The Effect of the Method of Downhole Deployment on Distributed Acoustic Sensor Measurements: Field Experiments and Numerical Simulations

Distributed acoustic sensing (DAS) is a promising technology for seismic data acquisition, particularly in downhole applications. However, downhole DAS measurements can be affected by the deployment method of the fibre-optic cable. These effects were explored in a field trial in two wells (one vertical and one deviated) drilled at the Otway International Test Centre. The trial in the vertical well shows that (1) fibre-optic cables cemented behind the casing provide data of the highest quality due to the best coupling to the formation, and (2) tubing-conveyed cable shows only slightly weaker coupling, but the data quality can be severely degraded by source-generated noise. A cable loosely suspended in the deviated well provided data quality comparable to that of the cemented DAS cable. To better understand the nature of the observed effects, the field experiments were supplemented by numerical modelling with a 1.5D full wave reflectivity algorithm (3D wave propagation in a 1D model), where cement, casing and wellbore were represented by infinite vertical layers. The results show that (1) a cement layer has only a slight effect (<5%) on the DAS amplitude; (2) the vertical strain in a liquid-filled borehole is comparable to that in the formation; and (3) the strain amplitude in the cable is of the same order of magnitude both in the formation and in the fluid. The strain in the cable is zero both when the cable's Poisson's ratio is zero and when the borehole fluid is air. The results confirm the feasibility of borehole DAS measurements with fibre-optic cables suspended in a borehole liquid (but not gas!).

Ultrasonic study of water adsorbed in nanoporous glasses

Thermodynamic properties of fluids confined in nanopores differ from those observed in the bulk. To investigate the effect of nanoconfinement on water compressibility, we perform water sorption experiments on two nanoporous glass samples while concomitantly measuring the speed of longitudinal and shear ultrasonic waves in these samples. These measurements yield the longitudinal and shear moduli of the water-laden nanoporous glass as a function of relative humidity that we utilize in the Gassmann theory to infer the bulk modulus of the confined water. This analysis shows that the bulk modulus (inverse of compressibility) of confined water is noticeably higher than that of the bulk water at the same temperature. Moreover, the modulus exhibits a linear dependence on the Laplace pressure. The results for water, which is a polar fluid, agree with previous experimental and numerical data reported for nonpolar fluids. This similarity suggests that irrespective of intermolecular forces, confined fluids are stiffer than bulk fluids. Accounting for fluid stiffening in nanopores may be important for accurate interpretation of wave propagation measurements in fluid-filled nanoporous media, including in petrophysics, catalysis, and other applications, such as in porous materials characterization.

Evidence of Nonlinear Seismic Effects in the Earth from Downhole Distributed Acoustic Sensors

Seismic velocities and elastic moduli of rocks are known to vary significantly with applied stress, which indicates that these materials exhibit nonlinear elasticity. Monochromatic waves in nonlinear elastic media are known to generate higher harmonics and combinational frequencies. Such effects have the potential to be used for broadening the frequency band of seismic sources, characterization of the subsurface, and safety monitoring of civil engineering infrastructure. However, knowledge on nonlinear seismic effects is still scarce, which impedes the development of their practical applications. To explore the potential of nonlinear seismology, we performed three experiments: two in the field and one in the laboratory. The first field experiment used two vibroseis sources generating signals with two different monochromatic frequencies. The second field experiment used a surface orbital vibrator with two eccentric motors working at different frequencies. In both experiments, the generated wavefield was recorded in a borehole using a fiber-optic distributed acoustic sensing cable. Both experiments showed combinational frequencies, harmonics, and other intermodulation products of the fundamental frequencies both on the surface and at depth. Laboratory experiments replicated the setup of the field test with vibroseis sources and showed similar nonlinear combinations of fundamental frequencies. Amplitudes of the nonlinear signals observed in the laboratory showed variation with the saturating fluid. These results confirm that nonlinear components of the wavefield propagate as body waves, are likely to generate within rock formations, and can be potentially used for reservoir fluid characterization.

