DCET1 Controls Male Sterility Through Callose Regulation, Exine Formation, and Tapetal Programmed Cell Death in Rice

In angiosperms, anther development comprises of various complex and interrelated biological processes, critically needed for pollen viability. The transitory callose layer serves to separate the meiocytes. It helps in primexine formation, while the timely degradation of tapetal cells is essential for the timely callose wall dissolution and pollen wall formation by providing nutrients for pollen growth. In rice, many genes have been reported and functionally characterized that are involved in callose regulation and pollen wall patterning, including timely programmed cell death (PCD) of the tapetum, but the mechanism of pollen development largely remains ambiguous. We identified and functionally characterized a rice mutant dcet1, having a complete male-sterile phenotype caused by defects in anther callose wall, exine patterning, and tapetal PCD. DCET1 belongs to the RNA recognition motif (RRM)-containing family also called as the ribonucleoprotein (RNP) domain or RNA-binding domain (RBD) protein, having single-nucleotide polymorphism (SNP) substitution from G (threonine-192) to A (isoleucine-192) located at the fifth exon of LOC_Os08g02330, was responsible for the male sterile phenotype in mutant dcet1. Our cytological analysis suggested that DCET1 regulates callose biosynthesis and degradation, pollen exine formation by affecting exine wall patterning, including abnormal nexine, collapsed bacula, and irregular tectum, and timely PCD by delaying the tapetal cell degeneration. As a result, the microspore of dcet1 was swollen and abnormally bursted and even collapsed within the anther locule characterizing complete male sterility. GUS and qRT-PCR analysis indicated that DCET1 is specifically expressed in the anther till the developmental stage 9, consistent with the observed phenotype. The characterization of DCET1 in callose regulation, pollen wall patterning, and tapetal cell PCD strengthens our knowledge for knowing the regulatory pathways involved in rice male reproductive development and has future prospects in hybrid rice breeding.

Improving Lodging Resistance: Using Wheat and Rice as Classical Examples

One of the most chronic constraints to crop production is the grain yield reduction near the crop harvest stage by lodging worldwide. This is more prevalent in cereal crops, particularly in wheat and rice. Major factors associated with lodging involve morphological and anatomical traits along with the chemical composition of the stem. These traits have built up the remarkable relationship in wheat and rice genotypes either prone to lodging or displaying lodging resistance. In this review, we have made a comparison of our conceptual perceptions with foregoing published reports and proposed the fundamental controlling techniques that could be practiced to control the devastating effects of lodging stress. The management of lodging stress is, however, reliant on chemical, agronomical, and genetic factors that are reducing the risk of lodging threat in wheat and rice. But, still, there are many questions remain to be answered to elucidate the complex lodging phenomenon, so agronomists, breeders, physiologists, and molecular biologists require further investigation to address this challenging problem.

LSSR1 facilitates seed setting rate by promoting fertilization in rice

Seed setting rate is one of the major components that determine rice (Oryza sativa L.) yield. Successful fertilization is necessary for normal seed setting. However, little is known about the molecular mechanisms governing this process. In this study, we report a novel rice gene, LOW SEED SETTING RATE1 (LSSR1), which regulates the seed setting rate by facilitating rice fertilization. LSSR1 encodes a putative GH5 cellulase, which is highly conserved in plants. LSSR1 is predominantly expressed in anthers during the microsporogenesis stage, and its encoded protein contains a signal peptide at the N-terminal, which may be a secretory protein that stores in pollen grains and functions during rice fertilization. To explore the physiological function of LSSR1 in rice, loss-of-function mutants of LSSR1 were created through the CRISPR-Cas9 system, which showed a significant decrease in rice seed setting rate. However, the morphology of the vegetative and reproductive organs appears normal in lssr1 mutant lines. In addition, lssr1 pollen grains could be normally stained by I₂-KI solution. Cytological results demonstrate that the blockage of fertilization mostly accounted for the low seed setting rate in lssr1 mutant lines, which was most likely caused by abnormal pollen grain germination, failed pollen tube penetration, and retarded pollen tube elongation. Together, our results suggest that LSSR1 plays an important role in rice fertilization, which in turn is vital for maintaining rice seed setting rate.

