bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Parenteral Nutrition Using a Mixture of Fat, Amino Acids and Carbohydrates in a Single Three‐Litre Bag
Authors: FLAATTEN H.
Published: January 2009

Long‐term parenteral nutrition is today an established therapy, both in hospitals and at home. A variety of patients with chronic intestinal dysfunction, leading to malnutrition, are candidates for this treatment.

There are however several problems related to this therapy, some of which can be attributed to the infusion system. In Scandinavia most patients receiving parenteral nutrition are given separate bottles of aminoacids, fat‐emulsions and carbohydrates. This method has several disadvantages. A new system which includes premixing of all nutrients in a single bag is discussed. Nutrients are mixed in three litre bags in the hospital pharmacy, under optimal conditions, and can be stored refrigerated for several days.
Ketanserin and malignant hyperthermia in pigs
Authors: ØRDING H. , HALD A. , SJØNTOFT E.
Published: January 2009

Four Danish landrace pigs susceptible to MH were challenged with halothane and suxamethonium on six occasions after pretreatment with the serotonin‐S2 antagonist ketanserin 0.4 mg/kg (three animals) or 4 mg/kg (three animals). The animals developed typical MH on all occasions despite the pretreatment. Dantrolene remains the only specific drug for prevention and treatment of MH.
Ranitidine and prevention of pulmonary aspiration syndrome
Authors: AROMAA U. , KALIMA T. V.
Published: January 2009

Thirty‐seven patients undergoing elective abdominal surgery (excluding gastric operations) received either ranitidine 300 mg or placebo orally at 10 p. m. in the evening preceding surgery in a double‐blind randomised study. The mean time interval between this oral premedication and induction of anaesthesia was 12 h. When compared to placebo, ranitidine decreased significantly (P<0.05) the amount of gastric juice, and none of the ranitidine‐treated patients had an increased risk of acid pulmonary aspiration (pH below 2.5 and volume over 25 ml), while four patients in the control group had an increased risk (21%). The mean ranitidine blood level was 237 ng/ml at the time of induction of anaesthesia. It is concluded that in elective abdominal surgery ranitidine included in the premedication is likely to decrease the risk for acid pulmonary aspiration.
Estimation of central venous pressure by measurement of proximal axillary venous pressure using a “half‐way” catheter
Authors: RICKSTEN S. ‐E. , MEDEGÅRD A. , CURELARU I. , GUSTAVSSON B. , LINDER L. E.
Published: January 2009

The pressure in the proximal axillary vein (AVP) was compared with central venous pressure (CVP) in eight patients during and after elective abdominal surgery. Both pressures were recorded from soft, elastic, polyurethane catheters inserted in the basilic or cephalic veins (“half‐way” catheters), punctured at the fossa cubiti (AVP), and via the right jugular vein (CVP). The AVP and CVP were recorded simultaneously using hydrostatic, conventional disposable venous pressure measurement sets. The measurements were performed during intermittent positive pressure ventilation with positive end‐expiratory pressure from 0 to 7.5 cmH2O (0‐0.74 kPa), as well as during spontaneous breathing. During both controlled and spontaneous respiration, small mean differences (0.2‐1.0 cmH2O) (0.02‐0.1 kPa), and a highly significant (P<0.001) positive correlation between CVP‐ and AVP‐values were found. An increase of 1 cmH2O (0.10 kPa) in the CVP was associated with an increment of practically identical order (0.99‐1.04 cmH2O) (0.10‐0.11 kPa) in the AVP. The results suggest that monitoring of the AVP by a basilic “half‐way” catheter produces diagnostic information similar to that from the measurement of the CVP from subclavian, external or internal jugular, as well as “long‐way” brachial catheter, with no risk of the major mechanical complications which accompany the use of the latter catheters.
Perivascular axillary block VI: the distribution of gelatine solution injected into the axillary neurovascular sheath of cadavers
Authors: VESTER‐ANDERSEN T. , BROBY‐JOHANSEN U. , BRO‐RASMUSSEN F.
Published: January 2009

Axillary perivascular injection of 50 ml blue‐stained gelatine was made in 20 cadavers, and a total dissection of the axilla was performed. The distribution of injected gelatine and the contact between nerves and gelatine were examined on cross‐sections of the neurovascular bundle. The spread of gelatine was characterized by: 1) restriction of gelatine to the neurovascular bundle, 2) an upper border of the gelatine which was constantly found to be proximal to the coracoid process, and 3) bulging of the gelatine towards the medial part of the axillary space. Cross‐sections of the neurovascular bundle showed the nerves and vessels to be located in the periphery of the gelatine and in close contact with the lateral wall of the axillary space. The median and the ulnar nerves were in all dissections found to be in direct contact with the gelatine, whereas the radial, the musculocutaneous, and the axillary nerves did not always have direct contact with the gelatine. Abduction of the arm to 90 brings the stretched neurovascular bundle close to the lateral wall of the axilla and this compromises perivascular circumferential spread of the injected gelatine. On the basis of the present investigation, it is hypothesized that insufficient circumferential spread is the cause of incomplete axillary blockades, and the perivascular injection of local anaesthetic should consequently be made with the arm along the side of the body.
Hemodynamic effects of vecuronium in patients with coronary artery disease
Authors: BARAKA A. , CHAYA L.
Published: January 2009

