bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypoxic Pulmonary Vasoconstriction in Man: Effects of Hyperventilation
Authors: BINDSLEV L. , JOLIN‐CARLSSON Å. , SANTESSON J. , GOTTLIEB I.
Published: January 2009

The pulmonary vasoconstriction response to hypoxia was studied in eight anaesthetized supine subjects. One lung was made hypoxic while the other was ventilated with 100% oxygen. This was achieved by separating the tidal gas‐distribution to the lungs by means of a double‐lumen tracheal catheter. The hypoxic pulmonary vasoconstriction (HPV) response was estimated from the blood flow diversion away from the hypoxic lung. Blood flow distribution between the lungs was calculated from the regional expired carbon dioxide production, assuming regional carbon dioxide production to be proportional to blood flow. The subjects were studied during six different conditions. Firstly, when ventilated with 100% oxygen to both lungs at a Paco2 of about 6 kPa. Secondly, with 100% oxygen to the left lung and 5% oxygen in nitrogen to the right (test) lung. The ratio between carbon dioxide output from right and left lung was calculated. These measurements were repeated during two states of hyperventilation (Paco2 of about 4.5 kPa and 3.5 kPa, respectively) with and without hypoxia (conditions 3–6). During normoventilation, blood flow distribution between the lungs was equal. During hypoxia, blood flow distribution to the hypoxic lung decreased by 35% of the prehypoxic value. Furthermore, a decrease in arterial oxygen tension from 51.5 ± 4.5 to 11.5 ± 2.1 kPa was observed. During excessive hyperventilation (Paco2 3.2 ± 0.2 kPa), blood flow distribution to the hypoxic right lung decreased by only 10% of its prehypoxic value. A further decrease in arterial oxygen tension to 8.5 ± 1.8 kPa was observed. This decrease in Pao2 was possibly due to an increased venous admixture caused by an abolished HPV response. It is concluded that hyperventilation counteracts hypoxic pulmonary vasoconstriction in man.
Fistula Formation following Epidural Catheter:A Case Report
Authors: WANSCHER M. , RIISHEDE L. , KROGH B.
Published: January 2009

A case of fistula formation following epidural catheterisation is presented. The diagnosis and treatment of epidural abscesses are discussed.
Effects of Epidural Analgesia on Plasma Catecholamines and Cortisol in Parturition
Authors: Neumark J. , Hammerle A. F. , Biegelmayer CH.
Published: January 2009

To assess the effect of epidural block on plasma catecholamines and cortisol during labour and delivery, plasma epinephrine, norepinephrine and cortisol levels were determined in 26 healthy parturients, all of whom delivered vaginally (18 received an epidural block, eight had meperidine 50 mg intramuscularly). We found a significant drop of plasma epinephrine and cortisol and no significant reduction of plasma norepinephrine l h after administration of epidural block compared to preblock values. Observing the data during the whole course of labour in correlation with cervical dilatation, in the control group, where the parturients received meperidine, all hormones rose progressively up to the moment of delivery. One hour after delivery the catecholamines returned to normal levels; cortisol returned more slowly. In the epidural group the increase of plasma epinephrine and cortisol was significantly inhibited but not that of norepinephrine.
Effect of Aspiration of Cerebro‐Spinal Fluid on Spinal Anaesthesia with Isobaric 0.5% Bupivacaine
Authors: Pitkänen M. , Tuominen M. , Asantila R. , Rosenberg P. H.
Published: January 2009

The effect of changing the volume of cerebro‐spinal fluid (CSF) before spinal anaesthesia with 3 ml of isobaric 0.5% bupivacaine was investigated in 60 elderly (58–77 years) orthopaedic or urological patients. The patients were randomly allocated to three groups. They received the spinal anaesthetic either with or without the aspiration of 3 ml of CSF. In the third group a mixture of 3 ml of aspirated CSF and 3 ml of 0.5% isobaric bupivacaine was given. Pin‐prick analgesia and motor block were tested during the induction and recovery. The only statistically significant difference between the groups was in the time‐lag from administration to maximum spread of pin‐prick analgesia, which was shortest in the group without aspiration (mean 19.5 min, other groups 29–30 min). The mean maximum level of analgesia was T6‐T7 in each group. The anaesthesia was satisfactory in most cases. One death occurred because of a massive pulmonary embolism. The clinical significance of aspirating CSF before attempting spinal anaesthesia with 3 ml of 0.5% isobaric bupivacaine was found to be small.
Effects of Fentanyl on Local Cerebral Blood Flow in the Rat
Authors: Safo Y. , Young M. L. , Smith D. S. , Greenberg J. , Carlsson C. , Reivich M. , Keykhah M. , Harp J. R.
Published: January 2009

