bluuebunny/crossref_metadata_2025 huggingface dataset:
The interaction of pancuronium and vecuronium with cardiac muscarinic receptors
Authors: Sugai Y. , Sugai K. , Hirata T. , Okuda C. , Miyazaki M.
Published: January 2009

The interaction of vecuronium, a monoquaternary analogue of pancuronium, with the cardiac muscarinic receptors in canine hearts was investigatedin vitroby [3H] QNB binding assay and compared with that of pancuronium. Both pancuronium and vecuronium, which are nicotinic antagonists of competitive types, inhibited the binding of [3H] QNB to cardiac muscarinic receptors with values of IC50of 5.41 × 10‐7mol/l and 3.97 × 10‐6mol/l respectively. According to the Kd and Bmax values on the Scatchard plot, pancuronium, while not influencing the number of receptors, had a 3‐fold greater inhibitory effect than vecuronium on the affinity of the muscarinic receptors. The K1values of vecuronium and pancuronium showed that pancuronium had a 7.3‐fold greater affinity with the receptors than vecuronium. We concluded that vecuronium had a direct inhibitory action on the binding of [3H] QNR to the canine heart muscarinic receptors, but this action was much weaker than pancuronium.
Effects of rectal thiopentone and methohexitone on carbon dioxide tension in infant anaesthesia with spontaneous ventilation
Authors: Larsson L. E. , Nilsson K. , Andreasson S. , Ekström‐Jodal B.
Published: January 2009

The influence of rectal administration of barbiturates on Pco2 during mask anaesthesia with spontaneous ventilation was studied in 72 infants. The age of the patients ranged between 6 and 24 months and they were all subjected to minor paediatric surgery. The patients were divided into four equally large groups: a control group receiving no premedication, a group receiving rectal thiopentone 30 mg·kg‐1 and two groups receiving methohexitone either 20 or 30 mg·kg‐1. In all patients Pco2 was measured in an arterialized capillary blood sample obtained during stable anaesthesia with oxygen, nitrous oxide and halothane before and after surgery. After rectal induction with barbiturates, the mean Pco2 was significantly higher in the different barbiturate groups than in the control group (P<0.05). The mean Pco2 value ± s.d. in kPa for the control group was 5.6 ± 0.7, for the group receiving thiopentone 30 mg·kg‐1 6.5 ± 1.6, for the groups receiving methohexitone 20 or 30 mg·kg‐1 6.1 ± 1.2 and 6.3 ± 1.1, respectively. It is concluded that the combination of rectal induction with barbiturates and mask anaesthesia with oxygen, nitrous oxide and halothane carries an increased risk of hypoventilation in infants under 2 years of age.
Changes in cardiac metabolism, perfusion, ECG and plasma catecholamines during increased intracranial pressure in the pig
Authors: Rudehill A. , Hjemdahl P. , Sollevi A. , Sylvén C. , ÖWall A.
Published: January 2009

The effects of graded elevations of intracranial pressure (ICP) on cardiac metabolism, blood flow and electrophysiology, and plasma catecholamines were studied in eight open‐chest pigs. ICP was consecutively elevated from 15 ± 3 mmHg in the control state to 40 ± 4, 84 ± 4 and 152 ± 11 mmHg. Mean arterial blood pressure and heart rate were significantly increased at the two highest ICP levels. Cardiac oxygen uptake was also increased from 2.9 ± 0.4 ml × min‐1 to a maximum of 7.1 ± 2.0 ml × mir‐1, and coronary sinus blood flow increased from 49 ± 7 to 131 ± 35 ml × min‐1 at the highest ICP level. The transmyocardial blood flow distribution was unchanged, as determined by the microspheres technique. Arterial plasma catecholamine concentrations were significantly elevated at the two highest ICP levels, but noradrenaline overflow from the heart did not increase. The high arterial adrenaline concentrations (51 ± 25 nmol × l‐1 at the highest ICP level) may he responsible for the cardiac stimulation seen in these experiments. No signs of ischaemia, as judged by myocardial lactate production or the relative flow distribution to the endocardium were observed. Changes in the T‐wave morphology appeared in the subendocardial ECG at all ICP levels, the changes being more prominent with increasing ICP levels. It is concluded that the increase in circulating catecholamine levels, adrenaline in particular, together with an elevation of afterload cause an increase of myocardial work, which may explain the T‐wave changes in the ECG which are observed upon rapid elevation of intracranial pressure.
Postoperative water and electrolyte changes in skeletal muscle: a clinical study with three different intravenous infusions
Authors: Stillström A. , Person E. , Vinnars E.
Published: January 2009

Twenty‐seven patients admitted for cholecystectomy were matched for age and sex in three groups for different perioperative fluid therapies over a period of 3 days. Group I was given an acetated half‐isotone “balanced” saline solution with the addition of 2.5% glucose, Group II an acetated Ringer solution and Group III an isotonic glucose solution. Percutaneous muscle biopsies were performed before and on the third day after surgery for the determination of water content and the concentration of sodium, potassium, magnesium and chloride in skeletal muscle. The cumulative balance of sodium and potassium was measured daily during the study. In all three groups a significant increase in the total muscle water content was demonstrated. The concentration of sodium and chloride in skeletal muscle increased significantly in Groups II and III, whereas the concentration of potassium decreased in all groups. The cumulative sodium balance was positive in Groups I and II; the potassium balance was negative in all groups. In conclusion, the patients given the balanced saline solution showed the least change in water content and electrolyte concentrations in skeletal muscle.
The anticonvulsive activity and toxicity of diazepam in three different formulations. An experimental study in mice
Authors: Högskilde S. , Nielsen J. W. , Carl P. , Angelo H. , Sörensen M. Bredgaard
Published: January 2009

