bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of dantrolene in an in vivo and in vitro model of myocardial reperfusion injury
Authors: Preckel B. , Schlack W. , Comfère T. , Thämer V.
Published: March 2003

Background: In skeletal muscle, dantrolene reduces free cytosolic calcium by inhibiting calcium release from the sarcoplasmic reticulum. A similar effect in ischemic‐reperfused heart cells would protect myocardial tissue against reperfusion injury. We tested the hypothesis that dantrolene infusion during reperfusion protects the heart against reperfusion injury.

Methods: Isovolumetric beating rat hearts were subjected to 30 min of ischemia followed by 60 min of reperfusion. Left ventricular (LV) developed pressure (LVDP) and creatine kinase release (CKR) were determined as indices of myocardial performance and cellular injury, respectively. In the treatment groups, dantrolene (25 (DAN25) or 100 (DAN100) μmol l−1) was infused during the first 15 min of reperfusion; control hearts received the respective concentration of the vehicle (mannitol (CON25, CON100), each group n=7). To investigate the effects of dantrolene on reperfusion injury in vivo, 18 chloralose‐anesthetized rabbits were subjected to 30 min occlusion and 180 min reperfusion of a major coronary artery. LV pressure (LVP), cardiac output (CO), and infarct size were determined. During the last 5 min of ischemia, nine rabbits received 10 mg kg−1 dantrolene intravenously (DAN). Another nine rabbits received the vehicle (dimethylsulfoxide) and served as controls (CON).

Results: In isolated rat hearts, there was no recovery of LVDP in any group. Total CKR during 1 h of reperfusion was 845±76 (CON100) and 550±81 U g−1 dry mass (DAN100, P<0.05). In rabbits in vivo, hemodynamic baseline values were similar between groups (CON vs. DAN: LVP, 99±6 (mean±SEM) vs. 91±6mm Hg, P=0.29; CO, 252±26 vs. 275±23 ml min−1, P=0.53). During coronary artery occlusion, LVP and CO were reduced in both groups (CON: LVP, 89±3%; CO, 90±5% of baseline values) and LVP did not recover to baseline values during reperfusion (51±5% (CON) vs. 67±7% (DAN) of baseline, P=0.10). Infarct size was 41±4% of the area at risk in controls and 37±6% in dantrolene treated hearts (P=0.59).

Conclusions: Dantrolene reduced CKR, indicating an attenuation of lethal cellular reperfusion injury in isolated rat hearts. However, in the rabbit in vivo, there was no effect on the extent of reperfusion injury after regional myocardial ischemia.
In vivo protein synthesis of circulating human T lymphocytes does not respond to a cortisol challenge within 24 h
Authors: Januszkiewicz A. , Essén P. , Mcnurlan M. A. , Ringdén O. , Wernerman J. , Garlick P. J.
Published: March 2003

Background: Although immunocompetence is often measured by assessing responsiveness of lymphocytes to mitogenic stimulation in vitro, this approach may not reflect the in vivo situation. The aim of this investigation was to determine in vivo the protein synthesis rate (FSR) in isolated T lymphocytes and to study the effect of a short‐term cortisol infusion on FSR.

Methods: Healthy volunteers (n=24) were randomised into 4 groups. A continuous cortisol infusion (6 μg kg−1 min−1) during 6 h was given to groups 1 and 2, whereas groups 3 and 4 served as control groups and received saline infusion. Protein synthesis was studied before and after 6 h of the cortisol/saline infusion (groups 1 and 3) or 24 h after the start of the infusion (groups 2 and 4). FSR was determined in vivo by the flooding method. The isotopic enrichment of phenylalanine in plasma and lymphocyte protein was determined with gas chromatography‐mass spectrometry.

Results: The FSR in T lymphocytes was 13.6±0.9%/24 h as a mean value (±SD) of the first determination in 4 groups. There was no significant difference in FSR from the baseline value immediately after the cortisol infusion (group 1: 13.3±1.4%/24 h vs 13.5±2.8%/24 h) or 24 h after the start of the infusion (group 2: 13.6±0.7%/24 h vs 12.3±2.4%/24 h).

Conclusion: The metabolic activity of circulating T lymphocytes, as reflected by a quantitative measurement of in vivo protein synthesis of human T lymphocytes, was not affected by the increased level of cortisol.
Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects
Authors: Mols G. , Rohr E. , Benzing A. , Haberthür C. , Geiger K. , Guttmann J.
Published: March 2003

Background: Automatic tube compensation (ATC) is a new option to support spontaneously breathing tracheally intubated patients. We have previously demonstrated an increased respiratory comfort compared to pressure support ventilation (PSV) in volunteers. Here we characterized the breathing pattern during ATC associated with respiratory comfort in comparison to PSV. Furthermore, we studied whether ATC can be substituted by a simple modification of PSV.

Methods: We exposed 10 volunteers breathing through a 7.5 mm endotracheal tube via mouthpiece to PSV with 1) immediate and 2) delayed pressure rise and to 3) ATC. Immediate changes of the respiratory pattern after mode shifts were analyzed in detail. Furthermore, the volunteers were instructed to indicate changes in comfort after transitions between these modes as increased, unchanged, or decreased.

Results: Decreased comfort was associated with a substantial increase of tidal volume, minute ventilation, gas flow, and pressure. No differences in respiratory comfort were perceived between immediate and delayed pressure rise during PSV.

