bluuebunny/crossref_metadata_2025 huggingface dataset:
Analgesic action of metoclopramide in prosthetic hip surgery
Authors: Kandler D. , Lisander B.
Published: January 2009

Prosthetic hip surgery was performed under subarachnoidal anaesthesia with bupivacaine 16–20 mg and morphine 0.2 mg. Preoperatively, metoclopramide 1 mg · kg‐1 was given i.v., followed by an infusion of 1.5 mg · kg‐1 over 9 h (n= 17). Control patients received corresponding volumes of solvent (n = 23). The design of the study was double blind. The characteristics of the spinal block (level of analgesia to pinprick and muscular block) and postoperative VAS pain scores were similar in both groups. During the 24 h following the start of the infusion, four patients receiving metoclopramide required i.v. opioids, compared to 15 in the control group (P<0.05). The pain‐free period was longer (P<0.05) in the metoclopramide group. Arterial PcO2‐levels were increased, reaching a maximum within 6 h of infusion, with no significant difference between the groups. The study suggests an analgesic action of metoclopramide.
Effects of intrathecal morphine and spinal anaesthesia on sympathetic nerve activity in humans
Authors: KirnÖoU K. , Lundin S. , Elam M.
Published: January 2009

Microneurography with direct registration of efferent sympathetic nerve activity to muscle or skin was used to study the effect of morphine and procaine given intrathecally to patients scheduled for transurethral resection of the prostate. A lumbar spinal catheter was inserted and multiunit postganglionic sympathetic activity was recorded in a muscle or skin fascicle of the peroneal nerve. After injection of 0.4 mg morphine, sympathetic nerve activity to muscle (n = 6) or skin (n = 2) was recorded for 30 min. Compared with a 10‐min control period prior to the injection no change in activity could be observed. In contrast, spinal anaesthesia (procaine 75–100 mg) with an upper level of sensory blockade at T3‐T11 completely eliminated intraneurally recorded sympathetic activity within 5 min (n = 8). Skin vasodilation and loss of sudomotor responses in the foot accompanied the neural blockade.
Renal vascular response to left atrial injection. An experimental study in the pig
Authors: Sandin R. , Feuk U. , Modig J.
Published: January 2009

It has previously been shown that a rapid, transient and pronounced reduction in superficial renal cortical blood flow can be elicited by injection of 1 ml of plasma into the left atrium of the anaesthetized pig. This renal vascular response might constitute an important error in measurements of renal blood flow by means of the microsphere technique. In the present study we have investigated total renal (ultrasonic Doppler) and superficial renal cortical (laser Doppler flowmetry) blood flow after left atrial injections of saline and autologous blood. The average reductions in total renal blood flow were 4.7 ± 2.4% (mean ± s.d.) and 18.4 ± 12.5% (mean ± s.d.) for the blood and saline injections, respectively. The flow reduction was more pronounced in the superficial renal cortex with average reductions of 17.4 ± 26.0% (mean ± s.d.) and 59.4 ± 38.5% (mean ± s.d.) for blood and saline, respectively (laser Doppler flowmetry). Furthermore, two consecutive injections of microspheres were performed. The results from the second injection were compared with those from the first injection. In the superficial renal cortex the second injection indicated a significant reduction in blood flow and an significantly increased heterogeneity in the blood flow in two different tissue volumes. No corresponding differences were found in the juxtamedullary cortex. These results indicate that the renal vascular response to a left atrial injection is detectable as a reduction in total renal blood flow and is most pronounced in the superficial renal cortex. All these results taken together constitute an important error in measurements of superficial renal cortical blood flow by the microsphere technique.
Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine
Authors: Møiniche S. , HjortsØ N‐C. , Blemmer T. , Dahl J. B. , Kehlet H.
Published: January 2009

Thirty‐one patients scheduled for elective cholecystectomy performed through a mini‐laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg · h‐1 and morphine 0.2 mg · h‐1 for 38 h after surgery plus systemic ibuprofen 600 mg · 8 h‐1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg · 8 h‐1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest and during mobilisation was superior compared to systemic morphine and NSAID. There were no significant differences between groups in haemodynamic responses (BP and heart rate) during rest, orthostatic stress and after walking assessed before, 24 and 48 h after operation except for a clinically unimportant lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group at 24 h) or in number of episodes of dizziness, nausea or vomiting during rest or mobilisation. These results do not support the common belief that low‐dose thoracic epidural bupivacaine/morphine may prevent ambulation due to sympathetic blockade or to impaired cardiovascular adaptation to the upright position.
The cardiovascular response to ketamine: the effects of clonidine and lignocaine
Authors: Munro H. M. , Sleigh J. W. , Paxton L. D.
Published: January 2009

The effectiveness of clonidine or lignocaine in reducing the cardiostimulatory effects of ketamine was studied. A double‐blind, randomized design was used in three groups of 20 patients each, of ASA grade 1 or 2 presenting for minor elective surgery. The clonidine group received 0.3 mg clonidine orally with the premedication while the lignocaine group received 1.5 mg · kg‐1 lignocaine prior to induction. The third group formed the controls. All patients were induced with 2 mg · kg‐1 ketamine intravenously. The systolic blood pressure in the clonidine group was significantly lower than that of both the control and lignocaine groups throughout the study (P<0.05). It was concluded that clonidine was effective in reducing the hypertensive response to ketamine, whereas lignocaine had no effect.
The calcium channel blocker nifedipine fails to inhibit leucocyte elastase release during cardiopulmonary bypass
Authors: Massaut J. , Hennebert N. , Tasiaux N. , Demanet H.
Published: January 2009

