bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia for Cesarean Section IV
Authors: Magno R. , Berlin A. , Karlsson K. , Kjellmer I.
Published: January 2009

Epidural analgesia with bupivacaine was used for elective cesarean section, and repeated maternal and neonatal blood samples were collected over 24 h for calculation of drug concentration. A gas‐chromatographic micro‐method was used for the analysis. The aim of this investigation was to evaluate the placental transfer and the elimination rate of the drug.

No signs of systemic toxicity were observed in any mother or child, despite relatively high blood concentrations. The fetal‐maternal ratio of concentrations at delivery was higher than in previous studies, most probably due to the protein‐binding characteristics of bupivacaine and the dosage used. The biological half‐life of the rapid phase of elimination (a‐phase) in the newborn was shorter than in the mother (P < 0.002), indicating a more rapid distribution process. The half‐life of the slow phase of elimination (β‐phase) in the newborn was of the same magnitude as in the mother, indicating that neonatal elimination processes of bupivacaine may be well developed at birth.
Arterial and Venous Blood Lidocaine Concentrations after Local Anaesthesia of the Respiratory Tract using an Ultrasonic Nebulizer
Authors: Karvonen S. , Jokinen K. , Karvonen P. , Hollmén A.
Published: January 2009

Arterial and venous blood lidocaine concentrations were intermittently measured in 15 bronchoscopy patients in whom local anaesthesia was induced by an inhalation technique. A De‐Villbiss ultrasonic nebulizer model 3574 was used. The anaesthetic was 10 ml of 4% lidocaine without adrenaline. Blood concentrations were measured 5 min after commencement of inhalation, on completion of inhalation, and then after 10, 30 and 60 min. Statistically significantly higher concentrations were found in the arterial blood at the first two sampling times (P < 0.01 and P < 0.05, respectively). The highest average concentration in both arterial and venous blood was reached 10 min after completion of anaesthesia. After 30 min, there was no difference between the arterial and venous samples; and after 60 min, the concentration was higher in venous blood. The highest individual concentration was 2.8 hg/ml in arterial blood and 2.1 pg/ml in venous blood, well below that reported to cause systemic toxic symptoms. Thus, the inhalation technique may be considered a safe means of inducing anaesthesia in the respiratory tract.
Comparison of Haemodynamic Effects of Pethidine and Anileridine in Patients with Coronary‐Artery Disease
Authors: Tuominen Marjatta , Heinonen J. , Heikkilä J.
Published: January 2009

The circulatory effects of anileridine, a derivative of pethidine, have been little studied. Therefore we compared the haemodynamic effects of equianalgesic doses of pethidine (1 mg/kg i.v.) and anileridine(0.25 mg/kg) in matched patients requiring myocardial revascularization.

Cardiac output was significantly increased 5 min after the administration of pethidine, mainly due to an increase in heart rate. A transient rise in the systolic pulmonary‐arterial pressure was found after anileridine. No remarkable changes were found in systemic arterial pressures, central venous pressure, balloon‐occluded pulmonary‐arterial pressure, stroke volume, systemic or pulmonary vascular resistances and derived oxygen consumption. Further, 20 min after drug administration, there were no significant differences in any circulatory parameters between the two groups. One patient developed acute cardiac failure after anileridine, though as he had very severe coronary heart disease it remains an open question whether this was spontaneous or drug‐induced.

Since the rate‐pressure product tended to increase after pethidine, this drug may not be considered an ideal analgesic for patients with ischaemic heart disease. Anileridine had less influence on this variable. Since the circulatory effects of pethidine seem to depend on the haemodynamic status of the patient, the haemodynamic properties of anileridine may also deserve further investigation.
Respiration and Circulation after Total Hip Replacement Surgery
Authors: >Modig Jan
Published: January 2009

The cardiopulmonary effects of two different types of postoperative analgesic regimens were compared in 31 cardiorespiratorily healthy patients subjected to total hip replacement surgery. The investigation was performed preoperatively on the morning of the day of surgery and during the first 3 days postoperatively. All patients received continuous lumbar epidural analgesia preoperatively, during surgery and up to the end of the first measurement period, which started 2.5 h after surgery. Ten patients were subsequently given pentazocine (Fortalgesic®) intramuscularly on demand for pain relief throughout the investigation, while 14 patients received 0.4% plain lidocaine (Xylocain®), and seven patients 0.4% lidocaine with adrenaline (1/400,000) as a continuous lumbar epidural drip for analgesia throughout the investigation.

It was confirmed that the operative procedure itself did not significantly influence the postoperative arterial oxygenation, while the type of postoperative analgesic regimen was of considerable importance in this respect. Thus, patients given pentazocine showed a significant increase in pulmonary venous admixture, due both to an increase in true shunt and to an increase in ventilation/perfusion disturbances. This pattern, of poor pulmonary function still persisted on the third postoperative day, and caused a significant decrease in Pao, during days 1 to 3 postoperatively. In patients given an epidural block no significant changes in pulmonary venous admixture were noted postoperatively, and thus there was no reduction in Pao2. All patients, irrespective of the type of analgesic regimen used, had a significantly increased cardiac index and oxygen uptake postoperatively, although patients given an epidural block showed a greater increase in cardiac index, and thus a tendency towards a more hyperkinetic circulation than those given pentazocine.
Postanaesthetic Use of Naloxone Hydrochloride after Moderate Doses of Fentanyl
Authors: Andersen R. , Dobloug I. , Refstad S.
Published: January 2009

