K-Y™ jelly inhibits increase in endotracheal tube cuff pressure during nitrous oxide exposure in vitro.

BACKGROUND: The increase in endotracheal tube cuff pressure due to nitrous oxide diffusion is a well-known risk during general anesthesia using nitrous oxide. We hypothesized that lubricating endotracheal tube cuffs with K-Y™ Jelly might inhibit the increase in cuff pressure that occurs during exposure to nitrous oxide. METHODS: We used two types of endotracheal tube cuffs: one made from ultrathin polyurethane (PU) and another made from conventional polyvinyl chloride (PVC). Using a pediatric trachea model, which consisted of an acrylic cylinder with an internal diameter of 12 mm, we measured changes in the cuff pressure during nitrous oxide exposure in size 5.0-mm internal diameter endotracheal tubes with each type of cuff, with and without lubrication with K-Y™ Jelly. RESULTS: During nitrous oxide exposure, the increase in cuff pressure was significantly lower in the lubricated cuffs than in the non-lubricated cuffs in both types of cuffs (PVC, P < 0.0001; PU, P < 0.0001). However, the cuff compliance in the trachea model was unaffected by lubrication in both types of cuffs. CONCLUSIONS: Lubrication of endotracheal tube cuffs with K-Y™ Jelly may effectively delay the increase in cuff pressure that occurs during general anesthesia using nitrous oxide.

Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube.

BACKGROUND: Lubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study. METHODS: We placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmH2O and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmH2O and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen. RESULTS: For both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15-35) cmH2O. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15-25) and 15 (15-35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15-35) cmH2O. Water application did not change these outcomes compared with the N group. CONCLUSION: Pre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.

Effects of gas composition on the delivered tidal volume of the Avance Carestation.

BACK GROUND: Measurements with various flowmeters are affected by changes in gas mixture density. The Avance Carestation incorporates ventilator feedback controlled by a built-in flowmeter with a variable orifice sensor. We hypothesised that changes in the composition of delivered gas may cause changes in the delivered tidal volume by affecting the flow measurement unless appropriate corrections are made. METHODS: We used 100 % O2, 40 % O2 in N2 and 40 % O2 in N2O as carrier gases with/without sevoflurane and desflurane. We measured delivered tidal volume using the FlowAnalyzer™ PF 300 calibrated with the corresponding gas mixtures during volume control ventilation with 500-ml tidal volume using the Avance Carestation connected to a test lung. RESULTS: Change of carrier gas and addition of sevoflurane and desflurane significantly altered delivered tidal volume. Desflurane 6 % reduced delivered tidal volume by 7.6, 3.6 and 16 % of the pre-set volume at 100 % O2, 40 % O2 in N2 and 40 % O2 in N2O, respectively. Importantly, the Carestation panel indicator did not register these changes in measured expired tidal volume. Ratios of delivered tidal volume to 500 ml correlated inversely with the square root of the delivered gas density. CONCLUSIONS: These results support our hypothesis and suggest that changing gas composition may alter delivered tidal volume of anesthesia machines with built-in ventilators that are feedback-controlled by uncorrected flowmeters due to changes in gas mixture density.

[Incidence of inappropriate cases for training of emergency medical technicians in endotracheal intubation].

BACKGROUND: Before emergency medical technicians are licensed to perform prehospital endotracheal intubation, they must undergo training in the operating room setting. We investigated the incidence of cases of difficult intubation classified as Cormack & Lehane grade III or IV, because such cases are considered inappropriate for training emergency medical technicians. METHODS: We examined anesthesia records between March 2002 and April 2003, retrospectively. The survey included 585 adult surgical patients with ASA physical status I or II requiring general endotracheal anesthesia. RESULTS: Five anesthesiologists and three doctors from the surgical department performed laryngoscopy during this period. In initial laryngoscopy with a Macintosh blade, the view of larynx was grade I in 436, grade II in 98, grade III in 27 and grade IV in 24 patients. In 68 patients, application of cricoid pressure led to improvement of laryngoscopy grade. The use of McCoy blade was necessary for intubation in 16 patients. Out of 51 patients classified as difficult intubation grade III or IV, 35 were originally not expected to be difficult cases. CONCLUSIONS: Patients with grade I or II view of larynx with a Macintosh blade was only 91%. In order to prepare for unexpected case of difficult intubation, it is necessary to take various measures such as having instructors perform laryngoscopy.

Optimizing high-resolution melting analysis for the detection of mutations of GPR30/GPER-1 in breast cancer.

