Airway Irritation Research Articles

Interactions of the immune and sensory nervous systems in atopy.

A striking feature underlying all atopic disorders, such as asthma, atopic dermatitis, and food allergy, is the presence of pathologic sensory responses, reflexes, and behaviors. These symptoms, exemplified by chronic airway irritation and cough, chronic itch and scratching, as well as gastrointestinal discomfort and dysfunction, are often cited as the most debilitating aspects of atopic disorders. Emerging studies have highlighted how the immune system shapes the scope and intensity of sensory responses by directly modulating the sensory nervous system. Additionally, factors produced by neurons have demonstrated novel functions in propagating atopic inflammation at barrier surfaces. In this review, we highlight new studies that have changed our understanding of atopy through advances in characterizing the reciprocal interactions between the immune and sensory nervous systems.

Asthma and Cleaning: What’s New?

Professional and domestic cleanings are associated with work-related asthma (WRA). Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Moreover, exposure to cleaning chemicals could be associated with severe uncontrolled asthma. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma or airway respiratory diseases. Their measurements at the workplace could be interesting but hardly feasible. It is still under controversy whether cleaning products are airway irritants or sensitizers. The social consequence of unemployment in this population is one of the most important limitations to the management of occupational in cleaning professionals. The prognosis of the disease depends of removal from exposure, with avoidance of high-risk cleaning products, even at home.

The Determination of Metals in Welding Fume by X-RaySpectrometry

Analysis of the current hygienic situation in the welding production showed that the intensification of welding processes involves the deterioration of air quality, which negatively affects the welders health. Respiratory effects seen in full-time welders have included bronchitis, airway irritation, lung function changes, and a possible increase in the incidence of lung cancer. The metal concentration in the air of the working area have been determined using the photometric method of analysis, which involves the stage of decomposition of the sample material before analysis. However, losses of the analyzed elements are possible when the sample is decomposed. The X-ray fluorescence method of analysis has the advantage of being nondestructive. The investigations shown the data of photometric determination of metals in welding aerosols is 1.5÷2 times lower than the results of X-ray fluorescence analysis.

Effect of intravenous lidocaine on the incidence of postextubation laryngospasm: A double-blind, placebo-controlled randomized trial.

Objectives:The study aimed to test the effect of intraoperative intravenous (IV) lidocaine on the incidence of postextubation laryngospasm in adult patients.Methods:The prospective randomized clinical trial was conducted at tertiary care hospital in Riyadh, between January and December 2012. Seventy-two patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either placebo (n = 36) or IV lidocaine (n = 36), 1 mg/kg bolus after desflurane was discontinued. Laryngospasm was graded from 0 to 3 based on the absence or presence of signs and the severity of postextubation laryngospasm.Results:The study was terminated early by the data monitoring committee because of safety concerns due to an increased incidence of postextubation laryngospasm. Patient demographics were similar for both groups. The incidence of postextubation laryngospasm was 19.5% in the placebo group and 0% in the treatment (lidocaine) group; this difference was statistically significant (P = 0.017; 95% confidence interval, 4.6% to 36.0%).Conclusions:The cause of laryngospasm in our study was most likely the rapid increase in the concentration of inspired desflurane, which might have caused airway irritation. Therefore, we believe that pretreating patients at risk of developing laryngospasm with IV lidocaine could be effective.

Effect of dexmedetomidine infusion on hemodynamic responses in microsurgery of larynx.

Background and Aims:Microlaryngeal surgery is a frequently performed ear, nose, and throat procedure used to diagnose and treat laryngeal disorders. Suspension laryngoscopy causes prolonged stimulation of the deep pressure receptors of the larynx leading to adverse circulatory responses and consequently cardiac complications. In this study, dexmedetomidine infusion was used to assess its effectiveness for attenuation of this hemodynamic stress response.Material and Methods:Sixty patients undergoing elective microlaryngeal surgery randomly received either dexmedetomidine 1 μg/kg over 10 min followed by continuous infusion of 0.5 μg/kg (Group D) or normal saline infusion at the same rate (Group P) till the end of surgery. Anesthesia in all patients was induced with propofol, succinylcholine to facilitate endotracheal intubation after premedication with fentanyl 2 μg/kg and glycopyrrolate. Intraoperative, vital parameters were maintained within 20% of baseline with rescue analgesic fentanyl 1 μg/kg and subsequently with propofol boluses up to 1 mg/kg. The percentage of patients and the total amount of intraoperative fentanyl and propofol required in each group were recorded. Sedation score at 10 minutes postextubation was assessed by Ramsay sedation score.Results:Intraoperative heart rate and mean arterial pressure in Group D were lower than the baseline values and the corresponding values in Group P (P > 0.05). The percentage of patients requiring rescue fentanyl and propofol was higher in Group P than Group D (36.6% and 30% vs. 6.6% and 3.3% P = 0.01). Recovery scores were better in dexmedetomidine group.Conclusion:Dexmedetomidine infusion attenuates the hemodynamic stress response during laryngoscopy, intubation, and microlaryngeal surgery and is associated better recovery profile.

