Bioaccumulation of the antifouling paint booster biocide Irgarol 1051 by the green alga Tetraselmis suecica.
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Chlorophyta↗
Biomedical subjects
R A Dyer
Publications and source records attributed to R A Dyer.
A prospective observational study of the use of the Proseal laryngeal mask airway for postpartum tubal ligation.
BACKGROUND: Though controversial, the risk of pulmonary aspiration during general anaesthesia in the immediate postpartum period appears low. The efficacy of the Proseal laryngeal mask airway was studied prospectively in a group of patients undergoing postpartum tubal ligation. METHODS: The Proseal laryngeal mask airway was employed for airway management in 90 fasted patients undergoing tubal ligation via minilaparotomy at least 8 h after normal vaginal delivery (mean 36.5, range 8-96 h). Gastric volume and pH were measured, using aspiration through a gastric tube. RESULT: Proseal laryngeal mask airway insertion was successful in all patients, requiring one attempt in 75 patients (83%). The median (range) leak pressure was 35 (23-40) cmH2O. Twenty-two patients (25%) had a leak pressure of 40 cmH2O or greater. Gastric tube placement was successful in all patients, described as easy in 79 (87%), and difficult in 11 (13%). The mean initial volume of gastric aspirate was 10.7 (0-64) mL and the final volume 15.6 (0-71) mL. The mean pH of the gastric aspirate was 2.6 (1.2-6.6). There were no incidents of suspected fluid regurgitation or aspiration, but two patients required intubation during surgery. Ten patients (11.1%) complained of sore throat in the recovery room, nine of which were described as mild. All patients reported being satisfied with their anaesthesia. CONCLUSION: The Proseal laryngeal mask airway provides an effective airway for general anaesthesia in fasted patients undergoing tubal ligation from 8 h after normal vaginal delivery. While the safety of an unprotected airway in this population remains uncertain, this study suggested a low risk of regurgitation, especially in the first 24 h post partum.
Adult↗
Cardiovascular responses to the change from the left lateral to the upright position in pregnant hypertensives.
OBJECTIVES: To evaluate by non-invasive means, the autonomically mediated changes in heart rate and blood pressure in response to postural change in pregnancy. METHODS: Ninety-one patients were studied, of whom 17 were non-pregnant controls, 21 were normotensive parturients, 22 had non-proteinuric hypertension, and 31 were pre-eclamptics. In all patients the heart rate and blood pressure response to the change from the left lateral to the erect position was measured non-invasively, during the third trimester in the pregnant groups. RESULTS: The change from the left lateral to the erect position induced significantly greater mean changes (increases) in systolic blood pressure in the normotensive pregnant (PC) women than all other groups (P<0.05). Pre-eclamptic patients (PE) exhibited significantly less of an increase in systolic blood pressure than the non-proteinuric hypertensive (H) group. Both the H and PC groups showed significantly greater increases in diastolic pressure than the non-pregnant (NP) group. PE patients had a significantly smaller increase in diastolic pressure than the H group. There were no significant differences between heart rate changes when comparing the PC, NP and H groups. The PE group exhibited a significantly greater increase in heart rate on adopting the erect position than all other groups. CONCLUSIONS: Pre-eclamptics exhibit smaller changes in blood pressure than normotensive pregnant patients and non-proteinuric hypertensives on standing, while producing an exaggerated heart rate response, indicating altered autonomic compensatory mechanisms in these patients.
Adult↗
Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section.
Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml x kg(-1) of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload). Significantly more patients in the coload group did not require vasopressor therapy pre-delivery (P=0.047). The coload group required a lower median dose (P=0.03) and a lower median number (P=0.04) of ephedrine doses for the treatment of maternal hypotension pre-delivery. There was no between-group difference in either the total cumulative dose, or in the total number of doses of ephedrine. Neonatal outcomes among the two groups were similar. Rapid crystalloid administration after, rather than over 20 minutes before the induction of spinal anaesthesia for elective caesarean section, may be advantageous in terms of managing maternal blood pressure prior to delivery.
