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Sample records for local anesthesia optimizing

  1. [Classification of local anesthesia methods].

    Science.gov (United States)

    Petricas, A Zh; Medvedev, D V; Olkhovskaya, E B

    The traditional classification methods of dental local anesthesia must be modified. In this paper we proved that the vascular mechanism is leading component of spongy injection. It is necessary to take into account the high effectiveness and relative safety of spongy anesthesia, as well as versatility, ease of implementation and the growing prevalence in the world. The essence of the proposed modification is to distinguish the methods in diffusive (including surface anesthesia, infiltration and conductive anesthesia) and vascular-diffusive (including intraosseous, intraligamentary, intraseptal and intrapulpal anesthesia). For the last four methods the common term «spongy (intraosseous) anesthesia» may be used.

  2. [Safe local anesthesia in patients with bronchial asthma].

    Science.gov (United States)

    Anisimova, E N; Gromovik, M V

    The paper presents the analysis of studies of local anesthesia in patients with bronchial asthma. It was found that the diagnosis of hypersensitivity to sodium metabisulfite in patients with bronchial asthma must be optimized for development of local anesthesia selection algorithm in outpatient dentistry.

  3. Local anesthesia for prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Simpson, Colleen; Roof, James; Arthurs, Sandy; Korssjoen, Tammy; Sutlief, Steven

    1999-01-01

    Purpose: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. Methods and Materials: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). Results: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the

  4. Vasoconstrictors in local anesthesia for dentistry.

    Science.gov (United States)

    Sisk, A. L.

    1992-01-01

    Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects: a decrease in the peak plasma concentration of the local anesthetic agent, increase in the duration and the quality of anesthesia, reduction of the minimum concentration of anesthetic needed for nerve block, and decrease of blood loss during surgical procedures. The addition of a vasoconstrictor to a local anesthetic may also have detrimental effects. A review of the literature indicates that vasoconstrictor concentrations in local anesthetics marketed for dental use in the United States are not always optimal to achieve the purposes for which they are added. In most cases, a reduced concentration of vasoconstrictor could achieve the same goal as the marketed higher concentration, with less side-effect liability. PMID:8250339

  5. Open hemorrhoidectomy under local anesthesia for symptomatic ...

    African Journals Online (AJOL)

    standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting.

  6. Advances in local anesthesia in dentistry.

    Science.gov (United States)

    Ogle, Orrett E; Mahjoubi, Ghazal

    2011-07-01

    Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Clinically Enhancing Local Anesthesia Techniques for Endodontic Treatment.

    Science.gov (United States)

    Bahcall, James; Xie, Qian

    2017-02-01

    Local anesthesia is one of the most important drugs given to patients who undergo endodontic treatment. Yet, clinicians often do not view local anesthetic agents as drugs and, therefore, struggle clinically to consistently achieve profound pulpal anesthesia. To improve the clinical effects of local anesthesia for endodontic treatment, in conjunction with selecting the correct type of local anesthesia, clinicians need to thoroughly understand how the local anesthetic process works and how to objectively test for clinical signs of pulpal anesthesia and integrate supplemental anesthesia when appropriate.

  8. Updates of Topical and Local Anesthesia Agents.

    Science.gov (United States)

    Boyce, Ricardo A; Kirpalani, Tarun; Mohan, Naveen

    2016-04-01

    As described in this article, there are many advances in topical and local anesthesia. Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The modern-day dentist has the responsibility of knowing the variety of products on the market and should have at least references to access before, during, and after treatment. This practice ensures proper care with topical and local anesthetics for the masses of patients entering dental offices worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Modern technologies of local injection anesthesia in dental practice

    Directory of Open Access Journals (Sweden)

    Sohov S.Т.

    2013-09-01

    Full Text Available Objective: To assess the importance of using the new system Quick Sleeper for local anesthesia, to highlight benefits of quick and comfortable anesthesia. Material and Methods. The examination of effectiveness, convenience of this kind of anesthesia has been carried out. Results. All patients, taking part in this examination, confirmed more comfortable condition after this anesthesia than conductor and infiltration methods of anesthesia. The effect of anesthesia is better than after conductor anesthesia. Conclusion. This technology guarantees equal introduction and spread of anesthetic, independently of tissue density, eliminating the risk of carpule breakage.

  10. HEMOGLOBIN AND HEMATOCRITE CHANGES DURING UNCOMPLICATED ANESTHESIA: GENERAL ANESTHESIA AND LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    KH NAGHIBI

    2002-12-01

    Full Text Available Introduction. Despite of vital role of blood and it"s components as an only curable treatment, it"s transfusion is accompanied by many complications. In the other way, the most important adverse effects of anemia is decrease in oxygen supply to the tissues. Therefore, it is essential to determine those patients need to blood transfusion and exact hemoglobine and hematocrite level which transfusion become necessary. Recent studies show that during general anesthesia due to vasodilation in the level of microcirculation and passage of many red blood cells from microcirculation there is a decreasing in hemoglobine level measured in peripheral veins which named plasma skimming. So, during sampling of hemoglobine and hematocrite from peripheral veins, there is a pseudodecrease in Hb and HCT levels. In this study we want to determine this decrease in Hb and HeT. Methods. Study was done in 182 patients with ASA 1 and 2 undergoing general or local anesthesia for cataract surgery. Duration of nill per os (NPO, preoperotive and intraoperative intravenous fluid administration were simillar in two groups. A sample of blood for preoperative evaluation and another one immediately after operation achevied and compared with each other. Results. There was not significant differences between mean Hb and HCT in two groups preoperotive. But postoperative, there was a significant differences between mean Hb and HCT in general anesthesia vs local anesthesia (P < 0.01. This decrease in Hb and HCT was orderly 0.91 ± 1.14 gr/dl for Hb and 2.862±3.6 percent for Hct. Discussion. In determining of Hb and HCT immediately after general anesthesia, there is some pseudo decrease due to plasma skimming that must be appreciated.

  11. Use of Local Anesthesia During Dental Rehabilitation With General Anesthesia: A Survey of Dentist Anesthesiologists

    Science.gov (United States)

    Townsend, Janice A.; Hagan, Joseph L.; Smiley, Megann

    2014-01-01

    The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: “stabilization of vital signs/decreased depth of general anesthesia” (92.9%, 26/28) and “improved patient recovery” (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia. PMID:24697820

  12. Optimal Technique in Cardiac Anesthesia Recovery

    OpenAIRE

    Svircevic, V.

    2014-01-01

    The aim of this thesis is to evaluate fast-track cardiac anesthesia techniques and investigate their impact on postoperative mortality, morbidity and quality of life. The following topics will be discussed in the thesis. (1.) Is fast track cardiac anesthesia a safe technique for cardiac surgery? (2.) Does thoracic epidural anesthesia have an effect on mortality and morbidity after cardiac surgery? (3.) Does thoracic epidural anesthesia have an effect on quality of life after cardiac surgery? ...

  13. Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia

    OpenAIRE

    Satoh, Kenichi; Ohashi, Ayako; Kumagai, Miho; Hoshi, Hideki; Otaka, Kousei; Joh, Shigeharu

    2015-01-01

    Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed.

  14. Optimal Technique in Cardiac Anesthesia Recovery

    NARCIS (Netherlands)

    Svircevic, V.

    2014-01-01

    The aim of this thesis is to evaluate fast-track cardiac anesthesia techniques and investigate their impact on postoperative mortality, morbidity and quality of life. The following topics will be discussed in the thesis. (1.) Is fast track cardiac anesthesia a safe technique for cardiac surgery?

  15. Percutaneous planter fasciitis release under local anesthesia: A prospective study

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2017-04-01

    Conclusion: Percutaneous planter fasciitis release under local anesthesia is a minimally invasive procedure that can be performed in the outpatient setting. It is easy, quick, effective and moreover with few complications.

  16. Advanced techniques and armamentarium for dental local anesthesia.

    Science.gov (United States)

    Clark, Taylor M; Yagiela, John A

    2010-10-01

    Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis. Copyright © 2010 Elsevier Inc. All rights reserved.

  17. Cholecystectomy with local anesthesia as a resource in the elderly

    International Nuclear Information System (INIS)

    Del Campo Abad, Roberto; Noel Mederos Curbelo, Orestes

    2011-01-01

    In the case of a patient presenting with acute cholescystectomy ideally is to remove the gallbladder. Sometimes there are special situations in malnourished elderlies with deterioration of its general status in whom a lengthy anesthesia intervention, even using not much invasive means as the videosurgery, put at risk the life of patient. In such cases the cholescystectomy with local anesthesia is an alternative that must to be taken into account. (author)

  18. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin (Eilish)

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  19. Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry.

    Science.gov (United States)

    Dabarakis, Nikolaos N; Alexander, Veis; Tsirlis, Anastasios T; Parissis, Nikolaos A; Nikolaos, Maroufidis

    2007-01-01

    To clinically evaluate the jet injection Injex (Rösch AG Medizintechnik) using 2 different anesthetic solutions, and to compare the jet injection and the standard needle injection techniques. Of the 32 patients in the study, 10 received mepivacaine 3% anesthetic solution by means of the jet injection technique, while the remaining 22 patients received lidocaine 2% with epinephrine 1:80,000 by the same method. The 14 patients in whom pulp anesthesia was achieved were selected for an additional evaluation of the pulp reaction using standard needle injection anesthesia. The differences between the 2 compounds with Injex were statistically evaluated by means of independent-samples t test analysis. The differences between subgroups receiving both jet injection and needle injection anesthesia were evaluated by means of paired t test analysis. The administration of mepivacaine 3% using Injex did not achieve pulp anesthesia in any of the 10 patients, although the soft tissue anesthesia was successful. The administration of lidocaine with epinephrine using Injex resulted in pulp anesthesia in only 14 patients; soft tissue anesthesia was observed in all patients of this group. There was no statistically significant difference between Injex and the needle injection technique in onset of anesthesia. However, the duration of anesthesia was significantly longer for the needle infiltration group than for the Injex injection group. The anesthetic solution should be combined with a vasoconstriction agent when the Injex technique is implemented.

  20. Anesthesia

    Science.gov (United States)

    ... arm or leg. A common type is epidural anesthesia, which is often used during childbirth. General - makes ... afterwards. Sedation can be used with or without anesthesia. The type of anesthesia or sedation you get ...

  1. Adjuncts to local anesthesia: separating fact from fiction.

    Science.gov (United States)

    Wong, J K

    2001-01-01

    Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection, computer-controlled delivery systems, periodontal ligament injection and needleless jet injection, have been proposed to hold particular advantages over conventional means of achieving local anesthesia. This article describes the use of each technique and proprietary armamentarium and reviews the literature appraising their use.

  2. [Practical advices in choosing local anesthesia tools in dentistry. Management of carpule's quality in local anesthesia in dentistry].

    Science.gov (United States)

    Kuzin, A V

    2014-01-01

    The equipment for local anesthesia is described in this article. Practical recommendations for the selection of the injection needle length, size, bevel type is given. Using dental needle for local anesthesia should be guided by the "one injection - one needle" rule, as a needle tends to deform by even the slightest contact with jawbone. Some of the shortcomings of carpule quality may be detected before use: signs of cup corrosion, the presence of sediment, air bubbles, rubber plunger disposition. In the case of such defects being identified all the package should not be used. The use of such carpule in clinical practice is unsafe.

  3. Local anesthesia in dentistry - Clinical Considerations

    OpenAIRE

    Sharmraaj Subramaniam; Prasanna Neelakantan

    2013-01-01

    Local anaesthesia is commonly employed prior to most dental procedures. It is imperative to understand the mechanisms by which local anaesthetics work, so that their efficacy can be improved for painless dental care. Local anaesthesia also has major clinical implications in that it can precipitate emergencies in patients with an underlying systemic disease. It is imperative that a dentist have a thorough knowledge of the considerations one must take when administering local anaesthesia in pat...

  4. [Piezosurgery for surgically assisted rapid maxillary expansion under local anesthesia].

    Science.gov (United States)

    Sun, Hao; Li, Biao; Sun, Hao; Liu, Zhixu; Wang, Xudong

    2014-08-01

    This study evaluates piezosurgery for surgically assisted rapid maxillary expansion (SARME) under local anesthesia. SARME was performed on adults with maxillary transverse deficiency under local anesthesia with a piezosurgical device. Fourteen patients (six males and eight females) underwent lateral maxillary osteotomies, midpalatal osteotomies, and bilateral pterygomaxillary disjunction. The feelings of patients during the operation were determined through questionnaires. All patients underwent SARME in the out-patient operating room. The surgical procedures were completed under local anesthesia. All patients exhibited satisfactory tolerance. Ultrasonic bone-cutting surgery was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery for its technical characteristics of precision and safety. The device used was unique in that cutting action occurred when the tool was employed on mineralized tissues, but stoped on soft tissues. The results of the questionnaires showed that eight (57.14%) patients felt a mild sensation of ultrasonic vibration, tweleve (85.7 1%) felt mild tolerable pain and tooth soreness during surgery, and eleven (78.57%) felt little fear and hardly heard the ultrasonic sound. Preoperative and postoperative six months later measurements showed an evident effect of expansion. Piezosurgery enabled patients to undergo all the steps of SARME under local anesthesia, but more cases and longer follow-up are needed to verif ' the results.

  5. Review of knee arthroscopy performed under local anesthesia

    Directory of Open Access Journals (Sweden)

    Law Billy

    2009-01-01

    Full Text Available Abstract Local anesthesia for knee arthroscopy is a well documented procedure with diagnostic and therapeutic role. Numerous therapeutic procedures including partial menisectomy, meniscus repair, abrasion chondroplasy, synovectomy, loose body removal can be performed safely and comfortably. Appropriate case selection, anesthetic strategy and technical expertise are the key to smooth and successful surgery.

  6. Comparison of Sedation With Local Anesthesia and Regional Anesthesia in Transurethral Resection of Prostate (TURP

    Directory of Open Access Journals (Sweden)

    H Aghamohammadi

    2008-12-01

    Full Text Available ABSTRACT: Introduction & Objective: Transurethral Resection of Prostate (TURP is usually performed under regional or general anesthesia. An alternative to conventional anesthesia is performing of TURP under local anesthetic infiltration with sedation. The aim of this study was to evaluate the efficacy and complication of sedoanalgesia in TURP. Material & Methods: In a prospective clinical trial from September 2006 to December 2007, 60 patients (30 in each group with prostate hypertrophy, candidate for TURP, were randomly assigned into two groups. In the first group, standard spinal anesthesia was done. In the second group, five minutes before the operation, 25 mgs of diazepam plus 25-50 mgs of pethedine was intravenously administered followed by injection of 10 ml lidocaine 2% gel in the urethra and the skin in the suprapubic area was anesthetized with 2 ml of 1% lidocaine. Using a 22 gauge nephrostomy needle, the suprapubic skin was punctured and the needle was directed toward prostate apex and 10-20ml of 1% lidocaine was injected at the serosal aspect of the rectal wall. For dorsal nerve block, 5-10ml of 1% lidocaine was injected at penopubic junction, and then a standard TURP was performed. Patients were switched to another anesthetic technique if the selected technique failed. Severity of pain was assessed by visual analogue scale. Results: The average prostate size was 25 grs (range10-50grs in the local anesthetic group (group 1 and 27.5 grs (range 10-50 grs in the spinal group (group2. In the local anesthetic group, 82.3% had no or mild pain while moderate to severe pain was reported in 16, 7% of the patients. In the group with spinal anesthesia, these were 93.1% and 6.9% respectively. Intolerable pain was observed in 23.3% and 13.8% of groups 1 and 2 respectively (p>0.05. Two patients in spinal group and 5 in local anesthetic group (3 due to severe pain and 2 for unsatisfaction required conversion to general anesthesia or receiving

  7. Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia

    DEFF Research Database (Denmark)

    Bertelsen, Claus Anders

    2011-01-01

    The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before.......The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before....

  8. Local anesthesia selection algorithm in patients with concomitant somatic diseases.

    Science.gov (United States)

    Anisimova, E N; Sokhov, S T; Letunova, N Y; Orekhova, I V; Gromovik, M V; Erilin, E A; Ryazantsev, N A

    2016-01-01

    The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

  9. An update on local anesthesia for pediatric dental patients

    Science.gov (United States)

    Peedikayil, Faizal C.; Vijayan, Ajoy

    2013-01-01

    Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients. PMID:25885712

  10. An update on local anesthesia for pediatric dental patients

    OpenAIRE

    Peedikayil, Faizal C.; Vijayan, Ajoy

    2013-01-01

    Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

  11. The Thermodynamics of General and Local Anesthesia

    Science.gov (United States)

    Græsbøll, Kaare; Sasse-Middelhoff, Henrike; Heimburg, Thomas

    2014-05-01

    General anesthetics are known to cause depression of the freezing point of transitions in biomembranes. This is a consequence of ideal mixing of the anesthetic drugs in the membrane fluid phase and exclusion from the solid phase. Such a generic law provides physical justification of the famous Meyer-Overton rule. We show here that general anesthetics, barbiturates and local anesthetics all display the same effect on melting transitions. Their effect is reversed by hydrostatic pressure. Thus, the thermodynamic behavior of local anesthetics is very similar to that of general anesthetics. We present a detailed thermodynamic analysis of heat capacity profiles of membranes in the presence of anesthetics. This analysis is able to describe experimentally observed calorimetric profiles and permits prediction of the anesthetic features of arbitrary molecules. In addition, we discuss the thermodynamic origin of the cutoff-effect of long-chain alcohols and the additivity of the effect of general and local anesthetics.

  12. Seizure After Local Anesthesia for Nasopharyngeal Angiofibroma

    Directory of Open Access Journals (Sweden)

    Cheng-Jing Tsai

    2007-02-01

    Full Text Available We report a young male patient who experienced seizure after local injection of 3 mL 2% lidocaine with epinephrine 1:200,000 around a recurrent nasal angiofibroma. After receiving 100% oxygen via mask and thiamylal sodium, the patient had no residual neurologic sequelae. Seizure immediately following the injection of local anesthetics in the nasal cavity is probably due to injection into venous or arterial circulation with retrograde flow to the brain circulation. Further imaging study or angiography should be done before head and neck surgeries, especially in such highly vascular neoplasm.

  13. Local Anesthesia Part 2: Technical Considerations

    Science.gov (United States)

    Reed, Kenneth L.; Malamed, Stanley F.; Fonner, Andrea M.

    2012-01-01

    An earlier paper by Becker and Reed provided an in-depth review of the pharmacology of local anesthetics. This continuing education article will discuss the importance to the safe and effective delivery of these drugs, including needle gauge, traditional and alternative injection techniques, and methods to make injections more comfortable to patients. PMID:23050753

  14. Guidelines for administration of local anesthesia for dermatosurgery and cosmetic dermatology procedures

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    Mysore Venkataram

    2009-08-01

    Full Text Available Introduction, definition, rationale and scope: Dermatosurgery and Cosmetic dermatology procedures are being performed by increasing number of dermatologists. Most dermatosurgeries are performed in an outpatient setting and as day care surgeries, under local anesthesia. Hence, it is important to improve patient comfort during all procedures. These guidelines seek to lay down directives in the use of local anesthesia, outline the different local anesthetics, the mode of administration, complications arising out of such procedure and management of the same. Facility for administration of local anesthesia: Local anesthesia is usually administered in the dermatologist′s procedure room. The room should be equipped to deal with any emergencies arising from administration of local anesthesia. Qualifications of local anesthesia administrator: Local anesthesia administrator is a person who applies or injects local anesthetic agent for causing analgesia. Procedures done under local anesthesia are classified as Level I office procedures and require the administrator to have completed a course in Basic Cardiac Life Support (BCLS. Evaluation of patients for topical or infiltrative anesthesia: Details of patient′s past medical history and history of medications should be noted. Allergy to any medications should be specifically enquired and documented. Patients for tumescent anesthesia need additional precautions to be observed as described in these guidelines. Methods of administration of local anesthesia: Different methods include topical anesthesia, field block, ring block, local infiltration and nerve block. Also, it includes use of local anesthetics for anesthetizing oral and genital mucosa. Tumescent anesthesia is a special form of local anesthesia used in liposuction and certain selected procedures. Local anesthetic agents: Different local anesthetics are available such as lignocaine, prilocaine, bupivacaine. The dermatologist should be aware of the

  15. Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

    Science.gov (United States)

    Liu, Yu-Yin; Yeh, Chun-Nan; Lee, Hsiang-Lin; Wang, Shang-Yu; Tsai, Chun-Yi; Lin, Chih-Chung; Chao, Tzu-Chieh; Yeh, Ta-Sen; Jan, Yi-Yin

    2009-01-01

    AIM: To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery. METHODS: From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups. RESULTS: There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay. CONCLUSION: Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients. PMID:19452582

  16. MR arthrography of the shoulder: Do we need local anesthesia?

    International Nuclear Information System (INIS)

    Spick, Claudio; Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred

    2014-01-01

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  17. MR arthrography of the shoulder: Do we need local anesthesia?

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio, E-mail: claudio.spick@meduniwien.ac.at [Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna (Austria); Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred [Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz (Austria)

    2014-06-15

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  18. Advances in dental local anesthesia techniques and devices: An update

    Science.gov (United States)

    Saxena, Payal; Gupta, Saurabh K.; Newaskar, Vilas; Chandra, Anil

    2013-01-01

    Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available. PMID:24163548

  19. Advances in dental local anesthesia techniques and devices: An update.

    Science.gov (United States)

    Saxena, Payal; Gupta, Saurabh K; Newaskar, Vilas; Chandra, Anil

    2013-01-01

    Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.

  20. ARTHROSCOPIC MENISCUS REPAIR WITH BIOABSORBABLE ARROWS IN LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Vladimir Senekovič

    2004-11-01

    Full Text Available Background. The menisci have important function in the knee joint. Because of this it is universally accepted that we have to preserve them as much as possible. After open and partially arthroscopic suture techniques new methods of all-inside meniscus repair with bioabsorbable arrows have been developed in the last decade. The meniscus repair using these arrows represents an easy task for a skilled surgeon. In addition, it can be performed in local anesthesia. We have evaluated the results of the first group of patients who were treated by this method.Methods. From February 2001 to August 2002 15 patients with torn meniscuses have been treated at the Clinical Department for Traumatology, University Medical centre, Ljubljana. We repaired their torn menisci arthroscopically with bioabsorbable arrows in local anesthesia. We divided patients in three groups: a group with isolated meniscus injury, a group with meniscus injury and anterior cruciate ligament injury and a group with associated pathology. Four patients had incarcerated meniscuses. Preoperative Lysholm score in the first group was 38, in the second 42 and in the third group 48. We repaired 12 medial and 3 lateral meniscuses. On average we need 45 minutes for therapeutic arthroscopy. Torn meniscus was fixated with minimum of 1 and maximum of 5 bioabsorbable arrows. All patients except one had the affected knee immobilized with cylinder plaster for 15 days on average.Results. At least three months after the arthroscopic fixation of the torn meniscus in local anesthesia another clinical evaluation was made. In all groups significant improvement was observed regarding the range of motions and absence of pain. Postoperative Lysholm score in the first group was 89, in the second 75 and in the third 71. Average deficit of flexion was 3 degrees while extension was full. One patient complained about the same pain in the joint, he underwent another arthroscopy which showed that the meniscus was

  1. Results of Endoscopic Dacryocystorhinostomy under Local Anesthesia with Minimal Sedation

    Directory of Open Access Journals (Sweden)

    Woong Chul Choi

    2017-01-01

    Full Text Available Purpose. We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy (Endo-DCR in patients treated in the leaning position and under local anesthesia with minimal sedation (LAS. Study Design. Questionnaire to determine subjective success of Endo-DCR. Methods. From May 2013 to August 2014, a total of 95 eyes with epiphora presented to the Myoung Eye Plastic Surgery Clinic in Seoul, Korea, and were treated with Endo-DCR under LAS. Three nerve blocks were administered to achieve local anesthesia. Postoperatively, the wound site was packed with Nasopore to control bleeding and promote wound healing. Outcome measures included a patient questionnaire completed on postoperative day 7 to evaluate intraoperative and postoperative pain based on the VAS (0 to 10. Results. Mean intraoperative and postoperative pain scores were 1.03 and 1.64, respectively, for 95 eyes. Of the 95 eyes treated, the patients in 82 eyes (86.31% reported that they would prefer LAS over GA for a repeat Endo-DCR. The subjective and objective surgical success rates were 90.14% and 95.77%, respectively. Conclusions. Endo-DCR carried out under LAS with the patient in the leaning position is more useful, efficient, and feasible than Endo-DCR performed under GA with the patient in the supine position.

  2. Ocular complications associated with local anesthesia administration in dentistry.

    Science.gov (United States)

    Boynes, Sean G; Echeverria, Zydnia; Abdulwahab, Mohammad

    2010-10-01

    The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol. Copyright © 2010 Elsevier Inc. All rights reserved.

  3. Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series

    OpenAIRE

    Iwanaga, Joe; Nakamura, Yoshiaki; Kusukawa, Jingo; Tubbs, R. Shane

    2016-01-01

    Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the...

  4. Optimized PID control of depth of hypnosis in anesthesia.

    Science.gov (United States)

    Padula, Fabrizio; Ionescu, Clara; Latronico, Nicola; Paltenghi, Massimiliano; Visioli, Antonio; Vivacqua, Giulio

    2017-06-01

    This paper addresses the use of proportional-integral-derivative controllers for regulating the depth of hypnosis in anesthesia by using propofol administration and the bispectral index as a controlled variable. In fact, introducing an automatic control system might provide significant benefits for the patient in reducing the risk for under- and over-dosing. In this study, the controller parameters are obtained through genetic algorithms by solving a min-max optimization problem. A set of 12 patient models representative of a large population variance is used to test controller robustness. The worst-case performance in the considered population is minimized considering two different scenarios: the induction case and the maintenance case. Our results indicate that including a gain scheduling strategy enables optimal performance for induction and maintenance phases, separately. Using a single tuning to address both tasks may results in a loss of performance up to 102% in the induction phase and up to 31% in the maintenance phase. Further on, it is shown that a suitably designed low-pass filter on the controller output can handle the trade-off between the performance and the noise effect in the control variable. Optimally tuned PID controllers provide a fast induction time with an acceptable overshoot and a satisfactory disturbance rejection performance during maintenance. These features make them a very good tool for comparison when other control algorithms are developed. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Breakdown of local information processing may underlie isoflurane anesthesia effects.

    Science.gov (United States)

    Wollstadt, Patricia; Sellers, Kristin K; Rudelt, Lucas; Priesemann, Viola; Hutt, Axel; Fröhlich, Flavio; Wibral, Michael

    2017-06-01

    The disruption of coupling between brain areas has been suggested as the mechanism underlying loss of consciousness in anesthesia. This hypothesis has been tested previously by measuring the information transfer between brain areas, and by taking reduced information transfer as a proxy for decoupling. Yet, information transfer is a function of the amount of information available in the information source-such that transfer decreases even for unchanged coupling when less source information is available. Therefore, we reconsidered past interpretations of reduced information transfer as a sign of decoupling, and asked whether impaired local information processing leads to a loss of information transfer. An important prediction of this alternative hypothesis is that changes in locally available information (signal entropy) should be at least as pronounced as changes in information transfer. We tested this prediction by recording local field potentials in two ferrets after administration of isoflurane in concentrations of 0.0%, 0.5%, and 1.0%. We found strong decreases in the source entropy under isoflurane in area V1 and the prefrontal cortex (PFC)-as predicted by our alternative hypothesis. The decrease in source entropy was stronger in PFC compared to V1. Information transfer between V1 and PFC was reduced bidirectionally, but with a stronger decrease from PFC to V1. This links the stronger decrease in information transfer to the stronger decrease in source entropy-suggesting reduced source entropy reduces information transfer. This conclusion fits the observation that the synaptic targets of isoflurane are located in local cortical circuits rather than on the synapses formed by interareal axonal projections. Thus, changes in information transfer under isoflurane seem to be a consequence of changes in local processing more than of decoupling between brain areas. We suggest that source entropy changes must be considered whenever interpreting changes in information

  6. Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Christina Bognet

    2011-12-01

    Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

  7. Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients.

    Science.gov (United States)

    Mittal, M; Kumar, A; Srivastava, D; Sharma, P; Sharma, S

    2015-01-01

    Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

  8. Local Anesthesia in Cataract Surgery-A Comparison of Different Methods

    Institute of Scientific and Technical Information of China (English)

    Nolan; J; Aziz; M; Ahmad; M; Shehata; M; Iqbal; F

    1993-01-01

    Seven groups of thirty patients undergoing cataract extraction under local anesthesia were each given different combinations of local anesthesia. These varied from a maximum approach using supra-orbital, infra-orbital and facial blocks with Hyalase, orbital compression and pre-operative Acetazolamide down to a minimum group receiving purely an infra- orbital and supra-orbital block with a Ugnocaine/Bupivacaine mixture. There was no significant difference in local analgesia or in the complication rates b...

  9. Administration of Anesthesia

    Medline Plus

    Full Text Available ... extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here to ... extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here to ...

  10. Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

    Directory of Open Access Journals (Sweden)

    Al-Khayat Jehad

    2008-04-01

    Full Text Available Abstract Background Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988 can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. Purpose The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. Methods 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS (ranging from 0 = no pain to 10 = maximum pain. Results One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min. The pain score related to injection was 2.5 (0.8 and to tourniquet was 3.6 (0.9. Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. Conclusion Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.

  11. Articaine: a review of its use for local and regional anesthesia

    Directory of Open Access Journals (Sweden)

    Snoeck M

    2012-06-01

    Full Text Available Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.Keywords: articaine, regional anesthesia, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability, neurotoxicity

  12. Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series

    Directory of Open Access Journals (Sweden)

    Joe Iwanaga

    2016-01-01

    Full Text Available Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years. Bilateral eminectomy of the TMJ was performed for two patients, and unilateral eminectomy was performed for three patients. Two were examined under intravenous propofol sedation and local anesthesia, while three patients were examined under general anesthesia. One patient died from ileus one month after surgery. The follow-up period except for the case that died from ileus ranged from 12 to 33 months. No recurrent dislocation of the TMJ has been identified. Based on our experience and two other series in the literature, eminectomy with sedation and local anesthesia can be considered and might be a good option in elderly patients.

  13. Comparison of two local anesthesia techniques (conventional & akinosi for inferior alveolar dental nerve

    Directory of Open Access Journals (Sweden)

    Refua Y

    2001-09-01

    Full Text Available Different techniques for local anesthesia are used in the mandible. The purpose of this study"nwas to determine the effects of inferior alveolar dental nerve blocks by comparing the two akinosi and"nconventional techniques. 80 patients (aged 15-60 years old were randomly divided into tow groups for"nextracting the mandibuler posterior teeth by akinosi and conventional techniques. Patients were all"ninjected with 1.8 ml of Lidocaine 2% plus Adernaline j^nnnn .Then the Pain Sensation during injection,"npositive aspiration, beginning time of anesthesia, duration of anesthesia depth of anesthesia, and the anesthesia of soft tissue related to sensory nerves were evaluated. The results showed that the pain sensation in conventional technique was significantly higher than that of akinosi technique. The number of positive aspirations in conventional technique (12,5% was higher than that of akinosi (5% but not significantly different. The long buccal nerve anesthesia in akinosi technique (75% was significantly higher than that of conventional technique. There was no significant difference between the two techniques for the depth of anesthesia. The success rate was 87.5% in conventional technique and 80% in akinosi technique. The average time of lips anesthesia in conventional technique was 3 minutes compared with 4 minutes in akinosi technique, which was not significantly different from each other. However, the beginning time of aneshtesia in tongue was significantly lower in conventional technique. No significant difference in the duration of anesthesia in lips and tonques between the two techniques was observed.

  14. Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Krogh, J; Rye, B

    1992-01-01

    Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used...... on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly...... less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy....

  15. Radiofrequency-assisted Liposuction for Arm Contouring: Technique under Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Spero Theodorou, MD

    2013-08-01

    Conclusions: In appropriately selected patients, RFAL arm contouring under local anesthesia represents an alternative procedure with acceptably low morbidity and high patient satisfaction. To achieve consistent results while minimizing complications, consideration to anatomic details, infiltration of the local anesthetic, and application of the radiofrequency energy must be given.

  16. Articaine: a review of its use for local and regional anesthesia

    Science.gov (United States)

    Snoeck, Marc

    2012-01-01

    Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations. PMID:22915899

  17. Ophthalmologic complications after administration of local anesthesia in dentistry: a systematic review.

    Science.gov (United States)

    Alamanos, Christos; Raab, Philipp; Gamulescu, Andreea; Behr, Michael

    2016-03-01

    The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic mechanisms, and the measures that offer patients a restitutio ad integrum. This systematic review adopted a structured protocol to access available publications and followed the PRISMA statement. Eighty-nine cases of patients experiencing ocular adverse events after administration of dental local anesthesia have been reported in the literature. Most of the complications manifested as double vision. Only 8% of the complications caused permanent functional damage, either as vision deficit or anisocoria. Complete permanent blindness was not reported. Ocular complications as a result of dental local anesthesia may be seen as rare occurrences with usually low intensity. However, visual function may become permanently impaired and serious medical conditions may obscure ocular dysfunction. Copyright © 2016. Published by Elsevier Inc.

  18. When local anesthesia becomes universal: Pronounced systemic effects of subcutaneous lidocaine in bullfrogs (Lithobates catesbeianus)

    DEFF Research Database (Denmark)

    Williams, Catherine; Alstrup, Aage Kristian Olsen; Bertelsen, Mads Frost

    2017-01-01

    Sodium channel blockers are commonly injected local anesthetics but are also routinely used for general immersion anesthesia in fish and amphibians. Here we report the effects of subcutaneous injection of lidocaine (5 or 50mgkg-1) in the hind limb of bullfrogs (Lithobates catesbeianus) on reflexes...... regained over 4h. Systemic sedative effects were not coupled to local anti-nociception, as a forceps pinch test at the site of injection provoked movement at the height of the systemic effect (tested at 81±4min). Amphibians are routinely subject to general anesthesia via exposure to sodium channel blockers...

  19. Lumpectomy and sentinel lymph node navigation surgery for breast cancer under local anesthesia

    International Nuclear Information System (INIS)

    Nakajima, Hiroo; Fujiwara, Ikuya; Mizuta, Naruhiko; Sakaguchi, Koichi; Hachimine, Yasushi; Nakatsukasa, Katsuhiro; Kobayashi, Aya

    2007-01-01

    We studied and analyzed therapeutic outcomes of a radical surgery under local anesthesia for breast cancer in our department. Subjects were 53 patients with breast cancer whose diagnoses were definitely made before surgery. Indications were: localized ductal carcinoma in situ (DCIS) diagnosed preoperatively; invasive carcinoma less than 3 cm in tumor diameter on ultrasound and magnetic resonance imaging scan; and clinically tumors with negative axillary lymph nodes. Operative procedures included microdochectomy or lumpectomy associated with sentinel lymph node navigation biopsy (SLNB). We could perform the operation under local anesthesia in all the 53 patients, and were not demanded to shift from local to general anesthesia. Surgical stumps were positive in 10 patients (18.9%). Of the ten patients, additional resection was performed in one, and irradiation was added to the remaining nine patients. SLNB was performed in a total of 39 patients, six (15.4%) patients of them had metastasis and two out of the six patients underwent additional axillary lymph node dissection. None of serious complications were encountered. Local recurrence and hepatic metastasis occurred in each one patient in an averaged observation period of 15.1 months. This day's radical operation under local anesthesia for breast cancer is a useful procedure as minimally invasive surgery as for the indications employed in this study. (author)

  20. Effect of Hypnosis During Administration of Local Anesthesia in Six- to 16-year-old Children.

    Science.gov (United States)

    Oberoi, Jyoti; Panda, Anup; Garg, Iti

    2016-01-01

    Hypnosis is a tool that can help pediatric dentists allay fear or increase patient cooperation while administering local anesthesia. The purpose of this study was to determine whether hypnosis altered a patient's physical and/or verbal resistance and oxygen saturation or heart rate during administration of local anesthesia. Two hundred six- to 16-year-olds were randomly allocated to either a control group or an experimental group that received hypnotic induction prior to the delivery of local anesthesia. Subjects were monitored for signs of physical or verbal resistance and changes in pulse rate and oxygen saturation at baseline and upon administration of local anesthetic. Children under hypnosis exhibited significantly less resistance to administration of local anesthesia (P<0.05). A bi-serial correlation for age and resistance showed a significant positive correlation (0.337) in the experimental group, indicating that resistance in children increases with age, but none was shown between gender and hypnotic suggestibility. There was a significant difference in pulse rate, attributable to the hypnotic condition (P=.000), but not in oxygen saturation level. Using hypnosis may increase patient cooperation, decrease resistance during painful procedures, and lead to a lower heart rate.

  1. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    instillation (IPI) of saline and local anesthesia (LA) to minimize SP. METHODS: A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP...

  2. Using Mixed-Reality Technology to Teach Techniques for Administering Local Anesthesia

    Science.gov (United States)

    Hanson, Kami M.

    2011-01-01

    The ability to perform local anesthesia on dental patients is an important clinical skill for a dental hygienist. When learning this procedure in an academic situation, students often practice on their peers to build their skills. There are multiple reasons why the peer practice is not ideal; consequently, educators have sought the means to…

  3. Evaluation of new injection and cavity preparation model in local anesthesia teaching

    NARCIS (Netherlands)

    Yekta, S.S.; Lampert, F.; Kazemi, S.; Kazemi, R.; Brand, H.S.; Baart, J.A.; Mazandarani, M.

    2013-01-01

    The aim of this study was to evaluate a recently developed preclinical injection and cavity preparation model in local anesthesia. Thirty-three dental students administered an inferior alveolar nerve block injection in the model, followed by preparation on a tooth. The injection was evaluated by

  4. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval...... from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median...... anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other...

  5. Local Anesthesia at ST36 to Reveal Responding Brain Areas to deqi

    Directory of Open Access Journals (Sweden)

    Ling-min Jin

    2014-01-01

    Full Text Available Background. Development of non-deqi control is still a challenge. This study aims to set up a potential approach to non-deqi control by using lidocaine anesthesia at ST36. Methods. Forty healthy volunteers were recruited and they received two fMRI scans. One was accompanied with manual acupuncture at ST36 (DQ group, and another was associated with both local anesthesia and manual acupuncture at the same acupoint (LA group. Results. Comparing to DQ group, more than 90 percent deqi sensations were reduced by local anesthesia in LA group. The mainly activated regions in DQ group were bilateral IFG, S1, primary motor cortex, IPL, thalamus, insula, claustrum, cingulate gyrus, putamen, superior temporal gyrus, and cerebellum. Surprisingly only cerebellum showed significant activation in LA group. Compared to the two groups, bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC were remarkably activated. Conclusions. Local anesthesia at ST36 is able to block most of the deqi feelings and inhibit brain responses to deqi, which would be developed into a potential approach for non-deqi control. Bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC might be the key brain regions responding to deqi.

  6. Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia

    Directory of Open Access Journals (Sweden)

    Robert A. Goldberg

    2014-01-01

    Full Text Available To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females underwent tumor removal through eyelid crease (17 eyes, conjunctival (nine eyes, lateral canthal (two eyes, and transcaruncular (two eyes approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range age and follow-up duration were 48.5 (31–87 years old and 24.5 (4–375 weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases, pleomorphic adenoma (5 cases, solitary fibrous tumor (4 cases, neurofibroma (2 cases, schwannoma (2 cases, and orbital varix (1 case. None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.

  7. Articaine: a review of its use for local and regional anesthesia

    OpenAIRE

    Snoeck, Marc

    2012-01-01

    Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects wer...

  8. The impact of cardiovascular drugs on the efficacy of local anesthesia in dentistry.

    Science.gov (United States)

    Milosavljevic, Мarko J; Jankovic, Slobodan M

    2016-12-01

    Drugs used chronically by patients with diseases of the cardiovascular system (group C of the ATC classification) may act on adrenergic receptors and/or certain ion channels, which gives them the potential to interact with the action of local dental anesthetics. The aim of the study was to investigate the effect of systemically administered chronic cardiovascular medication (oral route) on the efficacy of intraoral local anesthesia in patients with diseases of the cardiovascular system. This was a prospective cohort study which analyzed the efficacy of local terminal anesthesia (onset of anesthesia, duration anesthetized area) in the upper jaw of 70 patients: 40 patients on medication for cardiovascular system disorders and 30 patients who were not using these drugs (the control group). The following cardiovascular drugs were used: beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, vasodilatators, diuretics, angiotensin receptor blockers, antiarrhythmics, statins and alfa blockers. The onset of anesthesia on the vestibular side was faster in those taking cardiovascular drugs (40.50±19.87 s) than the control patients (58.93±31.07 s; P = 0.004) and duration of anesthesia on this side was shorter. Although the difference was not significant, it was evident that on vestibular and palatal side the anesthetized area was more rapidly reduced in the patients taking cardiovascular drugs. The duration of cardiovascular therapy also had a significant impact on the anesthetized area. Drugs acting on cardiovascular system may influence the effect of local anesthetics used in dentistry, possibly through interaction with autonomic receptors and ion channels.

  9. Simplified local anesthesia technique for external dacryocystorhinostomy without nasal packing: a new technique and pilot study outcome

    Directory of Open Access Journals (Sweden)

    Tawfik HA

    2013-11-01

    Full Text Available Hatem A Tawfik,1 Osama R Youssef21Department of Ophthalmology, 2Department of Anesthesiology, Ain Shams University, Cairo, EgyptBackground: The purpose of this paper is to describe a simplified local anesthesia technique for external dacryocystorhinostomy (EXT-DCR.Methods: In this pilot, retrospective, noncomparative, interventional case series, 448 patients (480 eyes underwent EXT-DCR using a simplified local anesthesia technique. Nasal mucosal anesthesia was achieved using combined application of 6 mL of oxymetazoline 0.025% nasal spray and lidocaine 1% in the same spray bottle, without any packing of the nose with either pledgets or ribbon gauze. Local infiltration anesthesia consisted of subcutaneous injection of a 7 mL mixture of 2% lidocaine with 1:100,000 epinephrine injected on the flat side of the nose beneath the incision site, in addition to a second medial peribulbar injection (3 mL, 2% lidocaine without epinephrine.Results: Successful unilateral or bilateral EXT-DCR was achieved in 432/448 patients (96.4%. Four patients could not tolerate the procedure under local anesthesia and were converted to general anesthesia. Four patients required additional local anesthetic injections because of intolerable pain. Heavy sedation was essential in eight uncooperative patients because surgical manipulation was impossible. The remaining patients tolerated the procedure well. The intraoperative bleeding rate was very low except in one patient. Mean operative time was 16 minutes. Severe postoperative epistaxis was observed in four patients. Temporary anosmia developed in one patient.Conclusion: Our simplified local anesthesia approach of EXT-DCR is convenient for the patient because it avoids unnecessary nasal packing. It is also safe and effective, as evidenced by the high rate of successful completion of the procedure without conversion to general anesthesia or the need for supplemental local anesthesia.Keywords: local anesthesia, external

  10. The use of local anesthesia during dental rehabilitations: a survey of AAPD members.

    Science.gov (United States)

    Townsend, Janice A; Martin, Ashla; Hagan, Joseph L; Needleman, Howard

    2013-01-01

    The purpose of this study was to document current practices among pediatric and general dentists who are members of the American Academy of Pediatric Dentistry (AAPD) regarding the use of local anesthesia (LA) on children undergoing dental rehabilitation under general anesthesia (GA). A survey was administered via e-mail to AAPD members to document the use of LA during dental rehabilitations under GA and the rationales for its use. A total of 952 of 5,599 members responded to this survey; 79 percent of respondents use LA at least part of the time during dental rehabilitations under GA. "Improved patient recovery" was the most commonly cited rationale for administering LA. Extraction of permanent and primary teeth were the two most common procedures cited for the use of LA, respectively. There is no consensus among the respondents on the use of local anesthesia during dental rehabilitation under general anesthesia, but the majority responded that it does play a role in their perioperative patient management.

  11. [Comparison of the systems used for providing local anesthesia in dentistry--the Wand (Milestone Scientific) and Injex (Rosch)].

    Science.gov (United States)

    Zarzecka, Joanna; Gończowski, Krzysztof; Kesek, Barbara; Darczuk, Dagmara; Zapała, Jan

    2006-01-01

    Local anesthesia is one of the basic and the most often executed interventions in dentistry. This procedure is very stressful for the patients because it is combined with pain. The new systems for delivering local anesthesia in dentistry have revolutionized the technique considerably by its simplify as well as reduction in pain. this study presents the comparison between the local anesthesia delivery systems used in dentistry--The Wand and Injex, taking into consideration pain intensity during performing anesthesia and the intensification of fear before executed anesthesia with the given system. the Visual Analogue Scale (VAS), verbal scale and questionnaires were used to evaluate pain and fear. On the basis of our investigations it can be concluded that there were statistically important differences between men and women in fear intensity combined with the anesthesia procedure--men were less afraid than women. The patients who were anaesthetized with system The WAND declared less fear before similar anesthesia in future. The average value of intensity of pain analyzed with both verbal and visual scales during anaesthetizing with the system Injex (independently from sex) was statistically significantly higher than for system The WAND--respectively 0.57 and 8.55 for The WAND, 2.02 and 32.18 for Injex (p = 0.001). on the basis of the results of this study it can be concluded that the less stressful and painful local anesthesia delivery system is the WAND.

  12. Inguinal hernia repair with tension-free hernioplasty under local anesthesia

    International Nuclear Information System (INIS)

    Gao, Jia-Sen; Wang, Zhen-Jun; Zhao, Bo; Ma Song Zhang; Pang, Guo-Yi; Na, Dong-Ming; Zhang Yu-Dong

    2009-01-01

    To evaluate the use of local anesthesia in tension-free hernioplasty in a local hospital. The study took place at Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China during the period from January 2007 to May 2008. All 110 patients who had undergone inguinal hernia repair with mesh under local anesthesia were included in the study. To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, non-elective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. We performed a retrospective review of all 110 patients' data. The average operating time was 45 minutes (30-70 minutes), and the average hospital stay was 3-4 days. There was no postoperative mortality in this study. No surgical site infection occurred. Two patients (18%) that suffered from a moderate scrotal hematoma had recovered after extract injection therapy was applied. The duration of incisional pain was 2-3 days, and no patient required post-operative analgesia. During the follow-up, no recurrence occurred. The use of local anesthesia in inguinal hernia repair with tension-free hernioplasty is a safe and effective alternative for inpatient treatment. (aothor)

  13. Simplified Surgical Placement of Tenckhoff Catheter under Local Anesthesia: The Dammam Central Hospital Experience

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    Youmbissi T

    2001-01-01

    Full Text Available Many methods are used for the placement of Tenckhoff catheters. Eighteen consecutive Tenckhoff catheters were placed under local anesthesia through a mini laparotomy with a reduced operating team. There were only three total catheter failures. Complications were infrequent and operating time was less than one hour on average. This simple procedure should be a part of the training program of all junior surgeons and nephrologists.

  14. Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia

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    Jafar Rafiei Kiasari

    2012-08-01

    Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.

  15. Applicability and Effectiveness of Closed Reduction of Nasal Fractures under Local Anesthesia

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    Vilela, Fernando

    2014-03-01

    Full Text Available Introduction A significant portion of patients treated in emergency departments have nasal fracture. It is important that the otolaryngologist know how to treat such damage. Objectives To evaluate the effectiveness of nasal fracture reduction under local anesthesia and tolerance to the procedure. Methods Twenty-four patients treated in the emergency department with closed reduction under local anesthesia were prospectively followed. Epidemiologic information and data regarding pain and complications during the management were noted. The degree of satisfaction was researched by visual analog scale. Results The majority of patients were male (75%, and the most common cause of injury was motor vehicle accident. We found a significant association between time to reduction and referred pain during the procedure. In patients in whom the procedure was delayed (over 3 days, there was less pain, and those who bled during the procedure had a shorter average time to reduction than the group of patients who did not bleed. Most patients were very satisfied, with more than 95% of these willing to undergo the same process again, if necessary. Conclusions The closed approach in the clinic under local anesthesia was effective and safe in restoration of the nose.

  16. Feasibility analysis of loop colostomy closure in patients under local anesthesia

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    Abreu Rone Antônio Alves de

    2006-01-01

    Full Text Available PURPOSE: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS: The mean duration of the operation was 133 minutes (range: 85 to 290 minutes. The mean postoperative hospitalization was four days (range: one to twelve days. No patients died. Complications occurred in two patients (9.4%: abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21 and on the first postoperative day by 85% (18/21. At hospital discharge, 95.2% of the patients (20/21 said they were in favor of the local anesthesia technique. CONCLUSION: Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

  17. Effects of opioids on local anesthesia in the rat: a codeine and tramadol study

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    Talita Girio Carnaval

    2013-12-01

    Full Text Available Opioids are central analgesics that act on the CNS (central nervous system and PNS (peripheral nervous system. We investigated the effects of codeine (COD and tramadol (TRAM on local anesthesia of the sciatic nerve. Eighty Wistar male rats received the following SC injections in the popliteal fossa: local anesthetic with epinephrine (LA; local anesthetic without vasoconstrictor (LA WV; COD; TRAM; LA + COD; LA + TRAM; COD 20 minutes prior to LA (COD 20' + LA or TRAM 20 minutes prior to LA (TRAM 20' + LA. As a nociceptive function, the blockade was considered the absence of a paw withdraw reflex. As a motor function, it was the absence of claudication. As a proprioceptive function, it was the absence of hopping and tactile responses. All data were compared using repeated-measures analysis of variance (ANOVA. Opioids showed a significant increase in the level of anesthesia, and the blockade duration of LA + COD was greater than that of the remaining groups (p < 0.05. The associated use of opioids improved anesthesia efficacy. This could lead to a new perspective in controlling dental pain.

  18. Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia.

    Science.gov (United States)

    Fui, Stéphanie Li Sun; Bonnichon, Philippe; Bonni, Nicolas; Delbot, Thierry; André, Jean Pascal; Pion-Graff, Joëlle; Berrod, Jean-Louis; Fontaine, Marine; Brunaud, Catherine; Cocagne, Nicolas

    2016-10-01

    With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery. Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h. Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery. In patients 80 years or older, minimally invasive surgery as an

  19. Children′s behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ali Bagherian

    2016-01-01

    Conclusion: It may be concluded that the cotton-roll vibration method can be more helpful than the routine topical anesthesia in reducing behavioral pain reactions in children during local anesthesia administration.

  20. Anesthesia for ambulatory anorectal surgery.

    Science.gov (United States)

    Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

    2004-01-01

    The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

  1. A questionnaire study regarding local anesthesia in dentistry and safety measures in dental clinics among dental students

    OpenAIRE

    オオケ, ハナコ; クドウ, マサル; シンヤ, ノボル; Hanako, OHKE; Masaru, KUDO; Noboru, SHINYA

    2005-01-01

    This reports the results of a questionnaire study of dental students on the awareness of "local anesthesia" and "use of patient monitoring systems" in dental clinics. Subjects participated in the present study included 96 sixth year dental students (D6) and 93 first year dental students (D1). The results indicate that the majority of respondents including both D6 and D1 support the notion that a "dentist" is the most suitable person to perform local anesthesia in dental treatment. With respec...

