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Biomedical subjects

C E Smith

Publications and source records attributed to C E Smith.

At least 73 records · Page 4Linked to original sources
PubMed1997

Cycle-time and residence-time density approximations in a stochastic model for circulatory transport.

The concentration of a drug in the circulatory system is studied under two different elimination strategies. The first strategy--geometric elimination--is the classical one which assumes a constant elimination rate per cycle. The second strategy--Poisson elimination--assumes that the elimination rate changes during the process of elimination. The problem studied here is to find a relationship between the residence-time distribution and the cycle-time distribution for a given rule of elimination. While the presented model gives this relationship in terms of Laplace-Stieltjes transform., the aim here is to determine the shapes of the corresponding probability density functions. From experimental data, we expect positively skewed, gamma-like distributions for the residence time of the drug in the body. Also, as some elimination parameter in the model approaches a limit, the exponential distribution often arises. Therefore, we use Laguerre series expansions, which yield a parsimonious approximation of positively skewed probability densities that are close to a gamma distribution. The coefficients in the expansion are determined by the central moments, which can be obtained from experimental data or as a consequence of theoretical assumptions. The examples presented show that gamma-like densities arise for a diverse set of cycle-time distribution and under both elimination rules.

Humans↗
PubMed1997

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium.

PURPOSE: To evaluate the tracheal intubating conditions and neuromuscular blocking characteristics of divided dose mivacurium or single dose rocuronium. METHODS: Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg.kg-1, followed by an infusion of 150 micrograms.kg-1.min.1. Patients were randomized to receive either mivacurium-0.15 mg.kg-1 followed 30 sec later by 0.1 mg.kg-1, or rocuronium- 0.9 mg.kg-1, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetists who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured. RESULTS: Successful tracheal intubation was performed in all patients after both mivacurium and rocuronium. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacurium were more likely to experience coughing and bucking after tracheal tube insertion (10/16 patients) than those receiving rocuronium (3/16 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to 10 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacurium (20 +/- 1 and 23 +/- 1 min, respectively) than after rocuronium (45 +/- 5 and 57 +/- 8 min, respectively). CONCLUSION: The results suggest that, during conditions of the study, divided dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable.

Adult↗
PubMed1997

Taping methods and tape types for securing oral endotracheal tubes.

PURPOSE: To evaluate tapes and taping methods with respect to the minimum force required to dislodge endotracheal tubes (ETTs). METHODS: A simulated face model consisting of a section of PVC pipe was used. The ETT was attached to a piezo-electric force transducer and pullout force was manually applied in a vertical, right or left direction. Five tape types were tested: Curity, Leukosilk, Hy.tape, Leukopore, and Transpore, Seven taping methods were used to secure the ETT. The methods differed with respect to tape width and whether the tape was split along its longitudinal axis. Each taping condition was replicated 20 times (7 methods x 5 tapes x 3 directions) for a total of 2100 pullout tests. RESULTS: Minimum forces to dislodge ETTs were higher (P < 0.05) with Curity tape (mean +/- SD; 135 +/- 75 N) than with the other tapes (Leukosilk: 93 +/- 51 N, Hy.tape: 78 +/- 34 N, Leukopore: 47 +/- 32, and Transpore: 37 +/- 23 N). The most secure taping method was achieved by taping the ETT, using 2.5 cm wide Curity tape, in a circumferential fashion to both the upper and lower borders of the simulated mouth opening, and reinforcing these tapes with two strips applied longitudinally across the borders of the mouth opening (method 7). Taping methods which involved splitting the tape along its longitudinal axis resulted in lower minimal pullout forces whenever the pullout force was directed towards the side of attachment (P < 0.05 vs right and vertical direction). CONCLUSION: There are differences in ETT pullout forces and mechanisms of dislodgement depending on taping method and tape type.

Humans↗
PubMed1997

Heat conservation vs convective warming in adults undergoing elective surgery.

