bluuebunny/crossref_metadata_2025 huggingface dataset:
Alveolar integrity and ultrastructure in pigs remain undamaged after exposure to sevoflurane
Authors: Takala R. S. K. , Soukka H. R. , Kirvelä O. A. , Kujari H. P. , Pelliniemi L. J. , Kääpä P. O. , Aantaa R. E.
Published: March 2003

Previous studies have shown that both halothane and isoflurane have adverse but reversible effects on alveolar physiology. The present study was designed to test the hypothesis that also sevoflurane may affect alveolar integrity.

Fifteen pigs were randomly selected to receive either thiopentone infusion (control group, n=8) or sevoflurane (n=7) at 4.0% inspiratory concentration (1.5 MAC) in air for 6 h. Tissue samples from the lungs were obtained at the end of the experiment. Both histopathological light microscopy and electron microscopy were used to assess the structural integrity of the alveoli.

Pulmonary hemodynamics were comparable in both groups. Light microscopy showed no difference between the groups in the amount of alveolar macrophages, red blood cells or edema. Electron microscopy showed minor changes such as moderate local swelling of alveolar epithelium in both study groups. Alveolar type II cells were ultrastructurally unaltered in both study groups.

We conclude that long‐term, high concentration exposure to sevoflurane has no detrimental effect on the alveolar integrity in pigs.
Teaching hospital physicians' skills and knowledge of resuscitation algorithms are deficient
Authors: Iirola T. , Lund V. E. , Katila A. J. , Mattila‐Vuori A. , Pälve H.
Published: March 2003

Background:  The resuscitation skills of 78 on‐call physicians in a tertiary referral center were evaluated in a simulated sudden cardiac arrest (SCA).

Methods:  The study subjects consisted of physicians whose on‐call duty included handling emergency situations. First they were drawn without warning to a simulated witnessed cardiac arrest (ventricular fibrillation (VF)). They were provided with two nurses and all the equipment and medicine needed to treat SCA. Second, they were asked to write the current treatment protocols for basic life support (BLS) and VF.

Results: The median time to defibrillation was 2.38 min, and only 31% of the physicians were able to use the defibrillator correctly. Thirty per cent treated asystole according to the guidelines of the time. Twenty‐four per cent were able to return the spontaneous circulation and the median time to ROSC (return of spontaneous circulation) was 5.75 min Only 25% of the physicians wrote the guideline for treatment of VF and basic life support correctly or nearly correctly.

Conclusion:  Regular resuscitation education should be compulsory to all physicians responsible for on‐call duties in hospitals. Hospitals should have at least one employee part‐time responsible for this duty.
Complete recovery after 2 h of cardiopulmonary resuscitation following high‐dose prostaglandin treatment for atonic uterine haemorrhage
Authors: Krumnikl J. J. , Böttiger B. W. , Strittmatter H. J. , Motsch J.
Published: March 2003

We report the case of a 31‐year‐old woman who delivered twins by Caesarean section in whom atonic uterine haemorrhage developed 6 h postoperatively. During conservative treatment with the high‐dose prostaglandin analogs sulprostone (PGE2) and dinoprost (PGF2α), acute pulmonary oedema and cardiac decompensation developed and, subsequently, the patient suffered cardiopulmonary arrest. After a 2h‐period of cardiopulmonary resuscitation (CPR), it was possible to restore and stabilize circulation under the highest dose of catecholamines. Despite 2h of CPR, the patient was discharged from hospital 3 months later without any major physical or neurocognitive deficit.
Thoracic epidural anesthesia and epidural hematoma
Authors: Persson J. , Flisberg P. , Lundberg J.
Published: March 2003

This report involves a 74‐year‐old‐male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection.

The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High‐dose steroid treatment may have been a contributing factor for the positive outcome.
Mortality rates among Swedish physicians:  a population‐based nationwide study with special reference to anesthesiologists
Authors: Svärdsudd K. , Wedel H. , Gordh T.
Published: March 2003

Background: Recent studies both in the UK and in the USA have indicated a higher mortality rate among anesthesiologists than among other physicians. We therefore decided to investigate the situation in Sweden during the years 1993–99.