Monitoring Injected CO2 Using Earthquake Waves Measured by Downhole Fibre-Optic Sensors: CO2CRC Otway Stage 3 Case Study

Monitoring changes of formation properties along the well bore associated with the presence of carbon dioxide can be important for both tracking the plume inside of the primary containment and detecting leakage into the zone located above the reservoir. This can be achieved with time lapse wireline logging, but this approach requires well intervention and is not always possible. If the well is permanently instrumented with an optical fibre, it can be used as a distributed seismic receiver array to detect gas behind the casing by monitoring changes in amplitude of the seismic waves generated by active or passive seismic sources. Previous research showed the efficacy of this technique using continuous seismic sources. The Stage 3 Otway Project presented an opportunity to test this technique using passive seismic recording, as downhole fibre-optic arrays recorded numerous regional earthquakes over the period of nearly 2 years before, during, and after CO₂ injection. Analysis of P-wave amplitudes extracted from these downhole gathers shows a consistent amplitude anomaly at the injection level, visible in all events that occurred after the start of injection. This indicates that the anomaly is caused by changes in elastic properties in the reservoir caused by CO₂ saturation. However, extracted amplitudes show significant variability between earthquakes even without subsurface changes; thus, multiple events are required to distinguish the time-lapse anomaly from time-lapse noise. Ubiquity of these events even in a tectonically quiet region (such as Australia) makes this technique a viable and cost-effective option for downhole monitoring.

Optimal bounds for attenuation of elastic waves in porous fluid-saturated media

Explicit expressions for bounds on the effective bulk and shear moduli of mixture of an elastic solid and Newtonian fluid are derived. Since in frequency domain the shear modulus of the Newtonian fluid is complex valued, the effective mixture moduli are, in general, also complex valued and, hence, the bounds are curves in the complex plane. From the general expressions for bounds of effective moduli of viscoelastic mixtures, it is shown that effective bulk and shear moduli of such mixtures must lie between the real axis and a semicircle in the upper half-plane connecting formal lower and upper Hashin-Shtrikman bounds of the mixture of the solid and inviscid fluid of the same compressibility as the Newtonian fluid. Furthermore, it is shown that the bounds on the effective complex bulk and shear moduli of the mixture are optimal; that is, the moduli corresponding to any point on the bounding curves can be attained by the Hashin sphere assemblage penetrated by a random distribution of thin cracks. The results are applicable to a variety of solid/fluid mixtures such as fluid-saturated porous materials and particle suspensions.

Frequency-dependent effective hydraulic conductivity of strongly heterogeneous media

The determination of the transport properties of heterogeneous porous rocks, such as an effective hydraulic conductivity, arises in a range of geoscience problems, from groundwater flow analysis to hydrocarbon reservoir modeling. In the presence of formation-scale heterogeneities, nonstationary flows, induced by pumping tests or propagating elastic waves, entail localized pressure diffusion processes with a characteristic frequency depending on the pressure diffusivity and size of the heterogeneity. Then, on a macroscale, a homogeneous equivalent medium exists, which has a frequency-dependent effective conductivity. The frequency dependence of the conductivity can be analyzed with Biot's equations of poroelasticity. In the quasistatic frequency regime of this framework, the slow compressional wave is a proxy for pressure diffusion processes. This slow compressional wave is associated with the out-of-phase motion of the fluid and solid phase, thereby creating a relative fluid-solid displacement vector field. Decoupling of the poroelasticity equations gives a diffusion equation for the fluid-solid displacement field valid in a poroelastic medium with spatial fluctuations in hydraulic conductivity. Then, an effective conductivity is found by a Green's function approach followed by a strong-contrast perturbation theory suggested earlier in the context of random dielectrics. This theory leads to closed-form expressions for the frequency-dependent effective conductivity as a function of the one- and two-point probability functions of the conductivity fluctuations. In one dimension, these expressions are consistent with exact solutions in both low- and high-frequency limits for arbitrary conductivity contrast. In 3D, the low-frequency limit depends on the details of the microstructure. However, the derived approximation for the effective conductivity is consistent with the Hashin-Shtrikman bounds.

Effect of estrogens on blood glutamate levels in relation to neurological outcome after TBI in male rats

PURPOSE

Estrogen has been shown to possess neuroprotective properties both in vitro and in vivo. Traumatic brain injury (TBI) in ovulating females results in favorable neurological outcomes when compared to males with similar insults. The brain-to-blood glutamate gradient removes excess glutamate from brain extracellular fluids (ECF). Enhancing this gradient leads to improved neurological outcomes following TBI. In this study we investigate the effect of female gonadal steroids on blood glutamate levels and neurological outcomes.

METHODS

Forty male Sprague-Dawley rats were assigned to one of five groups: (1) sham, (2) Premarin treatment, (3) TBI, (4) TBI + Premarin treatment, and (5) TBI + Premarin pretreatment. TBI was induced, and estrogen and glutamate levels were determined at 0, 60, 120, 135, and 150 min. Neurological recovery was evaluated using the Neurological Severity Score (NSS) at 1 h and reassessed at 24 h post TBI.

