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As feed-additive aquaculture expands to open ocean areas, there is concern that ecologically important habitats may be adversely impacted by sedimentation of farm wastes. In this study, we investigated assimilation of salmon faecal wastes by an ecosystem engineering bivalve that occurs in open ocean environments (Atrina zelandica), as well as effects on physiology and fatty acid metabolism. A. zelandica were subjected to one of 3 treatment diets (fish faeces, 1:1 mix of algae:faeces and algae) in a 51 d laboratory trial. We found a diet-related response in fatty acid composition, including increased prevalence of oleic acid (OA) in digestive tissues of A. zelandica fed on both the fish faeces diet and the mixed diet, indicating fish wastes were assimilated in both treatments. Fish waste consumption was related to a more marked reduction in fatty acid content of digestive gland, as well as lower proportions of long-chain polyunsaturated fatty acids (LC-PUFA) in digestive tissues. Fatty acid composition in gonad and muscle tissues was more strongly influenced by sex. Regardless of dietary treatment, females accumulated C18 fatty acids in gonad tissues, particularly OA, which may preclude the use of OA as a fish waste tracer in this organ. The accumulation of specific fatty acids according to sex may indicate a capacity for preferential selection and retention or biosynthesis of biologically important fatty acids. If present, these mechanisms may increase resilience of A. zelandica to stress from deficiencies in LC-PUFA when using fish wastes as a trophic subsidy.

Biofouling pests can have significant economic impacts on aquaculture operations, including increased processing and production costs. An important first step towards improved biofouling management is understanding the density and distribution of the biofouling species within a growing region. In this study, biofouling communities were sampled from 73 commercial mussel farms within New Zealand’s main mussel growing region, Pelorus Sound. At each farm, photoquadrats (0.08 m2, n = 6) of biofouling organisms were obtained at 2 depth ranges (3 per range) from suspended long-line droppers, both at the surface (0 to 3 m of the dropper) and bottom (9 to 24 m, depending on dropper length and water depth). Biomass samples and visual estimates of biofouling biomass were also obtained. Strong spatial variation in the structure of biofouling communities was evident, with increasing dissimilarity between communities along Pelorus Sound. Problematic taxa (e.g. the brown alga Undaria pinnatifida and calcareous tubeworm Pomatoceros sp.) were dominant near the entrance to the Sound, where annual temperature cycles are often reduced and salinity concentrations are higher. Generally, biofouling cover decreased with increasing water depth. A large proportion (48%) of biofouling biomass scores were categorised as high, equating to 121.2 ± 20 g m-2 (or 16%) of long-line for a heavily fouled farm, or 10 t for a typical 3 ha farm. Distributional patterns, such as those identified in this study, could be used by aquaculture industries to better inform the timing and placement of susceptible crop species and production stages (e.g. mussel spat). Refined monitoring methods may also facilitate industry participation in collecting long-term biofouling records.

There is a lack of cost-effective, environmentally-friendly tools available to manage marine biofouling accumulation on static artificial structures such as drilling rigs, wind turbines, marine farms, and port and marina infrastructure. For there to be uptake and refinement of tools, emerging technologies need to be tested and proven at an operational scale. This study aimed to see whether biofouling accumulation could be suppressed on marine infrastructure under real-world conditions through the delivery of continuous bubble streams. Submerged surfaces of a floating marina pontoon were cleaned in-situ by divers, and the subsequent colonisation by biofouling organisms was monitored on treated (bubbles applied) and untreated sections. Continuous bubble streams proved highly effective (>95%) in controlling macrofouling accumulation on the underside surface of the marina pontoon for the first 2 months after deployment, but efficacy dropped off rapidly once bubble stream delivery was partially obscured due to biofouling accumulation on the diffuser itself. Although extensive macrofouling cover by mussels, bryozoans and hydroids was observed on treated surfaces by 4 months (27.5%, SE = 4.8%), biofouling % cover and diversity was significantly higher on untreated surfaces (79.6%, SE = 2.9%). While this study demonstrates that continuous bubble streams greatly restrict biofouling accumulation over short-to-medium timescales, improved system design, especially the incorporation of diffusers resistant to fouling, is needed for the approach to be considered a viable long-term option for biofouling management on static artificial structures., Competing Interests: The authors declare that they have no competing interests., (© 2023 Hopkins et al.)

