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Background: Maintaining arterial partial pressures of carbon dioxide and oxygen within physiological range is very crucial for the better outcome of neurosurgery patients. We studied respiratory effect of dexmedetomidine, fentanyl combination along with infiltration of local anesthesia for chronic SDH evacuation in ASA 2,3 and 4 patients. Material and methods: 56 patients with chronic SDH posted for burrhole evacuation were divided in to 2 groups. Group A received bolus dose dexmedetomidine 1 mcg/kg over 10 minutes in addition to fentanyl 1µgm/kg, midazolam 0.02 mg/kg , followed by infusion of dexmedetomidine 0.3µg/kg/min .group B recieved fentanyl 1 µg/kg , midazolam 0.02 mg/kg. Haemodynamics and artetial blood gas (ABG), between the two groups were compared. Results; Following medication, Partial pressure of carbon dioxide increased from baseline values in both the groups but the increase was significantly less in dexmedetomidine group (P

L'objectif etait d'evaluer les etats hemodynamiques et respiratoires des operees de fistules obstetricales et rapporter nos experiences sur la prise en charge de ces malades. Il s'agit d'une etude transversale descriptive effectuee au Bloc operatoire et Reanimation du CHRR Manakara allant du 20 au 30 aout 2013. Etaient incluses les patientes operees de fistules obstetricales sous rachianesthesie. Nous avons exclu les patientes classees ASA >2 et celles ayant des tares cardio-vasculaires ou respiratoires. Apres consultations preanesthesiques, et bilans preoperatoires, nous avons administre chez les patientes 12,5mg de bupivacaine adrenalinee 0,5% isobare en intrathecal. Elles etaient mises en position de Trendelenburg 5 minutes apres l'injection du produit anesthesique et durant toute l'intervention. Le niveau sensitif, la pression arterielle, la frequence cardiaque, la frequence respiratoire et la saturation pulsee en oxygene (SpO2) etaient enregistres pendant l'intervention. Nous avons retenues 57 malades. Le bloc sensitivomoteur etait excellent pour toutes les malades. Un niveau metamerique superieur a T6 etait atteint chez 56,36% des malades. A part quelques episodes d'hypertension arterielle et tachycardie, nous n'avons trouve aucune difficulte respiratoire ni cardiovasculaire en rapport avec la position. Seuls, le niveau sensitif et la frequence respiratoire presentaient une correlation (p=0,01). Cette etude suggere que la position de Trendelenburg est realisable au cours de la rachianesthesie en utilisant un produit anesthesique approprie, en faisant attention, notamment aux changements de position et en tenant compte de l'examen preanesthesique.

Background: Protective effects of deep inspiration (DI) fail in chronic obstructive pulmonary disease (COPD). It is unknown if this reflects abnormal properties of the airway wall. Aim: To determine if the response of the airway wall to stretch is abnormal in COPD. Methods: Subjects undergoing lung surgery (65±3y) had lung function assessed before surgery and a bronchial segment was dissected from resected lung tissue for in vitro study. Subjects with COPD had a post-bronchodilator FEV 1 /FVC ratio and FEV 1 below lower limit of normal. Response to DI was assessed from maximal and partial (M/P) flow ratio. In bronchial segments, bronchodilation to simulated DI was measured from the change in airway volume after a transient stretch. Wall dimensions were measured on fixed airways. Results: The M/P ratio positively correlated with FEV 1 /FVC (%predicted, p=0.002, r=0.72) and was reduced from 0.87±0.14 (mean±SE) in the control group (n=9) to 0.50±0.08 in the COPD group (n=7, P=0.047). An M/P ratio of Conclusion: A DI produces bronchoconstriction in subjects not undergoing bronchial challenge, which is greater in subjects with COPD. While the intrinsic response of the airway wall to stretch contributes to the respiratory effect of DI, it is not different in subjects with COPD.

External intercostal muscle is considered as an inspiratory muscle. Its electromyographic (EMG) activity is exquisitely sensitive to proprioceptive afferents and is predominant in zones with the greatest respiratory effect. In the current series of studies, we assessed the contribution of segmental reflexes to this particular distribution of activity in anesthetized rabbits. We first established a parallel between gradients of activity and mechanical advantage. The sensitivity of external intercostal EMG activity to rib displacement was then assessed in the 3rd and 5th interspaces and in the dorsal, middle and ventral muscle bundles of the 3rd interspace. Finally, persistence of the dorso-ventral gradient was tested after a dorsal rhizotomy (interspaces 3-5). There were no differences in the sensitivity to rib motion in the studied positions. After rhizotomy, the dorso-ventral gradient of activity persisted at rest and with inspiratory resistive loading. We, therefore, conclude that the neuromechanical matching of respiratory drive in the external intercostal muscles is not the result of segmental reflexes.

