bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of central regional anesthesia techniques in Sweden: results of a nation‐wide survey
Authors: HOLMSTRÖM B. , RAWAL N. , ARNÉR S.
Published: January 2009

Background: Epidural and subarachnoid anesthesia are well established central regional techniques for surgical anesthesia. TWO additional techniques, combined spinal epidural (CSE) block and continuous spinal anesthesia (CSA), have recently become popular. However, data on nation‐wide use of central regional blocks are not available.

Method: With the aims to survey the use of central regional techniques, to evaluate the risk of complications to central regional blocks and to document the use of continuous epidural techniques for postoperative pain management in Sweden during 1993, a questionnaire was mailed to all 105 Swedish anesthesiology departments.

Results: Questionnaires were returned by 62 departments, representing all categories of Swedish hospitals. Central regional blocks were used for surgical anesthesia in 2040% of reported surgical procedures. Subarachnoid anesthesia was the main technique for orthopedic surgery on the lower limb, elective cesarean section and transurethral resection of the prostate. Epidural block was used for orthopedic and vascular surgery. CSE block was used by 42 departments and CSA by 21 departments. Postoperative epidural analgesia was used by 59 departments, most commonly with continuous infusion of local anesthestics and/or epidural bolusdoses of morphine. Nineteen neurological sequelae were reported after epidural (n=7) and subarachnoid (n=12) blocks. Routines for registration of complications varied greatly.

Conclusions: Subarachnoid block was preferred for shorter surgical procedures (<60 min), whereas epidural and CSE blocks were chosen when severe postoperative pain could be anticipated, as continuous epidural analgesia was well established for postoperative pain management. Improved routines for registration of complications to central regional blocks are needed.
Intravenous phentolamine test ‐ an aid in the evaluation of patients with persistent pain after low‐back surgery?
Authors: SÖRENSEN J. , BENGTSSON M.
Published: January 2009

Background: Persistent pain following surgery in the treatment of chronic low‐back pain patients is still relatively frequent. Most of these patients with persistent pain have clinical signs of neuropathic pain. The neuropathic pain might be sympathetically maintained pain (SMP) or sympathetically independent pain (SIP). Systemic administration of phentolamine, a competitive alpha‐adrenergic antagonist, has been used as a diagnostic tool to identify patients with SMP.

Methods: Thirty‐seven patients with persistent pain after low‐back surgery (lumbar laminectomy, with or without discectomi, or a posterior fusion, with or without decompression) received intravenous phentolamine (0.5 mg/kg over 30 min) in a single‐blind, placebo‐controlled manner. Prior to this infusion the patients were classified clinically into different pain groups based on physical examination and imaging findings. An opioid epi‐dural test blockade was used as a control.

Results: Clinical classification divided the patients into nocicep‐tive pain (n=7), neuropathic pain (n=22) and mixed pain (n= 8). In the phentolamine test there were only one responder, 34 non‐responders and 2 patients were placebo‐responders. In the control epidural blockade there were 11 non‐responders, 23 fen‐tanyl/local anaesthetic‐responders and 3 placebo‐responders. Conclusions: SMP is either an uncommon cause of persistent pain in this type of failed back surgery patients or the phentolamine test, as we performed it, was unable to identify SMP.
Segmental effects on motor function following different intrathecal receptor agonists and antagonists in rabbits
Authors: BORGBJERG F. M. , FRIGAST C.
Published: January 2009

Background:The occurrence of motor impairment after intrathecal drug administration is infrequently reported in the literature and the methods of determining motor function vary.

Methods:Motor function was examined in rabbits after a wide dose range of a variety of intrathecally administered opioid agonists, α‐adrenergic agonists, non‐competitive NMDA antagonists, a benzodiazepine agonist, a sigma agonist, paracetamol, isotonic and acidified saline. The opioids, sigma agonist and NMDA antagonists were additionally examined following pre‐treatment with naloxone. The opioid antagonists naltrindole and MR2266 (δ‐ and K‐opioid receptor antagonists, respectively) were administered before the δ agonist and the K agonist. The δ adrenergic antagonist yohimbine was given before administration of dexmedetomidine and xylazine. Motor function was evaluated by a five‐point scale of motor impairment ranging from normal function to total paralysis of the hindlegs.

Results:DPDPE (δ agonist), paracetamol, naloxone, naltrindole, yohimbine, isotonic and acidified saline did not affect motor function. MR2266 produced minor motor impairment. The α‐adrenergic agonist dexmedetomidine reduced motor function slightly and dose independently. The remaining compounds affected motor function in a dose‐dependent fashion. High doses of morphine produced hypersensitivity and myoclonus. An irreversible paralysis of the hindlegs was observed following intrathecal administration of the sigma agonist SKF10047 in high doses. Naloxone and MR2266 attenuated the effects of U50488H (K agonist).

Conclusion:The present results reveal a dose‐dependent reduction in motor function after intrathecal administration of some of the investigated compounds. The mechanisms behind these effects appear to be multifactorial.
Bupivacaine does not suppress cardiac sympathetic nerve activity during halothane anesthesia in the cat
Authors: NISHIKAWA K. , TERAI T. , MONMOTO O. , YUKIOKA H. , ASADA A.
Published: January 2009

Background:The finding that IV lidocaine suppresses cardiac sympathetic nerve activity during 1 MAC halothane, but not during 2 MAC or 3 MAC halothane, suggests that the neurally mediated circulatory effects of IV local anesthetics may vary with background autonomic activity. This study aimed to compare the effects of IV lidocaine and bupivacaine on cardiac sympathetic nerve activity (CSNA) during normal and high levels of CSNA.

