Magnesium sulfate in pediatric anesthesia: the Super Adjuvant.

Magnesium is an essential chemical element in all organisms, intervening in most cellular enzymatic reactions; thus, its importance in homeostasis and as a therapeutic tool in highly challenging patients such as pediatrics. The primary purpose of this paper was to review the role of magnesium sulfate as an adjuvant drug in pediatric anesthesia. This compound already has the scientific backing in certain aspects such as analgesia or muscle relaxation, but only theoretical or empirical backing in others such as organ protection or inflammation, where it seems to be promising. The multitude of potential applications in pediatric anesthesia, its high safety, and low cost make magnesium sulfate could be considered a Super Adjuvant.

Lipid rescue in children: The prompt decision.

We report the case of a 17-month-old child who underwent laparotomy under general anesthesia and caudal block. Electrocardiogram ST-T changes were observed after local anesthetic injection. The prompt use of Intralipid 30% was successful in normalizing ECG alterations. Our experience is consistent with previous literature, mainly carried out in adults. Thereby, we conduct a brief review of the subject in pediatrics. As a major conclusion, we strongly recommend the "fast-track" lipid rescue as soon as this severe complication is detected.

Assessment of crude glycerol for Enhanced Biological Phosphorus Removal: Stability and role of long chain fatty acids.

Enhanced Biological Phosphorus Removal (EBPR) of urban wastewaters is usually limited by the available carbon source required by Polyphosphate Accumulating Organisms (PAO). External carbon sources as volatile fatty acids (VFA) or other pure organic compounds have been tested at lab scale demonstrating its ability to enhance PAO activity, but the application of this strategy at full-scale WWTPs is not cost-effective. The utilization of industrial by-products with some of these organic compounds provides lower cost, but it has the possible drawback of having inhibitory or toxic compounds to PAO. This study is focused on the utilization of crude glycerol, the industrial by-product generated in the biodiesel production, as a possible carbon source to enhance EBPR in carbon-limited urban wastewaters. Crude glycerol has non-negligible content of other organic compounds as methanol, salts, VFA and long chain fatty acids (LCFA). VFA and methanol have been demonstrated to enhance PAO activity, but there is no previous study about the effect of LCFA on PAO. This work presents the operation of an EBPR SBR system using crude glycerol as sole carbon source, studying also its long-term stability. The effect of LCFA is evaluated at short and long-term operation, demonstrating for the first time EBPR activity with LCFA as sole carbon source and its long-term failure due to the increased hydrophobicity of the sludge.

A novel control strategy for efficient biological phosphorus removal with carbon-limited wastewaters.

This work shows the development and the in silico evaluation of a novel control strategy aiming at successful biological phosphorus removal in a wastewater treatment plant operating in an A(2)/O configuration with carbon-limited influent. The principle of this novel approach is that the phosphorus in the effluent can be controlled with the nitrate setpoint in the anoxic reactor as manipulated variable. The theoretical background behind this control strategy is that reducing nitrate entrance to the anoxic reactor would result in more organic matter available for biological phosphorus removal. Thus, phosphorus removal would be enhanced at the expense of increasing nitrate in the effluent (but always below legal limits). The work shows the control development, tuning and performance in comparison to open-loop conditions and to two other conventional control strategies for phosphorus removal based on organic matter and metal addition. It is shown that the novel proposed strategy achieves positive nutrient removal results with similar operational costs to the other control strategies and open-loop operation.

Effect of nitrite, limited reactive settler and plant design configuration on the predicted performance of simultaneous C/N/P removal WWTPs.

