bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative autonomic hyperreflexia in high spinal cord lesions: a case report
Authors: Ræeder J. C. , Gisvold S. E.
Published: January 2009

We report the case of a 20‐year‐old man with serious perioperative attacks of autonomic hyperreflexia starting during urological surgery 14 months after a complete C6‐C7 spinal cord injury. The intraoperative attacks were controlled by deepening the level of anaesthesia, while the postoperative attacks were treated with emepronium bromide. A brief discussion of the pathophysiology and treatment is given.
CO2 production after suxamethonium and diazepam
Authors: Schou‐Olesen A. , Christensen K. J. S. , Hartmann‐Andersen F. , Jørgensen S.
Published: January 2009

The CO2‐production and degree of relaxation after increasing doses of suxamethonium were measured in seven patients undergoing alloplastic surgery of the hip. The study indicates that the CO2‐production rises following the injection of increasing doses of suxamethonium. Another group of patients received diazepam 0.1 mg kg‐1 before the injection of suxamethonium 1 mg kg‐1. CO2‐production was significantly reduced compared to CO2 production when suxamethonium was not preceded by diazepam. It is suggested that diazepam in doses larger than 0.1 mg kg‐1 might be effective in preventing fasciculations and postoperative muscle pains before the injection of suxamethonium in a dose of 0.5 mg kg‐1.
Alfentanil as an adjuvant of balanced anaesthesia for tonsillectomy in adults
Authors: Saarnivaara L. , Klemola U.‐M.
Published: January 2009

In a double‐blind study, 80 adult patients, undergoing tonsillectomy, were randomly allocated to one of the four groups: 1) d‐tubocurarine (d‐Tc) 50 μg/kg + alfentanil (Alf) 20 μg/kg, 2) d‐Tc 50 μg/kg + Alf 50 μg/kg, 3) Alf 10 μg/kg + Alf 20 μg/kg, 4) Alf 10 μg/kg + Alf 50 μg/kg. The first drug was given 2 min before thiopental and the second drug 1 min before inserting the mouth gag. Intubation was facilitated with suxamethonium. Anaesthesia was maintained with 70% nitrous oxide in oxygen and peripheral muscle relaxation during operation with vecuronium. For analysis of the induction characteristics, both d‐Tc‐pretreatment groups were treated together and compared with the results of the Alf‐pretreatment groups. Muscle fasciculations occurred in 20% in the d‐Tc group and in 70% in the Alf group. Neither d‐tubocurarine nor alfentanil prevented the cardiovascular intubation response. Cardiovascular responses to the placement of the mouth gag occurred only in the lower‐dose alfentanil groups. ECG changes during operation occurred in 25–45% of the patients. The most common ECG change was junctional rhythm. The operating conditions were good in 65–80% of the patients. The mean recovery score (0–10) ranged from 9.3 to 9.7 between the groups. The incidence of nausea ranged from 20–30% and that of vomiting from 10–25%, between the groups. Bleeding from the operation site occurred in 20–30%, of the patients. None of the patients needed sutures to stop the bleeding.
Interaction of verapamil with d‐tubocurarine and cholinergic agonists at the avian neuromuscular junction
Authors: Wali F. A.
Published: January 2009

The effect of verapamil on neuromuscular transmission and muscle contraction was studied in the skeletal muscle of chickin vitro.The interactions of verapamil with d‐tubocurarine (d‐TC)‐induced neuromuscular blockade, acetylcholine (ACh) and tctraethylammonium (TEA)‐induced contractures were also studied. The purpose of the present investigation was to see if verapamil: (a) intensified the neuromuscular blockade produced by d‐TC; (b) modified the cholinergic responses to ACh, TEA; and (c) inhibited both directly and indirectly elicited twitch contractions. The results showed that verapamil (1–100 μg/ml, 2–200 μmol/l) had a neuromuscular blocking activity on its own; i.e. it reduced both directly and indirectly evoked twitch contractions, and intensified the neuromuscular blockade produced by d‐TC. In addition, verapamil reduced the contractures produced by ACh and TEA in the chick muscle. The results are in favour of the possibility that verapamil acts by a mixture of pre‐ and postjunctional effects at the chick neuromuscular junction.
Constitutional factors promoting development of atelectasis during anaesthesia
Authors: Strandberg Å. , Tokics L. , Brismar B. , Lundquist H. , Hedenstierna G.
Published: January 2009

The extent of atelectasis was correlated to constitutional factors in 38 patients who underwent computed tomography prior to and during general anaesthesia with halothane. All patients but two developed atelectasis in dependent regions of both lungs immediately after induction of anaesthesia prior to surgery. The transverse area of the densities ranged from 0 to 27 cm2, and there were no significant differences between patients of different age or sex, or with different smoking habits. A significant linear regression was found between Broca's index and the area of the densities, and also between an index describing the shape of the thorax and the density area. Thus, patients who were overweight and/or had a low and wide thorax tended to develop more extensive atelectasis during anaesthesia. This finding might partly explain why overweight patients develop postoperative pulmonary complications more often than non‐obese patients.
Continuous monitoring of oxygen tension with a transcutaneous sensor during hypotensive anesthesia
Authors: Megerman J. , Mihelakos P. Th. , Katsamouris A. N. , Fahmy N. R. , Lappas D. G. , Abbott W. M.
Published: January 2009