  2. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  3. Local vaginal anesthesia during high-dose-rate intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Chen, H.-C.; Wan Leung, Stephen; Wang, C.-J.; Sun, L.-M.; Fang, F.-M.; Huang, E.-Y.; Wang, S.-J.; Yang, C.-W.

    1998-01-01

    Purpose: To evaluate the clinical efficacy of local vaginal lidocaine application for pain relief during high-dose-rate (HDR) intracavitary brachytherapy for patients with cervical cancer, and to investigate sequential changes in serum levels of lidocaine during the procedures. Methods and Materials: This prospective study was designed to examine the analgesic effect, physical response, and side effects of local anesthesia during HDR intracavitary brachytherapy. Forty patients were enrolled. All patients received 10-15 MV X-rays to the pelvis with a total dose of 45-59.4 Gy 5-6 weeks before undergoing HDR intracavitary brachytherapy. All patients underwent first intracavitary brachytherapy under general anesthesia. These patients were randomly allocated to receive one of two different treatment protocols as follows: (1) treatment session - control session - treatment session - control session; or (2) control session - treatment session- control session - treatment session. In the treatment sessions, topical anesthesia was administered using 4 ml of 10% lidocaine solution sprayed liberally on the cervix and vagina during intracavitary brachytherapy. In the control sessions, a placebo was administered in the same manner during brachytherapy. The Hensche's applicators for brachytherapy were inserted into the cervix and vagina 5 min after lidocaine application. The visual analogue scale (VAS) was used to assess pain and discomfort during brachytherapy. Blood pressure and heart rates were measured to evaluate the physiological response. Another prospective study was then performed to investigate the sequential changes of serum lidocaine levels during the anesthetic procedure. Eleven additional patients with similar disease state and demographic characteristics were enrolled and blood samples were obtained before, and 5, 15, 30, and 45 min after the initiation of lidocaine application. Results: The mean VAS values recorded during the treatment sessions and control

  4. The use of local anesthesia and sedation in transanal hemorrhoidal dearterialization with Doppler

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    Fernanda Bellotti Formiga

    2018-04-01

    Full Text Available The treatment of hemorrhoidal disease has never been as innovated as in recent decades. The transanal hemorrhoidal dearterialization with Doppler (THD was described under general anesthesia or spinal blockage and there is no use of local anesthesia reports. This study aims to evaluate the safety of the use of local anesthesia with sedation in THD. For this purpose, two cases are reported describing the technical and safety analysis and results. Both patients were women with grade II and III hemorrhoidal disease. These patients underwent pre-anesthetic sedation with intravenous diazepam, then were positioned in lithotomy and sedated with midazolam and pethidine. The intersphincteric blockage was followed by THD with mucopexy. One patient made a small submucosal hematoma without expansion. The patients were stable and comfortable throughout the procedure. Both were discharged the next day, with regular analgesia. In the seventh postoperative day, both had mild annoyance at constant tenesmus, which was reduced gradually. The cases illustrate that THD is feasible when performed with local anesthesia and sedation, as it is safe and effective. This new technology can be incorporated into services that have a local anesthesia protocol as their standard. Resumo: O tratamento da doença hemorroidária nunca foi tão inovado como nas últimas décadas. A desarterialização hemorroidária transanal é uma dessas inovações. Foi originalmente descrita sob anestesia geral ou bloqueio espinal e não há relatos de utilização de anestesia local. Assim, este estudo visa avaliar a segurança do uso da anestesia local com sedação na desarterialização hemorroidária transanal. Para tal, dois casos são relatados com descrição da técnica e análise da segurança e resultados. Ambas pacientes eram mulheres com doença hemorroidária grau II e III. Foram submetidas à indução anestésica, posicionadas em litotomia e sedadas com midazolan e petidina

  5. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children

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    Mangalampally Shilpapriya

    2015-01-01

    Full Text Available Aim: Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "gate control" theory of Melzack and Wall. The present study was carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Materials and Methods: Thirty patients aged 6-12 years old of both the genders with Frankel′s behavior rating scale as positive and definitely positive requiring bilateral local anesthesia injections for dental treatment were included in the split-mouth cross over design. Universal pain assessment tool was used to assess the pain with and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Results: Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001 compared to the injections without the use of vibe. Conclusion: The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.

  6. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children.

    Science.gov (United States)

    Shilpapriya, Mangalampally; Jayanthi, Mungara; Reddy, Venumbaka Nilaya; Sakthivel, Rajendran; Selvaraju, Girija; Vijayakumar, Poornima

    2015-01-01

    Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "gate control" theory of Melzack and Wall. The present study was carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Thirty patients aged 6-12 years old of both the genders with Frankel's behavior rating scale as positive and definitely positive requiring bilateral local anesthesia injections for dental treatment were included in the split-mouth cross over design. Universal pain assessment tool was used to assess the pain with and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001) compared to the injections without the use of vibe. The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.

  7. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

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    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  8. General Anesthesia versus Local Anesthesia in StereotaXY (GALAXY) for Parkinson's disease: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Holewijn, R. A.; Verbaan, D.; de Bie, R. M. A.; Schuurman, P. R.

    2017-01-01

    Background: The aim of the study is to investigate if deep brain stimulation (DBS) in the subthalamic nucleus (STN) for Parkinson's disease (PD) under general anesthesia further improves outcome by lessening postoperative cognitive, mood, and behavioral adverse effects; shorten surgical time and

  9. Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults.

    Science.gov (United States)

    Hersh, Elliot V; Moore, Paul A; Papas, Athena S; Goodson, J Max; Navalta, Laura A; Rogy, Siegfried; Rutherford, Bruce; Yagiela, John A

    2008-08-01

    The authors conducted two multicenter, randomized, double-blinded, controlled Phase III clinical trials to study the efficacy and safety of phentolamine mesylate (PM) in shortening the duration and burden of soft-tissue anesthesia. The study involved 484 subjects who received one of four commercially available local anesthetic solutions containing vasoconstrictors for restorative or scaling procedures. On completion of the dental procedure, subjects randomly received a PM or a sham injection (an injection in which a needle does not penetrate the soft tissue) in the same site as the local anesthetic injection. The investigators measured the duration of soft-tissue anesthesia by using standardized lip- and tongue-tapping procedures every five minutes for five hours. They also evaluated functional measures and subject-perceived altered function, sensation, appearance and safety. Median recovery times in the lower lip and tongue for subjects in the PM group were 70 minutes and 60 minutes, respectively. Median recovery times in the lower lip and tongue for subjects in the sham group were 155 minutes and 125 minutes, respectively. Upper lip median recovery times were 50 minutes for subjects in the PM group and 133 minutes for subjects in the sham group. These differences were significant (P < .0001). Recovery from actual functional deficits and subject-perceived altered function, sensation and appearance also showed significant differences between the PM and the sham groups. PM was efficacious and safe in reducing the duration of local anesthetic- induced soft-tissue numbness and its associated functional deficits. Clinicians can use PM to accelerate reversal of soft-tissue anesthesia and the associated functional deficits.

  10. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Just, Sven; Foegh, Pia

    2015-01-01

    BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired qu...... stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. CONCLUSION: Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS....

  11. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

    Science.gov (United States)

    Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Antò, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  12. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    Directory of Open Access Journals (Sweden)

    Annelyse Garret-Bernardin

    2017-01-01

    Full Text Available Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years, requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  13. Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia.

    Science.gov (United States)

    Thiem, Daniel G E; Schnaith, Florian; Van Aken, Caroline M E; Köntges, Anne; Kumar, Vinay V; Al-Nawas, Bilal; Kämmerer, Peer W

    2018-04-01

    The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible. In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min). IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique. Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.

  14. Relationship between Child and Parental Dental Anxiety with Child's Psychological Functioning and Behavior during the Administration of Local Anesthesia.

    Science.gov (United States)

    Boka, Vasiliki; Arapostathis, Konstantinos; Kotsanos, Nikolaos; Karagiannis, Vassilis; van Loveren, Cor; Veerkamp, Jaap

    2016-01-01

    The aims of this study were to determine: 1) the relationship between children's psychological functioning, dental anxiety and cooperative behavior before and during local anesthesia, 2) the relationship of parental dental anxiety with all the above child characteristics. There was a convenient sample of 100 children (4-12 years). Child dental anxiety and psychological functioning were measured using the "Children's Fear Survey Schedule" (CFSS-DS) and the "Strengths and Difficulties Questionnaire" (SDQ) respectively. Parental dental anxiety was measured using the "Modified Dental Anxiety Scale" (MDAS). All questionnaires were completed by parents. Before and during local anesthesia, the child behavior was scored by one experienced examiner, using the Venham scale. Non-parametric tests and correlations (Mann-Whitney, Spearman's rho) were used for the analysis. The mean SDQ score was 10±5.6 for boys (n=60) and 8.3±4.8 for girls (n=40) (p=0.038), but there was no correlation with children's age. The mean CFSS-DS score was 33.1±11.86 and there was no correlation with age or gender. Children with higher levels in the pro-social subscale of the SDQ had significantly less anxiety and better behavior before local anesthesia. Higher mean CFSS-DS scores were significantly associated with uncooperative behavior during local anesthesia (p=0.04). There was no correlation between parents' and their children's dental anxiety, psychological functioning and behavior. 46% of the children had previous dental experience in the last 6 months. As time since the last dental treatment increased, an improvement was found in children's behavior during local anesthesia. Child psychological functioning was related to dental anxiety and behavior during dental appointment involving local anesthesia.

  15. Comparison of Postoperative Pain between Infiltrative Local Anesthesia plus Paracetamol and Total Intravenous Anesthesia plus Paracetamol in Ambulatory Breast Surgery

    Directory of Open Access Journals (Sweden)

    Kasra Karvandian

    2015-08-01

    Full Text Available Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia.Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA, the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU stay was recorded for each patient.Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001. The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001. Patients in the LA group had longer PACU admission (P = 0.001.Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient.

  16. Update on emerging regional techniques and novel local anesthetics in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Szafran MJ

    2015-12-01

    Full Text Available Martin J Szafran, Eldhose Abrahams, Tong Joo Gan Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA Abstract: New regional anesthetic techniques have been incorporated into the multimodal approach to postoperative analgesia. Blocks such as the transversus abdominis plane block, adductor canal block, and pectoral nerves blocks all show promise as potential tools used in opioid-sparing techniques, but at the same time have significant limitations to their utility. Novel long-acting formulations of local anesthetics further add to the possible benefit of these blocks, but their application to peripheral nerve blocks is currently being investigated and is not well defined. This review focuses on evaluating the relevant anatomy, technique, and indications of several newer peripheral nerve blocks, the emerging evidence supporting the use of liposomal bupivacaine and SABER®-Bupivacaine, and the application of both in ambulatory anesthesia. Keywords: transversus abdominis plane (TAP block, adductor canal block, pectoral nerves block, regional anesthesia, liposomal bupivacaine, SABER®-Bupivacaine

  17. Ambulatory phlebectomy under tumescent local anesthesia in a kidney-transplant patient

    Directory of Open Access Journals (Sweden)

    Bjelanović Zoran

    2013-01-01

    Full Text Available Introduction. Tumescent local anesthesia (TLA is widely used for ambulatory surgery. Patients with transplanted organs are on immunosuppressive therapy and with risk for organ rejection or severe infection. Case report. Saphenectomy with phlebectomy on the left leg under TLA was performed in a patient with kidney transplantation performed four years ago. A combination of 35 mg of 1% prilocaine-hydrochloride, 5 mL of 8.4% sodium bicarbonate and 500 μg of epinephrine in 460 mL of normal saline was used for TLA. Overall 750 mL of the solution was used. The patient had satisfactory postoperative analgesia and was discharged home on the same day. Blood levels of urea, creatinine, estimated glomerular filtration rate (eGFR and tacrolimus concentration, measured preoperatively and on the second postoperative day, were in a regular range. Prilocaine blood concentrations determined on the 4th, 10th and 16th postoperative hours, were below toxic levels. Conclusion. TLA in a kidney-transplanted patient performed for saphenectomy with phlebectomy proved to be a safe and reliable anesthesia method.

  18. Comparison of the Efficacy of Subtenon with Peribulbar Local Anesthesia without Hyaluronidase in Patients Undergoing Cataract Surgery

    International Nuclear Information System (INIS)

    Khan, S. A.; Aftab, A. M.; Iqbal, M.

    2014-01-01

    Objective: To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. Study Design: A randomized controlled trial. Place and Duration of Study: Eye B Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. Methodology: Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. Results: There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B (p < 0.001). At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups (p = 0.999 and 0.59 respectively). Group A had better akinesia as compared to group B (p = 0.04). There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A (p < 0.001); in both groups, the intraocular pressure declined to its base level 10 minutes after the injection (p = 0.52). Conclusion: Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia. (author)

  19. Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

    International Nuclear Information System (INIS)

    Kim, Dong Wook; Rho, Myung Ho; Kim, Ki Nam

    2009-01-01

    This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was

  20. Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

    International Nuclear Information System (INIS)

    Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

    2011-01-01

    Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

  1. An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review

    OpenAIRE

    Preetinder Singh

    2012-01-01

    Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of...

  2. Modifying the baricity of local anesthetics for spinal anesthesia by temperature adjustment: model calculations.

    Science.gov (United States)

    Heller, Axel R; Zimmermann, Katrin; Seele, Kristin; Rössel, Thomas; Koch, Thea; Litz, Rainer J

    2006-08-01

    Although local anesthetics (LAs) are hyperbaric at room temperature, density drops within minutes after administration into the subarachnoid space. LAs become hypobaric and therefore may cranially ascend during spinal anesthesia in an uncontrolled manner. The authors hypothesized that temperature and density of LA solutions have a nonlinear relation that may be described by a polynomial equation, and that conversion of this equation may provide the temperature at which individual LAs are isobaric. Density of cerebrospinal fluid was measured using a vibrating tube densitometer. Temperature-dependent density data were obtained from all LAs commonly used for spinal anesthesia, at least in triplicate at 5 degrees, 20 degrees, 30 degrees, and 37 degrees C. The hypothesis was tested by fitting the obtained data into polynomial mathematical models allowing calculations of substance-specific isobaric temperatures. Cerebrospinal fluid at 37 degrees C had a density of 1.000646 +/- 0.000086 g/ml. Three groups of local anesthetics with similar temperature (T, degrees C)-dependent density (rho) characteristics were identified: articaine and mepivacaine, rho1(T) = 1.008-5.36 E-06 T2 (heavy LAs, isobaric at body temperature); L-bupivacaine, rho2(T) = 1.007-5.46 E-06 T2 (intermediate LA, less hypobaric than saline); bupivacaine, ropivacaine, prilocaine, and lidocaine, rho3(T) = 1.0063-5.0 E-06 T (light LAs, more hypobaric than saline). Isobaric temperatures (degrees C) were as follows: 5 mg/ml bupivacaine, 35.1; 5 mg/ml L-bupivacaine, 37.0; 5 mg/ml ropivacaine, 35.1; 20 mg/ml articaine, 39.4. Sophisticated measurements and mathematic models now allow calculation of the ideal injection temperature of LAs and, thus, even better control of LA distribution within the cerebrospinal fluid. The given formulae allow the adaptation on subpopulations with varying cerebrospinal fluid density.

  3. Pharmacokinetics and effect of intravenous meloxicam in weaned Holstein calves following scoop dehorning without local anesthesia

    Directory of Open Access Journals (Sweden)

    Coetzee Johann F

    2012-09-01

    Full Text Available Abstract Background Dehorning is a common practice involving calves on dairy operations in the United States. However, less than 20% of producers report using analgesics or anesthetics during dehorning. Administration of a systemic analgesic drug at the time of dehorning may be attractive to dairy producers since cornual nerve blocks require 10 – 15 min to take effect and only provide pain relief for a few hours. The primary objectives of this trial were to (1 describe the compartmental pharmacokinetics of meloxicam in calves after IV administration at 0.5 mg/kg and (2 to determine the effect of meloxicam (n = 6 or placebo (n = 6 treatment on serum cortisol response, plasma substance P (SP concentrations, heart rate (HR, activity and weight gain in calves after scoop dehorning and thermocautery without local anesthesia. Results Plasma meloxicam concentrations were detectable for 50 h post-administration and fit a 2-compartment model with a rapid distribution phase (mean T½α = 0.22 ± 0.087 h and a slower elimination phase (mean T½β = 21.86 ± 3.03 h. Dehorning caused a significant increase in serum cortisol concentrations and HR (P  Conclusions To our knowledge, this is the first published report examining the effects of meloxicam without local anesthesia on SP, activity and performance of calves post-dehorning. These findings suggest that administration of meloxicam alone immediately prior to dehorning does not mitigate signs of acute distress but may have long term physiological, behavior and performance effects.

  4. Clinical application of synthesized brain surface imaging for preoperative simulation of brain biopsy under local anesthesia

    International Nuclear Information System (INIS)

    Ogura, Yuko; Katada, Kazuhiro; Imai, Fumihiro; Fujisawa, Kazuhisa; Takeshita, Gen; Kanno, Tetsuo; Koga, Sukehiko

    1994-01-01

    Surface anatomy scanning (SAS) is the technique which permits the direct visualization of brain surface structures, including cortical sulci, guri, subcortical lesions as well as skin markings for craniotomy. A synthesized brain surface image is a technique that combines MR angiography (MRA) with SAS, and it proposed by us for detecting cerebral superficial veins with these surface structures on the same image. The purpose of this report is to present the result of applying the synthesized brain surface image to the preoperative simulation of biopsy under local anesthesia in 2 cases of multiple metastatic brain tumors. The parameters for SAS were TR/TE=50/40 msec, flip angle=60deg by the fast T 2 technique using refocused FID in steady-state (STERF technique). SAS images were processed by gray scale reversal. The MRA data were acquired with two-dimensional time of flight (TOF) sequence after intravenous administration of Gd-DTPA. Before imaging, the water-filled plastic tubes were placed on the patients scalp as markings for craniotomy. Their positions were planned by the neurosurgeons. On SAS, the markings for burr-hole appeared located above the tumors. However on the synthesized brain surface images, the positions of burr-hole were considered to be inadequate, since superficial cerebral vein and sinus were also visualized in the area of the markings. From these results, the positions of burr-hole were reset to avoid the venous structures, and so as to include the lesions in operations. The biopsies were performed successfully and safely because the venous structure could be excluded from the operative field. By this technique it was easy to confirm the relationships among lesions, skin markings and venous structures. The technique described appears to be a useful method for preoperative simulation of biopsies for multiple metastatic brain tumors under local anesthesia. (author)

  5. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary...... analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly....

  6. Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study.

    Science.gov (United States)

    Wolf, Thomas Gerhard; Wolf, Dominik; Callaway, Angelika; Below, Dagna; d'Hoedt, Bernd; Willershausen, Brita; Daubländer, Monika

    2016-01-01

    This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0-10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

  7. [Efficiency of teeth local anesthesia by articaine-containing formulation with adrenaline and clonidine in pediatric dentistry].

    Science.gov (United States)

    Mel'nikova, A V; Shugaĭlov, I A; Garus, Ia N

    2014-01-01

    The study evaluated duration and depth of the local infiltration anesthesia by articaine with different combinations of epinephrine and clonidine : articaine (4%) + epinephrine (1: 200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1: 400 000) + clonidine (1:100, 000) in pediatric dental practice. It was revealed that the replacement of the vasoconstrictor epinephrine on clonidine associated with reduced depth and duration of analgesia. This increased efficiency is provided by inclusion of epinephrine (1:200 000), and clonidine (1:100 000) into anesthetic solution, which provided statistically significant increase in depth and duration of anesthesia.

  8. Effect of ketoprofen, lidocaine local anesthesia, and combined xylazine and lidocaine caudal epidural anesthesia during castration of beef cattle on stress responses, immunity, growth, and behavior.

    Science.gov (United States)

    Ting, S T L; Earley, B; Hughes, J M L; Crowe, M A

    2003-05-01

    To determine the effects of burdizzo castration alone or in combination with ketoprofen (K), local anesthesia (LA), or caudal epidural anesthesia (EPI) on plasma cortisol, acute-phase proteins, interferon-gamma production, growth, and behavior of beef cattle, 50 Holstein x Friesian bulls (13 mo old, 307 +/- 5.3 kg) were assigned to (n = 10/treatment): 1) control (handled; C); 2) burdizzo castration (B); 3) B following K (3 mg/ kg of BW i.v.; BK); 4) B following LA (8 mL into each testis and 3 mL s.c. along the line where the jaws of the burdizzo were applied with 2% lidocaine HCl; BLA); and 5) B following EPI (0.05 mg/kg of BW of xylazine HCl and 0.4 mg/kg of BW of lidocaine HCl as caudal epidural; BEPI). The area under the cortisol curve against time was lower (P castration groups than in C. On d 7, haptoglobin and fibrinogen concentrations remained higher (P castration increased plasma cortisol and acute-phase proteins, and suppressed immune function and growth rates. Local anesthesia prolonged the increase in acute-phase proteins. Ketoprofen was more effective than LA or EPI in decreasing cortisol and partially reversed the reduction in ADG following castration. The use of K or EPI was more effective than LA in decreasing pain-associated behavioral responses observed during the first 6 h after treatment. Systemic analgesia with ketoprofen, a non-steroidal antiinflammatory drug, was more effective in reducing inflammatory responses associated with castration than LA or EPI.

  9. Examination of cardiovascular function variables in tooth extraction under local anesthesia

    Directory of Open Access Journals (Sweden)

    Životić-Vanović Mirjana

    2006-01-01

    Full Text Available Background/Aim. Local anesthesia is the one of the most used procedures in surgical practice. It is used for toot extraction to produce analgesic and anesthetic effects. However, there is a question if it is equally safe to apply a local anesthetic combined with a vasoconstrictor (adrenaline in healthy persons, and in the patients with a certain cardiovascular system disease. The aim of this study was to determine whether there were differences in cardiovascular variables during tooth extraction in healthy persons, and in cardiovascular patients when an anesthetic was applyted with adrenaline, or without it. Methods. The examinees were divided into the group with cardiovascular diseases (CV, n = 57 of II and III type, according to the American Society of Anesthesiologists (ASA qualification, and healthy persons (H, n = 55. Both groups were randomly divided into two subgroups: CVa and Ha - where the anesthetic solution had the vasoconstrictor (3% lidocaine, and 1 : 100 000 adrenaline; CVb and Hb - where the anesthetic solution was without the vasoconstrictor (3% lidocaine. During the preparation for tooth extraction, the application of anesthetics, extraction and relaxation puls (fc, systolic (TAs and diastolic arterial blood pressure (TAd and ECG were registered. Results. The values of fc did not significantly differ among the groups in any measured term. The values of systolic and diastolic blood pressure in the groups CVa and CVb were significantly higher in all the terms of measuring (p < 0.05 from the values in the groups Ha and Hb. A significant increase of TAs was registered only in the phase of tooth extraction in the CVa and CVb group (< 0.05. The values of TAd did not significantly differ between the groups in all the measured terms. Extrasystolic beats were registered in 11 patients of the CV group and in 7 patients of the H group in the phase of anesthetic application or tooth extraction. Conclusion. This research shoved that tooth

  10. Optimal resource states for local state discrimination

    Science.gov (United States)

    Bandyopadhyay, Somshubhro; Halder, Saronath; Nathanson, Michael

    2018-02-01

    We study the problem of locally distinguishing pure quantum states using shared entanglement as a resource. For a given set of locally indistinguishable states, we define a resource state to be useful if it can enhance local distinguishability and optimal if it can distinguish the states as well as global measurements and is also minimal with respect to a partial ordering defined by entanglement and dimension. We present examples of useful resources and show that an entangled state need not be useful for distinguishing a given set of states. We obtain optimal resources with explicit local protocols to distinguish multipartite Greenberger-Horne-Zeilinger and graph states and also show that a maximally entangled state is an optimal resource under one-way local operations and classical communication to distinguish any bipartite orthonormal basis which contains at least one entangled state of full Schmidt rank.

  11. Optimizing preoperative blood ordering with data acquired from an anesthesia information management system.

    Science.gov (United States)

    Frank, Steven M; Rothschild, James A; Masear, Courtney G; Rivers, Richard J; Merritt, William T; Savage, Will J; Ness, Paul M

    2013-06-01

    The maximum surgical blood order schedule (MSBOS) is used to determine preoperative blood orders for specific surgical procedures. Because the list was developed in the late 1970s, many new surgical procedures have been introduced and others improved upon, making the original MSBOS obsolete. The authors describe methods to create an updated, institution-specific MSBOS to guide preoperative blood ordering. Blood utilization data for 53,526 patients undergoing 1,632 different surgical procedures were gathered from an anesthesia information management system. A novel algorithm based on previously defined criteria was used to create an MSBOS for each surgical specialty. The economic implications were calculated based on the number of blood orders placed, but not indicated, according to the MSBOS. Among 27,825 surgical cases that did not require preoperative blood orders as determined by the MSBOS, 9,099 (32.7%) had a type and screen, and 2,643 (9.5%) had a crossmatch ordered. Of 4,644 cases determined to require only a type and screen, 1,509 (32.5%) had a type and crossmatch ordered. By using the MSBOS to eliminate unnecessary blood orders, the authors calculated a potential reduction in hospital charges and actual costs of $211,448 and $43,135 per year, respectively, or $8.89 and $1.81 per surgical patient, respectively. An institution-specific MSBOS can be created, using blood utilization data extracted from an anesthesia information management system along with our proposed algorithm. Using these methods to optimize the process of preoperative blood ordering can potentially improve operating room efficiency, increase patient safety, and decrease costs.

  12. Efficient Iris Localization via Optimization Model

    Directory of Open Access Journals (Sweden)

    Qi Wang

    2017-01-01

    Full Text Available Iris localization is one of the most important processes in iris recognition. Because of different kinds of noises in iris image, the localization result may be wrong. Besides this, localization process is time-consuming. To solve these problems, this paper develops an efficient iris localization algorithm via optimization model. Firstly, the localization problem is modeled by an optimization model. Then SIFT feature is selected to represent the characteristic information of iris outer boundary and eyelid for localization. And SDM (Supervised Descent Method algorithm is employed to solve the final points of outer boundary and eyelids. Finally, IRLS (Iterative Reweighted Least-Square is used to obtain the parameters of outer boundary and upper and lower eyelids. Experimental result indicates that the proposed algorithm is efficient and effective.

  13. Infraorbital Foramen and Pterygopalatine Fossa Location in Dry Skulls: Anatomical Guidelines for Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Omar Masabni

    2017-01-01

    Full Text Available Purpose. The aim of the study was to locate the infraorbital foramen (IOF in relation to the infraorbital margin (IOM for proper injections of local anesthetics in skull specimens. Another aim was to determine the depth of needle penetration into pterygopalatine fossa through the greater palatine canal (GPC. Materials and Methods. 102 skull halves were used to measure the distances between (1 IOF and IOM and (2 IOF and alveolar ridge of maxilla at second premolar. Needles were inserted and bent at a 45° angle, passing through the GPC at the level of hard palate. The depth of the tip of needle emerging out of GPC into pterygopalatine fossa was measured. Results. The mean distance between IOF and IOM was 6.46±1.57 mm on the right side and 6.74±1.72 mm on the left. The mean distance between IOF and alveolar bone process of the maxilla at second premolar was 29.07±3.58 mm on the right side and 29.39±3.78 mm on the left. The mean depth of penetration of the needle into the pterygopalatine fossa was similar on both sides. Conclusions. Proper identification of IOF and pterygopalatine fossa is of great significance during local anesthesia injections, due to their close proximity to vital anatomic structures.

  14. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia

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    Krishna P. Shetty

    2016-03-01

    Full Text Available Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS. After checking the vital signs the initial pulpal oxygen saturation (initial SpO2 was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2 was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2 was measured. Results. The mean initial (SpO2 was 96.37% which significantly decreased to 90.76% (SpO2 after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2 after administration of local anesthetic solution. Statistical significance was set at P<0.0001. Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury.

  15. [Pharmacology of local anesthetics and clinical aspects of segmental blocking. II. Spinal anesthesia].

    Science.gov (United States)

    Kozlov, S P; Svetlov, V A; Luk'ianov, M V

    1998-01-01

    Clinical picture of development of segmental blocking after subarachnoidal injection of hyperbaric solutions of 0.75% bupivacaine, 5% ultracaine, and isobaric 0.5% bupivacaine is studied. A total of 152 patients operated on the lower part of the body and the lower limbs were examined under conditions of single, prolonged subarachnoidal, and combined spinal epidural anesthesia. Ultracaine and bupivacaine in different concentrations with different barism provided anesthesia equivalent by the efficacy, depth, and dissemination of sensory block. Segmental blocking with 5% ultracaine was characterized by the shortest latent period (3.14 +/- 0.16 min, p anesthesia in comparison with a single injection, and combined spinal epidural anesthesia shortened the latent period of segmental blocking and ensured intraoperative anesthesia and postoperative analgesia at the expense of the epidural component.

  16. Sigmund Freud (1856-1939) and Karl Köller (1857-1944) and the discovery of local anesthesia.

    Science.gov (United States)

    dos Reis, Almiro

    2009-01-01

    The understanding, occasionally recognized, that Sigmund Freud had the intuition to use cocaine as local anesthetic for surgical procedures, or even that he played any role in the discovery of local anesthesia is not true. The objective of Freud's studies were different, and based in irrefutable evidence, Karl Köller was the real inventor of local anesthesia. In face of those facts, proper knowledge of this historically important subject is due. This report refers to the long-known properties of cocaine. It also remembers personal data, and the professional and scientific activities of Sigmund Freud and Karl Köller. It presents Freud's researches on the pathophysiological effects of cocaine. It exposes the reasons for the harsh criticism of Freud's concepts. It describes the sudden, but conscious and justified, idea of Karl Köller to study scientifically the use of cocaine as a local anesthetic in animals and humans. It indicates how those pioneering studies, that culminated with the discovery of local anesthesia by Köller and two presentations in Vienna on the subject, were done. It also reports the first ophthalmologic surgery under local anesthesia. It shows the immediate dissemination throughout the world of the discovery that marked the beginning of regional blocks. It comments several documents corroborating the role of Köller in this discovery. And, finally, it mentions the numerous homages received by Köller in different areas of the world. COCLUSIONS: Regional block was introduced by Karl Köller in 1884, when he demonstrated the feasibility of performing painless ophthalmologic surgeries by using cocaine as a local anesthetic. Sigmund Freud studied cocaine extensively, but he did not have direct participation in this important discovery.

  17. Comparison of Two Local Anesthesia Injection Methods During a Transrectal Ultrasonography-guided Prostate Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Song Ee; Oh, Young Taik [Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Jang Hwan; Rha, Koon Ho; Hong, Sung Joon; Yang, Seung Choul [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-09-15

    To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. The mean VAS score showed no significant differences between the groups (group 1, 3.4{+-}1.78: group 2, 2.8{+-}1.3: p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia: one of tinnitus and the other of mild dizziness. There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk

  18. Comparison of Two Local Anesthesia Injection Methods During a Transrectal Ultrasonography-guided Prostate Biopsy

    International Nuclear Information System (INIS)

    Baek, Song Ee; Oh, Young Taik; Kim, Jang Hwan; Rha, Koon Ho; Hong, Sung Joon; Yang, Seung Choul

    2010-01-01

    To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. The mean VAS score showed no significant differences between the groups (group 1, 3.4±1.78: group 2, 2.8±1.3: p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia: one of tinnitus and the other of mild dizziness. There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk

  19. Comparison of Two Local Anesthesia Injection Methods During a Transrectal Ultrasonography-guided Prostate Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Song Ee; Oh, Young Taik [Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Jang Hwan; Rha, Koon Ho; Hong, Sung Joon; Yang, Seung Choul [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-09-15

    To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. The mean VAS score showed no significant differences between the groups (group 1, 3.4{+-}1.78: group 2, 2.8{+-}1.3: p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia: one of tinnitus and the other of mild dizziness. There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk

  20. Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas Mapeamento cortical da fala com o paciente acordado: optimização para ressecção de lesões intracranianas localizadas próximas a área da fala

    Directory of Open Access Journals (Sweden)

    Robson Luis Oliveira de Amorim

    2008-09-01

    Full Text Available OBJECTIVE: The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex. METHODS: A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years. RESULTS: Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66% of patients while remaining cases had greater than 80% resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia. CONCLUSION: Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.OBJETIVO: O presente estudo visa discutir as vantagens e as limitacões do uso da técnica de mapeamento cortical da área da fala com o paciente acordado. MÉTODO: esta é uma revisão retrospectiva dos casos em que foi realizado monitoramento cortical intraoperatório em cirurgias para ressecção de lesões intracranianas localizadas próximas à área da fala. Todos os pacientes foram submetidos a avaliação neuropsicológica no pré e intra-operatório. O grau das ressecções foi verificado através de exames de imagem pós-operatórios. Foram avaliados um total de 12 pacientes. Destes, 6 eram do sexo masculino e 6 do feminino. RESULTADOS: 7 lesões eram tumorais. A ressecção total foi atingida em 66% e ressec

  1. The influence of location of local anesthesia and complexity/duration of restorative treatment on children's behavior during dental treatment.

    Science.gov (United States)

    Davidovich, Esti; Wated, Alham; Shapira, Joseph; Ram, Diana

    2013-01-01

    The purpose of this study was to investigate whether the region of local anesthetic injection and the complexity and duration of restorative treatment were associated with children's behavior during and immediately after dental treatment. This study examined 90 children, divided into two age groups (2-3.5 years old and >3.5-5.5 years old), who underwent dental treatment while lightly sedated. The region of local anesthesia (maxillary infiltration or mandibular block), complexity and duration of treatment, and behavior during and after treatment were assessed. Children's behavior during and after dental treatment, within and between age groups, was not found to be associated with the region of local anesthesia or complexity of treatment. For both age groups, more children exhibited negative behaviors during treatment when procedures exceeded 30 minutes. For younger children, more negative behaviors were also observed after longer vs shorter procedures. Treatment duration, not the region of local anesthesia or complexity of treatment, was associated with children's behavior during and after dental procedures.

  2. Optimizing radiation exposure for CT localizer radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Bohrer, Evelyn; Maeder, Ulf; Fiebich, Martin [Univ. of Applied Sciences, Giessen (Germany). Inst. of Medical Physics and Radiation Protection-IMPS; Schaefer, Stefan; Krombach, Gabriele A. [Univ. Hospital Giessen (Germany). Dept. of Radiology; Noel, Peter B. [Technische Univ. Muenchen (Germany). Dept. of Diagnostic and Interventional Radiology

    2017-08-01

    The trend towards submillisievert CT scans leads to a higher dose fraction of localizer radiographs in CT examinations. The already existing technical capabilities make dose optimization of localizer radiographs worthwhile. Modern CT scanners apply automatic exposure control (AEC) based on attenuation data in such a localizer. Therefore not only this aspect but also the detectability of anatomical landmarks in the localizer for the desired CT scan range adjustment needs to be considered. The effective dose of a head, chest, and abdomen-pelvis localizer radiograph with standard factory settings and user-optimized settings was determined using Monte Carlo simulations. CT examinations of an anthropomorphic phantom were performed using multiple sets of acquisition parameters for the localizer radiograph and the AEC for the subsequent helical CT scan. Anatomical landmarks were defined to assess the image quality of the localizer. CTDI{sub vol} and effective mAs per slice of the helical CT scan were recorded to examine the impact of localizer settings on a helical CT scan. The dose of the localizer radiograph could be decreased by more than 90% while the image quality remained sufficient when selecting the lowest available settings (80 kVp, 20 mA, pa tube position). The tube position during localizer acquisition had a greater impact on the AEC than the reduction of tube voltage and tube current. Except for the use of a pa tube position, all changes of acquisition parameters for the localizer resulted in a decreased total radiation exposure. A dose reduction of CT localizer radiograph is necessary and possible. In the examined CT system there was no negative impact on the modulated helical CT scan when the lowest tube voltage and tube current were used for the localizer.

  3. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

    International Nuclear Information System (INIS)

    Medhi, Jayanta; Handique, Akash; Goyal, Amit; Lynser, Donbok; Phukan, Pranjal; Sarma, Kalyan; Padmanabhan, Aswin; Saikia, Manuj Kumar; Chutia, Happy

    2016-01-01

    To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. We achieved technical success in all the three patients with immediate relief of dyspnea. Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort

  4. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

    Directory of Open Access Journals (Sweden)

    Jayanta Medhi

    2016-01-01

    Full Text Available Purpose: To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. Materials and Methods: We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril and fluoroscopic guidance. Results: We achieved technical success in all the three patients with immediate relief of dyspnea. Conclusion: Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.

  5. Does audiovisual distraction reduce dental anxiety in children under local anesthesia? A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Cai; Qin, Dan; Shen, Lu; Ji, Ping; Wang, Jinhua

    2018-03-02

    To perform a systematic review and meta-analysis on the effects of audiovisual distraction on reducing dental anxiety in children during dental treatment under local anesthesia. The authors identified eligible reports published through August 2017 by searching PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Clinical trials that reported the effects of audiovisual distraction on children's physiological measures, self-reports and behavior rating scales during dental treatment met the minimum inclusion requirements. The authors extracted data and performed a meta-analysis of appropriate articles. Nine eligible trials were included and qualitatively analyzed; some of these trials were also quantitatively analyzed. Among the physiological measures, heart rate or pulse rate was significantly lower (p=0.01) in children subjected to audiovisual distraction during dental treatment under local anesthesia than in those who were not; a significant difference in oxygen saturation was not observed. The majority of the studies using self-reports and behavior rating scales suggested that audiovisual distraction was beneficial in reducing anxiety perception and improving children's cooperation during dental treatment. The audiovisual distraction approach effectively reduces dental anxiety among children. Therefore, we suggest the use of audiovisual distraction when children need dental treatment under local anesthesia. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. Local-regional anesthesia in the management of stingray stings: Experience of the Bouffard medical-surgical hospital in Djibouti.

    Science.gov (United States)

    Vanoye, C; Lacroix, G; Le Gonidec, E; Couret, A; Benois, A; Peigne, V

    2017-02-01

    Stingray injuries are very painful. Systemic analgesics are ineffective, and the use of local-regional anesthesia has been reported. This retrospective descriptive study reviewed all cases of stingray injuries seen at the emergency department of the Bouffard Hospital (Djbouti, Africa) between 2011 and 2014. The study included 35 patients. Most of the injuries (n= 31, 89%) concerned the lower limbs. Median pain intensity was 6 [5-8] on a visual analog scale of 0 (no pain) to 10. The following systemic medications were administered: acetaminophen to 13 (27%) patients, morphine to 8 (23%), and tramadol to 6 (17%). In all, 25 (71%) patients received local-regional anesthesia, 15 (60%) by injections at the ankle. All procedures were successful, and no adverse event was reported. This study reports clinical data about stingray injuries in the Red Sea area and highlights the interest of local-regional anesthesia in their management. Most of the procedures were distal and could be performed by trained emergency physicians.

  7. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

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    Almog Levi

    Full Text Available Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI. Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI cure rate in patients with mixed urinary incontinence (MUI, intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10 and from the local anesthesia. Visual analog scale (VAS rating was low during and after the procedure (2.38 and 2.69 respectively. Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

  8. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy.

    Science.gov (United States)

    Sairyo, Koichi; Chikawa, Takashi; Nagamachi, Akihiro

    2018-03-01

    Transforaminal (TF) percutaneous endoscopic surgery for the lumbar spine under the local anesthesia was initiated in 2003 in Japan. Since it requires only an 8-mm skin incision and damage of the paravertebral muscles would be minimum, it would be the least invasive spinal surgery at present. At the beginning, the technique was used for discectomy; thus, the procedure was called PELD (percutaneous endoscopic lumbar discectomy). TF approach can be done under the local anesthesia, there are great benefits. During the surgery patients would be in awake and aware condition; thus, severe nerve root damage can be avoided. Furthermore, the procedure is possible for the elderly patients with poor general condition, which does not allow the general anesthesia. Historically, the technique was first applied for the herniated nucleus pulposus. Then, foraminoplasty, which is the enlargement surgery of the narrow foramen, became possible thanks to the development of the high speed drill. It was called the percutaneous endoscopic lumbar foraminoplasty (PELF). More recently, this technique was applied to decompress the lateral recess stenosis, and the technique was named percutaneous endoscopic ventral facetectomy (PEVF). In this review article, we explain in detail the development of the surgical technique of with time with showing our typical cases. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  9. A randomized controlled clinical trial to evaluate blood pressure changes in patients undergoing extraction under local anesthesia with vasopressor use.

    Science.gov (United States)

    Uzeda, Marcelo José; Moura, Brenda; Louro, Rafael Seabra; da Silva, Licínio Esmeraldo; Calasans-Maia, Mônica Diuana

    2014-05-01

    The control of hypertensive patients' blood pressure and heart rate using vasoconstrictors during surgical procedures under anesthesia is still a major concern in everyday surgical practice. This clinical trial aimed to evaluate the variation of blood pressure and heart rate in nonhypertensive and controlled hypertensive voluntary subjects undergoing oral surgery under local anesthesia with lidocaine hydrochloride and epinephrine at 1:100,000 (Alphacaine; DFL, Brazil), performed in the Oral Surgery Department, Dentistry School, Fluminense Federal University. In total, 25 voluntary subjects were divided into 2 groups: nonhypertensive (n = 15) and controlled hypertensives (n = 10). Blood pressure and heart rate were measured at 4 different times: T0, in the waiting room; T1, after placement of the surgical drapes; T2, 10 minutes after anesthesia injection; and T3, at the end of the surgical procedure. A statistically significant difference (P 0.05) between the amount administered to nonhypertensive and hypertensive subjects. It was concluded that the local anesthetics studied could safely be used in controlled hypertensive and nonhypertensive patients in compliance with the maximum recommended doses.

  10. [Clinical and physiological rationale for use of clonidine with articaine and adrenaline for local anesthesia in pediatric dentistry].

    Science.gov (United States)

    Mel'nikova, A V; Shugaĭlov, I A

    2014-01-01

    The study evaluated the effect of local anesthesia with articaine in different combinations with epinephrine and clonidine (articaine (4%) + epinephrine (1:200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1:400 000) + clonidine (1:100 000)), on a number of physiological parameters in pediatric dental practice that characterize cardiovascular system, patient's degree of adaptation to a stressful situation and efficacy of analgesia. It is shown that in terms of impact on the cardiovascular system and stress adaptation indicators anesthesia including combination of epinephrine (1: 200 000) and clonidine (1: 100 000) in the anesthetic solution is the safest. Furthermore, this method ensures the most appropriate analgesic effect.

  11. Children's behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia: A randomized controlled trial.

    Science.gov (United States)

    Bagherian, Ali; Sheikhfathollahi, Mahmood

    2016-01-01

    Topical anesthesia has been widely advocated as an important component of atraumatic administration of intraoral local anesthesia. The aim of this study was to use direct observation of children's behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia. Forty-eight children participated in this randomized controlled clinical trial. They received two separate inferior alveolar nerve block or primary maxillary molar infiltration injections on contralateral sides of the jaws by both cotton-roll vibration (a combination of topical anesthesia gel, cotton roll, and vibration for physical distraction) and control (routine topical anesthesia) methods. Behavioral pain reactions of children were measured according to the author-developed face, head, foot, hand, trunk, and cry (FHFHTC) scale, resulting in total scores between 0 and 18. The total scores on the FHFHTC scale ranged between 0-5 and 0-10 in the cotton-roll vibration and control methods, respectively. The mean ± standard deviation values of total scores on FHFHTC scale were lower in the cotton-roll vibration method (1.21 ± 1.38) than in control method (2.44 ± 2.18), and this was statistically significant (P anesthesia in reducing behavioral pain reactions in children during local anesthesia administration.

  12. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration.

    Science.gov (United States)

    Gavrilovska-Brzanov, Aleksandra; Kuzmanovska, Biljana; Kartalov, Andrijan; Donev, Ljupco; Lleshi, Albert; Jovanovski-Srceva, Marija; Spirovska, Tatjana; Brzanov, Nikola; Simeonov, Risto

    2016-03-15

    The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration. In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well. The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren't any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention. Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

  13. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

    Science.gov (United States)

    Neal, Joseph M; Barrington, Michael J; Fettiplace, Michael R; Gitman, Marina; Memtsoudis, Stavros G; Mörwald, Eva E; Rubin, Daniel S; Weinberg, Guy

    2018-02-01

    The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

  14. An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review.

    Science.gov (United States)

    Singh, Preetinder

    2012-03-01

    Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.

  15. An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review

    Directory of Open Access Journals (Sweden)

    Preetinder Singh

    2012-01-01

    Full Text Available Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.

  16. Proximal Tibial Bone Harvesting Under Local Anesthesia Without Intravenous Sedation in the Dental Office: A Case Report

    Directory of Open Access Journals (Sweden)

    Chun-Ming Chen

    2008-02-01

    Full Text Available Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

  17. Anestesia local e sedação para cirurgia de implante coclear: uma alternativa possível Local anesthesia for cochlear implant surgery: a possible alternative

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    Rogério Hamerschmidt

    2010-10-01

    Full Text Available Aanestesia geral sempre foi motivo de dúvida dos pacientes que vão ser submetidos a qualquer cirurgia, especialmente o implante coclear. Como já realizamos as cirurgias otológicas com anestesia local e sedação, julgamos perfeitamente possível a realização da cirurgia do implante coclear também com esse tipo de anestesia, diminuindo os riscos, a morbidade e os custos para o hospital. OBJETIVOS: Estudo prospectivo para demonstrar a técnica anestésica e cirúrgica utilizada em três casos de adultos submetidos ao implante coclear, avaliando a segurança e a eficácia de tal técnica. MATERIAL E MÉTODOS: Foram feitas três cirurgias de implante coclear, duas com implante Cochlear e uma com Med-EL, sem intercorrências transoperatórias, durante a telemetria e no pós-operatório imediato. RESULTADOS: Os três pacientes adultos tiveram alta hospitalar aproximadamente três horas após a cirurgia, deambulando, sem eventos nauseosos, relatando um pós-operatório mais fácil do que esperavam, mesmo no momento da telemetria intraoperatória. CONCLUSÃO: Anestesia local e sedação é uma alternativa para casos selecionados de pacientes para o implante coclear, principalmente naqueles de mais idade ou que apresentem contraindicação para a anestesia geral, os riscos e a morbidade são menores.The aim of this paper is to illustrate the possibility of performing a cochlear implant surgery with local anesthesia and sedation, the anesthetic technique and the advantages of that in comparison to a general anesthesia. AIMS: prospective study demonstrating the possibility of doing cochlear implant surgery under local anesthesia and sedation. MATERIALS AND METHODS: we describe three successful cases operated under local anesthesia, including neural telemetry and the conditions the patient presented after the surgery, with a very good recovery and no complications during and after the procedure. RESULTS: these three surgeries show the possibility of

  18. Effect of hydralazine on duration of soft tissue local anesthesia following dental treatment: a randomized clinical trial.

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    Fakheran Esfahani, Omid; Pouraboutaleb, Mohammad Fazel; Khorami, Behnam

    2015-01-01

    Prolonged numbness following routine dental treatments can cause difficulties in speaking and swallowing and may result in inadvertent biting of soft tissues. Local injection of vasodilator agents may represent a solution to this problem. The aim of this study was to evaluate the effect of submucosal injection of hydralazine hydrochloride (HCl) on the duration of oral soft tissue anesthesia after routine dental treatment. This randomized, single-blinded, controlled clinical trial included 50 patients who received inferior alveolar nerve block (2% lidocaine with 1:100,000 epinephrine) for simple restorative treatment. Upon completion of the dental treatment, patients randomly received a hydralazine HCl or sham injection in the same site as the local anesthetic injection. The reversal time to normal sensation of soft tissues (lips, tongue, and perioral skin) was evaluated and reported every 5 minutes by the patients, who followed an assessment protocol that they were taught in advance of treatment. Median recovery times in the hydralazine group and the sham group were 81.4 (SD, 3.6) and 221.8 (SD, 6.3) minutes, respectively. Based on Kaplan-Meier survival analysis, the duration of soft tissue anesthesia in the 2 groups was significantly different (P local anesthetic-induced soft tissue numbness and the related functional problems.

  19. Comparative clinical evaluation of transcutaneous electrical nerve stimulator over conventional local anesthesia in children seeking dental procedures: A clinical study

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    M Varadharaja

    2014-01-01

    Full Text Available Aim: The aim of this study to evaluate the effectiveness of pain control by employing transcutaneous electrical nerve stimulator (TENS over conventional injectable local anesthesia for children requiring restorative procedures under rubber dam. Materials and Methods: The study design considered was the split mouth design, in experiment (right side, dental procedures under rubber dam was performed under TENS and in control (left side, dental procedures under rubber dam was performed under conventional injectable local anesthetic (LA. The level of comfort and discomfort experienced during TENS and conventional LA was determined using visual analog scale (VAS and heart rate. Result: Increase in mean heart rate associated with TENS (0.78% was significantly less compared to increase in heart rate with administration of conventional local anesthesia (11.78%. In VAS, the mean values for pain indicate that minimum pain was felt with TENS, which was closely followed by LA. Conclusion: TENS can offer many safer and psychological advantages and is a valuable alternative to conventional LA for children.

  20. Effects of local low-dose rocuronium on the quality of peribulbar anesthesia for cataract surgery

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    Ayman A Abdellatif

    2011-01-01

    Full Text Available Objectives: Peribulbar anesthesia is associated with delayed and/or incomplete orbital akinesia compared with retrobulbar anesthesia. This study examined the effects of adding rocuronium 5 mg to two different concentrations of lidocaine-bupivacaine mixture on onset time of orbital and eyelid akinesia in patients undergoing cataract surgery. Methods: In a double-blind study, 90 patients were equally randomized to receive a mixture of 0.5 ml normal saline, 4 ml lidocaine 2%, and 4 ml bupivacaine 0.5% (group I, a mixture of rocuronium 0.5 ml (5 mg, 4 ml lidocaine 2%, and 4 ml bupivacaine 0.5% (group II, or a mixture of rocuronium 0.5 ml (5 mg, 4 ml lidocaine 1%, and 4 ml bupivacaine 0.25% (group III. Orbital akinesia was assessed on a 0-8 score (0 = no movement, 8 = normal at 2 min intervals for 10 min. Time to adequate anesthesia was also recorded. Results are presented as mean±SD. Results: Ocular movement score decreased during the assessment period in all groups. However, at 2 min after block administration, the score decreased to 4±2 (95% CI 3,5 in groups II and III compared with 5±2 (95% CI 4,6 in group I (P<0.01. Time to adequate condition to begin surgery was 9.8±2.9 vs. 6.9±4.1 vs. 7.9±3.9 min for groups I, II, and III, respectively (P=0.01. Conclusion: The addition of rocuronium 5 mg to a mixture of lidocaine 2% and bupivacaine 0.5% shortened the onset time of peribulbar anesthesia in patients undergoing cataract surgery without causing adverse effects.

