The prediction of a family group of two-dimensional node-line semimetals

Using first-principles calculations, we predict a family group of two-dimensional semimetals MX (M = Pd, Pt; X = S, Se, Te), which has a zig-zag type mono-layer structure in the Pmma (no. 41) layer group. Band structure analysis reveals that node-line features are caused by band inversion and the inversion exists even in the absence of spin-orbital-coupling. First-principles calculations show the robust lattice stability of these predicted materials. This work provides the possibility of making a group of novel two-dimensional materials with semimetal features.

Quasi-One-Dimensional Metal-Insulator Transitions in Compound Semiconductor Surfaces

Existing examples of Peierls-type 1D systems on surfaces involve depositing metallic overlayers on semiconducting substrates, in particular, at step edges. Here we propose a new class of Peierls system on the (101[over ¯]0) surface of metal-anion wurtzite semiconductors. When the anions are bonded to hydrogen or lithium atoms, we obtain rows of threefold coordinated metal atoms that act as one-atom-wide metallic structures. First-principles calculations show that the surface is metallic, and below a certain critical temperature the surface will condense to a semiconducting state. The idea of surface scaffolding is introduced in which the rows are constrained to move along simple up-down and/or sideways displacements, mirroring the paradigm envisioned in Peierls's description. We predict that this type of insulating state should be visible in the partially hydrogenated (101[over ¯]0) surface of many wurtzite compounds.

Differing epidemiology of two major healthcare-associated meticillin-resistant Staphylococcus aureus clones

BACKGROUND

Two meticillin-resistant Staphylococcus aureus (MRSA) clones, sequence type (ST) 22 and ST239, have successfully spread globally. Across Australia, ST22 has supplanted ST239 as the main healthcare-associated MRSA. To understand the reasons underlying this shift, the epidemiology and clinical features of infections due to ST22 and ST239 MRSA isolates from a tertiary hospital in Melbourne, Australia were compared.

METHODS

Over six months, consecutive MRSA isolates with clinical data were collected from specimens referred to Alfred Health Pathology (AHP). Isolates were genotyped by a multi-locus-sequence-typing-based high-resolution melting method.

FINDINGS

Three hundred and twenty-eight of 1079 (30%) S. aureus isolated by AHP were MRSA. Of these, 313 were genotyped; 78 (25%) were clonal complex (CC) 22 (representing ST22) and 142 (45%) were CC239 (representing ST239). Common clinical syndromes included skin or soft tissue, respiratory tract and osteo-articular infections. On multi-variate logistic regression, compared with CC239, CC22 was associated with older patients [adjusted odds ratio (aOR) 1.04 for each year increase, 95% confidence interval (CI) 1.02-1.07)], and patients from subacute hospitals (aOR 2.7, 95% CI 1.2-5.8) or long-term care facilities (LTCFs; aOR 5.5, 95% CI 2.0-14.5). Median time from patient admission to MRSA isolation was nine days for CC239 and one day for CC22 (P < 0.01). MRSA strain epidemiology varied according to hospital unit.

CONCLUSIONS

CC22 and CC239 MRSA have differing ecological niches. CC22 is associated with elderly patients in LTCFs, and CC239 is associated with nosocomial acquisition. Infection control strategies involving LTCFs and their residents will likely be required to achieve continued MRSA control.

Transillumination-assisted orotracheal intubation: a comparison of the Bonfils fibrescope and the lightwand (Trachlight)

BACKGROUND

Because the Bonfils fibrescope has a semi-rigid optical stylet and is similar in shape to a lightwand, we aimed to evaluate and compare the efficacy of transillumination-assisted orotracheal intubation with the Bonfils fibrescope and the Trachlight(TM) lightwand in patients with normal airways.

METHODS

As a preliminary investigation to form a basis for later studies, therefore, we performed a randomized, single-blind study of 300 patients with normal airways to compare the efficiency of Trachlight and transillumination-assisted Bonfils orotracheal intubation in these patients. In both groups, orotracheal intubation was performed using a transillumination technique. The first attempt and overall success rates of tracheal intubation, the times required, and any untoward effects were recorded.

RESULTS

Although the overall success rates were similar for Bonfils and Trachlight intubations (97.3% and 98.7%, respectively), tracheal intubation was successful on the first attempt in 87.3% of patients with the Bonfils fibrescope compared with 95.3% of patients with the Trachlight (P < 0.05). The mean intubation time for the first attempt was 15 ± 5 s with the Bonfils fibrescope and 9 ± 2 s with the Trachlight (P < 0.001). Patients intubated using the Bonfils fibrescope also experienced significantly more sore throat and hoarseness than those intubated using the Trachlight.

CONCLUSIONS

For patients with normal airways, the Trachlight is superior for orotracheal intubation with respect to reliability, rapidity, and safety compared with the Bonfils fibrescope used with the transillumination technique.

Secondary missed abdominal pregnancy due to iatrogenic uterine perforation: a case report

Abdominal pregnancy is extremely rare and can result from the reimplantation of an intrauterine pregnancy after spontaneous uterine rupture. In this report, we present the case of a secondary missed abdominal pregnancy resulting from iatrogenic uterine perforation during dilatation and curettage in an early intrauterine pregnancy and subsequently misdiagnosed as intrauterine trophoblastic disease. Transvaginal ultrasound missed the diagnosis, which was finally confirmed by computed tomography. We discuss the particulars of the case along with a review of the relevant literature.

The effects of obesity and HER-2 polymorphisms as risk factors for endometrial cancer in Korean women

OBJECTIVE

To evaluate the relationship between single nucleotide polymorphisms (SNPs) in the HER-2 gene, body mass index (BMI) and the risk of endometrial cancer.

DESIGN

Case-control study.

SETTING

Medical centres in Korea.

SAMPLE

DNA samples and medical histories were obtained from 125 endometrial cancer cases and 302 controls.

METHODS

The genotypes evaluated in HER-2 at positions -423, -655, -776, -857, -1170, -1177, -1253 of the coding region and two SNPs located in an intron by SNP-IT assay using SNPstream Ultra-high throughput system.

