Science.gov

Sample records for anesthetic management techniques

  1. Pheochromocytoma resection: Current concepts in anesthetic management

    PubMed Central

    Ramakrishna, Harish

    2015-01-01

    Pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. These chromaffin tissue tumors are not uncommon in anesthetic practice and have varied manifestations. The perioperative management of these tumors has improved remarkably over the years, in conjunction with the evolution of surgical techniques (open laparotomy to laparoscopic techniques and now to robotic approaches in the present day). This review attempts to comprehensively address the intraoperative and postoperative issues in the management of these challenging tumors with an emphasis on hemodynamic monitoring and anesthetic technique. PMID:26330708

  2. [Anesthetic management in bronchial asthma].

    PubMed

    Kozian, Alf; Schilling, Thomas; Hachenberg, Thomas

    2016-06-01

    In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome. PMID:27359239

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

    PubMed

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

    2015-08-01

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

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

    PubMed

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

    2015-08-01

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

  5. Anesthetic Techniques and Cancer Recurrence after Surgery

    PubMed Central

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

    2014-01-01

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

  6. Child with aplastic anemia: Anesthetic management

    PubMed Central

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

    2012-01-01

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

  7. Anesthetic management of maternal Mirror syndrome.

    PubMed

    Tayler, E; DeSimone, C

    2014-11-01

    Mirror syndrome (Ballantyne syndrome, triple edema, maternal hydrops, pseudotoxemia) is a rarely diagnosed condition associated with pregnancy that can be life-threatening for both the mother and fetus. There is limited literature on its pathogenesis and anesthetic management, making prevention and treatment complex. The duration of pregnancy and severity of maternal or fetal presentation often determines outcome. We describe the anesthetic considerations of a morbidly obese parturient with Mirror syndrome. PMID:25066819

  8. The Anesthetic Effect of Anterior Middle Superior Alveolar Technique (AMSA)

    PubMed Central

    de Souza Tolentino, Lívia; Barbisan Souza, André; Girardi, Ana Alice; Romito, Giuseppe Alexandre; Araújo, Maurício Guimarães

    2015-01-01

    Anesthesia of the soft and hard tissues of the maxilla may require up to 5 injections. Thus, the aim of this study was to evaluate the anesthetic efficacy of the anterior middle superior alveolar (AMSA) and supraperiosteal injection techniques during subgingival scaling and root planing (SRP). Thirty individuals with periodontitis were scheduled for SRP on the buccal aspect of teeth in the anterior maxilla. Before SRP, on a randomly chosen side of the maxilla, the supraperiosteal injection was performed in 1 session, while the AMSA injection was conducted in the contralateral side of the same patient in another session. Immediately after each SRP session, patients rated their pain perception during the procedure with a visual analog scale. No statistically significant differences in mean pain ratings during SRP were found after both anesthetic techniques (P > .05). This preliminary study demonstrated that the AMSA and supraperiosteal injection techniques provided similar anesthetic comfort during SRP. The AMSA injection could be an alternative to anesthetize the buccal aspect of maxilla, without the undesirable effects on facial structures such as the upper lip, nostrils, and lower eyelids. However, further randomized clinical trials with larger samples are necessary to confirm such results. PMID:26650493

  9. Management of exposure to waste anesthetic gases.

    PubMed

    Smith, Francis Duval

    2010-04-01

    Anesthetic agents were developed in the 1700s, and nitrous oxide was first used in 1884. Research on the effects of waste anesthetic gas exposure started appearing in the literature in 1967. Short-term exposure causes lethargy and fatigue, and long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. Today, perioperative staff members are exposed to trace amounts of waste anesthetic gas, and although this exposure cannot be eliminated, it can be controlled. Health care facilities are required to develop, implement, measure, and control practices to reduce anesthetic gas exposure to the lowest practical level. Exposure levels must be measured every six months and maintained at less than 25 parts per million for nitrous oxide and 2 parts per million for halogenated agents to be compliant with Occupational Safety and Health Administration standards.

  10. [Anesthetic management for patients with mitochondrial disease].

    PubMed

    Imai, Yousuke; Yamada, Yoshitsugu

    2014-01-01

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

  11. Anesthetic technique for inferior alveolar nerve block: a new approach

    PubMed Central

    PALTI, Dafna Geller; de ALMEIDA, Cristiane Machado; RODRIGUES, Antonio de Castro; ANDREO, Jesus Carlos; LIMA, José Eduardo Oliveira

    2011-01-01

    Background Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 1329% of cases. Objective Objective: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. Materials and Methods A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. Results The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. Conclusion This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry. PMID:21437463

  12. Anesthetic management of hysterosalpingooophorectomy in a case with severe idiopathic dilated cardiomyopathy.

    PubMed

    Kaya, Cengiz; Koksal, Ersin; Ustun, Yasemin Burcu; Semizoglu, Yasemin; Yilmaz, Nurullah

    2014-01-01

    Idiopathic dilated cardiomyopathy is a primary myocardial disease with unknown aetiology. This disease follows a prospective course that is characterized by ventricular dilation and impaired myocardial dilation. Congestive heart failure and malignant arrhythmias are the most widespread complications. The incidence of idiopathic dilated cardiomyopathy in the general population is 5-8/100.000. Because of the increased risks of perioperative complications, anesthetic management of this disease requires the application of a specific technique. This case report demonstrates the application of successful regional anesthetic management (thoracic epidural anesthesia) in a patient who had been diagnosed with severe idiopathic dilated cardiomyopathy. PMID:24937943

  13. Anesthetic management of an infant for aortopexy.

    PubMed

    Kumar, Shruti; Gupta, Richa; Wadhawan, Sonia

    2013-04-01

    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

  14. Anesthetic management of a myotonic dystrophy patient with paraganglionoma.

    PubMed

    Subramaniam, Ashwin; Grauer, Robert; Beilby, David; Tiruvoipati, Ravindranath

    2016-11-01

    Myotonic dystrophy (DM), though rare, can significantly complicate anesthesia due to muscular and extra-muscular involvement. When this condition is compounded by a pheochromocytoma, anesthetizing such patients becomes extra challenging. We present a case report of a 61-year-old lady with congenital DM, with the whole gamut of associated features, was diagnosed with a noradrenaline secreting paraganglionoma following investigation of refractory hypertension. We anesthetized her for an open resection of the lesion. The conduct of anesthesia and recovery of this patient is described. Our experience suggests that anesthetizing these patients though challenging can be safely managed with relaxant general anesthesia and epidural analgesia with meticulous care pre, intra and post-surgical intervention. PMID:27687340

  15. Anesthetic Management in a Gravida with Type IV Osteogenesis Imperfecta

    PubMed Central

    Vue, Elizabeth; Davila, Juan

    2016-01-01

    Osteogenesis imperfecta (OI) is an inherited disorder of the connective tissues caused by abnormalities in collagen formation. OI may present many challenges to the anesthesiologist. A literature review reveals a wide range of implications, from basic positioning to management of the difficult airway. We present the anesthetic management of a 25-year-old gravid woman with OI, fetal demise, and possible uterine rupture, admitted for an exploratory laparotomy. PMID:27433164

  16. ANESTHETIC MANAGEMENT DURING COMBINED LIVER AND KIDNEY TRANSPLANTATION.

    PubMed

    El Kouny, Amr; Harbi, Mohammed; Ismail, Hesham; Abouras, Chadi; Basha, Abdulatif; Abojeesh, Ibrahim; Naeim, Annas; Kashkoush, Sami; Khalid, Abdullah; Ohali, Wael; Dimitriou, Vassilios

    2016-06-01

    Combined liver and kidney transplantation is a highly demanding and challenging procedure for anesthesiologists due to the lengthy and complicated nature of the procedure, the critical patient condition and the need to balance the intravascular volume to maintain the venous outflow of the hepatic allograft and also the diuresis of the renal allograft. Intravascular volume management and coagulation control, seem to be the most important issues during combined liver and kidney transplantation. There is sparsity of data in the literature concerning the anesthetic and fluid management in CLKT. We present and discuss the anesthetic management in a case series in three patients, who underwent combined liver and kidney transplantation in our institution during the last two years. PMID:27487641

  17. [Anesthetic Management of Three Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy].

    PubMed

    Maruyama, Naoko; Wakimoto, Mayuko; Inamori, Noriko; Nishimura, Shinya; Mori, Takahiko

    2015-08-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronically progressing or relapsing disease caused by immune-mediated peripheral neuropathy. We report the anesthetic management of three CIDP patients who underwent elective orthopedic surgeries. Owing to the risk of neuraxial anesthetics triggering demyelination, general anesthesia was selected to avoid epidural or spinal anesthesia or other neuraxial blockade. It was also judged prudent to avoid prolonged perioperative immobilization, which might compress vulnerable peripheral nerves. For Patient 1, general anesthesia was induced with propofol, remifentanil, and sevoflurane, and was maintained with sevoflurane and remifentanil. For Patients 2 and 3, general anesthesia was induced and maintained with propofol and remifentanil. For tracheal intubation, under careful monitoring with peripheral nerve stimulators, minimal doses of rocuronium (0.6-0.7 mg x kg(-1)) were administered. When sugammadex was administered to reverse the effect of rocuronium, all patients rapidly regained muscular strength. Postoperative courses were satisfactory without sequelae.

  18. Anesthetic management of patent ductus arteriosus in adults

    PubMed Central

    Shinde, Shital Rajesh; Basantwani, Shakuntala; Tendolkar, Bharati

    2016-01-01

    Patent ductus arteriosus (PDA) is an extracardiac left to right shunt. It should be corrected at an early age, but some patients may survive into adult life even without repair. Anesthetic management for adult patients with PDA poses many challenges for the anesthesiologist due to alterations in the cardiopulmonary physiology. We report successful anesthesia management of a case of an adult patient of PDA with moderate pulmonary artery hypertension with infective endarteritis (two large mobile vegetations at the pulmonary end of the duct). PMID:27716713

  19. Anesthetic Management of a Patient with Myasthenia Gravis for Meningioma Surgery - A Case Report.

    PubMed

    Srivastava, V K; Agrawal, S; Ahmed, M; Sharma, S

    2015-01-01

    Myasthenia gravis is a disease of great challenge to the anesthesiologist, because it affects the neuromuscular junction. Anesthetic management involves either muscle relaxant or non-muscle relaxant techniques. This case report documents the safe use of fentanyl, propofol and sevoflurane combination guided by bispectral index, without the use of muscle relaxants in a patient with myasthenia gravis who presented for meningioma surgery. PMID:26620756

  20. Central bronchial carcinoid: Management of a case and anesthetic perspectives.

    PubMed

    Goswami, D; Kashyap, L; Batra, R K; Bhagat, C

    2016-01-01

    Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance. PMID:26955320

  1. Anesthetic and dental management of a child with IMAGe syndrome.

    PubMed

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

    2014-01-01

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

  2. Anesthetic and Dental Management of a Child With IMAGe Syndrome

    PubMed Central

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

    2014-01-01

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

  3. Anesthetic management of robot-assisted thoracoscopic thymectomy

    PubMed Central

    Karlekar, Anil; Dutta, Devesh; Saxena, Ravindra; Sharma, Krishna Kant

    2016-01-01

    Myasthenia gravis (MG) is a rare disorder involving neuromuscular junction. In conjunction with medical therapy, thymectomy is a known modality of treatment of MG and has shown to increase the probability of remission and overall symptomatic improvement. For minimally invasive thymectomy, video-.assisted thoracoscopic surgery has been the preferred surgical approach till recently. The robotic surgical procedure must necessarily bring new challenges to the anesthesiologists to effectively meet the specific requirements of the technique. At present, there is a paucity of literature regarding the anesthetic concerns of robotic assisted thymectomy, patient in question specifically posed a challenge since different maneuvers and techniques had to be tried to obtain optimum surgical conditions with stable ventilatory and hemodynamic parameters. Concerns of patient positioning and hemodynamic monitoring have also been discussed.

  4. Anesthetic management of robot-assisted thoracoscopic thymectomy

    PubMed Central

    Karlekar, Anil; Dutta, Devesh; Saxena, Ravindra; Sharma, Krishna Kant

    2016-01-01

    Myasthenia gravis (MG) is a rare disorder involving neuromuscular junction. In conjunction with medical therapy, thymectomy is a known modality of treatment of MG and has shown to increase the probability of remission and overall symptomatic improvement. For minimally invasive thymectomy, video-.assisted thoracoscopic surgery has been the preferred surgical approach till recently. The robotic surgical procedure must necessarily bring new challenges to the anesthesiologists to effectively meet the specific requirements of the technique. At present, there is a paucity of literature regarding the anesthetic concerns of robotic assisted thymectomy, patient in question specifically posed a challenge since different maneuvers and techniques had to be tried to obtain optimum surgical conditions with stable ventilatory and hemodynamic parameters. Concerns of patient positioning and hemodynamic monitoring have also been discussed. PMID:27625494

  5. Anesthetic management of robot-assisted thoracoscopic thymectomy.

    PubMed

    Karlekar, Anil; Dutta, Devesh; Saxena, Ravindra; Sharma, Krishna Kant

    2016-01-01

    Myasthenia gravis (MG) is a rare disorder involving neuromuscular junction. In conjunction with medical therapy, thymectomy is a known modality of treatment of MG and has shown to increase the probability of remission and overall symptomatic improvement. For minimally invasive thymectomy, video-.assisted thoracoscopic surgery has been the preferred surgical approach till recently. The robotic surgical procedure must necessarily bring new challenges to the anesthesiologists to effectively meet the specific requirements of the technique. At present, there is a paucity of literature regarding the anesthetic concerns of robotic assisted thymectomy, patient in question specifically posed a challenge since different maneuvers and techniques had to be tried to obtain optimum surgical conditions with stable ventilatory and hemodynamic parameters. Concerns of patient positioning and hemodynamic monitoring have also been discussed. PMID:27625494

  6. Peripartum anesthetic management of a patient with brittle cornea syndrome.

    PubMed

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

    2011-03-01

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

  7. Pain management via local anesthetics and responsive hydrogels

    PubMed Central

    Bagshaw, Kyle R; Hanenbaum, Curt L; Carbone, Erica J; Lo, Kevin WH; Laurencin, Cato T; Walker, Joseph; Nair, Lakshmi S

    2015-01-01

    Acute and chronic pain control is a significant clinical challenge that has been largely unmet. Local anesthetics are widely used for the control of post-operative pain and in the therapy of acute and chronic pain. While a variety of approaches are currently used to prolong the duration of action of local anesthetics, an optimal strategy to achieve neural blockage for several hours to days with minimal toxicity has yet to be identified. Several drug delivery systems such as liposomes, microparticles and nanoparticles have been investigated as local anesthetic delivery vehicles to achieve prolonged anesthesia. Recently, injectable responsive hydrogels raise significant interest for the localized delivery of anesthetic molecules. This paper discusses the potential of injectable hydrogels to prolong the action of local anesthetics. PMID:25690085

  8. Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage.

    PubMed

    Varela, N; Golvano, M; Monedero, P

    2016-10-01

    Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

  9. Anesthetic management of a large mediastinal mass for tracheal stent placement.

    PubMed

    Rajagopalan, Suman; Harbott, Mark; Ortiz, Jaime; Bandi, Venkata

    2016-01-01

    The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

  10. Modern Spirometry Supports Anesthetic Management in Small Animal Clinical Practice: A Case Series.

    PubMed

    Calice, Ivana; Moens, Yves

    2016-01-01

    Modern spirometry, like no other monitoring technique, allows insight into breath-to-breath respiratory mechanics. Spirometers continuously measure volume, airway pressure, and flow while calculating and continuously displaying respiratory system compliance and resistance in the form of loops. The aim of this case series is to show how observation of spirometric loops, similar to electrocardiogram or CO2 curve monitoring, can improve safety of anesthetic management in small animals. Spirometric monitoring cases described in this case series are based on use of the anaesthesia monitor Capnomac Ultima with a side stream spirometry sensor. The cases illustrate how recognition and understanding of spirometric loops allows for easy diagnosis of iatrogenic pneumothorax, incorrect ventilator settings, leaks in the system, kinked or partially obstructed endotracheal tube, and spontaneous breathing interfering with intermittent positive-pressure ventilation. The case series demonstrates the potential of spirometry to improve the quality and safety of anesthetic management, and, hence, its use can be recommended during intermittent positive-pressure ventilation and procedures in which interference with ventilation can be expected. PMID:27487353

  11. Use of continuous local anesthetic infusion in the management of postoperative split-thickness skin graft donor site pain.

    PubMed

    Hernandez, Jorge L Reguero; Savetamal, Alisa; Crombie, Roselle E; Cholewczynski, Walter; Atweh, Nabil; Possenti, Paul; Schulz, John T

    2013-01-01

    Donor sites from split-thickness skin grafts (STSG) impose significant pain on patients in the early postoperative period. We report the use of continuous local anesthetic infusion as a method for the management of postoperative STSG donor site pain. Patients undergoing single or dual, adjacent STSG harvest from the thigh (eight patients) or back (one patient) were included in this study. Immediately after STSG harvest, subcutaneous catheters were placed for continuous infusion of local anesthetic. Daily donor site-specific pain severity scores were prospectively recorded in nine patients receiving local anesthetic infusion. Patient characteristics, technical aspects, and postoperative complications were identified in the study. The thigh was the anatomic location chosen for most donor sites. A single catheter was placed for donor sites limited to 4 inches in width or less. A dual catheter system was used for those wider than 4 inches. An elastomeric pump delivered continuously a total of 4 ml/hr of a solution of 0.5% bupivacaine. The average anesthetic infusion duration was 3.1 days. A substantial decrease in worst, least, and average donor site pain scores was found from the first 24 hours to the second postoperative day in our patients, a treatment trend that continued through postoperative day 3. One patient developed minor anesthetic leakage from the catheter insertion site; and in three cases, accidental dislodgement of the catheters occurred. There were no cases of donor site secondary infection. All donor sites were completely epithelialized at 1-month follow-up. Continuous local anesthetic infusion is technically feasible and may represent an option for postoperative donor site pain control after STSG harvesting. Relative cost-benefit of the technique remains to be determined. PMID:23271060

  12. ASD and VSD Flow Dynamics and Anesthetic Management.

    PubMed

    Yen, Philip

    2015-01-01

    Atrial septal defects and ventricular septal defects are often encountered in patients presenting for treatment under anesthesia. The flow mechanisms for both defects are predominantly left to right shunting prior to long-term maladaptive changes that may occur. Close examination of the shunt dynamics demonstrates a minor right to left shunt that occurs as well. The article discusses these dynamics and the impact on an anesthetic plan. PMID:26398131

  13. ASD and VSD Flow Dynamics and Anesthetic Management

    PubMed Central

    Yen, Philip

    2015-01-01

    Atrial septal defects and ventricular septal defects are often encountered in patients presenting for treatment under anesthesia. The flow mechanisms for both defects are predominantly left to right shunting prior to long-term maladaptive changes that may occur. Close examination of the shunt dynamics demonstrates a minor right to left shunt that occurs as well. The article discusses these dynamics and the impact on an anesthetic plan. PMID:26398131

  14. Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome.

    PubMed

    Klein Nulent, Casper G A; de Graaff, Henri J D; Ketelaars, Rein; Sewnaik, Aniel; Maissan, Iscander M

    2016-08-15

    A 44-year-old man presented to our emergency department with a pharyngeal hemorrhage, 6 weeks after a total laryngectomy and extensive neck dissection. Immediate surgical intervention was necessary to stop massive arterial hemorrhage from the pharynx. The head and neck surgeon successfully ligated the common carotid artery during this procedure. We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol. PMID:27310900

  15. Anesthetic management of a pregnant patient with pseudo-pancreatic cyst for cysto-gastrostomy

    PubMed Central

    Shetti, Akshaya N.; Dhulkhed, Vithal K.; Gujarati, Amrish; Swetha, G. S.

    2014-01-01

    Non-obstetric diseases during pregnancy are not uncommon. The presence of systemic disease may further insult the pregnancy leading to alteration in the normal function of other system. Hence, it is important to treat the disease depending upon the severity and type of urgency. Several systemic diseases in pregnancy and management have been reported earlier but it is necessary to report a rare pathology, treatment option and its anesthetic management. We report anesthetic management of a rare case of pseudo pancreatic cyst in a pregnant lady operated for cysto-gastrostomy and also highlighting the recent guidelines for non-obstetric surgery in pregnancy. PMID:25886112

  16. Anesthetic management of a pituitary tumor resection with dexmedetomidine.

    PubMed

    Brady, Tim

    2010-04-01

    Dexmedetomidine (Precedex, Hospira, Lake Forest, Illinois), an alpha-2 agonist, mainly is used for sedating mechanically ventilated uncooperative patients in the intensive care setting. It also is being used by anesthesia providers for multiple purposes, including cardiothoracic surgeries, neurological surgeries, and awake-fiberoptic intubations and for patients with a high risk for airway obstruction. This article reports the investigation of the off-label use of dexmedetomidine as an anesthetic adjunct for a transsphenoidal pituitary tumor resection in an adult. The dexmedetomidine infusion not only provided the patient with added sedation but also decreased the need for narcotics and volatile agents while providing hemodynamic stability.

  17. Local anesthetic wound infiltration for pain management after periacetabular osteotomy

    PubMed Central

    2014-01-01

    Background and purpose To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postoperative analgesia after PAO. Patients and methods We performed a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT00815503) in 53 patients undergoing PAO to evaluate the effect of local anesthetic infiltration on postoperative pain and on postoperative opioid consumption. All subjects received intraoperative infiltration followed by 5 postoperative injections in 10-hour intervals through a multi-holed catheter placed at the surgical site. 26 patients received ropivacaine and 27 received saline. The intervention period was 2 days and the observational period was 4 days. All subjects received patient-controlled opioid analgesia without any restrictions on the total daily dose. Pain was assessed at specific postoperative time points and the daily opioid usage was registered. Results Infiltration with 75 mL (150 mg) of ropivacaine did not reduce postoperative pain or opioid requirements during the first 4 days. Interpretation The clinical importance of ropivacaine as single component in postoperative treatment of pain is questionable, and we are planning further studies to explore the potential of LIA in larger volume—and also a multimodal regimen—to treat pain in this category of patients. PMID:24650022

  18. Anesthetic management of a rare case of extra-adrenal pheochromocytoma

    PubMed Central

    Pratibha, S. D.; Katti, Vijay; Patil, Basvaraj

    2016-01-01

    Anesthetic management of pheochromocytoma is complicated and challenging. Extra-adrenal pheochromocytoma is a rare neuroendocrine tumor that produces, stores and secretes catecholamines. The main-stay in the management of pheochromocytoma surgeries is Preoperative preparation which has improved perioperative outcome. Modern anesthetic drugs with advanced monitoring have contributed to intraoperative stability. Resection of the tumor results in acute withdrawal of catecholamines, which may lead to severe hypotension. In perioperative period, adequate hydration should be maintained. Beta-blockers, nitroglycerine, sodium nitroprusside and phenylephrine are required to avoid hemodynamic fluctuations and should be used appropriately. PMID:26957701

  19. Anesthetic management of a neonate with arthrogryposis multiplex congenita for emergency laparotomy

    PubMed Central

    Chowdhuri, Rajat; Samui, Samarendranath; Kundu, Asim Kumar

    2011-01-01

    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 anesthetic management 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. PMID:21772690

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

    PubMed Central

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

    2012-01-01

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

  1. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

    PubMed Central

    Manchikanti, Laxmaiah; Nampiaparampil, Devi E.; Manchikanti, Kavita N.; Falco, Frank J.E.; Singh, Vijay; Benyamin, Ramsin M.; Kaye, Alan D.; Sehgal, Nalini; Soin, Amol; Simopoulos, Thomas T.; Bakshi, Sanjay; Gharibo, Christopher G.; Gilligan, Christopher J.; Hirsch, Joshua A.

    2015-01-01

    Background: The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups. Methods: Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV). Results: A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone. Conclusion: This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone. PMID:26005584

  2. Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study

    PubMed Central

    Idris, Mohamed; Sakkir, Nasil; Naik, Kishore Gopalakrishna; Jayaram, Nandakishore Kunijal

    2014-01-01

    Background: The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. Aim: A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Materials and Methods: Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Results: Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Conclusion: Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25298642

  3. Left atrial ball thrombus with acute mesenteric ischemia: anesthetic management and role of transesophageal echocardiography.

    PubMed

    Makhija, Neeti; Malankar, Dhananjay; Singh, Pooja; Goyal, Sameer; Patel, Kartik; Jagia, Priya

    2014-01-01

    A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri-operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed.

  4. Anesthetic Concerns of Space Flight

    NASA Technical Reports Server (NTRS)

    Norfleet, William T.

    1999-01-01

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

  5. Anesthetic management of a patient with giant retroperitoneal liposarcoma: case report with literature review

    PubMed Central

    Feng, Dandan; Xu, Fangxia; Wang, Meng; Gu, Xiaoping; Ma, Zhengliang

    2015-01-01

    Patients with giant retroperitoneal liposarcomas are considered at great risks of perioperative complications and require meticulous anaesthetic management. There have been few reports about anaesthetic management of giant retroperitoneal liposarcoma. We present the case of a 66-year-old patient who suffered from a giant retroperitoneal liposarcoma (diameter 45 cm and weigh 4.5 kg), needing a resection surgery under general anesthesia. We successfully managed anesthesia procedures in this patient using FloTrac/VigileoTM monitoring system without major perioperative complications. The surgery was completed uneventfully and the patient recovered smoothly. After reviewing the literature, we summarize FloTrac/VigileoTM monitoring system is useful to help anaesthesiologists adjust infusion rate to maintain the stability of circulatory state. Anesthetic monitoring, fluid management and temperature control need to be focused in the anesthetic management. PMID:26770605

  6. Anesthetic Management of a Pediatric Patient With Wilsons Disease

    PubMed Central

    Baykal, Mehmet; Karapolat, Sami

    2010-01-01

    Wilsons disease, characterized by cirrhosis, extrapyramidal symptoms and Kayser-Fleischer corneal rings, is a rare hereditary disease of human copper metabolism. Clinical findings in Wilsons disease are complex and neurological symptoms such as tremor, dysarthria, rigid dystonia, seizures, psychiatric disorders, acute liver failure, chronic hepatitis or cirrhosis may develop. A 4-year-old male patient was operated for traumatic depressed skull fracture and intracerebral hematoma. He was diagnosed with Wilsons disease at the age of 2.5 years and treated with zinc sulphate and D-penicillamine. General anesthesia was induced with propofol, fentanyl, atracurium, and maintained with isoflurane, and oxygen. No complications were encountered during the operation or in the postoperative period. We concluded that general anesthesia can successfully be given to Wilsons disease patients using an anesthetic agent, the metabolism of which is least affected by the liver disease, one that induces least hepatic toxicity. By close follow-up of patients clinically and biochemically, it is possible to reduce the complication rates to a minimum. Keywords Wilson's Disease; Craniocerebral trauma; Thoracic injuries; General anesthesia; Surgery PMID:21811529

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

    PubMed Central

    Batra, Meenu; Valecha, Umesh K.

    2014-01-01

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

  8. Anesthetic management of a patient with sustained severe metabolic alkalosis and electrolyte abnormalities caused by ingestion of baking soda.

    PubMed

    Soliz, Jose; Lim, Jeffrey; Zheng, Gang

    2014-01-01

    The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies. PMID:25180100

  9. Anesthetic management of a patient with sustained severe metabolic alkalosis and electrolyte abnormalities caused by ingestion of baking soda.

    PubMed

    Soliz, Jose; Lim, Jeffrey; Zheng, Gang

    2014-01-01

    The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies.

  10. Anesthetic Management of a Patient with Sustained Severe Metabolic Alkalosis and Electrolyte Abnormalities Caused by Ingestion of Baking Soda

    PubMed Central

    Lim, Jeffrey

    2014-01-01

    The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies. PMID:25180100

  11. Anesthetic management of a patient with Edwards syndrome.

    PubMed

    Mifsud, Stephanie; Bezzina, Maureen; Paris, Simon

    2016-08-01

    The use of suxamethonium in our case was uneventful and despite craniofacial anomalies, airway management was straightforward. This case illustrates that pediatric patients with trisomy 18, presenting with potentially acute life-threatening conditions and requiring emergency major surgery can be managed successfully with a multidisciplinary approach. PMID:27525073

  12. Epidermolysis bullosa: dental and anesthetic management of two cases.

    PubMed

    Wright, J T

    1984-02-01

    Epidermolysis bullosa (EB) is a group of rare genetic disorders which are of dental interest because of their specific oral manifestations and management difficulties. Two cases of recessive EB which may be classified clinically as the atrophicans-gravis Herlitz type are described. Dental therapy consisted of extractions and stainless steel crown restorations, with inhalation general anesthesia. The need for and advantages of early preventive and restorative dental care are illustrated by the cases presented.

  13. Congenital Lobar Emphysema: An Approach of Anesthetic Management.

    PubMed

    Mourya, Meenakshi; Meena, Dharam Singh

    2016-08-01

    Congenital Lobar Emphysema (CLE) is a medical condition which is quiet rarely seen especially in neonates. The disease is characterized by over inflation of lungs which is produced due to inhibition of escape of inspired air from lungs. This condition usually occurs in infants due to partial obstruction of the bronchus and can be reversed with timely and planned anaesthetic management. Here in, we are presenting a case of an infant who was merely four months of age. CLE was affecting his left upper lobe since birth which was being treated as lobar pneumonia outside at some peripheral health center. The case presented to hospital with the symptoms acute respiratory distress and was taken up for urgent surgical management. Left upper lobectomy was performed which relived his symptoms. Case was discharged from hospital after 10 days of uneventful hospital stay. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung. PMID:27656534

  14. Congenital Lobar Emphysema: An Approach of Anesthetic Management

    PubMed Central

    Meena, Dharam Singh

    2016-01-01

    Congenital Lobar Emphysema (CLE) is a medical condition which is quiet rarely seen especially in neonates. The disease is characterized by over inflation of lungs which is produced due to inhibition of escape of inspired air from lungs. This condition usually occurs in infants due to partial obstruction of the bronchus and can be reversed with timely and planned anaesthetic management. Here in, we are presenting a case of an infant who was merely four months of age. CLE was affecting his left upper lobe since birth which was being treated as lobar pneumonia outside at some peripheral health center. The case presented to hospital with the symptoms acute respiratory distress and was taken up for urgent surgical management. Left upper lobectomy was performed which relived his symptoms. Case was discharged from hospital after 10 days of uneventful hospital stay. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung. PMID:27656534

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

    PubMed Central

    Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

    2014-01-01

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

  16. Anesthetic management of intestinal obstruction: A postgraduate educational review

    PubMed Central

    Parthasarathy, S.; Sripriya, R.; Krishnaveni, N.