The anticonvulsive activity (ED50), acute toxicity (LD50), and minimal neurotoxicity (TD50) of diazepam in an emulsion form (Diazemuls®) were compared with two different water‐based diazepam solutions (Valium® and Stesolid®). The diazepam preparations were administered intravenously to male mice. After determination of time of peak drug activity, the ED50's were established against pentetrazol‐induced convulsions, at peak drug activity. The most important difference between the three diazepam preparations was a significantly higher LD50 of diazemuls (275 mg/kg) compared to Valium (49 mg/kg) and stesolid (51 mg/kg). ED50 was: diazemuls 0.24 mg/kg, Valium 0.14 mg/kg and stesolid 0.10 mg/kg. The therapeutic indices (LD50/ED50) were thus calculated to he 1146 for diazemuls, 350 for Valium and 510 for stesolid. Time of peak drug activity and TD50 were equal for all three drugs. No signs of pain on injection or necrosis were observed following diazemuls, whereas this was common after Valium and stesolid.
Per‐ and postoperative changes in the concentration of serum thyreotropin under general anaesthesia, compared to general anaesthesia with epidural analgesia
Authors: Noreng M. F. , Jensen P. , Tjelldén N. U.
Published: January 2009

In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3‐uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4‐S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous‐oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma‐TSH, compared to the other group, which had a significant (P < 0.05) increase peroperatively. The patients receiving epidural analgesia were pain‐free and the normal stress‐induced increase in plasma‐glucose was abolished. Concerning T3 we found a significant decrease in both groups and a steady level of T4‐ and T3‐uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma‐TSH concentration are markedly similiar to the effects of other anterior pituritary hormones, i.e. HGH, prolactin and ACTH.
Benzodiazepines as oral premedication. A comparison between oxazepam, flunitrazepam and placebo
Authors: Hofstad B. , Haavik P. E. , Wickström E. , Steen P. A.
Published: January 2009

Oxazepam 25 mg, flunitrazepam 1 mg and placebo were compared as oral premedication in 602 gynecological patients in a double‐blind randomised parallel study. In 251 patients undergoing major surgery the same drug was also given as a hypnotic the night before the operation. Both active drugs shortened the sleep‐onset time, decreased the number of spontaneous awakenings at night and improved the quality of sleep when compared to placebo. The active drugs were significantly better than placebo as premeditation when assessed by both the patients and the anesthesiologist. In 351 patients admitted for day‐case minor surgery with no previous night medication, flunitrazepam was significantly better than placebo as premedication when assessed by both the patients and the anesthesiologist, while oxazepam was only better than placebo when judged by the anesthesiologist, not by the patients.
Acute salicylate self‐poisoning in 177 consecutive patients treated in ICU
Authors: Thisted B. , Krantz T. , Ström J. , Sørensen M. Bredgaard
Published: January 2009

The course of 177 consecutive patients with severe salicylate self‐poisoning treated in an intensive care unit (ICU) during a period of 15 years is presented. On admission, cerebral depression was observed in 61%, respiratory failure was present in 47%, acidosis in 36% and cardiovascular function was impaired in 14%. A mortality rate of 15%, was observed, which was proportionally higher in patients more than 40 years old and in patients with delayed diagnosis. Twenty‐seven patients died and an autopsy was performed on 26 patients. The main autopsy diagnosis was ulcers of the gastrointestinal tract in 46%, pulmonary oedema in 46%, cerebral oedema in 31% and cerebral haemorrhage in 23%.
Effect of clonidine on haemodynamic responses to endotracheal intubation and on gastric acidity
Authors: Orko R. , Pouttu J. , Ghignone M. , Rosenberg P. H.
Published: January 2009

Sixty‐three patients (ASA 1–2), scheduled for elective surgery under general anaesthesia, were randomly given rather oral clonidine (225–375 μg) + diazepam (5–15 mg), cimetidine (300 mg the night before and 300 mg in the morning) + diazepam or only diazepam for premedication. Anaesthesia was induced with thiopentone and maintained with N2O + O2 (70:30), enflurane and fentanyl. Vecuronium bromide was used as a muscle relaxant, the sleep dose of thiopentone was significantly smaller in the patients pretreated with clonidine than in the other groups. The mean maximal increase in heart rate was lowest in the clonidine‐pretreated patients, but there were no significant differences in the mean arterial pressure changes associated with intubation. Before and just after intubation and in the recovery room, the arterial pressures were lowest in the patients pretreated with clonidine. During anaesthesia, marked bradycardia ( 45 beats min‐1) did not occur more often when clonidine was used, but in the recovery room there were statistically significantly more patients with bradycardia in the clonidine group than in the other groups. On the electrocardiogram (ECG) during the endotracheal intubation, the incidence of bigeminy was higher in the diazepam patients (5/20) than in the cimetidine patients (2/20) and the clonidine patients (0/23). There were significantly more gastric content samples with a pH above 2.5 in the cimetidine group than in the other groups, and clonidine patients did not differ from diazepam patients in this respect. The high incidence of bradycardia with the concomitant hypotension may limit use of this drug to highly selected patients.
Prevention of intraoperative hypothermia during abdominal surgery
Authors: Joachimsson P.‐O. , Hedstrand U. , Tabow F. , Hansson B.
Published: January 2009

