bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous positive airway pressure by mask in patients after coronary surgery
Authors: JOUSELA I. , RÄSÄNEN J. , VERKKALA K. , LAMMINEN A. , MÄKELÄINEN A. , NIKKI P.
Published: January 2009

Thirty patients who underwent coronary artery bypass grafting were randomized to receive 30% oxygen by mask either with an ambient airway pressure or with 7.4 mmHg (1 kPa) continuous positive airway pressure (CPAP) for 8 h after extubation. Arterial blood oxygen tension (Pao2) decreased remarkably in the control group after extubation (from 19.2± 5.3 kPa to 12.4 ± 2.7 kPa) but less in the CPAP group (from 16.4 ± 3.3 kPa to 14.0 ± 2.1 kPa). On the second postoperative morning Pao2 was equally low in both groups (control: 8.4 ± 1.5 kPa, CPAP: 8.9 ± 1.9 kPa). Atelectatic areas were seen with similar frequency in both groups, 17% (whole material) on the first and 50% on the second postoperative morning. Atelectasis was more common in patients with internal thoracic artery grafting and/or pleural drainage. In conclusion, CPAP therapy was well tolerated, and minimized the decrease in Pao2 after extubation, but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperative day.
Interpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study
Authors: BROCKMEIER V. , MOEN H. , KARLSSON B. R. , FJELD N. B. , REIESTAD F. , STEEN P. A.
Published: January 2009

The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg ml‐1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The epidural group was given bupivacaine 3.75 mg–ml‐1 with 5 microgram epinephrine as a 5 ml epidural bolus, followed by a continuous infusion starting at a rate of 5 ml per hour and interpleurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The draining tubes were clamped during the injection of the interpleural bolus and 15 min afterwards. Adequacy of pain relief was evaluated with the Prins–Henry pain scale. Morphine requirement was registered, there was no difference between the groups in painscores or need for additional morphine.
Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man
Authors: CEDERHOLM I. , AKERMAN B. , EVERS H.
Published: January 2009

Ropivacaine, a new long–acting amino–amide local anaesthetic agent, and bupivacaine, in various concentrations with or without addition of adrenaline, were tested in a randomized, double–blind study using intradermal wheals. Ten non–smoking, healthy, young male volunteers participated. Inseries Iplain solutions of ropivacaine (0.25%, 0.5%, 0.75% and 1%) and bupivacaine (0.25%, 0.5% and 0.75%) were injected intradermally and inseries IIthe same concentrations, with the addition of adrenaline 5 ug ml‐1(1:200 000), were used. The same volunteers took part in both series, with an interval of at least three weeks between the experiments. Saline was included as control in both series. Pin–pricking was used to assess the dermal analgesia. Plain solutions of ropivacaine produced significantly longer durations of dermal analgesia than did plain solutions of bupivacaine, in all tested concentrations. A significant increase in duration was seen for both local anaesthetics when adding adrenaline. Local vascular effects at the injected areas were determined by visual inspection (nil, pink, pale). Local blanching (pale) was significantly more frequent for plain solutions of ropivacaine, in all tested concentrations. Local redness (pink) was significantly more frequent with plain bupivacaine, in a dose–dependent relation. An initial redness was frequently observed for both local anaesthetics containing adrenaline, followed by blanching at most sites.
The effect of balanced analgesia on early convalescence after major orthopaedic surgery
Authors: MØINICHE S. , HJORTSØ N–C. , HANSEN B. L. , DAHL J. B. , ROSENBERG J. , GEBUHR P. , KEHLET H.
Published: January 2009

Forty–two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and acetaminophen regimen. Patients undergoing knee– or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does not per se lead to important improvements in convalescence and hospital stay.
Paravertebral vs epidural block in children. Effects on postoperative morphine requirement after renal surgery
Authors: LÖNNQVIST P. A. , OLSSON G. L.
Published: January 2009

Continuous thoracic paravertebral blockade (PVB) has only recently been reported in pediatric patients. The aim of the present study was to compare retrospectively the postoperative analgesic efficacy of PVB vs conventional lumbar epidural blockade (EDA) in children. Thirty–five consecutive pediatric patients undergoing renal surgery, receiving either PVB (n = 15) or EDA (n = 20), were reviewed. The need for supplemental morphine administration during the first 24 postoperative hours was used to assess the postoperative analgesic efficacy of the two different regional techniques. Both the total amount of supplemental morphine and the number of patients with no need for supplemental morphine administration, were compared between the two groups. The need for supplemental morphine administration was significantly lower (P = 0.046) and the number of patients with no need for supplemental morphine administration postoperatively was significantly higher (P = 0.019) in patients treated with PVB vs EDA. The present study indicates that PVB may possess a potential for postoperative analgesia equal to or maybe even superior to conventional lumbar EDA in pediatric patients undergoing renal surgery. Further prospective studies investigating the analgesic efficacy of this novel technique are warranted.
Midazolam and flumazenil pharmacokinetics and pharmacodynamics following simultaneous administration to human volunteers
Authors: SHORT T. G. , YOUNG K. K. , TAN P. , TAM Y. H. , GIN T. , OH T. E.
Published: January 2009