Transcutaneous oxygen tension (TCPo2) is a useful noninvasive technique for monitoring arterial oxygen tension under stable circulatory conditions. This study was undertaken to determine if TCPo2 is also reliable during sodium nitroprusside‐induced hypotension under general anesthesia. Arterial blood gases and TCPo2 were measured prior to inducing hypotension (baseline), at 20‐min intervals during hypotension, and when systemic arterial pressure had returned to within 10% of the control (pre‐hypotension) value. With induced hypotension, Pao2 and TGPo2 decreased significantly (P<0.05), and were well correlated by linear regression (r>0.85); however, regressions were strongly dependent on the individual patient. The mean regression line for all patients as a group was given by TCPo2 = 0.69 Pao2 + 20.7 mmHg (r = 0.93, P<0.01); significantly different regressions were obtained for each patient (P<0.0001). Comparing changes in TCPo2 versus those in Pao2 (relative change from baseline values) did not substantially reduce the variability among patients. It is concluded that TCPo2 reliably reflects changes in arterial oxygen tension during controlled hypotension under general anesthesia, but that a separate calibration of TCPo2 vs. Pao2, obtained prior to inducing hypotension, may be required for each individual patient.
Granulocytes in bronchial lavage fluid after major vascular surgery
Authors: Fosse E. , Opdahl H. , Sunde S. , Aasen A. O. , Svennevig J.‐L.
Published: January 2009

Increased numbers of polymorphonuclear granulocytes (PMN) in the airways, as measured by PMN content in bronchial lavage fluid (P<0.01), were found 3 h postoperatively in ten patients undergoing surgery for lumbar aortic aneurysms. An increase in plasma levels of the complement split product C3dg from 6 (0–19) AU/ml preoperatively to 20 (13–50) AU/ml 3 h after surgery (P<0.01), indicates an activation of the complement cascade. These changes were not accompanied by increased elastase activity in the bronchial lavage fluid or by major changes in pulmonary blood gas exchange or vascular resistance, indicating that massive PMN activation, analogous lo that proposed in adult respiratory distress syndrome (ARDS) had not taken place. In conclusion, complement system activation and migration of PMN into the airways, as seen in connection with major vascular surgery, does not seem to contribute to ARDS‐type pulmonary dysfunction.
Effects of halothane and enflurane on myocardial metabolism during postischaemic reperfusion in the rat
Authors: Kashimoto S. , Tsuji Y. , Kumazawa T.
Published: January 2009

In experiments on isolated rat heart‐lung preparation, the effects of halothane and enflurane on myocardial metabolism during postischaemic reperfusion were evaluated with intramyocardial high energy phosphates, lactate and glycogen. Hearts were perfused for 10 min initially and made globally ischacmic for 8 min. Afterwards, they were reperfused for 12 min. Halothane or enflurane was administered from 5 min after the start of perfusion to the end of reperfusion. There were no significant differences in contents of high energy phosphates between control (C), halothane (H) and enflurane (E) groups (ATP: 15.50 ± 0.87, 16.05 ± 1.99 and 15.16 ± 2.03 μmol/g dry wt, respectively). However, lactate levels in the hearts in Groups H and E were significantly higher than those in Group C (44.04 ± 10.54, 40.63 ± 10.34 vs 28.63 ± 5.98). Slight deterioration in the myocardial oxidation‐reduction state may be caused by inhalational anaesthetics when they are administered during the postischaemic reperfusion period.
Cardiovascular reactions to intramedullary reaming of long bones in dogs
Authors: Reikerås O.
Published: January 2009

The cardiovascular reactions to reaming of the medullary cavity of the femoral bones in dogs were studied. Intramedullary reaming caused marked reductions in systemic and pulmonary artery blood pressure. Cardiac‐output was maintained, while total peripheral resistance was reduced. The haemodynamic changes were transient, and it is suggested that they were caused by a neurally transmitted reflex mechanism.
Effects of prenalterol on central hemodynamics and myocardial metabolism in experimental propoxyphene‐induced shock
Authors: Häggmark S. , Strøm J. , Reiz S. , Nyhman H. , Angelo H. , Madsen P. Sloth , Sørensen M. Bredgaard
Published: January 2009

The hemodynamic and cardiometabolic effects of prenalterol were evaluated in propoxyphene‐induced circulatory shock in 10 pentobarbital‐anesthetized pigs. Circulatory shock (i.e. a systolic arterial blood pressure below 60 mmHg (8 kPa) and/or a cardiac index of less than 2.01·min‐1·m‐2) was induced by intravenous propoxyphene chloride 15 mg‐min‐1. Circulatory shock occurred after 26 ± 3 mg·kg‐1of propoxyphene. During continuous infusion of propoxyphene, consecutive doses of prenalterol 0.5, 1.0, 2.0 and 4.0 mg i.v. were injected with an interval between increments of 8 min. The maximum effect of prenalterol was seen following the 2 mg dose. Increases were observed in mean arterial blood pressure, cardiac index, stroke volume index, left ventricular stroke work index, right ventricular stroke work index, maximum rate of rise of ventricular pressure, and total body oxygen consumption. Decreases were observed in pulmonary artery occlusion pressure, mean right atrial pressure and systemic vascular resistance, whereas heart rate and pulmonary vascular resistance remained unchanged. The cardiometabolic parameters: coronary sinus now, coronary vascular resistance, myocardial oxygen consumption and extraction, remained low. Due to profound vasodilation, normal perfusion pressures were not reestablished. In conclusion, prenalterol improved cardiac performance by a significant positive inotropic action. However, pure inotropic stimulation was not sufficient to counteract the circulatory shock state during severe propoxyphene intoxication.
Hypoxia‐induced vasoconstriction in human lung exposed to enflurane anaesthesia
Authors: Carlsson A. J. , Hedenstierna G. , Bindslev L.
Published: January 2009

