bluuebunny/crossref_metadata_2025 huggingface dataset:
How are haemodynamic and metabolic responses to haemorrhage influenced by segmental thoracic and thoracolumbar epidural analgesia? An experimental study in dogs
Authors: Yoshikawa G. , Agune T. , Takasaki M.
Published: January 2009

To determine the effects of the spread of sympathetic blockade administered prior to haemorrhage on haemodynamic and metabolic responses 10 haemorrhage, we compared these responses among dogs treated by segmental thoracic epidural analgesia, thoracolumbar epidural analgesia and general anaesthesia.

Group 1 of six dogs received 0.2% halothane plus epidural analgesia ranging from C4 to T5, group 2 of seven 0.2% halothane plus epidural analgesia ranging from C5 to L7, and group 3 of eight 0.9% (1 MAC) halothane anaesthesia. A volume of 35 ml · kg‐1 was bled over 30 min. The haemodynamic, metabolic and catecholamine variables were measured repeatedly at 30‐min intervals for 2.5 h.

The mean arterial pressure decreased significantly in all groups immediately after haemorrhage. It recovered to 80–90 mmHg at 2–2.5 h in groups 1 and 3 but remained at 20–30 mmHg in group 2. The cardiac output decreased significantly in all groups. The systemic vascular resistance increased significantly in group 1 but decreased significantly in group 2. In group 3 it decreased significantly but soon recovered. Arterial pH and base excess decreased significantly in all groups immediately after haemorrhage. After that, base excess recovered slowly in groups 1 and 3 but decreased further in group 2. The plasma epinephrine concentration increased immediately after haemorrhage and then decreased slowly in groups 1 and 3. In group 2 it remained unchanged at the lower level. The decreases in mean arterial pressure, systemic vascular resistance and base excess were significantly larger in group 2 than in groups 1 and 3.

These results demonstrate that the haemodynamic and metabolic changes after haemorrhage are milder under segmental thoracic epidural analgesia or 1 MAC halothane anaesthesia than under thoracolumbar epidural analgesia. Widespread epidural analgesia would weaken haemodynamic and metabolic compensatory responses to haemorrhage.
Comparison of the recovery characteristics of midazolam, alone or antagonised with flumazenil, and thiopental in ASA III‐IV patients
Authors: Tamayo E. , Gomez J. I. , Rio M. C. Del , Alvarez F. J.
Published: January 2009

Sixty non‐premedicated male patients, physically ASA III‐IV, 50–80 years of age, undergoing translumbar aor‐thography, were randomly allocated into three groups. Group A received midazolam (0.13 mg·kg‐1), group B received thiopental (4 mg · kg‐1), and group C midazolam (0.13 mg · kg‐1) combined with flumazenil (6 μg · kg‐1) at the end of the operation. Three minutes before the anaesthesia began, fentanyl (1.5 μg · kg‐1) was administered to all the patients. An evaluation was made of the time they took to open their eyes spontaneously, of time‐space orientation, comprehension‐collaboration, hypnosedation, psychomotor performance and memory. In groups “C” and “B” spontaneous opening of the eyes took place before that of group “A”. The recovery of orientation, comprehension and hypnosedation was fastest with thiopental, next with midazolam combined with flumazenil, and later with midazolam. Psychomotor performance in Trieger test was impaired for a shorter period with thiopental than in the other two groups. Recovery in group “C” was incomplete within the time, with the result that resedation was detected in 20% of the subjects.
Intramuscular ketorolac following total hip replacement with spinal anaesthesia and intrathecal morphine
Authors: Fogakty D. J. , O'Hanlon J. J. , Millioan K. R.
Published: January 2009

We have studied the analgesic and morphine sparing effect of ketorolac tromethamine in 60 patients after total hip replacement under spinal anaesthesia.

In this double blind study 30 patients received ketorolac 30 mg IM 6 hourly postoperatively and the control group received saline. Analgesia was assessed by visual analogue pain scores (VAS) and morphine consumption by patient controlled analgesia (PCA). There was a significantly (P<0.02) lower morphine consumption in the ketorolac group (7.1 ±8.6 mg; Mean±s.d.) when compared to the saline group (14.2±13.6 mg). Although there was a trend for lower VAS on the first postoperative night this was only significant at 10 hours postoperatively and the next morning at 08:00 hr. The incidence of side effects (emetic sequelae, pruritus and headache) were similar in both groups. It is concluded that ketorolac reduces the consumption of additional morphine in conjunction with intrathecal morphine but had no effects on the side effects.
Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy
Authors: Scheinin B. , Kellokumpu I. , Lindgren L. , Haglund C. , Rosenberg P. H.
Published: January 2009

The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1–2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double‐blind fashion 100 ml of either plain 0.15% bupivacaine {150 mg · 100 ml‐1) or the same solution with adrenaline (1.5 μg ml‐l), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 μg ml‐1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine‐adrenaline group. During the follow‐up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30–45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen.

