bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerized tomography of the chest and gas exchange measurements during ketamine anaesthesia
Authors: Tokics L. , Strandberg A. , Brismar B. , Lundqwist H. , Hedenstierna G.
Published: January 2009

The effects of atelectasis on pulmonary gas exchange were studied in eight supine, clinically lung‐healthy patients. Atelectasis was studied by computerized tomography (CT), and gas exchange by blood gas analysis. The distribution of ventilation/perfusion ratios was assessed by a multiple inert gas elimination technique. No patient had any signs of atelectasis in the awake state, and gas exchange was normal. During ketamine anaesthesia and spontaneous breathing, lung ventilation and perfusion were well matched in most subjects. In one patient there was perfusion of poorly ventilated regions amounting to 14% of cardiac output, and in another there was a shunt of 4% of cardiac output; this patient was the only one who developed atelectasis in dependent lung regions. After muscular relaxation and commencement of mechanical ventilation, all patients but one developed both shunt (2–6% of cardiac output) and atelectasis. The shunt correlated to the size of atelectasis. It is concluded that the occurrence of shunt during anaesthesia is related to the development of atelectasis in dependent lung regions, which is consistent with the hypothesis that it is changes in chest‐wall mechanics that cause atelectasis.
Outcome and costs of intensive care. A follow‐up study on patients requiring prolonged mechanical ventilation
Authors: Thoner J.
Published: January 2009

This historically prospective study analysed hospital costs and long‐term outcome in 249 consecutive patients who required intensive care including intermittent positive pressure ventilation (IPPV) for 48 h or more. The mean age of the patients was 46.7 years and the mean duration on IPPV was 9.1 days. Mortality in hospital was 43%, increasing to 54.6% five years after admission. The mean cost per patient treated was 22823 US dollars (USD (1980 value)). The mean cost to yield one survivor was 40035 USD. The mean cost per survivor was 26 056 USD, whereas that of a non‐survivor was 18 500 USD. The cost‐benefit ratio, i.e. calculated cost per year of extended life until the age of 75 years, averaged 1420 USD (range 360–7980 USD). With the exception of patients suffering from cancerous diseases, the cost‐benefit ratio found in this study was favourable in comparison to other high‐cost medical care. This is further emphasized by the fact that for the years saved, the quality of life was mostly good.
Tetanic fade during neuromuscular blockade produced by atracurium in the rat diaphragm preparation
Authors: Wali F. A. , Suer A. H. , Dark C. H. , McAteer E. J.
Published: January 2009

In the present investigation, we studied and measured the phenomenon of tetanic fade and peak tetanic tension depression in the rat diaphragm preparation in the presence of a blocking concentration of atracurium (e.g., 10 μmol.l‐1). Atracurium (10 μmol.l‐1) produced a pronounced tetanic fade (i.e., 47–69% reduction of total sustained tetanic tension) at a time (15 s) when it reduced the peak tetanic tension by only 25%. The time course for total tetanic fade was 30–35 s, whereas the time taken for complete peak tetanic tension depression was 3‐3.5 min, suggesting that the two effects were produced via different mechanisms, involving presynaptic and postsynaptic mechanism. It was concluded that atracurium produces a profound tetanic fade, with respect to its effect on twitch or tetanic tension, suggesting that the drug is a potent neuromuscular blocker, with rapid onset of blockade.
Binding of fentanyl and alfentanil to the extracorporeal circuit
Authors: Hynynen M.
Published: January 2009

Adsorption of fentanyl and alfentanil to the cardiopulmonary bypass (CPB) equipment was studied in vitro by adding one of the analgesics to the priming solution consisting of either saline or a mixture of saline and blood. Opiate concentrations in the solutions were measured during a 60‐min circulation period of a closed CPB system. When the saline prime was used, 29% of the predicted fentanyl level of 30 ng ml‐1 was found at the end of the experiment, while the recovery of alfentanil was 80% of the calculated level of 1500 ng ml‐1. When blood was added to the prime, experiments with fentanyl produced similar results to those with pure saline prime, but recovery exceeding the calculated concentration was obtained with alfentanil. The difference between the alfentanil levels in the two primes may reflect the poor distribution of this analgesic into red blood cells. In another set of experiments, the CPB circuit was primed with fentanyl or alfentanil and circulated for 10 min before connection of the apparatus to patients undergoing cardiac surgery under high‐dose opiate anaesthesia. This priming prevented the steep reduction in plasma opiate concentration regularly observed during the institution of CPB. It is concluded that in a clinically relevant dose range a smaller fraction of alfentanil is sequestered by the CPB apparatus than fentanyl.
Effects of PEEP on extra vascular lung water and central blood volume in the dog
Authors: Frostell C. , Blomqvist H. , Wickerts C.‐J.
Published: January 2009