G protein-coupled receptor 30/G protein estrogen receptor-1 (GPR30/GPER-1) is a novel membrane receptor for estrogen whose mRNA is expressed at high levels in estrogen-dependent cells such as breast cancer cell lines. However, mutations in GRP30 related to diseases remain unreported. To detect unknown mutations in the GPR30 open reading frame (ORF) quickly, the experimental conditions for high-resolution melting (HRM) analysis were examined for PCR primers, Taq polymerases, saturation DNA binding dyes, Mg(2+) concentration, and normalized temperatures. Nine known SNPs and 13 artificial point mutations within the GPR30 ORF, as well as single nucleotide variants in DNA extracted from subjects with breast cancers were tested under the optimal experimental conditions. The combination of Expand High Fidelity(PLUS) and SYTO9 in the presence of 2.0 mM MgCl(2) produced the best separation in melting curves of mutations in all regions of the GPR30 ORF. Under these experimental conditions, the mutations were clearly detected in both heterozygotes and homozygotes. HRM analysis of GPR30 using genomic DNA from subjects with breast cancers showed a novel single nucleotide variant, 111C>T in GPR30 and 4 known SNPs. The experimental conditions determined in this study for HRM analysis are useful for high throughput assays to detect unknown mutations within the GPR30 ORF.

Predictors of coronary heart disease in Japanese patients with type 2 diabetes: Screening for coronary artery stenosis using multidetector computed tomography.

UNLABELLED: Aims/Introduction: Multidetector computed tomography (MDCT) coronary angiography has been applied as a tool for non-invasive evaluation of the coronary arteries. The purpose of the present study was to evaluate the effectiveness of MDCT in screening for coronary artery disease (CAD), and to identify the indications for screening in diabetes patients with CAD. MATERIALS AND METHODS: The study population consisted of 52 Japanese type 2 diabetes patients who underwent examination with a 64-slice MDCT scanner, electrocardiogram (ECG), echocardiography and ultrasonographic scanning of the carotid arteries. Regression analysis was carried out to assess the correlation between MDCT results and CAD risk factors. RESULTS: Stenosis of the coronary artery was detected in 19/52 patients. Of the 19 patients, 7 patients had no symptoms, including chest pain, and no ischemic changes in ECG. Significant differences between patients with stenosis and those without stenosis were detected by mean IMT (1.21 vs 0.95 mm), and duration of diabetes (20 vs 13 years). Two-tailed χ(2)-test showed that a duration of diabetes of more than 20 years (odds ratio 6.222) and more than 1.1 mm of mean-IMT (odds ratio 4.600) significantly correlated with the stenosis. CONCLUSIONS: It was shown that MDCT is useful in detecting coronary artery stenosis in diabetic patients without symptoms of CAD or ECG abnormality, and the predictors of CAD are mean IMT and duration of diabetes. It is recommended that patients with more than 1.1 mm mean IMT at the carotid artery and/or more than 20 years duration of diabetes should be screened for CAD by carrying out MDCT.

Components of ether-insoluble resin glycoside (rhamnoconvolvulin) from rhizoma jalapae braziliensis.

Alkaline hydrolysis of the ether-insoluble resin glycoside (convolvulin) fraction of the roots of Ipomoea operculata (GOMES) MART. (Convolvulaceae) afforded a glycosidic acid named operculinic acid H along with isovaleric, tiglic, and exogonic (3,6:6,9-diepoxydecanoic) acids. Operculinic acid H was characterized to be 3S,12S-dihydroxyhexadecanoic acid 12-O-beta-D-glucopyranosyl-(1-->3)-O-alpha-L-rhamnopyranosyl-(1-->2)-[O-beta-D-glucopyranosyl-(1-->3)]-O-beta-D-glucopyranosyl-(1-->2)-[O-alpha-L-rhamnopyranosyl-(1-->6)]-O-beta-D-glucopyranoside on the basis of spectroscopic data and chemical evidence. The absolute configuration of exogonic acid determined from the alpha-methoxy-alpha-trifluoromethylphenylacetic acid esters of the hydrogenolysis products revealed that exogonic acid exists as a mixture (ca. 1 : 1) of two epimers, (3S,6S,9R)- and (3S,6R,9R)-diepoxydecanoic acids.

A novel epsilon gamma delta beta thalassemia of 1.4 Mb deletion found in a Japanese patient.

A novel large deletion, causing epsilon gamma delta beta thalassemia (here called, epsilon gamma delta beta thalassemia Jpn-I) was discovered in a 6-year-old Japanese boy. He was born uneventfully, but revealed thalassemia minor after birth. The mutation was inherited from his mother. The deletion, caused by an illegitimate recombination extended from 750 kb upstream to 660 kb downstream of e-globin gene, and removed about 1.4 Mb of DNA, the largest in epsilon gamma delta beta thalassemias. A 19-nucleotide orphan sequence and direct repeats were present at the junction. The deletion lost several functional genes, but no relevant symptoms manifested. The breakpoints were determined by relatively simple methods.