It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.
Eye symptoms, visual evoked potentials and EEG during intravenous infusion of glycine
Authors: Hahn R. G. , Andersson T. , Sikk M.
Published: January 2009

Disturbance of vision is a complication that may occur from absorption of the glycine solution used to irrigate the bladder during transurethral operations. We examined for a possible dose‐response relationship between glycine dose, eye symptoms and neurophysiological changes after repeated intermittent intravenous infusions of 4.4 g of glycine for up to 22 g over 1 h in 10 male volunteers. The serum glycine concentration increased from 230±75 to 5,232±1,088 μmol/1 (mean±s.d.) during the infusions. We found an increase in diastolic arterial pressure but no significant changes in systolic pressure, heart rate or mental status. Five of the volunteers developed blurring of vision which lasted for 10 30 min. The visual evoked potentials (VEP) of these subjects showed an increase of the P100 and N70 latencies which started after no more than 4.4 g of glycine had been administered. The amplitude of the VEP was preserved and the main frequency of the EEG did not change, indicating that VEP changes were not due to cortical dysfunction. There was no dose‐response relationship between glycine infusion and eye symptoms but a sub‐group of volunteers responded with both visual disturbances and VEP changes.
Rectal versus intramuscular morphine‐scopolamine as premedication in children
Authors: Guldbrand P. , Mellström A.
Published: January 2009

Intramuscular morphine‐scopolamine for premedication was compared with a hydrogel of the same drugs for rectal administration in 205 healthy children scheduled for minor ENT surgery. The intramuscular dose was 0.15±0.006 mg × kg‐1 compared to 0.25±0.015 mg×kg‐1 rectally. Reaction at administration and anaesthetic induction, incidence of intraoperative airway difficulties, Spo2, ECG changes, postoperative pain and incidence of nausea were recorded. The administration for the rectal hycrogel group worked better and resulted in less postoperative nausea and slightly more postoperative pain. The children's behaviour at anaesthesia induction and the frequency of perioperative complications were similar in both groups. We conclude that for minor ENT surgery on children, premedication with rectal hydrogel of morphine‐scopolamine is a good alternative to intramuscular morphine‐scopolamine.
Replacement of major surgical blood loss by hypo‐oncotic or conventional plasma substitutes
Authors: Hiippala S. , Linko K. , Myllylä G. , Lalla M. , Hekali R. , Mäkeläinen A.
Published: January 2009

The purpose of the study was to examine the effects of hypooncotic 4% hydroxyethyl starch 120/0.7, 3% dextran 70, 5% albumin and hyperoncotic 6% hydroxyethyl starch 120/0.7 on the perioperative colloid osmotic pressure (COP), albumin and protein concentrations and fluid balance.

The plasma substitutes were used with red cell concentrates to replace blood loss with equal volume in sixty major abdominal or urological surgeries. A special effort was made to keep replacements and losses at even volumes constantly and to avoid fluctuation of blood volume. The blood specimen were obtained before induction, after each 20% blood loss, at the end of the recovery room phase and on the three following postoperative mornings.

There were significant differences in the peroperative and immediate postoperative COPs. However, these differences had vanished by the first postoperative morning. COP was preserved above 16 mmHg in all groups throughout the study. The identical peroperative albumin and protein concentrations of the synthetic colloid groups suggests that their volume effect was the same, regardless of the varying COP. During the observation period there were no significant differences among the groups concerning the diuresis and the fluid balances. We conclude, that the hypooncotic 4% HES 120 and 3% dextran 70 solutions provide the same clinical effect as 6% HES 120 solution. Consequently less colloid is needed, which allows the use of greater volumes of the dilute colloid solutions in replacement therapy.
Desflurane analgesia for vaginal delivery
Authors: Abboud T. K. , Swart F. , Zhu J. , Donovan M. M. , Silva E. Peres Da , Yakal K.
Published: January 2009

The use of subanaesthetic concentration of inhalational anaesthetic for vaginal delivery offers many advantages to the mother and newborn‐ Desflurane, with the characteristics of rapid onset and minimal metabolism, may provide better analgesia and safety for labour pain control.

Eighty healthy parturients were randomly assigned to receive either desflurane 1.0–4.5% and oxygen (n = 40) or nitrous oxide 30–60% in oxygen (n=40). Analgesia was assessed using a score from 0 (no relief) Lo 4+ (excellent analgesia), amnesia for the delivery, blood loss were recorded. Neonates were evaluated by Apgar scores and neurologic and adaptive capacity scores (NACS). Data were analyzed for statistical significance using Student's l‐test or Chi‐square when appropriate.

Analgesia scores were similar for both groups with more amnesia in desflurane group (23% vs 0%P<0.05). Blood loss did not differ significantly, 364 ml for the desflurane group and 335 ml for the nitrous oxide group. There were no significant differences for neonatal Apgar score at 1 min or at 5 min or the NACS at 2 hr or 24 hr between the two groups.

We conclude that desflurane in subanaesthetic doses is safe and effective inhalation agent for normal delivery but might be associated with amnesia.
Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975
Authors: Tikkanen J. , Hovi‐Viander M.
Published: January 2009

Mortality associated with anaesthesia and surgery in Finland in 1986 was studied using a retrospective method and was compared with the results of a similar study performed in 1975. The total number of procedures was 325 585. 570 patients fulfilled one of the three criteria: 1. The patient died within three days of a procedure needing anaesthesia. 2. The patient died more than three days after a procedure needing anaesthesia, but had suffered a cardiac arrest or been resuscitated, or there was a surgical or an anaesthesiological complication contributing to the death. 3. The patient suffered a major handicapping neurological (or other) deficit, which was associated with anaesthesia, or there was a surgical or an anaesthesiological complication possibly contributing to the death or handicap (no patients). The number of consultant anaesthesiologists had more than doubled since 1975. At the same time there was also a significant increase in recovery room and intensive care facilities. Surgery‐was the main contributing factor in the death of 22 (frequency 0.68/10 000 procedures), and anaesthesia in the death of five (frequency 0.15/10 000 procedures) patients. The role of surgery had decreased to about one third and the role of anaesthesia to less than one tenth as the main cause of death associated with anaesthesia and surgery compared to the year 1975. 95.3% of all the patients died mainly because of co‐existing medical or surgical disease.
Intraoperative anaphylaxis caused by a hydatid cyst
Authors: Sola J. L. , Vaquerizo A. , Madariaga M. J. , Opla J. M. , Bondia A.
Published: January 2009

