bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of propofol vs isoflurane on respiratory gas exchange during laparoscopic cholecystectomy
Authors: Gehring Dr.H. , Kuhmann K. , Klotz K. F. , Ocklitz E. , RothIsigkeit A. , SedemundAdib B. , Schmucker P.
Published: January 2009

Background: Respiratory function and pulmonary gas exchange are affected in laparoscopic procedures where a pneumoperitoneum is introduced using CO2. Previous studies have shown differing results concerning pulmonary gas exchange during laparoscopic procedures: Whereas in patients undergoing isoflurane anaesthesia decreases in PaO2 are demonstrated, this factor remains unchanged in patients undergoing propofol anaesthesia. In the present study, the effects of propofol on pulmonary gas exchange were compared with those of isoflurane in patients undergoing elective laparoscopic cholecystectomy in a prospective randomised manner.

Methods: Twenty ASA patients with physical status I and II were divided randomly between isoflurane (IG) and propofol groups (PG). After induction of anaesthesia patients were moderately hyperventilated. Respirator settings remained unchanged during pneumoperitoneum (PP) until 10 min after deflation of the peritoneal cavity. Blood gas analyses were performed at 5 time points: 15 min after induction of anaesthesia (giving pre‐PP values), immediately before carbon dioxide insufflation (0 min PP), after both 30 and 60 min of PP and 10 min post PP. Inspiration plateau pressure (Pplat), compliance of the respiratory system, and both ins‐ and expiratory gas concentrations were continuously recorded by an Ultima V® monitor (Datex Corp., Helsinki, Finland). The difference between arterial and end‐tidal CO2 partial pressure (P(a‐et)CO2) was calculated so as to allow assessment of physiological dead space by the modified Bohr equation.

Results: Pulmonary gas exchange differed significantly after 30 min of PP between the IG and the PG. At this time, PaO2 was 19.5 ± 2.9 kPa (mean ± SD) in the IG and 23.1 ± 1.8 kPa in the PG (P<0.01), whereas PaCO2 was 5.5 ± 0.37 kPa in the IG and 4.9 ± 0.27 kPa in the PG (P<0.01). These discrepancies remained until after carbon dioxide desufflation. At 10 min post PP, PaO2 was 18.3 ± 2.6 kPa in the isoflurane group and 21.9 ± 2.2 kPa in the propofol group (P<0.01), whereas PaCO2 was 5.4 ± 0.46 kPa in the IG and 4.8 ± 0.22 kPa in the PG (P<0.01). During carbon dioxide insufflation the P(a‐et)CO2 increased significantly in the IG from 0.47 ± 0.13 kPa to 0.76 ± 0.37 kPa (P<0.05), while the values in the PG remained constant.

Conclusion: This study demonstrates that pulmonary gas exchange in patients with laparoscopic cholecystectomy is affected by the choice of anaesthetic procedure. During and after laparoscopic cholecystectomy using isoflurane as the anaesthetic, the PaCO2 is significantly higher and the PaO2 significantly lower than they are with propofol.
The palm print as a sensitive predictor of difficult laryngoscopy in diabetics
Authors: Nadal J. L. Y. , Fernandez B. G. , Escobar I. C. , Black M. , RosenblattM.D W. H.
Published: January 2009

Background: Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom tracheal intubation may be difficult because of glycosylation of both metacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indices in a diabetic population.

Method: 83 adult, diabetic patients scheduled for surgery under general anesthesia were evaluated preoperatively using 4 physical examination indices predictive of difficult laryngoscopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index was calculated.

Results: The palm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies.

Conclusion: We believe that in the diabetic population, the palm print index may be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have greater utility, in distinct populations as compared to when they are applied to all patients.
Prevention of nausea and vomiting in female patients undergoing breast surgery: A comparison with granisetron, droperidol, metoclopramide and placebo
Authors: Fujii Dr.Y. , Tanaka H. , Toyooka H.
Published: January 2009

Background: Breast surgery is associated with a relatively high incidence of postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the efficacy of granisetron, droperidol and metoclopramide for preventing PONV after breast surgery.

Methods: In a randomized, double‐blind, placebo‐controlled trial, 120 female patients received granisetron 40μg.kg‐1, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n=30 for each) intravenously immediately before the induction of anaesthesia. A standard general anaesthetic technique was employed throughout. Postoperatively, during the first 24 h after anaesthesia, the incidence of PONV and adverse events was recorded.

Results: The incidence of PONV was 17% with granisetron, 37% with droperidol, 43% with metoclopramide and 50% with placebo (P<0.05; overall Fisher's exact probability test). The incidence of adverse events was not different among the groups.

Conclusion: Granisetron is highly effective for reducing the incidence of PONV in female patients undergoing breast surgery. Droperidol and metoclopramide are ineffective in this population.
Effects of veratridine on mechanical responses of human malignant hyperthermic muscle fibers
Authors: Adnet P. J. , Etchrivi T. S. , Halle I. , Haudecoeur G. , Reyford H. G. , Krivosic‐Horber R. M.
Published: January 2009

Background: To determine if alteration in the function of the sodium channel may in turn modify halothane‐induced changes in mechanical responses of muscle bundles from patients susceptible to malignant hyperthermia (MH).