The hemodynamic effects of vecuronium 0.2 mg/kg were investigated in 11 patients with coronary artery disease. Vecuronium, at a dose double the ED90, produced 90% neuromuscular block in a mean time of 163 7 s, and was not associated with any significant hemodynamic changes. The results suggest that vecuronium can safely be used in cardiac patients.
Out‐patient laparoscopy in general anaesthesia with alfentanil and atracurium A comparison with fentanyl and pancuronium
Authors: RÆDER J. C. , HOLE A.
Published: January 2009

The effects of the new intravenous anaesthetic drugs alfentanil (50 μg/kg) and atracurium (0.5 mg/kg) on per‐ and post‐operative function in out‐patients clinics were compared with fentanyl (5 μg/kg) and pancuronium (0.07 mg/kg). Sixty‐two healthy female patients submitted for out‐patient sterilization by laparoscopy participated in the study. Thirty patients receiving alfentanil and atracurium (the AA‐group) had significantly less pain during analgetic injection, less coughing during intubation, and faster and more pronounced muscle relaxation during induction of anaesthesia, compared with 32 patients receiving fentanyl and pancuronium (the FP‐group). The AA‐group had less adrenocortical stress‐response judged by systolic blood pressure and pulse rate during anaesthesia. Reversal of anaesthesia and neuromuscular blockade were performed without differences in awakening parameters between the two groups. The AA‐group had a significantly better score on P‐deletion test 45 min after reversal of anaesthesia, a better street fitness score in the afternoon after the procedure and a better day‐life function score at home in the evening. There was no difference between the groups in postoperative complaints and in function after the day of operation.
Inaccuracy of peranesthetic gastric intubation for emptying liquid stomach contents
Authors: ADELHØJ B. , PETRING O. U. , HAGELSTEN J. O.
Published: January 2009

To assess the accuracy of the method of peranesthetic gastric intubation for emptying the liquid stomach contents, this procedure was tried on 80 patients undergoing general anesthesia. Half of the patients had a double‐barrelled 16F‐Argyle Salem sump tube, length 120 cm, size 16 CH, and the other half had a singlebarrelled stomach tube, length 80 cm, size 25 CH. After emptying the stomach with the tubes 25 ml of glucose was given through the gastric tube to half of the Salem tube group and half of the stomach tube group. Similarly 100 ml of glucose was given to half of the Salem tube group and half of the stomach tube group. After instillation of glucose 25 ml or 100 ml, the Salem tube recovered 21.0 9.1 ml (mean s. d.), median 24 ml, range 6–36 ml or 86.8 26.9 ml, median 92 ml, range 18–136 ml, respectively, and the stomach tube 17.1 10.8 ml, median 18 ml, range 2–34 ml or 54.0 28.5 ml, median 50 ml, range 14–104 ml, respectively. This indicates that the method of gastric intubation for emptying the liquid stomach contents is inaccurate.
Circulatory effects of carbon dioxide in experimental endotoxic shock
Authors: LARSSON L. E. , EKSTRÖM‐JODAL B.
Published: January 2009

In seven anaesthetized dogs the central circulatory effects of changes in Paco2 were studied before and after an intravenous injection of E. coli endotoxin 1.0 mg kg‐1. The animals were on controlled ventilation with constant minute volumes, and Paco2 was changed by variations in the inspired gas mixture. Before endotoxin was given, cardiac output, mean aortic pressure, mean pulmonary artery pressure, total peripheral resistance and stroke volume were little affected by the changes in Paco2 from 3.9 0.4 to 7.2 0.4 kPa (mean s. e. mean). Only heart rate decreased significantly (P<0.05). The intravenous endotoxin injection resulted in a decreased cardiac output (P<0.01), a decreased mean aortic pressure (P<0.01) and a decreased stroke volume (P<0.05). Mean pulmonary artery pressure, total peripheral resistance and heart rate showed only minor changes. In endotoxic shock an increase in PaCO2 from 4.4 0.4 to 7.8 0.3 kPa (mean s. e. mean) resulted in a significant increase in cardiac output (P<0.05), stroke volume (P<0.05) and mean pulmonary artery pressure (P<0.05), while the other parameters remained unchanged. It can be concluded that the carbon dioxide tension is of importance for the cardiac performance in experimental endotoxic stock in a manner not seen in control animals. The mechanisms behind these findings need further investigation.
Prophylactic and delayed treatment with indomethacin in a porcine model of early adult respiratory distress syndrome induced by endotoxaemia
Authors: BORG T. , GERDIN B. , MODIG J.
Published: January 2009

