, and applications and the methods of preventing and treating complications of systemic toxicity, allergy, and methemoglobinemia.
Effective regional block is not possible without the use of local anesthetics. Even though local anesthetics have been used\\u000a for more than 115 years, details about balancing risks of their toxic effects with the benefits of their therapeutic effects\\u000a remain poorly focused for many clinicians. In this chapter, the most frequent toxic effect of local anesthetics — local anesthetic\\u000a systemic
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.
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
The accidental overdose of local anesthetics may prove fatal. The commonly used amide local anesthetics have varying adverse effects on the myocardium, and beyond a certain dose all are capable of causing death. Local anesthetics are the most frequently used drugs amongst anesthetists and although uncommon, local anaesthetic systemic toxicity accounts for a high proportion of mortality, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anesthetic-cardiotoxicity, and anesthetic organisations, over the globe have developed guidelines on the use of this drug. Despite this, awareness amongst practitioners appears to be lacking. All who use local anesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using local anesthetics, and the initial management of systemic toxicity with intravenous lipid emulsion. In this paper we intend to discuss the pharmacology and pathophysiology of local anesthetics and toxicity, and the rationale for lipid emulsion therapy. PMID:21969824
In anestheticmanagement of surgery for a huge renal tumor with the inferior vena cava invasion, maintaining circulatory state is one of the key points. Several hemodynamic parameters are required to evaluate the circulatory state, such as central venous oxygen saturation (ScvO2), cardiac output (CO) and direct arterial blood pressure, in addition to routine hemodynamic parameters like heart rate and central venous pressure. Pulmonary artery catheter is considered as a standard apparatus to obtain those parameters; however, the catheter is invasive and may cause possible pulmonary artery damage, cardiac penetration, or severe arrhythmia. Therefore, application of pulmonary artery catheter is a relative contraindication in some cases. We used Vigileo system to obtain similar hemodynamic parameters. This system provided an arterial based pressure-based cardiac output, central venous oxygen saturation, stroke volume variation (SVV) and so on. In the present case, the system was an alternative device to pulmonary artery catheter system. PMID:21384671
Michael Trick, Associate Professor of Industrial Administration at Carnegie-Mellon University, has designed a course to give consultants (and others who want to improve their quantitative skills) an introduction to a variety of useful techniques in management science, with an emphasis on practicality. The course covers sensitivity analysis, solving large problems, integer programming, heuristic decision-making, genetic algorithms/neural networks, relaxations, network models, data envelopment analysis, scenario optimization and multiple objective decision making. In addition to the class notes, the site also contains the homework for the class.
Michael Trick, Associate Professor of Industrial Administration at Carnegie-Mellon University, has designed a course to give consultants (and others who want to improve their quantitative skills) an introduction to a variety of useful techniques in management science, with an emphasis on practicality. The course covers sensitivity analysis, solving large problems, integer programming, heuristic decision-making, genetic algorithms/neural networks, relaxations, network models, data envelopment analysis, scenario optimization and multiple objective decision making. In addition to the class notes, the site also contains the homework for the class.
... Infused Local Anesthetics (marketed as bupivacaine, chlorprocaine, lidocaine, mepivacaine, procaine and ropivacaine) [ARCHIVED] 11/13/2009 ... More results from www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a unique diagnostic and therapeutic procedure performed in high risk patients in prone/semi-prone position. Propofol based deep sedation has emerged as the method of choice however, the ability to predict possible complications is yet un-explored. Aims: The present study aimed to evaluate known high risk-factors for general anesthesia (American Society of Anesthesiologists (ASA) status, body mass index (BMI), and Mallampati class) for their ability to affect outcomes in ERCP patients. Study Design: Retrospective data of 653 patients who underwent ERCP during a period of 26 months at university hospital of Pennsylvania was reviewed. Patient-specific and procedure specific data was extracted. Desaturation was defined by fall of pulse oximeter saturation below 95% and its relation to patient specific high risk-factors was analyzed. Results: Only 45 patients had transient de-saturation below 95% without any residual sequlae. No statistically significant relation between desaturation episodes and patients higher ASA status or BMI or modified Mallampati (MMP) class was found. Despite 60% patients being ASA III/IV none required emergency intubation or procedural interruption. Optimal oxygenation and airway patency was maintained with high degree of success using simple airway maneuvers or conduit devices (nasal/oral trumpet) with oxygen supplementation in all patients. Conclusions: Unlike general anesthesia, pre-operative patient ASA status, higher MMP or increasing BMI does not bear relation with likelihood of patients desaturating during ERCP. In presence of vigilant apnea monitoring and careful dose titration of maintenance anesthetics with airway conduits, general anesthesia, emergency intubations, and procedure interruptions can be avoided.
Goudra, Basavana G.; Singh, Preet Mohinder; Sinha, Ashish C.
We report the anestheticmanagement of a parturient with postural orthostatic tachycardia syndrome. This syndrome is associated with hemodynamic instability, which can be worsened by the physiology of labor and delivery. We discuss anesthetic concerns with this disease in the parturient and suggest approaches for management of this disease. PMID:17179264
Patients with genetic disorders associated with multiple congenital anomalies present unique challenges to the anesthesiologist. We report the successful perioperative management of a child with biliary atresia, situs inversus totalis, and Kartegener syndrome scheduled for corrective biliary surgery. We recommend that patients with multiple congenital anomalies need to be thoroughly and cautiously evaluated. The perioperative management should be individualized based on associated anomalies along with appropriate monitoring.
We present a patient who experienced airway obstruction during an elective esophagogastroduodenoscopy (EGD) under anesthesia secondary to previously undiagnosed tracheomalacia. Physiology of airway obstruction with forced breathing maneuvers is discussed along with the potential advantages of dexmedetomidine-ketamine sedation for management of patients with achalasia undergoing outpatient endoscopic procedures.
Atkins, Joshua H.; Mandel, Jeff E.; Metz, David C.
As many populations of neotropical migrant songbirds decline, wildlife managers pursue measures to help restore these populations to acceptable levels. One management option is the control of the brown-headed cowbird. The cowbird parasitizes the nest of o...
Modern project management is a well-understood discipline that can produce predictable, repeatable results. The methodologies of modern project management are highly analytical, usually requiring automated tools to support them on large projects. Like most other disciplines, it is learned through both practice and past experience. Project management encompasses many different skills, such as understanding the interdependencies among people, technologies, budgets,
... health advisory to alert you to the potential hazards of using skin-numbing products, also known as topical anesthetics, for cosmetic procedures. ... More results from www.fda.gov/drugs/drugsafety/drugsafetypodcasts
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
Kasabach-Merritt syndrome (KMS) is a rare and severe coagulation disorder caused by vascular malformations within or outside the liver. It is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and consumption coagulopathy. We successfully managed the anesthesia for a giant hemangioma resection complicated with KMS using FloTrac/Vigileo system. A 78-year-old woman (51 kg, 141 cm) was admitted for giant hemangioma with disseminated intravascular coagulation (DIC). General anesthesia was induced with sevoflurane and remifentanil. Epidural anesthesia was not induced because of coagulopathy. We evaluated arterial pressure-based cardiac output (APCO), stroke volume variation (SVV) as a predictor for fluid responsiveness, systolic blood pressure (SBP), and central venous pressure (CVP) during the operation. Prior to tumor resection, 6,000 ml of fluid was suctioned from the tumor. The increase of SVV and sudden decrease of APCO and SBP were recognized during surgical procedure. The SVV demonstrated marked changes in response to hemorrhage, and it was more sensitive than CVP change during operation. We conclude that SVV is an accurate predictor of intravascular hypovolemia, and it is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during a giant hemoangioma resection. PMID:22175175
Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetictechnique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
This paper examines the accounting techniques presently used to assist decision making and control within the marketing function of companies that operate in a highly competitive industry. The overall observation is that, while the use of these techniques is greater than in earlier studies conducted in less competitive industries, only a handful of management accounting techniques considered superior by the
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.
The risk of accidental intravascular injection and consequent acute toxicity is ever-present with most neural blockade techniques. The severity of cardiovascular and central nervous system (respectively, CVS and CNS) toxicity is directly related to the local anesthetic potency, dose, and rate of administration. Nonetheless, although the anesthetic potency of ropivacaine and levobupivacaine is similar to that of bupivacaine, at usual
Laurence E. Mather; Susan E. Copeland; Leigh A. Ladd
Continuous infusions of intravenous anesthetics are becoming increasingly popular during surgical procedures, largely because relatively precise, consistent control of anesthetic depth is possible over intravenous injection techniques. In this paper we investigate the main issues involved with the development of automatic intravenous anesthesia delivery systems in the context of robust multivariable control. We present a pharmacodynamic model that may be
|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.
|This text is designed for professional preparation classes in physical education and sports administration and serves as a guide for inservice secondary school athletic directors. Managerial principles are applied to athletic personnel and programs: coaches are depicted as managerial supervisors, the athletic director is middle management, and…
The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine. PMID:23330414
Despite the widespread clinical use of anesthetics since the 19th century, a clear understanding of the mechanism of anesthetic action has yet to emerge. On the basis of early experiments by Meyer, Overton, and subsequent researchers, the cell's lipid membrane was generally concluded to be the primary site of action of anesthetics. However, later experiments with lipid-free globular proteins, such as luciferase and apoferritin, shifted the focus of anesthetic action to proteins. Recent experimental studies, such as photoaffinity labeling and mutagenesis on membrane proteins, have suggested specific binding sites for anesthetic molecules, further strengthening the proteocentric view of anesthetic mechanism. With the increased availability of high-resolution crystal structures of ion channels and other integral membrane proteins, as well as the availability of powerful computers, the structure-function relationship of anesthetic-protein interactions can now be investigated in atomic detail. In this Account, we review recent experiments and related computer simulation studies involving interactions of inhalational anesthetics and proteins, with a particular focus on membrane proteins. Globular proteins have long been used as models for understanding the role of protein-anesthetic interactions and are accordingly examined in this Account. Using selected examples of membrane proteins, such as nicotinic acetyl choline receptor (nAChR) and potassium channels, we address the issues of anesthetic binding pockets in proteins, the role of conformation in anesthetic effects, and the modulation of local as well as global dynamics of proteins by inhaled anesthetics. In the case of nicotinic receptors, inhalational anesthetic halothane binds to the hydrophobic cavity close to the M2-M3 loop. This binding modulates the dynamics of the M2-M3 loop, which is implicated in allosterically transmitting the effects to the channel gate, thus altering the function of the protein. In potassium channels, anesthetic molecules preferentially potentiate the open conformation by quenching the motion of the aromatic residues implicated in the gating of the channel. These simulations suggest that low-affinity drugs (such as inhalational anesthetics) modulate the protein function by influencing local as well as global dynamics of proteins. Because of intrinsic experimental limitations, computational approaches represent an important avenue for exploring the mode of action of anesthetics. Molecular dynamics simulations-a computational technique frequently used in the general study of proteins-offer particular insight in the study of the interaction of inhalational anesthetics with membrane proteins. PMID:19788306
Vemparala, Satyavani; Domene, Carmen; Klein, Michael L
Photolabeling has allowed considerable progress in the understanding of anesthetic binding to proteins, of target identity, and of site localization. There are, however, few groups doing this work, so this article is an attempt to demystify the method. We will discuss the theory, method, and limitations of this useful experimental approach. PMID:20336439
The NCDOT has made significant strides to reduce collisions and increase capacity along strategic highway corridors across the state. Efforts have led to the implementation of many different access managementtechniques along corridors, such as installing...
B. Schroeder C. M. Cunningham D. Carter D. Katz D. J. Findley M. Miller R. S. Foyle S. Smith
|A number of brief, focused self-help interventions designed to help faculty manage stress more effectively are described such as being assertive, setting priorities, and using quick relaxation techniques. Related causes of stress are cited. (MSE)|
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.
Keith J. Slifer; Jessica C. Hankinson; Melissa A. Zettler; Robin A. Frutchey; Melissa C. Hendricks; Cynthia M. Ward; Jennifer Reesman
The purpose of this study was to assess the attitudes of parents toward behavior managementtechniques 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 managementtechniques were used successfully: general anesthesia, Papoose Board ®a , sedation, hand-over- mouth exercise (HOME), physical restraint by the dentist, physical
Knowledge about the structure and organization of terrorist networks is important for both terrorism investigation and the development of effective strategies to prevent terrorist attacks. Theory from the knowledge management field plays an important role in dealing with terrorist information. Knowledge management processes, tools, and techniques can help intelligence analysts in various ways when trying to make sense of the
Often, the performance of risk managementtechniques is evaluated by measuring the concentrations of the chemials of concern before and after risk management effoprts. However, using bioassays and chemical data provides a more robust understanding of the effectiveness of risk man...
This study reports the relationships between coping styles of Australian teachers and the classroom based classroom managementtechniques 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…
|Discusses sampling of circulation data as a technique for library media program management. Highlights include random and purposive sampling techniques; studies of circulation samples; factors affecting circulation patterns; guidelines for sampling circulation statistics over shorter time periods; and an example using statistics gathered from an…
We propose a novel approach for the automatic representation of pictures achieving a more effective organization of personal photo albums. Images are analyzed and described in multiple representation spaces, namely, faces, background, and time of capture. Faces are automatically detected, rectified, and represented, projecting the face itself in a common low-dimensional eigenspace. Backgrounds are represented with low-level visual features based on an RGB histogram and Gabor filter bank. Faces, time, and background information of each image in the collection is automatically organized using a mean-shift clustering technique. Given the particular domain of personal photo libraries, where most of the pictures contain faces of a relatively small number of different individuals, clusters tend to be semantically significant besides containing visually similar data. We report experimental results based on a data set of about 1000 images where automatic detection and rectification of faces lead to approximately 400 faces. Significance of clustering has been evaluated, and results are very encouraging.
Ardizzone, Edoardo; La Cascia, Marco; Morana, Marco; Vella, Filippo
Local anesthesia forms the foundation of pain control techniques in clinical dentistry. Within the rich local anesthetic drugs available in dentistry for the prevention and management of pain 4% articaine solutions achieve highest level of anesthetic potency and lowest systemic toxicity in all clinical situations, prior to its superlative physicochemical characteristics and the pharmacological profile. These are - low lipid solubility, high plasma protein binding rate, fast metabolization, fast elimination half time; low blood level. Articaine inactivates in both ways: in the liver and the blood serum. It has good spreading through tissues. Thus, articaine seems to be the local anesthetic of first choice in tissues with suppurative inflammation, for adults, children (over 4), elderly, pregnant women, breastfeeding women, patients suffering from hepatic disorders and renal function impairment. In Articaine solutions (1: 200,000) epinephrine is in low concentration, thus in patients at high risk adverse responses are maximally decreased. In these patients articaine should be used with careful consideration of risk/benefit ratio. Articaine solutions must not be used in persons who are allergic or hypersensitive to sulphite, due to content of Sodium metabisulfite as vasoconstrictor's antioxidant in it. Incidence of serious adverse effects related to dental anesthesia with articaine is very low. Toxic reactions are usually due to an inadvertent intravascular injection or use of excessive dose. To avoid overdoses maximum recommendation dose (MRD) must not be exceeded and aspiration test always performed prior all LA injections. In these article we introduce new graphs providing a quick and effect way to determine maximum LA dose. If the overdose reactions develop, adherence to the basic step of emergency management with end to a successful outcome in virtually all cases. PMID:21346262
Nizharadze, N; Mamaladze, M; Chipashvili, N; Vadachkoria, D
Effective management of area-wide integrated pest management (AW-IPM) programmes that integrate the sterile insect technique (SIT) is key to success. Programme planning includes collection of baseline data and a feasibility assessment. The optimal management structure is where the programme can be implemented effectively and flexibly, independent of government politics, bureaucracy, and even corruption that impede timely goal achievement. Ideally, programmes
V. A. DYCK; J. Reyes Flores; M. J. B. VREYSEN; E. E. REGIDOR FERNÁNDEZ; T. Teruya; B. Barnes; P. Gómez Riera; D. Lindquist; M. Loosjes
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
Abstract—A cognitive radio must,detect the presence of primary,users to avoid,interfering with them. This report summarizes,the research work,done in the field of spectrum sensing in terms of (1) Receiver Detection, and (2) Interference Management.,This report also revisits the recent collaborative strategies that have been proposed,to solve the spectrum,sensing problem. Index Terms—Spectrum Sensing, Receiver Detection, Interference Management, Cooperative Techniques for Spectrum,Sensing
This article provides some insight into the basic science and concepts relevant to the use of local anesthetics by clinicians in the management of their patients, including a brief history of the development of local anesthetics and their physical properties, effectiveness, uses, limitations, and safety considerations. A generalized overview of the mechanism of action is also provided. The molecular detail of local anesthetics and voltage-gated ion channels can form the basis of understanding of (1) future developments in this area, and (2) toxicity. Most of the peer-reviewed literature related to this topic stems from work in adult humans and animals. PMID:24093648
An anger-aggression management curriculum utilizing cognitive-behavioral principles and techniques was evaluated for its effects on a classroom of urban, at risk middle school students. The 10-session curriculum was taught over a 5-week period to a racially integrated classroom of 22 males and females. Heavy use of video symbolic modeling was integrated with techniques of self-instruction, problem solving and self-monitoring. Significant
A technique for the management of anterior flail chest consisting of osteosynthesis and the positioning of two long Kirschner wires behind the sternum in the form of a St Andrew's cross is described. The procedure is easy to perform, the patient is ambulant early, and the results are good. Images
Guernelli, N; Bragaglia, R B; Briccoli, A; Mastrorilli, M; Vecchi, R
We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.
SUMMARY - It is largely recognized that shifting from a reactive to a proactive approach is necessary to face successfully hydrological drought risk. Nonetheless, such an change in drought management requires the support of several methods and techniques that can find application both for planning mitigation actions as well as for implementing the measures. In the paper a planning framework
The structural equation modelling (SEM) technique has been touted as a useful tool for tightening links between theoretical and empirical operations management (OM) research. Despite SEM's increasing prominence in the field, leading scholars continue to call for a deeper infusion of theory into empirical OM research. To strengthen ties between theory and analysis in OM research, this study evaluates previous
Nicholas Roberts; Jason Bennett Thatcher; Varun Grover
Power density continues to increase exponentially with each new technology generation, posing a major challenge for thermal management in modern processors. Much past work has examined microarchitectural policies for reducing total chip power, but these techniques alone are insufficient if not aimed at mitigating individual hotspots. The industry's current trend has been toward multicore architectures, which provide additional opportunities for
Power density continues to increase exponentially with each new technology generation, posing a major challenge for thermal management in modern processors. Much past work has examined microarchitectural policies for reducing total chip power, but these techniques alone are insufficient if not aimed at mitigating individual hotspots. The industry's cur- rent trend has been toward multicore architectures, which provide additional opportunities
In this study, we explored the use of selected visual techniques (e.g. video, photography, diagramming) in facilitating learning among Indigenous communities living in remote protected areas at sites in Vietnam and Australia. The techniques were employed during interviews and workshops aimed at accessing and enhancing local peoples' perspectives on their landscape and on specific natural resource management issues. The effectiveness of the different techniques for enabling learning varied markedly with the context, highlighting the need for facilitator skill and flexibility in application of techniques. Visual techniques helped to engage participants; encourage unrestrained and lateral thinking; provide opportunities for self-expression and reflection; and to expose participants to perspectives of other community members. Valuable insights emerged on broad aspects of learning and these were incorporated into a simple model that highlights three types of conceptualisation found to be important in these processes. PMID:21733618
Obesity is a worldwide health problem and its prevalence is reaching epidemic proportions. As obesity does not spare women of childbearing age, obstetric anesthesiologists will increasingly be exposed to the challenges of anesthesia in this population. The purpose of this article is to give the reader a thorough understanding of the anesthetic implications of obesity relating to cesarean deliveries. Obesity is associated with hypertension, diabetes, obstructive sleep apnea and other comorbidities. It increases the risk of cesarean delivery, postpartum wound infections and deep venous thromboembolism. Obese parturients are prone to anesthetic complications such as aspiration of gastric contents, difficult monitoring, positioning, airway management and challenging neuraxial techniques. A thorough precesarean delivery preparation should include an evaluation by an anesthesiologist for women with a BMI over 40 kg/m² and institution of an antacid prophylaxis protocol, thromboprophylaxis and antibiotic prophylaxis. Regional anesthesia should ideally be used in all obese parturients unless contraindicated. The goals of postpartum care include efficacious analgesia, physiotherapy and early mobilization. Monitoring and vigilance in an intensive care unit or step-down units should be considered for morbidly obese women. PMID:21410344
This study was undertaken to develop an anesthetized dog heatstroke model. Forty-six animals were anesthetized with Sodium pentobarbital (25 mg/kg) intravenously, and maintained at an ambient temperature of 42-46 C with a water heating blanket over 2.5 to...