Resedation after antagonism of midazolam sedation with flumazenil may occur because some individuals have rapid elimination of flumazenil but slow elimination of midazolam. To determine whether there are parallel or divergent rates of elimination of the two drugs between individuals, the pharmacokinetic profiles of midazolam and flumazenil were studied simultaneously in 12 adult male volunteers. Free drug concentration data for the two drugs were incorporated into a receptor occupancy model and psychomotor testing was performed and correlated with receptor occupancy. Variation was found between individuals in the pharmacokinetics of the two drugs. There were significant correlations between Cltot, (P< 0.01) but not in t1/2a, t1/2b, Vc, or VDst. In individuals, midazolam elimination half–life ranged from less than half that of flumazenil to more than three times that of flumazenil. There was a relatively poor, although statistically significant linear correlation found between calculated receptor occupancy and critical flicker fusion frequency, r = 0.50,P<0.01, and linear analogue scales of sedation r = 0.56,P<0.005; and anxiolysis, r = 0.54,P< 0.005. There is divergence in the disposition and elimination of midazolam and flumazenil in some individuals. A benzodiazepine receptor occupancy model is useful for predicting the consequent differences in clinical effect when the drugs are given together.
Performance characteristics of a novel reusable intermediate–volume low–pressure cuffed endotracheal tube
Authors: HÄHNEL J. , TREIBER H. , KONRAD F. , MUTZBAUER T. , STEFFEN P. , GEORGIEFF M.
Published: January 2009

Study objective: To evaluate the performance of the reusable intermediate–volume low–pressure cuffed “Super Safety Yellow” (Willy Rüsch AG, P. O. Box 1620, D–71332 Waiblingen, Germany) endotracheal tube with regard to cuff seal, tube tip position, and incidence of postoperative throat complaints. The “Super Safety Yellow” was compared with the “Super Safety Clear” (W. Rusch AG), the “lo–pro” (Mallinckrodt Laboratories, Cornamady, Athlone County, Ireland), and the “red rubber” (W. Rüsch AG) tubes.

Methods: Two hundred adult patients scheduled for minor surgery under standardized general anaesthesia were allocated to one of these tubes. Past–cuff leakage (indicator: orally instilled 0.2% indigocarmine) as well as intratracheal tube tip position (degree of being centred) were assessed by fibre–optic tracheoscopy. The semi–standardized interviews for the recording of postoperative sore throat were performed in double–blind fashion once a day, starting on the day of operation till p.o. day 3. Statistics: x 2–test; significance: P < 0.05.

Main Results: A past–cuff leakage was found in three “red rubber” tubes. There were significant differences in tube tip position with the “Super Safety Clear” being best, and the “Super Safety Yellow” being worst centred (P = 0.010). The incidence of postoperative throat complaints showed a nonsignificant tendency in favour of the PVC–tubes. A significant number of such complaints were observed in women (P = 0.0004) and in obese patients (P = 0.011). By contrast, this incidence did not significantly differ with age, tracheal cross–sectional shape, tube tip position, use of atropine, and duration of intubation.

Conclusion: Although resembling the “red rubber” tube in the incidence of postoperative throat complaints, the “Super Safety Yellow” may be an alternative to the currently used disposable tubes in anaesthesia. Its performance is comparable with regard to cuff seal and intra–cuff pressure. Additionally, it helps in reducing PVC waste and may lessen costs.
Effects of induced hypotension on arterial blood–gases under spontaneous breathing
Authors: YAMAKAGE M. , IWASAKI H. , SATOH K. , NAMIKI A.
Published: January 2009

The effects of deliberate hypotension on both Pao2 and Paco2 were investigated under isoflurane anaesthesia with spontaneous breathing from a laryngeal mask. Lumbar epidural block was introduced; anaesthesia was induced with thiamylal (4 mg kg‐1) and maintained with 0.5% isoflurane in nitrous oxide (4 1 min‐1) and oxygen (2 1 min‐1) under spontaneous breathing. After that nitroglycerin, trimetaphan or prostaglandin E1 were used to induce a hypotension of 70% of control. All three drugs significantly decreased Pao2, from 19.9 ± 3.3, 19.2 ±2.7, and 19.6 ± 3.1 kPa to 14.6 ± 1.9, 16.6 ± 2.2, and 16.2 ± 2.4kPa (mean ± s.d.), respectively; none of them increased Paco2. In spite of the sparing of functional residual capacity under spontaneous breathing, the levels of reduction of Pao2 were the same as levels reported in paralyzed and mechanically ventilated subjects. In conclusion, under deliberate hypotension Pao2 decreases to a considerable degree, even under spontaneous breathing, presumably not because of alveolar hypoventilation, but because of the suppression of hypoxic pulmonary vasoconstriction by the drugs used in this study.
Heparin–coated circuit during cardiopulmonary bypass
Authors: SELLEVOLD O. F. M. , BERG T. M. , REIN K. A. , LEVANG O. W. , IVERSEN O–J. , BERGH K.
Published: January 2009

