bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety, efficacy, and long‐term results of a modified version of rapid opiate detoxification under general anaesthesia: A prospective study in methadone, heroin, codeine and morphine addicts
Authors: Hensel M. , Kox W. J.
Published: March 2003

Background: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long‐term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine).

Methods: Seventy‐two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long‐term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature.

Results: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre‐existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow‐up. Six patients were lost during follow‐up.

Conclusions: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.
Contractures in skeletal muscle of malignant hyperthermia susceptible patients after in vitro exposure to sevoflurane
Authors: Snoeck M. M. J. , Gielen M. J. M. , Tangerman A. , Van Egmond J. , Dirksen R.
Published: March 2003

Background: Sevoflurane, a potent inhalational anaesthetic agent that is structurally similar to halothane, has some favourable characteristics, but may also be able to trigger malignant hyperthermia (MH) in susceptible patients. The diagnosis of malignant hyperthermia susceptibility relies on the in vitro contracture test on skeletal muscle. The present study was undertaken to investigate whether exposure to sevoflurane of muscles of malignant hyperthermia susceptible (MHS) patients would also cause an abnormal contracture.

Methods: Muscle fascicles obtained from three MHS patients, one malignant hyperthermia non‐susceptible (MHN) patient, two control patients and one malignant hyperthermia equivocal (MHE) patient were exposed to sevoflurane instead of halothane in the in vitro contracture test, carried out according to the protocol of the European Malignant Hyperthermia Group. The muscle fascicles were surplus to diagnostic requirements. Sevoflurane concentrations in the testbath were measured using a headspace gas chromatographic technique.

Results: The kinetics of sevoflurane concentration in the testbath were similar to those of halothane. An in vitro contracture response of 2 mN or more was seen in all four MHS/MHE patients with sevoflurane but not in the three control/MHN patients. The magnitude of muscle contracture in the sevoflurane test was less than in the conventional halothane test at comparable testbath concentrations.

Conclusions: Sevoflurane can trigger an abnormal contracture in human muscle in vitro. This is indicative of malignant hyperthermia susceptibility. Exposure to sevoflurane should be avoided in patients thought to be susceptible to malignant hyperthermia.
Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia
Authors: Schwall B. , Jakob W. , Sessler D. I. , Taeger K. , Fröhlich D.
Published: March 2003

Background: Previous studies reported that, contrary to local anesthesia, cataract surgery under inhalational anesthesia is associated with substantial adrenergic activation. We tested the hypothesis that total intravenous anesthesia (TIVA) with propofol and alfentanil produces less or comparable adrenergic activation during cataract surgery than local anesthesia.

Methods: Patients were randomly assigned to peribulbar local block (n=10) or TIVA (n=10). The heart rate, blood pressure, plasma concentrations of catecholamines, cortisol, and glucose were assessed at seven pre‐, intra‐, and post‐operative time points.

Results: In the patients given local anesthesia, plasma concentrations of epinephrine, norepinephrine and cortisol did not change significantly. In contrast, plasma epinephrine decreased by roughly 66% during TIVA: from 45±16 to 15±8 pg/ml. Plasma norepinephrine concentration decreased by roughly 50%, from 462±265 to a minimum value of 219±6 pg/ml and plasma cortisol concentrations decreased by roughly 61%, from 16.4 ng/ml to 6.4 ng/ml. Blood pressure and heart rates remained near baseline values during local anesthesia. In contrast, systolic blood pressure decreased by 30% and heart rate by 12 beats/min during TIVA.

Conclusion: The presented study and available data clearly suggest that local anesthesia produces the best adrenergic and hemodynamic stability during cataract surgery. Contrary to previously reported results on inhalational anesthesia (thiopentone/enflurane), the TIVA regimen used effectively prevents the adrenergic and metabolic response during cataract surgery.
The effect of sedation on weaning following coronary artery bypass grafting: propofol versus oxycodone‐thiopental
Authors: Leino K. , Nunes S. , Valta P. , Pikänen O. , Vanakoski J. , Takala J.
Published: March 2003

Background: Propofol has been advocated for sedation in intensive care because of superior recovery characteristics. We hypothesised that the use of two totally different sedation methods after coronary artery bypass grafting should result in differences not only in extubation time, but also in breathing pattern and gas exchange during weaning and after extubation.

Methods: Thirty patients participated in this randomised and controlled study. We used propofol infusion and oxycodone‐thiopental bolus dosage, titrated to sedation level 4 or 5 according to Ramsey. Weaning was performed using protocol‐based pressure support trials.

Results: Total (SD) fentanyl dose during operation was 33 (6) μg · kg−1 for propofol and 34 (6) μg · kg−1 for oxycodone‐thiopental (ns). The target sedation was achieved equally with both methods. The time from admission to intensive care unit to extubation was 494 (100) min for propofol and 521 (98) min for oxycodone‐thiopental (ns). Weaning times were 63 (24) min and 112 (63) min in the propofol and oxycodone‐thiopental groups, respectively (P<0.05). Breathing frequency increased and tidal volume decreased from weaning to 2 h postextubation.

