bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Breathing Therapy with a Dead‐Space‐Resistance Device on Postcardiac Surgical Patients
Authors: Takeda K. , Shimada Y. , Yoshiya I.
Published: January 2009

The effects of a dead‐space‐resistance device (IDSEP breather) on PaO2, PaCO2 and functional residual capacity (FRC) in 11 post‐cardiac surgical patients were studied. There were no significant changes in PaO2, PaCO2 and FRC after the IDSEP therapy. Changes in PaO2 between the pre‐ and post‐IDSEP therapy correlated well with changes in FRC (r = 0.797, P<0.01). Breathing therapy with the dead‐space‐resistance device appeared not to bring any benefit in early post‐cardiac surgical patients.
The Effects of Cardiac Pacing on Central Hemodynamics in Experimental Propoxyphene‐Induced Cardiac Failure
Authors: Strøm J. , Häggmark S. , Madsen P. S. , Reiz S. , Bredgaard Sørensen M.
Published: January 2009

Coronary sinus pacing was evaluated in 10 pigs during propoxyphene‐induced cardiac failure. From baseline, propoxyphene chloride 15 mg. min‐1was infused until circulatory shock developed. Cardiac pacing was evaluated at different dose levels expressed as % of the shock dose of propoxyphene: at intoxication levels below 50% of the shock dose, cardiac pacing improved cardiac performance. At dose levels above 50% of the shock dose cardiac performance deteriorated further during pacing. The results are consistent with a severe negative inotropic effect of propoxyphene in overdose.
A Combined tc‐Po2 and Skin Blood Flow Sensor
Authors: Jaszczak P. , Baumbach P.
Published: January 2009

A new approach to the determination of energy delivered to the skin during transcutaneous oxygen tension (tc‐Po2) measurements was tested. The test was carried out using a tc‐Po2 electrode constructed with an active thermal shield in order to provide more sensitive and specific heat transport measurements, and consequently to create the possibility of determining skin blood flow rates. The oxygen measurement properties did not differ from the conventional tc‐Po2 electrode. In vivo measurements were performed on 11 adult volunteers. Skin blood flow was determined by a blood flow cessation technique to be 0.124 ± 0.053 ml‐cm‐2‐min‐1 at the start of the experiments, rising to 0.164 ± 0.61 ml‐cm‐2‐min‐1. Tc‐Po2 changed from 56.2 ± 9.8 mmHg (7.5 ± 1.3 kPa) to 68.3 ± 9.0 mmHg(9.1 ± 1.2 kPa). It is concluded that a thermally shielded electrode makes it possible to determine the convectional component of the heat loss from the electrode to the skin and consequently to compute a relative measure of skin blood flow rate. The observed change in computed skin blood flow rate was correlated to the observed change in tc‐Po2 (P > 0.1).
Effects of Six Anaesthetic Agents on UDP‐Glucuronic Acid and Other Nucleotides in Rat Liver
Authors: Christensson P. I. , Eriksson G.
Published: January 2009

Anaesthesia affects the liver nucleotide pool. It was the aim of the present study to examine how anaesthesia for 60 min with pentobarbital, ketamin + diazepam, halothane, enflurane and isoflurane may influence the nucleotide pool in the rat liver, studied with isotachophoresis. It was found that none of the agents gave both safe and reproducible anaesthesia without affecting the nucleotide pools or affecting the experiments in some other way. Halothane and isoflurane were the two best alternatives with respect to both efficiency and safety. Isoflurane may be preferable since it gives a higher energy charge.
Respiratory Effects of Premedication during Enflurane N2O Anaesthesia in Children
Authors: Sigurdsson G. H.
Published: January 2009

The influence of premedication on induction characteristics and respiration was studied in 40 children breathing spontaneously during enflurane‐nitrous oxide anaesthesia. Two different premedications were used. Twenty children (Group DA) received a rectal solution containing diazepam 0.25 mg kg‐1 and atropine 0.015 mg kg‐1 and 20 (Group DMS) received a rectal solution of diazepam 0.5 mg kg‐1, morphine 0.15 mg kg‐1 and scopolamine 0.01 mg kg‐1. The children in Group DMS had a significantly higher preoperative sedative score (P<0.01), faster induction of anaesthesia (P<0.01), lower occurrence of airway problems during induction and a smoother intubation (P<0.05) than the children in Group DA. However, the endtidal carbon dioxide tensions were higher and the occurrence of apnoea was more common in Group DMS than in Group DA. Thus it was concluded that if the more sedative premedication (DMS) is to be used for enflurane anaesthesia in children, controlled ventilation would be preferable.
Tolerance to Nitrous Oxide in Volunteers
Authors: Rupreht J. , Dworacek B. , Bonke B. , Dzoljic M. R. , Van Eijndhoven J. H. M. , De Vlieger M.
Published: January 2009

Nociception and loss of awareness during exposure to anaesthetic concentration of nitrous oxide (N2O) were studied in eight male medical students. The cold water nociception test, where a hand is immersed in 0°C stirred water, was used for measurement of nociception. At irregular intervals an auditory command was given to oppose two fingers, and this served to monitor consciousness. The selected inspiratory concentration of N2O used per individual was sufficient to induce a loss of consciousness for more than 2.5 min, within 10 min of exposure to N2O. This concentration of N2O varied from 60% to 80%. The experimental exposure to N2O lasted 3 h. In all volunteers significant antinociception was observed within 2 min of exposure to N2O. The maximal analgesic effect was observed between 20 and 30 min of exposure to N2O. The analgesic effect of N2O gradually decreased and was absent in all eight volunteers within 150 min. Two volunteers regained consciousness at 77 and 91 min of exposure, whilst still breathing 60 and 80% N2O. These results show that tolerance to antinociceptive effects of N2O in man rapidly develops and that awareness may occur in some volunteers during prolonged exposure to N2O.
Successful Vasoconstrictor Therapy of Anaphylactoid Reactions during Induction of Anaesthesia: A Report of Two Cases
Authors: Pontén J. , Biber B. , Henriksson B. A.
Published: January 2009

