bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Analgesic Dose‐Effect Relationships of Nefopam and Oxycodone in Postoperative Pain
Authors: Tigerstedt I. , Tammisto T. , Leander P.
Published: January 2009

The analgesic dose‐effect relationship of nefopam was compared in a double‐blind randomised trial with that of oxycodone in immediate postoperative pain. Nefopam 15 mg or oxycodone 4 mg was given every 10 min i.v. (maximum six times) to patients in pain after upper abdominal surgery until their wound pain (scored 0–3) disappeared. The mean pain intensity (PI), initially 2.2 in both groups, decreased by approximately the same extent for up to two doses in both groups (to 1.5 after nefopam 30 mg and to 1.1 after oxycodone 8 mg). Thereafter PI was significantly less in the oxycodone group and diminished almost linearily to 0.1 after the sixth dose (24 mg). In the nefopam group, the PI score fell to 1.1 after the fourth dose (60 mg). This seemed to be the “ceiling” effect since additional doses up to 90 mg did not result in greater pain relief. In the oxycodone group, only two patients (12%) needed maximal dosage (6 times 4 mg), one of them requiring 32 mg of oxycodone. In the nefopam group, 12 patients (75%) needed further pain relief after the maximal dosage (6 times 15 mg). In these patients, oxycodone (maximally 16 mg) gave satisfactory analgesia. Drowsiness and a decrease in the respiratory rate were the principal side‐effects of oxycodone, whereas tachycardia, restlessness, sweating and nausea were more frequent after nefopam.
Flunitrazepam Versus Placebo Premedication for Minor Surgery
Authors: Kanto J. , Kangas L. , Mansikka M.
Published: January 2009

The clinical effects of oral flunitrazepam (2 mg on the night before operation followed by 2 mg on the morning of operation) and placebo as premedicants were tested in a double‐blind study in 81 gynaecological patients. The separate or total concentrations of flunitrazepam and its demethylated metabolite in plasma (measured by gas chromatography) were correlated with the clinical effects of flunitrazepam prcmedication, assessed both subjectively and objectively. In most parameters tested (sleep on the night before operation, sedation, apprehension, headache, pulse rate), there was a positive, significant difference between the flunitrazepam group (n = 44) and the placebo group (n = 37). No significant difference was found between the two groups in emetic effect, excitement, systolic blood pressure increase, and venc‐puncture, but the patients receiving flunitrazepam felt significantly more dizziness. The temperature of the left forefinger before, during and after the anaesthesia did not vary significantly between the two groups. There was no correlation between the plasma concentration of flunitrazepam and its demethylated metabolite (separate or total concentrations) and any of the parameters tested before induction of anaesthesia. Flunitrazepam is a new oral premedicant with prominent sedative and anxiolytic actions. When the drug is given as a sedative on the night before operation, followed by a second dose on the morning of operation, the beneficial effects last for at least 8 hours after the second dose.
Decrease in Arterial Pressure Following Heparin Injection Prior to Cardiopulmonary Bypass
Authors: Seltzer J. L. , Gerson J. I.
Published: January 2009

Evidence exists in the literature that heparin has vasodilating properties. We recorded arterial blood pressure changes that occur after administration of 300 units/kg of beef‐lung heparin prior to cardiopulmonary bypass. In 37 out of 43 patients there was a significant decrease in arterial pressure following administration of beef‐lung sodium heparin. Systolic blood pressure fell approximately 10 mmHg (1.3 kPa) and diastolic blood pressure fell about 5 mmHg (0.65 kPa). Heart rates remained unchanged. In 7 of the 43 patients in whom pulmonary artery catheters were placed, cardiac output was determined and systemic vascular resistance was calculated. On the basis of these calculations, it seems that a decrease in systemic vascular resistance is responsible for the decrease in arterial blood pressure noted following sodium heparin.
Hemodynamic and Caxdiometabolic Effects of Infrarenal Aortic and Common Iliac Artery Declamping in Man—An Approach to Optimal Volume Loading
Authors: Reiz S. , Peter T. , Rais O.
Published: January 2009

Nineteen patients undergoing abdominal aortic aneurysm surgery were randomly assigned to two groups and investigated to elucidate the mechanisms of declamping hypotension. The control group of nine patients was kept at an average mean pulmonary artery occlusion pressure (MPAOP) of 11 mmHg (1.46 kPa) before declamping. The other group was volume loaded to a MPAOP of 16 mmHg (2.13 kPa) shortly before declamping. Following declamping there was a significantly greater decrease in mean arterial pressure in the control group, with the same reduction of MPAOP in both groups. In parallel, cardiac and stroke volume indices decreased in the control patients, but remained unchanged in the volume‐loaded patients. In the control group there was a reduction in myocardial substrate utilization which was not seen in the volume‐loaded patients. No signs of myocardial ischemia could be demonstrated in any of the groups. The results indicate that mismatching between intravascular volume and blood volume is the main cause of infrarenal aortic or rommon iliac artery declamping hypotension. Volume loading before declamping to a slightly elevated MPAOP can effectively prevent hypotension, while a normal MPAOP does not guarantee a stable hemodynamic situation after declamping.
Fluoride Kinetics and Renal Function During Enflurane Anaesthesia
Authors: Jårnberg P.‐O. , Ekstrand J. , Irestedt L. , Santesson J.
Published: January 2009