A consecutive series of 273 anaesthetics is presented. All patients were given moderate doses of droperidol and fentanyl intravenously to supplement nitrous oxide and oxygen anaesthesia. 28.6% of the patients needed reversal of the analgesic respiratory depressant effect at the end of anaesthesia to establish stable spontaneous respiration. The opiate antagonist, naloxone hydrochloride (Narcan®), was found to give rapid and reliable reversal of the respiratory depression. A mean dose of 2 pg/kg body weight of naloxone was found adequate in that no patient required further doses in the post‐operative period in order to maintain adequate ventilation. Neither does the dose seem to have been too large. Patients in the naloxone group had no need for additional analgesics during the first 5 3/4 hours postoperatively, as compared to the painfree interval of 3 1/4 hours in the control group.
Arrhythmias during Halothane Anesthesia I: The Influence of Atropine During Induction with Intubation
Authors: Eikard Bent , Sørensen Birgit
Published: January 2009

The changes in cardiac rhythm which occurred during induction of halothane‐N2O/O2 anesthesia with thiopenthal and one single dose of suxamethonium for intubation were studied in two groups of patients, one (at random) of which was given atropine intravenously 0.1 mg/10 kg 2 min before induction.

There was a significantly higher incidence of arrhythmias in the atropine group (P < 0.01) ‐ including sinustachycardia ® 120 beats/min.

The most common arrhythmias were supra ventricular ectopies. About half of those registered in the atropine group arose in direct connection with atropine administration. There was a relative accumulation of arrhythmias in connection with intubation in both groups. Ventricular ectopies were only observed during and immediately after intubation, and most often in the atropine group. The occurrence of arrhythmias was not age‐dependent.

The cardioacceleration following intubation was significantly higher in the atropine group (P<0.01). No consistent changes in blood pressure as the result of the change in cardiac rhythm were observed in connection with the single arrhythmia episode or following atropine. On the other hand, no advantage could be seen in the use of the drug, and the cardioacceleration which is inherent in its action may be injurious to patients with a limited cardiac reserve.
The Flow Requirement in a Non‐Polluting Mapleson C Circuit
Authors: NørregaardChristensen K.
Published: January 2009

Capnography and measurement of the respiratory minute volume were carried out on normal, conscious subjects during breathing of pure O2 via a Mapleson C modification of a Magill attachment, with and without continuous gas evacuation. The measurements were performed in two series, with intermittent discharge and with continuous evacuation. Rebreathing was calculated in relation to the test subject's basal respiratory minute volume, measured at the commencement of the test. The measurements indicated CO2 accumulation at a flow below 200% of the respiratory minute volume. There was no significant difference between the systems with and without evacuation.
Effects of Halothane on the Metabolism of Human Adipose Tissue
Authors: Bennis Jarl , Olson Jim , Smith Ulf
Published: January 2009

The metabolism of specimens of human adipose tissue exposed to different concentrations of halothane was studied. Halothane was added to the incubation medium directly or via the gas phase above the medium. The basal lipolysis was significantly increased by low concentrations of halothane. Higher concentrations clearly diminished the lipolysis, but here, in spite of the inhibitory effect on the basal lipolysis, the lipolytic effect of noradrenaline expressed as percent increment was increased. The rate of lipid synthesis from glucose was reduced when halothane was present in the gas phase. The effect of insulin on glucose metabolism was not affected by the presence of halothane, while the antilipolytic action was abolished by high concentrations of halothane.

The results show that halothane may exert dual effects on the mobilization of lipids from human adipose tissue; at low concentrations halothane enhances the basal lipolysis, while at higher concentrations it exerts inhibitory effects.
Supraphysiologic Glucocorticoid Treatment in Hypoxic Stress in Dogs
Authors: Engquist A. , Sørensen Birgit , Kann T.
Published: January 2009

Effects of supraphysiologic methylprednisolone succinate doses on systolic time intervals, hemodynamic performance, and metabolism were studied in normal dogs during normoxia, after 60 min of normocapnic hypoxemia (Pao2= 30 mm Hg), and reoxygenation. Bolus injections of 30 or 100 mg/kg methylprednisolone did not exert any positive inotropic action during normoxia. Cardiovascular and metabolic changes induced by hypoxia were modified only to a modest and statistically insignificant degree by sustained high levels of methylprednisolone.
Inadvertent Abducens Nerve Block during Therapeutic Trigeminal Nerve Block
Authors: Aass AnneS. , Tenicela Ruben
Published: January 2009

A case is presented where reversible abducens nerve block accompanied second and third division trigeminal block with bupivacaine on two occasions. Intra‐orbital injection through the inferior orbital fissure most likely took place. Careful positioning of the needle and limitation of the drug volume is mandatory for therapeutic trigeminal nerve blocks with neurolytic solutions.
Respiratory Depressant Action of Tilidine during N2O+O2, Anaesthesia
Authors: Tammisto Tapani , Tigerstedt Irma
Published: January 2009

The respiratory depressant actions of pethidine and tilidine during anaesthesia were compared in 18 surgical patients anaesthetized with N2O + O2 after thiopental induction. Five minutes after thiopental, 0.5 mg/kg pethidine or 1.5 mg/kg tilidine were each given intravenously to six patients, the remaining six patients serving as controls.