Comparative Evaluation between Sevoflurane and Propofol for Endotracheal Intubation without Muscle Relaxants in Pediatric Cleft Surgeries.

Background and Objectives:Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties. Hence, we sought to compare effectiveness of propofol with sevoflurane in achieving good intubation conditions without the use of muscle relaxants.Materials and Methods:In this prospective randomized study, eighty children belonging to American Society of Anesthesiologist physical status Class I and II, aged 1–10 years, scheduled for cleft surgery were included. All participants were premedicated. Patients were allotted to Group A and Group B randomly. Group A received propofol and Group B received sevoflurane as induction agents. Tracheal intubation was attempted in all patients at 150 s. Intubation conditions were assessed by using Steyn modification of Helbo–Hansen intubating conditions score. Statistical analysis was done using Student's t-test and Chi-square test with P < 0.05 regarded as significant.Results:Group B patients receiving sevoflurane had significantly more clinically acceptable intubation conditions than patients of Group A receiving i.v. propofol (P = 0.001).Conclusion:We conclude that intubation conditions using inhalational 8% sevoflurane are superior to i.v. propofol of 3 mg/kg for tracheal intubation without muscle relaxants in children undergoing cleft surgeries.

Electronic Cigarettes: Their Constituents and Potential Links to Asthma.

Vaping is gaining popularity in the USA, particularly among teens and young adults. While e-cigs are commonly represented as safer alternatives to tobacco cigarettes, little is known regarding the health effects of their short- or long-term use, especially in individuals with pre-existing respiratory diseases such as asthma. Flavored e-cig liquids (e-liquids) and e-cig aerosols contain airway irritants and toxicants that have been implicated in the pathogenesis and worsening of lung diseases. In this review, we will summarize existing data on potential health effects of components present in e-cig aerosols, such as propylene glycol, vegetable glycerin, nicotine, and flavorings, and discuss their relevance in the context of asthma. Recent survey data indicate that adolescents with asthma had a higher prevalence of current e-cig use (12.4%) compared to their non-asthmatics peers (10.2%) and conveyed positive beliefs about tobacco products, especially e-cigs. Similarly, a study conducted among high school students from Ontario, Canada, indicated a greater likelihood of e-cig use in asthmatics as compared to their non-asthmatic peers. Availability of different flavorings is often cited as the main reason among youth/adolescents for trying e-cigs or switching from cigarettes to e-cigs. Occupational inhalation of some common food-safe flavoring agents is reported to cause occupational asthma and worsen asthmatic symptoms. Moreover, workplace inhalation exposures to the flavoring agent diacetyl have caused irreversible obstructive airway disease in healthy workers. Additionally, recent studies report that thermal decomposition of propylene glycol (PG) and vegetable glycerin (VG), the base constituents of e-liquids, produces reactive carbonyls, including acrolein, formaldehyde, and acetaldehyde, which have known respiratory toxicities. Furthermore, recent nicotine studies in rodents reveal that prenatal nicotine exposures lead to epigenetic reprogramming in the offspring, abnormal lung development, and multigenerational transmission of asthmatic-like symptoms. Comparisons of the toxicity and health effects of e-cigs and conventional cigarettes often focus on toxicants known to be present in cigarette smoke (CS) (i.e., formaldehyde, nitrosamines, etc.), as well as smoking-associated clinical endpoints, such as cancer, bronchitis, and chronic obstructive pulmonary disease (COPD). However, this approach disregards potential toxicity of components unique to flavored e-cigs, such as PG, VG, and the many different flavoring chemicals, which likely induce respiratory effects not usually observed in cigarette smokers.