    2016-01-01

    Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients. PMID:27746522

  17. Scientometrics of anesthetic drugs and their techniques of administration, 1984-2013.

    PubMed

    Vlassakov, Kamen V; Kissin, Igor

    2014-01-01

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

  18. [Anesthetic management for pheochromocytoma resection: a comparison of epinephrine predominant and norepinephrine predominant pheochromocytoma].

    PubMed

    Doi, M; Ikeda, K

    1994-04-01

    Eleven patients with pheochromocytoma were divided into two groups; epinephrine predominant group (n = 4) and norepinephrine predominant group (n = 7). In each case, anesthesia was given using only inhalational anesthetics and adenosine triphosphate (ATP); and the same strategy was used to control cardiovascular variables. If arterial blood pressure, pulmonary artery pressure, central venous pressure or heart rate failed to be controlled with the strategy before the tumor resection, phentolamine, trinitroglycerine or propranolol was used. After the tumor resection, if decreasing the anesthetic concentration, cessation of ATP infusion and rapid intravenous infusion could not maintain the systolic arterial blood pressure above 80 mmHg, norepinephrine was infused. Maximum heart rate and arterial blood pressure during the tumor exploration were similar in both groups. No ventricular arrhythmias were recognized in any case. The frequency of usage of the cardiovascular depressants was not different between the two groups. In the norepinephrine predominant group, five cases required norepinephrine infusion after the tumor resection, but in the epinephrine predominant group, none required the norepinephrine infusion. Desensitization of alpha 1 adrenergic receptor induced by continuous high plasma norepinephrine concentration, was considered to decrease vascular resistance. In conclusion, except for the hypotension after the tumor resection in the norepinephrine predominant pheochromocytoma, both epinephrine predominant and norepinephrine predominant pheochromocytoma could be managed with similar anesthetic risks. PMID:8189622

  19. Intraoperative anesthetic complications.

    PubMed

    Milam, S B

    1987-01-01

    Intraoperative anesthetic complications can be prevented or minimized if the anesthetist is able to anticipate such problems in the preanesthetic period. Therefore, an adequate preanesthetic medical history that includes previous anesthetic experiences and past and current drug therapy is extremely important. Furthermore, the anesthetist must be properly trained to anticipate undesirable reactions to anesthetic agents. The signs of an impending disaster are subtle and nonspecific in the anesthetized patient. Therefore, continuous vigilance of the patient's physiologic status coupled with a high index of suspicion are essential to safe anesthetic management of dental patients. PMID:3468015

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

    PubMed

    Duffield, Adrienne T; Smith, Kathleen A

    2013-10-01

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

  1. Peripartum Anesthetic Management and Genomic Analysis of Rare Variants in a Patient with Familial Pulmonary Fibrosis.

    PubMed

    Sugino, Shigekazu; Bortz, Brandon J; Vaida, Sonia; Karamchandani, Kunal; Janicki, Piotr K

    2015-11-15

    A 29-year-old patient, 32 weeks' pregnant, with a history of familial interstitial fibrosis, was treated for acute hypoxemia after admission to the intensive care unit. Within 48 hours, this was followed by an emergent cesarean delivery, under general anesthesia, due to acute respiratory failure. Successful perinatal obstetric and anesthetic management resulted in the delivery of a baby and recovery of the mother. Subsequent genomic analysis using next-generation sequencing of the patient's entire exome revealed that she was a carrier of a deleterious mutation in the TERT gene, previously associated with the hereditary forms of interstitial fibrosis. PMID:26576048

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

    PubMed

    Duffield, Adrienne T; Smith, Kathleen A

    2013-10-01

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

  3. Two different anesthetic managements of a patient with von Gierke's disease.

    PubMed

    Huang, I-Ren; Jean, Wei-Horng; Lu, Cheng-Wei; Wu, Chia-Chan; Lin, Tzu-Yu; Chuang, Yueh-Hsun; Sun, Wei-Zen

    2006-03-01

    Von Gierke's disease, a form of glycogen storage disturbance, is a rare metabolic disorder with important implications for anesthesiologists. It is caused by the lack of the glucose-6-phosphatase, which is necessary for the liver to convert glycogen to glucose. To avoid severe hypoglycemia, it is crucial to keep oral feeding at intervals 2-3 hr for maintaining a normal blood sugar level. The metabolic derangements of von Gierke's disease may result in serious complications in patients undergoing surgery and anesthesia. We report the anesthetic managements of a patient with von Gierke's disease in two operations with different encounters. PMID:16623410

  4. [Anesthetic management of laparoscopic cholecystectomy for a patient with Churg-Strauss syndrome: a case report].

    PubMed

    Koda, Kenichiro; Uzawa, Masashi; Kimura, Haruka; Harada, Masaki; Sambe, Norie; Sugano, Takayuki; Ide, Yasuo; Kitamura, Takayuki; Tagami, Megumi

    2014-09-01

    Churg-Strauss syndrome (CSS) is an uncommon disease characterized by bronchial asthma, eosinophilia and systemic vasculitis. Many patients with CSS are suffering from cardiovascular disorders, neurological disorders and/or renal disorders which are associated with systemic vasculitis. Cardiac diseases are considered as the main cause of the death in patients with CSS. Steroid administration is the standard pharmacological therapy for CSS. There are very few clinical reports concerning anesthetic management for the patients with CSS. We suppose that precise perioperative managements are required for the patients with CSS, including the appropriate control of bronchial asthma and the careful treatments of disorders in cardiovascular system, neurological system and/or kidney. In addition, we believe that the steroid cover should be considered during the perioperative period of the patients with CSS. Here, we describe an anesthetic management of a 28-year-old man with CSS undergoing laparoscopic cholecystectomy. General anesthesia was induced with midazolam and fentanyl. Rocuronium was administered to facilitate tracheal intubation. After tracheal intubation, anesthesia was maintained with sevoflurane and remifentanil. Prior to the surgery, 100 mg of hydrocortisone was administered for the steroid cover. The surgery was uneventful. The patient emerged from general anesthesia smoothly, and was extubated safely. PMID:25255668

  5. [A regular internal auditing and registration of critical incidents regarded as safety maintenance elements within the anesthetic management of patients].

    PubMed

    Vinogradov, V L; Likhvantsev, V V; Alekseev, A A

    2004-01-01

    The paper summarizes a 5-year experience of evaluating the safety of anesthetic management 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 anesthetic management 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 anesthetic management.

  6. Choice of anesthetic technique on plasma concentrations of interleukins and cell adhesion molecules

    PubMed Central

    2013-01-01

    Background Whether inflammatory responses to surgery are comparably activated during total intravenous anesthesia (TIVA) and during volatile anesthesia remains unclear. We thus compared the perioperative effects of TIVA and isoflurane anesthesia on plasma concentrations of proinflammatory and anti-inflammatory interleukins and cell adhesion molecules. Methods Patients having laparoscopic cholecystectomies were randomly allocated to two groups: 44 were assigned to TIVA and 44 to isoflurane anesthesia. IL-1β, IL-6, IL-8, IL-10, IL-13, and the cellular adhesion molecules intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 were determined preoperatively, before incision, and at 2 and 24 hours postoperatively. Our primary outcomes were area-under-the-curve cytokine and adhesion molecule concentrations over 24 postoperative hours. Results The only statistically significant difference in area-under-the-curve concentrations was for IL-6, which was greater in patients given isoflurane:78 (95% confidence interval (CI): 52 to 109) pg/ml versus 33 (22 to 50) pg/ml, P= 0.006. Two hours after surgery, IL-6 was significantly greater than baseline in patients assigned to isoflurane: 47 (95% CI: 4 to 216, P<0.001) pg/ml versus 18 (95%CI: 4 to 374, P<0.001) pg/ml in the TIVA group. In contrast, IL-10 was significantly greater in patients assigned to TIVA: 20 (95% CI: 2 to 140, P<0.001) pg/ml versus 12 (95% CI: 3 to 126, P<0.001) pg/ml. By 24 hours after surgery, concentrations were generally similar between study groups and similar to baseline values. Conclusion The only biomarker whose postoperative area-under-the-curve concentrations differed significantly as a function of anesthetic management was IL-6. Two hours after surgery, IL-6 concentrations were significantly greater in patients given isoflurane than TIVA. However, the differences were modest and seem unlikely to prove clinically important. Further studies are needed. PMID:24472144

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

    PubMed

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

    2013-12-01

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

  8. Anesthetic management of staged thoracoscopic repair of bilateral eventration of diaphragm in a neonate

    PubMed Central

    Rao, Subramanian Hari; Natarajan, Saravanan; Pallavi, Vyapaka

    2016-01-01

    Congenital eventration of the diaphragm is a rare disorder, the perioperative management of which is challenging. The introduction of thoracoscopic repair of these defects has considerably reduced the perioperative morbidity and mortality in these patients. In spite of the advantages of thoracoscopy which include smaller chest incisions, reduced postoperative pain, and more rapid postoperative recovery compared with thoracotomy, it is still inherent with complications unique to it. A clear understanding of the pathophysiologic changes, potential complications and institution of appropriate monitoring and good planning is essential for the safe conduct of thoracoscopic procedures in neonates. We describe the anesthetic management of staged thoracoscopic repair of bilateral congenital eventration of the diaphragm in a neonate. PMID:26957704

  9. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

    PubMed

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. PMID:26614152

  10. [Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery].

    PubMed

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. PMID:26655713

  11. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

    PubMed

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  12. [Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery].

    PubMed

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    WANG, CHERYL; RICHMOND, ROBERT; ELDESOUKI, ENAS

    2015-01-01

    Paragangliomas account for 15–20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has a high mortality rate due to hypertension and challenging anesthetic management. The present report is of a case of the successful management of paraganglioma resection with unexpected aortic resection. The patient presented for paraganglioma resection. The blood pressure (BP) was well controlled with α blockade followed by β blockade prior to surgery. The patient was under general anesthesia, with multiple intravenous lines, catheters and an arterial line. Induction was achieved by the administration of narcotic and volatile agents. During the procedure, the aorta was found to require resection in order to complete the tumor resection. The BP changed markedly with clamping and unclamping, tumor vein ligation and tumor resection. The increased BP due to catecholamine release and unclamping was controlled with phentolamine, nitroprusside, esmolol and labetolol. Drops in BP due to tumor vein ligation and clamping were managed with norepinephrine and vasopressin. With close communication and monitoring, the surgery on the patient was successfully completed and the patient was discharged days later in a hemodynamically stable condition. The diagnosis was further confirmed by pathology. This was a challenging case of paraganglioma resection with unexpected aortic resection. The success achieved suggests that the resection of paraganglioma and an aortic segment requires delicate anesthetic management. The key are α blockade and β blockade as necessary to control BP pre-operatively, frequent communication between the anesthesiologist and surgeons, intra-operative intervention in excess catecholamine release with phentolamine, nitroprusside and labetalol prior to tumor removal, and vasopressin for catecholamine deficiency when clamping or subsequent to tumor removal. It is a delicately orchestrated process requiring team work. PMID:25780466

  15. [Anesthesia for geriatric patients : Part 2: anesthetics, patient age and anesthesia management].

    PubMed

    Herminghaus, A; Löser, S; Wilhelm, W

    2012-04-01

    Part 2 of this review on geriatric anesthesia primarily describes the multiple influences of age on the pharmacokinetics and pharmacodynamics of different anesthetic agents and their impact on clinical practice. In the elderly the demand for opioids is reduced by almost 50% and with total intravenous anesthesia the dosages of propofol and remifentanil as well as recovery times are more determined by patient age than by body weight. As a result depth of anesthesia monitoring is recommended for geriatric patients to individually adjust the dosing to patients needs. With muscle relaxants both delayed onset of action and prolonged duration of drug effects must be considered with increasing age and as this may lead to respiratory complications, neuromuscular monitoring is highly recommended. The following measures appear to be beneficial for geriatric patients: thorough preoperative assessment, extended hemodynamic monitoring, use of short-acting anesthetics in individually adjusted doses best tailored by depth of anesthesia monitoring, intraoperative normotension, normothermia and normocapnia, complete neuromuscular recovery at the end of the procedure and well-planned postoperative pain management in order to reduce or avoid the use of opioids.

  16. [Facial locoregional anesthetics: principles and precautions].

    PubMed

    Lefort, H; Lacroix, G; Cordier, A; Bey, E; Duhamel, P

    2009-12-01

    Facial locoregional anesthetics (ALR) with nervous blocks are simple and reliable to perform, need little technical resources with a very low iatrogenic risk. These blocks allow anesthesia without deforming wound banks using the same materials as usual local anesthetic procedures. Three principal nervous blocks, in a straight line along the vertical pupil axis, allow managing - even extensive - facial wounds. Few side effects may occur which can be easily prevented. It is a good alternative to local anesthetic for the treatment of extensive and deep areas which is performed with a lower number of injections and a high rate of success. These techniques are easy to learn and practise. These anesthetic techniques allow a nice treatment of different kinds of facial wounds from simple suture to flaps.

  17. [Anesthetic Management of a Patient with Central Core Disease for Scoliosis Surgery].

    PubMed

    Jimi, Nobuo; Izumi, Kaoru; Sumiyoshi, Rieko; Mizuno, Keiichiro

    2016-06-01

    Central core disease (CCD) is a dominantly inherited congenital myopathy. CCD is also associated with muscular and skeletal abnormalities such as abnormal curvature of the spine (scoliosis), hip dislocation, and joint deformities. CCD and malignant hyperthermia (MH) are both associated with mutations in the ryanodine receptor on chromosome 19q13.1. An 11-year-old boy with CCD complicated with severe scoliosis was scheduled for spinal fusion surgery under general anesthesia. Furthermore, he had trismus caused by temporomandibular contracture. He was considered as MH susceptible. Anesthesia was managed with remifentanil and propofol without using muscle relaxtants and volatile anesthetics. We could intubate the trachea with Airtraq laryngoscope without any complications. The perioperative course was uneventful. PMID:27483668

  18. [Anesthetic Management for Non-cardiac Surgery in a Patient with Severe Pulmonary Arterial Hypertension].

    PubMed

    Ohno, Sho; Niiyama, Yukitoshi; Murouchi, Takeshi; Yamakage, Michiaki

    2016-05-01

    Severe pulmonary arterial hypertension is a significant risk factor for anesthetic management in patients undergoing even non-cardiac surgery. A 64-year-old female patient with severe pulmonary arterial hypertension was scheduled to undergo inguinal hernioplasty. Preoperative systolic pulmonary arterial pressure was 115 mmHg. We selected monitored anesthesia care with 0.2-0.5 μg x kg(-1) x hr(-1) dexmedetomidine and ultrasound-guided iliohypogastric block. Thereafter, LiDCOrapid was used to acquire the hemodynamic responses during surgery. Continuous iliohypogastric block produced postoperative pain relief and the supplemental analgesic was not needed. The monitored anesthesia care by dexmedetomidine and ultrasound guided continuous iliohypogastric block would be a safe procedure for patients with severe pulmonary arterial hypertension undergoing non-cardiac surgery. LiDCO rapid could be low invasive and useful as a hemodaynamic monitor in such a case. PMID:27319099

  19. Anesthetic management of vallecular cyst excision in an infant: An airway challenge

    PubMed Central

    Namshikar, Viraj N.; Dukle, Nimisha V.; Sukhthanker, Dattraj S.

    2016-01-01

    Vallecular cyst is uncommon but well-recognized cause of upper airway obstruction in newborn and infants. We hereby present anesthetic management of a case of vallecular cyst in an infant posted for excision and marsupialization. A 4-month-old female infant weighing 3.5 kg presented with inspiratory stridor progressively worsening over 2 months. Anesthesia plan was to carry out inhalational induction maintaining spontaneous respiration and keeping tracheostomy as standby option. In this case, laryngoscopy was challenging due to the size and extent of the cyst thus necessitating gentle laryngoscopy to prevent cyst rupture and pulmonary aspiration. On performing laryngoscopy, epiglottis was not visualized, which made intubation difficult. At the end of surgery, extubation was not carried out as the possibility of laryngomalacia could not be eliminated and also in view of intraoperative airway manipulation. The patient was electively ventilated postoperatively and extubated on the 2nd postoperative day. PMID:27375399

  20. Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report

    PubMed Central

    Dell'Anna, Antonio Maria; Catarci, Stefano; Frassanito, Luciano; Vagnoni, Salvatore; Draisci, Gaetano

    2016-01-01

    Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management. PMID:27066212

  1. Evaluation of Common Anesthetic and Analgesic Techniques for Tail Biopsy in Mice

    PubMed Central

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

    2012-01-01

    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

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

    PubMed

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

    2012-11-01

    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.

  3. ANESTHETIC MANAGEMENT OF FEMORAL FRACTURE REPAIR IN A PATIENT WITH CERVICAL MYELOPATHY, AUTONOMIC DYSFUNCTION, AND DIFFICULT AIRWAY.

    PubMed

    Vellore, Ajay R; Robards, Christopher B; Clendenen, Steven R

    2016-02-01

    Spinal stenosis is a potentially serious condition that can lead to myelopathies and autonomic instability, both of which, as a result, may complicate anesthetic management. Additionally, neuraxial anesthesia appears to increase the risk of worsened neurological outcomes in this population. A 56-year-old female with spinal stenosis, autonomic dysfunction, and known difficult airway who required anesthesia for repair of a femur fracture is presented. After pre-operative arterial line and femoral block placement, an ultrasound guided subarachnoid block was safely placed. This supports the notion that in the appropriate setting, a safe, successful neuraxial blockade can be performed when a general anesthetic may be fraught with more risk. PMID:27382821

  4. Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy

    PubMed Central

    Ayrian, Eugenia; Kaye, Alan David; Varner, Chelsia L.; Guerra, Carolina; Vadivelu, Nalini; Urman, Richard D.; Zelman, Vladimir; Lumb, Philip D.; Rosa, Giovanni; Bilotta, Federico

    2015-01-01

    Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based. PMID:26345202

  5. Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy.

    PubMed

    Ayrian, Eugenia; Kaye, Alan David; Varner, Chelsia L; Guerra, Carolina; Vadivelu, Nalini; Urman, Richard D; Zelman, Vladimir; Lumb, Philip D; Rosa, Giovanni; Bilotta, Federico

    2015-10-01

    Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based. PMID:26345202

  6. Update on administration of anesthetics and psychoactive drugs for pain management in China.

    PubMed

    Gu, Weiping

    2015-06-01

    Anesthetics and psychoactive drugs could relieve diseases, if used properly. However, they can cause dependency, and their misuse or abuse could adversely affect people's health and social stability. For a long time, the Chinese government has been reinforcing the regulation on anesthetics and psychoactive drugs to ensure their legal and proper usage, and to prevent abuse. The state council issued 'the regulations on the administration of anesthetic drugs and psychotropic drugs' in 2005, based on which a legal system was established for administration of anesthetics and psychoactive drugs with the objectives of ensuring their legitimate medical utilization, and preventing illegal abuse.

  7. Anesthetic management of a patient with Hermansky-Pudlak syndrome undergoing video-assisted bullectomy.

    PubMed

    Ideno, Satoshi; Hatori, Eiki; Takeda, Junzo; Morisaki, Hiroshi

    2015-05-01

    The Hermansky-Pudlak syndrome (HPS) is a rare set of disorders characterized by oculocutaneous albinism, bleeding diathesis, and pulmonary fibrosis, with the latter 2 conditions presenting major challenges in anesthetic management. We report a 53-year-old woman with pulmonary fibrosis secondary to HPS who underwent video-assisted bullectomy to treat recurrent pneumothorax. Preoperative bleeding time and platelet count were within normal limits, but the surgeons had difficulty with continuous oozing from the incision site; the surgical blood loss was 270 mL, which was a relatively large amount for this surgery. Because of her restrictive lung disease, the patient's tidal volume was only 250 mL under pressure-controlled ventilation, with a peak inspiratory pressure of 30 cm H2O and a positive end-expiratory pressure of 5 cm H2O. She also had postoperative respiratory insufficiency, with a partial pressure of arterial CO2 of 112 mm Hg and a pH of 7.08 on arterial blood gas analysis. Then, the patient needed mechanical ventilation for 4 days. In conclusion, patients with HPS require strict respiratory management to support their restrictive pulmonary dysfunction, and, also, we should consider preventive management for hemostasis and adequate analgesia to reduce the patient's work of breathing. PMID:25547825

  8. [Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].

    PubMed

    Ideno, Satoshi; Miyazawa, Noriko; Ishikawa, Saki; Wakamiya, Rie; Shinto, Atsushi; Mikasa, Hiromi; Yamamoto, Shinichi

    2014-06-01

    A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. Following the American Society of Anesthesiologist (ASA) guidelines for management of difficult airway, we prepared various types of equipment to facilitate intubation and surgeons were beside the patient during induction of anesthesia for emergency invasive airway access. To prevent the progression of emphysema, preservation of spontaneous breathing during the perioperative period was also important. Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.

  9. [Anesthetic Management with Dexmedetomidine in Patients with Serious Mental and Physical Disabilities Undergoing Dental Treatment].

    PubMed

    Shimotori, Hisashi; Kawano, Mari

    2016-04-01

    Midazolam and propofol are widely used for the sedation of patients with serious mental and physical disabilities. However, we often experience difficulty in the management of airway and respiratory depression when using these sedatives. Dexmedetomidine (DEX) is being increasingly used as a sedative because of the lack of associated respiratory depression. Here we report anesthetic management with DEX in two patients with disability undergoing dental treatment To avoid movement during treatment, DEX was infused at the rate recommended in the package insert, with an initial administration at 6 μg x kg(-1) x hr(-1) for 10 min followed by maintenance infusion at 0.7 μg x kg(-1) x hr(-1). Although the infusion rate seemed to be sufficient for the patients, DEX was not effective and administration of additional sedatives was required. Further, respiratory depression, such as airway obstruction and increase in the concentration of end-tidal carbon dioxide, was observed even when DEX was used as the sole agent for inducing sedation. No remarkable change in hemodynamics was observed. Therefore, it is difficult to maintain the sedative state using DEX alone in patients with serious mental and physical disabilities in comparison with patients with no disability. PMID:27188121

  10. Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.

    PubMed

    Liossi, Christina; White, Paul; Hatira, Popi

    2006-05-01

    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

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

    PubMed

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

    2007-07-01

    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.

  12. Laser Scar Management Technique

    PubMed Central

    Ohshiro, Toshio; Sasaki, Katsumi

    2013-01-01

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

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

    PubMed Central

    Sethi, Sameer; Kapil, Sonia

    2014-01-01

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

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

    PubMed

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

    2014-06-01

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

  15. [Anesthetic Management of Peritonectomy and Extended Operation for Peritoneal Pseudomyxoma Combined with Massive Ascites].

    PubMed

    Yamasaki, Tomoki; Komasawa, Nobuyasu; Matsunami, Sayuri; Kido, Haruki; Minami, Toshiaki

    2016-06-01

    We report successful anesthetic management of extended operation for peritoneal pseudomyxoma combined with massive ascites (16.5 l). A 66-year-old man (weight 76 kg) who could not keep a supine position due to massive ascites associated with peritoneal pseudomyxoma was scheduled for elective peritonectomy and extended surgery. With the patient in the semisitting position, we administered 3% sevoflurane to induce loss of consciousness while preserving spontaneous ventilation. We then performed crush induction with propofol and rocuronium after topical anesthesia to the tongue base. Tracheal intubation with the Macintosh laryngoscope was successful. During the operation, we aspirated about 16.5 l of ascites over 20 l normal saline irrigation. To maintain the body temperature, we performed both active and passive extracorporeal warming. The operation included not only total peritonectomy but also distal gastrectomy, right colon resection, splenectomy, and cholecystectomy. To perform effective postoperative analgesia, we placed two epidural catheters from the upper and lower thoracic epidural spaces. The patient was extubated 3 days after operation, and discharged uneventfully on the 18th postoperative day. PMID:27483656

  16. [Interest of cervical epidural anesthesia in perioperative management of thyroidectomy with the high-risk anesthetic patient].

    PubMed

    Mahoungou Guimbi, K C; Itiere Odzili, F A; Soussa, G R

    2014-03-01

    Cervical epidural anesthesia is an anesthetic technique that can be useful in patients with high perioperative risk undergoing to cervical surgery. We report the case of a patient of 49 years old with hypertension, diabetes mellitus, epilepsy, left hemiparesis sequelae of stroke and congestive left ventricular failure. The patient underwent total thyroidectomy under cervical epidural anesthesia. No difficulty breathing or decompensation of chronic underlying diseases were noted in the postoperative.

  17. Anesthetic Implications of Ebola Patient Management: A Review of the Literature and Policies.

    PubMed

    Missair, Andres; Marino, Michael J; Vu, Catherine N; Gutierrez, Juan; Missair, Alfredo; Osman, Brian; Gebhard, Ralf E

    2015-09-01

    As of mid-October 2014, the ongoing Ebola epidemic in Western Africa has affected approximately 10,000 patients, approached a 50% mortality rate, and crossed political and geographic borders without precedent. The disease has spread throughout Liberia, Guinea, and Sierra Leone. Isolated cases have arrived in urban centers in Europe and North America. The exponential growth, currently unabated, highlights the urgent need for effective and immediate management protocols for the various health care subspecialties that may care for Ebola virus disease patients. We conducted a comprehensive review of the literature to identify key areas of anesthetic care affected by this disease. The serious potential for "high-risk exposure" and "direct contact" (as defined by the Centers for Disease Control and Prevention) of anesthesiologists caring for Ebola patients prompted this urgent investigation. A search was conducted using MEDLINE/PubMed, MeSH, Cochrane Review, and Google Scholar. Key words included "anesthesia" and/or "ebola" combined with "surgery," "intubation," "laryngoscopy," "bronchoscopy," "stethoscope," "ventilation," "ventilator," "phlebotomy," "venous cannulation," "operating room," "personal protection," "equipment," "aerosol," "respiratory failure," or "needle stick." No language or date limits were applied. We also included secondary-source data from government organizations and scientific societies such as the Centers for Disease Control and Prevention, World Health Organization, American Society of Anesthesiologists, and American College of Surgeons. Articles were reviewed for primary-source data related to inpatient management of Ebola cases as well as evidence-based management guidelines and protocols for the care of Ebola patients in the operative room, infection control, and health care worker personal protection. Two hundred thirty-six articles were identified using the aforementioned terminology in the scientific database search engines. Twenty articles

  18. Anesthetic management for anterior mediastinal mass and mediastinoscopy: a case study.

    PubMed

    McKeown, T J

    1991-08-01

    A 27-year-old white male was scheduled for a mediastinoscopy of an anterior mediastinal mass. The patient was induced with thiopental and succinylcholine, in anticipation of possible difficulty managing the airway. There was no distortion of the airway, and he was easily intubated with a No. 8.5 anode tube and given 20 mg of atracurium. The extent of tumor growth was greater than expected and, as a result, biopsies of the neck were taken without the need for mediastinoscopy. The atracurium was reversed with atropine and edrophonium. Although respirations were being assisted, the SaO2 decreased significantly, and end-tidal CO2 was greatly increased. When the drapes were removed, the patient was found to be cyanotic, with vein distention in the neck and upper extremities. All anesthetic agents were discontinued, the patient was hyperventilated with 100% oxygen, 100 mg of lidocaine was given for coughing and breath-holding, and the patient was placed in the reverse Trendelenburg position. The SaO2 then increased, and the end-tidal CO2 decreased. Respirations were spontaneous, and the patient could be extubated. The probable cause of this episode was obstruction of the superior vena cava by the anterior mediastinal mass. When the muscle relaxant was reversed, the increase in intrathoracic pressure caused the mass to compress the superior vena cava. The compression was released by placing the patient in a reverse Trendelenburg position, which caused the mass to shift. In addition to superior vena cava compression, other complications of anterior mediastinal masses include airway obstruction, distortion of anatomy, impaired cerebral circulation and myasthenic syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Anesthetic management of surgical neuroendoscopies: usefulness of monitoring the pressure inside the neuroendoscope.

    PubMed

    Fàbregas, N; López, A; Valero, R; Carrero, E; Caral, L; Ferrer, E

    2000-01-01

    Neuroendoscopic procedures are increasing in frequency in neurosurgical practice. We describe the anesthetic technique and the perioperative complications found in 100 neuroendoscopic interventions performed at our institution. Cranial tumor biopsy or retrieval (62%) and cisternostomy for hydrocephalus (33%) were the most frequent indications for neuroendoscopy. The mortality rate was low (1%). Intraoperative complications occurred in 36 patients, with arterial hypertension being the most frequent (53%). Postoperative complications occurred in 52 patients; anisocoria (31%) and delayed arousal (29%) were the most frequent. The pressure inside the endoscope was monitored intraoperatively in the last 47 patients. A saline-filled catheter from a pressure transducer connected to the neuroendoscopy system was used for pressure monitoring. We recorded the highest peak of pressure values measured during each procedure. Twenty-three patients (49%) had peak pressure values >30 mm Hg, 12 patients (25%) >50 mm Hg, and 3 patients >100 mm Hg. Only one patient had hemodynamic changes occurring simultaneously with the pressure changes. We found an association between pressure inside the endoscope >30 mm Hg and postoperative (P = .003) but not intraoperative complications. A relationship was found between surgical duration and postoperative complications (P = .002). Neither the pressure inside the endoscope or the intraoperative morbidity were related to surgical duration. We conclude that there may be a high rate of postoperative complications after neuroendoscopies, namely, new neurologic deficits. High pressure levels inside the endoscope during neuroendoscopic procedures can occur without hemodynamic warning signs. Pressure values >30 mm Hg are associated with postoperative morbidity, especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the

  20. Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease.

    PubMed

    Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M

    2016-01-01

    Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD. PMID:27269665

  1. Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease.

    PubMed

    Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M

    2016-01-01

    Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD.

  2. Case Report: Genetic analysis and anesthetic management of a child with Niemann-Pick disease Type A.

    PubMed

    Dalal, Priti G; Coleman, Melissa; Horst, Meagan; Rocourt, Dorothy; Ladda, Roger L; Janicki, Piotr K

    2015-01-01

    A 14-month-old child, recently diagnosed with Niemann-Pick disease type A, presented for a laparoscopic placement of a gastrostomy tube under general anesthesia. The disease was confirmed and further characterized by genetic testing, which revealed evidence of the presence of two known pathogenic mutations in the SMPD1 gene, and enzyme studies showed a corresponding very low level of enzymatic activity of acidic sphingomyelinase. The anesthetic management involved strategies to manage an anticipated difficult intubation and avoid post-operative ventilation. PMID:26913189

  3. Truncal blocks for perioperative pain management: a review of the literature and evolving techniques.

    PubMed

    Go, Ramon; Huang, Yolanda Y; Weyker, Paul D; Webb, Christopher Aj

    2016-10-01

    As the American healthcare system continues to evolve and reimbursement becomes tied to value-based incentive programs, perioperative pain management will become increasingly important. Regional anesthetic techniques are only one component of a successful multimodal pain regimen. In recent years, the use of peripheral and paraneuraxial blocks to provide chest wall and abdominal analgesia has gained popularity. When used within a multimodal regimen, truncal blocks may provide similar analgesia when compared with other regional anesthetic techniques. While there are other reviews that cover this topic, our review will also highlight the emerging role for serratus plane blocks, pectoral nerve blocks and quadratus lumborum blocks in providing thoracic and abdominal analgesia.