Heat balance and core and skin temperatures were studied in 111 patients during abdominal surgery. In minor surgical procedures the effects of heating of inspired humidified gases (n = 23) and of a heating mattress (n = 21) were compared with the conditions in an unwarmed control group (n = 24). These two methods were about equally effective in preserving total body heat, although the major effect of the heating mattress was to conserve heat which had been redistributed to the surface, and such heat could subsequently he lost to the environment. During major abdominal surgery 18 unwarmed control patients were compared with patients (n = 25) provided with a heat supply. The combined measures of heated humidified inspired gases, a heating mattress, insulation by a heat‐reflecting blanket, warming of all infusions and transfusions arid a warm operating room were all needed to balance the great heat losses during the major surgical procedures. With such massive heat supply it was possible to prevent heat loss and a fall in core temperature.
The effect of segmental epidural analgesia on the neurobehavioural responses of newborn infants
Authors: Kangas‐Saarela T. , Jouppila R. , Jouppila P. , Hollmén A. , Puukka M. , Juujärvi K.
Published: January 2009

The effects of maternal segmental epidural analgesia on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4–5 days. Subjects were healthy, term neonates born vaginally to 14 mothers with an epidural block and to 15 mothers without analgesia. The only statistically significant differences were found at the age of 1 day, when the epidural group infants habituated and oriented better to inanimate auditory stimuli. It is concluded that segmental epidural analgesia with a low dose of bupivacaine can be regarded as being a safe obstetric analgesic method as regards neonatal behavioural responses.
Oxygen tension and consumption measured by a tc‐Po2 electrode on heated skin before and after epidermal stripping
Authors: Jaszczak P. , Sejrsen P.
Published: January 2009

Oxygen tensions, cutaneous blood flow rate, and skin oxygen consumption rate were detrrmincd by tc‐Po2 measurements at an electrode temperature of 45°C. The epidermal surface was stripped by 50 applications of adhesive plaster to the surface. Ten healthy, normotensive adults were examined. Cutaneous blood flow rate was 41.2 ± 8.6 ml. (100 g)‐1. min‐1 before and 42.8 ± 5.9 ml. (100g)‐1. min‐1 after epidermal stripping. Oxygen consumption before stripping was 0.327 ± 0.065 ml O2· (100 g)‐1 · min‐1, and after stripping it was determined at two different saturation levels to be 0.208±0.072 ml O2· (100 g)‐1 · mill‐1 and 0.251 ± 0.096 ml O2· (100g)‐1. min‐1· Capillary temperature was estimated to be approximately 43°C before and after stripping. At this temperature mean arterial Po2 was estimated to be 18.1 kPa (136 mmHg), which would be reduced by the computed local metabolism to a mean capillary Po2 of 14.4 kPa (108 mmHg) before stripping and 15.2 kPa (114 mmHg) after. Stripping increased mean skin Pop from 10.9 ± 0.6 kPa (82.3 ± 4.7 mmHg) to 14.6 k 1.0 kPa (109.4 ± 7.7 mmHg). Thus, stripping eliminated 82% of the gradient between the capillaries and electrode while reducing the computed oxygen consumption by 23–36%. It is concluded that the epidermal membrane is a significant barrier to oxygen diffusion and that the transcutaneous oxygtm electrode has a significant effect on skin Po2 owing to its own even low oxygen consumption. This will reduce the observed skin Pop significantly.
Gas exchange during thoracotomy in children. A study using the single‐breath test for CO2
Authors: Fletcher R.
Published: January 2009

Gas exchange during thoracotoniy was studied in 13 children aged 6 months to 14 years (median age 5 years), anaesthetized for repair of coarctation of the aorta or closure of a patent ductus arteriosus. All received halothane in equal parts of N2O/O2 supplemented with fentanyl. CO2) single‐breath tests were obtained with a computerised on‐line system based on the Servo ventilator. From signals for airway flow pressure, CO2 concentration and timing, the computer calculated the airway deadspace (VDaw) and the static compliance and resistance of the respiratory system. Given a value for Paco2, the computer also calculated the physiological aud alveolar deadspaces. Measurements were taken at six stages during the procedure, starting with the supine position before surgery. After turning to the lateral position, airway deadspace increased by 19%, thus increasing the physiological deadspace fraction. When the pleura was opened, both Voaw and Pao2 were reduced. When the upper lung was retracted, compliance was reduced and also Pao2 ‐ the minimum value noted was 17.3 kPa. Hypoxic Pao2 values were possibly avoided because both ventilation and perfusion were reduced in the retracted lung. The alveolar dradspace fraction increasrd during these intra‐operative stages. Although the net effect of the changes in airway and alveolar dradspace during surgery was a significant increase in physiological deadspace fraction (from 0.23 to 0.28), gas exchange could be maintained at the cost of only moderate increases in peak airway pressure: the mean increase was from 2.4 to 2.8 kPa (24 to 29 cmH2O). After manual hyperinflation of the lung and wound suture, deadspace variables returned to their original values, but compliance was reduced and resistance increased compared to preoperatively. Children who initially had high Pao2s showed a slight deterioration in oxygenation by the end of surgery. The mainly younger children whose initial Pao2s were low (presumably because of atelectasis) improved, perhaps as a result of the manual hyperinflation.
Predictive value of skin testing, neutrophil migration and C‐reactive protein for postoperative infections in cardiopulmonary bypass patients
Authors: Kress H. G. , Gehrsitz P. , Elert O.
Published: January 2009