Renal function, fluoride formation and excretion were studied during and after enflourane anaesthesia in seven patients. During anaesthesia, urine flow rate, inulin clearance, PAH clearance and fractional sodium excretion were 13, 78, 65 and 49“., of control values, respectively. Renal function was promptly restored postoperatively. Enflurane was metabolized to inorganic fluoride with a mean maximal serum level of 17.4 k 3.3 μM. Fractional Huoride excretion decreased during anaesthesia to 35% of the control value. Postoperatively, them was a highly significant correlation between the increase in fractional fluoride excretion and the rise in urinary pH during two consecutive 3‐hour periods. It is suggested that tubular reabsorption of fluoride is inversely related to tubular fluid pH and that fluoride is reabsorbed by non‐ionic diffusion.
Effects of Enflurane and Halothane on the Microcirculation
Authors: Novelli G. P.
Published: January 2009

Experiments have been carried out on the microvessels of the inesocaccurn of Wistar rats exposed to equipment doses of either halothane or enflurane. Parameters for evaluating microcirculation included venular flow, capillary How, vasomotricity of prccapillary sphincters and response to norepinephrine. Vennlar and capillary flow underwent relatively small modifications in both groups, but sensitivity to norepinephrine was increased in the halothane‐treated rats and decreased in the enflurane‐treated group. Although these variations were of a limited degree, the reduced sensitivity to norepinephrine in the enflurane group may express a certain degree of protection against tissue ischemia.
Ketamine/Diazepam Infusion Anaesthesia With Special Attention to the Effect on Cerebrospinal Fluid Pressure and Arterial Blood Pressure
Authors: Thorsen T. , Gran L.
Published: January 2009

Ketamine/diazepam solution was used as the only anaesthetic in 105 patients selected for neuroradiological examinations. A rapid intravenous injection, 1 ml/kg bodyweight, followed by continuous drip infusion constituted the method used. No important side effects were seen, except psychotomimetic reactions in two cases. Cardiovascular disturbances were absent and no significant intracranial pressure rise occurred in nine patients examined.
Effects of Thoracic Epidural Block and Prenalterol on Coronary Vascular Resistance and Myocardial Metabolism in Patients with Coronary Artery Disease
Authors: Reiz S. , Nath S. , Rais O.
Published: January 2009

A thoracic epidural block from T1 to T12 was performed with plain prilocaine in four patients with coronary artery disease who were scheduled for abdominal aortic aneurysm surgery. The hernodynamic effects of the block consisted of marked reduction in arterial blood pressure due to impairment of cardiac performance and reduction in systemic vascular resistance. The heart rate decreased moderately. The epidural block induced a marked reduction in coronary vascular resistance with only a moderate decrease in coronary sinus blood flow. The myocardial oxygen and lactate utilization decreased in parallel to the decrease in cardiac work. In spite of the absence of arrhythmias and ST‐T‐segment changes following the epidural block, regional myocardial dysoxia could not be ruled out with the present methods. Administration of the cardioselective beta,‐adrenoreceptor agonist prenalterol increased cardiac performance and thereby arterial blood pressure, but did not affect the systemic or coronary vascular resistance.
The Ejector Flowmeter as Air/Oxygen Mixing Device: An Apparatus Providing Gas Mixtures with Adjustable Oxygen Content for High‐Flow Humidification Systems
Authors: Christensen K. Nørregaarad , Waaben J. , Jørgensen S.
Published: January 2009

The ejector flowmeter is constructed for continuous removal of excess gas from anaesthetic circuits. This instrument can be used as an air/oxygen mixing device for high‐flow humidification systems in wards where compressed air is not available. Pure oxygen is used as driving gas through the ejector. A nomogram has been constructed to show the relationship between oxygen driving pressure, inlet of air to the flowmeter, F1O2and total outflow.
Effects of Minute Volume Increases on the Rebreathing Characteristics of the Bain Anaesthesia Circuit During Controlled Ventilation
Authors: Ramanathan S. , Chalon J. , Rothblatt A. J. , Patel C. , Klein G. S. , Turndorf H.
Published: January 2009

In the course of a study on the carbon dioxide rebreathing characteristics of the Bain anaesthesia circuit, it was noted that raising the minute volume without changing the fresh gas inflow invariably led to increased rebreathing of expired gases. Altering tidal volume and rate in order to reproduce a given minute volume had the same efFect on rebreathing. A nomogram constructed to quantitate increases in rebreathing in function of carbon dioxide production per minute, fresh gas flow from the anaesthesia machine, and minute volume is produced. It can be used to assess the amount of fresh gas flow necessary to mantain a steady and inspired gas composition.
Vascular Resistance in Atelectatic Lungs: Effects of Inhalation Anesthetics
Authors: Bjertnæs L. , Mundal R. , Hauge A. , Nicolaysen A.
Published: January 2009