Conclusion: Propofol infusion and oxycodone‐thiopental bolus dosages, titrated to the same sedation end point, resulted in similar time from admission to extubation, although the weaning period was shorter in the propofol group. In terms of breathing pattern, gas exchange, blood gases and haemodynamics, the methods were similar. Propofol, despite its attractive pharmacological profile, may offer no clinical benefit in short‐term sedation after a moderate dose fentanyl anaesthesia in cardiac surgery.
Effect of PEEP and inhaled nitric oxide on pulmonary gas exchange during gaseous and partial liquid ventilation with small volumes of perfluorocarbon
Authors: Max M. , Kuhlen R. , Falter F. , Reyle‐Hahn M. , Dembinski R. , Rossaint R.
Published: March 2003

Background: Partial liquid ventilation, positive end‐expiratory pressure (PEEP) and inhaled nitric oxide (NO) can improve ventilation/perfusion mismatch in acute lung injury (ALI). The aim of the present study was to compare gas exchange and hemodynamics in experimental ALI during gaseous and partial liquid ventilation at two different levels of PEEP, with and without the inhalation of nitric oxide.

Methods: Seven pigs (24±2 kg BW) were surfactant‐depleted by repeated lung lavage with saline. Gas exchange and hemodynamic parameters were assessed in all animals during gaseous and subsequent partial liquid ventilation at two levels of PEEP (5 and 15 cmH2O) and intermittent inhalation of 10 ppm NO.

Results: Arterial oxygenation increased significantly with a simultaneous decrease in cardiac output when PEEP 15 cmH2O was applied during gaseous and partial liquid ventilation. All other hemodynamic parameters revealed no relevant changes. Inhalation of NO and instillation of perfluorocarbon had no additive effects on pulmonary gas exchange when compared to PEEP 15 cmH2O alone.

Conclusion: In experimental lung injury, improvements in gas exchange are most distinct during mechanical ventilation with PEEP 15 cmH2O without significantly impairing hemodynamics. Partial liquid ventilation and inhaled NO did not cause an additive increase of PaO2.
The risk of cardiac injury during laparoscopic fundoplication: cardiac troponin I and ECG study Note
Authors: Boccara G. , Pouzeratte Y. , Troncin R. , Bonardet A. , Boularan A.‐M. , Colson P. , Mann C.
Published: March 2003

Background: Myocardial trauma has been described during gastroesophageal reflux laparoscopic surgery, in association with the proximity of cardiac structures. In addition, specific haemodynamic changes induced by CO2 pneumoperitoneum could exacerbate perioperative cardiac complication even in patients without cardiac risk factors. The aim of this study was to evaluate the influence of gastroesophageal reflux laparoscopic surgery on the perioperative ECG, cardiac troponin I and myocardial enzyme changes.

Methods: Forty‐two ASA I–II patients without ischaemic heart disease or combined double‐risk factors were studied. Automated ST segment analysis was used intraoperatively. ECG, plasma myocardial enzyme and cardiac troponin I concentrations were reported on arrival in the recovery room (H0), 4 h (H4) and 24 h (H24) postoperatively.

Results: Intraoperative ST segment changes occurred in two patients: the first during a hypotensive episode (MAP<55 mmHg; 3/42 patients) and the second during a hypertensive episode (MAP >110 mmHg; 3/42 patients). One case of intraoperative subcutaneous emphysema occurred without ST disturbance. One case of pneumothorax was observed at H0–H4 in another patient without clinical symptoms. Cardiac troponin I and CK‐MB were not increased postoperatively. Transaminase concentrations increased (2‐fold normal values) in 26/42 patients. In these 26 patients, 7 experienced 5‐fold isolated transaminase increase, associated with left hepatic artery section.

Conclusion: According to perioperative ECG changes and/or specific cardiac troponin I measurements, we did not identify specific myocardial damage following gastroesophageal reflux laparoscopic surgery. Unexpectedly, the incidence of hepatic cytolysis was frequent (62%) and has not previously been reported in the literature.
A catheter technique in ophthalmic regional anaesthesia
Authors: László C. J. , Gombos K. , Vimláti L. , Salacz G. , Hatvani I.
Published: March 2003

Background: Regional anaesthesia for ophthalmic surgery is generally accomplished by peri‐ or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri‐ or retrobulbar space continuously.

Methods: Twenty‐five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra‐ or intraconal space. Methylene blue solution was injected through the catheter.

Results: Using the same transcutaneous retro‐ and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra‐ or extraconally.

Conclusion: Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra‐ or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.
Tubeless combined high‐frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesia
Authors: Ihra G. , Hieber C. , Adel S. , Kashanipour A. , Aloy A.
Published: March 2003

Background: High‐frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children.

Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low‐frequency (LF) and a high‐frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed.

Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months–10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia.The mean duration of supralaryngeal HFJV was 46 min (range 15–75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4–1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7–1.0 bar and 0.9–1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively.

Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea.
Reciprocating tachycardia during central venous cannulation in a patient with Wolff‐Parkinson‐White syndrome
Authors: Diz J. C. , Rodriguez J. , Blanco E. , Alvarez J.
Published: March 2003

Wolff‐Parkinson‐White syndrome is important for the anesthesiologist because the sudden development of tachyarrhythmias may result in deleterious hemodynamic changes. We describe an episode of reciprocating tachycardia triggered by the insertion of the guide wire during central venous cannulation in a patient with this syndrome.
Pain intensity and side effects during titration of morphine to cancer patients using a fixed schedule dose escalation
Authors: Klepstad P. , Kaasa S. , Skauge M. , Borchgrevink P. C.
Published: March 2003

Background: Considerable dose variations and frequent initial side effects have been postulated during start of morphine treatment to patients with pain caused by malignant disease. However, to our knowledge, only one previous study has reported effective doses in morphine naive cancer patients and no prospective evaluation has compared symptoms before with symptoms during morphine titration.

Methods: We recruited 40 cancer patients with uncontrolled pain despite receiving codeine or dextropropoxyphen. Baseline data were obtained for two days before start of morphine titration using a fixed scheduled escalation of immediate‐release (IR) morphine. When a stable morphine dose was achieved, IR morphine was replaced with slow‐release (SR) morphine in equivalent doses. Intensity of pain and side effects were assessed daily. The daily consumption of morphine, rescue analgesics and rescue antiemetics were registered.

Results: The mean titration time to achieve adequate analgesia was 2.3 days (range: 1–6) using a mean daily morphine dose of 97 mg (range: 60–180). Nausea was unaltered after start with morphine but an increased incidence of vomiting occurred (premorphine period 5%, IR morphine period 29%). Transient sedation delayed dose increment in 9 of the 40 patients but mean sedation scores were unaltered. Constipation scores increased while other side effect scores were unaltered. Eighty‐two percent of the patients were satisfied or very satisfied with the pain treatment during introduction of morphine.

Conclusion: In cancer patients with uncontrolled pain on weak opioids, successful titration of morphine is achieved fast, with a three‐fold morphine dose variation and with little increase in side effects.
Marked enhancement of anti‐allodynic effect by combined intrathecal administration of the adenosine A1‐receptor agonist R‐phenylisopropyladenosine and morphine in a rat model of central pain
Authors: Von Heijne M. , Hao J.‐X. , Sollevi A. , Xu X.‐J. , Wiesenfeld‐Hallin Z.
Published: March 2003

Background: There is often no satisfactory treatment for chronic pain after spinal cord injury. We have previously reported that intrathecal (i.t.) administration of the adenosine A1‐receptor agonist R‐phenylisopropyl‐adenosine (R‐PIA) or the opioid morphine has anti‐allodynic effects in a model of presumed chronic central pain after photochemically induced spinal cord injury in rats. In the present study, we set out to investigate the possible interaction between i.t. R‐PIA and morphine in spinally injured rats.

Methods: Sprague‐Dawley rats displaying allodynia‐like behaviors to mechanical and cold stimuli after photochemically induced spinal cord injury with minor motor deficits were used. R‐PIA and morphine, either alone or in combination, were administered i.t. through an implanted catheter to lumbar spinal cord.

Results: Cumulative doses of R‐PIA or morphine dose‐dependently reduced the mechanical allodynia‐like behavior, with a threshold of 1 nmol and 1.5 nmol, respectively. When co‐administrated, R‐PIA and morphine produced marked suppression of mechanical allodynia at doses of 5 pmol and 7.5 pmol, respectively. The effect of i.t. co‐administration of R‐PIA and morphine on cold allodynia was comparable to i.t. R‐PIA alone. The combination of R‐PIA and morphine did not increase adverse effects such as motor deficits in comparison to either drug alone.

Conclusion: These results demonstrate a supra‐additive interaction between the adenosine A1‐receptor agonist R‐PIA and morphine to reduce mechanical allodynia‐like behavior in rats with chronic spinal cord injury. The combination of R‐PIA and morphine administered spinally may be superior to R‐PIA or morphine alone for treating such pain.
Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia
Authors: Schlaich N. , Mertzlufft F. , Soltész S. , Fuchs‐Buder T.
Published: March 2003

Background: The use of muscle relaxants in outpatient anaesthesia is controversial; some authors recommend an induction regimen including propofol and opioids without muscle relaxants. This study evaluated the requirements for rocuronium after remifentanil/propofol.

