Smith's Anaesthesia for Infants and Children, 7th Edn. E. K. Motoyama and P. J. Davies (editors). Published by Mosby Elsevier, Philadelphia, USA. Pp. 1256; indexed; illustrated. Price {pound}124.00. ISBN 978-0323-02647-5.

Every department of anaesthesia has a collection of referencetextbooks or bench books where unusual cases can be found, normalpractice can be confirmed and those unfamiliar to a specialityarea can brush up their knowledge usually prior to a teachingsession or an exam. Previous editions of this book are the referencepaediatric tome for many departments and this seventh editioncomprehensively covers the subject. It comes with a DVD tuckedinto     

Measurement of Carboxyhemoglobin and Methemoglobin by Pulse Oximetry: A Human Volunteer Study

Background: A new eight-wavelength pulse oximeter is designed to measure methemoglobin and carboxyhemoglobin, in addition to the usual measurements of hemoglobin oxygen saturation and pulse rate. This study examines this device's ability to measure dyshemoglobins in human volunteers in whom controlled levels of methemoglobin and carboxyhemoglobin are induced.

Methods: Ten volunteers breathed 500 ppm carbon monoxide until their carboxyhemoglobin levels reached 15%, and 10 different volunteers received intravenous sodium nitrite, 300 mg, to induce methemoglobin. All were instrumented with arterial cannulas and six Masimo Rad-57 (Masimo Inc., Irvine, CA) pulse oximeter sensors. Arterial blood was analyzed by three laboratory CO-oximeters, and the resulting carboxyhemoglobin and methemoglobin measurements were compared with the corresponding pulse oximeter readings.

Results: The Rad-57 measured carboxyhemoglobin with an uncertainty of +/-2% within the range of 0-15%, and it measured methemoglobin with an uncertainty of 0.5% within the range of 0-12%.     

Effect of the calcium entry blocker verapamil on renal ischemia

The ability of the calcium entry blocker verapamil to ameliorate the effects of renal ischemia was studied in ten sheep. Postanesthesia, bilateral cutaneous ureterostomies were placed in each sheep to facilitate urine collection and analysis. Both kidneys were made ischemic for one hour by occluding each renal artery. However, immediately before occlusion of the right renal artery, 0.05 mg/kg of verapamil was injected into the artery. Comparison of urinary creatinine excretion and urine volume for 72 h after reversal of ischemia demonstrated that those kidneys pretreated with verapamil had greater functional preservation (p less than .05). In this study, verapamil appeared to provide protection against renal damage after an ischemic insult.     

Ultra wide field fundus biomicroscopy with the Volk Quadraspheric lens

Fundus biomicroscopy as a clinical technique has been enhanced significantly by the addition of indirect view condensing lenses. The combination of this type of lens with a corneal contact element allows higher power and better stability so that a wider field can be obtained. The Panfunduscope of Schlegel and the Mainster retinal lens are examples of this design that have been successfully applied to both examination and to pan-retinal photocoagulation. Volk has recently introduced a new aspheric design indirect contact lens system which is higher in power and provides a wider field of view (125 degrees) than previously obtainable. This article describes the optical properties and use of the Quadraspheric lens.     

Preliminary evidence for a role of apolipoprotein E alleles in identifying haemodialysis patients at high vascular risk

Conventional risk factors have very low predictive power in identifying haemodialysis patients at high risk of vascular accidents. A role for apolipoprotein E isotypes was looked for in a small, but rigorously defined, cohort of longterm haemodialysis patients. In individuals with high vascular risk, as identified by higher common carotid intima/media thickness, we found an excess of apolipoprotein E4 alleles. This preliminary result requires confirmation in large patient cohorts.      

The effect of oral dosing of xamoterol on systolic time intervals in man and xamoterol plasma concentrations in heart failure patients.

1. Six healthy male human volunteers of mean age 30.8 years (range 23-37) were given single oral doses of xamoterol (20, 50, 100 or 250 mg) and placebo with a 1 week interval between each dose. Xamoterol produced a significant decrease in systolic time intervals (QS2I, LVETI and PEPI) and a significant increase in systolic blood pressure indicating a positive inotropic effect on the heart at rest. The changes in QS2I were dose-related. Maximum decreases in QS2I were noted 1 to 2 h after dosing and were achieved with a dose of 100 mg. 2. In a second study, oral administration of xamoterol at 3 doses (100, 200 or 300 mg) and placebo were studied in 12 patients of mean age 60.4 years (range 52-73) with mild to moderate heart failure. Each dose was given twice daily for 7 days in a random order. Each dose of xamoterol produced a significant decrease in systolic time intervals indicating a positive inotropic effect on the heart at rest in patients with heart failure. It was not possible to distinguish between the effects of the three doses of xamoterol. 3. In heart failure patients, peak plasma concentrations of xamoterol occurred 1 to 2 h after dosing at all dosage levels and there was a linear relationship between dose and plasma concentration. 4. In both studies xamoterol was well tolerated and only minor adverse experiences were reported. 5. We conclude that, at rest, xamoterol has a positive inotropic effect on the heart when given orally to healthy volunteers or patients with mild to moderate heart failure.     

Paediatric Anaesthesia and Critical Care in the District Hospital: a Practical Guide

I do not think that the title of this book of nearly 300 closelyprinted pages really does it justice, as it might not attractthose anaesthetists, of all grades, for whom it could be anextremely useful addition to the personal library. The bookis written     

Does the ANSI Z80.3 nonprescription sunglass and fashion eyewear standard go far enough?

The recent public concern regarding sunglass protection from UV energy has sparked a significant debate among those in the research community and industry. This debate grows out of concern for the known effects of UV energy in producing or contributing to eye effects such as keratitis, cataract formation, and retinal damage. The ANSI Z80.3 Standard addresses itself to this issue by setting levels of UV energy that are permitted to be transmitted in various labeling categories for over-the-counter sunlenses. One important issue is that the ANSI Standard does not provide for an absolute block of UV energy in any category of these lenses. Because the technology to provide this sort of total UV block is currently available, it is argued that there should be at least one category of lens that is fully protective in the UV range.