bluuebunny/crossref_metadata_2025 huggingface dataset:
Precurarization with Vecuronium and Pancuronium in Awake, Healthy Volunteers: The Influence on Neuromuscular Transmission and Pulmonary Function
Authors: ENGBÆK J. , HOWARDY‐HANSEN P. , ØRDING H. , VIBY‐MOGENSEN J.
Published: January 2009

The influence of pretreatment with pancuronium and vecuronium on the neuromuscular transmission was compared in 24 healthy, awake, non‐premedicated volunteers using train‐of‐four (TOF) nerve stimulation and measurement of respiratory frequency, vital capacity, inspiratory force and peak expiratory flow (PEF). The subjects were randomly allocated to one of three groups. Each subject received one dose of pancuronium and one dose of vecuronium: Group I pancuronium 0.01 mg/kg and vecuronium 0.005 mg/kg; Group II pancuronium 0.01 mg/kg and vecuronium 0.01 mg/kg and Group III pancuronium 0.01 mg/kg and vecuronium 0.015 mg/kg intravenously. The median TOF ratio decreased significantly in Groups I and II following both pancuronium and vecuronium. The TOF ratio following vecuronium in Group II was significantly lower compared to the TOF ratio following vecuronium in Group I. Only PEF decreased significantly in Group I following pancuronium and in Group II following both pancuronium and vecuronium. There was no significant difference between Group I and Group II regarding the number of subjects with signs or symptoms of partial neuromuscular blockade. Following vecuronium 0.005 mg/kg, one subject was unable to swallow and the twitch height decreased to 0.25. In Group II one subject was unable to lift her head and had difficulty in swallowing following pancuronium 0.01 mg/kg. Only four subjects entered Group III because of an unacceptably high frequency of signs and symptoms of partial neuromuscular blockade and a decrease in median TOF ratio to 0.64 following vecuronium. The subjects felt it difficult to swallow, and one subject could just sustain head lift for 10 s following vecuronium 0.015 mg/kg. It is concluded that vecuronium in dose levels up to 0.01 mg/kg only causes minor changes in neuromuscular transmission and pulmonary function. Increasing the dose of vecuronium to 0.015 mg/kg is followed by an unacceptably high frequency of signs and symptoms of partial neuromuscular blockade.
Dose‐response Curves for Vecuronium during Halothane and Neurolept Anaesthesia: Single Bolus versus Cumulative Method
Authors: ØRDING H. , SKOVGAARD L. T. , ENGBÆK J. , VIBY‐MOGENSEN J.
Published: January 2009

The purpose of this study was to compare the incremental, cumulative dose method and the single bolus injection technique for construction of dose‐response curves for vecuronium. Dose‐response curves were determined in 77 patients divided into four groups according to the anaesthetic given and the method used for construction of dose‐response curves. The regression lines corresponding to the four dose‐response curves were found to be parallel. For vecuronium ED50 during neurolept anaesthesia was found to be 28 μg kg‐1 with the single bolus injection technique and 35.2 μg kg‐1 with the incremental, cumulative dose method (P<0.05). During halothane anaesthesia, ED50 was found to be 25.7 μg kg‐1 and 26.2 μg kg‐1, respectively (P>0.05). Potentiation of vecuronium by halothane was found with the cumulative method only. It is concluded that the incremental, cumulative dose method is not suitable for potency determinations of vecuronium.
Effects of Three Anaesthesia Methods on Haemodynamic Responses Connected with the Use of Thigh Tourniquet in Orthopaedic Patients
Authors: VALLI H. , ROSENBERG P. H.
Published: January 2009

Haemodynamic changes were studied in 51 patients undergoing orthopaedic surgery of the lower extremity, including exsanguination and thigh tourniquet for longer than 60 min. The patients were randomly divided into three anaesthesia groups: general anaesthesia (including enflurane), epidural anaesthesia (20 ml 0.5% bupivacaine) and spinal anaesthesia (3 ml 0.5% bupivacaine). During the study, five epidural and one spinal patient excluded from haemodynamic comparison required general anaesthesia because of pain from the surgery or ischaemia. In the general anaesthesia group, there was a rise in either systolic or diastolic arterial pressure of over 30% of the control value in 8/15 patients. In the spinal anaesthesia patients, there was a transient rise above 30% in only one patient out of 15 and no rise in the 15 epidural group patients. On the other hand, 11/15 of the epidural patients needed additional analgesics and/or sedation for pain or restlessness. The mean rise in the haemodynamic parameters including CVP was small on inflation of the tourniquet cuff; on deflation there was a mean decrease in CVP of 1–3 cmH2(0.1‐0.3 kPa), the maximum decrease being 8 cmH2O (0.8 kPa). The mean decrease in systolic arterial blood pressure ranged from 2 to 14 mmHg (0.27 to 1.87 kPa) when the cuff was deflated.
Comparison of Alfentanil and Fentanyl as Supplements to Induction of Anaesthesia with Thiopentone
Authors: HYNYNEN M. , KORTTILA K. , WIRTAVUORI K. , LEHTINEN A. ‐M.
Published: January 2009