Methods: We examined in four groups of ASA I–II patients (n=30 for each) the intubating conditions three minutes after induction of anaesthesia with remifentanil 0.5 μg kg−1 min−1, propofol 2 mg kg−1 without muscle relaxants or with different doses of rocuronium (0.6 mg kg−1, 0.45 mg kg−1, 0.3 mg kg−1) applying the criteria proposed by the Copenhagen Consensus Conference. In the second part of the study the time course of neuromuscular block was determined by electromyography using train‐of‐four (TOF) stimulation. To this end, another 60 ASA I–II patients were randomly assigned to receive remifentanil 0.5 μg kg−1 min−1, propofol 2 mg kg−1 and either rocuronium 0.6 mg kg−1, 0.45 mg kg−1, 0.3 mg kg−1, or 0.3 mg kg−1 followed by neostigmine 40 μg kg−1 and atropine 20 μg kg−1 at a T1 recovery of 10% (n=15 for each).

Results: Intubating conditions were good or excellent in 30 patients after rocuronium 0.6 mg kg−1 and in 18 patients when rocuronium was omitted (P<0.01). After 0.45 mg kg−1 and 0.3 mg kg−1 rocuronium the numbers were 29 and 30 patients, respectively. Reducing rocuronium from 0.6 mg kg−1 to 0.45 mg kg−1 or 0.3 mg kg−1 increased the onset time from 136 (35) s to 199 (34) s and 249 (52) s (mean (SD)), (P<0.01); the clinical duration decreased from 38 (10) min to 24 (8) min and 16 (5) min, respectively (P<0.01); and the duration to a TOF‐ratio of 0.8 decreased from 60 (11) min to 45 (9) min and 34 (7) min (P<0.01). After rocuronium 0.3 mg kg−1 this time interval further decreased to 22 (3) min when neostigmine was given at a T1 of 10% (P<0.01 compared with spontaneous recovery after rocuronium 0.3 mg kg−1).

Conclusion: After remifentanil/propofol intubation conditions were poor in 40% of patients without muscle relaxants; adding reduced doses of rocuronium to this regimen improved the intubation conditions significantly. In addition, reducing the initial dose of rocuronium markedly shortened its time course of action.
Esmolol cardioplegia in unstable coronary revascularisation patients
Authors: Rinne T. , Harmoinen A. , Kaukinen S.
Published: March 2003

Background: Esmolol has been studied and applied to control hypertension and tachycardia during open heart surgery. Esmolol has been used on a minor scale as a single cardioplegic agent. Little information is available on esmolol as a component of blood cardioplegia. In this prospective, randomised, double‐blind clinical study we investigated whether esmolol improves cardioprotection in patients scheduled for an urgent coronary operation.

Methods: Forty patients with unstable angina were operated using cold blood cardioplegia as the basic cardioprotective method. Cardioplegia was infused intermittently, and esmolol was given into the cardioplegia line (15 mg/min) during cold infusions. Patients with ongoing myocardial infarction were excluded.

Results: The arrest time during the cardioplegic induction or the rate of spontaneous resumption of the heart rhythm did not differ significantly between the groups. The serial measurements of plasma creatine kinase MB‐fraction activity (P=0.27), serum creatine kinase MB‐fraction mass assay (P=0.16), troponin I (P=0.41) and myoglobin (P=0.14) similarly did not differ between the groups, nor did myocardial lactate extraction (P=0.12).

Conclusion: Esmolol addition to blood cardioplegia did not increase the efficacy of cardioprotection in the present study setting in unstable patients during urgent coronary revascularisation.
Topical tenoxicam from pharyngeal pack reduces postoperative sore throat
Authors: Elhakim M. , Siam A. , Rashed I. , Hamdy M. H.
Published: March 2003

Background: One puff of beclomethasone inhaler has been shown to reduce the incidence of sore throat following endotracheal intubation. The aim of this study was to determine the effect of a pharyngeal pack on the incidence of sore throat and whether tenoxicam‐impregnated gauze pack significantly influenced the frequency of sore throat.

Methods: Eighty patients undergoing general anaesthesia for elective surgery of the nasal septum were evaluated. The anaesthetist sprayed the upper airway towards the trachea with one puff of beclomethasone inhaler (50 μg) before orotracheal intubation. Patients were randomly assigned to have either a 0.2% tenoxicam‐ or a 0.9% saline‐impregnated gauze pack in the oropharynx during operation. They were evaluated for occurrence and severity of postoperative sore throat by direct questions 12–24 h after surgery.

Results: Four patients who experienced any symptoms in the tenoxicam group scored mild sore throat compared to 16 patients in the control group scoring mild, gradually developing moderate or severe sore throat (P<0.01). No drug‐related side effects were observed.

