bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA and Chromosome Alterations in Lymphocytes of Operating Room Personnel and in Patients before and after Inhalation Anaesthesia
Authors: Holmberg K. , Lambert B. , Lindsten J. , Söderhäll S.
Published: January 2009

In order to evaluate the possible genotoxic effects of inhalation anaesthetics, the frequency of sister chromatid exchanges and chromosome aberrations was studied in peripheral lymphocytes of control subjects, operating room personnel and patients before and after inhalation anaesthesia during orthopaedic operations. In the patients, the frequency of DNA breaks was studied as well. None of the genotoxic parameters showed an increase which could be related to anaesthetic exposure. The frequency of sister chromatid exchange was very similar in the control and personnel groups, as well as in patients before and after operation. The frequency of chromosome aberrations was unusually low in the control group, whereas the personnel and patient groups showed normal levels of chromosome aberrations which did not differ from previously studied control groups. There was no statistical difference in the frequency of chromosome aberrations or DNA breaks in the patient group after, as compared to before, operation. Smokers were found to have a significantly increased frequency of chromosome gaps compared to nonsmokers, but there was no indication that this difference was related to anaesthetic exposure. The data presented give no indications of genotoxic effects in vivo of inhalation anaesthetics, by either occupational exposure to waste anaesthetic gases, or anaesthesia during operation. On the other hand, our present data do not contradict previous data indicating that hospital personnel, irrespective of exposure to inhalation anaesthetics, may have a small average increase of chromosome abnormalities.
Attenuation of Circulatory Response to Laryngoscopy and Tracheal Intubation: A Comparison of Two Methods of Topical Anaesthesia
Authors: Kautto U.‐M. , Heinonen J.
Published: January 2009

Circulatory responses to laryngoscopy and endotracheal intubation were compared between throe groups of patients, two of which were subjected to a procedure of topical anaesthesia before induction of general anaesthesia. Topical anaesthesia, achieved with either a lidocaine dose aerosol or by gargling with viscous lidocaine, attenuated the magnitude of the pressor response to laryngoscopy and intubation but had no effect on the heart rate response. Lidocaine aerosol had some advantages over viscous lidocaine; these were the significantly smaller haemodynamic response to the local anaesthetic procedure itself and probably shorter duration of the circulatory changes produced by intubation. It is concluded that both of these simple methods are relatively ineffective in preventing haemodynamic changes associated with laryngoscopy and intubation and should probably be combined with another preventive method.
Pentobarbital Plasma Concentrations and Cardiac Electrophysiology During Prolonged Pentobarbital Infusion Anaesthesia in the Dog
Authors: Hotvedt R. , Platou E. S. , Koppang E. R. , Refsum H.
Published: January 2009

There is need for a prolonged stable level of anaesthesia, and we therefore investigated the cardiac electrophysiological effects of continuous pentobarbital infusion after initial pentobarbital injection to induce anaesthesia in dogs. Plasma concentrations of pentobarbital were measured by gas‐liquid chromatography. Heart rate, atrial, atrioventricular (AV) nodal and His‐Purkinje conduction times were measured by His bundle electrography, and atrial, AV nodal and ventricular refractoriness by programmed electrical stimulation. Over a 5‐h observation period, continuous infusion of pentobarbital 3.5 mg · kg‐1h‐1after an initial pentobarbital injection of 25 mg · kg‐1intravenously gave stable mean plasma concentrations of 140‐135 μmol · l‐1. The cardiac electrophysiological variables studied did not change significantly during this period. We conclude that a stable experimental model for cardiac electrophysiological studies can be obtained for several hours by‐continuous pentobarbital infusion.
Pharmacokinetics of Pethidine During Anaesthesia and Patient‐Controlled Analgesic Therapy
Authors: Hartvig P. , Tamsen A. , Fagerlund C. , Dahlström B.
Published: January 2009

The pharmacokinetics of pethidine has been studied in 12 patients subjected to major intraabdominal surgery. Pethidine and norpethidine were analyzed in plasma samples collected during anesthesia and during patient‐controlled administration of small intravenous doses of pethidine in the early postoperative period. A second study on the pharmacokinetics of pethidine was performed on the 3‐5th postoperative day. The plasma clearance of pethidine was significantly lower in the peroperative study (8.9±1.8ml·kg·min‐1) compared with the postoperative study (12.0 ±3.1 ml·kg·min‐1). Volume of distribution (Vd) was not significantly influenced, being 4.25±1.72 l·kg‐1 peroperatively and 3.14±0.84 l·kg‐1 postoperatively. Elimination half‐life decreased from 5.91 ±3.57 h peroperatively to 3.25 ± 1.40 h postoperatively. The kinetics of pethidine in the postoperative study agreed with pethidine kinetics reported for healthy volunteers. The fraction of unbound pethidine decreased from 0.26±0.1 peroperatively to 0.18±0.1 postoperatively. Norpethidine, a metabolite of pethidine, has been claimed to be responsible for several side effects like respiratory depression and convulsions during pethidine therapy. No side effect attributable to norpethidine was observed in the self‐administration period. Norpethidine plasma concentrations did not exceed 500 ng/ml. The altered pethidine pharmacokinetics during anesthesia and the ensuing postoperative hours and the interindividual differences of the disposition of the drug strongly suggest that pethidine should be given by individualized regimens in surgical patients.
Clinical Pharmacokinetics of Methadone
Authors: Nilsson M. I. , Meresaar U. , ÄNggård E.
Published: January 2009

