bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of dextromethorphan, alone or in combination with ibuprofen, on postoperative pain after minor gynaecological surgery
Authors: Ilkjær S. , Nielsen P. A. , Bach L. F. , Wernberg M. , Dahl J. B.
Published: March 2003

Background: Experimental studies have demonstrated that peripheral tissue injury may lead to hyperexcitability of nociceptive neurones in the dorsal horn, in part mediated by N‐methyl‐D‐aspartate (NMDA)‐receptor mechanisms. Sensitisation of dorsal horn neurones may be an important contributor to postoperative pain. The aim of the present study was to investigate the effect of the NMDA‐receptor antagonist dextromethorphan on pain after minor gynaecological surgery, and to evaluate a potential additive effect with ibuprofen.

Methods: In a double‐blind, placebo‐controlled study, 100 patients scheduled for elective termination of pregnancy were randomised to receive placebo, oral ibuprofen 400 mg, oral dextromethorphan 120 mg, or a combination of ibuprofen 400 mg and dextromethorphan 120 mg, 1 h before surgery. Pain and analgesic requirements were assessed 0.5, 1 and 2 h after operation.

Results: We observed no effect of dextromethorphan on visual analogue scale (VAS) pain scores or analgesic consumption, and no additive or synergistic analgesic effects between ibuprofen and dextromethorphan. Ibuprofen reduced pain scores compared with placebo, and analgesic consumption compared with both placebo and dextromethorphan. The combination of ibuprofen and dextromethorphan increased preoperative nausea compared with both placebo and ibuprofen, whereas no statistically significant side effects were observed with dextromethorphan alone.

Conclusion: No analgesic effects of oral dextromethorphan 120 mg on pain after surgical termination of labour, and no additive analgesic effects when combined with ibuprofen 400 mg, were observed. Ibuprofen reduced both VAS pain scores and analgesic consumption compared with placebo.
Subcutaneous infiltration with ammonium sulphate 10% does not prolong the local anaesthetic duration of lidocaine in humans
Authors: Møiniche S. , Dahl A. , Dahl J. B.
Published: March 2003

Background: The aim of the present study was to investigate whether a solution of ammonium sulphate and lidocaine had a prolonged duration of action compared with lidocaine alone after subcutaneous infiltration in human volunteers.

Methods: In a double‐blind, randomised, controlled trial 12 male volunteers had either 4 ml lidocaine 1% (40 mg) or a solution of 4 ml ammonium sulphate 10% and lidocaine 1% (40 mg) subcutaneously infiltrated in corresponding skin areas on the right and left calf. The duration of the local anaesthetic action of the test medications was assessed 1–6 h after the infiltrations using thresholds to mechanical (von Frey hairs) and thermal stimulation (heat detection thresholds: HDT, and heat pain dectection thresholds: HPDT), and by calculation of areas under the curve (AUC) for electronic visual analogue scale (VAS) pain ratings (sampled at 2 Hz) during a heat stimulation on the test areas for 30 s with a 45°C warm thermode.

Results: At no assessment were thresholds to mechanical or thermal stimulation increased in favour of ammonium sulphate treated legs compared with control legs. On the contrary, HPDT were significantly lower in ammonium sulphate treated legs than control legs at the 3 h and 4 h assessment after infiltration (P<0.02). Similarly, the AUC for the VAS ratings was significantly higher in treatment legs compared with control legs 2 h and 3 h after infiltration (P<0.05).

Conclusion: No improvement in local anaesthetic duration of ammonium sulphate 10% plus lidocaine 1% compared with lidocaine 1% alone was demonstrated early after subcutaneous infiltration in human volunteers.
Bilateral re‐expansion pulmonary edema in a child: a reminder
Authors: Özlü O. , Kiliç A. , Cengizlier R.
Published: March 2003

Re‐expansion pulmonary edema (RPE) is an uncommon complication of sudden reinflation of a lung collapsed by pneumothorax or pleural effusion. We present a case of bilateral pulmonary edema following unilateral drainage of a pleural effusion in a young child with non‐Hodgkin’s lymphoma.
Low‐dose prostacyclin in treatment of severe brain trauma evaluated with microdialysis and jugular bulb oxygen measurements
Authors: Grände P.‐O. , Möller A. D. , Nordström C.‐H. , Ungerstedt U.
Published: March 2003

Background: The endogenous substance prostacyclin is a substance with the potential to improve microcirculation and oxygenation around contusions in the brain following a head trauma by its vasodilatory, antiaggregatory and antiadhesive effects. Microdialysis measurements of local concentrations of selected interstitial substances in the brain, and measurements of venous jugular bulb oxygenation reflecting overall brain oxygenation, might be useful to evaluate possible therapeutic effects of a specific therapy, such as treatment with prostacyclin.

