bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients
Authors: INAGAWA GAKU , OKUDA KOJI , MIWA TAKAAKI , HIROKI KOICHI 
Published: March 2003

Background: It has been generally accepted that a higher airway seal pressure indicates adequate positioning of the laryngeal mask airway (LMA™) in adult patients. The present study was undertaken to clarify whether a higher airway seal pressure correlates with an adequate positioning of the LMA in paediatric patients. Methods: One hundred and eighty‐one healthy children, aged 6–121 months, weighing 7.0–30.0 kg, managed with size 1.5–2.5 LMAs during elective surgery, were enrolled in this study. LMAs were inserted without using muscle relaxants, and patients breathed spontaneously during surgery. At the end of surgery, we documented oropharyngeal sealing pressure and fibreoptic aperture views of the LMA. We used a new fibreoptic score evaluating the anatomical relationship between LMA aperture and epiglottis: 1, the aperture view covered with anterior epiglottis completely, but the airway staying open; 2, anterior epiglottis seen for more than two‐thirds of the aperture view in diameter; 3, anterior epiglottis seen for more than one‐third, but less than two‐thirds of the aperture view in diameter; and 4, anterior epiglottis seen for less than one‐third of the aperture view in diameter. Results: The oropharyngeal sealing pressures for each fibreoptic position, scores 1 to 4, were 17.0 ± 6.4, 17.9 ± 4.2, 20.1 ± 7.3 and 17.1 ± 6.1 cm H2O, respectively. There were no significant differences in sealing pressure between the four groups (P=NS). Conclusions: A higher airway seal is believed to be one of the clinical signs correlating with the correct position of an LMA. We found no relationship between oropharyngeal sealing pressure and LMA cuff position in paediatric patients.
Effects of rocuronium pretreatment on muscle enzyme levels following suxamethonium
Authors: ÖZLÜ ONUR , ERIS SENAY , MERT ALI 
Published: March 2003

Background: The effects of different time intervals between rocuronium pretreatment and suxamethonium administration on muscle‐derived enzymes and myoglobin were evaluated. Methods: Fifty‐two patients, aged 3–6 years, were allocated randomly to receive pretreatment of either rocuronium 1 min or 4 min, or a placebo, before suxamethonium. Serum creatine‐phosphokinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase (AST) and myoglobin concentrations were measured before treatment and at 30 min, 6 h and 24 h after suxamethonium administration. Results: Mean serum CK and myoglobin concentrations in the rocuronium groups were significantly less than in the saline group 24 h and 30 min after suxamethonium administration, respectively (P < 0.05). There were no significant differences between the rocuronium groups. Mean LDH and AST concentrations were higher at 6 h and 24 h after suxamethonium administration compared with preadministration levels, respectively (P < 0.05). Conclusions: We concluded that intervals of 1 min or 4 min between the rocuronium and suxamethonium administrations have the same effect on enzyme levels.
Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway™ with the cuffed oropharyngeal airway
Authors: MAMAYA BIRUTA 
Published: March 2003

Background: The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA™). Methods: Seventy children of school age (7–16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used. Results: Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group. Conclusions: The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short‐term assisted manual ventilation.
Pulmonary volume recruitment manoeuvre restores pulmonary compliance and resistance after apnoea in anaesthetized lambs
Authors: Russell F.E. , Van Der Walt J.H. , Jacob J. , Slater A.J. , Baghurst P. 
Published: March 2003

