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Sample records for intragastric ethanol intubation

  1. Conditioned place aversion induced by intragastric administration of ethanol in rats.

    PubMed

    Fidler, Tara L; Bakner, Lee; Cunningham, Christopher L

    2004-04-01

    Most experiments investigating ethanol-induced place conditioning in rats have produced conditioned place aversion (CPA). In one of the few reports of ethanol-induced conditioned place preference (CPP) in rats, selectively bred alcohol-preferring (msP) rats showed CPP in a biased procedure when ethanol was administered via intragastric (IG) catheter but not when ethanol was administered via intraperitoneal injection or by gavage. This finding suggests the importance of both route of administration and genetic variables to the outcome of place conditioning studies. We conducted three experiments examining place conditioning induced by IG ethanol in genetically heterogeneous rats to test the generality of the earlier finding. We employed an unbiased procedure that is more sensitive to detecting preference changes in either direction (preference or aversion). Ethanol-naive (Experiment 1) and ethanol-experienced Sprague-Dawley rats (Experiment 2) showed robust CPA. In Experiment 3, infusion rate was varied to see if the CPA observed in Experiments 1 and 2 was a result of the rapidity of the transition from the sober to the intoxicated states. Both groups showed strong CPA. Overall, the present findings are consistent with previous findings of CPA in heterogeneous rats, suggesting that the aversive postabsorptive effects of ethanol produce CPA.

  2. Postnatal ethanol exposure disrupts signal detection in adult rats.

    PubMed

    Woolfrey, Kevin M; Hunt, Pamela S; Burk, Joshua A

    2005-01-01

    Human prenatal ethanol exposure that occurs during a period of increased synaptogenesis known as the "brain growth spurt" has been associated with significant impairments in attention, learning, and memory. The present experiment assessed whether administration of ethanol during the brain growth spurt in the rat, which occurs shortly after birth, disrupts attentional performance. Rats were administered 5.25 g/kg/day ethanol via intragastric intubation from postnatal days (PD) 4-9, sham-intubation, or no intubation (naïve). Beginning at PD 90, animals were trained to asymptotic performance in a two-lever attention task that required discrimination of brief visual signals from trials with no signal presentation. Finally, manipulations of background noise and inter-trial interval duration were conducted. Early postnatal ethanol administration did not differentially affect acquisition of the attention task. However, after rats were trained to asymptotic performance levels, those previously exposed to ethanol demonstrated a deficit in detection of signals but not of non-signals compared to sham-intubated and naïve rats. The signal detection deficit persisted whenever these animals were re-trained in the standard task, but further task manipulations failed to interact with ethanol pretreatment. The present data support the hypothesis that early postnatal ethanol administration disrupts aspects of attentional processing in the rat.

  3. Awake intubation.

    PubMed

    Peiris, Kawshala; Frerk, Chris

    2008-03-01

    Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Awake intubation can be achieved via several methods. Using the fibreoptic laryngoscope is the most widely used technique in the UK with minimal patient discomfort and a wide margin of safety. When compared with attempts at difficult direct laryngoscopy, awake fibreoptic intubation provides excellent cardiovascular stability when performed under good topical anaesthesia and conscious sedation. Understanding the equipment used as well as preparing the patient and being aware of potential pitfalls are important elements to performing a successful awake intubation.

  4. Altered spatial learning and delay discounting in a rat model of human third trimester binge ethanol exposure

    PubMed Central

    Bañuelos, Cristina; Gilbert, Ryan J.; Montgomery, Karienn S.; Fincher, Annette S.; Wang, Haiying; Frye, Gerald D.; Setlow, Barry; Bizon, Jennifer L.

    2012-01-01

    Ethanol exposure during perinatal development can cause cognitive abnormalities including difficulties in learning, attention, and memory, as well as heightened impulsivity. The purpose of this study was to assess performance in spatial learning and impulsive choice tasks in rats subjected to an intragastric intubation model of binge ethanol exposure during human third trimester-equivalent brain development. Male and female Sprague–Dawley rat pups were intubated with ethanol (5.25 g/kg/day) on postnatal days 4–9. At adolescence (between postnatal days 35–38), these rats and sham intubated within-litter controls were trained in both spatial and cued versions of the Morris water maze. A subset of the male rats was subsequently tested on a delay-discounting task to assess impulsive choice. Ethanol-exposed rats were spatially impaired relative to controls, but performed comparably to controls on the cued version of the water maze. Ethanol-exposed rats also showed greater preference for large delayed rewards on the delay discounting task, but no evidence for altered reward sensitivity or perseverative behavior. These data demonstrate that early postnatal intermittent binge-like ethanol exposure has prolonged, detrimental, but selective effects on cognition, suggesting that even relatively brief ethanol exposure late in human pregnancy can be deleterious for cognitive function. PMID:22129556

  5. Endotracheal intubation

    MedlinePlus

    ... RF, McGill JW, Clinton JE. Tracheal intubation. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine . 6th ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer ...

  6. Ethanol exposure during development reduces resident aggression and testosterone in rats.

    PubMed

    Lugo, Joaquin N; Marino, Melissa D; Gass, Justin T; Wilson, Marlene A; Kelly, Sandra J

    2006-02-28

    Ethanol exposure during development has been shown to alter social behaviors in people, but the range of deficits is not clear. Using an animal model of Fetal Alcohol Spectrum Disorders, inter-male aggression and testosterone levels were examined in adult rats. Rats were exposed to ethanol during the entire prenatal period and from postnatal day 2 through 10. Ethanol was administered via intragastric intubation. Two other groups consisted of a nontreated control and an intubated control group that was exposed to the administration procedures but not ethanol. Both offensive and defensive aggression were examined in experimental residents and intruders under three different housing conditions for the resident males: (1) with another male, (2) with a pregnant female, and (3) with a female and litter fathered by the experimental animal. When housed with a female and litter, ethanol-exposed rats displayed reduced offensive aggression compared to control groups under the same condition. Defensive aggression in the non-experimental intruders was reduced in this same condition. There were no differences in duration of non-aggressive social behaviors among the groups in any of the housing conditions. Testosterone levels were reduced in ethanol-exposed rats compared to controls. In summary, ethanol exposure over the combined prenatal and postnatal periods reduces aggressive behavior in a condition where aggressive behavior is normally seen. This reduction may be related to lower testosterone levels.

  7. The Kepler intubation system.

    PubMed

    Hemmerling, Thomas M; Wehbe, Mohamad; Zaouter, Cedrick; Taddei, Riccardo; Morse, Joshua

    2012-03-01

    Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard videolaryngoscope via a robotic arm. Ninety intubations were performed by the Kepler Intubation System on an airway trainer mannequin by a single operator. The first group of 30 intubations was performed with the operator in direct view of the mannequin (direct view group). The second group of 30 intubations was performed with the operator unable to see the mannequin (indirect view group). Thirty semiautomated intubations were also performed during which the robotic system replayed a trace of a previously recorded intubation maneuver (semiautomated group). First-attempt success rates and intubation times for each trial were recorded. Trends were analyzed using linear regression. Data are presented as mean (SD). All intubations were successful at first attempt. The mean intubation times were 46 (18) seconds, 51 (19) seconds, and 41 (1) seconds for the direct view, indirect view, and semiautomated group, respectively. Both the direct and indirect view groups had a negative slope, denoting that each successive trial required less time. The semiautomated group had a slope of 0 and a low SD of 1 second, illustrating the high reproducibility of automated intubations. We concluded that a robotic intubation system has been developed that can allow remote intubations within 40 to 60 seconds.

  8. Intragastric Balloons in Clinical Practice.

    PubMed

    Papademetriou, Marianna; Popov, Violeta

    2017-04-01

    Cost-effective therapies to address the growing epidemic of obesity are a leading priority in modern medicine. Intragastric balloons (IGBs) are one such option, with increased effectiveness compared with pharmacotherapy and lifestyle and a lower rate of adverse events than bariatric surgery. IGBs are endoscopically placed or swallowed space-occupying devices in the stomach. Three IGB systems were approved in 2015 to 2016 by the Food and Drug Administration for use in the United States, with more devices nearing approval. This paper reviews the adverse events and efficacy of IGBs, and practice setup, management of common complications, and dietary advice for patients.

  9. Eyeblink Classical Conditioning and Interpositus Nucleus Activity Are Disrupted in Adult Rats Exposed to Ethanol as Neonates

    PubMed Central

    Green, John T.; Johnson, Timothy B.; Goodlett, Charles R.; Steinmetz, Joseph E.

    2002-01-01

    Neonatal exposure to ethanol in rats, during the period of brain development comparable to that of the human third trimester, produces significant, dose-dependent cell loss in the cerebellum and deficits in coordinated motor performance. These rats are also impaired in eyeblink conditioning as weanlings and as adults. The current study examined single-unit neural activity in the interpositus nucleus of the cerebellum in adults following neonatal binge ethanol exposure. Group Ethanol received alcohol doses of 5.25 g/kg/day on postnatal days 4–9. Group Sham Intubated underwent acute intragastric intubation on postnatal days 4–9 but did not receive any infusions. Group Unintubated Control (from separate litters) did not receive any intubations. When rats were 3–7 mo old, pairs of extracellular microelectrodes were implanted in the region of the interpositus nucleus. Beginning 1 wk later, the rats were given either 100 paired or 190 unpaired trials per day for 10 d followed by 4 d of 100 conditioned stimulus (CS)-alone trials per day. As in our previous study, conditioned response acquisition in Group Ethanol rats was impaired. In addition, by session 5 of paired acquisition, Group Sham Intubated and Group Unintubated Control showed significant increases in interpositus nucleus activity, relative to baseline, in the CS–unconditioned stimulus interval. In contrast, Group Ethanol failed to show significant changes in interpositus nucleus activity until later in training. These results indicate that the disruption in eyeblink conditioning after early exposure to ethanol is reflected in alterations in interpositus nucleus activity. PMID:12359839

  10. Effects of Preconceptional Ethanol Consumption on ADHD-Like Symptoms in Sprague-Dawley Rat Offsprings

    PubMed Central

    Choi, Inah; Kim, Pitna; Joo, So Hyun; Kim, Min Kyeong; Park, Jin Hee; Kim, Hee Jin; Ryu, Jong Hoon; Cheong, Jae Hoon; Shin, Chan Young

    2012-01-01

    Ethanol exposure during gestational period is related to growth retardation, morphological abnormality, and even in neurological abnormalities including attention deficit/hyperactivity disorder (ADHD)-like behaviors on offspring. However, relatively little is known about the effects of maternal ethanol consumption prior to conception on their offspring. In this study, we investi-gated whether maternal ethanol administration during preconceptional phase produces ADHD-like behaviors in the rat offspring. Sprague-Dawley (SD) female rats were administrated ethanol via intragastric intubation with dosing regimen of 6 g/kg daily for 10 consecutive days and treated female rats then mated with non-treated male SD rats after 8 weeks. Another group subjected to the same procedure as those conducted on ethanol treated group except the saline administration instead of ethanol. Offspring was tested for their ADHD-like behaviors using open field test, Y maze test and impulsivity test that is performed in the aversive electronic foot shock paradigm. Offspring of preconceptional ethanol treated (EtOH) group showed hyperlocomotive activity, attention deficit and impulsivity. And reduction of striatal dopamine transporter (DAT) level was observed by Western blot in the EtOH group, compared to control (Con) group, while the immunohistochemical analysis exhibited increased expression of norepinephrine transporter (NET) in the frontal cortex. These results suggest that maternal ethanol consumption in the preconceptional phase induces ADHD-like behaviors in offspring that might be related to the abnormal expression of DAT and NET in rat. PMID:24116300

  11. Intragastric Balloon for Overweight Patients

    PubMed Central

    Martins Fernandes, Flavio Augusto; Lima, Diego L.; Rao, Prashanth; Shadduck, Phillip P.; Montandon, Isabelle D.; de Souza Barros, Juscielle; Rodrigues, Ingrid Lais Vieira

    2016-01-01

    Background and Objectives: Current treatments for overweight adults include reduced-calorie diet, exercise, behavior modification, and selective use of medications. Many achieve suboptimal results with these measures and progress to obesity. Whether the intragastric balloon (IGB), a reversible device approved for treatment of obesity, is a safe and effective option in overweight adults is less well studied. We conducted a study to prospectively analyze the safety and effectiveness of IGB in overweight adults, to compare the results to a simultaneously studied cohort of obese patients, and to share procedural tips for safe IGB placement and removal. Methods: One hundred thirty-nine patients were evaluated in this prospective, nonrandomized study. Twenty-six overweight [body mass index (BMI), 26–30)] and 113 obese (BMI > 30) patients underwent outpatient, endoscopic IGB placement under intravenous sedation. The IGB was filled with a 550–900 mL (average, 640 mL) solution of saline, radiological contrast, and methylene blue, with an approximate final proportion of 65:2:1. The patients were followed up at 1–2 weeks and then monthly for 6 months. At 6 months, they underwent IGB removal via an esophageal overtube to optimize safety, and then they were observed for 6 more months. Results: IGB time was 190 ± 36 d in the overweight patients and 192 ± 43 d in the obese patients. Symptoms of IGB intolerance included nausea and pain, which were transiently present in 50–95% of patients for several days, and necessitated early IGB removal in 6% of patients. There were no procedure-related complications and no IGB-related esophagitis, erosion, perforation, or obstruction. The percentage of excess weight loss (EWL%) was 96 ± 54% in the overweight group and 41 ± 26% in the obese group (P < 0.001). Conclusion: In overweight adults failing standard treatments, IGB placement for 6 months had an acceptable safety profile and excellent weight loss. PMID:26955259

  12. Endotracheal intubation in swine.

    PubMed

    Chum, Helen; Pacharinsak, Cholawat

    2012-11-01

    Swine are commonly used as research models for cardiovascular surgery and disease, gastrointestinal disease, organ transplantation and intra-renal surgery. These surgical models require anesthesia and, consequently, endotracheal intubation in order to protect the airway; prevent aspiration of saliva, blood and foreign materials; and maintain positive pressure ventilation of the animal. Successful intubation is vital to the stable maintenance of swine under inhalational anesthesia. Here we discuss key features of swine anatomy that make intubation challenging, equipment necessary for successful intubation and techniques for endotracheal intubation in swine.

  13. Mouse intragastric infusion (iG) model

    PubMed Central

    Ueno, Akiko; Lazaro, Raul; Wang, Ping-Yen; Higashiyama, Reiichi; Machida, Keigo; Tsukamoto, Hidekazu

    2014-01-01

    Direct intragastric delivery of a diet, nutrient or test substance can be achieved in rodents (mice and rats) on a long-term (2–3 months) basis using a chronically implanted gastrostomy catheter and a flow-through swivel system. This rodent intragastric infusion (iG) model has broad applications in research on food intake, gastrointestinal (GI) physiology, GI neuroendocrinology, drug metabolism and toxicity, obesity and liver disease. It achieves maximal control over the rate and pattern of delivery and it can be combined with normal ad libitum feeding of solid diet if so desired. It may be adopted to achieve infusion at other sites of the GI system to test the role of a bypassed GI segment in neuroendocrine physiology, and its use in genetic mouse models facilitates the genetic analysis of a central question under investigation. PMID:22461066

  14. Response of rat brain protein synthesis to ethanol and sodium barbital

    SciTech Connect

    Tewari, S.; Greenberg, S.A.; Do, K.; Grey, P.A.

    1987-01-01

    Central nervous system (CNS) depressants such as ethanol and barbiturates under acute or chronic conditions can induce changes in rat brain protein synthesis. While these data demonstrate the individual effects of drugs on protein synthesis, the response of brain protein synthesis to alcohol-drug interactions is not known. The goal of the present study was to determine the individual and combined effects of ethanol and sodium barbital on brain protein synthesis and gain an understanding of the mechanisms by which these alterations in protein synthesis are produced. Specifically, the in vivo and in vitro effects of sodium barbital (one class of barbiturates which is not metabolized by the hepatic tissue) were examined on brain protein synthesis in rats made physically dependent upon ethanol. Using cell free brain polysomal systems isolated from Control, Ethanol and 24 h Ethanol Withdrawn rats, data show that sodium barbital, when intubated intragastrically, inhibited the time dependent incorporation of /sup 14/C) leucine into protein by all three groups of ribosomes. Under these conditions, the Ethanol Withdrawn group displayed the largest inhibition of the /sup 14/C) leucine incorporation into protein when compared to the Control and Ethanol groups. In addition, sodium barbital when added at various concentrations in vitro to the incubation medium inhibited the incorporation of /sup 14/C) leucine into protein by Control and Ethanol polysomes. The inhibitory effects were also obtained following preincubation of ribosomes in the presence of barbital but not cycloheximide. Data suggest that brain protein synthesis, specifically brain polysomes, through interaction with ethanol or barbital are involved in the functional development of tolerance. These interactions may occur through proteins or polypeptide chains or alterations in messenger RNA components associated with the ribosomal units.

  15. Percutaneous intragastric catheter (PIC) for administration of an unpalatable substance to large animals.

    PubMed

    Oleszczuk, Agnieszka; Spannbauer, Michael M; Bluher, Matthias; Ott, Rudolf; Pietsch, Uta-Carolin; Schneider, Katja; Madaj-Sterba, Petra; Furll, Manfred; Hauss, Johann P; Schön, Michael R

    2009-01-01

    We studied an easy and reliable technique for administration of an unpalatable substance to large animals. There were three groups of pigs: group I (n = 6) received 1 g ethanol/kg body weight per day orally with water for 24 days, group II (n = 6) received 2 g ethanol/kg orally with water for 24 days and 4 g ethanol/kg via percutaneous intragastric catheter (PIC) for the next 24 days, group III (n = 6) received 6 g ethanol/kg via PIC for 72 days. The catheter was placed after insufflation of the stomach using an orogastric tube. PIC was successfully placed in each pig. No complications occurred during placement. The total amount of the administrated dose was assimilated each time. PIC is a safe, effective, well tolerated, and precise method of administering ethanol that is inexpensive and easy to perform. Ethanol administration via PIC is a convenient and effective mean of exposing animals to high levels of alcohol on a long-term basis.

  16. Effects of early postnatal exposure to ethanol on retinal ganglion cell morphology and numbers of neurons in the dorsolateral geniculate in mice

    PubMed Central

    Dursun, Ilknur; Jakubowska-Doğru, Ewa; van der List, Deborah; Liets, Lauren C.; Coombs, Julie L.; Berman, Robert F.

    2012-01-01

    Background The adverse effects of fetal and early postnatal ethanol intoxication on peripheral organs and the central nervous system are well documented. Ocular defects have also been reported in about 90% of children with Fetal Alcohol Syndrome (FAS), including microphthalmia, loss of neurons in the retinal ganglion cell layer (GCL), optic nerve hypoplasia and dysmyelination. However, little is known about perinatal ethanol effects on retinal cell morphology. Examination of the potential toxic effects of alcohol on the neuron architecture is important since the changes in dendritic geometry and synapse distribution directly affect the organization and functions of neural circuits. Thus, in the present study estimations of the numbers of neurons in the GCL and dorsolateral geniculate nucleus (dLGN), and a detailed analysis of RGC morphology were carried out in transgenic mice exposed to ethanol during the early postnatal period. Methods The study was carried out in male and female transgenic mice expressing Yellow Fluorescent Protein (YFP) controlled by a Thy-1 (thymus cell antigen 1) regulator on a C57 background. Ethanol (3 g/kg/day) was administered to mouse pups by intragastric intubation throughout postnatal days (PD) 3–20. Intubation control (IC) and untreated control (C) groups were included. Blood alcohol concentration (BAC) was measured in separate groups of pups on PD3, PD10, and PD20 at 4 different time points, 1, 1.5, 2 and 3 h after the second intubation. Numbers of neurons in the GCL and in the dLGN were quantified on PD20 using unbiased stereological procedures. Retinal ganglion cell morphology was imaged by confocal microscopy and analyzed using Neurolucida software. Results Binge-like ethanol exposure in mice during the early postnatal period from PD3 through PD20 altered RGC morphology and resulted in a significant decrease in the numbers of neurons in the GCL and in the dLGN. In the alcohol exposure group, out of 13 morphological parameters

  17. Current status of intragastric balloon for obesity treatment

    PubMed Central

    Kim, Seung Han; Chun, Hoon Jai; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Jeen, Yoon Tae

    2016-01-01

    Endoscopic bariatric therapy may be a useful alternative to pharmacological treatment for obesity, and it provides greater efficacy with lower risks than do conventional surgical procedures. Among the various endoscopic treatments for obesity, the intragastric balloon is associated with significant efficacy in body weight reduction and relief of comorbid disease symptoms. Anatomically, this treatment is based on gastric space-occupying effects that increase the feeling of satiety and may also affect gut neuroendocrine signaling. The simplicity of the intragastric balloon procedure may account for its widespread role in obesity treatment and its applicability to various degrees of obesity. However, advances in device properties and procedural techniques are still needed in order to improve its safety and cost-effectiveness. Furthermore, verification of the physiological outcomes of intragastric balloon treatment and the clinical predictive factors for treatment responses should be considered. In this article, we discuss the types, efficacy, safety, and future directions of intragastric balloon treatment. PMID:27350727

  18. Nasal intubation: A comprehensive review

    PubMed Central

    Chauhan, Varun; Acharya, Gaurav

    2016-01-01

    Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure. PMID:27994382

  19. Endotracheal intubation in the ICU.

    PubMed

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  20. Intubation methods by novice intubators in a manikin model.

    PubMed

    O'Carroll, Darragh C; Barnes, Robert L; Aratani, Ashley K; Lee, Dane C; Lau, Christopher A; Morton, Paul N; Yamamoto, Loren G; Berg, Benjamin W

    2013-10-01

    Tracheal Intubation is an important yet difficult skill to learn with many possible methods and techniques. Direct laryngoscopy is the standard method of tracheal intubation, but several instruments have been shown to be less difficult and have better performance characteristics than the traditional direct method. We compared 4 different intubation methods performed by novice intubators on manikins: conventional direct laryngoscopy, video laryngoscopy, Airtraq® laryngoscopy, and fiberoptic laryngoscopy. In addition, we attempted to find a correlation between playing videogames and intubation times in novice intubators. Video laryngoscopy had the best results for both our normal and difficult airway (cervical spine immobilization) manikin scenarios. When video was compared to direct in the normal airway scenario, it had a significantly higher success rate (100% vs 83% P=.02) and shorter intubation times (29.1 ± 27.4 sec vs 45.9 ± 39.5 sec, P=.03). In the difficult airway scenario video laryngoscopy maintained a significantly higher success rate (91% vs 71% P=0.04) and likelihood of success (3.2 ± 1.0 95%CI [2.9-3.5] vs 2.4 ± 0.9 95%CI [2.1-2.7]) when compared to direct laryngoscopy. Participants also reported significantly higher rates of self-confidence (3.5 ± 0.6 95%CI [3.3-3.7]) and ease of use (1.5 ± 0.7 95%CI [1.3-1.8]) with video laryngoscopy compared to all other methods. We found no correlation between videogame playing and intubation methods.

  1. A rare complication of tracheal intubation

    PubMed Central

    Shukeri, Wan Fadzlina Wan Muhd; Hassan, Wan Mohd Nazaruddin Wan; Nadarajan, Chandran

    2016-01-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI. PMID:27275080

  2. Cervical Spinal Motion During Intubation.

    DTIC Science & Technology

    2000-01-01

    Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the...performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The data are currently being analyzed. A...paper entitled Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization was published in the Journal of Neurosurgery.

  3. Binge ethanol exposure in late gestation induces ethanol aversion in the dam but enhances ethanol intake in the offspring and affects their postnatal learning about ethanol

    PubMed Central

    Chotro, M. Gabriela; Arias, Carlos; Spear, Norman E.

    2009-01-01

    Previous studies show that exposure to 1 or 2 g/kg ethanol during the last days of gestation increases ethanol acceptance in infant rats. We tested whether prenatal exposure to 3 g/kg, a relatively high ethanol dose, generates an aversion to ethanol in both the dam and offspring, and whether this prenatal experience affects the expression of learning derived from ethanol exposure postnatally. The answer was uncertain, since postnatal administration of a 3 g/kg ethanol dose induces an aversion to ethanol after postnatal day 10 but increases ethanol acceptance when administered during the first postnatal week. In the present study pregnant rats received intragastric administrations of water or ethanol (3 g/kg) on gestation days 17-20. On postnatal days 7-8 or 10-11 the offspring were administered water or ethanol (3 g/kg). Intake of ethanol and water, locomotor activity in an open-field and ethanol odor preference were evaluated in the pups, while the mothers were evaluated in terms of ethanol intake. Results indicated an aversion to ethanol in dams that had been administered ethanol during gestation, despite a general increase in ethanol intake observed in their pups relative to controls. The prenatal ethanol exposure also potentiated the increase in ethanol intake observed after intoxication on postnatal days 7-8. Ethanol intoxication on postnatal days 10-11 reduced ethanol consumption; this ethanol aversion was still evident in infant rats exposed prenatally to ethanol despite their general increase in ethanol intake. No effects of prenatal ethanol exposure were observed in terms of motor activity or odor preference. It is concluded that prenatal exposure to ethanol, even in a dose that induces ethanol aversion in the gestating dam, increases ethanol intake in infant rats and that this experience modulates age-related differences in subsequent postnatal learning about ethanol. PMID:19801275

  4. Effects of ethanol exposure during adolescence or in adulthood on Pavlovian conditioned approach in Sprague-Dawley rats.

    PubMed

    McClory, Alexander James; Spear, Linda Patia

    2014-12-01

    Human studies have shown that adolescents who repeatedly use alcohol are more likely to be dependent on alcohol and are more likely to suffer from psychological problems later in life. There has been limited research examining how ethanol exposure in adolescence might contribute to later abuse or addiction in adulthood. The present experiment examined effects of intermittent ethanol exposure during adolescence on sign-tracking behavior in adulthood, indexed by a Pavlovian conditioned approach (PCA) task wherein an 8s lever presentation served as a cue predicting subsequent delivery of a flavored food pellet. Although no response was required for food delivery, after multiple pairings, 1 of 2 different responses often emerged during the lever presentation: goal tracking (head entries into the food trough) or sign tracking (engagement with the lever when presented). Sign tracking is thought to reflect the attribution of incentive salience to reward-paired cues and has been previously correlated with addiction-like behaviors. Following the last PCA session, blood samples were collected for analysis of post-session corticosterone levels. Sixty-two rats (n = 10-12/group) were pseudo-randomly assigned to 1 of 2 intragastric (i.g.) exposure groups (water or 4 g/kg ethanol) or a non-manipulated (NM) control group. Animals were intubated with ethanol or water every other session from postnatal session (PND) 28-48 or PND 70-90. Rats were then tested in adulthood (PND 71-79 or PND 113-122) on the PCA task. Animals exposed chronically to ethanol during adolescence exhibited significantly higher levels of sign-tracking behavior in adulthood than NM and water-treated animals, and showed higher corticosterone than NM control animals. These effects were not seen after comparable ethanol exposure in adulthood. These results suggest that adolescent alcohol exposure has long-term consequences on the expression of potential addiction-relevant behaviors in adulthood.

  5. Teaching fibreoptic intubation in anaesthetised patients.

    PubMed

    Schaefer, H G; Marsch, S C; Keller, H L; Strebel, S; Anselmi, L; Drewe, J

    1994-04-01

    One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Contribution of the stomach to ethanol oxidation in the rat

    SciTech Connect

    Caballeria, J.; Baraona, E.; Lieber, C.S.

    1987-08-24

    To estimate the amount of ethanol that can be oxidized in the stomach, steady-state conditions were created in a group of fed rats by giving a loading dose of ethanol (2 g/kg body wt I.V.) followed by continuous infusion either intravenously or intragastrically. The rate of ethanol oxidation was calculated from the rate of infusion required to maintain steady blood levels of approximately 30 mM for at least 3 hours. Gastrointestinal ethanol concentrations and total contents also remained steady. The rate of ethanol oxidation was 19.3% faster during intragastric than during intravenous infusion (p<0.01). When measured at the prevailing luminal ethanol concentration (145 mM) and expressed per body weight, the gastric ADH activity represented 14% of the hepatic activity at 30 mM ethanol, suggesting that gastric ADH activity could account for most of the increased rate of oxidation when ethanol is given intragastrically. Thus, gastric ethanol oxidation by a high Km ADH in the rat represents a significant fraction of the total rate of ethanol oxidation and it is therefore one of the factors which determines the bioavailability of orally administered ethanol. 22 references, 1 figure, 2 tables.

  7. Effects of ALDH2 genotype, PPI treatment and L-cysteine on carcinogenic acetaldehyde in gastric juice and saliva after intragastric alcohol administration.

    PubMed

    Maejima, Ryuhei; Iijima, Katsunori; Kaihovaara, Pertti; Hatta, Waku; Koike, Tomoyuki; Imatani, Akira; Shimosegawa, Tooru; Salaspuro, Mikko

    2015-01-01

    Acetaldehyde (ACH) associated with alcoholic beverages is Group 1 carcinogen to humans (IARC/WHO). Aldehyde dehydrogenase (ALDH2), a major ACH eliminating enzyme, is genetically deficient in 30-50% of Eastern Asians. In alcohol drinkers, ALDH2-deficiency is a well-known risk factor for upper aerodigestive tract cancers, i.e., head and neck cancer and esophageal cancer. However, there is only a limited evidence for stomach cancer. In this study we demonstrated for the first time that ALDH2 deficiency results in markedly increased exposure of the gastric mucosa to acetaldehyde after intragastric administration of alcohol. Our finding provides concrete evidence for a causal relationship between acetaldehyde and gastric carcinogenesis. A plausible explanation is the gastric first pass metabolism of ethanol. The gastric mucosa expresses alcohol dehydrogenase (ADH) enzymes catalyzing the oxidation of ethanol to acetaldehyde, especially at the high ethanol concentrations prevailing in the stomach after the consumption of alcoholic beverages. The gastric mucosa also possesses the acetaldehyde-eliminating ALDH2 enzyme. Due to decreased mucosal ALDH2 activity, the elimination of ethanol-derived acetaldehyde is decreased, which results in its accumulation in the gastric juice. We also demonstrate that ALDH2 deficiency, proton pump inhibitor (PPI) treatment, and L-cysteine cause independent changes in gastric juice and salivary acetaldehyde levels, indicating that intragastric acetaldehyde is locally regulated by gastric mucosal ADH and ALDH2 enzymes, and by oral microbes colonizing an achlorhydric stomach. Markedly elevated acetaldehyde levels were also found at low intragastric ethanol concentrations corresponding to the ethanol levels of many foodstuffs, beverages, and dairy products produced by fermentation. A capsule that slowly releases L-cysteine effectively eliminated acetaldehyde from the gastric juice of PPI-treated ALDH2-active and ALDH2-deficient subjects. These

  8. Effects of ALDH2 Genotype, PPI Treatment and L-Cysteine on Carcinogenic Acetaldehyde in Gastric Juice and Saliva after Intragastric Alcohol Administration

    PubMed Central

    Maejima, Ryuhei; Iijima, Katsunori; Kaihovaara, Pertti; Hatta, Waku; Koike, Tomoyuki; Imatani, Akira; Shimosegawa, Tooru; Salaspuro, Mikko

    2015-01-01

    Acetaldehyde (ACH) associated with alcoholic beverages is Group 1 carcinogen to humans (IARC/WHO). Aldehyde dehydrogenase (ALDH2), a major ACH eliminating enzyme, is genetically deficient in 30–50% of Eastern Asians. In alcohol drinkers, ALDH2-deficiency is a well-known risk factor for upper aerodigestive tract cancers, i.e., head and neck cancer and esophageal cancer. However, there is only a limited evidence for stomach cancer. In this study we demonstrated for the first time that ALDH2 deficiency results in markedly increased exposure of the gastric mucosa to acetaldehyde after intragastric administration of alcohol. Our finding provides concrete evidence for a causal relationship between acetaldehyde and gastric carcinogenesis. A plausible explanation is the gastric first pass metabolism of ethanol. The gastric mucosa expresses alcohol dehydrogenase (ADH) enzymes catalyzing the oxidation of ethanol to acetaldehyde, especially at the high ethanol concentrations prevailing in the stomach after the consumption of alcoholic beverages. The gastric mucosa also possesses the acetaldehyde-eliminating ALDH2 enzyme. Due to decreased mucosal ALDH2 activity, the elimination of ethanol-derived acetaldehyde is decreased, which results in its accumulation in the gastric juice. We also demonstrate that ALDH2 deficiency, proton pump inhibitor (PPI) treatment, and L-cysteine cause independent changes in gastric juice and salivary acetaldehyde levels, indicating that intragastric acetaldehyde is locally regulated by gastric mucosal ADH and ALDH2 enzymes, and by oral microbes colonizing an achlorhydric stomach. Markedly elevated acetaldehyde levels were also found at low intragastric ethanol concentrations corresponding to the ethanol levels of many foodstuffs, beverages, and dairy products produced by fermentation. A capsule that slowly releases L-cysteine effectively eliminated acetaldehyde from the gastric juice of PPI-treated ALDH2-active and ALDH2-deficient subjects. These

  9. The role of the GABAergic and dopaminergic systems in the brain response to an intragastric load of alcohol in conscious rats.

    PubMed

    Tsurugizawa, T; Uematsu, A; Uneyama, H; Torii, K

    2010-12-01

    The brain's response to ethanol intake has been extensively investigated using electrophysiological recordings, brain lesion techniques, and c-Fos immunoreactivity. However, few studies have investigated this phenomenon using functional magnetic resonance imaging (fMRI). In the present study, we used fMRI to investigate the blood oxygenation level-dependent (BOLD) signal response to an intragastric (IG) load of ethanol in conscious, ethanol-naive rats. An intragastrically infused 10% ethanol solution induced a significant decrease in the intensity of the BOLD signal in several regions of the brain, including the bilateral amygdala (AMG), nucleus accumbens (NAc), hippocampus, ventral pallidum, insular cortex, and cingulate cortex, and an increase in the BOLD signal in the ventral tegmental area (VTA) and hypothalamic regions. Treatment with bicuculline, which is an antagonist of the gamma-aminobutyric acid A (GABA(A)) receptor, increased the BOLD signal intensity in the regions that had shown decreases in the BOLD signal after the IG infusion of 10% ethanol solution, but it did not affect the BOLD signal increase in the hypothalamus. Treatment with SCH39166, which is an antagonist of D1-like receptors, eliminated the increase in the BOLD signal intensity in the hypothalamic areas but did not affect the BOLD signal decrease following the 10% ethanol infusion. These results indicate that an IG load of ethanol caused both a GABA(A) receptor-mediated BOLD decrease in the limbic system and the cortex and a D1-like receptor-mediated BOLD increase in the hypothalamic regions in ethanol-naive rats.

  10. Acute pancreatitis caused by intragastric balloon: A case report.

    PubMed

    Issa, Iyad; Taha, Alaa; Azar, Cecilio

    2016-01-01

    Obesity represents a global hazard that predisposes to many serious health problems. Various solutions have been proposed to overcome obesity ranging from dietary balance to bariatric surgery. Intragastric balloons are a widely used measure to decrease weight, although they are advocated as safe devices, some major complications have been reported. We report a case of acute pancreatitis after insertion of a gastric balloon for weight reduction. Abdominal pain associated with nausea and vomiting maybe due to acute pancreatitis caused by compression of the pancreas by the balloon. It is advisable that physicians recognise these complications early to avoid serious and severe end-results.

  11. Effects of ethanol on the sphincter of Oddi: an endoscopic manometric study.

    PubMed Central

    Viceconte, G

    1983-01-01

    The effects of ethanol, given either intragastrically or intravenously, on the sphincter of Oddi was evaluated by endoscopic manometry. In 12 subjects intragastric ethanol (150 ml of 32%) was given over 10 minutes. In five control subjects saline solution (150 ml of 0.9%) was given intragastrically instead of ethanol. In five other subjects ethanol was infused intravenously (6 ml/kg of 10%) for 36 minutes. Ethanol given intragastrically produced a significant inhibitory effect on sphincter of Oddi pressure. Peak pressure fell from a control value of 75.7 +/- 26.35 mmHg to 39 +/- 15.39 mmHg (p less than 0.001) at 35 minutes. Basal pressure fell from a control value of 30.17 +/- 19.47 mmHg to 11.83 +/- 6.35 mmHg (p less than 0.01) at 35 minutes. Wave height fell from a control value of 41.33 +/- 15.4 mmHg to 27.16 +/- 11.25 mmHg (p less than 0.02) at 35 minutes. No effects on sphincter of Oddi wave frequency were observed. No significant modifications of sphincter motor activity were observed after intragastric saline infusion. Ethanol given intravenously also produced an appreciable inhibitory effect on sphincter of Oddi pressure, without affecting its wave frequency. PMID:6848429

  12. [Intra-gastric penetration of an adjustable gastric band].

    PubMed

    Ablassmaier, B; Opitz, I; Jacobi, C A; Müller, J M

    2001-07-01

    Between November 1995 and August 2000 we performed adjustable silicone gastric banding laparoscopically in 252 patients. The body mass index varied from 37 to 86 kg/m2. We report on a 38-year-old woman who was operated on in 1997 with a body mass index of 47 kg/m2 (167 cm, 132 kg). The postoperative follow-up was uneventful until January 2000. The patient lost weight until she weighed 78 kg. Then she complained of diffuse epigastric pain. Gastroscopy revealed gastritis. Omeprazol was prescribed. No amelioration occurred. Endoscopic control showed partial intragastric migration of the band. After laparoscopic removal of the band, the patient was free of symptoms. Band erosion is a possible complication of adjustable gastric banding. As is known from intragastric penetration of the Angelchik prosthesis, the clinical symptoms of this complication may be mild. Since the follow-up of most patients with gastric banding is less than 5 years, more complications similar to that one described may be diagnosed in the future.

  13. Foreign Body Obstruction Preventing Blind Nasal Intubation

    PubMed Central

    Prior, Simon

    2006-01-01

    A healthy young male patient was scheduled for dental care under nasotracheal intubated general anesthesia. The presence of a plastic calculator key complicated the intubation. This case report describes the event and reviews some possible techniques for coping with an airway that becomes obstructed by a foreign object. PMID:16863390

  14. Large bowel impaction by the BioEnterics Intragastric Balloon (BIB) necessitating surgical intervention.

    PubMed Central

    Kim, W. Y.; Kirkpatrick, U. J.; Moody, A. P.; Wake, P. N.

    2000-01-01

    A case of large bowel impaction caused by migration of a BioEnterics Intragastric Balloon (BIB) is presented. The literature is reviewed regarding both the use and the complications inherent in such balloon devices. This is the first reported case of an intragastric balloon impacted in the colon 9 months after insertion. Images Figure 1 PMID:10858686

  15. Cervical Spinal Motion During Orotracheal Intubation.

    DTIC Science & Technology

    1998-01-01

    Sixteen fresh human cadavers were intubated while recording cervical motion using a cine fluoroscopic technique. Segmental cervical motion from the...intubation was performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The cadaveric spine motion...immobilization reduced motion at the destabilize C4-5 level. Four patients without significant cervical pathology and normal motion of flexion

  16. Assessment of intubation in croup and epiglottitis.

    PubMed

    Zulliger, J J; Schuller, D E; Beach, T P; Garvin, J P; Birck, H G; Frank, J E

    1982-01-01

    Nasotracheal intubation for the management of airway obstruction in acute epiglottitis has become a well-received practice. However, the same technique has not received widespread support in laryngotracheobronchitis. The purpose of this study was to update the series of nasotracheal intubations in croup and epiglottitis from Columbus Children's Hospital with the specific intent to evaluate its effectiveness. All patients were evaluated for any immediate and delayed complications. Delayed complications were evaluated using parent interviews and measuring expiratory flow rates. This study of 45 children intubated for epiglottitis and 83 intubations for croup reconfirms the earlier report from this institution about its safety in both conditions. However, it has identified a subset of the croup patients who are definitely at risk to develop complications of the technique. In those children under 1 year of age, a disturbingly high incidence of subglottic stenosis was identified and this appeared to be related to the patient's age, tube size, serial intubations (dilatations), and duration of intubation. Suggested guidelines for airway management in the light of the new information are presented.

  17. Flavor preferences conditioned by intragastric monosodium glutamate in mice.

    PubMed

    Ackroff, Karen; Sclafani, Anthony

    2013-11-01

    The consumption of monosodium glutamate (MSG) solutions has been shown to reinforce preferences for MSG and for MSG-paired flavors in mice. These effects appear to have a strong postoral component, such that MSG detected in the gut is associated with concurrently consumed flavors. Two experiments investigated postoral MSG reward by infusing 400mM MSG intragastrically (IG) to C57BL/6 mice as they consumed a conditioned stimulus (CS+) flavor. An alternate CS- flavor was paired with IG water. In Experiment 1, the grape and cherry CS flavors were unsweetened, and intakes and preferences for the CS+ flavor were modest. Experiment 2 attempted to generate stronger preferences by adding 0.05% saccharin to the CS flavors. Sweet taste did enhance intakes during training and testing but did not significantly increase percent CS+ intake or persistence of the preference. However, only conditioning with the sweet CS+ resulted in the mice expressing a preference for oral MSG in an initial choice test with water. These findings extend recent studies demonstrating postoral MSG conditioning in rats.

  18. [Studies of effects of aluminum oxide nanoparticles after intragastric administration].

    PubMed

    Shumakova, A A; Tananova, O N; Arianova, E A; Mal'tsev, G Iu; Trushina, É N; Mustafina, O K; Guseva, G V; Trusov, N V; Soto, S Kh; Sharanova, N É; Selifanov, A V; Gmoshinskiĭ, I V; Khotimchenko, S A

    2012-01-01

    Growing Wistar rats received intragastrically nanoparticles (NPs) of aluminum oxide (Al2O3) daily during 28 days at doses of 1 or 100 mg per kg body mass. There were studied body mass of animals, relative mass of internals, rate of protein macromolecules absorption in the gut, oxidative damage of DNA, pool of tissue thiols, activity of hepatic enzymes of xenobiotic detoxication system, biochemical and hematological blood indices, stability of lysosome membranes, condition of antioxidant defense system, apoptosis of hepatocytes. Conducted experiments didn't reveal any marked toxic action of Al2O3 NPs on rats after 28 days of administration both in high and low dose. Among effects probably related to NPs influence on animals there were lowering of relative liver and lung masses, decrease of hepatic thiol pool, activity of CYP1A1 isoform in liver and glutathione reductase in erythrocytes, increase of diene conjugates of fatty acids in blood plasma. Said shifts were small in magnitude, didn't come out of margins of physiological norm and didn't show any distinct relation to NPs dose. However considering great importance of this nanomaterial as probable environmental contaminant the studies of it's toxicity must be continued in conditions of low doses (less than 1 mg per kg body mass) for long period of time.

  19. Early exposure to ethanol differentially affects ethanol preference at adult age in two inbred mouse strains.

    PubMed

    Molet, Jenny; Bouaziz, Elodie; Hamon, Michel; Lanfumey, Laurence

    2012-08-01

    Although the acute effects of ethanol exposure on brain development have been extensively studied, the long term consequences of juvenile ethanol intake on behavior at adult age, regarding especially ethanol consumption, are still poorly known. The aim of this study was to analyze the consequences of ethanol ingestion in juvenile C57BL/6J and DBA/2J mice on ethanol intake and neurobiological regulations at adulthood. Mice were given intragastric ethanol at 4 weeks of age under different protocols and their spontaneous ethanol consumption was assessed in a free choice paradigm at adulthood. Both serotonin 5-HT(1A) and cannabinoid CB1 receptors were investigated using [(35)S]GTP-γ-S binding assay for the juvenile ethanol regimens which modified adult ethanol consumption. In DBA/2J mice, juvenile ethanol ingestion dose-dependently promoted adult spontaneous ethanol consumption. This early ethanol exposure enhanced 5-HT(1A) autoreceptor-mediated [(35)S]GTP-γ-S binding in the dorsal raphe nucleus and reduced CB1 receptor-mediated G protein coupling in both the striatum and the globus pallidus at adult age. In contrast, early ethanol ingestion by C57BL/6J mice transiently lowered spontaneous ethanol consumption and increased G protein coupling of postsynaptic 5-HT(1A) receptors in the hippocampus but had no effect on CB1 receptors at adulthood. These results show that a brief and early exposure to ethanol can induce strain-dependent long-lasting changes in both behavior toward ethanol and key receptors of central 5-HT and CB systems in mice.

  20. Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity.

    PubMed Central

    Sharma, B K; Walt, R P; Pounder, R E; Gomes, M D; Wood, E C; Logan, L H

    1984-01-01

    In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients. PMID:6469081

  1. Swallowing dysfunction following endotracheal intubation

    PubMed Central

    Tsai, Min-Hsuan; Ku, Shih-Chi; Wang, Tyng-Guey; Hsiao, Tzu-Yu; Lee, Jang-Jaer; Chan, Ding-Cheng; Huang, Guan-Hua; Chen, Cheryl Chia-Hui

    2016-01-01

    Abstract To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters. For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20–64 years) and older participants (≥65 years). PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008). Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients. PMID:27310972

  2. Laryngeal complications by orotracheal intubation: Literature review

    PubMed Central

    Mota, Luiz Alberto Alves; de Cavalho, Glauber Barbosa; Brito, Valeska Almeida

    2012-01-01

    Sumamry Introduction: The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective: To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations: This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. PMID:25991942

  3. Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report.

    PubMed

    Sorour, Khaled; Donovan, Lucas

    2015-03-01

    Impaired visualization during intubation due to vomitus of gastric contents is a potential cause of failed intubation. An 82-year-old woman was intubated emergently for respiratory distress secondary to aspiration of gastric contents. Her intubation was hindered by the presence of a massive amount of ongoing vomitus that impaired visualization and overwhelmed all suction capabilities. Intentional blind intubation of the esophagus with an endotracheal tube was performed with successful diversion of ongoing vomitus away from the airway. Thereafter, after brief suctioning, the larynx was quickly visualized and the patient was successfully intubated.

  4. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients.

    PubMed

    Genco, Alfredo; Cipriano, Massimiliano; Bacci, Vincenzo; Maselli, Roberta; Paone, Emanuela; Lorenzo, Michele; Basso, Nicola

    2010-11-01

    Aim of this study is to compare the efficacy of BioEnterics Intragastric Balloon (BIB®) followed by diet with BIB followed by another BIB. A prospective study was designed: a homogeneous group of 100 obese patients (age range 25-35, BMI range 40.0-44.9, M/F ratio 1/4) was allocated into two groups according to procedure: BIB (6 months) followed by diet therapy (7 months; group A = 50 pts), BIB positioning followed by another BIB after 1 month (group B = 50 pts). Baseline demographics were similar in both groups (Group A 10M/40F; mean age 31.4 ± 2.6; range 25-35; mean weight 106.3 ± 12.5 Kg; range 88-150; mean BMI 42.6±2.7 Kg/m(2); range 40.2-43.8; Group B 10M/40F; mean age 32.1 ± 2.1; range 25-35; mean weight 107.1 ± 11.9 Kg; range 90-150; mean BMI 42.9 ± 2.3; range 40.2-43.9). In both groups, weight loss parameters (Kg, BMI, and % EBL) were considered. Statistics were by Fisher's exact test (p < 0.05 was considered significant). At the time of 1st BIB removal, weight loss parameters in both groups were not significantly different: Group A: mean weight was 83.7±19.1 (range 52-151); mean BMI 34.2 ± 3.9 (range 32.4-43.8); and mean %EBL 43.5 ± 21.1 (range 0-68). Group B: mean weight was 84.9 ± 18.3 (range 50-148); mean BMI 34.8 ± 3.3 (range 32.4-43.8); and mean % EBL 45.2 ± 22.5% (range 0-68). At the study end, weight loss parameters were significantly lower in patients who underwent consecutive BIB (p < 0.05): mean BMI was 30.9 ± 7.2 Kg/m(2) (range 24-40), and 35.9 ± 9.7 Kg/m(2) (range 34-42); mean % EBL was 51.9 ± 24.6% (range 0-100) and 25.1 ± 26.2% (range 0-100) in group B and A, respectively. As compared with diet, a second intragastric balloon can be positioned without difficulties, achieving good results with continuous weight loss.

  5. Effects of intragastric L-arginine administration on proximal stomach tone under basal conditions and after an intragastric diet.

    PubMed

    Savoye, Guillaume; Jemaa, Yassine; Mosni, Grégory; Savoye-Collet, Céline; Morcamp, Paola; Déchelotte, Pierre; Bouin, Mickael; Denis, Philippe; Ducrotté, Philippe

    2006-12-01

    Nitric oxide (NO) plays an important role as a nonadrenergic, noncholinergic inhibitory neurotransmitter in the GI tract. Our study aims were to investigate the effect of a single intragastric L-arginine (L-Arg) administration, as a source of NO, on proximal stomach tone in basal and postintragastric administration of a polymeric diet in humans and to evaluate concomitantly the effect on antral area as an indirect assessment of gastric emptying. Eight healthy volunteers were studied in a randomized double-blind crossover study after, respectively, 15 g L-Arg, 30 g L-Arg, or placebo administered in the stomach through a gastric tube. The drug administration was followed by a polymeric diet infusion (500 ml/500 kcal) at a rate of 250 ml/hr. Gastric tone variations were recorded with an electronic barostat, gastric emptying was concomitantly estimated by repeated ultrasound measurements of antral area, and symptoms were recorded throughout the experiment.L-Arg administration was associated with significantly higher increases in barostat bag volumes at both dosages, 30 g (117+/-16 ml) and 15 g (67+/-15 ml), compared to placebo (46+/-11 ml; P < 0.05). In response to the polymeric diet the 30-g L-Arg challenge was associated with a smaller increase in intrabag volume, whereas postinfusion final volumes did not differ in the three treatment conditions. Antral areas were not different at any time of measurement among the three challenges. Bloating and diarrhea were observed after 30-g L-Arg administration in five subjects of eight. Short-term L-Arg administration was able to induce proximal stomach relaxation that allowed a secondary response to enteral feeding only at the 15-g dosage. This 15-g dosage was as well tolerated as the placebo and was associated with no significant changes in gastric emptying patterns.

  6. Delayed sequence intubation: is it ready for prime time?

    PubMed

    Taylor, John A; Hohl, Corinne Michele

    2017-01-01

    Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation.

  7. Adolescent rats are resistant to the development of ethanol-induced chronic tolerance and ethanol-induced conditioned aversion.

    PubMed

    Pautassi, Ricardo Marcos; Godoy, Juan Carlos; Molina, Juan Carlos

    2015-11-01

    The analysis of chronic tolerance to ethanol in adult and adolescent rats has yielded mixed results. Tolerance to some effects of ethanol has been reported in adolescents, yet other studies found adults to exhibit greater tolerance than adolescents or comparable expression of the phenomena at both ages. Another unanswered question is how chronic ethanol exposure affects subsequent ethanol-mediated motivational learning at these ages. The present study examined the development of chronic tolerance to ethanol's hypothermic and motor stimulating effects, and subsequent acquisition of ethanol-mediated odor conditioning, in adolescent and adult male Wistar rats given every-other-day intragastric administrations of ethanol. Adolescent and adult rats exhibited lack of tolerance to the hypothermic effects of ethanol during an induction phase; whereas adults, but not adolescents, exhibited a trend towards a reduction in hypothermia at a challenge phase (Experiment 1). Adolescents, unlike adults, exhibited ethanol-induced motor activation after the first ethanol administration. Adults, but not adolescents, exhibited conditioned odor aversion by ethanol. Subsequent experiments conducted only in adolescents (Experiment 2, Experiment 3 and Experiment 4) manipulated the context, length and predictability of ethanol administration. These manipulations did not promote the expression of ethanol-induced tolerance. This study indicated that, when moderate ethanol doses are given every-other day for a relatively short period, adolescents are less likely than adults to develop chronic tolerance to ethanol-induced hypothermia. This resistance to tolerance development could limit long-term maintenance of ethanol intake. Adolescents, however, exhibited greater sensitivity than adults to the acute motor stimulating effects of ethanol and a blunted response to the aversive effects of ethanol. This pattern of response may put adolescents at risk for early initiation of ethanol intake.

  8. Intubating condition, hemodynamic parameters and upper airway morbidity: A comparison of intubating laryngeal mask airway with standard direct laryngoscopy

    PubMed Central

    Kavitha, J.; Tripathy, Debendra Kumar; Mishra, Sandeep Kumar; Mishra, Gayatri; Chandrasekhar, L. J.; Ezhilarasu, P.

    2011-01-01

    Background: Intubating Laryngeal Mask Airway (ILMA) is a relatively new device designed to have better intubating characteristics than the standard Laryngeal Mask Airway. This study was designed to compare Intubating Laryngeal Mask with standard Direct Laryngoscopy (DLS), taking into account ease of intubation, time taken for intubation, success rate of intubation, hemodynamic responses and upper airway morbidity. Materials and Methods: Sixty patients, ASA I or II, of age between 20 and 60 years, were enrolled in this prospective and randomized study. They were randomly allocated to one of the two groups: group ILMA, Intubating Laryngeal Mask Airway; group DLS, Direct Laryngoscopy. The patients were intubated orally using either equipment after induction of general anesthesia. Results and Conclusions: DLS is comparatively a faster method to secure tracheal intubation than Intubating Laryngeal Mask. ILMA offers no advantage in attenuating the hemodynamic responses compared to direct laryngoscope. The success rate of intubation through Intubating Laryngeal Mask is comparable with that of DLS. The upper airway morbidity and mean oxygen saturation are comparable in both the groups. PMID:25885300

  9. Submandibular intubation in awake patient of panfacial trauma

    PubMed Central

    Kamra, SK; Khandavilli, HK; Banerjee, P

    2016-01-01

    Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems. PMID:27833492

  10. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

    PubMed

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  11. Ethanol poisoning

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/002644.htm Ethanol poisoning To use the sharing features on this page, please enable JavaScript. Ethanol poisoning is caused by drinking too much alcohol. ...

  12. Intragastric infusion of denatonium benzoate attenuates interdigestive gastric motility and hunger scores in healthy female volunteers.

    PubMed

    Deloose, Eveline; Janssen, Pieter; Corsetti, Maura; Biesiekierski, Jessica; Masuy, Imke; Rotondo, Alessandra; Van Oudenhove, Lukas; Depoortere, Inge; Tack, Jan

    2017-03-01

    Background: Denatonium benzoate (DB) has been shown to influence ongoing ingestive behavior and gut peptide secretion.Objective: We studied how the intragastric administration of DB affects interdigestive motility, motilin and ghrelin plasma concentrations, hunger and satiety ratings, and food intake in healthy volunteers.Design: Lingual bitter taste sensitivity was tested with the use of 6 concentrations of DB in 65 subjects. A placebo or 1 μmol DB/kg was given intragastrically to assess its effect on fasting gastrointestinal motility and hunger ratings, motilin and ghrelin plasma concentrations, satiety, and caloric intake.Results: Women (n = 39) were more sensitive toward a lingual bitter stimulus (P = 0.005) than men (n = 26). In women (n = 10), intragastric DB switched the origin of phase III contractions from the stomach to the duodenum (P = 0.001) and decreased hunger ratings (P = 0.04). These effects were not observed in men (n = 10). In women (n = 12), motilin (P = 0.04) plasma concentrations decreased after intragastric DB administration, whereas total and octanoylated ghrelin were not affected. The intragastric administration of DB decreased hunger (P = 0.008) and increased satiety ratings (P = 0.01) after a meal (500 kcal) in 13 women without affecting gastric emptying in 6 women. Caloric intake tended to decrease after DB administration compared with the placebo (mean ± SEM: 720 ± 58 compared with 796 ± 45 kcal; P = 0.08) in 20 women.Conclusions: Intragastric DB administration decreases both antral motility and hunger ratings during the fasting state, possibly because of a decrease in motilin release. Moreover, DB decreases hunger and increases satiety ratings after a meal and shows potential for decreasing caloric intake. This trial was registered at clinicaltrials.gov as NCT02759926.

  13. Ethanol Basics

    SciTech Connect

    2015-01-30

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  14. Laparoscopic adjustable silicone gastric banding: prospective evaluation of intragastric migration of the lap-band.

    PubMed

    Silecchia, G; Restuccia, A; Elmore, U; Polito, D; Perrotta, N; Genco, A; Bacci, V; Basso, N

    2001-08-01

    Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.

  15. A Case of Duodenal Obstruction and Pancreatitis Due to Intragastric Balloon

    PubMed Central

    Öztürk, Alaattin; Yavuz, Yunus; Atalay, Talha

    2015-01-01

    Background: Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. Case Report: A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. Conclusion: Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon. PMID:26185725

  16. [Complications in morbid obesity treatment--pylorus obstruction caused by a deflated intragastric balloon].

    PubMed

    Constantin, V; Socea, B; Moculescu, C; Sireţeanu, G; Ciofoaia, V; Popa, F

    2009-01-01

    An aggressive array of new treatments and improvements of existing approaches for addressing morbid obesity were developed during the last two decades in response to the recognition that a new pandemic affects humanity, i.e. obesity. Initially used as a temporizing solution for other specific interventions used for obesity treatment, the endoscopic placement of an intragastric balloons has currently became in certain cases a complete therapeutic solution. Multiple studies emphasize the efficiency of this new therapeutic method, in some cases resulting in a 45 kg weight loss at the end of the monitoring period. The intragastric balloon, after endoscopic placement can be kept into position for an average period of 4-6 months. After this period, balloon extraction is recommended because of the complications that can occur with prolonged intragastric placement. This paper presents a case of pyloric obstruction by an intragastric balloon kept for 14 months. In this case, the initial approach was endoscopic, but the surgical approach offered the definitive therapeutic solution.

  17. [Intragastric balloon: a review concerning alternative balloons compared to the classical ones (Bioenterics)].

    PubMed

    Martínez Olmos, Miguel Ángel; Cancer, Emilia; Bretón, Irene; Álvarez, Visitación; Abilés, Verónica; Abilés, Jimena; Peláez, Noelia; Mellado, Carmen; Mazure, Rose-Anne; Culebras, Jesús Manuel

    2014-10-06

    Since de Tarpon Springs Consensus Conference in 1987, the Bioenterics Intragastric Balloon represents the standard model for obesity treatment with this technique. Nevertheless, over the last 30 years, especially for the last ten years, novel concept of balloons has appeared, as well as new alternative models, which are reviewed in this paper.

  18. An innovative approach to orotracheal intubations: the Alexandrou Angle of Intubation position.

    PubMed

    Alexandrou, Nikolaos A; Yeh, Benson; Barbara, Paul; Leber, Mark; Marshall, Lewis W

    2011-01-01

    Visualization of the vocal cords is paramount during orotracheal intubations. We employed a novel patient position in this derivation study. The Alexandrou Angle of Intubation (AAI) position is defined as a 20°-30° incline where the supine patient's head is elevated in relation to the body and legs. Our study participants were blinded to the goals of the research as well as our novel technique. Using intubation manikins, our participants ranked their preference for visualizing the vocal cords between the Flat, Trendelenburg, and AAI positions. A majority (58.8%) of our study participants preferred the AAI for visualizing the vocal cords over the other two positions. Future studies will reveal whether AAI will play a significant role in emergent airway management.

  19. Risk Factors for Hypotension in Urgently Intubated Burn Patients

    DTIC Science & Technology

    2012-01-01

    fold increase in the odds of death. The use of propofol for the induction of anesthesia for endotracheal intubation in critically ill burned patients...did not increase the odds of hypotension or death. In burn patients requiring emergent endotracheal intubation in the BICU, the care team should...01 DEC 2012 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Risk factors for hypotension in urgently intubated burn patients 5a

  20. Chronic intermittent ethanol exposure during adolescence: effects on social behavior and ethanol sensitivity in adulthood.

