bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the effects of fentanyl on respiratory mechanics under propofol or thiopental anaesthesia
Authors: Cigarini I. , Bonnet F. , Lorino A. M. , Harf A. , Desmonts J. M.
Published: January 2009

Twenty patients were randomly anaesthetized with either thiopental 5 mg/kg followed by a 15 mg/kg/h continuous infusion, or propofol 2.5 mg/kg followed by a 9 mg/kg/h continuous infusion, paralysed with vecuronium 0.1 mg/kg, intubated and ventilated with nitrous oxide 50% in oxygen. Fifteen minutes after induction, fentanyl 5 μg/kg was injected. Inspiratory tracheal pressure (PT), gas flow (V) and volume (V) were continuously measured while the lungs were inflated with a constant inspiratory flow ventilator. Respiratory compliance (Crs) and resistance (Rrs) were calculated from the regression of PT on V. In both groups Crs decreased following anaesthesia. Fentanyl injection elicited an increase in Rrs (from 1.04 ± 0.70 to 1.63 ± 0.92 kPa · 1‐t · s) and a further decrease in Crs (from 0.55 ± 0.30 to 0.42.± 0.10 1 · kPa‐1) in the thiopental group but not in the propofol group (Rrs: 1.26 ± 0.69 to 1.08.± 0.44 kPa · 1‐1 · s, Crs: 0.49 ± 0.11 to 0.48 ± 0.13 1 · kPa ‐1). These results suggest that the dose of propofol administered in this study may prevent fentanyl‐induced bronchoconstriction.
Predicted normocapnea in infants and children using the Bain circuit with controlled ventilation
Authors: Jonsson L. O. , Bain J. A. , Lee R.
Published: January 2009

We have constructed a nomogram for fresh gas flow (Vfg) and minute ventilation (Ve) for paediatric anaesthesia during controlled ventilation using the Bain coaxial Mapleson D circuit. Vfc was based upon the assumption of a high fresh gas utilization because of a low Vfg/Ve ratio (0.67) and known figures of carbon dioxide elimination. The formulas Vfg = 27.8 Vco2 and Ve = 1.5 · Vfg were used to calculate the necessary flows to generate normocapnea. The nomogram was evaluated in 59 children (6–62 kg, age 5 months‐14 years). Paco2 (mean · s.d.) was 5.0 ± 0.5 kPa (38 · 4 mmHg) with a total range of 3.9–6.3 kPa (29–47 mmHg). Ninety percent of the children had a Paco2 of 5.7 kPa (43 mmHg) or lower. There was no correlation between body weight and Paco2. Hence, there was no difference in mean values between children below or above a body weight of 20 kg.
QT interval of the ECG, heart rate and arterial pressure using propofol, methohexital or midazolam for induction of anaesthesia
Authors: Saarnivaara L. , Klemola U.‐M. , Lindgren L. , Rautiainen P. , Suvanto A.
Published: January 2009

The effects of propofol 2 mg/kg, methohexital 2 mg/kg or midazolam 0.3 mg/kg were studied on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during induction of anaesthesia in 87 ASA class I‐(II)‐patients. The patients were randomly allocated to one of the three anaesthetic groups. The incidence of the patients with a prolonged QTc interval (= more than 440 ms) ranged from 29 to 41% between the groups. In each group these patients were treated separately. After all anaesthetics, the QTc interval was significantly prolonged in the patients with a normal control QTc interval, whereas in the patients with a prolonged control QTc interval, it tended to be shortened both after propofol and methohexital and it was significantly shortened after midazolam. After injection of suxamethonium, no significant QTc interval changes occurred in the patients with a normal control QTc interval in either the propofol or the methohexital groups, whereas in the patients with a prolonged control QTc interval treated with propofol the QTc interval decreased significantly 60 s after suxamethonium when compared with the corresponding preceding values. The mean values in the propofol group in the patients with a normal control QTc interval were always below the upper limit of the normal range. In the patients with a normal control QTc interval treated with midazolam, the QTc interval was significantly prolonged 60 s after suxamethonium and after intubation and in the patients with a prolonged control QTc interval treated with midazolam the QTc interval was significantly decreased after midazolam and increased 30 s after suxamethonium when compared with the corresponding preceding values. Only after methohexital did the heart rate increase significantly. A cardiovascular intubation response occurred in all groups. The incidence of ECG changes ranged from 0 to 17% between the groups. There was no correlation between the incidence of ECG changes and prolongation of the QTc interval. On the basis of the present results, in the patients with a normal control QTc interval propofol and methohexital are superior to midazolam in situations in which prolongation of the QTc interval should be avoided. On the other hand, in the patients with a prolonged control QTc interval, midazolam is superior or at least equal to the other drugs. Due to a considerable increase of the heart rate, methohexital is inferior to propofol and midazolam.
Comparison of the effects of isoflurane and halothane on intraocular pressure
Authors: Mirakhur R. K. , Elliott P. , Shepherd W. F. I. , McGalliard J. N.
Published: January 2009

Intraocular pressure (IOP) was measured in four groups of patients receiving isoflurane or halothane in consecutively increasing or decreasing concentrations (1.0, 2.0 and 3.0 MAC in 70% nitrous oxide). IOP decreased significantly in all groups irrespective of whether the higher or the lower concentration of the volatile agent was used first. There were no further significant changes in IOP whether the concentrations were increased or decreased, suggesting no dose‐relation. Maximum reductions in IOP were slightly greater in those receiving the higher concentrations of the volatile agents first (64 and 66% with isoflurane and halothane, respectively) in comparison to those receiving the lower concentrations first (54 and 46%, respectively).
Reduced expression of mannose‐specific receptors on murine peripheral blood polymorphonuclear leukocytes following prolonged anaesthesia with different inhalation agents
Authors: Bardosi L. , Bardosi A. , Hendrys M. , Gabius H.‐J.
Published: January 2009