Twenty‐four mongrel dogs were anaesthetized and ventilated mechanically in the supine position. Extravascular lung water (EVLW) and central blood volume (CBV) were measured with a double indicator (dye/cold) dilution technique. Both indicators were detected intravascularly in the aortic root with a fibreoptic thermistor catheter. Seven dogs ventilated with a positive end‐expiratory pressure (PEEP) of 1.0 kPa (10 cmH2O) for a short period of time (< 20 min) displayed no significant change in EVLW as measured with the indicator dilution technique (= EVLWi), while reductions were seen in both CBV (15%, P<0.01) and cardiac output (CO‐thermodilution technique) (10%, P<0.05). Another seven dogs ventilated with a PEEP of 1.0 kPa for 8 h showed a gradual increase in EVLWi. After 8 h, a mean increase of 34% (P<0.01) was recorded, and the increase was also verified by post‐mortem gravimetric determination of EVLW (= EVLWg), displaying an increase of 61% (P<0.01). In five dogs ventilated with zero end‐expiratory pressure (ZEEP) for 8 h, no changes in EVLWi, CO, and CBV were observed, and EVLWg was mean 4.39 g/kg body weight (BW). Five additional dogs were sacrificed after 15 min of anaesthesia without catheterization and EVLWg was found to be 4.24 g/kg BW. It is concluded that EVLWi does not change measurably during ZEEP or short periods of PEEP. However, long periods (8 h) of PEEP result in elevated EVLWi values. Gravimetry supports these conclusions. Although PEEP recruits lung volume after lung damage and in this way enhances gas exchange, it appears that prolonged ventilation with PEEP also causes a significant increase of extravascular lung water in otherwise healthy lung tissue.
The predictive value of preoperative perfusion/ventilation scintigraphy, spirometry and x‐ray of the lungs on postoperative pulmonary complications. A prospective study
Authors: Fogh J. , Wille‐Jørgensen P. , Brynjolf I. , Thorup J. , Jørgensen T. , Bording L. , Kjaergaard J.
Published: January 2009

Prospectively, 125 patients were examined with 99mTc‐perfusion scintigraphy, 89mKr‐ or 127Xe‐ventilalion scintigraphy and chest radiogram prior to major surgery. Postoperative therapy‐demanding pulmonary complications occurred in 18% of the patients. A statistical association could be demonstrated between all the preoperative tests except ventilation scintigraphy and the frequency of complications. However, the predictive values of each of the tests, or even the combined results, were not significantly different from the frequency of complications among all the patients. It is concluded that the predictive values of perfusion‐and ventilation scintigraphy, spirometry and radiogram of the chest are too low to be of any practical use.
Intravenous diclofenac sodium decreases prostaglandin synthesis and postoperative symptoms after general anaesthesia in outpatients undergoing dental surgery
Authors: Valanne J. , Korttila K. , Ylikorkala O.
Published: January 2009

One hundred unpremedicated patients scheduled for outpatient restorative dentistry and/or oral surgery were given either 75 mg diclofenac sodium (prostaglandin synthesis inhibitor) or a saline placebo i.v. in a double‐blind random fashion before induction of anaesthesia with methohexitone (2 mg/kg). Intubation was facilitated with suxamethonium (1.2 mg/kg) and anaesthesia was maintained with isoflurane in 50% nitrous oxide and oxygen using spontaneous respiration. Cuff pressure was continuously monitored and maintained at 10–25 mmHg. The mean duration of anaesthesia was 141 ± 75 min in the diclofenac group and 150 ± 73 min in the saline group. Diclofenac inhibited prostaglandin synthesis, as evident from serum thromboxane B2 and urinary 6‐keto‐prostaglandin F1α data. There was no difference in recovery as assessed from the orientation time (14.2 ± 5.7 min and 14.5 ± 6.3 min for diclofenac and saline patients, respectively), perceptual speed and ability to walk along a straight line 30 and 60 min after anaesthesia. Emetic symptoms were equally common in both groups: an overall incidence of 32.6% and 36.7% for the diclofenac and saline patients, respectively. In the whole patient series women became nauseated and vomited more than men (P<0.01). Diclofenac reduced the incidence of pain in the throat or oral region I h after anaesthesia (P<0.05) and other symptoms 1–24 h postoperatively (P<0.01). Thus, preoperative intravenous diclofenac appears useful in ambulatory patients undergoing restorative dentistry and oral surgery under isoflurane anaesthesia.
Oral premedication with clonidine: effects on stress responses during general anaesthesia
Authors: Pouttu J. , Scheinin B. , Rosenberg P. H. , Viinamäki O. , Scheinin M.
Published: January 2009

The effect of clonidine (4.5 μg kg‐1) on haemodynamics and hormonal stress responses was evaluated in 21 female patients undergoing breast surgery. The standardized general anaesthesia included diazepam as premedicant, thiopentone, enflurane, N2O, fentanyl and vecuronium. Venous plasma concentrations of noradrenaline, adrenaline, growth hormone, vasopressin, and Cortisol were assayed at various times before, during and after surgery. Clonidine attenuated the sympathoadrenal response; arterial blood pressure and heart rate increases in association with intubation were lower in clonidine‐premedicated patients. Noradrenaline levels were lower throughout and 3 h after surgery in the clonidine group (P<0.05). Adrenaline levels were lower in this group 2 min after intubation (P<0.05). Growth hormone, vasopressin and Cortisol plasma levels were increased at the end of and after surgery, with no differences between the groups. In spite of the effect on sympathoadrenal response, clonidine did not have any significant additive anxiolytic effect. Statistically significant differences were not found as to need for postoperative analgesics.
Reduction of pain at venous cannulation in children with a eu tec tic mixture of lidocaine and prilocaine (EMLA® cream): comparison with placebo cream and no local premedication
Authors: Manner T. , Kanto J. , Iisalo E. , Lindberg R. , Viinamäki O. , Scheinin M.
Published: January 2009

