Amnioinfusion: A Technique for the Relief of Variable Deceleration

Human and animal studies have demonstrated an association between decreased amniotic fluid and the occurrence of variable decelerations in the fetal heart rate. Amnioinfusion is a new investigational technique directed at decreasing the number and severity of variable decelerations by infusion of a normal saline solution into the uterine cavity. The technique may provide a mechanism for protecting the umbilical cord from compression and, thereby, ameliorating fetal distress. This article describes amnioinfusion and discusses related nursing implications for patients undergoing the procedure.     

Simultaneous, Multiple Point Mapping During Surgery for Wolff-Parkinson-White Syndrome Without the Use of a Computer

Epicardial mapping of patients undergoing surgical correction of the Wolff-Parkinson-White syndrome is usually accomplished by using a single point probe. This somewhat tedious and time consuming method has been streamlined by computer-based systems allowing multiple simultaneous point maps to be developed either by electrodes applied as a band around the atrioventricular groove or a sock over the ventricle. Because the computer technology required to access, analyze, and display this data is not widely available, a system was devised to display ten simultaneous electrograms from a wrap of ten electrodes placed about the atrial or ventricular side of the atrioventricular groove. Using this technique three patients undergoing surgery for accessory pathway removal were accurately and quickly mapped allowing surgical cure of the preexcitation in each case.     

The Effect of Promoting Intrauterine Attachment in Primiparas on Postdelivery Attachment

Twenty-two women participated in a modified replicate study which examined the effects of prenatal maternal attachment behaviors during first pregnancies. A pretest reflected the degree of maternal-fetal attachment behaviors and attitudes already formed. The women in the experimental group received three interventions aimed at directing the mothers' attentions toward their fetuses. The remaining women received routine prenatal care only. All mothers were observed once in the first few days postpartum to assess maternal attachment behaviors. Data analysis did not substantiate the findings of the earlier study. Factors identified in the added pretest may have accounted for this difference.     

Alcoholism,antisocial behavior and family history*

Previous investigations in selected and clinical samples have demonstrated a close association between alcoholism and both antisocial behavior and a family history of problem drinking. This study uses the National Institute of Mental Health (NIMH) Epidemiological Catchment Area (EGA) data to assess this relationship in the general population in St. Louis, Missouri (U.S.A.). The results showed that serious antisocial behavior (both conduct disorder and antisocial personality disorder), gender, and a family history of problem drinking were all significantly associated with alcoholism (DSM-III alcohol abuse or dependence). Having either conduct disorder, antisocial personality, or a first-degree relative (parent, sibling, or child) with problem drinking increased the probability of alcoholism; being male also increased its probability. Antisocial behavior and gender interacted in that antisocial behavior was a more potent risk factor for women than for men. However, despite their close association with alcoholism, having either antisocial personality or a positive family history of problem drinking identified only 49% of male alcoholics and 14% of female alcoholics. Thus, these two important predictors of alcoholism would be somewhat inefficient screeners for primary prevention. More investigation is needed to understand the development of alcoholism in those without these major risk factors and the lack of alcoholism in those with them.     

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

Background:  Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues.
Methods:  We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction.
Results:  We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens.
Conclusions:  A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.     

Development of a parent-report computer-adaptive test to assess physical functioning in children with cerebral palsy I: lower-extremity and mobility skills

The objective of this project was to develop computer-adaptive tests (CATs) using parent reports of physical function in children and adolescents with cerebral palsy (CP). The specific aims of this study were to (1) examine the psychometric properties of an item bank of lower-extremity and mobility skills for children with CP; (2) evaluate a CAT using this item bank; (3) examine the concurrent validity of the CAT with the Pediatric Outcomes Data Collection Instrument (PODCI) and the Functional Assessment Questionnaire (FAQ); and (4) establish the discriminant validity of simulated CATs with Gross Motor Function Classification System (GMFCS) levels and CP type (diplegia, hemiplegia, or quadriplegia). Parents ( n =190) of children and adolescents with spastic diplegic (48%), hemiplegic (22%), or quadriplegic (30%) CP consisting of 108 males and 82 females with a mean age of 10 years 7 months (SD 4y 1mo, range 2–21y) and in GMFCS levels I to V participated in item pool calibration and completed the PODCI and FAQ. Confirmatory factor analyses supported a unidimensional model for the 45 basic lower-extremity and mobility items. Simulated CATs of 5, 10, and 15 items demonstrated excellent accuracy (intraclass correlation coefficients [ICCs] >0.91) with the full item bank and had high correlations with PODCI transfers and mobility (ICC = 0.86) and FAQ scores (ICC = 0.77). All CATs discriminated among GMFCS levels and CP type. The lower-extremity and mobility skills item bank and simulated CATs demonstrated excellent performance over a wide span of ages and severity levels.     

Effects of Changes in the L‐Type Calcium Current on Hysteresis in Restitution of Action Potential Duration

Background : Electrical restitution and memory of action potential duration (APD) are considered key determinants of stability of activation. Calcium handling also impacts stability of activation via its modification of the above and independently. We determined the effects of reduction in an important calcium current, I_CaL, on hysteresis in restitution of APD, which provides assessment of restitution and memory. Methods : Transmembrane potentials were recorded from isolated ventricular tissues from pigs. The pacing protocols consisted of sequential and oscillatory changes in diastolic intervals (DI). Two protocols were used, one where DIs ranged between 100 and 700 ms and the other where DIs ranged between 10 and 290 ms. Verapamil (2 μM/L) was used to reduce I_CaL. From the hysteresis observed in restitution, loop area, thickness, overall tilt, and the maximum and minimum delays between DIs and APDs were calculated to obtain measures of memory and restitution. Results : Restitution during sequential and oscillatory changes in DI displayed hysteresis. All measures of hysteresis decreased after reduction in I_CaL. The decreases in area, thickness, and overall tilt were most pronounced (50%, 50%, and 33%). Conclusion : Sequential and oscillatory changes in DIs reveal that while the overall slope of restitution of APD decreases with decrease in I_CaL, so do measures of memory. Because slopes and memory are considered to have contrasting effects on stability, our results suggest that predicting effects of alteration in I_CaL on stability of activation using slope alone may not be adequate. (PACE 2010; 451–459)