Summary Background: We studied the effects of an episode of induced apnoea on the dynamic compliance (Crs) and resistance (Rrs) of the respiratory system in anaesthetized lambs and investigated the mechanisms underlying the effectiveness of a timed reexpansion inspiratory manoeuvre (TRIM). Methods: Following 2 min of apnoea, three manoeuvres were randomly performed: (i) control: reventilated without TRIM using initial settings and gas composition of 30% oxygen in 70% nitrous oxide; (b) T1: TRIM with 30% oxygen in 70% nitrous oxide, followed by reventilation with the initial settings; and (c) T2: preoxygenate with 100% oxygen, apnoea, then TRIM with 100% oxygen, then reventilation with 100% oxygen at the initial settings. The percentage change in Crs and Rrs was calculated at first breath, second breath, 10, 20, 40, 60, 90, 120 and 180 s postapnoea. Results: Mean control decreased 15% and did not return to baseline during the study period. TRIM increased mean Crs in T1 and T2 by 8% and 9%, respectively, at first breath and returned to baseline and did not deteriorate for the remainder of the study period. Mean Rrs in the control group increased 20% and did not return to baseline during the study period. Mean Rrs in T1 and T2 initially increased 17% and 27%, respectively, at first breath and returned to baseline within 40 s. Conclusions: These results demonstrate that significant deterioration occurs in Crs and Rrs following 2 min of apnoea in anaesthetized lambs, which is not corrected with normal ventilation but is rapidly and completely reversed with a TRIM. This supports our hypothesis that volume recruitment of alveoli is an effective manoeuvre in restoring lung function. The practice of preoxygenation is also reinforced as the lambs maintained maximal oxygen saturation if they were ventilated with 100% oxygen prior to the 2 min of apnoea.
Flush volumes delivered from pressurized bag pump flush systems in neonates and small children
Authors: Cornelius Anita , Balmer Christian , Hug Maja I. , Gerber Andreas CH. , Weiss Markus 
Published: March 2003

Summary Background: The aim of this study was to measure the volumes of fluid delivered with a fast flush bolus from a flow regulating device. Methods: In‐vitro fast flush bolus volumes, the volumes delivered from a bag pump flush system while opening the flow regulating device for 1, 2 or 5 s, were gravimetrically measured through a 22‐G and a 24‐G cannula. In‐vivo 1‐ and 2‐s fast flush bolus volumes and the volume required to purge the tubing between stopcock and arterial cannula from visible blood after blood sampling were recorded in 12 anaesthetized neonates and infants (mean age 2.17 ± 1.97 months, range 0.26–5.37 months) with a 24‐G radial arterial cannula by continuously weighing the bag pump flush system at manometer pressures of 100, 200 and 300 mmHg. Results: In‐vitro fast flush bolus volumes ranged from 0.23 ± 0.04 ml (1‐s , 100 mmHg, 24‐G cannula) to 2.95 ± 0.38 ml (5‐s, 300 mmHg, 22‐G cannula). Volumes were larger using a 22‐G cannula than a 24‐G cannula (P < 0.01) and increased with longer flushing periods (P < 0.0001) and higher manometer pressures (P < 0.0001). In‐vivo 1‐ and 2‐s fast flush bolus volumes correlated well with driving pressures (infusion pressure minus mean arterial pressure) (r2 = 0.81/0.72). 1‐s fast flush bolus volumes delivered (ml) were 0.0025 × mmHg driving pressure and 2‐s fast flush bolus volumes delivered (ml) were 0.0043 × mmHg driving pressure. The mean volume delivered to purge blood from the arterial pressure tubing was 0.94 ± 0.18 ml (range 0.61–1.34 ml). Conclusions: Fast bolus flushing from pressurized infusion bag systems, using the flow regulating device tested, can be applied during neonatal and paediatric anaesthesia without delivering uncontrolled amounts of fluid.
Use of ultrasound bladder monitoring in children after caudal anaesthesia
Authors: Koomen Erik , Janssen Stephen , Anderson Brian J. 
Published: March 2003