Fentanyl reduces the cortical cerebral blood flow and metabolic rate for oxygen in rats, though seizure activity occurs in some animals at high doses. However, the effects of fentanyl on blood flow and metabolism in subcortical structures have not been clearly delineated. The present study examines the effects of intravenous fentanyl (100 or 400 μg·kg‐1) on local cerebral blood flow (1‐CBF) in paralyzed, mechanically ventilated rats. Rats ventilated with 70% N2O in 30% O2 served as controls. Local CBF was measured using 14C‐iodoantipyrine and autoradiography. Blood pressure, Pao2, Paco2, pH, and temperature were comparable in all groups. The EEG showed slow wave activity in most animals given 100 μg·kg‐1 fentanyl while seizure activity occurred in all animals given 400 μg·kg‐1 fentanyl. With 100 μg·kg‐1 fentanyl, CBF tended to be depressed in all cortical and subcortical areas, except the peri‐aqueductal gray; and with 400 μg·kg‐1 fentanyl, 1‐CBF tended to be elevated (compared to 100 μg·kg‐1 fentanyl) in most areas of the brain. The limbic system structures, however, were most affected by 400 μg·kg‐1 fentanyl with statistically significant increases (compared to the 100 μg · kg‐1 group) in 1‐CBF of 86% and 67% respectively in the amygdala and septal nucleus. These results confirm that moderately high doses of fentanyl which cause slow wave activity on the EEG also depress 1‐CBF in rats; moreover, doses of fentanyl that produce seizure activity produce increases in 1‐CBF in most cerebral structures with greatest effects on limbic system 1‐CBF.
The Influence of Plasma Volume Expanders on Initial Haemostasis in the Rabbit Mesentery
Authors: Bergqvist D.
Published: January 2009

An experimental study was undertaken to evaluate the effect of dose (1 and 2 g/kg b. w.) and molecular weight (40 000, 70 000, 110 000 and 500 000 daltons) of dextran on primary haemostatic plug formation in the rabbit mesenteric microcirculation. All experiments were made 3 h after the infusion of the different substances. Albumin and hydro‐oxyethyl starch treatment was used for control plasma volume expansion and did not influence arteriolar and venular haemostasis as compared with saline. Dextran gave a prolonged haemostatic plug formation time with increasing dose and with increasing molecular weights. Clinically relevant doses of dextran 40 and 70 (1 g/kg b. w.) did not influence haemostatic plug formation time.
Assessment of the Presynaptic Effect of Atracurium: Train‐of‐Four and Tetanic Stimulation in in Vitro Preparations
Authors: Wali F. A.
Published: January 2009

The present experiments were designed to study the effect of atracurium on the contractile responses produced by repetitive motor nerve stimulation and by depolarizing drugs in frog, chick and rat skeletal muscle‐nerve preparations, using electrophysiological and neurochemical techniques. The presynaptic effect of atracurium was assessed using train‐of‐four (2 Hz) and tetanic stimulation (50 Hz) in isolated chick and rat neuromuscular junctions. A further measure of the presynaptic effect of atracurium was examined by studying its effect on the uptake of labelled choline, 3H‐methylcholine, in the control preparations. The effect of atracurium on postjunctional contractile responses of the chick isolated biventer cervicis skeletal muscle was studied using cholinergic drugs such as acetylcholine and tetraethylammonium. The results indicated that in addition to its postjunctional competitive and non‐depolarizing blocking effect, atracurium may have a prejunctional inhibitory action at the neuromuscular junction. Atracurium reduced all the contractile responses produced by both electrical and chemical stimulation.
Malignant Hyperthermia Triggered by Heating in Anaesthetized Pigs
Authors: Ørding H. , Hald A. , Sjøntoft E.
Published: January 2009

Three malignant hyperthermia susceptible (MHS) and three normal Danish landrace pigs were heated using a water‐heated mattress, warm blankets and warm intravenous saline during anaesthesia with barbiturate and 50% nitrous oxide in oxygen. The MHS pigs developed typical malignant hyperthermia (MH) at a rectal temperature of 41.0 ± 0.7°C, whereas the normal pigs tolerated heating to the same temperature without any ill effects. Haemodynamic and metabolic findings during MH were similar to those previously reported for anaesthetic‐induced MH in pigs. Heat intolerance may thus be one factor in the genesis of MH.
Increased Thiopental Sensitivity in Cardiac Patients
Authors: Christensen J. H. , Andreasen F. , Jansen J. A.
Published: January 2009

The average dose of thiopental necessary for induction was 3.4 mg/kg body weight in seven patients on long‐term therapy with digoxin and a diuretic and 4.7 mg/kg body weight in seven matched control patients (P<0.05). The initial volumes of distribution (V1) did not differ significantly. The amounts of thiopental redistributed (removed from V1) during the induction were calculated as V1 × k12 × c1 and V1 × k13 × c1, where k12 and k13 are the rate constants describing the drug transfer from V1 to V2 and V3 and c1 the computer‐calculated average thiopental concentration in V1 during the initial 40 s of the induction period. There was no evidence of a lower amount being removed during the induction in the cardiac patients. The intravascular drug concentration at the time of sleep was expressed as the average of the arterial and the venous sleep concentrations. In the cardiac patients the average of that value was 20.1 μg/ml and in the control patients 30.2 μg/ml (P<0.05). It is concluded that the lower dose requirement in the cardiac patients was caused at least in part by a higher cerebral sensitivity to the drug.
A Hemodynamic Profile Diagram and Its Application in Septic Patients
Authors: Hesselvik F. , Carlsson C. , Brodin B. , Jorfeldt L. , Schildt B.
Published: January 2009

A physiologic profile is presented in the form of a circular diagram, in which hemodynamic parameters, oxygen uptake and arterial lactate are displayed on 12 radial spokes. Results are presented as per cent of reference values. In the normal state the profile will be evenly circular, while different circulatory disturbances present typical patterns. This is shown in serial measurements on 12 septic patients, who displayed increases in cardiac output, oxygen metabolism, stroke volume, heart rate, pulmonary artery pressure, right atrial pressure, pulmonary capillary wedge pressure and arterial lactate, while pulmonary and systemic vascular resistances were decreased. Stepwise multiple regression analysis indicated that systemic vascular resistance was the best early discriminator between survivors and non‐survivors. The hemodynamogram offers a compact and easily understood presentation of data, which makes it possible to follow the course of the disease and provides a diagnostic and didactic tool.
Effect of Subcutaneous Salbutamol on Postoperative Pulmonary Function in Patients Undergoing Elective Cholecystectomy
Authors: Adelhøj B. , Petring O. U. , Larsen J. C. , Bigler D. R. , Andersen J. B.
Published: January 2009