Inhalation anaesthetic agents are known to depress phagocytic functions such as mobilization, attachment, chemotactic motility, engulfment and intracellular killing. Mannose‐specific sugar receptors on the surface of leukocytes are involved in a series of phagocytosis‐related activities. To investigate the effect of anaesthesia on the expression of this type of sugar receptor, mice were anaesthetized with halothane, enflurane and isoflurane. The presence of mannose‐binding receptors on peripheral blood polymorphonuclear leukocytes was examined glycocytochemically using the biotinylated neoglycoprotein mannosylated bovine serum albumin. Prolonged administration of inhalation anaesthetic agents, especially halothane, markedly depressed expression of mannose‐specific receptors. This reduction may possibly contribute to postoperative immunodepression, resulting from the impaired cellular interaction which is involved in the phagocytic function of granulocytes.
The effect of 0.5 % ropivacaine on epidural blood flow
Authors: Dahl J. B. , Simonsen L. , Mogensen T. , Henriksen J. H. , Kehlet H.
Published: January 2009

Twenty patients scheduled for elective abdominal surgery received epidural analgesia with 20 ml 0.5% ropivacaine or 0.5% bupivacaine. Epidural blood flow was measured by an epidural 133Xe clearance technique on the day before surgery (no local anaesthetic) and again 1 h before surgery, 30 min after injection of the local anaesthetic during continuous infusion (8 ml/h). Median initial blood flow was 5.0 ml/min and 6.0 ml/ min per 100 g tissue in patients receiving ropivacaine and bupivacaine, respectively. After epidural bupivacaine, blood flow increased in 8 of 10 patients to 6.9 ml/min per 100 g tissue (P<0.05) in contrast to a decrease in 9 of 10 patients to 3.3 ml/min per 100 g tissue after ropivacaine (P<0.05), (P<0.01 between groups). The median level of sensory analgesia was T3.5 and T4.5 in the ropivacaine and bupivacaine group, respectively (P>0.05). The demonstrated vasoconstrictor effect of epidural ropivacaine may influence the duration of its local anaesthetic effect.
Distribution of local anesthetics injected into the interpleural space, studied by computerized tomography
Authors: Stromskag K. E. , Hauge O. , Steen P. A.
Published: January 2009

Twenty‐one patients were given interpleural analgesia for postoperative pain relief after cholecystectomy, or renal or breast surgery. The patients were classified randomly into two groups: an interpleural injection of 20 ml of 0.375% bupivacaine mixed with 10 ml contrast medium was given to 11 patients in the supine position, and 10 in the lateral position. The patients remained in this position for 1 h. There was no significant difference in the rostrocaudal distribution of the contrast on computerized tomography taken 20 min later: Th3‐L1 in the supine group vs. Th5‐L1 in the lateral group. In the supine group the mean level of contrast medium reached significantly higher medially along the mediastinum (51 ± 11 mm) than laterally (27 ± 11 mm).
Anaphylatoxin and terminal complement complexes in red cell salvage
Authors: Bengtsson A. , Lisander B.
Published: January 2009

Thirteen patients undergoing elective orthopedic surgery were studied regarding anaphylatoxin (C3a and C5a) and terminal complement complex (TCC) formation in association with red cell salvage. The auto‐transfusion equipment gave a centrifuged and washed erythrocyte fraction. The concentrations of C5a and TCC were not increased but elevated C3a levels were found in the suspension. After infusion of the erythrocyte fraction to the patient, no signs of systemic complement activation were observed. Thus, plasma levels of C3a, C5a and TCC were within the normal range in all the patients before and after autotransfusion. This study indicates that the complement system is activated in the cellsaver equipment. The washing procedure, however, seems to eliminate most of the anaphylatoxins and terminal complement complexes. No extensive systemic activation of complement seems to occur in association with autotransfusion to patients undergoing elective surgery.
Post‐dural puncture headache in young patients. A comparative study between the use of 0.52 mm (25‐gauge) and 0.33 mm (29‐gauge) spinal needles
Authors: Geurts J. W. , Haanschoten M. C. , van Wijk R. M. , Kraak H. , Besse T. C.
Published: January 2009

In a prospective study of 80 patients under 40 years of age, given spinal anaesthesia through either a 0.52 mm (25‐gauge) needle or a 0.33 mm (29‐gauge) needle, the incidence of post‐dural puncture headache and backache was compared. There were no headaches in the 0.33 mm needle group, while in the 0.52 mm needle group an incidence of 25% was found. The incidence of backache was the same in both groups. The technique of performing spinal anaesthesia was evaluated and concluded to be slightly more difficult with a 0.33 mm needle, as estimated by the number of redirections of the needle needed to obtain cerebrospinal fluid. There were no differences between the two needles with respect to obtaining adequate spinal anaesthesia and spread of blockade.
Insufficient effect of local analgesics in Ehlers Danlos type III patients (connective tissue disorder)
Authors: Arendt‐Nielsen L. , Kaalund S. , Bjerring P. , Høgsaa B.
Published: January 2009