RESULTS

Premarin treatment groups demonstrated a decline in blood glutamate levels by 60 min. This decline was found to be more pronounced in the TBI + Premarin group, which maintained the decline throughout the experiment. At 120 min, the difference between groups was most pronounced (TBI + Premarin 99 ± 36 μM/l vs. control 200 ± 46 μM/l, p < 0.01). Neurological recovery was significantly better in the Premarin treatment group (NSS at 24 h 6 ± 1 vs. control 11 ± 1).

CONCLUSIONS

Premarin injected into male rats significantly decreases blood glutamate levels in rats suffering TBI. This decrease is associated with improved neurological outcomes, thus implicating the role of estrogen in neuroprotection.

The effect of hyperthermia on blood glutamate levels

INTRODUCTION

Glutamate neurotoxicity is determined by the balance between glutamate release within the brain and efflux of excess glutamate from the brain. Brain-to-blood efflux of glutamate is increased by decreasing the concentration of glutamate in blood. Little is known about the effect of hyperthermia on blood glutamate concentrations, and the effectiveness of blood glutamate-decreasing mechanisms in these conditions. Although hyperthermia is hypothesized to decrease blood glutamate concentrations by activation of stress mechanisms, blunting the stress response by blocking β-adrenergic receptors should prevent this decrease. Furthermore, during hyperthermia there should be a concurrent process of leakage of glutamate from muscle tissue into blood, resulting in a contradictory increase of blood glutamate concentrations. In this study we investigated the effects of hyperthermia on blood glutamate levels and studied the effects of the β-adrenergic receptor antagonist propranolol on stress-induced changes in glutamate levels. We then studied the effectiveness of the blood glutamate scavenger oxaloacetate on hyperthermia-induced increases of glutamate levels.

MATERIALS AND METHODS

Twenty-four rats were randomly divided into 3 groups. Rats' body temperatures were increased (by 1°C every 40 minutes) from 37°C to 42°C. The first group received 1 mL per 100 g of isotonic saline (control). The second group received 1 mL per 100 g of 1M oxaloacetate when the temperature reached 39°C. The third group received 10 mg/kg of propranolol before initiation of the warming.

RESULTS

Warming the rats from 37°C to 39°C decreased the blood glutamate levels in the control group (P < 0.01) and oxaloacetate treatment group (P < 0.0001), whereas further increases in temperature from 40°C to 42°C increased the blood glutamate levels (P < 0.01 and P < 0.0001, respectively). Pretreatment with propranolol prevented the decrease in blood glutamate concentrations seen in mild hyperthermia and did not affect the increase in blood glutamate levels seen at temperatures of 41°C and 42°C (P < 0.005).

DISCUSSION

The results of this study demonstrated that hyperthermia leads to decreases in glutamate levels in the blood, presumably by activation of the sympathetic nervous system. Oxaloacetate, previously reported to reduce blood glutamate levels at 37°C, was ineffective at temperatures over 40°C. Propranolol pretreatment blunted the initial decrease in blood glutamate, and thereafter had no effect when compared with control and treatment groups. Understanding the mechanisms underlying glutamate regulation in the blood during states of hyperthermia and stress has important clinical implications in treating neurodegenerative conditions.

Sedimentary cyclicity from X-ray CT images in Campos Basin, offshore Brazil

Small-scale changes in rock properties, such as those resulting from centimeter-scale depositional layering, are usually undetectable in standard borehole logs (Murphy et al., 1984). Even high-resolution logs with a small sampling interval (e.g., 2 inches) may still have a relatively large investigation volume. This presents a problem when we wish to capture the full variation in physical properties for purposes such as rock physics modeling.

Pain specialists' evaluation of patient's prognosis during the first visit predicts subsequent depression and the affective dimension of pain

OBJECTIVE

To examine the predictive value of physician's prognosis after patient's first visit to a pain specialty clinic.

DESIGN

This is a prospective-longitudinal study in which patients completed questionnaires regarding their pain and psychological constructs before their first visit to a pain specialist and again after an average of 5 months. Physicians rated patient's prognosis immediately after the first visit.

SETTING

This study was conducted at the outpatient specialty pain clinic at Soroka University Medical Center.

PATIENTS

Forty-five chronic pain patients suffering from a range of nonmalignant pain conditions.