Studies with single doses of methadone have shown that the oral biological availability is 79±21%, range 41–99%. The rate of elimination is mostly due to metabolic clearance. Below a urinary pH of 6, renal clearance becomes of quantitative importance. In five subjects treated with ammonium chloride (acidic urine), the plasma half‐life of methadone was found to be 19.5±3.6 h. When treated with sodium bicarbonate the same subjects had plasma half‐lives of 42.1±8.8 h. During continuous treatment with methadone, cellular tolerance may occur and in some subjects also metabolic tolerance. In treatment of severe cancer pain such adaptive changes in methadone pharmacodynamics and pharmacokinetics are best managed by a regimen involving a fixed dose but a flexible and patient‐controlled dosage interval.
Pain Treatment in a Palliative Unit or Team of a University Hospital
Authors: Scott J. F.
Published: January 2009

A Palliative Care Unit and Team provides a model for delivering care, in which narcotic analgesics can be optimally effective in the treatment of cancer pain. Our rapidly expanding knowledge of pain physiology and narcotic pharmacokinetics will not benefit patients unless we design more appropriate organizational structures to implement therapy and to teach symptom control. The Palliative Care Service model, as developed at several university hospitals in Canada, is designed to assist and complement oncology departments. Its primary role is to provide a consultation service to cancer patients wherever they may be in the health care system (home, O.P.D., hospital). A multi‐specialty and interdisciplinary team offers assessment and therapy of pain and other symptoms. The McGill Pain Questionnaire is one useful tool in evaluating pain treatment. The Service also provides the university with a Palliative Care Unit designed for patients with advanced cancer who have complex symptomatology. Hospital organization must reflect the fact that environmental and psychosocial factors alter pain perception and response. Oral morphine is more effective when administered in a Palliative Care Unit than when it is given to patients in other settings. The Unit provides personnel skilled in analgesic titration and a supportive environment in which psychological, social and spiritual components of the pain experience can be evaluated and treated.
Clinical Evaluation of Oral Methadone in Treatment of Cancer Pain
Authors: Hansen J. , Ginman C. , Hartvig P. , Jakobsson P. Å. , Nilsson M. I. , Rane A. , Säwe J. , ÄNggård E.
Published: January 2009

A dose‐adjustment program for oral methadone and the long‐term effects of the analgesic therapy have been evaluated in 15 patients with incurable cancer. Rapid and continuous pain relief without serious side‐effects was achieved by “ad libitum” dosage in the first 3–5 days. Thereafter, a dosage based on each patient's subjective need was instituted. The mean daily dose was 44 mg during the first day and it decreased to 22 mg daily at the end of the dose‐adjustment week. Three patients did not complete the program because of insufficient effect or severe nausea. Among the 12 patients who chose to continue the methadone treatment after the initial dose‐adjustment period, four continued the therapy to their death, three discontinued the therapy due to insufficient effect, and three due to adverse reactions. In one case it was possible to stop the treatment due to decreased pain. The treatment period in these 12 patients varied between 8 and 270 days. Oral methadone offers good pain relief for long periods of time in this group of patients and has obvious advantages as compared to long term parenteral therapy with narcotic analgesics.
Regional Epidural Analgesia: Kinetics of Pethidine
Authors: Gustafsson L. L. , Garle M. , Johannisson J. , Rane A. , Stenport J. , Walson P.
Published: January 2009

Low intrathecal doses of opiates produce dose‐dependent long‐lasting elevation of the pain threshold in rats. The effect is postulated to be mediated by a direct action on the substantia gelatinosa of the spinal cord. Eight uncontrolled and two controlled studies in man showed a long duration of analgesia for most patients in the postoperative period. The duration of effect differs widely within and between studies. Using a double‐blind design, we compared the relative efficacy of epidural and parenteral pethidine to control postoperative pain after total hip replacement. Preliminary pharmacokinetic data from six patients show that epidural doses of 20 or 60 mg pethidine give a similar pattern of absorption and elimination in plasma as 1 mg pethidine/kg body weight intramuscularly. The terminal elimination half‐lives of pethidine in plasma are 5–7 h for all routes of administration. The possibility cannot be excluded that the analgesic effect of epidural pethidine is partly systemically mediated.
Regional Blockade Versus Analgesic Therapy
Authors: Wiklund L.
Published: January 2009

Like other investigators, we have found that the postoperative period is characterized by high energy expenditure, pain, high plasma catecholamines and decreased arterial oxygen tension, and also glycogenolysis, lipolysis, proteolysis and a low turn‐over rate of glucose. Regional anaesthesia has often been supposed to counteract some of these phenomena without causing ventilatory depression. During the past few years a number of studies have been carried out in our department with the aim of elucidating possible differences between the effects of systemic analgesics and different regional anaesthetic blockades. Thus, we have found that both systemic analgesics and regional anaesthesia decrease the total postoperative energy expenditure. Adequately administered regional anaesthesia and systemic analgesic therapy both relieve postoperative pain, the former without interfering with normal ventilatory function. In addition, regional anaesthetic techniques cause less mental confusion, fewer bowel problems and possibly less postoperative lung complications. Moreover, high spinal blockades seem to be the only means of reducing the post‐traumatic metabolic stress reaction.
The Interactions between β‐Blockers and Anaesthetics. Experimental Observations
Authors: Foëx P. , Francis C. M. , Cutfield G. R.
Published: January 2009

