bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Halothane and Enflurane Anaesthesia for Tonsillectomy in Adults
Authors: Saarnivaara L.
Published: January 2009

Halothane and enflurane in combination with N2O/O2were compared in 103 adults undergoing tonsillectomy. Anaesthesia was induced with thiopental, and intubation was facilitated with suxamethonium. During halothane anaesthesia the mean heart rate ranged from 91 to 106 beats/min and the mean systolic arterial pressure from 111 to 127 mmHg. The values did not diifer significantly from the corresponding values during enflurane anaesthesia. Electrocardiographic changes occurred in 56% and 31% of the patients anaesthetized with halothane or enflurane, respectively. The incidence of junctional rhythm, the most common ECG change, was 46% in the halothane group and 29% in the enflurane group. 19% of the patients in the halothane group and 31% in the enflurane group responded to surgical stimulus by swallowing or coughing. The responses were mostly short‐lasting and did not much disturb the surgeon. The incidence of laryngospasm was 6% after halothane and 2% after enflurane anaesthesia. The mean total recovery score (0—10) was 6.1 after halothane and 6.3 after enflurane at arrival in the recovery room and 9.8 in both groups 30 min later. After halothane, nausea and vomiting occurred in 8 and 12% of the patients, respectively. The corresponding figures after enflurane were 2 and 8%. It is concluded that both halothane and enflurane arc suitable anaesthetics for tonsillectomy in adults. The most striking difference between the anaesthetics was the significantly more common occurrence of ECG changes during halothane than enflurane anaesthesia.
Cardiac Function and Central Circulation in Lysine‐Vasopressin Treatment of Experimental Burns
Authors: Vernersson E.
Published: January 2009

Anesthetized piglets were subjected to a standardized full thickness skin burn, covering one third of the body surface area, and given fluid treatment. One group was also submitted to early excision of the burned area 5 h after the burn and another group was excised and given lysine‐vasopressin by continuous infusion. In both the excised groups there was earlier circulatory restitution compared with the conservatively treated animals. After 24 h, cardiac function was best in the pigs treated with vasopressin and excision. The mechanisms by which vasopressin treatment and excision might have favourable circulatory effects in burn treatment are discussed.
Plasma Vasopressin Response to Extracorporeal Circulation in Children
Authors: Yamashita M. , Ishihara H. , Kudo M. , Matsuki A. , Oyama T.
Published: January 2009

Plasma vasopressin levels were measured during open‐heart surgery in nine children. The control value of vasopressin was 5.5 ± 1.5 (s.e.mean) μU/ml. During extracorporeal circulation, a maximum 7.3‐fold increase of plasma vasopressin level was demonstrated. This high level of vasopressin was considered to have circulatory effects rather than anti‐diuretic effects.
Failure of Large Tidal Volumes to Improve Oxygen Availability During Anaesthesia
Authors: Askitopoulou H. , Chakrabarti M. K. , Morgan M. , Sykes M. K.
Published: January 2009

Eight patients undergoing peripheral vascular surgery were ventilated with small (5.3 ml/kg) and large (16.3 ml/kg) tidal volumes at a constant respiratory rate. Carbon dioxide was added to the inspired gases to maintain normal end‐tidal levels. The use of large tidal volumes resulted in a significant increase in arterial oxygen tension and content, but, due to a reduction in cardiac output, failed to improve oxygen availability.
Anesthesia Under Field Conditions. A Review of 945 Cases
Authors: Lenz G. , Stehle R.
Published: January 2009

In 1980, two Geraian Red Cross surgical teams served for 6 months at a field hospital in the Kampuchean Refugee Camp Khao I Dang in Thailand. The responsibilities of the two participating anesthesiologists, whose experience is reported in the present study, included anesthetic administration, resuscitation, triage, postoperative intensive care as well as consultations in nonsurgical emergencies and teaching programs. 40% of the 945 emergency operations were battle casualties. Since many patients were in poor condition before surgery, maintenance or restoration of vital functions was of prime importance, particularly shock therapy. Although local or regional anesthesia was preferred, general anesthesia was necessary in 568 cases (60%), with endotracheal intubation in 336 of these cases. Ketamine, generally combined with diazepam or flunitrazepam, proved advantageous for spontaneous respiration, assisted ventilation, and endotracheal anesthesia. Although the conditions were primitive, no fatal anesthetic complications were observed (surgical mortality rate, less than 2%).
Lorazepam and High‐Dose Fentanyl Anaesthesia: Effects on Haemodynamics and Oxygen Transportation in Patients Undergoing Coronary Revascularization
Authors: Heikkilä H. , Jalonen J. , Laaksonen V. , Arola M. , Oja R.
Published: January 2009

The effects of intravenous lorazepam (0.05 mg/kg) on haemodynamics and oxygen transportation were studied in a group of 11 patients undergoing a coronary artery bypass grafting operation with high‐dose fentanyl anaesthesia and compared to the changes in another group of 11 patients receiving the same anaesthesia, but saline instead of lorazepam. The measurements were made under stable haemodynamic conditions before the injection of lorazepam or saline, and repeated 5, 20 and 40 min after the injection. Lorazepam caused a slight decrease in the systemic and pulmonary arterial pressures and in the left ventricular stroke work index, as compared to the control group. The ECG or the rate‐pressure product did not show changes indicative of myocardial oxygen supply/demand imbalance in either group. There was a similar decrease in the systemic oxygen transportation and an increase in the arterio‐venous oxygen content difference in both groups, but the unchanged systemic oxygen consumption and arterial lactate level suggest a well‐maintained tissue oxygenation. It is concluded that intravenous lorazepam does not cause important haemodynamic untoward effects as an adjunct to high‐dose fentanyl anaesthesia in patients undergoing coronary artery bypass grafting.
Effect of Lignocaine on the Responses Produced by Depolarizing Agents at the Chick Neuromuscular Junction
Authors: Wali F.A.
Published: January 2009