OUTCOME MEASURES

Sensory and affective pain measured by the Short-Form McGill Pain Questionnaire and depressive symptoms measured by the Center for Epidemiological Studies-Depression Scale.

RESULTS

Multiple regression analysis revealed that physician's rating of patient prognosis at Time 1 uniquely predicted subsequent depressive symptoms and affective pain but not sensory pain at Time 2 even after controlling for Time 1 levels of these variables.

CONCLUSION

Physician's pessimistic evaluation of patient's prognosis after the first visit was longitudinally associated with an increase in depression and in the affective dimension of pain over time, but not with changes in the sensory component of pain. Referring to physician pessimism as a marker for pre-depressed patient may lead to early preventive interventions.

Modeling of axisymmetric wave modes in a poroelastic cylinder using spectral method

Algorithm and code are presented which solve the dispersion equation for cylindrical poroelastic structures. The algorithm is based on the spectral method, which discretizes the underlying wave equations with the help of spectral differentiation matrices and solves the corresponding equations as a generalized eigenvalue problem. The results are illustrated for the case of a fluid-saturated free cylinder with open- and closed-pore boundary conditions on its surface. The computed dispersion curves are in good agreement with analytical results, which confirms the accuracy of the method.

Modeling of wave dispersion along cylindrical structures using the spectral method

Algorithm and code are presented that solve dispersion equations for cylindrically layered media consisting of an arbitrary number of elastic and fluid layers. The algorithm is based on the spectral method which discretizes the underlying wave equations with the help of spectral differentiation matrices and solves the corresponding equations as a generalized eigenvalue problem. For a given frequency the eigenvalues correspond to the wave numbers of different modes. The advantage of this technique is that it is easy to implement, especially for cases where traditional root-finding methods are strongly limited or hard to realize, i.e., for attenuative, anisotropic, and poroelastic media. The application of the new approach is illustrated using models of an elastic cylinder and a fluid-filled tube. The dispersion curves so produced are in good agreement with analytical results, which confirms the accuracy of the method. Particle displacement profiles of the fundamental mode in a free solid cylinder are computed for a range of frequencies.

Anesthetic considerations during percutaneous nephrolithotomy

STUDY OBJECTIVE

To assess anesthesia-related complications during and following percutaneous nephrolithotomy (PCNL) for staghorn stones.

DESIGN

Prospective study and a detailed case report.

SETTING

Medical center in southern Israel.

PATIENTS

20 consecutive patients undergoing PCNL for staghorn stones.

INTERVENTIONS

All patients underwent PCNL during general anesthesia.

MEASUREMENTS

Duration of surgery, esophageal temperature, hemoglobin (Hb) concentration, and requirements for blood transfusion, mean volume of irrigation fluid, and serum sodium and potassium concentration were recorded.

MAIN RESULTS

Mean age was 50.7 +/- 14.9 y (range, 26-76 y). Mean duration of the procedure was 120.0 +/- 42.5 min (range, 75-240 min). Mean volume of irrigation fluid was 34.1 +/- 15.3 L (range, 18-80 L). There was a significant decrease in Hb concentration from 13.7 +/- 1.71 to 12.2 +/- 1.4 g/dL, but no patient required blood transfusion. There was a statistically significant reduction in esophageal temperature from 36.4 degrees C +/- 0.32 degrees C to 35.2 degrees C +/- 0.5 degrees C. There were no significant changes in sodium or potassium concentration before or after PCNL.

CONCLUSIONS

Anesthesia during PCNL for staghorn stones is a challenge because of the possibility of fluid absorption, dilutional anemia, hypothermia, or significant blood loss.

Patients' self-criticism is a stronger predictor of physician's evaluation of prognosis than pain diagnosis or severity in chronic pain patients

The experience of pain is influenced by patients' personality, social and cultural background, and patient-doctor interaction. This study examines the role of self-reported pain, pain diagnosis, age, gender, depression, and the personality trait of self-criticism (defined as individuals' tendency to set unrealistically high self-standards and to adopt a punitive stance toward one's self), in determining physicians' view of expected prognosis in response to chronic pain management. Before the first visit to a tertiary chronic pain clinic, patients provided information regarding their perceived pain, depression, and self-criticism. Immediately subsequent to the visit, physicians' evaluated expected prognosis. Participating physicians were blinded to the patient's psychosocial variables collected. Sixty-four patients with chronic pain (34 women and 30 men) with various diagnoses were included. Patients' age, gender, pain diagnosis, self-reported pain, and depression did not significantly correlate with physician's estimation of expected prognosis. In contrast, patients' self-criticism emerged as an independent predictor of physicians' pessimism regarding outcome. Thus, in the chronic pain clinic setting, patients' personality, rather than self-reported pain experience, determines doctor's clinical judgment of expected prognosis.

