bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of heparin and low molecular weight heparin on lipid transport during parenteral feeding in the rat
Authors: Rothi B , Ekelund M. , Fan B.‐G. , Ekstroivi U. , Nilsson‐Ehle P.
Published: January 2009

Background: Treatment with heparin has been reported to interfere with lipid metabolism by release of Lipoprotein Lipase (LPL) into the circulation. The purpose of the present study was to determine the effects on LPL activity by anticoagulants in combination with total parenteral nutrition (TPN) in the rat. In an earlier investigation we could show that TPN, per se, caused a three‐fold increase of triglyceride content in liver tissue, retention of lipids in the circulation and disturbed cholesterol metabolism with accumulation of cholesterol in the non High Density Lipoprotein (HDL) fraction of lipoproteins. The activity of Hepatic Lipase (HL) was decreased, while the activities of LPL in adipose tissue and heart were up‐regulated.

Methods: Effects on lipid metabolism by TPN for seven days with or without simultaneous administration of heparin or Low Molecular Weight Heparin (LMWH) were studied in 52 healthy male Sprague‐Dawley rats. Combinations of Heparin or LMWH and discontinuous or continuous administration of TPN solutions (including approximately 8g triglycerides/kg body weight daily) were investigated.

Results: Addition of LMWH, but not heparin, to treatment with TPN resulted in significant up‐regulation of LPL activity in the heart. Combination of heparin and continuous administration of TPN solutions was followed by modest, but significant, increases of S‐Triglycerides and HDL‐Triglycerides. No differences between the TPN groups were observed concerning liver steatosis, cholesterol metabolism, phospholipid metabolism or HL activity.

Conclusion: Treatment with LMWH during TPN resulted in up‐regulated LPL activity in the heart, which might represent a compensatory mechanism for enzyme release from the capillary walls induced by anticoagulants. Administration of heparin, a more effective lipase‐releasing agent, was not associated with increased LPL activity. Heparin treatment in combination with continuous TPN administration was followed by increased levels of triglycerides in blood and HDL particles, suggesting that treatment with heparin might have impaired the capacity for LPL up‐regulation, resulting in the development of hyperlipidemia. Further investigations are necessary for evaluation of the mechanisms. Depletion of LPL activity could not be demonstrated by this study in healthy rats.
Leucocyte depletion filter removes cancer cells in human blood
Authors: Kongsgaard U. E. , Wang M. Y. , Kvalheim G.
Published: January 2009

Background. Autologous blood transfusion has been avoided in cancer surgery because of the metastatic potential of reinfused tumour cells.

Methods. This study evaluated the efficacy of a blood transfusion filter in removing tumour cells from blood. Whole human blood was admixed with two different malignant cell lines (breast cancer PMI and MCF7). The blood was filtered through a RC400TE leucocyte depletion filter. Unfiltered blood was used as a control. Detection of malignant cells was performed with immuno‐magnetic beads and clonogenic assays.

Results No viable tumour cells were found after filtration with the leucocyte depletion filter.

Conclusion. These findings suggest that the use of a leucocyte filter after intra‐operative blood salvage may make autotrans‐fusion safe even in tumour surgery.
Hypertonic‐hyperoncotic solution increases canine lymph flows
Authors: Wickerts C.‐J. , Berg B. , Blomqvist H.
Published: January 2009

Background: Hypertonic‐hyperoncotic solutions (HHS) have attracted a lot of interest in the treatment of various forms of hypovolaemic conditions during the last decade. It has been speculated that HHS might even be of therapeutic value in normo‐ and hypervolaemic conditions by mobilising extravascular fluid.

Methods: We studied thoracic and abdominal lymphatic flows and circulatory response following the administration of a single bolus injection of hypertonic‐hyperoncotic solution, 10% dextran 60 in 7.2% saline (HHS), in a nonhypovolaemic canine model. A modified surgical procedure for collecting thoracic lymp is also presented.

Results: Both thoracic and abdominal lymph flow increased significantly by approximately 50% after administration of HHS. Cardiac output and calculated pulmonary capillary hydrostatic pressure increased.

Conclusion: Hypertonic‐hyperoncotic solution given intravenously as a single injection increased both thoracic and abdominal lymph flows in the initially normovolaemic animal.
Balanced analgesia improves recovery and outcome after outpatient tubal ligation
Authors: Eriksson H. , Tenhunen A. , Korttila K.
Published: January 2009

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission.

Ninety patients were randomised to this double‐blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. The balanced analgesia group received 5 ml of 2% lidocaine gel on the sterilization clips and perioperatively 200 mg of ketoprofen i.v. The lidocaine group received 5 ml of 2% lidocaine gel on the clips and placebo i.v. perioperatively. The placebo group received 5 ml of placebo gel on the clips and placebo i.v. perioperatively. Infusion of propofol and 67% nitrous oxide in oxygen were used for maintenance of anesthesia. Succinylcholine and vecuronium were used for muscle relaxation and 0.1 mg of fentanyl i.v. was given to dl patients at induction of anesthesia.

Postoperative pain and analgesic requirements, incidence of POW and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70–90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day).

It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.
The influence of alfentanil pre‐treatment on ventilatory effects of doxapram following induction of anaesthesia with propofol
Authors: O‘connor B. , Levy D. M. , Peacock J. E.
Published: January 2009

Background: Hypoventilation may occur following induction of anaesthesia with propofol and is potentiated by concurrent use of opioid drugs. This effect is undesirable in patients who will continue to maintain spontaneous respiration during anaesthesia and surgery. The analeptic drug doxapram is known to have selective respiratory stimulatory effects but its action during induction of anaesthesia has been inconsistent.