The purpose of this study was to examine the effects of a clinically relevant opioid on the production of augmented breaths (ABs) in unanesthetized animals breathing normal room air, using a dosage which does not depress breathing. To do this we monitored breathing noninvasively, in unrestrained animals before and after subcutaneous injection of either morphine, or a saline control. The effect of ketamine/xylazine was also studied to determine the potential effect of an alternative sedative agent. Last, the effect of naloxone was studied to determine the potential influence of endogenous opioids in regulating the normal incidence of ABs. Morphine (5 mg/kg) had no depressive effect on breathing, but completely eliminated ABs in all animals in room air ( P = 0.027). However, when animals breathed hypoxic air (10% O2), animals did express ABs, although their incidence was still reduced by morphine ( P < 0.001). This was not a result of sedation per se, as ABs continued at their normal rate in room air during sedation with ketamine. Naloxone had no effect on breathing or AB production, and so endogenous opioids are not likely involved in regulating their rate of production under normal conditions. Our results show that in unanesthetized animals breathing normal room air, a clinically relevant opioid eliminates ABs, even at a dose that does not cause respiratory depression. Despite this, hypoxia-induced stimulation of breathing can facilitate the production of ABs even with the systemic opioid present, indicating that peripheral chemoreceptor stimulation provides a potential means of overcoming the opioid-induced suppression of these respiratory events.

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV1.0%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, γ-GTP, CRP, IgE) and 8-hydroxy-2’-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

Yousser Mohammad, Mouna Kakah, Yasser MohammadDepartment of Internal Medicine, Tishreen University School of Medicine, Lattakia, SyriaAbstract: Narguileh is a water pipe. Narguileh smoking is a traditional pattern of smoking among Eastern Mediterranean women, publicly considered as a harmless entertainment. We performed a survey aimed at tracking chronic respiratory symptoms and alteration in respiratory functions in 77 female narguileh smokers, 77 cigarette smokers, and controls. A questionnaire about respiratory symptoms, quantity, and duration of smoking was completed by each woman, and a flow-volume loop was performed with all women. Women were then categorized in subgroups according to a cumulative smoking duration of over 5 years, and cumulative quantity of 50 kilograms smoked. We obtained 8 subgroups for quantity and 10 for duration. Results showed a higher proportion of chronic bronchitis in narguileh smokers compared with cigarette smokers for both quantity and duration (p value < 0.001), as well as quasi-permanent alteration in maximum mid-expiratory flow (MMEF 25%–75%) in narguileh smokers compared with cigarette smokers (p value < 0.001). Forced expired volume in one second was more altered in cigarette smokers than in narguileh smokers (p value > 0.001). These results will help to raise health authority awareness that narguileh smoking is also dangerous for women.Keywords: sheesha, narguileh, narguile, COPD, MMEF, smoking in women

Background: Conducted electrical weapons (CEWs) are used by law enforcement to subdue combative subjects. Occasionally, subjects will die after a CEW has been used on them. It is theorized that CEWs may contribute to these deaths by impairing respiration. Objectives: To examine the respiratory effects of CEWs. Methods: Human volunteers received a 15-second application of electrical current from a CEW while wearing a respiratory measurement device. Common respiratory parameters were collected before, during, and after exposure. Health histories and demographic information were also collected. Results: Fifty-two subjects were analyzed. Thirty-four underwent a 15-second continuous exposure, and 18 underwent three 5-second burst exposures. In the continuous application group, the baseline mean tidal volume of 1.1 L increased to 1.8 L during application, the baseline end-tidal CO2 level went from 40.5 mm Hg to 37.3 mm Hg after exposure, the baseline end-tidal oxygen level went from 118.7 mm Hg to 121.3 mm Hg after exposure, and the baseline respiratory rate went from 15.9 breaths/min to 16.4 breaths/min after exposure. In the 5-second burst group, the baseline mean tidal volume increased to 1.85 L during application, the baseline end-tidal CO2 level went from 40.9 mm Hg to 39.1 mm Hg after exposure, the baseline end-tidal oxygen level went from 123.1 mm Hg to 127.0 mm Hg after exposure, and the baseline respiratory rate went from 13.8 breaths/min to 14.6 breaths/min after exposure. Conclusions: Prolonged CEW application did not impair respiratory parameters in this population of volunteers. Further study is recommended to validate these findings in other populations.