  4. Comparison of anesthetic management and outcomes of robot-assisted versus open radical cystectomy.

    PubMed

    Trentman, Terrence L; Fassett, Sharon L; McGirr, Dustin; Anderson, Brad; Chang, Yu-Hui H; Nateras, Rafael Nunez; Castle, Erik P; Rosenfeld, David M

    2013-09-01

    Robot-assisted cystectomy surgery may be advantageous for patients. The purpose of this study was to compare anesthetic management and outcomes in patients undergoing robot-assisted versus open radical cystectomy. In a retrospective review of 256 cystectomy procedures, procedure duration, blood loss, respiratory parameters, recovery room opiate consumption, pain scores and antiemetic use in the recovery room, and hospital length of stay were compared. After exclusions, 96 robot-assisted and 102 open procedures were analyzed. Anesthesia and surgery duration were significantly longer in the robot-assisted group, while the length of hospital stay was significantly shorter in the robot-assisted group: 7.1 ± 5.8 versus 9.8 ± 5.03 days, p = 0.0005. Estimated blood loss was 601.8 ± 491.4 ml in the open group versus 257.7 ± 164.3 ml in the robot-assisted group, p < 0.0001. Recovery room opiate consumption was significantly less in the robot-assisted group: 9.5 ± 8.9 versus 12.6 ± 9.9 mg (morphine equivalents), p = 0.02. The highest recorded respiratory rate was significantly higher in the robot-assisted group, as was the highest recorded peak airway pressure. Among patients with arterial blood gas data, the highest arterial partial pressure of CO2 was significantly greater in the robot-assisted group than in the open surgery group: 42.6 ± 5.6 versus 37.4 ± 4.8 mmHg CO2, p = 0.0001. Surgeons and anesthesia providers can expect robot-assisted radical cystectomy surgery to last longer than traditional open surgery, but to be associated with less pain and blood loss. Positioning and abdominal insufflation for robot-assisted surgery may contribute to ventilation challenges.

  5. Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation.

    PubMed

    Sbrana, Francesco; Ripoli, Andrea; Formichi, Bruno

    2015-01-01

    Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic(®) latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01-0.02 mg/kg, fentanyl 2.5-5 μg/kg and propofol: bolus dose 1-1.5 mg/kg, maintenance 2-4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH -0.52 ± 0.83 vs -1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation. PMID:26937093

  6. Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control

    PubMed Central

    Tympa, Aliki; Theodoraki, Kassiani; Tsaroucha, Athanassia; Arkadopoulos, Nikolaos; Vassiliou, Ioannis; Smyrniotis, Vassilios

    2012-01-01

    Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed. PMID:22690040

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

    PubMed

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

    2014-10-01

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

  8. Anesthetic Management of Urgent Cesarean Section with Undiagnosed Transposition of Great Arteries

    PubMed Central

    Yilmaz, Nurullah; Koksal, Ersin; Ozgen, Gokce Ultan; Ozen, Ersan; Dilek, Ahmet; Karakaya, Deniz; Ulger, Fatma

    2016-01-01

    We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods. PMID:27594753

  9. Anesthetic Management of Urgent Cesarean Section with Undiagnosed Transposition of Great Arteries.

    PubMed

    Yilmaz, Nurullah; Koksal, Ersin; Ozgen, Gokce Ultan; Ozen, Ersan; Dilek, Ahmet; Karakaya, Deniz; Ulger, Fatma

    2016-06-01

    We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods. PMID:27594753

  10. [New anesthetics].

    PubMed

    Malamed, S F

    2000-01-01

    Since the introduction of cocaine local analgesia in 1886, and the subsequent development of procaine (1904) and other closely related ester-type compounds, dentistry has prided itself on being as close to 'painless' as possible. In the late 1940s the newest group of the local anesthetic compounds, the amides, was introduced. The initial amide local analgesic, lignocaine (Xylocaine), revolutionised pain control in dentistry worldwide. In succeeding years other amide-type local anesthetics, mepivacaine, prilocaine, bupivacaine and etidocaine, were introduced. They gave the dental practitioner a local anesthetic armamentarium which provided pulpal analgesia for periods of from 20 minutes (mepivacaine) to as long as three hours (bupivacaine and etidocaine with adrenaline). In addition these popular drugs proved to be more rapid-acting than the older ester-type drug and, at least from the perspective of allergenicity, more safe. In 1976, in Germany, the newest amide local analgesic, carticaine HCl was introduced into dentistry. Articaine (the generic name was changed) possesses properties similar to lignocaine but has additional properties which made the drug quite attractive to the general dental practitioner. In 1986 articaine was introduced in North America (Canada) where it has become the most used local anesthetic, supplanting lignocaine. Articaine has been approved for use in the United Kingdom. In this introductory discussion we review the development of articaine and discuss its place in the dental local analgesic armamentarium.

  11. Local Anesthetic-Induced Neurotoxicity

    PubMed Central

    Verlinde, Mark; Hollmann, Markus W.; Stevens, Markus F.; Hermanns, Henning; Werdehausen, Robert; Lirk, Philipp

    2016-01-01

    This review summarizes current knowledge concerning incidence, risk factors, and mechanisms of perioperative nerve injury, with focus on local anesthetic-induced neurotoxicity. Perioperative nerve injury is a complex phenomenon and can be caused by a number of clinical factors. Anesthetic risk factors for perioperative nerve injury include regional block technique, patient risk factors, and local anesthetic-induced neurotoxicity. Surgery can lead to nerve damage by use of tourniquets or by direct mechanical stress on nerves, such as traction, transection, compression, contusion, ischemia, and stretching. Current literature suggests that the majority of perioperative nerve injuries are unrelated to regional anesthesia. Besides the blockade of sodium channels which is responsible for the anesthetic effect, systemic local anesthetics can have a positive influence on the inflammatory response and the hemostatic system in the perioperative period. However, next to these beneficial effects, local anesthetics exhibit time and dose-dependent toxicity to a variety of tissues, including nerves. There is equivocal experimental evidence that the toxicity varies among local anesthetics. Even though the precise order of events during local anesthetic-induced neurotoxicity is not clear, possible cellular mechanisms have been identified. These include the intrinsic caspase-pathway, PI3K-pathway, and MAPK-pathways. Further research will need to determine whether these pathways are non-specifically activated by local anesthetics, or whether there is a single common precipitating factor. PMID:26959012

  12. Anesthetic management of patients receiving calculus therapy with a third-generation extracorporeal lithotripsy machine.

    PubMed

    Hosking, M P; Morris, S A; Klein, F A; Dobmeyer-Dittrich, C

    1997-10-01

    We reviewed the anesthetic requirements for satisfactory use of a third-generation electromagnetic-source design for extracorporeal shockwave lithotripsy (SWL). Medical records were reviewed for a period of 9 months on all patients receiving anesthesia care for SWL with and without other urologic procedures. The Modulith SL20 was used on 56 ASA Class I-III patients having 87 SWL treatments. Demographic and anesthetic variables were recorded. Complications documented included dysrhythmias, nausea necessitating treatment, and conversion from sedation to regional or general anesthesia. The majority of procedures (83%) were performed on an outpatient basis. Patients were classified as ASA physical status I (27%), II (63%), or III (10%). Monitored anesthesia care with intravenous sedation was utilized in 93% of cases. Of these cases, 78 involved a combination of intravenous propofol, fentanyl, and midazolam; the remaining 3 involved propofol, alfentanil, and/or midazolam. The mean treatment duration was 36 minutes. Patients were discharged within 1 hour after procedure completion in 77 cases (89%). Nausea necessitating treatment was rare (3%). The mean dose of propofol administered with SWL as the only procedure was 272 +/- 112 mg. When SWL was combined with other urologic procedures, the mean dose of propofol was 334 +/- 121 mg. Continuous intravenous propofol infusion provides excellent procedural conditions for SWL on the Modulith SL120, a third-generation lithotripter.

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

    PubMed

    Yamaguchi, Satoshi; Ohno, Giichiro; Kitamura, Jiro

    2014-10-01

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

  14. Anesthetic management during surgery for left ventricular aneurysm and false aneurysm occurring in stage: a case report

    PubMed Central

    Lee, Chung Hun; Lim, Sang Ho

    2016-01-01

    Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture. PMID:27703635

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

    PubMed Central

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

    2006-01-01

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

  16. Aerospace management techniques: Commercial and governmental applications

    NASA Technical Reports Server (NTRS)

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

    1971-01-01

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

  17. School Business Management Techniques: A Compendium.

    ERIC Educational Resources Information Center

    Cresswell, Anthony; And Others

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

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

    PubMed

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

    2013-01-01

    The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries. PMID:25885972

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

    PubMed Central

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

    2013-01-01

    The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries. PMID:25885972

  20. Anesthetic considerations in myofibrillar myopathy.

    PubMed

    Latham, Gregory J; Lopez, Grace

    2015-03-01

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

  1. Anesthetic Management of a Surgical Patient with Chronic Renal Tubular Acidosis Complicated by Subclinical Hypothyroidism

    PubMed Central

    Yamazaki, Haruyuki; Yasumura, Rie; Wada, Kosuke

    2016-01-01

    A 53-year-old man with chronic renal tubular acidosis and subclinical hypothyroidism underwent lower leg amputation surgery under general anesthesia. Perioperative acid-base management in such patients poses many difficulties because both pathophysiologies have the potential to complicate the interpretation of capnometry and arterial blood gas analysis data; inappropriate correction of chronic metabolic acidosis may lead to postoperative respiratory deterioration. We discuss the management of perioperative acidosis in order to achieve successful weaning from mechanical ventilation and promise a complete recovery from anesthesia.

  2. Anesthetic Management of a Surgical Patient with Chronic Renal Tubular Acidosis Complicated by Subclinical Hypothyroidism.

    PubMed

    Yoshioka, Hiroe; Yamazaki, Haruyuki; Yasumura, Rie; Wada, Kosuke; Kobayashi, Yoshiro

    2016-01-01

    A 53-year-old man with chronic renal tubular acidosis and subclinical hypothyroidism underwent lower leg amputation surgery under general anesthesia. Perioperative acid-base management in such patients poses many difficulties because both pathophysiologies have the potential to complicate the interpretation of capnometry and arterial blood gas analysis data; inappropriate correction of chronic metabolic acidosis may lead to postoperative respiratory deterioration. We discuss the management of perioperative acidosis in order to achieve successful weaning from mechanical ventilation and promise a complete recovery from anesthesia. PMID:27648310

  3. Anesthetic Management of a Surgical Patient with Chronic Renal Tubular Acidosis Complicated by Subclinical Hypothyroidism

    PubMed Central

    Yamazaki, Haruyuki; Yasumura, Rie; Wada, Kosuke

    2016-01-01

    A 53-year-old man with chronic renal tubular acidosis and subclinical hypothyroidism underwent lower leg amputation surgery under general anesthesia. Perioperative acid-base management in such patients poses many difficulties because both pathophysiologies have the potential to complicate the interpretation of capnometry and arterial blood gas analysis data; inappropriate correction of chronic metabolic acidosis may lead to postoperative respiratory deterioration. We discuss the management of perioperative acidosis in order to achieve successful weaning from mechanical ventilation and promise a complete recovery from anesthesia. PMID:27648310

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

    PubMed

    Park, Sang-Hee; Lee, Yoon-Sook; Min, Too Jae; Kim, Woon Young; Kim, Jae Hwan; Park, Young Cheol

    2014-10-01

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

  5. Anesthetic management of a patient with 3-methylcrotonyl-CoA carboxylase deficiency.

    PubMed

    Robbins, Karen A; León-Ruiz, Elias N

    2008-08-01

    Patients with inborn errors of metabolism require special considerations in perioperative care. In the following case report, we describe the successful management of a patient with 3-methylcrotonyl-CoA carboxylase deficiency, a deficit that causes a secondary carnitine deficiency and impaired beta oxidation. Patients may have significant underlying cardiomyopathy, and are at risk for metabolic decompensation, acidosis, and hypoglycemia during periods of stress.

  6. Anesthetic management of Amplatzer atrial septal defect closure device embolization to right ventricular outflow tract

    PubMed Central

    Das, S; Kumar, P; Bhardwaj, V; Palleti, R

    2016-01-01

    Percutaneous device closure of atrial septal defect (ASD) is an alternative treatment to surgery with advantages of avoidance of surgery, short procedure time, early discharge from hospital, and lower rates of complications. However, percutaneous device closure is associated with infrequent life-threatening complications such as device embolization. We report a case device embolization of the ASD occlude device into right ventricular outflow tract resulting progressive hypoxia. The role of anesthesiologist as a team leader in managing such emergency is discussed. PMID:27375392

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

    PubMed

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

    2010-12-01

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

  8. Management Styles and Techniques: Time.

    ERIC Educational Resources Information Center

    Matthews, Priscilla J.

    1987-01-01

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

  9. Complete heart block in pregnancy: case report, analysis, and review of anesthetic management.

    PubMed

    Sundararaman, Lalitha; Hochman Cohn, Jennifer; Ranasinghe, J Sudharma

    2016-09-01

    Maternal complete heart block can pose significant challenges for the anesthesiologist in the antepartum, peripartum, and postpartum periods. Some patients may present for the first time in the puerperium with dizziness, weakness, syncope, or congestive heart failure as a result of the additional hemodynamic burden that accompanies pregnancy. Although there is an increase in permanent pacemaker placement in young symptomatic patients before pregnancy, prophylactic placement of pacemakers in asymptomatic parturients is not always indicated. The need for temporary or permanent pacemakers in asymptomatic women should be assessed on a case-by-case basis; many of these patients may be safely managed during labor and delivery without pacing. The parturient with complete heart block must be followed vigilantly during pregnancy and post delivery, as the need for pacemaker insertion can also arise in the postpartum period. We present a case of third-degree heart block in a 26-year-old parturient. PMID:27555134

  10. Anesthetic management of a patient with hyperthyroidism due to hydatidiform mole.

    PubMed

    Matsumoto, Shigekiyo; Shingu, Chihiro; Hidaka, Seigo; Goto, Koji; Hagiwara, Satoshi; Iwasaka, Hideo; Noguchi, Takayuki

    2009-01-01

    Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. Tachycardiac atrial fibrillation was detected by electrocardiography at the preoperative examination. No abnormalities were found in blood count, coagulation, biochemical tests, chest radiographs, or respiratory function. General anesthesia with nitrous oxide, oxygen, and sevoflurane, combined with fentanyl and 1% mepivacaine, was administered intermittently from an epidural catheter. Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward. PMID:19921374

  11. Implications of recent accumulating knowledge about endothelial glycocalyx on anesthetic management.

    PubMed

    Bashandy, Ghada M N

    2015-04-01

    The endothelial glycocalyx is a labile, fine structure coating the luminal membrane of intact healthy vascular endothelium. For many decades, no physiologic importance was linked to this structure. It is crucial for vascular barrier function. There has been an immense interest in recent years for studying this important structure, and research is needed to disclose more information about it. Perioperative damage of the glycocalyx has been demonstrated, and is linked with morbidity and even mortality in surgical patients. Research on the glycocalyx should change many of the current perioperative management guidelines, and focusing on its protection is plausible. The present article reviews what we already know about the glycocalyx and how this knowledge has changed anesthesiologist perspectives.

  12. ANESTHETIC MANAGEMENT IN UNEXPECTED EXTRA- ADRENAL PHEOCROMOCYTOMA PRESENTING WITH THORACIC SPINAL CORD COMPRESSION.

    PubMed

    El Kouny, Amr; Al Harbi, Mohammed; Arif, Rashid Muhammad; Ilyas, Nazar; Hamed, El Abbasy Omar; Memon, Maqsood; Nawaz, Ali; Dimitriou, Vassilios

    2016-02-01

    A 52 yearold female presented with a thoracic paravertebral tumour causing spinal nerve root compression and lower limbs neurologic symptoms. The patient was scheduled to undergo thoracic decompression laminectomy and instrumentation. Markedly severe hemodynamic fluctuations happened during the manipulation of the tumor and continued after the tumor was removed. After multimodal antihypertensive therapy the vital signs were adequately managed and the surgery was successfully performed without complications. The patient was discharged without any sequelae ten days later. The pathology report indicated the diagnosis of extra-adrenal pheochromocytoma. Unexpected pheochromocytoma may lead to a fatal hypertensive crisis during surgery. For anesthesiologists and surgeons who encounter an unexpected hypertensive crisis during surgery, undiagnosed pheochromocytoma should always be considered. PMID:27382822

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

    PubMed

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

    2014-04-01

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

  14. [Anesthetic management of a child with moyamoya disease combined with von Gierke's disease].

    PubMed

    Takeuchi, Mitsue; Nohmi, Toshihiro; Ichikawa, Makiko; Ohnishi, Yoshihiko

    2010-02-01

    We report on a child with moyamoya disease combined with von Gierke's disease. A 7-year-old girl with von Gierke's disease had a stroke associated with moyamoya disease. She had had many episodes of hypoglycemia and severe metabolic acidosis before surgery. General anesthesia was induced with midazolam 3 mg and fentanyl 100 microg followed by rocuronium 12 mg. After tracheal intubation, anesthesia was maintained with sevoflurane 2.5% in 33% oxygen and 66% nitrous oxide. We used mainly mixture of saline and glucose as intraoperative fluid instead of acetated Ringer solution, and controlled administration of glucose according to blood glucose levels. The patient's plasma lactate levels and base excess during operation showed changes compared with those before operation, because sodium bicarbonate was used during the surgery. The duration of anesthesia was 374 minutes. The patient woke up and spontaneous respiration returned, and the trachea was extubated in the operating room. We were able to manage this case safely without any complications. PMID:20169974

  15. [Anesthetic Management of Cesarean Section in a Pregnant Woman with Advanced Tongue Cancer].

    PubMed

    Kojima, Mikiko; Yoshie, Kazuka; Shimazaki, Azusa; Ohtsuka, Naoki; Otake, Hiroshi; Koide, Keiko; Sato, Youko

    2016-06-01

    It is very difficult to decide the best time to deliver the baby for a pregnant woman with advanced cancer. We experienced the perioperative and perinatal management of a 39-year-old pregnant woman with advanced tongue cancer. The cancer had already metastasized to the lung and lymph nodes. Furthermore a recurrent thumb-sized tumor was found in her mouth. She had firmly desired to discontinue all anticancer treatment for protecting the fetus. On the other hand, her family could not accept her determination yet. Therefore the medical team was organized with doctors and co-medicals from multiple departments such as gynecology, pediatrics, radiology, oncology, midwife, psychotherapy and anesthesiology. After several conferences including herself and family, finally cesarean section was scheduled for the 30th gestational week. Prepared for unexpected emergency delivery, airway stenosis was ruled out by fiberoptic laryngoscopy and the consent for emergency tracheostomy was obtained. The operation was performed successfully under spinal anesthesia without any severe troubles. Medical care as a team from early phase enabled elaborate observation and preparation through the perioperative and perinatal period. Furthermore, it was efficient to provide satisfaction to the patient and her family as well. PMID:27483663

  16. Management Styles and Techniques: People.

    ERIC Educational Resources Information Center

    DeLoach, Marva L.; And Others

    1987-01-01

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

  17. Management Styles and Techniques: Space.

    ERIC Educational Resources Information Center

    Montanelli, Dale S.; And Others

    1987-01-01

    Two articles discuss the management of space in library facilities. The first focuses on three general aspects of space management: how to organize for space management; necessary data collection; and human factors. The second article focuses specifically on space requirements for library technical processes. (CLB)

  18. Techniques for Managing a Computer Classroom.

    ERIC Educational Resources Information Center

    Sedran, Mary Ann

    1985-01-01

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

  19. Efficacy and outcomes of perioperative anesthetic management of extracranial to intracranial bypass for complex intracranial aneurysm in the absence of advanced neurological monitoring

    PubMed Central

    Durga, Padmaja; Kinthala, Sudhakar; Sahu, Barada Prasad; Panigrahi, Manas Kumar; Mantha, Srinivas; Ramachandran, Gopinath

    2014-01-01

    Background and Aims: Anesthetic management of extracranial to intracranial (EC-IC) bypass for complex intracranial aneurysms is challenging as the goals involve balancing the cerebral perfusion during parent artery clamping and avoiding factors that predispose to rupture of the unsecured aneurysm. There is very sparse literature available on anesthetic management for this procedure. Materials and Methods: A retrospective review of the records of 20 patients undergoing EC-IC bypass was performed with an objective of assessing the efficacy and outcomes of anesthetic management in the absence of advanced neurological monitoring. Results: A total of 20 patients underwent EC-IC bypass as an adjunct cerebral revascularization in the management of complex intracranial aneurysms. Intraoperatively normotension and normocarbia were maintained. During the EC-IC bypass, when the temporary clamp was applied, mild hypertension (increase from baseline by 20%) and hypervolemia (central venous pressure increased to 12 mmHg) were maintained. Cerebral protection during temporary clipping of intracranial vessel was provided using moderate hypothermia to 34°C and intravenous thiopentone. Temporary clip time ranged from 15 min to 54 min (mean-25 min). All patients except one were extubated post-operatively (19/20 = 95%). None of the patients had rupture of aneurysm in the peri-operative period. Three patients developed neurologic events (3/20 = 15%). One patient had cerebral vasospasm and two patients developed cerebral infarction. Two patient subsequently improved and one succumbed to the neurological deterioration (mortality 1/20 = 5%). Conclusion: Adherence to the principal goals for the procedure, avoidance of hemodynamic fluctuations such as hypotension and hypertension, maintenance of normocarbia, and cerebral protection, result in favorable neurological outcome even in the absence of advanced neuromonitoring. PMID:25190941

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

    PubMed Central

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

    2012-01-01

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

  1. Anesthetic consideration for neurointerventional procedures.

    PubMed

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

    2014-09-01

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

  2. Environmental implications of anesthetic gases.

    PubMed

    Yasny, Jeffrey S; White, Jennifer

    2012-01-01

    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.

  3. Systems management techniques and problems

    NASA Technical Reports Server (NTRS)

    1971-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  5. Traditional and non-traditional uses of anesthetic drugs--an update.

    PubMed

    Mama, Khursheed R

    2002-04-01

    Many new or modified injectable anesthetic techniques are available for use in horses. This increased availability allows the clinician to select the technique most appropriate for the patient and clinical circumstance. The use of sedative and anesthetic drugs in managing a variety of anesthesia-related and unrelated aspects of patient care is also increasing. As we begin to use these techniques in the clinical management of our patients, it is important to remember that, while there are more options, no single anesthetic agent or combination of agents is devoid of undesirable effects. Knowledge of the pertinent advantages and disadvantages of the drugs when used individually and in combination and appropriate patient monitoring are essential to ensure a positive outcome.

  6. Anesthetic management for magnetic resonance imaging in a pediatric patient addicted to palm wine: An alcoholic beverage

    PubMed Central

    Yadav, Monu; Ram, A. Anand; Srikanth, I.; Gopinath, Ramachandran

    2016-01-01

    The incidence of drug and alcohol abuse is on rise despite increasing awareness and education about health hazards related to it. Anesthesiologist may come across patients with alcohol abuse in elective as well as emergency situations. We report a rare case of excessive requirement of anesthetics in a pediatric patient of only six years for MRI, addicted to palm wine, an alcoholic beverage created from the sap of various species of palm tree. PMID:26957706

  7. Modern Reservoir Sedimentation Management Techniques with Examples

    NASA Astrophysics Data System (ADS)

    Annandale, G. W.

    2014-12-01

    Implementation of reservoir sedimentation management approaches results in a win-win scenario, it assists in enhancing the environment by preserving river function downstream of dams while concurrently providing opportunities to sustainably manage water resource infrastructure. This paper summarizes the most often used reservoir sedimentation management techniques with examples of where they have been implemented. Three categories can be used to classify these technologies, i.e. catchment management, sediment routing and sediment removal. The objective of catchment management techniques is to minimize the amount of sediment that may discharge into a reservoir, thereby reducing the loss of storage space due to sedimentation. Reservoir routing is a set of techniques that aim at minimizing the amount of sediment that may deposit in a reservoir, thereby maximizing the amount of sediment that may be passed downstream. The third group consists of techniques that may be used to remove previously deposited sediment from reservoirs. The selection of reservoir sedimentation management approaches is site specific and depends on various factors, including dam height, reservoir volume, reservoir length, valley shape, valley slope, sediment type and hydrology. Description of the different reservoir sedimentation management techniques that are used in practice will be accompanied by case studies, including video, illustrating criteria that may be used to determine the potential success of implementing the techniques.

  8. Anesthetic management of an elderly patient with kyphoscoliosis and dilated cardiomyopathy posted for abdominal hysterectomy and salpingo-oophorectomy

    PubMed Central

    Sood, Suvidha; Kamath, Manjunath R.; Shetty, Anil S.

    2015-01-01

    A 76-year-old kyphoscoliotic female patient presented with severe pain and sudden acute abdominal distension for 1-week and was diagnosed to have right-sided massive twisted ovarian cyst. The patient was a known case of hypertension, dilated cardiomyopathy with low 20% cardiac ejection fraction. Though very few incidences of multiple co-morbid conditions existing together in a single elderly patient have been reported in the past, it is important to titrate the dosage, type of anesthetic agents and their routes of administration in high risk patients. PMID:26543469

  9. Stress Management Techniques for Young Children.

    ERIC Educational Resources Information Center

    Piper, Francesca M.

    The director of a not-for-profit nursery school adapted the adult stress management techniques 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…

  10. Pro-Activeness of Parents in Accepting Behavior Management Techniques: A Cross-Sectional Evaluative Study

    PubMed Central

    Shah, Jolly; Kaur, Manpreet; Trivedi, Krishna; Shah, Shalin; Virda, Mira

    2016-01-01

    Introduction The contemporary parents are more active and participate in the decision making during dental treatment. Aim To assess the parents’ acceptance towards behavior management techniques commonly used in the pediatric dentistry in different dental situation. Materials and Methods Fifty-one parents participated in the study. Children’s dental fear was assessed by the parents before attending power point presentation using Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS). Parents viewed power point presentation of eight behavior management techniques being used during pediatric dental treatment. The techniques were: 1) Voice control; 2) Tell-Show-Do; 3) Positive reinforcement; 4) Parental presence or absence; 5) HOME; 6) Physical restraint; 7) N2O-O2 sedation; 8) General anesthesia. Parents were asked to arrange various behavior management techniques from most accepted technique to least accepted technique in various dental situations according to their view. Results All the parents completed the questionnaire. Most children show increased anxiety related to dental component of CFSS-DS scale particularly during the administration of local anesthetic. In present study most preferred behavior management technique was Tell-Show-Do followed by positive reinforcement and least preferred behavior management technique was general anesthesia followed by physical restraint. Conclusion Children’s anxiety level increases during the condition related to dentistry which can be overcome by developing positive approach in children and parents towards dentistry and by utilizing various behaviour management strategies. A generalized low parental tolerance level for firm management techniques was seen in the present study population. PMID:27630952

  11. Practicing Positive Reinforcement: Ten Behavior Management Techniques.

    ERIC Educational Resources Information Center

    McDaniel, Thomas R.

    1987-01-01

    Presents practical techniques teachers can use for classroom management: (1) teach specific directions, (2) look for good behavior, (3) praise effectively, (4) model good behavior, (5) use nonverbal reinforcement, (6) establish token economies, (7) "premack" (students determine reinforcers for appropriate behavior), (8) teach kids to reinforce one…

  12. Anesthetic management of a child with complete atrioventricular septal defect and single ventricle posted for noncardiac surgery

    PubMed Central

    Mir, Aabid Hussain; Ali, Zulfiqar; Dar, Bashir Ahmad; Naqash, Imtiaz A.; Bashir, Samreena

    2016-01-01

    Congenital heart defects are associated with various physiological disturbances. They pose anesthetic challenges for both cardiac and noncardiac surgeries. Atrioventricular septal defects are due to a developmental failure in the separation of atria and the ventricles into separate chambers and failure in the separation of mitral and tricuspid valves. We present a case of a child (1½ years), weighing 10 kg, diagnosed as congenital hydrocephalus who was planned for ventriculoperitoneal shunt. Child was having an oxygen saturation of 76% on room air. Anesthesia was induced with morphine and propofol. After tracheal intubation, saturation improved to 93%. Anesthesia was maintained with a combination of oxygen and nitrous oxide along with isoflurane. Measures were taken to maintain normovolemia and avoid hypotension, hypoxia, tachycardia, cardiac dysrhythmias and acidosis. The patient remained hemodynamically stable, maintaining arterial blood gasses within normal limits. The overall intraoperative course remained uneventful. At the end of the procedure, patient was reversed with neostigmine 60 mcg/kg and glycopyrrolate 10 mcg/kg. Extubation was done after the child was alert and opening eyes and was shifted to intensive care on oxygen inhalation for further monitoring.

  13. Anesthetizing animals: Similar to humans yet, peculiar?

    PubMed Central

    Kurdi, Madhuri S.; Ramaswamy, Ashwini H.

    2015-01-01

    From time immemorial, animals have served as models for humans. Like humans, animals too have to undergo several types of elective and emergency surgeries. Several anesthetic techniques and drugs used in humans are also used in animals. However, unlike humans, the animal kingdom includes a wide variety of species, breeds, and sizes. Different species have variable pharmacological responses, anatomy, temperament, behavior, and lifestyles. The anesthetic techniques and drugs have to suit different species and breeds. Nevertheless, there are several drugs and many peculiar anesthetic techniques used in animals but not in human beings. Keeping this in mind, literature was hand searched and electronically searched using the words “veterinary anesthesia,” “anesthetic drugs and techniques in animals” using Google search engine. The interesting information so collected is presented in this article which highlights some challenging and amazing aspects of anesthetizing animals including the preanesthetic assessment, preparation, premedication, monitoring, induction of general anesthesia, intubation, equipment, regional blocks, neuraxial block, and perioperative complications. PMID:26712963

  14. Anesthetic considerations in intracranial aneurysm surgery.

    PubMed

    Steen, Stephen N; Johnson, Calvin; Lumb, Phillip D; Zelman, Vladimer; Mok, Martin S

    2002-03-01

    Rupture of an intracranial aneurysm generally has a poor outcome, though perioperative treatments have improved. At the present time, the important factors in the management of intracranial aneurysm surgery appear to be the maintenance of adequate cerebral perfusion pressure and the avoidance of hyperglycemia. Relevant features of the anesthetic management of this surgery are discussed.