The degree of hypoxic pulmonary vasoconstriction was studied in eight subjects during enflurane anaesthesia and was compared with that during intravenous pentobarbital anaesthesia in the same subjects. The lungs were ventilated separately with the aid of a double‐lumen endobronchial catheter. After preoxygenation of both lungs for 30 min, during intravenous anaesthesia, the right lung (test lung) was rendered hypoxic by ventilation with 6% O2 in nitrogen. The left lung (control lung) was ventilated continuously with 100% oxygen. Cardiac output (Q̇T) was determined by thermodilution, and the distribution of blood flow between the lungs was assessed from the elimination of a continuously infused, poorly soluble inert gas (SF6). The hypoxic challenge resulted in a reduction of the distribution of perfusion to the test lung from 57% to 36% of Q̇T. Mean pulmonary arterial pressure increased by 37% and pulmonary vascular resistance of the test lung doubled. Arterial oxygen tension decreased from 45.9 to 9.5 kPa. Administration of enflurane to an end‐tidal concentration of 2% to both lungs caused no significant change in the distribution of the pulmonary blood flow, PVR, or any other circulatory variable. The arterial blood gases remained unaltered. When the hypoxic challenge was discontinued, all variables returned towards control values. The findings suggest that the inhalational anaesthetic enflurane does not reduce the hypoxic vasoconstrictor response in the human lung.
Spontaneous versus controlled ventilation in anaesthetized children with congenital cardiac malformations
Authors: Olsson A.‐K. , Lindahl S. G. E.
Published: January 2009

The effects of intermittent positive pressure ventilation on gas exchange were studied in 12 children with congenital cardiac malformation. Six children (b.w. 3.7–16 kg) had a left‐to‐right shunt (Group LR) resulting in overperfused lungs, while six others (b.w. 3.4–12 kg) had a right‐to‐left shunt (Group RL) with oligaemic lungs. Measurements, prior to surgery, were done during spontaneous breathing (SB) and controlled mechanical ventilation (CMV) with a short (25%) and a long (55%) duration of inspiration. In children with oligaemic lungs P(a‐E)co2 differences and VD/VT ratios were greater and Pao2 was lower than in those with overperfused lungs, indicating a less efficient ventilation. In Group RL, ventilation and gas exchange during SB were similar at the two settings of CMV. In Group LR, however, VD/VT was reduced during CMV, with the lowest VD/VT ratio at the longer inspiration time. It is concluded that in children with an oligaemic lung perfusion, either of the two ventilator settings could be used. When controlled ventilation is to be used in children with overperfused lungs, the longer duration of inspiration seems to be preferable.
In vitro effect of etomidate and thiopental on granulocyte migration
Authors: Knudsen F. , Klausen N. O. , Ferguson A. H. , Pedersen J. O.
Published: January 2009

An increased mortality has been reported during long‐term etomidate infusion. Inhibition of adrenal corticosteroid synthesis has been incriminated — but other factors related to host defence cannot be excluded. Using an under‐agarose assay, we investigated the effect of etomidate on in vitro granulocyte migration. Unlike thiopental (50 μg/ml), etomidate (4–32 μg/ml) did not affect either spontaneous or directed migration. Impaired granulocyte migration is an unlikely cause of morbidity during long‐term etomidate infusion.
Granulocyte microbicidal function in patients undergoing major abdominal surgery under balanced anaesthesia
Authors: Perttilä J. , Salo M. , Rajamäki A.
Published: January 2009

Granulocyte microbicidal functions were studied in 11 major abdominal surgery patients with the luminol‐enhanced chemiluminescence method. The responses of granulocytes in phagocytosis of zymosan, S. aureus and E. coli and responses to N‐formylmethionyl‐leucylphenylalanine (FMLP) were unaffected by surgery. The percentage of high‐peroxidase‐activity cells among neutrophils was increased on postoperative days 1 (P<0.01) and 3–4 (P<0.05). We propose that microbicidal‐related oxidative phagocytic functions of granulocytes are well maintained after major abdominal surgery under balanced anaesthesia.
Spectral analysis of the EEG during hypothermic cardiopulmonary bypass
Authors: Russ W. , Kling D. , Sauerwein G. , Hempelmann G.
Published: January 2009

In 39 patients undergoing aorto‐coronary‐bypass grafting, spectral analysis of the EEG (compressed spectral array: CSA) and calculation of spectral edge frequency (SEF) were performed. The effects of different temperatures and of perfusion pressure (PP) were analyzed. Predictable patterns were observed. During cooling on cardiopulmonary bypass (CPB). linear regression analysis revealed a close correlation between SEF and tympanic membrane (Tty) or nasopharyngeal temperature (Tnp). During rewarming, a nonlincar correlation between SEF and Tty or Tnp was found. Rectal temperature as well as blood temperature in the arterial or venous line of the oxygenator seemed to be less useful. The independence of SEF and PP was demonstrated during the whole procedure. At the onset of CPB, after correction of the aortic clamp for performance of the aortic anastomosis and after removal of the aortic clamp, bilateral EEG slowing of varying duration occurred in 20 patients. Comparison of mean SEF before and after CPB revealed a difference of about 5 Hz. In no patient were major neurological abnormalities observed postoperatively.
Thermoregulation, plasma catecholamine and metabolite levels during submaximal work in individuals susceptible to malignant hyperpyrexia
Authors: Green J. H. , Ellis F. R. , Halsall P. J. , Campbell I. T. , Currie S. , Caddy J.
Published: January 2009

