The effect of initial local anesthetic dose with continuous interscalene analgesia on postoperative pain and diaphragmatic function in patients undergoing arthroscopic shoulder surgery: a double-blind, randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Interscalene block (ISB) is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB) with reduced initial bolus volumes.</p> <p>Methods</p> <p>Subjects undergoing arthroscopic rotator cuff repair were randomized to receive 5, 10, or 20 mL ropivacaine 0.75% for ISB in a double-blind fashion (N = 36). Continuous infusion with ropivacaine 0.2% was maintained for 48 h. Pain and diaphragmatic excursion were assessed before block and in the recovery unit.</p> <p>Results</p> <p>Pain ratings in the recovery room were generally less than 4 (0-10 NRS) for all treatment groups, but a statistically significant difference was noted between the 5 and 20 mL groups (NRS: 2.67 vs. 0.62 respectively; p = 0.04). Pain ratings and supplemental analgesic use were similar among the groups at 24 h, 48 h and 12 weeks. There were no differences in the quality of block for surgical anesthesia. Dyspnea was significantly greater in the 20 mL group (p = 0.041). Subjects with dyspnea had significant diaphragmatic impairment more frequently (Relative risk: 2.5; 95%CI: 1.3-4.8; p = 0.042). Increased contralateral diaphragmatic motion was measured in 29 of the 36 subjects. Physical shoulder function at 12 weeks improved over baseline in all groups (baseline mean SST: 6.3, SEM: 0.6; 95%CI: 5.1-7.5; 12 week mean SST: 8.2, SEM: 0.46; 95%CI: 7.3-9.2; p = 0.0035).</p> <p>Conclusions</p> <p>ISB provided reliable surgical analgesia with 5 mL, 10 mL or 20 mL ropivacaine (0.75%). The 20 mL volume was associated with increased complaints of dyspnea. The 5 mL volume was associated with statistically higher pain scores in the immediate postoperative period. Lower volumes resulted in a reduced incidence of dyspnea compared to 20 mL, however diaphragmatic impairment was not eliminated. Compensatory increases in contralateral diaphragmatic movement may explain tolerance for ipsilateral paresis.</p> <p>Trial Registration</p> <p>clinicaltrials.gov. identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00672100">NCT00672100</a></p

Experimental investigation of the uncertainty principle in the presence of quantum memory

Heisenberg's uncertainty principle provides a fundamental limitation on an observer's ability to simultaneously predict the outcome when one of two measurements is performed on a quantum system. However, if the observer has access to a particle (stored in a quantum memory) which is entangled with the system, his uncertainty is generally reduced. This effect has recently been quantified by Berta et al. [Nature Physics 6, 659 (2010)] in a new, more general uncertainty relation, formulated in terms of entropies. Using entangled photon pairs, an optical delay line serving as a quantum memory and fast, active feed-forward we experimentally probe the validity of this new relation. The behaviour we find agrees with the predictions of quantum theory and satisfies the new uncertainty relation. In particular, we find lower uncertainties about the measurement outcomes than would be possible without the entangled particle. This shows not only that the reduction in uncertainty enabled by entanglement can be significant in practice, but also demonstrates the use of the inequality to witness entanglement.Comment: 8 pages, 4 figures, comments welcom

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Attentional control and inferences of agency : Working memory load differentially modulates goal-based and prime-based agency experiences

Previous research indicates that people can infer self-agency, the experience of causing outcomes as a result of one's own actions, in situations where information about action-outcomes is pre-activated through goal-setting or priming. We argue that goal-based agency inferences rely on attentional control that processes information about matches and mismatches between intended and actual outcomes. Prime-based inferences follow an automatic cognitive accessibility process that relies on matches between primed and actual information about outcomes. We tested an improved task for a better examination of goal-based vs. primed-based agency inferences, and examined the moderating effect of working memory load on both types of inferences. Findings of four studies showed that goal-based, but not prime-based agency inferences dwindled under working memory load. These findings suggest that goal-based (vs. primed-based) agency inferences indeed rely on attentional control, thus rendering goal-based agency inferences especially prone to conditions that modulate goal-directed control processes

The Art of Anger : Reward Context Turns Avoidance Responses to Anger-Related Objects Into Approach