MAIN OUTCOME MEASURES

Odd ratio for endometrial cancer associated with HER-2 polymorphisms and BMI.

RESULTS

Cases had a significantly higher BMI than controls and the obese subjects had a 2.65-fold increased risk for endometrial cancer. However, HER-2 polymorphism was not associated significantly with the risk of endometrial cancer. Subjects with BMI > or = 25 kg/m2 who carried rs1801200 AA, rs1801200 GA/GG, rs1810132 CT/CC, rs2517951 CT/TT and rs1058808 CG/GG genotype had significantly increased risk of endometrial cancer than subjects with a normal BMI (P for linear trend <0.05). However, the risk in the subjects with the variant allele for HER-2 genotypes did not differ significantly compared to those with homozygous wild-type allele within specific BMI subgroups.

CONCLUSIONS

Endometrial cancer risk increased significantly in proportion to BMI. However, HER-2 polymorphism did not affect significantly on the risk of endometrial cancer.

Human papillomavirus genotype as a prognostic factor in carcinoma of the uterine cervix

The clinical implications of specific human papillomavirus (HPV) types in invasive cervical carcinomas are only now beginning to be appreciated. The objective of this study was to determine the clinical implications and prognostic value of the HPV genotype in cervical carcinomas. In this study, we employed an HPV DNA chip to detect the type-specific sequence of HPV from cervical swabs taken from women with biopsy-proven neoplastic lesions of the cervix. We divided the patients into four groups: HPV-negative, HPV-16-related, HPV-18-related, and intermediate risk type-related. Associations with clinicopathologic data (stage, histologic type, lymph node status, parametrial invasion, lymphvascular space invasion, tumor size, vaginal involvement) and overall survival were assessed. HPV DNA was detected in 81.4% of the patients, and 19.0% harbored multiple HPV variants. HPV-16-related was the predominant type and was detected in 47.4% (46/97) of the patients. The HPV-16-related types were detected more frequently in patients with squamous cell carcinomas, whereas the HPV-18-related types were more prevalent in cases of adenocarcinomas and adenosquamous carcinomas (P < 0.05). Otherwise, no significant correlations were detected between the HPV genotype and any other clinicopathologic parameters. After a median follow-up of 30 months, the 5-year survival rate was lower in the HPV-18-related patients, but this difference was not found to be statistically significant, according to the results of the log-rank test. We conclude that neither the presence nor type of HPV DNA bears any prognostic significance in cases of cervical carcinoma.

Identification of differentially expressed genes using annealing control primer-based GeneFishing in human squamous cell cervical carcinoma

AIMS

To compare different gene expression patterns between squamous cell cervical carcinoma (SCC) and normal cervical tissue in Korean women and to identify those genes that are specifically or predominantly expressed in SCC by employing annealing control primer (ACP)-based GeneFishing polymerase chain reaction (PCR).

MATERIALS AND METHODS

Cervical cancer specimens were obtained from patients enrolled at the Department of Obstetrics and Gynecology, Kang Nam St. Mary's Hospital, Catholic University of Korea. We used a common reference that was mixed with an equal amount of RNA extracted from patients without cervical cancer. The profiles of expressed genes were compared between the SCC and normal cervix identified using GeneFishing differentially expressed gene kits, screened by a BLAST search, and confirmed by semi-quantitative reverse transcription-PCR (RT-PCR).

RESULTS

Almost 100 differentially expressed genes were identified in the control and SCC samples. Using 60 arbitrary ACPs, 50 differentially expressed genes were identified, and 30 up-regulated and 20 down-regulated expressed genes were sequenced. Among 50 clones selected by ACP-based GeneFishing PCR, six genes with different expression patterns were determined and confirmed by semi-quantitative RT-PCR. The functional roles of two up-regulated genes, fibrillarin and calgranulin A, and one down-regulated gene, clusterin, were previously identified. However, the functional roles of two up-regulated genes and one down-regulated gene were not identified.

CONCLUSION

We identified distinctive gene expression profiles in Korean women with SCC using ACP-based GeneFishing PCR.

Efficient calculation of electron diffraction for the structural determination of nanomaterials

A critical advance in the technique of low-energy electron diffraction is presented and shown to enable determining detailed structures of nanomaterials, based on experimental methods that already exist or have been proposed. Our new cluster approach speeds up the computation to scale as n logn, rather than the current n3 or n2, with n the number of atoms, for example. Applications are illustrated for C60 molecules adsorbed on a Cu(111) surface, with and without coadsorbed metal atoms, exhibiting sensitivity to important structural features such as buckyball size and deformation.

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate

BACKGROUND

The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities.

METHODS

A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group.

RESULTS

The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively.

CONCLUSIONS

Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.

Structures and energetics of hydrogen-terminated silicon nanowire surfaces

The analysis and density-functional tight-binding simulations of possible configurations of silicon nanowires (SiNWs) enclosed by low-index surfaces reveal a number of remarkable features. For wires along <100>, <110>, and <111> directions, many low-index facet configurations and cross sections are possible, making their controlled growth difficult. The 112 wires are the most attractive for research and applications because they have only one configuration of enclosing low-index facets with a rectangular cross section, enclosed with the most stable (111) facet and the (110) facet next to it. In general, the stability of the SiNWs is determined by a balance between (1) minimization of the surface energy gamma(111)<gamma(110)<gamma(001), and (2) minimization of the surface-to-volume ratio [svr; svr(hexagonal)>svr(rectangular)>svr(triangular)]. The energy band gaps follow the order of <100>wires > <112>wires > <111>wires > <110>wires. The results are compared with our recent scanning tunneling microscopy and transmission electron microscopy data.

Spectral features of LO phonon sidebands in luminescence of free excitons in GaN

In the paper a combined experimental and theoretical investigation of the longitudinal optical phonon sidebands (PSBs) in the luminescence of free excitons in GaN at moderately high temperatures was reported. The spectral features, including line broadening, shift, and asymmetry of the one- and two-phonon PSBs, were revealed both experimentally and theoretically. It is found that the linewidth of the one-phonon PSB is surprisingly always larger than that of the two-phonon PSB in the interested temperature range. Moreover, the thermal broadening rates of the one- and two-phonon PSBs are considerably different. We adopted the Segall-Mahan theory [B. Segall and G. D. Mahan, Phys. Rev. 171, 935 (1968)] to compute the PSB spectra of the free excitons in GaN. Only one adjustable parameter, the effective mass of the holes, was used in the calculations. For the one-phonon PSB, an excellent agreement between theory and experiment is achieved when an adequate effective mass of the holes was used.