Desflurane versus sevoflurane in pediatric anesthesia with a laryngeal mask airway: A randomized controlled trial.

Background:Desflurane with a laryngeal mask airway may have advantages during ambulatory anesthesia. However, desflurane-induced airway irritability makes the use of desflurane challenging, especially in children. This study compared desflurane with sevoflurane maintenance anesthesia in terms of respiratory events and the emergence characteristics in children with a laryngeal mask airway.Methods:This randomized controlled trial evaluated 200 children undergoing strabismus surgery allocated to desflurane or sevoflurane groups. After inducing anesthesia with sevoflurane and thiopental sodium 5 mg kg−1, the anesthetic agent was changed to desflurane in the desflurane group, whereas sevoflurane was continued in the sevoflurane group. Respiratory events, emergence time, recovery time, and emergence agitation were compared between the groups.Results:The overall respiratory events did not differ between the groups. However, the incidence of mild desaturation (90% ≤ SpO2 < 97%) was significantly higher in the desflurane group (7%) than in the sevoflurane group (0%) (P = .007). Emergence was significantly faster in the desflurane group (6.6 ± 3.9 vs 8.0 ± 2.2 min, P = .003). The recovery time and emergence agitation in the postanesthesia care unit were comparable between groups. Laryngospasm developed in 5 children (1 in the sevoflurane group and 4 in the desflurane group, P = .365); of these, 4 patients were younger than 3 years.Conclusion:Desflurane maintenance anesthesia in children with a laryngeal mask airway shows a similar rate of overall respiratory events compared with sevoflurane anesthesia. However, anesthesiologists should be cautious of using desflurane in younger children concerning desaturation events during emergence.

PENGARUH PERUBAHAN HIPERPLASIA SEL GOBLET SELAMA 28 HARI PAPARAN ASAP ROKOK DENGAN PEMBERIAN ANTIOKSIDAN SUPEROXIDE DISMUTASE

The number of Indonesian smokers in 2013 has reached 36.3% and continues to increase each year. This will directly affect the increase in passive smokers in Indonesia. Harmful free radicals from cigarette smoke inhaled can lead to irritation of the bronchial airways. Irritation of the airways characterized by mucus hypersecretion induced goblet cell hyperplasia of the bronchi. Giving antioxidants superoxide dismutase melon extract with a combination of gliadin (SOD-gliadin) reduces radical that goblet cell hyperplasia in the bronchial airways can be reduced. This study aims to determine the effectiveness of the SOD-gliadin to the decrease of goblet cell hyperplasia of the bronchi. Giving SOD-gliadin carried out for 28 days with exposure to smoke two cigarettes per day using 5 groups: negative control, positive control and 3 treatment groups with different doses (2,25 IU; 4,5 IU; 9 IU). Observation of goblet cell hyperplasia performed on histological preparations with a longitudinal section with four visual field. With the effects of the antioxidant superoxide dismutase melon extract on percentage of goblet cell hyperplasia (ANOVA, p = 0396). It can be concluded supplementation with SOD-gliadin not influence the percentage of goblet cell hyperplasia.Keywords: goblet cell, superoxide dismutase, antioxidants, cigarette, free radical

Work-related asthma in a sample of subjects with established asthma.

To assess the impact of occupational exposure to irritants or sensitizers on the occurrence, recrudescence and worsening of asthma and to identify unrecognized cases of work related asthma (WRA) including Work-Exacerbated Asthma (WEA) and Occupational Asthma (OA), in a general asthma clinic population sample. The study was a population-based cross sectional survey. 1289 asthmatic subjects (from 15 to 46yrs old) living in a vast district of Tuscany (Italy) were identified from the Medical Reimbursement Register of the National Health System. 893 subjects agreed to take part in the study. Subjects who were currently working or had worked in past were classified in different categories of occupational risk exposure (No, Low or High) according to the italian standard classification for industries and job titles, associated with the judgment of occupational hygiene experts. 41% of subjects worked in industries and in job titles at risk for exposure to airway irritants and/or sensitizers, 48.6% reported an occupational exposure to gases, dust and fumes, more males than females. Prevalence of WEA and OA was higher in subjects who worked at higher risk exposure; these subjects reported a higher prevalence of markers of asthma severity (asthma control, level of treatment, FEV1) than subjects without WRA. Risk of WEA was significantly associated to female gender, older age, and self-reported exposure, while risk of OA was associated to job title with higher exposure risk to occupational asthmogens. Our study shows a high prevalence of WRA (especially WEA) associated with employment in industries and job titles at risk for airways sensitizers and/or irritants; data also support a role for occupational exposure in determining a poor asthma control and a higher level of asthma severity.

