Absence of memory for intraoperative information during surgery under adequate general anaesthesia

Using the isolated forearm technique (IFT), we wished to determine if patients known to be unresponsive to commands during general anaesthesia with nitrous oxide, halothane and neuromuscular blocking agents had any evidence of explicit or implicit recall. Two groups of women, studied in a single-blind sequential block design, heard different tapes, either a command and information tape (n = 34) or radio static (n = 34), throughout surgery. Four women (two radio static, two command) had unequivocal evidence of explicit recall for a period near the beginning or end of the procedure, at a time when the IFT was not being used. With or without hypnosis, category generation, serial position of category exemplars and word association tests did not reveal evidence of priming. We conclude that during light general anaesthesia with nitrous oxide, halothane and atracurium, patients had neither explicit nor implicit memory for information presented during a period when they are known to be unresponsive to commands.      

Ascorbic acid, HDL, and total plasma cholesterol in the elderly

The relationships between ascorbic acid (plasma and dietary) and plasma HDL cholesterol (HDL-C), total plasma cholesterol (T-C) and T-C:HDL-C ratio were examined in a population of 235 males and 445 females, age 60-98 years. Many known or suspected determinants of HDL-C and T-C, including age, sex, triceps skinfold thickness, fasting blood glucose, alcohol intake, and others, were considered as covariates due to their potential confounding or modifying effects on the relationships under study. The results show that plasma ascorbic acid is significantly (p less than 0.05) correlated with HDL-C (r = 0.09), T-C:HDL-C (r = 0.10), but not with T-C (r = 0.03). There is a strong age interaction with the largest effect of ascorbic acid in the youngest age group studied (60-69 years). The effects of dietary ascorbic acid are similar but slightly reduced in magnitude.     

Experimental evaluation of free-tissue transfer to promote healing of infected wounds in dogs

An experimental model was designed to evaluate the course of healing and the changes in bacterial concentrations of infected forelimb wounds with devascularized bone in dogs. Infected leg wounds were allowed to heal by secondary intention or were covered with a full-thickness or split-thickness skin graft, an epigastric skin/fat flap, or a gracilis musculocutaneous flap. All skin grafts failed. Gracilis muscle flaps were superior to epigastric skin/fat flaps in decreasing soft-tissue bacterial concentrations. Quantitative bone cultures, however, were positive at reexploration 6 weeks later in 33% of all legs covered with a flap. X-ray films were successful in predicting the presence or absence of bone infection in 70% of all legs. Postmortem arteriograms of legs covered with muscle flaps showed neovascularity to bone. This study suggests muscle flap coverage of wounds debrided of contaminated, necrotic, or infected bone and soft tissue to be an excellent method of providing well-vascularized soft tissue promoting healing and resolution of infection.     

Persistent otitis media with effusion: A new experimental model

Objectives/Hypothesis: Numerous mechanical animal models for the creation of otitis media with effusion (OME) have been described since the 1920s. However, there are many problems associated with these models, including high infection rates, unreliability, and high resolution rates. The aim of the current study was to create a suitable mechanical animal model that would produce a sterile and long-lasting effusion. Study Design: A new technique using an external surgical approach on specific pathogen–free rats is described. Method: The eustachian tubes of 56 rats were obstructed in the mid portion along the skull base with gutta percha. Results: All animals developed an effusion within 1 week of the procedure. The resolution rate was 8%, with 80% maintaining sterile effusions for up to 1 year. Conclusions: This new procedure for an OME model has proved consistently reliable in creating a persistent and long-lasting effusion. It has a low infection rate and should benefit future studies on the prolonged effects of OME on the tympanic membrane and middle ear.     

Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure.

Cotinine elimination from plasma, saliva, and urine was studied over 11 days in five subjects (three nonsmokers and two occasional smokers). Half-lives for cotinine averaged 16-19 hours in the different body fluids (range 10 to 27 hours between subjects). There was no tendency for the half-life in saliva to be longer than in plasma or urine. We conclude that choice of body fluid for cotinine assay in smoking studies should depend on practical rather than pharmacokinetic considerations.     

Parental presence during procedures: a survey of attitudes amongst paediatricians.

As a child's primary caretaker, the parent plays a significant role in the management of paediatric pain. Is this what physicians want and allow? This paper analyses the results of a survey conducted among paediatricians. Three hundred and fourteen consultant paediatricians were sent questionnaires about their attitudes towards parental presence during medical procedures performed on children under local anaesthesia. Paediatricians were asked under what circumstances they allowed parents to remain, and what factors led to their exclusion. The response rate was high--60.8%. Though 98.5% of paediatricians were willing to let parents remain, 57.5% excluded some parents from certain procedures, particularly if parents were anxious and the procedure difficult or painful. Ninety-one per cent relied on verbal explanations alone to prepare parents prior to procedures.