bluuebunny/crossref_metadata_2025 huggingface dataset:
The nursing care recording system. A preliminary study of a system for assessment of nursing care demands in the ICU
Authors: Hjortsø E. , Buch T. , Ryding J. , Lundstrøm K. , Bartram P. , Dragsted L. , Qvist J.
Published: January 2009

A new system, Nursing Care Recording (NCR), for the recording of nursing care in a general ICU is presented. NCR classifies ICU patients according to their need for intensive nursing care. Comparing the NCR with the Therapeutic Intervention Scoring System (TISS), a correlation coefficient of 0.60 was found. The main difference between the two systems was related to recording procedures allowing changes in nursing intensity within a 24‐h period, reflecting patient improvement due to therapy, which was detected by NCR but not by TISS. NCR can be used to estimate nursing capacity during different shifts and may be useful in the assessment of the total nursing staff necessary for a given ICU. It is suggested that NCR will allow detection of changes in the nursing care work load, whether this change is due to new activities in the unit or to alterations in the individual patient care.
Anaesthetic uptake and washout characteristics of patient circuit tubing with special regard to current decontamination techniques
Authors: Gilly H. , Weindlmayr‐Goettel M. , Köberl G. , Steinbereithner K.
Published: January 2009

The amounts of halothane and isoflurane trapped after exposure for up to 3 h at 2 MAC in commonly used anaesthesia circuit tubing were quantitated by gas chromatography. The decontaminating effects of procedures such as flushing with oxygen, thermal disinfection and/or routine storage were assessed in a similar way. After halothane exposure, anaesthetic content was highest in silicone (398 ± 55 mg 100 g‐1). Lower quantities were found in all other tubings investigated (electrically conductive latex: 64 ± 4, conductive rubber: 62 ± 4, polyethylene‐vinyl‐acetate (PEVA): 293 ± 10 and 149 ± 17 for non‐conductive corrugated and spiral tubes, respectively, polysulfone (Hytrel®): 155 ± 10 mg 100 g‐1). The isoflurane contents were substantially lower (silicone: 278 ± 23; others: 55 ± 7, 61 ± 6, 163 ± 9 and 86 ± 8, 74 ± 4 mg 100 g‐1). The tubings' content did not correlate with the material's partition coefficient as full saturation was not achieved during exposure. Decontamination procedures reduced the content of volatile anaesthetics to a variable extent. Conductive latex and rubber showed the highest residual content, even after thermal disinfection and subsequent storage. Twenty‐minute flushing with oxygen (8 1 min‐1) decreased effluent gas concentrations below 5 p.p.m. in all tubings. With silicone, after 1 h flushing, halothane concentrations still exceeded 10 p.p.m. (isoflurane: 8 p.p.m.). It is concluded that urgent decontamination by a 20‐min flush warrants the safe re‐use of previously ‘contaminated’ conductive rubber and latex as well as polysulfone tubings in critical situations, e.g. in malignant hyperthermia patients if disposable tubing is not immediately available. In contrast, we warn against re‐using silicone and disposable PEVA tubing because of high uptake and considerable release during desorption.
Is acupuncture an alternative in idiopathic pain disorder?
Authors: Thomas M. , Arnèr S. , Lundeberg T.
Published: January 2009

This study investigated the pain‐relieving effect of an intensive type of periosteal acupuncture stimulation in patients with idiopathic pain disorder. Twelve patients, 2 males and 10 females, with a mean age of 54, were included in the study. The average duration of their pain was 12.6 years. Each treatment consisted of brief but painful manual stimulation of 3 to 4 periosteal sites. Over a 3–8‐month period each patient had between 4–11 treatments, an average of 7. Analgesic drugs that patients were on prior to the study were continued but no other physical or psychological treatment for their pain was applied. Ten patients had either no responses to treatment or only transient responses which were not maintained until the following treatment. Two patients benefitted from treatment, having long periods of substantial pain reduction. All responses were assessed on pain scales maintained daily before and during the entire period of treatments. For the majority (83%) of patients in this study, with an idiopathic pain disorder, periosteal acupuncture stimulation was not a treatment alternative.
Intra‐articular bupivacaine plus adrenaline for arthroscopic surgery of the knee
Authors: Gyrn J. P. , Olsen K. S. , Appelquist E. , Chraemmer‐Jørgensen B. , Duus B. , Hansen L. Berner
Published: January 2009

The purpose of the study was to evaluate three different doses of intra‐articular bupivacaine plus adrenaline in relation to per‐ and postoperative pain relief following arthroscopy. Sixty patients were allocated to three groups of 20 patients each scheduled for arthroscopy. They were randomized prospectively to receive bupivacaine plus adrenaline 25 mg + 50 μg, 50 mg + 100 μg, 75 mg + 150 μg, respectively, diluted to a volume of 30 ml. Four patients were excluded because the operation could not be carried out under intraarticular analgesia, 18 patients had a diagnostic arthroscopy and 38 patients had different arthroscopic operations performed. The number of patients scoring pain in the knee as moderate or severe was less in Group 3 than in the other two groups, i.e. the highest dose had a better pain relief. No adverse effects were registered. With respect to per‐ or postoperative administration of analgesics, postoperative pain occurrence, and the surgeon's acceptance of the method, there were no statistically significant differences. Ninety‐two percent of the patients would prefer intraarticular analgesia if they should need to have another arthroscopy performed.
Effect of piroxicam in addition to continuous thoracic epidural bupivacaine and morphine on postoperative pain and lung function after thoracotomy
Authors: Bigler D. , Møller J. , Kamp‐Jensen M. , Berthelsen P. , Hjortsø N. C. , Kehlet H.
Published: January 2009