The effect of lignocaine on the depolarization and contracture responses produced by acetylcholine (ACh) or tetraethylammonium (TEA) was studied in the isolated chick biventer cervicis (BVC) nerve‐muscle preparation using the moving fluid electrode technique. Lignocaine (37 μmol.1‐1‐1.8 mmol.1‐1) produced concentration‐dependent contractures in the chick BVC muscle. The contractures produced by lignocaine were not accompanied by membrane depolarizations. ACh (5.5 μmol.1‐1‐11.0 mmol.1‐1) and TEA (0.48–24.0 mmol.1‐1) produced concentration‐dependent depolarizations and contractures in the chick BVC muscle. Lignocaine (0.93 mmol.1‐1) greatly reduced the responses produced by ACh, while it markedly increased the contracture responses produced by TEA. The depolarizations produced by TEA were reduced in lignocaine (0.93 mmol.1‐1). It was concluded that the local anaesthetic lignocaine produces contractures in the chick BVC muscle. Lignocaine potentiates the contractures produced by TEA, while it greatly reduces those produced by ACh.
Atropine vs Glycopyrrolate During Reversal of Pancuronium Block in Patients Anaesthetized with Halothane
Authors: Takkunen O. , Salmenperä M. , Heinonen J.
Published: January 2009

Atropine 0.015 mg kg‐1 and glycopyrrolate 0.0075 mg kg‐1 were compared as antimuscarinic agents during reversal of pancuronium block with neostigmine 0.03 mg kg‐1 in 30 patients anaesthetized with thiopental‐N2O‐halothane and undergoing minor surgery. In patients treated with atropine‐neostigmine, the frequencies of bradycardia and junctional rhythm were relatively high and about the same as those reported by us previously in patients anaesthetized with thiopental‐N2O‐fentanyl. As in our previous study, glycopyrrolate seemed to have advantages over atropine during reversal of pancuronium block: the incidences of bradycardia and junctional rhythm were significantly less in patients treated with glycopyrrolate. Recovery from anaesthesia, as assessed by the awakening after discontinuation of N2O and halothane administration, and the incidence of postoperative nausea and vomiting, were not significantly different between the atropine and glycopyrrolate groups.
Halothane Dissolved in Fat as an Intravenous Anaesthetic to Rats
Authors: Johannesson G. , Alm P. , Biber B. , Lennander Ö. , Werner O.
Published: January 2009

The anaesthetic properties of a halothane‐in‐fat solution given either as a single i.v. dose or as a continuous i.v. infusion were investigated in rats. 0.3 ml of a 5% solution of halothane in a fat emulsion was injected i.v. into 15 awake rats. At the end of the 30 s injection, all rats had collapsed from the upright position and showed no response to a firmly applied tail clamp. Breathing usually became shallow and irregular just after injection. Two rats died. In the surviving rats, movement in response to clamping of the tail reappeared after some 30 s (range 15–90 s). The rats regained the upright position after about 100 s, and appeared fully awake about 3 min (range 2–5 min) after injection. Surviving rats behaved normally after the experiment, and gained in weight. They were killed 1–29 days later. The lungs, kidneys, heart, brain and liver had a normal macroscopic and microscopic appearance. In a second set of experiments (n = 9), a 10% solution of halothane was continuously infused i.v. (3.75 (μ min‐1). The anaesthetic depth, as well as the mean arterial pressure, heart rate, respiratory rate and arterial Pco2 and Po2 were similar to values observed during inhalation of halothane in air at an inspired concentration of 1.1%. By doubling the infusion rate, MAP was reduced by 23%. It was easy to adjust anaesthetic depth by changing the infusion rate and recovery was fast.
Intervillous Blood Flow During Caesarean Section With Prophylactic Ephedrine and Epidural Anaesthesia
Authors: Hollmén A. I. , Jouppila R. , Albright G. A. , Jouppila P. , Vierola H. , Koivula A.
Published: January 2009

We administered a 15 mg i.v. bolus of ephedrine at the commencement of epidural blockade to nine healthy parturients scheduled for elective caesarean section. Nine other patients did not receive prophylactic ephedrine before epidural anaesthesia (control group). Lactated Ringer solution, 30 ml/kg, was infused before and during blockade, and left uterine displacement was used to minimize aortocaval compression. A133Xe i.v. technique was used to measure intervillous blood flow (IBF) before and 20–25 min after epidural block. The mean arterial pressure (MAP) decreased after epidural blockade in the ephedrine group by 0.67 ± 0.8 (mean ± s.d.) kPa and by 1.20 ± 1.1 (mean ± s.d.) kPa in the control group. In spite of the decrease in MAP, IBF increased by 6% in patients receiving ephedrine (N.S.), whereas it decreased by 11% in the control group (N.S.). In the ephedrine group there was in this preliminary study a trend to increasing IBF during falling perfusion pressure (MAP). The results of this preliminary study suggest that ephedrine will not affect IBF, but to prevent maternal hypotension ephedrine should be used as an i.v. infusion instead of a bolus injection.
Reaction Time Course During Weaning from Respirator Treatment
Authors: Elsass P. , Christensen S. E.
Published: January 2009

