bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Evaluation of Combined Treatment with Methadone and Psychotropic Drugs in Cancer Patients
Authors: Breivik H. , Rennemo F.
Published: January 2009

We reviewed the hospital charts of 111 patients treated with oral methadone for cancer pain during a period of 2½12 years. Fifty‐six of these patients, treated with the personal involvement of the authors, were also given haloperidol, levomepromazine, diazepam, amitriptyline or nitrazepam for hallucination, confusion, nausea, overwhelming pain, depression and anxiety, or insomnia. The remaining 55 patients, treated by different ward physicians, did not receive psychotropic drugs. The dose of methadone increased from a mean of 37 mg/day to 113 mg/day in the seven patients who were still being given methadone after seven months. Of the 56 patients given methadone and psychotropic drugs as needed, 80% obtained good pain relief, 16% moderate, and only 4% inadequate pain relief. Nausea or intestinal obstruction caused discontinuation of methadone by mouth in 20% of these patients. Of the 55 patients who did not receive psychotropic drugs, 67% obtained good pain relief, but 33 % did not obtain adequate pain relief. Hallucinations, confusion, nausea or intestinal obstruction caused discontinuation of methadone treatment in 42% of these patients. Less than 20% of these patients were treated for 5 weeks or more, compared to more than 50% of the patients treated with psychotropic drugs in addition to methadone. There was no sign of overdosage from accumulation with prolonged treatment, but tolerance developed slowly. Thus methadone may be administered safely for several months for severe cancer pain. However, psychotropic drugs appear to be necessary to suppress side‐effects and to give sufficient pain relief. To obtain satisfactory pain relief, it is also necessary that the doctor and other health personnel treating patients with disseminated cancer and pain have sufficient time, patience and dedication to re‐evaluate the patients' problems and adjust treatment frequently.
Long‐Term Epidural Morphine Analgesia
Authors: Mandaus L. , Blomberg R. , Hammar E.
Published: January 2009

Long‐term treatment for malignant pain with morphine epidurally poses some technical problems: infection and contamination of epidural space, fixation of the epidural cannula, personal hygiene of the patient, etc. We suggest that a solution to these problems is subcutaneous tunnelling of the epidural cannula. This paper describes our technique and presents the case histories of two patients. In one case, a single epidural cannula was used for 207 days for treatment with morphine epidurally without any complications.
Patient‐Controlled Analgesic Therapy: Clinical Experience
Authors: Tamsen A. , Hartvig P. , Fagerlund C. , Dahlström B. , Bondesson U.
Published: January 2009

Fifty‐six surgical patients self‐administered i.v. narcotic analgesics to combat postoperative pain. Analgesic demand per h was 2.7±1.1 mg of morphine, 26±10 mg of pethidine or 2.3±0.8 mg of ketobemidone, which reflects the equianalgesic ratios. Acute respiratory depression was seen in two hypovolaemic patients as evidenced by a raised PaCO2 on air breathing. Carbon dioxide retention disappeared upon correction of hypovolaemia. Late respiratory complications of short duration were encountered in 13%. Drowsiness and dry mouth were the most frequent complaints. Self‐administered analgesia was considered highly satisfactory by the patients.
The Endocrine‐Metabolic Response to Postoperative Pain
Authors: Kehlet H.
Published: January 2009

A short review is given on the role of pain as a release mechanism of the endocrine‐metabolic response to surgery. It is concluded that: (1) the stress‐response is mainly released through afferent neurogenic stimuli from the surgical area; (2) pain may be an additional release mechanism but quantitatively of minor importance compared to other afferent stimuli; (3) neurogenic blockade and analgesia with local anaesthetics prevents a major part of the stress‐response to surgery; (4) systemically administered opiates may lessen the postoperative endocrine‐metabolic response, but further studies are needed before any definite conclusion can be drawn; and (5) epidural administration of opiates has no major influence on the postoperative stress‐responses.
Emerging Aspects of the Adrenergic Nervous Systems
Authors: Svensson Torgny
Published: January 2009

The present paper reviews some recent experiments with relevance to the functional significance of brain noradrenergic systems with bearing on three clinically relevant topics: 1. The withdrawal and abstinence reactions after the antihypertensive agent clonidine as well as after opiates. 2. The mental reactions associated with alterations in blood volume and acid‐base balance. 3. The central actions and side‐effects of β‐adrenoceptor blocking agents. The available evidence indicates that central NA neurons may serve a function within the CNS analogous to that of the peripheral sympathetic nerves, i.e. to alert and alarm the individual to significant events in the external and internal environment. Thus, the largest brain NA system, which emanates from locus coeruleus and innervates vast regions of the neuroaxis, is largely activated in the same situations and by the same mechanisms (e.g. blood‐volume and chemoreceptors) as the sympathetic system, and may provide part of the central machinery for the anxiety reaction associated with hypercapnia as well as the withdrawal reactions after clonidine or morphine. Some, but not all centrally active β‐adrenoreceptor blocking agents were found to affect the activity of brain NA systems. This result suggests that there may be significant differences with respect to the clinical, central side effects of these drugs.
Aspects of the Pharmacology of β‐Adrenoceptor Agonists and Antagonists
Authors: Andersson Karl‐Erik
Published: January 2009

A short review is given of the distribution of and effects mediated through beta‐receptors. The pharmacodynamic profiles of some beta‐receptor agonists and antagonists are briefly outlined and the clinical advantages and disadvantages of different pharmacodynamic properties are discussed.
Anaesthesia and Cardiovascular Regulation
Authors: Martner Jan , Biber Björn
Published: January 2009