The analgesic effects of intradermal lidocaine infiltration and topical EMLA cream applications (eutectic mixture of local anaesthetics) were studied in 8 patients with Ehlers Danlos syndrome type III, a heritable disorder of connective tissue, and in 8 controls. Cutaneous analgesia was evaluated by sensory and pain thresholds to short argon laser stimulation, and the depth of cutaneous analgesia was measured by sensory and pain thresholds to controlled needle insertion. Five minutes after lidocaine infiltration, the laser‐induced pain was abolished in both groups, but I h later only the skin of the controls remained analgesic. EMLA cream was applied for 30, 60, and 120 min, but none of the patients obtained sufficient analgesia. Full analgesia was obtained for the controls after 60 and 120 min of application. The depth of cutaneous EMLA analgesia was significantly less for the patients compared to controls. The present quantitative findings support clinical observations that long‐lasting cutaneous analgesia is difficult to obtain for this group of patients.
Lung fluid balance evaluated by the rate of change of extravascular lung water content
Authors: Frostell C. , Blomqvist H. , Wickerts C. J. , Hedenstierna G.
Published: January 2009

Lung fluid balance was studied in 27 mongrel dogs by measuring changes in extravascular lung water content (EVLW). The expression delta EVLWi, which is the difference in EVLWi per kilo bodyweight per hour between two measurement occasions, was used as an estimate of the rate of change of EVLW. EVLW was measured by a double‐indicator dilution technique (EVLWi) using iced glucose and indocyanine green. In addition, EVLW was determined at the end of each experiment with gravimetric technique (EVLWg), which enabled the calculation of a regression equation between EVLWi and EVLWg. Delta EVLWi was calculated repeatedly during an 8‐h period of mechanical ventilation (MV) with no application of a positive end‐expiratory pressure (n=5), during an 8‐h period with a positive end‐expiratory pressure (PEEP) of 10 cmH2O (1.0 kPa) (n=5), during the development of oleic acid (OA)‐induced pulmonary oedema (n=7), and hydrostatic pulmonary oedema (left atrial balloon inflation) (n=9). An increase of EVLW was seen during PEEP 8 h (mean 35%) and after induction of OA and hydrostatic oedema (mean 300%), but no change was found during MV without PEEP. The regression equation was EVLWi=5.5+0.97 × EVLWg (P=0.001, r=0.90). OA‐induced oedema caused a mean maximum delta EVLWi of 5.1 ml/kg/h, indicating capillary leakage which, however, was self‐limiting within 2 h after OA injection. In hydrostatic oedema there was a maximum delta EVLWi of 16.0 ml/kg/h. Delta EVLWi was negative after deflation of the left atrial balloon, indicating reabsorption of oedema.
Measurement of dynamic lung fluid balance in the mechanically ventilated dog. Theory and results
Authors: Blomqvist H. , Frostell C. , Pieper R. , Hedenstierna G.
Published: January 2009

An expression (Ln) is presented for the net fluid leakage from the intravascular to the extravascular space in the lung. It is based on a new dog model and is the sum of rate of change in extravascular lung water content (EVLW), thoracic lymph flow, and pleural fluid formation. The rate of change of EVLW (delta EVLW) in ml/kg/h was calculated from repeated measurements of EVLW with a double‐indicator dilution technique (dye/cold) and corrected according to the relation between EVLW measured by this technique and gravimetry. Ln was studied in lung‐healthy mechanically ventilated dogs during a prolonged period of mechanical ventilation with and without the application of a positive end‐expiratory pressure of 10 cmH2O (1.0 kPa). During mechanical ventilation, Ln was found to be 0.3 ml/kg/h in the basal condition, increasing to 0.5 ml/kg/h (P<0.01) after a mean period of 7 h. After the application of a positive end‐expiratory pressure (PEEP) of 10 cmH2O (1 kPa) for 0.5–2 h, Ln was found to increase significantly, from a mean of 0.3 ml/kg/h to 0.9 ml/kg/h (P<0.01). We conclude that Ln is a useful quantitative expression in experimental studies on lung fluid balance.
Net fluid leakage (LN) in experimental pulmonary oedema in the dog
Authors: Blomqvist H. , Berg B. , Frostell C. , Wickerts C. J. , Hedenstierna G.
Published: January 2009

Net fluid leakage (Ln) from the intravascular to the extravascular pulmonary space was estimated in anaesthetised dogs after injection of oleic acid (OA) (n = 8), or after hydrostatic pressure elevation by inflation of a left atrial balloon (n= 5). Ln was calculated as the sum of: (i) rate of change in extravascular lung water (delta EVLW), (ii) thoracic lymph flow, and (iii) pleural fluid formation per time unit. Pleural fluid formation was measured in five dogs with hydrostatic or OA induced pulmonary oedema and was 1.8 ± 0.9 ml/kg/h. In OA‐induced pulmonary oedema, Ln increased to a peak of 9.2 ml/kg/h within 2 h after OA injection. Thereafter Ln fell and was 2–4 ml/kg/h during the succeeding 2–4 h. During hydrostatic pulmonary oedema Ln was increased to as much as 13 ml/kg/h, but it became negative, ‐5 to ‐8 ml/kg/h (reabsorption of extravascular fluid) as soon as pulmonary vascular pressures returned to normal following deflation of the left atrial balloon. We conclude that in both forms of oedema there is an initial rapid leakage. In OA‐induced oedema this leakage continues, although at a slower rate, whereas in hydrostatic oedema there is a considerable net fluid absorption from the pulmonary extravascular to the intravascular space as soon as vascular pressures are brought to normal levels.
Allopurinol inhibits hypoxic pulmonary vasoconstriction. Role of toxic oxygen metabolites
Authors: Kjæve J. , Veel T. , Bjertnies L.
Published: January 2009

