bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of flumazenil during administration of midazolam on pial vessel diameter and regional cerebral blood flow in cats
Authors: KUMANO H. , SHIMOMURA T. , FURUYA H. , YOMOSA H. , OKUDA T. , SAKAKI T. , KURO M.
Published: January 2009

We implanted closed cranial windows in ten cats in order to observe the response of pial vessel diameter by microscopy using fluorescein isothiocyanate‐labeled dextran and regional cerebral blood flow (rCBF) by laser Doppler flowmetry during administration of midazolam and reversal with flumazenil. Midazolam was given at 0.8 mg.kg‐1 min‐1 for 10 min and maintained at 0.04 mg‐kg‐1 min‐1 for 50 min (total 10 mg‐kg‐1). The diameter of arterioles and venules and rCBF showed no significant change. During the last 10 min of midazolam administration, flumazenil, given at 0.1 mg‐kg‐1 min‐1 for 10 min (total 1 mg kg‐1), caused an increase of MAP and rCBF (P < 0.01) at 5 min after infusion and diameter of larger arterioles (>50 μm) and venules (50–100 μ) were dilated (P < 0.05). These results indicate that midazolam does not affect the diameter of cerebral arterioles and venules; however, the reversal effects of flumazenil against midazolam are transient vasodilation of larger arterioles accompanied by an elevation of MAP, and an increase in CBF.
Acute hyperglycaemic effect of anaesthetic induction with thiopentone
Authors: AMAR D. , SHAMOON H. , LAZAR E. J. , FRISHMAN W. H.
Published: January 2009

The acute effects of thiopentone on plasma glucose concentration and regulation in humans have not been well described. We therefore examined the effect of a single dose (6 mg/kg) of thiopentone on plasma glucose, insulin, glucagon, adrenaline and noradrenaline in 16 healthy women undergoing elective abdominal surgery. To assess involvement of the neuroendocrine system in the response to thiopentone, half of the patients labetalol prior to induction of anaesthesia. Thiopentone injection resulted in a 50% increase in plasma glucose levels (P< 0.001) in both labetalol‐treated and non‐treated patients 90 s following its administration. This was associated neither with significant increases in plasma glucagon, adrenaline and noradrenaline nor with a decline in plasma insulin. We conclude that acute hyperglycaemia following thiopentone is most likely the consequence of a non‐adrenergically‐mediated increase in hepatic glucose release.
Metastatic pain in the parturient: treatment with patient‐controlled epidural sufentanil
Authors: MGGRADY E. M. , MALINOW A. M. , PALY D. A. , MOKRISKI B. K.
Published: January 2009

A 30‐year‐old primigravid woman presented at 28 weeks gestation with severe pain related to metastatic gastric carcinoma. Pain control was achieved with epidural sufentanil, administered via a patient‐controlled analgesia pump, for 5 days, prior to caesarean delivery. Considerations in deciding the optimal therapeutic regime are discussed.
Changes in the T‐wave amplitude of ECG during isoflurane anaesthesia
Authors: ANNILA P. , JANTTI V. , LINDGREN L. , YLI‐HANKALA A.
Published: January 2009

R/T‐wave amplitude ratio of electrocardiogram (ECG), heart rate (HR) and systolic arterial pressure (SAP) were recorded in 15 patients awake, at 1 minimal alveolar concentration of isoflurane before and during surgery, and in deep anaesthesia (electroencephalogram burst suppression) during surgery. R/T‐wave amplitude ratio and HR were sensitive to both surgery and changes in the level of isoflurane anaesthesia; induction of anaesthesia, skin incision and the rapid increase in the concentration of isoflurane all significantly decreased the T‐wave amplitude, without influence on the R‐wave. Changes in the T‐wave amplitude correlated directly to HR. SAP increased at skin incision and decreased when the anaesthesia was deepened. The authors conclude that the R/T‐wave amplitude ratio of ECG provides a reliable method for monitoring the sympathetic tone during isoflurane anaesthesia.
Effect of intravenous diclofenac or indomethacin on the emergence from anaesthesia for tonsillectomy
Authors: RORARIUS M. G. F. , BAER G. A. , SIIRTOLA M. , LAHTI T. , LAIPPALA P.
Published: January 2009

We evaluated the effects of a single dose of diclofenac (75 mg) or indomethacin (50 mg) on intraoperative events and on the early recovery phase. The study was performed in a randomised, double‐blind, placebo‐controlled fashion in 63 adult patients scheduled for elective tonsillectomy. Study infusions started intravenously immediately after the induction of general anaesthesia with thiopentone; maintenance was with N2O/O2 and halothane. After intubation with the aid of suxamethonium, the patients breathed spontaneously via a Bain coaxial system. Perioperative events (bleeding tendency, bleeding, need for pain medication, physical recovery) were recorded with the aid of a questionnaire applied to the anaesthesia nurses and estimation of vigilance, attention, concentration, short‐term memory, and simple motor speed during recovery was with the aid of three neuropsychological tests (thumb tapping test, digit span test and homogenic interference test). No significant differences between the three groups were found in systolic and diastolic arterial pressures, the results of the questionnaire, and those of the neuropsychological tests. The ability to keep the head elevated for at least 5 s recovered significantly later (P < 0.05) and heart rate levels in the indomethacin group were significantly lower (P < 0.001) than in the other two groups. No enhanced bleeding during the perioperative period was observed. Diclofenac and indomethacin in the doses used in our study have only a marginal effect on the patient's emergence from anaesthesia.
Pharmacokinetics and related pharmacodynamics of anticholinergic drugs
Authors: ALI–MELKKILÄ T. , KANTO J. , IISALO E.
Published: January 2009