Method: In a double‐blind, placebo‐controlled study, the influence of alfentanil pre‐treatment on the ventilatory effects of doxapram given during induction of anaesthesia with propofol was studied in 40 patients. Four groups of ten patients (two groups pre‐treated with 7 μg·kg‐1 of alfentanil and two groups with saline) were randomly allocated to receive either 0.5 mg·kg‐1doxapram or saline following infusion of propofol to loss of verbal contact.

Results: In the groups that received doxapram, minute volumes were significantly increased and end‐tidal carbon dioxide concentrations were significantly reduced compared to control groups, although the duration and extent of these effects were less in the group that received alfentanil. Doxapram also reversed an alfentanil‐induced reduction in respiratory rate. No adverse cardiovascular or neurological stimulatory effects of doxapram were evident at any time.

Conclusion: We conclude that doxapram 0.5 mg·kg‐1 is effective in augmenting ventilation that has been obtunded following induction of anaesthesia with propofol in patients pre‐treated with alfentanil.
Midlatency auditory evoked potentials during anaesthesia with increasing endexpiratory concentrations of desflurane
Authors: Schwender D. , Klasing S. , Conzen P. , Finsterer U. , Pöppel E. , Peter K.
Published: January 2009

Background. Under general anaesthesia with the volatile anaesthetics halothane, enflurane and isoflurane, midlatency auditory evoked potentials (MLAEP) are suppressed dose‐dependently. Therefore, MLAEP have been used to measure depth of anaesthesia and to indicate intraoperative awareness. Desflurane is a new volatile anaesthetic and its effects on MLAEP have not been studied previously.

Methods. We have studied MLAEP during general anaesthesia with increasing endexpiratory concentrations of desflurane in 12 patients scheduled for elective gynaecological surgery. Auditory evoked potentials were recorded in the awake state and during anaesthesia with endexpiratory steady state concentrations of 1.5, 3.0, 4.5 and 6.0 vol %, of desflurane on vertex (positive) and mastoids on both sides (negative). Latencies of the peaks V, Na, Pa, Nb, Pl (ms) and amplitudes Na/Pa, Pa/Nb and Nb/Pl (μV) were measured.

Results. In the awake state, MLAEP had high peak‐to‐peak amplitudes and a periodic waveform. During general anaesthesia with increasing endexpiratory concentration of desflurane, the latency of the brainstem response V increased only slightly. In contrast, MLAEP showed a marked dose‐dependent and statistically significant increase in latencies of Na, Pa, Nb and Pl and decrease in amplitudes of Na/Pa, Pa/Nb and Nb/Pl. Under 6.0 vol % of desflurane MLAEP were severely attenuated or even abolished.

Conclusion. Based on these observations, endexpiratory concentrations of ≥4.5 vol % desflurane should suppress awareness phenomena such as auditory perceptions during anaesthesia.
Systemic and central effects of morphine on gastroduodenal motility
Authors: Thorn S.‐E. , Wattwil M. , Lindberg G. , Säwe J.
Published: January 2009

Gastrointestinal side effects still constitute a major drawback in both acute and chronic use of opioids. The exact mechanism behind the gastrointestinal effects is not known, but experimental studies indicate both central and peripheral actions.

In an attempt to clarify to what extent the systemic effects of morphine after epidural administration contribute to the action on gastrointestinal motility, a study aiming to resemble the situation with epidural morphine was designed. Twenty healthy male volunteers were randomly allocated to two groups. Group one (n = 10) received intrathecal (0.4 mg) and intramuscular (4 mg) morphine (IT‐IM‐group). Group two (n=10) received intrathecal (0.4 mg) morphine and i.m. saline (IT‐group).

Gastroduodenal activity was assessed by gastric emptying, manometry and electrogastrography. The plasma and urine concentrations of morphine and its inactive metabolite morphine‐3‐ and active metabolite morphine‐6‐glucuronide were also determined

During the fasted state the gastrointestinal activity is characterised by a cyclic pattern with a duration of 80–120 min in the duodenum comprising three different phases with intense activity during Phase III. This pattern was seen in all volunteers. After the intrathecal administration the Phase III activity occurred significantly earlier in the IT‐IM group (median 31 min; IR 34 min) compared to IT group (82 min; 37 min) (P< 0.01). The number of Phase IIIs was higher in the IT‐IM group during the first 4 h after the morphine administration, compared to the IT group. However, after 6 h, there was no difference between the groups. The propagation velocity of Phase III decreased significantly in both groups (P< 0.001), but there was no difference between the groups. Tachygastria increased significantly with time in both groups. The acetaminophen absorption test showed that the area under the concentration curve (120 min) was significantly smaller in the IT‐IM group compared to the IT group (P< 0.05). There were no measurable plasma concentrations of morphine or the gluco‐ronidated metabolites M3G and M6G in the group that only received intrathecal morphine.

This study showed that intrathecal morphine (0.4 mg) influenced gastroduodenal motility and that intramuscular morphine (4 mg) gave additional effects. These results might be applicable to the epidural situation and are indirect evidence that the gastroduodenal effects of epidural morphine are caused by both central and systemic effects of morphine.
No additional metal particle formation using the needle‐through‐needle combined epidural/spinal technique
Authors: Herman N. , Molin J. , Knape K. G.
Published: January 2009

Background. Combined epidural/spinal analgesia utilizing a needle‐through‐needle technique has become very popular in anesthesia. However, findings of concave deformities at the orifice of Tuohy needles after spinal needle passage have raised concerns that metal fragments might be deposited within the epidural space. This study was proposed to investigate whether the needle‐through‐needle technique does produce metallic flecks.