Cardiovascular homeostasis is dependent on the efficient performance of the effector organs, i.e. the vascular smooth muscle and the heart. Besides inherent activity and local control mechanisms, these effector organs are regulated by circulatory control centres within the central nervous system, which in turn receives information from receptors inside and outside the cardiovascular system. All these components of the circulatory systems, i.e. receptors, afferent and efferent pathways, control centres and effector organs, are possible sites for interactions by anaesthetics. Since different anaesthetics have different potencies and special predilections, there are a large variety of interaction patterns, as is discussed in the paper. Another way of evaluating circulatory effects of drugs used in anaesthesia is to analyse how these drugs may modify circulatory reflexes associated with surgery and trauma. For example, pain, hypoxia and/or hypovolaemia may evoke circulatory adjustments which correspond to and are functionally related to, from experimental physiology, well‐known reflex patterns such as the somatosympathetic reflex, the chemoreceptor reflex and the baroreceptor reflex. These reflex adjustments are liable to modification by anaesthetics, as exemplified in the paper. Due to the complexity of circulatory control and the varying effects of different anaesthetic agents, it is difficult to draw general conclusions. It can, however, be stated that most general anaesthetics depress cardiovascular reflexes in proportion to the depth of anaesthesia, and that suprabulbar centres are more easily depressed than bulbar ones. Opiates seem to have a specific inhibitory effect on circulatory adjustments induced by noxious stimuli. Transmission in efferent and afferent pathways is liable to modification by local anaesthetics, ganglionic blockers or α‐ and β‐receptor antagonists.
β‐Receptor Blocker Withdrawal. A Preoperative Problem in General Surgery?
Authors: Pontén J. , Biber B. , Bjurö T. , Henriksson B‐Å. , Hjalmarson Å.
Published: January 2009

A prospective randomized study was performed in 91 patients scheduled for general surgery on 99 occasions. The patients were chronically (>3 months) treated with β‐receptor blockers because of ischaemic heart disease and/or hypertension and the β‐receptor blockade was either gradually withdrawn (n = 51) during 4 days preoperatively or continued until surgery (n=48). The effects on arterial blood pressure (BP), heart rate (HR) and rate‐pressure product (RPP) at rest and the incidence of chest pain during daily activities were registered. A withdrawal of the β‐receptor blockade was associated with increases of HR (in eight patients >30 beats min‐1) and RPP and in patients treated for hypertension there were also increases of systolic and diastolic BP (in five patients ≥30/15 mmHg). Patients who continued the β‐receptor blockade until surgery showed no changes. Nine out of 23 patients with a previous history of ischaemic heart disease had an increase of chest pain after withdrawal of the β‐receptor blockers, whereas none of the corresponding 25 patients who continued the therapy suffered from an increased chest pain. Due to the severity of symptoms after β‐receptor blocker withdrawal, surgery had to be postponed in 4 patients. The observations suggest that a 4‐day preoperative withdrawal of long‐term β‐receptor blockade is potentially hazardous in ischaemic and/or hypertensive patients.
Interactions of Anaesthesia and High Pre‐operative Doses of β‐Receptor Antagonists*
Authors: Prys‐Roberts C.
Published: January 2009

Haemodynamic responses to anaesthesia and surgery were observed in 13 patients with severe renovascular hypertension treated with high doses of β‐receptor antagonists (equivalent to 10–37 mg/kg/day of propranolol) and 24 patients receiving moderate doses of β‐receptor antagonists (equivalent to 120–480 mg propranolol per day). Chronotropic and inotropic responses to the noxious stimuli of laryngoscopy or surgical stimulation were effectively suppressed by β‐receptor blockade thus increasing arterial pressure due to these stimuli or aortic cross‐clamping which indicated a purely resistive load for the left ventricle. In no patient was evidence found that myocardial performance, and its effect on left ventricular ejection, was seriously compromised.
β‐Receptor Blockade and Spinal Anaesthesia. Withdrawal versus Continuation of Long‐term Therapy
Authors: Pontén J. , Biber B. , Bjurö T. , Henriksson B‐Å. , Hjalmarson Å. , Lundberg D.
Published: January 2009

A prospective study was performed in 43 men scheduled for transurethral resections under spinal anaesthesia. All patients were on chronic β‐receptor blockade because of hypertension and/or ischaemic heart disease. The patients were randomly subjected to either a gradual preoperative withdrawal or a continuation of the β‐receptor blockade. Haemodynamics were measured non‐invasively. Spinal anaesthesia was performed and an i.v. injection of atropine given. The patients were then placed in a lithotomy position. Mean anaesthetic level included T6. After β‐receptor blocker withdrawal consistently elevated heart rates, a high incidence of arhythmias, angina pectoris and postoperative ST‐T changes indicating myocardial ischaemia were seen. These changes were not seen in patients with continued β‐receptor blockade. Withdrawal of β‐receptor blockers was also associated with an increased total peripheral vascular resistance in connection with spinal anaesthesia. These results suggest that patients on long‐term β‐receptor blockade should continue the therapy during and after spinal anaesthesia.
Transcutaneous Po2 Monitoring During Treatment with Continuous Positive Airway Pressure in Infants with Idiopathic Respiratory Distress Syndrome
Authors: KamperM.D. J. , Nielsen G. , Erichsen G. , Filtenborg J. A. , Lillquist K. , FaurholtPedersen V. , Skjoldå J. , Stabell I.
Published: January 2009