Twenty‐eight patients scheduled for lung resection with lateral thoracotomy and postoperative chest drains during combined thoracic epidural bupivacaine plus morphine and general anaesthesia were studied. Post‐operative pain treatment was continuous epidural infusion of bupivacaine 0.25% 5 ml h‐1 plus morphine 0.2 mg h‐1 for 48 h and, in addition, the patients received rectal piroxicam 40 mg randomly and double‐blind 12 h and 1 h before surgery and 20 mg 24 h‐1 postoperatively or placebo. Pain was evaluated at rest, during cough and mobilisation, together with pulmonary function (FEV1, FVC, PEFR) and sensory level of analgesia repeatedly for 48 h. The results showed efficient pain relief, but without differences in pain scores or need for supplementary analgesics between the two groups. Pulmonary function decreased similarly in the two groups. Thus we were unable to show enhanced analgesia by supplementing an otherwise effective low‐dose epidural bupivacaine and morphine treatment with piroxicam after thoracic surgery with chest drains.
Pulmonary granulocyte accumulation is reduced by nebulized corticosteroid in septic pigs
Authors: Walther S. , Jansson I. , Berg S. , Lennquist S.
Published: January 2009

Nebulized beclomethasone dipropionate was administered to 14 anesthetized and artificially ventilated pigs at 6‐hourly intervals after infusion of live S. aureus (BDP group). Changes in pulmonary activity from autologous granulocytes labeled with In‐111 was detected externally for 12 (n = 8) to 44 h (n = 6). The changes were compared with those in ten pigs (12 h n = 7, 44 h n = 3) subjected to the same insults but given no corticosteroid (placebo group). Serial measurements of blood radioactivity, and cardiac output were performed in animals observed for 12 h. Corticosteroid‐treated pigs showed a gradual decline in decaycorrected pulmonary In‐111 activity. The placebo group displayed a more varied reaction, but most animals had an increased activity compared to the corticosteroid group. The difference between the groups was significant at 8 h (BDP‐group 92% (88–98), placebo‐group 107% (97–121), median (lower‐upper quartiles), baseline = 100%. P < 0.01, U‐test). Blood radioactivity and cardiac output did not differ significantly between the two groups. Nebulized corticosteroid thus diminished pulmonary granulocyte accumulation, which may be of value in the treatment of septic respiratory distress.
Ten ml bupivacaine 0.125% with 12.5 μg epinephrine is a reliable epidural test dose to detect inadvertent intravascular injection in obstetric patients. A double‐blind study
Authors: Gieraerts R. , Van Zundert A. , de Wolf A. , Vaes L.
Published: January 2009

A double‐blind study was designed in order to determine the specificity and sensitivity of an epidural test dose to detect inadvertent intravenous injection in obstetric patients undergoing epidural analgesia. Forty unselected obstetric patients were given an intravenous injection of 10 ml bupivacaine 0.125% with 12.5 μg epinephrine (test dose) or 10 ml normal physiologic saline. The maternal heart rate was monitored by the direct ECG mode of a fetal monitor and registered simultaneously with the tocogram. The primary investigator was blinded to the solution he injected into an antecubital vein. After the injection was given, he recorded his judgment of which solution he had administered. Eight other anesthesiologists made similar judgments on the basis of the recordings plus various levels of additional information (presence or absence of epidural analgesia, time of injection, subjective signs and symptoms). In contrast to the primary investigator, the blood pressure values were not given to them. For the primary investigator, the specificity of the test dose was 100% and the sensitivity 97.5%. The judgments of the 8 other anesthesiologists resulted in an excellent specificity (99.1%) and a good sensitivity (91.9% with information on time of injection and subjective signs and symptoms). The better performance of the primary investigator is probably due to the availability of blood pressure data.
Adrenaline absorption: effect of pH in mepivacaine and bupivacaine solutions. A clinical study during halothane anesthesia
Authors: Ueda W. , Hirakawa M. , Mori K.
Published: January 2009

The effect of the pH of the solution on the rate of absorption into the blood stream of locally‐injected adrenaline using an adrenaline solution mixed with either mepivacaine or bupivacaine was investigated. Forty patients undergoing elective craniotomy received one of the following five solutions for subcutaneous and subgaleaic injection in the dose 0.5 ml/kg: 1) mepivacaine‐adrenaline (pH = 6.1), 2) mepivacaine‐adrenaline (pH = 7.5), 3) bupivacaine‐adrenaline (pH = 6.1), 4) bupivacaine‐adrenaline (pH = 7.4), or 5) adrenaline (pH = 6.1). Both mepivacaine and bupivacaine added to the adrenaline solution increased the plasma concentration of adrenaline. Alkalinization attenuated the peak concentration of adrenaline in the case of a mepivacaine‐adrenaline solution, but not in the case of a bupivacaine‐adrenaline solution.
Differential effect of pancuronium at the adductor pollicis, the first dorsal interosseous and the hypothenar muscles. An electromyographic and mechanomyographic dose‐response study
Authors: Engbæk J. , Roed J.
Published: January 2009