The possibility of interactions between β‐adrenoceptor antagonists and anaesthetic drugs is particularly relevant to the anaesthetic management of patients suffering from arterial hypertension and ischaemic heart disease. Maintenance of adrenergic beta‐receptor blockade in patients with ischaemic heart disease and arterial hypertension is now widely accepted in order to avoid the cardiac risks of its sudden withdrawal and also to minimize the effects of sympathetic overactivity on the cardiovascular system. However, maintenance of adrenergic beta‐receptor blockade may impose some constraints on the choice of the anaesthetic agent. While no adverse interaction has been found between beta blockade and anaesthesia with halothane, halothane supplementing nitrous oxide, or isoflurane, substantial reductions of cardiac performance have been observed in the case of the association of beta blockade and anaesthesia using methoxyflurane or trichloroethyiene. An adverse interaction has also been observed between propranolol and enflurane anaesthesia but not between oxprenolol and enflurane anaesthesia. Recent studies of the effects of anaesthesia in the presence of critically narrowed coronary arteries have shown that both halothane and enflurane may cause regional myocardial dysfunction. This dysfunction is minimized by oxprenolol and it appears that adrenergic beta‐receptor blockade, besides improving cardiovascular stability, protects the myocardium supplied by narrowed coronary arteries.
Beta‐blockers and Thoracic Epidural Analgesia. Cardioprotective and Synergistic Effects
Authors: Reiz Sebastian , Häggmark Sören , Rydvall Anders , ÖStman Margareta
Published: January 2009

Seven groups of patients with and without hypertension or with ischaemic heart disease, treated with different beta blockers were investigated to study the circulatory effects of neurolept anaesthesia alone or combined with thoracic epidural analgesia from T4 to T12/L2 during abdominal surgery. The combination of thoracic epidural analgesia and neurolept anaesthesia in hypertensive subjects treated with non‐cardiosclective beta blockers induced slightly lower blood pressure than measured in similar patients on cardioselective beta blockers with neurolept anaesthesia only. Patients on non‐selective beta blockers with intrinsic stimulatory activity (ISA) had higher blood pressure and heart rate after neurolept anaesthesia induction than patients on cardioselective blockers. During surgery, heart rate remained at a higher level in the patients treated with ISA blockers, whereas blood pressure increased to the same level as in patients with cardioselective blockers. Cardiovascular stability was, however, best maintained in the epidural group, where myocardial energy expenditure during maximal surgical stress was comparable to that in a group of healthy subjects with the same format of anaesthesia and significantly lower than in healthy subjects with neurolept anaesthesia alone. No circulatory side effects of the combination of thoracic epidural analgesia and beta blockade were seen. In patients with ischaemic heart disease, with or without non‐selective beta blockade, similar haemodynamic changes were recorded following neurolept anaesthesia. During maximal surgical stress, unmasking of alpha adrenergic activity with marked rise in blood pressure was seen in the beta‐blocked patients. Despite the more accelerated haemodynamic changes in the blocked patients, a lower increase in myocardial oxygen consumption was recorded compared with the non‐blocked patients. Simultaneously, a lower myocardial uptake of catecholamines, especially noradrenaline was measured in the beta‐blocked group. It is suggested that beta blockade may inhibit the uptake of catecholamines in the myocardium, thereby reducing metabolic rate. Addition of thoracic epidural analgesia during surgery restored cardiovascular stability and did not induce circulatory side effects. Myocardial uptake of catecholamines was completely abolished after the epidural block.
Bupivacaine for Intercostal Nerve Blockade in Patients on Long‐term β‐Receptor Blocking Therapy
Authors: Pontén J. , Biber B. , Henriksson B‐Å. , Jonsteg C.
Published: January 2009

Possible cardiovascular side effects of a local anaesthetic in patients on long‐term β‐receptor blocking therapy were studied in 26 patients given postoperative intercostal nerve blockades (ICB) with 18–28 ml of plain bupivacaine 0.5% (1.30‐1.82 mg kg‐1). The patients had a history of hypertension and/or ischaemic heart disease and were scheduled for gall bladder surgery. Thirteen patients were randomized to a gradual preoperative withdrawal of the β‐receptor blockers and the other 13 continued the β‐receptor blockade until surgery. Cardiovascular changes were measured noninvasively and 11 patients were also monitored with pulmonary artery catheters. Blood pressure and heart rate (HR) were stable in all patients although those in whom the β‐receptor blockade was withdrawn had the highest HR and most frequent arrhythmias both before and after ICB. The ICB was associated with a decrease in the overall postoperative arrhythmia incidence, but seemed most efficient (P<0.02) concerning the ventricular arrhythmias in the β‐receptor‐blocked patients (even including idionodal rhythm). The bupivacaine blood levels did not modify other cardiovascular changes except in one β‐receptor‐blocked patient with cardiac failure in whom signs of a slight transient cardiodepression were observed. It is concluded that bupivacaine does not negatively affect cardiovascular stability in long‐term β‐receptor‐blocked patients. In the presence of cardiac failure, however, an additive cardiodepression may be elicited.
Effect of Cardioselective β‐Blockers on the Heart Rate and Arterial Pressure Responses to Laryngoscopy
Authors: Werner O. , Magnusson J. , Fletcher R. , Carlsson C. , Pettersson K. I.
Published: January 2009

The effects of the cardioselective β‐blockers practolol (Eraldin, ICI) and metoprolol (Seloken, Hässle) were studied during microlaryngoscopy. I. v. practolol (0.4 mg/kg before and 0.2 mg/kg during anaesthesia) did not protect against increases in arterial pressure, although heart rate was reduced. Oral metoprolol (0.2 g for 4 days) reduced the level of arterial pressure both before and during anaesthesia. Variations in arterial pressure were not attenuated. Very low levels of arterial pressure were seen, and variations in arterial pressures were attenuated when metoprolol was combined with fentanyl.
Analgesic, Respiratory and Endocrine Responses in Normal Man to THIP, a GABA‐Agonist
Authors: LindeburgM.D. T. , Følsgård S. , Sillesen H. , Jacobsen E. , Kehlet H.
Published: January 2009