PERSPECTIVE

Chronic pain is a multimodal negative experience that is determined by physiological, cognitive, personological, and interpersonal factors. In line with this observation, we found patients' personality, specifically, their self-criticism, determines physicians' clinical judgment of expected prognosis.

Brain neuroprotection by scavenging blood glutamate

Excess glutamate in brain fluids characterizes acute brain insults such as traumatic brain injury and stroke. Its removal could prevent the glutamate excitotoxicity that causes long-lasting neurological deficits. As blood glutamate scavenging has been demonstrated to increase the efflux of excess glutamate from brain into blood, we tested the prediction that oxaloacetate-mediated blood glutamate scavenging causes neuroprotection in a pathological situation such as closed head injury (CHI), in which there is a well established deleterious increase of glutamate in brain fluids. We observed highly significant improvements of the neurological status of rats submitted to CHI following an intravenous treatment with 1 mmol oxaloacetate/100 g rat weight which decreases blood glutamate levels by 40%. No detectable therapeutic effect was obtained when rats were treated IV with 1 mmol oxaloacetate together with 1 mmol glutamate/100 g rat. The treatment with 0.005 mmol/100 g rat oxaloacetate was no more effective than saline but when it was combined with the intravenous administration of 0.14 nmol/100 g of recombinant glutamate-oxaloacetate transaminase, recovery was almost complete. Oxaloacetate provided neuroprotection when administered before CHI or at 60 min post CHI but not at 120 min post CHI. Since neurological recovery from CHI was highly correlated with the decrease of blood glutamate levels (r=0.89, P=0.001), we conclude that blood glutamate scavenging affords brain neuroprotection Blood glutamate scavenging may open now new therapeutic options.

The Effect of Hypertonic (3%) Saline With and Without Furosemide on Plasma Osmolality, Sodium Concentration, and Brain Water Content After Closed Head Trauma in Rats

Adding furosemide (F) to mannitol causes a greater decrease of brain volume, intracranial pressure, and brain water content (BW) as compared with mannitol alone. We examined whether adding F to hypertonic saline (HS) causes less increase of BW early after closed head trauma (CHT) as compared with HS alone. With institutional approval, 125 rats underwent sham surgery or CHT and then immediately received no treatment, HS (1.2 g/kg, 3% solution), or HS + F (2 mg/kg). In groups 1-10 (n = 8/group), the percent BW content was determined at 30, 60, or 120 minutes. In groups 11-14 (n = 8/group), physiologic values were determined at 0, 30, 60, and 120 minutes. At 120 minutes, the increase of BW caused by CHT (sham = 78.9 +/- 0.6% and CHT = 81.5 +/- 2.2%, mean +/- SD) was prevented by HS + F (78.0 +/- 0.8%) but not by HS (80.7 +/- 2.2%). Both HS and HS + F similarly increased plasma osmolality and sodium concentration. Post-CHT hypotension and acidosis (30 and 60 minutes) and decrease of hemoglobin concentration (120 minutes) were less with HS + F than with HS. We conclude that adding F to HS decreases BW without causing more increase of osmolality and Na than that caused by HS alone.

Controlled-release oxycodone-induced seizures

BACKGROUND

The use of the opioid oxycodone hydrochloride in the management of chronic pain is gaining popularity principally because of its tolerability. However, opioid-related seizure in patients with epilepsy or other conditions that may decrease seizure threshold has been described in the literature; in particular, oxycodone has been associated with seizure in a patient with acute renal failure.

OBJECTIVE

The aim of this article was to report a patient with a history of seizures but normal renal and hepatic function who developed seizure on 2 occasions after oxycodone ingestion.

METHODS

A 54-year-old male patient presented with a history of tonic-clonic seizures that developed immediately after intracranial surgery. Long-term treatment with carbamazepine 400 mg QD was started, and the patient was free of convulsions for approximately 7 years. The patient presented to us with severe headache that was nonresponsive to an NSAID and the opiate agonist tramadol. Treatment with controlled-release (CR) oxycodone and tramadol drops (50 mg QID if necessary) was started, and tonic-clonic seizures developed 3 days later.