Minute ventilation, respiratory rate, end‐tidal CO2 and Pco2 from arterialized venous blood were measured up to 30 min. Pethidine caused the following maximal changes: 0–0.98±0.24 (s.e. mean) 1/min, rate ‐.5.5 ± 0.7/min, C02ET+0.7±0.1 vol % and Pco2 + 5.7±1.1 mm Hg. These changes occurred within 10 xnin of the injection.

In terms of the above parameters, tilidine caused at least as pronounced a respiratory depression as pethidine. The peak effect of tilidine, however, could not be measured with certainty, since the respiratory depression first became apparent 15 min after the injection, and then increased throughout the study period. The long onset time of tilidine explains our previous failure to demonstrate tilidine‐induced respiratory depression.
The Hafnia A Circuit: A Valveless Non‐palluting Anaesthetic System
Authors: Thomsen A. , Jørgensen S.
Published: January 2009

An anaesthetic circuit is described, which fulfils the following requirements: 1) It is suitable for patients of all age groups; 2) There is no expiratory resistance; 3) There is no anaesthetic gas exposure risk to operating room staff; 4) The change from spontaneous to controlled respiration can be made without the necessity of access to the patient attachment; 5) It is easy to handle and clean.

The system is a modified Magill circuit, consisting of a corrugated tube with breathing bag, relief valve, and dumping valve. Gas evacuation is performed continuously through an ejector flowmeter connected to a narrow branch tube at the patient attachment.

The flow requirement was calculated by analyses of the system and was investigated using 10 conscious volunteers (spontaneous respiration) and five anaesthetized patients (controlled respiration). Significant rebreathing was not seen with a fresh gas flow exceeding the basal respiratory minute volume requirement by 35%.
Clinical Effects of Carticaine, a New Local Anesthetic. A Survey and a Double‐Blind Investigation Comparing Carticaine with Lidocaine in Epidural Analgesia
Authors: Brinkløv M. M.
Published: January 2009

Carticaine, a new local anesthetic of the amide type, differs from those previously known in that it contains a thiophene ring. The physico‐chemical properties of the compound, its pharmacology and its toxicology are reviewed from the literature. A controlled, double‐blind investigation in which carticaine was compared with lidocaine for the purpose of throwing light on the effect of the new local anesthetic in epidural analgesia is presented. Carticaine and lidocaine 2% with adrenaline 1:200 000 were used in the investigation. It was not possible to show any statistically significant difference as regards latency, spread, duration, or motor blockade obtained with the two substances. Marked differences in the type of side effects or their frequency were not noted. From this investigation and a scrutiny of the published clinical studies on the effect of carticaine, it is concluded that its clinical properties are comparable to those of lidocaine.
Lack of Impairment in Skills Related to Driving after Intramuscular Administration of Prilocaine or Mepivacaine
Authors: Korttila K.
Published: January 2009

A saline placebo, 3 mg/kg of 2% plain prilocaine, and 3 mg/kg of 2% plain mepivacaine were injected into the deltoid muscles of 10 healthy subjects in a double‐blind, cross‐over trial.

Before and at 0.5, 1.5 and 3 h after injection, psychomotor skills related to driving were measured. When compared to the saline placebo, neither prilocaine nor mepivacaine impaired the parameters of psychomotor function measured. Blood concentrations of prilocaine were significantly (P < 0.001) lower than those of mepivacaine during the whole observation period.

It was concluded that in comparison to lidocaine, bupivacaine, or etidocaine, which have been tested previously and found to impair psychomotor performance, mepivacaine and, especially, prilocaine are the anaesthetic agents to be preferred when effects on central nervous system should be avoided, e.g. in outpatient practice.
Segmental Epidural Analgesia and Urinary Excretion of Catecholamines during Labour
Authors: Jouppila R. , Hollmén A. , Jouppila P. , Kärki N.
Published: January 2009

Urinary excretion of catecholamines was determined separately during the first stage of labour and during the period from the beginning of the second stage until 1/2 h after delivery in 16 healthy mothers, whose labours were induced at term. Seven mothers were given segmental epidural analgesia, at the height of Th10–12, to achieve complete pain relief during the first stage of labour. The remaining parturients served as controls. During the first stage of labour the urinary excretion rate of catecholamines was at the normal nongravid rest level in both groups. During the second stage, and 1/2 h after the delivery, the amount of urinary catecholamines increased significantly in both groups. The latter values corresponded to the amounts of catecholamines excreted during heavy physical work.
Acid‐Base Status Before and After Arterial Clamping
Authors: Stokke D. B. , Juhl B. , Juel G.
Published: January 2009

The necessity of providing alkalizing therapy after re‐establishment of the local circulation was studied in 10 otherwise healthy patients with intermittent claudication. No such necessity was found in providing stable peroperative circulation, normo‐ to slight hypothermia, adequate infusions, and normal acid‐base values prior to arterial clamping.