Layer spacings in coherently strained epitaxial metal films

Laterally resolved measurements of the quantum size effect (QSE) in electron reflectivity are made with low energy electron microscopy on coherently strained Ag films on a W(110) surface. The evolution of the total film thickness with increasing number of atomic layers is determined accurately by dynamical theory analysis of the QSE features. Combined with a model of layer spacings obtained from first-principles calculations, this provides for a novel approach to determine the buried interface layer spacing, which is inaccessible to other methods.

Small-diameter silicon nanowire surfaces

Small-diameter (1 to 7 nanometers) silicon nanowires (SiNWs) were prepared, and their surfaces were removed of oxide and terminated with hydrogen by a hydrofluoric acid dip. Scanning tunneling microscopy (STM) of these SiNWs, performed both in air and in ultrahigh vacuum, revealed atomically resolved images that can be interpreted as hydrogen-terminated Si (111)-(1 x 1) and Si (001)-(1 x 1) surfaces corresponding to SiH3 on Si (111) and SiH2 on Si (001), respectively. These hydrogen-terminated SiNW surfaces seem to be more oxidation-resistant than regular silicon wafer surfaces, because atomically resolved STM images of SiNWs were obtained in air after several days' exposure to the ambient environment. Scanning tunneling spectroscopy measurements were performed on the oxide-removed SiNWs and were used to evaluate the electronic energy gaps. The energy gaps were found to increase with decreasing SiNW diameter from 1.1 electron volts for 7 nanometers to 3.5 electron volts for 1.3 nanometers, in agreement with previous theoretical predictions.

Surface atomic arrangement visualization via reference-atom-specific holography

We demonstrate the direct reconstruction of 3D atomic images from measured low-energy electron diffraction (LEED) intensity spectra. A multiple-incident angle and multiple-energy integral are first applied to the spectra to obtain a map of interatomic vectors. From this map, a nonbulk interatomic vector is chosen that points to a desired reference atom. A second integral transformation, using the chosen interatomic vector as a filter, is applied to the LEED spectra to produce images of individual atoms in the vicinity of the selected reference atom. This two-step method overcomes the problem of multiple, nonequivalent reference atoms and is applicable to elemental or compound materials.

Surface Patterson function by inversion of low-energy electron diffraction I-V spectra at multiple incident angles

An accurate Patterson function, free of artifacts, is obtained by transforming low-energy electron diffraction I-V spectra at multiple incident angles. The demonstration is carried out using normal incidence measured spectra and calculated spectra at three angles of incidence. The errors between intensity spots in the Patterson function and known interatomic distances are less than 0.01 A in the horizontal direction and 0.09 A in the vertical direction. The reason for the high accuracy in the horizontal direction is given.

Observation of "Ghost" islands and surfactant effect of surface gallium atoms during GaN growth by molecular beam epitaxy

We observe "ghost" islands formed on terraces during homoepitaxial nucleation of GaN. We attribute the ghost islands to intermediate nucleation states, which can be driven into "normal" islands by scanning tunneling microscopy. The formation of ghost islands is related to excess Ga atoms on the surface. The excess Ga also affect island number density: by increasing Ga coverage, the island density first decreases, reaching a minimum at about 1 monolayer (ML) Ga and then increases rapidly for coverages above 1 ML. This nonmonotonic behavior points to a surfactant effect of the Ga atoms.

Molecular spectroscopy study of the reaction of nucleic acids with brilliant cresol blue

The interaction of brilliant cresol blue (BCB) with nucleic acids in aqueous solution has been studied by spectrophotometry and Rayleigh light scattering (RLS) spectroscopy. Under suitable conditions, the RLS spectra of BCB changed significantly due to the presence of nucleic acids. RLS intensity of BCB at 364 nm is greatly enhanced with the addition of nucleic acids, and a new RLS peak is observed at 552 nm. This peak is about half the intensity of that at 364 nm. The results of this study show that BCB interacts with DNA possibly due to the cooperative effect of electrostatic attraction, intercalation, coordination and hydrophobic effect. Under optimum conditions, the increase of RLS at 364 nm of a BCB solution is proportional to the concentration of nucleic acids added. This result is the basis for a new RLS method for determination of nucleic acids. The linear range of ctDNA, fsDNA and yRNA is 0.12-4.70, 0.11-4.64 and 0.43-7.07 microg ml(-1), respectively.

Observation of the correlation of postanaesthesia recovery scores with early postoperative hypoxaemia in children

To observe the correlation of the postanaesthesia recovery score (PARS) with the incidence, and severity of early postoperative hypoxaemia in children, 1213 infants and children, ASA physical status I, aged three months to 14 years, scheduled for elective plastic surgery were included in this study. Arterial oxygen saturation (Spo2) levels were recorded while children were breathing room air shortly after arrival in the recovery room (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120 and 180 min thereafter. The PARS was also determined on all patients when Spo2 levels were recorded in the recovery room. On the basis of different PARS, children were divided into the three groups: Group 1-children having the PARS of < or = 6; Group 2-children having the PARS of 7-9; and Group 3-children having a PARS of 10. The results showed that during the early postoperative period, the incidence and severity of hypoxaemia correlated closely with the PARS. The lower the children's PARS, the higher the incidences of hypoxaemia (Spo2 = 86-90%) and severe hypoxaemia (Spo2 < or = 85%). The incidences of hypoxaemia and severe hypoxaemia were 12.9% and 15.8%, respectively, in Group 1, 20.9% and 2.9% in Group 2, 0.8% and 0% in Group 3. There were significant differences among the three groups. Of the 91 children who required O2 supplementation in the recovery room because of low measured Spo2, 69 had the PARS of < or = 6, and 22 had the PARS of 7-8. It is concluded that if a patient has a PARS of 10, the patient will not need routine oxygen supplement because hypoxaemia will not occur.