Conclusion: The intraoperative use of a tenoxicam‐impregnated gauze pack is effective in reducing moderate or severe postoperative sore throat following the use of throat pack.
Changes in rapidly extracted auditory evoked potentials during tracheal intubation
Authors: Urhonen E. , Jensen E. W. , Lund J.
Published: March 2003

Background: One of the problems encountered in assessment of the hypnotic level during anesthesia is the extraction of a consistent and reliable measure online and close to real time. Hemodynamic parameters such as heart rate and blood pressure are not, at least with the traditional single parameter versus time presentation, adequate for ensuring an optimal level of anesthesia, especially when using neuromuscular blocking agents (NMBA). In the literature, it has been demonstrated that auditory evoked potentials (AEP) are able to provide two aspects relevant to determining level of anesthesia: firstly, they have identifiable anatomical significance and, secondly, their characteristics reflect the way the brain perceives a stimulus.

Methods: The aim of this study was to evaluate the AEP index based on a system identification model, the autoregressive model with exogenous input (ARX‐model), and to compare it to the classical method, the moving time average (MTA). The ARX enables the extraction within 15–25 sweeps, depending on the signal‐to‐noise ratio (SNR), whereas MTA typically needs 250–500 sweeps. The hypothesis of the present study was that since the ARX‐model extracts the AEP faster than the MTA‐model, the former should be able to detect changes during the brief, intense stimulus of endotracheal intubation. Twelve female patients scheduled for gynecological surgery were included in the study. Anesthesia was initiated with thiopentone and maintained with isoflurane and alfentanil. The AEP was mapped into an index (AEP‐index) normalized to 100 when the individual was awake and decreasing to an average of 25 during thiopentone induced anaesthesia. The results were compared to those obtained by MTA‐extracted AEP.

Results: During tracheal intubation 9 patients showed an increase in the ARX‐extracted AEP‐index larger than 15, and 6 of these patients showed an increase larger than 25 (mean increase=33, SD=18). The MTA‐extracted AEP‐index showed only one patient with an increase larger than 15. The ARX‐extracted AEP changed significantly faster than the MTA‐extracted AEP.

Conclusion: The ARX‐extracted AEP‐index increases during tracheal intubation. There is a significant difference between the ARX‐extracted AEP and the traditional MTA‐extracted AEP, in terms of response time. In order to trace short‐lasting changes in the hypnotic level by AEP, the AEP should be extracted by a method with a fast response such as the ARX‐model.
Use of the laryngeal mask for placement of a bronchial blocker in children
Authors: Asai T. , Oishi K. , Shingu K.
Published: March 2003

For one‐lind ventilation in children, a bronchial blocker (e.g. Fogarty catheter) is often used, but its insertion may not be easy. We report a new method of placement of a bronchial blocker in an infant, using the laryngeal mask.
Risk factors for postoperative anxiety in children
Authors: Caumo W. , Broenstrub J. C. , Fialho L. , Petry S. M. G. , Brathwait O. , Bandeira D. , Loguercio A. , Ferreira M. B. C.
Published: March 2003

Background: Anxiety is defined as a set of behavioural manifestations that can be divided into state‐ and trait‐anxiety. State‐anxiety is a transitory emotional condition that varies in intensity and fluctuates over time. Trait‐anxiety is a personality trait which remains relatively stable over time. The objective of this study was to identify and quantify perioperative risk factors for immediate postoperative anxiety in children.

Methods: A prospective cohort study was performed with 90 schoolchildren, ages ranging from 7 to 13 years old, ASA physical status I–II, submitted to elective surgery. The measuring instruments were verbal scale of pain, visual analogue scale (VAS), Trait‐State Anxiety Inventory for Children (STAIC), Trait‐State Anxiety Inventory (STAI) for parents, and structured questionnaire.

Results: Patients not submitted to analgesic block and patients with moderate and intense pain presented an estimated risk 5‐ and 13‐fold greater for high levels of postoperative state‐anxiety, respectively. High levels of preoperative state‐anxiety and administration of doses of midazolam less than 0.056 mg · kg−1 constituted an estimated risk for postoperative state‐anxiety of 3‐ and 4‐fold, respectively. A positive history of previous surgery was associated with lower risk for postoperative anxiety.

Conclusions: High levels of preoperative state‐anxiety, administration of less than 0.056 mg · kg−1 of midazolam, absence of analgesic block and presence of moderate and intense postoperative pain constituted risk factors for immediate postoperative state‐anxiety in children. Previous surgery reduced the risk for postoperative anxiety.
Occupational exposure to inhaled anaesthetics: A follow‐up study on anaesthetists of an eastern European university hospital
Authors: Wiesner G. , Harth M. , Hoerauf K. , Szulc R. , Jurczyk W. , Sobczynski P. , Hobbhahn J. , Taeger K.
Published: March 2003

Background: Although no dose–response relationship for the health risks associated with the occupational exposure to inhaled anaesthetics exists, public health authorities recommend threshold values. The aim of the present study was to assess if and to what extent these threshold values are exceeded in an eastern European university hospital before and after measures had been taken to reduce occupational exposure.

