The superiority of oral cryotherapy (OC) for prevention of chemotherapy-induced oral mucositis (OM) has been demonstrated in several trials. In clinical settings, cooling is usually initiated prior ...to the chemotherapy infusion. It then continues during the infusion, and for a period after the infusion has been completed. While the cooling period post-infusion depends on the half-life of the chemotherapeutic drug, there is no consensus on when cooling should be initiated prior to the infusion. The lowest achieved temperature in the oral mucosa is believed to provide the best condition for OM prevention. Given this, it was of interest to investigate when along the course of intraoral cooling this temperature is achieved. In total, 20 healthy volunteers participated in this randomized crossover trial. Each subject attended three separate cooling sessions of 30 min each, with ice chips (IC) and the intraoral cooling device (ICD) set to 8 and 15 °C, respectively. At baseline and following 5, 10, 15, 20 and 30 min of cooling, intraoral temperatures were registered using a thermographic camera. The greatest drop in intraoral temperature was seen after 5 min of cooling with IC, ICD
8°C
and ICD
15°C
, respectively. A statistically significant difference, corresponding to 1.4 °C, was seen between IC and the ICD
15°C
(
p
< 0.05). The intraoral temperature further declined throughout the 30 min of cooling, showing an additional temperature reduction of 3.1, 2.2, and 1.7 °C for IC, ICD
8°C
and ICD
15°C
, respectively.
Background
The use of neuromuscular blocking agents is still controversial in myasthenic patients but rocuronium could be useful after the introduction of sugammadex as a selective antagonist. The ...aim of the study was to evaluate the use of rocuronium‐sugammadex in myasthenic patients undergoing thoracoscopic thymectomy.
Methods
After ethical approval, 10 myasthenic patients undergoing videothoracoscopic‐assisted thymectomy were enrolled in the study. Neuromuscular block was achieved with 0.3 mg/kg rocuronium and additional doses were given according to train‐of‐four (TOF) monitoring or movement of the diaphragm. Sugammadex 2 mg/kg was given after surgery. Recovery time (time to obtain a TOF value > 0.9) was recorded for all subjects.
Result
All patients were extubated in the operating room after administration of sugammadex. Mean rocuronium dose was 48 mg and the average operation time was 62 min. Recovery time after sugammadex administration was 111 s (min 35; max 240).
Conclusions
A rapid recovery of neuromuscular function was found in myasthenic patients receiving rocuronium when sugammadex was used for reversal. This combination could be a rational alternative for myasthenic patients for whom neuromuscular blockade is mandatory during surgery.
In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia TEA with and without preoperative initiation and IV ...patient-controlled analgesia IV-PCA) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain.
Preoperatively initiated thoracic epidural analgesia has the most satisfying results in controlling postthoracotomy pain in the acute and long-term period, and it is associated with a decreased incidence (and intensity) of chronic pain compared with postoperative (epidural or IV) analgesia. Chronic pain has an incidence of 62%.
Landmark-based morphometric analyses are used by anthropologists, developmental and evolutionary biologists to understand shape and size differences (eg. in the cranioskeleton) between groups of ...specimens. The standard, laborintensive approach is for researchers to manually place landmarks on 3D image datasets. As landmark recognition is subject to inaccuracies of human perception, digitization of landmark coordinates is typically repeated (often by more than one person) and the mean coordinates are used. In an attempt to improve efficiency and reproducibility between researchers, we have developed an algorithm to locate landmarks on CT mouse hemi-mandible data. The method is evaluated on 3D meshes of 28-day old mice, and results compared to landmarks manually identified by experts. Quantitative shape comparison between two inbred mouse strains demonstrate that data obtained using our algorithm also has enhanced statistical power when compared to data obtained by manual landmarking.
Interest in combining local and general anaesthesia has lead to studies investigating possible interactions. In a prospective, randomized, double-blind study, we tested whether local anaesthetics ...administered i.m. potentiate the hypnotic effect of propofol.
Sixty patients (three groups, n=20) undergoing lower abdominal surgery with total i.v. propofol anaesthesia were investigated. Patients in Group B received i.m. bupivacaine (5 mg ml−1) 1 mg kg−1, patients in Group L received i.m. lidocaine (100 mg ml−1) 2 mg kg−1 and patients in Group C received i.m. saline 5 ml before operation. Hypnosis was measured with bispectral index (BIS).
