Hyperbaric bupivacaine for spinal anaesthesia in 7-18 yr old children: comparison of bupivacaine 5 mg ml-1 in 0.9% and 8% glucose solutions.
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We have compared two hyperbaric bupivacaine solutions for spinal anaesthesia in 7-18-yr-old school-aged children in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam orally. Half of the patients were sedated with either midazolam or thiopental. After lumbar puncture with a 27-gauge spinal needle, bupivacaine 5 mg ml-1 in either 0.9% or 8% glucose was injected in a dose of 0.3 mg kg-1. Maximum cephalad spread and regression of block were tested by transcutaneous electrical stimulation. Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T4 (10-90th percentiles T1-T7) in the 0.9% glucose group and T4 (T1-T5) in the 8% glucose group. Time to two segment regression of block was 83 (50-143) min in the 0.9% glucose and 85 (53-150) min in the 8% glucose group. The incidence of adverse effects was similar. Six children were given etilefrin to treat hypotension and six atropine for bradycardia. Nausea was associated with a high level of block. Shivering was detected in 16 children. (+info)
Effect of alkalinization of lidocaine on median nerve block.
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Median nerve blocks were performed in 10 volunteers in a randomized, double-blind, crossover study to compare the effects of 1% plain lidocaine with 1% lidocaine in sodium bicarbonate 0.1 mmol litre-1. Sensations of hot, cold, pinprick and light touch, compound motor and sensory nerve action potentials, and skin temperature were assessed at 2-min intervals. pH was 6.4 +/- 0.1 for plain lidocaine and 7.7 +/- 0.2 for alkalinized lidocaine (P < 0.001). Alkalinized lidocaine produced more rapid inhibition of compound motor action potentials than plain lidocaine (median 4 (range 2-6) vs 9 (2-14) min) (P = 0.039). Alkalinized lidocaine also produced more rapid onset of inhibition of compound motor than sensory nerve action potentials (4 (2-6) vs 8 (4-12) min) (P = 0.0039). There was no significant difference in any other sensory modality between alkalinized and plain lidocaine. These data suggest that addition of bicarbonate to lidocaine for median nerve block significantly increased the rate of motor block without changing the onset or extent of sensory block. (+info)
A Drosophila mechanosensory transduction channel.
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Mechanosensory transduction underlies a wide range of senses, including proprioception, touch, balance, and hearing. The pivotal element of these senses is a mechanically gated ion channel that transduces sound, pressure, or movement into changes in excitability of specialized sensory cells. Despite the prevalence of mechanosensory systems, little is known about the molecular nature of the transduction channels. To identify such a channel, we analyzed Drosophila melanogaster mechanoreceptive mutants for defects in mechanosensory physiology. Loss-of-function mutations in the no mechanoreceptor potential C (nompC) gene virtually abolished mechanosensory signaling. nompC encodes a new ion channel that is essential for mechanosensory transduction. As expected for a transduction channel, D. melanogaster NOMPC and a Caenorhabditis elegans homolog were selectively expressed in mechanosensory organs. (+info)
Intention-related activity in the posterior parietal cortex: a review.
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Over the last few years it is becoming increasingly apparent that an important role of the posterior parietal cortex is to process sensory information for the purpose of planning actions. We review studies showing that a large component of neural activity in area LIP is related to planning saccades and activity in a nearby parietal reach region (PRR) to reaches. This intention related activity dominates the delay period in delayed movement tasks, and also comprises a substantial component of the transient response. These findings, along with additional anatomical and physiological evidence, lends support to the idea that different cortical areas within the PPC represent plans for different actions. We also found strong modulation of activity when movement plans were changed without changes in the locus of attention. This result suggests that PPC, which has been postulated to play a role in shifting attention, may also play a role in changing movement intentions. Sensory related activity was also present in these tasks and may be related to the stimulus or to attention. These experiments show that there are intention and sensory related activities in the PPC consistent with its proposed role in sensory-motor transformations. These studies also show that care must be taken to measure intention-related signals and not assume that all task dependent modulation in the PPC reflects attention. (+info)
Warm air sensation for assessment of block after spinal anaesthesia.
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We have evaluated a new method of assessing dermatomal sensory levels after regional anaesthesia based on warm sensation. Sensory levels were assessed in 30 patients after spinal anaesthesia using a respiratory gas humidifier, adapted to deliver a constant flow of warm air at 40 +/- 0.2 degrees C. This was compared with the cold sensation from ethyl chloride spray. The frequency distribution of the dermatomal differences showed 96.6% of the comparisons were between +1 and -1 dermatomes. The median difference in dermatomal levels between the two methods of assessment was 0 (interquartile range 0-1) (P = 0.65). We conclude that the warm air method compares favourably with ethyl chloride spray and both can be used interchangeably. (+info)
Respiratory sensation during chest wall restriction and dead space loading in exercising men.