In a double‐blind study, 14 patients underwent elective cholecystectomy. The patients were randomly allocated to two groups of seven to receive either s.c. salbutamol 0.5 mg or placebo 0.5 mg immediately before extubation and every 6 h for 48 h. In the placebo group there was a significant reduction in mean arterial oxygen tension of seven patients 3, 27 and 51 h after surgery (P = 0.006, P = 0.01 and P = 0.02) compared with the mean value before operation. The reduction in mean arterial oxygen tension in the group receiving salbutamol was not significant 3 h after surgery (P = 0.13), whereas the reduction was significant 27 and 51 h later (P = 0.01 and P = 0.02) compared with the mean value before operation. Mean arterial oxygen tension was significantly higher in the salbutamol group than in the placebo group 3 h after operation (P = 0.03), whereas it was not significant 27 and 51 h later (P = 0.48 and P = 0.55). Mean spirometric values showed significant reductions 27 and 51 h after operation in both groups compared with the pre‐operative measurements. Smaller insignificant differences were found between the salbutamol and placebo groups 27 and 51 h after operation. However, mean FEV1 in the salbutamol group 51 h after operation was 22% higher in comparison with the placebo group. Our results suggest that salbutamol may reduce postoperative hypoxaemia during the first few hours after the operation, but not later on.
Effects of Hyperventilation and Hypoventilation on Stress‐Induced Intestinal Vasoconstriction
Authors: Winsö O. , Biber B. , Martner J.
Published: January 2009

The combined effects of defined changes in ventilation and stress‐induced vasoconstriction were studied in the intestinal vascular bed in cats (n = 20) anaesthetized with fentanyl, nitrous oxide and diazepam. Intestinal reflex vasoconstriction was induced by stimulation either of the hypothalamic defence‐alarm area or of somatic and visceral pain afferents. The volume‐controlled ventilation was changed by altering the tidal volume, and stimulations were performed during either control conditions (Paco24.5–5.0 kPa), hyperventilation (Paco23.0–3.5 kPa) or hypoventilation (Paco26.5–7.5 kPa). The increase in intestinal vascular resistance (IVR) elicited by defence‐alarm area stimulation was potentiated during hyperventilation (306 ± 83% vs 198 ± 62%;P<0.01) and attenuated during hypoventilation (176 ±62 % vs 240 ± 44%;P<0.05). The increase in IVR elicited by pain fibre stimulation was potentiated during hyperventilation (73 ± 21% vs 54 ± 19%;P<0.01), but not significantly changed during hypoventilation (47 ± 19% vs 68 ± 34% during control ventilation). Our data indicate that the ventilatory pattern can be decisive for the vasoconstrictor response during experimental stress. We suggest that remote neurogenic mechanisms account for the increased responsiveness during hyperventilation. The decreased responsiveness during hypoventilation, on the other hand, seems to correlate with the local vasodilator effects of carbon dioxide.
Portable Emergency Ventilators: 2. Sensitivity to Environment
Authors: Dahlgren B. E. , Nilsson H. G. , Peters B. , Skedevik C.
Published: January 2009

Three compact ventilators (Oxylog®, Maxaman® and Pneupac 2®), commercially available in Sweden, were subjected to tests concerning sensitivity to environmental stress. The ventilators functioned very well at temperatures above 0°C. The Oxylog apparatus was very sensitive to subzero temperatures. It also had a spectrum of resonance frequencies when subjected to vibration testing that restricts its use outside the sheltered hospital environment. The Maxaman and Pneupac 2 in the modified version withstood the tests in a reliable way. The shock tests performed had no negative effects on any of the ventilators or their functions.
The Influence of Isoflurane on Blood Flow in Coronary Bypass Grafts
Authors: ÖHqvist G. , Settergren G. , Ekeström S. , Brodin L. Å.
Published: January 2009

The effects of isoflurane on graft blood flow, central hemodynamics and ECG were evaluated in 20 patients during coronary artery surgery in the period immediately after cardiopulmonary bypass (CPB). Intravenous anesthesia with thiopentone, diazepam, fentanyl (continuous infusion), droperidol and pancuronium supplemented with nitrous oxide was used before, and thiopentone and fentanyl were used during CPB. A first measurement of graft flow was performed during fentanyl infusion and the patients were randomly allocated to a control (n= 10) and a study (n= 10) group. In the study group isoflurane was administered in a dose that reduced systolic arterial blood pressure (SAP) to approximately 100 mmHg (13.3 kPa) (inspired concentration 0.5–1.5%) and a second measurement was performed after 30 min. In the control group the infusion of fentanyl was continued. Isoflurane reduced graft blood flow from 52 ± 5 (mean and s. e. mean) to 40 ± 5 ml × min‐1 (P<0.01) concomitant with reductions in SAP, cardiac index, stroke index, left ventricular stroke work index and power index, while these parameters as well as graft flow remained unchanged in the control group. Isoflurane did not produce any change in the degree of ischemia as judged from the ECG. A high blood flow in recently established coronary artery bypass grafts is essential for the prevention of early graft occlusion; therefore the graft‐flow‐reducing effect of isoflurane has to be taken into consideration when evaluating different anesthetic regimens in the period after CPB.
A Controlled Study on the Effect of Epidural Analgesia with Local Anaesthetics and Morphine on Morbidity after Abdominal Surgery
Authors: Hjortsø N. C. , Neumann P. , Frøsig F. , Andersen T. , Lindhard A. , Rogon E. , Kehlet H.
Published: January 2009