Over an 18-month period, the department of Forensic Medicine and Science at the University of Glasgow investigated four rather unusual drug-related deaths. In all cases, death was due to the obstruction of the airway by a foreign body after an attempt to evade arrest. In all cases, the obstruction was drug packages of various shapes and sizes. Results of toxicology revealed levels of drugs that may have had a significant respiratory effect on the deceased in three of the cases. Rupturing of the packages and hence leakage of drugs being conducive to death was obvious in only one case.

The external intercostal muscles in humans show marked regional differences in respiratory effect, and this implies that their action on the lung during breathing is primarily determined by the spatial distribution of neural drive among them. To assess this distribution, monopolar electrodes were implanted under ultrasound guidance in different muscle areas in six healthy individuals and electromyographic recordings were made during resting breathing. The muscles in the dorsal portion of the third and fifth interspace showed phasic inspiratory activity with each breath in every subject. However, the muscle in the ventral portion of the third interspace showed inspiratory activity in only three subjects, and the muscle in the dorsal portion of the seventh interspace was almost invariably silent. Also, activity in the ventral portion of the third interspace, when present, and activity in the dorsal portion of the fifth interspace were delayed relative to the onset of activity in the dorsal portion of the third interspace. In addition, the discharge frequency of the motor units identified in the dorsal portion of the third interspace averaged (mean +/- S.E.M.) 11.9 +/- 0.3 Hz and was significantly greater than the discharge frequency of the motor units in both the ventral portion of the third interspace (6.0 +/- 0.5 Hz) and the dorsal portion of the fifth interspace (6.7 +/- 0.4 Hz). The muscle in the dorsal portion of the third interspace started firing simultaneously with the parasternal intercostal in the same interspace, and the discharge frequency of its motor units was even significantly greater (11.4 +/- 0.3 vs. 8.9 +/- 0.2 Hz). These observations indicate that the distribution of neural inspiratory drive to the external intercostals in humans takes place along dorsoventral and rostrocaudal gradients and mirrors the spatial distribution of inspiratory mechanical advantage.

The pulmonary capillary wedge pressure (PCWP) value provides valuable assessment data to guide therapeutic interventions. Proper interpretation of PCWP becomes complicated when respiratory excursions are imposed upon the pressure waveform. Critical care nurses and advanced practice nurses who understand the mechanics of this respiratory effect can accurately interpret the PCWP.

Slow breathing increases cardiac-vagal baroreflex sensitivity (BRS), improves oxygen saturation, lowers blood pressure, and reduces anxiety. Within the yoga tradition slow breathing is often paired with a contraction of the glottis muscles. This resistance breath “ujjayi” is performed at various rates and ratios of inspiration/expiration. To test whether ujjayi had additional positive effects to slow breathing, we compared BRS and ventilatory control under different breathing patterns (equal/unequal inspiration/expiration at 6 breath/min, with/without ujjayi), in 17 yoga-naive young healthy participants. BRS increased with slow breathing techniques with or without expiratory ujjayi (P < 0.05 or higher) except with inspiratory + expiratory ujjayi. The maximal increase in BRS and decrease in blood pressure were found in slow breathing with equal inspiration and expiration. This corresponded with a significant improvement in oxygen saturation without increase in heart rate and ventilation. Ujjayi showed similar increase in oxygen saturation but slightly lesser improvement in baroreflex sensitivity with no change in blood pressure. The slow breathing with equal inspiration and expiration seems the best technique for improving baroreflex sensitivity in yoga-naive subjects. The effects of ujjayi seems dependent on increased intrathoracic pressure that requires greater effort than normal slow breathing.