In 120 premedicated patients undergoing general surgery, anaesthesia was induced with thiopentone 3 mg kg‐1, preceded by alfentanil 4.5, 9.0 or 13.5 μg kg‐1or fentanyl 1.5 μg kg‐1. The largest alfentanil dose attenuated the arterial blood pressure response to laryngoscopy and intubation better than the smaller doses of alfentanil. Changes in frontal muscle electromyogram or plasma cortisol and prolactin levels were not dependent on the adjuvant used. After thiopentone, 30, 7 and 17% of the patients given alfentanil 9.0 and 13.5 μg kg‐1and fentanyl 1.5 μg kg‐1, respectively, reacted to pinching of the lower abdomen. Patients given alfentanil 4.5 μg kg‐1did not tolerate the endotracheal tube after recovery from suxamethonium block and their heart rate was increased 12 min after alfentanil administration. We conclude that the antinociceptive effect of alfentanil is distinctly shorter than that of fentanyl. The analgesic potency of alfentanil is between one sixth and one ninth of that of fentanyl.
Sublingual Buprenorphine for Premedication and Postoperative Pain Relief in Orthopaedic Surgery
Authors: RISBO A. , JØOSRGENSEN B. CHRÆAEMMER , KOLBY P. , PEDERSEN J. , SCHMIDT J. F.
Published: January 2009

The effect of sublingual buprenorphine (Temgesic®) as a premedicant and for postoperative pain relief compared with morphine/pethidine was studied in 50 patients scheduled for elective surgery of the knee joint. Twenty‐five patients received buprenorphine 0.4 mg sublingually 1 h before surgery and the same dose on demand postoperatively. Twenty‐five patients were given morphine intramuscularly (7.5 mg or 10 mg to females and males respectively) 1 h preoperatively. This group received pethidine (75 mg) intramuscularly on demand postoperatively. All the patients were anaesthetized with halothane N2O/O2 after induction with thiopentone. No significant differences were found with regard to sedation, dizziness, nausea and vomiting during the study period. Emergence shivering, confusion and restlessness just after termination of the operation were equal in the two groups. In the recovery room, however, there was a higher frequency of shivering (P < 0.05) in the morphine group. During the first 24 h postoperatively the buprenophine group was given an average of 3.8 doses compared with 2.3 in the pethidine group (P >0.05). It is concluded, that buprenorphine sublingually is as good as morphine intramuscularly for premedication and therefore should be recommended to patients who wish to avoid injections. For postoperative pain relief the initial dose of buprenorphine should be given intravenously. Only minor and unimportant side effects were seen.
Sublingual Flunitrazepam for Premedication
Authors: HöUUTTEL M. S. , BANG U.
Published: January 2009

The clinical effects of a standard 2 mg flunitrazepam tablet given sublingually for premedication were evaluated in a group of 50 patients undergoing otorhinolaryngologic surgery. A comparable group of 49 patients received 10 mg of diazepam orally. The degree of sedation and anxiety was assessed objectively and subjectively before induction of anaesthesia. Flunitrazepam produced better sedation judged by the observer as well as by the patients. There was less anxiety in the flunitrazepam group but this was not statistically significant. Side effects were few and patient acceptability high. Sublingual premedication using flunitrazepam could be a useful alternative to other forms of premedication.
Hemorrheological Effects of Colloidal Plasma Substitutes Infusion A Comparative Study
Authors: GOTO Y. , SAKAKURA S. , HATTA M. , SUGIURA Y. , KATO T.
Published: January 2009

Our objective was to investigate experimentally the easily overlooked effect of the clinical use of colloidal plasma substitutes on tissue perfusion. The experimental animals were dogs, and the study was carried out using several independent rheological experimental methods. The following are the principal findings: 1) Based on the observations made under a microscope, the stability of blood suspensions was best maintained by dextran‐40 (Dex 40) and hydroxyethyl starch (HES0.55; Hespander®), both of which cause little rouleaux formation by erythrocytes. In addition, the electronegativity of the erythrocyte membrane was simultaneously elevated. 2) The blood viscosity was greatly affected by the hematocrit and the serum protein concentration. 3) At a high shear rate, the blood viscosity among these colloidal plasma substitutes showed no great difference after infusion; in contrast, at a low shear rate, the blood viscosity after infusion of Dex 40 or HES0.55 was lower than after other substitutes. 4) The ratio of the viscosity at a low shear rate to the viscosity at a high shear rate is more significant and useful as a clinical indicator. On the basis of the preceding findings, Dex 40 and HES0.55 were generally superior to the other substitutes, especially HES0.55.
The Role of Polymorphonuclear Leucocytes in the Pulmonary Dysfunction Induced by Complement Activation
Authors: BORG T. , GERDIN B. , HÄAULLGREN R. , MODIG J.
Published: January 2009

To determine the role of polymorphonuclear leucocytes (PMNs) in the pulmonary reaction induced by complement activation, pigs were infused with complement‐activated plasma (CAP), cell‐free supernatant from PMNs activated in vitro, or washed PMN aggregates produced in vitro. Infusion of CAP resulted in transient peripheral leucopenia, a reversible rise in pulmonary vascular resistance (PVR) and decreased arterial oxygen tension (Pao2). Indomethacin did not influence the CAP‐induced drop in PMN count or the accumulation of PMNs in the lung, but significantly counteracted the rise in PVR and fall in Pao2. Antihistamines did not prevent the cellular or pulmonary reactions to CAP infusion. Methylprednisolone did not inhibit the decrease in PMN count, but modified the pulmonary reaction to CAP, although it did not prevent the rise in PVR to the same extent as indomethacin; it counteracted the fall in Pao2. Infusion of supernatant from activated PMNs did not influence the PMN count, but caused a reversible increase in PVR and a drop in Pao2. Indomethacin counteracted the pulmonary reaction to this infusion. Infusion of washed PMN aggregates did not result in any cellular or physiological changes. These findings suggest that the pulmonary reaction induced by complement activation is mediated by humoral components generated and/or released during activation of PMNs. Arachidonic acid metabolites play an important role and it is likely that substance(s) released from activated PMNs trigger prostanoid synthesis in other cells. It is conceivable, however, that PMNs exposed to activated complement factors also directly synthesize and release arachidonic acid metabolites.
Isoflurane v Fentanyl for Outpatient Laparoscopy
Authors: Rising S. , Dodgson M. S. , Steen P. A.
Published: January 2009