Measurements of body temperature, respiratory gas exchange, sweat evaporation rate and circulating level of catecholamines, lactate, pyruvate, free fatty acids and glucose were made in seven patients susceptible to malignant hyperpyrexia (MHS) and in seven control subjects during 2 h of treadmill walking at 40% of maximum oxygen consumption. These studies took place in an ambient temperature or 22°C. The MHS patients displayed the same thermoregulatory, plasma catecholamine and metabolic responses as the control subjects. The results or the present study suggest that non‐competitive. low‐intensity, steady‐state exercise need not be contraindicated for MHS patients.
Preservation of humidity and heat of respiratory gases during anaesthesia ‐ a laboratory investigation
Authors: Bengtson J. P. , Sonander H. , Stenqvist O.
Published: January 2009

Humidification and heating of anaesthetic gases are desirable to prevent respiratory tract damage and a fall in body temperature during operative procedures. Numerous studies on the humidity and temperature of inspiratory gases in different breathing systems for anaesthesia have been carried out, but comparisons arc difficult since different methods have been used. In this laboratory set‐up we studied a non‐rebreathing system with and without humidifiers and a circle absorber system with low (0.5 l/min) or medium (5 l/min) fresh gas flows regarding their ability to heat and humidify anaesthetic gases. The humidity of inspired g was acceptable in the non‐rebreathing system using either a Bennett Cascade humidifier or disposable humidifiers and in the circle absorber system using a fresh gas flow of 5 l/min or less. The temperature of the inspired gases was highest with the Bennett Cascade humidifier, followed by the low‐flow circle system. The circle absorber system used with low fresh gas flow gave higher inspiratory gas temperature and humidity than the non‐rebreathing system with a good disposable humidifier.
Circulatory effects of short‐term hypercapnia during thoracolumbar epidural anaesthesia
Authors: Sundberg A. , Wattwil M. , Wiklund L.
Published: January 2009

In ten elderly patients subjected to extensive thoracolumbar epidural anaesthesia, circulatory changes were studied before and during sympathetic stimulation. Induced hypercapnia was used as a sympathetic stimulus. After establishment of the epidural anaesthesia, which extended from TI to L2, there were decreases in heart rate, mean arterial blood pressure, cardiac output and systemic vascular resistance. Hypercapnia before the epidural block increased heart rate, arterial blood pressure and cardiac output, while hypercapnia after established epidural block induced only a slight increase in arterial blood pressure. The results indicate that in spite of an extensive epidural block, there are some “escaped” sympathetic nerve fibres that can be mobilized during sympathetic stimulation.
Local anaesthetics inhibit cholinergic and non‐cholinergic neural and muscular contractions in avian tracheal smooth muscle
Authors: Wali F. A.
Published: January 2009

The effects of Live different local anaesthetics: lignocaine, prilocaine, etidocaine, mepivacaine, bupivacaine, on tone, contractility, and on cholinergic and non‐cholinergic responses of chick tracheal smooth mu were studied and compared in vitro. The cholinergic and non‐cholinergic contractions of the tracheal smooth muscle were elicited by electrical field stimulation, at a maximal voltage with 0.2 Hz and 0.2 ms square pulse duration, in the presence of adrenergic blockers, guanethidine, propranolol, and other drugs, e.g. indomethacin. Atropine was used to reduce the cholinergic responses due to electrical field stimulation arid to applied acetylcholine (ACh). Lignocaine, in low concentrations, reduced these responses and also those produced by electrical field stimulation in the presence of atropine. In high concentration (>100 times clinical concentrations), lignocaine abolished all the responses and produced a sustained contracture in the muscle. Among the local anaesthetics studied, bupivacaine and lignocaine were found to be more effective than mepivacaine, prilocaine and etidocaine, in reducing the cholinergic contractions produced by electrical field stimulation and by exogenous ACh. It was suggested that lignocaine, and other local anaesthetic drugs, may have anti‐ spasmic effect on the tracheal smooth muscle, in that they inhibited the contractions induced by electrical field stimulation and by depolarizing agents.
Metabolic acidosis in dextran‐induced anaphylactic reactions
Authors: Ljungström K.‐G. , Renck H.
Published: January 2009

Results of arterial blood gas and acid‐base balance analyses were analyzed in 50 patients suffering from dextran‐induced anaphylactic reactions. Metabolic acidosis was always present in severe cases, leading to cardiac arrest, and also frequently found in those with less severe reactions with only slightly impaired circulation. Bronchospastic respiratory signs were frequently encountered but acidosis was noted to develop even without these symptoms. The severity of the acidosis was generally underestimated during treatment. Arterial Po2and PCO2were not significantly affected during these reactions.
The effect of bupivacaine and morphine on pain and bowel function after colonic surgery
Authors: Scheinin B. , Asantila R. , Orko R.
Published: January 2009

Sixty patients scheduled for colonic surgery were randomly allocated to four groups according to postoperative pain medication: I. Control group, the patients received oxycodone intramuscularly (0.15 mg kg1) on request. II. Epidural bupivacaine (0.25%) continuously administered by infusion pump, 66 ml h‐1, for 48 h. III. Epidural morphine, 2–6 mg, at the end of operation and repeated on the first and second postoperative mornings. IV. Epidural morphine, 2–6 mg per die, administered for 48 h continuously by infusion pump. All patients received a balanced anaesthesia with enflurane, fentanyl and vecuronium. Postoperatively, intramuscular oxycodone was given on request. There were no significant differences between the groups in changes in peak flow, spirometry and blood‐gas analyses postoperatively. Pain intensity (visual analogue scale) was lower in Groups II and III at 3 h and in Group IV at 24 h compared to the control Group I. All the epidurally treated groups needed less additional analgesics than the control Group I. Postoperatively bowel movements occurred on the second day in Group II (bupivacaine) as compared to the fourth day in all other groups (P < 0.05).
The effect of spinal analgesia and surgery on peroperative drug absorption and gastric emptying in man
Authors: Adelhøj B. , Petring O. U. , Frøsig F. , Jensen B. N. , Ibsen M. , Poulsen H. E.
Published: January 2009

