bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory Depression and Morphine Concentration in Serum after Epidural and Intramuscular Administration of Morphine
Authors: Møller I.W , Vester‐Andersen T. , Steentoft A. , Hjortsø E. , Lunding M.
Published: January 2009

The ventilatory response to carbon dioxide and the serum level of free morphine were measured in six adult patients scheduled for operation under lumbar epidural analgesia. The investigation was performed on 2 consecutive days before the operation. The measurements were performed before, and 30 and 90 min after the intramuscular administration of morphine chloride (0.15 mg/kg body weight) as well as lumbar epidural administration of morphine chloride (5 mg morphine chloride diluted in 10 ml isotonic saline). The ventilatory response to carbon dioxide was depressed significantly both 30 and 90 min after epidurally administered morphine compared to the control value, while the depression of the ventilatory response was demonstrated in only five of six patients 30 min after intramuscularly administered morphine. The peak serum levels of free morphine were reached within 20 min of administration and it seemed that the injected quantity of morphine and not the method of administration determined the serum level.
Haemodynamics in Patients Undergoing Porto‐Caval Shunt Operations
Authors: Sørensen M. Bredgaard , Bille‐Brahe N. E. , Christiansen L. , Malmstrom J. , Nielsen O. Vagn
Published: January 2009

Haemodynamic parameters, including cardiac output, blood volume, and blood pressures in the systemic and pulmonary circulations, were followed in eight patients undergoing portocaval shunt operations because of portal hypertension. Measurements were performed in the awake patients before premedication, during operation immediately before clamping of the portal vein, and immediately after opening of the porto‐caval shunt. Further measurements were performed 2–4 h, and 22–26 h postoperatively. Preoperative!), cardiac index and blood volume were increased, whereas the blood pressures in the systemic and pulmonary circulations were within normal accepted limits. After opening the porto‐caval shunt, increases in pulmonary arterial mean pressure of between 35 and 80% and in pulmonary capillary wedge pressure of between 40 and 200% were observed in the four patients in whom the pressure gradient between the caval vein and the portal vein was normalized, i.e. where a pressure gradient after opening the porto‐caval shunt was measured between 0 and 0.67 kPa. Otherwise, the haemodynamic changes were only partly related to changes in the pressure gradient. The courses of the postoperative haemodynamic changes did not seem to be different from the courses in other categories of patients. The most important haemodynamic changes in patients undergoing porto‐caval shunt operations seem to take place immediately after opening the shunt. To minimize the extent of changes in the pulmonary circulation, the shunt should be opened gradually.
Regional Differences in Lung Function during Anaesthesia and Intensive Care: Clinical Implications
Authors: Hedenstierna G. , Santesson J. , Bindslev L. , Baehrendtz S. , Klingstedt C. , Norlander O.
Published: January 2009

Anaesthesia and most frequently acute respiratory failure are accompanied by a lowered functional residual capacity (FRC). This lowering promotes airway closure in dependent lung units and forces ventilation to non‐dependent regions. Perfusion, on the other hand, is forced towards dependent lung units. A ventilalion‐perfusion mismatch is created and hypoxaemia may develop. General PEEP counters airway closure, but impedes cardiac output and forces perfusion further to dependent regions. In addition, barotrauma may occur. Improved matching of ventilation and perfusion can be achieved by: 1 positioning the subject in the lateral posture; 2 ventilating each lung separately in proportion to its perfusion (differential ventilation); and 3 applying PEEP only to the dependent lung (selective PEEP). Because of less overall intrathoracic pressure and lung expansion, interference with the total lung blood How and the danger of barotrauma should be less than with general PEEP. Improved gas exchange with a 50–100% increase in PaO2 has been observed in a limited number of patients with acute bilateral lung disease studied so far during differential ventilation and selective PEEP.
Spinal Anaesthesia with Hyperbaric 0.5 % Bupivacaine: Effects of Volume
Authors: Axelsson K. H. , Edström H. H. , Sundberg A. E. A. , Widman G. B.
Published: January 2009

Different volumes (1.5, 2, 3 and 4 ml) of hyperbaric 0,5% bupivacaine (8% glucose) were compared in spinal anaesthesia for urological surgery in 40 patients. The blockade was given with the patient in the sitting position. Two minutes after the injection the patient was placed in the lithotomy position. The time required for maximum cephalad spread of analgesia was about 20 min for all volumes. The maximum cephalad spread was directly related to log volume of the local anaesthetic solution. The onset time for motor blockade of the lower limbs decreased and the frequency increased with increasing volume. Four ml produced complete blockade in all patients. The duration of analgesia increased with increasing volume: 3–4 ml produced analgesia at T8 for 1.5‐2.5 h and at L1 for 2–3 h. With this volume, complete motor blockade was obtained for 1.5‐2.5 h. Satisfactory surgical anaesthesia for transurethral resection was obtained with 3–4 ml of the local anaesthetic solution.
Cerebral Hemodynamics, Oxygen Uptake and Cerebral Arteriovenous Differences of Catecholamines Following E. coli Endotoxin in Dogs
Authors: EkströmJodal B. , Häggendal J. , Larsson L. E. , Westerlind A.
Published: January 2009