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint–attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin–coated equipment (CBAS) and reduced i.v. heparin (1.5 mg kg‐1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg–kg‐1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ngml‐1±1.2 to 27.5 ng ml‐1 ± 4.8 on day 2 and in the CBAS group from 10.7 ng ml‐1 ± 1.2 to 35.6 ng ml‐1 ± 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups. The present results confirm the feasibility of reducing general heparin when using heparin–coated systems but the study does not support the superiority of such coating with regard to biocompatibility in short procedures with a Theologically optimized circuit. The potential benefit from reduced heparin and protamine has not been fully evaluated.
Effect of prior administration of succinylcholine on duration of action of vecuronium during enflurane anaesthesia
Authors: NISHIZAWA M. , GOTO H. , OTAGIRI T. , NAKAJIMA K. , HARASHIMA N. , SAKAKI J.
Published: January 2009

The effects of succinylcholine, which was given to facilitate tracheal intubation on the duration of action of subsequently administered vecuronium bromide, were evaluated in 54 adult patients who underwent abdominal surgeries under enflurane anaesthesia. The electromyographic response to train–of–four ulnar nerve stimulation was measured. Twenty–seven patients received 1 mg–kg‐1 of succinylcholine, followed by 0.15 mg kg‐1 of vecuronium when the electromyographic response recovered to 50% of control after succinylcholine–induced neuromuscular blockade. The other 27 patients served as the control group, receiving 0.15 mg kg‐1 of vecuronium without prior administration of succinylcholine. In both groups, administration of supplemental 0.04 mg kg‐1 of vecuronium was repeated whenever the electromyographic response recovered to 25% of control during surgical procedures. The duration of blockade induced by the initial 0.15 mg kg‐1 of vecuronium was 56.5 ± 12.8 (mean ± s.d.) min for the group with succinylcholine, and 58.5 ± 21.5 min for the control group. In both groups, the average duration of four consecutive supplemental doses of vecuronium was approximately 35 min. No significant differences between groups were found in the duration of neuromuscular blockade induced by initial and supplemental doses of vecuronium.
Comparison of continuous epidural infusion of morphine/bupivacaine with fentanyl/ bupivacaine for postoperative pain relief
Authors: SAITO Y. , UCHIDA H. , KANEKO M. , NAKATANI T. , KOSAKA Y.
Published: January 2009

The efficacy and safety of postoperative analgesia with continuous epidural infusion of either morphine or fentanyl in combination with bupivacaine were evaluated in 85 patients, ASA physical status I or II, undergoing thoracic and/or upper abdominal surgery. Patients were treated with one of the combinations for 48 h after surgery. The morphine/bupivacaine group (MB; n = 45) received morphine at the rate of 0.2 mg h‐1, and bupivacaine at the rate of 10 mg h‐1 for the first 24 h or 5 mg h‐1 for the second 24 h; the fentanyl/bupivacaine group (FB; n = 40) received fentanyl at the rate of 20 μg–h‐1, and bupivacaine at the rate of 10 mg h‐1 for the first 24 h or 5 mg h‐1 for the second 24 h. The degree of pain relief assessed by the visual pain scale and the modified Prince Henry pain scale was satisfactory in most patients in both groups. In group MB 74% and in group FB 76% of patients did not need any supplementary analgesics. No significant differences were observed between the groups in assessment of pain. The incidence of hypotension (P < 0.05) and pruritus (P < 0.05) was higher in group MB than in group FB. None of the patients developed respiratory depression in either group.
Intraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia
Authors: NIEMI L. , PITKÄNEN M. , TUOMINEN M. , BJÖRKENHEIM J.–M. , ROSENBERG P. H.
Published: January 2009

Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight–in–patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. Local anaesthesia with 1% lidocaine plus adrenaline, was selected for another 40 out–patients. At the end of the arthroscopy either 1 mg morphine or saline was injected intraarticularly. As a rescue medication the spinal anaesthesia patients received oxycodone 0.14 mg kg‐1 i.m. or ketoprofen 100 mg p.o. and the local anaesthesia patients received ketoprofen 100 mg p.o. The need for additional postoperative analgesic was almost similar in both spinal anaesthesia groups. The patients having local anaesthesia and given intraarticular morphine needed fewer doses of ketoprofen (22 doses) postoperatively than the control group (39 doses) (P < 0.05). Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.
Use of 29–gauge spinal needles and a fixation device with combined spinal epidural technique
Authors: SlMSA J.
Published: January 2009