Summary Urinary retention occurring after caudal anaesthesia in children has a low incidence. Most children will void within 12 h of surgery, although the incidence of retention is higher after hypospadias repair. However, overdistention causing bladder atony that is temporary, or may become permanent, is described in adults. Long‐term effects of overdistention in children have not been described. Urine volume, used to describe overdistention, is traditionally measured after catheterization.We report two children suffering from urine retention after caudal anaesthesia (bupivacaine 0.25%) was used to supplement a general anaesthetic. Ultrasound bladder monitoring was used to assist with the clinical diagnosis of bladder distension in the postanaesthesia care unit (PACU) and subsequent management.In–out catheterization was required in a 1‐year‐old‐girl with a bladder volume of 12 ml·kg−1 after external manual compression over the bladder was unable express urine. Spontaneous micturation occurred within the subsequent 8 h. A 10‐year‐old boy suffered distress in PACU with a bladder volume, measured by ultrasound, of 5 ml·kg−1. Catheterization relieved distress and spontaneous micturation returned 18 h after surgery. Measured urine volumes were similar to those estimated by ultrasound.Ultrasound bladder monitoring is a simple, noninvasive technique that can be used to assist with the diagnosis and management of urinary retention in children. It may replace catheterization as the prefered technique to measure urine volume. The correlation between measured bladder volumes and urine volume appears reasonable. A volume of approximately 10 mg·kg−1 may be considered as causing overdistension.
A study of peri‐operative respiratory complications in patients with Apert syndrome
Authors: Berlet J. , Mackersie A. , Bingham R. 
Published: March 2003

Introduction  Children with Apert syndrome (acrocephalosyndactyly) require anaesthesia for a variety of diagnostic and surgical procedures. These range from non‐invasive radiological imaging to major craniofacial interventions.Recent reports have suggested that patients with Apert syndrome have an incidence of peri‐operative respiratory complication in the order of 10% of anaesthetics administered.Over the fast ten years 73 patients with Apert syndrome have been treated in our institution. Each child receives approximately 10 anaesthetics during the course of their treatment. Anecdotal evidence suggested that the peri‐operative complication rate may be significantly lower than 10% and that children with Apert syndrome may therefore be falsely labelled as being high risk. A formal analysis of the incidence of complications was therefore undertaken.Methods  Following local Ethical Committee approval, a retrospective case note review was performed of a series of 73 patients with Apert syndrome. Information was recorded relating to each anaesthetic administered over the period from 1991 to 2001. This information included details of pre‐operative status, anaesthetic technique employed, operative procedure, peri‐operative observations recorded, the patient's post‐operative course and the occurrence of documented respiratory complications.Analysis of results will be presented.
Reduction of blood loss using aprotonin during spinal surgery in children for non‐idiopathic scoliosis.
Authors: Colovic V. , Walker R.W.M. , Patel D. , Rushman S. 
Published: March 2003

Background  Aprotinin, a serine protease inhibitor, reduces surgical blood loss by mechanisms including antifibrinolysis and preservation of platelet function. Its effectiveness has been reported in adult patients undergoing cardiac, major orthopaedic surgery (1) and liver surgery, as well as in paediatric cardiac surgery.Spinal surgery in children with scoliotic deformities involves major blood loss. This may often be more than one circulatory blood volume and therefore results in exposure to blood products and the accompanying risks and problems. Patients with Duchenne muscular dystrophy or other neuromuscular conditions presenting for correction of a spinal deformity pose a particular problem because of their propensity to bleed during surgery.Aprotinin was introduced into the RMCH for the purpose of reducing blood loss in this group of patients in 1999. Administration of aprotinin carries the risk of the formation of aprotinin specific antibodies and anaphylaxis. Re‐exposure carries a greater risk.The aim of this study was to investigate the effect of aprotinin on blood loss during corrective spinal surgery in the neuromuscular patients.Methods  We have performed a retrospective review of 33 ASA III cases operated on in period June 1998–September 2000. All notes were studied and data recorded on the intraoperative blood loss and the length of surgical procedure. Aprotinin was used only in children where it was felt that they would be unlikely to be re‐exposed because of their initial presenting diagnosis. Our regimen for aprotinin administration was: test dose 5 ml (50 000 KIU) over 20 min, loading dose 2 ml·kg−1 (20 000 KIU·kg−1) infused over 30 min, then maintenance at 0.5 ml·kg−1·hr−1 (5 000 KIU·kg−1·h−1).Results  In the group that had not received aprotinin were 15 patients aged 7–17 years (mean age 13 ± 2 years), measured blood loss was 2849 ± 1802 ml, length of surgery 343 ± 78 min. In the aprotinin group we had 18 patients aged 7–15 years (mean age 12 ± 2 years) with recorded mean blood loss of 1380 ± 1000 ml and duration of procedure 389 ± 142 min. The blood loss in the group that had received aprotinin was significantly reduced (P < 0.01).Discussion  Our two groups of patients were similar regarding the age of patients, pathology and clinical presentation. We believe that the use of aprotinin resulted in significant reduction of blood loss and requirements for blood products.
Phacofragmentation for morgagnian cataract in a horse
Authors: Hardman Chloe , McIlnay Tonya R. , Dugan Steven J. 
Published: March 2003