Despite antibiotic cover for cardiac surgery the development of Postoperative infrction remains a feared complication. The preserit prospective study was designed to evaluate whether it is possible to identify pre‐operatively thosc individuals in whom the risk of a postoperative infection is significantly greater. Skin test response, chemotaxis and random migration of neutrophils, and serum levels of C‐reactive protein (CRP) were chosen as indicators of host resistance. Pre‐operatively and at defined postoperative time intervals, 80 patients undergoing open‐heart surgery with the aid of cardiopulmonary bypass were examined. Of all the immunological variables measured in this study, the state of anergy proved the most reliable predictor of postoperative infection. Six of the nine pre‐operatively anergic patients developed infections (P= 0.00026) representing one half of the postoperatively infected patients. No predictive role of CRP level or neutrophil chemotaxis can be derived from our data. The pre‐operatively decreased random migration of polymorphonuclear leukocytes (PMN) from postoperatively infected patients, however, along with the significant defects in chemotactic and random PMN motility seen after cardiac surgery may partly explain the predisposition to bacterial infection in these patients. In conclusion, a pre‐operative skin test makes a valuable contribution to the assessment of the patient's postoperative infectious risk.
Effect of chronic bupivacaine infusion on seizure threshold to bupivacaine
Authors: Skeie B. , Dodgson M. S. , Forsman M. , Steen P. A.
Published: January 2009

Thirty rats were pretreated with a continuous infusion of bupivacaine or placebo. On the fourth day the acute seizure threshold to bupivacaine was determined for both groups. The seizure dose, blood and brain concentration of bupivacaine showed no difference between the groups. The tachyphylaxis seen clinically when bupivacaine is used for a regional nerve blockade does not seem to evolve for the CNS‐effects.
Cost of a saved life following out‐of‐hospital cardiac arrest resuscitated by specially trained ambulance personnel
Authors: Jakobsson J. , Nyquist O. , Rehnqvist N. , Norberg K.‐A.
Published: January 2009

During a 1‐year‐study period three emergency ambulances manned by specially trained emergency medical technicians (EMTs) were successful in the resuscitation of 28 out‐of‐hospital cardiac arrest patients, who were admitted to hospital for further treatment. Nineteen patients died in hospital while nine were discharged to their homes, a survival rate corresponding to 3.5 saved lives per 100000 inhabitants per year. The extra pre‐hospital costs and the estimated costs for hospital treatment of the admitted patients amounted to 929 600 Swedish kronor (SEK). The program cost of the early defibrillation by trained EMTs accounted for only 12% of this amount, or 113 600 SEK. The cost of hospital treatment accounted for the remaining 88%, or 816000 SEK. Intensive care accounted for 53% of the hospital costs, coronary care 4%, treatment in a general ward 33% and in a ward for rehabilitation or long‐term care 10%. Nan‐survivors accounted for 58% of the hospital expenditure. The marginal prehospital cost (program cost) for each survivor was 12 622 SEK or approximately 1800 US dollars. The total cost per life saved was 103000 SEK or approximately 14 700 US dollars. The estimated cost to each taxpayer of providing this extra emergency resource would be approximately 0.5 SEK a year.
Glycopyrrolate compared with atropine in association with ketamine anaesthesia
Authors: Toft P. , Rømer U. D.
Published: January 2009

Atropine and glycopyrrolate given intravenously before the induction of a ketamine anaesthesia to diminish salivary secretion were compared for their effect on psychotomimetic side‐effects, awakening time and heart rate. Though atropine is a tertiary amine that crosses the blood‐brain barrier, which glycopyrrolate as a quaternary ammonium compound does not, it did not increase the incidence of psychotomimetic side‐effects nor did it significantly prolong the awakening time after ketamine anaesthesia. During intubation the increase in heart rate was significantly higher following atropine than following glycopyrrolate.
Calcium reverses global and regional myocardial dysfunction caused by the combination of verapamil and halothane
Authors: Lehot J. J. , Leone B. J. , Foëx P.
Published: January 2009

In order to evaluate the effects of the combination of halothane and verapamil on left ventricular function and coronary blood flow (CBF), six sheep were anaesthetized with halothane (1.2% inspired) and given increasing cumulative doses of intravenous verapamil. Regional myocardial function was assessed by sonomicrometry in the areas supplied by the left anterior descending coronary artery (LAD) and the left circumflex coronary artery (LC). Changes in global haemodynamics, atrioventricular conduction, LV relaxation and systolic shortening alter 0.32 mg·kg‐1 intravenous verapamil indicated impaired left ventricular function. Significant myocardial dysfunction (post‐systolic shortening) occurred in the LAD territory, accompanied by a 64% decrease (42 ± 6 to 15 ± 3, p < 0.01) in coronary perfusion pressure (CPP). Coronary blood flow in the LC segment decreased 83% (102 ± 15 to 17 ± 13, P < 0.01) as coronary reserve was exhausted with the decrease in CPP. Calcium chloride reversed the impairment of global and regional myocardial function observed with verapamil, improved the impaired left ventricular relaxation, but did not significantly alter atrioventricular conduction. Thus the combination halothane‐verapamil can cause significant left ventricular depression and myocardial dysfunction, possibly by inducing suhendocardial ischaemia or by direct pharmacologic effect. calcium chloride reverses this regional myocardial dysfunction as well as the deleterious global haemodynamic changes caused by halothane‐verapamil; however, the changes in atrioventricular conduction are not corrected by calcium.
Gastric contents and pH after oral premedication
Authors: Brocks K. , S.Jensen J. , Schmidt J. F. , Jørgensen B. Chræmmer
Published: January 2009