A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low‐dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4‐S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P<0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. The incidence of deep venous thrombosis (125I‐fibrinogen scan) was 32% after general anaesthesia and low‐dose heparin and 34% after epidural analgesia with no prophylactic antithrombotic treatment (P>0.9). Postoperative weight loss and decrease in serum‐albumin and serum‐transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self‐aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the abovementioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
Serum Concentrations and Urinary Excretion of Lidocaine and its two Desethylated Metabolites after Spinal Anaesthesia using Lidocaine or Lidocaine with Phenylephrine
Authors: Lindberg R. , Kanto J. , Hovi Viander M. , Laurikainen E.
Published: January 2009

In 13 patients undergoing transurethral prostatic resection under spinal anaesthesia with heavy lidocaine or with heavy lidocaine plus phenylephrine hydrochloride, the serum concentrations of lidocaine, monoethylglycinexylidide and glycinexylidide and their renal excretion were measured with a HPLC method. Seven patients were given lidocaine alone 1.25 mg/kg and six lidocaine 1.25 mg/kg mixed with phenylephrine hydrochloride 3 mg. There was no significant difference between the two groups either in the serum levels of lidocaine or in the renal excretion rate of lidocaine and its metabolites. This finding gives support to the opinion that phenylephrine in low doses has no prolonging effect on spinal anaesthesia performed with heavy lidocaine.
A Porcine Model of Early Adult Respiratory Distress Syndrome Induced by Endotoxaemia
Authors: Borg T. , Alvfors A. , Gerdin B. , Modig J.
Published: January 2009

To study the pathophysiology of early adult respiratory distress syndrome (ARDS) induced by sepsis, spontaneously breathing pigs under ketamine anaesthesia were investigated. Twenty animals were infused i. v. with E. coli endotoxin (10 μg · h‐1 · kg‐1) over 6 h, and ten control animals received physiological saline. In the controls, cardiac output (Qt) and O2 delivery decreased slightly. There were no changes in pulmonary gas exchange, pulmonary haemodynamics or extravascular lung water (EVLW). The polymorphonuclear (PMN) leucocyte count gradually increased, while the platelet count decreased slightly. Endotoxin infusion caused profound deterioration of pulmonary gas exchange, a marked rise in pulmonary vascular resistance (PVR) and a moderate increase in EVLW. The pulmonary dysfunction was not attributable to the pulmonary oedema per se, whereas a “dry” ventilation/perfusion inequality played an important role. The “responders” (peak venous admixture >20%; n = 14) were characterized by higher Qt and lower PVR than the “nonresponders”. Qt declined progressively, especially in non‐survivors. O2 delivery decreased considerably. Metabolic acidosis probably indicated oxygen deficit. Eleven of 20 animals died during the observation period. Mortality was related more to the imbalance between O2 delivery and oxygen demand than to the deterioration in pulmonary gas exchange. The PMN count decreased markedly while the gradual decline in platelet count was similar to that in the controls. Lung microscopy revealed PMN accumulation in the microvasculature, moderate interstitial oedema and microvascular blood stasis. Our porcine model, which closely mimics early ARDS in man, will be useful in further studies of the pathophysiological pathways and the treatment of this syndrome.
An Oesophageal Thermal Tube for Rewarming in Hypothermia
Authors: Kristensen G. , Gravesen H. , Benveniste D. , Jordening H.
Published: January 2009

Five dogs were cooled externally with ice‐bags to rectal temperatures of 21.8–24.8°C. Rewarming was performed with a specially constructed double‐lumen oesophageal tube with circulating water at 42°C. With this device, rewarming of the dogs to 30°C took place in 60–102 min (mean 82 min). Up to a temperature of 31 °C (the “cardiac safety temperature”), the rise in blood temperature was 4.5°C/h ± 0.79 (s. d.). Calculation of a “rewarming efficiency index” showed an inverse relationship between surface area and temperature rise per hour. The efficiency of this rewarming method is comparable to that of peritoneal dialysis. No afterdrop in temperature was observed and there were no other complications during these experiments. Rewarming with an oesophageal thermal tube is very simple and safe to use.
Circulatory Changes during High Thoracic Epidural Anaesthesia ‐ Influence of Sympathetic Block and of Systemic Effect of the Local Anaesthetic
Authors: Wattwil M. , Sundberg A. , Arvill A. , Lennquist C.
Published: January 2009

Circulatory changes during high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of echocardiography and systolic time intervals. The subjects also underwent a physical work test with bicycle ergometry. To evaluate the systemic effect of the local anaesthetic (bupivacaine), the same subjects were investigated 3 weeks later when a corresponding dose of the local anaesthetic was injected intramuscularly instead of epidurally. On the first occasion, after baseline measurements an epidural catheter was inserted at T4 level and 5 ml of 0.5% bupivacaine were injected. This volume led to sensory block within dermatomes T1‐T5. On the second occasion all subjects received 8 ml of 0.5% bupivacaine intramuscularly. Heart rate (HR) and systolic blood pressure decreased during TEA, both at rest and during exercise. Following i. m. injection, HR decreased at rest but remained unchanged during exercise. The systolic blood pressure was not affected but the diastolic blood pressure increased during the exercise test. After administration of TEA, stroke volume (SV) decreased 22% and cardiac output (CO) 33%. Following i. m. injection of bupivacaine, SV decreased 8% and CO 20%. The pre‐ejection period/left ventricular ejection time ratio increased 23% during TEA and 16% after i. m. injection. The results indicate that the circulatory changes did not seem to be caused entirely by the cardiac sympathetic block, but were due partly to the systemic effect of bupivacaine.
Resolution of Bronchospasm by Atropine: Report of a Case
Authors: Berger J. M. , Stirt J. A.
Published: January 2009

