bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Abdominal Surgery Under General Anaesthesia and of Postoperative Analgesic Therapy on Splanchnic Exchange of Some Blood Borne Energy Metabolites
Authors: Wiklund Lars , Jorfeldt Lennart
Published: January 2009

Sixteen patients with gallbladder disease, but otherwise healthy, were studied in connection with cholecystectomy. For postoperative analgesia, seven patients were given a posterior splanchnic blockade, 30 ml of 0.5 % plain lidocaine, and nine patients were given fentanyl intramuscularly in a dose of 3.5 μg/kg b.w. Immediately after the operation and before analgesia, the arterial blood concentrations of glucose, lactate, glycerol, 3‐hydroxybutyrate, and free fatty acids increased significantly. The splanchnic exchange of these metabolites was also significantly increased, except for glucose, the splanchnic release of which was significantly reduced. Induction of analgesia, by both methods, was followed by a rapid significant decrease of the arterial blood concentration of glycerol, which tended to rise later when the analgesia disappeared. The arterial blood concentration of glucose and lactate showed a tendency to decrease slowly following both kinds of analgesia, while the arterial blood concentration of 3‐hydroxybutyrate remained stable. The splanchnic release of glucose was significantly reduced after administration of fentanyl, while it increased significantly following splanchnic blockade, the splanchnic glucose release being correlated to arterial blood pH. The splanchnic release of 3‐hydroxybutyrate was significantly reduced during maximal analgesia in both groups. The splanchnic uptakes of glycerol and free fatty acids were correlated to their splanchnic inflows.
Comparative Effects of Repeated and Prolonged Inhalation Exposure of Beagle Dogs and Cynomolgus Monkeys to Anaesthetic and Subanaesthetic Concentrations of Enflurane and Halothane
Authors: Clark G. C. , Kesterson J. W. , Coombs D. W. , Cherry C. P. , Prentice D. E. , Kohn F. E.
Published: January 2009

Male and female Beagle dogs and Cynoniolgus monkeys were exposed to anaesthetic (1.5 MAC) and subanaesthetic [1/100 MAC) levels of enflurane and halothane for 3 hours on alternate days for 4 weeks. One‐half of the animals were killed following the last exposure and the remainder after 4 weeks of recovery. The animals' condition was assessed during anaesthetic periods by measuring respiration, ECG, I)lood pressure, temperature and EEC:. Haematology, urinalysis and clinical chemistry parameters were evaluated. Gross and microscopic pathological examinations were conducted at the end of the exposure and recovery periods. Two female monkeys in the mid‐ and high‐dose halothane groups died during the study. No deaths were observed in the enflurane group. No quantitative diffcrences were observed in respiration rate, heart rate, blood pressure and KEG activity of animals anaesthetized with enflurane or halothane. Muscle twitches were observed in slome mid‐ and high‐dose dogs inhaling enflurane, but not in monkeys. A number of liver function tests became abnormal in mid‐ and high‐dose halothane‐treated dogs and high‐dose haiothane‐treated monkeys. This was not observed with enflurane. Histopathologic alterations were confined to the her of animals exposed to halothane. In dogs, the lesions were characterized by centrilobular hepatocyte degeneration and/or necrosis, fibrohlastic proliferation, hepatocyte enlargement, fat deposition and glycogen depletion; and in mid‐ and high‐dosc monkeys by moderate to marked hepatocyte vacuolation and fat deposition. Except for one highdose dog, these lesions were not seen in animals killed after 4 weeks of recovery. No histopathologic alterations were observed with enflurane.
Effects of Enflurane Anesthesia on the Function of Ischemically Damaged Kidneys
Authors: Wickström I.
Published: January 2009

Enflurane is metabolizcd to inorganic fluoride. Serum levels of inorganic fluoride exceeding 50 pM/l are considered nephrotoxic for normal kidneys. Renal damage has not been observed after enflurane anesthesia in patients with normal renal function. Further impairment in patients with previously damaged kidneys has been reported. The restitution of function of is chemically damaged kidneys was studied in two groups of dogs. In one of the groups, dogs were submitted to a long duration enflurane anesthesia. The other group served as a control. In the first group the serum level of inorganic fluoride at the end of the anesthesia was 27.9 pM/L Renal function was studied with endogenous clearances and concentration capacity. The inorganir fluoride level achieved by enflurane anesthesia did not influence the restitution of renal function.
Enflurane in Renal Transplantation: Report of 375 Cases
Authors: de Temmerman P. , Gribomont B.
Published: January 2009

Our experience to date covers 675 kidney grafts performed in the Transplantation Department of the University of Louvain. The evolution of our anaesthesia methods has led us since the end of 1973 to conduct 375 transplantations with enflurane. The patients, aged between 18 months and 50 years, receive a conventional premedication, do not receive corticoids preoperatively nor undergo dialysis immediately prior to operation, but systematically receive a 5‐unit transfusion beforehand. Having successively abandoned gallamine, succinylcholine, thiopentone and finally halothane, our present anaesthetic protocol is as follows: induction under benzodiazepines, fentanyl and enflurane, intubation under laryngeal anaesthesia. Maintenance: enflurane (2–3 MAC hours) in open circuit, pancuronium (0.02 mg/kg/h) and occasionally fentanyl. Details and comparative advantages are discussed. This anaesthesia technique combined with the systematic administration of antilymphocytic and antithyniocytic serum in the postoperative period, and particularly the preliminary transfusion (producing blocking antibodies), has provided us, using cadaver kidney, with a survival rate of 96% at 6 months, 86% at 1 year and 80% at 2 years, the longest presently being 15 years.
Effects of Enflurane Anaesthesia and Surgery on Endocrine Function in Man
Authors: Oyama T. , Taniguchi K. , Ishihara H. , Matsuki A. , Maeda A. , Murakawa T. , Kudo T.
Published: January 2009