Rayleigh light scattering study on the reaction of nucleic acids and methyl violet

A new quantitative determination method for nucleic acids in aqueous solutions, based on the enhancement of Rayleigh light scattering of methyl violet by nucleic acids, has been developed. The sensitivity of the assay allows amounts of nucleic acids as little as 100 ng/ml to be quantitated reliably. In addition to its high sensitivity, this method has other advantages: rapidity of reaction (<5 min), simplicity of operation (one-step assay), commonality of spectrofluorimeter and reagents, stability of mixtures formed, and reproducibility. Under the experimental conditions, there is little or no interference from proteins, nucleosides, and most metal ions. Interference by a few metal ions, detergents, and some salts can be minimized by dilution. The method can also be used to determine the total amount of nucleic acids without the arduous choice of standard and difficult separation of DNA and RNA.

A comparative study of the dose-response and time course of action of rocuronium and vecuronium in anesthetized adult patients

STUDY OBJECTIVES

(1) To compare the dose-response relations of rocuronium and vecuronium in healthy adult patients anesthetized with nitrous oxide-oxygen-fentanyl-thiopental; and (2) to evaluate the time-course of action of two drugs following equipotent doses.

DESIGN

Prospective, randomized, clinical comparison.

SETTING

Operating room, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College.

PATIENTS

60 ASA physical status I patients, aged 17-51 years, scheduled for elective plastic surgery.

INTERVENTIONS

All patients were randomly assigned to either the rocuronium or vecuronium group. General anesthesia was induced with thiopental 4 to 6 mg/kg and fentanyl 2 to 4 micrograms/kg intravenously (i.v.), and maintained with 60% nitrous oxide (N2O) in oxygen. Further increments of thiopental or fentanyl were given as required. The dose-response relations of rocuronium and vecuronium were determined by the cumulative dose-response technique.

MEASUREMENTS AND MAIN RESULTS

Neuromuscular function was assessed mechanomyographically with train-of-four (TOF) stimulation at the wrist every 12 seconds. The percentage depression of first twitch (T1) was used as the study parameter. The cumulative dose-response curve of vecuronium was shifted to the left in a parallel fashion compared with that of rocuronium. As assessed by linear regression, the potency ratio of vecuronium: rocuronium was 1:7.2. There were significant differences in the ED50, ED90, and ED95 between the two drugs. After i.v. administration of equipotent doses of both drugs (2 x ED90), the duration of peak effect, clinical duration, recovery index, and total duration were not significantly different between the two drugs.

CONCLUSIONS

Compared with vecuronium, rocuronium is a low-potency, nondepolarizing relaxant, and its neuromuscular blocking potency is approximately 15% that of vecuronium in adult patients anesthetized with N2O and fentanyl. Following equipotent doses, the time-course of recovery for rocuronium is similar to that of vecuronium.

Dose-response curve and time-course of effect of vecuronium in male and female patients

To determine the differences between men and women in the dose-response curve and the time-course of effect of vecuronium, we studied 60 adult patients (30 male and 30 female), ASA I, age 18-51 yr, undergoing elective plastic surgery. Anaesthesia was maintained with nitrous oxide 60% in oxygen; thiopentone and incremental doses of fentanyl were given as required. Neuromuscular function was assessed mechanomyographically using the train-of-four (TOF) stimulation at the wrist every 12 s. The percentage depression of T1 was used as the study variable. The dose-response relationship of vecuronium was determined by a cumulative dose-response technique. The dose-response curve in men was shifted in a parallel fashion to the right, indicating a decrease in the sensitivity to vecuronium-induced neuromuscular block, compared with women. The ED50, ED90 and ED95 of vecuronium were 23.9 (4.7), 45.4 (11.2) and 55.7 (14.3) micrograms kg-1 in men and 18.4 (3.7), 33.5 (7.8) and 39.8 (9.6) micrograms kg-1 in women respectively. There were statistically significant differences in these values between the two groups (P < 0.01 in each instance). After a total dose of vecuronium 80 micrograms kg-1, neuromuscular block was significantly longer in women than in men. The duration of peak effect, clinical duration, and the total duration were 18.7 (7.1), 26.6 (8.8) and 50.6 (16.0) min respectively in men and 26.0 (7.2), 37.1 (11.2) and 65.9 (20.7) min in women. They differed significantly between men and women (P < 0.005 in each case).

Influence of surgical technique on early postoperative hypoxaemia in children undergoing elective palatoplasty

We have assessed the influence of different surgical procedures on the incidence, severity and duration of early postoperative hypoxaemia in 312 healthy infants and children undergoing elective palatoplasty. Group 1 patients underwent von Langenbeck palatoplasty (n = 149), group 2 patients underwent push-back palatoplasty (n = 124) and group 3 patients underwent combined push-back palatoplasty and superior pharyngeal flap surgery (n = 39). Arterial oxygen saturation (SpO2) was recorded while patients were breathing air shortly after arrival in the recovery room (0 min), and at 5, 10, 15, 20, 30, 40, 50, 60, 120 and 180 min thereafter. Patients who underwent more complex surgical techniques for palatoplasty had lower postoperative SpO2 values, slower recovery of SpO2 and a higher incidence of hypoxaemia during the early postoperative period. There were significant differences in postoperative SpO2, values and the incidence of hypoxaemia. The incidences of hypoxaemia and severe hypoxaemia were 27% and 1%, respectively, in group 1, 37% and 12% in group 2, and 36% and 33% in group 3. Hypoxaemia occurred most commonly in the first 15 min in children after von Langenbeck palatoplasty, in the first 40 min after push-back palatoplasty and in the 120 min after combined push-back palatoplasty and superior pharyngeal flap surgery. There were significant associations between low SpO2 values, incidence of hypoxaemia on admission to the recovery room and recovery scores.

