Effect of detraining on bone and muscle tissue in subjects with chronic spinal cord injury after a period of electrically-stimulated cycling: a small cohort study

Objective: To investigate adaptive changes in bone and muscle parameters in the paralysed limbs after de-training or reduced functional electrical stimulation (FES) induced cycling following high-volume FES-cycling in chronic spinal cord injury (SCI). Subjects: Five subjects with motor-sensory complete SCI (age 38.6 years, lesion duration 11.4 years) were included. Four subjects stopped FES-cycling completely after the training phase whereas one continued reduced FES-cycling (2-3 times/week, for 30min). Methods: Bone and muscle parameters were assessed in the legs using peripheral quantitative computed tomography at six and twelve months after cessation of high-volume FES-cycling. Results: Gains achieved in the distal femur by high-volume FES-cycling were partly maintained at one year of detraining: 73.0% in trabecular bone mineral density (BMD), 63.8% in total BMD, 59.4% in bone mineral content and 22.1% in muscle cross-sectional area (CSAmuscle) in the thigh. The subject who continued reduced FES-cycling maintained 96.2% and 95.0% of the previous gain in total and trabecu-lar BMD, and 98.5% in CSAmuscle. Conclusion: Bone and muscle benefits achieved by one year of high-volume FES-cycling are partly preserved after 12 months of detraining whereas reduced cycling maintains bone and muscle mass gained. This suggests that high-volume FES-cycling has clinical relevance for at least 1y after detraining

Vergleich von Antibeschlagmethoden in der Endoskopie: Was wirklich hilft

Zusammenfassung: Hintergrund und Fragestellung: Endoskopische Verfahren, wie die fiberoptische Intubation, haben sich als Standard in der Anästhesie etabliert. Obwohl allgemein bekannt ist, dass zur sicheren Anwendung von Endoskopen eine Antibeschlagmethode unerlässlich ist, fehlen Studien zum Vergleich der Wirksamkeit verschiedener Antibeschlagmethoden. Ziel dieser Studie war es, die Wirksamkeit von 7Antibeschlagmethoden im Einsatz mit einem flexiblen und einem starren Endoskop zu untersuchen. Material und Methoden: Die Wirksamkeit von je 2Antibeschlaglösungen und -tüchern, einem induktiven Endoskopvorwärmer, sowie kontinuierlichem Sauerstofffluss über den Arbeitskanal der Optik wurde in einem Atemwegsmodell mithilfe eines flexiblen und eines starren Endoskops getestet sowie verblindet beurteilt. Ergebnisse: Insgesamt wurden 300Testbilder aufgezeichnet und analysiert. Sowohl in der Gruppe mit dem flexiblen als auch in der Gruppe mit dem starren Endoskop erzielten je eine Antibeschlaglösung und ein -tuch die besten Ergebnisse. Flexible Endoskopie: Anti-Fog (Versagerquote: 3%), Lina Clear (4%). Starre Endoskopie: Ultrastop (5%), Lina Clear (3,5%). Der Endoskopvorwärmer mit 2-maliger Anwendung zeigte in beiden Gruppen sehr gute Ergebnisse (6% und 10%). Keinen positiven Effekt gegen das Beschlagen eines Endoskops ergab die Verwendung des Sauerstoffflusses (93,5%). Schlussfolgerungen: Die Studie konnte aufzeigen, dass es Unterschiede in der Effektivität von Antibeschlagtüchern und -lösungen gibt. Der klinische Einsatz ist aber auch von weiteren Faktoren wie Endoskoptyp und Häufigkeit der Verwendung, Kosten- und Hygieneaspekten abhängig. Der induktive Endoskopvorwärmer kann trotz hoher Anschaffungskosten eine Alternative darstellen. Jedoch fehlen bislang klare Sicherheitshinweise zur mehrfachen Anwendung durch den Hersteller. Der kontinuierliche Sauerstofffluss über den Arbeitskanal einer flexiblen Optik kann nicht als Antibeschlagmethode empfohlen werde

Intrathekale Opioidmedikation zur perioperativen Analgesie bei schwer behinderten Kindern mit Wirbelsäulenoperationen