The local analgesic efficacy of a cream formulation of lidocaine and prilocaine (EMLA®) in reducing pain at venous cannulation was investigated in children scheduled for elective surgery. Forty children participated in a double‐blind, randomized comparison between EMLA and inactive placebo cream. Another group of 18 children without any local treatment was studied as an additional control material. Subjective pain scores, expressed with a visual analogue scale, were significantly lower in the EMLA group compared with both the group treated with placebo cream (P<0.001) and the open control group (no cream; P<0.01). Local pallor and slight oedema were the only side‐effects, registered in both cream‐treated groups. A preliminary study was also carried out with 10 children (five with EMLA and five without) in order to determine whether catecholamine and vasopressin levels in venous blood are affected by the stress and anxiety associated with venepuncture in children premedicated with oral flunitrazepam. No significant hormone responses were, however, detected. The lidocaine concentrations measured in venous blood taken from the application site of EMLA cream were low, and there were no measurable levels of lidocaine in simultaneous blood samples from the opposite extremity. In our opinion EMLA cream is safe and alleviates effectively the pain associated with venepuncture, and thus deserves a place in the routine premedication of children.
Modulation of oxygen‐free radicals from human leukocytes during halothane‐ and enflurane‐induced general anesthesia
Authors: Barth J. , Petermann W. , Entzian P. , Wustrow C. , Wustrow J. , Ohnhaus E. E.
Published: January 2009

Oxidative metabolism correlates with the release of microbiocidal oxygen‐free radicals, measured as luminol‐dependent chemiluminescence. The effect of general anesthesia on the oxidative metabolism of human leukocytes was investigated. Sixteen patients undergoing a halothane‐induced general anesthesia and 14 patients receiving an enflurane‐induced general anesthesia participated in the study. Halothane‐induced anesthesia was accompanied both by a suppression of basic chemiluminescence and by a decrease in chemiluminescence during the phagocytosis of zymosan A. This was monitored 15 min, 30 min and 60 min after starting general anesthesia and compared to the level of chemiluminescence before starting general anesthesia. Ninety minutes after finishing general anesthesia, a significant recovery of chemiluminescence was seen to exceed the level before general anesthesia. Comparable findings were observed with enflurane‐induced general anesthesia, suggesting a decreased release of oxygen‐free radicals during genera) anesthesia, and afterwards an increase exceeding the initial level.
Patient‐controlled analgesia: a controlled trial
Authors: Dahl J. B. , Daugaard J. J. , Larsen H. V. , Mouridsen P. , Nielsen T. H. , Kristoffersen E.
Published: January 2009

Thirty‐six patients undergoing lower abdominal surgery were included in a prospective randomized controlled study to compare the effects of patient‐controlled analgesia (PCA) and a standard intramuscular/intravenous treatment (conventional analgesia, CA) of postoperative pain. Morphine was used in both groups. There were no significant differences between the two analgesic regimens in respect of linear analogue pain scores, verbal pain‐relief scores, amount of morphine used or side‐effects. No treatment‐induced alterations in vital values were experienced.
The effects of alpha adrenergic blockade on central haemodynamics and regional blood flows during positive pressure ventilation
Authors: Feuk U. , Jakobson S. , Norlén K.
Published: January 2009

The effects of alpha receptor blockade on cardiac output distribution in pigs were studied. Recordings were made during spontaneous breathing (SB), during ventilator treatment with 8 Pa positive end‐expiratory pressure (8 PEEP), after alpha blockade during SB (SB‐α) and at 8 PEEP (8 PEEP‐α). The microsphere method was used for blood flow determinations. The animals received either 5 ml·kg‐1·h‐1 (Group A) or 10 ml·kg‐1·h‐1 (Group B) of fluids. In Group A on SB‐α, CO was maintained due to tachycardia but mean arterial pressure (MAP) decreased, renal blood flow and urine production decreased. At 8 PEEP‐α, CO decreased despite increased heart rate (HR), MAP decreased alarmingly, renal blood flow decreased, urine production ceased and cerebral blood flow decreased, reflecting failing autoregulation. In Group B, CO increased during SB‐α, SVR decreased, myocardial blood flow increased and organ blood flows were otherwise unchanged. At 8 PEEP‐α, MAP, SVR, renal, pancreatic and splenic blood flows decreased in Group B. Gastric, intestinal and muscular blood flows were unchanged at 8 PEEP‐α in Group B which is interpreted as an effect of the alpha blockade. In both groups peripheral arterio‐venous shunting increased after alpha blockade.
The volatile anesthetics, halothane, enflurane and isoflurane, influence the distribution of thiopental in man differently
Authors: Altmayer P. , Bügh U. , Hutschenreuter K. , Bügh H. P.
Published: January 2009

In man, a change of thiopental pharmacokinetics was observed under halothane anesthesia, but not when patients were anesthetized with enflurane and isoflurane. After an initial subancsthetic dose of 50 mg thiopental, the concentrations in serum (T) were determined over 15 min (4 samples). From these T‐valucs the pharmacokinetic parameters Vc (central volume of distribution), t½ α and Cl were established (control). 16 min after the first thiopental dose, one of the inhalation anesthetics was administered (randomized). After 45 min exposure to the respective inhalation anesthetic (2–3 MAC in combination with N2O, steady‐state) a second dose of 50 mg thiopental was injected and the T‐values were determined again over 15 min. The T‐values of the control course varied considerably; the logarithmic frequency distribution revealed two distinct subgroups of patients, A and B, with characteristic Vc and t½ α. Both subgroups were influenced by the volatile anesthetics in a similar way with regard to pharmacokinetic parameters. With halothane, Vc was decreased and t½ α was shortened. In contrast, enflurane and isoflurane did not affect the pharmacokinetic parameters.
Insensible water loss and its assessment in adult patients: a review
Authors: Cox Peter
Published: January 2009

