An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

INTRODUCTION: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. METHODS: Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET-based and a Ce-based prediction. Similarly, 2 predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared with observations with graphical and temporal analyses. RESULTS: While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (> or = 99%). However, after termination of the anesthetic, models exhibited a wide range of predictions at emergence (1%-97%). Although wide, the Ce-based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET-based predictions. For the ET-based model, 45% of the patients awoke within 2 min of the 50% model predicted probability of unresponsiveness and 65% awoke within 4 min. For the Ce-based model, 45% of the patients awoke within 1 min of the 50% model predicted probability of unresponsiveness and 85% awoke within 3.2 min. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce- and ET-based models. DISCUSSION: Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.

Effects of Environmentally Relevant Concentrations of Poultry Litter Associated Contaminates on the Sexual Development of Xenopus laevis

Poultry litter contains high levels of natural sex hormones, nitrogen, phosphorous, and trace amounts of heavy metals. Poultry litter runoff from poultry and farming operations in the Delmarva region can have serious impacts on frog development in the Chesapeake Bay Watershed. In this study, we investigated potential effects of litter compounds on Xenopus laevis development when exposed to environmental levels (0.35 and 0.70 g/L) of litter solution. We found that despite rapid hormone degradation, poultry litter solution still affected X. laevis development. Hormones were also more persistent in the lower poultry litter concentration, leading to even greater effects. Slowed growth and increased female gonadal abnormalities were observed after exposure to 0.35 g/L but not to 0.70 g/L of litter solution, and increased male gonadal abnormalities were observed after treatment to both litter concentrations. The developmental impacts examined in this study may have greater environmental impacts on frog reproduction and survival.

Predicting toxic gas concentrations resulting from enclosure fires using local equivalence ratio concept linked to fire field models

A practical CFD method is presented in this study to predict the generation of toxic gases in enclosure fires. The model makes use of local combustion conditions to determine the yield of carbon monoxide, carbon dioxide, hydrocarbon, soot and oxygen. The local conditions used in the determination of these species are the local equivalence ratio (LER) and the local temperature. The heat released from combustion is calculated using the volumetric heat source model or the eddy dissipation model (EDM). The model is then used to simulate a range of reduced-scale and full-scale fire experiments. The model predictions for most of the predicted species are then shown to be in good agreement with the test results

Predicting toxic species concentrations in a full-scale vitiated fire

A toxicity model on dividing the computational domain into two parts, a control region (CR) and a transport region (TR), for species calculation was recently developed. The model can be incorporated with either the heat source approach or the eddy dissipation model (EDM). The work described in this paper is a further application of the toxicity model with modifications of the EDM for vitiated fires. In the modified EDM, chemical reaction only occurs within the CR. This is consistent with the approach used in the species concentration calculations within the toxicity model in which yields of combustion products only change within the CR. A vitiated large room-corridor fire, in which the carbon monoxide (CM) concentrations are very high and the temperatures are relatively low at locations distant from the original fire source, is simulated using the modified EDM coupled with the toxicity model. Compared with the EDM, the modified EDM provide significant improvements in the predictions of temperatures at remote locations. Predictions of species concentrations at various locations follow the measured trends. Good agreements between the measured and predicted species concentrations are obtained at the vitiated fire stage.

Predicting HCl concentrations in fire enclosures using an HCl decay model coupled to a CFD-based fire field model

The amount of atmospheric hydrogen chloride (HCl) within fire enclosures produced from the combustion of chloride-based materials tends to decay as the fire effluent is transported through the enclosure due to mixing with fresh air and absorption by solids. This paper describes an HCl decay model, typically used in zone models, which has been modified and applied to a computational fluid dynamics (CFD)-based fire field model. While the modified model still makes use of some empirical formulations to represent the deposition mechanisms, these have been reduced from the original three to two through the use of the CFD framework. Furthermore, the effect of HCl flow to the wall surfaces on the time to reach equilibrium between HCl in the boundary layer and on wall surfaces is addressed by the modified model. Simulation results using the modified HCl decay model are compared with data from three experiments. The model is found to be able to reproduce the experimental trends and the predicted HCl levels are in good agreement with measured values