bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebral Blood Flow and Oxygen Consumption in Normocapnia and Hypercapnia: Modulating Influence of Paravertebral Sympathetic Blockade at the Low Thoracic Level
Authors: Dahlgren N. , Siesjö B. K.
Published: January 2009

The objective of the present study was to explore whether the systemic consequences of sympathoadrenal activation influence the cerebral circulatory and metabolic effects of hypercapnia in the rat. To that end, a bilateral blockade of the sympathetic chain was performed at the low thoracic level by paravertebral injection of local anaesthetic. The injection was followed by a reduction in blood pressure and, in comparison to animals injected with local anaesthetic intramuscularly, those with paravertebral blockade showed lower blood and tissue concentrations of glucose and lactate. Overall (“cortical”) CBF and CMRO2were measured with a233xenon modification of the Kety‐Schmidt technique, and local CBF was estimated autoradiographically with14C‐iodoantipyrine as the diffusible tracer. Paravertebral blockade failed to modify the circulatory response to hypercapnia, nor did it prevent the increase in CMRO2previously noted in this preparation. In animals maintained ventilated on 70% N2O, paravertebral blockade reduced overall CBF by 30% and local CBF by 30–40%, with a suggested but statistically nonsignificant reduction in CMRO2. In unparalysed, awake animals the blockade failed to affect local CBF. It is concluded, therefore, that blockade of the sympathetic chain causes a reduction of CBF only in the stressful conditions prevailing in paralysed and ventilated animals.
Central Haemodynamics During Halothane and Enflurane Anaesthesia in Vascular Surgery
Authors: Euler Ch. v. , Cronestrand R. , Jorfeldt L. , Nowak J. , Sonnenfeld T. , Wåhlin Å. , ÅStröm H.
Published: January 2009

Central haemodynamics were studied before and during reconstructive vascular surgery in 18 patients receiving halothane or enflurane Anaesthesia (nine patients in each group). In both groups cardiac output (CO), stroke volume (SV), oxygen uptake (V̇O2) and arterial blood pressure fell significantly after induction of anaesthesia, whereas the arterio‐venous oxygen difference (AVD) and the total peripheral resistance (TPR) remained unchanged. In spite of an average intraoperative blood loss of 600 ml, which had not been substituted for, surgery brought about an increase in CO, SV and V̇o2, while the AVD and TPR remained unchanged. Following transfusion of 900 ml of blood, CO and SV showed a further significant increase in both groups, whereas Vo2 was unchanged and the AVD and TPR fell significantly. The pulmonary capillary venous pressure (Ppcv) was stable during induction of Anaesthesia and surgery but increased after blood transfusion. The changes in SV and Ppcv were analyzed in relation to the concept of ventricular function curves. It is concluded that there were no fundamental differences in central haemodynamics between halothane and enflurane Anaesthesia either before or during surgery. In both groups the changes in CO and SV were due mainly to a reduced demand of oxygen transport and expected changes in sympatho‐adrenergic tone rather than to myocardial depression.
Haemodynamic Changes with the Administration of Nitrous Oxide During Coronary Artery Surgery
Authors: Lilleaasen P. , Semb B. , Lindberg H. , Hatteland K. , Ottesen S. , Simonsen S.
Published: January 2009

Haemodynamic responses to 50% nitrous oxide in oxygen during coronary artery surgery were investigated in 10 patients. Morphine, diazepam and pancuronium were given intravenously as both induction and maintenance anaesthesia. A significant decrease was seen in heart rate, arterial pressure, pulmonary artery pressure, heart rale‐systolic arterial pressure product, peripheral vascular resistance, left ventricular end‐diastolic pressure, dP/dT of the left ventricle and resistance as measured in the graft to the left anterior descending coronary artery (LAD). No variations occurred in cardiac output, stroke volume, flow in the LAD‐graft, pulmonary artery pressure or heart rate‐systolic pulmonary artery pressure product or in dP/dT of the right ventricle. Pulmonary vascular resistance increased. It was concluded that left ventricular performance did not decrease and that no deterioration of the oxygenation to the myocardium seemed to occur.
The Effect of Positive End‐Expiratory Pressure on Central Haemodynamics in the Pig
Authors: Haldén E. , Jakobson S. , Janerås L.
Published: January 2009

The effect on central haemodynamics of a stepwise increase in airway pressure from spontaneous breathing (SB) to intermittent positive pressure ventilation with a positive end‐expiratory pressure (PEEP) of 0, 8, 16 and 24 cmH2O was studied in eight pigs under ketamine anaesthesia. Compared with SB, cardiac output (CO) was reduced by 12, 36, 50 and 64% at the respective ventilator settings. The transmural pressures of the right and left atrium, measured as the difference between atrial and pleural pressure, both decreased with increments in airway pressure. At a PEEP level of 24, there was a threefold increase in pulmonary vascular resistance. This increase was secondary to the decrease in CO and no signs of CO deterioration due to increased right ventricular afterload were found. When 250 ml of dextran 70 was administered at a PEEP level of 24 and the airway pressure was then released stepwise, the left ventricular function curve improved, disclosing a relative myocardial failure at the highest PEEP levels. It is concluded that the principal causative mechanism in CO reduction due to increased intrathoracic pressure is a decrease in preload to the right ventricle. At high PEEP levels there are also signs of myocardial depression.
Influence of Moderate Alcohol Intake on Thiopental Anesthesia
Authors: Loft S. , Jensen V. , Røsgaard S. , Dyrberg V.
Published: January 2009