Methods: This case report study on six patients, of whom five were given prostacyclin, includes cerebral microdialysis measurements of interstitial lactate (n=5), pyruvate (n=3), glycerol (n=5) and glucose (n=4), and is combined with measurements of venous jugular bulb oxygenation in three of the patients. One microdialysis catheter was placed adjacent to a contusion, and in four of the patients another catheter was also placed in the contralateral less injured side for comparison. Low‐dose prostacyclin infusion (0.5–1.0 ng kg−1 min−1) was started when lactate concentrations in the more injured side was raised at a constant level for more than 10 h. The study also includes one patient used as control to whom no prostacyclin was given.

Results: Lactate was markedly lower in the less injured than in the more injured area of the brain. During the prostacyclin infusion elevated lactate and lactate/pyruvate ratio were reduced. Elevated glycerol decreased, a low glucose increased and jugular bulb blood oxygenation increased following start of prostacyclin. The control patient showed an increase in lactate and lactate/pyruvate ratio.

Conclusion: The microdialysis data combined with the jugular bulb oxygenation data indicated that low‐dose prostacyclin exerts effects compatible with improved oxygenation and reduced cell damage in the severely traumatised brain.
Future anesthesiologists will be as much outside as inside operating theaters
Authors: Lindahl S. G. E.
Published: March 2003

During the first decade of the new millennium the intense reorganization of hospitals and of medical care will be replaced by stability and long‐term goals. An anesthesiologist is now as active outside as within the operating theater, being a predominant resource in intensive care, pain management, emergency and prehospital care. The anesthesiologist will also have a key part to play in risk analysis of patients scheduled for various kinds of advanced treatment. Anesthesiologists are now also more involved in primary home care where, together with other physicians and categories of health care providers, they offer qualified treatment of various diseases at home – the environment preferred by the patient.
Prevention of post‐herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone
Authors: Pasqualucci A. , Pasqualucci V. , Galla F. , De Angelis V. , Marzocchi V. , Colussi R. , Paoletti F. , Girardis M. , Lugano M. , Del Sindaco F.
Published: March 2003

Background: Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post‐herpetic neuralgia (PHN).

Methods: Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6–12 ml bupivacaine (0.25%) every 6–8 or 12 h+methylprednisolone 40 mg every 3–4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and “abnormal sensations” (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent‐to‐treat population.

Results: In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir + steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B.

Conclusions: Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone.
Randomised, placebo‐controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery
Authors: Aubrun F. , Langeron O. , Heitz D. , Coriat P. , Riou B.
Published: March 2003

Background: The additive effect of non‐steroidal anti‐inflammatory drugs administered with propacetamol after major orthopaedic surgery has not been studied. Thus, we performed a prospective, placebo‐controlled study to assess the analgesic effects of ketoprofen in patients undergoing spinal fusion surgery and receiving propacetamol.

Methods: Fifty patients undergoing spinal fusion surgery received either 100 mg of ketoprofen every 8 h or a placebo, postoperatively. All patients received propacetamol and morphine (intravenous titration followed by patient‐controlled analgesia (PCA) over 24 h). Pain was assessed using a visual analogue pain scale (VASpi). Data are mean±SD.

Results: During morphine titration, ketoprofen did not significantly reduce the dose of morphine (8±6 vs 11±4 mg, NS) whereas it significantly decreased VASpi (P<0.001). During PCA, ketoprofen significantly reduced morphine consumption (25±17 vs 38±20 mg, P=0.04) and VASpi (P=0.002). The total postoperative morphine consumption was significantly (33%) reduced with ketoprofen.

Conclusion: Ketoprofen reduced morphine requirements and improved postoperative analgesia in patients undergoing major spinal surgery and receiving propacetamol.
Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement
Authors: Fournier R. , Van Gessel E. , Macksay M. , Gamulin Z.
Published: March 2003

Background: We designed this study to compare the postoperative analgesic effects of intrathecal morphine and nalbuphine, the endpoints being onset and offset of action.

Methods: Geriatric patients scheduled for elective total hip replacement under continuous spinal anaesthesia were randomized to two double‐blinded groups in the recovery room as soon as they experienced a pain score higher than 3 cm on the visual analogue scale (VAS, 0–10 cm). Either 160 μg morphine or 400 μg nalbuphine in 4 ml normal saline were administered intrathecally. Pain scores on VAS, rescue analgesia (diclofenac and morphine, not allowed during the first 60 min), and the adverse effects (respiratory depression, postoperative nausea and vomiting, itching) were recorded for 24 h after surgery.

Results: The study was stopped after inclusion of 2×12 patients due to slow onset of analgesia in the morphine patients. In the nalbuphine group, when compared to the morphine group, the time to a pain score <3 cm (8±6 vs. 31±32 min, P<0.001), the time to the lowest pain score (18±11 vs. 66±75 min, P<0.001) and the time to the first systemic analgesic intervention for a pain score >3 cm (218±256 vs. 1076±440 min, P<0.05) were significantly shorter. The analgesic requirements during the first 24 h were significantly lower in the morphine group (P<0.001).