Circulating concentrations of leucocyte elastase were measured in 16 adult patients undergoing cardiopulmonary bypass (CPB) with a flat‐sheet membrane oxygenator. Eight patients (Group I) received the calcium channel blocker nifedipine (9 µmUg · kg‐1· h‐1) during CPB. Eight patients (Group II) did not receive any calcium channel blocker during surgery and served as the control group. Elastase concentrations were measured at 7 time points: 2 before, 2 during, and 3 after CPB. The bypass procedure was associated with elevation in elastase concentrations (P<0.001). Comparing to baseline values elastase concentrations were significantly elevated (P<0.05) 60 min after the start of CPB and on all measurements done after CPB. Elastase concentrations correlated with the duration of CPB (rs = 0.76,P<0.001), and were not influenced by nifedipine infusion as revealed by comparing the two groups. This study demonstrates moderate elastase release during CPB with a fiat‐sheet membrane oxygenator and fails to confirm inhibition of elastase release by nifedipine infusion during CPB.
Myocardial ischaemia as judged from transoesophageal echocardiography and ECG in the early phase after coronary artery bypass surgery
Authors: ÖOwall A. , Ehrenberg J. , Brodin L.‐ÅAR.
Published: January 2009

The incidence of myocardial ischaemia, as diagnosed by transoesophageal echocardiography (TEE) versus ECG, and the relationship between ischaemic events and haemodynamic parameters were studied in 30 patients in the early phase after coronary artery bypass grafting. Information comprising invasive haemodynamics, TEE measurements, and 12‐lead ECG was obtained on arrival of the patient in the intensive care unit (ICU), and then hourly in the ICU for 5 h. In the ICU, TEE signs of ischaemia were found in 14 patients and ECG signs of ischaemia in six patients. The ischaemic events were not related to levels of blood pressure or heart rate. Three patients showed signs of myocardial infarction postoperatively. All three of these patients showed both TEE and ECG signs of ischaemia in the ICU. It was concluded that TEE reveals more ischaemic events than ECG in the early postoperative period and that these ischaemic events do not correlate with the haemodynamic indices.
Intra‐arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia
Authors: RØoSrdam P. , Jensen L. P. , Schroeder T. , Lorentzen J. E. , Secher N. H.
Published: January 2009

In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra‐arterial (i.a.) papaverine. Eight patients had a low epidural block (Th. 10) and eight patients were operated during high epidural anaesthesia (>Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated during low epidural anaesthesia (P<0.02). Increase in arterial flow after i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin‐dependent diabetes mellitus who had low epidural anaesthesia, the increase in flow after i.a. papaverine was not significantly different to that noted during high epidural anaesthesia. The results indicate that the level of analgesia influences graft flow after i.a. papaverine, probably reflecting differences in the effect of epidural anaesthesia on sympathetic tone to the leg.
Effect of acute experimental liver dysfunction on the pharmacodynamics of heptabarbital in rats
Authors: Hoffman A. , Baluom M.
Published: January 2009

The present study aimed to investigate whether the pharmacodynamics of a lipophilic barbiturate, heptabarbital, is altered by liver dysfunction. Heptabarbital was slowly infused i.v., to rats with liver necrosis induced by carbon‐tetrachloride, until the rats lost their righting reflex. The concentrations of the drug in serum, brain and CSF were determined in both the diseased animals and solvent‐treated controls. Although the concentrations of heptabarbital in the CSF, serum and brain were not significantly different between controls and diseased rats, the total heptabarbital dose required to induce sleep was markedly lower in the diseased animals. Accordingly, the pharmacodynamics of heptabarbital is unaffected in experimental liver dysfunction in rats.
Propofol induces bronchodilation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients
Authors: Conti G. , Dell'Utri D. , Vilardi V. , Blasi R. A. De , Pelaia P. , Antonelli M. , Bufi M. , Rosa G. , Gasparetto A.
Published: January 2009

The aim of this study was to evaluate the effects of propofol administration (2 mg · kg‐1 i.v.) on the airways resistances and respiratory mechanics of patients affected by COPD exacerbation, requiring mechanical ventilation. Twenty patients required anaesthesia for diagnostic or therapeutic procedures. Fourteen consecutive patients were divided at random into two groups: Group P received propofol and Group C (control) received only Intralipid 10%; an additional group of six patients received i.v. flunitrazepam (0.03 mg · kg‐1). Lung mechanics (dynamic and static compliance, peak inspiratory pressure, intrinsic positive and expiratory pressure, minimal and maximal resistances of the respiratory system) were evaluated in basal conditions and 3 and 6 min after propofol, Intralipid or flunitrazepam administration. We did not observe significant variations of the evaluated variables after Intralipid or flunitrazepam (Groups C and F), while in patients who received propofol (Group P), we observed the following modifications: dynamic compliance increased from 2.3 ± 0.3 to 2.8 ± 0.4 ml · kPa‐1 (P<0.05), peak inspiratory pressure decreased from 3.3 ± 0.7 to 2.8 ± 0.4 kPa (P <0.05), minimal resistances of the respiratory system (that mainly reflect airways resistances) decreased from 1 ± 0.2 to 0.7 ± 0.2 kPa · 1‐1 · s‐1 (P <0.01). Our results suggest that propofol induces bronchodilation in mechanically ventilated COPD patients, and that this effect is not related specifically to the induction of general anesthesia.
Postoperative pain treatment on wards – USA experience
Authors: Ready LB
Published: January 2009