This study aimed to identify the techniques used by manipulative physiotherapists in the management of headaches. Two hundred and two patients with headache presented to 44 Victorian trained manipulative physiotherapists (MPTs) who completed questionnaires to determine techniques used. Upper cervical (O-C3) passive accessory intervertebral movement was the most frequently used technique (84.7 per cent). Techniques such as manipulation (42.1 per cent), soft tissue massage (35.6 per cent), postural education/advice (30.2 per cent), muscle stretches (29.2 per cent), traction (26.7 per cent) and postural exercises (21.3 per cent) were usually introduced during the initial consultation, whereas passive physiological intervertebral movements (17.3 per cent), muscle retraining (16.8 per cent) and neural techniques (5.4 per cent) were more commonly introduced in later sessions. The low incidence of muscle retraining was surprising and may not reflect contemporary practice. The results indicate that the clinicians studied employ a diverse range of techniques in the management of headaches. PMID:11676805
Nanogels are robust nanoparticles that could be used to deliver active drug compounds in controlled drug delivery applications. This review discusses the design, synthesis, loading, and release of local anesthetics using polymeric nanoparticles produced via various types of polymerization techniques. The strategy of using layer-by-layer approach to control the burst release of procaine hydrochloride (PrHy; a local anesthetic drug of the amino ester group) is described and discussed.
At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk ManagementTechniques 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 managementtechniques 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.
The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.
The experience of clinical use of the new Russian myorelaxant of the non-depolarizing action vero-pipecuronium (pipecuronium bromided) manufactured by "Veropharm" is described. Vero-pipecuronium was found to ensure splendid and good conditions for the intubation of the trachea and to maintain reliably myorelaxation. The recommended doses and availability of an antidote (prozerine) provide for a sufficiently controllable myorelaxation. Vero-pipecuronium does not virtually exert any effect on the parameters of hemodynamics and can be successfully used in patients with a high anesthetic risk including heart surgeries. Thus, Russian vero-pipecuronium has now an effective and safe myorelaxant manufactured inside the country, whose parameters are not inferior to those of pipecuronium bromide (arduan) manufactured by "Gedeon Richter", Hungary. Since the described drug is made in Russia, one can hope it will be highly effective both economically and pharmacologically. PMID:15573726
Buniatian, A A; Vyzhigina, M A; Mizikov, V M; Deshko, Iu V; Kozhevnikov, V A; Zhukova, S G; Batchaev, Sh S
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.
Mounier Kuhn syndrome, or congenital tracheobronchomegaly, is an under diagnosed clinical entity with peculiar anatomical and physiological features making anesthetic care challenging. A 58-year-old chronic smoker with history of recurrent pneumonia and bronchiectasis presented for septoplasty. Thoracic imaging revealed a dilated trachea and main bronchi, tracheal and bronchial diverticuli, and chronic bronchiectasis with mediastinal lymphadenopathy. An 8.5 cuffed endotracheal tube (ETT) proved too big for his glottic aperture. An 8.0 cuffed ETT with wet gauze packing yielding an adequate seal. Postoperative continuous positive airway pressure to prevent airway collapse followed awake extubation. Anesthetic concerns include grossly enlarged and weakened airways, inefficient cough mechanisms, presence of tracheal diverticuli, and post operative tracheal collapse. Anesthetic planning includes management of endotracheal cuff size. Small size yields air leak and ineffective ventilation. Large size may lead to mucosal damage. Tube dislodgement, copious secretions, chance of expiratory collapse due to the abnormally dilated and thin airways, and post operative monitoring all must be considered. PMID:22606408
Ushakumari, Deepu Sasikumaran; Grewal, Navneet; Green, Michael
Mounier Kuhn syndrome, or congenital tracheobronchomegaly, is an under diagnosed clinical entity with peculiar anatomical and physiological features making anesthetic care challenging. A 58-year-old chronic smoker with history of recurrent pneumonia and bronchiectasis presented for septoplasty. Thoracic imaging revealed a dilated trachea and main bronchi, tracheal and bronchial diverticuli, and chronic bronchiectasis with mediastinal lymphadenopathy. An 8.5 cuffed endotracheal tube (ETT) proved too big for his glottic aperture. An 8.0 cuffed ETT with wet gauze packing yielding an adequate seal. Postoperative continuous positive airway pressure to prevent airway collapse followed awake extubation. Anesthetic concerns include grossly enlarged and weakened airways, inefficient cough mechanisms, presence of tracheal diverticuli, and post operative tracheal collapse. Anesthetic planning includes management of endotracheal cuff size. Small size yields air leak and ineffective ventilation. Large size may lead to mucosal damage. Tube dislodgement, copious secretions, chance of expiratory collapse due to the abnormally dilated and thin airways, and post operative monitoring all must be considered.
Ushakumari, Deepu Sasikumaran; Grewal, Navneet; Green, Michael
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.
Multiple surgeries are often required to manage segmental bone loss because of the complex mechanics and biology involved in reconstruction. These procedures can lead to prolonged recovery times, poor patient outcomes, and even delayed amputation. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge. In the first stage, a polymethyl methacrylate spacer is placed in the defect to produce a bioactive membrane, which appears to mature biochemically and physically 4 to 8 weeks after spacer placement. In the second, cancellous autograft is placed within this membrane and, via elution of several growth factors, the membrane appears to prevent graft resorption and promote revascularization and consolidation of new bone. Excellent clinical results have been reported, with successful reconstruction of segmental bone defects >20 cm. PMID:22382286
Taylor, Benjamin C; French, Bruce G; Fowler, T Ty; Russell, Jeremy; Poka, Attila
The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention.
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 managementtechniques to extend the use, and has certain practical and guidance significances.
Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease. PMID:23347550
In our previous work, we have presented the performability manager, a distributed environment component that, using a model-based approach, realizes and maintains user-requested QoS. Generic modelling and monitoring techniques are inevitable for such a model-based approach. The planning of user-requested QoS is done by the evaluation of automatically created models out of a library of model components, while achieved QoS is checked using monitoring. In this paper we experiment with the generic modelling and monitoring of a multimedia service in an open distributed processing environment. We both use simulation and numerical techniques to evaluate the models. In this particular case study, end-user requested QoS is specified by throughput, mean end-to-end delay and delay-jitter.
Franken, Leonard J. N.; Haverkort, Boudewijn R. H. M.
A patent, unobstructed airway is fundamental in the care of the trauma patient, and is most often obtained by placing a cuffed tube in the trachea. The presence of shock, respiratory distress, a full stomach, maxillofacial trauma, neck hematoma, laryngeal disruption, cervical spine instability, and head injury all combine to increase tracheal intubation difficulty in the trauma patient. Complications resulting from intubation difficulties include brain injury, aspiration, trauma to the airway, and death. The use of devices such as the gum-elastic bougie, McCoy laryngoscope, flexible and rigid fiberscopes, intubating laryngeal mask, light wand, and techniques such as rapid-sequence intubation, manual in-line axial stabilization, retrograde intubation, and cricothyroidotomy, enhance the ability to obtain a definitive airway safely. The management of the failed airway includes calling for assistance, optimal two-person bag-mask ventilation, and the use of the laryngeal mask airway, Combitube, or surgical airway. The simulation of airway management using realistic simulator tools (e.g. full-scale simulators, virtual reality airway simulators) is a promising modality for teaching physicians and advanced life support personnel emergency airway management skills. PMID:17016402
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
Whereas converging lines of evidence suggest that anesthetic-induced unconsciousness may result from disruption of functional interactions within neural networks involving the thalamus and cerebral cortex, the effects anesthetics have on human thalamocortical connectivity remain unexamined with current neuroimaging techniques. To address this issue we retrospectively analyzed positron emission tomography data from 11 volunteers scanned for regional cerebral glucose utilization (rCMRglu)
The superfamily of ligand-gated ion channels (LGICs) has been implicated in anesthetic and alcohol responses. Mutations within glycine and GABA receptors have demonstrated that possible sites of anesthetic action exist within the transmembrane subunits of these receptors. The exact molecular arrangement of this transmembrane region remains at intermediate resolution with current experimental techniques. Homology modeling methods were therefore combined with
Edward J. Bertaccini; Jessica Shapiro; Douglas L. Brutlag; James R. Trudell
Fish discards and by-catch issues are highly topical subjects that are permanently under a social focus. Two main approaches are being considered to address this discard problem: reducing the by-catch and increasing by-catch utilization. Interest in increased by-catch valorization may arise from a greater demand for fish products, such as the development of new markets for previously discarded species, the use of low-value specimens for aquaculture or the creation of value-added fish products for the food, pharmaceutical or cosmetic industries. However, contaminants present in fish discards may be transferred to their valorized products, leading to possible long-term bioaccumulation and subsequent adverse health effects. In this valorization framework, the aim is to promote responsible and sustainable management of marine resources. The pollutant levels in catches from European fisheries and the best available decontamination techniques for marine valorized discards/by-products are compiled and analyzed in this work. PMID:22542692
Antelo, Luis T; Lopes, Carla; Franco-Uría, Amaya; Alonso, Antonio A
As chip power dissipation becomes a critical challenge in scaling processor performance, computer architects are forced to fundamentally rethink the design of modern processors and hence, the chip-design industry is now at a major inflection point in its hardware roadmap. The high leakage power and low density of SRAM poses serious obstacles in its use for designing large on-chip caches and for this reason, researchers are exploring non-volatile memory (NVM) devices, such as spin torque transfer RAM, phase change RAM and resistive RAM. However, since NVMs are not strictly superior to SRAM, effective architectural techniques are required for making them a universal memory solution. This book discusses techniques for designing processor caches using NVM devices. It presents algorithms and architectures for improving their energy efficiency, performance and lifetime. It also provides both qualitative and quantitative evaluation to help the reader gain insights and motivate them to explore further. This book will be highly useful for beginners as well as veterans in computer architecture, chip designers, product managers and technical marketing professionals.
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.
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. PMID:24015145
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 ...
Current project management literature exhibits a rise in popularity (at least in discussion) of Critical Chain Project Management (CCPM), a management concept based on Eli Goldratt's Theory of Constraints. Some of the literature notes this to be a signifi...
Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. This article provides anesthesiologists with an overview of seizures in the pediatric population, including evaluation, medical treatment, surgical options, and the anesthetic implications of caring for this special population. PMID:22901606
The administration of anesthesia to patients undergoing lung volume reduction surgery (LVRS) requires a complete understanding of the pathophysiology of severe chronic obstructive pulmonary disease, the planned surgical procedure, and the anticipated postoperative course for this group of patients. Risk factors and associated morbidity and mortality are discussed within the context of patients with obstructive pulmonary disease in the National Emphysema Treatment Trial having surgical procedures. Preoperative evaluation and the anesthetictechniques used for patients undergoing LVRS are reviewed, as are monitoring requirements. Intraoperative events, including induction of anesthesia, lung isolation, management of fluid requirements, and options for ventilatory support are discussed. Possible intraanesthetic complications are also reviewed, as is the optimal management of such problems, should they occur. To minimize the potential for a surgical air leak in the postoperative period, positive-pressure ventilation must cease at the conclusion of the procedure. An awake, comfortable, extubated patient, capable of spontaneous ventilation, is only possible if there is careful attention to pain control. The thoracic epidural is the most common pain control method used with patients undergoing LVRS procedures; however, other alternative methods are reviewed and discussed.
Brister, Neil W.; Barnette, Rodger E.; Kim, Victor; Keresztury, Michael
The administration of anesthesia to patients undergoing lung volume reduction surgery (LVRS) requires a complete understanding of the pathophysiology of severe chronic obstructive pulmonary disease, the planned surgical procedure, and the anticipated postoperative course for this group of patients. Risk factors and associated morbidity and mortality are discussed within the context of patients with obstructive pulmonary disease in the National Emphysema Treatment Trial having surgical procedures. Preoperative evaluation and the anesthetictechniques used for patients undergoing LVRS are reviewed, as are monitoring requirements. Intraoperative events, including induction of anesthesia, lung isolation, management of fluid requirements, and options for ventilatory support are discussed. Possible intraanesthetic complications are also reviewed, as is the optimal management of such problems, should they occur. To minimize the potential for a surgical air leak in the postoperative period, positive-pressure ventilation must cease at the conclusion of the procedure. An awake, comfortable, extubated patient, capable of spontaneous ventilation, is only possible if there is careful attention to pain control. The thoracic epidural is the most common pain control method used with patients undergoing LVRS procedures; however, other alternative methods are reviewed and discussed. PMID:18453351
Brister, Neil W; Barnette, Rodger E; Kim, Victor; Keresztury, Michael
PM. The blockade started im- mediately when OND was applied to the cell body us- ing a fast perfusion system, reached a plateau within 15 s, and recovered to the control level within 30 s after washout of the OND-containing solution. Because this is a known property of local anesthetics, we used the tail-flick technique to verify this effect in
Jiang Hong Ye; Wui Chiu Mui; Jun Ren; Thurman E. Hunt; Wen-Hsien Wu; Vlasta K. Zbuzek
This paper proposes an authentication technique for use in the global mobility network (GLOMONET), which provides a personal communication user with global roaming service. This technique is based on new distributed security management, where authentication management in roaming-service provision is conducted only by the roamed network (the visited network). The original security manager (OSM) administrates the original authentication key (OAK)
The use of various nonpharmacologic behavior managementtechniques 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
The aim of this research paper is to study risk management system and to find some tools and techniques recommended by different journals and articles. We have gone through different approaches in context of risk management. We have taken risk management paradigm introduced by Software Engineering Institute as our standard to analyze different techniques and tools. Different features have been
|These Project TEAMS (Techniques and Education for Achieving Management Skills) instructional materials consist of five units for use in training business and industrial supervisors. Unit 1 is designed to help managers in business or industry increase management skills in regard to leadership techniques, problem solving and decision making, and…
General anesthetic drugs interact with many receptors in the nervous system, but only a handful of these interactions are critical for producing anesthesia. Over the last 20 years, neuropharmacologists have revealed that one of the most important target sites for general anesthetics is the GABAA receptor. In this review we will discuss what is known about anesthetic – GABAA receptor interactions.
This paper describes the development of a management model to control barriers devised to prevent major hazard scenarios. Additionally, an audit technique is explained that assesses the quality of such a management system. The final purpose of the audit technique is to quantify those aspects of the management system that have a direct impact on the reliability and effectiveness of the barriers and, hence, the probability of the scenarios involved. First, an outline of the management model is given and its elements are explained. Then, the development of the audit technique is described. Because the audit technique uses actual major hazard scenarios and barriers within these as its focus, the technique achieves a concreteness and clarity that many other techniques often lack. However, this strength is also its limitation, since the full safety management system is not covered with the technique. Finally, some preliminary experiences obtained from several test sites are compiled and discussed. PMID:16111813
Local anesthetics effectively block and relieve pain, but with a relatively short duration of action, limiting its analgesic\\u000a effectiveness. Therefore, a long-acting local anesthetic would improve the management of pain, but no such agent is yet available\\u000a for clinical use. The aim of this study is to evaluate the potentiation of the anesthetic effect of neosaxitoxin, with bupivacaine\\u000a or epinephrine
Alberto J. Rodriguez-Navarro; Marcelo Lagos; Cristian Figueroa; Carlos Garcia; Pedro Recabal; Pamela Silva; Veronica Iglesias; Nestor Lagos
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…
The rating of acceptability by parents either in groups of five or alone of behavior managementtechniques (BMT) displayed in videotaped vignettes was studied. Ratings of acceptability of the techniques for use on \\
Purpose – The aim of this paper is to determine whether the adoption of managementtechniques influences organizational performance and to determine the antecedents of adoption. Design\\/methodology\\/approach – This paper uses a survey method to collect data from 106 large businesses in multiple industries. Findings – The findings suggest that the adoption of managementtechniques influences organizational performance, especially when
This article describes the effort to join two different approaches for the development of the proactive network management. The first approach was developed in the Laboratory of Network and Management, at Federal University of Santa Catarina, which uses remote monitoring and simulation tools. The second one, was developed in the National Supercomputing Center, which handles the problem with artificial intelligence
A. S. M. de Franceschi; M. A. da Rocha; H. L. Weber; C. B. Westphall
Emergency room management means time management. A time and four color based algorithm is described to improve workflow, follow up of diagnostic procedures and initial treatment. As a result introducing the time based interdisciplinary emergency algorithm within 60 minutes all necessary treatment and diagnostic procedures were completed. This algorithm is an effective tool to improve emergency room treatment. PMID:11995228
Beck, A; Gebhard, F; Fleiter, Th; Pfenninger, E; Kinzl, L
The safety benefits of access management, the controlling of access points on roadways, have been proven and have been well documented in past research. However, there is limited research on the economic impacts of access management, and most existing research is qualitative. Further quantitative research is needed because commercial business owners believing that direct and complete access to their land
The American Society for Pain Management Nursing believes that the administration of analgesia and the management of the associated effects are fundamental nursing responsibilities. This position statement will address the registered nurse’s responsibilities for the management and monitoring of analgesia by catheter techniques in all patients of all ages and in all care settings. It will provide recommendations for the
Chris Pasero; Nancy Eksterowicz; Maggie Primeau; Charlene Cowley
The purpose of this study was to determine whether parental social status influences preference toward behavior managementtechniques used during dental treatment of children. One hundred and twenty-two parents from two private practices and one institutional site completed a questionnaire and rated eight commonly used behavior managementtechniques. These techniques were tell-show-do, nitrous oxide~oxygen, Papoose Board@ (Olympic Medical Group, Seattle,
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.