PURPOSE: To determine the relative efficacy of heat conservation and convective warming in maintaining perioperative normothermia, (central temperature > or = 36 degrees C). METHODS: Thirty-seven patients undergoing elective gynaecological, orthopaedic, or general surgery scheduled to last two hours were prospectively studied. Patients were randomized to one of two groups. Group 1 patients received heat conservation with reflective blankets (Thermadrape, Vital Signs, Inc., Totowa, NJ) applied preoperatively and warmed i.v. fluids (Hotline SIMS Level I Technologies, Inc, Rockland, MA), Group 2 patients received convective warming (BairHugger, Augustine Medical Inc., Eden Prairie, MN) after induction of anaesthesia and i.v. fluids at room temperature. All patients received general anaesthesia with isoflurane. Tympanic membrane and forearm-fingertip skin temperature gradients were measured perioperatively at 15 min intervals. RESULTS: Central temperature decreased after induction to a minimum level of 35.9 +/- 0.1 degrees C in group 1 and 36.0 +/- 0.1 degrees C in group 2 and then increased towards pre-induction values in group 2, and were higher (P < 0.05) than in group 1: 95% group 2 patients had central temperature > or = 36.0 degrees C at the end of surgery (vs 69% of group 1, P < 0.05). During the first 30 min in PACU, central temperatures were higher in group 1 than in group 2 (36.8 +/- 0.1 degrees C vs 36.2 +/- 0.2 degrees C, P < 0.05). After 60 min, central temperatures were similar (36.8 degrees C). The incidence of shivering and degree of peripheral cutaneous vasoconstriction were also similar. CONCLUSION: Patients receiving convective warming were more likely to leave the operating room normothermic, and had higher central temperatures during the first 30 min in the recovery room. The intergroup temperature differences were small, and by 60 min, had disappeared.

Adult↗
PubMed1997

Assessment of the synergistic interactions of levofloxacin and ampicillin against Enterococcus faecium by the checkerboard agar dilution and time-kill methods.

Multidrug-resistant enterococci have become increasingly difficult to eradicate in a growing number of nosocomial infections. With the emergence of vancomycin-resistant enterococci, the use of synergistic antibiotic combinations has become one of the only remaining therapeutic options. Levofloxacin, the active l-isomer of ofloxacin, is a new oral and intravenous fluoroquinolone with a broad spectrum of activity against numerous Gram-positive, Gram-negative, and atypical organisms. The in vitro activity of levofloxacin, alone and in combination with ampicillin, against recent clinical isolates of Enterococcus faecium was assessed for synergistic interactions using the checkerboard agar dilution technique and time-kill methodology. Against all strains, the static technique of checkerboard agar dilution demonstrated indifferent or additive effects for the ampicillin + levofloxacin combination. With the dynamic time-kill technique, synergy was demonstrated for ampicillin (16 micrograms/ml) + levofloxacin (2 micrograms/ml) combination against three levofloxacin-sensitive, ampicillin-resistant isolates. At 24 h, the combination yielded a > or = 2-log10 decrease in CFU/ml compared to levofloxacin alone, while ampicillin had negligible effects. Against both a levofloxacin-intermediate, ampicillin-resistant isolate, and a highly levofloxacin-resistant, ampicillin-resistant isolate, none of the ampicillin+levofloxacin combinations tested demonstrated a synergistic interaction. The time-kill method suggested synergy for the ampicillin+levofloxacin combination against some strains of E. faecium.

Ampicillin↗
PubMed1997

Primary branchial cleft carcinoma--a case report.

Primary branchial cleft carcinoma is a diagnostic challenge. The majority of cases have been shown, following the application of rigid criteria, to have developed from an occult metastasis elsewhere. We describe what we believe to be only the second reported case in a patient who fulfils all of the established criteria.

Branchioma↗
PubMed1997

Sulfation and sialylation requirements for a glycoform of CD34, a major endothelial ligand for L-selectin in porcine peripheral lymph nodes.