In experimental endotoxic shock in dogs, a decrease in cerebral blood flow and an increase in cerebral metabolic rate of oxygen (CMRo2) have been shown to occur. In this situation the blood levels of adrenaline and noradrenaline are markedly elevated. The aim of the present study was to investigate whether a cerebral uptake of circulating catecholamines with a possible influence on CMRo2 takes place in the brain. In eight anaesthetized dogs, arterial blood, superior sagittal sinus blood and cerebrospinal fluid were analysed for the concentrations of adrenaline, noradrenaline and dopamine before and up to 4 h after an injection of E. coli endotoxin 1.0–1.5 mg·kg‐1. The blood levels of adrenaline and noradrenaline, but not dopamine, increased in response to the endotoxin. From about 30 min after the endotoxin injection, arteriovenous adrenaline and noradrenaline differences indicating a cerebral uptake were most often seen. Increased concentrations of noradrenaline, adrenaline and dopamine in cerebrospinal fluid were observed. Noradrenaline gave the highest concentrations and these were correlated to the CMRo2. In some animals the blood and cerebrospinal fluid concentrations of adrenaline seemed to be related. These results indicate that catecholamines might be of importance for the development of an increased CMRo2 in endotoxic shock.
Cardiovascular Effects of Nitroglycerin as a Hypotensive Agent in Cerebral Aneurysm Surgery
Authors: Lagerkranser M.
Published: January 2009

The cardiovascular effects of nitroglycerin (TNG) were studied in 20 patients undergoing cerebral aneurysm clipping under controlled hypotension. Total oxygen consumption was also calculated in 15 patients. Mean arterial blood pressure was reduced by 36% from 91 to 58 mmHg (12.1 to 7.7 kPa) by TNG due to decrease in both total peripheral resistance (16%) and cardiac output (24%). Right atrial and pulmonary capillary wedge pressures were reduced during hypotension, indicating a decrease in venous return to the heart. There were no significant changes in total oxygen consumption. It is concluded that the fall in cardiac output results from a reduction in central blood volume due to venous pooling of blood, and that TNG has no major overall metabolic effects.
Modification of Ketamine‐Induced Intracranial Hypertension in Neurosurgical Patients by Pretreatment with Midazolam
Authors: Belopavlovic. M. , Buchthal A.
Published: January 2009

The effect on intracranial pressure (ICP) of ketamine as an anaesthetic induction agent following pretreatment with either midazolam (ten cases) or diazepam (five cases) was investigated in unpremedicated neurosurgical patients. In all patients in the midazolam group, ICP increased following ketamine while the cerebral perfusion pressure (CPP) fell in five cases. ICP rose further after intubation by a mean of 21 mmHg (2.8 kPa) with a further drop in CPP in two cases. The changes were usually terminated after pethidine was given but were allowed to continue for 10 min or more in two cases. There was little increase in ICP after the diazepam‐ketamine combination, while the CPP fell in one case and increased markedly in two cases. The mean increase in ICP following intubation was 6 mmHg (0.8 kPa) above control values. All patients required assisted ventilation after either benzodiazepine‐ketamine combination. It is concluded that midazolam much more effectively suppresses the cardiostimulatory action of ketamine than the increase in ICP and that neither a midazolam‐ketamine nor a diazepam‐ketamine combination should be considered safe for use in patients who may have reduced intracranial compliance.
Comparative Effects of Etidocaine and Lidocaine on Nerve and Neuromuscular Conduction in the Frog
Authors: Post E. L. , Sarracino S. M. , Gergis S. D. , Sokoll M. D.
Published: January 2009

The effects of etidocaine and lidocaine were studied on frog nerve and neuromuscularjunction. Etidocaine is 10 times more potent than lidocaine in blocking nerve conduction. At pH 6.9, the first peak of the compound action potential is blocked more profoundly than is the second. At pH 7.2 and 7.5, both peaks are blocked to about the same degree. There was a dose‐related decrease in miniature endplate potential (mepp) amplitude and acetylcholine sensitivity of the endplate region produced by both drugs. Lidocaine increased the time required for mepp repolarization, while with etidocaine receptor desensitization was observed.
The Haemodynamic Effects of Dopamine and Prenalterol in Patients after Cardiac Valve Surgery
Authors: Tydén H. , Johansson N. L. , Nyström S. O.
Published: January 2009

The haemodynamic effects of prenalterol and dopamine were compared in 10 patients about 4 h after cardiac valve replacement during a phase of temporarily depressed myocardial function. The rate of infusion was adjusted to give similar increases in stroke volume with the two drugs (dopamine +17 % and prenalterol +18%). Both drugs produced marked inotropic and chronotropic effects with significant increases in heart rate, cardiac output, arterial blood pressure, and left and right ventricular stroke work. The arterial blood pressure and the left ventricular stroke work increased significantly more with dopamine than with prenalterol, however. The systemic vascular resistance decreased significantly with prenalterol, whereas it was unchanged with dopamine. The effects of prenalterol could be traced after 90 min, whereas the effects of dopamine vanished within 15 min.
Ketamine and Sympathetic Mechanisms in Cardiac and Smooth Muscle
Authors: Byrne A. J. , Tomlinson D. R. , Healy T. E. J.
Published: January 2009

The effects of ketamine on the response of rat isolated cardiac and smooth muscle to electrical stimulation of intramural sympathetic nerves and to exogenous norepinephrine are reported. Low concentrations of ketamine (1×10‐5to 5×10‐5mol l‐1) significantly potentiated, whilst high concentrations (2×10‐4and 4×10‐4mol l‐1) significantly depressed the positive inotropic response of left atria to sympathetic nerve stimulation. Ketamine 5×10‐5mol l‐1caused a leftward shift of the concentration‐response curves of left atria to norepinephrine (threefold increase in potency) and isoproterenol (twofold increase in potency). Spontaneously beating right atria were slowed in a concentration‐dependent manner by ketamine (5×10‐5to 4×10‐4mol l‐1). Ketamine 1×10‐4mol l‐1potentiated the positive chronotropic response of right atria to low frequency (2 and 5 Hz) sympathetic nerve stimulation, whilst ketamine 4×10‐4mol l‐1depressed the response to all stimulation frequencies. Ketamine 3×10‐5mol l‐1significantly potentiated the amplitude of the response of both hepatic portal vein and vas deferens to field stimulation of sympathetic nerves, and to exogenous norepinephrine. In the presence of reuptake blockade of norepinephrine by pancuronium 1×10‐4mol l‐1, ketamine caused no further potentiation of the response of the vas to nerve stimulation.
Cannulation of the Internal Jugular Vein ‐ 500 Cases
Authors: Tydén H.
Published: January 2009

