bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular blocking drugs in children
Authors: Hiller A. , Klemola U. M. , Saarnivaara L.
Published: January 2009

In a double‐blind study, intubating conditions and haemodynamic responses were assessed in two age‐groups of 45 ASA I‐II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: aifentanil 20 μg · kg‐1 + lidocaine 1 mg · kg‐1 (AIRO + Lign); alfentanil 20 μg μ kg‐1 (Alf20); or alfentanil 40 μg · kg‐1 (Alf40), followed by propofol 3.5 mg · kg‐1 in the children aged 1–3 years and 3.0 mg · kg‐1 in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. In the younger age group the frequencies of good, moderate or impossible intubating conditions were 87, 13 and 0% in the Alf40, 40, 60 and 0% in the Alf20 (P < 0.05 compared to the Alf40 group) and 53, 47 and 0% in the Alf20 + Lign group. In the older age group the corresponding frequencies were 60, 33 and 7% in the Alf20 + Lign, 47, 53 and 0% in the Alf20 and 47, 40 and 13% in the Alf40 group. All the drugs prevented any increase in arterial pressure and heart rate after tracheal intubation. The QTc interval of the EGG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg · kg‐1 and alfentanil 40 μg · kg‐1 in the younger age group. In the other children good or moderate intubating conditions occurred in 87–100% after all the drugs used in the present study.
Comparison of cardiovascular changes during anaesthesia and recovery from propofol‐alfentanil‐nitrous oxide and thiopentone‐halothane‐nitrous oxide anaesthesia in children undergoing otolaryngological surgery
Authors: Hiller A.
Published: January 2009

Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam‐atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double‐blind. The children were divided into two age groups: 1–3 years and 4 years and older. Particular attention was paid to EGG changes during anaesthesia and to the rapidity of recovery. One minute after alfentanil 15 μg · kg‐1, the children in the propofol group received propofol 2.0–3.0 mg · kg‐1 followed by propofol infusion 15 mg · kg‐1 · h‐1. In addition, 0.1% suxamethonium 6 mg · kg‐1 · h‐1 was infused during operation. The other children received thiopentone 5–7 mg · kg‐1 followed by halothane (0.5–2%) immediately after endotracheal intubation. Junctional rhythm occurred in 5–35% of the children independent of anaesthesia method, and ventricular ectopic beats were seen in 20% of the older children during halothane anaesthesia. Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/ halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1–3 years and propofol/alfentanil anaesthesia for older children undergoing adenoidectomy and/or tonsillectomy.
Nausea: the most important factor determining length of stay after ambulatory anaesthesia. A comparative study of isoflurane and/or propofol techniques
Authors: Green G. , Jonsson L.
Published: January 2009

Speed of recovery and length of stay in hospital were studied in 95 ambulatory patients undergoing laparoscopy or arthroscopy. The patients were divided into three groups regarding maintenance of anaesthesia. Group A (n = 32) received isoflurane 0.7% end‐tidally, group B (n = 31) propofol infusion for 25 min and thereafter isoflurane, and group C (n = 32) received an infusion of propofol throughout the procedure. Recovery was assessed by a combination of the Maddox‐Wing, the Choice Reaction Time test and p‐deletion. The awakening period was somewhat shorter in group A, but psychomotor recovery was somewhat slower compared to groups B and C. The length of stay in hospital depended on whether the patient was nauseated or not. In group A, 44% suffered from nausea requiring medical intervention compared to 13% and 19% in groups B and C, respectively. The stay in hospital was 235 ± 90 min (mean ± standard deviation) in group A compared to 184 ± 56 min and 197 ± 55 min in groups B and C, respectively. The non‐nauseated patients in group A had a stay in hospital of 188 ± 55 min compared to 184 ± 52 and 184 ± 37 in the non‐nauseated patients in groups B and C, respectively. In total, the nauseated patients (n = 24) stayed 267 ± 95 min compared to 185 ± 47 min for the non‐nauseated patients (n = 71), P < 0.001. We found nausea to be the most important factor determining length of stay after ambulatory anaesthesia. Propofol in a dose higher than a normal induction dose decreases the incidence of nausea and thus the length of stay in hospital.
Comparison of acute central nervous system and cardiovascular toxicity of 2‐chloroprocaine and prilocaine in the rat
Authors: Rosenberg P. H. , Zou J. , Heavner J. E.
Published: January 2009

In this study, we compared the central nervous system and cardiovascular system toxicity of i.v. administered 0.5% 2‐chloroprocaine (N=10) and 0.5% prilocaine (N=10) in lightly anaesthetised rats. Arterial blood pressure, ECG and EEG were continuously recorded. Prilocaine produced the predetermined toxic end‐points (i.e. seizure activity on EEG, isoelectric EEG, cardiac arrhythmia on ECG, asystole on ECG) at significantly lower doses than 2‐chloroprocaine (P < 0.05). The mean dose of prilocaine producing asystole was 166 mg · kg‐1 (± 45 mg · kg‐1, s.d.) vs. 255 mg · kg‐1 (± 42 mg · kg‐1) for 2‐chloroprocaine (P < 0.01). The rate of decrease of mean arterial blood pressure during the infusion was significantly faster with prilocaine (P < 0.01). Typically, arrhythmias did not appear until just before asystole, suggesting that neither of the local anaesthetics possessed marker arrhythmogenic properties. It is concluded that prilocaine is slightly more toxic than 2‐chloroprocaine in the rat, but that both local anaesthetics have a wide margin of safety. Doses producing seizure activity on the EEG (prilocaine 53 mg · kg‐1 and 2‐chloroprocaine 70 mg · kg‐1, on average) are much higher than those used in clinical practice (usually < 10 mg · kg‐1).
Distribution of radioactive microspheres injected into the vertebral artery of the dog
Authors: Larsson L. E. , Westerlind A. , Ekström‐Jodal B. , Nilsson N. J.
Published: January 2009