The effects of prophylactic and delayed treatment with indomethacin were evaluated in a porcine model of early adult respiratory distress syndrome (ARDS) 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 indomethacin i. v., 5 mg kg‐1in 30 min, followed by further infusion at a rate of 2 mg h‐1kg‐1. Ten animals received the same dosage of indomethacin beginning 2 h after the start of endotoxin infusion. Pretreatment with indomethacin inhibited the endotoxin‐induced impairment in pulmonary gas exchange, but did not prevent pulmonary oedema. The pulmonary hypertension was counteracted. Oxygen delivery did not improve, because of a marked reduction in cardiac output (Qt). Systemic vascular resistance (SVR) increased markedly, and mean arterial pressure (MAP) was higher. Survival was improved. Delayed indomethacin treatment prevented a further deterioration in pulmonary gas exchange and restored it towards the baseline level. The pulmonary oedema was not counteracted, while the pulmonary hypertension was reduced. O2delivery was not restored, owing to the greater decrease in Qtcompared with the untreated endotoxin group. SVR increased considerably, and MAP was better maintained. Survival was not improved. These results indicate that cyclo‐oxygenase inhibitors might benefit pulmonary gas exchange in human ARDS. Drugs which interfere with arachidonate metabolism will probably be of great importance in the prophylaxis, in particular, and also in the treatment of ARDS.
Anaesthesia for colonoscopy. An examination of the anaesthesia as an element of risk at colonoscopy
Authors: KJÆRGÅRD H. , NORDKILD P. , GEERDSEN J. , DYRBERG V.
Published: January 2009

The importance of anaesthesia as an element of risk at colonoscopy has been examined retrospectively over a 10‐year period from 1975 to 1984. The colonoscopic examinations were made by surgical gastroenterologists and anaesthesiologists working in cooperation. In 1242 cases the patients received diazepam/fentanyl anaesthesia during the colonoscopy (Group I) and in 126 cases they received general anaesthesia (Group II). The incidence of perforations of the large bowel in Group I was 0.8% (95% confidence limits: 0.4‐1.5%) and in Group II 0.0% (95% confidence limits: 0.0–2.9%). Statistically the difference is not significant (P = 0.38). The groups were comparable with a view to the patients' age, weight, the duration of the colonoscopy and the number of times that polypectomy had been performed. All anaesthesia was administered by staff qualified by training and experience to administer anaesthesia, and did not cause any complications. However, four patients had vasovagal reflexes due to manipulation of the colonoscope. The dosing in the patients in Group I averaged: diazeparn as premedication 9.2 mg, intravenous diazepam 12.4 mg, intravenous fentanyl 0.14 mg, and the duration of the colonoscopy was 36.5 min. The medication and the duration of the colonoscopy did not vary significantly in the patients with perforation of the large bowel. Our conclusion is that diazepam/fentanyl anaesthesia, administered by experienced staff, is harmless, and that general anaesthesia for colonoscopy did not involve an increased risk of perforation of the large bowel.
Hemodynamic effects of metocurine during isoflurane anesthesia
Authors: FYMAN P. N. , HARTUNG J. , CASTHELY P. A. , ABRAMS L. M. , SCHNEIDER A. , WEINBERG S.
Published: January 2009

Anesthesia was induced in 42 adults with thiopentone 3–7 mg/kg i. v. and maintained with isoflurane at a constant inspired concentration of 1–2%. After 30 min of hemodynamic stabilization with continuous muscle relaxation and an absence of surgical stimulation, each patient was randomly assigned to one of four metocurine dosage groups: I ‐ control (n=11); II ‐ 0.2 mg/kg (n= 10); III ‐ 0.3 mg/kg (n= 10); and IV ‐ 0.4 mg/kg (n = 11). There were no significant hemodynamic changes in Groups I or II. In Groups III and IV mean arterial pressure (MAP) decreased 32% and 26% respectively, and systemic vascular resistance (SVR) decreased 42% and 36%, respectively (P<0.01). In Group IV, an increase of 24% in cardiac output was also significant (P<0.05). These results, especially in Group IV patients, stand in marked contrast to the lack of hemodynamic effects produced by metocurine during balanced anesthesia.
Aspiration during anaesthesia: a computer‐aided study of 185 358 anaesthetics
Authors: OLSSON G. L. , HALLEN B. , HAMBRAEUS‐JONZON K.
Published: January 2009

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic record‐keeping system of the Department of Anaesthesia and the computer‐based register of diagnoses of in‐patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty‐three cases of aspiration were retrieved from the file of anaesthetic records and four from the in‐patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e. g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e. g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x‐ray. Fifteen patients (17%) needed mechanical ventilation, and four died. The mortality due to aspiration during anaesthesia was estimated to be 0.2 per 10 000 anaesthetics, and the mortality when aspiration had occurred during anaesthesia was approximately 5%. The conclusion to be drawn from this study is that today the mortality due to aspiration during anaesthesia is low. The patients in this study who died were in poor physical condition before the operation.
Peripheral airway pressure during high frequency ventilation
Authors: ELIASEN K. , MOGENSEN T. , ANDERSEN J. B.
Published: January 2009

Peripheral airway pressure (Pp) was measured during high frequency ventilation (HFV) (open system) (1–20 Hz) by retrograde catheters in eight excised dog lungs. Central airway pressure (Pc) and pleural pressure (Ppl) were measured simultaneously. We found a significant increase in peripheral end‐expiratory pressure at frequencies 5 Hz and higher, when the minute ventilation was increased. Mean Pc and mean Pp remained unchanged during ventilation at different frequencies with constant minute ventilation, although tidal volume decreased. With increasing tidal volume Pc, Pp, and Ppl (mean) increased at all frequencies. The increase in end‐expiratory pressure indicates an “auto‐PEEP” effect, which may contribute to the better gas exchange described during HFV.
Effects of cortisol suppression by etomidate on changes in circulating metabolites associated with pelvic surgery
Authors: LACOUMENTA S. , PATERSON J. L. , MYERS M. A. , HALL G. M.
Published: January 2009