Cumulative dose‐response curves were constructed from evoked compound electromyographic (EMG) recordings in man to compare the sensitivity to pancuronium of the adductor pollicis, the hypothenar and the first dorsal interosseous muscles. Also, the EMG and mechanomyography‐based sensitivity of the adductor pollicis muscle were compared. The EMG and the mechanomyogram were evaluated in random sequence in each of 21 adult thiopental, fentanyl and diazepam anesthetized patients. The EMG‐based ED50 were 36–38 μg · kg‐1 with no differences between muscles. The EMG‐based ED90 of the adductor pollicis and the hypothenar muscles were 62–65 μg · kg‐1 compared to the 60 μg · kg‐1 of the first dorsal interosseous muscle (P<0.05). ED50 (34 μg · kg‐1), and ED90 (56 μg · kg‐1) obtained from the adductor pollicis mechanomyogram were significantly lower than those based on the EMG (P<0.05). It is concluded that differences in sensitivity to pancuronium exist between the three muscles when evaluated from the EMG, and that the apparent sensitivity of a given muscle to a muscle relaxant may depend upon whether the response is evaluated using EMG or mechanomyography.
Haemodynamic changes associated with thermodilution cardiac output determination during myocardial ischaemia or pulmonary oedema in dogs
Authors: Nishikawa T. , Dohi S.
Published: January 2009

Since the technique of thermodilution (TD) cardiac output measurementsper secauses haemodynamic alterations, the authors examined whether the alterations elicited by iced injectate are augmented in the presence of myocardial ischaemia (MI) or pulmonary oedema (PE), compromised conditions frequently associated with critically ill patients. MI (N = 7) or PE (N = 7) was induced by clamping the anterior descending coronary artery or by a slow infusion of oleic acid into the right atrium, respectively, in anaesthetized dogs. Injection of iced injectate, 3 ml, caused similar changes in heart rate, mean systemic and pulmonary arterial pressures, pulmonary blood flow, right ventricular dP/dt, and right atrial pressure in dogs with and without MI or PE. Cardiac output estimated by TD correlated closely with pulmonary blood flow measured by electromagnetic flowmeter in both MI and PE (r>0.9). No profound alterations in haemodynamics were observed at any injection during TD cardiac output measurements under MI or PE. These results indicate that TD cardiac output determination does not cause serious haemodynamic alterations, and can estimate right ventricular output accurately under MI and PE.
Plasma prilocaine and mepivacaine concentrations after combined lumbosacral plexus block
Authors: Kaiser H. , Niesel H. C. , Biscoping J. , Al‐Rafai S. , Klimpel L.
Published: January 2009

In a pharmacokinetic study of combined sciatic/3‐in‐1 block for lower limb surgery, the two moderate‐acting local anaesthetics prilocaine and mepivacaine were compared. The mean maximum venous plasma concentrations of mepivacaine were more than twice as high as when prilocaine was used as anaesthetic (5.1 μg/ml vs. 2.37 μg/ml). When used in combination with the former, ornipressin did not reduce plasma concentrations of mepivacaine to values which were below the threshold for toxic symptoms (5–6 mg/ml). The peak plasma concentrations exceeded the threshold of 5 μg/ml in four of the nine patients of the mepivacaine group (maximum value 7.21 mg/ml) and in two of the nine patients of the mepivacaine + ornipressin group (maximum value 8.61 μg/ml).
Attenuated ventilatory response to hypoxaemia at vecuronium‐induced partial neuromuscular block
Authors: Eriksson L. I. , Lennmarken C. , Wyon N. , Johnson A.
Published: January 2009

The effect of a partial neuromuscular block on the ventilatory response to hypercarbia and to hypoxaemia was studied in 11 non‐anaesthetized male subjects. Respiratory frequency, tidal volume, minute volume, respiratory timing and drive were measured during air breathing and during stimulation by hypercarbia and hypoxaemia. The ventilatory response was defined as the ratio between, respectively, tidal volume and minute volume during ventilation stimulated by hypercarbia and hypoxaemia compared to measurements during air breathing. The ventilatory measurements were repeated on three separate occasions: before neuromuscular block was established, during an infusion of vecuronium aiming at a mechanical adductor pollicis train‐of‐four (TOF) ratio of 0.70, and after the infusion had been stopped and the neuromuscular block had spontaneously recovered to a TOF ratio of >0.90. Resting ventilation during air breathing remained with minor variations throughout the experiment. The ventilatory response to hypercarbia was not affected at a TOF ratio of 0.70 as compared to measurements before vecuronium and at a TOF ratio of >0.90. In contrast, the ventilatory response to hypoxaemia was markedly reduced at a TOF ratio of 0.70. We conclude that a mechanical TOF ratio of 0.70 following vecuronium may be associated with an inadequate ventilatory response to hypoxaemia.
Comparison of ketorolac and morphine for postoperative pain after major surgery
Authors: Stouten E. M. , Armbruster S. , Houmes R. J. , Prakash O. , Erdmann W. , Lachmann B.
Published: January 2009