    PubMed

    Varlinskaya, Elena I; Truxell, Eric; Spear, Linda P

    2014-08-01

    This study assessed long-lasting consequences of repeated ethanol exposure during two different periods of adolescence on 1) baseline levels of social investigation, play fighting, and social preference and 2) sensitivity to the social consequences of acute ethanol challenge. Adult male and female Sprague-Dawley rats were tested 25 days after repeated exposure to ethanol (3.5 g/kg intragastrically [i.g.], every other day for a total of 11 exposures) in a modified social interaction test. Early-mid adolescent intermittent exposure (e-AIE) occurred between postnatal days (P) 25 and 45, whereas late adolescent intermittent exposure (l-AIE) was conducted between P45 and P65. Significant decreases in social investigation and social preference were evident in adult male rats, but not their female counterparts following e-AIE, whereas neither males nor females demonstrated these alterations following l-AIE. In contrast, both e-AIE and l-AIE produced alterations in sensitivity to acute ethanol challenge in males tested 25 days after adolescent exposure. Ethanol-induced facilitation of social investigation and play fighting, reminiscent of that normally seen during adolescence, was evident in adult males after e-AIE, whereas control males showed an age-typical inhibition of social behavior. Males after l-AIE were found to be insensitive to the socially suppressing effects of acute ethanol challenge, suggesting the development of chronic tolerance in these animals. In contrast, females showed little evidence for alterations in sensitivity to acute ethanol challenge following either early or late AIE. The results of the present study demonstrate a particular vulnerability of young adolescent males to long-lasting detrimental effects of repeated ethanol. Retention of adolescent-typical sensitivity to the socially facilitating effects of ethanol could potentially make ethanol especially appealing to these males, therefore promoting relatively high levels of ethanol intake later

  1. Submental Intubation in Patients with Complex Maxillofacial Injuries

    PubMed Central

    Cheong, Yuseon; Kang, Seong Sik; Kim, Minsoo; Son, Hee Jeong; Park, Jaewoo; Kim, Jeong-Mo

    2016-01-01

    Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. A flexible and kink-resistant reinforced endotracheal tube with detachable universal connector is commonly used for submental intubation. Herein, we report cases involving submental intubation using a reinforced endotracheal tube with a non-detachable universal connector in patients with complex maxillofacial injuries. PMID:27924286

  2. Fuel ethanol

    SciTech Connect

    Not Available

    1989-02-01

    This report discusses the Omnibus Trade and Competitiveness Act of 1988 which requires GAO to examine fuel ethanol imports from Central America and the Caribbean and their impact on the U.S. fuel ethanol industry. Ethanol is the alcohol in beverages, such as beer, wine, and whiskey. It can also be used as a fuel by blending with gasoline. It can be made from renewable resources, such as corn, wheat, grapes, and sugarcane, through a process of fermentation. This report finds that, given current sugar and gasoline prices, it is not economically feasible for Caribbean ethanol producers to meet the current local feedstock requirement.

  3. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    PubMed Central

    Hansen, Matthew; Loker, William; Warden, Craig

    2016-01-01

    Introduction The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots) of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic regression. The

  4. Ethanol-induced hypothermia and hyperglycemia in genetically obese mice

    SciTech Connect

    Haller, E.W.; Wittmers, L.E. Jr.

    1989-01-01

    Blood glucose and rectal temperatures were monitored in two strains of genetically obese mice (C57 BL/6J ob/ob) prior to and following intragastric ethanol administration in an attempt to relate the hypothermic response to ethanol to extracellular glucose concentration. In contrast to expectation, ethanol administration was typically associated with a hyperglycemia and a hypothermic response. In the ob/ob genotype, the hypothermic response was associated with pronounced hyperglycemia which was more emphatic in older animals. The data support the conclusion that ethanol-induced hypothermia is independent of blood glucose levels. In light of the known sensitivity of ob/ob mice to insulin, it is suggested further that the observed hypothermic response was not a function of the animals' ability to transport glucose into peripheral cells. The observed hyperglycemia of the obese animals was most likely stress-related

  5. Interarytenoid osseous bridge after prolonged endotracheal intubation.

    PubMed

    Boemo, Rafael Luis; Navarrete, María Luisa; Genestar, Elisabet Ingrid; González, Mireia; Fuentes, Juan Fernando; Fortuny, Pedro

    2012-01-01

    Posterior glottic stenosis or interarytenoid fibrous adhesion is uncommon and has sometimes been misdiagnosed as cord paralysis. Laryngoscopy and laryngeal electromyography studies are the two main diagnostic aids. We present the case of a 63-year-old man under endotracheal intubation during 10 days after a cardiac procedure who was evaluated in our department for persistent dysphonia. The laryngoscopy showed a granuloma-like lesion in the posterior glottic space. During the microlaryngoscopy procedure, the osseous consistence of the interarytenoid lesion was observed. Laser surgery excision of the lesion was performed with good results. According to our review of the literature, this corresponds to the second case reported.

  6. Cytokine and Chemokine Expression Associated with Steatohepatitis and Hepatocyte Proliferation in Rats Fed Ethanol Via Total Enteral Nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sprague-Dawley rats were intragastrically fed low carbohydrate-containing ethanol (EtOH) diets via total enteral nutrition for up to 49 d. Induction of EtOH metabolism and appearance of steatosis preceded development of oxidative stress, inflammation, and cell death. A transitory peak of tumor necro...

  7. Alcohol-induced insulin resistance in liver: Potential roles in regulation of ADH expression; ethanol clearance and alcohol liver disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Using total enteral nutrition (TEN), we demonstrated that low carbohydrate, high alcohol-containing diets (10-12 g/kg/dO produced alcoholic liver disease (ALD) in adult male Sprague-Dawley rats (300 g). Intragastric infusion of this diet generates regular pulses of blood ethanol concentrations (BEC...

  8. Sinusitis associated with nasogastric intubation in 3 horses

    PubMed Central

    Nieto, Jorge E.; Yamout, Sawsan; Dechant, Julie E.

    2014-01-01

    Sinusitis has not been reported as a complication of long-term nasogastric intubation in horses. We describe 3 horses that developed nosocomial sinusitis following abdominal surgery with associated perioperative nasogastric intubation. Sinusitis was suspected by the presence of malodorous discharge and confirmed by percussion, upper airway endoscopy, radiographs (n = 3), and bacterial culture (n = 1). PMID:24891638

  9. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    PubMed Central

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  10. Intragastric balloon therapy in the management of obesity: why the bad wrap?

    PubMed

    Evans, Joshua T; DeLegge, Mark H

    2011-01-01

    For the first time in the history of the United States, in the 21st century, there may be a decline in life expectancy, as a result of the increasing rate of obesity. It is known that even the modest reduction of 10% of excess body weight significantly reduces obesity-associated comorbidities. Conservative measures such as diet and exercise seldom give durable results in the long term. Bariatric surgery has been shown to achieve durable weight loss but is not without significant risks and complications. As a result, greater focus has turned toward minimally invasive endoscopic therapies for the management of obesity. There have been multiple reports of creative endoscopic devices and techniques in the literature, but most have only demonstrated early pilot data. By far, the most widely studied of the minimally invasive endoscopic therapies for obesity is the gastric balloon. Now obsolete, the Garren-Edwards gastric bubble was removed from the market in the United States after several sham-controlled studies showed that diet and behavior modification were equally efficacious and that the device was associated with a prohibitive number of complications. However, the concept and technique of intragastric balloon placement has evolved considerably since that time, and we now have data on nearly 3,000 patients who have undergone placement of the BioEnterics Intragastric Balloon (Carpenteria, CA) worldwide. The balloon is approved as part of a multifaceted approach to obesity in many countries and has been shown to result in at least a 10% excess weight loss durable over 1 year. However, the device is not yet approved for use in the United States. In this article, the authors review the efficacy, indications, complications, and potential uses for the intragastric balloon. The intragastric balloon might be the best start as gastroenterologists in the United States begin to play an increasing role in the treatment of the obesity pandemic.

  11. Morbid Obesity: treatment with Bioenterics Intragastric Balloon (BIB), psychological and nursing care: our experience

    PubMed Central

    Galloro, Giuseppe; Ruggiero, Simona; Alessandro Telesca, Donato; Russo, Teresa; Amato, Maurizio; Di Palma, Immacolata; Iovino, Speranza; Amato, Bruno; Sivero, Stefania; Forestieri, Pietro

    2016-01-01

    Abstract Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery. All patients in the study underwent a psychological evaluation prior to placement of the BIB. PMID:28352828

  12. Morbid Obesity: treatment with Bioenterics Intragastric Balloon (BIB), psychological and nursing care: our experience.

    PubMed

    Sivero, Luigi; Galloro, Giuseppe; Ruggiero, Simona; Alessandro Telesca, Donato; Russo, Teresa; Amato, Maurizio; Di Palma, Immacolata; Iovino, Speranza; Amato, Bruno; Sivero, Stefania; Forestieri, Pietro

    2016-01-01

    Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery. All patients in the study underwent a psychological evaluation prior to placement of the BIB.

  13. The protective effect of hymochromone against ethanol-induced thiamin deficiency.

    PubMed

    Basu, T K; Chakraborty, J C

    1982-01-01

    Intragastric administration of ethanol to male rats given at 6 gm/kg body weight, daily for two weeks, produced no significant change in the body or liver weights. Hepatic total lipid increased but this was no more than a trend. Treatment with ethanol, however, resulted in a marked decrease in transketolase activity (TK) of the haemolysed whole blood, associated with a pronounced rise in the stimulating effect of thiamin pyrophosphate on this enzyme (TPP effect). These changes mediated by ethanol were counteracted by hymochromone.

  14. Evaluation of the ethanol antagonist' Ro15-4513 on cardiovascular and metabolic responses induced by ethanol

    SciTech Connect

    Lerner, M.R.; Gauvin, D.V.; Holloway, F.A.; Wilson, M.F.; Brackett, D.J. Veterans Affairs Medical Center, Oklahoma City, OK )

    1992-02-26

    The putative ethanol antagonist Ro15-4513 has been reported to attenuate many behavioral responses induced by ethanol, including motor coordination, narcosis, ethanol self administration and intake, and anticonvulsant actions. This study was designed to study the effect of Ro15-4513 on cardiovascular and metabolic responses elicited by intragastric ethanol in conscious rats. Four groups of rats were catheterized under enflurane anesthesia and allowed to regain consciousness. Each group was given either 3.2, 10.0, or 32.0 mg/kg Ro15-4513 or equivalent Tween (i.p.) following ethanol. Ro15-4513 had no effect at any concentration on the decreases in mean arterial pressure, cardiac output, central venous pressure, respiration rate, and cardiac stroke volume and the increases in systemic vascular resistance, heart rate, and glucose evoked by the ethanol challenge. Blood alcohol concentrations measured throughout the study were not affected by any concentration of Ro15-4513. These data suggest that even though Ro15-4513 has significant effects on behavioral responses induced by ethanol it has no effect on the cardiovascular and metabolic responses elicited during ethanol intoxication.

  15. Prosthodontic Approach in Management of Prolonged Neonatal Intubation

    PubMed Central

    Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-01-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation. PMID:28050517

  16. Prosthodontic Approach in Management of Prolonged Neonatal Intubation.

    PubMed

    Kamble, Vikas B; Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-11-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation.

  17. Body posture during simulated tracheal intubation.

    PubMed

    Matthews, A J; Johnson, C J; Goodman, N W

    1998-04-01

    Seventeen experienced anaesthetists and 15 novices were filmed intubating the trachea of a training manikin. Measurements were made of the distance from manikin's chin to subject's nose and of the angles at the elbow, the shoulder and of the forearm with the horizontal. Trained subjects stood further back (trained: median 43 cm, interquartile range 41-56 cm; novices 35 cm, 26-38 cm; Mann-Whitney U, p < 0.01), with a straighter arm (trained elbow angle: 108 degrees, 99-121 degrees; novices': 92 degrees, 88-102 degrees; Mann-Whitney U, p < 0.01). Trained subjects tended to hold the laryngoscope closer to the hinge, with a pincer grip; novices were more likely to use a full grip of the handle. Trainers should consider giving novices explicit instructions on how to stand and how to hold the laryngoscope.

  18. Palatopharyngeal wall perforation during Glidescope intubation.

    PubMed

    Leong, W L; Lim, Y; Sia, A T H

    2008-11-01

    We report a case of palatopharyngeal wall perforation during intubation with a GlideScope laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope" monitor Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.

  19. Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope

    PubMed Central

    2014-01-01

    Background Tracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one. Methods Twenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt. Results Intubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P < 0.05). Duration of glottis exposure was significantly shorter in Airtraq group compared to Macintosh group (50 ± 19 s vs. 81 ± 27 s, P < 0.001). A grade I Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation in Airtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group

  20. [The transillumination technique. An alternative to conventional intubation?].

    PubMed

    Lipp, M; de Rossi, L; Daubländer, M; Thierbach, A

    1996-10-01

    The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I. ASA I-III) were included in the study (conventional intubation [group KL, n = 60]. Trachlight intubation [group TT, n = 60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood pressure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6 +/- 10.4 s, range 12-60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT. 54 were intubated successfully, the mean time needed being 29.9 +/- 14.8 s (range: 6-61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal

  1. Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit

    PubMed Central

    Rezaei, Sahra; Rezaei, Korosh; Mahboubi, Mohaddese; Jarahzadeh, Mohammad Hossein; Momeni, Ehsan; Bagherinasab, Mostafa; Targhi, Mehrdad Gaffari; Memarzadeh, Mohammad Reza

    2016-01-01

    Background: Intubated patients in Intensive Care Unit (ICU) are not able to take care of their mouth health, so they are at risk of bacterial colonization and dental plaques formation that can lead to systemic diseases such as pneumonia and gingivitis. Aims: In randomized, double-blind clinical study, the efficacy of natural herbal mouthwash containing Salvadora persica ethanol extract and Aloe vera gel was compared with chlorhexidine on gingival index (GI) of intubated patients in ICU. Materials and Methods: Seventy-six intubated patients (18–64 years old with mean age 40.35 ± 13.2) in ICU were admitted to this study. The patients were randomly divided into two groups: (1) Herbal mouthwash and (2) chlorhexidine solution. Before the intervention, the GIs was measured by modified GI device into two groups. The mouth was rinsed by mouthwashes every 2–3 h for 4 days. 2 h after the last intervention, GIs were determined. Results: Along with mechanical methods, herbal mouthwash in reducing GI was statistically significant than that of chlorhexidine (P < 0.05). Conclusion: The results of this study introduce a new botanical extract mouthwash with dominant healing effects on GI (1.5 ± 0.6) higher than that of synthetic mouthwash, chlorhexidine (2.31 ± 0.73). PMID:28298822

  2. Opioid antagonists block the acquisition of ethanol-mediated conditioned tactile preference in infant rats.

    PubMed

    Nizhnikov, Michael Eduard; Pautassi, Ricardo Marcos; Truxell, Eric; Spear, Norman E

    2009-08-01

    It has been difficult to find conditioned preference for tactile cues paired with ethanol intoxication in rats. Toward understanding the ontogeny of ethanol reinforcement, we aimed at establishing a simple and reliable procedure for (1) assessing primary appetitive conditioning to ethanol in infant rats and (2) discerning the role the opioid system plays in ethanol-mediated conditioning at this age. Experiment 1 determined the parameters (i.e., dose, interval of conditioning) for assessing ethanol-mediated conditioning. Pups were then trained with differential Pavlovian conditioning (Experiments 2 and 3) in which ethanol intoxication (1.0-2.0 g/kg, intragastrically or intraperitoneally delivered) was paired with a tactile stimulus (sandpaper) while an alternative texture signaled the absence of ethanol's effects. Unpaired control conditions were also used. Tactile preferences were assessed after two conditioning sessions. Paired rats spent significantly more time on sandpaper than unpaired controls, an effect that was greater after intragastric administration of 1.0 than 2.0 g/kg ethanol. This effect was replicated in Experiments 4a and 4c and found to be inhibited by pretreatment with general (naloxone [NAL]) or specific (d-Pen-Cys-Tyr-d-Trp-Orn-Thr-Pen-Thr-NH2 [CTOP] and naltrindole) opioid antagonists. Blood ethanol levels at conditioning were not altered by NAL (Experiment 4b). The study outlines a procedure that reveals appetitive conditioning to ethanol by infant rats. The results are discussed in terms of a potential ethanol-induced activation of the endogenous opioid system during the onset of the intoxication process.

  3. Long-term effects of intragastric instillations of silastic 386 foam elastomer

    SciTech Connect

    Smith, D.M.; Drake, G.A.; London, J.E.

    1981-12-01

    Young male Sprague-Dawley rats (87 days old) were given a single dose (5 g/kg body weight (BW)) of Silastic 386 foam elastomer intragastrically (IG), and young female Swiss-Webster mice (83 days old) were given a single dose (5 g/kg BW) IG, or a dose (1 g/kg BW) IG on each of 5 consecutive days, of Silastic 386 foam elastomer. All animals were then maintained for the rest of their lives and autopsied at death. No significant effects resulting from the oral administration of this of this material were seen in any of the rats or mice.

  4. Submental intubation in maxillofacial fracture: a case report

    PubMed Central

    2016-01-01

    It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text. PMID:27429940

  5. Factors Associated with Intubation Time and ICU Stay After CABG

    PubMed Central

    Flegler, Suzanny; Paro, Flavia Marini

    2015-01-01

    OBJECTIVE The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass. METHODS This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil. RESULTS The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay. CONCLUSION In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay. PMID:26934403

  6. Preauricular skin tags and difficult tracheal intubation: a case report.

    PubMed

    Moschini, V; Collini, R

    2009-10-01

    Despite the large variety of equipment available for pediatric intubations, difficult tracheal intubation is still a main factor in deaths associated with anesthesia, especially in children with congenital anomalies of the airways or with rare diseases and syndromes. The aim of this study was to focus attention on the possibility of difficult intubation in children with preauricular tags. This condition is reported as both isolated and associated with more complex syndromes, including nephrourological anomalies and multiple craniofacial dysmorphysms. We retrospectively analyzed the anesthesia procedures for seven children (aged between 3 and 18 months) who underwent surgical ablation of preauricular tags between October 2006 and April 2008 at the Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena of Milan. Two of these children, both native residents of Sri Lanka, presented with a problematic airway and difficult tracheal intubation, which was suspected in one case but totally unexpected in the other. Considering the International Guidelines for difficult intubation in pediatrics and the data of other authors, our conclusions for how to approach a child with preauricular tags are: 1) to verify whether the defect is isolated or associated with other malformations; 2) to analyze the medical history and to perform an accurate physical examination to identify a possibly difficult airway; and 3) to not exceed three attempts to intubate and, if possible, to choose an alternative strategy.

  7. Ethanol-induced damage to mucosal capillaries of rat stomach. Ultrastructural features and effects of prostaglandin F2 beta and cysteamine

    SciTech Connect

    Trier, J.S.; Szabo, S.; Allan, C.H.

    1987-01-01

    Impairment of the mucosal microcirculation may contribute to ethanol-induced gastric mucosal damage. In this report, we describe diffuse and severe ultrastructural damage to the capillaries of the gastric glandular mucosa of the rat that occurred within 1 min after intragastric instillation of 100% ethanol. There was a gradient of damage in that endothelial cell structure was most severely disrupted in profiles of capillaries located close to the luminal surface but some morphologic evidence of damage was evident in the wall of capillary profiles to a mean depth of 256 micron. Capillary structure was generally normal in the deeper regions of the mucosa. Pretreatment with intragastric cysteamine, 30 mg/100 g, or intragastric prostaglandin F2 beta, 0.5 mg/100 g, significantly reduced the depth in the mucosa to which damage to capillaries extended. Pretreatment with intragastric prostaglandin F2 beta, 0.2 mg/100 g, afforded no significant protection. We conclude that a 1-min exposure to 100% ethanol induces striking damage to the microcirculation of glandular mucosa of the rat stomach with severe damage to capillary profiles near the lumen and sparing of capillary profiles near the muscularis mucosa, and pretreatment with the sulfhydryl agent, cysteamine, or with a large dose of prostaglandin F2 beta reduces the extent of but does not abolish ethanol-induced damage to gastric mucosal capillaries.

  8. [Training of endotracheal intubation for an emergency medical technician and three cases of endotracheal intubation during emergency situation].

    PubMed

    Kaneda, Toru; Suzuki, Toshiyasu

    2007-05-01

    It is said that airway management is an important part of lifesaving at the prehospital care for a seriously ill emergency patient. We performed the training of endotracheal intubation for an emergency medical technician, and in this report we discussed the results of trainings and examined 3 cases of endotracheal intubation in the emergency situation after training. Various kinds of problem arose through this training, for example, difficulty to get the consent from patients, overlap of a case for clinical resident and emergency medical technician, large responsibility of the anesthesiologist as a teaching staff. In addition, there may be no useful case for lifesaving at the emergency situation in 3 cases of endotracheal intubation. We consider that it may be difficult, but possibility cannot deny if endotracheal intubation by emergency medical technicians contribute to lifesaving rate improvement from viewpoint of prehospital care.

  9. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

    PubMed Central

    Thakar, Sudip D.; Truong, Angela T.; Truong, Dam-Thuy

    2016-01-01

    Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient. PMID:28116174

  10. Tone conditioning potentiates rather than overshadows context fear in adult animals following adolescent ethanol exposure.

    PubMed

    Broadwater, Margaret A; Spear, Linda P

    2014-07-01

    We have shown that adults exposed to ethanol during adolescence exhibit a deficit in the retention of context fear, reminiscent of that normally seen in preweanling rats. However, preweanlings have been reported to exhibit a potentiation of context fear when they are conditioned in the presence of a tone. Therefore, this study examined context retention 24 hr after tone or context conditioning in male Sprague-Dawley rats exposed intragastrically to 4 g/kg ethanol or water every 48 hr (total of 11 exposures) during adolescence [Postnatal day (P) 28-48] or adulthood (P70-90). Approximately 3 weeks following exposure, retention of fear to the context in animals exposed to ethanol during adolescence was attenuated after context conditioning, but enhanced after tone conditioning. Comparable adult ethanol exposure groups showed typical overshadowing of context fear retention after tone conditioning. These data suggest that adolescent ethanol exposure may induce an immature pattern of cognitive processing.

  11. The potential role of intragastric balloon in the treatment of obese-related infertility: personal experience.

    PubMed

    Musella, Mario; Milone, Marco; Bellini, Marcello; Fernandez, Miguel Emilio Sosa; Fernandez, Loredana Maria Sosa; Leongito, Maddalena; Milone, Francesco

    2011-04-01

    The prevalence of people who are overweight or obese has increased dramatically in high-income countries over the past 20 years. There is a strong association between obesity and infertility, and weight loss can result in increased fecundity in obese women. The aim of this study is to demonstrate the potential role of intragastric balloon in the treatment of obese-related infertility. This is a retrospective study. A chart review of 27 obese women seen between September 2003 and July 2008 was performed. They all presented with the diagnosis of infertility and had undergone endoscopic intragastric balloon positioning. Among these women who tried unsuccessfully to become pregnant before weight loss, 15 became pregnant afterward. The pregnancies proceeded without complications and ended with live births. An improvement in the fertility status after weight loss has been described, although data on fertility after weight loss following bariatric surgery are still limited. The results obtained in our experience are not different from data reported in literature for bariatric surgery. Therefore, balloon treatment might be effective in young infertile obese women who wish to become pregnant.

  12. Progression of Parkinson's Disease Pathology Is Reproduced by Intragastric Administration of Rotenone in Mice

    PubMed Central

    Pan-Montojo, Francisco; Anichtchik, Oleg; Dening, Yanina; Knels, Lilla; Pursche, Stefan; Jung, Roland; Jackson, Sandra; Gille, Gabriele; Spillantini, Maria Grazia; Reichmann, Heinz; Funk, Richard H. W.

    2010-01-01

    In patients with Parkinson's disease (PD), the associated pathology follows a characteristic pattern involving inter alia the enteric nervous system (ENS), the dorsal motor nucleus of the vagus (DMV), the intermediolateral nucleus of the spinal cord and the substantia nigra, providing the basis for the neuropathological staging of the disease. Here we report that intragastrically administered rotenone, a commonly used pesticide that inhibits Complex I of the mitochondrial respiratory chain, is able to reproduce PD pathological staging as found in patients. Our results show that low doses of chronically and intragastrically administered rotenone induce alpha-synuclein accumulation in all the above-mentioned nervous system structures of wild-type mice. Moreover, we also observed inflammation and alpha-synuclein phosphorylation in the ENS and DMV. HPLC analysis showed no rotenone levels in the systemic blood or the central nervous system (detection limit [rotenone]<20 nM) and mitochondrial Complex I measurements showed no systemic Complex I inhibition after 1.5 months of treatment. These alterations are sequential, appearing only in synaptically connected nervous structures, treatment time-dependent and accompanied by inflammatory signs and motor dysfunctions. These results strongly suggest that the local effect of pesticides on the ENS might be sufficient to induce PD-like progression and to reproduce the neuroanatomical and neurochemical features of PD staging. It provides new insight into how environmental factors could trigger PD and suggests a transsynaptic mechanism by which PD might spread throughout the central nervous system. PMID:20098733

  13. Progression of Parkinson's disease pathology is reproduced by intragastric administration of rotenone in mice.

    PubMed

    Pan-Montojo, Francisco; Anichtchik, Oleg; Dening, Yanina; Knels, Lilla; Pursche, Stefan; Jung, Roland; Jackson, Sandra; Gille, Gabriele; Spillantini, Maria Grazia; Reichmann, Heinz; Funk, Richard H W

    2010-01-19

    In patients with Parkinson's disease (PD), the associated pathology follows a characteristic pattern involving inter alia the enteric nervous system (ENS), the dorsal motor nucleus of the vagus (DMV), the intermediolateral nucleus of the spinal cord and the substantia nigra, providing the basis for the neuropathological staging of the disease. Here we report that intragastrically administered rotenone, a commonly used pesticide that inhibits Complex I of the mitochondrial respiratory chain, is able to reproduce PD pathological staging as found in patients. Our results show that low doses of chronically and intragastrically administered rotenone induce alpha-synuclein accumulation in all the above-mentioned nervous system structures of wild-type mice. Moreover, we also observed inflammation and alpha-synuclein phosphorylation in the ENS and DMV. HPLC analysis showed no rotenone levels in the systemic blood or the central nervous system (detection limit [rotenone]<20 nM) and mitochondrial Complex I measurements showed no systemic Complex I inhibition after 1.5 months of treatment. These alterations are sequential, appearing only in synaptically connected nervous structures, treatment time-dependent and accompanied by inflammatory signs and motor dysfunctions. These results strongly suggest that the local effect of pesticides on the ENS might be sufficient to induce PD-like progression and to reproduce the neuroanatomical and neurochemical features of PD staging. It provides new insight into how environmental factors could trigger PD and suggests a transsynaptic mechanism by which PD might spread throughout the central nervous system.

  14. Central Fos expression and conditioned flavor avoidance in rats following intragastric administration of bitter taste receptor ligands.

    PubMed

    Hao, Shuzhen; Dulake, Michelle; Espero, Elvis; Sternini, Catia; Raybould, Helen E; Rinaman, Linda

    2009-03-01

    G protein-coupled receptors that signal bitter taste (T2Rs) are expressed in the mucosal lining of the oral cavity and gastrointestinal (GI) tract. In mice, intragastric infusion of T2R ligands activates Fos expression within the caudal viscerosensory portion of the nucleus of the solitary tract (NTS) through a vagal pathway (Hao S, Sternini C, Raybould HE. Am J Physiol Regul Integr Comp Physiol 294: R33-R38, 2008). The present study was performed in rats to further characterize the distribution and chemical phenotypes of brain stem and forebrain neurons activated to express Fos after intragastric gavage of T2R ligands, and to determine a potential behavioral correlate of this central neural activation. Compared with relatively low brain stem and forebrain Fos expression in control rats gavaged intragastrically with water, rats gavaged intragastrically with T2R ligands displayed significantly increased activation of neurons within the caudal medial (visceral) NTS and caudal ventrolateral medulla, including noradrenergic neurons, and within the lateral parabrachial nucleus, central nucleus of the amygdala, and paraventricular nucleus of the hypothalamus. A behavioral correlate of this Fos activation was evidenced when rats avoided consuming flavors that previously were paired with intragastric gavage of T2R ligands. While unconditioned aversive responses to bitter tastants in the oral cavity are often sufficient to inhibit further consumption, a second line of defense may be provided postingestively by ligand-induced signaling at GI T2Rs that signal the brain via vagal sensory inputs to the caudal medulla.

  15. Comparison of different intubation techniques performed inside a moving ambulance: a manikin study.

    PubMed

    Wong, K B; Lui, C T; Chan, William Y W; Lau, T L; Tang, Simon Y H; Tsui, K L

    2014-08-01

    OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS

  16. OPIOID ANTAGONISTS BLOCK THE ACQUISITION OF ETHANOL-MEDIATED CONDITIONED TACTILE PREFERENCE IN INFANT RATS

    PubMed Central

    Nizhnikov, Michael Eduard; Pautassi, Ricardo Marcos; Truxell, Eric; Spear, Norman E.

    2009-01-01

    It has been difficult to find conditioned preference for tactile cues paired with ethanol intoxication in rats. Toward understanding the ontogeny of ethanol reinforcement, we aimed at establishing a simple and reliable procedure for: (i) assessing primary appetitive conditioning to ethanol in infant rats and (ii) discerning the role the opioid system plays in ethanol-mediated conditioning at this age. Experiment 1 determined the parameters (i.e., dose, interval of conditioning) for assessing ethanol-mediated conditioning. Pups were then trained with differential Pavlovian conditioning (Experiments 2 and 3) in which ethanol intoxication (1.0 – 2.0 g/kg, intragastrically or intraperitoneally delivered) was paired with a tactile stimulus (sandpaper) while an alternative texture signaled the absence of ethanol’s effects. Unpaired control conditions were also employed. Tactile preferences were assessed after two conditioning sessions. Paired rats spent significantly more time on sandpaper than unpaired controls, an effect that was greater following intragastric administration of 1.0 than 2.0 g/kg ethanol. This effect was replicated in Experiments 4a and 4c and found to be inhibited by pretreatment with general (naloxone) or specific (D-Pen-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 [CTOP] and naltrindole) opioid antagonists. Blood ethanol levels at conditioning were not altered by naloxone (Exp. 4b). The study outlines a procedure that reveals appetitive conditioning to ethanol by infant rats. The results are discussed in terms of a potential ethanol-induced activation of the endogenous opioid system during the onset of the intoxication process. PMID:19671461

  17. Anxiolytic, Psychostimulant, and Analgesic Effects of Various Volumes of Ethanol Solution in Different Concentrations, but in the Same Dose.

    PubMed

    Sudakov, S K; Alekseeva, E V; Bogdanova, N G; Kolpakov, A A; Nazarova, G A

    2016-05-01

    We studied the effect of ethanol (dose 2 g/kg) in various concentrations (5, 13, and 40%) and different volumes (40, 15.5, and 5 ml/kg) on the level of anxiety, locomotor activity, and pain sensitivity in rats. Administration of 40 ml/kg water to animals was followed by a significant increase in the time spent in the open arms of the elevated plus maze. Administration of water in a volume of 5 or 15.5 ml/kg had little effect on the level of anxiety. The greater was the volume of intragastrically administered ethanol, the stronger was the anxiolytic effect. The psychostimulant and analgesic effects of ethanol were more pronounced after administration of medium volumes and intermediate concentrations of ethanol-containing solutions. Since administration of these solutions cannot produce maximum blood concentration of ethanol, we believe that the observed effects are mainly related to the direct effect of ethanol on the stomach tissue.

  18. Daidzin, an antioxidant isoflavonoid, decreases blood alcohol levels and shortens sleep time induced by ethanol intoxication.

    PubMed

    Xie, C I; Lin, R C; Antony, V; Lumeng, L; Li, T K; Mai, K; Liu, C; Wang, Q D; Zhao, Z H; Wang, G F

    1994-12-01

    The extract from an edible vine, Pueraria lebata, has been reported to be efficacious in lessening alcohol intoxication. In this study, we have tested the efficacy of one of the major components, daidzin, from this plant extract. When ethanol (40% solution, 3 g/kg body weight) was given to fasted rats intragastrically, blood alcohol concentration (BAC) peaked at 30 min after alcohol ingestion and reached 1.77 +/- 0.14 mg/ml (mean values +/- SD, n = 6). If daidzin (30 mg/kg) was mixed with the ethanol solution and given to animals intragastrically, BAC was found to peak at 90 min after alcohol ingestion and reached only 1.20 +/- 0.30 mg/ml (n = 6) (p < 0.05 vs. controls). The ability of daidzin to delay and decrease peak BAC level after ethanol ingestion was also observed in fed animals. In both fasted and fed rats given alcohol without daidzin, BAC quickly declined after reaching its peak at 30 min. By contrast, BAC levels receded more slowly if daidzin was also fed to the animals. Daidzin showed a chronic effect. Rats fed daidzin for 7 days before ethanol challenge, but not on the day of challenge, also produced lower and later peak BAC levels. Interestingly, daidzin, whether fed to rats only once or chronically for 7 days, did not significantly alter activities of either alcohol dehydrogenase or mitochondrial aldehyde dehydrogenase in the liver. Further experiments demonstrated that daidzin shortened sleep time for rats receiving ethanol intragastrically (7 g/kg) but not intraperitoneally (2 g/kg). To test whether daidzin delayed stomach-emptying, [14C]polyethylene glycol was mixed with ethanol and fed to rats.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Conditioned effects of ethanol on the immune system.

    PubMed

    Gano, Anny; Pautassi, Ricardo Marcos; Doremus-Fitzwater, Tamara L; Deak, Terrence

    2017-04-01

    Several studies indicate that the immune system can be subjected to classical conditioning. Acute ethanol intoxication significantly modulates several pro-inflammatory cytokines (e.g. interleukins-1 and 6 [IL-1β and IL-6, respectively] and tumor necrosis factor alpha [TNFα])) in several brain areas, including amygdala (AMG), paraventricular nucleus (PVN), and hippocampus (HPC). It is unknown, however, whether cues associated with ethanol can elicit conditioned alterations in cytokine expression. The present study analyzed, in male Sprague-Dawley rats, whether ethanol-induced changes in the central cytokine response may be amenable to conditioning. In Experiments 1 and 2, the rats were given one or two pairings between a distinctive odor (conditional stimulus, CS) and the post-absorptive effects of a high (3.0 or 4.0 g/kg, Experiments 1 and 2, respectively) ethanol dose. Neither of these experiments revealed conditioning of IL-6, IL-1β, or TNFα, as measured via mRNA levels. Yet, re-exposure to the lemon-odor CS in Experiment 1 significantly increased C-Fos levels in the PVN. In Experiment 3, the rats were given four pairings between an odor CS and a moderate ethanol dose (2.0 g/kg), delivered intraperitoneally (i.p.) or intragastrically (i.g.). Re-exposure to the odor CS significantly increased IL-6 levels in HPC and AMG, an effect only evident in paired rats administered ethanol i.p. Overall, this study suggests that ethanol exposure can regulate the levels of IL-6 at HPC and AMG via classical conditioning mechanisms. These ethanol-induced, conditioned alterations in cytokine levels may ultimately affect the intake and motivational effects of ethanol. Impact statement This study examines, across three experiments, whether odor cues associated with ethanol exposure can condition changes in cytokine expression. The analysis of ethanol-induced conditioning of immune responses is a novel niche that can help understand the transition from social drinking to

  20. Randomized study comparing the efficacy of a self-retaining bicanaliculus intubation stent with Crawford intubation in patients with canalicular obstruction

    PubMed Central

    Tabatabaie, Syed Ziaeddin; Rajabi, Mohammad Taher; Rajabi, Mohammad Bagher; Eshraghi, Bahram

    2012-01-01

    Background The purpose of this study was to compare the efficacy of self-retaining stent (SRS) bicanalicular intubation with bicanalicular silicone (Crawford) intubation in patients with canalicular and punctal obstruction. Methods In this prospective, randomized clinical trial, 38 patients with canalicular or punctal obstruction (25 partial, 13 complete) and epiphora were randomized into two groups. Twenty-one patients (14 with partial and seven with complete obstruction) underwent SRS intubation and 17 patients underwent bicanalicular silicon intubation in a randomized fashion. Results After a mean follow-up of 6 months following tube removal, 16 (76%, 12 partial, four complete) of the 21 eyes in the SRS intubation group and 13 (76%, 10 partial, three complete) in the bicanalicular silicon intubation group had a successful outcome and remained symptom-free. For partial obstructions, the success rate was 85% and 90% for the SRS and bicanalicular silicon intubation groups, respectively. The corresponding values for complete obstruction were 63% and 50% for the SRS and bicanalicular silicon intubation groups, respectively. Conclusion SRS could effectively substitute for a more extensive procedure such as bicanalicular silicon intubation in patients with canalicular obstruction, particularly those with partial obstruction. The newly developed SRS intubation procedure has the advantages of simple, easy implementation and extubation, low cost, and a lower rate of trauma when compared with bicanalicular silicon intubation. PMID:22259230

  1. Comparison of 24-hour intragastric pH using four liquid formulations of lansoprazole and omeprazole.

    PubMed

    Sharma, V K

    1999-12-01

    The results of previous studies evaluating the effect of four liquid formulations of proton-pump inhibitors on 24-hour intragastric pH are described. Patients with a gastrostomy who were resident in a Veterans Affairs medical center or its affiliated nursing home were eligible for enrollment in one of four open-label studies in which each patient served as his own control. Patients underwent 24-hour intragastric pH studies before and after receiving seven consecutive days of one of the following liquid formulations of a proton-pump inhibitor administered once daily: omeprazole granules 20 mg in orange juice, lansoprazole granules 30 mg in orange juice, simplified omeprazole suspension 20 mg, and simplified lansoprazole suspension 30 mg. The suspensions were prepared with 10 mL of 8.4% sodium bicarbonate solution. Mean intragastric pH was measured, as was the time pH stayed above 3.0 and 4.0 during the 24-hour period. Six to 14 patients participated in each study. The mean posttreatment pH was 4.9+/-0.8, 4.7+/-0.6, 4.1+/-1.5, and 5.1+/-1.1 for omeprazole granules in orange juice, lansoprazole granules in orange juice, simplified omeprazole suspension, and simplified lansoprazole suspension, respectively. Both drugs in orange juice maintained pH above 4.0 longer than 14 hours and above 3.0 for close to 20 hours, which are the levels deemed optimal for healing erosive esophagitis and duodenal ulcers, respectively. Simplified lansoprazole suspension maintained pH above those thresholds for the optimal times, but simplified omeprazole suspension did not (20 and 15 hr above 3.0, 17 and 12 hr above 4.0 for lansoprazole and omeprazole, respectively). Further development of liquid formulations of proton-pump inhibitors may have important implications for the treatment of acid-related diseases in patients, including children, who are unable to swallow capsules.

  2. Inhibitory effects of ethanol on phosphatidylinositol breakdown in pancreatic acini

    SciTech Connect

    Towner, S.J.; Peppin, J.F.; Tsukamoto, H.

    1986-03-01

    Recently the physiological relationship between the phospholipid effect and secretagogue-induced cellular function has begun to be understood. In this study, the authors investigated acute and chronic effects of ethanol on phosphatidylinositol (PI) synthesis and breakdown in pancreatic acini. Five pairs of male Wistar rats were intragastrically infused for 30 days with high fat diet (25% total calories) plus ethanol or isocaloric dextrose. After intoxication, isolated in HEPES media, followed by 30 min incubation with CCK-8 (0, 100, 300 or 600 pM) and ethanol (0 or 100 mM). Acinar lipids were extracted and counted for labeled PI. Incorporation of /sup 3/H-inositol into alcoholic acinar PI was reduced to 38.2% of that in controls. A percent maximal PI break down by CCK-8 was similar in the two groups (13-24% of basal). However, the magnitude of PI breakdown was markedly lower in alcoholic acini (482 vs 1081 dpm) due to the decreased PI synthesis rate. The presence of 100 mM ethanol in the media further inhibited the breakdown by 50% in this group. These results strongly indicate that chronic ethanol intoxication inhibits PI synthesis and breakdown in pancreatic acini, and that this inhibition can be potentiated by acute ethanol administration.

  3. Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation.

    PubMed

    Rodrigues, Estela T; Suazo, Iván C; Guimarães, Antonio S

    2009-01-01

    The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.

  4. Preparation of the patient and the airway for awake intubation

    PubMed Central

    Ramkumar, Venkateswaran

    2011-01-01

    Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned. PMID:22174458

  5. Reconstruction of soft plate necrosis after endotracheal intubation.

    PubMed

    Lee, Hyuck Jae; Lim, So Young; Pyon, Jai-Kyong; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung

    2014-01-01

    Uvular necrosis after long-term endotracheal intubation has been previously reported, but there have been no reports regarding soft palate necrosis after endotracheal intubation. Recently, we encountered 2 patients who had a high degree of soft palate necrosis following endotracheal intubation during long-term care in the intensive care unit. This study reports noncongenital soft palate cleft caused by endotracheal intubation. Two patients, aged 30 and 38 years, with noncongenital cleft palate were treated with pharyngeal flap and/or palatoplasty at our institution from March 2011 to May 2013. Initially, the patients complained of acquired speech disorder and severe oronasal regurgitation caused by a palatal defect. Speech ability was evaluated preoperatively and postoperatively by a perceptual language test and nasopharyngoscopy. The cleft soft palates of both patients were completely repaired, and the aforementioned symptoms improved after surgery. Postoperative courses were uneventful in both of the cases, and neither patient experienced a recurrence. Although rare, long-term intensive care unit care with endotracheal intubation can cause noncongenital soft palate cleft. In cases with iatrogenic cleft palate that does not heal with conservative treatment, surgical procedures such as pharyngeal flap and palatoplasty can be helpful.

  6. Endotracheal Administration of Sufentanil and Tetracaine During Awake Fiberoptic Intubation.

    PubMed

    Ji, Meng; Tao, Jun; Cheng, Min; Wang, Qingli

    2016-01-01

    Combined use of local anesthetics and low-dose opioids enhances the effects of local anesthetics. This study aimed to evaluate the efficacy of combined administration of sufentanil and tetracaine through the cricothyroid membrane during awake nasal intubation using fiberoptic bronchoscopy in patients with difficult airways. Forty patients were divided into 2 groups: group A received endotracheal administration of 25 μg of sufentanil and 2 mL of 1% tetracaine mixture; group B received endotracheal administration of 2 mL 1% tetracaine and routine local anesthetic sprays followed by slow intravenous injection of 25 μg of sufentanil. The results showed that endotracheal intubation was safely completed in all patients and vital signs including blood pressure, heart rate, and pulse oxygen saturation were not significantly different between groups A and B. However, time required for local anesthesia to take effect, time required to complete intubation, cough reflex, patient tolerance during intubation, and hemodynamic indices were significantly better in group A than in group B. In conclusion, our results suggest that endotracheal administration of sufentanil combined with tetracaine is safe, effective, and feasible in the context of awake nasal intubation using fiberoptic bronchoscopy.

  7. Bioavailability of ethanol is reduced in several commonly used liquid diets.

    PubMed

    de Fiebre, N C; de Fiebre, C M; Booker, T K; Nelson, S; Collins, A C

    1994-01-01

    Liquid diets are often used as a vehicle for chronically treating laboratory animals with ethanol. However, a recent report suggested that one or more components of these diets may bind ethanol which could result in a decrease in the bioavailability of ethanol. Consequently, we compared the blood ethanol concentration vs. time curves obtained following the intragastric (i.g.) administration of ethanol dissolved in water or in one of three liquid diets (Bioserv AIN-76, Sustacal, or Carnation Slender) using the long-sleep (LS) and short-sleep (SS) mouse lines. The initial rates of absorption were generally the same for the water-ethanol and diet-ethanol groups, but the diets generally produced lower peak levels and the areas under the ethanol concentration-time curves were less for all of the liquid diets than for the control, ethanol-water solution. In vitro dialysis experiments indicated that the Bioserv diet binds ethanol in a saturable manner. Therefore, it may be that the slower release of ethanol, which should occur as a result of binding, serves to increase the role of first pass metabolism in regulating ethanol concentrations following oral administration. Because the effects of the diets were seen even after pyrazole treatment, it may be that the lower blood ethanol levels arise because metabolism by gastric ADH, rather than hepatic ADH, is responsible for a major portion of ethanol metabolism as ethanol is slowly released by the diets. If so, the observation that the diet/water differences were uniformly greater in the LS mice may indicate that LS-SS differences in gastric ADH exist.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Estrogen-dependent enhancement of NO production in the nucleus tractus solitarius contributes to ethanol-induced hypotension in conscious female rats

    PubMed Central

    Li, Guichu; Abdel-Rahman, Abdel A.

    2009-01-01

    Background Our previous pharmacological and cellular studies showed that peripheral (cardiac and vascular) NOS-derived NO is implicated in the estrogen-dependent hypotensive action of ethanol in female rats. The objective of this study was to test the hypothesis that enhanced NO production in the nucleus tractus solitarius (NTS) is implicated in the estrogen-dependent hypotensive action of ethanol. Methods To achieve this goal, we utilized in vivo electrochemistry to measure real time changes in neuronal NO to investigate the acute effects of intragastric ethanol (0, 0.5 or 1 g/kg) on NO in NTS neurons, blood pressure (BP) and heart rate (HR) in conscious female rats in the absence (ovariectomized, OVX, rats) or presence of estrogen. Results In sham operated (SO) rats, ethanol elicited dose-related increase in NTS NO and reduction in BP. These neurochemical and blood pressure effects of ethanol were absent in OVX rats. Whether the neurochemical effect of ethanol and the associated hypotension are dependent on rapid estrogen signaling was investigated. In OVX rats pretreated, 30 min earlier, with estrogen (E2, 1µg/kg), intragastric ethanol (1 g/kg) increased NTS NO and reduced BP and these responses were comparable to those obtained in SO rats. Conclusions The present findings suggest that increased production of NO in NTS neurons contributes to ethanol-evoked hypotension in female rats. Further, ethanol enhancement of neuronal NO production in the brainstem is dependent on rapid estrogen signaling. PMID:19076118

  9. Anemia and genotoxicity induced by sub-chronic intragastric treatment of rats with titanium dioxide nanoparticles.

    PubMed

    Grissa, Intissar; Elghoul, Jaber; Ezzi, Lobna; Chakroun, Sana; Kerkeni, Emna; Hassine, Mohsen; El Mir, Lassaad; Mehdi, Meriem; Ben Cheikh, Hassen; Haouas, Zohra

    2015-12-01

    Titanium dioxide nanoparticles (TiO2 NPs) are widely used for their whiteness and opacity. We investigated the hematological effects and genotoxicity of anatase TiO2 NPs following sub-chronic oral gavage treatment. TiO2-NPs were characterized by X-ray diffractometry (XRD), X-ray photoelectron spectroscopy (XPS), and transmission electron microscopy (TEM). Wistar rats were treated with anatase TiO2 NPs by intragastric administration for 60 days. Hematological analysis showed a significant decrease in RBC and HCT and a significant increase in MCV, PLT, MPV and WBC at higher doses. Furthermore, abnormally shaped red cells, sometimes containing micronuclei, and hyper-segmented neutrophil nuclei were observed with TiO2 NPs treatment. The micronucleus test revealed damage to chromosomes in rat bone marrow at 100 and 200mg/kg bw; the comet assay showed significant DNA damage at the same doses.

  10. Intragastric inulin as a measure of mucosal damage caused by aspirin

    SciTech Connect

    Wittmers, L.E. Jr.; Anderson, L.A.; Fall, M.M.; Alich, A.A. )

    1990-11-01

    In an attempt to find a method of gastric mucosal damage assessment that yields consistent results, the experiments presented here employed the measurement of the movement of inulin out of the gastric contents into the stomach wall and vascular compartment as an estimate of mucosal damage. Anesthetized male Sprague-Dawley rats were functionally nephrectomized and were administered a control or test solution containing 3H-inulin. The test solutions contained one of three doses of aspirin. Blood samples were taken at 15-min intervals over a 90-min exposure period. The stomach was removed from the animal and full-thickness tissue samples taken for measurement of 3H-inulin content. When the gastric mucosa was exposed to the test agents, there was a significantly greater accumulation of inulin in the body and antrum as well as in the plasma when compared to controls. We conclude that intragastric inulin can be employed to estimate gastric mucosal damage.

  11. Effect of carbonated water on gastric emptying and intragastric meal distribution.

    PubMed

    Pouderoux, P; Friedman, N; Shirazi, P; Ringelstein, J G; Keshavarzian, A

    1997-01-01

    Carbonated water has long been advocated to relieve dyspeptic symptoms, suggesting that it may alter gastric motility via gastric distension. This study aimed to determine the effect of carbonated water on gastric emptying of a radiolabeled mixed meal in eight healthy volunteers. Meal emptying and its distribution within the stomach were assessed with carbonated and still water in a crossover study. Emptying of both solid and liquid, including the duration of the lag phase, was identical for both drinks. However, the proximal stomach contained a greater proportion of solids (74 +/- 7% vs 56 +/- 8%, P < 0.05) and liquids (43 +/- 5% vs 27 +/- 4%, P < 0.05) with carbonated water as opposed to still water. Retention of the meal within the proximal stomach ended with the lag phase and was likely related to proximal distension. In conclusion, carbonated water did not alter overall gastric emptying but profoundly modified intragastric distribution of the meal.

  12. Intragastric pressure: Useful indicator in the management of congenital diaphragmatic hernia

    PubMed Central

    Mandal, Kartik Chandra; Halder, Pankaj; Barman, Shibsankar; Kumar, Rajarshi; Mukhopadhyay, Biswanath; Shukla, Ram Mohan

    2016-01-01

    Aims: To assess the role of measuring of intragastric pressure (IGP) during closure of congenital diaphragmatic hernia. Materials and Methods: Thirty-two cases were included in the study (August 2008 to February 2014), and IGP has been measured intraoperatively during closure. Result: Patients were categorized in group A (15 patients), group B (14 patients) and group C (3 patients). In group C, IGP was more than 30 cm of water pressure and all of tehm required creation of ventral hernia and ventilator support. Conclusion: Measurement of IGP as an objective, noninvasive and simple method to evaluate intra-abdominal pressure and prevention of abdominal compartment syndrome and intraoperative IGP value determines the types of abdominal closure. PMID:27695209

  13. Early effects of oral administration of omeprazole and roxatidine on intragastric pH

    PubMed Central

    Iida, Hiroshi; Kato, Shingo; Sekino, Yusuke; Sakai, Eiji; Uchiyama, Takashi; Endo, Hiroki; Hosono, Kunihiro; Sakamoto, Yasunari; Fujita, Koji; Yoneda, Masato; Koide, Tomoko; Takahashi, Hirokazu; Tokoro, Chikako; Goto, Ayumu; Abe, Yasunobu; Kobayashi, Noritoshi; Kubota, Kensuke; Gotoh, Eiji; Maeda, Shin; Nakajima, Atsushi; Inamori, Masahiko

    2012-01-01

    Objective: The ideal medication for the treatment of acid-related diseases, e.g., peptic ulcers, stress-related gastric bleeding, functional dyspepsia, and gastroesophageal reflux disease, should have a rapid onset of action to promote hemostasis and relieve the symptoms. The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral administration of a proton pump inhibitor, omeprazole 20 mg, and an H2-receptor antagonist, roxatidine 75 mg. Methods: Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 h after single oral administration of omeprazole 20 mg and roxatidine 75 mg. Each administration was separated by a 7-d washout period. Results: During the 6-h study period, the average pH after administration of roxatidine was higher than that after administration of omeprazole (median: 4.45 vs. 2.65; P=0.0367). Also during the 6-h study period, a longer duration of maintenance at pH above 2, 5, and 6 was observed after administration of roxatidine 75 mg than after administration of omeprazole 20 mg (median: 90.6% vs. 55.2%, P=0.0284; 43.7% vs. 10.6%, P=0.0125; 40.3% vs. 3.3%, P=0.0125; respectively). Conclusions: In Helicobacter pylori-negative healthy male subjects, oral administration of roxatidine 75 mg increased the intragastric pH more rapidly than that of omeprazole 20 mg. PMID:22205617

  14. Ischemic subglottic damage following a short-time intubation.

    PubMed

    Silva, Marta João; Aparício, José; Mota, Teresa; Spratley, Jorge; Ribeiro, Augusto

    2008-12-01

    The objective of this study is to report a case of ischemic subglottic damage after a short-time intubation with a large, overinflated endotracheal tube cuff in a child. The study uses individual case report. A 6-year-old boy was admitted to the pediatric intensive care unit after a head trauma intubated with a 5.5-mm inner diameter cuffed endotracheal tube overinflated with 16 ml of air that produced a pressure of more than 120 cm H2O. The endotracheal tube cuff pressure produced by inflation was reduced after 4 h. The child presented postextubation stridor with subglottic edema. Inappropriate handling of tracheal intubation without accurate measurement of endotracheal tube size and intracuff pressures of endotracheal tubes, can cause airway trauma and place patients at risk.

  15. Dental trauma prevention during endotracheal intubation--review of literature.

    PubMed

    Mańka-Malara, Katarzyna; Gawlak, Dominika; Hovhannisyan, Anahit; Klikowska, Marta; Kostrzewa-Janicka, Jolanta

    2015-01-01

    Endotracheal intubation is a procedure performed during general anaesthesia with the use of an endotracheal tube in order to maintain a patent airway. This routinely used procedure is connected with a risk of complications within the region of the masticatory system. Trauma of teeth, their surrounding structures and the soft tissue of the oral cavity is observed in app. 1.38 per 1000 procedures. The main causes of this damage are the surgical skills and experience of the surgeon, the anatomical conditions present and the mode of conducting the procedure. In order to reduce the risk of postoperative complications, patients with a high risk of sustaining an injury during endotracheal intubation should be equipped with elastic mouthguards, which reduces the possibility of damage. The scoring in a scale of endotracheal intubation difficulty should be used for qualification for the use of such mouthguards.

  16. [Tracheal rupture after orotracheal intubation in intensive care].

    PubMed

    Hayi-Slayman, D; Page, M; Ben Cheikh, A; Christin, F; Ber, C-E; Rimmelé, T

    2007-06-01

    We report a case of an iatrogenic tracheal rupture following an endotracheal intubation. The 78-year-old patient was admitted to the intensive care unit because of an acute respiratory failure related to a severe nosocomial pneumonia occurring 21 days after an abdominal aorta surgery. His main antecedent was a cigarette smoke-induced chronic obstructive pulmonary disease. Immediately after being intubated, a traumatic tracheobronchial rupture was suspected because of the sudden appearance of cervicothoracic subcutaneous emphysema. A thoracic computed tomography with multiplanar reformations confirmed the diagnosis and the evolution was unfortunately rapidly unfavourable. Risk factors, clinical and radiological aspects, and management of this rare but serious complication of endotracheal intubation will be discussed.

  17. Effects of ethanol on pregnant rats and their offspring.

    PubMed

    Abel, E L

    1978-04-14

    Pregnant rats were intubated with either 1.0 or 2.0 g/kg of ethanol daily throughout gestation. Pair-fed vehicle-treated, and nontreated rats fed ad libitum, served as control groups for ethanol-treated animals. Ethanol treatment reduced food and water consumption and attenuated the gain in body weight of pregnant animals relative to nontreated animals fed ad libitum. Litter size, litter weight, and the mean weight per pup were reduced in both the ethanol-treated and pair-fed control groups. There was no evidence of gross malformations in any of the off-spring. Since the reduction in litter size and litter weights did not differ significantly between ethanol-treated and pair-fed controls, the effects of treatment with ethanol appeared to be related to a reduction in maternal intake of calories rather than to the direct effect of ethanol on the developing fetus. There were no significant differences between any of the groups of offspring on one-way shock avoidance learning, water maze escape learning, spontaneous alternation, or brightness discrimination learning in tests beginning at 75 days of age. Thus, at the doses of alcohol used in this study, there was no evidence of behavioral teratogenesis comparable to that reported for higher doses in animals or in man characterized by the fetal alcohol syndrome.

  18. Developing competency in interns for endotracheal intubation: An educational article

    PubMed Central

    Makwana, Harsha Dhirubhai; Suthar, Nilay N; Gajjar, Mehul P; Thakor, Advait V

    2016-01-01

    Background: Our existing undergraduate curriculum lacks developing competency for endotracheal intubation. Even though it is a lifesaving procedure, interns are exposed only during their posting in anesthesia or emergency medicine and so, when need arises, they fail to perform endotracheal intubation and it leads to catastrophes. Aims and Objectives: The aim of this study was to develop competency in interns for endotracheal intubation. Materials and Methods: A study was conducted on fifty interns of medical college. Lecture and demonstration were used for cognitive domain and one-to-one training and practice on manikin for affective and psychomotor domains, respectively. Live demonstration on patients was done whenever possible. Gain in knowledge was evaluated by pre- and post-test using standardized validated questionnaire. Skills were assessed by direct observation of procedural skill on manikin, split in steps: Laryngoscopy, intubation, and ventilation. Session was evaluated using feedback questionnaire and Likert scale. Results: Interns showed mean marks of 8.12 ± 1.63 in pretest compared to 13.86 ± 1.06 of posttest with a gain of 34.8% (P = 0.0001), which is highly significant. Twenty-two percent interns completed all steps correctly in the first attempt, 62% in the second attempt, while 16% required third attempt to correctly complete all steps. Conclusion: This training developed competency for basic knowledge and practice of endotracheal intubation in interns adequately on manikin. Training for endotracheal intubation should be carried out at the beginning of internship before they go for clinical practice and repeated during their rotation of Anesthesia and Emergency Medicine Department, so they can retain their competency for it and can do later on whenever required. PMID:27563588

  19. Metabolic and structural consequences of ethanol and chloroquin administration during gestation on the developing fetus

    SciTech Connect

    Sharma, A.; Rawat, A.K.

    1987-05-01

    In the present study the effects of ethanol and chloroquin administration during gestation have been investigated on the developing rat fetus. Ethanol was given in liquid Sustacal diet as 30% of calories and controls were fed isocaloric sucrose-diet. Chloroquin was given intragastrically corresponding controls received saline. Chloroquin resulted in prenatal growth retardation leading to maximum decrease of 46% in body weight of the fetus. It also resulted in 30% higher incidence of hepatomegaly; 15% higher incidence of liquification of visceral organs; 34% decrease in the ossification of sternum; 9% higher defects of cleft palate, wrist drop, clubbed foot and brain liquification compared to the corresponding controls. Ethanol resulted in pre and post-natal growth retardation, cleft palate, still births and lowered brain weights. Fetuses from the ethanol-fed group also showed inhibited protein synthesis, RNA and DNA synthesis in the brain compared to the controls.

  20. Extended anaesthesia and nasotracheal intubation of a red kangaroo (Macropus rufus).

    PubMed

    Bauquier, S H; Golder, F J

    2010-11-01

    Anaesthesia requires maintenance of a patent airway. Nasotracheal intubation of a red kangaroo (Macropus rufus) was performed when the inability to open the animal’s mouth prevented orotracheal intubation. Nasotracheal intubation was easy to perform, secured the airway and permitted delivery of supplemental oxygen, isoflurane and intermittent positive pressure ventilation.

  1. Neonatal sensitization to ethanol-induced breathing disruptions as a function of late prenatal exposure to the drug in the rat: modulatory effects of ethanol's chemosensory cues.

    PubMed

    Cullere, Marcela; Macchione, Ana Fabiola; Haymal, Beatriz; Paradelo, Martin; Langer, Marcos Daniel; Spear, Norman E; Molina, Juan Carlos

    2015-02-01

    Preclinical and clinical studies have systematically demonstrated abrupt changes in fetal respiratory patterns when the unborn organism is exposed to the effects of maternal ethanol intoxication. In subprimates, chronic exposure to this drug during gestation and infancy results in marked alterations of the plasticity of the respiratory network. These alterations are manifested in terms of an early incapability to overcome deleterious effects of hypoxic events as well as in terms of sensitization to ethanol's depressant effects upon breathing patterns. It has also been demonstrated that near term rat fetuses process ethanol's chemosensory cues when the drug contaminates the amniotic fluid and that associative learning processes occur due to the temporal contiguity existing between these cues and different ethanol-related physiological effects. In the present study during the course of late gestation (gestational days 17-20), pregnant rats were intragastrically administered with either 0.0 or 2.0 g/kg ethanol. Seven-day-old pups derived of these dams were evaluated in terms of respiration rates (breaths/min) and apneas when subjected to different experimental conditions. These conditions were defined by postnatal exposure to the drug (intragastric administrations of either 0.0, 0.5, 1.0 or 2.0 g/kg ethanol), postadministration time of evaluation (5-10 or 30-35 min) and olfactory context at test (no explicit ambient odor or ethanol ambient odor). The results, obtained via whole body plethysmography, indicated that brief prenatal experience with the drug sensitized the organisms to ethanol's depressant effects particularly when employing the higher ethanol doses. In turn, presence of ethanol odor at test potentiated the above mentioned respiratory alterations. Prenatal treatment with ethanol was not found to alter pharmacokinetic profiles resulting from postnatal exposure to the drug or to affect different morphometric parameters related with lung development. These

  2. The Bullard laryngoscope. Reports of two cases of difficult intubation.

    PubMed

    Midttun, M; Laerkholm Hansen, C; Jensen, K; Pedersen, T

    1994-04-01

    The Bullard laryngoscope is a new combination of a fibreoptic light source and an anatomically shaped rigid blade, to aid visualization of the larynx. We present two patients with expected severe difficult endotracheal intubation and describe their anaesthetic management. Our experience confirms previous observations which showed that the Bullard laryngoscope provides an excellent view of the vocal cords in patients with severe difficult airways.