During a 20‐month period, 20 infants with idiopathic respiratory distress syndrome (IRDS) were treated with continuous positive airway pressure (CPAP) when they required at least 40% inspired oxygen. The infants were allocated to monitoring with either repeated blood‐gas determinations according to the usual practice or continuous transcutaneous Po2 measurements supplemented by blood‐gas measurements only when judged necessary. The groups were comparable with regard to birth weight and gestational age, and did not differ significantly with regard lo effectiveness or duration of the CPAP treatment, survival rates (90 versus 80%) or number of complications. None developed retrolental fibroplasia. However, Ptco2 monitoring resulted in significantly less hypo‐ and hyperoxaemia and the number of blood‐gas analyses performed during CPAP therapy amounted to only 0.6 per infant per day in the transcutaneously monitored group as against 5.3 in the other group. We propose that Ptco2 monitoring should now be the method of choice and that the use of umbilical artery catheterization should be restricted to selected groups of very low birth‐weight infants and to infants in need of ventilator therapy.
Lung Uptake of Lidocaine in Man as Influenced by Anaesthesia, Mepivacaine Infusion or Lung Insufficiency
Authors: JorfeldtM.D. L. , Lewis D. H. , Löfström J. B. , Post C.
Published: January 2009

Pulmonary uptake of lidocaine was investigated in patients before surgery, and aimed at elucidating the influence of general anaesthesia, the presence of another local anaesthetic agent in the blood, or the possible impact of lung insufficiency. When the lung uptake of lidocaine, injected as a bolus together with indocyanine green dye, was calculated as uptake at 95% pass of the dye, there were no statistically significant differences between the four groups. When the extraction in each of the arterial blood samples was calculated on the basis of the relation between relative concentrations, there were statistically significant differences, with a general tendency towards higher extraction of lidocaine in the awake, healthy volunteers, not given mepivacaine, compared to the other groups. In the group in whom mepivacaine was infused, the arterial concentration of mepivacaine increased transiently after the injection of lidocaine. This probably reflects a displacement of mepivacaine from binding sites for both agents. From this study, it is postulated that the ability of the pulmonary circulation to clear the blood of lidocaine is high, and that it is not affected markedly by those situations studied in the present investigation.
Haemodynamic Effects of Calcium Chloride Administered Intravenously to Patients with and without Cardiac Disease during Neurolept Anaesthesia
Authors: Eriksen C. , BredgaardSørensen M. , Bille‐Brahe N. E. , Skovsted P. , LundingM.D. M.
Published: January 2009

During neurolept anaesthesia, calcium chloride (15 mg/kg) was administered intravenously to two different groups of patients undergoing vascular surgery on the abdominal aorta. The patients in group I all suffered from cardiac disease and were treated with digoxin, while the patients in group II had no cardiac symptoms. Cardiovascular measurements were made during steady‐state anaesthesia. In group I, CaCl2 increased cardiac index (CI) significantly while systemic vascular resistance index (SVRI) remained unchanged. Mean arterial pressure (MAP) increased. In group II, both MAP and SVRI increased while CI remained unchanged. No significant changes in heart rate were observed and no arrhythmias occurred. It is concluded that CaCl2 administered intravenously is an effective means of improving cardiac function when it is depressed by anaesthesia, underlying cardiac disease, or both.
Bupivacaine Cardiotoxicity in a Patient with Renal Failure
Authors: GouldM.D. D. B. , Aldrete J. A.
Published: January 2009

Bradycardia and hypotension were the first major signs of toxicity from a 250 mg bupivacaine axillary brachial plexus block experienced by a patient with chronic renal failure, who had an anion gap acidosis and hyperkalemia. Without these metabolic abnormalities, this patient received four similar blocks: three were without incident and one was complicated by seizure. Acidosis and/or hyperkalemia in man appears to increase the myocardial susceptibility to bupivacaine toxicity into the range of arterial concentrations of the drug normally produced by plexus blocks, even in the absence of drug‐induced cerebral toxicity, seizures and hypoxia.
Effect of Analgesia on Respiratory Muscle Function after Upper Abdominal Surgery
Authors: BenhamouM.D. D. , Samii K. , Noviant Y.
Published: January 2009

The effects of three methods of analgesia (intravenous morphine, epidural lidocaine and epidural morphine) on vital capacity (VC), forced expiratory volume in 1 s (FEV1) and maximal expiratory and inspiratory pressures (MEP and MIP) at the mouth were studied in 12 high respiratory risk patients following upper abdominal surgery. VC, FEV1, MEP and MIP markedly decreased following laparotomy. VC and FEV1, were partially restored by epidural analgesia and remained unchanged following intravenous morphine. MEP and MIP remained unchanged after each of the three methods of analgesia. This suggests the existence of a non‐analgesic dependent dysfunction of inspiratory and expiratory muscles following upper abdominal surgery.
Alveolar Stability during Anaesthesia for Reconstructive Vascular Surgery in the Leg
Authors: HedenstiernaM.D. G. , Lundh R. , Johansson H.
Published: January 2009

Alveolar stability was studied during prolonged enflurane anaesthesia by using a multiple inert‐gas elimination technique for the assessment of the “continuous” distribution of ventilation‐perfusion ratios (V̇A/Q̇). All 10 patients (mean age: 61 years, six smokers) presented with increased V̇A/Q̇ mismatching during anaesthesia, with a redistribution of lung blood flow to regions with low or high V̇A/Q̇. Five patients had perfusion of units with V̇A/Q̇≤0.07 which may cause unstable alveoli with the presently used inspiratory gas mixture. However, only two patients displayed increasing shunting suggestive of alveolar collapse during the 3.5 h observation period. This lower than expected incidence may indicate protective mechanisms against atelectasis, such as mechanical interdependence between lung units, or collateral ventilation.
Portable Emergency Ventilators. A Lung Model Study
Authors: DahlgrenM.D. B.‐E. , Johnson A. , Löfström J. B.
Published: January 2009