This study was designed to determine the relative analgesic efficacy and safety of single intramuscular injections of ketorolac (10 mg or 30 mg) and morphine (10 mg) in patients of either sex with moderate to severe pain after major surgery. In a single‐dose, randomised, double‐blind study of parallel design, pain was assessed immediately before injection of test medication and at regular intervals for 8 h thereafter. One hundred and seventeen patients (109 undergoing cardiac surgery; 8 lung surgery) were randomized to one of the three treatment groups. Pain intensity was assessed using a 5‐point verbal scale before administration of study drugs. Postadministration, at 30 min and hourly for 8 h, pain intensity and pain relief were assessed, again using the 5‐point verbal scale. Additionally, as a measure of analgesia, forced expiratory volume (FEV1) was obtained in all patients. Vital signs including blood pressure, pulse, temperature, respiratory rate and blood gases (Paco2) were recorded prior to and after study medication. Based on hourly pain intensity differences and hourly pain relief observations, ketorolac 10 mg was generally more effective than morphine 10 mg, and ketorolac 30 mg was generally more effective than ketorolac 10 mg. The results of this study show that ketorolac is an effective and safe (with regard to arterial pressure, blood gases and lung function) analgesic for relief of postoperative pain after major surgery in stable patients. No clinically significant adverse effects occurred during the study. One cannot exclude an influence on patients with organ system dysfunction or on parameters not measured in this study.
Increased volume of gastric contents in diabetic patients undergoing renal transplantation: lack of effect with cisapride
Authors: Reissell E. , Taskinen M. R. , Orko R. , Lindgren L.
Published: January 2009

Gastroparesis is a frequently unrecognized complication of insulin‐dependent diabetes mellitus, which subjects these patients to the risk of aspiration at induction of anaesthesia. The effect of oral cisapride on volume and pH of gastric contents was studied in 24 diabetic and 24 non‐diabetic uraemic patients undergoing renal transplantation. All patients were allocated randomly in a double‐blind fashion to receive either 10 mg of cisapride or placebo orally approximately 100 min before anaesthesia and three times daily for the first 2 postoperative days. After the induction of anaesthesia, gastric contents were aspirated through a nasogastric tube, and the pH and volume were measured. The emptiness of the stomach was verified by gastroscopy. Gastric volumes exceeding 0.4 ml · kg‐1were observed in 12/24 of the diabetic and 4/24 of the non‐diabetic uraemic patients (P<0.01). The pH of the gastric contents did not differ between the groups, ranging from 1–8 in diabetics and 1–7 in non‐diabetics. Cisapride lacked effect on gastric contents and postoperative gastrointestinal motility. Diabetic uraemic patients had larger gastric volumes than their non‐diabetic controls at induction of anaesthesia. Cisapride had no effect on gastric emptying preoperatively nor on postoperative bowel function.
Effect of antithrombin concentrate on haemostatic variables in critically ill patients
Authors: Albert J. , Blomqvist H. , Gårdlund B. , Jakobsson J. , Svensson J. , Blombäck M.
Published: January 2009

In a controlled pilot study of 32 critically ill patients, we have attempted prospectively to identify laboratory variables which can be used to select and monitor patients on antithrombin (AT) therapy. Patients with plasma AT levels less than 70% of normal were randomized to receive (AT group) or not to receive AT concentrate (non‐AT group). The groups did not differ in median age, sex, median APACHE II and TISS scores, number of days spent in the Intensive Care Unit or mortality rate. At the time of inclusion all patients had activated coagulation and fibrinolysis demonstrated as high levels of soluble fibrin, thrombin‐antithrombin complexes and fibrin‐D‐dimers (twice, four and ten times the upper reference range, respectively). In the AT group these levels decreased faster and the prothrombin complex concentration increased more rapidly to normal (i.e. the prothrombin time decreased). The level of C‐reactive protein which was high in both groups on inclusion (139 and 98 mg/l, respectively) decreased by 40% in the AT group but did not change in the control group. Our study indicates that laboratory variables normalize faster in seriously ill patients who have activated coagulation and fibrinolysis when they receive AT concentrate and that the variables mentioned above seem to be useful for monitoring the treatment.
Reaction to succinylcholine in two patients segregating for the plasma cholinesterase allele Ek
Authors: Jensen F. S. , Viby‐Mogensen J.
Published: January 2009

Recently, several new alleles have been identified at plasma cholinesterase locus E1. We have had the opportunity for the first time to monitor the response to succinylcholine in two patients with the newly discovered genotype E1aEk1. The duration of action and type of neuromuscular block following succinylcholine 1.0 and 1.5 mg kg‐1 i.v., respectively, were evaluated using train‐of‐four nerve stimulation and a Myograph 2000. One patient was anaesthetized with halothane, and the other was given a modified neurolept anaesthesia. Time to first response to nerve stimulation was 15 and 16 min, and time to 50% twitch height recovery was 19 and 20 min, respectively in the two patients. Both showed a depolarizing block. One of the patients received three bolus doses of succinylcholine 1 mg kg‐1. This patient gradually developed a phase II block, which was easily reversed by edrophonium. The results indicate that patients with genotype E1aE1k are slightly more sensitive to succinylcholine than are genotypically normal patients (E1u E1u) and patients heterozygous for the normal and the atypical gene (E1uE1a).
Therapeutic intervention scoring system (TISS) — a method for measuring workload and calculating costs in the ICU
Authors: Mälstam J. , Lind L.
Published: January 2009

