Dexmedetomidina vs Remifentanil en fast track (transito rápido) durante cirugía cardiaca

Actualmente las técnicas de anestesia de tránsito rápido en cirugía cardiaca se basan en la utilización de remifentanil, sin embargo este al tener una vida media tan corta hace que sea necesaria la utilización de opioides durante el posoperatorio inmediato presentandose el riesgo de depresión ventilatoria, y complicaciones respiratorias, es por esto que la dexmedetomidina podría ser una opción bastante atractiva debida a que no produce depresión de los centros respiratorios, y disminuye el consumo de opioides en el postoperatorio hasta un 66%. Previa aprobación del comité de ética se realizó un estudio clínico controlado y aleatorizado en dos grupos de 20 pacientes, El primer grupo recibió inducción con propofol 2mg/Kg, pancuronio 0.8mg/kg, y fentanil 2mcg/kg seguido de un bolo de dexmedetomidina de 0.5mcg/kg y una infusión de 0.3 - 0.7 mcg/kg/h la cual fue suspendida al finalizar la colocación de los alambres esternales, el grupo de remifentanil recibió una inducción con propofol y pancuronio a las mismas dosis, seguido de una infusión de remifentanil de 0.1 - 0.5 mcg/kg/min suspendida al finalizar el cierre de la piel, ambos grupos recibieron analgesia con dipirona 50mg/kg, morfina 0.1mg/kg seguida de dosis de rescate de 3mg según necesidad, e infiltración de la herida quirurgica con 40cc de Bupivacaina al 0.25%. Se midio el tiempo y lugar de extubación, el consumo de medicamentos vasopresores y vasodilatadores durante la cirugiaasi como el consumo de morfina el VAS y la incidencia de nausea y vomito durante las primeras 24h posoperatorias. El 85% de los pacientes fueron extubados en salas de cirugia, sin encontrarse diferencias estadiscamente significativas entre los tiempos de extubación de ambos grupos (11.7min) para remifentanil, y (9.6min) para dexmedetomidina, en cuanto al consumo de morfina este fue significativamente menor en el grupo de dexmedetomidina 4mg vs 15mg en el grupo de remifentanil así como también lo fue la incidencia de nausea y vomito 42.9% remifentanil vs 5.2% dexmedetomidina p:0.00009. A nuestro saber este es el primer estudio clínico en la literatura en el cual se ha propuesto a la dexmedetomidina como una alternativa para técnicas anestésicas de transito rápido en cirugia cardiaca. Los resultados sugieren que es tan eficaz como el remifentanil para permitir la extubación temprana de este grupo de pacientes con una menor consumo de morfina y una menor incidencia de nauseas y vomito durante el posoperatorio. Se recomiendan la realización de estudios adicionales que permitan ratificar los resultados previamente encontrados.

The Storm-Track Response to Idealized SST Perturbations in an Aquaplanet GCM

The tropospheric response to midlatitude SST anomalies has been investigated through a series of aquaplanet simulations using a high-resolution version of the Hadley Centre atmosphere model (HadAM3) under perpetual equinox conditions. Model integrations show that increases in the midlatitude SST gradient generally lead to stronger storm tracks that are shifted slightly poleward, consistent with changes in the lower-tropospheric baroclinicity. The large-scale atmospheric response is, however, highly sensitive to the position of the SST gradient anomaly relative to that of the subtropical jet in the unperturbed atmosphere. In particular, when SST gradients are increased very close to the subtropical jet, then the Hadley cell and subtropical jet is strengthened while the storm track and eddy-driven jet are shifted equatorward. Conversely, if the subtropical SST gradients are reduced and the midlatitude gradients increased, then the storm track shows a strong poleward shift and a well-separated eddy-driven jet is produced. The sign of the SST anomaly is shown to play a secondary role in determining the overall tropospheric response. These findings are used to provide a new and consistent interpretation of some previous GCM studies concerning the atmospheric response to midlatitude SST anomalies.

Storm track sensitivity to sea surface temperature resolution in a regional atmosphere model

A high resolution regional atmosphere model is used to investigate the sensitivity of the North Atlantic storm track to the spatial and temporal resolution of the sea surface temperature (SST) data used as a lower boundary condition. The model is run over an unusually large domain covering all of the North Atlantic and Europe, and is shown to produce a very good simulation of the observed storm track structure. The model is forced at the lateral boundaries with 15–20 years of data from the ERA-40 reanalysis, and at the lower boundary by SST data of differing resolution. The impacts of increasing spatial and temporal resolution are assessed separately, and in both cases increasing the resolution leads to subtle, but significant changes in the storm track. In some, but not all cases these changes act to reduce the small storm track biases seen in the model when it is forced with low-resolution SSTs. In addition there are several clear mesoscale responses to increased spatial SST resolution, with surface heat fluxes and convective precipitation increasing by 10–20% along the Gulf Stream SST gradient.