Zusammenfassung: Hintergrund: An gesunden Kindern konnte gezeigt werden, dass intrathekal verabreichte Opioide eine sichere und effektive perioperative Analgesie bei wirbelsäulenchirurgischen Eingriffen ermöglichen. Das Ziel der vorliegenden Untersuchung ist es, ihre Anwendbarkeit bei schwer- und schwerstbehinderten Kindern für wirbelsäulenchirurgische Eingriffe zu überprüfen. Methode: Mit Zustimmung der lokalen Ethikkommission wurden Patienten vom Status3 und 4 der Klassifikation der American Society of Anesthesiologists (ASA), die sich einem wirbelsäulenchirurgischen Eingriff unterziehen mussten, retrospektiv untersucht. Zusätzlich zur Allgemeinanästhesie mit Sevofluran oder i.v.-verabreichtem Propofol erhielten die Patienten vor der Operation 20µg/kgKG Morphin und 1,5µg/kgKG Sufentanil intrathekal. Nach Beendigung des Eingriffs wurde eine Nalbuphindauerinfusion gestartet. Der Bedarf an zusätzlichen intra- und postoperativen Analgetika, der Zeitpunkt der Extubation, die postoperativen Schmerz-Scores und die arteriellen Kohlendioxidpartialdruck- (paCO2)-Werte sowie das Auftreten unerwünschter Nebenwirkungen wurden untersucht. Ergebnisse: Es wurden 28Patienten im Alter von 2,8 bis 18,5Jahren (Median 11,6Jahre) untersucht. Unmittelbar im OP konnten 17Patienten extubiert werden; bei 11Patienten entschied man sich zu einer verzögerten Extubation. Bis auf einen Patienten mit postoperativer Massivtransfusion konnten alle innerhalb von 24h extubiert werden. Eine adäquate postoperative Analgesie mit Schmerz-Scores ≤3 wurde mithilfe der Kombination von intrathekal verabreichten Opioiden mit Nalbuphin postoperativ bei 26 von 28Patienten (93%) erreicht. Bei 2Patienten war der Wechsel auf eine i.v.-Morphin-Gabe erforderlich. Postoperative Übelkeit und Erbrechen ("postoperative nausea and vomiting", PONV), Pruritus und leichte Hypoventilation mit paCO2-Werten zwischen 5,2 bis 9,7kPa (Median 6,3kPa) waren die beobachteten Nebenwirkungen. Schlussfolgerung: Der Einsatz intrathekal verabreichter Opioide, ergänzt durch eine postoperative Nalbuphininfusion, erlaubt in den allermeisten Fällen eine frühzeitige Extubation ohne persistierende Atemdepression und ist eine praktikable sowie effektive Methode zur postoperativen Analgesie bei schwer behinderten Kindern nach wirbelsäulenchirurgischen Eingriffe

Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study

Background This study compared the fluid leakage in the new ‘tapered' shaped against the classic ‘cylindrical' shaped tracheal tube cuffs when placed in different sized tracheas. Methods The 7.5 mm internal diameter (ID) tracheal tube cuffs—Tapered Seal Guard (TSG), Standard Seal Guard (SSG), Hi-Lo, Microcuff, Ruesch, and Portex Profile—were compared in an in vitro apparatus. Vertical artificial tracheas with 16, 20, and 22 mm ID were intubated, 5 ml clear water was applied above the unlubricated tube cuffs, and fluid leakage was measured up to 60 min. Data of tapered vs non-tapered tube cuffs (16 observations) were compared for each tracheal diameter using the Mann-Whitney test. Results Median (range) fluid leakage (ml) at 60 min was 2.14 (0.05-4.88), 1.14 (0.00-4.84), and 0.13 (0.00-1.32), respectively, for 16, 20, and 22 mm tracheas in the TSG tube studies when compared with 4.58 (0.44-4.88), 2.21 (0.00-4.81), and 0.00 (0.00-4.81) in the SSG tube and 4.54 (1.54-4.82), 0.90 (0.00-4.49), and 4.85 (4.40-4.99) in the Microcuff tube studies. Leakage in all polyvinylchloride (PVC) tube cuffs was almost complete (5 ml) within 5 min (P<0.001). Conclusions The tapered PU tube cuff was as effective as the cylindrical PU cuffs in smaller tracheal diameters and was more efficient than the cylindrical Microcuff PU tube cuff in larger tracheal diameter in preventing subglottic fluid leakage across the tube cuff tested in this in vitro study. PVC tube cuffs leaked much more and faster than PU cuff

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia

Objective: Disuse osteoporosis is a major long-term health consequence of spinal cord injury (SCI) that still needs to be addressed. Its management in SCI should begin with accurate diagnosis, followed by targeted treatments in the most vulnerable subgroups. We present data quantifying disuse osteoporosis in a cross-section of the Scottish paraplegic population to identify subgroups with lowest bone mineral density (BMD). Materials and Methods: Forty-seven people with chronic SCI at levels T2-L2 were scanned using peripheral Quantitative Computed Tomography (pQCT) at four tibial sites and two femoral sites, at the Queen Elizabeth National Spinal Injuries Unit, Glasgow (U.K.). At the distal epiphyses, trabecular BMD (BMDtrab), total BMD, total bone cross-sectional area (CSA), and bone mineral content (BMC) were determined. In the diaphyses, cortical BMD, total bone CSA, cortical CSA, and BMC were calculated. Bone, muscle and fat CSAs were estimated in the lower leg and thigh. Results: BMDtrab decreased exponentially with time since injury, at different rates in the tibia and femur. At most sites, female paraplegics had significantly lower BMC, total bone CSA and muscle CSA than male paraplegics. Subjects with lumbar SCI tended to have lower bone values and smaller muscle CSAs than in thoracic SCI. Conclusion: At the distal epiphyses of the tibia and femur, there is generally a rapid and extensive reduction in BMDtrab after SCI. Female subjects, and those with lumbar SCI, tend to have lower bone values than males or those with thoracic SCI, respectively. Keywords: Bone loss, osteoporosis, paraplegia, peripheral Quantitative Computed Tomography, spinal cord injur