Methods:Cats were anesthetized with halothane and allocated to three groups. In groups I‐L and I‐B, sympathetic hyperactivity was induced by electrical stimulation of the posterior hypothala‐mus. CSNA, heart rate and mean arterial pressure were then measured before and after administration of lidocaine 2 mgkg BW‐lIV (Group I‐L, n=7) or bupivacaine 0.5 mgkg BW‐1IV (Group I‐B, n=7) during 1% halothane anesthesia. In Group II (n=7), following administration of bupivacaine 0.5 mgkg BW‐1IV, CSNA, sinus cycle length (SCL), and subintervals of atrio‐ventricular conduction time (A‐H, H‐V, and H‐S) at pacing were measured during O.8%, 1.6% and 2.4% halothane anesthesia without sympathetic hyperactivity.

Results:Lidocaine suppressed CSNA hyperactivity and tachycardia significantly in Group I‐L, but bupivacaine did not do so in Group I‐B. In Group 11, bupivacaine did not affect CSNA at any concentrations of halothane, but lengthened SCL, A‐H, H‐V and H‐S intervals significantly at each concentration of halothane.

Conclusions:We conclude that IV bupivacaine, unlike IV lidocaine, does not suppress CSNA during either normal or high CSNA under halothane anesthesia although IV bupivacaine has stronger depressive effects on cardiac conduction than does IV lidocaine during deep halothane anesthesia.
The effect of patient positioning on dynamic lung compliance
Authors: TANSKANEN P. , KYNA J. , RANDELL T.
Published: January 2009

Background: Side‐stream spirometry offers a non‐invasive method to monitor continuously respiratory mechanics in intubated patients. We studied the effects of different positions on dynamic lung compliance during anaesthesia.

Methods: The study consisted of 56 patients, operated in supine, prone, kneeling or lateral park‐bench position. Dynamic lung compliance and inspiratory peak pressure were recorded after induction of anaesthesia, 15 min and 1 h after posturing the patient.

Results: The first measured compliances were comparable in all groups. The compliance in the lateral and the prone positions was significantly lower than in the supine position at 15 min (P < 0.01) and 1 h (P < 0.001) after the posture change. The peak inspiratory pressure was significantly lower in the kneeling position than in the other groups (P < 0.01 at the first measurement, P < 0.001 at the later measurements). No correlation was found between body mass index and compliance.

Conclusion: We found that dynamic lung compliance decreased significantly upon change of posture from supine to lateral or prone position, whereas in the kneeling position no change in compliance was observed. We suggest that the kneeling position might be preferable to the prone position.
The effect of acute normovolemic hemodilution on homologous blood requirements and total estimated red blood cell volume lost
Authors: KAHRAMAN S. , ALTUNKAYA H. , ÇELEBÍOǧLU B. , KANBAK M. , PASLAOLU ÎI. , ERDEM K.
Published: January 2009

Background:Acute normovolemic hernodilution combined with retransfusion is one of the various techniques proposed to avoid homologous blood transfusion in cardiac surgery. The purpose of the present paper is to study the effect of the volume of autologous blood collected pre‐cardiopulmonary bypass (CPB) on homologous blood requirements and total estimated red blood cell (RBC) volume lost in coronary artery bypass grafting (CABG) surgery.

Methods:Following induction of anesthesia, sequestration of one (5–8 ml/kg; Group I, n=14) or two units (12–15 ml/kg; Group 11, n=14) of fresh autologous blood was performed under electrocardiographic and hernodynamic control. Group III (n= 14) was designated as the control group. Autologous blood was reinfused at the conclusion of CPB.

Results: The use of homologous blood in the study groups was significantly less than in the control group. High‐volume phlebotomy did not make a significant difference in the requirement of the homologous blood, while causing a mild increase in the total estimated RBC volume lost. No significant differences could be demonstrated in preoperative, post‐CPB and discharge hematocrit levels and postoperative blood drainage between the groups.

Conclusion:Acute intraoperative hemodilution with high‐ and low‐volume phlebotomy reduced the homologous blood requirements similarly regardless of the amount of phlebotomy.
Maintained cardiac output during positive end‐expiratory pressure ventilation in open‐chest pigs
Authors: BERGLUND J. E. , HALDÉN E. , JAKOBSON S.
Published: January 2009

Background:Does ventilation with positive end‐expiratory pressure (PEEP) act to reduce cardiac output (CO) not only by impeding venous return but also by inducing myocardial depression? The present study was aimed to demonstrate the possible existence of this latter mechanism.

Methods:Eight pigs of Swedish native breed weighing 20–25 kg and 10–12 weeks old were anaesthetized, tracheotomized and connected to a volume‐controlled ventilator. To prevent intra‐thoracic pressure from interfering with venous return, the heart and juxtacardiac vessels were exposed to atmospheric pressure by opening and retracting the chest and pericardium. Heart rate (HR), CO, stroke volume (SV), mean arterial (MAP), mean right (MRAP) and left (MLAP) atrial pressures were recorded before and after retransfusion of 500 ml of autologous blood. This procedure was carried out twice in each animal ‐ during ventilation with zero and with 15 cm H2O of PEEP.

Results:Comparison of the two ventilation modes before volume load revealed negligible differences in HR, CO, SV, MAP, MRAP and MLAP. Moreover, the changes evoked by volume load were practically identical.

