bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal anaesthesia with glucose–free 2% lignocaine. Effect of different volumes
Authors: KRISTENSEN J. , HELBO–HANSEN H. S. , TOFT P. , HOLE P.
Published: January 2009

Spinal anaesthesia with 2, 3 or 4 ml of glucose–free 2% lignocaine was studied in 64 patients undergoing transurethral surgery of the bladder. Cephalad spread of analgesia, onset time, duration of analgesia, duration of motor block, quality of analgesia, and the cardiovascular effects were assessed. Two ml of 2% lignocaine was insufficient to produce reliable analgesia. Three ml provided sufficient analgesia in most of the patients, but 4 ml was needed to guarantee sufficient analgesia in all patients. Onset times for analgesia and motor block were 10–20 min. After 4 ml the median and interquartile values were: maximum cephalad spread: T8, (T10–T5); time from injection to regression of analgesia to T11: 84 min, (60–103 min); duration of complete motor block: 90 min, (60–120 min). All patients in the 3–ml and 4–ml groups developed complete motor block. There was a positive correlation between the dose and the duration of analgesia and motor block. A positive correlation, although weaker, was also seen between the dose and the maximum cephalad spread of analgesia. There was an inverse relationship between the cephalad spread of analgesia and the duration of motor block. Falls in systolic blood pressure > 30% were noted in seven patients in whom the cephalad spread of analgesia was higher than in the rest of the patients. Spinal anaesthesia with glucose–free 2% lignocaine in doses of 3–4 ml provides reliable analgesia for transurethral surgery of the bladder.
The effect of continuous intravenous indomethacin infusion on bleeding time and postoperative pain in patients undergoing emergency surgery of the lower extremities
Authors: TAIVAINEN T. , HILLER A. , ROSENBERG P. H. , NEUVONEN P.
Published: January 2009

Fifty–four orthopaedic patients were given either indomethacin (25–50 mg bolus plus infusion, 5–7.5 mg h‐1) or only lactated Ringer solution intravenously over 20 h in a randomized and double–blind fashion. The study was started at the casualty department as soon as possible after the decision to operate was made. The patients were given a spinal block with bupivacaine, and the evaluation included postoperative analgesia and IVY bleeding times. Indomethacin plasma concentrations were measured and found to be at a therapeutic level throughout the study. The oxycodone dose (mean s.d.) during the postoperative observation was lower in the indomethacin group (17.4 13.7 mg) than in the control group (25.6 15.6 mg) (P = 0.05). Fewer patients in the indomethacin group needed oxycodone more than once during the follow–up period (P < 0.001). The mean IVY bleeding time was prolonged in the indomethacin group after 20 h of infusion (P < 0.05). No abnormal bleeding was observed immediately postoperatively. However, at the end of the infusion there were more patients who bled through their bandages and casts in the indomethacin group (4/28 vs. 1/26).
Calculation of end–tidal carbon dioxide fractions in the Bain system
Authors: JONSSON L. O. , ZETTERSTRÖM H.
Published: January 2009

The validity of the Stenqvist–Sonander formula for calculating the end–expiratory fraction of carbon dioxide (FACO2) in the coaxial Mapleson D (Bain) systems was evaluated using a lung model for simulated spontaneous breathing with an optional respiratory wave form. Two different respiratory flow patterns were used, one representing relaxed breathing in a volunteer and one resembling the respiration found in halothane anaesthesia. Each pattern was used with five different fresh gas flows and three different respiratory rates. The formula was found to be quite accurate when the flow pattern of an awake volunteer was simulated, but it underestimated the observed FETCO2 value by about 10% in halothane breathing. It is concluded that the formula can be recommended for use in theoretical and educational situations but that it is too complicated for application in clinical practice.
Effects of heparin on serum ionized calcium and haemodynamics during coronary artery surgery
Authors: TAKKUNEN O.
Published: January 2009

Heparin has been reported to possess hypotensive and vasodilating properties when given in 3 mg/kg bolus injection. The haemodynamic effect has been thought to be related to an acute lowering of serum ionized calcium levels. The effects of heparin on haemodynamics and ionized calcium were compared with saline in 30 patients during coronary artery surgery before the commencement of cardiopulmonary bypass. There were no significant differences in haemodynamics or ionized calcium levels between heparin or saline during the observation period of 10 min. The results are at variance with some previous findings, and suggest that the hypotensive reaction occasionally seen after heparin is given is not mediated by the reduction of serum ionized calcium.
Continuous interscalene brachial plexus block: clinical efficacy, technical problems and bupivacaine plasma concentrations
Authors: TUOMINEN M. , HAASIO J. , HEKALI R. , ROSENBERG P. H.
Published: January 2009