Conclusion: PSV resulted in excessive tidal volumes and airflow, which was perceived as discomfort. This cannot be avoided by a delayed pressure rise but can be by the more comfortable ATC. ATC seems to adapt better to the ventilatory demand than PSV.
Impact of acute renal failure on antioxidant status in multiple organ failure
Authors: Metnitz PH. G. H. , Fischer M. , Bartens C. , Steltzer H. , Lang TH. , Druml W.
Published: March 2003

Background: Acute renal failure (ARF) can be triggered or aggravated by reactive oxygen species (ROS) but established ARF per se might also affect the antioxidant defence mechanisms of the organism. We evaluated a broad pattern of antioxidants in critically ill patients with multiple organ failure with (MOF‐ARF) and without acute renal failure (MOF) to identify any potential involvement of renal dysfunction in the depletion of the antioxidant system.

Methods: Observational study; 13 patients with MOF were investigated (9 with and 4 without ARF), and 17 healthy subjects served as controls. Blood samples were drawn after establishment of MOF. Plasma levels of ascorbate, α‐tocopherol, retinol, β‐carotene, selenium and lipid peroxidation products (MDA) were determined and the activities of the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione‐peroxidase (GSH‐PX) in erythrocytes were measured. In addition, ROS production (superoxide anion and hydrogen peroxide) in activated neutrophils was assessed.

Results: Plasma levels of ascorbate, β‐carotene and selenium were reduced in both patient groups, when compared to controls. Decrease in selenium was more pronounced in the MOF‐ARF group. MDA levels were increased in both groups, again being more pronounced in MOF‐ARF patients compared to MOF patients. Hydrogen peroxide production by neutrophils from both patient groups was lower than from controls.

Conclusion: A depression of the antioxidative system is present in critically ill patients with MOF. In patients with associated ARF this was even more pronounced and plasma MDA levels were higher, suggesting an additional effect on the antioxidative potential in the presence of renal dysfunction and/or renal replacement therapy.
Core and thenar skin temperature variation during prolonged abdominal surgery: comparison of two sites of active forced air warming
Authors: Motamed C. , Labaille T. , Léon O. , Panzani J. P. , Duvaldestin PH. , Benhamou D.
Published: March 2003

Background: This study was designed to compare the efficacy of two different sites of active forced air warming, upper body or lower body, to maintain normothermia; and their respective effect on thenar skin temperature in relation to the accelerographic monitoring of neuromuscular blockade during long‐lasting abdominal surgery.

Methods: Twenty‐six patients were randomised into two groups: upper body, (n=13) and lower body, (n=13), for intraoperative forced air warming. General anaesthesia was induced with thiopentone, sufentanil, and maintained with a mixture of N2O/O2/isoflurane. Pancuronium, 0.1 mg · kg−1was used to facilitate tracheal intubation. Reinjection doses of 0.01 mg · kg−1 were administered once 25% recovery of first twitch height of train‐of‐four stimulation had occurred, or if surgical relaxation was estimated as inadequate by the surgeon. Thenar skin temperature and core temperature were monitored continuously.

Results: A similar trend for core temperature profile was observed in both groups. After an initial mild hypothermia, normothermia was reached progressively. Normothermia was obtained faster with lower body forced air warming than with upper body (2 h versus 3 h), P<0.05. Thenar skin temperature significantly increased during the first 90 min of surgery. This rise was significantly higher in the upper body group at 40 min and 60 min, P=0.03 and P=0.01, respectively. Stabilisation of thenar skin temperature occurred after 2 h without any further significant difference between groups. Muscle relaxant requirements were not significantly different between the groups.

Conclusion: This study suggests that during long‐lasting abdominal surgery, normothermia is maintained after 2–3 h by either upper or lower body active forced air warming. After an initial post‐induction mild hypothermia, normothermia was achieved faster with lower body surface warming. Thenar skin temperature trend showed that it remained above 32°C during most of the procedure in both groups.
Lung lymph response to overinfusion with hydroxyethyl starch in sheep
Authors: Koizumi T. , Kaneki T. , Yamamoto H. , Ri‐Li GE. , Drome Y. , Kubo K. , Shibamoto T.
Published: March 2003

Background: Several hydroxyethyl starch (HES) solutions are available clinically. We performed comparative studies of low and high molecular weight HES to evaluate the effects on lung lymph flow in sheep, to see the difference in the types of HES.

Methods: We prepared awake sheep with vascular monitorings and lung lymph fistulas. We measured systemic artery pressure (Psa), pulmonary artery pressure (Ppa), and left atrial pressure (Pla) continuously. Cardiac output (CO) was measured every 30 min. Lung lymph flow (Qlym) was collected every 15 min. After baseline measurements, two HES solutions were infused over 2 h, respectively. Experiment 1 (n=6): low molecular weight HES (MW 70 000, substitution ratio 0.5–0.55), Experiment 2 (n=5): high molecular weight HES (MW 450 000, substitution ratio 0.7).

Results: Both low and high molecular HES behaved similarly as a volume expander, increasing Psa, CO, Pla and Ppa, and decreasing hematocrit. In addition, the actual oncotic pressure gradient (plasma – lymph) was widened after the start of either low or high molecular HES, but the value for high molecular HES was significantly higher than that for low molecular HES. Qlym of low molecular HES rose significantly from the baseline and the percent increase in Qlym for low molecular HES was significantly higher than that for high molecular HES.