  3. Effectiveness and safety of a protocol for promotion of early intragastric feeding in critically ill children.

    PubMed

    Briassoulis, G C; Zavras, N J; Hatzis MD, T D

    2001-04-01

    OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastric feeding (EPIGF) in critically ill children. DESIGN: A prospective clinical study. SETTING: Pediatric intensive care unit in a tertiary care children's hospital. PATIENTS: Seventy-one consecutively enrolled critically ill children requiring prolonged mechanical ventilation. INTERVENTIONS: Full-strength intragastric tube feedings (Nutrison Pediatric, Standard) were initiated within 12 hrs of the study-entry event. Enteral feedings were advanced to a target volume of energy intake = 1/2, 1, 5/4, 6/4, and 6/4 of the predicted basal metabolic rate (PBMR) on days 1-5, respectively. MEASUREMENTS AND MAIN RESULTS: Nutritional status by the caloric intake, recommended dietary allowances, PBMR, predicted energy expenditure (PEE), anthropometry, and clinical indices were evaluated on days 1 and 5. Safety was assessed by the clinical course of disease, laboratory findings, and occurrence of complications. Success was determined by accomplishment of the PEE target. The early success rate was 94.4% and predicted late enteral feeding success accurately (p =.0001). Caloric intake approached PBMR the second day (43 +/- 1.7 kcal/kg/day vs. 43.2 +/- 1.1 kcal/kg/day) and PEE the fifth day (66.2 +/- 2.7 kcal/kg/day vs. 67.7 +/- 6.4 kcal/kg/day). Multivariate stepwise regression analysis showed that poor outcome and a high Therapeutic Intervention Scoring System score correlated with failure of EPIGF (p <.0001). Patients who succeeded EPIGF had significantly higher myocardial ejection (65% vs. 43%; p <.0001) or shortening fractions (34% vs. 20%; p =.0001) on day 1 than those who failed. Patients tolerated EPIGF well; 9.9% developed nosocomial pneumonia, 5.6% developed diarrhea, and 8.5% needed treatment with cisapride because of a delay of gastric emptying. The mortality rate (5.6%) was different between initial and final success and failure groups (p <.0001) and was lower than predicted

  4. The Obalon swallowable intragastric balloon in pediatric and adolescent morbid obesity

    PubMed Central

    De Peppo, Francesco; Caccamo, Romina; Adorisio, Ottavio; Ceriati, Emanuela; Marchetti, Paola; Contursi, Antonio; Alterio, Arianna; Della Corte, Claudia; Manco, Malnia; Nobili, Valerio

    2017-01-01

    Background and study aims Incidence of morbid obesity has grown dramatically in the last half century and this phenomenon affects with particular severity the pediatric population. Dietary restrictions and careful programs to improve lifestyle are often ineffective to manage this particular group of patients, due to poor compliance typical of the adolescence. The aim of this study was to evaluate the effectiveness of a new intragastric balloon for treatment of morbidly obese children. Patients and methods A new swallowable intragastric balloon (Obalon) has been used for the first time in 17 obese children in order to assess its safety and effectiveness in terms of reduction in excess weight. In 9 of 17 children a second balloon was placed 30 to 40 days after the first insertion. All devices were endoscopically removed after a mean time of 18 weeks. Results In the group of 16 patients who completed the study (1 patient still under treatment) mean weight decreased from 95.8 ± 18.4 Kg to 83.6 ± 27.1 (P < 0.05). Mean body mass index (BMI) decreased from 35.27± 5.89 (range 30.4 – 48) to 32.25 ± 7.1 (range 23.5 – 45.7) (P > 0.05); mean excess weight, calculated according to Cole’s curves for pediatric populations, decreased from 36.2 ± 15.9 to 29.4 ± 18.3 Kg (P = 0.14), with an %EWL of 20.1 ± 9.8 (range 2.3 – 35.1). Waist circumference decreased from 109 ± 12.3 cm to 99 ± 10.5 cm (P < 0.05). Conclusions Obalon can be administered easily without complications, inducing an appreciable weight loss with a statistically significant reduction in BMI and an improvement in associated comorbidities. PMID:28180149

  5. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation in Cadavers—Cadavers vs. Patients, the Effect of Repeated Intubations, and the Effect of Type II Odontoid Fracture on C1-C2 Motion

    PubMed Central

    Hindman, Bradley J.; From, Robert P.; Fontes, Ricardo B.; Traynelis, Vincent C.; Todd, Michael M.; Zimmerman, M. Bridget; Puttlitz, Christian M.; Santoni, Brandon G.

    2015-01-01

    Introduction The aims of this study were to characterize: 1) cadaver intubation biomechanics, including the effect of repeated intubations; and 2) the relationship between intubation force and the motion of an injured cervical segment. Methods Fourteen cadavers were serially intubated using force-sensing Macintosh and Airtraq laryngoscopes in random order, with simultaneous cervical spine motion recorded with lateral fluoroscopy. Motion of the C1-C2 segment was measured in the intact and injured state (Type II odontoid fracture). Injured C1-C2 motion was proportionately corrected for changes in intubation forces that occurred with repeated intubations. Results Cadaver intubation biomechanics were comparable to those of patients in all parameters other than C2-C5 extension. In cadavers, intubation force (Set 2/Set1 force ratio = 0.61 [95% CI: 0.46, 0.81]; P=0.002) and Oc-C5 extension (Set 2 –Set 1 difference = −6.1 degrees [95% CI: −11.4, −0.9]; P=0.025) decreased with repeated intubations. In cadavers, C1-C2 extension did not differ: 1) between intact and injured states; or 2) in the injured state, between laryngoscopes (with and without force correction). With force correction, in the injured state, C1-C2 subluxation was greater with the Airtraq (mean difference 2.8 mm [95% CI: 0.7, 4.9 mm]; P=0.004). Discussion With limitations, cadavers may be clinically relevant models of intubation biomechanics and cervical spine motion. In the setting of a Type II odontoid fracture, C1-C2 motion during intubation with either the Macintosh or Airtraq does not appear to greatly exceed physiologic values or to have a high likelihood of hyperextension or direct cord compression. PMID:26288267

  6. Naloxone blocks ethanol-mediated appetitive conditioning and locomotor activation in adolescent rats.

    PubMed

    Pautassi, Ricardo Marcos; Nizhnikov, Michael E; Acevedo, María Belén; Spear, Norman E

    2011-01-01

    Age-related differences in ethanol sensitivity could put adolescents at risk for developing alcohol-related problems. Little information exists, however, about adolescent sensitivity to ethanol's appetitive effects and the neurobiological mechanisms underlying ethanol reinforcement during this developmental stage. The present study assessed the role of the opioid system in adolescent rats in an appetitive second-order schedule of ethanol reinforcement and ethanol-induced locomotor stimulation. On postnatal day 32 (PD32), animals were pretreated with the general opioid antagonist naloxone (0.0, 0.75, 1.50, or 2.5 mg/kg) and then given pairings of ethanol (0.0 or 2.0 g/kg, intragastrically) with intraoral pulses of water (conditioned stimulus 1 [CS₁], first-order conditioning phase). CS₁ delivery occurred 30-45 min after ethanol administration when the effect of ethanol was assumed to be appetitive. On PD33, adolescents were exposed to CS₁ (second-order conditioning phase) while in a chamber featuring distinctive exteroceptive cues (CS₂). Preference for CS₂ was then tested. Adolescents given CS₁-ethanol pairings exhibited greater preference for CS₂ than controls, indicating ethanol-mediated reinforcement, but only when not pretreated with naloxone. Blood alcohol levels during conditioning were not altered by naloxone. Experiment 2 revealed that ethanol-induced locomotor activation soon after administration, and naloxone dose-dependently suppressed this stimulating effect. The present study indicates that adolescent rats are sensitive to ethanol's reinforcing and locomotor-stimulating effects. Both effects of ethanol appear to be mediated by endogenous opioid system activation.

  7. NALOXONE BLOCKS ETHANOL-MEDIATED APPETITIVE CONDITIONING AND LOCOMOTOR ACTIVATION IN ADOLESCENT RATS

    PubMed Central

    Pautassi, Ricardo Marcos; Nizhnikov, Michael E.; Acevedo, María Belén; Spear, Norman E.

    2010-01-01

    Age-related differences in ethanol sensitivity could put adolescents at risk for developing alcohol-related problems. Little information exists, however, about adolescent sensitivity to ethanol's appetitive effects and the neurobiological mechanisms underlying ethanol reinforcement during this developmental stage. The present study assessed the role of the opioid system in adolescent rats in an appetitive second-order schedule of ethanol reinforcement and ethanol-induced locomotor stimulation. On postnatal day 32 (PD32), animals were pretreated with the general opioid antagonist naloxone (0.0, 0.75, 1.50, or 2.5 mg/kg) and then given pairings of ethanol (0.0 or 2.0 g/kg, intragastrically) with intraoral pulses of water (conditioned stimulus 1 [CS1], first-order conditioning phase). CS1 delivery occurred 30–45 min after ethanol administration when the effect of ethanol was assumed to be appetitive. On PD33, adolescents were exposed to CS1 (second-order conditioning phase) while in a chamber featuring distinctive exteroceptive cues (CS2). Preference for CS2 was then tested. Adolescents given CS1-ethanol pairings exhibited greater preference for CS2 than controls, indicating ethanol-mediated reinforcement, but only when not pretreated with naloxone. Blood alcohol levels during conditioning were not altered by naloxone. Experiment 2 revealed that ethanol induced locomotor activation soon after administration, and naloxone dose-dependently suppressed this stimulating effect. The present study indicates that adolescent rats are sensitive to ethanol's reinforcing and locomotor-stimulating effects. Both effects of ethanol appear to be mediated by endogenous opioid system activation. PMID:20708642

  8. Repeated Binge Ethanol Administration During Adolescence Enhances Voluntary Sweetened Ethanol Intake in Young Adulthood in Male and Female Rats

    PubMed Central

    Maldonado-Devincci, Antoniette M.; Alipour, Kent K.; Michael, Laura A.; Kirstein, Cheryl L.

    2014-01-01

    Binge alcohol consumption is a rising concern in the United States, especially among adolescents. During this developmental period alcohol use is usually initiated and has been shown to cause detrimental effects on brain structure and function as well as cognitive/behavioral impairments in rats. Binge models, where animals are repeatedly administered high doses of ethanol typically over a period of three or four days cause these effects. There has been little work conducted aimed at investigating the long-term behavioral consequences of repeated binge administration during adolescence on later ethanol-induced behavior in young adulthood and adulthood. The repeated four-day binge model may serve as a good approximate for patterns of human adolescent alcohol consumption as this is similar to a “bender” in human alcoholics. The present set of experiments examined the dose-response and sex-related differences induced by repeated binge ethanol administration during adolescence on sweetened ethanol (Experiment 1) or saccharin (Experiment 2) intake in young adulthood. In both experiments, on postnatal days (PND) 28–31, PND 35–38 and PND 42–45, ethanol (1.5, 3.0 or 5.0 g/kg) or water was administered intragastrically to adolescent rats. Rats underwent abstinence from PND 46–59. Subsequently, in young adulthood, ethanol and saccharin intake were assessed. Exposure to any dose of ethanol during adolescence significantly enhanced ethanol intake in adulthood. However, while female rats had higher overall g/kg intake, males appear to be more vulnerable to the impact of adolescent ethanol exposure on subsequently increased ethanol intake in young adulthood. Exposure to ethanol during adolescence did not alter saccharin consumption in young adulthood in male or female rats. Considering that adolescence is the developmental period in which ethanol experimentation and consumption is usually initiated, the present set of experiments demonstrate the importance of

  9. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

    PubMed Central

    Rajabi, Mohammad Taher; Zavarzadeh, Najmeh; Mahmoudi, Alireza; Johari, Mohammad Karim; Hosseini, Seyedeh Simindokht; Abrishami, Yalda; Rajabi, Mohammad Bagher

    2016-01-01

    AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing. PMID:27803865

  10. Fiberoptic Guided Retrograde Intubation in an Anticipated Difficult Airway: Revival of an Antiquated Technique

    PubMed Central

    Ninu, Marie; Yunus, Md.; Syiemiong, Newstar

    2016-01-01

    Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation. This fiber optic guided retrograde intubation is a first reported case of its kind in a predicted difficult airway which can be beneficial in different difficult airway situations. PMID:27891428

  11. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration

    PubMed Central

    Kumar, Nitin

    2015-01-01

    A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery. PMID:26240686

  12. Continuous intragastric delivery of fenoldopam: relationship between plasma concentration and effects on renal function.

    PubMed Central

    Ziemniak, J A; Boppana, V K; Cyronak, M J; Beck, T R; Familiar, R G; Dubb, J W; Allison, N L; Stote, R M

    1988-01-01

    1. The pharmacodynamics of the dopamine DA1 agonist fenoldopam were examined in six healthy male volunteers after constant intragastric infusions of fenoldopam at dosages of 0, 10, 25, 50 and 75 mg h-1 for 6 h. 2. Hourly p-aminohippurate (PAH) clearance was used to assess fenoldopam induced renal plasma flow changes. Marked dose-related increases in renal plasma flow were noted with a maximal increase of 65% over baseline values of 711 ml min-1 being seen at the 75 mg h-1 rate. No changes in sodium excretion and glomerular filtration rate were observed. 3. Mean steady-state fenoldopam plasma concentrations were related to mean PAH clearance based on an Emax model (r = 0.996) with an Emax of 1350 ml min-1 and an EC50 of 6.2 ng ml-1. 4. Mean steady-state plasma concentrations of fenoldopam-7-sulphate and fenoldopam-8-sulphate failed to increase with dose but were linearly correlated to mean PAH changes (r = 0.998, r = 0.981 respectively). 5. These results support the concept of extending fenoldopam's duration of action through the development of an oral sustained delivery system. PMID:2896014

  13. A Magnetic Soft Endoscopic Capsule-Inflated Intragastric Balloon for Weight Management

    PubMed Central

    Do, Thanh Nho; Ho, Khek Yu; Phee, Soo Jay

    2016-01-01

    Overweight and obesity have been identified as a cause of high risk diseases like diabetes and cancer. Although conventional Intragastric Balloons (IGBs) have become an efficient and less invasive method for overweight and obesity treatment, the use of conventional tools such as catheter or endoscope to insert and remove the IGBs from the patient’s body causes nausea, vomiting, discomfort, and even gastric mucous damage. To eliminate these drawbacks, we develop a novel magnetic soft capsule device with gas-filled balloon inflation. The balloon is made from a thin and biocompatible material that can be inflated to a desired volume using biocompatible effervescent chemicals. In addition, both the outer balloon and inner capsule are designed to be soft and chemical resistance. The soft capsule shell is fabricated using scaffold-solvent approach while the outer balloon utilizes a novel fabrication approach for 3D spherical structure. A prototype of the proposed capsule and balloon is given. Experiments are successfully carried out in stimulated gastric environment and fresh porcine stomach to validate the effectiveness and reliability of the proposed approach. PMID:28000756

  14. Wax-incorporated emulsion gel beads of calcium pectinate for intragastric floating drug delivery.

    PubMed

    Sriamornsak, Pornsak; Asavapichayont, Panida; Nunthanid, Jurairat; Luangtana-Anan, Manee; Limmatvapirat, Sontaya; Piriyaprasarth, Suchada

    2008-01-01

    The purpose of this study was to prepare wax-incorporated pectin-based emulsion gel beads using a modified emulsion-gelation method. The waxes in pectin-olive oil mixtures containing a model drug, metronidazole, were hot-melted, homogenized and then extruded into calcium chloride solution. The beads formed were separated, washed with distilled water and dried for 12 h. The influence of various types and amounts of wax on floating and drug release behavior of emulsion gel beads of calcium pectinate was investigated. The drug-loaded gel beads were found to float on simulated gastric fluid if the sufficient amount of oil was used. Incorporation of wax into the emulsion gel beads affected the drug release. Water-soluble wax (i.e. polyethylene glycol) increased the drug release while other water-insoluble waxes (i.e. glyceryl monostearate, stearyl alcohol, carnauba wax, spermaceti wax and white wax) significantly retarded the drug release. Different waxes had a slight effect on the drug release. However, the increased amount of incorporated wax in the formulations significantly sustained the drug release while the beads remained floating. The results suggest that wax-incorporated emulsion gel beads could be used as a carrier for intragastric floating drug delivery.

  15. Thermal conditions influence changes in body temperature induced by intragastric administration of capsaicin in mice.

    PubMed

    Mori, Noriyuki; Urata, Tomomi; Fukuwatari, Tsutomu

    2016-08-01

    Capsaicin has been reported to have unique thermoregulatory actions. However, changes in core temperature after the administration of capsaicin are a controversial point. Therefore, we investigated the effects of environmental thermal conditions on changes in body temperature caused by capsaicin in mice. We showed that intragastric administration of 10 and 15 mg/kg capsaicin increased tail temperature and decreased colonic temperatures in the core temperature (CT)-constant and CT-decreasing conditions. In the CT-increasing condition, 15 mg/kg capsaicin increased tail temperature and decreased colonic temperature. However, 10 mg/kg capsaicin increased colonic temperature. Furthermore, the amount of increase in tail temperature was greater in the CT-decreasing condition and lower in the CT-increasing condition, compared with that of the CT-constant condition. These findings suggest that the changes in core temperature were affected by the environmental thermal conditions and that preliminary thermoregulation state might be more important than the constancy of temperature to evaluate the effects of heat diffusion and thermogensis.

  16. Tapioca starch blended alginate mucoadhesive-floating beads for intragastric delivery of Metoprolol Tartrate.

    PubMed

    Biswas, Nikhil; Sahoo, Ranjan Kumar

    2016-02-01

    The objective of the study was to develop tapioca starch blended alginate mucoadhesive-floating beads for the intragastric delivery of Metoprolol Tartrate (MT). The beads were prepared by ionotropic gelation method using calcium chloride as crosslinker and gas forming calcium carbonate (CaCO3) as floating inducer. The alginate gel beads having 51-58% entrapped MT showed 90% release within 45 min in gastric medium (pH 1.2). Tapioca starch blending markedly improved the entrapment efficiency (88%) and sustained the release for 3-4 h. A 12% w/w HPMC coating on these beads extended the release upto 9-11 h. In vitro wash off and buoyancy test in gastric media revealed that the beads containing CaCO3 has gastric residence of more than 12 h. In vitro optimized multi-unit formulation consisting of immediate and sustained release mucoadhesive-floating beads (40:60) showed good initial release of 42% MT within 1h followed by a sustained release of over 90% for 11 h. Pharmacokinetic study performed in rabbit model showed that the relative oral bioavailability of MT after administration of oral solution, sustain release and optimized formulation was 51%, 67% and 87%, respectively. Optimized formulation showed a higher percent inhibition of isoprenaline induced heart rate in rabbits for almost 12 h.

  17. Comparative study of heart rate responses to laryngoscopic endotracheal intubation and to endotracheal intubation using intubating laryngeal mask airway under general anaesthesia in patients with pure mitral stenosis for closed mitral commissurotomy.

    PubMed

    Das, Soumi; Gupta, Sampa Dutta; Goswampi, Anupam; Kundu, Kanak Kanti

    2013-04-01

    The various drugs and methods studied in an attempt to curb the haemodynamic stress response associated with conventional laryngoscopic endotracheal intubation have not been found to be ompletely satisfactory. The rise in heart rate can be detrimental to patients with mitral stenosis. This study was aimed to compare the heart rate responses to endotracheal intubation using conventional laryngoscope and with the help of intubating laryngeal mask airway (ILMA) in patients with isolated mitral stenosis. Thirty-four adult patients of either sex, aged between 18 and 40 years with isolated mitral stenosis to undergo closed mitral commissurotomy were randomly allocated into two groups : Group A (n=17)- To be intubated using laryngoscopy. Group B (n=17)- To be intubated with the help of ILMA. The heart rate was recorded immediately preinduction, just prior to introducing the intubating device and postintubation every minute up to first 5 minutes. On applying statistical tests, it was found that the median heart rate values in group A at 2, 3, 4 and 5 minutes postintubation were significantly higher than in group B (p<0.05). Although use of both laryngosope and ILMA for endotracheal intubation was associated with rise in heart rate, the rise was less with ILMA compared to laryngoscope. Hence, it can be concluded that use of ILMA may be a preferable device for endotracheal intubation laryngoscopy in patients with isolated mitral stenosis.

  18. McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation

    PubMed Central

    Wan, Li; Liao, Mingfeng; Li, Li; Qian, Wei; Hu, Rong; Chen, Kun; Zhang, Chuanhan; Yao, Wenlong

    2016-01-01

    Abstract Background: Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. Methods: Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. Results: The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05). Conclusions: When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty. PMID:28002347

  19. Airway management using submental intubation in head and neck surgery.

    PubMed

    Szantyr, Aleksandra; Szuta, Mariusz; Zapała, Jan

    2016-01-01

    In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform

  20. Intragastric administration of allyl isothiocyanate increases carbohydrate oxidation via TRPV1 but not TRPA1 in mice.

    PubMed

    Mori, Noriyuki; Kawabata, Fuminori; Matsumura, Shigenobu; Hosokawa, Hiroshi; Kobayashi, Shigeo; Inoue, Kazuo; Fushiki, Tohru

    2011-06-01

    The transient receptor potential (TRP) channel family is composed of a wide variety of cation-permeable channels activated polymodally by various stimuli and is implicated in a variety of cellular functions. Recent investigations have revealed that activation of TRP channels is involved not only in nociception and thermosensation but also in thermoregulation and energy metabolism. We investigated the effect of intragastric administration of TRP channel agonists on changes in energy substrate utilization of mice. Intragastric administration of allyl isothiocyanate (AITC; a typical TRPA1 agonist) markedly increased carbohydrate oxidation but did not affect oxygen consumption. To examine whether TRP channels mediate this increase in carbohydrate oxidation, we used TRPA1 and TRPV1 knockout (KO) mice. Intragastric administration of AITC increased carbohydrate oxidation in TRPA1 KO mice but not in TRPV1 KO mice. Furthermore, AITC dose-dependently increased intracellular calcium ion concentration in cells expressing TRPV1. These findings suggest that AITC might activate TRPV1 and that AITC increased carbohydrate oxidation via TRPV1.

  1. Intragastric gelation of whey protein-pectin alters the digestibility of whey protein during in vitro pepsin digestion.

    PubMed

    Zhang, Sha; Vardhanabhuti, Bongkosh

    2014-01-01

    The aim of this work is to investigate the effect of pectin on in vitro digestion of whey protein. Digestion of heated whey protein isolate (WPI) and pectin solutions (WPI-pectin) as influenced by pectin concentration and pH was studied under simulated gastric conditions. Electrophoresis, dynamic light scattering, colorimetric measurements, and gel microstructures were used to study the digestion pattern. At low pectin concentration (0.25% w/w), pectin did not significantly influence the degradation of whey protein. Increasing the pectin concentration to 1% led to extensive intragastric gelation immediately after mixing with simulated gastric fluid. The microstructure of intragastric gel from WPI-pectin at pH 6.0 showed a more interconnected and denser gel network than that at pH 7.0. More protein and pectin were involved in the gelation at pH 6.0 than pH 7.0. The digesta of samples at pH 6.0 was mainly composed of peptides, while that at pH 7.0 mostly consisted of aggregates and crosslinked peptides. This study suggests that WPI-pectin at high biopolymer ratio formed intragastric gel in simulated gastric models, which could delay protein digestion and potentially slow gastric emptying and promote satiety.

  2. Intragastric administration of allyl isothiocyanate reduces hyperglycemia in intraperitoneal glucose tolerance test (IPGTT) by enhancing blood glucose consumption in mice.

    PubMed

    Mori, Noriyuki; Kurata, Manami; Yamazaki, Hanae; Hosokawa, Hiroshi; Nadamoto, Tomonori; Inoue, Kazuo; Fushiki, Tohru

    2013-01-01

    We investigated the effects of allyl isothiocyanate (AITC) on the blood glucose levels of mice using an intraperitoneal glucose tolerance test. The intragastric administration of 25 mg/kg body weight AITC reduced the increase in blood glucose level after 2 g/kg body weight glucose was given intraperitoneally, compared with that of control mice. To elucidate the mechanism responsible for the reduction, respiratory gas analysis employing (13)C-labeled glucose was performed. The intragastrically administering AITC increased (13)CO2 emission, compared to vehicle, after intraperitoneal administration of (13)C-labeled glucose. This indicated that AITC increased the utilization of exogenously administered glucose, which was excessive glucose in the blood. To examine whether transient receptor potential (TRP) channels mediated this reduction in the blood glucose levels, we used TRPA1 and TRPV1 knockout (KO) mice. Intragastrically administering AITC reduced the increase in the blood glucose level in TRPA1 KO mice but not in TRPV1 KO mice. These findings suggest that dietary AITC might reduce the increases in blood glucose levels by increasing the utilization of excessive glucose in the blood by activating TRPV1.

  3. Binge ethanol exposure causes endoplasmic reticulum stress, oxidative stress and tissue injury in the pancreas

    PubMed Central

    Ren, Zhenhua; Wang, Xin; Xu, Mei; Yang, Fanmuyi; Frank, Jacqueline A.; Ke, Zun-ji; Luo, Jia

    2016-01-01

    Alcohol abuse is associated with both acute and chronic pancreatitis. Repeated episodes of acute pancreatitis or pancreatic injury may result in chronic pancreatitis. We investigated ethanol-induced pancreatic injury using a mouse model of binge ethanol exposure. Male C57BL/6 mice were exposed to ethanol intragastrically (5 g/kg, 25% ethanol w/v) daily for 10 days. Binge ethanol exposure caused pathological changes in pancreas demonstrated by tissue edema, acinar atrophy and moderate fibrosis. Ethanol caused both apoptotic and necrotic cell death which was demonstrated by the increase in active caspase-3, caspase-8, cleaved PARP, cleaved CK-18 and the secretion of high mobility group protein B1 (HMGB1). Ethanol altered the function of the pancreas which was indicated by altered levels of alpha-amylase, glucose and insulin. Ethanol exposure stimulated cell proliferation in the acini, suggesting an acinar regeneration. Ethanol caused pancreatic inflammation which was indicated by the induction of TNF-alpha, IL-1beta, IL-6, MCP-1 and CCR2, and the increase of CD68 positive macrophages in the pancreas. Ethanol-induced endoplasmic reticulum stress was demonstrated by a significant increase in ATF6, CHOP, and the phosphorylation of PERK and eiF-2alpha. In addition, ethanol increased protein oxidation, lipid peroxidation and the expression of iNOS, indicating oxidative stress. Therefore, this paradigm of binge ethanol exposure caused a spectrum of tissue injury and cellular stress to the pancreas, offering a good model to study alcoholic pancreatitis. PMID:27527870

  4. Using monosodium glutamate to initiate ethanol self-administration in inbred mouse strains.

    PubMed

    McCool, Brian A; Chappell, Ann M

    2012-01-01

    Voluntary oral ethanol consumption in rodents is generally limited by strong taste-aversion in these species. Historically, this has been overcome by combining ethanol with a sweetener, typically sucrose or saccharine, and then slowly 'fading' away the sweetener. While useful in most instances, this approach has not proven as successful for some inbred strains of mice (e.g. DBA/2J) despite consistent evidence in the literature that these same strains express strong conditioned place preference for intraperitoneal- or intragastric-administered ethanol. Importantly, DBA/2J mice express a polymorphism in a 'sweet' taste receptor subunit gene that reduces the potency of sweet substances in these mice. We hypothesized that the presence of this polymorphism might help explain the contrasting behavioral findings of weak voluntary oral ethanol consumption following sucrose-fade yet robust conditioned place preference for ethanol in this strain. To test this, we compared ethanol consumption initiated by either a 'traditional' sucrose-fade or a fade from an alternative tastant, monosodium glutamate (MSG). We found that in both C57BL/6J and DBA/2J mice, the MSG-fade produced robust increases in home cage ethanol consumption relative to the traditional sucrose-fade. This increased ethanol intake following MSG-fade was evident across a range of ethanol concentrations. Our findings suggest the potential utility of the MSG-fade to establish stable voluntary oral ethanol consumption in mice, particularly ethanol 'non-preferring' strains such as DBA/2J and lend additional support to the notion that ethanol consumption in DBA/2J mice is limited by pronounced taste aversion.

  5. Ethanol induces second-order aversive conditioning in adolescent and adult rats.

    PubMed

    Pautassi, Ricardo Marcos; Myers, Mallory; Spear, Linda Patia; Molina, Juan Carlos; Spear, Norman E

    2011-02-01

    Alcohol abuse and dependence are considered public health problems, with an etiological onset often occurring during late childhood and adolescence, and understanding age-related differences in ethanol sensitivity is important. Low to moderate ethanol doses (0.5 and 2.0 g/kg, intragastrically [i.g.]) induce single-trial, appetitive second-order place conditioning (SOC) in adolescent, but not adult, rats. Recent studies have demonstrated that adolescents may be less sensitive than adults to the aversive properties of ethanol, reflected by conditioned taste aversion. The present study assessed the aversive motivational effects of high-dose ethanol (3.0 and 3.25 g/kg, i.g., for adolescents and adults, respectively) using SOC. Experiment 1 revealed similar blood and brain ethanol levels in adolescent and adult rats given 3.0 and 3.25 g/kg ethanol, respectively. In Experiment 2, animals received ethanol or vehicle paired with intraoral pulses of sucrose (conditioned stimulus 1 [CS1]). After one, two, or three conditioning trials, the rats were presented with the CS1 while in a distinctive chamber (CS2). When tested for CS2 preference, ethanol-treated animals exhibited reduced preference for the CS2 compared with controls. This result, indicative of ethanol-mediated aversive place conditioning, was similar for adolescents and adults; for females and males; and after one, two, or three training trials. In conjunction with previous results, the present study showed that, in adolescent rats subjected to SOC, ethanol's hedonic effects vary from appetitive to aversive as the ethanol dose increases. Adolescent and adult animals appear to perceive the postingestive effects of high-dose ethanol as similarly aversive when assessed by SOC.

  6. Comparison between different tests and their combination for prediction of difficult intubation: An analytical study

    PubMed Central

    Basunia, Sandip Roy; Ghosh, Sarmila; Bhattacharya, Susmita; Saha, Indranil; Biswas, Atanu; Prasad, Anu

    2013-01-01

    Context: There is an impelling need for accurate tests to predict difficult intubation, as failure to achieve endotracheal intubation causes significant morbidity and mortality in anesthetic practice. Aim: To calculate the validity of the different tests along with their combination and agreement when compared with endotracheal intubation in predicting difficult intubation. Settings and Design: Operation theaters, analytical study. Materials and Methods: Three hundred patients aged between 16 and 60 years of American society of anesthesiologist (ASA) physical status I and II, scheduled for elective surgical procedures requiring endotracheal intubation were studied during January-July 2012. Mallampati grade (MP), sternomental distance (SMD), thyromental distance (TMD), and Delilkan and Calder test were recorded for every patient. Endotracheal intubation was performed by an experienced anesthesiologist blinded to the measurements and recorded grading of intubation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR), odds ratio (OR), and kappa coefficient of tests individually and in combination were calculated. Statistical Analysis Used: IBM SPSS software (version 16.0) and Epi-info software (version 3.2). Results: Difficult and failed intubation was 13.3% and 0.6%, respectively. Difficult intubation increased with age. TMD and Calder test showed highest sensitivity individually and Dellilkan's test showed least sensitivity. Among the combination of tests, MP with SMD and MP with Calder test had the highest sensitivity. Conclusion: Among individual test TMD and Calder are better predictive tests in terms of sensitivity. Combination of tests increases the chance of prediction of difficult intubation. PMID:25885730

  7. Airway Management in Maxillofacial Trauma: Do We Really Need Tracheostomy/Submental Intubation

    PubMed Central

    Mittal, Geeta; Mittal, Rajinder K.; Katyal, Sunil; Uppal, Sanjeev; Mittal, Varun

    2014-01-01

    Background: There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. Aim: To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. Materials and Methods: In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Results: Young patients with male predominance is the most common affected population. Panfacial fracture is the most common type of injury (39.83%) among facial fractures. Airway was managed with intraoperative change of nasotracheal to orotracheal intubation in 33.05% of the patients whereas submental intubation or tracheostomy was done in 8.62% of the patients. Conclusion: Nasal route for endotracheal intubation is not a contraindication in the presence of nasal fractures, base of skull fractures and CSF leak. By changing the nasotracheal intubation to orotracheal intubation intraoperatively in cases panfacial fractures, most of the tracheostomies and submental intubations can be avoided. PMID:24783087

  8. Interactions between splanchnic and vagus nerves in the control of mean intragastric pressure in the ferret.

    PubMed Central

    Andrews, P L; Lawes, I N

    1984-01-01

    To determine whether splanchnic nerves relax the stomach by direct or indirect mechanisms, ramp inflations of the stomach, section and electrical stimulation of the vagus and greater splanchnic nerves, and step inflations of the duodenum were used. A high threshold, sustained inhibition of the gastric pressure response to ramp inflation was mediated by the vagus. Prior splanchnectomy increased vagal inhibition. The greater splanchnic nerves had no effect on gastric responses to inflation, although after vagotomy they were shown to be mediators of a low threshold, powerful but transient inhibition of the stomach. This was not dependent on intrinsic neurones with nicotinic receptors. Electrical stimulation of the greater splanchnic nerves produced a relaxation of the stomach, the magnitude of which was determined by resting pressure. Splanchnically mediated relaxation was not abolished by atropine, nor was it reduced by concurrent vagal stimulation. At submaximal levels of vagal stimulation the two nerves had a partially additive effective on relaxation. Duodenal inflation had an effect on intracorpus pressure similar to that of electrical stimulation of the greater splanchnic nerves on intragastric pressure. Reflex relaxation of the corpus evoked by duodenal distension was decreased by atropine but greatly increased by atropine coupled with vagotomy. These changes were caused by variations in resting pressure. It was concluded that the principal effect of splanchnic nerves on mean gastric pressure is direct and does not depend on inhibition of cholinergic neurones either centrally or peripherally. Evidence is presented for central interactions between the vagus and the greater splanchnic nerves in the anaesthetized ferret. PMID:6747874

  9. Mucosal and systemic T cell response in mice intragastrically infected with Neospora caninum tachyzoites

    PubMed Central

    2013-01-01

    The murine model has been widely used to study the host immune response to Neospora caninum. However, in most studies, the intraperitoneal route was preferentially used to establish infection. Here, C57BL/6 mice were infected with N. caninum tachyzoites by the intragastric route, as it more closely resembles the natural route of infection through the gastrointestinal tract. The elicited T-cell mediated immune response was evaluated in the intestinal epithelium and mesenteric lymph nodes (MLN). Early upon the parasitic challenge, IL-12 production by conventional and plasmacytoid dendritic cells was increased in MLN. Accordingly, increased proportions and numbers of TCRαβ+CD8+IFN-γ+ lymphocytes were detected, not only in the intestinal epithelium and MLN, but also in the spleen of the infected mice. In this organ, IFN-γ-producing TCRαβ+CD4+ T cells were also found to increase in the infected mice, however later than CD8+ T cells. Interestingly, splenic and MLN CD4+CD25+ T cells sorted from infected mice presented a suppressive activity on in vitro T cell proliferation and cytokine production above that of control counterparts. These results altogether indicate that, by producing IFN-γ, TCRαβ+CD8+ cells contribute for local and systemic host protection in the earliest days upon infection established through the gastrointestinal tract. Nevertheless, they also provide substantial evidence for a parasite-driven reinforcement of T regulatory cell function which may contribute for parasite persistence in the host and might represent an additional barrier to overcome towards effective vaccination. PMID:23937079

  10. Flavor preferences conditioned by intragastric sugar infusions in rats: maltose is more reinforcing than sucrose.

    PubMed

    Azzara, A V; Sclafani, A

    1998-06-15

    Prior research indicates that glucose conditions much stronger flavor preferences in rats than does fructose. This could occur because intestinal absorption of fructose is much slower than that of glucose and because fructose malabsorption may have aversive consequences. Fructose absorption is facilitated when glucose is also present in the gut. The present study therefore compared the flavor conditioning effects of maltose (a glucose + glucose disaccharide) to those of sucrose (a glucose + fructose disaccharide). In Experiment 1, rats had different flavors paired with intragastric infusions of 32% maltose (CS+M), 32% sucrose (CS+S), and water (CS-) 23 h/day. In subsequent two-bottle tests, both CS+ solutions were strongly preferred to the CS-, but the CS+M was also preferred (78%) to the CS+S. Experiment 2A revealed that the rats also learned to prefer a CS+M to a CS+S when 16% sugar infusions were used. In Experiment 2B, the same rats preferred a flavor paired with 16% maltose to a flavor paired with 8% maltose. They did not reliably prefer a flavor paired with 16% sucrose to a flavor paired with 8% maltose. These results demonstrate that the postingestive actions of maltose are more reinforcing than those of sucrose. This indicates that fructose is less reinforcing than glucose even when malabsorption is not a factor. In contrast to their preference for the CS+M over the CS+S, the rats preferred sucrose to maltose when drinking the sugars by mouth. Therefore, sugar preferences mediated by oral taste receptors differ from those conditioned by postoral nutrient detectors.

  11. Sublingual glyceryl trinitrate during colonoscopy and terminal ileal intubation: a randomized controlled trial.

    PubMed

    Hill, Patsy-Anne; Panteleimonitis, Sofoklis; McKay, Graham; Watson, Carol; Prach, Andre; Macdonald, Angus

    2017-02-01

    Background and aims Sublingual glyceryl trinitrate has been used as an aid to cannulate the Sphincter of Oddi during endoscopic retrograde cholangiopancreatography. Its role in terminal ileal intubation during colonoscopy is unknown. This study examines the role of sublingual glyceryl trinitrate in terminal ileal intubation during colonoscopy. Methods A triple-blind randomized controlled trial comparing sublingual glyceryl trinitrate (800 µg) vs. placebo (saline) in relation to terminal ileal intubation during colonoscopy was performed. Following caecal intubation, participants received sublingual glyceryl trinitrate/placebo followed by a 2-min observation period before intubation was attempted. Data on time to intubate the terminal ileum and intubation rate were collected. Results A total of 110 patients (age: 58 years (18-75)) were recruited and randomised as per protocol: 54 received sublingual glyceryl trinitrate. Terminal ileal intubation was successful in all patients receiving sublingual glyceryl trinitrate and in 53 (94.6%) of those receiving saline ( p = 0.243: Fischer's exact). The median time taken for ileal intubation after application of spray was 72.5 (7-900) s in the glyceryl trinitrate group compared with 125 (5-900) s in the placebo group ( p = 0.150: Mann-Whitney). There were no major adverse events reported in either group. Conclusions Terminal ileal intubation rates and timing were very good in both groups. Routine sublingual glyceryl trinitrate was not proven to be beneficial in improving terminal ileal intubation or intubation success rates in the hands of experienced colonoscopists. However, trends in this small study might suggest that glyceryl trinitrate could be useful in the hands of less experienced colonoscopists or in difficult terminal ileal intubation cases.

  12. The non-intubated anesthesia for airway surgery

    PubMed Central

    Nakanishi, Ryoichi

    2016-01-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed. PMID:28066621

  13. Pulmonary Delivery of Vancomycin Dry Powder Aerosol to Intubated Rabbits.

    PubMed

    Sullivan, Bradley P; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2015-08-03

    Antibiotic multiresistant pneumonia is a risk associated with long-term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant Staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study, we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of iv and pulmonary administered vancomycin in intubated rabbits through an endotracheal tube system. Cascade impaction studies indicated that using an endotracheal tube, which bypasses deposition in the mouth and throat, increased the amount of drug entering the lung. Bypassing the endotracheal tube with a catheter further enhanced drug deposition in the lung. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus iv infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, indicating that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during iv administration.

  14. The non-intubated anesthesia for airway surgery.

    PubMed

    Okuda, Katsuhiro; Nakanishi, Ryoichi

    2016-11-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.

  15. Comparison of the serial dilution indicator and intragastric titration methods for measurement of meal-stimulated gastric acid secretion in man.

    PubMed

    Hogan, D L; Turken, D; Stern, A I; Isenberg, J I

    1983-11-01

    Two in vivo methods that permit quantitation of gastric acid secretion immediately after the meal are currently in use: intragastric titration and the serial dilution indicator method. During intragastric titration, intragastric pH is artificially maintained at 5.5 to 7 by the continuous addition of alkali to the gastric contents, while during serial dilution the intragastric pH is permitted to seek its natural pH. This study compared gastric acid secretion and serum gastrin in response to a liquid protein meal measured by both techniques in 10 subjects. Mean (+/- SE) 3-hr acid outputs were almost identical (53.6 +/- 6.0 mmol/3 hr with intragastric titration and 52.0 +/- 8.5 mmol/3 hr with serial dilution indicator). Furthermore, 30 min secretory responses in individual subjects were highly correlated (r = 0.98 +/- 0.01, P less than 0.001). Also, in spite of intragastric pH being less than 1.5 by 90 min after the meal during the serial dilution method, total integrated serum gastrin concentrations after the meal were similar (intragastric titration = 20.6 +/- 7.3 ng min/ml versus serial dilution indicator = 23.5 +/- 9.8 ng min/ml) and individual 30-min gastrins during the two separate tests were highly correlated (r = 0.80 +/- 0.06, P less than 0.01). It is concluded that both meal-stimulated gastric acid secretion and serum gastrin concentrations as measured by intragastric titration and by the serial dilution indicator method produced similar results.

  16. The influence of gastric pentadecapeptide BPC 157 on acute and chronic ethanol administration in mice.

    PubMed

    Blagaic, Alenka Boban; Blagaic, Vladimir; Romic, Zeljko; Sikiric, Predrag

    2004-09-24

    The stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W.1419), which was promising in inflammatory bowel disease (PL-10, PLD-116, PL-14736, Pliva) trials, protects against both acute and chronic alcohol-induced lesions in stomach and liver, but also, given peripherally, affects various centrally mediated disturbances. Now, in male NMRI mice BPC 157 (10 pg intraperitoneally, 10 ng and 10 microg, intraperitoneally or intragastrically) (i) strongly opposed acute alcohol (4 g/kg intraperitoneally) intoxication (i.e., quickly produced and sustained anesthesia, hypothermia, increased ethanol blood values, 25% fatality, 90-min assessment period) given before or after ethanol, and (ii) when given after abrupt cessation of ethanol (at 0 or 3 or 7 h withdrawal time), attenuated withdrawal (assessed through 24 hours) after 20%-alcohol drinking (7.6 g/kg) through 13 days, with provocation on the 14th day.

  17. Comparison of Successful Intubation Between Video Laryngoscopy View Before Attempted Intubation and Direct Laryngoscopic Intubation by Student Registered Nurse Anesthetists: A Pilot Study.

    PubMed

    Wands, Brenda; Minzola, Debra

    2015-12-01

    Airway management is a primary focus when student registered nurse anesthetists (SRNAs) begin clinical rotations in their nurse anesthesia program. Successful endotracheal intubation requires both knowledge of and experience with the airway and its structures. Lack of clinical maturity and unfamiliarity with the patient airway intensifies student anxiety in the clinical arena. The purpose of this pilot study was to examine the success rate of direct laryngoscopy by 9 SRNAs who were just entering clinical practice rotations. This study required group 1 to perform direct laryngoscopy in their first clinical opportunity in the operating room; group 2 was required to observe a minimum of 3 video laryngoscopic (GlideScope, Verathon Inc) intubations performed by the clinical preceptor before the students' first attempt using direct laryngoscopy. Other modalities used to secure the airway in this study included the GlideScope and a laryngeal mask airway. Results of the data analysis revealed there was no significant difference between groups for success of direct laryngoscopy (group 1, 54%; group 2, 58%; P = .45).

  18. Sexual orientation of male mouse offspring prenatally exposed to ethanol.

    PubMed

    Watabe, T; Endo, A

    1994-01-01

    Pregnant mice were intubated with either low (2 g/kg) or high (4 g/kg) dose of ethanol twice daily throughout the last third of the gestational period (from dg14 to dg18: gestational day; plug positive = dg 0). Ninety days after birth, the sexual orientation test was conducted on male offspring. This test was designed to observe a two-choice preference for either male or female partners in a setting in which the test animal could move freely between the two incentive compartments within which a stud male and an estrous female had been placed. We found that young adult males that had been exposed to ethanol prenatally have a decreased preference for the opposite sex and an increased preference for the same sex as a partner, although their physical development was apparently unaffected.

  19. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome

    PubMed Central

    Guo, Zhihua; Yin, Weiqiang; Pan, Hui; Zhang, Xin; Xu, Xin; Shao, Wenlong; Chen, Hanzhang

    2016-01-01

    Background The aim of this study was to reveal the short-term outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy without tracheal intubation compared with intubated general anesthesia with one-lung ventilation (OLV). Methods We performed a retrospective review of our institutional database of consecutive 140 patients undergoing VATS anatomical segmentectomy from July 2011 to June 2015. Among them, 48 patients were treated without tracheal intubation using a combination of thoracic epidural anesthesia (TEA), intrathoracic vagal blockade, and sedation (non-intubated group). The other 92 patients were treated with intubated general anesthesia (intubated group). Safety and feasibility was evaluated by comparing the perioperative profiles and short-term outcomes of these two groups. Results Two groups had comparable surgical durations, intraoperative blood loss, postoperative chest tube drainage volume, and numbers of dissected lymph nodes (P>0.05). Patients who underwent non-intubated segmentectomy had higher peak end-tidal carbon dioxide (EtCO2) during operation (44.81 vs. 33.15 mmHg, P<0.001), less white blood cell changes before and after surgery (△WBC) (6.08×109 vs. 7.75×109, P=0.004), earlier resumption of oral intake (6.76 vs. 17.58 hours, P<0.001), shorter duration of postoperative chest tube drainage (2.25 vs. 3.16 days, P=0.047), less cost of anesthesia (¥5,757.19 vs. ¥7,401.85, P<0.001), and a trend toward shorter postoperative hospital stay (6.04 vs. 7.83 days, P=0.057). One patient (2.1%) in the non-intubated group required conversion to intubated OLV since a significant mediastinal movement. In the intubated group, there was one patient (1.1%) required conversion to thoracotomy due to uncontrolled bleeding. The incidence difference of postoperative complications between groups was not significant (P=0.248). There was no in-hospital death in either group. Conclusions Compared with intubated general anesthesia, non-intubated

  20. Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway

    PubMed Central

    Kwak, Hyun Jeong; Lee, Sook Young; Lee, Su Youn; Kim, Yong Beom; Kim, Jong Yeop

    2016-01-01

    Abstract Background: During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation. Methods: One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I–II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed. Results: Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695). Conclusion: This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation. PMID:27902612

  1. Airtraq® versus Macintosh laryngoscope: A comparative study in tracheal intubation

    PubMed Central

    Bhandari, Geeta; Shahi, K. S.; Asad, Mohammad; Bhakuni, Rajani

    2013-01-01

    Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Materials and Methods: Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups. Results: We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001. Conclusion: Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant. PMID:25885839

  2. Prenatal and postnatal ethanol experiences modulate consumption of the drug in rat pups, without impairment in the granular cell layer of the main olfactory bulb

    PubMed Central

    Pueta, Mariana; Rovasio, Roberto A.; Abate, Paula; Spear, Norman E.; Molina, Juan C.

    2010-01-01

    The effect of moderate exposure to ethanol during late gestation was studied in terms of its interaction with moderate exposure during nursing from an intoxicated dam. A further issue was whether behavioral effects of ethanol, especially the enhanced ethanol intake known to occur after moderate ethanol prenatally or during nursing, depend upon teratological effects that may include death of neurons in the main olfactory bulb (MOB). During gestational days 17–20 rats were given 0, 1 or 2 g/kg ethanol doses intragastrically (i.g.). After parturition these dams were given a dose of 2.5 g/kg ethanol i.g. each day and allowed to perform regular nursing activities. During postnatal days (PDs) 15 and 16, ethanol intake of pups was assessed along with aspects of their general activity. In a second experiment pups given the same prenatal treatment as above were tested for blood ethanol concentration (BEC) in response to an ethanol challenge on PD6. A third experiment (Exp. 2b) assessed stereologically the number of cells in the granular cell layer of the MOB on PD7, as a function of analogous pre- and postnatal ethanol exposures. Results revealed that ethanol intake during the third postnatal week was increased by prenatal as well as postnatal ethanol exposure, with a few interesting qualifications. For instance, pups given 1 g/kg prenatally did not have increased ethanol intake unless they also had experienced ethanol during nursing. There were no effects of ethanol on either BECs or conventional teratology (cell number). This increases the viability of an explanation of the effects of prenatal and early postnatal ethanol on later ethanol intake in terms of learning and memory. PMID:20951715

  3. Kansas Ethanol Lyons Approval

    EPA Pesticide Factsheets

    This update August 9, 2016 letter from EPA approves, with modifications, the petition from Kansas Ethanol, LLC, Lyons facility, regarding non-grandfathered ethanol produced through a dry mill process, qualifying under the Clean Air Act for renewable fuel

  4. [A device to facilitate training of intubation by emergency medical technician].

    PubMed

    Fujita, Yasuaki; Takahashi, Ayako; Yamada, Aya; Kobayashi, Kazuhiko; Nakata, Jun; Teramoto, Yuzo

    2012-06-01

    In our hospital, the average duration of training in intubation by the emergency medical technician training intubation was 17.9 days. Compared to other reports, our training period is shorter. Short training period has reduced burden of hospital and fire station. One of the important contributions to the society for anesthesiologists is to increase the number of emergency medical technicians who can intubate. But long training period has been increasing the burden of anesthesiologists and emergency medical technicians. We report a practical method of intubation by emergency medical technician in our hospital.

  5. Anaphylactoid reaction to ethanol.

    PubMed

    Kelso, J M; Keating, M U; Squillace, D L; O'Connell, E J; Yunginger, J W; Sachs, M I

    1990-05-01

    We studied a 14-year-old boy who developed a pruritic rash and facial swelling after ingestion of beer or wine. A blinded challenge with purified ethanol was positive demonstrating ethanol itself to be the offending agent. An IgE-mediated reaction to ethanol or one of its metabolites as a hapten is possible, or the reaction may involve unusual metabolism of ethanol with accumulation of acetaldehyde and/or direct mast cell degranulation.

  6. Ethanol Basics (Fact Sheet)

    SciTech Connect

    Not Available

    2015-01-01

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  7. Behavioral effects and pharmacokinetics of (±)-3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) after intragastric administration to baboons.

    PubMed

    Goodwin, Amy K; Mueller, Melanie; Shell, Courtney D; Ricaurte, George A; Ator, Nancy A

    2013-06-01

    (±)-3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy") is a popular drug of abuse. We aimed to characterize the behavioral effects of intragastric MDMA in a species closely related to humans and to relate behavioral effects to plasma MDMA and metabolite concentrations. Single doses of MDMA (0.32-7.8 mg/kg) were administered via an intragastric catheter to adult male baboons (N = 4). Effects of MDMA on food-maintained responding were assessed over a 20-hour period, whereas untrained behaviors and fine-motor coordination were characterized every 30 minutes until 3 hours postadministration. Levels of MDMA and metabolites in plasma were measured in the same animals (n = 3) after dosing on a separate occasion. MDMA decreased food-maintained responding over the 20-hour period, and systematic behavioral observations revealed increased frequency of bruxism as the dose of MDMA was increased. Drug blood level determinations showed no MDMA after the lower doses of MDMA tested (0.32-1.0 mg/kg) and modest levels after higher MDMA doses (3.2-7.8 mg/kg). High levels of 3,4-dihydroxymethamphetamine (HHMA) were detected after all doses of MDMA, suggesting extensive first-pass metabolism of MDMA in the baboon. The present results demonstrate that MDMA administered via an intragastric catheter produced behavioral effects that have also been reported in humans. Similar to humans, blood levels of MDMA after oral administration may not be predictive of the behavioral effects of MDMA. Metabolites, particularly HHMA, may play a significant role in the behavioral effects of MDMA.

  8. Fat Emulsion Intragastric Stability and Droplet Size Modulate Gastrointestinal Responses and Subsequent Food Intake in Young Adults1234

    PubMed Central

    Hussein, Mahamoud O; Hoad, Caroline L; Wright, Jeff; Singh, Gulzar; Stephenson, Mary C; Cox, Eleanor F; Placidi, Elisa; Pritchard, Susan E; Costigan, Carolyn; Ribeiro, Henelyta; Ciampi, Elisabetta; Nandi, Asish; Hedges, Nick; Sanderson, Paul; Peters, Harry PF; Rayment, Pip; Spiller, Robin C; Gowland, Penny A

    2015-01-01

    Background: Intragastric creaming and droplet size of fat emulsions may affect intragastric behavior and gastrointestinal and satiety responses. Objectives: We tested the hypotheses that gastrointestinal physiologic responses and satiety will be increased by an increase in intragastric stability and by a decrease in fat droplet size of a fat emulsion. Methods: This was a double-blind, randomized crossover study in 11 healthy persons [8 men and 3 women, aged 24 ± 1 y; body mass index (in kg/m2): 24.4 ± 0.9] who consumed meals containing 300-g 20% oil and water emulsion (2220 kJ) with 1) larger, 6-μm mean droplet size (Coarse treatment) expected to cream in the stomach; 2) larger, 6-μm mean droplet size with 0.5% locust bean gum (LBG; Coarse+LBG treatment) to prevent creaming; or 3) smaller, 0.4-μm mean droplet size with LBG (Fine+LBG treatment). The participants were imaged hourly by using MRI and food intake was assessed by using a meal that participants consumed ad libitum. Results: The Coarse+LBG treatment (preventing creaming in the stomach) slowed gastric emptying, resulting in 12% higher gastric volume over time (P < 0.001), increased small bowel water content (SBWC) by 11% (P < 0.01), slowed appearance of the 13C label in the breath by 17% (P < 0.01), and reduced food intake by 9% (P < 0.05) compared with the Coarse treatment. The Fine+LBG treatment (smaller droplet size) slowed gastric emptying, resulting in 18% higher gastric volume (P < 0.001), increased SBWC content by 15% (P < 0.01), and significantly reduced food intake by 11% (P < 0.05, equivalent to an average of 411 kJ less energy consumed) compared with the Coarse+LBG treatment. These high-fat meals stimulated substantial increases in SBWC, which increased to a peak at 4 h at 568 mL (range: 150–854 mL; P < 0.01) for the Fine+LBG treatment. Conclusion: Manipulating intragastric stability and fat emulsion droplet size can influence human gastrointestinal physiology and food intake. PMID

  9. Intragastric immunization with recombinant Lactobacillus casei expressing flagellar antigen confers antibody-independent protective immunity against Salmonella enterica serovar Enteritidis.

    PubMed

    Kajikawa, Akinobu; Satoh, Eiichi; Leer, Rob J; Yamamoto, Shigeki; Igimi, Shizunobu

    2007-05-04

    A recombinant Lactobacillus casei expressing a flagellar antigen from Salmonella enterica serovar Enteritidis was constructed and evaluated as a mucosal vaccine. Intragastric immunization of the recombinant strain conferred protective immunity against Salmonella infection in mice. This immunization did not result in antigen-specific antibody in either feces or sera but induced the release of IFN-gamma on restimulation of primed lymphocytes ex vivo. The results suggested that the protective efficacy provided by flagellin-expressing L. casei is mainly attributable to cell-mediated immune responses. In addition, an adjuvant-type effect of the antigen delivery system with L. casei was also observed.

  10. Protection of oral or intestinal candidiasis in mice by oral or intragastric administration of herbal food, clove (Syzygium aromaticum).

    PubMed

    Taguchi, Yuuki; Ishibashi, Hiroko; Takizawa, Toshio; Inoue, Shigeharu; Yamaguchi, Hideyo; Abe, Shigeru

    2005-01-01

    We examined the effect of a clove (Syzygium aromaticum) administered by two different routes on Candida albicans growth, using a murine oral candidiasis model. When the clove preparation was administered into the oral cavity of Candida-infected mice, their oral symptoms were improved and the number of viable Candida cells in the cavity was reduced. In contrast, when the clove preparation was administered intragastrically, oral symptoms were not improved, but viable cell numbers of Candida in the stomach and feces were decreased. These findings demonstrate that oral intake of an herbal food, clove, may suppress the overgrowth of C. albicans in the alimentary tract including the oral cavity.

  11. Pulmonary delivery of vancomycin dry powder aerosol to intubated rabbits

    PubMed Central

    Sullivan, Bradley P.; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2016-01-01

    Antibiotic multi-resistant pneumonia is a risk associated with long term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of i.v. and pulmonary administered vancomycin in intubated rabbits using a novel endotracheal tube catheter system. Cascade Impaction studies indicated that using an endotracheal tube, which bypasses deposition the mouth and throat, increased the amount of drug entering the lung. Drug deposition in the lung was further enhanced by using an endotracheal tube catheter, which did not alter the aerosol fine particle fraction. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus i.v. infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, suggesting that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during i.v. administration. PMID:25915095

  12. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  13. Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study

    PubMed Central

    Dhanger, Sangeeta; Gupta, Suman Lata; Vinayagam, Stalin; Bidkar, Prasanna Udupi; Elakkumanan, Lenin Babu; Badhe, Ashok Shankar

    2016-01-01

    Background: Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation. Aims: The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation. Settings and Design: In this study, 200 patients belonging to age group 18–60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled. Patients with upper airway pathology, neck mass, and cervical spine injury were excluded from the study. Materials and Methods: An attending anesthesiologist conducted preoperative assessment and recorded parameters such as body mass index, modified Mallampati grading, inter-incisor distance, neck circumference, and thyromental distance (NC/TMD). After standard anesthetic induction, laryngoscopy was performed, and intubation difficulty assessed using intubation difficulty scale on the basis of seven variables. Statistical Analysis: The Chi-square test or student t-test was performed when appropriate. The binary multivariate logistic regression (forward-Wald) model was used to determine the independent risk factors. Results: Among the 200 patients, 26 patients had difficult intubation with an incidence of 13%. Among different variables, the Mallampati score and NC/TMD were independently associated with difficult intubation. Receiver operating characteristic curve showed a cut-off point of 3 or 4 for Mallampati score and 5.62 for NC/TMD to predict difficult intubation. Conclusion: The diagnostic accuracy of NC/TM ratio and Mallampatti score were better compared to other bedside tests to predict difficult intubation in Indian population. PMID:26957691

  14. The role of social isolation in ethanol effects on the preweanling rat

    PubMed Central

    Kozlov, Andrey P.; Nizhnikov, Michael; Varlinskaya, Elena I.; Spear, Norman E.

    2011-01-01

    The present experiments investigated the effects of acute ethanol exposure on voluntary intake of 0.1% saccharin or water as well as behavioral and nociceptive reactivity in twelve–day-old (P12) rats exposed to differing levels of isolation. The effects of ethanol emerged only during short-term social isolation (STSI) with different patterns observed in males and females and in pups exposed to saccharin or water. The 0.5 g/kg ethanol dose selectively increased saccharin intake in females, decreased rearing activity in males and attenuated isolation-induced analgesia (IIA) in all water-exposed pups. Ingestion of saccharin decreased IIA, and the 0.5 g/kg ethanol dose further reduced IIA. The 1.0 g/kg ethanol dose, administered either intragastrically or intraparentionally, also decreased IIA in P12 females, but not in P9 pups. A significant correlation between voluntary saccharin intake and baseline nociceptive reactivity was revealed in saline injected animals, saccharin intake was inversely correlated with behavioral activation and latency of reaction to noxious heat after 0.5 g/kg ethanol in females. The 0.5 g/kg ethanol dose did not affect plasma corticosterone (CORT) measured 5 hours after maternal separation or 20 minutes after ethanol injection. Female pups CORT level was inversely correlated with magnitude of IIA that accompanied the first episode of STSI (pretest isolation) 1.5–2 hours before CORT measurement. The present findings suggest that the anxiolytic properties of ethanol are responsible for enhancement of saccharin intake during STSI. Furthermore, differential reactivity of P12 males and females to STSI plays an important role in ethanol effects observed at this age. PMID:22051944

  15. Post-Intubation Sore Throat and Menstruation Cycles

    PubMed Central

    Orandi, Amirali; Orandi, Amirhossein; Najafi, Atabak; Hajimohammadi, Fatemeh; Soleimani, Sara; Zahabi, Somayeh

    2013-01-01

    Background Postoperative sore throat is one of the most common complications of general anesthesia and intubation with prevalence of 18%-65% in different studies. Several risk factors including female gender, postoperative nausea and vomiting and so on have been mentioned. Objectives The aim of this study was to evaluate the incidence of postoperative sore throat in females and its association with menstrual cycles. Patients and Methods One hundred females between 18-45 years old with ASA class I or II without predicted difficult airway that were candidate for operation in supine position were enrolled in study. Patients who had pulmonary disease, smoking, common cold within two weeks prior to the operation, previous traumatic intubation history, removable dentures, any congenital or acquired deformity in face, neck, mouth and airway, any known pathology in mouth like aphthous and mouth ulcer,pregnant women, and patients with irregular cycles, and those taking oral contraceptive pills were excluded. By the same protocol general anesthesia was provided and the patients were asked to fill out a three-point scale questionnaire (Low, High, None) 1,6 and 24 hours following intubation to study and record the incidence and severity of sore throat, dysphagia and hoarseness. The date of last menstrual period had been recorded as well. Results Of 100 patients, in the first six hours, 51 patients had sore throat and 49 had no pain. During the first 6 hours, 33 patients (33%) had dysphagia and 13 patients had hoarseness at 6th postoperative hour. Age, weight, LMP, intubation time, operation and extubation time and coughing were compared to sore throat, dysphagia and hoarseness. The association between the incidence of coughing and bucking and sore throat was significant (P = 0.03). None of the parameters had a statistically meaningful association with dysphagia. Conclusions According to our results, by omitting probable risk factors of incidence of sore throat and evaluation

  16. [Successful surgical treatment of tracheal rupture caused by endotracheal intubation].