Leukocyte recruitment from blood into peripheral lymph nodes is controlled in part by a specific interaction of lymphocyte-associated L-selectin with endothelial cell receptors known as peripheral addressins. In murine lymph nodes, two peripheral addressins have been identified, Gly-CAM-1, a 50 kDa molecule that also appears as a secreted form in plasma, and CD34, a 90 kDa membrane-associated sialomucin. A predominant 105 kDa CD34 mucin-like protein has also been identified in human tonsil as peripheral addressin. We have identified a 120 kDa sialomucin as the predominant peripheral addressin in porcine lymph nodes. Validation of the 120 kDa porcine molecule as a peripheral addressins was based on its ability to bind MECA-79, a monoclonal antibody previously used to isolate peripheral addressins from mouse and human tissues, and to bind an L-selectin-Fc chimera (LS-Fc). The binding with LS-Fc was abolished in the presence of fucoidin, a sulfated polysaccharide known to inhibit L-selectin-receptor interactions. To address the possibility that the 120 kDa ligand may contain common recognition determinants for MECA-79 and L-selectin, the requirements for sialylation and sulfation were compared. Whereas desialylation of 120 kDa ligand drastically reduced its binding to LS-Fc, this treatment appeared to enhance the binding of 120 kDa ligand to MECA-79. In contrast, the binding of both MECA-79 and LS-Fc to 120 kDa ligand was drastically reduced when de novo sulfation of this ligand was reduced by including chlorate, a metabolic inhibitor of sulfation, in the culture media. N-Terminal amino acid sequences of the porcine 120 kDa protein revealed homology with human CD34. Taken together, these findings suggest that the porcine 120 kDa peripheral addressin is an L-selectin-binding glycoform of CD34.

Amino Acid Sequence↗
PubMed1997

A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1'R-cis isomer of atracurium, with atracurium besylate in healthy patients.

We have compared the pharmacokinetics of cisatracurium with atracurium when given by bolus dose followed by continuous infusion. Twenty healthy patients were anaesthetised with thiopentone, midazolam, fentanyl and 70% nitrous oxide in oxygen. Ten patients (Group C) were randomly allocated to receive cisatracurium 0.1 mg.kg-1 and 10 patients (Group A) were given atracurium 0.5 mg.kg-1. Neuromuscular block was monitored using a mechanomyograph. When the first twitch of the train-of-four had recovered to 5% of control, an infusion of cisatracurium 3 micrograms.kg-1.min-1 was started in Group C and an infusion of atracurium 10 micrograms.kg-1.min-1 was started in Group A. The infusion rates were adjusted to maintain the first twitch of the train-of-four at 5% of control. The times to 90% and maximum depression of the first twitch of the train-of-four were significantly longer after cisatracurium than atracurium (2.2 and 3.4 min compared with 1.3 and 1.8 min, respectively; p < 0.01 in each instance). No significant differences were found in recovery parameters between the two groups. Blood samples were taken at regular intervals following the bolus, during the infusion and for 8 h thereafter. The plasma samples were analysed using high-performance liquid chromatography for cisatracurium and atracurium (using a method which distinguishes between the three geometric isomer groups), laudanosine and monoquaternary alcohol. The results were analysed using the Non-linear Mixed Effects Model program. A two-compartment model was fitted to the data. The different isomer groups of atracurium have different pharmacokinetics, the trans-trans group having the highest clearance (1440 ml.min-1) and the cis-cis group the lowest (499 ml.min-1). The clearance of cisatracurium (425 ml.min-1) is less than that of cis-cis atracurium and its elimination half-life is longer (34.9 min and 21.9 min, respectively). The plasma concentration of laudanosine after cisatracurium was one-fifth of that after atracurium.

Adult↗
PubMed1997

Comparison of the postantibiotic and postantibiotic sub-MIC effects of levofloxacin and ciprofloxacin on Staphylococcus aureus and Streptococcus pneumoniae.