Forty‐five patients underwent enflurane anaesthesia and surgery. Anaesthesia alone evoked little change in the plasma concentrations of ACIH, cortisol or antidiuretic hormone (ADH), but there were significant increases during surgery. 'l'he plasma levels of aldosterone rose during anaesthesia alone, and a further increase was noted during surgery. Neither enflurane anaesthesia nor surgery significantly influenced plasma concentrations of renin activity and thyroxine. A significant decrease in the plasnia triiodothyronine levels was detected during anaesthesia alone, and a further decrease was found during and following surgery. Enflurane anaesthesia did not afIect the plasma level of luteinizing hormone (LH) in male subjects throughout surgery, but a significant decrease was detected in female patients on the first postoperative day. The plasma concentrations of testosterone decreased during anaesthesia alone and surgery, and a further decrease was noted on the first postoperative day.
Influence of Inhalation Anaesthetics on Bronchomotor Tone — Animal Experiments on Vago‐Vagal Reflex Bronchoconstriction
Authors: Morr‐Strathmann U. , Morr H.
Published: January 2009

Animal experiments showed that the inhalation anaesthetic agents enflurane and halothane caused neither a direct increase in bronchial resistance nor an indirectl) mediated increase in the susceptibility of the bronchial system to acetylcholine. There are, therefore, no contraindications to the clinical use of enflurane and halothane in cases of obstructive airway diseases, nor does the use of these agents present an increased risk for these patients.
Enflurane in Patients with Coronary Artery Disease
Authors: van Ackern K. , Franke N. , Peter K. , Schmucker P.
Published: January 2009

In 12 patients with coronary artery disease, hypertensive periods during aortocoronary bypass surgery were treated with 1 MAC enflurane. The effect of enflurane on the major determinants of myocardial oxygen consumption was studied. Systolic arterial pressure was reduced to a level of about 120 mmHg (16 kPa). The heart rate diminished by 16.5'x1. The cardiac index during enfiurane application was unchanged. Pulmonary artery wedge pressure was measured at short intervals and remained unchanged. The fall in arterial pressure and heart rate under unchanged preload produced a significant reduction in myocardial oxygen consumption as determined by calculation of the systolic wall tension and the tension time index. In five patients, the O2 content in coronary sinus blood was measured and the arterial‐coronary sinus 02 difference was found to be diminished. In the concentration used, enflurane reduced the myocardial oxygen consumption of patients with coronary artery disease.
The effect of nasotracheal intubation on the paranasal sinuses: A prospective study of 434 intensive care patients
Authors: PEDERSEN J. , SCHURIZEK B. A. , MELSEN N. C. , JUHL B.
Published: January 2009

A total of 434 patients admitted to the intensive care unit for mechanical ventilation were followed prospectively to investigate the influence of a nasotracheal tube on the paranasal sinuses. Twenty‐five patients died before the examination was completed. The rest were examined for clinical symptoms of sinusitis. If sinusitis was suspected or the patients were intubated for 5 days or more, an x‐ray of the sinuses was performed. In patients intubated for less than 5 days (N = 357), sinusitis was clinically suspected in three, but radiograph‐ically verified in only one. In patients intubated for 5 days or more (N = 47), 23 (49%) had affection of the paranasal sinuses. Patients needing a nasotracheal tube should be examined for sinusitis if they are intubated for more than 5 days or if unexplained fever, sepsis or purulent nasal secretion develops. If the suspicion is confirmed, the nasotracheal tube should be removed.
Transnasal butorphanol: a new method for pain relief in post‐cesarean section pain
Authors: ABBOUD T. K. , ZHU J. , GANGOLLY J. , LONGHITANO M. , SWART F. , MAKAR A. , CHU G. , COOL M. , MANTILLA M. , KURTZ N. , REICH L.
Published: January 2009

This study was undertaken to evaluate the efficacy and the safety of transnasal butorphanol (TNB) compared to intravenous butorphanol (IVB) in 186 patients experiencing moderate to severe post‐cesarean section pain. Patients were randomly assigned to five groups in a double‐blind fashion: Group I (n = 37) received 2 mg IVB, Group II (n = 38) 2 mg TNB, Group III (n = 36) 1 mg TNB followed by a repeat dose of 1 mg TNB at 60 min, Group IV (n = 38) 0. 5 mg TNB followed by a repeat dose of 0. 5 mg at 60 min, and Group V (n = 37) received placebo. All administrations were double dummy. Pain intensity and relief were noted and the incidence of side effects was recorded. Remedication with the same study drug was allowed up to 72 h. Onset of analgesia was more rapid in the 2 mg IV group compared to the three TN groups: 5 min vs 15 min, respectively. However, the 2 mg and the 1–1 mg TN groups had a longer duration of analgesia, approximately 4. 5 h, compared to 3. 0 h for the 2 mg IV group (P<0. 05). Somnolence was dose related and was the most frequent side effect, and was less frequent when the TN dose was divided into 2 doses administered 1 h apart. Multiple doses of TNB and IVB were safe and clinically acceptable up to 3 days at all doses studied. There were no incidences of nasal mucosa irritation, or cardiovascular or respiratory depression. It is concluded that transnasal butorphanol represents a safe and effective alternative to injectable butorphanol for post‐cesarean section pain and offers a better and longer duration of analgesia compared to IV butorphanol. The optimum dose seems to be 2 mg TN butorphanol and it is tolerated better when divided into 1 mg increments, given 1 h apart.
Effects of oral clonidine premedication and postoperative i.v. infusion on haemodynamic and adrenergic responses during recovery from anaesthesia
Authors: BERNARD J. M. , BOURRÉLI B. , HOMMÉRIL J. L. , PINAUD M.
Published: January 2009

