Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costs.

BACKGROUND: This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients. METHODS: Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated. RESULTS: Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01-4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5-1.0) l/min] than in the uncuffed ETT group [2.0 (0.5-4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4-82.8) ml in the uncuffed ETT group and 6.2 (1.1-14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53-552) l in the uncuffed ETT group vs. 46 (9-149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0-67.3)euro/patient in the uncuffed ETT group and 5.2 (1.0-12.5)euro/patient in the cuffed ETT group, P<0.001. CONCLUSIONS: The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption.

Object localization in cluttered acoustical environments.

In nature, sounds from objects of interest arrive at the ears accompanied by sound waves from other actively emitting objects and by reflections off of nearby surfaces. Despite the fact that all of these waveforms sum at the eardrums, humans with normal hearing effortlessly segregate one sound source from another. Our laboratory is investigating the neural basis of this perceptual feat, often called the "cocktail party effect", using the barn owl as an animal model. The barn owl, renowned for its ability to localize sounds and its spatiotopic representation of auditory space, is an established model for spatial hearing. Here, we briefly review the neural basis of sound-localization of a single sound source in an anechoic environment and then generalize the ideas developed therein to cases in which there are multiple, concomitant sound sources and acoustical reflection.

The synthesis and use of the owl's auditory space map.

The barn owl ( Tyto alba) is capable of capturing prey by passive hearing alone, guided by a topographic map of auditory space in the external nucleus of its inferior colliculus. The neurons of this auditory space map have discrete spatial receptive fields that result from the computation of interaural differences in the level (ILD) and time-of-arrival (ITD) of sounds. Below we review the synthesis of the spatial receptive fields from the frequency-specific ITDs and ILDs to which the neurons are tuned, concentrating on recent studies exploiting virtual auditory space techniques to analyze the contribution of ILD. We then compared the owl's spatial discrimination, assessed behaviorally, with that of its space map neurons. Spatial discrimination was assessed using a novel paradigm involving the pupillary dilation response (PDR), and neuronal acuity was assessed by measuring the changes in firing rate resulting from changes in source location, scaled to the variance. This signal-detection-based approach revealed that the change in the position of the neural image on this map best explains the spatial discrimination measured using the PDR. We compare this result to recent studies in mammalian systems.

Long-term performance summary for the Boot Wetland Treatment System.

The Boot WTS is a 46.5-ha, hydrologically altered cypress-gum wetland in Polk County, Florida. Poinciana Wastewater Treatment Plant No. 3 has discharged advanced secondary treated effluent to the Boot WTS since August 1984. Comprehensive operational monitoring has been ongoing since 1990. The Boot WTS has provided consistent removal of nitrogen and phosphorus. Influent total nitrogen (TN) and total phosphorus (TP) concentrations averaged approximately 10.0 mg/L and 2.5 mg/L at an average hydraulic loading rate (HLR) of 0.2 cm/d. Wetland effluent concentrations for TN and TP averaged 1.8 mg/L and 1.2 mg/L. Available flow and water quality data were used to develop estimates of the first-order removal rate, k, for TN (14 m/y) and TP (1.8 m/y). These removal rates are within the range of values for other forested treatment wetlands. Biochemical oxygen demand (2.2 mg/L) and total suspended solids (4.9 mg/L) in the influent are near background levels for forested wetlands and are not significantly reduced with passage through the system.

Representation of temporal features of complex sounds by the discharge patterns of neurons in the owl's inferior colliculus.