Continuous interscalene brachial plexus block with a single dose of 0.5% bupivacaine 1.25 mg/kg, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h, was performed on 24 patients to provide analgesia during shoulder surgery and in the postoperative period. The drugs for general anaesthesia included glycopyrrolate, thiopentone, vecuronium, enflurane and N2O/O2. All patients had signs of regional analgesia 30 min after the block without haemodynamic problems. The infusion of local anaesthetic was interrupted in six patients because of a failure in catheter function. Of the remaining 18 patients, nine needed no complementary analgesics and nine patients received, on average, 1.6 doses of oxycodone (0.15 mg/kg/dose) during a 24–h period. Displacement of the interscalene catheters could be prevented by a fixation suture to the skin. Two patients noted a metallic taste during the bupivacaine infusion. The most common complaints were numbness of the hand (n = 15) and hoarseness (n= 5). The mean (s. e. mean) plasma concentrations of bupivacaine at 30, 60, 180 min and 24 h were 0.68 0.06, 0.62 0.05, 0.52 0.04 and 0.76 0.01 μg/ml, respectively. During the 24–h period, the α1–acid glycoprotein (AAG) concentration (mean s. e. mean) in plasma rose from 0.41 0.04 g/1 to 0.54 0.04 g/1 (P < 0.001). The concentration of free bupivacaine was below detectable levels (<0.01 μg/ml) after the 24–h infusion. The rise in AAG probably increases binding of bupivacaine to plasma proteins, diminishing the risk of systemic toxicity.
Low–flow anaesthesia does not increase the risk of microbial contamination through the circle absorber system
Authors: BENGTSON J. P. , BRANDBERG A. , BRINKHOFF B. , SONANDER H. , STENQVIST O.
Published: January 2009

In the circle absorber system, a decrease in fresh gas flow means a higher degree of rebreathing, and, consequently, a higher temperature and humidity within the system. With our present hygienic routines, the circle system tubings are changed and decontaminated once daily. Thus, the same circle system is used for several patients each day. In order to evaluate whether the risk of bacterial contamination increased with the introduction of low–flow anaesthesia, 122 patients anaesthetized with either a low–flow technique (< 1.5 1 fresh gas flow/min) or with medium fresh gas flows (3–6 1/min) were studied. Bacterial samples were taken preoperatively from the oropharynx and postoperatively from five locations in the circle system. The patients were studied postoperatively for signs of respiratory tract infection. There were few positive bacteria cultures from the tubings in the circle system, regardless of fresh gas flow. No pathogens were found in the inspiratory tubings and no cases of postoperative respiratory tract infection could be related to bacterial spread from the anaesthesia machine. There were no indications that the present hygienic management was insufficient for the medium– or the low–flow circle system techniques.
Cardiotoxicity of ropivacaine – a new amide local anaesthetic agent
Authors: REIZ S. , HÄGGMARK S. , JOHANSSON G. , NATH S.
Published: January 2009

Anaesthetically equipotent doses of lidocaine, bupivacaine and a new bupivacaine–like local anaesthetic agent, ropivacaine, were injected into the left anterior descending coronary artery of pentobarbital–anaesthetized pigs. The aim was to study the cardiotoxicity of ropivacaine in relation to the two other drugs. A random, crossover, dose response study design was used. The following doses of the drugs were administered: lidocaine (L): 1,2,4,8 and 16 mg, bupivacaine (B): 0.25, 0.5, 1,2 and 4 mg and ropivacaine (R): 0.33, 0.66 1.33, 2.66 and 5.33 mg. Systemic haemodynamics, left ventricular dP/dT and a 12–lead electrocardiogram were recorded continuously during the study period. The drugs depressed cardiac contractility in relation to their local anaesthetic potency on the isolated nerve–4:3:l(B:R:L). The prolongation of the ECG QRS–interval was regarded as a measure of electrophysiologic toxicity. Comparable prolongation of the QRS–interval was recorded after 2 mg of bupivacaine, 4.5 mg of ropivacaine and 30 mg of lidocaine. Thus, the electrophysiological toxicity ratio was 15:6.7:1 (B:R:L). Provided local anaesthetic potency data can be extrapolated from the isolated nerve preparation to regional anaesthesia in humans, ropivacaine appears to provide a greater margin of safety than bupivacaine, if inadvertently injected into the venous circulation.
Isoflurane and intravenous anesthesia used for induction before coronary artery bypass grafting
Authors: DAHLGREN G. , ÖHQVIST G. , BRODIN L–Å. , FISCHERSTRÖM A. , SETTERGREN G.
Published: January 2009

Induction of anesthesia with isoflurane in combination with fentanyl, thiopentone, nitrous oxide and pancuronium was studied in nine patients scheduled for coronary artery bypass grafting. Ejection fraction (EF) of the left ventricle was monitored with a single crystal probe linked to a microcomputer, after injection of 200 MBq Tc 99m–HSA. Stroke volume index determined by thermodilution and EF were used to calculate left ventricular end–diastolic volume index (LVEDVI). The degree of ischemia was numerically scored as evaluated from the ECG (modified Vs lead). The study protocol covered seven periods from awake before induction to 5 min after intubation. EF decreased moderately during intubation (P < 0.05). Systemic vascular resistance index (SVRI) was decreased (P < 0.05) at all times except during intubation when it was unchanged compared to control. LVEDVI decreased during induction (P<0.05), while left ventricular filling pressure remained unchanged. Heart rate did not change. Systolic arterial pressure decreased from 147 mmHg (19.6 kPa) to about 100 mmHg (13.3 kPa) during induction (P < 0.05). Two patients were given vasoconstrictors because of low arterial pressure. The mean ischemic score did not change. One patient, however, had signs of progressive ischemia. In this patient isoflurane administration was stopped after the last recording and the ECG normalized within 20 min.
Continuous infusion of midazolam during anaesthesia and postoperative sedation after maxillofacial surgery
Authors: DRIESSEN J. J. , DIRKSEN M. S. C. , RUTTEN J. M. J. , SANTMAN F. , VAN EGMOND J. , VREE T. B.
Published: January 2009

