bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy
Authors: Hendolin H. , Poikolainen E. , Mattila M. A. K. , Alhava E. , Hänninen A. , Puttonen E. , Kataja M.
Published: January 2009

The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double‐blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. Simultaneously the need for etilefrine hydrochloride was reduced. No significant changes in the pulsatile inflow of the leg or the outflow were detected. Deep vein thrombosis (DVT) was detected by fibrinogen uptake test in five patients (three in DHEH and two in the control group) and verified by ascending phlebography in four patients. Intraoperative characteristics in patients with postoperative DVT were tachycardia (P°0.001), enhanced need for etilefrine (P°0.01) and a more rapid increase in big toe temperature (P°0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.
Effects of hypothermia in hypercapnia and hypercapnic hypoxemia
Authors: Wetterberg T. , Sjöberg T. , Steen S.
Published: January 2009

Anesthetized, paralyzed and mechanically ventilated pigs were hypoventilated to extrene hypercapnia (Paco2≅20 kPa) at Fio2 0.5, and allotted to a hypothermic group (31.5 ±0.l°C, n = 6) or a control group (39.6±0.2°C, n = 6). Compared with the controls, the hypothermic animals had higher Pao2 (19.2 vs 15.6 kPa, P>0.05), Sao2 (97.2 vs 89.3%), Sv̈o2 (78.7 vs 68.2%), end‐tidal 02 (34.5 vs 24.8 kPa) and arterial pH (7.01 vs 6.91), (P>0.01), but lower Pv̈o2 (7.0 vs. 10.2 kPa) and Paco2 (13.2 vs 23.5 kPa), (P>0.01). Hypothermia reduced O2 delivery (Do2), O2 consumption (Vo2) and CO2 production by 40–45% (P> 0.05), but O2 extraction ratio, i.e. VO2, Do2‐1. 100 (%), did not differ between groups. Hypothermic animals had lower heart rate (127 vs 223 beats.min‐1, P>0.05) and cardiac output (2.5 vs 3.9 l.min‐1, P>0.01). Subsequently, the inspired oxygen fraction (Fio2) was decreased stepwise (0.3, 0.25, 0.21, 0.15, 0.10) at 30‐ min intervals. At Fio2 0.3, the hypothermic group had higher Pao2 (10.0 vs 5.7 kPa), Sao2 (91.3 vs 28.5%), Pv̈o, (5.8 vs 3.4 kPa), Sv̈o2 (70.7 vs 10.3%), end‐tidal O2 (16.7 vs 8.5 kPa), O2 delivery (344 vs 155 ml.min‐1), arterial pH (7.02 vs 6.94) and systemic vascular resistance (3850 vs 1652 dyn.s. cm‐5(38500 vs 16520 μN. s. c m‐5)) compared with the controls (P>0.01), while Paco2 was lower (12.4 vs 22.7 kPa), as well as O2 extraction ratio (23 vs 63%) and O2 half saturation tension (4.3 vs 8.0 kPa) (P>0.01). Except for Pao2, all differences between groups remained significant at Fio2 0.25. The control animals died during Fio2 0.25 and 0.21, while all hypothermic animals remained circulatorily stable. One hypothermic animal died after 12 min at Fio2 0.15 and the remainder after 6–39 min (mean 22 min) at Fio2 0.10. We conclude that hypothermia markedly improves whole‐body oxygen balance, cardiovascular stability and survival in hypercapnic hypoxemia.
Combined effects of adrenergic and intravenous anesthetic agents on inositol monophosphate levels in rat liver prisms
Authors: ShibataM.D. O. , Makita T. , Nagatani A. , Fujigaki T. , Nakamura H. , Fukusaki M. , Sumikawa K.
Published: January 2009

Combined effects of adrenergic and intravenous anesthetic agents on phosphatidylinositol (PI) turnover were studied using rat liver prisms incubated with [3H]myo‐inositol. Rat liver prisms responded to epinephrine, norepinephrine and phenylephrine dose‐dependently with an increase in inositol monophosphate (IP1) formation but they did not respond to ephedrine. Dopamine‐induced effects were seen only at concentrations as high as 10‐4mol 1‐1. The enhancement of IP1formation induced by epinephrine was potentiated by thiamylal at concentrations of 10‐5mol. 1‐1and 10‐4mol. 1‐1, remained unaffected by ketamine, fentanyl or midazolam, but was dose‐dependently inhibited by droperidol. The present results fromin vitrostudies of liver cell metabolism suggest that α‐adrenergic agents in combination with barbiturates may potentiate liver cell damage by activation of PI turnover and interrelated intracellular Ca++ accumulation.
Chronic catheterization of the epidural space in rabbits: a model for behavioural and histopathological studies. Examination of meptazinol neurotoxicity
Authors: Madsen J. B. , Jensen F. M. , FABER T. , Bille‐Hansen V.
Published: January 2009