  15. Adherence to Guidelines for the Management of Local Anesthetic Systemic Toxicity Is Improved by an Electronic Decision Support Tool and Designated ‘Reader’

    PubMed Central

    McEvoy, Matthew D.; Hand, William R.; Stoll, W. David; Furse, Cory M.; Nietert, Paul J.

    2014-01-01

    Background and Objectives A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity (LAST) when given to the team leader. However, there remains room for improvement in order to ensure a system that can achieve perfect adherence to the published guidelines for LAST management. Recent research has shown that implementing a checklist via a designated reader may be of benefit. Accordingly, we sought to investigate the effect of an electronic decision support tool (DST) and designated ‘Reader’ role on team performance during an in-situ simulation of LAST. Methods Participants were randomized to Reader+DST (N = 16, rDST) and Control (N = 15, memory alone). The rDST group received the assistance of a dedicated Reader on the response team who was equipped with an electronic DST. The primary outcome measure was adherence to guidelines. Results For overall and critical percent correct scores, the rDST group scored higher than Control (99.3% vs 72.2%, P < 0.0001; 99.5% vs 70%, P < 0.0001, respectively). In the LAST scenario, 0 of 15 (0%) in the control group performed 100% of critical management steps, while 15 of 16 (93.8%) in the rDST group did so (P < 0.0001). Conclusions In a prospective, randomized single-blinded study, a designated Reader with an electronic DST improved adherence to guidelines in the management of an in-situ simulation of LAST. Such tools are promising in the future of medicine, but further research is needed to ensure the best methods for implementing them in the clinical arena. PMID:24956454

  16. Anesthetic consideration for nonintubated VATS

    PubMed Central

    Yang, Jen-Ting; Hung, Ming-Hui; Chen, Jin-Shing

    2014-01-01

    In the recent decade, nonintubated-intubated video-assisted thoracoscopic surgery (VATS) has been extensively performed and evaluated. The indicated surgical procedures and suitable patient groups are steadily increasing. Perioperative anesthetic management presents itself as a fresh issue for the iatrogenic open pneumothorax, which is intended for unilateral lung collapse to create a steady surgical field, and the ensuing physiologic derangement involving ventilatory and hemodynamic perspectives. With appropriate monitoring, meticulous employment of regional anesthesia, sedation, vagal block, and ventilatory support, nonintubated VATS is proved to be a safe alternative to the conventional intubated general anesthesia. PMID:24455170

  17. Neurometric assessment of intraoperative anesthetic

    DOEpatents

    Kangas, Lars J.; Keller, Paul E.

    1998-01-01

    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.

  18. Neurometric assessment of intraoperative anesthetic

    DOEpatents

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

    1998-07-07

    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.

  19. Laser technique in management of laryngomalacia

    NASA Astrophysics Data System (ADS)

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

    1998-07-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2014-10-01

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

  2. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative

  3. Anesthetic considerations on adrenal gland surgery.

    PubMed

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

    2015-01-01

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

  4. Anesthetic Considerations on Adrenal Gland Surgery

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2010-01-01

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

  6. [Anesthetic Management of an Infant who Underwent Awake-intubation for Her Pharyngeal Injury Caused by a Toothbrush].

    PubMed

    Nakano, Yoko; Suzuki, Hiroaki; Arai, Takero; Hashimoto, Yuichi; Okuda, Yasuhisa

    2016-04-01

    A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush. After the intubation, we administered fentanyl 25 μg rocuronium 15 mg and sevoflulane 3-5% to her, and then she underwent arteriography. The neurosurgeon found no sign of major arterial injury nor traumatic aneurysm nor CNS involvement. She went to the ICU intubated after the removal of the toothbrush. She was extubated 5 days after operation. One of the benefits of the Glidescope is that we can share the visual image, and we chose it this time. When we expect a difficult airway during management for oropharyngeal trauma, we have to consider the way to manage the airway.

  7. [Anesthetic Management of an Infant who Underwent Awake-intubation for Her Pharyngeal Injury Caused by a Toothbrush].

    PubMed

    Nakano, Yoko; Suzuki, Hiroaki; Arai, Takero; Hashimoto, Yuichi; Okuda, Yasuhisa

    2016-04-01

    A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush. After the intubation, we administered fentanyl 25 μg rocuronium 15 mg and sevoflulane 3-5% to her, and then she underwent arteriography. The neurosurgeon found no sign of major arterial injury nor traumatic aneurysm nor CNS involvement. She went to the ICU intubated after the removal of the toothbrush. She was extubated 5 days after operation. One of the benefits of the Glidescope is that we can share the visual image, and we chose it this time. When we expect a difficult airway during management for oropharyngeal trauma, we have to consider the way to manage the airway. PMID:27188104

  8. Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism.

    PubMed

    Bianchin, Giovanni; Tribi, Lorenzo; Reverzani, Aronne; Formigoni, Patrizia; Polizzi, Valeria

    2015-01-01

    We describe the novel solution adopted in positioning middle ear implant in a child with bilateral congenital aural atresia and craniofacial dysmorphism that have posed a significant challenge for the safe and correct management of deafness. A five-year-old child, affected by a rare congenital disease (Van Maldergem Syndrome), suffered from conductive hearing loss. Conventional skin-drive bone-conduction device, attached with a steel spring headband, has been applied but auditory restoration was not optimal. The decision made was to position Vibrant Soundbridge, a middle ear implant, with an original surgical application due to hypoplasia of the tympanic cavity. Intubation procedure was complicated due to child craniofacial deformities. Postoperative hearing rehabilitation involved a multidisciplinary team, showing improved social skills and language development. PMID:26491591

  9. Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism

    PubMed Central

    Bianchin, Giovanni; Tribi, Lorenzo; Reverzani, Aronne; Formigoni, Patrizia; Polizzi, Valeria

    2015-01-01

    We describe the novel solution adopted in positioning middle ear implant in a child with bilateral congenital aural atresia and craniofacial dysmorphism that have posed a significant challenge for the safe and correct management of deafness. A five-year-old child, affected by a rare congenital disease (Van Maldergem Syndrome), suffered from conductive hearing loss. Conventional skin-drive bone-conduction device, attached with a steel spring headband, has been applied but auditory restoration was not optimal. The decision made was to position Vibrant Soundbridge, a middle ear implant, with an original surgical application due to hypoplasia of the tympanic cavity. Intubation procedure was complicated due to child craniofacial deformities. Postoperative hearing rehabilitation involved a multidisciplinary team, showing improved social skills and language development. PMID:26491591

  10. A literature review on anesthetic practice for carotid endarterectomy surgery based on cost, hemodynamic stability, and neurologic status.

    PubMed

    Meitzner, Mark C; Skurnowicz, Julie A; Mitchell, Anne

    2007-06-01

    An extensive literature review was undertaken to evaluate the best anesthetic practice for carotid endarterectomy surgery. Two anesthetic techniques were evaluated: general anesthetic with an endotracheal tube and regional anesthetic block. Three variables were reviewed with respect to significant clinical outcomes based on anesthetic technique. Relevant literature was obtained through multiple sources that included professional journals, a professional website, and textbooks. According to the literature, there is an advantage to performing regional anesthesia with respect to cost and neurologic status. Information analyzed was inconclusive with respect to hemodynamic stability and anesthetic technique. We conclude that regional anesthesia may have some slight advantages; however, more investigation is warranted. PMID:17591300

  11. [Anesthetic management for removal of a giant ovarian tumor using FloTrac x Vigileo monitoring system].

    PubMed

    Ikeda, Tsubasa; Kurasako, Naoko; Nishitani, Kyoko; Okada, Shohei; Arai, Tatsuru

    2014-04-01

    We successfully managed anesthesia in a patient with a giant ovarian tumor weighting 22 kg, using FloTrac x Vigileo monitoring system. A 43-year-old woman (67.2 kg, 154.5 cm and abdominal girth 111.3 cm) was admitted for removal of a giant ovarian tumor. Arterial blood pressure (ABP), heart rate, percutaneous arterial oxygen saturation, cardiac index (CI) and stroke volume variation (SVV) were monitored. General anesthesia was induced, with the patient in the supine position, using 50 mg propofol, 0.25 microgram x kg(-1) x min(-1) remifentanil. 30 mg rocuronium bromide and inhalation of 100% oxygen, and maintained with sevoflurane 1.5% and remifentanil administration between 0.1-0.3 microgram x kg(-1) x min(-1). Following 6 l fluid drainage from the ovarian tumor, ABP and CI decreased, but SVV remained within normal ranges. Therefore, we only decreased the drainage speed without increasing fluid administration rate. When the tumor was lifted up, both CI and SVV increased, but the increase of SVV was 10%, still within normal ranges. Therefore, we did not increase fluid administration rate to avoid excessive hydration. After tracheal extubation, respiratory and hemodynamic states were stable, and the patient had no postoperative complication. We conclude that FloTrac x Vigileo System is useful for monitoring cardiac performance parameters, and helps anesthesiologists adjust drainage speed of the content and infusion rate to maintain the stability of circulatory state, in removal of a giant cyst.

  12. Minimum anesthetic volume in regional anesthesia by using ultrasound-guidance.

    PubMed

    Di Filippo, Alessandro; Falsini, Silvia; Adembri, Chiara

    2016-01-01

    The ultrasound guidance in regional anesthesia ensures the visualization of needle placement and the spread of Local Anesthetics. Over the past few years there was a substantial interest in determining the Minimum Effective Anesthetic Volume necessary to accomplish surgical anesthesia. The precise and real-time visualization of Local Anesthetics spread under ultrasound guidance block may represent the best requisite for reducing Local Anesthetics dose and Local Anesthetics-related effects. We will report a series of studies that have demonstrated the efficacy of ultrasound guidance blocks to reduce Local Anesthetics and obtain surgical anesthesia as compared to block performed under blind or electrical nerve stimulation technique. Unfortunately, the results of studies are widely divergent and not seem to indicate a dose considered effective, for each block, in a definitive way; but it is true that, through the use of ultrasound guidance, it is possible to reduce the dose of anesthetic in the performance of anesthetic blocks. PMID:27591464

  13. Interaction of general anesthetics with phospholipid vesicles and biological membranes.

    PubMed

    Vanderkooi, J M; Landesberg, R; Selick, H; McDonald, G G

    1977-01-01

    Low concentrations of general anesthetics, including halothane, ethrane, trilene, diethyl ether and chloroform are observed to shift the phase transitions of phospholipid vesicles to lower temperatures, and from these data partition coefficients for the anesthetic between lipid and water can be calculated. In contrast to the anesthetics, high concentrations of ethanol are required to shift the phase transition of lipids and glycerol causes no effect. Above the phase transition general anesthetics alter nuclear magnetic resonance spectra of phospholipid dispersions and increase the rotational and lateral diffusion rates of fluorescent probes located in the hydrocarbon core of the bilayer, indicating that they induce disorder in the structure. In red blood cell membranes and sarcoplasmic reticulum fragments, the rotational diffusion rate of 1-phenyl-6-phenylhexatriene is increased in the presence of general anesthetics. The 220 MHz nuclear magnetic resonance spectra of sarcoplasmic reticulum reveal some resolved lines from the lecithin fatty acid protons; addition of general anesthetic increases the contribution of these peaks. The data from the NMR and fluorescence techniques lead to the conclusion that general anesthetics increase the pool size of melted lipids in the bimolecular phospholipid layers of biological membranes; this would account for the ability of general anesthetics to increase passive diffusion rates of various substances in membranes.

  14. The efficacy of eutectic mixture of local anesthetics as a topical anesthetic agent used for dental procedures: A brief review

    PubMed Central

    Daneshkazemi, Alireza; Abrisham, Seyyed Mohammad; Daneshkazemi, Pedram; Davoudi, Amin

    2016-01-01

    Dental pain management is one of the most critical aspects of modern dentistry which might affect patient's quality of life. Several methods are suggested to provide a painless situation for patients. Desensitization of the oral site using topical anesthetics is one of those methods. The improvements of topical anesthetic agents are probably one of the most important advances in dental science in the past 100 years. Most of them are safe and can be applied on oral mucosa with minimal irritation and allergic reactions. At present, these agents are various with different potent and indications. Eutectic mixture of local anesthetics (EMLA) (lidocaine + prilocaine) is a commercial anesthetic agent which has got acceptance among dental clinicians. This article provides a brief review about the efficacy of EMLA as a topical anesthetic agent when used during dental procedures. PMID:27746520

  15. Fault Management Techniques in Human Spaceflight Operations

    NASA Technical Reports Server (NTRS)

    O'Hagan, Brian; Crocker, Alan

    2006-01-01

    This paper discusses human spaceflight fault management operations. Fault detection and response capabilities available in current US human spaceflight programs Space Shuttle and International Space Station are described while emphasizing system design impacts on operational techniques and constraints. Preflight and inflight processes along with products used to anticipate, mitigate and respond to failures are introduced. Examples of operational products used to support failure responses are presented. Possible improvements in the state of the art, as well as prioritization and success criteria for their implementation are proposed. This paper describes how the architecture of a command and control system impacts operations in areas such as the required fault response times, automated vs. manual fault responses, use of workarounds, etc. The architecture includes the use of redundancy at the system and software function level, software capabilities, use of intelligent or autonomous systems, number and severity of software defects, etc. This in turn drives which Caution and Warning (C&W) events should be annunciated, C&W event classification, operator display designs, crew training, flight control team training, and procedure development. Other factors impacting operations are the complexity of a system, skills needed to understand and operate a system, and the use of commonality vs. optimized solutions for software and responses. Fault detection, annunciation, safing responses, and recovery capabilities are explored using real examples to uncover underlying philosophies and constraints. These factors directly impact operations in that the crew and flight control team need to understand what happened, why it happened, what the system is doing, and what, if any, corrective actions they need to perform. If a fault results in multiple C&W events, or if several faults occur simultaneously, the root cause(s) of the fault(s), as well as their vehicle-wide impacts, must be

  16. Hyperlipidemia sink for anesthetic agents.

    PubMed

    Johnson, Thomas J; Porhomayon, Jahan; Nader, Nader D; Eldesouki, Enas; Smith, Kelly; Hobika, Geoffrey G

    2016-11-01

    We present a case that involves anesthetic resistance during anesthesia for electroconvulsive therapy. Despite adequate dosing of both intravenous and inhalation anesthetics, our patient was resistant to induction of the state of general anesthesia. Subsequently, we noticed extreme hyperlipidemia. We hypothesized that the patient's extreme hyperlipidemia served as an anesthetic "sink" and prevented the full dose of intravenous agents from quickly reaching their intended site of action.

  17. Local anesthetics: pharmacology and toxicity.

    PubMed

    Moore, Paul A; Hersh, Elliot V

    2010-10-01

    The development of safe and effective local anesthetic agents has possibly been the most important advancement in dental science to occur in the last century. The agents currently available in dentistry are extremely safe and fulfill most of the characteristics of an ideal local anesthetic. These local anesthetic agents can be administered with minimal tissue irritation and with little likelihood of inducing allergic reactions. A variety of agents are available that provide rapid onset and adequate duration of surgical anesthesia. This introductory article provides a brief update of the clinical pharmacology of local anesthetic agents and formulations used in dentistry at present.

  18. Local anesthetics: dentistry's most important drugs, clinical update 2006.

    PubMed

    Malamed, Stanley F

    2006-12-01

    Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs. Bupivacaine has become a standard part of the armamentarium for postsurgical pain control while articaine has become the second-most used local anesthetic in the United States since its introduction in 2000. Despite an increase in anecdotal reports of paresthesia since articaine's introduction there is yet, no supporting scientific evidence.

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

    PubMed

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

    2011-08-01

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

  20. Representation of Knowledge on Some Management Accounting Techniques in Textbooks

    ERIC Educational Resources Information Center

    Golyagina, Alena; Valuckas, Danielius

    2016-01-01

    This paper examines the coverage of management accounting techniques in several popular management accounting texts, assessing each technique's claimed position within practice, its benefits and limitations, and the information sources substantiating these claims. Employing the notion of research genres, the study reveals that textbooks in their…

  1. Respiratory anesthetic emergencies in oral and maxillofacial surgery.

    PubMed

    Gesek, Daniel J

    2013-08-01

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

  2. Respiratory anesthetic emergencies in oral and maxillofacial surgery.

    PubMed

    Gesek, Daniel J

    2013-08-01

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

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

    USGS Publications Warehouse

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

    1992-01-01

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

  4. Novel Technique for Management of Axillary Hidradenitis Suppurativa Using Setons

    PubMed Central

    Lajevardi, Sepehr Seyed; Abeysinghe, Jayantha

    2015-01-01

    Management of hidradenitis suppurativa (HS) of the axilla which is nonresponding to conservative management presents a significant therapeutic challenge. Most surgical treatment options are associated with significant morbidities and prolonged hospital stay. We present a technique of management of HS using setons which is simple and allows the ongoing treatment to be done on an outpatient basis. Given the fact that HS is a chronic relapsing condition each recurrence may again be managed using this technique. This will allow the patients to manage their recurrences with minimal impact on their activities of daily living. PMID:26301111

  5. ISWHM: Tools and Techniques for Software and System Health Management

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

  6. [Transdermal Local Anesthetics].

    PubMed

    Hanaoka, Kazuo; Arita, Hideko; Nagase, Masaki; Suzuki, Takashi; Ogawa, Sestsuro

    2015-11-01

    Taking EMLA cream and Penles tape 18 mg as examples, this article describes the conditions for skin penetration of topical anesthetics, with their onset time of action, duration of effect and a precautions for their use. EMLA cream is a unique cream for topical anesthesia which is the eutectic mixture of lidocaine and propitocaine to increase skin penetration. The safety study demonstrated that blood concentrations of active ingredients of EMLA cream were below toxic levels. EMLA cream, with confirmed high skin penetrability and safety, should be used for pain reduction of various treatments for many diseases. Here in Japan, EMLA cream has indications not only for pain reduction of skin laser therapy but also for reduction of needle puncture pain. This means the use of topical anesthesia would be expanded to wider ranges of treatments. PMID:26689066

  7. Project management techniques for highly integrated programs

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

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

  8. Optimization Techniques for College Financial Aid Managers

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  9. Creative Management Techniques in Interscholastic Athletics.

    ERIC Educational Resources Information Center

    Fuoss, Donald E.; Troppmann, Robert J.

    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…

  10. Opioid induced hyperalgesia in anesthetic settings.

    PubMed

    Lee, Hyeon Jeong; Yeomans, David C

    2014-11-01

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

  11. Teaching managed care : philosophy and technique.

    PubMed

    Chester, J G; Sanguineti, V R; Best, K

    1998-03-01

    The authors describe a case-oriented seminar on managed care designed to teach psychiatric residents and medical students the principles of cost containment and delivery of quality care. The participants engage in role-play (reviewer, provider, appeal arbitrator) to elucidate the process. The response of the participants indicates that this seminar is a useful teaching model. Salient points regarding the content and process of the seminar are discussed in some detail.

  12. PBPC collections: Management, techniques and risks.

    PubMed

    Gašová, Zdenka; Bhuiyan-Ludvíková, Zdeňka; Böhmová, Martina; Marinov, Iuri; Vacková, Blanka; Pohlreich, David; Trněný, Marek

    2010-10-01

    We evaluated the efficiency, safety and risks of three techniques which were used for autologous PBPC collections: (a) large-volume leukapheresis (LVL), (b) standard collections, and (c) a new modified technique which was named as "Mixed" collections. In spite of the fact that the standard and LVL collection techniques are used routinely, there may occur special conditions in which the procedures cannot be recommended. Some patients may suffer from serious clinical complications and they cannot tolerate either standard procedures with administration of higher doses of ACD-A, or the high extent of procedure in the course of LVL. We tried to find the safe and efficient collection technique which could help this group of patients to overcome their problems. The "Mixed" collection technique could be such a choice. The numbers of 136 autologous PBPC collections were performed in 98 patients who suffered from hemato-oncological diseases. We evaluated the results of (a) 93 LVL (more than 3 TBV, total blood volumes of the patients were processed; anticoagulation: ACD-A and Heparin), (b) 16 Standard procedures (less than 3 TBV were processed; anticoagulation: ACD-A), and (c) 27 "Mixed" collections (less than 3 TBV of patients were processed; anticoagulation: ACD-A+ Heparin). Collections were performed by the use of separator Cobe Spectra, Caridian. In patients (a) with a good effect of mobilization (precollection CD 34+ cells in blood higher than 20×10(3)/mL) we prepared almost the same median dose of CD 34+ cells from the standard and "Mixed" collections, 3.8 and 4×10(6)/kg, respectively. In LVL the median yield of CD 34+ cells was 8.2×10(6)/kg. In patients (b) who were mobilized weakly (precollection CD 34+ cells in blood lower than 20×10(3)/mL), LVL enabled to prepare 1.5×10(6) of CD 34+/kg from one collection, while the median yield of CD 34+ cells from the standard and "Mixed" collections was 0.9 and 1.2×10(6)/kg. All the standard, LVL and "Mixed" procedures were

  13. Selected Antimicrobial Activity of Topical Ophthalmic Anesthetics

    PubMed Central

    Reynolds, Margaret M.; Greenwood-Quaintance, Kerryl E.; Patel, Robin; Pulido, Jose S.

    2016-01-01

    Purpose Endophthalmitis is a rare complication of intravitreal injection (IVI). It is recommended that povidone-iodine be the last agent applied before IVI. Patients have reported povidone-iodine application to be the most bothersome part of IVIs. Topical anesthetics have been demonstrated to have antibacterial effects. This study compared the minimum inhibitory concentration (MIC) of topical anesthetic eye drops (proparacaine 0.5%, tetracaine 0.5%, lidocaine 2.0%) and the antiseptic, 5.0% povidone-iodine, against two organisms causing endophthalmitis after IVI. Methods Minimum inhibitory concentration values of topical anesthetics, povidone-iodine, preservative benzalkonium chloride (0.01%), and saline control were determined using five isolates of each Staphylococcus epidermidis and viridans group Streptococcus species (VGS). A broth microdilution technique was used with serial dilutions. Results Lidocaine (8.53 × 10−5mol/mL) had MICs of 4.27 to 8.53 × 10−5 mol/mL, and tetracaine (1.89 × 10−5 mol/mL) had MICs of 9.45 × 10−6 mol/mL for all isolates. Proparacaine (1.7 × 10−5 mol/mL) had MICs of 1.32 to 5.3 × 10−7 and 4.25 × 10−6 mol/mL for S. epidermidis and VGS, respectively). Benzalkonium chloride (3.52 × 10−7 mol/mL) had MICs of 1.86 × 10−9 to 1.1 × 10−8 and 4.40 × 10−8 mol/mL for S. epidermidis and VGS, respectively. Povidone-iodine (1.37 × 10−4 mol/mL) had MICs of 2.14 to 4.28 × 10−6 and 8.56 × 10−6 mol/mL for S. epidermidis and VGS, respectively. Conclusion Proparacaine was the anesthetic with the lowest MICs, lower than that of povidone-iodine. Benzalkonium chloride had lower MICs than proparacaine. All tested anesthetics and povidone-iodine inhibited growth of S. epidermidis and VGS at commercially available concentrations. Translational Relevance For certain patients, it could be possible to use topical anesthetic after povidone-iodine for comfort without inhibiting and perhaps contributing additional antimicrobial

  14. 21 CFR 872.6100 - Anesthetic warmer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthetic warmer. 872.6100 Section 872.6100 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6100 Anesthetic warmer. (a) Identification. An anesthetic warmer is an AC-powered device into which tubes containing anesthetic solution are intended to...

  15. 21 CFR 868.5880 - Anesthetic vaporizer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthetic vaporizer. 868.5880 Section 868.5880...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5880 Anesthetic vaporizer. (a) Identification. An anesthetic vaporizer is a device used to vaporize liquid anesthetic and deliver a...

  16. 21 CFR 868.5880 - Anesthetic vaporizer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthetic vaporizer. 868.5880 Section 868.5880...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5880 Anesthetic vaporizer. (a) Identification. An anesthetic vaporizer is a device used to vaporize liquid anesthetic and deliver a...

  17. 21 CFR 872.6100 - Anesthetic warmer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthetic warmer. 872.6100 Section 872.6100 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6100 Anesthetic warmer. (a) Identification. An anesthetic warmer is an AC-powered device into which tubes containing anesthetic solution are intended to...

  18. 21 CFR 868.5880 - Anesthetic vaporizer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthetic vaporizer. 868.5880 Section 868.5880...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5880 Anesthetic vaporizer. (a) Identification. An anesthetic vaporizer is a device used to vaporize liquid anesthetic and deliver a...

  19. 21 CFR 868.5880 - Anesthetic vaporizer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthetic vaporizer. 868.5880 Section 868.5880...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5880 Anesthetic vaporizer. (a) Identification. An anesthetic vaporizer is a device used to vaporize liquid anesthetic and deliver a...

  20. 21 CFR 872.6100 - Anesthetic warmer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthetic warmer. 872.6100 Section 872.6100 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6100 Anesthetic warmer. (a) Identification. An anesthetic warmer is an AC-powered device into which tubes containing anesthetic solution are intended to...

  1. 21 CFR 872.6100 - Anesthetic warmer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthetic warmer. 872.6100 Section 872.6100 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6100 Anesthetic warmer. (a) Identification. An anesthetic warmer is an AC-powered device into which tubes containing anesthetic solution are intended to...

  2. 21 CFR 872.6100 - Anesthetic warmer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthetic warmer. 872.6100 Section 872.6100 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6100 Anesthetic warmer. (a) Identification. An anesthetic warmer is an AC-powered device into which tubes containing anesthetic solution are intended to...

  3. 21 CFR 868.5880 - Anesthetic vaporizer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthetic vaporizer. 868.5880 Section 868.5880...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5880 Anesthetic vaporizer. (a) Identification. An anesthetic vaporizer is a device used to vaporize liquid anesthetic and deliver a...

  4. Allergy to local anesthetics: Reality or myth?

    PubMed

    Malinovsky, Jean-Marc; Chiriac, Anca M; Tacquard, Charles; Mertes, Paul Michel; Demoly, Pascal

    2016-09-01

    The incidence of allergic reactions to local anesthetics is low. Most cases involve a psychogenic reaction rather than an allergic reaction. Additives and preservatives added to local anesthetics may cause allergic reactions. Vascular resorption of epinephrine-containing local anesthetics may produce cardiovascular signs similar to an allergic reaction. Diagnosis of allergy to local anesthetics must be established by skin testing and provocative challenge.

  5. Managing difficult polyps: techniques and pitfalls

    PubMed Central

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

    2013-01-01

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

  6. Management of Intracranial Meningiomas Using Keyhole Techniques

    PubMed Central

    Burks, Joshua D; Conner, Andrew K; Bonney, Phillip A; Archer, Jacob B; Christensen, Blake; Smith, Jacqueline; Safavi-Abbasi, Sam

    2016-01-01

    Background: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas. Methods: Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II.  Results: The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed.  Conclusions: With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results. PMID:27284496

  7. Nitrous oxide-oxygen: a new look at a very old technique.

    PubMed

    Malamed, Stanley F; Clark, Moris S

    2003-05-01

    Inhalation sedation utilizing nitrous oxide-oxygen has been a primary technique in the management of dental fears and anxieties for more than 150 years and remains so today. Though other, more potent, anesthetics have been introduced, nitrous oxide is still the most used gaseous anesthetic in the world. Administered properly with well-maintained equipment, the nitrous oxide-oxygen technique has an extremely high success rate coupled with a very low rate of adverse effects and complications.

  8. Altered states: psychedelics and anesthetics.

    PubMed

    Icaza, Eduardo E; Mashour, George A

    2013-12-01

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

  9. Altered states: psychedelics and anesthetics.

    PubMed

    Icaza, Eduardo E; Mashour, George A

    2013-12-01

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

  10. Coping Styles as Mediators of Teachers' Classroom Management Techniques

    ERIC Educational Resources Information Center

    Lewis, Ramon; Roache, Joel; Romi, Shlomo

    2011-01-01

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

  11. "Anger Busters" A New Technique for Anger Management.

    ERIC Educational Resources Information Center

    Hajzler, Darko J.

    1988-01-01

    A procedure for anger management, developed from a rational-emotive therapy orientation, is described. The technique makes use of humor and referral to "Anger Busters" (based on the film, "Ghost Busters" to defuse angry emotions. Use of the technique with an 8-year-old is described. (DB)

  12. Capitalizing on Stress Management Techniques in Developmental Classes.

    ERIC Educational Resources Information Center

    Price, Elsa C.

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

  13. Classroom Management Through the Application of Behavior Modification Techniques.

    ERIC Educational Resources Information Center

    Ferinden, William E., Jr.

    The primary aim of this book is to bring to the grade school teacher a survey of the most recent techniques and ideas of behavior modification which are applicable to good classroom management. All of the approaches and techniques presented could be of interest to teachers working at all grade levels. Since research has shown that the systematic…

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

    NASA Astrophysics Data System (ADS)

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

    2003-10-01

    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.

  15. Communication action for case managers. Techniques to manage conflict.

    PubMed

    Marino, T Y; Kahnoski, B

    1998-01-01

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

  16. Power Management Techniques for Data Centers: A Survey

    SciTech Connect

    Mittal, Sparsh

    2014-07-01

    With growing use of internet and exponential growth in amount of data to be stored and processed (known as ``big data''), the size of data centers has greatly increased. This, however, has resulted in significant increase in the power consumption of the data centers. For this reason, managing power consumption of data centers has become essential. In this paper, we highlight the need of achieving energy efficiency in data centers and survey several recent architectural techniques designed for power management of data centers. We also present a classification of these techniques based on their characteristics. This paper aims to provide insights into the techniques for improving energy efficiency of data centers and encourage the designers to invent novel solutions for managing the large power dissipation of data centers.

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

    PubMed

    Tennant, C; Roberts, P A

    2000-01-01

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

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

    PubMed

    Tennant, C; Roberts, P A

    2000-01-01

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

  19. Clinical comparison of preinjection anesthetics.

    PubMed

    Plotkin, S

    1998-02-01

    To minimize injection anxiety and discomfort, the podiatric surgeon can choose from a variety of topical anesthetics. Available modalities include skin refrigerants (also referred to as vapocoolants), needleless injection systems, iontophoresis, and eutectic mixtures of topical anesthetic cream such as EMLA Cream. Many of the vapocoolants contain chlorofluorocarbons, which are known to damage the ozone layer, a stratospheric layer that filters out harmful ultraviolet B radiation. In accordance with the 1992 Montreal Protocol, which banned the manufacture of certain chlorofluorocarbon compounds, many commonly used vapocoolants will no longer be available. Some newly marketed vapocoolants produce extremely cold temperatures, limiting their use. This article discusses the properties of various vapocoolants and other topical anesthetics and compares their effectiveness in patient trials.