We have investigated the relative contribution of mechanical obstruction and hypoxia‐induced vasoconstriction to the increased pulmonary vascular resistance (PVR) in atelectatic lungs. For this purpose we have utilized the previous observation that inhalation anesthetics inhibit the vasoconstrictor response to pulmonary hypoxia. The effects of halothane. enfluranr and ether on PVR in atelectatic lungs have been explored. Two pairs of isolated rat lung were perfused in series at constant flow. One of the preparations was made atelectatic by airway occlusion subsequent to ventilation with a high Po2 gas (95% 02). Ventilation of the other preparation continued with hypoxic gas (2% 02). resulting in a gradual increase in PVR in both preparations. When maximum PVR was reached, one of the above inhalation anesthetics was administered to the atelectatic lungs via the ventilated lung preparation. This caused a dose‐dependent, reversible reduction of PVR. The same effect was observed when pulmonary arterial PQ was increased (>66.5kPa). Histological examination revealed that two out of four preparations were completely atelectatic I h after airway occlusion, whereas atelectasis was nearly complete in the other two. In two groups, airways were occluded for 1 h. In the first group PVR increased to 163% (median) above baseline level, as found during ventilation with high PO2. High arterial Po2 reduced PVR in the atelectatic lungs to 50% (median) above baseline, whereas papaverine induced a further PVR reduction. to 7% (median) above baseline. In the other group, papaverine was given before airway occlusion, and PVR increased to 10% (median) above baseline. Comparison of the two groups shows that mechanical Obstruction accounts for about 6% (10/163) of the overall rise in PVR during atelectasis.
Effects of Changes in Acid‐Base Balance on Neuromuscular Blockade Produced by ORG‐NC 45
Authors: Funk D. I. , Crul J. F. , Pol F. M. V. D.
Published: January 2009

The effects of acute acid‐base changes on the neuromuscular blocking action of ORG‐NC 45 (a monoquaternary homologue of pancuronium) were measured in 10 cats. utilizing a constant infusion technique. Partial NC 45 blockade was antagonized slightly in the tibialis, soleus, and diaphragm during respiratory alkalosis pH 7.53; Paco21.9 kPa), whereas metabolic alkalosis (pH 7.64; Paco, 3.5 kPa) produced significant antagonism of NC 45 block in those muscles. Respiratory acidosis (pH 6.98; Paco210.3 kPa) and metabolic acidosis (pH 7.13; Paco24.9 kPa) significantly potentiated partial NC 45 blocks in the tibialis, soleus, and diaphragm (except in the diaphragm during metabolic acidosis). Cumulative dose responses studied in six cats showed that the NC 45 dosage required to produce 85–95% tibialis block was slightly greater than controls during respiratory and metabolic alkalosis. Conversely, significantly less NC 45 was needed to produce the same degree of block during respiratory and metabolic acidosis.In vitrostudies in rat hemidiaphragms likewise showed minimal NC 45 block antagonism when pH was raised to 7.68, and significant potentiation under acidotic conditions (pH 7.05).

These actions are attributed in part to an increased rate of NC 45 metabolism by alkaline hydrolysis in alkalotic states and greater molecular stability during acidosis. Possible clinical implications are discussed.
Quantitative Assessment of Placenta Transfer of Fazadinium in Obstetric Anaesthesia
Authors: Bertrand J. C. , Duvaldestin P. , Henzel D. , Desmonts J. M.
Published: January 2009

Fazadinium, 1 mg/kg, was administered to 16 women undergoing general anaesthesia for caesarean section or vaginal delivery with forceps. Fazadinium serum levels were measured fluorimetrically in samples of maternal venous blood and umbilical arterial and venous blood obtained at the time of delivery. The umbilical to maternal ratio of venous fazadinium averaged 20% and was not influenced by the interval between induction and delivery. A lower concentration was found in the umbilical artery, and the arterial to venous cord blood concentration ratio was about 75% suggesting foetal drug uptake. In all cases, Apgar scores were normal at the fifth minute. It is concluded that there is a placental transfer of fazadinium; however, this transfer is limited and the rihk of paralysis of the newborn appears unlikely after a single intubating dose of 1 mg/kg administered to the mother.
An Assessment of Human Regulatory Nonshivering Thermogenesis
Authors: Jessen K.
Published: January 2009

To assess human thermoregulation independent of muscular activity, a method was developed exposing adult man not previously acclimatized to cold under simultaneous vasodilatation, resulting in a heat debt from the body. During exposure, a significant increase in oxygen consumption was found in two groups, the increases were 0.06 mmol., kg‐l min‐1 (41%) (range: 0.023–0.113) and 0.046 mmol. kg‐1., min‐1 (30%) (range: ‐ 0.013–0.078), respectively. The change in plasma concentration of catecholamines showed a significant increase in noradrenaline of 4.58 nmol/l (300%) (range: 1.86–9.56), whereas adrenaline did not change measurably. The plasma concentration of non‐esterified fatty acids (NEFA) showed a significant increase of 0.471 mmol/1 (96%) (range: 0.033 to 0.687), whereas the plasma concentration of glucose fell by only 0.3 mmol/l (6%) (range: 0.1–0.9). The results obtained by this method mirror findings from studies on small mammals acclimatized to cold, indicating that man without visible shivering and discomfort can increase heat production by an increased secretion of noradrenaline and by utilizing the fat stores in adipose tissue as the major substrate for this increased energy demand.
The Relation Between Thyroid Function and Human Regulatory Nonshivering Thermogenesis
Authors: Jessen K.
Published: January 2009

By a standardized exposure to cold air under simultaneous vasodilation, it was possible to elucidate the chemical factors responsible for heat production independent of muscular activity in seven patients with thyrotoxicosis and in nine patients with hypothyroidism. The results showed that hyperthyroid patients have a thermoregula‐tory reserve equal to normal persons, as they were able to increase their oxygen consumption significantly by an average of 0.035 mmol kg‐1., mid‐1 (16%) (range: 0.014–0.064). The plasma concentration of non‐esterified fatty acids (NEFA) increased significantly by an average of 0.675 mmol/l (64%) (range: 0.015–2.220). The hypothyroid patients also increased their oxygen consumption significantly by an average 010.032 mmol., kg‐1., min‐1 (30%) (range: ‐0.016 ‐ 0.066), but in this group the normal fat mobilization was inhibited as no rise in plasma NEFA was seen. Administration of exogenous thyroxine restored thermoregulation to the level and pattern seen in normothyroid persons, as the increase in plasma NEFA after treatment was on average 0.483 mmol/l (192%) (range: 0.342 ‐ 0.733).
Data Acquisition and Information Processing in MDO Oxygen Electrode Measurement of Tissue Oxygen Pressure
Authors: ÖDman S. , Lund N.
Published: January 2009

