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81.
S. H. CRAY MB BS FRCA J.L. DIXON MB BS FRCA C.M.B. HEARD MB BS FRCA D.S. SELSBY MB BS FRCA 《Paediatric anaesthesia》1996,6(4):265-270
Forty-nine children having day-stay surgical procedures were randomly assigned to receive oral midazolam 0.75 mg·kg?1 or placebo in a double blind fashion. The child's level of anxiety was assessed before premedication using parental, child and observer scales. The child and observer anxiety scores were repeated in the anaesthetic room. Most children presented for anaesthesia in a calm state, irrespective of whether they had received midazolam. Parents tended to overestimate their child's level of anxiety. Observer anxiety scores reliably predicted behaviour during induction of anaesthesia in the absence of a sedative. Observer scores decreased in the midazolam group (P<0.02), but not in the placebo group, children below six years having the greatest decrease with midazolam. The median time to discharge from hospital was delayed by 30 min in the midazolam group (P<0.01). Children do not require routine sedative premedication for day case procedures, but oral midazolam is useful in producing calm behaviour in those children with high observer anxiety scores. 相似文献
82.
C. Veigel R. D. von Maydell K.R. Kress J. E. Molloy R. H. A. Fink 《Pflügers Archiv : European journal of physiology》1998,435(6):753-761
Recent atomic 3-D reconstructions of the acto-myosin interface suggest that electrostatic interactions are important in the
initial phase of cross-bridge formation. Earlier biochemical studies had also given strong evidence for the ionic strength
dependence of this step in the cross-bridge cycle. We have probed these interactions by altering the ionic strength (Γ/2)
of the medium mainly with K+, imidazole+ and EGTA2– to vary charge shielding. We examined the effect of ionic strength on the kinetics of rigor development at low Ca2+ (experimental temperature 18–22°C) in chemically skinned single fast-twitch fibres of mouse extensor digitorum longus (EDL)
muscle. On average the delay before rigor onset was 10 times longer, the maximum rate of rigor tension development was 10
times slower, the steady-state rigor tension was 3 times lower and the in-phase stiffness was 2 times lower at high (230 mM)
compared to low (60 mM) ionic strength. These results were modelled by calculating ATP depletion in the fibre due to diffusional
loss of ATP and acto-myosin Mg.ATPase activity. The difference in delay before rigor onset at low and high ionic strength
could be explained in our model by assuming a 15 times higher Mg.ATPase activity and a threefold increase in K
m in relaxing conditions at low ionic strength. Activation by Ca2+ induced at different time points before and during onset of rigor confirmed the calculated time course of ATP depletion.
We have also investigated ionic strength effects on rigor development with the activated troponin/tropomyosin complex. ATP
withdrawl at maximum activation by Ca2+ induced force transients which led into a ”high rigor” state. The peak forces of these force transients were very similar
at low and high ionic strength. The subsequent decrease in tension was only 10% slower and steady-state ”high rigor” tension
was reduced by only 27% at high compared to low ionic strength. Addition of 10 mM phosphate to lower cross-bridge attachment
strongly suppressed the transient increases in force at high ionic strength and reduced the steady-state rigor tension by
17%. A qualitatively similar but smaller effect of phosphate was observed at low ionic strength where steady-state rigor force
was reduced by 10%. The data presented in this study show a very strong effect of ionic strength on rigor development in relaxed
fibres whereas the ionic strength dependence of rigor development after thin filament activation was much less. The data confirm
the importance of electrostatic interactions in cross-bridge attachment and cross-bridge-attachment-induced activation of
thin filaments.
Received: 3 September 1997 / Received after revision and accepted: 12 December 1997 相似文献
83.
One hundred and one patients, nursed in an intensive care unit for at least 24h, were monitored for bacterial colonization
and infection. The infection rates were similar to those in other reports. Patients were not generally colonized with common
environmental strains in the unit. Bacterial dissemination between patients was uncommon. No gentamicin resistant gram negative
or Staphylococcus aureus strains were observed, nor methicillin resistant Staphylococcus aureus strains. the hypothesis that these favourable conditions are partly related to the excellent isolation and barrier nursing
facilities in the unit cannot be fully substantiated. 相似文献
84.