The effects of cortisol suppression by etomidate on the changes in circulating metabolites associated with pelvic surgery were investigated in healthy female patients. The use of etomidate resulted in the inhibition of cortisol secretion for 24 h compared with a control group of patients. However, the inhibition of steroidogenesis was not associated with a significant effect on blood glucose, blood lactate and plasma nonesterified fatty acid values, although the glycaemic response to surgery was consistently less in those patients who received etomidate. Heart rate and arterial pressure were significantly decreased during surgery in the etomidate group compared with the control group, but were similar in the postoperative period when the difference in plasma cortisol between the groups was greatest. The results suggest that cortisol has only a minor role in determining changes in circulating metabolites associated with surgery.
Premedication administered to anesthesiologists as patients: their evaluations of its effect and its influence on premedication prescribing habits
Authors: ILIAS W. K.
Published: January 2009

Inquiries were sent to practising Austrian anesthesiologists to ascertain their premedication‐prescribing habits and their assessment of premedicants that they received as patients. The 143 replies received showed meperidine/promethazine (M/P) as most used n = 83 and received (n = 54) drug (combination), followed by fentanyl/droperidol (F/D) n = 33 (n = 21), benzodiazepines (BZ) n = 17 (n = 10) and several other drugs (combinations) n = 10 (n = 14). There was no significant difference in the premedication habits of the 82 anesthesiologists who had received premedication and those (61) who had no personal experience with premedicants. The former judged M/P to be significantly superior to F/D and other schemes; however there was no significant difference from the judgement of the BZ. Unpleasant side effects have been described in 9% of M/P, 10% of BZ, 24% of F/D and 21% of other premedicants. On future occasions 10% of BZ‐, 13% of the M/P‐, 24% F/D‐ and 21%‐receivers of other combinations would reject the same drug. Seven F/D and five M/P users converted their prescription schemes after they had received the same drug for their own premedication. The prescription habits were not influenced by dependency on departmental or hospital orders. Of those who had received it 75% desired premedication and 25% accepted premedication, suggesting that anesthesiologists believe in the positive effects of premedication. However, the overall incidence of 10% unpleasant side effects, even in the better ranked drugs, shows that the available premedicants do not yet seem to be satisfactory.
The effect of naloxone on the preoperative gastric volume and pH
Authors: JENSEN E MOLKE , THIESSEN K. A. , CHRISTENSEN AA.
Published: January 2009

The effect of 4 mg oral naloxone on preoperative gastric volume and pH of gastric aspirate was studied in a double‐blind, randomized study. Twenty patients received 10 ml of naloxone (4 mg) mixed with 10 ml of orange juice, and 20 patients received 10 ml of isotonic saline mixed with 10 ml of orange juice, 2 h before surgery. Gastric content was obtained immediately after intubation of the trachea. No significant difference in gastric volume and pH of gastric aspirate was found between the two groups. It is concluded that naloxone does not affect gastric emptying and gastric acid secretion to a degree great enough to protect against aspiration of gastric contents into the lungs.
Distribution of tris buffer between intracellular and extracellular space as a function of plasma pH in the rat
Authors: ROTHE K. F. , HEISLER N.
Published: January 2009

Rats were anaesthetized with halothane and artificially ventilated. After bilateral nephrectomy and implantation of arterial and venous catheters, arterial plasma pH (pHc) was adjusted by infusion of HC1 or sodium bicarbonate to 7.2, 7.4, or 7.5 and kept constant throughout the experiment. The distribution of tris between intra‐ and extracellular compartments was determined as a function of time up to 24 h after infusion of14C‐labelled tris and3H inulin in five skeletal muscle groups, heart, liver, spleen, and brain tissue. The following results were obtained: 1. Tris diffuses very slowly into the intracellular space of the investigated tissues. 2. For different arterial plasma pH, the intracellular tris concentration is quite different. It rises more rapidly and reaches higher levels in alkalemia. 3. Five different skeletal muscle groups showed the same rates of rise of intracellular tris at the same pHv. 4. Tris diffuses almost immediately into liver cells, the rates being slower in spleen, heart, skeletal muscle and brain, in that order. 5. Only in the liver did intracellular tris concentration reach a steady state, at levels higher than theoretically predicted, suggesting that ionic tris also is permeable. In other tissues, lack of steady states at the end precluded similar conclusions. It can be concluded that the clinical importance of tris therapy is in its elimination of H+ ions from the extracellular space and in the generation of bicarbonate that then penetrates the intracellular compartment.
Ventilation and ventilatory CO2 response in children during halothane anaesthesia after nonopioid (midazolam) and opioid (papaveretum) premedication
Authors: CHARLTON A. J. , LINDAHL S. G. E. , HATCH D. J.
Published: January 2009