A case of bronchospasm during general anesthesia is presented in which atropine appeared to reverse bronchoconstriction, after high halothane concentrations, intratracheal lidocaine, and isoproterenol i. v. had all proved ineffective. This case illustrates a rational approach to the treatment of bronchospasm during anesthesia, based on determination of the most likely site of origin of bronchoconstriction within the tracheobronchial tree.
The Consequences of a Cavalier Approach to Central Venous Catheterization
Authors: Hoshal V. L.
Published: January 2009

A cavalier approach on the part of some physicians, and poor research on the part of some equipment manufacturers, has made central venous catheterization more dangerous to the patient than it need be. Here, the relationship between these factors is discussed, with special reference to the fact that central venous catheterization is an invasive surgical operation which should not be taken lightly by its practitioners.
Design and Use of Double Lumen Right Atrial Catheters in Bone Marrow Transplant Recipients
Authors: Petersen F.B. , Clift R. , Buckner C.D. , Sanders J.E. , Hickman R. , Meyers J.
Published: January 2009

Bone marrow transplant recipients require central venous catheterization for a variety of fluids. They are also particularly susceptible to infection. Here we discuss the use of double lumen catheters to reduce the number of invasions necessary. We make particular reference to infection, neutropenia, prophylactic antibiotics, additional catheters, and presence of graft vs host disease.
“Half‐Way” Venous Catheters
Authors: Curelaru I. , Gustavsson B. , Wojciechowski J. , Zachrisson B. F. , Hultman E. , Linder L.E.
Published: January 2009

In order to develop a “half‐way” venous catheter for clinical use, anthropometric (n = 200), radiographic (n = 101), and phlebographic (n = 44) investigations were undertaken to determine the lengths, diameters, and morphology of the basilic and cephalic veins from fossa cubiti to the lateral edge of the first rib. The lengths of basilic and cephalic veins varied from 25 to 45 cm, exceeding 40 cm in approximately 5% of cases. Catheter lengths to be inserted were correlated (“r” = 0.6–0.7) with body heights, accurately estimated by 1/5 of the body height (cm) plus 2 cm for the basilic vein, and 4 cm for the cephalic vein. The cephalic veins have small proximal end diameters (mean = 6 mm), and present terminal arches of 2–3 cm. These are connected by a rich anastomotic network to the superficial cervical veins. The basilico‐axillary courses are regular with gradually increasing diameters (mean = 16 mm), but in some observations, with the arms maximally abducted, the axillary veins presented accentuated folds. With these considerations, we recommend the insertion of the “half‐way” catheters by basilic approach with the patient's arm in 90d̀ abduction. The axillosubclavian length (mean = 18.5 cm) ensures wide limits for accurate placement of the “half‐way” catheter tips when a basilic approach is used. Further, their large diameters (16–19 mm) make flotation of the soft catheters probable.
“Half‐Way” Venous Catheters
Authors: Linder L. E. , Wojciechowski J. , Zachrisson B. F. , Curelaru I. , Gustavsson B. , Hultman E. , Bylock A.
Published: January 2009

“Half‐way”, Secalon‐Seldy®, soft venous catheters, 40 cm long, were inserted by basilic (n = 90) and cephalic (n = 31) veins at the fossa cubiti in 121 patients (71 men and 50 women) aged between 19 and 88 years whose heights varied from 152–197 cm. The inserted catheter lengths approximated 1/5 of the patient's height. Sixty‐five per cent of 106 radiologically investigated catheter tips were located proximally in the axillary veins, and 34% distally in the subclavian veins. The duration of catheterization varied from 1 to 44 (mean 9±7) days (x ±1 s.d). Perfect function was recorded in 93 of 121 catheters. No serious, but some minor complications were registered such as temporary interruption of infusion flow with movements of the arm (n = 12), partial or total catheter occlusion (n = 16), leakage of the infusate at the insertion site (n = 1), and pain along the vein during infusion (n = 2). Five patients (4%) developed thrombophlebitis 2‐.10 days after insertion. Pull out phlebographies at catheter withdrawal (4–35 days after insertion) were performed in 36 patients. Radiological thrombi were small and similar to those recorded in another 53 phlebographies of “long‐way” brachial catheters of similar stiffness. Neither local infection nor episodes of sepsis were registered over a period of 1,081 catheter days. “Half‐way” catheters proved able to take over all the functions of both peripheral and central venous catheters, lacking the frequent complications (phlebitis and infection) of the former, and the serious mechanical complications (pneumothorax, vein perforations, and injuries of the ductus thoracicus, nerves, arteries, and heart) of the latter.
Complications of Central Venous Catheterization of the Subclavian Vein: The Influence of a Parenteral Nutrition Team
Authors: Jong P. C. M. De , Meyenfeldt M. R. Von , Rouflart M. , Wesdorp R. I. C. , Soeters P. B.
Published: January 2009

Early and late complications of central venous catheterization were investigated in 488 consecutive catheters, 389 introduced in the subclavian vein by a percutaneous puncture technique, 84 by a cut down technique of the cephalic vein, and 15 by a peel away technique. Care and introduction of the catheters was controlled by the parenteral nutrition team in 239 cases.