In this work we evaluate the joint robustness of a multilead delineation and a parametric approach to study the relations between HRV and QTV. The performance of the automatic system is studied over simulated 3-lead ECG signals in order to quantify the improvement allowed by the multilead delineation. Respiratory effect and contamination with realistic noise extracted from a real ECG, rescaled to obtain SNR levels from 30 to 5 dB, were also considered. Compared with same parametric methods over RR and QT series measured from a single lead based approach, the multilead delineator allows to reduce the error in QTV quantification, in particular the error bias in signals at SNR=20 dB. It improves the joint performance facing realistic 3 lead noise at SNRges20 dB, remarkably around 20 dB, making it usable for ECG signals with QTV levels corresponding to a QT standard deviationges13 ms

There is conflicting evidence regarding the association between different size fractions of particulate matter (PM) and cardiac and respiratory morbidity and mortality. We investigated the short-term associations of four size fractions of particulate matter (PM(1), PM(2.5), PM(10), and PM(10-2.5)) and carbon monoxide with hospital admissions and emergency room (ER) visits for respiratory and cardiac conditions and mortality in Spokane, Washington. We used a log-linear generalized linear model to compare daily averages of PM and carbon monoxide with daily counts of the morbidity and mortality outcomes from January 1995 to June 2001. We examined pollution lags ranging from 0 to 3 days and compared our results to a similar log-linear generalized additive model. Effect estimates tended to be smaller and have larger standard errors for the generalized linear model. Overall, we saw no association with respiratory ER visits and any size fraction of PM. However, there was a suggestion of greater respiratory effect from fine PM when compared to coarse fraction. Carbon monoxide was associated with both all respiratory ER visits and visits for asthma at the 3-day lag. We feel that carbon monoxide may be serving as a marker for combustion-derived pollutants, which is one large component of the diverse air pollutant mixture. We also found no association with any size fraction of PM or CO with cardiac hospital admissions or mortality at the 0- to 3-day lag. We found no consistent associations between any size fraction of PM and cardiac or respiratory ER visits or hospital admissions.

The actions of the canine external and internal interosseous intercostal muscles on the lung were assessed by applying the Maxwell reciprocity theorem. The external intercostals in the dorsal part of the cranial interspaces were found to have a large inspiratory effect. However, this effect decreases continuously in the caudal and the ventral direction, such that the muscles in the ventral part of the caudal interspaces have an expiratory effect. The internal intercostals also show marked gradients, such that the muscles in the dorsal part of the caudal interspaces have a large expiratory effect and those in the ventral part of the most cranial interspaces have a small inspiratory effect. During breathing, however, inspiratory activity is found only in the external intercostals with an inspiratory effect, and expiratory activity is confined to the internal intercostals with an expiratory effect. The spatial distribution of inspiratory activity among the canine external intercostals closely mirrors the distribution of inspiratory effect, and the distribution of expiratory activity among the internal intercostals closely mirrors the distribution of expiratory effect. Therefore, the external intercostals have a clear-cut inspiratory action on the lung during breathing, whereas the internal intercostals have a definite expiratory action. The distribution of neural drive among these muscles appears to be equally well matched to the distribution of respiratory effect in humans.

Keywords: amoxicillin; contact urticaria; occupational; healthcare workers; nurse; respiratory effect; β-lactam antibiotics

The choice of impact categories for operationalisation has been justified in Subsection 4.3.6. In this chapter we operationalise the impact category ‘respiratory effects in human beings’. Effects in humans due to the different acting agents are assessed through the construction of damage factors. Damage factors are composed of the fate factors to calculate exposure due to emissions (Section 7.2), of the effect factors to determine expected effects in humans (Section 7.3), and of the disability adjusted life years lost due to the assessed effects (Section 7.4).

A central sleep apnea is the absence of respiratory effect, and, thus, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The sensory component of central sleep apnea; defects involving the integrative and executive neurons; non-neurologic causes of central sleep apneas, including chronic obstructive pulmonary disease and congestive heart failure; diagnosis; treatment; and other topics are reviewed in detail.

We describe an outbreak of contact dermatitis in a tulip bulb processing company Shortly after the introduction of a new pesticide, the fungicide fluazinam, employees started to complain of dermatitis of the arms and the face. 8 employees were investigated and showed positive patch tests to fluazinam. The dermatitis disappeared quickly when they stopped work, but returned as soon they restarted. Subsequent investigations showed that the fungicide had not been used according to the manufacturer's recommendations. Fluazinam was shown to be a strong; sensitizer under these circumstances.

Keywords: occupational; carpenter; construction industry; allergic contact dermatitis; chromate; epoxy; obeche; jacaranda; woods; respiratory effect

This review is an update of a previously published one on airborne-induced contact dermatoses. Because reports in the literature often omit the term 'airborne', 12 volumes of Contact Dermatitis (July 1985-April 1991) were screened, and the cases cited were classified as to history, lesion locations, causative agents, and other factors. The number of reports of airborne dermatoses has increased considerably in recent years.