Methods: At nine workplaces occupational exposure of anaesthetists to nitrous oxide and halothane or isoflurane was measured by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces and an air‐conditioning system at one workplace.

Results: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared to 1996. In 1997 most of the nitrous oxide values still exceeded the threshold value of 100 ppm, whereas most of the halothane and isoflurane values were already below the threshold values of 5 ppm and 10 ppm in 1996.

Conclusion: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach western European standards. These efforts comprise structural measures such as active scavenging devices and air‐conditioning systems at all workplaces, the use of total intravenous anaesthesia, low‐flow anaesthesia and an appropriate working technique.
Anaesthesia for patients with a transplanted organ
Authors: Toivonen H. J.
Published: March 2003

Increasing numbers of individuals leading normal lives have transplanted organs. They may appear in any hospital for treatment of trauma or general diseases. Common anaesthesia methods can be used for these patients, but safe conduct of anaesthesia requires knowledge of the immunosuppression, risk factors, and altered physiology or drug actions. This article reviews the anaesthesia‐related literature on patients with transplanted organs.
Intrathecal adenosine administration in abdominal hysterectomy lacks analgesic effect
Authors: Rane K. , Sollevi A. , Segerdahl M.
Published: March 2003

Background: Adenosine (Ado) is known, from studies in both animals and humans, to produce antinociception when administered systemically or intrathecally (IT). The current aim was to evaluate, in a placebo‐controlled, randomised, double‐blind study, whether IT adenosine given before surgery could reduce anaesthetic requirement and the need of opioids during 48 h after visceral surgery.

Method:

Forty women (37–66 years, ASA I and II) scheduled for elective hysterectomy were included. Before inducing the standardised O2/N2O/isoflurane/fentanyl anaesthesia, the patients received an IT injection of either adenosine (500 μg in 1 ml volume) or placebo 1 ml (saline). Intraoperative anaesthetic drug doses and haemodynamics were recorded. Postoperative pain was assessed by visual analogue scale. For postoperative analgesia, cetobemidone was provided via intravenous patient‐controlled analgesia (PCA).

Results: During surgery, there were no differences between groups in anaesthetic requirement or haemodynamic parameters. Postoperative cetobemidone requirements were similar in both groups (median 48 mg for adenosine/50 mg for saline) during the first 48 postoperative hours.

Conclusion: IT adenosine did not influence the requirement of anaesthetic drug or postoperative analgesics after hysterectomy.
A comparison of three doses of sufentanil in combination with bupivacaine‐adrenaline in continuous epidural analgesia during labour
Authors: Eriksson S. Ledin , Frykholm P. , Stenlund P.‐M. , Olofsson CH.
Published: March 2003

Background: Sufentanil is now frequently added to local anaesthetic in labour epidural analgesia. However, this opioid has some side effects such as pruritus, and in higher doses could harm the neonate. The purpose of this study was to compare three doses of sufentanil combined with low‐dose bupivacaine, to determine the lowest appropriate dose.

Method:

In a prospective, randomized, double‐blind study, 243 parturients were randomized, to receive A – 0.5 μg/ml, or B – 0.75 μg/ml or C – 1 μg/ml sufentanil, in addition to bupivacaine 0.625 mg/ml+adrenaline 1.25 μg/ml. All were given an 8 ml bolus of the study solution, followed by continuous infusion at 6 ml/h. The analgetic effect was scored on a visual analogue scale (VAS). Onset quality was measured as VAS after 20 min, the total effect as VAS maximum during the first stage of labour. Overall maternal satisfaction was recorded within two hours post partum. Side effects were noted.

Results: There were no differences between groups in VAS assessments after 20 min or in maximum registered VAS. In group A, 83% had VAS 0–4 after 20 min, in group B 77% and in group C 71%. Maximum VAS during the first stage was 0–4 for 60% of group A, 68% of group B and 61% of group C . Maternal satisfaction was also the same in the three groups. In group A, 70% reported excellent effect and 22% good effect. The corresponding figures in group B were 68% and 24% respectively, and in group C 62% and 24% respectively. Group A received a mean total dose of 21 μg sufentanil, group B 30 μg and group C 44 μg. Pruritis occurred in 51% of group A, 53% of group B and 65% of group C.

Conclusion: We found no difference in the analgesic effect between three different concentrations of sufentanil. We conclude that the lowest dose may be used. This should decrease the risk of adverse effects on mother and child.
The N‐methyl‐D‐aspartate‐receptor antagonist dextromethorphan lacks analgesic effect in a human experimental ischemic pain model
Authors: Plesan A. , Sollevi A. , Segerdahl M.
Published: March 2003

Background: N‐methyl‐D‐aspartate‐receptor antagonists may be useful in pain management. The aim of this study was to evaluate dextromethorphan (DEX), a commonly used oral antitussive drug with NMDA‐receptor antagonistic properties, in respect of its analgesic properties as single drug and co‐administered with morphine (MO) on experimental ischemic pain. In addition, the analgesic effects of another clinically available NMDA‐receptor antagonist, ketamine (KET) as well as of morphine (MO) were tested as active controls.