Conclusion: We conclude that after total hip replacement, administration of intrathecal nalbuphine resulted in a significantly faster onset of pain relief and shorter duration of analgesia than intrathecal morphine (
Note).
Total and prolonged filling of the lungs with Ringer’s solution under extracorporeal lung assist (ECLA) in dogs
Authors: Sakanashi Y. , Tanimoto H. , Okamoto T. , Tashiro M. , Ao H. , Terasaki H.
Published: March 2003

Background: Massive alveolar lavage has been used clinically to remove materials accumulated in the alveoli. Recently, filling the lungs with oxygenated perfluorochemical (total liquid ventilation) has been investigated. However, effects of complete and prolonged filling of bilateral lungs with aqueous fluid, such as saline or Ringer’s solution, has not been evaluated, although it is possible to sustain gas exchange without the natural lung by using extracorporeal circulation and an artificial lung (extracorporeal lung assist: ECLA). It is also not known whether the lung can recover gas exchange ability after prolonged fluid filling.

Methods: Normal mongrel dogs were endotracheally intubated under general anesthesia and mechanically ventilated. After initiation of venoarterial ECLA, warmed lactated Ringer’s solution was instilled into the lungs through the endotracheal tube, and the lungs were completely filled at a hydrostatic pressure of 15 cmH2O (fluid‐filled group: group F). After the lungs were filled for 4 h, the fluid was drained and ventilation was re‐instituted. ECLA, then mechanical ventilation was gradually weaned within 24 h after fluid drainage. In control group (group C), dogs were kept apneic for 4 h with their lungs inflated at an airway pressure of 15 cmH2O with air.

Results: Transient hypoxemia occurred during fluid filling but every dog could be weaned from ECLA and mechanical ventilation to spontaneous respiration. The average rate of fluid absorption from the lung during fluid filling was 4.2±1.8 ml kg−1 h−1. After fluid drainage and restart of mechanical ventilation, bilateral lungs were expanded and well aerated. Total static respiratory system compliance (static compliance) remained unchanged even after fluid filling, and the weight of the lung water did not increase significantly compared to that in group C. Total urine volume was significantly increased in group F. Histologically, alveolar structures were preserved and no interstitial edema or bleeding was seen in either group.

Conclusion: Complete filling of the bilateral lungs for 4 h with lactated Ringer’s solution under ECLA causes no deterioration in gas exchange or static compliance in normal dogs, although transient hypoxemia occurs during fluid filling.
Use of an EEG‐bispectral closed‐loop delivery system for administering propofol
Authors: Sakai T. , Matsuki A. , White P. F. , Giesecke A. H.
Published: March 2003

Closed‐loop control of propofol delivery was instituted in three patients who received a propofol infusion as part of: (Case 1) general “balanced” anesthesia, (Case 2) total intravenous anesthesia, and (Case 3) monitored anesthesia care. The bispectral index was the input variable used in a proportioned, integral and differential controller to determine the infusion rate of propofol required to maintain a stable level of hypnosis (Cases 1 and 2) or sedation (Case 3). This feedback control system provided intraoperative hemodynamic stability and a prompt recovery from the sedative‐hypnotic effects of propofol.
Chloroquine poisoning: report of two cases
Authors: Reddy V. G. , Sinna S.
Published: March 2003

Two patients intentionally took chloroquine in overdose for different purposes. The first patient took chloroquine 2.7 g to terminate her pregnancy and the second patient took 3.75 g to terminate his life. The management of these two patients mainly consisted of gastric lavage, activated charcoal, ventilation, diazepam and inotropic support. The effect of chloroquine on the myocardium is discussed and the role of chloroquine as an abortifacient is reviewed. Hypokalemia should be recognized early and treated cautiously to avoid hyperkalemia. Refractory seizures not responding to benzodiazepine may require an antiepileptic drug.
Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery
Authors: Tenling A. , Joachimsson P.‐O. , Tydén H. , Hedenstierna G.
Published: March 2003

Background: A lasting impairment of pulmonary function is common after cardiac surgery. Pain from the sternotomy may contribute to the impairment. Thoracic epidural analgesia (TEA) can efficiently relieve pain in the postoperative phase, but may also affect respiratory muscle function if local anaesthetics are used. We examined the effects of TEA on pulmonary function and ventilation at rest, before and after coronary artery bypass graft surgery (CABG).

Methods: Thirty patients scheduled for CABG were randomized to receive either general anaesthesia alone or general anaesthesia with TEA. Before and after the operation the patients were examined by respiratory inductive plethysmography and spirometric tests.

Results: Before the operation, TEA caused significant reductions in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), maximal inspiratory (PImax) and expiratory (PEmax) pressure. The rib cage contribution to tidal volume decreased significantly but the co‐ordination of the thoracic and abdominal movements remained essentially unaffected. Minute volume and respiratory frequency did not change significantly. On the first postoperative day a decrease in maximal breathing efforts was found in both groups. No differences between the groups in FVC, FEV1 and PImax were found, but PEmax was significantly greater in the TEA group. Despite the impairment, breathing at rest was largely normal in both groups.