  1. Localization of 14C-labeled 2% lidocaine hydrochloride after intraosseous anesthesia in the rabbit.

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    Goto, Takashi; Mamiya, Hideki; Ichinohe, Tatsuya; Kaneko, Yuzuru

    2011-10-01

    The purpose of this study was to investigate the tissue distribution of lidocaine hydrochloride in mandibular bone marrow after intraosseous anesthesia (IOA) in rabbits. We used macroautoradiography to examine the tissue distribution of a (14)C-labeled 2% lidocaine hydrochloride solution containing 1:80,000 epinephrine ((14)C-lidocaine). Under general anesthesia, (14)C-lidocaine was injected intraosseously or paraperiosteally. After IOA, animals were divided into three groups and observed at 1 (IOA-1), 5 (IOA-5), and 10 minutes (IOA-10) after injection. After infiltration anesthesia (IA), animals were observed at 1 minute after injection. The accumulation of (14)C-lidocaine was observed around the injection site in both the IA and the IOA groups. Paraperiosteally injected (14)C-lidocaine diffused to the surrounding tissues such as the lip, whereas IOA showed concentrated accumulation around the root apex throughout the experiment. The distribution area was significantly smaller in the IOA-1 group than in the IA group. The distribution area in the IOA-5 group was larger than those in the IOA-1 and IOA-10 groups. The accumulation of (14)C-lidocaine injected by IOA in rabbits was concentrated around the root apex. These results may explain the rapid onset time of IOA. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. Heart rate, salivary α-amylase activity, and cooperative behavior in previously naïve children receiving dental local anesthesia.

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    Arhakis, Aristidis; Menexes, George; Coolidge, Trilby; Kalfas, Sotirios

    2012-01-01

    Psychosomatic indicators, such as heart rate (HR), salivary alpha amylase (sAA) activity, and behavior, can be used to determine stress. This study's aim was to assess the pattern of changes of salivary alpha amylase, heart rate, and cooperative behavior in previously naïve children receiving dental treatment under local anesthesia. Included were 30 children with no prior dental experience who needed 4 or more sessions of dental treatment involving local anesthesia. In each session, sAA, HR, and behavior were assessed before and during the application of local anesthesia and at the end of the treatment. The highest sAA value was always observed at the end of each session; overall, the value was lower in the fourth session. HR always increased during the local anesthesia, and did not vary across sessions. No significant relationship was found between child cooperation and either sAA or HR. In this sample, child cooperation may not be an accurate indicator of stress. Based on salivary alpha amylase activity changes, dental treatment involving local anesthesia in naïve children appeared to be less stressful after 3 sessions.

  3. The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines.

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    Vongsavan, Kadkao; Samdrup, Tshering; Kijsamanmith, Kanittha; Rirattanapong, Praphasri; Vongsavan, Noppakun

    2018-05-10

    The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects. Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT). IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved. IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur. IO anesthesia is safe to use as a primary technique in teeth with normal pulp.

  4. Efficacy in the use of local anesthesia in patients with surgical intervention for the resolution of anorectal pathologies

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    Victoria Dowling

    2018-01-01

    Full Text Available A prospective, comparative, longitudinal study was conducted in the period from April 2016 to January 2017 in order to determine the efficacy of local anesthesia for the surgical resolution of anorectal pathologies in surgically operated patients who attended the General University Hospital “Luis Gomez Lopez. Thus, the population was composed of patients with anorectal pathologies of low complexity, with no previous anorectal surgical history (Hemorrhoids, anal fissure, perianal fistula, hypertrophic anal papilla, perianal condyloma acuminata, which were agreed to be included in this study, without contraindications for use of local anesthesia. A non-probabilistic, intentional sample was made up of 30 patients and the anesthetic protocol was administered following an anesthetic protocol of perianal local anesthesia using anesthetic mixture (70% of 2% lidocaine + 30% of 0.5% bupivacaine quantifying pain tolerance during the intraoperative period on the first and fifth postoperative days, as well as any adverse effects. The results were expressed in absolute numbers and percentages; a good tolerance to pain was observed with some differences related to the sex of the individuals studied; no complications were observed. Resumo: Esse estudo prospectivo, comparativo e longitudinal foi realizado no período de abril de 2016 a janeiro de 2017, com o objetivo de determinar a eficácia da anestesia local para resolução cirúrgica de patologias anorretais em pacientes cirurgicamente operados que compareceram no Hospital Geral Universitário Luis Gomez Lopes. Essa população se compunha de pacientes com patologias anorretais de baixa complexidade, sem história prévia de cirurgia anorretal (hemorroidas, fissura anal, fístula perianal, papila anal hipertrófica, condiloma acuminado perianal, com prévia concordância em participar no presente estudo e sem contraindicações para o uso de anestesia local. Foi obtida uma amostra intencional e n

  5. 1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia.

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    Chia, Christopher T; Theodorou, Spero J

    2012-08-01

    Advances in suction-assisted lipectomy (SAL) include improved instrumentation, better understanding of fluid dynamics, and an improved concept of appropriate indications. The tumescent technique uses subcutaneous injection of isotonic fluid containing vasoconstrictive and analgesic agents and is proved to be safe, with low morbidity and mortality rates. Laser-assisted liposuction (LAL) using local infiltration of an anesthetic and no general anesthesia or sedation has been developed, with claims of fat destruction and skin tightening. This study aimed to review 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia and to determine whether this represents a safe technique with few complications. During a period of 22 months, 581 consecutive patients (486 females and 95 males) underwent 1,000 LAL/SAL operations, 545 of whom had multiple procedures performed. None of the patients had a body mass index (BMI) higher than 30 kg/m2. The patients ranged in age from 18 to 62 years. The fat aspirate ranged from 50 to 1,400 ml. Patients were given an oral sedative, an antibiotic, and an analgesic. Ringer's lactate solution containing lidocaine and epinephrine was injected into the subcutaneous space. The 1,064-nm and/or 1,320-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used for laser lipolysis followed by SAL using standard and/or power-assisted liposuction (PAL) cannulas. The treated areas included the neck, triceps, male breast, midback, flanks, axilla, abdomen, mons pubis, thighs, presacrum, and knees. No patient was administered intravenous sedation or general anesthesia. The average number of areas treated was 1.8, and no major complications or mortalities were observed. There were three burns, two infections, one hematoma, and one seroma. A total of 73 secondary procedures were performed (7.3%). No tertiary procedures were required. For appropriately selected patients, comparable results can be obtained with an excellent

  6. Real-time ultrasound image classification for spine anesthesia using local directional Hadamard features.

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    Pesteie, Mehran; Abolmaesumi, Purang; Ashab, Hussam Al-Deen; Lessoway, Victoria A; Massey, Simon; Gunka, Vit; Rohling, Robert N

    2015-06-01

    Injection therapy is a commonly used solution for back pain management. This procedure typically involves percutaneous insertion of a needle between or around the vertebrae, to deliver anesthetics near nerve bundles. Most frequently, spinal injections are performed either blindly using palpation or under the guidance of fluoroscopy or computed tomography. Recently, due to the drawbacks of the ionizing radiation of such imaging modalities, there has been a growing interest in using ultrasound imaging as an alternative. However, the complex spinal anatomy with different wave-like structures, affected by speckle noise, makes the accurate identification of the appropriate injection plane difficult. The aim of this study was to propose an automated system that can identify the optimal plane for epidural steroid injections and facet joint injections. A multi-scale and multi-directional feature extraction system to provide automated identification of the appropriate plane is proposed. Local Hadamard coefficients are obtained using the sequency-ordered Hadamard transform at multiple scales. Directional features are extracted from local coefficients which correspond to different regions in the ultrasound images. An artificial neural network is trained based on the local directional Hadamard features for classification. The proposed method yields distinctive features for classification which successfully classified 1032 images out of 1090 for epidural steroid injection and 990 images out of 1052 for facet joint injection. In order to validate the proposed method, a leave-one-out cross-validation was performed. The average classification accuracy for leave-one-out validation was 94 % for epidural and 90 % for facet joint targets. Also, the feature extraction time for the proposed method was 20 ms for a native 2D ultrasound image. A real-time machine learning system based on the local directional Hadamard features extracted by the sequency-ordered Hadamard transform for

  7. Herniorrafia inguinal em crianças: valor da anestesia local associada Inguinal hernia repair in children: importance of local anesthesia association

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    José Guilherme Minossi

    2002-07-01

    Full Text Available OBJETIVO: Descrever uma técnica de anestesia local no tratamento de hérnias inguinais em crianças. MÉTODO: Foram operadas 48 crianças com hérnias inguinais sob anestesia local na Santa Casa de Misericórdia de Cerqueira César, SP, sendo 34 do sexo masculino e 14 do sexo feminino, com idades entre 3 meses e 12 anos. Apenas quatro crianças tinham hérnia bilateral. A anestesia local foi realizada com lidocaína a 1% na dose de 5 mg/kg de peso através do bloqueio dos nervos abdominogenitais próximos à espinha ilíaca ântero-superior, à altura do anel inguinal externo e na pele ao redor da incisão. A sedação foi feita com cetamina na dose de 1 a 2 mg/kg e diazepam 0,2 a 0,4 mg/kg de peso. RESULTADOS: Todas as cirurgias puderam ser realizadas com tranqüilidade com este método, com exceção de uma criança em que o bloqueio não foi efetivo e a anestesia complementada com inalação de halogenado, sob máscara. Como complicações pós-operatórias, ocorreram três hematomas, sendo um de parede e dois em bolsa escrotal, todos com boa evolução. CONCLUSÕES: O uso da anestesia local associada à sedação é procedimento simples e seguro para realizar herniorrafias inguinais em crianças.AIM: To describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children. PATIENTS/METHODS: Forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "Santa Casa de Misericórdia de Cerqueira César", State of São Paulo, Brazil. There were 34 male and 14 female patients, range from 3 months to 12 years old. Local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. Sedation was done with an association of ketamine (1 to 2 mg/kg and diazepam (0,2 to 0,4 mg/kg. RESULTS: In all patients except one the procedure was

  8. Local Optimization Strategies in Urban Vehicular Mobility.

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    Pierpaolo Mastroianni

    Full Text Available The comprehension of vehicular traffic in urban environments is crucial to achieve a good management of the complex processes arising from people collective motion. Even allowing for the great complexity of human beings, human behavior turns out to be subject to strong constraints--physical, environmental, social, economic--that induce the emergence of common patterns. The observation and understanding of those patterns is key to setup effective strategies to optimize the quality of life in cities while not frustrating the natural need for mobility. In this paper we focus on vehicular mobility with the aim to reveal the underlying patterns and uncover the human strategies determining them. To this end we analyze a large dataset of GPS vehicles tracks collected in the Rome (Italy district during a month. We demonstrate the existence of a local optimization of travel times that vehicle drivers perform while choosing their journey. This finding is mirrored by two additional important facts, i.e., the observation that the average vehicle velocity increases by increasing the travel length and the emergence of a universal scaling law for the distribution of travel times at fixed traveled length. A simple modeling scheme confirms this scenario opening the way to further predictions.

  9. The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature.

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    Kumar, Prashant; Thepra, Manju; Bhagol, Amrish; Priya, Kannu; Singh, Virendra

    2016-01-01

    Despite the availability of a wide variety of pharmacological agents in the field of anesthesia, there has always been a continuous search for newer local anesthetic agents with improved efficacy, potency, and better handling properties. Dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, is an emerging agent for provision of additive local anesthetic effect if used with conventional local anesthetics, which can be implicated in dentistry for performing many minor oral surgical procedures. The present paper reports a pilot study comparing clinical efficacy and potency of this newer emerging drug in combination with lignocaine. Ten patients undergoing orthodontic extraction for correction of malocclusion and other dentofacial deformities requiring orthodontic treatment were locally infiltrated with 2% lignocaine plus dexmedetomidine 1μ/ml and 2% lignocaine plus adrenaline in 1:200,000 dilution at two different appointments. The onset of action, duration of action, and pain threshold were assessed. Onset of action was found to be faster with longer duration of action with the newer drug dexmedetomidine and lignocaine combination when compared with combination of lignocaine and adrenaline. The study demonstrated that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine without significant systemic effects when locally injected into oral mucosa.

  10. Optimization of a Pain Model: Effects of Body Temperature and Anesthesia on Bladder Nociception in Mice

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    Sadler, Katelyn E.; Stratton, Jarred M.; DeBerry, Jennifer J.; Kolber, Benedict J.

    2013-01-01

    Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urological condition that is resistant to treatment and poorly understood. To determine novel molecular treatment targets and to elucidate the contribution of the nervous system to IC/BPS, many rodent bladder pain models have been developed. In this study we evaluated the effects of anesthesia induction and temperature variation in a mouse model of bladder pain known as urinary bladder distension (UBD). In this model compressed air is used to distend the bladder to distinct pressures while electrodes record the reflexive visceromotor response (VMR) from the overlying abdominal muscle. Two isoflurane induction models are commonly used before UBD: a short method lasting approximately 30 minutes and a long method lasting approximately 90 minutes. Animals were anesthetized with one of the methods then put through three sets of graded bladder distensions. Distensions performed following the short anesthesia protocol were significantly different from one another despite identical testing parameters; this same effect was not observed when the long anesthesia protocol was used. In order to determine the effect of temperature on VMRs, animals were put through three graded distension sets at 37.5 (normal mouse body temperature), 35.5, and 33.5°C. Distensions performed at 33.5 and 35.5°C were significantly lower than those performed at 37.5°C. Additionally, Western blot analysis revealed significantly smaller increases in spinal levels of phosphorylated extracellular-signal regulated kinase 2 (pERK2) following bladder distension in animals whose body temperature was maintained at 33.5°C as opposed to 37.5°C. These results highlight the significance of the dynamic effects of anesthesia on pain-like changes and the importance of close monitoring of temperature while performing UBD. For successful interpretation of VMRs and translation to human disease, body temperature should be maintained at 37.5

  11. Is local anesthesia the optimum strategy in retrograde transcatheter aortic valve implantation? A systematic review and meta-analysis.

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    O' Sullivan, Katie E; Bracken-Clarke, Darragh; Segurado, Ricardo; Barry, Mitchel; Sugrue, Declan; Flood, Georgina; Hurley, John

    2014-09-01

    Retrograde transcatheter aortic valve implantation (TAVI) can be performed under local anesthesia (LA) or general anesthesia (GA); however, a wide variation in practice exists. PubMed was searched between 2009 and 2013. Data were extracted from eligible studies. Random-effects meta-analysis was performed using DerSimonian Laird between-study variance. There was no statistically significant difference identified between groups based on age or EuroSCORE. There was no statistically significant difference seen in all-cause mortality, or complication rates between groups. Mean procedural duration was 36 minutes shorter in the LA group (p = 0.001). There was increased vasopressor use in the GA group (odds ratio 3.92; p = 0.017). Mean hospital stay was 3.41 days shorter in the LA group (p = 0.018). Results suggest that the use of LA for retrograde TAVI is feasible. There are several potential benefits associated, shorter procedural duration, and hospital stay with lower vasopressor requirements. Further studies and randomized trials are mandatory to confirm the presented findings and to identify those patients for whom LA would be appropriate. Georg Thieme Verlag KG Stuttgart · New York.

  12. [Prader-Willi syndrome case with proliferative diabetic retinopathy in both eyes treated by early vitrectomy under local anesthesia].

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    Hori, Hideyuki; Sato, Yukihiro; Nakashima, Motohiro; Nakajima, Motohiro

    2012-02-01

    Although patients with Prader-Willi syndrome have a high rate of diabetes, to date, there have been only 4 reported cases (6 eyes) undergoing vitrectomy for proliferative diabetic retinopathy. Herein, we report a case of Prader-Willi syndrome with proliferative diabetic retinopathy that was treated by early vitrectomy OU under local anesthesia. A 30-year-old man was diagnosed as having Prader-Willi syndrome at the age of 2 years and diabetes at age 17. He was referred to our hospital as diabetic retinopathy had been detected in his first ophthalmological examination at age 29. Visual acuity was 0.6 bilaterally. Proliferative retinopathy, with cataract and macular edema, was identified in both eyes. Panretinal photocoagulation was performed on both eyes. However, proliferative membranes developed bilaterally, and vitreous hemorrhage occurred OS. Visual acuity decreased to 0.3 OU. The patient was hospitalized at our internal medicine department for blood glucose control. Subsequently, with an anesthesiologist on standby, a hypnotic sedative was injected intramuscularly, achieving retro-bulbar anesthesia. Combined cataract and vitreous surgery was performed on the left eye. One week later, a similar operation was performed on the right eye. The patient was discharged four days later. In the two years since these operation, visual acuity has been maintained at 0.8 OU. Patients with Prader-Willi syndrome should be examined for early detection and treatment of diabetic retinopathy.

  13. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

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    Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

    2018-02-01

    Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

  14. Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts

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    Flamer D

    2011-11-01

    Full Text Available David Flamer, Philip WH PengDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaPurpose: To provide a review of local anesthetic (LA agents and adjuncts, opioids and muscle relaxants, and their intraoperative effects and postoperative outcomes in intravenous regional anesthesia (IVRA.Source: A search for prospective, double-blind, randomized controlled trials evaluating LA agents, opioids and muscle relaxants as adjuvants for IVRA, was conducted (MEDLINE®, Embase. Intraoperative benefits (onset/recovery of sensory and motor block, intraoperative analgesia, tourniquet pain, postoperative benefits (pain score, analgesic consumption, time to first analgesia, and side effects were recorded. A conclusion for overall benefit was made based on statistical significance and clinical relevance.Findings: Thirty-one studies were evaluated, with data collected on 1523 subjects. LA agents evaluated were lidocaine, ropivacaine, and prilocaine. Adjuncts evaluated were opioids (morphine, fentanyl, meperidine, sufentanil, tramadol and muscle relaxants (pancuronium, atracurium, mivacurium, cisatacurium. There was good evidence that ropivacaine provided effective IVRA and improved postoperative analgesia. Lidocaine and prilocaine were effective LA agents, however they lacked postoperative benefits. Morphine, fentanyl, and meperidine as sole adjuncts did not demonstrate clinically significant benefits or result in an increased risk of side effects. Sufentanil data was limited, but appeared to provide faster onset of sensory block. Tramadol provided faster onset of sensory block and tourniquet tolerance, however postoperative benefits were not consistent and the risk of minor side effects increased. Muscle relaxants improved the quality of motor block, but at the expense of delayed motor recovery. The combination of fentanyl and muscle relaxants can achieve an equivalent quality of IVRA with 50

  15. Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic.

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    Boynes, Sean G; Riley, Amah E; Milbee, Sarah; Bastin, Meghan R; Price, Maylyn E; Ladson, Andrea

    2013-08-01

    This study sought to identify and quantify complications with local anesthetic administration and reversal on consecutive patients seen for comprehensive dental care in a school-based, portable dental clinic, and includes data on the patients seen by the participating portable dental providers. In 923 dental visits where local anesthetic was administered, a standardized form was used to gain further information and identify any complications; this was accompanied by a questionnaire for the student's teacher, in order to quantify the student's distraction and disruption ratings following the dental visit. After statistical analysis of the 923 consecutive cases, the overall complication rate was 5.3%. All of the complications were considered to be mild or moderate, and there were no severe event reports. The complications encountered most frequently (n = 49) were associated with self-inflicted soft tissue injury. The results of this study indicate that comprehensive care with local anesthesia delivered by a school-based portable dental clinic has a low risk of complications. Whereas safe administration of dental care is achievable with or without phentolamine mesylate as a local anesthetic reversal agent, its use was determined to improve safety outcomes. Three factors appeared to directly increase the incidence of complications: the administration of an inferior alveolar nerve block, attention deficit disorder, and obesity. Teacher evaluations demonstrated that children receiving care by a portable dental team were able to reorient back to classwork and were not disruptive to classmates.

  16. Hybrid Firefly Variants Algorithm for Localization Optimization in WSN

    Directory of Open Access Journals (Sweden)

    P. SrideviPonmalar

    2017-01-01

    Full Text Available Localization is one of the key issues in wireless sensor networks. Several algorithms and techniques have been introduced for localization. Localization is a procedural technique of estimating the sensor node location. In this paper, a novel three hybrid algorithms based on firefly is proposed for localization problem. Hybrid Genetic Algorithm-Firefly Localization Algorithm (GA-FFLA, Hybrid Differential Evolution-Firefly Localization Algorithm (DE-FFLA and Hybrid Particle Swarm Optimization -Firefly Localization Algorithm (PSO-FFLA are analyzed, designed and implemented to optimize the localization error. The localization algorithms are compared based on accuracy of estimation of location, time complexity and iterations required to achieve the accuracy. All the algorithms have hundred percent estimation accuracy but with variations in the number of firefliesr requirements, variation in time complexity and number of iteration requirements. Keywords: Localization; Genetic Algorithm; Differential Evolution; Particle Swarm Optimization

  17. A STRONG OPTIMIZATION THEOREM IN LOCALLY CONVEX SPACES

    Institute of Scientific and Technical Information of China (English)

    程立新; 腾岩梅

    2003-01-01

    This paper presents a geometric characterization of convex sets in locally convex spaces onwhich a strong optimization theorem of the Stegall-type holds, and gives Collier's theorem ofw* Asplund spaces a localized setting.

  18. The feasibility and safety of thoracoscopic surgery under epidural and/or local anesthesia for spontaneous pneumothorax: a meta-analysis.

    Science.gov (United States)

    Chen, Wei; Zhang, Chenlei; Wang, Gebang; Li, Zhengjun; Wang, Hailong; Liu, Hongxu

    2017-09-01

    The aim of this study was to compare thoracoscopic surgery for spontaneous pneumothorax under epidural and/or local anesthesia (ELA) with that under general anesthesia and prove the feasibility and safety of thoracoscopic surgery under ELA for spontaneous pneumothorax. Relevant studies were searched in five databases from their date of publication to June 2016. We collected and analyzed the data concerning operative time, hospital stay, complications, air leak, recurrence and perioperative mortality. A forest plot was performed to compare the differences between the two groups. There were no significant differences between the ELA group and the general anesthesia (GA) group in operative time, hospital stay, complications, air leak or recurrence. There were 6 deaths reported in two studies. However, patients in the ELA group had significantly shorter global operating room time. Our study demonstrated that ELA, in comparison with GA, is feasible and safe for thoracoscopic surgery of spontaneous pneumothorax.

  19. Efeitos cardiovasculares da anestesia local com vasoconstritor durante exodontia em coronariopatas Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

    Directory of Open Access Journals (Sweden)

    Valeria C. L. S. Conrado

    2007-05-01

    during or after dental treatment under anesthesia with vasoconstrictor (epinephrine. METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes: group I (27 patients using anesthetics with vasoconstrictor, and group II (27 cases without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.

  20. Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing – A split-mouth clinical trial

    Directory of Open Access Journals (Sweden)

    Kalyan Chintala

    2017-01-01

    Full Text Available Background and Aim: Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. Materials and Methods: Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group. Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. Results: No difference was observed in visual analog scale (P > 0.05 and verbal rating scale (P > 0.05 pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47% was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05. Conclusion: Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.

  1. Intraosseous anesthesia: a review.

    Science.gov (United States)

    Brown, R

    1999-10-01

    The recent introduction of intraosseous injection devices has renewed interest in the modality of local anesthesia. Three devices currently available are the Stabident System, the Hypo Brand Intraosseous Needle, and the Cyberjet System. The Stabident System is the most popular and the only one for which published research is available. Primary intraosseous anesthesia is 45 percent to 93 percent effective but of short duration. Supplemental intraosseous anesthesia is 80 percent to 90 percent effective and provides profound anesthesia of long duration (60 minutes or longer). It is used when a prior conventional infiltration or nerve block is inadequate. During use of an anesthetic solution with a vasoconstrictor for intraosseous anesthesia, 46 percent to 100 percent of patients reported an increase in heart rate. There was a 2 percent to 27 percent incidence of moderate and sometimes severe pain during the intraosseous procedure. Postoperative complications occurred in 2 percent to 15 percent of patients and lasted one to 14 days.

  2. Efficacy and safety of bupivacaine versus lidocaine in local anesthesia of the nasopharynx: A meta-analysis.

    Science.gov (United States)

    Yu, Xiaoyun; Wang, Jiyun; Huang, Lizhen; Yu, Xiao; He, Zheyun

    2016-09-30

    To assess the efficacy and safety of bupivacaine compared with lidocaine in local anesthesia of nasopharynx through meta-analysis. A number of medical literature data bases were searched electronically. Relevant journals and references of included studies were manually searched. Two reviewers independently performed data extraction and quality assessment. Four studies were included. Visual analog scale (VAS) scores, acceptable discomfort, and bleeding scores were analyzed for bupivacaine versus lidocaine. When considering the VAS scores, bupivacaine as a local anesthetic agent was better than lidocaine in controlling the pain of postoperative patients (p bupivacaine group demonstrated a higher acceptable discomfort than the patients in the lidocaine group (p = 0.008). With regard to the bleeding scores of the patients with nasal surgery, lidocaine was better at bleeding in postoperative patients compared with bupivacaine (p = 0.0007). These results indicated that bupivacaine showed better pain control of postoperative patients and acceptable discomfort in patients with upper gastrointestinal endoscopy. Lidocaine had a significantly increased ability the pain of patients with transnasal fiberoptic nasopharyngolaryngoscopic examination and bleeding in postoperative patients. No systemic adverse events were reported. Bupivacaine was found to have better promotion to pain control than did lidocaine for the patients after nasal surgery. Lidocaine had a significantly increased inhibition of bleeding in these postoperative patients; however, the efficacy between bupivacaine and lidocaine was unclear for the patients who had transnasal endoscopic examinations.

  3. Topical anesthesia

    Directory of Open Access Journals (Sweden)

    Mritunjay Kumar

    2015-01-01

    Full Text Available Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

  4. Perioperative blood ordering optimization process using information from an anesthesia information management system.

    Science.gov (United States)

    Rinehart, Joseph B; Lee, Tiffany C; Kaneshiro, Kayleigh; Tran, Minh-Ha; Sun, Coral; Kain, Zeev N

    2016-04-01

    As part of ongoing perioperative surgical home implantation process, we applied a previously published algorithm for creation of a maximum surgical blood order schedule (MSBOS) to our operating rooms. We hypothesized that using the MSBOS we could show a reduction in unnecessary preoperative blood testing and associated costs. Data regarding all surgical cases done at UC Irvine Health's operating rooms from January 1, 2011, to January 1, 2014 were extracted from the anesthesia information management systems (AIMS). After the data were organized into surgical specialties and operative sites, blood order recommendations were generated based on five specific case characteristics of the group. Next, we assessed current ordering practices in comparison to actual blood utilization to identify potential areas of wastage and performed a cost analysis comparing the annual hospital costs from preoperative blood orders if the blood order schedule were to be followed to historical practices. Of the 19,138 patients who were categorized by the MSBOS as needing no blood sample, 2694 (14.0%) had a type and screen (T/S) ordered and 1116 (5.8%) had a type and crossmatch ordered. Of the 6073 procedures where MSBOS recommended only a T/S, 2355 (38.8%) had blood crossmatched. The cost analysis demonstrated an annual reduction in actual hospital costs of $57,335 with the MSBOS compared to historical blood ordering practices. We showed that the algorithm for development of a multispecialty blood order schedule is transferable and yielded reductions in preoperative blood product screening at our institution. © 2016 AABB.

  5. Continuous spinal anesthesia.

    Science.gov (United States)

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a

  6. Anesthesia Basics

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anesthesia Basics KidsHealth / For Teens / Anesthesia Basics What's in ... español Conceptos básicos sobre la anestesia What Is Anesthesia? No doubt about it, getting an operation can ...

  7. Post Laparoscopic Pain Control Using Local Anesthesia through Laparoscopic Port Sites

    Directory of Open Access Journals (Sweden)

    Seyyed Amir Vejdan

    2014-08-01

    Full Text Available Background: Severe abdominal pain is not common after laparoscopic surgeries, but acute or chronic pain after operation is considerable in some patients. Post-operative Pain control after laparoscopic surgeries, is conventionally achieved using analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs and narcotics, but their administration has a lot of side effects. This study compares the efficacy and side effects of local anesthetic drugs versus conventional analgesics in post-operative pain control.Materials and Methods: This prospective investigation was conducted into two groups of patients (n=93. Group 1, as control group, was given conventional analgesics such as narcotics and NSAIDs. In investigational group, at the end of laparoscopic surgery, prior to port withdrawal, a local anesthetic mixture, a short acting (Lidocaine 2% plus a long acting (Bupivacaine 0.5% is instilled through the port lumen between the abdominal wall layers. The efficacy of both types of medications was compared to their efficacy and side effects.Results: 85% of the control group, received 5 to 20 ml Morphine for pain control while the others were controlled with trans-rectal NSAIDs. In the treatment group, the pain of 65% of the patients was controlled only by local anesthetic drugs, 30% required NSAIDs and the other 5% required narcotics administration for pain control.Conclusion: The administration of local anesthetic drugs after laparoscopic surgery is an effective method for pain control with a low complications rate and side effects of narcotics.

  8. OPTIMIZING LOCAL BUDGET BALANCING IN ROMANIA

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    Gyorgy Adina Crsitina

    2011-07-01

    Full Text Available The importance of the local public finance is growing in accordance with the increasing proportion of the decentralization process. The mechanism of resource allocation, and especially the allocation criteria used, constitutes subjects of debate. Our objective pursued is to assess whether the avoidance of the first step for balancing the allocation of funds can provide enhanced fairness in balancing the local budgets across the country. Local budgets in Romania receive significant resources from the state budget in the form of amounts and quotas distributed from certain taxes, which are revenues for the state budget. Some of these amounts are designed to balance the local budgets. The distribution of funds from the state budget to the local budgets requires two steps. Firstly, the amounts are divided by county, secondly, these amounts are directed within the county especially towards localities which have a lower financial standing. Given the significant disparities between counties, we believe that this mechanism does not ensure fairness in the allocation because the funds distributed according to the first step may not use fair criteria to meet the requirements for balanced local budgets. Therefore, we intend to simulate a balanced allocation of national funds for eliminating the first step that produces the most significant inequities. Direct application of the second step of allocation, with its two phases, will provide more funds serving those local administrative units for the income tax per capita is lower than the national average. Comparing the values allocated for the year 2011 with those obtained in the simulation we will examine changes that occur after the application of this method which seems to be more equitable and appropriate. This work was supported by CNCSISUEFISCSU, project number PNII-IDEI 1780/2008

  9. Handy-type gamma probe-guided sentinel lymph node biopsy for breast cancer under ambulatory local anesthesia

    International Nuclear Information System (INIS)

    Fujiwara, Ikuya; Nagata, Hiroaki; Takaki, Wataru

    2016-01-01

    Prior to surgery for clinically node-negative breast cancer, we diagnosed metastases on the basis of permanent sections and sentinel lymph node biopsy (SNB) using the combined radio isotope (RI)/blue dye method with a hand-type gamma probe under ambulatory local anesthesia. SNB was performed for 99 patients with 103 lesions, including 4 patients with bilateral breast cancer. We achieved an identification rate of 100%, in which the identification pattern included detection by RI and blue-dye in 65 patients (63.1%), detection by RI alone in 37 patients (35.9%), and blue-dye alone in one patient (1.0%). Sentinel lymph node metastasis was macrometastasis in 21 patients (20.4%), micrometastasis in 8 patients (7.8%), and isolated tumor cells in patients (4.9%). In the 80 patients who did not undergo post-SNB axillary lymph node dissection, the median observation period was 33 months and there were no recurrences in the axillary lymph nodes observed. Although the present procedure requires two surgeries, it is a useful method that enables metastasis detection and highly accurate SNB. (author)

  10. The Effect of Different Local Anesthesia Methods on Pain Relief in Outpatient Endometrial Biopsy: Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Elaheh Olad-Saheb-Madarek

    2013-08-01

    Full Text Available Introduction: Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. Methods: In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB, candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3- intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Results: Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Conclusion: Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect.

  11. The pharmacokinetics and effects of meloxicam, gabapentin, and flunixin in postweaning dairy calves following dehorning with local anesthesia.

    Science.gov (United States)

    Glynn, H D; Coetzee, J F; Edwards-Callaway, L N; Dockweiler, J C; Allen, K A; Lubbers, B; Jones, M; Fraccaro, E; Bergamasco, L L; KuKanich, B

    2013-12-01

    Approved analgesic compounds in cattle are not currently available in the United States due to the lack of validated pain assessment methods and marker residue depletion studies. In this study, we compared the pharmacokinetic parameters and effect of preemptive analgesics administered to calves subjected to dehorning with local anesthesia. Holstein steers were randomly assigned to receive one of the following treatments per os (PO) or intravenously (IV) (n = 8/group): meloxicam (1 mg/kg PO), gabapentin (15 mg/kg PO), meloxicam (1 mg/kg), and gabapentin (15 mg/kg) PO, flunixin (2.2 mg/kg IV), or a placebo. Plasma drug, haptoglobin, substance P (SP) concentrations, serum cortisol concentrations, ocular thermography, mechanical nociceptive threshold (MNT), and average daily gain (ADG) were evaluated. Data were analyzed using mixed-effects models and noncompartmental pharmacokinetic analysis. Meloxicam, gabapentin, and meloxicam with gabapentin at the present doses did not reduce cortisol concentrations. Analgesic-treated calves had significantly lower plasma SP concentrations and improved ADG compared with controls. Flunixin calves had reduced circulating cortisol compared with controls. Meloxicam-treated calves showed an increase in MNT at two horn bud sites compared with the other treatments. Analgesics improved ADG and reduced biomarkers of pain, but effects differed by compound and route of administration. © 2013 John Wiley & Sons Ltd.

  12. Implantation of venous access devices under local anesthesia: patients’ satisfaction with oral lorazepam

    Directory of Open Access Journals (Sweden)

    Chang DH

    2015-07-01

    Full Text Available De-Hua Chang,1 Sonja Hiss,1 Lena Herich,2 Ingrid Becker,2 Kamal Mammadov,1 Mareike Franke,1 Anastasios Mpotsaris,1 Robert Kleinert,3 Thorsten Persigehl,1 David Maintz,1 Christopher Bangard1 1Department of Radiology, 2Institute of Medical Statistics, Informatics and Epidemiology, 3Department of Surgery, University Hospital of Cologne, Cologne, Germany Objective: The aim of the study reported here was to evaluate patients’ satisfaction with implantation of venous access devices under local anesthesia (LA with and without additional oral sedation.Materials and methods: A total of 77 patients were enrolled in the prospective descriptive study over a period of 6 months. Subcutaneous implantable venous access devices through the subclavian vein were routinely implanted under LA. Patients were offered an additional oral sedative (lorazepam before each procedure. The level of anxiety/tension, the intensity of pain, and patients’ satisfaction were evaluated before and immediately after the procedure using a visual analog scale (ranging from 0 to 10 with a standardized questionnaire.Results: Patients’ satisfaction with the procedure was high (mean: 1.3±2.0 with no significant difference between the group with premedication and the group with LA alone (P=0.54. However, seven out of 30 patients (23.3% in the group that received premedication would not undergo the same procedure without general anesthesia. There was no significant influence of lorazepam on the intensity of pain (P=0.88. In 12 out of 30 patients (40% in the premedication group, the level of tension was higher than 5 on the visual analog scale during the procedure. In 21 out of 77 patients (27.3%, the estimate of the level of tension differed between the interventionist and the patient by 3 or more points in 21 out of 77 patients (27.3%.Conclusion: Overall patient satisfaction is high for implantation of venous access devices under LA. A combination of LA with lorazepam administered

  13. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures

    Science.gov (United States)

    Davoudi, Amin; Rismanchian, Mansour; Akhavan, Ali; Nosouhian, Saeid; Bajoghli, Farshad; Haghighat, Abbas; Arbabzadeh, Farahnaz; Samimi, Pouran; Fiez, Atiyeh; Shadmehr, Elham; Tabari, Kasra; Jahadi, Sanaz

    2016-01-01

    Dental anxiety and fear of needle injection is one of the most common problems encountered by dental practitioners, especially in the pediatric patient. In consequences, it might affect the patient's quality of life. Several methods are suggested to lower the discomfort of local anesthesia injection during dental procedures. Desensitization of injection site is one of the recommended strategies. Among chemical anesthetic topical agents that are effective but might have allergic side effects, using some nonpharmacological and safe techniques might be useful. This study aimed to overview the efficacy of using cooling techniques, mostly by ice or popsicles, warming or pH buffering of drug, and using modern devices to diminish the discomfort of local anesthesia injection during dental procedures. PMID:26957683

  14. Optimal conditions for local NQR observation

    International Nuclear Information System (INIS)

    Grechishkin, V.S.; Grechishkina, P.V.

    1998-01-01

    At last the local NQR is used widely for detection of explosions and narcotics. Two methods are applied usually: one-sided detection and translucent detection (TD). These methods are analyzed in the paper. It is shown that the TD method has the greater sensitivity

  15. [Comparison of two methods for conscious sedation in maxillofacial surgery with local anesthesia].

    Science.gov (United States)

    Zöller, J; Zöller, B; Hassfeld, S; Köhler, J

    1992-01-01

    A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.

  16. Cytotoxic effects of local anesthesia through lidocaine/ropivacaine on human melanoma cell lines

    Directory of Open Access Journals (Sweden)

    Ding-Kun Kang

    Full Text Available Abstract Background: Local anesthetics (LAs are generally considered as safe, but cytotoxicity has been reported for several local anesthetics used in humans, which is not well investigated. In the present study, the cytotoxicity of lidocaine, ropivacaine and the combination of lidocaine and ropivacaine were evaluated on human melanoma cell lines. Melphalan, a nitrogen mustard alkylating agent, was used as a control agent for comparison of cytotoxic activity. Methods: Melanoma cell lines, A375 and Hs294T, were exposed to 1 h to different concentrations of above agents. Cell-viability after exposure was determined by flow cytometry. Results: Investigated LAs showed detrimental cytotoxicity on studied melanoma cell lines in time- (p < 0.001, concentration- (p < 0.001, and agent dependant. In both A375 and Hs294T cell lines, minimum cell viability rates were found after 72 h of exposure to these agents. Lidocaine 2% caused a reduction of vital cells to 10% ± 2% and 14% ± 2% in A375 and Hs294T, respectively after 72 h of exposure. Ropivacaine 0.75% after 72 h reduced viable cells to 15% ± 3% and 25% ± 3% in A375 and Hs294T, respectively. Minimum cell viability after 72 h exposure to the combination was 10% ± 2% and 18% ± 2% in A375 and Hs294T, respectively. Minimum cell viability after 72 h exposure to melphalan was 8% ± 1% and 12% ± 2%, in A375 and Hs294T, respectively. Conclusion: LAs have cytotoxic activity on human melanoma cell lines in a time-, concentration- and agent-dependant manner. Apoptosis in the cell lines was mediated through activity of caspases-3 and caspases-8.

  17. Theory and Algorithms for Global/Local Design Optimization

    National Research Council Canada - National Science Library

    Watson, Layne T; Guerdal, Zafer; Haftka, Raphael T

    2005-01-01

    The motivating application for this research is the global/local optimal design of composite aircraft structures such as wings and fuselages, but the theory and algorithms are more widely applicable...

  18. Topology optimization of nanoparticles for localized electromagnetic field enhancement

    DEFF Research Database (Denmark)

    Christiansen, Rasmus Ellebæk; Vester-Petersen, Joakim; Madsen, Søren Peder

    2017-01-01

    We consider the design of individual and periodic arrangements of metal or semiconductor nanoparticles for localized electromagnetic field enhancement utilizing a topology optimization based numerical framework as the design tool. We aim at maximizing a function of the electromagnetic field...

  19. Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure Ensaio clínico randomizado comparando raquianestesia com anestesia local, associadas à sedação para o fechamento de colostomia em alça

    Directory of Open Access Journals (Sweden)

    Rone Antônio Alves de Abreu

    2010-09-01

    Full Text Available CONTEXT: Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES: Randomized clinical trial to compare the results from these two techniques. METHODS: Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25 and using local anesthesia (n = 25. Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin. Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS: Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS: Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.CONTEXTO: Estudos recentes têm demonstrado que a anestesia local para o fechamento de colostomia em alça é tão segura quanto a raquianestesia para estes procedimentos. OBJETIVOS: Comparar os resultados do fechamento de colostomia em alça usando essas duas técnicas. MÉTODOS: Cinquenta pacientes foram randomizados para o fechamento de colostomia em alça sob raquianestesia (n = 25 e anestesia local (n = 25. No pré-operatório, o cólon foi avaliado por colonoscopia e o preparo intestinal foi realizado com solução oral de manitol a 10% e limpeza com solução salina fisiológica através do orifício distal da colostomia. Todos os

  20. Spinal anesthesia: the Holy Grail?

    OpenAIRE

    Voet, Marieke; Slagt, Cornelis

    2017-01-01

    Marieke Voet, Cornelis SlagtDepartment of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The NetherlandsAfter reading the paper recently published in Local and Regional Anesthesia by Whitaker et al:1 “Spinal anesthesia after intraoperative cardiac arrest during general anesthesia in an infant,” we would like to share our thoughts. In a recently published paper by Habre et al,2 the incidence of severe critical events in pediatric anes...

  1. Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta-analysis of randomized, controlled trials.

    Science.gov (United States)

    Sivaramakrishnan, Gowri; Sridharan, Kannan

    2018-05-01

    Alternatives to adrenaline with lignocaine local anesthesia, such as clonidine, have been trialed in various randomized, controlled trials. Therefore, the aim of the present systematic review was to compile the available evidence on using clonidine with lignocaine for dental anesthesia. Electronic databases were searched for eligible studies. A data-extraction form was created, extracted data were analyzed using non-Cochrane mode in RevMan 5.3 software. Heterogeneity between the studies were assessed using the forest plot, I 2 statistics (where >50% was considered to have moderate-to-severe heterogeneity), and χ 2 -test. Random-effects models were used because of moderate heterogeneity. Five studies were included for the final review. While clonidine was found to significantly shorten the onset of local anesthesia when measured subjectively, no significant difference was observed objectively. No significant difference was observed in the duration and postoperative analgesia. Stable hemodynamic parameters within the safe range were observed postoperatively when clonidine was used. Clonidine could be considered as an alternative to adrenaline in cases of contraindications to adrenaline, such as like cardiac abnormalities, hypertension, and diabetes. © 2017 John Wiley & Sons Australia, Ltd.

  2. Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.

    Science.gov (United States)

    Chaki, Tomohiro; Sugino, Shigekazu; Janicki, Piotr K; Ishioka, Yoshiya; Hatakeyama, Yosuke; Hayase, Tomo; Kaneuchi-Yamashita, Miki; Kohri, Naonori; Yamakage, Michiaki

    2016-01-01

    Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed. Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

  3. Optimizer convergence and local minima errors and their clinical importance

    International Nuclear Information System (INIS)

    Jeraj, Robert; Wu, Chuan; Mackie, Thomas R

    2003-01-01

    Two of the errors common in the inverse treatment planning optimization have been investigated. The first error is the optimizer convergence error, which appears because of non-perfect convergence to the global or local solution, usually caused by a non-zero stopping criterion. The second error is the local minima error, which occurs when the objective function is not convex and/or the feasible solution space is not convex. The magnitude of the errors, their relative importance in comparison to other errors as well as their clinical significance in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP) were investigated. Two inherently different optimizers, a stochastic simulated annealing and deterministic gradient method were compared on a clinical example. It was found that for typical optimization the optimizer convergence errors are rather small, especially compared to other convergence errors, e.g., convergence errors due to inaccuracy of the current dose calculation algorithms. This indicates that stopping criteria could often be relaxed leading into optimization speed-ups. The local minima errors were also found to be relatively small and typically in the range of the dose calculation convergence errors. Even for the cases where significantly higher objective function scores were obtained the local minima errors were not significantly higher. Clinical evaluation of the optimizer convergence error showed good correlation between the convergence of the clinical TCP or NTCP measures and convergence of the physical dose distribution. On the other hand, the local minima errors resulted in significantly different TCP or NTCP values (up to a factor of 2) indicating clinical importance of the local minima produced by physical optimization

  4. [The anesthesia of anesthesia].

    Science.gov (United States)

    Pfleiderer, G

    2005-03-01

    Viewed from a cultural-ethical perspective, anesthesiology can be understood as a comprehensive concept of medicine in general. As such it contains two dilemmas: very often pain must be inflicted in order to alleviate pain and this can only be done by somebody who is himself relatively free of pain. The necessary apathy or anesthesia of the anesthetist is correlated with a general twentieth century-type of perception: the cool observer. Nevertheless, it is also a modern variation of the original religious constellation of the priest in relationship to the sick person. Curing occurs by representation. The weak self of the sick person is able to take over the strong self, represented by the therapist. In twentieth century art and literature this process of self-therapy by representation was often illustrated. On the background of a phenomenological philosophy that process can be understood as the regaining of a balance between body and soul. In the psalms of the biblical Book of Job there a variety of fundamental forms of pain which may be helpful even in this secular age.

  5. Effects of Anesthesia

    Science.gov (United States)

    ... About Policymakers Media ASA Member Toolkit Anesthesia 101 Effects of Anesthesia Explore this page: Effects of Anesthesia ... the types of anesthesia and their side effects? Effects of Anesthesia If you’re having surgery, you ...

  6. Is local participation always optimal for sustainable action?

    DEFF Research Database (Denmark)

    Brandt, Urs Steiner; Svendsen, Gert Tinggaard

    2013-01-01

    Is local participation always optimal for sustainable action? Here, Local Agenda 21 is a relevant case as it broadly calls for consensus-building among stakeholders. Consensus-building is, however, costly. We show that the costs of making local decisions are likely to rapidly exceed the benefits......-solutions, or not making any choices at all. Even though the informational value of meetings may be helpful to policy makers, the model shows that it also decreases as the number of participants increase. Overall, the result is a thought provoking scenario for Local Agenda 21 as it highlights the risk of less sustainable...

  7. A dynamic global and local combined particle swarm optimization algorithm

    International Nuclear Information System (INIS)

    Jiao Bin; Lian Zhigang; Chen Qunxian

    2009-01-01

    Particle swarm optimization (PSO) algorithm has been developing rapidly and many results have been reported. PSO algorithm has shown some important advantages by providing high speed of convergence in specific problems, but it has a tendency to get stuck in a near optimal solution and one may find it difficult to improve solution accuracy by fine tuning. This paper presents a dynamic global and local combined particle swarm optimization (DGLCPSO) algorithm to improve the performance of original PSO, in which all particles dynamically share the best information of the local particle, global particle and group particles. It is tested with a set of eight benchmark functions with different dimensions and compared with original PSO. Experimental results indicate that the DGLCPSO algorithm improves the search performance on the benchmark functions significantly, and shows the effectiveness of the algorithm to solve optimization problems.

  8. Geometrical optimization of a local ballistic magnetic sensor

    Energy Technology Data Exchange (ETDEWEB)

    Kanda, Yuhsuke; Hara, Masahiro [Graduate School of Science and Technology, Kumamoto University, 2-39-1 Kurokami, Kumamoto 860-8555 (Japan); Nomura, Tatsuya [Advanced Electronics Research Division, INAMORI Frontier Research Center, Kyushu University, 744 Motooka, Fukuoka 819-0395 (Japan); Kimura, Takashi [Advanced Electronics Research Division, INAMORI Frontier Research Center, Kyushu University, 744 Motooka, Fukuoka 819-0395 (Japan); Department of Physics, Kyushu University, 6-10-1 Hakozaki, Fukuoka 812-8581 (Japan)

    2014-04-07

    We have developed a highly sensitive local magnetic sensor by using a ballistic transport property in a two-dimensional conductor. A semiclassical simulation reveals that the sensitivity increases when the geometry of the sensor and the spatial distribution of the local field are optimized. We have also experimentally demonstrated a clear observation of a magnetization process in a permalloy dot whose size is much smaller than the size of an optimized ballistic magnetic sensor fabricated from a GaAs/AlGaAs two-dimensional electron gas.

  9. Local beam angle optimization with linear programming and gradient search

    International Nuclear Information System (INIS)

    Craft, David

    2007-01-01

    The optimization of beam angles in IMRT planning is still an open problem, with literature focusing on heuristic strategies and exhaustive searches on discrete angle grids. We show how a beam angle set can be locally refined in a continuous manner using gradient-based optimization in the beam angle space. The gradient is derived using linear programming duality theory. Applying this local search to 100 random initial angle sets of a phantom pancreatic case demonstrates the method, and highlights the many-local-minima aspect of the BAO problem. Due to this function structure, we recommend a search strategy of a thorough global search followed by local refinement at promising beam angle sets. Extensions to nonlinear IMRT formulations are discussed. (note)

  10. Global-local optimization of flapping kinematics in hovering flight

    KAUST Repository

    Ghommem, Mehdi; Hajj, M. R.; Mook, Dean T.; Stanford, Bret K.; Bé ran, Philip S.; Watson, Layne T.

    2013-01-01

    The kinematics of a hovering wing are optimized by combining the 2-d unsteady vortex lattice method with a hybrid of global and local optimization algorithms. The objective is to minimize the required aerodynamic power under a lift constraint. The hybrid optimization is used to efficiently navigate the complex design space due to wing-wake interference present in hovering aerodynamics. The flapping wing is chosen so that its chord length and flapping frequency match the morphological and flight properties of two insects with different masses. The results suggest that imposing a delay between the different oscillatory motions defining the flapping kinematics, and controlling the way through which the wing rotates at the end of each half stroke can improve aerodynamic power under a lift constraint. Furthermore, our optimization analysis identified optimal kinematics that agree fairly well with observed insect kinematics, as well as previously published numerical results.

  11. Global-local optimization of flapping kinematics in hovering flight

    KAUST Repository

    Ghommem, Mehdi

    2013-06-01

    The kinematics of a hovering wing are optimized by combining the 2-d unsteady vortex lattice method with a hybrid of global and local optimization algorithms. The objective is to minimize the required aerodynamic power under a lift constraint. The hybrid optimization is used to efficiently navigate the complex design space due to wing-wake interference present in hovering aerodynamics. The flapping wing is chosen so that its chord length and flapping frequency match the morphological and flight properties of two insects with different masses. The results suggest that imposing a delay between the different oscillatory motions defining the flapping kinematics, and controlling the way through which the wing rotates at the end of each half stroke can improve aerodynamic power under a lift constraint. Furthermore, our optimization analysis identified optimal kinematics that agree fairly well with observed insect kinematics, as well as previously published numerical results.

  12. Interactive Cosegmentation Using Global and Local Energy Optimization

    OpenAIRE

    Xingping Dong,; Jianbing Shen,; Shao, Ling; Yang, Ming-Hsuan

    2015-01-01

    We propose a novel interactive cosegmentation method using global and local energy optimization. The global energy includes two terms: 1) the global scribbled energy and 2) the interimage energy. The first one utilizes the user scribbles to build the Gaussian mixture model and improve the cosegmentation performance. The second one is a global constraint, which attempts to match the histograms of common objects. To minimize the local energy, we apply the spline regression to learn the smoothne...