A technique of epidural catheterization in rabbits is described. Twelve albino rabbits received a totally implanted epidural catheter system. The system was implanted surgically, and the functioning of the system tested for a period of 3 months. X‐ray examinations following epidural contrast injections showed a distribution up to Th4 following 1.5 ml and Th8–9 following 1.0 and 1.25 ml. Epidural injection of lidocaine throughout the study period proved the system to be functioning for all 3 months. Another 12 rabbits were included for the neurotoxicological examinations following epidural catheterization, without any injections (three rabbits), epidural injections of saline (four rabbits) and meptazinol (five rabbits) once a day for 14 days. Histopathological examinations showed a fibrous cocoon, at the tip of the catheter, in all rabbits. In the group of rabbits which did not receive any injections, the cocoon was slightly infiltrated with leukocytes and local depression of the spinal cord was observed in one rabbit. In the saline‐injected group this infiltration was more pronounced and in one rabbit it extended into the meninges. Three rabbits showed local depression of the spinal cord and local myelopathy of the white matter in the area adjacent to the cocoon. In the group of rabbits receiving meptazinol, three out of five had local depression and myelopathy of the white matter. In this group these findings were more pronounced. In two rabbits the myelopathy extended transversely through the white matter into the grey matter of the spinal cord. The number of pathological changes in the group receiving meptazinol was significantly higher compared to the control and placebo groups. The epidural catheterization technique proved to be simple and reliable. Neurotoxicological examinations showed local effects following catheterization and injection of saline. Following injection of meptazinol, a significant neurotoxicological potential was shown.
Mivacurium‐induced neuromuscular blockade in patients with atypical plasma cholinesterase
Authors: ØStergaard D. , Jensen F. s. , Jensen E. , Skovgaard L. T. , Viby‐Mogensen J.
Published: January 2009

The duration of action of mivacurium was evaluated during a modified neurolept anaesthesia in 17 patients heterozygous for the usual and the atypical plasma cholinesterase (pChe) gene (Ea1Ea1) and in five patients homozygous for the atypical gene (Ea1Ea1). The response to train‐of‐four nerve stimulation was recorded using a Myograph 2000. Five heterozygous patients were given a small dose of mivacurium 0.03 mg kg bw‐1 intravenously (Group 1). The mean (range) suppression of the first twitch in the train‐of‐four response (T1) was 91% (69–100%). The time to 90% T1 recovery was 23.9 min (14.0–31.3 min). Twelve other heterozygous patients (Group 2) received mivacurium 0.2 mg kg bw‐1 (2.5 * ED95). In these patients the time to 100% T1 suppression was 1.4 min (1.1–2.0 min). The time to reappearance of the T1 response, to 90% T1 recovery, and the recovery index (25.3 min (14.5–34.5), 45.5 min (30.9–59.2), and 9.8 min (6.8–19.6), respectively) were significantly longer than reported in phenotypically normal patients. Five patients homozygous for the atypical gene (Group 3) were given 0.03 mg kg bw‐1 mivacurium. The time to reappearance of T1 response following this low dose of mivacurium ranged from 26–128 min. In all five patients the neuromuscular block was successfully antagonized with neostigmine preceded by atropine. In conclusion, mivacurium‐induced neuromuscular blockade was moderately prolonged in patients heterozygous for the usual and the atypical gene for plasma cholinesterase. Patients homozygous for the atypical plasma cholinesterase gene appear to be markedly sensitive to mivacurium.
Volume‐controlled inverse ratio ventilation: effect on dynamic hyperinflation and auto‐PEEP
Authors: VALTA P. , TAKALA J.
Published: January 2009

The effects of inverse ratio ventilation (IRV) and PEEP on dynamic hyperinflation and auto‐PEEP were studied in sedated, paralysed patients with adult respiratory distress syndrome (ARDS) (n = 9) and in 10 postoperative patients after coronary artery by‐pass (CABG). During volume‐controlled mechanical ventilation with constant tidal volume (VT 12 ml‐kg‐1) and respiratory rate (12‐min‐1), two consecutive experiments were carried out: (1) with constant I:E ratio PEEP was increased in steps of 2 cmH20 (0.2 kPa) from 0 to 12 craH2O (0 to 1.2 kPa) and (2) with no PEEP I: E ratio was changed stepwise from 1: 4 to 4: 1. Flow, V‐T peak airway pressure (Pmax) and static end‐expiratory pressure (PEEPtot) were registered. PEEPtot was measured while occluding the airway in the end‐expiration. The changes in the end‐expiratory lung volume (EELV) were measured with respiratory inductive plethysmograph. We found that: (1) increasing PEEP and IRV caused a similar increase in EELV and PEEPtot in ARDS, but in CABG the increase in EELV was greater with PEEP; (2) at the same PEEPtot the increase in EELV was similar with PEEP and IRV in both groups; and (3) the reduction in Pmax was marginal during IRV. We conclude that the effect of reduced expiratory time on end‐expiratory lung volume and pressure during volume controlled IRV is similar to the use of PEEP.
Effects of high dose E. coli lipopolysaccharide on rabbit lung function, and of subsequent addition of chemotactic granulocyte activators to their isolated, blood‐perfused lungs
Authors: OPDAHL H. , MOLLNES T. E. , Næss O.
Published: January 2009

E. coli LPS was infused (1 μg/kg to 5 mg/kg over 30 min) to spontaneously breathing rabbits, and their arterial blood pressure (ABP), blood leukocyte count and blood gases were observed for 2.5–3.5 h. Pulmonary vascular and airway function were subsequently evaluated in vitro by comparing weight changes, fluid filtration rates, pulmonary vascular resistance (PVR) and airway pressures in their isolated, blood‐perfused lungs with those in lungs from untreated rabbits. Lung preparations from both groups of animals were then exposed to autologous zymosan‐activated plasma (ZAP) or n‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP) and perfused for 2 more hours. LPS addition to isolated rabbit leukocytes increased cell aggregation; cell chemiluminescence after activation with FMLP was also enhanced. Infusion of 1–5 mg/kg LPS decreased the count of all types of leukocytes and caused a metabolic acidosis (BE< –8 mmol), but no decrease in ABP. PAo2‐Pao2 increased by about 2.0 kPa. No vascular permeability increase was detected in the lungs of these animals during subsequent in vitro perfusion. Addition of ZAP or FMLP during perfusion markedly increased the PVR in lungs from LPS animals, but did not induce major microvascular leakage. No significant differences in edema between lungs from LPS‐treated and control animals were found by microscopy.
Effects of buffering in hypercapnia and hypercapnic hypoxemia
Authors: WETTERBERG T. , SJÖBERG T. , STEEN S.
Published: January 2009