The aim of the present study was to evaluate the use of the vertebral artery for cerebral blood flow studies. In eight dogs a small catheter was introduced into an unligated a. vertebralis sin. Radioactive microspheres (141Cerium) were injected and detected with a gamma camera. The microspheres were distributed to all parts of the brain. The concentrations were highest in the cerebellum, pons and medulla oblongata, while the total activity was greatest in the cerebrum because of its higher weight. The activity in the extracerebral tissues in the head was found to be less than 5% of the brain activity.
Epidural analgesia with 4 mg of morphine following caesarean section: effect of injected volume
Authors: Asantila R. , Eklund P. , Rosenberg P. H.
Published: January 2009

The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18–20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. Six patients in each group reported no pain during the 24‐h follow‐up period. No additional pain medication during the 24 h after surgery was required in 11, 14 and 10 patients in groups I, II and III, respectively. Most of the others managed with the addition of a single dose of rectal ketoprofen. There were no differences in analgesic therapy between the groups. Pruritus was the most common adverse effect (18/20, 19/20 and 18/20 in groups I, II and III, respectively). 10/20, 12/20 and 14/20 (N.S.) patients had nausea and vomiting in groups I, II and III, respectively. Metoclopramide, prescribed for persistent nausea, was given to 4/20 patients in group I, 6/20 patients in group II and 9/20 patients in group III (N.S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N.S.). In this study a tenfold dilution of 4 mg of morphine did not influence the quality of analgesia after caesarean section or cause statistically significant differences in the appearance of side‐effects.
Cold and warm infusion of Ringer's acetate in healthy volunteers: the effects on haemodynamic parameters, transcapillary fluid balance, diuresis and atrial peptides
Authors: Tølløfsrud S. , Bjerkelund C. E. , Kongsgaard U. , Hall C. , Noddeland H.
Published: January 2009

The effects of Ringer's acetate (RAc) infusion with different temperatures, 18d̀C compared to 36d̀C, were studied in 20 healthy volunteers. An infusion volume of 20% of the estimated extracellular volume was given over 45 min. Before and after the RAc infusion, interstitial colloid osmotic pressure and interstitial fluid hydrostatic pressure were measured on the lateral part of the thorax and in the lower leg. Blood sampling and pressure measurements were performed through a cannula placed in the left radial artery, and arterial oxygen saturation was measured by pulse oximetry. Atrial peptides ANF (99–126) and ANF (1–98) in plasma were measured as indicators of volume loading. Cold RAc infusion increased mean arterial pressure from 82 (s.d. ± 7) to 96 (s.d. ± 9) mmHg (10.9–12.8 kPa) at the end of the infusion with a simultaneous fall in heart rate. Warm RAc infusion gave no changes in blood pressure or heart rate. The arterial oxygen saturation during the infusion of cold RAc was higher than during warm RAc infusion. Cold infusion produced the expected haemodilution with a fall in erythrocyte volume fraction (EVF) from 0.39 (± 0.03) to 0.33 (± 0.03) and a fall in plasma colloid osmotic pressure (COPp) from 21.7 (± 1.1) mmHg to 15.0 (± 1.3) mmHg (2.9–2.0 kPa). Warm infusion induced a nearly identical haemodilution. Interstitial colloid osmotic pressure fell from 11.6 (± 2.3) mmHg to 8.9 (± 2.7) mmHg (1.5–1.2 kPa) after warm infusion while cold infusion gave no changes. The changes in interstitial fluid hydrostatic pressure were not significant. Cold infusion induced a higher diuresis compared to warm RAc infusion. ANF increased during cold, but not during warm infusion. We conclude that infusions of RAc at 18d̀C vs. 36d̀C have different volume effects. Cold infusion increased blood pressure and diuresis, while warm infusion induced peripheral vasodilation with increased capillary leakage and subcutaneous oedema formation.
Intrathecal injection of lysine acetylsalicylic acid in the rat: a neurotoxicological study
Authors: Svensson B. A. , Karlsten R. , Kristensen J. D. , Sottile A. , Bennett A. , Jr. T. Gordh
Published: January 2009