Pests of bivalve aquaculture are a challenging problem that can reduce productivity, profitability and sustainability. A range of pest management approaches have been developed for bivalve aquaculture, but a general absence of guiding frameworks has limited the scale and permanency of implementation. Applying principles of 'integrated pest management' (IPM) could change this paradigm to improve economic and environmental outcomes. We reviewed existing research and tools for pest management in bivalve aquaculture, with studies grouped under five pillars of IPM: pest ecology (25 studies), bioeconomic cost-benefits (4 studies), continual monitoring (17 studies), proactive prevention (32 studies) and reactive control (65 studies). This body of knowledge, along with insights from terrestrial agriculture, provide a strong foundation for developing and implementing IPM in bivalve aquaculture. For example, IPM principles have been applied by a regional collective of oyster farmers in the US Pacific Northwest to optimize pesticide application and search for other options to control problematic burrowing shrimps. However, IPM has not yet been broadly applied in aquaculture, and data gaps and barriers to implementation need to be addressed. Priorities include establishing meaningful pest-crop bioeconomic relationships for various bivalve farming systems and improving the efficacy and operational scale of treatment approaches. An IPM framework also could guide potential step-change improvements through directing selective breeding for resistance to pests, development of bespoke chemical control agents, applying emerging technologies for remote surveillance and farm management, and regional alignment of management interventions. © 2022 Society of Chemical Industry., (© 2022 Society of Chemical Industry.)

Biofouling accumulation is not proactively managed on most marine static artificial structures (SAS) due to the lack of effective options presently available. We describe a series of laboratory and field trials that examine the efficacy of continuous bubble streams in maintaining SAS free of macroscopic biofouling and demonstrate that this treatment approach is effective on surface types commonly used in the marine environment. At least two mechanisms were shown to be at play: the disruption of settlement created by the bubble stream, and the scouring of recently settled larvae through shear stress. Field trials conducted over a one-year period identified fouling on diffusers as a major issue to long-term treatment applications. Field measurements suggest that noise associated with surface mounted air blowers and sub-surface diffusers will be highly localised and of low environmental risk. Future studies should aim to develop and test systems at an operational scale., Competing Interests: Matt K. Pine is an acoustic consultant who is employed by the Styles Group Underwater Acoustics. Matt volunteered his time to undertake the sound recordings reported in this project., (©2021 Hopkins et al.)

Disentangling pathways by which nonindigenous species expand and spread regionally remains challenging. Molecular ecology tools are often employed to determine the origins and spread of introduced species, but the complexities of some organisms may be reducing the efficacy of these tools. Some colonial species exhibit complexities by way of chimerism and winter colony regression, which may alter the genetic diversity of populations and mask the connectivity occurring among them. This study uses nuclear microsatellite data and simple GIS-based modeling to investigate the influence of chimerism and winter regression on the genetic diversity and patterns of genetic population connectivity among colonies of Didemnum vexillum on artificial substrates. Colonies sampled in summer were shown to form a metapopulation, with high levels of admixture, extreme outcrossing, and some substructure. These patterns were consistent within the subsampled winter colonies and with the inclusion of chimeric data. However, allelic richness and diversity were significantly different between winter and summer samples, altering interpretations relating to population connectivity and pelagic larval duration. This study demonstrates the importance of including seasonal sampling and imperative life history traits in genetic studies for clear interpretations and the successful management of introduced species., Competing Interests: None Declared.

The likelihood that viable non-indigenous biofouling species will survive a voyage on a vessel is influenced by a range of factors, including the speed, duration, and route of the voyage and the amount of time the vessel spends in port. In this study, a land-based dynamic flow device was used to test the effect of recruit age, vessel speed and voyage duration on the survivorship and growth of the bryozoan Bugula neritina. In the experiment, one-week-old recruits had a higher likelihood (100%) of surviving voyages than older (one-month-old, 90%) or younger (one-day-old, 79%) recruits, but survival was not influenced by vessel speed (6 and 18 knots) or voyage duration (two and eight days). The results suggest that the non-indigenous species B. neritina can be effectively transferred at a range of ages but one-week-old recruits are more likely to survive the translocation process and survive in the recipient environment.

