Anaesthesiology

Format: 170 x 240 mm ; 608 pages
ISBN: 9782294739897

Sous la direction de Catherine Muller et Jérôme Chevillotte

La formation des infirmiers anesthésistes diplômés d'État (IADE) est centrée sur les techniques d'anesthésie-réanimation-urgences et vise à l'acquisition des connaissances théoriques et cliniques nécessaires à la pratique infirmière au cours des anesthésies générales ou locorégionales.

Riche et complet,cet ouvrage est axé sur le référentiel des deux années de formation et couvre, de manière théorique et pratique, l'ensemble du programme.

Le contenu, composé de 200 fiches illustrées de schémas et dessins, est émaillé de conseils et d'études de cas analysées pour l'IADE diplômé ou en cours d'études.
Présentées de façon claire et synthétique, ces 200 fiches sont regroupées en 6 grands chapitres :
Sciences humaines, sociales et droit ;
Sciences cliniques, biologiques et médicales ;
Fondamentaux en anesthésie-réanimation-urgences ;
Exercices particuliers en anesthésie-réanimation-urgences ;
Outils en anglais ;
Situations cliniques.

Véritable vade-mecum unique pour un usage quotidien théorique et pratique en anesthésie réanimation et urgences, ce Guide de l'infirmier anesthésiste est conforme au nouveau programme de formation et aux dernières recommandations professionnelles et ainsi autant destiné aux étudiants infirmiers anesthésistes qu'aux professionnels diplômés soucieux de parfaire leurs connaissances.

Objective: Nutritional compounds that potentially limit inflammation and tissue factor expression may decrease the progression of chronic kidney disease (CKD) and associated cardiovascular disease. This project aimed to determine the effect of curcumin, bovine colostrum, and fish oil on inflammatory cytokine and tissue factor procoagulant activity of peripheral blood mononuclear cells (PBMCs) from patients with CKD before dialysis. Methods: Peripheral blood mononuclear cells from patients with CKD before dialysis (n ¼ 13) and age-and sex-matched healthy controls (n ¼ 12) were cultured alone and with low and high doses of the nutritional compounds for 24 h. Cells were cultured with and without lipopolysaccharide. Supernatants were analyzed for tumor necrosis factor-a, interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1, IL-1b, C-reactive protein, and tissue factor procoagulant activity. Results: The production of C-reactive protein, monocyte chemoattractant protein-1, IL-6, and IL-1b by PBMCs was inhibited by low-and high-dose fish oil in the CKD group (P < 0.05). Curcumin decreased secretion of IL-6 (P ¼ 0.015) and IL-1 b (P ¼ 0.016). Curcumin was more effective than colostrum at decreasing the procoagulant activity of PBMCs in the CKD and control groups (P < 0.019). Conclusion: Fish oil decreased inflammatory cytokine secretion from CKD PBMCs. In addition, the beneficial effects of curcumin were demonstrated in decreasing inflammation in vitro, often to a similar magnitude as fish oil.

Background: administration of general anesthesia is associated with endotracheal intubation which in turn causes postoperative sore throat. Our aim was to see the effectiveness of intravenous dexamethasone in prevention of postoperative sore throat. Methods: 100 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into two groups of 50 each. Group I (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group II (placebo group) received 50 ml of normal saline for 10 minutes after intubation. Incidence and severity of sore throat and incidence of hoarseness of voice was assessed at different study intervals postoperatively. Results: There was statistically significant decrease in sore throat and hoarseness in dexamethasone group than placebo group (p-value<0.05). Conclusion: Dexamethasone given intravenously reduces incidence and severity of sore throat and incidence of hoarseness caused due to endotracheal intubation.

Aims and Objective: The technique of securing upper airway that avoids or minimizes pharyngo-laryngeal stimulation may produce lesser hemodynamic response. We compared hemodynamic response with ILMA and I-gel insertion during general anaesthesia. Materials and Methods: The study was carried out as a prospective, randomized, blinded clinical study among 70 patients, divided in two equal groups 35 each, who underwent different surgical procedures under general anesthesia. After induction of anaesthesia, Supraglottic airway device was inserted in both groups, tracheal intubation was attempted through the ILMA. HR, SBP, DBP, ST-T segment changes and SPO 2 values were recorded before insertion of airway device, at one minute and at five minute after insertion in each case. Results: There was no change in HR at 1 min in I-gel group, while in ILMA group, it increased. Rise in SBP at 1 min after insertion of supra-glottic airway device was observed in both groups, but at 5 min rise was insignificant in I-GEL group and significant in ILMA group. When both groups were compared significant difference (P<0.05) was observed. Rise in DBP in I-GEL group was insignificant but in ILMA group, rise was significant. When both groups were compared significant difference (P<0.05) was observed in HR and BP. Saturation did not change in both groups and also no change in ST-T segment was observed. Conclusion: We conclude that insertion of I-gel is accompanied by minimal cardiovascular responses than those associated with intubation through intubating laryngeal mask airway (ILMA), so it is recommended for patient where a minimal pressure response to airway manipulation is desired.

Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects.

Background: Anaesthetic record is an essential part of the patient's medical record. It includes the perioperative management that is relevant to the anaesthesia practice. This information helps other staff who will be involved in the care of the patient, for medico-legal defense and for quality assurance. We sometimes found anaesthetic recording sheets with incomplete information during the postoperative visit of patients in the recovery room and on the wards in our hospital. We aimed to assess the level of anaesthetic record completeness.

Duodenal perforation is a common emergency in hospital setup and has to be attended efficiently. It's a challenge to an anaesthetist. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative evaluation and stabilising vitals is a key along with surgical intervention (laparotomy). Time of presentation to hospital for definitive management is an important factor for the morbidity associated with these patients.

Here we present a dataset with a description of portrayed emotions in the movie ”Forrest Gump”. A total of 12 observers independently annotated emotional episodes regarding their temporal location and duration. The nature of an emotion was characterized with basic attributes, such as arousal and valence, as well as explicit emotion category labels. In addition, annotations include a record of the perceptual evidence for the presence of an emotion. Two variants of the movie were annotated separately: 1) an audio-movie version of Forrest Gump that has been used as a stimulus for the acquisition of a large public functional brain imaging dataset, and 2) the original audio-visual movie. We present reliability and consistency estimates that suggest that both stimuli can be used to study visual and auditory emotion cue processing in real-life like situations. Raw annotations from all observers are publicly released in full in order to maximize their utility for a wide range of application...

Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anesthetic management of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the level of L2-L3. The anesthetic implications of the various aspects of spinocerebellar degeneration are discussed.

Background: The addition of opioids like the lipophilic opioid fentanyl to local anaesthetics enhances surgical anaesthesia and prolongs the duration of anaesthesia in the postoperative period. Aims and Objectives: To compare the efficacy of Intrathecal Fentanyl along with bupivacaine and bupivacaine alone and their effect on prolonging the duration of postoperative analgesia in lower segment caesarean section without any adverse effects on the foetus, determined clinically by the APGAR scoring. Materials and Methods: The subjects included 50 patients belonging to ASA physical status I scheduled for lower segment caesarean section. Patients were randomly categorized in to two groups, group FB and group B consisting of 25 each. Patients in the group FB were given 8.5 mg of Bupivacaine plus 25 µg (0.5cc) fentanyl. Group B received 8.5 mg of Bupivacaine plus 0.5cc normal saline to adjust the final volume to 2.20 cc. Level of sensory block, duration of postoperative analgesia and any complications were noted. Results: There was not much difference in the onset of analgesia in both the groups. Majority of the patients in both the groups had a higher level of sensory block at T4. The time to reach highest sensory level did not show any significant difference among the groups. Postoperative analgesia lasted for a longer time in Group FB than Group B, the difference being statistically significant. Among various complications observed, pruritus (20%) was the commonest followed by nausea, bradycardia and hypotension. In Group B, only 6 (24%) patients had adverse effects, out of which 3 had shivering, 2 had hypotension and one had bradycardia. Conclusion: Fentanyl 25 µg does not enhance the onset and duration of sensory block produced by 8.5mg intrathecal hyperbaric bupivacaine. Fentanyl however prolongs postoperative analgesia and lowers the incidence of shivering.

