bluuebunny/crossref_metadata_2025 huggingface dataset:
A placebo‐controlled trial of flumazenil given by continuous infusion in severe benzodiazepine overdosage
Authors: Höjer J. , Baehrendtz S. , Magnusson A. , Gustafsson L. L.
Published: January 2009

A controlled trial was performed to study the effect and any adverse reactions of continuously infused flumazenil in severe benzodiazepine overdosage. The study comprised 51 adults admitted to an intensive care unit with poisoning. Enrolment criteria were unconsciousness on admission and a clear response within 5 min after an i.v. bolus injection of 1 mg flumazenil. The level of consciousness was assessed according to a modified Glasgow coma scale immediately before and at defined intervals up to 12 h after injection. A double‐blind infusion was started 15 min after the bolus injection and administered for 5 h. The patients were randomly allocated to one of three groups: a group given flumazenil 0.5 mg/h, a group given flumazenil 0.1 mg/h and a placebo group. The groups were comparable in age, sex and toxicological laboratory results. There were no significant differences between the groups in the average coma score on admission or 15 min after the bolus injection. In the flumazenil 0.5 mg/h group the level of consciousness remained unchanged between the 15‐min recording and the subsequent assessments. In the two other groups the level of consciousness decreased significantly during the course of the infusion. The infusions were well tolerated. It is concluded that a continuous infusion of 0.5 mg of flumazenil per hour can prevent relapse into coma in patients with severe benzodiazepine poisoning aroused with a single injection of the antagonist.
Allowing pre‐operative patients to drink: effects on patients' safety and comfort of unlimited oral water until 2 hours before anaesthesia
Authors: Read M. S. , Vaughan R. S.
Published: January 2009

The effect of allowing patients unlimited access to oral water in the time up until 2 h pre‐operatively was the subject of a randomised, blind, controlled trial. No effect was seen on gastric volume or pH, or on plasma osmolality, and allowing water pre‐operatively was associated with a reduction in anxiety in the anaesthetic room.
Effect of aminophylline or physostigmine on recovery from nitrous oxide‐enflurane anaesthesia
Authors: Kesecioglu J. , Rupreht J. , Telci L. , Dzoljic M. , Erdmann W.
Published: January 2009

If facilities for recovery are limited, shortening the recovery time from general anaesthesia is important. A comparative study on the effect of 3 mg·kg‐1 aminophylline or 0.04 mg·kg‐1 physostigmine on duration and quality of the recovery time from nitrous oxide‐enflurane anaesthesia is presented. Three groups of 35 patients were observed, placebo being included for comparison in this double‐blind study. Without treatment, recovery from nitrous oxide‐enflurane inhalation anaesthesia lasted 18.8 ± 5.80 min. Aminophylline considerably shortened the recovery time (12.06 ± 3.52 min), whereas physostigmine did not (18.97 ± 9.18 min). In the physostigmine group, however, a remarkably calm recovery and early return of protective reflexes was observed. Although aminophylline shortens the recovery time, due to earlier incidence of pain and other disturbances, it cannot be recommended for general improvement of recovery, whereas physostigmine clearly improves the quality of recovery from nitrous oxide‐enflurane anaesthesia.
Arterial desaturation in healthy children during and after minor surgery
Authors: Walther‐Larsen S. , Sloth M. , Valentin N.
Published: January 2009

Pulse oximetry (PO) was applied to 79 otherwise healthy children during and after minor ENT surgery under general anaesthesia in private practice. The PO data were not available to the anaesthetist unless desaturation to ≤85% was present for ≥30 s. This occurred in 12 and 9 cases during anaesthesia and recovery, respectively, only 8 and 5 cases, respectively, being diagnosed clinically. Desaturation during and after anaesthesia was more common in children undergoing adenoidectomy than during procedures for which endotracheal intubation was not performed. During recovery, desaturation was more likely to occur in the same patients again. Lower values of Sao2 were found in younger children and in children resisting or crying at induction. There was a (weak) negative correlation between Sao2 and HR. As clinically undiagnosed desaturation occurs even in healthy children undergoing minor surgical procedures, a more widespread use of PO during and after anaesthesia may be advisable.
Measurement of transcutaneous P±o2, Pco2 and skin blood flow at different probe temperatures using mass spectrometry
Authors: Christensen P. , Hjarbæk J. , Jensen B. , Grønlund J.
Published: January 2009

Transcutaneously measured partial pressures of oxygen and carbon dioxide (Ptco2, Ptcco2) approximate the corresponding arterial values at a probe temperature of 44d̀C. The temperature‐dependent increase of Ptco2 and Ptcco2 is caused by an increased skin perfusion, a decrease in the mean diffusion path, a change of skin metabolism, a decrease of tissue solubility of oxygen and carbon dioxide and a right shift of the oxygen and carbon dioxide binding curves of blood. Seven healthy volunteer test subjects participated in the study. A transcutaneous probe connected to a mass spectrometer was placed on the earlobe of the test subject. Four measurements of the transcutaneous Po2, Pco2 and skin blood flow (from the washout kinetics of argon) were determined on each test subject. The first measurement was made with a transcutaneous probe temperature of 37d̀C. The probe temperature was then increased to 44d̀C before the next determination. Finally, two determinations were made at 37d̀C, separated by a time interval of 1 h. The Ptco2 and skin blood flow increased when the probe temperature increased from 37d̀C to 44d̀C. However, when the probe temperature was decreased again from 44d̀C to 37d̀C, the estimated skin blood flow returned to the initial value while the Ptco2 remained unchanged. It required a further 1 h before the Ptco2 returned to the initial value at 37d̀C. The most likely explanation of the experimental results is that heating of the skin to 44d̀C causes a reversible decrease in the skin metabolism.
Intravenous morphine and oxycodone for pain after abdominal surgery
Authors: Kalso E. , Pöyhiä R. , Onnela P. , Linko K. , Tigerstedt I. , Tammisto T.
Published: January 2009