The influence of non‐opioid (NO) and opioid (O) premedication on ventilation and ventilatory CO2 response was studied in 18 spontaneously breathing children during halothane anaesthesia. Eight patients in Group NO and 10 in Group O were comparable in age, body weight and type of surgery performed. The sedative effect was evaluated and measurements by pneumotachography and in‐line capnography were made immediately after induction of sleep, just before the start of surgery, during surgery and after surgery both before and after 3 min of about 2% CO2 inhalation. Immediately after induction the mean value (X s. e. mean) of end‐tidal CO2 concentration (ETCO2) was 4.86 X 0.21% in Group NO and 5.28 X 0.22% in Group O. Before and during surgery, minute ventilation (VE) was higher in Group NO (P<0.05) mainly due to higher respiratory rates. ETCO2 was similar in the two groups before, during and after surgery. The ratio of VE to CO2 elimination (VCO2) and of dead space (VD) to tidal volume (VT) was higher in Group NO, but ventilatory response to CO2 inhalation immediately before the postoperative period was similar in both groups. It was concluded that opioid premedication resulted in more efficient ventilation during anaesthesia and surgery, and that CO2 response at the end of surgery was maintained in both groups.
Ventilatory responses to inspiratory mechanical loads in spontaneously breathing children during halothane anaesthesia
Authors: LINDAHL S. G. E. , CHARLTON A. J. , HATCH D. J. , PHYTHYON J. M.
Published: January 2009

The effect of the addition of two different resistive loads (producing 23 and 36 cmH2O (2.26 and 3.53 kPa) 1‐1 s‐1, respectively, at 71 min‐1) on minute volume, tidal volume, respiratory rate, duration of inspiration and inspiratory drive was studied in six intubated children during nitrous oxide, oxygen and halothane anaesthesia. With both resistive loads, tidal volume was initially reduced in all patients except one, the reduction being greater in older children. Tidal volume returned to baseline values within 3–5 min in most cases, and a transient increase was seen on removal of the load. Changes in inspiratory drive were also most marked in older children. End‐tidal carbon dioxide concentration rose by 0.5% when the higher resistance was used. Respiratory rate and duration of inspiration were unchanged, suggesting the absence of a respiratory off‐switch‐reflex mechanism directly mediated by stretch receptors within the airways or lungs. Ventilatory compensation occurring after 3–5 min may have resulted from chemical stimulation and/or from reflexes from joint receptors and respiratory muscle spindles.
Electrocardiographic changes during microlaryngoscopy in practolol‐pretreated patients under balanced anaesthesia
Authors: SAARNIVAARA L. , KENTALA E. , KAUTTO U. ‐M. , YRJÖLÄ H.
Published: January 2009

Electrocardiographic (ECG) changes were studied in 82 adult patients with a mean age of 49 years undergoing microlaryngoscopy. The patients were pretreated with practolol 0.15 mg/kg i. v. 5 min before induction of anaesthesia with thiopental. Anaesthesia was maintained with nitrous oxide in oxygen, fentanyl and suxamethonium‐infusion. ECG changes occurred in 49% of the patients before anaesthesia and procedure. Pre‐existing ECG changes increased or new changes occurred in 39% of the patients during intubation and in 38% during the procedure. The most common preanaesthetic ECG changes were flat or negative T‐wave (18%), sinus tachycardia (13%), ischaemic S‐T segment depression (8.5%) and intraventricular conduction disturbance (8.5%). ECG changes during intubation were sinus tachycardia (16%), ventricular ectopic beats (12%), supraventricular ectopic beats (10%) and ischaemic S‐T segment depression (10%). The most common changes during microlaryngoscopy were supraventricular ectopic beats (16%), T‐wave flattening or inversion (15%), ischaemic S‐T segment depression (11%) and sinus bradycardia (10%). In all patients ECG changes disappeared without any special treatment. Unlike our earlier identical study without practolol pretreatment, neither sinus tachycardia nor junctional rhythm occurred during microlaryngoscopy in the present study. The results suggest that practolol pretreatment before microlaryngoscopy is especially useful when sinus tachycardia and junctional rhythm should be avoided.
Electrolyte and acid‐base disturbances caused by blood transfusions
Authors: LINKO K. , SAXELIN I.
Published: January 2009

The effect of blood transfusions on the electrolyte, metabolic and hemodynamic status of 31 patients undergoing major laparotomies was studied. Two groups were compared: Group I, II patients receiving continuous intraoperative blood transfusions exceeding 5 units at a rate over 0.3 ml/kg/min, and Group II, 20 patients receiving transfusions of 1–5 units at a rate below the limit. Transiently increased potassium values (5.2 0.3 mmol/1) were found in Group I during the rapid transfusion phase. The difference was statistically significant (P<0.05) when compared to Group II (4.3 0.2 mmol/1). There was also a significant correlation (r = 0.64; P<0.05) between the increase in serum potassium concentrations and the respective potassium load caused by the blood transfused. Most of the hyperpotassemic patients had surgery of the abdominal aorta. During the rapid transfusion, the patients in Group I had significantly lower concentrations of serum ionized calcium (P<0.05) and higher central venous pressures (P<0.05), but more periods of hypotension when compared to Group II. After the transfusion the massively transfused patients had slight metabolic alcalosis, the BE and pH differing significantly (P<0.05) from the values of Group II. It is concluded that hyperpotassemia may occur during rapid transfusions (over 0.4 ml/kg/min) of stored blood, especially in patients undergoing surgery of the abdominal aorta, even without simultaneous shock, acidosis or hypothermia. Calcium administration may be of benefit especially in situations where combined hyperpotassemia and hypocalcemia reduce the myocardial performance.
Self‐poisoning treated in an ICU: drug pattern, acute mortality and short‐term survival
Authors: STRØM J. , THISTED B. , KRANTZ T. , SØRENSEN M. BREDGAARD
Published: January 2009