Anaphylactoid reactions were evoked during intravenous induction of anaesthesia in two patients on three occasions. In the first patient the reaction occurred during the first anaesthetic on propranolol and hydrochlorthiazide medication due to hypertension. Since the major target organ for the anaphylactoid reaction in this patient was the pulmonary circulation, the cardiovascular collapse at his first anaesthetic was misinterpreted as a nonspecific reaction to anaesthesia reinforced by the beta‐receptor blocking therapy. At the second anaesthetic central haemodynamics, plasma adrenaline (A) and noradrenaline (NA) were measured. Following injection of thiopentone sudden decreases of mean arterial blood pressure (60%), cardiacoutput (60%). and systemic vascular resistance (20%) were observed. Thirty minutes later, still during circulatory shock, the concentration of A had increased whereas that of NA was normal. In the second patient the anaphylactogenic drug was supposed to be thiopentone, suxamethonium or alcuronium. In this patient, the fall in arterial blood pressure was associated with bronchospasm and the sudden appearance of peripheral oedema. In both cases initial resuscitation comprised volume replacement and beta1‐agonist therapy but the cardiovascular state was not normalized until vasoconstricting agents were infused.
The Effects of Dopamine on Central Hemodynamics and Myocardial Metabolism in Experimental Propoxyphene‐Induced Shock
Authors: Strøm J. , Häggmark S. , Nyhman H. , Reiz S. , Madsen P. Sloth , Angelo H. , Sørensen M. Bredgaard
Published: January 2009

The hemodynamic and cardiometabolic effects of dopamine were evaluated in propoxyphene‐induced circulatory shock in eight pentobarbital anesthetized pigs. Circulatory shock was induced by an infusion of propoxyphene chloride 15 mg·min‐1 i. v. At shock, i. e. CI≤2.0 1·min‐1 · m‐2 and/or MAP≤60 mmHg, dopamine was infused at 10, 20, 40, 80 and 160 μg · kg‐1 · min‐1 with an interval between increments of 8 min. After 30 min at 160 μg · kg‐1 · min‐1, the infusion rate was reversibly decreased. The propoxyphene infusion of 15 mg · min‐1 was continued throughout the study. Dopamine improved the circulation in seven animals; one animal died in refractory shock during dopamine infusion. Dopamine infusion at shock level resulted in an increase of the following variables (% of baseline value): MAP (69%), HR (109%), CI (138%) and SVI (129%). Normalisation was seen in MRAP (120%) and in MPAOP (100%). A profound decrease in systemic vascular resistance was unchanged. Increases were seen in left and right ventricular stroke work index, to 88% and 176% of baseline, respectively. Left ventricular dP/dt increased (170%). In the coronary circulation myocardial blood flow increased (133%) as did myocardial oxygen consumption (65%) concomitant with a decrease in myocardial oxygen uptake (41%), but coronary vascular resistance progressively decreased (38%). The myocardial propoxyphene extraction changed from + 54% to ‐86% during peak dopamine infusion. In conclusion, dopamine reversed cardiac failure in propoxyphene overdose by a marked positive inotropic stimulation restoring contractility. A marked positive chronotropic stimulation maintained a sufficient cardiac index and a normal blood pressure in spite of a profound vasodilatation which was unresponsive to dopamine.
Pain on i.v. Injection of Propofol (ICI 35 868) in Emulsion Formulation
Authors: Hynynen M. , Korttila K. , Tammisto T.
Published: January 2009

Pain on injection of three anaesthetic induction agents, thiopentone, methohexitone and propofol (diisopropyl phenol), administered into a vein on the dorsum of the hand or wrist, was studied in 32 premedicated patients undergoing elective surgery. The pain was rated as none, mild or severe. A 1% emulsion formulation of propofol (ICI 35 868) (2 mg kg‐1) and methohexitone (2 mg kg‐1) induced pain significantly more often, in 100% and 80% of patients, respectively, than thiopentone (4 mg kg‐1), 0%. The pain was rated as severe more often in patients receiving propofol (67%, P<0.01 vs thiopentone) than in those anaesthetized with methohexitone (20%) or thiopentone (0%). It is concluded that the fat emulsion form of propofol, when injected into a peripheral vein, frequently induces severe pain.
Rectally Administered Morphine: Plasma Concentrations in Children Premedicated with Morphine in Hydrogel and in Solution
Authors: Westerling D.
Published: January 2009