Methods: All 26 086 doctors in Sweden with a specialist licence in 1993, including those who were retired or who received one until 1999, were identified in official records and followed up regarding survival until 1999; generating approximately 179 300 person‐years.

Results: Overall, 893 deaths occurred during the 7‐year follow up. Mean age at death was 72.9 years in the whole population, the lowest being 64.1 years among the anesthesiologists and the highest 77.0 among the pediatricians. However, there were large differences in the age and sex distribution among the specialities. For this reason a series of proportional hazard regression analyses (Cox's) of the mortality rates in the various speciality groups were performed, taking into account the influence of age and gender differences. After this procedure anesthesiologists had a 46% higher mortality rate and pediatricians a 24% lower mortality rate than other specialist groups; both deviations being statistically significant. All other specialities had a mortality risk within the expected range. Anesthesiologists tended to have higher rates than other specialists for most underlying causes of death.

Conclusion: Anesthesiologists have a higher mortality rate than other specialities. The cause is so far unknown. However, it is unlikely to be caused by obvious confounders such as age, gender, or smoking habits. Other factors linked to occupational exposure should be investigated.
Mortality among Finnish anesthesiologists from 1984–2000
Authors: Ohtonen P. , Alahuhta S.
Published: March 2003

Background: Previous studies have suggested increased mortality among anesthesiologists. We report age‐standardized mortality rates and causes of death among Finnish anesthesiologists.

Methods:  Data covering the deaths of all medical specialists during 1984–2000 were obtained and analyzed. There were 799 deaths, of which 18 involved anesthesiologists. The causes of deaths of these anesthesiologists were obtained from the database of Statistics Finland.

Results:  The age‐standardized mortality rate (SR) for the male anesthesiologists was 33.9 years (per 1000), and that for the other male specialists was 84.6 years. The SR for the female anesthesiologists was 45.4 years, and that for the other female specialists was 77.3 years. The mean age at death among the anesthesiologists was 63.0 years (SD 11.0), while the mean age at death among the other specialists was 68.6 years (SD 14.7). The age structures of the anesthesiologists and other specialists were different, with the anesthesiologists being younger.

Conclusion: The different age distributions of the anesthesiologists and other specialists caused the difference in age at death. The SR values for the anesthesiologists are clearly lower than those for other specialists. Thus, the present findings do not show increased mortality among Finnish anesthesiologists.
Mortality of anesthesiologists, pediatricians, and other specialists in Norway
Authors: Aasland O. G.
Published: March 2003

Background: Following sensational media reports, particularly from Sweden, there has been discussion in Scandinavia during the last couple of years about whether anesthesiologists have shorter life spans than other medical specialists.

Methods: Survival analysis (Cox regression) from the master file of the Norwegian Medical Association was used to compare anesthesiologists with pediatricians and other specialists. Data was taken from 10 367 specialists, 533 anesthesiologists, 488 pediatricians, and 9325 other specialists, with Norwegian citizenship. These comprised 574 065 man‐years, of which 171 190 were lived after achieving specialty.

Conclusion: No differences in mortality were found between the three groups.
Mortality among anesthesiologists in Denmark, 1973–95
Authors: Juel K. , Husum B. , Viby‐Mogensen J. , Viskum S.
Published: March 2003

Background: Preliminary data from Sweden indicating that anesthesiologists have a high mortality risk has caused a lot of concern in Denmark. The aim of this study therefore was to compare mortality between consultant anesthesiologists and other consultants in Denmark.

Methods: A historical prospective cohort study based on the membership register of the Danish Medical Association from 1973 to 1992. The study population consisted of 6854 consultants who were members of the Association of Medical Specialists, 406 of whom were anesthesiologists. The all‐cause mortality between the two groups was compared during the period 1972–95 using Cox's proportional hazard regression model.

Results: The study covered approximately 86 000 person‐years. A total of 1205 deaths occurred within the period studied, 41 of whom were anesthesiologists. The relative risk for all‐cause mortality among the anesthesiologists compared with all the other consultants was 1.0 (95% confidence limit: 0.7–1.4).