RESULTS

Based on laboratory analysis, the patient had normal renal and hepatic function. On discontinuation of oxycodone treatment, the seizures resolved. However, due to effective pain relief with oxycodone, the patient decided to continue treatment, and seizures recurred. Carbamazepine was then administered 4 hours before oxycodone dosing, which allowed continuation of treatment without seizure.

CONCLUSIONS

A patient with a history of seizures controlled with long-term carbamazepine therapy developed seizures when he started treatment with oxycodone CR at recommended doses. Oxycodone CR should be used with extreme caution in patients with epilepsy or other conditions that may decrease seizure threshold.

Wave-induced fluid flow in random porous media: attenuation and dispersion of elastic waves

A detailed analysis of the relationship between elastic waves in inhomogeneous, porous media and the effect of wave-induced fluid flow is presented. Based on the results of the poroelastic first-order statistical smoothing approximation applied to Biot's equations of poroelasticity, a model for elastic wave attenuation and dispersion due to wave-induced fluid flow in 3-D randomly inhomogeneous poroelastic media is developed. Attenuation and dispersion depend on linear combinations of the spatial correlations of the fluctuating poroelastic parameters. The observed frequency dependence is typical for a relaxation phenomenon. Further, the analytic properties of attenuation and dispersion are analyzed. It is shown that the low-frequency asymptote of the attenuation coefficient of a plane compressional wave is proportional to the square of frequency. At high frequencies the attenuation coefficient becomes proportional to the square root of frequency. A comparison with the 1-D theory shows that attenuation is of the same order but slightly larger in 3-D random media. Several modeling choices of the approach including the effect of cross correlations between fluid and solid phase properties are demonstrated. The potential application of the results to real porous materials is discussed.

A first-order statistical smoothing approximation for the coherent wave field in random porous random media

An important dissipation mechanism for waves in randomly inhomogeneous poroelastic media is the effect of wave-induced fluid flow. In the framework of Biot's theory of poroelasticity, this mechanism can be understood as scattering from fast into slow compressional waves. To describe this conversion scattering effect in poroelastic random media, the dynamic characteristics of the coherent wavefield using the theory of statistical wave propagation are analyzed. In particular, the method of statistical smoothing is applied to Biot's equations of poroelasticity. Within the accuracy of the first-order statistical smoothing an effective wave number of the coherent field, which accounts for the effect of wave-induced flow, is derived. This wave number is complex and involves an integral over the correlation function of the medium's fluctuations. It is shown that the known one-dimensional (1-D) result can be obtained as a special case of the present 3-D theory. The expression for the effective wave number allows to derive a model for elastic attenuation and dispersion due to wave-induced fluid flow. These wavefield attributes are analyzed in a companion paper.

Determining Minimum Alveolar Anesthetic Concentration of Halothane in Rats: The Effect of Incremental Change in Halothane Concentration and Number of Crossovers

Computer simulations for the technique of estimating minimum alveolar anesthetic concentration (MAC) in patients (quantal design) suggest that incremental concentration changes and the number of crossovers affect MAC. We hypothesized that these variables may also apply to estimating MAC in rats (bracketing design). This study tested that hypothesis and also examined whether these variables might mask differences in MAC between groups in which MAC might be expected to differ (pregnant [P] versus nonpregnant [NP]). There were 2 cohorts (n = 27 and n = 30 rats). Each cohort included NP females, females in early P, and females in late P. MAC was tested by using an incremental concentration change of 0.20% and one within-subject crossover in the first cohort and by using an increment size of 0.10% and four crossovers in the second cohort. MAC was statistically significantly increased in the three groups in the second cohort (NP, 1.16 +/- 0.12; early P, 1.14 +/- 0.10; late P, 1.07 +/- 0.10; mean +/- sd) compared with values in the three comparable groups in the first cohort (NP, 0.95 +/- 0.06; early P, 1.01 +/- 0.09; late P, 0.93 +/- 0.13). Values did not differ among groups within each cohort. Post hoc simulations indicated that up to 36% of the difference between cohorts was due to increment size, with the balance due to experimental factors. Our findings confirmed the hypothesis that increment size affects estimates of MAC when a bracketing design is used.