The incidence of the hydatid disease is still high in some regions of the Mediterranean. A serious, but rare, peroperative complication is lgE,‐medialed anaphylaxis, as a result of passing of the highly antigenic hydatid cyst content into the bloodstream. We present here a case of anaphylactic reactiori in a patient who underwent surgical treatment of hydatid cyst.
Clinical and Laboratory Studies on Propofol
Authors: Jensen A G
Published: January 2009

Abstract: The aims of this study were to assess the suitability during major surgery of an intravenous anaesthetic technique based on propofol and to study the influence of this technique on early and late recovery, on postoperative bowel and lung function, and on the incidence of complications. Further, the effects of propofol were evaluated on the migration ability of human leucocytes, and on the cytoskeletal organization and the intracellular calcium ion concentration of cultured cells.

Patients undergoing major abdominal surgery were randomly given either total intravenous anaesthesia based on propofol and fentanyl, or anaesthesia based on propofol, fentanyl and nitrous oxide or anaesthesia based on isoflurane and fentanyl. Postoperative atelectasis demonstrated by computed tomography of the chest was found to a similar extent, and a similar decrease in arterial oxygen pressure was seen in the groups. No correlation was seen between the size of atelectasis and postoperative oxygen pressure. Cardiovascular stability was equally well maintained during surgery, but the patients anaesthetized with propofol needed more ephedrine and glycopyrrolate to achieve stability. In all groups the Acute Physiology Score was normal by day 1 (range 1–7). A similar impairment of bowel function after operation was found, with passage of gas day 3 (1–6) and tolerance of enteral intake day 5 (1–10). Hospital stay 11 (6–45) days and incidence of complications were unaffected by anaesthetic technique. Early recovery was similar in the three groups, but patients anaesthetized with propofol reported fewer symptoms, better subjective control and a higher degree of social orientation than patients anaesthetized with isoflurane.

Clinically relevant concentrations of propofol decreased random and chemotactic locomotion of leucocytes in an agarose assay. Concentration dependent and reversible effects of propofol (concentrations between 0.3μg·ml‐1 and 50 μg·ml‐1(1.7 to 280μM) were found on the actin distribution of the cytoskeleton in cultured cells. The maximal effect was seen after 20 min. of incubation. An increase in cytosolic free calcium in rat neurons was seen immediately after the addition of propofol, lasting 128±39 seconds and thereafter returning to normal. This effect was dual, 60–75% of the increase came from the extracellular buffer and the remaining part from intracellular stores. A rise in intracellular calcium can lead to changes in the cytoskeleton and to hyperpolarization of neurons.
Pulse oximetry ‐ clinical implications and recent technical developments
Authors: Lindberg L. G. , Lennmarken C. , Vegfors M.
Published: January 2009

The pulse oximeter has been shown to be a reliable monitor of arterial oxygen saturation and has therefore been recommended as mandatory monitoring for patients during anaesthesia and intensive care. In 1989 two review articles on pulse oximetry were published (1, 2) and two years ago Severinghaus and Kelleher summarized the literature between 1989 and October 1991 (3). Our aim is to focus the discussion on technical aspects and applications of pulse oximetry with special attention centred on recent developments. This review is consequently an update on pulse oximetry since the end of 1991, and the first on technically‐based publications in the two last decades.
Recovery from neuromuscular blockade: residual curarisation following atracurium or vecuronium by bolus dosing or infusions
Authors: Fawcett W. J. , Dash A. , Francis G. A. , Liban J. B. , Cashman J. N.
Published: January 2009

We conducted a survey of the incidence of Postoperative Residual Curarisation (PORC) in two groups of patients following the use of atracurium or vecuronium. In the first group (B) the neuromuscular blocking drugs were administered by bolus dosing, and in the second group (I) by continuous infusion. On arrival in the recovery room, neuromuscular function was assessed both by compound evoked electromyogram (EMG) in a train of four pattern and also clinically, by the ability to sustain a headlift for >5 seconds, and to cough. Results were obtained from 150 patients (100 in group B and 50 in group I). The incidence of PORC, as defined by a train of four ratio of <0.7, on arrival in the recovery room was 12% in group B, and 24% in group I. Clinical criteria of adequate neuromuscular reversal revealed different results, with the majority of patients being unable to perform either clinical test on arrival in recovery. Those patients in whom a peripheral nerve stimulator was used intra‐operatively did not have a reduced incidence of PORC. We have demonstrated that PORC is still a common occurrence even with intermediate duration of action neuromuscular blocking drugs.
Lack of effect of flumazenil on the reversal of propofol anaesthesia
Authors: Fan S. Z. , Liu C. C. , Yu H. Y. , Chao C. C. , Lin S. M.
Published: January 2009

Propofol, like the benzodiazepines, activates the GABAA receptor‐chloride ionophore complex; they potentiate one another. Since neither pharmacodynamic nor pharmacokinetic data concerning drug interaction between flumazenil and propofol is available, and especially considering the relationship of binding sites, flumazenil, the antagonist of benzodiazepines, was investigated to determine its effect upon recovery from propofol anaesthesia. Forty women receiving dilatation and curettage procedures were included in this double‐blind test. After 50 μg fentanyl, propofol 2 mg · kg‐1 was injected for induction and followed by infusion at the rate of 15 mg · kg‐1 · hr‐1. After the operation, patients were given normal saline (Group A) or flumazenil 10 μg · kg‐1 (Group B) randomly.