Conclusion: In Denmark there is no evidence of a high mortality risk in consultant anesthesiologists compared with other consultants.
Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
Authors: Koga I. , Stiernström H. , Wiklund L.
Published: March 2003

Background: The objective of the present study was to determine if colonic endoluminal mucosal oxygen saturation, as determined by reflectance pulse oximetry, is an appropriate method to monitor colonic ischemia produced by a gradual partial constriction of the aorta in a porcine experimental model.

Methods: Piglets were anesthetized and mechanically ventilated. A Nellcor RS‐10 reflectance pulse oximeter probe was attached to a Foley balloon catheter and passed transanally to record the oxygen saturation of the sigmoid colonic mucosa. For comparison, a tonometry catheter was introduced into the sigmoid colon. Hypoperfusion shock was induced by partial gradual constriction of the aorta. The same measurements but no intervention was performed in the control group.

Results: During one‐third reduction of the aortic blood flow, the plethysmographic signal disappeared suddenly and the sigmoid colonic mucosa oxygen saturation (ScO2) measurements showed zero in seven out of the eight pigs. During two‐thirds flow reduction, no plethysmographic signals were observed in any of the piglets. During the reperfusion period, ScO2 measurements with a good plethysmographic signal were obtained immediately after complete release of the aortic constriction in all pigs. Significantly decreased intramucosal pH and increased difference between the arterial and regional PCO2 (PCO2 gap) were observed during two‐thirds blood flow reduction.

Conclusion: In contrast to the results of previous investigations, the sigmoid colonic pulse oximetry was not useful because the method proved to be overly sensitive and non‐linear in relation to regional blood flow.
Prospective, randomized cost analysis of anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery
Authors: Loop T. , Priebe H.‐J.
Published: March 2003

Background: In the era of cost containment, cost analysis should demonstrate the cost‐effectiveness of new anesthetic drugs.

Methods: This single‐blind, prospective, randomized study compared the costs of three remifentanil (REM)‐based anesthetic techniques with a conventional one in 120 patients undergoing otorhinolaryngeal surgery. The patients were randomized (n=30 each group) to either receive a combination of REM with propofol, desflurane or sevoflurane, or a conventional anesthetic with thiopentone, alfentanil, isoflurane and N2O.

Results: The costs for anesthetic and nonanesthetic drugs and for disposables were twice as high in the three REM‐based groups as in the conventional group (REM/PRO 0.51 €/min, REM/DES 0.42 €/min, and REM/SEVO 0.41 €/min vs. 0.18 €/min in the ALF/ISO/N2O group; P<0.05). Wastage of intravenous drugs accounted for up to 40% of total costs. In all REM groups, early recovery was predictably faster and more complete (P<0.05). Patient satisfaction was equally high (90–97%) in all groups, with less nausea in the REM/PRO group.

Conclusion: This study demonstrates that REM‐based anesthetic techniques are more expensive than a conventional technique using alfentanil, isoflurane and N2O. This is the result of higher costs of anesthetic and nonanesthetic drugs and of disposables. The wastage of intravenous drugs contributes considerably to these costs.
Lamotrigine monotherapy for control of neuralgia after nerve section
Authors: Sandner‐Kiesling A. , Rumpold Seitlinger G. , Dorn C. , Koch H. , Schwarz G.
Published: March 2003

Background: We present six patients treated only with the new‐generation anticonvulsant lamotrigine to define its sole effect on neuralgia after nerve section.

Methods: Previous surgical or pharmacological attempts failed to relieve this neuropathic pain in our patients. Before initiation of lamotrigine therapy, patients reported spontaneous and touch‐evoked shooting pain followed by periods of burning pain. No breakthrough medication was needed during the maintenance phase of 1–23 months. Data were acquired by a pain diary on a weekly basis.

Results: With 75–300 mg of lamotrigine per day, the burning and shooting pain intensity was relieved by 33–100%. Most obviously, the attack frequency of the shooting pain was reduced by 80–100%. No adverse effects were observed.