Intravenous morphine and oxycodone were given double blind in doses of 0.05 mg/kg after major abdominal surgery to 39 patients. The dosing interval was 5 min, until the patient did not want any further analgesics. Less oxycodone was needed than morphine, both to achieve the “first state of pain relief” (13.2 mg vs. 24.9 mg) and during the whole 2‐h study period (21.8 mg vs. 34.2 mg). The “first state of pain relief” was achieved faster (28 min vs. 46 min) and lasted longer (39 min vs. 27 min) with oxycodone than morphine. Morphine caused more sedation and a greater decrease in the mean arterial blood pressure than oxycodone. In other respects the two opioids were comparable.
Cumulation of bupivacaine, desbutylbupivacaine and 4‐hydroxybupivacaine during and after continuous interscalene brachial plexus block
Authors: Pere P. , Tuominen M. , Rosenberg P. H.
Published: January 2009

Desbutylbupivacaine (DBB) and 4‐hydroxybupivacaine (4‐OHB) are major metabolites of bupivacaine. They may cumulate during continuous infusion blocks. In the present study, all patients received an interscalene brachial plexus block with 20–28 ml of 0.75% bupivacaine plus adrenaline. A catheter was introduced into the interscalene space, and an infusion of 0.25% bupivacaine (5–9 ml/h) was started and continued with ten patients for 24 h and with another ten for 48 h. An infiltration block of the suprascapular and intercostobrachial nerves was performed using 0.5% bupivacaine. Before surgery, light general anaesthesia was induced. For measurement of plasma concentrations of bupivacaine, DBB and 4‐OHB blood samples were taken before the block and 30 min, 3 h, 24 h and 48 h after the blocks as well as 30 min, 1 h, 2 h, 4 h and 6 h after the termination of the infusions. The highest plasma concentrations of bupivacaine, mean 1.84 μg/ml, were measured 30 min after the block. There was a slight but statistically significant rise in the bupivacaine concentrations between 24 and 48 h. The bupivacaine concentration decreased by 54% and 45%, on average, during the first 6 h following the 24‐ and 48‐h infusions, respectively. On average, the highest DBB concentrations were measured 2 h after the 24‐h infusion (0.31 ± 0.18 μg/ml) and 30 min after the 48‐h infusion (0.33 ± 0.13 μg/ml). The highest 4‐OHB concentrations were measured 1 h (0.18 ± 0.09 μg/ml) and 30 min (0.20 ± 0.05 μg/ml) after the 24‐ and 48‐h infusions, respectively. The increase of the 4‐OHB concentration between 24 and 48 h was statistically significant (P<0.005). The use of a large initial bupivacaine dose (150–210 mg) followed by a continuous infusion of 12.5–22.5 mg/h for 24 and 48 h, resulted in marked cumulation of bupivacaine and the two metabolites in the plasma. No toxic symptoms or potentially toxic concentrations were observed.
Oral atropine enhances the risk for acid aspiration in children
Authors: Randell T. , Saarnivaara L. , Oikkonen M. , Lindgren L.
Published: January 2009

Two modes of administration of an anticholinergic drug were compared in 58 healthy children undergoing adenoidectomy. The study was double‐blind and randomized. All children were premedicated with oral midazolam 0.5 mg/kg. Twenty‐nine children received oral atropine 0.03 mg/kg (Group A) and the rest were given i.v. glycopyrrolate 0.005 mg/kg at the induction of anaesthesia (Group G). In Group A, of 29 children, the stomach was empty in 2, pH was less than 2.5 in 23, the gastric volume was greater than 0.4 ml/kg in 19, and both these risk factors were present in 17 children. The same figures in Group G were 5 (NS), 14 (P<0.05), 10 (P<0.05) and 9 (P<0.05) children, respectively. The antisialagogue effect was similar in both groups.
Variation in spinal analgesia with plain bupivacaine 0.5% when repeated in the same patient
Authors: Anker‐MØoSller E. , Spangsberg N. , Christensen E. F. , Schultz P. , Dyring S. , Wernberg M.
Published: January 2009

The study was done to see if it was possible to predict the level of analgesia in repeated spinal blocks with our routine technique where the patient is seated during injection of plain 0.5% bupivacaine 3.5 ml at the L3L4 interspace and placed in the lithotomy position after 0.5 min. Thirty patients with tumour of the bladder had two spinal blocks during a 13‐month period. The segmental spread of sensory loss was tested with the pin‐prick technique. A wide range of height of blocks was found, increasing with age. Regression analysis on maximum cephalad spread of the second spinal analgesia against the first had a slope of 0.48 (P<0.01 for the hypothesis that the slope is zero). A significant correlation between the time for maximal cephalad spread was found, while the correlation between duration of thoracal analgesia was non‐significant.
Local changes in venous tone due to bolus injections
Authors: Lewis G. B. H. , Hecker J. F.
Published: January 2009