Methods: Mechanical responses of muscle bundles from 12 MH‐susceptible and 20 MH non‐susceptible patients were measured prior to and during administration of halothane alone and in the presence of 10μM veratridine, an inhibitor of sodium channel inactivation. Peak tension (PT), time to peak tension (TPT), positive peak of isometric tension derivative (+dP/dtmax) were used to characterize the inotropic state. Analysis of relaxation process was performed using half relaxation time (RT1/2) and the negative peak of isometric tension derivative (‐dP/dtmax). The ratio (R)=(+dP/dtmax)/(‐dP/dtmax) was used to measure the coupling between contraction and relaxation under isometric condition.

Results: Veratridine significantly enhanced the 0.5, 1, 2 and 3 vol% halothane‐induced contracture and induced a negative inotropic effect in MH‐susceptible muscle bundles. R increased by nearly 90% indicating that the combined effects were more pronounced in the relaxation phase. In MH non‐susceptible muscle, veratridine did not significantly enhance the effects of halothane.

Conclusions: These results on cut MH‐susceptible human muscle bundles support the hypothesis that halothane‐induced contracture in MH can be modified by the binding of an inhibitor of sodium channel inactivation.
Efficacy of EMLA® cream prior to dorsal penile nerve block for circumcision in children
Authors: SerourM.D F. , Mandelberg A. , Zabeeda D. , Mori J. , Ezra S.
Published: January 2009

Background: While circumcision may be performed solely with dorsal penile nerve block (DPNB), some painful steps in its use are skin needle penetration and infiltration of the anesthetic product. The objective of this study was to evaluate the efficacy of EML® cream, prior to DPNB for circumcision in children.

Methods: We conducted a prospective, randomized, double‐blinded, placebo‐controlled study with 42 children undergoing circumcision with DPNB alone, as an ambulatory procedure. Overall efficacy of EMLA® cream (Group A) during needle penetration and infiltration was assessed using a visual analog scale, compared with a placebo cream (Group B). Patients were asked to orally report any pain during skin needle penetration and infiltration of anesthetic, and were graded from 1 to 4 according to intensity of pain, as 1) none, 2) slight, 3) moderate, or 4) severe. The child graded the global discomfort of the entire procedure using the visual analog scale.

Results: When assessing needle penetration, none from Group A suffered any pain, whereas all from Group B suffered at least mild pain. Considering infiltration of the anesthetic, all children suffered at least slight‐to‐moderate pain. Based on the children's visual analog scale scores, EMLA® cream has no beneficial effect for penile block.

Conclusion: Since the dorsal penile nerves are located under the Buck's fascia, topical anesthesia may not reach them and other techniques may be necessary to anesthetize them. We found that although EMLA® cream is efficient as a topical anesthesia during needle penetration for DPNB, it has no beneficial effect during infiltration.
Local anaesthetic toxicity in a pregnant patient undergoing lignocaine‐induced intravenous regional anaesthesia
Authors: Coleman Dr.M. , Kelly D. J.
Published: January 2009

A pregnant patient at 38 weeks' gestation developed symptoms of local anaesthetic toxicity following intravenous regional anaesthesia (IVRA) for hand surgery, using a standard dose of lignocaine. Reports suggest that a number of factors, both physiological and pharmacological, combine to increase the likelihood of local anaesthetic (LA) toxicity in pregnancy despite employment of a conventional “safe” IVRA technique. It is suggested that for IVRA, pregnant patients are premedicated with a benzodiazepine, the tourniquet time is increased and the concentration of LA is decreased to reduce the risks of LA toxicity.
Pulmonary function in adult survivors of severe acute lung injury treated with inhaled nitric oxide
Authors: Luhr O. , Aardal S. , Nathorst‐Westfelt U. , Berggren L. , Johansson L.‐Å. , Wahlin L. , Frostell C.
Published: January 2009

Background: Following an episode of acute respiratory distress syndrome (ARDS), some degree of measurable pulmonary impairment may be anticipated. ARDS is thought to be the more severe form of acute lung injury (ALI) and a recently proposed addition to conventional therapy in ALI/ARDS is inhaled nitric oxide (INO). We carried out a non‐randomised follow‐up study with pulmonary function tests on survivors of severe ALI/ARDS treated with INO.

Methods: Sixteen previously healthy pulmonary patients, survivors of severe ALI/ARDS, were evaluated with pulmonary function tests >8 months after the acute event. The tests included static and dynamic spirometry, diffusion capacity for carbon monoxide (DLCO), blood gas analysis and evaluation of a chest radiograph.

Results: The most common abnormality seen was a low DLCO in 69% of the patients. Abnormally low values were seen in forced vital capacity in 31%, in forced expiratory volume in 1 s in 13%, and in residual volume and total lung capacity in 6%. Blood gas data were within normal limits in 15/16 patients. All chest radiographs showed resolution of the interstitial and alveolar changes present during the acute event.

Conclusion: In this non‐randomised follow‐up study we conclude that a degree of measurable pulmonary impairment after INO treatment in severe ALI/ARDS was common, but did not differ markedly from other published studies on pulmonary function in similar patient material. No late unexpected major abnormalities due to the inhaled nitric oxide treatment could be identified in these survivors.
Metabolic effects of a low‐pressure tourniquet system compared with a high‐pressure tourniquet system in arthroscopic anterior crucial ligament reconstruction
Authors: Kokki H. , Väätäinen U. , Penttilä I.
Published: January 2009

Background: Bloodless field is an integral part of orthopedic surgery. Use of tourniquet is associated with a risk of skeletal muscle ischemia and reperfusion injury. The purpose of this prospective, open‐randomized study was to determine if the use of a tourniquet system using low pressure, with a wide, curved cuff connected to a microprocessor pump is safer than a standard tourniquet system with a narrow, straight cuff using higher inflation pressures.