Seventeen healthy children undergoing eye surgery in general anaesthesia were given morphine rectally for premedication. Six patients (Group I) were given morphine 0.15 mg·kg‐1 in a propylene glycol solution also containing diazepam and hyoscine. Eleven patients (Group II) were given morphine 0.5 mg·kg‐1 in a starch hydrogel preparation. The plasma concentrations of morphine (Groups I and II) and diazepam (Group I) were studied. After the lower dosage of morphine the plasma concentrations never exceeded 10 ng·ml‐1, whereas the mean peak plasma concentration was 25.3 ± 5.5 ng·ml‐1 after the higher dosage. One child in each of Groups I and II needed postoperative analgesics. The simultaneous plasma concentration of morphine was then lower than 5 ng·ml‐1. Postoperative nausea occurred to about the same extent in both groups. It is suggested that morphine given rectally in a starch hydrogel may be an alternative to oral and parenteral routes of administration.
Comparative Maternal and Neonatal Effects of Halothane and Enflurane for Cesarean Section
Authors: Abboud T. K. , Kim S. H. , Henriksen E. H. , Chen T. , Eisenman R. , Levinson G. , Shnider S. M.
Published: January 2009

The effects of placental transfer of enflurane and halothane were studied in 81 women undergoing cesarean sections. All patients had rapid sequence induction using thiopental, succinylcholine, and endotracheal intubation. They were then randomly assigned to one of five groups: Group I (n = 16) received N2O and oxygen, Group II (n = 16) N2O, oxygen, and 0.25% halothane, Group III (n = 18) N2O, oxygen, and 0.5% halothane, Group IV (n = 18) N2O, oxygen, and 0.5% enflurane, Group V (n = 13) N2O, oxygen, and 1% enflurane. At delivery, blood was drawn from the maternal artery, umbilical vein and artery for measurement of the halogenated agents using gas chromatography. The neonates were evaluated by Apgar scores, umbilical artery and vein acid base status and the Early Neonatal Neurobehavioral Scores (ENNS) at 2 and 24 h of age. Blood loss and the incidence of maternal awareness were also determined. The umbilical vein to maternal vein ratio was approximately 0.5 and 0.6 for enflurane and halothane, respectively. The umbilical artery to umbilical vein ratio was 0.5 with both agents; higher inspired anesthetic concentrations produced higher blood levels. All neonates had Apgar scores of 8 or more at 5 min with the exception of one neonate in the N2O group. Maternal and neonatal acid base status, blood loss, and ENNS were not affected by the addition of the halogenated agents. Of the patients who had N2O alone, 12% had awareness versus none in the other groups. These data demonstrate that low dose halothane or enflurane decreases the incidence of maternal awareness and does not adversely affect the neonate.
Plasma Fluoride and Bromide Concentrations during Occupational Exposure to Enflurane or Halothane
Authors: Carlsson P. , Ekstrand J. , Hallén B.
Published: January 2009

The plasma fluoride and bromide concentrations were studied in operating theatre personnel. When enflurane was used, the increase in plasma fluoride concentration could not be distinguished from normal individual variations, but the plasma bromide concentration increased significantly when halothane was used. Seven patients were exposed to enflurane in a concentration of 200 parts per million for 4 h. A significant increase in the plasma concentration of fluoride was observed. The peak concentrations of fluoride occurred during exposure and the increase lasted less than 12 h. The increase in fluoride concentration was larger at this trace concentration than reported after anaesthetic concentrations. Cerebrospinal fluid (CSF) fluoride concentration was also studied; a smaller and delayed increase was found in CSF compared to plasma.
Comparison of Rectal Diazepam and Subcutaneous Morphine‐Scopolamine Administration for Outpatient Sedation in Minor Oral Surgery
Authors: Lundgren S.
Published: January 2009

In a randomized cross‐over study on sedation in outpatient oral surgery, subcutaneous administration of morphine‐scopolamine was compared with rectal administration of diazepam. The mean dose of morphine was 0.13 mg kg‐1 (range 0.13–0.24) and of diazepam 0.57 mg kg‐1 (range 0.50–0.71). Apprehension, the determining factor for patients' preference for sedation method, the recovery from sedation and the postoperative course were studied. Both methods produced the desired effects. For diazepam, the effect was scored higher by the patient than the nurse observer and for morphine‐scopolamine the opposite was found. Postoperative pain and patients' preference for sedation did not differ between the methods and the determining factor for the patients' preference for sedation method was the experience of stronger tranquillization. Side‐effects such as prolonged recovery, nausea, dizziness, and dysphoria were frequent during the postoperative course after the morphine‐scopolamine sedation but were not seen during diazepam sedation. Thus, rectal administration of diazepam should be preferred to morphine and scopolamine for sedation in minor oral surgery performed under local anesthesia.
Comparison of Paracetamol and Aminophenazone Plus Diazepam Suppositories for Anxiety and Pain Relief after Tonsillectomy in Children
Authors: Lindgren L. , Saarnivaara L.
Published: January 2009

The anxiety and pain‐relieving effect of paracetamol 10 mg/kg or a combination of aminophenazone 4 mg/kg and diazepam 0.2 mg/kg suppositories was studied in 82 children after tonsillectomy in a double‐blind study. Both suppositories were studied after halothane or enflurane anaesthesia. At 30 min after administration of coded suppositories, 88–90% of the children in various groups needed extra analgesics, and received pethidine 0.5 mg/kg i.v. Thereafter, the anxiety and pain relief was satisfactory in all groups. There was no significant difference between the effects caused by the drugs. No bleeding occurred from the operation site in any of the study groups. The results suggest that both paracetamol and a combination of aminophenazone and diazepam in the doses used here were weak analgesics for throat pain after tonsillectomy in children during the early postoperative period.
Fentanyl‐Droperidol‐Nitrous Oxide Anaesthesia in Patients with Ischaemic Heart Disease and Various Degrees of Left Ventricular Functional Impairment
Authors: Milocco I. , Schlossman D. , William‐Olsson G. , Appelgren L. K.
Published: January 2009

