Spontaneous breathing during anaesthesia: first, do no harm

Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may be more subtle advantages such as improved cardiopulmonary interaction, better distribution of ventilation, and reduced mechanically induced lung damage. Some of these advantages may be also applied during mechanical ventilation, by allowing continued muscle activity or continuously varying the size of the tidal breaths.Mechanical ventilation is often unnecessary and may be harmful

Spontaneous breathing during anaesthesia: first, do no harm

Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may be more subtle advantages such as improved cardiopulmonary interaction, better distribution of ventilation, and reduced mechanically induced lung damage. Some of these advantages may be also applied during mechanical ventilation, by allowing continued muscle activity or continuously varying the size of the tidal breaths.Mechanical ventilation is often unnecessary and may be harmful

The citric acid cough threshold and the ventilatory response to carbon dioxide on ascent to high altitude

SummaryVentilatory control undergoes profound changes on ascent to high altitude. We hypothesized that the fall in citric acid cough threshold seen on ascent to altitude is mediated by changes in the central control of cough and would parallel changes in central ventilatory control assessed by the hypercapnic ventilatory response (HCVR). Twenty-five healthy volunteers underwent measurements of HCVR and citric acid sensitivity at sea level and during a 9 day sojourn at 5200m. None of the subjects had any evidence of respiratory infection. Citric acid cough threshold fell significantly on ascent to 5200m. The slope, S, of the HCVR increased significantly on ascent to 5200m and during the stay at altitude. There was no correlation between citric acid sensitivity and HCVR. We conclude that the change in citric acid cough threshold seen on exposure to hypobaric hypoxia is unlikely to be mediated by changes in the central control of cough. Sensitivity to citric acid may be due to early subclinical pulmonary edema stimulating airway sensory nerve endings

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

Superposition of macroscopic numbers of atoms and molecules

We theoretically examine photoassociation of a non-ideal Bose-Einstein condensate, focusing on evidence for a macroscopic superposition of atoms and molecules. This problem raises an interest because, rather than two states of a given object, an atom-molecule system is a seemingly impossible macroscopic superposition of different objects. Nevertheless, photoassociation enables coherent intraparticle conversion, and we thereby propose a viable scheme for creating a superposition of a macroscopic number of atoms with a macroscopic number of molecules.Comment: 4 pages, 2 figs, to appear in Phys. Rev. Let

Microbial ligand costimulation drives neutrophilic steroid-refractory asthma

Funding: The authors thank the Wellcome Trust (102705) and the Universities of Aberdeen and Cape Town for funding. This research was also supported, in part, by National Institutes of Health GM53522 and GM083016 to DLW. KF and BNL are funded by the Fonds Wetenschappelijk Onderzoek, BNL is the recipient of an European Research Commission consolidator grant and participates in the European Union FP7 programs EUBIOPRED and MedALL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Exploration of key stakeholders' preferences for pre-hospital physiologic monitoring by emergency rescue services

Peer reviewedPostprintPostprin