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

    PubMed Central

    2014-01-01

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

  1. New patents on topical anesthetics.

    PubMed

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

    2014-01-01

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

  2. Attitudes of Hispanic parents toward behavior management techniques.

    PubMed

    Scott, S; García-Godoy, F

    1998-01-01

    The purpose of this study was to evaluate attitudes of parents with Hispanic surnames at the University of Texas Health Science Center at San Antonio toward various behavior management techniques used in pediatric dentistry. Thirty-two parents of pediatric patients who presented for dental treatment were selected at random in the Pediatric Dentistry Clinic of the UTHSC-SA. The research study was explained to the parent by one dentist from a standardized explanation script. Eighty-one percent of the parents had at least a high school education. The parents viewed one of two videotapes with a recorded program demonstrating eight different behavior management techniques. One tape, shown to half of the parents, had a brief explanation and rationale of the specific behavior management technique before its demonstration (Group A). The other tape, shown to the remainder of the parents, had no explanation before the demonstration of each technique (Group B). Following each segment of the tape, the parents indicated their degree of accept-ability of the technique, using a visual analogue scale. An F-test (0.05 level) and Pearson and Spearman correlation tests were used. The results showed that hand-over-mouth (HOM) was unacceptable by 63 percent of the parents in Group A and 81 percent in Group B. The papoose board (PB) technique was unacceptable in 81 percent in Group A and 63 percent in group B. In both groups, parents would prefer to have had the child given general anesthesia rather than HOM.

  3. Lenses for learning: visual techniques in natural resource management.

    PubMed

    Petheram, L; High, C; Campbell, B M; Stacey, N

    2011-10-01

    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.

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  5. A Rationale and Bibliography for Classroom Management and Intervention Techniques.

    ERIC Educational Resources Information Center

    Karr-Kidwell, PJ

    This 51-item bibliography offers a selection of writings on issues and problems related to classroom management and discipline. Most citations concern works written between 1972-1983. Intervention techniques in dealing with deviant behavior are highlighted along with discipline and control in the classroom. Articles on methods of behavior…

  6. Structured Information Management Using New Techniques for Processing Text.

    ERIC Educational Resources Information Center

    Gibb, Forbes; Smart, Godfrey

    1990-01-01

    Describes the development of a software system, SIMPR (Structured Information Management: Processing and Retrieval), that will process documents by indexing them and classifying their subjects. Topics discussed include information storage and retrieval, file inversion techniques, modelling the user, natural language searching, automatic indexing,…

  7. Self Management Techniques and Disclosure of Sero Status

    ERIC Educational Resources Information Center

    Falaye, Ajibola; Afolayan, Joel Adeleke

    2015-01-01

    This study looked at using Self Management Technique (SMT) to promote self-disclosure of Sero status in Kwara State, Nigeria. A pre-test, post-test and control group quasi experimental design using a 2x2x2 factorial matrix was adopted. Sixty participants were sampled by balloting from two HIV/AIDS screening centres. Four instruments were used such…

  8. Dentistry's wonder drugs: local anesthetics and vasoconstrictors.

    PubMed

    Wahl, Michael J; Brown, Ronald S

    2010-01-01

    This article reviews recent developments concerning local anesthetics, including the amount of pain resulting from injection, which drugs achieve anesthesia most effectively, proper dosing for anesthetizing children and adults, the maximum recommended doses of lidocaine 2% with epinephrine for cardiac patients, and which drugs can be used for patients taking monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, or nonselective beta blockers. Dentists should be familiar with all aspects of local anesthetics, especially anesthetic toxicity and maximum recommended doses. PMID:20236919

  9. From micro- to nanostructured implantable device for local anesthetic delivery.

    PubMed

    Zorzetto, Laura; Brambilla, Paola; Marcello, Elena; Bloise, Nora; De Gregori, Manuela; Cobianchi, Lorenzo; Peloso, Andrea; Allegri, Massimo; Visai, Livia; Petrini, Paola

    2016-01-01

    Local anesthetics block the transmission of painful stimuli to the brain by acting on ion channels of nociceptor fibers, and find application in the management of acute and chronic pain. Despite the key role they play in modern medicine, their cardio and neurotoxicity (together with their short half-life) stress the need for developing implantable devices for tailored local drug release, with the aim of counterbalancing their side effects and prolonging their pharmacological activity. This review discusses the evolution of the physical forms of local anesthetic delivery systems during the past decades. Depending on the use of different biocompatible materials (degradable polyesters, thermosensitive hydrogels, and liposomes and hydrogels from natural polymers) and manufacturing processes, these systems can be classified as films or micro- or nanostructured devices. We analyze and summarize the production techniques according to this classification, focusing on their relative advantages and disadvantages. The most relevant trend reported in this work highlights the effort of moving from microstructured to nanostructured systems, with the aim of reaching a scale comparable to the biological environment. Improved intracellular penetration compared to microstructured systems, indeed, provides specific drug absorption into the targeted tissue and can lead to an enhancement of its bioavailability and retention time. Nanostructured systems are realized by the modification of existing manufacturing processes (interfacial deposition and nanoprecipitation for degradable polyester particles and high- or low-temperature homogenization for liposomes) or development of novel strategies (electrospun matrices and nanogels). The high surface-to-volume ratio that characterizes nanostructured devices often leads to a burst drug release. This drawback needs to be addressed to fully exploit the advantage of the interaction between the target tissues and the drug: possible strategies

  10. From micro- to nanostructured implantable device for local anesthetic delivery.

    PubMed

    Zorzetto, Laura; Brambilla, Paola; Marcello, Elena; Bloise, Nora; De Gregori, Manuela; Cobianchi, Lorenzo; Peloso, Andrea; Allegri, Massimo; Visai, Livia; Petrini, Paola

    2016-01-01

    Local anesthetics block the transmission of painful stimuli to the brain by acting on ion channels of nociceptor fibers, and find application in the management of acute and chronic pain. Despite the key role they play in modern medicine, their cardio and neurotoxicity (together with their short half-life) stress the need for developing implantable devices for tailored local drug release, with the aim of counterbalancing their side effects and prolonging their pharmacological activity. This review discusses the evolution of the physical forms of local anesthetic delivery systems during the past decades. Depending on the use of different biocompatible materials (degradable polyesters, thermosensitive hydrogels, and liposomes and hydrogels from natural polymers) and manufacturing processes, these systems can be classified as films or micro- or nanostructured devices. We analyze and summarize the production techniques according to this classification, focusing on their relative advantages and disadvantages. The most relevant trend reported in this work highlights the effort of moving from microstructured to nanostructured systems, with the aim of reaching a scale comparable to the biological environment. Improved intracellular penetration compared to microstructured systems, indeed, provides specific drug absorption into the targeted tissue and can lead to an enhancement of its bioavailability and retention time. Nanostructured systems are realized by the modification of existing manufacturing processes (interfacial deposition and nanoprecipitation for degradable polyester particles and high- or low-temperature homogenization for liposomes) or development of novel strategies (electrospun matrices and nanogels). The high surface-to-volume ratio that characterizes nanostructured devices often leads to a burst drug release. This drawback needs to be addressed to fully exploit the advantage of the interaction between the target tissues and the drug: possible strategies

  11. From micro- to nanostructured implantable device for local anesthetic delivery

    PubMed Central

    Zorzetto, Laura; Brambilla, Paola; Marcello, Elena; Bloise, Nora; De Gregori, Manuela; Cobianchi, Lorenzo; Peloso, Andrea; Allegri, Massimo; Visai, Livia; Petrini, Paola

    2016-01-01

    Local anesthetics block the transmission of painful stimuli to the brain by acting on ion channels of nociceptor fibers, and find application in the management of acute and chronic pain. Despite the key role they play in modern medicine, their cardio and neurotoxicity (together with their short half-life) stress the need for developing implantable devices for tailored local drug release, with the aim of counterbalancing their side effects and prolonging their pharmacological activity. This review discusses the evolution of the physical forms of local anesthetic delivery systems during the past decades. Depending on the use of different biocompatible materials (degradable polyesters, thermosensitive hydrogels, and liposomes and hydrogels from natural polymers) and manufacturing processes, these systems can be classified as films or micro- or nanostructured devices. We analyze and summarize the production techniques according to this classification, focusing on their relative advantages and disadvantages. The most relevant trend reported in this work highlights the effort of moving from microstructured to nanostructured systems, with the aim of reaching a scale comparable to the biological environment. Improved intracellular penetration compared to microstructured systems, indeed, provides specific drug absorption into the targeted tissue and can lead to an enhancement of its bioavailability and retention time. Nanostructured systems are realized by the modification of existing manufacturing processes (interfacial deposition and nanoprecipitation for degradable polyester particles and high- or low-temperature homogenization for liposomes) or development of novel strategies (electrospun matrices and nanogels). The high surface-to-volume ratio that characterizes nanostructured devices often leads to a burst drug release. This drawback needs to be addressed to fully exploit the advantage of the interaction between the target tissues and the drug: possible strategies

  12. Adverse reactions triggered by dental local anesthetics: a clinical survey.

    PubMed Central

    Kaufman, E.; Goharian, S.; Katz, Y.

    2000-01-01

    One hundred and seventy-nine patients completed a questionnaire focusing on adverse reactions to dental local anesthetics as manifested by 16 signs and symptoms. Twenty-six percent of the participants reported having at least 1 adverse reaction. It was found that most of the adverse reactions occurred within the first 2 hours following the injection of local anesthetics. Pallor, palpitations, diaphoresis, and dizziness were the most common adverse reactions reported in the study. The results pointed to a significant relationship between anxiety, gender, injection technique, and procedure with a higher incidence of adverse reactions. PMID:11432179

  13. General Anesthetic Actions on GABAA Receptors

    PubMed Central

    Garcia, Paul S; Kolesky, Scott E; Jenkins, Andrew

    2010-01-01

    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. PMID:20808541

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

    PubMed

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

    2015-04-01

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

  15. Risk Management Techniques and Practice Workshop Workshop Report

    SciTech Connect

    Quinn, T; Zosel, M

    2008-12-02

    At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk Management Techniques and Practice (RMTAP) workshop held September 18-19 at the Hotel Nikko in San Francisco. The purpose of the workshop, which was sponsored by the SC/Advanced Scientific Computing Research (ASCR) program and the National Nuclear Security Administration (NNSA)/Advanced Simulation and Computing (ASC) program, was to assess current and emerging techniques, practices, and lessons learned for effectively identifying, understanding, managing, and mitigating the risks associated with acquiring leading-edge computing systems at high-performance computing centers (HPCCs). Representatives from fifteen high-performance computing (HPC) organizations, four HPC vendor partners, and three government agencies attended the workshop. The overall workshop findings were: (1) Standard risk management techniques and tools are in the aggregate applicable to projects at HPCCs and are commonly employed by the HPC community; (2) HPC projects have characteristics that necessitate a tailoring of the standard risk management practices; (3) All HPCC acquisition projects can benefit by employing risk management, but the specific choice of risk management processes and tools is less important to the success of the project; (4) The special relationship between the HPCCs and HPC vendors must be reflected in the risk management strategy; (5) Best practices findings include developing a prioritized risk register with special attention to the top risks, establishing a practice of regular meetings and status updates with the platform partner, supporting regular and open reviews that engage the interests and expertise of a wide range of staff and stakeholders, and documenting and sharing the acquisition/build/deployment experience; and (6) Top risk categories include system scaling issues, request for proposal/contract and acceptance testing, and

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

    PubMed

    Baranov, P A

    2011-01-01

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

  17. Genotoxicity of Anesthetics Evaluated In Vivo (Animals)

    PubMed Central

    Braz, Mariana G.; Karahalil, Bensu

    2015-01-01

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

  18. Project TEAMS (Techniques and Education for Achieving Management Skills): Independent Business Owner/Managers.

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    These Project TEAMS (Techniques and Education for Achieving Managerial Skills) instructional materials consist of five units for use in training independent business owner/managers. The first unit contains materials which deal with management skills relating to personal characteristics of successful business people, knowledge of self and chosen…

  19. Potent Inhalational Anesthetics for Dentistry.

    PubMed

    Satuito, Mary; Tom, James

    2016-01-01

    Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings. PMID:26866411

  20. Potent Inhalational Anesthetics for Dentistry.

    PubMed

    Satuito, Mary; Tom, James

    2016-01-01

    Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings.

  1. Potent Inhalational Anesthetics for Dentistry

    PubMed Central

    Satuito, Mary; Tom, James

    2016-01-01

    Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings. PMID:26866411

  2. Wetland assessment, monitoring and management in India using geospatial techniques.

    PubMed

    Garg, J K

    2015-01-15

    Satellite remote sensing and GIS have emerged as the most powerful tools for inventorying, monitoring and management of natural resources and environment. In the special context of wetland ecosystems, remotely sensed data from orbital platforms have been extensively used in India for the inventory, monitoring and preparation of action plans for conservation and management. First scientific inventory of wetlands in India was carried out in 1998 by Space Applications Centre (ISRO), Ahmedabad using indigenous IRS (Indian Remote Sensing Satellite) data of 1992-93 timeframe, which stimulated extensive use of geospatial techniques for wetland conservation and management. Subsequently, with advances in GIS, studies were carried out for development of Wetland Information System for a state (West Bengal) and for Loktak lake wetland (a Ramsar site) as a prelude to National Wetland Information System. Research has also been carried out for preparation of action plans especially for Ramsar sites in the country. In a novel research, use of the geospatial technology has also been demonstrated for biodiversity conservation using landscape ecological metrics. A country-wide estimate of emission of methane, a Green House Gas, from wetlands has also been made using MODIS data. Present article critically reviews the work carried out in India for wetland conservation and management using geospatial techniques.

  3. Breastfeeding Problems Following Anesthetic Administration

    PubMed Central

    Howie, William O.; McMullen, Patricia C.

    2006-01-01

    Research literature supports the notion that maternal comfort should be considered a priority and that mothers should receive adequate information regarding any drug prior to receiving that drug. Some studies indicate that difficulties with breastfeeding may be related to the amount of the anesthetic or analgesic that is administered to the mother. Thus, it seems wise to administer the lowest possible dose to the mother in order to minimize the amount of drug (or metabolite) exposure to the nursing infant. Infant exposure can be further reduced if breastfeeding is avoided during the times when the mother receives high doses of anesthetics and analgesics. However, because relatively small amounts of the drug are excreted into the breast milk, some mothers may opt to continue nursing after weighing the benefits of breastfeeding against the potential risk to the infant. Others may choose to “pump and dump” breast milk while they receive anesthetic or analgesic agents. Any concerns in this regard should be discussed with the anesthesia provider, preferably prior to labor or to any surgeries while breastfeeding. PMID:17541461

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

    PubMed

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

    2015-01-01

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

  5. Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique.

    PubMed

    Afifi, Yousri; Mahmud, Ayesha; Fatma, Alfia

    2016-02-01

    Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy, which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID appears to be a useful, safe, minimally invasive technique that can be used in both laparoscopic and open surgical procedures.

  6. Application of fisheries-management techniques to assessing impacts

    SciTech Connect

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

    1983-01-01

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

  7. An overview of imaging techniques for liver metastases management.

    PubMed

    Matos, António P; Altun, Ersan; Ramalho, Miguel; Velloni, Fernanda; AlObaidy, Mamdoh; Semelka, Richard C

    2015-01-01

    Evaluation of liver metastases is one of the most common indications for liver imaging. Imaging plays a key role in the of assessment liver metastases. A variety of imaging techniques, including ultrasonography, computed tomography, MRI and PET combined with CT scan are available for diagnosis, planning treatment, and follow-up treatment response. In this paper, the authors present the role of imaging for the assessment of liver metastases and the contribution of each of the different imaging techniques for their evaluation and management. Following recent developments in the field of oncology, the authors also present the importance of imaging for the assessment of liver metastases response to therapy. Finally, future perspectives on imaging of liver metastases are presented. PMID:26414180

  8. Flexible use and technique extension of logistics management

    NASA Astrophysics Data System (ADS)

    Xiong, Furong

    2011-10-01

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

  9. Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty.

    PubMed

    Barrington, John W; Dalury, David F; Emerson, Roger H; Hawkins, Richard J; Joshi, Girish P; Stulberg, Bernard N

    2013-10-01

    Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay. This article examines the use of bupivacaine liposome injectable suspension (EXPAREL®; Pacira Pharmaceuticals, Inc., San Diego, California), a non-opioid product for pain management. Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief.

  10. Strabismus complications from local anesthetics.

    PubMed

    Guyton, David L

    2008-01-01

    Strabismus developing after retrobulbar or peribulbar anesthesia for both anterior and posterior segment eye surgery may be due to myotoxicity to an extraocular muscle from the local anesthetic agent. Initial paresis often causes diplopia immediately after surgery, but later progressive segmental fibrosis occurs, and/or hypertrophy of the muscle, producing diplopia in the opposite direction from the direction of the initial diplopia. The inferior rectus muscle is most commonly affected. Usually a large recession on an adjustable suture of the involved muscle(s) yields good alignment. Using topical anesthesia or sub-Tenon's anesthesia can avoid this complication.

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

    PubMed

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

    2015-08-01

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

  12. Use of interactive immersive visualization techniques for natural resources management

    NASA Astrophysics Data System (ADS)

    Bishop, Ian D.; Karadaglis, Chris

    1996-03-01

    Natural resources management typically requires prediction of environmental changes over long time periods. In the case of forest management, for example, decisions can affect timber production, water catchment properties, recreational values, aesthetic values, energy usage or employment opportunities. This paper presents an application of advanced visualization techniques in combination with a geographic information system and linear programming in this context. The emphasis is on provision of visual feedback on the outcome of decision options. This main interactive window include a 3D view of the management area based initially on remote sensing imagery draped on a digital terrain model. Also on screen are a slider for time (from the present to 200 years hence), and sliders for decision variables such as required job support level, extent of habit conservation or catchment performance. As the time, or the decision variables are altered by the user the result is presented through replacement of textures in the 3D view to represent the changes in land cover. Initially the visualization is based on prior modeling in a well-defined decision space. The system reads model output in ARC/INFO export format while interactive visualization is based on the Silicon Graphics Performer Toolkit.

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

    NASA Astrophysics Data System (ADS)

    Port, Daniel; Boehm, Barry

    2002-03-01

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

  14. Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome.

    PubMed

    Nag, Kusha; Nagella, Amrutha Bindu; Kumar, V R Hemanth; Singh, Dewan Roshan; Ravishankar, M

    2015-01-01

    A 60-year-old woman posted for percutaneous nephrolithotomy with ureterolithotripsy was found to have a history of hypertension and ischemic heart disease from past 6 months on regular treatment. Pulse rate was irregularly irregular in a range of 56-60/min, unresponsive to atropine, with a sinus pause on the electrocardiogram. Although the patient was asymptomatic, anticipating unmasking of the sick sinus syndrome during general anesthesia in the prone position, a temporary pacemaker was implanted at right ventricular outflow tract (RVOT) septum before the scheduled surgery. A balanced anesthesia technique with endotracheal intubation was administered. There were several episodes of continuous pacing by the temporary pacemaker intraoperatively, which may be attributed to unmasking of the sinus node dysfunction due to general anesthesia. At the end of surgery, patient was extubated after adequate reversal from neuromuscular blockade. Postoperative period remained uneventful, and the pacemaker wires were removed on the 2(nd) postoperative day. With this case report, we highlight the importance of inserting a temporary pacemaker prior to anesthesia even in an asymptomatic patient if a sinus node dysfunction is suspected preoperatively and if intraoperative access to transvenous pacing is difficult such as in prone position. Pacing at RVOT septum minimizes ventricular dyssynchrony and improves hemodynamic parameters.

  15. Stress Management Techniques for Graduate Students: Cognitive Coping, Problem-Solving and Time Management.

    ERIC Educational Resources Information Center

    Kolko, David J.

    The application of stress management techniques to highly specialized populations and disorders has become an increasingly important clinical endeavor in recent years. Curiously, however, individuals undergoing one of the most stress-laden experiences, graduate school, have rarely been the focus of such efforts. There are three major forms of…

  16. Anesthetic action of volatile anesthetics by using Paramecium as a model.

    PubMed

    Zhou, Miaomiao; Xia, Huimin; Xu, Younian; Xin, Naixing; Liu, Jiao; Zhang, Shihai

    2012-06-01

    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.

  17. n-Dodecyl β-D-maltoside specifically competes with general anesthetics for anesthetic binding sites.

    PubMed

    Xu, Longhe; Matsunaga, Felipe; Xi, Jin; Li, Min; Ma, Jingyuan; Liu, Renyu

    2014-01-01

    We recently demonstrated that the anionic detergent sodium dodecyl sulfate (SDS) specifically interacts with the anesthetic binding site in horse spleen apoferritin, a soluble protein which models anesthetic binding sites in receptors. This raises the possibility of other detergents similarly interacting with and occluding such sites from anesthetics, thereby preventing the proper identification of novel anesthetic binding sites. n-Dodecyl β-D-maltoside (DDM) is a non-ionic detergent commonly used during protein-anesthetic studies because of its mild and non-denaturing properties. In this study, we demonstrate that SDS and DDM occupy anesthetic binding sites in the model proteins human serum albumin (HSA) and horse spleen apoferritin and thereby inhibit the binding of the general anesthetics propofol and isoflurane. DDM specifically interacts with HSA (Kd = 40 μM) with a lower affinity than SDS (Kd = 2 μM). DDM exerts all these effects while not perturbing the native structures of either model protein. Computational calculations corroborated the experimental results by demonstrating that the binding sites for DDM and both anesthetics on the model proteins overlapped. Collectively, our results indicate that DDM and SDS specifically interact with anesthetic binding sites and may thus prevent the identification of novel anesthetic sites. Special precaution should be taken when undertaking and interpreting results from protein-anesthetic investigations utilizing detergents like SDS and DDM.

  18. Clinical efficacy of tetracaine anesthetic paste.

    PubMed

    Hopp, Christa; Goebel, William; Hildebolt, Charles; Rotter, Bruce

    2012-01-01

    Benzocaine, the most commonly used topical anesthetic in dentistry, often fails to eliminate the pain associated with injections. One type of anesthetic used frequently in medicine with success is tetracaine, but minimal research has been done regarding the application of tetracaine in dentistry. This study sought to evaluate the effectiveness and safety of tetracaine anesthetic paste (TAP), a newly formulated topical anesthetic. For this study, TAP was applied to the maxillary mucobuccal fold of one side of the arch and benzocaine paste was applied to the opposite side prior to injection of anesthetic. Patients then reported the level of pain experienced on each side and were evaluated for any adverse reactions. The results showed no difference in effectiveness between TAP and benzocaine paste, and no adverse reactions were reported. Because of the safety and effectiveness of tetracaine extraorally, further research is warranted on its intraoral use.

  19. Transcatheter aortic valve implantation: anesthetic considerations.

    PubMed

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

    2009-05-01

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

  20. Architectural Techniques For Managing Non-volatile Caches

    SciTech Connect

    Mittal, Sparsh

    2013-01-01

    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.

  1. Translocations of amphibians: Proven management method or experimental technique

    USGS Publications Warehouse

    Seigel, Richard A.; Dodd, C. Kenneth

    2002-01-01

    In an otherwise excellent review of metapopulation dynamics in amphibians, Marsh and Trenham (2001) make the following provocative statements (emphasis added): If isolation effects occur primarily in highly disturbed habitats, species translocations may be necessary to promote local and regional population persistence. Because most amphibians lack parental care, they areprime candidates for egg and larval translocations. Indeed, translocations have already proven successful for several species of amphibians. Where populations are severely isolated, translocations into extinct subpopulations may be the best strategy to promote regional population persistence. We take issue with these statements for a number of reasons. First, the authors fail to cite much of the relevant literature on species translocations in general and for amphibians in particular. Second, to those unfamiliar with current research in amphibian conservation biology, these comments might suggest that translocations are a proven management method. This is not the case, at least in most instances where translocations have been evaluated for an appropriate period of time. Finally, the authors fail to point out some of the negative aspects of species translocation as a management method. We realize that Marsh and Trenham's paper was not concerned primarily with translocations. However, because Marsh and Trenham (2001) made specific recommendations for conservation planners and managers (many of whom are not herpetologists or may not be familiar with the pertinent literature on amphibians), we believe that it is essential to point out that not all amphibian biologists are as comfortable with translocations as these authors appear to be. We especially urge caution about advocating potentially unproven techniques without a thorough review of available options.

  2. Factors influencing the use of behavioral management techniques during child management by dentists.

    PubMed

    Folayan, M O; Idehen, E

    2004-01-01

    Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques. PMID:14969376

  3. DAMAGE CONTROL TECHNIQUES IN THE MANAGEMENT OF SEVERE LUNG TRAUMA

    PubMed Central

    Garcia, Alberto; Martinez, Juan; Rodriguez, Julio; Millan, Mauricio; Valderrama, Gustavo; Ordoñez, Carlos; Puyana, Juan Carlos

    2014-01-01

    Background Damage Control (DC) has improved survival from severe abdominal and extremities injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries is scarce. Methods Retrospective review of the patients treated with DC for thoracic/pulmonary complex trauma at two level I trauma centers from 2006 to 2010. Subjects 14 and older, were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. Results A total of 840 trauma thoracotomies were performed. Damage control thoracotomy (DCT) was done in 31 (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 (IQR 20–34) years, Revised Trauma Score was 7.11, (IQR 5.44–7.55), and Injury Severity Score was 26 (IQR 25–41). Nineteen patients had gunshot-wounds, four stab-wounds and two blunt trauma. Pulmonary trauma was managed by pneumorrhaphy in three cases, tractotomy in 12, wedge resection in one and packing as primary treatment in 8. Clamping of the pulmonary hilum was used as a last resource in 7 cases. Five patients returned to the ICU with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 to 90 hours after the initial DCT. Four of them survived. Bleeding from other intra-thoracic sources was found in 20 cases: major vessels in nine, heart in three, and thoracic wall in nine. DCT mortality in pulmonary trauma was 6/25, (24%) due to coagulopathy or persistent bleeding in five cases and to multiorgan failure in one. Conclusion This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries, and the use of packing as a definitive method for hemorrhage control. PMID:25539202

  4. Percutaneous endoscopic gastrostomy: indications, technique, complications and management.

    PubMed

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

    2014-06-28

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

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

    PubMed Central

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

    2014-01-01

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

  6. Anesthetics and red blood cell rheology

    NASA Astrophysics Data System (ADS)

    Aydogan, Burcu; Aydogan, Sami

    2014-05-01

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

  7. Benzocaine as an anesthetic for striped bass

    USGS Publications Warehouse

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

    1991-01-01

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

  8. Current techniques for management of transverse displaced olecranon fractures

    PubMed Central

    den Hamer, Anniek; Heusinkveld, Maarten; Traa, Willeke; Oomen, Pim; Oliva, Francesco; Del Buono, Angelo; Maffulli, Nicola

    2015-01-01

    Summary Background displaced transverse fractures of the olecranon are the most common fractures occurring in the elbow in adults that requires operative intervention. Methods a literature search was performed on PubMed, Web of Science, Science Direct/Scopus, Google Scholar and Google using the keywords ‘olecranon’, ‘fracture’, ‘internal fixation’ and ‘tension band wiring’, with no limit for time or restrictions to language. Results thirty-one clinical articles were selected: 20 retrospective studies, 9 prospective cohort studies, and 2 randomized control trials. The CMS ranged from 18 to 66 (mean 41.68): overall, the quality of the studies was poor, and no moderate or good quality studies were found. The mean follow-up was 46.7 months (range 1 to 350 months). Several complications occurred after surgery: prominent hardware, skin breakdown, wire migration and infections occurred frequently. Removal of the hardware was required in 472 patients, usually after complaints, but also removal was routinely undertaken. Conclusions tension band wiring is still the most widely applied method to operatively manage olecranon fractures, with the transcortical method of using K-wires the most satisfactory. Plate fixation is a good alternative as complications are minimal. Other techniques using absorbable sutures are less investigated, but are promising, especially in children. PMID:26261793

  9. An update on local anesthetics in dentistry.

    PubMed

    Haas, Daniel A

    2002-10-01

    Local anesthetics are the most commonly used drugs in dentistry. This article provides a brief update on the pharmacology, adverse effects and clinical applications of these drugs, as well as the role of vasoconstrictors. PMID:12366885

  10. General anesthetics and β-amyloid protein

    PubMed Central

    Xie, Zhongcong; Xu, Zhipeng

    2012-01-01

    With roughly 234 million people undergoing surgery with anesthesia each year worldwide, it is important to determine whether commonly used anesthetics can induce any neurotoxicity. Alzheimer's disease (AD) is the most common form of age-related dementia, and a rapidly growing health problem. Several studies suggest that anesthesia could be associated with the development of AD. Moreover, studies in cultured cells and animals show that commonly used inhalation anesthetics may induce changes consistent with AD neuropathogenesis, e.g., β-amyloid protein accumulation. Therefore, in this mini review, we focus on the recent research investigating the effects of commonly used anesthetics including isoflurane, sevoflurane, desflurane, nitrous oxide, and propofol, on Aβ accumulation in vitro and in vivo. We further discuss the future direction of the research determining the effects of anesthetics on β-amyloid protein accumulation. PMID:22918033

  11. Local anesthetics: dentistry's most important drugs.

    PubMed

    Malamed, S F

    1994-12-01

    One hundred and fifty years ago, Horace Wells opened the door to local anesthetics. Since then, many advances have been made in pain control. The development of dentistry's most important drugs is highlighted here.

  12. General anesthetics and β-amyloid protein.

    PubMed

    Xie, Zhongcong; Xu, Zhipeng

    2013-12-01

    With roughly 234 million people undergoing surgery with anesthesia each year worldwide, it is important to determine whether commonly used anesthetics can induce any neurotoxicity. Alzheimer's disease (AD) is the most common form of age-related dementia, and a rapidly growing health problem. Several studies suggest that anesthesia could be associated with the development of AD. Moreover, studies in cultured cells and animals show that commonly used inhalation anesthetics may induce changes consistent with AD neuropathogenesis, e.g., β-amyloid protein accumulation. Therefore, in this mini review, we focus on the recent research investigating the effects of commonly used anesthetics including isoflurane, sevoflurane, desflurane, nitrous oxide, and propofol, on Aβ accumulation in vitro and in vivo. We further discuss the future direction of the research determining the effects of anesthetics on β-amyloid protein accumulation. PMID:22918033

  13. General Anesthetics and Molecular Mechanisms of Unconsciousness

    PubMed Central

    Forman, Stuart A.; Chin, Victor A.