Solutions were infused at a constant rate into ear veins of anaesthetized sheep and changes in venous tone were measured from changes in pressures in the infusion line when boluses of drugs and solutions were given. Approximately one in six veins was unresponsive. These appeared to be larger veins and the lack of response was probably due to greater blood flow causing appreciable dilution of the test solutions with blood. Most veins gave a transient venoconstriction to boluses of saline which had been made acid or alkaline and also to boluses of drugs such as aminophylline, calcium chloride, noradrenaline, metoclopramide, pentobarbitone, ethanol and thiopentone. Transient venoconstriction was usually repeatable and in proportion to the amount of solution or drug given, but sometimes the magnitude of the response changed unpredictably. Papavarine and nicotinamide usually reduced tone.
Extradural block in obstetric patients: review of experience with gravity administration
Authors: Cohen S. , Amar D. , Nagashima H.
Published: January 2009

Charts of 2284 obstetric patients who received extradural block with gravity administration of local anaesthetic were evaluated retrospectively. Despite a 1.3% incidence of vascular puncture and a 1.8% incidence of dural puncture, accidental intravascular or intrathecal injection of local anaesthetic did not occur. We propose that this method may be safer than the traditional “injection by needle” technique, and has a high degree of “visualization” of the otherwise “blind” extradural block procedure.
Isorhythmic atrioventricular dissociation following pancuronium
Authors: Fonsmark L. , Wolff J.
Published: January 2009

We report a case of isorhythmic atrio‐ventricular dissociation caused by pancuronium. The possible mechanism of the rhythm disorder is discussed and the haemodynamic consequences are described. It will be useful to realise that the circulatory effects of the arrhythmia may be pronounced in patients with decreased cardiovascular reserve.
A comparison of median frequency, spectral edge frequency, a frequency band power ratio, total power, and dominance shift in the determination of depth of anesthesia
Authors: Drummond J. C. , Brann C. A. , Perkins D. E. , Wolfe D. E.
Published: January 2009

Five numerical descriptors were derived from the electroencephalogram (EEG), recorded, and processed (Tracor Nomad®) during emergence from isoflurane‐nitrous oxide anesthesia. The five descriptors (median frequency, spectral edge frequency‐90%, total power, a frequency band power ratio, and the ratio of frontal to occipital power) were compared for their ability to predict imminent arousal. Arousal was defined as spontaneous movement, coughing or eye opening. All of the descriptors except the frontal‐occipital power ratio underwent significant (P<0.05) changes between the initial recordings made intraoperatively during surgical stimulus under anesthesia and later recordings in the 40 s preceding arousal. A post hoc analysis was performed to identify the threshold value for each parameter that best served to predict imminent arousal. For median frequency, spectral edge frequency‐90%, total power, and the frequency band power ratio, thresholds that predicted imminent arousal with sensitivities of 90% and specificities of 82–90% could be identified. The data indicate that, even in the favorable circumstances of the present study (uniform anesthetic technique, post hoc identification of thresholds), none of several previously popularized EEG descriptors (median frequency, spectral edge frequency‐90%, total power, a frequency band power ratio) can serve as a completely reliable sole predictor of imminent arousal. As presently derived, these EEG descriptors at best provide trend information to be used in concert with other clinical signs of depth of anesthesia.
Failure of transcutaneous electrical nerve stimulation and indomethacin to reduce opiate requirement following cholecystectomy
Authors: Laitinen J. , Nuutinen L.
Published: January 2009

This randomized study examined the effect of transcutaneous electrical nerve stimulation (TENS) and indomethacin on postoperative opiate requirement in 60 patients after cholecystectomy. An open intravenous bolus of 25 mg of indomethacin followed by an infusion of 5 mg in 1 h, alone or combined with either low or high frequency TENS, was administered during the study period of 16 h. An intravenous bolus of either 5 mg of oxycodone or 0.15 mg of buprenorphine was administered double blindly for postoperative pain relief. The number of doses of buprenorphine given (3, 9) differed (P = 0.01) from the number of doses of oxycodone given (5, 4). Neither indomethacin nor TENS reduced the postoperative opiate requirement.
Gas flow distribution in distal high frequency jet ventilation and lung thorax compliance
Authors: Spoelstra A. J. G. , Tamsma T. J. A.
Published: January 2009

To investigate the influence of changes in thorax and lung compliance on ventilation during distal High Frequency Jet Ventilation (HFJV), similar ventilator settings were compared before and after changing the compliance in two groups of anaesthetized mongrel dogs. Each period of distal HFJV was preceded by adequate Intermittent Positive Pressure Ventilation (IPPV) to assure a start with baseline values. In Group 1 (n = 7), thorax compliance was changed by chest strapping, while in Group 2 (n = 7) lung compliance was changed by inducing acute lung injury by injection of oleic acid into the right atrium. Gas flow distribution in the ventilatory circuit during distal HFJV was determined before and after the changes in compliance were induced. Comparing similar ventilator settings during distal HFJV in the same dog, a decrease in lung or thorax compliance led to changes in gas flow distribution in the ventilatory circuit. Entrainment was decreased and bypass increased with a negative effect on the gas volume entering the lungs and on gas exchange. The results indicate that distal HFJV should be regarded as pressure‐limited ventilation.
Hemodynamic effect of the prone position during anesthesia
Authors: Yokoyama M. , Ueda W. , Hirakawa M. , Yamamoto H.
Published: January 2009