The exact mechanism whereby hypoxic pulmonary vasoconstriction (HPV) is elicited is still unsettled. We have evaluated a possible role for toxic oxygen metabolites (TOM), employing a set‐up of blood‐perfused isolated rat lungs. HPV reflected as pulmonary arterial pressor responses, was evoked by alternately challenging the airways with a hypoxic‐ and a normoxic gas mixture, resulting in gradually increasing responses until a maximum was obtained. In a sequence of responses (mean ± s.e.mean) increasing from 2.5 ± 0.2 kPa to 3.2 ± 0.1 kPa, administration to the perfusate of the inhibitor of xanthine oxidase (XO), allopurinol (AP) reduced the subsequent response to 2.5 ± 0.2 kPa (P<0.001). By contrast, AP did not affect vasoconstriction induced by serotonin or bradykinin. In control experiments responses continued to increase after administration of hypoxanthine (substrate of XO). Neither pretreatment with daily injections of the antioxidant vitamin E for 3 days in advance, nor addition to the perfusate of the scavenger enzymes superoxide dismutase and catalase, or dimethylsulfoxide had any impact on HPV; the subsequent responses rose at the same rate and in the same way as before. Thus, the present study has shown that AP inhibition of XO depresses HPV. This could be due either to reduced production of TOM or to accumulation of purine metabolites. The absence of inhibitory effects of quenchers of TOM refutes a role for these metabolites in the elicitation of HPV. More likely, AP inhibits HPV by interfering with the purine metabolism
Anesthetic induction with thiopental: its effect on scalp topography of median nerve somatosensory evoked potentials
Authors: Pinto F. , Ragazzoni A. , Amantini A. , de Scisciolo G. , Bartelli M. , Rossi R. , Pieraccioli E.
Published: January 2009

The effects on median nerve somatosensory evoked potentials (SEPs) of analgesic doses of fentanyl, meperidine or morphine and of sodium thiopental (STP) anesthesia (4 mg/kg) were tested in 36 surgical patients. We also explored changes in SEP components as a function of their scalp location. Before and after medication, responses were recorded from the scalp overlying the parietal cortex (ipsi‐ and contralateral to the stimulated arm) and the precentral (contralateral) cortex. None of the three opiates affected SEP latencies or amplitudes. The barbiturate increased the amplitudes of subcortical and early cortical components (N18, N20, P22, P25), whose latencies, however, were not significantly modified. The effect of STP on later SEP cortical components depended on their scalp topography: parietal N33 and P45 underwent significant changes in both latency and amplitude, whereas precentral N30 showed a significant amplitude increase only. Thiopental anesthesia produces clearer short‐latency SEP recordings, from both parietal (components N20—P25) and precentral (P22, N30) areas.
Influence of intravenous local anaesthetics upon quadriceps muscle function
Authors: Nydahl P. A. , Axelsson K. , Larsson P. G. , Philipson L. , Leissner P. , Sjöstrand U. H.
Published: January 2009

This study was undertaken to assess the effects of intravenous administration of mepivacaine and etidocaine on muscle function. Seven male volunteers were given mepivacaine (5 mg/kg) and etidocaine (50 mg) intravenously, on separate occasions. A reference group of 11 male volunteers received 0.9% saline solution intravenously. Muscle function was tested by measurements of isometric muscle force of knee extension and by quantitative electromyographic (EMG) recordings from the quadriceps muscle during knee extension at different degrees of isometric muscle force. At the end of the mepivacaine and etidocaine infusions, the mean venous plasma concentrations of the two anaesthetic agents were 2.9 and 1.2. μg/ml, respectively. The muscle strength remained unchanged during infusion of the two local anaesthetics. Mepivacaine had a minor effect on the mean rectified EMG amplitudes at the end of the infusion at maximal voluntary muscle contraction, but no such effect was observed at submaximal knee extension force. However, at the plasma concentrations mentioned above, the clinical influence of intravenous infusion of the local anaesthetics on muscle function was negligible.
Propofol as the main anaesthetic agent in dental surgery
Authors: Guidon‐Attali C. , Mouillac F. , Quilichini D. , Paut O. , François G.
Published: January 2009

Propofol was used as the main anaesthetic agent for induction and maintenance of anaesthesia in 30 patients undergoing dental surgery requiring tracheal intubation. Anaesthesia was successfully induced and intubation performed in all patients, with a propofol induction dose of 3.5 mg/kg and without muscle relaxants or opioids. Intubating conditions were good for 77% of the patients. No haemodynamic changes occurred. Maintenance with propofol 9 mg/kg/h and 70% nitrous oxide provided suitable conditions for surgery. Awakening and recovery times were short and few side effects were recorded. However, post‐operative dental pain was systematically recorded and was present in 60% of the patients.
Ventilation‐perfusion relationships and atelectasis formation in the supine and lateral positions during conventional mechanical and differential ventilation
Authors: Klingstedt C. , Hedenstierna G. , Baehrendtz S. , Lundqvist H. , Strandberg Å. , Tokics L. , Brismar B.
Published: January 2009