The effects of clonidine, a central alpha2‐adrenoreceptor agonist, on haemodynamic and catecholamine changes were assessed during emergence from anaesthesia, a period which is associated with increased sympathetic nervous discharge, hypertension and tachycardia. According to a double‐blind randomized design, 32 patients received either clonidine, preoperatively given by oral route (3. 5 μg kg‐1) and postoperatively by i. v. infusion (0. 3 μg‐kg‐1‐h‐1), or a placebo. Perioperative management was similar in both groups. Measurements were made in the recovery room, before starting clonidine or placebo infusions for evaluation of clonidine premedication, and then during infusion as follows: when core temperature reached 37°C; then 2 h, and 6 h later. Prior to starting infusions, mean blood pressure (88 ± 15 vs 103± 14 mmHg) (11. 7 ± 2. 0 vs 13. 7 ± 1. 9 kPa), heart rate (67 ±8 vs 87 ± 17 beats min‐1) and plasma norepinephrine levels (462 ±393 vs 615 + 361 pg‐ml‐1) were lower in the clonidine group. Only at the latest measurement (6 h after core temperature reached 37°C) did clonidine elicit significant effects. The values during clonidine infusion compared to placebo were at this time: mean blood pressure (73 ± 10 vs 86 ± 13 mmHg) (9. 7 ± 1. 3 vs 11. 5 ± 1. 7 kPa), heart rate (71±6 vs 93± 13 beats‐min‐1) and plasma norepinephrine levels (240 ± 224 vs 451 ± 111 pg‐ml‐1). Our results suggest that: 1) preoperative clonidine may improve the haemodynamic profile associated with anaesthetic discontinuation, but 2) i. v. infusion (0. 3 μg · kg‐1. h‐1) did not prolong this effect during the early postoperative period in the face of the sympathetic nervous discharge of recovery.
Effects of bupivacaine and calcium antagonists on the rat uterine artery
Authors: NORÉN H. , LINDBLOM B. , KALLFELT B.
Published: January 2009

Bupivacaine is a commonly used local anesthetic in obstetrical practice, but since this compound also has a constrictor action on vascular smooth muscle it can be hazardous to the fetus. The aim of the present study was to analyze the effect of bupivacaine on the uterine vasculature using the rat uterine artery as a model. Small arterial segments were mounted in tissue chambers for isometric recording of vascular tension using a specially designed teflon‐steel gauge. Bupivacaine induced marked vasoconstriction and this vasoconstriction was reduced considerably by two different Ca antagonists, verapamil and nifedipine. Verapamil (10–5mol. 1‐1) reduced bupivacaine‐produced arterial contraction by a mean of 78% and nifedipine (2. 9 times 10‐7mol‐l‐1) reduced arterial contraction by a mean of 57%.
Maternal and fetal plasma atrial natriuretic peptide concentrations during elective caesarean section
Authors: Datta S. , Murphy M. T. , Carr D. B. , Bader A. M. , Johnson M. D.
Published: January 2009

Atrial natriuretic peptide (ANP) is stored in the atrial cardiocyte and is capable of exerting potent, selective, and transient effects on fluid and electrolyte balance and on blood pressure. Because fluid shifts and hemodynamic adjustments occur during parturition, ANP might play a homeostatic role in the parturient and fetoplacental unit. We measured maternal and fetal plasma ANP concentrations in 19 parturients during elective caesarean section. Plasma ANP levels were also measured in seven nonpregnant women of the same age group. The baseline ANP concentration in parturients was significantly higher (29.77 6.06 pg/ml vs 7.37 2.1 pg/ml; mean s.e. mean) than in their nonpregnant counterparts. The umbilical artery (UA) ANP concentration was significantly higher than the umbilical vein concentration (91.91 14.91 pg/ml vs. 40.04 9.71 pg/ml). Factors under the anaesthesiologist's control may influence maternal and fetal plasma ANP levels. There was a significant correlation between the volume of maternal Ringer's lactate infusion received and maternal ANP concentration. A significant correlation was seen between the total dose of ephedrine administered acutely prior to delivery and the UA ANP concentration. These data suggest that: 1) increased blood volume during pregnancy is associated with increased maternal plasma ANP levels, and 2) the fetus can produce its own ANP, and is thereby capable of responding to ANP stimulating factors.
Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia
Authors: Christensen E. F. , Schultz P. , Jensen O. V. , Egebo K. , Engberg M. , Grøn I. , Juhl B.
Published: January 2009

The effect of three postoperative regimes of respiratory therapy on pulmonary complications and lung function was compared in high‐risk patients. Fifty‐one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self‐administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS‐, PEP‐ and RMT‐groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT‐group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (Pao2) declined to mean 8.1 kPa and arterial saturation (Sao2) to 89%. There was no difference between the groups except for FVC, Pao2 and Sao2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT‐group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self‐administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.
Effects of interpleurally administered bupivacaine 0.5% on opioid analgesic requirements and endocrine response during and after cholecystectomy: a randomized double‐blind controlled study
Authors: Rademaker B. M. P. , Sih I. L. , Kalkman C. J. , Henny Ch. p. , Kok J. C. Filedt , Endert E. , Zuurmond W. W. A.
Published: January 2009