Ten patients who developed disturbed mental function during respirator weaning were studied. They were investigated during respirator treatment and 1 h after start of spontaneous ventilation with continuous reaction time measurements and clinical ratings. During the spontaneous ventilation the reaction times increased and the patients experienced fatigue. Paco2 was higher and Pao2 was lower than during respirator treatment. A significant correlation was found between individual differences of reaction times and arterial blood gas levels in the two conditions, whereas no general correlation between reaction times and arterial blood gas levels could be established. The findings must be considered tentative, but the results of this study indicate the value of continuous reaction time measurements for quantitative assessment of mental status during respirator treatment.
Controlled Ventilation Using the Lack Circuit with an Injector Device
Authors: Hopkinson N. D. , Harrison M. J.
Published: January 2009

A Lack breathing system with an injector device has been used for controlled ventilation. Oxygen was delivered through an injector device, which was positioned between the Lack circuit and the catheter mount, whilst nitrous oxide was delivered from the anaesthetic machine. The circuit was fully tested on two model lungs. Satisfactory tidal volumes were obtained and with fresh gas flow rates of about 41.min‐1, rebreathing was not detected. The circuit was then studied on ten patients undergoing surgery and it was found that an end‐tidal carbon dioxide concentration of 5–6% could be maintained. The use of this system during general anaesthesia is discussed.
Airway Deadspace, End‐Tidal CO2, and Christian Bohr
Authors: Fletcher R.
Published: January 2009

In order to calculate alveolar deadspace, an important measure of ventilation/perfusion mismatching, it is necessary to measure airway or anatomical deadspace (VDaw) and physiological deadspace. VDaw is usually measured graphically or by similar means, but sometimes it is estimated from a formula, based on Christian Bohr's work, in which end‐tidal Pco2 is used as a measure of alveolar Pco2. In 58 patients undergoing anaesthesia and positive pressure ventilation, there were large errors in this estimate of VDaw compared to a graphical method. At tidal volumes of 400–500 ml, the median error was 34 ml; at larger tidal volumes, the median error increased to 74 ml (P<0.001). The size of the error was correlated to the slope of phase III, the part of the CO2 tracing representing alveolar CO2, at both ventilator settings (P<0.01). It is concluded that estimates of VDaw based on end‐tidal Pco2 are unreliable, and their use will lead to a large part of the alveolar deadspace being wrongly accredited to VDaw.
Isoflurane and Enflurane in Long Anaesthesias for Plastic Microsurgery
Authors: Oikkonen M.
Published: January 2009

Isoflurane and enflurane as main anaesthetics at 0.5–0.7% end‐tidal concentrations in 70% N2O/30% O2supplemented with fentanyl maintained smooth basal anaesthesia in ASA I‐II patients during long (6–11 h) plastic surgery (n = 7 + 6) as well as during shorter (2—4 h) operations (n = 5 + 5). There were no statistically significant differences in haemodynamic parameters between isoflurane and enflurane patients, although mean arterial pressure was somewhat lower and heart rate higher in the isoflurane patients during the course of long anaesthesias. Both isoflurane and enflurane patients had to be given extra colloids and occasionally vasodilators to maintain peripheral temperature during the long anaesthesias. No clinically adverse renal or hepatic effects were seen, but the liver enzyme activities of four isoflurane and enflurane patients increased after the long anaesthesias. The highest serum inorganic fluoride concentration was 44 μmol/1 in the enflurane patients and 5.6 μmol/1 in the isoflurane patients.
Large Airway Response to Cemented Arthroplasty: Relationship to Hypoxaemia. An Experimental Study in Dogs
Authors: Sherman R. M. P. , Waddell J. P. , Kay J. C. , Byrick R. J.
Published: January 2009

Alteration in airway smooth muscle tone has been implicated in the mechanism of hypoxemia, pulmonary hypertension and changes in dynamic thoracic compliance after total hip arthroplasty (THA). We used the pressure within a water‐filled cuff of an endotracheal tube as a continuous measure of changes in tracheomotor tone during THA in mongrel dogs, while intermittently assessing gas exchange abnormalities. In all 16 dogs the instillation of polymethylmethacrylate (PMMA) into the femoral medullary shaft resulted in tracheal dilation. In ten dogs we demonstrated simultaneous hypotension, hypoxemia and increase in shunt fraction (Qs/Qt) after THA. In six dogs the medullary canal was thoroughly lavaged prior to PMMA injection, and no hypoxemia, hypotension or increased Qs/Qtwas found in spite of persisting tracheomotor relaxation. We conclude that these well‐documented gas‐exchange abnormalities are not mediated by changes in large airway tone. Since the hypoxemia was abolished by medullary lavage in our animal model, we suggest that this syndrome is mediated by alterations in lung perfusion and associated small airway constriction and not by changes in large airway smooth muscle tone.
The Duration of Pain Relief after Penile Block to Boys Undergoing Circumcision
Authors: Carlsson P. , Svensson J.
Published: January 2009

Bupivacaine plain, 2.5 mg/ml, was used for a nerve block of the dorsal nerves of the penis. Satisfactory postoperative analgesia was obtained in 24 of 28 boys undergoing circumcision. Eighteen of the 24 boys with a successful nerve block did not require analgesics during the first 24 h postoperatively. All blocks were performed by the surgeon just before surgery.
Fade in Voluntary Muscle Contractions of Patients with Sequelae after Poliomyelitis
Authors: Segher N. H.
Published: January 2009