Conclusions: A better pain‐relief from TEA after CABG may improve the ability to cough by a greater expiratory muscle strength. FVC, FEV1, PImax and breathing at rest are not affected by TEA after cardiac surgery.
Thoracic epidural anaesthesia and analgesia: United Kingdom practice
Authors: O'Higgins F. , Tuckey J. P.
Published: March 2003

Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists.

Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom.

Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non‐steroidal anti‐inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid‐based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy‐eight percent of hospitals provided an acute pain team to review epidural analgesia.

Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid‐based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow‐up.
Mixed venous oxygen saturation during mobilization after cardiac surgery: are reflectance oximetry catheters reliable?
Authors: Kirkeby‐Garstad I. , Skogvoll E. , Sellevold O. F. M.
Published: March 2003

Background: Oximetry catheters immediately reflect changes in mixed venous oxygen saturation (Sv¯O2). We have used the Baxter 2‐SAT system to register changes in Sv¯O2 during early mobilizations after cardiac surgery. To assess catheter reliability, readings were compared to blood gases.

Methods: A total of 352 paired catheter and bench haemoximetry measurements were obtained at the expected highest and lowest levels of Sv¯O2 during the mobilization procedures. The agreement between methods was explored by a Bland‐Altman plot. The influence of haemoglobin (Hgb), pH, cardiac output (CO), posture, catheter identity and catheter calibration on agreement was assessed through analysis of covariance.

Results: Data included a substantial number of low Sv¯O2 values, 95 paired means of Sv¯O2≤50% and 37 paired means ≤40%. Mean oxygen saturation difference between catheter and haemoximeter readings was −1.6±5.7% (SD). Agreement between the methods depended upon the level of Sv¯O2. At Sv¯O2 of 65%, the two methods were virtually identical. Below 65%, the catheters increasingly underestimated the corresponding haemoximetric values by 1.5% for every 10% reduction in Sv¯O2. Agreement was to some degree dependent on individual calibrations and catheter identity, but to a lesser extent on Hgb, CO and posture.

Conclusion: The two methods are interchangeable for most clinical purposes. Catheter readings are, however, substantially lower than the corresponding haemoximetric measurements at low Sv¯O2 values. Careful interpretation of the absolute values resulting from catheter measurements is recommended, especially when Sv¯O2 readings are low.
Interaction of isoflurane and cromakalim, a KATP channel opener, on coronary and systemic haemodynamics in chronically instrumented dogs
Authors: Sakai K. , Zhang S. , Ureshino H. , Tomiyasu S. , Sumikawa K.
Published: March 2003

Background: Although isoflurane has been shown to cause coronary and systemic vasodilation through KATP channel activation, the interaction of KATP channel openers and isoflurane has not been fully investigated. The present study was carried out to determine the haemodynamic actions of cromakalim, a KATP channel opener, under the conscious state and during isoflurane anaesthesia in chronically instrumented dogs.

Methods: Fourteen dogs were chronically instrumented to measure systemic and coronary haemodynamics. Each dog was randomly assigned to receive doses of either cromakalim, 4 and 10 μg · kg−1 i.v., or isoflurane, 2.1% end‐tidal (1.5 MAC), plus cromakalim, 4 and 10 μg · kg−1 i.v.

Results: Cromakalim dose‐relatedly decreased mean arterial pressure and systemic vascular resistance and increased coronary blood flow in both conscious and anaesthetized states. With isoflurane, the duration of effects of cromakalim were prolonged. Isoflurane exerted an additive effect on the increase in coronary blood flow induced by a low‐dose cromakalim, whereas it did not influence the effect of a high‐dose cromakalim. The maximum rate of increase in left ventricular pressure and segment shortening were increased by cromakalim in the conscious state but unchanged during isoflurane anaesthesia.

Conclusion: The results suggest that the coronary vasodilating effects of isoflurane and cromakalim are basically additive until cromakalim exerts the maximal effect, and that the action of cromakalim on the coronary vasculature is prolonged by isoflurane.
Comparison of the effects of amrinone, milrinone and olprinone in reversing bupivacaine‐induced cardiovascular depression
Authors: Hirabayashi Y. , Igarashi T. , Saitoh K. , Fukuda H. , Suzuki H. , Shimizu R.
Published: March 2003

Background: Increasing evidence indicates that amrinone, a phosphodiesterase fraction III (PDE‐III) inhibitor, has relative efficacy as an initial treatment for cardiovascular depression after bupivacaine in an experimental setting. This study was performed to compare the cardiovascular effects of the other new PDE‐III inhibitors, milrinone and olprinone, with those of amrinone in reversing bupivacaine‐induced cardiovascular depression.