Methods: Test parameters used as markers of muscular injury and anaerobic metabolism were femoral vein blood lactate, pH, pCO2, pO2, potassium, aspartate aminotransferase activity, myoglobin, creatine kinase and creatine kinase‐MM activity levels after release of tourniquet. Twenty‐six ASA I‐II patients were studied.

Results: Tourniquet times varied between 30 and 144 min. Deflation of the tourniquet caused a significant release of lactate, myoglobin and potassium detected in the femoral vein blood. pCO2 increased, but pH and pO2 decreased after tourniquet deflation. There were no differences between the study groups. The tourniquet time showed a significant correlation with femoral vein lactate.

Conclusion: The main finding of this study was that the metabolic changes were more pronounced with the longer tourniquet time. The results of the study did not show any difference on metabolic markers of muscular injury during the first hour afterelease of tourniquet between the two tourniquet systems.
Combined effect of patient variables on sensory level after spinal 0.5% plain bupivacaine
Authors: Pargger H. , Hampl K. F. , Aeschbach A. , Paganoni R. , Schneider M. C.
Published: January 2009

Background: The combined effect of age, weight, height, and vertebral column length (VCL) on the distribution of isobaric 0.5% bupivacaine within the subarachnoid space is unclear. The aim of the present study was to evaluate the combined influence of these patient variables on the upper sensory level and on its predictability.

Methods: In 100 patients who were above the age of 49 years, the age, weight, height, VCL, body surface (BS), and body mass index (BMI) were noted. Spinal puncture and subarachnoid drug administration were standardized. Cephalad spread of spinal anaesthesia (SA) was assessed by loss of temperature sensation and pinprick discrimination 15, 30, 60, 90, and 120 min following subarachnoid injection of 18 mg of plain 0.5% bupivacaine. Linear regression analysis was performed for each of the patient variables and the cephalad segmental spread of anaesthesia. Multiple regression analysis was used to test for combined correlation between patient variables and the sensory level of SA.

Results: No linear correlation was found between the patient variables and the sersory level of anaesthesia. In contrast, multiple regression analysis revealed that age (P<0.01), weight (P<0.05), and height (P<0.01) significantly contributed to the spread of anaesthesia. A squared multiple comparison coefficient between 0.10 and 0.21, however, is an indication that the predictive value of the combined variables remained rather low.

Conclusion: Multiple regression analysis revealed that age, weight, and height significantly correlated with the sensory level after subarachnoid injection of plain bupivacaine. The low predictive value suggests that patient factors other than age, weight, or height add to cephalad spread of SA.
Electrophysiological evidence for an antinociceptive effect of ketamine in the rat spinal cord
Authors: Hao J.‐X. , Sjölund B. H. , Wiesenfeld‐Hallin Z.
Published: January 2009

Background: The dissociative anesthetic ketamine also has antinociceptive effects. The mechanism and the site of action of such effect of ketamine have been, however, elusive and controversial. The present study was conducted to examine the effect of systemically administered ketamine on spinal nociceptive transmission.

Methods: We investigated and compared the effects of ketamine (0.25‐8 mg/kg) on the hamstring flexor reflex in intact, lightly anesthetized rats and spinally transected rats. The opioid receptor antagonist naloxone was used to examine the involvement of opioid receptors in the actions of ketamine. Finally, the effects of ketamine on dorsal horn neuronal activity to electrical stimulation of peripheral nerves were also studied.

Results: Ketamine caused similar dose‐dependent depression of the hamstring flexor reflex recorded from spinally intact rats and from spinalized rats. Even the highest dose of ketamine failed to influence the monosynaptic reflex. The depressive effect of ketamine on the flexor reflex was not reversed by naloxone. Ketamine i.v. also exerted a relatively selective inhibition of the responses of dorsal horn wide‐dynamic‐range neurons to C‐fiber input of electrical stimulation of the plantar nerve.

Conclusions: Our present results support the notion that ketamine can exert a direct antinociceptive effect in rat spinal cord. Moreover, the data indicated that the spinal antinociceptive effect of ketamine does not involve naloxone‐sensitive opioidergic mechanisms.
Epidural anesthesia and the thermoregulatory responses to hyperthermia ‐ preliminary observations in volunteer subjects
Authors: Glosten B. , Savage M. , Rooke G. A. , Brengelmann G. L.
Published: January 2009

Background: Clinical reports associate the use of epidural anesthesia with an increase in core temperature in women in labor. We tested the hypothesis that epidural anesthesia alters thermoregulatory responses to hyperthermia in human volunteers.

Methods: Each of four volunteers were studied on two days: Control and Anesthesia. On the Control day, the subject was warmed via the skin, and the core (esophageal) temperature threshold for sweating (detected on the forehead) was determined. The subject was then cooled until sweating stopped. The subject was warmed again, and a second sweating threshold was determined. The difference between the first and second sweating thresholds was noted. On the Anesthesia day, two sequential sweating threshold measurements were obtained in a similar fashion; however, a mid‐thoracic level of epidural anesthesia was established before the second sweating threshold measurement. The first and second sweating threshold differences were compared between the two study days. The presence or absence of sweating on the thigh was noted during all four warming periods.

