bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Variables of Disseminated Intravascular Coagulation in the Diagnosis of Adult Respiratory Distress Syndrome
Authors: Modig J. , Borg T. , Wegenius G. , Bagge L. , Saldeen T.
Published: January 2009

In an investigation on 19 patients with traumatic (n = 11) and septic (n = 8) shock, at risk of developing adult respiratory distress syndrome (ARDS), various coagulation and fibrinolysis variables and also blood gases and chest x‐ray were monitored. Eight patients developed ARDS ‐ two after traumatic shock and six following septic shock. Laboratory findings: the conventional disseminated intravascular coagulation variables (fibrinogen, platelet counts, activated partial thromboplastin time, ethanol gelation test, thrombotest, normotest and fibrin degradation products) could not discriminate between ARDS and non‐ARDS patients, but showed an essentially similar reaction pattern in these two groups. Antithrombin‐III and plasminogen levels were significantly lower in patients with ARDS, while factor VIII‐related antigen levels were significantly higher in ARDS than in non‐ARDS patients. Clinical data: patients with septic shock run a significantly greater risk of developing ARDS (6 of 8) than those with traumatic shock (2 of 11; P<0.02). Furthermore, the onset of ARDS after septic shock seems to occur in a more rapid way, while ARDS following traumatic shock develops more gradually. Early ventilator treatment with positive end expiratory pressure counteracts the classical radiographic picture of ARDS with bilateral alveolar densities.
Effects of Dihydroergotamine on Haemodynamics and Oxygen Consumption in the Dog During High Epidural Block with Special Reference to the Splanchnic Region
Authors: Greitz T. , Andreen M. , Irestedt L.
Published: January 2009

Dihydroergotamine (DHE) 0.02 mg·kg‐1was administered i. v. in 9 dogs with high epidural block. Mean arterial blood pressure was restored from 11.0±2.4 kPa to 18.8 ±2.5 kPa by DHE due to a near twofold increase in systemic vascular resistance while cardiac output was unchanged. Hepatic arterial blood flow was reduced by 50% by a marked increase in hepatic arterial resistance above the pre‐epidural value, while portal venous blood flow remained unchanged. Hepatic oxygen consumption decreased following DHE in spite of an increase in total oxygen consumption, probably partly due to a reduction in hepatic arterial oxygen availability. The mechanism by which the arterial blood pressure is restored by DHE in dogs during high epidural block must be regarded as unfavourable, especially with respect to the liver.
Modification by Baroreceptor Feedback of Circulatory Responses to Noxious Stimuli During Anaesthesia in Cats
Authors: Biber B. , Martner J. , Werner O.
Published: January 2009

In eight cats anaesthetized with chloralose, the carotid sinus on one side was either exposed to systemic arterial pressure or perfused with a pump in order to control sinus pressure. Baroreceptor influences from the contralateral carotid sinus and from the aortic arch were interrupted by denervation. Arrangements were made for intermittent electric stimulation of pain fibres in somatic and visceral nerves with stimulation parameters chosen to elicit reproducible increases in arterial blood pressure and in skeletal muscle vascular resistance. The elicited increases in arterial pressure and muscle vascular resistance were both about 40% smaller when the carotid sinus was exposed to systemic arterial pressure in comparison with the experimental condition of a constant carotid sinus pressure. I. v. metoprolol (0.1‐0.3 mg kg‐1) reduced base‐line arterial pressure, but did not attenuate the arterial blood pressure increase in response to pain stimulation. The baroreceptor modulation of the haemodynamic response to the pain stimulation was not affected by metoprolol.
The Effects of Intravenous Lorazepam Alone and with Meperidine on Ventilation in Man
Authors: Paulson B. A. , Becker L. D. , Way W. L.
Published: January 2009

The respiratory effects of lorazepam (a 1, 4 benzodiazepine) were studied using a modified Read rebreathing technique in healthy adult males about to undergo elective surgery. Lorazepam 0.05 mg/kg (IV) produced an increase in slope and a shift to the left of the CO2 response curve. These effects were also detectable but of smaller magnitude when the same lorazepam dose (IV) was given with meperidine (IV). End‐expiratory CO2 (Peco2), which was significantly elevated in all drug groups, is not a sensitive indicator of either the time course or the degree of respiratory depression.
A Comparative Evaluation of Disposable Humidifiers
Authors: Membius C.
Published: January 2009

The performance of four hygroscopic condenser humidifiers (HCH) and two conventional heat and moisture exchangers (HME), all commercially available, have been evaluated in laboratory tests. A clinical study was also made in order to confirm the test results. It was found that the new generation of heat and moisture exchangers, which have hygroscopic properties, are superior to conventional HME units. When dry inspired gases are used, the HCH units, but not the HME units, deliver a moisture level that is comparable to what is produced in the upper trachea during normal breathing through the nose. Our clinical experience as well as the extensive body of literature on humidification requirements support the conclusion that in most cases they can be recommended to be used for extended time periods even with dry gases. The humidification efficiency decreases with increasing tidal volume for all units. However, the best units can be used up to tidal volumes of 1000–1500 ml. The dead space of these units varies from 90 ml to 100 ml and the resistances are only about 50 Pa at 0.5 1/s. The weight is in the range 18–40 g. One of the best HCH devices also has distinct antimicrobial properties. The others are found at least not to promote organism growth. This feature added to others such as safety and simplicity in use make an HCH device an attractive alternative to conventional humidification techniques.
Tissue Distribution of Thiopental and Diazepam in Rats at 71 Atmospheres Pressure
Authors: AanderudM.D L. , Thoner J. , Bakke O. M.
Published: January 2009