Conclusions:Addition of PEEP to regular positive pressure ventilation does not induce any haemodynamically detectable myocardial depression in the piglet.
Amrinone improves lung compliance in patients receiving mechanical ventilation for cardiogenic pulmonary edema
Authors: TAKEDA S. , TAKANO T. , NAKANISHI K. , NEJIMA J. , TAKAYAMA M. , KIM C. , OGAWA R.
Published: January 2009

Background: Decrease in lung compliance is one of the major causes of respiratory failure. We investigated whether amrinone could improve lung compliance.
A survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists
Authors: RANTA S. , HYNYNEN M. , TAMMISTO T.
Published: January 2009

Background:The American Society of Anesthesiologists' (ASA) Classification of Physical Health is a widely used grading system for preoperative health of the surgical patient. In previous studies conducted in North America and Great Britain, considerable variation in the ASA classification allocation has been reported. We hypothesised that in smaller and culturally more homogeneous countries there might be less variation in the ASA classification.

Methods: A postal questionnaire depicting 10 hypothetical patient cases was sent to 249 randomly selected members of the Finnish Society of Anaesthesiologists. Responses of anaesthesiologists working in university teaching and non‐teaching hospitals were compared, as well as the answers of specialists and non‐specialists.

Results: Responses were received from 108 anaesthesiologists (response rate 43%). There was marked variation in the classification of all the 10 cases: 1 case was classified to all five possible grades (ASA grades I‐V). In 2 cases, there was significant variation between anaesthesiologists working in university teaching and non‐teaching hospitals. There was no difference in the grading between specialist and non‐specialist anaesthesiologists.

Conclusion:In a small and culturally homogeneous country, like Finland, there exists similar wide variation in the ASA classification as has been previously reported from larger and culturally more heterogeneous countries. The significant variation should always be considered when using this classification in clinical or scientific work.
Large increase in cardiac output in a patient with ARDS and acute right heart failure during inhalation of nitric oxide
Authors: BENZING A. , MOLS G. , BEYER U. , GEIGER K.
Published: January 2009

Background Inhaled nitric oxide (NO), a selective pulmonary vasodilator, reduces pulmonary artery pressure in patients with acute respiratory distress syndrome (ARDS). In spite of the reduction of right ventricular afterload, the effect of NO on cardiac output remains unclear.

Methods:A patient with ARDS and echocardiographically determined severe acute right heart failure was treated with increasing concentrations of inhaled nitric oxide (NO). Haemo‐dynamic and gas exchange variables were determined for each concentration of NO. NO treatment was continued for 3 days.

Results:During initial right heart failure, administration of NO: resulted in a large increase (32%) in cardiac output in a dose‐dependent manner. When right ventricular function had improved, inhalation of NO did not increase cardiac output.

Conclusion: Our observations suggest that inhalation of NO is likely to increase cardiac output in ARE when severe acute right heart failure is present.
Reversal of multiorgan system dysfunction in sickle cell disease with plasma exchange
Authors: GEIGEL E. J. , FRANCIS C. W.
Published: January 2009

A 23–year‐old man with sickle cell anemia and multiorgan system dysfunction was treated with plasma exchange during a sickle cell crisis. The patient failed to respond to conventional treatment including hydration, blood transfusions, broad spectrum antibiotics, supplemental oxygen, and analgesics. The clinical picture resembled thrombotic thrombo‐cytopenic purpura (TTP), and the patient responded dramatically to plasma exchange with reversal of a rapidly deteriorating clinical state. This case illustrates possible similarities in the pathophysiology of TTP and sickle cell crisis, and the value of plasma exchange in related critical disease states.
The combination of external high‐frequency oscillation and pressure support ventilation in acute respiratory failure
Authors: TAKEDA S. , NAKANISHI K. , TAKANO T. , NEJIMA J. , TAKAYAMA M. , OGAWA R.
Published: January 2009

Background: Effective gas exchange can be maintained in animals by using external high‐frequency oscillation (EHFO). The present study evaluates the effect of relatively long‐term duration EHFO combined with pressure support ventilation (PSV) in patients with acute respiratory failure.

Methods: Twelve patients were ventilated with EHFO combined with PSV for 8 h at 60 oscillations min‐1, with a cuirass pressure of 36 cm H2O: ‐26 to +10 cm H2O (27 mm Hg: ‐19.5 to +7.5 mm Hg) and an inspiratory‐to‐expiratory ratio of 1: 1. Blood gas values and hemodynamic parameters were measured. Results: Significant increases were noted in cardiac index (3.0±0.7 to 3.2±0.7 1 min‐1 m‐2, P < 0.05) and stroke volume index (32±14 to 35±13 ml m‐2, P < 0.05) without changes in pulmonary artery wedge pressure at 1 h after EHFO. PaO2(kPa)/FiO2 and PaCO2 improved from 21.9±7.5 to 26.8±8.0 (P < 0.05) at 2 h and from 6.9±1.7 to 6.1±0.9 kPa (P < 0.01) at 30 min after EHFO, respectively. Breath sounds could be heard well throughout the lung fields after institution of EHFO. The mucous rales also decreased.

Conclusions: As a method of ventilation for patients with acute respiratory failure, EHFO combined with PSV may have potential advantages over conventional mechanical ventilation when drainage of secretions is facilitated. Beneficial effects of EHFO may appear after several hours.
Atrial natriuretic peptide and N‐terminal atrial natriuretic peptide in plasma reflect right ventricular volumes following coronary artery surgery
Authors: HONKONEN E. L. , KAUKINEN L. , PEHKONEN E. J. , KAUKINEN S.
Published: January 2009

Background: Atrial natriuretic peptide (ANP) and the more stable N‐terminal fragment (N‐ANP) of prohormone are peptides, released in equimolar amounts from cardiac myocytes in response to atrial stretch or ventricular overload and myocardial ischaemia. Protection of the right ventricular (RV) myocardium during ischaemia in cardiac surgery is difficult, especially in patients with severe right coronary artery (RCA) disease. This prospective study was designed to ascertain a possible relationship between changes in plasma ANP/N‐ANP concentration and RV function in RCA‐diseased patients.