The relationship between alcohol intake over the week preceding anesthesia and various anesthetic parameters was examined in 119 women scheduled for termination of pregnancy under thiopental‐nitrous oxide anesthesia. In terms of pure alcohol, the weekly intake was 1.0±1.09 ml·kg‐1(mean±s.d.), range 0–5.93. i.e. below average consumption in Denmark. Alcohol intake was negatively correlated with anesthetic sleeping time (P <0.01). Time and quality of anesthesia induction and frequency of anesthetic complications were not significantly correlated with the use of alcohol. Preanesthetic anxiety was not significantly correlated with any of the above data. Induction time and postoperative awareness were positively and sleeping time negatively correlated with age (P <0.05). The results indicate cross‐tolerance between alcohol and thiopental, even when the regular intake of the former is low, and increasing thiopental requirements with increasing age.
Cardiocirculatory Effects of Prolonged Administration of Isoflurane in Normocarbic Human Volunteers
Authors: Shimosato S. , Carter J. G. , Kemmotsu O. , Takahashi T.
Published: January 2009

Effects of the prolonged administration of isoflurane on haemodynamics were studied in 17 healthy volunteen under normocarbic conditions. The anaesthetic was administered for 90 min at a constant alveolar concentration. Cardiac index was unchanged in the presence of decreased stroke volume index and increased heart rate. The mean arterial pressure decreased with parallel reductions in total peripheral resistance. 1, eft ventricular work decreased. The left ventricular ejection time index increased marginally but significantly. Isoflurane caused no change in the pump performance of the heart but depressed the muscle performance.
Droperidol (Dehydrobenzperido®): Postoperative Anti‐Emetic Effect when Given Intravenously to Gynaecological Patients
Authors: Mortensen P. T.
Published: January 2009

In a double‐blind investigation, comprising 300 gynaecological patients, the prophylactic use ol droperidol i.v. at the start of the anaesthesia produced a significant reduction in the frequency of nausea and vomiting postoperatively in the tirst 24 h from 34.4% to 10.3% (P=0.0001). There was no significant dilrercnce between the effect of droperidol 2.5 mg and 5 mg (P=0.45). Increased postoperative sedation was the only side‐cftect of any importance observed; however, this did not result in any increased period of observation in the recovery room, and the majority of patients considered it advantageous. Droperidol is recommended as a prophylactic anti‐emetic for selected groups of patients, given as 2.5 mg i.v. at the start of the anaesthesia.
Routine Induction of Anaesthesia with Thiopental and Suxamethonium: Apnoea without Ventilation?
Authors: Gabrielsen J. , Valentin N.
Published: January 2009

Changes in PaO2 and PaCO2 during the induction of anaesthesia with thiopental, suxamethonium, and intubation were investigated in 20 patients who received preoxygenation for 2 min, but no ventilation before intubation. Both in fit patients below the age of 60 years (Group I) and in patients above that age ‐ several suffering from cardiopulmonary disease ‐ (Group II), PaO2 increased to about 40 kPa during preoxygenation and remained at that level during apnoea. Mean PaCO2 increased to 6.3 and 5.7 kPa in Groups I and II, respectively. No complications were seen, and it is concluded that the apnoea involved in the “crash induction” technique is safe. Pulmonary aspiration of acid gastric fluid may also occur in fasting patients, and it is suggrhted that even in elective cases ventilation might advantageously be replaced by preoxygenation when anaesthesia is induced with thiopental and suxamethonium.
Airway Closure and Gas Distribution during Hip Arthroplasty
Authors: Mebius C. , Hedenstierna G.
Published: January 2009

Airway closure, resting lung volume (FRC) and gas distribution were assessed by single breath nitrogen washout during hip arthroplasty. Airway closure occurred above FRC in all the patients during enflurane anaesthesia and surgery, with no change in either FRC or airway closure when the femoral and acetabular prostheses were inserted. The slope of the nitrogen aIveolar plateau, which was considered to indicate gas distribution, rose significantly from 4.1 to 5.7% N2/I when the prostheses were inserted. By the end of surgery the slope had returned to the initial value. This finding indicates a transient effect on the airways when the prostheses are implanted.
Oxygen and Carbon Dioxide Concentrations in Anaesthetic Circuits Ventilated with an AGA UV 705 in an Oxygen Consuming Model Lung
Authors: Sonander H. , Stenqvist O.
Published: January 2009

An oxygen consuming and carbon dioxide producing model lung was used for evaluation of anaesthetic circle systems. Two different circles, the AGA metal circle and the AGA Monosorbcircle ventilated hy an AGA UV‐705 were tested with reference to inspired oxygen concentrations and end‐tidal CO2 levels. Cartmn dioxide is dependent on alveolar ventilation and CO2 production and thus was stable throughout the experiments. The oxygen concentration of inspired gas decreased progressively with decreasing fresh gas flow. When using the fresh gas inlet on the ventilator outlet block, the inspired oxygen concentration fell 8% as compared to using the fresh gas inlet in the circle. Fresh gas flows under 3 1/min should only be used with oxygen monitoring in the circle. The fresh gas inlet must be directly into the circle, and not in the ventilator outlet block, to avoid hypoxia.
Effects of Mannitol and Furosemide on Urinary Fluoride Excretion of Surgical Patients Anaesthetized with Enflurane or Halothane
Authors: Oikkonen M. , Rosenberg P. H. , Collan R.
Published: January 2009