Conclusion: These data suggest that low molecular HES is as useful a plasma substitute as high molecular HES, but may increase lung fluid filtration in the overinfused state.
Intraperitoneal lidocaine for postoperative pain after laparoscopy
Authors: Elhakim M. , Elkott M. , Ali N. M. , Tahoun H. M.
Published: March 2003

Background: A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating pain after laparoscopic cholecystectomy. The use of intraperitoneal lidocaine was evaluated in this study.

Methods: At the end of surgery, 200 ml saline containing 200 mg lidocaine, or the same volume of saline, were randomly splashed under the right diaphragmatic surface in 50 patients in a double‐blind manner. Postoperative shoulder and abdominal pain intensity were recorded on a numeric grading scale and a visual analogue scale, respectively. Analgesic consumption was also recorded. Respiratory function tests were compared before and after surgery. Side effects and recovery variables were assessed by the nurses at 2‐h intervals.

Results: The incidence, severity and duration of shoulder pain were reduced from 40% of patients scoring 3.9±0.2 for duration of 17.9±0.2 h in the control group to 12% scoring 2.5±0.5 for duration of 1.6±0.01 h in the lidocaine group. Lidocaine treated patients had significantly less abdominal postoperative pain immediately on return to the ward and during the first postoperative day (P<0.05). “No pain on deep inspiration” was reported by 72% of patients in the lidocaine group immediately on return to the ward compared to 8% of those in the control group. Analgesic consumption for 24 h after surgery was significantly less in the lidocaine group (P<0.05). There were no significant differences in respiratory function tests, recovery variables or incidence of side effects between the two groups.

Conclusion: Intraperitoneal lidocaine is simple to use and results in a long‐lasting reduction of pain after a single administration.
The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%
Authors: Keld D. B. , Hein L. , Dalgaard M. , Krogh L. , Rodt S. Å.
Published: March 2003

Background: The incidence of TNS after spinal anaesthesia is a problem. Especially the use of hyperbaric lidocaine in patients placed in the lithotomy position during surgery has been associated with a high incidence of TNS. The present study was performed to investigate whether TNS is present more frequently in patients undergoing surgery in the supine position with use of hyperbaric lidocaine compared with hyperbaric bupivacaine.

Method:

Seventy patients were included and randomised to receive either hyperbaric lidocaine or hyperbaric bupivacaine. All patients were contacted on the first and third postoperative days by an anaesthesiologist blinded to the local anaesthetic used. The patients were asked about symptoms of TNS, pain not associated with the operation area, and asked to grade the complaints after a verbal analogue score from 0 to 10.

Results: We found a total of ten patients who showed signs of TNS. There were nine patients in the lidocaine group (26%) who showed signs of TNS compared to only one patient in the bupivacaine group (3%) (P<0.01). The average score of TNS complaints was 3.5. A total of 13 patients (19%) complained of back pain. There were no significant differences with regard to which local anaesthetic was used. The average score of back pain was 3.3.

Conclusion: TNS is a significant problem in patients having spinal anaesthesia with hyperbaric lidocaine compared to hyperbaric bupivacaine, both in the supine position. For day‐case surgery, TNS would start after dismissal from hospital. The use of hyperbaric lidocaine is therefore questionable, even though these problems are of an order that the majority of patients would still choose spinal anaesthesia for future operations.
High‐dose rectal and oral acetaminophen in postoperative patients – serum and saliva concentrations
Authors: Hahn T. W. , Mogensen T. , Lund C. , Schouenborg L. , Rasmussen M.
Published: March 2003

Background: The primary purpose of the study was to examine the absorption of acetaminophen by measuring serum and saliva concentrations produced by a standard postoperative acetaminophen dosing regimen and secondary to examine the correlation between saliva and serum concentrations of acetaminophen after rectal and oral dosing.

Methods: Twenty‐four women, aged 18–60 years, scheduled for minor gynaecological laparoscopic surgery were studied. Patients received acetaminophen 2000 mg suppositories after surgery and oral doses of 1000 mg at 4 and 8 h postoperatively. Alfentanil was available via patient‐controlled analgesia. Saliva and blood samples were collected postoperatively.

Results: At 1, 2, 3, and 4 h after rectal dosing the saliva concentrations (mean±SD) were 15.2±5.9 μmol/l, 33.7±12.5 μmol/l, 45.5±19.1 μmol/l, and 55.4±23.1 μmol/l, respectively. The serum concentrations at 2 and 4 h were 31.0±11.2 μmol/l and 54.8±23.8 μmol/l, respectively. Additional oral dosing resulted in saliva concentrations at 5, 8, and 9 h of 99.7±49.5 μmol/l, 106.9±31.7 μmol/l, and 139.3±55.4 μmol/l, respectively, with coincident serum concentrations of 100.1±50.2 μmol/l, 105.6±29.0 μmol/l, and 141.2±52.1 μmol/l. After rectal dosing the linear regression resulted in r2=0.96, P<0.001 and saliva/serum‐ratio=0.99. After additional oral dosing the outcome of linear regression was: r2=0.90, P<0.001 and saliva/serum‐ratio=1.00.