Results: Average skin temperatures were similar (about 37°C) during all four sweating threshold measurements. On the Control day, the second sweating threshold value was always slightly less than the first (average difference (mean±SD): — 0.18±0.14°C). In contrast, on the Anesthesia day, the second sweating threshold value (determined with an epidural block) was always greater than the first (average difference: +0.37±0.16°C). Epidural anesthesia, therefore, increased the sweating threshold by 0.55±0.27°C. Epidural anesthesia blocked sweating in the thigh in two of the subjects.

Conclusions: An epidural block alters the thermoregulatory responses to warming by increasing the threshold for thermoregulatory sweating and, in some cases, preventing leg sweating.
Propofol and alfentanil total intravenous anaesthesia: a comparison of techniques for major thoracic surgery
Authors: Trinder T. J. , Johnston J. R. , Lowry K. G. , Phillips A. S. , Cosgrove J.
Published: January 2009

Background: Previous work has highlighted the disadvantages of propofol as a sole agent for total intravenous anaesthesia (TIVA). This randomised study investigated three combinations of propofol and alfentanil as TIVA for major thoracic surgery.

Methods: In 73 patients undergoing elective thoracic surgery, anaesthesia was conducted either with sodium thiopentone induction and inhalational maintenance (incorporating isoflurane) or with TIVA using propofol with alfentanil (by infusion at one of two rates or in incremental doses). Vital signs and recovery characteristics were recorded.

Results: There were no significant differences in heart rate or blood pressure between groups during either induction or maintenance. Depth of anaesthesia was controlled satisfactorily in all groups. Recovery characteristics were similar between treatment groups, although there was a trend towards earlier orientation

Conclusion: Continuous infusions of propofol and alfentanil provide safe and reliable TIVA for major thoracic surgery. TIVA was found to be a satisfactory technique in more elderly patients than previously described. The higher of the two alfentanil infusion rates may result in a better combination of propofol and alfentanil with respect to recovery times than the lower.
Effects of four anticholinesterase‐anticholinergic combinations and tracheal extubation on QTc interval of the ECG, heart rate and arterial pressure
Authors: Saarnivaara L. , Simola M.
Published: January 2009

Background: Imbalance in cardiac sympathetic tone causes prolongation of the QTc interval of the ECG. On the other hand, impairment of the parasympathetic control of the heart rate caused by anticholinesterase‐anticholinergic combinations might also affect the cardiac sympathetic tone and hence the QTc interval of the ECG. The main purpose of the present study was to compare the effects of four anticholinesterase‐anticholinergic combinations used for the antagonism of the neuromuscular block on the QTc interval of the ECG, heart rate and arterial pressure.

Methods: Eighty‐four ASA class I‐II patients with a mean age of 32 to 37 yr undergoing otolaryngological surgery were randomly allocated to one of the following groups: neostigmine 40 μg/kg+glycopyrronium 8 μg/kg (Ne‐Glyc), neostigmine 40 μg/kg+atropine 20 μg/kg (Ne‐Atr), edrophonium 200 μg/ kg+atropine 300 μg (Edr‐Atr (1)), edrophonium 500 μg/ kg+atropine 7 μg/kg (Edr‐Atr (2)). QTc interval and heart rate were measured by a signal processing method based on an IBM/PC/xT‐compatible microcomputer and arterial pressure with a sphygmomanometer at 1‐min intervals up to 10 min after the injection of the drugs and immediately and 2 min after extubation. The ECG, lead II, was continuously recorded. Neuro‐muscular block was measured by a Datex relaxograph.

Results: In all groups, the most pronounced increase in both QTc interval, heart rate and arterial pressure occurred 1 min after the study drugs and immediately after extubation. In all groups, the mean QTc intervals at 1 and 2 min after the study drugs and after extubation were longer than the upper limit of the normal range (440 ms). Junctional rhythm occurred in 1 to 3 patients in all other groups with the exception of the Edr‐Atr(1) group in which no cardiac arrhythmias occurred. At 1 min, the heart rate in the Ne‐Atr group was at a significantly higher level than that in the Ne‐Glyc group. From 3 to 6 min, the heart rate in the Edr‐Atr(2) group and at 3 min in the Edr‐Atr(1) group was at a lower level than the heart rate in the Ne‐Glyc group.

Conclusions: On the basis of the present results, anticholinesterase‐anticholinergic combinations should be avoided in patients having a long QT interval syndrome or a prolonged QT interval from other causes. In addition, the cardiovascular stimulation caused by tracheal extubation should also be avoided in these patients.
Succinylcholine‐induced fasciculations in denevated rat muscles as measured using 31P‐NMR spectroscopy
Authors: Mizogami M. , Fujibayashi T. , Goto Y.
Published: January 2009

Background: We have previously demonstrated by 31P nuclear magnetic resonance (NMR) that succinylcholine (SCh) induces metabolic changes in denervated muscle. To specify those changes, we attempted to inhibit them using two different kinds of drugs, dantrolene and vecuronium.