Five hundred consecutive cases of internal jugular vein catheterization are presented. The success rate varied from 88% in infants under 1 year of age to 99% in adults. There were 16 arterial punctures (3.2%). In one patient surgical removal of a haematoma was necessary. No pneumothorax occurred. Compared to other techniques for central venous catheterization, the internal jugular vein approach gives a high incidence of correct catheter positions and few complications, and is thus recommended.
Effects of Nitroglycerin on Central Haemodynamics and VA/Q Distribution Early after Coronary Bypass Surgery
Authors: Lindskog E. Anjou , Broman L. , Holmgren A.
Published: January 2009

Central haemodynamics and ventilation‐perfusion (V̇AA/Q̇) distributions were studied in nine patients, 21 h after coronary bypass surgery, before and during nitroglycerin (TNG) infusion. V̇A/Q̇ distributions were established with the multiple inert gas elimination technique of Wagner and West. Administration of TNG resulted in a decrease in mean arterial pressure, a slight reduction in cardiac output and stroke volume and a significant increase in heart rate, possibly explained by an initial relative hypovolaemia. Pulmonary arterial pressures and filling pressures for the right and left ventricles decreased significantly. There was a significant reduction in Pao2 and an increase in venous admixture (Q̇VA/Q̇T) from 11.3 to 16.5% of cardiac output. This was mainly due to an initial SF6‐shunt of 6.4% increasing to 12.8%. Only 3.5% of cardiac output during TNG was due to perfusion of hypoventilated areas. The mean for the control Q̇‐distribution was 0.88 with a mean log s.d. of ±1.14, indicating V̇A/Q̇‐mismatch and did not change significantly. The reduction of pressures in the pulmonary vascular bed was accompanied by increased ventilation of areas with high V̇A/Q̇.
Epidural Morphine by the Caudal Route for Postoperative Pain Relief
Authors: Jensen P. J. , Siem‐Jørgensen P. , Nielsen T. Bang , Wichmand‐Nielsen H. , Wintherreich E.
Published: January 2009

In order to detect the ability of epidural morphine, administered by the caudal route, to produce pain relief and in order to compare pain relief by this method with intramuscular injections of opiates, 90 patients scheduled for surgery below the umbilical level were studied. Four milligrams of preservative‐free morphine in 10 ml normal saline was compared with intramuscular injections of opiates, using a visual analogue scale. The average pain score was significantly lower in the epidural group during the first 12 postoperative hours. In the epidural group, 38% required additional intramuscular injections during the first 12 h, whereas 86% of the patients in the intramuscular group received opiate injections. No patients developed respiratory depression. Side effects were more common in the intramuscular group than in the epidural group. It is concluded that epidural morphine by the caudal route is a better choice than intramuscular injections in controlling postoperative pain below the umbilical level.
Postoperative Analgesia and Lung Function: a Comparison of Intramuscular with Epidural Morphine
Authors: Rybro L. , Schurizek B. A. , Petersen T. K. , Wernberg M.
Published: January 2009

Thirty healthy patients subjected to cholecystectomy or operation for duodenal ulcer were allocated randomly for postoperative analgesic treatment with morphine i.m. or epidurally. Morphine was given only at the request of the patients and only as much was given as was needed to obtain satisfactory pain relief. Patients in the epidural group were given morphine exclusively by epidural injection. In the epidural group a lower incidence of radiological changes in the lungs was found postoperatively ‐ 21 % as against 67%. Compared with the i.m. group, there was a higher arterial oxygen tension and a slower increase in alveolar‐arterial oxygen difference. It is concluded that epidural morphine analgesia reduces the degree of postoperative lung dysfunction compared with conventional i.m. morphine treatment.
Perivascular Axillary Block I: Blockade Following 40 ml 1 % Mepivacaine with Adrenaline
Authors: Andersen T. Vester , Christiansen C. , Sørensen M. , Eriksen C.
Published: January 2009

Perivascular axillary block was performed on 80 patients by a catheter technique. All patients had a standard dose of 40 ml mepivacaine 1% with adrenaline. Thirty minutes after the injection, the motor and sensory blockade was determined. Eighty‐six pet cent of the patients had a distinct motor blockade, whereas the remaining 14% had only a slight motor blockade. The sensory blockade was complete in 63%, whereas 37% had lack of analgesia in one or several cutaneous areas. Lack of analgesia was most often found in the cutaneous area of the axillary, musculocutaneous and radial nerves. The frequency of analgesia in the three areas of innervation was analysed with reference to the influence of the age, height and weight of the patient, and of differences in technique: paraesthesias, position of catheter, and unintended puncture of blood vessels. None of these variables seems to be important for the low frequency of analgesia in the three areas of innervation.
Effects of Commercial (pH ˜ 3.5) and Freshly Prepared (pH ˜ 6.5) Lidocaine‐Adrenaline Solutions on Tissue pH
Authors: Wennberg E. , HaljamäeM.D. H. , Edwall G. , Dhuner K‐G.
Published: January 2009