Conclusion: The slow and ongoing absorption process resulting in no maximum concentration within 4 h after administration of 2000 mg acetaminophen suppositories makes this rectal regimen therapeutically irrational for treatment of postoperative pain. The significant ratio and linear correlation between saliva and serum concentrations of acetaminophen suggests that saliva could be used instead of blood to monitor acetaminophen administration in patients.
Sevoflurane as a sole anaesthetic for thymectomy in myasthenia gravis
Authors: Kiran U. , Choudhury M. , Saxena N. , Kapoor P.
Published: March 2003

Myasthenia gravis is a challenging situation for anaesthesiologists due to its neuromuscular involvement. The main concerns are respiratory muscle weakness and side effects due to a heavy dose of anticholinesterases. This limits the use of sedatives, hypnotics and muscle relaxants. Inhalational anaesthetics are best suited. We describe our experience with sevoflurane as a sole anaesthetic in a child having juvenile‐type myasthenia gravis with thymoma, who underwent thymectomy by midsternal incision. Very smooth and short duration of induction (35 s) and easy intubation within 60 s without use of muscle relaxant were the remarkable features. Sevoflurane in oxygen and nitrous oxide (MAC=0.5–0.7) was used for maintenance of anaesthesia. Recovery was smooth and fast with no residual respiratory insufficiency. Hence we found sevoflurane to be a highly suitable agent for thymectomy in mysthenia gravis.
Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy
Authors: Frietsch T. , Krafft P. , Becker H. D. , Buelzebruck H. , Wiedemann K.
Published: March 2003

Background: Gas exchange during high‐frequency jet ventilation (HFJV) for prolonged rigid bronchoscopy (RBS) is usually monitored by arterial blood gas analysis. Capnography of expired gases during brief HFJV discontinuation may be a reliable and noninvasive supplemental method. Capnography can be performed either for single breaths or with respiratory rate (RR) reduced to 10 · min−1. The aim of this study was to demonstrate that capnography during short periods of HFJV discontinuation represents a reliable measure of PaCO2 during prolonged RBS.

Methods: We prospectively investigated 100 consecutive patients (75 male and 25 female) undergoing HFJV for RBS. HFJV was delivered through the rigid bronchoscope at the following settings: working pressure 1.2 bar, rate 100 · min−1, FIO2 0.99, ti/ttot0.6. The light guiding channel ending at the distal tip of the rigid bronchoscope was used for gas sampling. Capnograms were assessed at 5 min intervals and compared to PaCO2 from arterial blood samples drawn simultaneously. The accuracy of single breath CO2 sampling was compared with sampling at RR=10 · min−1.

Results: Mean duration of RBS was 30±21 min. A significant correlation between capnography (PetCO2) and arterial blood gas analysis (PaCO2) was observed, being r=0.90 for the RR=10 · min−1 method and r=0.91 for the single breath method. Mean difference between PaCO2 and PetCO2 was 0.37±0.2 kPa throughout the entire study period. No significant differences between single breath sampling or sampling at RR=10 · min−1 were observed.

Conclusion: Capnography performed during short periods of HFJV discontinuation reliably and noninvasively reflects PaCO2 during prolonged endoscopic procedures. Capnography during HFJV for RBS may reduce the frequency of arterial blood gas sampling, the duration of unmonitored intervals and costs.
Milrinone therapy in catecholamine‐dependent critically ill patients with heart failure
Authors: Siostrzonek P. , Koreny M. , Delle‐Karth G. , Haumer M. , Koller‐Strametz J. , Heinz G.
Published: March 2003

Background: Treatment with the PDE‐III inhibitor milrinone improves hemodynamics in patients with heart failure. We examined whether therapy with milrinone is safe and effective in critically ill patients with catecholamine‐dependent heart failure and whether treatment with milrinone facilitates weaning from prolonged catecholamine therapy.

Methods: Twenty adult patients with reduced left ventricular function and prolonged (7±4 days) catecholamine therapy in whom attempts at catecholamine weaning had failed were examined. Patients were prospectively randomised either to group A (addition of a fixed dose of 0.5 μg · kg−1 · min−1 milrinone to catecholamine therapy) or to group B (continued catecholamine therapy without milrinone). Dobutamine and norepinephrine treatment and fluid intake were titrated according to predefined hemodynamic goals. Hemodynamic parameters, fluid requirements and catecholamine dose were monitored.

Results: After 24 h of study treatment goup A showed a significant increase in cardiac index (2.2±0.4 l min−1 · m−2 to 2.7±0.5 l min−1 · m−2; P<0.005), a decrease in systemic vascular resistance (1427±609 dyn · s · cm−5 to 951±184 dyn · s · cm−5; P<0.005), required lower doses of dobutamine (5.9±4.2 μg · kg−1 · min−1 to 2.2±3.3 μg · kg−1 · min−1; P<0.02), but showed a tendency for higher vasoconstrictor (0.14±0.16 μg · kg−1 · min−1 to 0.29±0.43 μg · kg−1 · min−1; P=n.s.) and fluid requirements (+1404±2257 ml/24 h to +2508±1873 ml/24 h; P=n.s.). No significant changes occurred in group B. Weaning from catecholamine therapy was more often achieved in group A and more milrinone treated patients were discharged alive from the ICU (80% vs. 30%; P<0.05).

Conclusions: Milrinone improves central hemodynamics and may facilitate weaning from prolonged catecholamine support in critically ill patients with heart failure. Its administration in this subset of critically ill patients is safe, but eventually is associated with additional vasoconstrictor and fluid requirements.
Differential action of spasmolytic vasodilators on platelet aggregation and endothelial cell‐dependent anti‐aggregation
Authors: Az‐Ma T. , Saeki N. , Yuge O.
Published: March 2003

Background: The perioperative use of spasmolytic vasodilators during reconstructive or vascular surgery is an important therapeutic procedure to prevent vascular spasm. Platelet aggregation at vascular endothelium injured by the surgical manipulation is thought to be associated with the persistency of spasm, although little is known about the effects of these drugs on platelet aggregation and on anti‐aggregation provoked by endothelial cells.