In 30 patients undergoing cholecystectomy, a randomized double‐blind saline‐controlled study was performed using inaterpleural 0.5% bupivacaine with or without epinephrine (5 μg ml‐1) in combination with 0.8d̀· halothane inspired concentration in oxygen. The aim of the study was to investigate whether interpleural 0.5% bupivacaine could decrease the intraoperative opioid requirements and attenuate the metabolic endocrine response to surgical stress. Patients were randomly allocated to one of three groups: Group 1: 0.5d̀· bupivacaine; Group 2: 0.5% bupivacaine with epinephrine (5 μg ml‐1); and Group 3: saline. The interpleural catheter was inserted after induction of anesthesia in the spontaneously breathing patient. The study drug was injected 30 min prior to surgery. Peak plasma bupivacaine concentrations in the respective groups were 1.30 X 0.78 and 1.16 X 0.48 μ X ml‐1. In all patients concentrations were below suggested convulsive level. Two patients in Group 1 and two in Group 2 required intraoperative fentanyl (0.1 mg each). In contrast, eight patients in the saline group received an average of 0.21 mg (range 0.1 X 0.4 mg) fentanyl (P <0.05). Postoperatively, a second dose of the study drug was given. Subsequently, pain was assessed using a visual analog score and a verbal rating scale. Pain scores decreased significantly 30 min after the interpleural injection in both bupivacaine groups and remained unchanged in the saline group (P <0.05). Pain management by means of interpleural bupivacaine was successful in 17 of the 20 patients. In the saline group seven out of ten patients needed additional analgesics (P <0.05). Cortisol levels increased in response to surgery in all groups: maximum levels in Groups 1, 2 and 3 were: 1.09 X 0.29, 1.11 X 0.20 and 1.19 X 0.16 μol X 1‐1, respectively. Plasma glucose concentrations increased significantly in all groups: maximum levels in Groups 1, 2 and 3 were: 7.6 X 1.3, 7.3 X 1.7 and 8.3 X 1.7 mmol X 1‐1, respectively. The results of this study indicate that painful surgical stimuli can be attenuated by interpleural administration of 0.5% bupivacaine. The metabolic endocrine response, however, remained unaffected.
Cerebral vasoreactivity and the prediction of outcome in severe traumatic brain lesions
Authors: Schalén W. , Messeter K. , Nordström C.H.
Published: January 2009

Mean hemispheric blood flow (CBF) was studied in 38 comatose, severely brain‐injured patients following intravenous administration of xenon‐133. Repeated measurements were performed in order to evaluate cerebral vasoreactivity following a decrease in Paco2. Simultaneously, arterial‐venous oxygen differences (AVDo2) and intracranial pressure (ICP) were measured. An impaired CBF response to hyperventilation (ΔCBF/ΔPaco2 < 1.0) was obtained in 22 patients. Three of 16 patients with preserved CO2‐reactivity died because of their brain injuries and 12 patients reached good recovery/moderate disability. In the group of patients with impaired vasoreactivity 11 of 22 patients died and only three patients reached good recovery/moderate disability. The study documents that in patients with severe traumatic brain lesions measurements of cerebral vasoreactivity to hyperventilation give prognostic information that is not obtained by clinical observations or CT‐scanning.
Plasma protein binding of bupivacaine in pregnant women at term
Authors: Wulf H. , Münstedt P. , Maier Ch.
Published: January 2009

The increased toxicity of bupivacaine in parturients is a well‐known phenomenon. The reduced plasma protein binding of bupivacaine is one of the possible reasons. Therefore, we measured the free fraction of bupivacaine in plasma samples of parturients and non‐pregnant volunteers. The free fraction was significantly higher in parturients (8.2% vs 5.4%) associated with a lower concentration of the alpha‐1‐acid glycoprotein (0.42 vs 1.01 g/l) and a higher concentration of progesterone (156 vs 0.4 ng/ml). The addition of progesterone to plasma samples of non‐pregnant volunteers did not influence the free fraction of bupivacaine, whereas the addition of alpha‐1‐acid glycoprotein to the plasma of parturients decreased the free fraction significantly. Therefore, the lower concentration of this protein is the principal reason for the higher free fraction of bupivacaine in pregnancy and possibly one of the causes of the higher incidence of toxic side effects of bupivacaine in obstetric use.
Adrenergic support during anesthesia in experimental endotoxin shock: norepinephrine versus dobutamine
Authors: van der Linden P. , Gilbart E. , Engelman E. , de Rood M. , Vincent J. L.
Published: January 2009

The effects of norepinephrine and dobutamine were compared during endotoxin shock in dogs anesthetized either with enflurane (E: 1.5%, N = 12) or with i.v. ketamine (K: 5 mg X kg‐1+ 0.2 mg X kg‐1X min‐1, N = 12). An i.v. bolus of 1.5 mg X kg‐1E. coliendotoxin was followed by saline infusion to restore left‐sided filling pressures at baseline. With E, heart rate, mean arterial pressure and stroke index decreased (P<0.01). The decrease in oxygen delivery (Do2) and in oxygen consumption (Vo2) was associated with an increase in blood lactate. In contrast, K anesthesia was associated with remarkable hemodynamic stability. Do2was well maintained, Vo2decreased (P<0.01) and blood lactate did not change. Under E anesthesia, mean arterial pressure increased more with norepinephrine and heart rate increased more with dobutamine. Under K anesthesia, cardiac index, stroke index and left ventricular stroke work index increased similarly with both agents. In both groups Do2and Vo2increased markedly. The amount of fluid infused was higher with dobutamine than with norepinephrine. Thus, enflurane but not ketamine had depressant cardiovascular effects at the doses used in this model. With both anesthetics, norepinephrine and dobutamine could effectively improve cardiac function. Dobutamine could therefore represent a valuable alternative to norepinephrine for cardiovascular support during anesthesia in septic shock.
Studies on the development of tolerance and potential spinal neurotoxicity after chronic intrathecal carbachol‐antinociception in the rat
Authors: Svensson B. A. , Sottile A. , Jr T. Gordh
Published: January 2009