Lysine acetylsalicylic acid has been reported to induce analgesic effects in humans after intrathecal (i.t.) injection. Before conducting further studies in humans with this drug, it is important to evaluate potential toxicological effects on the spinal cord in animals. In the present study the effects of chronic intrathecal administration of provocative doses of lysine acetylsalicylic acid (L‐ASA) on the rat spinal cord were evaluated using light and electron microscopy and a quantitative morphometric method. We also investigated the effects of single doses of the drug on the spinal cord blood flow (SCBF) using the laser‐Doppler flowmetry technique. No histopathological changes or differences in number or density of neuronal cells could be seen after chronic administration of L‐ASA as compared to controls. The SCBF decreased immediately after i.t. injection of a large dose (4 mg) of L‐ASA and returned to predrug levels within 10 min. At the end of the experiment metabolic acidosis was detected, indicating a systemic effect of acetylsalicylic acid. It is concluded that no neurotoxic effects on the spinal cord were seen after chronic i.t. injection of L‐ASA. From a neurotoxicological point of view, our findings do not contraindicate the spinal use of L‐ASA in humans.
Incidence and aetiology of perioperative hypertension
Authors: LESLIE J. B.
Published: January 2009

The reported incidence of perioperative hypertension associated with coronary artery bypass–graft (CABG) surgery ranges from 30–80%, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. The majority of these studies indicate that perioperative hypertension is predictive of perioperative cardiac morbidity, but others do not confirm this finding, rendering the issue unresolved. The consequences of perioperative hypertensive episodes include bleeding from vascular suture lines, cerebrovascular haemorrhage or subendocardial ischaemia, and are associated with a mortality rate that may approach 50%. Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiologies.
Therapies for perioperative hypertension: pharmacodynamic considerations
Authors: LEVI R.
Published: January 2009

Cardiac output (CO) and peripheral resistance (PR), the two major determinants of systemic arterial blood pressure (BP), are regulated principally by the adrenergic (ADR) and renin–angiotensin–aldosterone (RAA) systems. Antihypertensive medications ultimately decrease CO, PR, or both, by acting at various sites in the ADR and RAA pathways or affecting cardiovascular functions directly. Beta–ADR–receptor blockers decrease heart rate (HR) and stroke volume (SV) by preventing the cardiostimulating effects of catecholamines and inhibiting renin release. Alpha–ADR–receptor blockers prevent the vasoconstricting effects of catecholamines and reduce PR (afterload). Angiotensin–converting enzyme inhibitors (ACEI) block the formation of angiotensin, a potent peripheral vasoconstrictor and aldosterone releaser. Hence, ACEI cause a decrease in both PR and CO, the latter by preventing salt and water retention by aldosterone, thereby reducing plasma volume and venous return. Direct vasorelaxation and, thus, a fall in PR can be achieved by vasodilators. These include drugs (e.g. calcium antagonists) that prevent the entry of calcium ions into vascular smooth muscle cells, and others (e.g. nitrovasodilators) that boost the intracellular levels of vasodilating second messengers (e.g. cyclic GMP). Antihypertensives from different classes are often combined to improve the ratio between therapeutic and adverseeffects.
The ideal agent for perioperative hypertension and potential cytoprotective effects
Authors: LEVY J. H.
Published: January 2009

Perioperative hypertension is primarily due to increased systemic vascular resistance (SVR). Therefore, the major therapeutic approaches are directed at reducing vasoconstriction, using drugs that increase cyclic nucleotides or block calcium entry into vascular smooth muscle. Nitroprusside and other nitric oxide–derived vasodilators affect both the resistance vessels and the vascular capacitance bed. Antihypertensive drugs that affect venous return can have unpredictable effects on blood pressure and calculated SVR. The new intravenous dihydropyridine calcium antagonists have arterial vasodilating actions and are especially promising as new therapeutic approaches for perioperative hypertension. Following coronary bypass–grafting, patients have undergone direct mechanical manipulation of their native grafts, coronary arteries, and internal mammary artery, creating a potential risk for coronary or internal mammary spasm. Calcium antagonists may be an important therapy for perioperative hypertension in such patients. Experimental models have demonstrated that calcium antagonists can attenuate the production of inflammatory mediators and thereby reduce cellular damage following reperfusion. These potential anti–inflammatory drugs may prove to offer additional benefits in the therapy of perioperative hypertension. The potential anti–inflammatory and cytoprotective effects of calcium antagonists may make them the ideal agents for the treatment of acute perioperative hypertension.
Role of isradipine and other antihypertensive agents in the treatment of peri– and postoperative hypertension
Authors: MARTY J.
Published: January 2009

The traditional therapy of perioperative hypertension is now being challenged by the availability of new agents. Vasodilator therapy should be the first–line choice, although dihydropyridine calcium antagonists, particularly isradipine, appear to be suitable in this setting because of their pharmacological properties. Because of its ultrashort half–life, sodium nitroprusside has to be administered by continuous infusion, even for the treatment of an acute elevation of blood pressure. This is not the case with the new agents that have longer durations of action. A bolus administration is sufficient for the correction of most elevations of arterial pressure that are due to transient adrenergic activation. Continuous infusion is required only in patients who have sustained increases of systemic vascular resistance; these are usually patients who are already hypertensive.
Effects of propofol on the human heart electrical system: a transesophageal pacing electrophysiologic study
Authors: ROMANO R. , CICCAGLIONI A. , FATTORINI F. , QUAGLIONE R. , FAVARO R. , ARCIONI R. , CONTI G. , GASPARETTO A.
Published: January 2009