35S‐thiopental 15 mg/kg and14C‐diazepam 5 mg/kg were injected intravenously in separate groups of rats (n=6) at 1 ATA air and at 71 ATA air‐He. Total radioactivity was measured in the brain, liver, kidney, muscle and fat after 1, 3, 5 and 15 min. The thiopental content was significantly reduced at pressure in the brain at 3, 5 and 15 min. The diazepam content of the brain was significantly reduced at pressure at 1, 5 and 15 min. The liver, muscle and kidney tissue generally contained slightly less of either drug at pressure, particularly at the earliest sampling times.
Regulation of Intracellular Acid‐Base Equilibrium in Rats
Authors: Rothe K. F.
Published: January 2009

The extracellular pH (pHe) of unrestrained male Sprague‐Dawley rats was altered by either inhalation of CO2 or infusion of sodium bicarbonate and then kept constant for at least 2 h. The intracellular pH (pHi) was then determined by the DMO (5,5‐dimethyl‐2,4‐oxazolidinedione)‐method in heart, brain, liver, spleen, and ten different skeletal muscle groups. pHi varied linearly with pHe in the heart and the parenchymal organs. pHi in skeletal muscle remained constant over a pHe range from 7.31 to 7.45 but varied linearly with pHe outside this range. Conclusions: 1. pHi is influenced by CO2 inhalation or bicarbonate infusion. 2. pHi may be different in different tissues at specified pHe. 3. Skeletal muscle seems to be well protected against mild extracellular acidosis. 4. Slight changes of pHe affect the pHi of the heart, brain, liver, and spleen. 5. Regulation of intra‐ and extracellular acid‐base balance probably occurs by bicarbonate transfer between the intra‐ and extracellular compartments. 6. The acid‐base status of the various intracellular compartments cannot be determined from blood‐gas analysis.
Stroke Volume Measured by Pulsed Ultrasound Doppler and M‐Mode Echocardiography
Authors: Lang‐Jensen T. , Berning J. , Jacobsen E.
Published: January 2009

The velocity of the bloodstream in the ascending aorta was measured by pulsed ultrasound Doppler. The diameter of the aorta was measured by M‐mode echocardiography. Forty‐three measurements were performed in six patients, who all had a Swan‐Ganz catheter. The calculated stroke volumes from the Doppler‐Echo method were compared with the stroke volumes measured by the thermodilution technique, which was performed simultaneously with the Doppler measurements. The correlation between the measurements was good (r=0.80). It is concluded that it is possible non‐invasively to measure stroke volume (and cardiac output) by means of ultrasound Doppler and an echocardiograph.
Nitrous Oxide Augments the Systemic and Coronary Haemodynamic Effects of Isoflurane in Patients with Ischaemic Heart Disease
Authors: Reiz S.
Published: January 2009

The effects of 70% nitrous oxide, added to 1% end‐tidal isoflurane and administered by intermittent positive pressure ventilation (IPPV), on coronary haemodynamics and myocardial oxygenation were investigated in 10 patients with ischaemic heart disease. Standard methods were used for determination of their central haemodynamic effects. Coronary blood flow was measured by the retrograde thermodilution technique and coronary sinus blood sampled for measurement of myocardial oxygen consumption and lactate extraction. One per cent end‐tidal isoflurane decreased systemic blood pressure (‐39%) by a combination of systemic vasodilation and reduction in cardiac performance. Coronary blood flow remained unaltered despite the fall in coronary perfusion pressure and myocardial oxygen consumption (‐30%) and extraction (‐30%) fell significantly. Ischaemic ECG changes parallelled by decreased myocardial lactate extraction or lactate production were recorded in 6 of the 10 patients during steady state isoflurane anaesthesia. When nitrous oxide was added to isoflurane there was a fall in heart rate (‐13%), a further reduction in systemic blood pressure (‐18%) and myocardial oxygen consumption (‐31%) and extraction (‐17%) whereas all other variables including coronary blood flow remained unaltered. The myocardial ischaemia was worsened in three of the six patients with ECG and metabolic signs of impaired oxygenation during isoflurane alone. It is concluded that nitrous oxide potentiates the systemic and coronary haemodynamic effects of isoflurane in patients with coronary artery disease. The mechanisms for myocardial ischaemia seem to be decreased coronary perfusion pressure and/or redistribution of coronary blood flow by direct coronary vasodilation.
Respiratory Complications Following Surgery. Improved Prediction with Preoperative Spirometry
Authors: Wirén J. E. , Janzon L.
Published: January 2009

Patients who are old, overweight, who smoke and/or have symptoms of respiratory disease have an increased risk of atelectases and/or arterial hypoxemia in conjunction with surgery. The present study in 53 middle‐aged men, operated on for gallbladder or peptic ulcer disease, illustrates how spirometry can be used to improve the prediction of respiratory complications. The relative risk of atelectases was greater in patients with functional residual capacity ‐ closing capacity (FRC‐CC) below ‐ 0.11 and the risk prediction based on age, body weight, smoking habits and respiratory symptoms was improved by adding information on FRC‐CC. Arterial hypoxemia was more common in patients with wash‐out volumes (WOV) above than below 35 1. The preoperative identification in high‐risk patients of arterial hypoxemia based on the above‐mentioned risk factors, was improved by adding information on WOV.
Cardiac Arrhythmias in Intubated Children During Adenoidectomy. A Comparison Between Enflurane and Halothane Anaesthesia
Authors: SigurdssonMD G. H. , Lindahi S.
Published: January 2009

