The close proximity of the surgeon's breathing zone to the craniotomy window does not appear to be a source of increased exposure to sevoflurane. The observed higher exposure of the anesthesiologist to sevoflurane in the operating room environment warrants further exploration.

THE fact that phosphates stimulate the respiratory sugar metabolism in higher plants suggests that the formation of phosphoric esters may occur as part of this process. Stoklasa et al. [1904-1913] obtained cell-free zymase-like preparations from peas, beetroots , potatoes etc., which actively fermented sugars. Bodnar [1916] confirmed these results under strictly aseptic conditions, since some investigators had attributed Stoklasa's findings to bacterial contamination. Evidence of phosphorylation was first given by Bodnar [1925] who demonstrated that inorganic phosphate disappeared when added to ground peas in presence of toluene. His results were confirmed by Zalesky and Pissarjewski [1927] who did not however regard this process as a necessary step in the respiration and attributed the stimulation to alkalinity of the phosphate rather than to the formation of phosphoric esters. More recently, Rao [1935] has prepared active cell-free aqueous extracts by plasmolysing fermenting peas with light petroleum and states that in such extracts the decomposition of sugar and the phosphorylation are concomitant processes.

BackgroundExposure of the OR staff to inhalational anesthetics has been proven by numerous investigators, but its potential adverse effect under the present technical circumstances is a debated issue. The aim of the present work was to test whether using a laminar flow air conditioning system exposure of the team to anesthetic gases is different if the anesthetist works in the sitting as compared to the standing position.MethodsSample collectors were placed at the side of the patient and were fixed at two different heights: at 100 cm (modelling sitting position) and 175 cm (modelling standing position), whereas the third collector was placed at the independent corner of the OR. Collected amount of sevoflurane was determined by an independent chemist using gas chromatography.ResultsAt the height of the sitting position the captured amount of sevoflurane was somewhat higher (median and IQR: 0.55; 0.29–1.73 ppm) than that at the height of standing (0.37; 0.15–0.79 ppm), but this difference did not reach the level of statistical significance. A significantly lower sevoflurane concentration was measured at the indifferent corner of the OR (0.14; 0.058–0.36 ppm, p < 0.001).ConclusionsOpen isolation along with the air flow due to the laminar system does not result in higher anesthetic exposure for the sitting anesthetist positioned to the side of the patient. Evaporated amount of sevoflurane is below the accepted threshold limits in both positions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0284-0) contains supplementary material, which is available to authorized users.

In einer jüngst erschienenen Arbeit 1 ) aus dem hiesigen Institut wurden Versuche über Acetoinbildung durch Erbsenmehl veröffentlicht, welche Dirscherls 2 ' 3 ) Auffassung beim Problem der "Carboligase" unterstützten. Die Frage, ob dabei optisch aktives Acetoin entsteht, wurde dort nicht berührt. Die optische Aktivität des enzymatisch gebildeten Acetoins wurde von mehreren Seiten als ein Beweis für die Existenz einer selbständigen "Carboligase" betrachtet, nach Dirscherl und Schöllig 4 ) (vgl. dort einschlägige Literatur) kann aber die Bildung von optisch aktivem Acetoin auch dann erklärt werden, wenn man die Acetoinbildang nur als eine Folge der Carboxylasewirkung auffaßt.Es fragt sich nun, wie sich die spezifischen Drehungen der durch verschiedene Versuchsobjekte gebildeten Acetoine verhalten? Sind sie einander nach Richtung und Größe gleich, oder gibt es dabei Unterschiede, woraus man vielleicht auf Verschiedenheit der decarboxylierenden Mechanismen schließen darf? Schon aus älteren Untersuchungen der Neubergschen Schule 5 ) ging hervor, daß durch frische Hefe optisch aktives Acyloin gebildet wird. Tomiyasu 0 ) gab genaue Daten an, wonach die spezifische Drehung des gebildeten Acetoins bei frischer Hefe oder Trockenhefe, sowie bei Macerationssaft im Mittel [e] D =-40° beträgt; derselbe Autor 7 ) fand bei Bacillus natto [f*]D = -98°, bei Bacillus mesentericus f uscus[a] D = -78°. Alle diese Daten beziehen sich auf stark verdünnte wäßrige Lösungen (meistens einige Zehntel Prozent oder noch weniger Acetoin): zu den Versuchen wurde kein Pyruvinat, nur Glucose und Acetaldehyd zugesetzt.

IntroductionThere are multiple reports of the use of vasopressin with phaeochromocytoma resections in adults. Support for vasopressin in the paediatric patient, however, is not quite as substantiated. We report such a case to add to the limited evidence for its use in a young child. Case reportA 6-year-old boy, weighing 21 kg, was admitted to a local District General Hospital with severe headaches not responding to simple analgesics. His initial blood pressure was recorded as 166/91 mmHg. This was persistently elevated and, subsequently, he developed vomiting, photophobia and bilateral papilloedema. He was referred to our institution for further investigation and treatment. Tests showed raised urinary levels of catecholamine metabolites over 24 h and a subsequent computed tomography (CT) scan confirmed a left-sided adrenal phaeochromocytoma. He was started on gradually increasing doses of phenoxybenzamine and atenolol, and a laparoscopic adrenalectomy was planned for within 6 weeks. In the meantime, his blood pressure was controlled with phenoxybenzamine, 20 mg twice daily, and atenolol, 30 mg once daily. Cardiac workup included electrocardiography and echocardiography, which were both normal. PreoperativeThe boy was admitted to our hospital 48 h before surgery when he was noted to have an increased BP of 140/80 mmHg. In addition to the phenoxybenzamine and atenolol, he was started on hydralazine 10 mg three times daily; all three of which were continued until the morning of surgery. As a premedication, he was given midazolam (0.5 mg kg À1 orally) 30 min prior to coming to theatre. The BP before induction of anaesthesia was 105/68 mmHg. Induction of anaesthesiaAnaesthesia was induced with intravenous propofol (4 mg kg À1 ) and fentanyl (slowly titrated up to 5 mg kg À1 ), and he was paralysed with rocuronium (1 mg kg À1 ). After endotracheal intubation, large bore peripheral intravenous catheters, an arterial line, a central venous line and an epidural catheter (L1/2) were inserted. The epidural was dosed with 10 ml of 0.25% ropivacaine over a period of 30 min. The patient remained normotensive with blood pressure readings around 100/50 mmHg. Anaesthesia was maintained with oxygen, air and isoflurane. Operative procedureThe operation was performed in the right lateral position via a laparoscopic retroperitoneal route, using three 5 mm operative ports and gas insufflation with CO 2 . The ventilation was adjusted to maintain normocapnia throughout. Dissection of the adrenal gland was kept to an absolute minimum until its blood vessels were identified. It was clear that any contact with the adrenal gland did cause major spikes in blood pressure. As soon as these vessels were clearly identified, the adrenal vein was double clipped and divided, the remaining vessels were then divided. The adrenal gland was removed intact with no damage to the surrounding structures, and there was no significant bleeding or breach of the peritoneum.During the operation, sodium chloride 0.9% was infused at a rate of 10 ml kg À1 h À1 for...