In 1956, Clark presented the principle for the modern, membrane‐covered, oxygen electrode, comprising the anode and the cathode within the same unit. A further development was the MDO (Mehrdraht Dortmund Oberfläche) oxygen electrode presented by Lübbers & Kessler during the 1960s. This electrode comprises eight separate measuring points for collecting statistical samples to calculate tissue oxygen pressure fields. In order to perform studies on humans and to enable fast presentation of measurement results, a system was developed including a PDP 11/03 D computer, which fulfils patient safety demands. The computer program included corrections for electrode drift and temperature influences, as well as statistical calculations including mean, standard deviation, skewness and kurtosis. Also included was the two‐sample Kolmogorov‐Smirnov test for comparisons of tissue oxygen distributions. Experience from studies on humans has shown that the measurement system enables us to collect and read important patient data directly at the bedside in the intensive care ward.
The Effect of Galanthanine Hydrobromide on Plasma ACTH in Patients Undergoing Anaesthesia and Surgery
Authors: Cozanitis D. , Dessypris A. , Nuuttila K.
Published: January 2009

The effects of two anticholinesterases, galanthamine and neostigmine, on ACTH and, in some cases, cortisol were compared in 16 patients undergoing relaxant anaesthesia and surgery for varicose veins. The procedures produced increases both in ACTH and cortisol. Following administration of the study drugs to reverse the non‐depolarising neuromuscular block, a statistically significant elevation of ACTH occurred in those patients who received galanthamine. It was concluded, therefore, that the rise in plasma cortisol is ACTH‐dependent and not due to a peripheral cholinergic mechanism.
Healing of Lesions Caused by Cuffed Tracheostomy Tubes and their Late Sequelae A Follow‐Up Study
Authors: Arola M. K. , Puhakka H. , Mäkelä P.
Published: January 2009

The healing of tracheostomy and cuff‐induced tracheal injury was followed up in 48 tracheostomized patients (44 men and 4 women). The patients were studied by means of tracheoscopy, fluoroscopy and tracheography, with a positive contrast medium. At extubation, tracheoscopy revealed 12 mild, 23 moderate and 13 severe injuries at the cuff level. Three months after extubation, the stoma had closed in 89% of the patients studied. In 85% of the patients, the side wall of the stoma was found to have collapsed inwards and in 71% scars were observed at the cuff level. No significant changes took place after the follow‐up study at 3 months. At tracheography it was found that narrowing of the tracheal diameter at the stomal level was of only mild or moderate degree (i.e. 0–33 %). There was not a single instance of severe stenosis. At the cuff level, a slight inward collapse of the side wall was observed in one patient, and in all the other patients the lumen was normal. Fluoroscopy did not reveal severe tracheomalacia in any patient. Increased mobility of the stomal scar, especially in connection with coughing was seen in some patients. One tracheo‐innominate artery erosion and one bleeding granulation tissue at the stoma were confirmed during follow‐up. Surgical trauma to the trachea at the stoma seems to be a more potent cause of subsequent narrowing of the trachea than the cuff. Even though severe injuries may also heal with few sequelae, the use of tracheostomy tubes with large, low‐pressure cuffs, which have been shown to cause less damage to the trachea, is indicated.
Anesthesia for Cesarean Section ‐ VI Late Effects on the Infant of Enflurane Anesthesia for Cesarean Section
Authors: Kristianson B. , Magno R. , Wickström I.
Published: January 2009

Enflurane anesthesia for cesarean section has given favourable results with regard to anesthetic effect and lack of depression of the neonate, Enflurane is metabolized to fluoride. High serum levels of inorganic fluoride are nephrotoxic. The nephrotoxic level is known for healthy adult kidneys but not for neonatal kidneys. In a study on enflurane anesthesia for cesarean section serum analyses revealed increased inorganic fluoride levels in the neonates. To exclude unwanted effects on the children, a follow‐up study was undertaken 6–12 months after delivery. General developnlent and renal function were studied. No abnormalitites were found, indicating that entlurane anesthesia for cesarean section has no persistent unfavourable effects on the children.
Anesthesia for Cesarean Section ‐ VII Early Effects on Neonatal Renal Function of Enflurane Anesthesia for Cesarean Section
Authors: Wickström I. , Kjellmer I. , Kristianson B. , Macno R.
Published: January 2009

Fourteen women undergoing elective cesarean section were anesthetized with enflurane for induction and maintenance of anesthesia. Blood enflurane and serum inorganic fluoride levels were studied in the mothers at delivery and in the neonates at delivery and in the early neonatal period. Also neonatal urinary excretion of inorganic fluoride was determined. Renal function of the neonates was tested with a sodium load at the age of 1 day. Enflurane showed the expected distribution between mothers and neonates. The enflurane level of the neonates declined rapidly after delivery. Serum inorganic fluoride level increased significantly in the mothers from start of anesthesia until delivery. The neonatal level was lower and did not reach the level of neonates in areas with a high natural fluoride content in drinking water. The level of inorganic fluoride in urine was higher than the corresponding serum level, indicating an inorganic fluoride concentrating effect of the neonatal kidney. The difference between urinary excretion and Serum content of inorganic fluoride showed neonatal metabolism of enflurane. The urinary sodium excretion did not differ from that of infants delivered without halogenated inhalation agents given to the mothers.
Airway Closure During Anaesthesia, and its Prevention by Positive End Expiratory Pressure
Authors: Bindslev L. , Hedenstierna G. , Santesson J. , Norlander O. , Gram I.
Published: January 2009

