Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

2015 ◽  
Vol 18 (3) ◽  
pp. 098
Author(s):  
Cem Arıtürk ◽  
Serpil Ustalar Özgen ◽  
Behiç Danışan ◽  
Hasan Karabulut ◽  
Fevzi Toraman
Keyword(s):  
Body Temperature ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Extracorporeal Circulation ◽  
Group Iii ◽  
Oxygen Fraction ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

<p class="p1"><span class="s1"><strong>Background:</strong> The inspiratory oxygen fraction (FiO<sub>2</sub>) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO<sub>2</sub>) to reach hyperoxemic levels (&gt;180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO<sub>2</sub> levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO<sub>2</sub> levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO<sub>2</sub> during cardiac surgery.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO<sub>2</sub> adjustment strategies applied to the patients in the groups were as follows: FiO<sub>2</sub> levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Mean PaO<sub>2</sub> was significantly higher in Group I than in Group II at T2 and T3 (<em>P</em> = .0001 and <em>P</em> = .0001, respectively); in Group I than in Group III at T1 (<em>P</em> = .02); and in Group II than in Group III at T2, T3, and T4 <br /> (<em>P</em> = .0001 for all). </span></p><p class="p1"><span class="s1"><strong>Conclusion: </strong>Adjustment of FiO<sub>2</sub> according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO<sub>2</sub> between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO<sub>2</sub> levels in concordance with the body temperature in the <br /> rewarming period.</span></p>

Functional adaptation to reduced renal mass in early development

1982 ◽  
Vol 242 (2) ◽  
pp. F190-F196 ◽  
Author(s):  
R. L. Chevalier
Keyword(s):  
Renal Mass ◽  
Left Kidney ◽  
Extracellular Fluid ◽  
Functional Adaptation ◽  
Fluid Loss ◽  
Group Iii ◽  
Arterial Blood ◽  
India Ink ◽  
Group I ◽  
Group Ii

To determine whether reduced renal mass in the newborn results in acceleration of normal renal development, the response to unilateral nephrectomy (N) before 36 h of age was compared with sham-operated (S) guinea pigs during the period of most rapid nephron maturation. Studies were performed at 7-13 days (group I) and 19-25 days (group II). Mean arterial blood pressure (AP), left kidney glomerular filtration rate (LKGFR), and urine sodium excretion (UNaV) were measured. Superficial single nephron GFR (sSNGFR) and proximal fractional water reabsorption (FRH2O) were measured by micropuncture, and the number of glomeruli (NG) was determined by India ink perfusion. In view of the susceptibility of the neonate to extracellular fluid loss, groups I and II were plasma infused to maintain euvolemia and group II was compared with 19- to 25-day-old hydropenic animals (group III). Increase in body weight with age was unaffected by neonatal N. In group IN, the compensatory increase in sSNGFR was greater than SNGFR for deeper nephrons, which normally contribute most to GFR at this age. In group IIN there was an 80% adaptive increase in LKGFR that could not be entirely explained by the rise in SNGFR. Since NG in group IIN was greater than in group IIS and similar to that in adulthood, the enhanced adaptation in LKGFR in group IIN may be due in part to earlier recruitment of a population of underperfused glomeruli. FRH2O did not change significantly with age and did not differ in N and S groups. Animals in group III developed a rise in hematocrit during the experiment, and AP, LKGFR, and UNaV were lower in group IIIN than in group IIN. It is concluded that following N at birth, the sequence of renal functional maturation is accelerated while glomerulotubular balance is preserved. As a result of these adaptative changes, homeostasis is maintained and body growth proceeds without impairment.

Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 139-143 ◽  
Author(s):  
Waldemar A. Carlo ◽  
Lucia Pacifico ◽  
Robert L. Chatburn ◽  
Avroy A. Fanaroff
Keyword(s):  
Respiratory Failure ◽  
Computer Program ◽  
Computer Assisted ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Assisted Management

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P &lt; .005; and group III, 46/63, 73%, P &lt; .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

Effect of norepinephrine on diaphragm contractility and blood flow

1990 ◽  
Vol 69 (6) ◽  
pp. 2019-2028 ◽  
Author(s):  
G. S. Supinski ◽  
A. F. DiMarco ◽  
J. Gonzalez ◽  
M. D. Altose
Keyword(s):  
Blood Flow ◽  
Group Iv ◽  
Arterial Flow ◽  
Force Frequency ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Intramuscular Electrodes ◽  
Phrenic Artery ◽  
Group Ii