Patients without respiratory symptoms were studied awake and during general anesthesia with mechanical ventilation prior to elective surgery. Ventilation‐perfusion (a) relationships, gas exchange and atelectasis formation were studied during five different conditions: 1) supine, awake; 2) supine during anesthesia with conventional mechanical ventilation (CV); 3) in the left lateral position during CV; 4) as 3) but with 10 cm of positive end‐expiratory pressure (PEEP) and 5) as 3) but using differential ventilation with selective PEEP (DV + SPEEP) to the dependent lung. Atelectatic areas and increases of shunt blood flow and blood flow to regions with low a, ratios appeared after induction of anesthesia and CV. With the patients in the lateral position, further a mismatch with a fall in Pao2 an icreased dead space ventilation was observed. Atelectatic lung areas were still present, although the total atelectatic area was slightly decreased. Some of the effects caused by the lateral position could be counteracted by adding PEEP. Perfusion of regions with low a ratios and venous admixture were then diminished, while Pao2 was slightly increased; shunt blood flow and dead space ventilation were essentially unchanged. During CV + PEEP, there was a decrease in cardiac output, compared to CV in the lateral position. DV + SPEEP was more effective than CV + PEEP in decreasing shunt flow and increasing Pao2 in the lateral position; in addition to this, cardiac output was not affected.
Position of minitracheostomy tube verified fiberoptically – a report of 2 cases
Authors: Randell T. , Kalli I.
Published: January 2009

Two reports concerning difficulties at insertion of a minitracheostomy cannula are presented. In one patient, a minitracheostomy tube perforated the posterior wall of the trachea, resulting in pneumomediastinum. In another patient, conventional signs, i.e. airflow and passing of a suction catheter through the cannula, were misleading in assessing the position of the tube. Fiberoptic tracheoscopy immediately after the performance of minitracheostomy revealed the position of the cannula in both cases.
Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%
Authors: Anker‐Møller E. , Spangsberg N. , Dahl J. B. , Christensen E. F. , Schultz P. , Carlsson P.
Published: January 2009

In 20 patients a continuous block of the lumbar plexus was administered after knee joint surgery, and the analgesic effect of two different concentrations of bupivacaine was compared. The same volume of bupivacaine was given to both groups of patients: a bolus dose of 0.4 ml/kg, 0.5% or 0.25%, followed by infusion of 0.14 ml/kg/h, 0.25% or 0.125%, respectively, via a catheter placed in the neurovascular fascial sheath of the femoral nerve according to the “3‐in‐1 block” technique. The median morphine consumption during the first 16 h postoperatively was 6.0 mg when bupivacaine 0.5/0.25% was used and 9.5 mg when 0.25/0.125% was used. This difference is not significant. The visual analogue pain scores were also similar in the two groups (P > 0.05). All plasma concentrations were below 4 μg/ml, the highest concentration measured being 3.6 μg/ml. It is concluded that when used for a continuous block of the lumbar plexus after knee‐joint surgery, bupivacaine in a concentration of 0.125% offers the same pain relief as a concentration of 0.25%, and the risk of toxic reactions is reduced.
Amrinone in perioperative low cardiac output syndrome
Authors: Fita G. , Gomar C. , Jimenez M. J. , Pacheco M. , Mulet J. , Nalda M. A.
Published: January 2009

Amrinone has been shown to have a beneficial effect on left ventricular function in low output syndrome (LOS), but its use after open‐heart surgery has not been extensively revised. We studied 10 patients with LOS post‐cardiopulmonary bypass (CPB), who failed to respond to conventional treatment (vasoactive drugs plus intraaortic balloon pump) and were treated with amrinone, 0.75 mgkg‐1 followed by a continuous infusion of 5 to 10 μgkg‐1 min‐1. One patient failed to respond to the treatment and subsequently died, but in the other nine patients blood pressure and cardiac index increased, left filling pressure decreased and they were successfully weaned from the CBP and survived. These results suggest that amrinone, either alone or combined with other inotropic drugs and mechanical support, is a valuable drug in the management of LOS after CPB.
Parenteral nutrition in preterm neonates with and without carnitine supplementation
Authors: Larsson L. E. , Olegård R. , Ljung B. M. L. , Niklasson A. , Rubensson A. , Cederblad G.
Published: January 2009

The effects of carnitine supplementation on fat and glucose metabolism and carnitine balance were studied in 12 preterm neonates receiving full or partial parenteral nutrition (PN) for 5 to 21 days. The gestational age ranged from 27 to 32 weeks and the birth weight from 790 to 2090 g. The neonates were assigned at random to receive either L‐carnitine 10 mg/kg (n=6) or saline (n=6). In the carnitine group, increased concentrations in plasma of total and free carnitine were observed. Less than 50% of the given dose was recovered in urine. In the placebo group no changes in the total plasma carnitine concentration were seen. In all neonates plasma triglycerides, free fatty acids, glycerol, alanine, 3‐hydroxybutyrate (BOB), glucose and lactate were measured at predetermined intervals. The only significant difference between the groups was higher BOB‐concentrations in the carnitine group 2 days after the start of parenteral nutrition. Elevated BOB concentrations are an indicator of improved fatty acid oxidation in the carnitine group. In this study, only a temporary effect of the carnitine supplementation was found.
Anaesthesia for resection of tumours in the trachea and central bronchi using the Nd‐YAG‐laser technique
Authors: Blomquist S. , Algotsson L. , Karlsson S. E.
Published: January 2009

The use of lasers in upper airway surgery is now common practice. The introduction of the Nd‐YAG laser technique makes it possible to perform endoscopic resection of tumours located in the trachea and central bronchi. Usually these patients require general anaesthesia. Our experience in 13 patients using total intravenous anaesthesia and jet ventilation with air is reported. Oxygen saturation was maintained at a higher level than when the patients were breathing 100% oxygen before anaesthesia. Occasional reductions in saturation were due to airway obstruction and were easily corrected by a short interruption of the procedure. All patients tolerated the anaesthesia and surgery well. No complications related to the anaesthetic method or the use of the Nd‐YAG‐laser occurred. A review of the possible hazards in these procedures is given together with advice on safety precautions needed.
Long‐term continuous axillary plexus blockade using 0.25% bupivacaine
Authors: Sarma V. J.
Published: January 2009