The Therapeutic Intervention Scoring System (TISS) is an easily applicable method for measurement of workload in the intensive care unit (ICU). In the present study a modified TISS‐scoring (mTISS) was performed daily during 1988–1989 on 2693 patients in a general ICU. Of these, 900 could be classified as ‘true’ ICU‐patients (ICU‐stay ≥ 24 h or TISS ≥ 20 points), whereas the rest were postoperative. In ICU‐patients the average length of stay was 4.5 ± 8.9 days and the average workload 114 ± 218 mTISS‐points. The workload was not significantly related to age or type of admission (scheduled vs unscheduled). Hospital non‐survivors (13.6%) showed a significantly increased mean total mTISS‐score (239 ± 364, P<0.001). Critically ill (TISS Class IV) patients (14% of the sample), with an average workload of 437 ± 401 mTISS points, consumed 53% of the total resources. Patients categorized (ICD‐9) to respiratory and infectious diseases showed the greatest average workload (207 ± 315 and 208 ± 355 mTISS‐points, respectively). A workload‐index was also developed relating the actual workload to the ICU personnel. The cost of each mTISS‐point was calculated. In conclusion, the present study showed that mTISS is a valuable tool when evaluating resource utilization in the ICU. Together with the proposed workload‐index and calculation of costs, mTISS could be used for ICU management control.
Recollections of general anaesthesia: a survey of anaesthesiological practice
Authors: Moerman N. , van Dam F. S. A. M. , Oosting J.
Published: January 2009

In order to identify the factors to which patients attach importance when undergoing general anaesthesia, 678 patients were retrospectively asked about their recollections of previous anaesthetics during routine preoperative screening over a period of 14 months. The most frequently mentioned recollections concerned the post‐anaesthetic period, followed by recollections of the induction of anaesthesia. From the post‐anaesthetic period, nausea/vomiting and drowsiness were most often cited. The number of anaesthetics previously undergone had no influence on the reports of the two most frequently mentioned complaints. The rate of nausea/vomiting in this series was 21.0%. The number of patients reporting nausea/vomiting following an anaesthetic has not changed over the years. The last 250 patients were asked to assess the quality of their anaesthetics on a 5‐point scale. More than a quarter of the patients were not satisfied with the anaesthesia. No correlation was found between the assessment of the anaesthesia and complaints about nausea/vomiting and drowsiness. The possible role of psychological factors in the origin of complaints about anaesthesia is discussed.
A device for measuring the lateral wall cuff pressure of endotracheal tubes
Authors: Lomholt N.
Published: January 2009

A new method for measuring the lateral wall pressure on the trachea from cuffs of endotracheal tubes is presented. The method is based on measuring the force necessary to force a small, constant flow of air through a Teflon or silicone rubber envelope, placed between the cuff and the tracheal wall. The pressures recorded are 0.1 to 0.3 kPa higher than the theoretically correct values. The response time is 0.28 s for 90% of full deflection. Dynamic recordings of the lateral wall pressure of high and low residual volume cuffs can be obtained for analysis of the interaction between the cuff and the tracheal compliance. No method for accurate, dynamic recording of the lateral wall cuff pressure has previously been published.
Clinical and metabolic responses to different kinds of premedication in ASA III patients
Authors: Kirvelä O. , Kanto J. H.
Published: January 2009

Clinical and metabolic responses to atropine plus pethidine and to scopolamine plus morphine premedication were studied in 45 ASA physical status III patients undergoing gynaecological procedures. Atropine 0.5 mg plus pethidine 50 mg intramuscularly (Group 1), scopolamine 0.24 mg plus morphine 8 mg (Group 2), or intramuscular placebo (Group 3) premedication were given in random, double‐blind fashion. Scopolaminemorphine premedication caused a significant decrease in energy expenditure (EE) and oxygen consumption (Vo2) (from 1229 ± 193 to 1184 ± 221 kcal/24 h, P=0.004 and from 105 ± 11 to 102 ± 12 ml/min/m2, P=0.006, respectively) simultaneously with a decrease in rate‐pressure product (RPP) (P=0.0001) and an increase in pressure‐rate quotient (PRQ) (P=0.034). Atropine‐pethidine premedication induced a decrease in RPP but not in EE or Vo2. In the placebo group both RPP and Vo2 first increased and then slowly returned to the levels measured prior to premedication. The RPP was significantly lower in Group 2 than in Groups 1 and 3 at both 30 and 60 min. The degrees of subjective tiredness and anxiolysis were significantly greater in Groups 1 and 2 (showing good sedative and anxiolytic effect) than in Group 3. These results show that in ASA III patients, atropine‐pethidine premedication does not decrease the sympathoadrenal reaction to the degree its anxiolytic and sedative effect would suggest. This may indicate neuroendocrine stress induced by atropine‐pethidine.
Ventilatory effects of epidural clonidine during the first 3 hours after caesarean section
Authors: Narchi P. , Benhamou D. , Hamza J. , Bouaziz H.
Published: January 2009