A large variety of treatment options are now available to experienced pain therapists. Effective doses of opioids can be administered by the oral, rectal, transdermal, or sublingual route, or by subcutaneous, intramuscular, or intravenous injection or infusion. Patient–controlled analgesia (PCA) is now familiar and commonly available. Most PCA pumps also offer the option to add a continuous background infusion to the basic patinet–controlled mode with the possibility of therapeutic benefits and new problems. Alternative delivery routes and PCA drugs have been reported.

A variety of neural blockade techniques can provide effective and safe analgesia. These include topical application, local infiltration of incicions, and blockade of peripheral nerves or plexuses. Intrathecal and epidural opioids are now commonly used to control pain following a wide variety of surgical procedures, but many questions remain to be answered.

The concept of postoperative pain management by anesthesiologists is growing in popularity in North America. It is not surprising that such a revolutionaryidea involving basic changes in long–established practices is receiving attention not only from clinicians, but also from economists and politicians. One manifestation of this attention in the United States is a clinical practice guideline entitled Acute Pain Management: Operative or Medical Procedures and Trauma. Important elements of the guideline include recognition of historic inadequacies in postoperative pain management and acknowledgement of the importance of effective pain control.
Postoperative pain management in children
Authors: Henneberg SW , Hole P.
Published: January 2009

During the past decade an increasing awareness concerning postoperative pain treatment in children has arisen. There is overwhelming evidence that this treatment often is insufficient (1, 23, 4). The special problems related to the neonatal period has also been discussed (5, 6). To day there are a number of drugs and regional anaesthetic techniques available and the provision of adequate postoperative pain relief should be possible in all children. The object of this paper is to rewiev these methods.
Anaesthetic depth and auditory evoked potentials
Authors: Thornton C. , Creagh–Barry P. , Jordan C. , Newton DEF
Published: January 2009

We have investigated the auditory evoked response (AER) in a series of experimental and clinical studies to assess its usefulness as a measure of depth of anaesthesia. Three questions were posed. Does the AER show: –l) graded changes with increasing concentrations of general anaesthetics which are similar for different anaesthetic drugs 2) appropriate changes with surgical stimulation 3) changes with loss of consciousness?

The AER was found to satisfy these criteria in that six general anaesthetics, belonging to different chemical groups, showed similar graded reductions in the amplitudes and increases in the latencies of the AER waves originating from the primary cortical section of the auditory nerve pathway. These changes were reversed by surgical stimulation indicating that the AER does not simply act as a concentration monitor but reflects true depth of anaesthesia. In addition there were changes in these early cortical AER waves which indicate potential awareness.

The clinical investigations also suggested that the AER is a valid measure of depth of anaesthesia. A numerical index derived from the AER decreased when the anaesthetic blood concentration increased and increased when surgical stimulation increased in severity. The numerical index gave the same value at the same depth of anaesthesia in different patients. This means that a monitoring device based on the AER would not have to be calibrated separately for each patient and further that it could be attached to the patient when they are already anaesthetised. Further work is in progress on the display of information for the anaesthetist and in reducing the time taken to produce a reliable response.
The nature of haemodynamic monitoring data
Authors: Mäkivirta A. , Koskp EMJ.
Published: January 2009

The fast–acting physiological control mechanisms as well as varying types of noise both in the measurement system and patient–to–machine interface affect the values of monitored variables. The artefactual wide fluctuations often occur more commonly than the clinically true extreme values. The artefact values in the signals may be markedly high or low, tending to result in considerable deviations in the variable values also on monitors which use averaging to process the data before presenting it in digital form. The extreme values result in prompt but often undue activation of limit alarms, diminishing the reliability of alarms and creating resistance to activate the limit alarm system of the monitors. This paper discusses the extent and origin of extreme values in haemodynamic monitoring data providing an example of actual clinical material.
Computerized patient monitoring
Authors: Sukuvaara T. , Heikelä A. , Koskp EMJ. , Nieminen H. , Sydänmaa M.
Published: January 2009