A total of 1558 admissions to an ICU over 5 years because of severe self‐poisoning with drugs provides the basis for this study. Three drugs accounted for 60% of the admissions: overdose with barbiturates in 28%, with tricyclic antidepressants in 19% and with propoxyphene in 14%. The annual incidence of poisonings with barbiturates and tricyclic antidepressants was the same during the period, whereas the incidence of propoxyphene intoxication increased by 80%. Intensive supportive care was the main principle of treatment. All patients were artificially ventilated. The mortality rate was 6.1%, salicylate, propoxyphene and strong analgesics having the highest mortalities (11%, 9% and 9%, respectively). A mortality rate of 3% was found following overdose with tricyclic antidepressants. By 36 months after the overdose, 235 patients (18%) had died. The expected number of deaths was 39 (3%). The suicide rate in the follow‐up period was 10%, in the majority (75%) of whom death was caused by a new episode of self‐poisoning.
Changes in CMRO2, EEG and concentration of etomidate in serum and brain tissue during craniotomy with continuous etomidate supplemented with N2O and fentanyl
Authors: COLD G. E. , ESKESEN V. , ERIKSEN H. , LYON B. BLATT
Published: January 2009

Fourteen patients with supratentorial cerebral tumours were anaesthetized with continuous etomidate infusion (30 or 60 μg kg‐1 min‐1) supplemented with N2O 67% and fentanyl. Peroperatively cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice by the Kety and Schmidt method. Simultaneously with the CBF measurements, blood for serum etomidate was sampled and EEG was recorded in 2‐min periods in 12 patients. In 10 patients a brain biopsy for etomidate was taken peroperatively and correlated with the other data. The results indicate a dose‐dependant increase in scrum etomidate and brain tissue etomidate, a decrease in CMRo2 and suppression of EEG activity. In individual studies an increase in serum etomidate or a decrease in CMRo2 correlated to a suppression of the EEG activity, and vice versa. However, the wide variations in these relationships within and between patients make any conclusion regarding CMRo2 impossible from the EEG recording, infusion rate of etomidate or scrum concentration of etomidate.
Effect of inspired nitrous oxide concentration on the rate of fall of alveolar concentration: reversed concentration effect
Authors: MASUDA T. , IKEDA K.
Published: January 2009

The effect of inspired nitrous oxide concentration on the rate of fall of alveolar nitrous oxide concentration was studied in six patients ranging in age from 25 to 46 years. After equilibrium was reached with nitrous oxide, nitrous oxide administration was stopped and replaced by the same concentration of nitrogen. The decrease in alveolar concentration of nitrous oxide (FE/FEo) was measured continuously, where FE = measured end‐tidal concentration of nitrous oxide, and FEo = the end‐tidal concentration immediately preceding the cessation of nitrous oxide administration. The rate of decrease in FE/FEo was more rapid when 70% nitrous oxide was inspired (Part I) than when 30% nitrous oxide was inspired (Part II). One minute after the cessation of nitrous oxide administration, FE/FEo was 0.30 0.03 (mean s. d.) in Part I and 0.36 0.02 in Part II (P<0.05). Mean expired tidal volume increased from 515 43 ml to 552 48 ml in Part I and from 510 48 ml to 526 39 ml in Part II (P<0.05). The authers conclude that the more rapid decrease in alveolar concentration of nitrous oxide (FE/FEo) at higher concentrations of nitrous oxide results from augmentation of expired ventilation. We have called this phenomenon the “reversed concentration effect”.
Pharmacokinetics of physostigmine after intravenous, intramuscular and subcutaneous administration in surgical patients
Authors: HARTVIG P. , WIKLUND L. , LINDSTRÖM B.
Published: January 2009

The pharmacokinetics of physostigmine after intravenous, intramuscular or subcutaneous administration as well as its arousal effect after anaesthesia have been studied in surgical patients in the early postoperative period. After intravenous administration physostigmine had a very rapid plasma elimination with a plasma clearance ranging from 47 to 163 1/h with a mean s. d. of 92.5 37.7 1/h. The volume of distribution was 46.5 19.2 1, while distribution and plasma elimination half‐lives were 2.3 and 22 min, respectively. A fraction of the dose was probably hydrolyzed in blood since its blood elimination half‐lifein vitrowas approximately 190 min. After both intramuscular and subcutaneous administration the systemic availability was almost complete, the plasma terminal half‐lives only being somewhat longer than after intravenous administration. Plasma clearance, volume of distribution and elimination half‐life of physostigmine were not correlated to age or body weight of the patients. The rapid plasma clearance of physostigmine resulted in a short duration of antisedative effect. After administration of 1 mg physostigmine salicylate i. v., druginduced sedation was rapidly reversed with a duration of 30–60 min. The duration of action was similar after intramuscular injection but onset was delayed by 20–30 min. It was concluded that a plasma concentration of 3–5 ng/ml of physostigmine should be exceeded if an adequate analeptic effect is to be achieved, meaning that 2 mg of physostigmine had to be administered subcutaneously in order to achieve a satisfactory reversal of sedation. The short duration of action may hamper the use of physostigmine as an agent for reversal of drug‐induced sedation and anticholinergic effects after surgery.
Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis
Authors: HEDENSTIERNA G. , TOKICS L. , STRANDBERG Å. , LUNDQUIST H. , BRISMAR B.
Published: January 2009