Recent studies have shown that diaphragm fatigue can be reversed by mechanical augmentation of phrenic arterial flow. The purpose of the present experiment was to determine whether it was possible to pharmacologically augment diaphragm blood flow and reverse fatigue by the administration of norepinephrine. Four groups of studies were performed, all employing our previously described in situ isometric canine diaphragm strip preparation (Supinski et al., J. Appl. Physiol. 60: 1789-1796, 1986). Group I studies examined the effects of norepinephrine on the contractility of the nonfatigued diaphragm in normotensive dogs, group II studies examined the effects of this drug on the contractility of the fatigued diaphragm in normotensive animals, and group III studies examined the effect of this drug on the contractility of the fatigued diaphragm in hypotensive animals. Group IV studies examined the effect of norepinephrine in normotensive animals in which the phrenic artery was cannulated and pump perfused at constant flow. Fatigue was induced in group II, III, and IV studies by rhythmically stimulating the diaphragm via intramuscular electrodes. Norepinephrine had no effect on the contractility of the nonfatigued diaphragm (group I). In normotensive (group II) and hypotensive animals (group III), norepinephrine elicited dramatic increases in arterial blood pressure and phrenic arterial flow and produced a significant upshift in the force-frequency curve of the fatigued diaphragm. However, when phrenic flow was held constant (group IV experiments), norepinephrine failed to augment the contractility of the fatigued diaphragm. These results indicate that 1) norepinephrine can increase phrenic blood flow and augment the contractility of the fatigued diaphragm in both normotensive and hypotensive conditions and 2) this effect of norepinephrine to partially reverse fatigue is secondary to its action to augment diaphragmatic blood flow.

Estimating changes in volume-weighted mean body temperature using thermometry with an individualized correction factor

2010 ◽  
Vol 299 (2) ◽  
pp. R387-R394 ◽  
Author(s):  
Ollie Jay ◽  
Michel B. DuCharme ◽  
Paul Webb ◽  
Francis D. Reardon ◽  
Glen P. Kenny
Keyword(s):  
Body Temperature ◽  
Skin Temperature ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Estimation Error ◽  
Core Shell ◽  
Weighted Mean ◽  
Mean Body Temperature ◽  
C 30

This study investigated whether the estimation error of volume-weighted mean body temperature (ΔT̄b) using changes in core and skin temperature can be accounted for using personal and environmental parameters. Whole body calorimetry was used to directly measure ΔT̄b in an Experimental group (EG) of 36 participants (24 males, 12 females) and a Validation group (VG) of 20 (9 males, 11 females) throughout 90 min of cycle ergometry at 40°C, 30% relative humidity (RH) ( n = 9 EG, 5 VG); 30°C, 30% RH ( n = 9 EG, 5 VG); 30°C, 60% RH ( n = 9 EG, 5 VG); and 24°C, 30% RH ( n = 9 EG, 5 VG). The core of the two-compartment thermometry model was represented by rectal temperature and the shell by a 12-point mean skin temperature (ΔT̄sk). The estimation error (X0) between ΔT̄b from calorimetry and ΔT̄b from thermometry using core/shell weightings of 0.66/0.34, 0.79/0.21, and 0.90/0.10 was calculated after 30, 60, and 90 min of exercise, respectively. The association between X0 and the individual variation in metabolic heat production (M − W), body surface area (BSA), body fat percentage (%fat), and body surface area-to-mass ratio (BSA/BM) as well as differences in environmental conditions (Oxford index) in the EG data were assessed using stepwise linear regression. At all time points and with all core/shell weightings tested, M − W, BSA, and Oxford index independently correlated significantly with the residual variance in X0, but %fat and BSA/BM did not. The subsequent regression models were used to predict the thermometric estimation error (X0_pred) for each individual in the VG. The value estimated for X0_pred was then added to the ΔT̄b estimated using the two-compartment thermometry models yielding an adjusted estimation (ΔT̄b_adj) for the individuals in the VG. When comparing ΔT̄b_adj to the ΔT̄b derived from calorimetry in the VG, the best performing model used a core/shell weighting of 0.66/0.34 describing 74%, 84%, and 82% of the variation observed in ΔT̄b from calorimetry after 30, 60, and 90 min, respectively.