Methods. Ten unused Tuohy and Hustead epidural needles were inspected microscopically and photomicrographed prior to flushing saline through each into a single tissue culture well. After drying, a single pass was made with a 120 mm 24‐gauge Sprotte needle through each epidural needle to maximal extension while the orifice was within another tissue culture well. Each needle was again flushed into a third well before reexamination and photomicroscopy. Each of the wells was inspected for metallic particles by microscopy. Additional freshly unpackaged Tuohy needles were microscopically examined after exposure to a magnetic field.

Results. Comparison of micrographs before and after needle experiments revealed concave deformities at the orifice of all the Tuohy and Hustead needles. No particles were observed in either of the two saline‐flushed wells or within the well in which the needle‐through‐needle passes were made. Inspection of unused Tuohy needles exposed to a magnetic field revealed metal filings “standing up” along the bevel of every needle examined.

Conclusions. Metallic particles are not produced by the needle‐through‐needle technique. However, metal particles are an apparent contaminant of all epidural needles and are probably routinely introduced into patients when the needle is placed.
Influence of age on circulation and arterial blood gases in man
Authors: Gunnarsson L. , Tokics L. , Brismar B. , Hedenstierna G.
Published: January 2009

Background.Modem data on the influence of age on hemodynamic and blood gas data in healthy subjects are sparse, especially in middle aged or older subjects. Most measurements have been done in patients during major surgery or in intensive care when the patients have one or more failing organ systems. This study reports on hemodynamics, blood gases and blood volume in healthy patients prior to anesthesia and elective surgery.

Methods.A total of 116 subjects (92 males, 24 females) were investigated prior to anesthesia and elective surgery. No one had received any premedication or was taking regular medication. All subjects were in good physical condition, except for their surgical disease, and clinical examination and history did not reveal any sign of cardiopulmonary disease. Measurements were made of systemic and pulmonary vascular pressures, cardiac output, arterial blood gases and blood volume by131I‐Albumin distribution.

Results.Cardiac output, stroke volume, and blood volume correlated to body surface. Relating these variables to body size eliminated almost all differences between the male and female groups. These variables, as well as both systemic and pulmonary artery systolic vascular pressures, were affected by increasing age. Pulmonary capillary wedge and right atrial pressures were not influenced by age. PaO2decreased with age from 14.0 kPa at 20 years to 11.3 kPa at 80, whereas PaCO2was unaltered. No effect of light smoking was found on pulmonary circulation or arterial blood gases. Significant correlations were found between blood volume on the one hand and body size and age on the other hand, but not in regard to sex.
Venous air embolism retrieval catheters cannot capture bubbles; an air lock is required
Authors: Gould D. S. , Gould D. B.
Published: January 2009

Differently designed right atrial venous air embolism retrieval catheters were tested in vitro in clinical simulations to determine if increasing numbers of aspirating orifices enhance the recovery of air bubbles by aspirating through these catheters. Air bubbles of 1.5 to 2.0 mm diameter were directly observed to pass against the aspirating orifices while catheters were vertically suspended in a 3.7 cm diameter glass cylinder filled with hetastarch. Essentially, no air, only fluid, was recovered by any of these submerged catheters upon aspiration. Only when an orifice was positioned above a fluid level could air be retrieved.
Pharmacodynamics of subarachnoid hyperbaric 5% lignocaine
Authors: Jones R.D.M. , Rushmer J. , Chan S.S.C.
Published: January 2009

Twenty male patients (55 to 85 yr) undergoing cystoscopy received spinal anaesthesia with either 75 mg (n = 10) or 100 mg of hyperbaric lignocaine 5% under standardised conditions. Plantar flexion muscle power was recorded during onset and offset of anaesthesia using a load cell interfaced with a computer (PFPD) and these data were compared with intermittent clinical assessments of spinal anaesthesia. Onset of paralysis was rapid and complete with motor power declining exponentially to 5% of preoperative values by 5 minutes in all patients. Extent of block to cold and pinprick was similar in both dosage groups (median T4), as was the rate of block onset. Block regression was complete by three hours in all patients and restitution of plantar flexion motor power was associated with normal thermosens‐ibility at L1 and recovery of the patient's ability to walk and micturate. Recovery of plantar flexion motor power occurred at 95.5±7.38 min in patients given 75 mg compared with 129±9.5 min in those given 100 mg lignocaine (P <0.05). The time between onset and full motor recovery in the 75 mg group (7.2±1.2 min) was less than the 100 mg lignocaine group (29±5.1 min) (P <0.001). The larger dose of lignocaine did not confer any clinical advantage in block onset or intensity and made the onset of recovery less predictable. The Bromage grading, while clinically appropriate during anaesthesia onset, does not provide data relating to the density of block and the PFPD was therefore useful for describing the anaesthesia recovery phase.
Treatment of acute reflex sympathetic dystrophy with DMSO 50% in a fatty cream
Authors: Zuurmond W. W. A. , Langendijk P. N. J. , Bezemer P. D. , Brink H. E. J. , de Lange J. J. , van Loenen A. C.
Published: January 2009

Acute Reflex Sympathetic Dystrophy (acute RSD) was defined using a reproducible classification. Elevated temperature of the affected extremity (“calor”), measured by the dorsal side of the observer's hand and mentioned by the patient, pain (“dolor”) measured by the Visual Analogue Scale (VAS), redness (“rubor”), edema (“tumor”) and limited active range of motion (“functio laesa”), all contributed to the classification system. Patients scoring 4 or 5 positive symptoms were considered to have acute RSD.