The ventilatory performance of four portable emergency ventilators (Logic 07, Motivus Oxylog and Pneupac II) was tested on a lung model. The model consisted of one common (tracheal) tube, two separate (bronchial) tubes in which different obstructions could be applied, and two glass jars filled with water to suitable compliances. Dialled volume was compared to measured volume. The gas distribution produced by the different ventilators was also studied. It was found that alt lour ventilators could distribute gas to the lungs. The ventilators Logic 07 and Oxylog had acceptable relationships between dialled and measured volume/frequency and they also produced a good final distribution.
Immediate and Long‐term Mental Recovery from General versus Epidural Anesthesia in Elderly Patients
Authors: Riis J. , Lomholt B. , Haxholdt O. , Kehlet H. , Valentin N. , Danielsen U. , DyrbergM.D. V.
Published: January 2009

The postoperative course of mental performance during the first week and at 3 months after operation was studied in 30 patients above the age of 60, undergoing total hip replacement arthroplasty. The patients were randomly allocated to receive either general anesthesia, epidural analgesia, or general anesthesia plus epidural analgesia. The surgically induced increase in plasma Cortisol and glucose was inhibited in the two groups receiving epidural analgesia. Mental performance was studied with psychological methods. An equal degree of postoperative impairment of mental performance of 3–4 days' duration was found in all groups. Three months after surgery, mental junction had improved slightly and to the same extent in all groups. We conclude that the transient mental impairment occurring within the first postoperative week is caused by factors other than general anesthetic agents and the endocrine‐metabolic response to surgery.
Controlled Hypotension with Sodium Nitroprusside: Effects on Cerebral Blood Flow and Cerebral Venous Blood Gases in Patients Operated for Cerebral Aneurysms
Authors: HenriksenM.D. L. , Thorshauge C. , Harmsen A. , Christensen P. , Sørensen M. B. , Lester J. , Paulson O. B.
Published: January 2009

The effect on cerebral haemodynamics of arterial hypotension induced by sodium nitroprusside infusion was studied in nine patients at the end of operations for intracranial aneurysms under N2O‐O2halothane anaesthesia. Cerebral blood flow (CBF), using the intraarteria113Xe injection method, and cerebral jugular venous blood gases were monitored before, during and after the induced hypotension. CBF and jugular venous oxygen tension (PvO2) remained constant during the hypotensive period. Following its termination, a 13% increase in CBF occurred (P<0.05) and PvO2 showed the same trend, a 5% increase (P<0.30). Regional CBF recordings (rCBF) in 16 small areas within the cerebral hemisphere were obtained at each measurement. In four of the patients, rCBF abnormalities were present in the form of hyperacmic regions, probably induced by the operation or the disease itself. The focal abnormalities were not accentuated during hypotension nor were ischaemic regions disclosed. It is concluded that sodium nitroprusside has only a minor influence on cerebral haemodynamics in the anaesthetized state.
Ketamine: Effects on the Mechanical Properties of the Frog Sartorius Muscle
Authors: Rydqvist B. , Faijerson B.
Published: January 2009

Isolated frog sartorius muscles were exposed to ketamine in concentrations up to 15·10‐5 M and the mechanical response to directly and indirectly stimulated muscles was studied. The effect on the directly elicited action potential was also investigated. The amplitude of the indirectly elicited twitches was decreased in a dose‐dependent manner with a 50% decrease in twitch amplitude, at a ketamine concentration of 7.3·10‐5 M. The twitch amplitude was not affected by ketamine during direct stimulation of the muscle. However, direct tetanic stimulation of the muscle (80 Hz, 200 ms) revealed a decrease in the tetanic force of 20% during exposure to 7.3·10‐5 M ketamine. This decrease in tetanic force can be explained on the basis of effects on the sarcoplasmic reticulum, and/or the effects of ketamine on the directly elicited action potentials (decrease in amplitude and increase in duration) seen in these experiments. At concentrations of ketamine below about 4·10‐5 M, small effects were seen in this nerve‐muscle preparation. If the effects on the frog muscle are similar to mammalian striated muscle, clinical concentrations of ketamine would have very small effects on the nerve‐muscle system.
Catecholamine Response to the Clinical Use of Alpha Adrenergic Receptor Blocking Agents
Authors: Risbo A. , JessenM.D. K. , Hagelsten J. O.
Published: January 2009

Treatment with alpha adrenergic receptor blocking agents has been used clinically for many years to obviate peripheral vasoconstriction in patients suffering from circulatory or thermoregulatory distress. Various reports indicating that administration of these agents may be followed by an increased plasma concentration of catecholamines, and subsequently an increased oxygen demand, led to 29 investigations on humans who we replaced in a horizontal position in a thermoneutral environment and given 25 mg chlorpromazine intravenously, dissolved in 500 cc low molecular weight dextran. Blood pressure and heart rate remained unchanged during the infusions and significant changes in plasma noradrenaline (average fall: 4.42 nmol·1‐1, range: ‐31.9‐ + 5.1) and in plasma adrenaline (average fall: 1.06 nmol·1‐1, range: ‐ 16.3‐ + 5.11) were observed (P<0.01). The results indicate that as long as any baro‐reflex activation of the sympathetic nervous system and acceleration of the nonshivering thermogenesis is avoided, the recommended treatment with alpha adrenergic receptor blocking agents can be performed without any increase in plasma concentration of catecholamines.
Perivascular Axillary Block II: Influence of Injected Volume of Local Anaesthetic on Neural Blockade
Authors: Vester‐Andersen T. , Christiansen C. , Sørensen M. , Kaalund‐Jørgensen H. O. , Saugbjerg P. , Schultz‐Møller K.
Published: January 2009