Methods: (1) To test the direct effect of vasodilators against platelet aggregation, change in light transmission through platelet‐rich plasma (PRP) stimulated with 4 μg/ml collagen was measured in the absence or presence of pentobarbital, papaverine, prostaglandin E1 (PGE1), trinitroglycerin, nitroprusside, nicardipine, and diltiazem. (2) Effects of these drugs on endothelial cell‐dependent anti‐aggregation were then evaluated. Incubation buffer of cultured porcine aortic endothelial (PAE) cells, which were preincubated with vasodilators for 10 min prior to a 1‐min stimulation with 1 μM bradykinin, was transferred to collagen‐stimulated PRP.

Results: (1) Papaverine and PGE1 directly inhibited platelet aggregation in a concentration‐dependent manner. All other drugs failed to inhibit aggregation. (2) Incubation buffer of PAE cells stimulated with bradykinin showed a potent anti‐aggregation. Pentobarbital concentration‐dependently inhibited the endothelial cell‐dependent anti‐aggregation. Every other drug did not inhibit the anti‐aggregation by PAE cells.

Conclusion: Because of the direct anti‐aggregatory effect without inhibiting endothelial cell‐dependent anti‐aggregation, we suggested that papaverine and PGE1 were the most promising vasodilators of all drugs examined in this study while further evaluation is required for the clinical relevance of the present study.
A randomised study of lidocaine and prilocaine for spinal anaesthesia
Authors: Østgaard G. , Hallaråker O. , Ulveseth O. K. , Flaatten H.
Published: March 2003

Background: Transient neurologic symptoms (TNS) are common after lidocaine‐induced spinal anaesthesia (SA). Recent data indicate that TNS may be less frequent after prilocaine‐induced spinal anaesthesia, for which reason the isobaric solution was compared with lidocaine.

Methods: One hundred patients scheduled for short urologic procedures under spinal anaesthesia were randomised to receive 80 mg prilocaine or lidocaine, both 20 mg/ml. The clinical course and the duration of anaesthesia were monitored. The following day an anaesthesiologist unaware of the randomisation interviewed the patients using a structured questionnaire.

Results: Following prilocaine spinal anaesthesia the mean time until 2‐segment regression was 123(SD 42) min and total sensory block lasted 221(49) min, compared to 106(26) and 181(48) min following lidocaine. TNS occurred in 7/49 patients in the lidocaine group and in 2/50 in the prilocaine group (ns).

Conclusion: TNS occurred also after isobaric prilocaine SA. The frequency was not significantly different from that following lidocaine SA but larger studies are needed to establish the relative risk of TNS following SA induced by the two local anaesthetics. Isobaric prilocaine has a longer duration of action than an equal dose of lidocaine and may be an alternative drug for spinal anaesthesia of intermediate or short duration.
A comparison of the hemodynamic effects of paracervical block and epidural anesthesia for labor analgesia
Authors: Manninen T. , Aantaa R. , Salonen M. , Pirhonen J. , Palo P.
Published: March 2003

Background: Both paracervical block (PCB) and epidural analgesia are sometimes associated with hemodynamic effects potentially harmful to the well‐being of the fetus. Our study was designed to test the hypothesis that PCB would have a more profound effect on maternal and fetal blood flow than epidural analgesia.

Methods: Forty‐four healthy primiparous parturients were randomized to receive either PCB (n=21) or epidural analgesia (n=23) with 25 or 30 mg of bupivacaine, respectively, for labor analgesia. Maternal blood pressure and fetal heart rate were recorded. Blood flow was measured using a color Doppler device. The blood flow measurements consisted of assessment of the pulsatility indices (PI) of the right maternal femoral artery and the main branch of the uterine artery (placental side), the umbilical artery and the fetal middle cerebral artery. The measurements were performed before administration of analgesia and approximately 15–20 min later after the onset of analgesia.

Results: Both methods provided in general good analgesia, but rescue medication was required more often after PCB. Epidural analgesia decreased maternal blood pressure more than PCB and the PI of maternal femoral artery decreased after onset of epidural analgesia, indicating epidural‐induced vasodilation. The PI of the uterine artery increased after the onset of PCB, indicating vasoconstriction of this artery. No significant adverse effects or differences in the well‐being of the newborn were observed, as indicated by similar Apgar scores and pH‐status.

Conclusion: There were small differences in the effects of PCB and epidural analgesia on uteroplacental circulation as well as on maternal hemodynamics. PCB may have a vasoconstrictive effect on the uterine artery. This and the fact that the parturients required rescue analgesia more frequently after PCB than after epidural block speaks for the feasibility of the latter in obstetrics.
A catheter technique in ophthalmic regional anaesthesia
Authors: Gombos K. , László C. J. , Hatvani I. , Vimláti L. , Salacz G.
Published: March 2003

Background: Usually general anaesthesia is chosen if ophthalmic surgery of longer duration is expected. Our goal was to introduce a flexible catheter preoperatively into the extra‐ or intraconal space and to provide sufficient anaesthesia by continuous administration of a local anaesthetic via the catheter.

Methods: The continuous anaesthetic technique was applied in 28 patients undergoing vitreoretinal surgery. An indwelling catheter was introduced in 20 patients into the intraconal and in 8 patients into the extraconal space. In 6 patients, the position of the catheter was controlled by ultrasound examination prior to the injection of the local anaesthetic agent.