The basic ingredients of the North Atlantic storm track. Part I: land-sea contrast and orography

Understanding and predicting changes in storm tracks over longer time scales is a challenging problem, particularly in the North Atlantic. This is due in part to the complex range of forcings (land–sea contrast, orography, sea surface temperatures, etc.) that combine to produce the structure of the storm track. The impact of land–sea contrast and midlatitude orography on the North Atlantic storm track is investigated through a hierarchy of GCM simulations using idealized and “semirealistic” boundary conditions in a high-resolution version of the Hadley Centre atmosphere model (HadAM3). This framework captures the large-scale essence of features such as the North and South American continents, Eurasia, and the Rocky Mountains, enabling the results to be applied more directly to realistic modeling situations than was possible with previous idealized studies. The physical processes by which the forcing mechanisms impact the large-scale flow and the midlatitude storm tracks are discussed. The characteristics of the North American continent are found to be very important in generating the structure of the North Atlantic storm track. In particular, the southwest–northeast tilt in the upper tropospheric jet produced by southward deflection of the westerly flow incident on the Rocky Mountains leads to enhanced storm development along an axis close to that of the continent’s eastern coastline. The approximately triangular shape of North America also enables a cold pool of air to develop in the northeast, intensifying the surface temperature contrast across the eastern coastline, consistent with further enhancements of baroclinicity and storm growth along the same axis.

The zonal asymmetry of the Southern Hemisphere storm-track

Atmospheric general circulation model experiments have been performed to investigate how the significant zonal asymmetry in the Southern Hemisphere (SH) winter storm track is forced by sea surface temperature (SST) and orography. An experiment with zonally symmetric tropical SSTs expands the SH upper-tropospheric storm track poleward and eastward and destroys its spiral structure. Diagnosis suggests that these aspects of the observed storm track result from Rossby wave propagation from a wave source in the Indian Ocean region associated with the monsoon there. The lower-tropospheric storm track is not sensitive to this forcing. However, an experiment with zonally symmetric midlatitude SSTs exhibits a marked reduction in the magnitude of the maximum intensity of the lower-tropospheric storm track associated with reduced SST gradients in the western Indian Ocean. Experiments without the elevation of the South African Plateau or the Andes show reductions in the intensity of the major storm track downstream of them due to reduced cyclogenesis associated with the topography. These results suggest that the zonal asymmetry of the SH winter storm track is mainly established by stationary waves excited by zonal asymmetry in tropical SST in the upper troposphere and by local SST gradients in the lower troposphere, and that it is modified through cyclogenesis associated with the topography of South Africa and South America.

Infrared filters and dichroics for the advanced along track scanning radiometer

The design and manufacture of the band-defining filters and their associated dichroic beam splitter for the 11- and the 12-µm infrared channels of the advanced along-track scanning radiometer are described. The filter requirements that have led to the choice of coating designs, coating materials, disposition of coatings, and effects of polarization are discussed. Overall spectral throughputs of the filter and dichroic interaction for the two channels are also presented.

The basic ingredients of the North Atlantic Storm Track. Part II: Sea surface temperatures

The impact of North Atlantic SST patterns on the storm track is investigated using a hierarchy of GCM simulations using idealized (aquaplanet) and “semirealistic” boundary conditions in the atmospheric component (HadAM3) of the third climate configuration of the Met Office Unified Model (HadCM3). This framework enables the mechanisms determining the tropospheric response to North Atlantic SST patterns to be examined, both in isolation and in combination with continental-scale landmasses and orography. In isolation, a “Gulf Stream” SST pattern acts to strengthen the downstream storm track while a “North Atlantic Drift” SST pattern weakens it. These changes are consistent with changes in the extratropical SST gradient and near-surface baroclinicity, and each storm-track response is associated with a consistent change in the tropospheric jet structure. Locally enhanced near-surface horizontal wind convergence is found over the warm side of strengthened SST gradients associated with ascending air and increased precipitation, consistent with previous studies. When the combined SST pattern is introduced into the semirealistic framework (including the “North American” continent and the “Rocky Mountains”), the results suggest that the topographically generated southwest–northeast tilt in the North Atlantic storm track is enhanced. In particular, the Gulf Stream shifts the storm track south in the western Atlantic whereas the strong high-latitude SST gradient in the northeastern Atlantic enhances the storm track there.