Three patients, presenting with various traumatic, vasospastic and chronic neuromuscular disorders of the upper body, received continuous axillary block ranging from 4 to 16 days. Intermittent injections of 0.25% bupivacaine were used to provide analgesia, sympathetic blockade and muscle relaxation. No systemic or neurological side‐effects were recorded. Nerve function recovered promptly after stopping the injections. It is concluded that continuous brachial plexus blockade is a clinically safe and effective technique for the relief of acute traumatic pain and vasospastic disorders of the upper limb. The technique, its merits and possible complications are discussed.
Responses to barbiturates of isolated dog cerebral and mesenteric arteries contracted with KCl and prostaglandin F2a
Authors: Moriyama S. , Nakamura K. , Hatano Y. , Harioka T. , Mori K.
Published: January 2009

In helical strips of dog cerebral and mesenteric arteries previously contracted with KCl or prostaglandin F2a (PGF2a), the addition of pentobarbital (10‐5 to 10‐3 moll‐1‐1) caused dose‐related relaxation, whereas thiamylal and thiopental in a low concentration (10‐5 to 10‐4 moll‐1‐1) caused further contraction and in a high concentration (10‐3 mol‐1‐1) profound relaxation. Thiobarbiturate‐induced contractions were greater in mesenteric than in cerebral arteries previously contracted with PGF2a. In cerebral and mesenteric arteries exposed to Ca++‐free media for 60 min and treated with KCl or PGF2a, reintroduction of Ca ++ produced a transient contraction, a transient relaxation and a persistent contraction. The Ca++ ‐induced persistent contraction was attenuated by pretreatment with pentobarbital (10‐4 to 10‐3 mol‐1‐1) and thiamylal (10‐3 mol‐1‐1); the attenuation was greater in arteries treated with KCl than with PGF2a. The Ca++ ‐induced contractions of mesenteric artery treated with PGF2a were potentiated by 10‐4 mol‐1‐1 thiamylal. It is concluded that pentobarbital possesses only a vasodilator effect, whereas thiamylal and thiopental have both constrictor and dilator effects on vascular smooth muscle. The vasodilator effect of barbiturates is associated in part with inhibition of transmembrane influx of Ca++; the inhibition is more predominant on the influx evoked by KCl‐induced depolarization than by a stimulation of PGF2a receptors. Thiamylal in low concentrations appears to enhance Ca++ influx through a receptor‐operated Ca++ channel for PGF2a.
The pericardium exerts constraint on the right ventricle during cardiac surgery
Authors: Reich D. L. , Konstadt S. N. , Thys D. M.
Published: January 2009

The right ventricle may be particularly susceptible to the effects of pericardial constraint. This study examined the effects of pericardiotomy on right ventricular function. Twenty‐four anesthetized patients with coronary artery disease, but without evidence of pericardial pathology, were studied. Anesthesia consisted of fentanyl (100 μg‐kg‐1), diazepam, pancuronium, and 100% oxygen. The American Edwards REF‐1 Cardiac Output Computer, rapid‐response thermistor pulmonary arterial catheter, and a radial arterial catheter were used to measure hemodynamic variables. Baseline measurements were obtained with the sternum fully retracted. The measurements were then repeated following pericardiotomy by a midline incision. There were significant (P<0.05) changes in systolic arterial pressure (+4.5%), mean arterial pressure (+3.7%), systolic pulmonary arterial pressure (+11.8%), cardiac output (+9.1%), stroke volume (+6.9%), right ventricular end‐diastolic volume (+7.6%), and right atrial pressure (‐8.6%). In the current study, pericardiotomy augmented right ventricular diastolic filling and stroke volume, while the right atrial pressure decreased. These results support the concept of pericardial constraint.
Anaesthesia in malignant hyperthermia‐susceptible patients without dantrolene prophylaxis: a report of 30 cases
Authors: Hackl W. , Mauritz W. , Winkler M. , Sporn P. , Steinbereithner K.
Published: January 2009

The intra‐ and postoperative course of 30 anaesthetics in 24 MH‐carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically and only agents known to be non‐triggers were used for anaesthesia. Neither MH‐related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed. We conclude that the prophylactic use of dantrolene is not necessary in patients suspected to be prone to MH if triggering agents are avoided and the patients are closely monitored.
Heat and moisture exchangers and the body temperature: a peroperative study
Authors: Eckerbom B. , Lindholm C.‐E.
Published: January 2009

The importance of conditioning the inhaled gas for maintaining the body temperature during artificial respiration was investigated. The mean body temperature (MBT) was deduced from readings from five measuring sites, four of which were situated at the skin and the fifth in the rectum. Temperature recordings were made every 15th min. Twenty patients were admitted to the study. In 10 patients a heat and moisture exchanger was used (the HME group), and the other 10 were ventilated without an HME (the control group). The patients were normoventilated, and a non‐rebreathing system was used. All operations were made in the ENT‐region of the body. Great care was taken to avoid variation of external factors that may affect the MBT. We found that the MBT decreased 0.2Â°C/h less in the HME group than in the control group. If corrections were made for differences in amounts of fluids given and age factors, a difference in heat loss of 41.6 kj/h between the two groups could be derived from this figure. This difference was statistically significant. Our finding correlated fairly well with a predicted reduction of heat loss of 26.0 kj/h for the type of HME used. A certain margin of error seemed to be inevitable in measuring body temperatures, and the reason for this is discussed. Our results support the fact that the investigation is adequately designed, and that the heat conserved with an HME is rather low.
Partial reversal of the cerebral effects of isoflurane in the dog by theophylline
Authors: Roald O. K. , Forsman M. , Steen P. A.
Published: January 2009