The pharmacokinetics and some pharmacodynamic properties of atropine, glycopyrrolate and scopolamine are reviewed. With the development of new analytical methods for drug determination, it is now possible to measure relatively low concentrations of these drugs in biological fluids and, consequently, some new kinetic data have been collected. Following intravenous administration, a fast disappearance from the circulation is observed and due to a high total clearance value their elimination phase half–lives vary from 1 to 4 h. All these agents are nonselective muscarinic receptor antagonists, but their actions on various organ systems with cholinergic innervation show considerable diversity. The cardiovascular effects are of short duration; other peripheral muscarinic effects and CNS effects can last up to 8 h or even longer. Differing from atropine and scopolamine, glycopyrrolate as a quaternary amine penetrates the biological membranes (blood–CNS, placental barriers) slowly and incompletely, making it the drug of choice for elderly patients with coexisting diseases and for obstetric use. Similarly, its oral absorption is slow and erratic, and hence it cannot be used as an oral premedicant. Atropine, scopolamine and glycopyrrolate have a definitely faster absorption rate, when injected into the deltoid muscle compared with administration into the gluteal or vastus lateralis muscles. There appear to be significant differences in the metabolism and renal excretion of these agents. Scopolamine is apparently excreted into the urine mainly as inactive metabolites, nearly half of the atropine dose administered is recovered in the urine as the parent drug or as active metabolites and about 80% of glycopyrrolate is excreted as unchanged drug or active metabolites. However, despite the diversity in some pharmacokinetic features, the differences in clinical effects are not very prominent in healthy patients.
Persistent postoperative hiccups: a review
Authors: HANSEN B. J. , ROSENBERG J.
Published: January 2009

The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess or gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined. Numerous treatment modalities have been tried but with questionable success. Valproat has proven effective in two trials investigating persistent non–surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided.
Halothane–associated enhancement of the secondary immune response to sheep erythrocytes in mice: cell transfer studies
Authors: PUIG N. R. , ELENA G. A. , BARRAGAN J. , COMBA J. O. , AMERIO N.
Published: January 2009

The effect of halothane anesthesia on the humoral immune response to sheep red blood cells was studied in mice immunized twice, with a 15–day interval. On both occasions, mice were exposed to 1.5% halothane for 40 min immediately after sensitization. Halothane reexposure resulted in increased numbers of IgG–secreting cells (IgG–SC) as well as circulating 7S–serum agglutinins. To examine further whether this effect could be obtained in syngeneic recipients, adoptive transfer experiments employing spleen cells were performed. While mice receiving cells from unimmunized and anesthetized donors displayed significantly higher levels of IgG–SC, recipients of cells from normal, immunized and immunized–anesthetized donors showed a depressed response when compared to control counterparts. Besides the possibility of an enhancing effect of halothane reexposure on the humoral response, this procedure may counteract normal physiological immunoregulatory processes during the generation of the immune response.
Hydroxyethyl starch as a prime for cardiopulmonary bypass: effects of two different solutions on haemostasis
Authors: KUITUNEN A. , HYNYNEN M. , SALMENPERÄ M. , HEINONEN J. , VAHTERA E. , VERKKALA K. , MYLLYLÄ G.
Published: January 2009

Hydroxyethyl starch (HES) is efficacious as a volume expander in cardiac surgical patients, but it may impair the haemostatic mechanisms. However, this latter effect may be less conspicuous with low molecular weight (LMW) solutions than with high molecular weight (HMW) solutions. Therefore, LMW– and HMW–HES solutions were evaluated as priming solutions for cardiopulmonary bypass (CPB) with respect to their effect on haemostasis. Forty–five patients undergoing coronary bypass grafting were prospectively randomised to three groups and in a double–blind manner as their CPB prime either 20 ml kg‐1 LMW–HES (Mw 120 000), 20 ml kg‐1 HMW–HES (Mw 400000) or Ringer's acetate 2000 ml. The final volume of the prime was completed to 2000 ml with Ringer's acetate in the HES groups. Anaesthesia and CPB management were standardised. Plasma levels of von Willebrand factor antigen and factor VIII procoagulant activity were significantly more depressed after CPB in both HES–groups as compared with the crystalloid prime group. In addition, APTT was more prolonged and the maximal amplitude of thromboelastographic tracing was more decreased in the HES–groups. It is concluded that it may be advisable to avoid HES solutions in the CPB prime, especially in patients with an increased risk for bleeding after cardiac operations.
The independent metabolic effects of halo thane and isoflurane anaesthesia
Authors: CARLI F. , RONZONI G. , WEBSTER J. , KHAN K. , ELIA M.
Published: January 2009