A prospective, randomized and double blind study was performed in 32 patients, all suffering from acute RSD. In all of these patients the primary injury was the result of a previous accident. One patient was taken out of the study because of his surgery. The study involved treatment with a fatty cream with 50% dimethyl sulfoxide (DMSO, group A), or without DMSO (placebo, group B), both for 2 months. All patients received physiotherapy applied within pain limits.

Application of the creams resulted in both groups in an improvement of RSD‐scores and VAS‐scores after 2 months. However, the improvement of the RSD score in patients of group A (DMSO‐group) was significantly (P<0.01) better compared to group B. The results suggest a certain activity of DMSO 50% cream in patients suffering from RSD and is, therefore, recommendable.
Surgery during inhalation with nitric oxide in a patient with severe adult respiratory distress syndrome (ARDS)
Authors: Flaatten H. , Gjerde S. , Gullestad S. , Aardal S.
Published: January 2009

Nitric oxide (NO) is increasingly used in intensive care units (ICU) in order to treat serious hypoxaemia secondary to ARDS. Since interrupting NO delivery in such patients for more than a few minutes could lead to serious adverse events, moving the patient outside the ICU has been very difficult. Recently developed equipment (Noresc 1503®) enabled us to deliver 10 or 20 ppm NO from a ventilatory bag with reservoir. This is used for ventilation under transport from the ICU to the operating theatre (OT) or radiology department. We present a patient with severe ARDS undergoing major surgery while being treated with NO. The patient could be moved to the OT and operated on during five hours without significant changes in vital functions.
Management of upper airway obstruction using a Seldinger minitracheotomy kit
Authors: Ala‐Kokko T. I. , Kyllönen M. , Nuutinen L.
Published: January 2009

Two adult patients with upper airway obstruction due to epiglottitis and infectious mononucleosis requiring urgent airway management are presented. Successful establishment of an open airway was achieved by performing a minitracheotomy using the Seldinger technique followed finally with nasotracheal fibreoptic intubation.
Malignant hyperthermia (MH) diagnostics: a comparison between the halothane‐caffeine‐and the ryanodine‐contracture‐test results in MH susceptible, normal and control muscle
Authors: Hartung E. , Koob M. , Anetseder M. , Schoemig P. , Krauspe R. , Hogrefe G. , Engelhardt W.
Published: January 2009

Recent studies demonstrated different contracture responses in muscle from malignant hyperthermia susceptible (MHS) compared to normal (MHN) individuals following exposure to the plant alkaloid ryanodine in‐vitro. To confirm if ryanodine has a specific action in MHS muscle, the effect of a single concentration was investigated in skeletal muscle from MHS, MHN and control subjects using a new evaluation technique. In‐vitro contracture test (IVCT) and MH diagnosis were performed according to the European Protocol in 86 patients sent to us for MH diagnostic testing and in 24 controls. Viable fresh muscle bundles were exposed to a single bolus of ryanodine 1.0 μM. Contracture onset time (OTp: defined as the time (min) from administration of ryanodine to the start of a contracture as measured by a contracture exceeding predrug baseline height), and the time to an increase of the baseline height to 10 mN above the predrug level (10Tp) were recorded.

29 patients were identified by IVCT to be MHS, 50 MHN, 7 MHE (equivocal) and 24 controls MHN. The indices from the ryanodine test separated all MHS (OTp: <16 min; 10Tp <27.4 min) from MHN (>18 and >27.7 min) and control subjects (>17.4 and >29 min). Values for MHE (equivocal) individuals ranged from 17.1 to 27.8 min for the OTp and from 32 to 49.2 min for the 10Tp. 5 patients with fulminant MH crises were included in the MHS group and showed the 95% confidence intervals (CI) of the median value ≤8.05min (OTp) and ≤13.35min (IOTP) for MHS. In contrast, CI of the median value for the control group were found to be ≥25.2min (OTp) and 43.15min (10Tp) for normal muscle.

Thus the ryanodine test protocol showed markedly different contractures in MHS and MHN or control muscle. These results suggest that MHS muscle has a higher sensitivity to ryanodine. However, the protocol should be investigated for reproducibility and validation of thresholds by other laboratories. Ryanodine can help to improve MH diagnostic tests.
Early cerebral functional outcome after coronary artery bypass surgery using different acid‐base management during hypothermic cardiopulmonary bypass
Authors: Engflhardt W. , Dierks T. , Pause M. , Hartung E.
Published: January 2009

Background: Cerebral injury can render meaningless an otherwise successful cardiac operation. As carbon dioxide management during hypothermic cardiopulmonary bypass has a major impact on cerebral blood flow during bypass, it may also influence postoperative cerebral function. The objective of this prospective, controlled, double‐blind study was to compare the effect of pH‐stat (temperature correction of blood gas analyses) or α‐stat (no temperature correction) on brain function.