In 75 children undergoing adenoidectomy, occurrence of cardiac, arrhythmias and influence of anaesthesia on respiration were studied during halothane and enflurane anaesthesia. All the children were intubated orally. In 25 children halothane, and in another 25 children enflurane was used during spontaneous ventilation. Twenty‐five children were also followed during halothane anaesthesia with manually controlled ventilation. The overall incidence of cardiac arrhythmias was higher during halothane anaesthesia (72% at spontaneous breathing and 68% with controlled ventilation) than during enflurane anaesthesia (32%, P<0.05). Ventricular arrhythmias were noted in 20% of the spontaneously breathing children and in 12% of those with controlled ventilation during halothane anaesthesia. Three children breathing spontaneously during halothane anaesthesia developed ventricular tachycardia. During enflurane anaesthesia the incidence of ventricular arrhythmias was lower (8 %) in spite of higher end‐tidal CO2 tensions and an anaesthetic depth that was only just the level needed to allow intubation. The incidence of ventricular arrhythmias during halothane anaesthesia was shown to be influenced by the anaesthetic technique used, which was not found with enflurane anaesthesia. The greater stability in cardiac rhythm with enflurane indicates a more favourable effect of this agent on the myocardium as well as a decreased sympathetic response to anaesthesia and surgery as compared with halothane anaesthesia.
Haemodynamic Comparison of Dopamine and Dobutamine in Normovolaemic and Hypovolaemic Dogs
Authors: Vainionpää V. , Nuutinen L. , Kairaluoma M. , Mokka R. , Tuononen S.
Published: January 2009

The haemodynamic effects of dopamine and dobutamine in doses of 1–106 μg/kg/min were compared in dogs, first in the normovolaemic stale and then after bleeding (10 ml/kg). In normovolaemia, dopamine caused a dose‐dependent rise in systolic, mean and diastolic aortic pressures, while dobutamine caused a rise only in systolic pressure. In hypovolemia, a rise in all three aortic pressures was caused by both drugs, but to a lesser extent by dobutamine. Heart rate and cardiac output were similarly increased by both drugs, as was pulmonary artery pressure with high doses, in both states. Renal blood flow and diuresis increased in the middle‐dose area. Both inotropic drugs caused an elevation in Paco2and a drop in Pao2and O2‐saturation in both normovolaemia and hypovolemia. The results agree with current opinion on the dose‐dependent alpha‐sympathomimetie action of dopamine and the relatively pure beta‐action of dobutamine.
Oxygen Transport During Hemodilution in Normoxic and Hypoxic Dogs Treated with Verapamil
Authors: Scherer R. , Wendt M. , Schneider U. , Kober S. , Lawin P.
Published: January 2009

In order to determine the possible limitations of acute isovolemic hemodilution in patients taking verapamil, the various factors determining oxygen availability were analyzed in an animal experiment. Twenty‐four anaesthetized dogs were subjected to a gradual isovolemic hemodilution. Six dogs received a bolus injection of 0.1 mg kg‐1 of verapamil followed by 0.01 mg kg‐1 min‐1. In 12 dogs, mild hypoxic hypoxia was induced by ventilation with 16–17% oxygen; six of them also received verapamil. Six dogs served as a control group. In the latter, due to an increase in heart rate and stroke volume, oxygen availability in the clinically relevant range of hemodilution between HC 25 and 25% was maintained at 81 % of its control value. In normoxic animals treated with verapamil, oxygen availability decreased more rapidly and was below the level of the control group once HC reached 25%. Mild hypoxic hypoxia alone did not reduce oxygen availability as much as its combination with verapamil. Even though the verapamil‐induced reduction in oxygen availability was similar during normoxia and hypoxia, the sharp rise in serum lactate at HC levels below 35‐30% in the hypoxic verapamil group was a sign of impairment of tissue oxygenation. Hematocrit levels below 35‐30% and even moderate hypoxemia should be avoided whenever the cardiovascular response to hemodilution is influenced by verapamil.
Clinical Effects of Regional Intravenous Guanethidine (Ismelin®) in Reflex Sympathetic Dystrophy
Authors: Driessen J.J. , van der Werken Chr. , Nicolai J. P. A. , Crui J. F.
Published: January 2009

Twenty patients with documented reflex sympathetic dystrophy were treated with a series of regional intravenous guanethidine blocks. The mean delay between the first clinical symptoms and the start of guanethidine blocks was 3.6 months. The overall result was good in 11 patients, moderate in two patients and poor in seven patients. Poor results are due mainly to incorrect diagnosis and to application either too late in the third phase or too early in the first phase when only signs of increased blood flow are part of the symptomatology. Side effects, except pain after the injection, were few and of minor importance. The tolerance of the procedure may be improved by preceding the injection of guanethidine by an injection of a local anaesthetic agent. It may be concluded that with correct diagnosis and indication, guanethidine injections may play an important part in the treatment of reflex sympathetic dystrophy and may replace sympathetic blocks with local anaesthetics because of the longer duration of action and lower incidence of serious side‐effects.
Topical Anaesthesia with EMLA, a New Lidocaine‐Prilocaine Cream and the Cusum Technique for Detection of Minimal Application Time
Authors: Ehrenström‐Reiz G. , Reiz S. , Stockman O.
Published: January 2009

The minimal effective onset time of the new topical anaesthetic, formulation EMLA (a eutectic mixture of lidocaine and prilocaine), was evaluated by the double‐blind technique in 53 female and 66 male patients (median age 40 and 36 years, respectively) subjected to intravenous cannulation. Conventional plotting and regression analysis failed to answer the question. The Cusum technique, originally designed for industrial production control, could successfully be applied to solve the problem. It demonstrated a minimal effective EMLA application time of 45 min in adults.
In VivoInduced Malignant Hyperthermia in Pigs. III. Localization of Calcium in Skeletal Muscle Mitochondria by Means of Electronmicroscopy and Microprobe Analysis
Authors: Stadhouders A. M. , Viering W. A. L. , Verburg M. P. , Ruitenbeek W. , Sengers R. C. A.
Published: January 2009