Haemodynamic stability and left ventricular function (LVF) during induction of anaesthesia and sternotomy were compared in three groups of patients with ischaemic heart disease, angiographically classified as having good, poor and depressed LVF. Anaesthesia was given with fentanyl‐droperidol and nitrous oxide. The group with good LVF showed large variations in arterial pressure and heart rate between stimulated and unstimulated states with a reasonable preservation of LVF, expressed as stroke volume, through the whole observation period. The group with poor LVF showed monotonously falling arterial pressure, and no heart rate response to tracheal intubation. These patients maintained remarkably stable stroke volumes in connection with low afterloads. After nitrous oxide, additional volume loading was required because of profound hypotension. The majority of the patients in the intermediate group, labelled “depressed LVF”, reacted to intubation and sternotomy with signs of left ventricular failure in connection with tachycardia and increased afterloads. The individual variations between patients with different degrees of left ventricular impairment were considerable, and these haemodynamic patterns need to be confirmed with a larger material.
The Effects of Naloxone on Central Hemodynamics and Myocardial Metabolism in Experimental Propoxyphene‐Induced Circulatory Shock
Authors: Strøm J. , Häggmark S. , Madsen P. S. , Östman M. , Reiz S. , Angelo H. , Sørensen M. Bredgaard
Published: January 2009

The courses of the hemodynamic and cardiometabolic effects of naloxone were evaluated in propoxyphene‐induced shock in eight pentobarbital‐anesthetized pigs. Circulatory shock was induced by an infusion of propoxyphene chloride 15 mg·min‐1i.v. At shock, i.e. MAP<60 mmHg and/or CI<2.0 l·min‐1·m‐2, naloxone was administered at 0.75, 1.5 and 3.0 mg·kg‐1with an interval between increments of 8 min. The propoxyphene infusion of 15 mg·min‐1was continued throughout the study. Following the injection of naloxone 0.75 mg·kg‐1, increases were observed (% of baseline value) in MAP (41%), i.e. deficit to baseline 59%, HR (66%), CI (67%) and SVI (108%), whereas MPAP and MPAOP were unchanged. dP/dt increased (34%). In the coronary circulation naloxone initiated the following changes: CSF increased (69%) as did MVo2(48%) with unchanged Mo2‐extraction, but CVR decreased further (36%). The maximum effects of naloxone were registered 2–3 min after 0.75 mg·kg‐1. Following 1.5 and 3.0 mg·kg‐1, no changes in hemodynamics were observed other than those caused by progressing propoxyphene intoxication.
Continuous Epidural Analgesia for Vaginal Delivery in Sweden: Report of a Nationwide Inquiry
Authors: Hanson B. , Matouskova‐Hanson A.
Published: January 2009

Volumetric pump infusion of bupivacaine into the epidural space for pain relief during labour was introduced in Sweden in 1976. Since then the method has gained widespread use. A questionnaire concerning the use of epidural analgesia (EDA) in 1982 was sent to anaesthetists at all Swedish maternity clinics. During the year, 84 188 vaginal deliveries were registered. EDA for pain relief was performed in 11 324 of them (13.4%). At that time, EDA was available in 56 out of 66 clinics. In almost all clinics (52/56), bupivacaine plain 2.5 mg/ml was used for the blocks. Analgesia was maintained by volumetric pump infusion of bupivacaine in 28 units, by intermittent technique in 25, and both techniques were used in three units. No clinic had abandoned the infusion technique once it had been introduced. Experience from both techniques showed the infusion technique to be more convenient as it produces stable analgesia, is easily conducted and can be supervised by midwives. No complication which could be connected with infusion technique was noted. Maternal hypotension was rare and the instrumental delivery rate was low. The technique proved to be a valuable aid to the organisation of a 24‐h service for obstetric analgesia, without requiring any increase in staff.
Lung and Chest Wall Mechanics during Differential Ventilation with Selective PEEP
Authors: Klingstedt C. , Baehrendtz S. , Bindslev L. , Hedenstierna G.
Published: January 2009

Eight patients free from cardio‐pulmonary disease and with a mean age of 46 years were studied during general anaesthesia in the lateral position. Measurements of hemithoracic mechanics were made during four different modes of ventilation: 1. Conventional ventilation (free distribution of ventilation) with no positive end‐expiratory pressure (PEEP) (CV), 2. differential ventilation (50% of ventilation to each lung) with no PEEP (DV:0), and 3 and 4. DV with selective PEEP of 0.8 and 1.6 kPa, respectively, to the dependent lung only (DV:8, DV:16). During CV, 60% of ventilation was distributed to the non‐dependent lung. Nondependent hemithoracic compliance was 64% greater and inspiratory resistance 39% lower than those of the dependent hemithorax. No significant differences between the two hemithoraces were noted during DV:0, but on application of selective PEEP the compliance of the dependent hemithorax increased and its resistance decreased. With DV:16, the compliances of the two hemithoraces were essentially equal, as were their resistances. Selective PEEP caused a larger volume increase in the dependent lung than general PEEP. Selective PEEP reduced the volume of the non‐dependent lung but only by 1/3 of the simultaneous increase in that of the dependent lung. Oesophageal pressure increased only slightly on selective inflation of the dependent lung, and remained negative within the 2 1 volume range studied. It is suggested that the altered mechanics of the dependent lung during selective PEEP result in a more even distribution of the inspired gas within that lung.
Subclavian Venous Catheterization in Children
Authors: Hüttel M. S. , Christensen P. , Olesen A. S.
Published: January 2009