Many authors have shown the analgesic efficacy of 150–800 μg of epidural clonidine in the postoperative period. Its use as an analgesic after caesarean section has recently been studied with higher dosages (400–800 μg). Our study aimed at assessing the analgesic and ventilatory effects of two smaller doses of epidural clonidine (150 and 300 μg), which were compared to the effects of 10 mg of parenteral morphine (M) during the first 3 h after caesarean section. The duration of the analgesic effect was longest with 150 μg of epidural clonidine. Arterial blood pressure decreased from 30 min after the injection to the end of the study in both epidural clonidine groups. A marked sedation was observed in patients receiving 300 μg of epidural clonidine and was frequently associated with snoring, obstructive apnoea and episodes of arterial oxygen desaturation. We conclude that 150 μg of epidural clonidine provides better and longer analgesia after caesarean section than 10 mg of parenteral morphine, and seems preferable to higher doses (300 μg) in this setting, since 300 μg of epidural clonidine may produce unacceptable respiratory obstructive disturbances.
Anaesthetic practice and postoperative pulmonary complications
Authors: Pedersen T. , Viby‐Mogensen J. , Ringsted C.
Published: January 2009

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty‐nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty‐two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P<0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long‐lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P<0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia. By utilizing logistic regression, a model for prediction of postoperative pulmonary complications was developed. Six variables were found to be significant in predicting complications: high age, major abdominal surgery, emergency surgery, a history of chronic obstructive lung disease, long‐lasting general anaesthesia (≥ 180 min) involving pancuronium, and anaesthesia involving pancuronium, in the order given.
Core temperature measured in the auricular canal: comparison between four different tympanic thermometers
Authors: Jakobsson J. , Nilsson A. , Carlsson L.
Published: January 2009

Four different tympanic thermometers, absorbing infra‐red radiation, (FirstTemp, Diatek, Ivac and Genius) were studied. Variations from repeated measurements and reliability of tympanic temperature compared to oesophageal, rectal and pulmonary artery temperature were studied. Core temperature measured by the “FirstTemp” and the “Genius” thermometers showed slightly higher values than core temperature measured by oesophageal, rectal and pulmonary artery thermistors. Compared to oesophageal temperature “FirstTemp” showed 0.56°C and “Genius” 0.28°C higher values, while the “Diatek” and the “Ivac” gave slightly lower values (‐0.5°C and ‐0.28°C). All four thermometers were found accurate for repeated measurement both in terms of standard deviation and coefficient of variance. All four tympanic thermometers showed good accuracy for changes in core temperatures compared to the reference thermistors (r2 values 0.96 for “FirstTemp”, 0.88 for “Diatek”, 0.96 for “IVAC” and 0.95 for “Genius”). The tympanic thermometer was found to be a valuable alternative for measuring core temperature in most clinical settings.
The effect of acute hypothermia and serum potassium concentration on potassium cardiotoxicity in anesthetized rats
Authors: Sprung J. , Cheng E. Y. , Gamulin S. , Kampine J. P. , Bosnjak Z. J.
Published: January 2009

We examined the effects of hypothermia on serum K+ concentration and the interaction of body temperature and K+ load on cardiac toxicity in anesthetized rats. Serum K+ concentration significantly decreased to 2.61 ± 0.13, 2.59 ± 0.19 and 2.39 ± 0.14 mmol/1 at 31.0°C, 28.0°C and 25.0°C, respectively, from the control value of 2.80 ± 0.15 mmol/l at 37.0°C. We used a 300% increase in baseline QRS duration as evidence of cardiac toxicity. Serum K+ concentrations of 4.95 ± 0.12, 4.71 ± 0.10, 4.45 ± 0.14 and 4.07 ± 0.14 mmol/l resulted in cardiac toxicity at 37.0°C, 31.0°C, 28.0°C, and 25.0°C, respectively. These data indicate that the level at which an elevation of serum K+ concentration causes cardiac toxicity diminishes with progressive hypothermia. We conclude that hypothermia induces hypokalemia, possibly through redistribution, and that the myocardium appears to be more sensitive to the toxic effects of K+ as hypothermia deepens.
Cardiac herniation after pneumonectomy
Authors: Baaijens P. F. J. , Hasenbos M. A. W. M. , Lacquet L. K. , Dekhuijzen P. N. R.
Published: January 2009

Cardiac herniation is a rare, lethal complication of intrapericardial pneumonectomy demanding urgent treatment. It usually occurs within the first 24 h postoperatively. We present a patient with late cardiac herniation, 28 h postoperatively, where the electrocardiographic changes were evident several hours before the clinical picture became clear. After the diagnosis was made, the patient was treated surgically and survived.
Alfentanil infusion in total intravenous anaesthesia (TIVA). Population pharmacokinetics fails to predict plasma concentration of alfentanil
Authors: Jenstrup M. , Fruergård K. , Nielsen J. , Møller A. M. , Wiberg‐Jørgensen F.
Published: January 2009

In order to evaluate the ability to predict plasma concentrations from population‐corrected pharmacokinetics, a prospective study comprising 14 women admitted for elective hysterectomy was done. Alfentanil was given in combination with propofol in a total intravenous anaesthesia technique. The predicted median alfentanil concentration (289(256–363) ng ml‐1) was significantly lower than the measured median plasma concentration of 368(168–666) ng ml‐1). In conclusion, population‐based pharmacokinetics were found not to be accurate as they underestimate plasma concentrations of alfentanil.
Effects of deliberate hypotension induced by labetalol with isoflurane on neuropsychological function
Authors: Toivonen J. , Kuikka P. , Kaukinen S.
Published: January 2009