The isometric contraction pattern was followed in three female and two male patients with lower moto‐neuron paralysis due to sequelae from poliomyelitis in 1942–48. In uninstructed contractions, force increased slowly to an almost horizontal level which could be kept up for as long as desired. During rapid maximal voluntary contractions, a “biphasic” mechanogram was seen in 49% of 204 contractions, with a first maximum after 0.3 s (0.1–0.9), separated by a notch from a second maximum after 1.1 s (0.3–2.3). In the rest of the contractions, force could not be generated rapidly, despite the intention of the subjects, and a single maximum in the mechanogram was seen after 0.9 s (0.2–2.4). In contractions where a biphasic contraction pattern was seen, the electromyographic activity was greatest during approximately the first one half second of the contraction. In the other contractions the electromyographic activity was about the same during the whole contraction. The results suggest that the mechanograms are composed of a high innervation threshold, fast phasically active component, and a low innervation threshold, slow tonically active component. Fade represents the waning of tension in the phasically active component present in some contractions, while this component appears to be eliminated by poliomyelitis in other muscle contractions.
Thiopental Loading During Controlled Hypotension for Intracranial Aneurysm Surgery
Authors: Bendtsen A. O. , Cold G. E. , Astrup J. , Rosenørn J.
Published: January 2009

In this study we report our clinical experience with supplementary thiopental loading, based on 30 patients undergoing surgery for intracranial aneurysm after a recent episode of subarachnoid haemorrhage. As standard procedure we used pentobarbitone induction, pancuronium relaxation, endotracheal intubation, maintenance with halothane 0.5%, N2O 66% in oxygen, fentanyl, and moderate hypocapnia. A thiopental load of up to 20 mg.kg‐1 was supplied while the aneurysm was approached. Satisfactory and well‐controlled hypotension was obtained in five cases after thiopental alone, and after thiopental and sodium nitroprusside (SNP) (x̄ ± s.d.) 1.3 ± 0.9 μg‐kg‐1‐min‐1 in the remaining 25 patients. No ECG sign of myocardial ischaemia was observed. One disadvantage was a prolonged recovery period, which in some cases necessitated controlled ventilation for some hours. We conclude that thiopental loading can be used safely as a supplement to neuroanaesthesia for aneurysm surgery.
Minimum Cerebral Blood Flow and Metabolism During Craniotomy. Effect of Thiopental Loading
Authors: Astrup J. , Rosenørn J. , Cold G. E. , Bendtsen A. , Sørensen P. Møller
Published: January 2009

Cerebral blood flow and metabolism were measured repeatedly during surgery for cerebral tumours by a modification of the classical Kety & Schmidt method using 133Xe infusion intravenously. Our standard procedure for neuroanaesthesia (pentobarbitone‐fentanyl induction, halothane‐nitrous oxide maintenance) reduced blood flow from 47.1 to 24.2 ml.100 g . ml‐1 and metabolism from 3.30 to 1.83 ml O2 . 100 g‐1 . ml‐1. PacO2 was reduced by hyperventilation from 5.3 to 3.6 kPa. Additional thiopental loading and maintenance using 4 + 4 mg.kg‐1 (n=5) or 8 + 8 mgkg‐1 (n = 5) reduced cerebral metabolism by an additional 15% (P <0.0) and blood flow by 16.5% (P <0.01), while mean arterial blood pressure fell from 11.0 to 9.9 kPa (P <0.05). Paco2 remained unchanged. This additional reduction in cerebral metabolism and blood flow is small, but we nevertheless conclude that it may well be of clinical interest to the problem of protecting the brain in case of episodes of focal cerebral ischaemia which may arise peroperatively during intracramal surgery.
Determination of Skin Blood Flow by133Xe Washout and by Heat Flux from a Heated tc‐Po2Electrode
Authors: Jaszgzak P. , Sejrsen P.
Published: January 2009

133Xe washout measurements were used to determine cutaneous and subcutaneous blood flow beneath a specially designed double‐thermostated tc‐Po2electrode. The skin blood flow was determined using thermal methods based on reduced heat dissipation during blood flow cessation. A total of 20 measurements were performed on two healthy volunteers, using the volar side of the right forearm as the experimental area. Cutaneous as well as subcutaneous blood flow increased with increasing electrode temperature. The cutaneous blood flow increased from 12.3 ± 1.3 ml (100 g)‐1‐min‐1(37d̀C) to 49.1 ± 5.4 ml (100 g)‐1.min‐1(45d̀C) and the subcutaneous values from 20.9 ± 0.2 ml (100 g)‐1‐min‐1to 57.3 ± 0.5 ml (100 g)‐1‐min‐1. Preheating of the measuring area or injection of papaverine as blood flow accelerator did not increase the maximum blood flow values. A considerable inter‐individual difference between cutaneous and subcutaneous blood flow was observed, but in spite of that a good overall correlation between the133Xe washout measurements and the two thermal flow measurements was found (r = 0.932 and 0.945, respectively). It is concluded that in some cases, but not always, measurements of tc‐Po2at electrode temperatures of 45d̀C take place on a maximally perfused skin and that it is possible to determine skin blood flow by means of determinations of the heat dissipated from the tc‐Po2 electrode to the underlying skin.
Natural Killer Cell Activity After Open‐Heart Surgery
Authors: Ryhänen P. , Huttunen K. , Ilonen J.
Published: January 2009