    2013-01-01

    General anesthetic agents are unique in clinical medicine, because they are the only drugs used to produce unconsciousness as a therapeutic goal. In contrast to older hypotheses that assumed all general anesthetics produce their central nervous system effects through a common mechanism, we outline evidence that general anesthesia represents a number of distinct pharmacological effects that are likely mediated by different neural circuits, and perhaps via different molecular targets. Within the context of this neurobiological framework, we review recent molecular pharmacological and transgenic animal studies. These studies reveal that different groups of general anesthetics, which can be discerned based on their clinical features, produce unconsciousness via distinct molecular targets and therefore via distinct mechanisms. We further postulate that different types of general anesthetics selectively disrupt different critical steps (perhaps in different neuronal circuits) in the processing of sensory information and memory that results in consciousness. PMID:18617817

  14. Frequency dependence of capnography in anesthetized rabbits.

    PubMed

    Ioan, I; Demoulin, B; Duvivier, C; Leblanc, A L; Bonabel, C; Marchal, F; Schweitzer, C; Varechova, S

    2014-01-01

    Aspirative capnography may be of help to diagnose early childhood asthma, but clinical usefulness in young children is limited by the relatively high respiratory rate. This study aimed to characterize the [Formula: see text] time course during airway constriction in 8 anesthetized rabbits, artificially ventilated at 30, 60 and 80breaths/min. Methacholine was inhaled to double the respiratory resistance measured at 8Hz by the forced oscillation technique. The capnogram shape changed in response to both methacholine and ventilatory frequency. Slope of phase II, the peak of first-order time derivative and trough of the second-order time derivative of the [Formula: see text] signal, were significantly attenuated after methacholine compared with baseline at all breathing rates (p<0.02). Moreover, significant correlations between respiratory reactance and resistance were observed with the phase III slope and the angle described by phase II and phase III (p<0.01). It is concluded that capnography may be useful to identify acute airway changes related to bronchoconstriction, even at high breathing frequencies. PMID:24035836

  15. Waste anesthetic gas exposures to veterinarians and animal technicians

    SciTech Connect

    Wingfield, W.E.; Ruby, D.L.; Buchan, R.M.; Gunther, B.J.

    1981-02-15

    A survey of veterinarians was conducted in an 11-county region of eastern Colorado to determine the extent of usage of inhalation anesthetics and to measure exposures of veterinarians and their assistants to waste anesthetic gases. The survey indicated that inhalation anesthetics were used in 80.8% of the 210 practices. Exposures to waste anesthetics in veterinary practices were far less than reported in human hospitals. Waste anesthetic concentrations were affected by size of the patient, type of breathing system, and use of scavenging systems. Dilution ventilation had no effect on breathing zone concentrations. The endotracheal tube and occasionally the anesthetic machine were the major sources of leakage of anesthetic gases.

  16. Integration of Risk Management Techniques into Outdoor Adventure Program Design.

    ERIC Educational Resources Information Center

    Bruner, Eric V.

    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…

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

    PubMed Central

    Fukazawa, Kyota

    2014-01-01

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

  18. Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants.

    PubMed

    Boiano, James M; Steege, Andrea L

    2016-10-01

    nurse anesthetists compared to the other anesthesia care providers. Successful management of waste anesthetic gases should include scavenging systems, hazard awareness training, availability of standard procedures to minimize exposure, regular inspection of anesthesia delivery equipment for leaks, prompt attention to spills and leaks, and medical surveillance. PMID:27542098

  19. Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty.

    PubMed

    Barrington, John W; Dalury, David F; Emerson, Roger H; Hawkins, Richard J; Joshi, Girish P; Stulberg, Bernard N

    2013-10-01

    Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay. This article examines the use of bupivacaine liposome injectable suspension (EXPAREL®; Pacira Pharmaceuticals, Inc., San Diego, California), a non-opioid product for pain management. Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief. PMID:24911371

  20. Remote sensing techniques for support of coastal zone resource management.

    NASA Technical Reports Server (NTRS)

    Piland, R. O.

    1973-01-01

    Description of remote sensing studies carried out for the purpose of developing and/or demonstrating techniques which can be employed for land use inventory, marsh vegetation classification, and water characteristics surveys. Attention is given to results obtained with (1) photo interpretation techniques and procedures for the development of land use information from high-altitude aircraft and satellite imagery, (2) computer based pattern recognition techniques utilizing multispectral scanner data for marsh vegetation classification, and (3) infrared and microwave techniques for the monitoring and surveying of coastal water temperature and salinity characteristics.

  1. Anesthetic Approach for a Patient with Jeune Syndrome

    PubMed Central

    Buget, Mehmet I.; Ozkan, Emine; Edipoglu, Ipek S.; Kucukay, Suleyman

    2015-01-01

    Jeune syndrome (JS) is an autosomal recessive disease also known as asphyxiating thoracic dystrophy. A narrow bell-shaped thoracic wall and short extremities are the most typical features of the syndrome. Prognosis in JS depends on the severity of the pulmonary hypoplasia caused by the chest wall deformity. Most patient deaths are due to respiratory problems at early ages. Herein, we report a case of JS patient, who was scheduled for femoral extension under general anesthesia. The severity of respiratory problems in JS patients is thought to diminish with age. Our case supported this theory, and we managed the anesthetic process uneventfully. PMID:26366306

  2. Predicting Student Misbehavior, Responsibility and Distraction from Schoolwork from Classroom Management Techniques: The Students' Views

    ERIC Educational Resources Information Center

    Tran, Van Dat

    2015-01-01

    This study reports students' perceptions of the classroom management techniques utilized in fourteen classrooms at eight junior high schools in one province in Vietnam. It examines data from 498 students in fifteen high schools in one district in Vietnam in grades 10 to 12 to identify how teachers' use of various management techniques, and the…

  3. Software-Enabled Project Management Techniques and Their Relationship to the Triple Constraints

    ERIC Educational Resources Information Center

    Elleh, Festus U.

    2013-01-01

    This study investigated the relationship between software-enabled project management techniques and the triple constraints (time, cost, and scope). There was the dearth of academic literature that focused on the relationship between software-enabled project management techniques and the triple constraints (time, cost, and scope). Based on the gap…

  4. Study of systems and techniques for data base management

    NASA Technical Reports Server (NTRS)

    1976-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2008-04-01

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

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

    PubMed

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

    2014-02-01

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

  7. Methemoglobinemia from topically applied anesthetic spray.

    PubMed

    Dinneen, S F; Mohr, D N; Fairbanks, V F

    1994-09-01

    Topically applied anesthetic spray is commonly used as part of premedication for general anesthesia and for endoscopic procedures; it is rarely associated with side effects. In this report, we describe two cases of toxic methemoglobinemia that resulted from topically applied anesthetic spray used before endoscopy. In both cases, standard doses were used; however, methemoglobin levels of 45% and 38% developed within 1 hour of the procedure. Both patients had normal levels of erythrocyte methemoglobin reductase, an indication that this rare but potentially fatal side effect can occur in persons who have no predisposing factors. Because toxic methemoglobinemia is easily treated, our report emphasizes the need to recognize this problem when topically applied anesthetic sprays are used.

  8. [Successful airway management using i-gel in 7 patients undergoing awake craniotomy].

    PubMed

    Matsunami, Katsuaki; Sanuki, Michiyoshi; Yasuuji, Masakazu; Nakanuno, Ryuichi; Kato, Takahiro; Kawamoto, Masashi

    2014-07-01

    In order to secure airway during awake craniotomy, we used i-gel to perform positive-pressure ventilation in 7 patients for their anesthetic management. During removal of a tumor around the motor speech center, anesthetic management including asleep-awake-asleep technique was applied for speech testing. The technique, insertion and re-insertion of i-gel, was needed and it was easy in all the patients. During positive-pressure ventilation, peak pressure, tidal volume both for inspiration and expiration, and endtidal-CO2 were not markedly altered. Leakage around i-gel, and its differences between inspiration and expiration were negligible, while the tidal volume was adequate. We conclude that i-gel is useful for anesthetic management for awake craniotomy procedure for both securing airway and ventilation.

  9. Research to Develop Effective Teaching and Management Techniques for Severely Disturbed and Retarded Children. Final Report.

    ERIC Educational Resources Information Center

    Kauffman, James M.; Birnbrauer, Jay S.

    The final report of a project on teaching and management techniques 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…

  10. [Anesthetic maintenance during circular face lifting].

    PubMed

    Parshin, V I; Pastukhova, N K

    2010-01-01

    The paper deals with the specific features of anesthetic maintenance (ketamine, diprivan, dormicum, perfalgan, promedol) during circular face lifting without artificial ventilation. All intravenous anesthesia procedures have yielded good results. Narcotic analgesics may be removed from the anesthetic maintenance scheme, ruling out the necessity of their licensing, storing, and recording. The use of perfalgan causes no hallucinogenic reactions and offers the optimum level of anesthesia. During face lifting, 2.3 +/- 0.6-hour anesthesia with spontaneous breathing is possible, safe, and warranted. PMID:20524331

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

    PubMed

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

    1998-01-01

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

  12. Irreversible pulpitis and achieving profound anesthesia: Complexities and managements

    PubMed Central

    Modaresi, Jalil; Davoudi, Amin; Badrian, Hamid; Sabzian, Roya

    2016-01-01

    Dental pain management is one of the most critical aspects of modern dentistry. Irreversible pulpitis and further root canal therapy might cause an untolerated pain to the patients. The improvements in anesthetic agents and techniques were one of the advantages of studying nerve biology and stimulation. This article tried to overview of the nerve activities in inflammatory environments or induced pain. Furthermore, the proper advises, and supplementary techniques were reviewed for better pain management of irreversible pulpitis. PMID:26957681

  13. A relaxation technique in the management of hypercholesterolemia.

    PubMed

    Cooper, M J; Aygen, M M

    1979-12-01

    Chronic sympathetic nervous system overactivity has been implicated as a factor capable of elevating and maintaining high serum cholesterol levels independent of dietary measures. We conducted a controlled trial to determine the effect of a relaxation technique. Transcendental Meditation, on serum cholesterol levels in hypercholesterolemic subjects. Serum cholesterol levels were measured at beginning and end of an 11-month period in 12 hypercholesterolemic subjects who regularly practiced meditation. Eleven hypercholesterolemic controls who did not practice the technique were similarly followed up for 13 months. Paired comparisons showed a significant (p less than 0.005) reduction in fasting serum cholesterol levels of those subjects who practiced meditation. These results suggest that the regular practice of a relaxation technique may contribute, most likely through a reduction in adrenergic activity, to the amelioration of hypercholesterolemia in certain subjects.

  14. Stealing time. Time management techniques add hours to each day.

    PubMed

    Davis, Nadinia

    2003-06-01

    Time not only flies when we're having fun, but also when we're filing paperwork, checking e-mail, and looking for our car keys. But you can add hours to your day by managing yourself rather than time. Here's how.

  15. Management Science/Industrial Engineering Techniques to Reduce Food Costs.

    ERIC Educational Resources Information Center

    Greenberg, Murray

    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…

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

    ERIC Educational Resources Information Center

    Roessler, Richard T.; Rubin, Stanford E.

    2006-01-01

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

  17. Regional environmental analysis and management: New techniques for current problems

    NASA Technical Reports Server (NTRS)

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

    1974-01-01

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

  18. A Survey Of Techniques for Managing and Leveraging Caches in GPUs

    SciTech Connect

    Mittal, Sparsh

    2014-09-01

    Initially introduced as special-purpose accelerators for graphics applications, graphics processing units (GPUs) have now emerged as general purpose computing platforms for a wide range of applications. To address the requirements of these applications, modern GPUs include sizable hardware-managed caches. However, several factors, such as unique architecture of GPU, rise of CPU–GPU heterogeneous computing, etc., demand effective management of caches to achieve high performance and energy efficiency. Recently, several techniques have been proposed for this purpose. In this paper, we survey several architectural and system-level techniques proposed for managing and leveraging GPU caches. We also discuss the importance and challenges of cache management in GPUs. The aim of this paper is to provide the readers insights into cache management techniques for GPUs and motivate them to propose even better techniques for leveraging the full potential of caches in the GPUs of tomorrow.

  19. Contemporary behavior management techniques in clinical pediatric dentistry: out with the old and in with the new?

    PubMed

    Oliver, Kelly; Manton, David John

    2015-01-01

    Effective behavior management guides children through the complex social context of dentistry utilizing techniques based on a current understanding of the social, emotional, and cognitive development of children. Behavior management techniques facilitate effective communication and establish social and behavioral guidelines for the dental environment. Contemporary parenting styles, expectations, and attitudes of modern parents and society have influenced the use of behavior management techniques with a prevailing emphasis on communicative techniques and pharmacological management over aversive techniques. PMID:25909839

  20. Charles bonnet syndrome, management with simple behavioral technique.

    PubMed

    Issa, Baba Awoye; Yussuf, Abdullahi Dasliva

    2013-01-01

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

  1. Improved outage management techniques for better plant availability

    SciTech Connect

    Bemer, J.P.

    1989-01-01

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

  2. Test monkeys anesthetized by routine procedure

    NASA Technical Reports Server (NTRS)

    1965-01-01

    Test monkeys are safely anesthetized for five minutes by confining them for less than six minutes in enclosures containing a controlled volume of ether. Thus the monkeys can be properly and safely positioned on test couches and fitted with electrodes or other devices prior to physiological tests.

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

    PubMed Central

    Simonet, Daniel

    2011-01-01

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

  4. 21 CFR 868.5550 - Anesthetic gas mask.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask. (a) Identification. An anesthetic gas mask is a device, usually made of conductive rubber, that is positioned over...

  5. 21 CFR 868.5550 - Anesthetic gas mask.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask. (a) Identification. An anesthetic gas mask is a device, usually made of conductive rubber, that is positioned over...

  6. 21 CFR 868.5550 - Anesthetic gas mask.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask. (a) Identification. An anesthetic gas mask is a device, usually made of conductive rubber, that is positioned over...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthetic cabinet, table, or tray. 868.6100... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a device intended to...

  8. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147... SHIPS' STORES Stowage and Other Special Requirements for Particular Materials § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthetic cabinet, table, or tray. 868.6100... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a device intended to...

  10. 46 CFR 111.105-37 - Flammable anesthetics.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA 99 (incorporated by reference, see 46 CFR... 46 Shipping 4 2010-10-01 2010-10-01 false Flammable anesthetics. 111.105-37 Section...

  11. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147... SHIPS' STORES Stowage and Other Special Requirements for Particular Materials § 147.105 Anesthetics, drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

  12. 46 CFR 111.105-37 - Flammable anesthetics.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA 99 (incorporated by reference, see 46 CFR... 46 Shipping 4 2011-10-01 2011-10-01 false Flammable anesthetics. 111.105-37 Section...

  13. 46 CFR 111.105-37 - Flammable anesthetics.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA 99 (incorporated by reference, see 46 CFR... 46 Shipping 4 2012-10-01 2012-10-01 false Flammable anesthetics. 111.105-37 Section...

  14. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthetic cabinet, table, or tray. 868.6100... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a device intended to...

  15. 46 CFR 111.105-37 - Flammable anesthetics.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA 99 (incorporated by reference, see 46 CFR... 46 Shipping 4 2013-10-01 2013-10-01 false Flammable anesthetics. 111.105-37 Section...

  16. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthetic cabinet, table, or tray. 868.6100... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a device intended to...

  17. 21 CFR 868.6100 - Anesthetic cabinet, table, or tray.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthetic cabinet, table, or tray. 868.6100... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6100 Anesthetic cabinet, table, or tray. (a) Identification. An anesthetic cabinet, table, or tray is a device intended to...

  18. 46 CFR 111.105-37 - Flammable anesthetics.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-37 Flammable anesthetics. Each electric installation where a flammable anesthetic is used or stored must meet NFPA 99 (incorporated by reference, see 46 CFR... 46 Shipping 4 2014-10-01 2014-10-01 false Flammable anesthetics. 111.105-37 Section...

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

    PubMed

    Redshaw, Charlotte; Stewart, Catherine

    2014-11-01

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

  20. Comparative analysis of tissue reactions to anesthetic solutions: histological analysis in subcutaneous tissue of rats.

    PubMed Central

    Ribeiro, Paulo Domingos; Sanches, Marcio Giampietro; Okamoto, Tetuo

    2003-01-01

    Postanesthetic pain is a relatively common complication after local anesthesia. This complication may be caused by the anesthetic technique 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 PMID:14959905

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

    PubMed

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

    2007-10-01

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

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

    SciTech Connect

    Nijs, Els L. F.; Cahill, Anne Marie

    2010-12-15

    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.

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

    PubMed

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

    2014-03-01

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

  4. Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

    PubMed

    Dávila, Sylvia A; Johnston-Jones, Karen

    2006-01-01

    Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture. PMID:16713873

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

    PubMed

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

    2012-09-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

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

  7. Development of analytical techniques for risk management training. Final report

    SciTech Connect

    Barnett, J.R.

    1992-10-01

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

  8. Culture control in crop fields: A habitat management technique

    NASA Astrophysics Data System (ADS)

    Mayse, Mark A.

    1983-01-01

    Cultural factors, including vegetational backgrounds adjacent to and/or within the crop, harvest procedures, crop rotation patterns, planting dates, and plant density/spacing patterns provide a major portion of the ecological context in which arthropod populations in crop fields exist These cropping practices can often be manipulated to help favorably manage arthropod populations Some research highlights involving various types of cultural control are presented, including a discussion of several problems faced by researchers investigating cultural control of arthropods in field crop agroecosystems. In order to understand the complexities involved in cultural factor effects on arthropod populations, investigators must perform carefully designed research. Also, the most appropriate and meaningful way(s) to express arthropod population levels in such studies must be critically determined

  9. Thermal Management Techniques for Oil-Free Turbomachinery Systems

    NASA Technical Reports Server (NTRS)

    Radil, Kevin; DellaCorte, Chris; Zeszotek, Michelle

    2006-01-01

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

  10. Nucleus management with Blumenthal technique: Anterior chamber maintainer

    PubMed Central

    Malik, Krishnan P S; Goel, Ruchi

    2009-01-01

    The Blumenthal's ‘Mininuc’ technique enables nuclear expression through a 5-6.5-mm sclerocorneal tunnel incision using a Sheet's lens glide and anterior chamber maintainer (ACM). A 6-mm or larger capsulorrhexis, reduction in nuclear size by hydroprocedure and its manipulation manually into the anterior chamber are performed. The nucleus is expressed out of the chamber by use of hydrostatic pressure created by balanced salt solution delivered continuously through the ACM. This continuous flow from ACM to anterior chamber keeps the eye under positive pressure physiological state besides clearing the chamber of cortex, blood and pigments offering excellent visualization. The procedure, with an initial learning curve, is highly effective, applicable to all grades of cataracts, has minimum intraocular instrumentation resulting in an early rehabilitation of the patient. PMID:19075404

  11. Allergic response to metabisulfite in lidocaine anesthetic solution.

    PubMed Central

    Campbell, J. R.; Maestrello, C. L.; Campbell, R. L.

    2001-01-01

    True allergies to local anesthetics are rare. It is common for practitioners to misdiagnose a serious adverse event to local anesthetics as an allergic reaction. The most likely causes for an allergic response are the preservative, antioxidant, or metabolites and not the anesthetic itself. This case report illustrates the need for practitioners to understand the many potential allergens in local anesthetics and to correctly diagnose patients that are truly allergic to the local anesthetic. Images Figure 1 Figure 2 Figure 3 Figures 4 and 5 PMID:11495401

  12. Vascular tracers alter hemodynamics and airway pressure in anesthetized sheep

    SciTech Connect

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

    1986-11-01

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

  13. Suitability of online 3D visualization technique in oil palm plantation management

    NASA Astrophysics Data System (ADS)

    Mat, Ruzinoor Che; Nordin, Norani; Zulkifli, Abdul Nasir; Yusof, Shahrul Azmi Mohd

    2016-08-01

    Oil palm industry has been the backbone for the growth of Malaysia economy. The exports of this commodity increasing almost every year. Therefore, there are many studies focusing on how to help this industry increased its productivity. In order to increase the productivity, the management of oil palm plantation need to be improved and strengthen. One of the solution in helping the oil palm manager is by implementing online 3D visualization technique for oil palm plantation using game engine technology. The potential of this application is that it can helps in fertilizer and irrigation management. For this reason, the aim of this paper is to investigate the issues in managing oil palm plantation from the view of oil palm manager by interview. The results from this interview will helps in identifying the suitable issues could be highlight in implementing online 3D visualization technique for oil palm plantation management.

  14. Teaching Natural Resource Management-Teaching Techniques and Difficulties in Greek Vocational Lyceum: A Case Study

    ERIC Educational Resources Information Center

    Koutsoukos, Marios; Mouratidis, Antonios

    2016-01-01

    The aim of the present study is to investigate the teaching techniques applied, as well as the difficulties, with which educators in teaching Natural Resource Management are confronted. For research purposes, a case study was conducted on teaching Natural Resource Management in the Third Grade of Vocational Lyceum (EPAL) in Northern Greece. It was…

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

    ERIC Educational Resources Information Center

    Tsai, Bor-sheng

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Berger, Ellie D.

    2009-01-01

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

  17. Intraoperative magnetic resonance imaging for neurosurgical procedures: anesthetic implications.

    PubMed

    Henrichs, Bernadette; Walsh, Robert P

    2011-02-01

    Intraoperative magnetic resonance imaging (IMRI) for tumor resection allows a neurosurgeon to pinpoint the exact location of the tumor before resection and to navigate to the tumor after the incision is made. Although the anesthetic management is not substantially different from that for other neurosurgical procedures, strategies to keep the patient and operating room personnel safe can be challenging. Because of the risk of injury by the strong force of the magnet, safety precautions with respect to anesthetic delivery must be taken. Ferrous objects must be removed and kept outside the operating room. Only MRI-compatible equipment is allowed in the MRI operating room. This includes the anesthesia machine, anesthesia cart, intubating equipment, monitors, stethoscopes, poles for intravenous solutions, and body warmers. Surgical equipment and instruments must be MRI-compatible. Absolute contraindications to entering the MRI suite include pacemakers, cochlear implants, certain cranial aneurysm clips, and metal joints or implants. Goals of anesthesia delivery during IMRI procedures include the following: (1) promoting the safety of patients and staff, (2) preventing MRI-associated accidents, (3) identifying potential equipment-related hazards, (4) recognizing limitations of physiologic monitoring, and (5) acknowledging other potential hazards such as noise. PMID:21473229

  18. Special article: general anesthetic gases and the global environment.

    PubMed

    Ishizawa, Yumiko

    2011-01-01

    General anesthetics are administered to approximately 50 million patients each year in the United States. Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. All the volatile anesthetics that are currently used are halogenated compounds destructive to the ozone layer. These halogenated anesthetics could have potential significant impact on global warming. The widely used anesthetic gas nitrous oxide is a known greenhouse gas as well as an important ozone-depleting gas. These anesthetic gases and vapors are primarily eliminated through exhalation without being metabolized in the body, and most anesthesia systems transfer these gases as waste directly and unchanged into the atmosphere. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Our estimation using the most recent consumption data indicates that the anesthetic use of nitrous oxide contributes 3.0% of the total emissions in the United States. Studies suggest that the influence of halogenated anesthetics on global warming will be of increasing relative importance given the decreasing level of chlorofluorocarbons globally. Despite these nonnegligible pollutant effects of the anesthetics, no data on the production or emission of these gases and vapors are publicly available. The primary goal of this article is to critically review the current data on the potential effects of general anesthetics on the global environment and to describe possible alternatives and new technologies that may prevent these gases from being discharged into the atmosphere.

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  1. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands

    PubMed Central

    Twidwell, Dirac; Wonkka, Carissa L.; Sindelar, Michael T.; Weir, John R.

    2015-01-01

    Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1) a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2) a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3) an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related) equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands. PMID:26465329

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

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

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

  3. Unexpected Complete Heart Block and Anesthetic Implications.

    PubMed

    Torres, Arturo G

    2015-08-01

    A healthy, active duty military 25-year-old female with a history of congenital complete heart block presented for a routine septorhinoplasty. During the preoperative interview, she did not disclose her heart condition. A preordered electrocardiogram was not available. During induction of anesthesia, she became extremely bradycardic, approaching asystole, requiring resuscitation. This case highlights the potential anesthetic risks in individuals with a history of congenital heart rhythm disease.

  4. Challenges in the transfer of contingency management techniques: comment on Silverman et al. (2001).

    PubMed

    Petry, N M

    2001-02-01

    This article critiques K. Silverman, D. Svikis, E. Robles, M. L. Stitzer, and G. E. Bigelow's (2001) study of a contingency management intervention for reinforcing development of job-related skills in substance abusing women. The strengths of Silverman et al.'s study include studying a patient population of major public health concern, expanding contingency management techniques to a vocational training setting, reinforcing gradual approximations, implementing the intervention for a long duration, and carefully designing and executing the experimental procedures. However, many of these strengths may also be interpreted as weaknesses if the ultimate goal is to apply contingency management techniques in self-sustaining, community-based settings. The need to evaluate long-term cost-effectiveness of these procedures is described, and the difficulties in transferring contingency management techniques to real-world settings is discussed.

  5. Parental presence during pediatric anesthetic inductions.

    PubMed

    Himes, Mary Kay; Munyer, Kristina; Henly, Susan J

    2003-08-01

    Children's responses to parental presence during anesthetic induction have been researched thoroughly; however, not much is known about the response of parents to being present at their child's induction. The purpose of this research was to examine parent's preparation for, attitudes and emotions about, and experiences with being present for their child's anesthetic induction. Participants included parents who accompanied their children ranging from 1 to 10 years of age during induction by general anesthesia. Multiple-choice surveys were distributed preoperatively to a convenience sample of 55 parents who were present for their child's anesthetic induction. Of 55 surveys, 38 (69%) were returned postoperatively. Data were analyzed using frequency distributions, cross-tabulations with chi 2 tests, and correlation coefficients. In general, parents felt accurately prepared and satisfied with their preparation. They thought their presence was beneficial to their child, themselves, and anesthesia personnel. Overall satisfaction with preparation was related to the completeness of the information they received (r = 0.35; P < .04). Complete and accurate information about the induction event before surgery and emotional support during induction are important psychosocial aspects of anesthesia care for parents who plan to be present during their child's induction.

  6. A Qualitative Description of Women’s HIV Self-Management Techniques: Context, Strategies, and Considerations

    PubMed Central

    Webel, Allison R.; Dolansky, Mary A.; Henry, Anna G.; Salata, Robert A.

    2011-01-01

    Women living with HIV face unique challenges managing their disease. The purpose of this descriptive, qualitative study was to describe self-management techniques 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-management techniques: 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. PMID:22079674

  7. Differential membrane effects of general and local anesthetics.

    PubMed

    Diamond, B I; Havdala, H S; Sabelli, H C

    1975-12-01

    The authors studied the effects of varying Na+ and Ca++ concentrations and of replacing H2O with D2O in Ringer's solution upon the actions of general and local anesthetics on isolated frog sciatic nerves. This experimental model was used to study whether general anesthetics affect excitable membranes in a manner similar to that of typical membrane stabilizers (local anesthetics). Procaine (2.5-7.5 mM), halothane (9, 18, and 36 mM), enflurane (8 mM), and ketamine (0.15 and 0.73 mM) raised threshold and lowered spike amplitude, and their effects were facilitated by reducing Na+ concentration in the Ringer's solution. The local anesthetic effects of procaine (2.5-7.5 mM) and ketamine (0.73 mM) were antagonized by Ca++, while the axonal depressant effect of halothane was facilitated by increasing Ca++ concentration in the Ringer's solution, indicating a different mode of action. General anesthetics also differed from local anesthetics in their interaction with water: replacement by D2O of H2O in the Ringer's solution selectively increased the axonal depressant effects of halothane and enflurane but not those of ketamine or procaine. Since D2O differs from H2O in its greater ice-likeness, these results are consistent with the view that general anesthetics stabilize excitable membranes via stabilization of the water-biopolymer lattice, as predicted by the hydrate-microcrystal theory of anesthesia. In contrast, local anesthetics may stabilize excitable tissues by binding to the same fixed negative charges of the membrane to which Ca++ is normally bound. (Key words: Theories of anesthesia, hydrate-microcrystal; Nerve, mode of action of anesthetics; Anesthetics, volatile, halothane; Anesthetics, volatile, enflurane; Anesthetics, local, procaine; Anesthetics, intravenous, ketamine.)

  8. Independent Business Owner/Managers. Project TEAMS. (Techniques and Education for Achieving Management Skills).

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

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

  9. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Preanesthetic" Era-1700 to 1846.

    PubMed

    Matioc, Adrian A

    2016-02-01

    Basic airway management modern history starts in the early 18th century in the context of resuscitation of the apparently dead. History saw the rise and fall of the mouth-to-mouth and then of the instrumental positive-pressure ventilation generated by bellows. Pulmonary ventilation had a secondary role to external and internal organ stimulation in resuscitation of the apparently dead. Airway access for the extraglottic technique was to the victim's nose. The bellows-to-nose technique was the "basic airway management technique" applicable by both medical and nonmedical personnel. Although the techniques had been described at the time, very few physicians practiced glottic (intubation) and subglottic (tracheotomy) techniques. Before the anesthetic era, positive-pressure ventilation was discredited and replaced by manual negative-pressure techniques. In the middle of the 19th century, physicians who would soon administer anesthetic gases were unfamiliar with the positive-pressure ventilation concept.

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

    PubMed

    Das, Sudeb; Kundu, Malay Kumar

    2013-09-01

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

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

    PubMed

    Das, Sudeb; Kundu, Malay Kumar

    2013-09-01

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

  12. Anesthetic diffusion through lipid membranes depends on the protonation rate.

    PubMed

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

    2014-12-18

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

  13. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D

    2016-08-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  14. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed Central

    Bech, N. H.; Hulst, A. H.; Spuijbroek, J. A.; van Leuken, L. L. A.; Haverkamp, D.

    2016-01-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

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

    PubMed

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

    2006-12-01

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

  16. Prograde dilatation with Tucker bougies: a technique for managing postoperative rectal strictures.

    PubMed

    Gamliel, Z; Wesson, D

    1991-11-01

    Postoperative rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal strictures that were not amenable to conventional methods of dilatation but were successfully managed by a technique of dilatation using Tucker bougies without general anesthesia.

  17. A Unitary Anesthetic Binding Site at High Resolution

    SciTech Connect

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

    2011-12-31

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

  18. A Unitary Anesthetic Binding Site at High Resolution

    SciTech Connect

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

    2009-10-21

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

  19. A Unitary Anesthetic-Binding Site at High Resolution

    SciTech Connect

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

    2009-01-01

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

  20. A Unitary Anesthetic Binding Site at High Resolution*

    PubMed Central

    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.

    2009-01-01

    Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABAA receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology methods advance to the point of being able to deal with systems such as the 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. PMID:19605349

  1. Mimosa pudica, Dionaea muscipula and anesthetics.

    PubMed

    De Luccia, Thiago Paes de Barros

    2012-09-01

    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.