Pulmonary gas exchange and the development of atelectasis were studied in eight essentially lung‐healthy patients, awake and during halothane anaesthesia with mechanical ventilation. Gas exchange was evaluated by a multiple inert‐gas elimination technique and conventional blood‐gas analysis, and atelectasis was studied by computerized tomography (CT). Ventilation and lung perfusion were well matched in the majority of the patients when awake. In two patients there was low perfusion of poorly ventilated regions (low VA/Q). One patient had a shunt corresponding to 4% of cardiac output. None of the patients showed signs of atelectasis on the CT scans. After 15 min of anaesthesia, shunt had appeared in all patients, ranging from 1% in two patients (unchanged from the awake state) to 17%. The major VA/Q mode was widened and ventilation of poorly perfused regions (high VA/Q) was noted in seven patients. Densities in dependent lung regions (interpreted as atelectasis) were seen on the CT scans in six patients. The extent of atelectasis was significantly correlated both to the magnitude of shunt (r = 0.93, P<0.01) and to the impairment of arterial oxygenation (r = 0.99, P<0.001). The findings indicate that atelectasis in dependent lung regions during halothane anaesthesia creates shunting of blood flow and that atelectasis is the major or sole cause of impaired gas exchange in the lung‐healthy, anaesthetized subject.
Comparative effects of intrathecal bupivacaine and tetracaine on analgesia, cardiovascular function and plasma catecholamines
Authors: Bigler D. , Hjortsø N. C. , Edström H. , Christensen N. J. , Kehlet H.
Published: January 2009

Forty otherwise healthy male patients, scheduled for elective inguinal herniotomy, were randomly allocated to spinal anaesthesia with 3 ml 0.5% hyperbaric tetracaine or bupivacaine under double‐blind conditions. The extent of blockade (pin‐prick and cold sensation), blood pressure and heart rate and plasma catecholamines were measured before and 5, 10, 15, 20 and 30 min after injection, before skin incision. Cephalad spread of sensory and temperature analgesia was insignificantly higher after tetracaine. The mean time taken to reach maximal spread of analgesia was 22 min in both groups. Mean arterial pressure showed a more pronounced decrease in the tetracaine group (22 vs 12%, P<0.009). Heart rate fell slightly and similarly in both groups, while rate‐pressure product was significantly lower in the tetracaine group. The correlation between the decrease in mean arterial pressure and the cephalad spread of sensory analgesia was similar in the two groups, suggesting that at identical levels of sensory analgesia changes in blood pressure were similar after tetracaine and bupivacaine. Plasma norepinephrine and epinephrine measurements before spinal puncture and at maximal decrease in mean arterial pressure showed a depressed response to fall in blood pressure in the tetracaine group. It is concluded that spinal anaesthesia with 3 ml hyperbaric 0.5% tetracaine is followed by a more pronounced fall in blood pressure compared to an identical dose of bupivaeaine. The more pronounced sympathetic blockade, confirmed by plasma catechoiamine measurements, following tetracainc is probably due to a higher cephalad spread of neurogenic blockade, rather than a differential effect on sympathetic nerve fibres.
Per‐ and postoperative changes in coagulation and fibrinolytic variables during abdominal hysterectomy under epidural or general anaesthesia
Authors: Bredbacka S. , Blombäck M. , Hägnevik K. , Irestedt L. , Raabe N.
Published: January 2009

Blood coagulation and fibrinolysis were studied in 20 premenopausal women undergoing abdominal hysterectomy under general anaesthesia (GA) or high epidural analgesia (EDA). As expected, the adrenocortical stress response was suppressed in the EDA group. The Factor VIII complex (F VIII:C, F VIII R:Ag = von Willebrand factor), known to be related to adrenocortical activity and/or vessel wall reactivity, was found to increase less in the EDA group. With regard to all the other variables analysed there were no significant differences between the groups. With both anaesthetic procedures activation of coagulation could be demonstrated by a decrease in prekallikrein, F X and antithrombin as well as by an increase in fibrinopeptide A levels, A decrease in plasminogen and alpha2‐antiplasmin suggested activation of the fibrinoiytic system and a decrease in prekallikrein and kallikrein inhibition activity (C‐1‐esterase inhibitor) an activation of the kallikrein system. In this study only the differences in F VIII complex could explain the previously reported higher thromboembolic frequency after GA as compared to EDA.
Peri vascular axillary block VII: the effect of a supplementary dose of 20 ml mepivacaine 1 % with adrenaline to patients with incomplete sensory blockade
Authors: Vester‐Andersen T. , Husum B. , Zaric D. , Eriksen C.
Published: January 2009