We studied the effects of elective open‐heart surgery with cardiopulmonary bypass on peripheral blood natural killer (NK) cell activity in 12 patients with heart disease. Separated mononuclear cells from patients and control cells taken from healthy volunteers were incubated in microtiter plates for 24 h with 3H‐thymidine‐labelled K 562 cells as target cells. In this test system, higher counts per minute (cpm) values represent a greater number of surviving target cells and thus weaker NK activity. Results of cultures prepared from blood samples taken preoperatively were compared with those taken 2, 7 and 14 days postoperatively. NK cell activity was depressed (P<0.01) for 2 days after surgery. NK cell activity in the control samples did not change significantly. The results show an impairment of NK cell activity immediately after open‐heart surgery.
Delayed Hydrothorax Following Percutaneous Central Venous Cannulation
Authors: Molinari P. S. , Belani K. G. , Buckley J. J.
Published: January 2009

Isolated cases of delayed complications associated with prolonged use of percutaneous central venous lines have been reported. We report four patients who developed hydrothorax more than 24 h after central venous cannulation due to perforation of an intrathoracic vein wall by the catheter tip. The patients were all adults of average body habitus. Left‐sided catheters were placed in the operating room after anesthetic induction by experienced personnel using the Seldinger technique and secured in position with a dressing and tape. Chest x‐rays taken in the recovery room showed all catheter tips terminated in the central vein and no evidence of hydrothorax. Hydrothorax was manifested in the post‐operative period and occurred 1–7 days postcannulation. We are left with the conclusion that the delayed hydrothorax resulted from gradual penetration of the vein wall by the catheter tip. We feel a combination of factors probably contributed to the vein wall erosion. First, the insecure fixation of the catheter combined with head, neck, and cardiopulmonary motion has been shown to result in the back‐and‐forth movement of the catheter tip. Second, the stiff catheters in the left jugular system take a curved course to the superior vena cava bringing the catheter tip into close proximity to the wall of the superior vena cava. We therefore conclude that late developing hydrothorax can be minimized by using a soft, pliable catheter, sutured firmly in place. Right‐sided line placement is preferable to left‐sided placement because of the anatomic relationships.
Cardiac Dysrhythmias During Outpatient Dental Anaesthesia With Enflurane. The Role of “Beta Blockade”
Authors: Rollason W. N. , Bennetts F. E. , Clarke I.
Published: January 2009

In a study of 120 unpremedicated outpatients presenting for outpatient dental anaesthesia, the incidence of dysrhythmias was lower with enflurane than had previously been found with halothane (1). The intravenous use of the cardioselective beta adrencrgic blocking agents practolol and metoprolol, in a dose of 0.05–0.22 and 0.16–0.17 mg/kg body weight, respectively, proved effective in the treatment of sinus tachycardia in excess of 150 beats/min and/or ventricular dysrhythmias. Although metoprolol, unlike practolol, has no intrinsic sympathetic activity, there were no side‐effects related to either beta‐blocker in the dosages used during enflurane anaesthesia.
Hypotensive Anesthesia, Thromboprophylaxis and Postoperative Thromboembolism in Total Hip Arthroplasty
Authors: Fredin H. , Gustafson C. , Rosberg B.
Published: January 2009

A prospective study was performed in 120 patients undergoing total hip arthroplasty. The patients were randomly allocated to four groups. The first two groups had nitroprusside‐induced hypotensive anesthesia with either a fixed combination of sodium heparin and dihydroergolamine mesylate (HDHE) or dextran 70. The other two groups had normotensive halothane anesthesia with either HDHE or preoperative hemodilution with dextran 70. Hypolensive anesthesia reduced surgical bleeding. Blood loss was increased in patients undergoing preoperative hemodilution as compared to thromboprophylaxis with HDHE, whereas no difference was found between conventional administration of dextran and HDHE. Deep vein thrombosis, diagnosed with ascending phlcbography of the operated leg, was registered in 48% of the patients. There was no difference between the techniques of anesthesia and thromboprophylaxis. Pulmonary embolism, studied with perfusion‐ventilation scintigraphy, was diagnosed in 19% of the patients. No significant difference was found between hypotensive and normotensive anesthesia, or between thromboprophylaxis with conventional dextran and HDHE. There was a lower incidence of pulmonary embolism in patients with HDHE and normotensive anesthesia. Major wound hematomas were noted postoperatively in 12% of the patients receiving HDHE, whereas no major hematomas developed following dextran prophylaxis. No anaphylactic reaction was noted from dextran 70, using hapten‐dextran prophylaxis.
Impairment of Postural Stability Following Perivascular Axillary Block with Mepivacaine
Authors: Kærgård H. , Larsen T. Korsgaard , Rasmussen P. S. , Brøndum L.
Published: January 2009

Perivascular axillary block was performed on 10 patients using a catheter technique. All patients received a standard dose of 50 ml mepivacaine 1 % with adrenaline 1:200 000. Using a quantitative Romberg‐test performed on a computerized force‐plate system, postural stability was tested before and 40 min after the local anesthesia. There was a significant increase in body‐sway following axillary block (P <0.01). Nine out of 10 patients had an increased sway‐tendency, an average of 31%. A proportionate increase in postural imbalance has been found in normal persons after alcohol consumption, when blood levels were 0.8 mg/ml.
Changes in Heart Rate and Impulse Conduction After a Single Dose of Succinylcholine
Authors: Jensen F. Molke , Guldager H.
Published: January 2009