The clinical effects and pharmacokinetics of 24 h infusion of midazolam (MDZ) during major maxillofacial surgery and postoperative observation in an Intensive Care Unit (ICU) were studied in 20 patients. During anaesthesia, infusion of MDZ at 5 mg/h combined with 67% nitrous oxide, 1.8 (s.d. = 0.8) mg of fentanyl, and 26.5 (s.d. = 11.4) mg of vecuronium, adequately suppressed clinical responses to surgical nociceptive stimuli. Postoperatively, infusion of MDZ was continued in the ICU at 5 mg/h until 9 a.m. of the first postoperative day for sedation of the intubated but spontaneously breathing patients. The depth of sedation in the ICU was scored from 1–5 (1 = “awake and tense”, 5 = “unable to communicate”). During infusion the sedation score decreased from 3.8 after ICU arrival to 2.2 at 8 a.m. of the first postoperative day. Neither ventilatory nor circulatory depression were observed. After cessation of MDZ, recovery from sedation was fast. The degree of amnesia was low. During constant rate infusion no increase in plasma concentration of either MDZ or metabolites occurred. of MDZ after cessation was 125 min (range 90–320) and its total body clearance was 10.5 ml/kg/min (s.d. = 3.1). The volume of distribution, clearance and T1/2β were significantly longer in women than in men. It was concluded that 24 h of MDZ infusion at 5 mg/h caused satisfactory ICU sedation with fast recovery, but that individual tailoring of the infusion rate may still improve the quality of sedation.
Suppression of neutrophil migration and chemiluminescence is due to the sulphur atom in the thiobarbiturate molecule
Authors: KRESS H. G. , EBERLEIN T. , HÖRBER B. , WEIS K. H.
Published: January 2009

In this study the hypothesis was tested that the substituent at the C 2 position of the barbiturate molecule is crucial for the obvious differences in inhibitory potencies between various barbiturates with respect to neutrophil functions in vitro. Using isolated neutrophils from healthy volunteers, the comparative effects of two pairs of sulphur or oxygen–substituted analogues on chemiluminescence, random and chemotactic migration were examined. Five other i.v. barbiturates were also tested in the chemiluminescence assay. The key observation with all the assay systems was that the oxybarbiturates proved ten to a hundredfold less suppressive than their sulphurated analogues or the other thiobarbiturates. Thus, enhanced inhibitory potency was dependent on the presence of the sulphur atom in the barbiturate molecule and could no longer be explained exclusively on the basis of divergent physicochemical features.
Cimetidine and ranitidine do not affect enflurane metabolism in surgical patients
Authors: OIKKONEN M. , ROSENBERG P. H. , SAARNIVAARA L.
Published: January 2009

Hepatic cytochrome–P–450–linked microsomal metabolism is inhibited by cimetidine, and to a lesser extent by ranitidine. Such an inhibition might protect against the metabolite–related toxicity of inhalation anesthetics. However, in comparison with the values measured in a control group, neither cimetidine (600 mg p.o. + 200 mg i.m.) nor ranitidine (150 mg p.o. + 50 mg i.m.), both administered 11–12 h and 1 h before anesthesia, inhibited enflurane metabolism as assessed by the increase in plasma inorganic fluoride concentration and urinary fluoride excretion in 21 ASA I patients anesthetized with enflurane (end–tidal concentration 0.5 0.05% for 2–6 h). The inorganic fluoride concentration in the gastric juice remained low in all groups.
The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2–insufflation
Authors: JOHANNSEN G. , ANDERSEN M. , JUHL B.
Published: January 2009

Sixteen women were studied during elective diagnostic laparoscopy with CO2–insufflation to an intraabdominal pressure (IAP) of 2 kPa and Trendelenburg tilt to 30. They were allocated to either a halothane (Group I) or a balanced (Group II) anaesthesia with relaxation and controlled ventilation. Heart rate (HR), arterial pressure, stroke volume, CO2–elimination, end–tidal CO2 vol.% and total respiratory compliance (TRC) were the parameters measured, and mean arterial pressure (MAP), total peripheral resistance (TPR), stroke index (SI) and cardiac index (CI) were calculated. At maximum haemodynamic strain, SI and CI were on average reduced by 42% m both groups, without significant changes in HR and MAP. TPR increased by 50% in Group I and 100% in Group II. The reduction in SI was related to the changes in TRC. A small increment in CO2–elimination after CO2–insufflation was most pronounced in Group II. SI and CI did not reach the pre–insufflation values after return to the horizontal position and CO2–exsufflation. The haemodynamic differences between the two groups were small compared to the effects of the laparoscopy procedures.
Thoracic paravertebral block: a method of pain control
Authors: GILBERT J. , HULTMAN J.
Published: January 2009

The adverse effects of pain on acutely ill or traumatized patients are well documented. A variety of pain–relieving techniques are now available to meet the varied requirements for pain relief. This paper presents the results of a single, large–volume injection of bupivacaine 0.5% in the thoracic paravertebral space, achieving pain relief over several thoracic dermatomes in patients with respiratory compromise secondary to thoracic or upper abdominal injury. The block proved quick and simple to perform, with excellent clinical results of long duration and virtually no complications. Although not previously described, this single, large–volume injection approach to achieving an extensive thoracic paravertebral block may well become an important pain management technique in appropriate patients.
Treatment of post–thoracotomy pain with intermittent instillations of intrapleural bupivacaine
Authors: SCHEININ B. , LINDGREN L. , ROSENBERG P. H.
Published: January 2009

