Intensification of separation effects of nanoporous polymeric membranes in the gas separation processes

The purpose of the present work is the intensification of the separation effects of nanoporous polymeric membranes in the gas separation processes by the use of the membrane modules with feeding reservoir

Efficacy of regional analgesia techniques in abdominal surgery patients with obesity

Abstract The use of regional anesthetic techniques in abdominal surgery is an essential component of the multimodal approach to perioperative analgesia, yet data on their use in obese patients remains limited. The aim of this study is to determine the effectiveness of the epidural analgesia (EA) and the transversus abdominis plane block (TAP-block) in laparoscopic obese patients, as well as to evaluate the possibility of using the rectus sheath block (RSB) as a “rescue” anesthetic technique after laparotomy in obese patients. Materials and methods. The data on the 102 obese patients operated on esophageal hiatal diaphramgmatic hernia, colon tumor, postoperative ventral hernia, morbid obesity and choledocholithiasis were analyzed. In laparoscopic surgery 20 patients received EA (EA group), 21 patients – TAP-block (TAP group), 21 patients – opioids and non-steroidal anti-inflammatory drugs (NSAIDs) without any regional anesthesia techniques (group TIVA1). In laparotomic surgery 16 patients received RSB (RSB group) and 24 patients – only opioids and NSAIDs (TIVA2 group). After the surgery the following was estimated: the time of extubation, the total dose of opioids, the level of pain according to the 10-point numeric range score (NRS), the incidence of dyspnea using the monitor Utas 300 (Ukraine), the incidence of postoperative nausea and vomiting (PONV), the time of active patient mobilization, and the level of satisfaction with analgetic regimen. For the RSB group, the complexity of the RSB and the mean time to achieve adequate analgesia (pain intensity ≤3 points per NRS) were determined additionally. The statistical analysis was performed using the Statistica for Windows version 6.0 software. Results. In the EA group, the intraoperative dose of fentanyl was twice lower, and patients were extubated two times faster than in the TAP, TIVA1, RSB, TIVA2 groups (P < 0.05). At the same time, none of the patients in the EA group required the restoration of neuromuscular conduction with neostigmine (P < 0.05). After the surgery, the pain level was 2–3 times higher in the TIVA1, RSB, and TIVA2 groups than in the EA and TAP groups (P < 0.05). “Rescue” analgesia in the RSB group was performed from the first attempt in all the patients in 5–10 minutes and provided an adequate effect in 3 (2–4) min. The complexity level of RSB was defined as “easy” in 12 (75 %) patients, as “average” in 4 (25 %) patients (P < 0.05). The incidence of dyspnea and opioid doses after surgery in the EA, TAP and RSB groups of patients were 2 times lower, and the incidence of PONV was 3 to 4 times lower than in the TIVA1 and TIVA2 patients’ groups (P < 0.05). In the EA and TAP groups, patients became mobile after 8–13 hours after surgery, in the group TIVA1 – after 16–22 hours, in the group RSB – after 18–36 hours, in the group TIVA2 – after 48–96 hours (P < 0.05). 100 % of the respondents from the EA, TAP and RSB groups were satisfied with the analgesic regimen at the “excellent – good” level. In the TIVA1 and TIVA2 groups, 20–25 % of respondents identified analgesic comfort as “good”, 60–65 % of respondents – as “satisfactorily”, about 15 % of respondents – as “unsatisfactorily” (P < 0.05). Conclusions. In laparoscopic surgery the use of EA or TAP-block in obese patients significantly reduces the level of postoperative pain, the need for opioids, the incidence of dyspnea and PONV, which leads to the possibility of patients’ mobilization within 8–13 hours after surgery. After laparotomic surgery in obese patients RSB effectively “rescues” from pain and prevents excessive use of opioids, which reduces the number of adverse reactions and increases satisfaction with the quality of analgesia

Ionic liquids at electrified interfaces

Until recently, “room-temperature” (<100–150 °C) liquid-state electrochemistry was mostly electrochemistry of diluted electrolytes(1)–(4) where dissolved salt ions were surrounded by a considerable amount of solvent molecules. Highly concentrated liquid electrolytes were mostly considered in the narrow (albeit important) niche of high-temperature electrochemistry of molten inorganic salts(5-9) and in the even narrower niche of “first-generation” room temperature ionic liquids, RTILs (such as chloro-aluminates and alkylammonium nitrates).(10-14) The situation has changed dramatically in the 2000s after the discovery of new moisture- and temperature-stable RTILs.(15, 16) These days, the “later generation” RTILs attracted wide attention within the electrochemical community.(17-31) Indeed, RTILs, as a class of compounds, possess a unique combination of properties (high charge density, electrochemical stability, low/negligible volatility, tunable polarity, etc.) that make them very attractive substances from fundamental and application points of view.(32-38) Most importantly, they can mix with each other in “cocktails” of one’s choice to acquire the desired properties (e.g., wider temperature range of the liquid phase(39, 40)) and can serve as almost “universal” solvents.(37, 41, 42) It is worth noting here one of the advantages of RTILs as compared to their high-temperature molten salt (HTMS)(43) “sister-systems”.(44) In RTILs the dissolved molecules are not imbedded in a harsh high temperature environment which could be destructive for many classes of fragile (organic) molecules