OsGPAT3 Plays a Critical Role in Anther Wall Programmed Cell Death and Pollen Development in Rice

In flowering plants, ideal male reproductive development requires the systematic coordination of various processes, in which timely differentiation and degradation of the anther wall, especially the tapetum, is essential for both pollen formation and anther dehiscence. Here, we show that OsGPAT3, a conserved glycerol-3-phosphate acyltransferase gene, plays a critical role in regulating anther wall degradation and pollen exine formation. The gpat3-2 mutant had defective synthesis of Ubisch bodies, delayed programmed cell death (PCD) of the inner three anther layers, and abnormal degradation of micropores/pollen grains, resulting in failure of pollen maturation and complete male sterility. Complementation and clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) experiments demonstrated that OsGPAT3 is responsible for the male sterility phenotype. Furthermore, the expression level of tapetal PCD-related and nutrient metabolism-related genes changed significantly in the gpat3-2 anthers. Based on these genetic and cytological analyses, OsGPAT3 is proposed to coordinate the differentiation and degradation of the anther wall and pollen grains in addition to regulating lipid biosynthesis. This study provides insights for understanding the function of GPATs in regulating rice male reproductive development, and also lays a theoretical basis for hybrid rice breeding.

Spinal anaesthesia for pelvic surgery: low concentrations of lignocaine and bupivacaine are effective with less adverse events

BACKGROUND

The aim of this study was to compare the clinical efficacy of 5% lignocaine, 2.5% lignocaine, 0.5% bupivacaine and 0.25% bupivacaine in subarachnoid block for pelvic surgeries.

METHODS

80 adult ASA grades I and II patients of either sex between the ages of 18-60 yrs, undergoing routine pelvic surgery of short duration were included in this prospective, randomized double blind study. Patients were allotted by computer generated random number table into 4 groups of 20 patients each. Group A (n = 20): injected with 2 ml of 0.5% hyperbaric bupivacaine Group B (n = 20): injected with 2 ml of 0.25% hyperbaric bupivacaine Group C (n = 20): injected with 5% hyperbaric lignocaine Group D (n = 20): injected with 2.5% hyperbaric lignocaine The following parameters were measured every five minutes till 60 minutes and then every 15 minutes till recovery. 1. Onset of sensory block assessed by pin prick method bilaterally at middle of the shin. Maximum height of sensory block noted. 2. Onset of motor block assessed by inability to raise the leg. 3. Duration of sensory block judged as time to first postoperative analgesic requirement by the patient. 4. Duration of motor block assessed by return to Bromage scale of 1. 5. Non invasive blood pressure (NIBP) and Heart Rate- 6. Complications if any were noted -nausea, vomiting, headache, transient neurological symptoms Statistical analysis was done with Kruskal-Wallis, Mann-Whitney tests and ANOVA test.

RESULTS

The groups were comparable with respect to age, weight and male to female ratio (p <0.05). Time to onset of sensory block in seconds in groups A, B, C and D was 79.5 +/- 52.26, 104.24 +/- 24.53, 33.6 +/- 14.98 and 62.50 +/- 25.05 respectively. 5% lignocaine was observed to have statistically. significant shortest onset of sensory block compared to other three groups (p <0.05). The mean onset of motor block in seconds was 137.25 +/- 60.92, 240.75 +/- 73.31, 62.30 +/- 24.56, 119.5 +/- 56.51 sec in Groups A, B, C and D respectively with 5% lignocaine observed to have statistically significant fastest onset of time compared to the other groups (p <0.05). The upper dermatomal height reached was T8 or T9 in groups A, C & D. However in group B, the upper dermatomal height reached was T 10. Duration of sensory block in minutes was 172.5 +/- 49.64, 146 p.00 +/- 35.87, 105.9 +/- 31.68 and 133.6 +/- 17.68 in groups A, B, C & D respectively. 0.5% bupivacaine was observed to have the longest duration of sensory block compared to both the groups of lignocaine (p <0.01). The duration of motor block m minutes was 159.25 +/- 53.49, 137.4 +/- 15.71, 100.5 +/- 21.81, 110.0 +/- 27.76 respectively in groups A, B, C & D. The duration of motor blockade with 0.5% bupivacaine was significantly more as compared to 5% and 2.5% lignocaine (p <0.005). Nine, one, twelve and four boluses of intravenous boluses of ephedrine were required in Groups A, B, C & D respectively. Most of the boluses were required after 30 minutes in Group A as compared to 5% lignocaine wherein the doses were required in the initial 30 minutes post spinal. Four boluses each of intravenous atropine 0.3 mg were required in 0.5% and 0.25% bupivacaine which was not statistically significant amongst the four groups. Significantly more patients in 0.5% bupivacaine required intravenous boluses of ondansetron 4 mg; five in Group A, one each in Group B and C and none in Group D (p <0.05). None of the atients showed transient neurological symptoms till 5 days postoperatively. None of the patients of this series developed post spinal headache at any time till discharge of the patient from the hospital (8-1 0 days).