Previous studies have shown that infusion of propofol has sometimes been associated with bradyarrhythmias. To evaluate the effects of propofol on the electrical system of the heart, we carried out an electrophysiologic study with transesophageal pacing on ten healthy subjects scheduled for minor elective maxillo–facial surgery. By means of atrial pacing conducted by a progressive increase in stimulation cycles, we determined, in awake patients and during propofol anesthesia (2.5 mg kg‐1 for induction, followed by 100 μg kg‐1 min‐1 for maintenance), the correct sinus recovery time and the eventual appearance of Wenckebach atrio–ventricular block. We did not notice sinoatrial node depression or pathologic increase in the atrio–ventricular conduction.
Postoperative nausea and vomiting. A comparison between intravenous and inhalation anaesthesia in breast surgery
Authors: ODDBY–MUHRBECK E. , JAKOBSSON J. , ANDERSSON L. , ASKERGREN J.
Published: January 2009

Nausea and vomiting during the first 24 postoperative hours after breast surgery were studied. Ninety patients scheduled for elective breast surgery were randomly assigned to one of three anaesthetic methods: total intravenous anaesthesia with propofol, or propofol or thiopental for induction followed by isoflurane anaesthesia. All three groups received fentanyl for peroperative analgesia. A total of 46 (51%) patients experienced emetic sequelae: 19 (21%) complained about nausea and another 27 (30%) vomited once or more during the postoperative course. More than 50% of the patients with nausea and 70% with vomiting first suffered from these symptoms in the surgical wards after leaving the postoperative unit. Nausea and vomiting were seen in 18 (60%), 13 (43%) and 15 (50%) for the groups propofol–propofol, propofol–isoflurane and thiopental–isoflurane, respectively. In conclusion, every second patient experienced nausea or vomiting after breast surgery, the majority of these emetic symptoms occurring after leaving the postoperative unit. Propofol for induction or as a main anaesthetic did not make any major difference with regard to postoperative nausea or vomiting.
Aerosolized surfactant reverses respiratory failure in lung–lavaged rats
Authors: Li W‐Z. , CHEN W‐M. , KOBAYASHI T.
Published: January 2009

The effects of surfactant replacement by aerosol inhalation and by bolus instillation were compared in rats with respiratory failure induced by repeated lung lavage. The rats were anesthetized with pentobarbital sodium and mechanically ventilated with 100% oxygen. The Pao2 of control rats not given surfactant (n = 9) remained below 13 kPa. A bolus instillation of a modified natural surfactant (75 mg kg‐1 b.w. in 1.5 ml–kg‐1 b.w. saline) into the airways rapidly reversed the respiratory failure; the mean Pao2 value (n = 9) 15–180 min after instillation remained over 50 kPa (P < 0.05 vs. controls). Inhalation of the aerosolized surfactant for 60 min through an ultrasonic nebulizer delivering 75 mg kg‐1 b.w. of the surfactant into the lungs gradually reversed the respiratory failure. The mean Pao2 value (n = 9) 15 min after initiation of inhalation was 19.6 kPa (NS vs. controls), but after 60 min it rose to above 43 kPa (P < 0.05 vs. controls; NS vs. bolus instillation). Treatment with surfactant either by continuous aerosol or by bolus led to significant increases of over 24% in the dynamic lung–thorax compliance. We conclude that aerosolized surfactant reverses respiratory failure induced by lung lavage, although the response is slower than after bolus instillation.
Interactive cardiovascular effects between isoflurane and peroperative events
Authors: RANER C
Published: January 2009

Abstract. The objective of this five–part (IV) study was to evaluate cardiovascular interactions between isoflurane and some pathophysiological and pharmacological interventions, likely to occur peroperatively. Specific aims were to investigate:

Interactive responses between hemorrhage–induced hypovolemia and isoflurane in the intestinal circulations.

Interactive response between regional hypothermia (28°C) and isoflurane in the intestinal circulation.

Interactive responses between amrinone and isoflurane in the intestinal and renal circulations.

Modulation by dopamine of the cardiovascular responses to isoflurane.

Modulation by dopamine of the cardiovascular responses to thoracic epidural blockade concurrent with isoflurane administration

Intestinal (I–III) and renal (III) blood circulations were studied by optic flowmetry in cat models, with regional perfusion pressures controlled either by an extracorporeal pumpassisted circuit (I, II) or by adjustable abdominal aortic occlusion (III). Central hemodynamics were assessed in cat and dog models (III–V).

Isoflurane was found to depress cardiac function in a doserelated fashion. In the regional circulation, isoflurane dose dependently produced vasodilation in the small intestine and in the kidney. The net response from these cardiac and vascular effects of isoflurane was a decrease in arterial pressure. In the small intestine, reflex vasoconstriction, induced by hemorrhage, was overruled by the vasodilator effects of isoflurane. Regional hypothermia in the small intestine attenuated the local vasodilator effects of isoflurane. The phosphor diesterase III inhibitor amrinone induced intestinal and renal responses, which added to the vasodilations induced by a moderate dose of isoflurane. The depressor effect of isoflurane could effectively be controlled by exogenous dopamine through counter–directed actions on cardiac function and through increased systemic vascular tone. The combination of isoflurane and thoracic epidural blockade was associated with depressed cardiac function. Exogenous dopamine effectively countered such actions and, in this situation, increased vascular tone to a greater extent than in control situations.
Cardiovascular depression by isoflurane and concomitant thoracic epidural anesthesia is reversed by dopamine
Authors: RANER C. , BIBER B. , LUNDBERG J. , MARTNER J. , WINSÖ O.
Published: January 2009