Electrocardiographic alterations during intravascular application of three different test doses of bupivacaine and epinephrine: experimental study in neonatal pigs

Background Origin of electrocardiographic (ECG) alterations during intravascular injection of local anaesthetic solutions is controversial. The aim of this study was to elucidate whether epinephrine, bupivacaine or their combination is responsible for ECG alteration. Methods Forty-five piglets were randomized into three groups. After induction of general anaesthesia using sevoflurane and peripheral venous cannulation, the trachea was intubated, the lungs were artificially ventilated, and anaesthesia was maintained by sevoflurane. Under steady state 0.2 ml kg−1 and after 10 min 0.4 ml kg−1 of one of the following three test solutions was administered i.v.: bupivacaine 0.125% (Group 1), bupivacaine 0.125%+epinephrine 1:200 000 (Group 2), and plain epinephrine 1:200 000 (Group 3). The ECG was analysed for alterations in heart rate and T-elevation. Results After injection of 0.2 or 0.4 ml kg−1 test solution, an increase in heart rate of at least 10% was found in none of Group 1 and in all of Groups 2 and 3. After application of 0.2 ml kg−1 test solution, T-elevation was found in 7% of Group 1 and in 93% of Groups 2 and 3. The injection of 0.4 ml kg−1 revealed a T-elevation in 27%, 100%, and 100%, respectively, in Groups 1, 2, and 3. Conclusions This animal model demonstrated that increases in heart rate and T-elevation in the ECG during i.v. application of a common test dose (0.2 ml kg−1) of bupivacaine are caused by epinephrine addition. Whether higher doses of bupivacaine alone can cause similar ECG changes or not requires further studie

Electrocardiographic changes during continuous intravenous application of bupivacaine in neonatal pigs

Background It is controversial as to whether T-wave elevation is caused by local anaesthetics, epinephrine, or their combination. It has been shown that T-elevation after intravascular injection of a small bupivacaine test dose is caused by epinephrine and not by bupivacaine. The aim of this study was to investigate ECG changes with higher doses of i.v. bupivacaine. Methods Thirty neonatal pigs were anaesthetized with sevoflurane and their tracheas intubated and artificially ventilated. Under steady-state conditions, bupivacaine was continuously infused (flow rate 3.2 ml kg−1 min−1) by a syringe infusion pump through a central venous catheter. Group 1 received bupivacaine 0.125%, Group 2 bupivacaine 0.5%. The ECG was continuously printed and subsequently analysed for alterations in heart rate, ventricular de- and repolarization, and arrhythmias at 1.25, 2.5, and 5 mg kg−1 bupivacaine infused. Results Sinus rhythm persisted in all pigs. Heart rate decreased progressively in both groups, but this was significantly more pronounced in Group 1. T-wave elevation occurred in 40% and 0% (Groups 1 and 2) at 1.25 mg kg−1, in 80% and 0% at 2.5 mg kg−1, and in 93% and 80% at 5 mg kg−1 bupivacaine infused. There were significant differences between the two groups at 1.25 and 2.5 mg kg−1 infused. Conclusions Higher doses of i.v. infused bupivacaine can cause T-elevation. With slower injection technique, T-elevation can already be detected at lower bupivacaine doses administere

The effect of arm position and bed adjustment on comfort and pressure under the shoulders in people with tetraplegia: a randomized cross-over study

Study design: Randomized, within-in participant cross-over study. Objective: The purpose of this study was to determine the effect on comfort and pressure of lying with the shoulders and bed in different positions for people with tetraplegia. Setting: Rehabilitation hospital. Methods: Twenty people with tetraplegia were tested lying supine with the shoulders and bed in seven different positions. The positions used a combination of three arm and two bed positions. Six of the positions reflected what is commonly recommended in acute spinal cord injury units including a crucifix-type position. The seventh position was selected by participants and reflected their preferred sleeping position. There were five outcomes: general comfort, shoulder comfort, participant choice of preferred position, peak pressure under the shoulders and areal pressure under the shoulders. Pressure was measured using a pressure mapping system and comfort using a visual analogue scale (VAS). Results: The participants reported significantly higher (Po0.01) general comfort and shoulder comfort in their self-selected position compared with all other positions. There was no statistical difference in peak pressure (P ¼ 0.15) or areal pressure (P ¼ 0.08) under the shoulders between the seven positions. Most participants indicated that they preferred to lie with their shoulders adducted and internally rotated and the hands either by their sides or on their stomachs. Conclusion: The position of the shoulders has little effect on pressure but a notable effect on comfort. Participants preferred to sleep with their arms beside their bodies, not with their arms in a crucifix position as commonly advocated