\\u000a Approximately 600,000 severe head injuries occur annually in the United States, with a mortality rate of 17\\/100,000. Death\\u000a rates peak between 17–24 and over 75 years of age (1). Overall mortality of trauma patients complicated by head injury (18%) is three times higher than if no head injury occurred\\u000a (2). This mortality was little influenced by extracranial injuries except when
With increasing complexity of construction industry problems, researchers are experimenting with computationally rigorous techniques with the aim of seeking innovative solutions. In order to trace the applications of quantitative analysis techniques to research in the two fields of construction economics and construction management for both conventional and AI techniques, the methodology involves compiling all the relevant papers from the top
|The final report of a project on teaching and managementtechniques with severely disturbed and/or retarded children presents analysis of single subject research using contingent imitation of the child as an intervention technique. The effects of this technique were examined on the following behaviors: toyplay and reciprocal imitation, self…
Total Quality Management (TQM) is a new management philosophy and a set of guiding principles that represent the basis of a continuously improving organization. This paper sheds light on the application of TQM concepts for software development. A fieldwork study was conducted on a Lebanese software development firm and its customers to determine the major problems affecting the organization's operation and to assess the level of adoption of TQM concepts. Detailed questionnaires were prepared and handed out to the firm's managers, programmers, and customers. The results of the study indicate many deficiencies in applying TQM concepts, especially in the areas of planning, defining customer requirements, teamwork, relationship with suppliers, and adopting standards and performance measures. One of the major consequences of these deficiencies is considerably increased programming errors and delays in delivery. Recommendations on achieving quality are discussed. PMID:10589453
No significant complications including retrobulbar orbital hemorrhage after retrobulbar anesthetic block were identified in a retrospective review of 3,415 consecutive cataract surgical cases blocked and performed by one surgeon. The technique for retrobulbar injections using a disposable retrobulbar needle is described in detail. All injections were deliberately retrobulbar, directed toward the inferior temporal muscle cone, and were given immediately prior to cataract surgery by the surgeon. PMID:8487175
The purpose of this paper is to informally lay out for health planning agencies the basic principles of personal time management. It does not address the general problem of budgeting overall staff time through the use of agency work programs. Rather, it f...
Summary form only given as follows. Many companies are attaining a significant competitive advantage through the adoption of new technology. However, for senior management to fully commit themselves to the level of expenditure associated with the attainment of a competitive advantage, they need to be convinced of the business justification of such investments. Analysis of the literature demonstrates that a
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
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…
High-resolution magnetic resonance imaging (MRI) provides non-invasive images of retinal anatomy, physiology, and function with depth-resolved laminar resolution. Eye movement and drift, however, could limit high spatial resolution imaging, and anesthetics that minimize eye movement could significantly attenuate retinal function. The aim of this study was to determine the optimal anesthetic preparations to minimize eye movement and maximize visual-evoked retinal response in rats. Eye movements were examined by imaging of the cornea with a charge-coupled device (CCD) camera under isoflurane, urethane, ketamine/xylazine, and propofol anesthesia at typical dosages in rats. Combination of the paralytic pancuronium bromide with isoflurane or ketamine/xylazine anesthesia was also examined for the eye movement studies. Visual-evoked retinal responses were evaluated using full-field electroretinography (ERG) under isoflurane, ketamine/xylazine, urethane, and ketamine/xylazine + pancuronium anesthesia in rats. The degree of eye movement, measured as displacement per unit time, was the smallest under 1% isoflurane + pancuronium anesthesia. The ketamine/xylazine groups showed larger dark-adapted ERG a- and b-waves than other anesthetics tested. The isoflurane group showed the shortest b-wave implicit times. Photopic ERGs in the ketamine/xylazine groups showed the largest b-waves with the isoflurane group showing slightly shorter implicit times at the higher flash intensities. Oscillatory potentials revealed an early peak in the isoflurane group compared with ketamine/xylazine and urethane groups. Pancuronium did not affect the a- and b-wave, but did increase oscillatory potential amplitudes. Compared with the other anesthetics tested here, ketamine/xylazine + pancuronium was the best combination to minimize eye movement and maximize retinal function. These findings should set the stage for further development and application of high-resolution functional imaging techniques, such as MRI, to study retinal anatomy, physiology, and function in anesthetized rats. PMID:21519880
Nair, Govind; Kim, Moon; Nagaoka, Tsukasa; Olson, Darin E; Thulé, Peter M; Pardue, Machelle T; Duong, Timothy Q
There is conflicting information in the literature regarding nerve damage following regional anesthesia. Intraneural injection of local anesthetic was described as a safe practice in regional anesthesia. This review focuses on the histopathological and functional assessment of peripheral nerve function following intraneural injection of local anesthetics.
In the nematode C. elegans, immobility induced by the anesthetic halothane is coupled to its ability to modulate neuronal resting membrane potential, perhaps through effects on leak channels; a similar anesthetic, isoflurane, appears to work a different way. PMID:22192828
The report presents a comprehensive compilation and data base of volume reduction techniques for low-level radioactive wastes generated in fuel cycle and non-fuel cycle facilities. Discussions of the volume reduction techniques are provided to include system descriptions, system performance data, volume reduction capabilities, process parameters, system limitations, and operating experience. An economic analysis is presented for shredding and compaction, incineration, calcination, evaporation/crystallization, and bituminization. PWR, BWR and non-fuel cycle scenarios are evaluated for volume reduction techniques used at a waste generator's facility and on a regional basis. The economic analyses estimate cost of capital equipment, construction, operation, processing, transportation, and disposal at the Barnwell, SC and the Hanford, WA disposal sites.
Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus. PMID:23546356
Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus.
Collisions between birds and aircraft (birdstrikes) have caused the loss of at least 88 aircraft and 243 lives in world civil aviation. Conservative estimates suggest that more routine damage and delays following birdstrikes cost the industry and its insurers US$1.2–1.5 billion per year. The majority of strikes happen close to airports and most countries have regulations that require airport managers
Anomaly detection has become more and more difficult for telecommunication network due to the various trends of networking technologies and the growing number of unauthorized activities in the performance data. This paper builds up a performance management system based on the one-class-support vector machine (OCSVM) and k-means clustering algorithm, which achieves not only the automatic detection of network anomalies but
A survey of earlier works is given with particular emphasis on optimization models and solution techniques. First, a multilevel model of the different ATC functions is proposed. Then, attention is devoted to the on-line control functions (flow control, on...
|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)|
The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients. PMID:22983540
Antoniou, George A; Schiro, Andrew; Antoniou, Stavros A; Farquharson, Finn; Murray, David; Smyth, J Vincent; Serracino-Inglott, Ferdinand
While an important factor in depth perception, the occlusion effect in 3D environments also has a detrimental impact on tasks involving discovery, access, and spatial relation of objects in a 3D visualiza- tion. A number of interactive techniques have been developed in recent years to directly or indirectly deal with this problem using a wide range of different approaches. In
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
These techniques determine when to speed up a processor to reach performance targets and when to slow it down to save energy. They use dynamic voltage and frequency scaling to balance speed and avoid worst case frequency limitations for both multiple-clock-domain and chip multiprocessors.
Qiang Wu; Philo Juang; Margaret Martonosi; Li-shiuan Peh; Douglas W. Clark
We have developed computer software to store data on all surgical and obstetrical anesthetics administered by our department. The computer system provides information for monitoring the residency training program, department and operating room management, professional fee billing, and research. It imposes little additional workload on our clinical personnel, who use simple codes to record the necessary data directly on the anesthetic record. Department secretarial staff transcribe data from the anesthesia and operating room records into the computer file, which is then available for producing scheduled reports and for answering inquiries from a video terminal. The system employs extensive manual and computer verification to minimize errors and omissions in the data. We report design details and more than 3.5 years experience with this system, which is now used at four affiliated teaching hospitals, has over 50,000 cases on file, and adds more than 1800 cases monthly. PMID:3838630
This tape contains the USAC Municipal Data ManagementTechnique Module (DMT) for the Reading, Pennsylvania Integrated Municipal Information System (IMIS). Information on the tape includes the source code for existing root logic sets, linkage logic sets (A...
This study is designed to acquaint members of the Defense Systems Acquisition Management Community with the fundamental operating characteristics of a stochastic networking simulation scheme known as GERT(Graphical Evaluation Review Technique). The develo...
Purpose: The objective of this study was to examine parental attitudes toward behavior managementtechniques currently used in pediatric dentistry. Methods: Fifty-five parents viewed videotaped scenes of 8 behavior management tech- niques being used during actual pediatric dental treatment. The 8 techniques shown were: (1) tell-show-do; (2) nitrous oxide sedation; (3) passive restraint; (4) voice control; (5) hand-over-mouth; (6) oral
Jonathan J. Eaton; Dennis J. McTigue; Henry W. Fields; F. Michael Beck
For lesions smaller than 4 cm, nephron-sparing surgery has been shown to be oncologically equivalent to radical nephrectomy, albeit with the advantage of preservation of overall renal function. As such, partial nephrectomy became the first-line treatment option for localized, small renal masses. Minimally invasive options associated with limited morbidity--such as probe-ablative procedures--are, however, being investigated in selected patients for whom invasive, nephron-sparing surgery (whether laparoscopic or open) is undesirable. The main probe-ablative techniques being investigated as alternatives to partial nephrectomy are cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. Advances in imaging, ablative system technologies, and early evidence that in situ tumor ablation can yield comparable results to those achieved with tumor resection in selected cases, have sparked significant interest in these minimally invasive techniques. PMID:17483811
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: firstname.lastname@example.org [University of Pennsylvania, Department of Clinical Radiology, Children's Hospital of Philadelphia (United States); Cahill, Anne Marie, E-mail: email@example.com [University of Pennsylvania, Department of Radiology, Children's Hospital of Philadelphia (United States)
Security is one of the major issues in MANETs. Their natural characteristics make them vulnerable to numerous severe attacks. It is widely acknowledged that cryptography provides a set of strong techniques against most vulnerabilities. Several cryptographic mechanisms for MANETs can be found in the literature. Among them, identity-based cryptographic mechanisms and key management schemes are proposed to simplify key management
EDUARDO DA SILVA; ALDRI L. DOS SANTOS; L. C. P. Albini; MICHELE N. LIMA
|Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…
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
A wireless sensor network (WSN) comprises many sensor nodes each one containing a processing unit, one or more sensors, a power unit, and a radio for data communication. Nodes are power constrained, because they run on batteries, that in many cases cannot be easily replaced. In this paper present a novel dynamic power managementtechnique, named Dynamic Power Management with
P. S. Sausen; J. R. B. Sousat; M. A. Spohn; A. PerkusichO; A. M. N. Lima
Purpose – This paper seeks to present an empirical snapshot of the application of operations management (OM) activities in Australian service firms. The four key areas addressed in this study are the nature or characteristics of services, the level of importance of OM techniques, the level of importance of performance indicators, and the challenges encountered by the management of service
Previous studies have shown that teachers' aggressive classroom management impacts negatively on students. The authors compared student reaction to teachers' use of aggressive managementtechniques 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
|Prepared as part of Platte Technical Community College's project to help managers and supervisors develop practical, up-to-date managerial skills in a relatively short time, this instructional workbook provides information and exercises applicable to on-the-job situations. Unit I focuses on time management, the causes and management of stress,…
Prostate cancer is diagnosed in younger men who want treatment that does not compromise their quality of life, take time away from work, or cause worrisome side effects. Laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, and third-generation cryotherapy are modifications of previously used techniques in the treatment of prostate cancer and are presented in this article. Although some or all of the outcomes might be expected to change in the future, the urologic surgeon is left to select an approach, presumably on the basis of the experience, level of training, and care pathways at his or her institution.
The ideal treatment for posterior cruciate ligament (PCL) injuries is controversial and remains an active area of orthopedic research. The indications for surgery and the ideal method of reconstruction continue to be evaluated in biomechanical and clinical studies. Recent research has provided information on the anatomy and biomechanics of the PCL, and the merits and drawbacks of the transtibial compared with the tibial inlay technique, the use of single vs double-bundle reconstruction, and different graft options for reconstruction. This review discusses important factors in the surgical treatment of PCL injuries, with attention to the most current literature on these topics. PMID:23430587
Montgomery, Scott R; Johnson, Jared S; McAllister, David R; Petrigliano, Frank A
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
The ever-increasing concern of property owners, potential property owners, real estate lawyers, and all others associated with the selling and purchasing of such properties, has led to an overwhelming demand for accurate, efficient, and economical site assessment programs. The overriding concern for the majority of these individuals is the possibility of underground storage tanks (UST's), waste deposits, and/or contaminated subsurface soils that may be located at the site. Depending on the nature of the purchase, the location or confirmation of buried waste will be a deciding factor in the decision to purchase toe proposed property. Due to the overwhelming cost of remediation of contaminated sites, and these costs being the sole responsibility of the property owner, it is imperative that the existence and amount of any subsurface contaminants be known prior to the purchase of the property. The recent introduction of two testing techniques has led to a viable solution for dependable, cost effective location and characterization of underground waste deposits. This testing procedure uses infrared thermography as a primary testing method and ground penetrating radar as a secondary investigation technique. Both technologies have been proven effective in numerous nondestructive testing (NDT) applications for many years. However, few companies have fused these technologies to incorporate data results and the testing advantages of each technology for locating and characterizing subsurface waste sites. This method of data fusion has proven to be accurate and cost-effective for gaining detailed information pertaining to subsurface conditions of both large and small sites.
Weil, G.J.; Graf, R.J. (EnTech Engineering, Inc., St. Louis, MO (United States))
Information landscaping--an integration of information mapping, charting, querying and reporting techniques--has been developed to enable the construction of a total quality knowledge management system focusing on a particular subject information field. The techniques apply five major parameters of the Fuzzy commonality model (FCM) including unionization, quantity, continuity or stability, changeability, and critical probability, to construct a series of information maps
Purpose – This paper aims to examine the use of projective techniques for published marketing and management research in the USA. The paper emphasizes the influence that McClelland, Atkinson, Clark and Lowell's study, The Achievement Motive (1953), has had on subsequent research. That work applied quantitative analysis to responses obtained using projective techniques. Design\\/methodology\\/approach – The approaches used in this
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
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.
With the increasing utilization of cardiac implantable electronic devices, the ability to extract leads using the transvenous approach has become important. Devices that are infected and leads that pose a risk to the patient by causing damage to cardiovascular structures, interference with device function or life-threatening arrhythmias should be removed. While the majority of extractions are performed through the vein of implantation, other approaches, such as the femoral approach, are required in some circumstances. Simple traction may be successful in removing the lead in relatively new (<1 year) implants. Older devices invariably require devices such as locking stylets and simple or powered sheaths. With current techniques, complete lead extraction can be achieved in >90% of cases with a major complication rate of <2% and mortality rate of <1%. Transvenous lead extraction should be performed only by experienced operators with the resources to address life-threatening complications. PMID:22908921
Madhavan, Malini; Swale, Matthew J; Gard, Joseph J; Hayes, David L; Asirvatham, Samuel J
Endopyelotomy is currently advocated for management of the obstructed ureteropelvic junction (UPJ). Healing of the stented UPJ occurs by secondary intention. Regardless of the method employed, success rates approach 85%. In order to increase the rate of success, we have devised a method of performing endopyelotomy in conjunction with endoscopic suturing of the incised UPJ. Two methods were developed to allow for the placement of a single absorbable monofilament suture. In the first method, endopyelotomy is carried out in the standard antegrade manner, and endoscopic suturing is performed with the use of a second retroperitoneal access sheath at the UPJ. In the second method, endoscopic placement of the suture is carried out through the standard renal access sheath, with suturing performed via the nephroscope. We have performed endoscopic pyeloplasty in eight patients. With a mean follow-up of 12 months, the procedure was successful in seven of these patients. Endoscopic suturing of the UPJ is technically demanding, but once sufficient expertise is gained, it may be utilized for immediate tissue coaptation, possibly decreasing urinary extravasation and, it is hoped, maximizing the caliber of the UPJ. PMID:8728680
Women living with HIV face unique challenges managing their disease. The purpose of this descriptive, qualitative study was to describe self-managementtechniques reported by 48 women living with HIV in the United States. Participants were involved in one, 90-minute, digitally-recorded focus group exploring aspects of HIV self-management strategies. Descriptive statistics, qualitative description, and content analysis were used to analyze the data. Participants had been living with HIV for an average of 12 years, most (69%) were engaged in routine HIV care (85%) and were currently prescribed antiretroviral therapy. Participants reported using self-managementtechniques: taking personal time (n = 23; 48%), advocacy (n = 12; 25%), sleeping (n = 17, 35%); attending support groups (n = 10; 21%), and attending medical appointments (n = 8; 17%). Nurses can add strategies to enhance HIV self-management to routine clinical care, which may have a positive impact on the health of women living with HIV.
Webel, Allison R.; Dolansky, Mary A.; Henry, Anna G.; Salata, Robert A.
One century after the clinical introduction of cocaine, local anesthesia remains the most important method of pain control in dentistry. Many local anesthetics have been marketed since 1884, and it is likely that attempts to produce drugs that enhance anesthetic efficacy, reduce systemic and local toxicity, and increase nociceptive selectivity, will continue. In addition, new methods of drug administration have been and will be developed to achieve these goals. Of fundamental importance to such improvements are investigations into the pharmacology of drugs with local anesthetic activity and anatomical and physiologic studies pertaining to the reasons why local anesthetics sometimes fail to achieve desired results. This paper reviews recent advances in our understanding of these drugs and their clinical use. ImagesFig. 1
Text VersionPage 1. Page 1 Anesthetic and Life Support Drugs Advisory Committee Briefing Document Cymbalta (duloxetine) Chronic Pain ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials
...6100 Section 872.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices Â§ 872.6100 Anesthetic warmer. (a)...
Renal cell apoptosis contributes significantly to the pathogenesis of acute renal failure. Local anesthetics induce apoptosis in neuronal and lymphocytic cell lines. We examined the effects of chronic (48 h) local anesthetic treatment (lidocaine, bupivacaine and tetracaine) on human proximal tubular (HK-2) cells. Apoptosis induction was assessed by detecting poly(ADP)-ribose polymerase fragmentation, caspase activation, terminal deoxynucleotidyl transferase biotin-dUTP nick end
H. Thomas Lee; Hua Xu; Cory D. Siegel; Igor E. Krichevsky
The neural mechanisms behind anesthetic-induced behavioral changes such as loss of consciousness, amnesia, and analgesia,\\u000a are insufficiently understood, though general anesthesia has been of tremendous importance for the development of medicine.\\u000a In this review, I summarize what is currently known about general anesthetic actions at different organizational levels and\\u000a discuss current and future research, using systems neuroscience approaches such as
Although empirically well understood in their clinical administration, volatile anesthetics are not yet well comprehended in their mechanism studies. A major conundrum emerging from these studies is that there is no validated model to assess the presumed candidate sites of the anesthetics. We undertook this study to test the hypothesis that the single-celled Paramecium could be anesthetized and served as a model organism in the study of anesthetics. We assessed the motion of Paramecium cells with Expert Vision system and the chemoresponse of Paramecium cells with T-maze assays in the presence of four different volatile anesthetics, including isoflurane, sevoflurane, enflurane and ether. Each of those volatiles was dissolved in buffers to give drug concentrations equal to 0.8, 1.0, and 1.2 EC50, respectively, in clinical practice. We could see that after application of volatile anesthetics, the swimming of the Paramecium cells was accelerated and then suppressed, or even stopped eventually, and the index of the chemoresponse of the Paramecium cells (denoted as I ( che )) was decreased. All of the above impacts were found in a concentration-dependent fashion. The biphasic effects of the clinical concentrations of volatile anesthetics on Paramecium simulated the situation of high species in anesthesia, and the inhibition of the chemoresponse also indicated anesthetized. In conclusion, the findings in our studies suggested that the single-celled Paramecium could be anesthetized with clinical concentrations of volatile anesthetics and therefore be utilized as a model organism to study the mechanisms of volatile anesthetics. PMID:22684567
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 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
A case of bronchobiliary fistula is reported in an adult following liver laceration repair. Since patients with bronchobiliary fistula usually have poor lung condition preoperatively, perioperative respiratory management and intraoperative double-lumen tube insertion assists in the management of these patients.