Anesthetized, paralyzed and mechanically ventilated pigs were exposed to extreme hypercapnia (Paco2‐20 kPa) at Fio20.4 for 480 min, with (n = 6) or without (n = 6) continuous infusion of isotonic buffers (bicarbonate and trometamol). Arterial pH was higher in buffered animals than controls, 7.21 ±0.01 vs 7.01±0.01 (mean ± s.e.mean,P< 0.01). Serum osmolality and Paco2did not differ between groups throughout the experiment. The hemodynamic response to hypercapnia was attenuated in the buffered group, who had lower heart rate, 133 ± 6 vs 189±12 min‐1(P< 0.01), mean arterial pressure (MAP) 109 ± 4 vs 124 ± 4 mmHg (14.5 ± 0.5 vs 16.5 ± 0.5 kPa) (P< 0.05), mean pulmonary arterial pressure 16±1 vs 23 ± 1 mmHg (2.1 ±0.1 vs 3.1 ±0.1 kPa) (P< 0.01), and pulmonary vascular resistance (PVR) 249 ± 21 vs 343 ± 20 dyn s‐cm‐5(2490±210 vs 3430±200 μN‐s‐cm‐5) (P< 0.01), compared with the control group. Subsequently, both groups were exposed to hypercapnic hypoxemia by stepwise increases in Fio2(0.15, 0.10, 0.05) at 30‐min intervals, while Fico2was kept at 0.2. PVR increased in both groups (P< 0.05) but, except for heart rate, all hemodynamic differences between the groups disappeared during hypoxia. At Fio20.15, buffered animals had higher arterial oxygen saturation (73 ± 5%) than the controls (55 ± 5%), (P< 0.05). The control animals died after 1–29 min (mean 14 min) at Fio20.10, while all buffered animals survived Fio20.10 with stable MAP (122 ± 14 mmHg (16.3 ± 1.9 kPa). The buffered animals died after 4–22 min (mean 15 min) at Fio20.05. We conclude that buffering to a pH of 7.21 attenuates the observed hemodynamic response in extreme hypercapnia and improves survival in hypercapnic hypoxemia.
Caudal buprenorphine for postoperative analgesia in children: a comparison with intramuscular buprenorphine
Authors: GIROTRA S. , KUMAR S. , RAJENDRAN K. M.
Published: January 2009

This study was conducted on 44 children aged 1–10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 μg‐kg‐1 body weight. The quality and duration of postoperative analgesia were evaluated by a single observer using a 5‐point score for the first 24 h postoperatively. The time until the patient required postoperative analgesic was recorded. The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 μg‐kg‐1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.
Respiratory mechanics in anaesthetised patients after neostigmine‐atropine. A comparison between patients with and without chronic obstructive pulmonary disease
Authors: BOURGAIN J. L. , DEBAENE B. , MEISTELMAN C. , DONATI F.
Published: January 2009

The aim of this study was to compare the effects of pharmacological reversal of neuromuscular blockade on static compliance and resistance in patients with and without chronic obstructive pulmonary disease (COPD). Twenty patients were studied: 12 patients were free of respiratory disease (NCOPD) and had normal pulmonary function tests. Eight subjects (COPD) had a clinical history of chronic bronchitis and a FEV1 < 70% of the predicted value. All patients were anaesthetised with a continuous infusion of methohexitone and alfentanil. Airway pressure (Paw) was recorded continuously. Static compliance (Crs) was calculated from the relationship between 21 syringe volume (250 ml step) and Paw. Total respiratory resistance (Rrs) was measured at two levels of inspiratory flow and tidal volume. These measurements were made before vecuronium (control), after injection of vecuronium to abolish the first neuromuscular response to train of four, 5 and 15 min after administration of neostigmine 40 μgkg‐1 and atropine 10 μg kg‐1. In COPD patients Crs and Rrs were significantly greater (1450 ± 580 ml kPa‐1 and 1.06 ± 0.68 kPa l‐1 ‐s‐1) than in normal patients (1000±380 ml‐kPa‐1 and 0.58 ± 0.22 kPa‐1‐l‐s‐1) (P < 0.01). In both groups Crs and end‐expiratory pulmonary volume were similar before injection of vecuronium and after neostigmine‐atropine administration. In both groups, Rrs was not altered significantly by neostigmine‐atropine for the two inspiratory flows. These results suggest that neostigmine‐atropine mixture is associated with small changes in respiratory mechanics, and the changes are similar in COPD compared with normal patients.
Complications related to thoracic epidural analgesia: a prospective study in 1071 surgical patients
Authors: SCHERER R. , SCHMUTZLER M. , GIEBLER R. , ERHARD J. , STÖCKER L. , Kox W.J.
Published: January 2009