It is pointed out that alkalosis can cause circulatory problems that are just as serious as those occurring with acidosis; therefore the routine use of alkalizing agents during vascular surgery is inadvisable. Should unstable circulatory parameters occur and hypoperfusion be suspected, then repeated control of the acid‐base values is indicated.
General Anaesthesia or Lumbar Epidural Block for Caesarean Section? Effects on the Foetal Heart Rate
Authors: Belfrage P. , Irestedt L. , Raabe N. , Arnér S.
Published: January 2009

Caesarean section was performed in 10 patients under general anaesthesia and in 10 other patients under epidural block. The foetal heart rate was monitored continuously during anaesthesia and operation with a scalp electrode and a cardio‐tocograph. There was no major difference between the two anaesthetic techniques in their effect on the foetal heart rate. The most common finding was a reduction of the beat‐to‐beat variation. The operative time was longer in the epidural group than in the general anaesthesia group, due to a higher frequency of Pfannenstiel incisions and repeat caesarean sections in the epidural group. Clinically, all newborns seemed to be unaffected, with normal Apgar scores. Epidural block seems to be a good alternative to general anaesthesia for caesarean section, particularly when a long operative time is expected.
Comparison of Electrocardiographic Changes during Microlaryngoscopy under Halothane Anaesthesia induced by Althesin® or Thiopentone
Authors: Saarnivaara Laila , Kentala Eero
Published: January 2009

The incidences of electrocardiographic (ECG) changes during microlaryngoscopy under halothane anaesthesia were compared by using Althesin® and thiopentone as induction agents.

During the procedure the most common ECG change in both groups was junctional rhythm, which occurred in 37% of the patients in the Althesin group and in 29% of the patients in the thiopentone group. The next most common changes in the Althesin group were: ventricular ectopic beats (22%), ischaemic S‐T segment depression (14%), and T wave flattening or inversion (14%); those in the thiopentone group were ventricular ectopic beats (18%) and rapidly ascending S‐T segment depression (12%). As well as during the procedure, some ECG changes were registered in both groups during intubation. ECG changes disappeared without any special treatment after manipulation of the vocal cords or after intubation.

There was no statistically significant difference in the total incidence of dysrhythmias between the Althesin and thiopentone groups, but the types of dysrhythmias were different in the two groups. There were more lower nodal rhythms, less serious ectopic beats and more ischaemic S‐T segment depression in the Althesin group than in the thiopentone group.

The results suggest that Althesin is useful and superior to thiopentone in patients with a tendency to develop serious ventricular ectopic beats, whereas in patients with heart and coronary arterial disease, Althesin is inferior to thiopentone and should be used with care.
Human Hepatic Blood Flow and its Relation to Systemic Circulation during Intravenous Infusion of Lidocaine
Authors: Wiklund Lars
Published: January 2009

Twelve healthy young volunteers were studied before and during intravenous administration of lidocaine at a dose rate of 2 or 4 mg/min. Five additional volunteers, who did not receive lidocaine solution but were given the same amount of physiological saline, were studied in the same manner. Heart rate, cardiac output, mean arterial blood pressure, mean right atrial blood pressure, estimated hepatic blood flow and plasma concentration of lidocaine were measured repeatedly. The results showed an increase in heart rate, cardiac output and mean arterial blood pressure, the latter two variables in relation to the plasma concentration of lidocaine. The estimated hepatic blood flow increased, partly as a result of the reduction of splanchnic vascular resistance and partly due to the stimulation of cardiac output. The decrease in splanchnic vascular resistance was proportional to the plasma concentration of lidocaine.
Peripheral Nerve Injury due to Injection Needles used for Regional Anesthesia
Authors: Selander Dag , Dhunér Karl‐Gustav , Lundborg Göran
Published: January 2009

Nerve injury can arise as a complication of peripheral nerve block anesthesia. Of the various factors involved, the trauma caused by the injection needle may be of significance. In this experimental study the frequency of fascicular injury was investigated immediately after needling isolated rabbit sciatic nerve preparations, and after intraneural injection with the nerve in situ. Two different injection needles were used, one with a bevel angle of 14° and the other with a 45° bevel angle. Fascicular injury was indicated by a fluorescence microscopy technique, tracing locally applied Evans Blue Albumin. The results show that a 45°‐beveled needle less frequently produces fascicular damage and should therefore be recommended for use in clinical anesthesia. It is also concluded that paresthesiae, when necessary, should be elicited gently, and that intraneural injections should be avoided.
The Cerebrovascular CO2 Reactivity during the Acute Phase of Brain Injury
Authors: Gold Georg E. , Jensen Finn Taagehøj , Malmros Richard
Published: January 2009

Using the intra‐arterial 133xenon (133Xe) method, the cerebrovascular response to acute PaCo2 reduction was studied in 26 unconscious, brain‐injured patients subjected to controlled ventilation. The CO2 reactivity was calculated as δ In CBF/δ Paco2. The perfusion pressure was defined as the difference between mean arterial pressure and mean intraventricular pressure.

Although the CO2 reactivities did not differ significantly from that in awake, normocapnic subjects, it was low in the acute phase of injury, especially in those patients with severe outcome in whom the brain‐stem reflexes were often affected. An increase of the CO2 reactivity with time was observed, indicating normal response after 1–2 weeks.