This paper describes a modelling study where five new benchmark plant design configurations for biological nutrient removal (A(2)/O, UCT, JHB, MUCT and BDP-5 stage) are simulated and evaluated under different model assumptions. The ASM2d including electron dependent decay rates is used as the reference model (A1). The second case (A2) adds nitrite as a new state variable, describing nitrification and denitrification as two-step processes. The third set of models (A3 and A4) considers different reactive settlers types (diffusion-limited/non limited). This study analyses the importance of these new model extensions to correctly describe the nitrification behaviour and the carbon source competition between ordinary heterotrophic organisms (OHO) and polyphosphate accumulating organisms (PAO) under certain operation conditions. The economic and environmental aspects when meeting the P discharge limits by adding an external carbon source are also studied.

Methanol-driven enhanced biological phosphorus removal with a syntrophic consortium.

The presence of suitable carbon sources for enhanced biological phosphorus removal (EBPR) plays a key role in phosphorus removal from wastewater in urban WWTP. For wastewaters with low volatile fatty acids (VFAs) content, an external carbon addition is necessary. As methanol is the most commonly external carbon source used for denitrification it could be a priori a promising alternative, but previous attempts to use it for EBPR have failed. This study is the first successful report of methanol utilization as external carbon source for EBPR. Since a direct replacement strategy (i.e., supply of methanol as a sole carbon source to a propionic-fed PAO-enriched sludge) failed, a novel process was designed and implemented successfully: development of a consortium with anaerobic biomass and polyphosphate accumulating organisms (PAOs). Methanol-degrading acetogens were (i) selected against other anaerobic methanol degraders from an anaerobic sludge; (ii) subjected to conventional EBPR conditions (anaerobic + aerobic); and (iii) bioaugmented with PAOs. EBPR with methanol as a sole carbon source was sustained in a mid-term basis with this procedure.

Glycerol as a sole carbon source for enhanced biological phosphorus removal.

Wastewaters with low organic matter content are one of the major causes of EBPR failures in full-scale WWTP. This carbon source deficit can be solved by external carbon addition and glycerol is a perfect candidate since it is nowadays obtained in excess from biodiesel production. This work shows for the first time that glycerol-driven EBPR with a single-sludge SBR configuration is feasible (i.e. anaerobic glycerol degradation linked to P release and aerobic P uptake). Two different strategies were studied: direct replacement of the usual carbon source for glycerol and a two-step consortium development with glycerol anaerobic degraders and PAO. The first strategy provided the best results. The implementation of glycerol as external carbon source in full-scale WWTP would require a suitable anaerobic hydraulic retention time. An example using dairy wastewater with a low COD/P ratio confirms the feasibility of using glycerol as an external carbon source to increase P removal activity. The approach used in this work opens a new range of possibilities and, similarly, other fermentable substrates can be used as electron donors for EBPR.

The nature of the carbon source rules the competition between PAO and denitrifiers in systems for simultaneous biological nitrogen and phosphorus removal.

The presence of nitrate in the theoretical anaerobic reactor of a municipal WWTP aiming at simultaneous C, N and P removal usually leads to Enhanced Biological Phosphorus Removal (EBPR) failure due to the competition between PAO and denitrifiers for organic substrate. This problem was studied in a continuous anaerobic-anoxic-aerobic (A2/O) pilot plant (146 L) operating with good removal performance and a PAO-enriched sludge (72%). Nitrate presence in the initially anaerobic reactor was studied by switching the operation of the plant to an anoxic-aerobic configuration. When the influent COD composition was a mixture of different carbon sources (acetic acid, propionic acid and sucrose) the system was surprisingly able to maintain EBPR, even with internal recycle ratios up to ten times the influent flow rate and COD limiting conditions. However, the utilisation of sucrose as sole carbon source resulted in a fast EBPR failure. Batch tests with different nitrate concentrations (0-40 mg L(-1)) were performed in order to gain insight into the competition for the carbon source in terms of P-release or denitrification rates and P-release/C-uptake ratio. Surprisingly, no inhibitory or detrimental effect on EBPR performance due to nitrate was observed. A model based on ASM2d but considering two step nitrification and denitrification was developed and experimentally validated. Simulation studies showed that anaerobic VFA availability is critical to maintain EBPR activity.