Urinary excretion of fluoride after enflurane anaesthesia has been found to correlate Mith urinary pH, while the correlation with urinary volume has remained unsettled. We therefore studied the ellert of moderate dobes of mannitol and furosemide on serum fluoride levels and urinary excretion of fluoride in aurgical patients alter controlled doses of enflurane (6+6+6 patients) or halothane (5+5+5 patients). The highest serum fluoride level was 31 μmol/l in an enflurane patient (enflurane dose 1.26 end‐tidal vol.%×h) and 8 μmol/l in a halothane patient (halothane dose 0.59 end‐tidal vol.%×h). Mannitol caused the greatest mean exmetion of fluoride not significant (n.s.)) in the enflurane patients without any marked rise in urinary pH or volume. Furosemide increased urinary output markedly but did not enhance urinary fluoride excretion or raise urinary pH. Compared with the control groups of both inhalation anaesthetic patients, the diuretics appeared to have no effect on the serum fluoride levels. In the enflurane patients there was a positive correlation between the change in fluoride clearance and the change in urinary pH, but not with the change in urinary volume during the first postoperative hours. On the other hand, in the halothane patients there was a positive correlation between the change in fluoride clearance and the change in urinary volume. A possible “fluoro‐uretic” action of mannitol was also seen in the halothane patients, as in the later postoperative period fluoride excretion was greatest when mannitol had been given.
Avoiding Psychic Adverse Effects during Induction of Neurolept Anaesthesia with Levomepromazine A Double‐Blind Study of Levomepromazine and Droperidol
Authors: Rennemo F. , Larsen R. , Breivik H.
Published: January 2009

Levomepromazine 0.1 μg/kg or droperidol 0.15 mg/kg for induction of neurolept anaesthesia were compared in a double‐blind prospective study of 60 patients undergoing upper abdominal surgery. On the morning after surgery, eight of 30 patients (26.7%) who received droperidol remembered having had unpleasant anxiety, or nightmarish or panicky experiences during induction of anaesthesia, whereas only one of 30 patients (3.3%) receiving levomepromazine experienced such unpleasant adverse effects (P<0.0l). During anaesthesia, the patients induced with levomepromazine needed somewhat less fentanyl, had somewhat less pain intensity, during the first 3 h after surgery, and they required the first postoperative dose of morphine 1.5 h later than the patients receiving droperidol (p<0.02). There was no difference in the number of patients receiving naloxone at the end of anaesthesia in the two groups. However, 21 of 30 patients (70%) in the levomepromazine group and only seven of 30 patients (23.3%) in the droperidol group were given physostigmine for arousal at the end of anaesthesia (p<0.0l). There was no difference between the two groups in the occurrence of postoperative nausea, restlessness, hallucinations, or sedation in the recovery ward. This study shows that levomepromazine is superior to droperidol for induction of neurolept anaesthesia because it gives less psychic adverse effects. more analgesia, and a deeper sedation, which is easily reversed with physostigmine at the end of anaesthesia.
Material Thrombogenicity in Central Venous Catheterization I. A Comparison Between Uncoated and Heparin‐Coated, Long Antebrachial, Polyethylene Catheters
Authors: Bennegard K. , Curelaru I. , Gustavsson B. , Linder L. E. , Zachrisson B. F.
Published: January 2009

In order to evaluate a new method of heparinization, uncoated (22) and heparin‐coated (27) central venous polyethylene catheters were inserted in 49 patients via basilic and cephalic veins punctured at the fossa cubiti. The mean duration of catheterization was 5.7 (1–11) days. One‐third of the patients with heparin‐coated catheters, and one sixth with uncoated catheters developed clinical thrombophlebitis, with a maximum incidence between 4 and 8 days after catheterization. A higher risk of developing thrombophlebitia in the first 4 days after catheterization was found in the patients with heparin‐coated polyethylene catheters. After 8 days of catheterization, it seems that there is a lower risk of new cases of thrombophlebitis appearing both in patients with uncoated and those with heparin‐coated polyethylene catheters. Radiological thrombosis, regardless of duration of catheterization and heparin‐coating, was demonstrated in all 22 patients investigated by “pull‐out” phlebography. The heparin‐coating did not decrease the rate of thrombotic complications. Location of the catheter tip in subclavian veins was associated with a significantly higher incidence of large, parietal thrombi and catheter occlusion than when the tip was situated in anonymous veins, the superior vena cava, or the right atrium. Cannulation by heparin‐coated, polyethylene tubing did not reduce the rate of catheter occlusion.
Ketamine as Induction Agent for Caesarean Section
Authors: Nielsen J. Dich , Holasek J.
Published: January 2009

A series of 100 patients undergoing caesarean section was studied using ketamine 1.2 mg/kg as induction agent. Fifteen minutes prior to induction, atropine 0.25‐0.5 mg and diazepam 1 mg was given intravenously as premedication. Anaesthesia was maintained with N2O:O2, FIO2 0.4. Once the umbilical cord was clamped, 0.2 mg fentanyl and 9 mg diazepam was given intravenously. Except for nitrous oxide, no more anaesthetic intravenous or inhalational agent was needed. Despite the fact that patients with known intrauterine asphyxia before the induction were included in the material, we found excellent Apgar scores (mean 9.1 at 1 min and 9.9 at 5 min). None of the patients reported awareness during the operation. Eight patients experienced pleasant dreams and three unpleasant. There were no hallucinations in the recovery area. The mental condition of the mothers after the operation was acceptable. It is suggested that ketamine can be used not only on special indications but also as a routine method for induction of anaesthesia for caesarean section.
Early Effects ofE. coliEndotoxin on Superior Sagittal Sinus Blood Flow. An Experimental Study in Dogs
Authors: EkströmJodai B. , Elfverson J. , Larsson L. E.
Published: January 2009