Airway closure, functional residual capacity (FRC) and the transpulmonary pressure volume relationship of each lung were studied in the anaesthetized subject in the supine and the left lateral positions. In the supine posture, FRC was of approximately the same size in each lung as was closing capacity (CC). CC exceeded FRC in either lung. In the left lateral position, FRC was increased by 0.91 in the non‐dependent lung and was reduced by 0.2 1 in the dependent lung, while CC was unaltered in either lung. Consequently, FRC exceeded CC in the non‐dependent lung and was further lowered beneath CC in the dependent lung. Airway closure did not occur in the non‐dependent lung until an average of 0.51 of gas had been expelled after the dependent lung had ceased to empty. The addition of positive end‐expiratory pressure (PEEP) in the range 0.5–2 kPa, increased FRC more in the non‐dependent than the dependent lung. The findings suggest that airway closure is evenly distributed in the horizontal level, while it has a discontinuous distribution between the dependent and non‐dependent lung. Moreover, the increase in lung volume caused by PEEP has a distribution that is by no means ideal for the purpose of countering airway closure.
Primary and Secondary Displacement of Central Venous Catheters
Authors: Lang‐Jensen T. , Nielsen R. , Sørensen M. Bredgård , Jacobsen E.
Published: January 2009

The purpose of this study was to investigate the frequency of primary and secondary displacement of central venous catheters. One hundred and two central venous catheters, inserted through a peripheral or a central vein before surgery or in the intensive care unit, were controlled by chest X‐ray 5–720 min after insertion. The number of primarily displaced catheters was 27. Of these, the position was corrected in 8. Thereafter, the 83 correctly placed catheters were observed for 4–560 h. The number of X‐ray controls was 2–24. The number of secondary displacements was 2, whereas 12 catheters showed minimal secondary displacement. The rate of complications was very low.

We conclude that chest X‐ray immediately after insertion of central venous catheters is absolutely necessary, but since the number of secondary displacements is very low, daily chest X‐ray control is not necessary. We also conclude that the internal jugular vein is the best route for introducing a central venous catheter, since complications are very few and the number of displacements is very low.
Ear Injury Caused by Elevated Intratympanic Pressure During General Anaesthesia
Authors: Man A. , Segal S. , Ezra S.
Published: January 2009

Two cases of middle‐ear injury, due to sharp fluctuations of intratympanic pressure as a result of general anaesthesia with nitrous oxide are presented. A study is reported indicating that the degree of these fluctuations is a function of the concentration of nitrous oxide. In order to reduce the risk of middle‐ear injury due to nitrous oxide anaesthesia, it is suggested that the lowest concentration feasible should be used where there is a history of previous ear surgery.
Venous Complications After Intravenous Injection of Diazepam, Flunitrazepam, Thiopentone and Etomidate
Authors: Korttila K. , Aromaa U.
Published: January 2009

The Occurrence of phlebitis, thrombosis, and thrombophlebitis after intravenous premedication with diazepam (0.15 mg/kg) dissolved in propylene glycol (Valium®) or in polyethylene glycol (Diapam®) or flunitrazepam (0.0125 mg/kg), and after intravenous induction of balanced general anaesthesia with thiopentone (4.0 mg/kg) or etomidate (0.3 mg/kg) was studied on the 7th and 14th postoperative days in 115 patients undergoing short‐stay varicose vein surgery. Venous complications occurred most frequently after etomidate (43% at 14 days), thiopentone (23% at 14 days), and Valium (21 % at 7 days). Diapam caused fewer venous sequelae (9% at 14 days) than Valium (18 % at 14 days), but the smallest number of complications were noticed after flunitrazepam (8% at 7 days and none at 14 days). Venous sequelae were more severe and more extended after thiopentone and after etomidate than those after the diazepam preparations. It is concluded that venous complications after flunitrazepam premedication were mild and infrequent and that the incidence of such complications was unacceptably high after etomidate induction.
Tissue Perfusion and Distribution of Cardiac Output During Ketamine Anesthesia in Normovolemic Rats
Authors: Idvall J. , Aronsen K. F. , Stenberg P.
Published: January 2009

Based on previous clinical experience, an anesthetic technique for the rat, using ketamine, has been evaluated. The method comprised an i.v. bolus injection of 30 mg/kg for induction and an i.v. continuous infusion of 1.5 mg/kg/min for maintenance of anesthesia, Minor differences in ketamine metabolism between man and the rat are discussed. It appears that a higher ketamine concentration at the receptor site was required in the rat as compared to man. During ketamine anesthesia in the rat, fractional distribution of cardiac output and regional tissue perlusion were determined with the aid of the microsphere method. The study showed increased fractions to the heart, brain and tongue. The carcass fraction was elevated shortly after induction but reduced during steady‐state anesthesia. Stomach, bowel and kidneys received reduced fractions early, but later these fractions returned to their initial levels. As a consequence of the increased cardiac output, regional tissue perfusion was increased in practically all organs.
Skeletal Muscle Oxygen Pressure Fields in Healthy Human Volunteers: A Study of the Normal State and the Effects of Different Arterial Oxygen Pressures
Authors: Lund N. , Jorfeldt L. , Lewis D. H.
Published: January 2009