Results: For all patients adequate anaesthesia could be achieved and maintained with continuous retrobulbar administration (CRA) of a local anaesthetic by catheter. There were two patients who experienced moderate pain intraoperatively during continuous peribulbar administration (CPA). No complications occurred with the placement of the catheters. The catheter did not disturb the surgeon or the process of the ophthalmic surgery.

Conclusions: Continuous administration of a local anaesthetic agent via an indwelling catheter into the intraconal space allowed ophthalmic anaesthesia without time restriction. Thus, CRA is a good alternative to general anaesthesia for patients undergoing long‐lasting ophthalmic surgery.
Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol
Authors: Klemola U.‐M. , Mennander S. , Saarnivaara L.
Published: March 2003

Background: Alfentanil‐propofol combination provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil, especially in ambulatory surgery. In this study intubating conditions after remifentanil‐propofol were compared to those after alfentanil‐propofol.

Methods: In a randomized, double‐blind study 60 healthy patients were assigned to one of three groups (n=20). After intravenous atropine, remifentanil 3 or 4 μg kg−1 (Rem3 or Rem4) or alfentanil 30 μg kg−1 (Alf30) was injected over 30 s followed by propofol 2.5 mg kg−1. Sixty seconds after the administration of propofol, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.

Results: Overall conditions at intubation were significantly (P<0.05) better, and the frequency of excellent conditions was significantly (P<0.05) higher in the Rem4 group compared with the Alf30 group. Intubation was judged to be impossible in 20%, 25% or 5% of the patients in the Alf30, Rem3 or Rem4 groups, respectively. No patient manifested signs of opioid‐induced muscular rigidity. In terms of arterial pressures or heart rate, there were no differences between the groups.

Conclusion: The best method was the combination of remifentanil 4 μg kg−1 and propofol 2.5 mg kg−1. This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.
Assessment of postoperative nausea using a visual analogue scale
Authors: Boogaerts J. G. , Vanacker E. , Seidel L. , Albert A. , Bardiau F. M.
Published: March 2003

Background: Assessment of postoperative nausea intensity is difficult because nausea is a subjective and unpleasant sensation. We propose using the Visual Analogue Scale (VAS) device to increase the efficiency and precision in the assessment of nausea. We carried out a pilot study on postoperative patients suffering from nausea to measure the degree of agreement between the VAS scores and those given on a 4‐point verbal descriptive scale (VDS).

Methods: Postoperative nausea was evaluated by means of a classical VAS (0–10 cm) device and a 4‐point VDS (0=no nausea, 1=mild, 2=moderate, 3=severe) in 128 surgical spontaneously complaining patients. Evaluation was repeated 45 min after rescue medication given if nausea was intractable, lasted more than 10 min or at the request of the patient. Ordinal logistic regression was used to measure the association between VAS and VDS and to determine cut‐off points on the VAS.

Results: The VAS device was easily understood and used by patients. VAS scores decreased significantly from 5.5±2.3 to 1.4±1.8 after rescue medication (P=0.002). Application of ordinal logistic regression to pre‐ and post‐medication data combined yielded an agreement of 86% between VAS and VDS and the cut‐off points on the VAS were estimated as follows: 0–1 (no nausea), 1+–4 (mild), 4+–7 (moderate) and 7+–10 (severe).

Conclusion: The VAS method proved to be useful for assessing quantitative nausea intensity and for testing the efficacy of rescue medication. It was found that a cut‐off value of 4 on the VAS may be considered as a critical threshold triggering anaesthesiologists or nurses to administer rescue medication.
Anaesthesia, recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia
Authors: Lie Karlsen K. , Persson E. , Wennberg E. , Stenqvist O.
Published: March 2003

Background: Whereas induction and recovery will occur more rapidly with the new low soluble anaesthetics than with isoflurane, the quality of anaesthesia and recovery with special emphasis on postoperative nausea and vomiting (PONV) is not well known.

Methods: In an open (peroperatively), double‐blinded (postoperatively), randomised controlled study, we assessed anaesthesia characteristics, recovery and 24 h PONV after breast surgery comparing isoflurane, desflurane and sevoflurane.

Results: There were no significant quality differences between the three agents during anaesthesia and recovery except for the incidence of PONV in the postanaesthesia care unit (PACU). The PONV rate (24 h in PACU and ward) was higher in the desflurane group (67%) than in the isoflurane group (22%), (P<0.01). The corresponding PONV rate for sevoflurane was 36%.

Conclusion: The quality of anaesthesia, time to opening of eyes and influence on respiration was similar with all three anaesthetics. As the emergence from anaesthesia did not differ significantly between the three agents, the choice of agent could be based on PONV rate and price. Desflurane had a significantly higher 24 h PONV rate than isoflurane. Early PACU PONV rate was significantly (P<0.05) lower for the more soluble isoflurane (4%) than for the low soluble gases, desflurane and sevoflurane together (28%). The result of this study does not give a rationale for a transition to the new low soluble agents in breast cancer surgery.
Postural post‐dural puncture headache. A prospective randomised study and a meta‐analysis comparing two different 0.40 mm O.D. (27 g) spinal needles
Authors: Flaatten H. , Felthaus J. , Kuwelker M. , Wisborg T.
Published: March 2003

Background: To compare the incidence of postural post‐dural puncture headache (PPDPH) after spinal anaesthesia using two different 0.40 mm O.D. (27 g) spinal needles: pencil‐point needle and Quincke needle. In addition, a meta‐analysis of studies comparing small bore spinal needles with regard to development of PPDPH was performed.