The postantibiotic subminimum inhibitory concentration effect (PA SME) may simulate in vivo drug exposure more accurately than the postantibiotic effect (PAE) since subinhibitory concentrations of drug persist between antibiotic dosings. In this study, we compared the PAEs and PA SMEs of levofloxacin and ciprofloxacin for clinical isolates of fluoroquinolone-susceptible Staphylococcus aureus and Streptococcus pneumoniae. At two times the MIC, PAEs of levofloxacin were an average of 0.6 h longer than the PAEs obtained for ciprofloxacin for methicillin-susceptible and methicillin-resistant S. aureus strains. The PAEs of levofloxacin and ciprofloxacin ranged from 1.8 to 3.1 and 1.1 to 2.4 h, respectively. Continued exposure of the methicillin-resistant strain to 1/16, 1/8, and 1/4 the MIC resulted in PA SMEs of 6.5, 15.3, and >22.3 h, respectively, for levofloxacin and 3.8, 8.0, and 12.3 h, respectively, for ciprofloxacin. For isolates of S. pneumoniae, at two times the MIC of both fluoroquinolones, the average PAEs of levofloxacin and ciprofloxacin were equivalent: 1.3 h for the penicillin-susceptible isolate and 0.6 h for the penicillin-resistant isolate. Continued exposure of the penicillin-susceptible S. pneumoniae strain to 1/16, 1/8, and 1/4 the MIC resulted in average PA SMEs of 1.0, 1.4, and 2.8 h, respectively, for levofloxacin and 1.8, 2.0, and 2.5 h, respectively, for ciprofloxacin. Continued exposure of penicillin-resistant S. pneumoniae to 1/16, 1/8, and 1/4 the MIC of the same fluoroquinolones resulted in average PA SMEs of 0.6, 1.1, and 2.9 h, respectively, for levofloxacin and 0.6, 1.1, and 1.5 h, respectively, for ciprofloxacin. The PA SMEs observed demonstrate the superior activity of levofloxacin against methicillin-susceptible or methicillin-resistant S. aureus. Although PAEs were similar for the penicillin-susceptible and penicillin-resistant S. pneumoniae strains, the PA SME of levofloxacin at one-fourth the MIC was longer for penicillin-resistant S. pneumoniae.

Anti-Infective Agents↗
PubMed1997

Structure and activity of uroguanylin and guanylin from the intestine and urine of rats.

Uroguanylin and guanylin are related peptides that activate common guanylate cyclase signaling molecules in the intestine and kidney. Uroguanylin was isolated from urine and duodenum but was not detected in extracts from the colon of rats. Guanylin was identified in extracts from small and large intestine but was not detected in urine. Uroguanylin and guanylin have distinct biochemical and chromatographic properties that facilitated the separation, purification, and identification of these peptides. Northern assays revealed that mRNA transcripts for uroguanylin were more abundant in small intestine compared with large intestine, whereas guanylin mRNA levels were greater in large intestine relative to small intestine. Synthetic rat uroguanylin and guanylin had similar potencies in the activation of receptors in T84 intestinal cells. Production of uroguanylin and guanylin in the mucosa of duodenum is consistent with the postulate that both peptides influence the activity of an intracellular guanosine 3',5'-cyclic monophosphate signaling pathway that regulates the transepithelial secretion of chloride and bicarbonate in the intestinal epithelium.

Amino Acid Sequence↗
PubMed1997

Unlicensed assistive personnel in the perioperative setting.

The present climate in health care, including a tendency toward more managed care and capitation systems, has caused hospital administrators and perioperative managers to reexamine traditional work systems and their associated costs. Some decisions around work redesign may be financially driven or based on the decreased availability of qualified professionals in the job market. The use of an increased number of unlicensed assistive personnel (UAP) in hospital settings has become a common redesign strategy to address both issues. In the perioperative setting, some traditional roles are well established for UAP. Today, changes associated with downsizing, cost containment, and increasing technology have opened up new opportunities to explore ways to integrate UAP roles into the perioperative setting.

Clinical Competence↗
PubMed1996

Identification, characterization, and cloning of a phosphonate monoester hydrolase from Burkholderia caryophilli PG2982.