Paracetamol 20 mg kg‐1 dissolved in 200 ml of water was given by mouth to seven patients undergoing minor orthopedic surgery in spinal analgesia, and again 2 weeks later. The rate of paracetamol absorption was significantly delayed by spinal analgesia and surgery, indicating an inhibition of peroperative drug absorption and gastric emptying. The effect of spinal analgesia on gastric emptying was not able to normalize the delayed peroperative gastric emptying produced by surgery, and suggests that surgery is an important factor in peroperatively delayed gastric emptying.
A complication of subclavian vein catheterisation. Extravascular knotting of a guidewire
Authors: Wang L. P. , Einarsson E.
Published: January 2009

A case is presented in which a Seldinger guidewire perforated and then became knotted outside the subclavian vein. The management of this complication is described, and possible causes and preventive measures are discussed.
Evaluation of the efficacy of elastic compression stockings in prevention of hypotension during epidural anaesthesia for elective caesarean section
Authors: Lee A. , McKeown D. , Wilson J.
Published: January 2009

The ability of graduated compression elastic stockings to prevent hypotension during elective epidural caesarean section was evaluated. Twenty women were randomly assigned to two groups of ten, one group being fitted with the stockings. The incidence and degree of hypotension were the same in both groups. Graduated compression clastic stockings are of no benefit in reducing the incidence of maternal hypotension during caesarean section.
Atracurium infusion in total intravenous anesthesia
Authors: Nilsson A. , Tamsen A. , Persson M. P.
Published: January 2009

The neuromuscular blocking effect of atracurium given as a bolus dose (0.5 mg·kg‐1) followed by a maintenance infusion was studied during two different anesthetic techniques. It has been reported that benzodiazepines interact with non‐depolarising neuromuscular blockers. In this study no difference was found in the effect of atracurium given with conventional fentanyl/nitrous oxide anesthesia when compared to total intravenous anesthesia using midazolam/alfentanil. More than 90% twitch depression was achieved after 123 and 137 s, respectively. Recovery time to 10% twitch height following the bolus dose was around 32 min. The dosage range for atracurium given by infusion (0.29‐0.44 mg·kg‐1·‐1) was confirmed.
Renal and liver function tests in surgical septicemia
Authors: Smith‐Erichsen N.
Published: January 2009

The prognostic value of conventional renal and liver function tests was evaluated during surgical septicemia. Changes in renal function variables were associated with the development of septic shock. Creatinine clearance was the most sensitive variable in predicting the outcome of septic shock, but serum creatinine and urine output were also of some value in this respect. Significantly lower creatinine clearance and urine output values, as well as significantly higher serum creatinine concentration, were thus observed during septic shock with fatal outcome compared to non‐fatal septic shock. In septicemia not complicated with shock, the variables of renal function remained in the normal range irrespective of final outcome. Among the liver function tests, serum albumin and total protein concentration revealed significant differences in behaviour between survivors and patients dying with persistent septicemia. However, due to the small differences and considerable overlap observed between the two groups of patients during the first 2 weeks of septicemia, these two variables are of limited practical value as prognostic predictors. The other liver function tests gave no information as regards the outcome of septicemia in the present study.
Mucopolysaccharidoses and anaesthetic risks
Authors: Sjøgren P. , Pedersen T. , Steinmetz H.
Published: January 2009

The purpose of this review is to assess the current knowledge of mucopolysaccharidosis (MPS), with reference to the serious complications which may arise in connection with anaesthesia and operation. MPS consists of a heterogeneous group of hereditary diseases which are characterized by an abnormal accumulation of mucopolysaccharides, especially in cartilaginous and bone tissue. Because of their progressive and disabling nature, frequent surgical intervention is common, and is associated with a high degree of per‐ and postoperative risk. The clinical manifestations of MPS are frequently dwarfism, scaphocephaly, grotesque facial features with snub nose, hypertelorism, macroglossia and dental anomalies. The chest is deformed by pectus carinatum or excavatum, club‐formed ribs and kyphosis with gibbus. Furthermore, cardiomegaly, abdomen pendens, hepatosplenomegaly, umbilical hernia, corneal clouding, conductive deafness and subnormal intelligence are common findings. Prior to operation, patients should be thoroughly evaluated through clinical examination and laboratory investigations. In particular, lung function should be optimized by lung physiotherapy and treatment of airway infections. When inducing general anaesthesia, spontaneous respiration is recommended until the patient has been intubated, as airway anomalies, bleeding and salivation may make intubation extremely difficult. Local or regional anaesthesia is often preferable, though age and mental status are relative contraindications. When used in combination with careful sedation, many problems may be overcome. Postoperatively, it is important to treat stagnation of secretions and airway infections with lung physiotherapy, positive end‐expiratory pressure, and antibiotics. In connection with anaesthesia, it is vital to monitor the patient carefully before, during and after anaesthesia
Propofol emulsion for induction and maintenance of anaesthesia. A combined technique of general and regional anaesthesia
Authors: Grood P. M. R. M. De , Coenen L. G. J. , Egmond J. van , Booij L. H. D. J. , Crul J. F.
Published: January 2009