In patient monitoring, the set of conclusions that is possible to make is larger when combining information from several variables than when making conclusions on separately applied single variables. During patient monitoring, a high amount of physiological variables is already produced electronically but the information they bear is not fully utilized. The present patient monitoring equipment typically just represent measured variables without combining information that can derived from them. In literature, several prototype systems have been developed to generate high level assessments of the patient's state (e.g., hypovolemia) on a multivariate basis. The development of these systems has not yet resulted in commercial products, probably partly because these systems easily grow complex. Modularization of a system makes the development easier and enables gradual development of the system. In our architecture for patient monitoring, source data is first preprocessed in order to provide representative and informative numerical features for further processing. Preprocessed variables are transformed into a standard scale to separate the physiological interpretation of single variables and the combining of them. The applied standard scale of the physiologically interpreted variables makes the development of patient's state assessment easier. On top of the architecture, the assessment of the patient's state is performed by assessing first the subsystems of the patient's physiology.
Laboratory methods for detecting disseminated intravascular coagulation (DIC): new aspects
Authors: Bredbacka S. , Blombäck M. , Wiman B. , Pelzer H.
Published: January 2009

The objective was to diagnose a hypercoagulative state or “pre‐DIC” with new laboratory tests. APACHE II score was used as a measure of primary illness. Ventilator time was used as a reflexion of secondary complications. Twenty‐three ICU patients were divided into two groups depending on time on the ventilator: Group 1 > 7 days and Group II ≤ 7 days. If, after admittance patients deteriorated or complications occurred, new quantitative coagulation tests were done: soluble fibrin, prothrombin fragment 1 + 2, thrombin‐antithrombin complex, D‐dimer and elastase. We found a positive correlation between SF levels, the APACHE II score and the ventilator time. Diagnostic efficacy for SF was 87%, sensitivity 91%, specificity 83%, the predictive value of a positive result was 87% and the predictive value of a negative result 91%. The levels of the other new tests were also generally higher in the clinically worse group, although not significantly. Prothrombin complex, APTT, platelet count and AT III were pathologic to the same extent in both groups. The patients who developed most secondary complications, resulting in longer ventilator treatment (Group I), were also hypercoagulative. Soluble fibrin, in particular, seems to be valuable in the diagnosis of “pre‐DIC” and possibly of predictive value for organ system complications.
Contribution of rib cage and abdominal movement to ventilation for successful weaning from mechanical ventilation
Authors: Ochiai R. , Shimada M. , Takeda J. , Iwao Y. , Fukushima K.
Published: January 2009

In order to test the hypothesis whether the breathing pattern is helpful in predicting weaning outcome in patients being weaned from mechanical ventilation, 38 patients who underwent operation for esophageal cancer were evaluated at weaning from mechanical ventilation (19 unsuccessful weanings, group U, and 19 successful weanings in age‐matched patients, group S). Since all patients initially fullfilled our weaning criteria, ventilatory parameters such as tidal volume, respiratory frequency, minute ventilation, and arterial blood gas analysis showed no significant differences between the groups. The breathing pattern was registered quantitatively by means of respiratory inductive plethysmography at 3 cmH2O (0.3 kPa) of CPAP prior to weaning. The contribution of rib cage movement to tidal volume (%RC) was significantly greater in group U than in group S (P<0.05). Indeed, 84% of the patients in group S showed %RC less than 50%, compared to only 16% of the patients in group U ((P<0.05). The results suggest that the breathing pattern is one important factor in predicting the outcome of weaning in patients after thoraco‐abdominal surgery. Diaphragmatic fatigue is suspected to be the mechanism for the increase in the RC component in patients with unsuccessful weaning outcome.
Evaluation of the time course of action of maintenance doses of rocuronium (ORG 9426) under halothane anaesthesia
Authors: Khuenl‐Brady K. S. , Pühringer F. , Koller J. , Mitterschiffthaler G.
Published: January 2009

The time course of action of rocuronium was compared using three different sizes of maintenance doses after at least three subsequent administrations of the same repeat dose in each patient under halothane anaesthesia. Following endotracheal intubation facilitated with 0.6 mg.kg‐1 rocuronium (ORG 9426), muscle relaxation was maintained in three groups each consisting of ten patients, using increments of equal repeat doses of either 75 μg‐kg‐1, 150 μg‐kg‐1 or 225 μg.kg‐1 equivalent to 1/4, 1/2 and 3/4 of the ED95 of this new compound, respectively. Maintenance doses were administered when the twitch height depression induced by the previous dose returned to 25% of its control value. The clinical duration of the intubating dose averaged 27 ± 7.5 min (mean ± s.d.). The time course of action of the various maintenance doses depended on their size, but not on the number of administrations. The durations of repeat doses averaged 8–9 min, 14–16 min and 19–23 min after the low, medium and high maintenance doses, respectively. No overt cumulative effects were observed.
Effects of low‐dose adenosine on myocardial performance after coronary artery bypass surgery
Authors: ÖWall A. , Ehrenberg J. , Brodin L. A. , Juhlin‐Dannfelt A. , Sollevi A.
Published: January 2009