Chronic hypocapnia in six unconscious patients resulted in sustained CSF pH adaptation. The question whether a delay in CSF pH adaptation exerts an influence on the CO2 reactivity, and the influence of cerebral lactacidosis on the CO2 response are discussed.
Peroperative Arterial Blood Pressure Control in Ophthalmological Anaesthesia
Authors: Pihlajaniemi Raimo , Helve Jyrki
Published: January 2009

The effects were studied of a standardised general anaesthesia on mean arterial blood pressure, central venous pressure, blood gas values and the course of cataract operations. The material consisted of 20 unselected senile cataract operations, the mean age of the patients being 71.3 years. The arterial blood pressure was continuously checked, using an intra‐arterial cannula. In order to avoid vitreous loss, the blood pressure was successfully kept optimally low during the extraction of the lens. No vitreous problems were noted. The oxygenation and ventilation of the patients were sufficient during anaesthesia and immediately postoperatively.
Weaning from Mechanical Ventilation by means of Intermittent Assisted Ventilation I.A.V. Case Reports
Authors: Harboe Svein
Published: January 2009

A new ventilator is described which is capable of interposing controlled breaths synchronized with the patient's own breathing rhythm. This ventilation pattern is called “intermittent assisted ventilation” (IAV). It differs from intermittent mandatory ventilation (IMV) in that each ventilator cycle is triggered by the patient. IAV constitutes a new approach to the problems during the critical period of weaning from mechanical ventilation. Further, this new ventilator provides means for continuous display and recording of airway gas flow and pressures and expired minute volume (EMV) during different types of ventilation, e.g. controlled ventilation, intermittent assisted, and spontaneous ventilation.
Anaphylactic Shock in the Monkey: its Hemodynamics and Mediators1
Authors: Pavek Karel
Published: January 2009

Anaphylactic shock (AS) was induced in 15 monkeys, and their hemodynamics were studied in order to identify the mechanisms initiating the low cardiac output (CO) state. Further, in 16 monkeys various substances were used with the aim of mimicking or antagonizing the changes in AS. Initial peripheral collapse was indicated by lowering of the right atrial pressure (RAP). The subsequent development of pulmonary hypertension increased RAP and, by extending venous pooling, reduced filling of the left heart. The degree of pulmonary hypertension or arterial hypotension was a poor indicator of the fall in CO. Hypoxemia and dysrythmias occurred occasionally, but early hemoconcentration was not found. Light depression of CO (—42%), due to venous pooling and reduction in left heart filling, could be corrected by fluid administration. In contrast, severe depression of CO (—81%) associated with ST‐T depression and with decreased cardiac contractility responded less to the fluid load, suggesting that myocardial failure was partly responsible for the low output state.

Inhibition of prostaglandin (PG) synthesis by indomethacin did not prevent the development of AS. Injections of PGE2 and PGF2α, alone or together with histamine (Hi), did not mimic AS. PGE2 induced hypotension accompanied by an increase in CO, and PGF2α induced general vasoconstriction and a somewhat diminished CO. Hi induced hypotension and pulmonary hypertension; CO increased after low doses but decreased after sublethal doses. Compound 48/80, a liberator of Hi and slow‐reacting substance (SRS), imitated Hi effects initially, but later mimicked a minor state of AS. Infusion of FPL 55712, a selective antagonist of SRS, prevented AS, and general vasoconstriction occurred instead. In this model of AS, SRS is a more important mediator than Hi or PG.
High Precision Mixing of Anesthetic Gases Based on a New Principle
Authors: Lundsgaard J. S. , Einer‐Jensen N. , Juhl B.
Published: January 2009

A machine has been constructed for mixing O2 and N2O. It consists of: (a) a proportional pressure and thereby flow regulator at the inlets for O2 and N2O; (b) a digital gas mixer which determines the gas mixture; and (c) a rotameter to measure the outlet flow.

The contents of mixtures obtained from the machine were measured with a quadropole mass spectrometer (at 2 and 5 1 min‐1 with downstream pressures of 500 and 3000 Pa). The mean numeric difference between desired and registered vol% O2 varied between 0.3 and 0.5 vol% at the four conditions tested. The maximal deviation was 1.2 vol%. Five conventional machines in daily use at the hospital were also tested. The mean numeric difference for these machines varied between 1.1 and 2.7 vol% O2. The maximum deviation was 7.4 vol%.
Catheter Technique in Axillary Plexus Block Presentation of a New Method
Authors: Selander Dag
Published: January 2009

A flexible, disposable intravenous catheter can be introduced into the neurovascular sheath in the axilla and used for injection of local anesthetic solution to block the axillary brachial plexus. The technique is described and the results of the first 137 consecutive catheter blocks are reported and compared to a similarly evaluated series of conventional axillary blocks.

The catheter method constitutes an interesting alternative to needle techniques and offers the possibility of a continuous axillary block.
The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery
Authors: Engquist Allan , Brandt Mogens R. , Fernandes Alvito , Kehlet Henrik
Published: January 2009

The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10‐S4–5 (group II), general anesthesia + epidural analgesia extending from Th8‐S4–5 (group III), general anesthesia + epidural analgesia extending from Th4–6‐S5 (group IV) and epidural analgesia extending from Th4‐S5 without general anesthesia (group V).

The results showed that the Cortisol response was abolished in group V, inhibited in group IV and normal in groups II and III. The hyperglycemic response to surgery was inhibited in groups II, III and IV, and abolished in group V.