To provide general anaes hesia with endotracheal intubation during regional blockades, three dose regimens of propofol emulsion were studied: induction 2 mg kg‐1, infusion rate 9 mg kg‐1 h‐ (Group I); induction 2.5 mg kg‐1, infusion rate I? mg kg‐1 h‐1 (Group 2); induction 2.5 mg kg‐1, infusion rate 9 mg kg‐1 (Group 3). Each group comprised 10 healthy (ASA class 1 or 2) unpremedicated patients. The induction times measured from the start of injection until counting ceased (± 50 s) and until eye‐lash reflex disappeared (± 80 s) showed no statistical differences between groups. In five patients in Group 1 and one patient in each of Groups 2 and 3 the induction dose was too low for intubation. Pain on injection was seen in 13 cases (mild 6, moderate 6 and severe I). Cough accompanied by hypersalivation was the most important side‐effect. Recovery times varied widely and showed no statistical differences. Answering simple questions was possible after 14 min in Group 1, 23 min in Group 2 and 19 min in Group 3. Apart from a short period of euphoria, recovery was uneventful. There was no tendency to fall asleep again. None of the combinations of induction doses and infusion rates provided good anaesthesia conditions for an acceptable number of patients.
Malignant hyperthermia during isoflurane anaesthesia. A case report
Authors: Johannesson G. , Veel T. , Rogstadius J.
Published: January 2009

A case of malignant hyperthermia during isoflurane anaesthesia without the use of muscle relaxants in a healthy 7‐year‐old girl is presented. In this case only premedication and nitrous oxide were used together with isoflurane. Thus isoflurane by itself can trigger malignant hyperthermia, even in the absence of muscle relaxants.
Halothane, enflurane and isoflurane anaesthesia for adenoidectomy in children, using two different premedications
Authors: Johannesson G. P. , Lindahl S. G. E. , Sigurdsson G. H. , Nordén N. E.
Published: January 2009

In 48 children subjected to adenoidrectomy, comparisons of airway problems, heart rates, cardiac arrhythmias, ventilation and stress hormone reactions were studied during halothane, enflurane and isoflurane anaesthesia. Sixteen children were anaesthetized with either of the three agents and eight patients in each group received diazepam 0.25 mg kg‐1 and atropine 0.015 mg kg‐1 rectally (DA) as premedication and the remainder diazepam 0.5 mg kg‐1, morphine 0.15 mg kg‐1 and scopolamine 0.01 mg kg‐1 (DMS) rectally. All children were intubated and breathing spontaneously. Equianaesthetic inspired concentrations of halothane, enflurane and isoflurane were used. Airway problems were of the same magnitude during halothane and isoflurane anaesthesia but were less frequent with both agents compared with enflurane anaesthesia. DMS reduced the number of airway reactions in all groups. Respiratory rates were uninfluenced by anaesthesia, intubation and surgery during enflurane anaesthesia. Cardiac arrhythmias were less frequent with enflurane and isoflurane than with halothane. Plasma ACTH and cortisol were similar with all three agents. During induction of anaesthesia in the DA‐premedicated halothane group, however, plasma catecholamines were higher than in the group which received DMS, in contrast to the findings during enflurane and isoflurane anaesthesia. The DMS premedication decreased the response of plasma ACTH, cortisol and plasma catecholamines to surgery.
Does the choice of the neuromuscular blocking agent affect the cardiovascular response to intubation?
Authors: Lavery G. G. , Mirakhur R. K. , Clarke R. S. J. , Gibson F. M. , Lowry K. G.
Published: January 2009

Heart rate and arterial pressure changes induced by tracheal intubation, 3 min after administration of atracurium, vecuronium, tubocurarine, pancuronium or alcuronium, have been studied under thiopcntonenitrous oxide‐oxygen anaesthesia supplemented by either 0.5% halothane or fentanyl 2 μg kg‐1. Pancuronium and alcuronium were associated with the greatest increase in heart rate and tubocurarine with the greatest decrease in arterial pressure prior to intubation. Following intubation, all groups, with the exception of tubocurarine showed a similar and significant rise in heart and arterial pressure when compared with control values. The cardiovascular response to intubation, particularly the effect on heart rate, was less marked when fentanyl was given at induction and was short lived with atracurium and vecuronium. Although those patients who received tubocurarine showed no significant rise in arterial pressure following tracheal intubation, this was due to significant hypotension occurring in this group prior to intubation.
Bronchospasm during anaesthesia. A computer‐aided incidence study of 136 929 patients
Authors: Olsson G. L.
Published: January 2009

With the aid of a computer‐based anaesthetic record‐keeping system, anaesthetics complicated by bronchospasm during anaesthesia at the Karolinska Hospital were retrieved. The incidence of bronchospasm was calculated in groups characterized by various variables. In total, 246 cases of bronchospasm in 156 064 anaesthetics were retrieved. This corresponds to one case in 634 anaesthetics or 1.7 per 1000 patients. High incidence figures were seen in the age group 0–9 years (4.0/1000) when the patients showed a respiratory infection (41.1/1000), a pathological preoperative ECG (24.3/1000), an obstructive lung disease [21.9/1000). were classified as belonging to ASA class III (23.8/1000), if a tracheal intubation was performed (9.1/1000) or a rectal anaesthesia (35.7/1000) was given. In the age group 50–69 years (1.8/1000), high incidence figures were seen when there was an airway obstruction (8.8/1000), an obstructive lung discase (7.7/1000), a previous myocardial infarction (5.4/1000), a bronchoscopy (7.6/1000) or a mediastinoscopy (7.8/1000) was performed. Most of the cases had no history of allergy or asthma recorded in the anaesthetic form. In this series the triggering factor more often seemed to be of mechanical origin. There were no intraoperative deaths.
Effects of dobutamine on haemodynamics and renal function in patients after major vascular surgery
Authors: Westman L. , Järnberg P.‐O.
Published: January 2009

