Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic ...efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial.
Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 µg (SM) or saline (SS) and a postoperative bilateral TAP block with either bupivacaine (TLA) 2 mg kg−1 or saline (TS).
Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: SMTLA (20 mm)<SMTS (27.5 mm)<SSTS (51.5 mm)<SSTLA (52.0 mm) (P<0.05, highest vs lowest). The rank order of median morphine consumption at 6 h was: SMTS (4.0 mg)<SMTLA (5.0 mg)<SSTLA (8.0 mg)<SSTS (12.0 mg) and at 24 h was: SMTLA (5.0 mg)<SMTS (6.0 mg)<SSTS (9.5 mg)<SSTLA (15.0 mg) (P<0.05, highest vs lowest). Sedation scores and patient satisfaction did not differ between groups. Anti-emetic use and pruritus were highest in the SMTLA group.
Spinal morphine—but not TAP block—improved analgesia after Caesarean section. The addition of TAP block with bupivacaine 2 mg kg−1 to spinal morphine did not further improve analgesia.
Heavy ion, neutron, and laser experimental data are used to evaluate the effectiveness of various single event latchup (SEL) hardening strategies, including silicon-on-insulator (SOI), triple well, ...and guard rings. Although SOI technology is widely reported to be immune to SEL, conventional pnpn latchup can occur and has been observed in non-dielectrically isolated SOI processes. Triple well technologies are shown to be more robust against SEL than dual well technologies under all conditions used in this study, suggesting that the introduction of a deep N-well is an excellent zero-area-penalty hardening strategy. A single guard ring is shown to be sufficient for SEL immunity in the 180 nm CMOS technology investigated, and is likely sufficient for more modern CMOS technologies. After triggering latchup in a certain pnpn region, latchup was observed to spread to neighboring pnpn regions, which then infected other more distant regions until it had spread over a total distance of 700 micrometers. We discuss the physical mechanism of this latchup domino effect and its implications for device characterization and hardness assurance.
Summary
We present a randomised, controlled, crossover trial of the Caudwell Xtreme Everest (CXE) closed circuit breathing system vs an open circuit and ambient air control in six healthy, hypoxic ...volunteers at rest and exercise at Everest Base Camp, at 5300 m. Compared with control, arterial oxygen saturations were improved at rest with both circuits. There was no difference in the magnitude of this improvement as both circuits restored median (IQR range) saturation from 75%, (69.5–78.9 68–80%) to > 99.8% (p = 0.028). During exercise, the CXE closed circuit improved median (IQR range) saturation from a baseline of 70.8% (63.8–74.5 57–76%) to 98.8% (96.5–100 95–100%) vs the open circuit improvement to 87.5%, (84.1–88.6 82–89%; p = 0.028). These data demonstrate the inverse relationship between supply and demand with open circuits and suggest that ambulatory closed circuits may offer twin advantages of supplying higher inspired oxygen concentrations and/or economy of gas use for exercising hypoxic adults.
Summary
We describe a unique ambulatory closed circuit for delivering high fractions of inspired oxygen to an exercising user who does not require isolation from their environment. We describe the ...major components and their function and suggest potential applications for such a circuit. This circuit may benefit patients who are chronically dependant on oxygen, are unable to exercise due to hypoxia, or require oxygen supplementation at high altitude.
The Variable Depth Bragg Peak method has been investigated for single event latchup testing by comparing latchup cross sections for heavy ions at low and high energies and by pulse height analysis. ...Results show that, unlike for an SOI device previously tested, where the charge collection depth is very small (70 nm), the comparison is not straightforward for latchup because of the large charge collection volumes involved. The variation in LET with depth for lower-energy ions greatly affects the comparison, but, if a charge collection depth of 50 μm is assumed and the LET is averaged over that distance, the comparison improves significantly.
Massive post-partum haemorrhage continues to be one of the world's leading causes of maternal morbidity and mortality. Any new treatment that potentially helps at risk parturients should be ...thoroughly investigated. Recombinant factor VIIa (rVIIa) is increasingly being used in the treatment of massive haemorrhage. We performed a case-matched analysis of its use since 2003 in the treatment of massive post-partum haemorrhage at our hospital.
Twenty-eight cases of massive post-partum haemorrhage were identified over a 3-yr period since 2003. In six of these cases, rVIIa was used as part of their management. Six case-matched controls were sought. The six women with the greatest requirement for packed red cell transfusion who also had a deranged prothrombin time were included. The groups were then compared for differences. The worst prothrombin time in each group was noted as was the best prothrombin time within 6 h, this was used as our measure of response to treatment.