The antinociceptive effect in rats produced by chronic intrathecal administration of carbachol was studied for 14 days by the tail immersion test and the paw compression test. Daily injection of 10 μg carbachol intrathecally (lumbar level) to 8 rats produced an increase in latency times lasting from day 1 to day 4. The effect was statistically significant during the first 4 days, but not thereafter in both the tail immersion test and the paw compression test as compared to the rats (n = 6) injected with saline. Histopathological examinations of the lumbar spinal cord by light and electron microscopy revealed no signs of neurotoxic reactions of the neurons, nor the spinal tracts. Quantitative morphometric analyses were made by the “disector method”, which is an unbiased stereological estimator of cell number and mean cell volume. In the laminae I‐III of the L:I segment, an average number of 88000 cells/mm3was found and the mean cell volume was calculated at 560 μm3. Comparison with untreated rats (n = 4) and those injected with saline showed no statistically significant differences. In the present study, the combination of different morphological analyses offers a sensitive method to trace toxic reactions of the nervous tissue. According to these results, intrathecal carbachol produces antinociception, and seems atoxic to spinal nervous tissue, but before intrathecal administration of carbachol to humans is considered, more neurotoxicological data must be obtained.
Arterial blood gases in patients with acute head injury at the accident site and upon hospital admission
Authors: Pfenninger E. G. , Lindner K.‐H.
Published: January 2009

Prior to the start of supportive therapy at the site of the accident, arterial blood samples from 47 patients with acute head injury were taken for blood gas analysis. At the same time, the degree of unconsciousness was assessed using the Glasgow‐Coma‐Scale. After transport to the hospital, arterial blood gases and the level of unconsciousness were again determined. A very close correlation was found between the initial depth of unconsciousness and the degree of hypercapnia (R = ‐0.90). Patients with head injury and other multiple injuries did not differ in this respect (R= ‐0.95) from those with isolated head injury. ‘The correlation between Pao’, and the degree of unconsciousness was less well defined, and the results showed a greater degree of scatter (R = 0.54). The acidosis observed resulted mainly from the rise in Paco2. The absence of any correlation between the base excess and the Glasgow‐Coma‐Scale levels (R= ‐ 0.27) makes a common metabolic derangement unlikely. As a result of intubation and controlled ventilation, the hypercapnia of the comatose patients had been corrected, and a correlation could no longer be found between the Glasgow‐Coma‐Scale level and the Paco2. In order to avoid hypoventilation, which carries with it the danger of a rise in intracranial pressure, all patients with severe head injury should be intubated and ventilated as soon as possible after the accident.
Isocapnic high frequency jet ventilation: dead space depends on frequency, inspiratory time and entrainment
Authors: Fletcher R. , Malmkvist G. , Lührs C. , Mori N. , Drefeldt B. , Brauer K. , Jonsson B.
Published: January 2009

Twelve healthy pigs were ventilated with high frequency jet ventilation via a Mallincrodt HiLo jet tube. The expired gas was led to a conventional ventilator and CO2 analyzer which were used to measure CO2 climination. There was no bias flow, so that the jet entrained only expired gas, i.e. rebreathing occurred. Frequency was varied between 2 and 11 Hz and the duration of inspiration, as a fraction of the ventilatory cycle (Ti/Ttot), from 5 to 20%. The minute ventilation, Vjet, delivered by the jet ventilator was adjusted to maintain a constant Paco2. At 2 Hz and a Ti/Ttot of 5%, Vjet was of the same magnitude as ventilation during conventional intermittent positive pressure ventilation, and the total dead space fraction, VD/VT was 0.32. Both increasing frequency at a constant Ti/Ttot, and increasing Ti/Ttot at a constant frequency, increased VD/VT which was maximal (0.8) at 11 Hz and a Ti/Ttot of 20%. When entrainment was blocked, tidal jet volume had to be greatly increased. The continuous measurement of CO2 climination was found to be useful for maintaining isocapnia when the jet ventilator setting was changed.
Serum potassium levels after induction of epidural anaesthesia using mepivacaine with and without adrenaline
Authors: Löfgren A. , Hahn R. G.
Published: January 2009

The short‐term effect of epidural anaesthesia (EDA) on the serum potassium (S‐K) concentration was studied in 40 elderly men scheduled for minor urological surgery. In Group I, EDA was induced with mepivacaine 2% + adrenaline 1:200,000 (n = 20) and in Group II mepivacaine 2% was used (n = 20). When EDA had been induced, the mean plasma level of adrenaline was tripled in Group I, while it had decreased in Group II. In Group I there was a decrease in the arterial S‐K concentration of up to 0.75 mmol‐I‐1 with a mean of 0.31 mmol‐I‐1, s.d. 0.20 (P < 0.001). In Group II, a small but significant decrease of the S‐K level was recorded in arterial (0.14 mmol‐I‐1, s.d. 0.14; P<0.001) but not in venous serum. Two‐way analysis of variance showed that the addition of adrenaline to the local anaesthetic solution, but not the choice of using arterial or venous serum for analysis, significantly correlated to the lowering of the S‐K concentration (P <0.001).
The effect of orally administered diazepam and midazolam on plasma beta‐endorphin, ACTH and preoperative anxiety
Authors: Pippingsköld K. , Lehtinen A‐M. , Laatikainen T. , Hänninen H. , Korttila K.
Published: January 2009