The effect of intrapleural bupivacaine in the treatment of post–thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 μg/ml) was given through an indwelling intrapleural catheter, at 4–h intervals four times daily for 2 days. No pleural suction was applied during and 10 min after each injection. A control group received intramuscular oxycodone on request. A visual analogue scale (VAS), a pain questionnaire (PQ) and registration of the need for supplementary analgesics were used for the assessment of postoperative analgesia. Blood–gas analyses showed elevated Pacoz values in both groups on the day of operation and on the first postoperative day, without differences between the groups. Plasma concentrations of bupivacaine did not reach toxic values, and no symptoms of central nervous toxicity or any other untoward reactions were found during the study period. Clinically, there was some pain relief after the intrapleural bupivacaine. The VAS and PQ scores 30 min after bupivacaine instillations diminished to an extent similar to that after oxycodone treatment. The need for analgesics during the day of operation was less in the bupivacaine group than in the control group (P < 0.001). The number of oxycodone supplementation doses during 48 h postoperatively was, however, not smaller in the bupivacaine group than in the control group.
Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy
Authors: THORÉN T. , SUNDBERG A. , WATTWIL M. , GARVILL J.–E. , JÜRGENSEN U.
Published: January 2009

A comparison was made of the effects of continuous epidural analgesia with bupivacaine and intermittent epidural morphine on bowel function after abdominal hysterectomy. The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces. Twenty–two patients were randomly allocated to two equal groups. An “epidural morphine” group received general anesthesia and epidural morphine for postoperative pain relief, and an “epidural bupivacaine” group was given combined general anesthesia and epidural anesthesia with 0.5% bupivacaine intraoperatively and epidural analgesia with 0.25% bupivacaine postoperatively. Epidural morphine or bupivacaine was given for 42 h postoperatively. Pain intensity (visual analog scale) was low in both groups, but lower (P< 0.05) in the epidural bupivacaine group. The time to first passage of flatus was 22 16 h in the epidural bupivacaine group and 56 22 h in the epidural morphine group (P< 0.001). The time to first postoperative passage of feces was shorter (P< 0.05) in the former than in the latter (57 44 h vs 92 22 h). The patients of the epidural bupivacaine group started intake of oral fluids earlier (P<0.01) and to a greater extent (P< 0.05) than those in the epidural morphine group. It is concluded that the duration of postoperative ileus after hysterectomy is shorter when epidural bupivacaine is given for postoperative pain relief than when this is achieved by epidural morphine.
The effects of prolonged isoflurane anaesthesia on cerebral blood flow and metabolism in the dog
Authors: ROALD O. K. , FORSMAN M. , STEEN P. A.
Published: January 2009

To determine whether cerebral blood flow (CBF) changed with time under isoflurane anaesthesia, as has been reported for halothane, CBF and cerebral metabolic rate for oxygen (CMRo2) were studied in five dogs under prolonged isoflurane anaesthesia. CBF was measured with a modified sagittal sinus technique and CMRo2 was calculated as the product of CBF and the arteriovenous O2 difference. Maintaining this experimental dog model with 1 % isoflurane in oxygen and nitrogen for 3 h in five dogs and for 4 h in three dogs did not cause any significant changes in CMRo2 or CBF. Cerebral metabolite levels were consistent with earlier reports from short–time studies and the EEG recordings showed a continuous sleep pattern with no pathological changes. It is concluded that there is no change in CBF or CMRo2 in our modified sagittal outflow model during 3–4 h of 1 % isoflurane anaesthesia.
Cannula thrombophlebitis: a study in volunteers comparing polytetrafluoroethylene, polyurethane, and polyamide–ether–elastomer cannulae
Authors: LARSSON N. , STENBERG K. , LINDER L.–E. , CURELARU I.
Published: January 2009

Cannulae made of polytetrafluoroethylene (PTFE: n = 11), thermoplastic polyether–urethane (TPEU: n = 11), and a new test material, polyamide–ether–elastomer (XLON: n = 10) were inserted into the veins of the dorsum of the hand in 32 healthy volunteers (10 women and 22 men), 21–50 years old. The cannulae were intended to be left in place for 5 days. No infusion was given and the dressings were not exchanged. The resulting thrombophlebitis, defined as two or more of the symptoms pain, redness, oedema and hardness, was estimated on a scale which took into account the incidence, location, intensity, and duration of the symptoms. Except for one volunteer in the XLON group, all the volunteers developed thrombophlebitis, generally observed on the third day of cannulation, and being more frequent and intense over the cannulae (P < 0.001) and at the tip (P < 0.01) than at the insertion sites. Pain and oedema were, on the whole, the most frequent and severe symptoms during the period of indwelling. After withdrawal, hardness was the most intense, and together with pain, the most long–lasting (up to 10 days) symptom. The differences between the materials in thrombophlebitis incidence and intensity were statistically significant only when each symptom was analysed separately. Thus, the PTFE cannulae caused more pain and hardness (probably because of greater platelet adhesion and a relatively greater stiffness), while the TPEU and XLON cannulae produced more periphlebitis (redness and oedema), probably because of potentially irritant and antigenic substances leaking from them (polyurethane oligomers and polyamide/polyethyleneglycol oligomers).
Effects of halothane on membrane ionic currents in guinea pig atrial and ventricular myocytes
Authors: HIROTA K. , ITO Y. , MASUDA A. , MOMOSE Y.
Published: January 2009