The nature, magnitude and factors influencing insensible water loss are discussed. A brief overview of the current practice of estimating insensible perspiration in Sweden is presented. Finally, a suggestion is put forward regarding a simplified formula for estimating insensible water loss in adult patients, based on information currently available in the literature.
CSF distribution of opioids in animals and man
Authors: Payne Richard
Published: January 2009

The CSF distribution of opioids after subarachnoid administration is important in determining therapeutic and undesirable side‐effects. There are many factors which influence CSF distribution of opioids including the age, position, anatomy of the spinal column of the patient or animal, and the physico‐chemical properties of the opioid solution and of the CSF. Opioids are cleared from their site of administration in CSF by three mechanisms: 1) uptake into the spinal cord, 2) diffusion through the dura and uptake into the blood, and 3) rostral‐caudal CSF distribution. Physico‐chemical factors such as lipid solubility, degree of ionization in the CSF and the baricity of the opioid solution are important in determining the rate of clearance by these three routes. Opioids which are highly lipid soluble, have high affinity for delta and/or kappa opiate receptor subtypes, and are largely non‐ionized at physiologic CSF pH, would have optimal pharmacokinetic properties for subarachnoid administration. These properties would allow administration of a small dose of opioid which would be rapidly taken up into the spinal cord, thereby limiting CSF and vascular distribution to supraspinal brain regions.
Intraspinal morphine for cancer pain
Authors: Ventafridda V. , Spoldi E. , Caraceni A. , De Conno F.
Published: January 2009

From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow‐up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long‐term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side‐effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.
Intrathecal therapy: rationale, technique, clinical results
Authors: Madrid José L. , Fatela Lorenza V. , Lobato Ramiro D. , Gozalo Adolfo
Published: January 2009

In 35 patients a subcutaneously implanted injection port/reservoir was used to provide intrathecal morphine to relieve pain due to cancer. The reservoir offers an alternative to rather expensive devices. It can be used for repeated injections or for infusion. It is easy to locate and facilitates ambulatory treatment. The injections were carried out by members of the patient's family after they had been taught how to do it. Initially, doses of 0.25–0.5 mg of morphine resulted in pain relief for 14 to 24 hours. After 5 weeks of treatment morphine requirements increased to 0.75–2 mg. Side‐effects were minimal, and three delayed CSF fistula, two of them confirmed by isotope tracking with Tc99m, closed spontaneoulsy.
Pulmonary complications after upper abdominal surgery: their prevention with intercostal blocks
Authors: Engberg G. , Wiklund L.
Published: January 2009

A prospective study of postoperative pulmonary complications (PPC) appearing during the hospital stay was carried out in 417 patients undergoing surgery through a subcostal or midline incision. Postoperative pain was relieved either by intercostal block and centrally‐acting analgesics on demand or by centrally‐acting analgesics alone. Pulmonary complications were diagnosed from combined physical and radiological signs. After biliary surgery through a subcostal incision, PPC were less frequent (P<0.05) in patients receiving intercostal blocks (6%) than in those given centrally‐acting analgesics (11%). After surgery through a midline incision, the complication rate was higher, 15–57%, and was related to the type of surgery, the highest incidence being found after partial gastrectomy and operations for malignancy, and no significant reduction in the rate of PPC after intercostal blocks with this incision was found in any age group. Indeed, an increased rate of PPC was found in our patients over the age of 60 who had received bilateral intercostal blocks. Irrespective of the type of incision, surgery or method of postoperative pain relief, the patients with PPC more often had respiratory or other disorders preoperatively or a surgical complication intra‐ or postoperatively than those with normal postoperative recovery. Predisposing physical factors and high age were more common among the patients developing PPC in spite of treatment with intercostal blocks compared to those without such treatment.
Cerebral blood flow and oxygen consumption during isoflurane and halothane anesthesia in man
Authors: Algotsson L. , Messeter K. , Nordstrom C. H. , Ryding E.
Published: January 2009

In 13 patients, the effects on cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMR02) of isoflurane and halothane administered in a clinically relevant situation were studied. Measurements were performed during fentanyl/nitrous oxide (65%) anesthesia together with moderate hyperventilation (Pac02 approx 4.5 kPa), and repeated after addition of 0.65 MAC of isoflurane (n = 6) or halothane (n=7). CBF was measured after intravenous administration of 133xenon and CMR02 was calculated from the arterial venous differences of oxygen content (AVD02) determined in arterial and jugular venous bulb blood. CBF and CMR02 (means ± s.e. mean) determined prior to administration of volatile agents were 28 ± 5 ml × 100‐1 × min‐1 and 2.0 ± 0.3 ml × 100 g‐1 × min‐1, respectively, in the isoflurane group. In the halothane group, CBF was 25 ± 0.4 ml × 100 g‐1 × min‐1 and CMR02 was 2.0±0.4 ml × 100 g‐1 × ml‐1. There were no significant intergroup differences. Isoflurane did not change CBF, whereas halothane produced an increase of 36% (P<0.05) compared to values obtained during fentanyl/N20 anesthesia. In addition, isoflurane caused a further decrease in CMRo2 of 12% (P<0.01) as compared to a 20% increase (P<0.05) with halothane. The cerebral metabolic depression caused by the short‐acting anesthetic induction agents would be expected to decrease with time, and could partly explain the observed increase in CMR02 produced by halothane. The study suggests that the cerebrovascular and metabolic properties of isoflurane differ from those of halothane, also in man.
Malignant hyperthermia susceptibility confirmed in both parents of probands
Authors: Mauritz W. , Sporn P. , Steinbereithner K.
Published: January 2009