Ninety‐five women undergoing induced abortion were randomly premedicated with oral diazepam, 5 or 10 mg, midazolam 15 mg, or intramuscular placebo, 40–60 min before the induction of anesthesia. Prior to premedication and again prior to the procedure, the women completed the questionnaire sheet for the Profile of Mood States (POMS), and plasma samples for immunoreactive β‐endorphin (ir β‐E) and ACTH were taken. The Oblique Tension‐Anxiety (T‐A) Factor scores derived from POMS correlated with plasma concentrations of ir β‐E and ACTH after premedication. The T‐A scores decreased in women premedicated with diazepam, 5 and 10 mg, or midazolam, 15 mg, but not in women treated with placebo. The women premedicated with midazolam, 15 mg, became more fatigued after premedication. The changes in blood pressure after premedication correlated with T‐A scores. A positive correlation was found between heart rate and plasma β‐endorphin concentration. The changes in ir β‐E and ACTH did not correlate with the changes in T‐A scores. We conclude that POMS T‐A scores are useful for assessment of preoperative anxiety and the effect of premedication. The present study did not provide any reliable proof to confirm the hypothesis of a relationship between plasma concentrations of ir β‐E or ACTH and preoperative anxiety. Since many factors modulate endorphin and ACTH secretion prior to operation, the measurement of endogenous opiates may be of limited value in assessment of the effects of preanesthetic medication.
Oxygenation during local anaesthesia for cataract surgery
Authors: Pälve H. , Ali‐Melkkilä T.
Published: January 2009

The oxygenation of 48 elderly patients scheduled for cataract surgery under local anaesthesia was studied using pulse oximetry and nasopharyngeal oxygen measurement. After a control period the patients breathed supplemental oxygen 2 1/min and later 4 1/min, via either a face mask or a nasal catheter. The effects of the two oxygen flow levels and oxygen delivery methods on oxygenation were assessed. The lowest oxygen saturation values were seen after retrobulbar block before the patients were transferred to the operating room. The surgical draping did not cause hypoxaemia and the 2 1/min oxygen flow was sufficient to cause hyperoxaemia in all patients. The face mask and nasal catheter appeared to be equally good in oxygenating the patients.
Minimum alveolar concentration of halothanediethyl‐ether azeotrope
Authors: Kalman S. , Bengtsson M. , Lindmark D.
Published: January 2009

The azeotropic mixture of halothane and diethyl ether (HE) may be a valuable alternative to other anaesthetic agents under circumstances such as war, civil disaster, and primitive conditions. In the present study the minimum alveolar concentrations (MACs) for HE in man (n = 25) and in pigs (n = 6) were determined. For comparison with results of other studies, the MAC for halothane in man (n = 14) was also determined. A Normac gas analyser and a Varian 3700 gas chromatograph were calibrated against known standards of HE. The performance of two vaporizers (Fluotec Mark III, Servo vaporizer for halothane) was studied. The Fluotec Mark III vaporizer and the Servo halothane vaporizer filled with HE gave a linear performance with increasing dial settings. The Normac gas analyser set for methoxyflurane was linearly sensitive to the ether component of the azeotrope. The MAC for HE in man was 0.71 vol.% 0.03 (s.e.mean) (ether 0.21 vol.%, halothane 0.50 vol.%) in the age group 19–42 years. MAC for halothane in man was 0.65 0.03 in the age group 19–32 years. The MAC for HE in pigs between 20–24 kg was 0.99 vol.% 0.07. The ether component seems to act synergistically with halothane in the azeotropic mixture. The present study provides an opportunity to compare HE with other volatile anaesthetic agents.
Postoperative patient‐controlled analgesia with sufentanil: analgesic efficacy and minimum effective concentrations
Authors: Lehmann K. A. , Gerhard A. , Horrichs‐Haermeyer G. , Grond S. , Zech D.
Published: January 2009

Sufentanil has so far seldom been used for intravenous postoperative patient‐controlled analgesis (PCA), and the resulting serum concentrations have not yet been determined. Forty ASA I‐III patients recovering from major gynecological operations were investigated to evaluate analgesic efficacy, side effects, patient acceptance and threshold concentrations of sufentanil in serum during the early postoperative period, using the On‐Demand Analgesia Computer (ODAC). Following an individualized intravenous loading dose of 19.1 35.7 μg (mean 1 s.d.), sufentanil demand doses were 6 μg with a concurrent infusion of 1.15 μg/h and a maximum hourly dose of 40 μg/h; the lockout time was set to 1 min. The duration of PCA was 17.3 2.1 h. During this time 16 11 demands per patient were recorded, resulting in an average sufentanil consumption of 131.1 69.4 μg or 7.5 3.7 μg/h (including loading dose). Analgesia was mostly judged good. Side effects were only of minor intensity. Sufentanil proved to be about 2.2 to 3.8 times as potent an analgesic as fentanyl when both analgesic effect and duration were considered. Minimum effective sufentanil serum concentration (MEC) as determined by radioimmunoassay varied greatly and could be best described by a log‐normal distribution (range < 0.01–0.56 ng/ml, median 0.024 ng/ml). Intraindividual MEC variability was slightly lower than intersubject variability (76.0 vs. 84.8%). It is concluded that sufentanil is suitable for postoperative PCA. To get into the therapeutic window for analgesia, a serum sufentanil concentration of more than 0.03 ng/ml seems to be necessary.
Pneumoperitoneum — a rare complication of cardiopulmonary resuscitation
Authors: Hartoko T. J. , Demey H. E. , Rogiers P. E. , Decoster H. L. , Nagler J. M. , Bossaert L. L.
Published: January 2009