Forty women, aged 26–40 years, were investigated with regard to gastric contents and pH before general anaesthesia. The patients were divided into two groups (20 in each). Group 100 received 0.3 mg kg‐1 diazepam orally with 100 ml of water 2 h before surgery. Group 50 received 0.3 mg kg‐1 diazepam with 50 ml of water 2 h before surgery. The amount of gastric content was significantly greater in Group 100 than in Group 50 (P < 0.05). There was no statistical difference in pH values between the groups. The number of patients with both gastric pH less than 2.5 and gastric volume greater than 25 ml was significantly higher in Group 100 compared to Group 50 (P <0.05). We cannot recommend the use of oral premedication using these amounts of water, considering the increased risk of aspiration of gastric contents.
In vitro diagnosis of susceptibility to malignant hyperthermia: comparison between dynamic and static halothane and caffeine tests
Authors: ØRding H. , Skovgaard L. T.
Published: January 2009

In vitro tests for the diagnosis of malignant hyperthermia susceptibility were performed in 105 patients and 20 normal controls according to the protocol of the European MH Group. Results of dynamic halothane and caffeine tests (in which muscle bundle length is cyclically changed) were compared to those of static tests (constant muscle bundle length). Overall, no significant differences between dynamic and static tests were found in threshold concentrations eliciting contractures. Identical diagnostic results with dynamic and static tests were obtained in 94.3% with halothane and in 88.9% with caffeine. The magnitude of contractures was, however, significantly greater in the dynamic than in the static halothane test for halothane concentrations less than 3%, but this did not influence diagnosis. The results indicate that dynamic tests are not superior to static tests, but several tests should be performed to enhance diagnostic safety.
Spinal anaesthesia with hyperbaric tetracaine: effect of age and body mass
Authors: Tuominen M. , Pitkänen M. , Doepel M. , Rosenberg P. H.
Published: January 2009

To discover the influence of age and body mass on spinal analgesia with hyperbaric tetracaine, 60 patients (17–82 years) were administered a subarachnoid injection of 15 mg tetracaine in 3 ml of 5% glucose. The patients were in the lateral position during the injection and in the supine position thereafter. The maximal spread of analgesia (mean T4, range T1‐T11) did not correlate with age or body mass. Any variable studied was not significantly different for the different age groups. In 29 patients (48%) the block required supplementation with fentanyl or general anaesthesia (five patients). Tourniquet‐induced pain occurred in eight patients (28% of patients with tourniquet). Decreases in systolic arterial blood pressure, >30% of the preanaesthetic value, correlated with the level of analgesia and were more frequent in patients over 50 years (P<0.01). Severe hypotension and bradycardia with transient serious changes in QRS‐complexes occurred in one patient (analgesia level, T3). In conclusion, 15 mg of hyperbaric tetracaine provided a relatively high sensory spinal blockade without correlating with age or body mass. Supplementation of analgesia during surgery was needed in almost half of the patient material.
Cerebral blood flow and metabolism during controlled hypotension with sodium‐nitroprusside and general anaesthesia for total hip replacement a.m. Charnley
Authors: Bünemann L. , Jensen K. , Thomsen L. , Riisager S.
Published: January 2009

Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo2) were studied during hypotension induced with sodium nitroprusside (SNP) in 10 patients undergoing total hip replacement a.m. Charnley. Cerebral blood flow was measured using an injection of xenon‐133 into an arm vein. The decay curve was detected by five scintillation counters placed over each hemisphere and analysed with the Novo 10a cerebrograph. Blood samples were drawn from the radial artery and the jugular venous bulb to calculate the CMRo2. In the group as a whole, there were significant decreases in mean arterial pressure and in cerebrovascular resistance. There were no significant changes, in either CBF or CMRo2 in the group as a whole, but there were substantial individual differences. In conclusion, the use of SNP‐induced hypotension for extracranial surgery should be used only in patients monitored closely.
Differences and similarities between human and rabbit neutrophil granulocyte responses in vitro: the effects of zymosan‐activated plasma, phorbol myristate acetate and n‐formyl‐methionyl‐leucyl‐phenylalanine
Authors: Opdahl H. , Benestad H. B. , Nicolaysen G.
Published: January 2009

The amount of reactive oxygen intermediates (ROI) generated by activated polymorphonuclear neutrophils (PMN), as well as the closeness of contact between PMN and vessel wall, may determine whether PMN activators will induce the adult respiratory distress syndrome. We examined the ROI‐generating and aggregating effects of zymosan activated plasma (ZAP), phorbol myristate acetate (PMA) and n‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP), on isolated human and rabbit PMN. PMA, after a short lag phase, induced a large and long‐lasting increase in ROI generation. The initial peak response was higher and more rapid in human than in rabbit cells. The reaction to FMLP occurred almost instantaneously, but was much weaker than that to PMA, and ROI generation returned to near baseline in less than 10 min. No species difference was seen. ZAP caused an FMLP‐like ROI response in human cells, whereas no response was observed in rabbit PMN. PMN aggregation was induced by all three activators, most markedly by PMA. No species difference was detected for PMA; FMLP gave a stronger aggregation of rabbit than of human PMN, however, while the opposite was true for ZAP. In conclusion, ZAP was a potent stimulus for PMN aggregation, but had modest (or no) effects on the production of ROI. Marked differences between human and rabbit PMN responses were observed.
Effects of zymosan‐activated plasma and phorbol myristate acetate on isolated, perfused rabbit lungs
Authors: Opdahl H. , Nicolaysen G. , Benestad H. B.
Published: January 2009