The MDO (Mehrdraht Dortmund Oberfläche) oxygen electrode was used for studies of tissue oxygen pressure fields (presented as histograms) in healthy human volunteers breathing room air and gas mixtures with different oxygen concentrations. Forearm blood flow measurements were performed with strain gauge plethysmography, and local blood flow and permeability‐surface area product (PS) were studied by the clearances of 133xenon and 51Cr‐EDTA. At ordinary arterial oxygen pressure levels the histograms were normal, i.e. their distribution type was approximately Gaussian. Higher arterial oxygen pressures caused changes in tissue oxygenation. However, at arterial oxygen pressure levels above 31 kPa two types of abnormal histogram distribution types were distinguished: scattered multi‐population histograms (type a) and a type with predominantly low values (type b). Mean forearm blood flow showed only minor variations, whereas the clearances of 133xenonand and 51Cr‐EDTA were higher with higher PaO2. A parallel increase was also seen in PS.
Epidural Versus General Anaesthesia for Total Hip Arthroplasty in Elderly Patients
Authors: Hole A. , Terjesen T. , Breivik H.
Published: January 2009

Sixty elderly patients were given at random either epidural analgesia with bupivacaine 0.75% or general anaesthesia with thiopentone, fentanyl, pancuronium, N2O/O2 for total hip replacement. Preoperatively the patients were of equal physical status with normal and similar laboratory values. All patients were mentally normal for their age. On the 1st postoperative day, the general anaesthesia group had a signilicantly lower PaO2 than the epidural group (p<0.025). Pao2 in the general anaesthesia group was significantly lower than the preoperative value on the 1st and 3rd postoperative days (P<0.001 and P<0.01, respectively). None of the 29 patients in the epidural group but seven of 31 patients in the general anaesthesia group had signscant mental changes postoperatively (p<0. 01). Five of these patients still had mental changes which reduced their quality of life several months later. In the general anaesthesia group, one patient died from an acute myocardial infarction. Low postoperative PaO2 might have contributed to this death. Two patients in the epidural group had symptoms of pulmonary embolism postoperatively. Thus elderly patients appear to do better after hip replacement with less deterioration of cerebral and pulmonary functions when given epidural analgesia than when surgery is performed under general anaesthesia. These patients should therefore be offered epidural analgesia whenever possible.
Plasma Oncotic Pressure and Plasma Protein Concentration in Patients Following Thermal Injury
Authors: Zetterström H. , Arturson G.
Published: January 2009

Plasma oncotic pressure (POP), albumin and total protein were measured in 14 patients with thermal injuries varying in extent from 16 to 90 % of the body surface. The patients were treated with large amounts of balanced salt solutions in the initial phase. There was an abrupt, pronounced decrease in POP to about 52% of the normal during the first 24 h. Despite the low POP values (minimum 0.78 kPa) and marked peripheral oedema, no patient had overt pulmonary oedema. Clinical and roentgenological evidence of pulmonary dysfunction during the initial period was only seen in conjunction with lung burn or aspiration pneumonitis. Oedema‐preventing mechanisms and inability to detect interstitial pulmonary oedema are discussed as possible explanations. There was no significant correlation between decrease in POP and mortality, but low POP values seemed to persist longer in the patients who died.
Effect of Epidural Versus General Anaesthesia on Calf Blood Flow
Authors: Modig J. , Malmberg P. , Karlström G.
Published: January 2009

The arterial inflow into the calf, venous emptying rate and venous capacity were studied by means of venous occlusion plethysmography on the non‐operated leg in two groups of patients undergoing total hip replacement. One group of eight patients received epidural blockade intraoperatively, which was prolonged postoperatively for pain relief, while the other group of eight patients was given general anaesthesia with intermittent positive‐pressure ventilation intraoperatively and parenteral analgesics for pain relief in the postoperative period. The calf blood flow and venous capacity were lower in patients receiving general anaesthesia when measured at the end of surgery and significantly lower in this group when measured 3 h postoperatively. The sustained reduction of flow in the deep veins of the lower limb might be a significant contributory factor in the initiation of deep venous thrombosis. In three of the eight patients in the general anaesthesia group, the venous emptying rate and venous capacity had decreased 3 h postoperatively to a very low level, indicating thrombus formation in immediate association with the surgery.
Comparison of Electrocardiographic Changes during Microlaryngoscopy under Balanced Anaesthesia Induced by Althesin or Thiopentone
Authors: Saarnivaara L. , Kentala E.
Published: January 2009

