Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N₂O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1–12 months were studied. All received inhalation induction with N₂O, O₂ and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N₂O, 30% O₂ and halothane. Group II received 70% N₂O, 30% O₂, halothane and 2 μg·kg^?1 fentanyl. Group III received 70% N₂O, 30% O₂ and 10 μg·kg^?1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (Spo ₂ >90% for greater than 30 s). Decreased Spo ₂ occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO₂ (TcCO₂) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. Spo ₂ <90% and TcCO₂ >9 kPa (70 mmHg) was more common in infants receiving 2 and 10 μg·kg^?1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants <3 months old did not have a higher incidence of Spo ₂ <90% or significantly higher TcCO₂ values when compared to infants >3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.     

Breastfeedilzg Support Services in the Neonutd Intensive-Care Unit

Objective: To describe a model for providing breastfeeding support in the neonatal intensive-care unit (NICU).
Design: Naturalistic, participant observation.
Setting: Suburban Level III NICU.
Patients: One hundred thirty-two mother-infant pairs over 1 year. Infants were hospitalized In the NICU, and mothers had initiated lactation efforts.
Interventions: Investigators provided breastfeeding interventions for the mother-infant pairs, based on identified problems, the research literature, or both.
Main Outcome Measures: Percentage of mothers who were breastfeeding at the time of discharge from the NICU.
Results: Interventions were classified into jive categories: expression and collection of mothers' milk, gavage feeding of expressed mothers' milk, in-hospital breastfeeding sessions, postdischarge breastfeeding management, and additional consultation.
Conclusions: This model was effective In preventing breastfeeding failure for this population. The model can provide the basis for NICU breastfeeding standards of care, protocols, and chart records, or for reimbursement purposes. The model also provides a framework for studying a specific category or breastfeeding intervention.     

Visual spatial attention to stimuli presented on the vertical and horizontal meridian: An ERP study

In the first experiment, 48 subjects carried out a visual spatial attention task. Stimuli were presented at the vertical meridian, either above or below a fixation dot, and the subjects were instructed to attend to one of these stimulus positions and ignore the other position. In three different conditions, the distances between stimulus positions and fixation were 0.5°, 0.9°, and 1.3°. Subjects searched for the presence of prememorized target letters at the attended location: memory load was one or four items in different conditions. The P1/N1 enhancement typically found on the horizontal dimension was not observed on the vertical dimension. Instead, a positive shift of the attended compared with the unattended stimuli was found, which was most prominent at anterior electrodes. This positivity showed effects of the distance manipulation. The N2b-P3a effect of attention and the effect of memory load (search negativity) normally present in this kind of selective search task were also found. Reaction times were faster when attention was directed above fixation than when it was directed below fixation. The event-related potential data suggested that this difference could be attributed to a more efficient neglecting of irrelevant stimuli presented below fixation. In Experiment 2, we examined whether the absence of the P1/N1 enhancement as the result of spatial attention in Experiment 1 could be attributed to (a) the presentation of stimuli along the vertical meridian instead of along the horizontal meridian, (b) the use of midline electrodes instead of lateralized electrodes, and (c) the relatively small spatial separation between the relevant and irrelevant stimuli. Twelve subjects searched for the presence of a single target letter at an attended position in three different conditions. In two of the conditions the letters were presented to the left or right of fixation. The distance between fixation and the stimulus positions was 1.3° in one of these conditions and 3° in the other condition. In the third condition, the stimuli were presented at 3° above or below fixation. In all three conditions effects similar to those in Experiment 1 were observed. In addition, in all three conditions an enhancement of the P1 and N1 components was found at two lateral occipitotemporal electrodes.     

Effects of the Long-Term Depletion of Reduced Glutathione in Mice Administered L-Buthionine-S,R-sulfoximine

Effects of the Long-Term Depletion of Reduced Glutathione inMice Administered L-Buthionine-S,R-sulfoximine. SUN, J. D.,RAGSDALE, S. S., BENSON, J. M., AND HENDERSON, R. F. (1985).Fundam. Appl. Toxicol.. 5,913-919. Previous methods to depletein vivo concentrations of reduced glutathione (GSH) have notbeen able to lower tissue GSH levels for extended periods, havebeen toxic, and can alter the metabolism of xenobiotics. A possiblealternative to lower in vivo concentrations of GSH may be theuse of buthionine-S,R-sulfoximine (BSO) in the drinking waterof laboratory animals to inhibit the biosynthesis of GSH. Ithas been previously reported that 20 mM BSO in the drinkingwater given to mice was able to lower GSH levels in a varietyof tissues after 15 days. In order to more fully characterizethe in vivo depletion of GSH in tissues by ingestion of BSOand determine if this method would be suitable in studies requiringdepressed levels of GSH for extended periods, we added differentamounts of this agent to the drinking water given to mice forvarious times up to 28 days. We found that ingested BSO at thehighest concentrtion used in drinking water (30 mM) was ableto maximally lower GSH concentrations in mouse lungs, lung lavagefluid, liver, kidneys, and blood to 59.0 ? 3.6%, 35.0 ? 5.1%,44.3 ? 1.5%, 69.5 ? 3.9%, and 70.0 ? 6.0% of control mice, respectively,for up to 28 days. These lowered concentrations of tissue GSHreturned to control levels after mice were returned to untreateddrinking water for 7 days. The potential toxicity of such treatmentswas also evaluated. Levels of alkaline phosphatase, lactatedehydrogenase, glucose-6-phosphate dehydrogenase, glutathioneperoxidase, and glutathione reductase in lungs and lung lavagefluid, and total and differential cell counts from lung lavagefluid were not different between control and BSO-treated mice.This showed that BSO treatment did not produce indications oflung injury as measured by these biochemical parameters. Serumaspartyl transferase and -glutamyl transpeptidase activitieswere unaffected by the BSO treatments, indicating normal liverfunctions. Lung and liver cytochrome P-450 concentrations werealso not different between controls and BSO-treated animals.Thus, BSO in the drinking water of mice was able to effectivelylower in vivo levels of GSH without eliciting aCUte toxic responses.     