We studied 21 patients undergoing lumbar spinal surgery under halothane anesthesia on a convex saddle frame, in order to determine the hemodynamic effect of the prone position. A thermodilution pulmonary arterial catheter was placed in 14 patients (Group PA‐1: n = 8; and Group PA‐2: n = 6), and an inferior vena caval catheter in the remaining seven patients (Group IVC). Group PA‐1 and Group IVC patients were placed in the prone position on a convex saddle frame. In the prone position, the cardiac index (CI) decreased significantly from 3.1 ± 0.5 to 2.5 ± 0.3 (1·min‐1·m‐2 mean ± s.d., P<0.01) without accompanying significant changes in the other hemodynamic variables in Group PA‐1. The postural change in Group IVC did not exert a significant effect on the inferior vena caval pressure. Group PA‐2 were initially placed in the flat prone position on a flat saddle frame, which produced no significant changes in the hemodynamic variables. Then the convex curvature of the frame was adjusted to the grade appropriate for surgery, which produced a significant reduction in CI (from 2.9 ± 0.3 to 2.4 ± 0.4, P<0.05). We conclude that the prone position itself may not interfere with the circulatory function. The prone position using a convex saddle frame causes significant reductions in CI, but little change in the other hemodynamic variables.
Prevention of endotoxin‐induced increase of cerebral oxygen consumption in dogs by propranolol pretreatment
Authors: Westerlind A. , Larsson L. E. , Häggendal J. , Ekström‐Jodal B.
Published: January 2009

Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo2) were studied in experimental endotoxic shock in dogs. Eight animals were pretreated with a beta‐adrenoceptor blocking agent, propranolol (PPL),per as12 mg/kg once a day for 7 days. Ten animals served as controls. After an intravenous injection of endotoxin, 1 mg/kg, CBF decreased in both groups, with no significant differences between the groups. CMRo2, increased in the control animals by about 18% from the baseline value both 1 and 2 h after the injection of endotoxin. CMRo2in the PPL‐pretreated animals was unchanged after endotoxin. The CMRo2‐reactions to endotoxin in control and PPL animals were significantly different after both 1 and 2 h (P<0.05). The present results indicate that the increase in CMRo2following intravenous endotoxin is mediated via beta‐adrenoceptors.
Intravenous ketamine for prevention of severe hypotension during spinal anaesthesia
Authors: Hemmingsen C. , Nielsen J. E. Klint
Published: January 2009

Spinal block causes paralysis of preganglionic sympathetic fibres, while ketamine induces activation of the sympathetic nervous system. Hypotension is a frequent complication during spinal anaesthesia and is associated with an increased risk of postoperative mortality. The aim of our study was to compare circulatory changes in patients who received either fentanyl or ketamine during spinal anaesthesia. Thirty patients (ASA I‐III) scheduled to undergo spinal anaesthesia for osteosynthesis of hip fractures were allocated to receive either ketamine or fentanyl intravenously during the procedure. Immediately before anaesthesia, 7 ml/kg BW of an isotonic NaCl solution was administered i.v. Patients received either fentanyl 1.5 mg/kg BW i.v. before anaesthesia, or ketamine 0.7 mg/kg BW i.v. before anaesthesia, and 0.35 mg/kg BW 15 and 30 min after the first dose. No prophylactic vasopressor was used. During the first 40 min of anaesthesia a fluid load of 14 ml/kg BW was given i.v. If the mean arterial pressure (MAP) fell more than 20%, the infusion rate was increased. If the reduction in MAP exceeded 33% or if the systolic pressure decreased to less than 80 mmHg, patients were registered as haemodynamically unstable. In both groups the spinal anaesthesia caused a reduction in MAP. The MAP was lower in the fentanyl group than in the ketamine group at all times. In the kentanyl group six subjects developed a haemodynamically unstable condition, while only one subject in the ketamine group was registered as such (P<0.05). There was no significant change in heart rate in either group. We conclude that during spinal anaesthesia patients can in part be kept haemodynamically stable by intravenous administration of ketamine.
Influence of nitrous oxide administration and discontinuation thereof on blood flow in cerebral cortex, cerebellum and brain stem in the rat
Authors: Carlsson C. , Vasthare U. S. , Tuma R. F. , Rocco M. J. , Dombkoski R. A.
Published: January 2009

The effect of nitrous oxide on blood flow in the cerebral cortex, the cerebellum and the brain stem was evaluated in a rat model. Catheters were surgically implanted in advance to avoid influence from other anaesthetics. The animals were housed in a plastic tube where they were allowed to breathe spontaneously. Blood flow was determined with a microsphere technique. Animals were exposed to nitrous oxide, 75–80%, for 45 min and blood flow was measured after 15 and 45 min exposure and was compared to values obtained during room air breathing. In one animal group, nitrous oxide was administered for 45 min and blood flows were measured after 5 and 30 min withdrawal of the gas. Results showed that all animals had significant hyperventilation. In three groups CO2 had to be added to inspiratory gases to normalize arterial blood gases. This was interpreted as caused by stressful experimental conditions, not blunted by the nitrous oxide. Cortical blood flow values in the control situation were also higher than obtained in other animal studies. Despite this, nitrous oxide showed a significant vasodilatation in the cerebral cortex and the brain stem at 15 min exposure. At discontinuation of nitrous oxide administration, blood flow values had decreased at 5 min.
Furosemide, when used in combination with positive end‐expiratory pressure, facilitates the resorption of extravascular lung water in experimental hydrostatic pulmonary oedema
Authors: Wickerts C.‐J. , Blomqvist H. , Berg B. , Rösblad P.‐G. , Hedenstierna G.
Published: January 2009