In an earlier study in dogs we found a reduced cerebral blood flow measured intermittently during the first holm after an intravenous injection ofE. coliendotoxin. Within 5 rnin after the endotoxin injection, a temporarily reduced cerebrospinal fluid pressure was seen irrespective of changes in arterial blood pressure. One possible explanation for this could be an early reduction of the blood flow in the brain. To test this hypothesis, the initial flow reaction was evaluated by measurement of the blood flow in the superior sagittal sinus using an electromagnetic probe around the intact sinus. In five animals followingE. coliendotoxin 1.0–1.5 mg/kg intravenously, the superior sagittal sinus blood flow decreased within 2 min, followed by increasing flows within 15 min and thereafter continuously decreasing values up to 60 min, thus giving a two‐phase vascular reaction. In all animals there was a marked initial increase in cerebrovascular resistance and the Fall in blood flow was thus not a mere consequence of blood pressure changes. In three other animals pretreated with methysergide. a serotonin antagonist, no increase in cerebrovascular resistance was seen during the initial phase. Later, the reaction was similar in all eight animals.
Anesthetic Techniques and Surgical Blood Loss in Total Hip Arthroplasty
Authors: Rosberg B. , Fredin H. , Gustafson C.
Published: January 2009

Blood loss during total hip arthroplasty and the relation of different anesthetic techniques to surgical bleeding was explored in a consecutive, prospective study involving 157 patients with no previous history of hip surgery. Intraoperative blood loss was significantly reduced in patients operated under sodium nitroprusside induced hypotensive anesthesia as compared to halothane, NLA or epidural block. It might be suspected that postoperative blood loss is increased when the lowered blood pressure is raised towards normotension, but this was not the case. However, regression analysis between mean arterial pressure and intraoperative blood loss in patients anesthetized with hypotensive as well as “normotensive” techniques showed a poor correlation. Blood loss was greater with NLA and halothane anesthesia than with epidural block. The authors consider controlled hypotension a useful adjuvant in anesthesia for total hip arthroplasty in selected patients. Epidural block, on the other hand, is a suitable anesthetic technique for most patients and has the additional advantage of reduced surgical bleeding as compared to general anesthesia.
Comparison of Intra‐ and Extracellular Buffering of Clinically Used Buffer Substances: Tris and Bicarbonate
Authors: Rothe K. F. , Diedler J.
Published: January 2009

A large and important group of acid‐base disturbances are the metabolic acidosrs. In grneral. every type of nietabolir acidosis can be treated with infusion of base when the underlying cause of the disturbances is removed. In our medical centers, the use of tris and bicarbonate is common. For a long time they were competitive agents and until now it was not possible to decide by available clinical methods which of these substances was more suitable for correction of metabolic acidosis. The intracellular pH of the whole rat (mean Icf‐pH) was determined from the distribution of 14C labelled DMO (5,5‐dimethyl‐2,4‐oxazolidinedione) and monitored for 6 h following intravenous application of tris or sodiumbicarbonate in a dose of 10 mmol per kq body mass. Arterial plasma pH and PCO2 were also measured. To determine and compare the effectiveness of the two buffer substances, intra‐and extracellular bicarbonate were calculated from the Henderson‐Hasselbalch equation. It was found that the buffering following bicarbonate infusion is more effective in both body compartments. Sodiumbicarbonate should be preferred in daily practice.
Cardiovascular Effects of Etomidate Used for Induction and in Combination with Fentanyl‐Pancuronium for Maintenance of Anaesthesia in Patients with Valvular Heart Disease
Authors: Lindeburg T. , Spotoft H. , BredgaardSorensen M. , Skovsted P.
Published: January 2009

The effects of induction of anaesthesia by etomidate 3 mg·kg‐‐1 followed by continuous infusion of etomidate 2 mg·min‐1, fentanyl 0.01 mg·kg‐1 and pancuronium 0.1 mg·kg‐1 were studied in ten patients with valvular heart disease. No haemodynamic changes were seen after injection of etomidate, but after fentanyl was given thew was a significant decline in cardiac index (10%), in mean arterial systemic pressure (20%), in systemic vascular resistance (14%), in left ventricular minute work index (27%) and in right ventricular minute work index (21%) compared to the control values. After supplementing with pancuronium, no further significant changes were seen. There was no significant change in the pulmonary vascular resistance during the whole study. In conclusion, it appears that etomidate is a safe intravenous agent, and is worth further study, in particular in patients with minimal cardiac reserve requiring high inspired oxygen tension.
Unpredictable Central Nervous System Effects after Lorazepam Premedication for Neurosurgery
Authors: Korttila K. , Tarkkanen L. , Kuurne T. , Himberg J‐J. , Abbondati G.
Published: January 2009