The effect of 1 and 2 mg/kg b.w. succinylcholine on changes in cardiac rate and rhythm was studied in 40 fit, adult patients undergoing non‐emergency surgery. Induction of anaesthesia consisted of atropine 0.007 mg/kg b.w., pancuronium 0.015 mg/kg b.w., thiopental 5 mg/kg and succinylcholine 1 or 2 mg/kg b.w. Succinylcholine 1 mg/kg b.w. intravenously resulted in a significant decrease in heart rate after 1 min. 1 his decrease persisted after 2 min. The heart rate was unchanged 1 and 2 min after succinylcholine 2 mg/kg b.w. When the two groups were compared, no significant difference was found. No serious cardiac arrhythmias were seen. These results suggest that the larger single dose of succinylcholine is not more likely to cause severe bradycardia or asystole.
Diazepam Does Not Prevent Succinylcholine‐Induced Fasciculations and Myalgia: A Comparative Evaluation of the Effect of Diazepam and d‐Tubocurarine Pretreatments
Authors: Manchikanti L.
Published: January 2009

To determine the effeetiveness of diazepam pretreatment in preventing succinylcholine (SCh)‐induced fasciculations and body pains, 587 patients were randomly allocated to six groups. Patients in Group I received no pretreatment and served as controls. Patients in Groups II and III were pretreated with 0.05 mg/kg of diazepam either 4—5 min (Group II) or 8–10 min (Group III) prior to SCh administration. Patients in Groups IV and V received 0.1 mg/kg of diazepam either 4—5 min (Group IV) or 8–10 min (Group V) prior to SCh administration, while patients in Group VI were pretreated with 0.05 mg/kg of d‐tubocurarine (dTc) 4—5 min prior to SCh. The succinylcholine dosage was 1.0 mg/kg in Groups I through V and 1.5 mg/kg in Group VI. Fasciculations, intubation conditions and postoperative body pains were evaluated in all groups. Fasciculations were seen in 90% of patients in the control group and 15% in the dTc pretreatment group, while diazepam was ineffective in altering the frequency or intensity of fasciculations. Conditions for intubation were judged to be clinically adequate in all groups. Body pains were seen in 33% of patients in the control group and 28–36% in diazepam‐pretreated groups and in only 8% of patients in the dTc pretreatment group. There was no statistically significant difference in the incidence of body pains by virtue of site of operation, age, sex, and inpatient/outpatient status. It is concluded that the problem of postoperative myalgia is significant and that dTc pretreatment is the effective method for prevention of fasciculations and postoperative myalgia. Diazepam pretreatment was ineffective for the prevention of fasciculations and myalgia.
Kinetics of Morphine in Cerebrospinal Fluid After Epidural Administration
Authors: Gustafsson L. L. , Grell A. M. , Garle M. , Rane A. , Scmldt B.
Published: January 2009

Forty patients undergoing arthroscopy were given an epidural dose of 0.05 mg morphine‐HCl in 0.1 ml saline/kg body weight to study the disposition of morphine in the cerebrospinal fluid (CSF). In each patient one to three CSF samples were collected (86 samples in total). A mean peak concentration of 13 890 nmol/ 1 was achieved 75 min after morphine administration. The compiled data show an elimination half‐life of 162 min (r = 0.98). Individual half‐lives in seven patients with three samples ranged from 61–172 min. Large interindividual variations were found in CSF‐concentrations of morphine, 9‐ and 8‐fold at 3 and 8 h, respectively, after the dose. However, 16 h after administration no patient had a concentration less than 81 nmol/1. At 8 h after the dose, CSF concentrations of morphine were significantly higher (P<0.05) in a group of patients (n = 5) kept uptilted (80d̀), as compared to those in the supine position (n = 5). Such a difference was not observed 3 h after the dose. The sampling procedure and age also seemed to influence CSF concentrations of morphine. There was no correlation between the dose given in rag and the CSF concentrations achieved. Strict standardization is thus mandatory when studying the disposition of opiates in CSF after epidural or intrathecal administration. Since our calculated half‐lives of morphine in CSF were similar to those reported in plasma, the long‐lasting effect is probably related to the high initial morphine concentrations in CSF.
High Frequency Ventilation and Gas Diffusion
Authors: Chakrabarti M. K. , Loh L. , Gilchrist I.
Published: January 2009

The efficiency of CO2 removal was studied using a simple lung model with a high frequency positive pressure device (up to 100 b.p.m.) with and without an anatomical deadspace. At a constant minute ventilation without an anatomical dead space, the efficiency of CO2 elimination increased with increasing frequency. However, when a dead space was introduced, the efficiency of CO2 elimination decreased with increasing frequency. Using a high frequency oscillation technique (360 to 900 b.p.m.), it was not possible to maintain a reasonable CO2 elimination with tidal volumes less than the anatomical dead space. In this model there was no evidence that accelerated diffusion was a factor in CO2 removal during high frequency ventilation or oscillation.
Prevalence of Viral Hepatitis in the Staff in Norwegian Anaesthesiology Units
Authors: Siebke J. C. , Degré M.
Published: January 2009