Interactive effects between exogenous dopamine (DA) and isoflurane (I) combined with thoracic epidural blockade (TEA) were studied in dogs during chloralose anesthesia. The I–TEA intervention per se decreased heart rate (HR; 28%), mean arterial pressure (MAP; 63%), cardiac output (CO; 54%), left ventricular dP/ dt (LVdP/dt; 75%) and LVdP/dt/systolic arterial pressure (SAP; 42%). Prior to the I–TEA intervention, dopamine increased MAP, CO, LVdP/dt, LVdP/dt/SAP and stroke volume (SV) already at the dose 10 μg–kg‐1. min‐1 and, additionally, increased mean pulmonary artery pressure (MPAP) at the dose 20 μg–kg‐1. min‐1. During the I–TEA intervention, the DA–induced increases in MAP and systemic vascular resistance (SVR) were significantly higher than prior to I–TEA, as indicated by significant ANOVA interactive effects. At the dose 10 μg–kg‐1 min‐1, DA restored MAP, CO, LVdP/dt, LVdP/dt/SAP and SV to levels found before the I–TEA intervention, while HR was restored first at the dose 20 μg–kg‐1 –min‐1. At the dose 20 μg–kg‐1–min‐1, DA also increased MAP (39%), LVdP/dt (119%), LVdP/dt/SAP (73%), SVR (28%) and MPAP (70%) above levels prior to I–TEA. To conclude, exogenous dopamine effectively and dose–dependently counters cardiovascular depression induced by the anesthetic technique of combining I and TEA. The pressor and systemic vasoconstrictor actions of dopamine are potentiated by conjoint administration of I and TEA.
Prolongation of the QT–interval during induction of anesthesia in patients with coronary artery disease
Authors: LISCHKE V. , WILKE H.–J. , PROBST S. , BEHNE M. , KESSLER P.
Published: January 2009

During induction of anesthesia in 60 patients undergoing coronary artery bypass grafting (CABG), we measured the QT–interval (QTI) in the ECG, heart rate (HR) and mean arterial pressure (MAP). Based on the HR, we corrected the QT–interval (QTcI). Prior to induction, six patients(10%) already had abnormal prolongation of QTcI (≥440 ms). After injection of fentanyl and vecuronium, the QTcI increased significantly (P<0.01); to a far lesser extent after injection of hypnotics (i.e. etomidate, midazolam or propofol). Orotracheal intubation caused significant shortening of QTCI (P < 0.01). HR decreased markedly after injection of fentanyl. MAP decreased, however, only after injection of hypnotics. In the immediate post intubation period, HR and MAP increased significantly. The various hypnotics produced no significant difference in HR and QTcI at any measurement point. MAP changed only after injection of hypnotics. The decrease of HR and MAP during induction of anesthesia is thought to result from a corresponding reduction of adrenosympathetic stimulation. We believe that QTcI is similarly influenced.
Effects of inhalation anesthetics on myocardial and hepatic energy metabolism in normotensive and spontaneously hypertensive rats subjected to hemorrhage
Authors: KASHIMOTO S. , NONAKA A. , YAMAGUCHI T. , NAKAMURA T. , KUMAZAWA T.
Published: January 2009

Forty spontaneously hypertensive rats (SHRs) and forty normotensive Wistar–ST rats (NRs) were used to assess the influence of anesthetics on myocardial and hepatic energy metabolism after hemorrhage. They were divided into five pairs of groups: a control group (pentobarbital 6 mg– 100 g BW‐1p), and four others which received 1.2% halothane, 2.2% enflurane, 1.4% isoflurane, and 3.3% sevoflurane, respectively. Following a 10 min stabilization period, blood (2 ml. 100 g BW‐1′) was gradually withdrawn over a 5 min period from a femoral artery. Thirty min after the induction of hemorrhage, the heart and liver were removed and myocardial and hepatic metabolites (ATP, lactate, pyruvate and glycogen) were measured by enzymatic methods. There were no significant differences in myocardial metabolites among either the anesthetic groups or between SHRs and NRs. However, hepatic ATP levels in all SHR groups were significantly lower than those in NR groups. Moreover, ATP levels in the inhalation anesthetic groups of SHRs were significantly higher than that in the control group of SHRs. All inhalation anesthetics, especially isoflurane, may reduce metabolic deterioration of the liver during hemorrhage when compared to barbiturate anesthesia.
Mild hypothermia during isoflurane anesthesia decreases resistance to E. coli dermal infection in guinea pigs
Authors: SHEFFIELD CLARK W. , SESSLER DANIEL I. , HUNT THOMAS K.
Published: January 2009