Recovery time in Group A was 15.2±5.1 min and Group B 15.8±4.8 min. Propofol concentrations at the end of infusion were 4.17±1.33 μg ·ml‐1 (Group A) and 4.03±1.45 μg · ml‐1 (Group B); these then declined to 1.22±0.17 μg · ml‐1 (Group A) and 1.18±0.15 μg · ml‐1 (Group B) when patients were able to open their eyes on command. No significant differences were found between the groups based on propofol concentrations and recovery time, nor did haemodynamic changes differ between them after administration of reversal agents. It was concluded that flumazenil 10 μg · ml‐1 does not influence recovery from propofol anaesthesia.
Lung function after open versus laparoscopic cholecystectomy
Authors: Gunnarsson L. , Lindberg P. , Tokics L. , Thorstensson Ö. , Thörne A.
Published: January 2009

Postoperative lung function and gas exchange were studied in 36 patients after cholecystectomy. Twenty‐four of the patients underwent laparoscopic cholecystectomy while the remaining twelve were operated with open technique. Before surgery all patients had normal ventilatory volumes (forced vital capacity, FVC and forced expired volume in 1 s, FEV1) and normal gas exchange. Two hours postoperativley FVC was reduced to 64±16% (P<0.05) of the preoperative level in the laparoscopic group and to 45±23% (P<0.05) after open cholecystecomy. On the first postoperative day FVC was virtually normal in the laparoscopic patients (77±17% of preoperative level, NS), whereas the open surgery patients still had a decreased FVC (56±13% of preoperative, P<0.05). FEV1 in the postoperative period followed the same course as FVC. Gas exchange was significantly impaired in the early postoperative period in all patients but no difference between the two groups was found. Two hours postoperatively Pao2 was reduced to 85% (P<0.05) of preoperative value and Paco2 had increased by 0.5 kPa (p<0.05). The alveolo‐arterial oxygen tension difference (PA‐ao2) had increased by approximately 45% to a mean of 3.7 kPa (P<0.05). On the first postoperative day gas exchange was still significantly impaired in the open surgery patients. Atelectasis detected by computed X‐ray tomography of the lungs were found in both groups. However, the amount of atelectasis tended to be smaller in the laparoscopic group than in the open surgery patients.

In summary, cholecystectomy irrespective of whether it was performed by open or laparoscopic technique was followed by deterioration in ventilatory function and gas exchange. However, the magnitude of this impairment was less pronounced in laparoscopic cholecystectomy patients than in the open surgery patients which may suggest that this minimal invasive procedure is favourable with respect to postoperative lung function.
Clinical application of differential ventilation with selective positive end‐expiratory pressure in adult respiratory distress syndrome
Authors: Wickerts C.‐J. , Blomqvist H. , Baehrendtz S. , Klingstedt C. , Hedenstierna G. , Frostell C.
Published: January 2009

Differential ventilation in the lateral position with positive end‐expiratory pressure (PEEP) selectively applied to the dependent lung (DVSP) has been shown to reduce venous admixture and improve oxygenation without compromizing cardiac output in short term studies of patients with acute respiratory failure. We have applied this ventilation technique as a long‐term treatment in severe adult respiratory distress syndrome (ARDS) in an open clinical trial. Eleven patients with ARDS of varying aetiology were treated with DVSP for a total of 34 days.

Median duration of conventional ventilatory therapy before start of DVSP was 5 days (1 to 18 days), inspiratory oxygen fraction (F1***2) was 0.61 ±0.16 (mean±s.d.), resulting in a mean arterial oxygen tension (Pao2) of 7.1±2.1 kPa (Pao2/F1o2= 11 ± 4 kPa). A gradual improvement in gas exchange was seen during the first 24 h of DVSP such that Pao2 increased to 8.4±1.4 with a decreased F1o2 (0.52±0.14) resulting in an increased Pao2/F1o2 (16±5 kPa). Five out of the eleven patients survived. No major complication was noted using DVSP as a method. We found a steady improvement in gas exchange over the first 24 hours in most patients. However, mortality rate was no lower than expected. Drawbacks with DVSP were increased demand on staff and difficulties with adequate endo‐bronchial suctioning.
Prophylactic oral ibuprofen or ibuprofen‐codeine versus placebo for postoperative pain after primary hip arthroplasty
Authors: Dahl V. , Raeder J. C. , Drøsdal S. , Wathne O. , Brynildsrud J.
Published: January 2009

The postoperative analgesic effect of ibuprofen was compared with a combination of ibuprofen and codeine versus placebo. The study was prospective, randomized, double blind with 123 consecutive hip arthroplasly operations. All the patients received oral diazepam as premedication and spinal anaesthesia with bupivacaine 5 mg/ml 3–4 ml.