The study aimed to establish whether furosemide given intravenously improved resorption of hydrostatic pulmonary oedema in 14 dogs mechanically ventilated with positive end‐expiratory pressure (PEEP). Hydrostatic pulmonary oedema was created by simultaneous inflation of a left atrial balloon and rapid intravenous infusion of isotonic saline. The hydrostatic process was terminated by deflating the balloon and reducing the infusion rate. A PEEP of 10 cmH2O (1.0 kPa) was applied in all animals; in seven, furosemide was administered (diuretic group), 1 mg/kg intravenously as a bolus followed by an infusion of 0.5 mg/kg per hour, while the remaining seven dogs served as a control group. All dogs were studied for a period of 4 h. The extravascular lung water measured with the double indicator dilution technique was 28.3 ± 3.8 (diuretic group) and 28.2 ± 6.8 ml/kg (control group) during maximum oedema. It was reduced to 16.4 ± 2.2 (diuretic group) vs 19.8 ± 3.7 ml/kg ·(control group) after 4 h of resorption, P<0.05. Postmortem gravimetric values of extravascular lung water were 9.1 ± 3.4 (diuretic group) vs 12.6 ± 5.0 g/kg (control group). In the diuretic group the urinary output increased threefold, and haemoglobin and serum protein concentrations were higher than in the control group. There was a significantly greater decrease in cardiac output and central blood volume in the diuretic group. In conclusion, furosemide given intravenously improved lung fluid resorption in hydrostatic pulmonary oedema, probably by increasing the plasma colloid osmotic pressure.
Termination of paroxysmal supraventricular tachycardia with a nasogastric tube — a case report
Authors: Gupta A. , Lennmarken G. , Lemming D. , Lindqvist J.
Published: January 2009

The case is described of a 29‐year‐old man with a history of recurrent attacks of paroxysmal supraventricular tachycardia. The patient presented to the emergency ward with complaints of palpitations which had not been relieved by vagal stimulation maneuvers and propranolol. When intravenous metoprolol failed to convert the rhythm, a nasogastric tube was passed which immediately converted the tachycardia to normal sinus rhythm. The literature is reviewed and problems and complications of various techniques are discussed.
Ventricular dysrhythmias following an alfentanil anesthetic in a patient on reserpine for hypertension
Authors: Jahr J. S. , Weber S.
Published: January 2009

The case is presented of a hypertensive patient on reserpine, who developed ventricular irritability after administration of alfentanil, a new ultra‐short‐acting narcotic used in anesthesia. The dysrhythmias resolved after cessation of the offending agent. There are no reported cases of interaction of reserpine and alfentanil in the literature.
Hypertonic saline and dextran in normovolaemic and hypovolaemic healthy volunteers increases interstitial and intravascular fluid volumes
Authors: Tølløfsrud S. , Tønnessen T. , Skraastad ø. , Noddeland H.
Published: January 2009

Background: Hypertonic saline (HS) is increasingly used for fluid resuscitation in hypovolaemic patients. Although the effects of HS have been investigated in animal models, controlled studies in healthy human individuals are few. Aim: The effects of iv. hypertonic saline 75 mg . ml‐1 in dextran 70, 60 mg . ml‐1 (HSD) infusion on fluid shifts between the interstitial and intravascular fluid spaces, diuresis and haemodynamics were studied in normovolaemic and moderately hypovolaemic healthy volunteers.

Material and methods: Nine fasting subjects received 4 ml . kg‐1 HSD as a 10‐min infusion in a normovolaemic situation. Seven days later they served as their own controls in a hypovolaemic situation after 10% of the calculated blood volume had been withdrawn during a 15‐min period. Before and after the HSD infusion, interstitial colloid osmotic pressure (COPi) and interstitial fluid hydrostatic pressure (Pi) were measured on the lateral part of the thorax. During the study, blood sampling and pressure measurements were performed through a radial artery cannula, and central venous pressure measured through a catheter in the cubital vein.

Results: In these awake and normovolaemic healthy volunteers, HSD infusion caused a transitory unpleasant sensation of headache and heat in the thorax up to the throat. A transitory haemodynamic effect was found with increased heart rate (HR), increased mean arterial pressure (MAP) from 77 ± 5 mmHg to 92 ± 13 mmHg (P<0.05) and CVP increase from 5 ± 1 mmHg to 8 ± 1 mmHg (P<0.05) after end of infusion. A haemodilution with increase in calculated blood volume lasting longer than the MAP increase was observed, with decreased COPi from 14.4 ± 2.2 mmHg to 12.1 ± 2.0 mmHg (P<0.05). The diuresis measured at 180 min was higher in the normovolaemic than in the hypovolaemic situation. More pronounced effects of the infused fluid (HSD) on calculated blood volume, interstitial compartment and CVP were observed during moderate hypovolaemia.

Conclusions: HSD infusion resulted in increased calculated blood volume with increased HR, MAP, and CVP. These effects were greater in a hypovolaemic situation. The haemodilution was most likely caused by fluid shifts from the intracellular compartment to the interstitial and vascular fluid spaces, eventually increasing diuresis.
Perioperative transoesophageal echocardiography with low‐dose dobutamine stress for evaluation of myocardial viability: a feasible approach?
Authors: Palmgren I. , HultmanM.D J. , Houltz E.
Published: January 2009

Background: The feasibility of low‐dose dobutamine stress combined with transoesophageal echocardiography (TEE) to detect viable left ventricular myocardium was evaluated in 22 anaesthetised patients prior to sternotomy for elective coronary artery bypass grafting (CABG).

Methods:After baseline measurements, a dobutamine infusion beginning with 5 μg . kg‐1 . min‐1 was started and eventually increased to 10 μg . kg‐1 . min‐1. Viability was assessed as visual improvement of left ventricular wall motion (LVWM). The criteria for discontinuation of the infusion were: 1. any changes in LVWM, 2. an increase in preanaesthetic blood pressure exceeding 40 MMHg, and/or a >20% increase in preanaesthetic heart rate compared to preanaesthetic levels. An off‐line evaluation of LVWM was based upon visualisation of the left ventricle in a transgastric short‐axis mid‐papillary (mid‐P) view, and the left ventricle was divided into anterior, septal, inferior, and lateral segments. Moreover, an off‐line semiautomatic analysing system was used for assessing regional and global LVWM. With this analysis the effects on LVWM from changes in preload and afterload could be addressed.