Small changes in core temperature profoundly alter cutaneous blood flow, a major factor influencing resistance to wound infection. Furthermore, when measured in vitro, various immune functions are temperature dependent in the physiological range. Accordingly, we tested the hypothesis that mild hypothermia impairs and mild hyperthermia improves resistance to dermal infections. Thirty–two guinea pigs were anesthetized for 6 h using 1.5% (1.25 MAC) inspired isoflurane. Their core temperatures were maintained at either 39˚C (normal for guinea pigs, n= 11), 36˚C (n = 12), or 41˚C (n = 9). One h after induction of anesthesia, 2times108 E.coli were injected intradermally with a 26–g needle at eight sites on each animal's back. Core temperatures were not controlled after recovery from anesthesia, and animals in each group were maintained in the same environment. Twenty–four h after injection, the area of induration surrounding each injection site was measured. This is a standard test of resistance to wound infection. Values were compared using one–way ANOVA and Scheffe's S tests. Results are presented as means ± standard deviations; differences were considered significant when P < 0.05. Areas of inflammation on the hypothermic animals were significantly larger (48± 10 mm2) than those on normothermic (36± 10 mm2) or hyperthermic (37 ± 6 mm2) animals. These data suggest that mild hypothermia during anesthesia significantly impairs resistance to dermal infection. In contrast, mild hyperthermia does not appear to be protective.
Somatosensory evoked potentials during isoflurane anaesthesia
Authors: PORKKALA T. , JÄNTTI V. , KAUKINEN S. , HÄKKINEN V.
Published: January 2009

Short latency somatosensory evoked potentials (SEPs) to median nerve stimulation during isoflurane anaesthesia were recorded in 12 elective–surgery patients. The effect of isoflurane on the shape, amplitude and latency of SEPs was evaluated. SEPs were recorded at awake, 1 MAC, 1.5 MAC, at electroencephalogram (EEG) burst suppression and at continuous suppression levels. Finally, SEPs were recorded when anaesthesia was lightened back to 1 MAC. The peak latency and amplitude of the first cortical N20 wave were measured. The latencies increased with increasing isoflurane concentrations. At high concentrations only an almost monophasic N20 wave was recorded, reduced in shape and amplitude. No specific changes could be correlated with the burst suppression or suppression patterns. This suggests that EEG and SEP generators are differently affected with increasing isoflurane concentration. The results indicate that SEPs can also be recorded in drug–induced EEG suppression.
Melperon premedication for cataract surgery
Authors: OlKKONEN M.
Published: January 2009

Given as a peroral premedicant for geriatric patients having cataract surgery under regional block, a butyrophenone neuroleptic melperon (15–30 mg, n = 50) ranked equally with diazepam (4–10 mg, n = 50), assessed using a qualitative subjective estimation of the patients' anxiety. The patients treated with melperon needed significantly fewer supplementations with intravenous drugs, to withstand the surgery, compared to those medicated with diazepam. Melperon is a compatible alternative, but its possible propensity to cause occasional arterial hypotension must be noticed.
Dixyrazine premedication for cataract surgery. A comparison with diazepam
Authors: OIKKONEN M. , HEINE H. , SALMINEN U. , ROMPPANEN O. , INBERG P.
Published: January 2009

Peroral dixyrazine (15–30 mg, n = 50) and diazepam (4–10 mg, n = 50) were used as premedicants for geriatric patients having cataract surgery under regional block. Compared to the diazepam patients, a larger number of the dixyrazine medicated patients appeared anxious, and there was a statistically significant difference between the groups, when summing up changes in anxiety throughout the study period. The dixyrazine patients needed more frequent supplementation with intravenous sedative drugs, compared with their diazepam counterparts. Peroral dixyrazine is an applicable choice for calm patients, when only slight sedation, or avoidance of somnolence are required.
Postoperative pain treatment after cholecystectomy with epidural sufentanil at lumbar or thoracic level
Authors: VERBORGH C. , CLAEYS M. , VANLERSBERGHE C. , CAMU F.
Published: January 2009

The difference in analgesic activity following lumbar (group I) or thoracic (group II) epidural administration of 50 ug sufentanil was studied after cholecystectomy. Fifteen patients in each group were evaluated for pain relief using a linear analog scale (LAS), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume (FEV,) and arterial CO2 tension (Paco2). In five additional patients in each group 75 μg sufentanil was injected for determination of serum levels. Pain scores were lower than three in both groups after 10 min, while mean pain scores remained below one from 20 min until 2 h following injection in both groups. Satisfactory pain relief lasted for 4 h. RR was significantly decreased from two until 360 min. in the lumbar group and from five until 120 min in the thoracic group. Paco2 was raised in both groups only during the first hour. PEF and FVC were significantly improved compared to control 1, 2 and 4 h following injection. Serum sufentanil levels reached a maximum of 0.299 ±0.052 ng.ml‐1 in the lumbar group and 0.377 ± 0.076 ng–ml‐1 in the thoracic group after 5 min. There were no significant differences between the two groups in the variables studied.
Intramuscular dexmedetomidine premedication—an alternative to midazolam‐fentanyl‐combination in elective hysterectomy?
Authors: JAAKOLA M.‐L. , KANTO J. , SCHEININ H. , KALLIO A.
Published: January 2009