Twelve healthy, unpremedicated women scheduled for total abdominal hysterectomy were given either isoflurane (n = 6) or halothane (n = 6) anaesthesia. They all general anaesthesia for a period of 3 h, with surgery being carried out only in the last hour. The anaesthesia consisted of thiopentone, pancuronium and a mixture of oxygen–enriched air (Fio2= 34%) supplemented with 1 MAC of either isoflurane or halothane. The patients were maintained normothermic, and with an arterial Sao2above 95% throughout the period of the study. The following measurements were made before, during and after anaesthesia (with and without surgery): oxygen consumption (Vo2), carbon dioxide production (Vco2); circulating concentrations of various hormones (insulin, growth hormone and Cortisol); various metabolites; selected amino acids and albumin; forearm arterio–venous concentration difference of glucose, lactate, free fatty–acids and selected amino acids (four patients in each group). Whole body Vo2decreased significantly by over 20% during anaesthesia (with or without surgery),P< 0.05). Although the circulating concentration of most amino acids showed little or no change during anaesthesia alone, there was a tendency for the flux of most metabolites to decrease, and this persisted during surgery (P< 0.05). During anaesthesia alone there was a twofold reduction in the plasma Cortisol concentration (P< 0.05), and a decrease in albumin concentration (P< 0.01). With the onset of surgery, plasma Cortisol concentration increased rapidly (in association with several other hormones and metabolites) but hypoalbuminemia persisted.
A comparison between vecuronium and atracurium in myasthenia gravis
Authors: CHAN K. H. , YANG M. W. , HUANG M. H. , HSEU S. S. , CHANG C. G. , LEE T. Y. , LIN C. Y.
Published: January 2009

We evaluated the effect of vecuronium bromide and atracurium besylate on the train–of–four response in the management of muscle relaxation in 20 patients with myasthenia gravis (MG) who were undergoing thymectomy. We confirmed the safe use of these two non–depolarizing muscle relaxants in MG patients. Vecuronium (0.04 mg–kg‐1) demonstrated a lesser clinical duration than did atracurium (0.2 mg–kg‐1) (38± 19 vs 50 ± 21 min, mean ± s.e.mean). The recovery time for vecuronium patients was shorter than that for atracurium patients (22 ± 18 vs 38± 18 min), but the time until onset of neuromuscular blockade was longer with vecuronium (246 ±105 vs 107 ± 103 s). During spontaneous recovery from neuromuscular relaxation, at Tl/C of 25% and 100%, the train–of–four fade with vecuronium was significantly greater than that with atracurium (0.04 ± 0.02, 0.16 ± 0.03 vs 0.17 ±0.01, 0.83 ± 0.03), suggesting that vecuronium had a greater prejunctional effect than did atracurium.
Peroperative nitrous oxide does not influence recovery after laparoscopic cholecystectomy
Authors: JENSEN A. G. , PREVEDOROS H. , KULLMAN E. , ANDERBERG B. , LENNMARKEN C.
Published: January 2009

We have evaluated the effects of nitrous oxide on recovery following laparoscopic cholecystectomy in a prospective, randomised, double–blind study with 42 otherwise healthy patients. All patients received meperidine 1 mg/kg and atropine 6 μg/kg im for premedication, and anaesthesia was induced with fentanyl 2 μg/ kg and thiopental 4—‐6 mg/kg. Succinylcholine was used for the intubation and muscle relaxation was achieved using vecuronium. Isoflurane with 70% nitrous oxide in oxygen and fentanyl was used for maintenance of anaesthesia in group I (n=19), and isoflurane in air/oxygen and fentanyl in group II (n = 23). The postoperative ward staff and the surgeon evaluating the postoperative recovery were blinded to the anaesthetic technique. No differences were found in duration of operation and anaesthesia, need for postoperative analgesia or postoperative nausea treated medically. Recovery, judged by the Steward Coma Score, comprehension and collaboration, degree of sedation and orientation in time and space, was similar in the two groups. Postoperative hospital stay was 1 (1–4) day in the nitrous oxide group (median (10–90th percentiles) versus 2 (1–4) days in the air group. The time until patients were recovered, as judged by return to work and normal daily activities, was the same in the two groups: 8 (4–11) days in the nitrous oxide group and 8 (4—‐11) days in the air group. We conclude that nitrous oxide has no influence on recovery after laparoscopic cholecystectomy.
Evaluation of a new system for ventilatory administration of nitric oxide
Authors: STENQVIST O. , KJELLTOFT B. , LUNDIN S.
Published: January 2009

A new system for delivery of nitric oxide (NO) to inspiratory gas consisting of two mass flow regulators and a soda–lime absorber for scavenging of nitrogen dioxide (NO2) is described. The system was evaluated using three different techniques for NO analysis (infrared, chemi–luminescence and electro–chemical fuel cell technique). The electro–chemical fuel cell was less sensitive to humidity in the sample and is suitable for clinical routine use. The infrared analyser was very sensitive to humidity and the gas sample must be dried by silica gel, which absorbs NO2 and will cause falsely low NO2 values. NO2 was analysed with ultra–violet methodology. NO2 is highly toxic and the highest recommended occupational health and safety level for inhalation is 5 ppm. The highest values of NO2 in our system were detected before the absorber in the inspiratory limb of the breathing system, being 5 ppm at 100% oxygen and 100 ppm NO using “infant” respiratory settings (3 1/min in ventilation, frequency of 30/min). The corresponding value for “adult” respiratory settings (10 1/min in ventilation, frequency of 15/min) was 3.2 ppm. The absorber reduced these levels to well below 1 ppm. When clinically relevant levels of NO were used (20 ppm), no NO2 could be detected after the absorber, irrespective of oxygen concentration in the breathing gas. It was observed that gas cylinders with NO mixed in nitrogen may initially have a high NO2 concentration (around 12 ppm) and should be flushed thoroughly before use.
The influence of nitrous oxide on recovery of bowel function after abdominal hysterectomy
Authors: PEDERSEN F. M. , WILKEN–JENSEN C. , KNUDSEN F. , LINDEÆR A. L. , SVAREM E. I.
Published: January 2009