In a controlled study, the effects of THIP (a synthetic gamma‐aminobutyric‐acid‐agonist) on respiratory function (ventilatory response to Co2), first detection of stimulation (electrical stimulation of a tooth), pain threshold, magnitude of maximal tolerated pain stimulation, and plasma cortisol, prolactin and glucose were investigated in six normal men. Intramuscular injection of THIP in dosages of both 10 mg and 20 mg increased the magnitude of stimulus before first detection, and the pain threshold as well as the maximal tolerance of pain stimulation. THIP did not lead to changes in respiratory function, or in plasma cortisol, prolactin or glucose, suggesting an analgesic action independent of opiate receptors.
Rehydration using Solutions with and without Glucose before Emergency Abdominal Surgery in Children
Authors: PerssonM.D. B. , Feychting H. , Josephson S. , Larsson A. , Settergren G. , Tordai P.
Published: January 2009

The metabolic effects of six different solutions used for rehydration were studied in 88 children before emergency abdominal surgery. A volume corresponding to 5% of the body weight was given i.v. during 4 h (12.5 ml kg‐1 h‐1) between admission and surgery. The different solutions were: low glucose electrolyte solution (LGE), Rehydrex 2.5 %®, Rehydrex 5%® containing 0.9, 2.5 and 5.0% glucose, respectively, Ringer®, Ringer lactate® and Ringerdex® (30 mmol acetate 1‐1). Venous blood samples were drawn before and after rehydration and analysed for glucose, insulin, alanine, 3‐hydroxybutyrate (3‐HB), non‐esterified fatty acids (NEFA), glycerol and base excess. Before rehydration the plasma concentrations of NEFA, glycerol and 3‐HB were elevated, while that of alanine was decreased. Plasma levels of NEFA and 3‐HB remained unchanged, whereas glucose and insulin decreased after rehydration with glucose‐free solutions, i.e. Ringer, Ringer lactate and Ringerdex. With solutions containing glucose the concentrations of NEFA and 3‐HB decreased significantly. With Rehydrex 5% hyperglycaemia and hyperinsulinaemia were observed. Rehydration using LGE and especially Rehydrex 2.5% resulted in decreased lipid mobilization and ketonaemia without concomitant marked increase of glucose and insulin. LGE and Rehydrex 2.5% thus appeared to be the most appropriate solutions in a situation where moderate dehydration had to be corrected during a short period of time before emergency abdominal surgery.
Endocrine Stress Response during General and Epidural Anaesthesia for Elective Caesarean Sections
Authors: LindahlM.D. S. , Nordén N. , Nybell‐Lindahl G. , Westgren M.
Published: January 2009

In 17 patients scheduled for elective caesarean sections, the influence of general (GA, n = 9) and epidural anaesthesia (EA, n = 8) on maternal and umbilical vein blood plasma concentrations of ACTH, Cortisol, 17‐α‐hydroxyprogesterone (OHP) and blood glucose (BG) was studied. Mean blood pressure (MBP mmHg) and heart rate (HR beats min‐1) were also followed during the operation and Apgar scores were evaluated in all neonates. With epidural anaesthesia, an MBP of 102±6.5 mmHg and an HR of 87 ±4.9 beats min‐1 was found at hysterotomy (HT). With general anaesthesia, the corresponding values were 143 ±6.9 mmHg (P<0.01) and 108 ±6.3 beats min‐1 (P<0.05). The plasma concentration of ACTH at HT was higher during GA than during EA (P<0.01), while the plasma concentration of Cortisol during GA was higher 30 min alter HT (P<0.05). Maternal ACTH and Cortisol levels at HT were higher than umbilical vein levels, while OHP was 2–3 times higher in the umbilical vein than in maternal blood at HT. Umbilical vein Cortisol concentration was higher in the EA than in the GA group (P<0.01). With epidural anaesthesia, neonates had higher Apgar scores than with general anaesthesia (P<0.01). The increased umbilical vein Cortisol concentration with epidural anaesthesia challenged the assumption of a higher fetal stress response. The results might have a bearing on the choice of the most suitable anaesthetic method in complicated pregnancies.
Ventilation ‐ Perfusion Relationship during Hip Arthroplasty
Authors: HedenstiernaM.D. G. , Mebius C. , Bygdeman S.
Published: January 2009

Ventilation‐perfusion relationships (V̇A/Q̇) were studied during hip arthroplasty, using a multiple inert‐gas elimination technique. True shunt (V̇A/Q̇=0) increased on 10 out of 16 prosthesis‐anchoring occasions, while “low” V̇A/Q̇values (<V̇A/Q̇<0.1) increased on 2 occasions only. Pao2 fell by l‐2kPa. “High” V̇A/Q̇. values (10<V̇A/Q̇<100) appeared or increased with the insertion of the prosthesis, while dead space (V̇A/Q̇>100) was unaltered. Cardiac output did not change. Pulmonary artery pressure fell and airway peak pressure rose by approximately 2 mmHg. It is possible that the blood flow is forced from non‐dependent to dependent lung regions by the altered pressure in airways and blood vessels, creating a “high” V̇A/Q̇ in upper and shunt regions and a “low” V̇A/Q̇ in lower lung regions.
Cardiac Arrhythmias in Non‐intubated Children during Adenoidectomy. A Comparison between Enflurane and Halothane Anaesthesia
Authors: SigurdssonM.D. G. H. , Carlsson C. , Lindahl S. , Werner O.
Published: January 2009