During a 12‐month period, infraclavicular subclavian catheterization, using a Seldinger technique, was attempted on 77 occasions in 54 children with a median age of 2 years (range newborn to 10 years). General anaesthesia was used in the majority of cases, and catheterization was successful in 74 cases (96%). The initial catheter tip position was satisfactory in 81% of the cases, and catheters remained in situ for a median period of 7 days (range 1–28 days). There were few complications. Providing extensive experience in subclavian venous cannulation is gained in the adult, there is in our experience no minimal age or size which should limit the use of a subclavian vein catheter.
Effects of Adjuvants to Local Anaesthetics on Their Duration
Authors: Johansson A. , Hassan H. , Renck H.
Published: January 2009

A randomized study of the duration of ulnar nerve blockade induced with 2% prilocaine or 0.5% bupivacaine with and without 0.4% hyaluronic acid was performed in volunteers. In contrast to results in experimental animals, the addition of hyaluronic acid to the local anaesthetic solution did not affect the duration of sensory nerve block.
Potential Anti‐Thrombotic Effects of Local Anaesthetics due to their Inhibition of Platelet Aggregation
Authors: Borg T. , Modig J.
Published: January 2009

The aim was to study the possible anti‐aggregating effects of local anaesthetics on platelets stimulated by physiological doses of adenosine‐diphosphate and collagen. Platelet‐rich plasma was therefore incubated in an aggregometer with lidocaine, bupivacaine or tocainide in various concentrations and for different incubation times. It was found that of the local anaesthetics tested, lidocaine was the most effective anti‐aggregating compound. Furthermore, the longer the incubation time with the different local anaesthetics, the more efficient the anti‐aggregating effect. These results may have clinical implications, and they may be one of the explanations for the lower incidence of thromboembolism in patients operated on under lumbar epidural anaesthesia.
Thermal Balance during Transurethral Resection of the Prostate: A Comparison of General Anaesthesia and Epidural Analgesia
Authors: Stjernström H. , Henneberg S. , Eklund A. , Tabow F. , Arturson G. , Wiklund L.
Published: January 2009

Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio‐pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per‐ and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age.
Clinical Application of Continuous Flow Apneic Ventilation
Authors: Babinski M. F. , Sierra O. G. , Smith R. Brian , Leano E. , Chavez A. , Castellanos A.
Published: January 2009

Continuous flow apneic ventilation (CFAV) was studied in five adult female patients. After induction of anesthesia with thiopental sodium (5 mg/kg) and fentanyl (5 μg/kg), and paralysis with pancuronium bromide (0.12 mg/kg), the patients were ventilated with oxygen at an FIO2 of 1.0 by face mask. Two polyethylene catheters (outside diameter [OD] 2.5 mm) were each inserted into the right and left mainstem bronchi. Each catheter had a curved tip measuring 2 cm in length. The angulation of the catheter tip from the axis was 20° for the right side and 30° for the left side. The endobronchial position was checked by fiberoptic bronchoscopy. Subsequently, tracheal intubation was performed using a 7.5 mm OD tracheal tube. CFAV was started when both catheters were connected to the gas delivery system. Humidified oxygen was delivered at total flows between 0.6 and 0.7 1/min. Arterial blood gases were analyzed every 5 min for 30 min. Monitoring included electrocardiogram, indirect blood pressure, heart rate, temperature, and peripheral nerve stimulation. Adequate oxygenation was maintained in all patients, 39.76 ± 4.32 kPa (299 ± 37 mmHg) at 30 min. There was a significant rise in Paco2 (P<0.05) at 30 min compared to the control, 4.92 ± 0.25 kPa compared to 7.30 ± 0.53 kPa (37.0 ± 1.9 mmHg compared to 54.9 ± 4.0 mmHg). There was a mean rise in Paco2 of 0.03 kPa/min (0.6 mmHg/min) compared to 0.5 kPa/min (3.8 mmHg/min) with apneic diffusion ventilation. In one patient there was no increase in Paco2 during the 30 min of CFAV. The results demonstrate that CFAV can maintain blood gases in a clinically useful range for as long as 30 min.
Skin Disinfection before Intravenous Cannulation: Intraluminal Contamination after Disinfection with 70% Isopropylalcohol
Authors: Grabe N. , Jakobsen C. J. B. , Damm M. D.
Published: January 2009

A prospective randomized study evaluating the effects of skin disinfectants before intravenous cannulation was undertaken. 187 intravenous cannulae were examined. Patients were divided into two groups: in one, 70% isopropylalcohol was used as a skin disinfectant while in the other, no skin disinfectant was used. Intraluminal contamination rates, colony counts and organisms isolated were analysed. No significant differences were found between the two groups. There was no correlation between the use of the sideport and contamination. It appears, therefore, that 70% isopropylalcohol cannot prevent or even reduce the intraluminal contamination.
Three Per Cent Dextran‐60 as a Plasma Substitute in Blood Component Therapy
Authors: Schött U. , Sjöstrand U. , Thorén T. , Berséus O.
Published: January 2009