Electrocardiographic (ECG) changes during microlaryngoscopy were studied with three methods of anaesthesia. In the two main groups, balanced anaesthesia was induced by Althesin (=Althesin I group) in 98 patients or by thiopentone (=thiopentone group) in 68 patients. In 23 patients, halothane anaesthesia was induced by Althesin (= Althesin II group). During the procedure, the most common ECG changes in all groups were sinus tachycardia (54–78%), junctional rhythm (28–57%), ventricular ectopic beats (12–26%), T‐wave changes (9–22 %) and supra ventricular ectopic beats (7–17%). There was no statistically significant difference in the total number of ECGchanges between the groups. There was, however, significantly more sinus tachycardia in the Althesin II group (78%) than in the thiopentone group (54%). Junctional rhythm occurred significantly more often in the Althesin II group (57%) than in the Althesin I group (31 %) or in the thiopentone group (28%). Upper junctional rhythm was most common in the Althesin I group, whereas middle junctional rhythm dominated in the Althesin II group. Ischaemic S‐T segment depression did not occur in the thiopentone group, whereas in the Althesin I and II groups its incidence ranged from 6 to 13%. In all patients ECG changes disappeared without any special treatment after the manipulation of the vocal cords. The results suggest that there is no decisive difference in the occurrence of ECG changes between the three methods of anaesthesia.
Skeletal Muscle Oxygen Pressure Fields in Artificially Ventilated, Critically 111 Patients
Authors: Lund N. , Jorfeldt L. , Lewis D. H. , ÖDman S.
Published: January 2009

The MDO (Mehrdraht Dortmund Oberfläche) oxygen electrode was used in a study of skeletal muscle oxygen pressure fields. presented as histograms, in critically ill patients artificially ventilated with gas mixtures of different oxygen concentrations. The histograms were compared with forearm blood flow measurements performed with strain gauge plethysmography. Local blood flow and permeability‐surface area product (PS) were also studied by the simultaneous clearances of 133xenon and 51 Cr‐EDTA. The histogram distribution type was normal, i.e. approximately Gaussian, at arterial oxygen pressure levels between 10 and 18 kPa. At arterial oxygen pressures outside this range the histogram distribution types were abnormal, i.e. they showed a nonsymmetrical distribution of oxygen pressure values, but their mean was approximately the same as in the normal histogram. However, there were significantly higher tissue oxygen pressure mean values in the patients (3.43 kPa) than in a group of healthy human volunteers (2.25 kPa). Mean forearm blood flow and the clearances of 133 xenon and 51 Cr‐EDTA showed marked variations during the measurements both intraindividually and interindividually. Mean forearm blood now and mean clearances of133 xenon showed opposite trends compared with arterial oxygen pressures. Mean clearances of 51 Cr‐EDTA and mean PS showed only minor variations at the different arterial oxygen pressure levels.
The Cardiovascular Effects of Pancuronium during Halothane and Cyclopropane Anaesthesia
Authors: Qvist T. F. , Lang‐Jensen T. , Korshin J. D. , Skovsted P.
Published: January 2009

The effects of pancuronium 0.1 mg/kg i.v. on heart rate (HR) and mean arterial blood pressure were investigated in two groups of eight patients, each receiving inhalational anaesthesia with either halothane or cyclopropane. A more pronounced effect on HR in the cyclopropane group with a mean increase of 104% occurred. The mean increase in the halothane group was 54%. There was a statistically significant difference (P<0.05) between the HR increases. The vagolytic effect of pancuronium and the influence of halothane and cyclopropane on the autonomic nervous system are discussed.
Neuromuscular Blocking Properties of Dioxonium
Authors: Tammisto T. , Salmenperä M.
Published: January 2009

The characteristics of the myoneural block caused by a new neuromuscuiar blocking agent, dioxonium (Dx), were evaluated in surgical patients. The force and the corresponding electromyogram (EMG) of the thumb adduction evoked by various modes of ulnar nerve stimuli were measured. Onset, maintenance and disappearance of blockade after sequential administration of Dx were compared with results obtained with d‐tubocurarine (dTc) or suxamethonium (Sx).

Initially the Dx block was shown to be depolarizing with a negligible fade in the 2 Hz train of four stimuli with a single twitch suppression of 90%. On a weight basis, Dx was found to be about 15 times as potent as dTc in suppressing twitch to the 90 % level. During maintenance, the block gained nondepolarizing characteristics with profound fades in the 2 and 50 Hz trains. The transition was associated with tachyphylaxis and with a more pronounced suppression of EMG amplitude than that measured in the twitch force. After a total dose of about 100 μg/kg of Dx, the sensitivity to Dx again increased and the discrepancy between twitch tension and EMG disappeared. This pattern of changes was also seen with Sx. Spontaneous recovery occurred slightly faster than after dTc blocks of corresponding duration. With neostigmine, reversal was hastened and a full recovery with restitution of prerelaxant twitch and disappearance of fades was reached in about 20 min. Some discrepancy in EMG amplitude and twitch force persisted, however.
Epidural Block with Chloroprocaine during Labour
Authors: Carlsson C. , Dahlgren N. , Magnusson J. , Hanson A.
Published: January 2009

Lumbar epidural block was performed during labour in 50 healthy women, with 2% chloroprocaine in an initial dose of about 6 ml. Pain relief was achieved within 5 min and the mean duration of action was 43 min. The frequency of instrumental deliveries was lower than earlier obtained with bupivacaine. No specific adverse reactions were found in the infants. In 20 cases, serum cholinesterase activity was analysed in mothers as well as infants and found to be normal.
Acute Postoperative Digitalization of Patients with Arteriosclerotic Heart Disease after Major Surgery
Authors: Bille‐Brahe N. E. , Engell H. C. , Sørensen M. Bredgaard
Published: January 2009