From 1976 to 1986, 79 cases of suspected malignant hyperthermia (MH) were reported to the authors' institution. A total of 233 muscle biopsies was done in 66 families. The mother and father of the proband were investigated in 44 families; in three of these, both parents of probands gave positive test results. These three families, all from Vorarlberg, a secluded mountain area, represent 4.5% of all our MH‐positive families (n = 61) and 7.3% of all MH‐positive families where both parents had been tested (n = 41). This observation might be explained by: 1) a much higher incidence of MH in this part of Austria, and 2) a different test policy, as at the authors' institution, if possible, both parents are investigated, even if there is a positive test result in one of them. It is concluded that family investigations of MH susceptibility should always include both parents of a proband.
Intravenous indomethacin prevents venipuncture inflammatory sequelae
Authors: Hiller A. , Pitkänen M. , Tuominen M. , Rosenberg P. H.
Published: January 2009

One hundred general or orthopaedic surgery patients (ASA I—II) were randomly given either indomethacin (25–50 mg bolus plus infusion, 5–7.5 mg h‐l) in lactated Ringer solution intravenously in one hand and only lactated Ringer solution into a corresponding vein of the other hand (50 patients) or only lactated Ringer solution intravenously in both hands (50 patients), starting before anaesthesia induction and ending at 7 a.m. the following morning. All anaesthetic drugs were given equally divided into both drips. The need for additional analgesia as well as venipuncture and infusion sequelae were registered on the postoperative morning in a double‐blind fashion. The mean ± s.d. oxycodone dose in the postoperative observation period was lower in the indomethacin group (18±16mg) than in the control group (27 ± 20 mg) (n.s.). There was a lower number of patients requiring oxycodone more than once in the indomethacin group than in the control group (P<0.05). Fewer patients in the indomethacin group (22%) had inflammatory changes at the venipuncture site than in the control group (46%) (P<0.05). There was no difference between hands; i.e. in patients given indomethacin inflammatory changes were equally common in both hands. No thrombophlebitic complications developed, which was confirmed by a mailed questionnaire (response 96/100) 2 weeks after surgery.
Monitoring of cardiac output and cardiac work during anaesthesia by means of pulsed ultrasound Doppler
Authors: Lang‐Jensen T.
Published: January 2009

During anaesthesia haemodynamic measurements were performed with pulsed ultrasound Doppler in six patients with a Swan‐Ganz catheter. Cardiac output (CO), heart rate (HR), arterial blood pressure (AP), systemic vascular resistance (SVR) and left cardiac work (LCW) were measured simultaneously with the velocity measurements of the bloodstream in the ascending aorta. Six to fourteen (median 9) simultaneous measurements were done in each patient. Sixty‐two measurements were made. The velocity (V) and the product of velocity and heart rate (VHR) were compared with CO in order to establish a non‐invasive index of the cardiac output. The product of velocity, the heart rate and the arterial blood pressure (VHRAP) was compared with LCW, showing a good correlation between VHR and CO (V = maximum velocity) (rho = median 0.85), as was the case between VHRAP and LCW (rho = 0.88). Furthermore, a negative correlation between V and SVR was found, illustrating that the velocity of the bloodstream in the aorta obviously depends on the afterload. It is concluded that pulsed ultrasound Doppler in combination with HR and AP can measure relative changes in CO and LCW.
The influence of alfentanil on the intubating conditions after priming with vecuronium
Authors: Hei.Bo‐Hansen S. , Ravlo O. , Andersen S. Trap
Published: January 2009

The ability of alfentanil 15 μg kg‐1 or 30 μg kg‐1 to improve intubating conditions was studied in four groups of 25 ASA class 1 patients. Induction of anaesthesia was with thiopentone 5 mg kg‐1. Neuromuscular blockade was induced with vecuronium using the priming principle. The priming dose, priming interval and intubating dose were 0.01 mg kg‐1, 4 min, and 0.1 mg kg‐1, respectively. Intubation was attempted 1 min after the intubating dose. Intubating conditions were judged unacceptable in about 30% of the patients belonging to the control groups. Alfentanil 15 μg kg‐1, when administered 65 s before intubation, reduced the incidence of coughing and diaphragmatic movement (P<0.05) but did not reduce the incidence of overall unacceptable intubating conditions. Alfentanil 30 ug kg‐1, however, reduced the incidence of vocal cord movement (P<0.005) as well as coughing and diaphragmatic movement (P<0.002). Alfentanil 30 ug kg‐1 reduced the incidence of unacceptable intubating conditions from about 30% to 4% (P<0.02).
Relations between irrigant absorption rate and hyponatraemia during transurethral resection of the prostate
Authors: Hahn R. G.
Published: January 2009