The spiking pattern evoked in cells of the owl's inferior colliculus by repeated presentation of the same broadband noise was found to be highly reproducible and synchronized with the temporal features of the noise stimulus. The pattern remained largely unchanged when the stimulus was presented from spatial loci that evoke similar average firing rates. To better understand this patterning, we computed the pre-event stimulus ensemble (PESE)-the average of the stimuli that preceded each spike. Computing the PESE by averaging the pressure waveforms produced a noisy, featureless trace, suggesting that the patterning was not synchronized to a particular waveform in the fine structure. By contrast, computing the PESE by averaging the stimulus envelope revealed an average envelope waveform, the "PESE envelope," typically having a peak preceded by a trough. Increasing the overall stimulus level produced PESE envelopes with higher amplitudes, suggesting a decrease in the jitter of the cell's response. The effect of carrier frequency on the PESE envelope was investigated by obtaining a cell's response to broadband noise and either estimating the PESE envelope for each spectral band or by computing a spectrogram of the stimulus prior to each spike. Either method yielded the cell's PESE spectrogram, a plot of the average amplitude of each carrier-frequency component at various pre-spike times. PESE spectrograms revealed surfaces with peaks and troughs at certain frequencies and pre-spike times. These features are collectively called the spectrotemporal receptive field (STRF). The shape of the STRF showed that in many cases, the carrier frequency can affect the PESE envelope. The modulation transfer function (MTF), which describes a cell's ability to respond to time-varying amplitudes, was estimated with sinusoidally amplitude-modulated (SAM) noises. Comparison of the PESE envelope with the MTF in the time and frequency domains showed that the two were closely matched, suggesting that a cell's response to SAM stimuli is largely predictable from its response to a noise-modulated carrier. The STRF is considered to be a model of the linear component of a system's response to dynamic stimuli. Using the STRF, we estimated the degree to which we could predict a cell's response to an arbitrary broadband noise by comparing the convolution of the STRF and the envelope of the noise with the cell's post-stimulus time histogram to the same noise. The STRF explained 18-46% of the variance of a cell's response to broadband noise.

Head-related transfer functions of the Rhesus monkey.

Head-related transfer functions (HRTFs) are direction-specific acoustic filters formed by the head, the pinnae and the ear canals. They can be used to assess acoustical cues available for sound localization and to construct virtual auditory environments. We measured the HRTFs of three anesthetized Rhesus monkeys (Macaca mulatta) from 591 locations in the frontal hemisphere ranging from -90 degrees (left) to 90 degrees (right) in azimuth and -60 degrees (down) to 90 degrees (up) in elevation for frequencies between 0.5 and 15 kHz. Acoustic validation of the HRTFs shows good agreement between free field and virtual sound sources. Monaural spectra exhibit deep notches at frequencies above 9 kHz, providing putative cues for elevation discrimination. Interaural level differences (ILDs) and interaural time differences (ITDs) generally vary monotonically with azimuth between 0.5 and 8 kHz, suggesting that these two cues can be used to discriminate azimuthal position. Comparison with published subsets of HRTFs from squirrel monkeys (Saimiri sciureus) shows good agreement. Comparison with published human HRTFs from the frontal hemisphere demonstrates overall similarity in the patterns of ILD and ITD, suggesting that the Rhesus monkey is a good acoustic model for these two sound localization cues in humans. Finally, the measured ITDs in the horizontal plane agree well between -40 degrees and 40 degrees in azimuth with those calculated from a spherical head model with a radius of 52 mm, one-half the interaural distance of the monkey.

Head-related transfer functions of the barn owl: measurement and neural responses.

Sounds arriving at the eardrum are filtered by the external ear and associated structures in a frequency and direction specific manner. When convolved with the appropriate filters and presented to human listeners through headphones, broadband noises can be precisely localized to the corresponding position outside of the head (reviewed in Blauert, 1997). Such a 'virtual auditory space' can be a potentially powerful tool for neurophysiological and behavioral work in other species as well. We are developing a virtual auditory space for the barn owl, Tyto alba, a highly successful auditory predator that has become a well-established model for hearing research. We recorded catalogues of head-related transfer functions (HRTFs) from the frontal hemisphere of 12 barn owls and compared virtual and free sound fields acoustically and by their evoked neuronal responses. The inner ca. 1 cm of the ear canal was found to contribute little to the directionality of the HRTFs. HRTFs were recorded by inserting probetube microphones to within about 1 or 2 mm of the eardrum. We recorded HRTFs at frequencies between 2 and 11 kHz, which includes the frequencies most useful to the owl for sound localization (3-9 kHz; Konishi, 1973). Spectra of virtual sounds were within +/- 1 dB of amplitude and +/- 10 degrees of phase of the spectra of free field sounds measured near to the eardrum. The spatial pattern of responses obtained from neurons in the inferior colliculus were almost indistinguishable in response to virtual and to free field stimulation.

Submicrosecond pacemaker precision is behaviorally modulated: the gymnotiform electromotor pathway.