In a prospective study, the complications of 1071 patients scheduled for thoracic epidural catheterization for postoperative analgesia (TEA) were studied. All catheters were inserted preoperatively between segment Th 2/3 and Th 11/12 under local anesthesia. Balanced anesthesia with endotracheal intubation and TEA were combined. Postoperatively 389 patients (36.9%) were monitored on a normal surgical ward. Buprenorphine, 0.15 to 0.3 mg, and if needed bupivacaine 0.375% 3–5 ml h‐1 were given epidurally. Primary perforation of the dura occurred in 13 patients (1.23%). Radicular pain syndromes were observed in six patients (0.56%). In one patient (0.09%) respiratory depression was seen in close connection with the epidural administration of 0.3 mg buprenorphine. Although 116 patients (10.83%) showed one abnormal clotting parameter but no clinical signs of hemorrhage, there was no complication related to this group. No persisting neurological sequelae caused by the thoracic epidural catheters were found. In conclusion, continuous TEA with buprenorphine for postoperative pain relief after major abdominal surgery is a safe method without too high a risk of catheter‐related or drug‐induced complications, even on a normal surgical ward and when one clotting parameter is abnormal.
Comparison of epidural methadone with epidural diamorphine for analgesia following caesarean section
Authors: HAYNES S. R. , DAVIDSON I. , ALLSOP J. R. , DUTTON D. A.
Published: January 2009

Analgesia provided by either 5 mg diamorphine, or 5 mg methadone administered by the epidural route during elective caesarean section was compared in 40 women. The median time to further analgesia in the methadone group was 395 min, and 720 min in the diamorphine group, P = 0.0003. Linear analogue scores to assess pain were measured 2‐hourly for 12 h, then again at 24 h postoperatively. Pain scores were significantly lower in the diamorphine group at 8 and 10 h. The median cumulative i.m. morphine dose administered during the first 24 h was 20 mg in the methadone group and 0 mg in the diamorphine group (P = 0.0005). Nausea and pruritis were common side effects in both groups. Continuous pulse oximetry data were available for 12 h post‐operatively in 15 patients receiving methadone, and in 17 patients receiving diamorphine. One or more episodes of significant desaturation (<90% for 30 s), occurred in three patients receiving methadone, and in nine patients receiving diamorphine. Desaturation to 90–92% occurred in a further three patients given epidural diamorphine, and in one further patient given epidural methadone.
The influence of fentanyl and alfentanil on functions of human polymorphonuclear leukocytes in vitro
Authors: KRUMHOLZ W. , DEMEL C. , JUNG S. , MEUTHEN G. , HEMPELMANN G.
Published: January 2009

Polymorphonuclear leukocytes (PMNL) play an important part in protecting against invading bacteria. It is known that some anaesthetics may impair PMNL functions, thus possibly promoting infection. We investigated the effect of fentanyl and alfentanil on superoxide anion production, hydrogen peroxide generation, and activity of released myeloperoxidase in vitro. However, the two opioids did not have any significant influence on the tested PMNL functions.
Is there a cholinergic and an adrenergic phase of the oculocardiac reflex during strabismus surgery?
Authors: BRAUN U. , FEISE J. , MÜHLENDYCK H.
Published: January 2009

We investigated the counterregulatory effect of the oculocardiac reflex (OCR) in 25 infants and children during strabismus surgery under three experimental conditions. In group 1, a series of measurements were recorded when the OCR was elicited by traction. The beat‐to‐beat heart rate reduction ranged from ‐ 26 to ‐64 beats/min (median: –46 beats/min). Constant traction increased heart rate in all patients from ± 23 to ±50 beats/min (median: ±30.5; P < 0.001). After a sudden release of the stimulation, heart rate rose further from +6 to +40 beats/min (median: + 15; P < 0.001). In group 2, atropine (0.01 mg/kg) was administered 3–4 min prior to the same manipulations as in group 1. Constant traction changed heart rate from – 1 to +20 beats/min (median: +4.5; P < 0.01). In group 3, a retrobulbar blockade suppressed the OCR and the counterregulation completely. These findings indicate that there is an active counterregulatory process which maintains heart rate during traction at the extraocular muscles after the bradycardic reflex has been initiated. The bradycardia and the counterregulation may be referred to as cholinergic and adrenergic phrases of the OCR. Atropine eliminates the cholinergic phase. Our study indicates that there may be receptors and afferent fibres for both phases, which can be blocked by local anaesthetics.
Effects of pentoxifylline on hemodynamics, gas exchange and multiple organ platelet sequestration in experimental endotoxic shock
Authors: SIGURDSSON G. H. , YOUSSEF H.
Published: January 2009

In an intensive care setting we studied the effects of pentoxifylline on hemodynamics, gas‐exchange and platelet sequestration in multiple organs in three groups of sheep exposed to endotoxin shock (n = 7 in each). Group P‐E was given pentoxifylline before and group E‐P after E. coli endotoxin infusion, while group E received normal saline (controls). The endotoxin infusion caused a three‐fold increase in pulmonary artery pressure (PAP) and a significant decrease in mean arterial pressure (25–30%; MAP), respiratory compliance (CT 60%) and arterial oxygen tension (65–70%; Pao2) in all groups after 30 min. After 4 h MAP had improved significantly in the pretreated animals (group P‐E) and arterial pH, Pao2 and CT improved in both pentoxifylline‐treated groups compared with the controls. On the other hand, the effects of endotoxin on PAP and cardiac index were not significantly influenced by pentoxifylline treatment. In addition, there was a pronounced platelet sequestration in the lungs and in the liver in groups E and E‐P during the 4 h study, but in the pretreated group (group P‐E) the changes were significantly less marked (P < 0.01). The wet‐to‐dry weight ratios of the lungs were significantly lower in both pentoxifylline‐treated groups compared with the controls (P < 0.01). It was concluded that pentoxifylline modified the effects of endotoxin on hemodynamics, gas exchange and platelet sequestration in the lungs and liver in sheep when it was given prior to endotoxin. However, when it was given after hemodynamic and respiratory signs of shock had appeared, the effects were more moderate.
Postoperative pain relief, from the patients5 and the nurses' point of view
Authors: JUHL I. U. , CHRISTENSEN B. V. , BÜLOW H. H. , WILBEK H. , DREIJER N. C. , EGELUND B.
Published: January 2009