Isoflurane and fentanyl have been compared as anaesthetic agents for outpatient laparoscopy. In 50 female patients anaesthesia was induced with thiopentone and maintained with nitrous oxide 66% in oxygen combined with either isoflurane 1–2% or fentanyl 0.3 mg according to a randomized list. Suxamethonium was used to facilitate intubation and for further muscle relaxation. Immediate recovery from anaesthesia was assessed by eye opening and time before giving the date of birth. Additional observations made hourly for 4 h were: nausea or vomiting; clinical assessment of wakefulness; psychic or motor agitation; antiemetic or analgesic drugs given; reaction time; respiratory depression. Immediate recovery was more rapid in the fentanyl group (P < 0.05). Reaction times in the isoflurane patients returned to control by 3 h, whereas the fentanyl patients were 10% slower than control at 4 h (P < 0.05 at 2 h, 3 h, 4 h). Nausea and vomiting were more frequent in the fentanyl group, and four of the fentanyl patients required naloxone. Both anaesthetic techniques provided satisfactory operating conditions, but isoflurane appeared to provide a better recovery with less side effects than fentanyl.
The Venturi Anaesthesia Circuit II Carbon Dioxide Production and Gas Flow Requirements
Authors: Christensen K. J. S. , Andersen A. P. D. , Jørgensen S.
Published: January 2009

Carbon dioxide production was measured in 20 adult patients undergoing alloplastic operation of the hip. Body weight ranged from 40 to 81 kg. Anaesthesia consisted of lumbar plexus block, i. v. diazepam, pethidine, pavulon and N2O/O2 under controlled ventilation. CO2 production was 2.13 ml kg‐1 min‐1 (interquartile range 2.09‐2.23). A fresh gas flow rate of about 30 ml kg‐1 min‐1 was required for the elimination of CO2 produced when using the Venturi system for inhalation anaesthesia.
The Venturi Anaesthesia Circuit III Carbon Dioxide Elimination
Authors: Andersen A. P. D. , Christensen K. J. S. , Jørgensen S.
Published: January 2009

The Venturi circuit was studied with regard to CO2 elimination in a model experiment. A mean concentration of 0.6% CO2 in the fresh gas supply to the patient was accepted. The experiments demonstrated that a sodalime charge of 200 g will cover the elimination requirements of CO2 in a Venturi circuit for any patient below 100 kg b. w. for a period of 3 h, while a soda‐lime charge of 300 g will suffice for 5 h. The utilization of the soda lime charge is of the same order of magnitude as that of the much larger canisters used in circle circuits. In the Venturi circuit, the size of the soda‐lime charge can be adjusted to suit the body weight of the patient and the expected length of the anaesthetic procedure. One soda‐lime charge for each anaesthetic procedure is preferable from the point of view of hygiene. The charge should not be less than 200 g.
Energy Expenditure on Breathing during Anaesthesia
Authors: Christensen K. J. S. , Andersen A. P. D. , Jøsrgensen S.
Published: January 2009

Measurements of carbon dioxide production were carried out on 20 patients undergoing arthroplastic operation of the hip joint, under halothane anaesthesia supplemented with lumbar plexus block. Compared to spontaneous respiration, the carbon dioxide production during controlled ventilation, with and without muscular relaxation, showed a decrease of 19% and 12%, respectively.
Effects of Mechanical Ventilation and Halothane on Pulmonary Serotonin Removal in Dogs
Authors: Tarkka M.
Published: January 2009

The type of anesthesia and anesthetic drug used may significantly change the capacity of the lungs to regulate blood concentrations of serotonin. This study was performed to examine the possible effect of mechanical ventilation and 1% halothane in ventilation air on pulmonary serotonin removal using C14‐ serotonin in eight dogs. Mechanical ventilation significantly increased serotonin removal when compared with spontaneous ventilation during anesthesia, the removal rates being 74.4% and 48.4%, respectively. The 1% halothane concentration in ventilation air did not significantly affect the pulmonary serotonin removal. It was concluded that mechanical ventilation protects the organism against harmful cardiovascular effects of serotonin during anesthesia.
Halothane‐Relaxant Anaesthesia in Elderly Patients
Authors: Tokics L. , Brismar B. , Hedenstierna G.
Published: January 2009

Twenty‐three elderly patients, scheduled for elective cholecystectomy, were studied during halothane‐relaxant anaesthesia. Anaesthesia was induced with thiopentone and maintained with halothane in 12 patients, six of whom had also received premedication. Eleven patients were anaesthetized with halothane, without thiopentone induction and with no premedication. Measurements of central haemodynamics were performed awake and during anaesthesia at end‐tidal halothane concentrations of 0.5 and 1.0%; at the lower concentration, measurements were also made after addition of nitrous oxide. Premedication and thiopentone had no influence on the subsequent halothane anaesthesia. Halothane caused reductions of cardiac index, mean arterial blood pressure and oxygen uptake. However, neither right atrial nor pulmonary capillary venous pressure increased and the arterio‐venous oxygen content difference decreased. These findings differ from those made by others in younger subjects and are probably attributable to a dose‐dependent reduction in systemic vascular resistance. The addition of nitrous oxide had only minor effects on central circulation. The results suggest that the age of the patients influences their reaction to halothane anaesthesia.
Bladder Function in Spinal Anaesthesia
Authors: Axelsson K. , Möllefors K. , Olsson J. O. , Lingårdh G. , Widman B.
Published: January 2009