The effect of a non‐hypotensive dose of adenosine infusion on myocardial performance after coronary artery bypass surgery was examined. Upon arrival at the intensive care unit, 16 patients (14 males, 2 females; mean age 64.5, range 46–71) were randomized to a blinded infusion of either low‐dose adenosine (n = 8) or placebo (n = 8). The infusion continued at a rate corresponding to 30 μg. kg‐1. min‐1 of adenosine into the right ventricle over 4 h. Data were collected from the arterial line, thermodilution pulmonary artery catheter, transoesophageal echocardiogram (TEE), and 12‐lead ECG on six occasions: before infusion, hourly during the infusion, and 1 h after terminating the infusion. Mean arterial blood pressure did not differ between the adenosine and placebo groups at any measurement point. Heart rate increased by approximately 15% during the first hour of adenosine infusion. Cardiac index increased by approximately 50% during infusion of adenosine and cardiac index remained higher while systemic vascular resistance remained lower in the adenosine‐treated group during infusion. The E/A ratio (ratio between peak left ventricular inflow blood velocities during early filling and atrial contraction) was significantly higher in the adenosine‐treated group after treatment for 1 h while the area injection fraction did not differ between groups at any time. The number of patients with ischaemic events as judged from ECG and from left ventricular regional wall motion abnormalities (RWMA) as visualized by TEE did not differ between groups (ECG: one patient in the adenosine group and one patient in the placebo group ‐ RWMA: four patients in the adenosine group versus three in the placebo group). According to enzyme determinations, three patients (two in the adenosine group and one in the placebo group) developed a perioperative myocardial infarction. In conclusion, adenosine could be infused at a rate that induced peripheral vasodilation and improved cardiac output, without affecting arterial blood pressure. The echo Doppler indices area ejection fraction and E/A ratio revealed no signs of impaired ventricular function during the infusion of adenosine.
Interpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double‐blind study
Authors: Engdahl O. , Boe J. , Sandstedt S.
Published: January 2009

The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8‐hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double‐blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. The scores were significantly lower in the bupivacaine group at 5, 15, 30 and 60 min after the first injection. No significant differences in pain scores were found after 4 or 8 h. Pain scores in the bupivacaine group were also reduced after the 2nd, 4th, 7th and 10th injections, but compared with placebo the differences were significant only after the 2nd and 7th injections. Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8‐h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.
Inhibitory effects of amide local anaesthetics on stimulus‐induced human leukocyte metabolic activation, LTB4release and IL‐1 secretionin vitro
Authors: Sinclair R. , Eriksson A. S. , Gretzer C. , Cassuto J. , Thomsen P.
Published: January 2009

The anti‐inflammatory effects of the amide local anaesthetics lidocaine and bupivacaine were evaluatedin vitroby examination of the metabolic activation and secretory responses of human polymorphonuclear granulocytes (PMNGs) and mononuclear cells. Pretreatment with lidocaine or bupivacaine had a dose‐dependent inhibitory effect on PMNG luminol‐amplified chemiluminescence stimulated by bovine serum albumin (BSA)/anti‐BSA immune complexes (IC) or by serum‐opsonized zymosan (SOZ) particles. Both lidocaine and bupivacaine inhibited the release of the inflammatory mediators leukotriene B4(LTB4) and interleukin‐1 (IL‐1) evaluated by radioimmunoassay (RIA). Pretreatment of suspended PMNGs and monocytes with the anaesthetics caused a marked inhibition of LTB4release when the cells were stimulated with SOZ. In short‐term (24 h) cultures of mononuclear cells the addition of lidocaine or bupivacaine reduced, in a dose‐dependent manner, the level of IL‐1 detected after stimulation with lipopolysaccharide (LPS). In all three assays (chemiluminescence, LTB4and IL‐1 RIA) bupivacaine was found to be more potent than lidocaine. The present results show that amide local anaesthetics have marked suppressive effects on the metabolic activation and secretory functions of leukocytes stimulated by different agonists. Although the detailed mechanisms for these effects are not known, they may explain part of the potent anti‐inflammatory actions of local anaesthetics previously describedin vivo.
Blood glucose after ethanol monitoring of irrigating fluid absorption in transurethral surgery
Authors: Hahn R. G.
Published: January 2009

The purpose of this study was to assess the risk of alcohol‐induced hypoglycaemia from the use of irrigating fluids containing ethanol in transurethral surgery. In the first part of the study, seven healthy male volunteers, aged between 26 and 36, received 1000 ml of irrigating fluid by intravenous infusion. The results confirm the existence of an alcohol‐induced decrease in blood glucose when ethanol is given together with 1.5% glycine. In the second part of the study, 40 patients, between 56 and 88 years of age, underwent epidural anaesthesia and a transurethral resection of the prostate (TURP) in which the irrigating fluid used contained 1.5% glycine and either 1% or 2% ethanol. The results suggest that the use of ethanol‐containing irrigating fluids is often followed by a slight reduction of the blood glucose level, but the magnitude of this change is too small to be of clinical importance.
Metabolic consequences of different perioperative fluid therapies in the neonatal period
Authors: Sandström K. , Nilsson K. , Andréasson S. , N A. , Larsson L. E.
Published: January 2009