Tunicates are useful models for exploring microbiomes because they have an innate immune system resembling that of chordates. Automated ribosomal RNA intergenic spacer analysis and High-Throughput Sequencing were used to compare the tunic microbiomes of Ciona robusta (formerly Ciona intestinalis type A), Ciona savignyi, Botrylloides leachi and Botryllus schlosseri sampled from three distinct locations with limited genetic connectivity. Bacterial phylotype profiles were conserved within each species, and there were no detectable differences between tunic and tunic + cuticle subsamples from an individual. Bacterial operational taxonomic unit (OTU) diversity was lowest for C. savignyi (320 ± 190 OTUs) and highest for B. schlosseri (1260 ± 190 OTUs). Each species had a distinct set of bacterial OTUs (pseudo-F = 3.0, p > 0.001), with the exception of B. leachi and B. schlosseri from one sampling location (t = 1.2, p = 0.09). Of note were OTUs assigned to Alphaproteobacteria from C. robusta plus Phyllobacteriaceae and Endozoicomonas from C. savignyi. These OTUs contributed 51, 22 and 10% of sequence reads, respectively, and are related to known bacterial symbionts. The within-species conservation of core OTUs across three distinct and co-occurring populations of tunicates provides compelling evidence that these tunicates foster defined microbiomes., (© 2016 Society for Applied Microbiology and John Wiley & Sons Ltd.)

In this experimental study the patterns in early marine biofouling communities and possible implications for surveillance and environmental management were explored using metabarcoding, viz. 18S ribosomal RNA gene barcoding in combination with high-throughput sequencing. The community structure of eukaryotic assemblages and the patterns of initial succession were assessed from settlement plates deployed in a busy port for one, five and 15 days. The metabarcoding results were verified with traditional morphological identification of taxa from selected experimental plates. Metabarcoding analysis identified > 400 taxa at a comparatively low taxonomic level and morphological analysis resulted in the detection of 25 taxa at varying levels of resolution. Despite the differences in resolution, data from both methods were consistent at high taxonomic levels and similar patterns in community shifts were observed. A high percentage of sequences belonging to genera known to contain non-indigenous species (NIS) were detected after exposure for only one day.

Encapsulation of fouled structures is an effective tool for countering incursions by non-indigenous biofoulers. However, guidelines for the implementation of encapsulation treatments are yet to be established. This study evaluated the effects of temperature, biomass, community composition, treatment duration and the biocide acetic acid on biofoulers. In laboratory trials using the model organisms Ciona spp. and Mytilus galloprovincialis, increasing the temperature or biomass speeded up the development of a toxic environment. Total mortality for Ciona spp. occurred within 72 and 24 h at 10 and 19°C, respectively. M. galloprovincialis survived up to 18 days, with high biomass increasing mortality at 10°C only. In a field study, three-month-old and four-year-old communities were encapsulated with and without acetic acid. Mortality took up to 10 days for communities encapsulated without acetic acid, compared to 48 h with acetic acid. The insights gained from this study will be useful in developing standardised encapsulation protocols.

The desiccation tolerance of biofouling taxa (adults and early life-stages) was determined under both controlled and 'realistic' field conditions. Adults of the ascidian Ciona spp. died within 24 h. Mortality in the adult blue mussel Mytilus galloprovincialis occurred within 11 d under controlled conditions, compared with 7 d when held outside. The Pacific oyster Crassostrea gigas was the most desiccation-tolerant taxon tested (up to 34 d under controlled conditions). Biofouling orientated to direct sunlight showed faster mortality rates for all the taxa tested. Mortality in Mytilus juveniles took up to 24 h, compared with 8 h for Ciona, with greater survival at the higher temperature (18.5°C) and humidity (~95% RH) treatment combination. This study demonstrated that desiccation can be an effective mitigation method for a broad range of fouling taxa, especially their early life-stages. Further work is necessary to assess risks from other high-risk species such as algae and cyst forming species.

Marine biofilms are precursors for colonization by larger fouling organisms, including non-indigenous species (NIS). In this study, high-throughput sequencing (HTS) of 18S rRNA metabarcodes was used to investigate four sampling methods (modified syringe, sterilized sponge, underwater tape and sterilized swab) for characterizing eukaryotic communities in marine biofilms. Perspex™ plates were sampled in and out of water. DNA collected with tape did not amplify. Otherwise, there were no statistical differences in communities among the remaining three sampling devices or between the two environments. Sterilized sponges are recommended for ease of use underwater. In-depth HTS analysis identified diverse eukaryotic communities, dominated by Metazoa and Chromoalveolata. Among the latter, diatoms (Bacillariophyceae) were particularly abundant (33% of reads assigned to Chromalveolata). The NIS Ciona savignyi was detected in all samples. The application of HTS in marine biofilm surveillance could facilitate early detection of NIS, improving the probability of successful eradication.