Microaggregate‐poor erythrocyte concentrate with 3% dextran‐60 as a plasma substitute was compared with microaggregate‐poor whole blood for replacement of intra‐operative and immediately postoperative blood loss. Sixty patients undergoing total hip arthroplasty randomly received either of these two forms of therapy. In accordance with the clinical routine of our orthopedic department, an infusion of 500 ml of 6% dextran‐70 (Macrodex®) was given as thrombo‐prophylaxis in both groups. Use of 3% dextran‐60 as a plasma substitute in blood component therapy for surgical hemorrhage of up to 50% of the calculated blood volume caused no increase in bleeding tendency or frequency of postoperative hematoma compared with whole blood replacement. Plasma protein levels were low immediately postoperatively in patients given the dextran, but from the 4th postoperative day onward there was no difference between the groups. Applied in clinical practice, this would be efficient in saving plasma for other urgent purposes.
Three Per Cent Dextran‐60 as a Plasma Substitute in Blood Component Therapy
Authors: Schött U. , Thorén T. , Sjöstrand U. , Berséus O. , Söderholm B.
Published: January 2009

Microaggregate‐poor erythrocyte concentrate with 3% dextran‐60 as a plasma substitute was compared with microaggregate‐poor whole blood for replacement of intra‐operative blood loss. Their blood volume‐conserving effects were studied by sequential blood volume determination with radioactive technetium (99mTc) in 19 patients undergoing total hip arthroplasty. Pre‐operatively there was no difference in blood volume between the groups. Immediately after surgery and on the 2nd postoperative day there was no difference in total blood volume. Blood component therapy with 3% dextran as a plasma substitute is an efficient principle for intra‐operative blood loss replacement at hip operations.
The Influence of Body Weight on Plasma Concentration of Atropine after Rectal Administration in Children
Authors: Bejersten A. , Olsson G. L. , Palmér L.
Published: January 2009

To avoid an unpleasant injection, the rectal administration of drugs to children is often to be preferred. Very little has been published on plasma concentrations of atropine given rectally. To determine whether body weight has any influence on the plasma concentrations of atropine, 18 children weighing 7.5 ‐ 55.0 kg were given 0.02 mg atropine sulphate per kg rectally, and the plasma levels of atropine were determined. The mean peak plasma concentration of atropine was 1.17 ng/ml and it was reached after 33 min. In the group of smaller children (b. w. < 15 kg) the peak plasma concentration was (0.83 ng/ml) lower than that observed in older children (1.26 ‐ 1.36 ng/ml), but this difference was not statistically significant. Plasma concentrations in the group of smaller children declined significantly faster than in the other weight groups.
Myorelaxant Effect of Diazepam. Interactions with Neuromuscular Blocking Agents and Cholinergic Drugs
Authors: Wali F. A.
Published: January 2009

Experiments were performed, using electrophysiological techniques, to investigate the effects and interactions of diazepam with commonly‐used neuromuscular blocking agents and cholinergic agonists in chick and rat isolated nerve‐muscle preparations. The results showed that in low concentrations (3.4–340 μmol/1, i. e. 1–100 μg ml‐1) diazepam increased, in a dose‐dependent manner, the twitch contractions in response to motor nerve stimulation of the chick and rat. High concentrations of diazepam (>340 μmol/1) decreased the twitch tension and greatly reduced the contractures produced by acetylcholine (ACh) and tetraethylammonium (TEA) in the chick skeletal muscle. However, in the concentration range studied (close to a therapeutic dose of 0.15 mg kg‐1), diazepam had no significant effect on the neuromuscular blockade produced either by tubocurarine or by succinylcholine. It was concluded that diazepam may either increase or decrease the twitch tension, in rat and chick skeletal muscle, the effect being dependent on the concentrations used. The mechanism of action of diazepam may depend on an increasing intracellular calcium concentration, which is directly involved in the increase of the twitch tension by low concentrations of diazepam.
Influence of Pre‐operative Treatment with Phenoxybenzamine on the Incidence of Adverse Cardiovascular Reactions during Anaesthesia and Surgery for Phaeochromocytoma
Authors: Stenström G. , Haljamäe H. , Tisell L. E.
Published: January 2009

The influence of pre‐operative treatment with the α‐adrenoceptor blocking agent, phenoxybenzamine, on the incidence of adverse cardiovascular reactions during anaesthesia and surgery for phaeochromocytoma was evaluated in a series of 62 patients. Fifty‐one of them received pre‐operative treatment with phenoxybenzamine and eight of these were also treated with β‐adrenoceptor blocking agents. The median final daily dose of phenoxybenzamine was 160 mg and the median period of treatment 23 days. The evening before surgery and in the early morning on the day of surgery, intravenous infusion of phenoxybenzamine was given to 42 of the patients. Eleven patients operated on between 1956 and 1963 received no specific preoperative treatment and served as a reference group. The α‐adrenoceptor blocking treatment resulted in a considerably smoother peroperative course, as evidenced by a statistically significant reduction in the incidence of excessive blood‐pressure variations. The blockade was not complete since 69% of the patients had systolic peaks > 175 mmHg during surgery. Pre‐operative blood transfusions did not significantly affect the incidence of hypotensive episodes. Pre‐operative β‐adrenoceptor blockade did not reduce the incidence of peroperative arrhythmia. On the basis of our experience, we recommend that all phaeochromocytoma patients be treated pre‐operatively with α‐adrenoceptor blocking agents.
Left Ventricular Dysfunction after Non‐Cardiac Surgical Procedures in Patients with Ischemic Heart Disease
Authors: Coriat P. , Fauchet M. , Bousseau D. , Mundler O. , Rous A. C. , Echter E. , Viars P.
Published: January 2009