  13. Localization of multilayer networks by optimized single-layer rewiring.

    Science.gov (United States)

    Jalan, Sarika; Pradhan, Priodyuti

    2018-04-01

    We study localization properties of principal eigenvectors (PEVs) of multilayer networks (MNs). Starting with a multilayer network corresponding to a delocalized PEV, we rewire the network edges using an optimization technique such that the PEV of the rewired multilayer network becomes more localized. The framework allows us to scrutinize structural and spectral properties of the networks at various localization points during the rewiring process. We show that rewiring only one layer is enough to attain a MN having a highly localized PEV. Our investigation reveals that a single edge rewiring of the optimized MN can lead to the complete delocalization of a highly localized PEV. This sensitivity in the localization behavior of PEVs is accompanied with the second largest eigenvalue lying very close to the largest one. This observation opens an avenue to gain a deeper insight into the origin of PEV localization of networks. Furthermore, analysis of multilayer networks constructed using real-world social and biological data shows that the localization properties of these real-world multilayer networks are in good agreement with the simulation results for the model multilayer network. This paper is relevant to applications that require understanding propagation of perturbation in multilayer networks.

  14. Local Approximation and Hierarchical Methods for Stochastic Optimization

    Science.gov (United States)

    Cheng, Bolong

    In this thesis, we present local and hierarchical approximation methods for two classes of stochastic optimization problems: optimal learning and Markov decision processes. For the optimal learning problem class, we introduce a locally linear model with radial basis function for estimating the posterior mean of the unknown objective function. The method uses a compact representation of the function which avoids storing the entire history, as is typically required by nonparametric methods. We derive a knowledge gradient policy with the locally parametric model, which maximizes the expected value of information. We show the policy is asymptotically optimal in theory, and experimental works suggests that the method can reliably find the optimal solution on a range of test functions. For the Markov decision processes problem class, we are motivated by an application where we want to co-optimize a battery for multiple revenue, in particular energy arbitrage and frequency regulation. The nature of this problem requires the battery to make charging and discharging decisions at different time scales while accounting for the stochastic information such as load demand, electricity prices, and regulation signals. Computing the exact optimal policy becomes intractable due to the large state space and the number of time steps. We propose two methods to circumvent the computation bottleneck. First, we propose a nested MDP model that structure the co-optimization problem into smaller sub-problems with reduced state space. This new model allows us to understand how the battery behaves down to the two-second dynamics (that of the frequency regulation market). Second, we introduce a low-rank value function approximation for backward dynamic programming. This new method only requires computing the exact value function for a small subset of the state space and approximate the entire value function via low-rank matrix completion. We test these methods on historical price data from the

  15. Long-term self-reported treatment effects and experience of radiofrequency-induced thermotherapy of the inferior turbinates performed under local anesthesia: a retrospective analysis.

    Science.gov (United States)

    Safiruddin, F; Vroegop, A V M T; Ravesloot, M J L; de Vries, N

    2013-05-01

    Nasal obstruction due to inferior turbinate hypertrophy is a common complaint. Radiofrequency-induced thermotherapy of the inferior turbinates (RFITT) under local anesthesia is now a widely used treatment, however reports of assessment of the long-term self-reported benefits and patient satisfaction of the treatment are scarce. This study focuses on the self-reported long-term effects of treatment and experience of RFITT. A questionnaire was sent to 441 patients who underwent RFITT in our clinic to treat symptoms of impaired nasal passage due to enlarged inferior turbinates. All patients had enlarged inferior turbinates on nasal examination. Patients were included if RFITT was done under local anaesthesia, was performed more than a year before the questionnaire was forwarded and on the indication-significant nasal obstruction because of enlarged inferior turbinates. Improvement of nasal breathing (by means of a Visual Analog Scale, VAS), changes in use of nasal spray (VAS), usage of pain medication, patient friendliness of the treatment, complaints reported after treatment, permanent effect of treatment during day and night time and willingness to recommend treatment to others were analyzed. No significant post-operative complications were observed. There was a significant reduction in use of nasal spray and the majority of patients interviewed reported long-term positive effects of RFITT during the daytime. This study shows that RFITT performed under local anesthesia is a valuable, minimally invasive, patient-friendly and well-tolerated treatment in patients with impaired nasal passage due to inferior turbinate hypertrophy.

  16. Locally optimized separability enhancement indices for urban land cover mapping

    DEFF Research Database (Denmark)

    Feyisa, Gudina L.; Meilby, Henrik; Darrel Jenerette, G.

    2016-01-01

    data in LULC classification. To more accurately quantify landscape patterns and their changes, we applied new locally optimized separability enhancement indices and decision rules (SEI–DR approach) to address commonly observed classification accuracy problems in urban environments. We tested the SEI...

  17. Topology Optimization of Continuum Structures with Local Stress Constraints

    DEFF Research Database (Denmark)

    Duysinx, Pierre; Bendsøe, Martin P

    1998-01-01

    We introduce an extension of current technologies for topology optimization of continuum structures which allows for treating local stress criteria. We first consider relevant stress criteria for porous composite materials, initially by studying the stress states of the so-called rank 2 layered m...

  18. How Much Volume of Local Anesthesia and How Long Should You Wait After Injection for an Effective Wrist Median Nerve Block?

    Science.gov (United States)

    Lovely, Lyndsay M; Chishti, Yasmin Z; Woodland, Jennifer L; Lalonde, Donald H

    2018-05-01

    Many surgeons and emergentologists use non-ultrasound-guided wrist nerve blocks. There is little evidence to guide the ideal volume of local anesthesia or how long we should wait after injection before performing pain-free procedures. This pilot study examined time to maximal anesthesia to painful needle stick in 14 volunteer participants receiving bilateral wrist blocks of 6 versus 11 mL of local. One surgeon performed all 14 bilateral wrist median nerve blocks in participants who remained blinded until after bandages were applied to their wrist. No one could see which wrist received the larger 11-mL volume injection versus the 6-mL block. Blinded sensory assessors then measured perceived maximal numbness time and numbness to needle stick pain in the fingertips of the median nerve distribution. Failure to get a complete median nerve block occurred in seven of fourteen 6-mL wrist blocks versus failure in only one of fourteen 11-mL blocks. Perceived maximal numbness occurred at roughly 40 minutes after injection, but actual numbness to painful needle stick took around 100 minutes. Incomplete median nerve numbness occurred with both 6- and 11-mL non-ultrasound-guided blocks at the wrist. In those with complete blocks, it took a surprisingly long time of 100 minutes for maximal anesthesia to occur to painful needle stick stimuli to the fingertips of the median nerve distribution. Non-ultrasound-guided median nerve blocks at the wrist as described in this article lack reliability and take too long to work.

  19. Context-Aware Local Optimization of Sensor Network Deployment

    Directory of Open Access Journals (Sweden)

    Meysam Argany

    2015-07-01

    Full Text Available Wireless sensor networks are increasingly used for tracking and monitoring dynamic phenomena in urban and natural areas. Spatial coverage is an important issue in sensor networks in order to fulfill the needs of sensing applications. Optimization methods are widely used to efficiently distribute sensor nodes in the network to achieve a desired level of coverage. Most of the existing algorithms do not consider the characteristics of the real environment in the optimization process. In this paper, we propose the integration of contextual information in optimization algorithms to improve sensor network coverage. First, we investigate the implication of contextual information in sensor networks. Then, a conceptual framework for local context-aware sensor network deployment optimization method is introduced and related algorithms are presented in detail. Finally, several experiments are carried out to evaluate the validity of the proposed method. The results obtained from these experiments show the effectiveness of our approach in different contextual situations.

  20. [Examination of the optimal midazolam dose required for loss of puncture memory at the time of spinal anesthesia].

    Science.gov (United States)

    Boku, Aiji; Koyama, Shinichi; Kishimoto, Naotaka; Nakatani, Keiji; Kurita, Satoshi; Nagata, Noboru; Niwa, Hitoshi

    2011-08-01

    We examined midazolam ED50 according to age that was necessary for loss of puncture memory at the time of spinal anesthesia and determined whether we could estimate the presence of puncture memory from the degree of sedation after midazolam administration. We enrolled patients with ASA PS 1 or 2 and patients from 50 to 80 years of age who had been planned for surgery with spinal anesthesia. We divided the patients into groups according to their age--50s, 60s, and 70s as L, M, and H groups, respectively. We evaluated the degree of sedation with six phases of scores after intravenous administration of midazolam and spinal anesthesia was performed. The midazolam dose was based on the ups and downs method. The midazolam ED50s required for the loss of puncture memory in groups L, M, and H were 0.043, 0.035, and 0.026 mg x kg(-1), respectively. We estimated the association between the sedation degree score after midazolam administration and the puncture memory from ROC curve, but AUC was 0.56 for all cases. The midazolam ED50 required for the loss of puncture memory decreased with age but it was difficult to estimate puncture memory from the degree of sedation.

  1. Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

    Directory of Open Access Journals (Sweden)

    Marcela Alves dos Santos-Paul

    2015-03-01

    Full Text Available OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.

  2. Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report.

    Science.gov (United States)

    Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Hayashi, Fumio; Tezuka, Fumitake; Morimoto, Masatoshi; Chikawa, Takashi; Nagamachi, Akihiro; Sairyo, Koichi

    2017-01-01

    Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery. J. Med. Invest. 64: 291-295, August, 2017.

  3. Milligan-Morgan hemorrhoidectomy under local anesthesia - an old operation that stood the test of time. A single-team experience with 2,280 operations.

    Science.gov (United States)

    Argov, Samuel; Levandovsky, Olga; Yarhi, Danielle

    2012-07-01

    This study was carried out to evaluate the morbidity and efficacy of Milligan-Morgan (M&M) hemorrhoidectomy in comparison to novel techniques (e.g., hemorrhoidal artery ligation [HAL], stapler hemorrhoidopexy [PPH]). This is a retrospective review of a single-team experience with 2,280 M&M hemorrhoidectomy patients, with 1-12 years follow-up. All patients were operated upon in jack-knife position, using local anesthesia under light sedation in an ambulatory facility. This method allowed us to operate on 40 pregnant women. All operations were performed using simple, commercially available instruments. We found negligible morbidity, no mortality and a very efficient operation on long-term follow-up. The surgical literature is littered with dreadful complications and even mortality from stapled hemorrhoidopexy (Giordano et al., Dis Colon Rectum 51:1574-1576, 2008; Brown et al., Tech Coloproctol 11:357-358, 2007; Cipriani and Pescatori, Colorectal Dis 4:367-370, 2002; Mongardini et al., G Chir 26:275-277, 2005) and the inefficiency of Doppler HAL (Faucheron and Gangner, Dis Colon Rectum 51:945-949, 2008; Scheyer et al., Am J Surg, 191:89-93, 2006). In days of soaring medical expenditures, nobody will argue about the superiority of M&M hemorrhoidectomy as the cheapest operation available. In all aspects, M&M hemorrhoidectomy under local anesthesia beats its competitors in terms of morbidity, mortality, long-term efficiency and low cost.

  4. Localized Multiple Kernel Learning Via Sample-Wise Alternating Optimization.

    Science.gov (United States)

    Han, Yina; Yang, Kunde; Ma, Yuanliang; Liu, Guizhong

    2014-01-01

    Our objective is to train support vector machines (SVM)-based localized multiple kernel learning (LMKL), using the alternating optimization between the standard SVM solvers with the local combination of base kernels and the sample-specific kernel weights. The advantage of alternating optimization developed from the state-of-the-art MKL is the SVM-tied overall complexity and the simultaneous optimization on both the kernel weights and the classifier. Unfortunately, in LMKL, the sample-specific character makes the updating of kernel weights a difficult quadratic nonconvex problem. In this paper, starting from a new primal-dual equivalence, the canonical objective on which state-of-the-art methods are based is first decomposed into an ensemble of objectives corresponding to each sample, namely, sample-wise objectives. Then, the associated sample-wise alternating optimization method is conducted, in which the localized kernel weights can be independently obtained by solving their exclusive sample-wise objectives, either linear programming (for l1-norm) or with closed-form solutions (for lp-norm). At test time, the learnt kernel weights for the training data are deployed based on the nearest-neighbor rule. Hence, to guarantee their generality among the test part, we introduce the neighborhood information and incorporate it into the empirical loss when deriving the sample-wise objectives. Extensive experiments on four benchmark machine learning datasets and two real-world computer vision datasets demonstrate the effectiveness and efficiency of the proposed algorithm.

  5. Evolutionary multimodal optimization using the principle of locality

    KAUST Repository

    Wong, Kachun; Wu, Chunho; Mok, Ricky; Peng, Chengbin; Zhang, Zhaolei

    2012-01-01

    The principle of locality is one of the most widely used concepts in designing computing systems. To explore the principle in evolutionary computation, crowding differential evolution is incorporated with locality for multimodal optimization. Instead of generating trial vectors randomly, the first method proposed takes advantage of spatial locality to generate trial vectors. Temporal locality is also adopted to help generate offspring in the second method proposed. Temporal and spatial locality are then applied together in the third method proposed. Numerical experiments are conducted to compare the proposed methods with the state-of-the-art methods on benchmark functions. Experimental analysis is undertaken to observe the effect of locality and the synergy between temporal locality and spatial locality. Further experiments are also conducted on two application problems. One is the varied-line-spacing holographic grating design problem, while the other is the protein structure prediction problem. The numerical results demonstrate the effectiveness of the methods proposed. © 2012 Elsevier Inc. All rights reserved.

  6. Evolutionary multimodal optimization using the principle of locality

    KAUST Repository

    Wong, Kachun

    2012-07-01

    The principle of locality is one of the most widely used concepts in designing computing systems. To explore the principle in evolutionary computation, crowding differential evolution is incorporated with locality for multimodal optimization. Instead of generating trial vectors randomly, the first method proposed takes advantage of spatial locality to generate trial vectors. Temporal locality is also adopted to help generate offspring in the second method proposed. Temporal and spatial locality are then applied together in the third method proposed. Numerical experiments are conducted to compare the proposed methods with the state-of-the-art methods on benchmark functions. Experimental analysis is undertaken to observe the effect of locality and the synergy between temporal locality and spatial locality. Further experiments are also conducted on two application problems. One is the varied-line-spacing holographic grating design problem, while the other is the protein structure prediction problem. The numerical results demonstrate the effectiveness of the methods proposed. © 2012 Elsevier Inc. All rights reserved.

  7. Locally optimal extracellular stimulation for chaotic desynchronization of neural populations.

    Science.gov (United States)

    Wilson, Dan; Moehlis, Jeff

    2014-10-01

    We use optimal control theory to design a methodology to find locally optimal stimuli for desynchronization of a model of neurons with extracellular stimulation. This methodology yields stimuli which lead to positive Lyapunov exponents, and hence desynchronizes a neural population. We analyze this methodology in the presence of interneuron coupling to make predictions about the strength of stimulation required to overcome synchronizing effects of coupling. This methodology suggests a powerful alternative to pulsatile stimuli for deep brain stimulation as it uses less energy than pulsatile stimuli, and could eliminate the time consuming tuning process.

  8. Anesthesia Fact Sheet

    Science.gov (United States)

    ... Education About NIGMS NIGMS Home > Science Education > Anesthesia Anesthesia Tagline (Optional) Middle/Main Content Area En español ... Version (464 KB) Other Fact Sheets What is anesthesia? Anesthesia is a medical treatment that prevents patients ...

  9. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ... and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ...

  10. Administration of Anesthesia

    Medline Plus

    Full Text Available ... information Anesthesia: Safety and Comfort in the OMS Office Part I Introduction and History of Dental Anesthesia ... OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad Access to Care, ...

  11. Optimal matching for prostate brachytherapy seed localization with dimension reduction.

    Science.gov (United States)

    Lee, Junghoon; Labat, Christian; Jain, Ameet K; Song, Danny Y; Burdette, Everette C; Fichtinger, Gabor; Prince, Jerry L

    2009-01-01

    In prostate brachytherapy, x-ray fluoroscopy has been used for intra-operative dosimetry to provide qualitative assessment of implant quality. More recent developments have made possible 3D localization of the implanted radioactive seeds. This is usually modeled as an assignment problem and solved by resolving the correspondence of seeds. It is, however, NP-hard, and the problem is even harder in practice due to the significant number of hidden seeds. In this paper, we propose an algorithm that can find an optimal solution from multiple projection images with hidden seeds. It solves an equivalent problem with reduced dimensional complexity, thus allowing us to find an optimal solution in polynomial time. Simulation results show the robustness of the algorithm. It was validated on 5 phantom and 18 patient datasets, successfully localizing the seeds with detection rate of > or = 97.6% and reconstruction error of < or = 1.2 mm. This is considered to be clinically excellent performance.

  12. Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2009-03-01

    . A descriptive cross-sectional study was conducted among the first 38 patients operated on by Lichtenstein's technique with local anesthesia (Braun and Sheleider's combined technique. The patients underwent ambulatory surgery between January 2001 and December 2007. The patients operated on in the morning were discharged in the afternoon, whereas those operated in the afternoon were discharged next morning in order to prevent the ecchymosis with the early mobilization. RESULTS. Four of the patients had recurrent hernias. The most used prosthetic material was polypropilene (86.9 %. The complications accounted for 9.1 % (referred not to the 38 patients, but to the 76 hernioplasties. After a follow-up ranging from 1 to 36 months, a rejection to the prosthetic material (1.3 % and a relapse (1.3 % were observed. CONCLUSIONS. It was concluded that this material may be applied to bilateral hernias, since stress, institutional costs and the patient's discomforts are reduced, showing this way its efficiency.

  13. Engineering local optimality in quantum Monte Carlo algorithms

    Science.gov (United States)

    Pollet, Lode; Van Houcke, Kris; Rombouts, Stefan M. A.

    2007-08-01

    Quantum Monte Carlo algorithms based on a world-line representation such as the worm algorithm and the directed loop algorithm are among the most powerful numerical techniques for the simulation of non-frustrated spin models and of bosonic models. Both algorithms work in the grand-canonical ensemble and can have a winding number larger than zero. However, they retain a lot of intrinsic degrees of freedom which can be used to optimize the algorithm. We let us guide by the rigorous statements on the globally optimal form of Markov chain Monte Carlo simulations in order to devise a locally optimal formulation of the worm algorithm while incorporating ideas from the directed loop algorithm. We provide numerical examples for the soft-core Bose-Hubbard model and various spin- S models.

  14. Energy network dispatch optimization under emergency of local energy shortage

    International Nuclear Information System (INIS)

    Cai, Tianxing; Zhao, Chuanyu; Xu, Qiang

    2012-01-01

    The consequence of short-time energy shortage under extreme conditions, such as earthquake, tsunami, and hurricane, may cause local areas to suffer from delayed rescues, widespread power outages, tremendous economic losses, and even public safety threats. In such urgent events of local energy shortage, agile energy dispatching through an effective energy transportation network, targeting the minimum energy recovery time, should be a top priority. In this paper, a novel methodology is developed for energy network dispatch optimization under emergency of local energy shortage, which includes four stages of work. First, emergency-area-centered energy network needs to be characterized, where the capacity, quantity, and availability of various energy sources are determined. Second, the energy initial situation under emergency conditions needs to be identified. Then, the energy dispatch optimization is conducted based on a developed MILP (mixed-integer linear programming) model in the third stage. Finally, the sensitivity of the minimum dispatch time with respect to uncertainty parameters is characterized by partitioning the entire space of uncertainty parameters into multiple subspaces. The efficacy of the developed methodology is demonstrated via a case study with in-depth discussions. -- Highlights: ► Address the energy network dispatch problem under emergency of local energy shortage. ► Minimize the energy restoration time for the entire energy network under emergency events. ► Develop a new MILP model and a sensitivity analysis method with respect to uncertainties.

  15. Toward Optimal Manifold Hashing via Discrete Locally Linear Embedding.

    Science.gov (United States)

    Rongrong Ji; Hong Liu; Liujuan Cao; Di Liu; Yongjian Wu; Feiyue Huang

    2017-11-01

    Binary code learning, also known as hashing, has received increasing attention in large-scale visual search. By transforming high-dimensional features to binary codes, the original Euclidean distance is approximated via Hamming distance. More recently, it is advocated that it is the manifold distance, rather than the Euclidean distance, that should be preserved in the Hamming space. However, it retains as an open problem to directly preserve the manifold structure by hashing. In particular, it first needs to build the local linear embedding in the original feature space, and then quantize such embedding to binary codes. Such a two-step coding is problematic and less optimized. Besides, the off-line learning is extremely time and memory consuming, which needs to calculate the similarity matrix of the original data. In this paper, we propose a novel hashing algorithm, termed discrete locality linear embedding hashing (DLLH), which well addresses the above challenges. The DLLH directly reconstructs the manifold structure in the Hamming space, which learns optimal hash codes to maintain the local linear relationship of data points. To learn discrete locally linear embeddingcodes, we further propose a discrete optimization algorithm with an iterative parameters updating scheme. Moreover, an anchor-based acceleration scheme, termed Anchor-DLLH, is further introduced, which approximates the large similarity matrix by the product of two low-rank matrices. Experimental results on three widely used benchmark data sets, i.e., CIFAR10, NUS-WIDE, and YouTube Face, have shown superior performance of the proposed DLLH over the state-of-the-art approaches.

  16. Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla

    Directory of Open Access Journals (Sweden)

    Kämmerer PW

    2018-03-01

    Full Text Available Peer W Kämmerer, Monika Daubländer Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Centre Mainz, Mainz, GermanyWe read the article by Al-Shayyab1 with great interest, though we think that there is a methodical bias. Usage of standard dental syringes with 27-gauge needles is not recommended for periodontal ligament (PDL injections as they are very unlikely to achieve the correct pressure needed for successful single tooth anesthesia. In accordance with this, specialized syringes with short 30-gauge needles are commonly used all over the literature.2 The author addresses this in the “Discussion” section and writes that “a standard conventional dental syringe was used in the present study, not a special PDL syringe, since the former is readily available in the clinic and proves equally successful when a standard 27-gauge short needle was used,” citing Malamed from 1982 (a time during which the modern PDL syringes were not developed yet3 and Madan et al who write that “intraligamentary injection technique is equally effective when a standard 27-gauge needle is used”.4 The second assumption refers to the needle only, not the syringe. In addition, this needle issue is not proven by any reference or study. Therefore, one might come to the conclusion that PDL was not carried out correctly. Also, the authors did not evaluate pulp or tissue anesthesia and started the extraction procedure after a latency period of 5 minutes in all cases. In accordance with this, the success rates of the PDL injection cannot be given, but would be of interest.View the original paper by Al-Shayyab and colleagues.

  17. A model of optimization for local energy infrastructure development

    International Nuclear Information System (INIS)

    Juroszek, Zbigniew; Kudelko, Mariusz

    2016-01-01

    The authors present a non-linear, optimization model supporting the planning of local energy systems development. The model considers two forms of final energy – heat and electricity. The model reflects both private and external costs and is designed to show the social perspective. It considers the variability of the marginal costs attributed to local renewable resources. In order to demonstrate the capacity of the model, the authors present a case study by modelling the development of the energy infrastructure in a municipality located in the south of Poland. The ensuing results show that a swift and significant shift in the local energy policy of typical central European municipalities is needed. The modelling is done in two scenarios – with and without the internalization of external environmental costs. The results confirm that the internalization of the external costs of energy production on a local scale leads to a significant improvement in the allocation of resources. - Highlights: • A model for municipal energy system development in Central European environment has been developed. • The variability of marginal costs of local, renewable fuels is considered. • External, environmental costs are considered. • The model reflects both network and individual energy infrastructure (e.g. individual housing boilers). • A swift change in Central European municipal energy infrastructure is necessary.

  18. Reinforcement active learning in the vibrissae system: optimal object localization.

    Science.gov (United States)

    Gordon, Goren; Dorfman, Nimrod; Ahissar, Ehud

    2013-01-01

    Rats move their whiskers to acquire information about their environment. It has been observed that they palpate novel objects and objects they are required to localize in space. We analyze whisker-based object localization using two complementary paradigms, namely, active learning and intrinsic-reward reinforcement learning. Active learning algorithms select the next training samples according to the hypothesized solution in order to better discriminate between correct and incorrect labels. Intrinsic-reward reinforcement learning uses prediction errors as the reward to an actor-critic design, such that behavior converges to the one that optimizes the learning process. We show that in the context of object localization, the two paradigms result in palpation whisking as their respective optimal solution. These results suggest that rats may employ principles of active learning and/or intrinsic reward in tactile exploration and can guide future research to seek the underlying neuronal mechanisms that implement them. Furthermore, these paradigms are easily transferable to biomimetic whisker-based artificial sensors and can improve the active exploration of their environment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Low flow anesthesia: Efficacy and outcome of laryngeal mask airway versus pressure-optimized cuffed-endotracheal tube

    Directory of Open Access Journals (Sweden)

    El-Seify Zeinab

    2010-01-01

    Full Text Available Background: Low flow anesthesia can lead to reduction of anesthetic gas and vapor consumption. Laryngeal mask airway (LMA has proved to be an effective and safe airway device. The aim of this study is to assess the feasibility of laryngeal mask airway during controlled ventilation using low fresh gas flow (1.0 L/min as compared to endotracheal tube (ETT. Patients and Methods : Fifty nine non-smoking adult patients; ASA I or II, being scheduled for elective surgical procedures, with an expected duration of anesthesia 60 minutes or more, were randomly allocated into two groups - Group I (29 patients had been ventilated using LMA size 4 for females and 5 for males respectively; and Group II (30 patients were intubated using ETT. After 10 minutes of high fresh gas flow, the flow was reduced to 1 L/min. Patients were monitored for airway leakage, end-tidal CO 2 (ETCO 2 , inspiratory and expiratory isoflurane and nitrous oxide fraction concentrations, and postoperative airway-related complications Results : Two patients in the LMA-group developed initial airway leakage (6.9% versus no patient in ETT-group. Cough and sore throat were significantly higher in ETT patients. There were no evidences of differences between both groups regarding ETCO 2 , uptake of gases, nor difficulty in swallowing. Conclusion : The laryngeal mask airway proved to be effective and safe in establishing an airtight seal during controlled ventilation under low fresh gas flow of 1 L/min, inducing less coughing and sore throat during the immediate postoperative period than did the ETT, with continuous measurement and readjustment of the tube cuff pressure.

  20. Asymptotically optimal data analysis for rejecting local realism

    International Nuclear Information System (INIS)

    Zhang, Yanbao; Glancy, Scott; Knill, Emanuel

    2011-01-01

    Reliable experimental demonstrations of violations of local realism are highly desirable for fundamental tests of quantum mechanics. One can quantify the violation witnessed by an experiment in terms of a statistical p value, which can be defined as the maximum probability according to local realism of a violation at least as high as that witnessed. Thus, high violation corresponds to small p value. We propose a prediction-based-ratio (PBR) analysis protocol whose p values are valid even if the prepared quantum state varies arbitrarily and local realistic models can depend on previous measurement settings and outcomes. It is therefore not subject to the memory loophole [J. Barrett et al., Phys. Rev. A 66, 042111 (2002)]. If the prepared state does not vary in time, the p values are asymptotically optimal. For comparison, we consider protocols derived from the number of standard deviations of violation of a Bell inequality and from martingale theory [R. Gill, e-print arXiv:quant-ph/0110137]. We find that the p values of the former can be too small and are therefore not statistically valid, while those derived from the latter are suboptimal. PBR p values do not require a predetermined Bell inequality and can be used to compare results from different tests of local realism independent of experimental details.

  1. [The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods].

    Science.gov (United States)

    Moudouni, S M; Zahraoui, M R; Adarmouch, L; Lakmichi, M A; Bentani, N; Jarir, R; Dahami, Z; Amine, M; Sarf, I

    2014-02-01

    The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol. Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3). There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3. The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Improved Particle Swarm Optimization with a Collective Local Unimodal Search for Continuous Optimization Problems

    Science.gov (United States)

    Arasomwan, Martins Akugbe; Adewumi, Aderemi Oluyinka

    2014-01-01

    A new local search technique is proposed and used to improve the performance of particle swarm optimization algorithms by addressing the problem of premature convergence. In the proposed local search technique, a potential particle position in the solution search space is collectively constructed by a number of randomly selected particles in the swarm. The number of times the selection is made varies with the dimension of the optimization problem and each selected particle donates the value in the location of its randomly selected dimension from its personal best. After constructing the potential particle position, some local search is done around its neighbourhood in comparison with the current swarm global best position. It is then used to replace the global best particle position if it is found to be better; otherwise no replacement is made. Using some well-studied benchmark problems with low and high dimensions, numerical simulations were used to validate the performance of the improved algorithms. Comparisons were made with four different PSO variants, two of the variants implement different local search technique while the other two do not. Results show that the improved algorithms could obtain better quality solution while demonstrating better convergence velocity and precision, stability, robustness, and global-local search ability than the competing variants. PMID:24723827

  3. Effectiveness of various formulations of local anesthetics and additives for topical anesthesia – a prospective, randomized, double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Weilbach C

    2017-05-01

    , the addition of trometamol (Tris/THAM accelerated the onset of the effect compared to the native formulation (at 0.4 and 0.8 N. In all of the adult subjects of this study, the minimum exposure time was 60 min for any of the tested topical anesthetic creams.Conclusion: The results of this study indicate that a cream containing 20% lidocaine, 38% trometamol and 10% propylene glycol may be used as an alternative to lidocaine/prilocaine with a comparable effect and without the need to extend exposure time. Keywords: local anesthetics, topical anesthesia, EMLA®, topical anesthetic cream, lidocaine, prilocaine 

  4. Factors predictive of the onset and duration of action of local anesthesia in mandibular third-molar surgery: a prospective study.

    Science.gov (United States)

    Al-Shayyab, Mohammad H; Baqain, Zaid H

    2018-04-01

    The aim of this study was to assess the influence of patients' and surgical variables on the onset and duration of action of local anesthesia (LA) in mandibular third-molar (M3) surgery. Patients scheduled for mandibular M3 surgery were considered for inclusion in this prospective cohort study. Patients' and surgical variables were recorded. Two per cent (2%) lidocaine with 1:100,000 epinephrine was used to block the nerves for extraction of mandibular M3. Then, the onset of action and duration of LA were monitored. Univariate analysis and multivariate regression analysis were used to analyze the data. The final cohort included 88 subjects (32 men and 56 women; mean age ± SD = 29.3 ± 12.3 yr). With univariate analysis, age, gender, body mass index (BMI), smoking quantity and duration, operation time, and 'volume of local anesthetic needed' significantly influenced the onset of action and duration of LA. Multivariate regression revealed that age and smoking quantity were the only statistically significant predictors of the onset of action of LA, whereas age, smoking quantity, and 'volume of local anesthetic needed' were the only statistically significant predictors of duration of LA. Further studies are recommended to uncover other predictors of the onset of action and duration of LA. © 2018 Eur J Oral Sci.

  5. Poloxamer 407/188 binary thermosensitive hydrogels as delivery systems for infiltrative local anesthesia: Physico-chemical characterization and pharmacological evaluation

    International Nuclear Information System (INIS)

    Akkari, Alessandra C.S.; Papini, Juliana Z. Boava; Garcia, Gabriella K.; Franco, Margareth K.K. Dias; Cavalcanti, Leide P.; Gasperini, Antonio; Alkschbirs, Melissa Inger; Yokaichyia, Fabiano; Paula, Eneida de; Tófoli, Giovana R.; Araujo, Daniele R. de

    2016-01-01

    In this study, we reported the development and the physico-chemical characterization of poloxamer 407 (PL407) and poloxamer 188 (PL188) binary systems as hydrogels for delivering ropivacaine (RVC), as drug model, and investigate their use in infiltrative local anesthesia for applications on the treatment of post-operative pain. We studied drug-micelle interaction and micellization process by light scattering and differential scanning calorimetry (DSC), the sol-gel transition and hydrogel supramolecular structure by small-angle-X-ray scattering (SAXS) and morphological evaluation by Scanning Electron Microscopy (SEM). In addition, we have presented the investigation of drug release mechanisms, in vitro/in vivo toxic and analgesic effects. Micellar dimensions evaluation showed the formation of PL407-PL188 mixed micelles and the drug incorporation, as well as the DSC studies showed increased enthalpy values for micelles formation after addition of PL 188 and RVC, indicating changes on self-assembly and the mixed micelles formation evoked by drug incorporation. SAXS studies revealed that the phase organization in hexagonal structure was not affected by RVC insertion into the hydrogels, maintaining their supramolecular structure. SEM analysis showed similar patterns after RVC addition. The RVC release followed the Higuchi model, modulated by the PL final concentration and the insertion of PL 188 into the system. Furthermore, the association PL407-PL188 induced lower in vitro cytotoxic effects, increased the duration of analgesia, in a single-dose model study, without evoking in vivo inflammation signs after local injection. - Highlights: • We present the development and relationships between physico-chemical and biopharmaceutical/pharmacological parameters for the PL407-PL188 binary hydrogel, as well as its use for infiltrative local anesthesia • The addition of PL188 and RVC evoked changes on enthalpy values, self-assembly and the mixed micelles formation • The

  6. Poloxamer 407/188 binary thermosensitive hydrogels as delivery systems for infiltrative local anesthesia: Physico-chemical characterization and pharmacological evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Akkari, Alessandra C.S. [Human and Natural Sciences Center, ABC Federal University, Santo André, SP (Brazil); Papini, Juliana Z. Boava [São Francisco University, Bragança Paulista, São Paulo (Brazil); Garcia, Gabriella K. [Human and Natural Sciences Center, ABC Federal University, Santo André, SP (Brazil); Franco, Margareth K.K. Dias [Nuclear and Energy Research Institute, São Paulo, SP (Brazil); Cavalcanti, Leide P. [School of Chemical Engineering, University of Campinas, SP (Brazil); Gasperini, Antonio; Alkschbirs, Melissa Inger [Brazilian Synchrotron Light Laboratory, Campinas, SP (Brazil); Yokaichyia, Fabiano [Department Quantum Phenomena in Novel Materials Helmholtz-Zentrum Berlin für Materialien und Energie GmbH, Berlin (Germany); Paula, Eneida de [Department of Biochemistry, Institute of Biology, State University of Campinas, Campinas, SP (Brazil); Tófoli, Giovana R. [Faculty of Dentistry São Leopoldo Mandic, Campinas, São Paulo (Brazil); Araujo, Daniele R. de, E-mail: daniele.araujo@ufabc.edu.br [Human and Natural Sciences Center, ABC Federal University, Santo André, SP (Brazil)

    2016-11-01

    In this study, we reported the development and the physico-chemical characterization of poloxamer 407 (PL407) and poloxamer 188 (PL188) binary systems as hydrogels for delivering ropivacaine (RVC), as drug model, and investigate their use in infiltrative local anesthesia for applications on the treatment of post-operative pain. We studied drug-micelle interaction and micellization process by light scattering and differential scanning calorimetry (DSC), the sol-gel transition and hydrogel supramolecular structure by small-angle-X-ray scattering (SAXS) and morphological evaluation by Scanning Electron Microscopy (SEM). In addition, we have presented the investigation of drug release mechanisms, in vitro/in vivo toxic and analgesic effects. Micellar dimensions evaluation showed the formation of PL407-PL188 mixed micelles and the drug incorporation, as well as the DSC studies showed increased enthalpy values for micelles formation after addition of PL 188 and RVC, indicating changes on self-assembly and the mixed micelles formation evoked by drug incorporation. SAXS studies revealed that the phase organization in hexagonal structure was not affected by RVC insertion into the hydrogels, maintaining their supramolecular structure. SEM analysis showed similar patterns after RVC addition. The RVC release followed the Higuchi model, modulated by the PL final concentration and the insertion of PL 188 into the system. Furthermore, the association PL407-PL188 induced lower in vitro cytotoxic effects, increased the duration of analgesia, in a single-dose model study, without evoking in vivo inflammation signs after local injection. - Highlights: • We present the development and relationships between physico-chemical and biopharmaceutical/pharmacological parameters for the PL407-PL188 binary hydrogel, as well as its use for infiltrative local anesthesia • The addition of PL188 and RVC evoked changes on enthalpy values, self-assembly and the mixed micelles formation • The

  7. [Anesthesia in bronchial asthma].

    Science.gov (United States)

    Bremerich, D H

    2000-09-01

    Asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli. Characteristic clinical symptoms of asthma are bronchial hyperreactivity, reversible airway obstruction, wheezing and dyspnea. Asthma presents a major public health problem with increasing prevalence rates and severity worldwide. Despite major advances in our understanding of the clinical management of asthmatic patients, it remains a challenging population for anesthesiologists in clinical practice. The anesthesiologist's responsibility starts with the preoperative assessment and evaluation of the pulmonary function. For patients with asthma who currently have no symptoms, the risk of perioperative respiratory complications is extremely low. Therefore, pulmonary function should be optimized preoperatively and airway obstruction should be controlled by using steroids and bronchodilators. Preoperative spirometry is a simple means of assessing presence and severity of airway obstruction as well as the degree of reversibility in response to bronchodilator therapy. An increase of 15% in FEV1 is considered clinically significant. Most asymptomatic persons with asthma can safely undergo general anesthesia with and without endotracheal intubation. Volatile anesthetics are still recommended for general anesthetic techniques. As compared to barbiturates and even ketamine, propofol is considered to be the agent of choice for induction of anesthesia in asthmatics. The use of regional anesthesia does not reduce perioperative respiratory complications in asymptomatic asthmatics, whereas it is advantageous in symptomatic patients. Pregnant asthmatic and parturients undergoing anesthesia are at increased risk, especially if regional anesthetic techniques are not suitable and prostaglandin and its derivates are administered for abortion or operative delivery. Bronchial hyperreactivity associated with asthma is an important risk factor of perioperative bronchospasm. The

  8. Optimization of initial propofol bolus dose for EEG Narcotrend Index-guided transition from sevoflurane induction to intravenous anesthesia in children.

    Science.gov (United States)

    Dennhardt, Nils; Boethig, Dietmar; Beck, Christiane; Heiderich, Sebastian; Boehne, Martin; Leffler, Andreas; Schultz, Barbara; Sümpelmann, Robert

    2017-04-01

    Sevoflurane induction followed by intravenous anesthesia is a widely used technique to combine the benefits of an easier and less traumatic venipuncture after sevoflurane inhalation with a recovery with less agitation, nausea, and vomiting after total intravenous anesthesia (TIVA). Combination of two different anesthetics may lead to unwanted burst suppression in the electroencephalogram (EEG) during the transition phase. The objective of this prospective clinical observational study was to identify the optimal initial propofol bolus dose for a smooth transition from sevoflurane induction to TIVA using the EEG Narcotrend Index (NI). Fifty children aged 1-8 years scheduled for elective pediatric surgery were studied. After sevoflurane induction and establishing of an intravenous access, a propofol bolus dose range 0-5 mg·kg -1 was administered at the attending anesthetist's discretion to maintain a NI between 20 and 64, and sevoflurane was stopped. Anesthesia was continued as TIVA with a propofol infusion dose of 15 mg·kg -1 ·h -1 for the first 15 min, followed by stepwise reduction according to McFarlan's pediatric infusion regime, and remifentanil 0.25 μg·kg -1 ·min -1 . Endtidal concentration of sevoflurane, NI, and hemodynamic data were recorded during the whole study period using a standardized case report form. Propofol plasma concentrations were calculated using the paedfusor dataset and a TIVA simulation program. Median endtidal concentration of sevoflurane at the time of administration of the propofol bolus was 5.1 [IQR 4.7-5.9] Vol%. The median propofol bolus dose was 1.2 [IQR 0.9-2.5] mg·kg -1 and median NI thereafter was 33 [IQR 23-40]. Nine children presented with a NI 13-20 and three children with burst suppression in the EEG (NI 0-12); all of them received an initial propofol bolus dose >2 mg·kg -1 . Regression equation demonstrated that NI 20-64 was achieved with a 95% probability when using a propofol bolus dose of 1 mg·kg -1 after

  9. Grey Wolf Optimizer Based on Powell Local Optimization Method for Clustering Analysis

    Directory of Open Access Journals (Sweden)

    Sen Zhang

    2015-01-01

    Full Text Available One heuristic evolutionary algorithm recently proposed is the grey wolf optimizer (GWO, inspired by the leadership hierarchy and hunting mechanism of grey wolves in nature. This paper presents an extended GWO algorithm based on Powell local optimization method, and we call it PGWO. PGWO algorithm significantly improves the original GWO in solving complex optimization problems. Clustering is a popular data analysis and data mining technique. Hence, the PGWO could be applied in solving clustering problems. In this study, first the PGWO algorithm is tested on seven benchmark functions. Second, the PGWO algorithm is used for data clustering on nine data sets. Compared to other state-of-the-art evolutionary algorithms, the results of benchmark and data clustering demonstrate the superior performance of PGWO algorithm.

  10. Analgesia/anesthesia for external cephalic version.

    Science.gov (United States)

    Weiniger, Carolyn F

    2013-06-01

    Professional society guidelines recommend that women with breech presentation be delivered surgically due to a higher incidence of fetal risks compared with vaginal delivery. An alternative is attempted external cephalic version, which if successful, enables attempted vaginal delivery. Attitudes towards external cephalic version (ECV) will be considered in this review, along with pain relief methods and their impact on ECV success rates. Articles suggest that ECV is infrequently offered, due to both physician and patient factors. Success of ECV is higher in multiparous women, complete breech, posterior placenta, or smaller fetus. Preterm ECV performance does not increase vaginal delivery rates. Neuraxial techniques (spinal or epidural) significantly increase ECV success rates, as do moxibustion and hypnosis. Four reviews summarized studies considering ECV and neuraxial techniques. These reviews suggest that neuraxial techniques using high (surgical) doses of local anesthetic are efficacious compared with control groups not using anesthesia, whereas techniques using low-doses are not. Low-dose versus high-dose neuraxial analgesia/anesthesia has not been directly compared in a single study. Based on currently available data, the rate of cephalic presentation is not increased using neuraxial techniques, but vaginal delivery rates are higher. ECV appears to be a low-risk procedure. The logistics of routine ECV and provision of optimal neuraxial techniques for successful ECV require additional research. Safety aspects of neuraxial anesthesia for ECV require further investigation.

  11. Administration of Anesthesia

    Medline Plus

    Full Text Available ... OMS Office Part I Introduction and History of Dental Anesthesia Part II OMS Education and Training Part III The OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad ...

  12. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Anesthesia Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) are trained in all aspects of anesthesia administration. Following dental ... evaluate patients for anesthesia, deliver the anesthetic and monitor post- ...

  13. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... SAMBA Link Digital Newsletter Educational Bibliography Research IARS/Anesthesia & Analgesia SCOR About SCOR Sponsor SAMBA Meetings Affinity Sponsor Program We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, ...

  14. Administration of Anesthesia

    Medline Plus

    Full Text Available ... and History of Dental Anesthesia Part II OMS Education and Training Part III The OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad Access to Care, Patient Safety ...

  15. Administration of Anesthesia

    Medline Plus

    Full Text Available ... We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral ... of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery ...

  16. Administration of Anesthesia

    Medline Plus

    Full Text Available ... in the OMS Office Part I Introduction and History of Dental Anesthesia Part II OMS Education and Training Part III The OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad ...

  17. Administration of Anesthesia

    Medline Plus

    Full Text Available ... further information Anesthesia: Safety and Comfort in the OMS Office Part I Introduction and History of Dental Anesthesia Part II OMS Education and Training Part III The OMS Anesthesia ...

  18. Optimal growth entails risky localization in population dynamics

    Science.gov (United States)

    Gueudré, Thomas; Martin, David G.

    2018-03-01

    Essential to each other, growth and exploration are jointly observed in alive and inanimate entities, such as animals, cells or goods. But how the environment's structural and temporal properties weights in this balance remains elusive. We analyze a model of stochastic growth with time correlations and diffusive dynamics that sheds light on the way populations grow and spread over general networks. This model suggests natural explanations of empirical facts in econo-physics or ecology, such as the risk-return trade-off and the Zipf law. We conclude that optimal growth leads to a localized population distribution, but such risky position can be mitigated through the space geometry. These results have broad applicability and are subsequently illustrated over an empirical study of financial data.

  19. Painful stimulation and transient blocking of nerve transduction due to local anesthesia evoke perceptual distortions of the face in healthy volunteers.

    Science.gov (United States)

    Skyt, Ina; Dagsdóttir, Lilja; Vase, Lene; Baad-Hansen, Lene; Castrillon, Eduardo; Roepstorff, Andreas; Jensen, Troels Staehelin; Svensson, Peter

    2015-04-01

    Anecdotally, orofacial pain patients sometimes report that the painful face area feels "swollen." Because there are no clinical signs of swelling, such illusions may represent perceptual distortions. In this study, we examine whether nociceptive stimulation can lead to perceptual distortion of the face in a way similar to that of local anesthesia. Sixteen healthy participants received injections of .4 mL hypertonic saline to induce short-term nociceptive stimulation, .4 mL mepivacaine (local anesthetic) to transiently block nerve transduction, and .4 mL isotonic saline as a control condition. Injections were administered in both the infraorbital and the mental nerve regions. Perceptual distortions were conceptualized as perceived changes in magnitude of the injected areas and the lips, and they were measured using 1) a verbal subjective rating scale and 2) a warping procedure. Prior to the study, participants filled in several psychological questionnaires. This study shows that both nociceptive stimulation (P blocking of nerve transduction (P face. A test-retest experiment including 9 new healthy subjects supported the results. Perceptual distortions were positively correlated with the psychological variable of dissociation in several conditions (P face is important to understand the possible implications of perceptual distortions in orofacial pain disorders (and possibly other chronic pain states). Such information may ultimately open up new avenues of treatment for persistent orofacial pain. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  20. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

    Directory of Open Access Journals (Sweden)

    Aleksandra Gavrilovska-Brzanov

    2016-02-01

    CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

  1. First-principle optimal local pseudopotentials construction via optimized effective potential method

    International Nuclear Information System (INIS)

    Mi, Wenhui; Zhang, Shoutao; Wang, Yanchao; Ma, Yanming; Miao, Maosheng

    2016-01-01

    The local pseudopotential (LPP) is an important component of orbital-free density functional theory, a promising large-scale simulation method that can maintain information on a material’s electron state. The LPP is usually extracted from solid-state density functional theory calculations, thereby it is difficult to assess its transferability to cases involving very different chemical environments. Here, we reveal a fundamental relation between the first-principles norm-conserving pseudopotential (NCPP) and the LPP. On the basis of this relationship, we demonstrate that the LPP can be constructed optimally from the NCPP for a large number of elements using the optimized effective potential method. Specially, our method provides a unified scheme for constructing and assessing the LPP within the framework of first-principles pseudopotentials. Our practice reveals that the existence of a valid LPP with high transferability may strongly depend on the element.

  2. Needle localization using a moving stylet/catheter in ultrasound-guided regional anesthesia: a feasibility study

    Science.gov (United States)

    Beigi, Parmida; Rohling, Robert

    2014-03-01

    Despite the wide range and long history of ultrasound guided needle insertions, an unresolved issue in many cases is clear needle visibility. A well-known ad hoc technique to detect the needle is to move the stylet and look for changes in the needle appearance. We present a new method to automatically locate a moving stylet/catheter within a stationary cannula using motion detection. We then use this information to detect the needle trajectory and the tip. The differences between the current frame and the previous frame are detected and localized, to minimize the influence of tissue global motions. A polynomial fit based on the detected needle axis determines the estimated stylet shaft trajectory, and the extent of the differences along the needle axis represents the tip. Over a few periodic movements of the stylet including its full insertion into the cannula to the tip, a combination of polynomial fits determines the needle trajectory and the last detected point represents the needle tip. Experiments are conducted in water bath and bovine muscle tissue for several stylet/catheter materials. Results show that a plastic stylet has the best needle shaft and tip localization accuracy in the water bath with RMSE = 0:16 mm and RMSE = 0:51 mm, respectively. In the bovine tissue, the needle tip was best localized with the plastic catheter with RMSE = 0:33 mm. The stylet tip localization was most accurate with the steel stylet, with RMSE = 2:81 mm and the shaft was best localized with the plastic catheter, with RMSE = 0:32 mm.

  3. Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars.

    Science.gov (United States)

    Venkat Narayanan, J; Gurram, Prashanthi; Krishnan, Radhika; Muthusubramanian, Veerabahu; Sadesh Kannan, V

    2017-09-01

    The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline. A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias. The pain scores in both groups were analyzed using the Mann-Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted. From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

  4. Types of Anesthesia

    Science.gov (United States)

    ... Videos for Educators Search English Español Types of Anesthesia KidsHealth / For Teens / Types of Anesthesia What's in ... Get? Print en español Tipos de anestesia About Anesthesia Anesthesia is broken down into three main categories: ...

  5. 21 CFR 868.5150 - Anesthesia conduction needle.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient to...

  6. Towards Optimal Event Detection and Localization in Acyclic Flow Networks

    KAUST Repository

    Agumbe Suresh, Mahima

    2012-01-03

    Acyclic flow networks, present in many infrastructures of national importance (e.g., oil & gas and water distribution systems), have been attracting immense research interest. Existing solutions for detecting and locating attacks against these infrastructures, have been proven costly and imprecise, especially when dealing with large scale distribution systems. In this paper, to the best of our knowledge for the first time, we investigate how mobile sensor networks can be used for optimal event detection and localization in acyclic flow networks. Sensor nodes move along the edges of the network and detect events (i.e., attacks) and proximity to beacon nodes with known placement in the network. We formulate the problem of minimizing the cost of monitoring infrastructure (i.e., minimizing the number of sensor and beacon nodes deployed), while ensuring a degree of sensing coverage in a zone of interest and a required accuracy in locating events. We propose algorithms for solving these problems and demonstrate their effectiveness with results obtained from a high fidelity simulator.

  7. Poloxamer 407/188 binary thermosensitive hydrogels as delivery systems for infiltrative local anesthesia: Physico-chemical characterization and pharmacological evaluation.

    Science.gov (United States)

    Akkari, Alessandra C S; Papini, Juliana Z Boava; Garcia, Gabriella K; Franco, Margareth K K Dias; Cavalcanti, Leide P; Gasperini, Antonio; Alkschbirs, Melissa Inger; Yokaichyia, Fabiano; de Paula, Eneida; Tófoli, Giovana R; de Araujo, Daniele R

    2016-11-01

    In this study, we reported the development and the physico-chemical characterization of poloxamer 407 (PL407) and poloxamer 188 (PL188) binary systems as hydrogels for delivering ropivacaine (RVC), as drug model, and investigate their use in infiltrative local anesthesia for applications on the treatment of post-operative pain. We studied drug-micelle interaction and micellization process by light scattering and differential scanning calorimetry (DSC), the sol-gel transition and hydrogel supramolecular structure by small-angle-X-ray scattering (SAXS) and morphological evaluation by Scanning Electron Microscopy (SEM). In addition, we have presented the investigation of drug release mechanisms, in vitro/in vivo toxic and analgesic effects. Micellar dimensions evaluation showed the formation of PL407-PL188 mixed micelles and the drug incorporation, as well as the DSC studies showed increased enthalpy values for micelles formation after addition of PL 188 and RVC, indicating changes on self-assembly and the mixed micelles formation evoked by drug incorporation. SAXS studies revealed that the phase organization in hexagonal structure was not affected by RVC insertion into the hydrogels, maintaining their supramolecular structure. SEM analysis showed similar patterns after RVC addition. The RVC release followed the Higuchi model, modulated by the PL final concentration and the insertion of PL 188 into the system. Furthermore, the association PL407-PL188 induced lower in vitro cytotoxic effects, increased the duration of analgesia, in a single-dose model study, without evoking in vivo inflammation signs after local injection. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

    OpenAIRE

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2011-01-01

    Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite...