Biceps femoris muscle biopsies of malignant hyperthermia susceptible (MH+) and non‐susceptible (MH‐) Dutch Landrace pigs were studied ultrastructurally, and exchangeable calcium was demonstrated, using the antimonate precipitation technique in combination with electron probe x‐ray microanalysis. Biopsies were taken before and during the administration of halothane‐plus‐succinylcholine and after dantrolene sodium treatment of the animals. MH+ muscle, taken before the MH triggering, showed a high proportion (about 35%) of cells with supercontraction. Both MH+ and MH‐ muscle had broad but nearly identical ranges of cell diameter. Core‐like structures were occasionally present in muscle from MH+ pigs. Muscle mitochondria from the MH+ pigs accumulated large amounts of calcium in their matrix compartment during the halothane‐plus‐succinylcholine induced MH crisis. This calcium loading in the course of time caused swelling and structural damage to the mitochondria. Skeletal muscle mitochondria from MH+ pigs did not show such a reaction pattern on challenge with halothane and succinylcholine. It is concluded that in MH+ pigs the challenge brings about an increase in myoplasmic free calcium, which is predominantly due to calcium influx from the extracellular fluid. This rise in cytosolic calcium causes the mitochondria to accumulate the cation in an energy‐dependent way. These findings are discussed in relation to the diverging halothane and caffeine contraction responses of aerobic type I and anaerobic type II muscle fibres.
Haemodynamic Effects of Intravenous Procaine as a Supplement to General Anaesthesia in Patients with Valvular Heart Disease
Authors: Waaben J. , Sørensen O. , Wlberg‐Jørgensen F. , Flachs H. , Skovsted P.
Published: January 2009

The effect of intravenous procaine, 2 mg/kg/min, on the cardiovascular function of nine patients scheduled for cardiac valve replacement was studied under enflurane‐pancuronium anaesthesia. Procaine infusion was started after intubation during steady‐state anaesthesia, and continued until start of cardiopulmonary by‐pass. Systemic vascular resistance decreased steadily from 198.2±28.7 to 133.0±17.2 kPas/1 (P<0.05). A simultaneous decline in mean arterial pressure from 10.13±0.68 to 7.47±0.48 kPa was observed (P<0.01). Cardiac index, heart rate, central venous pressure, pulmonary arterial mean pressure and pulmonary capillary wedge pressure were all unaffected by procaine as well as by surgical stimulation. It is concluded that continuous procaine infusion as an adjuvant to general anaesthesia effectively abolishes the hypertensive and tachycardiac response to surgical stimulation. The limiting factor in the amount of infused procaine appears to be the hypotension caused by vasodilation, not myocardial depression or convulsions.
Pain‐Reducing Effect of Self‐Taming Suxamethonium
Authors: Strøm J. , Jansen E. C.
Published: January 2009

The effect was evaluated of a small “self‐taming” dose of suxamethonium (0.1 mg/kg) on fasciculations and postoperative muscle pain following a normal intubating dose of suxamethonium (1.0 mg/kg). Forty outpatients undergoing bronchoscopy were randomly allocated to pretreatment with either sodium chloride or suxamethonium 0.1 mg/kg. The pretreatment dose was followed in 60 s by suxamethonium 1.0 mg/kg. Visual rating and mechanical registration of muscle fasciculations were done separately. Muscle pain was found in 74 % and in 26% of the patients following pretreatment with sodium chloride and suxamethonium 0.1 mg/kg, respectively (P<0.01). No significant relationship was found between pain and muscle fasciculations. It is concluded that self‐taming with suxamethonium has a marked pain‐reducing effect; and this technique may be used as an alternative to pretreatment with a non‐depolarizing relaxant.
Caudal Anaesthesia for Upper Abdominal Surgery in Infants and Children: A Simple Calculation of the Volume of Local Anaesthetic
Authors: Satoyoshi M. , Kamiyama Y.
Published: January 2009

Where the use of non‐depolarizing muscle relaxants and antagonists is undesirable in infants and children undergoing abdominal surgery, caudal anaesthesia is frequently adopted, combined with light general anaesthesia. A simple calculation has been derived to determine the volume of local anaesthetic needed to obtain a higher effective anaesthetic level (up to T4–5) for upper abdominal operations using caudal anaesthesia. Clinically, a linear correlation was found between an empirically injected volume of local anaesthetic and the distance from C7 to the sacral hiatus in 21 infants and children. A similar relationship was also demonstrated radiographically in 16 cadavers by studying the spread of radio‐opaque solution in the epidural space introduced by the caudal technique. From both statistical studies, a simple formula to determine the required volume of local anaesthetic for upper abdominal surgery was derived: V = D– 13, where V is the volume of local anaesthetic in ml and D is the distance from C7 to the sacral hiatus in cm.
Precurarization ‐ a Hazard to the Patient?
Authors: Engbæk J. , Viby‐Mogensen J.
Published: January 2009

Four case histories are presented illustrating the unpleasant and serious reactions that may follow precurarization with small doses of non‐depolarizing muscle relaxants. The importance of preoperative information, the necessity of relating the dose of the precurarizing drug to the weight of the patient and the possibility of hypersensitivity to this drug are emphasized.
Ventilatory and Mental Effects of Alfentanil and Fentanyl
Authors: Scamman F. L. , Ghoneim M. M. , Korttila K.
Published: January 2009