Anesthesia, Obstetrical↗
Prevention and treatment of cardiovascular instability during spinal anaesthesia for caesarean section.
Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability.
Anesthesia, Obstetrical↗
Supraventricular tachycardia during spinal anaesthesia for caesarean section.
A woman of 40 weeks' gestation, who was apparently previously healthy, required emergency caesarean section after a failed vacuum delivery. While under spinal anaesthesia she developed a supraventricular tachycardia of unknown origin. Intravenous verapamil resulted in a conversion to sinus rhythm. Further investigations confirmed Wolff-Parkinson-White syndrome, for which she required ablation therapy. Appropriate methods of cardioversion in this clinical setting are discussed.
Journal Article↗
Excision of a giant hydatid cyst of the lung under thoracic epidural anaesthesia.
We present a patient with a large pulmonary hydatid cyst compressing underlying lung, with previous pulmonary tuberculosis, who presented in respiratory failure. After institution of thoracic epidural anaesthesia employing 0.25% bupivacaine, 1% lignocaine and fentanyl, the patient was placed in the sitting position and the hydatid cyst excised and drained after a limited rib resection. An air leak persisted until the 16th postoperative day. A marked improvement in symptoms as well as in spirometly and arterial blood gases occurred, and the patient was discharged on the 20th day. Thoracic epidural anaesthesia may be a safer method than general anaesthesia for removal of a hydatid cyst in a patient with severe respiratory compromise.
Adjuvants, Anesthesia↗
Airway pressure release ventilation with a short release time in a child with acute respiratory distress syndrome.
Airway pressure release ventilation (APRV) allows ventilation and oxygenation to occur at lower peak and mean airway pressures than conventional positive pressure ventilation. The use of APRV in adults is an effective method of ventilation for patients with acute lung injury and acute respiratory distress syndrome. However, the use of APRV in children is less established. We report the use of APRV with a short release time of 0.2 s in a child with acute respiratory distress syndrome secondary to respiratory syncytial virus pneumonia.
Acute Disease↗
Can insertion length for a double-lumen endobronchial tube be predicted?
It has been suggested that the appropriate length of insertion for double-lumen tubes can be estimated by external measurement. This study examined the accuracy of external measurement in estimating the actual length of insertion required in 130 patients. It also examined the relationship between the length inserted and the patient's height in 126 patients and their weight in 125 patients. Although there was a fair correlation between the measured external length and the final inserted length (r = 0.61), the 95% confidence intervals of slope and intercept allowed a large variation and the prediction was too wide to be clinically useful. Height was reasonably well correlated with the final length (r = 0.51) but an equally wide 95% confidence interval rendered it of little clinical value. There was no correlation between weight and final tube length. It is concluded that external measurement alone is not adequate to predict a clinically acceptable position of the double-lumen tube.
Adolescent↗
Analysis of the right ventricular function in the exercising horse: use of the Fourier Transform.
The objective of this study was to develop and test a technique to allow dynamic cardiac function to be studied during exercise in the horse. Blood pressure waveforms in the exercising horse are difficult to interpret because of the large influence of stride and respiration. A method has been devised to study dynamic right ventricular variables during high-speed exercise in the horse. A Fast Fourier Transform was performed on the digitised pressure waveforms and the frequency components associated with stride and respiration were removed. An inverse Fourier Transform was then performed to generate a time-domain pressure signal. Several dynamic right ventricular variables were calculated using the derived signal. Various parameters associated with removing frequencies from the frequency-domain pressure signal were changed to determine their influence on the variables. Most of the variables were not sensitive to these parameters. When compared during separate exercise bouts, some variables differed among runs, while others were not significantly different. Using the signal separation technique described here, right ventricular function of an exercising horse can be critically analysed.
Animals↗
Eltanolone (5-beta-pregnanolone) does not trigger, and attenuates halothane triggering of, malignant hyperthermia in malignant hyperthermia susceptible swine.