Purpose – The paper seeks to address the viability of planning and executing the integration of four often independent marketing information managementtechniques, i.e. competitive intelligence (CI), customer relationship management (CRM), data mining (DM) and market research (MR). Design\\/methodology\\/approach – The research presented is a longitudinal, exploratory and descriptive case study, covering a three-year period during a critical development phase
Background and rationale : The purposes of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes were to survey patients, surgical, anesthetic profiles and determine factors related to adverse events. Material and Method : A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia
We investigated the molecular basis for the immobiliz- ing activity of halogenated volatile anesthetics using comparative molecular field analysis. In vivo potency data (expressed as minimum alveolar concentrations) for 69 structurally diverse anesthetics were obtained from the literature. The drugs were randomly divided into a training set (n 52) used to derive the activity model and a test set (n
We examined cultural differences in mothers’ acceptance of and intent to use behavioral parenting techniques for managing\\u000a disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences.\\u000a A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to 8-years participated. Chinese-immigrant\\u000a mothers had more favorable attitudes towards punishment techniques
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;
Le LHC, grand collisionneur de hadrons en cours de construction au CERN, à Genève, pose des problèmes de management particuliers dus au caractère mondial de son financement, de sa construction et sa future utilisation. La gestion technique du projet a donc nécessité la mise en place d'outils spécifiques, qui font largement appel au Web et qui sont décrits ci-dessous. Enfin,
Dynamic power management (DPM) is a design methodology for dynamically reconfiguring systems to provide the requested services and performance levels with a minimum number of active components or a minimum load on such com- ponents. DPM encompasses a set of techniques that achieves energy-efficient computation by selectively turning off (or re- ducing the performance of) system components when they are
Luca Benini; Alessandro Bogliolo; Giovanni De Micheli
A distributed embedded system consists of different processing elements (PEs) communicating via communication links. PEs have various power characteristics and in turn, have different thermal profiles. With new technologies, processor power density is dramatically increased which results in high temperature. This alarming trend underscores the importance of temperature management methods in system design. The majority of proposed techniques to address
The Department of Defense (DoD) is probably the biggest buyer and developer of computer software in the world. Over the years the DoD has developed, implemented, and tested various software managementtechniques. In this paper the authors describe the major formalized techniques and indicate how they could be applied to software development projects in medical environments. The major control technique used to manage the design of a software project is formal, standardized system documentation. The military departments have developed detailed definitions of the required content for the system documents; these can be found in Mil. Std. 7935.1-S and in Mil. Std. 490. The authors present the major documents in the 7935.1-S documentation suite and indicate their appropriate use. The DoD also uses another formal technique, Configuration Management, to control the contents of the documents and to control changes to the system as its development progresses. After the software is installed at one or more sites, the Status Accounting portion of the Configuration Management discipline is used to keep track of the contents of the operating versions of the software out in the field.
This paper presents a control method for a structured compressed air network, fed by a single fixed speed, electrically driven, compressor. A set of suitably controlled valves intercept air at the desired pressure level. The overall system efficiency improves and a reduction in the pressure dynamics is obtained. The target is achieved by applying real-time scheduling techniques to the management
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
This paper presents a research in progress on the use of knowledge engineering and knowledge managementtechniques for the development of a strategic approach for the transfer of professional know-how. This transfer is based on the design of devices for sharing and learning clearly identified knowledge in the oil industry domains. This work is based on a pilot study which
New product development (NPD) is a great challenge for manufacturers. However, empirical research on the impact of innovation managementtechniques (IMT) on innovation performance is seldom reported. An industrial survey is therefore conducted to verify the perceived usefulness of 41 IMT and their impact on innovation performance in Hong Kong electronics and electrical appliances industry. After 153 out of 527
Management of chronic pain is often difficult. Interventional approaches, such as joint injections and nerve blocks, can reduce dependence on opioid therapy, polypharmacy, and long-term costs; they can also dramatically improve pain control and function. However, interventional techniques must be used ethically and judiciously as part of a comprehensive approach to patient-centered care. PMID:23940890
|The result of a project to develop short courses to help business and industrial supervisors in developing practical, up-to-date managerial skills, this instructional workbook provides information and exercises applicable to on-the-job situations. Unit I covers the following aspects of management: leadership techniques, problem solving, decision…
|We examined cultural differences in mothers' acceptance of and intent to use behavioral parenting techniques for managing disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences. A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to…
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 managementtechniques used to complete the TMX-Upgrade within its allocated ...
We examined cultural differences in mothers' acceptance of and intent to use behavioral parenting techniques for managing disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences. A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to…
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
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. PMID:23915963
Chordee with or without hypospadias is usually managed successfully in a fairly straightforward manner. However, on occasion there are patients with severe chordee that cannot be corrected with the standard techniques. In this setting tunica vaginalis grafts, dermal grafts and Nesbit plication techniques have been used but all of these procedures have major drawbacks. During the last 5 years we have used an alternative technique for the correction of severe ventral curvature that persists despite complete resection of fibrous chordee. This technique combines a deep vertical incision between the corporeal bodies ventrally with a series of transverse dorsal plicating sutures to correct chordee. There is no incision into the corporeal bodies and no shortening of the penis as with the Nesbit technique, and potential injury to the neurovascular bundles is minimized. Followup 1 to 5 years later in 6 patients confirms satisfactory chordee correction in all cases. PMID:8326611
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…
Strategies for poverty alleviation in much of Africa have been driven from outside in communities concerned. Potentials of natural resources under the jurisdiction of communities and their local level institutions have never been factored in these strategies. This paper explores the traditional natural resource managementtechniques by the Kalanga people of Bulilimamangwe District of Zimbabwe so that these could be
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 anestheticmanagement, 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
The need for economic analysis for the design and implementation of efficient water resources management policies is well documented in the economics literature. This need is also emphasised in the European Union's recent Water Framework Directive (2000/60/EC), and is relevant to the objectives of Euro-limpacs, an EU funded project which inter alia, aims to provide a decision-support system for valuing the effects of future global change on Europe's freshwater ecosystems. The purpose of this paper is to define the role of economic valuation techniques in assisting in the design of efficient, equitable and sustainable policies for water resources management in the face of environmental problems such as pollution, intensive land use in agriculture and climate change. The paper begins with a discussion of the conceptual economic framework that can be used to inform water policy-making. An inventory of the available economic valuation methods is presented and the scope and suitability of each for studying various aspects of water resources are critically discussed. Recent studies that apply these methods to water resources are reviewed. Finally, an application of one of the economic valuation methods, namely the contingent valuation method, is presented using a case study of the Cheimaditida wetland in Greece. PMID:16647102
Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetictechnique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anestheticmanagement of OI patients with severe anesthetic problems. PMID:23931253
Erdo?an, Mehmet Ali; Sanli, Mukadder; Ersoy, Mehmet Ozcan
Conditioned flavor aversions (CFA) are acquired by anesthetized rats but effects of various anesthetics on acquisition of aversions for separate odor and taste components are unknown. In Experiment 1, rats drank tomato juice and then were tranquilized with \\
Federico Bermudez-Rattoni; Debra L. Forthman; Marco A. Sanchez; Jorge L. Perez; John Garcia
This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective. PMID:23724568
Pain during venipuncture is a major source of concern to children and their caretakers. Iontophoresis is a novel technique that uses an electrical current to facili- tate movement of solute ions (lidocaine) across the stra- tum corneum barrier to provide dermal analgesia. In this study, we compared dermal analgesia provided by lidocaine iontophoresis and eutectic mixture of local anesthetics (EMLA®).
Jeffrey L. Galinkin; John B. Rose; Kathleen Harris; Mehernoor F. Watcha
The Practice Advisory on Liposuction published by the American Society of Plastic Surgeons provides a thorough review of anesthetictechniques and guidelines for surgeons who perform liposuction. However, there is evidence to support several changes to the anesthetic infiltrate guidelines that will improve patient safety. These proposed recommendations will have the most impact on patients undergoing office-based procedures, where dedicated anesthesia providers may not be present, but they should also guide practice in both ambulatory care centers and hospitals. The primary foci of the proposed changes include restrictions on bupivacaine use and creation of lidocaine concentration guidelines. PMID:23629121
Pace, Meredith M; Chatterjee, Abhishek; Merrill, Douglas G; Stotland, Mitchell A; Ridgway, Emily B
The aim of climatisation of anesthetic gases in prolonged anesthesia is to maintain tracheobronchial climate comparable to that of spontaneous nasal breathing. The humidity and temperature of inspired gases attained in the circle system at a fresh gas flow of 6.0, 3.0 and 1.5 l/min are inadequate for prolonged anesthesia. According to the results of our study with the scanning electron microscope, the minimal flow technique (0.5 l/min) leads to major improvement of heat (28 to 32 degrees C) and moisture (20 to 27 mg H2O/l) conditions of anesthetic gases in anesthesia systems. PMID:2260425
Aim: The aim of our study is to value the vasoconstrictor effect of two most utilized topical anesthetics, the first one containing a mixture 2.5% lidocaine and 2.5% prilocaine and the second one containing 4% liposomal lidocaine, in the treatment of vascular lesion during cosmetic dermatologic procedures. Methods: Ten healthy volunteers were enrolled in our department. They showed telangiectasias, measuring between 0.5 and 1 millimeter in diameter on their face and limbs. Five volunteers were randomized to receive topical 4% liposomal lidocaine and five to receive 2.5% lidocaine and 2.5% prilocaine. In all treated areas, the 4% liposomal lidocaine was left for at least 30 minutes and the 2.5% lidocaine and 2.5% prilocaine was left for at least 60 minutes. Results: Clinically, the volunteers who received the 4% liposomal lidocaine showed minimal vasoconstrictor difference between before and after treatment; while the others who received the 2.5% lidocaine and 2.5% prilocaine showed a major vasoconstrictor effect. Furthermore the 4% liposomal lidocaine cream has the advantage of an anesthetic effect after 30 minutes, rather than 60 minutes for the 2.5% lidocaine and 2.5% prilocaine cream. Conclusion: This study demonstrated that the 4% liposomal lidocaine has relatively minor vasoconstrictor effect when compared to the other anesthetic, and it shows how this type of anesthetic allows a clear vision of the lesion during the dermatologic procedures. Furthermore, this cream achieves an anesthetic effect in 30 minutes rather than the 60 minutes required for the other cream, making the first one more suitable for cosmetic dermatologic procedures and for the emergency. PMID:24005138
Carbone, A; Marciani, D; Piemonte, P; Frascione, P
Postanesthetic pain is a relatively common complication after local anesthesia. This complication may be caused by the anesthetictechnique or by the anesthetic solution used. Tissue reactions induced by the anesthetic solutions may be one of the factors resulting in pain after anesthesia. The objective of this study was to comparatively analyze tissue reactions induced by different anesthetic solutions in the subcutaneous tissue of rats. The following solutions were utilized: 2% lidocaine without vasoconstrictor; a 0.5% bupivacaine solution with 1:200,000 adrenaline; a 4% articaine solution and 2% mepivacaine, both with 1:100,000 adrenaline; and a 0.9% sodium chloride solution as a control. Sterilized absorbent paper cones packed inside polyethylene tubes were soaked in the solutions and implanted in the subcutaneous region. The sacrifice periods were 1, 2, 5, and 10 days after surgery. The specimens were prepared and stained with hematoxylin and eosin for histological analysis. The results showed that there is a difference in tissue irritability produced by the local anesthetic solutions. The results also showed that there is no relation between the concentration of the drug and the inflammatory intensity, that the mepivacaine and articaine solutions promoted less inflammatory reaction than the bupivacaine, and that the lidocaine solution produced the least intense inflammation. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11
Ribeiro, Paulo Domingos; Sanches, Marcio Giampietro; Okamoto, Tetuo
The effect of general anesthetics on frog motoneurons and rat hippocampal pyramidal cells was examined with sucrose gap and intracellular recording, respectively. A number of volatile and intravenous anesthetics directly hyperpolarized the motoneurons. The potency of these agents in hyperpolarizing motoneurons was strongly correlated with their anesthetic potency. While the responses to barbiturates and alpha -chloralose were blocked by gamma
Inhaled anesthetic agents are widely used in the maintenance of general anesthesia. The newer agents, desflurane and sevoflurane, possess pharmacokinetic profiles that are distinctly different from the older inhaled anesthetics. These differences significantly impact the PACU nursing care. This article will focus on the uptake, distribution, and elimination of inhaled anesthetic agents with emphasis being placed on the postanesthesia care
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.
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
Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation.
Knowledge of the characteristics of industrial process wastes allows for some innovative and cost savings techniques for investigating and managing these wastes over conventional methods. This paper explores examples of some of these techniques employed on cement kiln dust (CKD) and pulp and paper mill process waste. Similar to Portland Cement, unleached CKD contains free lime and sources of reactive silica and/or alumina. Thus, it can set up in the presence of water. Properly moisture-conditioned CKD has been successfully used in Michigan as a landfill liner and cover material on closures of old CKD piles and newly permitted fills. However, CKD also contains high concentrations of soluble salts and when improperly managed can generate a leachate with high total dissolved solid concentrations. Surface and downhole geophysical methods employing electromagnetic conductivity have proven effective in delineating the horizontal and vertical extent of groundwater plumes caused by releases of CKD leachate.
Peters, C.S. [RMT, Inc., Okemos, MI (United States)
We investigated the molecular basis for the immobilizing activity of halogenated volatile anesthetics using comparative molecular field analysis. In vivo potency data (expressed as minimum alveolar concentrations) for 69 structurally diverse anesthetics were obtained from the literature. The drugs were randomly divided into a training set (n = 52) used to derive the activity model and a test set (n = 17) used to independently assess the model's predictive power. The anesthetic structures were aligned so as to maximize their similarity in molecular shape and electrostatic potential to the most potent drug in the group, CF2H-(CF2)3-CH2OH. The conformers and alignments of the anesthetics with maximum similarity (calculated as Carbo indices) were retained and used to derive the comparative molecular field analysis models. The final model explained 94.2% of the variance in the observed activities of the training set compounds. The model showed good predictive capability for both the training set (cross-validated r2 = 0.705) and randomly excluded test set anesthetics (r2 = 0.837). Three-dimensional pharmacophoric maps were derived to identify the spatial distribution of key areas where steric and electrostatic interactions are important in determining immobilizing activity of the halogenated drugs and were compared with our previously published maps obtained for nonhalogenated volatile anesthetics. PMID:16492826
A managementtechniques report on blasting artificial potholes is provided as Section 5.5.4 of the US Army Corps of Engineers Wildlife Resources Management Manual. The report was prepared as a guide to assist biologists and resource managers in developing...
One of the main objectives of image processing is to optimize visualization of particular thematic dataset. The processing methodology and strategy are very different from broadband image processing in many aspects. This strategy highly depends on the application and its objectives. For natural disasters such as earthquakes and tsunamis which affect a large area, the data obtained from satellite image processing can be utilized. The data can be used for disaster management for rescue and relief plan during disaster and disaster preparedness for future disasters. In order to meet objectives of disaster management, it is normally required to have a complete information system. The type of disaster may also dictate the type of processing and interpretation technique of images. This paper reviews the methods of satellite image processing and also the disaster management requirements. Based in these two issues the advantages and limitations of image processing methods have been discussed considering important natural disasters.
Poursaber, Mohammadreza; Ariki, Yasuo; Safi, Mohammad
Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia for thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy, as well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic plan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult ventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative area, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should be customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage. Several non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to prevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and how they affect the multiple components of the anestheticmanagement for thoracic procedures.
Benign esophagorespiratory fistula is a relatively rare condition in adults that poses a technical challenge to manage. This case series describes our experience in the treatment of benign esophagorespiratory fistula in 12 adults. A retrospective review of case records of 12 patients with benign esophagorespiratory fistula was done. There were eight tracheoesophageal fistulae and four bronchoesophageal fistulae. Among them, four fistulae were congenital, one was secondary to corrosive injury, three were due to foreign body (dentures), one was secondary to erosion because of prolonged endotracheal intubation, one was secondary to penetrating trauma, and two were infective in etiology. Of the 12 patients, there were nine males and three females. The mean age of presentation was 30.16 years (range 15-53 years). Nine patients had a definitive surgical intervention. The esophageal end of the fistula was managed by primary closure of the esophageal defect and reinforcement with pleural or intercostal muscle flap or a subtotal esophagectomy. The respiratory end of the fistula was dealt with by primary closure of the defect or by a novel technique of neomembranous airway formation, whereby the tracheal defect was closed with the help of a vascularized patch of the esophageal wall. The technique of this neomembranous airway formation is described in detail, and to our knowledge, this is the first time that this technique is being reported in the English literature. This technique is a novel method for definitive repair and can be considered as an option for repair of esophagorespiratory fistula with large defects. PMID:22486830
Deshpande, G; Samarasam, I; Banerjee, S; Gnanamuthu, R B; Chandran, S; Mathew, G
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
Mastocytosis is an orphan disease rarely encountered by practicing anesthesiologists. Children with mastocytosis often present for procedures or surgery requiring anesthesia. Because many of the medications commonly used in pediatric anesthesia have been reported to initiate mast cell activation, parents are often very anxious about their child's perioperative experience. Laboratory investigations of serum histamine assays associated with different anesthetic drugs have not been shown to predict mast cell degranulation in these patients. However, the pediatric literature suggests that children with disease limited to the skin rarely suffer serious side effects from anesthesia, and there are no reported fatalities. Preoperative prophylaxis is usually based on expert opinion and case reports. Detailed tables summarizing reports of anesthetic medications used for children with mastocytosis undergoing anesthesia, reported side effects, and suggested prophylaxis regimens are included in this review. PMID:23408045
\\u000a A 42 year old man (ASA 1) is scheduled for an elective elbow surgery. He is 72 kg and 6 ft). He consents to an interscalene\\u000a block as he would prefer not to have a general anesthetic. In the preoperative holding area an IV is placed. Sedation, consisting\\u000a of 2 mg midazolam and 50 mcg of fentanyl is given. The
Anesthesia is a sine qua non for most surgeries. Like any medical advance, progress in regional anesthesia has not come without its share of complications, including a spectrum extending from localized nerve injury to systemic cardiovascular toxicity and death. This article discusses the mechanisms and clinical presentation, prevention, treatment, and future trends of local anesthetic systemic toxicity. The adverse effects of lipid emulsion therapy are also included. PMID:21620340
Miniaturization of the cardiopulmonary bypass (CPB) system may provide several benefits, such as decreasing the manpower,\\u000a cost, and amount of homologous blood required and improving patient care. We have proposed a portable CPB system-mountable\\u000a anesthetic machine. Our portable CPB system consists of a bypass circuit, a hard shell reservoir, a membrane oxygenator, and\\u000a two pumps. The reservoir has three chambers,
\\u000a The anesthetic state is achieved through various sites of action located in the brain and the spinal cord. In-vivo electrophysiology\\u000a in humans can help to close the gap between the knowledge about molecular mechanisms from animal experiments and the observed\\u000a clinical effects in humans. Information about altered processing in the brain can be won through analyses of the stimulated\\u000a and
Effect of thermal stimulation on salivary secretion was examined in urethane anesthetized (i.p., 1.0 g\\/kg) rats. First, rectal temperature (Tre) was maintained at various levels by warming the whole trunk with a heating blanket. Copious salivary secretion occurred whenTre reached a threshold value above 40°C, which is considerably higher than the threshold for tail vasodilation. Local warming of the scrotum,
Over the past two decades, transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as peptic ulcer bleeding, malignant disease, hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding. Transcatheter interventions include the following: selective embolization of the feeding artery, sandwich coil occlusion of the gastroduodenal artery, blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery. Transcatheter embolization is a fast, safe and effective, minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract. This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies.
