Elements not Graded in the Cardiac Enhanced Recovery After Surgery Guidelines Might Improve Postoperative Outcome: A Comprehensive Narrative Review.

Enhanced Recovery Programs (ERPs) are protocols involving the whole patient surgical journey. These protocols are based on multimodal, multidisciplinary, evidence-based, and patient-centered approaches aimed at improving patient recovery after a surgical intervention. Such programs have shown striking positive results in different surgical specialties. However, only a few research groups have incorporated preoperative, intraoperative, and postoperative evidence-based interventions in bundles used to standardize care and build cardiac surgery ERPs. The Enhanced Recovery After Surgery Society recently published evidence-based recommendations for perioperative care in cardiac surgery. Their recommendations included 22 perioperative interventions that may be part of any cardiac ERP. However, various components integrated in already-published cardiac ERPs were neither graded nor reported in these recommendations. The goals of the current review are to present published cardiac ERPs and their effects on patient outcomes and reported components incorporated into these ERPs and to discuss the objectives and scope of cardiac ERPs.

A qualitative descriptive study of underground workers who received aluminum dust treatment and its organizational level impact.

From 1943 to 1980, some underground gold and uranium workers in Ontario, Canada were required to inhale aluminum dust for silicosis prevention. Workers were exposed to the dust for up to 30 min daily. This study explored the perceived organizational impact on workers exposed to the aluminum dust treatment in Northeastern Ontario. This qualitative descriptive study included 16 respondents who participated in individual semi-structured interviews. All respondents were Northeastern Ontario workers who were exposed to aluminum dust treatment for at least 1 year. Interviews were transcribed verbatim and analyzed thematically. Themes that emerged were: 1) confidence and trust in companies, 2) lack of participants' and heath care providers' knowledge, and 3) need for compensation and formal apology. Workers' perceived that their long term health was impacted by exposure. The results will be used to help workers, companies, and unions address workplace exposures. The latest information about McIntyre powder will enhance the knowledge about the impact of the exposure.

I-gel Versus LMA-Fastrach Supraglottic Airway for Flexible Bronchoscope-Guided Tracheal Intubation Using a Parker (GlideRite) Endotracheal Tube: A Randomized Controlled Trial.

BACKGROUND: The I-gel (IG) supraglottic airway device is a reliable way to establish an airway. Its large ventilation lumen allows for easy passage of an endotracheal tube. With the use of a flexible bronchoscope, the IG offers a good visualization of the laryngeal inlet. This prospective randomized study aims to compare the success rate of flexible bronchoscope-guided tracheal intubation using either the IG or the LMA-Fastrach (FT) laryngeal masks. METHODS: One hundred twenty patients requiring general anesthesia were randomized to 1 of the 2 study groups: IG or FT. After anesthesia induction, the assigned laryngeal mask was inserted to obtain adequate ventilation. We then proceeded to a flexible bronchoscope-guided intubation through the supraglottic device. Tracheal intubation and laryngeal mask insertion success rates were noted, as well as the time required for these manipulations. The view of the laryngeal inlet was graded for each intubation attempt. RESULTS: Sixty patients were assigned to each study group. The intubation success rates were similar between the IG and the FT groups (100 % vs 95.0 % at first attempt; P = 0.12). The times required for tracheal intubation were significantly lower in the IG group (30 ± 11 seconds vs 50 ± 21 seconds; P < 0.0001). Glottic visualization was better in the IG group, with a significantly higher percentage of grade 1 visualization (63.3% vs 3.3%; P < 0.0001) and a lower percentage of grade 3 visualization (1.7% vs 60.0%; P < 0.0001), than that in the FT group. CONCLUSIONS: The use of the IG supraglottic airway device as a conduit for flexible bronchoscope-guided tracheal intubation results in a success rate equivalent to the use of the LMA-FT. However, the IG allows for shorter intubation times and a better visualization of the glottic opening compared with the LMA-FT.

Recommendations for Tobacco Control on Post-Secondary Campuses that are Geographically Isolated.