    PubMed

    Baranyai, Zsolt; Kocsis, Akos; Jósa, Valéria

    2010-06-06

    Rupture of the trachea is a rare complication of endotracheal intubation. The most common cause of the injury is the overinflation of the cuff. The authors present the case of a 45-year-old male in whom a 6 cm long trachea lesion was perceived during the operation due to a meso-hypopharyngeal tumor. Primary intervention resulted in successful reconstruction and full recovery. The case demonstrates the importance of prompt diagnosis and adequate therapy that helped in preventing an assumingly life-long complication or even death.

  17. The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

    PubMed Central

    Chatrath, Veena; Sharan, Radhe; Jain, Payal; Bala, Anju; Ranjana; Sudha

    2016-01-01

    Aims of Study: To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks. Materials and Methods: In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine. Results: Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades. Discussion: The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique. Conclusion: A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes. PMID:27212757

  18. Successful Management of Rabbit Anesthesia Through the Use of Nasotracheal Intubation

    PubMed Central

    2009-01-01

    Although nasotracheal intubation in the rabbit has been briefly described, scientific assessment of the procedure has not been reported. In this report we describe nasotracheal intubation performed in 38 male New Zealand White rabbits (3.0 to 5.5 kg) used for a vascular patch study. The rabbits were placed under general anesthesia twice, with 2 mo between the initial and final intubations. Rabbits were intubated by the oral or nasotracheal route and compared. Previous literature dismissed nasotracheal intubation, citing the possibility of introducing pathogens into the lungs and the necessity of high oxygen flow rates (presumably greater than 3 L/min). However, no clinical signs of respiratory disease were noted among the study animals, nor were high oxygen flow rates necessary. Several key points collectively facilitated a successful procedure. Total relaxation was essential, modification of the classic blind approach eased placement, a correct approach was necessary, and our development of a unique method of securing the tube improved tube management. The findings suggest that nasotracheal intubation can be used as an easy, less traumatic method of rabbit intubation when compared with orotracheal intubation. PMID:19383213

  19. Difficult intubation in an infant with Pierre Robin syndrome and concomitant tongue tie.

    PubMed

    Jones, S E; Derrick, G M

    1998-01-01

    Intubation and airway difficulties may be assumed in infants with Pierre Robin syndrome. We report a case of a six month old cleft palate repair who also had a tongue tie which compounded the problem. He was eventually intubated using the two anaesthetist technique. The contribution of the tongue tie is assessed.

  20. Tracheal intubation with a camera embedded in the tube tip (Vivasight(™) ).

    PubMed

    Huitink, J M; Koopman, E M; Bouwman, R A; Craenen, A; Verwoert, M; Krage, R; Visser, I E; Erwteman, M; van Groeningen, D; Tijink, R; Schauer, A

    2013-01-01

    We studied tracheal intubation in manikins and patients with a camera embedded in the tip of the tracheal tube (Vivasight(™) ). Four people in two teams and two individuals attempted intubation of a manikin through an i-gel(™) 10 times each. The tracheas of 12 patients with a Mallampati grade of 1 were intubated with a Vivasight tracheal tube through a Berman airway, passed over a Frova(™) introducer. All 60 manikin intubations were successful, taking a mean (SD) time of 1.4 (0.5) s. The fastest intubation was performed in 0.5 s. All 12 participants' tracheas were successfully intubated in a median (IQR [range]) time of 90 (70-120 [50-210]) s. Seven participants complained of a sore throat, comparable with earlier findings for standard laryngoscopy and intubation: five mild; one moderate; and one severe. Tracheal intubation with the Vivasight through the i-gel or Berman airway is an alternative to existing techniques, against which it should be compared in randomised controlled trials in human participants. It has potential as a fast airway rescue technique.

  1. [Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome].

    PubMed

    Fuentes, Ricardo; De la Cuadra, Juan Carlos; Lacassie, Hector; González, Alejandro

    2016-09-27

    Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al.

  2. Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report-

    PubMed Central

    Jo, Youn Yi; Park, Woo Young; Choi, Eunkyeong; Koo, Bon Nyeo

    2010-01-01

    A tracheal intubation-related tracheobronchial rupture is a relatively rare complication. We report a case of tracheobronchial rupture after single lumen endotracheal intubation. Twenty four hours after extubation of an endotracheal tube, subcutaneous emphysema developed on the patient's neck. A pneumomediastinum was also detected by computerized tomography (CT). The patient recovered uneventfully after conservative management. PMID:20877710

  3. Curcuma aromatica Water Extract Attenuates Ethanol-Induced Gastritis via Enhancement of Antioxidant Status

    PubMed Central

    Jeon, Woo-Young; Lee, Mee-Young; Shin, In-Sik; Jin, Seong Eun; Ha, Hyekyung

    2015-01-01

    Curcuma aromatica is an herbal medicine and traditionally used for the treatment of various diseases in Asia. We investigated the effects of C. aromatica water extract (CAW) in the stomach of rats with ethanol-induced gastritis. Gastritis was induced in rats by intragastric administration of 5 mL/kg body weight of absolute ethanol. The CAW groups were given 250 or 500 mg of extract/kg 2 h before administration of ethanol, respectively. To determine the antioxidant effects of CAW, we determined the level of lipid peroxidation, the level of reduced glutathione (GSH), the activities of catalase, degree of inflammation, and mucus production in the stomach. CAW reduced ethanol-induced inflammation and loss of epithelial cells and increased the mucus production in the stomach. CAW reduced the increase in lipid peroxidation associated with ethanol-induced gastritis (250 and 500 mg/kg, p < 0.01, resp.) and increased mucosal GSH content (500 mg/kg, p < 0.01) and the activity of catalase (250 and 500 mg/kg, p < 0.01, resp.). CAW increased the production of prostaglandin E2. These findings suggest that CAW protects against ethanol-induced gastric mucosa injury by increasing antioxidant status. We suggest that CAW could be developed for the treatment of gastritis induced by alcohol. PMID:26483844

  4. Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation-Based Study

    PubMed Central

    Thomas, Eric J; Katakam, Lakshmi

    2017-01-01

    Background Neonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught. Objective To determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting. Methods A randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013–8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate. Results One hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03–9.28). Conclusions In a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance. PMID:28168139

  5. Effect of Thoracentesis on Intubated Patients with Acute Lung Injury.

    PubMed

    Bloom, Matthew B; Serna-Gallegos, Derek; Ault, Mark; Khan, Ahsan; Chung, Rex; Ley, Eric J; Melo, Nicolas; Margulies, Daniel R

    2016-03-01

    Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios.

  6. Endotracheal suctioning in intubated newborns: an integrative literature review

    PubMed Central

    Gonçalves, Roberta Lins; Tsuzuki, Lucila Midori; Carvalho, Marcos Giovanni Santos

    2015-01-01

    Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected. PMID:26465249

  7. Design for a three-dimensional printed laryngoscope blade for the intubation of rats.

    PubMed

    Vongerichten, Anna; Aristovich, Kirill; dos Santos, Gustavo Sato; McEvoy, Andrew W; Holder, David S

    2014-04-01

    Endotracheal intubation of rats is a common technique that is best carried out with a laryngoscope blade. The blade allows direct visualization of the trachea during intubation, reducing the risk of accidental intubation of the esophagus. Laryngoscope blades for use in rats are not commercially available, however. Three-dimensional (3D) printers have recently become available and can be used to produce small plastic items simply and reliably based on an established design. The authors created a design for a laryngoscope blade to be printed with a 3D printer and polylactide filament material. Using the printed laryngoscope blade, the authors successfully intubated 35 rats. The presented design may be used by any experimenter with access to a 3D printer to fabricate the same laryngoscope blade for their intubation procedures.

  8. Induction of brain CYP2E1 by chronic ethanol treatment and related oxidative stress in hippocampus, cerebellum, and brainstem.

    PubMed

    Zhong, Yanjun; Dong, Guicheng; Luo, Haiguang; Cao, Jie; Wang, Chang; Wu, Jianyuan; Feng, Yu-Qi; Yue, Jiang

    2012-12-16

    Ethanol is one of the most commonly abused substances, and oxidative stress is an important causative factor in ethanol-induced neurotoxicity. Cytochrome P450 2E1 (CYP2E1) is involved in ethanol metabolism in the brain. This study investigates the role of brain CYP2E1 in the susceptibility of certain brain regions to ethanol neurotoxicity. Male Wistar rats were intragastrically treated with ethanol (3.0 g/kg, 30 days). CYP2E1 protein, mRNA expression, and catalytic activity in various brain regions were respectively assessed by immunoblotting, quantitative quantum dot immunohistochemistry, real-time RT-PCR, and LC-MS. The generation of reactive oxygen species (ROS) was analyzed using a laser confocal scanning microscope. The hippocampus, cerebellum, and brainstem were selectively damaged after ethanol treatment, indicated by both lactate dehydrogenase (LDH) activity and histopathological analysis. Ethanol markedly increased the levels of CYP2E1 protein, mRNA expression, and activity in the hippocampus and cerebellum. CYP2E1 protein and activity were significantly increased by ethanol in the brainstem, with no change in mRNA expression. ROS levels induced by ethanol paralleled the enhanced CYP2E1 proteins in the hippocampus, granular layer and white matter of cerebellum as well as brainstem. Brain CYP2E1 activity was positively correlated with the damage to the hippocampus, cerebellum, and brainstem. These results suggest that the selective sensitivity of brain regions to ethanol neurodegeneration may be attributed to the regional and cellular-specific induction of CYP2E1 by ethanol. The inhibition of CYP2E1 levels may attenuate ethanol-induced oxidative stress via ROS generation.

  9. Poisonings Associated with Intubation: US National Poison Data System Exposures 2000-2013.

    PubMed

    Beauchamp, G A; Giffin, S L; Horowitz, B Z; Laurie, A L; Fu, R; Hendrickson, R G

    2016-06-01

    Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this association may inform future research on intubation after exposures to specific substances and guide poison prevention education. Our objective was to determine which exposures were commonly associated with intubation using the data from National Poison Data System (NPDS). The NPDS tracks data from potential exposures to substances reported to all American Association of Poison Control Centers. We performed a retrospective analysis of NPDS data from January 1st, 2000 to December 31st, 2013 to identify human exposures to substances that were associated with endotracheal intubation. Descriptive statistics were used to analyze the data. There were 93,474 single substance exposures and 228,507 multiple substance exposures that were associated with intubation. The most common exposures to substances that were associated with intubation were atypical antipsychotics (7.4 %) for single exposures and benzodiazepines (27.4 %) for multiple exposures. Within each age group, the most common known exposures to substances were for patients under 6 years, clonidine for single and multiple exposures; for patients aged 6-12 years, clonidine for single exposures and atypical antipsychotics for multiple exposures; for patients aged 13-19 years, atypical antipsychotics for single and multiple exposures; and for patients over 19 years, atypical antipsychotics for single exposures and benzodiazepines for multiple exposures. From 2000-2013, the exposures to substances most commonly associated with intubation varied by single versus multiple exposures and by age. This study helps clarify the exposures to substances that are associated with

  10. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study

    PubMed Central

    Naziri, Freshteh; Amiri, Hakimeh Alereza; Rabiee, Mozaffar; Banihashem, Nadia; Nejad, Farhad Mohammad; Shirkhani, Ziba; Solimanian, Sedigheh

    2015-01-01

    Introduction: Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant. Materials and Methods: In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation. Results: There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia. Conclusions: In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R. PMID:26543458

  11. Docosahexaenoic acid partially ameliorates deficits in social behavior and ultrasonic vocalizations caused by prenatal ethanol exposure.

    PubMed

    Wellmann, Kristen A; George, Finney; Brnouti, Fares; Mooney, Sandra M

    2015-06-01

    Prenatal ethanol exposure disrupts social behavior in humans and rodents. One system particularly important for social behavior is the somatosensory system. Prenatal ethanol exposure alters the structure and function of this area. Docosahexaenoic acid (DHA), an omega 3 polyunsaturated fatty acid, is necessary for normal brain development and brains from ethanol-exposed animals are DHA deficient. Thus, we determined whether postnatal DHA supplementation ameliorated behavioral deficits induced by prenatal ethanol exposure. Timed pregnant Long-Evans rats were assigned to one of three groups: ad libitum access to an ethanol-containing liquid diet, pair fed an isocaloric isonutritive non-alcohol liquid diet, or ad libitum access to chow and water. Pups were assigned to one of two postnatal treatment groups; gavaged intragastrically once per day between postnatal day (P)11 and P20 with DHA (10g/kg in artificial rat milk) or artificial rat milk. A third group was left untreated. Isolation-induced ultrasonic vocalizations (iUSVs) were recorded on P14. Social behavior and play-induced USVs were tested on P28 or P42. Somatosensory performance was tested with a gap crossing test around P33 or on P42. Anxiety was tested on elevated plus maze around P35. Animals exposed to ethanol prenatally vocalized less, play fought less, and crossed a significantly shorter gap than control-treated animals. Administration of DHA ameliorated these ethanol-induced deficits such that the ethanol-exposed animals given DHA were no longer significantly different to control-treated animals. Thus, DHA administration may have therapeutic value to reverse some of ethanol's damaging effects.

  12. Fermentation method producing ethanol

    DOEpatents

    Wang, Daniel I. C.; Dalal, Rajen

    1986-01-01

    Ethanol is the major end product of an anaerobic, thermophilic fermentation process using a mutant strain of bacterium Clostridium thermosaccharolyticum. This organism is capable of converting hexose and pentose carbohydrates to ethanol, acetic and lactic acids. Mutants of Clostridium thermosaccharolyticum are capable of converting these substrates to ethanol in exceptionally high yield and with increased productivity. Both the mutant organism and the technique for its isolation are provided.

  13. Ethanol immunosuppression in vitro

    SciTech Connect

    Kaplan, D.R.

    1986-03-01

    Ethanol in concentrations equivalent to levels achieved by the ingestion of moderate to large amounts of alcoholic beverages has been shown to inhibit mitogen and anti-CD3 stimulated human T lymphocyte proliferation. This inhibition was monophasic suggesting that ethanol affected a single limiting component of T cell proliferation. In experiments designed to test the effect of ethanol on various aspects of proliferation, it was demonstrated that ethanol inhibited the capacity of exogenously supplied interleukin 2 to stimulate proliferation of T cells that had previously acquired interleukin 2 receptors in a monophasic, dose-dependent manner. Moreover, there was no suppression of interleukin 2 production or interleukin 2 receptor acquisition. Thus, ethanol was shown to mediate immunosuppression by a mechanism specific to one component of proliferation. Additive inhibition of T cell proliferation was seen with ethanol plus cyclosporin A which inhibits interleukin 2 production. The level of inhibition with 250 ng/ml cyclosporin A alone was equivalent to the level seen with 62 ng/ml cyclosporin A plus 20 mM (94 mg%) ethanol. Ethanol also suppressed an immune effector mechanism. NK cytotoxicity was depressed in a monophasic, dose-dependent manner. Thus, ethanol might be considered as a possible adjunct in immunosuppressive therapy.

  14. Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving.

    PubMed

    Levitan, Richard M

    2003-07-01

    Concern about patient safety and failed rapid sequence intubation has led to an increased awareness of potentially difficult laryngoscopy situations and algorithms promoting techniques in awake patients. Given the low overall incidence of failed laryngoscopy, however, prediction of difficult laryngoscopy has poor positive predictive value and uncertain clinical utility, especially in emergency settings. Non-rapid sequence intubation approaches have comparatively lower chances of intubation success, require more time, and are associated with more complications. As a specialty, emergency medicine has adopted rapid sequence intubation as the mainstay of emergency airway treatment for many appropriate reasons; the problem that must be addressed is how patient safety can be ensured while what is an inherently dangerous procedure is performed. A novel way to conceptualize patient risk and safety issues in rapid sequence intubation is to examine how inherent risk is managed in skydiving. Metaphorical lessons from skydiving that are applicable to rapid sequence intubation include (1) a redundancy of safety; (2) a methodic approach to primary chute deployment; (3) use of backup chutes that are fast, simple, and easy to deploy; (4) attention to monitoring; and (5) equipment vigilance. This article reviews how each of these lessons apply metaphorically to rapid sequence intubation, wherein the primary chute is laryngoscopy, the backup chute is rescue ventilation, and monitoring involves pulse oximetry.

  15. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

    PubMed

    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.

  16. Complications from submental endotracheal intubation: a prospective study and literature review.

    PubMed

    de Toledo, Guilherme Lacerda; Bueno, Sebastião Cristian; Mesquita, Ricardo Alves; Amaral, Márcio Bruno Figueiredo

    2013-06-01

    Submental endotracheal intubation, as compared to the use of tracheotomy, is an alternative for the surgical management of maxillofacial trauma, as described by Altemir FH (The submental route for endotracheal intubation: a new technique. J Maxillofac Surg 1986; 14: 64). Although the submental endotracheal intubation is a useful technique, a wide range of complications have been reported in the literature. The core aim of this article is to present additional data from 17 patients who have undergone submental endotracheal intubation and who have received at least 6 months of postoperative follow up. A prospective study was carried out on patients who suffered maxillofacial trauma between 2008 and 2011. Age, gender, etiology of trauma, fracture type, complications, and follow up were evaluated. Case series, as well as retrospective and prospective studies regarding submental endotracheal intubation in maxillofacial trauma, were also reviewed. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas.

  17. Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope

    PubMed Central

    Lee, Jiyoung; Kim, Jong Yeop; Kang, Se Yoon; Kwak, Hyun Jeong; Lee, Dongchul; Lee, Sook Young

    2017-01-01

    Abstract Background: The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60° vs 90°) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). Methods: One hundred and forty patients aged 19 to 70 years (American Society of Anesthesiologists classification I or II) who required tracheal intubation for elective surgery were randomly allocated to 1 of 2 groups, at the 60° angle (n = 70) or the 90° angle (n = 70). Anesthesia was induced with propofol, fentanyl, and rocuronium. The primary outcome was TTI assessed by a blind observer. Glottic grade, use of optimal external laryngeal manipulation, failed intubation at first attempt, ease of intubation, and severity of oropharyngeal bleeding were also recorded. Results: The mean TTI was significantly shorter in the 60° group than in the 90° group (29.3 ± 6.4 vs 32.5 ± 9.4 s, P = 0.022). The glottic grade and degree of intubation difficulty were not significantly different between the 2 groups. Conclusions: When intubating the patients with the McGrath videolaryngoscope, the 60° angled stylet allowed for faster orotracheal intubation than did the 90° angled stylet. PMID:28207549

  18. Prenatal exposure to ethanol during late gestation facilitates operant self-administration of the drug in 5-day-old rats

    PubMed Central

    Miranda-Morales, Roberto Sebastián; Nizhnikov, Michael E.; Spear, Norman E.

    2014-01-01

    Prenatal ethanol exposure modifies postnatal affinity to the drug, increasing the probability of ethanol use and abuse. The present study tested developing rats (5-day-old) in a novel operant technique to assess the degree of ethanol self-administration as a result of prenatal exposure to low ethanol doses during late gestation. On a single occasion during each of gestational days 17–20, pregnant rats were intragastrically administered ethanol 1 g/kg, or water (vehicle). On postnatal day 5, pups were tested on a novel operant conditioning procedure in which they learned to touch a sensor to obtain 0.1% saccharin, 3% ethanol, or 5% ethanol. Immediately after a 15-min training session, a 6-min extinction session was given in which operant behavior had no consequence. Pups were positioned on a smooth surface and had access to a touch-sensitive sensor. Physical contact with the sensor activated an infusion pump, which served to deliver an intraoral solution as reinforcement (Paired group). A Yoked control animal evaluated at the same time received the reinforcer when its corresponding Paired pup touched the sensor. Operant behavior to gain access to 3% ethanol was facilitated by prenatal exposure to ethanol during late gestation. In contrast, operant learning reflecting ethanol reinforcement did not occur in control animals prenatally exposed to water only. Similarly, saccharin reinforcement was not affected by prenatal ethanol exposure. These results suggest that in 5-day-old rats, prenatal exposure to a low ethanol dose facilitates operant learning reinforced by intraoral administration of a low-concentration ethanol solution. This emphasizes the importance of intrauterine experiences with ethanol in later susceptibility to drug reinforcement. The present operant conditioning technique represents an alternative tool to assess self-administration and seeking behavior during early stages of development. PMID:24355072

  19. Sonographic detection of tracheal or esophageal intubation: A cadaver study

    PubMed Central

    Tejesh, CA; Manjunath, AC; Shivakumar, S; Vinayak, PS; Yatish, B; Geetha, CR

    2016-01-01

    Background: The correct position of the endotracheal tube is confirmed by various modalities, most of which are not entirely reliable. Ultrasound is now increasingly available to anesthesiologists in the operating theater and is an attractive alternative. To investigate the usefulness of sonography in identifying the correct tracheal tube position in human cadavers. Materials and Methods: Endotracheal tubes placed randomly into trachea or esophagus was identified with a linear ultrasound probe placed transversely just above the suprasternal notch by a single anesthesiologist. Results: Of the 100 intubations performed at random, 99 were correctly identified to give a sensitivity of 100% and a specificity of 97.9%. Conclusion: Sonography is a useful technique to identify correct position of the tracheal tube. PMID:27375387

  20. Phenylephrine potentiates the anticonvulsant effect and neutralizes the sedative effect of diazepam in rats upon combined intragastric administration.

    PubMed

    Serdyuk, S E; Gmiro, V E

    2014-12-01

    High doses of phenylephrine and diazepam (1 and 10 mg/kg, respectively) suppressed the development of generalized tonic-clonic pentylenetetrazole-induced convulsions in 86-100% rats, but did not prevent local clonic pentylenetetrazole-induced convulsions. Diazepam in the specified dose produced strong sedation, while phenylephrine had no sedative effect in the open-field test. Combined intragastric administration of phenylephrine in a medium and individually ineffective dose (0.3 mg/kg) and diazepam in a high dose (10 mg/kg) potentiated the anticonvulsant effect of diazepam: it prevented not only tonic-clonic, but also clonic pentylenetetrazole-induced convulsions in 100% rats and 2.6-fold increased anticonvulsant activity of diazepam. The specified combination of diazepam and phenylephrine had no sedative effect. The mechanism of potentiation of the anticonvulsive effect and elimination of the sedative side effect is based on stimulation of gastric mucosa afferents by phenylephrine.

  1. Hemorrhagic Fever Occurs After Intravenous, But Not After Intragastric, Inoculation of Rhesus Macaques With Lymphocytic Choriomeningitis Virus

    PubMed Central

    Lukashevich, Igor S.; Djavani, Mahmoud; Rodas, Juan D.; Zapata, Juan C.; Usborne, Amy; Emerson, Carol; Mitchen, Jacque; Jahrling, Peter B.; Salvato, Maria S.

    2008-01-01

    Arenaviruses can cause hemorrhagic fever and death in primates and guinea pigs, but these viruses are not highly pathogenic for most rodent carriers. In the United States, arenaviruses precipitated outbreaks of hepatitis in captive monkeys, and they present an emerging health threat in the tropical areas of Africa and South America. We describe infection of rhesus macaques with the prototype arenavirus, lymphocytic choriome-ningitis virus (LCMV), using the WE strain that has been known to cause both encephalopathy and multifocal hemorrhage. Five macaques were inoculated: two by the intravenous (i.v.) and three by the intragastric (i.g.) route. Whereas the two i.v.-inoculated monkeys developed signs and lesions consistent with fatal hemorrhagic fever, the i.g.-inoculated monkeys had an attenuated infection with no disease. Pathological signs of the primate i.v. infection differ significantly from guinea pig arenavirus infections and make this a superior model for human viral hemorrhagic disease. PMID:11992578

  2. BioEnterics Intragastric Balloon (BIB) versus Spatz Adjustable Balloon System (ABS): Our experience in the elderly.

    PubMed

    Russo, Teresa; Aprea, Giovanni; Formisano, Cesare; Ruggiero, Simona; Quarto, Gennaro; Serra, Raffaele; Massa, Guido; Sivero, Luigi

    2017-02-01

    The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37-46 and 70-80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.

  3. Air-Q intubating laryngeal airway: A study of the second generation supraglottic airway device

    PubMed Central

    Attarde, Viren Bhaskar; Kotekar, Nalini; Shetty, Sarika M

    2016-01-01

    Background and Aims: Air-Q intubating laryngeal mask airway (ILA) is used as a supraglottic airway device and as a conduit for endotracheal intubation. This study aims to assess the efficacy of the Air-Q ILA regarding ease of insertion, adequacy of ventilation, rate of successful intubation, haemodynamic response and airway morbidity. Methods: Sixty patients presenting for elective surgery at our Medical College Hospital were selected. Following adequate premedication, baseline vital parameters, pulse rate and blood pressure were recorded. Air-Q size 3.5 for patients 50-70 kg and size 4.5 for 70-100 kg was selected. After achieving adequate intubating conditions, Air-Q ILA was introduced. Confirming adequate ventilation, appropriate sized endotracheal tube was advanced through the Air-Q blindly to intubate the trachea. Placement of the endotracheal tube in trachea was confirmed. Results: Air-Q ILA was successfully inserted in 88.3% of patients in first attempt and 11.7% patients in second attempt. Ventilation was adequate in 100% of patients. Intubation was successful in 76.7% of patients with Air-Q ILA. 23.3% of patients were intubated by direct laryngoscopy following failure with two attempts using Air-Q ILA. Post-intubation the change in heart rate was statistically significant (P < 0.0001). 10% of patients were noted to have a sore throat and 5% of patients had mild airway trauma. Conclusion: Air-Q ILA is a reliable device as a supraglottic airway ensuring adequate ventilation as well as a conduit for endotracheal intubation. It benefits the patient by avoiding the stress of direct laryngoscopy and is also superior alternative device for use in a difficult airway. PMID:27212722

  4. Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

    PubMed Central

    Ferrando, Carlos; Aguilar, Gerardo; Belda, F. Javier

    2011-01-01

    Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score. Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq) anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared. Results. The Airtraq significantly decreased the Cormack-Lehane score (P = 0.04). On the other hand, there were no differences in times of laryngoscopy (P = 0.645; IC 95% 3.1, +4.8) and intubation (P = 0.62; C95%  −6.1, +10.0) between the two devices. No relevant complications were found during the maneuvers of intubation using both devices. Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation. PMID:22162683

  5. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice

    PubMed Central

    Collado-Pacheco, David; Rábago-Torre, Luis Ramon; Arias-Rivera, Maria; Ortega-Carbonel, Alejandro; Olivares-Valles, Ana; Alonso-Prada, Alicia; Vázquez-Echarri, Jaime; Herrera-Merino, Norberto

    2016-01-01

    Background: Surgery has been the method most widely used to manage the extraction of gastric bands with inclusion as a late complication of bariatric surgery; however, surgical extraction entails morbidity and limits future surgical procedures. The development of endoscopic techniques has provided an important means of improving the treatment of this complication, enabling minimally invasive and safe procedures that have a high success rate. Methods: A retrospective analysis was conducted of patients who had laparoscopic gastric banding complicated by intragastric migration and were treated endoscopically. A technique already described for managing this complication was employed. An MTW Endoskopie Dormia basket for mechanical lithotripsy or a standard 0.0035-in guidewire was placed around the band, and an MTW Endoskopie emergency lithotripter was used to section it, after which the band was extracted with a standard polypectomy snare. Also analyzed were the initial symptoms of patients with this complication, the mean time from surgery to development of the event, the success rate of endoscopic treatment, and complications, Results: A total of 127 patients had undergone gastric banding surgery in our Bariatric Surgery Center; of these, 12 patients (9.4 %) developed a complication such as intragastric migration of the band. Weight gain and pain were the main symptoms in 11 patients (92 %), and the mean time to the development of symptoms was 51.3 months. A single endoscopic treatment was successful in 7 of 9 patients (78 %). Only 1 complication, involving ventilation during anesthesia, occurred; no other adverse events were recorded. Conclusions: The endoscopic extraction of bands with inclusion is feasible and can be performed easily and successfully. The procedure is available in all hospitals and has a low incidence of related complications, so that unnecessary surgical procedures can be avoided. PMID:27556077

  6. Treatment of Helicobacter pylori Infection with Intra-Gastric Violet Light Phototherapy – a Pilot Clinical Trial

    PubMed Central

    Lembo, Anthony J; Ganz, Robert A; Sheth, Sunil; Cave, David; Kelly, Ciaran; Levin, Philip; Kazlas, Peter T; Baldwin, Paul C; Lindmark, William R; McGrath, Jonathan R; Hamblin, Michael R

    2009-01-01

    Background and Objective Helicobacter pylori infects the mucus layer of the human stomach and causes peptic ulcers and adenocarcinoma. We have previously shown that H. pylori accumulates photoactive porphyrins making the organism susceptible to inactivation by light, and that small spot endoscopic illumination with violet light reduced bacterial load in human stomachs. This study assessed the feasibility and safety of whole-stomach intra-gastric violet phototherapy for the treatment of H. pylori infection. Study Design/Materials and Methods A controlled, prospective pilot trial was conducted using a novel light source consisting of laser diodes and diffusing fibers to deliver 408-nm illumination at escalating total fluences to the whole stomach. Eighteen adults (10 female) with H. pylori infection were treated at 3 U.S. academic endoscopy centers. Quantitative bacterial counts were obtained from biopsies taken from the antrum, body and fundus, and serial urea breath tests. Results The largest reduction in bacterial load was in the antrum (>97%), followed by body (>95%) and fundus (>86%). There was a correlation between log reduction and initial bacterial load in the antrum. There was no dose-response seen with increasing illumination times. The urea breath test results indicated that the bacteria repopulated in days following illumination. Conclusion Intragastric violet light phototherapy is feasible and safe and may represent a novel approach to eradication of H. pylori, particularly in patients who have failed standard antibiotic treatment. This was a pilot study involving a small number of patients. Further research is needed to determine if phototherapy can be effective for eradicating H. pylori. PMID:19533762

  7. Delineation of vagal emetic pathways: intragastric copper sulfate-induced emesis and viral tract tracing in musk shrews

    PubMed Central

    Meyers, Kelly; Lim, Audrey; Dye, Matthew; Pak, Diana; Rinaman, Linda; Yates, Bill J.

    2014-01-01

    Signals from the vestibular system, area postrema, and forebrain elicit nausea and vomiting, but gastrointestinal (GI) vagal afferent input arguably plays the most prominent role in defense against food poisoning. It is difficult to determine the contribution of GI vagal afferent input on emesis because various agents (e.g., chemotherapy) often act on multiple sensory pathways. Intragastric copper sulfate (CuSO4) potentially provides a specific vagal emetic stimulus, but its actions are not well defined in musk shrews (Suncus murinus), a primary small animal model used to study emesis. The aims of the current study were 1) to investigate the effects of subdiaphragmatic vagotomy on CuSO4-induced emesis and 2) to conduct preliminary transneuronal tracing of the GI-brain pathways in musk shrews. Vagotomy failed to inhibit the number of emetic episodes produced by optimal emetic doses of CuSO4 (60 and 120 mg/kg ig), but the effects of lower doses were dependent on an intact vagus (20 and 40 mg/kg). Vagotomy also failed to affect emesis produced by motion (1 Hz, 10 min) or nicotine administration (5 mg/kg sc). Anterograde transport of the H129 strain of herpes simplex virus-1 from the ventral stomach wall identified the following brain regions as receiving inputs from vagal afferents: the nucleus of the solitary tract, area postrema, and lateral parabrachial nucleus. These data indicate that the contribution of vagal pathways to intragastric CuSO4-induced emesis is dose dependent in musk shrews. Furthermore, the current neural tracing data suggest brain stem anatomical circuits that are activated by GI signaling in the musk shrew. PMID:24430885

  8. Delineation of vagal emetic pathways: intragastric copper sulfate-induced emesis and viral tract tracing in musk shrews.

    PubMed

    Horn, Charles C; Meyers, Kelly; Lim, Audrey; Dye, Matthew; Pak, Diana; Rinaman, Linda; Yates, Bill J

    2014-03-01

    Signals from the vestibular system, area postrema, and forebrain elicit nausea and vomiting, but gastrointestinal (GI) vagal afferent input arguably plays the most prominent role in defense against food poisoning. It is difficult to determine the contribution of GI vagal afferent input on emesis because various agents (e.g., chemotherapy) often act on multiple sensory pathways. Intragastric copper sulfate (CuSO4) potentially provides a specific vagal emetic stimulus, but its actions are not well defined in musk shrews (Suncus murinus), a primary small animal model used to study emesis. The aims of the current study were 1) to investigate the effects of subdiaphragmatic vagotomy on CuSO4-induced emesis and 2) to conduct preliminary transneuronal tracing of the GI-brain pathways in musk shrews. Vagotomy failed to inhibit the number of emetic episodes produced by optimal emetic doses of CuSO4 (60 and 120 mg/kg ig), but the effects of lower doses were dependent on an intact vagus (20 and 40 mg/kg). Vagotomy also failed to affect emesis produced by motion (1 Hz, 10 min) or nicotine administration (5 mg/kg sc). Anterograde transport of the H129 strain of herpes simplex virus-1 from the ventral stomach wall identified the following brain regions as receiving inputs from vagal afferents: the nucleus of the solitary tract, area postrema, and lateral parabrachial nucleus. These data indicate that the contribution of vagal pathways to intragastric CuSO4-induced emesis is dose dependent in musk shrews. Furthermore, the current neural tracing data suggest brain stem anatomical circuits that are activated by GI signaling in the musk shrew.

  9. Ethanol tolerance in bacteria.

    PubMed

    Ingram, L O

    1990-01-01

    The adverse effects of ethanol on bacterial growth, viability, and metabolism are caused primarily by ethanol-induced leakage of the plasma membrane. This increase in membrane leakage is consistent with known biophysical properties of membranes and ethanolic solutions. The primary actions of ethanol result from colligative effects of the high molar concentrations rather than from specific interactions with receptors. The ethanol tolerance of growth in different microorganisms appears to result in large part from adaptive and evolutionary changes in cell membrane composition. Different cellular activities vary in their tolerance to ethanol. Therefore, it is essential that the aspect of cellular function under study be specifically defined and that comparisons of ethanol tolerance among systems share this common definition. Growth is typically one of the most sensitive cellular activities to inhibition by ethanol, followed by survival, or loss of reproductive ability. Glycolysis is the most resistant of these three activities. Since glycolysis is an exergonic process, a cell need not be able to grow or remain viable for glycolysis to occur.

  10. A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex.

    PubMed

    Kyle, B C; Gaylard, D; Riley, R H

    2012-03-01

    A 'can't intubate, can't oxygenate' airway crisis is a rare event which most anaesthetists will never experience during their career(1,2). This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in 'can't intubate, can't oxygenate' crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the 'can't intubate, can't oxygenate' situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.

  11. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-effect of severe distractive-flexion injury on C3-4 motion.

    PubMed

    Hindman, Bradley J; Fontes, Ricardo B; From, Robert P; Traynelis, Vincent C; Todd, Michael M; Puttlitz, Christian M; Santoni, Brandon G

    2016-11-01

    OBJECTIVE With application of the forces of intubation, injured (unstable) cervical segments may move more than they normally do, which can result in spinal cord injury. The authors tested whether, during endotracheal intubation, intervertebral motion of an injured C3-4 cervical segment 1) is greater than that in the intact (stable) state and 2) differs when a high- or low-force laryngoscope is used. METHODS Fourteen cadavers underwent 3 intubations using force-sensing laryngoscopes while simultaneous cervical spine motion was recorded with lateral fluoroscopy. The first intubation was performed with an intact cervical spine and a conventional high-force line-of-sight Macintosh laryngoscope. After creation of a severe C3-4 distractive-flexion injury, 2 additional intubations were performed, one with the Macintosh laryngoscope and the other with a low-force indirect video laryngoscope (Airtraq), used in random order. RESULTS During Macintosh intubations, between the intact and the injured conditions, C3-4 extension (0.3° ± 3.0° vs 0.4° ± 2.7°, respectively; p = 0.9515) and anterior-posterior subluxation (-0.1 ± 0.4 mm vs -0.3 ± 0.6 mm, respectively; p = 0.2754) did not differ. During Macintosh and Airtraq intubations with an injured C3-4 segment, despite a large difference in applied force between the 2 laryngoscopes, segmental extension (0.4° ± 2.7° vs 0.3° ± 3.3°, respectively; p = 0.8077) and anterior-posterior subluxation (0.3 ± 0.6 mm vs 0.0 ± 0.7 mm, respectively; p = 0.3203) did not differ. CONCLUSIONS The authors' hypotheses regarding the relationship between laryngoscope force and the motion of an injured cervical segment were not confirmed. Motion-force relationships (biomechanics) of injured cervical intervertebral segments during endotracheal intubation in cadavers are not predicted by the in vitro biomechanical behavior of isolated cervical segments. With the limitations inherent to cadaveric studies, the results of this study suggest

  12. Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients

    PubMed Central

    Girgis, Karim K.; Youssef, Maha M. I.; ElZayyat, Nashwa S.

    2014-01-01

    Background: One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway (Air-Q) and the Cobra Perilaryngeal Airway (CobraPLA) to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. Materials and Methods: A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure (ALP), fiber optic grade of glottic view and occurrence of complications. Results: Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA (96.7% vs. 90%), as was the first attempt success rate (90% vs. 80%). The intubation time was significantly longer with the CobraPLA (29.5 ± 10.9 s vs. 23.2 ± 9.8 s; P < 0.05), but the device removal time was comparable in the two groups. The CobraPLA showed a significantly higher ALP (20.8 ± 5.2 cmH2O vs. 16.3 ± 4.5 cmH2O; P < 0.001), but the fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. Conclusion: Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA. PMID:25422603

  13. DOCOSAHEXAENOIC ACID PARTIALLY AMELIORATES DEFICITS IN SOCIAL BEHAVIOR AND ULTRASONIC VOCALIZATIONS CAUSED BY PRENATAL ETHANOL EXPOSURE

    PubMed Central

    Wellmann, Kristen A.; George, Finney; Brnouti, Fares; Mooney, Sandra M.

    2015-01-01

    Prenatal ethanol exposure disrupts social behavior in humans and rodents. One system particularly important for social behavior is the somatosensory system. Prenatal ethanol exposure alters the structure and function of this area. Docosahexaenoic acid (DHA), an omega 3 polyunsaturated fatty acid, is necessary for normal brain development and brains from ethanol-exposed animals are DHA deficient. Thus, we determined whether postnatal DHA supplementation ameliorated behavioral deficits induced by prenatal ethanol exposure. Timed pregnant Long-Evans rats were assigned to one of three groups: ad libitum access to an ethanol-containing liquid diet, pair fed an isocaloric isonutritive non-alcohol liquid diet, or ad libitum access to chow and water. Pups were assigned to one of two postnatal treatment groups; gavaged intragastrically once per day between postnatal day (P)11 and P20 with DHA (10 g/kg in artificial rat milk) or artificial rat milk. A third group was left untreated. Isolation-induced ultrasonic vocalizations (iUSVs) were recorded on P14. Social behavior and play-induced USVs were tested on P28 or P42. Somatosensory performance was tested with a gap crossing test around P33 or on P42. Anxiety was tested on elevated plus maze around P35. Animals exposed to ethanol prenatally vocalized less, play fought less, and crossed a significantly shorter gap than control-treated animals. Administration of DHA ameliorated these ethanol-induced deficits such that the ethanol-exposed animals given DHA were no longer significantly different to control-treated animals. Thus, DHA administration may have therapeutic value to reverse some of ethanol’s damaging effects. PMID:25746516

  14. Is it safe to use frova airway intubating device during tracheal intubation in difficult airway patient with multiple and chest trauma?

    PubMed

    Hajjar, Waseem M; Alsubaie, Nourah; Nouh, Thamer A; Al-Nassar, Sami A

    2016-01-01

    Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.

  15. Submental intubation: alternative short-term airway management in maxillofacial trauma

    PubMed Central

    Kumar, Ravi Raja; Vyloppilli, Suresh; Thangavelu, Annamala; Joseph, Benny; Ahsan, Auswaf

    2016-01-01

    Objectives To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications. PMID:27429937

  16. Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine

    PubMed Central

    Raval, Chetankumar; Patel, Heena; Patel, Pranoti; Kharod, Utpala

    2010-01-01

    Ankylosing spondylitis (AS) patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed. PMID:20668567

  17. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

    PubMed

    Ulusoy, Hulya; Besir, Ahmet; Cekic, Bahanur; Kosucu, Muge; Geze, Sukran

    2014-01-01

    Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

  18. Study of intragastric structuring ability of sodium alginate based o/w emulsions under in vitro physiological pre-absorptive digestion conditions.

    PubMed

    Soukoulis, Christos; Fisk, Ian D; Bohn, Torsten; Hoffmann, Lucien

    2016-04-20

    In the present work, the intragastric structuring ability of o/w emulsions either stabilised (1-4%, w/w of sodium alginate (SA)) or structured with sheared ionic gel (1-3%, w/w of SA crosslinked with Ca(2+)) in the absence (saliva and gastric phases constituted of deionised water) or presence of in vitro pre-absorptive conditions (physiological simulated saliva and gastric fluids) was investigated. Visualisation of the morphological aspects of the gastric chymes, in the absence of multivalent counterions, demonstrated that SA stabilised systems underwent a remarkable swelling in the pH range of 2-3, whilst at the same pH range, ionic SA gel structured systems maintained their major structure configuration. When the aforementioned systems were exposed to physiological intragastric fluids, a reduction of the length and the hydrodynamic volume of the alginate fibres was detected regardless the structuring approach. On their exposure to physiological intragastric conditions (pH=2), SA stabilised emulsions underwent sol-gel transition achieving a ca. 3- to 4-order increase of storage modulus (at 1Hz). In the case of ionic sheared gel structured emulsions, exposure to physiological intragastric fluids resulted in a 10-fold reduction ability of their acid structuring ability, most likely due to the dialysis of egg-box dimer conformations by monovalent cations and protons and the sterical hindering of hydrogen bonding of MM and GG sequences under acidic conditions. Using of non-physiological simulated intragastric fluids was associated with overestimated structuring performance of SA regardless its physical state.

  19. Differential sensitivity of ethanol-elicited ERK phosphorylation in nucleus accumbens of Sardinian alcohol-preferring and -non preferring rats.

    PubMed

    Rosas, Michela; Zaru, Alessandro; Sabariego, Marta; Giugliano, Valentina; Carboni, Ezio; Colombo, Giancarlo; Acquas, Elio

    2014-08-01

    Sardinian alcohol-preferring (sP) and -non preferring (sNP) rats have been selectively bred for opposite ethanol preference and consumption; sP rats represent a validated experimental tool to model several aspects of excessive ethanol drinking in humans. Phosphorylated Extracellular signal-Regulated Kinase (pERK) in dopamine-rich terminal areas plays a critical role in several psychopharmacological effects of addictive drugs, including ethanol. This study was aimed at investigating whether ethanol-elicited ERK activation may differ in key brain areas of ethanol-naïve sP and sNP rats. To this end, the effects of ethanol (0, 0.5, 1, and 2 g/kg, administered intra-gastrically [i.g.]) on ERK phosphorylation were assessed by pERK immunohistochemistry in the shell (AcbSh) and core (AcbC) of the nucleus accumbens (Acb) as well as in the prelimbic (PrL) and infralimbic (IL) prefrontal cortex (PFCx), in the bed nucleus of stria terminalis (BSTL) and in the central nucleus of the amygdala (CeA). Ethanol (1 g/kg) significantly increased pERK immunoreactivity in AcbSh and AcbC of sP but not sNP rats. Conversely, ethanol failed to affect pERK expression in PrL and IL PFCx as well as in BSTL and CeA of both sP and sNP rats. These results suggest that selective breeding of these rat lines results in differential effects of acute ethanol on ERK phosphorylation in brain regions critical for the psychopharmacological effects of ethanol.

  20. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation

    PubMed Central

    Gupta, Priyamvada; Jethava, Durga; Choudhary, Ruchika; Jethava, Dharam Das

    2016-01-01

    Background and Aims: Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. Methods: Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20–45 years old, 40–65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin). They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used. Results: It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation. Conclusion: Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation. PMID:27761033

  1. Nasotracheal intubation: an unusual cause of palatal perforation in an insulin dependent diabetes mellitus patient.

    PubMed

    Bhowate, Rahul; Dubey, Alok

    2004-01-01

    A case of palatal perforation occurring in 7-year-old girl with IDDM due to nasotracheal intubation is reported. The child, who was not previously diagnosed of IDDM, was brought to hospital in comatose stage and was put on nasotracheal tube for maintaining respiration. This paper highlights the link between IDDM and palatal perforation communicating the nasal cavity due to naso-tracheal intubation.

  2. Awake nasotracheal intubation using fiberoptic bronchoscope in a pediatric patient with Freeman-Sheldon syndrome.

    PubMed

    Kim, J S; Park, S Y; Min, S K; Kim, J H; Lee, S Y; Moon, B K

    2005-09-01

    The Freeman-Sheldon syndrome is a congenital disease primarily affecting the facial, limb and respiratory muscles that give rise to classical clinical features including typical whistling face and short webbed neck associated with difficult intubation. We present successful awake nasotracheal intubation in a 6-year-old patient with typical clinical features of Freeman-Sheldon syndrome by using fiberoptic bronchoscope on two separate occasions.

  3. Non-intubated laparoscopic repair of giant Morgagni’s hernia for a young man

    PubMed Central

    Zhang, Miao; Wang, Heng; Liu, Dong; Pan, Xuefeng; Wu, Wenbin; Hu, Zhengqun

    2016-01-01

    An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni’s hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH. PMID:27621903

  4. Uniportal video-assisted thoracic surgery colorectal lung metastasectomy in non-intubated anesthesia

    PubMed Central

    Sellitri, Francesco; Perroni, Gianluca; Schillaci, Orazio; Mineo, Tommaso Claudio

    2017-01-01

    Background More than ten years ago we started a program of video-assisted thoracic surgery (VATS) lung metastasectomy in non-intubated local anesthesia. In this study we investigated the effectiveness and long term results of this combined surgical-anesthesiological technique. Methods Between 2005 and 2014, 48 patients (25 men and 23 women) with pulmonary oligometastases from colorectal cancer, at the first episode, underwent VATS metastasectomy under non-intubated local anesthesia. Three patients required intubation for intolerance. In the same period 13 patients scheduled for non-intubated metastasectomy refused awake surgery and were used as a control group. Results The two groups were homogeneous for both demographic and pathological features. Mean number of lesions resected per patient were 1.51 (non-intubated) vs. 1.77 (control), respectively (P=0.1). The oxygenation was significantly lower in the non-intubated group especially at the end of the procedure, but the values inverted from the first postoperative hour. There was no mortality in any groups. The non-intubated group demonstrated a significant shorter overall operating time (P=0.04), better quality of recovery after both 24 (P=0.04) and 48 hours (P=0.04), shorter median hospital stay (P=0.03) and lower estimated costs (P=0.03), even excluding the hospital stay. Major morbidity rate was lower (6% vs. 23%) yet not significant (P=0.1). Both disease free survival and overall survival were similar between groups. Conclusions VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Morbidity rate was lower yet not significant. Long term results were similar. PMID:28275472

  5. Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study

    PubMed Central

    Saraçoğlu, Ayten; Dal, Didem; Baygın, Ömer; Göğüş, Fevzi Yılmaz

    2016-01-01

    Objective Training students on simulators before allowing their direct contact with patients is well accepted. There is no clinical or manikin-based simulation study in the literature comparing tracheal intubation with Airtraq, laryngeal mask airway (LMA) CTrach and Macintosh laryngoscopes performed by medical students having no prior intubation experience. Methods After obtaining written informed consents, 123 participants were included in the study. The participants were asked to intubate the manikin five times with each device randomly. After all the participants had completed their fifth intubations, the measurements were performed. The primary outcome variables were the first-attempt success rate and the time for a successful intubation, while the secondary outcome variables were to determine the scores of dental trauma, the difficulty visual analogue scale and the optimization manoeuvres. Results The LMA CTrach group revealed a significantly higher number of intubation attempts. The mean time for a successful intubation was the longest in the LMA CTrach group (17.66±8.22 s, p<0.05). Students defined the Airtraq as the easiest to use and the Macintosh laryngoscope as the most difficult device to use and learn. Dental trauma severity was significantly lower in the Airtraq group than in the other groups (p<0.05), and it was found to be 0 in 81.1% in the Airtraq group. The head extension optimization manoeuvre rate was significantly higher with the Macintosh laryngoscope than with the Airtraq laryngoscope (p<0.05). Conclusion This study, in which different types of laryngoscopes were compared, revealed that the Airtraq laryngoscope has advantages, such as shorter intubation duration, less additional optimization manoeuvres, less dental trauma intensity and is easier to learn compared with the LMA CTrach and Macintosh laryngoscopes. PMID:27366562

  6. Strengths and weaknesses of in-tube solid-phase microextraction: A scoping review.

    PubMed

    Fernández-Amado, M; Prieto-Blanco, M C; López-Mahía, P; Muniategui-Lorenzo, S; Prada-Rodríguez, D

    2016-02-04

    In-tube solid-phase microextraction (in-tube SPME or IT-SPME) is a sample preparation technique which has demonstrated over time its ability to couple with liquid chromatography (LC), as well as its advantages as a miniaturized technique. However, the in-tube SPME perspectives in the forthcoming years depend on solutions that can be brought to the environmental, industrial, food and biomedical analysis. The purpose of this scoping review is to examine the strengths and weaknesses of this technique during the period 2009 to 2015 in order to identify research gaps that should be addressed in the future, as well as the tendencies that are meant to strengthen the technique. In terms of methodological aspects, this scoping review shows the in-tube SPME strengths in the coupling with LC (LC-mass spectrometry, capillary LC, ultra-high-pressure LC), in the new performances (magnetic IT-SPME and electrochemically controlled in-tube SPME) and in the wide range of development of coatings and capillaries. Concerning the applicability, most in-tube SPME studies (around 80%) carry out environmental and biomedical analyses, a lower number food analyses and few industrial analyses. Some promising studies in proteomics have been performed. The review makes a critical description of parameters used in the optimization of in-tube SPME methods, highlighting the importance of some of them (i.e. type of capillary coatings). Commercial capillaries in environmental analysis and laboratory-prepared capillaries in biomedical analysis have been employed with good results. The most consolidated configuration is in-valve mode, however the cycle mode configuration is frequently chosen for biomedical analysis. This scoping review revealed that some aspects such as the combination of in-tube SPME with other sample treatment techniques for the analysis of solid samples should be developed in depth in the near future.

  7. [Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].

    PubMed

    Engel, B; Schuh, F T

    1985-12-01

    The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. After administration of 0.1 mg/kg vecuronium, the actual maximum effect (more than 90% block) was established within 4 min; after 0.1 mg/kg pancuronium within 6 min and after 1.0 mg/kg suxamethonium within 2 min. Intubation conditions improved with time. After 0.1 mg/kg vecuronium atraumatic intubation was possible within 2 min and after 0.1 mg/kg pancuronium within 4 min. Following 1.0 mg/kg suxamethonium, optimum intubation conditions were achieved within 1 min. Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.

  8. Comparison between remifentanil and dexmedetomidine for sedation during modified awake fiberoptic intubation

    PubMed Central

    LIU, HUI-HUI; ZHOU, TAO; WEI, JIAN-QI; MA, WU-HUA

    2015-01-01

    Cricothyroid membrane injections and the application of a coarse fiberoptic bronchoscope (FOB) below the vocal cords for topical anesthesia have a number of limitations for certain patients. Thus, the aim of the present observational study was to assess the effect of a novel modified topical anesthesia method using the effective sedation drugs, remifentanil (Rem) or dexmedetomidine (Dex), during awake fiberoptic orotracheal intubation (AFOI). In total, 90 adult patients, who had been classified as American Society of Anesthesiologists I–II, were included in the study. The patients had anticipated difficult airways and were to undergo orotracheal intubation for elective surgery. The patients were enrolled in the double-blinded randomized pilot study and received Rem or Dex for sedation during the modified AFOI procedure. The two groups received 2% lidocaine for topical anesthesia via an epidural catheter, which was threaded through the suction channel of the FOB. The main clinical outcomes were evaluated by graded scores representing the conditions for intubation and post-intubation. Additional parameters analyzed included airway obstruction, hemodynamic changes, time required for intubation, amnesia level and subjective satisfaction. All 90 patients were successfully intubated using the modified AFOI technique. The comfort scores and airway events during intubation did not significantly differ between the two groups. However, the Rem group experienced less coughing, and less time was required for tracheal intubation when compared with the Dex group. No statistically significant differences were observed in the changes to the mean arterial pressure and heart rate at any time point between the two groups. Therefore, the current study demonstrated that the modified AFOI method is feasible and effective for difficult airway management, and that Dex and Rem exhibit similar efficacy as adjuvant therapies. PMID:25780419

  9. Parker Flex-It stylet is as effective as GlideRite Rigid stylet for orotracheal intubation by Glidescope

    PubMed Central

    Sheta, Saad A.; Abdelhalim, Ashraf A.; ElZoughari, Ismail A.; AlZahrani, Tariq A.; Al-Saeed, Abdulhamid H.

    2015-01-01

    Objectives: To evaluate Parker Flex-It stylet as an alternative to GlideRite Rigid stylet to aid tracheal intubation with the Glidescope. Methods: This prospective randomized trial was conducted at King Abdulaziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia between May and December 2014. Sixty American Society of Anesthesiologists I-II patients were randomly assigned to one of 2 equal groups receiving intubation by Glidescope using either GlideRite Rigid stylet (Group GS) or Parker Flex-It stylet (Group PS). The total intubation time, ease of intubation, incidences of successful intubation at first attempt, number of intubation attempts, use of optimization maneuvers, and possible complications were recorded. Results: No significant differences between both groups regarding the total intubation time (p=0.08) was observed. Intubation was significantly easier in group PS compared with group GS as measured by visual analogue scale (p=0.001) with no significant differences between the groups regarding the rate of successful tracheal intubation from first attempt (p=0.524). However, the number of attempts at intubation and usage of external laryngeal manipulation were similar in both groups (p>0.05). The incidence of sore throat, dysphagia, hoarseness, and trauma were significantly higher in group GS (p<0.05). Conclusion: Parker Flex-It stylet is as effective as GlideRite Rigid stylet when used by experienced operators in patients with normal airways using Glidescope; however, it is easier and less traumatic. PMID:26620987

  10. A systematic review and meta-regression analysis of mivacurium for tracheal intubation.

    PubMed

    Vanlinthout, L E H; Mesfin, S H; Hens, N; Vanacker, B F; Robertson, E N; Booij, L H D J

    2014-12-01

    We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.

  11. The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.

    PubMed

    Raymondos, K; Seidel, T; Sander, B; Gerdes, A; Goetz, F; Helmstädter, V; Panning, B; Dieck, T

    2014-09-01

    The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices.

  12. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    PubMed

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

  13. Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit

    PubMed Central

    Clark, Matthew T.; Vergales, Brooke D.; Paget-Brown, Alix O.; Smoot, Terri J.; Lake, Douglas E.; Hudson, John L.; Delos, John B.; Kattwinkel, John; Moorman, J. Randall

    2013-01-01

    Background Infants admitted to the neonatal intensive care unit (NICU), and especially those born with very low birth weight (VLBW; <1500 grams), are at risk for respiratory decompensation requiring endotracheal intubation and mechanical ventilation. Intubation and mechanical ventilation are associated with increased morbidity, particularly in urgent unplanned cases. Methods We tested the hypothesis that the systemic response associated with respiratory decompensation can be detected from physiological monitoring, and that statistical models of bedside monitoring data can identify infants at increased risk of urgent, unplanned intubation. We studied 287 VLBW infants consecutively admitted to our NICU and found 96 events in 51 patients, excluding intubations occurring within 12 hours of a previous extubation. Results In order of importance in a multivariable statistical model, we found the characteristics of reduced O2 saturation, especially as heart rate was falling, increased heart rate correlation with respiratory rate, and the amount of apnea all were significant independent predictors. The predictive model, validated internally by bootstrap, had receiver-operating characteristic area of 0.84 ± 0.04. Conclusions We propose that predictive monitoring in the NICU for urgent unplanned intubation may improve outcomes by allowing clinicians to intervene non-invasively before intubation is required. PMID:23138402

  14. Effects of electroacupuncture on ethanol-induced impairments of spatial learning and memory and Fos expression in the hippocampus in rats.

    PubMed

    Lu, Bin; Ma, Zhao; Cheng, Fei; Zhao, Yan; Zhang, Xin; Mao, Huijuan; Shen, Xueyong; Liu, Sheng

    2014-07-25

    It is well established that alcohol impairs spatial learning and memory. Here, we investigated the effects of electroacupuncture (EA) at ST36 or nonacupoint on ethanol-induced learning and memory impairment and the expression of Fos in the hippocampus. Ethanol (5g/kg) was administered intragastrically once a day for 5 consecutive days; 2Hz EA was administered immediately after ethanol exposure. After a 2-day ethanol abstinence, for 6 consecutive days, the rats were submitted to Morris water maze training. Probe trials were performed on 1 day after the final training session. We also applied immunohistochemistry to detect Fos-positive nuclei in the hippocampus. We found that 5-day ethanol exposure markedly decreased spatial learning and memory abilities in the Morris water maze task as indicated by escape latency and time in the target quadrant. EA treatment shortened the time of reaching platform and increased times traveled in the target quadrant (P<0.05). Animals administered with ethanol emitted significantly fewer Fos expression in the hippocampal CA1 area. EA increased Fos expression in the hippocampal CA1 area. Significant correlations were obtained between Fos protein expression in CA1 and time in the target quadrant. Altogether, these results suggest that EA protects against ethanol-induced impairments of spatial learning and memory, which may be involved in the hippocampal CA1 area. EA treatment may provide a novel nonpharmacological strategy for ethanol-induced learning and memory impairment.

  15. Biofuel Ethanol Transport Risk

    EPA Science Inventory

    Ethanol production has increased rapidly over the last 10 years and many communities lack awareness of the increased and growing extent of biofuel transportation through their jurisdictions. These communities and their emergency responders may not have the information and resour...

  16. Process for producing ethanol

    SciTech Connect

    Lantero, O.J.; Fish, J.J.

    1993-07-27

    A process is described for producing ethanol from raw materials containing a high dry solid mash level having fermentable sugars or constituents which can be converted into sugars, comprising the steps of: (a) liquefaction of the raw materials in the presence of an alpha amylase to obtain liquefied mash; (b) saccharification of the liquefied mash in the presence of a glucoamylase to obtain hydrolysed starch and sugars; (c) fermentation of the hydrolysed starch and sugars by yeast to obtain ethanol; and (d) recovering the obtained ethanol, wherein an acid fungal protease is introduced to the liquefied mash during the saccharification and/or to the hydrolysed starch and sugars during the fermentation, thereby increasing the rate of production of ethanol as compared to a substantially similar process conducted without the introduction of the protease.

  17. Ethanol production from lignocellulose

    DOEpatents

    Ingram, Lonnie O.; Wood, Brent E.

    2001-01-01

    This invention presents a method of improving enzymatic degradation of lignocellulose, as in the production of ethanol from lignocellulosic material, through the use of ultrasonic treatment. The invention shows that ultrasonic treatment reduces cellulase requirements by 1/3 to 1/2. With the cost of enzymes being a major problem in the cost-effective production of ethanol from lignocellulosic material, this invention presents a significant improvement over presently available methods.

  18. Unusual Displacement of a Mobilised Dental Bridge during Orotracheal Intubation.

    PubMed

    Feltracco, Paolo; Barbieri, Stefania; Salvaterra, Francesca; Tiano, Letizia; Gaudio, Rosa Maria; Galligioni, Helmut; Ori, Carlo; Avato, Francesco Maria

    2011-01-01

    Dental trauma during tracheal intubation mostly happens in case of poor dentition, restricted mouth opening, and/or difficult laryngoscopy. 57-year-old man undergoing laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma had his dental work detached at induction of anesthesia. Oropharyngeal direct view, manual inspection, fibreoptic nosendoscopy, tracheobronchoscopy, and fiberoptic inspection of the esophagus and stomach were unsuccessful in locating the dislodged bridge. While other possible exams were considered, such as lateral and AP x-ray of head and neck, further meticulous manual "sweepings" of the mouth were performed, and by moving the first and second fingers below the soft palate deep towards the posterolateral wall of the pharynx, feeling consistent with a dental prosthesis was detected in the right pharyngeal recess. Only after pulling the palatopharyngeal arch upward was it possible to grasp it and extract it out with the aid of a Magill Catheter Forceps. Even though the preexisting root and bridge deficits were well reported by the consultant dentist, the patient was fully reimbursed. The lack of appropriate documentation of the advanced periodontal disease in the anesthesia records, no mention of potential risks on anesthesia consent, and insufficient protective measures during airway instrumentation reinforced the reimbursement claim.