Spinal anaesthesia with bupivacaine (22.5 mg) or with a glucose‐containing solution of bupivacaine (20 mg) or tetracaine (15 mg) was given to 21 patients allocated randomly to these three groups. A urodynamic study was performed by CO2 cystometry. It consisted of recording of first sensation of bladder filling, sensation of full bladder, strength of maximal detrusor contraction, bladder capacity and urethral pressure. At the same time, using a quantitative method for measuring muscle strength, the motor block was evaluated for three separate movements ‐ hip flexion, knee extension and plantar flexion of the big toe. After the spinal injection, the micturition reflex was rapidly blocked. One minute after the injection, eight patients experienced no strong desire to void when the bladder was overfilled, and 5 min after the injection bladder paralysis was present in most patients. The length of time from spinal injection to complete recovery of detrusor strength was 7–8 h and did not differ significantly between the three groups. The level of analgesia lay at or caudal to L5 when the detrusor strength returned. On the average, sensibility (pin‐prick) in the sacral segments returned simultaneously with or somewhat earlier than complete recovery of detrusor strength. The muscle strength in the lower limbs was fully restored 40–140 min, on average, before the detrusor strength had completely recovered. There was good correlation between the time of full restoration of hip flexion and detrusor strength in the bupivacaine groups. Urethral pressure was reduced by a mean of 48% and returned to normal either at the same time as or slightly before complete recovery of detrusor strength. The urine production during spinal anaesthesia with routine fluid therapy (ca. 300 ml/h) was so great that if the patient had not been catheterized there would have been a risk of over‐distension of the bladder. This should be kept in mind in patients receiving spinal anaesthesia with local anaesthetics that give motor block of long duration.
Metoclopramide Given Pre‐operatively Empties the Stomach
Authors: Adelhøj B. , Petring O. U. , Pedersen N. O. , Andersen R. D. , Busch P. , Vestergård A. S.
Published: January 2009

Sixty adult patients admitted for emergency major orthopedic surgery were studied according to a doubleblind, randomized design in order to evaluate if a single dose of 20 mg metoclopramide given intravenously at least 90 min before premedication could evacuate the stomach before anesthesia. Three patients were excluded. X‐ray examination following intake of barium sulfate before anesthesia showed 10 patients with a full stomach, all belonging to the placebo group. This study demonstrates significantly fewer (P< 0.002) patients with a full stomach before anesthesia after metoclopramide, indicating that administration of metoclopramide reduces the risk of aspiration of gastric contents to the lungs during anesthesia.
Vecuronium in Patients with and without Renal Failure
Authors: Orko R. , Heino A. , Rosenberg P. H.
Published: January 2009

Fifteen patients with and ten patients without renal failure (RF) were given vecuronium as the sole muscle relaxant during anaesthesia. RF patients were divided into two subgroups according to the daily diuresis (RF I, below 0.5 1/d; RF II, over 0.5 1/d). Vecuronium was given in small doses until the electromyographic twitch response showed 90% relaxation. The results showed great individual variations, and there were no statistically significant differences between the study groups in the parameters studied (ED90 dose, total consumption of the drug in mg kg‐1 min‐1, vecuronium plasma concentrations, twitch response) during induction and anaesthesia. After reversal of relaxation, the twitch response recovered more slowly in the RF I group than in the others (P<0.05). No complications occurred and it is confirmed that it is safe to use vecuronium as a muscle relaxant in patients with RF.
Basophil Histamine Release in Asthma Patients after in Vitro Provocation with Althesin and Etomidate
Authors: Guldager H. , Søndergaard I. , Jensen F. Molke , Cold G.
Published: January 2009

Our aim was to compare the histamine‐releasing effect of etomidate and Althesin® on basophil leukocytes from asthmatic patients and normal persons. Blood from eight asthmatic patients and six normal persons was tested for histamine release after in vitro provocation with etomidate and althesin. In the group of asthmatic patients there was a significantly higher histamine release after provocation with althesin than after provocation with etomidate at all concentrations (P<0.05, P<0.01, P<0.02). There was significantly higher histamine release for asthmatic patients than for normal persons after provocation with althesin at all concentrations (P<0.05, P<0.01, P<0.02). There was no difference between the asthma group and the normal group after provocation with etomidate. Data were analysed using Wilcoxon's and Mann‐Whitney's rank sum tests. We conclude that asthmatic patients may risk bronchospasm during induction of anaesthesia with althesin, and that etomidate may be a suitable intravenous anaesthetic for asthmatic patients.
Effect of a Small Dose of Droperidol on Nausea, Vomiting and Recovery after Outpatient Enflurane Anaesthesia
Authors: VALANNE J. , KORTTILA K.
Published: January 2009

