Purpose
Compartment syndrome that occurs after lengthy surgery in the lithotomy position is known as well-leg compartment syndrome. It has serious consequences for patients, including amyotrophic renal failure, limb loss, and sometimes even death. This study aimed to identify effective preventive measures against well-leg compartment syndrome using a retrospective cohort study of 1,951 patients (985 and 966 in the prevention and control groups, respectively).
Material and methods
The following preventive interventions were analyzed: (1) changing from the lithotomy position to the open-leg position, (2) removing lower leg pressure caused by the lithotomy position, (3) limiting leg elevation based on the height of the right atrium, (4) horizontally repositioning the operating table every 3 hours, and (5) decompressing the contact area of the lower leg in the lithotomy position during operation.
Results
Eight cases of well-leg compartment syndrome occurred in the control group, whereas no well-leg compartment syndrome occurred in the prevention group.
Conclusion
These findings suggest that the five interventions assessed can prevent the development of well-leg compartment syndrome.
Background
The main mechanism of body temperature decrease during cesarean delivery under spinal anesthesia is core-to-peripheral redistribution of body heat, attributable to vasodilation. Perfusion index (PI) obtained with a pulse oximeter helps to assess peripheral perfusion dynamics by detecting the change in peripheral vascular tone. This study aimed to examine whether preoperative toe PI could predict the decrease in core temperature induced by spinal anesthesia during cesarean delivery.
Methods
Parturients undergoing scheduled cesarean delivery under combined spinal-epidural anesthesia from September 2019 to March 2020 were enrolled in this single-center prospective cohort study. All parturients received 0.5% hyperbaric bupivacaine (10 mg) with fentanyl (15 μg) intrathecally. A pulse oximeter probe was placed on the left second toe for continuous PI measurement. The 3 M™ Bair Hugger™ Temperature Monitoring System placed over the right temporal region was used to record core temperature over time. We evaluated the association between the maximum core temperature decrease, which is the primary outcome, and the preoperative toe PI at operating room (OR) admission using a segmented regression model (SRM) and a generalized additive model (GAM). The maximum core temperature decrease was defined as the difference between core temperature at OR admission and minimum intraoperative core temperature.
Results
Forty-eight patients were evaluated. In the SRM, the slope for the association between the maximum core temperature decrease and the preoperative toe PI changed from 0.031 to 0.124 after PI = 2.4%. Likewise, with the GAM, there was a small core temperature decrease when preoperative toe PI was greater than 2.0 to 3.0%.
Conclusions
Low preoperative toe PI was associated with maternal core temperature decrease during cesarean delivery under spinal anesthesia. Preoperative toe PI is a simple, non-invasive, and effective tool for the early prediction of perioperative core temperature decrease during cesarean delivery.
Trial registration
UMIN Clinical Trials Registry (registry number: UMIN000037965).
Background
The efficacy of glucagon for adrenaline-resistant anaphylactic shock in patients taking β-blockers is controversial. However, understanding the efficacy of glucagon is important because adrenaline-resistant anaphylactic shock is fatal. We present a case of severe adrenaline-resistant anaphylactic shock in a patient taking a β-blocker, and glucagon was effective in improving hemodynamics.
Case presentation
An 88-year-old woman with severe aortic stenosis and taking a selective β-1 blocker underwent transcatheter aortic valve implantation under general anesthesia. Postoperatively, she received 100 mg sugammadex, but 2 min later developed severe hypotension and bronchospasm. Suspecting anaphylactic shock, we intervened by administering adrenaline, fluid loading, and an increased noradrenaline dose. Consequently, the bronchospasm improved, but her blood pressure only increased minimally. Therefore, we administered 1 mg glucagon intravenously, and the hypotension resolved immediately.
Conclusions
Glucagon may improve hemodynamics in adrenaline-resistant anaphylactic shock patients taking β-blockers; however, its efficacy must be further evaluated in more cases.
The blocking time of a level crossing influences traffic on a road that crosses a rail line. The blocking time of a level crossing will be especially long on a heavy traffic rail line. The purpose of this paper is to reduce the blocking time of level crossings by optimising the railroad schedule. We propose an optimal schedule in which the departure time at each station is delayed minutely from the time of the planned schedule. Since there are many trains on a heavy traffic rail line, the number of combinations of minutely adjusted departure times will be enormous. We used the genetic algorithm (GA) for searching for an optimal railroad schedule. The delay time for each train at each station is used as a gene value, and a chromosome is composed by connecting the genes for each train. The fitness value is the total blocking time of all level crossings on the model rail line. Results for the computer simulation show that our optimal railroad schedule gives a shorter total blocking time compared with the planned schedule. In addition, we report our examination of a composition of the GA calculation with a grid computing technology for the purpose of reducing the GA operation time
order to reduce windage Ioss in a gear box , this paper presents a method to realize low air pressure in the gear box. lhe gear pair is operated like a gear pump with a tip cylinder fixed at mesh approaching region . lhe paper focuses on temperatures ofthe air in the gearbox and equipment components to find out sources ofheat generation in the test rig . Air adiabatic compression between gear teeth is noticed to bc the main cause of heat gencration . Ihen , we desigried a
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