The influence of nitrous oxide on the recovery of bowel function was studied in 36 patients anaesthetised for elective abdominal hysterectomy with or without salpingooophorectomy. Patients were randomly assigned to receive either isoflurane in nitrous oxide and 30% oxygen (N2O group) or isoflurane in air and 30% oxygen (Air group). Anaesthetic management included thiopentone, fentanyl, suxamethonium and atracurium. The lungs were not ventilated prior to intubation. Before closing the abdomen, the surgeon assessed the degree of distension of the intestines and the closing conditions. Postoperative nausea and vomiting was assessed 2, 6, 12 and 24 h after recovery from anaesthesia. The lapse of time before mobilisation and passing of flatus and faeces was recorded. The patients in the Air group were significantly older than the patients in the N2O group (48.9 years versus 44.0 years, P = 0.04); otherwise, there were no differences in the demographic data of the patients. We found no significant differences between the groups with respect to nausea and vomiting, distension of the intestines before closure of the abdomen, closing conditions, time elapsing before mobilisation, constipation before recovery of bowel function or time elapsing before passing of flatus. We found a statistically significant delay of 10.3 h in time elapsing before passing of faeces in the N2O group compared to the Air group (P = 0.04), suggesting a potentially adverse effect of nitrous oxide. However, the delay seen in the present study is of dubious clinical significance. In conclusion, regarding operating conditions and time elapsing before recovery of bowel function, our results do not justify the omission of nitrous oxide from anaesthetics lasting approximately 2 h or less.
Comparison of 5 mg tetracaine diluted in 1 ml, 2 ml and 4 ml of 10% glucose for spinal anesthesia
Authors: GAGGERO G. , VAN GESSEL E. , FORSTER A. , GOSTELI P. , GAMULIN Z.
Published: January 2009

The influence of variations in the volume of injectate when maintaining an identical dose of a hyperbaric local anesthetic has not previously been investigated when performing spinal anesthesia. This study compares spinal anesthesia of 5 mg of lyophilized tetracaine diluted in 1 ml, 2 ml or 4 ml of 10% glucose in 45 elderly patients undergoing elective hip surgery. While supine and horizontal, each patient received double–blind one of the three solutions through a catheter inserted 4 cm into the intrathecal space at the L2–L3 or L3–L4 interspace. No difference in the anesthetic effects was found between the three groups. The median value of the maximal sensory level was T6 (range T3–L2), T4 (range T3–T9) and T5 (range T3–T11) in the 1–ml, 2–ml, and 4–ml groups, respectively. The number of patients with a motor blockade of grade 2 or 3 was 12/ 15, 14/15 and 13/15, and the time from the initial dose to the need for the first top–up dose (mean ± s.d.) was 88 ± 35 min, 75±15 min and 68 ±x 15 min for the 1–ml, 2–ml and 4–ml groups, respectively. Hemodynamic changes were also comparable between the three groups. The authors conclude that in elderly patients, undergoing spinal anesthesia while supine and horizontal, variations in volume from 1 to 4 ml do not influence the characteristics of hyperbaric spinal anesthesia while injecting an identical dose of local anesthetic.
Efficacy of epidural blood patch for postdural puncture headache
Authors: TAIVAINEN T. , PITKÄNEN M. , TUOMINEN M. , ROSENBERG P. H.
Published: January 2009

This prospective investigation was conducted to evaluate the efficacy of different volumes of epidural blood patch (EBP) for treatment of postdural puncture headache (PDPH) in 81 consecutive patients. In the first part of the investigation (Study part I), 10 ml of blood was injected for EBP in 28 patients. In the second randomized part of the investigation (Study part II), the patients were allocated to receive for EBP either 10 ml (27 patients) or 10–15 ml (26 patients), according to the height of the patient. The procedure was considered initially successful if PDPH disappeared completely during the 2–h recovery room follow–up. To evaluate the long–term success, a questionnaire was mailed to all patients. The EBP performed 3.7± 2.9 days following the dural puncture was initially successful in 88–96% of the patients in the different study groups. In the questionnaire, only 50–68% of the patients reported that PDPH had disappeared immediately without recurrence. In 16–36% of the patients the PDPH returned at lesser intensity and in 14–17% PDPH was reported to have continued, disappearing gradually in all patients. Despite this, 87% of all patients were satisfied with the EBP treatment. There were no statistically significant differences between the groups. The results indicate that a larger, height–adjusted volume of blood for EBP in adults does not produce a better effect on PDPH compared to a standard 10–ml volume. Despite the excellent initial effect (91%) seen in our patients, a permanent effect of the blood patch was only achieved in 61%.
Early and late recovery after major abdominal surgery. Comparison between propofol anaesthesia with and without nitrous oxide and isoflurane anaesthesia
Authors: Kalman S. H. , Jensen A. G. , Ekberg K. , Eintrei C.
Published: January 2009