At KIST Medical College, Lalitpur, Nepal, a Medical Humanities Background: module for first year medical students has been conducted. Role plays are used to explore social, medical and sexual issues in the Nepalese context. The present study obtained student feedback about the role plays used in the module, the difficulties faced, and obtained suggestions for further improvement. The module was conducted from January to August 2011 using a Method: total of 15 role plays. Student feedback was obtained using a semi-structured questionnaire. Informal discussions were held and a questionnaire was circulated among the first year students who had participated in the module. Ninety-eight of the 100 students in the module participated in the Results: study. The overall opinion regarding the role plays was positive. Students stated role plays helped to make module objectives concrete and interesting, made students identify with the problem being investigated and improved communication skills. Role plays were designed to address important health issues in Nepal and prepare students for addressing these issues in future practice. A lack of sufficient time for preparing the role plays and initial problems with group dynamics were mentioned by the respondents during the study. Student feedback about the use of role plays during the module Conclusions: was positive. Role plays helped in making module objectives more concrete and interesting, improved communication skills and addressed important health issues in Nepal. Role plays are not resource intensive and can be considered for use in medical schools in developing nations. Referees v1

Breast cancer is the most commonly diagnosed cancer in women. The latest world cancer statistics calculated by the International Agency for Research on Cancer (IARC) revealed that 1,677,000 women were diagnosed with breast cancer in 2012 and 577,000 died. The TNM classification of malignant tumor (TNM) is the most commonly used staging system for breast cancer. Breast cancer is a group of very heterogeneous diseases. The molecular subtype of breast cancer carries important predictive and prognostic values, and thus has been incorporated in the basic initial process of breast cancer assessment/diagnosis. Molecular subtypes of breast cancers are divided into human epidermal growth factor receptor 2 positive (HER2 +), hormone receptor positive (estrogen or progesterone +), both positive, and triple negative breast cancer. By virtue of early detection via mammogram, the majority of breast cancers in developed parts of world are diagnosed in the early stage of the disease. Early stage breast cancers can be completely resected by surgery. Over time however, the disease may come back even after complete resection, which has prompted the development of an adjuvant therapy. Surgery followed by adjuvant treatment has been the gold standard for breast cancer treatment for a long time. More recently, neoadjuvant treatment has been recognized as an important strategy in biomarker and target evaluation. It is clinically indicated for patients with large tumor size, high nodal involvement, an inflammatory component, or for those wish to preserve remnant breast tissue. Here we review the most up to date conventional and developing treatments for different subtypes of early stage breast cancer. Abstract | Publisher Full Text 6. van't Veer LJ, Dai H, van de Vijver MJ, et al.: Gene expression profiling predicts clinical outcome of breast cancer. Nature. 2002; 415(6871): 530-536. PubMed Abstract | Publisher Full Text 7. Carlson RW, Hudis CA, Pritchard KI: Adjuvant endocrine therapy in hormone receptor-positive postmenopausal breast cancer: evolution of NCCN, ASCO, and St Gallen recommendations. J Natl Compr Canc Netw. 2006; 4(10): 971-979. PubMed Abstract 8. Stanford JL, Szklo M, Brinton LA: Estrogen receptors and breast cancer. Epidemiol Rev. 1986; 8: 42-59. PubMed Abstract 9. Goldhirsch A, Wood WC, Coates AS, et al.: Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. modulator (SERM) action. J Pharmacol Exp Ther. 2000; 295(2): 431-437. PubMed Abstract 30. Trunet PF, Vreeland F, Royce C, et al.: Clinical use of aromatase inhibitors in the treatment of advanced breast cancer. J Steroid Biochem Mol Biol. 1997; 61(3-6): 241-245. PubMed Abstract 31. Jordan VC: Tamoxifen: a most unlikely pioneering medicine. Nat Rev Drug Discov. 2003; 2(3): 205-213. PubMed Abstract | Publisher Full Text 32. Waters EA, Cronin KA, Graubard BI, et al.: Prevalence of tamoxifen use for breast cancer chemoprevention among U.S. women. Cancer Epidemiol Biomarkers Prev. 2010; 19(2): 443-6. PubMed Abstract | Publisher Full Text | Free Full Text

Laparoscopy for gynaecological procedures is minimally invasive and is mostly performed as a daycase. The advancement of laparoscopy and minimal access surgery has greatly influenced the evolution of anaesthetic techniques. Preoperative assessment can be simplified by the use of questionnaires in pre-assessment clinics. Intraoperative intravenous fluid administration improves patient well being while airway management can be by the age-old, tried and trusted orotracheal tube or by the newer laryngeal mask airways. The use of propofol as an induction agent, a short acting non-depolarizing muscle relaxant e.g. mivacurium, an inhalational anaesthetic agent with a fast wake up time e.g. sevoflurane or desflurane, and short acting opioids e.g. fentanyl guarantees quick recovery of patients. The trend towards a multimodal approach to postoperative pain and prevention of postoperative nausea and vomiting (PONV) improves postoperative profile of day case gynaecological patients. Expertise in providing a pneumoperitoneum with carbon dioxide is desirable even as other options for lifting the abdominal wall are being investigated.

Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. Articulating the rationale for such decisions is an arduous task. Thus, a brief introduction to the basic conceptual framework and vocabulary of clinical ethics may be useful to this population of physicians. The most important concept is that interventions offered should be both clinically appropriate and ethically proportionate, desirable by both the patient and the medical team, and offering a meaningful benefit to the patient within the context of his or her own life narrative. This puts an emphasis on understanding, from the patient or his/her proxies, not just who the patient is biologically but also biographically: that is what gives meaning to his/her life subjectively, and what quality of life would be compatible with this level of functioning, as well as when he/she would wish life sustaining therapy to be withheld or withdrawn.

Background
Medical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritisation of essential supplies have previously been highlighted. This pragmatic review summarises existing guidelines and literature relevant to surgical and anaesthesia equipment, with recommendations for future initiatives and research.

Methods
Retrospective literature review including both academic and grey literature from 1980 to 2018. We conducted a narrative synthesis to identify key factors that were condensed thematically.

Results
Thirty-three biomedical equipment donation guidelines were identified from governments, WHO, World Bank, academic colleges and non-governmental organisations, and 36 relevant studies in peer-reviewed literature. These highlighted the need to consider all stages of the donation process, including planning, sourcing, transporting, training, maintaining and evaluating equipment donation. Donors were advised to consult national guidelines to ensure equipment was appropriate, desirable and non-costly to both parties. User training and access to biomechanical engineers were suggested as necessary for long-term sustainability. Finally, equitable partnerships between donors and recipients were integral to reducing inappropriate donations and to improve follow-up and evaluation.

Conclusion
There is a paucity of evidence on the causes of success or failure in medical equipment donation, despite its domination of equipment sourcing across many low-resource settings. Equitable partnerships, consultation of policies and guidelines, and careful planning may improve equipment usability and life span. A concerted effort is required to increase awareness of guidelines among health professionals worldwide.

Among the congenital heart diseases causing right to left shunt Tetrology of Fallot is one of the most common congenital heart disease. It is characterized by VSD, over-riding of aorta, right ventricular outflow obstruction and Right ventricular hypertrophy. Uncorrected TOF causes significant morbidity and mortality to the patient. Pregnancy in a patient with uncorrected TOF results in worsening of symptoms as well as poses additional challenge to the anesthesiologist.