Forty healthy, young volunteers received intravenously, in a double‐blind and random fashion, 7.5 or 15 μg/kg of alfentanil, 1.5 or 3 μg/kg of fentanyl, or saline. The ventilatory response to CO2 was measured before and at 4, 20, 30, 50, 80, and 120 min post‐treatment. Mental and psychomotor functions were measured before and at 10, 40, 100, 130, and 180 min post‐treatment. Low and high‐dose fentanyl caused significant respiratory depression up to 30 and 80 min post‐treatment, respectively, while there was no depression with low‐dose alfentanil and only at 4 min with high‐dose alfentanil. The fentanyl to alfentanil potency ratio for respiratory depression was 13:1. High‐dose fentanyl caused more intense and prolonged mental effects than other treatments. Neitherdrug affected learning or recall, although high‐dose fentanyl impaired motor activity. Nausea and vomiting rates were similar between high‐dose alfentanil and low‐dose fentanyl.
Methylmethacrylate and Atrioventricular Conduction in Dogs
Authors: Brown D. L. , Parmley C. Lee
Published: January 2009

The effect of intravenous methylmethacrylate (MMA) on atrioventricular conduction times was studied in dogs, utilizing His‐bundle electrograms. Dogs were anesthetized with halothane or enflurane; then MMA in a dose causing minimal to profound hemodynamic changes was administered and His‐bundle electrograms, and arterial, pulmonary artery, and central venous pressures were recorded. This experimental model did not demonstrate a prolongation of atrioventricular conduction intervals which could be implicated as etiologic in MMA‐induced dysrhythmias.
Central and Splanchnic Haemodynamics in the Dog During Controlled Hypotension with Sodium Nitroprusside
Authors: Lagerkranser M. , Andreen M. , Irestedt L.
Published: January 2009

The effects of controlled hypotension induced by sodium nitroprusside (SNP) on central and splanchnic haemodynamics were studied in ten artificially ventilated dogs under neurolept anaesthesia. SNP was given intravenously as a continuous infusion in order to maintain a mean arterial blood pressure (MABP) of about 50 mmHg. Observations were made before (control) and at 20 and 60 min after the start of the SNP infusion. The mean SNP dosage was 13.7 μ1g kg‐1 min‐1. Systemic vascular resistance (SVR) decreased by 47%. After 20 min there was a 17% decrease in cardiac output, while the hepatic arterial blood flow was diminished by 39%, and portal venous blood flow by 16%. Cardiac output and portal venous blood flow tended to return towards control values at 60 min, while the hepatic arterial blood flow remained depressed. The total oxygen uptake was unaltered after 20 min, but slightly decreased after 60 min. There were no changes in hepatic or preportal tissue oxygen consumption, nor in hepatic lactate uptake. It is concluded that SNP‐induced hypotension was achieved primarily by a profound reduction of SVR, and initially also by a slight decrease in cardiac output. Although splanchnic and hepatic blood flows decreased, there were no signs of hypoxia in the preportal tissues or in the liver.
Synergistic Effect of Acidosis and Succinylcholine‐Induced Hyperkalemia in Spinal Cord Transected Rats
Authors: Koller M‐E. , Breivik H. , Greider P. , Jones D. J. , Smith R. B.
Published: January 2009

The effects of spinal cord transection and acidosis on succinylcholine (SCC)‐induced hyperkalemia were studied in Sprague‐Dawley rats. The effectiveness of pretreatment with subparalyzing doses (“self‐taming”) of SCC or with the cholinesterase inhibitor hexafluorenium bromide in preventing hyperkalemia was also studied. The increase in plasma potassium after administration of SCC (1 mg/kg) was found to be significantly increased 10 days after spinal cord transection. This potassium increase could not be prevented by pretreatment with either hexafluorenium (0.3 mg/kg) or subparalyzing doses (0.15 mg/kg) of SCC. Respiratory acidosis caused an increase in plasma K+ in both normal and in spinal cord transected rats. Acidosis had a synergistic effect on succinylcholine‐induced hyperkalemia. These findings support the clinical practice of not using succinylcholine in patients at risk of having a pathological sensitivity to SCC. Furthermore, SCC may be especially dangerous when administered to patients who are acidotic.
Comparison of Some Postanaesthetic Effects of Atropine and Glycopyrrolate with Particular Emphasis on Urinary Problems
Authors: Orko R. , Rosenberg P. H.
Published: January 2009

Two hundred and two patients undergoing elective surgery were given either atropine (98 patients) or glycopyrrolate (104 patients) for intravenous premedication and as an adjunct to reversal of neuromuscular block by neostigmine in a double‐blind study. The dose ratio of atropine and glycopyrrolate was 2.5:1. After reversal, both drugs induced an initial increase and a subsequent decrease in heart rate. The mean values in % heart rate were statistically significantly higher in the glycopyrrolate group than in the atropine group. Semiquantitative measurement of salivation showed glycopyrrolate to be more potent as an antisialogogue drug. Nausea and vomiting were equally common after both drugs. There were no differences between the drugs in the occurrence of postoperative micturition difficulties, the total rate of this complication being 18%. It is concluded that factors other than the choice of anticholinergic drug may be blamed for postoperative micturition difficulties.
Effect of Pethidine, Fentanyl and Morphine on Post‐Operative Shivering in Man
Authors: Pauca A. L. , Savage R. T. , Simpson S. , Roy R. C.
Published: January 2009