Postoperatively, when the spinal anaesthesia started to wear off, the patients were randomly assigned to one of three groups; the ibuprofen group (n=48) received 800 mg of ibuprofen orally. The ibuprofen/codeine group (IC, n=48) received 800 mg of ibuprofen combined with 60 mg of codeine. The placebo group (P, n=25), received oral placebo medication. The patients were observed for the need of additional opioid (e.g. ketobemidone), pain score (verbal and VAS), bleeding and side effects for five hours. The patients in the placebo group (P) had significantly higher pain scores (P >0.05) compared with the two other groups after 2 and 4 hours, with no significant differences after 1, 3 and 5 hours. The P group also received 45% more opioids (P<0.001) compared with the two other groups during the same period. No significant differences in bleeding or side‐effects were observed between the groups. There were no significant differences between the ibuprofen group and the ibuprofen/codeine group.

We conclude that a prophylactic dose of 800 mg ibuprofen orally has an opioid sparing effect with a tendency of less pain experience during the first hours after hip arthroplasty.
Contribution from upper and lower airways to exhaled endogenous nitric oxide in humans
Authors: Schedin U. , Frostell C. , Persson M. G. , Jakobsson J. , Andersson G. , Gustafsson L. E.
Published: January 2009

Endogenous nitric oxide (NO) is thought to regulate many biological functions, including pulmonary circulation and bronchomotion, and it has been found in exhaled air. Our aim was to study the excretion of NO in different parts of the respiratory system.

Exhaled concentrations of NO were measured by chemiluminescence in chronic tracheostomy outpatients (group 1), in patients admitted for minor abdominal surgery (group 2), and in patients with acute respiratory failure (ARF) during mechanical ventilation (group 3). In awake volunteers (group 4), 0.57 L/min gas was aspirated through the nasal cavity into the chemiluminescence device.

In group 1 (tracheostomy, n=5) we detected 16±2 (mean±s.c. mean) parts per billion (ppb) NO when exhaling through the mouth, and a lower (P<0.05) value of 4.6±0.8 ppb NO when exhaling through the tracheostomy. Before anaesthesia, group 2 (n=11) exhibited 13±2.4 ppb NO in orally exhaled gas, increasing considerably during exhalation through the nose. Upon endotracheal intubation exhaled NO concentration dropped to 1.3±0.2 ppb (P<0.05). In group 3 (ARF, n=7) tracheal NO concentrations were 0.8±0.2 ppb. In group 4 (volunteers, n=6) 394±23 ppb NO was recorded in air from the nasal cavity.

In both healthy subjects and patients with respiratory failure a significant NO excretion occurs in the lower airways and lungs. The upper airways, expecially the nose, contribute the largest amount of NO (>90%) to exhaled air. The physiological implications of an upper airway source of NO remain to be defined.
Implicit processing and therapeutic suggestion during balanced anaesthesia
Authors: Oddby‐Muhrbeck E. , Jakobsson J. , Enquist B.
Published: January 2009

The effect of therapeutic suggestion ‐ implicit processing during balanced anaesthesia was studied in 70 female patients scheduled for elective breast surgery. The patients were randomly allocated to listen to a message with reassuring information focused on minimising postoperative nausea and vomiting, or just a blank tape during surgery. Occurrence of nausea and vomiting was studied during the postoperative period. No patient recalled any explicit memories during the peroperative period. No major differences were observed in the number of patients who experienced nausea or vomiting during the 24 hour observation period. The patients exposed to positive suggestion did, however, have a lower frequency of recall for nausea and vomiting compared to those just listening to the blank tape. We did not observe any major effect of peroperative suggestion for postoperative nausea and vomiting. However, we cannot rule out some implicit processing during balanced anaesthesia.
Modulation of ryanodine‐induced contractures in human skeletal muscle pretreated with dantrolene
Authors: Lenzen Ch. , Roewer N. , Wappler F. , Köchling A. , Steinfath M. , Sgholz J. , Esch J. Schulte am
Published: January 2009

Dantrolene seems to be the causal therapy in malignant hyperthermia (MH) crisis but the complex mechanisms of MH and dantrolene therapy are still not fully understood. The influence of dantrolene on ryanodine‐induced contractures has been reported in animal studies only. In the present study 20 patients from] 7 families were tested for MH using the protocol of the European Malignant Hyperthermia Group. In addition ryanodine‐induced contractures were evaluated following bolus application of 10.0 μmol · 1‐1ryanodine. After pretreatment with 1 μimol · 1‐1dantrolene ryanodine‐provoked contractures developed significantly later in MHS (15.8±1.8 min) and MHN (46.0±4.2 min) muscle specimens than after ryanodine alone (MHS 4.8±0.7 min), (MHN 13.7±0.9 min). They were no longer observed in either group after pretreatment with 5 μimol · 1‐1dantrolene. We conclude that dantrolene is able to attenuate ryanodine‐induced contractures dose‐dependendy, and therefore it is speculated that dantrolene could specifically act at the ryanodine receptor binding site.
Diabetic autonomic neuropathy and the haemodynamic actions of vecuronium and pancuronium during vitrectomy
Authors: Oikkonen M.
Published: January 2009