AbstractA 3‐year‐old Paint gelding was presented for sudden onset of cataract affecting the right eye. Ophthalmic examination revealed subtle to mild microphthalmia and a mature cataract affecting the right globe. The right eye was treated with an antibiotic‐corticosteroid ophthalmic ointment and phacofragmentation was recommended. On re‐examination 5 months later, resorption of the cortex of the right lens and a morgagnian cataract were evident. The nucleus was positioned ventronasally in the lens capsule. The right eye had light perception, and a menace response was present. Examination of the right fundus via binocular indirect ophthalmoscopy was not possible. Ophthalmic ultrasonography revealed that the right globe was 4 mm shorter in axial length when compared with the left globe. There was a marked reduction in the size of the right lens vs. the left lens, and the presence of a moderate amount of hyperechoic debris was identified within the vitreal compartment of the right globe. Phacofragmentation, irrigation and aspiration of the morgagnian cataract and an anterior vitrectomy were performed. On postoperative examination, the eye was comfortable and a menace response was present. The horse regained useful vision and continues to have a comfortable, visual eye 7 months postoperatively.
Bilateral neuroepithelial choristomas of the optic disc in a cynomolgus monkey (Macaca fascicularis): a case report
Authors: Munger Robert J. , Behrana Jensen V. , Bouldin Thomas W. , Peiffer Robert L. 
Published: March 2003

AbstractA 6‐year‐old intact male cynomolgus monkey of Chinese origin was received at the Sierra Biomedical Facility. While physical examination revealed good body condition with no abnormalities, routine ophthalmic examination revealed bilateral proliferative optic neuropathy involving the dorsal aspect of the optic disc. No changes were noted in the appearance of the lesions over 8 months, and fluoroescein angiography revealed no abnormalities other than obstruction of the view of the retinal vessels by the lesions. Histopathologic studies revealed characteristics consistent with a diagnosis of bilateral neuroepithelial choristoma.
Ocular disease in rats: a review
Authors: Williams David L. 
Published: March 2003

AbstractThe rat Rattus norvegicus is widely used in experimental work, both providing a rodent model for human ocular disease and as a species for toxicologic screening. In addition, the rat is more and more widely kept as a pet, being both friendly and intelligent. Diagnosis and treatment of ocular disease is important for the welfare of individual animals and whole colonies, but also to ensure that spontaneous disease is not compromising experimental work. Here, ophthalmic conditions are reviewed in order to provide a survey of ocular disease in the rat both for veterinary ophthalmologists and for laboratory animal veterinarians and research workers.
AfrotropicalPolypedilumsubgenusTripodura, with a review of the subgenus (Diptera: Chironomidae)
Authors: Vårdal Hege , Bjørlo Alfred , Sæther Ole A. 
Published: March 2003