The influence of acute normovolemic hemodilution on the dose-response and time course of action of vecuronium

To evaluate the influence of acute isovolemic hemodilution on the dose-response and time course of action of vecuronium, we studied 60 adult patients with and without hemodilution during surgery. The patients with hemodilution underwent major elective plastic surgery with an anticipated surgical loss of more than 600 mL. Anesthesia was induced with thiopental 4-6 mg/kg and fentanyl 2-4 microg/kg i.v. and was maintained with 60% nitrous oxide in oxygen. Further increments of thiopental 2 mg/kg or fentanyl 2 microg/kg were given as required. Acute isovolemic hemodilution in the hemodilution group was induced by drainage of venous blood and an i.v. infusion of lactated Ringer's solution and 6% dextran, during which hematocrit and hemoglobin decreased from 45.7% to 26.2% and from 148.5 g/L to 90.2 g/L, respectively. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s, and the percent depression of T1 response was used as the study parameter. The dose-response relationships of vecuronium in the two groups were determined by using the cumulative dose-response technique. The results showed that during hemodilution, the dose-response curve of vecuronium was shifted to the left in a parallel fashion, and the potency of vecuronium was increased. There were significant differences in the 50%, 90%, and 95% effective doses between the two groups. After the i.v. administration of vecuronium 80 microg/kg, vecuronium-induced neuromuscular block was significantly longer in the patients with hemodilution than in the control patients. The duration of peak effect, clinical duration, recovery index, and total duration in the hemodilution patients were significantly different from those in the control patients. We conclude that hemodilution induces significant changes in the pharmacodynamics of vecuronium.

IMPLICATIONS

We found that patients with hemodilution were 20% more sensitive to vecuronium and had a longer duration of action after the administration of the same dose than the controls. This should be taken into account when vecuronium is used as a muscle relaxant during acute hemodilution.

Influence of acute normovolaemic haemodilution on the relation between the dose and response of rocuronium bromide

The influence of acute moderate haemodilution on the relation between dose and response for rocuronium was evaluated in 60 adult patients, ASA grade I, undergoing elective plastic surgery. The patients were randomly allocated to either the control or the haemodilution group. Following the induction of general anaesthesia, the status of acute moderate haemodilution in the haemodilution group was achieved by draining venous blood, and intravenous infusion of lactated Ringer's solution, 6% dextran or gelofusine, during which the levels of haemoatocrit and haemoglobin dropped from 44% to 27.5% and from 148.3 to 91.3 g L-1, respectively. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s and the percentage depression of T1 response was used as the study parameter. The relation between dose and response for rocuronium in the two groups was determined by the cumulative dose-response technique. The results showed that the dose-response curve for rocuronium during acute moderate haemodilution was shifted in a parallel fashion to the left and the potency of rocuronium was increased. There were significant differences in ED50, ED90 and ED95 between the two groups. The ED50, ED90 and ED95 of rocuronium in the haemodilution group was decreased by 28.2%, 35.4% and 38.8%, respectively, compared with the control group.

Dose-response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia

To evaluate the influence of sevoflurane on the dose-response relationship and on the time-course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12s and the percentage depression of the first twitch of the train-of-four was used as the study parameter. The dose-response relationship of rocuronium in the two groups was determined by the cumulative dose-response technique. The dose-response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium-induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 micrograms.kg-1, the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups.

Pharmacokinetics of vecuronium during acute isovolaemic haemodilution

To evaluate the effect of acute isovolaemic haemodilution on the pharmacokinetics of vecuronium, we studied 13 patients undergoing haemodilution during surgery and 13 control patients. General anaesthesia was induced with thiopentone 4-6 mg kg-1 and fentanyl 2-4 micrograms kg-1, and maintained with enflurane and 60% nitrous oxide in oxygen. The haemodilution patients underwent major elective plastic surgery with an anticipated surgical loss of more than 600 ml. Haemodilution was achieved by drainage of venous blood and i.v. infusion of lactated Ringer's solution and 6% dextran, during which the packed cell volume and haemoglobin concentration decreased from 45% to 28.1% and from 14.7 g dl-1 to 9.1 g dl-1, respectively. After administration of a bolus of vecuronium 100 micrograms kg-1, an improved fluorimetric assay was used to measure the plasma concentrations of vecuronium for 5 h. The results showed that the disposition kinetics of vecuronium were best described mathematically by a three-compartment open model in the two groups. The mean volume of the central compartment and volume of distribution at steady state were 42.3 (SD 11.8) ml kg-1 and 168.4 (31.5) ml kg-1, respectively, in control patients, and significantly greater (55.2 (13.4) ml kg-1 and 225.9 (53.3) ml kg-1) in the haemodilution patients (P < 0.05). The elimination half-life was 50.3 (11.5) min in control patients and significantly greater (68.2 (15.1) min) in the haemodilution patients (P < 0.05). The half-lives of fast distribution and distribution, mean residual time, area under the plasma concentration curve and plasma clearance were unchanged in patients who underwent haemodilution compared with the control group.

Dose-response and time course of effect of rocuronium in male and female anesthetized patients

To determine differences from dose-response and time-course of rocuronium between male and female patients, 60 adult patients (30 male and 30 female), ASA grade I, aged 17-52 yr, undergoing elective plastic surgery were studied. Anesthesia was maintained with 60% nitrous oxide in oxygen, thiopental, and incremental doses of fentanyl as required. Neuromuscular function was assessed mechanomyographically with train-of-four (TOF) stimulation at the wrist every 12 s, and the percentage depression of the T1 response was used as the study variable. The dose-response relationship of rocuronium was determined by a cumulative dose-response technique. The results showed that the dose-response curve of rocuronium in the men was shifted to the right, indicating a decrease in the sensitivity to rocuronium-induced neuromuscular block versus the women. The 50%, 90%, and 95% effective doses of rocuronium were 178.4 +/- 53.7, 358.7 +/- 101.3, and 386.2 +/- 113.4 microg/kg, respectively, in male patients, and 128.8 +/- 42.5, 252.8 +/- 51.7, and 274.4 +/- 59.4 microg/kg in female patients. After an intravenous administration of total dose of 400 microg/kg rocuronium, neuromuscular block was significantly longer in the men than in the women. The duration of peak effect, clinical duration, and total duration were 6.5 +/- 3.0, 12.5 +/- 4.9, and 33.6 +/- 8.7 min, respectively, in male patients, and 11.8 +/- 2.7, 18.5 +/- 5.3, and 46.8 +/- 9.6 min in female patients. We conclude that women were approximately 30% more sensitive to rocuronium compared with men.

