Preliminary investigation into the effects of electrical stimulation on mandibular distraction osteogenesis in goats.

Craniofacial distraction osteogenesis (DO) was found to be a procedure with low preoperative and postoperative morbidity. Direct current electrical stimulation is used clinically to treat different orthopaedic problems. It provided a significant increase in new-bone formation, and a higher mechanical strength of healing. The purpose of this study was to test the effect of electric current on distraction osteogenesis and to establish the best period to apply an electric current during the different distraction phases. Twelve healthy adult goats were subjected to a vertical osteotomy in the symphyseal area. A distraction device was fixed to the bone. Animals were divided into two groups, Group I (three goats) and group II (nine goats). In group I, the device was activated 1mm per day for 10 days; while in group II, the device was activated 1mm per day for 10 days with the application of direct electric current stimulation of 10 microA either during the first 3 days of latency in a continuous mode (ESL group), or during the first 3 days of the activation period in a continuous mode (ESA group); or during the first 3 days of the consolidation period in a continuous mode (ESC group). After the activation period was completed, the distraction device left in place for additional 15 days for bone consolidation in all animals. Animals were then sacrificed, the mandible was harvested, and the distracted areas were removed and processed for mechanical and histological studies. The results of this study suggested that direct current electrical stimulation display synergism on mandibular distraction when this stimulation applied to the distraction zone during activation or consolidation periods.

Complications associated with diabetes mellitus.

There is an increased risk of perioperative complications in patients with diabetes. Knowledge of underlying pathophysiology and assessment and appropriate preoperative preparation can minimize the risk. Although vigilance in monitoring is the key to successful outcomes in these high risk patients, cardiac arrest has been reported. We should anticipate this serious complication in diabetic patients with cardiac autonomic neuropathy.

Acute adrenal insufficiency: a case report.

The chances of cardiovascular collapse leading to a diagnosis of Addison's disease are rare. One report cited 3 of 60,000 cases in which this may have occurred. However, it can happen and should be considered in hemodynamically unstable patients if the usual causes of hypotension have been eliminated. This is especially true in high-risk patients, ie, those who chronically receive steroids.

Report of the National Commission on Nurse Anesthesia Education. An analysis of the cost of nurse anesthesia programs.

Cost-benefit questions that require nurse anesthesia education administrators to justify their programs are looked at from the perspective of the director of a large hospital program that entered into a cooperative arrangement with a school of nursing.

A new beginning: the International Federation of Nurse Anesthetists.

In 1978, two European nurse anesthetists attended the 1978 AANA Annual Meeting in Detroit. Mr. Hermi Lohnert, Switzerland, inquired about the willingness of the AANA to support international cooperation among nurse anesthetists. The AANA agreed. In 1985, the First International Symposium was held in Lucerne, Switzerland. A Second International Congress of Nurse Anesthetists was held in Amsterdam in 1988, and in June 1989, the AANA joined 10 other countries in Teufen, Switzerland, to sign the founding charter of the International Federation of Nurse Anesthetists (IFNA). At the close of the meeting, the bylaws had been adopted, officers elected and 11 countries admitted as charter members. This editorial highlights events that led to this historic meeting. It discusses the purpose and function of the IFNA and summarizes its organizational structure. Education, practice and organizational backgrounds of the founding countries precede comments regarding the future of the IFNA.

Esmolol: a unique beta adrenergic antagonist.

Since the introduction of propranolol in the 1970s, beta adrenergic antagonists have been used widely for cardiac and noncardiac disorders. The recent introduction of esmolol offers many advantages over other beta blockers. Included among them are rapid onset and elimination and beta selectivity. It has wide application in acute care settings.

A case approach: the pathophysiology of thyroid storm.

As is illustrated in the case report presented here, disorders other than malignant hyperthermia can lead to fever and tachydysrhythmias. Should such symptoms develop in a patient with a previous history of thyrotoxicosis, the possibility of thyroid storm should be considered. Careful monitoring must not cease with the termination of the operation, because this complication usually develops after surgery. Should the complication occur, a successful outcome is dependent upon an understanding of the pathophysiology of the disease process, aggressive monitoring, and appropriate pharmacological management.

AANA journal course. The endocrine system. Preoperative evaluation and physical assessment of the patients. Part III-The endocrine system.

The endocrine system is primarily concerned with governing body processes. Abnormalities of this system can lead to wide-spread pathophysiological effects. Since patients with underlying endocrine disease are frequently encountered in the operating room, an understanding of the normal gland and its pathology is essential. Because these patients are at increased risk, the identification of these patients and optimum preoperative planning are imperative.

Preoperative assessment: the excretory system.

The majority of anesthetics are nephrotoxic in that they depress, usually temporarily, renal hemodynamics and functions. The author briefly reviews renal anatomy and physiology; the relevance of laboratory data associated with excretory function; the effects of abnormal values on the body including electrolytes, cardiac status and acid base balance; and the overall impact of these alterations on the anesthetic management of the surgical patient.