Epidural analgesia from Th4 to S5, preventing the adrenocortical and hyperglycemic responses to hysterectomy, and possibly also inhibiting other components of the endocrine‐metabolic response to surgery, may have important applications in further studies of the physiologic significance of the endocrine‐metabolic response to surgery.
Postoperative Pulmonary Function in Obese Patients after Upper Abdominal Surgery
Authors: Eriksen Jørgen , Andersen Jens , Rasmussen Jens Peter
Published: January 2009

The pulmonary course after jejuno‐ileal by‐pass operation in six massively obese patients (mean weight 130.2 kg) was followed for the first 5 postoperative days by means of arterial blood gas analysis and measurements of forced vital capacity (FVC), forced expired volume in the first second (FEV1.0) and peak expiratory flow rate (PEFR). The patients were extubated in the operating room and were breathing spontaneously in the postoperative period. Pao2 and FVC reached their minimum values in the first 24 postoperative hours (respectively, 74% and 45% of their preoperative values), but were almost restored in 5 days. PEFR had at this time reached 77% of its preoperative value. FEV1.0% (FEV1.0 in per cent of FVC) did not change from the pre‐ to the postoperative period, but remained about 70%.
The Effects of PaCO2 Reduction on Regional Cerebral Blood Flow in the Acute Phase of Brain Injury
Authors: Cold Georg E. , Jensen Finn Taagehøj , Malmros Richard
Published: January 2009

In 26 unconscious patients with brain injuries, regional cerebral blood flow (rCBF) was measured with a 16‐channel Cerebrograph before and after acute reduction of Paco2 The intra‐arterial 133xenon washout technique was used, and CBF was calculated regionally as initial slope index or stochastic flow. The CO2 reactivity was calculated as ΔIn CBF/ΔPaco2.

In supratentorial cortical lesions, an acute fall in Paco2 increased the homogeneity of the regional flow pattern (decrease in the standard deviation of the regional flow values), and reduced the number of focal hyperaemic regions (tissue peaks). The CO2 reactivity in tissue peak regions was generally higher than in regions without tissue peaks. In severely injured patients with a poor outcome (dementia, vegetative survival or death), inverse steal reaction was accounted for in 11% of all regions, but only in 3% of the regions in patients who survived without dementia. Inverse steal reaction was most frequently seen during the first 3 days after the trauma. In repeated CBF studies, an increase in the CO2 reactivity with time was observed after the acute trauma.

In comparison with the CO2 reactivity found in normocapnic awake subjects, this increase was higher than expected in several cases.
Anaesthesia for Short‐stay Varicose Vein Surgery
Authors: Aromaa Ulla
Published: January 2009

The study was undertaken in order to elucidate the suitability of four different types of general anaesthesia and of epidural block in short‐stay varicose vein surgery. Special consideration was given to recovery after anaesthesia. The series consisted of 230 female patients subjected to varicose vein surgery of one lower extremity. The patients' recovery after surgery was observed through tests measuring visual‐motor coordination and through questionnaires. The general anaesthesias used were halothane‐nitrous oxide‐oxygen anaesthesia with spontaneous respiration (Ha), relaxant‐dominated combined anaesthesia (Re), analgesic‐dominated combined anaesthesia (An), and analgesic‐dominated combined anaesthesia with hyperventilation (Hy).

Of the general anaesthesias, halothane nitrous‐oxide inhalation anaesthesia gave the fastest recovery, although there were no major differences between it and analgesic‐dominated combined anaesthesia. In contrast, immediate recovery was prolonged after hyperventilation and after relaxant‐dominated anaesthesia. Epidural blockade provided a good alternative to general anaesthesia.
A Comparison between the Influence of Halothane or Fentanyl and Droperidol Anaesthesia on the Adrenergic Receptor Response in Human Adipose Tissue in vitro
Authors: Rosenqvist U. , Lindholm M. , Eklund J.
Published: January 2009

A comparison was made between the adrenergic receptor response in vitro in human adipose tissue obtained under halothane and neuroleptanaesthesia. In both groups the net release of glycerol was significantly stimulated (P < 0.01) by the combined alpha‐ and beta‐adrenergic agonist, 1‐noradrenaline. In the halothane group, the lipolysis was further increased by the addition of phentolamine (an alpha‐adrenergic blocking agent). No such effect could be demonstrated in specimens from the fentanyl/droperidol group. This difference in response was most probably explained by the fact that droperidol had quite a long‐lasting alpha‐adrenergic blocking property, which totally obliterated the effect of another alpha‐adrenergic blocking agent.

The findings stress the importance of using a standardized procedure, including the choice of anaesthetic agents, when human adipose tissue is sampled for metabolic studies in vitro. The results also indicate the possibility of a difference in metabolic effects in vivo between the two procedures.
Prolonged Succinylcholine‐induced Paralysis in Connection with Caesarean Section A Case Report
Authors: Aagesen G. , Ronquist G.
Published: January 2009

A prolonged succinylcholine‐induced paralysis was observed in connection with a caesarean section in an otherwise healthy, 25‐year‐old female. Her serum pseudo‐cholinesterase was analysed and found to be pathologically low, displaying in addition an atypical dibucaine number. Ten individuals related to her were also studied as regards pseudocholinesterase in serum. She had two brothers, one displaying the same pattern as herself, while the other had a normal pattern. Both of the parents had ordinary dibucaine numbers, while the father had a slightly decreased pseudocholinesterase activity. Possible mechanisms underlying the disorder are discussed.
Some Aspects of Ocular Function after Precurarization
Authors: Eriksen Søren , Bramsen Thorkild , Hommelgaard Peter
Published: January 2009

Small doses of nondepolarizing relaxants are often recommended as prior medication to suxamethonium in order to avoid or attenuate the side effects elicited by the latter drug. After D‐tubocurarine (0.05 mg/kg b.w. and 0.075 mg/kg b.w.) in unmedicated volunteers, a dose‐dependent recession of the monocular near point of accommodation was recorded. This recession, which parallelled the decrease in grip strength, was 4 cm and 9 cm, respectively. The same doses evoked an exophoria of 14 and 17 prism diopters, respectively.