Perivascular axillary blockade was performed on 150 patients with the aid of a catheter technique. Blockade failure due to injection outside the neurovascular sheath was found in 5.7% of the subject material. The patients were randomly allocated to three groups. The amount of local anaesthetic was constant in each group: 400 mg mepivacaine with adrenaline. However, the injected volume was a variable factor, namely 20, 40 or 80 ml. Sensory and motor blockade was tested 30 min after each injection. The following results were obtained: 1) Apart from the axillary, musculocutaneous and radial nerves, a high frequency of analgesia was found in all cutaneous areas (over 85%). 2) In the axillary area, improvements were found with increasing volume. 3) Analgesia in the musculocutaneous area occurred in 52% of the patients in group 1 (20 ml) and improved to 75% in group 2 (40 ml). However, no difference was found between group 2 and group 3 (80 ml). 4) Volume had no influence on analgesia in the radial area. 5) Motor blockade was intensified with decreasing volume, i.e. with an increase of concentration of local anaesthetic solution.
Effect of Age on the Establishment of Muscle Paralysis Induced in Anaesthetized Adult Subjects by ORG NC 45
Authors: D'Hollander A. A. , Nevelsteen M. , Barvais L. , Baurain M.
Published: January 2009

The establishment of muscle paralysis produced by a single dose of 70 μg · kg‐1of ORG NC 45 was studied in 30 healthy anaesthetized patients, aged 15–85 years, by recording adductor pollicis isometric mechanical activity‐twitch height (TH). Significant correlations were observed between age and the latency of ORG NC45 action, defined as the reduction of TH to 95% of its initial value (r: 0.315,P<0.05)and between age and the onset time, defined as the time elapsing between ORG NC 45 administration and maximum TH depression observed (r: 0.454,P<0.005). Correlation between age and maximum TH depression was not significant. These results show that if the maximum TH depression observed after a standard dose of ORG NC 45 is not altered by the age of the patient, the establishment of the paralysis is delayed by ageing.
Lidocaine Given Intravenously as a Suppressant of Cough and Laryngospasm in Connection with Extubation after Tonsillectomy
Authors: Gefke K. , Andersen L. W. , Friesel E.
Published: January 2009

The preventive effect of lidocaine against coughing in the recovery period after general anaesthesia was observed. The study was carried out as a double‐blind sequential trial. At the same time the incidence of laryngospasm was registered. Lidocaine or placebo was given intravenously just before extubation. Nineteen patients for tonsillectomy, all of them over the age of 15, randomly received a 2% solution of lidocaine 2 mg/kg body weight or placebo (saline) 2 min prior to expected extubation. We found that lidocaine in this dose given prophylactically just before extubation was able to inhibit and prevent coughing in the recovery period after general anaesthesia. None of the patients included in this study got laryngospasm, and none of the patients developed serious side‐effects.
Comparison of Haemodynamic Effects of Morphine and Fentanyl in Patients with Coronary Artery Disease
Authors: Yrjölä H.
Published: January 2009

The haemodynamic effects of morphine (2.5 mg kg‐1) and fentanyl (16.7 and 25 μg kg‐1) were compared in patients undergoing coronary artery bypass surgery. Morphine or fentanyl in combination with pancuronium, nitrous oxide and a small dose of thiopentone produced some deterioration of myocardial performance. Both analgesics failed to block haemodynamic responses to noxious stimulation including tracheal intubation and sternotomy. Heart rate increased following tracheal intubation and systemic vascular resistance increased after sternotomy. However, the larger dose of fentanyl (25 μg kg‐1) was accompanied by the smallest haemodynamic changes. Supplementary anaesthetic agents were often required to maintain haemodynamic stability during sternotomy. It is suggested here that larger doses of fentanyl, or the addition of other intravenous or inhalation anaesthetics might be employed for patients with severe coronary artery disease and good left ventricular function. On the other hand, in patients with poor left ventricular function, the myocardial depressant properties of thiopentone and nitrous oxide may be detrimental.
Prolongation of QT Interval During Induction of Anaesthesia
Authors: Saarnivaara L. , Lindgren L.
Published: January 2009

QT interval was studied in 156 adults and in 127 children during the induction of anaesthesia. Both in adults and in children, QT interval was prolonged statistically significantly after thiopentone 5 mg/kg and the most marked prolongation occurred after suxamethonium 1 to 1.5 mg/kg. In adults, d‐tubocurarine 0.06 mg/kg, but not alcuronium 0.03 mg/kg or pancuronium 0.01 mg/kg, prevented statistically significantly the prolongation of the QT interval after suxamethonium 1.5 mg/kg. In children, all three muscle relaxants prevented statistically significantly the effect of suxamethonium 2 mg/kg and pancuronium also prevented the effect of thiopentone. The most common ECG changes were ventricular ectopic beats (VEB) which occurred in 26% of the adults and in 22% of the children who were not pretreated with the muscle relaxants. After pretreatment with d‐tubocurarine, the incidence of VEB was 3% in both groups. In adults, alcuronium was as effective as d‐tubocurarine in the prevention of VEB but in the alcuronium group supraventricular ectopic beats and junctional rhythm occurred in 6% and 9% of the patients, respectively. Pancuronium did not significantly prevent the incidence of VEB. On the basis of the present results, d‐tubocurarine is the relaxant of choice for the prevention of the prolongation of QT interval as well as ECG changes during the induction of anaesthesia.
Effects of Working Environment on the Liver in 10 Anaesthetists
Authors: Rosenberg P. H. , Oikkonen M.
Published: January 2009