The prevalence of markers for present or past hepatitis B infection has been studied in 1230 staff members of anaesthesiology units throughout Norway. HBsAg was not detected in any of the participants in the study. The prevalence of antibodies against hepatitis B in the younger participants was similar to that in the control group, but was significantly increased among the older participants and in those with longer seniority in medical work. This result was to some extent influenced by a fairly large number of staff members who had grown up or had had professional experience in countries with a higher prevalence of hepatitis B. The results may be interpreted as reflecting a very moderate incidence of hepatitis B infections in anaesthesiology units during the last 15 years. However, relevant to the discussion of vaccination programs for these units are three reported cases of hepatitis B infections with a fatal outcome among Norwegian anaesthesiologists, suggesting a greater severity of hepatitis B infections within this occupational group.
Effects of Ephedrine on Haemodynamics and Oxygen Consumption in the Dog During High Epidural Block with Special Reference to the Splanchnic Region
Authors: Greitz T. , Andreen M. , Irestedt L.
Published: January 2009

High lumbar epidural block was induced in seven dogs with 0.5% bupivacaine, causing a fall in mean arterial blood pressure (AP̄) from 19.2 ± 3.2 to 10.5 ± 3.2 kPa, owing to equal reductions in cardiac output (Qt) and systemic vascular resistance (SVR). After the administration of ephedrine (a single injection of 200–300 μg × kg‐1b.w. followed by a continuous infusion of 10–20 μg × kg‐1b.w. × min‐1) AP̄, Qt and SVR rose to pre‐epidural values. Furthermore, the hypokinetic circulation following the epidural block returned to normokinetic levels. Portal venous blood flow was increased from 16.5 ± 6.2 to 25.5 ± 4.3 ml × kg‐1b.w. × min‐1by ephedrine, while the hepatic arterial blood flow was unchanged and remained at its pre‐epidural level. In spite of a slight rise in hepatic oxygen consumption from 1.2 ± 0.4 to 1.6 ± 0.6 ml × kg‐1b.w. × min‐1, the percentages of oxygen extracted from the portal vein and the hepatic artery decreased significantly. It is concluded that ephedrine restores central and splanchnic haemodynamics in a desirable manner during high epidural anaesthesia.
Laryngospasm During Anaesthesia. A Computer‐Aided Incidence Study in 136 929 Patients
Authors: Olsson G. L. , Hallen B.
Published: January 2009

With the aid of a computerized anaesthetic record‐keeping system, the incidence of laryngospasm during anaesthesia was studied, in order to quantify the risk of this complication. 136 929 patients given 156 064 anaesthetics were studied. There were 1 232 cases of laryngospasm recorded in 1 197 patients. The incidence of laryngospasm was calculated in subgroups characterized by age, sex, preanaesthetic conditions, premeditation, anaesthetic technique, type of surgery and concomitant complication. An incidence exceeding 50 laryngospasms in 1 000 patients was observed when giving anaesthesia to children with bronchial asthma, with airway infection, in those who had a previous anaesthetic complication, during oesophagoscopy and when correction of hypospadias was performed. Extirpation of skin tumours and scars in males 50–59 years old was also accompanied by a similarly high incidence. Figures exceeding 25 laryngospasms in 1 000 patients were seen in the age group 1–3 months and in children undergoing appendicectomy, oral endoscopy and plastic surgery, when trachcal intubation had been performed and when a gastrointestinal tube was used. In the age group 50–59 years, an incidence exceeding 25 in 1 000 patients was seen when there had been preoperative airway obstruction and in females when the anaesthetic technique included spontaneous breathing and face mask, or apnoic oxygenation. Dilatation of the anal sphincter and mediastinoscopy in males were also associated with an increased incidence of laryngospasm.
Micro‐Drop Size and Intravenous Administration of Sedative‐Anaesthetic Solutions
Authors: Owen‐Falkenberg A. P. A. , Møller J. , Owen‐Falkenberg T.
Published: January 2009

The variation in micro‐drop size was studied for a series of sedative‐anaesthetic solutions administered via a standard paediatric infusion set in combination with an infusion pump and drop counter. Of the solutions tested, only Diazemulsr̀ 20 mg% failed to alter micro‐drop size. Solutions containing Ketalarr̀, Apozepamr̀, Hypnomidater̀ and Althesinr̀ all caused a decrease in drop size and therefore in administered volume. The largest error (37%) occurred with a solution containing althesin 20% (v/v).
Spinal Analgesia with Glucose‐Free Bupivacaine ‐ Effects of Volume and Concentration
Authors: Bengtsson M. , Malmqvist L. Å. , Edström H. H.
Published: January 2009

Spinal analgesia using 22.5 mg glucose‐free bupivacaine, given either as 3.0 ml of 0.75% solution or 4.5 ml of 0.5% solution was studied in a double‐blind fashion in 40 patients scheduled for transurethral surgery. No differences in onset, duration and regression of analgesia or motor blockade were noticed, indicating that dosage (in mg) is more important than either volume or concentration when glucose‐free bupivacaine solutions are used for spinal analgesia. The cardiovascular effects were small and no side‐effects attributable to the spinal anaesthetic were seen.
Hydroxyethyl Starches, Dextran and Balanced Salt Solution in Correction of Hypotension during Epidural Anaesthesia
Authors: Koski E. , Tuppurainen T. , Mattila M. , Gordin A. , Salo H.
Published: January 2009