A comparison was made between early and late recovery after major abdominal surgery under intravenous anaesthesia with propofol (with and without nitrous oxide) or inhalational anaesthesia with isoflurane. Sixty patients were randomly allocated to one of three forms of anaesthesia: propofol, propofol/nitrous oxide, or isoflurane/nitrous oxide anaesthesia. All received fentanyl and vecuronium. Recovery was monitored during the first 2 h after extubation and on days 1, 2, 3, 7 and 30 after surgery. Every 30 min during the first 2 postoperative hours, the Steward recovery scale, sedation, orientation, collaboration, and comprehension were assessed by a blinded observer. Psychomotor function was evaluated by computerised simple reaction time and finger tapping speed in 32 patients. A scale of symptoms and mood check list were filled in by 35 patients on days 1, 2, 3, 7 and 30. The preoperative values for all tests were collected 1–4 days before surgery. The time between end of surgery and extubation was longer in the propofol group, but early and late recovery of psychomotor function were similar in the three groups. Patients anaethetised with isoflurane reported more vegetative symptoms than those who received propofol (P < 0.03). The addition of nitrous oxide to propofol did not change the reported degree of symptoms. The difference in vegetative symptoms between groups was most obvious on day 7. Patients anaesthetised with propofol reported better subjective control (P < 0.02) and were more socially oriented (P < 0.05) than patients anaesthetised with isoflurane. We conclude that early recovery was similar in the three groups. Patients anaesthetised with propofol reported fewer late symptoms and better mood after operation than those anaesthetised with isoflurane. The addition of nitrous oxide did not affect the results.
Diclofenac for pain relief after arthroscopy: a comparison of early and delayed treatment
Authors: Sandin R. , Sternlo J.‐E. , Stam H. , Brodd B. , Björkman R.
Published: January 2009

The effect of diclofenac on pain after arthroscopy of the knee joint was investigated in 64 patients. The aim of this double‐blind, placebo‐controlled, randomised study was to compare administration before surgery with delayed treatment. The effect on postoperative pain was evaluated by means of a Visual Analogue Scale and recording of the need for additional analgesics postoperatively. After surgery, hourly assessments were performed within 6 h after the anaesthetic block (approximately 5 h after start of surgery), and on the morning after surgery. Both treatment with diclofenac before surgery and delayed treatment were superior to placebo concerning pain scores within 6 h after onset of anaesthesia (P < 0.0065 and P < 0.0005, respectively). On the morning after surgery, only delayed treatment was superior to placebo (P < 0.02). No differences in pain scores were evident between the different groups treated with diclofenac. No differences in the need for additional analgesics were found.
Management of a giant intracranial aneurysm using surface‐heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion. A case report
Authors: Jolin Å. , Edén E. , Berggren H. , Roos A. , Essen C. von , Stephensen H. , Hedström A. , Karlsson H. , Lindholm‐Fransson L. , Ricksten S.‐E.
Published: January 2009

Extracorporeal circulation with controlled hypothermic low flow perfusion was introduced during the surgical treatment of a patient with a giant intracranial aneurysm of the anterior communicating artery. Heparin‐coated equipment (Carmeda Bio‐Active Surface; CBAS) was utilized, thus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blood flow through the circuit was kept at 4.5 1/min during normothermia. Core cooling, in combination with external surface cooling, was performed for 30 min to a temperature of 18d̀C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blood flow was minimized to 0.4 1 · min‐1, equilibrating central and peripheral blood pressures to approximately 5–10 mmHg (0.65–1.3 kPa). Reper‐fusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36d̀C following 150 min. The patient could be weaned off the extracorporeal circulation with minimal inotropic support. The postoperative course was uneventful apart from a left‐sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weaned off the ventilator after 6 days. He recovered and the hemiparesis regressed slowly.
Comparison of two fentanyl doses to improve epidural anaesthesia with 0.5% bupivacaine for caesarean section
Authors: Halonen P. M. , Paatero H. , Hovorka J. , Haasio J. , Korttila K.
Published: January 2009

Ninety women undergoing elective caesarean section under epidural anaesthesia were double blindly randomised into three groups to receive either 2 ml of saline or 50 or 100 μg of fentanyl in 2 ml volume added to 0.5% bupivacaine. Both doses of fentanyl intensified the epidural anaesthesia and reduced patient discomfort during the operation. In both fentanyl groups the epidural blockade more often reached the 5th thoracic segment (P = 0.0258), the patients had significantly less pain (P = 0.0256), needed less intravenous diazepam medication during the operation (P = 0.0005) and the operating conditions were better when compared to the saline group (P = 0.0416). There was no difference between the groups in the condition of the neonates as assessed by the Apgar score and cord blood pH. The postoperative time until treatment for pain was requested by the patients was more than 1 h longer in the fentanyl groups, but there was no difference in the total amount of postoperative analgesics needed during the first 24 h when compared to the saline group. Mild pruritus not requiring treatment was more common in fentanyl groups than in the saline group (P = 0.0187). The results suggest that 50 μg of fentanyl added to 0.5% bupivacaine increases patient comfort and improves the quality of epidural anaesthesia for caesarean section, and that adding 100 μg does not give further advantage.
Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure
Authors: Sjøgren P. , Dragsted L. , Christensen C. B.
Published: January 2009

Myoclonic spasms occurred in a patient suffering from renal failure after high doses of continuous intravenous morphine (100 mg/h). The concentrations of morphine, morphine‐6‐glucuronide and morphino‐3‐glucoronide (μmol/l) in plasma were: 1.93, 52.06 and 381.8, and in cerebrospinal fluid were: 1.02, 5.86 and 61.82, respectively. The role of morphine and morphine glucuronides in myoclonic spasms is discussed.
Effects of 2‐, 4‐ and 12‐hour fasting intervals on preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis in children
Authors: Maekawa N. , Mikawa K. , Yaku H. , Nishina K. , Obara H.
Published: January 2009

