Exhaled nitric oxide and exercise-induced bronchospasm assessed by FEV1, FEF25-75% in childhood asthma.

The relationship between exhaled nitric oxide (eNO) and bronchial hyperresponsiveness (BHR) should be clarified. The aim of this study was to determine the relationship between eNO and exercise-induced bronchospasm (EIB) by estimation of the each lung parameter in asthmatic children who performed a bicycle ergometer exercise test. Twenty children with asthma were recruited. eNO concentration was examined by the recommended online method. To evaluate BHR, an exercise stress test was performed on a bicycle ergometer. The mean baseline eNO value was significantly correlated with the mean maximum % fall in forced expiratory volume in 1 second (FEV1), forced expiratory flow between 25% and 75% (FEF25-75%) after exercise (r=0.53, r=0.65, respectively). eNO in the EIB-positive group was significantly higher than that in the EIB-negative group by assessing FEV1, FEF25-75% (p<0.005, p=0.005). We demonstrated that the most important lung parameter assessed the occurrence of EIB by a bicycle ergometer exercise test was not only FEV1 but FEF25-75%, which significantly correlated with eNO. This suggests that not only FEV1 but FEF25-75% can be used to evaluate the correlations between BHR (EIB) and airway inflammation (eNO) in asthmatic children. A low eNO is useful for a negative predictor for EIB.

Effect of inhaled steroid therapy on exhaled nitric oxide and bronchial responsiveness in children with asthma.

Inhaled steroid therapy is reported to reduce the level of exhaled nitric oxide (eNO), but the effects of inhaled corticosteroids (ICS) on bronchial hyperresponsiveness (BHR) have been controversial. The aim of this study was to determine the effects of ICS on the relationship between eNO and BHR. Twenty-six children with asthma were recruited, including 14 children who were receiving ICS (ICS group) and 12 who were not (ICS-naive group). The fractional exhaled nitric oxide concentration (FE(NO)) was examined by the recommended online method. To evaluate BHR, an acetylcholine challenge test was performed. In the ICS-naive group, FE(NO) was significantly correlated with PC20 (p < 0.05, r = -0.70), but not in the ICS group. In conclusion, FE(NO) was significantly correlated with BHR in the ICS-naive group, but this relationship was not present in the ICS group. Our results suggest that the use of ICS should be taken into consideration when evaluating the relation between BHR and airway inflammation.

[Quantitative assessment of pressure relief at the sacral area in adults lying supine on the operating room table].

BACKGROUND: It is important to prevent development of the pressure ulcers in patients undergoing lengthy surgery, particularly at areas of skin overlying bony prominences. This study was designed to investigate distribution of the interface pressure (IP) over the body area (from the head to pelvic area) in supine adults and also evaluate the ability of a polyurethane-made cushion to reduce the IP at their sacral area. METHODS: Utilizing a recently developed device to measure the IP (ERGO-CHECK, ABW Co., Germany), we evaluated distribution of the IP (estimated per 3 x 4 cm2 area) over the body area in healthy volunteers (n=31) and patients under general anesthesia (n=6) lying supine on the operating room (OR) table. RESULTS: In all the subjects, the highest IP was generated at the sacrum; 62.5 +/- 23.8 (mean +/- SD) and 35.7 +/- 5.5 mmHg in the volunteers and patients, respectively. The polyurethane-made, "doughnut" cushion (5 cm in thickness) inserted between the pelvic area and the OR table significantly reduced (P < 0.05) the IP at the sacrum in both groups: the IPs after the insertion in the volunteers and patients were 35.1 +/- 11.1 and 25.6 +/- 6.5 mmHg, respectively. In addition, the insertion significantly reduced (P < 0.05) the high-risk area (i.e., area of IP > 32 mmHg) in both groups. CONCLUSIONS: Quantitative assessment of the IP would be useful in evaluating precisely the effectiveness of various types of pillows, cushions, or mattresses designed to reduce the IP.

[Spinal anesthesia using hyperbaric bupivacaine HCl for cesarean section].

BACKGROUND: We performed this prospective study to determine the proper amount of hyperbaric bupivacaine hydrochloride as a spinal anesthetic agent for cesarean section. METHODS: The parturients were randomly allocated to receive one of four spinal agents in a blind manner; tetracaine 10 mg (control), bupivacaine 10, 12.5 and 15 mg. Morphine HCl 0.1 mg was added to each agent and the total volume was adjusted to 3.1 ml with 10% glucose solution. RESULTS: All the four spinal agents provided an adequate analgesic level (T 5) without serious complications. Among the three dosages of bupivacaine, the time interval requiring for anesthetic level to reach T 5 tended to be shorter with a larger amount of bupivacaine. The incidence of intraoperative supplemental analgesic and hypotension and the dosage of ephedrine used to treat hypotension were greater in the patients anesthetized with tetracaine 10 mg than in those anesthetized with bupivacaine 10 mg, which is equipotent to tetracaine 10 mg. CONCLUSIONS: 1. As a spinal anesthetic agent for cesarean section, hyperbaric bupivacaine is superior to tetracaine. 2. Hyperbaric bupivacaine 10 mg, 12.5 mg or 15 mg can be used safely and effectively as a spinal agent for cesarean section. 3. High dose bupivacaine is recommended in an urgent case, and low dose bupivacaine is recommended when maternal hypotension must be strictly avoided.