Differences in the effects of commercially available, sodium bisulfite‐containing (pH 3.5‐4), and freshly prepared (pH 6.5) lidocaine‐adrenaline solutions on tissue pH and tissue oxygenation were studied experimentally. In rabbits, a 5×5 cm area under the panniculum was infiltrated with 0.9% NaCl, plain lidocaine, plain adrenaline or one of the two lidocaine‐adrenaline solutions. Tissue pH was measured continuously as well as intermittently in the infiltrated area with monocrystalline antimony needle electrodes. Infiltration of the tissue with the 4 ml volume of a test solution did not seem to induce any significant tissue injury. Tissue pH was decreased for 30 min following plain lidocaine and for 90 min or more following lidocaine‐adrenaline infiltration. With the exception of the first few minutes, no significant differences in the effects on tissue pH between commercial and freshly prepared lidocaine‐adrenaline solutions could be seen. Tissue hypoxia occurred only following infiltration with plain adrenaline. It may thus be concluded that in spite of the low pH and the O2‐reducing properties of commercial lidocaine‐adrenaline solutions, a rapid buffering occurs in the tissues. The use of commercial lidocaine‐adrenaline solution for local infiltration thus seems as safe as that of freshly prepared lidocaine‐adrenaline solutions.
Epidural Morphine for Postoperative Pain Relief
Authors: Hjortsø E. , Vester‐Andersen T. , Møller I. W. , Lunding M.
Published: January 2009

In a clinical, double‐blind study including 45 patients, who all underwent lower abdominal or urological surgery, the analgesic effect, latency and duration of epidural application of morphine were investigated in doses of 2 and 4 mg, respectively, compared to placebo. No significant difference was found in the effect of 2 mg morphine, compared to placebo. A significant decrease in pain score was found in the group of patients who received 4 mg morphine administered epidurally; however, this effect did not occur until 60 min after epidural administration. The effect of 4 mg morphine was found to be of long duration, as eight out of 15 patients did not require any supplementary analgesics within the first 24 h, compared to two out of 14 and three out of 15 patients, respectively, in the placebo and 2‐mg groups.
Oxygen Uptake, Plasma Catecholamines and Cardiac Output during Neurolept‐Nitrous Oxide and Halothane Anaesthesias
Authors: Brismar B. , Hedenstierna G. , Lundh R. , Tokics L.
Published: January 2009

Cardiac output, oxygen uptake and plasma catecholamines were studied in patients both awake and during anaesthesia prior to and during upper abdominal surgery. Two different forms of anaesthesia were used: neurolept‐nitrous oxide (NLA) and halothane (HALO) anaesthesia. Oxygen uptake was determined by using a masspectrometer, and cardiac output was measured according to the Fick principle. Plasma catecholamines were analysed by high performance liquid chromatography. Cardiac output fell by 40% during NLA and by 30% during HALO. Concomitantly, the oxygen uptake fell by 40% and 35%, respectively. A linear relationship between cardiac output and oxygen uptake could be established both in the awake state and during anaesthesia, with no significant change in the slope or position of the regression line when anaesthesia was commenced. Ventricular filling pressures fell during both anaesthetic procedures. Adrenaline fell to half the plasma concentrations seen in normal subjects under resting conditions, while noradrenaline returned to normal from an initially 30–40% increased value. Surgery caused no significant changes in either cardiac output or oxygen uptake, whereas plasma adrenaline increased by 20 times and noradrenaline by 60–90%. The findings suggest that the reduced oxygen uptake during anaesthesia causes the fall in cardiac output rather than any cardiodepressant action of the anaesthetic. It is possible that the anaesthetic depresses whole‐body metabolism by either blocking the effects of catecholamines or interfering with cellular metabolism.
Oxygen Delivery during Endobronchial Anaesthesia: A Comparison of Halothane‐Oxygen and Nitrous Oxide‐Oxygen
Authors: AaltoSetälä M. , Heinonen J.
Published: January 2009

Total oxygen delivery (cardiac output × arterial oxygen content) and oxygen consumption were determined in 22 patients undergoing one‐lung ventilation (OLV) during thoracotomy. In 11 patients, anaesthesia was maintained with halothane‐oxygen and in another 11 patients with nitrous oxide‐oxygen‐analgesic combination (Fio2 0.5). During OLV, oxygen delivery was greater in the halothane group and these patients tended to show a decrease in oxygen consumption compared with the patients of the nitrous oxide group. Therefore, as far as total oxygen balance (oxygen delivery/oxygen consumption) during OLV is concerned, halothane‐oxygen maintenance provides a greater margin of safety than nitrous oxide‐oxygen‐analgesic combination. However, in spite of occasional hypoxaemic episodes, none of our patients receiving 50% nitrous oxide in oxygen showed an oxygen delivery coefficient (oxygen delivery/oxygen consumption) significantly smaller than the predicted normal value for an unanaesthetized patient. This finding may explain why this anaesthetic technique has been used without apparent harm during OLV in patients with unimpaired cardiovascular function.
Intravenous Benzodiazepines as Anaesthetic Agents: Pharmacokinetics and Clinical Consequences
Authors: Kanto J. , Klotz U.
Published: January 2009