The accumulation of biofouling on coastal structures can lead to operational impacts and may harbour problematic organisms, including non-indigenous species. Benthic predators and grazers that can supress biofouling, and which are able to be artificially enhanced, have potential value as augmentative biocontrol agents. The ability of New Zealand native invertebrates to control biofouling on marina pontoons and wharf piles was tested. Caging experiments evaluated the ability of biocontrol to mitigate established biofouling, and to prevent fouling accumulation on defouled surfaces. On pontoons, the gastropods Haliotis iris and Cookia sulcata reduced established biofouling cover by >55% and largely prevented the accumulation of new biofouling over three months. On wharf piles C. sulcata removed 65% of biofouling biomass and reduced its cover by 73%. C. sulcata also had better retention and survival rates than other agents. Augmentative biocontrol has the potential to be an effective method to mitigate biofouling on marine structures.

This study documents eight years of benthic recovery at a highly impacted salmon farm. Substantial recovery occurred in the first 2 years, and was assessed to be complete after ∼5 years. However, minor differences were still evident, along with some on-going benthic instability, attributable to medium-scale spatial movements and successional patterns of macrobenthos. Quantifying the endpoint of 'recovery' proved challenging due to: lack of a widely accepted definition, inherent variability in recovering sediments, differing trajectories of impact and reference sites, and statistical challenges. More complex biotic indices and metrics incorporating multiple variables were the most robust indicators. Statistical tests for 'parallelism' in the trajectories of Cage and Reference sites proved useful, but results were contingent upon how the method was applied, and should therefore be used in conjunction with data-visualisation methods. The study highlights the importance of a predetermined recovery endpoint, and using multiple indicators and a weight-of-evidence assessment approach., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Non-indigenous species can dominate fouling assemblages on artificial structures in marine environments; however, the extent to which infected structures act as reservoirs for subsequent spread to natural habitats is poorly understood. Didemnum vexillum is one of few colonial ascidian species that is widely reported to be highly invasive in natural ecosystems, but which in New Zealand proliferates only on suspended structures. Experimental work revealed that D. vexillum established equally well on suspended artificial and natural substrata, and was able to overgrow suspended settlement plates that were completely covered in other cosmopolitan fouling species. Fragmentation led to a level of D. vexillum cover that was significantly greater than was achieved as a result of ambient larval recruitment. The species failed to establish following fragment transplants onto seabed cobbles and into beds of macroalgae. The establishment success of D. vexillum was greatest in summer compared with autumn, and on the underside of experimental settlement plates that were suspended off the seabed to avoid benthic predators. Where benthic predation pressure was reduced by caging, D. vexillum establishment success was broadly comparable to suspended treatments; by contrast, the species did not establish on the face-up aspect of uncaged plates. This study provides compelling evidence that benthic predation was a key mechanism that prevented D. vexillum's establishment in the cobble habitats of the study region. The widespread occurrence of D. vexillum on suspended anthropogenic structures is consistent with evidence for other sessile invertebrates that such habitats provide a refuge from benthic predation. For invasive species generally, anthropogenic structures are likely to be most important as propagule reservoirs for spread to natural habitats in situations where predation and other mechanisms do not limit their subsequent proliferation.

Augmentative biocontrol aims to control established pest populations through enhancement of their indigenous enemies. To our knowledge, this approach has not been applied at an operational scale in natural marine habitats, in part because of the perceived risk of adverse non-target effects on native ecosystems. In this paper, we focus on the persistence, spread and non-target effects of the sea urchin Evechinus chloroticus when used as biocontrol agent to eradicate an invasive kelp from Fiordland, New Zealand. Rocky reef macrobenthic assemblages were monitored over 17 months in areas where the indigenous algal canopy was either removed or left intact prior to the translocation of a large number of urchins (>50 ind.·m(-2)). Urchin densities in treated areas significantly declined ∼9 months after transplant, and began spreading to adjacent sites. At the end of the 17-month study, densities had declined to ∼5 ind.·m(-2). Compared to controls, treatment sites showed persistent shifts from kelp forest to urchin barrens, which were accompanied by significant reductions in taxa richness. Although these non-target effects were pronounced, they were considered to be localised and reversible, and arguably outweigh the irreversible and more profound ecological impacts associated with the establishment of an invasive species in a region of high conservation value. Augmentative biocontrol, used in conjunction with traditional control methods, represents a promising tool for the integrated management of marine pests.