Perivascular axillary blockade was performed on 233 patients with the aid of a catheter technique. All patients received a primary injection of 50 ml of mepivacaine 1% with adrenaline. Sensory blockade was evaluated 20, 30 and 40 min after injection, and a complete sensory blockade was found in 90 (39%), 131 (57%) and 146 (63%), respectively. The blockade effect of a supplementary perivascular injection of 20 ml of the same agent was investigated on the remaining 87 blockades, which could be divided into three categories: 1) blockades which at 20 min showed lack of analgesia in several cutaneous segments of the hand (34 patients); 2) blockades which at 30 min showed a total lack of sensory blockade within a limited area (29 patients); and 3) blockades which at 40 min showed signs of blockade of all cutaneous segments, but one or several segments were not blocked with an intensity compatible with surgery (24 patients). Blockades of categories 1 and 2 were at 20 and 30 min, respectively, randomly allocated to control or to perivascular supplementation groups, while blockades of category 3 all had supplementation at 40 min. Sensory blockade was reevaluated 10 and 20 min after group allocation, and it was found that perivascular supplementation had no significant effect on the sensory blockade in category 1 and 2, while 68% of the blockades in category 3 improved to a complete blockade. It was concluded that the effect of a supplementary perivascular dose of local anaesthetic could be judged as acceptable with regard to intensifying an insufficient sensory blockade, but that it was incapable of extending the blockade into areas which were totally unblocked after the primary injection. On the basis of a previous and the present investigation, we have suggested practical, simple guidelines which might help the anaesthetist in deciding on his course of action when faced with an inadequate axillary blockade.
Clonidine and the sympatico‐adrenal response to coronary artery by‐pass surgery
Authors: Helbo‐Hansen S. , Fletcher R. , Lundberg D. , Nordström L. , Werner O. , Ståhl E. , Nordén N.
Published: January 2009

Clonidine was administered intravenously in an attempt to limit sympatico‐adrenal activity and thereby reduce the incidence of arterial hypertension associated with coronary artery by‐pass graft surgery (CABG). Forty patients scheduled for CABG were assigned to two groups. Twenty patients received clonidine 4μg kg‐1 before surgery, 2 μg kg‐1 after cardiopulmonary by‐pass and 1 μg kg‐1 when the skin was sutured. The other 20 patients served as controls. All patients were anesthetized with fentanyl, droperidol, nitrous oxide and alcuronium. During surgery 5 min after sternotomy, mean arterial pressure was 13 mmHg lower (P<0.01) in the clonidine group, while after operation the difference between the groups was negligible. Both during and after surgery the plasma catecholamine concentrations were significantly lower in the clonidine group (P<0.01). The greatest difference between the groups was seen 90 min after operation, when plasma noradrenaline and plasma adrenaline concentrations in the clonidine group were less than 1/ 3 of those in the control group (P<0.01). As judged by catecholamine concentrations clonidine was effective in attenuating sympatico‐adrenal hyperactivity during and after surgery. Postoperative arterial hypertension was not reduced, however, and it is concluded that other factors besides sympatico‐adrenal hyperactivity must be important.
PEEP reverses nitroglycerin‐induced hypoxemia following coronary artery bypass surgery
Authors: Berthelsen P. , Haxholdt O. St. , Husum B. , Rasmussen J. P.
Published: January 2009

Intravenous nitroglycerin is increasingly used during and after cardiac surgery to control blood pressure and improve subendocardial and peripheral circulation. A dramatic decrease in arterial oxygenation has, however, been reported in a number of poorly controlled clinical trials. In the present investigation 16 patients were studied 2–4 h after coronary artery bypass procedures. All were treated with a continuous infusion of nitroglycerin (lμg · kg‐1 min‐1). Utilizing an on‐off‐on drug design, it was clearly established that nitroglycerin depresses arterial oxygenation by increasing the pulmonary venous admixture. Three possible underlying mechanisms are discussed, but at the present time no firm conclusion can be drawn as to the nature of the changes. Eight patients were ventilated with 1 kPa (10 cmH2O) positive end‐expiratory pressure (PEEP) during the nitroglycerin infusion. PEEP‐ventilation reversed nitroglycerin‐induced changes in arterial oxygenation and pulmonary shunting without adversely affecting hemodynamic stability.
The effect of anaesthesia on changes in blood pressure and plasma cortisol levels induced by cementation with methylmethacrylate
Authors: Svartling N. , Lehtinen A.‐M. , Tarkkanen L.
Published: January 2009

The effects of cementation on arterial blood pressure, arterial oxygen tension and plasma levels of cortisol were studied in 30 patients with femoral neck fracture treated with the Thompson prosthesis in spinal (n = 15) or general (n= 15) anaesthesia. In spinal anaesthesia hypotension of clinical importance was observed coincidentally with the use of methylmethacrylate, while the levels of plasma cortisol remained unchanged. A significant rise was noted in arterial blood pressure and plasma levels of cortisol after cementation in general anaesthesia. Arterial oxygen tension fell in both groups. These findings indicate that the hypotension frequently reported in connection with cementation is triggered by a complex mechanism which can be modified by the anaesthetic technique.
Evaluation of blood loss during suction termination of pregnancy: ketamine compared with methohexitone
Authors: Coad N. R. , Mills P. J. , Verma R. , Ramasubramanian R.
Published: January 2009

Blood loss during suction termination of pregnancy was estimated in patients anaesthetised with intravenous ketamine (n = 25) and compared with those anaesthetised with intravenous methohexitone (n = 25). Both groups received midazolam 0.15 mg/kg intravenously 3 min prior to induction of anaesthesia. No statistically significant difference was found in blood loss between the two groups (P=0.66). There was no incidence of dreaming or psychomotor disturbances associated with ketamine in our study.