Despite extensive and numerous pharmacokinetic studies on benzodiazepines, the published pharmacokinetic data do not adequately explain the clinical differences found between different benzodiazepine derivatives alter intravenous administration. Especially, correlations between initial drug responses and distributional changes of the benzodiazepines are limited. However, during the elimination phase some relationships exist between the kinetic and dynamic phenomena. Age, sex, diseases and concomitantly given drugs cause clinically important alterations in the pharmacokinetics of benzodiazepines. Generally these anxiolytics and sedatives should be considered as adjuvants to general anaesthesia, but not primarily as routine induction agents. The major reasons for this limitation are a high variability in drug response, a relatively slow onset of action and long‐lasting residual effects. However, benzodiazepines have many important advantages (see Table 5) when used as intravenous inducing agents of general anaesthesia.
Long‐Term β‐Receptor Blockade ‐ Adrenergic and Metabolic Response to Surgery and Neurolept Anaesthesia
Authors: Pontén J. , Biber B. , Henriksson B‐Å. , Hjalmarson Å. , Lundberg D.
Published: January 2009

Twenty‐six patients on chronic (>3 months) β‐receptor blocking therapy due to ischaemic heart disease and/or hypertension were randomly distributed to a 4‐day gradual withdrawal (n= 13) or a continuation of ordinary therapy until a planned cholecystectomy under neurolept anaesthesia (n = 13). Plasma‐adrenaline, ‐noradrenaline, ‐potassium, ‐glycerol, ‐FFA, ‐insulin and b‐glucose were determined perioperatively. The metabolic response to surgery was as expected with hyperglycaemia and depressed insulin levels, which did not differ significantly between the two groups of patients. Plasma‐catecholamines showed the highest mean values during emergence from anaesthesia. Plasma‐adrenaline and ‐potassium were constantly highest in the β‐receptor‐blocked patients, who also showed indices of a relatively depressed lipolysis compared to patients in whom β‐receptor blockers had been withdrawn. These discrepancies between withdrawal versus continuation of preoperative β‐receptor blockade seemed to be of small clinical importance and did not oppose the present view that β‐receptor blockers should generally be continued during surgery. However, findings in individual patients suggest that β‐receptor blockade may maintain hypoglycaemia in catabolic patients.
β‐Receptor Blockade and Neurolept Anaesthesia. Withdrawal vs Continuation of Long‐Term Therapy in Gall‐Bladder and Carotid Artery Surgery
Authors: Pontén J. , Biber B. , Henriksson B.‐Å. , Hjalmarson Å. , Jonsteg C. , Lundberg D.
Published: January 2009

Forty‐eight chronically (>3 months) β‐receptor‐blocked patients with ischaemic heart disease and/or hypertension were studied on 49 occasions after random distribution to a 4‐day, gradual preoperative withdrawal (n = 26) or a continuation (n = 23) of β‐receptor blockers. The patients were scheduled for either a cholecystectomy (n = 28) or a carotid thrombendarterectomy (n = 21) under neurolept anaesthesia. Three patients were excluded from the randomized part of the study due to complications (tachycardia, hypertension, severe angina) after therapy withdrawal. In subgroups, central haemodynamics (β‐receptor blockers withdrawn n = 6, continued n = 8) and creatinine‐kinase B (β‐receptor blockers withdrawn n = 9, continued n= 11) were studied. Withdrawal of β‐receptor blockers was associated with high heart rates, supraventricular tachyarrhythmias and a hyperkinetic circulation during pain stimuli. Significantly more postoperative ECG changes (p<0.02) indicative of myocardial ischaemia were found than in β‐receptor blocked patients. These patients had low heart rates but also pronounced increases in pulmonary capillary wedge pressures, which in single patients could be associated with myocardial damage. These results imply that β‐receptor blockers should be continued before surgery and that a concomitant vasodilatatory therapy is likely to avoid the drawbacks of an increased cardiac afterload.
Myocardial Blood Flow, Oxygen Uptake and Carbon Dioxide Release of the Human Heart during Hemodilution
Authors: Gisselsson L. , Rosberg B. , Ericsson M.
Published: January 2009

Myocardial blood flow, oxygen consumption and carbon dioxide release were studied before and during hemodilution in man. Dextran 70 was used as the dilutional agent to reduce hematocrit values from 37 to 28% (mean). The decrease of oxygen content in arterial blood after hemodilution was compensated by an increase of cardiac output. The myocardial blood flow increased proportionally more than the cardiac output, resulting in a virtually unchanged oxygen tension in coronary sinus blood. The metabolism of the heart was not affected as the respiratory quotient remained unchanged. This investigation suggests that blood losses up to 20% of the total blood volume can be replaced by dextran solutions, without a significant decrease of myocardial oxygen supply.
Influence of Ketamine on Non‐Pregnant Uterus in Vivo
Authors: Idvall J. , Sandahl B. , Stenberg P. , Ulmsten U.
Published: January 2009

This investigation was performed to evaluate the effect of ketamine anesthesia on non‐pregnant uterine activity. Seven healthy non‐pregnant women took part in the study. Anesthesia was induced with an i.v. bolus injection of ketamine 2 mg/kg and maintained with a continuous i.v. ketamine infusion, mean dosage 39 μg/kg/min. Before induction of anesthesia, each patient was placed in the lithotomy position, and a catheter fitted with two microtransducers for monitoring of intra‐uterine pressures was fed through the cervix into the uterine cavity. For determination of plasma concentrations of ketamine and norketamine, venous blood samples were collected. The assay was based on a gas‐liquid chromatographic technique. It was found that ketamine induced an increased uterine activity, both in basal tone and intensity of contractions. Only minor effects on the frequency were observed. This stimulatory effect was simultaneous with a hemodynamic stimulation with increases in heart rate and arterial blood pressure, and with the peak plasma concentration of ketamine.
EMLA ‐ a Eutectic Mixture of Local Anaesthetics for Topical Anaesthesia
Authors: EhrenströmReizR.N.A. G. M. E. , Reiz S. L. A.
Published: January 2009