One hundred consecutive patients who shivered following general or regional anesthesia and a surgical procedure were randomly treated with 25 mg pethidine, 2.5 mg morphine, 25 m̀g fentanyl or sodium chloride 0.9%, given in equal intravenous volumes over a 15‐min period. The effects were evaluated every 5 min after the first injection. There was a spontaneous, time‐related disappearance of shivering in the sodium chloride‐treated patients. In the pethidine‐treated group, shivering disappeared more than twice as fast as in the control group. The difference was highly significant at 15 and 20 min (P <0.001) and was unrelated to weight, body temperature or duration of anesthesia. Women responded sooner than men, reaching significance at 10 min(P<0.05), while men did so only at 20 min. Morphine or fentanyl had no effect. Nausea and vomiting were minimal and of equal incidence in narcotic‐ and placebo‐treated patients.
Effect of Epidural Morphine on the Hoffman‐Reflex in Man
Authors: Grossi P. , Arnér S.
Published: January 2009

Four healthy, young subjects undergoing knee surgery with epidural anaesthesia were given epidural morphine for the relief of post‐surgical pain. The Hoffman (H)‐reflex was tested before and after the injection of morphine in the epidural space. The reflex was chosen as a monitor of the function of monosynaptic pathways in the spinal cord. Analogue scales for the measurement of pain revealed a satisfactory decrease of nociception after morphine injection, while the H‐reflex was not significantly affected. This study may confirm that monosynaptic reflexes are not affected by epidural administration of morphine and that they are probably not involved in pain transmission.
Acute Epiglottitis in Adults. A Management Protocol Based on a 17‐Year Material
Authors: Andreassen U. K. , Husum B. , Tos M. , Leth N.
Published: January 2009

During a 17‐year period 75 adult patients were treated for acute epiglottitis. Twenty of the patients had respiratory symptoms and in 13 patients an artificial airway was established by means of nasotracheal intubation or tracheotomy. One patient died of suffocation and one other patient had severe incapacitating brain damage because of cardiac arrest in combination with respiratory obstruction. All the other patients were discharged from the hospital without any sequelae. On the basis of our 17‐year material and the literature, a protocol for the handling of patients with suspected acute epiglottitis is presented.
Long‐term Follow‐up of Infants Under Intensive Care with Tracheotomy During the Period 1956–1965
Authors: Haglund G. , Bjure J. , Claesson I. , Ekström‐Jodal B. , Hjalmarson O. , Jansson G. , Svanborg M. , Werkmäster‐Kollberg K.
Published: January 2009

Twenty‐seven infants who survived intensive care during early infancy in the pioneering period of neonatal intensive care (1956–1965) were investigated after 8–17 years. The selection criterion was maintenance of a tracheotomy for more than 15 days during the first 12 months of life. A variety of clinical, physiological, radiological and psychiatric sequelae was found. Respiratory symptoms were the dominating problem during the post‐tracheotomy period. The long‐term follow‐up revealed that these symptoms had a stong tendency to subside. At the time of the follow‐up, as many as 20 children (74%) did not experience any functional impairment.
Ventilation‐Perfusion Relationships During Halothane Anaesthesia and Mechanical Ventilation. Effects of Varying Inspired Oxygen Concentration
Authors: Lundh R. , Hedenstierna G.
Published: January 2009

Ventilation‐perfusion relationships (VA/Q.), assessed by a multiple inert‐gas elimination technique, were studied during halothane anaesthesia and mechanical ventilation at different inspiratory oxygen fractions (F102). All nine patients (mean age 65 years, five smokers) displayed unaltered VA/Q. distributions with increasing F102 from a mean of 29% to 53%. A further increase in F102 to a mean of 85% caused an increase in true shunt (VA/Q=0) from 7 to 10% of cardiac output (P<0.01), but no increase in “low” VA/Q (VA/ Q<0.1). On the return to F102 of 29%, true shunt was reduced to the initial level. The findings may fit in with release of hypoxic vasoconstriction when F102 is increased to 85%, or the opening up of a certain population of shunt vessels.
Infection Risks from Cannulae Used to Maintain Intravenous Access
Authors: Saloheimo S. , Henning C. , Hillborgh U.
Published: January 2009

In an experimental in vitro study, it was shown that the rate of infection through the injection route was higher with Venflon® cannulae than with Intraflux® cannulae (P<0.01). A restricted use of cannulae with injection side ports is recommended.
Influence of Anaesthesia on Blood Flow to the Calves During Surgery
Authors: Lindström B. , Ahlman H. , Jonsson O. , Stenqvist O.
Published: January 2009

The blood flow to the calves during abdominal surgery under different kinds of general anaesthesia was measured by strain gauge plethysmography in 12 patients. The volume flow increased 100% during surgery in both light and deep anaesthesia, caused by a decrease in peripheral resistance. The increase in volume flow could partly be explained by the anaesthesia itself, possibly induced by the use of a nitrous oxide‐oxygen gas mixture. The surgical procedure caused a further increase in volume flow. Possible underlying mechanisms are discussed.
Material Thrombogenicity in Central Venous Catheterization III. A Comparison Between Soft Polyvinylchloride and Soft Polyurethane Elastomer, Long, Antebrachial Catheters
Authors: Curelaru I. , Gustavsson B. , Hultman E. , Jondmundsson E. , Linder L. E. , Stefańsson T. , Stenqvist O.
Published: January 2009