CONCLUSION

[corrected] For subarachnoid block for pelvic surgeries longer than two hours 0.25% bupivacaine is a better choice as compared to 0.5% bupivacaine. However for short duration surgeries lasting up to one hour, 2.5% lignocaine is a better choice as compared to 5% lignocaine as the lower concentrated solutions of bupivacaine and lignocaine are more haemodynamically stable compared to their higher concentrations and with similar duration of ensory and motor block.

Current concepts in the management of hip pain in the young adult

Until recently, surgical management of hip disorders in adults has focused mainly on conventional total hip replacements for advanced arthritis. These have been performed mainly in the elderly, and there have been few surgical options in the younger patient. Over the past decade, the treatment of hip disorders in patients less than 55 years of age has changed rapidly; improved diagnostic techniques as well as newer diagnoses have lead to increased surgical options. This article reviews the recent literature on these advances.

Anterior cruciate ligament reconstruction in patients over 40 years using hamstring autograft

Anterior cruciate ligament (ACL) reconstruction is becoming increasingly popular in active middle-aged patients with symptomatic instability. The purpose of this study was to retrospectively evaluate the results of ACL reconstruction in patients over the age of 40. Twenty-one patients with a median age of 44 (range 40-56) who had arthroscopically assisted reconstruction using four-stranded hamstring autograft were reviewed. RCI titanium interference screw fixation was used in the tibia, and Endobutton CL fixation in the femur. The clinical results were assessed at a mean follow-up of 2 years. The median value for the Lysholm knee score was 92 (range 74-100), and the median value for the International Knee Documentation Committee score was 83 (range 53-97). For the Tegner activity scale, the median value was 6 (range 4-8) at follow-up. The median side-to-side difference using the KT-1000 arthrometer was 2 mm (range 0-3.5 mm). Hamstring ACL reconstruction in appropriately selected middle-aged patients can yield successful and satisfactory results.

Rapid fracture healing in a patient with inherited prion disease

There do not appear to be any reports or guidelines in the published literature regarding the outcomes of operative or conservative management of fractures in patients with known prion disease. This case report may be helpful in the clinical management of fractures in such patients.

Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube

BACKGROUND

The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube (ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication.

METHODS

Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups (n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra-operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post-operative discomfort were recorded.

RESULTS

The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more (P<0.01) as compared with Group B (17%). The incidence significantly increased (P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post-operative period in three patients in Group A and resolved spontaneously in <15 min in each case.

CONCLUSION

Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak-proof oropharyngeal cavity.

Assessment of manoeuvres required for successful blind tracheal intubation through the PAXpress

A PAXpress (Vital Signs Inc., Barnham, UK) airway device was placed in 50 adult ASA grade I and II patients undergoing elective surgery under general anaesthesia. The alignment of the PAXpress to the larynx was scored fibreoptically. The patients were then intubated blindly through the PAXpress and the adjusting manoeuvres required for successful intubation and complications of intubation observed. Insertion of the PAXpress was successful in all patients, and intubation was successful in 42 (84%) patients. Eleven patients were intubated in the neutral position, seven with a flexion manoeuvre and 24 with an extension manoeuvre. Intubation was successful in 17/20, 18/20, 6/8 and 1/2 of patients with a fibreoptic alignment score of 1, 2, 3 and 4, respectively. When the fibreoptic alignment score was between 2 and 4 intubation was achieved predominantly with the extension manoeuvre (20/30, 66%) rather than the flexion manoeuvre (1/30, 3%) or the neutral position (5/30, 16%). Blood staining was observed in 20 patients. We conclude that blind tracheal intubation through PAXpress has a moderately good success rate and a high incidence of mucosal trauma. 'Extension' is the predominant adjusting manoeuvre required for blind tracheal intubation, especially when the alignment of the PAXpress to the larynx is poor.