Administration of lorazepam for preanaesthetic medication is generally expected to produce amnesic action. We conducted two studies to evaluate the relationship of plasma levels of lorazepam with its clinical effects. Forty patients, receiving 0.03 or 0.05 mg/kg lorazepam i.m. as preanaesthetic medication for variolis neurosurgical procedures, were asked 24 h after anaesthesia whether they could recall the insertion of the i.v. needle and a picture shown to them before induction of anaesthesia. Another 11 patients were given 0.03 mg/kg lorazepam i.v. and their degree of drowsiness was rated immediately before induction of anaesthesia. Plasma levels of lorazepam were measured by gaschromatography from samples drawn before induction of anaesthesia. No relationship between either the dose of lorazepam used or the plasma levels of lorazepam and the incidence of amnesia or the degree of drowsiness was observed. Three patients receiving 0.05 mg/kg of lorazepam i.m. had prolonged drowsiness, which made it diflicult to check the patients' neurological condition after the operation, It is postulated that the unpredictable and variable central nervous system effects of lorazepam in neurosurgical patients may be due to differences in the capacity of lorazepam to penetrate the blood brain barrier.
Effect of Tubocurarine on Human Soleus and Gastrocnemius Muscles
Authors: Secher N. H. , Rube N. , Secher O.
Published: January 2009

The effect of a bolus injection of tubocurarine (0.1‐0.13 mg × kg‐1 i. v.) was followed in six young male subjects by registration of the rectified smoothed electromyogram (rsEMG) from them. soleus (71±5.1 (s.e.mean) % slow twitch muscle fibers) and from the m. gastrocnemius (54±3.1% slow twitch muscle fibers). Volitional muscle strength was recorded in isometric plantar flexions with the knee fully (0°) extended where m. soleus and m. gastrocnemius both are active, and with the knee bent 90° where m. soleus is dominating force development. During maximal action of the drug, the rsEMG from the soleus muscle was reduced to 30±4.0% of the control value, while the rsEMG from the gastrocnemius muscle was reduced to 53±5.2% (P<0.01). Muscle strength with the knee extended showed 53±7.5% force left, while 44±6.4% of the muscle strength remained when the knee was bent (P<0.01). The results suggest that tubocurarine aflects human muscles in proportion to their slow twitch muscle fiber content.
Recurrence of Respiratory Depression Following Neurolept Analgesia
Authors: Nilsson C. , Rosberg B.
Published: January 2009

Fentanyl, though generally regarded as a short‐acting narcotic analgesic, can give unexpected respiratory depression several hours after the last dose. This potentially very dangerous effect is explained in pharmacokinetic studies by a mobilisation of fentanyl from tissue stores. In this report we describe a patient who, following a Harrington correction for scoliosis done with neurolept analgesia, developed a severe respiratory depression 5 h after the last dose of fentanyl.
A Comparison of Memory Function Following Local and General Anaesthesia for Extraction of Senile Cataract
Authors: Karhunen U. , Jönn G.
Published: January 2009

The memory performance of 60 female patients, scheduled for either local or general anaesthesia and extraction of senile cataract, was investigated. Six subtests of the Wechsler Memory Scale and four items of memory tests according to Luria were performed. One week postoperatively there was a diminution in the performance of the Wechsler Memory Scale and Luria tests. Comparison of the pre‐ and postoperative diminutions between the local and general anaesthesia groups was statistically significant only in the Luria tests. According to this study general anaesthesia does not affect memory function more profoundly than local anaesthesia supplemented with tranquillizing and/or analgesic drugs in this respect, the advantages of general anaesthesia should be utilized, at least in patients without clearcut contraindications.
Pharmacokinetic Studies on Atropine with Special Reference to Age
Authors: Virtanen R. , Kanto J. , Iisalo E. , Iisalo E. U. M. , Salo M. , Sjövall S.
Published: January 2009

Pharmacokinetic studies on atropine were performed in 52 patients under general or spinal anaesthesia. Age had a clinically significant effect on the kinetics of this alkaloid in children under 2 years of age and in the elderly a prolonged elimination was found. This might explain, partly at least, the higher sensitivity of these age groups to the effects of atropine. Age had no effect on the serum protein binding of this alkaloid. Atropine was found in human CSF after a single i.m. administration, but not after a single i.v. administration. During anaesthesia alter i.v. atropine administration, a diminished cardiovascular response was found in the elderly in comparison with healthy adult patients. This indicates changes also at the cholinergic receptor sites in the elderly.
Cardiovascular Effects of High‐Dose Fentanyl Anaesthesia
Authors: Sebel P. S. , Bovill J. G. , Boekhorst R. A. A. , Rog N.
Published: January 2009

An anaesthetic technique using high‐dose fentanyl for coronary artery surgery is described. Fentanyl 160 or 70 μg kg‐1 was used as the sole anaesthetic agent, and patients were ventilated with air/O2 (fentanyl 70 μg kg‐1) or N2O/O2 (fentanyl 60 μg kg‐1). Cardiovascular data from 30 patients are presented. Fentanyl caused no significant cardiovascular depression. The only statistically significant changes in cardiovascular parameters were seen in the patients who received fentanyl 60 μg kg‐1. Five minutes after skin incision there was an increase in peripheral resistance. Diastolic pressure was increased following sternotomy. Problems associated with this technique of anaesthesia are a 50% incidence of hypertension following sternotomy (requiring treatment with sodium nitroprusside) and prolonged respiratory depression. The lack of cardiovascular depression produced by fentanyl and the ability of fentanyl to reduce hormonal and metabolic responses to surgery make it a satisfactory technique for cardiac anaesthesia.
An Oxygen‐Consuming Model Lung for Evaluation of Anaesthetic Circuits
Authors: Stenqvist O. , Sonander H. , Löfstrom B. , Nilsson K.
Published: January 2009