Effects of Known Determinants on Methylene Bisphenyl Isocyanate (MDI) Concentration During Spray-On Truck Bed-Lining Processes.

Occupational exposure to methylene bisphenyl isocyanate (MDI) presents serious worker health concerns as it may lead to short- and long-term health effects such as asthma, airway irritation, hypersensitivity pneumonitis, and irritation of skin and mucous membranes. While studies of worker isocyanate exposures during vehicle painting activities are widespread, few studies have investigated the spray-on truck bed-liner (STBL) industry. The purpose of this study was to determine the effectiveness of several ventilation system variables and process characteristics in controlling MDI concentrations in the STBL industry. A total of 47 personal air samples were collected for MDI during 18 site visits at nine STBL companies in Colorado and Wyoming. Ventilation system and process characteristics that were assessed included: ventilation system face velocity, airflow, air changes per minute (AC/M), capture velocity, percent of MDI in bed-liner product, application temperature, application pressure, paint booth temperature, paint booth relative humidity, paint booth volume, and quantity of bed-liner product applied. Pearson correlation revealed percentage of MDI in bed-liner product (r = 0.557, n = 14, P < 0.05) and process temperature (r = 0.677, n = 14, P < 0.05) had high positive correlation with MDI concentration. Ventilation system face velocity (r = -0.578, n = 14, P < 0.05) and AC/M (r = -0.657, n = 14, P < 0.05) had high negative correlation with MDI concentration while airflow (r = -0.475, n = 14, P < 0.05) and capture velocity (r = -0.415, n = 14, P = 0.07) had moderate negative correlation with MDI concentration. Multiple linear regression revealed process temperature and capture velocity made a statistically significant and unique contribution in estimating MDI concentration (F (2, 11) = 10.99, P < 0.05) with an adjusted R2 of 0.61, explaining 61% of the variability in MDI concentration. This investigation contributed to an understudied STBL industry by targeting determinants germane to MDI exposures during STBL application processes. Increasing ventilation performance for AC/M, airflow, face velocity, and capture velocity while also decreasing bed-liner application temperature and bed-liner product MDI content may have the greatest effect on reducing worker MDI exposures during STBL activities.

Nebulization with sodium chloride solution (0.9%) in the treatment of chronic canine bronchitis

Chronic bronchitis is a disease of high occurrence in dogs. Its etiology is usually associated with allergic and / or infectious causes, in which inflammation of the bronchi and bronchioles occurs, leading to airway irritation, accumulation of mucus and clinical signs such as productive cough and exacerbated lung noise. The therapeutic protocol of humidification and mucinase through aerosolization by nebulization, may gain attention for its use in veterinary medicine in the face of the obstacles often presented due to the non cooperation of the patient and unavailability of the tutor. The present study aimed to establish the adjuvant use of nebulization in the treatment of canine bronchitis.

Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach

BackgroundGround-level ozone is a potent airway irritant and a determinant of respiratory morbidity. Susceptibility to the health effects of ambient ozone may be influenced by both intrinsic and extrinsic factors, such as neighborhood socioeconomic status (SES). Questions remain regarding the manner and extent that factors such as SES influence ozone-related health effects, particularly across different study areas.MethodsUsing a 2-stage modeling approach we evaluated neighborhood SES as a modifier of ozone-related pediatric respiratory morbidity in Atlanta, Dallas, & St. Louis. We acquired multi-year data on emergency department (ED) visits among 5–18 year olds with a primary diagnosis of respiratory disease in each city. Daily concentrations of 8-h maximum ambient ozone were estimated for all ZIP Code Tabulation Areas (ZCTA) in each city by fusing observed concentration data from available network monitors with simulations from an emissions-based chemical transport model. In the first stage, we used conditional logistic regression to estimate ZCTA-specific odds ratios (OR) between ozone and respiratory ED visits, controlling for temporal trends and meteorology. In the second stage, we combined ZCTA-level estimates in a Bayesian hierarchical model to assess overall associations and effect modification by neighborhood SES considering categorical and continuous SES indicators (e.g., ZCTA-specific levels of poverty). We estimated ORs and 95% posterior intervals (PI) for a 25 ppb increase in ozone.ResultsThe hierarchical model combined effect estimates from 179 ZCTAs in Atlanta, 205 ZCTAs in Dallas, and 151 ZCTAs in St. Louis. The strongest overall association of ozone and pediatric respiratory disease was in Atlanta (OR = 1.08, 95% PI: 1.06, 1.11), followed by Dallas (OR = 1.04, 95% PI: 1.01, 1.07) and St. Louis (OR = 1.03, 95% PI: 0.99, 1.07). Patterns of association across levels of neighborhood SES in each city suggested stronger ORs in low compared to high SES areas, with some evidence of non-linear effect modification.ConclusionsResults suggest that ozone is associated with pediatric respiratory morbidity in multiple US cities; neighborhood SES may modify this association in a non-linear manner. In each city, children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying rates of respiratory morbidity.