Carbohydrate and fat metabolism during and after anaesthesia and surgery was studied in 14 neonates with major congenital non‐cardiac anomalies. They were either given a glucose solution until surgery or starved for at least 4 h before surgery. Ringer‐acetate alone or Ringer‐acetate plus 10% glucose was used for the intraoperative fluid therapy. After anaesthesia all neonates were given a 10% glucose solution. Concentrations of glucose, free fatty acids, triglycerides, lactate, pyruvate, alanine, glycerol and 3‐hydroxybutyrate were measured at predetermined intervals pre‐, intra‐ and postoperatively. Blood glucose concentrations rose during surgery both in neonates given glucose before and during surgery (n = 6) and in neonates not given glucose before and during surgery (n = 6). Increased intraoperative levels of free fatty acids and 3‐hydroxybutyrate were found in neonates not given glucose before and during surgery. The triglyceride levels were equal in both groups. In two neonates given glucose before surgery and Ringer‐acetate during surgery increased levels of 3‐hydroxybutyrate were found, particularly in one patient who became hypoglycaemic. In conclusion, starved neonates without intraoperative glucose supply mobilized fat and maintained blood glucose concentrations.
Pharmacokinetics of sufentanil in general surgical patients under different conditions of anaesthesia
Authors: Lehmann K. A. , Sipakis K. , Gasparini R. , Peer A.
Published: January 2009

The pharmacokinetics of sufentanil were studied in 56 surgical patients after an intravenous bolus of 2 μg kg‐1, in association with neurolept analgesia or volatile anaesthetics (halothane, enflurane and isoflurane). Plasma concentrations of sufentanil were measured by radioimmunoassay. The kinetics of sufentanil were comparable under neurolept analgesia and under anaesthesia with halothane, enflurane or isoflurane. The overall mean elimination half‐life was 182 min, Vd85 169 1 and the plasma clearance 910 ml min‐1. Except for the isoflurane subgroup, there was no significant correlation between half‐life, the volume of distribution or clearance with age (24–77 years) or body weight (45–95 kg).
Doxapram improves pulmonary function after upper abdominal surgery
Authors: Björk L. , Arborelius M. , Renck H. , Rosberg B.
Published: January 2009

The effects of doxapram on postoperative pulmonary function were studied in 40 ASA I and II patients randomly allocated to receive either doxapram 1.8 mg· kg‐1. h‐1 or placebo for 2 h immediately after elective cholecystectomy. The two groups displayed similar reductions of carbon dioxide production at 2 h and 6 h postoperatively, whereas oxygen consumption remained at preoperative levels for 24 h. Minute ventilation was similarly reduced in the two groups at 2 h and 6 h postoperatively, with corresponding increases in Paco2. Pao2 was similarly and significantly decreased in both groups postoperatively, whereas P(A‐a)o2 remained unchanged at 2 h and 6 h in doxapram‐treated patients. FRC was reduced postoperatively in both groups, significantly more so in the control group at 6 h. Various indices of intrapulmonary gas distribution, including the functional (nitrogen) dead space, underwent similar changes in the two groups. By contrast, the physiological dead space was reduced in doxapram‐treated patients at 2 h, 6 h and 24 h postoperatively, whereas no significant changes were seen in the control group. The ventilatory equivalent for CO2 was significantly lower in the doxapram‐treated group, implying higher ventilatory efficiency. Our findings indicate that infusion of doxapram postoperatively attenuates the impairment of pulmonary function postoperatively, chiefly via effects on V'A/Q' ratios. No side effects of doxapram were observed.
Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy
Authors: Yang L. C. , Jawan B. , Chen C. N. , Ho R. T. , Chang K. A. , Lee J. H.
Published: January 2009

Postoperative vomiting causes patients distress and delays discharge after outpatient surgery. Although P6 electroacupuncture is recognized as having an antiemetic effect, its inconvenient instrumentation may limit its clinical applicability. The purpose of this study was to explore a simple and effective alternative method for control of postoperative vomiting in outpatient surgery. We prospectively compared the effect of P6 acupoint injection with 0.2 ml 50% glucose in water (G/W) and intravenous injection of 20 μg/kg droperidol for prevention of vomiting in 120 consecutive outpatients undergoing gynecological laparoscopy with general anesthesia. Patients were randomly allocated to receive P6 acupoint injection, i.v. droperidol, or nothing as control group. Both P6 acupoint injection and i.v. droperidol 20 μg/kg were found to have a significant antiemetic effect when compared with the control group. We conclude that P6 acupoint injection with 50% G/W is a simple and effective method for reducing the incidence of postoperative emesis in outpatient surgery.
Evaluation of myocardial contractility in the chronically instrumented dog with intact autonomic nervous system function: effects of desflurane and isoflurane
Authors: Pagel P. S. , Kampine J. P. , Schmeling W. T. , Warltier D. C.
Published: January 2009