Results: 19 patients showed a decreased LVWM in one or several segments at baseline. A total of 36 segments exhibited decreased LVWM (an average of 1.9 segments/patient). Of these, 22 segments (61%) improved with dobutamine, while 12 segments (33%) did not, and 2 (6%) became more dysfunctional. Another 6 segments with normal motion at baseline became dysfunctional with dobutamine. According to the off‐line semiautomatic analysing system for LVWM, there were no statistically significant changes with dobutamine stimulation. Only one patient showed an increased postoperative aspartateamino‐transferase (ASAT) value (3.0 mmol . 1‐1) but no ECG changes.

Conclusion: Since we regard the visual assessment of LVWM as being more applicable for this protocol than the semiautomatic analysis, we conclude that low‐dose dobutamine stress echocardiography seems to be a feasible method for detecting viable myocardium in the anaesthetised patient scheduled for elective CABG surgery. However, the semiautomatic analysis complemented our findings, since the variations in pre‐ and afterload did not significantly change the size of the left ventricle, which hereby would imply LVWM changes.
Intubation difficulties in patients with rheumatoid arthritis
Authors: Hakala .P. , Randell T.
Published: January 2009

Background: Fibreoptic intubation has been suggested to be the best method to manage a compromised airway. This retrospective study was designed to compare endotracheal intubation with the help of a rigid laryngoscope or a fibrescope in patients with rheumatoid arthritis.

Methods: Intubation difficulties with the laryngoscope and the fibrescope in patients with rheumatoid arthritis were investigated during a period of five and a half years. The anaesthesia records were used for analysis. The patients were divided into two groups (group I with 41 patients and group II with 37 patients) reflecting the change in the routine airway management in patients with rheumatoid arthritis in our hospital from the beginning of 1993. Before that time the patients were usually intubated orotracheally under general anaesthesia, but since 1993 rheumatoid patients with anticipated difficulties in endotracheal intubation have been preferably intubated fibreoptically awake under sedation and topical anaesthesia with a fibrescope.

Results: Major difficulties in endotracheal intubations were encountered in 13% of patients in group I and in 8% in group II. On two occasions in group I tracheostomy was needed. In one of these patients, emergency tracheostomy was performed. In the latter group, the main reason for prolonged fibreoptic intubations was lack of experience.

Conclusion: The introduction of fibreoptic intubation technique has had a favourable influence on the safety in the airway management of surgical patients with rheumatoid arthritis.
Comparison of subhypnotic doses of thiopentone vs propofol on the incidence of postoperative nausea and vomiting following middle ear surgery
Authors: Honkavaara P. , Saarnivaara L.
Published: January 2009

Background: Middle ear surgery is associated with a high incidence of emetic sequelae and propofol has been reported to have antiemetic activity in subhypnotic doses.

Methods: In a double‐blind, randomized study, the patients received either thiopentone 1.0 mg.kg‐1 (n=26) or 0.5 mg.kg‐1 propofol (n=26) at the end of middle ear surgery under isoflurane‐N2O‐fentanyl‐vecuronium anaesthesia. Trained nurses, unaware of the group assignment, assessed postoperative nausea, retching and vomiting up to 24 h after the end of anaesthesia. Droperidol 10μg.kg‐1 was used as a “rescue” antiemetic.

Results: The main result was that the patients in the propofol group did not suffer from retching and vomiting (R&V) during the first 6 h, whereas these symptoms occurred in 46% (P<0.001) of the patients in the thiopentone group. The patients in the propofol group needed significantly less droperidol during the first 24 h (mean number of doses 0.39 ± 0.57 (SD)) than the patients in the thiopentone group (1.35 ± 1.47, P<0.005). Treatment with propofol was a predictor for lowered incidence of R&V, as well as male gender and negative history of motion sickness.

Conclusion: Propofol at a subhypnotic dose of 0.5 mg.kg‐1 provides prophylaxis against retching and vomiting for the first 6 h postoperatively after middle ear surgery. The incidence of nausea was not reduced by propofol.
Intravenous fluid and postoperative nausea and vomiting after day‐case termination of pregnancy
Authors: Elhakim Dr.M. , El‐Sebiae S. , Kaschef N. , Essawi G. H.
Published: January 2009

Background: Deprivation of oral fluid before minor surgery has been alleged to cause postoperative nausea. We examined the effect of intraoperative fluid load on postoperative nausea and vomiting over 3 d after day‐case termination of pregnancy.

Methods: In a randomized study, 100 patients were allocated into one of two groups; receiving 1000 ml of compound sodium lactate solution during surgery or no intraoperative fluid. Propofol and alfentanil was used to induce and maintain anaesthesia with nitrous oxide (67%) and oxygen (33%). Visual analogue scores for nausea and pain, the time and frequency of emetic episodes, analgesic and antiemetic consumption were recorded for 3 d postoperatively.

Results: The scores of nausea were significantly lower in the fluid group (P<0.05) compared with the control group at 1, 2, 4 h and during 24–48 h following surgery. The incidence of emesis was lower (P<0.01) after discharge, and the time to first oral fluid was shorter (P<0.05) in the fluid group. There was no difference in pain score or analgesic consumption between the groups. Five patients (10%) in the control group requested antiemetic medication compared with none in the fluid group.