Field Studies Measuring the Aerosolization of Endotoxin During the Land Application of Class B Biosolids.

Endotoxins are a component of Gram-negative bacteria cell walls and are known to be present in biosolids. Endotoxins have been shown to be potent stimulators of the innate immune response causing airway irritation and shortness of breath. Class B biosolids are routinely applied to agricultural lands to enhance soil properties and can be used as an alternative to chemical fertilizers. This study investigated the aerosolized endotoxin dispersed during the land application of Class B biosolids on agricultural land and a concrete surface at two sites in Colorado, USA. Aerosolized endotoxin was captured using HiVol samplers fitted with glass fiber filters, polycarbonate filter cassettes (both open and closed) and BioSampler impinger air samplers. Endotoxins were also measured in the biosolids to allow for correlating bulk biosolids concentrations with aerosol emission rates. Endotoxin concentrations in biosolids, impinger solutions and filter extracts were determined using the kinetic Limulus amebocyte lysate assay. Aerosolized endotoxin concentration was detected from all sites with levels ranging from 0.5 to 642 EU/m3. The four types of sampling apparatus were compared, and the HiVol and open-faced cassette samplers produced higher time-weighted average (TWA) measurements (EU/m3) than the impinger and closed cassette samplers. Ambient wind speed was found to be the variable best describing the observed results with optimal wind speed for highest deposition estimated at 5 m s-1. It is argued that HiVol air samplers are a particularly reliable approach and subsequent analyses relating TWA measurements to wind speed and biosolids characteristics were based on the measurements collected with those samplers.

Dexmedetomidine\u2019s inhibitory effects on acetylcholine release from cholinergic nerves in guinea pig trachea: a mechanism that accounts for its clinical benefit during airway irritation

BackgroundAirway instrumentation can evoke upper airway reflexes including bronchoconstriction and cough which can cause serious complications including airway trauma, laryngospasm or bronchospasm which may in turn lead to difficulty with ventilation and hypoxemia. These airway events are mediated in part by irritant-induced neuronal modulation of airway tone and cough responses. We investigated whether the commonly used anesthetic agents dexmedetomidine, lidocaine or remifentanil attenuated neuronal and airway smooth muscle responses in the upper airways of guinea pigs.MethodsThe ability of dexmedetomidine, lidocaine or remifentanil to attenuate direct cholinergic nerve stimulation, C-fiber stimulation or direct smooth muscle contraction were studied using isolated tracheal rings from male guinea pigs under four paradigms; (1) the magnitude of contractile force elicited by cholinergic electrical field stimulation (EFS); (2) the amount of acetylcholine released during cholinergic EFS; (3) the direct airway smooth muscle relaxation of a sustained acetylcholine-induced contraction and (4) the magnitude of C-fiber mediated contraction.ResultsDexmedetomidine (1–100 μM) and lidocaine (1 mM) attenuated cholinergic 30Hz EFS-induced tracheal ring contraction while remifentanil (10 μM) had no effect. Dexmedetomidine at 10 μM (p = 0.0047) and 100 μM (p = 0.01) reduced cholinergic EFS-induced acetylcholine release while lidocaine (10 μM-1 mM) and remifentanil (0.1–10 μM) did not. Tracheal ring muscle force induced by the exogenous addition of the contractile agonist acetylcholine or by a prototypical C-fiber analogue of capsaicin were also attenuated by 100 μM dexmedetomidine (p = 0.0061 and p = 0.01, respectively). The actual tracheal tissue concentrations of dexmedetomidine achieved (0.54–26 nM) following buffer application of 1–100 μM of dexmedetomidine were within the range of clinically achieved plasma concentrations (12 nM).ConclusionsThe α2 adrenoceptor agonist dexmedetomidine reduced cholinergic EFS-induced contractions and acetylcholine release consistent with the presence of inhibitory α2 adrenoceptors on the prejunctional side of the postganglionic cholinergic nerve-smooth muscle junction. Dexmedetomidine also attenuated both exogenous acetylcholine-induced contraction and C-fiber mediated contraction, suggesting a direct airway smooth muscle effect and an underlying mechanism for cough suppression, respectively.