[The significance and cost of preoperative laboratory screening in young healthy patients in a public hospital in Israel]

We evaluated the clinical significance and cost of routine preoperative laboratory screening in young healthy patients in a public hospital. Three hundred consecutive young (aged 18-40 years), healthy (ASA I) patients undergoing minor elective surgical procedures were enrolled in this prospective study. A preoperative test was considered to be significant if its result lead to a new diagnose or to cancellation of surgery. The lab tests revealed only one new diagnosis. None of the procedures were cancelled. The total cost of the lab tests was NIS 114,000. Of this amount, NIS 104,000 could have been saved if the tests were ordered as required by the patients medical history and physical examination and not performed routinely.

CONCLUSION

This study suggests that routine preoperative laboratory screening is not recommended prior to minor, elective surgery in young, healthy patients.

Labetalol-induced hypotension decreases blood loss during uncontrolled hemorrhage

In a model of uncontrolled hemorrhagic hypotension (UCHH) in rats, we examined whether blood loss or blood chemistry were affected by (1) deliberate, controlled hypotension induced with labetalol (L) or sodium nitroprusside (SNP) and (2) intravenous (iv) fluid therapy. Two hours of UCHH was induced by resecting the distal 25% of the tail. L or SNP was infused with the aim of decreasing MAP to 50 mmHg. In the groups receiving iv fluid, 3 ml of 0.9% saline was given for each 1 ml of blood loss. L decreased blood loss (2.8+/-2.0 and 3.0+/-1.9 ml, respectively, in the groups not receiving and receiving iv fluid) compared to the groups not given hypotensive drugs (6.3+/-4.1 and 13.5+/-6.6 ml). SNP did not decrease blood loss (5.7+/-4.7 and 11.0+/-6.2 ml), increased serum potassium (5.0+/-0.6 and 5.8+/-0.4 mEq l(-1)), and with accompanying iv fluid administration decreased hematocrit, worsened acidosis, and increased mortality. In this model of 2 h of UCHH in rats, hypotension to MAP of 50 mmHg with L but not with SNP decreased blood loss.

0.45% saline and 5% dextrose in water, but not 0.9% saline or 5% dextrose in 0.9% saline, worsen brain edema two hours after closed head trauma in rats

In this study, we examined the effect of four i.v. fluids (250 mL/kg) on blood glucose and osmolality and brain tissue specific gravity after closed head trauma (CHT) in rats. CHT was delivered at Time 0; blood was sampled at 60 min; fluid infusion began at 75 min and ended at 105 min. Blood was again sampled at 105 and 120 min, and brain tissue specific gravity was determined at 120 min. Five groups (one control and four fluid-treated groups) received CHT, and five other groups (one control and four fluid-treated) did not (n = 9 in each group). 0.45% saline (1/2 NS) and 5% dextrose in water (D5W) accentuated the decrease of brain tissue specific gravity (1.0366 +/- 0.0025 and 1.0368 +/- 0.0028, respectively; mean +/- SD) caused by CHT (1.0395 +/- 0.0036), but 5% dextrose in 0.9% saline (D5NS) and 0.9% saline (NS) did not (1.0431 +/- 0.0042 and 1.0389 +/- 0.0049, respectively). In addition, 1/2 NS decreased blood osmolality (248 +/- 6 mOsm/L), D5W increased blood glucose (1095 +/- 173 mg/dL), D5NS increased blood osmolality (350 +/- 5 mOsm/L) and glucose (1695 +/- 76 mg/dL), and NS caused no significant change. We conclude that administering hypoosmolar i.v. fluids after CHT causes a significant worsening of cerebral edema 2 h after CHT.

IMPLICATIONS

We previously reported worse neurological outcome and/or mortality after closed head trauma in rats when 5% dextrose in water or 0.45% saline was given i.v. compared with 0.9% saline or 5% dextrose in 0.9% saline. The present results and our previous findings indicate that worsening of outcome after closed head trauma in rats may be caused more by edema formation than by hyperglycemia.

Neuroprotective effects of NPS 846, a novel N-methyl-D-aspartate receptor antagonist, after closed head trauma in rats

OBJECT

The authors sought to determine whether 3,3-bis (3-fluorophenyl) propylamine (NPS 846), a novel noncompetitive N-methyl-D-aspartate receptor antagonist, alters outcome after closed head trauma in rats.