Methods: Cerebral function was assessed non‐invasively using neurological examination, a neuropsychological test battery, quantitative electroencephalogram and the cognitive evoked potential P300 preoperatively and on postoperative day 7 or 8. Forty‐five patients undergoing elective aortocoro‐nary bypass grafting in barbiturate/opiate anesthesia were randomised into a pH‐stat‐ (n=23) and an α‐stat‐group (n=22). Membrane oxygenators with arterial line filtration and non‐pulsatile flow at a perfussion pressure of 50–60 mmHg were used throughout.

Results: One patient in each group developed a new paresis. Among 49 comparisons of cerebral function parameters, only 3 showed significant differences at the 5%‐level, i.e. exactly what is expected purely by chance. These differences were too small to be clinically relevant and favored either pH‐stat (theta‐amplitude) or α‐stat (subtest 3 of syndrome‐short‐test, number of mistakes in aiming).

Conclusion: Under the bypass conditions of this study there was no difference in early cerebral functional outcome between pH‐ or α‐stat carbon dioxide management during hypothermic cardiopulmonary bypass.
Effect of nitrous oxide on human skeletal muscle function
Authors: Eiken O. , Tesch P. A. , Mejkavic I. B.
Published: January 2009

Background: Nitrous oxide (N2O) is commonly administered in conjunction with parturition, which requires the performance of repeated high‐force voluntary muscle actions. Therefore, we examined the effect of a subanesthetic dose of N2O on the force‐velocity relationship of the quadriceps femoris muscle.

Methods: Nine healthy subjects performed maximal voluntary muscle actions once while breathing air and once while breathing a normoxic gas mixture containing 35% (N2O). Peak torque of the knee extensors was measured during concentric muscle contractions at different angular velocities (30, 60, 90, 150 and 210°s‐1), and eccentric (30, 60, 90 and 150°s‐1) and isometric (knee‐joint angle=60°) muscle actions. Maximal angular velocity was determined during unloaded knee extensions.

Results: N2O decreased peak torque at any given angular velocity. The overall decrease in peak torque averaged 4.8±2.2% (P<0.001). Likewise, N2O decreased maximal angular velocity by 5.7±4.3% (P<0.01). Thus, the impairment in muscle function induced by a 35% N2O is only minute and hence most likely of little significance in clinical practice.
Cytokines in stored red blood cell concentrates: promoters of systemic inflammation and simulators of acute transfusion reactions?
Authors: Kristiansson M. , Soop M. , Saraste L. , Sundqvist K. G.
Published: January 2009

Background: The cytokine network has important implications for the systemic inflammatory and metabolic response in trauma and infection. Cytokines exogenously administered to traumatized and infected patients may have implications for the trauma response in these patients. The main objective of this study was to characterize red blood cell concentrates (RBCs) with regard to cytokine content.

Methods: We investigated the concentrations of tumor necrosis factor α (TNF), interleukin‐1 β (IL‐1), interleukin‐6 (IL‐6) and interleukin‐8 (IL‐8) in sixteen units of RBCs stored at +4° C during 40 days. Samples from RBCs were taken every tenth day. Healthy volunteers were used as controls.

Results: IL‐1 and IL‐8 in RBCs were increased compared to controls, P< 0.01 ‐ P < 0.001 and TNF in RBCs were increased on days 1 and 40 compared to controls, P < 0.05. During storage TNF was highest on day 1, 69 (< 3 ‐ 1060) pg/ml, median (range). IL‐1 concentrations increased during the period of storage from 5 (< 2 ‐ 205) pg/ml to 174 (< 2 ‐ 2180) pg/ml, P < 0.01. IL‐6 was 6 (< 2 ‐ 210) pg/ml on day 1 and did not change over the period of storage. IL‐8 was highest on day 40,164 (15 ‐ 790) pg/ml and compared to day 1 the concentrations were increased on day 10 and day 40, P < 0.05 for both comparisons.

Conclusions: The results indicate the presence of TNF, IL‐1, IL‐6 and IL‐8 in stored RBCs, though there was a great variability over the period of storage and between units of RBCs. In some samples of RBCs the content of cytokines reached levels that may be anticipated to contribute to systemic inflammation and the symptomatology of acute transfusion reactions.
PCO2 electrodes at the surface of the kidney detect ischaemia
Authors: Tønnessen T. I. , Kvarstein G.
Published: January 2009

Background: Under ischaemic (anaerobic) conditions there will be an accumulation of CO2 in the tissue secondary to a build up of protons that is buffered by HCO3‐. We reasoned that CO2 could be measured at the surface of the kidney by PCO2 electrodes to detect ischaemic conditions.

Methods: Anaesthetized, mechanically ventilated pigs (25–30 kg) were investigated. Two acute porcine models, one of haemorrhagic shock and one of renal artery stenosis were used. Renal blood flow was gradually decreased, either by successive episodes of bleeding through the arterial cannula or by successive snaring of the renal artery.

Results: In both models we found that with decreased blood flow but maintained aerobic metabolism (supply independence) PCO2 both at the surface of the kidney and in the renal vein increased by 2–3 kPa. Thus, the tissue‐venous PCO2 difference did not change much. At DO2crit, i.e., at the transition to supply‐dependent O2 consumption, the tissue PCO2 started to increase rapidly, as did the tissue‐venous PCO2 difference. This is compatible with the notion that a hallmark of ischaemia is decreased ability of the blood to transport away waste products because the contact between large parts of tissue and blood is virtually non‐existent. In the renal artery stenosis model kidney surface PCO2 values rose from a baseline of 6.6±0.6 kPa (mean±SEM) to a value near DO2crit of 10.6±0.8 kPa, reaching a final value of 29.9±3.5 kPa at no flow. PCO2 in the renal vein, however, reached a maximum of only 8.2±0.6 kPa. Numbers very similar to these were also found in the haemorrhagic model. The urine production decreased before the onset of ischaemia. When surface PCO2 values increased sharply indicating ischaemia, the urine production was zero. Lactate production by the kidney correlated very well with increasing tissue PCO2 values further corroborating that anaerobic metabolism was detected with the electrodes.