The Fungicide Benomyl (Methyl 1 -(Butylcarbamoyl)-2-benzimidazolecarbamate) Causes Testicular Dysfunction by Inducing the Sloughing of Germ Cells and Occlusion of Efferent Ductules

The Fungicide Benomyl (Methyl 1-(Butylcarbamoyl)-2-benzimidazolecarbamate)Causes Testicular Dysfunction by Inducing the Sloughing of GermCells and Occlusion of Efferent Ductules. HESS, R. A., MOORE,B. J., FORRER, J., LINDER, R. E., ABUEL-ATTA, A. A. (1991).Fundam. Appl. Toxicol 17, 733–745. Adult male Sprague-Dawleyrats (100 days of age) were given single oral doses of the fungicidebenomyl (methyl 1-(butylcarbamoyl)-2-benzimidazolecarbamate)in dosages ranging from 25 to 800 mg/kg body weight. The testisand excurrent ducts were examined at 2 and 70 days posttreatmentto determine the chemical effects on spermatogenesis and theepididymis. Primary effects seen at 2 days postexposure weretesticular swelling and occlusions of the efferent ductules.Mean testis weight peaked with 400 mg/kg. Premature releaseof germ cells (sloughing), detected even with the lowest dosage(25 mg/kg), was the most sensitive short-term response to benomyl.Sloughing was found primarily in Stage VII of the spermatogeniccycle at the lower dosages, but at higher dosages sloughingextended into all stages except for Stages VIII-XI. Occlusionsof the efferent ductules of the testis were dose-dependent andcorrelated with testis weight. Sperm and sloughed germ cellswere compacted in the ductal lumen of occluded ductules, whichwere surrounded by two to four layers of polymorphonuclear leukocytesand other inflammatory cells. Although the caput epididymidiscontained sloughed germ cells and appeared swollen, evidenceof permanent occlusion was not found. The long-term (70 days)effects of benomyl were decreased testis weight (at 400 mg/kg),dose-dependent increases in seminiferous tubular atrophy, andincreases in the number of reproductive tracts containing occludedefferent ductules. Fibrosis, granulomas, and abnormal growthwere long-term consequences of occluded ductules, which werepresent 100% of the time in testes containing 26–100%seminiferous tubular atrophy. Only a few testes were found tobe completely regressed. Occlusion of efferent ductules anddisruption of the seminiferous epithelium by sloughing of germcells are overlapping dose-dependent mechanisms responsiblefor short- and long-term effects of benomyl on the rat testis.     

FINDING MEANING IN A CHILD'S VIOLENT DEATH: A FIVE-YEAR PROSPECTIVE ANALYSIS OF PARENTS' PERSONAL NARRATIVES AND EMPIRICAL DATA

Finding meaning in the death of a loved one is thought to be extremely traumatic when the circumstances surrounding the death is perceived to be due to negligence, is intentional, and when the deceased suffered extreme pain and bodily harm immediately prior to death. We addressed this assumption by obtaining personal narratives and empirical data from 138 parents 4, 12, 24, and 60 months after an adolescent's or young adult child's death by accident, suicide, or homicide. Using the Janoff-Bulman and Frantz's(1997) framework ofmeaning-as-comprehensibility and meaning-as-significance, the purposes were to identify the time course to find meaning, present parents' personal narratives describing finding meaning in their experiences, identify predictors of finding meaning, and compare parents who found meaning versus those who did not on five health and adjustment outcomes. The results showed that by 12 months postdeath, only 12% of the study sample had found meaning in a child's death. By 60 months postdeath, 57% of the parents had found meaning but 43% had not. Significant predictors of finding meaning 5 years postdeath were the use of religious coping and support group attendance. Parents who attended abereavement support group were 4 times more likely to find meaning than parents who did not attend. Parents who found meaning in the deaths of their children reported significantly lower scores on mental distress, higher marital satisfaction, and better physical health than parents who were unable to find meaning. Recommendations for future research are made.