What are the limits and modulators of neural precision? We address this question in the most regular biological oscillator known, the electric organ command nucleus in the brainstem of wave-type gymnotiform fish. These fish produce an oscillating electric field, the electric organ discharge (EOD), used in electrolocation and communication. We show here that the EOD precision, measured by the coefficient of variation (CV = SD/mean period) is as low as 2 x 10(-4) in five species representing three families that range widely in species and individual mean EOD frequencies (70-1,250 Hz). Intracellular recording in the pacemaker nucleus (Pn), which commands the EOD cycle by cycle, revealed that individual Pn neurons of the same species also display an extremely low CV (CV = 6 x 10(-4), 0.8 micro sec SD). Although the EOD CV can remain at its minimum for hours, it varies with novel environmental conditions, during communication, and spontaneously. Spontaneous changes occur as abrupt steps (250 ms), oscillations (3-5 Hz), or slow ramps (10-30 s). Several findings suggest that these changes are under active control and depend on behavioral state: mean EOD frequency and CV can change independently; CV often decreases in response to behavioral stimuli; and lesions of one of the two inputs to the Pn had more influence on CV than lesions of the other input.

Motor control of the jamming avoidance response of Apteronotus leptorhynchus: evolutionary changes of a behavior and its neuronal substrates.

The two closely related gymnotiform fishes, Apteronotus and Eigenmannia, share many similar communication and electrolocation behaviors that require modulation of the frequency of their electric organ discharges. The premotor linkages between their electrosensory system and their medullary pacemaker nucleus, which controls the repetition rate of their electric organ discharges, appear to function differently, however. In the context of the jamming avoidance response, Eigenmannia can raise or lower its electric organ discharge frequency from its resting level. A normally quiescent input from the diencephalic pre-pacemaker nucleus can be recruited to raise the electric organ discharge frequency above the resting level. Another normally active input, from the sublemniscal pre-pacemaker nucleus, can be inhibited to lower the electric organ discharge frequency below the resting level (Metzner 1993). In contrast, during a jamming avoidance response, Apteronotus cannot lower its electric organ discharge frequency below the resting level. The sublemniscal pre-pacemaker is normally completely inhibited and release of this inhibition allows the electric organ discharge frequency to rise during the jamming avoidance response. Further inhibition of this nucleus cannot lower the electric organ discharge frequency below the resting level. Lesions of the diencephalic pre-pacemaker do not affect performance of the jamming avoidance response. Thus, in Apteronotus, the sublemniscal pre-pacemaker alone controls the changes of the electric organ discharge frequency during the jamming avoidance response.

Binaural cross-correlation predicts the responses of neurons in the owl's auditory space map under conditions simulating summing localization.

Summing localization describes the perceptions of human listeners to two identical sounds from different locations presented with delays of 0-1 msec. Usually a single source is perceived to be located between the two actual source locations, biased toward the earlier source. We studied neuronal responses within the space map of the barn owl to sounds presented with this same paradigm. The owl's primary cue for localization along the azimuth, interaural time difference (ITD), is based on a cross-correlation-like treatment of the signals arriving at each ear. The output of this cross-correlation is displayed as neural activity across the auditory space map in the external nucleus of the owl's inferior colliculus. Because the ear input signals reflect the physical summing of the signals generated by each speaker, we first recorded the sounds at each ear and computed their cross-correlations at various interstimulus delays. The resulting binaural cross-correlation surface strongly resembles the pattern of activity across the space map inferred from recordings of single space-specific neurons. Four peaks are observed in the cross-correlation surface for any nonzero delay. One peak occurs at the correlation delay equal to the ITD of each speaker. Two additional peaks reflect "phantom sources" occurring at correlation delays that match the signal of the left speaker in one ear with the signal of the right speaker in the other ear. At zero delay, the two phantom peaks coincide. The surface features are complicated further by the interactions of the various correlation peaks.

Responses to simulated echoes by neurons in the barn owl's auditory space map.

The natural acoustical environment contains many reflective surfaces that give rise to echoes, complicating the task of sound localization and identification. The barn owl (Tyto alba), as a nocturnal predator, relies heavily on its auditory system for tracking and capturing prey in this highly echoic environment. The external nucleus of the owl's inferior colliculus (ICx) contains a retina-like map of space composed of "space-specific" auditory neurons that have spatially limited receptive fields. We recorded extracellularly from individual space-specific neurons in an attempt to understand the pattern of activity across the ICx in response to a brief direct sound and a simulated echo. Space-specific neurons responded strongly to the direct sound, but their response to a simulated echo was suppressed, typically, if the echo arrived within 5 ms or less of the direct sound. Thus we expect there to be little or no representation within the ICx of echoes arriving within such short delays. Behavioral tests using the owl's natural tendency to turn their head toward a sound source suggested that owls, like their space-specific neurons, similarly localize only the first of two brief sounds. Naive, untrained owls were presented with a pair of sounds in rapid succession from two horizontally-separated speakers. With interstimulus delays of less than 10 ms, the owl consistently turned its head toward the leading speaker. Longer delays elicited head turns to either speaker with approximately equal frequency and in some cases to both speakers sequentially.