BACKGROUND: Many Ontarians continue to report exposure to second-hand smoke in public spaces. Completely smoke-free environments are the preferred and socially responsible option for non-smoking policies; however, when considering the variety of landscapes in which post-secondary institutions are located, 'a one size fits all' smoking policy is unrealistic to implement and enforce. The purpose of the study was to: 1) gain a better sense of the prevalence of smoking and exposure to second-hand smoke in a post-secondary context that is geographically isolated; 2) assess the awareness of existing non-smoking initiatives; and 3) identify preferred approaches for tobacco control. METHODS: An online survey was distributed in 2012 to all members of the Laurentian University community. Descriptive statistics are presented, using frequency distributions, and group comparisons are reported, using Chi-Square analyses. RESULTS: A total of 1282 persons completed the survey. Nearly 80% of respondents reported that they had been exposed to second-hand smoke in the past month on campus and the majority of respondents felt that smoking should only be allowed in Designated Outdoor Smoking Areas (51.5%); including 37.3% of daily smokers and occasional smokers. CONCLUSION: Institutions with a geographically isolated campus, which limit options to divert smokers from public entrances, should consider the use of Designated Outdoor Smoking Areas. Implementation will create immediate reductions in the prevalence of smoking at building entrances and in high traffic locations and will therefore protect non-smokers from the dangers of environmental tobacco smoke.

"Thinking outside the pack": examining physically active smokers and implications for practice among Ontario residents.

INTRODUCTION: It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths. Recent public health interventions have likely contributed to a steady decline in rates of smoking over the past decade. Nevertheless, innovative and cost-effective approaches to smoking cessation remain a public health priority. The purpose of this study was to profile physically active smokers. METHOD: Data from the Canadian Community Health Survey 2007-2008-Ontario Sharing File were used. Responses from 41,800 persons aged 12 years and older were assessed to compare (a) the sociodemographic characteristics of physically active smokers to physically active nonsmokers in Ontario and (b) the types of leisure-time physical activities that are more commonly practiced among active Ontario smokers to active nonsmokers. RESULTS: Pearson χ(2) and independent samples t tests revealed that active smokers were more likely to be male, younger, single, and less educated and to have lower income than active nonsmokers. Active smokers were also more likely to report inexpensive, low-intensity, and solitary leisure-time physical activities. CONCLUSION: Our findings have important implications for physical activity promotion among smokers. Physical activity interventions for smokers need to be tailored differently than for nonsmokers.

Cervical video-assisted thoracoscopic surgery using a flexible endoscope for bilateral thoracoscopy.

Video-assisted thoracoscopic surgery (VATS) has become the standard of care for pleural evaluation, drainage, and pleurodesis. The major limitations to standard VATS techniques include intercostal pain and the unilateral nature of the procedure. We report on a cervical VATS approach for bilateral thoracoscopy, pleural biopsy, and talc pleurodesis using a flexible video endoscope without any intercostal incision. A 64-year old male with peritoneal carcinomatosis was noted to have significant bilateral pleural effusions. A cervical video-assisted thoracoscopic surgery (C-VATS) procedure was performed through a 2-cm cervical incision using a sterile flexible gastroscope. Bilateral thoracoscopy, pleural drainage, pleural biopsies, lung biopsy, and talc pleurodesis were performed. No thoracic intercostal incisions were performed. Total operative time was 48 minutes. The procedure was successful and the recovery was uneventful. The patient was discharged 4 days after the procedure. C-VATS is an extremely minimally invasive procedure. It avoids intercostal incisions and allows for bilateral pleural procedures through a single small cervical incision.

Disorganization of the Mn4Ca complex of photosystem II by ruthenium red: a thermoluminescence study.

Ruthenium red (RR) is known to be an inhibitor that binds to Ca2+ sites. It releases Ca2+ and Cl(-) together with the extrinsic polypeptide of 17 kDa associated with the oxygen evolving complex of photosystem II. In this work we used thermoluminescence to study S2/3QB(-) and S2QA(-) charge recombination. It is shown that RR produced a deeper inhibition of oxygen evolution compared with the effect of extrinsic polypeptide or Ca2+/Cl(-) depletion. Even though Mn is not released, the Mn cluster is disorganized by RR and the S1-->S2 transition is inhibited.