Total joint replacement surgery is being performed on an increasingly large part of the population. Clinical longevity of implants depends on their osseointegration, which is influenced by the load, the characteristics of the implant and the bone-implant interface, as well as by the quality and quantity of the surrounding bone. Aseptic loosening due to periprosthetic osteolysis is the most frequent known cause of implant failure. Wear of prosthetic materials results in the formation of numerous particles of debris that cause a complex biological response. Dual-energy X-ray Absorptiometry (DXA) is regarded as an accurate method to evaluate Bone Mineral Density (BMD) around hip or knee prostheses. Further data may be provided by a new device, the Bone Microarchitecture Analysis (BMA), which combines bone microarchitecture quantification and ultra high resolution osteo-articular imaging. Pharmacological strategies have been developed to prevent bone mass loss and to extend implant survival. Numerous trials with bisphosphonates show a protective effect on periprosthetic bone mass, up to 72 months after arthroplasty. Strontium ranelate has been demonstrated to increase the osseointegration of titanium implants in treated animals with improvement of bone microarchitecture and bone biomaterial properties. Maria Luisa Brandi ( ) Corresponding author: m.brandi@dmi.unifi.it Cavalli L and Brandi ML. How to cite this article: Periprosthetic bone loss: diagnostic and therapeutic approaches [version 1; referees: 1 2013, :266 (doi: ) approved, 1 approved with reservations] F1000Research 2 PubMed Abstract | Publisher Full Text 2. Muratore M, Quarta E, Quarta L, et al.: Ibandronate and cementless total hip arthroplasty: densitometric measurement of periprosthetic bone mass and new therapeutic approach to the prevention of aseptic loosening. Clin Cases Miner Bone Metab. 2012; 9(1): 50-55. PubMed Abstract | Free Full Text 3. Goldring SR, Schiller AL, Roilke M, et al.: The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J Bone Joint Surg Am. 1983; 65(5): 575-84. PubMed Abstract 4. Harris WH, Schiller AL, Scholler JM, et al.: Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976; 58(5): 612-8. PubMed Abstract 5. Jasty MJ, Floyd WE 3d, Schiller AL, et al.: Localized osteolysis in stable nonseptic total hip replacement. J Bone Joint Surg Am. 1986; 68(6): 912-9. PubMed Abstract 6. Boynton E, Waddell JP, Morton J, et al.: Aseptic loosening in total hip implants: the role of polyethylene wear debris. Can J Surg. 1991; 34(6): 599-605. PubMed Abstract 7. Massari L, De Rito G, Brunoro A, et al.: Il Disodio Clodronato riduce il riassorbimento periprotesico in impianti non cementati nelle fasi precoci: studio prospettico con controllo. GIOT. 2002; 28: 79-87. Reference Source 8. Iolascon G: Bisfosfonati e protesi articolari. Up-to-date 2005. In: Adami S (Ed.) Bisfosfonati Yearbook. 2005; 71-78. Reference Source 9. Marotti G, Muglia MA, Palumbo C: Collagen texture and osteocyte distribution in lamellar bone. Ital J Anat Embryol. 1995; 100(Suppl. 1): 95-102. PubMed Abstract 10. Rubinacci A, Villa I, Dondi Benelli F, et al.: Osteocyte-bone lining cell system at the origin of steady ionic current in damaged amphibian bone. Calcif Tissue Int. 1998; 63(4): 331-339. PubMed Abstract | Publisher Full Text 11. Lin T, Yan SG, Cai XZ, et al.: Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials. Osteoporos Int. 2012; 23(6): 1823-1834. PubMed Abstract | Publisher Full Text 12. Furnes O, Lie SA, Espehaug B, et al.: Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987-99. J Bone Joint Surg Br. 2001; 83(4): 579-586. PubMed Abstract | Publisher Full Text 13. Maury AC, Pressman A, Cayen B, et al.: Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am. 2006; 88(5): 953-958. PubMed Abstract | Publisher Full Text 14. McLean AL, Patton JT, Moran M: Femoral replacement for salvage of periprosthetic fracture around a total hip replacement. Injury: Int J Care Injured 2012; 43(7): 1166-1169. PubMed Abstract | Publisher Full Text 15. Demos HA, Briones MS, White PH, et al.: A Biomechanical Comparison of Periprosthetic Femoral Fracture Fixation in Normal and Osteoporotic Cadaveric Bone. J Arthroplasty. 2012; 27(5): 783-738. PubMed Abstract | Publisher Full Text 16. Abu-Amer Y, Darwech I, Clohisy JC: Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther. 2007; 9(Suppl 1): S6. PubMed Abstract | Publisher Full Text | Free Full Text 17. Gelb H, Schumacher HR, Cuckler J, et al.: In vivo inflammatory response to polymethylmethacrylate particulate debris: effect of size, morphology, and surface area. J Ortho Res. 1994; 12(1): 83-92. PubMed Abstract | Publisher Full Text 18. Gonzalez O, Smith RL, Goodman SB: Effect of size, concentration, surface area, and volume of polymethylmethacrylate particles on human macrophages in vitro. J Biomed Mater Res. 1996; 30(4): 463-473. PubMed Abstract | Publisher Full Text 19. Shanbhag AS, Jacobs JJ, Glant TT, et al.: Composition and morphology of wear debris in failed uncemented total hip replacement. J Bone Joint Surg Br. 1994; 76(1): 60-67. PubMed Abstract 20. Abbas S, Clohisy JC, Abu-Amer Y: Mitogen-activated protein (MAP) kinases mediate PMMA-induction of osteoclasts. J Orthop Res. 2003; 21(6): 1041-1048. PubMed Abstract | Publisher Full Text 21. O'Keefe RJ, Rosier RN, Teot LA, et al.: Cytokine and matrix metalloproteinase expression in pigmented villonodular synovitis may mediate bone and cartilage destruction. Iowa Orthop J. 1998; 18: 26-34. PubMed Abstract | Free Full Text 22. Gallo J, Kamínek P, Tichá V, et al.: Particle disease. A comprehensive theory of periprosthetic osteolysis: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2002; 146(2): 21-28.