An anatomical substrate for the inhibitory gradient in the VLVp of the owl.

The interaural difference in the level of sounds is an important cue for the localization of the sound's source. In the barn owl, a keen auditory predator, this binaural cue is first computed in the nucleus ventralis lemnisci laterale, pars posterior (VLVp), a cell group found within the fibers of the lateral lemniscus. Its neurons are excited by inputs from the contralateral ear and inhibited by inputs to the ipsilateral ear and are therefore sensitive indicators of interaural level difference. The excitation arrives by a direct input from the contralateral nucleus angularis, a cochlear nucleus, and the inhibition is mediated by a commissural projection that interconnects the VLVps of the two sides. The dorsally located neurons in the VLVp are more heavily inhibited than those found more ventrally, thus giving rise to a gradient of inhibition. This inhibitory gradient plays a central role in recent models of VLVp function. We present evidence based on standard anterograde tracing methods that this gradient of inhibition is mediated by a dorsoventral gradient in the density of synaptic inputs from the contralateral VLVp, the source of inhibition. Specifically, injection of tracers into one VLVp, regardless of the position of the injection within the nucleus, produced a vertically oriented field of label that was densest along the dorsal margin of the contralateral VLVp and became sparser a more ventral levels. Furthermore, we found that injections into the medial and lateral aspects of the nucleus produced this dorsoventrally graded field of label along the medial and lateral aspects of the contralateral VLVp, respectively. Finally, we confirmed an earlier observation suggesting that the anterior and posterior aspects of one VLVp project to the anterior and posterior aspects of the contralateral nucleus, respectively.

Representation of multiple sound sources in the owl's auditory space map.

The barn owl's inferior colliculus contains a retina-like map of space on which a sound generates a focus of activity whose position corresponds to the location of the sound source. When there is more than one source of sound, the sound waves sum and may generate spurious binaural cues that degrade the auditory image. We investigated the signal conditions under which neurons in the owl's auditory space map are able to resolve two simultaneously active sound sources. We recorded from space map neurons responding to sounds from a pair of speakers separated in azimuth by 45 degrees and mounted on a rotatable arm. Stimuli consisted of a sum of sinusoids or pseudorandom noise bursts emitted simultaneously and at equal overall levels. The characteristics of the sounds in each speaker were varied, and the neuron's response was plotted as a function of the speaker pair's position. When the speakers emitted different sets of summed sinusoids, the cells responded to each speaker separately; that is, the cells were able to resolve two separate targets. However, when the speakers emitted identical summed sinusoids generating binaural cues that were identical to those of a single phantom source between the two speakers, the neurons responded when the speakers were on either side of their receptive fields. By manipulating the amplitude at which each speaker emitted the various frequencies, we could control the position, number, and size of the phantom sources detected by the cell. The cells also resolved two separate sources when they emitted noise bursts that were statistically independent or temporally reversed versions of one another. Since the overall spectra of such waveforms are identical, we suggest that the space map relies on differences between noise bursts that exist over brief time spans.

Simulated motion enhances neuronal selectivity for a sound localization cue in background noise.

In nature, sound sources move and signals are accompanied by background noise. Noting that motion helps the perception of visual stimuli, we tested whether motion similarly facilitates the detection of acoustic targets, at the neuronal level. Auditory neurons in the central nucleus of the barn owl's inferior colliculus (ICc), due to their selectivity for interaural phase difference (delta phi), are sharply tuned to the azimuth of sound sources and are arrayed to form a topographic map of delta phi. While recording from single ICc neurons, we presented tones that simulated either moving or stationary sound sources with and without background noise. We found that the tuning of cells in the ICc for delta phi was sharper for stimuli that simulated motion than for those that simulated stationary targets. The neurons signaled the presence of a tone obscured by noise better if the tone moved than if the tone remained stationary. The resistance to noise observed with moving stimuli could not be reproduced with the temporal modulation of the stimulus amplitude, suggesting that a change of position over time was required.

Commissural connections mediate inhibition for the computation of interaural level difference in the barn owl.