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Воздействие высокой концентрации оксида азота на оксигенаторы аппаратов искусственного кровообращения (экспериментальное исследование)

The aim of the study. To study the effect of high nitric oxide concentrations on hollow polypropylene fibers of oxygenators.Materials and methods. The study was conducted in two stages. At the first stage, we evaluated the stability of oxygenator membrane made of hollow polypropylene fibers after six hours of exposure to air-oxygen mixture containing NO at 500 parts per million, or 500 pro pro mille (ppm) concentration, using mass spectrometry and infrared spectroscopy. At the second stage, an experiment with cardiopulmonary bypass (CPB) was conducted on 10 pigs. In the study group (n=5) animals sweep gas was supplied to the oxygenator as an air-oxygen mixture with NO at 100 ppm. In the control group animals (n=5) an air-oxygen mixture was used without NO. The CPB lasted for 4 hours, followed by observation for 12 hours. NO, NO2 (at the inlet and outlet of the oxygenator), and the dynamics of methemoglobin were evaluated. After weaning of animals from CPB, the oxygenators were tested for leakproofness, and scanning electron microscopy (SEM) was performed.Results. The oxygenator made of polypropylene hollow fibers retained its gas transfer parameters after six hours of exposure to air-oxygen mixture containing NO at 500 ppm. Based on IR-Fourier spectroscopy findings, NO did not affect structural integrity of polypropylene membranes. NO added to gas mixture at 100 ppm did not increase NO2 to toxic level of 2 ppm in 91% of control tests during 4 hours CPB in pigs; mean value was 1.58 ± 0.28 ppm. Methemoglobin concentration did not exceed the upper limit of permissible level (3%), and there were no statistically significant differences with the control group. All tested oxygenators have passed the leakproofness test. According to SEM findings, larger amounts of fibrin deposits were found in the control group oxygenators vs study group.Conclusion. There were no negative effects of NO at 500 ppm concentration on the oxygenator membrane made of hollow polypropylene fibers. NO at 100 ppm in a gas-mixture supplied to oxygenators did not lead to an exceedance of safe NO2 and methemoglobin concentrations in an animal model. Reduced fibrin deposits on hollow fibers of polypropylene oxygenator membranes were observed when with NO at a level of 100 ppm was added to a gas mixture.  Цель исследования. Изучить воздействие высоких концентраций оксида азота на полипропиленовые полые волокна оксигенаторов.Материалы и методы. Исследование провели в два этапа. На первом этапе с помощью масс-спектрометрии и инфракрасной спектроскопии выполнили оценку стабильности мембраны оксигенатора из полых волокон полипропилена после шестичасового воздействия воздушно-кислородной смеси, содержащей NO в концентрации 500 пропромилле, или 500 частей на миллион – parts per million (ppm). На втором этапе провели эксперимент на 10 свиньях с подключением аппарата искусственного кровообращения (ИК). Животным основной группы (n=5) в оксигенатор подавали воздушно-кислородную смесь, содержащую NO в концентрации 100 ppm. Животным контрольной группы (n=5) в оксигенатор подавали воздушно-кислородную смесь без NO. Процедура ИК длилась 4 часа, затем следовало наблюдение в течение 12 часов. Оценивали NO, NO2 (на входе и выходе из оксигенатора), динамику метгемоглобина. После отключения от ИК оксигенаторы тестировали на герметичность, а также выполняли сканирующую электронную микроскопию (СЭМ).Результаты. Оксигенатор из полипропиленовых полых волокон сохранял свои газотранспортные характеристики после шестичасового воздействия воздушно-кислородной смеси с добавлением NO в концентрации 500 ppm. По данным ИК-Фурье спектроскопии показали, что NO не влияет на структуру мембран из полипропилена. Добавление NO в дозировке 100 ppm во время 4 часов ИК у свиней не сопровождалось повышением концентрации NO2 до токсичного уровня 2 ppm в 91% измерений: среднее значение составило 1,58 ± 0,28 ppm. Концентрация метгемоглобина не превышала верхнего  предела  допустимых  значений  (3%),  не  обнаружили  каких-либо статистически значимых различий при сравнении с группой контроля. Все исследуемые оксигенаторы выдержали тестирование на герметичность. По результатам СЭМ оксигенаторы группы контроля характеризовались большим количеством отложений фибрина, чем оксигенаторы основной группы.Заключение. Негативного воздействия NO в концентрации 500 ppm на мембраны оксигенаторов из полых волокон полипропилена не обнаружили. Подача в оксигенатор NO в концентрации 100 ppm NO2 не приводила к превышению безопасного содержания NO2 и метгемоглобина в эксперименте на животных. Выявили снижение образования отложений фибрина на полых волокнах мембран оксигенаторов из полипропилена при подаче NO в концентрации 100 ppm