  9. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia

    OpenAIRE

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2011-01-01

    Objective: To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. Material and method: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two ...

  10. Comparison of Depth of Anesthesia in Different Parts of Maxilla When Only Buccal Anesthesia Was Done for Maxillary Teeth Extraction

    OpenAIRE

    Isik, Kubilay; Kalayci, Abdullah; Durmus, Ercan

    2011-01-01

    Objective. Recently, some authors reported that maxillary teeth could be extracted without using palatal anesthesia, but they did not clearly specify the extracted teeth. This is important, because apparently the local anesthetic solution infiltrates the maxilla and achieves a sufficient anesthesia in the palatal side. Thus, thickness of the bone may affect the depth of anesthesia. The aim of this study was to compare the depth of anesthesia in different parts of the maxilla when only a bucca...

  11. Assessment of patient’s anxiety and expectation associated with hemodynamic changes during surgical procedure under local anesthesia

    Directory of Open Access Journals (Sweden)

    Marcos Vinícius Mendes DANTAS

    Full Text Available Abstract Introduction The dental patient’s anxiety and expectation may significantly alter their vital signs. The use of local anesthetics associated with a vasoconstrictor may also alter the vital signs of these patients, promoting hemodynamic changes that may result in emergency situations. Objective To evaluate the influence of anxiety of patients submitted to third molar extraction and the use of different anesthetic substances with adrenaline on their vital signs (oxygen saturation, heart rate, and systolic and diastolic blood pressure in different moments. Material and method Forty patients answered the questionnaire of the Dental Anxiety Scale (Corah’s Scale and fear (KleinKnecht’s Scale and were submitted to third molar extraction in two surgical times for the use of articaine or mepivacaine, both associated with adrenaline. The results were analyzed by ANOVA followed by Tukey post hoc test, Student's t test, and Pearson's correlation coefficients (α=0.05. Result There was no significant differences in saturation or heart rate. The blood pressure showed significant variations during time for both anesthetics, however mepivacaine resulted in a longer postoperative time to restore blood pressure. Patients with high or moderate anxiety and high fear index were those who had positive correlations with the highest blood pressure values. Conclusion Anxiety and fear positively influence the increase in blood pressure. Mepivacaine promoted a greater resistance to the return of normal vital signs, especially blood pressure levels.

  12. Spinal anesthesia; the Holy Grail?

    Directory of Open Access Journals (Sweden)

    Voet M

    2017-06-01

    Full Text Available Marieke Voet, Cornelis SlagtDepartment of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The NetherlandsAfter reading the paper recently published in Local and Regional Anesthesia by Whitaker et al:1 “Spinal anesthesia after intraoperative cardiac arrest during general anesthesia in an infant,” we would like to share our thoughts. In a recently published paper by Habre et al,2 the incidence of severe critical events in pediatric anesthesia was investigated. In 261 hospitals across Europe (33 countries, severe critical events were registered. In total, 31,127 anesthetic procedures in 30,874 children were included. Age, medical history, and physical condition were the major risk factors for a serious critical event. In total, 1,478 patients had a critical event, most of them during or immediately after anesthesia. Children younger than 3 years of age are at risk for critical events.View the original paper by Whitaker and colleagues.

  13. Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia.

    Science.gov (United States)

    Manolis, Antonis S; Georgiopoulos, Georgios; Metaxa, Sofia; Koulouris, Spyridon; Tsiachris, Dimitris

    2017-10-01

    We have previously reported our successful approach for percutaneous cardiac implantable electronic device (CIED) lead extraction using inexpensive tools, which we have continued over the years. Herein we report the results of the systematic use of a unique stylet, the lead-locking device (LLD), which securely locks the entire lead lumen, aided with non-powered telescoping sheaths in 54 patients to extract 98 CIED leads. This prospective observational clinical study included 38 men and 16 women aged 68.9±13.1 years undergoing lead extraction for device infection (n=46), lead malfunction (n=5), or prior to defibrillator implant (n=3). Leads were in place for 6.7±4.3 years. Infections were more commonly due to Staphylococcus species (n=40). There were 78 pacing (31 ventricular, 37 atrial, 4 VDD, and 6 coronary sinus leads) and 20 defibrillating leads. Using simple traction (6 leads) and the LLD stylets (92 leads) aided with telescoping sheaths (15 patients), 96 (98%) leads in 52 (96.3%) patients were successfully removed, with all but one leads removed using a subclavian approach; in 1 patient, the right femoral approach was also required. In 2 patients, distal fragments from one ventricular pacing and one defibrillating lead could not be removed. Finally, lead removal was completely (52/54) (96.3%) or partially (2/54) (3.7%) successful in 54 patients for 96 of 98 leads (98%) without major complications. Percutaneous lead extraction can be successful with mechanical tools using the LLD locking stylet aided with non-powered telescoping sheaths through a simplified, safe, and inexpensive procedure using local anesthesia.

  14. Initial Experience Performing In-office Ultrasound-guided Transperineal Prostate Biopsy Under Local Anesthesia Using the PrecisionPoint Transperineal Access System.

    Science.gov (United States)

    Meyer, Alexa R; Joice, Gregory A; Schwen, Zeyad R; Partin, Alan W; Allaf, Mohamad E; Gorin, Michael A

    2018-05-01

    To describe our procedural technique and initial outcomes performing in-office transperineal prostate biopsies using the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD). Following institutional review board approval, we retrospectively reviewed the records of men who underwent an in-office transperineal prostate biopsy using the PrecisionPoint device. Records were reviewed for baseline characteristics, biopsy results, and postbiopsy complications. Between January 4, 2017 and August 23, 2017, 43 men underwent an in-office transperineal prostate biopsy using the PrecisionPoint Transperineal Access System. Patients had a median serum prostate specific antigen level of 6.1 ng/mL (range 0.8-32.9). Of the 43 biopsies, 12 (27.9%) were performed for active surveillance of low-risk prostate cancer and 31 (72.1%) were performed for cancer screening. Overall, 21 (48.8%) men were found to have prostate cancer. Among those on active surveillance, cancer was detected in 8 of 12 (66.7%) patients, with 2 of 12 (16.7%) found to have Gleason ≥3 + 4 = 7 prostate cancer. Additionally, cancer was detected in 13 of 31 (41.9%) patients undergoing a biopsy for prostate cancer screening, with 5 (16.1%) found to have Gleason ≥3 + 4 = 7 disease. In total, 3 (7.0%) patients experienced a postbiopsy complication: 2 (4.7%) with urinary retention and 1 (2.3%) with gross hematuria requiring catheterization. No patient experienced an infectious complication despite omission of periprocedural antibiotics in all cases. The PrecisionPoint device allowed for the successful performance of in-office transperineal prostate biopsies under local anesthesia without the need for periprocedural antibiotics. We observed an acceptable cancer detection rate with no infectious complications. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6-11-year-old children during local anesthesia administration-a novel approach.

    Science.gov (United States)

    Melwani, Anjana M; Srinivasan, Ila; Setty, Jyothsna V; D R, Murali Krishna; Pamnani, Sunaina S; Lalitya, Dandamudi

    2018-02-01

    The sight of dental injection can bring about severe anxiety in children. Therefore, an alternative method that is convenient, effective, and keeps the needle hidden making it child friendly is necessary. The objective of the study was to compare the efficacy of a camouflaged syringe and conventional syringe on behavior and anxiety in 6-11-year-old children during local anesthesia administration. The study was a randomized, crossover clinical study including 30 children. Children were separated into two groups. Group 1 consisted of 15 children aged 6-8 years while group 2 consisted of 15 children aged 9-11 years. This study involved two sessions wherein all the children were injected using conventional and camouflaged syringes in separate sessions. Their behavior was assessed using the Faces, Legs, Activity, Cry, Consolability (FLACC) behavior pain scale and anxiety was assessed by measuring changes in pulse rate. Patient and operator preferences were compared. The results showed a lower mean change in pulse rate and FLACC scores in the camouflaged group, suggesting a positive behavior and lesser anxiety with camouflaged syringes than with conventional syringes. The use of camouflaged syringes for anesthesia was demonstrated to be effective in improving the behavior of children and decreasing their anxiety, and is therefore recommended as an alternative to the use of conventional syringes for local anesthesia.

  16. Administration of Anesthesia

    Medline Plus

    Full Text Available ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four ... complications and emergencies that may arise during the administration of anesthesia. Before your surgery, your OMS will ...

  17. Administration of Anesthesia

    Science.gov (United States)

    ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four ... complications and emergencies that may arise during the administration of anesthesia. Before your surgery, your OMS will ...

  18. Administration of Anesthesia

    Medline Plus

    Full Text Available ... in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS residents serve on the medical anesthesiology service, where they evaluate patients for anesthesia, ...

  19. Administration of Anesthesia

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  20. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  1. Administration of Anesthesia

    Medline Plus

    Full Text Available ... more. Anesthesia Download Download the ebook for further information Anesthesia: Safety and Comfort in the OMS Office ... comfortable as possible when you get home. The information provided here is not intended as a substitute ...

  2. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Part III The OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons ( ...

  3. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Training Part III The OMS Anesthesia Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) ...

  4. Theory and Algorithms for Global/Local Design Optimization

    National Research Council Canada - National Science Library

    Haftka, Raphael T

    2004-01-01

    ... the component and overall design as well as on exploration of global optimization algorithms. In the former category, heuristic decomposition was followed with proof that it solves the original problem...

  5. Optimal Local Dimming for LC Image Formation With Controllable Backlighting

    DEFF Research Database (Denmark)

    Shu, Xiao; Wu, Xiaolin; Forchhammer, Søren

    2013-01-01

    Light emitting diode (LED)-backlit liquid crystal displays (LCDs) hold the promise of improving image quality while reducing the energy consumption with signal-dependent local dimming. However, most existing local dimming algorithms are mostly motivated by simple implementation, and they often la...

  6. Indoor Localization for Optimized Ambient Assisted Living Services

    DEFF Research Database (Denmark)

    Mitev, Miroslav; Mihovska, Albena Dimitrova; Poulkov, Vladimir

    Indoor localization is very critical for the provision of Ambient Assisted Living (AAL) services, such as e-Health, smart home, etc. The success of deploying a real-time localization system depends on selecting the right performance characteristics. Bluetooth Low Energy (BLE) is a technology, which...

  7. Geometry optimization of molecules within an LCGTO local-density functional approach

    International Nuclear Information System (INIS)

    Mintmire, J.W.

    1990-01-01

    We describe our implementation of geometry optimization techniques within the linear combination of Gaussian-type orbitals (LCGTO) approach to local-density functional theory. The algorithm for geometry optimization is based on the evaluation of the gradient of the total energy with respect to internal coordinates within the local-density functional scheme. We present optimization results for a range of small molecules which serve as test cases for our approach

  8. Improved quantum-behaved particle swarm optimization with local search strategy

    Directory of Open Access Journals (Sweden)

    Maolong Xi

    2017-03-01

    Full Text Available Quantum-behaved particle swarm optimization, which was motivated by analysis of particle swarm optimization and quantum system, has shown compared performance in finding the optimal solutions for many optimization problems to other evolutionary algorithms. To address the problem of premature, a local search strategy is proposed to improve the performance of quantum-behaved particle swarm optimization. In proposed local search strategy, a super particle is presented which is a collection body of randomly selected particles’ dimension information in the swarm. The selected probability of particles in swarm is different and determined by their fitness values. To minimization problems, the fitness value of one particle is smaller; the selected probability is more and will contribute more information in constructing the super particle. In addition, in order to investigate the influence on algorithm performance with different local search space, four methods of computing the local search radius are applied in local search strategy and propose four variants of local search quantum-behaved particle swarm optimization. Empirical studies on a suite of well-known benchmark functions are undertaken in order to make an overall performance comparison among the proposed methods and other quantum-behaved particle swarm optimization. The simulation results show that the proposed quantum-behaved particle swarm optimization variants have better advantages over the original quantum-behaved particle swarm optimization.

  9. Optimizing the Management of High-Risk, Localized Prostate Cancer

    OpenAIRE

    Sundi, Debasish; Jeong, Byong Chang; Lee, Seung Bae; Han, Misop

    2012-01-01

    Prostate cancer has a high prevalence and a rising incidence in many parts of the world. Although many screen-detected prostate cancers may be indolent, prostate cancer remains a major contributor to mortality in men. Therefore, the appropriate diagnosis and treatment of localized prostate cancer with lethal potential are of great importance. High-risk, localized prostate cancer has multiple definitions. Treatment options that should be individualized to each patient include observation, radi...

  10. How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child?

    OpenAIRE

    Lee, Dong-Hee

    2016-01-01

    The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should kee...

  11. Role of intraseptal anesthesia for pain-free dental treatment.

    Science.gov (United States)

    Gazal, G; Fareed, W M; Zafar, M S

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  12. Role of intraseptal anesthesia for pain-free dental treatment

    Directory of Open Access Journals (Sweden)

    G Gazal

    2016-01-01

    Full Text Available Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003, and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine, and intraosseous injection (2% lidocaine are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  13. "Acupuncture anesthesia"--a clinical study.

    Science.gov (United States)

    Modell, J H; Lee, P K; Bingham, H G; Greer, D M; Habal, M B

    1976-01-01

    Forty-two patients who were to undergo plastic surgical procedures were asked whether they would accept acupuncture as a substitute for local anesthesia. Eight patients agreed to acupuncture; one of these had 2 operative procedures with acupuncture. Five of the 9 procedures were successful; the remaining 4 required conversion to local anesthesia. After interviewing the patients, we felt that the success of "acupuncture anesthesia" was largely dependent on patient motivation, and that a patient may experience pain during surgical procedures without any change in facial expression or vital signs. We concluded that "acupuncture anesthesia" is of little value in our patient population at present. Its results are unpredictable; therefore, we anticipate that patient acceptance will be small.

  14. Optimal algebraic multilevel preconditioning for local refinement along a line

    NARCIS (Netherlands)

    Margenov, S.D.; Maubach, J.M.L.

    1995-01-01

    The application of some recently proposed algebraic multilevel methods for the solution of two-dimensional finite element problems on nonuniform meshes is studied. The locally refined meshes are created by the newest vertex mesh refinement method. After the introduction of this refinement technique

  15. Towards optimal design of locally resonant acoustic metamaterials

    NARCIS (Netherlands)

    Krushynska, A.O.; Kouznetsova, V.; Geers, M.G.D.

    2014-01-01

    The paper presents an in-depth analysis of solid locally resonant acoustic metamaterials (LRAMs) consisting of rubber-coated inclusions. Dispersion properties of two-dimensional LRAMs are studied by means of finite-element modal analysis. For an incompressible rubber, only one practically important

  16. Measurement and Optimization of Local Coupling from RHIC BPM Data

    CERN Document Server

    Calaga, Rama; Bai, Mei; Fischer, Wolfram; Franchi, Andrea; Tomas, Rogelio

    2005-01-01

    Global coupling in RHIC is routinely corrected by using three skew quadrupole families to minimize the tune split. In this paper we aim to re-optimize the coupling at top energy by minimizing resonance driving terms and the C-matrix in two steps: 1. Find the best configuration of the three skew quadrupole families and 2. Identify locations with coupling sources by inspection of the driving terms and the C-matrix around the ring. The measurements of resonance terms and C-matrix are presented.

  17. Total-energy global optimizations using nonorthogonal localized orbitals

    International Nuclear Information System (INIS)

    Kim, J.; Mauri, F.; Galli, G.

    1995-01-01

    An energy functional for orbital-based O(N) calculations is proposed, which depends on a number of nonorthogonal, localized orbitals larger than the number of occupied states in the system, and on a parameter, the electronic chemical potential, determining the number of electrons. We show that the minimization of the functional with respect to overlapping localized orbitals can be performed so as to attain directly the ground-state energy, without being trapped at local minima. The present approach overcomes the multiple-minima problem present within the original formulation of orbital-based O(N) methods; it therefore makes it possible to perform O(N) calculations for an arbitrary system, without including any information about the system bonding properties in the construction of the input wave functions. Furthermore, while retaining the same computational cost as the original approach, our formulation allows one to improve the variational estimate of the ground-state energy, and the energy conservation during a molecular dynamics run. Several numerical examples for surfaces, bulk systems, and clusters are presented and discussed

  18. Sub-Optimal Management of Type 2 Diabetes Mellitus – A Local Audit

    African Journals Online (AJOL)

    Original Research: Sub-Optimal Management of Type 2 Diabetes Mellitus – A Local Audit ... despite clinical trial data documenting improved outcomes associated not ... were used to define the Metabolic Syndrome.9 Central obesity was.

  19. Effect of Local Junction Losses in the Optimization of T-shaped Flow Channels

    Science.gov (United States)

    Kosaraju, Srinivas

    2015-11-01

    T-shaped channels are extensively used in flow distribution applications such as irrigation, chemical dispersion, gas pipelines and space heating and cooling. The geometry of T-shaped channels can be optimized to reduce the overall pressure drop in stem and branch sections. Results of such optimizations are in the form of geometric parameters such as the length and diameter ratios of the stem and branch sections. The traditional approach of this optimization accounts for the pressure drop across the stem and branch sections, however, ignores the pressure drop in the T-junction. In this paper, we conduct geometry optimization while including the effect of local junction losses in laminar flows. From the results, we are able to identify a non-dimensional parameter that can be used to predict the optimal geometric configurations. This parameter can also be used to identify the conditions in which the local junction losses can be ignored during the optimization.

  20. Symmetrized local co-registration optimization for anomalous change detection

    Energy Technology Data Exchange (ETDEWEB)

    Wohlberg, Brendt E [Los Alamos National Laboratory; Theiler, James P [Los Alamos National Laboratory

    2009-01-01

    The goal of anomalous change detection (ACD) is to identify what unusual changes have occurred in a scene, based on two images of the scene taken at different times and under different conditions. The actual anomalous changes need to be distinguished from the incidental differences that occur throughout the imagery, and one of the most common and confounding of these incidental differences is due to the misregistration of the images, due to limitations of the registration pre-processing applied to the image pair. We propose a general method to compensate for residual misregistration in any ACD algorithm which constructs an estimate of the degree of 'anomalousness' for every pixel in the image pair. The method computes a modified misregistration-insensitive anomalousness by making local re-registration adjustments to minimize the local anomalousness. In this paper we describe a symmetrized version of our initial algorithm, and find significant performance improvements in the anomalous change detection ROC curves for a number of real and synthetic data sets.

  1. [Complications in pediatric anesthesia].

    Science.gov (United States)

    Becke, K

    2014-07-01

    As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

  2. Parameter Selection and Performance Comparison of Particle Swarm Optimization in Sensor Networks Localization

    Directory of Open Access Journals (Sweden)

    Huanqing Cui

    2017-03-01

    Full Text Available Localization is a key technology in wireless sensor networks. Faced with the challenges of the sensors’ memory, computational constraints, and limited energy, particle swarm optimization has been widely applied in the localization of wireless sensor networks, demonstrating better performance than other optimization methods. In particle swarm optimization-based localization algorithms, the variants and parameters should be chosen elaborately to achieve the best performance. However, there is a lack of guidance on how to choose these variants and parameters. Further, there is no comprehensive performance comparison among particle swarm optimization algorithms. The main contribution of this paper is three-fold. First, it surveys the popular particle swarm optimization variants and particle swarm optimization-based localization algorithms for wireless sensor networks. Secondly, it presents parameter selection of nine particle swarm optimization variants and six types of swarm topologies by extensive simulations. Thirdly, it comprehensively compares the performance of these algorithms. The results show that the particle swarm optimization with constriction coefficient using ring topology outperforms other variants and swarm topologies, and it performs better than the second-order cone programming algorithm.

  3. Parameter Selection and Performance Comparison of Particle Swarm Optimization in Sensor Networks Localization.

    Science.gov (United States)

    Cui, Huanqing; Shu, Minglei; Song, Min; Wang, Yinglong

    2017-03-01

    Localization is a key technology in wireless sensor networks. Faced with the challenges of the sensors' memory, computational constraints, and limited energy, particle swarm optimization has been widely applied in the localization of wireless sensor networks, demonstrating better performance than other optimization methods. In particle swarm optimization-based localization algorithms, the variants and parameters should be chosen elaborately to achieve the best performance. However, there is a lack of guidance on how to choose these variants and parameters. Further, there is no comprehensive performance comparison among particle swarm optimization algorithms. The main contribution of this paper is three-fold. First, it surveys the popular particle swarm optimization variants and particle swarm optimization-based localization algorithms for wireless sensor networks. Secondly, it presents parameter selection of nine particle swarm optimization variants and six types of swarm topologies by extensive simulations. Thirdly, it comprehensively compares the performance of these algorithms. The results show that the particle swarm optimization with constriction coefficient using ring topology outperforms other variants and swarm topologies, and it performs better than the second-order cone programming algorithm.

  4. Portfolio Optimization under Local-Stochastic Volatility: Coefficient Taylor Series Approximations & Implied Sharpe Ratio

    OpenAIRE

    Lorig, Matthew; Sircar, Ronnie

    2015-01-01

    We study the finite horizon Merton portfolio optimization problem in a general local-stochastic volatility setting. Using model coefficient expansion techniques, we derive approximations for the both the value function and the optimal investment strategy. We also analyze the `implied Sharpe ratio' and derive a series approximation for this quantity. The zeroth-order approximation of the value function and optimal investment strategy correspond to those obtained by Merton (1969) when the risky...

  5. Anesthesia information management systems

    OpenAIRE

    Feri Štivan; Janez Benedik; Tomaž Lužar

    2014-01-01

    Introduction: The use of anesthesia information management systems (AIMS) is on the increase. This is particularly true for academic anesthesia departments. The main reasons for slow adoption of these systems in the past are financial barriers associated with implementation of these systems and their not so traditionally obvious potential to improve patient care. In addition, a major obstacle to acceptance of this technology is the concern of users over the impact of the electronic anesthesia...

  6. Simulation to Support Local Search in Trajectory Optimization Planning

    Science.gov (United States)

    Morris, Robert A.; Venable, K. Brent; Lindsey, James

    2012-01-01

    NASA and the international community are investing in the development of a commercial transportation infrastructure that includes the increased use of rotorcraft, specifically helicopters and civil tilt rotors. However, there is significant concern over the impact of noise on the communities surrounding the transportation facilities. One way to address the rotorcraft noise problem is by exploiting powerful search techniques coming from artificial intelligence coupled with simulation and field tests to design low-noise flight profiles which can be tested in simulation or through field tests. This paper investigates the use of simulation based on predictive physical models to facilitate the search for low-noise trajectories using a class of automated search algorithms called local search. A novel feature of this approach is the ability to incorporate constraints directly into the problem formulation that addresses passenger safety and comfort.

  7. Optimalization of Beacon Selection for Localization in Wireless AD-HOC Networks

    Directory of Open Access Journals (Sweden)

    Martin Matula

    2008-01-01

    Full Text Available In this paper we engage in optimalization of convenient beacons for localization position of a node in the ad-hoc network. An algorithm designed by us localizes position of moving or static node by RSS (Received Signal Strength method and trilateration. At first, localization of unknown node runs by combination of all beacons. Than optimalizating algorithmreduces the number of beacons (and repeats localization, while only three left. Its reduction is based on highest levels of received signal strength. It is only when signals are from the nearest beacons. Position localizating exactness is statistically interpreted from all localization by beacons combination and its repeating.

  8. Formulation analysis and computation of an optimization-based local-to-nonlocal coupling method.

    Energy Technology Data Exchange (ETDEWEB)

    D' Elia, Marta [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Center for Computing Research; Bochev, Pavel Blagoveston [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Center for Computing Research

    2017-01-01

    In this paper, we present an optimization-based coupling method for local and nonlocal continuum models. Our approach couches the coupling of the models into a control problem where the states are the solutions of the nonlocal and local equations, the objective is to minimize their mismatch on the overlap of the local and nonlocal problem domains, and the virtual controls are the nonlocal volume constraint and the local boundary condition. We present the method in the context of Local-to-Nonlocal di usion coupling. Numerical examples illustrate the theoretical properties of the approach.

  9. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  10. SU-F-J-11: Radiobiologically Optimized Patient Localization During Prostate External Beam Localization

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Y; Gardner, S; Liu, C; Zhao, B; Wen, N; Brown, S; Chetty, I [Henry Ford Health System, Detroit, MI (United States)

    2016-06-15

    Purpose: To present a novel positioning strategy which optimizes radiation delivery with radiobiological response knowledge, and to evaluate its application during prostate external beam radiotherapy. Methods: Ten patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB-approved study. For each patient, a VMAT plan was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions with PTV = prostate + 7 mm margin, except for 5mm in the posterior direction. Five representative pretreatment CBCT images were selected for each patient, and prostate, rectum, and bladder were delineated on all CBCT images. Each CBCT was auto-registered to the corresponding PCT. Starting from this auto-matched position (AM-position), a search for optimal treatment position was performed utilizing a score function based on radiobiological and dosimetric indices (D98-DTV, NTCP-rectum, and NTCP-bladder) for the daily target volume (DTV), rectum, and bladder. DTV was defined as prostate + 4 mm margin to account for intra-fraction motion as well as contouring variability on CBCT. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS-position). Results: The indices, averaged over the 10 patients’ treatment plans, were (mean±SD): 77.7±0.2 Gy (D98-PTV), 12.3±2.7% (NTCP-rectum), and 53.2±11.2% (NTCP-bladder). The corresponding values calculated on all 50 CBCT images at the AM-positions were 72.9±11.3 Gy (D98-DTV), 15.8±6.4% (NTCP-rectum), and 53.0±21.1% (NTCP-bladder), respectively. In comparison, calculated on CBCT at the ROCS-positions, the indices were 77.0±2.1 Gy (D98-DTV), 12.1±5.7% (NTCP-rectum), and 60.7±16.4% (NTCP-bladder). Compared to autoregistration, ROCS-optimization recovered dose coverage to target volume and lowered the risk to rectum. Moreover, NTCPrectum for one patient remained high after ROCS-optimization and therefore could potentially benefit from adaptive planning

  11. Spatial planning via extremal optimization enhanced by cell-based local search

    International Nuclear Information System (INIS)

    Sidiropoulos, Epaminondas

    2014-01-01

    A new treatment is presented for land use planning problems by means of extremal optimization in conjunction to cell-based neighborhood local search. Extremal optimization, inspired by self-organized critical models of evolution has been applied mainly to the solution of classical combinatorial optimization problems. Cell-based local search has been employed by the author elsewhere in problems of spatial resource allocation in combination with genetic algorithms and simulated annealing. In this paper it complements extremal optimization in order to enhance its capacity for a spatial optimization problem. The hybrid method thus formed is compared to methods of the literature on a specific characteristic problem. It yields better results both in terms of objective function values and in terms of compactness. The latter is an important quantity for spatial planning. The present treatment yields significant compactness values as emergent results

  12. Administration of Anesthesia

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    Full Text Available ... Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ... more. TMJ and Facial Pain TMJ and Facial ... Teeth Management Wisdom Teeth Management An impacted wisdom tooth can ...

  13. Topical Drug Formulations for Prolonged Corneal Anesthesia

    Science.gov (United States)

    Wang, Liqiang; Shankarappa, Sahadev A.; Tong, Rong; Ciolino, Joseph B.; Tsui, Jonathan H.; Chiang, Homer H.; Kohane, Daniel S.

    2013-01-01

    Purpose Ocular local anesthetics (OLA’s) currently used in routine clinical practice for corneal anesthesia are short acting and their ability to delay corneal healing makes them unsuitable for long-term use. In this study, we examined the effect on the duration of corneal anesthesia of the site-1 sodium channel blocker tetrodotoxin (TTX), applied with either proparacaine or the chemical permeation enhancer OTAB. The effect of test solutions on corneal healing was also studied. Methods Solutions of TTX, proparacaine, and OTAB, singly or in combination were applied topically to the rat cornea. The blink response, an indirect measure of corneal sensitivity, was recorded using a Cochet-Bonnet esthesiometer, and the duration of corneal anesthesia calculated. The effect of test compounds on the rate of corneal epithelialization was studied in vivo following corneal debridement. Results Combination of TTX and proparacaine resulted in corneal anesthesia that was 8–10 times longer in duration than that from either drug administered alone, while OTAB did not prolong anesthesia. The rate of corneal healing was moderately delayed following co-administration of TTX and proparacaine. Conclusion Co-administration of TTX and proparacaine significantly prolonged corneal anesthesia but in view of delayed corneal re-epithelialization, caution is suggested in use of the combination. PMID:23615270

  14. Robotic anesthesia - A vision for the future of anesthesia

    OpenAIRE

    Hemmerling, Thomas M.; Taddei, Riccardo; Wehbe, Mohamad; Morse, Joshua; Cyr, Shantale; Zaouter, Cedrick

    2011-01-01

    Summary This narrative review describes a rationale for robotic anesthesia. It offers a first classification of robotic anesthesia by separating it into pharmacological robots and robots for aiding or replacing manual gestures. Developments in closed loop anesthesia are outlined. First attempts to perform manual tasks using robots are described. A critical analysis of the delayed development and introduction of robots in anesthesia is delivered.

  15. Optimization of distribution piping network in district cooling system using genetic algorithm with local search

    International Nuclear Information System (INIS)

    Chan, Apple L.S.; Hanby, Vic I.; Chow, T.T.

    2007-01-01

    A district cooling system is a sustainable means of distribution of cooling energy through mass production. A cooling medium like chilled water is generated at a central refrigeration plant and supplied to serve a group of consumer buildings through a piping network. Because of the substantial capital investment involved, an optimal design of the distribution piping configuration is one of the crucial factors for successful implementation of the district cooling scheme. In the present study, genetic algorithm (GA) incorporated with local search techniques was developed to find the optimal/near optimal configuration of the piping network in a hypothetical site. The effect of local search, mutation rate and frequency of local search on the performance of the GA in terms of both solution quality and computation time were investigated and presented in this paper

  16. Effect of magnesium added to local anesthetics for caudal anesthesia on postoperative pain in pediatric surgical patients: A systematic review and meta-analysis with Trial Sequential Analysis.

    Science.gov (United States)

    Kawakami, Hiromasa; Mihara, Takahiro; Nakamura, Nobuhito; Ka, Koui; Goto, Takahisa

    2018-01-01

    Magnesium has been investigated as an adjuvant for neuraxial anesthesia, but the effect of caudal magnesium on postoperative pain is inconsistent. The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of caudal magnesium. We searched six databases, including trial registration sites. Randomized clinical trials reporting the effect of caudal magnesium on postoperative pain after general anesthesia were eligible. The risk ratio for use of rescue analgesics after surgery was combined using a random-effects model. We also assessed adverse events. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE. Four randomized controlled trials (247 patients) evaluated the need for rescue analgesics. In all four trials, 50 mg of magnesium was administered with caudal ropivacaine. The results suggested that the need for rescue analgesia was reduced significantly by caudal magnesium administration (risk ratio 0.45; 95% confidence interval 0.24-0.86). There was considerable heterogeneity as indicated by an I2 value of 62.5%. The Trial Sequential Analysis-adjusted confidence interval was 0.04-5.55, indicating that further trials are required. The quality of evidence was very low. The rate of adverse events was comparable between treatment groups. Caudal magnesium may reduce the need for rescue analgesia after surgery, but further randomized clinical trials with a low risk of bias and a low risk of random errors are necessary to assess the effect of caudal magnesium on postoperative pain and adverse events. University Hospital Medical Information Network Clinical Trials Registry UMIN000025344.

  17. Phase-Field Relaxation of Topology Optimization with Local Stress Constraints

    DEFF Research Database (Denmark)

    Stainko, Roman; Burger, Martin

    2006-01-01

    inequality constraints. We discretize the problem by finite elements and solve the arising finite-dimensional programming problems by a primal-dual interior point method. Numerical experiments for problems with local stress constraints based on different criteria indicate the success and robustness......We introduce a new relaxation scheme for structural topology optimization problems with local stress constraints based on a phase-field method. In the basic formulation we have a PDE-constrained optimization problem, where the finite element and design analysis are solved simultaneously...

  18. Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais Cost analysis between spinal and venous anesthesia with propofol associated with local perianal block in anorectal procedures

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2009-09-01

    Full Text Available RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia, composto por 50 pacientes e grupo II (anestesia combinada, composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo, idade e complicações. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 minutos e de 44,08 minutos no grupo II (P=0,034. O tempo médio de internamento foi de 19,68 horas no grupo I e de 7,08 horas no grupo II (PBACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. There's no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5% bupivacaine with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were

  19. Health-related quality of life, optimism, and coping strategies in persons suffering from localized scleroderma.

    Science.gov (United States)

    Szramka-Pawlak, B; Dańczak-Pazdrowska, A; Rzepa, T; Szewczyk, A; Sadowska-Przytocka, A; Żaba, R

    2013-01-01

    The clinical course of localized scleroderma may consist of bodily deformations, and bodily functions may also be affected. Additionally, the secondary lesions, such as discoloration, contractures, and atrophy, are unlikely to regress. The aforementioned symptoms and functional disturbances may decrease one's quality of life (QoL). Although much has been mentioned in the medical literature regarding QoL in persons suffering from dermatologic diseases, no data specifically describing patients with localized scleroderma exist. The aim of the study was to explore QoL in localized scleroderma patients and to examine their coping strategies in regard to optimism and QoL. The study included 41 patients with localized scleroderma. QoL was evaluated using the SKINDEX questionnaire, and levels of dispositional optimism were assessed using the Life Orientation Test-Revised. In addition, individual coping strategy was determined using the Mini-MAC scale and physical condition was assessed using the Localized Scleroderma Severity Index. The mean QoL score amounted to 51.10 points, with mean scores for individual components as follows: symptoms = 13.49 points, emotions = 21.29 points, and functioning = 16.32 points. A relationship was detected between QoL and the level of dispositional optimism as well as with coping strategies known as anxious preoccupation and helplessness-hopelessness. Higher levels of optimism predicted a higher general QoL. In turn, greater intensity of anxious preoccupied and helpless-hopeless behaviors predicted a lower QoL. Based on these results, it may be stated that localized scleroderma patients have a relatively high QoL, which is accompanied by optimism as well as a lower frequency of behaviors typical of emotion-focused coping strategies.

  20. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Download Download the ebook for further information Anesthesia: Safety and Comfort in the OMS Office Part I ... Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) are ...

  1. Administration of Anesthesia

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    Full Text Available ... in the OMS Office Part I Introduction and History of Dental Anesthesia Part II OMS Education and ... experts in face, mouth and jaw surgery Contact Us Sitemap Terms of Use Privacy Policy © Copyright AAOMS ...

  2. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage ... I Introduction and History of Dental Anesthesia Part II OMS Education and ...

  3. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become infected. It can also ... Part IV Office Anesthesia Evaluation ...

  4. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become ... I Introduction and History of Dental Anesthesia Part II OMS ...

  5. Administration of Anesthesia

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    Full Text Available ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four years of training in a hospital-based surgical residency program alongside medical residents in ...

  6. Administration of Anesthesia

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    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... It can also invite bacteria that lead to gum disease. Click here to find out more. Anesthesia Download ...

  7. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ... II OMS Education and Training Part III The OMS Anesthesia Team ...

  8. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become infected. It can also invite ... Part IV Office Anesthesia Evaluation ...

  9. Administration of Anesthesia

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    Full Text Available ... general surgery, anesthesia and other specialties. During this time, OMS residents serve on the medical anesthesiology service, ... during and after the operation. This is the time to discuss any concerns you may have about ...

  10. Administration of Anesthesia

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    Full Text Available ... Team and Patient Care Part IV Office Anesthesia Evaluation Part V Broad Access to Care, Patient Safety ... and jaw surgery Contact Us Sitemap Terms of Use Privacy Policy © Copyright AAOMS 2008-2018 Facebook Twitter ...

  11. Pediatric anesthesia and neurotoxicity

    DEFF Research Database (Denmark)

    Disma, Nicola; Hansen, Tom G.

    2016-01-01

    Many studies have demonstrated a neurodegenerative effect of anesthetic drugs in cubs and young animals, raising the concern that similar effects can happen in children, and that the administration of anesthesia in young children undergoing surgical or diagnostic procedures may cause long- Term...... neurocognitive impairment. Thus, several epidemiological studies have been performed with the aim to find a possible association between early anesthesia exposure and poor long- Term outcome, like learning disabilities or worse school grading and two prospective trials are currently running, the GAS...... and the PANDA study. Interim results from the GAS study, which compared infants undergoing general and regional anesthesia for hernia repair, have demonstrated that a single exposure of about one hour of anesthesia does not affect the neurological outcome at 2 years of age. Nowadays, most of the knowledge...

  12. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or ... I Introduction and History of Dental Anesthesia Part II OMS ...

  13. Localized probability of improvement for kriging based multi-objective optimization

    Science.gov (United States)

    Li, Yinjiang; Xiao, Song; Barba, Paolo Di; Rotaru, Mihai; Sykulski, Jan K.

    2017-12-01

    The paper introduces a new approach to kriging based multi-objective optimization by utilizing a local probability of improvement as the infill sampling criterion and the nearest neighbor check to ensure diversification and uniform distribution of Pareto fronts. The proposed method is computationally fast and linearly scalable to higher dimensions.

  14. Design Optimization of Laminated Composite Structures with Many Local Strength Criteria

    DEFF Research Database (Denmark)

    Lund, Erik

    2012-01-01

    This paper presents different strategies for handling very many local strength criteria in structural optimization of laminated composites. Global strength measures using Kreisselmeier-Steinhauser or p-norm functions are introduced for patch-wise parameterizations, and the efficiency of the metho...

  15. Development and optimization of power plant concepts for local wet fuels

    Energy Technology Data Exchange (ETDEWEB)

    Raiko, M.O.; Gronfors, T.H.A. [Fortum Energy Solutions, Fortum (Finland); Haukka, P. [Tampere University of Technology (Finland)

    2003-01-01

    Many changes in business drivers are now affecting power-producing companies. The power market has been opened up and the number of locally operating companies has increased. At the same time the need to utilize locally produced biofuels is increasing because of environmental benefits and regulations. In this situation, power-producing companies have on focus their in-house skills for generating a competitive edge over their rivals, such as the skills needed for developing the most economical energy investments for the best-paying customer for the local biomass producers. This paper explores the role of optimization in the development of small-sized energy investments. The paper provides an overview on a new design process for power companies for improved use of in-house technical and business expertise. As an example, illustrative design and optimization of local wet peat-based power investment is presented. Three concept alternatives are generated. Only power plant production capacity and peat moisture content are optimized for all alternatives. Long commercial experience of using peat as a power plant fuel in Finland can be transferred to bioenergy investments. In this paper, it is shown that conventional technology can be feasible for bioenergy production even in quite small size (below 10 MW). It is important to optimize simultaneously both the technology and the two businesses, power production and fuel production. Further, such high moisture content biomass as sludge, seaweed, grass, etc. can be economical fuels, if advanced drying systems are adopted in a power plant. (author)

  16. PlayNCool: Opportunistic Network Coding for Local Optimization of Routing in Wireless Mesh Networks

    DEFF Research Database (Denmark)

    Pahlevani, Peyman; Roetter, Daniel Enrique Lucani; Pedersen, Morten Videbæk

    2013-01-01

    This paper introduces PlayNCool, an opportunistic protocol with local optimization based on network coding to increase the throughput of a wireless mesh network (WMN). PlayNCool aims to enhance current routing protocols by (i) allowing random linear network coding transmissions end-to-end, (ii) r...

  17. Hooke–Jeeves Method-used Local Search in a Hybrid Global Optimization Algorithm

    Directory of Open Access Journals (Sweden)

    V. D. Sulimov

    2014-01-01

    Full Text Available Modern methods for optimization investigation of complex systems are based on development and updating the mathematical models of systems because of solving the appropriate inverse problems. Input data desirable for solution are obtained from the analysis of experimentally defined consecutive characteristics for a system or a process. Causal characteristics are the sought ones to which equation coefficients of mathematical models of object, limit conditions, etc. belong. The optimization approach is one of the main ones to solve the inverse problems. In the main case it is necessary to find a global extremum of not everywhere differentiable criterion function. Global optimization methods are widely used in problems of identification and computation diagnosis system as well as in optimal control, computing to-mography, image restoration, teaching the neuron networks, other intelligence technologies. Increasingly complicated systems of optimization observed during last decades lead to more complicated mathematical models, thereby making solution of appropriate extreme problems significantly more difficult. A great deal of practical applications may have the problem con-ditions, which can restrict modeling. As a consequence, in inverse problems the criterion functions can be not everywhere differentiable and noisy. Available noise means that calculat-ing the derivatives is difficult and unreliable. It results in using the optimization methods without calculating the derivatives.An efficiency of deterministic algorithms of global optimization is significantly restrict-ed by their dependence on the extreme problem dimension. When the number of variables is large they use the stochastic global optimization algorithms. As stochastic algorithms yield too expensive solutions, so this drawback restricts their applications. Developing hybrid algo-rithms that combine a stochastic algorithm for scanning the variable space with deterministic local search

  18. Optimal Audiovisual Integration in the Ventriloquism Effect But Pervasive Deficits in Unisensory Spatial Localization in Amblyopia.

    Science.gov (United States)

    Richards, Michael D; Goltz, Herbert C; Wong, Agnes M F

    2018-01-01

    Classically understood as a deficit in spatial vision, amblyopia is increasingly recognized to also impair audiovisual multisensory processing. Studies to date, however, have not determined whether the audiovisual abnormalities reflect a failure of multisensory integration, or an optimal strategy in the face of unisensory impairment. We use the ventriloquism effect and the maximum-likelihood estimation (MLE) model of optimal integration to investigate integration of audiovisual spatial information in amblyopia. Participants with unilateral amblyopia (n = 14; mean age 28.8 years; 7 anisometropic, 3 strabismic, 4 mixed mechanism) and visually normal controls (n = 16, mean age 29.2 years) localized brief unimodal auditory, unimodal visual, and bimodal (audiovisual) stimuli during binocular viewing using a location discrimination task. A subset of bimodal trials involved the ventriloquism effect, an illusion in which auditory and visual stimuli originating from different locations are perceived as originating from a single location. Localization precision and bias were determined by psychometric curve fitting, and the observed parameters were compared with predictions from the MLE model. Spatial localization precision was significantly reduced in the amblyopia group compared with the control group for unimodal visual, unimodal auditory, and bimodal stimuli. Analyses of localization precision and bias for bimodal stimuli showed no significant deviations from the MLE model in either the amblyopia group or the control group. Despite pervasive deficits in localization precision for visual, auditory, and audiovisual stimuli, audiovisual integration remains intact and optimal in unilateral amblyopia.

  19. Is local participation always optimal for sustainable action? The costs of consensus-building in Local Agenda 21.

    Science.gov (United States)

    Brandt, Urs Steiner; Svendsen, Gert Tinggaard

    2013-11-15

    Is local participation always optimal for sustainable action? Here, Local Agenda 21 is a relevant case as it broadly calls for consensus-building among stakeholders. Consensus-building is, however, costly. We show that the costs of making local decisions are likely to rapidly exceed the benefits. Why? Because as the number of participants grows, the more likely it is that the group will include individuals who have an extreme position and are unwilling to make compromises. Thus, the net gain of self-organization should be compared with those of its alternatives, for example voting, market-solutions, or not making any choices at all. Even though the informational value of meetings may be helpful to policy makers, the model shows that it also decreases as the number of participants increase. Overall, the result is a thought provoking scenario for Local Agenda 21 as it highlights the risk of less sustainable action in the future. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Notions of local controllability and optimal feedforward control for quantum systems

    International Nuclear Information System (INIS)

    Chakrabarti, Raj

    2011-01-01

    Local controllability is an essential concept for regulation and control of time-varying nonlinear dynamical systems; in the classical control logic it is at the foundation of neighboring optimal feedback and feedforward control. We introduce notions of local controllability suited to feedforward control of classical input disturbances in bilinear quantum systems evolving on projective spaces and Lie groups. Tests for local controllability based on a Gramian matrix analogous to the nonlinear local controllability Gramian, which allow assessment of which trajectories can be regulated by perturbative feedforward in the presence of classical input noise, are presented. These notions explicitly incorporate system bilinearity and the geometry of quantum states into the definition of local controllability of quantum systems. Associated feedforward strategies are described.

  1. Notions of local controllability and optimal feedforward control for quantum systems

    Energy Technology Data Exchange (ETDEWEB)

    Chakrabarti, Raj, E-mail: rchakra@purdue.edu [School of Chemical Engineering, Purdue University, West Lafayette, IN 47907 (United States)

    2011-05-06

    Local controllability is an essential concept for regulation and control of time-varying nonlinear dynamical systems; in the classical control logic it is at the foundation of neighboring optimal feedback and feedforward control. We introduce notions of local controllability suited to feedforward control of classical input disturbances in bilinear quantum systems evolving on projective spaces and Lie groups. Tests for local controllability based on a Gramian matrix analogous to the nonlinear local controllability Gramian, which allow assessment of which trajectories can be regulated by perturbative feedforward in the presence of classical input noise, are presented. These notions explicitly incorporate system bilinearity and the geometry of quantum states into the definition of local controllability of quantum systems. Associated feedforward strategies are described.

  2. Genetic local search algorithm for optimization design of diffractive optical elements.

    Science.gov (United States)

    Zhou, G; Chen, Y; Wang, Z; Song, H

    1999-07-10

    We propose a genetic local search algorithm (GLSA) for the optimization design of diffractive optical elements (DOE's). This hybrid algorithm incorporates advantages of both genetic algorithm (GA) and local search techniques. It appears better able to locate the global minimum compared with a canonical GA. Sample cases investigated here include the optimization design of binary-phase Dammann gratings, continuous surface-relief grating array generators, and a uniform top-hat focal plane intensity profile generator. Two GLSA's whose incorporated local search techniques are the hill-climbing method and the simulated annealing algorithm are investigated. Numerical experimental results demonstrate that the proposed algorithm is highly efficient and robust. DOE's that have high diffraction efficiency and excellent uniformity can be achieved by use of the algorithm we propose.

  3. A Local and Global Search Combined Particle Swarm Optimization Algorithm and Its Convergence Analysis

    Directory of Open Access Journals (Sweden)

    Weitian Lin

    2014-01-01

    Full Text Available Particle swarm optimization algorithm (PSOA is an advantage optimization tool. However, it has a tendency to get stuck in a near optimal solution especially for middle and large size problems and it is difficult to improve solution accuracy by fine-tuning parameters. According to the insufficiency, this paper researches the local and global search combine particle swarm algorithm (LGSCPSOA, and its convergence and obtains its convergence qualification. At the same time, it is tested with a set of 8 benchmark continuous functions and compared their optimization results with original particle swarm algorithm (OPSOA. Experimental results indicate that the LGSCPSOA improves the search performance especially on the middle and large size benchmark functions significantly.

  4. Optimal reducibility of all W states equivalent under stochastic local operations and classical communication

    Energy Technology Data Exchange (ETDEWEB)

    Rana, Swapan; Parashar, Preeti [Physics and Applied Mathematics Unit, Indian Statistical Institute, 203 BT Road, Kolkata (India)

    2011-11-15

    We show that all multipartite pure states that are stochastic local operation and classical communication (SLOCC) equivalent to the N-qubit W state can be uniquely determined (among arbitrary states) from their bipartite marginals. We also prove that only (N-1) of the bipartite marginals are sufficient and that this is also the optimal number. Thus, contrary to the Greenberger-Horne-Zeilinger (GHZ) class, W-type states preserve their reducibility under SLOCC. We also study the optimal reducibility of some larger classes of states. The generic Dicke states |GD{sub N}{sup l}> are shown to be optimally determined by their (l+1)-partite marginals. The class of ''G'' states (superposition of W and W) are shown to be optimally determined by just two (N-2)-partite marginals.

  5. Multiple local minima in IMRT optimization based on dose-volume criteria

    International Nuclear Information System (INIS)

    Wu Qiuwen; Mohan, Radhe

    2002-01-01

    Multiple local minima traps are known to exist in dose-volume and dose-response objective functions. Nevertheless, their presence and consequences are not considered impediments in finding satisfactory solutions in routine optimization of IMRT plans using gradient methods. However, there is often a concern that a significantly superior solution may exist unbeknownst to the planner and that the optimization process may not be able to reach it. We have investigated the soundness of the assumption that the presence of multiple minima traps can be ignored. To find local minima, we start the optimization process a large number of times with random initial intensities. We investigated whether the occurrence of local minima depends upon the choice of the objective function parameters and the number of variables and whether their existence is an impediment in finding a satisfactory solution. To learn about the behavior of multiple minima, we first used a symmetric cubic phantom containing a cubic target and an organ-at-risk surrounding it to optimize the beam weights of two pairs of parallel-opposed beams using a gradient technique. The phantom studies also served to test our software. Objective function parameters were chosen to ensure that multiple minima would exist. Data for 500 plans, optimized with random initial beam weights, were analyzed. The search process did succeed in finding the local minima and showed that the number of minima depends on the parameters of the objective functions. It was also found that the consequences of local minima depended on the number of beams. We further searched for the multiple minima in intensity-modulated treatment plans for a head-and-neck case and a lung case. In addition to the treatment plan scores and the dose-volume histograms, we examined the dose distributions and intensity patterns. We did not find any evidence that multiple local minima affect the outcome of optimization using gradient techniques in any clinically

  6. RDEL: Restart Differential Evolution algorithm with Local Search Mutation for global numerical optimization

    Directory of Open Access Journals (Sweden)

    Ali Wagdy Mohamed

    2014-11-01

    Full Text Available In this paper, a novel version of Differential Evolution (DE algorithm based on a couple of local search mutation and a restart mechanism for solving global numerical optimization problems over continuous space is presented. The proposed algorithm is named as Restart Differential Evolution algorithm with Local Search Mutation (RDEL. In RDEL, inspired by Particle Swarm Optimization (PSO, a novel local mutation rule based on the position of the best and the worst individuals among the entire population of a particular generation is introduced. The novel local mutation scheme is joined with the basic mutation rule through a linear decreasing function. The proposed local mutation scheme is proven to enhance local search tendency of the basic DE and speed up the convergence. Furthermore, a restart mechanism based on random mutation scheme and a modified Breeder Genetic Algorithm (BGA mutation scheme is combined to avoid stagnation and/or premature convergence. Additionally, an exponent increased crossover probability rule and a uniform scaling factors of DE are introduced to promote the diversity of the population and to improve the search process, respectively. The performance of RDEL is investigated and compared with basic differential evolution, and state-of-the-art parameter adaptive differential evolution variants. It is discovered that the proposed modifications significantly improve the performance of DE in terms of quality of solution, efficiency and robustness.

  7. Comparison of NREM sleep and intravenous sedation through local information processing and whole brain network to explore the mechanism of general anesthesia.