  19. Floating modular drug delivery systems with buoyancy independent of release mechanisms to sustain amoxicillin and clarithromycin intra-gastric concentrations.

    PubMed

    Rossi, Alessandra; Conti, Chiara; Colombo, Gaia; Castrati, Luca; Scarpignato, Carmelo; Barata, Pedro; Sandri, Giuseppina; Caramella, Carla; Bettini, Ruggero; Buttini, Francesca; Colombo, Paolo

    2016-01-01

    Release modules of amoxicillin and clarithromycin combined in a single dosage form designed to float in the gastric content and to sustain the intra-gastric concentrations of these two antibiotics used for the eradication of Helicobacter pylori have been studied. The modules having a disc shape with curved bases were formulated as hydrophilic matrices. Two modules of clarithromycin were assembled by sticking the concave base of one module to the concave base of the other, creating an internal void chamber. The final dosage form was a floating assembly of three modules of clarithromycin and two of amoxicillin in which the drug release mechanism did not interfere with the floatation mechanism. The assembled system showed immediate in vitro floatation at pH 1.2, lasting 5 h. The in vitro antibiotics release profiles from individual modules and assembled systems exhibited linear release rate during buoyancy for at least 8 h. The predicted antibiotic concentrations in the stomach maintained for long time levels significantly higher than the respective minimum inhibitory concentrations (MIC). In addition, an in vivo absorption study performed on beagle dogs confirmed the slow release of clarithromycin and amoxicillin from the assembled system during the assembly's permanence in the stomach for at least 4 h.

  20. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

    PubMed Central

    2012-01-01

    Introduction Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy. Methods In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®). Results A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001). Conclusion Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur. PMID:22695007

  1. Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation.

    PubMed

    Grgurich, Erin; Arnemann, Cynthia; Amon, Kim; Horton, Rose; Carlson, Jestin N

    As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

  2. The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

    PubMed Central

    Min, Jeong Jin; Lee, Jong-Hwan; Kang, Se Hee; Kim, Eunhee; Lee, Sangmin M.; Cho, Jong Ho; Kim, Hong Kwan

    2016-01-01

    To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III. Trial Registration: ClinicalTrials.gov NCT02190032 PMID:27537372

  3. Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases.

    PubMed

    Oppenlander, Mark E; Hsu, Forrest D; Bolton, Patrick; Theodore, Nicholas

    2015-05-01

    Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6-7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4-T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6-T1 decompression and fixation for a C6-7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6-7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.

  4. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method

    PubMed Central

    2012-01-01

    Background The “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion. Methods A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated. Results Successful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a “Rusch” intubation stylet. Conclusions The “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients. Trial registration Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910) PMID:22853453

  5. Endotracheal intubation with a traditional videolaryngoscope blade versus an integrated suction blade in a hemorrhagic airway cadaver model.

    PubMed

    Wadman, Michael C; Nicholas, Thomas A; Bernhagen, Mary A; Kuper, Gail M; Schmidt, Steven; Massignan, Jason; Boedeker, Ben H

    2013-01-01

    Lightly embalmed hemorrhagic cadaver models and the Storz CMAC videolaryngoscope fitted with either an integrated suction blade vs. a traditional blade were used to determine efficacy of the instruments in hemorrhagic airway intubation. Significant differences were found between the devices in intubation success rates of the viscosity saliva and frothy blood models, as well as a significant difference in intubation times in the frothy blood model. Feedback provided by the study participants indicated preference for the integrated video suction blade in hemorrhagic airway intubation.

  6. Comparative trial of succinylcholine vs low dose atracurium-lidocaine combination for intubation in short outpatient procedures.

    PubMed Central

    Luyk, N. H.; Weaver, J. M.; Quinn, C.; Wilson, S.; Beck, F. M.

    1990-01-01

    Despite its many disadvantages, succinylcholine is the most commonly used drug for intubation of patients for short out-patient procedure. This double blind trial compared a low dose atracurium/lidocaine combination to succinylcholine for intubation in 40 ASA1 adult patients. Low dose atracurium/lidocaine provided clinical intubating conditions at two minutes and cardiovascular stability equivalent to succinylcholine with significantly less myalgia. Spontaneous respiration was slower after low dose atracurium/lidocaine relative to succinylcholine. Low dose atracurium/lidocaine may provide an acceptable alternative to succinylcholine for intubation in short outpatient procedures. PMID:2096747

  7. Supplemental choline does not attenuate the effects of neonatal ethanol administration on habituation of the heart rate orienting response in rats.

    PubMed

    Hunt, Pamela S; Jacobson, Sarah E; Kim, Sarah

    2014-01-01

    Several studies using rodent subjects have now shown that extra dietary choline may prevent or even reverse the deleterious effects of pre- and early post-natal ethanol administration. Choline supplementation has been shown to attenuate many, although not all, of ethanol's effects on brain development and behavior. Our laboratory has consistently reported impaired habituation of the heart rate orienting response to a novel olfactory stimulus in animals exposed to ethanol on postnatal days (PD) 4-9. Here we examine whether supplemental choline given both during and after ethanol administration could alleviate these ethanol-induced deficits. Subjects were given 5g/kg/day ethanol or sham intubations on PD 4-9. Half of the subjects in each group were given a single daily s.c. injection of choline chloride on PD 4-20, while the other half were injected daily with saline. Pups were tested for heart rate orienting and response habituation in a single test session on PD 23. Results replicated the ethanol-induced impairment in response habituation. However, choline supplementation had no effect on orienting or habituation in either neonatal treatment group. These findings indicate that habituation deficits induced by ethanol are not alleviated by extra dietary choline using these parameters. Choline holds great promise as a treatment for some fetal alcohol effects, but is not an effective treatment for all ethanol-related deficits.

  8. Male adolescent rats display blunted cytokine responses in the CNS after acute ethanol or lipopolysaccharide exposure.

    PubMed

    Doremus-Fitzwater, Tamara L; Gano, Anny; Paniccia, Jacqueline E; Deak, Terrence

    2015-09-01

    Alcohol induces widespread changes in cytokine expression, with recent data from our laboratory having demonstrated that, during acute ethanol intoxication, adult rats exhibit consistent increases in interleukin (IL)-6 mRNA expression in several brain regions, while showing reductions in IL-1 and TNFα expression. Given evidence indicating that adolescence may be an ontogenetic period in which some neuroimmune processes and cells may not yet have fully matured, the purpose of the current experiments was to examine potential age differences in the central cytokine response of adolescent (P31-33days of age) and adult (69-71days of age) rats to either an acute immune (lipopolysaccharide; LPS) or non-immune challenge (ethanol). In Experiment 1, male Sprague-Dawley rats were given an intraperitoneal (i.p.) injection of either sterile saline, LPS (250μg/kg), or ethanol (4-g/kg), and then trunk blood and brain tissue were collected 3h later for measurement of blood ethanol concentrations (BECs), plasma endotoxin, and central mRNA expression of several immune-related gene targets. In Experiment 2, the response to intragastrically (i.g.) administered ethanol was examined and compared to animals given tap water (i.g.). Results showed that LPS stimulated robust increases in expression of IL-1, IL-6, TNFα, and IκBα in the hippocampus, PVN, and amygdala, and that these increases were generally less pronounced in adolescents relative to adults. Following an i.p. ethanol challenge, IL-6 and IκBα expression was significantly increased in both ages in the PVN and amygdala, and adults exhibited even greater increases in IκBα than adolescents. I.g. administration of ethanol also increased IL-6 and IκBα expression in all three brain regions, with hippocampal IL-6 elevated even more so in adults compared to adolescents. Furthermore, assessment of plasma endotoxin concentrations revealed (i) whereas robust increases in plasma endotoxin were observed in adults injected with LPS

  9. Preparing Anesthetists to Manage Cannot Intubate/Cannot Ventilate Situations.

    PubMed

    Wofford, Kenneth A

    2017-01-01

    Cannot intubate/cannot ventilate (CICV) situations during anesthesia are rare, potentially catastrophic to the patient, and difficult to predict. Widely adopted practice guidelines advocate an algorithmic approach to CICV situations in which the anesthetist: (a) recognizes the CICV situation, (b) calls for help, (c) steadily progresses through a variety of methods to ventilate the patient and secure the airway, (d) restores ventilation via an infraglottic airway if the patient cannot be safely awakened prior to becoming moribund. Despite widespread consensus that rapid progression to placement of an infraglottic airway is critical to the survival of the patient in a CICV situation, the rarity of CICV is a substantial barrier for anesthetists attempting to gain and maintain skill at placing infraglottic airways. Peer-reviewed literature reveals a number of themes relevant to training anesthetists in infraglottic airway placement. Specific training in infraglottic airway access consistently decreased the time required for anesthetists to decide to place an infraglottic airway. No one approach or method for placing an infraglottic airway was consistently faster or more successful. Model fidelity (i.e., the use of low-fidelity task trainers vs. high-fidelity simulated patients) during teaching did not affect the performance of anesthetists at placing infraglottic airways, and performance rapidly plateaued after five repetitions during teaching. Finally, skill at placing an infraglottic airway was sustained for 6 to 12 months after training. These findings have implications for how nurse anesthetists should learn and sustain the skill of infraglottic airway placement. Nurse anesthetists should undergo initial training that requires the repetitive placement of infraglottic airways, and receive sustainment training every 6 to 12 months thereafter. Although rarely used, the skill of an anesthetist in infraglottic airway placement can mean the difference between life and

  10. Attenuation of pressor response following intubation: Efficacy of nitro-glycerine lingual spray

    PubMed Central

    Kumari, Indira; Naithani, Udita; Dadheech, Vinod Kumar; Pradeep, D. S.; Meena, Khemraj; Verma, Devendra

    2016-01-01

    Background and Aims: The role of nitro-glycerine (NTG) lingual spray for attenuation of the hemodynamic response associated with intubation is not much investigated. We conducted this study to evaluate the efficacy of NTG lingual pump or pen spray in attenuation of intubation induced hemodynamic responses and to elucidate the optimum dose. Material and Methods: In a prospective randomized controlled trial, 90 adult patients of ASA I, II, 18-60 year posted for elective general surgery under general anesthesia with intubation were randomly allocated to three groups as Group C (control) - receiving no NTG spray, Group N1 – receiving 1 NTG spray and Group N2 – receiving 2 NTG spray one minute before intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate were recorded at baseline, just before intubation (i.e., 60 s just after induction and NTG spray), immediately after intubation, at 1, 2, 5 and 10 min after intubation. Results: Incidence of hypertension was significantly higher in Group C (60%, n = 18) as compared to Group N1 and N2 (10%, n = 3 each), P < 0.01. Mean value of SBP, DBP and MAP showed a significant rise as compared to baseline, following intubation in control group (15.31% in SBP, 12.12% in DBP, 17.77% in MAP) that persisted till 5 min, while no significant rise was observed in Group N1 and N2. There was a trend toward fall in blood pressure in Group N2 (4.95% fall in SBP, 4.72% fall in MAP) 1-min following spray, which was clinically insignificant. Mean value of SBP, DBP and MAP was significantly higher in Group C than in Group N1, which was in turn greater than Group N2 (Group C > N1> N2), P < 0.05. However, incidence of tachycardia was comparable in three groups (70% in group C, 63.33% in Group N1 and 67.77% in Group N2, P > 0.05). Conclusions: We concluded that the NTG lingual spray in dose of 0.4 mg (1 spray) or 0.8 mg (2 sprays) was effective in attenuation of intubation induced

  11. Balloon Catheter Dilation and Nasolacrimal Intubation for Treatment of Nasolacrimal Duct Obstruction Following a Failed Probing

    PubMed Central

    2009-01-01

    Objective To compare the outcome of balloon catheter dilation and nasolacrimal intubation as treatments for congenital nasolacrimal duct obstruction (NLDO) after a failed probing in children less than 4 years of age Methods We conducted a prospective, non-randomized multicenter study which enrolled 159 children aged 6 to <48 months who had a history of a single failed nasolacrimal duct probing and had at least one of the following clinical signs of NLDO present: epiphora, mucous discharge and/or increased tear lake. One hundred ninety-nine eyes underwent either balloon catheter nasolacrimal duct dilation or nasolacrimal duct intubation. Treatment success was defined as no epiphora, mucous discharge or increased tear lake present at the outcome visit six months after surgery. Results Treatment success was reported in 65 of 84 eyes (77%, 95% CI = 65% to 85%) in the balloon group compared with 72 of 88 eyes (84%, 95% CI = 74% to 91%) eyes in the intubation group (risk ratio for success for intubation vs. balloon = 1.08, 95% CI = 0.95 to 1.22). Conclusions Balloon catheter dilation and nasolacrimal duct intubation each alleviate the clinical signs of persistent nasolacrimal duct obstruction in a similar proportion of patients. PMID:19433712

  12. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section

    PubMed Central

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m2 who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m2. The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively. PMID:28246593

  13. The temporary effect of short-term endotracheal intubation on vocal function.

    PubMed

    Paulauskiene, Iveta; Lesinskas, Eugenijus; Petrulionis, Mindaugas

    2013-01-01

    The objective of the study was to assess and perceive the vocal and pharyngeal symptoms and acoustic changes of voice after short-term endotracheal intubation and to evaluate the relation between these changes and the endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. A total of 108 patients were evaluated preoperatively, 1-2 and 24 h after extubation. The vocal and pharyngeal symptoms, voice acoustic characteristics and maximum phonation time (MPT) were evaluated to find the relationship with endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. All vocal and pharyngeal symptoms increased significantly at 24 h and remained significantly increased at 24 h after general anaesthesia. The vocal acoustic parameters changed significantly at 1-2 h: decrease of MPT and increase relative average perturbation were recorded. The day after the short-term intubation: only noise to harmony ratio and habitual pitch remains significantly changed. The most important endotracheal tube parameters that affect significantly (P value <0.05) the vocal function were the size of tube, cuff volume and number of intubation attempts. In relation to the anaesthesia, the changes of the acoustic parameters did not associate significantly with the anaesthesia-related parameters. No statistically significant relationship between experience of an anaesthesiologist and changes of the voice after anaesthesia was detected. Though being short-term, endotracheal anaesthesia is an invasive procedure, and its temporary influence on vocal function is important.

  14. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    PubMed

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  15. New visible endotracheal intubation method using the endoscope system for mice inhalational anesthesia.

    PubMed

    Konno, Kenjiro; Itano, Naoki; Ogawa, Teppei; Hatakeyama, Mika; Shioya, Kyoko; Kasai, Noriyuki

    2014-06-01

    Appropriate and effective anesthesia is critical, because it has a strong influence on laboratory animals, and its affect greatly impacts the experimental data. Inhalational anesthesia by endotracheal intubation is currently prevailing in general anesthesia and is prefered over injection anesthesia, especially for large laboratory animals, because it is a safe and easy control agent. However, it is not common for small laboratory animals, because of the high degree of technical skills required. We assessed the capability of use for mice of the endotracheal intubation by using the endoscope system "TESALA AE-C1" and inhalational anesthesia using a ventilator. Endotracheal intubation was successfully performed on all 10 C57BL/6 mice injected with M/M/B: 0.3/4/5 comprised of medetomidine, midazoram and butorphanol, at a dose of 0.3 mg/kg + 4.0 mg/kg + 5.0 mg/kg body weight/mouse, respectively. After the intubated mice were connected with the inhalational anesthesia circuit and the ventilator, vital signs were measured until 15 min after the connection. The data with M/M/B: 0.3/4/5 showed stable and normal values, which indicated that this new endotracheal intubation method was simple, reliable and safe, which mean that this anesthesia is favorable in regard to the animal's welfare.

  16. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    PubMed

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  17. A canine model of tracheal stenosis induced by cuffed endotracheal intubation

    PubMed Central

    Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

    2017-01-01

    Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

  18. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section.

    PubMed

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon; Limpawattana, Panita; Siriussawakul, Arunotai

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m(2) who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m(2). The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively.

  19. The etiological factors of recurrence after tracheal resection and reconstruction in post-intubation stenosis.

    PubMed

    Abbasidezfouli, Azizollah; Akbarian, Ehsan; Shadmehr, Mohammad Behgam; Arab, Mehrdad; Javaherzadeh, Mojtaba; Pejhan, Saviz; Abbasi-Dezfouli, Golbahar; Farzanegan, Roya

    2009-09-01

    We assessed several factors which might be responsible for the recurrence of post-intubation airway stenosis in a large group of patients who underwent resection and reconstruction surgery by one surgical team. Four hundred and ninety-four patients underwent reconstruction of post-intubation airway stenosis during 1995-2006. The case group comprised patients who had developed recurrence, while controls had no recurrence. The diagnosis of the recurrence was made based on the presence of clinical signs or symptoms and bronchoscopic evaluation. The following variables were compared in both groups: age, sex, duration of intubation, reason for intubation, period of time between intubation and surgery, history of previous tracheotomy, previous therapeutic interventions, subglottic involvement, length of resection, presence of unusual tension at the site of anastomosis and anastomotic infection. Fifty-two patients (10.5%) developed recurrence. Lengthy resection, presence of tension at the site of anastomosis, anastomotic infection and subglottic involvement were significantly higher in the case group. Logistic regression model showed that the three main predictors are anastomotic infection (OR=3.44), subglottic involvement (OR=2.43), and presence of tension (OR=1.97), respectively. It is concluded that the surgeon can play an important role in avoiding recurrence by decreasing tension, preventing infection, and preserving subglottic structure.

  20. [Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration].

    PubMed

    Goerig, M; Filos, K; Renz, D

    1988-10-01

    The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. Although the technique for this operation at that time was well developed, it was very often impossible to save the life of those moribund patients. The famous American paediatrician Joseph O'Dwyer re-initiated the technique of intubation and his excellent results became great success and promoted world-wide use, although it was a well-known procedure at that time. His intubation method - also called the O'Dwyer-Method-was first published in the N. Y. Medical Journal as "Intubation of the Larynx" 100 years ago. Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.

  1. Tolerance to ethanol-induced impairment of water escape in rats bred for ethanol sensitivity.

    PubMed

    Bass, M B; Lester, D

    1980-01-01

    Rats selectively bred for ethanol (EtOH)- induced reductions in locomotor activity ("least affected" = MA) showed a reversed order of senstivity (i.e., LA more sensitive) to EtOH-induced (1.75 g/kg, IP) impairment of swimming. Thirty days of daily EtOH intubation began the next day, starting at 3.5 g/kg for 4 days, and increasing by 0.5 g/kg after 4 days at each dose, until 6.0 and 6.5 g/kg were given for 5 days each. Subjects were retested on the swim task (1.75 g/kg, IP) following 10, 20, and 30 days of chronic EtOH, and at 10, 20, and 30 days after cessation of EtOH treatment. Rats of each line and sex showed progressively decreasing peak impairment during the chronic treatment period; impairment increased toward initial levels during the post-treatment period. LA rats were more impaired than MA rats prior to, throughout, and subsequent to the chronic treatment period; a significant positive correlation between initial impairment and impairment after 30 days of chronic EtOH was found. No line differences in rates of tolerance acquisition or loss, or in final levels of tolerance as indicated by post-treatment impairment relative to initial impairment were observed. The similarity of the dynamics of EtOH tolerance in rats selectively bred for sensitivity to its acute effects suggests independent genetic influences upon initial ethanol sensitivity as opposed to acquired ethanal tolerance.

  2. Effect of charge density of polysaccharides on self-assembled intragastric gelation of whey protein/polysaccharide under simulated gastric conditions.

    PubMed

    Zhang, Sha; Zhang, Zhong; Vardhanabhuti, Bongkosh

    2014-08-01

    This study focuses on the behavior of mixed protein and polysaccharides with different charge densities under simulated gastric conditions. Three types of polysaccharides, namely, guar gum, xanthan gum and carrageenan (neutral, medium negatively, and highly negatively charged, respectively) were selected for heating together with whey protein isolate (WPI) at a biopolymer ratio ranging from 0.01 to 0.1. Upon mixing with simulated gastric fluid (SGF), all WPI-guar gum samples remained soluble, whereas WPI-xanthan gum and WPI-carrageenan at biopolymer ratio higher than 0.01 led to self-assembled intragastric gelation immediately after mixing with SGF. The mechanism behind the intragastric gelation is believed to be the cross-linking between oppositely charged protein and polysaccharides when pH was reduced to below the pI of the protein. Higher biopolymer ratio led to a higher degree of intermolecular interaction, which tends to form stronger gel. More negatively charged carrageenan also formed a stronger gel than xanthan gum. SDS-PAGE results show that the digestibility of protein was not affected by the presence of guar gum as well as xanthan gum and carrageenan at biopolymer ratio lower than 0.02. However, intragastric gel formed by WPI-xanthan gum and WPI-carrageenan at biopolymer ratio higher than 0.02 significantly slows down the digestion rate of protein, which could potentially be used to delay gastric emptying and promote satiety.

  3. Induction of Fos expression in the rat forebrain after intragastric administration of monosodium L-glutamate, glucose and NaCl.

    PubMed

    Otsubo, H; Kondoh, T; Shibata, M; Torii, K; Ueta, Y

    2011-11-24

    l-glutamate, an umami taste substance, is a key molecule coupled to a food intake signaling pathway. Furthermore, recent studies have unveiled new roles for dietary glutamate on gut-brain axis communication via activation of gut glutamate receptors and subsequent vagus nerve. In the present study, we mapped activation sites of the rat forebrain after intragastric load of 60 mM monosodium l-glutamate (MSG) by measurement of Fos protein, a functional marker of neuronal activation. The same concentration of d-glucose (sweet) and NaCl (salty) was used as controls. MSG administration exclusively produced enhanced Fos expression in four hypothalamic regions (the medial preoptic area, lateral hypothalamic area, dorsomedial nucleus, and arcuate nucleus). On the other hand, glucose administration exclusively enhanced Fos induction in the nucleus accumbens. Both MSG and glucose enhanced Fos induction in three brain regions (the habenular nucleus, paraventricular nucleus, and central nucleus of the amygdala). However, MSG induced Fos inductions were more potent than those of glucose in the habenular nucleus and paraventricular nucleus. Importantly, the present study identified for the first time two brain areas (the paraventricular and arcuate hypothalamic nuclei) that are more potently activated by intragastric MSG loads compared with glucose and NaCl. Overall, our results suggest significant activation of a neural network comprising the habenular nucleus, amygdala, and the hypothalamic subnuclei following intragastric load with glutamate.

  4. Effects of beer, wine, whiskey, and ethanol on pregnant rats and their offspring.

    PubMed

    Abel, E L; Dintcheff, B A; Bush, R

    1981-04-01

    Pregnant rats were intubated twice daily throughout gestation with the equivalent of 3 gm/kg of alcohol in the form of either beer, wine, whiskey, or 95% ethanol. Control animals received vehicle. All animals were pair-fed to those receiving ethanol. Offspring were removed from their biological mothers immediately following birth and were nursed by nondrug-treated mothers. Animals in each of the four alcohol-treated groups weighed significantly less than the animals in the control group at birth and at 22 days of age and also performed significantly worse on a Rotarod at 17 days; differences among the four alcohol-treated groups were not significant for any of these measures. Results suggest that congeners present in these alcohol beverages do not potentiate the effects of alcohol on embryonic/fetal development in rats administered this alcohol dose.

  5. Preparation of the Branch Bark Ethanol Extract in Mulberry Morus alba, Its Antioxidation, and Antihyperglycemic Activity In Vivo

    PubMed Central

    Wang, Shu; Fang, Meng; Ma, Yong-Lei

    2014-01-01

    The biological activities of the branch bark ethanol extract (BBEE) in the mulberry Morus alba L. were investigated. The determination of active component showed that the flavonoids, phenols, and saccharides are the major components of the ethanol extract. The BBEE had a good scavenging activity of the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical with around 100 μg/mL of IC50 value. In vitro assay revealed that the BBEE strongly inhibited both α-glucosidase and sucrase activities whose IC50 values were 8.0 and 0.24 μg/mL, respectively. The kinetic analysis showed that the BBEE as a kind of α-glucosidase inhibitor characterized a competitive inhibition activity. Furthermore, the carbohydrate tolerance of the normal mice was obviously enhanced at 0.5 h (P < 0.05) and 1.0 h (P < 0.05) after the BBEE intragastric administration as compared to negative control. At 0.5, 1.0, 1.5, and 2.0 h after the intragastric administration with starch, the postprandial hyperglycemia of the type 2 diabetic mice can be significantly decreased (P < 0.01) by supplying various concentrations of the BBEE (10–40 mg/kg body weight). Therefore, the BBEE could effectively inhibit the postprandial hyperglycemia as a novel α-glucosidase activity inhibitor for the diabetic therapy. PMID:24587809

  6. Ethanol tolerance in yeasts.

    PubMed

    Casey, G P; Ingledew, W M

    1986-01-01

    It is now certain that the inherent ethanol tolerance of the Saccharomyces strain used is not the prime factor regulating the level of ethanol that can be produced in a high sugar brewing, wine, sake, or distillery fermentation. In fact, in terms of the maximum concentration that these yeasts can produce under batch (16 to 17% [v/v]) or fed-batch conditions, there is clearly no difference in ethanol tolerance. This is not to say, however, that under defined conditions there is no difference in ethanol tolerance among different Saccharomyces yeasts. This property, although a genetic determinant, is clearly influenced by many factors (carbohydrate level, wort nutrition, temperature, osmotic pressure/water activity, and substrate concentration), and each yeast strain reacts to each factor differently. This will indeed lead to differences in measured tolerance. Thus, it is extremely important that each of these be taken into consideration when determining "tolerance" for a particular set of fermentation conditions. The manner in which each alcohol-related industry has evolved is now known to have played a major role in determining traditional thinking on ethanol tolerance in Saccharomyces yeasts. It is interesting to speculate on how different our thinking on ethanol tolerance would be today if sake fermentations had not evolved with successive mashing and simultaneous saccharification and fermentation of rice carbohydrate, if distillers' worts were clarified prior to fermentation but brewers' wort were not, and if grape skins with their associated unsaturated lipids had not been an integral part of red wine musts. The time is now ripe for ethanol-related industries to take advantage of these findings to improve the economies of production. In the authors' opinion, breweries could produce higher alcohol beers if oxygenation (leading to unsaturated lipids) and "usable" nitrogen source levels were increased in high gravity worts. White wine fermentations could also, if

  7. Enhancement of intragastric acid stability of a fat emulsion meal delays gastric emptying and increases cholecystokinin release and gallbladder contraction.

    PubMed

    Marciani, Luca; Wickham, Martin; Singh, Gulzar; Bush, Debbie; Pick, Barbara; Cox, Eleanor; Fillery-Travis, Annette; Faulks, Richard; Marsden, Charles; Gowland, Penny A; Spiller, Robin C

    2007-06-01

    Preprocessed fatty foods often contain calories added as a fat emulsion stabilized by emulsifiers. Emulsion stability in the acidic gastric environment can readily be manipulated by altering emulsifier chemistry. We tested the hypothesis that it would be possible to control gastric emptying, CCK release, and satiety by varying intragastric fat emulsion stability. Nine healthy volunteers received a test meal on two occasions, comprising a 500-ml 15% oil emulsion with 2.5% of one of two emulsifiers that produced emulsions that were either stable (meal A) or unstable (meal B) in the acid gastric environment. Gastric emptying and gallbladder volume changes were assessed by MRI. CCK plasma levels were measured and satiety scores were recorded. Meal B layered rapidly owing to fat emulsion breakdown. The gastric half-emptying time of the aqueous phase was faster for meal B (72 +/- 13 min) than for meal A (171 +/- 35 min, P < 0.008). Meal A released more CCK than meal B (integrated areas, respectively 1,095 +/- 244 and 531 +/- 111 pmol.min.l(-1), P < 0.02), induced a greater gallbladder contraction (P < 0.02), and decreased postprandial appetite (P < 0.05), although no significant differences were observed in fullness and hunger. We conclude that acid-stable emulsions delayed gastric emptying and increased postprandial CCK levels and gallbladder contraction, whereas acid-instability led to rapid layering of fat in the gastric lumen with accelerated gastric emptying, lower CCK levels, and reduced gallbladder contraction. Manipulation of the acid stability of fat emulsion added to preprocessed foods could maximize satiety signaling and, in turn, help to reduce overconsumption of calories.

  8. Short-term outcomes of the new intragastric balloon End-Ball® for treatment of obesity

    PubMed Central

    Buzga, Marek; Kupka, Tomas; Siroky, Milan; Narwan, Habib; Machytka, Evzen; Holeczy, Pavol

    2016-01-01

    Introduction Intragastric balloons (IGBs) have been successfully used to treat obesity for the last 18 years. These balloons are made of different materials and filled with either air or saline. It seems that balloons filled with saline result in more effective weight loss, but are associated with worse tolerance after implantation. In contrast, balloons filled with air are associated with excellent tolerance, but result in less effective weight loss. Aim To report the early safety and effectiveness results of the End-Ball® balloon and to encourage discussions on how to best use this new-generation IGB for endoscopic weight loss management. Material and methods Twenty obese patients (mean age: 40.5 years; mean body mass index: 34.8 kg/m2) were included in a 6-month study. Balloons were inflated with 300 ml of saline containing 5 ml of methylene blue and 300 cm3 of air. Results No serious adverse events occurred during treatment. Patients experienced varying degrees of nausea, vomiting (mean: 3.7 times the first day), and abdominal pain after implantation. Six months (23–29 weeks) after End-Ball® balloon insertion, we observed a significant decrease in body weight (13.9 ±5.1 kg) and percent excess weight loss (37.9 ±12.9%). We also found a significant decrease in the levels of glycated hemoglobin (p < 0.001), C-peptide (p < 0.002), and triacylglycerols (p < 0.001) and an increase in the concentration of high-density lipoprotein cholesterol (p < 0.025). Conclusions The End-Ball® IGB is a safe and effective treatment for morbid obesity, with positive effects on weight loss and saccharide metabolism. PMID:28194241

  9. The Impact of Intragastric Balloons on Obesity-Related Co-Morbidities: A Systematic Review and Meta-Analysis.

    PubMed

    Popov, Violeta B; Ou, Amy; Schulman, Allison R; Thompson, Christopher C

    2017-03-01

    ObjectivesTherapies less invasive than surgery and more effective than lifestyle and pharmacotherapy are needed to contend with the obesity epidemic. Intragastric balloons (IGBs) are a minimally invasive endoscopic weight loss method recently approved for use in the US. The purpose of the study is to assess the effect of IGBs on metabolic outcomes associated with obesity.MethodsMEDLINE, Embase, and Cochrane Database were searched through July 2016. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. Primary outcomes included the change from baseline in metabolic parameters. Secondary outcomes included resolution and/or improvement in metabolic co-morbidities and association with baseline parameters.Results10 randomized controlled trials (RCT) and 30 observational studies including 5,668 subjects were analyzed. There was moderate-quality evidence for improvement in most metabolic parameters in subjects assigned to IGB therapy as compared to conventional non-surgical therapy in RCTs: mean difference (MD) in fasting glucose change: -12.7 mg/dl (95% confidence interval (CI) -21.5, -4); MD in triglycerides: -19 mg/dl (95% CI -42, 3.5); MD in waist circumference: -4.1 cm (95% CI -6.9, -1.4); MD in diastolic blood pressure: -2.9 mm Hg (95% CI -4.1, -1.8). The odds ratio for diabetes resolution after IGB therapy was 1.4 (95% CI 1.3, 1.6). The rate of serious adverse events was 1.3%.ConclusionsIGBs are more effective than diet in improving obesity-related metabolic risk factors with a low rate of adverse effects, however the strength of the evidence is limited given the small number of participants and lack of long-term follow-up.

  10. PIV and CFD studies on analyzing intragastric flow phenomena induced by peristalsis using a human gastric flow simulator.

    PubMed

    Kozu, Hiroyuki; Kobayashi, Isao; Neves, Marcos A; Nakajima, Mitsutoshi; Uemura, Kunihiko; Sato, Seigo; Ichikawa, Sosaku

    2014-08-01

    This study quantitatively analyzed the flow phenomena in model gastric contents induced by peristalsis using a human gastric flow simulator (GFS). Major functions of the GFS include gastric peristalsis simulation by controlled deformation of rubber walls and direct observation of inner flow through parallel transparent windows. For liquid gastric contents (water and starch syrup solutions), retropulsive flow against the direction of peristalsis was observed using both particle image velocimetry (PIV) and computational fluid dynamics (CFD). The maximum flow velocity was obtained in the region occluded by peristalsis. The maximum value was 9 mm s(-1) when the standard value of peristalsis speed in healthy adults (UACW = 2.5 mm s(-1)) was applied. The intragastric flow-field was laminar with the maximum Reynolds number (Re = 125). The viscosity of liquid gastric contents hardly affected the maximum flow velocity in the applied range of this study (1 to 100 mPa s). These PIV results agreed well with the CFD results. The maximum shear rate in the liquid gastric contents was below 20 s(-1) at UACW = 2.5 mm s(-1). We also measured the flow-field in solid-liquid gastric contents containing model solid food particles (plastic beads). The direction of velocity vectors was influenced by the presence of the model solid food particle surface. The maximum flow velocity near the model solid food particles ranged from 8 to 10 mm s(-1) at UACW = 2.5 mm s(-1). The maximum shear rate around the model solid food particles was low, with a value of up to 20 s(-1).

  11. Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: a double-blind comparative study.

    PubMed

    De Castro, Maria Luisa; Morales, María José; Del Campo, Víctor; Pineda, Juan R; Pena, Eduardo; Sierra, José M; Arbones, María José; Prada, Ignacio R

    2010-12-01

    The intragastric balloon is a temporary treatment for obese patients. Fluid-filled devices have shown efficacy and safety, and are widely used. Recently, although there are no comparative studies between them, an air-filled balloon, Heliosphere® bag, has been proposed. Prospective, double-blind study in 33 patients with morbid and type 2 obesity: 23 female, 43.9±10 years, 120.3±17 kg, and body mass index (BMI) of 44.2±5 kg/m2, placing 18 gastric balloons filled with 960 cm3 of air (Heliosphere® bag) or 15 balloons filled with 700 ml of saline (Bioenterics-BIB®). Both balloons were placed with conscious sedation and removed under general anesthesia 6 months later. Intravenous drugs were given to control symptoms for 48 h. Patients were sent home on a 1000-kcal diet, multivitamin supplements, and oral proton pump inhibitors, and were followed monthly. Complications, symptoms, weight, and quality of life evaluated by the Gastrointestinal Quality of Life Index (GIQLI) scale were recorded. At 6 months, mean weight loss (12.8±8 vs 14.1±8 kg), BMI loss (4.6±3 vs 5.5±3 kg/m2) and percent excess weight loss (27±16 vs.30.2±17) showed no significant differences between both groups. At removal, two Heliosphere® bags were not found in the stomach, and four patients required extraction of the balloon by rigid esophagoscopy or surgery (p=0.02). Tolerance was good in both groups, but early removal occurred in three BIB® (20%) due to vomits and dehydration. The GIQLI total scores remained unchanged. Both balloons achieve a significant weight loss with good tolerance in obese patients. Nevertheless, Heliosphere® bag has severe technical problems that need to be solved before recommending it.

  12. Diet and risk of ethanol-induced hepatotoxicity: carbohydrate-fat relationships in rats.

    PubMed

    Korourian, S; Hakkak, R; Ronis, M J; Shelnutt, S R; Waldron, J; Ingelman-Sundberg, M; Badger, T M

    1999-01-01

    Nutritional status is a primary factor in the effects of xenobiotics and may be an important consideration in development of safety standards and assessment of risk. One important xenobiotic consumed daily by millions of people worldwide is alcohol. Some adverse effects of ethanol, such as alcohol liver disease, have been linked to diet. For example, ethanol-induced hepatotoxicity in animal models requires diets that have a high percentage of the total calories as unsaturated fat. However, little attention has been given to the role of carbohydrates (or carbohydrate to fat ratio) in the effects of this important xenobiotic on liver injury. In the present study, adult male Sprague-Dawley rats (8-10/group) were infused (intragastrically) diets high in unsaturated fat (25 or 45% total calories), sufficient protein (16%) and ethanol (38%) in the presence or absence of adequate carbohydrate (21 or 2.5%) for 42-55 days (d). Animals infused ethanol-containing diets adequate in carbohydrate developed steatosis, but had no other signs of hepatic pathology. However, rats infused with the carbohydrate-deficient diet had a 4-fold increase in serum ALT levels (p < 0.05), an unexpectedly high (34-fold) induction of hepatic microsomal CYP2E1 apoprotein (p < 0.001), and focal necrosis. The strong positive association between low dietary carbohydrate, enhanced CYP2E1 induction and hepatic necrosis suggests that in the presence of low carbohydrate intake, ethanol induction of CYP2E1 is enhanced to levels sufficient to cause necrosis, possibly through reactive oxygen species and other free radicals generated by CYP2E1 metabolism of ethanol and unsaturated fatty acids.

  13. Protective Effects of Manassantin A against Ethanol-Induced Gastric Injury in Rats.

    PubMed

    Song, Ji-Won; Seo, Chang-Seob; Kim, Tae-In; Moon, Og-Sung; Won, Young-Suk; Son, Hwa-Young; Son, Jong-Keun; Kwon, Hyo-Jung

    2016-01-01

    Manassantin A, a neolignan isolated from Saururus chinensis, is a major phytochemical compound that has various biological activities, including anti-inflammatory, neuroleptic, and human acyl-CoA : cholesterol acyltransferase (ACAT) inhibitory activities. In this study, we investigated the protective effects of manassantin A against ethanol-induced acute gastric injury in rats. Gastric injury was induced by intragastric administration of 5 mL/kg body weight of absolute ethanol to each rat. The positive control group and the manassantin A group were given oral doses of omeprazole (20 mg/kg) or manassantin A (15 mg/kg), respectively, 1 h prior to the administration of absolute ethanol. Our examinations revealed that manassantin A pretreatment reduced ethanol-induced hemorrhage, hyperemia, and epithelial cell loss in the gastric mucosa. Manassantin A pretreatment also attenuated the increased lipid peroxidation associated with ethanol-induced acute gastric lesions, increased the mucosal glutathione (GSH) content, and enhanced the activities of antioxidant enzymes. The levels of pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β were clearly decreased in the manassantin A-pretreated group. In addition, manassantin A pretreatment enhanced the levels of cyclooxygenase (COX)-1, COX-2, and prostaglandin E2 (PGE2) and reduced the inducible nitric oxide synthase (iNOS) overproduction and nuclear factor kappa B (NF-κB) phosphorylation. Collectively, these results indicate that manassantin A protects the gastric mucosa from ethanol-induced acute gastric injury, and suggest that these protective effects might be associated with COX/PGE2 stimulation, inhibition of iNOS production and NF-κB activation, and improvements in the antioxidant and anti-inflammatory status.

  14. Ethanol Impacts on BTEX Plumes

    EPA Science Inventory

    The impacts of ethanol on benzene, toluene, ethylbenzene and xylenes (BTEX) are beginning to become established through laboratory, modeling and field research. Usage of ethanol, which increased due to federal mandates, drives interest and potential impacts on BTEX. Through co...

  15. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient

    PubMed Central

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate. PMID:28298795

  16. Novel biopsy forceps anchoring technique for completion of direct cholangioscopy after freehand intubation.

    PubMed

    Zimmer, V

    2017-03-16

    The widespread dissemination of direct cholangioscopy (DC) has been hindered by the need for special equipment and the perceived high procedure-related technical complexity. DC with freehand intubation has been reported to have high technical success rates in a single report, albeit the pervasive expert opinion question its clinical applicability, thus most centers resort to anchoring techniques for intubation and/or scope advancement.[1] However, although newer anchoring balloons are being developed, first-generation balloons have been withdrawn from the market.[2] Of interest, in a recent study a next-generation double bending cholangioscope has been reported to yield high rates of intubation success without endoscopic accessories. This article is protected by copyright. All rights reserved.

  17. [Preliminary study of transcutaneous oxygen partial pressure in adults after discontinuing normobaric hyperoxia during intubation].

    PubMed

    Brille, P; Milhaud, A; Delloue, M; Starobinsky, E; Kadri, N; Dembele, L; Tinturier, F; Cristin, J

    1989-01-01

    When tracheal intubation is conducted with traditional laryngoscope PtcO2 fall during the first minute after intubation; when continuous O2 supplied laryngoscope (Laryng O2) is used PtcO2 rise; the difference is statistically significant (p less than 0.001) either the subjects are in curarisation apnea or in spontaneous ventilation. With traditional laryngoscope, the fall is faster with spontaneous ventilation conditions than during curarisation apnea. Likewise in normal conscient subject the same fall is faster (p less than 0.001) during first minute of posthyperoxic spontaneous quiet ventilation than the first minute of voluntary hypocapnic apnea induced by hyperventilation during the same hyperoxia. Such results have to be taken into account for the indications of tracheal intubation technical means if hypoxic conditions are to be suspected, particularly for infants and subjects with cardio-respiratory failure.

  18. Methemoglobinemia after fiberoptic intubation in a patient with an unstable cervical fracture: a case report.

    PubMed

    Basra, Sushil K; Vives, Michael J; Reilly, Mark C; Reiter, Mitchell F; Kushins, Lawrence G

    2006-06-01

    Methemoglobinemia, a condition associated with cyanosis and diminished pulse oximetry values, has been reported after use of local anesthetics to facilitate fiberoptic intubation. The majority of reports in the literature detail this development during diagnostic procedures such as endoscopy and bronchoscopy. A case of methemoglobinemia in a multiple-injury patient with an unstable compressive-flexion injury of the cervical spine undergoing fiberoptic intubation is presented. A literature review of this entity is also presented. The patient underwent fiberoptic intubation using topical pharyngeal anesthetics before planned cervical corpectomy, strut grafting and instrumentation. He became acutely cyanotic with abruptly diminished pulse oximetry readings. Subsequent blood gas analysis demonstrated methemoglobinemia. Intravenous methylene blue administration led to an uncomplicated resolution of the condition. Surgeons and anesthesiologists who manage such patients should be aware of methemoglobinemia, a rare but potentially fatal complication related to topical airway anesthetics.

  19. Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

    PubMed

    Afreen, Mahrukh; Ansari, Murtaza Ahsan

    2015-12-01

    Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube.

  20. [Regional anesthesia of the airways in difficult tracheal intubation in a conscious patient with spontaneous respiration].

    PubMed

    Dziadz'ko, A M

    2002-01-01

    Clinical pattern of anesthesia, hemodynamic and gas exchange states were evaluated in 64 patients with congenital or acquired damage of maxillary-facial region due to tumor or trauma. 51 patients were intubated under locoregional anesthesia of the upper respiratory tract (superior laryngeal nerves, glossopharyngeal nerves, intratracheal anesthesia) by means of blind nasal or oral fiberoptic retrograde and by using laryngeal mask technique. In 12 cases fiberoptic device was used for intubation under local anesthesia by lidocaine solution. There was no airways obstruction in any case. Satisfactory anesthesia in oropharynx, larynx and trachea was reached in all cases, the most profound blockage of airways and lack of pharyngeal and laryngeal reflexes being in patients under locoregional anesthesia. So locoregional anesthesia can be used for awake intubation.

  1. The rigid nasendoscope as a tool for difficult tracheal intubation: a manikin study.

    PubMed

    Goodwin, N; Latto, I P; Hodzovic, I; Williams, G; Hall, J E

    2003-07-01

    We examined the use of the 30 degrees rigid nasendoscope in aiding difficult tracheal intubations. A Cormack and Lehane grade 4 difficult intubation (no view of glottis or epiglottis) was set up on a manikin. After 10 s of tuition, 40 anaesthetists attempted to pass a standard gum elastic bougie between the cords, with and without the nasendoscope, in randomised order. A bougie curved to an 'optimal curve' was also tested. Using the standard bougie 13/40 (33%) passed the bougie between the cords without the nasendoscope, compared with 31/40 (78%) when using the nasendoscope (p < 0.001). The 'optimal curve' bougie resulted in 29/40 (73%) and 39/40 (98%) success rates without and with the nasendoscope, respectively (p = 0.004). The nasendoscope is a simple and easy to use tool in grade 4 intubation, and results are improved further by the use of an 'optimal curve' bougie.

  2. Conditions of endotracheal intubation with and without muscle relaxant in children.

    PubMed

    Rizvanović, Nermina; Čaušević, Senada; Šabanović, Adisa

    2017-02-01

    Aim To compare intubation conditions and hemodynamic response of two induction regimens, with or without muscle relaxant using a combination of either fentanyl and propofol or propofol and suxamethonium. Methods A total of 80 children aged 4-12 years were enrolled in a prospective randomized double-blinded study. Children were randomly allocated in two equal groups. In group F induction was done with fentanyl and propofol, while propofol and suxamethonium were used in group S. Intubation conditions were assessed using Copenhagen Consensus Score (CCS), based on ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation and limb movements. Systolic blood pressure (SBP),diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were observed at preinduction, postinduction and postintubation at 1, 3 and 5 minute. Results Clinically acceptable CCS was found in 95% of patients in group F versus 100% in group S. Intubation conditions wereexcellent in 85%, good in 10% and poor in 5% of patients in group F. In the group F, signifficantly lower SBP and MAP postinduction and postintubation at 1 and 3 minute, and lower DBP postinduction and postintubation at 1 minute (p<0.05) was found comparing to group S. In group S, significantly higher postinduction and postintubation HR at 1 minute was found comparing to group F (p<0.05). Conclusion Induction combination fentanyl-propofol provide acceptable intubation conditions comparable with suxamethonium in children. This induction regimen ensures better hemodynamic stability associated with endotracheal intubation. It could be recommended for intubation when muscle relaxants are not indicated.

  3. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    PubMed Central

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  4. Making endotracheal intubation easy and successful, particularly in unexpected difficult airway

    PubMed Central

    Abdulla, Susanne; Abdulla, Sina; Schwemm, Karl-Peter; Eckhardt, Regina; Abdulla, Walied

    2014-01-01

    Background: Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians. Purpose: We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study. Settings and Design: Operating room, emergency department, intensive care unit (ICU), retrospective observational study. Materials and Methods: A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise. Statistical Analysis: Descriptive. Results: Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists. Conclusions: The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed. PMID:24741494

  5. Effect of varied training techniques on field endotracheal intubation success rates.

    PubMed

    Stewart, R D; Paris, P M; Pelton, G H; Garretson, D

    1984-11-01

    A pool of 146 mobile intensive care unit paramedics was divided into four equal groups and trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Group 1 was selected from supervisors and crew chiefs and trained as preceptors. The remaining paramedics were assigned to three other study groups. Groups 1 and 2 were trained with a didactic presentation followed by manikin practice, an animal laboratory exercise, and operating room experience. Group 3 had no OR experience; Group 4 had only didactic/manikin training. Intubations were observed by preceptors on scene. During the study period of 27 months, 689 of 763 patients (90.3%) were successfully intubated by 122 paramedics. While results suggest variation in skill levels according to training group (Group 1, 92.4%; Group 2, 87.6%, Group 3, 83.3%; Group 4, 76.9%), statistical analysis allowing for the variables of seniority and number of intubations performed by personnel failed to reveal differences in groups attributable to training programs. Complication rates were relatively low for all groups, the most common being prolonged intubation attempts. A significant improvement in the skill was seen as the study progressed when groups are pooled and compared. The findings suggest that endotracheal intubation of deeply comatose or cardiac arrest patients is a field procedure that can be performed safely and skillfully by well-monitored paramedical personnel. Operating room or animal laboratory experience may increase initial success levels, but these factors do not appear to greatly influence eventual performance or incidence of complications of the procedure.

  6. The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

    PubMed Central

    Ezzat, Alaa; Fathi, Essam; Zarour, Ahmad; Singh, Rajvir; Abusaeda, M. Osama; Hussien, M. Magdy

    2011-01-01

    Background Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. Objectives To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. Methods This retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Results Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients. Conclusion Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes. PMID:21772925

  7. Ethanol Myths Fact Sheet

    SciTech Connect

    2009-10-27

    Ethanol is a clean, renewable fuel that is helping to reduce our nation’s dependence on oil and can offer additional economic and environmental benefits in the future. This fact sheet is intended to address some common misconceptions about this important alternative fuel.

  8. Predictors of Difficult Intubation Among Malay Patients in Indonesia

    PubMed Central

    Tantri, Aida Rosita; Firdaus, Riyadh; Salomo, Sahat Tumpal

    2016-01-01

    Background Failure to maintain an adequate airway can lead to brain damage and death. To reduce the risk of difficulty in maintaining an airway during general anesthesia, there are several known predictors of difficult intubation. People with a Malay background have different craniofacial structures in comparison with other individuals. Therefore, different predictors should be used for patients of Malay race. Objectives The aim of this study was to determine the ability to predict difficult visualization of the larynx (DVL) in Malay patients based on several predictors, such as the modified Mallampati test (MMT), thyromental distance (TMD), and hyomental distance ratio (HMDR). Patients and Methods This cross-sectional study included 277 consecutive patients requiring general anesthesia. All subjects were evaluated using the MMT, TMD, and HMDR, and the cut-off points for the airway predictors were Mallampati III and IV, < 6.5 cm, and < 1.2, respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack-Lehane (CL) classification. CL grades III and IV were considered difficult visualization. The area under the curve (AUC), sensitivity, and specificity for each predictor were calculated both as sole and combined predictors. Logistic regression analysis was used to determine independent predictors of DVL. Results Difficulty in visualizing the larynx was found in 28 (10.1%) patients. The AUC, sensitivity, and specificity for the three airway predictors were as follows: MMT: 0.614, 10.7%, and 99.2%; HMDR: 0.743, 64.2%, and 74%; and TMD: 0.827, 82.1%, and 64.7%. The combination providing the best prediction in our study involved the MMT, HMDR, and TMD with an AUC, sensitivity, and specificity of 0.835, 60.7%, and 88.8%, respectively. Logistic regression analysis showed that the MMT, HMDR, and TMD were independent predictors of DVL. Conclusions The TMD, with a cut-off point of 65 mm, had superior diagnostic value compared with the HMDR and

  9. Sorghum to Ethanol Research

    SciTech Connect

    Dahlberg, Jeffrey A.; Wolfrum, Edward J.

    2010-09-28

    The development of a robust source of renewable transportation fuel will require a large amount of biomass feedstocks. It is generally accepted that in addition to agricultural and forestry residues, we will need crops grown specifically for subsequent conversion into fuels. There has been a lot of research on several of these so-called "dedicated bioenergy crops" including switchgrass, miscanthus, sugarcane, and poplar. It is likely that all of these crops will end up playing a role as feedstocks, depending on local environmental and market conditions. Many different types of sorghum have been grown to produce syrup, grain, and animal feed for many years. It has several features that may make it as compelling as other crops mentioned above as a renewable, sustainable biomass feedstock; however, very little work has been done to investigate sorghum as a dedicated bioenergy crop. The goal of this project was to investigate the feasibility of using sorghum biomass to produce ethanol. The work performed included a detailed examination of the agronomics and composition of a large number of sorghum varieties, laboratory experiments to convert sorghum to ethanol, and economic and life-cycle analyses of the sorghum-to-ethanol process. This work showed that sorghum has a very wide range of composition, which depended on the specific sorghum cultivar as well as the growing conditions. The results of laboratory- and pilot-scale experiments indicated that a typical high-biomass sorghum variety performed very similarly to corn stover during the multi-step process required to convert biomass feedstocks to ethanol; yields of ethanol for sorghum were very similar to the corn stover used as a control in these experiments. Based on multi-year agronomic data and theoretical ethanol production, sorghum can achieve more than 1,300 gallons of ethanol per acre given the correct genetics and environment. In summary, sorghum may be a compelling dedicated bioenergy crop that could help

  10. [Awake Nasotracheal Intubation for a 4-Year-old Boy with an Oral Penetrating Toothbrush Injury].

    PubMed

    Kobayashi, Naoya; Ando, Kokichi; Saito, Kazutomo; Toyama, Hiroaki; Fudeta, Hiroto; Yamauchi, Masanori

    2015-09-01

    We report a case of an oral penetrating injury caused by a toothbrush in a 4-year-old 17-kg boy. The toothbrush was lodged in the right cervical region through the oral cavity, and emergency surgery for removal was planned under general anesthesia. Although mask ventilation was not possible because of the protruding toothbrush handle, awake nasotracheal intubation was successfully performed with a fiber-scope and intravenous fentanyl 25 μg. We conclude that appropriate analgesics could facilitate awake intubation in pediatric patients.

  11. Long term intubation and successful weaning in two children with Guillain-Barre syndrome.

    PubMed

    Javed, H; Nair, M P; Koul, R L; Chacko, A; Fazalullah, M

    2000-07-01

    No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.

  12. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation.

    PubMed

    Oliveira, Elsa; Anastácio, Margarida; Marques, Anabela

    2016-01-01

    Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleeding secondary to aberrant right subclavian artery-esophageal fistula after prolonged intubation.

  13. Antioxidant and antihyperlipidemic effect of Solanum nigrum fruit extract on the experimental model against chronic ethanol toxicity

    PubMed Central

    Arulmozhi, Vadivel; Krishnaveni, Mani; Karthishwaran, Kandhan; Dhamodharan, Ganesan; Mirunalini, Sankaran

    2010-01-01

    The possible protective effect of Solanum nigrum fruit extract (SNFEt) was investigated for its antioxidant and antihyperlipidemic activity against ethanol-induced toxicity in rats. The experimental animals were intoxicated with 20% ethanol (7.9 g/kg/day) for 30 days via gastric intubation. SNFEt was administered at the dose of 250 mg/kg body weight along with the daily dose of ethanol for 30 days. From the result it was observed that ethanol-induced rats showed a significant elevation in the levels of Thiobarbituric acid reactive substances (TBARS), which lowered the antioxidant defense systems, such as, reduced glutathione (GSH) and vitamins C and E, when compared to the controls. In the lipid profiles, the levels of total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), free fatty acids (FFA), and phospholipids were significantly elevated in the ethanol-induced group, whereas, the high density lipoproteins (HDL) were found to be reduced in the plasma, and the phospholipid levels were significantly decreased in the tissues. Supplementation of SNFEt improved the antioxidant status by decreasing the levels of TBARS and altering the lipid profiles to near normal. These activities were also compared to the standard drug silymarin (25 mg/kg body weight). Thus the findings of the present study indicated a significant antioxidant and antihyperlipidemic activity of Solanum nigrum fruits, which offered protection against ethanol-induced toxicity. PMID:20548935

  14. The Interaction of Ethanol Ingestion and Social Interaction with an Intoxicated Peer on the Odor-Mediated Response to the Drug in Adolescent Rats

    PubMed Central

    Eade, Amber M.; Youngentob, Lisa M.; Youngentob, Steven L.

    2016-01-01

    Background Using a social transmission of food preference paradigm in rats, we previously demonstrated that ethanol exposure during adolescence, as either an observer (interaction with an intoxicated conspecific) or demonstrator (intragastric infusion with ethanol), altered the reflexive odor-mediated responses to the drug. The two modes of exposure were equivalent in the magnitude of their effects. Human adolescents, however, are likely to experience the drug in a social setting as both an ethanol observer and demonstrator. That is, both interacting with an intoxicated peer and experiencing ethanol’s post-ingestive consequences in conjunction with hematogenic olfaction. Therefore, we tested whether combined adolescent exposure as both an observer and demonstrator differed from either form of individual experience. Methods Beginning on postnatal day (P) 29, naïve rats received ethanol or water exposures in a social interaction paradigm as either an observer, a demonstrator or combined experience (where each animal in the interaction was, itself, an observer and demonstrator). Exposures occurred four times, once every 48 hours. On P37, the reflexive behavioral response to ethanol odor was tested, using whole-body plethysmography. Results The odor-mediated responses of adolescent ethanol observers, demonstrators and combined exposure animals all significantly differed from controls. Compared to controls, however, the magnitude of the behavioral effect was greatest in the combined exposure animals. Moreover, combined exposure as both an ethanol observer and demonstrator significantly differed from either form of individual ethanol experience. Conclusions Ethanol’s component chemosensory qualities are known to be central contributors to its acceptance and increases in the acceptability of ethanol’s odor, resulting from a social transmission experience, are predictive of enhanced ethanol avidity in adolescence. Our findings demonstrate that combined exposure as

  15. Neuropeptide Y suppresses ethanol drinking in ethanol-abstinent, but not non-ethanol-abstinent, Wistar rats.

    PubMed

    Gilpin, Nicholas W; Stewart, Robert B; Badia-Elder, Nancy E

    2008-11-01

    In outbred rats, increases in brain neuropeptide Y (NPY) activity suppress ethanol consumption in a variety of access conditions, but only following a history of ethanol dependence. NPY reliably suppresses ethanol drinking in alcohol-preferring rats, and this effect is augmented following a period of ethanol abstinence. The purpose of this experiment was to examine the effects of NPY on two-bottle choice ethanol drinking and feeding in Wistar rats that had undergone chronic ethanol vapor exposure, cycles of ethanol abstinence, or both. Ethanol-drinking Wistar rats were given 6 weeks of access to 15% (vol/vol) ethanol and water followed by either: two cycles of 1 week ethanol vapor exposure and 2 weeks with no ethanol; two cycles of 1 week ethanol bottle availability and 2 weeks with no ethanol; or 2 weeks of ethanol vapor exposure. Rats were infused intracerebroventricularly with one of four NPY doses (0.0, 2.5, 5.0, or 10.0 microg) following the ethanol exposure patterns described above, and tested for ethanol drinking and feeding in a two-bottle choice situation. NPY dose dependently increased food intake regardless of ethanol exposure history, but suppressed ethanol drinking only in rats that underwent cycles of ethanol access and ethanol abstinence. These results support the notion that dysregulation of brain NPY systems during chronic intermittent ethanol exposure is important in the motivational drive for subsequent relapse to ethanol drinking.

  16. Ethanol Sensitization during Adolescence or Adulthood Induces Different Patterns of Ethanol Consumption without Affecting Ethanol Metabolism

    PubMed Central

    Carrara-Nascimento, Priscila F.; Hoffmann, Lucas B.; Contó, Marcos B.; Marcourakis, Tania; Camarini, Rosana

    2017-01-01

    In previous study, we demonstrated that ethanol preexposure may increase ethanol consumption in both adolescent and adult mice, in a two-bottle choice model. We now questioned if ethanol exposure during adolescence results in changes of consumption pattern using a three-bottle choice procedure, considering drinking-in-the-dark and alcohol deprivation effect as strategies for ethanol consumption escalation. We also analyzed aldehyde dehydrogenase (ALDH) activity as a measurement of ethanol metabolism. Adolescent and adult Swiss mice were treated with saline (SAL) or 2.0 g/kg ethanol (EtOH) during 15 days (groups: Adolescent-SAL, Adolescent-EtOH, Adult-SAL and Adult-EtOH). Five days after the last injection, mice were exposed to the three-bottle choice protocol using sucrose fading procedure (4% + sucrose vs. 8%–15% ethanol + sucrose vs. water + sucrose) for 2 h during the dark phase. Sucrose was faded out from 8% to 0%. The protocol was composed of a 6-week acquisition period, followed by four withdrawals and reexposures. Both adolescent and adult mice exhibited ethanol behavioral sensitization, although the magnitude of sensitization in adolescents was lower than in adults. Adolescent-EtOH displayed an escalation of 4% ethanol consumption during acquisition that was not observed in Adult-EtOH. Moreover, Adult-EtOH consumed less 4% ethanol throughout all the experiment and less 15% ethanol in the last reexposure period than Adolescent-EtOH. ALDH activity varied with age, in which older mice showed higher ALDH than younger ones. Ethanol pretreatment or the pattern of consumption did not have influence on ALDH activity. Our data suggest that ethanol pretreatment during adolescence but not adulthood may influence the pattern of ethanol consumption toward an escalation in ethanol consumption at low dose, without exerting an impact on ALDH activity. PMID:28386220

  17. Automated and quantitative headspace in-tube extraction for the accurate determination of highly volatile compounds from wines and beers.