In this prospective, consecutive study, 191 patients were interviewed before and after surgery (orthopaedic, gynaecological, abdominal and urological operations) about their attitude to and the quality of received pain relief, respectively. In addition, nurses working in the surgical units involved in the study were asked to answer a questionnaire covering attitudes to postoperative pain and pain treatment. Of the patients, 47% were in pain at the time of the postsurgical interview, 10% had not any analgesic prescribed at all and 15% had received less than prescribed. In 36% of the cases there was a discrepancy between the amount of analgesic prescribed by the surgeon and the amount prescribed by the anaesthetist. In 80% of the patients the pain outlasted the first postoperative day, but only 64% would always tell the staff if they had pain. Seventeen per cent of the patients had never been asked about their postoperative pain status. Preoperative pain had a significant correlation to postoperative pain. Although the results are not impressive, they do constitute some improvement compared to previously published studies. Fifty‐one nurses (71% of the total nursing staff) answered the questionnaire. Of these, 63% were sometimes in doubt about the physicians' prescriptions, 55% would occasionally refuse to give analgesics for various reasons, and 37% were not satisfied with the routines of pain control in their ward. Conclusion: Knowledge of pain treatment and communication between surgeons, anaesthesiologists, nurses and patients must be improved to make postsurgical pain relief adequate.
Effect of methylprednisolone on the cytokine response in patients undergoing lung surgery
Authors: TØNNESEN E. , WANSCHER M. , HØHNDORF K. , BENDTZEN K. , HANSEN M. B. , DIAMANT M. , HANSEN G. L. , TOFT P.
Published: January 2009

Tumour necrosis factor α (TNFα), interleukin‐l α (IL‐lα) and IL‐6, when released in excess, have been suggested to be important host mediators of the immunoinflammatory response to injury and infections. Corticosteroids suppress this response in vitro. This study was undertaken to investigate if a single dose of methylprednisolone (MP) could modify the cytokine response in patients undergoing lung surgery. Twenty‐one patients with lung cancer were allocated randomly to treatment with MP 30 mg/kg i.v. (MP group) or isotonic saline (control group). Patients were anaesthetized with a balanced anaesthesia combined with thoracic epidural anaesthesia. MP or saline was administered immediately before induction of anaesthesia. The cytokines in plasma were measured by ELISA, and blood samples were collected preoperatively, at the end of surgery, 4 h later, and 1 and 5 days postoperatively. All patients had detectable IL‐6 in plasma. Compared to preoperative values, plasma IL‐6 levels in the MP group increased from 114 pg/ml (12–350 pg/ml) (mean, range) to peak value 146 pg/ml (15–580 pg/ml) on the first postoperative day. In the control group, IL‐6 levels increased from 99 pg/ml (17–350 pg/ml) preoperatively to 125 pg/ml (10–300 pg/ml) on the first postoperative day. The increases were not significant. TNFα was detectable in only two patients, one from each group. Low levels of IL‐la were demonstrated in three patients in the MP group and in four patients in the control group. In conclusion, the results of this study do not warrant steroid therapy as a modality to modify the secretion of cytokines in non‐infected surgical patients, as the systemic cytokine responses were remarkably low.
Cervicothoracic epidural anaesthesia blunts pancuronium‐induced increase in heart rate in humans
Authors: OMOTE K. , IWASAKI H. , NAMIKI A.
Published: January 2009

This study was conducted to evaluate the effects of cervico‐thoracic epidural anaesthesia upon pancuroniuminduced tachycardia in surgical patients. In the control (no blockade) group (n = 8) and the lumbar epidural group (n = 8), pancuronium produced significant increases in heart rate (P< 0.01 andP< 0.01), respectively) and no significant changes in mean arterial pressure. In the cervico‐thoracic epidural group (n = 8), no increase in heart rate and a significant decrease in mean arterial pressure were seen following pancuronium. The lack of an increase in heart rate following pancuronium with cervico‐thoracic epidural anaesthesia might be due to cardiac sympathetic denervation. The authors concluded that tachycardia after pancuronium administration was attenuated by cervico‐thoracic epidural anaesthesia in humans and that the pancuroniuminduced tachycardia seemed to be a cardiac sympathomimetic effect.
QT interval, heart rate and arterial pressures using propofol, thiopentone or methohexitone for induction of anaesthesia in children
Authors: SAARNIVAARA L. , HILLER A. , OIKKONEN M.
Published: January 2009

The effects on corrected QT interval (QTc), heart rate and arterial pressure were studied after induction with propofol 1.5, 2 or 2.5 mg'kg‐1, thiopentone 5 mg‐kg‐1 or methohexitone 2 mg‐kg‐1 in 123 ASA class I or II children undergoing outpatient otolaryngological surgery. Premedication consisted of oral midazolam and atropine. The children were randomly allocated to one of the three propofol groups or to the thiopentone or methohexitone group. After injection of the intravenous anaesthetic, the QTc interval was significantly prolonged after propofol 2.5 mg. kg‐1. Thirty seconds after suxamethonium 1.5 mg kg‐1, a significant prolongation of the QTc interval occurred in the thiopentone and propofol 1.5 and 2 mg‐kg‐1 groups. After intubation, no further prolongation of the QTc interval occurred in any of the groups. Heart rate increased significantly after the barbiturates but not after propofol. Systolic arterial pressure decreased significantly after propofol 1.5 and 2.5 mg kg‐1. In all groups a cardiovascular intubation response occurred. Bradycardia and junctional rhythm occurred in 4% of the children in both barbiturate groups and in 19–29% in the propofol groups. It is concluded that propofol causes prolongation of the QT interval and results in a higher incidence of bradycardia and junctional rhythm than the barbiturates.
Colloid osmotic pressure of plasma replacement fluids
Authors: TøNNESSEN T. , TøLL0FSRUD S. , KONGSGAARD U. E. , NODDELAND H.
Published: January 2009