We studied the effects of halothane on membrane potentials and ionic currents in single guinea pig atrial and ventricular cells prepared by an enzymatic dispersion procedure. In both atrial and ventricular cells, action potential overshoot and its plateau phase were significantly decreased by halothane (2%) without change in resting potential. However, the duration of the ventricular action potential measured at 90% repolarization was markedly shortened by halothane (2%) (to 60% of control), whereas that of the atrial action potential did not change significantly. Corresponding voltage clamp experiments demonstrated that in atrial cells halothane (2%) significantly depresses the time– and voltage–dependent outward K+ current (IK) (to 46% of control); and that in ventricular cells IK is then nearly absent. In both atrial and ventricular cells halothane had no effect on the inwardly rectifying K+ current (IK1). On the other hand, halothane (2%) decreased the slow inward Ca2+ current (ICa) in both atrial and ventricular cells (to 36% and 29% of control, respectively). The results suggest that the shortened action potential in ventricular cells by halothane may well be responsible for the decrease of the plateau phase resulting from the depression of ICa; and that in atrial cells the depression of IK and ICa by halothane had no significant effect on the duration of action potential.
Haemodynamic responses during general anaesthesia for renal transplantation in patients with and without hypertensive disease
Authors: POUTTU J.
Published: January 2009

Haemodynamic changes in 81 patients undergoing surgery for renal transplantation were studied. They were allocated to three groups depending on whether or not they had chronic hypertension and which drugs were used to control it. The patients in Group I (N = 18, 22%) were normotensive and were not receiving antihypertensive therapy, those in Group II (N = 21, 26%) were taking beta–blockers and those in Group III (N = 42, 52%) both beta–blockers and vasodilating agents. Antihypertensive medication was continued as prescribed until surgery. No anticholinergic premedication was given. All patients received a standardized anaesthesia which included thiopentone, fentanyl, vecuronium and isoflurane. Mean arterial blood pressure and mean heart rate were lowest in Group I compared with the other groups immediately before induction, following vecuronium and thiopentone administration, and after tracheal intubation (P < 0.05). After the 10–min induction period, blood pressure and heart rate values did not differ between the groups. Although before and during surgery and anaesthesia central venous pressure did not differ between the groups, CVP was higher in Group I postoperatively compared with the other groups (P < 0.05). No serious anaesthesia–related complications occurred.
Treatment of venous air embolism with papaverine
Authors: LANGE J. J. DE , BOOIJ L. H. D. J. , SMELT W. L. H.
Published: January 2009

Two cases of venous air embolism are described. One case occurred in a 12–year–old girl operated for uretero–ileo–cutaneostomy; the other case occurred in a 44–year–old patient who underwent a hemihepatectomy. The haemodynamic and pulmonary consequences were successfully treated with intravenous papaverine.
Midazolam does not potentiate the effect of vecuronium in patients
Authors: Husby P. , Vamnes J. S. , Rodt S. A. , Rørvik K. , Koller M.‐E. , Gramstad L.
Published: January 2009

Reports of midazolam interaction with vecuronium in animals prompted us to compare midazolam (0.25 mg kg‐1) with thiopentone (5 mg kg‐1) for possible interactions with vecuronium in patients, when used for induction of anaesthesia. After the administration of either of the two induction agents, the patients received vecuronium 0.1 mg kg‐1. The onset time, duration of action and 25–75% recovery index of the neuromuscular blockade were recorded by measuring the force of thumb adduction evoked by ulnar nerve stimulation. We found no differences between patients receiving either midazolam or thiopentone in their response to vecuronium. In three of the ten patients receiving midazolam, the injection of this drug produced a 8–29% reduction of the initial twitch height.
Subarachnoid analgesia with hyperbaric 0.5 % bupivacaine: effect of a 60‐min period of sitting
Authors: Povey H. M. R. , Jacobsen J. , Westergaard‐Nielsen J.
Published: January 2009

A prospective randomised study of the effect when the patient remained sitting for 2 (Group‐2) or 60 min (Group‐60) before being put in the supine horizontal position, was evaluated in 12 patients, aged 39–67 years and given a spinal anesthesia with 4 ml 0.5% bupivacaine in 8% glucose (hyperbaric). The maximal cephalad spread of analgesia was obtained after 12.5 min (median) in Group‐2 and 75 min in Group‐60 (P<0.01). The spread of sensory analgesia went to T‐6 (Group‐2) and L3 (Group‐60) after 60 min (P<0.01). After 90 min the spread went to T6.5 in Group‐60, the difference being statistically significant (P<0.001). Given as median and range the maximum cephalad spread in Group‐2 was T6(T3‐T10) and in Group‐60 T6.5 (T2‐T10).
Cardiovascular effects of vecuronium, atracurium, pancuronium, metocurine and RGH‐420 1 in dogs
Authors: Hackett G. H. , Jantzen J.‐P. A. H. , Earnshaw G.
Published: January 2009

The effect on the cardiovascular haemodynamic status of five neuromuscular blocking drugs, RGH‐4201, vecuronium, atracurium, pancuronium and metocurine, was studied in five conditioned foxhounds anaesthetised with fentanyl. Changes in heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output were recorded at 2, 5, 10, 20 and 30 min after administration of the drugs. From these, stroke volume, systemic vascular resistance and pulmonary vascular resistance were calculated. Administration of RGH‐4201 was followed by a pronounced increase in heart rate, accompanied by an increase in cardiac output and a decrease in systemic and pulmonary vascular resistance. Metocurine and pancuronium resulted in a decrease of right and left filling pressures and systemic‐/pulmonary vascular resistance. Changes after atracurium, vecuronium and metocurine were minimal. It is concluded that RGH‐4201 causes major alterations in the cardiovascular haemodynamic status in dogs anaesthetised with fentanyl when compared to vecuronium, atracurium, metocurine and pancuronium. With respect to cardiovascular stability, atracurium and vecuronium offer advantages.
Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants
Authors: Kangas‐Saarela T. , Koivisto M. , Jouppila R. , Jouppila P. , Hollmén A.
Published: January 2009