Conclusion: We conclude that lamotrigine may be beneficial in the treatment of neuralgia after nerve section following the failure of previous pharmacological or surgical attempts.
Intrathecal fentanyl/meperidine combined with  low‐dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors
Authors: Okutomi T. , Hoshino Y. , Amano K. , Okamoto H. , Hoka S.
Published: March 2003

This case report demonstrates the anesthetic management of a 41‐year‐old primiparous parturient with massive ascites due to advanced Krukenberg tumors, undergoing Cesarean section. We chose a combined intrathecal‐epidural technique, using intrathecal hypobaric fentanyl and hyperbaric meperidine, and a low dose of epidural bupivacaine in order to avoid hemodynamic instability in this critically ill patient. Surgery was carried out without difficulty under adequate regional anesthesia. The blood pressure was maintained with low doses of phenylephrine and dopamine. Opioid‐related complications such as nausea–vomiting, pruritus, drowsiness, and respiratory depression were not observed in this patient. Therefore, intrathecal opioids combined with a low dose of epidural local anesthetics for Cesarean section is suitable for critically ill patients with malignant abdominal tumors, such as a Krukenberg tumor, complicated by massive ascites.
An anaphylactic reaction to blood supplied from patient's mother
Authors: Nakaigawa Y. , Mitsuhata H. , Saitoh J. , Seo N.
Published: March 2003

We present the case of a 4‐year‐old girl who developed anaphylactic shock during general anesthesia. Symptoms appeared 80 min into the operation and may have been an immediate allergic reaction to the transfused blood supplied from the child's mother based on the clinical signs, the decrease of components of complements and the elevated concentrations of histamine and tryptase. The blood type was the same and antibody screening test and crossmatch was negative. The blood was irradiated and we used a white cell‐reduction filter. This patient possibly has antibodies to her mother's plasma and this type of reaction cannot be prevented by these routine methods. It is reported that the risk of transfusion associated graft‐vs.‐host disease is high when a patient receives blood from a closely related donor. However, there are, no reports of anaphylactic reactions to blood supplied from mother to child. We suggest that there is a potential for anaphylactic reaction as well as transfusion associated graft‐vs.‐host disease when a child patient receives blood from the mother.
Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta‐analysis of randomized controlled trials
Authors: Kranke P. , Morin A. M. , Roewer N. , Eberhart L. H. J.
Published: March 2003

Background: Diphenhydramine and its theoclate salt dimenhydrinate are traditional antiemetics still in use. However, so far the quantitative effect of dimenhydrinate in the prophylaxis of postoperative nausea and vomiting (PONV) has not been evaluated systematically.

Methods : Results from randomized controlled trials investigating the efficacy of dimenhydrinate vs. a control to prevent PONV were included in a meta‐analysis. Studies were systematically searched through MEDLINE, EMBASE, the Cochrane‐Library, manually screening of reference lists of matching review articles and current issues of locally available peer‐reviewed anesthesia journals, up to June 2001. The numbers of patients with complete absence of PONV within 6 h and within 48 h after surgery were extracted as the main end point. Pooled relative benefits (RB) and numbers‐needed‐to‐treat (NNT) with their corresponding 95% confidence intervals (CI) were calculated using a random effects model. This quantitative systematic review was performed following the recommendations of the QUORUM statement.

In all, 18 trials with 3045 patients were included in the analysis: 1658 patients received a placebo (control) and 1387 patients received dimenhydrinate.

Results: The RB to stay completely free of PONV was 1.2 (95% CI: 1.1–1.4) for the early period (NNT = 8; 95% CI: 5–25) and 1.5 (1.3–1.8) for the overall investigated period (NNT = 5; 95% CI: 3–9).

Conclusion : Dimenhydrinate is a traditional and inexpensive antiemetic with an efficacy that might be considered as clinically relevant. Although in use for a long time, the dose–response, precise estimation of side‐effects, optimal time of administration and the benefit of repetitive doses still remain unclear.
Myocardial ischemia induces coronary t‐PA release in the pig
Authors: Österlund B. , Andersson B. , Häggmark S. , Jern C. , Johansson G. , Seeman‐Lodding H. , Biber B.
Published: March 2003

Background:  Tissue‐type plasminogen activator (t‐PA) is the key factor in initiating endogenous fibrinolysis in the vascular compartment. Regulated release of t‐PA from endothelial stores is rapidly induced by several humoral factors as well as coagulation activation products. The aim of the present study was to test the hypothesis that regional myocardial ischemia induces regulated release of t‐PA in the coronary vasculature in vivo.