Study of oral itraconazole and terbinafine pulse therapy in onychomycosis

In this open, randomized and comparative study, the safety and efficacy of systemic intermittent itraconazole and terbinafine was examined in 30 patients with onychomycosis. The patient with positive mycological culture and also the patients with positive microscopy and negative culture were investigated. Patients were randomly assigned: 15 patients in each group received either 200mg itraconazole or 250 mg terbinafine twice daily during the first week of a 4 weeks cycle. The treatment duration was 16 weeks and was followed-up for 36 weeks. Both the treatment regimen showed significant reduction in onychomycosis affected areas after 8 weeks and maximum reduction was observed at the end of 36 weeks. At the end point of the follow-up period, the clinical cure rates (no residual deformity or with some deformity) were 86.7% in the itraconazole group and 100% in the terbinafine group. The mycological cure rates were 86.7% and 100% respectively. However, no statistically significant differences between the treatment groups were seen in clinical, mycological (P= 0.864) and severity assessment (P= 0.220). Nausea, abdominal cramp, headache, back pain and flu like syndrome are the adverse effects more frequently reported. At least one adverse effect was reported by 17 patients, of them 12 belonged to itraconazole group and 5 to terbinafine group and the difference was statistically significant (P= 0.027). The overall therapeutic effectiveness, safety and cost affectivity were in favor of Terbinafine pulse therapy.

A comparison of the laryngeal mask airway and PA(Xpress) for short surgical procedures

Sixty adult patients undergoing minor peripheral surgery under general anaesthesia were randomly allocated to receive either the laryngeal mask airway (laryngeal mask airway; size 4 for females and size 5 for males) or the PAXpress (adult size), inserted by a single operator with experience of > 50 insertions of each device. The laryngeal mask airway was correctly placed on the first attempt in 27 patients (90%) compared with 20 patients (67%) when using the PAXpress (p < 0.01). No patient required more than two attempts at insertion and there were no failures with the laryngeal mask airway, compared with four (13%) who needed three attempts and two failures (7%) with the PAXpress (p < 0.001 and p < 0.01, respectively). Mean (SD) total placement time was shorter with the laryngeal mask airway [24.6 (3.1) s] than with the PAXpress[35.4 (2.5) s; p < 0.01]. The most common complication was sore throat, which occurred less frequently with the laryngeal mask airway (8 patients; 26%) than with the PAXpress (15 patients; 53.5%; p < 0.001).

Tibial plateau fractures. A new classification scheme

Fractures of the tibial plateaus are common injuries. Various classification schemes have been used to describe these injuries. Although each system has its own purpose, the simpler systems do not allow comparison with more complex divisions. The problem is compounded by the variable use of adjectives that describe these fractures. A comprehensive classification of tibial plateau fractures should group fractures that are similar in topography, morphology, and pathogenesis, requiring similar treatment, and having a similar prognosis. Fracture dislocations and standard tibial plateau fractures should be incorporated into a single classification to avoid the use of two complementary classifications. Any such classification should not be difficult to remember or to use. Keeping in mind these requirements, the authors devised a simple yet comprehensive classification. The authors studied 80 cases of tibial plateau fractures from January 1988 to September 1997, and used contemporary classifications of tibial plateau fractures as a database to formulate the new classification. A new fracture, subcondylar bicondylar with coronal split, has been classified for the first time. An alphanumeric system has been developed that has made nomenclature easy to remember and use. An effort has been made to address the profoundly confusing issue of variable adjectives that describe these injuries. A review of the literature shows that fractures in the authors' classification have been grouped according to similar pathomechanics, treatment, and functional results.