Soft venous catheters, 36 made of polyurethane (PU) and 37 made of polyvinylchloride (PVC), were inserted in 73 patients via basilic and cephalic veins punctured at the cubital fossa, and compared regarding their thrombogenicity. The mean duration of catheterization was 12.5 days. Two patients with PU‐ and six patients with PVC‐catheters developed clinical thrombophlebitis 4–36 days after insertion. The radiological thrombi were rather small with both PU‐ and PVC‐catheters in both peripheral and central veins with no significant difference between the catheters. Also, the incidence of thrombosis and the rate of catheter occlusions were similar. The surface topography of the PVC‐catheters was relatively smoother, but less uniform than that of the PU‐catheters. Platelet adhesion in vitro to the catheter surfaces, expressed as ATP‐concentration in relation to catheter area after contact with human blood, was relatively low with both catheters. The results suggest that soft PU‐ and PVC‐catheters have a similar thrombogenicity.
Cardiac Tamponade and Different Modes of Artifical Ventilation
Authors: Mattila I. , Takkunen O. , Mattila P. , Harjula A. , Mattila S. , Merikallio E.
Published: January 2009

Cardiac tamponade after open‐heart surgery often occurs in a situation when the patient is still mechanically ventilated and needs circulatory support with catecholamines. To evaluate the effects of different modes of artificial ventilation and dopamine on cardiac tamponade, an experimental study was carried out in seven mongrel dogs. In pentobarbital ‐ N2O anaesthesia, a cardiac tamponade of 20 mmHg was produced by injecting 120–200 ml of normothermic saline into the pericardium. Intermittent positive pressure ventilation (IPPV) and positive end‐expiratory pressure (PEEP) ventilation with frequencies of 12 and 20 were tested before and after producing the tamponade. Cardiac tamponade produced a significant fall in arterial pressure and cardiac output, a significant rise in central venous pressure and only a slight increase in pulmonary arterial pressure. PEEP with the slower ventilation frequency of 12 produced additional, significant falls in cardiac output and systemic arterial pressure, which were not noted with the ventilation frequency of 20 and PEEP. Dopamine infusion increased the cardiac output by increasing the heart rate during tamponade. It is concluded that PEEP ventilation with a slow frequency should not be used if cardiac tamponade is suspected after open‐heart surgery, and that dopamine has a favourable effect on haemodynamics even in the presence of a severe cardiac tamponade.
Midazolam as Induction Agent Prior to Inhalational Anaesthesia: A Comparison with Thiopentone
Authors: NilssonM.D. A. , Lee P. F. S. , Revenäs B.
Published: January 2009

Midazolam, a new water‐soluble benzodiazepine, was compared with thiopentone as an induction agent prior to inhalational anaesthesia. Induction time, cardiovascular response and venous sequelae were studied in 100 healthy in‐patients randomly divided into two groups. Midazolam proved to be a good alternative to thiopentone, the longer induction time being compensated by a lower incidence and duration of apnoea.
Alfentanil and Skeletal Muscle Circulation, Oxygen Consumption and P50
Authors: Berthelsen P. , LehdPedersen J. , Strøm J. , Eriksen J. , Rasmussen J. P.
Published: January 2009

The preservation of blood flow to skeletal muscles has low priority in the intact organism. If cardiovascular function is disturbed, for example by anesthetic drugs, skeletal muscle circulation diminishes or stops. Skeletal muscle surface pH (m‐pH) is a sensitive indicator of muscle cell oxygenation and a fall in m‐pH therefore provides an early warning of deterioration in overall cardiovascular performance. In the present study we investigated the peripheral effects of a new short‐acting fentanyl derivative, alfentanil. Twelve dogs were anesthetized with a bolus injection of alfentanil 0.16 mg‐kg‐1 i.v. M‐pH was recorded continuously, while total body oxygen consumption, oxygen transport and P50 were calculated. No changes were found. In the second part of the study, we pretreated six of the dogs with the “calcium antagonist” verapamil 0.5 mg‐kg‐1, while the other six dogs served as controls. After a rechallenge dose of alfentanil, we again found the peripheral perfusion sufficient to meet the oxygen demand of the muscles. Side‐effects to alfentanil were a decrease in Pao2, due to an increase in pulmonary shunting of venous blood, and an increase in Paco2. The changes in pulmonary ventilation‐perfusion relationships were, however, not of a magnitude that should cause concern when alfentanil is used in normal subjects.
T and B Lymphocyte Function in Anaesthetists
Authors: Salo M. , Eskola J. , Nikoskelainen J.
Published: January 2009

Humoral and cell‐mediated immune functions of eight male anaesthetists working in scavenged operating theatres and eight male internists were compared. No differences could be observed between the groups in the numbers of unstimulated, pokeweed mitogen (PMW)‐ and Staphylococcus aureus Cowan I (StaCw)‐stimulated plaque‐forming (immunoglobulin producing and secreting) cells or in IgG, IgM and IgA amounts secreted into the culture medium by stimulated lymphocytes. The proliferative responses of lymphocytes to phytohaemagglutinin, concanavalin A, PWM, StaCw and the purified protein derivative of tuberculin, and the function of the hydrocortisone‐sensitive suppressor cells were also similar in both groups. These results do not show any harmful effects of operating theatre work in scavenged theatres on T and B lymphocyte responses in male anaesthetists.
Cardiorespiratory Effects of Nalbuphine and Morphine Premedication in Adult Cardiac Surgical Patients
Authors: Lake C. L. , Duckworth E. N. , DiFazio C. A. , Magruder M. R.
Published: January 2009