Methods: Three weeks after unilateral sciatic nerve section, 75 male Wistar rats were randomly assigned to one of the following 5 groups: (1) non‐pretreated normal muscle group; (2) non‐pretreated denervated muscle group; (3) denervated muscle group pretreated with a low dose of vecuronium (0.02 mg · kg‐1); (4) denervated muscle group pretreated with a high dose of vecuronium (0.2 mg · kg‐1); (5) denervated muscle group pretreated with dantrolene (2 mg · kg‐1). The change of the inorganic phosphate/phosphocreatine (Pi/PCr) ratio of each muscle was measured by 31P‐NMR before and after SCh (1 mg · kg‐1) administration and the corresponding peak amplitude of the electromyograms (EMG) was determined.

Results: The high dose of vecuronium totally inhibited SCh‐induced fasciculation on EMG (100%2%). In this group, though the Pi/PCr ratio significantly increased 10 min after SCh, the peak after 5 min disappeared. The inhibition with dantrolene was about the same order of magnitude as with the low dose of vecuronium (35%:21%). However, the increase in the Pi/PCr only lasted about 10 min, in contrast to the other drugs.

Conclusion: Our findings indicate that the Pi/PCr increases 5 and 10 min after SCh, respectively, as a result of two different processes. The first peak is caused by an excessive energy consumption in response to excessive muscle contraction. This in turn triggers the second peak, caused by breakdown of glycogen, initiated by an increased Ca2+ concentration.
The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery
Authors: Apfel C. C. , Greim C. A. , Haubitz I. , Grundt D. , Goepfert C. , Sefrin P. , Roewer N.
Published: January 2009

Background: Recently, we have demonstrated that the probability of postoperative vomiting (PV) following ENT surgery with inhalational anaesthetics can be predicted using a risk score. This score is based on gender, age, smoking status, history of motion sickness or postoperative nausea and vomiting and the duration of anaesthesia. Therefore, it is of interest whether this score is also accurate in predicting PV in patients undergoing different types of surgery.

Methods: Inpatients scheduled for bone, vascular, general or eye surgery were included in a prospective survey for PV over 24 h. Data of 1091 patients were analyzed, of which 542 were used for the validation of the previously constructed risk score (Score I). The data of the remaining 549 patients were used to evaluate the risk factors that contribute to PV in this setting and to develop a new score (Score II). The discriminating power of both scores to predict PV was tested in the validation set (n=542) and compared by calculating the area under the receiver operating characteristic (ROC) curves.

Results: The area under the ROC curve of Score I was 0.77 (SD 0.024). Risk factors for PV in the evaluation set were female gender, young age, history of motion sickness or postoperative nausea and vomiting and the type of surgery. The area under the curve of Score II was 0.75 (SD 0.026) and was not significantly different from Score I (P=0.57).

Conclusion: Score I was accurate in predicting PV in patients after most types of surgery with volatile anaesthetics, which suggests that this score might be useful for other centres as well.
Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery
Authors: Koivusalo A.‐M. , Scheinin M. , Tikkanen I. , Yli‐Suomu T. , Ristkari S. , Laakso J. , Lindgren L.
Published: January 2009

Background: Carbon dioxide (CO2) pneumoperitoneum for laparoscopic surgery increases arterial pressures, systemic vascular resistance and heart rate and decreases urine output.

Methods: In this double‐blind randomized study esmolol, an ultrashort‐acting β1‐adrenoceptor antagonist was compared with physiological saline (control) in 28 patients undergoing laparoscopic surgery in standardized 1 MAC isoflurane anaesthesia. Alfentanil infusion was used to prevent the increase of mean arterial pressure more than 25% from baseline.

Results: Esmolol effectively prevented the pressor response to induction and maintenance of CO2 pneumoperitoneum. Significantly (P<0.001) less alfentanil was needed in the esmolol group than in the control group. Urine output was higher (P<0.05) and plasma renin activity (P<0.01) and urine N‐acetyl‐β‐D‐glucosaminidase levels lower in the esmolol group when compared with the control group.

Conclusions: Esmolol blunts the pressor response to induction and maintenance of pneumoperitoneum and may protect against renal ischaemia during pneumoperitoneum.
Influence of premedication with diazepam or morphine on the induction dose of eltanolone
Authors: Czuchwicki A. , Plummer J. L. , Love D. R. , Owen H. , Ilsley A. H.
Published: January 2009

Background: This study examined the influence of premedication with morphine or diazepam on the dose of eltanolone, a steroidal intravenous anaesthetic agent, required to induce anaesthesia.

Methods: Two hundred and sixteen patients, aged 18 to 65 years, were randomly assigned to receive premedication with diazepam 10 mg orally, morphine 10 mg intramuscularly, or placebo. The double‐dummy technique was used to maintain blinding. Eltanolone 0.16‐0.75 mg·kg‐1 was given intravenously over 20 s. At the commencement of injection patients were instructed to begin counting; if the patient ceased counting within 120 s and failed to respond to commands to continue, anaesthesia was considered to have been induced. The dose required to anaesthetise 50% of patients (ED50) was determined by logistic regression.

Results: The ED50 (95% confidence interval) of eltanolone in patients who received placebo premedication was 0.31 (0.27‐0.34) mg · kg‐1. It was reduced slightly and nonsignificantly by premedication with diazepam, to 0.27 (0.24‐0.30) mg · kg‐1, or morphine, to 0.26 (0.23‐0.29) mg · kg‐1. Involuntary movement occurred in 65% of placebo premedicated patients. Its incidence was not significantly reduced by diazepam (57%), but was significantly (P<0.001) reduced by morphine (37%). Morphine premedication was, however, associated with a significant (P<0.01) increase in the incidence of apnoea (21%) compared to placebo premedicated patients (4%).