Conclusion: We conclude that PCO2 electrodes placed at the surface of the kidney detect renal cortical ischaemia.
Reduced hypoxic chemosensitivity in partially paralysed man. A new property of muscle relaxants?
Authors: Eriksson L. I.
Published: January 2009

Background: It was hypothesized that non‐depolarizing neuromuscular blocking agents impair hypoxic chemosensitivity in man.

Methods: In thirty randomly allocated male volunteers the hypoxic and hypercarbic ventilatory responses were measured during partial paralysis (TOF ratio 0.70) due to either atracurium (n=10), pancuronium (n=10) or vecuronium (n=10).

Results: Hypoxic ventilatory responses were depressed by 306, 287 and 296% (mean SD) at steady‐state infusion of atracurium, pancuronium and vecuronium, respectively. At a TOF ratio of >0.90, the HVR was not different from control measurements.

Conclusion: It is concluded that non‐depolarizing neuromuscular blocking agents impair hypoxic ventilatory regulation. Further experimental studies are warranted to fully describe the mechanism(s) responsible for this interaction.
Gastric emptying of a light hospital breakfast
Authors: Søreide E. , Hausken T. , Søreide J. A. , Steen P. A.
Published: January 2009

While intake of clear fluids 2–3 h before surgery is considered safe as it does not influence gastric content, it is not known if the same applies to a light breakfast meal. We therefore studied gastric emptying of a light breakfast in healthy, female volunteers without evidence of gastrointestinal motility disorders. The test meal consisted of one slice of buttered toast with jam, one cup of coffee without milk or sugar and one glass of pulp‐free orange juice taken together with a paracetamol mixture. Using gastric ultrasonography, the stomach was identified without problems in all subjects, and gastric emptying curves using changes in gastric antral area and serum‐paracetamol were obtained. Emptying of the fluid phase started immediately after intake of the meal. All subjects had solid particles in the stomach 120 min after the meal, 3 patients were considered empty after 180 min, 6 after 210 min and all after 240 min. The gastric antral area returned to fasting value significantly faster than the disappearance of solid particles; median 150 min versus 210 min; P=0.01. Our results show that in healthy subjects the stomach cannot be considered empty for solid particles the first 4 h after a light breakfast meal. To secure some safety limits, we suggest a 6‐h mandatory preoperative fast after a light breakfast.
Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist
Authors: Ranta S. , Jussila J. , Hynynen M.
Published: January 2009

We interviewed 303 cardiac surgery patients to evaluate the incidence of intraoperative awareness with recall.

First, we randomly interviewed 99 patients, of whom four patients (4%) reported awareness and recall. We informed the cardiac anaesthesiologists of the results of these interviews, and we also gave general information regarding means to reduce awareness and recall during general anaesthesia. Thereafter, we interviewed 204 consecutive cardiac surgery patients. Now, three of the patients (1.5%) had intraoperative awareness with recall. The reduction in the incidence from 4% to 1.5% was not significant. However, the doses of principal anaesthetic drugs had increased significantly between the two interview phases, while the dose of pancuronium, the main muscle relaxant used, had decreased significantly. Also, there was a significant increase in the number of anaesthesias where anaesthetic agents had been administered continuously instead of bolus or non‐continuous dosing techniques. Between the patients with awareness and recall and those without it, there was no difference in the doses of anaesthetic agents given. The patients with awareness were significantly younger than those not aware.

In conclusion, with educational measures and vigilance over the problem, the incidence of intraoperative awareness during cardiac anaesthesia may be reduced. The incidence figure of 1.5% we observed is of the magnitude reported recently by others with modern cardiac anaesthesia techniques.
Propofol anaesthesia in spontaneously breathing paediatric patients during magnetic resonance imaging
Authors: Levatt A. , Colombo N. , Arosio E. M. , Savoia G. , Tommasino C. , Scialfa G. , Boselli L.
Published: January 2009

Background:The aim of this study was to evaluate the use of propofol to induce and maintain anaesthesia in spontaneously breathing paediatric patients (age 2 weeks ‐ 11 years) during Magnetic Resonance Imaging (MRI) of the CNS.

Methods:All patients were spontaneously breathing, without intubation, and received supplemental O2. Pulse rate, blood pressure (BP), electrocardiogram and EtCO2were recorded in all patients, and in 38 subjects SpO2was also monitored. Patients were divided in 2 groups according to their body weights: Group A (n=34, bwt ≤ 10 kg), and Group B (n=48, bwt> Id kg).

Results:Dosage of propofol during the time of induction (from insertion of the i.v. cannula to positioning on the MRI table) was significantly higher in smaller children (Group A; 5.4 ± 2.2 (SD) mg/kg) as compared to children with bwt above 10 kg (Group B; 3.7 ± 1.6 mg/kg). Propofol dosage for maintenance of anaesthesia was significantly higher in smaller children (Group A: 10.1 ± 5.7 vs Group B: 7.1 + 3.0 mgkg‐1h‐1, P=0.003). During the time of induction, transient episodes of reduced BP (≤ 20%) occurred in 6 patients in Group A and 2 patients in Group B. During anaesthesia in Group B there was 1 episode of oxygen desaturation (95%), and 3 episodes of short and mild increases of EtCO2(≤ 52 mmHg). No other side effects occurred in any patient. MRI studies were successfully completed, only 3 sequences (Group A) had to be restarted.