Sniffing longer rather than stronger to maintain olfactory detection threshold

Air flow-rate is usually higher in one nostril in comparison to the other. Also, within bounds, higher nasal flow-rate improves odorant detection. It follows from the above that odorant detection should be better in the nostril with higher flow-rate in comparison to the nostril with lower flow-rate. Paradoxically, previous research has shown that odorant detection thresholds are equal for the high and low flow-rate nostrils. Here we resolve this apparent paradox by showing that when detecting through the nostril with lower air flow-rate, humans sniffed longer than when detecting through the nostril with higher air flow-rate, thus equalizing performance between the nostrils. When this compensatory mechanism was blocked, a pronounced advantage in odorant detection was seen for the nostril with higher air flow-rate over the nostril with lower air flow-rate. Finally, we show that normal birhinal sniff duration may enable only one nostril to reach optimal threshold. This finding implies that during each sniff, each nostril conveys to the brain a slightly different image of the olfactory world. It remains to be shown how the brain combines these images into a single olfactory percept.

Is spinal anaesthesia safe in pre-eclamptic toxaemia patients?

Thirty-three patients of pre-eclamptic toxaemia underwent caesarean section (CS) under general anaesthesia (n = 16) and spinal anaesthesia (n = 17). The Apgar score at 1, 5 and 10 minutes of the babies following spinal anaesthesia (SA) were only marginally better than that of general anaesthesia (GA; P > 0.05). The incidence of complication following GA (68.8%) were significantly (P < 0.05) more than that of SA (47.1%). Commonest complications following GA were intra-operative hypertension (68.8%) followed by difficult intubation (25%), pulmonary oedema (12.8%), delayed recovery (12.8%) and mortality (4.3%). While following SA complications were intra-operative hypotension (47.1%), difficult SA (29.4%) and intra-operative vomiting (5.9%). The nature of complications following GA were more serious which may even lead to mortality (4.3%), whereas following SA it was less serious and easily manageable. Hence SA is not as unsafe as it is thought.

Intra-operative suggestions reduce incidence of post hysterectomy emesis

The influence of therapeutic intraoperative auditory suggestions on the incidence and severity of emetic episodes was investigated in 50 adults ASA I and II patients undergoing elective abdominal hysterectomy. The patients were randomly divided into two groups, each consisting of 25 patients. In group I, a blank tape was played and in group II, positive suggestion was played via headphones throughout the anaesthetic period. It was observed that there was statistically significant difference (P < 0.05) between the incidence of vomiting in group I (60%) and group II (36%). The number of vomiting episodes per patient in group I was 3.1 +/- 1.2 as compared to 1.7 +/- 0.6 in group II. This difference was statistically significant. The patients requiring rescue antiemetic was significantly higher (P < 0.05) in group I (66.6%) as compared to group II (22.2%). It is concluded that positive therapeutic suggestion may be considered as an alternative to antiemetic therapy.

Lansoprazole potentiates vecuronium paralysis

The effect of lansoprazole, a newer second generation proton pump inhibitor, on vecuronium induced muscle paralysis was evaluated. Fifty adult patients comprising grade I (normal healthy patient) and grade II (patient with a mild systemic disease) as classified by the American Society of Anesthesiologists were randomly allocated into two different groups each consisting of 25 patients. Group I (control) did not receive lansoprazole and group II (study) received 30 mg lansoprazole in the night before operation. There was no statistically significant difference (p > 0.05) in the time required for complete paralysis between group I (215.7 +/- 15.19 seconds) and group II (197.5 +/- 14.13 seconds). However, the duration of paralysis was significantly different (p < 0.05) between group I (32.7 +/- 8.7 minutes) and group II (43.9 +/- 9.3 minutes). It was concluded that there is a potential for interactions and one should carefully and closely monitor the patients to prevent prolonged paralysis in patients receiving lansoprazole, as a pre-anaesthetic medication.

Modified Laryngeal Mask Airway--a useful aid to fiberoptic intubation

Modified Laryngeal Mask (MLMA) aided fiberoptic intubation (FOI) using larger than 6 mm ID endotracheal tube was studied in 25 adult patients and compared to unaided FOI in another 25 patients. MLMA aided FOI was successful in 96% cases compared to 56% in the unaided group. Furthermore, the time to successful intubation was increased by 67.1% when FOI was attempted without MLMA aid which was statistically significant (P < 0.001). However, maximum fluctuations in the heart rate and mean arterial pressure in the immediate post-intubation period were statistically insignificant between the groups. We conclude that MLMA not only adds to success rate of FOI but also significantly reduce the FOI time in adult patients.