Methods: Nineteen healthy volunteers were included in the study. Experimental ischemic pain was induced using the forearm tourniquet test. Placebo (PLAC), oral DEX (30 and 90 mg, respectively), KET (9 μg kg−1 min−1 i.v.), MO (0.1 mg kg−1 i.v.) and the DEX+MO and KET+MO combinations were evaluated during eight separate experiments. Development of ischemic pain was rated by visual analog scale (VAS) every minute over 30 min and ratings were summed as sum of pain scores (SPS).

Results: DEX by itself did not influence SPS compared to PLAC. The DEX+MO co‐administration did not enhance MO‐induced analgesia. MO and KET reduced pain ratings by 27% and 39%, respectively. The KET+MO combination showed no enhancement of the analgesic effect in comparison with the respective drugs in monotherapy.

Conclusion: DEX in clinical doses has no effect on the present acute ischemic pain model and does not influence MO‐induced analgesia. Further studies on other pain modalities are needed in order to evaluate the potential use of DEX in pain treatment.
Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy
Authors: Elhakim M. , Amine H. , Kamel S. , Saad F.
Published: March 2003

Background: Previous work has demonstrated that intraperitoneal (i.p.) lidocaine may provide analgesia after laparoscopic cholecystectomy. The aim of this prospective, randomized, double‐blind study was to compare pain relief, recovery variables, and side effects after i.p. instillation of lidocaine plus tenoxicam given either i.v. or i.p. after laparoscopic cholecystectomy.

Methods: Ninety patients were randomly allocated to one of three groups to receive either 200 ml normal saline i.p. and 2 ml of normal saline i.v. (saline group), 200 ml lidocaine 0.1% i.p. and 2 ml tenoxicam 20 mg i.v. (tenoxicam i.v. group), or 200 ml lidocaine 0.1% with 20 mg tenoxicam i.p. and 2 ml of normal saline i.v. (tenoxicam i.p. group). The i.p. instillation was made under the right diaphragm and on the gall bladder bed. VAS pain scores at rest, on movement and during coughing, were measured 2, 4, 6, 12, and 24 h after operation. The time to first demand of analgesia, total analgesic requirement, recovery variables, and side effects were investigated.

Results: In the tenoxicam i.p. group, pain scores were significantly lower both at rest and on movement and analgesic consumption was reduced compared with the saline group (P<0.05). In the tenoxicam i.v. group, pain scores at rest were significantly lower compared with the saline group. Although recovery of bowel function was significantly faster in the tenoxicam i.p. group (P<0.05), there were no differences in any other recovery characteristics or incidence of nausea between the groups.

Conclusion: Combination of intraperitoneal lidocaine and tenoxicam provided better analgesia on movement, and faster return of bowel function compared with i.p. lidocaine and i.v. tenoxicam during the 24 h period after surgery.
The effect of the obstetrician group and epidural analgesia on the risk for cesarean delivery in nulliparous women
Authors: Beilin Y. , Friedman F. , Andres L. A. , Hossain S. , Bodian C. A.
Published: March 2003

Background: The effects of regional anesthesia and of the obstetrician on the risk of cesarean delivery remain controversial. The purpose of this study was to determine whether epidural analgesia or the obstetrician group is associated with an increase in the risk for cesarean delivery in nulliparous women.

Methods: Data were collected for a two‐year period from the medical records of all nulliparous women who had a private obstetrician who delivered >20 babies per year, and who presented with a singleton gestation in the vertex presentation for a trial of labor.

Results: Data were collected for 3699 women of whom 1832 were nulliparous. Of the 1832 nulliparous women, data were analyzed for the 1278 women who met our study criteria, representing 14 separate obstetrician groups. Excluding the 50 women whose babies were delivered for fetal distress (leaving 1228 women for analysis), the epidural rate was 93%, range 81–98%, and the cesarean delivery rate was 14%, range 8–34%. Logistic regression analyses revealed that (odds ratio, 95% confidence interval) patient age (1.7, 1.2–2.4), birth weight (1.001, 1.001–1.002), induction of labor (1.9, 1.3–2.7), non‐Caucasian (1.9, 1.2–2.9) and the obstetrician group, (P=0.002), were independently associated with the risk of cesarean delivery, but epidural analgesia was not (1.6, 0.7–3.6).

Conclusions: The obstetrician group is independently associated with the risk of cesarean delivery in nulliparous women, but we could not demonstrate this association with epidural analgesia. We suggest that in future studies regarding epidural analgesia and cesarean delivery, the obstetrician group should be included as a variable (
Note).
Helicopter emergency medical service in out‐of‐hospital cardiac arrest – a 10‐year population‐based study
Authors: Skogvoll E. , Bjelland E. , Thorarinsson B.
Published: March 2003

Background: In 1988, Norway established a countrywide, physician staffed helicopter emergency medical service (HEMS). The medical benefit remains controversial. The aim of this study was to estimate the population incidence of HEMS involvement in out‐of‐hospital cardiac arrest, report the patient outcome and evaluate the contribution of HEMS to survival.