Conclusion:Propofol can be safely used for total intravenous anaesthesia in children undergoing MRI.
Sodium nitroprusside after cardiac surgery: systemic and splanchnic blood flow and oxygen transport
Authors: Parviainen I. , Ruokonen E. , Takala J.
Published: January 2009

Background:Vasoactive drugs may interfere with splanchnic blood flow and tissue oxygenation. Sodium nitroprusside (SNP) is widely used in the treatment of postoperative hypertension after cardiac surgery, but the effects of SNP and other vasodilators on splanchnic blood flow have not been well documented.

Methods:The effects of SNP on systemic blood flow, oxygen transport and gastric intramucosal pH (pHi) were studied in 12 patients with arterial hypertension after coronary artery bypass grafting. In 9 of these patients, the effect on regional (splanchnic and leg) blood flow and oxygen transport was also measured. Hemodynamic and regional blood flow responses were measured before and during SNP infusion (mean 2.8±1.7 μg/kg/min, range 0.6‐6.3 μg/kg/min), when the goal of the vasodilator treatment, mean arterial pressure 70–80 mmHg, had been reached.

Results:SNP increased splanchnic (0.65±0.22 vs. 0.87±0.37 L·min‐1·m‐2,P<0.01) and femoral blood flow (0.15±0.04 vs. 0.21±0.06 L·min‐1·m‐2,P<0.05) in parallel with cardiac index (2.6±0.6 vs. 3.3±0.7 L·min‐1·m‐2,P<0.01). Fractional regional blood flows did not change. Mean gastric intramucosal pH decreased slightly (7.40±0.07 vs. 7.37±0.06,P<0.05). Both systemic (420±85 vs. 495±90 mL·min‐1·m‐2,P<0.05) and femoral oxygen delivery (25±5 vs. 32±10 mL·min‐1·m‐2,P<0.05) increased, but neither systemic nor regional oxygen consumption changed.

Conclusions:These results suggest that vasoregulation is well preserved during treatment of early postoperative hypertension with SNP, and that SNP has no adverse effects on splanchnic tissue oxygenation.
Sumatriptan‐induced cerebral vasoconstriction as treatment of experimental intracranial hypertension
Authors: Nilsson F. , Nilsson T. , Edvinsson L. , Rosén I. , Bjórkman S. , Messeter K. , Nordström C‐H.
Published: January 2009

Background:Increased intracranial pressure (ICP) is a major cause of mortality in severe head injuries and pharmacologically induced cerebral vasoconstriction has been suggested as a possible treatment. In the present study a porcine model of increased ICP was utilized to study the changes in cerebral haemodynamics and energy metabolism induced by a selective 5‐hydroxytryptaminei agonist (sumatriptan).

Methods:ICP was raised by inflation of two balloons covering both parieto‐occipital regions extradurally. The animals were randomized into four groups receiving sumatriptan: 0.01 mg·kg‐1(A), 0.03 mg·kg‐1(B), 0.1 mg·kg‐1(C), and 0.5 mg·kg‐1(D) intravenously over 10 min. Measurements of cerebral blood flow (CBF), arterio‐venous oxygen content difference (CavO2), and jugular venous pH (vpH) were performed 5, 20, 40, 60, and 75 min after start of the infusion. ICP, mean arterial pressure, and EEG were recorded continuously. Direct effects of sumatriptan were also compared in cortical arteries and veinsin vitro.

Results:Significant decreases in ICP were obtained in groups A, B, and C while group D exhibited a progressive increase in ICP. Significant reductions in CBF, increase in CavO2, and slowing of EEG were observed in groups B, C, and D. Sumatriptan caused moderate constriction of the arteries and a more pronounced dilatation of veinsin vitro.

Conclusion:The results indicate that a low dose of sumatriptan has the potential to reduce a raised ICP. High doses of sumatriptan cause a further increase of ICP possibly by dilatation of intracerebral veins.
Effect of inotropic stimulation on the synchrony of left ventricular wall motion in a dog model of myocardial stunning
Authors: Schlack W. , Ebel D. , Thämer V.
Published: January 2009

Background: Reperfusion after short coronary occlusion induces regional myocardial dysfunction (“stunning”), including asynchrony of left ventricular (LV) wall motion. Contractile function of stunned myocardium can be increased by inotropic stimulation, but whether this has an influence on wall motion asynchrony is unknown.

Methods: In six anaesthetized dogs, the effect of inotropic stimulation on regional myocardial function, and LV asynchrony was tested after the induction of regional stunning (by 15 min of left circumflex artery side branch occlusion). Regional myocardial function was assessed as mean systolic wall thickening velocity (υswt) by sonomicrometry in the stunned (posterobasal wall) and normal myocardium (anteroapical wall), and LV asynchrony by the phase difference (φ) of the first Fourier transform of the wall thickness signals.

Results: In the stunned myocardium, υswt decreased from 8.6±1.0 to 1.7±1.4 mm s‐1 (mean±SEM), P<0.01, and simultaneously φ increased from 10.8±3.6 to 85.7±14.3°, P<0.01. Intra‐coronary noradrenaline (NADR, 0.25 μg) improved υswt (8.3±1.4 mm s‐1, P<0.01) in the stunned region and changed φ to ‐38.1±18.0°, P<0.05. Systemic NADR (5 μg) also increased υswt of the stunned region (to 3.8±2.1 mm s‐1, P<0.05), but left φ unchanged (82.9±19.8°).