In the barn owl (Tyto alba), the posterior nucleus of the ventral lateral lemniscus (VLVp) is the first site of binaural convergence in the pathway that processes interaural level difference (ILD), an important sound-localization cue. The neurons of VLVp are sensitive to ILD because of an excitatory input from the contralateral ear and an inhibitory input from the ipsilateral ear. A previously described projection from the contralateral cochlear nucleus, can account for the excitation. The present study addresses the source of the inhibitory input. We demonstrate with standard axonal transport methods that the left and right VLVps are interconnected via fibers of the commissure of Probst. We further show that the anesthetization of one VLVp renders ineffective the inhibition that is normally evoked by stimulation of the ipsilateral ear. Thus, one cochlear nucleus (driven by the ipsilateral ear) appears to provide inhibition to the ipsilateral VLVp by exciting commissurally-projecting inhibitory neurons in the contralateral VLVp.

The control of pacemaker modulations for social communication in the weakly electric fish Sternopygus.

Nearly sinusoidal electric organ discharges (EODs) of the weakly electric fish Sternopygus, occur at a regular rate within a range from 50 to 200 Hz and are commanded by a medullary pacemaker nucleus (Pn). During courtship and aggression, the rate of EODs is modulated as smooth EOD-frequency rises or brief EOD-interruptions (Hopkins 1974b). The present study examines the control of such modulations. Rises were elicited by L-glutamate stimulation of the diencephalic prepacemaker nucleus, the only previously known source of input to the Pn. We demonstrate an additional input to the Pn, the sublemniscal prepacemaker nucleus (SPPn). L-glutamate stimulation of this area caused EOD-interruptions. The Pn contains electrotonically coupled 'pacemaker cells' which generate the rhythm of the EODs, as well as 'relay cells' which transmit the command pulse to the spinal motor neurons that innervate the electric organ. Pacemaker cells recorded intracellularly during EOD-interruptions continued firing at their regular frequency but with slightly increased jitter. Relay cells, on the other hand, were strongly depolarized and fired spikelets at a greatly increased frequency during EOD-interruptions. Thus EOD-interruptions were caused by SPPn input to relay cells that caused their massive depolarization, blocking the normal input from pacemaker cells without greatly affecting pacemaker cell firing characteristics. Application to the Pn of an antagonist to NMDA-type glutamate receptors blocked EOD-frequency rises and EOD-interruptions. Antagonists to quisqualate/kainate receptor-types were ineffective.

Structure and function of neurons in the complex of the nucleus electrosensorius of the gymnotiform fish Eigenmannia: detection and processing of electric signals in social communication.

The complex of the diencephalic nucleus electrosensorius (nE) provides an interface between the electrosensory processing performed by the torus semicircularis and the control of specific behavioral responses. The rostral portion of the nE comprises two subdivisions that differ in the response properties and projection patterns of their neurons. First, the nEb, which contains neurons that are driven almost exclusively by beat patterns generated by the interference of electric organ discharges (EODs) of similar frequencies. Second, the area medial to the nEb, comprising the lateral pretectum (PT) and the nE-acusticolateralis region (nEar, 1 B-D), which contains neurons excited predominantly by EOD interruptions, signals associated with aggression and courtship. Neurons in the second area commonly receive convergent inputs originating from ampullary and tuberous electroreceptors, which respond to the low-frequency and high-frequency components of EOD interruptions, respectively. Projections of these neurons to hypothalamic areas linked to the pituitary may mediate modulations of a fish's endocrine state that are caused by exposure to EOD interruptions of its mate.

Spontaneous discharge of afferents in a neuroma reflects original receptor tuning.

Injured afferent axons trapped in chronic nerve-end neuromas frequently generate spontaneous discharge. We asked whether the patterns of discharge originating at such sites of ectopic electrogenesis bear a consistent relationship to the patterns of discharge characteristic of the corresponding intact afferent types before injury. Nerve-end neuromas were created in electrosensory lateral line nerves in 3 species of weakly electric Gymnotiform fish. Species were chosen in which normal afferent activity occurs at highly characteristic, non-overlapping, species-specific frequencies. Afferent impulse discharge was recorded in vivo from lateral line nerve end neuromas using the nerve-teasing technique. The distribution of firing frequencies of spontaneously active neuroma afferents was relatively uniform within a given fish species, and differed significantly from species to species. Mean values were somewhat lower than for corresponding intact afferents, but the rank order of frequencies across the species was preserved. These data indicate that differential membrane remodelling after axotomy tends to reestablish normal afferent fiber tuning despite failure of regeneration, and in the absence of peripheral electroreceptor reinnervation.