Colloid osmotic pressure (COP) of some of the most frequently used plasma replacement fluids was measured with a colloid osmometer. COP of 4% human albumin solutions was only half that of normal human serum (13.6±0.6 vs. 27.5 ± 2.7 mmHg (1.8±0.1 vs. 3.7±0.4 kPa)) (mean±s.d.), whereas COP of 20% human albumin solutions was eight times higher (196.0±12.3 mmHg (26.1 ± 1.6 kPa)). Enhancing the protein concentration from 4% to 20% in the human albumin solutions increased COP 14‐fold, reflecting the exponential relationship between protein concentration and COP of a solution. Fresh donor plasma furnished by the hospital blood‐bank had a COP about 30% below normal human serum (18.1 ± 1.3 mmHg (2.4 ± 0.2 kPa)), due to dilution during preparation. Dextran 70 (6%) had a COP more than twice, and RingerDextran 60 (3%) about 75% of that of normal human serum. Dextran 40 (10%) and gelatin (3.5%, Haemaccel) leaked markedly through the membrane of the colloid osmometer, making acceptable measurements impossible. Seven different hydroxyethyl starch (HES) solutions were measured, and the COP varied between half and 3 times that of normal human serum, depending on molecular weight and concentration of the HES.
Glycopyrrolate vs. atropine during anaesthesia for laryngoscopy and bronchoscopy
Authors: GRØNNEBECH H. , JOHANSSON G. , SMEDEBØL M. , VALENTIN N.
Published: January 2009

As glycopyrrolate has been reported superior to atropine with respect to reduction of salivation, stability of cardiac rate and rhythm, and recovery, a comparison of these properties of the two drugs and placebo was made in 45 patients undergoing direct laryngoscopy and 45 patients undergoing bronchoscopy, in most cases followed by mediastinoscopy. When given i.m. 30 min before anaesthesia (midazolam, alfentanil, thiopentone, and suxamethonium), the two test drugs were found to be equally potent regarding the antisialogogic effect. The same increase in heart rate after the test drugs was seen before induction, and during anaesthesia heart rate rose to the same level in the placebo group as the test groups. During anaesthesia, blood pressure was lowest in the atropine group. No differences could be demonstrated with respect to cardiac arrhythmias, possibly due to the small size of the material. The present study gives no reason for preferring either drug, and only the efficacy of both test drugs in controlling airway secretions provides an argument for using any anticholinergic drug when laryngoscopy or bronchoscopy is performed under the conditions of the present study.
High‐dose vecuronium may be an alternative to suxamethonium for rapid‐sequence intubation
Authors: KOLLER M.‐E. , HUSBY P.
Published: January 2009

Endotracheal intubation conditions 60 s after intravenous administration of either high‐dose vecuronium (0.3 mg kg‐1; n = 25) or suxamethonium (1.0 mg kg‐1; n = 25) were compared in a blind, randomised study. No significant differences were found between the two drugs. In 96% of the patients intubation conditions were characterized as excellent or good. In only one patient (4%) in each group were intubation conditions unsatisfactory. According to our findings, high‐dose vecuronium provides satisfactory intubation conditions after 60 s and may be used instead of suxamethonium for rapid sequence intubation when a long duration of neuromuscular blockade is acceptable.
Complications and late sequelae following nasotracheal intubation
Authors: HOLDGAARD H. O. , PEDERSEN J. , SCHURIZEK B. A. , MELSEN N. C. , JUHL B.
Published: January 2009

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow‐up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty‐five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.
Effect of single‐dose omeprazole and ranitidine on gastric juice acidity and volume in patients undergoing laparotomy
Authors: HENDOLIN H. , SUOJARANTA‐YLINEN R. , ALHAVA E.
Published: January 2009

The effects of oral omeprazole and oral ranitidine on gastric fluid volume and pH were compared in 95 elective surgical patients, randomly assigned to one of three groups. The patients received either 80 mg of omeprazole or 300 mg of ranitidine orally at 6.00 on the morning of surgery. One third of the patients received no antacid therapy. Following induction, a no. 18 nasogastric tube was passed into the stomach and all available gastric fluid was aspirated. pH and volumes were measured. In the omeprazole‐ and ranitidine‐treated groups, the mean pH was > 5.4 after induction, at completion of surgery and 1 h after operation, although at least one patient in both groups had pH < 2.5. The volumes of gastric aspirates were reduced equally by both drugs. Two patients in the omeprazole group, none in the ranitidine group and eight in the control group (26%) had pH <2.5 with volume> 25 ml at induction. Both drugs appeared to be effective in reducing the volume of intragastric fluid and acidity to acceptable values.
The influence of different procedures of general anaesthesia on platelet function, coagulation and the fibrinolytic system
Authors: LOICK H. M. , GOENNER‐RADIG CHR. , OSTERMANN H. , THEISSEN J. L. , ZANDER J.
Published: January 2009