A new topical anaesthetic formulation, EMLA, consisting of a eutectic mixture of the two local anaesthetics, prilocaine and lidocaine, was used in an attempt to reduce the pain associated with venous cannulation in children. The formulation of the local anaesthetic cream yields a high concentration (approximately 80%) of active substance compared with previous formulations (approximately 20%). A highly statistically significant difference in the experience of pain due to venous cannulation in favour of EMLA compared with placebo was found in this study (p<0.001) in 60 children from 6 to 15 years of age. Stimulus of C fibre endings in the subcutaneous tissue and/or the vascular wall seems to be the mechanism behind the slight to moderate discomfort experienced by about one third of the children treated with EMLA. Local side effects of EMLA were negligible.
Effects of Prenalterol on Renal Function in Normal Man
Authors: Järnberg P.‐O. , Westman L.
Published: January 2009

The effects of prenalterol infusion, 0.5 μg/kg/min, on renal function were studied in 10 male volunteers. Systolic blood pressure increased by 22 mmHg(P<0.01) and diastolic pressure decreased by 11 mmHg (P<0.01). Heart rate increased by 11 beats/min (P<0.01). Plasma catecholamine levels and plasma renin activity were not altered. Renal haemodynamics were unchanged. Urine flow rate and fractional free water excretion decreased by 29% and 45%, respectively (P<0.01). Fractional sodium excretion increased by 19% (P<0.01) and fractional potassium excretion fell by 33% (P<0.05).
Survival of Female Geriatric Patients after Hip Fracture Surgery. A Comparison of 5 Anesthetic Methods
Authors: Wickström I. , Holmberg I. , Stefánsson T.
Published: January 2009

Female geriatric patients (mean age 80.9 years; n = 169) undergoing surgery for hip fracture were given epidural, neurolept analgesia, ketamine, enflurane or halothane anesthesia. The rate of survival in the different groups was studied up to 4 years after the operation and compared with the expected survival of normal groups of women with the same age distribution. Mortality at 1 month (6.5%) was equally distributed between the anesthetic methods and was not correlated to age or the type of fracture. The preoperative condition of the patient seemed to be the most important factor for survival. At 6 months, the rate of mortality was 17.2%. Together with age, the type of fracture was the most important determinant for survival. Differences in late survival between the groups were recorded, but the clinical significance of these differences is uncertain since many factors other than the anesthetic method may be more important.
Effect of Labetalol on Intracranial Pressure in Dogs with and without Intracranial Hypertension
Authors: van Aken H. , Puchstein C. , Schweppe M.‐L. , Heinecke A.
Published: January 2009

Intracranial pressure measurements and ventricular volume pressure response curves were made during induced hypotension with labetalol, a combined α‐ and β‐adrenoceptor antagonist, in dogs without (group I) and with (group II) intracranial hypertension. The administration of 600 mg labetalol resulted in a percentage decrease of mean systemic arterial blood pressure (MAP) of 27% (± 10%) in group I, and 32% (± 9%) in group II from control values without changes in intracranial pressure and the ventricular volume pressure response curve. Larger decreases in MAP were not possible, even with a dose 3 times that clinically recommended. Labetalol may be a safe hypotensive agent to supplement neurolept analgesia, but it is not the drug of choice to induce deliberate hypotension.
A Comparison of Atropine and Glycopyrrolate in Anaesthetic Practice
Authors: Kongsrud F. , Sponheim S.
Published: January 2009

The two anticholinergics, atropine and glycopyrrolate, were used for premedication and as an adjunct to reversal of residual neuromuscular block in a double‐blind study. Glycopyrrolate, being about twice as potent as atropine in the clinical situation, was used in half the dosage of atropine. When used for premedication, no difference was found between the drugs concerning patients complaining of dry mouth, but more patients in the glycopyrrolate group had a gastric juice pH greater than 2.5 compared to the atropine group (not statistically different). The reversal mixture consisted of neostigmine 2.5 mg with either atropine 1 mg or glycopyrrolate 0.5 mg. The heart rate response between 2 and 10 min after injecting the reversal mixture was statistically) significant [P ranged from 0.0001 to 0.05), the atropine group showing the most marked decrease; 18% in the atropine group had sinus bradycardia compared to 5% in the glycopyrrolate group; 34% in the atropine group exhibited arrhythmias compared to 10% in the glycopyrrolate group, the most common form being a nodal rhythm in both groups. More patients in the atropine group had “excessive” oropharyngeal secretions (more than 2 ml) when extubated (P<0.05). The postoperative assessment showed little difference in the two groups, apart horn a lower incidence of nausea and vomiting in the atropine group (not statistically different. The study shows that the use of glycopyrrolate was associated with a more stable cardiovascular system, fewer arrhythmias and superior control of oropharyngeal secretions at the time of reversal.
Resuscitation Skills Among the Population
Authors: Klvelä S.‐L.
Published: January 2009

According to a postal survey, 49% of the population living in the Finnish Lapland county has been taught how to resuscitate, but only 19% of the whole population there thought they would be capable of resuscitating a patient. Even among those who had been properly instructed, only 33% thought they would be able to perform resuscitation. It thus seems that not enough teaching sessions have been arranged to teach resuscitation to the whole population. In addition, the teaching sessions arranged do not ensure an adequate resuscitation technique for those who have received instruction.
Hydration before Cardiopulmonary Bypass
Authors: ÖHqvist G. , Settergren G.
Published: January 2009