Augmentative biocontrol, defined as the use of indigenous natural enemies to control pest populations, has not been explored extensively in marine systems. This study tested the potential of the anemone Anthothoe albocincta as a biocontrol agent for biofouling on submerged artificial structures. Biofouling biomass was negatively related to anemone cover. Treatments with high anemone cover (>35%) led to significant changes in biofouling assemblages compared to controls. Taxa that contributed to these changes differed among sites, but included reductions in cover of problematic fouling organisms, such as solitary ascidians and bryozoans. In laboratory trials, A. albocincta substantially prevented the settlement of larvae of the bryozoan Bugula neritina when exposed to three levels of larval dose, suggesting predation as an important biocontrol mechanism, in addition to space pre-emption. This study demonstrated that augmentative biocontrol using anemones has the potential to reduce biofouling on marine artificial structures, although considerable further work is required to refine this tool before its application.

This study examined the efficacy of heated seawater for the treatment and remediation of fouled vessel sea chest habitats. In laboratory trials, three temperature regimes (37.5°C for 60 min, 40°C for 30min and 42.5°C for 20 min) were tested on a range of temperate taxa commonly found in sea chests. Field validation trials further assessed the efficacy of heat treatment within a replica sea chest environment. During laboratory trials, 100% mortality was achieved across all three treatments for the majority of taxa; the exceptions being the barnacle Elminius modestus and the oyster Crassostrea gigas. Temperature tolerance limits observed in the laboratory were successfully replicated under simulated sea chest conditions; however, a failure to achieve even heat distribution was an obstacle to achieving uniform mortality. This study provides guidance on the temperature/exposure parameters required for vessels plying temperate latitudes, and demonstrates that heated seawater has potential for controlling biofouling in vessel sea chests., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The potential for oil rigs to transport diverse, reef-like communities around the globe makes them high risk vectors for the inadvertent spread of non-indigenous species (NIS). This paper describes two case studies where a suite of pre-border management approaches was applied to semi-submersible drilling rigs. In the first case study, a drilling rig was defouled in-water prior to departure from New Zealand to Australia. Risk mitigation measures were successful in reducing biosecurity risks to the recipient region, but they resulted in the unintentional introduction of the non-indigenous brown mussel (Perna perna) to New Zealand when the rig was defouled in-water by divers. In the second case study, lessons learned from this high-profile incursion resulted in a more structured approach to pre-border management, and this serves as a useful template for future rig transfers., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The present study tested two diver-operated rotating brush systems, coupled with suction and collection capabilities, to determine their efficacy in the management of vessel biofouling. Both rotating brush systems proved effective (> 80%) in removing low-to-moderate levels of fouling from flat and curved experimental surfaces (Perspex plates). However, performance was generally poorer at removing more advanced levels of fouling. In particular, mature calcareous organisms were relatively resistant to the rotating brushes, with a high proportion (up to 50%) remaining on plates following treatment. On average, > 95% of defouled material was collected and retained by both systems. The amount of lost material generally increased when treating curved plates with increasing biomass, whereas the material lost from flat plates was typically less and remained relatively constant throughout the trials. The majority (> 80%) of fouling not captured by the systems was crushed by the brushes (ie non-viable). However, a diverse range of viable organisms (eg barnacles and hydroids) was lost to the environment during the defouling trials. When defouling a vessel, unintentional detachment of fouling organisms is likely to be high through physical disturbance by divers operating the devices and by associated equipment (eg hoses). Furthermore, residual biosecurity risks are also likely to remain due to diver error, persistent fouling remaining on treated surfaces and the inaccessibility of niche areas to the brush systems. To address these limitations, further research into alternative treatment methods is required.