In order to clarify whether autonomic neuropathy modifies the haemodynamic effects of alfentanil, vecuronium and pancuronium, twenty‐seven patients with diabetes mellitus were studied at thiopentone induction, and during nitrous oxide anaesthesia for ophthalmic vitreous surgery. Heart rate was lower in the diabetic patients receiving vecuronium compared with those receiving pancuronium, but no difference was seen in arterial pressure. During and after anaesthesia induction, the profiles of heart rate and arterial pressure resembled those found in healthy controls. Even in patients with advanced autonomic neuropathy, anaesthetics may exert their inherent vagotonic or sympathkotonic actions.
Comparison of induction time and characteristics between sevoflurane and sevoflurane / nitrous oxide
Authors: Yurino M. , Kmura H.
Published: January 2009

A previous investigation using nitrous oxide with 5% enflurane (3.8 MAC) for single breath induction produced a stage of excitement which may be related to the difference in blood/gas coefficient solubility of these agents. The closer blood/gas solubility coefficient of sevoflurane and nitrous oxide may eliminate this phenomenon. We therefore evaluated 40 volunteers in a randomized study using 7.5% sevoflurane (3.7 MAC) in oxygen (n=21) or sevoflurane with nitrous oxide (n=19) using a single breath induction technique. Sevoflurane in nitrous oxide and oxygen reduced induction time by 15% compared to sevoflurane in oxygen alone (41 ±16 and 48±16 sec (s.d.), respectively). This was, however, not statistically significant. There were scarcely induction‐related complications, such as coughing, laryngospasm, breath‐holding, movements of a limb and excessive salivation, in either group. Thus, the addition of nitrous oxide neither increased the number of complications, nor the speed of induction.
Long‐term local corticosteroid application does not influence nerve transmission or structure
Authors: Johansson A. , Dahlin L. , Kerns J. M.
Published: January 2009

The long‐term effects of a locally applied depot form of a corticosteroid on the electrical properties and structure of nerves were investigated in an animal experimental model.

The conduction in electrically stimulated A‐fibres of the plantar nerve was monitored by a bipolar volley recording of the sciatic nerve whereas the conduction in C‐fibres of the plantar nerve was measured through a C‐fibre evoked segmental flexion reflex in the anaesthetized rat. Droplets of either methylprednisolone acetate or vehicle were placed under direct observation on the plantar nerve. Saline was used as a control on the contralateral side. One to two weeks after the application both the A‐fibre volley of the sciatic nerve and the C‐fibre evoked reflex discharge of flexor motoneurons were recorded.

No difference was found between the nerves treated with corticosteroid, constituent vehicle or saline. Light and electron microscopic analysis of the nerves showed no changes in the nerve fibres or in the intraneural connective tissue in either the corticosteroid treated or the control nerves.

It is concluded that locally applied corticosteroids in limited amounts have no long‐term effects on the electrical and structural properties of peripheral nerves.
Recovery from sevoflurane and isoflurane anaesthesia after outpatient gynaecological laparoscopy
Authors: Eriksson H. , Haasio J. , Korttila K.
Published: January 2009

As the low blood solubility (blood gas partition coefficient 0.69) of sevoflurane suggests a rapid emergence from anaesthesia, recovery from sevoflurane anaesthesia was compared to isoflurane in outpatient gynaecological laparoscopy. Fifty ASA I or II, consenting women participated in a randomised, controlled and single blind study. The patients received, after induction of anaesthesia with propofol, either sevoflurane or isoflurane, both with 67% nitrous oxide in oxygen, for maintenance of anaesthesia. The study drug was administered at 1 MAC (end tidal concentration 0.6% for sevoflurane and 0.5% for isoflurane) but adjusted in 0.5 MAC steps, if clinically indicated. Before the end of surgery the end tidal concentration of the study drug was reduced to 0.5 MAC. Recovery assessments were made from the time anaesthetic gases were discontinued. The subjects were able to open eyes in 2.3 (0.8–7.0) min and 4.1 (2.0–6.8) min, orientate in 2.8 (1.0–6.8) min and 4.7 (2.2–8.3) min and follow orders in 2.6 (0.7–6.8) min and 4.3 (1.2–7.3) min, in the sevoflurane and isoflurane groups, respectively (P<0.05) [median (range)]. Walking was achieved in 72 (24–464) min and 66 (35—134) min, tolerance of oral fluids in 37 (15–88) min and 35 (45–161) min and voiding in 262 (96–459) min and 217 (52–591) min in the sevoflurane and isoflurane groups, respectively (NS). Overall home readiness was achieved in 281 (96–708) min after sevoflurane group and 242 (96–591) min after isoflurane (NS). Postoperative nausea and vomiting was common in both groups (55% for sevoflurane and 45% for isoflurane) and contributed to three subjects in the sevoflurane group and four in the isoflurane group being admitted to hospital.
Anesthetic modulation of the cardiovascular response to microlaryngoscopy
Authors: Sellgren J. , Ejnell H. , Pontén J. , Sonander H. G.
Published: January 2009

The modulating effects of propoiol versus methohexital on the cardiovascular response to microlaryngoscopy were studied in 35 patients divided into four equal groups (one patient participated twice). Heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO; impedance cardiography), leg blood flow (LBF; occlusion plethysmography) and concentrations of arterial catecholamines were measured. After administration of atropine and fentanyl (2 μg·kg‐1), anesthesia was induced by either an injection of propofol (2.0 mg·kg‐1) followed by a low (6 mg·kg‐1·h‐1; n=91 or a high (12 mg·kg‐1·h‐1; n = 9) dose propofol infusion or an injection of methohexital (1.5 mg·kg‐1) followed by a low (5 mg·kg‐1·h‐1; n=9) or a high (10 mg·kg‐1·h‐1; n—9) dose methohexital infusion.