Eight mechanically ventilated patients were studied, before and during a dobutamine infusion the day after major vascular surgery. During infusion of three different doses of dobutamine (2.5, 5. 10 μg/kg/min) increases were found in heart rate of 13%, 21% and 47%, systolic blood pressure of 17%, 27%, and 35%, and cardiac output of 11%, 22% and 45%, respectively. Right atrial pressure decreased by 20%, at the highest dosage. Pulmonary arterial pressure and pulmonary capillary wedge pressure remained unchanged. There were no changes in plasma catecholamine concentrations and plasma renin activity. Fractional potassium excretion decreased by 23%, 33%, and 43%, respectively, at the three dosages, while renal blood flow, glomerular filtration rate. urine flow, fractional sodium, chloride, osmolar and free water clearances were unchanged.
Hormonal and metabolic responses to cardiac surgery with sufentanil‐oxygen anaesthesia
Authors: Lacoumenta S. , Yeo T. H. , Paterson J. L. , Burrin J. M. , Hall G. M.
Published: January 2009

The effects of sufentanil, 10 and 20 μg kg‐1 on the hormonal and metabolic responses to coronary artery surgery were compared in 20 patients. The most important finding was that the changes in circulating β‐ endorphin, ACTH, cortisol, GH, glucose, lactate and glycerol concentrations during and after cardiac surgery were similar with both doses of sufentanil. Although sufentanil prevented a significant increase in plasma β‐endorphin, ACIH and cortisol values until 6 h after cardiopulmonary bypass (CPB), a significant increase in GH secretion occurred with the onset of CPB. Plasma insulin concentrations declined significantly after 30 min CPB, but recovered after 60 min CPB with the restoration of normothermia. Blood glucose values did not change during surgery before CPB, but started to rise with the onset of CPB and continued to increase significantly in the postoperative period. Changes in blood lactate and plasma glycerol concentrations primarily reflected the load of CPB and the effects of heparin, respectively. The results show that increasing the dose of sufentanil up to 20 μg kg‐1 does not result in better suppression of the endocrine and metabolic changes associated with cardiac surgery.
Carbon dioxide tensions in infants during mask anaesthesia with spontaneous ventilation
Authors: Larsson L. E. , Andréasson S. , Ekström‐Jodal B. , Nilsson K.
Published: January 2009

Carbon dioxide tensions (PCO2) in arterialized capillary blood samples were measured in 39 infants anaesthetized for minor paediatric surgery. Anaesthesia was induced and maintained with oxygen, nitrous oxide and halothane, using a Mapleson‐D system with spontaneous ventilation and a Rendell‐Baker face mask. The duration of anaesthesia was between 15 and 95 min. Two capillary blood samples were obtained during stable anaesthesia before and after surgery. The Pco2 values varied between 3.7 and 8.0 kPa. The highest values were found in infants aged 15–30 days, 6.6 ± 0.7 kPa (mean ± s.d.), compared to 5.9 ± 0.7 in infants aged 31–60 days, 5.6 ± 0.8 in infants aged 61–180 days and 5.5 ± 0.7 in infants aged 181–300 days. Comparison between measurements before and after surgery did not in any group indicate a progressive hypoventilation or a correlation between the length of the anaesthesia and the Pco2. It is concluded that anaesthesia with oxygen, nitrous oxide and halothane with spontaneous mask ventilation is a satisfactory method for minor procedures in infants over 1 month or age, while in younger infants controlled ventilation with intubation may be a safer choice of method.
Postoperative pain relief and bupivacaine plasma levels during continuous interscalene brachial plexus block
Authors: Tuominen M. , Pitkänen M. , Rosenberg P. H.
Published: January 2009

Interscalene brachial plexus block was performed on 40 patients for prophylactic pain relief after shoulder surgery. A dose of 1.25 mg/kg of 0.5%, bupivacaine was injected for the block (Group 1) and continued with an infusion of 0.25%, bupivacaine 0.25 mg/kg/h (Group 2). If the postoperative analgesia was insufficient, the patients received i.m. oxycodone 0.15 mg/kg. In Group 1, one patient managed without oxycodone supplementation during the 24‐h observation period compared with eight patients in Group 2 [P < 0.01). The rest of the patients received 3.8 ± 1.6 doses (Group 1) and 2.5 ± 1.2 doses (Group 2) of oxycodone (P < 0.05). At 30 min, the mean bupivacaine plasma concentration was 1.0 pg/ml in Group 1 and 0.9 pg/ ml in Group 2. The mean plasma level of bupivacaine increased from 0.7 μg/ml after 180 min to 1.1 μg/ml (P < 0.01) after 24 h of infusion, providing some evidence of accumulation during infusion. The dizziness and confusion experienced by three patients could be associated with the local anaesthetic, as they obtained relief after the infusion was stopped.
Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia
Authors: Valli H. , Rosenberg P. H. , Kytta J. , Nurminen M.
Published: January 2009

A hypertensive patient with left cardiac enlargement developed marked hypertension under general anaesthesia, during which time a tourniquet was applied around his thigh. When the tourniquet was released, severe hypotension ensued which responded to therapy. The patient, however, died 16 h later of a myocardial infarction. Because of this incident, the anaesthetic and haemodynamic data of 699 patients who underwent limb surgery with a pneumatic tourniquet inflated for at least an hour were retrospectively examined using multivariate analysis. A 30% increase in systolic and/or diastolic arterial blood pressure occurred in 27% of the total patient material and in 67%, of those who had had a general anaesthetic. There was a higher frequency of the occurrence of “tourniquet hypertension” with older age, longer operations and the operation site being the lower rather than the upper limb. Tourniquet hypertension rarely occurred in patients with spinal anaesthesia (2.7%) and brachial plexus blockade (2.5%), while those with intravenous regional anaesthesia had a higher incidence (19%) of hypertension.
Change in tracheal blood flow during endotracheal intubation
Authors: Joh S. , Matsuura H. , Kotani Y. , Sugiyama K. , Hirota Y. , Kiyomitsu Y. , Kubota Y.
Published: January 2009