Eltanolone is the lipid emulsion formulation, for intravenous use, of the steroid anaesthetic 5-beta-pregnanolone. We have screened this agent in malignant hyperthermia susceptible (MHS) Landrace swine to assess its potential to trigger the Malignant Hyperthermia (MH) syndrome in MHS subjects or to influence halothane triggering of MH in such patients. Administered in anaesthetic concentration, eltanolone did not trigger the MH syndrome in MHS swine. When co-administered in low dosage with halothane, the drug prevented initiation of the MH syndrome in four of eight pigs and attenuated its progress in the remainder.
Anesthetics, Inhalation↗
The effect of eltanolone on pulmonary vascular resistance in landrace swine.
This paper reports on the haemodynamic effects of eltanolone observed in Landrace swine during the investigation of the drug with respect to safety in malignant hyperthermia-susceptible individuals. Pigs were sedated with intramuscular ketamine, followed by induction of anaesthesia employing thiopentone administered via an ear-vein. After intubation, anaesthesia was maintained using nitrous oxide in oxygen. A total of eight pigs were then further anaesthetised on two separate occasions using one of two dose schedules. A bolus of 1.5 mg kg(-1) of eltanolone was administered, followed by a continuous infusion at either 2 or 10 mg kg(-1) h(-1). There were no significant changes in heart rate, mean arterial pressure, cardiac output or systemic vascular resistance following eltanolone. In all cases eltanolone induced marked rises in pulmonary artery pressure and pulmonary vascular resistance (P<0.01) at all measuring points and in right ventricular stroke work at 6-10 min after drug exposure. We conclude that the selective influence of eltanolone on the pulmonary vasculature is probably species-specific, but may have clinical significance in patients with pulmonary hypertension.
Animals↗
Dietary canola oil alters hematological indices and blood lipids in neonatal piglets fed formula.
This study was undertaken to determine the effects of canola oil on platelet characteristics, blood lipids and growth in exclusively formula-fed piglets. Piglets were fed from birth to 10 or 18 d with formula containing 51% energy from fat, with 100% fat as canola or soybean oil; 26% soybean, 59% high oleic acid sunflower and 12% flax oil (canola mimic); or 26% canola (canola blend) or soybean (soybean blend) with high oleic acid sunflower, palm and coconut oil. The canola mimic provided similar carbon chain 16 and 18 fatty acids without the sterol or 20:1 and erucic acid (22:1) of canola oil. The oil blends provided formula resembling infant formulas but with higher 16:0 and lower unsaturated fatty acid levels than in canola or soybean oil. Body weight, weight gain and heart and liver weight were not different after 10 or 18 d feeding canola when compared to soybean oil alone or blended oil formulas. Piglets fed formulas with 100% canola oil had lower platelet counts than piglets fed formula soybean oil or the canola oil mimic. Platelet counts were lower, and platelet distribution width and volume were higher, when formulas with 100% canola or soybean rather than the blended oil formulas were fed. The results show that formula fat composition influences the developing hematological system and that canola oil suppresses the normal developmental increase in platelet count in piglets by a mechanism apparently unrelated to the formula 16:0, 18:1, 18:2(n-6) or 18:3(n-3), or plasma phospholipid 20:4(n-6) or 20:5(n-3).
Analysis of Variance↗
Formula containing randomized fats with palmitic acid (16:0) in the 2-position increases 16:0 in the 2-position of plasma and chylomicron triglycerides in formula-fed piglets to levels approaching those of piglets fed sow's milk.
Human and pig milk fat contains a high proportion of palmitic acid (16:0) which is largely esterified to the 2-position of the triglycerides. In contrast, the 16:0 in most nonmilk fats and in infant formulas is mainly esterified at the triglyceride 1,3 positions. Gastric and pancreatic lipases hydrolyze fatty acids from the dietary triglyceride 1- and 3-positions to produce unesterified fatty acids and 2-monoglycerides which are absorbed and re-esterified. In this study, we determined whether formula with chemically randomized oils, which equally distributes 16:0 among all the positions of triglycerides, influences growth or the distribution of fatty acids in plasma and liver lipid of formula-fed piglets compared with piglets fed formula with native oils or sow's milk. After feeding from birth to 18 d, piglets fed formula with palm olein randomized with canola oil (co-randomized) had higher weight gain per liter of formula intake and higher 16:0 in the chylomicron triglyceride 2-position than piglets fed formula with randomized or native palm olein oil blended with canola oil. The fatty acid distribution of formula triglycerides is an important determinant of pathways of 16:0 absorption, and consequently of plasma lipid fatty acids in formula-fed piglets.