The glyphosate-degrading bacterium, Burkholderia caryophilli PG2982, was observed to utilize glyceryl glyphosate as a sole phosphorus source. The hydrolysis of glyceryl glyphosate to glyphosate by a phosphonate ester hydrolase (PEH) was identified as the first metabolic step in the mineralization pathway. This observation provides the first biological role for a phosphonate ester hydrolase activity. Purified PEH enzyme hydrolyzed several phosphonate esters including p-nitrophenyl phenylphosphonate, beta-naphthyl phenylphosphonate, and 5-bromo-4-chloro-3-indolyl phenylphosphonate. The purified PEH also hydrolyzed some phosphodiesters including p-nitrophenyl 5'-thymidine monophosphate and p-nitrophenyl phosphorylcholine. The most catalytically efficient substrate identified was bis-(p-nitrophenyl) phosphate with a Km of 0.9 mM and a kcat of 6.2 x 10(2) min-1, suggesting that the enzyme may also function in vivo as a phosphodiesterase. The native enzyme was a homotetramer of 58-kDa subunits and exhibited a pI of 4.2. The enzyme activity had a pH activity optimum of 9.0 and was stimulated 14-fold by Mn2+ ions, but a metal cofactor was not essential for activity. N-terminal and tryptic fragment amino acid sequences were obtained from the purified PEH protein and used to clone the B. caryophilli PG2982 gene, designated pehA. The unique substrate specificity of the enzyme and potential use as a novel conditional lethal gene in plants are discussed.

Amino Acid Sequence↗
PubMed1996

A mechanism for inducing plant development: the genesis of a specific inhibitor.

Parasitic strategies are widely distributed in the plant kingdom and frequently involve coupling parasite organogenesis with cues from the host. In Striga asiatica, for example, the cues that initiate the development of the host attachment organ, the haustorium, originate in the host and trigger the transition from vegetative to parasitic mode in the root meristem. This system therefore offers a unique opportunity to study the signals and mechanisms that control plant cell morphogenesis. Here we establish that the biological activity of structural analogs of the natural inducer displays a marked dependence on redox potential and suggest the existence of a semiquinone intermediate. Building on chemistry that exploits the energetics of such an intermediate, cyclopropyl-p-benzoquinone (CPBQ) is shown to be a specific inhibitor of haustorial development. These data are consistent with a model where haustorial development is initiated by the completion of a redox circuit.

Journal Article↗
PubMed1996

Isolation and characterization of a 30 kDa protein with antifungal activity from leaves of Engelmannia pinnatifida.

During the course of screening plants for novel antifungal activity, we found that a high-molecular-mass fraction of an extract from leaves of Engelmannia pinnatifida exhibited potent and broad-spectrum antifungal activity. In this study a 30 kDa protein from E. pinnatifida leaves was purified to homogeneity by ammonium sulphate precipitation, gel filtration, Mono-Q and C18 reverse-phase column chromatographies. The purified protein showed potent antifungal activity against various plant pathogens with as little as 50 ng. The N-terminal amino acid sequence of the purified protein was determined as XXTKFDFFTLALQXPAXF, where X indicates an unidentified residue. This sequence showed 35-50% sequence identity with purified style glycoproteins associated with self-incompatibility from wild tomato, tobacco and petunia, a phosphate-starvation-induced ribonuclease from cultured tomato cells and the SIR 63.4 kDa protein from yeast.

Amino Acid Sequence↗
PubMed1996

Protein dynamics of amelogenesis.

BACKGROUND: The synthesis, secretion, and fate of matrix proteins released by ameloblasts during enamel formation was studied in continuously erupting rat incisors. METHODS: Computerized image processing was used to quantify silver grain distribution in radioautographs of sections prepared from rats injected with 3H-methionine, and this was correlated with fluorographs defining radiolabeling patterns of proteins in enamel organ cell and enamel homogenates prepared from freeze-dried teeth of rats injected with 35S-methionine and other radioactive amino acids and precursors such as sugar, sulfate, and phosphate. Some rats were also treated with brefeldin A to characterize newly formed proteins blocked from being secreted from ameloblasts. RESULTS: The results indicate that ameloblasts rapidly synthesize and secrete (minutes) at least five primary enamel matrix proteins, including a 65 kDa sugar-containing sulfated enamel protein and four nonsulfated proteins with molecular weights near 31, 29, 27, and 23 kDa as estimated by SDS-PAGE. The 27 kDa protein appears to correspond to the primary amelogenin described in many species. The cells also appear to release at least one phosphoprotein with molecular weight near 27 kDa, which may be an amelogenin, and up to five cysteine-containing proteins with molecular weights near 94, 90, 72, 55, and 27 kDa. The proteins collectively are released at interrod and rod growth sites where they appear to remain close to their point of release from ameloblasts. The 65 kDa sulfated protein and 31 kDa nonsulfated protein are rapidly converted into lower molecular weight forms (hours), whereas nonsulfated proteins near 29, 27, and 23 kDa are more slowly transformed into fragments near 20, 18, and 10 kDa in molecular weight (days). These fragments do not accumulate but appear to be removed from the enamel layer as they are created. CONCLUSIONS: Enamel proteins seen by Coomassie blue (or silver) staining of one-dimensional polyacrylamide gels, therefore, represent a composite image of newly secreted and derived forms of sulfated and nonsulfated proteins that sometimes have similar molecular weights.