The effects of complement activation on pulmonary vascular permeability are disputed. In rabbit lungs perfused with autologous blood, zymosan activated plasma (ZAP) induced a moderate increase in pulmonary vascular resistance (PVR), but did not detectably change the vascular permeability within 2 h. The stronger neutrophil granulocyte (PMN) activator, phorbol myristate acetate (PMA), usually gave larger PVR increases and also increased pulmonary vascular permeability. Lungs from neutropenic animals, similarly perfused and given PMA, showed unchanged PVR reactions but had no apparent increase in vascular permeability. Lungs perfused with cell‐free medium and given PMA displayed modest PVR increases, and no measurable permeability change. The lung preparatory procedure itself markedly influenced leukocyte circulation. Exsanguination of lung donors decreased the concentration of circulating PMN significantly, and they virtually disappeared from the perfusate within minutes after start of lung perfusion. PMN‐mediated effects must therefore have been caused by cells already sequestered in the lungs. We conclude that ZAP docs not induce an increased pulmonary vascular permeability in isolated, perfused rabbit lungs, in contrast to PMA. The permeability effects of PMA appear to be PMN dependent.
Intravenous infusion of Diazemuls® in the control of status‐like epileptic seizures of different etiology
Authors: Høgskilde S. , Sørensen P. S. Soelberg , Thisted B. , Sørensen M. Bredgaard
Published: January 2009

This report concerns three patients in whom continuous intravenous infusion of Diazemuls® (diazepam dissolved in soya bean oil and emulsified) diluted in 5.5% glucose was used for the controlling of epileptic‐seizures (status). Diazemuls infusion was effective in one patient with complex partial status epilepticus; in another patient with convulsion secondary to a brain stem infarct, the convulsions were abolished; while only reduced jerking was achieved in the third patient suffering from myoclonic jerks caused by anoxic brain damage. Infusion time ranged from 15 to 33 h. The serum concentrations of diazepam obtained during the infusions were higher than recommended in the literature for treatment of status epilepticus, but could not be correlated to either clinical efficacy or infusion rate.
Peroperative hypothermia prevention
Authors: Bernard J. M. , Pinaud M. , Souron R.
Published: January 2009

Peroperative thermal losses were studied in 28 patients (mean age 64 years) operated for a total hip prosthesis under controlled hypotension. The patients were split into four groups according to the method of hypothermia prevention used: reflective blanket, heating humidifier of inhaled gases, combination of both techniques or no prevention at all. The thermal loss was quicker and more intense in the last group. The superiority of one prevention method over another could not be demonstrated, but the urgency of its implementation proved to be essential.
Postoperative ventilatory and circulatory effects of heating after aortocoronary bypass surgery
Authors: Joachimsson P. O. , Nyström S. O. , Tydén H.
Published: January 2009

Twenty‐four patients with stable angina pectoris were studied after aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). Twelve patients (radiant heat supply group) were rewarmed during CPB to a nasopharyngeal temperature of at least 38°C and a mean rectal temperature of 34.4°C. Postoperatively they received radiant heat supply from a thermal ceiling. In addition, a heating water mattress was used during the end of the operation and heated, humidified inspired gases were administered intra‐ and postoperatively. The other 12 patients (combination heat supply group) had the rewarming during CPB extended until the rectal temperature exceeded 36°C, but otherwise received the same treatment as the radiant heat supply group. The combination of extended rewarming during CPB and postoperative radiant heat supply significantly reduced oxygen uptake, carbon dioxide production and the required ventilation volumes during early recovery as compared with the values in the radiant heat supply group. The reduced metabolic demands were accompanied by lower cardiac index and oxygen delivery, which, however, were sufficient for adequate tissue perfusion as judged by the similarity in oxygen extraction and arterial base excess values in the two groups. The metabolic demands and ventilatory requirements were reduced to a level at which safe early extubation is possible.
Choice of anesthetic alters the circulatory shock pattern as gauged by conscious rat endotoxemia
Authors: Schaefer C. F. , Biber B. , Brackett D. J. , Schmidt C. C. , Fagraeus L. , Wilson M. F.
Published: January 2009

A standardized rat endotoxin shock model was used to assess the differential effects of four commonly used anesthetics upon hemodynamics before and during endotoxin shock. Forty‐nine male Spraguc‐Dawley rats weighing 307 ± 4 g were divided into five groups: freely‐moving conscious, enflurane (2%), isoflurane (1.4%), pentobarbital (6 mg kg‐1h‐11 i.v.), and ketamine (45 mg·kg‐1·h‐1i.v.). Anesthetic doses were chosen as 1.0 MAC equivalent. Anesthetized rats were intubated and ventilated with oxygen. The right carotid artery was cannulated with a thermocouple‐catheter for aortic blood pressure, heart rate, and thermodilution cardiac output measurements. The right jugular vein was cannulated for measurement of central venous pressure and for i.v. injections. Data were collected over a 30‐min baseline period and for 4 h after an i.v. bolus of endotoxin (40 mg·kg‐1, LD100within 24 h). Gross small intestinal pathology was rated on a 0–4 scale. Anesthetic effects were judged in terms of significant deviations from the awake data on each parameter. Despite differing patterns, total deviations were similar for enflurane, ketamine, and pentobarbital, although the latter drug was the least preferable due to particularly high systemic vascular resistance. Significantly less hemorrhagic small intestinal pathology occurred with enflurane. Ketamine offered no advantage over the inhalation anesthetics. Among the four anesthetics tested, results were closest to the awake pattern with isoflurane anesthesia, thus making it the logical choice for hemodynamic studies in experimental shock research.
Extreme metabolic acidosis
Authors: Sjøgren P. , Andersen L. W.
Published: January 2009