Drug‐metabolising ability, i.e. antipyrine half‐life, in anaesthetists was significantly slowed (23%) at the end of summer vacation (2–4 weeks), as compared to prevacation values. Despite changes in either direction, the antipyrine half‐lives, including four determinations within a year and a half from the ten anaesthetists, were within normal limits. Liver enzymes (aspartate aminotransferase, alanine amino‐transferase, alkaline phosphatase) were also normal. In one anaesthetist the test for anti‐HBsAg was positive in 1980, while in the others HBsAg and anti‐HBsAg were negative in 1980 and 1981. The inorganic fluoride concentrations of serum and urine (determined four times) were at normal levels. Only in one anaesthetist was there a transient, surprisingly high, serum concentration (7.9 μp.mol/l), apparently unrelated to work exposure.
The Effect of Epidural and General Anaesthesia on Lymphocyte Functions during and after Major Orthopaedic Surgery
Authors: Hole A. , Unsgaard G.
Published: January 2009

The blastogenic responses of lymphocytes to PHA‐stimulation and lymphocyte lymphokine production have been studied in 27 patients undergoing total hip replacement, operated under either general anaesthesia or epidural anaesthesia. The lymphocytes were isolated from the patients the day before operation, during the operation and on the first postoperative day. The assays were carried out with lymphocytes cultured in medium containing 25% of the patient's serum (Au‐medium) and in medium containing 25% of pooled AB+ serum (AB‐medium). In the epidural anaesthesia group, the blastogenic response to PHA of lymphocytes incubated in Au‐medium increased per‐and postoperatively to 132% (n.s.) and 155% (P<0.05) compared to preoperative values. In the general anaesthesia group, the PHA‐response decreased to 63.7% peroperatively (P<0.05) and 88.7% postoperatively (n.s.). When the lymphocytes were incubated in AB‐medium, the PHA‐response increased in both groups. Lymphocyte lymphokine production in the epidural group was unchanged both per‐ and postoperatively in both media. However, in the general anaesthesia group there was a reduction in lymphokine activity both per‐ and postoperatively. This reduction was most pronounced peroperatively when the lymphocytes were incubated in Au‐medium (64.2%, P<0.05). Control lymphocytes incubated in sera from general anaesthetized patients resulted in significantly lower lymphokine activity (P<0.05) in comparison with cultures with sera from patients in the epidural group. These findings indicate a lymphocyte depressing factor in serum from patients operated under general anaesthesia, which is absent during operations in epidural anaesthesia.
Effects of Prenalterol on Central Haemodynamics and VA/Q Distribution Early after Open‐Heart Surgery
Authors: Anjou‐Lindskog E. , Broman L. , Holmgren A. , Wedelin B.
Published: January 2009

The effects of intravenous injection of prenalterol, a selective β1,‐adrenoceptor agonist, on central haemodynamics and the distribution of ventilation‐perfusion (V̇A/Q̇) were assessed in eight patients alter aortic and/or mitral valve replacement. V̇A/Q̇ distributions were determined by the multiple inert gas elimination technique. Administration of prenalterol resulted in a significant increase in cardiac output and heart rate with no changes in mean pulmonary arterial pressure and wedge pressure. There was an insignificant fall in arterial oxygen tension from 14.3 to 12.4 kPa, accompanied by a significant increase in the inert gas shunt from 6.4 to 11.3% of cardiac output, while the configuration of the distributions of perfusion and ventilation on V̇A/Q̇, remained unchanged. The increase in shunt was probably more an effect of the increase in cardiac output than a direct effect of the drug on the pulmonary vascular bed.
Stiffness of Central Venous Catheters
Authors: Stenqvist O. , Curelaru I. , Linder L.‐E. , Gustavsson B.
Published: January 2009

Catheter stiffness has been suggested to be a principal factor in the thrombogenesis encountered after central venous cannulation. However, no data have been published to date about the stiffness of central venous catheters. A method for measuring catheter stiffness has been developed. The force needed to deflect a catheter tip 1.2 mm from a fastening point was measured with the help of a cantilever beam (Grass Model DA‐7). Six different sections of each catheter were measured, and the final results expressed as an average of these. Twenty‐seven central venous catheters made of silicone elastomer, polyurethane, polyvinylchloride, polyethylene and teflon were tested. The bending stiffness, EI (E=elastic modulus of the material, I = moment of inertia of catheter (a geometrical property)) was below 16×10‐6 Nm2 for all catheters made of silicone elastomer, polyvinylchloride and polyurethane. Polyethylene catheters were stiffer, but could be made softer by reduction of their diameters. Teflon catheters were up to 10 times stiffer than the catheters in the soft group. Heparinization and radioopacity of catheters do not significantly alter their bending stiffness. In a concomitant study the results indicate that there is a significantly lower incidence of thrombus formation in catheters with a bending stiffness below 16×10‐6 Nm2.
Material Thrombogenicity in Central Venous Catheterization II. A Comparison between Plain Silicone Elastomer, and Plain Polyethylene, Long, Antebrachial Catheters
Authors: Curelaru I. , Gustavsson B. , Hansson A. H. , Linder L. E. , Stenqvist O. , Wojciechowski J.
Published: January 2009