    PubMed

    Zapata, Julián; Mateo-Vivaracho, Laura; Lopez, Ricardo; Ferreira, Vicente

    2012-03-23

    An automatic headspace in-tube extraction (ITEX) method for the accurate determination of acetaldehyde, ethyl acetate, diacetyl and other volatile compounds from wine and beer has been developed and validated. Method accuracy is based on the nearly quantitative transference of volatile compounds from the sample to the ITEX trap. For achieving that goal most methodological aspects and parameters have been carefully examined. The vial and sample sizes and the trapping materials were found to be critical due to the pernicious saturation effects of ethanol. Small 2 mL vials containing very small amounts of sample (20 μL of 1:10 diluted sample) and a trap filled with 22 mg of Bond Elut ENV resins could guarantee a complete trapping of sample vapors. The complete extraction requires 100 × 0.5 mL pumping strokes at 60 °C and takes 24 min. Analytes are further desorbed at 240 °C into the GC injector under a 1:5 split ratio. The proportion of analytes finally transferred to the trap ranged from 85 to 99%. The validation of the method showed satisfactory figures of merit. Determination coefficients were better than 0.995 in all cases and good repeatability was also obtained (better than 7% in all cases). Reproducibility was better than 8.3% except for acetaldehyde (13.1%). Detection limits were below the odor detection thresholds of these target compounds in wine and beer and well below the normal ranges of occurrence. Recoveries were not significantly different to 100%, except in the case of acetaldehyde. In such a case it could be determined that the method is not able to break some of the adducts that this compound forms with sulfites. However, such problem was avoided after incubating the sample with glyoxal. The method can constitute a general and reliable alternative for the analysis of very volatile compounds in other difficult matrixes.

  18. The ethanol stress response and ethanol tolerance of Saccharomyces cerevisiae.

    PubMed

    Stanley, D; Bandara, A; Fraser, S; Chambers, P J; Stanley, G A

    2010-07-01

    Saccharomyces cerevisiae is traditionally used for alcoholic beverage and bioethanol production; however, its performance during fermentation is compromised by the impact of ethanol accumulation on cell vitality. This article reviews studies into the molecular basis of the ethanol stress response and ethanol tolerance of S. cerevisiae; such knowledge can facilitate the development of genetic engineering strategies for improving cell performance during ethanol stress. Previous studies have used a variety of strains and conditions, which is problematic, because the impact of ethanol stress on gene expression is influenced by the environment. There is however some commonality in Gene Ontology categories affected by ethanol assault that suggests that the ethanol stress response of S. cerevisiae is compromised by constraints on energy production, leading to increased expression of genes associated with glycolysis and mitochondrial function, and decreased gene expression in energy-demanding growth-related processes. Studies using genome-wide screens suggest that the maintenance of vacuole function is important for ethanol tolerance, possibly because of the roles of this organelle in protein turnover and maintaining ion homoeostasis. Accumulation of Asr1 and Rat8 in the nucleus specifically during ethanol stress suggests S. cerevisiae has a specific response to ethanol stress although this supposition remains controversial.

  19. Modeling water vapor and heat transfer in the normal and the intubated airways.

    PubMed

    Tawhai, Merryn H; Hunter, Peter J

    2004-04-01

    Intubation of the artificially ventilated patient with an endotracheal tube bypasses the usual conditioning regions of the nose and mouth. In this situation any deficit in heat or moisture in the air is compensated for by evaporation and thermal transfer from the pulmonary airway walls. To study the dynamics of heat and water transport in the intubated airway, a coupled system of nonlinear equations is solved in airway models with symmetric geometry and anatomically based geometry. Radial distribution of heat, water vapor, and velocity in the airway are described by power-law equations. Solution of the time-dependent system of equations yields dynamic airstream and mucosal temperatures and air humidity. Comparison of model results with two independent experimental studies in the normal and intubated airway shows a close correlation over a wide range of minute ventilation. Using the anatomically based model a range of spatially distributed temperature paths is demonstrated, which highlights the model's ability to predict thermal behavior in airway regions currently inaccessible to measurement. Accurate representation of conducting airway geometry is shown to be necessary for simulating mouth-breathing at rates between 15 and 100 l x min(-1), but symmetric geometry is adequate for the low minute ventilation and warm inspired air conditions that are generally supplied to the intubated patient.

  20. The Effects of Intravenous Dexmedetomidine Injections on IOP in General Anesthesia Intubation: A Meta-Analysis

    PubMed Central

    Zhu, Yu; Liu, Zhen

    2017-01-01

    Objective. The aim of this meta-analysis is to evaluate the effects of dexmedetomidine on intraocular pressure (IOP) in patients with general anesthesia administered via intubation. Methods. We searched randomized controlled trials (RCT) on the effects of intravenous injection of dexmedetomidine on IOP in patients with general anesthesia administered via intubation. Results. The meta-analysis study showed that (1) a statistically significant difference [WMD = −3.40 mmHg, 95% CI (−4.76, −2.04), P < 0.00001] was found between IOP of the two groups. (2) The IOP of the dexmedetomidine group that was administrated succinylcholine was lower than that of placebo group which was administrated succinylcholine [WMD = −4.13 mmHg, 95% CI (−6.01, −2.25), P < 0.0001]. (3) Compared with the IOP of patients in the placebo group, patients with intubation in the dexmedetomidine group maintained a lower IOP [WMD = −3.10 mmHg, 95% CI (−5.12, −1.07), P = 0.003]. However, for incidences of bradycardia, the use of dexmedetomidine was higher than that of the placebo [RR = 0.23, 95% CI (0.07, 0.76), P = 0.02]. Conclusion. This meta-analysis showed that, in many cases, dexmedetomidine can lower the IOP of patients with general anesthesia administered by intubation. PMID:28261613

  1. [Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

    PubMed

    Meyer, P; Guérin, J M; Habib, Y; Lévy, C

    1988-01-01

    Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

  2. The effect of the exit condition on the performance of intube condensers

    SciTech Connect

    Rabas, T.J.; Arman, B.

    1995-07-01

    Data collected from the open literature plus some new, unpublished data will be used to show that the exit condition can change the flow regimes, introduce certain types of instabilities, and alter flooding velocities with intube condensation. The major orientations will be considered: horizontal, vertical with vapor downflow, and vertical with vapor upflow (refluxing).

  3. Retrograde nasal intubation via the cleft in Pierre-Robin Sequence neonates: a case series.

    PubMed

    Portnoy, Joel E; Tatum, Sherard

    2009-12-01

    Pierre-Robin Sequence, the triad of glossoptosis, micrognathia and cleft palate, provides a challenge in airway management both in and out of the operating room. Transnasal intubation is greatly preferred during its surgical intervention for maximum oral exposure in these very small patients without the added encumbrance of an oral endotracheal tube. From 2001 to 2009, three neonates with Pierre-Robin Sequence who underwent surgery to improve their airway had a novel method of securing a transnasal airway performed in the operating theater. After successful placement of a laryngeal mask airway (LMA) and subsequent endotracheal intubation via the LMA, this technique was used to convert from an oral to a nasal intubation. After the LMA is removed, a smaller endotracheal tube is placed into the nose and out of the mouth via the cleft in each of these patients. This smaller tube is then telescoped into the larger one and secured with suture. Both tubes are subsequently backed out of the nose in a retrograde fashion and disarticulated so that the now transnasal endotracheal tube can be re-connected to the anesthesia circuit. This case series highlights a rapid technique utilizing the patient's congenital defect for securing a transnasal airway alternative to that of transnasal fiberoptic intubation in Pierre-Robin Sequence neonates.

  4. [Use of a gum elastic bougie for tracheal intubation with Pentax-AWS airway scope].

    PubMed

    Ueshima, Hironobu; Asai, Takashi; Shingu, Koh; Inoue, Hisashi; Hashimoto, Yuichi; Enomoto, Yoshiro; Okuda, Yasuhisa

    2008-01-01

    Pentax-AWS laryngoscope (Pentax, Tokyo, Japan) consists of a disposable anatomically shaped blade, a 12-cm cable with a charge-coupled device (CCD) camera and a 2.4-inch liquid crystal device (LCD) color monitor display. A tracheal tube can be attached to the right side of the blade. The device may be useful in patients with difficult airways. One limitation of the device is that intubation may be difficult if it is difficult to position the glottis to the target symbol on the monitor display. We experienced such a difficulty in four patients, and the use of a gum elastic bougie enabled intubation. In a 57-year-old woman with a difficult airway, tracheal intubation using either a Macintosh laryngoscope or a fiberscope had failed. By inserting the AWS laryngoscope, the glottis was easily seen on the monitor display. Nevertheless, it was difficult to position the glottis to the target symbol, and advancing a tracheal tube collided with the tissue around the glottis. A bougie was passed through the tracheal tube, and it became possible to insert the bougie into the trachea by adjusting the angle of its tip. The tracheal tube was then easily passed over the bougie into the trachea. We successfully used the same technique in other three patients. We believe that the gum elastic bougie can be useful for tracheal intubation using the Pentax-AWS laryngoscope.

  5. Microbiology of endotracheal aspirates in intubated pediatric intensive care unit patients: correlations with radiographic findings.

    PubMed

    Golden, S E; Shehab, Z M; Bjelland, J C; Ryan, K J; Ray, C G

    1987-07-01

    We studied the utility of Gram-stained smears and semiquantitative cultures of endotracheal aspirates (ETAs) in diagnosing pneumonia in intubated patients in a pediatric intensive care unit. The chest radiographs of 35 intubated patients were independently reviewed by a pediatric radiologist and classified into probable, possible and unlikely pneumonias. Concomitant bacteriologic and radiographic information was available in 15 episodes of probable and 13 of possible pneumonia. These findings were compared with the ETAs obtained during the study from patients with no radiographic evidence of pneumonia (N = 21). There was a good correlation between ETA findings and radiographic evidence of pneumonia when ETAs were obtained within 60 minutes of initial intubation. Only a growth of greater than or equal to 3+ of a pathogen was associated with probable pneumonia when ETAs were obtained more than 60 minutes from initial intubation. There was a poor correlation between the microbiologic findings from ETAs and the results of blood cultures and postmortem examinations. Moreover 5 of 10 pairs of ETAs obtained within 18 hours of each other demonstrated discordant results. The ETAs from patients with indwelling endotracheal tubes correlated poorly with radiographic findings and are of questionable value in diagnosing the presence of pneumonia or its etiology in this group. They must be cautiously interpreted in critically ill patients.

  6. Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

    PubMed Central

    Myatra, Sheila Nainan; Ahmed, Syed Moied; Kundra, Pankaj; Garg, Rakesh; Ramkumar, Venkateswaran; Patwa, Apeksh; Shah, Amit; Raveendra, Ubaradka S.; Shetty, Sumalatha Radhakrishna; Doctor, Jeson Rajan; Pawar, Dilip K.; Ramesh, Singaravelu; Das, Sabyasachi; Divatia, Jigeeshu Vasishtha

    2017-01-01

    Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  7. The role of magnesium sulfate in tracheal intubation without muscle relaxation in patients undergoing ophthalmic surgery

    PubMed Central

    Soltani, Hassan-Ali; Hashemi, Seyed Jalal; Montazeri, Kamran; Dehghani, Alireza; Nematbakhsh, Mehdi

    2016-01-01

    Background: Muscle relaxant agents usually use to facilitate tracheal intubation; however, sometimes limitations exist. Magnesium (Mg) sulfate is a candidate for muscle relaxant substitute. This study was designed to determine the effect of Mg sulfate accompanied with propofol and fentanyl in patients undergoing ophthalmic surgery. Materials and Methods: In a double-blind randomized protocol and before tracheal intubation, Mg sulfate 40, 45, or 50 mg/kg in 100 ml of saline (Groups 1–3, respectively) or saline alone (Group 4) were administrated intravenously in 100 patients (n = 25 in each group) with the American Society of Anesthesiologist (ASA) physical Status I, II, or III. The patients' intubation condition in all subjects were determined and described. Results: The patients' demographic data including age, ASA, systolic and diastolic blood pressures, intraocular pressure, and body mass index were not significantly different between the groups. A better mask ventilation feasibility in Mg sulfate 45 group (Group 2) was observed when compared with Mg sulfate 50 (Group 3) (P = 0.022) and saline group (Group 4) (P = 0.021). In addition, the vocal cord movement and muscle relaxant requirement in saline group were significantly different from others groups (P < 0.05). The laryngoscopic time in saline group was greater than other groups significantly (P < 0.0001). Conclusion: Intravenous administration of Mg sulfate accompanied with propofol and fentanyl facilitates the tracheal intubation without neuromuscular blocking agents. To avoid Mg level increasing in plasma; however, the low dose of Mg sulfate is suggested. PMID:28163742

  8. Prior esophagogastroduodenoscopy does not affect the cecal intubation time at bidirectional endoscopies

    PubMed Central

    Öner, Osman Zekai; Demirci, Rojbin Karakoyun; Gündüz, Umut Rıza; Aslaner, Arif; Koç, Ümit; Bülbüller, Nurullah

    2013-01-01

    Bidirectional endoscopy (BE) is often used to assess patients for the reason of anemia or to screen asymptomatic population for malignancy. Limited clinical data favors to perform first the upper gastrointestinal system endoscopy, but its effect to the duration of colonoscopy is yet to be determined. The aim of this retrospective study is to evaluate the effect of upper gastrointestinal system endoscopy on the time to achieve cecal intubation during colonoscopy in patients undergoing BE. Patients of four endoscopists at similar experience levels were retrospectively identified and categorized into the upper gastrointestinal system endoscopy before colonoscopy group (group 1) or the colonoscopy only group (group 2). The demographics, clinical data and the time to achieve cecal intubation for each patient were analyzed. The mean time to achieve cecal intubation in the first group that included 319 cases was 8.4 ± 0.93 minutes and the mean time in the second group that included 1672 cases was 8.56 ± 1.16 minutes. There was no statistically significant difference between the groups. There was also no significant difference between the Group 1 and Group 2 when compared according to which of the four endoscopists performed the procedures. Performing the upper gastrointestinal system endoscopy prior to colonoscopy did not affect the time to achieve cecal intubation. Considering that performing the upper gastrointestinal system endoscopy prior to the colonoscopy is more advantageous in terms of patient comfort and analgesic requirement, beginning to BE with it seems more favorable. PMID:23936601

  9. Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia

    PubMed Central

    Yang, H. L.; Tsai, S. C.; Tsay, P. K.; Lin, H. T.

    2016-01-01

    Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray) or group D (treated with distilled water spray). Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p < 0.001) and the pain intensity was significantly lower in group K than in group D at each time point (all p < 0.001). Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia. PMID:28025646

  10. Inadvertent Endobronchial Intubation in a Patient With a Short Neck Length.

    PubMed

    Cornelius, Bryant; Sakai, Tetsuro

    2015-01-01

    Inadvertent placement of the endotracheal tube into the right bronchus during intubation for general anesthesia is a fairly common occurrence. Many precautions should be taken by the anesthesia provider in order to minimize the incidence of endobronchial intubation, including bilateral auscultation of the lungs, use of the 21/23 rule, and palpation of the inflated endotracheal cuff at the sternal notch. These provisions, however, are not foolproof; anesthesia providers should realize that endobronchial intubation may occur from time to time because of variations in patient anatomy, changes in patient positioning, and cephalad pressures exerted during surgery. A 58-year-old man with chronic obstructive pulmonary disease received general endotracheal anesthesia for a laparoscopic cholecystectomy. His height was 165 cm (5 ft, 5 in) and the endotracheal tube was secured at his incisors at 21 cm after placement with a rigid laryngoscope. Bilateral breath sounds were confirmed with auscultation, although they were distant because of his chronic obstructive pulmonary disease. After radiographic examination in the postanesthesia care unit, a right main-stem intubation was revealed to have taken place, resulting in complete atelectasis of the left lung. After repositioning of the endotracheal tube, radiography confirmed that the patient had an anatomically short tracheal length.

  11. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

    PubMed Central

    Zarogoulidis, Paul; Kontakiotis, Theodoros; Tsakiridis, Kosmas; Karanikas, Michael; Simoglou, Christos; Porpodis, Konstantinos; Mitrakas, Alexandros; Esebidis, Agisilaos; Konoglou, Maria; Katsikogiannis, Nikolaos; Zervas, Vasilis; Aggelopoulou, Christina; Mikroulis, Dimitrios; Zarogoulidis, Konstantinos

    2012-01-01

    Management of a “difficult airway” remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a “difficult airway” and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality. PMID:22802693

  12. Subcellular location of secretory proteins retained in the liver during the ethanol-induced inhibition of hepatic protein secretion in the rat

    SciTech Connect

    Volentine, G.D.; Tuma, D.J.; Sorrell, M.F.

    1986-01-01

    Ethanol administration inhibits the secretion of proteins by the liver, resulting in their hepatocellular retention. Experiments were designed in this study to determine the subcellular location of the retained secretory proteins. Ethanol was administered acutely to nonfasted rats by gastric intubation, whereas control animals received an isocaloric dose of glucose. Two hours after intubation, when maximum blood ethanol levels (45 mM) were observed, (/sup 3/H)leucine and (/sup 14/C)fucose were injected simultaneously into the dorsal vein of the penis. The labelling of secretory proteins was determined in the liver and plasma at various time periods after label injection. Ethanol treatment decreased the secretion of both leucine- and fucose-labeled proteins into the plasma. This inhibition of secretion was accompanied by a corresponding increase in the hepatic retention of both leucine- and fucose-labeled immunoprecipitable secretory proteins. At the time of maximum inhibition of secretion, leucine labeled secretory proteins located in the Golgi apparatus represented about 50% of the accumulated secretory proteins in the livers of the ethanol-treated rats, whereas the remainder was essentially equally divided among the rough and smooth endoplasmic reticulum and cytosol. Because fucose is incorporated into secretory proteins almost exclusively in the Golgi complex, fucose-labeled proteins accumulated in the livers of the ethanol-treated rats mainly in the Golgi apparatus, with the remainder located in the cytosol. These results show that ethanol administration causes an impaired movement of secretory proteins along the secretory pathway, and that secretory proteins accumulate mainly, but not exclusively, in the Golgi apparatus.

  13. Xylose fermentation to ethanol

    SciTech Connect

    McMillan, J.D.

    1993-01-01

    The past several years have seen tremendous progress in the understanding of xylose metabolism and in the identification, characterization, and development of strains with improved xylose fermentation characteristics. A survey of the numerous microorganisms capable of directly fermenting xylose to ethanol indicates that wild-type yeast and recombinant bacteria offer the best overall performance in terms of high yield, final ethanol concentration, and volumetric productivity. The best performing bacteria, yeast, and fungi can achieve yields greater than 0.4 g/g and final ethanol concentrations approaching 5%. Productivities remain low for most yeast and particularly for fungi, but volumetric productivities exceeding 1.0 g/L-h have been reported for xylose-fermenting bacteria. In terms of wild-type microorganisms, strains of the yeast Pichia stipitis show the most promise in the short term for direct high-yield fermentation of xylose without byproduct formation. Of the recombinant xylose-fermenting microorganisms developed, recombinant E. coli ATTC 11303 (pLOI297) exhibits the most favorable performance characteristics reported to date.

  14. Facilitation of fiberoptic nasotracheal intubation with magnesium sulfate: A double-blind randomized study

    PubMed Central

    Elgebaly, Ahmed Said; Eldabaa, Ahmed Ali

    2014-01-01

    Background: A double-blinded, prospective, and randomized study was designed to determine the efficacy and tolerability of intravenous (IV) magnesium sulfate (MgSO4) to facilitate fiberoptic bronchoscopic (FOB) nasotracheal intubations. Patients and Methods: A total of 120 patients scheduled to undergo elective awake fiberoptic nasotracheal intubation, while they were anesthetized for elective surgery were randomly allocated to one of three groups: The control Group S (n = 40) received 100 ml (50 ml 0.9% saline + 50 ml paracetamol) was infused in 10 min and direct IV 5 ml 0.9% normal saline, Group MD (n = 40): Received midazolam IV in a dose of 0.07 mg/kg in 5 ml 0.9% normal saline and 100 ml 0.9% was infused in 10 min and Group MS (n = 40): IV 45 mg/kg MgSO4 10 min in 100 ml of 0.9% normal saline through 10 min and direct IV 5 ml 0.9% normal saline. Results: Time required for nasotracheal intubation was significantly less in group Groups MD and MS, as compared with the control group, but not significant between the two groups. (Group MD: 9.05 + 1.95 min, Group MS 3.75 + 0.75 min and Group S 16.85 + 1.7 min). However, the number of fiberoptic intubation was significantly more in the MD and MS groups, as compared with the control group. Easy intubation (control group: 0, Group MD: 25 and Group MS: 35), moderate difficulty (control group: 5, Group MD: 12 and Group MS: 4) and difficult (control group: 35, Group MD: 3 and Group MS: 1). Procedure adverse events were significantly lower in Group MS. None of the patients in Group MS had procedure hypoxia, but it occurred in 10 patients of Group MD and 20 patients in Group S. Six patients in Group S and two in Group MD had procedure apnea whereas, none of the patients in the MS group experienced this. After medication and just before intubation heart rate and mean arterial pressure were significantly less in Groups MD and MS, as compared to the control group (Group MD: 77 + 7.7 beat/min, Group MS: 70 + 5.6 beat/min and

  15. Etomidate: to use or not to use for endotracheal intubation in the critically ill?

    PubMed

    Smischney, Nathan J; Kashyap, Rahul; Gajic, Ognjen

    2015-09-01

    Endotracheal intubation is frequently performed in the intensive care unit (ICU). It can be life-saving for many patients who present with acute respiratory distress. However, it is equally associated with complications that may lead to unwanted effects in this patient population. According to the literature, the rate of complications associated with endotracheal intubation is much higher in an environment such as the ICU as compared to other, more controlled environments (i.e., operating room). Thus, the conduct of performing such a procedure needs to be accomplished with the utmost care. To facilitate establishment of the breathing tube, sedation is routinely administered. Given the tenuous hemodynamic status of the critically ill, etomidate was frequently chosen to blunt further decreases in blood pressure and/or heart rate. Recently however, reports have demonstrated a possible association with the use of etomidate for endotracheal intubation and mortality in the critically ill. In addition, this association seems to be predominantly in patients diagnosed with sepsis. As a result, some have advocated against the use of this medication in septic patients. Due to the negative associations identified with etomidate and mortality, several investigators have evaluated potential alternatives to this solution (e.g., ketamine and ketamine-propofol admixture). These studies have shown promise. However, despite the evidence against using etomidate for endotracheal intubation, other studies have demonstrated no such association. This leaves the critical care clinician with uncertainty regarding the best sedative to administer in this patient population. The following editorial discusses current evidence regarding etomidate use for endotracheal intubation and mortality. In particular, we highlight a recent article with the largest population to date that found no association between etomidate and mortality in the critically ill and illustrate important findings that the

  16. Non-intubated video-assisted thoracic surgery in patients aged 80 years and older

    PubMed Central

    Facktor, Matthew A.

    2015-01-01

    Background Video-assisted thoracic surgery (VATS) is routinely performed with general anesthesia and double-lumen endotracheal intubation, but this technique may stress an elderly patient’s functional reserve. We chose to study the safety and efficacy of non-intubated VATS, utilizing local anesthesia, sedation, and spontaneous ventilation in the elderly. Methods The medical records of all patients aged 80 years and older who underwent VATS under local anesthesia and sedation during the time period 6/1/2002 to 6/1/2010 at Geisinger Health System (Pennsylvania, USA) and 10/1/2011 to 12/31/2014 at Sinai Hospital (Maryland, USA) were retrospectively reviewed. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on comorbidity. Results A total of 96 patients ranging in age from 80 to 104 years underwent 102 non-intubated VATS procedures: pleural biopsy/effusion drainage with or without talc 73, drainage of empyema 17, evacuate hemothorax 4, pericardial window 3, lung biopsy 2, treat chylothorax 2, treat pneumothorax 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent procedure or biopsy. Complications occurred in three patients (3.1% morbidity): cerebrovascular accident, pulmonary embolism, prolonged air leak. One 94-year-old patient died from overanticoagulation and two 84-year-old patients died of their advanced lung cancers (3.1% morbidity). Conclusions Non-intubated VATS utilizing local anesthesia and sedation in the elderly is well tolerated and safe for a number of indications. PMID:26046042

  17. Hypothesis on the relationship between gastric cancer and intragastric nitrosation: N-nitrosamines in gastric juice of subjects from a high-risk area for gastric cancer and the inhibition of N-nitrosamine formation by fruit juices.

    PubMed

    Xu, G P; So, P J; Reed, P I

    1993-01-01

    The concentration of N-nitrosamines (NNA) in gastric juice was determined as an indicator of intragastric N-nitrosation in 85 subjects from a high-risk area for gastric cancer (GC) to examine the relationship between N-nitroso compounds (NOC), pH and intragastric lesions under strictly controlled conditions. Mean gastric pH in subjects with GC or dysplasia (Group GD, 5.0 +/- 2.7) was higher than that from subjects with intestinal metaplasia (Group IM, 3.8 +/- 2.1, p = 0.068) and significantly higher than in those with normal mucosa or superficial gastritis (Group NS, 2.6 +/- 1.9, p < 0.001). No significant difference (p > 0.1) was found in total NNA concentrations between the three groups (GD 1.81 +/- 1.05 micrograms/l, IM 1.46 +/- 0.79 micrograms/l, NS 1.56 +/- 1.38 micrograms/l). However, two obvious peaks of nitrosation were observed at pH ranges of < 2.0 and 5.5-7.5. These observations were confirmed by using the N-nitrosoproline test in the same subjects under the same conditions (r = 0.772, p < 0.05). These results indicate that intragastric nitrosation can occur in both acidic and nearly neutral conditions. The first peak is related to acid-catalysed nitrosation (ACN) and the second is related to biologically catalysed nitrosation (BCN). According to these and other published results the hypothesis that there are two basic mechanisms, ACN and BCN, for intragastric N-nitrosation in humans is explored. Gastric carcinogenesis in high-risk areas is more likely to be related to intragastric NOC formed by ACN, compared to low-risk areas where it is more likely to be related to intragastric NOC formed by BCN. Fruit juices and orange peel significantly inhibited intragastric nitrosation by both ACN and BCN.

  18. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    PubMed

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance < 6 cm, upper lip bite test class 3, Wilson risk sum score ≥ 2, Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.

  19. Endotracheal intubation with flexible fiberoptic bronchoscopy in patients with abnormal anatomic conditions of the head and neck.

    PubMed

    Elizondo, Eduardo; Navarro, Francisco; Pérez-Romo, Alfredo; Ortega, Concepción; Muñoz, Heberto; Cicero, Raúl

    2007-11-01

    We performed a retrospective chart review to evaluate the indications for endotracheal intubation via flexible fiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our 1100-bed, tertiary care university hospital. We reviewed 9201 clinical records of anesthetic procedures during which endotracheal intubation had been performed from January to December 2002. We identified 66 patients who had been intubated with flexible fiberoptic bronchoscopy. On preanesthetic examination, 61 of these patients had been found to be poor candidates for conventional laryngoscopic intubation-51 because of abnormal head and neck anatomy and 10 because of reduced visual access to the airway (Mallampati class IV). The remaining 5 patients were intubated via flexible fiberoptic bronchoscopy after conventional intubation had failed during emergency surgery. Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units.

  20. Intraperitoneal Injection of Ethanol Results in Drastic Changes in Bone Metabolism Not Observed When Ethanol is Administered by Oral Gavage

    PubMed Central

    Iwaniec, Urszula T.; Turner, Russell T.

    2013-01-01

    Background Chronic alcohol abuse is associated with increased risk for osteoporosis while light to moderate alcohol intake correlates with reduced osteoporosis risk. Addition of alcohol to a liquid diet is often used to model chronic alcohol abuse. Methods to model intermittent drinking (including bindge drinking and light to moderate consumption) include 1) intragastric administration of alcohol by oral gavage or 2) intraperitoneal (ip) administration of alcohol by injection. However, it is unclear whether the latter two methods produce comparable results. The purpose of this investigation was to determine the skeletal response to alcohol delivered daily by oral gavage or ip injection. Materials and Methods Ethanol or vehicle was administered to 4-month-old female Sprague Dawley rats once daily at 1.2 g/kg body weight for 7 days. Following necropsy, bone formation and bone architecture were evaluated in tibial diaphysis (cortical bone) and proximal tibial metaphysis (cancellous bone) by histomorphometry. mRNA was measured for bone matrix proteins in distal femur metaphysis. Results Administration of alcohol by gavage had no significant effect on body weight gain or bone measurements. In contrast, administration of the same dose of alcohol by ip injection resulted in reduced body weight, total suppression of periosteal bone formation in tibial diaphysis, decreased cancellous bone formation in proximal tibial metaphysis, and decreased mRNA levels for bone matrix proteins in distal femur. Conclusions Our findings raise concerns regarding the use of ip injection of ethanol in rodents as a method for modeling the skeletal effects of intermittent exposure to alcohol in humans. This concern is based on a failure of the ip route to replicate the oral route of alcohol administration. PMID:23550821

  1. Ketamine in the field: the use of ketamine for induction of anaesthesia before intubation in injured patients in the field.

    PubMed

    Gofrit, O N; Leibovici, D; Shemer, J; Henig, A; Shapira, S C

    1997-01-01

    Intubating the subconscious, struggling patient in a pre-hospital setting can be a difficult task even in experienced hands. We performed a clinical prospective study to evaluate the applicability of ketamine for induction of anaesthesia before intubation in the field. Ketamine was distributed to all air medical rescue teams--trained reserve army volunteers from various medical specialties. Lectures and literature concerning the use of ketamine for anaesthesia induction before intubation were given. The physicians were instructed to administer ketamine, in a dose of 2 mg/kg intravenously, if a single intubation attempt failed. Following the administration of ketamine, a questionnaire was filled in by the physician. Analysis of the data was performed after 24 months. During the study period, intubation was indicated in 161 injured patients evacuated by air in Israel. In 29 patients (18 per cent) the first intubation attempt had failed and they were given ketamine. The reasons for failure of the first intubation attempt were restlessness or trismus in 23 patients and traumatic distortion of the upper airway anatomical landmarks in six. Following ketamine administration, intubation was successful in 19 patients (65.5 per cent) in all of whom the indication for ketamine administration was restlessness or trismus. All patients with upper airway anatomy distortion were given a cricothyroidotomy. There were no complications attributed to ketamine. All patients reached hospital alive. This preliminary study suggests that the use of ketamine in this pre-hospital setting is safe. The drug is effective in cases where the primary reason for failure to intubate is restlessness or trismus. The drug is not effective in cases of anatomical damage to the upper airway. In these cases, cricothyroidotomy should probably be performed as early as possible.

  2. S-adenosylmethionine prevents the up regulation of Toll-like receptor (TLR) signaling caused by chronic ethanol feeding in rats.

    PubMed

    Oliva, Joan; Bardag-Gorce, Fawzia; Li, Jun; French, Barbara A; French, Samuel W

    2011-06-01

    Toll-like receptors (TLR) play a role in mediating the proinflammatory response, fibrogenesis and carcinogenesis in chronic liver diseases such as alcoholic liver disease, non-alcoholic liver disease, hepatitis C and hepatocellular carcinoma. This is true in experimental models of these diseases. For this reason, we investigated the TLR proinflammatory response in the chronic intragastric tube feeding rat model of alcohol liver disease. The methyl donor S-adenosylmethionine was also fed to prevent the gene expression changes induced by ethanol. Ethanol feeding tended to increase the up regulation of the gene expression of TLR2 and TLR4. SAMe feeding prevented this. TLR4 and MyD88 protein levels were significantly increased by ethanol and this was prevented by SAMe. This is the first report where ethanol feeding induced TLR2 and SAMe prevented the induction by ethanol. CD34, FOS, interferon responsive factor 1 (IRF-1), Jun, TLR 1,2,3,4,6 and 7 and Traf-6 were found to be up regulated as seen by microarray analysis where rats were sacrificed at high blood alcohol levels compared to pair fed controls. Il-6, IL-10 and IFNγ were also up regulated by high blood levels of ethanol. The gene expression of CD14, MyD88 and TNFR1SF1 were not up regulated by ethanol but were down regulated by SAMe. The gene expression of IL-1R1 and IRF1 tended to be up regulated by ethanol and this was prevented by feeding SAMe. The results suggest that SAMe, fed chronically prevents the activation of TLR pathways caused by ethanol. In this way the proinflammatory response, fibrogenesis, cirrhosis and hepatocellular carcinoma formation due to alcohol liver disease could be prevented by SAMe.

  3. Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries

    PubMed Central

    Chavan, SG; Gangadharan, S; Gopakumar, AK

    2016-01-01

    Background: The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 × ED95) and 0.9 mg/kg (3 × ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Materials and Methods: Ninety patients were divided into three groups of 30 each. Groups A, B received injection rocuronium at 0.6 mg/kg, 0.9 mg/kg respectively and Group C received succinylcholine at 2 mg/kg. Onset of action of relaxant, intubation conditions, time taken to intubate and duration of action were compared. Statistical Analysis Used: To compare the statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action analysis of variance and unpaired t-test were used. Results: The onset time was considerably shorter with rocuronium 0.9 mg/kg than 0.6 mg/kg. The onset time of rocuronium 0.9 mg/kg was found to be significantly longer than succinylcholine 2 mg/kg. Time taken to intubate was shortest with succinylcholine 2 mg/kg. The time taken to intubate with the rocuronium 0.9 mg/kg was found to be comparable to that of rocuronium 0.6 mg/kg. Intubation score of rocuronium 0.9 mg/kg was the best (17.75), which was comparable with succinylcholine. However, the intubation score obtained with rocuronium 0.6 mg/kg was inferior. Duration of action was shortest with succinylcholine. The duration of action is prolonged when the dose of rocuronium is increased from 0.6 to 0.9 mg/kg. Conclusion: Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated. PMID:27833478

  4. [A child with Klippel-Feil syndrome in whom GlideScope was effective for tracheal intubation].

    PubMed

    Arai, Takero; Hashimoto, Yuichi; Saito, Tomoyuki; Ogata, Tokiko; Chiba, Ayako; Sato, Hiromi; Enomoto, Sumie; Shimazaki, Mutsuhisa; Okuda, Yasuhisa

    2013-06-01

    GlideScope videolaryngoscope (GlideScope, herein-after referred to as "GS", Verathon Medical, Bothell, WA, USA), with a high-resolution camera positioned on a blade, enables operators to confirm the position of the larynx and a tube through clear view, thereby conducting intubation safely in a patient whose neck is difficult to be bent back. As the blade is slim, GS is indicated for use in children whose oral cavity is narrow. We herein report safe and smooth intubation with GS in a child with Klippel-Feil syndrome in whom difficult intubation was predicted.

  5. Precipitation of DNA with Ethanol.

    PubMed

    Green, Michael R; Sambrook, Joseph

    2016-12-01

    DNA can be precipitated out of solution for the removal of salts and/or for resuspension in an alternative buffer. Either ethanol or isopropanol can be used to achieve this purpose; however, the use of ethanol is generally preferred. Cations, provided as salts, are typically included to neutralize the negative charge of the DNA phosphate backbone. This method describes ethanol precipitation of DNA in microcentrifuge tubes.

  6. Ethanol from municipal cellulosic wastes

    NASA Astrophysics Data System (ADS)

    Parker, A. J., Jr.; Timbario, T. J.; Mulloney, J. A., Jr.

    This paper addresses the use of municipal cellulosic wastes as a feedstock for producing ethanol fuels, and describes the application of enzymatic hydrolysis technology for their production. The concept incorporates recent process technology developments within the framework of an existing industry familiar with large-scale ethanol fermentation (the brewing industry). Preliminary indications are that the cost of producing ethanol via enzymatic hydrolysis in an existing plant with minimal facility modifications (low capital investment) can be significantly less than that of ethanol from grain fermentation.

  7. Persistent loss of hippocampal neurogenesis and increased cell death following adolescent, but not adult, chronic ethanol exposure.

    PubMed

    Broadwater, Margaret A; Liu, Wen; Crews, Fulton T; Spear, Linda P

    2014-01-01

    Although adolescence is a common age to initiate alcohol consumption, the long-term consequences of exposure to alcohol at this time of considerable brain maturation are largely unknown. In studies utilizing rodents, behavioral evidence is beginning to emerge suggesting that the hippocampus may be persistently affected by repeated ethanol exposure during adolescence, but not by comparable alcohol exposure in adulthood. The purpose of this series of experiments was to explore a potential mechanism of hippocampal dysfunction in adults exposed to ethanol during adolescence. Given that disruption in adult neurogenesis has been reported to impair performance on tasks thought to be hippocampally related, we used immunohistochemistry to assess levels of doublecortin (DCX), an endogenous marker of immature neurons, in the dentate gyrus (DG) of the hippocampus 3-4 weeks after adolescent (postnatal day, PD28-48) or adult (PD70-90) intermittent ethanol exposure to 4 g/kg ethanol administered intragastrically. We also investigated another neurogenic niche, the subventricular zone (SVZ), to determine if the effects of ethanol exposure were region specific. Levels of cell proliferation and cell death were also examined in the DG via assessing Ki67 and cleaved caspase-3 immunoreactivity, respectively. Significantly less DCX was observed in the DG of adolescent (but not adult) ethanol-exposed animals about 4 weeks after exposure when these animals were compared to control age-mates. The effects of adolescent ethanol on DCX immunoreactivity were specific to the hippocampus, with no significant exposure effects emerging in the SVZ. In both the DG and the SVZ there was a significant age-related decline in neurogenesis as indexed by DCX. The persistent effect of adolescent ethanol exposure on reduced DCX in the DG appears to be related to significant increases in cell death, with significantly more cleaved caspase-3-positive immunoreactivity observed in the adolescent ethanol group

  8. Effect of rocuronium on the bispectral index under anesthesia and tracheal intubation

    PubMed Central

    Yue, Hui; Han, Jinyu; Liu, Ling; Wang, Kaiyuan; Li, Jincheng

    2016-01-01

    The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I–II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40–60, and a deep sedation group (group 2), with a BIS value <20 or with burst suppression. Each group was randomly divided into 4 subgroups A-D (n=9) according to the various doses of rocuronium (0.3, 0.6, 0.9 and 1.2 mg/kg). Tracheal intubation was performed after 2 min of rocuronium administration. BIS, electromyography (EMG), heart rate (HR) and mean arterial pressure (MAP) were recorded continuously and averaged over 1 min during baseline (T1), steady state (T2), 2 min after rocuronium infusion (T3), and 0, 2 and 5 min after tracheal intubation. The results demonstrated that HR and MAP decreased significantly at T2 and T3 compared with T1. Following tracheal intubation (L0), HR and MAP significantly increased compared with T2 and T3, and returned to levels similar to those prior to intubation after 5 min. In group 1C and 1D, BIS was significantly decreased at T3 compared with T2; BIS was significantly increased at L0 compared with T3 in group 1A and 1B. EMG at earlier stages of anesthesia was significantly higher compared with other points, and was significantly increased at L0 compared with T3 in group 1A and 1B. These results demonstrated that BIS response may be associated with the dosage of rocuronium in the normal sedation group, although no association was observed with the deep sedation group. Tracheal intubation resulted in marked hemodynamic

  9. Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study

    PubMed Central

    Schröder, H; Zoremba, N; Rossaint, R; Deusser, K; Stoppe, C; Coburn, M; Rieg, A; Schälte, G

    2016-01-01

    Objectives This study aimed to compare visualisation of the vocal cords and performance of intubation by anaesthetists using four different laryngoscopes while wearing full chemical protective equipment. Setting Medical simulation center of a university hospital, department of anaesthesiology. Participants 42 anaesthetists (15 females and 27 males) completed the trial. The participants were grouped according to their professional education as anaesthesiology residents with experience of <2 years or <5 years, or as anaesthesiology specialists with experience of >5 years. Interventions In a manikin scenario, participants performed endotracheal intubations with four different direct and indirect laryngoscopes (Macintosh (MAC), Airtraq (ATQ), Glidescope (GLS) and AP Advance (APA)), while wearing chemical protective gear, including a body suit, rubber gloves, a fire helmet and breathing apparatus. Primary and secondary outcome measures With respect to the manikin, setting time to complete ‘endotracheal intubation’ was defined as primary end point. Glottis visualisation (according to the Cormack-Lehane score (CLS) and impairments caused by the protective equipment, were defined as secondary outcome measures. Results The times to tracheal intubation were calculated using the MAC (31.4 s; 95% CI 26.6 to 36.8), ATQ (37.1 s; 95% CI 28.3 to 45.9), GLS (35.4 s; 95% CI 28.7 to 42.1) and APA (23.6 s; 95% CI 19.1 to 28.1), respectively. Intubation with the APA was significantly faster than with all the other devices examined among the total study population (p<0.05). A significant improvement in visualisation of the vocal cords was reported for the APA compared with the GLS. Conclusions Despite the restrictions caused by the equipment, the anaesthetists intubated the manikin successfully within adequate time. The APA outperformed the other devices in the time to intubation, and it has been evaluated as an easily manageable device for anaesthetists with varying

  10. Role of endogenous gastric mucosal prostaglandins in the formation of acute gastric mucosal lesions induced by aspirin, ethanol, HCl and CH3COOH.

    PubMed

    Amioka, I; Arima, T; Nagashima, H

    1987-06-01

    The role of endogenous mucosal prostaglandins (PGs) in the production of acute gastric mucosal lesions (AGML) was examined in rats. Aspirin, ethanol or 0.6 N-HCl was given intragastrically and 20% acetic acid was injected into the gastric wall. Endogenous gastric mucosal PG (A + B), PGE and PGF were determined by radioimmunoassay. Their gastric contents were markedly reduced by aspirin administration (p less than 0.001). The level of gastric mucosal PGs still remained low (p less than 0.001) after the aspirin-induced AGML began to heal. Furthermore, rats with AGML induced by ethanol, HCl or acetic acid, showed no decrease in endogenous gastric mucosal PGs compared with the controls. These findings indicated that endogenous PGs are not necessary for either the induction or healing of experimental AGML.

  11. Comparison of the Levitan FPS Scope and the single-use bougie for simulated difficult intubation in anaesthetised patients.

    PubMed

    Greenland, K B; Liu, G; Tan, H; Edwards, M; Irwin, M G

    2007-05-01

    A randomised cross-over study was performed in 34 patients with no evidence of airway difficulties, following induction of general anaesthesia, to compare the efficacy of the Levitan FPS scope (LFPS) and the single-use bougie for tracheal intubation during simulated grade IIIa laryngoscopy. Success rates for intratracheal placement of the device, and the time required for insertion and tracheal intubation were recorded. Both devices were equally successful (31/34 for the LFPS vs 29/34 for the bougie) for insertion into the glottis. The mean insertion time for the LFPS was statistically longer than that for the bougie (4.4-12.5 s) but this difference was not clinically relevant. Intubation times were similar between the two devices. Major problems hindering successful intubation using the LFPS were the presence of a narrow epiglottic-pharyngeal wall space and copious secretions. An inability to maintain the desired shape was the principal cause of failure with the bougie.

  12. Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: an old procedure revisited.

    PubMed

    Chalak, Lina F; Kaiser, Jeffrey R; Arrington, Robert W

    2007-02-01

    Pulmonary interstitial emphysema (PIE) contributes to worsening respiratory status in already compromised premature infants. Various treatments for PIE include high-frequency ventilation, postural therapy, pneumonectomy or lobectomy and selective bronchial intubation. While right main stem bronchus intubation is easy to perform at the bedside for treatment of PIE in the left lung, left main stem bronchus intubation for the treatment of right-sided PIE remains challenging and the technique was rarely reported and poorly described. In this case report, we revisit this procedure and describe successful treatment of right lung PIE with hyperinflation by selective left main stem intubation at 2 weeks of life in a 24-week-old premature infant who had respiratory distress syndrome and pulmonary hemorrhage. A detailed description is given to allow clinical bedside replication following specific anatomic landmarks.

  13. Submental intubation in paediatric oral and maxillofacial surgery: Review of the literature and report of four cases

    PubMed Central

    Taiwo, Olanrewaju Abdurrazaq; Ibikunle, Adebayo Aremu; Braimah, Ramat Oyebunmi; Suleiman, Musa Kallamu

    2015-01-01

    Several oral and maxillofacial surgery procedures require the simultaneous use of the oropharyngeal space by both the surgeons and the anaesthetists. This poses a lot of challenges especially in optimally securing the airway. Nasotracheal intubation or tracheostomy with their significant morbidity might even be contraindicated in these scenarios owing to several factors elucidated in the literature. Submental endotracheal intubation might be the last resort in adequately protecting the airway without interfering with the surgery. It also permits concurrent access to the dental occlusion and nasal pyramid without the risk associated with nasal intubation and morbidity of tracheostomy. Contraindications include patients who require long periods of assisted ventilation and a severe traumatic wound on the floor of the mouth. Complications include localised infection and sepsis, poor wound healing or scarring, and post-operative salivary fistula. The rationale for this study is to describe the indications, contraindications and the technique of submental endotracheal intubation as performed in our hospital. PMID:26712300

  14. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

    PubMed Central

    Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha

    2014-01-01

    Overview: Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate. PMID:25538514

  15. Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope.

    PubMed

    Rajendram, R; McGuire, N

    2006-10-01

    Although tracheostomy tube displacement is uncommon, the management is often difficult and the associated mortality is high. It is important to ensure that the airway is secure and then either replace or reposition the tracheostomy tube. This case report describes the use of an Aintree intubation catheter (C-CAE-19.0-56-AIC, William Cook Europe, Denmark) mounted on an intubating fibre-optic bronchoscope (11302BD1, Karl Storz Endoskope, Germany) to reposition a partially displaced tracheostomy tube.

  16. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients

    PubMed Central

    Kim, Min Jung; Park, Young Sook; Song, You Hong

    2015-01-01

    Objective To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. Methods This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed. Results Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively. Conclusion In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation. PMID:26605174

  17. Exhaled breath condensate analysis from intubated newborns by nano-HPLC coupled to high resolution MS.

    PubMed

    Kononikhin, A S; Starodubtseva, N L; Chagovets, V V; Ryndin, A Y; Burov, A A; Popov, I A; Bugrova, A E; Dautov, R A; Tokareva, A O; Podurovskaya, Y L; Ionov, O V; Frankevich, V E; Nikolaev, E N; Sukhikh, G T

    2017-03-15

    Invasiveness of examination and therapy methods is a serious problem for intensive care and nursing of premature infants. Exhaled breath condensate (EBC) is the most attractive biofluid for non-invasive methods development in neonatology for monitoring the status of intubated infants. The aim of the study was to propose an approach for EBC sampling and analysis from mechanically ventilated neonates. EBC collection system with good reproducibility of sampling was demonstrated. Discovery-based proteomic and metabolomic studies were performed using nano-HPLC coupled to high resolution MS. Label-free semi-quantitative data were compared for intubated neonates with congenital pneumonia (12 infants) and left-sided congenital diaphragmatic hernia (12 infants) in order to define disease-specific features. Totally 119 proteins and 164 metabolites were found. A number of proteins and metabolites that can act as potential biomarkers of respiratory diseases were proposed and require further validation.

  18. Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

    PubMed

    Karippacheril, John George; Umesh, Goneppanavar; Nanda, Shetty

    2013-10-01

    A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.

  19. A simple technique for intubating the mouth during OGD in patients with previous neck radiation

    PubMed Central

    Buckley, Christina E; Achakzai, Akbar Amin; O'Hanlon, Deirdre

    2014-01-01

    Trismus and microstomia are commonly associated complications of neck irradiation. In recent years we are seeing an increase in the number of patients with various head and neck cancers being treated with radiotherapy. This can pose a significant challenge in performing oesophagogastroduodenoscopy (OGD) in this cohort of patients. We describe a novel technique for intubating the mouth during OGD in patients with previous neck radiation. Instead of placing a standard mouthpiece, we place the barrel of a 5 mm syringe, which is cut in half, into the patient's mouth. This method allows easy passage of the gastroscope, where the mouth opening is limited by trismus from prior radiation. It also serves to protect the patient's teeth during OGD. Successful intubation with a gastroscope is possible in patients with severe trismus using our novel technique. PMID:24849645

  20. Survey of factors effective on re-intubation among children admitted to pediatric intensive care unit.

    PubMed

    Bilan, N; Ghaffari, S H

    2009-03-01

    This study was aimed to recognize the risk factors of re intubation among children who were admitted to pediatric intensive care unit. in an analytical cross-sectional study, the risk factors of reintubation in two groups of patients compared, both groups consist of 55 children, one with successful extubation and another with extubation failure. The study showed that neuromuscular disorders are the main underlying disease in extubation-failure group (p = 0.004). Besides, in comparison between two group of patients who had successful versus failed extubation, hypercapnia (PaCO2 > 50 mmHg) was shown to be the most common cause of both the first intubation (p = 0.003) and reintubation (p = 0.002) in patients who failed extubation. This study shows that neuromuscular disorders as a background, are the most common causes which defeat weaning from ventilator or result in reintubation by induction of hypercapnia.

  1. Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus.

    PubMed

    Schiermeyer, R P; Finkelstein, J A

    1994-03-01

    Rapid infusion of intravenous magnesium sulfate (MgSO4) was given to two young adults with impending respiratory failure caused by status asthmaticus. The infusion of 2 g of MgSO4 during a 2-minute period was associated with an immediate, dramatic reversal of their severe bronchospasm. This treatment obviated the need for intubation. Continuous beta 2-agonist therapy was performed simultaneously, taking advantage of the MgSO4-induced bronchodilation to deliver the beta 2-agonist to the target tissues. Rapid infusion of intravenous MgSO4 has been documented as safe in standard obstetric literature. Previous reports of MgSO4 therapy for acute asthma have used slow infusion. This is the first report of rapid infusion of MgSO4 for the emergency department management of asthma. In both cases, this therapy obviated the need for endotracheal intubation and mechanical ventilation.

  2. Interleukin-6 as a marker of inflammation secondary to endotracheal intubation in pediatric patients.

    PubMed

    Vasileiou, Panagiotis V S; Chalkias, Athanasios; Brozou, Vasiliki; Papageorgiou-Brousta, Mary; Kaparos, George; Koutsovasilis, Anastasios; Xanthos, Theodoros; Iacovidou, Nicoletta

    2013-12-01

    Ιnterleukin-6 (IL-6) has been identified as an early biochemical marker of inflammation both in animal and human studies. With this study, we sought to examine the development of local inflammation of the glottic tissues in correlation with the duration of intubation in anesthetized pediatric patients. We measured IL-6 levels in the organic material isolated from the tip of the tube post-extubation in 48 children aged 7 months to 14 years old who were submitted to a total of 72 surgical procedures. A statistically significant positive correlation (ρ = 0.28, p = 0.05) was detected among duration of anesthesia and IL-6 concentration. The odds of having detectable IL-6 levels rose by 36.7 % for every 10 min of anesthetic duration (p = 0.045). In conclusion, the increase of IL-6 in relation to the duration of the intubation indicates an increased risk of inflammation.

  3. Addition of a video camera system improves the ease of Airtraq(®) tracheal intubation during chest compression.

    PubMed

    Kohama, Hanako; Komasawa, Nobuyasu; Ueki, Ryusuke; Itani, Motoi; Nishi, Shin-ichi; Kaminoh, Yoshiroh

    2012-04-01

    Recent resuscitation guidelines for cardiopulmonary resuscitation emphasize that rescuers should perform tracheal intubation with minimal interruption of chest compressions. We evaluated the use of video guidance to facilitate tracheal intubation with the Airtraq (ATQ) laryngoscope during chest compression. Eighteen novice physicians in our anesthesia department performed tracheal intubation on a manikin using the ATQ with a video camera system (ATQ-V) or with no video guidance (ATQ-N) during chest compression. All participants were able to intubate the manikin using the ATQ-N without chest compression, but five failed during chest compression (P < 0.05). In contrast, all participants successfully secured the airway with the ATQ-V, with or without chest compression. Concurrent chest compression increased the time required for intubation with the ATQ-N (without chest compression 14.8 ± 4.5 s; with chest compression, 28.2 ± 10.6 s; P < 0.05), but not with the ATQ-V (without chest compression, 15.9 ± 5.8 s; with chest compression, 17.3 ± 5.3 s; P > 0.05). The ATQ video camera system improves the ease of tracheal intubation during chest compressions.

  4. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  5. Quality control in QuantiFERON-TB gold in-tube for screening latent tuberculosis infection in health care workers.

    PubMed

    Igari, Hidetoshi; Watanabe, Akira; Ichimura, Yasunori; Sakurai, Takayuki; Taniguchi, Toshibumi; Ishiwada, Naruhiko

    2017-04-01

    QuantiFERON-TB gold in-tube has been used for screening latent tuberculosis infection in newly employed health care workers in Japan. There have been a few studies concerning quality control. We retrospectively analysed QuantiFERON-TB gold in-tube results in a hospital in Japan. Interferon-γ values in three blood collection tubes for QuantiFERON-TB gold in-tube were analysed in association with the positivity rate. The data set consisted of health care workers aged 20-29 years during the 7 years between 2010 and 2016. The yearly QuantiFERON-TB gold in-tube positivity rate was 0.9%, 16.4%, 3.0%, 39.3%, 2.8%, 0.9% and 1.5%, and was extremely high in 2011 and 2013. The interferon-γ values in the tuberculosis antigen tube were elevated in these two years, as indicated by higher median and wider interquartile range. The interferon-γ value in the negative control tube was also higher in 2011. The higher interferon-γ values in collection tubes (tuberculosis antigen tube and/or negative control tube) resulted in higher QuantiFERON-TB gold in-tube positivity rate. The distribution of interferon-γ in tuberculosis antigen tube and negative control tube, as evaluated by median and interquartile range, proved to be an effective index for the quality control of QuantiFERON-TB gold in-tube.

  6. Numerical Simulation of Laser-Driven In-Tube Accelerator Operation

    SciTech Connect

    Ohnishi, N.; Ogino, Y.; Sawada, K.; Ohtani, T.; Mori, K.; Sasoh, A.

    2006-05-02

    To achieve a higher thrust performance in the laser-driven in-tube accelerator operation, numerical analysises have been carried out. The computational code covers from the generation of the blast wave to its interactions with the projectile and the acceleration wall. The thrust history and the momentum coupling coefficient evaluated from the numerical simulation depend on the fill pressure and the projectile shape. The confinement effect can be clearly found using the projectile attached with a shroud.

  7. Choice of Intravenous Agents and Intubation Neuromuscular Blockers by Anesthesia Providers

    DTIC Science & Technology

    1996-09-01

    of this study to determine if experience of the provider made a difference in the agent chosen. Both quantitative and qualitative methods were...comparison of quantitative and qualitative data of induction and intubation agents collected from CRNAs and MDAs according to experience of both types of...providers was analyzed to provide meaningful data. The difference in choice of agents by experience was found not to be significant. IV CHOICE OF

  8. Awake Tracheal Intubation in an 8-Year-Old Girl with McCune-Albright Syndrome.

    PubMed

    Bohman, J Kyle; Segura, Leal

    2013-10-01

    An 8-year-old girl with McCune-Albright syndrome presented for resection of a very large fibrous dysplasia mass of the face with significant distortion of the airway anatomy. She had significant obstructive sleep apnea with daytime somnolence and hemoglobin oxygen desaturations while breathing room air preoperatively. We were able to successfully manage her airway by providing IV sedation, topical anesthesia of the airway, and oral fiberoptic intubation in close collaboration with our otorhinolaryngology colleagues.

  9. Dependence of Initial Plasma Size on Laser-driven In-Tube Accelerator (LITA) Performance

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Ohtani, Toshiro; Sasoh, Akihiro; Choi, Jeong-Yeol

    2004-03-30

    At Tohoku University, experiments of Laser-driven In-Tube Accelerator (LITA) have been carried out. In order to observe the initial state of plasma and blast wave, the visualization experiment was carried out using the shadowgraph method. In this paper, dependency of initial plasma size on LITA performance is investigated numerically. The plasma size is estimated using shadowgraph images and the numerical results are compared with the experimental data of pressure measurement and results of previous modeling.

  10. [Delayed iatrogenic tracheal post-intubation rupture. A short review of the aetiopathology and treatment].

    PubMed

    Pinegger, S; Gómez-Ríos, M A; Vizcaíno, L; Carillo, M

    2013-05-01

    Iatrogenic tracheal rupture is a rare complication with a high morbidity and mortality. Tracheal intubation is the main cause and its origin is multifactorial. The diagnosis is based on non-specific but highly suggestive signs and symptoms, such as subcutaneous emphysema, pneumothorax, respiratory distress, or haemoptysis. Confirmation of the diagnosis requires an examination by bronchoscopy. Surgical repair has traditionally been the treatment of choice although the current trend is conservative management.

  11. Oleoylethanolamide prevents neuroimmune HMGB1/TLR4/NF-kB danger signaling in rat frontal cortex and depressive-like behavior induced by ethanol binge administration.

    PubMed

    Antón, María; Alén, Francisco; Gómez de Heras, Raquel; Serrano, Antonia; Pavón, Francisco Javier; Leza, Juan Carlos; García-Bueno, Borja; Rodríguez de Fonseca, Fernando; Orio, Laura

    2017-05-01

    Alcohol abuse is frequently characterized by a specific pattern of intake in binge drinking episodes, inducing neuroinflammation and brain damage. Here, we characterized the temporal profile of neuroinflammation in rats exposed to intragastric binge ethanol administrations (3 times/day × 4 days) and tested the anti-inflammatory/neuroprotective properties of the satiety factor oleoylethanolamide (OEA). Pre-treatment with OEA (5 mg/kg, i.p.) previous each alcohol gavage blocked the expression of high mobility group box 1 (HMGB1) danger signal and the innate immunity Toll-like receptors 4 (TLR4) in frontal cortex, and inhibited the nuclear factor-kappa B (NF-kB) proinflammatory cascade induced by alcohol binge administration. OEA reduced the levels of interleukin-1beta (IL-1β), the monocyte chemoattractant protein-1 (MCP-1), and the enzymes cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in ethanol binged animals. Elevations in plasma tumor necrosis factor alpha (TNF-α) and IL-1β after ethanol were also inhibited by OEA. OEA also prevented ethanol-induced lipid peroxidation, caspase-8 and pro-apoptotic caspase-3 activation in frontal cortex. Additionally, OEA blocked the rise in blood corticosterone levels after ethanol with no alteration in blood ethanol levels and may affect ethanol-induced gut permeability for endotoxin. Finally, OEA, administered as a pre-treatment during the ethanol binge, exerted antidepressant-like effects during acute withdrawal. Altogether, results highlight a beneficial profile of OEA as a potent anti-inflammatory, antioxidant, neuroprotective and antidepressant-like compound to treat alcohol abuse.

  12. Effectiveness of Synchronized Noninvasive Ventilation to Prevent Intubation in Preterm Infants

    PubMed Central

    Ramos-Navarro, Cristina; Sanchez-Luna, Manuel; Sanz-López, Ester; Maderuelo-Rodriguez, Elena; Zamora-Flores, Elena

    2016-01-01

    Background Noninvasive ventilation is being increasingly used on preterm infants to reduce ventilator lung injury and bronchopulmonary dysplasia. The aim of this study was to evaluate the effectiveness of synchronized nasal intermittent positive pressure ventilation (SNIPPV) to prevent intubation in premature infants. Methods Prospective observational study of SNIPPV use on preterm infants of less than 32 weeks' gestation. All patients were managed using a prospective protocol intended to reduce invasive mechanical ventilation (iMV) use. Previous respiratory status, as well as respiratory outcomes and possible secondary side effects were analyzed. Results SNIPPV was used on 78 patients: electively to support extubation on 25 ventilator-dependent patients and as a rescue therapy after nasal continuous positive airway pressure failure on 53 patients. For 92% of patients in the elective group and 66% in the rescue group, iMV was avoided over the following 72 hours. No adverse effects were detected, and all patients were in a stable condition even if intubation was eventually needed. Conclusions The application of SNIPPV in place of or to remove mechanical ventilation avoids intubation in 74.4% of preterm infants with respiratory failure. No adverse effects were detected. PMID:27500013

  13. A new curved laryngoscope blade for routine and difficult tracheal intubation.

    PubMed

    Nishikawa, Koji; Yamada, Koki; Sakamoto, Atsuhiro

    2008-10-01

    We have designed a new curved laryngoscope blade based on a new concept of reversing the peardrop phenomenon to facilitate a view of the larynx sufficient for intubation in a greater variety of patients than the current Macintosh blade affords. The new design has a bifid tip and S-shaped spatula to exert more effective pressure in the vallecula area, elevate the epiglottis and change directions of the forces on the tongue to prevent posteroinferior displacement of the compressed tongue in the submandibular space during laryngoscopy. A radiograph laryngoscopy technique was used to guide the new blade curvature design and compare the performance of the new blade with the Macintosh blade in patients with or without a difficult airway. Our results confirm that the new blade provides a laryngeal view sufficient to accomplish intubation by compressing the root of the tongue in an anterocephalad direction in the submandibular space and elevating the epiglottis effectively in patients with or without unanticipated difficult airway. The new curved blade can also effectively move the U-shaped epiglottis out of the laryngeal view to facilitate intubation in pediatric patients aged 2 mo-13 yr.

  14. [The EXIT procedure: Indications, limitations, risks and progress to the fetal endoscopical tracheal intubation].