Methods: Plasma ANP and N‐ANP concentrations and RV function, measured by fast‐response thermodilution, were determined serially in 15 patients with total RCA stenosis and in another 15 with no significant RCA disease (controls) before, during and after coronary artery surgery.

Results:The RV ejection fraction was lower and the RV end‐systolic volume index higher in the RCA‐diseased patients than in the controls (P < 0.05) on the second postoperative day, and both ANP and N‐ANP were higher in the RCA patients (P < 0.05) from 6 h after cardiopulmonary bypass till the second postoperative day. At the same time the changes in N‐ANP concentrations from the levels before induction of anaesthesia correlated with RV ejection fraction and RV volume indexes, but not with heart rate or parameters indirectly reflecting left‐sided loading. Right atrial pressure did not differ between the groups nor did it increase significantly during the study.

Conclusions:The relationships found between N‐ANP and RV volume indexes and RV ejection fraction suggest ventricular expression of ANP: ANP release may be stimulated by RV distension, the more so the poorer the RV function.
Mivazerol, a new α2‐adrenergic agonist, blunts cardiovascular effects following surgical stress in pentobarbital‐anesthetized rats
Authors: ZHANG X. , WÜLFERT E. , HANIN I.
Published: January 2009

Background:Mivazerol is a new and selective α2‐adrenoceptor agonist, devoid of hypotensive effects, which has been designed to prevent adverse cardiac outcome in perioperative patients with, or at risk of coronary artery disease.

Methods:In the present study, the effects of mivazerol on hemodynamic changes induced by trachea‐exposure surgery stress were investigated in pentobarbital‐anesthetized rats, and compared to those of dexmedetomidine.

Results:Intravenous infusion of 3 different doses of mivazerol (3.75, 7.5 and 15 μg kg‐1 h‐1) did not significantly alter BP but caused a dose‐related decrease in HR. The maximal decrease in HR was approximately 87 beats/min. Contrary to mivazerol, dexmedetomidine (7.5 μg kg‐1 h‐1, i.v.) decreased both BP (11±3.2 mmHg) and HR. The maximum decrease in HR was approximately 104 beats/min. Surgical stress produced a rapid increase in BP (maximal increase of 50 mmHg) and HR (maximal increase of 100 beats/min), which lasted for at least 15 min. Constant infusion of mivazerol, at a dose of 15 μg kg‐1 h‐1, beginning 20 min prior to surgery and lasting for 35 min, significantly inhibited surgical stress‐induced increases in BP (P < 0.05) and HR (P < 0.001). Dexmedetomidine, at a dose which produced hypotension and profound bradycardia prior to surgery, did not have any effect on the surgical stress‐induced elevation in BP (P>0.05), but prevented the increase in HR (P < 0.05). Pretreatment with the α2‐adrenoceptor antagonist rau‐wolscine (0.5 mg/kg, i.v.) blocked the bradycardia induced by mivazerol as well as the inhibitory effect of mivazerol on surgical stress‐induced elevations in HR and BP.

Conclusion:Mivazerol attenuates surgical stress‐induced elevations in BP and HR during pentobarbital anesthesia in rats, and these effects are mediated by stimulation of α2‐adrenoceptors. Unlike dexmedetomidine, mivazerol does not reduce BP, and is also more potent than dexmedetomidine in blunting surgical stress‐induced increases in BP in pentobarbital‐anesthetized rats.
Impedance cardiography in cardiac surgery patients: abnormal body weight gives unreliable cardiac output measurements
Authors: VAN DER MEER B. J. M. , VRIES J. P. P. M DE , SCHREUDER W. O. , BULDER E. R. , EYSMAN L. , VRIES P. M. J. M. DE
Published: January 2009

Background: To study the accuracy of cardiac output measurement by means of Electrical Impedance Cardiography (EIC) in post‐cardiac surgery patients.

Methods: In a prospective study, we compared cardiac output measurements by means of thermodilution (COTD) with impedance cardiographic‐derived values (COEIC) in 37 mechanically ventilated patients after cardiac surgery. Both methods were used simultaneously.

Results: COEIC values were weakly correlated with COTD in the total group when the equation of Sramek‐Bernstein was employed to calculate COEIC (r=0.60, P < 0.001, mean difference and standard deviation: ‐0.06±1.25 l‐min‐1). After exclusion of the 12 patients whose body weight differed >15% from their ideal body weight, no significant difference was found between the mean values (5.40±1.80 l‐min‐1 (COEIC) vs 5.31±1.69 l‐min‐1, n=25) while the correlation coefficient increased substantially (r=0.85, P < 0.001, mean difference and standard deviation: 0.09±0.96 l‐min‐1).

Conclusions: The results of this study indicate that weight is a very important factor in unreliable measurement of CO by impedance cardiography in cardiac surgery patients. The calculation equation as proposed by Sramek and Bernstein is not accurate enough in patients with more than 15% of weight deviation. Therefore, the use of impedance cardiography in these patients is of limited value until an accurate correction factor has been developed.
Complement partially mediates acid aspiration‐induced remote organ injury in the rat
Authors: YAMADA H. , KUDOH I. , NISHIZAWA H. , KANEKO K. , MIYAZAKI H. , OHARA M. , OKUMURA F.
Published: January 2009

Background:Acid aspiration into one lung is known to cause both a local as well as remote organ injury characterized by neutrophil sequestration and subsequent edema. This study investigated the role of the complement cascade in the development of acid aspiration‐induced local lung and remote organ injuries using K‐76 COONa (K76), an anticomplement agent that inhibits the complement pathway at the C5 step, and its usefulness as a treatment drug.