The incidence of cardiac arrhythmias, heart rate, blood pressure, capillary perfusion and end‐tidal CO2 tension were studied in 167 healthy children 1–12 years of age undergoing adenoidectomy (n = 82) and myringotomy (11=85) during enflurane and halothane anaesthesia. The incidence of cardiac arrhythmias was significantly lower during myringotomy than during adenoidectomy. In children undergoing adenoidectomy the incidence of arrhythmias was 38.9% during enflurane anaesthesia and 86.6% during halothane anaesthesia (P<0.001). In the halothane group ventricular arrhythmias were observed in 19 patients (41.3%) but only in one child (2.8%) in the enflurane group. The ventricular arrhythmias seen during halothane anaesthesia were unifocal in six patients and multifocal in five and classified as ventricular tachycardia in eight children. Heart rate was increased by about 40% at the onset of ventricular arrhythmias. The heart rate remained unchanged with enflurane anaesthesia during surgery, which may reflect a decreased sympathomimetic activity. It is suggested that the low incidence of ventricular arrhythmias during enflurane anaesthesia may be explained by the combination of a reduced sympathomimetic activity and a lowered susceptibility of the myocardium to the actions of endogenous catecholamines.
Circulatory Effects of Renin‐Angiotensin System Antagonists during Halothane Anaesthesia in Hypertensive Rats
Authors: KaukinenM.D. S. , Kataja J. , Ylitalo P.
Published: January 2009

The circulatory effects of captopril, an angiotensin I‐converting enzyme inhibitor, and saralasin, a competitive angiotensin II antagonist, were studied during halothane anaesthesia in spontaneously hypertensive (SH) rats. Captopril decreased blood pressure significantly in unanaesthetized rats. Pretreatment with indomethacin, a prostaglandin synthesis inhibitor, did not modify the antihypertensive action of captopril. During 1 MAC halothane anaesthesia, the mean arterial pressure (MAP) in unmedicated SH control rats was maintained at a relatively high level (16.2 ± 0.7 kPa, mean ± s.c. mean), while in captopril‐treated rats MAP decreased to 8.8 ± 1.1 kPa. Indomethacin somewhat inhibited MAP decrease in the caplopril‐medicated group. Saralasin infusion in halothane‐anaesthetized rats decreased MAP in the same way as captopril alone. The tolerance to haemorrhagic shock was markedly impaired in rats receiving captopril or saralasin, compared to untreated controls. During halothane anaesthesia, the plasma renin activities in the captopril, captopril + indomethacin, and saralasin groups were significantly higher than in untreated animals. Plasma kininogen was unaffected by any of the medications. The results suggest that the renin‐angiotensin system is important in maintaining blood pressure in halothane anaesthesia, and that the tolerance to haemorrhagic shock is particularly impaired by drugs inhibiting the renin‐angiotensin system.
Can 4‐Aminopyridine be Used to Reverse Anaesthesia and Muscle Relaxation?
Authors: Carlsson C. , Rosén I. , Nilsson E.
Published: January 2009

4‐aminopyridine has earlier been shown to antagonize neuromuscular block and to release transmitters in CNS. In a study in man the drug was given intravenously at the end of anaesthesia in order to counteract muscle relaxation and possibly also anaesthesia. The effects were followed by clinical observations, intraarterial blood pressure recording, EGG, repetitive muscle nerve stimulation and EEG. It was shown that the drug could reverse the neuromuscular block in lightly curarized patients, but was not as efficient as synstigmine methylsulphate (Neostigmine®). In two cases the drug produced a slowing of EEG activity, which was normalized by naloxone. No toxic effects of the drug were observed.
Haemodynamic Changes during Sodium Nitroprusside Induced Hypotension and Halothane/Nitrous Oxide Anaesthesia
Authors: Beierholm E. A. , Sørensen M. Bredgaard , Sroczynski Z. , Spotoft H. , Gøthgen I. , Thorshauge C.
Published: January 2009

The haemodynamic effects of nitroprusside (SNP) were studied in six patients undergoing surgery for intracranial aneurysm under controlled hypotension in endotracheal anaesthesia with halothane‐nitrous oxide during hypocapnia. Mean arterial pressure was reduced with SNP from mean 12.25 kPa to mean 8.29 kPa (32%). There were concomitant statistically significant decreases in systemic vascular resistance (‐21%), cardiac index (‐17%), stroke index (‐23%), pulmonary arterial mean pressure (‐27%) and pulmonary capillary wedge pressure (‐27%). Heart rate, central venous pressure and pulmonary vascular resistance did not change significantly. After the infusion of SNP was discontinued all parameters, except cardiac index and heart rate, returned to values not significantly different from the control values. The hypotension induced by SNP resulted from reductions in cardiac index and systemic vascular resistance. The reduction in cardiac index did not reach a critical level in any of the patients.
Suitability of Plasma Expanders in Patients Receiving Low‐dose Heparin for Prevention of Venous Thrombosis after Surgery
Authors: Korttila K. , Lauritsalo K. , Särmö A. , Gordin A. , Sundberg S.
Published: January 2009

Patients (132) receiving low‐dose heparin for the prevention of venous thrombosis alter surgery were given in random order in addition to standard fluid therapy, a 500 ml infusion of balanced salt solution and glucose, 4% gelatine, 6% dextran, or 6% hydroxyethyl starch (mean molecular weight 40,000 or 125,000) after induction of anaesthesia. Variables of blood coagulation and haemostasis were measured before and after the operation, and peroperative bleeding tendency and postoperative bleeding complications were subjectively evaluated by the surgeon. None of the treatments significantly decreased platelet count or increased capillary bleeding time when compared to values before operation. The peroperative bleeding tendency was similar alter each infusion (moderately‐to‐markedly increased in 18–32% of the patients). None of the patients given balanced salt solution and glucose only had postoperative bleeding complications, whereas 8–18% of patients given plasma expanders presented with such complications (plasma expanders vs no plasma expanders p<0.05), The results suggest that administration of gelatine, dextran or hydroxyethyl starch should be avoided in patients receiving low‐dose heparin treatment for surgery.
Disoprofol (ICI 35868) for Total Intravenous Anaesthesia
Authors: Fragen R. J. , Hanssen E. H. J. H. , Denissen P. A. F. , Booij L. H. D. J. , Crui. J. F.
Published: January 2009