Thirty‐one neonates delivered by elective caesarean section were evaluated at the ages of 3 h, 1 day, 2 days and 4–5 days using Scanlon's Early Neonatal Neurobehavioural Scale and tests for orientation. Thirteen of the mothers received general anaesthesia and 18 epidural anaesthesia. All the mothers were healthy and not in labour. All the neonates weighed 2500 g or more and had Apgar scores of 7 or more at 1, 5 and 15 min. The neonates delivered with epidural anaesthesia scored significantly lower on rooting at the age of 3 h than those delivered with general anaesthesia, but the latter scored significantly lower on habituation to sound and orientation to both animate and inanimate visual stimuli. General anaesthesia seemed to depress the infants' interactive processes (orientation items), and their ability to make an appropriate response to repetitive stimuli (habituation) more than did epidural anaesthesia, indicating greater global depression. This depression was short‐lived, however, and there were no differences between the groups on any of the parameters after 24 h.
Effects of volatile anesthetics on cardiac calcium channels
Authors: Nakao S. , Hirata H. , Kagawa Y.
Published: January 2009

In order to investigate how volatile anesthetics affect cardiac calcium channels, the effects of halothane, enflurane, and isoflurane on the specific binding of [3H]‐nitrendipine to bovine heart sarcolemmal membranes were studied. All three anesthetics added in liquid form inhibited [3H]‐nitrendipine binding in a dose‐dependent manner, and more interestingly, the order of inhibition by these volatile anesthetics roughly followed that of their anesthetic potencies. The partial pressures, calculated using the gas/water partition coefficients of halothane, enflurane, and isoflurane which inhibited [3H]‐nitrendipine binding by 30%, at 37°C were about 1.48 times 10‐2atm. (1.48%), 4.89 times 10‐2atm. (4.89%) and 2.76 times 10‐2atm. (2.76%), resupectively. One mmol/l halothane altered not only the maximal binding (Bmax) from 189 f mol/mg protein to 136 f mol/mg protein, but also the dissociation constant (Kd) from 0.074 nmol/l to 0.18 nmol/l. Halothanc was also added to the reaction mixture in the gaseous form with air. The partial pressure of halothane needed to bring about 30% inhibition was 0.82 times 10‐2(0.82%), a value almost similar to that for halothane added in the liquid form. These results indicate that all three volatile anesthetics have direct effects on cardiac calcium channels, and that the magnitude of the effects depends on their anesthetic potencies.
Intravenous regional analgesia – a new modification
Authors: Cox P.
Published: January 2009

A modification of the standard intravenous regional analgesia technique is described whereby excess local anaesthetic solution is removed from the veins of the isolated arm once analgesia has been established. This simple procedure was shown to reduce the incidence of oozing at the site of operation without affecting the quality of analgesia. Measurement of the quantity of local anaesthetic agent removed from the isolated arm 15 min after injection revealed that the amounts removed were small, indicating rapid uptake and binding in the tissues. This would imply that removal of excess local anaesthetic agent from the isolated arm after 15 min does not confer added safety as regards reducing the risk of leakage of agent into the general circulation in the event of cuff failure.
Effects of thiopental on granulocyte oxidative microbicidal capacity
Authors: Salo M. , Perttilä J.
Published: January 2009

Some anaesthetics are known to depress granulocyte chemiluminescence responses in the phagocytosis of zymosan as a measure of their oxidative microbicidal capacity. In this study the effects of thiopental were measured on chemiluminescence responses in the phagocytosis of Staphylococcus aureus and Escherichia coli, which are the commonest bacteria causing postoperative infections. Granulocytes from 14 healthy volunteers (mean age 35 ± 9 (s.d.) years) were tested in vitro in the presence of clinical thiopental concentrations 0, 5, 10 and 25 μg/ml (0, 18, 36 and 91 μmol/l, respectively). During a 60‐min exposure period, decreased chemiluminescence responses occurred to Staph. Aureus at 5 μg/ml (P< 0.01) and higher thiopental concentrations and to E. coil at 10 μg/ml (P<0.01) and higher concentrations, as a sign of depressed oxidative microbicidal activity.
Effects of various ventilation modes on immunocompetence in surgical patients
Authors: Perttilä J. , Salo M. , Vuori A. , Heikelä A.
Published: January 2009

The effects of controlled mechanical ventilation with PEEP (CMV), and spontaneous ventilation with continuous positive airway pressure (CPAP), CPAP with high frequency ventilation (CPAP‐HFV) and spontaneous respiration without CPAP (SV) on immunocompetence were compared in open‐heart surgery patients undergoing the weaning phase. T‐lymphocyte and T‐helper cell ratios decreased during CPAP (P<0.01) and SV (P<0.05). PWM‐induced lymphocyte proliferative responses were decreased during CPAP‐HFV (P<0.05), CPAP and SV (P<0.01) in whole blood and separated lymphocyte cultures compared to values during CMV. Con A‐induced responses were also depressed during SV in whole blood cultures (P<0.01). When the synthesis and secretion of immunoglobulins were studied, only IgM production showed a decrease in PWM‐stimulated cultures during SV (P<0.05). In spite of an increase in the cardiac index in the three spontaneous ventilation modes compared to CMV, a slight decrease instead of an immediate improvement was seen in immune responses on weaning to spontaneous ventilation modes.
Intravenous narcotics for premedication in outpatient anaesthesia
Authors: Pandit S. K. , Kothary S. P.
Published: January 2009