We investigated whether different procedures during general anaesthesia alter platelet activation in vivo and/ or activate coagulation and fibrinolysis. Forty‐one healthy adult patients, scheduled for elective ophthalmic surgery under general anaesthesia, were studied with regard to changes of plasma beta‐thromboglobulin (βG, index of platelet activation), thrombin‐antithrombin Ill‐complex (TAT, index of activation of coagulation) and d‐dimer (index of fibrinolysis) during anaesthesia. The patients underwent either inhalation anaesthesia with enflurane and nitrous oxide or balanced anaesthesia with enflurane (0.5% end‐tidal concentration) and alfentanil. Ten minutes after intubation the βTG level was significantly reduced compared to the preoperative value in both general anaesthesia groups. Balanced anaesthesia caused a moderate but significant increase of TAT values at 10 min after extubation. No significant change in d‐dimer levels was seen. Presuming a minimal effect of the surgical procedure on the determined variables, we conclude that none of the anaesthetic procedures induces platelet activation and fibrinolysis. The clinical relevance of the moderate coagulation activation during balanced anaesthesia remains to be investigated.
Effects of propofol on mean arterial pressure and systemic vascular resistance during cardiopulmonary bypass
Authors: PENSADO A. , MOLINS N. , ALVAREZ J.
Published: January 2009

This study was designed to evaluate the effects of propofol on mean arterial pressure (MAP) and systemic vascular resistance (SVR) during cardiopulmonary bypass (CPB). Twenty patients were divided randomly for administration of 2 mg·kg‐1 propofol (group Propofol, n = 10) or 0.9% saline solution (group Control, n=10) during CPB. The two groups were comparable with respect to sex, age, height, type of surgery (valvular or coronary), arterial hypertension and preoperative antihypertensive treatment. Only their weight and body surface area were significantly different (control group vs propofol group, respectively: 78.5 + 14.4 vs 64.7±7.7 kg, P < 0.05; and 1.85 ±0.2 vs 1.68 ±0.13 m2, P < 0.05). MAP, SVR and SVR index were significantly lower in the propofol group than in the control group at 10, 15 and 20 min of study, suggesting that the hypotensive effect of a bolus injection of propofol is due, at least in part, to a direct decrease in the SVR.
Low‐flow isoflurane‐nitrous oxide anaesthesia offers substantial economic advantages over high‐and medium‐flow isoflurane‐nitrous oxide anaesthesia
Authors: PEDERSEN F. M. , NIELSEN J. , IBSEN M. , GULDAGER H.
Published: January 2009

Isoflurane consumption was studied for three different fresh gas flows in patients scheduled for major elective abdominal, urological or gynaecological surgery under general anaesthesia with an expected duration of 2 h or more. Thirty patients were randomly assigned to either high‐flow anaesthesia using a partial rebreathing system without carbon dioxide absorption (Mapleson D) or medium‐ or low‐flow anaesthesia using a circle system with carbon dioxide absorption. Patients were anaesthetised with isoflurane in 40% oxygen and 60% nitrous oxide. The amount of isoflurane consumed was measured with a precision scale. The total consumption of liquid isoflurane (mean ± s.d.) during the first 2 h was 40.8± 12.2 ml in the high‐flow group, 18.5 ± 5.4 ml in the medium‐flow group and 7.9 ± 2.2 ml in the low‐flow group. The corresponding cost of isoflurane for the three groups was 214 Danish kroner (DKK) (±19.5), 97 DKK (±8.8) and 42 DKK (±3.8), respectively. The calculated total cost of anaesthetics was 286 DKK(±26), 155 DKK (±14.1) and 91 DKK (±8.3), respectively. In conclusion, low‐flow isoflurane‐nitrous oxide anaesthesia offers substantial economic advantages over high‐ and medium‐flow isoflurane‐nitrous oxide anaesthesia.
Epidural anesthesia in a patient with myasthenia gravis
Authors: SAITO Y. , SAKURA S. , TAKATORI T. , KOSAKA Y.
Published: January 2009

We present a patient with myasthenia gravis who was safely managed by epidural anesthesia during and after thymectomy. An epidural catheter was inserted via the C7‐T1 intervertebral space and 2% lidocaine was used during the surgery. The level of analgesia as determined by pinprick extending from C5 to T6. Epidural morphine or morphine and bupivacaine were used for postoperative pain relief. We evaluated ventilatory responses to CO2 and hypoxia after epidural anesthesia with lidocaine or morphine, and during continuous epidural infusion of the mixture of morphine and bupivacaine. Ventilatory responses to CO2 and hypoxia were both depressed following epidural injection of morphine. However, depression of ventilatory responses was not demonstrated following continuous epidural infusion of a mixture of morphine and bupivacaine. This case report suggests that epidural anesthesia is useful as a primary anesthetic and for postoperative pain control in patients with myasthenia gravis.
Low‐dose midazolam antagonizes cerebral metabolic stimulation by ketamine in the pig
Authors: ÅKESON J. , BJÖRKMAN S. , MESSETER K. , ROSÉN I.
Published: January 2009

