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Complete Block (complete + block)

Distribution by Scientific Domains
Medical Sciences77%
Distribution within Medical Sciences
Anesthesia & Pain Management42%

Terms modified by Complete Block

  • complete block design
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    Selected Abstracts

    Linear Ablation with Duty-Cycled Radiofrequency Energy at the Cavotricuspid Isthmus

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2010
    STEFANIE BOLL
    Background: Multielectrode catheters using duty-cycled radiofrequency (RF) have been developed to treat atrial fibrillation (AF). Many of these patients also have atrial flutter. Therefore, a linear multielectrode has been developed using the same RF energy. Objective: The concept and acute results of linear ablation using duty-cycled RF were tested in the cavotricuspid isthmus (CTI). Methods: The CTI was targeted in 75 patients, in 68 (90%) among them as an adjunct to AF ablation with the same technology. A linear electrode catheter with a 4-mm tip and five 2-mm ring electrodes was connected to a generator titrating duty-cycled RF at 20,45 W up to a target temperature of 70°C in 1:1 unipolar/bipolar mode. Results: During a mean procedure time of 20 ± 12 minutes, complete CTI block was achieved by 4 ± 3 applications of duty-cycled RF in 69 (92%) patients. No more than three RF applications were necessary in 60% of patients. During the initial learning curve, standard RF had to be used in five (7%) patients. Complete block was not achieved in one patient with frequent episodes of AF. Char was observed in five (7%) patients with poor electrode cooling; consequently, the temperature ramp-up was slowed and manually turned off in the event of low-power delivery. Two groin hematomas occurred; otherwise, no clinical complications were observed. Conclusion: Multielectrode catheters delivering duty-cycled RF can effectively ablate the CTI with few RF applications with promising acute results. Further modifications are necessary to improve catheter steering and prevent char formation. (PACE 2010; 444,450) [source]

    Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study

    ANAESTHESIA, Issue 10 2007
    G. J. Van Geffen
    Summary The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus. [source]

    Impact of Phosphorus from Dairy Manure and Commercial Fertilizer on Perennial Grass Forage Production

    JOURNAL OF AGRONOMY AND CROP SCIENCE, Issue 6 2003
    E. A. Mikhailova
    Abstract Increased recovery and recycling of manure phosphorus (P) by crops on dairy farms is needed to minimize environmental problems. The main objective of this study was to compare P utilization by orchardgrass (Dactylis glomerata L.) and tall fescue (Festuca arundinaceae Schreb.) from dairy manure or inorganic fertilizer. The study was conducted from 1994 to 2000 at the Cornell University Baker Farm, Willsboro, NY, on a somewhat poorly drained Kingsbury clay (very,fine, illitic, mesic Aeric Epiaqualfs). The design was a split-plot in a randomized complete block with two manure rates (16 800 and 33 600 kg ha,1) and one nitrogen (N) fertilizer rate (84 kg N ha,1 at spring greenup and 56 kg N ha,1 prior to each regrowth harvest) as the main plots and grass species as subplots replicated six times. Fertilizer P [Ca(H2PO4)2] was applied to the fertilizer treatment in 1995 and 1996 at 11 kg P ha,1 year,1. Orchardgrass P removal averaged 21 % higher than tall fescue P removal for the spring harvest, but orchardgrass averaged 24 % lower P removal than tall fescue removal for all regrowth harvests from 1995,99. Phosphorus herbage concentration in the fertilizer treatment was in the range of 1.9,2.7 g P kg,1 compared with 2.2,5.3 g P kg,1 in the manure treatments. Seasonal P removal ranged from as low as 9.2 kg P ha,1 to as high as 48.5 kg P ha,1. Morgan extractable soil P in the top 0,0.20 m remained high through 1999, with 29.1 kg P ha,1 at the highest manure rate in tall fescue compared with 8.4 kg P ha,1 measured in 1993 prior to the experiment. In 2000, soil P at the highest manure rate in tall fescue dropped to 10.1 kg P ha,1, following cessation of manure application in 1998. Intensively managed harvested orchardgrass and tall fescue have the potential to remove large quantities of manure P. [source]