Pneumoperitoneum following cardiopulmonary resuscitation (CPR) results from a thoracic air leak (pneumothorax, pneumomediastinum) with escape of the air through diaphragmatic apertures (mostly foramen of Winslow) or primary perforation of the gastrointestinal tract (stomach or esophagus). We report three cases of pneumoperitoneum complicating CPR. As there was no clinical evidence of peritonitis, and the patients remained stable, a conservative approach was followed without surgical exploration. All patients recovered completely.
Comparison of intravenous and topical lidocaine as a suppressant of coughing after bronchoscopy during general anesthesia
Authors: Jakobsen C.‐J. , Ahlburg P. , Holdgård H. O. , Olsen K. H. , Thomsen A.
Published: January 2009

Twenty‐four consecutive patients scheduled for fiberbronchoscopy were randomized to receive double‐blind either intravenous (1.5 mg/kg) or laryngotracheal (3 mg/kg) lidocaine to evaluate the influence on post‐bronchoscopic laryngospasm, pain in the throat and coughing. Plasma lidocaine concentrations were analyzed 5, 15, 30 and 60 min after administration. None of the patients demonstrated laryngospasm or pain in the throat during the first hour after bronchoscopy. Patients receiving topical lidocaine coughed significantly more than patients receiving intravenous lidocaine, with a median number of coughs of 20 compared to 4, during the first hour (P<0.01). The plasma lidocaine concentrations were significantly higher after intravenous than after topical administration (P<0.001). After intravenous administration the plasma lidocaine concentrations exceeded the accepted level for potential toxicity in five out of 11 patients, but none of the patients developed toxic symptoms and no side‐effects were observed.
Endocrine responses to positive end‐expiratory pressure ventilation in patients who have recently undergone heart surgery
Authors: Riddervold F. , Smiseth O. A. , Hall C. , Veddeng O. , Hysing E.
Published: January 2009

The effect of positive end‐expiratory pressure ventilation (PEEP) on angiotensin II and atrial natriuretic factor (ANF) was studied postoperatively following heart surgery. In nine patients pressures were recorded in the radial artery, pulmonary artery and the right atrium. PEEP of 5 cmH2O (0.5 kPa) and 10 cmH2O (1 kPa) increased angiotensin II from 38.820.3 (means.e.mean) to 56.729.6 (n.s.) and 66.728.7 (P<0.05) pmol/1, respectively. Plasma‐ANF showed no significant changes during PEEP. Pulmonary artery wedge pressure increased from 12.92.0 to 14.12.0 (n.s.) and 18.52.1 (P<0.01) mmHg, and right atrial pressure from 8.31.7 to 9.81.7 (n.s.) and 12.91.7 (P<0.01) mmHg with 5 and 10 cmH2O (0.5 and 1.0 kPa) of PEEP, respectively. Systemic blood pressure tended to decrease (n.s.) with PEEP. In conclusion, PEEP markedly increased angiotensin II. This may represent an important compensatory mechanism, helping to prevent reduction in aortic pressure during PEEP. ANF, however, did not change with PEEP of 5 or 10 cmH2O (0.5 and 1.0 kPa).
Twitch tension and train‐of‐four ratio during prolonged neuromuscular monitoring at different peripheral temperatures
Authors: Eriksson L. I. , Lennmarken C. , Jensen E. , Viby‐Mogensen J.
Published: January 2009

In eight healthy patients, the influence of the train‐of‐four (TOF) response of prolonged neuromuscular monitoring and of different peripheral temperatures was studied during normal core temperature. Anaesthesia was induced and maintained with midazolam‐fentanyl and a 70/30% mixture of nitrous oxide and oxygen. The mechanical TOF response of the adductor pollicis muscle (twitch tension and TOF ratio), was recorded simultaneously in both hands using supramaximal TOF stimulation of the ulnar nerve at the wrist. One arm was kept normothermic. The other arm was cooled using cold infusions and cold packings. Skin, muscle and core temperatures were continuously measured. In the normothermic arm (skin temperature >32.0d̀C), the twitch tension and TOF ratio were unchanged following 130–230 min of continuous nerve stimulation. In the hypothermic arm the twitch tension and TOF ratio showed only minor variations above a skin temperature of 32.0d̀C (corresponding to a mean muscle temperature of 34.50.3d̀C). Below a skin temperature of 32.0d̀C a progressive decrease in TOF response was recorded. A linear relationship was found between skin temperature and TOF response as well as between muscle temperature and TOF response. At a skin temperature of 27.0d̀C (corresponding to a mean muscle temperature of 30.80.4d̀C), an approximate 20d̀ reduction in twitch tension and a 10% decrease in TOF ratio were recorded with a considerable interindividual variation. We conclude that prolonged TOF nerve stimulation does not change the mechanical twitch response in patients with a normal central and peripheral temperature. A peripheral skin temperature below 32.0d̀C with sustained and normal body temperature is, however, associated with changes in both twitch tension and TOF ratio that may be a source of error when evaluating neuromuscular function.
Comparison of the haemodynamic effects of pipecuronium and pancuronium during fentanyl anaesthesia
Authors: Stanley J. C. , Carson I. W. , Gibson F. M. , McMurray T. J. , Elliott P. , Lyons S. M. , Mirakhur R. K.
Published: January 2009