Central venous catheters of two types were inserted through basilic or cephalic veins punctured at the fossa cubiti in 61 patients: 39 soft silicone elastomer (S.E.) and 22 stiffer polyethylene (P. E.) catheters were compared regarding their thrombogenicity. Mean duration of catheterization was 6.5 days. Radiological thrombi in the peripheral and central veins visualized by phlebography were significantly smaller, and the incidence of the mural thrombi in the central veins significantly lower with the S.E. than with the P.E.‐catheters, but the use of S.E.‐catheters did not reduce the incidence of clinical thrombophlebitis in arm veins: 14 cases in the group with S.E. and four in that with P.E.‐catheters. In both groups, the maximum incidence of clinical thrombophlebitis occurred 4–8 days after catheterization. Later, there seems to be a low risk for the appearance of clinical thrombophlebitis with both catheters. Neither the surface topography of the catheter materials, nor the platelet adhesion on their surfaces in contact with human blood in vitro offered conclusive arguments for interpretation of their thrombogenicity in vivo. Catheter stiffness seems to play an important role in inducing mural thrombus formation in central venous cannulation in man.
Peroral Diazepam Compared with Parenteral Morphine/Scopolamine with Regard to Gastric Content
Authors: Risbo A. , Schmidt J. F.
Published: January 2009

In a prospective study, 62 adult patients were studied with respect to the volume and pH of their gastric contents after receiving randomly one of three different premedications. One group received flunitrazepam 2 mg perorally on the night before operation and diazepam 0.2 mg per kg body weight perorally at 7.00 a.m. on the day of operation. The patients in the second group were given flunitrazepam 2 mg perorally the night before operation and morphine/scopolamine i.m. 1 h prior to operation. In the third group no flunitrazepam was given on the night before operation, and the patients were premedicated with morphine/scopolamine i.m. 1 h preoperatively. No statistically significant difference was found between the groups with respect to the volume and pH of gastric contents after induction of anaesthesia.
Ventilation‐Perfusion Relationships during Anaesthesia and Abdominal Surgery
Authors: Lundh R. , Hedenstierna G.
Published: January 2009

Nine patients, 61–72 years old, were studied awake and during halothane anaesthesia before and during upper abdominal surgery. Central circulation was evaluated by means of pulmonary artery catheterization and gas exchange by multiple inert gas elimination technique. Awake and supine, a rather wide distribution of V̇A/Q̇ was observed, with regions of low V̇A/Q̇ in five patients and a small shunt (1–3%) in three patients. The overall dispersion of blood flow was log s.d. 0.93. With anaesthesia and mechanical ventilation, cardiac output fell by 30%, whereas pulmonary vascular pressures remained unaltered. The dispersion of pulmonary blood flow against V̇A/Q̇ ratios was further increased with a log s.d. of 1.67. Perfusion of regions with a low V̇A/Q̇ was significantly increased. With surgery, no significant changes were seen in cardiac output or vascular pressures. True shunt appeared or increased in seven patients, ranging from 1.3 to 17%. Perfusion to regions with low V̇A/Q̇ did not change. It is concluded that abdominal surgery interferes with gas exchange, presumably because of a cranial shift of the diaphragm which lowers FRC and thereby promotes airway closure.
Estimation of Blood Flow in Transcutaneous PO2 Measurements
Authors: Jaszczak P. , Poulsen J.
Published: January 2009

A method for estimation of the cutaneous blood flow in transcutaneous Po2 measurements is presented. Recordings of electrode and skin temperature make it possible to compute the effect dissipated to the circulating blood. Eighteen measurements were performed on three healthy volunteers at electrode temperature settings from 37.0°C to 45.0°C. The blood‐flow estimates ranged from 0.07 to 0.19 ml·cm‐2·min‐1. At an electrode temperature of 45.0°C the investigations showed a tc‐Po2 value as low as 7 mmHg (0.9 kPa) which, however, corresponded well to the lowest blood‐flow estimate determined. The temperature‐corrected (37°C) a‐Po2‐tc‐Po2 gradient ranged from 50 mmHg to 95 mmHg (6.7–12.6 kPa). The investigations confirm the importance of simultaneous determinations of cutaneous blood flow, capillary temperature and cutaneous oxygen consumption in order to describe the connection between arterial and cutaneous oxygen tension. The cutaneous blood How seems in this connection to be the most important parameter.
Cardiac Tamponade as a Result of Infusion Therapy. A Potentially Amenable Complication of Central Venous Catheters
Authors: Eide J. , Odegaard E.
Published: January 2009

A fatal case of infusion of a (at emulsion (Intralipid®) into the pericardium is reported. Perforation of the anterior wall of the right ventricle of the heart by a central venous catheter had occurred 3 days after insertion via the basilic vein. Local myocardial inflammation and necrosis along the puncture wound through the myocardium was a feature. The incident underlines the necessity for prompt assurance of correct positioning of central venous catheters. It is emphasized that effective treatment is possible if one is aware of some important features of the condition. Immediate diagnosis is mandatory.
Anatomical Shape of the Airway
Authors: Alexopoulos C. , Larsson S. G. , Lindholm C.‐E.
Published: January 2009