Loffroy, Romaric F; Abualsaud, Basem A; Lin, Ming D; Rao, Pramod P
Extracorporeal Shockwave lithotripsy (SWL) is the main outpatient treatment modality for urinary tract calculi. Anesthesia\\u000a and analgesia are provided to treat the cutaneous, somatic, and visceral pain associated with SWL. Multiple anesthetictechniques\\u000a have been used effectively. The decision to employ one technique over another depends on patient, as well as procedural, factors.\\u000a Patient factors include intraoperative analgesia and sedation
Thermoelectric energy harvesting has increasingly gained acceptance as a potential power source that can be used for numerous commercial and military applications. However, power electronic designers have struggled to incorporate energy harvesting methods into their designs due to the relatively small voltage levels available from many harvesting device technologies. In order to bridge this gap, an ultra-low input voltage power conversion method is needed to convert small amounts of scavenged energy into a usable form of electricity. Such a method would be an enabler for new and improved medical devices, sensor systems, and other portable electronic products. This paper addresses the technical challenges involved in ultra-low-voltage power conversion by providing a solution utilizing novel power conversion techniques and applied technologies. Our solution utilizes intelligent power managementtechniques to control unknown startup conditions. The load and supply management functionality is also controlled in a deterministic manner. The DC to DC converter input operating voltage is 20mV with a conversion efficiency of 90% or more. The output voltage is stored into a storage device such as an ultra-capacitor or lithium-ion battery for use during brown-out or unfavorable harvesting conditions. Applications requiring modular, low power, extended maintenance cycles, such as wireless instrumentation would significantly benefit from the novel power conversion and harvesting techniques outlined in this paper.
Motor evoked potentials (MEPs) have shown promise as a valuable tool for monitoring intraoperative motor tract function and reducing postoperative plegia. MEP monitoring has been reported to contribute to deficit prevention during resection of tumors adjacent to motor structures in the cerebral cortex and spine, and in detecting spinal ischemia during thoracic aortic reconstruction. Many commonly used anesthetic agents have long been known to depress MEP responses and reduce MEP specificity for motor injury detection. Although new stimulation techniques have broadened the spectrum of anesthetics that can be used during MEP monitoring, certain agents continue to have dose-dependent effects on MEP reliability. Understanding the effects of anesthetic agents and physiologic alterations on MEPs is imperative to increasing the acceptance and application of this technique in the prevention of intraoperative motor tract injury. This review is intended as an overview of the effects of anesthetics and physiology on the reproducibility of intraoperative myogenic MEP responses, rather than an analysis of the sensitivity and specificity of this monitoring method in the prevention of motor injury. PMID:14676568
This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.
Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor's office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. ImagesFigure 7
This presentation reviews psychologist Jean Piaget's contributions to knowledge of cognitive development in children, relating it to behavior managementtechniques. 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
Rates of childhood obesity are increasing, and it is essential to identify the active components of interventions aiming to prevent and manage obesity in children. A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques (BCTs) that are most effective in changing physical activity and/or eating behaviour for the prevention or management of childhood obesity. An electronic search was conducted for randomised controlled trials published between January 1990 and December 2009. Of 4309 titles and abstracts screened, full texts of 135 articles were assessed, of which 17 published articles were included in this review. Intervention descriptions were coded according to the behaviour-specific CALO-RE taxonomy of BCTs. BCTs were identified and compared across obesity management (n=9) vs prevention (n=8) trials. To assess the effectiveness of individual BCTs, trials were further divided into those that were effective (defined as either a group reduction of at least 0.13 body mass index (BMI) units or a significant difference in BMI between intervention and control groups at follow-up) vs non-effective (reported no significant differences between groups). We reliably identified BCTs utilised in effective and non-effective prevention and management trials. To illustrate the relative effectiveness of each BCT, effectiveness ratios were calculated as the ratio of the number of times each BCT was a component of an intervention in an effective trial divided by the number of times they were a component of all trials. Results indicated six BCTs that may be effective components of future management interventions (provide information on the consequences of behaviour to the individual, environmental restructuring, prompt practice, prompt identification as role model/position advocate, stress management/emotional control training and general communication skills training), and one that may be effective in prevention interventions (prompting generalisation of a target behaviour). We identified that for management trials, providing information on the consequences of behaviour in general was a feature of non-effective interventions and for prevention trials, providing information on the consequences of behaviour in general, providing rewards contingent on successful behaviour and facilitating social comparison were non-effective. To design effective behaviour change programmes for the prevention and management of childhood obesity, we would recommend utilising the BCTs identified as effective in this review. The impact on intervention effectiveness of combining BCTs should be the topic of further research. PMID:23756676
In this study we used barium currents through voltage gated L-type calcium channels (recorded in freshly isolated cells with a conventional patch-clamp technique) to elucidate the cellular action mechanism for volatile anesthetics. It was found that halothane and isoflurane inhibited (dose-dependently and voltage independently) Ba(2+) currents through voltage gated Ca(2+) channels. Half maximal inhibitions occurred at 0.64±0.07mM and 0.86±0.1mM. The Hill slope value was 2 for both volatile anesthetics, suggesting the presence of more than one interaction site. Current inhibition by volatile anesthetics was prominent over the whole voltage range without changes in the peak of the current voltage relationship. Intracellular infusion of the GDP?S (100?M) together with staurosporine (200nM) did not prevent the inhibitory effect of volatile anesthetics. Unlike pharmacological Ca(2+) channel blockers, volatile anesthetics blocked Ca(2+) channel currents at resting membrane potentials. In other words, halothane and isoflurane induced an 'initial block'. After the first 4-7 control pulses, the cells were left unstimulated and anesthetics were applied. The first depolarization after the pause evoked a Ca(2+) channel current whose amplitude was reduced to 41±3.4% and to 57±4.2% of control values. In an analysis of the steady-state inactivation curve for voltage dependence, volatile anesthetics induced a negative shift of the 50% inactivation of the calcium channels. By contrast, the steepness factor characterizing the voltage sensitivity of the channels was unaffected. Unitary L-type Ca(2+) channels blockade occurred under cell-attached configuration, suggesting a possible action of volatile anesthetics from within the intracellular space or from the part of the channel inside the lipid bilayer. PMID:23948226
Most studies of the effect of cocaine 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 [alpha-chloralose (alpha-CHLOR) and isofluorane (ISO)] on the effects of acute cocaine (1 mg/kg i.v.) on cerebral blood flow (CBF), cerebral blood volume (CBV), and tissue hemoglobin oxygenation (S(t)O(2)) using optical techniques and cocaine's pharmacokinetics (PK) and binding in the rat brain using (PET) and [(11)C]cocaine. We showed that acute cocaine at a dose abused by cocaine abusers decreased CBF, CBV and S(t)O(2) in rats anesthetized with ISO, whereas it increased these parameters in rats anesthetized with alpha-CHLOR. Importantly, in ISO-anesthetized animals cocaine-induced changes in CBF and S(t)O(2) were coupled, whereas for alpha-CHLOR these measures were uncoupled. Moreover, the clearance of [(11)C]cocaine from the brain was faster for ISO (peak half-clearance 15.8 +/- 2.8 min) than for alpha-CHLOR (27.5 +/- 0.6 min), and the ratio of specific to non-specific binding of [(11)C]cocaine in the brain was higher for ISO- (3.37 +/- 0.32) than for alpha-CHLOR-anesthetized rats (2.24 +/- 0.4). For both anesthetics, cocaine-induced changes in CBF followed the fast uptake of [(11)C]cocaine in the brain (peaking at approximately 2.5-4 min), but only for ISO did the duration of the CBV and S(t)O(2) changes correspond to the rate of [(11)C]cocaine's clearance from the brain. These results demonstrate that anesthetics influence cocaine's hemodynamic and metabolic changes in the brain, and its binding and PK, which highlights the need to better understand the interactions between anesthetics and pharmacological challenges in brain functional imaging studies. PMID:19821842
Du, Congwu; Tully, Melissa; Volkow, Nora D; Schiffer, Wynne K; Yu, Mei; Luo, Zhongchi; Koretsky, Alan P; Benveniste, Helene
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 anestheticmanagement a challenge. Anestheticmanagement 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.
Random components play an especially important role in the management of secure communication systems, with emphasis on the key management of cryptographic protocols. For this reason, the existence of strong pseudo random number generators is highly required. This paper presents novel techniques, which rely on Artificial Neural Network (ANN) architectures, to strengthen traditional generators such as IDEA and ANSI X.9
Surgical correction is generally indicated as the primary form of management in children with severe early onset scoliosis. Even so, conservative, nonsurgical treatment is always considered first, as surgical correction carries significant concomitant consequences, including but not limited to crankshaft phenomenon and, more importantly, inhibition of further spine, lung, and chest growth in skeletally immature patients. Fusionless surgical procedures assuage some of these risks, as they are characteristically associated with techniques necessitating spinal fusion. One device looks particularly promising in treating and managing severe early onset scoliosis, the vertical expandable prosthetic titanium rib (VEPTR)-a device that was initially targeted toward children with thoracic insufficiency syndrome (TIS). Despite its promising results in correction of severe early onset scoliosis, as well as associated rib and chest wall deformities, the VEPTR nevertheless has a complication rate comparable to other fusionless techniques. Continued modifications and research will hopefully beget a device that permits thoracic and spinal growth in skeletally immature patients yet with fewer postoperative complications. In this chapter, the authors review the clinical experience with VEPTR to date and present their results in 16 children with congenital scoliosis cared for at Shriners Hospital of Philadelphia. PMID:19585438
Shah, Shailja C; Birknes, John K; Sagoo, Sukh; Thome, Shelby; Samdani, Amer F
We identified a fluorophore, 1-aminoanthracene (1-AMA), that is anesthetic, potentiates GABAergic transmission, and gives an appropriate dissociation constant, Kd ? 0.1 mM, for binding to the general anesthetic site in horse spleen apoferritin (HSAF). 1-AMA fluorescence is enhanced when bound to HSAF. Thus, displacement of 1-AMA from HSAF by other anesthetics attenuates the fluorescence signal and allows determination of Kd, as validated by isothermal titration calorimetry. This provides a unique fluorescence assay for compound screening and anesthetic discovery. Additional electrophysiology experiments in isolated cells indicate that 1-AMA potentiates chloride currents elicited by GABA, similar to many general anesthetics. Furthermore, 1-AMA reversibly immobilizes stage 45–50 Xenopus laevis tadpoles (EC50 = 16 ?M) and fluorescence micrographs show 1-AMA localized to brain and olfactory regions. Thus, 1-AMA provides an unprecedented opportunity for studying general anesthetic distribution in vivo at the cellular and subcellular levels.
Butts, Christopher A.; Xi, Jin; Brannigan, Grace; Saad, Abdalla A.; Venkatachalan, Srinivasan P.; Pearce, Robert A.; Klein, Michael L.; Eckenhoff, Roderic G.; Dmochowski, Ivan J.
Summary The long-acting local anesthetic, bupivacaine, was used in a series of 467 anorectal patients, both inpatients and outpatients.\\u000a Bupivacaine was found to be safe and effective. Like other local anesthetics, it has none of the operative and postoperative\\u000a complications frequently associated with general or spinal anesthetics. Its longer duration of action makes it extremely useful\\u000a in anorectal operations on hospitalized
Lawrence D. Ramalho; Eugene P. Salvati; Robert J. Rubin
ABSTRACT Volatile anesthetics are essential for modern medical practice but sites and mechanisms of action for any of their numerous,cellular effects remain largely unknown. Previous studies with yeast showed,volatile anesthetics induce nutrient-dependent inhibition of growth through mechanisms,involving inhibition of mRNA translation. Studies herein show that the volatile anesthetic halothane inhibits protein synthesis in perfused rat liver at doses ranging from
Laura K. Palmer; Sharon L. Rannels; Scot R. Kimball; Leonard S. Jefferson; Ralph L. Keil
A 48-year-old woman with cystic fibrosis and a previous left pneumonectomy had surgery planned for single lung transplantation under general anesthesia. Due to progressive dyspnea and recurrent respiratory infection, she could not maintain her normal daily life without lung transplantation. The anestheticmanagement and surgical procedure was expected to be difficult because of the left mediastinal shift and an asymmetric thorax after the left pneumonectomy, but the single lung transplantation was successfully done under cardiopulmonary bypass.
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
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.
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
The way general anesthetics cause their clinically useful effects on the nervous system is not known. Since the principal determinant of the potency of these agents is their solubility in oil, the role of chemical structure in affecting anesthetic targets has been obscured. In this work, we use an intense beam of light (Tinklenberg, J. A., Segal, I. S., Tianzhi, G. & Maze, M. (1991) Ann. N.Y. Acad. Sci. 625, 532-539) to assess the effect of general anesthetics on the capacity of fruit flies to sense a noxious stimulus and respond to it. By examining the effect of halothane-resistant (har) mutations on the potency of various volatile anesthetics in this assay, we establish similarities and differences between these agents that highlight the was chemical structure influences anesthetic action. In general, the potencies of anesthetics with different chemical structure are affected to different extents by one or more har mutations. However, three anesthetics of related structure (enflurane, isoflurane, and desflurane) show quantitatively indistinguishable alterations in potency in each of four genetic tests. These results not only identify important structural features of anesthetics but also place limits on the classical view that all anesthetics act at a common target. PMID:8134360
Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABAA receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology methods advance to the point of being able to deal with systems such as the GABAA 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 GABAA 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.
We report a 52-year-old woman scheduled for laparotomy with combined epidural-general anesthesia who experienced abnormal responses to local anesthetic injections administered via the epidural catheter. The catheter subsequently was found to be in the subdural space. A review of the literature is provided. PMID:10386284
Airway management is considered one of the most difficult and challenging procedures among the various anesthetic procedures. It becomes tougher when there is a diseased temporomandibular joint (TMJ) due to inadequate mouth opening. In the current scenario there are only a few methods that ensure a safe, uneventful intubation in a TMJ ankylosis patient with a difficult airway. These include techniques ranging from minimally invasive techniques like blind nasal intubation, retrograde intubation using a guide wire, the latest technique of intubating with the help of a fiberoptic laryngoscope and the time tested tracheostomy. All these techniques have got their own disadvantages. So we report a case series of five patients with TMJ ankylosis who underwent fluoroscopic-assisted intubation for airway management. We found that this technique is 100% successful in managing the airway in these patients. To the best of our knowledge, this is the first case series detailing this novel technique in the entire English medical literature.
Varughese, Ibin; Varughese, Parekkara I; Soman, Thomas; Mathew, James
The innovation of ultrasound-guided regional anesthesia technique has enabled the anesthesiologist to secure an accurate needle position and to monitor the distribution of the local anesthetic in real time. However, the evidence is necessary concerning increased benefits and reduced complications compared to conventional guidance techniques. This article highlights the importance of acquiring an understanding and knowledge of the complications related to regional anesthesia itself, including neural injury, local anesthetics systemic toxicity and vascular injury. Common complications of nerve blocks can be avoided with major principles of ultrasound-guided technique, which involves similar risk of complications and requires similar amount of knowledge for management. It is necessary to establish the recommendations for the scope of practice, teaching curriculum and the opinion for implementing the medical practice of ultrasound-guided regional anesthesia. PMID:22175169
Interrami intraoral Kirschner wire fixation technique is presented for the reduction, stabilization, and immobilization of a pulverized and avulsed lower jaw caused by rifle fragmented bullet injuries. This indirect mandibular war injury fixation technique was tolerated by the patients and tissue more than any indirect external fixation. In addition, it is easier than open reduction using large bone plates for disrupted ballistics mandibular injury defects. An interrami intraoral fixation is appropriate for severely disrupted mandibular hard and soft tissues, and has been adapted in cases of mass casualties and limited resources. Benefits of use include limited hospital beds and fewer follow-up visits. Rifle fragmented bullet injuries need more attention for several reasons: not only because of the higher mortality and devastating nature of the injuries, but also because these injuries are responsible for an unreported type of bullet biomechanism wounding in the craniofacial region. In turn, this necessitates specialized victim management. The survival rates depend on immediate proper execution of airway, breathing, and circulation, which become more complicated as it relates to airway compromise and oropharyngeal hemorrhage resuscitation. Survival is predicated on the implementation of feasible, sensible, life-saving techniques that are applied at the appropriate time. PMID:23851763
Many of the observations made in the management of large bowel injuries during World War II are applicable to similar cases encountered in civilian practice. Early administration of whole blood to combat shock cannot be overemphasized. The patient should be adequately examined for associated injuries. Ether-oxygen is the anesthetic agent of choice, and a closed technique should be used. Vertical incision offers the best exposure for the operation and is most rapidly performed. The surgical principles of exteriorization and/or a proximal colostomy to completely divert the fecal stream are the important features in the technical management of the injured large bowel. A method of colostomy closure is presented.
The authors have reviewed the main effects of anaesthetic agents on sensory evoked potentials (EPs) in the auditory, somatosensory and visual modalities. Knowledge of EP changes induced by anesthetic drugs is important to avoid false alarms when monitoring neural structures at risk during surgery. Intraoperative EP monitoring is all the more efficient as the following points are taken into account: 1) whatever the sensory modality considered, EPs are more attenuated by volatile halogenated agents than by intravenous drugs; 2) the cortical components of EPs are more sensitive to anesthetic drugs than the brainstem components; 3) in each modality, the first component of the "primary cortical complex" is less attenuated by anaesthetic agents than the following cortical waves; 4) continuous administration of anaesthetic agents rather than acute administration (bolus) is preferred during EP monitoring. EPs also represent an objective means to assess the depth of surgical anaesthesia, since they may provide a reliable index of cortical depression. Amplitude changes of middle-latency auditory responses (Pa/Nb) seem to be a good marker for estimating depth of anaesthesia with the aid of EPs. PMID:8326927
We describe the successful management of empyema in patients who need fenestration, but whose general condition is compromised by a high count of multi-drug resistant bacteria, deteriorating health, or bronchial fistula. The procedure is performed at the bed side, under local anesthesia. After making an incision in the thoracic wall using electric cautery, fenestration is created by inserting a Lap-Protector so as to widen the intercostal space. Fenestration using a Lap-Protector, which does not require resection of the ribs, is comparable to that obtained using the conventional rib resection method. However, it causes significantly less pain at the incision site, and the gauze can be changed without pain because it is not in direct contact with the fenestration wound. Thus, fenestration using a Lap-Protector is a more convenient and effective technique than conventional fenestration with rib resection for poor risk patients with empyema. PMID:23686573
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
Background Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia\\u000a for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This\\u000a prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related\\u000a and other factors which
The effectiveness of Particle-In-Cell (PIC) codes lies mainly in the robustness of the methods implemented, under the fundamental assumption that a sufficient number of pseudo-particles is concerned for a correct representation of the system. The consequent drawback is the huge increase of computational time required to run a simulation, to what concerns the particles charge assignment to the grid and the motion of the former through the latter. Moreover the coupling of such methods with Monte-Carlo-Collisional (MCC) modules causes another expensive computational cost to simulate particle multiple collisions with background gas and domain boundaries. Particles managementtechniques are therefore often introduced in PIC-MCC codes in order to improve the distribution of pseudo-particles in the simulation domain: as a matter of facts, the aim at managing the number of samples according to the importance of the considered region is a main question for codes simulating a local phenomenon in a larger domain or a strongly collisional system (e.g.: a ionizing plasma, where the number of particles increases exponentially). A clustering procedure based on the distribution function sampling applied to the 5D phase space (2D in space, 3D in velocity) is here proposed, representing the leading criterion for particles merging and splitting procedures guaranteeing the second order charge moments conservation. Applied to the study of the electrical breakdown in the early discharge phase of a Plasma Focus device, this technique is shown to increase performances of both PIC kernel and MCC module preserving the solution of the electric field and increasing samples representativeness in stochastic calculations (with respect to more traditional merging and splitting procedures).