  2. Mimosa pudica, Dionaea muscipula and anesthetics

    PubMed Central

    De Luccia, Thiago Paes de Barros

    2012-01-01

    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

  3. External cardiovascular resuscitation of the anesthetized pony.

    PubMed

    Frauenfelder, H C; Fessler, J F; Latshaw, H S; Moore, A B; Bottoms, G D

    1981-10-01

    External cardiac massage and concomitant respiratory support were used successfully 6 of 8 anesthetized ponies sustaining unexpected cardiac arrest while being used in a study of shock. Approximately 20 thoracic compressions/min maintained systolic and diastolic aortic blood pressures in excess of 50% of the corresponding base-line values in 5 ponies. The high success rate was attributed to early recognition of the problem, the small size of the patient, and the relatively short duration of cardiopulmonary resuscitation (average, 2.9 minutes). It was concluded that external cardiac message can be effective for cardiopulmonary resuscitation in selected equine patients that have sustained cardiac arrest.

  4. Methods to produce calibration mixtures for anesthetic gas monitors and how to perform volumetric calculations on anesthetic gases.

    PubMed

    Christensen, P L; Nielsen, J; Kann, T

    1992-10-01

    A simple procedure for making calibration mixtures of oxygen and the anesthetic gases isoflurane, enflurane, and halothane is described. One to ten grams of the anesthetic substance is evaporated in a closed, 11,361-cc glass bottle filled with oxygen gas at atmospheric pressure. The carefully mixed gas is used to calibrate anesthetic gas monitors. By comparison of calculated and measured volumetric results it is shown that at atmospheric conditions the volumetric behavior of anesthetic gas mixtures can be described with reasonable accuracy using the ideal gas law. A procedure is described for calculating the deviation from ideal gas behavior in cases in which this is needed. PMID:1453187

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

    ERIC Educational Resources Information Center

    Brunton, Margaret Ann; Jeffrey, Lynn Maud

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Pemberton, Joy R.; Borrego, Joaquin

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Mah, Janet W. T.; Johnston, Charlotte

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  9. Techniques of Document Management: A Review of Text Retrieval and Related Technologies.

    ERIC Educational Resources Information Center

    Veal, D. C.

    2001-01-01

    Reviews present and possible future developments in the techniques of electronic document management, the major ones being text retrieval and scanning and OCR (optical character recognition). Also addresses document acquisition, indexing and thesauri, publishing and dissemination standards, impact of the Internet, and the document management…

  10. Business and Industrial Supervisors. Project TEAMS. (Techniques and Education for Achieving Management Skills).

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    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…

  11. An Experimental Test of a Craving Management Technique for Adolescents in Substance-Abuse Treatment

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  12. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Planning and management techniques applicable to the plan. 10005.15 Section 10005.15 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND CONSERVATION COMMISSION POLICIES AND PROCEDURES FOR...

  13. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Planning and management techniques applicable to the plan. 10005.15 Section 10005.15 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND CONSERVATION COMMISSION POLICIES AND PROCEDURES FOR...

  14. 43 CFR 10005.15 - Planning and management techniques applicable to the plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Planning and management techniques applicable to the plan. 10005.15 Section 10005.15 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND CONSERVATION COMMISSION POLICIES AND PROCEDURES FOR...

  15. Two Student Self-Management Techniques Applied to Data-Based Program Modification.

    ERIC Educational Resources Information Center

    Wesson, Caren

    Two student self-management techniques, student charting and student selection of instructional activities, were applied to ongoing data-based program modification. Forty-two elementary school resource room students were assigned randomly (within teacher) to one of three treatment conditions: Teacher Chart-Teacher Select Instructional Activities…

  16. An examination of the potential applications of automatic classification techniques to Georgia management problems

    NASA Technical Reports Server (NTRS)

    Rado, B. Q.

    1975-01-01

    Automatic classification techniques are described in relation to future information and natural resource planning systems with emphasis on application to Georgia resource management problems. The concept, design, and purpose of Georgia's statewide Resource AS Assessment Program is reviewed along with participation in a workshop at the Earth Resources Laboratory. Potential areas of application discussed include: agriculture, forestry, water resources, environmental planning, and geology.

  17. Molecular mechanisms of nerve block by local anesthetics.

    PubMed

    Strichartz, G

    1976-10-01

    Local anesthetics block nerve conduction by preventing the increase in membrane permeability to sodium ions that normally leads to a nerve impulse. Among anesthetics containing tertiary amine groups, the cationic, protonated form appears to be more active than the neutral form. However, the neutral forms, as well as uncharged molecules like benzocaine and the aliphatic alcohols, also depress sodium permeability. Studies of single myelinated nerves and squid axons show no direct interaction between calcium ions and local anesthetics, thus disproving theories based on competition between these two agents. Likewise, hypotheses attributing local anesthesia to changes in electrical potentials at the membrane-water interface are disproven by the demonstrated potencies of electrically uncharged anesthetics. Hypotheses that propose that local anesthetics act by expanding the nerve membrane and causing a change in protein conformation that blocks sodium permeability are vague in conception and difficult to test experimentally. Evidence from voltage-clamp studies of single nerve fibers indicates that anesthetic molecules interact with the sodium channels directly, from the inner side of the nerve membrane. Anesthetics bind within sodium channels which have opened during membrane depolarization, preventing the normal sodium ion flux. Anesthetic molecules can dissociate from open channels, but not from channels that remain closed when the nerve is kept at rest. The "gating" properties that regulate the opening and closing of sodium channels are reversibly modified during anesthesia. Specifically, the inactivation function responds more slowly and requires more negative membrane potential changes to reach the same values as in unanesthetized nerves. A second, slow inactivation is observed following external application of tertiary amine anesthetics. The selective binding of anesthetics to open sodium channels provides a simple explanation for Wedenski inhibition, in which the

  18. Conditioned cortical slow potential responses in urethane anesthetized rats.

    PubMed

    Pirch, J H; Corbus, M J; Ebenezer, I

    1985-01-01

    Cortical slow potential (SP) responses to tone or light stimuli preceding medial forebrain bundle (MFB) stimulation were recorded in urethane anesthetized rats. In the first study, rats were implanted with Ag-AgCl electrodes for recording frontal cortex SPs as well as monopolar electrodes for MFB stimulation. Following recovery, optimum stimulation parameters for SP conditioning were determined for each rat during self-stimulation sessions. These animals were then subjected to extensive associative conditioning in the unanesthetized state. Trials were presented at variable intervals and a 2-sec tone preceded a single 0.5 sec train of MFB stimulation. Negative SP responses developed with training and responses of similar waveform and amplitude were observed in the same animals under urethane anesthesia. Other rats were implanted with MFB stimulating electrodes and, after recovery, stimulation parameters were determined as above but the animals were not subjected to the conditioning procedure prior to urethane administration. Under urethane anesthesia, Ag-AgCl electrodes were placed on the dura over frontal cortex for recording SP responses during pseudoconditioning, conditioning, extinction and retraining trials, using either light or tone stimuli. Negative bilateral SP responses to the tone or light were minimal or nonexistent during pseudoconditioning, developed gradually with pairing, diminished markedly during extinction and returned to maximum amplitude with retraining. The SP responses also reflected discrimination between reinforced and nonreinforced tone and light stimuli as well as reversal conditioning. Furthermore, turning off a light could also serve as the conditioned stimulus for SP response generation. Cortical slow potential responses can be conditioned in urethane anesthetized rats. Therefore, it may be possible to apply additional neurophysiological techniques in these animals to investigate event-related slow potential mechanisms. PMID:3872286

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Madhusudhanan, B; Chitra, S; Rajan, C

    2015-01-01

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

  1. Application of knowledge-based network management techniques for packet radio networks

    NASA Astrophysics Data System (ADS)

    Doyle, R. J.; Sastry, A. R. K.

    The authors developed a preliminary version of a knowledge-based model for network management and reconfiguration using blackboard techniques and have applied it to packet radio networks. The analysis is concerned with developing procedures for evaluation of candidate recovery/reconfiguration methodologies and techniques for fault isolation and related monitoring functions. As an initial step, the generic blackboard was chosen as the artificial intelligence environment to develop the management tools and interlink it to a packet radio network simulator that was used as a testbed network to be controlled and monitored. The details of the interaction of the management environment and the packet radio simulator as implemented in the model so far, and present numerical results obtained through the execution of some preliminary rules are described.

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

    PubMed

    Gerardi, Debra

    2004-01-01

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

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

    PubMed

    Gerardi, Debra

    2004-01-01

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

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

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

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

  5. Posttraumatic stress disorder: a special case of emergence delirium and anesthetic alternatives.

    PubMed

    Shoum, Steven M

    2014-09-01

    Two anesthesia cases are presented involving patients with a history of posttraumatic stress disorder (PTSD). The first patient experienced a prolonged dangerous flashback during emergence. In the second patient, after a thorough review of PTSD and the anesthesia literature, emergence was uneventful. A history of PTSD should be considered a risk factor in the assessment of every patient and anesthetic management designed to best avoid serious and potentially harmful reactions. PMID:25611354

  6. Using economic valuation techniques to inform water resources management: a survey and critical appraisal of available techniques and an application.

    PubMed

    Birol, Ekin; Karousakis, Katia; Koundouri, Phoebe

    2006-07-15

    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.

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

    ERIC Educational Resources Information Center

    Otani, Akira

    1989-01-01

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

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

    PubMed Central

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

    2004-01-01

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

  9. The local anesthetic potency of norcocaine, a metabolite of cocaine.

    PubMed

    Just, W W; Hoyer, J

    1977-01-15

    The local anesthetic effects of cocaine and one of its main metabolites norcocaine, were investigated comparatively on isolated ganglion cells of the marine gastropod, Aplysia californica. During a 4-hour-period, different action potential parameters such as amplitude, duration, maximum rate of rise were observed, which demonstrated that norcocaine exhibits a higher local anesthetic potency than cocaine.

  10. 21 CFR 868.5550 - Anesthetic gas mask.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask....

  11. 21 CFR 868.5550 - Anesthetic gas mask.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask....

  12. 21 CFR 346.10 - Local anesthetic active ingredients.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Local anesthetic active ingredients. 346.10 Section 346.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... § 346.10 Local anesthetic active ingredients. The active ingredient of the product consists of any...

  13. 21 CFR 346.10 - Local anesthetic active ingredients.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Local anesthetic active ingredients. 346.10 Section 346.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... § 346.10 Local anesthetic active ingredients. The active ingredient of the product consists of any...

  14. Effect of Local and General Anesthetics on Interfacial Water

    PubMed Central

    2016-01-01

    Background Water undergoes structural change as it interfaces with hydrophilic surfaces, including the many hydrophilic surfaces within the cell. This interfacial water has become known as “Exclusion Zone (EZ) water” or “fourth-phase water” [1]. Methods We tested the hypothesis that anesthetics diminish the amount of EZ water, and that this change may correlate with functional changes in anesthesia. By using the local anesthetics Lidocaine and Bupivacaine as well as a general inhalational anesthetic, Isoflurane, we tracked the EZ size as these anesthetics were introduced. Results All three anesthetics diminished EZ size in a concentration-dependent manner at concentrations of 0.18 mM and greater for Bupivacaine, 0.85 mM and greater for Lidocaine, and 0.2% for Isoflurane. At extremely low (micromolar) concentrations, however, all three anesthetics increased EZ size. Conclusions The sharp increase of EZ size associated with micromolar anesthetic concentrations follows a similar pattern to induction of general anesthesia, from the excitation stage (Stage II) to the depression and overdose stages of surgical anesthesia (Stages III and IV). The results are consistent with the hypothesis that anesthetics may act on water, a fundamental organizational component common to all cells. PMID:27054588

  15. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES HAZARDOUS..., drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

  16. 46 CFR 147.105 - Anesthetics, drugs, and medicines.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES HAZARDOUS..., drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Anesthetics, drugs, and medicines. 147.105 Section 147.105 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES HAZARDOUS..., drugs, and medicines. Anesthetics, drugs, and medicines must be stowed and dispensed in accordance...

  18. PROSPECTIVE RANDOMIZED STUDY COMPARING TWO ANESTHETIC METHODS FOR SHOULDER SURGERY

    PubMed Central

    Ikemoto, Roberto Yukio; Murachovsky, Joel; Prata Nascimento, Luis Gustavo; Bueno, Rogerio Serpone; Oliveira Almeida, Luiz Henrique; Strose, Eric; de Mello, Sérgio Cabral; Saletti, Deise

    2015-01-01

    Objective: To evaluate the efficacy of suprascapular nerve block in combination with infusion of anesthetic into the subacromial space, compared with interscalene block. Methods: Forty-five patients with small or medium-sized isolated supraspinatus tendon lesions who underwent arthroscopic repair were prospectively and comparatively evaluated through random assignation to three groups of 15, each with a different combination of anesthetic methods. The efficacy of postoperative analgesia was measured using the visual analogue scale for pain and the analgesic, anti-inflammatory and opioid drug consumption. Inhalation anesthetic consumption during surgery was also compared between the groups. Results: The statistical analysis did not find any statistically significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. Conclusion: Suprascapular nerve block with infusion of anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals in which an electrical nerve stimulating device is unavailable. PMID:27022569

  19. Focused suggestion with somatic anchoring technique: rapid self-hypnosis for pain management.

    PubMed

    Donatone, Brooke

    2013-04-01

    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

  20. Management strategy evaluation of pheromone-baited trapping techniques to improve management of invasive sea lamprey

    USGS Publications Warehouse

    Dawson, Heather; Jones, Michael L.; Irwin, Brian J.; Johnson, Nicholas; Wagner, Michael C.; Szymanski, Melissa

    2016-01-01

    We applied a management strategy evaluation (MSE) model to examine the potential cost-effectiveness of using pheromone-baited trapping along with conventional lampricide treatment to manage invasive sea lamprey. Four pheromone-baited trapping strategies were modeled: (1) stream activation wherein pheromone was applied to existing traps to achieve 10−12 mol/L in-stream concentration, (2) stream activation plus two additional traps downstream with pheromone applied at 2.5 mg/hr (reverse-intercept approach), (3) trap activation wherein pheromone was applied at 10 mg/hr to existing traps, and (4) trap activation and reverse-intercept approach. Each new strategy was applied, with remaining funds applied to conventional lampricide control. Simulating deployment of these hybrid strategies on fourteen Lake Michigan streams resulted in increases of 17 and 11% (strategies 1 and 2) and decreases of 4 and 7% (strategies 3 and 4) of the lakewide mean abundance of adult sea lamprey relative to status quo. MSE revealed performance targets for trap efficacy to guide additional research because results indicate that combining lampricides and high efficacy trapping technologies can reduce sea lamprey abundance on average without increasing control costs.

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

    PubMed Central

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

    2013-01-01

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

  2. A Review of Current Analgesic Techniques in Cardiac Surgery. Is Epidural Worth it?

    PubMed Central

    Ziyaeifard, Mohsen; Azarfarin, Rasoul; Golzari, Samad EJ

    2014-01-01

    In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers. PMID:25320659

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

    NASA Technical Reports Server (NTRS)

    Raiman, Laura B.

    1992-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Raiman, Laura B.

    1992-12-01

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

  5. Anesthetic implications of subxiphoid coronary artery bypass surgery

    PubMed Central

    Chakravarthy, Murali; Veerappa, Muralimanohar; Jawali, Vivek; Pandya, Nischal; Krishnamoorthy, Jayaprakash; Muniraju, Geetha; George, Antony; Baishya, Jitumoni

    2016-01-01

    Background: Minimal invasive surgeries are carried out to benefit the patient with less pain, blood loss, mechanical ventilation and hospital stay; a smaller scar is not the aim. Minimal invasive cardiac surgeries are carried out via small sternotomy, small thoracotomy and via robotic arms. Subxiphoid route is a novel method and avoids sternotomy. Aim: This case series is an attempt to understand the anesthetic modifications required. Secondly, whether it is feasible to carry out subxiphoid coronary artery bypass surgery. Methods: Elective patients scheduled to undergo subxiphoid coronary artery bypass surgery were chosen. The surgeries were conducted under general anesthesia with left lung isolation via either endobronchial tube or bronchial blocker. Results: We conducted ten (seven males and 3 females) coronary artery bypass graft surgeries via subxiphoid technique. The mean EuroSCORE was 1.7 and the mean ejection fraction was 53.6. Eight patients underwent surgery via endobronchial tube, while, in the remaining two lung isolation was obtained using bronchial blocker. Mean blood loss intraoperatively was 300 ± 42 ml and postoperatively 2000 ± 95 ml. The pain score on the postoperative day ‘0’ was 4.3 ± 0.6 and 2.3 ± 0.7 on the day of discharge. Length of stay in the hospital was 4.8 ± 0.9 days. There were no complications, blood transfusions, conversion to cardiopulmonary bypass. The modifications in the anesthetic and surgical techniques are, use of left lung isolation using either endobronchial tube or bronchial blocker, increased duration for conduit harvesting, grafting, requirement of transesophageal echocardiography monitoring in addition to hemodynamic monitoring. Other minor requirements are transcutaneous pacing and defibrillator pads, a wedge under the chest to ‘lift’ up the chest, sparing right femoral artery and vein (to serve as vascular access) for an unlikely event of conversion to cardiopulmonary bypass. Any anesthesiologist wishing

  6. Renal effects of methoxyverapamil in anesthetized rats.

    PubMed

    Brown, B; Churchill, P

    1983-05-01

    The purpose of these experiments was to determine the renal effects of methoxyverapamil (D-600). Three groups of rats were anesthetized with sodium pentobarbital and given 0, 0.85 or 1.69 nmol/min of methoxyverapamil i.v. Increases in urine flow and Na, K and Ca excretory rates occurred, in an apparently dose-dependent manner. Plasma Na and arterial renin concentration decreased at both doses and, at the higher dose, mean arterial blood pressure and effective renal plasma flow decreased while plasma K increased. Plasma Ca, glomerular filtration rate, filtration fraction and total renal plasma flow were not affected. The findings that methoxyverapamil increased urine flow and electrolyte excretion without changing glomerular filtration rate are consistent with the hypothesis that methoxyverapamil acts directly on tubular reabsorptive mechanisms. These effects, and the effect on plasma renin concentration, could contribute to the beneficial effects of this and other Ca entry antagonists in the treatment of hypertension.

  7. Guidelines for the use of local anesthetics in the dental treatment of patients who are susceptible to malignant hyperthermia.

    PubMed

    D'Ambrosio, J; Adragna, M G

    1988-01-01

    There is controversy regarding the safe use of local anesthetics in patients who are susceptible to malignant hyperthermia undergoing dental treatment. This article reviews the literature for reports of malignant hyperthermia reactions under local and general anesthesia, and suggests a protocol for the management of these patients in the dental office. PMID:2978768

  8. Developing nondestructive techniques for managing conflicts between fisheries and double-crested cormorant colonies

    USGS Publications Warehouse

    Suzuki, Yasuko; Roby, Daniel D.; Lyons, Donald E.; Courtot, Karen; Collis, Ken

    2015-01-01

    Double-crested cormorants (Phalacrocorax auritus) have been identified as the source of significant mortality to juvenile salmonids (Oncorhynchus spp.) in the Columbia River Basin. Management plans for reducing the size of a large colony on East Sand Island (OR, USA) in the Columbia River estuary are currently being developed. We evaluated habitat enhancement and social attraction as nondestructive techniques for managing cormorant nesting colonies during 2004–2007. We tested these techniques on unoccupied plots adjacent to the East Sand Island cormorant colony. Cormorants quickly colonized these plots and successfully raised young. Cormorants also were attracted to nest and raised young on similar plots at 2 islands approximately 25 km from East Sand Island; 1 island had a history of successful cormorant nesting whereas the other was a site where cormorants had previously nested unsuccessfully. On a third island with no history of cormorant nesting or nesting attempts, these techniques were unsuccessful at attracting cormorants to nest. Our results suggest that some important factors influencing attraction of nesting cormorants using these techniques include history of cormorant nesting, disturbance, and presence of breeding cormorants nearby. These techniques may be effective in redistributing nesting cormorants away from areas where fish stocks of conservation concern are susceptible to predation, especially if sites with a recent history of cormorant nesting are available within their foraging or dispersal range. Published 2015. Wiley Periodicals, Inc. This article is a US Government work and, as such, is in the public domain in the United States of America.

  9. Cardiovascular effects of esmolol in anesthetized humans.

    PubMed

    Menkhaus, P G; Reves, J G; Kissin, I; Alvis, J M; Govier, A V; Samuelson, P N; Lell, W A; Henling, C E; Bradley, E

    1985-03-01

    We studied the cardiovascular effects of esmolol, a newly synthesized beta-adrenocepter antagonist, in anesthetized humans. Forty patients (four groups of 10 each) with ischemic heart disease and normal ventricular function were anesthetized with diazepam, pancuronium, and N2O in O2. Esmolol was given by continuous infusion in cumulative doses of 1100 micrograms/kg (group 1), 2000 micrograms/kg (group 2), and 2700 micrograms/kg (group 3); a control group received no esmolol. Infusion of esmolol was begun 3 min prior to and ended 4 min after tracheal intubation. All three doses of esmolol significantly (P less than 0.001) attenuated the heart rate responses to intubation. Rate-pressure products were significantly (P less than 0.001) lower in esmolol-treated patients than in controls after intubation, but ST-segment changes compatible with ischemia occurred in one patient in each group. Increases in heart rate were associated with significant increases in plasma norepinephrine levels (r = 0.45, P = 0.02) in the control group, but not in esmolol-treated patients, a demonstration that esmolol antagonizes the beta-adrenergic effects of norepinephrine. The effect of esmolol on heart rate was absent 5 min after cessation of infusion, and plasma levels of esmolol were undetectable in 26 of 30 treated patients 15 min after the termination of esmolol infusion. Esmolol has a rapid onset and short duration of effect. It can be used safely during anesthesia in patients with normal ventricular function to attenuate cardiac response to sympathetic stimulation. PMID:2858169

  10. Advanced techniques in IR thermography as a tool for the pest management professional

    NASA Astrophysics Data System (ADS)

    Grossman, Jon L.

    2006-04-01

    Within the past five years, the Pest Management industry has become aware that IR thermography can aid in the detection of pest infestations and locate other conditions that are within the purview of the industry. This paper will review the applications that can be utilized by the pest management professional and discuss the advanced techniques that may be required in conjunction with thermal imaging to locate insect and other pest infestations, moisture within structures, the verification of data and the special challenges associated with the inspection process.

  11. A modified technique for the laparoscopic management of large gastric bezoars

    PubMed Central

    Ulukent, Suat C.; Ozgun, Yigit M.; Sahbaz, Nuri A.

    2016-01-01

    Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal. PMID:27570860

  12. Novel Matricing Technique for Management of Fractured Cusp Conundrum – A Clinician’s Corner

    PubMed Central

    Mittal, Priya Ramesh

    2016-01-01

    Longitudinal tooth fracture can be classified as craze lines, fractured cusp, cracked tooth, split tooth and vertical root fracture based on extent and severity of the fracture line. The most common type of longitudinal tooth fracture is fractured cusp that poses the treatment dilemma. Retention of the fractured cusp segment temporarily with matrix band followed by permanent bonded restoration and finally removal of tooth fragment during crown preparation is a novel technique. This paper throws light on a matricing and holding technique for the management of supra-crestally fractured palatal cusp of maxillary first premolar in a 29-year-old Asian male. PMID:27190970

  13. A modified technique for the laparoscopic management of large gastric bezoars.

    PubMed

    Ulukent, Suat C; Ozgun, Yigit M; Şahbaz, Nuri A

    2016-09-01

    Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal. PMID:27570860

  14. Management of First Branchial Cleft Anomalies via a Cartilage-Splitting Technique.

    PubMed

    Schmidt, Richard; Conrad, David; Field, Erin; O'Reilly, Robert

    2015-06-01

    First branchial cleft anomalies are uncommon lesions that often present as periauricular infections. They have high recurrence rates, due in part to scarring secondary to prior infections and their management. These lesions have a close relationship with the facial nerve, and most authors recommend its identification and dissection because of this relationship. Nonetheless, facial nerve palsy has been reported in up to 15% of cases. We describe a novel technique for the management of first branchial cleft anomalies. Such lesions that presented in an infra- or postauricular location were approached via an incision through the cartilage of the pinna, between the tragus and antitragus. This technique affords direct access to the lesion without the need for facial nerve dissection. Six patients were treated. Five had prior surgery, including 3 with previous attempts at excision. There were no complications. The median follow-up was 35 months. One patient developed a recurrence.

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

    PubMed Central

    Srivastava, Divya; Dhiraaj, Sanjay

    2013-01-01

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

  16. Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants

    PubMed Central

    Brown, Mitchell H.; Hedén, Per; Luan, Jie; Munhoz, Alexandre Mendonça; Carter, Mollie

    2015-01-01

    Background: Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410. Results: Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively. Conclusions: The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeon’s experience, will contribute to optimal clinical outcomes with Natrelle 410. PMID:26893982

  17. Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques.

    PubMed

    Karachalios, Theofilos; Koutalos, Antonios; Komnos, George

    2014-01-01

    Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. The nature of the disease is heterogeneous and for satisfactory management one has to weigh factors related to pathogen, host, local soft tissue, bone stock, surgeon experience and financial resources. Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.

  18. Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis

    PubMed Central

    Jebaraj, B; Khanna, P; Baidya, DK; Maitra, S

    2016-01-01

    Background: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. Materials and Methods: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis. PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration (CENTRAL) databases were searched for eligible controlled trials using the following search words: “Epidural”, “dexamethasone”, and “postoperative pain”, until February 20, 2015. Results: Data from five randomized control trials have been included in this meta-analysis. Epidural dexamethasone significantly decreased postoperative morphine consumption (mean difference −7.89 mg; 95% confidence interval [CI]: −11.66 to −3.71) and number of patients required postoperative rescue analgesic boluses (risk ratio: 0.51; 95% CI: 0.41-0.63). Conclusion: The present data shows that the addition of dexamethasone to local anesthetic in epidural is beneficial for postoperative pain management. PMID:27375389

  19. [Anesthetic considerations in laparoscopy for removal of a kidney from a live donor].

    PubMed

    Monsma, M; Gómez, G; Vidal, A; Vera, C D; Barberá, M

    2010-05-01

    Kidney transplantation is the main therapeutic alternative for patients with end-stage renal failure. However, the main constraint at present is the lack of available organs. Removal of a kidney from a live donor is a better option than conventional transplantation of a cadaver-donated organ. Among the advantages are a shorter waiting time for the organ recipient and greater assurance of graft quality and survival. The postoperative conditions made possible by laparoscopic surgery have encouraged the donation of tissues by live donors. Anesthetic treatment for patients undergoing laparoscopic surgery must be based on an understanding of the pathophysiologic changes that occur in this type of procedure so that complications can be prevented. This review provides an update of progress in laparoscopic surgery and the repercussions of anesthetic management, particularly with respect to anesthesia for kidney donors. PMID:20527345

  20. Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques

    PubMed Central

    Asai, Kengo; Zaydfudim, Victor; Truty, Mark; Reid-Lombardo, KMarie; Kendrick, Michael; Que, Florencia; Nagorney, David; Andrews, James; Farnell, Michael

    2015-01-01

    Background A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed. Methods Between 2002–2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem. PMID:26235930

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

    PubMed

    Akyuz, Gulseren; Kenis, Ozge

    2014-03-01

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

  2. Can anesthetic treatment worsen outcome in status epilepticus?

    PubMed

    Sutter, Raoul; Kaplan, Peter W

    2015-08-01

    Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. Although the rationale for the use of anesthetic drugs in patients with treatment-refractory status epilepticus seems clear, the recommendation of their use in treating status epilepticus is based on expert opinions rather than on strong evidence. Randomized trials in this context are lacking, and recent studies provide disturbing results, as the administration of anesthetics was associated with poor outcome independent of possible confounders. This calls for caution in the straightforward use of anesthetics in treating status epilepticus. However, there are still more questions than answers, and current evidence for the adverse effects of anesthetic drugs in patients with status epilepticus remains too limited to advocate a change of treatment algorithms. In this overview, the rationale and the conflicting clinical implications of anesthetic drugs in patients with treatment-refractory status epilepticus are discussed, and remaining questions are elaborated. This article is part of a Special Issue entitled "Status Epilepticus".

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

    PubMed

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

    2013-11-01

    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.

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

    NASA Technical Reports Server (NTRS)

    Saha, Bhaskar; Goebel, kai

    2007-01-01

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

  5. Innovative techniques for estimating illegal activities in a human-wildlife-management conflict.

    PubMed

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

    2013-01-01

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

  6. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report

    PubMed Central

    Kumaresan, Ramesh; Mohammed, Faraz; Thapasum Fairozekhan, Arishiya

    2013-01-01

    ABSTRACT Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204. PMID:25206223

  7. A novel technique for the management of blandin-nuhn mucocele: a case report.

    PubMed

    Kumaresan, Ramesh; Karthikeyan, Priyadarshini; Mohammed, Faraz; Thapasum Fairozekhan, Arishiya

    2013-09-01

    Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204.

  8. A novel technique for the management of blandin-nuhn mucocele: a case report.

    PubMed

    Kumaresan, Ramesh; Karthikeyan, Priyadarshini; Mohammed, Faraz; Thapasum Fairozekhan, Arishiya

    2013-09-01

    Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204. PMID:25206223

  9. Remote sensing techniques for conservation and management of natural vegetation ecosystems

    NASA Technical Reports Server (NTRS)

    Parada, N. D. J. (Principal Investigator); Verdesio, J. J.; Dossantos, J. R.

    1981-01-01

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

  10. Liposomal formulations of prilocaine: effect of complexation with hydroxypropyl-ß-cyclodextrin on drug anesthetic efficacy.

    PubMed

    Bragagni, Marco; Maestrelli, Francesca; Mennini, Natascia; Ghelardini, Carla; Mura, Paola

    2010-12-01

    A combined strategy, based on cyclodextrin complexation and loading in liposomes, has been investigated to develop a new delivery system with improved therapeutic activity of the local anesthetic, prilocaine (PRL). In order to evaluate the actual effectiveness and advantages of this approach compared to the traditional drug-in-liposome one, four different liposomal formulations were prepared: (1) liposomes loaded with PRL base as complex with hydroxypropyl-β-cyclodextrin (HP CD) in the aqueous phase; (2) liposomes loaded with PRL hydrochloride in the aqueous phase; (3) liposomes loaded with PRL base in the lipophilic phase; and (4) "double-loaded" liposomes, containing free PRL base in the membrane bilayer and its HP CD complex in the aqueous compartment. All batches were characterized for particle size, charge, deformability, and entrapment efficiency from using, respectively, light scattering, extrusion, and dialysis techniques, while the anesthetic effect was evaluated in vivo on Guinea pigs, according to the test of dorsal muscle contraction. All drug liposomal dispersions showed enhanced analgesic duration with respect to the corresponding aqueous solutions, but significant differences were observed between the different formulations. In particular, cyclodextrin complexation not only allowed an efficient encapsulation of PRL base in the aqueous vesicle core, but also increased the anesthetic effect duration and reduced the initial lag time, in comparison with the corresponding formulations containing, respectively, free PRL in the lipophilic phase or PRL hydrochloride in the aqueous vesicle core. The technique of double loading was the most effective, giving rise to the shortest onset time and longest duration of anesthetic effect.