Background
Diurnal variations in pain have been observed in experimental protocols, post-surgery states and pathological conditions. Chronotype is considered to have the most profound effect on diurnal variations, and in addition, previous studies suggest that evening types may be more vulnerable to pain than morning types. This study aimed to examine whether or not morning and evening chronotypes differ in terms of their daily levels and diurnal fluctuations of pain sensitivity.

Methods
A total of 16 morning-healthy and 15 evening-healthy men were selected using the Morningness-Eveningness Questionnaire and underwent nine measurements during 1 day (between 08:15 and 20:15 h), each consisting of five heat stimuli situated at the ventral side of the wrist.

Results
A marked difference between chronotypes was found, with morning types showing less sensitivity to pain than evening types all day long [M = 50.1; standard error (SE) = 1 and M = 47.2; SE = 1, respectively; pain thresholds in centigrade]. Diurnal variations in pain were not statistically significant.

Conclusions
The results showed that chronotype could be an important factor determining sensitivity to pain, regardless of time of day.

There is great improvement in the practice of anaesthesiology in the 21 st century when compared with the past. Anaesthesiology can only be studied after obtaining a medical qualification. The knowledge and appropriated skills are acquired during a specialist or fellowship training programme; while the duration of study may vary from country to country and is programme-specific. The innovations, high monitoring standard and technology available in modern times has made the delivery of anaesthesia to surgical patients very safe. Anaesthesiology remains a stressful medical profession but it provides diverse opportunities. It offers an exceptionally wide career prospect outside the operating room, as well as skills for team management and leadership positions.

Endotracheal intubation using flexometallic tubes are often required in anaesthesia practice for a variety of reasons. It is preferred in the head and neck region surgeries due to its
relative resistance to kinking forces. At times, these patients postoperatively may need to be shifted to ICU or HDU without extubation for further stabilization/management and extubation after adequate recovery. We present an unusual accident where a new flexometallic endotracheal tube was permanently tapered, transected and migrated proximally due to patient’s bite on tube leading to airway emergency in post-operative recovery period.

Purpose: Various drugs have been tried for prevention of postdural puncture headache. This prospective, observational study was conducted to evaluate the efficacy of oral pregabalin in the management of postdural puncture headache after spinal anaesthesia in lower abdominal and pelvic surgeries and to compare its effectiveness with acetaminophen. Method: Eighty patients, who developed postdural puncture headache (PDPH), were randomly assigned to two groups. Group A (n=42) received oral acetaminophen. Group P (n=38) received oral pregabalin. For each case, heart rate, mean arterial pressure and pain scores using Visual Analogue Scale (VAS) were recorded in the postoperative period; requirement for postoperative rescue analgesia was also noted. Results: The groups were similar in terms of baseline characteristics, and distribution of study subjects. VAS scores at the onset of PDPH were comparable between the two groups, (p-value˃0.05) and remained as such at next 24 hrs, however a comparison of VAS scores at 48 hrs and 72 hrs, showed significantly low VAS scores for pregabalin group with respect to acetaminophen group (p-value˂0.05). Conclusion: Oral pregabalin provides an effective alternative means for managing PDPH and may obviate the need for invasive modalities like epidural blood patch in such cases.

This brief review of current research progress on Charcot-Marie-Tooth (CMT) disease is a summary of discussions initiated at the Hereditary Neuropathy Foundation (HNF) scientific advisory board meeting on November 7, 2014. It covers recent published and unpublished and research. We in vitro in vivo discuss recent promising preclinical work for CMT1A, the development of new biomarkers, the characterization of different animal models, and the analysis of the frequency of gene mutations in patients with CMT. We also describe how progress in related fields may benefit CMT therapeutic development, including the potential of gene therapy and stem cell research. We also discuss the potential to assess and improve the quality of life of CMT patients. This summary of CMT research identifies some of the gaps which may have an impact on upcoming clinical trials. We provide some priorities for CMT research and areas which HNF can support. The goal of this review is to inform the scientific community about ongoing research and to avoid unnecessary overlap, while also highlighting areas ripe for further investigation. The general

Introduction: transient receptors sensitive to vanilloid-1 (TRPV-1), belonging to the family of receptors with transient potential, play an important role in the excitation of nociceptive neurons and the consequent generation of pain. What is an innovative alternative in the multimodal management of neuropathic pain.
Objective: the aim of this review was to know the management of the pain mediated by TRPV-1 receptors.
Results: there are endogenous ligands as inflammatory and exogenous mediators such as capsaicin, whose function is to modulate the activity of the TRPV-1 receptors; through intracellular signaling pathways in peripheral sensory neurons, the dorsal ganglion and even at the central level; leading to acute nociceptive effect and a state of neuroplasticity over time.
Conclusions: inhibiting the activity of TRPV1 is an alternative in the management of neuropathic pain. Being interesting and innovative in the population in which other pain inhibition pathways are not possible due to individual factors.