Desflurane for ambulatory anaesthesia: A comparison with sevoflurane for recovery profile and airway responses.

Background and Aims:Desflurane and sevoflurane have low blood gas solubility co-efficients, allowing a rapid awakening from anaesthesia. However, desfluraneis pungent and may cause airway irritability. We compared desflurane and sevoflurane with respect to recovery and occurrence of adverse airway responses in spontaneously breathing patients while using the ProSeal™ laryngeal mask airway (LMA).Methods:Ninety-four adult patients undergoing hysteroscopic procedures were divided into sevoflurane (S) group or desflurane (D) group. Patients were premedicated with midazolam 0.03 mg/kg and fentanyl 1μg/kg. Anaesthesia was induced with propofol 2.0–2.5 mg/kg, followed by insertion of a ProSeal™ LMA. Adverse airway responses such as cough, hiccups, laryngospasm and breathholding were recorded. In the post-operative period: time to awakening, response to verbal commands, orientation, ability to sit with support and the recovery room Aldrete score were recorded.Results:Three patients in group S (6.4%) and six patients (13.3%) in Group D had adverse airway events. The mean time to eye opening (Group S-10.75 ± 7.54 min, Group D-4.94 ± 1.74 min), obeying verbal commands (Group S-13.13 ± 8.75 min, Group D-6.55 ± 1.75 min), orientation (Group S-15.42 ± 8.46 min, Group D-6.23 ± 2.4 min) and to sit with support (Group S-36.09 ± 12.68 min, Group D-14.35 ± 3.75 min) were found to be lesser with desflurane than with sevoflurane (P < 0.001). The mean time to recovery was delayed in Group S-46.00 ± 12.86 min compared to Group D-26.44 ± 5.33 min (P < 0.001).Conclusion:Desflurane has faster awakening properties than sevoflurane without an increase in adverse airway events when used during spontaneous ventilation through a ProSeal™ LMA along with propofol and fentanyl.

Indoor Air Quality in Photocopy Centers, Nanoparticle Exposures at Photocopy Workstations, and the Need for Exposure Controls.

Photocopiers emit large amounts of nanoparticles (NP) and are a significant source of indoor air pollution. These emissions induce airway inflammation, irritation, and systemic oxidative stress in humans, lung injury and inflammation in animals, and cytotoxicity and epigenetic modifications in vitro. However, little is known regarding NP exposures at the workstation in the photocopy work environment, or the extent and use of emission controls. To survey the photocopy work environment with regards to emissions controls and to evaluate IAQ with emphasis on NP exposure at the operator's workstation. Work process, physical characteristics of the centers, and use of controls were recorded. Particle total number concentration (TNC), temperature, carbon dioxide, carbon monoxide, and percent relative humidity were measured during a random workday. Geometric mean (GM) TNC at workstations ranged between 1900 and 23000 particles cm-3, GSD 1.2-2.8, and maximum of 217000 particles cm-3. Fresh air ventilation was found to be less than American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) guidelines in 7 of 15 centers. Only one center used any type of emissions control. Elevated TNC at workstations was significantly correlated with number of copies (r = 0.72). While indoor/outdoor TNC ratios might be expected to be ≤1.0, the ratio here was >1.0 in 40% of centers visited, supporting the finding that copier emissions are a significant source of indoor air pollution. Number of copies per day was the most significant contributor to TNC. High NP concentrations at workstations were common and specific emission controls almost nonexistent. While 46% of copy centers had insufficient ventilation, high exposures were documented even for cases when ASHRAE ventilation guidelines per person were met or exceeded. We present various options to address IAQ in photocopy environment, including new clean photocopy technologies, engineering controls, and a comprehensive awareness campaign to improve the environmental health and safety, design, and operational conditions of these workplaces.