The purpose of this study was to evaluate disoprofol as the hypnotic for total intravenous anaesthesia. Sixty women undergoing minor gynaecological surgery participated and were randomly assigned to four groups (N= 15 in each group). Disoprofol, 2 mg/kg was given i.v. to induce anaesthesia after a bolus injection of either fentanyl 1.875 μg/kg or alfentanil 18.75 μg/kg. Vecuronium, 0.06 mg/kg, was given for muscle relaxation when indicated. One‐half of the patients received acute premedication with midazolam, 5 mg i.v. Anaesthesia was maintained with a continuous infusion of disoprofol 150 μg/kg/min and either fentanyl 0.125 μg/kg/min or alfentanil 1.25 μg/kg/min. These drug combinations were compatible and produced good operating conditions. Awakening time was significantly shorter for women who received no premedication and was not affected by the narcotic used. Respiration returned more quickly when fentanyl was the narcotic given and was not affected by premedication. Both hypotension and bradycardia were seen in some patients, but other side effects were infrequent. This total intravenous anaesthesia technique was very well accepted by the patients and the nurses who cared for them in the postoperative period.
Ketamine Anaesthesia for a Patient with the Shy‐Dräger Syndrome
Authors: Saarnivaara L. , Kautto U.‐M. , Teräväinen H.
Published: January 2009

A 58‐year‐old man with the Shy‐Dräger syndrome underwent laryngo‐ and tracheoscopies in general anaesthesia for evaluation of the larynx after tracheostomy following bilateral vocal cord paralysis. A profound fall in arterial pressure during anaesthesia induced with thiopentone has been demonstrated in previously reported patients with the Shy‐Dräger syndrome. In the present patient, anaesthesia induced with ketamine, maintained with nitrous oxide in oxygen and supplemented with fentanyl, diazepam and suxamethonium did not cause a fall in arterial pressure.
Echocardiography and Left Ventricular Function on Recovery from Anaesthesia in Patients with Coronary Artery Disease
Authors: Touze M.‐D. , Pinaud M. , Rozo L. , Souron R. , Nicolas F.
Published: January 2009

Eight patients with coronary artery disease and eight age‐matched patients without coronary artery‐disease undergoing noncardiac surgery were submitted to M‐mode echocardiography and haemodynamic measurements. In the patients with coronary artery disease, but not in the controls, recovery from anaesthesia was associated with echocardiographic and haemodynamic changes suggestive of impaired cardiac pump function. This impairment seems to result from an imbalance between myocardial oxygen availability and demand in patients with coronary artery disease.
The Effect of Spinal Analgesia on Skin Blood Flow, Evaluated by Laser Doppler Flowmetry
Authors: Bengtsson M. , Nilsson G. E. , Löfström J. B.
Published: January 2009

Changes in skin blood flow provoked by spinal analgesia were evaluated by laser Doppler flowmetry. This method permits a continuous and noninvasive measurement of the microvascular flow in the superficial skin layer. All recordings were made under controlled environmental conditions on 40 patients submitted to transurethral resection. During spinal analgesia a significant (P <0.001) reduction in skin blood flow was obtained in the shoulder and chest, while an increase (P<0.001) in skin blood flow was seen in the lower part of the body. In the postoperative period these changes still persisted, although they were less significant, indicating the individual duration of analgesia. The relations between intra‐individual relative changes in skin blood flow and skin temperature during spinal analgesia were found to be virtually uncorrelated. Laser Doppler flowmetry seems to be a useful tool in the further evaluation of the influence of spinal analgesia on the extent of tile associated sympathetic blockade.
Etomidate as a Sedative Agent in Intensive Care: Observations on its Cardiovascular Effects
Authors: Newby D. M. , Edbrooke D. L. , Mather S. J. , Bird T. M. , Hebron B. S.
Published: January 2009

The use of etomidate given by infusion as a sedative is described in six patients who, following major maxillofacial surgery, were electively ventilated in the intensive care unit. Measurement of various cardiovascular parameters showed that adequate sedative doses of etomidate had minimal effect on cardiovascular function. The technique was highly acceptable to both patients and staff.
Effect of Epidural Analgesia on Metabolic Response to Major Upper Abdominal Surgery
Authors: Asoh T. , Tsuji H. , Shirasaka C. , Takeuchi Y.
Published: January 2009

Blood concentrations of glucose, lactate, non‐esterified fatty acids (NEFA) and insulin (IRI) were measured in two groups of ten patients undergoing elective gastrectomy under general anesthesia with halothane (Group G) or epidural analgesia extending from Th.3–4 to L1–2 without halothane (Group E). The rise in blood glucose and the rise in NEFA in group E during operation were significantly less than in Group G. Blood lactate levels during operation were lower in group E than in group G although the difference was not statistically significant. The increase in IRI/glucose ratio on postoperative day 1 was significantly less in Group E than in Group G, suggesting that insulin sensitivity after surgery was higher in Group E. The postoperative course was uneventful in all subjects. These results suggest that the endocrine‐metabolic response to major upper abdominal surgery can be inhibited by epidural analgesia.
Attenuation of the Cardiovascular Intubation Response with N2O, Halothane or Enflurane
Authors: Kautto U.‐M. , Saarnivaara L.
Published: January 2009