Grasso, Giacomo; Frignani, Michele; Rocchi, Federico; Sumini, Marco
Repeated cutting of vegetation at or near ground level in power-line corridors is a common practice for inhibiting tree growth and regeneration. However, few data exist on long-term community responses. In this study, we sampled 20 northern Kentucky power-line corridors and compared their seedling and sapling communities to the edges and interiors of adjacent undisturbed forests. Mean seedling and sapling density in corridors was roughly twice that of adjacent undisturbed forest interiors, suggesting that repeated cutting is not a viable method of inhibiting tree regeneration. Corridor communities were dominated by Robinia pseudoacacia (black locust) and Fraxinus americana (white ash), but ordinations indicated strong similaritties among communities in corridors and adjacent forests. Many of the tree species found in adjacent forests, with the exception of a few shade-tolerant species, had highest seedling and sapling densities in corridors. Stump or root sprouting by many species appears to regenerate forests quickly after cutting. However, disturbed soil and detritus accumulations caused by management crews and their equipment may also create a large variety of microsites for seedling establishment. Because repeated cutting selects for dominance by species with highest sprout growth rates, it should not be used as the sole managementtechnique. It may instead be used to alter the vigor, stature, and stored reserves of trees so that herbicides or other methods of tree control can be used more efficiently.
Luken, James O.; Hinton, Andrew C.; Baker, Douglas G.
Exercise-related lower limb pain represents one of the most common presentations in sports medicine practice. This is usually caused by musculoskeletal overuse injuries but not uncommonly, a neuropathic cause may be suspected. A review of the literature revealed that peripheral neuropathic pain has never been documented in a child. It is possible that peripheral neuropathic pain of spinal origin may be more prevalent in children than previously recognized. This case report describes the presentation of a 12 year old tennis player with bilateral dorsal foot pain, who presented with positive findings of peripheral nerve sensitization which was successfully managed using neurodynamic treatment techniques. Differential diagnoses are considered and treatment and management described. A discussion of the clinical reasoning which led to the patient's diagnosis is included. This case report suggests the effectiveness of neurodynamic treatment in a child with bilateral foot pain who fulfilled published criteria for peripheral nerve sensitization. However, the single case methodology employed in this study limits generalization of its findings. Further studies are warranted to investigate the role of neurodynamics in musculoskeletal pain disorders in children. PMID:21376654
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: firstname.lastname@example.org [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)
The object of this study was to describe a unique method of managing ventriculostomy catheters in patients on antithrombotic therapy following endovascular treatment of ruptured intracranial aneurysms. The authors retrospectively reviewed 3 cases in which a unique method of ventriculostomy management was used to successfully avoid catheter-related hemorrhage while the patient was on dual antiplatelet therapy. In this setting, ventriculostomy catheters are left in place and fixed to the calvarium with titanium straps effectively ligating them. The catheter is divided and the distal end is removed. The proximal end can be directly connected to a distal shunt system during this stage or at a later date if necessary. The method described in this report provided a variety of management options for patients requiring external ventricular drainage for subarachnoid hemorrhage. No patient suffered catheter-related hemorrhage. This preliminary report demonstrates a safe and effective method for discontinuing external ventricular drainage and/or placing a ventriculoperitoneal shunt in the setting of active coagulopathy or antithrombotic therapy. The technique avoids both the risk of hemorrhage related to catheter removal and reinsertion and the thromboembolic risks associated with the reversal of antithrombotic therapy. Some aneurysm centers have avoided the use of stent-assisted coiling in cases of ruptured aneurysms to circumvent ventriculostomy-related complications; however, the method described herein should allow continued use of this important treatment option in ruptured aneurysm cases. Further investigation in a larger cohort with long-term follow-up is necessary to define the associated risks of infection using this method. PMID:23472845
Sweeney, Justin M; Vasan, Rohit; van Loveren, Harry R; Youssef, A Samy; Agazzi, Siviero
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.
Since the 1800s, inhaled agents have been administered to produce surgical anesthesia. Although inhaled anesthetics are commonly known to produce a state of sleep, they also influence many physiologic processes. This article explores the pharmacodynamics of the inhaled anesthetics used in current anesthesia practice. Equipped with this knowledge, the PACU nurse will be better prepared to anticipate the nursing care
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
Background: The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique. Materials and Methods: This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed. Results: Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group). Conclusions: LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.
Krishna, Handattu M; Kamath, Shyamsunder; Shenoy, Laxmi
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.
In this study, we have examined the effects of both volatile and IV general anesthetics on excitatory syn- aptic transmission, with and without recurrent inhi- bition,toclarifywhetherexcitatoryorinhibitorysyn- apsesarethemajortargetsofaction.Fieldpopulation spike amplitudes (fPSs) of CA1 pyramidal neurons were recorded in rat hippocampal slices. Schaffer- collateral-commissural fibers (Sch) were stimulated orthodromically, and the evoked fPSs (PS(Sch)) in CA1 area were measured. In addition, the
Takehisa Asahi; Koki Hirota; Rika Sasaki; Yamazaki Mitsuaki; Sheldon H. Roth
IntroductionFew clinical studies have evaluated the efficacy of the maxillary second division nerve block. The purpose of this prospective, randomized study was to compare the anesthetic efficacy of the greater palatine second division nerve block and the high tuberosity second division nerve block technique by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine.
Richard Broering; Al Reader; Melissa Drum; John Nusstein; Mike Beck
With ultrasound, continuous peripheral nerve blocks (CPNBs) are one of the most recent developments in regional anesthesia in children. CPNBs are now used more widely in children because more suitable materials have been marketed, allowing complete, and prolonged postoperative pain control. Their use after orthopedic procedures in children and treatment for complex regional pain syndrome in adolescents has demonstrated the benefits. Perineural catheters have also shown their superiority over other techniques of continuous regional anesthesia in terms of side effects. The efficiency and the safety of these techniques may facilitate early ambulation with improved pain management, treatment at home with disposable pumps, and improved rehabilitation of children. Studies on large cohorts of patients published to date have failed to highlight any severe complications in their use compared with other adult studies. Accidents owing to systemic toxicity are very unlikely if the recommended maximum dose is not exceeded. The safety of continuous regional anesthesia techniques in children relies on the use of low-concentration l-enantiomer solutions (ropivacaine or levobupivacaine) accompanied by low plasma concentrations of local anesthetics, limiting the risk of systemic toxicity of these molecules. CPNB can ensure strong and lasting analgesia in hospital or at home. PMID:22050550
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.
The purpose of this article is to describe the indications for use of n-butyl cyanoacrylate (NBCA) in abdominal and pelvic embolotherapy, appropriate techniques for NBCA embolotherapy, and NBCA-related complications and their management. NBCA embolotherapy is a feasible and effective method for treating a variety of abdominal and pelvic vascular lesions or tumors; however, the techniques suitable for each case and knowledge of NBCA-related complications are essential to achieve favorable outcomes. PMID:22367776
|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.
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
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
General anesthetics produce anesthesia by depressing central nervous system activity. Activation of inhibitory GABA(A) receptors plays a central role in the action of many clinically relevant general anesthetics. Even so, there is growing evidence that anesthetics can act at a presynaptic locus to inhibit neurotransmitter release. Our own data identified the neurotransmitter release machinery as a target for anesthetic action. In the present study, we sought to examine the site of anesthetic action more closely. Exocytosis was stimulated by directly elevating the intracellular Ca(2+) concentration at neurotransmitter release sites, thereby bypassing anesthetic effects on channels and receptors, allowing anesthetic effects on the neurotransmitter release machinery to be examined in isolation. Three different PC12 cell lines, which had the expression of different release machinery proteins stably suppressed by RNA interference, were used in these studies. Interestingly, there was still significant neurotransmitter release when these knockdown PC12 cells were stimulated. We have previously shown that etomidate, isoflurane, and propofol all inhibited the neurotransmitter release machinery in wild-type PC12 cells. In the present study, we show that knocking down synaptotagmin I completely prevented etomidate from inhibiting neurotransmitter release. Synaptotagmin I knockdown also diminished the inhibition produced by propofol and isoflurane, but the magnitude of the effect was not as large. Knockdown of SNAP-25 and SNAP-23 expression also changed the ability of these three anesthetics to inhibit neurotransmitter release. Our results suggest that general anesthetics inhibit the neurotransmitter release machinery by interacting with multiple SNARE and SNARE-associated proteins. PMID:23136341
Xie, Zheng; McMillan, Kyle; Pike, Carolyn M; Cahill, Anne L; Herring, Bruce E; Wang, Qiang; Fox, Aaron P
BACKGROUND Volatile aromatic compounds such as benzene are general anesthetics that cause amnesia, hypnosis, and immobility in response to noxious stimuli when inhaled. Although these compounds are not used clinically, they are frequently found in commercial items such as solvents and household cleaning products and are abused as inhalant drugs. Volatile aromatic anesthetics are useful pharmacological tools for probing the relationship between chemical structure and drug activity at putative general anesthetic targets. Neuronal nicotinic acetylcholine (nACh) receptors are ligand-gated ion channels widely expressed in the brain, which are thought to play important roles in learning and memory. In this study, we tested the hypothesis that aromatic anesthetics reversibly inhibit ?4?2 neuronal nACh receptor function and sought to determine the structural correlates of receptor inhibition. METHODS Electrophysiological techniques were used to quantify the effects of 8 volatile aromatic anesthetics on currents elicited by 1 mM ACh and mediated by human ?4?2 nACh receptors expressed in Xenopus oocytes. RESULTS All of the volatile aromatic anesthetics used in this study reversibly inhibited ?4?2 nACh receptors with IC50 values ranging from 0.00091 atm for 1,2-difluorobenzene to 0.045 atm for hexafluorobenzene. With the exception of hexafluorobenzene, all of the compounds had IC50 values less than minimum alveolar concentration. Inhibitory potency correlated poorly with the cation-? binding energies of the compounds (r2 = 0.48, P = 0.059). However, there was a good correlation between inhibitory potency and the octanol/gas partition coefficient (r2 = 0.87, P = 0.0008). CONCLUSIONS Volatile aromatic anesthetics potently and reversibly inhibit human ?4?2 neuronal nACh receptors. This inhibition may play a role in producing amnesia. In contrast to N-methyl-D-aspartate receptors, the inhibitory potencies of aromatic anesthetics for ?4?2 neubronal nACh receptors seem to be dependent on drug hydrophobicity rather than electrostatic properties. This implies that the volatile aromatic anesthetic binding site in the ?4?2 neuronal nACh receptor is hydrophobic in character and differs from the nature of the binding site in N-methyl-D-aspartate receptors.
Solt, Ken; Kelly, Elizabeth W.; Cotten, Joseph F.; Raines, Douglas E.
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
Modern naval battleforces generally include many different platforms each with onboard sensors such as radar, ESM, and communications. The sharing of information measured by local sensors via communication links across the battlegroup should allow for optimal or near optimal decisions. A fuzzy logic algorithm has been developed that automatically allocates electronic attack (EA) resources in real-time. The fuzzy logic approach allows the direct incorporation of expertise allowing decisions to be made based on these rules. Genetic algorithm based optimization is conducted to determine the form of the membership functions for the fuzzy root concepts. The resource manager is made up of five parts, the isolated platform model, the multi-platform model, the communication model, the fuzzy parameter selection tree and the fuzzy strategy tree. Automatic determination of fuzzy decision tree structure using a genetic program, an algorithm that creates other computer programs is discussed. A comparison to a tree obtained using a genetic program and one constructed based on expertise is made. The automatic discovery through genetic algorithms of multi-platform techniques, rules and strategies is discussed. Two new multi-platform power allocation algorithms based on fuzzy number theory and linear and nonlinear programming are introduced. Methods of validating the algorithms are examined.
Most drugs used in practical pediatric anesthesia are off-label. Pediatric anesthesiologists and non-pediatric anesthesiologists who rarely encounter pediatric patients need to be aware of the clinical usage of these drugs based on pediatric pharmacokinetics and pharmacodynamics to ensure that children are not exposed to unnecessary risks. Clinical guidelines on anesthetic drugs have been made available on the Japanese Society of Anesthesiologists website, and anesthesiologists are encouraged to access this site at least once. Propofol is commonly used in pediatric anesthesia and sedation in several situations. However, we should always consider the possibility of propofol infusion syndrome in the case of long-term administration. Rocuronium is widely used for general anesthesia in elective surgeries, examinations, and minor procedures in pediatric patients. Rocuronium can be used for rapid sequence induction, taking into consideration the dose and duration of action. Sugammadex has recently been introduced for practice in Japan. Rocuronium and sugammadex have been used safely in pediatric patients so far, and may change the induction methods used in difficult airway patients and the management of airway emergencies. Desflurane is novel in Japan and has not been commonly used in pediatric anesthesia. Desflurane may cause very high irritability in the airway and may be used for the maintenance of anesthesia in limited situations. PMID:24063135
Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.
Despite a long history in medical and dental application, the molecular mechanism and precise site of action are still arguable for local anesthetics. Their effects are considered to be induced by acting on functional proteins, on membrane lipids, or on both. Local anesthetics primarily interact with sodium channels embedded in cell membranes to reduce the excitability of nerve cells and cardiomyocytes or produce a malfunction of the cardiovascular system. However, the membrane protein-interacting theory cannot explain all of the pharmacological and toxicological features of local anesthetics. The administered drug molecules must diffuse through the lipid barriers of nerve sheaths and penetrate into or across the lipid bilayers of cell membranes to reach the acting site on transmembrane proteins. Amphiphilic local anesthetics interact hydrophobically and electrostatically with lipid bilayers and modify their physicochemical property, with the direct inhibition of membrane functions, and with the resultant alteration of the membrane lipid environments surrounding transmembrane proteins and the subsequent protein conformational change, leading to the inhibition of channel functions. We review recent studies on the interaction of local anesthetics with biomembranes consisting of phospholipids and cholesterol. Understanding the membrane interactivity of local anesthetics would provide novel insights into their anesthetic and cardiotoxic effects.
The emergence of middleware solutions and new services, even on small devices, will need adapted distributed management solutions which address these specificities, both in terms of software design and in terms of performance. We propose a management system where these high-level and low-level management concerns are separated. In particular for JAVA based solutions, we suggest a low-level management agent tightly
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
For teacher educators, classroom management education is one of the least researched aspects of the profession. The purpose of this study was to determine if classroom management was most effective learned through textbook analysis coupled with classroom discussion, or the experience of observing and practicing classroom management in the clinical experience. The results of this study suggest that the clinical
To quantify parietal bone motion in reference to the medial sagittal suture, a newly developed instrument was attached to the surgically exposed skull of anesthetized adult cats. The instrument differentiated between lateral and rotational parietal bone movements around the fulcrum of the suture. Bone movement was produced by external forces applied to the skull and by changes in intracranial pressure associated with induced hypercapnia, intravenous injections of norepinephrine, and controlled injections of artificial cerebrospinal fluid into the lateral cerebral ventricle. Responses varied considerably among test animals. Generally, lateral head compression caused sagittal suture closure, small inward rotation of the parietal bones, increased intraventricular pressure, transient apnea, and unstable systemic arterial blood pressure. Graded increases in intracranial volume produced stepped increases in pressure, lateral expansion at the sagittal suture, and outward rotation of the parietal bones. We attribute variations in animal response largely to differences in intracranial and suture compliance among them. Cranial suture compliance may be an important factor in defining total cranial compliance. PMID:1601696
Agranulocytosis induced by metamizole is uncommon, with a frequency of less than one case per million treatments. We describe such a case in a patient requiring emergency surgery. An 85-year-old man with a history of infantile paralysis with mental retardation and Paget's disease and X-ray signs of the right femur came to the emergency room with a diaphysial fracture. He received 1 g metamizole i.v. every 8 hours for analgesia. Ten hours after admission a routine blood cell count showed a rapid fall in the number of leukocytes; at 24 hours the count was 600 x 10(9)/l. The diagnosis was agranulocytosis induced by metamizole. Postponement of surgery was advisable and treatment with granulocyte colony stimulating factor (GCSF) at a dose of 5 micrograms/kg/day. Agranulocytosis resolved after 3 days of treatment, after which time the bone was set with a straight femoral plate under subarachnoid anesthesia. Two packs of red blood cells were required during the immediate postoperative period. Twelve days after surgery the patient was released. We review the anesthetic approach to agranulocytosis and its treatment. PMID:9719723
Prieto Alvarez, M P; Fuentes Bellido, J G; López Cebollada, J; Escoda Teigell, L; Lorenzo Foz, J P
We suggest that bubbles are the bistable hydrophobic gates responsible for the on-off transitions of single channel currents. In this view, many types of channels gate by the same physical mechanism-dewetting by capillary evaporation-but different types of channels use different sensors to modulate hydrophobic properties of the channel wall and thereby trigger and control bubbles and gating. Spontaneous emptying of channels has been seen in many simulations. Because of the physics involved, such phase transitions are inherently sensitive, unstable threshold phenomena that are difficult to simulate reproducibly and thus convincingly. We present a thermodynamic analysis of a bubble gate using morphometric density functional theory of classical (not quantum) mechanics. Thermodynamic analysis of phase transitions is generally more reproducible and less sensitive to details than simulations. Anesthetic actions of inert gases-and their interactions with hydrostatic pressure (e.g., nitrogen narcosis)-can be easily understood by actions on bubbles. A general theory of gas anesthesia may involve bubbles in channels. Only experiments can show whether, or when, or which channels actually use bubbles as hydrophobic gates: direct observation of bubbles in channels is needed. Existing experiments show thin gas layers on hydrophobic surfaces in water and suggest that bubbles nearly exist in bulk water. PMID:18234836
Roth, Roland; Gillespie, Dirk; Nonner, Wolfgang; Eisenberg, Robert E
Purpose of review To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. Recent findings A large and growing body of evidence shows that neuroinflammation participates in the development of neurodegeneration associated with Alzheimer’s disease. Modulation may be possible early in the pathogenesis, and less so when cognitive symptoms appear. A dysfunctional hypo-inflammatory response may permit accelerated damage due to other mechanisms in late disease. The peripheral inflammatory response elicited by surgery itself appears to provoke a muted neuroinflammatory response, which enhances ongoing neurodegeneration in some models. Anesthetics have both anti- and pro-inflammatory effects depending on the drug and concentration, but in general, appear to play a small role in neuroinflammation. Human studies at the intersection of chronic neurodegeneration, neuroinflammation, and surgery/anesthesia are rare. Summary The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
Tang, Junxia X; Eckenhoff, Maryellen F; Eckenhoff, Roderic G
...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous Â§ 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An...
Text Version... Anesthetic and Life Support Drugs Advisory Committee Members Absent: Sorin ... MD FASM, Founder and CEO-Two Dreams Outer Banks Barbara St ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials
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...