Methods: In sevoflurane‐anaesthetized dogs, bupivacaine was infused intravenously at 1 mg · kg−1 · min−1 until mean arterial pressure fell to 60 mmHg or less. The dogs received either amrinone (2 mg · kg−1), milrinone (0.2 mg · kg−1), olprinone (0.12 mg · kg−1) or 0.9% saline (0.5 ml · kg−1).

Results: Amrinone, milrinone and olprinone improved left ventricular systolic and diastolic function, resulting in an increase in cardiac index. The most significant difference observed among the three drugs was the change in heart rate (HR) after treatment. Milrinone significantly increased HR, but olprinone did not.

Conclusion: Milrinone and olprinone are as effective as amrinone in reversing bupivacaine‐induced cardiovascular depression.
Bispectral index, predicted and measured drug levels of target‐controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergence
Authors: Høymork S. C. , Ræder J. , Grimsmo B. , Steen P. A.
Published: March 2003

Background: Target‐controlled infusions (TCI) have been launched as simple, accurate and reliable delivery systems of intravenous drugs. Bispectral index of EEG (BIS) seems promising in measuring hypnotic effect of anaesthetic drugs. The aims of this study were to evaluate the accuracy of TCI systems in patients undergoing laparoscopic cholecystectomy and to correlate measured drug levels to BIS values. Data were analysed for possible gender differences during emergence.

Methods: After written informed consent, 20 patients were enrolled in an open study. Remifentanil was set at 7.5 ng/ml as target throughout the whole procedure, and propofol at 5 μg/ml at induction and 3 μg/ml after intubation. Values in blood samples of remifentanil and propofol were correlated to the estimated values and to systolic blood pressure and BIS. BIS values and measured drug levels during emergence and emergence time were compared for the two sexes.

Results: Measured drug values varied considerably from the set target with a prediction error of −22% for remifentanil and 49% for propofol. The anaesthesia level was regarded as quite deep with a mean BIS during stable surgery of 42±7, and at this level we found no correlation between measured values of either of the two drugs and BIS. The emergence time was significantly shorter for women (12.6±2.5 min) than for men (19.0±4.2 min) (P=0.001), with no significant differences in measured levels of propofol or remifentanil or BIS during the emergence period.

Conclusion: Present systems for TCI of remifentanil and propofol result in large intra‐ and interindividual variations in measured drug levels, and measured levels differ from target. There may be possible interaction between the two anaesthetics at a pharmacokinetic level. Within the level of anaesthesia studied here, BIS was not an indicator of the actual drug levels. Women woke up significantly faster than men.
Dynamic evaluation of fluid shifts during normothermic and hypothermic cardiopulmonary bypass in piglets
Authors: Heltne J. K. , Koller M.‐E. , Lund T. , Bert J. , Rynning S. E. , Stangeland L. , Husby P.
Published: March 2003

Background: Edema, generalized overhydration and organ dysfunction commonly occur in patients undergoing open‐heart surgery using cardiopulmonary bypass (CPB) and induced hypothermia. Activation of inflammatory reactions induced by contact between blood and foreign surfaces are commonly held responsible for the disturbances of fluid balance (“capillary leak syndrome”). We used an online technique to determine fluid shifts between the intravascular and the interstitial space during normothermic and hypothermic CPB.

Methods: Piglets were placed on CPB (fixed pump flow) via thoracotomy in general anesthesia. In the normothermic group (n=7), the core temperature was kept at 38°C prior to and during 2 h on CPB, whereas in the hypothermic group (n=7) temperature was lowered to 28°C during bypass. The CPB circuit was primed with acetated Ringer’s solution. The blood level in the CPB circuit reservoir was held constant during bypass. Ringer’s solution was added when fluid substitution was needed (falling blood level in the reservoir). In addition to invasive hemodynamic monitoring, fluid input and losses were accurately recorded. Inflammatory mediators or markers were not measured in this study.

Results: Cardiac output, s‐electrolytes and arterial blood gases were similar in the two groups in the pre‐bypass period. At start of CPB the blood level in the machine reservoir fell markedly in both groups, necessitating fluid supplementation and leading to a markedly reduced hematocrit. This extra fluid need was transient in the normothermic group, but persisted in the hypothermic animals. After 2 h of CPB the hypothermic animals had received 7 times more fluid as compared to the normothermic pigs.