Spermine and spermidine inhibition of photosystem II: Disassembly of the oxygen evolving complex and consequent perturbation in electron donation from TyrZ to P680+ and the quinone acceptors QA- to QB.

Polyamines are implicated in plant growth and stress response. However, the polyamines spermine and spermidine were shown to elicit strong inhibitory effects in photosystem II (PSII) submembrane fractions. We have studied the mechanism of this inhibitory action in detail. The inhibition of electron transport in PSII submembrane fractions treated with millimolar concentrations of spermine or spermidine led to the decline of plastoquinone reduction, which was reversed by the artificial electron donor diphenylcarbazide. The above inhibition was due to the loss of the extrinsic polypeptides associated with the oxygen evolving complex. Thermoluminescence measurements revealed that charge recombination between the quinone acceptors of PSII, QA and QB, and the S2 state of the Mn-cluster was abolished. Also, the dark decay of chlorophyll fluorescence after a single turn-over white flash was greatly retarded indicating a slower rate of QA- reoxidation.

Protective effect of active oxygen scavengers on protein degradation and photochemical function in photosystem I submembrane fractions during light stress.

The protective role of reactive oxygen scavengers against photodamage was studied in isolated photosystem (PS) I submembrane fractions illuminated (2000 microE x m(-2) x s(-1)) for various periods at 4 degrees C. The photochemical activity of the submembrane fractions measured as P700 photooxidation was significantly protected in the presence of histidine or n-propyl gallate. Chlorophyll photobleaching resulting in a decrease of absorbance and fluorescence, and a blue-shift of both absorbance and fluorescence maximum in the red region, was also greatly delayed in the presence of these scavengers. Western blot analysis revealed the light harvesting antenna complexes of PSI, Lhca2 and Lhca1, were more susceptible to strong light when compared to Lhca3 and Lhca4. The reaction-center proteins PsaB, PsaC, and PsaE were most sensitive to strong illumination while other polypeptides were less affected. Addition of histidine or n-propyl gallate lead to significant protection of reaction-center proteins as well as Lhca against strong illumination. Circular dichroism (CD) spectra revealed that the alpha-helix content decreased with increasing period of light exposure, whereas beta-strands, turns, and unordered structure increased. This unfolding was prevented with the addition of histidine or n-propyl gallate even after 10 h of strong illumination. Catalase or superoxide dismutase could not minimize the alteration of PSI photochemical activity and structure due to photodamage. The specific action of histidine and n-propyl gallate indicates that 1O2 was the main form of reactive oxygen species responsible for strong light-induced damage in PSI submembrane fractions.

Sevoflurane provides faster recovery and postoperative neurological assessment than isoflurane in long-duration neurosurgical cases.

UNLABELLED: Sevoflurane (SEVO) provides faster emergence than isoflurane (ISO). This advantage is thought to magnify with increased duration of exposure. In addition, SEVO has several of the characteristics of an ideal neuroanesthetic. We designed a prospective, randomized, double-blinded study to compare the recovery profile of SEVO versus ISO in neurosurgery. Sixty patients undergoing intracranial surgery were enrolled. They were randomized to receive SEVO or ISO in 40% oxygen as part of a balanced anesthetic regimen. The anesthetic concentration (0.5 to 1.0 minimum alveolar anesthetic concentration [MAC]) was adjusted to maintain mean arterial blood pressure within 20% of the preinduction baseline. At the end of the surgery, neuromuscular blockade was reversed, anesthetics were discontinued without prior tapering, and fresh gas flow was increased to 10 L/min. Recovery end-points were measured as the time from closure of the anesthetic vaporizer. Mean MAC-hours were identical in both groups (4.7). Patients in the SEVO group demonstrated a shorter time to emergence (P = 0.02) and for response to command (squeeze hand, P = 0.03; move feet, P = 0.01). Patients in the SEVO group obtained a Glasgow coma scale score of >/=10 5 min before patients in the ISO group (P = 0.04). Obtaining an early neurological examination can be critical in neurosurgical patients. The observed difference in emergence between SEVO and ISO could therefore be of clinical importance. IMPLICATIONS: The low-solubility anesthetic, sevoflurane, provides faster recovery and postoperative neurological assessment than isoflurane after long-duration (4.7 MAC-h) intracranial surgery.