Methods: Anesthetized rats underwent tracheostomy and insertion of a cannula. K76 was intraperitoneally administrated prior to or immediately after the instillation of 0.1 ml of HC1 (0.1N) or phosphate buffer solution (PBS) into the left lung. Inflammatory responses were evaluated by tumor necrosis factor a (TNFa) in the plasma and the bronchoalveolar lavage fluid (BALF) (n=4), tissue myeloperoxidase (MPO), wet‐to‐dry weight ratio (W/D ratio)(n=6), and protein concentration in the BALF (n=6).

Results: Acid instillation caused an increase in the plasma TNFa, which was significantly attenuated by the administration of K76 prior to or after the acid instillation. Acid instillation to the left lung resulted in an increase of MPO and W/D ratios of the left lung, the right lung, and the small intestine. The administration of K76 inhibited the increase of MPO in these organs. K76 inhibited the increase of W/D ratios of the right non‐in‐stillated lung and the small intestine. Acid instillation led to increased protein concentration in the BALF of the left lung, which was not inhibited by K76. K76 administrated after the acid instillation had the same effects. TNFa in the BALF was not detected in all groups.

Conclusion:These results suggest that localized acid aspiration induces, through the C5a step of the complement system‐dependent mechanisms, TNFa formation and neutrophil sequestration, which caused the increase of endothelial permeability of the systemic organs. K76 is effective as a treatment drug in modulating some of the injuries caused by the acid instillation, but further investigation is warranted as to its potential as a therapeutic agent.
Central cardiovascular and oxygen variables during haemorrhage in the pig
Authors: KRANTZ T. , SZTUK F. , SWIATEK F. , JACOBSEN J. , SECHER N. H.
Published: January 2009

Background:We evaluated the ability of the standards issued by the Danish Society of Anaesthesiologists to reflect a blood loss.

Methods:In 9 pigs bled (0–24 ml kg‐1) and retransfused (to 28 ml kg‐1) during halothane anaesthesia, central cardiovascular, thoracic electrical impedance (TI), oxygen, acid‐base and temperature variables were recorded.

Results: With the recommendation for minor surgery (mean arterial pressure (MAP) and heart rate (HR)), the correlation to the blood loss was 0.74 (P < 0.001) and with that for major surgery (MAP, HR, central venous pressure (CVP) and rectal temperature (Tempr)) it was 0.79 (P < 0.001). With the recommendation for extensive surgery (MAP, HR, CVP, pulmonary artery catheter variables and the central‐peripheral temperature difference (ΔTempr‐t)), the correlation was 0.84 (P < 0.001). Non‐invasive monitoring (MAP, HR, ΔTempr‐t TI and near‐infrared spectroscopy of the brain (SinvosO2)) was only slightly better than basal monitoring (r=0.76, P < 0.001). However, adding arterial base excess (BE), TI and peripheral temperature (Tempt) to the recommendation for major surgery resulted in a correlation of 0.87 (P < 0.001), while adding BE and TI to the recommendation for extensive surgery raised correlation to only 0.88 (P < 0.001).

Conclusion:When the recommendations were followed the correlation to the blood loss ranged from 0.74–0.84. However, with the recording of MAP, HR, CVP, ΔTempr‐t, BE and TI a correlation of 0.87 was achieved, indicating that a pulmonary artery catheter may not be in need for patients undergoing surgical procedures with expected haemorrhage.
Serum soluble selectins in patients undergoing cardiopulmonary bypass. Relationship with circulating blood cells and inflammation‐related cytokines
Authors: DIAGO M. C. , GARCÍA‐UNZUETA M. T. , MARCANO G. , MERINO J. , SALAS E. , AMADO J. A.
Published: January 2009

Background:Membrane‐bound selectins mediate the adhesion among leukocytes, platelets and endothelial cells, while circulating (soluble) selectins may function as competitive inhibitors of them. Open heart surgery is known to induce activation of these cells.

Methods: We studied the acute responses of soluble selectins, circulating blood cells and inflammation‐related cytokines in 12 patients undergoing elective open heart surgery with cardiopulmonary bypass. Serial blood samples were withdrawn before, during and after surgery.

Results: Serum soluble E‐selectin concentrations did not change significantly during all the perioperative period. In contrast, P‐selectin decreased after the initiation of cardiopulmonary bypass and remained low until the end of surgery. L‐selectin showed a similar course. A decrease in platelet count and albumin was found during the perioperative period and an increase in leukocyte count was found after cardiopulmonary bypass. Clear elevations in circulating IL (Interleukin)‐6, IL‐8, and IL‐10 were found after the end of surgery, while IL‐12 levels remained undetectable.

Conclusions: While serum inflammatory cytokines clearly rise in response to open heart surgery, soluble selectins do not change (E) or decrease (P and L). Correcting for haemodilution, E‐selectin rises postoperatively, but the decrease in P‐ and L‐selectins is not explained by haemodilution.
Comparison of body temperature changes during laparoscopic and open cholecystectomy
Authors: MÄKINEN M.‐T.
Published: January 2009

Background: Prevention of hypothermia during abdominal surgery by insulating or heat‐transferring methods has been the subject of numerous investigations. This study approaches the problem from a less discussed point of view, i.e. the effect of different surgical techniques on body temperature changes.