There was no statistical difference in age, gestation, parity, transfusion requirements, mode of delivery or the severity of the coagulopathy between the two groups. In both groups the prothrombin time improved with management. There was no significant difference in either the magnitude of the improvement in the value of the prothrombin time or the absolute value of the best prothrombin time (P = 0.09). Five out of the six women in the rFVIIa group had normal or low prothrombin times within 6 h yet only one woman who did not receive rFVIIa had a normal prothrombin time within 6 h though this was not significant (P = 0.08).
This case-matched analysis supports the management of massive post-partum haemorrhage with appropriate resuscitation, surgical intervention and use of blood and blood products. This study does not support the routine use of rFVIIa in the management of massive obstetric haemorrhage. rFVIIa may have a role to play in this management but further studies and analyses will be required.
A new mirrored laryngoscope McMorrow, R. C. N.; Mirakhur, R. K.
Anaesthesia,
October 2003, Letnik:
58, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Summary
A new laryngoscope has been designed, incorporating an adjustable mirror and a levered tip similar to the McCoy blade, in an attempt to bridge the gulf between simple direct laryngoscopy and ...fiberoptic laryngoscopy. Manual in‐line neck stabilisation was used to simulate difficult laryngoscopy in 14 anaesthetised patients after full neuromuscular blockade. The best view at laryngoscopy was assessed using a standard Macintosh laryngsocope, a size 3 McCoy laryngoscope and the mirrored laryngoscope. The best laryngeal view obtained in all cases with the Macintosh blade was a grade 3. The mirrored laryngoscope improved this view in 10 cases (71%) compared with five cases (36%) with the McCoy laryngoscope (p = 0.005); in seven cases (50%), the view improved to a grade 1 compared with no cases when the McCoy was used (p = 0.02). We conclude that the mirrored laryngoscope offers considerable advantages over the Macintosh and the McCoy laryngoscopes in simulated difficult laryngoscopy, is simple to use and requires no special training.
Laser and heavy-ion data reveal the areas and shapes of single-event latchup (SEL)-sensitive regions in CMOS test structures and their positions relative to the affected p-n-p-n paths. Contrary to ...previous two-dimensional studies, this three-dimensional study shows that the position of maximum SEL sensitivity in these structures is not centered on a p-n-p-n region, but between two neighboring p-n-p-n regions, suggesting that synergistic triggering increases SEL sensitivity. The SEL-sensitivity maps suggest that laser light scattered from metal lines toward the silicon can contribute to the SEE response, for both back-side-incident two-photon absorption and front-side-incident single-photon absorption laser tests. We describe the metallization configurations and laser pulse energies for which reflected and/or diffracted laser light may contribute to the single-event effect (SEE) response.
Interactions between electrons and lattice vibrations are responsible for a wide range of material properties and applications. Recently, there has been considerable interest in the development of ...resonant inelastic x-ray scattering (RIXS) as a tool for measuring electron-phonon (e-ph) interactions. Here, we demonstrate the ability of RIXS to probe the interaction between phonons and specific electronic states both near to, and away from, the Fermi level. We performed carbon $K$-edge RIXS measurements on graphite, tuning the incident x-ray energy to separately probe the interactions of the $\pi^*$ and $\sigma^*$ electronic states. Our high-resolution data reveals detailed structure in the multi-phonon RIXS features that directly encodes the momentum dependence of the e-ph interaction strength. We develop a Green's-function method to model this structure, which naturally accounts for the phonon and interaction-strength dispersions, as well as the mixing of phonon momenta in the intermediate state. This model shows that the differences between the spectra can be fully explained by contrasting trends of the e-ph interaction through the Brillouin zone, being concentrated at the $\Gamma$ and $K$ points for the $\pi^*$ states, while being significant at all momenta for the $\sigma^*$ states. Our results advance the interpretation of phonon excitations in RIXS, and extend its applicability as a probe of e-ph interactions to a new range of out-of-equilibrium situations.
Background: Normal subjects frequently experience troublesome respiratory symptoms when acclimatised to altitude. Bronchial hyperresponsiveness (BHR) and full and partial flow-volume loops were ...measured before and after ascent to 5000 m altitude to determine if there are changes in resting bronchial tone and BHR that might explain the symptoms. Methods: BHR to histamine was measured using a turbine spirometer to record partial and full flow-volume curves and expressed as log dose slopes. Twenty one subjects were tested at sea level and after acclimatisation at 5000 m altitude. Results: No significant change in log dose slope measurements of forced expiratory volume in 1 second occurred after acclimatisation, and the maximal expiratory flow with 30% of forced vital capacity remaining (MEF30%) rose on the full loop and fell on the partial loop. Their ratio (full divided by partial) rose on average by 0.28 (95% confidence limits 0.14 to 0.42) from the mean (SD) sea level value of 0.87 (0.20). Conclusions: There is no increase in BHR in normal subjects acclimatised to altitude but an increase in resting bronchial tone occurs that could be released by deep inspiration. This may be the result of increased cholinergic tone.
PDF