Vårdal, H., Bjørlo, A. & Sæther, O. A. (2002). AfrotropicalPolypedilumsubgenusTripodura, with a review of the subgenus (Diptera: Chironomidae). —Zoologica Scripta, 31,331–402.A subgeneric diagnosis for all stages of the subgenusTripoduraTownes,1945 of the genusPolypedilumKieffer,1912 is given. Nine new Afrotropical species ofTripoduraare described:P.(T.)chelumVårdal sp. n.,P.(T.)amplificatusBjørlo sp. n.,P.(T.)patulumBjørlo sp. n.,P.(T.)spinalveumVårdal sp. n.,P.(T.)eweiBjørlo sp. n.,P.(T.)ogoouenseBjørlo sp. n.,P.(T.)akaniBjørlo sp. n.,P.(T.)dagombaeBjørlo sp. n., andP.(T.)amputatumBjørlo sp. n.; all as male imagines only.P.(T.)alboguttatumKieffer,P.(T.)albosignatumKieffer,P.(T.)tropicumKieffer,P.(T.)pruinaFreeman,P.(T.)quinqueguttatumKieffer,P.(T.) aegyptiumKieffer,P.(T.) tridensFreeman,P.(T.)allansoniFreeman,P.(T.)longicrusKieffer,P.(T.)annulatipesKieffer andP.(T.)abyssiniaeKieffer are re‐described as male and female imagines, whileP.(T.)majiisLehmann,P.(T.)subovatumFreeman,P.(T.)griseoguttatumKieffer,P.(T.)aferumLehmann andP.(T.)kijabenseFreeman are re‐described as male imagines only. Keys to the male and the known female imagines of the 30 Afrotropical species in the subgenus are presented. A phylogenetic analysis based on all available information onTripodurafrom all over the world (135 species) is presented and discussed. The monophyly of the subgenusTripodurais confirmed. The subgenus can be divided into 20 groups with theacifergroup forming the sister group of two larger assemblages of groups in the orderacifer(titicacae(ginzansecundum((aferum(ewei(malickianum(floridense(halterale,pullum)))))) (subovatum(labeculosum((parascalaenum(allansoni(apfelbecki(udominatum,parvum))))) ((((alboguttatum,aegyptium)quinqueguttatum)annulatipes)). Only in thetiticacae,halterale,pullumandapfelbeckigroups are the larvae of more than one species described, while one larva is known in each of thesubovatum,parascalaenum,aegyptiumandquinqueguttatumgroups. Three or more pupae are known only from thehalterale,pullum,apfelbeckiandaegyptiumgroups. Thus, the tentative nature of the group divisions is obvious. Geographical co‐evolutionary analyses (Brooks parsimony analyses) of the subgenus as a whole and of the major groups are performed and the areas most likely to be part of the original areas estimated. Most probably, eastern South America and Africa were part of the ancestral area. There are multiple sister‐group relationships and generalized tracks between South and East Asia and Africa, between Africa and the Palaearctic region, between South and East Asia, between tropical Brazil and Africa, between East Asia and North America across a former Beringian land bridge, and between the Indo‐West Pacific region and New Zealand, but no evidence for transantarctic relationships.
Immunological and virological features of HIV‐infected patients with increasing CD4 cell numbers despite virological failure during protease inhibitor‐based therapy
Authors: Weiss L , Burgard M , Cahen YD , Chaix ML , Laureillard D , Gilquin J , Piketty C , Viard JP , Kazatchkine MD , Girard PM , Rouzioux C 
Published: March 2003

Objectives To investigate the extent of functional T cell recovery and to characterize plasma virus and virus producing cells in patients with increasing CD4 cell counts despite virological failure during protease inhibitor (PI) based therapy.Methods The study group included 13 patients who were treated for at least 12 months with a PI based regimen and were selected on the basis of a sustained immunological response (increase of > 70 CD4 cells/μL) despite virological failure (< 1 log10 copies/mL decrease in HIV‐1 RNA plasma levels).Results Compared to a historical series of 11 complete responders with less advanced disease, the proportion of memory CD4 T cells was significantly higher (67.8±17.8 vs. 52.8±11.0; P=0.045) and the proportion of naive CD4 T cells significantly lower (30.5±14.8 vs. 45.0±10.4, P=0.021) in patients who were immunological responders/virological nonresponders. In those patients, ongoing viral replication was associated with a strong activation of circulating CD8 T lymphocytes; interleukin‐2 production remained decreased. CD4 T cell reactivity to cytomegalovirus proteins was observed in nine of 11 patients tested. In the study group, the proportion of infectious virus present in plasma as well as the levels of intracellular viral replication were similar to those measured in untreated patients. Virological failure in this group of patients probably resulted from pre‐existing mutations in the reverse transcriptase gene.Conclusions This study of patients with increasing CD4 cell numbers despite virological failure shows the persistence of immune activation and partial immune restoration with no evidence of specific viral dynamics in vivo.