Characterization of changes in myocardial contractility using indices derived from ventricular pressure‐segment length loops in animals with intact autonomic nervous system (ANS) function is complicated by alterations in systemic hemodynamics mediated by baroreceptor reflexes and by spontaneous respiration and its effects on ventricular pressure and filling. This investigation examined and compared the effects of desflurane and isoflurane on myocardial contractility in dogs with intact ANS reflexes using techniques designed to overcome these potential difficulties. Two groups comprising 18 experiments were performed using nine dogs chronically instrumented for measurement of aortic and left ventricular pressure, the maximum rate of increase of left ventricular pressure (dP/dt), subendocardial segment length, cardiac output and intrathoracic pressure. A brief occlusion of the inferior vena cava was used to alter preload to generate pressure‐length loops prior to onset of baroreceptor reflex‐mediated increases in heart rate. Respiratory variation in ventricular pressure was negated by calculation of “transmural pressure” via instantaneous subtraction of intrathoracic pressure from corresponding left ventricular pressure. Contractility was then evaluated in the conscious and anesthetized states using transmural pressure‐length loops and calculation of the preload recruitable stroke work (PRSW) relationship. Dogs were anesthetized with 1.25, 1.5, or 1.75 MAC desflurane or isoflurane and measurements were repeated after 30 min of equilibration at each anesthetic concentration. Desflurane and isoflurane produced similar declines in PRSW slope [Mw; 41±6 (5.5 ±0.8) during 1.75 MAC desflurane compared to 43 ± 5 mmHg (5.7 ± 0.7 kPa) during 1.75 MAC isoflurane], indicating that these agents cause similar depression of contractile state at equivalent MAC. The PRSW relationship derived from transmural pressure‐length loops using brief inferior vena caval occlusion may facilitate the examination of the impact of other volatile and intravenous anesthetics on myocardial contractility using a load‐independent index of contractile state in the presence of intact ANS reflexes.
Cerebral pharmacodynamics of anaesthetic and subanaesthetic doses of ketamine in the normoventilated pig
Authors: ÅKeson J. , Björkman S. , Messeter K. , Rosen I. , Helfer M.
Published: January 2009

There are still divergent opinions regarding the pharmacodynamic effects of ketamine on the brain. In this study, the cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRo2) and electroencephalogra‐phic (EEG) activity were sequentially assessed over 80 min in 17 normoventilated pigs following rapid i.v. infusions of anaesthetic (10.0 mg‐kg‐1; n = 7) or subanaesthetic (2.0 mg‐kg‐1; n = 7) doses of ketamine or of its major metabolite norketamine (10.0 mg‐kg‐1; n = 3). The animals were continuously anaesthetized with fentanyl, nitrous oxide and pancuronium. CBF was determined by the intra‐arterial mXe technique. Ketamine (10.0 mg‐kg‐1) induced an instant, gradually reverting decrease in CBF, amounting to ‐26% (P<0.01) at 1 min and ‐13% (P<0.05) at 10 min, a delayed increase in CMRo2by 42% (P<0.01) at 10 min and a sustained rise in low‐ and intermediate‐frequency EEG voltage by 87% at 1 and 97% at 10 min (P<0.0001). It is concluded that metabolically formed norketamine does not contribute to these effects. Considering the dissociation of CBF from CMRo2found 10–20 min after ketamine (10.0 mg‐kg‐1) administration, it is suggested that ketamine should be used with caution for anaesthesia in patients with suspected cerebral ischaemia in order not to increase the vulnerability of brain tissue to hypoxic injury. Ketamine (2.0 mg‐kg‐1) had no significant effects on CBF, CMRo2or EEG. It therefore seems that up to one fifth of the minimal anaesthetic i.v. dose can be used safely for analgesia, provided that normocapnaemia is preserved.
Intrathecal morphine for the relief of post‐hysterectomy pain ‐ a double‐blind, dose‐response study
Authors: Sarma V. J. , Boström U. V.
Published: January 2009

Eighty patients undergoing total abdominal hysterectomy under general anaesthesia were randomly divided into four groups to study the dose‐response relationship of intrathecal morphine (0, 0.1, 0.3 and 0.5 mg) for postoperative pain relief. Pain scores, as assessed by using the visual analogue scale, revealed that intrathecal morphine provided long‐lasting pain relief, was most effective after 0.3 mg and significantly reduced the need for supplementary analgesics (P<0.05). There was no difference as regards the quality of analgesia or the use of supplementary analgesics between the 0.3 and 0.5 mg groups. Adequate pain relief was not evident after a 0.1 mg dose. There was no incidence of respiratory depression in any of the patients in this study. The incidence of side effects was least following 0.3 mg intrathecal morphine, which we consider to be the optimum dose.
Drug interactions with inhalational anaesthetics
Authors: Christensen L. Quist , Bonde J. , Kampmann J. P.
Published: January 2009

The literature concerning the interactions between volatile anaesthetics, nitrous oxide and other compounds is reviewed. The majority are well known and most can be managed by careful dosage of the anaesthetics. The following interactions should be stressed since these are less predictable or potentially fatal. Of the cardiovascular drugs mainly the Ca+ + channel blockers require attention. The volatile anaesthetics act synergistically with these drugs on the inhibition of cardiac conduction and may induce cardiac arrest. Aminoglycoside therapy should prompt an alternative to enflurane because of increased nephrotoxicity with this combination. Thiopentone induction makes the dog heart more susceptible to arrhythmias, especially during anaesthesia with volatile anaesthetics. Probably pentobarbitone, etomidate or a benzodiazepine should be preferred as an alternative to thiopentone when the use of adrenergic drugs peroperatively is anticipated. Nitrous oxide augments the sequelae after coronary air emboli and impaired cerebral perfusion in animals. The necessity of this drug should therefore be considered when anaesthetizing patients undergoing open heart surgery and patients with severe carotic or cerebral arteriosclerosis.
Redistribution of lymphocytes after major surgical stress
Authors: Toft P. , S P. , Tonnesen E. , Rasmussen J. w. , Christensen N. J.
Published: January 2009

