Airway pressure release ventilation (APRV) is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation, including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics, and potential lung-protective effects. It has many claimed disadvantages related to risks of volutrauma, increased work of breathing, and increased energy expenditure related to spontaneous breathing. APRV is used mainly as a rescue therapy for the difficult to oxygenate patients with acute respiratory distress syndrome (ARDS). There is confusion regarding this mode of ventilation, due to the different terminology used in the literature. APRV settings include the "P high," "T high," "P low," and "T low". Physicians and respiratory therapists should be aware of the different ways and the rationales for setting these variables on the ventilators. Also, they should be familiar with the differences between APRV, biphasic positive airway pressure (BIPAP), and other conventional and nonconventional modes of ventilation. There is no solid proof that APRV improves mortality; however, there are ongoing studies that may reveal further information about this mode of ventilation. This paper reviews the different methods proposed for APRV settings, and summarizes the different studies comparing APRV and BIPAP, and the potential benefits and pitfalls for APRV.

This study assessed the knowledge and practices about folic acid in pregnancy among pregnant women attending 2 main maternal and child health centres in Abu Dhabi. The majority of the 277 interviewed mothers (79.1%) had heard of folic acid and 46.6% had accurate knowledge about the role of folate in preventing neural tube defects. There were good practices regarding folate supplementation in the current pregnancy; most of the interviewed mothers took it daily and in the recommended dose. However, only a minority took it prior to pregnancy. Education, irrespective of age or parity, was the major factor determining better knowledge of folic acid in pregnancy. RÉSUMÉ La présente étude évalue les connaissances sur l'acide folique au cours de la grossesse et les pratiques en la matière chez des femmes enceintes fréquentant deux des principaux centres de soins maternels et infantiles d'Abu Dhabi. La majorité des 277 mères interrogées (79,1 %) avaient entendu parler de l'acide folique et 46,6 % avaient des connaissances précises sur le rôle des folates dans la prévention des malformations du tube neural. De bonnes pratiques ont été observées en matière de supplémentation en folates au cours de la grossesse. La plupart des femmes interrogées prenaient quotidiennement la dose recommandée. Cependant, seule une minorité en avait pris avant la grossesse. L'éducation, indépendamment de l'âge ou de la parité, était le principal facteur déterminant de meilleures connaissances sur l'acide folique pendant la grossesse. ‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫السادس‬ ‫املجلد‬ ‫الرابع‬ ‫العدد‬ 403

No abstract

F-FDG PET scan shows potential to detect BM involvement in NHL. In particular, image-guided repeat BMB should be considered in patients with negative initial iliac crest BMB, whose F-FDG PET scan demonstrates BM involvement in a different site.

Key wordsCOMPLICATIONS; hydrothorax; VEINS: cannulation, subclavian, complications.Since the introduction of central venous catheterization to clinical practice in 1945, t the technique has been widely used for the management of severely ill and injured patients. The subclavian route has gained popularity among anaesthetists because of easy access, reliability and catheter tolerance by conscious patients. The procedure is not without complications. Most reviews report complications in less than five per cent of cases, 2 but in one series the incidence of fatal complications was 1.4 per cent. 3The reported hazards of central venous catheterization include venous laceration, 4 haematoma formation,5 arterial puncture,6 catheter embolism,7From the Department of Anesthesiology, King Faisal University, King Fahd Hospital, P.O. Box 2208, A1 Khobar 31952; S audi Arabia; where correspondence should be addressed to Dr. Naguib.Homer's Syndrome with vocal cord paralysis, 8 pneumothorax, hydrothorax, 9 haemothorax, subcutaneous emphysema, arteriovenous fistula, brachial plexus injury, air embolism, 1~ thoracic duct injury,l~ hydromediastinum, t2 laceration of vertebral artery, 13 thrombus formation, 14 cardiac tamponade, 15 tracheal puncture, 16 and local and systemic infection. ~7The occurrence of bilateral hydrothorax following unilateral subclavian catheterization has not been previously reported.We report a patient who presented with bilateral hydrothorax following extravasation of the central venous line infusion into the mediastinum. Case reportA 28-year-old male presented to the emergency room with a fractured pelvis, fractured left tibia and fibula and internal haemorrhage, after a road traffic accident. He was in shock with blood pressure of 9.3/6.6 kPa (70/50 mmHg), and pulse rate of 145/ minute. After resuscitation, the patient was taken to the operating room for exploratory laparotomy under general anaesthesia, and the right internal lilac artery was ligated. During surgery, the anaesthetist found that the single intravenous line was inadequate to replace blood loss. He inserted a 14 gauge 8.3 cm angiocath into the left subclavian vein for fluid replacement. Three units of blood were transfused through the subclavian cannula during the operation. A chest x-ray taken postoperatively showed no abnormality. The patient was transferred in a stable condition, to the intensive care unit for observation. BP was 14.9/9.3 kPa (112/70 mmHg) and heart rate 100/minute.Three hours later, he again became tachycardiac and hypotensive with a heart rate of 136/minute and BP 12/9.3 kPa (90/70 mmHg). The respiratory rate was 34/minute. A diagnosis of hypovolemia was CAbl ANAESTH SOC J 1985 / 32: g / pp412-4

Anaesthesia for the repair of a large occipito cervical encephalomyelocele in a neonate with Kippel-Feil syndrome is described. The fusion of the cervical spines, a short neck, low posterior hair line and Sprengel's deformity, which were present in this patient, collectively indicated Klippel-Feil syndrome. In addition to the usual stigmata of the syndrome, this patient had a large encephalomyelocele and persistant patent ductus arteriosus complicated by congestive heart failure. Patients with this syndrome are vulnerable to cervical spinal cord injury and are at high risk for neurological injury not only during laryngoscopy and intubation but thereafter, lmpli. cations of Kippel-Feil syndrome for the anaesthetist are reviewed and discussed. Klippel-Feil syndrome, first described in 1912,1 is characterized by shortness of the neck resulting from reduction in the number of cervical vertebrae or the fusion of several vertebrae into an osseous mass. The posterior hair line is low and the movement of the neck is limited. L2 The syndrome is often associated with congenital anomalies of other skeletal parts of the same segments, such as

The hypothesis that prostaglandin inhibitors might reduce the incidence and severity of suxamethonium-induced myalgia was investigated using lysine acetyl salicylate (LAS) 13 mg kg-1 i.v. 3 min before the administration of suxamethonium in 20 patients. A comparison was made with atracurium 0.09 mg kg-1 (and placebo) in a double-blind prospective randomized trial. LAS and atracurium were effective in reducing the incidence and severity of postsuxamethonium myalgia and the increases in serum potassium concentration. There were no appreciable changes in serum calcium, sodium, chloride, phosphate, magnesium, creatinine, creatine phosphokinase concentrations or plasmacholinesterase activity. Atracurium caused a delay in the onset of action and a decrease in the intensity of suxamethonium-induced neuromuscular block. It is concluded that LAS pretreatment might have a place in suitable patients in the prevention of suxamethonium-induced myalgia and increases in serum potassium concentration.

No abstract