We evaluated 105 randomly‐selected unpremedicated children aged 1 14 years to determine the effects of a 2‐, 4‐ and 1 2‐h preoperative fasting interval on the preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis. Each child undergoing elective surgery ingested a large volume (approximately 10 ml/kg b.w.) of apple juice and then fasted for 2, 4 or 12 h before the estimated induction of anaesthesia. After induction of anaesthesia, gastric fluid was aspirated through a large‐bore, multiorifice orogastric tube. Plasma concentrations of glucose, total ketone bodies, non‐esterified fatty acid (NEFA), triglycerides, and cortisol were measured at the lime of induction to evaluate the fasting interval effects on preoperative plasma glucose and lipid homeostasis. There were no significant differences between the three groups in either gastric fluid volume or pH. In addition, there were no significant differences between the groups with respect to the proportion with a pH < 2.5 and volume > 0.4 ml/kg b.w. Neither plasma concentrations of glucose, triglycerides, nor cortisol at the time of anaesthetic induction differed between the three groups. Both 4 and 12 h nil per os (NPO) caused an increase in lipolysis, which was presumably a compensatory mechanism to maintain normoglycaemia. The plasma NEFA and total ketone bodies concentrations were therefore significantly higher in these two fasting intervals than in 2 h NPO. These data suggest that a 2‐h NPO, after a large volume of ingested apple juice, may offer additional benefits by preventing an increase in lipolysis during the lasting interval without either increasing the volume of gastric fluid or decreasing the gastric pH. However, we must emphasize that these limited results should not be extrapolated either to infants or to the general population.
Monitoring of neuromuscular transmission by electromyography (II)
Authors: Engbæk J. , Skovgaard L. T. , Fries B. , Kann T. , Viby‐Mogensen J.
Published: January 2009

The feasibility of the compound electromyogram (EMG) was evaluated during onset and recovery from pancuronium block in the tibialis anterior muscle of ten cats. The evoked EMG area, amplitude and duration of the total response and of the major negative deflection were evaluated and compared to the mechanomyogram during 0.1 Hz and train‐of‐four (TOF) stimulation. EMG areas and amplitudes were found to be linearly and similarly related to the mechanomyogram during onset and recovery. Slopes of the regression lines ranged between 1.00–1.02 and between 1.10–1.22 during onset and recovery, respectively, with high individual correlation coefficients (>0.95). The TOF ratio of the mechanomyogram was linearly related to the EMG TOF ratio during onset and to the square root of the EMG TOF ratio during recovery, with no differences between EMG areas and amplitudes, suggesting a higher initial recovery of the TOF ratio of the mechanomyogram during recovery. EMG duration increased as the level of block increased but was unsuitable for neuromuscular monitoring. Evaluation of the agreement between the two methods showed that the EMG may be from 15% below to 10% above the mechanomyogram during onset and from 40% below to 45% above the mechanomyogram during recovery, in spite of high correlation coefficients. In contrast, agreement between EMG parameters was found to be high. In conclusion, EMG is more reliable than the mechanomyogram for evaluation of neuromuscular transmission in the cat. EMG amplitudes and areas both reflect the degree of neuromuscular blockade equally well
Brain energy metabolism and blood flow during sevoflurane and halo thane anesthesia: effects of hypocapnia and blood pressure fluctuations
Authors: Fujibayashi T. , Sugiura Y. , Yanagimoto M. , Harada J. , Goto Y.
Published: January 2009

The effects of halothane and sevoflurane on cat brain energy metabolism and regional cerebral blood How (rCBF) were evaluated during normo‐ and hypocapnia. Brain energy status was evaluated with phosphorous nuclear magnetic resonance spectroscopy (31P‐MRS) and rCBF was measured by the hydrogen clearance method. A high concentration of halothane (3 MAC) impaired brain energy metabolism, while even a higher concentration of sevoflurane (4 MAC) had no untoward effect on brain energy metabolism. At 3 MAC of halothane, there were measurable decreases in brain phosphocreatine (69% of the control) and increases in brain inorganic phosphate (about 250% of control Pi), even though CBF was about 70% of the control value. During hypocapnia, the phosphocreatine levels began to decrease at a Paco2 of 2.7 kPa with 2 MAC of sevoflurane (90% of the control), and at a Paco2 of 4.0 kPa with 2 MAC of halothane (92% of the control). rCBF had decreased to less than 50%) of the control value when Paco2 was ≤2.7 kPa with 2 MAC of sevoflurane and ≤4.0 kPa with 2 MAC of halothane. Abnormal brian energy metabolism was only observed when rCBF was decreased to less than half of the control (non‐anesthetized and normocapnie) value. Following administration of a vasopressor, metaraminol, the abnormal brain energy metabolism induced by 2 MAC of halothane at a Paco2 of 1.33 kPa was normalized in parallel with the improved rCBF values. We conclude that hyperventilation and fluctuating blood pressure contribute to the occurrence of abnormal brain energy metabolism during halothane and sevoflurane anesthesia. This is more pronounced with halothane than with sevoflurane. The hypocapnia‐induced abnormality during exposure to 2 MAC of either agent was due to decreased CBF associated with low perfusion pressure, indicating that there was no direct effect of these anesthetics on cerebral energy metabolism.
Technical problems with 32‐gauge microcatheters in continuous spinal anaesthesia
Authors: Standl T. , Beck H.
Published: January 2009