Young, healthy outpatients (100) undergoing restorative dentistry and/or oral surgery under enfluranenitrous oxide‐oxygen anaesthesia were given 0.014 mg/kg of droperidol or a saline placebo i. v. in a doubleblind random fashion 5 min after induction of anaesthesia to prevent postoperative nausea and vomiting. Overall, less patients given droperidol were nauseated (18%) or vomited (7%) in comparison with patients given saline (27% and 11%, respectively). During the first postoperative hour, 4% of patients given droperidol were nauseated and 2% vomited, whereas 16% of patients given saline were nauseated and 6% vomited. Four patients given saline were not discharged from the clinic 1 h after anaesthesia owing to prolonged nausea and vomiting. The time elapsed until the patients were oriented as to time and place after cessation of enflurane and nitrous oxide administration was similar in both groups (mean±s. d., 13.5 ± 4.7 min). Thirty minutes after anaesthesia, the ability to walk on a straight line was significantly (P<0.001) worse in patients given droperidol as compared to patients given saline. After 60 min, only one patient given droperidol and four patients who received saline and vomited took side steps or were unable to walk. Psychomotor performance was significantly (P<0.05) better in a perceptual speed test both 30 and 60 min after anaesthesia in patients receiving saline as compared to those given droperidol. It is concluded that although droperidol is a less effective antiemetic after outpatient than after inpatient enflurane anaesthesia, small doses of droperidol may be used for outpatients prone to vomiting to prevent delayed discharge from the clinic due to prolonged vomiting.
Cardiovascular Effects of Enflurane and Asphyxia during Long‐Term Beta1‐Adrenoceptor Blockade
Authors: HENRIKSSON B.‐Å. , BIBER B. , HÄGGENDAL J. , LUNDBERG D. , PONTÉN J. , ROSÉN K. G.
Published: January 2009

The haemodynamic effects of enflurane (1.7% and 3.4% expiratory concentrations) were investigated in sheep (n = 6) pretreated with an infusion of metoprolol (0.2 mg ˙ kg‐1˙ h‐1for 5 days) and in control animals (n = 6). Chloralose was used as basal anaesthetic. A 90 s apnoea period was included in the experiment to evaluate further the possible side‐effects of long‐term metoprolol treatment in combination with enflurane anaesthesia. MAC 1.0 for enflurane in the sheep was found at 1.45% end‐tidal concentration by separate measurements. Before enflurane administration, the only significant differences between the two groups of animals were a lower systemic vascular resistance and a higher stroke volume during metoprolol treatment. Enflurane abolished these discrepancies in a dose‐dependent fashion and similar cardiovascular depression was observed in both groups of animals at 3.4% expiratory concentration of enflurane. Metoprolol did not significantly affect the hypertensive response to apnoea during chloralose anaesthesia alone. At enflurane 1.7% expiratory concentration the apnoea response was small and only the metoprolol‐treated animals showed a significant increase in left ventricular end‐diastolic pressure. We conclude that 5 days of pretreatment with metoprolol in the sheep model does not significantly impair cardiovascular performance during enflurane anaesthesia.
Release of Gastrointestinal Hormones in Cardiodepressive Shock
Authors: REVHAUG A. , LYGREN I. , LUNDGREN T. I. , JORDE R. , ANDERSEN O. , BURHOL P. G. , GIERCKSKY K‐E.
Published: January 2009

In previous studies increased plasma levels of vasoactive intestinal polypeptide (VIP), somatostatin and pancreatic polypeptide (PP) were demonstrated in a porcine endotoxin shock model. Unchanged levels of gastric inhibitory polypeptide (GIP) and secretin point to a specific shock reaction of peptide release and not to a diffuse mucosal leakage. A porcine model of cardiodepressive shock was developed to enable discrimination to be made between a general low‐flow state and endotoxin reaction. Infusion of the tricyclic antidepressive agent nortryptiline 15 mg/kg bodyweight resulted in a grave shock state. Increased plasma levels of somatostatin, PP and insulin were found. No increase in VIP levels could be demonstrated. Endotoxin given after nortryptiline administration resulted in the increase of VIP levels regularly seen during endotoxinaemia. VIP release during endotoxin shock is related to endotoxin and not to a general low flow state.
Effects of Adjuvants to Local Anaesthetics on Their Duration
Authors: HASSAN H. G. , RENCK H. , LINDBERG B. , ÅKERMAN B. , HELLQUIST R.
Published: January 2009

Local anaesthetics of the amide type were studied in a modified rat infraorbital nerve block model, with which it was possible to determine varying degrees of sensory block. Of the agents investigated, 0.5% bupivacaine tended to give a longer duration of block than 2% prilocaine or 2% lidocaine, while 0.5% etidocaine had the shortest duration. The duration of prilocaine was prolonged by addition of adrenaline, 5 μg/ml, more than that of the other agents. Addition of dextrans of Mw 40–110 × 103 did not cause any prolongation of block induced by bupivacaine. When mixed with dextrans over a wide range of M w (40–4900 × 103), prilocaine exhibited significant prolongations of its action by up to 200%. The extent of prolongation was dependent on the degree of block, the concentration of dextrans in the local anaesthetic solution, and the M w of the dextran although in a less uniform way. An increase in the relative viscosity of the solutions might be a factor of importance for the prolonging effect of addition of dextran to local anaesthetics. Since a formulation providing analgesia of a long duration would be of clinical value, further studies on combinations of the comparatively low‐toxicity agent prilocaine and macromolecular substances are of interest.
Effects of Adjuvants to Local Anaesthetics on Their Duration
Authors: HASSAN H. G. , RENKC H. , LINDBERG B. , LINDQUIST B. , ÅKERMAN B.
Published: January 2009