    Electrogram Polarity and Cavotricuspid Isthmus Block During Ablation of Typical Atrial Flutter

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2001
    HIROSHI TADA M.D.
    Electrogram Polarity in Atrial Flutter Ablation.Introduction: The atrial activation sequence around the tricuspid annulus has been used to assess whether complete block has been achieved across the cavotricuspid isthmus during radiofrequency ablation of typical atrial flutter. However, sometimes the atrial activation sequence does not clearly establish the presence or absence of complete block. The purpose of this study was to determine whether a change in the polarity of atrial electrograms recorded near the ablation line is an accurate indicator of complete isthmus block. Methods and Results: Radiofrequency ablation was performed in 34 men and 10 women (age 60 ± 13 years [mean ± SD]) with isthmus-dependent, counterclockwise atrial flutter. Electrograms were recorded around the tricuspid annulus using a duodecapolar halo catheter. Electrograms recorded from two distal electrode pairs (E1 and E2) positioned just anterior to the ablation line were analyzed during atrial flutter and during coronary sinus pacing, before and after ablation. Complete isthmus block was verified by the presence of widely split double electrograms along the entire ablation line. Complete bidirectional isthmus block was achieved in 39 (89%) of 44 patients. Before ablation, the initial polarity of E1 and E2 was predominantly negative during atrial flutter and predominantly positive during coronary sinus pacing. During incomplete isthmus block, the electrogram polarity became reversed either only at E2, or at neither E1 nor E2. In every patient, the polarity of E1 and E2 became negative during coronary sinus pacing only after complete isthmus block was achieved. In 4 patients (10%), the atrial activation sequence recorded with the halo catheter was consistent with complete isthmus block, but the presence of incomplete block was accurately detected by inspection of the polarity of E1 and E2. Conclusion: Reversal of polarity in bipolar electrograms recorded just anterior to the line of isthmus block during coronary sinus pacing after ablation of atrial flutter is a simple, quick, and accurate indicator of complete isthmus block. [source]

    Atrial Electrogram Amplitude and Efficacy of Cavotricuspid Isthmus Ablation for Atrial Flutter

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2003
    MEHMET OZAYDIN
    Large atrial electrogram amplitudes recorded in the cavotricuspid isthmus (CTI) may reflect thick atrial musculature. For this reason, in patients with atrial flutter, the efficacy of an application of conventional radiofrequency energy may be related to the amplitude of the local atrial electrogram. In 100 consecutive patients (mean age 59 ± 13 years) with atrial flutter, contiguous applications of radiofrequency energy were delivered in the CTI. The criterion for complete CTI block was the presence of widely split double potentials (>110 ms) along the entire ablation line during pacing from the coronary sinus and posterolateral right atrium. The atrial electrogram amplitude was measured before and after applications of radiofrequency energy at sites of gaps in the ablation line. Complete CTI block was achieved in 90 (90%) of the 100 patients. The mean atrial electrogram amplitudes at gap sites where an application of radiofrequency energy did and did not result in complete block were 0.36 ± 0.42 and 0.67 ± 0.62 mV, respectively (P < 0.01). The positive and negative predictive values (for complete block) of a ,50% decrease in electrogram amplitude after an application of radiofrequency energy were 100% and 35%, respectively. The mean atrial electrogram amplitude is larger at CTI sites where complete isthmus block cannot be achieved with conventional radiofrequency energy. The efficacy of conventional radiofrequency ablation may be improved by identifying areas in the CTI where the voltage is relatively low. (PACE 2003; 26:1859,1863) [source]

