Quality of emergence from anesthesia and incidence of vomiting with remifentanil in a pediatric population.

UNLABELLED: We conducted a randomized trial to compare the incidence of vomiting and the quality of emergence from anesthesia associated with the use of remifentanil versus a nonopiate. It was expected that remifentanil would provide smoother emergence from anesthesia with a comparably low rate of vomiting. The study sample consisted of 115 pediatric patients undergoing dental restoration and extraction who were randomly assigned to the nonopiate or remifentanil groups based on their hospital admission numbers. The nonopiate patients received sufficient desflurane to prevent movement, typically 7%-9%. The remifentanil group received remifentanil 0.2 microg x kg(-1) x min(-1) and enough desflurane to prevent movement, typically 3.2%-3.6%. A trained postanesthesia care unit nurse, blinded to the anesthetic technique, assessed the quality of emergence and incidence of vomiting. Sixty-three patients received remifentanil and 52 received the nonopiate. The groups were not significantly different in either quality of emergence or incidence of vomiting. Remifentanil provided results comparable to a nonopiate with no increase in emesis. IMPLICATIONS: A randomized, controlled clinical trial of 115 patients undergoing dental restoration indicated that an anesthetic technique using remifentanil provided quality of emergence comparable to and no greater incidence of vomiting than a nonopiate technique.

Detection of fetal anencephaly using real-time ultrasound.

Anencephaly can be diagnosed using real-time ultrasonography. This enables visualization of the fetal movements and facilitates identification of the fetal parts, making certain the exact orientation of the fetus. Thus, the negative finding of the lack of fetal calvarium, as well as the positive finding of insufficient space for a calvarium to exist between the fetal thorax and the uterine wall, can be confidently ascertained. One can then be certain that a fetal head is not being missed by the ultrasound beam, as is possible with a rapidly moving fetus using B-mode ultrasound.

Change in cell-surface glycoproteins of mouse embryos before implantation.

The early biochemical ontogeny of the mammalian cell surface has been examined in mouse embryos. After in vitro incubation of embryos in D-[(3)H]- or D-[(14)C]glucosamine, the cell-surface glycopeptides were removed by trypsinization, digested with Pronase, and fractionated by gel filtration on Sephadex G-50; radioactivity was determined in the fractions by scintillation counting. Cochromatography of digests from the surfaces of embryos of two age groups yielded markedly different elution patterns. The labeled surface material from embryos in or near the blastocyst stage, when the outermost cells are differentiating into trophoblast, was substantially enriched, as compared with material from cleavage-stage embryos, in relatively more rapidly eluted components of presumed higher molecular weight. A similar change has previously been reported by others in cultured mammalian cell lines after viral transformation, in comparison with corresponding untransformed cells. This similarity between blastocysts and transformed cells suggests that the early biochemical differentiation of the surface, as the embryo passes into the blastocyst stage, may be responsible for the stage-specific capacity of the outermost cells to attach to the uterine wall in response to an implantation-initiating stimulus and to become invasive.