Experiments to measure the hydrogen uptake kinetics of DEB getter/Pd catalyst/activated carbon pellets have been performed under isothermal isobaric conditions. The extracted kinetics were then used to predict the performance of the getter pellets under different temperatures and pressures, including nonisobaric situations. For isothermal isobaric uptake at higher H2 pressure (666.6-2666.5 Pa), H2 solubility in the getter matrix is responsible for the uptake observed up to a 40-60% reacted fraction. Once the hydrogenated product becomes thicker, the diffusions of the reactants (atomic hydrogen and getter molecules) toward the reaction front become the rate limiting step. However, in a dynamic but very low H2 pressure, encountered in many vacuum electronic applications, the hydrogen spillover effect, over micrometer scale, becomes the dominant reaction mechanism. Despite such a complex dependence of the rate limiting mechanisms on the experimental environment, there is good agreement between kinetic prediction models and experiments. The investigation also reveals that the ultimate uptake capacity in the getter pellets scales inversely with the free volume of the vacuum vessel in which the DEB getter pellets are used, and that DEB getter pellets' performance greatly deteriorates during the final 10-15% capacity (as evidenced by the sharp bend in the slopes of the reacted fraction vs time curves at 85-90% reacted fraction).

No abstract

For the perioperative management of pregnant patients with severe cardiac or aortic disease who require a cardiac surgical procedure and cardiopulmonary bypass, a close, cohesive, working relationship must exist among several medical and surgical specialties. For appropriate management, the well-being of both the mother and the fetus must be considered. The best interests of the mother and the fetus may not coincide, and optimal therapy for one may be inappropriate for the other. We present 10 cases of severe cardiac or aortic disease in pregnant women who required surgical intervention. Eight patients underwent cardiopulmonary bypass during pregnancy, and two patients had cesarean section performed immediately before cardiopulmonary bypass. We also discuss the pertinent pharmacologic aspects related to the perioperative period and the management of cardiopulmonary bypass for the pregnant patient.

Surprisingly little is known about the use of neuromuscular blockers (NMBs) in intensive care units (ICUs) in the USA. Recently, Klessig et al. surveyed anesthesiologists/intensivists in the USA and found that the 55% who responded used NMBs in the ICU in an average of 10 patients per ICU per month. Anxiolytics and analgesics were administered concomitantly with NMBs, but a majority of respondents did not use electrophysiologic measures of the degree of blockade. Another survey of predominantly medical ICUs also demonstrated widespread use of NMBs, but internists did not use sedation/analgesia as frequently as anesthesiologists for patients receiving NMBs, and infrequently monitored the degree of neuromuscular blockade. Because these were retrospective surveys, we decided to monitor prospectively the use of NMBs in our ICUs. The use of NMBs was ascertained by daily review of pharmacy records and, when use was documented, the patients' hospital records were reviewed. Where information was missing or not found, attending physicians were interviewed. On average, one patient per month per ICU received NMBs. Approximately 5% of neonatal and pediatric, and 1% of adult, ICU patients received NMBs. Eighty-three percent of patients received NMBs to facilitate mechanical ventilation, and mortality was high (51%) in those critically ill patients. More than half the patients were treated for < or = 24 h, the remainder for 2 days to > 3 weeks. Twitch monitors were used for monitoring the degree of neuromuscular blockade in adult patients, and all patients received sedatives/analgesics. We estimated that the risk of clinically significant, prolonged neuromuscular blockade following the discontinuation of NMBs was 5% per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Epinephrine and calcium possess both cardiac inotropic and vasopressor activity. In addition, epinephrine's cardiovascular effects are mediated via increases in intracellular calcium. As a result, many clinicians administer the two agents together in an attempt to augment their effects. Although this approach seems rational, it has never been proven effective. We evaluated the cardiovascular and hyperglycemic actions of epinephrine (10 and 30 ng/kg/min), with and without calcium chloride administration (10 mg/kg bolus followed by 2 mg/kg/hr infusion), in a prospective, randomized, blinded, crossover designed study. (Circulation 1990;81:196-200) E pinephrine increases cardiac output via its ,3-adrenergic inotropic and chronotropic actions. Because of these properties, epinephrine is frequently used to raise blood pressure and improve cardiac output in critically ill patients. Epinephrine's cardiovascular effects are believed to be mediated through membrane-associated f3-adrenergic receptors. These receptors raise free intracellular calcium levels and augment contraction in cardiac tissue' and lower free intracellular calcium and depress contraction in vascular smooth muscle.2Because epinephrine mediates its cardiotonic actions through elevation of free intracellular calcium concentrations, some clinicians administer cal- cium along with epinephrine in an attempt to augment epinephrine's effectiveness. Moreover, ,Badrenergic inotropic agents are often administered concurrently with calcium immediately after cardiopulmonary bypass.3 Although the coadministration of calcium with epinephrine would seem rational, the effectiveness of this practice in humans has never been documented. We previously demonstrated that calcium administration blunted both glucagon's chronotropic actions4 and epinephrine's hypertensive effects5 in animals. This surprising interaction led us to extend our animal study to humans by evaluating the effect of calcium on epinephrine's cardiovascular and metabolic actions in patients recovering from aortocoronary bypass surgery. These patients are especially appropriate for such studies because they are hemodynamically stable and they retain appropriate monitoring devices needed for studying cardiovascular function. Our findings indicate that calcium administration blunts epinephrine's cardiac, peripheral vascular, and hyperglycemic (i.e., hepatic) actions. MethodsAfter approval of our protocol by our institutional review board, 12 consenting adult patients recovering

No abstract

No abstract

No abstract