Intraocular pressure was significantly lowered by D‐tubocurarine 0.05 mg/kg b.w., from 2.01 kPa (15.1 mmHg) to 1.64 kPa (12.3 mmHg), and by pancuronium 0.015 mg/kg b.w. from 1.90 kPa (14.3 mmHg) to 1.44 kPa (10.8 mmHg). The decreases lasted for 7 min. Gallamine 0.3 mg/kg b.w. also decreased intraocular pressure, but to a lesser degree, and with statistical significance only during the fourth minute after administration.

Relaxation of extraocular muscles may change the slightly ovoid shape of the eyeball into a more spherical one, thereby inducing a fall in intraocular pressure and a recession of the near point of accommodation.
Glomerular Filtration Rate during Halothane Anaesthesia and Epidural Analgesia in Combination with Halothane Anaesthesia
Authors: Jensen B. H. , Berthelsen P. , Bröchner‐Mortensen J.
Published: January 2009

Pre‐ and peroperative determination of glomerular filtration rate (GFR) was performed in nine patients operated during light halothane anaesthesia (group A) and in nine patients operated during epidural analgesia in combination with light halothane anaesthesia (group B). In group A, the mean GFR decreased insignificantly by 7% and the mean arterial blood pressure increased significantly by 10%. In group B, the mean GFR decreased significantly by 19% and the mean arterial blood pressure decreased significantly by 15%. It is suggested that the difference in change in GFR between the two groups was caused by differences in mean arterial blood pressure.
Effects of Precurarization on the Heart Measured by Systolic Time Intervals
Authors: Hommelgaard Peter , Eriksen Søren
Published: January 2009

The effects of precurarization, with or without prior atropine medication, on heart rate, systolic time intervals (preejection period (PEP) and left ventricular ejection time (LVET)) and derivatives from these were studied in 80 healthy patients before minor surgery. Atropine (0.5–0.7 mg i.v.) exerted a vagolytic action with no changes in systolic time intervals. D‐tubocurarine (0.5 mg/kg b.w.) did not affect heart rate or systolic time intervals. Both gallamine (0.3 mg/kg b.w.) and pancuronium (0.015 mg/kg b.w.) increased heart rate due to the inherent vagolytic effect. Furthermore, a short‐lasting decrease in PEP and an increase in LVET were demonstrated. Consequently, a fall in PEP/LVET and a rise in 1/PEP2were induced, indicating an increase in cardiac pump performance. These changes were blocked by prior atropine medication, a result which is not easily explainable. Possible clinical implications are discussed.
Effects of Intercostal Nerve Blocks (Bupivacaine 0.25% and Etidocaine 0.5%) on Chest Wall Mechanics in Healthy Men
Authors: Jakobson Sven , Ivarsson Ingrid
Published: January 2009

Bilateral blockade of the 5th to 11th intercostal nerves, inclusive, was produced in 14 healthy subjects. In seven, bupivacaine 0.25% was used, and in the other seven, etidocaine 0.5%. The latter has been found to have a stronger motor‐blocking action than the former. Before and after the blockade, the vital capacity (VC), peak expiratory flow rate (PEF), tidal volumes, respiratory variations in rib cage and abdominal circumferences and in oesophageal and intragastric pressures were recorded. By transthoracic electrical impedance pneumography, measures indicating changes in the functional residual capacity (FRC) were obtained. Although it was considered that changes in the parameters investigated mainly demonstrated changes in motor function, no differences were found between the drugs. With this form of blockade they seem to have equivalent effects in this respect. Thus, VC decreased by an average of 7% and PEF by 6%. Signs of a reduction of FRC after the blockade were also observed. The blockade had no effect on the partitioning of costal and abdominal breathing at rest. Analysis of the relations between the fractions of costal and abdominal breathing and the corresponding variations in intragastric pressure gave support to the view that in normal individuals both intercostal and abdominal muscles remain passive during respiration at rest. This is thus achieved by the diaphragm alone.
Effects of Intercostal Nerve Blocks (Etidocaine 0.5%) on Chest Wall Mechanics in Cholecystectomized Patients
Authors: Jakobson Sven , Ivarsson Ingrid
Published: January 2009

In 20 patients who had undergone cholecystectomy through a right oblique incision, an intercostal nerve block with etidocaine 0.5% was performed on the day after operation — in 10 patients on the right side only and in the other 10 bilaterally. The block was applied to the 5th‐11th intercostal nerves, inclusive.

Tidal volumes, respiratory variations in the perimetry of the chest and abdomen, and intraoesophageal and intragastric pressures were recorded before and after the blockades. From analyses of the relations between the relative contributions of costal and abdominal respiration, on the one hand, and intragastric pressure variations, on the other, it was found that before the blockade the intercostal muscles contributed to respiratory movements at rest, but that this contribution decreased after the blockade ‐ to a greater extent after bilateral than after unilateral blockade. It is assumed that this return to a more normal type of breathing at rest implies relief for the patients. The nerve block led to no significant change of the fraction of abdominal breathing. Pulmonary elastance decreased after bilateral blockade, but remained unchanged after unilateral. Changes in the functional residual capacity (FRC) were evaluated by transthoracic electrical impedance pneumography. Signs of a reduction were noted after unilateral blockade, but there appeared to be no change after bilateral blockade.