We have constructed an oxygen‐consuming model lung based on pure combustion of hydrogen. Besides consuming oxygen the model produces water vapour, and carbon dioxide is delivered to the lung, thus mimicking carbon dioxide production. Oxygen consumption and carbon dioxide production can be set at desired values. The model lung can be used for investigations on and evaluation of all types of anaesthesia circuits. Results in a circle system with carbon dioxide absorption show that FIO2 is related to the fresh gas flow. The end tidal CO2 level is correlated to the alveolar ventilation and cannot be used for predicting FIO2.
Analgesia for Circumcision in Children: A Comparison of Caudal Bupivacaine and Intramuscular Buprenorphine
Authors: May A. E. , Wandless J. , James R. H.
Published: January 2009

In 44 boys undergoing day case circumcision, analgesia was provided with either buprenorphine 3 μg/kg intramuscularly or 0.25% bupivacaine 0.5 ml/kg by caudal injection. Both methods provided good analgesia; the frequency of side effects was less with caudal analgesia; and restoration to normal activity 24 h after operation was greater than with buprenorphine.
Chlormethiazole (Heminevrin®), Pethidine and Nitrous Oxide as Compared to Halothane for General Anaesthesia
Authors: Kristoffersen M. B. , Hansen E. Kjær , Jostell K.‐G. , Stockman O.
Published: January 2009

The anaesthetic and postanaesthetic course in a group of gynaecological patients anaesthetized with chlormethiazole (Heminevrin®) was investigated and the results compared to a similar group of patients anaesthetized with halothane. Both drugs were used as the main anaesthetic agent in the respective regimes, supplemented by nitrous oxide/oxygen and muscle relaxants. Because chlormethiazole is devoid of analgetic effects, the importance of using pethidine in combination with chlormethiazole is emphasized. An advantage of using chlormethiazole is that it can serve as both an induction and maintenance agent. The plasma concentrations of chlormethiazole were studied in seven patients. For induction, the mean concentration was 4.5 μg/ml. The mean concentration on waking at the termination of operation was 1.3 μg/ml. No serious side effets were encountered in either treatment. The results suggested that chlormethiazole in combination with an analgetic drug and nitrous oxide could be suitable in elderly patients, although occasionally less effective in the young.
How Much do Arm Movements Displace Cubital Central Venous Catheters?
Authors: Kalso E. , Rosenberg P. H. , Vuorialho M. , Pietila K.
Published: January 2009

The effect of abduction and adduction of the arm on the position of central venous catheters inserted via cubital veins was studied in 41 surgical patients. The location of the catheter tip and the abduction‐adduction angle were measured from x‐ray pictures. With adduction, the catheter always advanced inwards, the maximal movement being 9.5 cm. The average displacement varied from 2.0 cm to 3.3 cm and there was a statistically significant correlation (P < 0.001; r = 0.831) between the advancement of the catheter tip and the abduction‐adduction angle. There was no correlation between tip displacement and change in central venous pressure.
Anthropometric Studies of Human Subjects Susceptible to Malignant Hyperpyrexia
Authors: Campbell I. T. , Ellis F. R. , Halsall P. J. , Hogge M. ST. J.
Published: January 2009

Height, weight, and skinfold thickness were measured on 82 patients prior to muscle biopsy which was performed to determine their susceptibility to malignant hyperpyrexia. Percentage body fat was calculated from the skinfold measurements. Using AP photographs six coronal diameters of the left thigh. equally spaced between the lower border of the patella and the perineum, were measured on another group of 90 patients referred for biopsy. The subjects were then divided into those who were susceptible to malignant hyperpyrexia (MHS) and those who were normal and acted as controls. Each group was separated into males and females. There was no significant difference in age between the MHS and the control groups. There was no difference between MHS and controls in height or weight but the percentage body fat in the MHS males was significantly lower than in the controls (P<0.02). The upper three thigh diameters in the MHS females were significantly greater than in the control group (P<0.05). There appears to be a difference in the leanness/fatness relationship and in the development of the thigh in MHS subjects compared with controls, but these differences are subtle and appear to vary with sex.
A Comparative Study of the Haemostatic Properties and Cardiovascular Effects of Adrenaline and Ornipressin in Children during Enflurane Anaesthesia
Authors: Sharkey A. J. , Brennen M. D. , O'Neill Maureen P. , Black G. W.
Published: January 2009

In a randomised, double‐blind trial, haemostatic and cardiovascular effects of ornipressin and adrenaline were compared in 30 children requiring surgery for “bat‐ear” deformity. Mean total blood loss was 14.3 ml with ornipressin and 11.7 ml with adrenaline, this difference being insignificant. There was a significant and progressive reduction in mean heart rate in children who received ornipressin. from 134 to 116 bpm (P<0.0.5). and a significant rise from 127 to 134 bpm (P<0.05) with adrenaline. Mean systolic pressure was unaltered by ornipressin but was significantly increased from 97 to 105 mmHg (P<0.05) in children receiving adrenaline. Ornipressin is as effective a haemostatic agent as adrenaline and the rises in heart rate and systolic pressure associated with adrenaline, which are factors known to predispose to the onset of ventricular dysrhythmias, do not occur with ornipressin.
Cardiovascular and Metabolic Effects of Halothane and Enflurane Anesthesia in the Geriatric Patient
Authors: Stefánsson T. , Wickstrom I. , Haljamäe H.
Published: January 2009