Conclusion: Regional function of stunned myocardium can be augmented by inotropic stimulation with noradrenaline, but this does not result in an improvement of LV wall motion asynchrony during systemic inotropic stimulation.
Platelet factor 4 release in patients undergoing cardiopulmonary resuscitation ‐ can reperfusion be impaired by platelet activation?
Authors: Böttiger B. W. , Böhrer H. , Böker T. , Motsch J. , Aulmann M. , Martin E.
Published: January 2009

Background: Reperfusion following cardiac arrest is associated with a marked activation of blood coagulation. This seems to be associated with microcirculatory reperfusion disorders. The present study was designed to investigate the possible involvement of platelets in reperfusion injury following cardiac arrest. Plasma levels of platelet factor 4 (PF 4) were used as an indicator for in vivo platelet activation because PF 4 is known to be released from platelets during aggregation.

Methods: Plasma PF 4 levels (normal range: < 5 IU/mL) were measured in 18 patients at predetermined time points during cardiopulmonary resuscitation (CPR). In the case of restoration of spontaneous circulation, additional blood samples were analyzed until seven days after stabilization. The PF 4 levels of four sex‐matched volunteers were used as controls.

Results: The median of the maximum individual PF 4 levels measured during CPR was 27.5 IU/mL (range 1.2 to 90 IU/mL; P < 0.01 versus controls). Compared with PF 4 levels in control volunteers (median: 0.35 IU/mL; range 0.2 to 0.6 IU/mL), PF 4 levels were significantly elevated in patients during CPR and in the early phase until 24 hours after restoration of spontaneous circulation (P < 0.05).

Conclusion: A marked increase in PF 4 levels was observed during CPR and in the early phase after cardiac arrest in man. This increase in PF 4 levels has to be viewed as an indicator of platelet activation, which may play a role in the etiology of reperfusion injury and microcirculatory reperfusion disorders occurring after cardiac arrest.
Transfusion‐related acute lung injury (TRALI) after fresh frozen plasma in a patient with coagulopathy
Authors: Lindgren L. , Yli‐Hankala A. , Halme L. , Koskimies S. , Orko R.
Published: January 2009

Background: Transfusion‐related acute lung injury (TRALI) is due to specific antigen‐antibody reaction involving the donor's leucocyte or granulocyte antibodies towards the recipient's antigens. Aggregation in small pulmonary vessels occurs, leading to derangement of permeability.

Case history: TRALI after transfusion of four units of fresh frozen plasma (FFP) for factor V deficiency prior to elective cholecystectomy is presented. Within a few minutes after the third unit of FFP a florid pulmonary oedema developed. Hypotension and hypoxia with SpO2 83–87% at FiO2 1.0 followed. Prompt monitoring of central haemodynamics revealed a normal cardiac index without pulmonary hypertension. The operation was then conducted as planned. The bilateral pulmonary oedema resolved after 72 hours with ventilatory support. The patient recovered without complications. When tested postoperatively, the second unit of FFP contained granulocyte antibodies and the third unit contained HLA antibodies. The crossmatch of the patient's granulocytes and lymphocytes towards the two donors of the two units of FFP was positive.

Conclusion: When TRALI is suspected the donor blood has to be tested against the recipient. Ventilatory support of the patient is continued until adequate oxygenation is reached.
Reduction of ischemia‐reperfusion syndrome after abdominal aortic aneurysmectomy by N‐acetylcysteine but not mannito1,2
Authors: Kretzschmar M. , Klein U. , Palutke M. , Schirrmeister W.
Published: January 2009

Background:Abdominal aortic aneurysmectomy results in a general ischemia‐reperfusion syndrome accompanied by an acute rise in mean pulmonary artery pressure (MPAP). Severe and sometimes fatal postoperative cardiopulmonary complications have been described.

Methods:This pilot study examined whether N‐acetyl‐cysteine (NAC), a precursor of the most important physiological antioxidant glutathione (reduced form: GSH; oxidized form: GSSG), or the hydroxyl radical scavenger mannitol (MAN) modifies these events. The patients received 150 mg/kg b.m. NAC (n=9) 30 minutes before infrarenal aortic clamping or 500 mg/kg b.m. MAN (n=10) 10 minutes before declamping. 11 patients had no additional treatment (control).

Results:In the control group, a significant increase in plasma levels of oxidized glutathione and lipid peroxides was observed after declamping. Additionally, a significant increase in plasma levels of the stable metabolites of thromboxane (TXB2) and prostacyclin (6‐keto‐PGF1α) was measurable after declamping. There was a transient increase in MPAP and pulmonary vascular resistance (PVR), both of which returned to normal values within 20 minutes. Six hours after surgery, pulmonary dysfunction was manifest by increase in the intrapulmonary shunt fraction. Relative to the control group, NAC pretreatment led to a complete lack of changes in plasma lipid peroxide, thromboxane and prostacyclin levels after declamping; there was a significant increase in plasma GSH concentration persisting over a period of 12 hours. MPAP, PVR and Qs/QTvalues were unchanged. MAN pretreatment showed similar effects on the parameters obtained in the acute phase after declamping like the control group.

Conclusions:Pretreatment with NAC, but not mannitol, may help prevent ischemia‐reperfusion syndrome following aortic clamping.