    Science.gov (United States)

    Li, Yun; Wang, Shengpei; Pan, Chuxiong; Xue, Fushan; Xian, Junfang; Huang, Yaqi; Wang, Xiaoyi; Li, Tianzuo; He, Huiguang

    2018-01-01

    The mechanism of general anesthesia (GA) has been explored for hundreds of years, but unclear. Previous studies indicated a possible correlation between NREM sleep and GA. The purpose of this study is to compare them by in vivo human brain function to probe the neuromechanism of consciousness, so as to find out a clue to GA mechanism. 24 healthy participants were equally assigned to sleep or propofol sedation group by sleeping ability. EEG and Ramsay Sedation Scale were applied to determine sleep stage and sedation depth respectively. Resting-state functional magnetic resonance imaging (RS-fMRI) was acquired at each status. Regional homogeneity (ReHo) and seed-based whole brain functional connectivity maps (WB-FC maps) were compared. During sleep, ReHo primarily weakened on frontal lobe (especially preoptic area), but strengthened on brainstem. While during sedation, ReHo changed in various brain areas, including cingulate, precuneus, thalamus and cerebellum. Cingulate, fusiform and insula were concomitance of sleep and sedation. Comparing to sleep, FCs between the cortex and subcortical centers (centralized in cerebellum) were significantly attenuated under sedation. As sedation deepening, cerebellum-based FC maps were diminished, while thalamus- and brainstem-based FC maps were increased. There're huge distinctions in human brain function between sleep and GA. Sleep mainly rely on brainstem and frontal lobe function, while sedation is prone to affect widespread functional network. The most significant differences exist in the precuneus and cingulate, which may play important roles in mechanisms of inducing unconciousness by anesthetics. Institutional Review Board (IRB) ChiCTR-IOC-15007454.

  8. Optimal dietary patterns designed from local foods to achieve maternal nutritional goals.

    Science.gov (United States)

    Raymond, Jofrey; Kassim, Neema; Rose, Jerman W; Agaba, Morris

    2018-04-04

    Achieving nutritional requirements for pregnant and lactating mothers in rural households while maintaining the intake of local and culture-specific foods can be a difficult task. Deploying a linear goal programming approach can effectively generate optimal dietary patterns that incorporate local and culturally acceptable diets. The primary objective of this study was to determine whether a realistic and affordable diet that achieves nutritional goals for rural pregnant and lactating women can be formulated from locally available foods in Tanzania. A cross sectional study was conducted to assess dietary intakes of 150 pregnant and lactating women using a weighed dietary record (WDR), 24 h dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are frequently consumed in the study population. Dietary survey and market data were then used to define linear programming (LP) model parameters for diet optimisation. All LP analyses were done using linear program solver to generate optimal dietary patterns. Our findings showed that optimal dietary patterns designed from locally available foods would improve dietary adequacy for 15 and 19 selected nutrients in pregnant and lactating women, respectively, but inadequacies remained for iron, zinc, folate, pantothenic acid, and vitamin E, indicating that these are problem nutrients (nutrients that did not achieve 100% of their RNIs in optimised diets) in the study population. These findings suggest that optimal use of local foods can improve dietary adequacy for rural pregnant and lactating women aged 19-50 years. However, additional cost-effective interventions are needed to ensure adequate intakes for the identified problem nutrients.

  9. Damage approach: A new method for topology optimization with local stress constraints

    DEFF Research Database (Denmark)

    Verbart, Alexander; Langelaar, Matthijs; van Keulen, Fred

    2016-01-01

    In this paper, we propose a new method for topology optimization with local stress constraints. In this method, material in which a stress constraint is violated is considered as damaged. Since damaged material will contribute less to the overall performance of the structure, the optimizer...... will promote a design with a minimal amount of damaged material. We tested the method on several benchmark problems, and the results show that the method is a viable alternative for conventional stress-based approaches based on constraint relaxation followed by constraint aggregation....

  10. Optimally localized Wannier functions for quasi one-dimensional nonperiodic insulators

    DEFF Research Database (Denmark)

    Cornean, Horia; Nenciu, A.; Nenciu, Gheorghe

    2008-01-01

    It is proved that for general, not necessarily periodic, quasi one-dimensional systems the band position operator corresponding to an isolated part of the energy spectrum has discrete spectrum and its eigenfunctions have the same spatial localization as the corresponding spectral projection....... As a consequence, an eigenbasis of the band position operator provides a basis of optimally localized (generalized) Wannier functions for quasi one-dimensional systems, and this proves the strong Marzari-Vanderbilt conjecture. If the system has some translation symmetries (e.g. usual translations, screw...

  11. Optimally localized Wannier functions for quasi one-dimensional nonperiodic insulators

    DEFF Research Database (Denmark)

    Cornean, Horia; Nenciu, A.; Nenciu, Gheorghe

    It is proved that for general, not necessarily periodic quasi one dimensional systems, the band position operator corresponding to an isolated part of the energy spectrum has discrete spectrum and its eigenfunctions have the same spatial localization as the corresponding spectral projection....... As a consequence, an eigenbasis of the band position operator provides a basis of optimally localized (generalized) Wannier functions for quasi one dimensional systems. If the system has some translation symmetries (e.g. usual translations, screw transformations), they are "inherited" bythe Wannier basis....

  12. Local-scaling density-functional method: Intraorbit and interorbit density optimizations

    International Nuclear Information System (INIS)

    Koga, T.; Yamamoto, Y.; Ludena, E.V.

    1991-01-01

    The recently proposed local-scaling density-functional theory provides us with a practical method for the direct variational determination of the electron density function ρ(r). The structure of ''orbits,'' which ensures the one-to-one correspondence between the electron density ρ(r) and the N-electron wave function Ψ({r k }), is studied in detail. For the realization of the local-scaling density-functional calculations, procedures for intraorbit and interorbit optimizations of the electron density function are proposed. These procedures are numerically illustrated for the helium atom in its ground state at the beyond-Hartree-Fock level

  13. Theoretical Aspects of Optimizing the Allocation of Public Financial Resources at Local Level

    OpenAIRE

    Eugen DOGARIU

    2010-01-01

    The allocation of financial resources at local, but also at central level, is an issue especially since in times of crisis, finding the optimum way to spend public funds concerns all authorities. This paper aims to identify the ways in which, by leaving from the division of powers based on the allocation of resources and tools available, the local authorities can identify an optimal level of public expenditure so as to achieve a maximum level of using them. Also, the paper seeks to identify t...

  14. Comparing the Selected Transfer Functions and Local Optimization Methods for Neural Network Flood Runoff Forecast

    Directory of Open Access Journals (Sweden)

    Petr Maca

    2014-01-01

    Full Text Available The presented paper aims to analyze the influence of the selection of transfer function and training algorithms on neural network flood runoff forecast. Nine of the most significant flood events, caused by the extreme rainfall, were selected from 10 years of measurement on small headwater catchment in the Czech Republic, and flood runoff forecast was investigated using the extensive set of multilayer perceptrons with one hidden layer of neurons. The analyzed artificial neural network models with 11 different activation functions in hidden layer were trained using 7 local optimization algorithms. The results show that the Levenberg-Marquardt algorithm was superior compared to the remaining tested local optimization methods. When comparing the 11 nonlinear transfer functions, used in hidden layer neurons, the RootSig function was superior compared to the rest of analyzed activation functions.

  15. A note on eigenfrequency sensitivities and structural eigenfrequency optimization based on local sub-domain frequencies

    DEFF Research Database (Denmark)

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2014-01-01

    foundation. A numerical heuristic redesign procedure is proposed and illustrated with examples. For the ideal case, an optimality criterion is fulfilled if the design have the same sub-domain frequency (local Rayleigh quotient). Sensitivity analysis shows an important relation between squared system...... eigenfrequency and squared local sub-domain frequency for a given eigenmode. Higher order eigenfrequenciesmay also be controlled in this manner. The presented examples are based on 2D finite element models with the use of subspace iteration for analysis and a heuristic recursive design procedure based...... on the derived optimality condition. The design that maximize a frequency depend on the total amount of available material and on a necessary interpolation as illustrated by different design cases.In this note we have assumed a linear and conservative eigenvalue problem without multiple eigenvalues. The presence...

  16. A Particle Swarm Optimization-Based Approach with Local Search for Predicting Protein Folding.

    Science.gov (United States)

    Yang, Cheng-Hong; Lin, Yu-Shiun; Chuang, Li-Yeh; Chang, Hsueh-Wei

    2017-10-01

    The hydrophobic-polar (HP) model is commonly used for predicting protein folding structures and hydrophobic interactions. This study developed a particle swarm optimization (PSO)-based algorithm combined with local search algorithms; specifically, the high exploration PSO (HEPSO) algorithm (which can execute global search processes) was combined with three local search algorithms (hill-climbing algorithm, greedy algorithm, and Tabu table), yielding the proposed HE-L-PSO algorithm. By using 20 known protein structures, we evaluated the performance of the HE-L-PSO algorithm in predicting protein folding in the HP model. The proposed HE-L-PSO algorithm exhibited favorable performance in predicting both short and long amino acid sequences with high reproducibility and stability, compared with seven reported algorithms. The HE-L-PSO algorithm yielded optimal solutions for all predicted protein folding structures. All HE-L-PSO-predicted protein folding structures possessed a hydrophobic core that is similar to normal protein folding.

  17. Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations.

    Science.gov (United States)

    El-Boghdadly, Kariem; Chin, Ki Jinn; Chan, Vincent W S

    2017-07-01

    Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

  18. Procedural mishaps with trephine-based intraosseous anesthesia.

    Science.gov (United States)

    Small, Joel C; Witherspoon, David E; Regan, John D; Hall, Ellen

    2011-01-01

    Failure to achieve profound anesthesia during dental treatment can be a significant problem for dental clinicians, especially for endodontic procedures on teeth in the mandibular arch with irreversible pulpitis. A number of supplemental local anesthesia techniques exist, the most effective of which may be the intraosseous injection. Two cases are presented demonstrating the dangers associated with the use of the intraosseous anesthesia technique. While the technique can provide profound anesthesia in otherwise difficult to anesthetize cases, care must be taken during its administration. Both cases show the damage done to the root and overlying bone by the injudicious use of the trephine. It is incumbent on the clinician to fully consider the anatomy in the area prior to insertion of the trephine. Intraosseous anesthesia techniques are a valuable addition to the clinicians' armamentarium. However careless administration can result in problems of endodontic or periodontal nature that may be difficult to rectify.

  19. Anesthesia for radiologic procedures

    International Nuclear Information System (INIS)

    Forestner, J.E.

    1987-01-01

    Anesthetic techniques for neurodiagnostic studies and radiation therapy have been recently reviewed, but anesthetic involvement in thoracic and abdominal radiology has received little attention. Patient reactions to radiologic contrast media may be of concern to the anesthesiologist, who is often responsible for injecting these agents during diagnostic procedures, and thus is included in this discussion. Finally, the difficulties of administering anesthesia for magnetic resonance imaging (MRI) scans are outlined, in an effort to help anesthesiologist to anticipate problems with this new technologic development. Although there are very few indications for the use of general anesthesia for diagnostic radiologic studies in adults, most procedures performed with children, the mentally retarded, or the combative adult require either heavy sedation or general anesthesia. In selecting an anesthetic technique for a specific procedure, both the patient's disease process and the requirements of the radiologist must be carefully balanced

  20. Sigmund Freud (1856-1939 e Karl Köller (1857-1944 e a descoberta da anestesia local Sigmund Freud (1856-1939 y Karl Köller (1857-1944 y el Descubrimiento de la anestesia local Sigmund Freud (1856-1939 and Karl Köller (1857-1944 and the Discovery of local anesthesia

    Directory of Open Access Journals (Sweden)

    Almiro dos Reis Jr

    2009-04-01

    : The understanding, occasionally recognized, that Sigmund Freud had the intuition to use cocaine as local anesthetic for surgical procedures, or even that he played any role in the discovery of local anesthesia is not true. The objective of Freud's studies were different, and based in irrefutable evidence, Karl Köller was the real inventor of local anesthesia. In face of those facts, proper knowledge of this historically important subject is due. CONTENTS: This report refers to the long-known properties of cocaine. It also remembers personal data, and the professional and scientific activities of Sigmund Freud and Karl Köller. It presents Freud's researches on the pathophysiological effects of cocaine. It exposes the reasons for the harsh criticism of Freud's concepts. It describes the sudden, but conscious and justified, idea of Karl Köller to study scientifically the use of cocaine as a local anesthetic in animals and humans. It indicates how those pioneering studies, that culminated with the discovery of local anesthesia by Köller and two presentations in Vienna on the subject, were done. It also reports the first ophthalmologic surgery under local anesthesia. It shows the immediate dissemination throughout the world of the discovery that marked the beginning of regional blocks. It comments several documents corroborating the role of Köller in this discovery. And, finally, it mentions the numerous homages received by Köller in different areas of the world. COCLUSIONS: Regional block was introduced by Karl Köller in 1884, when he demonstrated the feasibility of performing painless ophthalmologic surgeries by using cocaine as a local anesthetic. Sigmund Freud studied cocaine extensively, but he did not have direct participation in this important discovery.

  1. Recent advances in topical anesthesia

    Science.gov (United States)

    2016-01-01

    Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain. PMID:28879311

  2. SU-E-J-130: Automating Liver Segmentation Via Combined Global and Local Optimization

    Energy Technology Data Exchange (ETDEWEB)

    Li, Dengwang; Wang, Jie [College of Physics and Electronics, Shandong Normal University, Jinan, Shandong (China); Kapp, Daniel S.; Xing, Lei [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States)

    2015-06-15

    Purpose: The aim of this work is to develop a robust algorithm for accurate segmentation of liver with special attention paid to the problems with fuzzy edges and tumor. Methods: 200 CT images were collected from radiotherapy treatment planning system. 150 datasets are selected as the panel data for shape dictionary and parameters estimation. The remaining 50 datasets were used as test images. In our study liver segmentation was formulated as optimization process of implicit function. The liver region was optimized via local and global optimization during iterations. Our method consists five steps: 1)The livers from the panel data were segmented manually by physicians, and then We estimated the parameters of GMM (Gaussian mixture model) and MRF (Markov random field). Shape dictionary was built by utilizing the 3D liver shapes. 2)The outlines of chest and abdomen were located according to rib structure in the input images, and the liver region was initialized based on GMM. 3)The liver shape for each 2D slice was adjusted using MRF within the neighborhood of liver edge for local optimization. 4)The 3D liver shape was corrected by employing SSR (sparse shape representation) based on liver shape dictionary for global optimization. Furthermore, H-PSO(Hybrid Particle Swarm Optimization) was employed to solve the SSR equation. 5)The corrected 3D liver was divided into 2D slices as input data of the third step. The iteration was repeated within the local optimization and global optimization until it satisfied the suspension conditions (maximum iterations and changing rate). Results: The experiments indicated that our method performed well even for the CT images with fuzzy edge and tumors. Comparing with physician delineated results, the segmentation accuracy with the 50 test datasets (VOE, volume overlap percentage) was on average 91%–95%. Conclusion: The proposed automatic segmentation method provides a sensible technique for segmentation of CT images. This work is

  3. SU-E-J-130: Automating Liver Segmentation Via Combined Global and Local Optimization

    International Nuclear Information System (INIS)

    Li, Dengwang; Wang, Jie; Kapp, Daniel S.; Xing, Lei

    2015-01-01

    Purpose: The aim of this work is to develop a robust algorithm for accurate segmentation of liver with special attention paid to the problems with fuzzy edges and tumor. Methods: 200 CT images were collected from radiotherapy treatment planning system. 150 datasets are selected as the panel data for shape dictionary and parameters estimation. The remaining 50 datasets were used as test images. In our study liver segmentation was formulated as optimization process of implicit function. The liver region was optimized via local and global optimization during iterations. Our method consists five steps: 1)The livers from the panel data were segmented manually by physicians, and then We estimated the parameters of GMM (Gaussian mixture model) and MRF (Markov random field). Shape dictionary was built by utilizing the 3D liver shapes. 2)The outlines of chest and abdomen were located according to rib structure in the input images, and the liver region was initialized based on GMM. 3)The liver shape for each 2D slice was adjusted using MRF within the neighborhood of liver edge for local optimization. 4)The 3D liver shape was corrected by employing SSR (sparse shape representation) based on liver shape dictionary for global optimization. Furthermore, H-PSO(Hybrid Particle Swarm Optimization) was employed to solve the SSR equation. 5)The corrected 3D liver was divided into 2D slices as input data of the third step. The iteration was repeated within the local optimization and global optimization until it satisfied the suspension conditions (maximum iterations and changing rate). Results: The experiments indicated that our method performed well even for the CT images with fuzzy edge and tumors. Comparing with physician delineated results, the segmentation accuracy with the 50 test datasets (VOE, volume overlap percentage) was on average 91%–95%. Conclusion: The proposed automatic segmentation method provides a sensible technique for segmentation of CT images. This work is

  4. An optimized ensemble local mean decomposition method for fault detection of mechanical components

    International Nuclear Information System (INIS)

    Zhang, Chao; Chen, Shuai; Wang, Jianguo; Li, Zhixiong; Hu, Chao; Zhang, Xiaogang

    2017-01-01

    Mechanical transmission systems have been widely adopted in most of industrial applications, and issues related to the maintenance of these systems have attracted considerable attention in the past few decades. The recently developed ensemble local mean decomposition (ELMD) method shows satisfactory performance in fault detection of mechanical components for preventing catastrophic failures and reducing maintenance costs. However, the performance of ELMD often heavily depends on proper selection of its model parameters. To this end, this paper proposes an optimized ensemble local mean decomposition (OELMD) method to determinate an optimum set of ELMD parameters for vibration signal analysis. In OELMD, an error index termed the relative root-mean-square error ( Relative RMSE ) is used to evaluate the decomposition performance of ELMD with a certain amplitude of the added white noise. Once a maximum Relative RMSE , corresponding to an optimal noise amplitude, is determined, OELMD then identifies optimal noise bandwidth and ensemble number based on the Relative RMSE and signal-to-noise ratio (SNR), respectively. Thus, all three critical parameters of ELMD (i.e. noise amplitude and bandwidth, and ensemble number) are optimized by OELMD. The effectiveness of OELMD was evaluated using experimental vibration signals measured from three different mechanical components (i.e. the rolling bearing, gear and diesel engine) under faulty operation conditions. (paper)

  5. An optimized ensemble local mean decomposition method for fault detection of mechanical components

    Science.gov (United States)

    Zhang, Chao; Li, Zhixiong; Hu, Chao; Chen, Shuai; Wang, Jianguo; Zhang, Xiaogang

    2017-03-01

    Mechanical transmission systems have been widely adopted in most of industrial applications, and issues related to the maintenance of these systems have attracted considerable attention in the past few decades. The recently developed ensemble local mean decomposition (ELMD) method shows satisfactory performance in fault detection of mechanical components for preventing catastrophic failures and reducing maintenance costs. However, the performance of ELMD often heavily depends on proper selection of its model parameters. To this end, this paper proposes an optimized ensemble local mean decomposition (OELMD) method to determinate an optimum set of ELMD parameters for vibration signal analysis. In OELMD, an error index termed the relative root-mean-square error (Relative RMSE) is used to evaluate the decomposition performance of ELMD with a certain amplitude of the added white noise. Once a maximum Relative RMSE, corresponding to an optimal noise amplitude, is determined, OELMD then identifies optimal noise bandwidth and ensemble number based on the Relative RMSE and signal-to-noise ratio (SNR), respectively. Thus, all three critical parameters of ELMD (i.e. noise amplitude and bandwidth, and ensemble number) are optimized by OELMD. The effectiveness of OELMD was evaluated using experimental vibration signals measured from three different mechanical components (i.e. the rolling bearing, gear and diesel engine) under faulty operation conditions.

  6. Pediatric ambulatory anesthesia.

    Science.gov (United States)

    August, David A; Everett, Lucinda L

    2014-06-01

    Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Risk in pediatric anesthesia.

    Science.gov (United States)

    Paterson, Neil; Waterhouse, Peter

    2011-08-01

    Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk. © 2010 Blackwell Publishing Ltd.

  8. NEURAXIAL ANESTHESIA and OBESITY

    Directory of Open Access Journals (Sweden)

    Aynur sahin

    2013-09-01

    Full Text Available Obesity is one of the serious condition that commonly effects health in modern age. It was reported that obesity was three-fold increased in the last three decades. According to the statement by World Health Organisation in 2005, 700 million people will be estimated obese in 2015. While neuraxial anesthesia is a commonly used technique in the worldwide, the process may have difficulties in obese patients. In this review, the pathophysiological changes and challenges in neuraxial anesthesia procedure in obesity were assessed with current literatures. [J Contemp Med 2013; 3(3.000: 234-236

  9. Anesthesia for interventional radiology

    International Nuclear Information System (INIS)

    van Sonnenberg, E.; Casola, G.; Varney, R.R.; D'Agostino, H.B.; Zornow, M.; Mazzie, W.

    1989-01-01

    We recognized that the complexity and surgical nature of many interventional radiology procedures dictate essential radiologic involvement into traditional anesthesiologic areas. They reviewed our experience with a variety of interventional procedures to document complications and problems related to anesthetic use (or misuse) and compile recommendations for rational monitoring and control for these procedures. In particular, the authors have studied complications of drug therapies and the treatment of these complications; use of complex anesthesia procedures (e.g., epidural anesthesia, succinylcholine blockage); reasons for choice of drugs (e.g., fentanyl vs meperidine vs morphine); and medico-legal aspects of radiologist performing traditional anesthesiology-type procedures

  10. Recent advances and perspectives in topical oral anesthesia.

    Science.gov (United States)

    Franz-Montan, Michelle; Ribeiro, Lígia Nunes de Morais; Volpato, Maria Cristina; Cereda, Cintia Maria Saia; Groppo, Francisco Carlos; Tofoli, Giovana Randomille; de Araújo, Daniele Ribeiro; Santi, Patrizia; Padula, Cristina; de Paula, Eneida

    2017-05-01

    Topical anesthesia is widely used in dentistry to reduce pain caused by needle insertion and injection of the anesthetic. However, successful anesthesia is not always achieved using the formulations that are currently commercially available. As a result, local anesthesia is still one of the procedures that is most feared by dental patients. Drug delivery systems (DDSs) provide ways of improving the efficacy of topical agents. Areas covered: An overview of the structure and permeability of oral mucosa is given, followed by a review of DDSs designed for dental topical anesthesia and their related clinical trials. Chemical approaches to enhance permeation and anesthesia efficacy, or to promote superficial anesthesia, include nanostructured carriers (liposomes, cyclodextrins, polymeric nanoparticle systems, solid lipid nanoparticles, and nanostructured lipid carriers) and different pharmaceutical dosage forms (patches, bio- and mucoadhesive systems, and hydrogels). Physical methods include pre-cooling, vibration, iontophoresis, and microneedle arrays. Expert opinion: The combination of different chemical and physical methods is an attractive option for effective topical anesthesia in oral mucosa. This comprehensive review should provide the readers with the most relevant options currently available to assist pain-free dental anesthesia. The findings should be considered for future clinical trials.

  11. Particle swarm optimization-based local entropy weighted histogram equalization for infrared image enhancement

    Science.gov (United States)

    Wan, Minjie; Gu, Guohua; Qian, Weixian; Ren, Kan; Chen, Qian; Maldague, Xavier

    2018-06-01

    Infrared image enhancement plays a significant role in intelligent urban surveillance systems for smart city applications. Unlike existing methods only exaggerating the global contrast, we propose a particle swam optimization-based local entropy weighted histogram equalization which involves the enhancement of both local details and fore-and background contrast. First of all, a novel local entropy weighted histogram depicting the distribution of detail information is calculated based on a modified hyperbolic tangent function. Then, the histogram is divided into two parts via a threshold maximizing the inter-class variance in order to improve the contrasts of foreground and background, respectively. To avoid over-enhancement and noise amplification, double plateau thresholds of the presented histogram are formulated by means of particle swarm optimization algorithm. Lastly, each sub-image is equalized independently according to the constrained sub-local entropy weighted histogram. Comparative experiments implemented on real infrared images prove that our algorithm outperforms other state-of-the-art methods in terms of both visual and quantized evaluations.

  12. OPTIMIZATION OF THE POSITION OF THE LOCAL DISTRIBUTION CENTRE OF THE REGIONAL POST LOGISTICS NETWORK

    Directory of Open Access Journals (Sweden)

    Paweł DROŹDZIEL

    2017-09-01

    Full Text Available The phenomenon of the present postal services is the fact that, customers expect the lowest price while maintaining the availability, security and on time delivery of mail items. We can find that, the costs associated with transport of the postal substrate is one of the most important factors affecting the total cost of the postal services. These transport costs depend on various factors such as the investment in vehicles purchase, operational costs of the postal vehicles (costs of maintenance, repairs, fuel costs of the vehicle, etc. labour costs of the drivers and so on. For this reason, it is important to find such an operational - organizational solutions that can reduce the costs associated with the transportation of postal shipments, resulting in reducing the total cost of postal services. One option to do this is to minimize the length of postal transportation routes. This article presents the approach based on the application of graph theory to optimize existing connections of postal logistics network. Published results is oriented to revaluate existing position of local centre and find a location for the new local distribution centre potentially. New location of local distribution centre can to optimize (minimize the total transport costs of the local postal transportation network in area of the Lublin Province.

  13. GWO-LPWSN: Grey Wolf Optimization Algorithm for Node Localization Problem in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    R. Rajakumar

    2017-01-01

    Full Text Available Seyedali Mirjalili et al. (2014 introduced a completely unique metaheuristic technique particularly grey wolf optimization (GWO. This algorithm mimics the social behavior of grey wolves whereas it follows the leadership hierarchy and attacking strategy. The rising issue in wireless sensor network (WSN is localization problem. The objective of this problem is to search out the geographical position of unknown nodes with the help of anchor nodes in WSN. In this work, GWO algorithm is incorporated to spot the correct position of unknown nodes, so as to handle the node localization problem. The proposed work is implemented using MATLAB 8.2 whereas nodes are deployed in a random location within the desired network area. The parameters like computation time, percentage of localized node, and minimum localization error measures are utilized to analyse the potency of GWO rule with other variants of metaheuristics algorithms such as particle swarm optimization (PSO and modified bat algorithm (MBA. The observed results convey that the GWO provides promising results compared to the PSO and MBA in terms of the quick convergence rate and success rate.

  14. Intraosseous anesthesia: implications, instrumentation and techniques.

    Science.gov (United States)

    Kleber, Christopher H

    2003-04-01

    The author reviews historical methods and the instruments used to bring about intraosseous anesthesia, or IOA; discusses the criteria for successful use of the intraosseous injection, or IOI, technique; and provides recommendations. Articles from before 1990 consisted of subjective reports of patient types and procedures performed using IOI as a primary technique. Studies published after 1990 yielded subjective findings on indications for expanded clinical use. The author discusses the expansion of the role of IOI relative to integrated local anesthetic delivery systems. The literature and studies verify the efficacy of IOI as a supplemental or primary technique. The author recommends anesthetics and infusion sites, and reports on the patients' perceptions of comfort. IOI can be used as a supplemental or primary technique to bring about local anesthesia in routine dental procedures. It can be used as a supplemental technique with mandibular nerve blocks to enhance deep pulpal anesthesia. It can be used as a primary technique so that patients do not experience numb lips or tongues postoperatively. Dentists can appreciate the immediate onset of anesthesia and reduced dosage levels of anesthetics associated with using IOI.

  15. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  16. Strategies for discovery and optimization of thermoelectric materials: Role of real objects and local fields

    Science.gov (United States)

    Zhu, Hao; Xiao, Chong

    2018-06-01

    Thermoelectric materials provide a renewable and eco-friendly solution to mitigate energy shortages and to reduce environmental pollution via direct heat-to-electricity conversion. Discovery of the novel thermoelectric materials and optimization of the state-of-the-art material systems lie at the core of the thermoelectric society, the basic concept behind these being comprehension and manipulation of the physical principles and transport properties regarding thermoelectric materials. In this mini-review, certain examples for designing high-performance bulk thermoelectric materials are presented from the perspectives of both real objects and local fields. The highlights of this topic involve the Rashba effect, Peierls distortion, local magnetic field, and local stress field, which cover several aspects in the field of thermoelectric research. We conclude with an overview of future developments in thermoelectricity.

  17. Matrix Completion Optimization for Localization in Wireless Sensor Networks for Intelligent IoT

    Directory of Open Access Journals (Sweden)

    Thu L. N. Nguyen

    2016-05-01

    Full Text Available Localization in wireless sensor networks (WSNs is one of the primary functions of the intelligent Internet of Things (IoT that offers automatically discoverable services, while the localization accuracy is a key issue to evaluate the quality of those services. In this paper, we develop a framework to solve the Euclidean distance matrix completion problem, which is an important technical problem for distance-based localization in WSNs. The sensor network localization problem is described as a low-rank dimensional Euclidean distance completion problem with known nodes. The task is to find the sensor locations through recovery of missing entries of a squared distance matrix when the dimension of the data is small compared to the number of data points. We solve a relaxation optimization problem using a modification of Newton’s method, where the cost function depends on the squared distance matrix. The solution obtained in our scheme achieves a lower complexity and can perform better if we use it as an initial guess for an interactive local search of other higher precision localization scheme. Simulation results show the effectiveness of our approach.

  18. Intraosseous anesthesia using a computer-controlled system during non-surgical periodontal therapy (root planing): Two case reports.

    Science.gov (United States)

    Han, Keumah; Kim, Jongbin

    2018-02-01

    Local anesthesia is administered to control pain, but it may induce fear and anxiety. Root planing is a non-surgical periodontal therapy; however, when it is performed in an extensive manner, some tissue removal is inevitable. Notably, this removal may be so painful that local anesthesia is required to be administered to the area scheduled for the treatment. Although patients tend to accept root planing easily, they frequently express a fear of local anesthesia. Intraosseous anesthesia (IA) is an intraosseous injection technique, whereby local anesthetic is injected into the cancellous bone supporting the teeth. A computer-controlled IA system (CIAS) exhibits multiple benefits, such as less painful anesthesia, reduced soft tissue numbness, and the provision of palatal or lingual, as well as buccal, anesthesia via single needle penetration. In this report, we present two cases of root planing that were performed under local anesthesia, using a CIAS.

  19. Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patients undergoing intrascrotal surgeries: randomized controlled multicenter clinical trial

    Directory of Open Access Journals (Sweden)

    Hetta DF

    2017-11-01

    Full Text Available Diab Fuad Hetta,1 Emad E Kamal,2 Ali M Mahran,2 Doaa G Ahmed,1 Abdelraheem Elawamy,3 Abdelraouf MS Abdelraouf3 1Department of Anesthesiology and Pain Management, South Egypt Cancer Institute, 2Department of Dermatology and Andrology, 3Department of Anesthesiology and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt Study objective: The objective of this study was to evaluate the effect of adding dexmedetomidine (DEX to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia. Design: This is a randomized, double-blind study. Setting: This study was performed in an educational and research hospital. Patients: One hundred twenty adult males were scheduled for intrascrotal surgeries. Interventions: Patients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously. Measurements: Time to first analgesic request, analgesic consumption, and visual analog scale (VAS pain score in the first 24 hours postoperatively were assessed. Main results: Time to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile range, 7 (6–12 hours versus 6 (5–7 hours, (p=0.000, the mean cumulative morphine consumption (mg in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI of −4.57 (−6.06 to −3.07 (p=0.000; also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8, VAS 6 hours (2.62±1.5 vs 3.93±1.2, VAS 12 hours (2.40±1.1 vs 3.57±0.65, VAS 24 hours (1.90±0

  20. DESTINATION MARKETING STRATEGY IN BALI THROUGH OPTIMIZING THE POTENTIAL OF LOCAL PRODUCTS

    Directory of Open Access Journals (Sweden)

    I Gusti Ayu Oka Suryawardani

    2014-03-01

    Full Text Available This study was designed to study destination marketing strategy in Bali through optimizing the potential of local products. Seventy nine of hotel managers were interviewed based on cluster sampling method to gain their point of view. The results show that destination must build their images around unique attributes that provide them sustainable competitive advantage including its attraction which should be designed to meet the needs of the target market and should be served by local products. The results also show that hotel managers thought that foreign tourists always preferred imported products, meanwhile previous statistical results indicate that foreign tourists significantly look for local products. There is a need to encourage hotel managers to change their perception and attitude about local and imported products. In fact, hoteliers expressed willingness to use local products as long as these meet the quality standard. As tourism involves four types of activities, namely something to see, something to do, something to buy, something to learn, destination product development could be focused in the above activities through offering foreign tourist, such as to stay in hotels, homestays or villas owned by Balinese; to eat in restaurants owned by Balinese by choosing the authentic local foods that are using local meat, seafood and vegetables, exotic local fruits and beverages; and to buy products that are produced by the Balinese. By promoting vacation on the real Balinese atmosphere such as stay in accommodations owned by the Balinese supported by the authenticity of local Balinese foods, fruits and beverages, these will strengthen the local economy, so the benefit of tourism development can be more beneficial to the local Balinese. The results suggests that destination management related to improvement of service and hospitality are really important through improvement of human resource by giving training to their employees, educate

  1. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  2. Administration of Anesthesia

    Medline Plus

    Full Text Available ... of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and ... of Use Privacy Policy © Copyright AAOMS 2008-2018 Facebook Twitter Instagram Pinterest YouTube Vimeo American Association of ...

  3. Defining depth of anesthesia.

    Science.gov (United States)

    Shafer, S L; Stanski, D R

    2008-01-01

    In this chapter, drawn largely from the synthesis of material that we first presented in the sixth edition of Miller's Anesthesia, Chap 31 (Stanski and Shafer 2005; used by permission of the publisher), we have defined anesthetic depth as the probability of non-response to stimulation, calibrated against the strength of the stimulus, the difficulty of suppressing the response, and the drug-induced probability of non-responsiveness at defined effect site concentrations. This definition requires measurement of multiple different stimuli and responses at well-defined drug concentrations. There is no one stimulus and response measurement that will capture depth of anesthesia in a clinically or scientifically meaningful manner. The "clinical art" of anesthesia requires calibration of these observations of stimuli and responses (verbal responses, movement, tachycardia) against the dose and concentration of anesthetic drugs used to reduce the probability of response, constantly adjusting the administered dose to achieve the desired anesthetic depth. In our definition of "depth of anesthesia" we define the need for two components to create the anesthetic state: hypnosis created with drugs such as propofol or the inhalational anesthetics and analgesia created with the opioids or nitrous oxide. We demonstrate the scientific evidence that profound degrees of hypnosis in the absence of analgesia will not prevent the hemodynamic responses to profoundly noxious stimuli. Also, profound degrees of analgesia do not guarantee unconsciousness. However, the combination of hypnosis and analgesia suppresses hemodynamic response to noxious stimuli and guarantees unconsciousness.

  4. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  5. Multi objective genetic algorithm to optimize the local heat treatment of a hardenable aluminum alloy

    Science.gov (United States)

    Piccininni, A.; Palumbo, G.; Franco, A. Lo; Sorgente, D.; Tricarico, L.; Russello, G.

    2018-05-01

    The continuous research for lightweight components for transport applications to reduce the harmful emissions drives the attention to the light alloys as in the case of Aluminium (Al) alloys, capable to combine low density with high values of the strength-to-weight ratio. Such advantages are partially counterbalanced by the poor formability at room temperature. A viable solution is to adopt a localized heat treatment by laser of the blank before the forming process to obtain a tailored distribution of material properties so that the blank can be formed at room temperature by means of conventional press machines. Such an approach has been extensively investigated for age hardenable alloys, but in the present work the attention is focused on the 5000 series; in particular, the optimization of the deep drawing process of the alloy AA5754 H32 is proposed through a numerical/experimental approach. A preliminary investigation was necessary to correctly tune the laser parameters (focus length, spot dimension) to effectively obtain the annealed state. Optimal process parameters were then obtained coupling a 2D FE model with an optimization platform managed by a multi-objective genetic algorithm. The optimal solution (i.e. able to maximize the LDR) in terms of blankholder force and extent of the annealed region was thus evaluated and validated through experimental trials. A good matching between experimental and numerical results was found. The optimal solution allowed to obtain an LDR of the locally heat treated blank larger than the one of the material either in the wrought condition (H32) either in the annealed condition (H111).

  6. Global-Local Analysis and Optimization of a Composite Civil Tilt-Rotor Wing

    Science.gov (United States)

    Rais-Rohani, Masound

    1999-01-01

    This report gives highlights of an investigation on the design and optimization of a thin composite wing box structure for a civil tilt-rotor aircraft. Two different concepts are considered for the cantilever wing: (a) a thin monolithic skin design, and (b) a thick sandwich skin design. Each concept is examined with three different skin ply patterns based on various combinations of 0, +/-45, and 90 degree plies. The global-local technique is used in the analysis and optimization of the six design models. The global analysis is based on a finite element model of the wing-pylon configuration while the local analysis uses a uniformly supported plate representing a wing panel. Design allowables include those on vibration frequencies, panel buckling, and material strength. The design optimization problem is formulated as one of minimizing the structural weight subject to strength, stiffness, and d,vnamic constraints. Six different loading conditions based on three different flight modes are considered in the design optimization. The results of this investigation reveal that of all the loading conditions the one corresponding to the rolling pull-out in the airplane mode is the most stringent. Also the frequency constraints are found to drive the skin thickness limits, rendering the buckling constraints inactive. The optimum skin ply pattern for the monolithic skin concept is found to be (((0/+/-45/90/(0/90)(sub 2))(sub s))(sub s), while for the sandwich skin concept the optimal ply pattern is found to be ((0/+/-45/90)(sub 2s))(sub s).

  7. Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification.

    Science.gov (United States)

    Ahmad, Nauman; Zahoor, Abdul; Motowa, Saeed A; Jastaneiah, Saba; Riad, Waleed

    2012-01-01

    Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. Ptopical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

  8. Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

    Directory of Open Access Journals (Sweden)

    Nauman Ahmad

    2012-01-01

    Full Text Available Background: Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Methods: Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS. The Student′s t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant. Results: Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively. In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively. Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Conclusion: Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

  9. Total spinal anesthesia in an achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Amiri H R

    2008-06-01

    Full Text Available Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

  10. A computational framework for the optimal design of morphing processes in locally activated smart material structures

    International Nuclear Information System (INIS)

    Wang, Shuang; Brigham, John C

    2012-01-01

    A proof-of-concept study is presented for a strategy to obtain maximally efficient and accurate morphing structures composed of active materials such as shape memory polymers (SMP) through synchronization of adaptable and localized activation and actuation. The work focuses on structures or structural components entirely composed of thermo-responsive SMP, and particularly utilizes the ability of such materials to display controllable variable stiffness. The study presents and employs a computational inverse mechanics approach that combines a computational representation of the SMP thermo-mechanical behavior with a nonlinear optimization algorithm to determine location, magnitude and sequencing of the activation and actuation to obtain a desired shape change subject to design objectives such as prevention of damage. Two numerical examples are presented in which the synchronization of the activation and actuation and the location of activation excitation were optimized with respect to the combined thermal and mechanical energy for design concepts in morphing skeletal structural components. In all cases the concept of localized activation along with the optimal design strategy were able to produce far more energy efficient morphing structures and more accurately reach the desired shape change in comparison to traditional methods that require complete structural activation prior to actuation. (paper)

  11. Optimization of the fiber laser parameters for local high-temperature impact on metal

    Science.gov (United States)

    Yatsko, Dmitrii S.; Polonik, Marina V.; Dudko, Olga V.

    2016-11-01

    This paper presents the local laser heating process of surface layer of the metal sample. The aim is to create the molten pool with the required depth by laser thermal treatment. During the heating the metal temperature at any point of the molten zone should not reach the boiling point of the main material. The laser power, exposure time and the spot size of a laser beam are selected as the variable parameters. The mathematical model for heat transfer in a semi-infinite body, applicable to finite slab, is used for preliminary theoretical estimation of acceptable parameters values of the laser thermal treatment. The optimization problem is solved by using an algorithm based on the scanning method of the search space (the zero-order method of conditional optimization). The calculated values of the parameters (the optimal set of "laser radiation power - exposure time - spot radius") are used to conduct a series of natural experiments to obtain a molten pool with the required depth. A two-stage experiment consists of: a local laser treatment of metal plate (steel) and then the examination of the microsection of the laser irradiated region. According to the experimental results, we can judge the adequacy of the ongoing calculations within the selected models.

  12. USING OF FIRST GENERATION OF Hl ANTIHISTAMINES As ALTERNATIVE OF LOCAL ANESTHETIC IN ODONTOLOGIC USE IN ANESTHESIA INFILTRATIVE TECHNICS. EXPERIMENTAL STUDY IN ANIMALS

    OpenAIRE

    Rodríguez Alfaro, Miguel; Burga Sánchez, Jonny; Chumpitaz Cerrate, Victor; Varas Hilario, Roberto; López Bellido, Roger; Chuquihuaccha Granda, Vilma; Zegarra Cuya, Juan

    2014-01-01

    The presence of adverse drug reactions with local anesthetics takes us to the search of effective alternatives to this drugs. 60 albino rabbits divided into 6 groups were submifted to infiltrative anesthetic technique in the maxilla with lidocaine, mepivacaine, bupivacaine, chlorpheniramine and dimenhidrinate, in front of sodium chloride 0,9%. The pain threshold belzavior was evaluated with electrical stimulation from Ruhnkorff s bobbin behind the drllg application and comparison between grou...

  13. [Cranial nerve damage after neuroaxial methods of anesthesia in puerperas].

    Science.gov (United States)

    Floka, S E; Shifman, E M

    2007-01-01

    The paper describes cranial nerve damage, a rare complication of neuroaxial anesthesia in obstetric care. In the literature, there are summarized data on 17 cases of neurological deficit developing after subarachnoidal or epidural anesthesia in puerperas. The etiological and pathogenetic factors of the above complications may be suggested to be the high disposition of a local anesthetic, arterial hypotension due to neuroaxial anesthetics, the outflow of cerebrospinal fluid after pachymeningeal puncture (including after unintended puncture during epidural anesthesia), and ischemic injury after the blood packing performed to relieve postpuncture headache. Closer consideration of these risk factors seems to reduce the incidence of cranial nerve damage in puerperas.

  14. The Optimization of the Local Public Policies’ Development Process Through Modeling And Simulation

    Directory of Open Access Journals (Sweden)

    Minodora URSĂCESCU

    2012-06-01

    Full Text Available The local public policies development in Romania represents an empirically realized measure, the strategic management practices in this domain not being based on a scientific instrument capable to anticipate and evaluate the results of implementing a local public policy in a logic of needs-policies-effects type. Beginning from this motivation, the purpose of the paper resides in the reconceptualization of the public policies process on functioning principles of the dynamic systems with inverse connection, by means of mathematical modeling and techniques simulation. Therefore, the research is oriented in the direction of developing an optimization method for the local public policies development process, using as instruments the mathematical modeling and the techniques simulation. The research’s main results are on the one side constituted by generating a new process concept of the local public policies, and on the other side by proposing the conceptual model of a complex software product which will permit the parameterized modeling in a virtual environment of these policies development process. The informatic product’s finality resides in modeling and simulating each local public policy type, taking into account the respective policy’s characteristics, but also the value of their appliance environment parameters in a certain moment.

  15. Anesthesia Methods in Laser Resurfacing

    Science.gov (United States)

    Gaitan, Sergio; Markus, Ramsey

    2012-01-01

    Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected forms (infiltrative, nerve blocks, and tumescent anesthesia) and supervised anesthesia (monitored anesthesia care and general anesthesia). In this review, the authors summarize the types of anesthesia used in laser resurfacing to aid the provider in offering the most appropriate method for the patient to have as painless a procedure as possible. PMID:23904819

  16. Particle Swarm Optimization Based on Local Attractors of Ordinary Differential Equation System

    Directory of Open Access Journals (Sweden)

    Wenyu Yang

    2014-01-01

    Full Text Available Particle swarm optimization (PSO is inspired by sociological behavior. In this paper, we interpret PSO as a finite difference scheme for solving a system of stochastic ordinary differential equations (SODE. In this framework, the position points of the swarm converge to an equilibrium point of the SODE and the local attractors, which are easily defined by the present position points, also converge to the global attractor. Inspired by this observation, we propose a class of modified PSO iteration methods (MPSO based on local attractors of the SODE. The idea of MPSO is to choose the next update state near the present local attractor, rather than the present position point as in the original PSO, according to a given probability density function. In particular, the quantum-behaved particle swarm optimization method turns out to be a special case of MPSO by taking a special probability density function. The MPSO methods with six different probability density functions are tested on a few benchmark problems. These MPSO methods behave differently for different problems. Thus, our framework not only gives an interpretation for the ordinary PSO but also, more importantly, provides a warehouse of PSO-like methods to choose from for solving different practical problems.

  17. Bilayer Local Search Enhanced Particle Swarm Optimization for the Capacitated Vehicle Routing Problem

    Directory of Open Access Journals (Sweden)

    A. K. M. Foysal Ahmed

    2018-03-01

    Full Text Available The classical capacitated vehicle routing problem (CVRP is a very popular combinatorial optimization problem in the field of logistics and supply chain management. Although CVRP has drawn interests of many researchers, no standard way has been established yet to obtain best known solutions for all the different problem sets. We propose an efficient algorithm Bilayer Local Search-based Particle Swarm Optimization (BLS-PSO along with a novel decoding method to solve CVRP. Decoding method is important to relate the encoded particle position to a feasible CVRP solution. In bilayer local search, one layer of local search is for the whole population in any iteration whereas another one is applied only on the pool of the best particles generated in different generations. Such searching strategies help the BLS-PSO to perform better than the existing proposals by obtaining best known solutions for most of the existing benchmark problems within very reasonable computational time. Computational results also show that the performance achieved by the proposed algorithm outperforms other PSO-based approaches.

  18. Supervised Kernel Optimized Locality Preserving Projection with Its Application to Face Recognition and Palm Biometrics

    Directory of Open Access Journals (Sweden)

    Chuang Lin

    2015-01-01

    Full Text Available Kernel Locality Preserving Projection (KLPP algorithm can effectively preserve the neighborhood structure of the database using the kernel trick. We have known that supervised KLPP (SKLPP can preserve within-class geometric structures by using label information. However, the conventional SKLPP algorithm endures the kernel selection which has significant impact on the performances of SKLPP. In order to overcome this limitation, a method named supervised kernel optimized LPP (SKOLPP is proposed in this paper, which can maximize the class separability in kernel learning. The proposed method maps the data from the original space to a higher dimensional kernel space using a data-dependent kernel. The adaptive parameters of the data-dependent kernel are automatically calculated through optimizing an objective function. Consequently, the nonlinear features extracted by SKOLPP have larger discriminative ability compared with SKLPP and are more adaptive to the input data. Experimental results on ORL, Yale, AR, and Palmprint databases showed the effectiveness of the proposed method.

  19. Reliability based topology optimization for continuum structures with local failure constraints

    DEFF Research Database (Denmark)

    Luo, Yangjun; Zhou, Mingdong; Wang, Michael Yu

    2014-01-01

    This paper presents an effective method for stress constrained topology optimization problems under load and material uncertainties. Based on the Performance Measure Approach (PMA), the optimization problem is formulated as to minimize the objective function under a large number of (stress......-related) target performance constraints. In order to overcome the stress singularity phenomenon caused by the combined stress and reliability constraints, a reduction strategy on target reliability index is proposed and utilized together with the ε-relaxation approach. Meanwhile, an enhanced aggregation method...... is employed to aggregate the selected active constraints using a general K–S function, which avoids expensive computational cost from the large-scale nature of local failure constraints. Several numerical examples are given to demonstrate the validity of the present method....

  20. Optimized curve design for image analysis using localized geodesic distance transformations

    Science.gov (United States)

    Braithwaite, Billy; Niska, Harri; Pöllänen, Irene; Ikonen, Tiia; Haataja, Keijo; Toivanen, Pekka; Tolonen, Teemu

    2015-03-01

    We consider geodesic distance transformations for digital images. Given a M × N digital image, a distance image is produced by evaluating local pixel distances. Distance Transformation on Curved Space (DTOCS) evaluates shortest geodesics of a given pixel neighborhood by evaluating the height displacements between pixels. In this paper, we propose an optimization framework for geodesic distance transformations in a pattern recognition scheme, yielding more accurate machine learning based image analysis, exemplifying initial experiments using complex breast cancer images. Furthermore, we will outline future research work, which will complete the research work done for this paper.

  1. Online Robot Dead Reckoning Localization Using Maximum Relative Entropy Optimization With Model Constraints

    International Nuclear Information System (INIS)

    Urniezius, Renaldas

    2011-01-01

    The principle of Maximum relative Entropy optimization was analyzed for dead reckoning localization of a rigid body when observation data of two attached accelerometers was collected. Model constraints were derived from the relationships between the sensors. The experiment's results confirmed that accelerometers each axis' noise can be successfully filtered utilizing dependency between channels and the dependency between time series data. Dependency between channels was used for a priori calculation, and a posteriori distribution was derived utilizing dependency between time series data. There was revisited data of autocalibration experiment by removing the initial assumption that instantaneous rotation axis of a rigid body was known. Performance results confirmed that such an approach could be used for online dead reckoning localization.

  2. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia.

    Science.gov (United States)

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María-José; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2012-05-01

    To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, panesthesia. Post-anesthetic biting showed no significant differences between the two techniques.

  3. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  4. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  5. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    Newman, Beverley; Gawande, Rakhee; Krane, Elliot J.; Holmes, Tyson H.; Robinson, Terry E.

    2014-01-01

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  6. Mentorship in anesthesia.

    Science.gov (United States)

    Flexman, Alana M; Gelb, Adrian W

    2011-12-01

    This article will provide a review of mentorship in academic medicine. The review will include definitions and an overview of the evidence supporting the benefits, barriers, and structure of mentorship programmes in academic medicine and anesthesia. Finally, we will identify areas of further research. Mentorship in medicine has been increasingly recognized as a core component of training and career advancement in academic medicine. Mentoring provides many benefits to both mentor and mentee and facilitates the growth of academic departments by improving research productivity, faculty career satisfaction, recruitment, and educational performance. Mentorship programmes may be formal or informal and should include some form of mentor education. There are several barriers to successful mentorship including time constraints, limited availability of mentors, gender, minority status, and generational differences. These barriers may be overcome with improved awareness and sensitivity. Further investigation into the prevalence of mentorship and specific needs in our specialty are urgently required. Mentorship has been demonstrated to be an integral part of training and career development in academic medicine and benefits both mentees and mentors. Despite the promotion of mentorship in many academic anesthesia departments, little is published in the available literature supporting mentorship in anesthesia.

  7. Intranet and village community: optimization of public service based on electronic government at the local level

    Science.gov (United States)

    Pradana, G. W.; Fanida, E. H.; Niswah, F.

    2018-01-01

    The demand for good governance is directed towards the realization of efficiency, effectiveness, and clean government. The move is demonstrated through national and regional levels to develop and implement electronic government concepts. Through the development of electronic government is done structuring management systems and work processes in the government environment by optimizing the utilization of information technology. One of the real forms of electronic government (e-Gov) implementation at the local level is the Intranet Sub-District program in Sukodono Sub-District, Sidoarjo. Intranet Sub-District is an innovation whose purpose is to realize the availability of information on the utilization of management, distribution, and storage of official scripts, and also the optimal delivery of information and communication in the implementation of guidance and supervision of local administration. The type of this paper is descriptive with a qualitative approach and focus on the implementation of the Intranet District Program in Sukodono District, Sidoarjo. The findings of the study are the limited number of human resources who have mastered ICT, the uneven network, the adequacy of institutional needs and the existence of budget support from the authorized institution and the information system has not accommodated all the service needs.