Effect of Enamel Deproteinization in Primary Teeth

2018 ◽  
Vol 42 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Ananthi Christopher ◽  
R Krishnakumar ◽  
N Venugopal Reddy ◽  
G Rohini
Keyword(s):  
Surface Area ◽  
Group Iv ◽  
Enamel Surface ◽  
Tooth Surface ◽  
Type I ◽  
Group Iii ◽  
Group I ◽  
Electron Microscope Analysis ◽  
Group Ii ◽  
Quality Type

Objective: To evaluate and compare the topographical features of enamel surface, etched with different materials. Study Design: 10 extracted human primary molars were randomly selected and cut and trimmed to 1 mm2. Each group comprised of 10 blocks and the enamel was treated as follows: Group I–35% H3PO4; Group II–5.25% NaOCl + 35% H3PO4 ;Group III–5.25% NaOCl; Group IV no treatment was carried out. All the samples were prepared for Scanning electron microscope analysis. The images were obtained and evaluated for the quality type I–II etching of the enamel surface using Auto-CAD 2011 software. Statistical Analysis Used: Wilcoxon Signed Ranks Test (p&lt;0.001). Results: The mean surface area of type I and II etching pattern values for Group- I was 39608.18 μm2 and Group- II was 45051.34 μm2. Conclusion: Deproteinization with 5.25% Sodium hypochlorite prior to acid etching could be used to increase the surface area of adhesion of composite material with the tooth surface.

scholarly journals Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement

2021 ◽  
pp. 177-188
Author(s):  
Heba Salah Eldin Ismail Gawish ◽  
Amr Arafa Mohammed Elbadry ◽  
Nagat Sayed Mohammed El-Shmaa ◽  
Abdelraheem Mostafa Dowidar
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Femoral Nerve ◽  
Group Iii ◽  
Insignificant Change ◽  
Adductor Canal ◽  
Arterial Blood ◽  
Group I ◽  
Total Knee ◽  
Group Ii

Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA. ‎Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021. Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II. Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II. Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day. Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.

scholarly journals Comparative Study between the Effect of Dexmedetomidine or Magnesium Sulphate Infusion on the Recovery Profile and Postoperative Analgesia in Patients Undergoing Laparoscopic Bariatric Surgery

2021 ◽  
pp. 42-52
Author(s):  
Doaa Kelany Ibrahim ◽  
Sameh Abd EL Khalik Ahmed ◽  
Ashraf Elsayed El Zeftawy ◽  
Sabry Mohamed Amin
Keyword(s):  
Bariatric Surgery ◽  
Magnesium Sulphate ◽  
Controlled Study ◽  
Laparoscopic Bariatric Surgery ◽  
Early Recovery ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Recovery Profile ◽  
Group Ii

Background: The increasing incidence of morbid obesity is a crisis in national healthcare which has precipitated an increase in bariatric surgery. Bariatric surgery is an effective treatment for obesity, with a mean percentage of weight loss after 2 years of 68.2% for laparoscopic bariatric surgery. Methods: This prospective randomized controlled study was carried out in Tanta University Hospitals in General Surgery Department on patients scheduled for elective laparoscopic bariatric surgery from July 2019 to June 2020. The study has been approved by the Institutional ethical committee at Faculty of Medicine, Tanta University with approval number (33161/05/19) Results: There was a significant decrease in heart rate, at T2 to T9, in group II (Dexmedetomidine group) and group III (Mg sulphate group) compared to group I (Control group). There was a significant decrease in mean arterial blood pressure, at T2 to T9,  in group II and group III compared to group I. Visual analog scale for pain (VAS) was decreased significantly in group II and group III compared to group I. There was a negative increase in nausea and vomiting in group I than group II and group III. Bradycardia, hypotension and postoperative hypoxemia were insignificantly different among the three groups. Conclusions: In patients undergoing laparoscopic bariatric surgeries, both dexmedetomidine and magnesium sulphate were safe and effective as regards early recovery profile, delayed time for the first request of analgesia and less opioid consumption.

scholarly journals Nephro protection property of double blockade versus single blocked of RAAS in delaying the progression of CKD