Balloon mitral valve dilatation as an aid to weaning from ventilatory support in patients with intractable pulmonary oedema caused by severe mitral stenosis

Intractable pulmonary oedema in patients undergoing mechanical ventilation must be investigated as older patients with severe mitral stenosis can be rescued by balloon dilatation of the mitral valve, thus enabling elective cardiac surgery at reduced risk. We describe two such cases and discuss the role of transoesophageal echocardiography in the intensive care unit in the diagnosis and management of these patients.

Hypobaric spinal anaesthesia with bupivacaine (0.1%) gives selective sensory block for ano-rectal surgery

Twenty adult male patients undergoing anorectal surgery in the jackknife position under spinal anaesthesia were studied for the anaesthetic properties of 5 ml hypobaric 0.1% bupivacaine. The patients were positioned in the prone, jack-knife position with a pillow under the hips and with an operating table break angulation of 30 degrees with head down tilt of 20 degrees. In this position a 25-gauge Quincke spinal needle was inserted intrathecally through L3-4 and 5 ml solution, prepared by mixing 1 ml bupivacaine 0.5% with 4 ml of distilled water with a specific gravity of 1.001 at 20 degrees C, was given over 15-20 sec. Onset time, progression and upper level of sensory blockade evaluated by pin prick, and the extent of motor block (1 = full motor movement at ankle and knee joint, 2 = restricted motor movements, 3 = full motor block, no movements) were measured at one minute intervals for the first five minutes, then every five minutes for 30 min. The number of dermatomes blocked was also noted. The median level of cephalad sensory blockage was of L1, with a range from T10-L3. On average, nine dermatomes were blocked (range 7-12). Motor blockade was not observed in any patient. Changes in heart rate and blood pressure were minimal. The average duration of postoperative analgesia was 339.5 +/- 182.9 min. Post-spinal headache was not observed in any patients. In conclusion, 5 ml intrathecal hypobaric bupivacaine, 0.1%, provided excellent perioperative analgesia without motor blockade and haemodynamic stability in patients undergoing anorectal surgery in jackknife position.

CPAP with air and oxygen to non-ventilated lung improves oxygenation during one lung anaesthesia

Ten adult patients undergoing one lung ventilation for elective thoracotomy were selected. All these patients failed to maintain oxygen saturation (SaO2) > 90% despite administration of 100% oxygen to the non-ventilated lung (NVL). These patients were studied for the efficacy of continuous positive airway pressure (CPAP) of the NVL using air and oxygen combination (FiO20.5) employing a variable FiO2CPAP system. It was observed that application of CPAP (5-10 cm H2O) with a mixture of air and oxygen to the NVL increased the SaO2 > 90% in all these patients. This could be attributed to nitrogen in air which prevented absorption atelectasis in the NVL. This produced a better ventilation/perfusion ratio and hence the increased oxygen saturation.

Post-anaesthetic pulmonary oedema following upper airway obstruction

Twelve cases of post-anaesthetic pulmonary oedema (PO) secondary to upper airway obstruction (UAO) are reported. All were adult male patients undergoing uneventful elective surgical procedure under general anaesthesia. Post-anaesthetic laryngospasm was the single most important factor for the upper airway obstruction (UAO) in 5 (41.6%) patients. PO secondary to partial UAO in drowsy patients was observed in 4 (33.3%) patients. UAO due to foreign body was responsible for PO in two patients. A combination of negative intrathoracic pressure, hypoxia and associated hyperadrenergic state were the most likely causes of PO in these patients with UAO. Early recognition, maintenance of patent airway and adequate oxygenation via face mask or endotracheal tube with mechanical ventilation resolved the syndrome within 6-36 hours in all of these patients. Invasive haemodynamic monitoring or aggressive drug therapy were not applied in any of the patients. A heightened awareness among anaesthesiologists of the varied causes of post-anaesthetic UAO leading to PO may help reduce the occurrence and facilitate early management of the potential complications.