Conclusion: Intraoperative fluid administration may offer some benefit in decreasing the incidence of postoperative nausea and vomiting following day‐case surgery.
Limiting life support
Authors: Sjökvist P. , Sundin P.‐O. , Berggren L.
Published: January 2009

Background: Different aspects of withholding or withdrawal of life‐sustaining treatment have been described in the literature. However, there are few descriptions of local policies or protocols regarding the limiting of life support. The present study describes the pattern of limiting life support in a Scandinavian intensive care unit (ICU) and the experience with a special protocol for such decisions.

Method: Prospective study of decisions to limit life support in the ICU of a tertiary referral hospital during 1 year using a special protocol and medical records.

Results: A decision to limit life support was documented in the special protocol in 61/1008 (6%) of the patients and in 39/79 (49%) of the patients dying in the ICU. Poor prognosis and failure to respond to treatment were the most common reasons for foregoing life‐sustaining treatment. Of the 61 patients with a special protocol, 7 survived more than 3 months. The decision was altered for 5 patients towards additional limitations and for 4 patients towards fewer or no limitations.

Conclusion: Decisions to limit life support in the ICU are common. There is a substantial survival rate. A structured clinical protocol can be used for continuous follow‐up of decisions and the decision‐making process.
Platelet transfusion for surgery in the presence of polycythemia vera
Authors: Terasako K. , Sasai S.
Published: January 2009

Surgery in the presence of uncontrolled polycythemia vera is associated with a high incidence of perioperative hemorrhage and postoperative venous thromboses. Control prior to surgery reduces the frequency of perioperative complications. A 73‐year‐old women suffering from polycythemia vera was scheduled for subtotal gastrectomy. Her platelet count before surgery was slightly elevated but bleeding time was prolonged. To manage the current case of polycythemia vera, hydroxyurea was effective for the control of hematocrit and transfusion of platelet concentrates was effective for hemostasis.
Detrimental effect of a non‐selective nitric oxide synthase inhibitor on the energy state of the liver following acute endotoxemia in rabbits
Authors: Kaneda K. , Makita K. , Yokoyama K. , Toyooka H. , Amaha K.
Published: January 2009

Background: The effect of nitric oxide synthase (NOS) inhibitors in septic shock is very controversial. It is known that the administration of NOS inhibitors to normal subjects itself increases pulmonary vascular resistance with a concomitant decrease of cardiac output. Therefore, the hypothesis was tested that the detrimental effects of a non‐selective NOS inhibitor on liver energetics in a rodent model of endotoxemia are mediated by the adverse pulmonary circulatory effect of the drug itself.

Methods: Twenty anesthetized rabbits were instrumented and two separate experiments (a magnetic resonance spectroscopic study and a hemodynamic study) were performed under similar conditions. Animals were assigned randomly to either a control group (group 1; animals received lipopolysaccharide (LPS) at a dose of 400 μg/kg alone) or a treatment group (group 2; animals received NG‐nitro‐L‐arginine methyl ester (L‐NAME) at a dose of 7.5 mg/kg, 75 min after administration of LPS).

Results: In group 1, slight decreases in hepatic adenosine triphosphate (ATP) value were observed. In group 2, the decreases in ATP values were more prominent than those observed in group 1. LPS produced an acute drop in mean arterial pressure (MAP) with a concomitant increase in pulmonary vascular resistance (PVR) and a reduction in the cardiac output (CO) at 30 min after LPS. The administration of L‐NAME caused a transient increase in MAP with a concomitant increase in systemic vascular resistance at 2 h after LPS. However, these changes in PVR and CO were more prominent than in group 1.

Conclusion: These results suggest that alterations within the pulmonary circulation may be a contributing factor which was responsible for the non‐selective NOS inhibitor‐induced acute hepatic energy derangement after LPS.
Retinyl palmitate injections reduce serum levels and effects of endotoxin on systemic haemodynamics and oxygen transport in the pig
Authors: Eriksson M. , Modig J. , Larsson A. , Rollman O. , Eriksson Ö.
Published: January 2009

Background: Retinyl palmitate [(RP) 230 IU · kg‐1] modulates the circulatory and respiratory responses of a subsequent infusion of endotoxin in the pig. The aims of this study were: I. To determine if RP (2300 IU · kg‐1) affects the serum endotoxin levels in this model. II. To evaluate the effect of this dose of RP on circulatory and respiratory variables in our porcine model. III. To investigate the levels of RP and neutrophil count in porcine endotoxaemia.

Methods: Ten anaesthetized pigs were randomly given 2300 IU · kg‐1 of RP or the solvent i.m. prior to the continuous i.v. infusion of E. coli endotoxin (10 μg · kg‐1 · h‐1). Another 4 sham animals were given either i.m. RP (n=2) or i.m. solvent (n=2) followed by an infusion of saline. Haemodynamics and oxygen extraction were monitored and samples taken for analysis of endotoxin, RP and blood cells.

Results: I. Endotoxin levels in serum were lower (P<0.001) in the RP‐pretreated pigs. II. These animals had higher cardiac index (P<0.05), mean arterial pressure and left ventricular stroke work index (both P<0.001), and lower oxygen extraction (P<0.01). III. RP‐Pre=pretreatmert caused a paradoxical decrease in serum retinyl (P<0.001) and a more rapid restitution of neutrophil count (P<0.05).

Conclusion: Pretreatment with RP (2300 IU · kg‐1) counteracts the progressive increase in serum endotoxin levels in porcine endotoxaemia.
Bedside troponin T testing is not useful for early out‐of‐hospital diagnosis of myocardial infarction
Authors: Gust R. , Gust A. , Böttiger B. W. , Böhrer H. , Martin E.
Published: January 2009

Background: A new commercially available rapid qualitative bedside immunoassay for cardiac troponin T has been developed. The aim of the study was to investigate whether this new rapid bedside cardiac troponin T assay facilitates diagnosing myocardial infarction in a pre‐hospital setting.