  11. In vivo comparison of the reinforcing and dopamine transporter effects of local anesthetics in rhesus monkeys.

    PubMed

    Wilcox, Kristin M; Kimmel, Heather L; Lindsey, Kimberly P; Votaw, John R; Goodman, Mark M; Howell, Leonard L

    2005-12-15

    Dopaminergic mechanisms are thought to play a central role in the reinforcing effects of cocaine. Similar to cocaine, other local anesthetics bind to the dopamine transporter (DAT) and inhibit DA uptake in rodent and monkey brain. Additionally, local anesthetics are self-administered in rhesus monkeys, indicative of abuse liability. The present study examined the reinforcing and DAT effects of the local anesthetics dimethocaine, procaine and cocaine using in vivo techniques. Monkeys were trained to respond under a second-order schedule for i.v. cocaine administration (0.10 or 0.30 mg/kg/infusion). When responding was stable, dimethocaine (0.030-1.7 mg/kg/ infusion) or procaine (0.10-10 mg/kg/ infusion) was substituted for the cocaine training dose. Dimethocaine administration produced higher response rates compared with that of procaine, and was a more potent reinforcer. Drug effects on behavior were related to DAT occupancy in monkey striatum during neuroimaging with positron emission tomography (PET). DAT occupancy was determined by displacement of 8-(2-[(18)F]fluroethyl)2beta-carbomethoxy-3beta-(4-chlorophenyl)nortropane (FECNT). DAT occupancy was between 66 and 82% and <10-41% for doses of dimethocaine and procaine that maintained maximum response rates, respectively. Finally, in vivo microdialysis in awake subjects determined drug-induced changes in extracellular DA in the caudate nucleus. There was close correspondence between peak increases in DA and DAT occupancy. Overall, reinforcing effects were consistent with DAT effects determined with in vivo techniques. The results further support a role for the DAT in the abuse liability of local anesthetics. PMID:16206183

  12. Challenges Encountered Using Ophthalmic Anesthetics in Space Medicine

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

  13. Anesthesia management in a child with osteogenesis imperfecta and epidural hemorrhage.

    PubMed

    Erdoğan, Mehmet Ali; Sanli, Mukadder; Ersoy, Mehmet Ozcan

    2013-01-01

    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 anesthetic technique 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 anesthetic management of OI patients with severe anesthetic problems. PMID:24565246

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

    PubMed

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

    2013-12-01

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

  15. Remotely sensed data assimilation technique to develop machine learning models for use in water management

    NASA Astrophysics Data System (ADS)

    Zaman, Bushra

    Increasing population and water conflicts are making water management one of the most important issues of the present world. It has become absolutely necessary to find ways to manage water more efficiently. Technological advancement has introduced various techniques for data acquisition and analysis, and these tools can be used to address some of the critical issues that challenge water resource management. This research used learning machine techniques and information acquired through remote sensing, to solve problems related to soil moisture estimation and crop identification on large spatial scales. In this dissertation, solutions were proposed in three problem areas that can be important in the decision making process related to water management in irrigated systems. A data assimilation technique was used to build a learning machine model that generated soil moisture estimates commensurate with the scale of the data. The research was taken further by developing a multivariate machine learning algorithm to predict root zone soil moisture both in space and time. Further, a model was developed for supervised classification of multi-spectral reflectance data using a multi-class machine learning algorithm. The procedure was designed for classifying crops but the model is data dependent and can be used with other datasets and hence can be applied to other landcover classification problems. The dissertation compared the performance of relevance vector and the support vector machines in estimating soil moisture. A multivariate relevance vector machine algorithm was tested in the spatio-temporal prediction of soil moisture, and the multi-class relevance vector machine model was used for classifying different crop types. It was concluded that the classification scheme may uncover important data patterns contributing greatly to knowledge bases, and to scientific and medical research. The results for the soil moisture models would give a rough idea to farmers

  16. Local anesthetics, pulpal blood flow and C. Edmund Kells.

    PubMed

    Gutmann, James L

    2011-01-01

    Historically there was an attempt by many dental practitioners to implicate anesthetic solutions in the death of the dental pulp. However, their implications may or may not have been valid, as damage to the dental pulp may have resulted from excessive and deleterious restorative procedures on teeth that were anesthetized. Unfortunately little was known about the anesthetic solutions at that time, their composition, which included vasoconstrictors, and their potential to alter pulpal blood flow. This paper will explore both the historical perspectives and concerns regarding the impact of anesthetic solutions on the dental pulp through the eyes of Dr. C. Edmund Kells, along with the contemporary perspectives and realities through the eyes of science, sound research data and clinical practice.

  17. [Introduces a novel scavenger for waste anesthetic gas].

    PubMed

    Hu, Yan-dong; Liang, Jin-bing; Song, Jin-hua

    2009-01-01

    This article introduces a novel scavenger for waste anesthetic gas which makes use of negative pressure in operating room. This setting can scavenge the exhaust gas absolutely without affection the normal work of anaesthesia.

  18. Top-down mechanisms of anesthetic-induced unconsciousness

    PubMed Central

    Mashour, George A.

    2014-01-01

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

  19. Failure detection and fault management techniques for flush airdata sensing systems

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

  20. The use of meditation--relaxation techniques for the management of stress in a working population.

    PubMed

    Carrington, P; Collings, G H; Benson, H; Robinson, H; Wood, L W; Lehrer, P M; Woolfolk, R L; Cole, J W

    1980-04-01

    The efficacy of meditation-relaxation techniques has been widely researched in the laboratory, but their effectiveness for management of stress in organizational settings is still relatively unexplored. The present study compared relaxation and control conditions as part of a program of stress-reduction in industry. A total of 154 New York Telephone employees self-selected for stress learned one of three techniques--clinically standardized meditation (CSM), respiratory one method meditation (ROM) or progressive relaxation (PMR)--or served as waiting list controls. At 5.5 months, the treatment groups showed clinical improvement in self-reported symptoms of stress, but only the meditation groups (not the PMR group) showed significantly more symptom reduction than the controls. The meditation groups had a 78% compliance rate at 5.5 months with treatment effect seen whether subjects practiced their techniques frequently or occasionally. The safe and inexpensive semi-automated meditation training has considerable value for stress-management programs in organizational settings.

  1. The state of the art in clinical knowledge management: An inventory of tools and techniques

    PubMed Central

    Sittig, Dean F.; Wright, Adam; Simonaitis, Linas; Carpenter, James D.; Allen, George O.; Doebbeling, Bradley N.; Sirajuddin, Anwar Mohammad; Ash, Joan S.; Middleton, Blackford

    2009-01-01

    Purpose To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support content. Methods In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM. Results The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and clinical decision support (CDS) implementations: 1) A multidisciplinary team responsible for creating and maintaining the clinical content; 2) An external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it; 3) An online, collaborative, interactive, internet-based tool to facilitate content development; 4) An enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using Computer-based Provider Order Entry with advanced Clinical Decision Support features for well over 15 years are not using all of the CKM tools or practices that we identified. Conclusions If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities. PMID:19828364

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

    SciTech Connect

    Mosier, J.E.; Fowler, J.R.; Barton, C.J.

    1980-04-01

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

  3. Comparative efficacy of 16 anesthetic chemicals on rainbow trout

    USGS Publications Warehouse

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

    1987-01-01

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

  4. Effects of anesthetic compounds on responses of earthworms to electrostimulation.

    PubMed

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

    2014-01-01

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

  5. Topical Ocular Anesthetic Abuse Among Iranian Welders: Time for Action

    PubMed Central

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

    2013-01-01

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

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

    SciTech Connect

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

    1986-02-01

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

  7. Effects of topical anesthetic and flexible fiberoptic laryngoscopy on professional sopranos.

    PubMed

    Jacobs, Margaret A; Kenny, Dianna T

    2005-12-01

    This study examined the acoustic and perceptual effects of topical anesthetic and flexible fiberoptic laryngoscopy (FFL) against a control condition on the singing voices of ten professional sopranos. Recordings of a section of an aria, various scales, and a messa di voce exercise were obtained in the three experimental conditions. Acoustic analyses of the same aria section recorded during the three conditions were similar with respect to the distribution of energy across the spectrum (LTAS) and vibrato rate and extent. The ability of the participants to achieve their highest and lowest notes or to complete the messa di voce was also not affected by the anesthetic or FFL. Perceptual ratings of a variety of parameters by experienced singing teachers also revealed little difference across conditions with only "appropriate velopharyngeal closure" found to differ in one comparison. These results indicate that highly experienced operatic sopranos are either not affected by or appear to have the ability to compensate for the presence of anesthetic and the FFL. The most likely explanation is that this group of singers relied on a solid vocal technique. Results will need to be replicated on less accomplished singers before concluding that this medical procedure does not affect the operatic singing voice. PMID:16301108

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

    PubMed

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

    2014-03-01

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

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

    PubMed

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

    2014-03-01

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

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

    USGS Publications Warehouse

    McGuinness, Charles Lee

    1969-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    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.

  12. Stereotactic radiosurgery in the management of vestibular schwannoma and glomus jugulare: indications, techniques, and results.

    PubMed

    Jacob, Jeffrey T; Pollock, Bruce E; Carlson, Matthew L; Driscoll, Colin L W; Link, Michael J

    2015-06-01

    Gamma Knife stereotactic radiosurgery (GKS) has become an important management strategy for an increasing number of patients with skull base tumors. For select patients with lateral skull base disorders, given the proximity to sensitive critical structures such as the brainstem, cranial nerves, and cochlea, this technology has emerged as a first-line treatment to achieve the paramount goals of long-term tumor control and maintenance of existing neurologic function. This article reviews the indications, technique, and results of GKS for the treatment of vestibular schwannoma and glomus jugulare tumors, and highlights our experience in treating these tumors at the Mayo Clinic. PMID:25873444

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-03-23

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

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

    PubMed

    Delitala, G

    2000-01-01

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

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

    PubMed Central

    Hains, Guy

    2002-01-01

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

  17. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

    PubMed Central

    Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan

    2016-01-01

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks. PMID:27134524

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

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

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

    PubMed

    Delitala, G

    2000-01-01

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

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

    USGS Publications Warehouse

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

    2003-01-01

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

  1. Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade

    PubMed Central

    Serrera Figallo, María A.; Velázquez Cayón, Rocío T.; Corcuera Flores, Jose R.; Machuca Portillo, Guillermo

    2012-01-01

    Objective: The use of local anesthetics associated to vasoconstrictor agents in dentistry is thoroughly justified and is widely extended, but we cannot ignore the fact that anesthetic infiltration poses risk of complications throughout the dental treatment period. The objective of the present review is to document the reported effects the use of the local anesthetics most widely employed in dentistry, with or without association to vasoconstrictor agents may have in patients with any sort of cardiopathy. Study Design: We have searched for randomized clinical trials on the assessment of the cardiovascular effects of local anesthetics used in dentistry, without limits as regards age or sex, conducted in patients with any type of cardiopathy which were published during the last decade and were index-linked in Cochrane, Embase and Medline. Results: We have found six randomized clinical trials index-linked in Medline and Cochrane in the past ten years. These trials compare different types of anesthetics: lidocaine 2%, mepivacaine 2%, prilocaine 2% , associated or not to different vasoconstrictor concentrations such as adrenaline or felypressin. The cardiopathies affecting the patients included in the different trials range from hypertension, ischemic heart disease, arrythmias, chronic coronary disease to heart transplantation. Conclusions: The use of anesthetics associated to vasoconstrictor agents is justified in the case of patients with cardiopathies (once we get over the period in which any type of dental manipulation is contraindicated) and in controlled hypertensive patients. In any case, we must be very careful with the choice and execution of the anesthetic technique, being it possible to use a dose between 1.8 and 3.6 ml, on a general basis. Further studies are necessary to establish the effects of these drugs on severe hypertensive patients or in patients with other more advanced cardiopathies. Key words:Vasoconstrictor agents, epinephrine/adverse effects

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

    PubMed

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

    2012-02-29

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

  3. Effective behaviour change techniques in the prevention and management of childhood obesity.

    PubMed

    Martin, J; Chater, A; Lorencatto, F

    2013-10-01

    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

  4. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    PubMed Central

    Gadsden, Jeffrey; Ayad, Sabry; Gonzales, Jeffrey J; Mehta, Jaideep; Boublik, Jan; Hutchins, Jacob

    2015-01-01

    Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site. PMID:26677342

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  6. Vertical expandable prosthetic titanium rib (VEPTR): indications, technique, and management review.

    PubMed

    Shah, Shailja C; Birknes, John K; Sagoo, Sukh; Thome, Shelby; Samdani, Amer F

    2009-04-01

    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

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

    PubMed

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

    2014-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

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

    PubMed

    Shuker, Sabri T

    2013-07-01

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

  10. Transpalatal screw traction: a simple technique for the management of sagittal fractures of the maxilla and palate.

    PubMed

    Ma, D; Guo, X; Yao, H; Chen, J

    2014-12-01

    Sagittal fractures of the maxilla and palate are uncommon in clinical practice. Current methods for the management of such fractures have advantages and limitations. The authors present the simple and practical technique of bilateral transpalatal screw traction to manage this fracture type.

  11. Stream segregation in the anesthetized auditory cortex

    PubMed Central

    Scholes, Chris; Palmer, Alan R.; Sumner, Christian J.

    2015-01-01

    Auditory stream segregation describes the way that sounds are perceptually segregated into groups or streams on the basis of perceptual attributes such as pitch or spectral content. For sequences of pure tones, segregation depends on the tones' proximity in frequency and time. In the auditory cortex (and elsewhere) responses to sequences of tones are dependent on stimulus conditions in a similar way to the perception of these stimuli. However, although highly dependent on stimulus conditions, perception is also clearly influenced by factors unrelated to the stimulus, such as attention. Exactly how ‘bottom-up’ sensory processes and non-sensory ‘top-down’ influences interact is still not clear. Here, we recorded responses to alternating tones (ABAB …) of varying frequency difference (FD) and rate of presentation (PR) in the auditory cortex of anesthetized guinea-pigs. These data complement previous studies, in that top-down processing resulting from conscious perception should be absent or at least considerably attenuated. Under anesthesia, the responses of cortical neurons to the tone sequences adapted rapidly, in a manner sensitive to both the FD and PR of the sequences. While the responses to tones at frequencies more distant from neuron best frequencies (BFs) decreased as the FD increased, the responses to tones near to BF increased, consistent with a release from adaptation, or forward suppression. Increases in PR resulted in reductions in responses to all tones, but the reduction was greater for tones further from BF. Although asymptotically adapted responses to tones showed behavior that was qualitatively consistent with perceptual stream segregation, responses reached asymptote within 2 s, and responses to all tones were very weak at high PRs (>12 tones per second). A signal-detection model, driven by the cortical population response, made decisions that were dependent on both FD and PR in ways consistent with perceptual stream segregation. This

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  15. Effects of Anesthetic Agent Propofol on Postoperative Sex Hormone Levels

    PubMed Central

    Kim, H.; Ku, S.-Y.; Kim, H. C.; Suh, C. S.; Kim, S. H.; Choi, Y. M.

    2016-01-01

    Introduction: Several studies have found anesthetic agents including propofol in ovarian follicular fluid. However, little is known about the effect of anesthetic agents on ovarian function. We aimed to investigate whether there were differences in the postoperative levels of sex hormones when propofol was used as the anesthetic agent. Methods: A retrospective review was done of 80 patients who underwent ovarian surgery, with 72 infertile women serving as controls. Patients were included in the study if their serum estradiol (E2) and follicle stimulating hormone (FSH) levels were measured during their first postoperative menstrual cycle. Results: Patients were grouped according to the use or non-use of propofol as follows: propofol group (n = 39) and non-propofol group (n = 41). The control group did not undergo surgery. Postoperative E2 levels did not differ between the three groups, but FSH levels were significantly higher in the patients who had undergone surgery compared to controls (p < 0.05). Post-hoc analysis of E2 and FSH levels in the propofol and non-propofol groups did not show any significant differences. Conclusions: The use of propofol did not result in any differences compared to other anesthetic agents in terms of postoperative sex hormone levels after gynecologic surgery. The type of anesthetic agent does not seem to affect the postoperative levels of female sex hormones. PMID:27134297

  16. [Experimental studies on the recovery of anesthetic gases].

    PubMed

    Marx, T; Gross-Alltag, F; Ermisch, J; Hähnel, J; Weber, L; Friesdorf, W

    1992-02-01

    The volatile anesthetic agents halothane, enflurane, and isoflurane are chlorofluorocarbons (CFC) and contribute to ozone depletion. Although the contribution is small, its importance is rising, as technical CFCs will be phased out according to the Montreal protocol (1987) and the London conference (1990) by the year 2000. Alternative procedures and CFC-free volatile agents such as des- and sevoflurane do not contribute to depletion of the ozone layer, but will not replace standard methods using volatile anesthetic agents in the near future. METHODS. In an experimental setup, we filtered anesthetic waste gases from scavenging systems of rebreathing circles by activated carbon filters. The filtered substances were desorbed by a heat chamber and condensed in a cold trap. RESULTS. By this method, it was possible to retrieve 50%-60% of the applied gases. Gas chromatographic analysis showed halothane containing traces of pollutants and isoflurane and enflurane as pure substances. DISCUSSION. The retrieval of anesthetic waste gases is easy; no sophisticated technical equipment is necessary. Purity of substances could make recycling possible and offer a method to avoid environmental pollution by volatile anesthetics.

  17. Effects of adenosine triphosphate (ATP) on somatosensory evoked potentials in humans anesthetized with isoflurane and nitrous oxide.

    PubMed

    Andoh, T; Ohtsuka, T; Okazaki, K; Okutsu, Y; Okumura, F

    1993-08-01

    In order to examine the usefulness of adenosine triphosphate (ATP) as an adjuvant to anesthesia for surgery requiring intraoperative somatosensory evoked potential (SSEP) monitoring, we have studied the effects of ATP on SSEPs in patients anesthetized with isoflurane and nitrous oxide (N2O). A control recording of SSEP was performed while anesthesia was maintained with 0.5% end-tidal concentration of isoflurane in 60% N2O. The recordings were repeated after an ATP infusion had been added to this basal anesthesia at the rates of 100 micrograms.kg bw-1.min-1 and 200 micrograms.kg bw-1.min-1. SSEP was also studied when end-tidal isoflurane concentration was increased to 1.5% after cessation of ATP infusion. An infusion of ATP combined with 0.5% isoflurane and 60% N2O effectively inhibited an increase in blood pressure during surgery. The amplitude of the cortical component of SSEP was lowered by 1.5% isoflurane, which also increased both cortical and spinal latencies as well as central conduction time (CCT). In contrast ATP infusions at both rates induced no significant changes in latencies, amplitude and CCT. The results indicate that ATP infusion combined with 0.5% isoflurane in 60% N2O can be a useful anesthetic technique for intraoperative SSEP monitoring because adequate anesthetic depth can be maintained by a low concentration of anesthetics without further suppression of SSEPs. PMID:8213025

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

    PubMed Central

    Peñarrocha-Diago, María; Maestre-Ferrín, Laura; Peñarrocha-Oltra, David; von Arx, Thomas

    2013-01-01

    Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl™). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05). Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant. Key words:Aluminum chloride, bleeding control, hemostasis, periapical surgery, outcome. PMID:23229242

  19. [Anesthetic management of a patient with metatropic dysplasia].

    PubMed

    Suzuki, Marie; Niiyama, Yukitoshi; Nawa, Yuko; Yamakage, Michiaki

    2013-02-01

    A 5-year-old girl with metatropic dysplasia was scheduled for an operation of posterior cervical fusion. This disease is a rare skeletal dysplasia characterized by long trunk and short limbs and severe scoliosis. As she had been suspected to have a difficult airway, we attempted fiberoptic intubation with a nasopharyngeal airway to prevent airway obstruction. The nasopharyngeal airway ensured a patent airway sufficient oxygenation, and anesthesia. Thus, it was possible to perform a fiberoptic intubation via the opposite nostril with no adverse event. The combination of a nasopharyngeal airway and fiberoptic guided tracheal intubation is a reliable and safe procedure for small children with metatropic dysplasia and difficult airway. PMID:23479930

  20. Transesophageal echocardiography in the anesthetic management of total hip arthroplasty.

    PubMed

    Johnson, C; Lewis, K D; Steen, S N; Mok, M S; Wu, C C

    2001-09-01

    Total hip arthroplasty is a common procedure in the elderly and thromboembolism continues to be a cause of mortality and morbidity associated with this procedure. When properly diagnosed and treated the mortality rate from pulmonary embolism can be reduced significantly. Transesophageal echocardiograpic (TEE) detection of central pulmonary artery thromboemboli in patients with severe pulmonary embolism has been reported to have a sensitivity of 96.7% and a specificity of 88%. However TEE is not universally available due to its cost and expertise that is required. Taking into consideration its cost/effectiveness we suggest that in patients undergoing the cement type of total hip arthroplasty who are cardiopulmonary compromised, debilitated or elderly the use of TEE is indicated.

  1. Tranexamic Acid in Anesthetic Management of Surgical Procedures.

    PubMed

    Mayeux, Jessica; Alwon, Kathy; Collins, Shawn; Hewer, Ian

    2016-06-01

    Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements. In addition, this journal course addresses concerns that use of antifibrinolytics increases embolic events, reviews research that demonstrates TXA does not increase the incidence of vascular occlusive events, and describes methods of TXA use in cardiac and orthopedic surgical procedures, neurosurgery, and obstetrics. The Certified Registered Nurse Anesthetist should consider the possibility, on a case-by-case basis, of using TXA in surgical procedures to reduce blood loss with minimal adverse effects. PMID:27501656

  2. Management and endoscopic techniques for digestive foreign body and food bolus impaction.

    PubMed

    Chauvin, Armelle; Viala, Jerome; Marteau, Philippe; Hermann, Philippe; Dray, Xavier

    2013-07-01

    Ingested foreign bodies, food bolus impaction, migration or retention of medical devices are frequent, in children as well as in adults. Most of these foreign bodies will naturally pass through the gastro-intestinal tract. Complications are rare but sometimes severe (oesophageal perforations are the most frequent and most feared). We aimed to review the literature on therapeutic management of digestive foreign bodies and food bolus impaction, with special focus on endoscopic indications, material, timing and techniques for removal. The role of the gastroenterologist is to recognise specific situations and to plan endoscopic removal in a timely manner with the most adequate conditions and extraction tools. Risk factors and underlying pathology, for example eosinophilic esophagitis, must be investigated and if necessary treated.

  3. A new technique of uterine suspension to pectineal ligaments in the management of uterovaginal prolapse.

    PubMed

    Joshi, V M

    1993-05-01

    The incidence of uterovaginal prolapse in young women is high in developing countries. Preservation of the uterus is of prime importance in the surgical management of these patients. A new technique of uterine suspension to the pectineal ligaments is presented as an alternative to traditional procedures. Through a Cherney incision, the uterus is suspended to the pectineal ligaments on both sides with mersilene tape. A simultaneous Burch colposuspension can be useful in selected cases. The operation has been done in 20 women, who averaged 27.5 years of age. There was no early or late morbidity during the follow-up period of 6-30 months. Of nine women desiring further childbearing, seven conceived within 6 months of surgery and thus far five have had an uneventful vaginal delivery at term; the other two have continuing normal gestations. There was no recurrence of prolapse at 6 weeks postpartum in any of the women. PMID:8469474

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

    USGS Publications Warehouse

    Bury, R.B.; Welsh, Hartwell H.; Germano, David J.; Ashton, Donald T.

    2012-01-01

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

  5. Intravenous sub-anesthetic ketamine for perioperative analgesia

    PubMed Central

    Gorlin, Andrew W; Rosenfeld, David M; Ramakrishna, Harish

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain. PMID:27275042

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

    NASA Astrophysics Data System (ADS)

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

    2013-08-01

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

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

    PubMed

    Dogan, Bugce; Kerestecioglu, Merih; Yetis, Ulku

    2010-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  9. A new technique in management of pilonidal sinus, a university teaching hospital experience.

    PubMed

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

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    1997-05-01

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

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

    PubMed

    Das, Sudeb; Kundu, Malay Kumar

    2012-10-01

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

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

    USGS Publications Warehouse

    Bergstedt, Roger A.; Twohey, Michael B.

    2005-01-01

    The parasitic sea lamprey (Petromyzon marinus) has been a serious pest since its introduction into the Great Lakes, where it contributed to severe imbalances in the fish communities by selectively removing large predators (Smith 1968; Christie 1974; Schneider et al.1996). Since the 1950s, restoration and maintenance of predator-prey balance has depended on the Great Lakes Fishery Commission (GLFC) sea lamprey management program. Initially, management relied primarily on stream treatments with a selective lampricide to kill larvae, on barriers to migration, and on trapping to remove potential spawners (Smith and Tibbles 1980). By the late 1970s, however, it was clear that the future of sea lamprey management lay in development of a larger array of control strategies, including more alternatives to lampricide applications (Sawyer 1980). Since then the only new alternative to chemical control to reach operational status is the release of sterilized male sea lampreys. Research on the concept began at the USGS, Hammond Bay Biological Station in Millersburg, MI (HBBS) during the 1970s (Hanson and Manion 1980). Development and evaluation continued through the 1980s, leading to the release of sterilized males in Great Lakes tributaries since 1991 (Twohey et al. 2003a). The objectives of this paper are 1) to review the implementation and evaluations of sterile-male-release technique (SMRT) as it is being applied against sea lampreys in the Great Lakes, 2) to review our current understanding of its efficacy, and 3) to identify additional research areas and topics that would increase either the efficacy of SMRT or expand its geographic potential for application.

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

    SciTech Connect

    Shah, Chirag; Vicini, Frank A.

    2011-11-15

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

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

    PubMed

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

    2013-01-01

    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.

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

    PubMed

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

    2013-01-01

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

  16. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity.

    PubMed

    Hahn, In-Hei; Hoffman, Robert S; Nelson, Lewis S

    2004-01-01

    This case report illustrates an adult presenting with the simultaneous occurrence of both methemoglobinemia (MetHb) and systemic toxicity from the topical application of local anesthetics while undergoing laser epilation therapy of the legs. The concurrent development of both is considered uncommon in this setting and may have been related to several factors, including her recent previous treatment, increased absorption secondary to abraded skin with the addition of occlusive dressing, and possible alteration of protein binding and drug metabolism due to the use of medications. The clinical manifestations and mechanisms of MetHb and systemic local anesthetic toxicity are discussed.

  17. General Anesthetics and Neurotoxicity: How Much Do We Know?

    PubMed

    Jevtovic-Todorovic, Vesna

    2016-09-01

    Over a decade ago, alarming findings were reported that exposure of the very young and very old animals to clinically used general anesthetics could be detrimental to their brains. The evidence presented suggested that the exposure to commonly used gaseous and intravenous general anesthetics induces the biochemical and morphologic changes in the immature and aging neurons ultimately resulting in their demise. More alarming was the demonstration of significant cognitive and behavioral impairments noted long after the initial anesthesia exposure. This article provides an overview of anesthesia-induced developmental neurotoxicity and commentary on the effects of general anesthesia on the aging brain. PMID:27521190

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

    NASA Astrophysics Data System (ADS)

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

    2015-04-01

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

  19. A Comparative Study of Lidocaine and Lidocaine­ Mannitol in Anesthetizing Human Teeth with Inflamed Pulps

    PubMed Central

    Talati, Ali; Bidar, Maryam; Sadeghi, Ghazal; Nezami, Hossein

    2006-01-01

    INTRODUCTION: Failure to achieve adequate and profound anesthesia in teeth with acute pulp inflammation is a common condition during emergency visits in root canal therapy. Many different anesthetic solutions such as morphine and capsaicin have accordingly been examined. Mannitol­ an alcoholic sugar with high osmotic pressure level- is applicated for reducing intracranial and post retinal pressure in medicine. It has also been used for its diuretic effect. In combination with local anesthetic solution, it increases permeability of the nerve fiber sheath and leads to influx of the local anesthetic through cytoplasmic membrane .The purpose of the present study was to compare the efficacy of routine local anesthesia with or without using mannitol in teeth with inflamed pulps. MATERIALS AND METHODS: one hundred patients with acute dental pain in posterior teeth were selected. Vials with 3 ml anesthetic solution containing 2.5% lidocaine with 1/80000 epinephrine or 2.5% lidocaine with 1/80000 epinephrine and 0.5 mol mannitol were used for anesthesia. For each patient, the routine injection technique was applied, during the removal of decay and dentine. Depth of anesthesia was evaluated and the supplementary injection was done in case of pain feeling and then pulpotomy was done. The analysis of data was done using chi-square statistical test. RESULTS: The results showed that complete anesthesia after the first injection was obtained with lidocaine mannitol in 46% and with lidocaine alone in 38% of cases. However, the difference was not significant. CONCLUSION: These finding suggest that the addition of mannitol to the standard anesthetic solution could insignificantly increase the level of anesthesia in teeth with inflamed pulps. PMID:24494021

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

    NASA Astrophysics Data System (ADS)

    Shao, Hui

    Micro-systems with features of tiny volume and wireless communications are developed for different applications. To prolong devices' lifetime, energy harvesting techniques which use environmental energy as the power source are proposed. Although the amount of environmental energy is theoretically infinite, it is usually unstable and the instantaneous power available is limited. To utilize the environmental energy efficiently, power management circuits have to be built to track the unstable energy status and extract maximum power from the energy transducer. In this work, we use solar energy as an example and demonstrate the design of power management circuit for micro-systems that use energy harvesting techniques. An inductor-less solar power management system was proposed and built. The system targets to operate in all lighting environments. When the light intensity is low, a charge pump is used to step up the output voltage from the photovoltaic cell. Meanwhile, charge pump switching frequency can be auto-adjusted to transfer maximum solar power to the load. Another power management circuit was proposed and designed for solar energy harvesting systems. It is based on single inductor dual-input dual-output DC-DC converter. The converter clamps photovoltaic cells to a point where maximum solar power is extracted. At the same time, it generates a stable output voltage to power the load. Also, the converter schedules energy utilization among different energy sources and consumers. The single inductor implementation can reduce the devices' volume and cost. For devices that have very stringent volume requirement, it may not be possible to have built-in battery, and the load is powered by environmental energy only. To cater for the source characteristic, power management is executed in the load side. A charge based computation methodology was proposed where the load operation is controlled by the source energy status. Moreover, a control strategy was derived to improve