Conclusion: Premedication with diazepam or morphine had little influence on the dose of eltanolone required to induce anaesthesia.
The inflammatory cytokine response after autotransfusion of shed mediastinal blood
Authors: Schmidt H. , Bendtzen K. , Mortensen P. E.
Published: January 2009

Background: The inflammatory response in patients undergoing cardiac surgery with cardiopulmonary bypass is well known and increased levels of inflammatory cytokines have been shown. High levels of cytokines have been reported in blood drained from the surgical field. The present study aimed to elucidate whether autotransfusion of shed mediastinal blood in itself causes increased cytokine levels in coronary artery bypass graft (CABG) patients.

Methods: A prospective, randomized controlled study was performed in 23 patients having elective uncomplicated CABG. Autotransfusion of shed mediastinal blood was done every hour for 18 h in group I. In group II, the shed mediastinal blood was accumulated for 4 h in the cardiotomy reservoir and then autotransfused every hour for the next 14 h. Plasma levels of tumour necrosis factor‐α (TNFα) and interleukin (IL)‐1α, IL‐1β, IL‐6 were measured. In vitro study of cytokine production was performed with or without stimulation (phytohaemagglutinin (PHA) and Escherichia coli (E. coli) lipopolysaccharide (LPS)).

Results: We found high levels of IL‐6 in the shed mediastinal blood. However, autotransfusion of shed mediastinal blood did not lead to increased level of cytokines (TNFα, IL‐1α, IL‐1β and IL‐6) in plasma in group I nor in group II. In vitro study showed activation of the leucocytes in the shed mediastinal blood with a significantly increased production of TNFα and IL‐6 both in the stimulated and non‐stimulated samples.

Conclusion: Shed mediastinal blood contains high levels of IL‐6. However, autotransfusion of shed mediastinal does not cause measurable elevations in plasma levels of IL‐6. In vitro study shows that autotransfusion activates leucocytes, which may enhance production of inflammatory cytokines.
Dose‐dependent suppression of the neutrophil respiratory burst by lidocaine
Authors: Hyvönen P. M. , Kowolik M. J.
Published: January 2009

Background: Oxygen radical production is thought to be fundamental to the pathogenesis of post‐ischaemic reperfusion injury which is routinely managed with lidocaine. Attention has, therefore, focused on the suppression of the neutrophil respiratory burst with a therapeutic endpoint. The widest application of lidocaine remains in local analgesia.

Methods: A standard chemiluminescence technique was used to assess the human neutrophil leukocyte response to increasing doses of lidocaine in the presence or absence of particulate hydroxyapatite.

Results: No reduction of oxygen radical production was seen at the drug concentration of 1 mg/ml. A clear, concentration‐dependent inhibition was seen at 2 mg/ml, 3 mg/ml, 4 mg/ml and 8 mg/ml concentrations. These drug concentrations may be reached at or near the site of injection in local anaesthetic use.

Conclusion: Lidocaine showed profound anti‐inflammatory action in this experimental system. Controlled studies in the clinical setting would identify the optimal analgesic and anti‐inflammatory dosage, whilst preserving host defence without compromising tissue repair.
Comparison of transarterial and multiple nerve stimulation techniques for an initial axillary block by 45 mL of mepivacaine 1% with adrenaline
Authors: Koscielniak‐Nielsen Z. J. , Hesselbjerg L. , Fejlberg V.
Published: January 2009

Background: The single‐injection axillary block is rapidly performed but gives unpredictable results. Axillary block by multiple nerve stimulation technique (MNS) gives better results, but takes longer to perform. Transarterial (TA) injections of high doses of local anaesthetics are very successful. This double‐blind study compared both block effectiveness and anaesthesiologic time consumption in 100 patients, having an axillary block by either TA or MNS techniques.

Methods: 45 mL of 1% mepivacaine with adrenaline 5 μg/mL was used in each patient. Five mL was injected subcutaneously. In the TA group, 20 mL was injected deep to, and 20 mL superficial to the axillary artery. In the MNS group, four terminal motor nerves were electrolocated in the axilla, and injected with 10 mL each. Analgesia was assessed every 10 min and when needed supplemented after 30 min. The block was considered successful when analgesia was present in all sensory nerve areas distal to the elbow.

Results: MNS group required 10δ2 min (meanδ1 SD) for the initial block performance compared with 7δ2 min for TA group, P<0.001. Latency of the initial block was shorter and the frequency of supplemental analgesia lower in the MNS group (mean 17 min and 12%), than in the TA group (25 min and 38%, respectively), P<0.001. All incomplete blocks were successfully supplemented by electrolocating the unblocked nerves. However, the total time to obtain 100% success rate was shorter in the MNS group (30 min), than in the TA group (38 min), P<0.001. The adverse effects (accidental intravascular injections and axillary haematomas) were fewer in the MNS group.

Conclusion: In the hands of anaesthetists experienced in nerve electrolocation, the MNS technique of an initial axillary block by four separate injections of 10 mL of mepivacaine produces faster and more extensive block than the TA technique by two separate injections of 20 mL. Hence, the MNS technique requires fewer supplementary blocks and results in faster patient readiness for surgery than the TA technique.
Neurolytic thoracic paravertebral block in cancer pain
Authors: Antila H. , Kirvelä O.
Published: January 2009

Background: Paravertebral block has successfully been used in the treatment of acute and chronic pain. The duration of paravertebral block could theoretically be prolonged by using neurolytic agents.