Aging↗
PubMed1996

Desflurane is not associated with faster operating room exit times in outpatients.

STUDY OBJECTIVE: To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary. DESIGN: Prospective study. SETTING: Ambulatory surgery unit of a university hospital. PATIENTS: 1,568 outpatients requiring anesthesia. INTERVENTIONS: Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit. MEASUREMENTS AND MAIN RESULTS: The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times. CONCLUSION: Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.

Adolescent↗
PubMed1996

Prospective, randomized comparison of the Flotem Iie and Hotline fluid warmers in anesthetized adults.

STUDY OBJECTIVE: To compare the fluid warming capabilities of the Hotline and Flotem IIe devices in surgical patients, and whether warming intravenous (i.v.) fluids with the Hotline device resulted in less hypothermia and less need for other warming methods compared with the Flotem IIe device. STUDY DESIGN: Part 1. Prospective, nonrandomized. Part 2. Prospective, randomized. SETTING: Teaching hospital, tertiary care center. PATIENTS: Part 1. 24 adult patients undergoing elective surgery. Part 2. 49 adult patients scheduled for major elective orthopedic or gynecologic surgery of greater than 2 hours' duration with general anesthesia. INTERVENTIONS: Part 1. Insertion of sterile in-line thermistors along the path of fluids delivered using the Hotline or Flotem device. Part 2. Patients were randomly assigned to receive i.v. fluids via the Hotline (n = 21) or Flotem IIe (n = 18) warmers. Intervention for core hypothermia [lower esophageal temperature (Teso) less than 35.5 degrees C], was with forced air warming. Intervention for postoperative shivering was with meperidine by a nurse who was blinded to the treatment group. MEASUREMENTS: Part 1. Temperature of infused fluids before and after the warmer (T in and T out) and before the fluid entered the patient after insertion of a standard 84 cm extension set having a stopcock for injection of medications (T distal). Part 2. Tympanic (Ttym) was recorded before induction of anesthesia (baseline) and at 15-minute intervals after induction. Teso was recorded at 15-minute intervals after induction. The maximum intraoperative Ttym decline from baseline (delta Ttym max) was calculated. MAIN RESULTS: Part 1. Flow rates were between 1 and 33 ml/min. T out and T distal (mean +/- SEM) of fluids infused through the Hotline device were warmer compared with those infused via the Flotem IIe device (Hotline T out: 35.7 +/- 0.1 degrees C and Hotline T distal: 33.4 +/- 0.2 degrees C vs. Flotem IIe T out: 28.9 +/- 0.2 degrees C and Flotem IIe T distal: 28.3 +/- 0.2 degrees C; p < 0.001 between warmers). Part 2. Maximal decrease in Ttym from preoperative baseline (before intervention) was greater in the Flotem IIe compared with the Hotline group (delta Ttym max = -1.4 +/- 0.1 vs. -0.9 +/- 0.1 degree C, p = 0.01). Five patients in the Flotem IIe group required forced air warming for treatment of hypothermia versus none in the Hotline group (p < 0.01). Postoperatively, five patients in the Flotem IIe group required treatment with meperidine for severe shivering versus one patient in the Hotline group (p < 0.05). CONCLUSIONS: The Hotline device delivered fluids to the patient at consistently warmer temperatures compared with the Flotem IIe device during actual clinical conditions. This was associated with maintenance of near normal core temperatures throughout the procedure in the Hotline group, and a decreased need for interventions such as forced-air warming and treatment for severe shivering.

Adult↗