The effects of adding various macromolecular substances to 2% prilocaine on duration of rat infraorbital nerve block were investigated. The tested substances consisted of dextrans with lipophilic or charged substituents as well as other neutral or highly charged macromolecules. Most of the adjuvants caused significant prolongations of sensory block. For substituted dextrans the duration of sensory block degree 3 amounted to between 120% (3% capryldextran II) and 350% (3% carboxymethyldextran) in comparison to prilocaine plain. The corresponding values for hydroxypropylstarch (3%) alginic acid (0.5%), β‐cyclodextrin (1.5%) and hyaluronic acid (0.25%) were about 170%, 285% and 380%, respectively. The results suggest that the increased duration of local analgesia by prilocaine is related to increased viscosity of the solution produced by the macromolecular compounds. The mechanism seems to be of a physical character, and hyaluronic acid seems to be worthy of further studies.
Effects of Isoflurane on Vascular Tone and Circulatory Autoregulation in the Feline Small Intestine
Authors: ÖSTMAN M. , BIBER B. , MARTNER J. , REIZ S.
Published: January 2009

The vascular response in autoperfused small intestine was studied in ten cats during basal chloralose anaesthesia and controlled ventilation with either air, nitrous oxide/oxygen (70/30) or 0.7% end‐tidal concentration of isoflurane + nitrous oxide/oxygen (70/30). Intestinal blood flow was measured by the optical drop recording technique, and intestinal perfusion pressure was kept constant at either 100, 75 or 50 mmHg (13.30, 9.98 or 6.65 kPa). At perfusion pressures of 100 and 75 mmHg (13.30 and 9.98 kPa), intestinal blood flow was significantly increased and intestinal vascular resistance decreased during isoflurane + nitrous oxide/oxygen anaesthesia, compared with nitrous oxide/oxygen or air. According to the equation of closed loop gain (Gf), autoregulation was active in the pressure range 100‐75 mmHg (13.30‐9.98 kPa). In the pressure range 75‐50 mmHg (9.98‐6.65 kPa), the autoregulatory capacity was attenuated during air or nitrous oxide/oxygen and absent during isoflurane + nitrous oxide/oxygen. The vasodilator responses and the autoregulatory pattern were not changed by post‐ganglionic intestinal denervation. The intestinal vasodilator effect of isoflurane was further investigated in the denervated intestine, perfused at systemic arterial pressure by local intra‐arterial administration of isoflurane dissolved in a fat emulsion. A dosedependent vasodilator response was hereby observed.
A New Method for Calculating Total Respiratory System Compliance Theory and Model Experiments
Authors: DAROWSKI M. , RUDOWSKI R. , RAWICZ M. , HEDENSTIERNA G.
Published: January 2009

A new method for calculating total respiratory system compliance is described, based on simple modelling of a ventilator‐respiratory system circuit that assumes linear characteristics of the circuit parameters compliances and resistances. The method requires only that flow measurement be conducted continuously to obtain compliance, if the internal compliance of the circuit is known beforehand. Model experiments showed that the compliance of a child test lung, calculated from the flow recording, differed at most by 10% from the compliance obtained by separate measurements of pressure and volume under static conditions, over a wide range of respiratory flows and airway resistances.
Effect of Selective PEEP on Pulmonary Blood Flow following Unilateral Hydrochloric Acid Aspiration in the Dog
Authors: TAKASAKI M. , KAWASAKI H. , KOSAKA Y.
Published: January 2009

We investigated the effect of unilateral or bilateral positive end‐expiratory pressure (PEEP) on pulmonary perfusion in 12 dogs with a hydrochloric acid aspiration injury of the left lung. The lungs were ventilated separately and PEEP was applied to the left lung at 10 cm H2O (1.0 kPa) in six and at 15 cmH2O (1.5 kPa) in six others. Measurements of the right and left pulmonary arterial blood flows (QR and QL.) and venous admixture were made before, during and after PEEP. After this study, 5 and 10 cmH2O (0.5 and 1.0 kPa) PEEP were applied to both lungs in six dogs and measurements were repeated. Following the application of PEEP to the left lung, a significant decrease in QJ. and increase in QR were observed. However, the application of PEEP to both lungs was followed by significant decreases in both QJ and QR. The cardiac output decreased slightly during unilateral PEEP and markedly during bilateral PEEP. The venous admixture decreased significantly during PEEP in all the groups. These findings indicate that selective PEEP causes a transfer of pulmonary blood flow from the injured lung to the normal lung, improving ventilation‐perfusion inequality, and improves gas exchange without impeding oxygen delivery.
Vecuronium and Atracurium in the Elderly: A Clinical Comparison with Pancuronium
Authors: LOWRY K. G. , MIRAKHUR R. K. , LAVERY G. G. , CLARKE R. S. J.
Published: January 2009

The intubating conditions, time to complete block and duration of clinical relaxation were observed in a group of 101 elderly patients (aged over 65 years) following pancuronium 0.1 mg kg‐1, vecuronium 0.1 mg kg‐1 or atracurium 0.5 mg kg‐1. The intubating conditions in the three groups were similar when assessed at 2 min following relaxant administration. The time to complete block was shortest with vecuronium (4.3 min) in comparison to atracurium (5.0 min) and pancuronium (6.0 min), but the differences were not statistically significant. The duration of clinical relaxation, however, was significantly shorter with vecuronium (37 min) and atracurium (35 min) in comparison to pancuronium (99 min).
Effects of Suxamethonium on CO2‐Production
Authors: CHRISTENSEN K. J. S. , OLESEN A. S. , JØRGENSEN S.
Published: January 2009