The track nanotechnology

The discipline now called Solid State Nuclear Track Detection (SSNTD) dates back to 1958 and has its roots in the United Kingdom. Its strength stems chiefly from factors such as its simplicity, small geometry, permanent maintenance of the nuclear record and other diversified applications. A very important field with exciting applications reported recently in conjuction with the nuclear track technique is nanotechnology, which has applications in biology, chemistry, industry, medicare and health, information technology, biotechnology, and metallurgical and chemical technologies. Nanotechnology requires material design followed by the study of the quantum effects for final produced applications in sensors, medical diagnosis, information technology to name a few. We, in this article, present a review of past and present applications of SSNTD suggesting ways to apply the technique in nanotechnology, with special reference to development of nanostructure for applications utilising nanowires, nanofilters and sensors.

Response of the North Atlantic storm track to climate change shaped by ocean–atmosphere coupling

A poleward shift of the mid-latitude storm tracks in response to anthropogenic greenhouse-gas forcing has been diagnosed in climate model simulations1, 2. Explanations of this effect have focused on atmospheric dynamics3, 4, 5, 6, 7. However, in contrast to storm tracks in other regions, the North Atlantic storm track responds by strengthening and extending farther east, in particular on its southern flank8. These adjustments are associated with an intensification and extension of the eddy-driven jet towards western Europe9 and are expected to have considerable societal impacts related to a rise in storminess in Europe10, 11, 12. Here, we apply a regression analysis to an ensemble of coupled climate model simulations to show that the coupling between ocean and atmosphere shapes the distinct storm-track response to greenhouse-gas forcing in the North Atlantic region. In the ensemble of simulations we analyse, at least half of the differences between the storm-track responses of different models are associated with uncertainties in ocean circulation changes. We compare the fully coupled simulations with both the associated slab model simulations and an ocean-forced experiment with one climate model to establish causality. We conclude that uncertainties in the response of the North Atlantic storm track to anthropogenic emissions could be reduced through tighter constraints on the future ocean circulation.

Changes in storm track and cyclone activity in three SRES ensemble experiments with the ECHAM5/MPI-OM1 GCM

Synoptic activity over the Northern Hemisphere is evaluated in ensembles of ECHAM5/MPI-OM1 simulations for recent climate conditions (20C) and for three climate scenarios (following SRES A1B, A2, B1). A close agreement is found between the simulations for present day climate and the respective results from reanalysis. Significant changes in the winter mid-tropospheric storm tracks are detected in all three scenario simulations. Ensemble mean climate signals are rather similar, with particularly large activity increases downstream of the Atlantic storm track over Western Europe. The magnitude of this signal is largely dependent on the imposed change in forcing. However, differences between individual ensemble members may be large. With respect to the surface cyclones, the scenario runs produce a reduction in cyclonic track density over the mid-latitudes, even in the areas with increasing mid-tropospheric activity. The largest decrease in track densities occurs at subtropical latitudes, e.g., over the Mediterranean Basin. An increase of cyclone intensities is detected for limited areas (e.g., near Great Britain and Aleutian Isles) for the A1B and A2 experiments. The changes in synoptic activity are associated with alterations of the Northern Hemisphere circulation and background conditions (blocking frequencies, jet stream). The North Atlantic Oscillation index also shows increased values with enhanced forcing. With respect to the effects of changing synoptic activity, the regional change in cyclone intensities is accompanied by alterations of the extreme surface winds, with increasing values over Great Britain, North and Baltic Seas, as well as the areas with vanishing sea ice, and decreases over much of the subtropics.

How large are projected 21st century storm track changes?

Projected changes in the extra-tropical wintertime storm tracks are investigated using the multi-model ensembles from both the third and fifth phases of the World Climate Research Programme's Coupled Model Intercomparison Project (CMIP3 and CMIP5). The aim is to characterize the magnitude of the storm track responses relative to their present-day year-to-year variability. For the experiments considered, the ‘middle-of-the-road’ scenarios in each CMIP, there are regions of the Northern Hemisphere where the responses of up to 40% of the models exceed half of the inter-annual variability, and for the Southern Hemisphere there are regions where up to 60% of the model responses exceed half of the inter-annual variability.