The low methohexital infusion dose was insufficient to control MAP, which increased 41% during microlaryngoscopy compared to the awake state. The HR increased in all groups but the increase was most prominent in the low dose methohexital group. There were no statistically significant changes in CO in any group, whereas LBF increased consistently in all groups except in patients anesthetized with the low dose of methohexital. The increases of LBF in the propofol groups were intermediate and not dose dependent. The methohexital low dose group showed increases in norepinephrine levels compared to awake values and in epinephrine levels compared to the other groups.

Propofol seems to differ from methohexital in modulation of peripheral vascular tone. The insufficient control of the cardiovascular response to microlaryngoscopy by the low methohexital dose in addition to longer recovery after the high methohexital dose favors the use of propofol.
Perioperative autotransfusion and functional coagulation analysis in total hip replacement
Authors: Ekbäck G. , Schött U. , Axelsson K. , Carlberg M.
Published: January 2009

Functional coagulation analyses like Sonoclot and thromboelastography have not been evaluated during perioperative autotransfusion. We have prospectively studied three different transfusion regimes in 45 patients undergoing total hip arthroplasty. Blood losses were replaced either with heterologous erythrocyte concentrate (group I), intra‐ and postoperative autotransfusion of blood salvaged with cellsaver technique (group II) or predonated autologous erythrocyte concentrates together with salvaged blood (group III). Routine and functional coagulation analyses with a Sonoclot were performed preoperatively, 6 hours postoperatively (6 h), day 1–5 and 10. An early postoperative hypo‐ and late postoperadve hypercoagulative phase could be detected with Sonoclot signs of platelet function and fibrin deposition in all groups. Sonoclot coagulation analyses better correlated to both blood loss and dextran dosage than APTT and platelet count in the routine coagulation analyses. Functional coagulation analysis has a potential use in individualizing plasmasubstitution and thromboprophylaxis regimes during autotransfusion in THR.
Train‐of‐Four recovery after pharmacologic antagonism of pancuronium‐, pipecuronium‐, and doxacurium‐induced neuromuscular block in anaesthetized humans
Authors: Stinson L. W. , Lanier W. L. , Lennon R. L.
Published: January 2009

Previous studies have suggested that the increased duration of action of long‐acting neuromuscular relaxants may make their pharmacologic antagonism more difficult and, thus, increase the likelihood of residual block. This hypothesis was tested in healthy, adult humans who received a background of isoflurane/N2O/fentanyl anaesthesia.

Study subjects were paralyzed with either pancuronium (N=8), pipecuronium (N=8), or the longer‐acting relaxant, doxacurium (N=8). Neuromuscular function was monitored, and, using a blinded, randomized study design, the relaxants were titrated to identify the ED95 dose in each patient. Thereafter, spontaneous recovery was observed until there was 25% ofbaseline response to the first supramaximal twitch (Tl) in a train‐of‐four (TOF). At this time, the block was antagonized with neostigmine 0.07 mg/kg and glycopyrrolate 0.014 mg/kg i.v., and recovery of TOF was recorded.

Spontaneous recovery to 25% of the baseline Tl response occurred at 52± 14 min (mean±SD) following administration of either pancuronium and pipecuronium, and 85 ±33 min following doxacurium (P<0.05 for doxacurium versus pancuronium and pipecuronium). In doxacurium‐rreated patients, reversal of block with neostigmine was less predictable and less complete than with the other two relaxants. For example, the ratio of the fourth to first twitch (T4/T1) of the TOF at 10 and 15 min after reversal was significantly less with doxacurium (59 ±14% and 61±16%, respectively) than with either pancuronium (75±6% and 75±10%) or pipecuronium (76±9% for both). At 30 min post‐neostigmine, the incidence of residual block (i.e. T4/T1 <0.70) was: pancuronium 2 patients, pipecuronium 1 patient, and doxacurium 5 patients.

These studies support the hypothesis that incomplete reversal of neuromuscular block is more likely with longer‐acting neuromuscular relaxants.
Early detection of CO2 pneumothorax with continuous spirometry during laparoscopic fundoplication
Authors: Mäkinen M‐T. , Yli‐Hankala A. , Kansanaho M.
Published: January 2009

In two patients, operated on because of gastroesophageal reflux, carbon dioxide pneumothorax developed during laparoscopic Nissen fundoplication. In both instances, decrease of lung compliance and a change of pressure‐volume loop configuration, computed and illustrated with on‐line spirometry, led quickly to diagnosis of this complication. We conclude that continuous spirometry is valuable as an early indicator of intraoperative pneumothorax.
Leucocyte content in blood processed by autotransfusion devices during open‐heart surgery
Authors: Perttilä J. , Leino L. , Pöyhönen M. , Salo M.
Published: January 2009