The shape of the standard endotracheal tube does not conform to the anatomy of the airway and this inconformity is probably the most injurious factor of tracheal intubation. In order to measure the tube recoil deformation pressure at different points of the airway, it is necessary to know the exact shape of the airway. The contours of the airway were studied from lateral radiographs in patients lying supine on the operating table, with the neck in the normal, extended and flexed position. A computer programme calculated the anterior and posterior contours of the airway as mean values of the original contours on the radiographs as well as of seven selected anatomical points. The mean configuration of the airway in non‐intubated individuals was then presented in a standard coordinate system. The “ideal” shape of the airway was subsequently designed in accordance with our results, and this shape can be used clinically as a standard for comparison in cases with suspected pathological configurations.
Dopamine versus Dobutamine after Open‐Heart Surgery
Authors: Tydén H. , Nyström S.‐O.
Published: January 2009

The haemodynamic effects of dopamine and dobutamine were compared in a cross‐over study of 12 patients in the early postoperative phase after open‐heart surgery. The drug infusion rates (dopamine (μg/kg/min) mean 6.5, range 2.8–12, dobutamine (μg/kg/min) mean 7.9, range 4.3–12.3) were adjusted so that the cardiac output increased by 50%. With both drugs this was achieved through simultaneous increases in stroke volume (dopamine + 16%, dobutamine + 9%) and heart rate (dopamine + 31 %, dobutamine + 38%). The systemic vascular resistance did not change with dopamine but decreased significantly (—18%) with dobutamine. Therefore, the systolic and diastolic arterial blood pressures rose significantly more with dopamine than with dobutamine. The left atrial pressure increased with dopamine but was unchanged with dobutamine. The urine output was significantly higher with dopamine than with dobutamine.
Capnography for Detection of Accidental Oesophageal Intubation
Authors: Linko K. , Paloheimo M. , Tammisto T.
Published: January 2009

The clinical diagnostic signs for detecting inadvertent oesophageal intubation may all be misleading. We therefore tested the practice of recording exhaled carbon dioxide during the intubation procedure as an additional measure for detection of accidental oesophageal intubation. Twenty patients were intubated simultaneously into the trachea and oesophagus and the carbon dioxide concentration was continuously recorded from both sources. Manual ventilation of the lungs always resulted in a typical CO2 curve pattern. Ventilation by mask prior to the intubation obviously resulted in some filling of the stomach by exhaled gas in 9 of the 20 patients. In these cases some CO2 could be detected during oesophageal ventilation. As the oesophageal CO2 concentrations were very low initially, compared to the tracheal recordings, and carbon dioxide completely disappeared after a few ventilations into the oesophagus, distinguishing between the tracheal and oesophageal capnography tracings was easy.
Intradermal Histamine Release by 3 Muscle Relaxants
Authors: Robertson E. N. , Booij L. H. D. J. , Fragen R. J. , Crul J. F.
Published: January 2009

The induration and redness caused by intradermal injections of equipotent doses of atracurium, vecuronium and d‐tubocurarine were measured in six healthy, male volunteers. Atracurium and d‐tubocurarine were almost indistinguishable in their reactions. Vecuronium caused a significantly smaller response than both atracurium and d‐tubocurarine. We therefore suggest that of these three drugs, vecuronium may cause the least histamine release and is, perhaps, the drug of choice in patients with a history of asthma or allergy.
Haemodynamics and Oxygen Consumption in the Dog During High Epidural Block with Special Reference to the Splanchnic Region
Authors: Greitz T. , Andreen M. , Irestedt L.
Published: January 2009

High epidural block (Th I‐IV) with bupivacaine was carried out in 16 dogs. Mean arterial blood pressure decreased to 52% of control value owing to nearly equal decreases in systemic vascular resistance and cardiac output. Portal venous blood flow decreased from 25.8 ± 8.6 to 16.7 ±7.2 ml/kg b.w. × min‐1 following epidural block, while hepatic arterial blood flow remained unchanged at 9.1 ± 3.1 ml/kg b.w. × min‐1 owing to a reduction in hepatic arterial resistance of 51 %. Hepatic oxygen uptake was maintained during the epidural block through increased oxygen extraction. However, total oxygen uptake decreased by 18 % and, in spite of this, arteriovenous oxygen content difference increased by 25%, indicating circulatory depression.
Appearance of Pethidine and Norpethidine in Cerebrospinal Fluid of Man Following Intramuscular Injection of Pethidine
Authors: Boréus L. O. , Sköldefors E. , Ehrnebo M.
Published: January 2009

The plasma and cerebrospinal fluid (CSF) concentrations of pethidine and its main metabolite in plasma, norpethidine, were determined in 20 patients undergoing minor surgery who had received pethidine chloride as premedication in a standard dose of 100 mg intramuscularly. The disposition of pethidine and norpethidine in plasma was followed for 3–8 h after administration. The rate of transfer of the drug and its metabolite from plasma to CSF was assessed on the basis of a single sample of CSF taken from each patient. Pethidine appeared within less than 18 min in the CSF, reaching a maximum after about 90 min. After that, the pethidine concentration ratio CSF/plasma was relatively stable at 0.4‐0.5. This is in agreement with the concept that the concentration of a drug in CSF is correlated with the concentration of unbound drug in plasma at equilibrium. Norpethidine which was present in rapidly increasing concentrations in plasma after a delay of 30 min, appeared in CSF in a slower and more erratic fashion as compared to the parent compound. However, after 240 min, the CSF/plasma concentration ratio was similar for pethidine and norpethidine. Thus, transfer from plasma to CSF occurs relatively rapidly. There is little evidence for a functionally significant blood‐brain barrier for pethidine and norpethidine.