METHODS

The experimental variables were: presence or absence of closed head trauma, treatment with NPS 846 or no treatment, and time at which the rats were killed (24 or 48 hours). The NPS 846 (1 mg/kg) was administered intraperitoneally at 1 and 3 hours after closed head trauma or sham operation. Outcome measures were the neurological severity score (NSS), ischemic tissue volume, hemorrhagic necrosis volume, and specific gravity, water content, and concentrations of calcium, sodium, potassium, and magnesium in brain tissue. The following closed head trauma-induced changes in the injured hemisphere (expressed as the mean +/- the standard deviation) were reversed by NPS 846: decreased specific gravity of 1.035 +/- 0.006 at 24 hours was increased to 1.042 +/- 0.004; the decreased potassium level of 0.583 +/- 0.231 mg/L at 48 hours and at 24 hours was increased to 2.442 +/- 0.860 mg/L; the increased water content of 84.7 +/- 2.6% at 24 hours was decreased to 79.8 +/- 2%; the increased calcium level of 0.592 +/- 0.210 mg/L at 24 hours was decreased to 0.048 +/- 0.029 mg/L; and the increased sodium level of 2.035 +/- 0.649 mg/L was decreased to 0.631 +/- 0.102 mg/L. Administration of NPS 846 also lowered the NSS (improved neurological status) at 48 hours (7 +/- 3) and caused no significant changes in ischemic tissue or hemorrhagic necrosis volumes in the injured hemisphere at 24 or 48 hours.

CONCLUSIONS

In this model of closed head trauma, NPS 846 improved neurological outcome, delayed the onset of brain edema, and improved brain tissue ion homeostasis.

Brain edema, hemorrhagic necrosis volume, and neurological status with rapid infusion of 0.45% saline or 5% dextrose in 0.9% saline after closed head trauma in rats

We previously reported that in rats with closed head trauma (CHT), intravenous (IV) administration of 0.25 mL/g of 5% dextrose solution (D5W) increased blood glucose (G), decreased blood sodium (Na), caused no change in blood osmolality (Osm), increased brain edema (BE), and worsened neurological severity score (NSS) and mortality rate (MR). D5W in 0.9% saline (D5NS) is isonatremic and hyperosmolar with respect to blood and may avoid the problems reported with D5W. The present study compared the effects of 0.25 mL/g of D5NS or 0.45% saline (0.45 S) after CHT in rats. In 11 groups of rats, the three experimental variables were CHT (yes or no), IV fluid (none, D5NS, or 0.45 S), and time of death (4 or 24 h). D5NS or 0.45 S was given IV at 1 h after surgical preparation with or without CHT, and experimental values were determined at 1, 2, 4, and 24 h. D5NS decreased BE at 4 h compared with the untreated group, increased Osm (380 +/- 2 mOsm/kg) and G (1278 +/- 199 mg/dL), decreased Na (131 +/- 2 mEq/L) in blood, and caused no significant change in hemorrhagic necrosis volume (HNV), NSS, or MR. 0.45 S increased MR (50%) at 24 h, decreased Osm (270 +/- 5 mOsm/kg) and Na (123 +/- 1 mEq/L) in blood, and caused no significant change in G, BE, HNV, or NSS. We conclude that after CHT in rats, D5NS decreased BE without changing NSS or MR. 0.45 S increased MR and significantly altered blood chemistries.

Influence of closed head injury on isoflurane MAC in the rat

We designed the present study to determine whether the minimum alveolar concentration (MAC) for isoflurane is decreased after closed head trauma (CHT) in rats and, if so, whether the decrease of MAC is related to the severity of neurological impairment following CHT. Isoflurane MAC was determined in 36 Sprague-Dawley rats. Then, at time = 0 h, animals were grouped. Group 1 (n = 8) received no CHT, group 2 (n = 14) received moderate CHT, and group 3 (n = 14) received severe CHT. Neurological severity score (NSS, 0 = no deficit and 25 = maximal impairment) and MAC were determined at 1, 4, 24, and 48 h. In groups 1 and 2, isoflurane MAC at 1, 2, 24, and 48 h (1.0-1.1 +/- 0.8-1.2%, median +/- range) was not significantly different from baseline (1.0-1.1 +/- 1.0-1.1%). In group 3, isoflurane MAC at 1, 2, 24, and 48 h (0.4 +/- 0.2-0.5%) was decreased as compared to baseline (1.1 +/- 1.0-1.1%). In group 2, NSS at 1 h was 18 +/- 11-21 and improved by 48 h to 9 +/- 4-15. In group 3, NSS at 1 h was 24 +/- 22-25 and was not significantly different from NSS at 48 h (24 +/- 24-25). Thus, moderate CHT does not significantly alter isoflurane MAC, whereas severe CHT equivalent to a Glasgow Coma Scale score of 3 to 6 significantly decreases isoflurane MAC.