Postoperative hypoalbuminemia following surgery related to craniosynostosis.

BACKGROUND: An episode of postoperative phenytoin toxicity in a patient undergoing surgery related to craniosynostosis highlighted the presence of hypoalbuminemia. We believe that hypoalbuminemia contributed to the altered pharmacokinetics of phenytoin in this case. OBJECTIVES: To establish the incidence of postoperative hypoalbuminemia in patients undergoing surgery related to craniosynostosis and to investigate the likely etiology. METHODS: Data on 114 patients undergoing surgery for craniosynostosis over a 2-year period at Oxford Children's Hospital, between May 2011 and May 2013, were retrospectively reviewed. Twenty-two patients were excluded due to incomplete data. This cohort represents the entire population for whom transfusion data had been formally collected at our institution. Preoperative and day 1 postoperative serum albumin levels were collected from the hospital laboratory database. Data regarding blood loss and intra-operative fluid management were reviewed from the anesthetic database. Linear regression analysis was used to establish the relationship between percentage drop in serum albumin with: (i) milliliters per kilogram (ml·kg(-1)) volume of albumin-poor fluids used intra-operatively and (ii) percentage estimated red cell mass loss. RESULTS: All patients experienced a statistically significant drop in serum albumin. The mean difference in albumin was 17.1 g·l(-1), 95% CI (16.1-18.0) (P < 0.001). Expressed as a percentage, the mean reduction was 37.9% (range 16-61%), SD 9.7. The decrease in albumin was associated with an increase in estimated red cell mass loss (P < 0.001) and an increased ml·kg(-1) volume of albumin-poor fluids given (P < 0.001). CONCLUSION: Hemodilution due to large volume blood loss and transfusion with albumin-poor fluids is strongly associated with postoperative hypoalbuminemia in patients undergoing surgery related to craniosynostosis. Practitioners should be aware of this risk and the implications of postoperative hypoalbuminemia in this population.

A kinetic study of the reaction between N,N-dimethyl-p-toluidine and its electrogenerated radical cation in a room temperature ionic liquid.

The reaction between N,N-dimethyl-p-toluidine (DMT) and the radical cation generated through its one-electron oxidation has been studied electrochemically in the room temperature ionic liquid N-methyl-N-butylpyrrolidinium bis(trifluoromethylsulfonyl)imide, [Py14][NTf2]. Kinetic information obtained as linear sweep and cyclic voltammetry collected at 5 microm, 10 microm and 0.3 mm diameter platinum disk electrodes over a range of initial substrate concentrations and scan rates spanning five orders of magnitude was complemented by chronoamperometric measurements designed to probe the rate of diffusion. At the fastest scan rates the homogeneous reactions following the initial electron transfer were effectively out-run, facilitating an assessment of the electrode kinetics using DIGISIM and a validated Nicholson's method. Through digital simulation the voltammetry was then shown to be consistent with a mechanism established for the same reaction in acetonitrile, involving dimerisation of the DMT radicals following an initial and rate-determining proton transfer step. After careful consideration of all parameters, a bimolecular rate constant of (3.4 +/- 1.1) x 10(2) dm3 mol(-1) s(-1) was deduced by fitting the data. This was compared to the equivalent value for acetonitrile and, in light of this, the implications on the viability of ionic liquids for use as alternative mainstream solvents briefly assessed.

A comparative electrochemical study of diffusion in room temperature ionic liquid solvents versus acetonitrile.