Methods:  Healthy anesthetized (pentobarbital) pigs (n=8) were studied before and after a 10‐min left anterior descending region coronary artery occlusion (LAD). Coronary fluxes of lactate, total t‐PA antigen (ELISA, detecting both complex bound and free fraction) and active t‐PA (functional assay detecting biological free fraction) were determined at 1, 3, 5 and 10 min of reflow.

Results:  Coronary occlusion induced myocardial lactate production in all animals. Net coronary release of total t‐PA, which was 21 ng/min during control, increased rapidly during reflow with a peak after only 1 min (136 ng/min), and returned to baseline within 3 min. Net release of active t‐PA mirrored the overall net release response, but fell short of statistical significance.

Conclusion:  Data indicate a local myocardial profibrinolytic response following regional ischemia, which may serve as a prompt defence against coronary thromboembolic events.
Detecting postoperative urinary retention with an ultrasound scanner
Authors: Rosseland L. A. , Stubhaug A. , Breivik H.
Published: March 2003

Background: Retention of urine is a common postoperative problem associated with risk of overdistention and permanent detrusor damage. Prevention of urinary retention by insertion of indwelling catheter may increase the risk of urinary infection. We have performed a reliability test of an ultrasound scanner, implemented in the postoperative monitoring equipment.

Methods: Patients were monitored after different types of surgery under spinal anesthesia with an ultrasound scanner in the postanesthesia care unit (PACU).

Patients: Patients who according to current guidelines required a urinary bladder catheter, were scanned before a catheter was inserted and urine volume was measured. These two urine volumes were compared and analyzed for agreement.

Results: Nineteen female and 17 male patients were included. The mean difference between ultrasound estimates and catheter urine volume measurements was − 21.5 mL, and limits of agreement, calculated as a 95% confidence interval, were − 147 and + 104 mL. This means that the urine volume estimated by ultrasound was on average 21.5 mL smaller than the urine volume when the bladder was emptied.

Conclusion: This study confirms a good agreement between the ultrasound scanner estimates of urinary bladder volume and urine volume measured after emptying the bladder. Nurses in the PACU could operate the ultrasound scanner after a brief instruction and training period. Considering the potentially serious long‐term consequences of undiagnosed postoperative urinary retention, introducing this equipment for routine monitoring of urinary bladder volume should be considered.
Spasmolytic effects of colforsin daropate on serotonin‐induced pulmonary hypertension and bronchoconstriction in dogs
Authors: Hirota K. , Yoshioka H. , Kabara S. , Koizumi Y. , Abe H. , Sato T. , Matsuki A.
Published: March 2003

Background: We have previously found that agents increasing intracellular cAMP levels of smooth muscles, such as PDE3 inhibitors, aminophylline and prostaglandin E1, produce both bronchodilation and pulmonary vasodilation in serotonin‐induced pulmonary hypertension and bronchoconstriction models. In the present study we have simultaneously evaluated the spasmolytic effects of colforsin daropate, a novel forskolin derivative, on serotonin‐induced pulmonary hypertension and bronchoconstriction.

Methods: Ten mongrel dogs were anesthetized with pentobarbital. The pulmonary hypertension and bronchoconstriction were elicited with serotonin (10 µg/kg + 1 mg·kg−1·h−1) and assessed as percentage changes in pulmonary vascular resistance (PVR) and bronchial cross‐sectional area (BCA) (basal = 100%). Initially, the relaxant effects of colforsin daropate (0–300 µg/kg) were determined. The PVR and BCA were assessed before and 30 min after serotonin infusion began and 5 min after each dose of colforsin daropate. To determine whether colforsin daropate‐induced relaxation is independent of plasma catecholamine, propranolol 0.4 mg/kg was given following colforsin daropate 300 µg/kg i.v.

Results:  Colforsin daropate reversed both pulmonary hypertension and bronchoconstriction dose‐dependently: ‐logED50 (95% confidence intervals, mean ED50) for pulmonary hypertension and bronchoconstriction 5.44 (5.08–5.80, 3.6 µg/kg) and 4.90 (4.06–5.20, 12.5 µg/kg), respectively. However, colforsin daropate (≥ 30 µg/kg) produced a more pronounced systemic than pulmonary vasodilation. Although colforsin daropate (≥ 30 µg/kg) significantly increased plasma catecholamines, propranolol did not reverse the relaxant effects.