In order to demonstrate the presence of postischemic ventricular dysfunction after non‐cardiac surgical procedures, myocardial perfusion scintigraphy with thallium 201 and radionuclide ventriculography were performed before and 24 h after intervention in 20 patients suffering from angina pectoris. A long‐term ECG recording was used in all patients to detect peroperative myocardial ischemia. In 14 of the 20 patients studied, both ventriculography and thallium scientigraphy were unchanged at the postoperative study. Comparison of pre‐ and postoperative radionuclide data revealed an increased deficit in one patient, both increased deficit and decreased ejection fraction in four others and a decreased ejection fraction in one other. In these five last patients, continuous ECG recording demonstrated the occurrence of peroperative ST segment depression. These results underline the part played by prolonged peroperative episodes of myocardial ischemia in the occurrence of postoperative left ventricular dysfunction.
Prophylactic and Delayed Treatment with High‐Dose Methylprednisolone in a Porcine Model of Early ARDS Induced by Endotoxaemia
Authors: Borg T. , Gerdin B. , Modig J.
Published: January 2009

The effects of prophylactic and delayed treatment with high‐dose methylprednisolone were evaluated in a porcine model of early adult respiratory distress syndrome induced by endotoxaemia. Spontaneously breathing pigs under ketamine anaesthesia were infused i. v. withE. coliendotoxin (10 μg · h‐1· kg‐1) over 6 h. Twenty animals received endotoxin without treatment. Eight animals were pretreated with methylprednisolone i. v., 60 mg · kg‐1, followed by an i. v. infusion at a rate of 10 mg · h‐1kg‐1. Ten animals received the same dosage of methylprednisolone beginning 2 h after the start of endotoxin infusion. Pretreatment with methylprednisolone prevented the endotoxin‐induced impairment in pulmonary gas exchange and the development of pulmonary oedema. The pulmonary hypertension was counteracted. Cardiac output (Q1) and O2delivery were improved. Mean arterial blood pressure (MAP) increased and was higher than in the untreated endotoxin group. The profound fall in PMN count was inhibited, while the accumulation of these cells in the lung was still substantial. Survival was improved. Delayed methylprednisolone treatment prevented further deterioration in pulmonary gas exchange and tended to restore it towards baseline. The pulmonary oedema and pulmonary hypertension were reduced. Q3and O2delivery did not improve. MAP was higher than in the untreated endotoxin group towards the end of the observation period. The decline in PMN count and the pulmonary accumulation of these cells were not significantly influenced. Survival was improved. These results indicate that high‐dose methylprednisolone, when given early in the course of sepsis, might be of clinical value in prevention of the devastating pulmonary and circulatory complications of this disease.
A Short History of Central Venous Catheterization
Authors: Kalso E.
Published: January 2009

The history of central venous catheterization is reviewed. Attention is drawn to the clinical problems that can occur with central venous catheters, and how these problems have been overcome.
Primary and Secondary Malposition of Silicone Central Venous Catheters
Authors: Vazquez R. M. , Brodski E. G.
Published: January 2009

We reviewed our experience with the percutaneous insertion of 459 silicone central venous catheters from 1979 to 1984. Special attention was given to the complication of malposition of these catheters. From 1981–1984, 116 consecutive percutaneous silicone central venous catheters (CVC) were inserted using the peel away sheath introducer. There were no primary catheter malpositions using this technique; however, secondary malposition occurred with 6% of the catheters. In addition to the use of this technique, patient response to movement of the guidewire during the catheterization procedure is described. The details of catheter insertion technique which permit operative assessment of the correctness of catheter location are presented. Symptoms and signs of secondary catheter malposition, as well as management required for this problem, are discussed.
Central Venous and Pulmonary Artery Catheterizations via the Axillary Vein
Authors: Gouin F. , Martin C. , Saux P.
Published: January 2009

We report the results of over 300 central venous and pulmonary artery catheterizations via the axillary vein. We found that the success rate with this method compares well with those of other catheterization routes, whilst the risk of mechanical injury, even for artificially ventilated patients, was virtually eliminated.
“Half‐Way” Venous Catheters
Authors: Gustavsson B. , Linder L. E. , Hultman E. , Curelaru I.
Published: January 2009

The theoretical premises and aims in the development of “half‐way” central venous catheters are described, and the advantages of a “half‐way” technique are discussed.
“Half‐Way” Venous Catheters
Authors: Wojciechowski J. , Curelaru I. , Gustavsson B. , Linder L. E.
Published: January 2009

Directions and sizes of displacement of “half‐way” catheter tips with movements of the upper extremities were investigated in thoracic radiographs in 21 patients (10 women and 11 men), 28–88 years old. Ten catheters were inserted by basilic, and 11 by cephalic veins punctured at the fossa cubiti. Catheter tip positions were related to the lateral edge of the first rib. The tip position with the patient's arm in 90d̀ abduction was considered as the reference point. Displacements caused by maximal flexion of the forearm, maximal adduction of the upper extremity, and maximal elevation of the brachium plus maximal flexion of the forearm were studied. With all movements and venous approaches there were significantly more medial than lateral displacements (P <0.001). The medial displacements varied from 0.2–5.0 cm, and the lateral ones from 0.5–1.8 cm. Location of the “half‐way” catheter tips in the proximal axillary vein, at the lateral edge of the first rib, is recommended. As found previously, this may be obtained by inserting a catheter length representing 1/5 of the patient's height. Such a location inhibits harbouring of the “half‐way” catheter tips in the jugular veins with movement in the upper extremities. Furthermore, estimation of central venous pressures by axillary venous pressures is not affected.
Evaluation of Central Venous Catheter Thrombogenicity
Authors: Borow M. , Crowley J. G.
Published: January 2009