One hundred patients between 15–46 years, undergoing elective surgery, were given spinal anaesthesia using 29–gauge spinal needles introduced through a Tuohy needle with a fixation device. Successful spinal anaesthesia was achieved in 98%. A success rate of 100% was achieved when a combined spinal epidural technique was used. Ninety–eight percent of the patients would prefer the same anaesthesia procedure for similar kind of surgery in the future.
Forces applied during laryngoscopy in children
Authors: Bucx M. J. L. , VAN GEEL R. T. M. , MEURSING A. E. E. , STIJNEN T. , SCHECK P. A. E.
Published: January 2009

Increased masticatory muscle tone after administration of suxamethonium has been demonstrated in children when combined with volatile anaesthetics. Whether volatiles are a prerequisite for this phenomenon is not known. In this study upper airway muscle tone, including the tone of the masticatory muscles, was determined in 54 children (age range 2–15 years), anaesthetized with propofol, fentanyl and nitrous oxide and avoiding any use of volatiles. The children were either relaxed with suxamethonium (n = 26) or vecuronium (n = 28). The forces applied during laryngoscopy were used to quantify upper airway muscle tone and were significantly greater in the suxamethonium group than in the vecuronium group: maximally applied force was 25 N versus 21 N (P=0.008), and mean applied force was 16 N versus 13 N (P=0.006), respectively. The results of this study indicate that upper airway muscle tone increases after administration of suxamethonium in children independent of the presence of volatile anaesthetics. Moreover, increased muscle tone had no effect on the difficulty of laryngoscopy or the intubation conditions. Increased masseter muscle rigidity after suxamethonium could be due to the very unique characteristics of this muscle.
The effect of epidural bupivacaine on vecuronium–induced neuromuscular blockade in children
Authors: TAIVAINEN T. , MERETOJA O. A. , ROSENBERG P. H.
Published: January 2009

The efTect of epidural bupivacaine on potency and duration of action of vecuronium–induced neuromuscular blockade (NMB) was evaluated in 30 general surgical paediatric patients (ASA I–II) of three to ten years of age. Premedication was midazolam 0.5 μg kg‐1 orally (max 15 mg). In addition to general anaesthesia, 15 of the children received a lumbar epidural block with 0.5% bupivacaine 2.5 mg kg‐1. Anaesthesia was induced and maintained with N2O:o2 (2:1), propofol and alfentanil. NMB was monitored by adductor pollicis EMG with the train–of–four stimulus every 20 sec. Thirty minutes following the epidural bupivacaine injection (mean plasma concentration 0.86 μg ml‐1) or induction of anaesthesia a cumulative dose–response curve of vecuronium was established to achieve a 95% depression of the twitch response. Thereafter, NMB was allowed to recover spontaneously. ED doses of vecuronium were 19–22% greater in the control group than in the epidural group. ED^ doses were 33.8 (s.e.mean 1.3) μg kg“1 and 28.4 (2.2) μg kg”‘, respectively (P<0.05). There were no differences in recovery times from NMB between control and epidural group, the recovery index (time of twitch height to recover from 25 to 75%) being 6.4 (0.4) min and 7.0 (0.9) min, respectively. However, a negative correlation was found between bupivacaine plasma concentration and an ED50 dose of vecuronium (P=0.01). Our results indicate that vecuronium is slightly more potent in children with bupivacaine epidural block than in children without it.
Changes of endothelin concentration in cerebrospinal fluid and plasma of patients with aneurysmal subarachnoid hemorrhage
Authors: SHIRAKAMI G. , MAGARIBUCHI T. , SHINGU K. , KIM S. , SAITO Y. , NAKAO K. , MORI K.
Published: January 2009

To investigate the clinical significance of endothelin (ET), a potent vasoconstrictor peptide, in subarachnoid hemorrhage (SAH) and SAH‐related cerebral vasospasm, we measured the ET‐like immunoreactivity (ETLI) in plasma and cerebrospinal fluid (CSF) obtained serially from patients with SAH due to ruptured cerebral aneurysm who underwent aneurysmal surgery. The normal ET–LI levels in plasma and CSF (n = 24) were 12.4±2.0 (mean±s.d.) and 9.1±1.2 pg·ml‐1, respectively. Plasma ET‐LI levels in patients with SAH before surgery (16.8±7.8 pg·ml‐1, n = 8) were higher than the normal values (P<0.05), and became further elevated after surgery (22.5±9.4 pg·ml‐1). ET‐LI levels in plasma and CSF one day after surgery were 18.7±5.5 and 18.4±6.8 pg·ml‐1 (P<0.01 vs. normal values), respectively, and declined thereafter. The plasma and CSF ET‐LI levels in patients who showed symptomatic vasospasm became concomitantly elevated again. These results suggest that ET is involved in SAH‐related vasospasm and raise the possibility that surgical stress influences the vasospasm.
Ibuprofen in the treatment of postoperative pain in small children. A randomized double–blindplacebo controlled parallel group study
Authors: KOKKI H. , HENDOLIN H. , MAUNUKSELA E–L. , VAINIO J. , NUUTINEN L.
Published: January 2009