Острая массивная кровопотеря (ОМК) остается тяжелым осложнением с высокой летальностью. Центральное место в танатогенезе этого состояния занимают нарушения коагуляции. ДВС-синдром и дилюционная коагулопатия часто осложняют ОМК и приводят к развитию полиорганной недостаточности. В статье рассмотрены современные подходы к назначению гемостатических средств при ОМК, принятые на территории РФ. Базисными препаратами для ле-чения ОМК являются свежезамороженная плазма, тромбоцитный концентрат, криопреципитат, отдельные факторы свертывания крови, препараты кальция и транексамовая кислота. Правильное использование этих средств предполагает адекватный мониторинг коагуляции. Ключевые слова: острая массивная кровопотеря, свежезамороженная плазма, криопреципитат, рекомбинантный фактор VII, концентрат протромбинового комплекса, тромбоцитный концентрат, кальций, транексамовая кислота.
Acute massive blood loss (AMBL) remains to be a severe complication with high mortality rate. Coagulation disorders take central place in tanatogenesis of this condition. DIC-syndrome and dilutional coagulopathy are often complicated by AMBL and lead to development of multiple organ failure. This article presents current approaches that are accepted in Russian Federation of hemostatic drugs prescription in AMBL treatment. Fresh frozen plasma, platelet concentrate, cryoprecipitate, some clotting factors, calcium and tranexamic acid are basic drugs for AMBL treatment. Adequate coagulation monitoring is required for correct use of these drugs.

The current regulatory requirements for donor eligibility pose a Context: challenge to blood centers in recruitment of voluntary blood donors, particularly in a developing country like India where awareness of the general population is low and myths about blood donation are prevalent. This study evaluates the reasons and rates of donor deferral in a tertiary hospital-based blood bank in western India.

Oxygen saturation monitoring of neonates is a demanding task, as oxygen saturation (SpO2) has to be maintained in a particular range. However, auditory displays of conventional pulse oximeters are not suitable for informing a clinician about deviations from a target range. A psychoacoustic sonification for neonatal oxygen saturation monitoring is presented. It consists of a continuous Shepard tone at its core. In a laboratory study it was tested if participants (N = 6) could differentiate between seven ranges of oxygen saturation using the proposed sonification. On average participants could identify in 84% of all cases the correct SpO2 range. Moreover, detection rates differed significantly between the seven ranges and as a function of the magnitude of SpO2 change between two consecutive values. Possible explanations for these findings are discussed and implications for further improvements of the presented sonification are proposed.

This brief review of current research progress on Charcot-Marie-Tooth (CMT) disease is a summary of discussions initiated at the Hereditary Neuropathy Foundation (HNF) scientific advisory board meeting on November 7, 2014. It covers recent published and unpublished and research. We in vitro in vivo discuss recent promising preclinical work for CMT1A, the development of new biomarkers, the characterization of different animal models, and the analysis of the frequency of gene mutations in patients with CMT. We also describe how progress in related fields may benefit CMT therapeutic development, including the potential of gene therapy and stem cell research. We also discuss the potential to assess and improve the quality of life of CMT patients. This summary of CMT research identifies some of the gaps which may have an impact on upcoming clinical trials. We provide some priorities for CMT research and areas which HNF can support. The goal of this review is to inform the scientific community about ongoing research and to avoid unnecessary overlap, while also highlighting areas ripe for further investigation. The general

Background : Exercise-induced arterial hypertension (EIAH) leads to myocardial hypertrophy and is associated with a poor prognosis. EIAH might be related to the &quot;cardiac fatigue&quot; caused by endurance training. The goal of this study was to examine whether there is any relationship between EIAH and left ventricular hypertrophy in Ironman-triathletes. We used echocardiography and spiroergometry to determine the left ventricular mass (LVM), the aerobic/anaerobic thresholds and the steady-state blood pressure of 51 healthy male triathletes. The main inclusion criterion was the participation in at least one middle or long distance triathlon. When comparing triathletes with LVM &lt;220g  and athletes with LVM &gt;220g there was a significant difference between blood pressure values (BP) at the anaerobic threshold (185.2± 21.5 mmHg vs. 198.8 ±22.3 mmHg, p=0.037). The spiroergometric results were: maximum oxygen uptake (relative VO 2max) 57.3 ±7.5ml/min/kg vs. 59.8±9.5ml/min/kg (p=...