IMPLICATIONS

The authors found that women were 30% more sensitive to rocuronium than men. This suggests that the routine dose of rocuronium should be reduced in women compared with men.

Enhancement of Rayleigh light scattering of acid chrome blue K by proteins and protein assay by the scattering technique

Rayleigh light scattering of Acid Chrome Blue K (ACBK) is enhanced greatly by proteins. Based on this, a method for protein assay in aqueous solution was developed. This assay matches the sensitivity of the colorimetric dye-binding method with a linear range of 0.136-10.88 micrograms ml-1. The measurements can be made easily on a common fluorimeter. The reaction between ACBK and proteins is completed in 2 min and the scattered light signal is stable for at lest 3 h. Protein-to-protein variability is encountered in this method as in many other protein assays. There is little or no interference from amino acids, most metal ions and complexing agents (e.g., EDTA). Interferences from salts, urea and detergents can be minimized by dilution.

Determination of nanograms of nucleic acids by their enhancement effect on the resonance light scattering of the cobalt(II)/4-[(5-chloro-2-pyridyl)azo]-1,3-diaminobenzene complex

Using a common spectrofluorometer to measure the intensity of resonance light-scattering, a method for determination of nucleic acids in the nanogram range has been developed. In the pH range 11.5-12.0, the resonance light-scattering of the binary complex of cobalt(II)/ 4-[(5-chloro-2-pyridyl)azo]-1,3-diaminobenzene (5-Cl-PADAB) is greatly enhanced by nucleic acids, with the maximum scattering peak located at 547.0 nm. The enhanced intensity of resonance light-scattering is in proportion to the concentration of calf thymus DNA in the range 0-400 ng/mL and to that of fish sperm DNA and yeast RNA in the range 0-300 ng/mL. The limits of detection are 1.4 ng/mL for calf thymus DNA, 0.8 ng/ mL for fish sperm DNA, and 1.3 ng/mL for yeast RNA. Precision at 200 ng/mL for the three nucleic acids is 1.9%, 2.0%, and 0.8%, respectively. Six synthetic samples were determined satisfactorily. Mechanism studies showed that the nature of the reaction is that the binary complex of Co(II)/5-Cl -PADAB reacts with single-stranded nucleic acid, and the enhancement effect of nucleic acids on the resonance light scattering of the binary complex is due to the stacking of the binary complex on nucleic acids, which act as a template.

Effect of epidural block on the lag time of pulse oximeter response

Thirty-six healthy patients, ASA 1, aged 16-41 years, scheduled for elective plastic surgery were studied to determine if thoracocervical or lumbar epidural blocks affected the lag time of the pulse oximeter response. Patients were allocated to receive thoracocervical epidural block (n = 20) (group 1) (lignocaine 1%) or lumbar epidural block (n = 16) (group 2) (lignocaine 1.5%). Epidural block was performed with a 17-gauge Tuohy needle inserted in the midline between C7-T2 vertebrae in group 1 and between L1-S1 in group 2 and an epidural catheter was introduced. Arterial oxygen saturation (SpO2) was measured continuously using a Datex pulse oximeter. The lag time of the pulse oximeter response was measured while breathing oxygen (100%) after breath-holding. Values were obtained 10 min before and 5, 10, 15, 20, 30, and 40 min after epidural injection of a test dose. There was a progressive decrease in the lag time of the pulse oximeter response so that by 30 min after epidural injection the mean (SD) value had decreased from 29 (6.1) to 14 (3.4) in Group 1 and 41 (12.8) to 23 (7.9) s in group 2 (p < 0.01).

Study of the safe threshold of apneic period in children during anesthesia induction

STUDY OBJECTIVES

(1) To investigate changes in arterial oxygen saturation via pulse oximeter (SpO2) during apnea and after reinstitution of manual ventilation at SpO2 of 95% or 90% following rapid sequence induction of anesthesia in children after 2-minute preoxygenation; (2) to determine whether the setting of a safe threshold of apneic period to an SpO2 of 95% is appropriate in children during anesthetic induction; and (3) to evaluate the influences of age, body weight, and height on the time from the start of apnea to SpO2 of 95%.

DESIGN

A clinical study of random design and comparison among groups.

SETTING

Operating room of a plastic surgery hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College.

PATIENTS

152 infants and children, ASA physical status 1, aged 3 months to 12 years, scheduled for elective plastic surgery.

INTERVENTIONS

Patients were divided into three age groups: Group 1-infants 3 months to 1 year (n = 39); Group 2 children 1 to 3 years (n = 41); and Group 3-children 3 to 12 years (n = 72). Patients in each age group were randomly allocated again to Subgroups A and B. After a 2-minute preoxygenation, anesthesia was induced with thiopental 5 mg/kg, fentanyl 5 micrograms/kg and suxamethonium 1.5 mg/kg. Patients were manually ventilated when SpO2 decreased to 90% in Subgroups A and 95% in Subgroups B, respectively, during apnea.

MEASUREMENTS AND MAIN RESULTS

SpO2 was measured continuously with a Datex pulse oximeter applied to the right index finger. During apnea, the times for SpO2 to decrease to 09% (T99) and 95% (T99) in all children, and 90% (T90) in Subgroups A were recorded. The time for SpO2 to decrease from 95% to 90% (T95-90) in Subgroups A was also measured. After reinstitution of manual ventilation, the time when SpO2 continued to decrease (T1) and the time from the end of apnea to recovery of SpO2 baseline (T2) were determined. In addition, the lowest value of SpO2 after apnea was also recorded. The results showed that younger children were more susceptible than older children to the risk of hypoxemia during apnea. There were significant differences in T99, T95, T90, and T95-90 between the three age groups T1 and T2 were significantly longer in Group 3 than in Groups 1 and 2. There were significant differences in the lowest values of SpO2 following apnea among the three Subgroups A and between Subgroups A and B of each age group. During apnea, heart rate decreased gradually as SpO2 decreased, showing a significant decrease at SpO2 of 95%. Bradycardia was found in three children in Subgroups A. The apnea time to SpO2 of 95% correlated well with age, weight, and height by linear regression analysis.