The serum sodium concentration (S‐Na) and the volume of irrigating fluid absorbed were measured during 10‐min periods in the course of 85 transurethral resections of the prostate (TUR). The hyponatraemic response to absorption of the irrigant was found to be dependent on the volume of fluid absorbed and the time required for the absorption. During the first 10 min of absorption the distribution volume of the irrigating medium was roughly equal to the extracellular space, but after this period the volume was greater. The sodium level could be compensated for further absorption to the extent of 200–300 ml irrigant per 10‐min period; when this volume was exceeded, hyponatraemia was aggravated. The results indicate that in the development of the very low S‐Na level typical of a severe TUR reaction, a rapid massive absorption is a more important factor than a large total absorbed volume.
Accidental puncture of the right lymphatic duct during pulmonary artery catheterization: A case report
Authors: Arditis J. , Giala M. , Anagnostidou A.
Published: January 2009

A case of an accidental placement of the introducer sheath of a Swan Ganz catheter into the right lymphatic duct during right internal jugular vein catheterization is presented. This rare complication has to be reported, because the choice of the right internal jugular vein for central venous catheterization has been strongly recommended, with special concern being paid to the avoidance of any thoracic duct injury. No deleterious complications were observed either in the immediate or in the later postanaesthetic period.
Baroreceptor control of central and regional hemodynamics with isoflurane in the dog
Authors: Bagshaw R. J. , Cox R. H.
Published: January 2009

Central and regional hemodynamics were studied at five levels of carotid sinus baroreceptor stimulation and three isoflurane levels. Apart from iliac blood flow, all regional blood flows, together with mean aortic–pressure, power and flow decreased in response to an increasing anesthetic level and/or carotid sinus baroreceptor stimulation. These effects were additive with no significant interaction between the two experimental factors. At the carotid sinus reflex set point pressure, isoflurane attenuated the ability of carotid sinus baroreceptors to change mean aortic pressure and power together with the maximum capacity of the carotid sinus baroreceptors to produce vasoconstriction. The maximum capacity of the carotid sinus baroreceptors to produce vasodilation was unaffected by isoflurane. Vagotomy only modified hemodynamic set point values at low isoflurane levels, increasing regional resistances at the expense of flow except for the iliac bed. Following vagotomy, reflex gain was increased as was the maximum capacity of the cardiovascular system to vasoconstrict and vasodilate in response to carotid sinus pressure stimulation, together with the range of arterial pressure control.
Survival of intensive care patients I: prognostic factors from the patient's medical history
Authors: Zarén B. , Bergström R.
Published: January 2009

All adult patients (978) admitted in 1983 to a multidisciplinary intensive care unit (ICU) were studied prospectively. 9.6% died in the unit. The cumulative mortality was 26.5% 1 year after admission. Of the patients who were 65 years and older, 43.1% had died after 1 year compared to 10.6% in the youngest age group (15–44 years). Using multiple logistic regression analyses, prognostic factors for mortality were identified. All the factors were known at the time of admission. Risk factors for death in the ICU included age, admission for disorders in several organ systems, cardiopulmonary arrest and acute respiratory disorder. In addition to age and acute conditions at the time of admission, cumulative mortality after 1 year was also influenced by chronic conditions such as diabetes mellitus, chronic heart failure and cancer. These data document the importance of taking age and chronic illness into account when making a prognosis for intensive care patients.
The effect of isoflurane on cerebrospinal fluid pressure in patients undergoing neurosurgery
Authors: Gordon E. , Lagerkranser M. , Rudehill A. , Von Holst H.
Published: January 2009

Ten patients with intracerebral tumours (TC) and 13 patients with subarachnoid haemorrhage (SAH) from a ruptured cerebral arterial aneurysm were studied before intracranial surgery, and during a 3–h postoperative period. Cerebrospinal fluid pressure (CSFP) determined by an intraventricular (TC group) or intraspinal (SAH group) catheter, and mean arterial blood pressure (MABP) were recorded under neurolept anaesthesia (control) followed by isoflurane inhalation. These two measurements were performed during normocapnia. A third measurement was made during hypocapnia, with unchanged isoflurane concentration. After the experimental period, isoflurane remained the main anaesthetic agent throughout the surgical procedure. After recovery from anaesthesia, the patients were monitored with CSFP and blood pressure during the first postoperative hours, and the quality of breathing was assessed by hourly blood–gas analyses. The results show that isoflurane causes a 10–14% reduction of MABP with no further changes during hyperventilation. Mean CSFP increased 27% in the TC group, and 12% in the SAH group after isoflurane induction and decreased from these levels by 29% during hyperventilation in both groups. Consequently, the impact on cerebral perfusion pressure (CPP) by isoflurane was a 19% and 21% mean decrease in the TC and SAH group, respectively. Controlled hyperventilation reduced this effect by partially restoring control CPP values, with 8% and 14% increase, respectively. In the postoperative follow–up, all patients had normal breathing and blood pressure with low values of CSFP. It is concluded that isoflurane can be used in intracranial surgery with adequate safety if combined with controlled hyperventilation.
Efficacy of 0.3 mg morphine intrathecally in preventing tourniquet pain during spinal anaesthesia with hyperbaric bupivacaine
Authors: Tuominen M. , Valli H. , Kalso E. , Rosenberg P. H.
Published: January 2009