A low molecular weight (M̄w 38 000) and a medium molecular weight (M̄w 125 000) hydroxyethyl starch and a medium molecular weight dextran (M̄w 70 000) solution were compared with a balanced salt solution in 123 patients undergoing operations of the lower extremities in epidural anaesthesia; 500 ml of the studied solutions were infused during 15 min after the injection of the epidural anaesthetic. The need for etilefrine hydrochloride as a vasoconstrictor in correcting hypotensive reactions was recorded. Changes in haemoglobin (Hb), haematocrit (Hct), serum total protein and serum albumin concentrations were measured. The number of patients given etilefrine hydrochloride in the plasma‐substitute groups was smaller than in the control group. The differences were, however, not statistically significant. The fall in blood pressure cannot be totally inhibited by administration of 500 ml plasma substitute. According to the differences in Hb, Hct, serum protein and albumin values, the hydroxyethyl starch solutions were significantly more effective plasma substitutes than the balanced salt solution and as effective as dextran. No side‐effects attributable to the solutions used were observed.
Respiratory Depression after Epidural Morphine in the Postoperative Period. Influence of Posture
Authors: Jensen F. Molke , Madsen J. B. , Guldager H. , Christensen A. A. , Eriksen H. O.
Published: January 2009

Twelve females scheduled for elective lower abdominal surgery received 4 mg of morphine by lumbar epidural injection for postoperative pain relief. The patients were divided into two groups nursed postoperatively in a supine or 45 degree elevated position, respectively. Mouth occlusion pressure during CO2stimulation was used for the determination of respiratory depression, following epidural morphine. No significant difference in occlusion pressure was found between the two groups. Within the groups a significant reduction of the occlusion pressure was found when compared with the value obtained immediately before the administration of epidural morphine. However, compared with the value obtained the day before surgery, no significant reduction of the occlusion pressure was observed. It is concluded that the 45 degree elevated position does not protect against the occurrence of respiratory depression following epidural morphine.
Comparison of Intramuscular Analgesia, Intercostal Block, Epidural Morphine and On‐Demand‐i.v.‐Fentanyl in the Control of Pain after Upper Abdominal Surgery
Authors: Rosenberg P. H. , Heino A. , Scheinin B.
Published: January 2009

Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54—0.99 μg min‐1 + on‐demand boluses of 7.2–13.5 μg (ODAG) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2–4.3 on a scale from 0–10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X‐ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood‐gas analyses there was a greater number of slightly elevated Pco2 values (6.0–7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814–2233 μg, as did the number of on‐demand boluses, 3–155. At 24 h, an efficacy rating “good” was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as “good” or “fair”.
The Effects of d‐Tubocurarine, Pancuronium and Atracurium on the Responses of Gastrocnemius and Soleus Muscles in the Cat
Authors: Choi W. W. , Gergis S. D. , Sokoll M. D.
Published: January 2009

In vivo, the effects of d‐tubocurarine (0.20 mg kg‐1), pancuronium (0.015 mg kg‐1) and atracurium (0.15 mg kg‐1) on the responses of the indirectly stimulated cat gastrocnemius (fast) and soleus (slow) muscles to a twitch, train‐of‐four and tetanic stimuli were studied. The soleus muscle demonstrated a greater degree of fade than the gastrocnemius in response to tetanic stimuli (50 Hz). There was no difference between the responses of the two muscles to twitch or train‐of‐four stimuli with any of the drugs. Recovery of train‐of‐four ratio occurred more rapidly than did the tetanic fade ratio. At a time when train‐of‐four ratio exceeded 0.7, tetanic fade was still evident, especially in the soleus muscle.
Effect of i.v. Atropine on Cardiac Rhythm, Heart Rate, Blood Pressure and Airway Secretion during Isoflurane Anaesthesia
Authors: Valentin N. , Staffeldt H. , Kyst A.
Published: January 2009

Atropine, 0.01 mg kg‐‐1, was given i.v. to 30 patients before mask anaesthesia with isoflurane. Controls (n = 28) received a placebo. ECG was recorded on tape throughout anaesthesia and analysed later. There were no ventricular arrhythmias, but six patients in the atropine group and two patients in the placebo group had supraventricular arrhythmias of very short duration. Most cases occurred shortly after atropine, i.e. before anaesthesia. Heart rate increased significantly in both groups, more so after atropine (up to 60%), and remained elevated. In both groups blood pressure fell after the induction of anaesthesia but was close to control during surgery. Suction of airway secretions was necessary in three placebo patients, but excessive secretions were not met. The frequency of airway reflexes was similar in the two groups. It is concluded that due to the pronounced tachycardia the routine use of i.v. atropine can hardly be recommended before mask anaesthesia with isoflurane.
Changes in Skin Blood Flow and Temperature during Spinal Analgesia Evaluated by Laser Doppler Flowmetry and Infrared Thermography
Authors: Bengtsson M.
Published: January 2009

Changes in skin blood flow and skin temperature during spinal analgesia and “sham” spinal analgesia were studied using laser Doppler flowmetry and skin temperature measurements on patients scheduled for transurethral resection. Infrared thermography was also used. During “sham” spinal analgesia skin blood flow decreased 17.7% ± 37% (s.d.) and skin temperature fell 0.05°C ± 0.6 (s.d.) d̀C. The height of the blockade was T10 or above in all cases. Using the laser Doppler technique with measuring points from the clavicle to T12, a tendency towards increased skin blood flow was seen in six cases out of 20 at T10 (significant elevations in 3/20) and in 14 cases out of 20 at T12 (significant elevations in 7/20). Skin temperature measurements and thermography showed a tendency towards cooling in the thoraco‐abdominal region in the vast majority of the cases and a marked temperature elevation in the foot only. No differences between hyperbaric and glucose‐free solutions for spinal analgesia were noticed. The conclusion of this study is that during spinal analgesia the extent of sympathetic blockade is less than the extent of analgesia.