CONCLUSIONS

The safe threshold of an apneic period setting to an SpO2 of 95% was appropriate in children during anesthesia induction. Despite the same duration of preoxygenation, younger children were more susceptible than elder ones to the risk of hypoxemia during apnea. The apnea time to SpO2 of 95% correlated with age, body weight, and height using linear regression analysis.

Prevalence of late orchidopexy is consistent with some undescended testes being acquired

To diagnose the incidence of orchidopexy versus age over a 15-year period, a study was conducted of all patients discharged from a single institution for orchidopexy with reference to age during operation. The hypothesis drawn was that some boys have acquired UDT and therefore, will present late despite recommendations for early diagnosis and treatment. The study was conducted on patients from Royal Children's Hospital, Melbourne (1980-94). The results suggested that while the optimal age for management of congenital UDT has been lowered to one to two years of age by under-graduate education, the persistence of a significant number of older children undergoing surgery suggests that some UDT's are acquired. It also showed that the proportion of orchidopexies performed in infancy increased over the 15-year period while the proportion performed in late childhood remained constant.

A comparative study of early postoperative hypoxemia in infants, children, and adults undergoing elective plastic surgery

To determine the influence of age on postoperative hypoxemia, we studied postoperative hypoxemia in 1152 patients, from infants to adults, ASA physical status I, undergoing elective plastic surgery. Subjects were divided into four groups on the basis of age: Group 1, infants aged 1 yr or less (n = 108); Group 2, children aged 1-3 yr (n = 240); Group 3, children aged 3-14 yr (n = 482); and Group 4, adults aged 14-58 yr (n = 322). Arterial oxygen saturation (Spo2) levels were recorded while patients were breathing room air in the postanesthesia recovery room shortly after arrival (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. Younger patients showed lower Spo2 levels and a higher incidence of hypoxemia during the early postoperative period. The incidences of hypoxemia (Spo2 = 86%-90%) and severe hypoxemia (Spo2 < or = 85%) in the recovery room were 30.6% and 16.7%, respectively, in Group 1, 20.0% and 10.0% in Group 2, 14.1% and 3.3% in Group 3, and 7.8% and 0.6% in Group 4. Hypoxemia occurred most commonly within 1 h after anesthesia, particularly during the first 40 min in infants and during the first 15 min in older children and adults. A significant correlation was found by linear regression analysis between low Spo2 levels on admission to the recovery room and children's age. Thereafter, Spo2 levels and the incidence of hypoxemia during the early postoperative period were related only to infants' recovery scores.

Stereological analysis of the layered collagen of human intracranial aneurysms

Intracranial saccular aneurysms are balloon-like distensions of the arterial wall; they increase in size gradually, a few to the point of bleeding or catastrophic rupture. Collagen is the primary structural component of the aneurysmal wall, and because only a small fraction of aneurysms fail, the collagen fabric must effectively reorganize in order to maintain mechanical integrity as an aneurysm changes size. Data were obtained from four human aneurysms, fixed at 110 mmHG of distending pressure with 10% buffered formalin, and sectioned completely through at 4 microns thickness. Each set of measurements included groups of data taken layer by layer from a radial corridor across the aneurysm wall. Each three-dimensional orientation measurement, for which we used a Zeiss polarizing microscope with a universal stage attachment, is defined by an azimuth and elevation angle relative to the section plane. We compared the interdependence of these measured angles with a mathematical model based on fibres following great circle trajectories, and related the measured azimuth and elevation angles to the relative depth of the section into the aneurysm. Data were plotted on Lambert equal-area projections, along with the theoretical relation between azimuth and elevation, that included wall thickness and depth of sectioning. The graphical relationship between measured azimuth and elevation for collagen fibres across the layered fabric of the aneurysmal wall is consistent with the theoretical great circle trajectories for collagen fibre alignment. Analysis was based on statistics for spherical data to give values for the mean orientation and the circular standard deviations (CSD) about that mean. The results indicate that any given region on the aneurysm wall is made up of many, very thin sublayers, most of which have a relatively coherent organization (mean CSD 8 degrees). These measurements agree well with the mathematical model and, when considered collectively, the layers provide a balanced distribution for bearing the biaxial tensile stress of the wall.

Microdetermination of proteins by resonance light scattering spectroscopy with bromophenol blue

Reaction of bromophenol blue with proteins results in an enhanced resonance light scattering at 334 nm. Based on this, a new quantitative determination method for proteins in the aqueous solution is established. This assay is characterized by high sensitivity (0.34-18.7 microg/ml), short reaction time (>2 min), and simplicity (a one-step assay). Due to protein-to-protein variability, this method gave results higher than that of the bromocresol green assay in detection of human serum albumin.

Determination of nucleic acids by a resonance light-scattering technique with alpha, beta, gamma, delta-tetrakis[4-(trimethylammoniumyl)phenyl]porphine

The resonance light-scattering technique, using a spectrofluorometer, was first developed as a sensitive instrumental analysis method. At pH 7.48 and ionic strength 0.004, the extent of light-scattering of alpha, beta, gamma, delta-tetrakis[4-(trimethylammoniumyl)phenyl]porphine (TAPP) is enhanced by nucleic acids near 432 nm. There are linear relationships between the enhanced extents of light-scattering and the concentrations of nucleic acids in the range of 1.8 x 10(-7)-10.8 x 10(-7) M for calf thymus and fish sperm DNA and in the range of 1.8 x 10(-7)-1.8 x 10(-6) M for yeast RNA. The limit of determination (3 sigma) is 4.1 x 10(-8) M for calf thymus DNA, 4.6 x 10(-8) M for fish sperm DNA, and 6.7 x 10(-8) M for yeast RNA. Mechanism study indicates that nucleic acids react with the title porphyrin in two modes, depending on the concentrations of nucleic acids. When the molar ratio of nucleic acids to TAPP is smaller than 4:1, the hypochromicity and fluorescence quenching of TAPP by nucleic acids appear, and the enhancement of resonance light-scattering can be observed. When the molar ratio of nucleic acids to TAPP is larger than 4:1, a new fluorescent complex is formed.