The efficacy of ibuprofen as a pre–emptive analgesic for postoperative pain was investigated in 81 children in the age between one and four years subjected to elective surgery. The patients were randomized into two groups receiving rectally either ibuprofen 40 mgkg‐1 d‐1, divided into four equal doses, or placebo in a double blind manner. Additional pain relief was provided by morphine. In the recovery room ibuprofen provided superior pain relief during the first hour and significantly reduced the need of morphine. Heart rate and arterial blood pressure were lower in children who received ibuprofen, probably reflecting better analgesia. The side effects were mild and similar in both groups. We conclude that rectal ibuprofen is a safe analgesic in children in the age between 1 and 4 years and reduces the need of opioids for postoperative pain relief.
The effect of thiopental on cerebral blood flow, and its relation to plasma concentration, during simulated induction of anaesthesia in a porcine model
Authors: BJÖRKMAN S. , NILSSON F. , ÅKESON J. , MESSETER K. , ROSÉN I.
Published: January 2009

The reversible effect of an induction dose of thiopental on the cerebral blood flow (CBF) was characterized by repeated 133Xe washout measurements during stable physiological conditions in anaesthetized pigs. A thiopental effect corresponding to induction of light and transient anaesthesia was confirmed by electroencephalography (EEG). The concentration (arterial plasma) – effect (– % CBF) relationship of thiopental was estimated using a sigmoidal Emax model. The injection caused a rapid 36 4.5% (means.d.) drop in CBF, with return to baseline by 80 min. According to the pharmacodynamic model, the maximal effect of thiopental (Emax) in this experimental set–up was a 58% lowering of the CBF and the concentration at half–maximal effect (EC50) was 25 μg–ml‐1. This study provides a complete characterization of the effect of thiopental on the CBF, including the time–course and concentration–effect relationship. A comparison to limited data in the literature suggests that the findings in the pigs constitute a fair approximation of the action of thiopental during the clinical induction of anaesthesia.
Central–to–peripheral arterial pressure gradient during cardiopulmonary bypass: relation to preand intra–operative data and effects of vasoactive agents
Authors: HERT S. G. DE , VERMEYEN K. M. , MOENS M. M. , HOFFMANN V. L. , BATAILLIE K.J.
Published: January 2009

A significant central–to–peripheral arterial pressure gradient may exist during and after cardiopulmonary bypass (CPB). The etiology and mechanisms of this phenomenon remain controversial. We studied the pressure gradient between aorta, brachial artery and radial artery in 68 patients, scheduled for elective coronary artery bypass surgery. We evaluated whether choice of cardioprotection during CPB (use of cold cardioplegic solution or use of intermittent crossclamping under protection with lidoflazine), and choice of pulsatile or nonpulsatile flow during the course of CPB, affected the magnitude and duration of the systolic pressure gradient. We also studied whether central–to–peripheral pressure gradient was influenced by administration on CPB of different vasoactive drugs with different mode of action: sodium nitroprusside (direct action on the vessels), droperidol (alpha–adrenergic blocking action), ketanserin (5–hydroxytryptamine antagonist) and phenylephrine (selective alpha,–agonist).

It appeared that central–to–peripheral gradient occurred early during CPB and remained constant throughout the course of CPB. The gradient disappeared within 60 min after weaning from CPB. We found the main pressure gradient to occur between the brachial and the radial artery. There was no relation between magnitude of the gradient and sex, weight, length or age of the patient. There was also no relation between magnitude of the pressure gradient and type of cardioprotection, choice of pulsatile vs nonpulsatile flow on CPB and duration of CPB. We also found no relation between pressure gradients and changes in temperature, haematocrit and systemic vascular resistance. The pressure gradient was not affected by any of the vasoactive drugs.
The reproducibility of measurement of right ventricular ejection fraction and cardiac output by the thermodilution technique in patients on mechanical ventilation
Authors: JENSEN P. J. , ANDERSEN P. K. , THØGERSEN C.
Published: January 2009