Methods: Clinical study: A prospective randomised double‐blind study was set up to investigate PPDPH after using 0.40 mm pencil‐point (Pencan, B. Braun) or Quincke (Spinocan, B. Braun) spinal needle. Postoperatively on day 5 to 7 a telephone interview was conducted in order to reveal postoperative complications such as headache and backache. PPDPH was considered present when the headache was new to the patient, and demonstrated posture dependence. Meta‐analysis: Electronic database search and manual search of relevant literature were performed in order to find randomised control trials comparing equal sized (outer diameter, O.D.) spinal needles with different bevel shape. Only studies with a proper method and not merely presented as an abstract were included in addition to the present clinical study.

Results: Out of 313 patients randomised, 301 were completely followed up, 153 in the pencil‐point group and 148 in the Quincke group. The two groups were comparable regarding surgical procedures and demographic data. Of 15 patients suffering from PPDPH, 12 were found in the Quincke group, and 3 in the pencil‐point group. The difference was 6.1% (95% CI from 1.2 to 12.5%). The meta‐analysis of 1131 patients gave a relative risk of developing PPDPH of 0.38 (95% CI from 0.19 to 0.75) in the pencil‐point group compared to the Quincke group.

Conclusion: A pencil‐point‐shaped spinal needle will significantly reduce PPDPH compared with Quincke‐type spinal needles, also when small bore needles (0.40 mm O.D.) are used.
Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action
Authors: Rømsing J. , Møiniche S. , Østergaard D. , Dahl J. B.
Published: March 2003

Background: In order to investigate the evidence for a peripheral analgesic effect of local infiltration with nonsteroidal anti‐inflammatory drugs (NSAIDs) in postoperative pain, we conducted a systematic review.

Methods: Randomised controlled and double‐blind trials were evaluated. Outcome measures were pain scores, the use of supplementary analgesics, and time to first analgesic request. Efficacy was estimated by significant difference (P<0.05) as reported in the original reports and by calculation of the weighted mean difference of pain scores between treatment groups.

Results: Sixteen studies with data from 844 patients were considered appropriate for analysis. The NSAIDs were administered as intra‐articular injections, as components of intravenous regional anaesthesia (IVRA), and by wound infiltration and were compared with systemic administration or placebo. In the four studies comparing intra‐articular NSAIDs with systemic administration a statistically significant effect in favour of intra‐articular NSAIDs was found. Only one study compared IVRA NSAID with systemic administration, showing a significant effect in favour of IVRA administration. No more than two of the five studies comparing intrawound NSAIDs with systemic administration showed significant effect after intrawound administration. Most of the studies comparing local infiltration with placebo showed significant effect in favour of local infiltration.

Conclusion: There is evidence for a clinically relevant peripheral analgesic action of intra‐articular NSAIDs while results of IVRA and wound infiltration with NSAIDs in postoperative pain are inconclusive. Trials without a systemic control group were not considered to provide evidence for a local effect.
Suppression of surgical hyperaldosteronism by potassium canrenoate during gynecologic surgery under sevoflurane anesthesia
Authors: Watanabe T. , Ogawa R.
Published: March 2003

Background: Surgical hyperaldosteronism leads to sodium and water retention during surgery and often causes postoperative edema. This study investigated the effect of potassium canrenoate (PC) on pituitary adrenocortical function in lower abdominal surgery under sevoflurane anesthesia.

Methods: Twenty patients were randomized to receive 400 mg of PC (the PC group, n=10) or saline (the control group, n=10) intravenously. The following parameters were determined: plasma aldosterone, adrenocorticotropic hormone (ACTH), plasma renin activity (PRA), serum sodium and potassium, urinary sodium and potassium, and urine output.

Results: The aldosterone and ACTH levels showed significant increases in the control group during surgery. Plasma ACTH also increased significantly in the PC group, but plasma aldosterone levels were unchanged during surgery. The urine Na/K ratio of the PC group was significantly higher than that of the control group.

Conclusion: The present study suggested that PC suppresses the increase of plasma aldosterone caused by surgical stress. That may prevent sodium retention and potassium excretion during surgery.
The effect of two low‐dose propofol infusions on the relationship between six‐pulse transcranial electrical stimulation and the evoked lower extremity muscle response
Authors: Van Dongen E. P. , Ter Beek H. T. , Aarts L. P. , Schepens M. A. , Morshuis W. J. , Benning F. J. , De Boer A. , Boezeman E. H.
Published: March 2003

Background: Transcranial stimulation of the motor cortex using high‐voltage electrical stimuli given in train is a method of monitoring the integrity of the motor pathways during thoracoabdominal aortic aneurysm surgery. The purpose of this study was to assess the relationship between the stimulus intensity and the corresponding amplitude of the myogenic motor evoked potential (tcMEP) in response to six‐pulse transcranial electrical stimulation during two levels of low‐dose propofol infusion and stable fentanyl/nitrous oxide anaesthesia.

Methods: Nine patients (37–78 yr) scheduled to undergo surgery on the thoracoabdominal aorta were studied. After achieving a stable anaesthetic state the output voltage was decreased with 50 V intervals from 350 V to 200 V during a target propofol infusion aimed at a plasma steady‐state concentration of 0.7 μg · ml−1 and increased with 50 V intervals from 200 V to 450 V during a target propofol infusion aimed at a plasma steady‐state concentration of 1.4 μg · ml−1. TcMEPs were recorded from the right tibialis anterior muscle.