Context The modern practice of anesthesia is highly dependent ona group of anesthetic drugs which many of them are metabolized in the liver. Evidence Acquisition The liver, of course, usually tolerates this burden. However, this is not always an unbroken rule. Anesthetic induced apoptosis has gained great concern during the last years; especially considering the neurologic system. Results However, we have evidence that there is some concern regarding their effects on the liver cells. Fortunately not all the anesthetics are blamed and even some could be used safely, based on the available evidence. Conclusions Besides, there are some novel agents, yet under research, which could affect the future of anesthetic agents' fate regarding their hepatic effects.
... for future preclinical and clinical studies; and (3 ... Anesthetic and Life Support Drugs Advisory Committee. ... BS, MS Center for Drug Evaluation and ... More results from www.fda.gov/advisorycommittees/calendar
... of the Anesthetic and Analgesic Drug Products Advisory Committee ... and efficacy for the new drug application ... This product represents the first drug ... More results from www.fda.gov/advisorycommittees/calendar
A 2-year-old boy with Russell-Silver syndrome (RSS) was scheduled for corrective surgery for hypospadia. He had characteristic features of RSS, such as intrauterine growth retardation with subsequent marked postnatal growth impairment, body asymmetry and small triangular face. Anesthesia was induced with sevoflurane in oxygen-enriched air. The lungs were easily ventilated with a bag and mask. Tracheal intubation was extremely difficult because of the micrognathia and high arched palate, but finally successful with the use of a stylet in the endotracheal tube. Caudal epidural block was not performed because of a possible spina bifida. There were no complications related to anesthesia and surgery. PMID:16856554
\\u000a Surgical repair of thoraco-abdominal aortic aneurysms is a technically demanding procedure which often mandates the participation\\u000a of very experienced anesthetists, surgeons, and intensivists. Its complexity resides not only in challenging surgical aspects\\u000a such as the need for interrupting the natural cerebral perfusion, but also in the requirement for meticulous monitoring strategies\\u000a during the perioperative period. In order to coordinate and
Javier G. Castillo; George Silvay; Gregory W. Fischer
Cardiac amyloidosis may cause restrictive cardiomyopathy associated with heart failure, conduction disorder and ischemic heart disease. Therefore, patients with amyloidosis require careful hemodynamic monitoring in perioperative period. A 63-year-old man with cardiac amyloidosis was scheduled for pneumonectomy. His transthoracic echocardiography assessment showed a hypertrophic interventricular septum and slight decreased ejection fraction of 55%, but left ventricular (LV) diastolic function was decreased. Pulse Doppler for mitral valve inflow showed that the early peak velocity/atrial peak velocity (E/A) ratio was 0.9, the deceleration time (DT) was 163 msec and the early diastolic mitral annular tissue velocity (E') was 4 cm x sec(-1). These data suggested a pseudonormalization state. We performed careful monitoring using arterial pressure-based cardiac output (APCO), central venous oxygen saturation (ScvO2) and transesophageal echocardiography. There were no severe complications such as circulatory collapse and arrhythmia in the perioperative period. PMID:21229694
ultiple pterygium syndrome is a rare, autoso- ma1 recessive disorder that involves webbing of the skin across joints, cleft palate, syn- gnathia (congenital bands of tissue between the max- illa and mandible), ankyloglossia (extensive adhesions of the tongue to the palate), micrognathia, and web- bing of the neck (l-3). These anomalies limit mouth opening, displace the tongue posteriorly, obscure vi-
Paul J. Kuzma; Mark D. Calkins; Mark D. Kline; Steven M. Karan; Michael D. Matson
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
This review will focus on inhalational anesthetic neuroprotection during cerebral ischemia and inhalational anesthetic preconditioning before ischemic brain injury. The limitations and challenges of past and current research in this area will be addressed before reviewing experimental and clinical studies evaluating the effects of inhalational anesthetics before and during cerebral ischemia. Mechanisms underlying volatile anesthetic neuroprotection and preconditioning will also
Hideto Kitano; Jeffrey R Kirsch; Patricia D Hurn; Stephanie J Murphy
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)
Neurotoxicity has been reported with tricyclic anti- depressants (TCAs) used as local anesthetics. We ex- amined the hypothesis that TCAs cause tissue injury, particularly myotoxicity, as occurs with many local anesthetics. Animals were given sciatic nerve injec- tions with 0-80 mM doxepin, amitriptyline, or bu- pivacaine (1.5 mL for histological studies, 0.3 mL for neurobehavioral studies). Four days after injection,
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
The carbanilate local anesthetics carbisocaine, heptacaine and pentacaine liberate histamine from isolated rat mast cells. Procaine, carticaine, trimecaine, cocaine and butanilicaine were ineffective. Histamine liberation was dose-dependent, followed by calcium displacement from membrane binding sites and occured without concomitant degranulation. Low temperature and pH-dependent inhibition of histamine liberation indicated a non-specific, membrane perturbing effect of highly liposoluble carbanilate local anesthetics.
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
There were presented operative technique and clinical results of extracorporeal circulation (ECG) with patients lungs utilization, instead of routinely applied artificial blood oxygenators. Auto-oxygenation method was applied in 12 patients with coronary artery disease treated by coronary artery bypass grafting (CABG). Operative procedure differs from the traditional one in two additional cannulations of pulmonary artery and left atrium. Two peristaltic pumps and incorporated in circulation blood reservoirs. Polystan 892910 allows for temporary substitution of cardiac function without lung disconnection. Lungs functioning during surgery do not render it difficult. Hypothermia enables to decrease respiration rate and tidal volume with no effect on physiological blood oxygenation and CO2 exhalation. Method assessment was based on results comparison with those obtained in patients treated by traditional method using bubble oxygenators-Venotherm 5,000. PO2, PCO2, platelets number and hemolysis extent were assessed before, in 10, 30, 60 min of ECG and just after it. Platelets activity and influence of the method on hemostatic disorders were evaluated based on clotting time by Ivy. Additionally hemostatic disorders were assessed by thoracic blood drainage volume calculated from the moment of protamine administration to drainage tubes withdrawal in average 18 hours after surgery. Laboratory parameters characteristically changing during ECG were also estimated. It was proved, that auto-oxygenation diminished negative effects of ECG. Increased platelets number, faster normalization of clotting time and decreased postoperative drainage were stated in the auto-oxygenation group. Postoperative drainage in this group was 260 +/- 60 ml in comparison with 800 +/- 100 ml of the control group. Authors consider that pulmonary function remaining during ECG positively affects on postoperative hemostasis. This method can be helpful in surgical management of coronary artery disease, especially in patients with primary coagulation disorders. PMID:2082071
Bochenek, A; Religa, Z; Zembala, M; Kustosz, R; Wo?, S; Bochenek, A; Toczek, K; Skiba, J; Wilczy?ski, M; Bachowski, R
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, we examined the 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. PMID:23408672
Barreveld, Antje; Witte, Jürgen; Chahal, Harkirat; Durieux, Marcel E; Strichartz, Gary
Qualitative distribution of coronary flow using thallium-201 perfusion scans immediately postintubation was studied in 22 patients scheduled for elective coronary artery bypass surgery. Ten patients received a thiopental (4 mg/kg) and halothane induction. Twelve patients received a fentanyl (100 micrograms/kg) induction. Baseline thallium-201 perfusion scans were performed 24 h prior to surgery. These scans were compared with the scans performed postintubation. A thallium-positive scan was accepted as evidence of relative hypoperfusion. Baseline hemodynamic and ECG data were obtained prior to induction of anesthesia. These data were compared with the data obtained postintubation. Ten patients developed postintubation thallium-perfusion scan defects (thallium-positive scan), even though there was no statistical difference between their baseline hemodynamics and hemodynamics at the time of intubation. There was no difference in the incidence of thallium-positive scans between those patients anesthetized by fentanyl and those patients anesthetized with thiopental-halothane. The authors conclude that relative hypoperfusion, and possibly ischemia, occurred in 45% of patients studied, despite stable hemodynamics, and that the incidence of these events was the same with two different anesthetictechniques.
Kleinman, B.; Henkin, R.E.; Glisson, S.N.; el-Etr, A.A.; Bakhos, M.; Sullivan, H.J.; Montoya, A.; Pifarre, R.
The majority of sensory physiology experiments have used anesthesia to facilitate the recording of neural activity. Current techniques allow researchers to study sensory function in the context of varying behavioral states. To reconcile results across multiple behavioral and anesthetic states, it is important to consider how and to what extent anesthesia plays a role in shaping neural response properties. The role of anesthesia has been the subject of much debate, but the extent to which sensory coding properties are altered by anesthesia has yet to be fully defined. In this study we asked how urethane, an anesthetic commonly used for avian and mammalian sensory physiology, affects the coding of complex communication vocalizations (songs) and simple artificial stimuli in the songbird auditory midbrain. We measured spontaneous and song-driven spike rates, spectrotemporal receptive fields, and neural discriminability from responses to songs in single auditory midbrain neurons. In the same neurons, we recorded responses to pure tone stimuli ranging in frequency and intensity. Finally, we assessed the effect of urethane on population-level representations of birdsong. Results showed that intrinsic neural excitability is significantly depressed by urethane but that spectral tuning, single neuron discriminability, and population representations of song do not differ significantly between unanesthetized and anesthetized animals. PMID:21543752
Schumacher, Joseph W; Schneider, David M; Woolley, Sarah M N
Background Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. Methods Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. Results Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV. Conclusions MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetictechniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.
Lee, Kyoungkyun; Yon, Jun Heum; Kim, Kye-Min; Kim, Mun-Cheol; Lee, Woo Yong; Lee, Sangseok; Lim, Yun-Hee; Nam, Sang Hyun; Choi, Young Woong; Kim, Hoon
Local anesthetics such as dibucaine, QX572, tetracaine, and phenacaine, as well as other drugs with local anesthetic-like properties (e.g., mepacrine, propranolol, and SKF 525A) inhibit the specific calmodulin-dependent stimulation of erythrocyte Ca2+-ATPase (ATP phosphohydrolase, EC 188.8.131.52) and cyclic nucleotide phosphodiesterases (3',5'-cyclic-nucleotide 5'-nucleotidohydrolase, EC 184.108.40.206) from brain and heart. Basal activities of these enzymes in the absence of calmodulin are relatively unaffected by concentrations of local anesthetics that strongly inhibit the specific stimulation by calmodulin. Increasing calmodulin, but not Ca2+, overcomes the inhibitory action of the local anesthetics on brain phosphodiesterase. However, excess calmodulin does not fully restore activity of erythrocyte CA2+-stimulated ATPase. Although the mechanism(s) by which the local anesthetics act is unclear, they inhibit binding of 125I-labeled calmodulin to the erythrocyte membrane. Antagonism of calmodulin provides a molecular mechanism that may explain the inhibition of many Ca2+-dependent cellular processes by local anesthetics--e.g., Ca2+ transport, exocytosis, excitation-contraction coupling, non-muscle-cell motility, and aggregation.
Volpi, M; Sha'afi, R I; Epstein, P M; Andrenyak, D M; Feinstein, M B
INTRODUCTION Revision surgery is increasingly performed as result of the increase in primary bariatric procedures. We describe a new technique of revision Roux-en-Y gastric bypass (RYGB) acombining stapled gastroenterostomy with fixed band placement. We report two cases of unique complications and its successful endoscopic and surgical management. PRESENTATION OF CASE Two out of twenty patients undergoing this revision RYGB procedure presented with gastric outlet obstruction due to band erosion within 10 weeks. Endoscopic band retrieval was successful in the first patient but the second patient required surgical removal. DISCUSSION We report the new complication of band erosion in 10% patients using a unique revision RYGB technique combining restriction of the gastric outlet and band placement. We advise using one or the other technique but not both in combination. Surgeons need to be aware of this as erosion which occurs early due to close proximity of band with fresh staple line. We report successful endoscopic and surgical management. CONCLUSION Revision surgery using this technique predisposes to bande erosion, presenting as gastric outlet obstruction. Endoscopic management should be attempted prior to surgical removal.
Suppiah, Aravind; Hamed, Mazin; Millson, Charles; Pollard, Stephen
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
This review will focus on inhalational anesthetic neuroprotection during cerebral ischemia and inhalational anesthetic preconditioning before ischemic brain injury. The limitations and challenges of past and current research in this area will be addressed before reviewing experimental and clinical studies evaluating the effects of inhalational anesthetics before and during cerebral ischemia. Mechanisms underlying volatile anesthetic neuroprotection and preconditioning will also be examined. Lastly, future directions for inhalational anesthetics and ischemic brain injury will be briefly discussed.
The paranasal sinuses are common sites of infection in children. The diagnosis of sinusitis may be challenging because the sinus cavities are small and variably contoured, the clinical manifestations are often nonspecific, and the radiologic findings may be equivocal. Because many local and systemic factors contribute to sinusitis in children, the therapeutic regimens vary. In addition to conventional medical approaches, new surgical procedures and improved anesthetictechniques have made functional endonasal sinus surgery an excellent management tool for selected patients with chronic or recurrent disease. PMID:1737417
A multi-stage optimization technique is proposed for solving large optimization problems. The primary advantages of this technique include the utilization of little computer memory and the preservation of much of the complexities inherent in the actual problems. A demonstration of the technique is presented via its application to a complex hydro-thermal scheduling problem faced by a particular company. With this
\\u000a Abstract\\u000a Purpose To explain the considerations governing the anestheticmanagement of pregnant patients with Klippel-Trenaunay syndrome (KTS).\\u000a Klippel-Trenaunay syndrome is a congenital vascular disease characterized by cutaneous hemangiomas, venous varicosities, and\\u000a limb hypertrophy; and is associated with both hemorrhagic and thrombotic complications. The importance of this diagnosis,\\u000a including the presence of neuraxial vascular anomalies, is often under-appreciated by both obstetric and
The authors analyze mortality rates during 338,000 anesthetic procedures. Mortality was 0.02%. Epidural, spinal, and plexus anesthesias were 15% of the total number of anesthetic procedures. In this group, mortality was twice less [0.01% (6 patients)] than that under general anesthesia. Under regional anesthesia, all deaths were associated with the induction of epidural anesthesia. A human factor is of profound importance for fatal cases under regional anesthesia. Regional anesthetictechniques are safer than general anesthetic ones. PMID:17566178
Mikha?lovichev, Iu I; Churliaev, Iu A; Sokolovski?, V S; Martynenkov, V Ia
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
Several different approaches to Strategic Management Accounting (SMA) can be found in the literature of management ac counting since Simmonds (1981) coined the term. However, there is a little survey research about SMA practice, with the exception of the studies of Guilding et al. (2000) and Cravens & Guilding (2001). The paper aims to enrich the fragmented knowledge on t
The interest in total quality management (TQM) has increased rapidly in recent years. Some people see TQM as something necessary to reach competitiveness but others claim TQM to be merely a management fad. We believe that there are several reasons for the different opinions about TQM. One is that the gurus, who often are seen as fathers of TQM, do
Conventional IP routers are passive devices that accept packets and perform the routing function on any input. Usually the tail-drop (TD) strategy is used where the input which exceeds the buffer capacity are simply dropped. In active queue management (AQM) methods routers manage their buffers by dropping packets selectively. We study one of the AQM methods called as random exponential
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
|The result of a project to develop short courses to help health care administrators and supervisors in developing practical, up-to-date management skills, this instructional workbook provides information and exercises applicable to on-the-job situations. Unit I covers the following leadership considerations: self-awareness, time management,…
Anesthetic agents, especially, volatile anesthetics are considered to exert organ toxicity such as nephrotoxicity and hepatotoxicity; however, recent aggressive researches explored the beneficial effects of volatile anesthetics as an organ protectant. Ischemic preconditioning is a phenomenon in which single or multiple brief periods of ischemia have been shown to protect the myocardium and brain against prolonged ischemic insult. General anesthesia showed the protection against both ischemic myocardial and brain reperfusion injuries. This phenomenon is called anesthetic preconditioning. Regarding the organ protection, anesthetic preconditioning is one of the useful ways to diverse the organ protective effects not only to heart but also brain. Nowadays, ischemic postconditioning, consisting of repeated brief cycles of ischemia-reperfusion performed immediately after reperfusion following a prolonged ischemic insult, dramatically reduces infarct size in experimental models and such clinical studies are reported. Both preconditioning and postconditioning share the same signal transduction pathway and inhibit the mitochondrial permeability transition (MPT) that leads to either apoptosis or necrosis of myocardium and neuronal cell. Both phenomena look very promising, but we still lack the real evidence for human reserach in terms of the clinical outcome and further analysis is necessary. Neurotoxicities of anesthetic agents are very crucial problems for the patient and they are considered to be due to the activation of IP3 receptor in ER after exposure to volatile anesthetics. Massive release of Ca2+ from ER induces Ca2+ overload leading to mitochondria permeability transition (MPT) and induces apoptosis in the brain or aggravates the neurodegenerative disease. Susceptible mechanisms and beneficial treatment for the toxicity of general anesthesia is considered as a critical subject to discuss and challenge to solve for our future. PMID:22702090
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
The public relations component of area-wide integrated pest management (AW-IPM) programmes that integrate the sterile insect technique (SIT) has a large impact on programme success. Full-time professionals should direct public relations activities and secure vital political support from governments and community organizations. Good communication among programme staff, and between programme staff and the public, is required to maintain participation and
V. A. DYCK; E. E. REGIDOR FERNÁNDEZ; J. Reyes Flores; T. Teruya; B. Barnes; P. GÓmez Riera; D. Lindquist; R. Reuben
Results are presented of an investigation of energy managementtechniques for fuel conservation in a large transport aircraft, the USAF C-141A. Using the methods of optimal control theory and numerical simulation, fuel-optimal flight paths are computed and compared with conventional vertical profiles for typical mission scenarios. Algorithms for on-board guidance to minimize fuel use are synthesized and evaluated, and functional
The stochastic nature of environmental processes and forcing functions diminishes the credibility of management decisions that are based on models that employ ''average'' conditions. Our thesis is that the environmental decision making process must quantitatively account for environmental uncertainties. In doing so, management strategies can be formulated that are based on acceptable levels of risk to the environment. We have extended this uncertainty analysis approach to include a linear programming optimization algorithm in order to demonstrate that acceptable risk scenarios can be devised which are cost effective as well. We demonstrate this point for the Great Lakes by showing that present and proposed phosphorus management plans have neither the probability of success nor the cost effectiveness of a management plan that is based on a combined uncertainty-optimization analysis. Present and proposed phosphorus management plans are predicted to have at most a 55% overall probability of meeting Great Lakes phosphorus goals. The combined uncertainty-optimization approach points to management options whose overall probability of success in meeting Great Lakes phosphorus goals varies between 55% and 99%. The costs associated with these options also vary, but savings as great as 400 million dollars per year could be realized with no diminishment in goal achievement when compared to present and proposed management plans.
This paper reviews the effects of six post-modern management concepts as applied to Turkish forestry. Up to now, Turkish forestry has been constrained, both in terms of its operations and internal organization, by a highly bureaucratic system. The application of new thinking in forestry management, however, has recently resulted in new organizational and production concepts that promise to address problems specific to this Turkish industry and bring about positive changes. This paper will elucidate these specific issues and demonstrate how post-modern management thinking is influencing the administration and operational capacity of Turkish forestry within its current structure. PMID:18194835
... (d) Regional planning aimed at conserving fish and wildlife, and/or providing recreation opportunities. (e) Management and operations agreements, strategies, and other institutional arrangements aimed at conserving fish and...