In order to test the hypothesis that low‐dose midazolam reduces excitatory cerebral symptoms by attenuating ketamine‐induced increases in the cerebral metabolic rate for oxygen (CMRo2), we compared the cerebral effects of a combination of an anaesthetic dose of ketamine hydrochloride (10.0 mg‐kg1 i.v.) and a subanaesthetic dose of midazolam maleate (0.25 mg‐ kg‐1 i.v., n = 6; or 0.10 mg‐kg‐1 i.v., n = 6) with results recently obtained with ketamine (10.0 mg‐kg‐1 i.v.) in normoventilated pigs anaesthetized with fentanyl, nitrous oxide and pancuronium. Cerebral blood flow (CBF) was measured with the intra‐arterial 133Xe clearance technique, and CMRo2 was calculated from CBF and the cerebral arteriovenous oxygen content difference (Cavo2). The CMRo2 did not increase significantly. In contrast, the maximal increase in cerebral Cavo2 (by 56–59% at 10 min; P < 0.01) was similar to that induced by ketamine, since CBF was more depressed (by 35–45% at 1 min: P < 0.001) by ketamine‐midazolam than by ketamine only. Midazolam was found to increase CVR (P < 0.01) and further depress CBF (P < 0.01), and to antagonize the ketamineinduced increase in CMRo2 (P < 0.05). Ketamine‐induced effects on mean arterial pressure (MAP) and spectral electroencephalographic (EEG) voltage were not significantly altered by midazolam. The pharmacokinetics of ketamine, as measured during an 80‐min period, were not affected by the concomitant administration of midazolam. We propose that a ketamine‐midazolam combination comprising a low‐dose fraction (1/ 100‐1/40) of midazolam is superior to ketamine alone for anaesthetic use.
Fentanyl and pethidine are antagonists on muscarinic receptors in guinea‐pig ileum
Authors: HUSTVEIT O. , SETEKLEIV J.
Published: January 2009

In order to evaluate the anticholinergic effect of fentanyl and pethidine, the influence of these drugs on the cumulative dose‐response curves of carbacholine on the guinea‐pig ileum has been investigated. Fentanyl and pethidine displaced the dose‐response curve for carbacholine to the right in a parallel fashion, indicating competitive antagonism. Dissociation constants determined by an agonist EC versus antagonist plot were 0.22 μmol/1 for fentanyl and 1.4 μmol/1 for pethidine. It is concluded that during high‐dose fentanyl anaesthesia, fentanyl may bind to muscarinic receptors and thereby produce a central anticholinergic syndrome. An additional finding was that the maximal response to carbacholine increased significantly when combined with pethidine.
Analysis of lung density by computed tomography before and during general anaesthesia
Authors: HACHENBERG T. , LUNDQUIST H. , TOKICS L. , BRISMAR B. , HEDENSTIERNA G.
Published: January 2009

Pulmonary structure was analysed by means of computed tomography (CT) in 20 lung‐healthy patients, relating tissue density to the attenuation value (AV) of a picture element. Regional density of pulmonary tissue (rlung) was determined using mean lung density in five regions of interest (ROI1–5) (sector method). Vertical and horizontal distributions of x‐ray attenuation were analysed by density profiles, relating AV values to evenly distributed and normalised length scales. In group I (n= 12), CT‐densitometry was obtained in awake, supine patients and after induction of general anaesthesia. In group II (n = 8), the effect of mechanical ventilation with positive end‐expiratory pressure (PEEP, 1.0 kPa [10 cmH2O]) was studied. In the awake state, a vertical tissue density difference between the top and the bottom of the lung was found in all patients, accounting for a mean of 0.235 g'cm‐3 (right lung) and 0.199 g'cm‐3 (left lung). Only minor changes were seen in the horizontal lung density profiles. After induction of anaesthesia, x‐ray attenuation of ROI1–4 showed no significant differences when compared with the awake state. The basal lung areas (ROI5) revealed a significantly increased tissue density (P ≤ 0.01), reaching mean values of 0.94 g cm‐3 (right lung) and 0.814 g‐cm‐3 (left lung). Similarly, vertical density profiles showed a markedly enhanced rlung of the bottom of the lung in all patients, interpreted as atelectasis. The amount of atelectasis accounted for 4.8 ± 2.6% (right lung) and 4.7 ± 2.1% (left lung) of the intrapulmonary area. There was no evidence of “non‐gravitational” inhomogeneity of density distribution seen in the horizontal density profiles. After application of PEEP, basal lung densities decreased significantly, although small basal densities remained in most patients (2.27 ± 2.57% of right intrapulmonary area [P ≤ 0.01], 2.2 ± 2.37% left intrapulmonary area [P ≤ 0.01]). Calculated alveolar recruitment was 7.7 cm2 and 8.4 cm2, whereas expansion of both lungs was smaller (4.3 cm2 and 4.4 cm2 [right and left lung]). Mean density of aerated tissue had decreased by 25%, and both horizontal and vertical attenuation profiles revealed an even distribution of rlung. Analysis of rlung provides useful information about regional pulmonary morphology during anaesthesia and may be related to lung function.
Evaluation of postural stability by computerised posturography following outpatient paediatric anaesthesia. Comparison of propofol/alfentanil/ N2O anaesthesia with thiopentone/halothane/N2O anaesthesia
Authors: HILLER A. , PYYKKÖ I. , SAARNIVAARA L.
Published: January 2009

Simple clinical tests, like Romberg's test or a walking test, have proved to be inadequate guidelines for safe discharge after outpatient anaesthesia (1, 2). A randomised study was therefore planned to compare postural stability measured by computerised posturography in 31 oral midazolam‐atropine premedicated children aged 6.9 (s.e. 0.4) years who had been anaesthetised with either propofol/aIfentanil/N2O or thiopentone/ halothane/N2O. The sway velocity of the children was measured before premedication and 1, 2 and 3 h after the end of anaesthesia. Results show that sway velocity had returned to baseline values 3 h after the end of anaesthesia in all children who had received propofoI/alfentanil/N2O and in 12 of the 15 children who had received thiopentone/halothane/N2O. The quantified version of the Romberg test performed with eyes open or closed was not impaired after anaesthesia, compared with the control values, indicating that in children poor equilibrium is not compensated by vision. The clinical recovery with respect to the times to eye opening, to responding to command or to being fully awake did not differ between the two anaesthesia methods. On the basis of recovery assessed by postural stability, propofol/alfentanil/N2O anaesthesia was not preferable to thiopentone/halothane/NsO anaesthesia after minor paediatric otolaryngological surgery.