Methods: Body temperature was measured at 3 core and 6 skin points in 40 patients scheduled for cholecystectomy through open laparotomy or laparoscopy with pneumoperitoneum created and maintained with unwarmed carbon dioxide (CO2) insufflation. End‐tidal CO2 was kept constant by adjustments of respiratory frequency. Anaesthesia, intravenous infusions, and draping of the patients were standardized.

Results: During the first 1 h of anaesthesia core temperatures decreased approximately by 0.7˚C and distal skin temperatures increased by 7˚C in both groups. At the end of surgery heat balance was similar in both groups. An increase of 2.5 1 min‐1 in respiratory minute volume was needed to control end‐tidal CO2 levels in the laparoscopy group during pneumoperitoneum, which was maintained with a CO2 flow of 1.2 l‐min‐1 through the abdominal cavity.

Conclusion:Laparoscopic technique with unwarmed carbon dioxide insufflation does not offer any advantage in terms of body temperature changes when compared to open surgery.
Granisetron reduces incidence of nausea and vomiting after breast surgery
Authors: FUJII Y. , TANAKA H. , TOYOOKA H.
Published: January 2009

Background: Postoperative nausea and vomiting (PONV) remains a troublesome problem. This study was performed to evaluate the antiemetic efficacy of prophylactic granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, on the incidence of PONV in patients undergoing general anaesthesia for breast surgery.

Methods: In a randomized, placebo‐controlled, double‐blind study, 50 female patients, 45–68 years, were given a single dose of either placebo (saline, n=25) or granisetron (40 ug kg‐1, n= 25) intravenously over 2–5 min immediately before the induction of anaesthesia. Postoperatively, during the first 24 hours after anaesthesia, the incidence of PONV and adverse events was recorded.

Results: The treatment groups were similar for patient demographics, types of surgery, anaesthetic and postoperative management. Postoperatively, the incidence of PONV was 48% and 16% after administration of placebo and granisetron, respectively (P < 0.05). No differences in the incidence of other adverse events were observed between the two groups.

Conclusion: Granisetron is an effective antiemetic for preventing PONV in patients undergoing general anaesthesia for breast surgery.
Serum potassium concentrations after suxamethonium in patients with familial amyloid polyneuropathy type I
Authors: VIANA J. S. , NEVES S. , VIEIRA H. , BENTO C. , PERDIGOTO R. , FURTADO A. L.
Published: January 2009

Background:Suxamethonium produces an abnormal increase in serum potassium in some neurological diseases and some authors have suggested that it is safer not to use this drug in patients with familial amyloid polyneuropathy (FAP). However, there are no data previously reported to support this hypothesis. The aim of this study was to evaluate the magnitude of the potassium increase produced by suxamethonium in FAP type I.

Method: Twenty‐one FAP Met 30 patients anaesthetised for liver transplantation were studied. Age was 34.9±6.9 years (mean± SD), time elapsed from first symptom 5.5 ±3.2 years and weight was 14±9% below ideal body weight. Anaesthesia was induced with thiopentone and low‐dose fentanyl. Samples for blood gas and electrolytes analyses were drawn before induction and 1 and 5 min after 1 mg/kg of suxamethonium was given for tracheal intubation.

Results: Before induction serum potassium levels were 3.8±0.4 mmol/L. One minute after suxamethonium, values were 3.8±0.4 mmol/L and 5 min after 4.3±0.5 mmol/L. The maximal increase observed was 1.6 mmol/L (from 3.4 mmol/L to 5.0 mmol/L).

Conclusion:The average increase in plasma potassium concentrations observed in FAP patients after suxamethonium was similar to the increase observed in a normal population by others. Our study can exclude the hypothesis that an anomalous increase in potassium would be a typical and frequent response to suxamethonium in FAP Met 30 patients. However, we cannot exclude that a dangerous rise in serum potassium may exist in a certain percentage of FAP patients.
The effect of halothane on mivacurium infusion requirements in adult surgical patients
Authors: KANSANAHO M. , OLKKOLA K. T.
Published: January 2009

Background: The extent of interaction between volatile anaesthetics and neuromuscular blocking agents depends both on the inhalational anaesthetic and the muscle relaxant. Halothane has the weakest potentiating effect on neuromuscular blocking drugs and previous studies of the interaction between halothane and mivacurium have been contradictory. We were interested in determining the effect of different levels of halothane‐nitrous oxide anaesthesia on infusion requirements of mivacurium.

Methods: Sixty adult surgical patients were studied. Anaesthesia was induced with thiopentone and fentanyl and intubation facilitated with mivacurium 0.15 mg kg‐1. The patients were randomly assigned to one of four study groups. The control group received nitrous oxide in oxygen (2: 1) supplemented with fentanyl, while in the other groups halothane was administered at different end‐tidal concentrations: 0.19% (Group 2), 0.37% (Group 3), 0.74% (Group 4), corresponding to 0.25, 0.5 and 1.0 MAC of halothane. Neuromuscular block was kept at 95% with a closed‐loop feedback infusion of mivacurium and monitored with electromyography. Plasma cholinesterase concentrations and dibucaine numbers were determined.

Results:Mivacurium infusion requirements (mean±SD) were 7.5±3.1 μg kg‐1 min‐1 with nitrous oxide‐fentanyl anaesthesia. In the groups receiving 0.25, 0.5 or 1.0 MAC of halothane the steady‐state infusion rates of mivacurium were reduced to 6.3±2.8, 5.6±1.4 and 5.7±2.5 μg‐kg‐1min‐1 (P < 0.05), respectively. There was a linear relationship between mivacurium infusion requirements and plasma cholinesterase activity.