  8. Nonlinear Optimization-Based Device-Free Localization with Outlier Link Rejection

    Directory of Open Access Journals (Sweden)

    Wendong Xiao

    2015-04-01

    Full Text Available Device-free localization (DFL is an emerging wireless technique for estimating the location of target that does not have any attached electronic device. It has found extensive use in Smart City applications such as healthcare at home and hospitals, location-based services at smart spaces, city emergency response and infrastructure security. In DFL, wireless devices are used as sensors that can sense the target by transmitting and receiving wireless signals collaboratively. Many DFL systems are implemented based on received signal strength (RSS measurements and the location of the target is estimated by detecting the changes of the RSS measurements of the wireless links. Due to the uncertainty of the wireless channel, certain links may be seriously polluted and result in erroneous detection. In this paper, we propose a novel nonlinear optimization approach with outlier link rejection (NOOLR for RSS-based DFL. It consists of three key strategies, including: (1 affected link identification by differential RSS detection; (2 outlier link rejection via geometrical positional relationship among links; (3 target location estimation by formulating and solving a nonlinear optimization problem. Experimental results demonstrate that NOOLR is robust to the fluctuation of the wireless signals with superior localization accuracy compared with the existing Radio Tomographic Imaging (RTI approach.

  9. [Development and clinical evaluation of an anesthesia information management system].

    Science.gov (United States)

    Feng, Jing-yi; Chen, Hua; Zhu, Sheng-mei

    2010-09-21

    To study the design, implementation and clinical evaluation of an anesthesia information management system. To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. With the system, kinds of patient data could be collected, stored, analyzed and archived, kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provide clinical proof.

  10. Scalable unit commitment by memory-bounded ant colony optimization with A{sup *} local search

    Energy Technology Data Exchange (ETDEWEB)

    Saber, Ahmed Yousuf; Alshareef, Abdulaziz Mohammed [Department of Electrical and Computer Engineering, King Abdulaziz University, P.O. Box 80204, Jeddah 21589 (Saudi Arabia)

    2008-07-15

    Ant colony optimization (ACO) is successfully applied in optimization problems. Performance of the basic ACO for small problems with moderate dimension and searching space is satisfactory. As the searching space grows exponentially in the large-scale unit commitment problem, the basic ACO is not applicable for the vast size of pheromone matrix of ACO in practical time and physical computer-memory limit. However, memory-bounded methods prune the least-promising nodes to fit the system in computer memory. Therefore, the authors propose memory-bounded ant colony optimization (MACO) in this paper for the scalable (no restriction for system size) unit commitment problem. This MACO intelligently solves the limitation of computer memory, and does not permit the system to grow beyond a bound on memory. In the memory-bounded ACO implementation, A{sup *} heuristic is introduced to increase local searching ability and probabilistic nearest neighbor method is applied to estimate pheromone intensity for the forgotten value. Finally, the benchmark data sets and existing methods are used to show the effectiveness of the proposed method. (author)

  11. Process planning optimization on turning machine tool using a hybrid genetic algorithm with local search approach

    Directory of Open Access Journals (Sweden)

    Yuliang Su

    2015-04-01

    Full Text Available A turning machine tool is a kind of new type of machine tool that is equipped with more than one spindle and turret. The distinctive simultaneous and parallel processing abilities of turning machine tool increase the complexity of process planning. The operations would not only be sequenced and satisfy precedence constraints, but also should be scheduled with multiple objectives such as minimizing machining cost, maximizing utilization of turning machine tool, and so on. To solve this problem, a hybrid genetic algorithm was proposed to generate optimal process plans based on a mixed 0-1 integer programming model. An operation precedence graph is used to represent precedence constraints and help generate a feasible initial population of hybrid genetic algorithm. Encoding strategy based on data structure was developed to represent process plans digitally in order to form the solution space. In addition, a local search approach for optimizing the assignments of available turrets would be added to incorporate scheduling with process planning. A real-world case is used to prove that the proposed approach could avoid infeasible solutions and effectively generate a global optimal process plan.

  12. VECTOR THEORY AND OPTIMAL CHOICE OF ANTIMICROBIAL DRUG FOR LOCAL WOUND TREATMENT

    Directory of Open Access Journals (Sweden)

    Boyko N. N

    2016-12-01

    Full Text Available Introduction. One of important problems in the field of medicine and pharmacy is an optimal choice among several alternatives. For example, the choice of drugs for treatment among several analogs, selection of excipients among analogs for development of pharmaceutical forms with optimal pharmacological, technological and economical parameters, etc.The aim of the work is to show the possibility of vector theory use for optimal choice of antimicrobial drugs for local wound treatment among analogs taking into account several criteria at the same time. Materials and methods. For our investigation we have chosen ten drugs with antimicrobial properties for local wound treatment in different pharmaceutical forms (ointment, liniment, water and glycerin solution, tincture. We have determined antibacterial activity of drugs by agar well diffusion method on six test-stain microorganisms: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Proteus vulgaris ATCC 4636, Bacillus subtilis ATCC 6633, and Candida albicans ATCC 885-653. Well diameter was 10 mm, the volume of drug in the well was 0.27±0.02 ml, microbial burden of agar upper layer was 107 CFU/ml, and total layer height in Petri dish was 4.0±0.5 mm. In order to integrate various qualitative and quantitative parameters into one index (vector object in multidimensional factors’ space we modify these parameters to non-dimensional normalized values. For this purpose we use a desirability theory. We have chosen the following criteria for optimal choice of the drug: antimicrobial activity (integrated index of drug’s antimicrobial activity, drug’s price, pharmacological and technological index, spectrum of drug’s action on test strains of microorganisms studied. Results and their discussions. Using vector and desirability theory, we have obtained the following range of drugs in decreasing order: Laevomecol ointment, Ioddicerinum, Tincture of Sophora

  13. Globally-Optimized Local Pseudopotentials for (Orbital-Free) Density Functional Theory Simulations of Liquids and Solids.

    Science.gov (United States)

    Del Rio, Beatriz G; Dieterich, Johannes M; Carter, Emily A

    2017-08-08

    The accuracy of local pseudopotentials (LPSs) is one of two major determinants of the fidelity of orbital-free density functional theory (OFDFT) simulations. We present a global optimization strategy for LPSs that enables OFDFT to reproduce solid and liquid properties obtained from Kohn-Sham DFT. Our optimization strategy can fit arbitrary properties from both solid and liquid phases, so the resulting globally optimized local pseudopotentials (goLPSs) can be used in solid and/or liquid-phase simulations depending on the fitting process. We show three test cases proving that we can (1) improve solid properties compared to our previous bulk-derived local pseudopotential generation scheme; (2) refine predicted liquid and solid properties by adding force matching data; and (3) generate a from-scratch, accurate goLPS from the local channel of a non-local pseudopotential. The proposed scheme therefore serves as a full and improved LPS construction protocol.

  14. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus...... on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children....... The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps...

  15. Local application of 133Xenon for measurement of regional cerebral blood flow (rCBF) during halothane, enflurane, and isoflurane anesthesia in humans

    International Nuclear Information System (INIS)

    Eintrei, C.; Leszniewski, W.; Carlsson, C.

    1985-01-01

    It is well known that halothane causes an increase in cerebral blood flow (CBF). In this study the effects of halothane, enflurane, and isoflurane on regional cerebral blood flow (rCBF) in humans were determined in the presence of 70% N 2 O at a combined MAC concentration of 1.5. CBF was determined in 24 patients from the washout of locally applied 133 Xenon with the use of an external scintillation. All 24 patients (control n = 6, halothane n = 6, enflurane n = 6, and isoflurane n = 6) were undergoing neurosurgical procedures. All patients were anesthetized with thiopental, fentanyl, droperidol, and 70% N 2 O in oxygen and paralyzed with pancuronium. The measurements were performed after the dura had been opened and before definitive surgery. The first measurement was done in the absence of any volatile agent, and the wash-out curve was registered for 6 min. The second measurement was done after one of the volatile agents had been added for at least 20 min and had reached a concentration of 0.58% for halothane, 1.14% for enflurane, or 1.0% for isoflurane in the expiratory gases in order to obtain about 1.5 MAC with each volatile anesthetic. The anesthetic concentrations were measured with the Engstroem multigas analyzer EMMA. The physiologic variables changed very little throughout the period of observation. Body temperature, heart rate, blood pressure, PaCO 2 , and PaO 2 were stable. Ephedrine was used to maintain a stable arterial pressure. At approximately 1.5 MAC, halothane (plus N 2 O) increased rCBF to nearly three times (166%) the control value, while enflurane induced only a slight increase (35%) in rCBF

  16. Inhibitory effect of pentobarbital anesthesia on venous stasis induced arteriolar vasoconstriction in the dog hindleg

    DEFF Research Database (Denmark)

    Bülow, J; Henriksen, O; Amtorp, Ole

    1984-01-01

    venous stasis. In another experimental series the effect of general pentobarbital anesthesia on the vasoconstrictor activity in response to venous stasis locally in subcutaneous and muscle tissue in the hind limb was examined in 6 dogs. It was found that during the first 2-3 h of anesthesia...... the vasoconstrictor response was present in both tissues although the response in muscle tissue exhibited a great variation between the dogs during this period. However, after 4-5 h of anesthesia the response was abolished in both tissues. During neurolept anesthesia with fentanyl/N2O the same vasoconstrictor...... response was demonstrated in the hindleg 1 h and 5 h after induction of the anesthesia. It is concluded that pentobarbital anesthesia abolishes the arteriolar constriction induced by venous stasis. The mechanism may be blockade of the local sympathetic vasoconstrictor fibres or interference with myogenic...

  17. Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

    International Nuclear Information System (INIS)

    McGarry, Conor K.; Bokrantz, Rasmus; O’Sullivan, Joe M.; Hounsell, Alan R.

    2014-01-01

    Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study’s aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8 Gy vs 35.5 ± 4.2 Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4 Gy vs 35.5 ± 4.2 Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to

  18. Energy Consumption Forecasting Using Semantic-Based Genetic Programming with Local Search Optimizer

    Directory of Open Access Journals (Sweden)

    Mauro Castelli

    2015-01-01

    Full Text Available Energy consumption forecasting (ECF is an important policy issue in today’s economies. An accurate ECF has great benefits for electric utilities and both negative and positive errors lead to increased operating costs. The paper proposes a semantic based genetic programming framework to address the ECF problem. In particular, we propose a system that finds (quasi-perfect solutions with high probability and that generates models able to produce near optimal predictions also on unseen data. The framework blends a recently developed version of genetic programming that integrates semantic genetic operators with a local search method. The main idea in combining semantic genetic programming and a local searcher is to couple the exploration ability of the former with the exploitation ability of the latter. Experimental results confirm the suitability of the proposed method in predicting the energy consumption. In particular, the system produces a lower error with respect to the existing state-of-the art techniques used on the same dataset. More importantly, this case study has shown that including a local searcher in the geometric semantic genetic programming system can speed up the search process and can result in fitter models that are able to produce an accurate forecasting also on unseen data.

  19. [Crisis management in pediatric anesthesia].

    Science.gov (United States)

    Takeuchi, Mamoru; Otsuka, Yoji; Taga, Naoyuki; Sato, Yuki; Iwai, Hidetaka; Okada, Osamu

    2009-05-01

    We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. Neonates and infants easily become hypoxic due to their insufficient functional residual capacity. Therefore airway management is most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation. The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.

  20. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... comfort. Medication is sometimes helpful. What are the risks of anesthesia? Serious anesthesia complications, such as brain damage or ... hereditary conditions, which are associated with a greater risk. Although ... reactions to anesthesia are extremely rare. All precautions are taken to ...

  1. Anesthesia -- What to Expect (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anesthesia - What to Expect KidsHealth / For Teens / Anesthesia - What ... Operating Room After Surgery Print Different Kinds of Anesthesia If you're having any kind of procedure ...

  2. Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

    Science.gov (United States)

    Son, Andrew; Mannoia, Kristyn; Herrera, Anthony; Chizari, Mohammad; Hagdoost, Muhammad; Molkara, Afshin

    2016-05-01

    Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery including general endotracheal intubation, laryngeal mask airway, regional anesthesia with nerve blocks, and monitored anesthesia care with local infiltration. It is unclear what effect the method of anesthesia has on AVF creation success rate. It is our objective to determine if anesthesia type affects success of these surgeries defined by complication and maturation rates. A retrospective review was performed in a single institution, single surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross analyzed between 3 anesthesia types (General Endotracheal Intubation, Laryngeal Mask Airway and Local Infiltration with Monitored Anesthesia Care) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition). No patients had regional anesthesia performed. Demographic data including comorbidities and risk factors were stratified among all categories. Analysis of variance, chi-squared testing, and Fisher's exact P testing was performed across all anesthesia types and specific operations and measured according to success of fistula maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome). There were no significant differences in maturation rate in terms of all 3 anesthesia types for radiocephalic (P = 0.191), brachiocephalic (P = 0.191), and basilic vein transposition surgeries (P = 0.305). In addition, there were no differences in complication rates between the surgeries and the 3 types of anesthesia (P = 0.557). Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically

  3. Optimal classical-communication-assisted local model of n-qubit Greenberger-Horne-Zeilinger correlations

    International Nuclear Information System (INIS)

    Tessier, Tracey E.; Caves, Carlton M.; Deutsch, Ivan H.; Eastin, Bryan; Bacon, Dave

    2005-01-01

    We present a model, motivated by the criterion of reality put forward by Einstein, Podolsky, and Rosen and supplemented by classical communication, which correctly reproduces the quantum-mechanical predictions for measurements of all products of Pauli operators on an n-qubit GHZ state (or 'cat state'). The n-2 bits employed by our model are shown to be optimal for the allowed set of measurements, demonstrating that the required communication overhead scales linearly with n. We formulate a connection between the generation of the local values utilized by our model and the stabilizer formalism, which leads us to conjecture that a generalization of this method will shed light on the content of the Gottesman-Knill theorem

  4. Optimizing heliostat positions with local search metaheuristics using a ray tracing optical model

    Science.gov (United States)

    Reinholz, Andreas; Husenbeth, Christof; Schwarzbözl, Peter; Buck, Reiner

    2017-06-01

    The life cycle costs of solar tower power plants are mainly determined by the investment costs of its construction. Significant parts of these investment costs are used for the heliostat field. Therefore, an optimized placement of the heliostats gaining the maximal annual power production has a direct impact on the life cycle costs revenue ratio. We present a two level local search method implemented in MATLAB utilizing the Monte Carlo raytracing software STRAL [1] for the evaluation of the annual power output for a specific weighted annual time scheme. The algorithm was applied to a solar tower power plant (PS10) with 624 heliostats. Compared to former work of Buck [2], we were able to improve both runtime of the algorithm and quality of the output solutions significantly. Using the same environment for both algorithms, we were able to reach Buck's best solution with a speed up factor of about 20.

  5. Optimal filter design with progressive genetic algorithm for local damage detection in rolling bearings

    Science.gov (United States)

    Wodecki, Jacek; Michalak, Anna; Zimroz, Radoslaw

    2018-03-01

    Harsh industrial conditions present in underground mining cause a lot of difficulties for local damage detection in heavy-duty machinery. For vibration signals one of the most intuitive approaches of obtaining signal with expected properties, such as clearly visible informative features, is prefiltration with appropriately prepared filter. Design of such filter is very broad field of research on its own. In this paper authors propose a novel approach to dedicated optimal filter design using progressive genetic algorithm. Presented method is fully data-driven and requires no prior knowledge of the signal. It has been tested against a set of real and simulated data. Effectiveness of operation has been proven for both healthy and damaged case. Termination criterion for evolution process was developed, and diagnostic decision making feature has been proposed for final result determinance.

  6. Nonlinear dynamics of the patient's response to drug effect during general anesthesia

    NARCIS (Netherlands)

    Ionescu, Clara; Machado, Jose Tenreiro; De Keyser, Robin; Decruyenaere, Johan; Struys, Michel M. R. F.

    In today's healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are

  7. Anesthesia for intellectually disabled

    Directory of Open Access Journals (Sweden)

    Kapil Chaudhary

    2017-01-01

    Full Text Available Anesthetizing an intellectually disabled patient is a challenge due to lack of cognition and communication which makes perioperative evaluation difficult. The presence of associated medical problems and lack of cooperation further complicates the anesthetic technique. An online literature search was performed using keywords anesthesia, intellectually disabled, and mentally retarded and relevant articles were included for review. There is scarcity of literature dealing with intellectually disabled patients. The present review highlights the anesthetic challenges, their relevant evidence-based management, and the role of caretakers in the perioperative period. Proper understanding of the associated problems along with a considerate and unhurried approach are the essentials of anesthetic management of these patients.

  8. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  9. Fucosidosis and anesthesia

    International Nuclear Information System (INIS)

    Soltani, Alireza E.; Moharari, Reza S.; Ghaffari, R.; Zahedi, H.; Hajmahmoodi, M.

    2007-01-01

    Fucosidosis is a rare, autosomal recessive lysosomal storage disorder caused by a severe deficiency of alpha -L-fucosidase. Patients usually have some problems with glycoprotein storage in the brain and other organs and some structural abnormalities that need special consideration in anesthesia. It has 2 types, the early onset or infantile and the juvenile. Here we present 8-year-old girl with deformities in the maxillofacial region, with big tongue, small and retracted chin, saddle nose and short neck that could not be extended, causing difficult intubation and congenital cardiac problems requiring a special anesthetic strategy. (author)

  10. [Anesthesia and bodybuilding].

    Science.gov (United States)

    Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

    2008-05-01

    A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

  11. Optimization modeling of U.S. renewable electricity deployment using local input variables

    Science.gov (United States)

    Bernstein, Adam

    For the past five years, state Renewable Portfolio Standard (RPS) laws have been a primary driver of renewable electricity (RE) deployments in the United States. However, four key trends currently developing: (i) lower natural gas prices, (ii) slower growth in electricity demand, (iii) challenges of system balancing intermittent RE within the U.S. transmission regions, and (iv) fewer economical sites for RE development, may limit the efficacy of RPS laws over the remainder of the current RPS statutes' lifetime. An outsized proportion of U.S. RE build occurs in a small number of favorable locations, increasing the effects of these variables on marginal RE capacity additions. A state-by-state analysis is necessary to study the U.S. electric sector and to generate technology specific generation forecasts. We used LP optimization modeling similar to the National Renewable Energy Laboratory (NREL) Renewable Energy Development System (ReEDS) to forecast RE deployment across the 8 U.S. states with the largest electricity load, and found state-level RE projections to Year 2031 significantly lower than thoseimplied in the Energy Information Administration (EIA) 2013 Annual Energy Outlook forecast. Additionally, the majority of states do not achieve their RPS targets in our forecast. Combined with the tendency of prior research and RE forecasts to focus on larger national and global scale models, we posit that further bottom-up state and local analysis is needed for more accurate policy assessment, forecasting, and ongoing revision of variables as parameter values evolve through time. Current optimization software eliminates much of the need for algorithm coding and programming, allowing for rapid model construction and updating across many customized state and local RE parameters. Further, our results can be tested against the empirical outcomes that will be observed over the coming years, and the forecast deviation from the actuals can be attributed to discrete parameter

  12. A comparison of optimization algorithms for localized in vivo B0 shimming.

    Science.gov (United States)

    Nassirpour, Sahar; Chang, Paul; Fillmer, Ariane; Henning, Anke

    2018-02-01

    To compare several different optimization algorithms currently used for localized in vivo B 0 shimming, and to introduce a novel, fast, and robust constrained regularized algorithm (ConsTru) for this purpose. Ten different optimization algorithms (including samples from both generic and dedicated least-squares solvers, and a novel constrained regularized inversion method) were implemented and compared for shimming in five different shimming volumes on 66 in vivo data sets from both 7 T and 9.4 T. The best algorithm was chosen to perform single-voxel spectroscopy at 9.4 T in the frontal cortex of the brain on 10 volunteers. The results of the performance tests proved that the shimming algorithm is prone to unstable solutions if it depends on the value of a starting point, and is not regularized to handle ill-conditioned problems. The ConsTru algorithm proved to be the most robust, fast, and efficient algorithm among all of the chosen algorithms. It enabled acquisition of spectra of reproducible high quality in the frontal cortex at 9.4 T. For localized in vivo B 0 shimming, the use of a dedicated linear least-squares solver instead of a generic nonlinear one is highly recommended. Among all of the linear solvers, the constrained regularized method (ConsTru) was found to be both fast and most robust. Magn Reson Med 79:1145-1156, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  13. Regional anesthesia is safe and effective for lower limb orthopedic surgery in patient with renal tubular acidosis and hypokalemia

    Directory of Open Access Journals (Sweden)

    Indira Gurajala

    2018-01-01

    Full Text Available Renal tubular acidosis (RTA with hypokalemia may precipitate acute respiratory failure and potentially fatal arrhythmias like ventricular fibrillation. Though there are random reports of respiratory failure needing mechanical ventilation and sudden death in patients with RTA and hypokalemia, the anesthetic management of these patients has not been clearly elucidated. Acidosis and hypokalemia have significant interactions with both general and local anesthetics and alter their effect substantially. Proper preoperative planning and optimization are required for the safe conduct of anesthesia in this subset of patients. We describe a case of distal RTA, hypokalemia, and metabolic bone disease in whom central neuraxial anesthesia was effectively used for lower limb orthopedic surgery with no complications.

  14. Normalization in Unsupervised Segmentation Parameter Optimization: A Solution Based on Local Regression Trend Analysis

    Directory of Open Access Journals (Sweden)

    Stefanos Georganos

    2018-02-01

    Full Text Available In object-based image analysis (OBIA, the appropriate parametrization of segmentation algorithms is crucial for obtaining satisfactory image classification results. One of the ways this can be done is by unsupervised segmentation parameter optimization (USPO. A popular USPO method does this through the optimization of a “global score” (GS, which minimizes intrasegment heterogeneity and maximizes intersegment heterogeneity. However, the calculated GS values are sensitive to the minimum and maximum ranges of the candidate segmentations. Previous research proposed the use of fixed minimum/maximum threshold values for the intrasegment/intersegment heterogeneity measures to deal with the sensitivity of user-defined ranges, but the performance of this approach has not been investigated in detail. In the context of a remote sensing very-high-resolution urban application, we show the limitations of the fixed threshold approach, both in a theoretical and applied manner, and instead propose a novel solution to identify the range of candidate segmentations using local regression trend analysis. We found that the proposed approach showed significant improvements over the use of fixed minimum/maximum values, is less subjective than user-defined threshold values and, thus, can be of merit for a fully automated procedure and big data applications.

  15. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    International Nuclear Information System (INIS)

    Mahmoud, Mohamed; Towe, Christopher; Fleck, Robert J.

    2015-01-01

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  16. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoud, Mohamed [Cincinnati Children' s Hospital Medical Center, Department of Anesthesiology, Cincinnati, OH (United States); Towe, Christopher [Cincinnati Children' s Hospital Medical Center, Department of Pulmonary Medicine, Cincinnati, OH (United States); Fleck, Robert J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2015-07-15

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  17. Optimal Solubility of Diclofenac β-Cyclodextrin in Combination with Local Anaesthetics for Mesotherapy Applications.

    Science.gov (United States)

    Tringali, Giuseppe; Navarra, Pierluigi

    2017-01-01

    Because of low injection volume, the recently marketed injectable solution of diclofenac in complex with β -cyclodextrin (Akis®, IBSA Farmaceutici Italia) is an ideal candidate for mesotherapy applications. In this study, we investigated the solubility of Akis, 25 and 50 mg/kg, in combination with various local anaesthetics (lidocaine, mepivacaine, bupivacaine, levobupivacaine, and ropivacaine) at different concentrations in aqueous vehicles (normal saline, sterile water, or bicarbonate). Final injection mixtures were classified as limpid, turbid, or milky at visual analysis under standardized conditions. We found that (i) the use of sterile water for injections or normal saline as vehicles to dilute Akis in combination with whatever local anaesthetic normally results in milky solutions and therefore is not recommended; (ii) using bicarbonate, optimal solubility was obtained combining Akis with lidocaine, both 1 and 2%, or mepivacaine, both 1 and 2%, whereas solutions were turbid in combination with bupivacaine, levobupivacaine, or ropivacaine. Thus, we recommend that Akis is used in combination with lidocaine or mepivacaine in a bicarbonate vehicle.

  18. Optimal Solubility of Diclofenac β-Cyclodextrin in Combination with Local Anaesthetics for Mesotherapy Applications

    Directory of Open Access Journals (Sweden)

    Giuseppe Tringali

    2017-01-01

    Full Text Available Because of low injection volume, the recently marketed injectable solution of diclofenac in complex with β-cyclodextrin (Akis®, IBSA Farmaceutici Italia is an ideal candidate for mesotherapy applications. In this study, we investigated the solubility of Akis, 25 and 50 mg/kg, in combination with various local anaesthetics (lidocaine, mepivacaine, bupivacaine, levobupivacaine, and ropivacaine at different concentrations in aqueous vehicles (normal saline, sterile water, or bicarbonate. Final injection mixtures were classified as limpid, turbid, or milky at visual analysis under standardized conditions. We found that (i the use of sterile water for injections or normal saline as vehicles to dilute Akis in combination with whatever local anaesthetic normally results in milky solutions and therefore is not recommended; (ii using bicarbonate, optimal solubility was obtained combining Akis with lidocaine, both 1 and 2%, or mepivacaine, both 1 and 2%, whereas solutions were turbid in combination with bupivacaine, levobupivacaine, or ropivacaine. Thus, we recommend that Akis is used in combination with lidocaine or mepivacaine in a bicarbonate vehicle.

  19. Imaging local cerebral blood flow by xenon-enhanced computed tomography - technical optimization procedures

    International Nuclear Information System (INIS)

    Meyer, J.S.; Shinohara, T.; Imai, A.; Kobari, M.; Solomon, E.

    1988-01-01

    Methods are described for non-invasive, computer-assisted serial scanning throughout the human brain during eight minutes of inhalation of 27%-30% xenon gas in order to measure local cerebral blood flow (LCBF). Optimized xenon-enhanced computed tomography (XeCT) was achieved by 5-second scanning at one-minute intervals utilizing a state-of-the-art CT scanner and rapid delivery of xenon gas via a face mask. Values for local brain-blood partition coefficients (Lλ) measured in vivo were utilized to calculate LCBF values. Previous methods assumed Lλ values to be normal, introducing the risk of systematic errors, because Lλ values differ throughout normal brain and may be altered by disease. Color-coded maps of Lλ and LCBF values were formatted directly onto CT images for exact correlation of function with anatomic and pathologic observations (spatial resolution: 26.5 cubic mm). Results were compared among eight normal volunteers, aged between 50 and 88 years. Mean cortical gray matter blood flow was 46.3 ± 7.7, for subcortical gray matter it was 50.3 ± 13.2 and for white matter it was 18.8 ± 3.2. Modern CT scanners provide stability, improved signal to noise ratio and minimal radiation scatter. Combining these advantages with rapid xenon saturation of the blood provides correlations of Lλ and LCBF with images of normal and abnormal brain in a safe, useful and non-invasive manner. (orig.)

  20. Least median of squares filtering of locally optimal point matches for compressible flow image registration

    International Nuclear Information System (INIS)

    Castillo, Edward; Guerrero, Thomas; Castillo, Richard; White, Benjamin; Rojo, Javier

    2012-01-01

    Compressible flow based image registration operates under the assumption that the mass of the imaged material is conserved from one image to the next. Depending on how the mass conservation assumption is modeled, the performance of existing compressible flow methods is limited by factors such as image quality, noise, large magnitude voxel displacements, and computational requirements. The Least Median of Squares Filtered Compressible Flow (LFC) method introduced here is based on a localized, nonlinear least squares, compressible flow model that describes the displacement of a single voxel that lends itself to a simple grid search (block matching) optimization strategy. Spatially inaccurate grid search point matches, corresponding to erroneous local minimizers of the nonlinear compressible flow model, are removed by a novel filtering approach based on least median of squares fitting and the forward search outlier detection method. The spatial accuracy of the method is measured using ten thoracic CT image sets and large samples of expert determined landmarks (available at www.dir-lab.com). The LFC method produces an average error within the intra-observer error on eight of the ten cases, indicating that the method is capable of achieving a high spatial accuracy for thoracic CT registration. (paper)

  1. Automatic boiling water reactor control rod pattern design using particle swarm optimization algorithm and local search

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Cheng-Der, E-mail: jdwang@iner.gov.tw [Nuclear Engineering Division, Institute of Nuclear Energy Research, No. 1000, Wenhua Rd., Jiaan Village, Longtan Township, Taoyuan County 32546, Taiwan, ROC (China); Lin, Chaung [National Tsing Hua University, Department of Engineering and System Science, 101, Section 2, Kuang Fu Road, Hsinchu 30013, Taiwan (China)

    2013-02-15

    Highlights: ► The PSO algorithm was adopted to automatically design a BWR CRP. ► The local search procedure was added to improve the result of PSO algorithm. ► The results show that the obtained CRP is the same good as that in the previous work. -- Abstract: This study developed a method for the automatic design of a boiling water reactor (BWR) control rod pattern (CRP) using the particle swarm optimization (PSO) algorithm. The PSO algorithm is more random compared to the rank-based ant system (RAS) that was used to solve the same BWR CRP design problem in the previous work. In addition, the local search procedure was used to make improvements after PSO, by adding the single control rod (CR) effect. The design goal was to obtain the CRP so that the thermal limits and shutdown margin would satisfy the design requirement and the cycle length, which is implicitly controlled by the axial power distribution, would be acceptable. The results showed that the same acceptable CRP found in the previous work could be obtained.

  2. Imaging local cerebral blood flow by xenon-enhanced computed tomography - technical optimization procedures

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, J.S.; Shinohara, T.; Imai, A.; Kobari, M.; Sakai, F.; Hata, T.; Oravez, W.T.; Timpe, G.M.; Deville, T.; Solomon, E.

    1988-08-01

    Methods are described for non-invasive, computer-assisted serial scanning throughout the human brain during eight minutes of inhalation of 27%-30% xenon gas in order to measure local cerebral blood flow (LCBF). Optimized xenon-enhanced computed tomography (XeCT) was achieved by 5-second scanning at one-minute intervals utilizing a state-of-the-art CT scanner and rapid delivery of xenon gas via a face mask. Values for local brain-blood partition coefficients (Llambda) measured in vivo were utilized to calculate LCBF values. Previous methods assumed Llambda values to be normal, introducing the risk of systematic errors, because Llambda values differ throughout normal brain and may be altered by disease. Color-coded maps of Llambda and LCBF values were formatted directly onto CT images for exact correlation of function with anatomic and pathologic observations (spatial resolution: 26.5 cubic mm). Results were compared among eight normal volunteers, aged between 50 and 88 years. Mean cortical gray matter blood flow was 46.3 +- 7.7, for subcortical gray matter it was 50.3 +- 13.2 and for white matter it was 18.8 +- 3.2. Modern CT scanners provide stability, improved signal to noise ratio and minimal radiation scatter. Combining these advantages with rapid xenon saturation of the blood provides correlations of Llambda and LCBF with images of normal and abnormal brain in a safe, useful and non-invasive manner.

  3. Pharmacologic Considerations for Pediatric Sedation and Anesthesia Outside the Operating Room: A Review for Anesthesia and Non-Anesthesia Providers.

    Science.gov (United States)

    Khurmi, Narjeet; Patel, Perene; Kraus, Molly; Trentman, Terrence

    2017-10-01

    Understanding the pharmacologic options for pediatric sedation outside the operating room will allow practitioners to formulate an ideal anesthetic plan, allaying anxiety and achieving optimal immobilization while ensuring rapid and efficient recovery. The authors identified relevant medical literature by searching PubMed, MEDLINE, Embase, Scopus, Web of Science, and Google Scholar databases for English language publications covering a period from 1984 to 2017. Search terms included pediatric anesthesia, pediatric sedation, non-operating room sedation, sedation safety, and pharmacology. As a narrative review of common sedation/anesthesia options, the authors elected to focus on studies, reviews, and case reports that show clinical relevance to modern day sedation/anesthesia practice. A variety of pharmacologic agents are available for sedation/anesthesia in pediatrics, including midazolam, fentanyl, ketamine, dexmedetomidine, etomidate, and propofol. Dosing ranges reported are a combination of what is discussed in the reviewed literature and text books along with personal recommendations based on our own practice. Several reports reveal that ketofol (a combination of ketamine and propofol) is quite popular for short, painful procedures. Fospropofol is a newer-generation propofol that may confer advantages over regular propofol. Remimazolam combines the pharmacologic effects of remifentanil and midazolam. A variety of etomidate derivatives such as methoxycarbonyl-etomidate, carboetomidate, methoxycarbonyl-carboetomidate, and cyclopropyl-methoxycarbonyl metomidate are in development stages. The use of nitrous oxide as a mild sedative, analgesic, and amnestic agent is gaining popularity, especially in the ambulatory setting. Utilizing a dedicated and experienced team to provide sedation enhances safety. Furthermore, limiting sedation plans to single-agent pharmacy appears to be safer than using multi-agent plans.

  4. A method to generate fully multi-scale optimal interpolation by combining efficient single process analyses, illustrated by a DINEOF analysis spiced with a local optimal interpolation

    Directory of Open Access Journals (Sweden)

    J.-M. Beckers

    2014-10-01

    Full Text Available We present a method in which the optimal interpolation of multi-scale processes can be expanded into a succession of simpler interpolations. First, we prove how the optimal analysis of a superposition of two processes can be obtained by different mathematical formulations involving iterations and analysis focusing on a single process. From the different mathematical equivalent formulations, we then select the most efficient ones by analyzing the behavior of the different possibilities in a simple and well-controlled test case. The clear guidelines deduced from this experiment are then applied to a real situation in which we combine large-scale analysis of hourly Spinning Enhanced Visible and Infrared Imager (SEVIRI satellite images using data interpolating empirical orthogonal functions (DINEOF with a local optimal interpolation using a Gaussian covariance. It is shown that the optimal combination indeed provides the best reconstruction and can therefore be exploited to extract the maximum amount of useful information from the original data.

  5. Use of Laminaria Japonica in intracavitary radiation therapy when anesthesia is contraindicated

    International Nuclear Information System (INIS)

    Peeples, W.J.; Given, F.T. Jr.; Bakri, Y.N.

    1983-01-01

    Laminaria tents have been used to dilate the cervix for interruption of pregnancy and other intrauterine procedures. Their use is presented in 5 patients with cervical and endometrial carcinoma where general anesthesia was contraindicated. Cervical dilation was sufficient with a single Laminaria to carry out intrauterine and intravaginal instrumentation for radiation therapy with no local or general anesthesia

  6. The use of intraosseous anesthesia in a patient with myositis ossificans progressiva.

    Science.gov (United States)

    Webb, M D; Wilson, C

    1996-01-01

    The case of a pediatric patient with myositis ossificans progressiva in whom it became increasingly difficult to obtain local anesthesia is presented. Intraosseous anesthesia was successful in allowing pain-free dental treatment to be completed. This approach should be considered in other patients who have limited mouth-opening ability due to injury or disease.

  7. What is the optimal management of high risk, clinically localized prostate cancer?

    Science.gov (United States)

    Eastham, James A; Evans, Christopher P; Zietman, Anthony

    2010-01-01

    To summarize the presentations and debate regarding the optimal treatment of localized high-risk prostate cancer as presented at the 2009 Spring Meeting of the Society of Urologic Oncology. The debate was centered on presentations arguing for radical prostatectomy (RP) or radiotherapy as the optimal treatment for this condition. The meeting presentations are summarized by their respective presenters herein. Dr. James Eastham presents the varied definitions for "high-risk" prostate cancer as strongly influencing which patients end up in this cohort. Based upon this, between 3% and 38% of patients with high-risk features could be defined as "high-risk". Despite that, these men do not have a uniformly poor prognosis after RP, and attention to surgical principles as outlined improve outcomes. Disease-specific survival at 12 years is excellent and up to one-half of these men may not need adjuvant or salvage therapies, depending on their specific disease characteristics. Adjuvant or salvage radiotherapies improve outcomes and are part of a sequential approach to treating these patients. Dr. Anthony Zietman presented radiotherapy as the gold-standard based upon large, randomized clinical trials of intermediate- and high-risk prostate cancer patients. Compared with androgen deprivation alone, the addition of radiotherapy provided a 12% cancer-specific survival advantage and 10% overall survival advantage. Dose escalation seems to confer further improvements in cancer control without significant escalation of toxicities, with more data forthcoming. There are no randomized trials comparing RP to radiotherapy for any risk category. In high-risk prostate cancer patients, both approaches have potential benefits and cumulative toxicities that must be matched to disease characteristics and patient expectations in selecting a treatment course. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  8. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    Science.gov (United States)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  9. Critical Elements for the Pediatric Perioperative Anesthesia Environment.

    Science.gov (United States)

    Polaner, David M; Houck, Constance S

    2015-12-01

    The American Academy of Pediatrics proposes guidance for the pediatric perioperative anesthesia environment. Essential components are identified to optimize the perioperative environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events. Copyright © 2015 by the American Academy of Pediatrics.

  10. Survey of comprehensive restorative treatment for children under general anesthesia

    Directory of Open Access Journals (Sweden)

    Yai-Tin Lin

    2015-09-01

    Conclusion: Although general anesthesia provides an optimal condition for treating children with high caries risk, high failure rates of composite restorations were noted. Indirect pulp capping and ferric sulfate pulpotomy followed by stainless steel crown restorations are successful techniques and can be used to treat deep carious lesions.

  11. Avaliação da analgesia pós-operatória em pacientes submetidos à cirurgia orificial com anestesia local associada ou não à morfina Evaluation of the postoperative analgesia in patients submitted to anorectal surgery with local anesthesia associated or not the morphine

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2007-03-01

    Full Text Available Ainda não esta comprovada a eficácia dos derivados morfínicos ao nível de receptores opióides periféricos. Estudos procuram demonstrar o poder da droga em interferir na intensidade da dor quando infiltrada em nervos periféricos. Avaliamos, então, a infiltração local de morfina associada à anestesia local em cirurgias orificiais proctológicas. Nesse estudo foram analisados 61 pacientes, independentemente do gênero, sendo divididos aleatoriamente em dois grupos: a um grupo foi associada morfina ao anestésico local enquanto ao outro houve a administração do anestésico local sem a droga morfínica. Os pacientes de ambos os grupos foram submetidos à sedação e analgesia pós-operatória padronizadas. Foram avaliados: a intensidade da dor, a analgesia pós-operatória e a morbidade. A intensidade da dor, no momento de seu surgimento, foi semelhante nos dois grupos; o tempo de analgesia pós-operatória foi maior no grupo em que a morfina foi administrada, entretanto, não se mostrou estatisticamente significativo; as complicações pós-operatórias foram irrelevantes nos dois grupos. Dessa forma, a infiltração local de morfina na região anorretal tem benefícios em relação à analgesia pós-operatória que não mostraram significância estatística e não aumenta a incidência dos efeitos colaterais tão temidos relacionados às drogas morfínicas como retenção urinária e prurido.It has not been proved the efficacy of morphine derived at periphery opium receivers. Studies are trying to demonstrate the power of the drug to interfere in the intensity of surgical pain while infiltrating in the periphery nerves. This study evaluated the infiltration of morphine associated with local anesthesia in anorectal surgery. Sixty one patients were analyzed, male and female, divided in two groups: in one group was associated morphine in the local anesthesia while in the other group only the local anesthetic was used. The patients of both

  12. Gender Differences in Recovery Times from General Anesthesia Using Sevoflurane and the Bispectral Index Monitor

    National Research Council Canada - National Science Library

    Alguire, Katherine

    2003-01-01

    Optimization of patient care is one goal of anesthesia providers. With individualized care nurse anesthetists can achieve high degrees of patient satisfaction, reduce overall costs and improve patient outcomes...

  13. Modelling and optimization of a local smart grid for an agro-industrial site

    Directory of Open Access Journals (Sweden)

    Enrico Fabrizio

    2013-09-01

    Full Text Available A smart grid is defined where different elements are interconnected between them and with the public utility grid. The development of smart grids is considered a strategic goal at both national and international levels and has been funded by many research programs. Within the BEE (Building Energy Ecosystems project, funded by the Piedmont Region under the European POR FESR 2007-13 scheme, the creation of an electricity smart grid at a local level in a small agroindustry was done. This industry is one of the so-called prosumer, that is both a producer and a consumer of energy. The energy production is done by means of solar photovoltaic and biomass. In this local smart grid, the elements were subdivided in two main groups: loads (process machineries in the case study and generators (PV and biomass in the case study. The loads may be further subdivided into permanent loads, mandatory loads and shiftable loads. The objective of the smart grid is the minimization of the exchanges between the local grid and the public utility grid. Even though no financial savings occur, this is important for the community grid. The problem is therefore to find the conditions that let the net exported energy going to zero at each time step, so arriving close to a self-sufficient system by modifying the shiftable loads. In a first phase of the study, the consumers were studied and, according to some characteristics of the machineries employed and the production requirements, grouped into production lines that can or not be switched off for intervals of time in order to compensate the smart grid fluctuations. The smart grid balancing may be done on an instantaneous basis, or in a predictive way considering the future weather forecasts and the future production requirements. The demo site was equipped with measurement instrumentation, data acquisition tools and a user interface that may be used to visualize all the quantities that are measured but also to perform the

  14. Learning Optimized Local Difference Binaries for Scalable Augmented Reality on Mobile Devices.

    Science.gov (United States)

    Xin Yang; Kwang-Ting Cheng

    2014-06-01

    The efficiency, robustness and distinctiveness of a feature descriptor are critical to the user experience and scalability of a mobile augmented reality (AR) system. However, existing descriptors are either too computationally expensive to achieve real-time performance on a mobile device such as a smartphone or tablet, or not sufficiently robust and distinctive to identify correct matches from a large database. As a result, current mobile AR systems still only have limited capabilities, which greatly restrict their deployment in practice. In this paper, we propose a highly efficient, robust and distinctive binary descriptor, called Learning-based Local Difference Binary (LLDB). LLDB directly computes a binary string for an image patch using simple intensity and gradient difference tests on pairwise grid cells within the patch. To select an optimized set of grid cell pairs, we densely sample grid cells from an image patch and then leverage a modified AdaBoost algorithm to automatically extract a small set of critical ones with the goal of maximizing the Hamming distance between mismatches while minimizing it between matches. Experimental results demonstrate that LLDB is extremely fast to compute and to match against a large database due to its high robustness and distinctiveness. Compared to the state-of-the-art binary descriptors, primarily designed for speed, LLDB has similar efficiency for descriptor construction, while achieving a greater accuracy and faster matching speed when matching over a large database with 2.3M descriptors on mobile devices.

  15. Matrix-product-state method with local basis optimization for nonequilibrium electron-phonon systems

    Science.gov (United States)

    Heidrich-Meisner, Fabian; Brockt, Christoph; Dorfner, Florian; Vidmar, Lev; Jeckelmann, Eric

    We present a method for simulating the time evolution of quasi-one-dimensional correlated systems with strongly fluctuating bosonic degrees of freedom (e.g., phonons) using matrix product states. For this purpose we combine the time-evolving block decimation (TEBD) algorithm with a local basis optimization (LBO) approach. We discuss the performance of our approach in comparison to TEBD with a bare boson basis, exact diagonalization, and diagonalization in a limited functional space. TEBD with LBO can reduce the computational cost by orders of magnitude when boson fluctuations are large and thus it allows one to investigate problems that are out of reach of other approaches. First, we test our method on the non-equilibrium dynamics of a Holstein polaron and show that it allows us to study the regime of strong electron-phonon coupling. Second, the method is applied to the scattering of an electronic wave packet off a region with electron-phonon coupling. Our study reveals a rich physics including transient self-trapping and dissipation. Supported by Deutsche Forschungsgemeinschaft (DFG) via FOR 1807.

  16. Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning

    International Nuclear Information System (INIS)

    Wala, Jeremiah; Craft, David; Paly, Jon; Zietman, Anthony; Efstathiou, Jason

    2013-01-01

    We examine the quality of plans created using multicriteria optimization (MCO) treatment planning in intensity-modulated radiation therapy (IMRT) in treatment of localized prostate cancer. Nine random cases of patients receiving IMRT to the prostate were selected. Each case was associated with a clinically approved plan created using Corvus. The cases were replanned using MCO-based planning in RayStation. Dose-volume histogram data from both planning systems were presented to 2 radiation oncologists in a blinded evaluation, and were compared at a number of dose-volume points. Both physicians rated all 9 MCO plans as superior to the clinically approved plans (p −5 ). Target coverage was equivalent (p = 0.81). Maximum doses to the prostate and bladder and the V50 and V70 to the anterior rectum were reduced in all MCO plans (p<0.05). Treatment planning time with MCO took approximately 60 minutes per case. MCO-based planning for prostate IMRT is efficient and produces high-quality plans with good target homogeneity and sparing of the anterior rectum, bladder, and femoral heads, without sacrificing target coverage

  17. Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning

    Energy Technology Data Exchange (ETDEWEB)

    Wala, Jeremiah; Craft, David [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Paly, Jon [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Zietman, Anthony [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Efstathiou, Jason, E-mail: jefstathiou@partners.org [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2013-10-01

    We examine the quality of plans created using multicriteria optimization (MCO) treatment planning in intensity-modulated radiation therapy (IMRT) in treatment of localized prostate cancer. Nine random cases of patients receiving IMRT to the prostate were selected. Each case was associated with a clinically approved plan created using Corvus. The cases were replanned using MCO-based planning in RayStation. Dose-volume histogram data from both planning systems were presented to 2 radiation oncologists in a blinded evaluation, and were compared at a number of dose-volume points. Both physicians rated all 9 MCO plans as superior to the clinically approved plans (p<10{sup −5}). Target coverage was equivalent (p = 0.81). Maximum doses to the prostate and bladder and the V50 and V70 to the anterior rectum were reduced in all MCO plans (p<0.05). Treatment planning time with MCO took approximately 60 minutes per case. MCO-based planning for prostate IMRT is efficient and produces high-quality plans with good target homogeneity and sparing of the anterior rectum, bladder, and femoral heads, without sacrificing target coverage.

  18. Local search for optimal global map generation using mid-decadal landsat images

    Science.gov (United States)

    Khatib, L.; Gasch, J.; Morris, Robert; Covington, S.

    2007-01-01

    NASA and the US Geological Survey (USGS) are seeking to generate a map of the entire globe using Landsat 5 Thematic Mapper (TM) and Landsat 7 Enhanced Thematic Mapper Plus (ETM+) sensor data from the "mid-decadal" period of 2004 through 2006. The global map is comprised of thousands of scene locations and, for each location, tens of different images of varying quality to chose from. Furthermore, it is desirable for images of adjacent scenes be close together in time of acquisition, to avoid obvious discontinuities due to seasonal changes. These characteristics make it desirable to formulate an automated solution to the problem of generating the complete map. This paper formulates a Global Map Generator problem as a Constraint Optimization Problem (GMG-COP) and describes an approach to solving it using local search. Preliminary results of running the algorithm on image data sets are summarized. The results suggest a significant improvement in map quality using constraint-based solutions. Copyright ?? 2007, Association for the Advancement of Artificial Intelligence (www.aaai.org). All rights reserved.

  19. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    Directory of Open Access Journals (Sweden)

    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  20. [Anatomic rationale for clinical efficacy of intraosseous mental nerve anesthesia].

    Science.gov (United States)

    Rabinovich, S A; Vasil'ev, Yu L; Kuzin, A N

    2018-01-01

    The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

  1. Dexmedetomidina associada a propofol em sedação durante anestesia local para cirurgia plástica Dexmedetomidina asociada a propofol en sedación durante anestesia local para cirugía plástica Dexmedetomidine/propofol association for plastic surgery sedation during local anesthesia

    Directory of Open Access Journals (Sweden)

    José Roberto Nociti

    2003-04-01

    grupo C. El tiempo medio para obedecer al comando de "abrir los ojos" fue menor en el grupo D (6,3 ± 2,5 min en relación al C (8,9 ± 2,7 min. El control del sangramiento per-operatorio fue superior en el grupo D en relación al C. CONCLUSIONES: El empleo de la dexmedetomidina asociada al propofol presenta las siguientes ventajas: reducción del consumo de propofol, estabilidad de los parámetros cardiovasculares, control adecuado del sangramiento per-operatorio, ausencia de efecto importante sobre la ventilación.BACKGROUND AND OBJECTIVES: Dexmedetomidine is a new alpha2-adrenergic receptor agonist with potentially useful characteristics for anesthesia. This comparative study aimed at evaluating the effects of dexmedetomidine on propofol requirements and cardiovascular/respiratory stability during plastic surgery sedation under local anesthesia. METHODS: Participated in this study 40 female patients aged 16 to 60 years, physical status ASA I or II, scheduled for elective face, nose and breast plastic surgeries under local anesthesia. Patients were randomly allocated into two groups of twenty patients: C (control and D (dexmedetomidine. Sedation was achieved in both groups with 1 mg.kg-1 bolus propofol followed by continuous infusion at an adjusted rate to provide conscious sedation. Group D patients received continuous intravenous dexmedetomidine at a rate of 0.01 µg.kg-1.min-1, concomitant with propofol infusion. The following were evaluated: effect of dexmedetomidine on propofol requirements; cardiovascular (SBP, DBP, MBP, HR and respiratory (SpO2, P ET CO2 parameters; quality of perioperative bleeding control and postanesthetic recovery features. RESULTS: Mean propofol infusion rate was lower in group D (35.2 ± 5.3 µg.kg-1.min-1 as compared to group C (72.6 ± 8.5 µg.kg-1.min-1. Mean SBP, DBP, MBP values have decreased as from 30 min in group D, remaining stable until procedure completion, while in Group C they have increased. HR remained stable in group D

  2. Speak Up: Anesthesia and Sedation

    Science.gov (United States)

    ... and you may be given oxygen. You may sleep until the drugs wear off. Tell your doctor or anesthesia professional about • General health issues and any recent changes • Allergies to medicines, ...

  3. A Local and Global Search Combine Particle Swarm Optimization Algorithm for Job-Shop Scheduling to Minimize Makespan

    Directory of Open Access Journals (Sweden)

    Zhigang Lian

    2010-01-01

    Full Text Available The Job-shop scheduling problem (JSSP is a branch of production scheduling, which is among the hardest combinatorial optimization problems. Many different approaches have been applied to optimize JSSP, but for some JSSP even with moderate size cannot be solved to guarantee optimality. The original particle swarm optimization algorithm (OPSOA, generally, is used to solve continuous problems, and rarely to optimize discrete problems such as JSSP. In OPSOA, through research I find that it has a tendency to get stuck in a near optimal solution especially for middle and large size problems. The local and global search combine particle swarm optimization algorithm (LGSCPSOA is used to solve JSSP, where particle-updating mechanism benefits from the searching experience of one particle itself, the best of all particles in the swarm, and the best of particles in neighborhood population. The new coding method is used in LGSCPSOA to optimize JSSP, and it gets all sequences are feasible solutions. Three representative instances are made computational experiment, and simulation shows that the LGSCPSOA is efficacious for JSSP to minimize makespan.