Vessel traffic is the primary pathway for non-indigenous marine species introductions to New Zealand, with hull fouling recognised as being an important mechanism. This article describes hull fouling on seven slow-moving commercial vessels sampled over a 1 year period. Sampling involved the collection of images and fouling specimens from different hull locations using a standardised protocol developed to assess vessel biofouling in New Zealand. A total of 29 taxa was identified by expert taxonomists, of which 24% were indigenous to New Zealand and 17% non-indigenous. No first records to New Zealand were reported, however 59% of species were classified as 'unknown' due to insufficient taxonomic resolution. The extent of fouling was low compared to that described for other slow-movers. Fouling cover, biomass and richness were on average 17.1% (SE = 1.8%), 5.2 g (SE = 1.1 g) and 0.8 (SE = 0.07) per photoquadrat (200 x 200 mm), respectively. The fouling extent was lowest on the main hull areas where the antifouling paint was in good condition. In contrast, highest levels of fouling were associated with dry-docking support strips and other niche areas of the hull where the paint condition was poor. Future studies should target vessels from a broader range of bioregions, including vessels that remain idle for extended periods (ie months) between voyages, to increase understanding of the biosecurity risks posed by international commercial slow-movers.

Muon Spin Relaxation and Avoided Level Crossing (ALC) measurements of ferrocene are reported. The main features observed are five high field resonances in the ALC spectrum at about 3.26, 2.44, 2.04, 1.19 and 1.17 T, for the low-temperature phase at 18 K. The high-temperature phase at 295 K shows that only the last feature shifted down to about 0.49 T and a muon spin relaxation peak at about 0.106 T which approaches zero field when reaching the phase transition temperature of 164 K. A model involving three muoniated radicals, two with muonium addition to the cyclopentadienyl ring and the other to the metal atom, is postulated to rationalise these observations. A theoretical treatment involving spin-orbit coupling is found to be required to understand the Fe-Mu adduct, where an interesting interplay between the ferrocene ring dynamics and the spin-orbit coupling of the unpaired electron is shown to be important. The limiting temperature above which the full effect of spin-orbit interaction is observable in the muSR spectra of ferrocene was estimated to be 584 K. Correlation time for the ring rotation dynamics of the Fe-Mu radical at this temperature is 3.2 ps. Estimated electron g values and the changes in zero-field splittings for this temperature range are also reported.

Objective: The optimal dose of i.m. ketamine for ED procedural sedation in children is not known. The authors wished to quantify the dose-response of ketamine with respect to sedation adequacy, time to discharge, and adverse effects in order to identify an optimal dose., Methods: The study was a consecutive case series of 1,022 children < or = 15 years of age given i.m. ketamine in the EDs of a university medical center and an affiliated county hospital over a nine-year period. Adequacy of sedation, time to discharge, and adverse effects were compared with dose administered., Results: Doses in the sample averaged 3.96+/-0.69 mg/kg, with a range of 0.48 to 9.09 mg/kg. Children judged to be adequately sedated received higher doses compared with those inadequately sedated (3.94+/-0.44 mg/kg vs 3.77+/-0.49 mg/kg, p=0.041), and a nonsignificant trend was noted toward uniformly adequate sedation with increasing dose (< or =91% at <4.00 mg/kg, 93% at 4.00-4.49 mg/kg, and 100% at > or = 4.50 mg/kg). No significant difference or trend in time to discharge or adverse effects was noted between the children receiving <4.00 mg/kg and those receiving > or = 4.00 mg/kg of ketamine, and the study had power (alpha=0.05, beta=0.20) to detect a 9-minute difference in times to discharge, a 3.3% difference in rates of airway complications, a 5.6% difference in rates of emesis, and a 12.3% difference in rates of recovery agitation., Conclusion: Ketamine doses of 4 to 5 mg/kg i.m. produced adequate sedation in 93%-100% of children, suggesting that this dosing range may be optimal for ED procedural sedation. No difference in time to discharge or adverse effects was observed for lower or higher doses.