Immediate and late complications were found using both the puncture and venous cut down techniques, but immediate complications differed in the two groups due to the different methods of insertion.

The rate of catheter related sepsis (CRS) did not differ significantly when the group under control of the nutrition team was compared with the group without nutritional control (5.9 vs. 6%). The rate of CRS was 1 CRS/220.7 days of therapy in the puncture group and 1 CRS/342.2 days of therapy in the venous cut down group. Catheter tips and blood were cultured from both CRS and non‐CRS patients, and the micro‐organisms identified.

Catheters were withdrawn, under supervision of the nutrition team, for a number of reasons including death, thrombosis, and technical problems, but suspicion of CRS accounted for a high percentage of withdrawals (18% in the puncture group, 16.6% in the venous cut down group). It is suggested that, when CRS is suspected, removal of the catheter should be delayed until all other possibilities have been investigated.
Central Venous Catheter Sepsis: The Experience of the Istituto Nazionale Tumori of Milan
Authors: Bozzetti F.
Published: January 2009

The pathogenesis of sepsis of central venous catheters has been studied. Catheter exchange is a useful and effective technique for the treatment of sepsis.
Traditions of Therapy in the Nordic Countries ‐ Norway The Back‐ground for Fluid and Electrolytes Substitution in Surgery
Authors: NESBAKKEN RAGNAR
Published: January 2009

The historical background for present day intravenous fluid therapy in Norway is described. The official Norwegian standard for such fluid is commented.
Which Carbohydrates Should We Recommend for Intravenous Nutrition?
Authors: HESSOV IB
Published: January 2009

In a short review solutions of glucose, fructose and invertose have been compared in regard to proteinsparing effects, side effects and infusion rates. It is concluded that fructose alone offers no advantage to glucose neither in the normal nor in the stressed organism. Compared with pure glucose and fructose solutions, higher amounts of carbohydrate can be administered as invertose, without increasing the risk of side effects.
Rationale for the Use of Colloids in the Treatment of Shock and Hypovolemia
Authors: HALJAMÄE H.
Published: January 2009

The question, “Are colloids or crystalloids to be preferred for resuscitation in hypovolemic shock conditions?” is detailed in this review. The effects of these two types of fluid regimes on restitution of circulating blood volume, interstitial rehydration, microvascular blood flow, cellular metabolic recovery and on the incidence of systemic complications such as adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and multiple organ failure are considered. Colloid containing solutions seem superior to crystalloids due to efficient reexpansion of circulating blood volume and enhancement of capillary blood flow. Resuscitation times and thereby the cellular hypoxic insult are considerable reduced while at the same time the formation of excessive tissue oedema is prevented. Colloids do not seem to adversely affect pulmonary function. Dextran has considerable advantages over other types of colloids for the initial shock treatment due to its antithrombotic properties whereby cell aggregability is prevented and the incidence of systemic complications (microembolism syndromes) is convincingly reduced.
Hospital Experience of Total Parenteral Nutrition with 3‐litre Containers (Big Bags)
Authors: MUTH LIISA
Published: January 2009

A system for total parenteral nutrition (TPN) with a 3‐litre container (big bag) has been developed. The bag is filled by a pharmacist in the hospital pharmacy. One of four standard nutritional regimes can be chosen depending on the patients weight and estimated metabolic condition. The bags contain aminoacids, electrolytes, trace elements and energy in the form of glucose. Lipids with vitamins are given separately via a side port and not mixed into the bags.

During one year 61 patients have been given a total of 846 bags. All patients, except for two, maintained or increased their body weight during TPN with the big bag system. However, almost all patients lost weight when TPN was exchanged for enteral or oral feeding. S‐phosphate was initially low but normalized within one week in all patients. S‐magnesium was low in 1/3 of the patients and remained low in 50% of those for the entire treatment period. S‐calcium increased beyond the normal upper limit in 25% of the cases. S‐albumin increased in all patients, except for those with metastasizing cancers. Fifteen positive cultures were obtained from big bags. Only in one patient, however, the same bacteria could be cultured from both the patient and the big bag. Some increase in infections related to central venous catheters was noticed. Better utilization due to increased amount of potassium, magnesium, phosphate and zinc compared to routine may be beneficial.
Pulmonary blood flow reduction by prostaglandin F2αand pulmonary artery balloon manipulation during one‐lung ventilation in dogs
Authors: SCHERER R. , VIGFUSSON G. , LAWIN P.
Published: January 2009