Measurements on the diffusion coefficient of the neutral molecule N,N,N',N'-tetramethyl-para-phenylenediamine and the radical cation and dication generated by its one- and two-electron oxidation, respectively, are reported over the range 298-348 K in both acetonitrile and four room temperature ionic liquids (RTILs). Data were collected using single and double potential step chronoamperometry at a gold disk electrode of micrometer dimension, and analysed via fitting to the appropriate analytical expression or, where necessary, to simulation. The variation of diffusion coefficient with temperature was found to occur in an Arrhenius-type manner for all combinations of solute and solvent. For a given ionic liquid, the diffusional activation energies of each species were not only closely equivalent to each other, but also to the RTIL's activation energy of viscous flow. In acetonitrile supported with 0.1 M tetrabutylammonium perchlorate, the ratio in diffusion coefficients of the radical cation and dication to the neutral molecule were calculated as 0.89 +/- 0.05 and 0.51 +/- 0.03, respectively. In contrast, amongst the ionic liquids the same ratios were determined to be on average 0.53 +/- 0.04 and 0.33 +/- 0.03. The consequences of this dissimilarity are considered in terms of the modelling of voltammetric data gathered within ionic liquid solvents.

Non-haloaluminate room-temperature ionic liquids in electrochemistry--a review.

Some twenty-five years after they first came to prominence as alternative electrochemical solvents, room temperature ionic liquids (RTILs) are currently being employed across an increasingly wide range of chemical fields. This review examines the current state of ionic liquid-based electrochemistry, with particular focus on the work of the last decade. Being composed entirely of ions and possesing wide electrochemical windows (often in excess of 5 volts), it is not difficult to see why these compounds are seen by electrochemists as attractive potential solvents. Accordingly, an examination of the pertinent properties of ionic liquids is presented, followed by an assessment of their application to date across the various electrochemical disciplines, concluding with an outlook viewing current problems and directions.

Amperometric detection of glucose using self-catalytic carbon paste electrodes.

The analytical detection of d-glucose by means of self-catalytic carbon paste electrodes is described. In the construction of these electrodes, carbon powder has been modified with the redox liquid n-butylferrocene, which simultaneously serves both to help bind the paste together whilst also acting as a mediator in the enzymatic oxidation of d-glucose by glucose oxidase. The sensor then functions by monitoring the electrochemical oxidation of the constituent n-butylferrocene itself. Through testing in model glucose solutions, the electrodes were found to yield a linear response over a d-glucose concentration range of 2-20 mM. They were also successfully employed in the determination of d-glucose levels in a spiked blood sample, giving a detection limit of 0.8 mM (based on the 3sigma criterion).

Effect of increasing depth of propofol anesthesia on upper airway configuration in children.

BACKGROUND: The upper airway tends to be obstructed during anesthesia in spontaneously breathing patients. The purpose of the current study was to determine the effect of increasing depth of propofol anesthesia on airway size and configuration in children. METHODS: Magnetic resonance images of the upper airway were obtained in 15 children, aged 2-6 yr. Cross-sectional area, anteroposterior dimension, and transverse dimension were measured at the level of the soft palate, dorsum of the tongue, and tip of the epiglottis. Images were obtained during infusion of propofol at a rate of 50-80 microg.kg-1.min-1 and after increasing the depth of anesthesia by administering a bolus dose of propofol and increasing the infusion rate to 240 microg.kg-1.min-1. RESULTS: Overall, the cross-sectional area of the entire pharyngeal airway decreased with increasing depth of anesthesia. The reduction in cross-sectional area was greatest at the level of the epiglottis (24.5 mm2, 95% confidence interval = 16.9-32.2 mm2; P < 0.0001), intermediate at the level of the tongue (19.3 mm2, 95% confidence interval = 9.2-29.3 mm2; P < 0.0001), and least at the level of the soft palate (12.6 mm2, 95% confidence interval = 2.7-22.6 mm2; P < 0.005) in expiration and resulted predominantly from a reduction in anteroposterior dimension. The airway cross-sectional area decreased further in inspiration at the level of the epiglottis. The narrowest portion of the airway resided at the level of the soft palate or epiglottis in the majority of children. CONCLUSION: Increasing depth of propofol anesthesia in children is associated with upper airway narrowing that occurs throughout the entire upper airway and is most pronounced in the hypopharynx at the level of the epiglottis.