Tourniquet–induced pain is probably mediated by C–fibres. The ability of morphine to interrupt this nociceptive conduction was studied in a double–blind fashion by administering either morphine 0.3 mg or saline intrathecally along with hyperbaric bupivacaine 15 mg for spinal anaesthesia in 40 patients undergoing orthopaedic, surgery on the lower extremity. The block characteristics were similar in both groups. During surgery, no patient in the morphine group complained of pain, whereas in the saline group one patient complained of pain caused by the tourniquet and two other patients experienced surgical pain. A 60–min experimental thigh tourniquet pressure provocation (53 kPa for 20 min; 0 kPa for 20 min; 53 kPa for 20 min) on the contralateral unoperated extremity was then performed following surgery, when the spread cephalad of the sensory block had decreased below the T10 dermatomal level. Eight patients in the morphine group experienced no pain in this test, compared with two patients in the saline group (P < 0.05). The remaining 12 patients in the morphine group had pain responses similar to those patients not given morphine. Intrathecal morphine provides a level of prophylaxis against tourniquet pain. However, the dosage employed here was associated with urinary and emetic side–effects.
When asleep, one is cooler on beta–blockade than on placebo
Authors: Fagher B. , Magnússon J. , Monti M. , Thulin T. , Werner O.
Published: January 2009

The effect of beta1–adrenergic blockade on body temperature was studied during general anaesthesia by means of a thermistor in an indwelling pulmonary arterial catheter. Metoprolol (200 mg daily) or placebo was given double–blind preoperatively for at least 2 weeks to 27 hypertensive patients undergoing abdominal surgery. A significantly greater temperature fall was observed in the metoprolol group compared with the placebo group. Heat production in the rectus abdominis muscle, measured by direct microcalorimetry, was significantly lower after metoprolol. The hypothermic effect of beta–adrenergic blockade during anaesthesia deserves special attention.
Premedication with intramuscular dixyrazine: (Esucos®)
Authors: Larsson S. , Hägerdal M. , Lundberg D.
Published: January 2009

Ninety patients scheduled for general or orthopaedic surgical procedures were randomly assigned to receive one of three different i.m. premedications: dixyrazine 0.5 mg kg‐1; morphine 0.15 mg kg‐l and scopolamine 0.0065 mg kg‐1; or placebo. The premedication was administered and evaluated in a double–blind fashion. The patients were anaesthetized with thiopentone, fentanyl, pancuronium, and ventilated with nitrous oxide in oxygen. The three premedications had no noticeable anxiolytic effect. Although there was no difference in the frequency of observed postoperative nausea and vomiting between the three groups, premedication with dixyrazine nonetheless reduced the patients' experience of postoperative nausea as well as their need for postoperative antiemetics. Although patients in the two treatment groups were significantly more sedated immediately before induction of anaesthesia than patients receiving placebo, the degree of postoperative sedation was similar in all three groups. Morphine–scopolamine caused more postoperative dizziness than dixyrazine and placebo. Lack of recall was produced by both morphine–scopolamine and dixyrazine. It is concluded that premedication with dixyrazine is a useful alternative, especially in patients who have previously experienced postoperative nausea and vomiting.
“Closing volume” during high–frequency ventilation in anesthetized dogs
Authors: Haghenberg T. , Wendt M. , Meyer J. , Wrenger K. , Lawin P.
Published: January 2009

Airway closure, mean airway pressure, gas exchange and different modes of artificial ventilation were investigated in anesthetized and paralyzed dogs with clinically healthy lungs. The animals were ventilated with either intermittent positive pressure ventilation (IPPV), continuous positive pressure ventilation (CPPV, positive end–expiratory pressure (PEEP) = 0.49 kPa) or high–frequency jet ventilation (HFJV, open system) of 2 and 30 Hz with an inspiratory to expiratory (I/E) – ratio of 30/70 and 60/40. Closing volume (CV) was determined by a modified technique, submitting the lung to constant subatmospheric pressure after an inspiratory vital capacity of oxygen. Two different tests for CV were used: the foreign gas bolus (FGB) with helium as nonresident gas and the single breath nitrogen dilution technique (SBO2). During conventional mechanical ventilation, CV decreased significantly (P < 0.05) after establishing a PEEP of 0.49 kPa. During HFJV, CV increased significantly (P < 0.01). This effect was predominantly dependent on I/E duration time ratio and to a lesser extent on ventilatory frequency. There were significant differences between CV obtained by the FGB–method (CV(helium)) and CV derived from the SBO2–test (CV(SBO2)), although both tests revealed the same proportional changes of CV during the different modes of ventilation. The elevated CV was associated with a decreasing Pao2 and increasing Aa–Do2 and Paco2, indicating substantial hypoventilation and mismatching of ventilation and perfusion. Mean airway pressure increased with both CPPV and HFJV, revealing a dissociation between airway pressure and regional FRC distribution during HFJV. It is concluded that certain modes of high–frequency ventilation lead to impaired distribution of inspired gas to dependent lung regions. This effect may contribute to pulmonary dysfunction in patients with compliant lungs and prolonged spontaneous relaxation time, and lead to overexpansion of peripheral airways.
Experience of multiple supplementary doses of vecuronium
Authors: Staun P. , Lennmarken C.
Published: January 2009