The purpose of this experimental study was to compare two methods of pulmonary blood flow manipulation during one‐lung ventilation (OLV), either reducing pulmonary blood flow to the non‐ventilated lung by inflation of a pulmonary artery catheter balloon (PAB) or by infusion of prostaglandin F2α(PGF2α). Seven anaesthetized dogs were intubated with a Kottmeier endobronchial tube and ventilated with 66% O2. Systemic and pulmonary pressures and blood gases, cardiac output and airway pressure were measured, and the venous admixture (Qsp/Q) was calculated. During two‐lung ventilation (TLV) Pao2was 43.6 1.9 kPa (mean s. d.) and (Qsp/Q) was 11 3%. OLV reduced Pao2to 12.1 1.6 kPa (P0.001) and increased Qsp/Q to 40 4% (P0.001). Mean pulmonary artery pressure and airway pressure increased. PAB inflation caused an increase in Paosb>2to 19.9 2.9 kPa (P0.02) and a decrease in Qsp/Q to 27 6% (P0.001). PGF2αinfusion (1.2 μg kg‐1min‐1) into the pulmonary artery of the non‐ventilated lung increased Pao2to 22.4 3.3 kPa (P0.001) and decreased Qsp/Q to 254 (P0.001). PGF2αinfusion resulted in a small increase in mean systemic and pulmonary artery pressures. During the infusion of 1.2 μg kg‐1min‐1of PGF2αno signs of bronchoconstriction were observed. PAB inflation and PGF2αinfusion were equally effective in improving oxygenation and reducing venous admixture during OLV. PGF2αinfusion is proposed as a practical and safe alternative to PAB inflation when application of PEEP or oxygen to the non‐ventilated lung during OLV is impractical or impossible.
The effect of intranasally administered nitroglycerin on the blood pressure response laryngoscopy and intubation in patients undergoing coronary artery by‐pass surgery
Authors: DICH‐NIELSEN J. , HOLE P. , LANG‐JENSEN T. , OWEN‐FALKENBERG A. , SKOVSTED P.
Published: January 2009

The effect of intranasally administered nitroglycerin (NTG) on the cardiovascular response to laryngoscopy and intubation was studied. Thirty patients scheduled to undergo coronary artery by‐pass surgery under thiopentone, enflurane and pancuronium anaesthesia were randomly divided into three groups. Group I received lignocaine 1.5 mg/kg i. v. prior to laryngoscopy and intubation (control group). Group II received lignocaine 1.5 mg/kg i. v. and in addition 2 mg nitroglycerin (NTG) was given intranasally. Group III received only 2 mg NTG intranasally. In Group I laryngoscopy and intubation caused a significant increase in mean arterial pressure (MAP) (P<0.01), heart rate (HR) (P<0.01) and rate pressure product (RPP) (P<0.01) compared to preoxygenation values. In Group II and III MAP and RPP remained unchanged, whereas HR increased (P<0.01 and P<0.01 respectively). It can be concluded that intranasally administered NTG effectively attenuates the pressor response to laryngoscopy and intubation in patients presenting for coronary artery by‐pass surgery and that it is a more effective and convenient method than intravenous lignocaine.
Alfentanil anaesthesia in gall‐bladder surgery
Authors: RÆDER J. C. , HOLE A.
Published: January 2009

Five different dosage schemes for alfentanil administration supplemented with thiopentone, pancuronium and N2O/O2 have been studied in 25 patients undergoing elective cholecystectomy. Six patients in the high dosage group experienced stiff chest during induction and five patients developed respiratory arrest on the recovery ward. The effects of the different schedules in blocking the surgical stress response have been elucidated by serial measurements of serum cortisol and glucose, heart rate and systolic blood pressure. There were no significant changes in serum cortisol, heart rate and blood pressure during anaesthesia and surgery in any group. All patients showed a significant increase in serum cortisol 2 h postoperatively. There was significant elevation of serum glucose after 1 h of surgery in two groups (maintenance dose 1 μg/kg/min of alfentanil) and in all groups except one (maintenance dose 3.0 μg/kg/min) 2 h postoperatively. High dosage of alfentanil resulted in frequent stiff chest during induction and respiratory arrest postoperatively. High dosage did not seem to give any additional benefits in blocking the surgical stress response in this type of surgery.
Effect of induced hypotension on serum concentrations of atropine after intramuscular administration
Authors: PIHLAJAMÄKI K. , HOVI‐VIANDER M. , KANTO J.
Published: January 2009

The serum concentrations of atropine after a single intramuscular injection of 0.01 mg/kg were determined by radioimmunoassay in nine general surgical patients during and after a combination anaesthesia and compared with those of 13 neurosurgical patients operated on during induced hypotensive anaesthesia (sodium nitroprusside plus trimetaphan). Surprisingly, comparable serum levels were found in both patient groups. We conclude that this kind of induced hypotension cannot be used as a model of drug absorption in such clinical situations as cardiac failure, haemorrhage or anaphylactic drug reactions.
Midazolam‐fentanyl anesthesia for major surgery. Plasma levels of midazolam during prolonged total intravenous anesthesia
Authors: NILSSON A. , TAMSEN A. , PERSSON P.
Published: January 2009

The water‐soluble benzodiazepine midazolam was used along with fentanyl and pancuronium in a totally intravenous anesthetic technique for hysterectomies. Midazolam was given as a 0.3 mg kg‐1 bolus dose followed by constant rate infusion of 0.25 mg kg‐1 h‐1. Plasma midazolam concentrations were measured during the anesthesia. The technique provided excellent conditions for surgery, with pulse rate and blood pressure under good control and without any recall of the peri‐operative period. A disadvantage was early respiratory depression, which necessitated administration of naloxone to make extubation possible. This was attributed to the proportionally large amount of fentanyl used. Drowsiness during the first postoperative hours was also pronounced.
Effects of dobutamine on renal function in normal man
Authors: WESTMAN L. , JÄRNBERG P.‐O.
Published: January 2009