Animals↗
Total i.v. anaesthesia with propofol and the laryngeal mask for orthopaedic surgery.
One hundred ASA I orthopaedic surgical patients (four randomized groups) were anaesthetized using continuous propofol and intermittent fentanyl (TIVA), with controlled ventilation via a tracheal tube in groups 1 and 2, and a laryngeal mask airway (LMA) in groups 3 and 4. Neuromuscular blockers were used in groups 1 and 3 only. There were no significant differences between groups in total anaesthetic requirements, as assessed by cardiovascular variables and movement. Coughing interfered with surgery and made controlled ventilation difficult to manage. In contrast, movement not associated with coughing did not impair surgery or ventilation. Patients in group 2 (tracheal tube, no neuromuscular blocker) required more interventions for coughing than the other groups, while patients in group 4 (LMA, no neuromuscular blocker) needed more boluses for movement than groups 1 and 3. Groups 1 and 2 (tracheal tube) had significantly higher heart rates and mean arterial pressures than groups 3 and 4 for varying periods up to 5 min after insertion of the airway management device. There was no correlation between mean arterial pressure and plasma concentrations of catecholamines related to insertion of either the tracheal tube or LMA. The LMA was found to be a highly effective device for controlled ventilation in TIVA and easier to manage than the tracheal tube in the absence of neuromuscular blockers.
Adolescent↗
Effects of exercise on the coherence of human EEG signals at selected hemispheric sites.
This study investigated the effects of exercise on the intrahemispheric coherence of human electroencephalographic (EEG) signals. The frontal and temporal sites of each hemisphere (left: F3, T3; right: F4, T4) were selected as the sites to be compared. The subjects were divided into an exercise group and a control (nonexercise) group. Subjects rested for ten minutes; exercised on a cycle ergometer or watched a videotape for three consecutive five-minute periods, and then rested again for ten minutes. EEG recordings were taken during each of these five activity periods. The coherences between F3 and T3 and between F4 and T4 were calculated for each activity period. The coherence values were averaged across a specific frequency band (alpha, beta 1, or beta 2), and a randomized block-design test was applied to the z-transformed mean coherence values to determine whether any significant differences existed among the coherences within a particular frequency band. In the exercise group the right- and left-hemisphere alpha-band coherences for all three exercise periods were significantly decreased compared with the alpha-band coherence for the final rest period. In the control group the right-hemisphere beta 1-band coherences for the videotape periods were significantly decreased compared with the beta 1-band coherence for the initial rest period.
Adult↗
Dimensional stability of denture bases following repair with microwave resin.
The dimensional stability of a commercially available acrylic resin, designed specifically for polymerization by microwave irradiation, was compared with that of a conventional water-bath-cured resin. Resin bases were processed on duplicate stone casts prepared from a cobalt chromium master die. Twenty bases were polymerized, using acrylic resin modified for rapid heat curing, in a water-bath at 100 degrees C for 22 min. A further 20 bases were polymerized using a microwave curing acrylic resin, in a conventional microwave oven at 500 W power output for 3 min. Ten bases from each group were sectioned in a parasagittal direction and repaired using the microwave curing resin. Following each curing cycle the fit of the posterior border of each base was evaluated via a silicone index formed between the base and the master die. The index was invested in stone and sectioned through the posterior palatal region to allow measurement of its thickness by means of an eyepiece micrometer. One-way analysis of variance and unpaired Student's t tests were employed to compare the differences in distortion at the initial cure and following repair. No significant differences were found in the distortion of the acrylic resin bases produced from the heat-cured or microwave-cured materials. All bases exhibited significant further distortion on repair with the microwave-cured acrylic resin.
Analysis of Variance↗
High-dose aprotinin in cardiac surgery--a prospective, randomized study.
Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.
Adolescent↗