Conclusions:  Colforsin daropate may attenuate bronchoconstriction and pulmonary hypertension. In addition, as β‐blockade did not change the attenuation, the relaxant effects may be independent of plasma catecholamines.
Remifentanil sedation compared with propofol during regional anaesthesia
Authors: Servin F. S. , Raeder J. C. , Merle J. C. , Wattwil M. , Hanson A. L. , Lauwers M. H. , Aitkenhead A. , Marty J. , Reite K. , Martisson S. , Wostyn L.
Published: March 2003

Background:  The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side‐effects and rapid recovery. In this study remifentanil is compared with propofol for sedation during successful regional anaesthetic blocks.

Methods:  After informed consent was given, 125 patients undergoing surgery under spinal or brachial plexus anaesthesia were randomized to receive, either propofol: bolus 500 µg/kg plus initial infusion 50 µgkg/min or remifentanil: bolus 0.5 µg/kg plus initial infusion 0.1 µgkg/min. Study drug infusion rate was titrated throughout the procedure according to level of sedation and side‐effects. Pain, discomfort, sedation level and side‐effects were recorded at regular intervals until discharge from the post operative care unit (PACU).

Results:  Two patients in the remifentanil group versus ten in the propofol group were treated for discomfort or pain during surgery (P<0.02). Due to a significantly higher rate of respiratory depression (46% vs. 19% with propofol, P<0.01) the mean remifentanil infusion rate was decreased to 0.078 ± 0.028 µgkg/min, whereas it was kept stable with propofol. Propofol patients had significantly higher (P<0.05) sedation levels and experienced more frequent amnesia of the procedure. Eleven propofol patients experienced pain at injection site, versus two remifentanil patients (P<0.02). Nausea and vomiting were more frequent in the remifentanil patients during infusion (27% vs. 2% in the propofol group, P<0.001) but similar postoperatively. Time to discharge from PACU was similar in the two groups.

Conclusion:  Propofol results in less respiratory depression and nausea when sedation is needed during a case with a successful regional block. Remifentanil may be considered as an alternative if pain during the procedure is a major concern or if amnesia is contraindicated.
Sevoflurane versus isoflurane – anaesthesia for lower abdominal surgery.  Effects on perioperative glucose metabolism
Authors: Geisser W. , Schreiber M. , Hofbauer H. , Lattermann R. , Füssel S. , Wachter U. , Georgieff M. , Schricker T.
Published: March 2003

Background: The aim of this study was to determine the impact of sevoflurane anaesthesia on metabolic and endocrine responses to lower abdominal surgery.

Methods: A prospective randomized controlled study in 20 patients undergoing abdominal hysterectomy. Patients were randomly assigned to receive either sevoflurane (S) or isoflurane anaesthesia (I). Using a stable isotope dilution technique, endogenous glucose production (EGP) and plasma glucose clearance (GC) were determined pre‐ and postoperatively (6,6‐2H2‐glucose). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured preoperatively, 5 min after induction of anaesthesia, during surgery and 2 h after the operation.

Results: EGP increased in both groups with no intergroup differences (preop. S 12.2 ± 1.6, I 12.4 ± 1.6; postop. S 16.3 ± 1.9*, I 19.0 ± 3.1*µmol kg−1 min−1, all values are means ± SD, *P < 0.05 vs. preop.). Plasma glucose concentration increased and GC decreased in both groups. There were no differences between groups. (Glucose conc. mmol l−1 preop.: S 4.1 ± 0.3, I 3.9 ± 0.5; 5 AI S 5.1 ± 0.6*, I 5.1 ± 1.0*, postop. S 7.0 ± 1.0*, I 7.1 ± 1.4*; * = P < 0.05 vs. preop.; GC ml kg−1min−1 preop. S 3.0 ± 0.4, I 3.2 ± 0.4; postop. S 2.4 ± 0.3*, I 2.7 ± 0.3*; *=P < 0.05 vs. preop.) Insulin plasma concentrations were unchanged. Cortisol plasma concentrations increased intra‐ and postoperatively with no changes between the groups. