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Biomedical subjects

S A Grant

Publications and source records attributed to S A Grant.

At least 19 recordsLinked to original sources
PubMed2003

Variability in determination of point of needle insertion in peripheral nerve blocks: a comparison of experienced and inexperienced anaesthetists.

Accurate identification of surface landmarks is essential for the successful performance of peripheral nerve blocks. The variability between experienced and inexperienced practitioners in identifying anatomical landmarks has not been studied previously. Anaesthetists were asked to identify the point of needle insertion for posterior lumbar plexus and sciatic nerve blocks on a volunteer using a standard textbook description. The chosen point for needle insertion was described in terms of X and Y co-ordinates, measured in millimetres, from a zero reference point marked on a volunteer's back. Fifteen experienced and 22 inexperienced anaesthetists took part in the study. The lumbar plexus block mean [range] values for the X, Y co-ordinates were 80 [62-108], 66 [46-86] and 92 [49-150], 62 [0-131] in the experienced and inexperienced groups, respectively. The sciatic nerve block X, Y co-ordinates were 77 [62-99], 70 [49-89] and 68 [29-116], 62 [26-93] in the experienced and inexperienced groups, respectively. The variance for the point of needle insertion was significantly greater in the inexperienced group (p <0.01) for both the lumbar plexus and sciatic nerve blocks. We conclude that with increasing experience, there is decreased variability in determining the point of needle insertion using anatomical landmarks.

Anesthesiology↗
PubMed2001

Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade.

PURPOSE: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case illustrates the use of lumbar plexus and sciatic nerve peripheral catheters for major knee surgery using intermittent bolus dosing for outpatient analgesia. CLINICAL FEATURES: A 20-yr-old male presented for multi-ligamentous knee reconstruction (posterior collateral ligament and revision anterior collateral ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general anesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0.2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 ml in each catheter (four injections total). This provided 96 hr of analgesia and low supplemental opioid use. CONCLUSION: The use of a lumbar plexus and sciatic nerve peripheral catheter offered an alternative to conventional pain control that worked well in the ambulatory setting. By providing prolonged unilateral lower limb analgesia, extensive knee surgery was performed that would normally require a hospital stay for pain control. Using a bolus dosing method the risk of local anesthetic complications occurring outside of the hospital with a continuous infusion was minimized.

Adult↗
PubMed2001

Development of dual receptor biosensors: an analysis of FRET pairs.

The development of a dual receptor detection method for enhanced biosensor monitoring was investigated by analyzing potential fluorescent resonance energy transfer (FRET) pairs. The dual receptor scheme requires the integration of a chemical transducer system with two unique protein receptors that bind to a single biological agent. The two receptors are tagged with special molecular groups (donors and acceptors fluorophores) while the chemical transduction system relies on the well-known mechanisms of FRET. During the binding event, the two FRET labeled receptors dock at the binding sites on the surface of the biological agent. The resulting close proximity of the two fluorophores upon binding will initiate the energy transfer resulting in fluorescence. The paper focuses on the analysis and optimization of the chemical transduction system. A variety of FRET fluorophore pairs were tested in a spectrofluorimeter and promising FRET pairs were then tagged to the protein, avidin and its ligand, biotin. Due to their affinities, the FRET-tagged biomolecules combine in solution, resulting in a stable, fluorescent signal from the acceptor FRET dye with a simultaneous decrease in fluorescent signal from the donor FRET dye. The results indicate that the selected FRET pairs can be utilized in the development of dual receptor sensors.

Biosensing Techniques↗
PubMed2000

Safety of patient-maintained propofol sedation using a target-controlled system in healthy volunteers.

We investigated the safety of a patient-maintained system that allows individuals to operate a target-controlled infusion of propofol to achieve sedation. Ten healthy volunteers were recruited and instructed to try to anaesthetize themselves with the system. A target-controlled infusion of propofol was set to deliver a target propofol concentration of 1 microgram ml-1, and the subjects allowed to increase the target in increments of 0.2 microgram ml-1 by pressing a control button twice in 1 s. There was a lockout time of 2 min and a maximum permitted target concentration of 3 micrograms ml-1. Heart rate and pulse oximetry oxygen saturation (SpO2) were monitored continuously, and non-invasive arterial pressure, ventilatory frequencies and sedation scores were measured every 5 min. Sedation was continued until the subject stopped pressing the button. A keyword was then read for the individual to remember and sedation discontinued. There were no instances of significant decrease of SpO2 or loss of airway control. Maximum target blood concentration of propofol recorded ranged from 1.4 to 3 micrograms ml-1. Two subjects became oversedated, one of whom was unrousable with loss of eyelash reflex. No subject could recall the keyword, although one recognized it from a list of 10 words. We conclude that the patient-maintained sedation system described could not be guaranteed to produce only conscious sedation in all patients, and that close clinical supervision by an anaesthetist would still be required for safe operation.

Adolescent↗
PubMed2000

Blood propofol concentration and psychomotor effects on driving skills.

We studied psychomotor performance in 10 healthy volunteers during recovery after a target-controlled infusion of propofol. Choice reaction time, dual task tracking with secondary reaction time and a within-list recognition task were assessed at target blood propofol concentrations of 0.8, 0.4 and 0.2 microgram ml-1. Performance was impaired most at the highest blood propofol concentration (choice reaction time increased by a mean of 247 ms and secondary reaction time by a mean of 178 ms). Choice reaction time and dual task tracking with secondary reaction time were the most sensitive and reliable methods of assessment (significant difference from baseline (P < 0.05) at a propofol concentration of 0.2 microgram ml-1 with choice and secondary reaction time testing). Within-list recognition assessment of memory was not sufficiently sensitive at very low propofol concentrations. The impairment in choice and secondary reaction time with a blood propofol concentration of 0.2 microgram ml-1 was less than that observed with a blood alcohol concentration of 50 mg 100 ml-1 and no greater than that observed with a blood alcohol concentration of 20 mg 100 ml-1 in a previous study involving healthy volunteers.

Adult↗
PubMed2000

Blood alcohol concentration and psychomotor effects.

This study assessed the effect of intravenous alcohol infusions on psychomotor impairment and compared it with that of alcohol administered orally. Comparisons were made between three European drink-driving limits of blood alcohol concentration (BAC) (20, 50 and 80 mg 100 ml-1) and an oral dose of alcohol 0.75 mg kg-1. Twelve volunteers, aged 22-34 yr, were recruited. At targets of 20, 50 and and 80 mg 100 ml-1, the mean (SD) BAC was 22.1 (3.7), 51.5 (3.3) and 80.5 (4.2) mg 100 ml-1, respectively. The peak BAC following an oral dose of alcohol 0.75 mg kg-1 ranged from 19 to 68 mg 100 ml-1. In psychomotor testing, choice reaction time deteriorated with increasing BAC and showed significant differences between baseline and the 50 (P < 0.05) and 80 mg 100 ml-1 (P < 0.01) conditions. Dual-task secondary reaction time deteriorated with increasing BAC and showed a statistically significant difference between all groups and baseline (oral and 20 mg groups, P < 0.05; 50 and 80 mg groups, P < 0.01). Dual-task tracking in the 50 and 80 mg groups was significantly different from baseline (P < 0.05 and P < 0.01, respectively). Oral dosing resulted in widely variable BACs, making it difficult to assess psychomotor impairment reliably. An intravenous infusion enables the BAC to be maintained within a narrow range. This allows precision when investigating the effects of alcohol on psychomotor performance.

Administration, Oral↗
PubMed2000

Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump.

Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.

Adolescent↗
PubMed2000

Development of fiber optic and electrochemical pH sensors to monitor brain tissue.

This article describes fiber optic and electrochemical pH sensors that could become part of a therapeutic arsenal to quickly and aggressively treat stroke victims as well as people who have suffered brain trauma. The fiber optic sensor design was based on the immobilization of a pH-sensitive dye, seminaphthorhodamine-1 carboxylate (SNARF-1C), onto the end of a 125-microm-diameter silica optical fiber using the sol-gel method. A miniature bench-top fluorimeter system was developed for use with the optical fiber to obtain pH measurements. The electrochemical sensor was based on sputter-coated iridium oxide thin films. Linear and reproducible responses for both sensors were obtained in human blood with pH varying between 6.8 ato 8.0, which encompasses the clinically relevant range. In vivo studies were also performed and results indicated that both types of sensors tracked pH with very little drift.

Animals↗
PubMed1999

Sol-gel-based biosensor for use in stroke treatment.

A fiber optic biosensor for the detection of fibrinolytic products produced during lysis of "soft" blood clots is described. The biosensor was constructed to be selective toward D dimer antigens, which form from the dissolution of cross-linked fibrin clots. The presence of D dimer antigens above a threshold level is a clinical diagnostic used to determine the presence of such occlusions following a stroke. Fluorescein-labeled D dimer antibodies are immobilized on the tip of an optical fiber by dip coating from a silica sol-gel solution. When D dimer antigens combine with the antibodies, fluorescence intensity decreases. The response of the sensor was examined in phosphate buffered saline, human plasma, and blood. Calibration plots for the sensor were obtained in the clinically significant D dimer concentration range from 0.54 microgram/ml to 6 micrograms/ml. Changes in spectroscopic properties as the sol-gel encapsulated tagged antibodies aged were examined; a decrease in fluorescence intensity with age was noted. The D dimer antibodies remain viable for at least 4 weeks while encapsulated in the sol-gel network when stored at 4 degrees C in PBS solution. This novel sensor is being developed for use with other catheter-based microtools to treat stroke resulting from occlusion in the vascular system.

Animals↗
PubMed1997

Degradation-induced transmission losses in silica optical fibers.

BACKGROUND AND OBJECTIVE: The interaction of surgical optical fibers with tissue has been studied. STUDY DESIGN/METHODS AND MATERIALS: Fibers (600 microns) were lased in chicken and beef tissue using a Nd:YAG laser from 5 to 50 W in both cw and pulsed modes. RESULTS: With longer lasing and higher power, larger transmission loss and degradation (burn-in) of the fiber tip, occurred. This degradation converts the Nd:YAG laser power to heat and leads to further energy loss. During contact lasing, tissue and blood adhere to the fiber tip surface limiting laser transmission, desiccating, and eventually destroying adhering tissues. Such tissue residues create high power densities and temperatures at the tip, which then cause a variety of degradation processes to be initiated. CONCLUSION: "Burned-in" fibers do not photocoagulate; rather they incise tissue. With continued lasing, thermal shock, chemical, and mechanical breakdown of the fiber leads to failure of the fiber tip and the spalling of glass fragments into the tissue bed.

Animals↗
PubMed1994

Fertilizability and structural properties of boar spermatozoa prepared by Percoll gradient centrifugation.

Two techniques for the preparation of boar spermatozoa for in vitro fertilization were studied: a simple washing procedure and centrifugation on a discontinuous Percoll gradient. Their respective effects on motility of spermatozoa were analysed by computer-assisted sperm analysis. The Percoll density gradient technique selected spermatozoa with significantly (P < 0.0001) enhanced motility and movement characteristics. In vitro matured oocytes inseminated with spermatozoa prepared by Percoll gradient centrifugation had significantly (P < 0.0001) greater cleavage rates than did oocytes inseminated with washed spermatozoa. This increased penetration ability was not due to an increased proportion of acrosome-reacted spermatozoa. Transmission electron microscopy revealed no unique ultrastructural differences between the spermatozoa from either preparation. Spermatozoa prepared by Percoll gradient centrifugation are recommended for insemination and studies of porcine in vitro fertilization.

Animals↗
PubMed1993

Tetracaine protects against cocaine lethality in mice.

STUDY HYPOTHESIS: Tetracaine will enhance cocaine toxicity. STUDY POPULATION: Two hundred forty female Swiss albino mice weighing 27 to 45 g. METHODS: Intraperitoneal injections of tetracaine and cocaine were given to groups of ten mice each in a controlled, blinded fashion. Either tetracaine or an equal volume of normal saline was given five minutes before one of six incremental doses of cocaine, ranging from 60 to 110 mg/kg. The experiment was repeated twice using two different doses of tetracaine: either an LD10 (40 mg/kg determined from preliminary studies), or one-twentieth of the dose of cocaine (which approximates the ratio used in tetracaine, epinephrine, and cocaine). Lethality was recorded at 24 hours. Lethality between groups was compared with a Wilcoxon sign-rank test. RESULTS: Tetracaine reduced cocaine lethality at all doses. This reduction in lethality was statistically significant at both tetracaine doses (P < .05). CONCLUSION: In the mouse, pretreatment with tetracaine significantly decreases cocaine lethality.

Animals↗
PubMed1992

Use of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department.

The combination of tetracaine, epinephrine, and cocaine has gained wide acceptance as a topical anesthetic agent for use on pediatric dermal lacerations in the ED. This is despite the fact that the optimal dose and formulation have yet to be determined. TAC can be applied painlessly to wounds and is about as effective as lidocaine infiltration for anesthetizing pediatric facial and scalp lacerations. It is relatively ineffective on lacerations located elsewhere or in adults. The most commonly used TAC solution contains high concentrations of cocaine, tetracaine, and epinephrine, drugs that individually can cause serious toxicity if absorbed in sufficient amounts. In addition, the three components of TAC may interact to potentiate their intrinsic toxicities. The deliberate and inadvertent application of TAC to mucous membranes has caused status epilepticus and two pediatric deaths. The risk of toxicity from misapplication of TAC is heightened because TAC is most effective and therefore most widely used on pediatric facial and scalp lacerations. Cocaine is also absorbed after TAC is applied to dermal lacerations and may cause toxicity by this route. Until additional research is performed to establish the minimum effective dose of TAC and its potential toxicity and until FDA approval is granted, we do not think that it can be recommended as the drug of choice for pediatric facial and scalp lacerations in the ED. If TAC is administered, a maximum dose of 2 to 3 mL of the "half-strength" formula proposed by Bonadio and Wagner should be used, and application should be performed by medical personnel, using a soaked gauze or cotton ball. Care should be taken to make sure none of the solution comes in contact with mucous membranes, and TAC should not be applied to lacerations involving the vermillion border of the lip or the lip itself. Close medical monitoring of the patient is essential to detect signs of toxicity. Research on other topical agents such as tetracaine with epinephrine is also needed. Although anesthetizing wounds painlessly remains a worthy goal, exposing patients to added and unknown risks and increasing the cost of health care is unacceptable.

Anesthetics, Local↗
PubMed1991

Effect of estrogen administration on endogenous and luteinizing hormone-releasing-hormone-induced luteinizing hormone secretion and follicular development in the lactating sow.

The objectives of this study were to investigate whether estradiol treatment during lactation modifies 1) the patterns of endogenous LH, FSH, and prolactin (PRL) release; 2) the sensitivity of the pituitary to exogenous injections of LHRH; and 3) the responsiveness of the ovarian follicles to gonadotropin. Plasma LH, FSH, and PRL were determined in samples taken repeatedly from 18 sows on Days 24-27 of lactation. Ovaries were then recovered, and follicular development was assessed by measuring the follicular diameter (FFD) and follicular fluid estradiol-17 beta concentration (FFE) of the ten largest follicles dissected from each ovary. Sows were randomly allocated to one of four treatments: 1) Group C (4 sows) received no treatment; 2) Group LHRH (5 sows) received 800 ng of LHRH every 2 h throughout the sampling period; 3) Group E2 (4 sows) received subcutaneous implants containing estradiol-17 beta 24 h after start of sampling; 4) Group LHRH + E2 (5 sows) were administered a combination of LHRH and estradiol-17 beta implants. Between-animal variability for plasma LH, FSH, and PRL was considerable. LH concentration and LH pulse frequency increased (p less than 0.05) after LHRH treatment in the LHRH and LHRH + E2 groups; however, an acute inhibition of LH secretion was observed in the latter group immediately after estradiol implant application. In the absence of LHRH treatment, estradiol caused chronic inhibition of LH secretion. Follicular development was greater in the LHRH and LHRH + E2 groups compared to the C and E2 groups (p less than 0.05 for both FFD and FFE).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Histological evidence for heterogeneity in the development of preovulatory pig follicles.

Ovaries were collected from naturally cycling gilts during the preovulatory period and the stage relative to the LH surge estimated by measurement of oestradiol and progesterone concentrations in follicular fluid. Many of the follicles recovered had become flaccid with an associated increase in follicular fluid viscosity. Marked infolding of both the granulosa and theca tissue in some follicles suggested early luteinization. However, these morphological changes did not necessarily occur simultaneously in the same follicle, or in all follicles within an ovary. Moreover, they were not consistently related to characteristic differences in the concentration of follicular fluid steroids, suggesting either that the morphological and biochemical aspects of the luteinization of follicles may be independently controlled, or may respond at different rates to the same signal.

Animals↗
PubMed1989

Morphological and biochemical characteristics during ovarian follicular development in the pig.

Ovaries were recovered from groups of naturally cyclic pigs (N = 5) on each of Days 16, 18, 20 and 21 of the oestrous cycle. Follicular diameter, follicular fluid volume and concentrations of oestradiol, testosterone and progesterone, and granulosa cell number were determined in all follicles greater than or equal to 2 mm in diameter (n = 511). In alternate follicles either granulosa cell aromatase activity and theca testosterone content or 125I-labelled hCG binding to granulosa and theca were determined. The mean total number of follicles recovered per animal decreased as the follicular phase progressed and a strong positive relationship (P less than 0.001) existed between follicular diameter and volume on all days. The number of granulosa cells recovered per follicle was variable, and not related to oestrogenic activity of the follicles. Mean follicular fluid oestradiol, testosterone and 125I-labelled hCG binding all increased until Day 20 and decreased on Day 21, whereas mean theca testosterone content, 125I-labelled hCG binding to theca tissue and aromatase were all maximal on Day 21. On Days 20 and 21 a subset of 14-16 large follicles was readily distinguishable from the remaining smaller, less oestrogenically active population in each animal. Yet, consistently within these subsets there was a difference in follicular diameter of approximately 2.0 mm and also a considerable range of biochemical development even among follicles of equal size. These results indicate asynchrony at the time of recruitment and selection among follicles destined to ovulate and suggest that heterogeneity continues into the immediate preovulatory period.

Animals↗