The circulatory intubation response was studied in 75 normotensive, otolaryngological patients after a thiopentone‐suxamethonium induction followed by 2 min artificial ventilation with 100% oxygen (control), 70% nitrous oxide in oxygen (N2O), halothane 2% with N2O, enflurane 3% with N2O or enflurane 5% in oxygen. The above study groups (n = 15) were chosen after preliminary experiments performed in 25 different patients with halothane 2% (n = 8) or enflurane 3% (n = 6) in oxygen, which did not prevent the increase of arterial pressure after intubation, or with halothane 3% (n = 11) which attenuated the pressor response but caused cardiac arrhythmias in 55% of patients. Enflurane 5% in oxygen attenuated the increase of systolic arterial pressure by 53%, enflurane 3% with N2O by 34% and halothane 2% with N2O by 31 %. The increase in heart rate after intubation was lowest in the halothane 2% with N2O group, but there were no statistically significant differences between the groups. Cardiac arrhythmias were commonest in the enflurane 3% with N2O group (20%) and they did not occur in the halothane 2% with N2O group. Considering the total effect on arterial pressure, heart rate and rate‐pressure product, we recommend the combination of halothane 2% with N2O.
Effect of Changes in Pleural Pressure on Fluid Filtration Rate in Expanded and Collapsed Rabbit Lungs
Authors: de Léon R. Sanchez , Orchard C. H. , Chakrabarti M. K. , Sykes M. K.
Published: January 2009

Eight isolated rabbit lungs were suspended from a force‐displacement transducer and perfused at constant flow. The pressure surrounding the lungs (“pleural” pressure) was then reduced from ‐0.5 kPa to ‐1.0 and ‐1.5 kPa, and the rate of weight gain recorded. The step reductions in “pleural” pressure produced greater‐increases in pulmonary vascular volume and fluid filtration rate when the lungs were collapsed than when they were expanded, thus suggesting that the change in “pleural” pressure was more effectively transmitted to the perimicrovascular space when the lung was collapsed. These observations may help to explain the phenomenon of re‐expansion pulmonary oedema.
Haemodynamic Effects of Midazolam in the Anaesthetized Patient with Coronary Artery Disease
Authors: Massaut J. , D'Hollander A. , Barvais L. , Dubois‐Primo J.
Published: January 2009

The haemodynamic effects of midazolam 0.25 mg/kg administered intravenously were studied in eight anaesthetized patients suffering from coronary artery disease. Heart rate, systemic and pulmonary pressures, right atrial pressure, capillary pressure and cardiac output were measured 2, 5, 8 and 12 min after injection of midazolam and were compared with reference values collected before the commencement of the haemodynamic test. The cardiovascular condition of all the patients followed the same course after the injection of midazolam. The greatest variations were seen at the twelfth minute, with the exception of capillary pressure where the largest decrease was noted at the eighth minute. These variations, expressed as a percentage of the initial values, were: mean arterial pressure ‐17% (P<0.01); capillary pressure ‐23.5 % (eighth minute, P<0.01); heart rate ‐9% (P<0.01); cardiac index ‐9% (P<0.01); systemic vascular resistance ‐12% (eighth minute, P<0.01). The stroke volume was well maintained (+0.1% NS). These haemodynamic variations were accompanied by a favourable evolution of the endocardial viability ratio (EVR), +12% (P<0.01). The slight tachycardia occasionally seen on induction of anaesthesia with midazolam was not seen in this group of patients. We conclude that these haemodynamic variations leading to an increase in EVR support the use of midazolam as a supplement to fentanyl anaesthesia for patients with coronary artery disease.
Plasma Catecholamines During Surgical Stress: Differences Between Neurolept and Enflurane Anaesthesia
Authors: Hamberger B. , Järnberg P.‐O.
Published: January 2009

To evaluate the influence of enflurane and neurolept anaesthesia on the sympatho‐adrenal response to surgery, arterial plasma concentrations of adrenaline and noradrenaline were measured at 11 carefully defined events before, during and after cholecystectomy in two groups of five patients. During steady‐state anaesthesia prior to operation and after cholangiography, when the operative procedure had been interrupted for 10 min, adrenaline concentrations were similar in the two groups. During periods of stress such as intubation, skin incision and abdominal exploration, adrenaline levels were 4–6 times higher in the neurolept patients compared to the enflurane patients (p<0.01), in whom adrenaline levels were very stable. Noradrenaline levels also varied with stress but without difference between the two groups. Systolic blood pressure was approximately 20 mmHg higher during operation in the neurolept group than in the enflurane group (P<0.05). It is concluded that enflurane blocks the sympatho‐adrenal response to surgical stress more effectively than conventional neurolept anaesthesia.
Selective PEEP in Acute Bilateral Lung Disease. Effect on Patients in the Lateral Posture
Authors: Baehrendtz S. , Bindslev L. , Hedenstierna G. , Santesson J.
Published: January 2009