The effects of graded doses of dobutamine on renal function were studied in eight male volunteers. The infusion rates were 2.5, 5 and 10 μg/kg/min. Systolic blood pressure increased by 19% (P<0.01), 31% (P<0.01), and 44% (P<0.01), respectively, while diastolic blood pressure decreased by 17% (P<0.02), 17% (P<0.02) and 25% (P<0.01), respectively. Heart rate increased at the highest dosage by 32%, (P<0.01). Glomerular filtration rate (GFR) diminished at all three infusion speeds by 10% (P<0.02), 9% (P<0.05) and 14% (P<0.02), respectively, while renal blood flow (RBF) was unchanged. Urine flow rate (UF) decreased by 36% (P<0.05) and fractional free water clearance (CH2O/CIn) diminished by 37% (P<0.05) at the rate of 10 μg/kg/min. Fractional potassium excretion (CK/Cin) decreased by 34% (P<0.01) and 44% (P<0.01) at the two highest rates. Fractional sodium excretion (CNa/CIn) and fractional chloride excretion (CCl/CIn) were unchanged. Catecholamine levels were unaltered. Plasma renin activity (PRA) rose significantly (P<0.05) at the highest infusion rate of dobutamine. It is concluded that dobutamine influences GFR, the clinical significance of which, however, is difficult to evaluate.
Cardiac effects of thoracic epidural morphine caused by increased vagal activity in the dog
Authors: HOTVEDT R. , REFSUM H.
Published: January 2009

This study was carried out in order to investigate possible side‐effects of thoracic epidural morphine on cardiac electrophysiology, haemodynamics and metabolism. In pentobarbital‐anaesthetized dogs, intracardiac conduction times were determined by His bundle electrography, and refractoriness by programmed electrical stimulation; monophasic action potential recordings were obtained from the right ventricle by the suction electrode technique. Cardiac output, left ventricular and aortic blood pressures were measured, as well as plasma concentrations of morphine, free fatty acids, glycerol, glucose and lactate. Thoracic epidural morphine (0.12 mg‐kg‐1) reduced spontaneous heart rate, prolonged atrioventricular nodal conduction time and refractoriness, and reduced left ventricular dP/dt max. Bilateral vagotomy reversed these effects. Intraatrial, His Purkinje and intraventricular conduction times, atrial and ventricular refractoriness and action potential duration, stroke volume and mean aortic blood pressure, as well as the metabolic variables, were not significantly influenced by thoracic epidural morphine with or without vagotomy. Peak plasma morphine levels of 12–25 ng‐ml‐1 were measured 10 min after morphine injection. In conclusion, this study demonstrates depressive side‐effects of epidural morphine on cardiac function, mediated by an increased vagal activity.
Skeletal muscle oxygen pressure fields during controlled hypotension with adenosine and sodium nitroprusside A comparative study in the rabbit
Authors: TORSSELL L. , SOLLEVI A. , THORBORG P. , LUND N.
Published: January 2009

The MDO (Mehrdraht Dortmund Oberfläche) multiwire oxygen electrode was used for studies of oxygen pressure fields in eight rabbit skeletal muscle preparations during controlled hypotension with adenosine and sodium nitroprusside (SNP). Tissue oxygen histograms were constructed from 120 simple tissue oxygen pressures (PtO2) samples that were collected during 5 min. Statistical analysis between histograms was performed with the two‐sample Kolmogorov‐Smirnov test. Mean arterial blood pressure was reduced to 60 mmHg with both drugs, corresponding to a 42–43% reduction during the 25‐min hypotension period. SNP‐induced hypotension caused significant reduction of muscle oxygenization (compared to normotensive controls) in six of the animals, while this occurred on three occasions during adenosine administration. When comparing the histograms during hypotension, the tissue oxygenation during adenosine infusion was higher than during SNP in five and equal to SNP in three animals. Low tissue oxygen pressure values (0‐0.6 kPa) were four times more frequent during SNP than during adenosine hypotension, although systemic arterial oxygen pressures were unaffected. We conclude that controlled hypotension with adenosine preserves tissue oxygen pressures better than hypotension induced by SNP.
Premedication with oral and rectal diazepam
Authors: RAVNBORG M. , HASSELSTRØM L. , ØSTERGÅRD D.
Published: January 2009

It has been postulated that esophageal retention of diazepam tablets is a problem of clinical significance, and that rectal administration is an advantageous alternative. To test this hypothesis, 100 patients were randomly allocated to premedication with either 15 mg diazepam orally or 10 mg diazepam as a rectal solution. A double dummy technique was used. A sedative effect was seen in 23 (50%) of the patients premedicated by mouth (O‐group), but only in eight (20%) of those premedicated rectally (R‐group) (P<0.05). Four patients (9%) in the O‐group and seven (18%) in the R‐group were unacceptably anxious before induction (n. s.). The plasma concentrations in the tablet group were nearly twice the concentrations found in the rectal‐solution group, but no correlation between premedication effect and plasma concentration was found. Timing of premedication was very inaccurate, and this favored oral administration because of a more prolonged effect. No evidence of persistent esophageal retention was found.
Intravenous regional anaesthesia for foot surgery
Authors: DAVIES J. A. H. , WALFORD A. J.
Published: January 2009

Intravenous regional anaesthesia, confined to the distal lower limb and using bupivacaine 0.25%, was studied in 12 patients undergoing orthopaedic procedures to the feet. The technique was well accepted by both surgeons and patients and was free from serious toxicity. Bupivacaine was demonstrated in the systemic venous circulation in every case prior to surgery, whilst the tourniquet remained inflated. The plasma bupivacaine levels were less than that associated with toxicity, except in one case exhibiting signs of minor toxicity (bupivacaine plasma level 1.99 μg/ml‐1). Reasons for the leak in spite of a well‐conducted technique are discussed.