Autologous red blood cells processed by autotransfusion devices have become increasingly common in major surgery. The finished product, however, often contains varying amounts of leucocytes. We compared leucocyte and their differential counts of blood processed by three autotransfusion devices (Haemonetics Cell Saver IV, Dideco Stat and Dideco Stat‐P) during open‐heart operations on 25 patients. In addition, a zymosan‐induced, luminol‐enhanced chemiluminescence method was used to evaluate the activity of neutrophils in prepared autologous blood. High leucocyte counts (3.6–10.9 × 1091‐1) were found in all saved red blood cell concentrates. The leucocyte counts of autologous blood produced by the Haemonetics device were lowest (P<0.01) and about one third of the patients' haematocrit‐corrected counts. The proportions of neutrophils were higher in salvaged blood than in the blood circulation before anaesthesia or before retransfusion (P <0.01). However, no general activation of neutrophils was seen, but the increase in chemiluminescence activity of about 30% that was seen in four patients may suggest an increased risk of reperfusion injury in such patients after aortic declamping. In conclusion, all three autotransfusion devices left leucocytes in the processed red blood cell concentrates, although great differences occurred between the devices.
Effects of sevoflurane on ischaemic myocardium in dogs
Authors: Takahata O. , Ichihara K. , Ogawa H.
Published: January 2009

We studied the effect of sevoflurane on ischaemic myocardium in terms of myocardial energy and carbohydrate metabolism. Mongrel dogs were anaesthetized initially with sodium pentobarbitone, and then inhaled sevoflurane at 0% (0 MAC), 2.4% (1.0 MAC) or 4.7% (2.0 MAC) of inspired concentration for 60 min. Ischaemia was then induced for 3 min by ligating the left anterior descending coronary artery. The tissue levels of energy and carbohydrate metabolites were determined before and after sevoflurane inhalation, and after 3 min of ischaemia. Sevoflurane significantly decreased systolic and diastolic blood pressures, heart rate, and rate‐pressure product in a dose dependent manner. When the animals did not inhale sevoflurane (0 MAC), ischaemia significantly decreased adenosine triphosphate and creatine phosphate levels, and produced alterations of carbohydrate metabolism. These metabolic changes induced by ischaemia were lessened by inhalation of sevoflurane. To exclude the influence of haemodynamic changes, blood pressure and heart rate were maintained during 1.0 MAC sevoflurane inhalation. Significant attenuation of ischaemia‐induced metabolic changes caused by sevoflurane was still observed in some metabolites. These results indicate that the ischaemic influences on the myocardium may be reduced by sevoflurane, and this protective effect can be explained not only by its haemodynamic effect.
High dose spinal anaesthesia with glucose free 0.5% bupivacaine 25 and 30 mg
Authors: Povey H. M. , Olsen P. Albrecht , Pihl H. , Jacobsen J.
Published: January 2009

The purpose of this study was to investigate if a more intense and/or prolonged blockade could be obtained safely when a high‐dose intrathecal plain bupivacaine was given.

Thirty patients for elective surgery were included. Two groups of 15 patients, received 25 or 30 mg 0.5% bupivacaine (plain). The sensory and motor blockade was determinated. Heart rate and respiratory frequency was monitored continuously, arterial blood pressure every 5 minutes. Peak expiratory flow (PEF) was performed before, and 45 min after the spinal injection.

In group 25 mg the maximal spread of analgesia was to T3.7±0.9 (mean±s.e.mean) after 45 minutes, in group 30 mg 13.1 ±0.4 also after 45 min (NS). The maximal extent of analgesia was retained for a significantly longer period and the initial decline in extent of analgesia was significantly slower in the 30 mg group. No significant difference as to duration of motor blockade was found. Peak expiratory flow diminished significantly 45 min after the spinal injection in both groups, but no significant difference was found between the groups. The total duration of analgesia did not differ significantly between the groups.

A significantly longer duration of maximal cephalad spread, and a slower initial regression, was found in the 30 mg group. No severe uncontrolled haemodynamic or respiratory side effects occurred.
Effects of propranolol pretreatment on cerebral blood flow, oxygen uptake and catecholamines during metabolic acidosis following E. coli endotoxin in dogs
Authors: Westerlind A. , Larsson L. E. , Häggendal J. , Ekström‐Jodal B.
Published: January 2009

After an intravenous injection of E. coli endotoxin in dogs a decrease in cerebral blood flow (CBF) and an increase in cerebral metabolic rate of oxygen (CMRo2) have been shown to occur. In metabolic acidosis following endotoxin CMRo2 increased with decreasing pH. A possible explanation for the increased CMRo2 after endotoxin and metabolic acidosis seems to be a damage of the blood‐brain barrier (BBB) by endotoxin. This gives possibilities for a leakage of hydrogen ions and circulating monoamines from the blood to the brain, thus affecting the cerebral blood flow and metabolism.

The effects of an E. coli endotoxin injection on CBF and CMRo2 during metabolic acidosis and P‐adrenoceptor blockade were studied in eight anaesthetized dogs. All the dogs were pretreated with propranolol (PPL), per os 12.5 mg . kg‐1 twice a day for one week. Metabolic acidosis (pH 7.01–7.30) was achieved by an intravenous infusion of hydrochloric acid. Endotoxin E. coli lipopolysaccharide O 111:B 4 was given as an intravenous injection of 1 mg . kg‐1 bodyweight over a 5 min period. Another five animals, published earlier, with the same experimental protocol but without PPL, constituted a control group.

After endotoxin no increase in CMRo2 or CBF was observed with increasing acidosis in the PPL‐group. In the control group, after endotoxin, both CBF and CMR02 increased with decreasing pH. This resulted in a significant difference in both CBF and CMRo2 between the groups in the pH range 7.01—7.15.

The present results indicate that the increase in CMRo2 and CBF with metabolic acidodis in endotoxinaemia is mediated via P‐adrenoceptors.