Results: Doubling the target propofol infusion to 1.4 μg · ml−1 resulted in a 30–50% decrease in tcMEP amplitude. The largest tcMEP amplitude using the six‐pulse paradigm was found during a propofol infusion aimed at a plasma concentration of 0.7 μg · ml−1 and demanded a stimulus output of 350 V, corresponding to a charge density of 7.5 μC · cm−2 per phase.

Conclusion: Doubling the target propofol infusion to 1.4 μg · ml−1 provides less robust, but still recordable tcMEPs in response to six‐pulse electrical stimulation. Safety guidelines are discussed.
Retracted: Changes in the impact factor of anesthesia/critical care journals within the past 10 years
Authors: Boldt J. , Haisch G. , Maleck W. H.
Published: March 2003

Background: The impact factor (IF) is published by the Institute for Scientific Information (ISI). There is a tendency to assess quality of scientific journals with the help of the IF. An analysis of the changes in the IF over time in the different specialities may help to further enlighten the worth and problems of the IF.

Methods: The IFs listed under the subheadings Anesthesiology and Emergency Medicine & Critical Care in the Science Citation Index – Journal Citation Report were descriptively analysed over the past 10 years. Additionally, IFs of some other important journals (subheadings Surgery, Cardiovascular, General Medicine) were analysed.

Results: The IF of most of the journals showed a constant increase over the years (average in Anesthesiology: +65%; average in Emergency Medicine & Critical Care: +145%). IFs of the highest ranked journals of other specialities showed a similar increase over the years (average in surgical journals: +56%; average in cardiac journals: +59%; average in general journals: +40%). More Anesthesiology and Emergency Medicine & Critical Care journals originated from the USA show an IF >2.0 over the past 10 years than do European journals.

Conclusion: Although the value of the IF is highly controversial, it is a frequently used tool to assess rating of a medical journal. Anesthesiology and Emergency Medicine & Critical Care journals showed a continuous increase in the IF over the past 10 years.
Gastro‐intestinal complement activation during human liver transplantation: Impact on postoperative liver function
Authors: Rønholm E. , Tomasdottir H. , Runeborg J. , Mattsby‐Baltzer I. , Olausson M. , Åneman A. , Bengtsson A.
Published: March 2003

Background: Liver transplantation elicits a systemic inflammatory response and eventually a multiple organ failure syndrome. Gastro‐intestinal inflammatory activation with release of proinflammatory cytokines and complement activation may occur. This study evaluates gastro‐intestinal complement activation and the association with postoperative parenchymatous liver cell injury and liver dysfunction.

Methods: In 17 patients undergoing liver transplantation, blood samples were collected from radial artery and portal vein for analysis of complement SC5b‐9 and endotoxin concentration. Portal venous‐arterial SC5b‐9 plasma concentration gradients at 30 min after reperfusion were calculated. Outcome parameters included postoperative organ failure and serum concentrations of aspartate aminotransferase, alanine aminotransferase, bilirubin and factor II‐VII‐X.

Results: Patients with gastro‐intestinal SC5b‐9 release (n=7) had higher postoperative serum aspartate aminotransferase and alanine aminotransferase concentrations [49 (32–80) μkat/l vs 8 (6–14) μkat/l, P<0.01 and 33 (15–54) μkat/l vs 8 (4–23) μkat/l, P<0.04, respectively] and lower factor II‐VII‐X concentrations [46 (21–48)% vs 60 (47–69)%, P<0.02] compared to patients without gastro‐intestinal SC5b‐9 release (n=10). The ICU stay was prolonged in patients with gastro‐intestinal complement release. There was no difference in number of organ failures and serum bilirubin concentration between the groups. The endotoxin concentration in arterial and portal vein blood was low and the association between endotoxaemia and complement activation was poor.

Conclusion: Gastro‐intestinal complement activation may contribute to postoperative parenchymatous liver cell injury and liver dysfunction in patients undergoing liver transplantation.
Effects of dopexamine and volume loading on hemodynamics and oxygenation parameters in patients undergoing pulmonary resection
Authors: Müller M. , Sticher J. , Schindler E. , Padberg W. , Jänich S. , Hempelmann G.
Published: March 2003

Background: Pulmonary resection may result in a reduction in arterial oxygen pressure as well as in cardiac output. Since cardiac index, oxygen delivery, and oxygen consumption are considered as important determinants of patients’ outcome, we evaluated the effects of dopexamine and volume loading on cardiopulmonary variables in patients undergoing pulmonary resection.

Methods: Forty adult patients undergoing pulmonary resection for lung or bronchial tumors were included in an open placebo‐controlled study. The patients were selected according to a randomized sequence to group A (n=20) or group B (n=20). Dopexamine (2 μg · kg−1 · min−1) was started when steady state conditions were achieved after induction of anesthesia in group A. Saline 0.9% was given as control (group B). Hemodynamic monitoring was performed using a pulmonary artery catheter.

Results: Dopexamine increased heart rate, cardiac output and oxygen delivery compared with control without increasing oxygen consumption during anesthesia and surgery. Furthermore, dopexamine was found not to alter the course of PaO2/FiO2 values.

Conclusion: In patients undergoing pulmonary resection, dopexamine can be used perioperatively to increase cardiac index without decreasing the PaO2/FiO2 ratio.