    PubMed

    Cruz-Martínez, Rogelio; Méndez, Antonio; Pineda-Alemán, Hugo; Rebolledo-Fernández, Carlos

    2015-01-01

    Congenital oral and neck masses are associated with a high perinatal mortality and morbidity secondary to airway obstruction due to a mass effect of the tumor with subsequent neonatal asphyxia and/or neonatal death. In 1997, the Ex Utero Intrapartum Treatment (EXIT) technique was designed to establish a secure neonatal airway. This procedure allows neonatal tracheal intubation while the uteroplacental circulation maintains fetal oxygenation in a partial fetal delivery during cesarean section. However, it must be emphasized that this technique requires a multidisciplinary team, maternal general anesthesia, high surgery times and potential maternal risks such as placental abruption and increased maternal blood loss due to uterine atony. In addition, the clinical algorithm to obtain a neonatal airway can be quite challenging and neonatal mortality has been reported due to the inability in obtaining an airway at birth. Recently, our Mexican group described a novel minimally invasive fetoscopical technique before cesarean delivery that allows prenatal airway control by means of a fetal endoscopic tracheal intubation (FETI) under maternal peridural anesthesia. This procedure attempted to avoid the need for an EXIT procedure and its potential risks. In this review we described the indications, risks and potential benefits of the EXIT technique and its possible replacement by the fetal endoscopic tracheal intubation technique.

  15. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation?

    PubMed

    Bindra, Ashish; Prabhakar, Hemanshu; Singh, Gyaninder Pal; Ali, Zulfiqar; Singhal, Vasudha

    2010-06-01

    Management of the airway is central to the practice of anesthesia. Several bedside airway assessment methods have been proposed for preoperative identification of patients who are difficult to intubate. The modified Mallampati test (MMT) remains a time-tested technique to date for recognizing an anticipated difficult tracheal intubation as assessed by Cormack-Lehane grade. Both Mallampati and its further modification by Samsoon and Young evaluate patients in the seated position. Recently a study mentioned a change in MMT score from sitting to supine position toward the higher side. However, there is a lack of data regarding the relationship of positional change in MMT with Cormack-Lehane grade. The aim of this prospective study was to assess if MMT score observed in sitting or supine position is a better predictor of difficult tracheal intubation. One hundred and twenty-three patients of ASA physical status I and II, aged 18-60 years, who were scheduled to undergo various neurosurgical procedures were enrolled for the study. We found that the MMT in supine position has a higher positive predictive value and is associated with more true positives as compared to MMT in the sitting position.

  16. Retrospective analysis of the clinical course for intubation vs. unspecified laryngeal granulomas.

    PubMed

    Kumai, Yoshihiko; Yumoto, Eiji; Nishimoto, Kohei; Minoda, Ryosei

    2014-05-01

    Intubation laryngeal granulomas (ILGs) are a well-known complication of endotracheal intubation. Cases other than ILGs can be categorized as unspecified laryngeal granulomas (ULGs) since their etiologies are often difficult to confirm. We intended to clarify clinical features of both ILGs and ULGs and that anticoagulant medication could cause the formation and delayed healing of ILGs in terms of wound-healing delay. We compared the results of our treatment of ILGs (n = 16) and ULGs (n = 47) treated between 1998 and 2009 to characterize these patients. The clinical course, treatment (medical vs. surgical), indications for surgical resection, treatment outcome, and use of anticoagulants for preexisting disease were reviewed and compared between these two groups. The resolution rate was significantly better in ILGs (p < .05). Five ILGs and seven ULGs were surgically resected. The main reason for resection was airway obstruction and the need for histological assessment, respectively. The use of anticoagulants was significantly higher in ILGs than ULGs (8/16 vs. 4/47, p < .01). The resolution period was significantly longer in the ILGs patients with anticoagulant medication compared to that in the ILGs patients without anticoagulant medication (152 ± 101 days vs. 76 ± 44 days, p < .05). ILGs may have different clinical course from ULGs, especially in terms of the resolution period. Moreover, administration of anticoagulants may deter healing of small injury due to intubation. Patients taking anticoagulants should be managed carefully during the perioperative period to prevent the occurrence of ILGs.

  17. Comparison of the Ambu Aura-i with the Air-Q Intubating Laryngeal Airway as A Conduit for Fiberoptic-guided Tracheal Intubation in Children with Ear Deformity.

    PubMed

    Zhi, Juan; Deng, Xiao-Ming; Yang, Dong; Wen, Chao; Xu, Wen-Li; Wang, Lei; Xu, Jin

    2016-12-20

    Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmH2O in the Air-Q group and (22.2±5.0) cmH2O in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmH2O in the Air-Q group and (33.9±15.9) cmH2O in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.

  18. Distribution of radioactivity in the chondrichthyes Squalus acanthias and the osteichthyes salmo gairdneri following intragastric administration of (9-/sup 14/C)phenanthrene

    SciTech Connect

    Solbakken, J.E.; Palmork, K.H.

    1980-12-01

    The fate of polycyclic hydrocarbons (PAH) in marine animals has received increasing attention in the last decade. The present studies dealing with spiny dogfish (Squalus acanthias) and rainbow trout (Salmo gairdneri) are part of a series of experiments with different marine organisms. All the experiments were performed under the same laboratory conditions using intragastric administration of the PAH-component, /sup 14/C-labelled phenanthrene. Thus it is possible to compare species differences of disposition of PAH in various marine organisms. The most pronounced differences in the disposition of phenanthrene between bony fish and cartilaginous fish in our studies are that the maximum value of radioactivity in the liver of cartilaginous fish occurred several days later than the corresponding value in bony fish. Furthermore, the radioactivity in cartilaginous fish was retained at a high level beyond 672 h (28 days), a time at which the radioactivity in bony fish is near the background values.

  19. Behavioral effects of pentobarbital, lorazepam, ethanol and chlorpromazine substitution in pentobarbital-dependent baboons.

    PubMed

    Lamb, R J; Griffiths, R R

    1993-04-01

    Baboons were given continuous intragastric infusions of 100 mg/kg/day of pentobarbital before and during these experiments. The baboons responded under a fixed-ratio (FR) 30-response schedule of food presentation from 10:00 A.M. of one day to 8:00 A.M. of the next day. Terminating pentobarbital administration (i.e., substituting water for pentobarbital) from 8:00 A.M. of one day to 8:00 A.M. of the next day produced large decreases in the number of pellets earned. Repeated 24-h terminations of pentobarbital administration at 1-week intervals produced similar decreases in the pellets earned. In another experiment, the effects of terminating pentobarbital administration for several days were examined. The number of pellets earned decreased within 2 h of terminating pentobarbital administration was maximally suppressed during the first day, and recovered over 3 to 5 days. When different doses of pentobarbital were substituted for 24 h, the disruption of responding seen after pentobarbital termination was attenuated in a dose-dependent manner. In another experiment, the effects of substituting lorazepam, ethanol or chlorpromazine for pentobarbital for 24 h were examined. Lorazepam produced a dose-dependent attenuation of the effects of pentobarbital termination, whereas ethanol did not. Chlorpromazine did not attenuate the effects of pentobarbital termination in two of the three baboons tested, and produced erratic results in the third.

  20. Adolescent binge ethanol treatment alters adult brain regional volumes, cortical extracellular matrix protein and behavioral flexibility.

    PubMed

    Coleman, Leon Garland; Liu, Wen; Oguz, Ipek; Styner, Martin; Crews, Fulton T

    2014-01-01

    Adolescents binge drink more than any other age group, increasing risk of disrupting the development of the frontal cortex. We hypothesized that adolescent binge drinking would lead to persistent alterations in adulthood. In this study, we modeled adolescent weekend underage binge-drinking, using adolescent mice (post-natal days [P] 28-37). The adolescent intermittent binge ethanol (AIE) treatment includes 6 binge intragastric doses of ethanol in an intermittent pattern across adolescence. Assessments were conducted in adulthood following extended abstinence to determine if there were persistent changes in adults. Reversal learning, open field and other behavioral assessments as well as brain structure using magnetic imaging and immunohistochemistry were determined. We found that AIE did not impact adult Barnes Maze learning. However, AIE did cause reversal learning deficits in adults. AIE also caused structural changes in the adult brain. AIE was associated with adulthood volume enlargements in specific brain regions without changes in total brain volume. Enlarged regions included the orbitofrontal cortex (OFC, 4%), cerebellum (4.5%), thalamus (2%), internal capsule (10%) and genu of the corpus callosum (7%). The enlarged OFC volume in adults after AIE is consistent with previous imaging studies in human adolescents. AIE treatment was associated with significant increases in the expression of several extracellular matrix (ECM) proteins in the adult OFC including WFA (55%), Brevican (32%), Neurocan (105%), Tenacin-C (25%), and HABP (5%). These findings are consistent with AIE causing persistent changes in brain structure that could contribute to a lack of behavioral flexibility.

  1. Adolescent binge ethanol treatment alters adult brain regional volumes, cortical extracellular matrix protein and behavioral flexibility

    PubMed Central

    Coleman, Leon Garland; Liu, Wen; Oguz, Ipek; Styner, Martin; Crews, Fulton T.

    2014-01-01

    Adolescents binge drink more than any other age group, increasing risk of disrupting the development of the frontal cortex. We hypothesized that adolescent binge drinking would lead to persistent alterations in adulthood. In this study, we modeled adolescent weekend underage binge-drinking, using adolescent mice (post-natal days [P] 28–37). The adolescent intermittent binge ethanol (AIE) treatment includes 6 binge intragastric doses of ethanol in an intermittent pattern across adolescence. Assessments were conducted in adulthood following extended abstinence to determine if there were persistent changes in adults. Reversal learning, open field and other behavioral assessments as well as brain structure using magnetic imaging and immunohistochemistry were determined. We found AIE did not impact adult Barnes Maze learning. However, AIE did cause reversal learning deficits in adults. AIE also caused structural changes in the adult brain. AIE was associated with adulthood volume enlargements in specific brain regions without changes in total brain volume. Enlarged regions included the orbitofrontal cortex (OFC, 4%), cerebellum (4.5%), thalamus (2%), internal capsule (10%) and genu of the corpus callosum (7%). The enlarged OFC volume in adults after AIE is consistent with previous imaging studies in human adolescents. AIE treatment was associated with significant increases in the expression of several extracellular matrix (ECM) proteins in the adult OFC including WFA (55%), Brevican (32%), Neurocan (105%), Tenacin-C (25%), and HABP (5%). These findings are consistent with AIE causing persistent changes in brain structure that could contribute to a lack of behavioral flexibility. PMID:24275185

  2. Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation

    PubMed Central

    Al-Zubaidi, Ali M; Alghamdi, Hassan U; Alzobydi, Abdu H; Dhiloon, Irshad A; Qureshi, Laeeque A

    2015-01-01

    A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances. PMID:25901223

  3. Intragastric pH and pressure profiles after intake of the high-caloric, high-fat meal as used for food effect studies.

    PubMed

    Koziolek, M; Schneider, F; Grimm, M; Modeβ, Chr; Seekamp, A; Roustom, T; Siegmund, W; Weitschies, W

    2015-12-28

    The intraluminal conditions of the fed stomach are critical for drug release from solid oral dosage forms and thus, often associated with the occurrence of food effects on oral bioavailability. In this study, intragastric pH and pressure profiles present after the ingestion of the high-caloric, high-fat (964 kcal) FDA standard breakfast were investigated in 19 healthy human subjects by using the telemetric SmartPill® capsule system (26 × 13 mm). Since the gastric emptying of such large non-digestible objects is typically accomplished by the migrating motor complex phase III activity, the time required for recurrence of fasted state motility determined the gastric emptying time (GET). Following the diet recommendations of the FDA guidance on food effect studies, the mean GET of the telemetric motility capsule was 15.3 ± 4.7 h. Thus, the high caloric value of the standard breakfast impeded gastric emptying before lunch in 18 out of 19 subjects. During its gastric transit, the capsule was exposed to highly dynamic conditions in terms of pH and pressure, which were mainly dependent on further meal and liquid intake, as well as the intragastric capsule deposition behavior. Maximum pH values in the stomach were measured immediately after capsule intake. The median pH value of the 5 min period after capsule ingestion ranged between pH 3.3 and 5.3. Subsequently, the pH decreased relatively constantly and reached minimum values of pH 0-1 after approximately 4 h. The maximum pressure within the stomach amounted to 293 ± 109 mbar and was clearly higher than the maximum pressure measured at the ileocaecal junction (60 ± 35 mbar). The physiological data on the intraluminal conditions within the fed stomach generated in this study will hopefully contribute to a better understanding of food effects on oral drug product performance.

  4. Environmental Releases in the Fuel Ethanol Industry

    EPA Science Inventory

    Corn ethanol is the largest produced alternate biofuel in the United States. More than 13 billion gallons of ethanol were produced in 2010. The projected corn ethanol production is 15 billion gallons by 2015. With increased production of ethanol, the environmental releases from e...

  5. Rapid Induction of Apoptosis in Gastrulating Mouse Embryos by Ethanol and Its Prevention by HB-EGF

    PubMed Central

    Kilburn, Brian A.; Chiang, Po Jen; Wang, Jun; Flentke, George R.; Smith, Susan M.; Armant, D. Randall

    2006-01-01

    Background Ethanol exposure during gastrulation and early neurulation induces apoptosis within certain embryonic cell populations, leading to craniofacial and neurological defects. There is currently little information about the initial kinetics of ethanol-induced apoptosis, and interest in the ability of endogenous survival factors to moderate apoptosis is growing. Ethanol alters intracellular signaling, leading to cell death in chick embryos, suggesting that apoptosis could occur rapidly and that signaling pathways activated by survival factors might reduce apoptosis. Methods Pregnant mice were intubated with 1, 2, or 4 g/kg ethanol on day 7.5 of embryogenesis (E7.5) 1, 3, or 6, hours before harvesting gastrulation-stage embryos. Control animals received maltose/dextran. Blood alcohol concentrations (BAC) were determined by gas chromatography. E7.5 embryos isolated from untreated dams were cultured in vitro for 1 or 3 hr with 0 or 400 mg% ethanol and 0 or 5 nM heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF). Apoptosis was quantified using fluorescence microscopy to detect annexin V binding and DNA fragmentation [terminal deoxynucleotidyl transferase-mediated dUTP-X nick end labeling (TUNEL)] in whole-mount or sectioned embryos. Results Both annexin V binding and TUNEL were elevated (p<0.05) in embryos exposed in utero to 1 g/kg ethanol for 3 hours, increasing linearly with time and ethanol concentration. Apoptosis increased (p<0.05) in all germ cell layers. Mice treated with 4 g/kg sustained BAC of 400 mg% for nearly 3 hours, significantly increasing apoptosis within the first hour. Cultured embryos exposed to 400 mg% ethanol displayed 2- to 3-fold more TUNEL than vehicle-treated embryos (p<0.05); however, exogenous HB-EGF prevented apoptosis. Conclusions Ethanol rapidly produced apoptosis in gastrulation-stage embryos, consistent with induction by intracellular signaling. The ethanol-induced apoptotic pathway was blocked by the

  6. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

    PubMed Central

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-01-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how

  7. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

    PubMed Central

    Myatra, Sheila Nainan; Shah, Amit; Kundra, Pankaj; Patwa, Apeksh; Ramkumar, Venkateswaran; Divatia, Jigeeshu Vasishtha; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Ahmed, Syed Moied; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Garg, Rakesh

    2016-01-01

    The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart. PMID:28003690

  8. Pentax-airway scope for tracheal intubation breaks through the limitation of neck motion in an ankylosing spondylitis patient wearing halo vest--a case report.

    PubMed

    Cheng, Wei-Chun; Jimmy-Ong; Lee, Chia-Ling; Lan, Cing-Hong; Chen, Tsung-Ying; Lai, Hsien-Yong

    2010-12-01

    The Airway Scope (AWS) provides better glottic view than the conventional direct laryngoscopy in tracheal intubation. With it, the endotracheal tube can be more easily inserted into the tracheal lumen easily. We hereby presented a 24-year-old ankylosing spondylitis (AS) patient wearing a halo vest who was successfully intubated for undergoing cervical spine surgery involving C1 and C2 under general anesthesia. Pre-operative airway assessment revealed that he was a case of difficult intubation. An AWS was used for oral tracheal intubation which was achieved smoothly in the first attempt. AWS can be an alternative device for airway management in a patient wearing halo vest.

  9. Mode of ethanol administration influences the severity of hemorrhage-induced lactic acidemia in conscious guinea pigs.

    PubMed

    McDonough, Kathleen H; Swafford, Albert N; Giaimo, Mary E; Adamson, Trinka W; Miller, Harvey I

    2010-09-01

    Mechanisms that limit metabolic acidemia during shock are limited by ethanol (EtOH). This may be due to (1) loss of respiratory compensation, (2) a greater fall in cardiac output, (3) altered removal of plasma lactate by the liver, and (4) alterations in central nervous system orchestration of compensatory responses. We have previously shown that loss of metabolic compensation during hemorrhage is correlated with plasma EtOH concentrations. The present study determines if the mode of ethanol administration influences compensation during hemorrhage. Male guinea pigs were administered EtOH (1 g/kg, 30% wt/vol) via intraperitoneal (IP) or intragastric (IG) routes. After 30 minutes, 60% of the estimated blood volume was removed. Animals remained in shock for 30 minutes were resuscitated with lactated Ringer solution and monitored for 3 hours. Plasma EtOH levels were similar in the 2 groups at the initiation of, and during, hemorrhage and resuscitation. Animals given EtOH IP exhibited more severe acidemia. The mode of EtOH administration may affect hepatic ethanol and lactate metabolism, thus exacerbating acidemia. An altered central nervous system response may impact compensatory responses during shock. Our results indicate that the "history" of the EtOH episode may be an important determinant in the compensation for hemorrhage and resuscitation.

  10. Plant cell walls to ethanol.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Conversion of plant cell walls to ethanol constitutes generation 2 bioethanol production. The process consists of several steps: biomass selection/genetic modification, physiochemical pretreatment, enzymatic saccharification, fermentation, and separation. Ultimately, it is desired to combine as man...

  11. Ethanol: A Strategic Energy Source?

    DTIC Science & Technology

    2009-05-04

    REPORT DATE (DD-MM-YYYY) 04-05-2009 2. REPORT TYPE Program Research Paper 3 . DATES COVERED (From - To) 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER...radical terrorists richer.” 3 This research project examines the viability of ethanol as an alternative fuel source. It will identify whether an ethanol...Japan in 1941 went to war to secure its energy supplies. The United States must 3 prepare for these shortages if we are to maintain our economic

  12. Ethanol-induced analgesia

    SciTech Connect

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  13. Renewable energy: ethanol from biomass

    SciTech Connect

    Mullins, J.T.; NeSmith, C.C.

    1985-08-01

    Information is provided on the current status of renewable energy in Florida. Florida can expect continued increases in the use of ethanol for blends of unleaded gasoline. The sales for 1984 represent about 10% of Florida gasoline consumption. Federal and state tax incentives and other financial assistance are in place to encourage the development and growth of the fuel ethanol industry in Florida. However, it is not expected that Florida will become a major force in the production of ethanol in the short term. All existing commercial ethanol producing facilities employ established fermentation processes that utilize grain or molasses for the most part as feedstocks. Florida is not a large grain producing state and there is not a sufficient supply of molasses to support large scale ethanol production. The use of these feedstocks for Florida ethanol producing facilities is not competitive with the Mid-West grain areas, for example. Research has shown that much of the abundant biomass materials naturally or commercially grown in Florida can be converted to alcohol, but commercial scale facilities have not yet been built. To attract investment money, the non-commercial fermentation technology must progress beyond the laboratory stage and reach a proven and tested pilot plant stage. If the pilot stage indicates a full scale plant will be economical, then the next step is commercialization. 23 refs.

  14. Inhibitory effects of DA-9601 on ethanol-induced gastrohemorrhagic lesions and gastric xanthine oxidase activity in rats.

    PubMed

    Huh, Keun; Kwon, Tae Hyup; Shin, Uk Sup; Kim, Won Bae; Ahn, Byoung Ok; Oh, Tae Young; Kim, Jung-Ae

    2003-10-01

    The exposure of gastric mucosa to ethanol produces pathological changes such as inflammatory process, hemorrhagic erosions, even acute ulcers. The gastric mucosal lesions accompanied by a significant decrease of gastric blood flow and increase of reactive oxygen species (ROS) implicate a role of xanthine oxidase in ethanol-induced gastric hemorrhagic erosions. DA-9601, a novel antipeptic formulation of extracts of Artemisia asiatica Nakai, was studied for its inhibitory effect on gastric xanthine oxidase activity and type conversion of the enzyme that has a profound role in free radical generation. Intubation of absolute ethanol (4 g/kg) significantly induced gastrohemorrhagic lesions and lipid peroxidation in the rat stomach. Oral administration of DA-9601 at 40 mg/kg body weight significantly reduced ethanol-induced gastric mucosal hemorrhagic lesions and lipid peroxidation, which was proportional to the inhibitory effect of DA-9601 on alcohol-induced xanthine oxidase-type conversion and enzyme activity. The results suggest that alcohol-induced gastric mucosal damage may be, in part, due to the increased activity of xanthine oxidase and type conversion rate of the enzyme and that the preventive effect of DA-9601 on gastrohemorrhagic lesions would result from its inhibitory action against xanthine oxidase and oxidative stress in alcohol-treated rats.

  15. Different effects of cytoprotective drugs on ethanol- and aspirin-induced gastric mucosal injury in pylorus-ligated rats

    SciTech Connect

    Takeuchi, K.; Nishiwaki, H.; Niida, H.; Okabe, S. )

    1990-02-01

    In anesthetized rats oral administration (2 ml) of both ethanol (50% in 150 mM HCl) and aspirin (80 mM in 150 mM HCl) produced bandlike lesions in the stomach, while more generalized lesions occurred in the pylorus-ligated stomach when the irritant was given intragastrically through the fistula prepared in the rumen and the mucosal folds were removed by stomach distension. The bandlike lesions induced in the intact stomach by both irritants were significantly and dose-dependently prevented by 16,16-dimethyl PGE2 (dmPGE2: 3 and 10 micrograms/kg, subcutaneously), cysteamine (30 and 100 mg/kg, subcutaneously) or timoprazole (10 and 30 mg/kg, per os) at the doses which significantly inhibited gastric motility. In the pylorus-ligated stomach, however, neither of these agents showed any protection against the generalized lesions induced by ethanol, but such lesions caused by aspirin were significantly prevented only by dmPGE2. These agents also showed similar effects against the reduction of transmucosal PD in the pylorus-ligated stomach exposed to ethanol and aspirin. These results suggest that (1) the formation of bandlike lesions caused by ethanol and aspirin depends on the presence of mucosal folds and may be prevented by the agents that inhibit gastric motility, (2) the pathogenesis of the lesions induced by aspirin and ethanol may be different in the pylorus-ligated stomach, and (3) dmPGE2 has a unique protective ability that is not shared by usual cytoprotective agents.

  16. Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis: A Randomized Controlled Trial

    PubMed Central

    Xu, Mao; Li, Xiao-Xi; Guo, Xiang-Yang; Wang, Jun

    2017-01-01

    Background: Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis. Methods: A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III–IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results: The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P < 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034). Conclusions: SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation

  17. From Ethanol to Salsolinol: Role of Ethanol Metabolites in the Effects of Ethanol

    PubMed Central

    Peana, Alessandra T.; Rosas, Michela; Porru, Simona; Acquas, Elio

    2016-01-01

    In spite of the global reputation of ethanol as the psychopharmacologically active ingredient of alcoholic drinks, the neurobiological basis of the central effects of ethanol still presents some dark sides due to a number of unanswered questions related to both its precise mechanism of action and its metabolism. Accordingly, ethanol represents the interesting example of a compound whose actions cannot be explained as simply due to the involvement of a single receptor/neurotransmitter, a scenario further complicated by the robust evidence that two main metabolites, acetaldehyde and salsolinol, exert many effects similar to those of their parent compound. The present review recapitulates, in a perspective manner, the major and most recent advances that in the last decades boosted a significant growth in the understanding on the role of ethanol metabolism, in particular, in the neurobiological basis of its central effects. PMID:27891052

  18. [Determination of alkyl-phenols in textiles by in-tube capillary solid-phase extraction-gas chromatography].

    PubMed

    Zhang, Luohong; Du, Ting; Zhong, Jiayu

    2015-10-01

    An in-tube capillary solid-phase extraction (SPE) -gas chromatography (GC) method was developed for confirmation and quantitative determination of octylphenol (OP) and nonylphenol (NP) in textiles. To make the in-tube capillary SPE column, the best SPE cartridge was chosen from four kinds of SPE cartridges. The adsorbent in the cartridge was used as the filling material to make the in-tube capillary SPE column. The nature, volume used, flow rate and adsorption capacity of the eluent were compared. Finally, the in-tube capillary solid-phase extraction was combined with gas chromatography to detect the alkyl phenols (APs). Abselut NEXUS extraction cartridge was chosen as the best solid phase extractant. The optimal in-tube capillary SPE extraction conditions were as follows: 1.2 μL methanol and 1.2 μL ultra-pure water for activating the extraction column, 1.2 μL methanol for eluting, 0.4 μL/min for solution loading. The method showed a good linear relationship in the low concentration range, and the enrichment ratios for the APs were about 100 times. The detection limits of octylphenol and nonylphenol were 3.7 μg/L and 4.5 μg/L, respectively. The recoveries of octylphenol were 85.6%-98.2%, and those of nonylphenol were 83.8%-95.7%. The experimental results demonstrated that the method is simple, rapid, and useful for detecting APs in textiles.

  19. The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

    PubMed Central

    Myatra, Sheila Nainan; Ahmed, Syed Moied; Kundra, Pankaj; Garg, Rakesh; Ramkumar, Venkateswaran; Patwa, Apeksh; Shah, Amit; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Divatia, Jigeeshu Vasishtha

    2016-01-01

    Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60–70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful. PMID:28003694

  20. Online in-tube microextractor coupled with UV-Vis spectrophotometer for bisphenol A detection.

    PubMed

    Poorahong, Sujittra; Thammakhet, Chongdee; Thavarungkul, Panote; Kanatharana, Proespichaya

    2013-01-01

    A simple and high extraction efficiency online in-tube microextractor (ITME) was developed for bisphenol A (BPA) detection in water samples. The ITME was fabricated by a stepwise electrodeposition of polyaniline, polyethylene glycol and polydimethylsiloxane composite (CPANI) inside a silico-steel tube. The obtained ITME coupled with UV-Vis detection at 278 nm was investigated. By this method, the extraction and pre-concentration of BPA in water were carried out in a single step. Under optimum conditions, the system provided a linear dynamic range of 0.1 to 100 μM with a limit of detection of 20 nM (S/N ≥3). A single in-tube microextractor had a good stability of more than 60 consecutive injections for 10.0 μM BPA with a relative standard deviation of less than 4%. Moreover, a good tube-to-tube reproducibility and precision were obtained. The system was applied to detect BPA in water samples from six brands of baby bottles and the results showed good agreement with those obtained from the conventional GC-MS method. Acceptable percentage recoveries from the spiked water samples were obtained, ranging from 83-102% for this new method compared with 73-107% for the GC-MS standard method. This new in-tube CPANI microextractor provided an excellent extraction efficiency and a good reproducibility. In addition, it can also be easily applied for the analysis of other polar organic compounds contaminated in water sample.

  1. Early laryngeal outcome of prolonged intubation using an anatomical tube: a double blind, randomised study.

    PubMed

    Nordang, Leif; Lindholm, Carl-Eric; Larsson, Jan; Linder, Arne

    2016-03-01

    The objective of this study was to study the short-term impact on larynx by a newly designed anatomical tube. A prospective randomised trial of a newly designed anatomical tube versus a standard endotracheal tube in patients operated under general anaesthesia for at least 12 h. Seventy adults were included and randomised to either type of tube. The patients were evaluated by means of fibre-optic laryngoscopy and VAS-rating of symptoms on two occasions in the first post-operative week. The evaluating investigators and the patients were blinded to the type of tube used. 27 cases and 23 controls had complete data for evaluation. Age, gender and intubation times were comparable. Symptoms such as hoarseness, coughing, and pain were rated above 30 % of maximum during at least one of the first post-operative days by 21 and 19 patients, respectively. At the first examination (within 24 h), 38 % of patients in the anatomical tube group stated no hoarseness; compared to 13 % of the controls (p = 0.057). Fibre-optic laryngoscopy showed some kind of pathology in all the patients examined within 24 h of extubation. After 3-6 days, seven patients with the anatomical tube and four patients in the control group showed complete resolution of the lesions, and the changes were limited to redness in the vocal process area in another seven and four, respectively. The differences between the groups did not attain statistical significance. The study shows considerable short-term laryngeal morbidity after prolonged intubation, and the anatomical tube only showed an advantage concerning hoarseness. Further improvement of the endotracheal tubes and intubation routines are still needed.

  2. Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy.

    PubMed

    Amani, Hamed; Lozano, Daniel D; Blome-Eberwein, Sigrid

    2012-01-01

    Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. Those suspected of inhalation injury are intubated for airway control. In the English literature, there is a paucity of data discussing the need for intubation. To date, this is the largest study to determine whether intubated patients had inhalation injury as observed by bronchoscopy and whether intubation was necessary. All patient's charts who sustained burns while on home oxygen therapy from May 2000 to May 2010 were retrospectively reviewed (n = 86). Data collected were age, sex, TBSA, ventilator days, length of stay (LOS), and presence or absence of inhalation. Of those patients intubated, a subset analysis was performed to determine whether intubation in the "Field" or "Outside Hospital" correlated with inhalation injury compared with intubation in our Emergency Department. Eighty-six patients (mean age 64 years, mean %TBSA 2.6) were included. Before transfer to the burn unit, 32 patients (37%) were intubated and 52 patients (61%) were not intubated. Of the 32 intubated patients, bronchoscopy confirmed inhalation injury in 12 patients (39%). No significant difference was seen in %TBSA between intubated vs nonintubated patients (3.5 vs 2.0, respectively). However, there was a difference in LOS between the two groups (12.7 vs 2.8, respectively). No difference was found in incidence of inhalation injury between patients intubated in the "Field/Outside Hospital" compared with patients intubated in our Emergency Department (39% and 37.5%, respectively). Between the subgroups, no difference was found in %TBSA, ventilator days, or LOS. One patient admitted for airway observation required intubation and one patient failed extubation

  3. The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit

    PubMed Central

    Cierniak, Marcin; Sobczak, Renata; Timler, Dariusz; Wieczorek, Andrzej; Borkowski, Bartosz; Gaszyński, Tomasz

    2016-01-01

    Abstract The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score. The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample. The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate. There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies

  4. The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study.

    PubMed

    Cierniak, Marcin; Sobczak, Renata; Timler, Dariusz; Wieczorek, Andrzej; Borkowski, Bartosz; Gaszyński, Tomasz

    2016-12-01

    The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score.The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample.The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to

  5. [Bleeding during central venous catheterization : Cannot intubate, cannot ventilate due to massive cervical hematoma].

    PubMed

    Engelen, C; Trebes, C; Czarnecki, S; Junger, A

    2016-03-01

    Central venous catheterization is an invasive procedure which can be associated with severe complications. These include in particular unsuccessful arterial puncture and vascular injuries, which in addition to loss of blood can lead to massive soft tissue swelling. A 63-year-old female patient developed massive cervical bleeding during ultrasound-guided internal jugular vein puncture and the rapidly enlarging hematoma led to compromisation of the airway. A cannot intubate, cannot ventilate situation developed and the subsequent hypoxia led to cardiac arrest that was only resolved after emergency surgical tracheotomy during cardiopulmonary resuscitation.

  6. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    NASA Astrophysics Data System (ADS)

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-01

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  7. Optimal dose of intravenous oxycodone for attenuating hemodynamic changes after endotracheal intubation in healthy patients

    PubMed Central

    Park, Yong-Hee; Lee, Seung-Hyuk; Lee, Oh Haeng; Kang, Hyun; Shin, Hwa-Yong; Baek, Chong-Wha; Jung, Yong Hun; Woo, Young Cheol

    2017-01-01

    Abstract Background: Intravenous oxycodone has been used as an adjunct to anesthetic agents. This study aimed to assess the optimal dose of intravenous oxycodone for the attenuation of the hemodynamic responses to laryngoscopy and endotracheal intubation. Methods: A prospective, randomized, double-blind study was conducted. Ninety-five patients were randomly divided into 5 groups based on the oxycodone dose: 0, 0.05, 0.1, 0.15, 0.2 mg/kg. After administering the assigned dose of intravenous oxycodone, anesthesia was induced with thiopental. Heart rate (HR) and blood pressure (BP) were measured at baseline, before intubation, and 1, 2, and 3 minutes after intubation. The percentage increase of BP was calculated as (highest BP after intubation − baseline BP)/baseline BP × 100 (%). The percentage increase of HR was calculated in same formula as above. Hypertension was defined as a 15% increase of systolic BP from baseline, and probit analysis was conducted. Results: Hemodynamic data from 86 patients were analyzed. The percentage increase of mean arterial pressure after intubation in groups 0.05, 0.1, 0.15, and 0.2 was significantly different from that in the control (P < 0.001). For HR, the percentage increase was lower than control group when oxycodone was same or more than 0.1 mg/kg (P < 0.05). Using probit analysis, the 95% effective dose (ED95) for preventing hypertension was 0.159 mg/kg (95% confidence interval [CI], 0.122–0.243). In addition, ED50 was 0.020 mg/kg (95% CI, −0.037 to 0.049). However, oxycodone was not effective for maintaining the HR in our study dosage. There were no significant differences in the incidence of hypotension during induction between groups. Conclusions: Using 0.1 mg/kg of intravenous oxycodone is sufficient to attenuate the increase of BP and HR during induction period in healthy patients. The ED95, which was 0.159 mg/kg, can be useful to adjust the dosage of IV oxycodone for maintain stable BP

  8. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-30

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  9. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    PubMed Central

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-01-01

    Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

  10. Ethanol in Olive Fruit. Changes during Ripening.

    PubMed

    Beltrán, Gabriel; Bejaoui, Mohamed A; Jimenez, Antonio; Sanchez-Ortiz, Araceli

    2015-06-10

    Ethanol is one of the precursors of ethyl esters, the virgin olive oil quality parameter for the "extra" category recently adopted by the European Union and International Olive Oil Council. Although ethyl ester content has great importance for virgin olive oil classification, the origin of ethanol is not clear. A possible source of ethanol may be the olive fruit itself while it remains on the tree. Variation of fruit ethanol content during ripening was studied for three different olive cultivars: 'Picual', 'Hojiblanca', and 'Arbequina'. Ethanol was measured in fruit homogenates by HS-SPME-GC-FID. The ethanol content varied between 0.56 and 58 mg/kg. 'Hojiblanca' fruits showed the highest ethanol concentration. For all of the cultivars, ethanol content of fruit increased during the ripening process, although a clear cultivar-dependent effect was observed because 'Hojiblanca' fruits showed the most significant raise. Therefore, results indicated that ethanol can be accumulated during fruit maturation on the olive tree.

  11. The use of a plastic guide improves the safety and reduces the duration of endotracheal intubation in the pig.

    PubMed

    Janiszewski, Adrian; Pasławski, Robert; Skrzypczak, Piotr; Pasławska, Urszula; Szuba, Andrzej; Nicpoń, Józef

    2014-10-01

    The successful endotracheal intubation of pigs using the standard orotracheal method is challenging and technically difficult, because of the pig's oral anatomy and the presence of excess tissue in the oropharyngeal region. Hence, the operator, who is usually an anesthetist, requires extensive training in order to successfully perform the procedure in pigs. In this report, we describe a safe and quick method of successful endotracheal intubation in the pig using an 80-cm blunt-tipped plastic vascular catheter, when the pig is placed in ventral recumbency. Specifically, the use of this plastic guide wire shortened the duration of the procedure and reduced the risks of the procedure. Since the use of the guide wire also improves the ease of the procedure, its use will also enable inexperienced operators to perform successful first-time endotracheal intubation of pigs without causing injury.

  12. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet.

    PubMed

    Warner, Matthew A; Fox, Jonathan F

    2016-02-15

    Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.

  13. An institutional approach to the management of the 'Can't Intubate, Can't Oxygenate' emergency in children.

    PubMed

    Sabato, Stefano C; Long, Elliot

    2016-08-01

    The 'Can't Intubate Can't Oxygenate' emergency is rare in children. Nevertheless, airway clinicians involved in pediatric airway management must be able to rescue the airway percutaneously through the front of the neck should this situation be encountered. Little evidence exists in children to guide rescue techniques, and extrapolation of adult evidence may be problematic due to anatomical differences. This document reviews the currently available evidence, and presents a practical approach to standardizing equipment, techniques, and training for managing the 'Can't Intubate Can't Oxygenate' emergency in children.

  14. Safety and Efficacy of Dexmedetomidine as a Sedative Agent for Performing Awake Intubation: A Meta-analysis.

    PubMed

    Zhou, Luo-Jing; Fang, Xiang-Zhi; Gao, Ju; Zhangm, Yang; Tao, Li-Jian

    To compare the efficacy and safety of dexmedetomidine with other alternative sedative agents used for performing awake intubation. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine with other alternative sedative agents used during awake intubation. The biomedical databases PubMed, Science Direct, and the Cochrane Library were searched for relevant RCTs with no restriction on the language of publication. The efficacy (level of sedation, success rate for intubation at the first attempt, intubation time, intubation conditions, and patient satisfaction) and safety (incidence of hypertension, hypotension, tachycardia, bradycardia, hypoxia, postsurgical memory, hoarseness, and sore throat) were assessed. Thirteen RCTs with a combined subject population of 591 patients came within the purview of this meta-analysis. Use of dexmedetomidine was associated with a higher Ramsay sedation scale score [mean difference (MD): 1.02, 95% confidence interval (CI), 0.77-1.28, P < 0.00001], vocal cord movement score (MD = 0.72, 95% CI, 0.20-1.24, P = 0.007), coughing scores (MD = 0.66, 95% CI, 0.10-1.22, P = 0.02), limb movement scores (MD = 0.69, 95% CI, 0.47-0.91, P < 0.00001); increased risk of bradycardia [relative risk (RR): 3.03, 95% CI, 1.38-6.68, P = 0.006] and hypotension (RR: 2.87, 95% CI, 1.44-5.75, P = 0.003); and lower risk of hypoxia (RR: 0.32, 95% CI, 0.15-0.70; P = 0.004) and postsurgical memory (RR: 0.50, 95% CI, 0.35-0.72, P = 0.0002). As indicated by our results, dexmedetomidine appears to be an effective and well-tolerated agent for performing awake intubation. Its use was associated with better intubation conditions, preservation of airway patency, and reduced recall of intubation, as compared with the traditional sedative agents. The risk of bradycardia and hypotension was significantly higher with dexmedetomidine as compared with that with other sedatives. However, these were easily managed with

  15. A modified bicanalicular intubation procedure to repair canalicular lacerations using silicone tubes

    PubMed Central

    Liang, X; Lin, Y; Wang, Z; Lin, L; Zeng, S; Liu, Z; Li, N; Wang, Z; Liu, Y

    2012-01-01

    Purpose To explore a modified technique for silicone intubation for the repair of canalicular lacerations. Methods The surgery was performed on 35 eyes in 35 adult patients from October 2007 to September 2009. Using a modified soft probe, silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3–10 months. Results The surgery was performed successfully in all cases. The tubes were removed after 3–10 months (mean 5.3±1.8 months). The mean follow-up time after tube removal was 13.8 months (range, 6–22 months). Lower punctum splitting occurred in one case (2.86%) after the surgery. No other complications associated with the silicone tubes occurred. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during tube removal. Conclusions The modified bicanalicular intubation procedure described here is an effective and atraumatic procedure for the management of canalicular lacerations in adults, and it is associated with fewer complications than the traditional sutures of canalicular lacerations. PMID:23060024

  16. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review.

    PubMed

    Xu, Xiaohan; Xing, Na; Chang, Yanzi; Du, Yingying; Li, Zhisong; Wang, Zhongyu; Yan, Jie; Zhang, Wei

    2016-04-01

    Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. The most likely cause of tracheal injury is massive overinflation of the endotracheal tube cuff and pre-existing tracheal wall weakness. We review the relevant literature and predisposing factors contributing to this complication. Only articles that reported at least the demographic data (age and sex), the treatment performed and the outcome were included. Papers that did not detail these variables were excluded. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. This patient received surgical repair and recovered uneventfully. Two hundred and eight studies that reported cases or case series were selected for analysis. Most of the reported cases (57·2%) showed an uneventful recovery after surgical therapy. The overall mortality was 19·2% (40 patients). Our patient too recovered without any serious complication. Careful prevention, early detection and proper treatment of the problem are necessary when tracheal rupture occurs. The morbidity and mortality associated with tracheal injury mandate a high level of suspicion and expedient management.

  17. Nasal septum giant pyogenic granuloma after a long lasting nasal intubation: case report.

    PubMed

    Neves-Pinto, Roberto M; Carvalho, Adolpho; Araujo, Elizabeth; Alberto, Carlos; Basilio-De-Oliveira; De Carvalho, Gustavo Adolpho

    2005-03-01

    The authors present a case of Pyogenic Granuloma (PG) arising from the nasal septum in the posterior nasal cavity of a patient male sex, caucasian, 32 years old, with a previous history of cranioencephalic trauma, several neurosurgeries for different subsequent neurological problems and the use of a nasogastric tube for feeding (nasal intubation) during 30 days. He underwent surgery in St. Vincent de Paul Hospital (Rio de Janeiro) on May 18, 1993, for the tumor removal and straightening of the nasal septum. Under endoscopic guidance the complete excision of the tumor mass was perfectly done thanks to the excellent exposure of the lesion, provided by the enlarged telescopic view, and the wide access afforded by the septum straighttening plus the cartilaginous septum mobilization through the maxilla-premaxilla approach of Cottle, allied to the lateralization and volume reduction of the right inferior nasal concha, simultaneously performed, thus making lateral rhinotomy or "degloving" unnecessary. The patient is until now (2004) completely free of the lesion operated on. This is the first report in the literature of such a lesion associated to nasal intubation as the triggering agent.

  18. [Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

    PubMed

    Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

    2015-01-01

    Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.

  19. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.

    PubMed

    Ogata, Junchi; Minami, Kouichiro; Horishita, Takafumi; Shiraishi, Munehiro; Okamoto, Takashi; Terada, Tadanori; Sata, Takeyoshi

    2005-07-01

    Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

  20. Triradiate caecal fold: Is it a useful landmark for caecal intubation in colonoscopy?

    PubMed Central

    Finlayson, Andrew; Chandra, Raaj; Hastie, Ian A; Jones, Ian T; Shedda, Susan; Hong, Michael K-Y; Yen, Aileen; Hayes, Ian P

    2015-01-01

    AIM: To determine the frequency of identification of the triradiate fold during colonoscopy and evaluate its reliability as a marker of caecal intubation. METHODS: One hundred consecutive patients undergoing colonoscopy in a tertiary hospital colorectal unit from May to September 2013 were studied. Video documentation of the caecum was recorded and shown to consultant colorectal surgeons on the unit. Each reviewer was asked through a series of questions to independently identify the triradiate fold. The main outcome was the frequency of visualisation of the triradiate fold in the caecum. RESULTS: The triradiate fold was seen on average in 18% of cases, but inter-observer agreement was poor. There were only four patients (4%) in which all reviewers agreed on the presence of a triradiate fold. In patients who had undergone previous appendicectomy, the appendiceal orifice was less frequently seen compared with patients who had not undergone appendicectomy. CONCLUSION: The triradiate fold is infrequently seen during colonoscopy and is therefore an unreliable landmark of caecal intubation. PMID:26421107

  1. Ethanol production method and system

    DOEpatents

    Chen, M.J.; Rathke, J.W.

    1983-05-26

    Ethanol is selectively produced from the reaction of methanol with carbon monoxide and hydrogen in the presence of a transition metal carbonyl catalyst. Methanol serves as a solvent and may be accompanied by a less volatile co-solvent. The solution includes the transition metal carbonyl catalysts and a basic metal salt such as an alkali metal or alkaline earth metal formate, carbonate or bicarbonate. A gas containing a high carbon monoxide to hydrogen ratio, as is present in a typical gasifer product, is contacted with the solution for the preferential production of ethanol with minimal water as a byproduct. Fractionation of the reaction solution provides substantially pure ethanol product and allows return of the catalysts for reuse.

  2. Chronic ethanol exposure combined with high fat diet up-regulates P2X7 receptors that parallels neuroinflammation and neuronal loss in C57BL/6J mice

    PubMed Central

    Asatryan, Liana; Khoja, Sheraz; Rodgers, Kathleen E; Alkana, Ronald L; Tsukamoto, Hidekatsu; Davies, Daryl L.

    2015-01-01

    The present investigation tested the role of ATP-activated P2X7 receptors (P2X7Rs) in alcohol-induced brain damage using a model that combines intragastric (iG) ethanol feeding and high fat diet in C57BL/6J mice (Hybrid). The Hybrid paradigm caused increased levels of pro-inflammatory markers, changes in microglia and astrocytes, reduced levels of neuronal marker NeuN and increased P2X7R expression in ethanol-sensitive brain regions. Observed changes in P2X7R and NeuN expression were more pronounced in Hybrid paradigm with inclusion of additional weekly binges. In addition, high fat diet during Hybrid exposure aggravated the increase in P2X7R expression and activation of glial cells. PMID:26198936

  3. Chronic ethanol exposure combined with high fat diet up-regulates P2X7 receptors that parallels neuroinflammation and neuronal loss in C57BL/6J mice.

    PubMed

    Asatryan, Liana; Khoja, Sheraz; Rodgers, Kathleen E; Alkana, Ronald L; Tsukamoto, Hidekazu; Davies, Daryl L

    2015-08-15

    The present investigation tested the role of ATP-activated P2X7 receptors (P2X7Rs) in alcohol-induced brain damage using a model that combines intragastric (iG) ethanol feeding and high fat diet in C57BL/6J mice (Hybrid). The Hybrid paradigm caused increased levels of pro-inflammatory markers, changes in microglia and astrocytes, reduced levels of neuronal marker NeuN and increased P2X7R expression in ethanol-sensitive brain regions. Observed changes in P2X7R and NeuN expression were more pronounced in Hybrid paradigm with inclusion of additional weekly binges. In addition, high fat diet during Hybrid exposure aggravated the increase in P2X7R expression and activation of glial cells.

  4. Ethanol Demand in United States Gasoline Production

    SciTech Connect

    Hadder, G.R.

    1998-11-24

    The Oak Ridge National Laboratory (OWL) Refinery Yield Model (RYM) has been used to estimate the demand for ethanol in U.S. gasoline production in year 2010. Study cases examine ethanol demand with variations in world oil price, cost of competing oxygenate, ethanol value, and gasoline specifications. For combined-regions outside California summer ethanol demand is dominated by conventional gasoline (CG) because the premised share of reformulated gasoline (RFG) production is relatively low and because CG offers greater flexibility for blending high vapor pressure components like ethanol. Vapor pressure advantages disappear for winter CG, but total ethanol used in winter RFG remains low because of the low RFG production share. In California, relatively less ethanol is used in CG because the RFG production share is very high. During the winter in California, there is a significant increase in use of ethanol in RFG, as ethanol displaces lower-vapor-pressure ethers. Estimated U.S. ethanol demand is a function of the refiner value of ethanol. For example, ethanol demand for reference conditions in year 2010 is 2 billion gallons per year (BGY) at a refiner value of $1.00 per gallon (1996 dollars), and 9 BGY at a refiner value of $0.60 per gallon. Ethanol demand could be increased with higher oil prices, or by changes in gasoline specifications for oxygen content, sulfur content, emissions of volatile organic compounds (VOCS), and octane numbers.

  5. Ethanol Pharmacokinetics in Neonates and Infants

    PubMed Central

    Marek, Elizabeth; Kraft, Walter K.

    2014-01-01

    Introduction Ethanol has been used for years in neonatal and infant liquid medications, yet the pharmacokinetics, pharmacodynamics, and safety of ethanol in this vulnerable population have not been well characterized. The purpose of this review is to raise awareness of ethanol use as an excipient in neonatal and infant medications and to provide insight, based on the available evidence, into clearance rates of ethanol in babies. We also discuss ethanol pharmacokinetics in adults, theoretical pharmacokinetic changes in neonates and infants as it may apply to ethanol disposition, and case reports involving ethanol exposure in neonates and infants. Materials and methods This study was a narrative review in which relevant papers were selected using databases and scientific search engines such as PubMed with the key words ethanol, infant, and newborninfant. Results It remains unclear what ethanol exposure is safe for neonates and infants. The Food and Drug Administration and American Academy of Pediatrics have both taken action, by either setting limits of ethanol content in over-the-counter medications or by recommending restricted exposure to ethanol-containing pediatric formulations. Conclusions Until the short- and long-term health effects of chronic ethanol administration can be further characterized, ethanol-containing medications should be used with caution. PMID:25379066

  6. Feasibility of producing ethanol from food waste.

    PubMed

    Kim, Jae Hyung; Lee, Jun Cheol; Pak, Daewon

    2011-01-01

    Food waste generated in Korea is rich in carbohydrate as high as 65% of total solids. Using the food waste, the feasibility of ethanol production was investigated in a lab-scale fermentor. Pretreatment with hydrolyzing enzymes including carbohydrase, glucoamylase, cellulase and protease were tested for hydrolysis of food waste. The carbohydrase was able to hydrolyze and produce glucose with a glucose yield of 0.63 g glucose/g total solid. Enzymatic hydrolysis and ethanol fermentation by using carbohydrase and Saccharomyces cerevisiae were conducted in the batch mode. For separated hydrolysis and fermentation (SHF), ethanol concentration reached at the level corresponding to an ethanol yield of 0.43 g ethanol/g total solids. For simultaneous saccharification and fermentation (SSF), the ethanol yield was 0.31 g ethanol/g total solids. During the continuous operation of SHF, the volumetric ethanol production rate was 1.18 g/lh with an ethanol yield of 0.3g ethanol/g total solids. For SSF process, the volumetric ethanol production rate was 0.8 g/lh with an ethanol yield of 0.2g ethanol/g total solids.

  7. Ethanol Metabolism and Osmolarity Modify Behavioral Responses to Ethanol in C. elegans

    PubMed Central

    Alaimo, Joseph T.; Davis, Scott J.; Song, Sam S.; Burnette, Christopher R.; Grotewiel, Mike; Shelton, Keith L.; Pierce-Shimomura, Jonathan T.; Davies, Andrew G.; Bettinger, Jill C.

    2012-01-01

    Background Ethanol is metabolized by a two-step process in which alcohol dehydrogenase (ADH) oxidizes ethanol to acetaldehyde, which is further oxidized to acetate by aldehyde dehydrogenase (ALDH). Although variation in ethanol metabolism in humans strongly influences the propensity to chronically abuse alcohol, few data exist on the behavioral effects of altered ethanol metabolism. Here, we used the nematode C. elegans to directly examine how changes in ethanol metabolism alter behavioral responses to alcohol during an acute exposure. Additionally, we investigated ethanol solution osmolarity as a potential explanation for contrasting published data on C. elegans ethanol sensitivity. Methods We developed a gas chromatography assay and validated a spectrophotometric method to measure internal ethanol in ethanol-exposed worms. Further, we tested the effects of mutations in ADH and ALDH genes on ethanol tissue accumulation and behavioral sensitivity to the drug. Finally, we tested the effects of ethanol solution osmolarity on behavioral responses and tissue ethanol accumulation. Results Only a small amount of exogenously applied ethanol accumulated in the tissues of C. elegans and consequently their tissue concentrations were similar to those that intoxicate humans. Independent inactivation of an ADH-encoding gene (sodh-1) or an ALDH-encoding gene (alh-6 or alh-13) increased the ethanol concentration in worms and caused hypersensitivity to the acute sedative effects of ethanol on locomotion. We also found that the sensitivity to the depressive effects of ethanol on locomotion is strongly influenced by the osmolarity of the exogenous ethanol solution. Conclusions Our results indicate that ethanol metabolism via ADH and ALDH has a statistically discernable but surprisingly minor influence on ethanol sedation and internal ethanol accumulation in worms. In contrast, the osmolarity of the medium in which ethanol is delivered to the animals has a more substantial effect on

  8. Enabling High Efficiency Ethanol Engines

    SciTech Connect

    Szybist, J.; Confer, K.

    2011-03-01

    Delphi Automotive Systems and ORNL established this CRADA to explore the potential to improve the energy efficiency of spark-ignited engines operating on ethanol-gasoline blends. By taking advantage of the fuel properties of ethanol, such as high compression ratio and high latent heat of vaporization, it is possible to increase efficiency with ethanol blends. Increasing the efficiency with ethanol-containing blends aims to remove a market barrier of reduced fuel economy with E85 fuel blends, which is currently about 30% lower than with petroleum-derived gasoline. The same or higher engine efficiency is achieved with E85, and the reduction in fuel economy is due to the lower energy density of E85. By making ethanol-blends more efficient, the fuel economy gap between gasoline and E85 can be reduced. In the partnership between Delphi and ORNL, each organization brought a unique and complementary set of skills to the project. Delphi has extensive knowledge and experience in powertrain components and subsystems as well as overcoming real-world implementation barriers. ORNL has extensive knowledge and expertise in non-traditional fuels and improving engine system efficiency for the next generation of internal combustion engines. Partnering to combine these knowledge bases was essential towards making progress to reducing the fuel economy gap between gasoline and E85. ORNL and Delphi maintained strong collaboration throughout the project. Meetings were held regularly, usually on a bi-weekly basis, with additional reports, presentations, and meetings as necessary to maintain progress. Delphi provided substantial hardware support to the project by providing components for the single-cylinder engine experiments, engineering support for hardware modifications, guidance for operational strategies on engine research, and hardware support by providing a flexible multi-cylinder engine to be used for optimizing engine efficiency with ethanol-containing fuels.

  9. [Ethanol content of Kefir water].

    PubMed

    Rabl, W; Liniger, B; Sutter, K; Sigrist, T

    1994-03-01

    The question of the influence of kefir on blood-alcohol-level has been asked in a legal proceeding. The questioned recipe consisted of 21 water, 6 soup-spoons of kefir granules (about 120 g), 150 g sugar, 2 figs and one lemon. The consumption took place after two days of fermentation. Experimentally we found, that one liter of this kefir product may contain up to 38 g/l ethanol after 7 to 10 days. On the second day we measured up to 16 g/l ethanol. Our results may be import for expert appraisements concerning unability of driving.

  10. Superhydrophobic, nanotextured polyvinyl chloride films for delaying Pseudomonas aeruginosa attachment to intubation tubes and medical plastics.

    PubMed

    Loo, Ching-Yee; Young, Paul M; Lee, Wing-Hin; Cavaliere, Rosalia; Whitchurch, Cynthia B; Rohanizadeh, Ramin

    2012-05-01

    Bacterial attachment onto the surface of polymers in medical devices such as polyvinyl chloride (PVC) is influenced by the physicochemical properties of the polymer, including its surface hydrophobicity and roughness. In this study, to prevent biofilm formation onto PVC devices, the PVC surface was modified using a combination of solvent (tetrahydrofuran) and non-solvents (i.e. ethanol and methanol). The surface of unmodified PVC was smooth and relatively hydrophobic (water contact angle (CA)=80°). Ethanol-treated PVCs revealed the presence of micron-sized particulates and porous structures as the concentration of ethanol was increased. Surface hydrophobicity (measured in terms of CA) increased from 73° to 150° as the ethanol concentration increased from 15% to 35% (v/v). In general, methanol-treated PVCs were more hydrophilic compared to those treated with ethanol. The colonization of Pseudomonas aeruginosa PAO1 onto unmodified PVC surface was rapid, and individual bacterial cells could be seen after 6h incubation. On the surface of treated PVC, the secretion of extracellular matrix layers was evident at 18 h and P. aeruginosa PAO1 start to form microcolonies at 24h of incubation. The initial attachment of P. aeruginosa PAO1 was delayed to 18 and 24h, respectively in the PVCs treated with 25% (v/v) and 35% (v/v) ethanol. It can be concluded that the treatment used in this study to prepare superhydrophobic PVC surface prevented the colonization of bacteria up to 24h after culture.

  11. Attenuation of the hemodynamic response to laryngoscopy and tracheal intubation with fentanyl, lignocaine nebulization, and a combination of both: A randomized controlled trial

    PubMed Central

    Kumar, Abhyuday; Seth, Anita; Prakash, Smita; Deganwa, Mangilal; Gogia, Anoop Raj

    2016-01-01

    Background: The present study was undertaken to compare and evaluate the efficacy of intravenous (IV) fentanyl and lignocaine airway nebulization and a combination of both in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: Ninety-six patients of either sex aged between 18 and 65 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included in the study. Patients were randomly divided into three groups. Group F received IV fentanyl 2 μg/kg, Group L received nebulization with 3 mg/kg of 4% lignocaine, and Group FL received both nebulization with 3 mg/kg of 4% lignocaine and IV fentanyl 2 μg/kg before intubation. Hemodynamic parameters were noted before and immediately after induction, 1 min after intubation, and every minute after intubation for 10 min. Results: Hemodynamic response to laryngoscopy and intubation was not completely abolished in any of the groups. Nebulized lignocaine was least effective in attenuating hemodynamic response to intubation, and hemodynamic parameters were significantly high after intubation as compared to other groups. Fentanyl alone or in combination with nebulized lignocaine was most effective, and Group F and Group FL were comparable. The maximum increase in mean blood pressure after intubation from baseline in Groups F, L, and FL was 7.4%, 14.6%, and 5.4%, respectively. Conclusion: In our study, IV fentanyl 2 μg/kg administered 5 min before induction was found to be the most effective in attenuating the hemodynamic response. There was no advantage to the use of nebulized lignocaine in attenuating the hemodynamic response to laryngoscopy and intubation. PMID:27746569

  12. McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

    PubMed Central

    Bailly, Arthur; Le Thuaut, Aurelie; Boisrame-Helms, Julie; Kamel, Toufik; Mercier, Emmanuelle; Ricard, Jean Damien; Lemiale, Virginie; Champigneulle, Benoit; Reignier, Jean

    2015-01-01

    Introduction Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope. The primary goal of this trial was to determine whether videolaryngoscopy increased the frequency of successful first-pass intubation in critically ill patients, compared to direct view Macintosh laryngoscopy. Methods and analysis MACMAN is a multicentre, open-label, randomised controlled superiority trial. Consecutive patients requiring intubation are randomly allocated to either the McGRATH MAC videolaryngoscope or the Macintosh laryngoscope, with stratification by centre and operator experience. The expected frequency of successful first-pass intubation is 65% in the Macintosh group and 80% in the videolaryngoscope group. With α set at 5%, to achieve 90% power for detecting this difference, 185 patients are needed in each group (370 in all). The primary outcome is the proportion of patients with successful first-pass orotracheal intubation, compared between the two groups using a generalised mixed model to take the stratification factors into account. Ethics and dissemination The study project has been approved by the appropriate ethics committee (CPP Ouest 2, # 2014-A00674-43). Informed consent is not required, as both laryngoscopy methods are considered standard care in France; information is provided before study inclusion. If videolaryngoscopy proves superior to Macintosh laryngoscopy, its use will become standard practice, thereby decreasing first-pass intubation failure rates and, potentially, the frequency of intubation

  13. Kinetics of ethanol inhibition in alcohol fermentation.

    PubMed

    Luong, J H

    1985-03-01

    The inhibitory effect of ethanol on yeast growth and fermentation has been studied for the strain Saccharomyces cerevisiae ATCC No. 4126 under anaerobic batch conditions. The results obtained reveal that there is no striking difference between the response of growth and ethanol fermentation. Two kinetic models are also proposed to describe the kinetic pattern of ethanol inhibition on the specific rates of growth and ethanol fermentation: microi/micro0 = 1 - (P/Pm)alpha (for growth) nui/nu0 = 1 - (P/P'm)beta (for ethanol production). The maximum allowable ethanol concentration above which cells do not grow was predicted to be 112 g/L. The ethanol-producing capability of the cells was completely inhibited at 115 g/L ethanol. The proposed models appear to accurately represent the experimental data obtained in this study and the literature data.

  14. A Quantitative Gas Chromatographic Ethanol Determination.

    ERIC Educational Resources Information Center

    Leary, James J.