Seventy–one supplementary doses of vecuronium were used for muscle relaxation during a 22–h–long NLA II anaesthesia. For assessment of neuromuscular blockade, train–of–four stimulation was used to measure the twitch force of the adductor pollicis after electrical stimulation of the ulnar nerve. No cumulative effect of vecuronium could be demonstrated, measured under strictly controlled conditions. Adding isoflurane 0.5% (end tidal) only slightly prolonged the neuromuscular blocking effect.
The double J–spring guide wire and its hazards. Partially retained double J–wire: a complication during central venous catheterization
Authors: Schou H.
Published: January 2009

A case is presented in which the outer part of a double J–spring guide wire was retained in the patient because of separation of the two parts. Warning against the use of this kind of wire is given.
Thoracic epidural anaesthesia in conscious and anaesthetized rats. Effects on central haemodynamics compared to cardiac beta adrenoceptor and ganglionic blockade
Authors: Blomberg S. , Ricksten S. E.
Published: January 2009

A simple technique for cannulation of the thoracic epidural space in rats was described. 40–50 μl of epidural bupivacaine 5 mg/tnl induced a distribution of sensory analgesia from lower cervical to lower thoracic segments. With this model, effects of thoracic epidural anaesthesia (TEA) on mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), heart rate (HR), central venous pressure (CVP), left ventricular end–diastolic pressure (LVEDP) and maximal increase of pressure in the left ventricle (max dp/dt) were studied in six groups of animals: 1) In conscious animals (n= 10) MAP, CO, SV and HR decreased significantly by 12%, 25%, 10% and 16%, respectively, while SVR increased significantly by 20% during TEA; 2) In chloralose–anaesthetized animals (n = 7) the reduction in CO during TEA was less pronounced and there were no significant changes in SV or SVR; 3) In conscious animals (n = 6) LVEDP, CVP and max dp/dt decreased significantly during TEA; 4) Hexamethonium, when administered to pharmacologically vagotomized conscious animals during TEA (n = 8), induced a significant decrease in SVR (23%) but no change in HR; 5) Changes in haemodynamics after cardiac adrenoceptor blockade with metoprolol, in conscious animals (n = 12), did not differ significantly from those seen during TEA, except for an unchanged SV after metoprolol; 6) 50 μl of bupivacaine (5 mg/ml) when given i.v. to conscious animals (n = 8) did not affect CO, SV, HR or TPR significantly, while MAP increased slightly but significantly. Thus, in this conscious animal model, TEA almost completely and rather selectively blocked cardiac sympathetic efferents. The decrease in CO is compensated for by an increase in SVR, in turn probably mediated by a reflex activation of unblocked sympathetic segments. This mechanism was attenuated in anaesthetized animals. TEA–induced negative inotropism was associated with decreased filling pressures.
Thoracic epidural anaesthesia decreases the incidence of ventricular arrhythmias during acute myocardial ischaemia in the anaesthetized rat
Authors: Blomberg S. , Ricksten S. E.
Published: January 2009

The aim of the present investigation was to study the effect of high thoracic epidural anaesthesia (TEA) on the incidence of ventricular arrhythmias after ligation of the left coronary artery in chloralose–anaesthetized rats. Forty animals were randomly assigned to receive either 40–50 μl of bupivacaine (5 mg/ml) or saline in implanted thoracic epidural catheters. TEA decreased mean arterial pressure (MAP) from 118 ± 5 mmHg to 72 ± 4 mmHg and heart rate (HR) from 450 ± 9 to 387 ± 8 beats/min, while epidural saline did not affect MAP and HR. In both groups coronary artery ligation induced a transient decrease in MAP within the first 5–10 min after ligation. In the control group HR increased, during the 30–min post–ligation period, from 453 ± 9 to 474 ± 10 beats/min (P < 0.05) while no significant change was seen in the TEA group. In both groups the mortality rate was 10%. In the TEA group 30% and in the control group 0% had normal sinus rhythm during the recording period (P < 0.001). The incidence of ventricular fibrillation and/or tachycardia was significantly lower (P < 0.05) in the TEA group (20%) compared to the control group (53%). The incidence of ventricular extrasystoles did not differ between the two groups. We conclude that TEA–induced blockade of sympathetic afferents and efferents may offer protection against malignant ventricular arrhythmias in the early phase of acute myocardial infarction.
Opioid treatment for radiating cancer pain: oral administration vs. epidural techniques
Authors: Vainio A. , Tigerstedt I.
Published: January 2009

In order to determine the optimal pain treatment for patients with cancer involvement of the brachial or lumbar nerve plexuses, a prospective comparative study was carried out using peroral opioid therapy (SO), epidural opioid by a conventional tunnelled epidural catheter (CE) or an epidural catheter connected to an implanted injection port (Port). Pain relief, measured by a visual analog scale (VAS), was similar and adequate in every group already after the first 24 h. CNS side–effects were less frequent and the Karnofsky performance grades slightly superior in the epidural groups. Occlusion and catheter disconnection complicated the pain therapy of five epidural port patients. Epidural dislocation occurred three times in the conventional epidural group. One local infection in the CE group and two in the Port group were recorded. However, no signs of epidural infection were seen at autopsy. The results suggest that due to a lower incidence of side–effects, epidural catheter techniques are superior to peroral opioid in treating pain in these patients. However, complete pain relief was not achieved in all patients, suggesting neurogenic, non–nociceptive pain components. Both epidural techniques seem suitable for long–term pain therapy. Technical improvements are needed in the epidural catheter and the port. The long–term epidural catheter does not seem to cause any major changes in the histology of the dura mater or the connective tissue of the epidural space.