Four studies were performed to evaluate the thrombogenicity of different central venous catheter materials. Two of these studies consisted of evaluating the amount of platelet deposition on different catheter materials, firstly in vitro and then in vivo using dogs. In these studies, 51‐chromium was used to label the platelets. In the following study, the volume of clot and the degree of fibrin sheath were determined by placing catheters in both arteries and veins of dogs for two to four weeks before removing the vessels and performing a quantitative analysis. For the fourth study, indium labelled platelet deposition with scintillation counting was performed on six dogs in whom catheters had been placed in the femoral and carotid arteries. The vessels in three of these animals were removed 48 hours after imaging was completed to correlate the scintigraphic findings with a quantitative analysis of the clot and fibrin sheath on each catheter. There was a high degree of correlation between all these studies. The most consistently thrombogenic catheter material was polyurethane, and the least thrombogenic catheter material was polyurethane coated with hydromer. Silicone was the next least thrombogenic material examined.
Deep Venous Thrombosis with Clinical Signs after Catheterization of the Superior Vena Cava System
Authors: Bouffard Y. , Bouletreau P. , Motin J.
Published: January 2009

This clinical investigation examined deep venous thrombosis with clinical signs indicating superior vena caval involvement, secondary to installation of central venous catheters. Thrombophlebitis was rare, but very dangerous if of septic origin.
Nomenclature on Energy. Practical Consequences of the Relevant SI‐shunt
Authors: NESBAKKEN RAGNAR
Published: January 2009

Measures should be taken to increase the use of joule and kilojoule as the unit for energy. The Scandinavian countries have made a political commitment for the SI‐system in medicine.
Prevention of Infusion Thrombophlebitis
Authors: HESSOV IB
Published: January 2009

Thrombophlebitis is a frequent and discomforting complication following infusions into peripheral veins. In controlled clinical and animal experiments, it has also been shown that following factors reduce the risk of development of infusion thrombophlebitis: a short infusion time, neutralization of the acid glucose solutions, addition of heparine to sugar solutions, use of short and thin needles instead of plastic cannulae or 30 cmteflon catheters, use of 5% glucose instead of more concentrated solutions and use of glucose in preference to fructose. The importance of in‐line membrane filters is not convincing, and the addition of hydrocortisone and the effects of changing administration sets seem without clinical importance. In conclusion, it is possible in clinical praxis to follow principles, which minimize the risk of the unpleasant and long‐lasting complication ‐ infusion thrombophlebitis.
Pathophysiology of Shock‐Induced Disturbances in Tissue Homeostasis
Authors: HALJAMÄE H.
Published: January 2009

A survey is given on disturbances in tissue homeostasis induced by hypovolemic shock conditions. Fluid shifts taking place between the extra‐ and intravascular fluid compartments are important early compensatory responses following hypovolemia. Usually the supply‐to‐demand ratio of oxygen in most tissues can however, not be kept up if the hypovolemic insult is severe due to deterioration of the microcirculation. Cellular hypoxia will ensue and may with time affect the integrity of the cells. Cellular functional disturbances occur earlier and are more pronounced in peripheral non‐vital tissues such as e. g. skeletal muscle than in central organs, the blood flow of which is more favoured during shock. Anaerobically produced cellular metabolites as well as intracellular components released from hypoxically injured cells in peripheral tissues may be of importance for the initiation of decompensatory reactions. Cellular components reaching the central circulation may induce direct effects on organs or systemic effects due to activation of the cascade systems. Thereby reactions leading to severe complications such as adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and multiple organ failure may be started. The aim of shock treatment should be to reverse as rapidly and as efficiently as possible the pathophysiological disturbances induced by a shock state. If the cellular hypoxic insult can be limited then the incidence of systemic complications in the post‐shock period will also be reduced.
Hypophosphatemia in Hypercatabolic Patients
Authors: TAKALA J. , NEUVONEN P. , KLOSSNER J.
Published: January 2009

Twenty‐four hypercatabolic surgical intensive care patients were treated with a daily phosphate dosage of 0.5 mmol/kg b. wt during the postoperative total parenteral nutrition (TPN). The adequacy of this regimen was evaluated by measuring the plasma phosphate concentration before and after five days of TPN. All the patients were in negative nitrogen balance throughout the study. Ten of them were hypophosphatemic at the beginning, while none was hypophosphatemic at the end of the study. Hyperphosphatemia was observed once, at the end of the study. The catabolic surgical patient receiving parenteral nutrition is at risk of hypophosphatemia, and particularly vulnerable to its consequences. A daily dosage of 0.5 mmol/kg b. wt of phosphate appeared adequate in covering the increased requirements of these patients.
Addition of Drugs to Infusion Fluids Pharmaceutical Considerations on Preparation and Use
Authors: MYHR KIRSTEN
Published: January 2009

In most hospitals, the addition of drugs to infusion fluids is carried out by nurses. The preparation involves certain hazards both microbiologically and pharmaceutically. Incompatibilities between drug and fluid or between drugs may result in admixtures which have reduced therapeutic activity or which are even hazardous to the patient.

The all‐in‐one total parenteral nutrition mixtures represent a new way of administering nutrition and has achieved increased popularity both for in‐ and outpatients. During preparation, which takes place in the pharmacy, several precautions have to be taken to assure a product with acceptable stability. Some of the important incompatibilities are mentioned.