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We mimicked important mechanical and ventilatory aspects of restrictive lung disorders by employing chest wall strapping (CWS) and dead space loading (DS) in normal subjects to gain mechanistic insights into dyspnea causation and exercise limitation. We hypothesized that thoracic restriction with increased ventilatory stimulation would evoke exertional dyspnea that was similar in nature to that experienced in such disorders. Twelve healthy young men [28 +/- 2 (SE) yr of age] completed pulmonary function tests and maximal cycle exercise tests under four conditions, in randomized order: 1) control, 2) CWS to 60% of vital capacity, 3) added DS of 600 ml, and 4) CWS + DS. Measurements during exercise included cardiorespiratory parameters, esophageal pressure, and Borg scale ratings of dyspnea. Compared with control, CWS significantly reduced the tidal volume response to exercise, increased dyspnea intensity at any given work rate or ventilation, and thus limited exercise performance. DS stimulated ventilation but had minimal effects on dyspnea and exercise performance. Adding DS to CWS further increased dyspnea by 1.7 +/- 0.6 standardized Borg units (P = 0.012) and decreased exercise performance (total work) by 21 +/- 6% (P = 0.003) over CWS alone. Across conditions, increased dyspnea intensity correlated best with decreased resting inspiratory reserve volume (r = -0.63, P < 0.0005). Dyspnea during CWS was described primarily as "inspiratory difficulty" and "unsatisfied inspiration," similar to restrictive disorders. In conclusion, severe dyspnea and exercise intolerance were provoked in healthy normal subjects when tidal volume responses were constrained in the face of increased ventilatory drive during exercise. (+info)
Sensory modalities conveyed in the hindlimb somatic afferent input to nucleus tractus solitarius.
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To determine the somatic sensory modalities conveyed by hindlimb somatic afferent inputs, the discharge of neurons in the nucleus tractus solitarius was recorded in anesthetized rats after electrical stimulation of either the contralateral sciatic nerve or L(6) spinal nerve, which innervates the hindlimb. The discharge of seven of eight cells was increased (P < 0.05) by capsaicin injected into the arterial supply of the hindlimb. Discharge was unaltered in 19 neurons tested for sensitivity to nonnoxious (40 degrees C) and noxious (47 degrees C) heating of the hindlimb skin. In contrast, lightly stroking the skin elicited discharge in 2 of 14 cells, whereas noxious pinching increased activity in 4 other cells. Rhythmic (1- to 3-s) muscle contraction (MC) increased (P < 0.05) discharge in >60% of neurons tested (11 of 18). Static (10- to 30-s) MC significantly (P < 0.05) increased discharge in four cells, two of which were also responsive to rhythmic MC. Rhythmic and sustained muscle stretch increased discharge (P < 0.05) in three of eight neurons tested. These data indicate that nucleus tractus solitarius neurons receive input from low- and high-threshold cutaneous mechanoreceptors, respond to capsaicin delivered into the hindlimb arterial supply, lack thermal sensitivity, and respond to activation of mechanosensitive as well as metabosensitive endings in skeletal muscle. (+info)
Onset of cross-modal synthesis in the neonatal superior colliculus is gated by the development of cortical influences.
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Many neurons in the superior colliculus (SC) are able to integrate combinations of visual, auditory, and somatosensory stimuli, thereby markedly affecting the vigor of their responses to external stimuli. However, this capacity for multisensory integration is not inborn. Rather, it appears comparatively late in postnatal development and is not expressed until the SC passes through several distinct developmental stages. As shown here, the final stage in this sequence is one in which a region of association cortex establishes functional control over the SC, thus enabling the multisensory integrative capabilities of its target SC neurons. The first example of this corticotectal input was seen at postnatal day 28. For any individual SC neuron, the onset of corticotectal influences appeared to be abrupt. Because this event occurred at very different times for different SC neurons, a period of 3-4 postnatal months was required before the adult-like condition was achieved. The protracted postnatal period required for the maturation of these corticotectal influences corresponded closely with estimates of the peak period of cortical plasticity, raising the possibility that the genesis of these corticotectal influences, and hence the onset of SC multisensory integration, occurs only after the cortex is capable of exerting experience-dependent control over SC neurons. (+info)