Eighteen patients undergoing alloplastic surgery of the hip were divided into three groups, each consisting of six patients. All operations were performed under endotracheal intubation using halothane N2O‐O2 anaesthesia. After a steady state as to CO2‐production had been obtained, suxamethonium 1 mg kg‐1 was given intravenously to the patients in Group I. A maximum rise in CO2‐production of 14.8% (range: 12.9–16.8) was observed after 5 min. In Group II, patients were pretreated with pancuronium 0.01 mg kg‐1: no increase in CO2‐production was observed. The third group received a continuous infusion of suxamethonium. In this group there was an increase in CO2‐production of 17.6% (range: 6.7–22.0) 5 min after start of infusion. The CO2‐production then fell to the preinfusion level over the next 10 min.
Haemodynamic Stability during Anaesthesia Induction and Sternotomy in Patients with Ischaemic Heart Disease
Authors: MILOCCO I. , LÖF B. AX:SON , WILLIAM‐OLSSON G. , APPELGREN L. K.
Published: January 2009

A comparison of haemodynamic stability with respect to arterial pressure, heart rate and cardiac output between six commonly used anaesthetic techniques: fentanyl (FE), halothane (HAL), morphine (MO), fentanyl/droperidol (NLA), and thiopentone (two dose levels: PE 3 and PE 6), all supplemented with nitrous oxide, was performed during induction of anaesthesia and sternotomy in 47 patients with good left ventricular function and maintained β‐blockers undergoing coronary bypass surgery. Interventions were kept to a minimum in order to characterize each anaesthesia group. Statistically, the material fell into two parts. The MO, PE 3 and PE 6 groups showed good stability under steady‐state anaesthesia, but variable and often extensive hyperdynamic responses were seen to endotracheal intubation and surgical stimulation. The FE, HAL and NLA groups were characterized by a good stability during the induction‐intubation phase but were unstable when combined with nitrous oxide in the absence of noxious stimuli.
Undiagnosed Phaeochromocytoma in the Perioperative Period: Case Reports
Authors: SELLEVOLD O. F. M. , RÆDER J. , STENSETH R.
Published: January 2009

Phaeochromocytomas appear as frequently as one in 1000–2000 patients. Release of catecholamines may be triggered by events in the perioperative period. Patients whose phaeochromocytomas are diagnosed in this period, have a mortality of about 80%. Three patients with perioperative debut of symptoms of a phaeochromocytoma are presented. A possible drug‐induced release of catecholamines from the tumour is suggested for two of the patients. The first symptoms of a phaeochromocytoma may be arrhythmias and shock, which favours the use of adrenergic blockade prior to elective removal of phaechromocytomas. Therapeutic approaches to the treatment of catecholamine‐induced heart failure may be potassium and magnesium supplements and possibly drugs reducing circulating angiotensin II activities. Caution is advised in the use of digitalis.
Etomidate Infusion and Adrenocortical Function
Authors: WANSCHER M. , TØNNESEN E. , HÜTTEL M. , LARSEN K.
Published: January 2009

The adrenocortical response to a short tetracosactrin (Synacthen®) test was studied in 11 patients receiving either etomidate infusion or thiopentone infusion used to maintain anaesthesia for abdominal hysterectomy. Pethidine was used as the narcotic component. The results showed that etomidate infusion (median 28.5 μg/kg/min) completely blocked the adrenocortical response to corticotropin stimulation for at least 24 h after surgery. No suppression was found in patients receiving thiopentone infusion. It is concluded that etomidate cannot be recommended for routine induction and maintenance of anaesthesia.
Etomidate Anesthesia Inhibits the Cortisol Response to Surgical Stress
Authors: MEHTA M. P. , DILLMAN J. B. , SHERMAN B. M. , GHONEIM M. M. , LEMKE J. H.
Published: January 2009

Plasma cortisol was measured in 18 patients undergoing gynecological procedures under etomidate or methohexital and nitrous oxide anesthesia. Plasma ACTH was also measured in three patients in each group. The mean plasma cortisol concentration before anesthesia was comparable in both groups. Plasma cortisol increased in patients anesthetized with methohexital, while none of the patients anesthetized with etomidate had an increase in plasma cortisol. The increase in plasma ACTH was equivalent in the two groups. Therefore, etomidate is a potent inhibitor of the adrenal response to surgery. The absence of clinical consequences associated with the blunted response suggests that a major increase in adrenal hormone production may not be necessary during surgery.
Enflurane Hepatitis. A Report of a Case with a Previous History of Halothane Hepatitis
Authors: SIGURDSSON J. , HREIDARSSON A. B. , THJODLEIFSSON B.
Published: January 2009

“Enflurane hepatitis” has only recently been accepted as a disease entity. As far as the authors know, this paper is the first report on enflurane hepatitis in a patient with a previous history of halothane hepatitis. Our conclusion is that a potent halogenated inhalation agent should never be given to a patient if a prior administration of another such agent has led to the development of hepatic injury.
HLA Antigens in Patients with Unexplained Hepatitis following Halothane Anesthesia
Authors: OTSUKA S. , YAMAMOTO M. , KASUYA S. , OHTOMO H. , YAMAMOTO Y. , YOSHIDA T. O. , AKAZA T.
Published: January 2009