Thermodilution determined right ventricular ejection fraction (RVEF) and cardiac output (CO) were measured in 48 critically ill patients requiring mechanical ventilation and inotropic and/or vasoactive drugs. The coefficient of variation on CO and RVEF were calculated from triple determinations. The average coefficient of variation based on 551 triple determinations was 12.6% for RVEF (range 2–51%) and 4.9% for CO (range 0–24%). If a 10% coefficient of variation was chosen as acceptable, 95% of the CO measurements were acceptable. The coefficient of variation on RVEF only fulfilled the 10% criteria in 46% of the measurements, but if the accepted level was raised to a 20% coefficient of variation, 90% of the measurements were acceptable. The measurement of RVEF and CO are used for calculation of e.g. right ventricular end diastolic volume (RVEDV). By applying the average coefficient of variation on RVEF and CO, the accumulated error on calculation of RVEDV was found to be 15%–+20% at worst. Before derived parameters such as RVEDV are interpreted or compared with previously obtained values, the accumulated error should be calculated. To ensure the quality of the measurements, our recommendation is always to calculate the coefficient of variation for each triple determination of RVEF and CO.
On the relative potency of amino–amide local anaestheticsin vivo
Authors: HASSAN H. G. , RENCK H. , ÅKERMAN B. , YOUSSEF H.
Published: January 2009

With the aim of comparing the analgesic effectiveness of lidocaine, prilocaine, bupivacaine and etidocainein vivo, a study of the relationships between dose and duration of infraorbital nerve block (IONB) of various intensities (IONB degrees 3–10) was performed in the rat. With increasing doses longer durations of action were obtained. Further analyses were performed using multiple regression analysis. The log (dose) – duration lines for bupivacaine and etidocaine were found to be linear, whereas those for lidocaine in degree 3 and degree 10 IONB and for prilocaine in degree 10 IONB were so only after omission of some data. The only comparisons yielding no deviation from parallelism of log (dose) – duration lines were etidocaine vs. lidocaine at IONB degree 10 and lidocaine vs. prilocaine and bupivacaine vs. etidocaine at IONB degree 3. The difference between these agents with respect to their duration of action at all dose levels amounted to 113 minutes (M s.e.m.) for etidocaine vs. lidocaine (IONB degree 10), 27 4 min for prilocaine vs. lidocaine and 54 5 min for bupivacaine vs. etidocaine (IONB degree 3). For all other comparisons the log (dose) duration lines deviated from parallelism, i.e. differences between agents with respect to their duration of action were found to be dose–dependent. The slopes of the log (dose) – duration lines were found to correlate closely to the log (partition coefficient) and log (protein binding) of the investigated agents.
The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation
Authors: WOOD M. L. B. , FORREST E. T. S.
Published: January 2009

The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.
Effects of morphine on neuronal and behavioural responses to visceral and somatic nociception at the level of sinal cord
Authors: OMOTE K. , KAWAMATA M. , IWASAKI H. , NAMIKI A.
Published: January 2009

This study was undertaken to examine the role of morphine in modulation of nociception in visceral and somatic pain tests at the level of the spinal cord, using neurophysiological and behavioural reflex assays. In the neurophysiological study, we recorded extracellularly the activity of the single viscero–somatic convergent neurons of the spinal dorsal horn, which was evoked by the colorectal distension (80 mmHg) of noxious visceral stimulation and the radiant heat (51C) of noxious somatic stimulation, in decerebrated, spinally transected cats. Spinally administered morphine (200 μg) produced significant suppression of noxiously evoked activity by both stimuli in a time–dependent manner. In addition, intravenously administered naloxone reversed the suppressive effects of morphine. In the behavioral reflex study, colorectal distension threshold and tail–flick latency were measured in rats chronically implanted with lumbar intrathecal catheter. Intrathecally administered morphine significantly elevated the colorectal distension threshold and prolonged the tail–flick latency in a time– and dose–dependent manner. The results of the present study demonstrated that spinal morphine was capable of suppressing the evoked activity of the viscero–somatic convergent neurons, resulting in suppression visceral and somatic pain behavioural reflexes.
Re–expansion pulmonary oedema following removal of intrathoracic haematoma
Authors: MORIKAWA H. , HIROTA K. , KITO K. , FUJITA H. , MISHIMA S.
Published: January 2009

Acute ipsilateral pulmonary oedema is a well documented complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion and atelectasis. We present a case of bilateral re–expansion pulmonary oedema following removal of an intrathoracic haematoma. High protein concentration of the oedema fluid suggests increased pulmonary vascular permeability as a cause of this pulmonary oedema.
Depolarizing neuromuscular block – a presynaptic mechanism?
Authors: FELDMAN S. , HOOD J.
Published: January 2009

It has been known since 1951 that drugs such as decamethonium and suxamethonium produced an acetylcholine like (agonist) effect on the postsynaptic membrane of the neuromuscular junction causing depolarization. Inspite of evidence of action of these drugs on the motor nerve terminals, it has been widely assumed that the neuromuscular block they produced is the result of depolarization followed by desensitization of the postsynaptic membrane.