Objectives: To determine the safety of i.v. ketamine when administered by emergency physicians (EPs) for pediatric procedures, and to contrast the sedation characteristics of the i.v. and i.m. routes., Methods: The study was a retrospective consecutive case series of children aged < or =15 years given i.v. ketamine in the EDs of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine was used by treating physicians. Records were reviewed for adverse effects, indication, dosing, adjunctive drugs, inadequate sedation, and time to release. Results were contrasted with previously reported data for the i.m. route., Results: During the study period i.v. ketamine was administered 156 times, primarily for laceration repair and fracture reduction. Transient apnea and respiratory depression occurred in one patient each; both were quickly identified and were without sequelae. Laryngospasm or aspiration was not noted in any children. There were 6 children with emesis and 2 with mild agitation during recovery. The median time from initial dose to ED release was 103 minutes (25th to 75th percentiles 76 to 146 minutes). The i.v. and i.m. routes were comparable in terms of adverse effects, inadequate sedation, and time to release., Conclusion: I.v. ketamine can be administered safely by EPs to facilitate pediatric procedures when used in a defined protocol. The sedation characteristics of the i.v. and i.m. routes appear comparable.

Study Objective: To determine the safety of intramuscular ketamine when administered by emergency physicians for pediatric procedures in accordance with a defined protocol., Methods: We assembled a consecutive case series of children aged 15 years or younger who were given ketamine in the emergency departments of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine use (4 mg/kg, intramuscularly) was followed. Treating physicians were instructed to complete data forms recording complications and adequacy of sedation concurrent with patient care. Subsequent chart review was used to determine indications, adjunctive drugs, time to discharge, and adverse reactions for all patients., Results: Intramuscular ketamine was administered 1,022 times, mainly for laceration repair and fracture reduction. Physicians completed data forms for 431 of treated children (42%). Transient airway complications occurred in 1.4%: airway malalignment (n = 7), laryngospasm (n = 4), apnea (n = 2), and respiratory depression (n = 1). All were quickly identified and treated without intubation or sequelae. Emesis occurred in 6.7%, without evidence of aspiration. Mild recovery agitation occurred in 17.6%, moderate to severe agitation in 1.6%. No child required hospitalization for complications caused by ketamine. Ketamine produced acceptable sedation in 98% of patients. The median time from injection to emergency department discharge was 110 minutes for children given a single dose of ketamine., Conclusion: Intramuscular ketamine may be administered safely by emergency physicians to facilitate pediatric procedures in accordance with a defined protocol and with appropriate monitoring. Ketamine is highly effective, has a wide margin of safety, does not require intravenous access, and uniquely preserves protective airway reflexes.

Background: External beam radiotherapy in advanced neuroblastoma is limited by the volume of normal radiosensitive tissues included in the radiation field. Limitations to external radiation are the late effects to these tissues. Intraoperative radiotherapy (IORT) delivers a single high-radiation dose to a tumor while displacing normal tissues that would have been included in an external field. Standard external radiotherapy can still be done after "boost" IORT., Methods: Eight advanced-stage neuroblastoma patients who received IORT as part of their multimodality therapy were reviewed to identify the impact of IORT on operative time, complications, and tumor control in the treatment field. The IORT was accomplished by patient transport from the OR to the radiation therapy suite; these were separated by three floors., Results: IORT added 30-75 min to the operative procedure. Tumors in the resection/IORT fields showed no evidence of disease (one), stable tumor size (six), and tumor recurrence (one). Two complications were identified: a urinary fistula and CO2 retention, which was detected and corrected before the IORT. Neither of these complications was related to the IORT. Two patients who had subsequent tumor resection after IORT demonstrated tumor differentiation to ganglioneuromatous tissue., Conclusions: IORT usually can be completed in less than an hour. No IORT-associated complications were identified. IORT along with maximal tumor resection, external radiation, and chemotherapy enhances local tumor control.

Drugs applied topically on the eye are partly absorbed into the eye (possibly 2 to 10%), the remainder can enter the systemic circulation through the conjuctival vessels or from the vessles of the nasolacrimal passages. Drug molecules which enter the stomach and are not transformed into inactive compounds may also enter the blood stream. Systemic reactions to topically applied ophthalmic drugs are shown to be rare and largely preventable.

Unwanted effects may occur when drugs are applied topically on the eye or when they are administered by other routes. The unwanted effects may be ocular, systemic or both. This paper discusses unwanted ocular effects which may arise when certain optometric drugs are applied directly on the eye. Among the effects described are allergic reactions, infections, pigmentary changes, and the production of aqueous "floaters." Changes in intraocular pressure and appropriate first aid measures to counter an acute rise in IOP are also discussed. Not discussed are the adverse ocular effects which are associated with topical application of the potent anticholinesterases nor those which can arise when certain drugs e.g. corticosteroids are applied to the eye for therapeutic purposes.