Sedation, anxiolysis, intubation responses and fentanyl anaesthetic requirements were investigated in a double‐blind, randomized study in twenty ASA I‐II elective hysterectomy patients. Ten patients received dexmedetomidine 2.5 μg kg‐1 i.m. 60 min before induction and saline placebo i.v. 2 min prior to induction (= DP group). Ten patients received midazolam 0.08 mg kg‐1 i.m. 60 min and fentanyl 1.5 μg kg‐1 i.v. (= MF group) 2 min before induction of anaesthesia with thiopentone 4 mg kg‐1. Anaesthesia was maintained with 70% nitrous oxide in oxygen and with fentanyl 2 μg kg‐1 i.v. increments according to predetermined criteria. Both premedications induced sedation (P < 0.01 in both groups) and anxiolysis (P < 0.01 in DP vs <0.05 in MF group) without any differences between the groups. Haemodynamic changes following tracheal intubation did not significantly differ between the groups. Intraoperatively systolic and diastolic arterial pressure were 15% and 13% lower in DP group (P < 0.01 and P < 0.05 for drug effect), the mean heart rate was approximately 9 beats min‐1 lower in DP group (n.s.). Fentanyl was required more often in MF group: median 3.5 (QD 1.5) vs. 2.5 (QD 0.5) times in DP group (P < 0.05), the total amount being 57% smaller in DP group: 0.03 (QD 0.01) vs. 0.07 (QD 0.02) μg kg‐1 min‐1 (P < 0.05). Postoperative course and analgesic requirements were similar in both groups. Dexmedetomidine premedication may offer an alternative to current anaesthesia practice in elective hysterectomy.
Nasal midazolam and ketamine for paediatric sedation during computerised tomography
Authors: LOUON A. , REDDY V. G.
Published: January 2009

We have studied the sedation achieved with a mixture of midazolam (0.56 mg–kg‐1) and ketamine (5 mg kg‐1) administered nasally in 30 children weighing less than 16 kg undergoing computerised tomography. Assessment was two fold using a visual analogue scale; the radiologist/radiographer rated the exam from “failed examination” to “perfect working conditions” while the anesthetist's assessment ranged from “poor sedation” to “perfect sedation with clinical well being”. This new method proved to be effective alone in 83% of the cases and there were no complications. The rapid onset obtained after intranasal midazolam and ketamine offers advantages over orally or rectally administered drugs. The absence of respiratory depression and oxygen desaturation suggests that this technique is safe and efficient in the CT room with its particular working conditions.
Preoperative infiltration of the surgical area enhances postoperative analgesia of a combined low–dose epidural bupivacaine and morphine regimen after upper abdominal surgery
Authors: BARTHOLDY J. , SPERLING K. , IBSEN M. , ELIASEN K. , MOGENSEN T.
Published: January 2009

In a randomized, blinded trial we assessed the value of adding preoperative infiltration of the surgical area with bupivacaine to a low dose epidural regimen for postoperative pain treatment. Forty–nine patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anaesthesia were studied. Postoperative analgesia was epidural bupivacaine 10 mg hr‐1 + morphine 0.2 mg hr‐1 for 72 h. The patients randomly received preoperative infiltration of the surgical area with bupivacaine 0.25%, 40 ml (group I); or no infiltration (group II). Pain was evaluated at rest, during cough and during mobilization six and eight h after start of surgery, and at 8 a.m. and 4 p.m. on the following days until 72 h after start of surgery. The sensory level of analgesia was evaluated by pin prick. We found no difference between the two groups during rest and cough. However, during mobilization group I had lower pain scores compared to group II (P < 0.05). There was a significant reduction in the need for supplemental intramuscular morphine in the treatment group compared to the control group (P <0.05). Thus an enhanced analgesic effect was demonstrated by adding preoperative infiltration of the surgical area with local anaesthetic to a low dose epidural bupivacaine/morphine regimen after upper abdominal surgery.
Cardiovascular effects and influence on blood gases
Authors: KIKUTA Y. , SERINE A. , TEZUKA S. , OKADA K. , YAMAURA T. , NAKAJIMA H.
Published: January 2009

Diadenosine tetraphosphate (AP4A) has a considerable vasodilating effect. Its dose was adjusted to decrease mean arterial pressure (MAP) by 20%, 40%, 50%, 60%, and 80% of the pretreatment value, and the effects on hemodynamics and gas exchange were evaluated. AP4A produced a dose–dependent decrease in MAP within the range of doses which decreased blood pressure by up to 60%. Heart rate remained constant at hypotension levels of 40% or less, but decreased significantly at hypotension levels of 50% or more. Cardiac output increased significantly at hypotension levels of 40% or less. Systemic vascular resistance (SVR) showed a significant decrease at that time. No significant changes were observed in central venous pressure and pulmonary capillary wedge pressure at any level of hypotension. Arterial oxygen tension and calculated pulmonary shunt ratio showed no change. Base excess and pH were decreased significantly with a 60% or 80% fall of blood pressure. In conclusion, APtA seems to act on the resistance vessels and cause a decrease in SVR.
The Bullard laryngoscope
Authors: MIDTTUN M. , HANSEN C.LÆERKHOLM , JENSEN K. , PEDERSEN T.
Published: January 2009

The Bullard laryngoscope is a new combination of a fibreoptic light source and an anatomically shaped rigid blade, to aid visualization of the larynx. We present two patients with expected severe difficult endotracheal intubation and describe their anaesthetic management. Our experience confirms previous observations which showed that the Bullard laryngoscope provides an excellent view of the vocal cords in patients with severe difficult airways.
Haematological effects of postoperative autotransfusion in spinal surgery
Authors: Riou B. , AROCK M. , GUERRERO M. , RAMOS M. , THOREUX P. , GUILLOSSON J. J. , ROY–CAMILLE R. , VIARS P.
Published: January 2009