A generous fluid regimen before cardiopulmonary bypass (6% of body weight) combined with a vasodilator (nitroprusside) was described recently. The present study deals with central haemodynamics, pulmonary oxygenation, glomerular filtration rate and the use of blood products before and after bypass in patients given crystalloid fluid corresponding to 3% of b.w. before bypass combined with nitroglycerin in a close that kept pulmonary artery pressure at a constant level. Ten patients with aortic stenosis and/or incompetence were studied. Cardiac output (thermodilution), heart rate, blood pressures, arterial oxygen tension (Pao2) at an inspired oxygen concentration of 30%, the concentration of oxygen in blood and endogenous creatinine clearance were measured. After the induction of neurolept anaesthesia, cardiac index, stroke volume, systemic and pulmonary vascular resistance, pulmonary arteriovenous oxygen difference. Pao2 (Fio2 = 0.3) and glomerular filtration rate were within normal limits. Neither hydration nor the bypass procedure itself caused any change in these parameters. The patients tolerated cannulation of the large vessels well without hypotensive episodes. When compared with a similar group of eight patients treated with a restrictive fluid regimen (0.21 before bypass), no significant differences in the above‐mentioned parameters were found.
Central Blood Pooling as an Explanation for Lowered FRC during Anaesthesia? Thigh Volume Measurements by Plethysmography
Authors: Hedenstierna G. , Johansson H. , Linde B.
Published: January 2009

Segmental volumes of the thigh and the upper arm were measured by means of an air‐filled plethysmograph before and during various anaesthesias. A small but significant fall in segmental volume was seen with the induction of anaesthesia with thiopentone. A further fall was observed during neurolept anaesthesia but not with halothane. Epidural and spinal anaesthesias caused no change in segmental thigh volume. The results suggest a redistribution of 50–150 ml blood from the extremities to the trunk during general anaesthesia. This redistribution may contribute to the well‐known fall in FRC with general anaesthesia.
Cerebral and Systemic Effects of Hypotension Induced by Trimetaphan or Nitroprusside in Dogs
Authors: Ishikawa T. , Funatsu N. , Okamoto K. , TakeshitaM.D. H. , McDowall D. G.
Published: January 2009

The effects of hypotension induced by trimetaphan (TMP) or nitroprusside (NTP) together with controlled haemorrhage on cerebral electrical activity, cerebrospinal fluid pressure (CSFP) and systemic circulatory and metabolic variables were measured in 10 mongrel dogs anaesthetized with halothane (end‐tidal, 0.88±0.03%). Induced hypotension was maintained at cerebral perfusion pressure (CPP) of 45 mmHg for 45 min and then at 30 mmHg for 45 min. In five TMP dogs, there were significant decreases in EEG‐power and slowing of peak power frequency from the frontal area, but not from the occipital area. The CSFP did not change significantly except for an increase during the induction stage of hypotension. In five NTP dogs, there were no significant changes in EEG‐power and peak power frequency throughout the study from either frontal or occipital areas, but CSFP increased significantly. With both drugs, an increase in glucose, lactate and lactate pyruvate ratio (L/P), and a decrease in Pao2 were more pronounced at 30 mmHg than 45 mmHg. With NTP, there were sustained increases in lactate and L/P, even after restoration of arterial pressure. The same magnitude and duration of the decrease in CPP induced by either TMP or NTP produced different effects on cerebral and systemic function.
Spondylitis Following Epidural Morphine: A Case Report
Authors: Wenningsted‐Torgard K. , Heyn J. , Willumsen L.
Published: January 2009

A case of staphylococcus aureus spondylitis following epidural analgesia is reported. Clindamycin and sodium fusidate treatment for 4½12 months led to recovery with wedge formation of the two vertebral bodies involved.
Experimental Cutaneous Pain Thresholds and Tolerance in Clinical Analgesia with Epidural Morphine
Authors: Eriksson M. B. E. , Lindahl S. , Nyquist J. K.
Published: January 2009

Ten patients experiencing significant analgesia from repealed low‐dose morphine injections via an indwelling epidural catheter were studied. One group (n=5) with acute, postoperative pain was tested for changes in experimental cutaneous pain thresholds with and without clinical morphine analgesia. Three of these patients received intravenous naloxone. The analgesia was reversed in two. There was no significant alteration in any cutaneous modality, including pain, although the postoperative deep pain was relieved. This discrepancy might be explained by the existence of separate subpopulations of opiate receptors at the spinal cord level, which differentiate nociceptive input from the skin and from deep body structures. The other group (n = 5) of cancer pain patients with a permanent epidural catheter was monitored for long‐term changes in clinical pain. Signs of tolerance were not seen with an observation period up to 6 weeks.
Halothane by the I. V. Route in Experimental Animals
Authors: Biber B. , Martner J. , Werner O.
Published: January 2009

In a preliminary investigation, halothane dissolved in a 20% fat emulsion (Intralipid®) was administered intravenously to chloralose‐anaesthetized cats. A dose‐related mixed expiratory concentration of halothane was encountered. The cardiovascular adaptation to i.v. halothane was in agreement with previous reports on haemodynamics during inhalation of halothane. Animal experimental applications for i.v. halothane administration are suggested, while the usefulness of the technique in man remains to be ascertained.
Endorphins and the Modulation of Acute Pain
Authors: Terenius L. , Tamsen A.
Published: January 2009