The cerebral effects of adding theophylline to 1.4% isoflurane anaesthesa were studied in five dogs by a sagittal sinus outflow technique with direct measurement of the cerebral blood flow (CBF) and calculation of the cerebral metabolic rate for oxygen (CMRo2). Three 3 mg ‐ kg‐1 doses of theophylline were given with intervals of 10 min. Five min after the second and the third dose, when the mean theophylline plasma concentration was 41 and 65 umol‐1–1, respectively, CMRo2 had increased significantly with a mean value varying between 15% and 13%, and the EEG had changed from a sleep pattern to a more awake pattern in the four dogs with evaluable recordings. There were no significant changes in CBF or mean arterial blood pressure (MABP). It is concluded that the adenosine receptor antagonist theophylline in this study partially reversed the cerebral effects of isoflurane.
The patterns of stress response in patients undergoing thyroid surgery under acupuncture anaesthesia in China
Authors: Kho H. G. , Egmond J. van , Zhuang C. F. , Zhang G. L. , Lin G. F.
Published: January 2009

The patterns of catecholamines (adrenaline and noradrenaline), peptide hormones (adrenocorticotropic hormone, antidiuretic hormone, β‐endorphin, growth hormone and prolactin), hydrocortisone (Cortisol) and those of immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood were investigated during and for 6 days after thyroid surgery in 20 patients (F/M: 18/2) performed under acupuncture anaesthesia, supplemented by small doses of pethidine (mean: 45.0 mg, s.d. 8.9). Throughout surgery the patients remained conscious. During surgery a significant increase in the level of catecholamines and the above‐mentioned circulating hormones and a decrease of immunoglobulins were observed, whereas the leucocyte and differential counts demonstrated leucocytosis due to lymphocytosis, a decreased percentage of eosinophils and a remarkably reduced percentage of neutrophils. In the postoperative phase, levels of noradrenaline and β‐endorphin remained elevated, whereas the other circulating hormones gradually returned to normal values. Immunoglobulin levels and eosinophil counts returned to the preinduction values within 24 h, and those of neutrophil and lymphocyte counts within 2 days. Changes in number of monocytes and basophils could not be detected peri‐ and postoperatively.
The effect of nitrous oxide on EEG spectral power during halothane and isoflurane anaesthesia
Authors: Yli‐Hankala A.
Published: January 2009

The effect of N2O on EEG during halothane and isoflurane anaesthesia was studied in 24 elective‐surgery patients. The total EEG power and various power bands were analysed with fast Fourier transform power spectra. Anaesthesia was induced by mask. EEG analysis was performed from the data collected before induction and during steady‐state halothane and isoflurane anaesthesia with and without N2O. In both halothane and isoflurane anaesthesia, N2O had a significant effect on EEG. Alpha‐ and beta‐range EEG power and total power decreased during N2O in both groups. Delta‐ and theta‐range power increased during N2O in the halothane group. The study shows that the effect of nitrous oxide should be taken into consideration when EEG is being studied or monitored during anaesthesia.
Hemodynamic effects in dogs of nitrous oxide‐meperidine and meperidine, respectively, in comparison with nitrous oxide
Authors: Rydgren B. , Dottori O. , Nordström G. , Seeman T.
Published: January 2009

The aim of this investigation on dogs, was to examine the hemodynamic effects of nitrous oxide (N2O) plus meperidine and of meperidine with room air ventilation, respectively, compared with those of N2O on its own. When meperidine (bolus dose 3 mg ± kg‐1and continued infusion 4 mg ± kg‐1± h‐1) was added to 80% N2O, mean arterial blood pressure fell from about 20 to 10 kPa (150 to 75 mmHg), as a result of a decrease in peripheral vascular resistance, but no compensatory changes in cardiac output were seen. When N2O was withdrawn, during continued meperidine infusion, cardiac output and stroke volume increased, while peripheral resistance remained low. Coronary vasodilation was noted when meperidine was added to N2O, and persisted when N2O was withdrawn. In the pulmonary circulation a different response was found. Here, no effects were observed when meperidine was added to N2O, while pressure and resistance decreased when N2O was withdrawn and meperidine continued.
Peroperative fluid management of the brain‐dead multiorgan donor
Authors: Randell T. , Orko R. , Höckerstedt K.
Published: January 2009

Brain‐dead organ donors are often dehydrated and have serum electrolyte disorders. This study was designed to analyse the haemodynamic condition and serum electrolyte balance of liver donors. Two different fluid management plans for the harvesting operation were studied. Sixteen consecutive organ donors were included. They were randomly infused either with a combination of colloid (hydroxy ethyl starch) and electrolyte solution (group COL) or with crystalloid fluid alone (group CR). Arterial pressures, heart rate, central venous pressure and oesophageal temperature were monitored and serum electrolytes were analysed before the beginning of the operation and during harvesting. The amount of fluid needed in the COL group was significandy less (P<0.01) than in the CR group. There were no statistical differences between the groups in the haemodynamic parameters during the study period. The oesophageal temperature was maintained in both groups. All donors were initially hypernatraemic, but the serum sodium values returned towards normal during surgery in both groups. Immediate function was seen in all livers. In conclusion, the haemodynamic stability is maintained with a smaller infused volume if hydroxyethyl starch is combined with crystalloid fluids. The formation of interstitial oedema will be less when colloids are used, but its significance in organ donation needs further evaluation.
Negative effect of insufflation on cardiac output and pulmonary blood volume
Authors: Versprille A. , Jansen J. R. C. , Frietman R. C. , Hulsmann A. R. , Klauw M. M. V.D.
Published: January 2009