Methods: We studied HEMS operations in central Norway (population 364 000) during a 10‐year period (1988–1997). Missions were classified according to type and quality of intervention done by the primary care providers. HEMS witnessed cardiac arrests were not considered. Patient outcome was determined as survival to hospital discharge with cerebral performance category (CPC) score. The contribution made by HEMS in each survivor was assessed from the timing of return of spontaneous circulation (ROSC) and from subsequent need for advanced medical intervention. The relation between survival and HEMS response time was investigated by ordinal correlation.

Results: A total of 541 requests (14.9 per 100 000 inhabitants per year) were identified, of which 424 missions were completed. Overall survival to discharge was 36/541 (6.6%), yielding a population survival incidence of 1 per 100 000 per year. Ninety‐five percent of survivors made a favourable cerebral outcome (CPC 1 or 2). General practitioners/ambulance personnel resuscitated 29 out of 36 survivors. The remainder achieved ROSC after HEMS arrival. Case by case, HEMS assistance was considered possibly important in 17 survivors. We found no relation between survival and HEMS response time (P=0.77).

Discussion:

Survival following out‐of‐hospital cardiac arrest assisted by HEMS in this region is low, but not negligible. While primary care is most important, HEMS may possibly contribute to the additional survival of 0.19 to 0.46 patients per 100 000 per year. This benefit appears to be independent of HEMS response time ( Note).
Elastic pressure–volume curves indicate derecruitment after a single deep expiration in anaesthetised and muscle‐relaxed healthy man
Authors: Sigurdsson S. , Svantesson C. , Larsson A. , Jonson B.
Published: March 2003

Background: In acute respiratory distress syndrome, lung volume is lost immediately after positive end‐expiratory pressure (PEEP) is removed and is not immediately regained when PEEP is restored to its original value. The aim of this study was to investigate whether the same phenomenon also occurs in cardiopulmonary healthy individuals during anaesthesia and muscle relaxation.

Methods: In 13 anaesthetised and muscle‐relaxed patients, inspiratory elastic pressure–volume (Pel–V) curves were, after lung recruitment, obtained from zero end‐expiratory airway pressure (ZEEP) and from a PEEP of 5 cmH2O. The curves were aligned on a common volume axis. Differences in lung volumes and compliance (Crs) were calculated at the different airway pressures.

Results: At comparable pressures the ZEEP curve showed significantly lower volumes up to an airway pressure of 25 cmH2O. Maximum Crs was similar on the curves obtained from ZEEP and PEEP. However, the lower segments of the curve recorded from PEEP showed lower Crs compared to the curve recorded from ZEEP.

Conclusion: During anaesthesia and muscle paralysis, the Pel–V relations change immediately when 5 cmH2O of PEEP is removed. This phenomenon is probably mainly caused by closure of small airways and only in a minor part, if any, by formation of atelectasis. This study indicates that under these conditions lung volume might easily be normalised by a large breath producing an airway pressure of 20 cmH2O.
Intraperitoneal tonometry for detection of regional enteric ischaemia
Authors: Koga I. , Stiernstrom H. , Christiansson L. , Wiklund L.
Published: March 2003

Background: The objective of this study was to test the hypothesis that intraperitoneal tonometry can be a specific monitor for ischaemia in the small intestine.

Methods: Twelve pigs were anaesthetized and mechanically ventilated. The celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) were identified. Tonometry catheters were positioned intraperitoneally at three different locations where blood supply varied. One at a time of the mesenteric arteries was occluded, producing regional ischaemia in different splanchnic organs.

Results: Regional PCO2 (Pr CO2) increased significantly in the intestinal region, in the small intestine, only during the SMA clamping. In the epigastric region, i.e. in the space between the liver and the stomach, PrCO2 increased significantly only during CA clamping.

Conclusion: Intraperitoneal tonometry in the intestinal region can be a specific monitor of ischaemia in the small intestine.
Heparin‐induced thrombocytopenia thrombosis after cardiac surgery. A case report
Authors: Antoniou TH. , Stavridis G. , Daganou M. , Melissari E. , Gatzonis S.
Published: March 2003

We report a rare case of cerebral infarct resulting in brain death due to heparin‐induced thrombocytopenia thrombosis (HITT), manifested in the immediate postoperative period following aortic valve replacement in a 46‐year‐old woman whose only prior exposure to heparin was during catheterization four months prior to surgery. The diagnosis of HITT was suspected after a significant decrease of the platelet count and it was confirmed by a heparin‐induced platelet activation assay showing platelet aggregation in the presence of heparin.