John D. Hughes MD Changyi Chen MD Samer G. Mattar MB ChB Ayten Someren MD Beverly Noe BS Carolyn R. Suwyn BS Alan B. Lumsden MD 《Annals of vascular surgery》1996,10(2):123-130
Hypothermia and preservative perfusates have been used to decrease ischemic renal injury. This study was performed to identify the preservative function of perfusates independent of the effects of hypothermia. Rats underwent 45 minutes of renal ischemia. Rectal and renal parenchyma temperatures were monitored and maintained within 1° C of normal. Perfusates were University of Wisconsin solution (UW), Euro-Collins solution, normal saline solution, and Ringer's lactate solution. A nonperfused ischemic control and a nonischemic control group were also evaluated. Parameters evaluated included serum creatinine and blood urea nitrogen levels, renal ischemic injury grade, renal weight, and gross appearance of the injured kidney. Rats treated with UW solution were found to have a significantly lower creatinine, blood urea nitrogen, and injury grade than the other three perfused groups. The external gross appearance of the UW-treated kidneys was normal, whereas that of the other groups demonstrated moderate to severe injury. Although the mean right/left renal weight difference of the UW-treated group was lower than that of the other three groups, this was not statistically significant. Under normothermic conditions in rats, UW solution affords significant renal protection from ischemia. Euro-Collins, normal saline, and Ringer's lactate solutions display no significant protective effect.Presented at the Twentieth Annual Meeting of the Peripheral Vascular Surgery Society, New Orleans, La., June 10, 1995. 相似文献
85.
M J Ahern MD FRACP M Wetherall BEd A Leslie MB BS R H James BSc P J Roberts-Thomson PhD FRACP G C Rennie BA BSc MA 《International journal of clinical practice》1992,46(4):229-233
The elderly (age >65 years) are more vulnerable to side-effects induced by non-steroidal anti-inflammatory drugs (NSAIDs). We therefore performed a double-blind comparative study of ketoprofen SR and sulindac in patients with active rheumatoid arthritis, 65 years of age or older. Sulindac was chosen because of its possible renal sparing effects, and ketoprofen SR because of its short half life and sustained release delivery system. Eighty patients were entered. More patients withdrew from the study due to side-effects in the sulindac group; both treatment groups had a high incidence of side-effects during this study and during previous exposure to other NSAIDs, demonstrating that the elderly are susceptible to side-effects from NSAIDs. 相似文献
86.
87.
N. D. Edwards MB BS FRCAnaes M. Hartley MB P. Clyburn MB BS FRCAnaes M. Harmer MB BS FRCAnaes 《Anaesthesia》1992,47(5):435-437
A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia. 相似文献
88.
89.
V Allen PhD DW Ryan MB FRCA A Murray PhD FIPSM 《International journal of clinical practice》1994,48(3):125-129
SUMMARY Four specialised air mattresses had interface pressure measured under six body sites prone to pressure sores in 10 subjects, supine and sitting. The mattresses were the Clinirest (SSI) and FirstStep (KCI) continuous airflow mattress overlays, and Airwave (Pegasus) and Nimbus (Huntleigh) alternating pressure air mattresses. On the mattress overlays, average supine interface pressures were 2.33 kPa (scapula), 4.15 kPa (elbow), 1.94 kPa (sacrum) and 2.79 kPa (buttock), although they were higher at the occiput (7.97 kPa) and heel (11.7 kPa). The alternating pressure air mattresses had an average minimum interface pressure close to zero for three sites, rising to 4.28 kPa under the heel. Average maximum interface pressures were 8.61 kPa (occiput), 5.21 kPa (scapula), 4.90 (elbow), 4.85 kPa (sacrum), 4.61 kPa (buttock) and 13.2 kPa (heel). No accepted scientific method exists for comparing the two types of mattress. Our data suggest a clinical benefit at the occiput and heel (supine) in using an alternating pressure air mattress and a benefit in using a continuous airflow mattress overlay at other sites. 相似文献
90.
Before informed advice can be given to parents and health care workers about the need for pertussis immunisation, an estimate of the risk of inadequately immunised children contracting pertussis is needed. The study reported here was conducted because the literature contains no such estimates of risk. Analysis was made of a county's Notification of Disease Reports. Computation was carried out of age-specific annual notification rates of pertussis amongst adequately and inadequately immunised children. It was found that inadequately immunised one-year-old children probably have more than a one in six chance of developing pertussis before age ten. 相似文献