Influence of solid surface, adhesive ability, and inoculum size on bacterial colonization in microcosm studies.

Microcosm studies were performed to evaluate the effect of solid surfaces, bacterial adhesive ability, and inoculum size on colonization success and persistence of Pseudomonas fluorescens and Xanthomonas maltophilia, each with a Tn5 insertion that conferred resistance to kanamycin and streptomycin. Two types of microcosms were used: (i) a simple system that was colonized by Aeromonas hydrophila and a coryneform and (ii) a complex system produced from lake water enrichment cultures. Simple microcosms contained 100 ml of peptone- and yeast extract-supplemented artificial lake water or 60 ml of peptone- and yeast extract-supplemented artificial lake water with 70 g of 3-mm glass beads. Complex microcosms contained 100 ml of lake water with no nutrient additions or 100 ml of lake water with 70 g of glass beads. The microcosms were incubated for 35 days at 20 degrees C. In lake water enrichment microcosms, the presence of beads increased the abilities of P. fluorescens or X. maltophilia to colonize, but their numbers decreased with time in microcosms both with and without beads. The adhesiveness of the bacteria, measured in an in vitro assay, did not relate to colonization success. In simple microcosms, the inoculum size (10, 10, or 10) of P. fluorescens did not influence colonization success. However, in complex microcosms, an inoculum of 10 cells was insufficient to ensure colonization by P. fluorescens, while 10 cells resulted in colonization of liquid and beads. Simple microcosm studies, utilizing only a few species, were poor models for complex natural systems. In complex enrichment systems, colonization of surfaces resulted in higher numbers of organisms but did not noticeably promote persistence. Adhesiveness of a particular organism may be a relatively minor factor influencing its ability to colonize solid surfaces in complex natural environments.

Hemodynamic effects of mivacurium chloride administered to patients during oxygen-sufentanil anesthesia for coronary artery bypass grafting or valve replacement.

The hemodynamic effects of mivacurium chloride were studied in 54 adult cardiac patients anesthetized with midazolam and sufentanil. After baseline data were collected, a placebo (N = 9) or mivacurium was administered over 60 seconds, the latter in doses of 0.15 (N = 18), 0.20 (N = 18), or 0.25 (N = 9) mg/kg. Measurements were repeated 2, 5, and 10 minutes later. Baseline measurements were similar. A slight decrease in heart rate over time reached statistical significance in several groups including the control group. Mean arterial, mean pulmonary arterial, pulmonary arterial occlusion, and right atrial pressures and cardiac output did not change, nor did systemic and pulmonary vascular resistances and cardiac index. Besides the decrease in heart rate, the only hemodynamic change to reach statistical significance was an increase in stroke volume in patients given mivacurium 0.25 mg/kg. Significant hypotension occurred in two patients; in one, a sudden decrease in mean arterial pressure of 24% occurred 1 minute after mivacurium 0.20 mg/kg. Blood pressure was restored by ephedrine 10 mg. In the other patient, given mivacurium 0.25 mg/kg, mean arterial pressure decreased 50% from 73 to 37 mm Hg. Recovery was rapid without treatment. It is concluded that mivacurium administered in doses of 0.15 to 0.25 mg/kg over 60 seconds to cardiac patients is associated with few significant hemodynamic effects. However, a small number of patients may experience significant transient hypotension when given doses greater than of 0.15 mg/kg, two times the ED95.

Hemodynamic effects of doxacurium chloride in patients receiving oxygen sufentanil anesthesia for coronary artery bypass grafting or valve replacement.

Doxacurium chloride is an investigational long-acting neuromuscular blocking drug, which has been shown to be devoid of cardiovascular side effects when administered in modest doses to healthy patients. This is the first hemodynamic study of doxacurium in adult patients with cardiac disease. Forty-one patients scheduled to undergo cardiac surgery were studied. Anesthesia consisted of induction with midazolam 0.2-0.3 mg/kg and sufentanil 0.01-0.03 mg followed by an infusion of sufentanil at 0.03-0.06 mg.min-1. Baseline hemodynamic data were collected during a stable state of sufentanil anesthesia. Doxacurium was then administered in doses of 1, 2, or 3 times its ED95 of 0.025 mg/kg. Hemodynamic measurements were repeated at 2, 5, and 10 min after doxacurium injection in the absence of surgical stimulation. An additional group of control patients received saline instead of doxacurium. Baseline hemodynamic measurements were similar among groups. There was a slight decrease in heart rate in all groups over time. However, there was no significant difference between the groups of patients receiving doxacurium and the control group in which the heart rate decreased progressively from 52 beats/min at baseline to 49 beats/min 10 min after doxacurium administration. At no time was there any significant change in mean arterial pressure, right atrial pressure, or cardiac output. Likewise derived hemodynamic variables including cardiac index, stroke volume, and pulmonary vascular resistance were unchanged. In addition to the decrease in heart rate, the hemodynamic changes, which reached statistical significance, were clinically insignificant and occurred predominantly in the group of patients receiving doxacurium 0.08 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Foetal monitoring in parturients undergoing surgery unrelated to pregnancy.

Foetal heart rate and tocodynamic monitoring of the uterus was performed in five pregnant patients undergoing urgent or emergency surgery unrelated to their pregnancy. All received general anaesthesia with halothane or enflurane and nitrous oxide. The loss of beat-to-beat variation of the foetal heart rate was observed in all patients under general anaesthesia, and is probably normal for the anaesthetized foetus. Since continuous intraoperative monitoring of foetal heart rate in pregnant patients is technically feasible during peripheral surgery and during many intra-abdominal procedures, attempts should be made to monitor foetal heart rate in all anaesthetized parturients to assure that the anaesthetic is not causing foetal insult. Postoperative monitoring of uterine tone is useful in the diagnosis and treatment of postoperative premature labor.

Comparison of the maternal and neonatal effects of halothane, enflurane, and isoflurane for cesarean delivery.

The maternal and neonatal effects of 50% O2-50% N2O alone and 50% O2-50% N2O combined with 0.5% halothane, 1.0% enflurane, or 0.75% isoflurane were studied in 42 healthy parturients undergoing general anesthesia for elective primary or repeat cesarean delivery at term. All patients received thiopental and succinylcholine for induction and were intubated and ventilated with a tidal volume of 10 ml/kg at a rate of 10 breaths/min. Two of 12 (17%) patients given O2-N2O alone had recall; none who received a potent inhalation agent had any recall. Blood loss was similar in all four groups. There were no significant differences between groups in induction-to-delivery and uterine incision-to-delivery intervals, the frequency of Apgar scores less than 7 at 1 and 5 min, maternal and fetal blood-gas tensions, acid-base balance, lactate values, and early neonatal neurobehavioral scores at 2-4 h. It is concluded that analgesic concentrations of halothane, enflurane, and isoflurane can be safely added to 50% O2-50% N2O to prevent maternal awareness during general anesthesia for cesarean delivery while maintaining normal maternal and neonatal conditions.