The endorphins constitute a large family of structurally but not generically related peptides. They act pharmacologically like narcotic analgesics. An intimate connection between endorphin fibers and pain pathways is present, for instance, at the spinal level and at the first synapse of primary afferent pain fibers. These fibers may contain the neuropeptide substance P. In acute pain, naloxone injection causes a significant increase in pain suffering. A patient with high preoperative endorphin levels in the cerebrospinal fluid will require less pethidine for adequate pain relief after major abdominal surgery. Pethidine administration reduces substance P levels in the cerebrospinal fluid. The data suggest that endorphins do have a protective role in acute pain conditions.
Neurophysiological Measurement of Pain
Authors: Llndblom U.
Published: January 2009

Neurophysiological measurement of pain is a research goal rather than a reality today. The gap may be narrowed by combining different techniques. Electrophysiological methods with stimulation and recording directly from the afferent pathway should contribute to a more specific and differentiated picture of the mode of action of analgesics, as a basis for development of new therapies. Such electrophysiological methods can be combined with behavioural studies, both in humans and in animal pain models.
Glucuronidation of Morphine in Human Liver and Interaction with Oxazepam
Authors: Säwe J. , Pacifici G. M. , Kager L. , von Bahr C. , Rane A.
Published: January 2009

Morphine is primarily metabolized through glucuronidation by a microsomal UDP‐glucuronyltransferase. With the use of14C‐morphine the activity of this enzyme was measured in hepatic microsomes from ten kidney transplant donors with total cerebral infarction and four icteric patients with pancreatic carcinoma. In the former livers the rate of glucuronidation varied from 1.08 to 8.67 nmol per mg microsomal protein per min, with a mean value of 3.83. These values were somewhat higher than in the liver biopsies from the four cancer patients. Oxazepam, at 1/10 the concentration of morphine, inhibited the morphine glucuronidation by 35%. The inhibition was competitive. Salicylamide also inhibited the morphine glucuronidation but only at concentrations considerably higher than morphine. The relevance of thein vitrodata for thein vivosituation is unclear, since the concentrations employed in this study are several‐fold higher than those encountered in the plasma of patients treated with these drugs.
Single‐Dose Kinetics and Bioavailability of Ketobemidone
Authors: Anderson P. , Arnér S. , Bondesson U. , Boréus L. O. , Hartvig P.
Published: January 2009

The single‐dose kinetics and the oral and rectal bioavailability of ketobemidone have been studied in patients after surgery. Plasma concentrations were determined following intravenous administration of Ketogin® 2 ml, containing ketobemidone chloride 10 mg and the spasmolytic substance N, N‐dimethyl‐3, 3‐diphenyl‐l‐methylallylamine chloride 50 mg and following oral or rectal administration of Ketogin. Ketobemidone was analyzed by gas chromatography‐mass spectrometry using a deuterated internal standard. Ketobemidone disappeared rapidly from plasma after i.v. or oral administration, yielding a mean plasma half‐life between 2.25 and 2.45 h. After rectal administration the plasma half‐life was somewhat prolonged (3.27 h), probably due to late absorption. The bioavailability of oral ketobemidone was 34%±16% s.d. (n=6), and when given rectally 44%±9% s.d. (n = 5). In contrast to earlier investigations performed without plasma analysis, ketobemidone was found to have a rapid elimination when given intravenously, orally or rectally.
Multiple Dose Kinetics of Ketobemidone in Surgical Patients
Authors: Bondesson U. , Tamsen A. , Dahlström B. , Hartvig P.
Published: January 2009

Twelve patients scheduled for major abdominal surgery were selected for a study of the kinetics of ketobemidone during the day of surgery and in a follow‐up study 3–5 days after surgery. In six patients ketobemidone was administered as ketobemidone plain and in the other six, it was given as Ketogin®, a combination formula containing a spasmolytic substance in addition to ketobemidone. Plasma samples were collected for approximately 24 h following induction of anesthesia, during which time multiple doses of ketobemidone were administered. A single‐dose study was performed 3–5 days after surgery using the same drug. No significant differences were found between the two formulations of ketobemidone. Plasma clearance did not change significantly between the two periods of study, being 18.0±4.4 ml · kg‐1 · min‐1 peroperatively and 21.7±7.6 ml · kg‐1 · min‐1 postoperatively. Peroperative Vd area was significantly larger than post‐operative Vd area, 5.84±2.621 · kg‐1 and 3.63±0.381 ·; kg‐1, respectively. T1/2 terminal decreased from 3.84±1.6 h peroperatively to 2.06±0.44 h postoperatively.
Morphine and Diamorphine in the Terminally Ill Patient
Authors: Twycross R. G.
Published: January 2009

In cancer, the use of morphine is dictated by intensity of pain and not by brevity of prognosis. It is a reliable and safe drug when given in simple aqueous solution and is the strong analgesic of choice at most hospices. The oral‐parenteral potency rate is 1:3. The effective analgesic dose varies from as little as 2.5 mg to more than 100 mg by mouth every 4 h, though most patients do not need more than 30 mg. Most patients require antiemetic and laxative medication concomitantly; many benefit by the concurrent use of aspirin, corticosteroid or other “co‐analgesic”. By mouth, morphine and diamorphine have similar actions and unwanted effects, though the latter is about 1.5 times more potent. When injections are necessary, diamorphine hydrochloride is used at all hospices in Britain. It is considerably more soluble than morphine sulphate which means that the volume injected need never be large. The main indication for parenteral administration, apart from the last few hours of life, is intractable vomiting despite the prescription of antiemetic. Most patients can be maintained on oral medication. Neither morphine nor diamorphine should be regarded as the panacea for severe cancer pain. To achieve maximum benefit they must be used within the context of “broad spectrum” pain control and comprehensive patient care and family support.