Technical problems with microspinal catheters for continuous spinal anaesthesia (CSA) are not unknown. The present case report deals with two unusual technical complications in CSA with 32‐gauge spinal catheters. The first case shows a catheter with extraordinary elongation due to breakage of the embedded stylet. The second case shows a tear in the extracorporeal part of the catheter with leakage of the local anaesthetic and consequently failed spinal anaesthesia.
Fluid therapy in burns
Authors: Onarheim H
Published: January 2009

Abstract: The dissertation evaluates changes in transcapillary fluid and protein balance in the initial phase after extensive burns, comparing the effects of different regimens for post‐burn fluid resuscitation.

Studies were performed in anaesthetized rats and sheep. Within 15 min after major thermal injury, cardiac output (CO) was reduced by 40–50%, mainly due to a reduced stroke volume. Mean arterial pressure (MAP) also dropped by 30–40 mmHg. Both lactated Ringer's and plasma improved this postburn circulatory impairment.

Rapid bolus infusions of small volumes of very hypertonic saline, 7.5% NaCl (2 400 mosmol/1), have rapidly corrected the circulatory impairment in haemorrhagic shock. Following a rapid bolus infusion of 7.5% NaCl in 6% Dextran 70, CO and MAP were completely restored, but the effect only lasted 30–60 min. When administered by a slow infusion, 7.5% NaCl gave no circulatory improvement.

The transcapillary colloid‐osmotic gradient was maintained in injured skin following infusion of plasma, whereas it was almost annihilated by infusion of lactated Ringer's. Plasma infusion thus induced a protein‐rich edema in injured skin, whereas lactated Ringer's resulted in a generalized edema.

Increased interstitial fluid flux can mobilize the interstitial matrix protcoglycan hyaluronan. Following burn injury, plasma concentrations of hyaluronan increased up to ten times above baseline. This observation suggests that at least some of the degradation of structural connective tissue components in thermally injured skin is by lymphatic removal (and subsequent degradation in liver). Increased plasma concentrations of interstitial components have not previously been observed after thermal injury.
Physiological aspects of vascular endothelial cell interactions in hypertension and atherosclerosis
Authors: HARRISON D. G.
Published: January 2009

Hypertension causes a number of alterations of the coronary circulation which may influence the outcome of anaesthesia and surgery. These include changes in the architecture of the coronary vasculature, and impairments in coronary reserve and autoregulatory ability of the coronary microvasculature during decreases in perfusion pressure. Chronic hypertension may also alter endothelial regulation of vascular control. Many of the vasodilators used to treat hypertension may have unique effects on the coronary circulation which may become modified by chronic hypertension and cardiac hypertrophy. In this review, each of these areas are considered together with some unique aspects of endothelial/vascular smooth muscle interactions as they relate to acute and chronic hypertension, and to the pharmacological agents used in the treatment of hypertension.
Isradipine: a profile in essential hypertension
Authors: HANSSON L.
Published: January 2009

Isradipine is a new dihydropyridine–derived calcium antagonist. It possesses marked vascular selectivity, resulting in a powerful vasodilating action, whereas, in practical terms, it is devoid of cardiac effects. The usefulness of isradipine in the treatment of arterial hypertension is well documented, both when used as single–drug treatment and in combination with other agents, particularly beta–blockers. Isradipine is well tolerated and does not negatively affect quality of life or capacity for physical exercise. It does not cause metabolic disturbances and, apart from the typical dihydropyridine–type vascular side–effects, specifically, flushing and ankle oedema, there are no specific adverse effects. Even ankle oedema is apparently relatively rare with this compound. Studies in animal models show that isradipine has a potent antiatherosclerotic effect, and a brain tissue–preserving effect after experimental stroke, in doses that are relevant for antihypertensive treatment. If such results can be confirmed in humans, they will undoubtedly be of great clinical importance.
Haemodynamics and tissue specificity with isradipine
Authors: LESLIE J. B.
Published: January 2009

The significant effects of isradipine in producing arterial vasodilatation and mild negative chronotropic effects without significant negative inotropic effects suggests that this agent should provide excellent antihypertensive efficacy in the treatment of perioperative hypertension. Isradipine may prove to be a safe antihypertensive treatment in patients with impaired ventricular function (cardiac failure), impaired myocardial perfusion (ischaemia), and in cases of selected conduction abnormalities or arrhythmias. The demonstration that its effects are limited to vascular resistance rather than vascular capacitance is an important distinguishing feature of isradipine compared with other antihypertensive agents. Finally, the potential application of this dihydropyridine calcium antagonist for cytoprotection and its effects on atherosclerosis remain exciting therapeutic prospects.
Isradipine and the coronary circulation
Authors: FENECK R. O. , UNDERWOOD S. M. , WALESBY R. K.
Published: January 2009

Isradipine has been shown to be an effective vasodilator in different vascular beds. Experimental evidence suggests that isradipine is a potent coronary vasodilator, and this is supported by clinical studies in both cardiology and cardiac surgery. Furthermore, in these studies, coronary vasodilatation was not accompanied by evidence of any significant effect on cardiac contractility or conduction. It can be concluded that the cardiac effects of isradipine will ultimately prove to be beneficial in patients undergoing myocardial revascularization.
A randomized comparative study of the electrophysiological and electrocardiographic effects of isradipine vs verapamil
Authors: TULLO N. G. , LANDAU S. , GOLDMAN I. , COUTINHO N. , SOMBERG J.
Published: January 2009