Conclusion: We found strong indications for a greater fluid extravasation during hypothermic CPB compared with normothermic CPB. The experimental model using the CPB‐circuit reservoir as a fluid gauge gives us the opportunity to study further fluid volume shifts, its causes and potential ways to optimize fluid therapy protocols.
The assessment of postoperative cognitive function
Authors: Rasmussen L. S. , Larsen K. , Houx P. , Skovgaard L. T. , Hanning C. D. , Moller J. T. ,   the ISPOCD group
Published: March 2003

Postoperative cognitive function (POCD) has been subject to extensive research. In the literature, large differences are apparent in methodology such as the test batteries, the interval between sessions, the endpoints to be analysed, statistical methods, and how neuropsychological deficits are defined. Traditionally, intelligence tests or tests developed for clinical neuropsychology have been used. The tests for detecting POCD should be based on well‐described sensitivity and suitability in relation to surgical patients. In tests using scores, floor/ceiling effects may compromise the evaluation if the tests are either too easy or to difficult. Uncontrolled testing facilities and change of test personnel may affect the test performance. Practice effects are pronounced in neuropsychological tests but have generally been ignored. The use of a suitable normative population is essential to allow correction for practice effects and variability between sessions. Missing follow‐up may severely compromise valid conclusions since subjects unable or unwilling to be examined are particularly prone to suffer from POCD. In the statistical analysis of the test results, the evaluation should be based on differences between pre‐ and postoperative performance. Parametric statistical tests are not relevant unless the appropriate Gaussian distributions are present, perhaps after transformation of data. The definition of cognitive dysfunction should be restrictive and the criteria should be fulfilled in only a small proportion of volunteers. In the literature, these requirements often have not been fulfilled. This precludes a reasonable estimation of the incidence of POCD and the conclusions of comparative studies should be interpreted with great caution. In this review article, we present a number of recommendations for the design and execution of studies within this area. In addition, the critical reader may use these recommendations in the evaluation of the literature.
Is transient lumbar pain after spinal anaesthesia with lidocaine influenced by early mobilisation?
Authors: Lindh A. , Andersson A.‐S. , Westman L.
Published: March 2003

Background: The aetiology of transient lumbar pain (TLP) after spinal anaesthesia has generated much interest. Many theories have been discussed. Early ambulation has been suggested as one plausible theory for developing TLP.

Methods: A total of 107 patients scheduled for inguinal hernial repair under spinal anaesthesia (20 mg/ml hyperbaric lidocaine) were randomised to either early or late ambulation: the early ambulation (group A), as early as possible after total regression of spinal block or the late mobilisation (group B) bedridden for more than 12 h. The clinical course and duration of operation were monitored. Assessments 4, 8 and 12 h after spinal anaesthesia were performed with respect to wound pain, nausea, tiredness and eventual symptoms of TLP were recorded. The patients also kept a diary about any symptoms once daily day 1–3 at home. A telephone follow‐up was performed at day 5–7.

Results: Our results showed an incidence of TLP of 23% in all patients. No difference was recorded between early and late mobilisation patients, 12 and 13 patients, respectively.

Conclusion: Early ambulation does not seem to increase the risk of developing TLP.
Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia
Authors: Enlund M. , Mentell O. , Krekmanov L.
Published: March 2003

Background: A probable causal relationship between submucosal infiltration of lidocaine, with adrenaline 12.5 μg · mL1, and untoward arterial hypotension during general anaesthesia for orthognathic surgery was investigated in two parts.

Methods: The first part of the study was open and non‐randomised. The patients served as their own controls, receiving 5.4 mL saline/adrenaline before mandibular or maxillary surgery on the first side of the jaw and 5.4 mL lidocaine (2%)/adrenaline on the other side a minimum of 40 min later. Nine patients received in total 11 pairs of injections of the study drugs. In Part Two, 50 mg or 100 mg of lidocaine with adrenaline was infiltrated in an observer‐blinded and randomised order in either side of the jaw in another 13 patients.

Results: A significant and dose‐dependent blood pressure decrease was observed after infiltration of lidocaine/adrenaline, but not after saline/adrenaline. The heart rate increased significantly after both types of injections, most pronounced after saline/adrenaline. Mean arterial blood pressure decreased on average 11% and 23% with lidocaine 50 mg and 100 mg, respectively (P<0.05, ANOVA).

Conclusion: Lidocaine induced dose‐dependent arterial hypotension when combined with a defined level of general anaesthesia. The causative mechanism is unclear.
Reduced isoflurane consumption with bispectral index monitoring
Authors: Guignard B. , Coste C. , Menigaux C. , Chauvin M.
Published: March 2003

Background: Bispectral index (BIS) monitoring has been found to decrease the requirements for propofol, sevoflurane and desflurane and to improve recovery. We wanted to assess the effect of BIS monitoring on intraoperative isoflurane utilisation, and the early recovery profile.

Methods: Eighty patients undergoing various surgical procedures were studied. In the first phase of the study, patients were anaesthetised without the use of BIS, the anaesthetists being blinded to the BIS readings, and isoflurane being administered according to standard clinical practice (control group). In a second phase, isoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60–70 during 15 min prior to the end of surgery (BIS group). Isoflurane consumption was measured. Recovery times and the time to achieve a modified Aldrete score of 9 were recorded.

Results: Despite similar mean BIS levels during maintenance of anaesthesia, the cumulative time spent with BIS values between 40 and 60 during maintenance of anaesthesia was significantly longer in the BIS group as compared with the control group (P<0.001). The isoflurane usage in the BIS group was 12–25% lower than in the control group (P<0.05). The time to awakening and extubation were comparable in the two groups. Although the patients were less sedated (P<0.01) during the three postoperative hours in the BIS (vs. control) group, no significant differences were observed in the time to obtain an Aldrete score of 9.