Conclusion: Halothane anaesthesia reduces mivacurium infusion requirements by 15–25% compared to nitrous oxide‐fentanyl anaesthesia. Interindividual differences in the extent of this interaction are great.
In vivo effects of halothane, enflurane, and isoflurane on hepatic sinusoidal microcirculation
Authors: GRUNDMANN U. , ZISSIS A. , BAUER C. , BAUER M.
Published: January 2009

Background: It has been proposed that halogenated anaesthetics interfere with the endothelium‐dependent circulatory control by attenuating the effects of endothelium‐derived relaxing factor (EDRF/NO). This study was designed to determine whether or not volatile anaesthetics in vivo influence the microvascular tone in hepatic sinusoids.

Methods: Using epifluorescence videomicroscopy, we compared the effects of the volatile anaesthetics halothane, enflurane, and isoflurane on hepatic microcirculation in ventilated Lewis rats. Animals were initially anaesthetized with pentobarbitone (50 mg‐kg‐1 i.p.) to allow instrumentation and laparotomy and were randomly allocated to one of 4 groups (n=5–6 each) to receive either a supplementary dose of i.v. pentobarbitone (25 mg kg‐1; control group) or 0.75 MAC halothane, enflurane or isoflurane (1.5 MAC h).

Results: Halothane decreased significantly the volumetric blood flow as compared with isoflurane (P < 0.05) or pentobarbitone controls (P < 0.05). The decrease in sinusoidal blood flow caused by halothane was largely attributable to a decrease in sinusoidal diameter (P < 0.05), while red blood cell velocity remained unchanged. Isoflurane led to a significant decrease in sinusoidal width compared with controls (P < 0.05) but an increase in red cell velocity offset the effect of sinusoidal narrowing on volumetric blood flow, while enflurane had no significant effect on any of the measured parameters.

Conclusion:This study provides the first direct evidence that the volatile anaesthetics halothane and isoflurane in vivo shift the hepatic microvascular tone toward a more constricted state; however, flow velocity is enhanced with isoflurane, offsetting this effect. As a result the volumetric flow is at least affected by isoflurane, then enflurane and most significantly by halothane. Furthermore, our data are consistent with the concept that volatile anaesthetics in clinically relevant concentrations may influence the balance between endothelium‐derived vasoactive factors which control microvascular tone.
Lidocaine‐induced hemodynamic effects are enhanced by the inhibition of endothelium‐derived relaxing factor in dogs
Authors: TOYOYAMA H. , YUKIOKA H. , HAYASHI M. , TATEKAWA S. , FUJIMORI M.
Published: January 2009

Background:Lidocaine has been shown to have direct vasoconstrictive effects at low concentrations. Since lidocaine inhibits endothelium‐dependent vasodilationin vitro, the vasoconstrictor effect of lidocaine may be due to inhibition of endothelium‐derived relaxing factor(EDRF/NO). Therefore, the current study was designed to determine the effects of NG‐nitro‐L‐arginine (L‐NNA), a potent inhibitor of nitric oxide synthase, on systemic and pulmonary hemodynamics during lidocaine infusion.

Methods:Systemic and pulmonary hemodynamic effects of lidocaine infusion, 1 mg kg‐1min‐1, for 10 min were measured in dogs anesthetized with 1% halothane in oxygen. Dogs were studied twice with an interval of 1 week in a cross‐over study, and were assigned to one of two groups that received saline or L‐NNA intravenously in group 1 (n=8), or L‐NNA or L‐NNA+L‐arginine which reverses the nitric oxide synthesis inhibitor effect of L‐NNA, intravenously in group 2 (n=8) prior to lidocaine infusion. The free serum concentration of and protein‐binding ratio for lidocaine were measured.

Results:With saline pretreatment in group 1, lidocaine infusion significantly decreased cardiac index (CI) and significantly in‐

Conclusion:In contrast toin vitrostudy, vasoconstrictor effect of lidocaine is enhanced when a capacity for compensatory vasodilation including EDRF/NO pathway is exhausted in halo‐thane‐anesthetized dogs.
2‐chloroprocaine antagonism of epidural morphine analgesia
Authors: KARAMBELKAR D. J. , RAMANATHAN S.
Published: January 2009

Background: 2‐chloroprocaine (2‐CP) used for lumbar epidural anesthesia (LEA) reportedly decreases the efficacy of epidural morphine (EM) administered for post‐cesarean section (CS) analgesia. The amount of supplemental i.v. morphine self‐administered by the patient via the patient‐controlled analgesia device (PCA) is used to study the interaction between EM and 2‐CP.

Methods: Forty‐two patients scheduled for elective CS were randomly divided into 3 equal groups, and received 2‐CP, 2‐CP+epinephrine (Epi, 5 μg ml‐1) or 2% lidocaine (Lido) with Epi for LEA. All patients received 5 mg EM and i.v. PCA morphine for postoperative pain. Cumulative amount of i.v. morphine used in the first 24 hours as well as the amount of the drug used during each 2‐h period were noted. Nonparametric analysis of variance and Chi‐squared analysis were used for statistical comparisons.

Results: The mean cumulative 24‐h i.v. PCA morphine requirement in the 2‐CP, 2‐CP+Epi and Lido+Epi groups respectively was 20.5±24, 33.1.5±27 and 4.07±6.3 (mean±SD). The Lido+Epi group used significantly less morphine (P = 0.01) compared to either of the 2‐CP groups with no significant difference between the 2‐CP groups. The maximum i.v. PCA morphine use occurred in the first 4 hours following surgery in all three groups.