Methods: We evaluated the sensitivity and specificity of the new rapid bedside troponin T assay for myocardial infarction. In 68 patients with acute, central, crushing chest pain, who were strongly suspected of having myocardial infarction, the emergency doctor performed preclinically a bedside cardiac troponin T test. The results were compared with the diagnosis after admission to hospital, using the criteria of the World Health Organization.

Results: The diagnosis of myocardial infarction was confirmed in 16/68 (24%) patients after admission to hospital, but only in 4/16 (25%) patients with myocardial infarction was a positive result observed preclinically with this test. The result was false positive in 1/5 patients (20%).

Conclusions: In contrast to an excellent specificity (0.98), sensitivity (0.25) of the rapid troponin T assay was poor. Thus, we conclude that this test cannot improve the distinction between myocardial infarction and angina pectoris in a pre‐hospital setting.
Transient radicular irritation (TRI) after spinal anaesthesia in day‐care surgery
Authors: Corbey M. P. , Bach A. B.
Published: January 2009

Background: A high incidence of backache with radiating pains to the lower extremities, termed transient radicular irritation (TRI), has been reported following the use of 5% hyperbaric lidocaine. This has been attributed to a neurotoxic reaction.

Methods: A retrospective audit has been carried out in our hospital on the postoperative anaesthetic records of all patients from the 1st of January 1993 to the 1st of September 1996, who received spinal anaesthesia with either hyperbaric lidocaine or hyperbaric bupivacaine for day‐care surgery.

Results: Backache was reported in 1.9% of patients (6/322) receiving hyperbaric lidocaine and in 2.4% of patients (1/41) receiving hyperbaric bupivacaine. This was not associated with any sensory, motor or sphincter disturbances. One patient complained of backache with bilateral pain referred to the gluteal area (TRI), which was assessed as acute facet joint syndrome. Unilateral accidental block of the femoral nerve was observed in 3 patients, sensory disturbances in the L2/3 dermatome was reported in a further 3 patients at 24 h, following wound infiltration with local anaesthetic during hernia repair.

Conclusions: The low incidence of backache at 24 h and the absence of associated symptoms of neurogenic pain, sensory and motor disturbances, does not support the hypothesis that TRI is a neurotoxic reaction, subsequent to the use of hyperbaric lidocaine.
Anaesthesia for videoarthroscopy of the knee
Authors: Naidu‐Sjösvärd K. , SJöberg F. , Gupta A.
Published: January 2009

Background: The newer inhalational agents desflurane and sevoflurane have a low blood‐gas partition coefficient and are not very fat soluble, and consequently recovery is rapid and smooth. Very few studies have been published concerning adults where a direct comparison has been made between sevoflurane and desflurane in the ambulatory setting.

Methods: This study was done to assess aspects of recovery following minor ambulatory videoarthroscopic knee surgery in 50 ASA I‐II patients. Baseline values were obtained on the following psychomotor tests: digit symbol substitution test (DSST), perceptive accuracy test (PAT) and simple reaction time (SRT). The patients were then randomly allocated to one of two groups according to an open (unblinded) study design: Group D (Desflurane) were maintained on desflurane while Group S (Desflurane) were maintained on sevoflurane. Propofol was used as the induction agent in all patients and the larynx mask was used to maintain a free airway. Oxygen and air (FiO2 0.33) were used as the carrier gases. The concentration of desflurane or sevoflurane was adjusted in order to maintain adequate anaesthesia and stable haemodynamics. Alfentanil was given at induction and every 15 min as an analgesic. At the end of the operation, the gases were turned off abruptly and 100% oxygen was delivered at 6 L/min until eye‐opening. Early recovery was measured by the time to eye‐opening, giving name and date of birth. Intermediate recovery was measured by psychomotor testing every 30 min, and the time to sitting up in bed, drinking fluids and discharge home by a nurse who was blinded to the anaesthetic technique.

Results: Early recovery was quicker in the desflurane compared to the sevoflurane group (P<0.001). Psychomotor recovery as measured by the PAT occurred significantly earlier in the desflurane compared to the sevoflurane group at 15 and 45 min (P<0.001) and as measured by the DSST at 30 min (P<0.05). The number of patients who could not perform the SRT test at 15 min was greater in the sevoflurane compared to the desflurane group (13 vs 0) (P<0.01). No differences were found in other recovery parameters, including home discharge, between the groups. The incidence of pain and other minor postoperative complications was similar between the groups except for sore throat which was higher in the desflurane group.

Conclusion: Early and intermediate (psychomotor) recovery is quicker in the desflurane compared to the sevoflurane group, but there is no difference in discharge times between the groups.
Intra‐ and postoperative myocardial ischemia without significant coronary artery stenosis
Authors: Kindgen‐Milles D. , Vester E. G. , Muller E. E.
Published: January 2009

A 73‐year‐old man without a history of coronary artery disease had two episodes of significant ST‐segment elevation indicative of inferior myocardial ischemia during the resection of an abdominal aortic aneurysm. During the further course, sudden ST‐segment elevations occurred and resolved spon taneously without preceding hemodynamic instability. The patient sustained two episodes of cardiac arrest due to ventricular fibrillation and intermittent third‐degree atrioventricular block with ventricular asystole. On cardiac catheterization, coronary arteries had a right dominant pattern. The right coronary artery w as entirely patent on multiple injections. Thus, right coronary artery spasm is the only possible explanation for these observations.