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus® system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion. After a 5–h postoperative collection period, analysis of the shed blood showed a haematocrit of 0.26± 0.11, few platelets (80 ± 63 10g1‐1), a fibronogen level of less than 0.1 gl‐1 and a high level of D‐dimers. The salvaged blood did not clot and aerobic and anaerobic culture produced no growth. The volume of blood collected was greater than 200 ml in 21 patients in the Solcotrans group who were autotransfused (384 ± 101 ml, range 200–600 ml), and in 16 patients in the Control group. Within 15 min following completion of reinfusion of the salvaged blood there was a significant, but moderate decrease in platelet count (181 ± 74 vs 223 ± 90 108 1‐1, P <0.001) and fibrinogen concentrations (2.1 ± 0.8 vs 2.3 ± 0.9 g 1‐1, P < 0.02), and an increase in circulating D–dimers (P < 0.001) and plasma free haemoglobin concentrations (236 ± 155 vs 82 ± 79 mg l‐1, P < 0.001). Prothrombin time (PT) and activated partial thromboplastin time (APTT) did not increase, and potassium concentrations were not significantly affected. Because the haematocrit of shed blood was lower than that in the patients' systemic blood, there was no significant increase in haematocrit following reinfusion. Cultures of systemic blood following reinfusion yielded no bacterial growth. No side–effects were observed. There were no significant differences in the haematological parameters (haematocrit, platelet count, free haemoglobin, APTT, PT, fibrinogen, D–dimers) between the two groups at the eighth (3 h after reinfusion) and the 24th postoperative h. No predictive factor of the volume of blood collected during the postoperative period could be identified. Postoperative autotransfusion induced no clinically relevant haematological effects after spinal surgery. However, since important haematological modification were found in the shed blood, further studies are required to determine the maximum amount of shed blood that can be safely transfused during the postoperative period.
Diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization
Authors: GRACE D. , MILLIGAN K. R. , LOUGHRAN P. G. , MCCAUGHEY W.
Published: January 2009

The effectiveness of an anaesthetic technique employing diclofenac sodium as an analgesic given preoperativey by intramuscular injection was compared against one employing intravenous fentanyl in patients undergoing laparoscopic sterilization. Postoperative pain was marked and both drugs provided partial relief only. Patients in the diclofenac group had pain scores that were initially higher than those in the fentanyl group and the difference between the groups was statistically significant (P < 0.02). Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 min than comparable patients in the fentanyl group (P < 0.03). These findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. Investigation of a combined analgesic technique employing morphine and a non–steroidal anti–inflammatory drug is warranted.
The cardiovascular changes associated with equipotent anaesthesia with either propofol or isoflurane
Authors: BOYD O. , MURDOCH L. J. , MACKAY C. J. , BENNETT E. D. , GROUNDS R. M.
Published: January 2009

The differences in effects of anaesthetic agents on right ventricular function have not been studied. We have developed a cross–over study design to compare the effects of propofol and isoflurane on cardiac and specifically right ventricular function. Ten patients were anaesthetised with equivalent MAC of isoflurane to MIR of propofol. After measurements had been taken on the randomly assigned first agent the patients were crossed over to the other agent and measurements were repeated. Cardiac function was assessed using a pulmonary artery catheter with a fast response thermistor. There were no differences in heart rate or blood pressure between the two agents suggesting that equivalent anaesthetic doses had been given. There were significantly (P < 0.05) higher cardiac output (4.0 to 4.5 1 min‐1), right ventricular ejection fraction (35.1 to 39.4%), stroke volume (35.4 to 39.6 ml) and right ventricular end–diastolic volume index (102 to 110 ml m2–1) with propofol compared to isoflurane. We conclude that propofol results in improved right ventricular performance compared to isoflurane. We have also shown that anaesthetic agents can be compared using a cross–over study design, and have demonstrated that MAC of isoflurane and MIR of propofol can be directly compared. We suggest that propofol may be a more suitable agent than isoflurane for anaesthesia in patients who may already have impaired right ventricular function and in whom maintaining high cardiac output may be beneficial.
Moderate induced hypotension provides satisfactory operating conditions in maxillofacial surgery
Authors: SCHINDLER I. , ANDEL H. , LEBER J. , KIMLA T.
Published: January 2009

Patients scheduled for maxillofacial surgery were randomly assigned to receive isoflurane (n = 22) or nitroglycerin (n = 18) in order to induce hypotension. Surgeons, blinded for the actual level of blood pressure and the technique used for inducing hypotension, were asked to rate operating conditions on a scale from 1 to 5. Systolic arterial pressure (SAP) and mean arterial pressure (MAP) were reduced by 26% for both groups. Although blood pressure levels showed little variation throughout the induced hypotension period, scores of 2 to 5 were given significantly more often at incision and at 30 min compared to the following measuring points (P < 0.01). In total, the surgical field was rated significantly more often with a score of 1 and 2 than with a score of 3 to 5 (P<0.01). A relation between score and SAP and/or MAP could not be found. There was also no relation between scores and the technique used for hypotension. Our data suggest that, with the exception of the first half hour of surgery, on average a SAP of 89 mmHg and a MAP of 65 mmHg were sufficient to produce satisfactory operating conditions.