Conclusion: Analgesic efficacy of EM is decreased when 2‐CP is used for LEA compared to when Lido+Epi is used.
Time course of subjective pain ratings, and wound and leg tenderness after hysterectomy
Authors: MØINICHE S. , DAHL J. B. , ERICHSEN C‐J. , JENSEN L. MEINERT , KEHLET H.
Published: January 2009

Background: Little information is available on time course of wound tenderness and relationship to subjective pain ratings following surgery. Furthermore, it is not clarified whether surgical procedures may induce hyperalgesia to mechanical stimulation outside the area of the surgical incision. We have therefore assessed postoperative pain and pressure pain thresholds (PPT) adjacent to and remote from the surgical incision in 16 patients undergoing hysterectomy.

Methods: Pressure pain threshold was assessed with pressure algometry preoperatively, 4 and 6 h and 1, 4 and 8 d after surgery on the abdominal wall 0.5, 5, 10 and 15 cm perpendicular to the wound, and on the anterior surface of the left thigh and tuberositas tibia. Furthermore, pain was assessed on a visual analogue scale (VAS) at rest and during cough.

Results: PPT decreased significantly 0.5, 5, 10 and 15 cm from skin incision up to 96 h after surgery (P < 0.01) with a trend towards higher PPT with increasing distance from the wound. There was no significant changes in PPT on the thigh or the tuberositas tibia (P = 0.49 and P = 0.12) and no correlation be tween changes in PPT near the wound and in remote areas (the legs) (Rs=‐0.082, P = 0.44 and Rs=‐0.0664, P = 0.53, respectively). VAS at rest increased from 4 to 24 h and the cough values, remained elevated throughout the study (P < 0.05). An inverse relationship was observed between PPT 5 cm from the incision and VAS at rest (Rs=‐0.406, P = 0.0002) and during cough (Rs=‐0.398, P = 0.0002).

Conclusion: These results indicate that wound pressure algometry correlates to postoperative pain at rest and during movement and may be an alternative way of assessing wound pain and tenderness. Increased tenderness to mechanical stimulation remote from the surgical wound could not be demonstrated.
Nasal turbinate dislocation caused by nasotracheal intubation
Authors: DOST P. , ARMBRUSTER W.
Published: January 2009

A case of nasal turbinate dislocation secondary to nasotracheal intubation is presented.
Uptake of inhaled nitric oxide in acute lung injury
Authors: WESTFELT U. NATHORST , LUNDIN S. , STENQVIST O.
Published: January 2009

Background: Despite the widespread use of inhaled nitric oxide (NO), little is known of its pulmonary uptake in patients with acute respiratory failure.

Methods: Fourteen patients with acute lung injury (ALI) and ongoing NO therapy were studied. Three doses of NO (5, 10 and 40 ppm) were given for 20 min and at each dose level the following parameters were recorded: minute ventilation, inspiratory NO cone, mixed expired NO cone, end‐tidal NO cone, mixed expired CO2 cone, end‐tidal CO2 cone and arterial CO2 tension. Total uptake was calculated and correlated to the total amount of NO inhaled, the amount of NO administered to the alveolar space, and the amount of NO administered to the perfused alveolar space.

Results: About 35% of the total amount of NO delivered is taken up by the lungs, 70% of NO administered to the alveolar space is taken up, and 95–100% of the NO administered to perfused alveolar space is taken up. The size of the alveolar dead space varied between 10 and60% of the alveolar space. At 40 ppm of inhaled NO there was no difference between inspired and mixed expired NO2 concentration, indicating that there is no significant NO2 formation taking place in the lungs during NO inhalation at the concentrations studied.

Conclusions: Practically all NO administered to the perfused alveolar space is taken up. The total uptake differs from that of healthy persons probably because of differences in the alveolar dead space.
Vitamin A exerts potential therapeutic effects in the endotoxaemic pig
Authors: ERIKSSON M. , LUNDKVIST K. , LARSSON A. , NELSON D. , SALDEEN T. , DROTT P. , ERIKSSON O.
Published: January 2009

Background: Pretreatment with an injection of vitamin A has beneficial effects on cardiac and pulmonary functions in normally bred endotoxaemic pigs. The present study was performed in order to elucidate whether the response of an ongoing infusion of E. coli can be modulated by a single injection of vitamin A.

Methods: Sixteen healthy (not vitamin A‐depleted) pigs were anaesthetized, monitored, mechanically ventilated and subjected to an infusion of E. coli endotoxin (10 μg kg‐1 h‐1). This infusion resulted within 30 min in a progressive haemodynamic derangement. When the mean pressure in the pulmonary artery was twice the baseline value, vitamin A (460 IU kg‐1) or a corresponding volume of vehicle was injected intravenously. After sacrificing the animals, the right lung was excised and weighed, and biopsy specimens were taken from the left lung for microscopical examination.

Results: Mean arterial blood pressure was significantly less affected (P < 0.01) between the 1st and 6th hour in endotoxaemic pigs treated with vitamin A than in those given vehicle. The mean lung weight in the vitamin A‐treated pigs was significantly lower than that in the vehicle group (164±5.3 vs 199±19.8 g; P < 0.01). Microscopical examination showed significantly less oedema (0.93±0.17 vs 2.00±0.26; P <0.01) and microatelectasis (0.56±0.17 vs 1.75±0.31; P < 0.01) in the vitamin A group. Endo‐toxaemia was also accompanied by an initial, steep decline in neutrophil counts in all animals; this decrease was significantly less pronounced (P < 0.05) in vitamin A‐injected pigs than in the vehicle‐injected group. The major difference was a more rapid restitution in the vitamin A group.

Conclusion: Several manifestations of endotoxaemia were expressed less in the vitamin A group. Thus, vitamin A may turn out to be a tool in the management of endotoxaemia.