We examined HLA‐A, B, C and DR locus antigens in 38 Japanese patients who had recovered from halothane hepatitis. The patients were divided into two subgroups, i. e. jaundice and non‐jaundice groups, because the clinical features were quite different in each. DR2 was positive in 14 (58.3%) of 24 patients with jaundice, compared with 281 (33.6%) of the 837 Japanese healthy controls (chi‐square with Yates' correction = 5.30, relative risk = 2.77, P<0.025). Conversely, Bw44 was increased in non‐jaundice patients (50.0%), compared with 157 (12.7%) of the 1234 Japanese healthy controls (chi‐square with Yates' correction = 13.75, relative risk = 6.86, P<0.001). The haplotype frequency (Hf) of Aw24‐Bw52‐DR2 was high in the patients with jaundice (Hf=0.2362), while it was zero in the patients without jaundice (P<0.0042). These data suggest that the two groups of halothane hepatitis have different genetic backgrounds.
Does Dopamine Suppress Stress‐Induced Intestinal and Renal Vasoconstriction?
Authors: WINSÖ O. , BIBER B. , MARTNER J.
Published: January 2009

Dopamine interference with intestinal and renal sympathetic reflex vasoconstrictor responses was studied in cats anaesthetized with diazepam, fentanyl and nitrous oxide. Vasoconstriction was induced by electric stimulation of the hypothalamic defence‐alarm area and by stimulation of somatic and visceral afferents. In addition, intestinal vasoconstriction was elicited by direct stimulation of postganglionic sympathetic efferent nerves. In the intestine, dopamine administration (7.5 μg ‐ kg‐1‐min‐1) was not associated with an attenuation of the investigated sympathetic vasoconstrictor responses, although dopamineper sedecreased intestinal vascular resistance by 36 ± 4%. Due to this dopamine‐induced background vasodilation, the intestinal blood flow level during stimulation procedures and concomitant dopamine infusion was higher than during similar stimulations prior to dopamine (for defence‐alarm area stimulation 45 ± 16%, for afferent nerve stimulation 79 ±22% and for efferent postganglionic nerve stimulation 66 ± 16%). In the kidney, dopamineper sehad only minor effects on vascular resistance and on changes in vascular tone elicited by the stimulation procedures. The renal blood flow level in response to the stimulation procedures was not significantly affected by dopamine. In conclusion, dopamine may contribute to a sustained intestinal blood flow level when administered during supervening stress‐related sympathetic activation.
Sciatic Nerve Block: a New Lateral Approach
Authors: GUARDINI R. , WALDRON B. A. , WALLACE W. A.
Published: January 2009

The currently available methods for local anaesthetic block of the sciatic nerve are difficult to perform. Here we describe a new and easier technique for the block. The sciatic nerve is approached from the lateral side of the thigh with the patient lying supine and is identified by simple anatomical landmarks with the help of a nerve stimulator. The technique was found to be safe and effective in over 100 cases. It can be learnt quickly and is easily remembered.
Inhibition of Human Leukocyte Metabolism and Random Mobility by Local Anaesthesia
Authors: HAMMER R. , DAHLGREN C. , STENDAHL O.
Published: January 2009

Hexose‐monophosphate shunt (HMS) activity, myelo‐peroxidase‐(MPO)‐mediated iodination and random mobility in human polymorphonuclear leukocytes (PMNs) were studied in the presence of lignocaine. Incubating the PMNs with 0.1% lignocaine during phagocytosis inhibited the14CO2produced from glucose‐1‐14‐C via the HMS shunt by 33%. On increasing the concentration of lignocaine, a dose‐dependent inhibition was noted. The MPO‐mediated iodination was inhibited by 73% in the presence of 0.1% lignocaine, and complete inhibition took place when the concentration was increased to 0.5%. The random mobility of leukocytes was studied by an opto‐electronic technique. In the presence of 0.5% lignocaine, all leukocytes examined were completely immobilized;in the presence of 0.1% lignocaine immobilization took place within 45–65 min.
Comparison of Pharmacokinetic and Pharmacodynamic Parameters following Oral or Intramuscular Atropine in Children
Authors: SAARNIVAARA L. , KAUTTO U.‐M. , IISALO E. , PIHLAJAMÄKI K.
Published: January 2009

Pharmacokinetic and pharmacodynamic parameters of atropine 0.03 mg/kg p. o. or 0.02 mg/kg i. m. were compared in a double‐blind study in 20 children with a mean age of 5.1 years undergoing otolaryngological surgery, mostly adenotomy. Outside the study protocol, two small children accidentally received an overdose of atropine 0.3 mg/kg p. o. In addition to atropine, all children received triclofos 70 mg/kg p. o. Following p. o. administration of atropine, the mean maximum serum concentration of 6.7 nmol/1 occurred at 2 h. The corresponding result after i. m. administration was 5.7 nmol/1 at 0.5 h. Serum concentrations of atropine were 3.5 and 1.3 nmol/1 8 h after p. o. and i. m. administrations, respectively. At 70 min the antisialogogue effect was clinically satisfactory after both modes of administration. The heart rate increased statistically significantly only after i. m. administration. The mean maximum rise in the rectal temperature before the start of anaesthesia occurred at 1 h and was 0.5°C in the p. o. group and 0.7°C in the i. m. group. The flush phenomenon, mostly on the face and sometimes also on the chest, occurred in both groups, being more intense in the i. m. group than in the p. o. group. The children who developed flush had a statistically significantly higher rise in rectal temperature than the children without flush. There was a positive but weak correlation between the serum concentration of atropine and the heart rate, whereas the correlation between the serum concentration after i. m. atropine and the rectal temperature was weakly negative. On the basis of the present study, there were no decisive differences between the effects and side‐effects of the two modes of administration of atropine. Since many children, however, are afraid of injections, oral administration of atropine is preferable to intramuscular administration. The children who received an overdose of atropine besides triclofos were sedated, exhibited widely dilated, fixed pupils, were flushed and developed tachycardia and elevated temperature. Both children were fully recovered without special treatments 8 h after administration of atropine.