The effect of deliberate hypotension on brain function measured by neuropsychological tests was studied in 41 adult patients. Twenty‐four patients were anaesthetized for middle‐ear surgery with deliberate hypotension induced by labetalol with isoflurane (hypotensive group). Seventeen patients without hypotension served as a control group. The mean arterial pressure was 77 ± 2 mmHg (10.3 ± 0.3 kPa) before hypotension and 50 ± 0 mmHg (6.7 ± 0.0 kPa) during hypotension in the hypotensive group, and 86 ± 2 mmHg (11.5 ± 0.3 kPa) during anaesthesia in the control group. The following psychological tests were performed: four subtests of the Wechsler Adult Intelligence Scale (similarities, digit span, vocabulary and digit symbol), Trail‐Making tests A and B, Zung tests (self‐rating anxiety scale and self‐rating depression scale) and two‐part memory test battery with immediate and delayed recall. The tests were performed preoperatively and 2 days postoperatively. There were no statistically significant differences between the groups in any of the tests in the changes from preoperative value to postoperative value. The results indicate that hypotension induced by labetalol with isoflurane has no significant harmful effects on mental functions compared to normotensive anaesthesia.
Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children
Authors: Gouyet I. , Dubois M.‐C. , Murat I. , Saint‐Maurice C.
Published: January 2009

Perioperative blood glucose and insulin levels were measured in children (1–9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n= 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n= 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P<0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P<0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P<0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.
Flexible fibreoptic bronchoscopy via the laryngeal mask
Authors: Dich‐Nielsen J. O. , Nagel P.
Published: January 2009

The efficacy of flexible fibreoptic bronchoscopy through the laryngeal mask was investigated in 20 patients under total intravenous anaesthesia with propofol, fentanyl, atropine and suxamethonium. Mask size 4 was used for men and size 3 for women. Ventilation was performed with oxygen in air, FIO2 0.6. The ventilatory pressures were median 18 (9–40) cmH2O (1.8 (0.9–3.9) kPa) before the bronchoscope was inserted. When the tip of the bronchoscope was above the vocal cords the ventilatory pressures increased to 22 (10–43) mmHg (2.2(1.0–4.2) kPa) (P<0.001), and when the tip was situated at the mid‐tracheal level there was a further increase to 24 (12–50) mmHg (2.4(1.2–4.9) kPa) (P<0.001). Maximal gas leakages were median 1 (0–2) 1/min‐1. PEEP at the mid‐tracheal level was 3 (0–7) cmH2O (0.3(0–0.7) kPa). When 15 min of the procedure had elapsed, Pao2 was 232 (112–350) mmHg (30.9(14.9–46.6) kPa) and Paco2 39 (33–46) mmHg (5.2(4.4–6.1) kPa). The lowest oxygen saturation was median 98 (96–100)% and the highest end‐tidal CO2 34 (24–41) mmHg (4.5(3.2–5.5) kPa). It was easy to examine the laryngeal opening and a good assessment of vocal cord function was allowed when muscle relaxation ceased. We conclude that flexible fibreoptic bronchoscopy through the laryngeal mask is a safe technique provided that total intravenous anaesthesia is used. It is a valuable alternative to flexible bronchoscopy performed with topical anaesthesia.
Postoperative decline in plasma aspirin‐esterase and cholinesterase activity in surgical patients
Authors: Puche E. , GÓoAmez‐Valverde E. , Morillas M. GarcÍiAa , Jorde F. , Fajardo F. , Gil J. M. GarcÍiAa
Published: January 2009

We studied preoperative and postoperative plasma hydrolysis of aspirin and plasma cholinesterase activity in surgical patients. Postoperative aspirin esterase and cholinesterase activities fell sharply (119 ± 32 μg ml h‐1 and 3746 ± 1068 U I‐1 respectively; P<0.01) in comparison to basal preoperative values (157 ± 33 μg ml h‐1 and 4620 ± 940 U I‐1 respectively, P ± 0.01). We suggest that alterations in plasma esterase during the postoperative period may be related to the metabolic response to anesthesia‐ and surgery‐induced stress.
Preoxygenation techniques: the value of nitrous oxide
Authors: Khoo S. T. , Woo M. , Kumar A.
Published: January 2009

Changes in arterial oxygen saturation during induction of anaesthesia and intubation were studied using the pulse oximeter. Seventy‐five young ASA I patients undergoing elective uncomplicated surgery were divided equally into three groups. The patients were preoxygenated with 100% oxygen, 50% oxygen: 50% nitrous oxide or 30% oxygen: 70% nitrous oxide for 1 min. All were then induced with thiopentone, paralysed with suxamethonium and orally intubated. Arterial oxygen saturations were continuously recorded by a separate investigator. All groups showed similar arterial desaturation during suxamethonium‐induced apnoea and intubation, but the degree of desaturation was not clinically significant and no patient showed clinical signs of hypoxaemia. Preoxygenation with mixtures of oxygen and nitrous oxide can hasten the build‐up of alveol nitrous oxide concentration and help to smooth induction without compromising oxygenation of patients.
Verification of the position of a central venous catheter by intra‐atrial ECG. When does this method fail?
Authors: Salmela L. , Aromaa U.
Published: January 2009