One hundred adult female patients scheduled for outpatient laparoscopie procedures were studied. Each patient received intravenous premedication about 30 min before induction of anaesthesia. The premedications were given in a double‐blind random order and were either a placebo, morphine (0.04 mg/kg), meperidine (0.35 mg/kg), fentanyl (0.75 μg/kg) or sufentanil (0.15 μg/kg). All patients received a standard anaesthetic regimen. Transient light‐headedness was common following narcotic injections. Overall, sufentanil was superior to the placebo and to other narcotics in its ability to reduce preoperative anxiety and to provide more satisfactory induction, maintenance and recovery from anaesthesia. The incidence of postoperative nausea, vomiting and other side effects was not higher and discharge times were not longer after sufentanil compared to the placebo group. Complete recovery as assessed by telephone interview 24–48 h after the operation revealed no difference between the sufentanil and the other groups. The results of this study indicate that intravenous short‐acting narcotics like fentanyl or sufentanil should be considered as an alternative premedicant for anxious patients who are scheduled for outpatient surgery.
Acute lung injury monitored with radiolabelled transferrin and lung volume measurements
Authors: Wetterberg T. , Svensjö E. , Larsson A. , Sigurdsson G. , G‐Wagner Z. , Willén H.
Published: January 2009

Anesthetized pigs (n= 12) were given oleic acid (OA) to induce acute lung injury. Three additional pigs were used as uninjured controls. Six of the animals were pretreated with terbutaline before OA infusion. 113mIn‐labeled transferrin and 99mTc‐labeled erythrocytes were used for tracing of extravascular plasma leakage. A computerized gamma camera supplied image analysis of the radioactivities over the heart and lungs. A lung transferrin index (LTI), which describes the net accumulation of plasma equivalents in the lung, was calculated. OA caused an immediate increase in LTI and concurrent, correlated decreases in functional residual capacity, lung thorax compliance and arterial Po2. LTI was also correlated to the content of plasma equivalents in lung tissue samples and also to the wet weight/dry weight‐ratios of the same tissue samples. Finally, LTI was correlated to the calculated plasma loss from the circulation. Changes in all these parameters were correlated to the dose of OA. We conclude that this noninvasive double radioisotope technique can detect plasma protein leakage in lung injury of different degrees. We found no significant anti‐edema effect of terbutaline.
Comparative clinical study of induction and emergence time in sevoflurane and enflurane anaesthesia
Authors: Saito S. , Goto F. , Kadoi Y. , Takahashi T. , Fujita T. , Mogi K.
Published: January 2009

The induction and emergence times in patients who received minor oral surgery under sevoflurane with nitrous oxide or enflurane with nitrous oxide were compared. The induction time required for the loss of eyelid reflex when using sevoflurane (1.6 ± 0.2 min) was significantly shorter than that in the enflurane group (2.9 ± 0.4 min). There was no significant difference in the recovery time in the two groups.
Halothane‐induced variability in the neuromuscular transmission of patients with myasthenia gravis
Authors: Nilsson E. , Paloheimo M. , Müller K. , Heinonen J.
Published: January 2009

The purpose of the present clinical study was to explore the skeletal muscle mechano (MMG)‐ and electromyographic (EMG) responses during halothane/oxygen/air anaesthesia in patients with myasthenia gravis (MG) compared with patients with normal neuromuscular transmission. The majority of MG‐patients had a significant decremental response of the evoked muscle action potentials to a train‐of‐four (TOF) stimulation during halothane exposure (mean decrease of train‐of‐four ratio was 33% during the highest mean halothane concentration of 1.9 MAC). An excellent correlation was found between MMG‐ and EMG‐measurements (r2=0.878, P<0.001). However, marked individual variations in the neuromuscular response to halothane were seen. Neither preoperative muscle fatigability nor acetylcholine receptor antibodies predicted the decremental muscle responses produced by halothane among MG‐patients. The increased presence of HLA‐B8 among myasthenics with halothane‐suppressed muscle responses after TOF stimulation could be demonstrated (P<0.01).
The Magill‐Venturi attachment: studies in volunteers and patients
Authors: Jakubaszko J. , Christensen P. , Jørgensen S.
Published: January 2009

Including a venturi injector in a Magill breathing attachment reduces the requirement of compressed gases to 40% of that normally used: 100–120 ml × kg‐1 × min‐1. The entrainment of ambient air through the venturi injector enables the supply of an adequate flow of gas mixture to the patient. In 10 awake volunteers and 12 patients under N2O/halothane anaesthesia, it was demonstrated that a fresh gas flow from the anaesthetic machine of 40 ml × kg‐1 × min‐1 is sufficient to prevent rebreathing during spontaneous respiration, when the venturi injector is included in the Magill attachment.
Excretion of morphine in human breast milk
Authors: Feilberg V. L. , Rosenborg D. , Christensen C. Broen , Mogensen J. Viby
Published: January 2009

Five lactating women who underwent surgery and were treated with morphine epidurally or IV/IM in the postoperative phase were included in the study. The morphine concentrations in plasma and breast milk were determined 0, 15, 30, 45, 60, 90, 120, 240, 360 and 480 min after drug administration by means of a specific radioimmunoassay for morphine. The milk‐to‐plasma ratio was 2.45 ± 0.8 (mean ± s.d.). The amount of morphine transferred by nursing is, even at the peak concentration of 500 ng/ml milk, small and will hardly cause respiratory depression or drowsiness in the child.
Sympathetic blockade during extradural analgesia with mepivacaine or bupivacaine
Authors: Malmqvist L‐A. , Tryggvason B. , Bengtsson M.
Published: January 2009