Premedication for cardiac surgical patients attempts to achieve relief of anxiety with minimal or no cardiorespiratory changes. Nalbuphine (NUBAIN) and morphine produced similar decreases in respiratory rate (1 ‐3 breaths per min) and Pao2 (averaging 1.34 kPa), and increases in arterial Paco2 (averaging 0.56 kPa). Cardiovascular changes were not seen with either agent. A similar degree of sedation and relief of anxiety was achieved with both drugs. Side effects were minimal and infrequent. Nalbuphine produces respiratory depression and sedation without cardiovascular changes which is comparable to an equivalent dose of morphine in patients with either valvular or coronary artery disease.
Anaesthesia System With Eliminated Spill Valve Adjustment and Without Lung Rupture Risk
Authors: Ruben H.
Published: January 2009

A new anaesthesia system is presented. Apart from the inclusion of an inflating valve which is influenced by bag compression, the components are those commonly used in any absorption circuit, but arranged in a new sequence. The anaesthesia system is characterized by its use of a spill valve with a fixed low opening pressure, thus eliminating the commonly haphazard adjustment of this valve. The magnitude of the fresh gas flow does not influence the pressure in the bag during its compression, thereby introducing the “closed system” bag feeling, otherwise excluded with semiclosed and high flow systems. For the same reason, dangerous pressures cannot arise in the lung, as its peak pressure is defined by the volume inflated from the bag, and is controllable by the anaesthetist. Dumping of expired air in preference to fresh gas makes gas expenses optimally low with any semi‐closed inflow. The permanent low pressure inside the carbon dioxide absorber makes it easier to produce a tightly closed system and also makes more economical use of expensive gases. Disclosure of disconnection by a steadily rotating volumeter pointer may add to safety, the same feature apparently also being helpful in teaching proper mask technique.
Preoperative Haemodynamic Evaluation of Patients Submitted for Renal Artery Stenosis
Authors: Sørensen M. Bredgaard , Brahe N. E. Bille
Published: January 2009

The ECG, chest x‐ray and haemodynamic parameters were investigated preoperatively in 19 patients subjected to surgery for renal artery stenosis (RAS) and in a control group comprising 19 nonnotensive patients subjected to other forms of major vascular surgery. Increased cardiac volume was demonstrated in 13 (68%) RAS patients and in two (11%) patients from the control group. Abnormal ECG (i.e. left ventricular hypertrophy or atrial fibrillation) was observed in 11 (58%) RAS patients and in one (5%) patient from the control group. In the RAS patients the following haemodynamic parameters were found to be statistically significantly increased, compared to the control group: systemic blood pressure, (systolic arterial pressure:+43%, diastolic arterial pressure:+38%, mean arterial pressure:+41%), pulmonary artery mean pressure (+ 64%), pulmonary capillary wedge pressure (+ 107%), heart rate (+ 15%), systemic vascular resistance (+ 27%), left ventricular minute work index (+46%) and right ventricular minute work index (+ 67%). The presence of increased cardiac volume and abnormal ECG were more closely related to the level of the pathologically increased pulmonary artery mean and wedge pressures than to the systemic blood pressure or central venous pressure. A preoperative haemodynamic evaluation is recommended to determine the degree of heart failure in RAS patients with: 1) left ventricular hypertrophy and increased cardiac volume, or 2) atrial fibrillation.
Influence of Alpha‐ and Beta‐Adrenergic Blockade on Systemic and Pulmonary Hemodynamics During Intravenous Administration of Local Anesthetics
Authors: Yukioka H. , Tatekawa S. , Nishimura K. , Fujimori M.
Published: January 2009

The effects of alpha‐ and beta‐adrenergic blockade on the systemic and pulmonary circulation during i.v. bolus injection of sub‐seizure doses of lidocaine and bupivacaine were studied in dogs anesthetized with nitrous oxide. Pretreatment with hexamethonium or propranolol produced a marked decrease in cardiac output (CO), although pretreatment with phenoxybenzamine inhibited the decrease in CO during i.v. administration of lidocaine. Pretreatment with hexamethonium or phenoxybenzamine attenuated the increase in total peripheral resistance (TPR) following lidocaine 10 mg/kg i.v. In contrast, the propranolol‐treated dogs developed a marked increase in TPR. The increases in mean pulmonary arterial pressure and pulmonary vascular resistance (PVR) following lidocaine 10 mg/kg i.v. were blocked by pretreatment with hexamethonium. Furthermore, PVR increased markedly with pretreatment with propranolol, although pretreatment with phenoxybenzamine prevented the large increase in PVR. These findings indicate that lidocaine has both a direct depressant effect and an indirect beta adrenergic stimulant effect on the heart. Systemic or pulmonary vasoconstriction following intravenous administration of lidocaine 10 mg/kg is associated primarily with an indirect stimulant effect mediated by alpha‐adrenergic mechanisms. Bupivacaine, as well as lidocaine, has an indirect stimulant effect mediated by the autonomic nervous system.
Postoperative Course of Serum Aminotransferases After Total Hip Arthroplasty
Authors: Benoni G. , Johnell O. , Rosberg B.
Published: January 2009

Skeletal muscle trauma and acute coronary occlusion increase the values of aminotransferases, which might render the diagnosis of myocardial infarction in connection with major orthopaedic surgery more difficult. To find clinically useful distinctions, the postoperative course of serum aminotransferases (ASAT, ALAT, LD, GT and ALP) was recorded for the first 3 weeks following total hip arthroplasty and compared with the values found in patients with acute myocardial infarction. The level of ASAT increased during the first days following surgery. The highest recorded value of ASAT during the first 4 days was found to be lower than corresponding values in patients with myocardial infarction, although an overlap between the groups was seen. However, the LD value did not increase significantly following surgery, in contrast to the findings in patients with myocardial infarction. Later in the postoperative course, values for ALAT, GT and ALP rose as well. Two case reports on myocardial infarction after total hip replacement are included.