The hemodynamic and metabolic effects of halothane and enflurane anesthesia during mechanical ventilation in geriatric patients (n = 16, mean age 83 years) with hip fractures were studied before premedication, at the end of operation and 15 min and 2 h after the end of anesthesia. During anesthesia and surgery. systolic arterial blood pressure (SAP), cardiac index (CI), left ventricular stroke work index (LVSWI) and oxygen consumption (V̇O2) decreased to a similar extent in both groups, while systemic vascular resistance index (SVRI) remained unchanged. Fifteen minutes after the end of anesthesia SAP, CI and LVSWI had returned to preoperative levels but SVRI was decreased in both groups. Pulmonary systolic and diastolic pressures were unchanged during anesthesia but slightly increased 15 min after the end of anesthesia. No change was seen in venous admixture. In the halothane group, a significant increase in V̇O2 occurred in the postanesthetic period due to shivering. During anesthesia and surgery, arterial oxygen tension and arterial pH increased but arterial carbon dioxide tension decreased in both groups due to hyperventilation with the oxygen‐enriched gas mixture (N2O:O2 = 1:1). A similar increase in blood glucose, lactate and pyruvate levels was seen in both groups in the per‐ and postanesthetic periods, but there was no excess lactate production. In skeletal muscle, glucose and lactate levels were increased 15 min after the end of anesthesia but no changes were seen in the high energy phosphagen levels. It may thus be concluded that both halothane and enflurane had similar hemodynamic and metabolic effects in the geriatric patient. Both agents induced a myocardial depression and a decrease in whole body oxygen consumption. The effects on tissue metabolism were small and seem to be mainly due to an increased sympathetic activity caused by surgical stimuli.
Preanesthetic Evaluation of the Female Geriatric Patient with Hip Fracture
Authors: Haljamäe H. , Stefánsson T. , Wickström I.
Published: January 2009

Female geriatric patients (mean age 81.0 years; n = 204) with hip fracture (trochanteric n = 86; cervical n= 118) were investigated before anesthesia with regard to social situation, medical condition and routine blood chemistry (including arterial blood gases and acid‐base balance). Forty of these patients were, in addition, subjected to more extensive hemodynamic studies (determination of pressures and resistances in systemic and pulmonary vasculatures and of cardiac function), pulmonary studies (determination of alveolo‐arterial O2difference and venous admixture) and metabolic studies (determination of oxygen consumption. blood and skeletal muscle levels of glycolytic metabolites and muscle levels of high energy phosphagens). Of the 204 patients, 56% were admitted from their homes and 44% from various types of institutions. The mean interval between the fracture and preanesthetic evaluation was 2.3 days. The medical examination revealed pathological findings in 92% of patients (cardiovascular 78%, mental 39%, pulmonary 14%, endocrinological 12%, neurological 10%). 87% of patients received drug therapy. Anemia (Hb<115 g·1‐1) was more common (24%) than hemoconcentration (Hb<115 g·1‐1, 8%). Low potassium in serum was seen in 14% of the patients. The mean Pao2level of 9.62 kPa indicated hypoxia in many patients (PaO2<7.5 kPa in 11% of patients) and a mean value of 22% was obtained for pulmonary venous admixture. The systemic vascular resistance was approximately twice as high as in young individuals, but the calculated stroke work index values for both ventricles were low, due to low stroke volume and cardiac output. Metabolic evaluation indicated that these elderly individuals had mainly oxidative Type I muscle fibers, in contrast to that seen in a control group of 11 young females, who had tissue metabolite levels characteristic for glycolytic Type II fibers. The lactate:pyruvate ratio in blood was also much lower in elderly (mean 14.0) than in young (mean 30.6) females. The significance of these findings with regard to anesthetic risk is discussed.
Effects of Positive End‐Expiratory Pressure on Cardiac Output Distribution in the Pig
Authors: Haldén E. , Jakobson S. , Janerås L. , Noklén K.
Published: January 2009

Cardiac output (CO) and the blood flow to the heart, cerebellum, kidney, pancreas, spleen and skeletal muscle were studied in 20 pigs during spontaneous breathing (SB) and intermittent positive pressure ventilation (Ippv) with a positive end‐expiratory pressure (Peep) of 0, 8, 16 or 24 cmH2O. Microspheres (15 μm) labelled with either 85‐Sr or 141‐Ce were used. Injection of microspheres labelled with one of the isotopes was given during SB (all pigs) and with the other isotope during Ippv with Peep of 0, 8, 16 or 24 cmH2O (five pigs at each level). CO decreased by 11% during Ippv with Peep of 0 and 31%, 53% and 66% during Peep of 8, 16 or 24 cmH2O, respectively. Mean arterial blood pressure was fairly well maintained in all groups except the group with Peep of 24 cmH2O. The perfusion of the six organs deteriorated, but when taken as fractions of CO measured at the same time, the blood flow to the heart, cerebellum and kidney increased with increasing airway pressure, while that to the pancreas, spleen and skeletal muscle decreased. The vascular resistance of the three former organs did not change, while in the latter it increased markedly. It is concluded that when CO decreases as a result of positive pressure ventilation, a redistribution takes place, mainly due to vascular constriction in skeletal muscle, which acts to preserve the blood flow to vital organs.
Pharmacological Evacuation of the Stomach with Metoclopramide
Authors: Olsson G. L. , Hallén B.
Published: January 2009