The extent of sympathetic blockade in 36 patients, who had been given extradural analgesia, was studied by means of the skin conductance response (SCR). The SCR was also studied in six healthy volunteers who received, in a cross‐over fashion, infusions of physiological saline (placebo) and saline containing mepivacaine. Two more volunteers were given saline containing bupivacaine. Extradural analgesia caused a partial blockade of sympathetic activity. The higher, the level of analgesia the greater the degree of inhibition of the SCR. Complete blockade of the SCR or only a weak response in the foot was obtained in the majority of cases when the level of analgesia reached a dermatome level of T4 or higher. There was no significant relationship between the degree of motor blockade of the lower extremities and the intensity of blockade of the SCR. Extradural injection of 2% mepivacaine had a greater effect on the SCR than did 0.5% bupivacaine. There was no indication that infusion of mepivacaine or bupivacaine in volunteers, whose blood levels were as high as or higher than those likely to be produced during extradural analgesia, affected the SCR.
Effect of adenosine‐induced hypotension on the cerebral autoregulation in the anesthetized pig
Authors: Stånge K. , Lagerkranser M. , Sollevi A.
Published: January 2009

The influence on cerebral blood flow (CBF) and autoregulation of systemic adenosine infusion, at doses that produced a 29 ± 4% (0.28 ± 0.06 mg/kg/min) or a 55 ± 2% (0.49 ± 0.07 mg/kg/min) reduction of mean arterial blood pressure (MABP), was evaluated in 12 normoventilated fentanyl/N2O anesthetized pigs. CBF was determined as sagittal sinus outflow and recorded continuously by an electromagnetic technique. Autoregulation was evaluated by two formal tests: infusion of angiotensin for elevation of MABP, and reduction of myocardial filling pressure by cavai block for graded MABP decrease before, during and after adenosine infusion. CBF as well as cerebral metabolic rate of oxygen were unaffected during both levels of hypotension and were not significantly altered after the hypotension. Signs of impaired autoregulation were found during the angiotensin test as well as during the cavai block at light hypotension (92 ± 3 mmHg, 12.3 ± 0.4 kPa), while autoregulation was completely abolished at moderate hypotension (59 ± 2 mmHg, 7.9 ± 0.3 kPa). After termination of adenosine‐induced hypotension, autoregulation was restored in all animals within 60 min. It is concluded that systemically administered adenosine preserves CBF, even at low MABP levels, by a direct cerebral vasodilatory effect. However, the cerebral autoregulatory mechanisms are impaired or abolished in a dose‐dependent and reversible manner.
Effects of isoflurane on feline intestinal blood flow during hemorrhage‐induced hypovolemia
Authors: Raner C. , Biber B. , Henriksson B.‐Å. , Martner J. , Winso O.
Published: January 2009

The influence of isoflurane on intestinal reflex vasoconstriction during hemorrhage was investigated in cats (n= 10) during basal chloralose‐nitrous oxide anesthesia. Intestinal blood flow (IBF) was studied in a model with controllable intestinal perfusion pressures to exclude local myogenic vascular responses related to changes in intraluminal pressure. A jejunal segment, which was dissected free in situ, was perfused via an extracorporeal arterial circuit which included a roller pump and a variable arterio‐venous shunt. Intestinal perfusion pressure wds controlled by adjusting the shunt flow. IBF was measured (optical drop‐recording) before and after hemorrhage (8% of estimated blood volume). The protocol included steady‐state recordings at defined perfusion pressures (50, 75, 100, 125 and 150 mmHg in a randomized order; 6.7, 10.0, 13.3, 16.7 and 20.0 kPa, respectively) with and without the addition of 0.7% (MAC 1.0) isoflurane. IBF levels were consistently higher during isoflurane anesthesia than during basal chloralose anesthesia in the perfusion pressure range 75–150 mmHg (10.0–20.0 kPa). During basal anesthesia, a hemorrhage‐induced decrease in IBF was demonstrated throughout the perfusion pressure range 50 to 150 mmHg (6.7–20.0 kPa). The magnitude of the hemorrhage‐induced decrease in IBF was not significantly influenced by the addition of isoflurane. Thus, IBF, following hemorrhage, was significantly higher during isoflurane anesthesia than during basal chloralose anesthesia at perfusion pressures 50, 100, 125 and 150 mmHg (6.7, 13.3, 16.7 and 20.0 kPa).
Reversal of profound paralysis: use of large doses of edrophonium to antagonize vecuronium and pancuronium induced neuromuscular blockade
Authors: Power S. J. , Jones R. M.
Published: January 2009

The ability to evoke reversal of dense vecuronium‐ and pancuronium‐induced paralysis (T1 10% of control) with edrophonium 1.0 mg · kg‐1 was studied using train‐of‐four nerve stimulation and electromyographic monitoring. Two different end‐points, train‐of‐four ratios of 0.5 and 0.7, were used to define “adequate reversal”, and the results for both relaxants were compared. Reversal was reliable and rapid for vecuronium if either ratio was used with times of 2.8 (1.5) and 9 (3) min required to achieve ratios of 0.5 and 0.7, respectively. However, if the block was due to pancuronium, reversal was unreliable with 2 of 9 and 4 of 9 patients not achieving ratios of 0.5 and 0.7, respectively. Reversal was also markedly prolonged in this group with a mean time of 37 (23) min to achieve a ratio of 0.7, and in almost half these patients a supplementary dose of edrophonium was required.