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Background: Hemidiaphragmatic palsy is a common consequence of the interscalene brachial plexus block. It occurs less commonly with the supraclavicular approach. Register data suggest that the analgesic quality of a supraclavicular blockade is sufficient for arthroscopic shoulder surgery, although data on the post-operative analgesic effect are lacking.Methods: After approval by the ethics committee, patients having arthroscopic shoulder surgery under general anaesthesia were randomized to receive a continuous interscalene or supraclavicular blockade. Phrenic nerve function was evaluated through ultrasound examination of the diaphragm in combination with spirometry. Pain scores at rest and activity etc. were determined before catheter insertion, during observation in the post- anaesthesia care unit (PACU) and on post-operative day 1 (POD1). The initial application of 10 ml of ropivacaine 0.2% was followed by continuous application of 4 ml of ropivacaine 0.2%, plus a patient controlled analgesia (PCA) bolus of 4 ml/h.Results: One hundred and twenty patients were randomized, of which 114 data sets were analysed. Complete hemidiaphragmatic paresis occurred in 43% of the interscalene group vs. 24% in the supraclavicular group during PACU stay. Rates of dyspnoea and hoarseness were similar. Horner's syndrome occurred in 21% of the interscalene but only 3% of the supraclavicular group on POD1. Pain scores were comparable for pain at rest and during stress at each time point.Conclusions: This trial showed a significantly greater incidence of phrenic nerve palsy of the interscalene group in PACU, but not on POD1. Post-operative analgesic quality was similar in both groups. Continuous supraclavicular blockade is a suitable alternative to the continuous interscalene technique. [ABSTRACT FROM AUTHOR]

Background: Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes., Methods: In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration., Results: In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation., Conclusion: During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation., Registration of Clinical Trial: DRKS-ID DRKS00014788 (www.drks.de)., (© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Literature on driving capacities of ventricular assist device patients is rare and driving restrictions differ from center to center. Currently, no guidelines exist on whether and when left ventricular assist device (LVAD) patients are allowed to begin driving cars after device implantation. In this study, we assess the driving abilities of patients after LVAD implantation. Three hundred and ninety LVAD patients have been surveyed in a worldwide, multicenter study. The single survey followed a multi-method design, including online, phone, and face-to-face interviews. Out of 390 patients, 72% are still driving and 28% did not continue driving after LVAD implantation. Reasons for discontinuation were capability (24%), insecurity (17%), and disapproval by family members (9%) or doctors (5%). Ninety percent of the patients describe their ability to drive as perfect or adequate. Sixty-nine percent state that they are not restricted in their general driving capacity. Forty-nine percent report not to be restricted in agility to drive by the device equipment. The majority of patients have not been involved in car accidents or major complications (94%). Eight accidents were reported (3%). Out of those, all were minor collisions. No patient reported the occurrence of a fatal accident or casualties. LVAD alarms did occur in six incidents (2%) with the majority being low battery alarms. The results of this study suggest that driving with a left ventricular assist device is safe for stable patients and driving can be resumed 3 months after LVAD implantation after careful patient assessment., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

The title compound, [Te(8)][NbOCl(4)](2), was obtained as translucent black crystals by reaction of elemental tellurium, niobium(V) chloride and niobium(V) oxychloride in the ionic liquid BMImCl (BMImCl is 1-butyl-3-methylimidazolium chloride). The synthesis was performed in argon-filled glass ampoules. According to X-ray structure analysis based on single crystals, the title compound crystallizes with triclinic lattice symmetry and consists of infinite {[Te(8)](2+)}(n) cations associated with pyramidal [NbOCl(4)](-) anions. The novel catena-octatellurium(2+) cation is composed of Te(5) rings that are linked via Te(3) units [Te-Te = 2.6455 (18)-2.8164 (19) Å]. The composition and purity of [Te(8)][NbOCl(4)](2) were further confirmed by energy-dispersive X-ray diffraction (EDX) analysis.

Tris(1-methylimidazolium) bis(1-methylimidazole)hexacosaoxidooctamolybdatesodium, (C(4)H(7)N(2))(3)[NaMo(8)O(26)(C(4)H(6)N(2))(2)], prepared from an aqueous solution containing Na(2)MoO(4) and 1-methylimidazole, contains the novel chain-like anion (infinity)(1)[NaMo(8)O(26)(mim)(2)](3-) (mim is 1-methylimidazole). The [Mo(8)O(26)(mim)(2)](4-) building unit, which lies across a center of inversion, is comprised of eight edge-sharing MoO(6) and MoO(5)(N(mim)) octahedra. These molybdate units are interlinked by sodium, itself exhibiting a sixfold coordination with O atoms.