Children admitted for emergency operations because of trauma run a high risk of chemical aspiration pneumonitis syndrome. Fifty‐eight children admitted for closed reduction of fractures and suturing of wounds were studied in a double‐blind manner in order to see if metoclopramide could be of value in decreasing the risk of aspiration during anaesthesia. Metoclopramide given before anaesthesia proved to enhance gastric evacuation and could thus be of value in these situations. In addition, the study showed that the time from last oral intake until start of anaesthesia is of less importance than the type of trauma in prolonging the gastric emptying time and thus increasing the risk of vomiting and aspiration of vomitus into the lungs during anaesthesia.
Malignant Hyperthermia in a Myopathic Child. Prolonged Postoperative Course Requiring Dantrolene
Authors: FletcherM.D. R. , Blennow G. , Olsson A.‐K. , Ranklev E. , Tornebrandt K.
Published: January 2009

An 18‐month‐old boy with congenital muscular dystrophy began to develop clear signs of the malignant hyperthermia syndrome after 85 min of halothane/nitrous oxide anaesthesia. Dantrolene, 2 mg/kg i.v., was immediately effective, but temperature, heart rate and carbon dioxide production were all increased for 2 days postoperatively in spite of repeated dantrolene administration.
Effect of Prophylactic Epidural Morphine or Bupivacaine on Postoperative Pain after Upper Abdominal Surgery
Authors: Scheinin B. , Rosenberg P. H.
Published: January 2009

Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the epidural space prior to general anaesthesia of 40 patients undergoing upper abdominal surgery. During anaesthesia, additional analgesics were not given. In the recovery room (4 h) the pain score (0–10) was lowest in the bupivacaine group (mean 2.4) followed by the 4 mg‐morphine group (4.1), 2 mg‐morphine group (5.3) and control group (5.7). Half of the patients of the bupivacaine group and those of the 4 mg‐morphine group needed no analgesics in the recovery room. Later, in the ward (until next morning 7 am), only morphine patients (5/20) managed without postoperative analgesics. The mean number of requests for analgesics during that time was: 4 mg‐morphine 1.3, 2 mg‐morphine 1.9, bupivacaine 2.7, and control 2.9. Episodes of hypotension and nausea were most frequent in the bupivacaine group. No serious respiratory complications occurred; 4 h after anaesthesia three patients in the 4 mg‐morphine group and two in the bupivacaine group had capillary Pco2 values above 6.65 kPa (50 mmHg), the highest being 7.1 kPa. In two additional patients with choledochal drainage (T‐tube), the intracholedochal pressure was shown to rise about 2 kPa (15 mmHg) and 2.7 kPa after epidural injection of 2 mg and 4 mg, respectively. A pressure peak was reached within 10 min and at 75 min the pressure was still 0.7‐1.3 kPa above the initial level.
Carbon Dioxide Homeostasis and Recovery after General Anaesthesia
Authors: Hovorka J.
Published: January 2009

The influence of different levels of carbon dioxide during general anaesthesia on postoperative recovery was studied. Sixty female patients were divided into two age groups. Thirty patients were over 60 years old and 30 patients were under 46 years old. Artificial ventilation with added carbon dioxide during general anaesthesia with thiopentone, nitrous oxide‐oxygen, alcuronium and fentanyl was used. According to the arterial CO2 tension, patients were allocated to subgroups: hypercarbic, Paco2 7.3 kPa, normocarbic, Paco2 5.3 kPa and two different levels of hypocarbia: older patients Paco2 3.7 kPa and younger patients Paco2 2.9 kPa. As criteria for recovery, a battery of recovery tests and postoperative questionnaires were used. Regardless of age, patients subjected to hypercarbic ventilation scored better in the recovery tests than patients subjected to normo‐ or hypocarbia. Normocarbic ventilation also gave better results than hypocarbic ventilation. The level of hypocarbia used in the older patients and that used in the younger patients, though different, resulted in nearly the same deterioration of scoring in the recovery tests. This deterioration was seen in some patients up to 48 h postoperatively. No subjective differences were elicited from the questionnaires after various types of ventilation.
Does Oral Premedication Increase the Risk of Gastric Aspiration?
Authors: Hjortsø E. , Mondorf T.
Published: January 2009

In a clinical study including 40 patients, who all underwent elective gynaecological surgery, the quantity and acidity of the gastric contents were compared for patients premedicated with diazepam (Apozepam®) intramuscularly and orally, respectively. A significant difference was found with regard to both the quantity and acidity of the gastric fluid. The volume of gastric fluid was smaller after oral than after intramuscular premedication with diazepam (1.5 ml and 20 ml, respectively). The acidity of the gastric fluid was also less after oral than after intramuscular premedication (pH 2.4 and 1.8, respectively).
Flunitrazepam as an Induction Agent in Elderly, Poor‐Risk Patients
Authors: HoviViander M. , Aaltonen L. , Kangas L. , Kanto J.
Published: January 2009

Great interindividual variation was found in response to flunitrazepam when the latter was used as an induction agent for general anaesthesia in elderly, poor‐risk patients. However, no significant changes in the pharmacokinetics of this nitrobenzodiazepine derivative were found, which suggests that there are pharmacodynamic alterations in response to the drug with advancing age. A sudden but transient drop in blood pressure was found in three out of 12 patients, even although flunitrazepam was given, i. v., in low 0.3‐0.5 mg incremental doses. A marked amnesic effect was found. No analgesics were needed in the recovery room (2 h), supporting the evidence that flunitrazepam has an analgesic‐sparing effect. Flunitrazepam resulted, in general, in smooth induction of anaesthesia, but a long time was needed for induction.