A 42‐year‐old male patient, who suffered from insulin‐dependent diabetes mellitus (IDDM) and intolerance of laetose, presented with extreme metabolic acidosis (lactic acidosis). On arrival, an arterial blood sample showed: pH 6.79, Po2 18.8 kPa, Pco2 0.9 kPa, base excess ‐ 33 mmol I‐1, blood glucose 38 mmol I‐1 and oesophageal temperature 30°C. Apart from the uncontrolled hyperglycaemia, a fluid balance disorder elicited by diarrhoea and disturbed tissue perfusion were possible aetiological factors. The patient was treated with a low‐dose insulin regimen and infusion of isotonic sodium bicarbonate with a satisfactory result.
Blood substitution and complement activation
Authors: Schött U. , Berséus O. , Järemo P.
Published: January 2009

Complement activation was studied in 45 patients undergoing total hip arthroplasty under epidural anesthesia. The patients were randomly allocated to three groups. In Group I blood loss was replaced with microaggregate‐poor erythrocyte concentrate (SAGM‐ERC) plus 3% dextran‐60 as plasma substitute, and postoperative analgesia was maintained with intramuscular ketobemidone. In Group II blood loss was replaced as in Group I, but epidural anesthesia was prolonged 12 h postoperatively and kept at a level of T4 with 0.5% bupivacaine. In Group III blood loss was replaced with non‐frozen stored plasma plus SAGM‐ERC, and postoperative analgesia was maintained with ketobemidone as in Group I. All groups received pre‐ and postoperative thrombo‐prophylaxis with dextran. The plasma concentration of C3a‐des‐argininc (C3a‐desArg) was measured by radioimmunoassay preoperatively, immediately after operation and 3, 6 and 18 h postoperatively. No significant differences in plasma C3 and C4 were found between the groups. G3a‐dcsArg was significantly (P<0.01) increased up to 6 h postoperatively in Group III compared with both the preoperative value and Groups I and II. It is demonstrated that infusion of plasma can enhance or initiate endogenous complement activation. Blood component therapy with SAGM‐ERC and 3% dextran‐60, on the other hand, did not significantly increase the plasma level of C3a‐desArg irrespective of the type of postoperative analgesia.
A haemoglobin dilution method (HDM) for estimation of blood volume variations during transurethral prostatic surgery
Authors: Hahn R. G.
Published: January 2009

A method for estimation of blood volume changes during transurethral prostatic surgery is presented (haemoglobin dilution method (HDM)). It is based on a calculation of the patient's preoperative total haemoglobin content, from which losses are subtracted. The haemoglobin concentration of the blood is used as an indicator of dilution. The HDM was compared to the 131 I‐RISA technique in 10 patients undergoing transurethral resection of the prostate (TUR). The difference between the HDM and RISA in estimating the total operative procedure blood volume change was 0.03 ±0.12l (ns) with a linearity of 0.90. The blood volume changes were also predicted by a fluid balance formula. With RISA as reference, the formula had a lower precision (0.24 l) and a poorer linearity (0.65) than the HDM. The HDM did not lose in accuracy if repeated several times during the TURs or if a theoretical formula for estimation of the preoperative blood volume was used.
The psychological effects of having a contact‐person from the anesthetic staff
Authors: Elsass P. , Duedahl H. , Friis B. , Møller I. W. , Sørensen M. Bredgaard
Published: January 2009

Seventy‐four patients admitted for elective surgery completed identical questionnaires and rating scales pre‐and postoperatively. The course of anxiety was compared between patients who were either routinely informed or had contact with an anesthetic nurse available for support during the 30‐min anesthesia and surgery preparation. Comparing the results with our three other studies, it is concluded that emotional support given by a “contact‐person” is more effective than either detailed information or a tranquillizer.
Experience with an automatic external defibrillator
Authors: Jakobsson J. G. , Rehnqvist N. , Nyquist O.
Published: January 2009

One emergency ambulance serving an urban part of the greater Stockholm area was equipped with a semiautomatic defibrillator Life Pack 200 Physio Control during an 8‐month study period. The equipment advises the user whether defibrillation is required or not, and in cases of detected ventricular fibrillation, defibrillation is advised. The user then has to press a button to defibrillate through the same electrodes that record the electrocardiogram. A built‐in tape recorder was used for documentation of the underlying rhythm disturbance. In all, advice was requested 332 times. Accuracy in interpretation of ventricular fibrillation was found to be high. The sensitivity and specificity in interpretation of ventricular fibrillation were 93% and 100%, respectively. No defibrillations were performed in patients without ventricular fibrillation. All instances of ventricular fibrillation were converted to another rhythm or asystole. Seven percent of the patients with cardiac arrest caused by ventricular fibrillation survived.
Factors influencing the osmolality and the concentrations of blood haemoglobin and electrolytes during transurethral resection of the prostate
Authors: Hahn R. G. , Berlin T. , Lewenhaupt A.
Published: January 2009