Bilateral intercostal block thus seems more satisfactory than unilateral in certain respects. The differences cannot be ascribed such importance, however, that bilateral blocks should be considered obligatory in cholecystectomized patients. Probably the most important effect ‐ the pain relief‐ is achieved in these patients by a right‐sided block only.
Immunosuppression after Cholecystectomy
Authors: Salo M. , Eskola J.
Published: January 2009

The effect on immune functions of cholecystectomy under combined anaesthesia was studied in nine patients. The parameters examined were the leucocyte and differential count, the T‐ and B‐lvmphocyte count, and the lymphocyte transformation induced by phytohaemagglutinin, concanavalin A, pokeweed mitogen and purified protein derivative of tuberculoprotein. The anaesthesia and operation decreased the total lymphocyte count in the peripheral blood. No significant change occurred in the proportion or absolute number of E‐binding (T) lymphocytes. The proportion of EAC‐binding (B) lymphocytes increased, although no change was observed in the lymphocytes with surface immunoglobulin representing another B‐cell marker. A statistically significant decrease was found in the lymphocyte response to all the mitogens used both in cultures with isolated lymphocytes and in whole blood. The changes returned to the pre‐induction level on the third postoperative day. These findings suggest a transitory decrease of cellmediated immunity after cholecystectomy.
Effect of Atropine‐Pethidine Premedication on Peripheral Blood Lymphocytes
Authors: Salo M.
Published: January 2009

Phenothiazines, which are also employed for premedication, are known to have an inhibitory effect on the cell‐mediated immunity. Therefore, the effect was studied in nine patients of the most commonly used atropine‐pethidine premedication on the leucocyte and differential count, the number of T‐ and B‐lymphocytes and the lymphocyte transformation by phytohaemagglutinin (PHA), concanavalin A (ConA), pokeweed mitogen (PWM) and purified protein derivative of tuberculin (PPD) in cultures of separated lymphocytes and of whole blood. The premedication increased the proportion and absolute number of surface immunoglobulin‐positive (B) lymphocytes in the peripheral blood and reduced the PHA and PPD responses in whole blood cultures. These vague changes in the immune response after premedication are of no importance in clinical work.
Splanchnic Elimination and Systemic Toxicity of Bupivacaine and Etidocaine in Man
Authors: Wiklund Lars , Berlin‐Wahlén Anita
Published: January 2009

Fifteen healthy young volunteers were studied in connection with an intravenous infusion of a local anaesthetic agent. Seven received bupivacaine and eight etidocaine in a dose rate of 2 mg × min‐1 over a period of 150 min. The hepatic blood flow and arterial‐hepatic venous differences of the two drugs were measured. The estimated hepatic blood flow increased during the infusion of both drugs. While the splanchnic extraction ratio decreased during infusion of bupivacaine to 0.41 ± 0.13, the same variable did not change (0.76 ± 0.07) when etidocaine was infused. After 150 min infusion, the splanchnic clearance of bupivacaine and etidocaine was 0.76 ± 0.27 and 1.32 ± 0.21 1 ± min‐1, respectively. Slight symptoms of central nervous toxicity were noted towards the end of the bupivacaine infusion, while no such symptoms appeared with etidocaine. A comparison between earlier published data on the blocking properties and the disposition pharmacokinetics of the two drugs shows that etidocaine is likely to confer a clinical advantage over bupivacaine as regards toxicity.
Postoperative Ventilatory Response to Carbon Dioxide Following Neurolept Anaesthesia
Authors: Hansen Vejlsted M. , Jacobsen E.
Published: January 2009

In order to investigate the duration of respiratory depression following neurolept anaesthesia, 21 patients who had hemilaminectomia performed were subjected to ventilation‐carbon dioxide response tests by a rebreathing method in the postoperative period. Up to 3 1/2 h after start of anaesthesia all patients had a decreased ventilatory response to carbon dioxide. After this period some patients showed a normal respiratory response, while others remained depressed for up to 6 h, the period for which the investigation lasted. Most patients in the depressed group were premedicated with pethidine.

We conclude that additional narcotics are contraindicated for a period of 3 1/2 h following the start of nerolept anaesthesia for surgical procedures lasting 1–2 h, while clinical control is still necessary before administration of additional narcotics within 6 h, especially if narcotics have been used as premedication.
Psychological Changes in Children after Anaesthesia: A Comparison between Halothane and Ketamine
Authors: Modvig K. M. , Nielsen S. Friberg
Published: January 2009

The psychological reactions to hospitalization, anaesthesia, and operation in a group of 107 children from 1 to 12 years old, anaesthetized with ketamine or halothane after randomization were investigated through questionnaires, which the parents answered 1 month postoperatively. The percentage of replies was 96.3%. Fifty‐three children were anaesthetized with ketamine and 50 with halothane. Thirteen children in the ketamine group and nine in the halothane group reacted with negative personality changes; the reactions were of less than 1 month's duration and were most frequent in the youngest children. The parents' preparation of the children had no influence on the results. The number of personality changes caused by the two anaesthetic agents did not differ significantly. Furthermore, the investigation showed that nine children reacted for the better. Thirty‐six per cent of the parents felt insufficiently informed of what the hospitalization implied for their child.