Changes in blood flow in the tracheal mucosa of the dog caused by the pressure exerted by high‐volume, low‐pressure cuffs were measured with the hydrogen clearance method. Before inflating the cuffs, the blood flow of the tracheal mucosa was measured as a control for 12 h in order to confirm that the procedures of the hydrogen clearance method itself had little or no influence on the blood flow in the tracheal mucosa. After inflating the cuffs to create a tracheal wall pressure (TWP) of 1.3 kPa (10 mmHg), 2.6 kPa (20 mmHg), 3.9 kPa (30 mmHg) or 6.0 kPa (45 mmHg), local blood flows of tracheal mucosa (TBF) corresponding to each TWP were measured every hour for 12 h. No significant changes in blood flow were observed in the tracheal mucosa with the hydrogen clearance method before inflating the cuffs. In the groups with TWP of 1.3 and 2.6 kPa, the TBF rose 1 h after inflation of the cuffs, and then returned to the baseline values. In the group with TWP of 6.0 kPa, the TBF decreased markedly already 1 h after inflation of the cuffs, and continued to decrease severely thereafter. In the group with TWP of 3.9 kPa, the TBF followed an intermediate course between the groups with TWP of 2.6 kPa and 6.0 kPa. From the results of the present study, it was found that TBF was significantly impaired by a TWP of more than 3.9 kPa. Therefore, in prolonged intubation, TWP should be kept at or below 2.6 kPd.
Comparison between 0.5% bupivacaine with and without glucose in lumbar epidural block for knee surgery
Authors: Kyttä J.
Published: January 2009

A double‐blind study was performed in 41 patients (ASA I) to compare 0.5% bupivacaine with and without 8%, glucose in epidural analgesia. There was no difference in the onset, spread, duration or intensity of the epidural anaesthesias. The absorption of bupivacaine to circulation was similar in both groups. No major complications were noted and the anaesthesias were satisfactory for surgery in all patients.
Spinal block, after dantrolene pretreatment, for resection of a thigh muscle herniation in a young malignant hyperthermia susceptible man
Authors: Oikkonen M. , Rosenberg P. H. , Björkenheim J.‐M. , Paetau A. , Huopaniemi T.
Published: January 2009

We describe a young man who experienced malignant hyperpyrexia, probably triggered by suxamethonium and/or enflurane during his second operation for an epigastric hernia. His malignant hyperthermia susceptibility was later verified using the caffeine/halothane contracture test in vitro. Subsequently, a tumorous mass, consisting of herniated and hypertrophied muscle grew in his thigh, and was resected under spinal anaesthesia. Whereas dantrolene (2.5 mg/kg i.v.) pretreatment produced impaired swallowing, the subsequent high spinal block, in addition, resulted in laboured breathing. It is stressed that respiratory power should be monitored when patients pretreated with dantrolene are given spinal anaesthesia. The muscular symptoms and test results in the patient's relatives are also discussed.
A comparison between two emergency cricothyroidotomy instruments
Authors: Ravlo O. , Bach V. , Lybecker H. , Møller J. T. , Werner M. , Nielsen H. K.
Published: January 2009

As part of a training programme for younger doctors, two commercially available, emergency cricothyroidotomy sets were evaluated. Prior to the surgical procedure, half of the doctors in each group received an audiovisual lesson. In a simulated hut realistic emergency situation, involving autopsy material, cricothyroidotomy was performed utilizing either the “Nutrake” or the “Gentofte” system. The audiovisual lesson increased the speed and the success rate of the doctors performing this procedure as well as strengthening their confidence. Both systems allowed positive pressure ventilation. The participating doctors achieved a higher success rate at a faster speed with the “Nutrake” set.
A study of haemostasis following the use of high doses of hydroxyethyl starch 120 and dextran in major laparotomies
Authors: Halonen P. , Linko K. , Myllylä G.
Published: January 2009

The safety of plasma expanders, hydroxyethyl starch 120 and dextran 70, administered in the highest recommended doses (20 ml/kg) as adjuncts of component therapy of surgical blood loss was studied in patients undergoing major abdominal surgery and compared with a group receiving 4% albumin solution for initial haemodilution and whole blood for further blood loss replacement. Each group consisted of five patients in a relatively severe surgical, but good general condition including a normal haemostatic function and serum albumin level. The dilutional effect of the expanders on serum albumin and prothrombin‐proconvertin level was observed during the day of operation. On the first postoperative day these values were equally low in all groups. Platelet count and bleeding time remained on a safe level throughout the study in all groups. Partial thromboplastic time values were unchanged. The factor VIII procoagulant (C), related antigen (R:Ag, vWF:Ag) and ristocetin cofactor levels, which were high preoperatively due to the underlying disease, remained at a safe level throughout the study. The increase in factor VIII related antigen associated with the hypercoagulable state induced by the surgical trauma was prevented by the plasma expanders. We conclude that dextran and hydroxyethyl starch can be used safely in a dose of 20 ml/kg in component therapy of surgical blood loss, provided that haematocrit is kept at an acceptable level, attention is paid to the postoperative hypoproteinaemia, and the patient has a normal haemostatic function preoperatively.