Summary form only given, as follows. On-line simulation refers to the use of simulation tools to aid in the management of operational systems. For example, faster-than-real-time simulation of the air transportation network can be used to aid air traffic controllers in managing traffic flows to reduce congestion and improve safety. Live feeds from air traffic control centers are used to
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.
The mechanism(s) and site(s) of action of volatile inhaled anesthetics are unknown in spite of the clinical use of these agents for more than 150 years. In the present study, the model eukaryote Saccharomyces cerevisiae was used to investigate the action of anesthetic agents because of its powerful molecular genetics. It was found that growth of yeast cells is inhibited by the five common volatile anesthetics tested (isoflurane, halothane, enflurane, sevoflurane, and methoxyflurane). Growth inhibition by the agents is relatively rapid and reversible. The potency of these compounds as yeast growth inhibitors directly correlates with their lipophilicity as is predicted by the Meyer-Overton relationship, which directly correlates anesthetic potency of agents and their lipophilicity. The effects of isoflurane on yeast cells were characterized in the most detail. Yeast cells survive at least 48 h in a concentration of isoflurane that inhibits colony formation. Mutants resistant to the growth-inhibitory effects of isoflurane are readily selected. The gene identified by one of these mutations, zzz4-1, has been cloned and characterized. The predicted ZZZ4 gene product has extensive homology to phospholipase A2-activating protein, a GO effector protein of mice. Both zzz4-1 and a deletion of ZZZ4 confer resistance to all five of the agents tested, suggesting that signal transduction may be involved in the response of these cells to volatile anesthetics.
Keil, R L; Wolfe, D; Reiner, T; Peterson, C J; Riley, J L
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.
A new approach to battery pack and fuel cell management, the battery health manager-BHM™ and the fuel cell health manager-FCHM™, both cell-based techniques that manage power supplies without disrupting operations, was described at INTELEC 2002. Using the BHM, each cell (or module) in a battery pack can be cycled to up to a full-load discharge, and then smart charged, in
W. A. Adams; James D. Blair; Kathryn R. Bullock; C. L. Gardner; Laishui Li
Dendritic spines form the postsynaptic contact sites for most excitatory synapses in the brain. Spines occur in a wide range of different shapes that can vary depending on an animal’s experience or behavioral status. Recently we showed that spines on living neurons can change shape within seconds in a process that depends on actin polymerization. We have now found that this morphological plasticity is blocked by inhalational anesthetics at concentrations at which they are clinically effective. These volatile compounds also block actin-based motility in fibroblasts, indicating that their action is independent of neuron-specific components and thus identifying the actin cytoskeleton as a general cellular target of anesthetic action. These observations imply that inhibition of actin dynamics at brain synapses occurs during general anesthesia and that inhalational anesthetics are capable of influencing the morphological plasticity of excitatory synapses in the brain.
A number of techniques have been described to remove rectal foreign bodies. In this report, a novel endoscopic technique using a pneumatic dilatation balloon normally used in achalasia patients is presented. In addition, a systematic review of the literature was performed for non-operative methods to remove foreign bodies from the rectum. These results are summarised, presented as a practical at-a-glance overview and a flow chart is offered to guide the clinician in treatment decisions. The design of the flow chart was based on the aims to treat the patient preferably on an outpatient basis with minimally invasive techniques and if possible under conscious sedation rather than general anaesthesia.
This study evaluated the effect of a new multimodal perioperative anesthetic and pain management strategy for primary total hip (THA) and total knee arthroplasty (TKA). Two cohorts of 50 consecutive THA and 50 TKA patients from before and after initiation of the new protocol were compared. The protocol involved scheduled oral narcotics, cyclooxygenase-2 inhibitors, no intrathecal narcotics, femoral nerve catheters
Christopher L. Peters; Brayton Shirley; Jill Erickson
Procedures used in the health and environmental chemistry departments at los Alamos National Laboratory are presented. Described are radiochemical analysis, qualitative, radiobioassay, radiotissue analytical procedures, instrument procedures, waste water chemistry analytical techniques, quality control, and laboratory safety procedures. (CBS)
Procedures used in the health and environmental chemistry departments at los Alamos National Laboratory are presented. Described are radiochemical analysis, qualitative, radiobioassay, radiotissue analytical procedures, instrument procedures, waste water chemistry analytical techniques, quality control, and laboratory safety procedures. (CBS)
A pilot study on the percutaneous introduction of a cecostomy tube for colonic irrigations in the treatment of children with fecal incontinence is described. The results were good, and the technique is recommended for certain patients.
Barry Shandling; Peter Graham Chait; Helen Forrest Richards
The primary challenge in the management of nodular goitre is to establish which thyroid nodules are malignant. Since selection of patients for operation on the basis of palpation of nodules alone gives a low yield of malignant disease, physicians have sought criteria for selection that combine the information obtained from special laboratory procedures with thoughtful clinical appraisal. Such special procedures, which include radioisotope scintiscanning, echography by B-mode ultrasonography, and either large- or fine-needle aspiration and cytologic examination of the aspirate, are considered valuable in a proposed clinical approach to the management of thyroid nodules. Images FIG. 1 FIG. 2 FIG. 3
Walfish, P. G.; Miskin, M.; Rosen, I. B.; Strawbridge, H. T.
Purpose: To report the technique of amniotic membrane transplantation dressing during the acute phase of Stevens-Johnson syndrome.Methods: Interventional case report. We report the clinical presentation, surgical technique and clinical outcome of a patient with acute Stevens-Johnson syndrome and progressive tarsal conjunctival epithelial loss.Results: A 10-year-old girl presented with extensive corneal, bulbar and tarsal conjunctival epithelial loss and severe ocular pain
Mahiul M K Muqit; Roger B Ellingham; Claire Daniel
Bariatric surgery is well established to treat morbidly obese patients (BMI >40 kg\\/m 2) with various techniques. Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28–33 kg\\/m 2 after 5 years), but they are less effective in super-obese patients and in sweet-eaters. For that group combined techniques, such as
Cervical laminoplasty has become a popular technique for the treatment of cervical myelopathy resulting from multilevel canal\\u000a stenosis. The goal of this technique is to increase the spinal canal space and to reconstruct the posterior bony arch at the\\u000a same time. The most common reason for laminoplasty failure is restenosis because of hinge closure. In the present report,\\u000a the authors
M. Orabi; S. Chibbaro; O. Makiese; J. F. Cornelius; B. George
The detection of altered or forged documents is an important tool in large scale office automation. Printing technique examination\\u000a can therefore be a valuable source of information to determine a questioned documents authenticity. A study of graylevel features\\u000a for high throughput printing technique recognition was undertaken. The evaluation included printouts generated by 49 different\\u000a laser and 13 different inkjet printers.
Christian Schulze; Marco Schreyer; Armin Stahl; Thomas M. Breuel
Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure. In the absence of any structural or biochemical abnormalities, and with spontaneous recovery approximating the anesthetic half-life, the authors' observations are consistent with transient brainstem paralysis caused by perioperative local anesthetic infiltration. PMID:22702331
Joannides, Alexis J; Santarius, Thomas; Fernandes, Helen M; Laing, Rodney J C; Trivedi, Rikin A
Local anesthetics such as dibucaine, QX572, tetracaine, and phenacaine, as well as other drugs with local anesthetic-like properties (e.g., mepacrine, propranolol, and SKF 525A) inhibit the specific calmodulin-dependent stimulation of erythrocyte Ca2+-ATPase (ATP phosphohydrolase, EC 220.127.116.11) and cyclic nucleotide phosphodiesterases (3',5'-cyclic-nucleotide 5'-nucleotidohydrolase, EC 18.104.22.168) from brain and heart. Basal activities of these enzymes in the absence of calmodulin are relatively
M. Volpi; R. I. Sha'Afi; P. M. Epstein; D. M. Andrenyak; M. B. Feinstein
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.
A new digital pulse width modulator (DPWM) design for a field programmable gate array (FPGA) based systems is presented in this paper. The proposed architecture fully utilizes the digital clock manager (DCM) resources available on new FPGA boards. The proposed segmented DCM DPWM is a digital modulator architecture with low power that allows for high switching frequency operation. It relies
Majd G. Batarseh; Wisam Al-Hoor; Lilly Huang; Chris Iannello; Issa Batarseh
|Community profiling is a tool that aims to help practitioners collect and make use of varied data to understand the diversity of stakeholders and issues in communities where they are delivering natural resource management programs. This paper will discuss some of the problems experienced with community profiling and propose a shift in the way in…
The Internet is providing worldwide c onnectivity for business organizations and has created a much greater opportunity for people to collaborate remotely. However, working on the Internet can b e inefficient due to the Internet l atency resulting from uncontrolled Internet traffic and finite bandwidth. In this paper, we investigate several research problems in distributed workflow management and propose a
|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…
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
This paper presents the design of a Demand Side Management (DSM) priority ranking. It utilizes sequential ordering and set theory. The priority ranking is formulated in conjunction with three DSM objectives: load shifting, valley filling and peak clipping; aiming at improving the system overall load factor and reducing the customer bill. The priority ranking utilizes parameters representing the individual load
M. M. El-Metwally; M. S. El-Sobki; H. A. Attia; S. A. Wahdan
The costs of deer-vehicle collisions (DVCs) nationwide are estimated to be in excess of $1 billion annually. In this study, factors contributing to the abundance of DVCs are identified and the potential effectiveness of various deer management strategies in reducing DVCs is investigated. The added benefits of such strategies are also evaluated in a bioeconomic context by comparing alternative outcomes
The use of case incidents has been found to be an effective tool for teaching business concepts to senior hospitality students. With proper classroom manage ment, the case incident can be useful in two ways—as an introduction to a specific topic or theme and as a \\
Four supervisors working in a sheltered workshop for developmentally disabled adults participated in a behavior management program. Tests of durability of the altered behavior at three months and six months after completion of training showed that three supervisors had maintained low levels of attending to inappropriate trainee behaviors. (Author)
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
The main goals of the 2PARMA project are: the definition of a parallel programming model combining component-based and single-instruction multiple-thread approaches, instruction set virtualisation based on portable byte-code, run-time resource management policies and mechanisms as well as design space exploration methodologies for many-core computing architectures.
Cristina Silvano; William Fornaciari; Stefano Crespi-Reghizzi; Giovanni Agosta; Gianluca Palermo; Vittorio Zaccaria; Patrick Bellasi; Fabrizio Castro; S. Corbetta; Andrea Di Biagio; E. Speziale; M. Tartara; David Siorpaes; Heiko Hübert; Benno Stabernack; Jens Brandenburg; Martin Palkovic; Praveen Raghavan; Chantal Ykman-Couvreur; Alexandros Bartzas; Sotirios Xydis; Dimitrios Soudris; Torsten Kempf; Gerd Ascheid; Rainer Leupers; Heinrich Meyr; Junaid Ansari; Petri Mähönen; Bart Vanthournout
A study was conducted to quantify the thermal characteristics and to determine alternative methods to maintain thermal equilibrium for an advanced linear motor (ALM). The ALM is an essential component in the design and development of the next generation aircraft launch and recovery systems. The development of a thermal management system for the ALM is critical for maximizing the benefits
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…
We surveyed the herpetofaunal (amphibian and reptile) communities inhabiting five types of habitat on a managed landscape. We conducted monthly surveys during 1997 in four replicate plots of each habitat type using several different methods of collection. Communities of the two wetland habitats (bottomland wetlands and isolated upland wetlands) were clearly dissimilar from the three terrestrial communities (recent clearcut, pine
Travis J Ryan; Thomas Philippi; Yale A Leiden; Michael E Dorcas; T. Bently Wigley; J. Whitfield Gibbons
|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
This article summarizes the project and risk management of a remediation\\/reclamation project in Lavrion, Greece. In Thoricos the disposal of mining and metallurgical wastes in the past resulted in the contamination with heavy metals and acid mine drainage. The objective of this reclamation project was to transform this coastal zone from a contaminated site to an area suitable for recreation
I. Panagopoulos; A. Karayannis; K. Adam; K. Aravossis
Drawing on experiences in New South Wales from 1950 to 1980 in modeling and re-use techniques in the development of desalination technology and its application in fresh water production for potable use, the paper describes how Australia realized its responsibilities in developing participative and sustainable approaches to land use and water resources management. An analysis of the lessons from the operation of the Bayswater zero-discharge power station significantly contributed to the debate on sustainable approaches, highlighting that no management policy of a water basin can be implemented without a model based on reliable data from all sectors (including the environment), and no management model can be implemented without the participation of all stakeholders. These ideals were reflected in the conception and establishment of the Murray-Darling Basin Commission. The Commission succeeded in bringing together all major stakeholders in this huge basin, though it took more than 15 years to do so. While widely recognized as one of the most advanced and successful experiences in integrated management of a drainage basin, it has still not achieved the reversal of many unsustainable agricultural practices, giving a clear indication of the difficulties and time required for producing sustainable solutions. PMID:15195414
The loose and unstable lower complete denture is one of the most common problems faced by denture patients. One of the methods used to solve this problem is the neutral zone technique. The neutral zone is the area where the displacing forces of the lips, cheeks, and tongue are in balance. It is in this zone that the natural dentitions lie and this is where the artificial teeth should be positioned. This area of minimal conflict may be located by using the neutral zone technique. The artificial teeth can then be set up in the correct positions.
Os acromiale is a common finding in shoulder surgery. We review the anatomy, prevalence, pathophysiology, and treatment options for this diagnosis. In addition, we report on a case series of 6 patients with a symptomatic meso os acromiale who were treated with a new technique involving arthroscopic acromioplasty in conjunction with the excision of the acromial nonunion site. We have demonstrated this novel treatment method to be a safe and effective technique in this case series. This arthroscopic partial resection of an os acromiale is considered to be an alternative option for treating a symptomatic meso os acromiale. PMID:24095078
Johnston, Peter S; Paxton, E Scott; Gordon, Victoria; Kraeutler, Matthew J; Abboud, Joseph A; Williams, Gerald R
Whole lung lavage is still the most effective treatment for pulmonary alveolar proteinosis. We report a 21-year-old male diagnosed with pulmonary alveolar proteinosis by open lung biopsy and who underwent whole lung lavage with a modified technique. He showed significant improvement in clinical and functional parameters. The technique of intermittent double lung ventilation during lavage procedure keeps the oxygen saturation in acceptable limits in patients at risk for severe hypoxemia and allows the procedure to be completed in a single setting. PMID:15756373
Ahmed, Raees; Iqbal, Mobeen; Kashef, Sayed H; Almomatten, Mohammed I
Purpose This systematic review outlines current evidence regarding the effectiveness of intraspinal techniques for cancer pain and\\u000a addresses practical implementation issues.\\u000a \\u000a \\u000a \\u000a Methods A search of electronic databases identified systematic reviews and randomized controlled trials (RCTs) evaluating the effectiveness\\u000a of intraspinal techniques in the setting of cancer pain. An environmental scan was completed via the internet to identify\\u000a practice guidelines and resource documents
Jeff Myers; Vincent Chan; Virginia Jarvis; Cindy Walker-Dilks
Cystic hygroma (CH) in the cervical region presents as a challenge to the anesthetist. The anaesthetic difficulties are usually associated with CH because of tumor extension into the mouth, airway management, thoracic extension, hemorrhage, involvement of pretracheal region, Post operative respiratory obstruction and coexisting anomalies (Down syndromes, Turner syndromes and congenital cardiac defects). Disorders of the CH relevant to anaesthesia and intensive care medicine are discussed in this review.
Esmaeili, Mohammad Reza Haji; Razavi, Seyed Soheil Ben; Harofteh, Hamid Reza Abbasi; Tabatabaii, Seyed Mahmood; Hosseini, Habib Allah; Sheikhi, Mohammad Ali
Neonatal limb ischaemia (NLI) is a rare but potentially catastrophic condition. Although medical therapy remains as first-line treatment, surgery has an important role when limb-threatening events are present. In this paper we outline the milking technique for open thrombectomy used by the senior author in the treatment of 5 NLI cases. We also present the use of Integra and it's specific benefits in the management of wounds in these challenging situations. Skin grafts over the Integra can be avoided by staged excision of the silicone layer from the margins. We believe this is a novel approach to the use of Integra. PMID:23318054
The establishment and maintenance of effective urinary tract drainage for patients with malignant extrinsic ureteric obstruction is a formidable challenge for the urologist. We have utilized an alternative method of urinary diversion, called Palliative Subcutaneous Tunneled Nephrostomy Tubes (PSTN), for long term urinary tract drainage when intracoropreal stenting has failed or is not tolerated. PSTN provides a simple and effective method of external urinary diversion and preservation of renal function. This technique should be an option in the armamentarium of urologists for management of malignant ureteral obstruction. PMID:11886602
SUMMARY High-performance computing clusters (commodity hardware with low-latency, high- bandwidth interconnects) based on Linux, are rapidly becoming the dominant computing platform for a wide range of scientific disciplines. Yet, straightforward software installation, maintenance, and health monitoring for large-scale clusters has been a consistent and nagging problem for non-cluster experts. The NPACI Rocks distribution takes a fresh perspective on management and
Hepatocellular carcinoma (HCC) is the most frequently occurring primary tumour of the liver in adults and the third most common\\u000a cause of cancer-related deaths in the world. The incidence of HCC is increasing both in Europe and in the United States due\\u000a to the increasing prevalence of hepatitis C. Of recognised importance, when making decisions regarding the most appropriate\\u000a management
The European Water Framework Directive prescribes that the development of a river assessment system should be based on an\\u000a ecological typology taking the biological reference conditions of each river type as a starting point. Aside from this assessment,\\u000a water managers responsible for river restoration actions also need to know the steering environmental factors to meet these\\u000a reference conditions for biological
V. Adriaenssens; P. F. M. Verdonschot; P. L. M. Goethals; N. De Pauw
Distance learning (e-learning) is expanding at a very rapid pace as organizations throughout the world search for economical, responsive, and effective means to train workers to meet the challenges of the information age workplace. The Army Distance Learning Program (TADLP) model is discussed in the context of the global e-learning environment. Both e-learning infrastructure and management issues are identified, with
Susan Haugen; Robert Behling; Wallace Wood; David Douglas
CH2M HILL Hanford Group, Inc. (CH2M HILL) plays a critical role in Hanford Site cleanup for the U. S. Department of Energy, Office of River Protection (ORP). CH2M HILL is responsible for the management of 177 tanks containing 53 million gallons of highly radioactive wastes generated from weapons production activities from 1943 through 1990. In that time, 149 single-shell tanks,
This paper investigates the extent to which firm level technological change that reduces unregulated emissions is driven by\\u000a regulatory pressures, and firms’ technological and organizational capabilities. Using a treatment effects model with panel\\u000a data for a sample of S&P 500 firms over the period 1994–1996, we find that organizational change in the form of Total Quality\\u000a Environmental Management leads firms
Madhu Khanna; George Deltas; Donna Ramirez Harrington
Data stream sources are currently emerged with the evolution of traditional data warehouse towards real-time data warehouse. Different solutions have been proposed to extract, transform and load the data streams but investigation is still needed to handle the bursts of incoming data streams. In this paper, we have proposed a flow regulation technique which regulates the fast and time varying
Understanding and application of various respiratory practices are impeded by the many interacting physiological and psychological variables. Yoga techniques may offer insights into useful breathing practices and control of important variables. This review integrates relevant data from (a) the psychophysiological\\/psychological literature, (b) the physiological\\/medical literature, and (c) studies of yoga. The available data indicate that yogic slow breathing practices promote