    1983-01-01

    Describes a gas chromatographic experiment for the quantitative determination of volume percent ethanol in water ethanol solutions. Background information, procedures, and typical results are included. Accuracy and precision of results are both on the order of two percent. (JN)

  15. Prenatal ethanol exposure leads to greater ethanol-induced appetitive reinforcement.

    PubMed

    Pautassi, Ricardo M; Nizhnikov, Michael E; Spear, Norman E; Molina, Juan C

    2012-09-01

    Prenatal ethanol significantly heightens later alcohol consumption, but the mechanisms that underlie this phenomenon are poorly understood. Little is known about the basis of 'this effect of prenatal ethanol on the sensitivity to ethanol's reinforcing effects. One possibility is that prenatal ethanol exposure makes subjects more sensitive to the appetitive effects of ethanol or less sensitive to ethanol's aversive consequences. The present study assessed ethanol-induced second-order conditioned place preference (CPP) and aversion and ethanol-induced conditioned taste aversion (CTA) in infant rats prenatally exposed to ethanol (2.0 g/kg) or vehicle (water) or left untreated. The involvement of the κ opioid receptor system in ethanol-induced CTA was also explored. When place conditioning occurred during the ascending limb of the blood-ethanol curve (Experiment 1), the pups exposed to ethanol in utero exhibited greater CPP than untreated controls, with a shift to the right of the dose-response curve. Conditioning during a later phase of intoxication (30-45 min post-administration; Experiment 2) resulted in place aversion in control pups exposed to vehicle during late gestation but not in pups that were exposed to ethanol in utero. Ethanol induced a reliable and similar CTA (Experiment 3) in the pups treated with vehicle or ethanol during gestation, and CTA was insensitive to κ antagonism. These results suggest that brief exposure to a moderate ethanol dose during late gestation promotes ethanol-mediated reinforcement and alters the expression of conditioned aversion by ethanol. This shift in the motivational reactivity to ethanol may be an underlying basis of the effect of prenatal ethanol on later ethanol acceptance.

  16. Re-engineering bacteria for ethanol production

    DOEpatents

    Yomano, Lorraine P; York, Sean W; Zhou, Shengde; Shanmugam, Keelnatham; Ingram, Lonnie O

    2014-05-06

    The invention provides recombinant bacteria, which comprise a full complement of heterologous ethanol production genes. Expression of the full complement of heterologous ethanol production genes causes the recombinant bacteria to produce ethanol as the primary fermentation product when grown in mineral salts medium, without the addition of complex nutrients. Methods for producing the recombinant bacteria and methods for producing ethanol using the recombinant bacteria are also disclosed.

  17. Cytokine and chemokine expression associated with steatohepatitis and hepatocyte proliferation in rats fed ethanol via total enteral nutrition.

    PubMed

    Ronis, Martin J J; Butura, Angelica; Korourian, Soheila; Shankar, Kartik; Simpson, Pippa; Badeaux, Jamie; Albano, Emanuele; Ingelman-Sundberg, Magnus; Badger, Thomas M

    2008-03-01

    To determine the temporal relationship between alcohol-induced changes in cytokines and chemokines, development of liver pathology and stimulation of hepatocyte proliferation, male Sprague-Dawley rats were intragastrically fed low carbohydrate-containing ethanol (EtOH) diets via total enteral nutrition (TEN) for up to 49 d. Induction of EtOH metabolism and appearance of steatosis preceded development of oxidative stress, inflammation, and cell death. A transitory peak of tumor necrosis factor (TNFalpha) and interferon gamma (IFN gamma) was observed at 14 d followed by reduced expression of TNFalpha, IFN gamma and another Th1 cytokine IL-12 accompanied by reduced expression of the Th1 regulators T-bet and STAT4. After 35-49 d of EtOH, at a time when hepatocyte proliferation was stimulated, IL-12 returned to control values and a second peak of TNFalpha occurred. The Th2 cytokine IL-4 remained suppressed throughout the study and was accompanied by reductions in the Th2 regulator GATA3. There was no temporal effect of EtOH on expression of IL-6 or TGFbeta. IL-5 and IL-13 mRNA were undetectable. Chemokine CXCL-2 expression increased progressively up to 35 d and preceded the appearance of inflammatory infiltrates. These data suggest that steatosis, increased ethanol metabolism, a transient induction of the innate immune response and suppression of Th2 responses were acute consequences of ethanol treatment and were followed by suppression of Th1 responses. However, the majority of necrosis, apoptosis and a late peak of TNFalpha only occurred after 6-7 weeks of ethanol, coincided with the appearance of inflammatory infiltrates and were associated with stimulation of hepatocyte proliferation.

  18. Chronic intermittent ethanol exposure during adolescence: Effects on stress-induced social alterations and social drinking in adulthood.

    PubMed

    Varlinskaya, Elena I; Kim, Esther U; Spear, Linda P

    2017-01-01

    We previously observed lasting and sex-specific detrimental consequences of early adolescent intermittent ethanol exposure (AIE), with male, but not female, rats showing social anxiety-like alterations when tested as adults. The present study used Sprague Dawley rats to assess whether social alterations induced by AIE (3.5g/kg, intragastrically, every other day, between postnatal days [P] 25-45) are further exacerbated by stressors later in life. Another aim was to determine whether AIE alone or in combination with stress influenced intake of a sweetened ethanol solution (Experiment 1) or a sweetened solution ("supersac") alone (Experiment 2) under social circumstances. Animals were exposed to restraint on P66-P70 (90min/day) or left nonstressed, with corticosterone (CORT) levels assessed on day 1 and day 5 in Experiment 2. Social anxiety-like behavior emerged after AIE in non-stressed males, but not females, whereas stress-induced social anxiety was evident only in water-exposed males and females. Adult-typical habituation of the CORT response to repeated restraint was not evident in adult animals after AIE, a lack of habituation reminiscent of that normally evident in adolescents. Neither AIE nor stress affected ethanol intake under social circumstances, although AIE and restraint independently increased adolescent-typical play fighting in males during social drinking. Among males, the combination of AIE and restraint suppressed "supersac" intake; this index of depression-like behavior was not seen in females. The results provide experimental evidence associating adolescent alcohol exposure, later stress, anxiety, and depression, with young adolescent males being particularly vulnerable to long-lasting adverse effects of repeated ethanol. This article is part of a Special Issue entitled SI: Adolescent plasticity.

  19. Involvement of cyclooxygenase-1 and cyclooxygenase-2 activity in the therapeutic effect of ghrelin in the course of ethanol-induced gastric ulcers in rats.

    PubMed

    Warzecha, Z; Ceranowicz, P; Dembinski, M; Cieszkowski, J; Ginter, G; Ptak-Belowska, A; Dembinski, A

    2014-02-01

    Previous studies have shown that treatment with ghrelin exhibits protective and therapeutic effects in the gut. Aim of our present investigation was to examine the influence of ghrelin administration on the healing of ethanol-induced gastric ulcers and determine the role of cyclooxygenase-1 and cyclooxygenase-2 in this effect. Our studies were performed on male Wistar rats. Gastric ulcers were induced by intragastric administration of 75% ethanol. Ghrelin alone or in combination with cyclooxygenase inhibitors was administered twice, 1 and 13 hours after ethanol application. Cyclooxygenase-1 (COX-1) inhibitor (SC-560, 10 mg/kg/dose) or COX-2 inhibitor (celecoxib, 10 mg/kg/dose) were given 30 min prior to ghrelin. Twelve or 24 hours after administration of ethanol, rats were anesthetized and experiments were terminated. The study revealed that administration of ethanol induced gastric ulcers in all animals and this effect was accompanied by the reduction in gastric blood flow and mucosal DNA synthesis. Moreover induction of gastric ulcer by ethanol significantly increased mucosal expression of mRNA for COX-2, IL-1β and TNF-α. Treatment with ghrelin significantly accelerated gastric ulcer healing. Therapeutic effect of ghrelin was associated with significant reversion of the ulcer-evoked decrease in mucosal blood flow and DNA synthesis. Ghrelin administration also caused the reduction in mucosal expression of mRNA for IL-1β and TNF-α. Addition of SC-560 slightly reduced the therapeutic effect of ghrelin in the healing of ethanol-induced ulcer and the ulcer area in rats treated SC-560 plus ghrelin was significantly smaller than that observed in rats treated with saline or SC-560 alone. Pretreatment with celecoxib, a COX-2 inhibitor, abolished therapeutic effect of ghrelin. We concluded that treatment with ghrelin increases healing rate of gastric ulcers evoked by ethanol and this effect is related to improvement in mucosal blood flow, an increase in mucosal cell

  20. Mechanisms of Ethanol Tolerance in Saccharomyces cerevisiae

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Saccharomyces cerevisiae is a superb ethanol producer, yet is also sensitive to higher ethanol concentrations especially under high gravity or very high gravity fermentation conditions. Ethanol tolerance is associated with interplay of complex networks at the genome level. Although significant eff...

  1. Advanced Biorefineries for Production of Fuel Ethanol

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This review, "Advanced biorefineries for production of fuel ethanol," is a chapter in the Wiley book entitled Biomass to Biofuels: Strategies for Global Industries and is intended to cover all major ethanol production processes to date. The chapter discusses current fuel ethanol production processe...

  2. THE ONTOGENY OF ETHANOL AVERSION

    PubMed Central

    Saalfield, Jessica; Spear, Linda

    2016-01-01

    Recent work has suggested separate developmental periods within the broader framework of adolescence, with data suggesting distinct alterations and vulnerabilities within these intervals. While previous research has suggested reduced sensitivity to the aversive effects of alcohol in adolescence relative to adults, a more detailed ontogeny of this effect has yet to be conducted. The adolescent brain undergoes significant transitions throughout adolescence, including in regions linked with drug reward and aversion. The current study aimed to determine the ontogeny of ethanol aversion by utilizing a conditioned taste aversion procedure at six different ages to test the hypothesis that the transitions into, through, and out of adolescence are associated with ontogenetic alterations in sensitivity to the aversive properties of ethanol. Non-deprived animals given Boost® as the conditioned stimulus (CS) were used in Experiment 1, whereas Experiment 2 used water-restricted animals provided with a saccharin/sucrose solution as the CS. In both experiments, an attenuated sensitivity to the aversive properties of ethanol was evident in adolescents compared to adults, although more age differences were apparent in water deprived animals than when a highly palatable CS was given to ad libitum animals. Overall, the data suggest an attenuated sensitivity to the aversive properties of ethanol that is most pronounced during pre- and early adolescence, declining thereafter to reach the enhanced aversive sensitivity of adults. PMID:26774181

  3. Ethanol production by recombinant hosts

    DOEpatents

    Ingram, Lonnie O.; Beall, David S.; Burchhardt, Gerhard F. H.; Guimaraes, Walter V.; Ohta, Kazuyoshi; Wood, Brent E.; Shanmugam, Keelnatham T.

    1995-01-01

    Novel plasmids comprising genes which code for the alcohol dehydrogenase and pyruvate decarboxylase are described. Also described are recombinant hosts which have been transformed with genes coding for alcohol dehydrogenase and pyruvate. By virtue of their transformation with these genes, the recombinant hosts are capable of producing significant amounts of ethanol as a fermentation product. Also disclosed are methods for increasing the growth of recombinant hosts and methods for reducing the accumulation of undesirable metabolic products in the growth medium of these hosts. Also disclosed are recombinant host capable of producing significant amounts of ethanol as a fermentation product of oligosaccharides and plasmids comprising genes encoding polysaccharases, in addition to the genes described above which code for the alcohol dehydrogenase and pyruvate decarboxylase. Further, methods are described for producing ethanol from oligomeric feedstock using the recombinant hosts described above. Also provided is a method for enhancing the production of functional proteins in a recombinant host comprising overexpressing an adhB gene in the host. Further provided are process designs for fermenting oligosaccharide-containing biomass to ethanol.

  4. Ethanol production by recombinant hosts

    DOEpatents

    Fowler, David E.; Horton, Philip G.; Ben-Bassat, Arie

    1996-01-01

    Novel plasmids comprising genes which code for the alcohol dehydrogenase and pyruvate decarboxylase are described. Also described are recombinant hosts which have been transformed with genes coding for alcohol dehydrogenase and pyruvate. By virtue of their transformation with these genes, the recombinant hosts are capable of producing significant amounts of ethanol as a fermentation product. Also disclosed are methods for increasing the growth of recombinant hosts and methods for reducing the accumulation of undesirable metabolic products in the growth medium of these hosts. Also disclosed are recombinant host capable of producing significant amounts of ethanol as a fermentation product of oligosaccharides and plasmids comprising genes encoding polysaccharases, in addition to the genes described above which code for the alcohol dehydrogenase and pyruvate decarboxylase. Further, methods are described for producing ethanol from oligomeric feedstock using the recombinant hosts described above. Also provided is a method for enhancing the production of functional proteins in a recombinant host comprising overexpressing an adhB gene in the host. Further provided are process designs for fermenting oligosaccharide-containing biomass to ethanol.

  5. Ethanol production in recombinant hosts

    DOEpatents

    Ingram, Lonnie O'Neal; Barbosa-Alleyne, Maria D.

    2005-02-01

    The subject invention concerns the transformation of Gram-positive bacteria with heterologous genes which confer upon these microbes the ability to produce ethanol as a fermentation product. Specifically exemplified is the transformation of bacteria with genes, obtainable from Zymomonas mobilis, which encode pyruvate decarboxylase and alcohol dehydrogenase.

  6. Binge ethanol intoxication heightens subsequent ethanol intake in adolescent, but not adult, rats.

    PubMed

    Fabio, María Carolina; Nizhnikov, Michael E; Spear, Norman E; Pautassi, Ricardo Marcos

    2014-04-01

    A question still to be answered is whether ethanol initiation has a greater effect on ethanol consumption if it occurs during adolescence than in adulthood. This study assessed the effect of ethanol initiation during adolescence or adulthood on voluntary ethanol consumption when animals were still within the same age range. Adolescent or adult rats were given 5, 2, or 0 ethanol exposures. The animals were tested for ethanol consumption through two-bottle choice tests, before undergoing a 1-week deprivation. A two-bottle assessment was conducted after the deprivation. Adolescents, but not adults, given two ethanol administrations during initiation exhibited significantly higher ethanol intake during the pre-deprivation period. These adolescents also exhibited a threefold increase in ethanol intake after 7 days of drug withdrawal, when compared with controls. These findings suggest that very brief experience with binge ethanol intoxication in adolescence, but not in adulthood, impacts later predisposition to drink.

  7. User preference comparing a conventional videolaryngoscope blade vs. a novel suction videolaryngoscope blade in simulated hemorrhagic airway intubation.

    PubMed

    Boedeker, Ben H; Bernhagen, Mary; Miller, David J; Murray, W Bosseau

    2012-01-01

    The hemorrhagic airway makes visualization during laryngoscopy and intubation difficult. A specially designed videolaryngoscope blade with integrated suction was developed and studied in a simulated hemorrhagic airway at the Omaha VA Medical Center. Results show that, if available, many users would choose to include this new suction device in their standard airway carts due to its "always there" design.

  8. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience

    PubMed Central

    Banerjee, Praveer K; Jain, Abhineet; Behera, Bikram

    2016-01-01

    Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist. PMID:27601740

  9. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices.

    PubMed

    Arslan, Z I; Yildiz, T; Baykara, Z N; Solak, M; Toker, K

    2009-12-01

    The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 microg kg(-1) fentanyl, 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p < 0.001). The mean (SD) time taken for tracheal intubation was also shorter with the Airtraq than the CTrach (25.6 (13.5) and 66.3 (29.3)s, respectively; p < 0.001). There was less mucosal damage in the Airtraq group (p = 0.008). Our findings demonstrate that use of the Airtraq device shortened the tracheal intubation time and reduced the mucosal damage when compared with the CTrach in patients who require cervical spine immobilisation.

  10. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail.

    PubMed

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured.

  11. Ethanol fermentation using novel techniques

    SciTech Connect

    Kim, K.

    1984-01-01

    Potato starch, sweet potato, and Jerusalem artichoke were hydrolyzed using high pressure extrusion and/or acid and the hydrolysates were utilized as substrates for ethanol fermentation. The first extrusion at 13,000 to 40,000 psi did not completely hydrolyze the starch solution to fermentable sugar. At elevated temperatures (79-97/sup 0/C) and in the presence of HCl, the high pressure extrusion (13,000 psi) effectively hydrolyzed starch into fermentable sugars to yield 12.1, 22.4, and 30.5 dextrose equivalent (DE) in 1, 2, and 3 N HCl, respectively. Maximal reducing sugar value of 84.2 DE and 0.056% hydroxymethylfurfural (HMF) was achieved after heating 8% sweet potato slurry (SPS) in 1 N HCl at 110/sup 0/C for 15 min. The degraded SPS was then fermented at 37/sup 0/C using an alcohol-tolerant strain of Saccharomyces cerevisiae to give 41.6 g of 200 proof ethanol from 400 g fresh Georgia Red Sweet potato tuber. A maximal reducing sugar value of 83.5 fructose equivalent and 0.004% HMF was formed from Jerusalem artichoke slurry (JAS) containing 8% total solid following heating in 0.1 N HCl at 97/sup 0/C for 10 min. The degraded JAS was then fermented at 37 C and 29.1 g 200 proof ethanol was produced from 320 g fresh tuber of Jerusalem artichoke. Continuous ethanol fermentation was successfully achieved using a bioreactor where cells were immobilized onto inorganic, channeled porous alumina beads. A maximum productivity (27.0/g ethanol/l.h) was achieved with the bioreactor at 35 C using malt yeast extract broth containing 10% glucose as the feedstock. The immobilized cell system showed good operational and storage stability, and could be stored for more than five months without loss of productivities.

  12. Adaptation of yeast cell membranes to ethanol

    SciTech Connect

    Jimenez, J.; Benitez, T.

    1987-05-01

    A highly ethanol-tolerant Saccharomyces wine strain is able, after growth in the presence of ethanol, to efficiently improve the ethanol tolerance of its membrane. A less-tolerant Saccharomyces laboratory strain, however, is unable to adapt its membrane to ethanol. Furthermore, after growth in the presence of ethanol, the membrane of the latter strain becomes increasingly sensitive, although this is a reversible process. Reversion to a higher tolerance occurs only after the addition of an energy source and does not take place in the presence of cycloheximide.

  13. Autophagy in ethanol-exposed liver disease.

    PubMed

    Wang, Li-Ren; Zhu, Gui-Qi; Shi, Ke-Qing; Braddock, Martin; Zheng, Ming-Hua

    2015-01-01

    Ethanol metabolism in hepatocytes causes the generation of reactive oxygen species, endoplasmic reticulum stress and alterations in mitochondrial energy and REDOX metabolism. In ethanol-exposed liver disease, autophagy not only acts as a cleanser to remove damaged organelles and cytosolic components, but also selectively clears specific targets such as lipid droplets and damaged mitochondria. Moreover, ethanol appears to play a role in protecting hepatocytes from apoptosis at certain concentrations. This article describes the evidence, function and potential mechanism of autophagy in ethanol-exposed liver disease and the controversy surrounding the effects of ethanol on autophagy.

  14. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

    PubMed Central

    Ramkumar, Venkateswaran; Dinesh, Ekambaram; Shetty, Sumalatha Radhakrishna; Shah, Amit; Kundra, Pankaj; Das, Sabyasachi; Myatra, Sheila Nainan; Ahmed, Syed Moied; Divatia, Jigeeshu Vasishtha; Patwa, Apeksh; Garg, Rakesh; Raveendra, Ubaradka S; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu

    2016-01-01

    The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs. PMID:28003691

  15. The optimal exhaled concentration of sevoflurane for intubation without neuromuscular blockade using clinical bolus doses of remifentanil

    PubMed Central

    Goo, Eui-Kyoung; Lee, Jong Seok; Koh, Jae Chul

    2017-01-01

    Abstract Background: The aim of this study was to investigate the optimal exhaled sevoflurane concentration that produces adequate endotracheal intubation conditions when sevoflurane is combined with the different bolus doses of remifentanil used in clinical practice. Methods: The patients were randomized to 3 groups (groups 1.0, 1.5, and 2.0), receiving remifentanil bolus doses of 1.0, 1.5, and 2.0 μg/kg, respectively. For each group, the concentration of sevoflurane used for each consecutive patient was increased or decreased using the “up-and-down” method based on the success or failure to achieve adequate conditions for intubation in the previous patient. The remifentanil bolus dose was administered 90 s before intubation and after the target sevoflurane concentration was achieved. Results: In groups 1.0, 1.5, and 2.0, the effective concentration in 50% (EC50) of the sevoflurane concentration required to perform successful intubation was 3.0, 2.0, and 1.29 vol% and the effective concentration in 95% was 3.45, 2.91, and 1.89 vol%, respectively. When sevoflurane was administered for the induction, the increase in heart rate (HR) of group 1.0 was the highest among the groups. The highest number of adverse events occurred in group 2.0, including vocal cord rigidity, hypotension, and bradycardia. Discussion: The EC50 of the sevoflurane concentration was 3.0, 2.0, and 1.29 vol% when it was combined with a bolus dose of remifentanil of 1.0, 1.5, and 2.0 μg/kg, respectively. Of the 3 different bolus doses of remifentanil, the dose of 1.5 μg/kg was least associated with changes in the HR/mean blood pressure during intubation without increasing adverse effects. PMID:28248887

  16. Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study

    PubMed Central

    Said, Tarek; Chaari, Anis; Hakim, Karim Abdel; Hamama, Dalia; Casey, William Francis

    2016-01-01

    Objective: To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS). Patients and Methods: All intubated critically ill patients with a disturbed level of consciousness were assessed using both the FOUR score and the GCS. The FOUR score and the GCS were compared regarding their predictive value for successful extubation at 14 days after intubation as a primary outcome measure. The 28-day mortality and the neurological outcome at 3 months were used as secondary outcome measures. Results: Eighty-six patients were included in the study. Median age was 63 (50–77) years. Sex–ratio (M/F) was 1.46. On admission, median GCS was 7 (3–10) while median FOUR score was 8.5 (2.3–11). A GCS ≤ 7 predicted the extubation failure at 14 days after intubation with a sensitivity of 88.5% and specificity of 68.3%, whereas a FOUR score <10 predicted the same outcome with a sensitivity of 80.8% and a specificity of 81.7%. The areas under the curves was significantly higher with the FOUR score than with GCS (respectively 0.867 confidence interval [CI]: 95% [0790–0.944] and 0.832 CI: 95% [0.741–0.923]; P = 0.014). When calculated before extubation, FOUR score <12 predicted extubation failure with a sensitivity of 92.3% and a specificity of 85%, whereas a GCS <12 predicted the same outcome with a sensitivity of 73% and a specificity of 61.7%. Both scores had similar accuracy for predicting 28-day mortality and neurological outcome at 3 months. Conclusion: The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients. PMID:28149821

  17. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: A comparison between two doses

    PubMed Central

    Sebastian, Bon; Talikoti, Anand T; Krishnamurthy, Dinesh

    2017-01-01

    Background and Aims: Laryngoscopic manipulation and endotracheal intubation are noxious stimuli capable of producing tachycardia, arrhythmias and hypertension. The aim of this study was to arrive at an optimal dose of dexmedetomidine by comparing two doses with placebo to attenuate stress response during laryngoscopy and endotracheal intubation. Methods: It was a randomised, prospective, double-blind placebo-controlled study. After Institutional Ethical Committee clearance, ninety patients of American Society of Anesthesiologists Physical Status 1 were enrolled in the study and divided into three equal groups. Group A received normal saline, Group B received injection dexmedetomidine 0.5 μg/kg and Group C received injection dexmedetomidine 0.75 μg/kg as infusion over 10 min. The general anaesthesia technique was standardised for all three groups. The primary outcome measures were haemodynamic response at 1, 3 and 5 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 15. Results: Groups were well matched for their demographic data. There was a statistically significant difference (P < 0.05) between dexmedetomidine and normal saline in heart rate, systolic, diastolic and mean arterial pressures at all time points after tracheal intubation with dexmedetomidine 0.75 μg/kg being most effective. Sedation scores were more with dexmedetomidine. None of the patients had any adverse effects such as hypotension, bradycardia, respiratory depression and fall in oxygen saturation. Conclusion: Dexmedetomidine in a dose of 0.75 μg/kg intravenous is the optimal dose to attenuate stress response to laryngoscopy and endotracheal intubation. PMID:28216704

  18. Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

    PubMed Central

    Pournajafian, Alireza; Rokhtabnak, Faranak; Kholdbarin, Alireza; Ghodrati, Mohammadreza; Ghavam, Siamak

    2012-01-01

    Background Intravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except for special cases such as preeclampsia, these drugs are not recommended for parturants candidate for cesarean section because of the respiratory depression caused in the newborn. Objectives According to rapid metabolism of remifentanil, the current study aimed to compare hemodynamic changes in preeclamptic parturants who received remifentanil and fentanyl for cesarean section under general anesthesia. Patients and Methods This single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 μg/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 μg) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index were measured and compared between the two groups. Results All hemodynamic variables increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771). Conclusions It can be postulated that remifentanil can be used in partituents candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn. PMID:24223345

  19. Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients

    PubMed Central

    Rajan, Sunil; Surendran, Jayasankar; Paul, Jerry; Kumar, Lakshmi

    2017-01-01

    Background and Aims: Obese individuals are predisposed to difficult airway and intubation. They usually yield confusing or misleading auscultatory findings. We aimed to assess the rapidity and efficacy of ultrasonographic (USG) sliding lung sign for confirming endotracheal intubation in normal as well as overweight and obese surgical patients. Methods: This prospective, observational study was performed in forty surgical patients. Twenty patients with body mass index (BMI) <25 were recruited to Group A, whereas twenty patients with BMI ≥25 constituted Group B. Following induction and intubation, appearance of end-tidal carbon dioxide waveform was used to confirm endotracheal intubation. Presence of breath sounds bilaterally was sought by auscultation, and time taken for auscultatory confirmation was noted. The USG confirmation of air entry to the lung field as indicated by lung sliding was sought, and the time taken was noted. Chi-square test, independent t-test and paired t-test were used as applicable. Results: Auscultatory confirmation was more rapid in Group A as compared to Group B (9.34 ± 2.43 s vs. 14.35 ± 5.53 s, P = 0.001). However, there was no significant difference in USG confirmation time in both the groups (8.57 ± 2.05 s vs. 8.61 ± 1.66 s). Four patients in Group B had doubtful breath sounds against none in Group A. There was no doubtful lung slide with USG in both groups. One case of endobronchial intubation in Group B was diagnosed with USG which was doubtful by auscultation. Conclusion: Ultrasound directed confirmation of endotracheal tube placement in overweight and obese patients is superior in speed and accuracy in comparison to the standard auscultatory method.

  20. Randomised controlled trial comparing the Ambu® aScope™2 with a conventional fibreoptic bronchoscope in orotracheal intubation of anaesthetised adult patients.

    PubMed

    Chan, J K; Ng, I; Ang, J P; Koh, S M; Lee, K; Mezzavia, P; Morris, J; Loh, F; Segal, R

    2015-07-01

    Fibreoptic intubation remains an essential skill for anaesthetists to master. In addition to the reusable fibrescope, an alternative disposable videoscope is available (aScope(™)2, Ambu®, Ballerup, Denmark). A total of 60 anaesthetised adult patients were randomised to either having orotracheal intubation using the aScope 2 or a Karl Storz fibrescope. Intubations were performed by experienced operators who were familiar with both devices. The primary outcome was the Global Rating Scale score. Secondary outcomes included intubation success, number of intubation attempts and intubation time. Other subjective outcomes including practicality, useability and image quality were also recorded. There was no significant difference in the Global Rating Scale score, intubation success orintubation time between the aScope 2 or Karl Storz fibrescope. Global Rating Scale scores were three and two in the aScope 2 and Karl Storz groups respectively (P=0.14). All of the other subjective outcomes were similar between the two groups, except that operators found it easier to use the aScope 2 compared to the fibrescope. There was no significant difference in clinical performance between the aScope 2 and the Karl Storz fibreoptic bronchoscope. The aScope's practicality, disposability and recently improved version (aScope(™)3) potentially make it an acceptable alternative to the reusable fibrescope.

  1. Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).

    PubMed

    Radesic, Brian P; Winkelman, Chris; Einsporn, Richard; Kless, Jack

    2012-10-01

    Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

  2. Adherence of Pseudomonas aeruginosa to tracheal cells injured by influenza infection or by endotracheal intubation.

    PubMed

    Ramphal, R; Small, P M; Shands, J W; Fischlschweiger, W; Small, P A

    1980-02-01

    Adherence of Pseudomonas aeruginosa to normal, injured, and regenerating tracheal mucosa was examined by scanning electron microscopy. Uninfected and influenza-infected murine tracheas were exposed to six strains of P. aeruginosa isolated from human sources and one strain of platn origin. All of the strains tested adhered to desquamating cells of the infected tracheas, but not to normal mucosa, the basal cell layer, or the regenerating epithelium. Adherence increased when the incubation time of the bacteria with the trachea was prolonged. Strains isolated from human tracheas appeared to adhere better than strains derived from the urinary tract. After endotracheal intubation of ferrets, P. aeruginosa adhered only to the injured cells and to areas of exposed basement membrane. We call this phenomenon "opportunistic adherence" and propose that alteration of the cell surfaces or cell injury facilitates the adherence of this bacterium and that adherence to injured cells may be a key to the pathogenesis of opportunistic Pseudomonas infections.

  3. An alternative method of endotracheal intubation of common marmosets (Callithrix jacchus).

    PubMed

    Thomas, A A; Leach, M C; Flecknell, P A

    2012-01-01

    Endotracheal intubation was carried out in 11 common marmosets (Callithrix jacchus). A commercially available tilting stand and a Miller laryngoscope blade were used to visualize the larynx. Anaesthesia was induced with alphaxalone (10.6 ± 1.6 mg/kg intramuscularly, followed by 3.2 ± 1.2 mg/kg intravenously). The diameter of the proximal trachea easily fitted an endotracheal tube made from readily available material (a 12 G 'over the needle' catheter). Once the tip of the endotracheal tube was at the level of the vocal folds, the tube had to be gently rotated through a 180° angle in order to pass through the larynx into the trachea. Assessment of the dimensions of the larynx and trachea, and comparison with external anatomical features of the animals (n = 10) showed that the length of the trachea could be predicted by multiplying the craniosacral length of the marmoset by a factor of 0.42.

  4. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation.

    PubMed

    Fowler, Robert A; Guest, Cameron B; Lapinsky, Stephen E; Sibbald, William J; Louie, Marie; Tang, Patrick; Simor, Andrew E; Stewart, Thomas E

    2004-06-01

    Nosocomial transmission of severe acute respiratory syndrome from critically ill patients to healthcare workers has been a prominent and worrisome feature of existing outbreaks. We have observed a greater risk of developing severe acute respiratory syndrome for physicians and nurses performing endotracheal intubation (relative risk [RR], 13.29; 95% confidence interval [CI], 2.99 to 59.04; p = 0.003). Nurses caring for patients receiving noninvasive positive-pressure ventilation may be at an increased risk (RR, 2.33; 95% CI, 0.25 to 21.76; p = 0.5), whereas nurses caring for patients receiving high-frequency oscillatory ventilation do not appear at an increased risk (RR, 0.74; 95% CI, 0.11 to 4.92; p = 0.6) compared with their respective reference cohorts. Specific infection control recommendations concerning the care of critically ill patients may help limit further nosocomial transmission.

  5. Transport and degradation of ethanol in groundwater

    NASA Astrophysics Data System (ADS)

    Zhang, Yi; Khan, Imtiyaz A.; Chen, Xun-Hong; Spalding, Roy F.

    2006-01-01

    Ethanol is rapidly replacing methyl tert-butyl ether (M tBE), the primary fuel oxygenate in the US, and ethanol releases from spills and leaky underground storage tanks (LUSTs) are anticipated. Ethanol has received little attention as a potential groundwater contaminant. This study investigates the fate and transport of ethanol under transient conditions in a sand and gravel aquifer. A pulse containing approximately 220 mg L - 1 ethanol and 16 mg L - 1 bromide was injected into the shallow sand and gravel aquifer and monitored to estimate its persistence and transport. The plume was monitored for 2.5 months using downgradient multilevel samplers (MLSs). Values for ethanol retardation were measured from ethanol and bromide breakthrough data and compared to estimates using published Koc values for low carbon aquifer sediments ( foc = 10 μg C g - 1 sediment). Ethanol transport was not retarded ( R = 0.99). A 3-dimensional model reasonably simulated bromide and ethanol breakthrough curves. An average first-order decay constant was estimated to be 0.32 d - 1 ( t1 / 2 = 2.2 d). At the second fence, 75% of the injected bromide and less than 3% of ethanol remained in the plume. Monitored terminal electron acceptor concentrations demonstrated that the majority of the ethanol was transformed by anaerobic processes other than denitrification and sulfate reduction.

  6. Transport and degradation of ethanol in groundwater.

    PubMed

    Zhang, Yi; Khan, Imtiyaz A; Chen, Xun-Hong; Spalding, Roy F

    2006-01-10

    Ethanol is rapidly replacing methyl tert-butyl ether (MtBE), the primary fuel oxygenate in the US, and ethanol releases from spills and leaky underground storage tanks (LUSTs) are anticipated. Ethanol has received little attention as a potential groundwater contaminant. This study investigates the fate and transport of ethanol under transient conditions in a sand and gravel aquifer. A pulse containing approximately 220 mg L-1 ethanol and 16 mg L-1 bromide was injected into the shallow sand and gravel aquifer and monitored to estimate its persistence and transport. The plume was monitored for 2.5 months using downgradient multilevel samplers (MLSs). Values for ethanol retardation were measured from ethanol and bromide breakthrough data and compared to estimates using published Koc values for low carbon aquifer sediments (foc=10 microg C g-1 sediment). Ethanol transport was not retarded (R=0.99). A 3-dimensional model reasonably simulated bromide and ethanol breakthrough curves. An average first-order decay constant was estimated to be 0.32 d-1 (t1/2=2.2 d). At the second fence, 75% of the injected bromide and less than 3% of ethanol remained in the plume. Monitored terminal electron acceptor concentrations demonstrated that the majority of the ethanol was transformed by anaerobic processes other than denitrification and sulfate reduction.

  7. PRENATAL ETHANOL EXPOSURE LEADS TO GREATER ETHANOL-INDUCED APPETITIVE REINFORCEMENT

    PubMed Central

    Pautassi, Ricardo M.; Nizhnikov, Michael E.; Spear, Norman E.; Molina, Juan C.

    2012-01-01

    Prenatal ethanol significantly heightens later alcohol consumption, but the mechanisms that underlie this phenomenon are poorly understood. Little is known about the basis of this effect of prenatal ethanol on the sensitivity to ethanol’s reinforcing effects. One possibility is that prenatal ethanol exposure makes subjects more sensitive to the appetitive effects of ethanol or less sensitive to ethanol’s aversive consequences. The present study assessed ethanol-induced second-order conditioned place preference (CPP) and aversion and ethanol-induced conditioned taste aversion (CTA) in infant rats prenatally exposed to ethanol (2.0 g/kg) or vehicle (water) or left untreated. The involvement of the κ opioid receptor system in ethanol-induced CTA was also explored. When place conditioning occurred during the ascending limb of the blood-ethanol curve (Experiment 1), the pups exposed to ethanol in utero exhibited greater CPP than untreated controls, with a shift to the right of the dose-response curve. Conditioning during a later phase of intoxication (30–45 min post-administration; Experiment 2) resulted in place aversion in control pups exposed to vehicle during late gestation but not in pups that were exposed to ethanol in utero. Ethanol induced a reliable and similar CTA (Experiment 3) in the pups treated with vehicle or ethanol during gestation, and CTA was insensitive to κ antagonism. These results suggest that brief exposure to a moderate ethanol dose during late gestation promotes ethanol-mediated reinforcement and alters the expression of conditioned aversion by ethanol. This shift in the motivational reactivity to ethanol may be an underlying basis of the effect of prenatal ethanol on later ethanol acceptance. PMID:22698870

  8. Can intravenous acetaminophen reduce the needs to more opioids to control pain in intubated patients?

    PubMed Central

    Mahshidfar, Babak; Sameti, Azadeh; Abbasi, Saeed; Farsi, Davood; Mofidi, Mani; Hafezimoghadam, Peyman; Rahimzadeh, Popak; Rezai, Mahdi

    2016-01-01

    Aims: To evaluate the effect of intravenous (IV) acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU). Settings and Design: Current study was done as a clinical trial on the patients supported by mechanical ventilator. Subjects and Methods: Behavioral pain scale (BPS) scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1st and 3rd days of admission and placebo during the 2nd and 4th days. Total dose of morphine sulfate needed, its complications, and the BPS scores at the end of every 6 h interval were compared. Results: Totally forty patients were enrolled. The mean pain scores were significantly lower in the 2nd and 4th days (4.33 and 3.66, respectively; mean: 4.0) in which the patients had received just morphine sulfate compared to the 1st and 3rd days (7.36 and 3.93, respectively; mean: 5.65) in which the patients had received acetaminophen in addition to morphine sulfate too (P < 0.001). Cumulative dose of morphine sulfate used, was significantly higher in the 1st and 3rd days (8.92 and 3.15 mg, respectively; 12.07 mg in total) compared to the 2nd and 4th days (6.47 mg and 3.22 mg, respectively; 9.7 mg in total) (P = 0.035). Conclusion: In our study, IV acetaminophen had no effect on decreasing the BPSs and need of morphine sulfate in intubated patients admitted to ICU. PMID:27630458

  9. Nasolacrimal recanalization as an alternative to external dacryocystorhinostomy for treating failed nasolacrimal duct intubation.

    PubMed

    Hong, Jiaxu; Qian, Tingting; Wei, Anji; Sun, Zhongmou; Wu, Dan; Chen, Yihe; Marmalidou, Anna; Lu, Yi; Sun, Xinghuai; Liu, Zuguo; Amparo, Francisco; Xu, Jianjiang

    2016-07-01

    To compare the surgical duration and clinical outcomes of nasolacrimal recanalization versus external dacryocystorhinostomy (DCR) in the treatment of failed nasolacrimal duct intubation.This is a retrospective, comparative, and interventional study. We evaluated the outcomes of 66 consecutive patients undergoing either nasolacrimal recanalization (n = 32) or DCR (n = 34) in a tertiary lacrimal disease referral center. Length of surgical duration, clinical outcomes, and rate of recurrence at 18 months postoperatively were compared.The mean surgical duration was 18.5 minutes (range, 15-25 minutes) for nasolacrimal recanalization and 48.2 minutes (range, 45-61 minutes) for DCR, respectively (P < 0.001). The rate of success was 84.4% in the recanalization group and 85.3% in the DCR group, respectively (P = 0.91). The time to recurrence was 2.6 ± 1.1 months in the recanalization group and 5.6 ± 2.1 months in the DCR group (P < 0.001). Five failed cases in each group received a secondary DCR surgery with the same resolution rate (40%). The absence of ocular discharge at baseline was a significant predictor for a successful outcome in the recanalization group (P = 0.04) but not in the DCR group (P = 0.63).Nasolacrimal recanalization is an effective, safe, and time-saving alternative to DCR for the treatment of failed nasolacrimal duct intubation. Clinicians should be cautious in patients with discharge.

  10. [Cuff damage during naso-tracheal intubation for general anesthesia in oral surgery].

    PubMed

    Nakamura, S; Watanabe, T; Hiroi, E; Sasaki, T; Matsumoto, N; Hori, T

    1997-11-01

    In our hospital, twenty-one cases of endotracheal tube cuff rupture during naso-tracheal intubation were noted in cases using 725 polyvinyl chloride (PVC) tracheal tubes. We analysed the causes of cuff troubles in these 21 samples of tubes. When the cuffs were inflated, they were not capable of containing the air in most cases. Some cuffs had small holes (described as pinholes), and the others had longer slits on scrape marks and burst. These scrape marks may have been caused by the object with sharp edges such as spina or crista of the nasal septum, or otherwise by the tip of intubation forceps. The cuff material appeared to be slightly hardened in some samples which may be due to the lubrication. We usually lubricated the tube with lidocaine spray or gel formulation and then sometimes placed it in hot water to soften it for avoiding naso-mucosal injury. It is not generally recommended to place tubes in hot water, as this procedure may soften the cuff and make it more suspectible to damage. The clarification is also needed on the use of lidocaine. Although the gel formulation is acceptable, but the spray formulation is known to react with cuff material and make it more susceptible to inducing blistering, pinholes and sudden rupture of PVC cuffs. We conclude that these cuff damages might have occurred from various causes. A main cause must be passing the tube through the narrow nasal turbinate with spina or crista. Other causes could not only be the use of Magill forceps but also lubrication of the tube with lidocaine spray and placing it in hot water.

  11. Work practices relating to intubation and associated procedures in intensive care units in Sweden.

    PubMed

    Mehta, S; Mickiewicz, M

    1986-11-01

    A survey into the current usage of tracheal tubes and associated procedures, such as various sedation regimes and antacid therapy, in intensive care units was carried out in Sweden by sending a questionnaire to physicians in charge of intensive care units in 70 acute hospitals which included seven main teaching hospitals. The purpose of the survey was to see how far the recent advances in tube and cuff design and awareness of the problems caused by prolonged therapeutic paralysis in intensive care units have influenced the attitudes and work practices of physicians in Sweden. Forty-nine replies were received (a 70% response rate). All hospitals used polyvinyl chloride tubes of Magill design, with high residual volume, low pressure cuffs. Intensive care units in 85.7% of teaching hospitals and 47.6% of non-teaching hospitals preferred the nasal route for intubation. Most non-teaching hospitals used a size 7 tube in both adult male and female patients for nasal intubation. The majority of units changed from tracheal tubes to tracheostomy after a period of 1-2 weeks. 85% of all hospitals monitored intracuff pressure as a routine, and in most intensive care units the cuff was inflated to no-leak ventilation. The majority of units rarely used muscle relaxants. Phenoperidine and diazepam were the most popular drugs used for the sedation technique. 71.4% of teaching hospitals and 40.9% of non-teaching hospitals used antacids routinely in patients on intermittent positive pressure respiration. The results are discussed.

  12. Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

    PubMed

    Efrati, Shai; Deutsch, Israel; Weksler, Nathan; Gurman, Gabriel M

    2015-02-01

    Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.

  13. Daidzin decreases ethanol consumption in rats.

    PubMed

    Heyman, G M; Keung, W M; Vallee, B L

    1996-09-01

    In a previous study, daidzin, a constituent of an ancient Chinese herbal treatment for alcoholism, decreased home-cage ethanol consumption in laboratory Syrian golden hamsters. The present study tested the generality of daidzin's antidipsotropic effects. Rats served as subjects in a two-lever choice procedure. At one lever, responses earned 10% ethanol, flavored with saccharin. At the other lever, responses earned an isocaloric starch solution. Daidzin decreased both ethanol and starch consumption, but the decreases in ethanol intake were larger. Changes in consumption were dose dependent, and differences in ethanol and food consumption increased slightly (but significantly) as dose increased. Daidzin produced a similar pattern of decreases in lever pressing. In baseline, there was an approximately equal distribution of responses between the two levers; at the highest daidzin dose, the relative number of responses at the ethanol lever decreased to 30%. These results replicate and extend earlier findings, and they encourage further research on daidzin's capacity to decrease ethanol consumption.

  14. Properties of ethanol fermentation by Flammulina velutipes.

    PubMed

    Mizuno, Ryoji; Ichinose, Hitomi; Maehara, Tomoko; Takabatake, Koji; Kaneko, Satoshi

    2009-10-01

    Basidiomycetes have the ability to degrade lignocellulosic biomass, and some basidiomycetes produce alcohol dehydrogenase. These characteristics may be useful in the direct production of ethanol from lignocellulose. Ethanol fermentation by basidiomycetes was investigated to examine the possibility of ethanol production by consolidated bioprocessing (CBP) using Flammulina velutipes. F. velutipes converted D-glucose to ethanol with a high efficiency (a theoretical ethanol recovery rate of 88%), but ethanol production from pentose was not observed. These properties of F. velutipes are similar to those of Saccharomyces cerevisiae, but the basidiomycete converted not only sucrose, but also maltose, cellobiose, cellotriose, and cellotetraose to ethanol, with almost the same efficiency as that for D-glucose. From these results, we concluded that F. velutipes possesses advantageous characteristics for use in CBP.

  15. Kinetics of ethanol inhibition in alcohol fermentation

    SciTech Connect

    Luong, J.H.T.

    1985-01-01

    The inhibitory effect of ethanol on yeast growth and fermentation has been studied for the strain Saccharo-myces cerevisiae ATCC No. 4126 under anaerobic batch conditions. The results obtained reveal that there is no striking difference between the response of growth and ethanol fermentation. Two kinetic models are also proposed to describe the kinetic pattern of ethanol inhibition on the specific rates of growth and ethanol fermentation. The maximum allowable ethanol concentration above which cells do not grow was predicted to be 112 g/L. The ethanol-producing capability of the cells was completely inhibited at 115 g/L ethanol. The proposed models appear to accurately represent the experimental data obtained in this study and the literature data.

  16. Does C-MAC® video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries?

    PubMed Central

    Patil, Vinuta V; Subramanya, Bala H; Kiranchand, N; Bhaskar, S Bala; Dammur, Srinivasalu

    2016-01-01

    Background and Aims: C-MAC® video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC® VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC® VL for NTI. Methods: Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8–18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC® VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups. Results: C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1–M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%). Conclusion: The overall performance of C-MAC® VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres. PMID:27761036

  17. Metabolic and pharmacokinetic studies of curcumin, demethoxycurcumin and bisdemethoxycurcumin in mice tumor after intragastric administration of nanoparticle formulations by liquid chromatography coupled with tandem mass spectrometry.

    PubMed

    Li, Rui; Qiao, Xue; Li, Qingyan; He, Rong; Ye, Min; Xiang, Cheng; Lin, Xionghao; Guo, Dean

    2011-09-15

    This paper aims to investigate the metabolism and pharmacokinetics of curcumin, demethoxycurcumin and bisdemethoxycurcumin in mice tumor. To improve water solubility, nanoparticle formulations were prepared as curcuminoids-loaded solid lipid nanoparticles (curcuminoids-SLNs) and curcumin-loaded solid lipid nanoparticles (curcumin-SLNs). After intragastric administration to tumor-bearing ICR mice, the plasma and tumor samples were analyzed by liquid chromatography with ion trap mass spectrometry. We discovered that curcuminoids were mainly present as glucuronides in plasma, whereas in free form in tumor tissue. A validated LC/MS/MS method was established to determine the three free curcuminoids in tumor homogenate. Samples were separated on a Zorbax SB-C(18) column, eluted with acetonitrile-water (containing 0.1% formic acid), and detected by TSQ Quantum triple quadrupole mass spectrometer in selected reaction monitoring mode. The method showed good linearity (r(2)=0.997-0.999) over wide dynamic ranges (2-6000 ng/mL). Variations within- and between-batch never exceeded 11.2% and 13.4%, respectively. The extraction recovery rates ranged from 78.3% to 87.7%. The pharmacokinetics of curcuminoids in mice tumor fit two-compartment model and first order elimination. For curcumin-SLNs group, the dosing of 250 mg/kg of curcumin resulted in AUC((0-48 h)) of 2285 ngh/mL and C(max) of 209 ng/mL. For curcuminoids-SLNs group, the dosing equivalent to 138 mg/kg of curcumin resulted in higher tumor concentrations (AUC=2811 ngh/mL, C(max)=285 ng/mL). It appeared that co-existing curcuminoids improved the bioavailability of curcumin.

  18. Role of CCK1 and Y2 receptors in activation of hindbrain neurons induced by intragastric administration of bitter taste receptor ligands.

    PubMed

    Hao, Shuzhen; Sternini, Catia; Raybould, Helen E

    2008-01-01

    G-protein-coupled receptors signaling bitter taste (T2Rs) in the oral gustatory system and the alpha-subunit of the taste-specific G-protein gustducin are expressed in the gastrointestinal (GI) tract. alpha-Subunit of the taste-specific G-protein gustducin colocalizes with markers of enteroendocrine cells in human and mouse GI mucosa, including peptide YY. Activation of T2Rs increases cholecystokinin (CCK) release from the enteroendocrine cell line, STC-1. The aim of this study was to determine whether T2R agonists in the GI tract activate neurons in the nucleus of the solitary tract (NTS) and whether this activation is mediated by CCK and peptide YY acting at CCK(1) and Y(2) receptors. Immunocytochemistry for the protooncogene c-Fos protein, a marker for neuronal activation, was used to determine activation of neurons in the midregion of the NTS, the region where vagal afferents from the GI tract terminate. Intragastric administration of the T2R agonist denatonium benzoate (DB), or phenylthiocarbamide (PTC), or a combination of T2R agonists significantly increased the number of Fos-positive neurons in the mid-NTS; subdiaphragmatic vagotomy abolished the NTS response to the mixture of T2R agonists. Deletion of CCK(1) receptor gene or blockade of CCK(1) receptors with devazepide abolishes the activation of NTS neurons in response to DB, but had no effect on the response to PTC. Administration of the Y(2) receptor antagonist BIIE0246 blocks the activation of NTS neurons to DB, but not PTC. These findings suggest that activation of neurons in the NTS following administration of T2R agonists to the GI tract involves CCK(1) and Y(2) receptors located on vagal afferent terminals in the gut wall. T2Rs may regulate GI function via release of regulatory peptides and activation of the vagal reflex pathway.

  19. Effect of intraperitoneal and intragastric loading with water and isosmotic solutions of saline and glucose on water intake of dehydrated rats.

    PubMed

    Fregly, M J; Greenleaf, J E; Rowland, N E

    1986-03-01

    Female rats, dehydrated with food available for 24 hr, lost 6 to 8% of body weight. When allowed access to water, 40 to 60% of the weight deficit was replaced within the first hr. Either intraperitoneal (IP) or intragastric (IG) water loads (3% of body weight) administered just prior to return of water inhibited water intake of dehydrated rats nearly completely during the first hr of access to water. In contrast, similar loads of isotonic saline were much less effective. Even when 0.5 and 1.0 hr elapsed between IP loading (3% of body weight) with isotonic saline and access to water, water intake was not significantly different from that of untreated, dehydrated controls. In contrast, a similar IP load of water at these times completely inhibited water intake. Because of the contrasting effects of similar loads of water and isotonic saline on water intake of dehydrated rats, additional studies were carried out with an isosmotic solution of glucose (5%). IG administration (3% of body weight) of glucose inhibited water intake of dehydrated rats. IP administration (3% of body weight) attenuated the drinking response but did not reduce it to the level observed in dehydrated rats given an IP water load. When isosmotic glucose was administered at 0.5, 1.0, and 2.0 hr prior to allowing access to water, water intake was reduced significantly below that of dehydrated controls and to the same extent regardless of time of administration of the glucose load.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Evaluation of intragastric vs intraperitoneal glucose tolerance tests in the evaluation of insulin resistance in a rodent model of burn injury and glucagon-like polypeptide-1 treatment.

    PubMed

    Watada, Susumu; Yu, Yong-Ming; Fischman, Alan J; Kurihara, Tomohiro; Shen, Chuan-An; Tompkins, Ronald G; Fagan, Shawn

    2014-01-01

    Evaluation of glucose tolerance in rodent models is usually performed after intraperitroneal administration of glucose (intraperitoneal glucose tolerance test [IPGTT]), whereas in humans the test is performed with oral glucose. Hyperglycemia is a major clinical manifestation of burn injury. Our previous studies using IPGTT have demonstrated burn injury-induced insulin resistance and the beneficial effects of glucagon-like polypeptide-1 (GLP-1) in improving insulin resistance. The goal of the present study is to compare the results of these two procedures under 1) burn injury-induced insulin resistance and 2) GLP-1 treatment after burn. Male CD rats were divided into three groups: sham burn, burn, and burn with GLP-1. Blood glucose and plasma insulin levels were measured during intragastric glucose tolerance test (IGGTT) on day 6 after 40% of full-thickness burn injury. The results were compared with our previous IPGTT. Blood glucose curves for IGGTT and IPGTT showed a similar pattern. However, IGGTT demonstrated a significant lower level of maximal blood glucose when compared with IPGTT. This was accompanied by higher peak insulin levels in sham burn and burn groups. In contrast, peak insulin levels of each burn with GLP-1 group were similar. 1) Both IPGTT and IGGTT demonstrated burn injury-induced insulin resistance and the efficacy of GLP-1 for reducing hyperglycemia after burn injury. 2) The observed differences in the plasma glucose and insulin levels between IGGTT and IPGTT suggest that endogenously produced GLP-1 during the IGGTT may play a role in ameliorating insulin resistance after burn injury.

  1. Lateral Cervical Spine Radiography to Demonstrate Absence of Bony Displacement After Intubation in a Patient with an Acute Type III Odontoid Fracture.

    PubMed

    Easker, David D; Policeni, Bruno A; Hindman, Bradley J

    2015-07-15

    A 72-year-old patient with an acute traumatic Type III odontoid fracture presented to the operating room for an urgent orthopedic procedure with a history of uncontrolled gastroesophageal reflux, a full stomach, and active vomiting. Rather than fiberoptic intubation, a rapid sequence intubation with manual inline stabilization was performed using a videolaryngoscope. A lateral cervical spine radiograph immediately after intubation showed no change in alignment of the fracture of C1-C2. In the presence of cervical spine instability, a postintubation radiograph provides assurance that the cervical spine is appropriately aligned during subsequent surgery.

  2. Ethanol-mediated operant learning in the infant rat leads to increased ethanol intake during adolescence

    PubMed Central

    Ponce, Luciano Federico; Pautassi, Ricardo Marcos; Spear, Norman E; Molina, Juan Carlos

    2008-01-01

    Recent studies indicate that the infant rat has high affinity for ethanol ingestion and marked sensitivity to the drug’s reinforcing effects (Spear & Molina, 2005). A novel operant technique was developed to analyze reinforcing effects of ethanol delivery during the third postnatal week. The impact of this ethanol-reinforcement experience upon subsequent ethanol consumption during adolescence (postnatal weeks 5–6 was also examined. In Experiment 1, pups (postnatal days 14–17 were given an explicit contingency between nose-poking behavior and intraoral delivery of either water or 3.75% v/v ethanol (paired groups). Yoked controls (pups receiving either reinforcer independently of their behavior) were also included. Paired subjects reinforced with ethanol exhibited rapid and robust operant conditioning leading to blood ethanol concentrations in the 25–48 mg% range. In Experiment 2, a higher ethanol concentration (7.5% v/v) provided significant reinforcement. During adolescence, animals originally reinforced with 3.75% v/v ethanol exhibited greater ingestion of ethanol than control animals without prior ethanol reinforcement. These results indicate that, without extensive initiation to ethanol, infant rats rapidly learn to gain access to ethanol and that this experience has a significant impact upon later ethanol intake patterns. PMID:18571224

  3. Hepatic energy metabolism correlated with pathology score in rats chronically fed ethanol

    SciTech Connect

    Takahasi, H.; Geoffrion, Y.; Butler, K.W.; French, S.W. )

    1989-02-09

    We repeatedly measured in vivo levels of hepatic phosphorylated metabolites in alcohol-fed rats using non-invasive 31P MRS to evaluate their relation to the severity of the pathologic changes of alcoholic liver disease (ALD). Five pairs of Wister rats were pair-fed with a liquid diet plus ethanol or an isocaloric amount of dextrose via an implanted intragastric tube for up to 6 months (mo). For MRS, the rats were sedated, air was provided by a face mask, and the diet was infused to maintain high blood alcohol levels. {sup 31}P MRS spectra were obtained using a CYCLOPS pulse-acquire sequence, 200 scans, and a 2s recycle delay. The inorganic phosphate (Pi)/ATP peak area ratio was found to be consistently higher in the alcohol-fed rats (E) compared to the pair-fed controls (C). The sugar phosphate/ATP ratio tended to be higher in E when compared to C. Cytosolic pH measured by the chemical shift of the Pi peak showed no significant differences between E and C. The monthly liver biopsies from E showed more severe steatosis, necrosis, and fibrosis with time of feeding and the Pi/ATP ratio was positively correlated with the scored histological changes. These results suggest that a low hepatic energetic state is associated with the progression of ALD pathology.

  4. Synthesis of nanoparticles using ethanol

    DOEpatents

    Wang, Jia Xu

    2017-01-24

    The present disclosure relates to methods for producing nanoparticles. The nanoparticles may be made using ethanol as the solvent and the reductant to fabricate noble-metal nanoparticles with a narrow particle size distributions, and to coat a thin metal shell on other metal cores. With or without carbon supports, particle size is controlled by fine-tuning the reduction power of ethanol, by adjusting the temperature, and by adding an alkaline solution during syntheses. The thickness of the added or coated metal shell can be varied easily from sub-monolayer to multiple layers in a seed-mediated growth process. The entire synthesis of designed core-shell catalysts can be completed using metal salts as the precursors with more than 98% yield; and, substantially no cleaning processes are necessary apart from simple rinsing. Accordingly, this method is considered to be a "green" chemistry method.

  5. Ethanol annual report FY 1990

    SciTech Connect

    Texeira, R.H.; Goodman, B.J.

    1991-01-01

    This report summarizes the research progress and accomplishments of the US Department of Energy (DOE) Ethanol from Biomass Program, field managed by the Solar Energy Research Institute, during FY 1990. The report includes an overview of the entire program and summaries of individual research projects. These projects are grouped into the following subject areas: technoeconomic analysis; pretreatment; cellulose conversion; xylose fermentation; and lignin conversion. Individual papers have been indexed separately for inclusion on the data base.

  6. Comparative chronic toxicity and carcinogenicity of acrylonitrile by drinking water and oral intubation to Spartan Sprague-Dawley rats.

    PubMed

    Johannsen, Frederick R; Levinskas, George J

    2002-06-24

    Groups of 100 male and 100 female Spartan Sprague-Dawley rats were administered lifetime oral doses of Acrylonitrile (AN) by one of two routes of dosing, either at 0.1 or 10 mg/kg per day, 7 day per week by intubation or continually at 1 or 100 ppm AN in their drinking water. The doses selected were designed to approximate the same daily intake of AN in each of two separate studies, whether by a single bolus dose (intubation) or a more continuous dosing regimen in drinking water. Each study had its own untreated control group of 100 rats per sex. In the drinking water study, the equivalent mean dosage of AN administered to males and females were 0, 0.09, and 0.15 mg/kg per day, respectively, at the 1 ppm level, and 0, 8.0 and 10.7 mg/kg per day, respectively, for 100 ppm dose groups. In both studies, groups of ten rats per sex were sacrificed at 6, 12 and 18 months and at study term. Ophthalmoscopic, hematological, clinical biochemistry, urinalysis and full histopathological exams were performed on control and high dose groups of rats in each study. Similar tests were done in lower dose groups, as required, to define dose-responses of observed effects. All animals were necropsied and underwent microscopic examination of target tissues, including brain, ear canal, stomach, spinal cord and any observable tissue masses. High dose male and female rats in both studies exhibited statistically decreased body weights. Food consumption and water intake were reduced only in the drinking water study. Due to increased deaths in groups of high dose rats of both studies receiving AN, all intubation test groups were terminated after 20 months of treatment. Surviving males and females in the drinking water study were terminated after 22 and 19 months, respectively. Small, sometimes statistically significant, reductions in hemoglobin, hematocrit and erythrocyte count were observed in male and female rats in both high dose (10 mg/kg per day intubation and 100 ppm drinking water

  7. Intragastric pH Monitoring,

    DTIC Science & Technology

    1993-10-01

    disposable sensor.. hnt Care 13. Peterson WL. GI bleeding. In: Sleisenger MH, Fordtran IS, Med 1988;14:232-5. ,. eds. Gastrointestinal disease: pathophysiology ... diagnosis and 27. Fimmel CL, Etienne A, Cilluffo T, et al. Long-term ambu- management, Vol I. 4th ed. Philadelphia: WB Saunders, latory gastric pH

  8. Ethanol Production from Ulva fasciata

    NASA Astrophysics Data System (ADS)

    Masutani, Evan M.; Yoza, Brandon A.

    The theoretical potential yield of Ulva fasciata as a biomass feedstock for fermentative ethanol was found to be about 310 L per tonne, dry weight. U. fasciata has numerous characteristics that render it a suitable mariculture energy crop. Specifically, it forms large complex structures that grow quickly, with high (14%) dry to wet weight percentages, holocellulose content for the dry mass of 51%, carbohydrate content of 5%, and relatively low (5%) lignin content. Enzymatic saccharification with a commercial cellulase (Accelerase) from Genencor was investigated: After a 12 hr digestion, 25% of the potential glucose was recovered from the cellulose fraction. The hydrolysate was supplemented with a modified YM medium and used directly for batch fermentation. A 12 hr incubation resulted in complete utilization of the glucose and production of ethanol. In this preliminary investigation, the ethanol yield corresponded to approximately 126 L per tonne (dry weight) of macroalga, or 43% of the theoretical alcohol yield with respect to only the cellulose and carbohydrate contents. Theoretical yields are higher when the hemicellulose fraction is considered. While sugar recovery needs further optimization, the data suggest that additional work is warranted.

  9. Chronobiology of ethanol: animal models.

    PubMed

    Rosenwasser, Alan M

    2015-06-01

    Clinical and epidemiological observations have revealed that alcohol abuse and alcoholism are associated with widespread disruptions in sleep and other circadian biological rhythms. As with other psychiatric disorders, animal models have been very useful in efforts to better understand the cause and effect relationships underlying the largel