Randomized Comparison of Isoflurane versus Sevoflurane and Desflurane for Maintenance of Ambulatory Anesthesia.

Background:Ambulatory surgeries demand safe anesthesia with faster recovery which makes it expensive due to the cost of inhalational anesthetic agents such as sevoflurane and desflurane. Isoflurane is inexpensive agent but can cause delayed recovery. The aim of this study was to evaluate cost-benefit ratio of all three agent with respect to recovery and safety profileMaterials and Methods:Patients posted for elective ambulatory surgeries were divided into three groups. Suitable size laryngeal mask airway was inserted following induction with propofol and vecuronium. Anesthesia was maintained on low-flow anesthesia with inhalational agent as isoflurane for Group I, sevoflurane for Group II and Group III received desflurane. Patients were monitored for recovery as per modified Aldrete score and as per postanesthesia discharge scoring system for discharge from hospital. Cost analysis was done by Dion's formula. Statistical analysis was done with analysis of variance for recovery profile, Chi-square test for safety profile and Kruskal Wallis test for cost comparison between groups.Results:Patient characteristics and duration of anesthesia were similar in all three groups. Time to eye-opening was significantly less with desflurane than sevoflurane and isoflurane (P = 0.001). Time to home readiness was similar in all three groups (P = 0.451). The incidence of airway irritation, pain, and nausea/vomiting was similar in all three groups. Cost of Group I was statistically lower than other two groups (P = 0.00).Conclusion:Home readiness and safety profile were comparable between agents; the cost involved was the least with isoflurane.

Perioperative adverse respiratory events in overweight and obese children

Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is arelevant problem in Germany. From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18years, ASAI-III, undergoing elective procedures (ENT and pediatric surgery), were observed. With the aid of special data sheets, the following parameters were determined: Mallampati Score, difficult mask ventilation and intubation, use of a Guedel/Wendl tube, Cormack-Lehane Score, number of intubation attempts, airway obstructions (broncho- and laryngospasms), coughing as a sign of airway irritation, and decreases in oxygen saturation >10 %. Overweight and obese children had asignificantly higher Mallampati Score and asignificantly higher prevalence of coughing (p< 0.05). None of the other parameters showed any significant differences between the groups. However, the incidence of desaturation was 9.5 % in overweight children and 6.3 % in children of normal weight, and that of airway obstructions was 4.1 vs 2.7 %. This study demonstrated avery low incidence of respiratory problems, which may be caused by the low proportion of morbidly obese children and the older age of overweight children in comparison with other studies.

Effects of sweet flavorings and nicotine on the appeal and sensory properties of e-cigarettes among young adult vapers: Application of a novel methodology

IntroductionProduct characteristics that impact e-cigarette appeal by altering the sensory experience of vaping need to be identified to formulate evidence-based regulatory policies. While products that contain sweet flavorings and produce a “throat hit” (i.e., desirable airway irritation putatively caused by nicotine) are anecdotally cited as desirable reasons for vaping among young adults, experimental evidence of their impact on user appeal is lacking. This experiment applied a novel laboratory protocol to assess whether: (1) sweet flavorings and nicotine affect e-cigarette appeal; (2) sweet flavorings increase perceived sweetness; (3) nicotine increases throat hit; and (4) perceived sweetness and throat hit are associated with appeal. MethodsYoung adult vapers (N=20; age 19–34) self-administered 20 standardized doses of aerosolized e-cigarette solutions varied according to a 3 flavor (sweet [e.g., cotton candy] vs. non-sweet [e.g., tobacco-flavored] vs. flavorless)×2 nicotine (6mg/mL nicotine vs. 0mg/mL [placebo]) double-blind, cross-over design. Participants rated appeal (liking, willingness to use again and perceived monetary value), perceived sweetness and throat hit strength after each administration. ResultsSweet-flavored (vs. non-sweet and flavorless) solutions produced greater appeal and perceived sweetness ratings. Nicotine produced greater throat hit ratings than placebo, but did not significantly increase appeal nor interact with flavor effects on appeal. Controlling for flavor and nicotine, perceived sweetness was positively associated with appeal ratings; throat hit was not positively associated with appeal. ConclusionsFurther identification of compounds in e-cigarette solutions that enhance sensory perceptions of sweetness, appeal, and utilization of e-cigarettes are warranted to inform evidence-based regulatory policies.