The induction (BIS <45), and the maintenance doses of propofol (BIS between 40 and 50) were significantly less in Group B and Group L compared with the control group. Induction doses were 1.58 (sd 0.39), 1.56 (0.24) and 2.03 (0.33) mg kg−1 respectively; P<0.0001. Maintenance doses were 6.33 (2.06), 7.08 (1.23) and 9.95 (2.02) mg kg−1 respectively in the first hour; P<0.0001. Groups B and L were associated with an attenuated haemodynamic response to both induction and intubation.
I.M. administered local anaesthetics are associated with a decrease in both the induction and maintenance doses of propofol during total i.v. anaesthesia and a reduction in haemodynamic responses.
Background: In this clinical randomized study, the effects of four anaesthesia techniques during one‐lung ventilation total intravenous anesthesia (TIVA) with or without thoracic epidural ...anaesthesia (TEA) (G‐TIVA‐TEA and G‐TIVA), isoflurane anaesthesia with or without TEA (G‐ISO‐TEA and G‐ISO) on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated.
Methods: In 100 patients (four groups, 25 patients in each) undergoing thoracotomy, a thoracic epidural catheter was inserted pre‐operatively. In G‐TIVA‐TEA and G‐ISO‐TEA, bupivacaine 0.1% + 0.1 mg/ml morphine was administered intra‐operatively (10 ml of first bolus + 7 ml/h infusion). Propofol infusion or isoflurane concentration was adjusted to keep a bispectral index (BIS) of between 40 and 50 in all groups. FiO2 was 0.8 during OLV and 0.5 before and after OLV. Partial arterial and central venous oxygen pressures (PaO2 and PvO2), arterial and venous oxygen saturations and Qs/Qt values were recorded before, during and after OLV.
Results: During OLV, PaO2 was significantly higher and Qs/QT significantly lower in G‐TIVA‐TEA and G‐TIVA compared with G‐ISO‐TEA and G‐ISO (PaO2: 188 ± 36; 201 ± 39; 159 ± 33; 173 ± 42 mmHg, respectively; Qs/Qt: 31.2 ± 7.4; 28.2 ± 7; 36.7 ± 7.1; 33.7 ± 7.7%, respectively). No statistical changes were observed in patients with TEA compared with without TEA in any measurement.
Conclusion: During OLV, TEA does not significantly affect the oxygenation and Qs/Qt and can be used safely regardless of whether TIVA or inhalation techniques are used.
This paper introduces a new tool to quantify and characterize asymmetry in bilaterally paired structures. This method uses deformable registration to produce a dense vector field describing the point ...correspondences between two images of bilaterally paired structures. The deformation vector field properties are clustered to detect and describe regions of relevant asymmetry. Three methods are provided to analyze the asymmetries: the global asymmetry score uses cluster features to quantify overall asymmetry, the local asymmetry score quantifies asymmetry in user-defined regions of interest, and the asymmetry similarity measure quantifies pairwise similarity of individual asymmetry. The scores and image distances generated by this tool are shown to correlate highly with asymmetry ratings assigned by an expert.
Pressure controlled ventilation (PCV) is an alternative mode of ventilation which is used widely in severe respiratory failure. In this study, PCV was used for one-lung anaesthesia and its effects on ...airway pressures, arterial oxygenation and haemodynamic state were compared with volume controlled ventilation (VCV). We studied 48 patients undergoing thoracotomy. After two-lung ventilation with VCV, patients were allocated randomly to one of two groups. In the first group (n = 24), one-lung ventilation was started by VCV and the ventilation mode was then switched to PCV. Ventilation modes were performed in the opposite order in the second group (n = 24). We observed that peak airway pressure (P = 0.000001), plateau pressure (P = 0.01) and pulmonary shunt (P = 0.03) were significantly higher during VCV, whereas arterial oxygen tension (P = 0.02) was significantly higher during PCV. Peak airway pressure (Paw) decreased consistently during PCV in every patient and the percentage reduction in Paw was 4-35% (mean 16.1 (SD 8.4) %). Arterial oxygen tension increased in 31 patients using PCV and the improvement in arterial oxygenation during PCV correlated inversely with preoperative respiratory function tests. We conclude that PCV appeared to be an alternative to VCV in patients requiring one-lung anaesthesia and may be superior to VCV in patients with respiratory disease.
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