The purpose of this study was to determine why intra‐atrial ECG tracing for checking the position of a central venous catheter fails in certain patients. Three hundred and fifty prospective and consecutive patients scheduled for central venous catheterization using various puncture sites and techniques were investigated. The catheters were 20 cm in length. After its introduction, the catheter was connected to an Alphacard® (Sterimed, Saarbrücken) for the intra‐atrial ECG tracing. The method failed in 29 patients, of whom nine had manifest myocardial pathology. In two patients the catheter looped, while in the remaining 18 the catheter proved to be too short. In these 18 patients, the cannulation was mainly performed via the external jugular vein and/or from the left side. Most of the patients were elderly males, and 11 of the 18 patients showed radiological signs of pulmonary emphysema. In such individuals it is advisable to use a catheter longer than 20 cm.
Psychomimetic reactions after neurolept and propofol anaesthesia
Authors: Linnemann M. U. S. , Guldager H. , Nielsen J. , Ibsen M. , Hansen R. W.
Published: January 2009

The purpose of this study was to compare the frequency of psychomimetic reactions after 24 h and 3 months following total intravenous anaesthesia with propofol and neurolept anaesthesia. Forty otherwise healthy female patients were randomly divided into two groups. All were undergoing elective gynaecological laparotomy for non‐malignant disease. Nineteen patients were anaesthetized with droperidol, fentanyl, pancuronium, N2O/O2. Twenty patients received total intravenous anaesthesia with propofol, fentanyl and pancuronium. Twenty‐four hours after the anaesthesia the patients were interviewed about their subjective experiences of anaesthesia and recovery. Three months after the operation the patients were sent a questionnaire concerning ability to work, sleep and memory disorders. After 24 h the anaesthesia was judged as good by 18 patients receiving propofol and 13 patients receiving NLA (n.s.). The recovery was judged as good by 16 patients in the propofol group and six patients in the NLA group (P<0.05). Locked‐in feelings were reported by one patient in the propofol group and ten patients in the NLA group (P<0.01). Impairment of memory was reported by one patient in the propofol group and seven patients in the NLA group (P<0.01). A questionnaire used after 3 months was answered by 18 patients in the propofol group and 17 patients in the NLA group. There were few complaints, and no differences were found between the two groups. In conclusion, total intravenous anaesthesia with propofol seems more acceptable than anaesthesia with neurolept as judged by the patients 24 h after anaesthesia. There were no differences between the two groups concerning psychomimetic reactions 3 months after anaesthesia.
Recall of music: a comparison between anaesthesia with propofol and isoflurane
Authors: Oddby‐Muhrbeck E. , Jakobsson J.
Published: January 2009

Sixty patients undergoing laparoscopy were randomly assigned to receive total intravenous anaesthesia with propofol or inhalation anaesthesia with isoflurane. Patients in these two groups were also randomly assigned to three subgroups listening to soft music, hard rock music or no music at all. Twenty‐four hours after surgery all patients were interviewed and asked if they had heard music during the operation. A tape with seven different pieces of music was also played for the patients. The music they heard during surgery was one of these. No patient had any memories or experiences from the operation. Four patients had dreams, three from the total intravenous anaesthesia group and one from the inhalation anaesthesia group. Twelve patients believed they had heard music, ten from the total intravenous anaesthesia group and two from the inhalation anaesthesia group (P<0.05). Two patients, one from each group, picked the right melody. In conclusion, there was no difference between the two groups with respect to recall during anaesthesia. Patients in the TIVA group were significantly more inclined to state that they had been exposed to music.
Influence of high thoracic epidural anesthesia on left ventricular contractility assessed using the end‐systolic pressure‐length relationship
Authors: Goertz A. W. , Seeling W. , Heinrich H. , Lindner K. H. , Schirmer U.
Published: January 2009

The effect of high thoracic epidural anesthesia (TEA) on left ventricular contractility was studied in a prospective clinical trial. Forty‐eight patients with ASA physical status 1 and 2 and without cardiovascular disease were included in the study. Thirty‐six patients scheduled for elective upper abdominal surgery were randomly assigned to Group 1 (TEA, bupivacaine 0.25%, n= 12), Group 2 (TEA, bupivacaine 0.5%, n = 12) or to Group 3 (control without TEA, n= 12). TEA induced a sensory block which extended over all cardiac segments. In order to assess the effect of systemically absorbed bupivacaine, we studied a separate group of patients who received lumbar epidural anesthesia without involvement of the cardiac segments: Group 4 (LEA, bupivacaine 0.5%, n= 10). Left ventricular contractility was assessed using the end‐systolic pressure‐length relationship. Left ventricular dimensions were measured by transesophageal echocardiography. All hemodynamic measurements were performed under general anesthesia. There was no significant difference in systolic or diastolic arterial pressure, heart rate, left ventricular end‐systolic and end‐diastolic cross‐sectional areas and left ventricular wall stress between the four groups. Left ventricular maximum elastance as a measure of left ventricular contractility was significantly (P<0.001) reduced in Groups 1 and 2 [8.1 (±3.5) and 9.6 (±4.4) kPa · cm‐1, respectively] as compared to Groups 3 and 4 [18.4 (±8.8) and 17.7 (±7.7) kPa · cm‐1, respectively]. No significant difference could be demonstrated between Groups 1 and 2 or between Groups 3 and 4. It is concluded that high TEA severely alters left ventricular contractility even in subjects without pre‐existing cardiac disease.