Conclusion: The addition of BIS to standard monitoring decreases isoflurane consumption. However, we found only a small advantage in using BIS with respect to recovery from isoflurane anaesthesia.
Postoperative tracheal extubation after orthotopic liver transplantation
Authors: Glanemann M. , Langrehr J. , Kaisers U. , Schenk R. , Müller A. , Stange B. , Neumann U. , Bechstein W.‐O. , Falke K. , Neuhaus P.
Published: March 2003

Background:The duration of postoperative mechanical ventilation and its influence on pulmonary function in liver transplant recipients is still debated controversially.

Methods:We retrospectively analyzed the incidence of immediate tracheal extubation, prolonged mechanical ventilation (>24 h following surgery), and episodes of reintubation in 546 patients who underwent orthotopic liver transplantation (OLT) at our institution.

Results:Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. In these, median time of extubation was 49.5 h, whereas the remaining 70.1% of patients required ventilation support for a median 5 h after OLT. As risk factors for prolonged mechanical ventilation we identified the indications of acute liver failure and retransplantation, as well as factors such as mechanical ventilation prior to OLT, massive intraoperative bleeding, and severe reperfusion injury of the liver graft. The incidence of reintubation was 8.8% in patients who were immediately extubated following surgery, and 13.1% in patients who underwent extubation within 24 h. The incidence was significantly increased in patients requiring prolonged mechanical ventilation (36.1%).

Conclusions:Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later. However, special attention should be given to transplant recipients presenting in reduced clinical condition at the time of OLT, undergoing complicated surgery, or receiving liver allografts with severe reperfusion injury because of an increased risk for prolonged mechanical ventilation.
Postoperative intensive care admittance: The role of tobacco smoking
Authors: Møller A. M. , Maaløe R. , Pedersen T.
Published: March 2003

Background: Smokers have been shown to have increased risk of intraoperative pulmonary complications and of a wide range of postoperative complications, but an increased risk of postoperative intensive care admittance has not yet been described. The aim of this study was to estimate the risk of pulmonary complications and postoperative intensive care admittance in smokers and non‐smokers in a general and orthopaedic surgical population.

Methods: A total of 4725 surgical patients were assessed. The following information was noted: age, sex and smoking status, history of heart and lung disease, ASA classification, type of anaesthesia, intensive care admittance and postoperative pulmonary or cardiovascular complications. A logistic regression model was used to determine the probability of intensive care admittance and pulmonary complications as a function of smoking status, age, and chronic heart and lung disease.

Results: Of the patients, 39.9% were smokers, 45.5% were non‐smokers and in 14.6% of the cases smoking status was unspecified. Postoperative intensive care admittance and pulmonary complications were found in 2.0% and 4.3% of the patients, respectively. Non‐smokers were more often female (P<0.01), and smokers had a higher incidence of emergency surgical procedures (P<0.05). When applying multiple regression analysis, we found that smoking, age >65 years, and a history of chronic lung disease increased the risk of unplanned intensive care admittance (odds ratio 1.55, 12.52 and 2.73).

Conclusion: Our results indicate a relationship between a history of tobacco smoking and postoperative intensive care admittance.
Modelling of hypoxaemia after gynaecological laparotomy
Authors: Kjærgaard S. , Rees S. E. , Nielsen J. A. , Freundlich M. , Thorgaard P. , Andreassen S.
Published: March 2003

Background: Late postoperative arterial hypoxaemia is common after major surgery, and may contribute to cardiovascular, cerebral or wound complications. This study investigates the time course of hypoxaemia following gynaecological laparotomy, and estimates parameters of mathematical models of pulmonary gas exchange to describe hypoxaemia.

Methods: Twelve patients were studied on four occasions; preoperatively, 2, 8 and 48 h after surgery. On each occasion inspired oxygen fraction (FIO2) was varied, changing end‐expired oxygen fraction (FEO2) to achieve arterial oxygen saturations (SaO2) ranging from 90% to 100%. Measurements of ventilation and blood gases were taken. Oxygenation was characterized plotting FEO2 against SaO2. The shape and position of the FEO2/SaO2 curve was described using two mathematical models including parameters describing gas exchange: either shunt and resistance to oxygen diffusion (Rdiff); or shunt and asymmetry of ventilation–perfusion (fA2).

Results: Two hours after surgery SaO2 was reduced from 97.5%±1.2% (mean±SD) to 93.8%±2.7% (mean±SD) (P<0.001). Values of shunt, Rdiff and fA2 were significantly changed at 2 and 8 h postoperatively. Forty‐eight hours postoperatively Rdiff and fA2 were still significantly changed.