Haemodynamic variables were measured following administration of pipecuronium 70 μgkg‐ and pancuronium 90 μgkg‐1 (approximately equivalent to 1.5 x ED95) in patients anaesthetised with fentanyl 50 μgkg‐1 and scheduled to undergo coronary artery bypass grafting. There were significant increases in heart rate (22%), mean arterial pressure (10%), cardiac index (16%), and the rate pressure product (35%) following administration of pancuronium. The absolute values of these parameters were, however, within acceptable clinical limits. Administration of pipecuronium produced minimal and insignificant changes in these parameters. Other measured or derived indices showed only small changes with both agents and these were generally insignificant. There were no incidences of significant bradycardia following pipecuronium administration. The results from the present study suggest that pipecuronium would have advantages for use in patients with significant cardiovascular disease.
Complement activation and pulmonary dysfunction in experimental Escherichia coli septicaemia
Authors: Bergh K. , Olsen P. O. , Halgunset J. , Iversen O.‐J.
Published: January 2009

Septicaemia was induced in anaesthetized and artificially ventilated rabbits. Three groups receiving different doses of Escherichia coli 055:B5 and a control group were studied. The animals were followed for 240 min after the start of the bacterial infusion. One animal in the high‐dose and one in the medium‐dose group died. Septic shock developed in the high‐dose group. The infusion of E. coli led to a severe, sustained neutropenia and a dose‐dependent thrombocytopenia. A severe arterial hypoxaemia developed during the infusion of bacteria in three of four animals, and in one of three animals in the high‐ and medium‐dose groups, respectively. Both the levels of C5a in plasma and the accumulation of granulocytes in the lung tissue, as assessed by a morphometric method, were dependent on the dose of bacteria. A strong positive correlation was found between levels of C5a and endotoxin. The levels of both C5a and endotoxin correlated positively to the degree of accumulation of granulocytes in the lung tissue. The results from the present study suggest that the magnitude of bacteraemia and the degree of complement activation are probably important factors determining the course and the severity of septicaemia.
Propofol‐fentanyl anesthesia for pheochromocytoma resection
Authors: Strebel S. , Scheidegger D.
Published: January 2009

Numerous anesthetic techniques and agents have been used for anesthetizing pheochromocytoma patients. However, a comparison based on literature reports is difficult, since most describe only isolated cases. We discuss current anesthetic techniques and a case report of a patient who successfully received a combined propofol‐fentanyl anesthesia for pheochromocytoma resection.
Experimental ischaemic tourniquet pain delays gastric emptying of semi‐solids in healthy volunteers
Authors: Petring O. U. , Madsen P. Sloth
Published: January 2009

The effect of controlled, experimental ischaemic pain, induced by tourniquet, on gastric emptying of a semi‐solid meal of Tc‐99m labelled Chelex‐100 resin/oatmeal was assessed in seven healthy volunteers, each acting as his/her own control. In the pain study, the submaximal effort tourniquet test was applied immediately, 30 min and 45 min after beginning of the study. Pain intensity was rated during the procedure using a linear visual analogue scale (VAS). All subjects participating in the study assessed their pain as close to maximal tolerance after 2–4 min. The pain stimulus caused an immediate acceleration, followed by a reproducible, significant delay in gastric emptying relative to the control situation. The median reduction in meal emptied after 60 min in the pain study was 15% (P=0.035). There was no difference in the duration of the lag period between the groups.
Long‐term use of central venous catheters in paediatric oncology treatment
Authors: Selldén H. , Lannering B. , Marky I. , Nilsson K.
Published: January 2009

During a 26‐month period, 158 central venous catheters were inserted in 114 children (median age: 4.5 years) with malignant diseases. Polyurethane catheters were used, inserted either using a cut‐down procedure or percutaneously in the external or internal jugular vein. All catheters were tunnelled from the point of insertion to the midpoint of the manubrium or upper sternum. The catheter tip reached the superior caval vein or the right atrium in 94% of the cases. The catheters were used for all infusions, including total parenteral nutrition, and for blood sampling. The median catheter duration was 104 days (range 5–835 days). Sixty‐eight (43%) of the catheters were removed as they were no longer needed, and 31 (20%) were removed due to local infection or septicaemia. During a total of 23486 catheter days (64.4 years), 110 episodes of septicaemia occurred. This represents one episode per 214 catheter days. In 43 of the 110 episodes of septicaemia, blood cultures showed growth of bacteria of the kind usually found in the gastrointestinal and respiratory tracts. All septicaemias were treated with intravenous broad‐spectrum antibiotics and in 21 cases the catheters were removed due to septicaemia. Thirty‐four (22%) catheters were removed accidentally. There were two cases of subclavian vein thrombosis.
Hemodynamics and arterial oxygen saturation during preoperative emptying of the stomach
Authors: Kristensen M. S. , Gellett S. , Bach A. B. , Jensen T. K.
Published: January 2009

We studied the hemodynamic response to preoperative emptying of the stomach by means of a gastric tube in 20 non‐fasting non‐premedicated patients aged 39 (24–54) (median and quartiles) presenting for emergency surgery. Systolic and diastolic blood pressure and heart rate increased by 24.4% (P<0.01), 29.9% (P<0.01) and 36% (P<0.01), respectively. Arterial oxygen saturation decreased by 2.1% (P<0.01). The rate pressure product increased by 68% (P<0.01), exceeding 20000 (mmHg · min‐1) [2667 kPa · min‐1] in nine patients. The cardiovascular response is of the same magnitude as reported after tracheal intubation without use of analgesies and is likely to cause cardiac ischemia and other adverse effects in patients suffering from coronary artery disease.