  4. Anesthesia Methods in Laser Resurfacing

    OpenAIRE

    Gaitan, Sergio; Markus, Ramsey

    2012-01-01

    Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected fo...

  5. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  6. Pediatric anesthesia in developing countries.

    Science.gov (United States)

    Bösenberg, Adrian T

    2007-06-01

    To highlight the problems faced in developing countries where healthcare resources are limited, with particular emphasis on pediatric anesthesia. The fact that very few publications address pediatric anesthesia in the developing world is not surprising given that most anesthetics are provided by nonphysicians, nurses or unqualified personnel. In compiling this article information is drawn from pediatric surgical, anesthetic and related texts. In a recent survey more than 80% of anesthesia providers in a poor country acknowledged that with the limited resources available they could not provide basic anesthesia for children less than 5 years. Although many publications could be regarded as anecdotal, the similarities to this survey suggest that the lack of facilities is more generalized than we would like to believe. The real risk of anesthesia in comparison to other major health risks such as human immunodeficiency virus, malaria, tuberculosis and trauma remains undetermined. The critical shortage of manpower remains a barrier to progress. Despite erratic electrical supplies, inconsistent oxygen delivery, paucity of drugs or equipment and on occasion even lack of running water, many provide life-saving anesthesia. Perioperative morbidity and mortality is, however, understandably high by developed world standards.

  7. SU-F-J-09: Radioactive Seed Localization for Breast Lumpectomy - Towards Optimization

    Energy Technology Data Exchange (ETDEWEB)

    Aima, M; Viscariello, N; Patton, T; Bednarz, B [University of Wisconsin, Madison, WI (United States)

    2016-06-15

    Purpose: The aim of this work is to propose a method to optimize radioactive source localization (RSL) for non-palpable breast cancer surgery. RSL is commonly used as a guiding technique during surgery for excision of non-palpable tumors. A collimated hand-held detector is used to localize radioactive sources implanted in tumors. Incisions made by the surgeon are based on maximum observed detector counts, and tumors are subsequently resected based on an arbitrary estimate of the counts expected at the surgical margin boundary. This work focuses on building a framework to predict detector counts expected throughout the procedure to improve surgical margins. Methods: A gamma detection system called the Neoprobe GDS was used for this work. The probe consists of a cesium zinc telluride crystal and a collimator. For this work, an I-125 Best Medical model 2301 source was used. The source was placed in three different phantoms, a PMMA, a Breast (25%- glandular tissue/75%- adipose tissue) and a Breast (75-25) phantom with a backscatter thickness of 6 cm. Counts detected by the probe were recorded with varying amounts of phantom thicknesses placed on top of the source. A calibration curve was generated using MATLAB based on the counts recorded for the calibration dataset acquired with the PMMA phantom. Results: The observed detector counts data used as the validation set was accurately predicted to within ±3.2%, ±6.9%, ±8.4% for the PMMA, Breast (75-25), Breast (25–75) phantom respectively. The average difference between predicted and observed counts was −0.4%, 2.4%, 1.4% with a standard deviation of 1.2 %, 1.8%, 3.4% for the PMMA, Breast (75-25), Breast (25–75) phantom respectively. Conclusion: The results of this work provide a basis for characterization of a detector used for RSL. Counts were predicted to within ±9% for three different phantoms without the application of a density correction factor.

  8. Estimating anesthesia and surgical procedure times from medicare anesthesia claims.

    Science.gov (United States)

    Silber, Jeffrey H; Rosenbaum, Paul R; Zhang, Xuemei; Even-Shoshan, Orit

    2007-02-01

    Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. The authors abstracted information on time of induction and entrance to the recovery room ("anesthesia chart time") from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure ("surgical chart time") on a subset of 1,888 patients. Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time are not related to these factors; however, the individual hospital did have some influence on these estimates. Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.

  9. Making it local: Beacon Communities use health information technology to optimize care management.

    Science.gov (United States)

    Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A

    2014-06-01

    Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

  10. Selection of the optimal radiotherapy technique for locally advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Lee, Ik-Jae; Seong, Jinsil; Koom, Woong-Sub; Kim, Yong-Bae; Jeon, Byeong-Chul; Kim, Joo-Ho; Han, Kwang-Hyub

    2011-01-01

    Various techniques are available for radiotherapy of hepatocellular carcinoma, including three-dimensional conformal radiotherapy, linac-based intensity-modulated radiotherapy and helical tomotherapy. The purpose of this study was to determine the optimal radiotherapy technique for hepatocellular carcinoma. Between 2006 and 2007, 12 patients underwent helical tomotherapy for locally advanced hepatocellular carcinoma. Helical tomotherapy computerized radiotherapy planning was compared with the best computerized radiotherapy planning for three-dimensional conformal radiotherapy and linac-based intensity-modulated radiotherapy for the delivery of 60 Gy in 30 fractions. Tumor coverage was assessed by conformity index, radical dose homogeneity index and moderated dose homogeneity index. Computerized radiotherapy planning was also compared according to the tumor location. Tumor coverage was shown to be significantly superior with helical tomotherapy as assessed by conformity index and moderated dose homogeneity index (P=0.002 and 0.03, respectively). Helical tomotherapy showed significantly lower irradiated liver volume at 40, 50 and 60 Gy (V40, V50 and V60, P=0.04, 0.03 and 0.01, respectively). On the contrary, the dose-volume of three-dimensional conformal radiotherapy at V20 was significantly smaller than those of linac-based intensity-modulated radiotherapy and helical tomotherapy in the remaining liver (P=0.03). Linac-based intensity-modulated radiotherapy showed better sparing of the stomach compared with helical tomotherapy in the case of separated lesions in both lobes (12.3 vs. 24.6 Gy). Helical tomotherapy showed the high dose-volume exposure to the left kidney due to helical delivery in the right lobe lesion. Helical tomotherapy achieved the best tumor coverage of the remaining normal liver. However, helical tomotherapy showed much exposure to the remaining liver at the lower dose region and left kidney. (author)

  11. Alzheimer disease and anesthesia.

    Science.gov (United States)

    Inan, Gözde; Özköse Satirlar, Zerrin

    2015-01-01

    Alzheimer disease (AD) is one of the most common neurodegenerative diseases and the most prevalent form of dementia. Some factors in the development of AD, age being the best-known one, have been suggested; however, no causes have been found yet. The pathophysiology of the disease is highly complex, current therapies are palliative, and a cure is still lacking. Adverse effects of anesthetics in the elderly have been reported since the 1950s; however, awareness of this old problem has recently gained inportance again. Whether exposure to surgery and general anesthesia (GA) is associated with the development of AD has been questioned. As the population is aging, many elderly patients will need to be anesthetized, and maybe some were already anesthetized before they were diagnosed. Exposure to anesthetics has been demonstrated to promote pathogenesis of AD in both in vitro and in vivo studies. However, to date, there have not been any clinical trials to address a link between exposure to GA and the development of AD in humans. Therefore, before making any conclusions we need further studies, but we should be aware of the potential risks and take cautions with vulnerable elderly patients.

  12. Anesthesia and Tau Pathology

    Science.gov (United States)

    Whittington, Robert A.; Bretteville, Alexis; Dickler, Maya F.; Planel, Emmanuel

    2013-01-01

    Alzheimer’s disease (AD) is the most common form of dementia and remains a growing worldwide health problem. As life expectancy continues to increase, the number of AD patients presenting for surgery and anesthesia will steadily rise. The etiology of sporadic AD is thought to be multifactorial, with environmental, biological and genetic factors interacting together to influence AD pathogenesis. Recent reports suggest that general anesthetics may be such a factor and may contribute to the development and exacerbation of this neurodegenerative disorder. Intra-neuronal neurofibrillary tangles (NFT), composed of hyperphosphorylated and aggregated tau protein are one of the main neuropathological hallmarks of AD. Tau pathology is important in AD as it correlates very well with cognitive dysfunction. Lately, several studies have begun to elucidate the mechanisms by which anesthetic exposure might affect the phosphorylation, aggregation and function of this microtubule-associated protein. Here, we specifically review the literature detailing the impact of anesthetic administration on aberrant tau hyperphosphorylation as well as the subsequent development of neurofibrillary pathology and degeneration. PMID:23535147

  13. Intestinal transplantation: The anesthesia perspective.

    Science.gov (United States)

    Dalal, Aparna

    2016-04-01

    Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis

  14. Osteonecrosis related to intraosseous anesthesia: report of a case.

    Science.gov (United States)

    Woodmansey, Karl F; White, Robert K; He, Jianing

    2009-02-01

    Intraosseous anesthesia is an effective and increasingly used technique with few reported complications. The technique uses a specialized drill to perforate the osseous cortex where local anesthetic can then be deposited to anesthetize teeth. It has been reported that separation of the perforation drills from their plastic bases can occur because of the friction generated during osseous perforation. Prolonged rotation of the perforator drills in the bone can also cause excessive heat, which can lead to bone necrosis. This report describes a case of focal osteonecrosis subsequent to intraosseous anesthesia and discusses possible etiologies of this sequela.

  15. A comparative study of pain following endodontic treatment under general anesthesia

    Directory of Open Access Journals (Sweden)

    Feizi Ghader

    2015-01-01

    Full Text Available   Background and Aims: Postoperativee endodontic pain is an outstanding problem for dental patients. Therefore, a successful management of endodontic pain has become as one of the main dental objectives. The aim of the present study was to compare the postoperative endodontic pain in patients under general anesthesia versus local anesthesia.   Materials and Methods: For conducting this clinical trial study, 50 patients having mandibular molars candidate for root canal therapy were selected. Twenty-five patients treated under general anesthesia because of their fear, anxiety or gag reflex. Other 25 patients treated under local anesthesia. All teeth were prepared using engine-driven rotary system in a crown-down technique and filled using lateral condensation technique. Heft- parker visual analog scale was used to measure the degree of pain at 6, 12, 24, and 48 hours after the treatment. Mann-Whitney, Chi-square, and T-tests were used to compare the intensity of postoperative pain between the groups.   Results: The mean intensity of postoperative pain in local and general anesthesia groups at 6, 12 and 24 hours had statistically significant difference (P<0.05.   Conclusion: Postoperative pain in patients who treated under general anesthesia was significantly less than the patients who treated under local anesthesia.

  16. Contribution to the development of a food guide in Benin: linear programming for the optimization of local diets.

    Science.gov (United States)

    Levesque, Sarah; Delisle, Hélène; Agueh, Victoire

    2015-03-01

    Food guides are important tools for nutrition education. While developing a food guide in Benin, the objective was to determine the daily number of servings per food group and the portion sizes of common foods to be recommended. Linear programming (LP) was used to determine, for each predefined food group, the optimal number and size of servings of commonly consumed foods. Two types of constraints were introduced into the LP models: (i) WHO/FAO Recommended Nutrient Intakes and dietary guidelines for the prevention of chronic diseases; and (ii) dietary patterns based on local food consumption data recently collected in southern Benin in 541 adults. Dietary intakes of the upper tertile of participants for diet quality based on prevention and micronutrient adequacy scores were used in the LP algorithms. Southern area of the Republic of Benin. Local key-players in nutrition (n 30) from the government, academic institutions, international organizations and civil society were partners in the development of the food guide directed at the population. The number of servings per food group and the portion size for eight age-sex groups were determined. For four limiting micronutrients (Fe, Ca, folate and Zn), local diets could be optimized to meet only 70 % of the Recommended Nutrient Intakes, not 100 %. It was possible to determine the daily number of servings and the portion sizes of common foods that can be recommended in Benin with the help of LP to optimize local diets, although Recommended Nutrient Intakes were not fully met for a few critical micronutrients.

  17. Development and Optimization of Polymeric Self-Emulsifying Nanocapsules for Localized Drug Delivery: Design of Experiment Approach

    Directory of Open Access Journals (Sweden)

    Jyoti Wadhwa

    2014-01-01

    Full Text Available The purpose of the present study was to formulate polymeric self-emulsifying curcumin nanocapsules with high encapsulation efficiency, good emulsification ability, and optimal globule size for localized targeting in the colon. Formulations were prepared using modified quasiemulsion solvent diffusion method. Concentration of formulation variables, namely, X1 (oil, X2 (polymeric emulsifier, and X3 (adsorbent, was optimized by design of experiments using Box-Behnken design, for its impact on mean globule size (Y1 and encapsulation efficiency (Y2 of the formulation. Polymeric nanocapsules with an average diameter of 100–180 nm and an encapsulation efficiency of 64.85 ± 0.12% were obtained. In vitro studies revealed that formulations released the drug after 5 h lag time corresponding to the time to reach the colonic region. Pronounced localized action was inferred from the plasma concentration profile (Cmax 200 ng/mL that depicts limited systemic absorption. Roentgenography study confirms the localized presence of carrier (0–2 h in upper GIT; 2–4 h in small intestine; and 4–24 h in the lower intestine. Optimized formulation showed significantly higher cytotoxicity (IC50 value 20.32 μM in HT 29 colonic cancer cell line. The present study demonstrates systematic development of polymeric self-emulsifying nanocapsule formulation of curcumin for localized targeting in colon.

  18. Automatic spinal cord localization, robust to MRI contrasts using global curve optimization.

    Science.gov (United States)

    Gros, Charley; De Leener, Benjamin; Dupont, Sara M; Martin, Allan R; Fehlings, Michael G; Bakshi, Rohit; Tummala, Subhash; Auclair, Vincent; McLaren, Donald G; Callot, Virginie; Cohen-Adad, Julien; Sdika, Michaël

    2018-02-01

    During the last two decades, MRI has been increasingly used for providing valuable quantitative information about spinal cord morphometry, such as quantification of the spinal cord atrophy in various diseases. However, despite the significant improvement of MR sequences adapted to the spinal cord, automatic image processing tools for spinal cord MRI data are not yet as developed as for the brain. There is nonetheless great interest in fully automatic and fast processing methods to be able to propose quantitative analysis pipelines on large datasets without user bias. The first step of most of these analysis pipelines is to detect the spinal cord, which is challenging to achieve automatically across the broad range of MRI contrasts, field of view, resolutions and pathologies. In this paper, a fully automated, robust and fast method for detecting the spinal cord centerline on MRI volumes is introduced. The algorithm uses a global optimization scheme that attempts to strike a balance between a probabilistic localization map of the spinal cord center point and the overall spatial consistency of the spinal cord centerline (i.e. the rostro-caudal continuity of the spinal cord). Additionally, a new post-processing feature, which aims to automatically split brain and spine regions is introduced, to be able to detect a consistent spinal cord centerline, independently from the field of view. We present data on the validation of the proposed algorithm, known as "OptiC", from a large dataset involving 20 centers, 4 contrasts (T 2 -weighted n = 287, T 1 -weighted n = 120, T 2 ∗ -weighted n = 307, diffusion-weighted n = 90), 501 subjects including 173 patients with a variety of neurologic diseases. Validation involved the gold-standard centerline coverage, the mean square error between the true and predicted centerlines and the ability to accurately separate brain and spine regions. Overall, OptiC was able to cover 98.77% of the gold-standard centerline, with a

  19. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  20. A Localization Method for Underwater Wireless Sensor Networks Based on Mobility Prediction and Particle Swarm Optimization Algorithms

    Directory of Open Access Journals (Sweden)

    Ying Zhang

    2016-02-01

    Full Text Available Due to their special environment, Underwater Wireless Sensor Networks (UWSNs are usually deployed over a large sea area and the nodes are usually floating. This results in a lower beacon node distribution density, a longer time for localization, and more energy consumption. Currently most of the localization algorithms in this field do not pay enough consideration on the mobility of the nodes. In this paper, by analyzing the mobility patterns of water near the seashore, a localization method for UWSNs based on a Mobility Prediction and a Particle Swarm Optimization algorithm (MP-PSO is proposed. In this method, the range-based PSO algorithm is used to locate the beacon nodes, and their velocities can be calculated. The velocity of an unknown node is calculated by using the spatial correlation of underwater object’s mobility, and then their locations can be predicted. The range-based PSO algorithm may cause considerable energy consumption and its computation complexity is a little bit high, nevertheless the number of beacon nodes is relatively smaller, so the calculation for the large number of unknown nodes is succinct, and this method can obviously decrease the energy consumption and time cost of localizing these mobile nodes. The simulation results indicate that this method has higher localization accuracy and better localization coverage rate compared with some other widely used localization methods in this field.

  1. A Localization Method for Underwater Wireless Sensor Networks Based on Mobility Prediction and Particle Swarm Optimization Algorithms.

    Science.gov (United States)

    Zhang, Ying; Liang, Jixing; Jiang, Shengming; Chen, Wei

    2016-02-06

    Due to their special environment, Underwater Wireless Sensor Networks (UWSNs) are usually deployed over a large sea area and the nodes are usually floating. This results in a lower beacon node distribution density, a longer time for localization, and more energy consumption. Currently most of the localization algorithms in this field do not pay enough consideration on the mobility of the nodes. In this paper, by analyzing the mobility patterns of water near the seashore, a localization method for UWSNs based on a Mobility Prediction and a Particle Swarm Optimization algorithm (MP-PSO) is proposed. In this method, the range-based PSO algorithm is used to locate the beacon nodes, and their velocities can be calculated. The velocity of an unknown node is calculated by using the spatial correlation of underwater object's mobility, and then their locations can be predicted. The range-based PSO algorithm may cause considerable energy consumption and its computation complexity is a little bit high, nevertheless the number of beacon nodes is relatively smaller, so the calculation for the large number of unknown nodes is succinct, and this method can obviously decrease the energy consumption and time cost of localizing these mobile nodes. The simulation results indicate that this method has higher localization accuracy and better localization coverage rate compared with some other widely used localization methods in this field.

  2. [Anesthesia in urology: notes on its history and development in Spain, 1847 to 1950].

    Science.gov (United States)

    Franco, A; Cortés, J; Hernández, B; Alvarez, J

    2007-01-01

    This review of the historical course of anesthesia performed in the context of urology in Spain relies on primary sources: doctoral theses, dissertations, published articles, inaugural addresses, conference proceedings, and books belonging to various archives and libraries. We collected a large number of documents relating to urology and of particular interest regarding anesthesia, classified them, and subjected them to critical analysis. This allowed us to carefully follow the development of anesthesia and urology itself, both of which attained notable clinical and scientific importance in Spain. Anesthesia with chloroform and incomplete anesthesia were the norm during the second half of the 19th century. However, during the first half of the 20th century, the most widely used techniques were the application of ether or spinal or local infusions, although epidural and intravenous techniques were also mentioned.

  3. Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia.

    Science.gov (United States)

    Peñarrocha-Oltra, D; Ata-Ali, J; Oltra-Moscardó, M-J; Peñarrocha-Diago, M-A; Peñarrocha, M

    2012-03-01

    To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (panesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%)(p=0.0032). The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments.

  4. Absence of multiple local minima effects in intensity modulated optimization with dose-volume constraints

    Energy Technology Data Exchange (ETDEWEB)

    Llacer, Jorge [EC Engineering Consultants, LLC 130, Forest Hill Drive, Los Gatos, CA (United States); Deasy, Joseph O [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Bortfeld, Thomas R [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 30 Fruit Street, Boston, MA (United States); Solberg, Timothy D [Department of Radiation Oncology, University of California, Los Angeles, CA (United States); Promberger, Claus [BrainLAB AG, Ammerthalstrasse 8, 85551 Heimstetten (Germany)

    2003-01-21

    This paper reports on the analysis of intensity modulated radiation treatment optimization problems in the presence of non-convex feasible parameter spaces caused by the specification of dose-volume constraints for the organs-at-risk (OARs). The main aim was to determine whether the presence of those non-convex spaces affects the optimization of clinical cases in any significant way. This was done in two phases: (1) Using a carefully designed two-dimensional mathematical phantom that exhibits two controllable minima and with randomly initialized beamlet weights, we developed a methodology for exploring the nature of the convergence characteristics of quadratic cost function optimizations (deterministic or stochastic). The methodology is based on observing the statistical behaviour of the residual cost at the end of optimizations in which the stopping criterion is progressively more demanding and carrying out those optimizations to very small error changes per iteration. (2) Seven clinical cases were then analysed with dose-volume constraints that are stronger than originally used in the clinic. The clinical cases are two prostate cases differently posed, a meningioma case, two head-and-neck cases, a spleen case and a spine case. Of the 14 different sets of optimizations (with and without the specification of maximum doses allowed for the OARs), 12 fail to show any effect due to the existence of non-convex feasible spaces. The remaining two sets of optimizations show evidence of multiple minima in the solutions, but those minima are very close to each other in cost and the resulting treatment plans are practically identical, as measured by the quality of the dose-volume histograms (DVHs). We discuss the differences between fluence maps resulting from those similar treatment plans. We provide a possible reason for the observed results and conclude that, although the study is necessarily limited, the annealing characteristics of a simulated annealing method may not be

  5. Providing intraosseous anesthesia with minimal invasion.

    Science.gov (United States)

    Giffin, K M

    1994-08-01

    A new variation of intraosseous anesthesia--crestal anesthesia--that is rapid, site-specific and minimally invasive is presented. The technique uses alveolar crest nutrient canals for anesthetic delivery without penetrating either bone or periodontal ligament.

  6. Multiple local feature representations and their fusion based on an SVR model for iris recognition using optimized Gabor filters

    Science.gov (United States)

    He, Fei; Liu, Yuanning; Zhu, Xiaodong; Huang, Chun; Han, Ye; Dong, Hongxing

    2014-12-01

    Gabor descriptors have been widely used in iris texture representations. However, fixed basic Gabor functions cannot match the changing nature of diverse iris datasets. Furthermore, a single form of iris feature cannot overcome difficulties in iris recognition, such as illumination variations, environmental conditions, and device variations. This paper provides multiple local feature representations and their fusion scheme based on a support vector regression (SVR) model for iris recognition using optimized Gabor filters. In our iris system, a particle swarm optimization (PSO)- and a Boolean particle swarm optimization (BPSO)-based algorithm is proposed to provide suitable Gabor filters for each involved test dataset without predefinition or manual modulation. Several comparative experiments on JLUBR-IRIS, CASIA-I, and CASIA-V4-Interval iris datasets are conducted, and the results show that our work can generate improved local Gabor features by using optimized Gabor filters for each dataset. In addition, our SVR fusion strategy may make full use of their discriminative ability to improve accuracy and reliability. Other comparative experiments show that our approach may outperform other popular iris systems.

  7. EEG entropy measures in anesthesia

    Directory of Open Access Journals (Sweden)

    Zhenhu eLiang

    2015-02-01

    Full Text Available Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs’ effect is lacking. In this study, we compare the capability of twelve entropy indices for monitoring depth of anesthesia (DoA and detecting the burst suppression pattern (BSP, in anesthesia induced by GA-BAergic agents.Methods: Twelve indices were investigated, namely Response Entropy (RE and State entropy (SE, three wavelet entropy (WE measures (Shannon WE (SWE, Tsallis WE (TWE and Renyi WE (RWE, Hilbert-Huang spectral entropy (HHSE, approximate entropy (ApEn, sample entropy (SampEn, Fuzzy entropy, and three permutation entropy (PE measures (Shannon PE (SPE, Tsallis PE (TPE and Renyi PE (RPE. Two EEG data sets from sevoflurane-induced and isoflu-rane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, phar-macokinetic / pharmacodynamic (PK/PD modeling and prediction probability analysis were applied. The multifractal detrended fluctuation analysis (MDFA as a non-entropy measure was compared.Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline vari-ability, higher coefficient of determination and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an ad-vantage in computation efficiency compared with MDFA.Conclusion: Each entropy index has its advantages and disadvantages in estimating DoA. Overall, it is suggested that the RPE index was a superior measure.Significance: Investigating the advantages and disadvantages of these entropy indices could help improve current clinical indices for monitoring DoA.

  8. Contact topical anesthesia for strabismus surgery in adult patients.

    Science.gov (United States)

    Vallés-Torres, J; García-Martín, E; Peña-Calvo, P; Sanjuan-Villarreal, A; Gil-Arribas, L M; Fernández-Tirado, F J

    2015-05-01

    To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. EEG entropy measures in anesthesia

    Science.gov (United States)

    Liang, Zhenhu; Wang, Yinghua; Sun, Xue; Li, Duan; Voss, Logan J.; Sleigh, Jamie W.; Hagihira, Satoshi; Li, Xiaoli

    2015-01-01

    Highlights: ► Twelve entropy indices were systematically compared in monitoring depth of anesthesia and detecting burst suppression.► Renyi permutation entropy performed best in tracking EEG changes associated with different anesthesia states.► Approximate Entropy and Sample Entropy performed best in detecting burst suppression. Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs' effect is lacking. In this study, we compare the capability of 12 entropy indices for monitoring depth of anesthesia (DoA) and detecting the burst suppression pattern (BSP), in anesthesia induced by GABAergic agents. Methods: Twelve indices were investigated, namely Response Entropy (RE) and State entropy (SE), three wavelet entropy (WE) measures [Shannon WE (SWE), Tsallis WE (TWE), and Renyi WE (RWE)], Hilbert-Huang spectral entropy (HHSE), approximate entropy (ApEn), sample entropy (SampEn), Fuzzy entropy, and three permutation entropy (PE) measures [Shannon PE (SPE), Tsallis PE (TPE) and Renyi PE (RPE)]. Two EEG data sets from sevoflurane-induced and isoflurane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, pharmacokinetic/pharmacodynamic (PK/PD) modeling and prediction probability (Pk) analysis were applied. The multifractal detrended fluctuation analysis (MDFA) as a non-entropy measure was compared. Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline variability, higher coefficient of determination (R2) and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an advantage in computation

  10. local

    Directory of Open Access Journals (Sweden)

    Abílio Amiguinho

    2005-01-01

    Full Text Available The process of socio-educational territorialisation in rural contexts is the topic of this text. The theme corresponds to a challenge to address it having as main axis of discussion either the problem of social exclusion or that of local development. The reasons to locate the discussion in this last field of analysis are discussed in the first part of the text. Theoretical and political reasons are there articulated because the question is about projects whose intentions and practices call for the political both in the theoretical debate and in the choices that anticipate intervention. From research conducted for several years, I use contributions that aim at discuss and enlighten how school can be a potential locus of local development. Its identification and recognition as local institution (either because of those that work and live in it or because of those that act in the surrounding context are crucial steps to progressively constitute school as a partner for development. The promotion of the local values and roots, the reconstruction of socio-personal and local identities, the production of sociabilities and the equation and solution of shared problems were the dimensions of a socio-educative intervention, markedly globalising. This scenario, as it is argued, was also, intentionally, one of transformation and of deliberate change of school and of the administration of the educative territoires.

  11. Descriptive Study: Anesthesia for Awake Craniotomy in Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Saipin Muangman

    2016-03-01

    Full Text Available Background: The purpose of awake craniotomy is to test neurological functions to ensure accurate lesion surgery and lessen postoperative neurological complications. There are several methods to provide anesthesia during awake craniotomy including local anesthesia infiltration, local anesthesia plus conscious sedation, general anesthesia and wake-up during surgery and sleep again (asleep-awake-asleep or AAA. Each method has its pro and con with different complications. In Siriraj Hospital, there was no prior study of anesthetic techniques and complications of awake craniotomy. Methods: The retrospective descriptive study of awake craniotomy was carried out with 60 patients in Siriraj Hospital 2007-2011. Results: There were 35 males (58.3% with average age 40.7±12.6 years and weight 64.2±12 kilograms undergoing awake craniotomy. Twenty patients (33.3% presented with seizure before surgery. Most diagnosis was oligodendroglioma in 25 patients (41.7%, mostly at the frontal lobe (44 patients or 73.3%. The most common position was supine(46patientsor76.7%. ICU lengthof stay was1.4±0.9(0,6days. Hospital stay was11.1±9 (4,55days. Total intravenous anesthesia (TIVA was mostlyused(52patientsor90% while18patients (30% received scalp block. Most patients (85% did not require nasal airways while 8 patients (13.3% did, and only 1 patient (1.7% required laryngeal mask airway (LMA to help open up air passage. The drugs used during asleep1 and asleep2 were propofol together with dexmedetomidine and fentanyl in 34 patients (56.7% and 23 patients (38.3%, respectively. Whilebeingawake (15patientsor20%,dexmedetomidine and/or fentanyl were administered. Complications during anesthesia were hypertension (33.3%, hypotension (26.7%, upper airway obstruction(23.3%, bradycardia (15%, tachycardia (10%, seizure (1.7% andnausea (1.7%. Conclusion: The most common anesthesia method inSiriraj Hospital for awake craniotomy was TIVA (90%, using propofol together with

  12. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

    International Nuclear Information System (INIS)

    Binkert, Christoph A.; Hirzel, Florian C.; Gutzeit, Andreas; Zollikofer, Christoph L.; Hess, Thomas

    2015-01-01

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h

  13. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hirzel, Florian C. [Kantonsspital Winterthur, Department of Gynecology (Switzerland); Gutzeit, Andreas; Zollikofer, Christoph L. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hess, Thomas [Kantonsspital Winterthur, Department of Gynecology (Switzerland)

    2015-10-15

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

  14. Effectiveness of Ibuprofen Administration on the Depth of Anesthesia in Inflamed Teeth

    Directory of Open Access Journals (Sweden)

    R Mahmodi

    2006-07-01

    Full Text Available Introduction: Incomplete anesthesia of inflamed teeth is a well known clinical occurrence and the purpose of this study was to evaluate the effectiveness of Ibuprofen as a premedication in improving the quality of anesthesia in patients with inflamed teeth pulps. Methods: Forty patients with the diagnosis of irreversible pulpitis in one mandibular tooth were selected. Two other teeth in the same quadrant were selected as controls. Electric pulp tester (EPT was used in this study to evaluate the quality of anesthesia. The subjects were divided into two groups randomly, and after recording of pulp tester response in each group, one of the two drugs; ibuprofen or placebo was administered 1 hour prior to anesthesia injection. After injection, EPT measurement was recorded. The reversed EPT scale was used for evaluation of the depth of anesthesia. Results : Data was analyzed to statistically compare the results before and after anesthesia and drug administration in cases and control group .Significantly lower TSLs were observed in the ibuprofen group (Pvalue= 0.001. Conclusion: This study concluded that preoperative administration of ibuprofen (if not contraindicated 1 hour before local anesthesia injection is an effective method for achieving deep anesthesia during RCT of teeth with irreversible pulpitis.

  15. Automatic fuel lattice design in a boiling water reactor using a particle swarm optimization algorithm and local search

    International Nuclear Information System (INIS)

    Lin Chaung; Lin, Tung-Hsien

    2012-01-01

    Highlights: ► The automatic procedure was developed to design the radial enrichment and gadolinia (Gd) distribution of fuel lattice. ► The method is based on a particle swarm optimization algorithm and local search. ► The design goal were to achieve the minimum local peaking factor. ► The number of fuel pins with Gd and Gd concentration are fixed to reduce search complexity. ► In this study, three axial sections are design and lattice performance is calculated using CASMO-4. - Abstract: The axial section of fuel assembly in a boiling water reactor (BWR) consists of five or six different distributions; this requires a radial lattice design. In this study, an automatic procedure based on a particle swarm optimization (PSO) algorithm and local search was developed to design the radial enrichment and gadolinia (Gd) distribution of the fuel lattice. The design goals were to achieve the minimum local peaking factor (LPF), and to come as close as possible to the specified target average enrichment and target infinite multiplication factor (k ∞ ), in which the number of fuel pins with Gd and Gd concentration are fixed. In this study, three axial sections are designed, and lattice performance is calculated using CASMO-4. Finally, the neutron cross section library of the designed lattice is established by CMSLINK; the core status during depletion, such as thermal limits, cold shutdown margin and cycle length, are then calculated using SIMULATE-3 in order to confirm that the lattice design satisfies the design requirements.

  16. 42 CFR 415.178 - Anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Anesthesia services. 415.178 Section 415.178 Public..., AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.178 Anesthesia... schedule payment may be made if a physician is involved in a single anesthesia procedure involving an...

  17. 21 CFR 868.6700 - Anesthesia stool.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  18. Benders decomposition for discrete material optimization in laminate design with local failure criteria

    DEFF Research Database (Denmark)

    Munoz, Eduardo; Stolpe, Mathias; Bendsøe, Martin P.

    2009-01-01

    in any discrete angle optimization design, or material selection problems. The mathematical modeling of this problem is more general than the one of standard topology optimization. When considering only two material candidates with a considerable difference in stiffness, it corresponds exactly...... to a topology optimization problem. The problem is modeled as a discrete design problem coming from a finite element discretization of the continuum problem. This discretization is made of shell or plate elements. For each element (selection domain), only one of the material candidates must be selected...... of the relaxed master problem and the current best compliance (weight) found get close enough with respect to certain tolerance. The method is investigated by computational means, using the finite element method to solve the analysis problems, and a commercial branch and cut method for solving the relaxed master...

  19. The relationship between the bladder volume and optimal treatment planning in definitive radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Naoki; Sekiguchi, Kenji; Akahane, Keiko; Shikama, Naoto; Takahashi, Osamu; Hama, Yukihiro; Nakagawa, Keiichi

    2012-01-01

    Background and purpose: There is no current consensus regarding the optimal bladder volumes in definitive radiotherapy for localized prostate cancer. The aim of this study was to clarify the relationship between the bladder volume and optimal treatment planning in radiotherapy for localized prostate cancer. Material and methods: Two hundred and forty-three patients underwent definitive radiotherapy with helical tomotherapy for intermediate- and high-risk localized prostate cancer. The prescribed dose defined as 95 % of the planning target volume (PTV) receiving 100 % of the prescription dose was 76 Gy in 38 fractions. The clinical target volume (CTV) was defined as the prostate with a 5-mm margin and 2 cm of the proximal seminal vesicle. The PTV was defined as the CTV with a 5-mm margin. Treatment plans were optimized to satisfy the dose constraints defined by in-house protocols for PTV and organs at risk (rectum wall, bladder wall, sigmoid colon and small intestine). If all dose constraints were satisfied, the plan was defined as an optimal plan (OP). Results: An OP was achieved with 203 patients (84%). Mean bladder volume (± 1 SD) was 266 ml (± 130 ml) among those with an OP and 214 ml (±130 ml) among those without an OP (p = 0.02). Logistic regression analysis also showed that bladder volumes below 150 ml decreased the possibility of achieving an OP. However, the percentage of patients with an OP showed a plateau effect at bladder volumes above 150 ml. Conclusions. Bladder volume is a significant factor affecting OP rates. However, our results suggest that bladder volumes exceeding 150 ml may not help meet planning dose constraints

  20. From basic concepts to emerging technologies in regional anesthesia.

    Science.gov (United States)

    Dillane, Derek; Tsui, Ban C H

    2010-10-01

    The present article details how our understanding of the basic concepts of regional anesthesia has recently evolved. We will appraise current technological advances and question the commensurate nature of the relationship between tradition and innovation. Ultrasound localization has enhanced our understanding of the needle-nerve relationship. Intraneural injection of local anesthetic may occur with greater frequency than previously thought without inevitably leading to neurological complications. The ratio of neural to non-neural tissue varies both between and within nerves and may be an important determinant of neural injury. Ultrasonographic evidence of intraneural injection is subject to observer expertise and the resolution of the ultrasound image. Current ultrasound resolution capability does not reliably permit differentiation between intrafascicular and extrafascicular drug injection. Perineural electrical impedance may be a determinant of current threshold and conceivably distinguish between intraneural and extraneural tissue. Technology that enhances the sonographic image of both procedure needle and target nerve is the focus of current endeavors in ultrasound innovation.There is inconclusive evidence that the use of ultrasound technology has reduced the incidence of local anesthetic toxicity. Lipid emulsion therapy is now an accepted treatment for systemic local anesthetic toxicity. There are new reports on the development of an ultra long-acting local anesthetic agent that would permit lower doses and superannuate catheter-based continuous regional anesthesia techniques. Over the past decade, our understanding of the fundamental concepts of regional anesthesia continues to be challenged by emerging experimental and clinical evidence.

  1. Local Contrast Enhancement Using Intuitionistic Fuzzy Sets Optimized By Artificial Bee Colony Algorithm

    Directory of Open Access Journals (Sweden)

    Daniel M. Wonohadidjojo

    2017-03-01

    was applied. The results of local contrast enhancement using both methods were compared with the results using histogram equalization method. The tests were conducted using two MDCK cell images. The results of local contrast enhancement using both methods were evaluated by observing the enhanced images and IEM values. The results show that the methods outperform the histogram equalization method. Furthermore, the method using IFSABC is better than the IFS method.

  2. Optimal Attitude Estimation and Filtering Without Using Local Coordinates Part I: Uncontrolled and Deterministic Attitude Dynamics

    OpenAIRE

    Sanyal, Amit K.

    2005-01-01

    There are several attitude estimation algorithms in existence, all of which use local coordinate representations for the group of rigid body orientations. All local coordinate representations of the group of orientations have associated problems. While minimal coordinate representations exhibit kinematic singularities for large rotations, the quaternion representation requires satisfaction of an extra constraint. This paper treats the attitude estimation and filtering problem as an optimizati...

  3. A localized navigation algorithm for Radiation Evasion for nuclear facilities. Part II: Optimizing the “Nearest Exit” Criterion

    Energy Technology Data Exchange (ETDEWEB)

    Khasawneh, Mohammed A., E-mail: mkha@ieee.org [Department of Electrical Engineering, Jordan University of Science and Technology (Jordan); Al-Shboul, Zeina Aman M., E-mail: xeinaaman@gmail.com [Department of Electrical Engineering, Jordan University of Science and Technology (Jordan); Jaradat, Mohammad A., E-mail: majaradat@just.edu.jo [Department of Mechanical Engineering, Jordan University of Science and Technology (Jordan); Malkawi, Mohammad I., E-mail: mmalkawi@aimws.com [College of Engineering, Jadara University, Irbid 221 10 (Jordan)

    2013-06-15

    Highlights: ► A new navigation algorithm for Radiation Evasion around nuclear facilities. ► An optimization criteria minimized under algorithm operation. ► A man-borne device guiding the occupational worker towards paths that warrant least radiation × time products. ► Benefits of using localized navigation as opposed to global navigation schemas. ► A path discrimination function for finding the navigational paths exhibiting the least amounts of radiation. -- Abstract: In this extension from part I (Khasawneh et al., in press), we modify the navigation algorithm which was presented with the objective of optimizing the “Radiation Evasion” Criterion so that navigation would optimize the criterion of “Nearest Exit”. Under this modification, algorithm would yield navigation paths that would guide occupational workers towards Nearest Exit points. Again, under this optimization criterion, algorithm leverages the use of localized information acquired through a well designed and distributed wireless sensor network, as it averts the need for any long-haul communication links or centralized decision and monitoring facility thereby achieving a more reliable performance under dynamic environments. As was done in part I, the proposed algorithm under the “Nearest Exit” Criterion is designed to leverage nearest neighbor information coming in through the sensory network overhead, in computing successful navigational paths from one point to another. For comparison purposes, the proposed algorithm is tested under the two optimization criteria: “Radiation Evasion” and “Nearest Exit”, for different numbers of step look-ahead. We verify the performance of the algorithm by means of simulations, whereby navigational paths are calculated for different radiation fields. We, via simulations, also, verify the performance of the algorithm in comparison with a well-known global navigation algorithm upon which we draw our conclusions.

  4. A localized navigation algorithm for Radiation Evasion for nuclear facilities. Part II: Optimizing the “Nearest Exit” Criterion

    International Nuclear Information System (INIS)

    Khasawneh, Mohammed A.; Al-Shboul, Zeina Aman M.; Jaradat, Mohammad A.; Malkawi, Mohammad I.

    2013-01-01

    Highlights: ► A new navigation algorithm for Radiation Evasion around nuclear facilities. ► An optimization criteria minimized under algorithm operation. ► A man-borne device guiding the occupational worker towards paths that warrant least radiation × time products. ► Benefits of using localized navigation as opposed to global navigation schemas. ► A path discrimination function for finding the navigational paths exhibiting the least amounts of radiation. -- Abstract: In this extension from part I (Khasawneh et al., in press), we modify the navigation algorithm which was presented with the objective of optimizing the “Radiation Evasion” Criterion so that navigation would optimize the criterion of “Nearest Exit”. Under this modification, algorithm would yield navigation paths that would guide occupational workers towards Nearest Exit points. Again, under this optimization criterion, algorithm leverages the use of localized information acquired through a well designed and distributed wireless sensor network, as it averts the need for any long-haul communication links or centralized decision and monitoring facility thereby achieving a more reliable performance under dynamic environments. As was done in part I, the proposed algorithm under the “Nearest Exit” Criterion is designed to leverage nearest neighbor information coming in through the sensory network overhead, in computing successful navigational paths from one point to another. For comparison purposes, the proposed algorithm is tested under the two optimization criteria: “Radiation Evasion” and “Nearest Exit”, for different numbers of step look-ahead. We verify the performance of the algorithm by means of simulations, whereby navigational paths are calculated for different radiation fields. We, via simulations, also, verify the performance of the algorithm in comparison with a well-known global navigation algorithm upon which we draw our conclusions

  5. Comparative evaluation of hemodynamic, vasoconstrictive, and SpO2variability during different stages of periodontal surgery performed using 0.5% ropivacaine or 2% lignocaine HCl (1:80,000 adrenaline local anesthesia: A randomized, double-blind, split-mouth pilot study

    Directory of Open Access Journals (Sweden)

    Ashank Mishra

    2018-01-01

    Full Text Available Aim: The aim of this study is to compare anesthetic, hemodynamic, vasoconstrictive, and SpO2variability of 0.5% ropivacaine to the “gold standard” lignocaine (2% with epinephrine (1:80,000 during periodontal surgery. Materials and Methods: A total of 20 systemically healthy controls meeting the inclusion criteria were selected from the Outpatient Department of Sri Sai College of Dental Surgery. Preoperatively, all participants were infiltrated with 0.5 ml of 0.5% ropivacaine intradermally as test solution to record any allergic reaction. Open flap debridement was performed using local anesthesia containing 2% lignocaine hydrochloride with 1:80,000 epinephrine or 0.5% ropivacaine. Recordings were made of the time of onset, duration of action, the intensity, and depth of anesthesia and various hemodynamic changes throughout the surgical procedure. In addition, blood loss volume and postoperative pain were also assessed. Results: Ropivacaine showed statistically longer duration of action (mean±SD =5.3±0.71 hrs than lignocaine with epinephrine (mean=2.14±0.98 hrs. Blood loss during flap surgery was comparatively less when performed under ropivacaine. No statistical differences were observed in systolic BP, diastolic BP, SpO2 and heart rate during different stages of periodontal surgery between either of the local anesthetic agents Conclusion: Ropivacaine demonstrates comparable efficacy as lignocaine with added advantage of longer duration of action and superior postoperative pain control. No adverse events from this newer anesthetic were noted, and hence, it can be used safely as a viable local anesthetic for periodontal surgical procedures.

  6. Intestinal circulation during inhalation anesthesia

    International Nuclear Information System (INIS)

    Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.

    1985-01-01

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of 86 Rb and 9-microns spheres labeled with 141 Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO 2 ) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines

  7. Periocular Anesthesia in Aesthetic Surgery

    OpenAIRE

    Skibell, Bentley C.; Soparkar, Charles N.S.; Tower, Robert N.; Patrinely, James R.

    2007-01-01

    This article focuses on the administration of anesthesia for periocular aesthetic procedures. Special emphasis is given to office-based procedures, most often without any systemic sedation, highlighting the importance of open communication with patients. Finally, attention is given to potential pitfalls including anesthetic systemic toxicity, ocular injuries, and orbicularis myotoxicity.

  8. How to teach regional anesthesia.

    Science.gov (United States)

    Bröking, Katrin; Waurick, René

    2006-10-01

    The demand for peripheral nerve blocks and neuroaxial blocks from both patients and surgeons has increased over the last few years. This change in attitude towards regional anesthesia is prompted by the insight that adequate perioperative pain management leads to earlier ambulation, shorter hospital stay, reduced cost and increased patient satisfaction. To avoid serious complications of these techniques structured residency programs need to be available. Until 2004, the Residency Review Committee for Anesthesiology in the United States required a minimum of 50 epidurals, 40 spinals and 40 peripheral nerve blocks during residency. Similarly, the German Society for Anesthesia and Intensive Care required 100 neuroaxial blocks and 50 peripheral nerve blocks. In 2004 the American Society of Regional Anesthesia and Pain Medicine endorsed standardized guidelines for regional anesthesia fellowships which regulate the administrative, equipment and educational demands. This review introduces the reader to the different teaching methods available, including cadaver workshops, three-dimensional videoclips, video filming, ultrasound guidance and acoustic assist devices as well as demonstrating their advantages and disadvantages. Moreover, an overview is given of future residency training programs, which integrate administrative, material and educative demands as well as the teaching means into the daily clinical routine.

  9. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  10. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  11. Attending Globally or Locally: Incidental Learning of Optimal Visual Attention Allocation

    Science.gov (United States)

    Beck, Melissa R.; Goldstein, Rebecca R.; van Lamsweerde, Amanda E.; Ericson, Justin M.

    2018-01-01

    Attention allocation determines the information that is encoded into memory. Can participants learn to optimally allocate attention based on what types of information are most likely to change? The current study examined whether participants could incidentally learn that changes to either high spatial frequency (HSF) or low spatial frequency (LSF)…

  12. Optimal local dimming for LED-backlit LCD displays via linear programming

    DEFF Research Database (Denmark)

    Shu, Xiao; Wu, Xiaolin; Forchhammer, Søren

    2012-01-01

    and the attenuations of LCD pixels. The objective is to minimize the distortion in luminance reproduction due to the leakage of LCD and the coarse granularity of the LED lights. The optimization problem is formulated as one of linear programming, and both exact and approximate algorithms are proposed. Simulation...

  13. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted. Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening

  14. Generalized seizures and transient contralateral hemiparesis following retrobulbar anesthesia: a case report.

    Science.gov (United States)

    Dettoraki, Maria; Dimitropoulou, Chrisafoula; Nomikarios, Nikolaos; Moschos, Marilita M; Brοuzas, Dimitrios

    2015-07-28

    Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported. A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later. Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.

  15. Anesthesia-induced epilepsy: causes and treatment.

    Science.gov (United States)

    Zhao, Xiaojuan; Wang, Xuefeng

    2014-09-01

    Epilepsy is a type of chronic brain disease that results from an abnormally high synchronization of neuronal discharge. The typical clinical features of epilepsy are paroxysms and transient and stereotyped brain dysfunction. Many cases of epileptic seizures occurring during anesthesia have been reportedx. Recently, risk assessment of epileptic seizures during surgery and anesthesia has gained increasing attention. In this review, we systematically summarize the influence of anesthesia on epileptic seizures; the types, durations and frequencies of seizures related to anesthesia; and the epidemiology, prevention, treatment and prognosis of epilepsy. We also explore the possible mechanism of epilepsy and provide guidance for anesthesia during surgeries.

  16. Optimization Of Scan Range For 3d Point Localization In Statscan Digital Medical Radiology

    Directory of Open Access Journals (Sweden)

    Jacinta S. Kimuyu

    2015-08-01

    Full Text Available The emergence of computerized medical imaging in early 1970s which merged with digital technology in the 1980s was celebrated as a major breakthrough in three-dimensional 3D medicine. However a recent South African innovation the high speed scanning Lodox Statscan Critical Digital Radiology modality posed challenges in X-ray photogrammetry due to the systems intricate imaging geometry. The study explored the suitability of the Direct Linear Transformation as a method for the determination of 3D coordinates of targeted points from multiple images acquired with the Statscan X-ray system and optimization of the scan range. This investigation was carried out as a first step towards the development of a method to determine the accurate positions of points on or inside the human body. The major causes of errors in three-dimensional point localization using Statscan images were firstly the X-ray beam divergence and secondly the position of the point targets above the X-ray platform. The experiments carried out with two reference frames showed that point positions could be established with RMS values in the mm range in the middle axis of the X-ray patient platform. This range of acceptable mm accuracies extends about 15 to 20 cm sideways towards the edge of the X-ray table and to about 20 cm above the table surface. Beyond this range accuracy deteriorated significantly reaching RMS values of 30mm to 40 mm. The experiments further showed that the inclusion of control points close to the table edges and more than 20 cm above the table resulted in lower accuracies for the L - parameters of the DLT solution than those derived from points close to the center axis only. As the accuracy of the L - parameters propagates into accuracy of the final coordinates of newly determined points it is essential to restrict the space of the control points to the above described limits. If one adopts the usual approach of surrounding the object by known control points then

  17. Automatic multi-cycle reload design of pressurized water reactor using particle swarm optimization algorithm and local search

    International Nuclear Information System (INIS)

    Lin, Chaung; Hung, Shao-Chun

    2013-01-01

    Highlights: • An automatic multi-cycle core reload design tool, which searches the fresh fuel assembly composition, is developed. • The search method adopts particle swarm optimization and local search. • The design objectives are to achieve required cycle energy, minimum fuel cost, and the satisfactory constraints. • The constraints include the hot zero power moderator temperature coefficient and the hot channel factor. - Abstract: An automatic multi-cycle core reload design tool, which searches the fresh fuel assembly composition, is developed using particle swarm optimization and local search. The local search uses heuristic rules to change the current search result a little so that the result can be improved. The composition of the fresh fuel assemblies should provide the required cycle energy and satisfy the constraints, such as the hot zero power moderator temperature coefficient and the hot channel factor. Instead of designing loading pattern for each FA composition during search process, two fixed loading patterns are used to calculate the core status and the better fitness function value is used in the search process. The fitness function contains terms which reflect the design objectives such as cycle energy, constraints, and fuel cost. The results show that the developed tool can achieve the desire objective

  18. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  19. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  20. Effort Optimization in Minimizing Food Related Greenhouse Gas Emissions, a look at "Organic" and "Local"

    Science.gov (United States)

    Bowen, E.; Martin, P. A.; Eshel, G.

    2008-12-01

    The adverse environmental effects, especially energy use and resultant GHG emissions, of food production and consumption are becoming more widely appreciated and increasingly well documented. Our insights into the thorny problem of how to mitigate some of those effects, however, are far less evolved. Two of the most commonly advocated strategies are "organic" and "local", referring, respectively, to growing food without major inputs of fossil fuel based synthetic fertilizers and pesticides and to food consumption near its agricultural origin. Indeed, both agrochemical manufacture and transportation of produce to market make up a significant percentage of energy use in agriculture. While there can be unique environmental benefits to each strategy, "organic" and "local" each may potentially result in energy and emissions savings relative to conventionally grown produce. Here, we quantify the potential energy and greenhouse gas emissions savings associated with "organic" and "local". We take note of energy use and actual GHG costs of the major synthetic fertilizers and transportation by various modes routinely employed in agricultural distribution chains, and compare them for ~35 frequently consumed nutritional mainstays. We present new, current, lower-bound energy and greenhouse gas efficiency estimates for these items and compare energy consumption and GHG emissions incurred during producing those food items to consumption and emissions resulting from transporting them, considering travel distances ranging from local to continental and transportation modes ranging from (most efficient) rail to (least efficient) air. In performing those calculations, we demonstrate the environmental superiority of either local or organic over conventional foods, and illuminate the complexities involved in entertaining the timely yet currently unanswered, and previously unanswerable, question of "Which is Environmentally Superior, Organic or Local?". More broadly, we put forth a