Twenty patients with impaired left ventricular function during exercise, who underwent major vascular surgery for arteriosclerotic disease, were randomly digitalized in the immediate postoperative period. All patients had a smooth postoperative course. Haemodynamic measurements showed improved left ventricular function in those who received digitalis, since 60 min after full digitalization the digitalized patients had a highly significant decrease in pulmonary capillary wedge pressure (PCWP) with unchanged stroke volume index (SVI) and left ventricular stroke work index (LVSWI). The same improvement in cardiac function was present the next morning. The present study provides haemodynamic data in support of clinical studies showing a beneficial effect of prophylactic digitalization in surgical patients with clinical signs of arteriosclerotic heart disease, though not in overt failure.
Haemodynamic Responses to Antagonism of Pancuronium and Alcuronium Block
Authors: Heinonen J. , Salmexperä M. , Takkunen O.
Published: January 2009

Using non‐invasive methods, haemodynamic responses to antagonism of pancuronium (Pc) and alcuronium (Ac) block were compared in patients anaesthetized with thiopental‐N2O‐fentanyl and undergoing minor surgery. Neuromuscular block (90%) was maintained with Pc in 10 patients and Ac in 10 patients. After surgery, atropine 0.015 mg kg‐1 and neostigmine 0.03 mg kg‐1 (AN) were given simultaneously. The rate of reversal of the block was equal in the two groups. Between 4 and 16 min after AN, the decrease of heart rate (HR) was more pronounced in patients who had received Pc. The mean of the lowest HR was 43.2 beats min‐1 in the Pc group, compared with 62.0 beats min‐1 in the Ac group. The bradycardia was associated with a moderate decrease in arterial pressure in patients treated with Pc. However, due to an increase in stroke volume, mean cardiac output (CO) was not lower in the Pc group. Some patients treated with Pc developed a temporary nodal rhythm after AN and this was associated with a considerable decrease in CO. It is concluded that, in spite of marked bradycardia during antagonism of Pc block, circulation is well maintained, provided that sinus rhythm is present.
Skeletal Muscle Circulation During Sufentanyl and Morphine Anesthesia in Propranolol Treated Dogs
Authors: Berthelsen P. , Eriksen J. , Ahn N. C. , Rasmussen J. P.
Published: January 2009

Sufentanyl is a new, potent, short‐acting, fentanyl‐like morphinomimetic. In the present study we compared the effects of high doses of sufentanyl and morphine on the peripheral circulation in β‐blocked dogs. Skeletal muscle surface pH (m‐pH) was recorded continuously as an index of the microcirculation. Sufentanyl (0.01 mg/kg) had no adverse effects on the peripheral perfusion. Morphine (4 mg/kg) caused a severe and rapid fall in m‐pH from 7.34 to 7.14 during the 30‐min experimental period. At the same time calculated blood volume decreased by 20%. This hypovolemic deterioration of the circulation was probably caused by a histamine‐mediated increase in capillary pressure and filtration of plasma from the intravascular space to the interstitial space. As sufentanyl could be safely administered to β‐blocked dogs, we recommend human studies. On the other hand, we discourage the use of high‐dose morphine anesthesia until human studies have proved that the collapse of the peripheral perfusion seen in this study is species specific.
Antithrombotic Effects of Lidocaine and Related Compounds on Laser‐Induced Microvascular Injury
Authors: Luostarinen V. , Evers H. , Lyytikäinen M.‐T. , Scheinin A. , Wahlén A.
Published: January 2009

The aim was to study whether topically applied local anaesthetics and related compounds exert an antithrombotic effect. The assay was carried out through vital microscopy of the microcirculation in the hamster cheek pouch model as injured by laser microbeam irradiation, essentially in order to record the differences in the incidence of thrombus formation between two main experimental and control series. The application of lidocaine hydrochloride was found to inhibit thrombus formation and also to restore the microcirculation after laser‐induced injury. The other investigated compounds, mono‐ethyl‐glycinexylidide, tocainide and bupi‐vacaine were found to be less active with regard to inhibition of thrombus formation and flow restitution effects. It is concluded that an antithrombotic effect may be attributed to lidocaine in particular.
Cortisol, Glucose, and Hemodynamic Responses to Surgery after Naloxone Administration
Authors: Engquist A. , Higquet J. , Saurbrey N. , Blichert‐Toft M.
Published: January 2009

The adrenocortical, hyperglycemic, and hemodynamic responses to cholecyslectomy or vagolomy were studied in 16 patients under halothane and N2O/O2 anesthesia. The patients were randomly divided into two groups: eight patients received naloxone in doses used clinically (2.5 μg/kg i.v.) just before induction of anesthesia, while eight subjects received placebo. The results showed insignificant differences in plasma concentrations of cortisol and glucose between groups. Nor did blood pressure, heart rates, and inspired halothane concentrations differ significantly between groups. Thus, inhibition of opiate receptors and endorphins by naloxone in an otherwise clinically effective dosage does not influence the adrenocortical, hyperglycemic, or hemodynamic responses to surgical stress. We therefore conclude from our data that opiate receptors and endorphins are not involved in the initial phase of the endocrine‐metabolic responses to surgery nor are they part of the neural mechanisms mediating stress‐induced analgesia.
Bioavariability of Rectal Aspirin in Neurosurgical Patients
Authors: Kanto J. , Klossner J. , Mäntylä R. , Yrjänä T.
Published: January 2009

Serum salicylate levels were determined fluorometrically in 12 neurosurgical patients after rectal and oral administration of 1.0 g aspirin. There was no significant difference in the AUC‐value between the two routes of administration, but a slower rate of absorption with no clear peak effect was found after rectal administration. Rectal aspirin is useful in clinical situations in which medication is difficult by the oral route, e.g. after neurosurgical and open‐heart surgical interventions.