Isradipine is a new dihydropyridine calcium antagonist reported to have minimal effects on cardiac electro–physiology. Of 19 patients with normal cardiac electrophysiological profiles, 11 received isradipine intravenously at doses of 0.0010, 0.0020, 0.0040 and 0.0080 mg–kg‐1 (0.0150 mg–kg‐1 total dose), and eight received verapamil intravenously at 0.0125, 0.0250, 0.0500 and 0.1000 mg–kg‐1 (0.1875 mg–kg‐1 total dose). One patient experienced hypotension several minutes after receiving the third isradipine dose. With isradipine, systolic blood pressure (BP) decreased from 154 ± 24 to 151 ± 22, 143 ± 25, 133 ± 19 and 124 ± 17 mmHg, respectively. Diastolic BP decreased from 83 ± 10 (baseline) to 80 ± 12, 76 ± 10, 74 ± 7 and 68 ± 9 mmHg, respectively. With verapamil, systolic BP changed from 132 ± 20 (baseline) to 135 ± 29, 132 + 24, 130 ± 25 and 115 ± 17 mmHg, respectively, and diastolic BP changed from 80 ± 14 to 84 ± 14, 81 ± 9, 78 ± 6 and 73 ± 5 mmHg, respectively. Isradipine had no significant effect on the PR, QRS, QT and QTc intervals, nor were there changes in the atrial–His (AH) and His–ventricle (HV) intervals, atrioventricular nodal effective refractory period, Wenckebach cycle length or sinus node recovery time. Similarly, verapamil at the doses studied did not significantly affect PR, QRS, QT, QTc, AH or HV intervals. However, with verapamil, the Wenckebach cycle length changed significantly from 394 + 82 (baseline) to 448 ± 93 ms. Despite the significant fall in BP with isradipine, heart rate did not change significantly. These results support the electrophysiological neutrality of isradipine on the cardiac conduction system.
Comparative study of isradipine and sodium nitroprusside in the control of hypertension in patients following coronary artery–bypass surgery
Authors: LAWRENCE C. J. , LESTRADE A. , CHAN E. , LANGE S. DE
Published: January 2009

Essential hypertension is a common occurrence after coronary artery bypass–graft surgery (CABG) and may lead to postoperative complications. In an open randomized study, either isradipine or sodium nitroprusside was given by infusion to 27 postoperative CABG patients who had a mean arterial pressure (MAP) greater than 100 raraHg. Both agents were able to achieve reductions in MAP to 80 – 90 mmHg quickly and safely, although the effects of isradipine at the dosage used were apparent sooner and gave smoother control than with sodium nitroprusside. There were two non–responders with the latter agent. Systemic vascular resistance fell and cardiac output increased in patients in both treatment groups. Also, an increase in heart rate was observed with both agents, although this increase was smaller with isradipine. In conclusion, isradipine appears to be a useful agent in the treatment of hypertension following CABG surgery and may have some advantages over sodium nitroprusside.
Amelioration of respiratory and circulatory changes in established endotoxic shock by ketoprofen
Authors: SIGURDSSON G. H. , YOUSSEF H.
Published: January 2009

In an intensive–care setting we studied the effects of ketoprofen, a dual inhibitor of cyclooxygenase and lipoxygenase, on circulatory and respiratory changes during established endotoxic shock in sheep. Two groups (n = 7 in each) were exposed to E. coli endotoxin, which caused a sharp increase in pulmonary artery pressure (200%; PAP), intrapulmonary shunt fraction (300%; Qs/QT%), and oxygen extraction ratio (50%; Vo2/ Do2%). There was also a significant decrease in mean arterial pressure (25%; MAP), respiratory compliance (60%; CT), arterial oxygen tension (65%; Pao2), and oxygen delivery index (15%; Do2) in both groups. After 30 min of endotoxin infusion, group K received ketoprofen, 2.5 mg/kg b.w. i.v., while group E served as shock controls. After 4 h there had been a significant improvement in MAP, Pao2, Do2, Qs/QT%, and CT in the ketoprofen–treated group compared with the controls (P < 0.01). In addition, the oxygen extraction ratio normalised in group K, but remained 70–100% increased in group E (P < 0.01). The wet–to–dry weight ratios of the lungs and the liver were significantly lower in the ketoprofen–treated group compared with the controls (P <0.05). It was concluded that ketoprofen significantly ameliorated the respiratory and circulatory effects of established endotoxic shock in sheep.
Effect of nitrous oxide and volatile anaesthetics on platelet function in man
Authors: NYGÅRD E. , NAESH O. , HINDBERG I. , VALENTIN N.
Published: January 2009

Twelve otherwise healthy male volunteers scheduled for arthroscopy of the knee were studied. The influencein vivoof nitrous oxide (N2O)per seand the addition of a halogenated volatile anaesthetic (halothane or isoflurane) on ADP–induced platelet aggregation and release of beta–thromboglobulin into plasma was evaluated. All measurements were made before surgery. We found that N2O increased platelet aggregation. Adding a halogenated anaesthetic reversed the relative hyperaggregation induced by NaO. The concentrations in plasma of the platelet release product beta thromboglobulin were not influenced by the anaesthetics.