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery.Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kgˉ¹∙hˉ¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog S...

Despite the universality of metabolic pathways, malignant cells were found to have their metabolism reprogrammed to generate energy by glycolysis even under normal oxygen concentrations (the Warburg effect). Therefore, the pathway energetically 18 times less efficient than oxidative phosphorylation was implicated to match increased energy requirements of growing tumors. The paradox was explained by an abnormally high rate of glucose uptake, assuming unlimited availability of substrates for tumor growth in vivo. However, ultrastructural analysis of tumor vasculature morphogenesis showed that the growing tissue regions did not have continuous blood supply and intermittently depended on autophagy for survival. Erythrogenic autophagy, and resulting ATP generation by glycolysis, appeared critical to initiating vasculature formation where it was missing. This study focused on ultrastructural features that reflected metabolic switch from aerobic to anaerobic. Morphological differences betw...

Free-ranging ticks are widely known to be restricted to the ground level of vegetation. Here, we document the capture of the tick species Amblyomma tapirellum in light traps placed in the forest canopy of Barro Colorado Island, central Panama. A total of forty eight adults and three nymphs were removed from carbon dioxide–octenol baited CDC light traps suspended 20 meters above the ground during surveys for forest canopy mosquitoes. To our knowledge, this represents the first report of questing ticks from the canopy of tropical forests. Our finding suggests a novel ecological relationship between A. tapirellum and arboreal mammals, perhaps monkeys that come to the ground to drink or to feed on fallen fruits.

Background: Spinal anaesthesia is widely used for urological operations particularly in transurethral surgical procedures as it permits early recognition of symptoms caused by over hydration (TURP syndrome) and bladder perforation. Methods: This study was done over a period of sixteen months in 60 patients (two groups of 30 each) in age group of 50years and above who underwent transurethral resection of prostate (TURP) under spinal anaesthesia. Group A: Patients received intrathecal Bupivacaine 2.2ml with Clonidine 30µg. Group B: Patients received intrathecal Bupivacaine 2.2ml with Fentanyl 20µg. The outcomes for sensory block were observed as time to achieve T10 level, highest level of sensory block and time to achieve it, time to two segment regression of sensory block and regression to T12 level. The outcomes for motor block were observed as time to achieve maximum motor block and time to motor block regression to bromage grade 0. The results was tabulated and statistically analysed using SPSS (Statistical Package for Social Sciences) Software version 15.0, Chi-square test was used for qualitative data (sex, ASA grade), HR, Mean blood pressure, was compared within the group against baseline values using paired t-test. Results: Time to sensory regression to T12 level was found to be significantly (p=0.0001) higher in Group A (120.33±9.46) than Group B (104.33±8.78). The total time of regression to bromage 0 was significantly (p=0.0001) higher in Group A (200.83±17.71) compared to Group B (156.50±13.78). The time of request of analgesia was significantly (p=0.01) higher in Group A than Group B. Conclusion: As an adjuvant to hyperbaric bupivacaine, clonidine (30 mcg) showed longer duration of sensory block and longer post operative analgesia when compared to fentanyl (20mcg) in subarachnoid block for trans-urethral resection of prostate.

The interpretation of genomic variants has become one of the paramount challenges in the post-genome sequencing era. In this review we summarize nearly 20 years of research on the applications of information theory (IT) to interpret coding and non-coding mutations that alter mRNA splicing in rare and common diseases. We compile and summarize the spectrum of published variants analyzed by IT, to provide a broad perspective of the distribution of deleterious natural and cryptic splice site variants detected, as well as those affecting splicing regulatory sequences. Results for natural splice site mutations can be interrogated dynamically with Splicing Mutation Calculator, a companion software program that computes changes in information content for any splice site substitution, linked to corresponding publications containing these mutations. The accuracy of IT-based analysis was assessed in the context of experimentally validated mutations. Because splice site information quantifies b...

Medical malpractice has been raised as an important problem in daily practice, while the media and public remain unforgiving to those perceived to have harmed the patients' life. This article highlights important legal issues related to medical malpractice and summarizes the sources and the nature of potential errors in anaesthesiology practice.