Methods: We retrospectively analyzed the results of neurolytic paravertebral blocks performed in 7 patients suffering from intense cancer‐related thoracic pain. Thirty‐seven spinal nerve roots were blocked during 20 visits. Nerve roots were identified by eliciting paresthesia radiating to the painful area. Each root was blocked separately. After test block using 0.5% bupivacaine, the paravertebral blocks were performed with 1–4 ml of 7% phenol in aqua.

Results: No technical failures or complications were recorded in the patient files. Pain relief lasted over 2 months after 4 visits (20%), from 1 week to 1 month after 5 visits (25%), and less than 1 week after a single visit (5%). After 9 visits (45%), the results were poor with no significant pain relief.

Conclusion: Neurolytic paravertebral block with phenol doses used in our patients appears to have only limited use. Some patients with pain restricted to a small number of thoracic segments may benefit from its use. Because of complication risks, this technique should be limited to intractable pain in cancer patients with poor prognosis.
Effect of an endotoxin‐removing column containing immobilized polymyxin B fiber in a patient with septic shock from gram‐positive infection
Authors: Iwama H. , Komatsu T.
Published: January 2009

A 67‐yr‐old patient with septic shock caused by gram‐positive infection fell into circulatory collapse. Direct hemoperfusion with an endotoxin‐removing column was then carried out for 120 min. As a result, blood pressure and systemic vascular resistance increased significantly during this therapy. Cardiac output changed from hyperdynamic to normodynamic, and plasma endotoxin level decreased. After this treatment, the patient recovered. From this experience, we consider that the endotoxin‐removing column may be effective for septic shock patients.
Methemoglobinemia induced by methylene blue pertubation during laparoscopy
Authors: Bilgin H. , ÖZcan B. , Bilgin T.
Published: January 2009

Methylene blue is used to check tubal patency during laparoscopy. A case of methemoglobinemia which was induced by methylene blue is presented. Methemoglobinemia is usually treated with methylene blue; however, in patients with glucose‐6‐phosphate dehydrogenase deficiency, methylene blue can induce methemoglobinemia.
Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism: A dose‐response study in patients subjected to craniotomy for cerebral tumours
Authors: Bundgaard H. , VON Oettingen G. , Larsen K. M. , Landsfeldt U. , Jensen K. A. , Nielsen E. , Cold G. E.
Published: January 2009

Background: Studies concerning the cerebrovascular effects of sevoflurane in patients with space‐occupying lesions are few. This study was carried out as a dose‐response study comparing the effects of increasing sevoflurane concentration (1.5% (0.7 MAC) to 2.5% (1.3 MAC)) on cerebral blood flow (CBF), intracranial pressure (ICP), cerebrovascular resistance (CVR), metabolic rate of oxygen (CMRO2) and CO2‐reactivity in patients subjected to craniotomy for supratentorial brain tumours.

Methods: Anaesthesia was induced with propofol/fentanyl/atracurium and maintained with 1.5% sevoflurane in air/oxygen at normocapnia. Blood pressure was maintained constant by ephedrine. In group 1 (n=10), the patients received continuously 1.5% sevoflurane. Subdural ICP, CBF and CMRO2 were measured twice at 30‐min intervals. In group 2 (n=10), sevoflurane concentration was increased from 1.5% to 2.5% after CBF1. CBF2 was measured after 20 min during 2.5% sevoflurane. Finally, CO2‐reactivity was studied in both groups.

Results: In group 1, no time‐dependent alterations in CBF, CVR, ICP and CMRO2 were found. In group 2, an increase in sevoflurane from 1.5% to 2.5% resulted in an increase in CBF from 29 ± 10 to 34±12 ml 100g−1 min−1 and a decrease in CVR from 2.7±0.9 to 2.3±1.2 mmHg ml−1 min 100g (P<0.05), while ICP and CMRO2 were unchanged. CO2‐reactivity was maintained at 1.5% and 2.5% sevoflurane.

Conclusion: Sevoflurane is a cerebral vasodilator in patients with cerebral tumours. Sevoflurane increases CBF and decreases CVR in a dose‐dependent manner. CO2‐reactivity is preserved during 1.5% and 2.5% sevoflurane.
Comparison of spontaneous frontal EMG, EEG power spectrum and bispectral index to monitor propofol drug effect and emergence
Authors: Struys M. , Versichelen L. , Mortier E. , Ryckaert D. , Mey J. C. De , Deyne C. De , Rolly G.
Published: January 2009

Background: The aim of this study was to investigate the accuracy of frontal spontaneous electromyography (SEMG) and EEG spectral edge frequency (SEF 95%), median frequency (MF), relative delta power (RDELTA) and bispectral index (BIS) in monitoring loss of and return of consciousness and hypnotic drug effect during propofol administration at different calculated plasma target concentrations.

Methods: Propofol was administered by using a target‐controlled infusion at different propofol steady‐state concentrations. All variables were measured simultaneously at specific calculated concentrations and endpoints.