Conclusion: Oxygenation in 12 patients preoperatively, 2, 8 and 48 h after gynaecological laparotomy is described. Two patients were hypoxaemic (SaO2 <92%) 48 h postoperatively. When two different models of oxygen transport are fitted to patient data, high values of Rdiff or low values of fA2 describe the right shift in the FEO2/SaO2 curve seen in patients with oxygenation problems. These models fit patient data identically, and may be useful in quantifying postoperative hypoxaemia.
Influence of colloid fluids on polymorphonuclear granulocyte function in vivo
Authors: Engel J. M. , Welters I. , Rupp M. , Langefeld T. , Ruwoldt R. , Menges T. , Hempelmann G.
Published: March 2003

Background: Granulocytes have a role in the immediate immune response. In a previous investigation we could demonstrate in vitro a moderate increase of the complement receptors CR1 (CD35) and CR3 (CD11b/CD18) on the surface of polymorphonuclear neutrophils (PMN) after incubation of whole blood with colloids. To elucidate the clinical significance, we investigated if these changes were also present in vivo.

Methods: The study was performed prior to anaesthesia for orthopaedic surgery. A total of 60 ASA‐I patients was evaluated. Patients received in a randomised manner 7 mL/kg of the following solutions: human albumin 5% (HA), gelatine 4% (GEL), hydroxyethylstarch solution 6% with MW 200 000 Da, degree of substitution 0.5 (HES), or Ringer’s solution. Prior to the infusion, at the end (30 min) and again 30 min later, blood samples were taken. Blood was incubated with fluorescein‐conjugated monoclonal antibodies (CD11b, CD16, CD35, CD62L) and analysed with flow cytometry.

Results: HA, GEL, HES, and Ringer’s solution failed to induce significant differences in the expression of complement receptors CR1 (CD35) and CR3 (CD11b/CD18), Fcγ receptor IIIb (CD16), and of L‐selectin (CD62L) receptor on the surface of PMN.

Conclusions: Application of colloids like HA, GEL, or HES in moderate amounts shows no short‐term effect on adhesion or activation molecules on granulocytes. However, in high doses, infused in situations such as multiple trauma and sepsis, the consequences on the function of PMN may be speculative and require further investigations.
Increased blood–brain barrier permeability of morphine in a patient with severe brain lesions as determined by microdialysis
Authors: Bouw R. , Ederoth P. , Lundberg J. , Ungerstedt U. , Nordström C.‐H. , Hammarlund‐Udenaes M.
Published: March 2003

Intracerebral microdialysis was utilised to obtain information regarding how morphine is transported across the blood–brain barrier (BBB). In a patient with a severe brain injury, we measured simultaneously unbound extracellular fluid (ECF) concentrations of morphine in human brain and in subcutaneous fat tissue, which were compared to morphine levels in arterial blood. This report shows an increase in morphine levels near the trauma site in the brain compared to uninjured brain tissue. The half‐life of morphine in uninjured and injured brain tissue of 178 min and 169 min, respectively, were comparable but were longer than in blood (64 min) and adipose tissue (63 min). This indicates that morphine is retained in brain tissue for a longer time than what could be expected from the blood concentration–time profile. These results show the potential of the microdialysis technique in providing new information regarding the pharmacokinetics of drug in the human brain close to the trauma site and in macroscopically intact tissue.
Reversible increase in QT dispersion during carbon monoxide poisoning
Authors: Macmillan C. S. A. , Wildsmith J. A. W. , Hamilton W. F. D.
Published: March 2003

Increased QT dispersion is a marker for cardiac morbidity and mortality. Carbon monoxide (CO) is a potent myocardial toxin and this report describes the change in QT dispersion during intensive care therapy for severe CO poisoning.
An outcome study of severe traumatic head injury using the “Lund therapy” with low‐dose prostacyclin
Authors: Naredi S. , Olivecrona M. , Lindgren C. , Östlund A. L. , Grände P.‐O. , Koskinen L. O. D.
Published: March 2003

Background: There are two independent head injury outcome studies using the “Lund concept”, and both showed a mortality rate of about 10%, and a favourable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund concept aims at controlling intracranial pressure, and improving microcirculation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary pressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculation, which finds support from a microdialysis‐based clinical study and an experimental brain trauma study. The present clinical outcome study aims at evaluating whether the previously obtained good outcome with the Lund therapy can be reproduced, and whether the addition of prostacyclin has any adverse side‐effects.

Methods: All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) ≤8, admitted to the University Hospital of Umeå during 1998 were included. The Lund therapy including prostacyclin infusion for the first three days at a dose of 0.5 ng kg−1 min−1. Outcome was evaluated according to the GOS >10 months after the injury.

Results: One patient died, another suffered vegetative state and 7 severe disability. Of the 22 patients with favourable outcome, 19 showed good recovery and 3 moderate disability. No adverse side‐effects of prostacyclin were observed.

Conclusion: The outcome results from previous studies using the Lund therapy were reproduced, and no adverse side‐effects of low‐dose prostacyclin were observed.