The donor records of a hospital blood bank, analyzed from a statistical standpoint demonstrated a low incidence of vasovagal reactions: 119 in 10,547 donations (1.13%). Donors of younger age and of lower diastolic blood pressure were more prone to reaction. There was no significant sex difference. Higher reaction rates were also associated with first-time donation, the time of year (spring), and a particular phlebotomist. The low reaction rate and the clearly demonstrated psychologic factors in the present study were attributed to a reflection of the small amount (200 ml) of blood withdrawn. The importance of the phlebotomist-donor relationship was stressed.
Toshimitsu Kitajima MDPurpose: We investigated the relationship between the generation of superoxide radicals and histopathological changes on delayed neuronal death in the hippocampal CA I subfield. Methods: Seventy gerbils were randomly assigned to two groups, a sham group and an ischaemia/reperfusion (I/R) group. In the I/R group, transient forebrain ischaemia was induced by occluding the bilateral common carotid arteries for four minutes. The cerebrum was removed after reperfusion at intervals of one minute, six, twelve and twentyfour hr and at three, five and seven days. Each forebrain was cut into two portions including the hippocampus. The quantity of superoxide radicals was measured by using chemiluminescence, and histopathological changes in the hippocampal CAI subfield were examined. Results: In the I/R group, superoxide radicals increased on the 3rd and 5th days compared with the sham group (16.1 ___ 3.4 vs 3.2 ___ 1.0 onthe third day(P < 0.0001); 10.9 + 1.9 vs 3.3 ___ 0.8 onthe fifth day (P < 0.0001)). In the I/R group, the pyramidal cells were atrophic and pycnotic; vacuolation, and structural disruption of the radial striated zone were observed from the third through the seventh day. In the sham group, these changes were not observed. There were differences of degenerative ratios in the pyramidal cells between the two groups from the third to seventh days (5.6 • 2.0 vs 80.9 +_ 3.3 on the third day (P < 0.05); 6.9 +--0.4 vs 93.6 ---2.4 on the fifth clay (P < 0.05); 6.2 _ 1.5 vs 95.0 ___ 1.3 on the seventh day (P < 0.05)). Condusion: There is a correlation between the generation of superoxide radicals and histopathological changes of the pyramidal cells in the hippocampal CAI subfield.Objectif: Investiguer la relation entre la production des radicaux superoxydes et les changements histopathologiques sur led&& neuronal retard~ darts le champ hippocampique CAl. M&hodes : Soixante-dix gerbilles ont ~t~ al6atoirement r~parties en 2 groupes, un groupe contr61e et un groupe isch~mie/reperfusion (I/R). Darts le groupe I/R, une isch~mie transitoire du prosenc6phale 6tait induite par rocclusion bilat&ale des carotides communes pour quatre minutes. Apr~s reperfusion, le cerveau ~tait retir~ de l'animal apr~s une minute de m~.me qu'~ six, douze et vingt-quatre heures ainsi qu'~ trois, cinq et sept jours. Chaque prosenc~phale ~tait coup~ en deux parties incluant l'hippocampe. La quantit6 de radicaux superoxydes &ait mesur& par chemiluminescence et les changements histopathologiques dans le champ hippocampique C.AI ~taient observ&. R&ultats : Darts le groupe I/R, les radicaux superoxydes ont augment~ aux jours 3 et 5 comparativement au groupe t~moin (I 6, I ---3,4 vs 3,2 + 1,0 au jour 3 (P<0,0001); 10,9 + 1,9 vs 3,3 ---0,8 au jour 5 (m<0,0001)). Darts le groupe I/R, les cellules pyramidales ~taient atrophiques et picnotiques; du 3e au 7e jour, on a observ~ de la vacuolisation et de la destruction structurale de la zone stri~e radiaire, et ces changements n'ont pas &6 retrouv& darts le groupe t~moin. On a observ~ ...
We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train-of-four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1 mg.kg-1 was used for paralysis and reversed with intravenous neostigmine 0.04 mg.kg-1 with atropine 0.02 mg.kg-1 when the train-of-four ratio on the right great toe returned to 25%. The mean (SD) times from initial administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1) s and 75 (14.3) s, respectively (p > 0.05). The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train-of-four ratio after the administration of neostigmine was 136 (49.1) s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.
SummaryWe evaluatedpossible differential effects of vecuronium on the thumb andgreat toe using two types of neuromuscular transmission monitor. Train-offour Electrical stimulation of the ulnar or tibial nerves is used to detect the degree of neuromuscular block after the administration of a non-depolarising muscle relaxant [I]. When the tibial nerve is electrically stimulated transcutaneously, the response can be measured by accelography or electromyography (EMG) in addition to other methods. Sopher and colleagues [2] demonstrated that the foot may be used instead of the hand as an alternative site for monitoring neuromuscular function using the EMG. However, we have reported that after vecuronium, the tibial nerve recovers more rapidly than the ulnar nerve when measured by accelography [3]. The response to electrical stimulation of the thumb and great toe, as measured by accelography and electromyography during non-depolarising block, has not been studied. We aimed to quantify possible differential responses to neuromuscular block at the hand and the foot using accelography and EMG after vecuronium during neuroleptanaesthesia (NLA) and sevoflurane-based anaesthesia. MethodsTwenty adult patients, ASA 1 or 2, aged between 24 and 58 years, who were scheduled to undergo elective ENT surgery, were studied after obtaining the approval of the hospital ethics committee and the patients' informed consent. They were within 15% of ideal body weight. Patients with hepatic, renal or neuromuscular disease were not studied.All patients were premedicated with atropine 0.5 mg and hydroxizine 50 mg intramuscularly 1 h before surgery. Patients were randomly allocated to be anaesthetised using either a neurolept technique (see below) or sevofluranebased anaesthesia. Indirect arterial blood pressure and pulse oximetry were monitored on the left arm and venous cannulation was performed on the dorsum of the left hand.Three neuromuscular transmission monitors (two accelographs and an electromyograph) were simultaneously used for each patient. The acceleration transducer of an Accelograph (Biometer) was fastened to the right thumb with adhesive tape and cutaneous electrodes were applied to the right wrist to stimulate the ulnar nerve at a frequency of 2 Hz for train-of-four (TOF) stimulation every 15 s. The positive electrode was positioned over the proximal part and the negative electrode over the distal part (Fig. 1). A second acceleration transducer was fastened to the left great toe and cutaneous electrodes were applied to the left ankle to stimulate the tibial nerve, using the same frequency as before (Fig. 2). Finally, a Relaxograph (Datex) was used for electromyography at the right great toe and cutaneouselectrodes were applied to the right ankle to stimulate the Accepted 6 June 1994.
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