Effects of benzodiazepine agonist, antagonist and inverse agonist on ethanol-induced changes in beta-endorphin levels in specific rat brain regions

The present study was conducted to evaluate and compare effects of the benzodiazepine agonist diazepam, antagonist flumazenil and inverse agonist RO 15-4513 on ethanol-induced changes in beta-endorphin (beta-EN) levels in specific rat brain regions. Male Sprague-Dawley rats (150-200 g) adapted to a 12-hour light:12-hour dark illumination cycle were used in this study. Ethanol (3 g/kg as 22.5% solution in saline), flumazenil (10 mg/kg), RO 15-4513 (10 mg/kg), diazepam (2 mg/kg) or a combination of ethanol (3 g/kg) and flumazenil (10 mg/kg), RO 15-4513 (10 mg/kg) or diazepam (2 mg/kg) were administered intraperitoneally to rats at 7.00 h. Control animals were injected with saline. Animals were sacrificed by decapitation 1 h after injection; the brains were immediately removed; the cortex, hippocampus and hypothalamus were dissected and their beta-EN levels measured by radioimmunoassay. Ethanol administration significantly increased beta-EN levels in the hippocampus and hypothalamus but had no effect on beta-EN levels in the cortex. Similar increases in beta-EN levels in the hippocampus and hypothalamus also occurred following either flumazenil or diazepam. On the other hand, RO 15-4513 significantly increased beta-EN levels in the cortex and hypothalamus. When flumazenil was concurrently administered with ethanol, it completely reversed the ethanol effects in the hippocampus but failed to do so in the hypothalamus. Concurrent administration of RO 15-4513 with ethanol also reversed the ethanol-induced rise of beta-EN in the hypothalamus. However, concurrent administration of diazepam and ethanol did not block the increase in beta-EN levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of patient controlled sedation and analgesia for ESWL

This study was designed to evaluate the quality of sedation/analgesia and patient cooperation provided by Patient Controlled Sedation & Analgesia (PCSA) using propofol and fentanyl (Group II) when compared with anesthetist administered propofol/fentanyl (Group I) in 32 ASA I & II patients undergoing ESWL of renal or ureteric stones. Demographics of the patients and the duration of ESWL were similar in both groups. Dose of propofol/fentanyl used during the procedure was significantly higher in Group I patients as compared to group II (p less than 0.05). Interpatient variability in propofol requirement was reflected in both groups in the lack of significant correlation between propofol dose and procedure duration. PCSA provided a marginally higher degree of patient and surgeon satisfaction scores as compared to anesthetist administered propofol/fentanyl. Quick recovery was more consistent in the PCSA group as compared to group I patients.

Ventilation with nitrous oxide during open cholecystectomy increases the incidence of postoperative hypoxemia

The effect of intraoperative use of air versus nitrous oxide (N2O) on postoperative oxygen (O2) saturation in blood was evaluated in 40 ASA Class I and II patients undergoing elective, open cholecystectomy. Patients were allocated randomly to two groups on the basis of whether they received air (Group A, n = 20) or N2O (Group B, n = 20) intraoperatively. Oxygen saturation was recorded on arrival of the patients in the ward, 24 h, and 48 h postoperatively. Although mean O2 saturation did not differ significantly (P > 0.05) between the groups over the first 24 h postoperatively, it was significantly higher (P < 0.05) in Group A as compared to Group B 48 h postoperatively. Incidence of hypoxemia (O2 saturation < 90%) was 40% in Group B as compared to 0% in Group A at the end of 48 h postoperatively. We conclude that the use of N2O during cholecystectomy is associated with a higher incidence of hypoxemia postoperatively.

Blood conservation and autotransfusion in cardiac surgery

Blood conservation techniques of withdrawal of blood just before surgery, intraoperative blood salvage with Solcotrans (Solco Basle [UK] Ltd.), and profound hemodilution were used in 14 patients undergoing open heart surgery (group I) and compared with equally matched 14 patients who had profound hemodilution only during cardiopulmonary bypass (CPB) and acted as controls (group II). Group I patients required a mean of 255 mL of homologous blood per patient to achieve a target hemoglobin of 8 g/dL compared to group II patients who required a mean of 1,011 mL per patient (p = 0.0001). By using autologous blood there was a marked reduction in homologous blood exposure. Eight patients in group I and two patients in group II required no homologous blood. No adverse events occurred. In the process of conservation of blood in open heart surgery, we found the combination of the above techniques used in Group I patients to be safe and effective.