Seven patients with acute respiratory failure due to diffuse and fairly uniform lung disease were studied during mechanical ventilation in the lateral decubital position with: (a) zero end‐expiratory pressure (ZEEP) through a double‐lumen oro‐bronchial tube to permit a recording of the ventilation to each lung; (b) bilateral positive end‐expiratory pressure (PEEP) of 1.2 kPa, with maintenance of ventilation distribution between lungs as observed during ZEEP; (c) selective PEEP of 1.2 kPa, applied to the dependent lung only, with ventilation as during ZEEP; and (d) conventional PEEP of 1.2 kPa applied to both lungs through a single‐lumen tube, with free distribution of ventilation between the lungs. During ZEEP, 69% of ventilation was distributed to the nondependent and 31 % to the dependent lung;: cardiac output was 6.5 l×min‐1, venous admixture (QS/QT) 40% and arterial oxygen tension (Pao2) 8.3 kPa. With bilateral PEEP, functional residual capacity (FRC) increased by 0.33 1, cardiac output was reduced to 5.1 l×min‐1 and venous admixture to 32%. Pao2 increased to 10.1 kPa. With selective PEEP the dependent lung FRC increased by 0.21 1 and the FRC of the non‐dependent lung decreased by 0.08 1. Cardiac output increased to 6.1 l×min‐1, which was no longer significantly different from that during ZEEP. Venous admixture remained at the same level as with bilateral PEEP. Pao2 increased to 12.0 kPa. Conventional PEEP, applied with a single‐lumen tube and with ventilation distribution assumed to be equal between the lungs, gave essentially the same results as bilateral PEEP. It is concluded that selective PEEP improves gas exchange without impeding cardiac output and that this beneficial effect cannot be reproduced by general PEEP whether ventilation is distributed evenly between the lungs or not.
Oxygen Uptake and Central Circulation During Ketamine Anaesthesia
Authors: Tokics L. , Brismar B. , Hedenstierna G. , Lundh R.
Published: January 2009

Cardiac output, oxygen uptake and plasma catecholamines were studied in patients when awake and during ketamine anaesthesia prior to and during upper abdominal surgery. Oxygen uptake was determined by using a masspectrometer and cardiac output was measured according to the Fick principle. Plasma catecholamines were analysed by high performance liquid chromatography. Stroke volume had fallen by 27% while heart rate had increased after 15 min of anaesthesia, maintaining cardiac output at the awake level. Concomitantly, the oxygen uptake had fallen by 18%. During the succeeding hour of anaesthesia and surgery, cardiac output displayed a transient decrease and oxygen uptake returned to the awake value. The plasma adrenaline concentration fell during the initial phase of anaesthesia and then returned to the awake level. The noradrenaline concentration was increased during the whole anaesthetic period. The data suggest a relationship between oxygen uptake and cardiac output during ketamine anaesthesia, similar to that seen during neuroleptnitrous oxide and halothane anaesthesia, except for the initial hyperkinetic period following the induction. No relationship could be shown between catecholamine concentrations in plasma and the central haemodynamics.
Pulmonary Vascular Response to Carotid Sinus Hypotension in the Awake and Anaesthetized Dog
Authors: Bagshaw Roger J. , Cox Robert H.
Published: January 2009

The pulmonary haemodynamic response to brachiocephalic artery occlusion (BGO) was studied in nine dogs. The animals were chronically instrumented for the measurement of pulmonary artery pressure and flow together with left atrial pressure. Measurements were performed in the awake state and also at end‐tidal halothane levels averaging 0.74±0.02 (H1), 0.92±0.02 (H2) and 1.13±0.03 (H3) %, with and without nitrous oxide. Halothane at any of the above concentrations, with or without nitrous oxide, had no effect on pulmonary vascular resistance compared to awake values. Most importantly, we found no evidence for active pulmonary vasomotion in response to BCO in the awake animal, or at any anaesthetic concentration.
Rectal and Oral Cimetidine for Prophylaxis of Aspiration Pneumonitis in Paediatric Anaesthesia
Authors: Tryba M. , Yildiz F. , Kühn K. , Dziuba M. , Zenz M.
Published: January 2009

In a prospective randomized study, 60 children between 1 and 8 years of age in three groups received no premedication, 10 mg kg‐1 cimetidine orally or 40 mg kg‐1 cimetidine rectally for prophylaxis of acid aspiration syndrome 120–180 min before induction of anaesthesia. The pH of the stomach contents was above 2.5 in both cimetidine groups. The aspirated gastric volume was significantly reduced with rectal cimetidine compared to the other groups. Rectal cimetidine proved to be the more effective drug for prophylaxis of acid aspiration syndrome in paediatric anaesthesia.
Differential Lung Ventilation with Unilateral PEEP Following Unilateral Hydrochloric Acid Aspiration in the Dog
Authors: East T. D. , Pace N. L. , Westenskow D. R. , Lund K.
Published: January 2009

Differential lung ventilation with positive end expiratory pressure (PEEP) improves pulmonary gas exchange when used in the supportive care of patients with severe unilateral or asymmetrical lung disease. Once the provision of selective PEEP to the two lungs is accomplished, the best method of partitioning the tidal volume between the two lungs is unknown. Twelve mongrel dogs were given a unilateral hydrochloric acid (HCl) aspiration injury. A computer controlled differential lung ventilation system was used to ventilate four dogs with equal volumes to each lung, four dogs with equal driving pressure (end inspiratory pressure‐PEEP) to each lung, and four dogs with equal end‐tidal CO2 fraction from each lung. The respiratory rate was feedback controlled to maintain Paco2 at 4.67 kPa. The dogs were kept supine and ventilated with 30% O2. Following injury, the PEEP was set at 0 kPa for 1 h. The dogs were then given 1.36 kPa and 2.72 kPa PEEP to the injured lung for 2 h in a cross‐over fashion. The assignment of the tidal volume controller, the side of injury, and the PEEP sequence was random. Oxygen tension fell and pulmonary venous admixture increased after giving the HCl injury. In all three groups considered simultaneously, unilateral PEEP improved Pao2 and venous admixture. The equal tidal volume distribution was the only group to show a significant improvement in Pao2 at both PEEP increments (0 to 1.36 kPa and 2.72 kPa). There was a significant difference in tidal volume allocation between the three groups with the equal end‐tidal and equal pause pressure groups only minimally ventilating the injured lung. With differential lung ventilation and unilateral PEEP, equal partitioning of tidal volume provides the highest Pao2, compared to the other two methods of partitioning tidal volume.