Major surgery evokes an endocrine stress response, characterized by increased serum cortisol, plasma adrenaline and noradrenaline. Furthermore, surgical stress is accompanied by lymphopenia and granulocytosis in peripheral blood. The changes in peripheral white blood cells have been demonstrated after surgery asiwell as after cortisol infusion. The aim of the present study was to investigate to which tissueslorgans peripheral blood lymphocytes are redistributed after major surgery. From 20 rabbits lymphocytes were isolated from peripheral blood, labelled with indium‐ 111‐tropolene and reinjected intravenously into the rabbits. Ten of the rabbits underwent major surgery (upper laparatomy) during general anaesthesia, while the control group (n= 10) was anaesthetized without surgery. The endocrine stress response to surgery was measured as serum cortisol, plasma adrenaline and noradrenaline. The redistribution of lymphocytes was imaged with a gamma camera and calculated with a connected computer before, 2, 4 and 7 h after the skin incision. Compared to preoperative values, laparotomy resulted in an increase in serum cortisol from 116.6 to 461.9 nmol/l (mean) and a decrease in the fraction/percentage of lymphocytes in peripheral blood from 43.8% to 14.7% 7 h after surgery. Simultaneously, the activity of the heart and lungs together decreased to 76.1% of initial values, while the spleen activity was unaffected. The radioactivity of the lymphatic tissue increased to 137.8% and 134.7%, respectively, 4 and 7 h after the start of surgery. The results indicate that major surgery induces a redistribution of lymphocytes from peripheral blood to lymphatic tissue. It is suggested that the endocrine stress response may be of major importance.
Beclomethasone prevents postoperative sore throat
Authors: Hakim M. EL
Published: January 2009

The effects of a dose of beclomethasone inhaler (50 μg) or lidocaine 10% spray on postoperative sore throat were studied in 120 patients undergoing tracheal intubation for elective surgical procedures. Fifty‐four patients (90%) in the beclomethasone group scored no postoperative sore throat compared with 27 (45%) in the lidocaine group (P<0.00l). Beclomethasone inhaler seems to be highly effective in the prevention of postoperative sore throat and is therefore to be recommended before tracheal intubation for general anaesthesia.
Reinduction of the hypnotic effects of thiopental with NSAIDs by decreasing thiopental plasma protein binding in humans
Authors: HuPhD. O. Y.‐P. , Chu K. M. , Liu H. s. , Chiao S. F. , Ho W. , Ho S. T.
Published: January 2009

The effects of 14 non‐steroidal anti‐inflammatory drugs (NSAIDs) ‐naproxen, ibuprofen, mefenamic acid, ketoprofen, indomethacin, fenoprofen, diclofenac sodium, aspirin, salicylic acid, piroxicam, sulindac, fenbufen, flurbiprofen and benzydamine, on the plasma protein binding of thiopental and the clinical consequences of such interactions were studied. Four of them, naproxen, ibuprofen, salicylic acid and aspirin, very significantly decreased the protein binding of thiopental in uitro in human plasma (P< 0.005). Structurally, they were salicylates and propionic acid derivatives among the six classes of NSAIDs studied. The aspirin study demonstrated that the protein‐displacing phenomenon was temperature‐dependent, and concentration‐dependent. Clinically, aspirin administered intravenously resulted in a significant increase in the percentage of plasma free thiopental from 16.01 ± 3.59% to 22.27 ± 3.96% (P< 0.001, n = 10) in patients undergoing surgery, and resulted in three of seven patients sleeping again during recovery from thiopental‐induced anesthesia. Although the effect of chronic use of NSAIDs before anesthesia is uncertain, studies should be carried out to find out if naproxen, ibuprofen, and aspirin influence the depth of anesthesia, time of recovery and duration of action of thiopental.
Platelets in shed mediastinal blood used for postoperative autotransfusion
Authors: KongsgaardM.D. U. E. , Hovig T. , Brosstad F. , Geiran O.
Published: January 2009

Ten patients undergoing open‐heart surgery received postoperative autotransfusion of shed mediastinal blood collected in the cardiotomy reservoir. The number, function and morphology of the platelets found in the shed blood were investigated. Platelets were counted using an electronic counter compared with light microscopy. Morphology of platelets was studied with electron microscopy. Platelet aggregation was studied using an aggregometer. Dense granule secretion was measured as the extracellular appearance of adenosine triphosphate. Enumeration of platelets in shed blood using the two methods gave different results. Thus, the electronic counter gave a mean platelet count of 62. 109.1‐1, while light microscopy revealed only a mean platelet count of 10. 109. 1‐1. Electron microscopy disclosed few platelets, but numerous cytoplasmatic fragments smaller than or up to the same size as platelets. The platelets found were mostly shape‐changed, spheroid, characterized by centralization and loss of alpha‐granules and dense bodies, all changes that indicated irreversible platelet activation. The platelets failed to aggregate in response to the presence of thrombin, adenosine diphosphate or collagen, and secretion of adenosine triphosphate was absent. Plasma from the shed blood was not capable of inducing spontaneous aggregation in platelet‐rich plasma from healthy donors. These results indicate that infusion of larger volumes of autotransfused blood should be supplemented with platelet concentrates.