Twenty patients undergoing transurethral resection of the prostate (TUR) were followed every 10 min intraoperatively as well as 1 and 2 h postoperatively with measurements of blood haemoglobin concentration (B‐Hb), serum sodium (S‐Na), serum potassium (S‐K), serum osmolality (S‐osmol), blood loss, central venous pressure and volumetric determination of the irrigating fluid absorption. Changes in B‐Hb correlated well with the sum of acetated Ringer solution given and intravascular irrigating fluid absorption. A transient decrease in S‐Na of 1–4 mmol/l followed absorptions <300 ml. With larger intravascular absorptions, three stages of dilutive changes in S‐Na and B‐Hb are described. Extravascular absorptions resulted in mild blood parameter changes at various times after their occurrence. Absorption of irrigating fluid was associated with an increase in S‐K. S‐osmol decreased in conjunction with some absorptions, although the irrigating fluid was isotonic. Postoperative analyses of blood parameters gave only limited information about intraoperative complications. The only consistent pattern was associated with intravascular irrigating fluid absorption.
Spinal analgesia with hyperbaric 0.5% bupivacaine: effects of different patient positions
Authors: Povey H. M. R. , Olsen P. Albrecht , Pihl H.
Published: January 2009

A prospective randomised study of the effect when the patient remained sitting for 2, 10, 15, 20 or 25 min, was evaluated in 50 patients (10 in each group) given a spinal anesthesia, with 4 ml 0.5% bupivacaine in 8% glucose (hyperbaric). The first period of sitting was followed by a second period in the horizontal supine position; this period ended when there was the same level of pin‐prick analgesia for 5 min. The patient was then placed in the Trendelenburg position until maximum spread was achieved. There was no difference in the spread of analgesia between the five groups at the end of each of the three periods. Between the five groups, there was no difference as to the duration of time from placing the patient in the supine horizontal position until maximum spread of analgesia (mean ± s.e. mean 12 ±2–13 ± 2 min) in this position, and from the start of the Trendelenburg position until maximum spread (mean ± s.e. mean 7.5± 1.2–9.5 ± 1.7 min). All patients except one in the 25‐min group had complete motor blockade of the lower limbs.
Total intravenous anaesthesia with midazolam and flumazenil in outpatient clinics
Authors: Ræder J. C. , Hole A. , Arnulf V. , Grynne B. Hougens
Published: January 2009

Total intravenous anaesthesia with midazolam and alfentanil, reversed with the benzodiazepine antagonist flumazenil, was studied in patients admitted for outpatient gynaecological dilatation and curettage. One hundred patients were randomly allocated to four groups with different anaesthetic techniques: I: alfentanil and thiopentone induction, 66% N2O maintenance; II: alfentanil and midazolam sedation prior to isoflurane and N2O induction and maintenance; III: midazolam and alfentanil induction; oxygen/air, placebo reversal; IV: midazolam and alfentanil induction, oxygen/air, flumazenil reversal. All methods of anaesthesia proved satisfactory with no serious side‐effects or complications. Induction was faster in Group I (26 s) compared with Group III and IV (37–38 s) and Group I (62 s). Respiration was less depressed in Group II compared with the other groups. Recovery function was better in Group IV during the first 30 postoperative min and worse in Group III during the first 120 postoperative min compared with the other groups. Reduced performances in P‐deletion and 4‐choice reaction‐time tests in the midazolam patients were not reversed by 0.5 mg flumazenil, suggesting that flumazenil did not antagonize all benzodiazepine effects in our patients. Postoperative amnesia was most pronounced in Group III. There was no significant difference in patient function 7 h postoperatively, at home in the evening or during the next days. We conclude that total intravenous anaesthesia with alfentanil and midazolam with flumazenil reversal is a promising technique for short outpatient anaesthetic procedures.
Quantification of train‐of‐four responses during recovery of block from non‐depolarising muscle relaxants
Authors: Gibson F. M. , Mirakhur R. K. , Clarke R. S.J. , Brady M. M.
Published: January 2009

Train‐of‐four (TOF) responses were assessed in 70 patients (seven groups of ten patients each) during recovery of neuromuscular block from atracurium (226 or 452 μg/kg), vecuronium (40 or 80 μg/kg), pancuronium (60 or 120 μg/kg) and tubocurarine (450 μg/kg) in order to quantify the height of T1 (first response in the TOF sequence) at which T2, T3 and T4 (2nd, 3rd and 4th response in TOF sequence) reappear. Patients were anaesthetised with thiopentone, nitrous oxide in oxygen and fentanyl. There were small but significant differences between relaxants. The clinically useful parameter, i.e. the 4th response in the TOF sequence, appeared at approximately 30% height of the first response (T1) rather than at 25% as generally believed. It is suggested that the third response in the TOF sequence, which reappeared at an average height of T1 of about 25%, be used for administration of further supplements of muscle relaxants since abdominal muscle relaxation becomes inadequate at this stage.
Persistent cardiac failure after mitral valve replacement due to free‐floating intracardiac thrombus formation
Authors: Hedenmark J. , Dubiel T. W. , Landelius J. , Lidell C. , Nyström S. O. , Tydén H.
Published: January 2009

A case of free‐floating left atrial‐ventricular thrombus early after mitral valve replacement (Carpentier‐Edwards pericardial bioprosthesis) is presented. Successful surgical removal was performed. The diagnostic and therapeutic efforts are discussed.