Search

Study Objective: To determine the rapidity and extent of core temperature decrease following release of a lower extremity pneumatic tourniquet., Design: Prospective study., Setting: Inpatient surgery in a university trauma center., Patients: 11 ASA status I and II adults undergoing unilateral lower extremity fracture fixation in which a tourniquet was used, with general anesthesia., Interventions: Temperature was measured in the esophagus before and after lower extremity tourniquet release., Measurements and Main Results: Tourniquet times ranged from 41 to 129 minutes (mean 98.5 +/- 9.1 minutes). Following tourniquet deflation core temperature decreased in all patients, with a maximal decline at 10 minutes, the termination of measurements, although trending downward. Esophageal temperature decreased an average of 0.46 degree C +/- 0.2 degree C at 5 minutes, and 0.67 degree C +/- 0.2 degree C at 10 minutes following tourniquet release, respectively. Temperature changes were significant (p = 0.0001) at both time intervals., Conclusion: Core temperature drops significantly immediately following release of the tourniquet at the esophageal temperature monitoring site. This decrease is the result of cooling of systemic blood reperfusing the hypothermic limb, and mixing of cool, "washed out" blood with the systemic circulation. As the consequences of hypothermia are well-known, we recommend core temperature monitoring in all patients having lower extremity tourniquet placed during general anesthesia, as well as vigilant monitoring for prolonged effects of anesthetics in the postoperative period.

Rationale and technique for use of intraoral glossopharyngeal nerve block is described in a parturient with severe preeclampsia and a past history of difficult intubation. Indications and contraindications for administration of other forms of airway anesthesia are discussed.

Dessicated and encysted gastrulae of the brine shrimp Artemia salina remain metabolically dormant until they are rehydrated. At this time development resumes, culminating in the hatching of free swimming nauplius larvae. The resumption of embryogenesis provides a convenient system for studying biochemical events which accompany development of a eukaryotic organism, and in particular Artemia has proven useful for studies of the transcriptional regulation of gene expression. Encysted gastrulae of Artemia yielded only trace amounts of DNA-dependent RNA polymerase activity when crude nuclear pellets were subjected to sonication at high ionic strength. Furthermore, when crude nuclear pellets from encysted gastrulae and developing nauplius larvae were mixed prior to sonication, subsequent solubilization of proteins from the mixture did not yield RNA polymerase activity; sonication of the pellet from nauplii alone resulted in the solubilization of large quantities of RNA polymerases I and II as we have previously found [1]. RNA polymerases I and II were detectable in sonicates of crude nuclear pellets after 1-h incubation of Artemia cysts in sea water. This presents the possibility that dormant gastrulae of the brine shrimp contain RNA polymerase which is inactive, and that the rapid appearance of nuclear enzymatic activity which accompanies the resumption of development may not require de novo synthesis of the polymerase.