Results: Loss of consciousness was accurately monitored by BIS, SEMG and SEF 95%, and propofol drug effect by BIS only. Return of consciousness was predicted by BIS, MF and SEF 95%. Due to the biphasic EEG pattern of propofol and the lack of reproducible data at specific propofol concentrations, the clinical usefulness of SEF 95%, MF and RDELTA was very limited. SEMG was useful to detect loss and return of consciousness, but without predictive value.

Conclusions: The BIS might be an accurate measure to monitor depth of anaesthesia and hypnotic drug effect. Other neurophysiologic measures have limited value to monitor depth of anaesthesia and hypnotic drug effect.
Nausea and vomiting after dexamethasone versus droperidol following outpatient laparoscopy with a propofol‐based general anesthetic
Authors: Rothenberg D. M. , McCarthy R. J. , Peng C. C. , Normoyle D. A.
Published: January 2009

Background: The purpose of this randomized, double‐blinded study was to compare the incidence and severity of postoperative nausea and vomiting (PONV) after dexamethasone versus droperidol following gynecologic laparoscopy, a group at high risk for developing PONV.

Methods: Ninety‐five patients who underwent a propofol‐based general anesthetic received either dexamethasone 0.17 mg/kg IV, or droperidol 0.02 mg/kg IV, just prior to abdominal incision. Nausea, retching, vomiting, degree of sedation, and discharge times were assessed in the Post Anesthesia Care Unit (PACU), and the Ambulatory Care Unit (ACU). Following hospital discharge (24 h), the patients were contacted by telephone to assess any further complications.

Results: PONV in the PACU (14.6% vs. 14.9%) and ACU (8.3% vs. 14.9%) was as common after dexamethasone as after droperidol. PONV following hospital discharge was, however, less common after dexamethasone than after droperidol (4.2% vs. 17.0%, P=0.041). Postoperatively, no complications of therapy were detected.

Conclusions: We conclude that PONV is similar with dexamethasone and droperidol, but dexamethasone may have a longer duration of action in patients undergoing gynecologic laparoscopy.
Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: Detection by transesophageal echocardiography
Authors: Mammoto T. , Hayashi Y. , Ohnishi Y. , Kuro M.
Published: January 2009

Background: Venous air embolism (VAE) and paradoxical air embolism (PAE) are serious complications associated with the sitting position for neurosurgery. Although PAE is the result of VAE, the incidence of PAE according to the severity of VAE has not been investigated systematically in humans.

Methods: Twenty‐one patients scheduled for neurosurgery in the sitting position were investigated prospectively. VAE and PAE were continuously monitored by cardiac two‐dimensional 4‐chamber view using transesophageal echocardiography (TEE) and the severity of VAE and PAE was quantitatively graded from 0 to 3 by the microbubbles score. Haemodynamic parameters and end‐tidal CO2 concentration (PETCO2) during VAE and PAE were also recorded.

Results: Microbubbles in the right atrium appeared in all patients and the number of patients involved in grades 0, 1, 2 and 3 of VAE was 0, 10, 3 and 8, respectively. PAE occurred in 3 patients and only followed grade 3 of VAE. PAE always appeared from 20 to 30 s after the most severe VAE. A reduction of PETCO2 and an increase of pulmonary artery pressure were noted during all episodes of grades 2 and 3 VAE. In contrast, a significant reduction of systemic blood pressure occurred in 1 case of grade 2 and 3 cases of grade 3.

Conclusions: VAE detected by TEE appeared in all patients undergoing neurosurgery in the sitting position and PAE only occurred following the most severe grade of VAE. To prevent growth of VAE is an important prophylactic for PAE.
Effects of desflurane and propofol on arterial oxygenation during one‐lung ventilation in the pig
Authors: Karzai W. , Haberstroh J. , Priebe H.‐J.
Published: January 2009

Background: Desflurane depresses hypoxic pulmonary vasoconstriction (HPV) in vitro. During one‐lung ventilation (OLV), HPV may reduce venous admixture and ameliorate the decrease in arterial O2 tension by diverting blood from the non‐ventilated to the ventilated lung. Accordingly, this study compares the effects of desflurane with those of propofol on oxygenation during two‐lung (TLV) and OLV in vivo.

Methods: Ten pigs (25–30 kg) were premedicated (flunitrazepam 0.4 mg/kg im), anaesthetized (induction: propofol 2 mg/kg iv; maintenance: N2O/O2 50%/50%, desflurane 3%, propofol 50 μg kg−1 min−1, and vecuronium 0.2 mg kg−1 h−1 iv), orally intubated and mechanically ventilated. Femoral arterial and thermodilution pulmonary artery catheters were placed, and the orotracheal tube was replaced by a left‐sided 28‐Ch double‐lumen tube (DLT) via tracheotomy. After DLT placement, N2O and propofol were discontinued, FiO2 was increased to 0.85, and anaesthesia continued randomly with either desflurane (1 MAC) or propofol 200 μg kg−1 min−1. Using a cross‐over design, in each animal the effects of a), changing from TLV to OLV (left lung) during both desflurane and propofol and b), the effects of changing between the two anaesthetics during OLV were studied.

Results: When changing from TLV to OLV, PaO2 decreased more (P<0.05) during desflurane (mean 75%) than during propofol (mean 60%). Changing between desflurane and propofol during OLV resulted in small but consistent (P<0.05) increases in PaO2 (mean 15%) during propofol.

Conclusion: Consistent with in vitro results on HPV, 1 MAC desflurane impaired in vivo oxygenation during OLV more than did propofol.