In 14 anaesthetized young pigs the changes in pulmonary blood flow and pulmonary blood volume (Qp) during mechanical ventilation were quantified. Ventilation was performed at 10 cycles per min and tidal volume (VT) was adjusted to an arterial Pco2 of about 40 mmHg (5.3 kPa). In 4 animals, 7 ventilatory cycles with an inspiratory pause (IP) of 7.2 s but different tidal volumes were inserted at intervals of 5 min to determine the decrease in Qp (ΔQp) from the differences between right ventricular (Qs,rv) and left ventricular (Qs,lv) stroke volume, and to relate ΔQp to VF We measured pressure in the aorta (Pao, central veins (Pcv), right and left ventricles (Prv,Plv) pericardium (Pit), and trachea (PT). Blood flow was measured electromagnetically (EM) in the pulmonary artery (Q′pa) and aorta (Q′ao). Stroke volumes were derived from the EM‐flow curves. In the other 10 experiments, Qs,lv was derived from the aortic pulse contour. Beat‐to‐beat analyses of Qs,rv and Qs,lv and blood pressures during the normal ventilatory cycles and those with an IP revealed the following: 1) The end‐expiratory RV output and LV output were constant and were defined as baseline values. 2) The accumulated decrease in Qs,rv during insumation caused a mean deficit in cardiac output of 10.3 ± 3.2% (s.d.), n= 135; the same was found for Qs,lv, indicating the pulse contour as a useful method to estimate the variations in cardiac output during a ventilatory cycle. 3) Part of the pulmonary blood volume shifted into the systemic circulation during insumation and recovered during expiration with a maximum of about 1.5 ml ▾ kg‐1 body weight for a VT above 20 ml ▾ kg‐1. The decreases in cardiac output and pulmonary blood volume were attributed to an accumulation of blood in the compliant systemic venous system due to the increased intrathoracic pressure. The decreased aortic pressure at early expiration contributed to the decrease in cardiac output. A squeezing effect on the pulmonary circulation during insumation contributed to the decrease in pulmonary blood volume.
pH in physiological salt solutions: direct measurements
Authors: Abrahamsen J. , Norrie B. , Andersen P. K. , Stokke D. B. , Nedergaard O. A.
Published: January 2009

Calculations of pH in modified Krebs solutions by inserting Pco2 and total‐CO2 in the Henderson‐Hasselbalch (H.‐H.) equation are obvious as the equation originally served for this purpose. An exact calculation of the relation between pH and Pco2 is complicated as the concentration of bicarbonate, the dissociation constant and the solubility of CO2 change. Furthermore, the dissociation constant in the H.‐H. equation is constant only if activities are used in the equation instead of stoichiometric concentrations. We therefore investigated the influence of different carbon dioxide tensions and bicarbonate concentrations on directly measured pH of organ baths aerated with mass‐spectrometric analyzed O2‐CO2 gases. For reference precision buffers were used. The measured pH values differed distinctly from calculated pH values in the acidic and alkaline parts of the pH interval investigated (6.57–8.15). Measurements of actual pH with proper calibration standards therefore seem mandatory.
Influence of a single dose of indomethacin on some biochemical changes and on postoperative intestinal paralysis following minor surgery. A prospective randomized double‐blind study
Authors: Jensen A. G. , Jensen V. J. , Gregersen B. , Johannesen N. W. , Jensen P. F. , Svendsen H. P.
Published: January 2009

The influence of a single dose of indomethacin on the surgical stress response was investigated in a double‐blind study including 43 patients scheduled for elective operation of inguinal hernia. Indomethacin or placebo was administered rectally 1 h before the start of operation. All patients had a standardized general anaesthetic. Blood samples for leucocyte count, sedimentation rate, iron and haemoglobin, and measurements of body temperature were taken preoperatively and on the day after surgery. Blood samples for glucose were taken preoperatively, and 4, 8 and 24 h after skin incision. In both groups a significant increase in leucocyte count and sedimentation rate as well as a decrease in serum iron were found, but there was no difference between the groups. Plasma glucose increased from 4 to 8 h after skin incision in the indomethacin group, but not in the placebo group. The postoperative need for methadon, the time needed to regain normal intestinal function and the hospital stay were the same in the two groups, and body temperature showed no change. These findings indicate that a single dose of indomethacin given preoperatively increased plasma glucose but had no effect on the other parameters studied.
The effect of the benzodiazepine antagonist flumazenil on regional cerebral blood flow in human volunteers
Authors: Wolff J. , Friberg L. , Jensen J. , Hansen P. B. , Andersen A. R. , Lassen N. A.
Published: January 2009

The influence of the benzodiazepine antagonist flumazenil on regional cerebral blood flow (rCBF) was investigated in ten healthy, alert volunteers. The design was a randomized, placebo‐controlled, double‐blind, cross‐over study. rCBF was measured by 133‐Xe inhalation and single photon emission computerized tomography, SPECT, immediately before, and 5 and 35 min after intravenous injection of flumazenil 1.0 mg or placebo. In addition, mean arterial blood pressure and Paco2 were measured. There were no significant differences in the mean arterial blood pressures or Paco2. rCBF were analysed for changes in various regions of interest (RoI). No alterations were found either in the global CBF or in rCBF in RoI after flumazenil injection. The results showed that a clinically active dose of flumazenil did not directly affect the cerebral circulation in the normal brain and indicated absence of significant intrinsic activity of the drug.