Does testosterone diffuse down the wolffian duct during sexual differentiation?

PURPOSE

Sexual differentiation in gonadal dysgenesis is commonly asymmetrical. In patients with true hermaphroditism there may be an ovary and müllerian duct on 1 side, and a testis and wolffian duct on the other side. Such asymmetry suggests that testicular hormones only act locally at this early stage of sexual differentiation. We tested the hypothesis that testosterone reaches the wolffian duct by transport down the duct rather than by simple diffusion.

MATERIALS AND METHODS

Mouse 14-day urogenital ridges were placed in organ culture and microinjected with testosterone-albumin-fluorescein isothiocyanate.

RESULTS

At 17 hours fluorescence was found throughout the wolffian duct and by 48 hours it was maximal in the dilated caudal end.

CONCLUSIONS

Our results support the hypothesis that androgens may be transported along the wolffian duct. Secretion of testicular hormones into the wolffian duct may maintain hormone levels in the biologically active range.

Morphometric study of the gubernaculum in male estrogen receptor mutant mice

To determine role of estrogen receptors in testicular descent, a morphometric study of the testis and structures derived from the gubernaculum was made in sexually mature male mice having an estrogen receptor disrupted gene mutation (ERKO). Macroscopic dissections and sagittal serial sections were made of the pelvis of four wild-type mice, four mice heterozygous for the ERKO mutation, and four homozygous ERKO males. By external morphological examination the testes appeared to be descended in all three genotypes. All mice had development of a cremaster sac, which is derived from the gubernaculum, but this was twice as large in wild-type mice than in both the heterozygote or homozygote ERKO groups. The cause for the smaller cremaster sac appeared to be excessive development of the cremaster muscle in ERKO mice. The thickened muscle was associated with postmortem retraction of the testes into the inguinal canal or abdomen. Spermatogenesis and testicular volume were deficient in homozygous ERKO mice at this age. This study demonstrates that estrogen has a previously unknown role in masculine sexual development of the gubernaculum and the structures derived from it, such as the cremaster muscle.

When is hypospadias not hypospadias?

Hypospadias is a deformity of urethral and penile development in the male. Some cases are secondary to more serious disorders of sexual differentiation. Simple clinical rules can sort the common morphological defect of hypospadias from the rarer but more dangerous diagnosis of intersex.

Fluorometric determination for micro amounts of albumin and globulin fractions without separation by using alpha, beta, gamma, delta-tetra(4'-carboxyphenyl)porphin

A simultaneous determination of micro amounts of albumin and globulin fractions by fluorometry with only reagent alpha,beta,gamma,delta-tetra(4'-carboxyphenyl)porphin (TCPP) in the aqueous solution has been developed. Under the experimental conditions (5.6 x 10(-7) mol/liter of TCPP, pH 3.0, and at room temperature), the linear range of this assay was 0.09-12 microgram/ml and the detection limits (3 S/N) were 60 ng/ml for albumin and 90 ng/ml for globulin, respectively. The human serum samples were measured satisfactorily by using this method.

Observation of early postoperative hypoxaemia in children undergoing elective plastic surgery

The incidence, severity and duration of early postoperative hypoxaemia were determined in 420 healthy infants and children undergoing elective plastic surgery. Mean value of preoperative SpO2 was 98.3 +/- 0.87%. However, it decreased significantly to 92.7 +/- 4.01% immediately following anaesthesia in the postanaesthesia recovery room (PAR) when children breathed room air. Then SpO2 gradually increased to 93.8 +/- 4.25% at 10 min, 95.4 +/- 3.14% at 30 min, 96.6 +/- 2.25% at 60 min, 96.9 +/- 1.69% at 120 min, and 97.4 +/- 1.55% at 180 min, respectively. The incidence of hypoxaemia and severe hypoxaemia, which were 14.8% and 6.2% respectively on arrival in the PAR, decreased significantly to 6.6% and 1.9%, 30 min later. The hypoxaemia occurred most commonly within 1 h, particularly the first 30 min following anaesthesia. The hypoxaemia was more common and more severe in children undergoing cleft palate repair than other kinds of plastic surgery. A significant correlation was found between low SpO2 levels on admission to the PAR and children's age, fentanyl doses, and the infants' recovery score.

Study of the optimal duration of preoxygenation in children

STUDY OBJECTIVE

To determine the optimal length of preoxygenation in children.

DESIGN

Random design and comparison among groups.

SETTING

Operating room of a plastic surgery hospital of the Chinese Academy of Medical Sciences and the Peking Union Medical College.

PATIENTS

Forty healthy, ASA status 1 children (age 2 to 7 yrs), undergoing elective plastic surgery.

INTERVENTIONS

Children in Group 1 breathed 100% oxygen (O2) for 1 minute. Group 2 children breathed 100% O2 for 2 minutes. Group 3 and Group 4 children breathed 100% O2 for 3 minutes. Anesthesia was induced with midazolam 0.3 mg/kg, fentanyl 5 micrograms/kg. Muscle relaxation was achieved with vecuronium 0.1 mg/kg (Groups 1, 2, and 3) or succinylcholine 1.5 mg/kg (Group 4).

MEASUREMENTS AND MAIN RESULTS

Oxygen saturation (SpO2) was measured by pulse oximeter. The oximeter probe was applied to the right big toe. After preoxygenation, the times for SpO2 to decrease to 98% (T98), 95% (T95), and 90% (T90), respectively, were recorded during the apneic period. T98, T95, and T90 were significantly shorter in Group 1 than in Group 2 or Group 3. There was no statistically significant difference among Groups 2, 3, or 4 regarding T98, T95, and T90. The times for SpO2 to decrease from 95% to 90% were similar among the four groups.

CONCLUSIONS

2 minutes of preoxygenation in children can provide the maximum benefit of denitrogenation and achieve 2 minutes of safe apea. 95% and 99% confidence intervals were 69 to 100 and 59 to 100, respectively. Succinylcholine had only a slight effect on the safe apneic period.