Anger has a special status among the emotions in that it can elicit avoidance as well as approach motivation. This study tested the ignored role of reward context in potentiating approach rather than avoidance responses toward objects associated with anger. In Experiment 1, angry and neutral facial expressions were parafoveally paired with common objects, and responses to the objects were assessed by subjective reports of motivation to obtain them. In Experiment 2, objects were again paired with angry or neutral faces outside of participants' awareness, and responses toward the objects were indexed by physical effort expended in attempting to win them. Results showed that approach motivation toward anger-related objects can be observed when responding is framed in terms of rewards that one can obtain, whereas avoidance motivation occurs in the absence of such a reward context. These findings point to the importance of a reward context in modulating people's responses to anger

Impaired frontal processing during agency inferences in schizophrenia

People generally experience themselves as the cause of outcomes following from their own actions. Such agency inferences occur fluently and are essential to social interaction. However, schizophrenia patients often experience difficulties in distinguishing their own actions from those of others. Building on recent research into the neural substrates underlying agency inferences in healthy individuals, the present study investigates how these inferences are represented on a neural level in patients with schizophrenia. Thirty-one schizophrenia patients and 31 healthy controls performed an agency inference task while functional magnetic resonance images were obtained. Participants were presented with a task wherein the relationship between their actions and the subsequent outcomes was ambiguous. They received instructions to cause specific outcomes to occur by pressing a key, but the task was designed to match or mismatch the color outcome with the participants' goal. Both groups experienced stronger agency when their goal matched (vs. mismatched) the outcome. However, region of interest analyses revealed that only controls showed the expected involvement of the medial prefrontal cortex and superior frontal gyrus, whereas in patients the agency experience was not related to brain activation. These findings are discussed in light of a hypofrontality model of schizophrenia

Abnormal agency experiences in schizophrenia patients : Examining the role of psychotic symptoms and familial risk

Experiencing self-agency over one's own action outcomes is essential for social functioning. Recent research revealed that patients with schizophrenia do not use implicitly available information about their action-outcomes (i.e., prime-based agency inference) to arrive at self-agency experiences. Here, we examined whether this is related to symptoms and/or familial risk to develop the disease. Fifty-four patients, 54 controls, and 19 unaffected (and unrelated) siblings performed an agency inference task, in which experienced agency was measured over action-outcomes that matched or mismatched outcome-primes that were presented before action performance. The Positive and Negative Syndrome Scale (PANSS) and Comprehensive Assessment of Symptoms and History (CASH) were administered to assess psychopathology. Impairments in prime-based inferences did not differ between patients with symptoms of over- and underattribution. However, patients with agency underattribution symptoms reported significantly lower overall self-agency experiences. Siblings displayed stronger prime-based agency inferences than patients, but weaker prime-based inferences than healthy controls. However, these differences were not statistically significant. Findings suggest that impairments in prime-based agency inferences may be a trait characteristic of schizophrenia. Moreover, this study may stimulate further research on the familial basis and the clinical relevance of impairments in implicit agency inferences

Abnormal agency experiences in schizophrenia patients : Examining the role of psychotic symptoms and familial risk

Experiencing self-agency over one's own action outcomes is essential for social functioning. Recent research revealed that patients with schizophrenia do not use implicitly available information about their action-outcomes (i.e., prime-based agency inference) to arrive at self-agency experiences. Here, we examined whether this is related to symptoms and/or familial risk to develop the disease. Fifty-four patients, 54 controls, and 19 unaffected (and unrelated) siblings performed an agency inference task, in which experienced agency was measured over action-outcomes that matched or mismatched outcome-primes that were presented before action performance. The Positive and Negative Syndrome Scale (PANSS) and Comprehensive Assessment of Symptoms and History (CASH) were administered to assess psychopathology. Impairments in prime-based inferences did not differ between patients with symptoms of over- and underattribution. However, patients with agency underattribution symptoms reported significantly lower overall self-agency experiences. Siblings displayed stronger prime-based agency inferences than patients, but weaker prime-based inferences than healthy controls. However, these differences were not statistically significant. Findings suggest that impairments in prime-based agency inferences may be a trait characteristic of schizophrenia. Moreover, this study may stimulate further research on the familial basis and the clinical relevance of impairments in implicit agency inferences