Anaesthesia for a morbidly obese patient with schizophrenia and intellectual disability

We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had been taking several antipsychotic agents, including haloperidol. Tracheal intubation was performed smoothly and anaesthesia was maintained uneventfully using propofol and remifentanil.This case demonstrates that the method of general anaesthesia presented here can be used safely in managing patients with these kinds of disabilities

General anaesthesia with and without intubation for patients with Cornelia de Lange syndrome

We present the use of different methods of general anaesthesia in two patients with Cornelia de Lange syndrome and its contribution to the patients’ oral health.Case 1: The patient was a 22-year-old woman with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. She exhibited the physical characteristics of Cornelia de Lange syndrome, including a small mouth, thin lips, short limbs, stiffness of joints and intellectual disability. General anaesthesia without intubation was performed safely eight times. No other complications except hypersensitivity to hypnotic agents were observed.Case 2: The patient was a 10-year-old boy with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. He had a history and symptoms of obstructive airway disorders in addition to showing physical characteristics of the syndrome similar to those seen in Case 1. General anaesthesia with nasal intubation was performed safely twice. Computed tomography (CT) of his head and neck produced unremarkable results. These cases demonstrate that both general anaesthesia with and without nasal intubation can be safely used in managing individuals with Cornelia de Lange syndrome during dental treatment.Keywords: general anaesthesia; Cornelia de Lange syndrome; dental treatmen

Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Background: Muscle weakness is a risk factor for mortality in haemodialysis (HD) patients; we wished to determine whether measuring the composition of the arm with bioimpedance was associated with arm muscle strength. Methods: We measured pinch strength (PS) and hand grip strength (HGS) in 250 adult HD patients with corresponding post-dialysis multifrequency bioelectrical assessments with segmental body analysis. Results: Mean age 64.0 ± 15.6, 66% male and 45.6% diabetic. The maximum HGS in the dominant or non-fistula arm was 18.9 ± 9.2 kg and PS 4.09 ± 1.96 kg respectively, with a correlation of r = 0.80, p < 0.001. HGS was associated with body cell mass (β 0.37, p < 0.001) and PS with appendicular muscle mass (β 0.06, p < 0.001). Both HGS and PS were independently associated with the ratio of extracellular water (ECW) to total body water (TBW); β -139.5, p = 0.024, β -44.8, p < 0.001 in the arm. The presence of an arterio-venous fistula increased the ECW/TBW ratio in the arm from 0.383 ± 0.009 to 0.390 ± 0.012, p < 0.05. Conclusion: Muscle strength measured by HGS and PS was associated with both markers of whole body and segmental body composition within the arm, particularly ECW/TBW. Bioimpedance measurements and assessment of muscle strength should be measured in the non-fistula arm

Restitution analysis of alternans and its relationship to arrhythmogenicity in hypokalaemic Langendorff-perfused murine hearts

Alternans and arrhythmogenicity were studied in hypokalaemic (3.0 mM K+) Langendorff-perfused murine hearts paced at high rates. Epicardial and endocardial monophasic action potentials were recorded and durations quantified at 90% repolarization. Alternans and arrhythmia occurred in hypokalaemic, but not normokalaemic (5.2 mM K+) hearts (P < 0.01): this was prevented by treatment with lidocaine (10 μM, P < 0.01). Fourier analysis then confirmed transition from monomorphic to polymorphic waveforms for the first time in the murine heart. Alternans and arrhythmia were associated with increases in the slopes of restitution curves, obtained for the first time in the murine heart, while the anti-arrhythmic effect of lidocaine was associated with decreased slopes. Thus, hypokalaemia significantly increased (P < 0.05) maximal gradients (from 0.55 ± 0.14 to 2.35 ± 0.67 in the epicardium and from 0.67 ± 0.13 to 1.87 ± 0.28 in the endocardium) and critical diastolic intervals (DIs) at which gradients equalled unity (from −2.14 ± 0.52 ms to 50.93 ± 14.45 ms in the epicardium and from 8.14 ± 1.49 ms to 44.64 ± 5 ms in the endocardium). While treatment of normokalaemic hearts with lidocaine had no significant effect (P > 0.05) on either maximal gradients (0.78 ± 0.27 in the epicardium and 0.83 ± 0.45 in the endocardium) or critical DIs (6.06 ± 2.10 ms and 7.04 ± 3.82 ms in the endocardium), treatment of hypokalaemic hearts with lidocaine reduced (P < 0.05) both these parameters (1.05 ± 0.30 in the epicardium and 0.89 ± 0.36 in the endocardium and 30.38 ± 8.88 ms in the epicardium and 31.65 ± 4.78 ms in the endocardium, respectively). We thus demonstrate that alternans contributes a dynamic component to arrhythmic substrate during hypokalaemia, that restitution may furnish an underlying mechanism and that these phenomena are abolished by lidocaine, both recapitulating and clarifying clinical findings

Anisotropic Swelling of Hydrogel Nanowires Based on Poly(vinylpyrrolidone) Fabricated by Single-Particle Nanofabrication Technique

We report a hydrogel nanowire based on poly(vinylpyrrolidone) (PVP) and N,N’-methylenebis(acrylamide) (MBA), which have anisotropic swelling ratio for radius and length direction. The PVP/MBA nanowires were fabricated by single particle nanofabrication technique, which is a technique for the fabrication of polymeric nanowires using the single ion event that cause the crosslinking reaction of polymer chains within the ion tracks along the ion paths; furthermore the size (length and radius) of the nanowires was controlled by changing the film thickness and amount of MBA crosslinker. The swelling behaviors in air and water were observed using atomic force microscopy. The PVP/MBA nanowires exhibited anisotropic swelling along the length and radius in aqueous environments, because the hydrogel nanowires consisted of crosslinked networks with inhomogeneous crosslinking points, which reflected the initial energy distribution from an incident ion within the ion track