Evidence questioning the view that these drugs produce their clinical effects as a consequence of depolarization of the postsynaptic membrane or desensitization is presented together with the results of recent experiments which are more readily explained by proposing a presynaptic action of these drugs, initially stimulating then depressing acetylcholine release.
Effects of fentanyl or alfentanil as supplement to propofol anaesthesia for termination of pregnancy
Authors: LINDHOLM P. , HELBO–HANSEN H. S. , JENSEN B. , BÜLOW K. , NIELSEN T. G.
Published: January 2009

One hundred and twenty patients undergoing early legal termination of pregnancy by dilatation and suction curettage before 12 weeks of pregnancy were randomly allocated to receive total intravenous propofol anaesthesia either alone or supplemented with fentanyl 1.5 μg·kg‐1 or alfentanil 15 μg kg‐1. Supplementation with fentanyl or alfentanil improved operating conditions (P<0.01), reduced total propofol requirements (P < 0.01) and reduced postoperative pain intensity (P < 0.05). Immediate recovery, assessed by the time patients took to open the eyes, to give correct date of birth and by co–operation score, was more rapid in the alfentanil group compared to the control group (P < 0.05), whereas there was no significant difference between the alfentanil and fentanyl groups. The three anaesthetic techniques did not differ with regard to side effects.

In conclusion, total intravenous propofol anaesthesia in patients undergoing early termination of pregnancy was improved by supplementation with either fentanyl 1.5 μg kg‐1 or alfentanil 15 μg–kg‐1. The benefit was slightly greater with alfentanil than with fentanyl.
ECG and cardiac enzymes after glycine absorption in transurethral prostatic resection
Authors: HAHN R. G. , ESSEN P.
Published: January 2009

The electrocardiogram (ECG) was recorded and the serum levels of creatine kinase (CK), aspartate transaminase (ASAT) and prostatic acid phosphatase (PAP) were measured in 22 patients undergoing transurethral resection of the prostate (TURP) under spinal or epidural anaesthesia. The irrigating fluid consisted of 1.5% glycine and 1 % ethanol, and absorption of the fluid was monitored by detection of alcohol in the expired breath. The results show that nine of the 11 patients (82%) who absorbed more than 1, 000 ml of irrigating fluid had developed ECG changes 24 h after the operations. The most common alteration was depression of the T wave. This sign was only seen in one (9%) of the patients who absorbed none or very small amounts of irrigating fluid (P < 0.001). The serum activity of CK and ASAT increased in five patients who also developed ECG changes, and the highest values were recorded 24 h after TURP. The CK–MB isoenzyme was detected in 85% of the samples with elevated total CK, but the criteria for myocardial infarction were never fulfilled. In contrast, PAP increased in all patients and the highest level occurred at the end of TURP. The activity–time profiles suggest that CK and ASAT entered the circulation by a mechanism different from that of PAP. We conclude that absorption of glycine solution during TURP is frequently followed by nonspecific ECG signs of altered cardiac function and also that the serum activities of CK and ASAT increase is some of these patients.
Oesophageal intubation can be undetected by auscultation of the chest
Authors: ANDERSEN K. H. , SCHULTZ–LEBAHN T.
Published: January 2009

Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. Auscultation of the epigastrium, right and left axilla is more reliable than auscultation of the chest, and the anaesthetist's feeling when he squeezes the bag. P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left axilla, are recommended.
Isosorbide dinitrate does not interfere with heparin anticoagulation:
Authors: MUIKKU O.
Published: January 2009

The possible nitrate‐induced heparin resistance was studied intraoperatively in 40 patients undergoing coronary artery bypass grafting. The patients were randomized to receive a continuous infusion of placebo, nitroglycerin (0.5 μg kg‐1 min‐1) or isosorbide dinitrate (0.5 or 2.5 μg kg‐1 min‐1). After the infusion had been administered, prior to the institution of cardiopulmonary bypass, for at least 60 min, porcine intestine heparin 300 I.U. kg‐1 (as divided in two consecutive doses of 100 and 200 I.U. kg‐1, respectively) was administered to achieve systemic anticoagulation. Activated coagulation time values and plasma heparin anti‐Xa activity showed no significant differences between the groups before and after the administration of heparin. It is concluded that in doses given in the present study, organic nitrates do not interfere with the anticoagulation effect of large doses of heparin required for the conduction of cardiopulmonary bypass.
Prediction of outcome from intensive care after gastroenterologic emergency
Authors: NISKANEN M. , KARI A. , NIKKI P. , IISALO E. , KAUKINEN L. , RAUHALA V. , SAARELA E.
Published: January 2009

