Sixty boys, aged 1-10 yr, undergoing orchidopexy were allocated randomly to receive one of three solutions for caudal extradural injection. Group A received 0.25% bupivacaine 1 ml kg-1 with adrenaline 5 micrograms ml-1 (1/200,000), group C received 0.25% bupivacaine 1 ml kg-1 with clonidine 2 micrograms kg-1 and group K received 0.25% bupivacaine 1 ml kg-1 with ketamine 0.5 mg kg-1. Postoperative pain was assessed using a modified objective pain score and analgesia was administered if this score exceeded 4. The median duration of caudal analgesia was 12.5 h in group K compared with 5.8 h in group C (P < 0.05) and 3.2 h in group A (P < 0.01). There were no differences between the groups in the incidence of motor block, urinary retention or postoperative sedation.
Abstract:The breath alcohol concentration (BrAC), standardized to the alveolar water vapour concentration has been shown to closely predict the arterial blood alcohol (ethanol) concentration (ABAC). However, a transient increase in the ABAC/BrAC ratio has been noticed, when alcohol is absorbed from the gastrointestinal tract (absorption phase) and the ABAC rapidly rise. We analysed the plot of simultaneously recorded alcohol, water vapour, and CO 2 against exhaled volume (volumetric expirogram) for respiratory deadspace volume (VD) , cumulative gas output and phase III slope within one breath to evaluate whether changes in the BrAC profile could explain this variability. Eight healthy subjects performed exhalations through pre-heated non-restrictive mouth pieces and the concentrations were measured by infrared absorption.In the absorption phase the respiratory VD of alcohol was transiently increased and the exhaled alcohol was displaced to the latter part of the expirogram. In the post-absorption phase, the respiratory VD for alcohol and water vapour was stable and always less than the respiratory VD for CO 2 , indicating that the first part of the exhaled alcohol and water originated from the conducting airway. The position of the BrAC profile between water vapour and CO 2 in the post-absorptive phase indicates an interaction within the conducting airway, probably including a deposition of alcohol onto the mucosa during exhalation. We conclude that the increase in the ABAC/BrAC ratio during the absorption phase of alcohol coincides with a transient increase in respiratory VD of alcohol and a delay in the appearance of alcohol in the exhaled air as the exhalation proceeds compared with the post absorption phase.
Estimation of kidney function is often part of daily clinical practice, mostly done by using the endoge-nous glomerular filtration rate (GFR)-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by the identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, # Linnea Malmgren and Carl Öberg contributed equally as first authors.
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