2018 ◽  
Vol 5 (3) ◽  
pp. 748
Author(s):  
Arvind Gupta ◽  
Upma Narain ◽  
Romar Dabu
Keyword(s):  
Blood Pressure ◽  
Phase Iii ◽  
P Value ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Protection Property

Background: Dual renin angiotensin aldosterone system blockade using angiotensin receptor blockers in combination with angiotensin converting enzyme inhibitors is reported to improve proteinuria in non-diabetic patients.Methods: A prospective observational study was done on 810 non-diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the nephro protection property of double blockade and single blocked of renin angiotensin aldosterone system in delaying the progression of chronic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0001) was found significant. Similarly, on comparing group II and group III, p value (0.003) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (<0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than monotherapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate. Newer potassium lowering therapies can effectively and safely correct hyperkalemia and maintain normokalemia in patients receiving background treatment with renin angiotensin aldosterone system blockade. However, the use of new potassium binders for cardiovascular and renal risk reduction with combined renin angiotensin aldosterone system blockade therapy will require phase III trials.

scholarly journals The efficacy of Coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning

2020 ◽  
Vol 9 (4) ◽  
pp. 444-453 ◽  
Author(s):  
Ragaa Talaat Darwish ◽  
Zahraa Khalifa Sobh ◽  
Emad Hamdy Hamouda ◽  
Eman Mohamed Saleh
Keyword(s):  
Coenzyme Q10 ◽  
Liquid Paraffin ◽  
Gastric Lavage ◽  
Residual Effects ◽  
Aluminum Phosphide ◽  
Group Iii ◽  
Arterial Blood ◽  
Paraffin Oil ◽  
Group I ◽  
Group Ii

Abstract Aluminum phosphide (AlP) poisoning had high morbidities and mortalities with absence of a standardized approach for the treatment. The present study investigated the efficiency of GIT decontamination methods and Coenzyme Q10(Co Q10) (Ubiquinone) in improving the outcome of acute AlP poisoning. A total of 90 patients were included and all patients received immediately supportive measures, then they distributed into three equal groups: In group I, gastric lavage was done using KMNO4 solution (1:10 000); group II received 250–500 ml liquid paraffin oil orally; group III received 300 mg of Co Q10 dissolved in liquid paraffin. Co Q10 was continued in a dose of 200 mg/day every 12 h. Follow-up blood pressure, arterial blood gases, serum troponin level and need for intubation revealed that the best improvement was in group III followed by group II. The percentage of survivors was 76.67% in group III and 70% of the patients had no residual effects. In group II, the survivors were 63.33%, and 36.67% of the cases discharged without sequelae. The survivors in group I constituted 26.67% and only 16.67% of the patients had no residual effects. GIT decontamination with aqueous solutions in acute AlP poisoning should be avoided. Rapid oral intake of any available oil as a prehospital treatment or immediately on hospital admission could critically improve the outcome of acute AlP poisoning. Besides, the addition of Co Q10 to the oil further improve patients’ prognosis. HighlightsAcute aluminum phosphide (AlP) poisoning is associated with high mortalities.The appropriate method of GIT decontamination in acute AlP poisoning is controversy.Conventional gastric lavage was associated with poor prognosis in acute AlP poisoning.GIT decontamination using liquid paraffin oil improved outcome of acute AlP poisoning.Coenzyme Q10 ameliorated AlP toxicity with improvement of cardiac functions.

scholarly journals Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study

2019 ◽  
Vol 8 (4) ◽  
pp. 464 ◽  
Author(s):  
Marcin Majos ◽  
Agata Majos ◽  
Michał Polguj ◽  
Konrad Szymczyk ◽  
Jakub Chrostowski ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Horseshoe Kidney ◽  
Group Iv ◽  
Renal Arteries ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Mean Diameter ◽  
The Mean ◽  
Group Ii

Background: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK). Methods: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries; these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA); Group II, branching from the aorta below the IMA; Group III, branching from the iliac artery; and Group IV, originating from the internal and external iliac artery. Results: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p < 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm; Group II, 4.28 mm; Group III, 3.41 mm; and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p < 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm; and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%; Group II, 82.4%; Group III, 68.4%; and Group IV, 66.6%. Conclusions: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.

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