    A comparison of coracoid and axillary approaches to the brachial plexus

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2000
    Z. J. Koscielniak-Nielsen
    Background: Brachial plexus block by the coracoid approach does not require arm abduction and may be more effective than the axillary approach because of a more proximal injection of local anaesthetic. However, the clinical usefulness of the coracoid approach has not been tested in prospective controlled trials. The present randomized, observer-blinded study compared success rates, time to obtain a complete block, frequency of adverse effects and block discomfort in two groups of 30 patients, anaesthetized for hand surgery using either the coracoid or the axillary approach to the brachial plexus. Methods: After subcutaneous infiltration with 5 ml of 1% mepivacaine/adrenaline the brachial plexus was located using a nerve stimulator and an insulated pencil-point needle. Ropivacaine 0.75%, 20,40 ml, depending on body weight, was used for the initial block. In the coracoid (C) group two plexus cords, and in the axillary (A) group four terminal nerves were electrolocated and the volume of ropivacaine was divided equally between them. Spread of analgesia to the arm was assessed every 5 min, by an anaesthetist unaware of the block technique. The block was defined as effective (complete) when analgesia was present in all five sensory nerve areas distal to the elbow. Incomplete blocks were supplemented 30 min after the initial block. Results: In the C group a median 11 min was required for block performance as compared to 12 min in the A group (NS). Onset of block was shorter and the frequency of incomplete blocks lower in the A group (median 17 min and 17%) than in the C group (30 min and 47%, respectively). Lack of analgesia of the ulnar nerve was the main cause of incomplete initial blocks in the C group. All incomplete blocks were successfully supplemented. However, total time to obtain complete block was shorter in the A group than in the C group (29 min vs. 41 min, P<0.05). Accidental arterial puncture occurred in seven patients (five in C and two in A group), which resulted in two haematomas, both in the C group (NS). No permanent sequelae were observed. Conclusion: The axillary approach to the brachial plexus using four injections of ropivacaine results in a faster onset of block and a better spread of analgesia than the coracoid approach using two injections. [source]

    Improving the precision of cotton performance trials conducted on highly variable soils of the southeastern USA coastal plain

    PLANT BREEDING, Issue 6 2007
    B. T. Campbell
    Abstract Reliable agronomic and fibre quality data generated in Upland cotton (Gossypium hirsutum L.) cultivar performance trials are highly valuable. The most common strategy used to generate reliable performance trial data uses experimental design to minimize experimental error resulting from spatial variability. However, an alternative strategy uses a posteriori statistical procedures to account for spatial variability. In this study, the efficiency of the randomized complete block (RCB) design and nearest neighbour adjustment (NNA) were compared in a series of cotton performance trials conducted in the southeastern USA to identify the efficiency of each in minimizing experimental error for yield, yield components and fibre quality. In comparison to the RCB, relative efficiency of the NNA procedure varied amongst traits and trials. Results show that experimental analyses, depending on the trait and selection intensity employed, can affect cultivar or experimental line selections. Based on this study, we recommend researchers conducting cotton performance trials on variable soils consider using NNA or other spatial methods to improve trial precision. [source]

    Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?

    COLORECTAL DISEASE, Issue 8 2009
    G. J. A. Stenhouse
    Abstract Objective, Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self-expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions. Method, A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7-year period (April 1999,October 2006) was undertaken. Results, Seventy-two patients (49 males) with a mean age of 71 years (range 49,98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death. Conclusion, Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable. [source]

    Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study

    ANAESTHESIA, Issue 3 2010
    P. Marhofer
    Summary Our study group recently evaluated an ED95 local anaesthetic volume of 0.11 ml.mm,2 cross-sectional nerve area for the ulnar nerve. This prospective, randomised, double-blind crossover study investigated whether this volume is sufficient for brachial plexus blocks at the axillary level. Ten volunteers received an ultrasonographic guided axillary brachial plexus block either with 0.11 (,low' volume) or 0.4 (,high' volume) ml.mm,2 cross-sectional nerve area with mepivacaine 1%. The mean (SD) volume was in the low volume group 4.0 (1.0) and 14.8 (3.8) ml in the high volume group. The success rate for the individual nerve blocks was 27 out of 30 in the low volume group (90%) and 30 out of 30 in the high volume group (100%), resulting in 8 out of 10 (80%) vs 10 out of 10 (100%) complete blocks in the low vs the high volume groups, respectively (NS). The mean (SD) sensory onset time was 25.0 (14.8) min in the low volume group and 15.8 (6.8) min in the high volume group (p < 0.01). The mean (SD) duration of sensory block was 125 (38) min in the low volume group and 152 (70) min in the high volume group (NS). This study confirms our previous published ED95 volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time. [source]