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.
Efficiency of a new radiant heater for postoperative rewarming
Authors: WEYLAND W. , WEYLAND A. , HELLIGE G. , FRITZ U. , NEUMANN H. , MARTENS S. , CROZIER T. , BRAUN U.
Published: January 2009

Effective rewarming devices have only become available recently. This investigation compares the efficiency of an new overhead radiant heater (ARAGONA Thermal Ceilings TM, CTCX, 1000 W) with that of an electric blanket (50 W) or a standard hospital blanket. 35 patients undergoing postoperative assisted ventilation and continued sedation were randomly assigned to one of the treatments. Shivering, oxygen uptake, heart rate and invasive blood pressure were measured and the increase in total body heat minus body heat production was calculated as heat balance. Results are given as medians (range). Subcutaneous temperatures were taken to calculate the mean skin temperature. The evaluation was undertaken for an oesophageal temperature interval of 35 to 37C. All groups exhibited a similar mean oxygen uptake i.e. thermogenesis (3.5 (2.7–4.0) ml kg‐1 min‐1; 3.3 (2.7–4.9) ml kg‐1·min‐1; 3.2 (2.4–5.1) ml kg‐1. min‐1) which correspond to a resting energy expenditure. The time of rewarming of the radiant heat treated group (n = 12) (100 (76–143) min) for this interval was significantly reduced in comparison to both other groups (183 (116–320) min; 231 (115–340) min). A slightly positive heat balance was only achieved in the group treated by radiant heat, indicating that all metabolic heat was conserved or heat losses were compensated by transfer of external heat. Shivering was significantly reduced in the radiant heater group whereas the rate pressure product was insignificantly higher. We did not find any significant effect for the electric heating blanket in comparison to the control group. We conclude that the ARAGONA Thermal Ceilings TM seems to be an effective device for postoperative rewarming without related side effects. For the investigated temperature interval it can reduce the time of rewarming to about 50% of control values at the same rate of thermogenesis.
Psychological factors influencing the surgical patients' consent to regional anaesthesia
Authors: PAPANIKOLAOU M. N. , VOULGARI A. , LYKOURAS L. , ARVANITIS Y. , CHRISTODOULOU G. N. , DANOU–ROUSSAKI A.
Published: January 2009

To investigate the preoperative attitude of surgical patients to regional anaesthesia, 162 subjects scheduled for elective surgery were studied. On the day before operation, patients were interviewed by an anaesthesio–logist, using a semi–structured schedule. Topics investigated were sociodemographic variables and clinical correlates, such as past anaesthetic experience, information about anaesthesia and surgery, as well as questions and fears related to anaesthesia. Subjects were assessed for personality characteristics and emotional symptoms by Eysenck's Personality Questionnaire (EPQ), Zung's Self–rating Anxiety and Depression Rating Scales, Schalling–Sifneos' Personality Scale and the 43–item Life Events Inventory of Holmes and Rahe. Seventy–one patients (44%) consented to regional anaesthesia. Consent to regional anaesthesia was associated with advanced age, low neuroticism and high extroversion score in the EPQ, as well as longer duration of illness. The deniers of consent asked more questions and expressed more fears about anaesthesia. It is suggested that the patients' characteristics influence their preference, acceptance or refusal of regional anaesthesia.
Use of the laryngeal mask for fibrescope–aided tracheal intubation in an awake patient with a deviated larynx
Authors: ASAI TAKASHI
Published: January 2009

I report a case in which fibrescope–aided awake tracheal intubation was achieved using a laryngeal mask, in a patient with a mediastinal goitre in whom tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope had failed. The tumour extended to the upper part of the mediastinum. The larynx and the upper segment of the trachea were displaced by the tumour. Awake tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope failed. The laryngeal mask was then inserted without difficulty. After a fibreoptic bronchoscope had been covered by a plastic tube, the combination was passed through the laryngeal mask into the trachea. The fibreoptic bronchoscope and the laryngeal mask were removed, and a reinforced endotracheal tube was then inserted over the plastic tube into the trachea. The time for tracheal intubation was about 70 s. The laryngeal mask may allow easier location of the laryngeal inlet with a fibreoptic bronchoscope, and this technique is a useful alternative to the conventional technique of tracheal intubation in the patient with a deviated larynx.
Splanchnic ischaemia and its role in multiple organ failure
Authors: LANDOW L. , ANDERSEN L. W.
Published: January 2009

Multiple organ failure remains the leading cause of death in the intensive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis of this syndrome. Their data indicate that inadequate gut perfusion leads to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration impairs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypothesized that production of tumor necrosis factor α, and other biologic mediators by endotoxin–stimulated macrophages, triggers a generalized and uncontrolled inflammatory response that ultimately leads to multiple organ failure.

Preliminary evidence suggests that survival can be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future studies are needed to determine whether additional treatment modalities can improve outcome once the inflammatory response has fully developed.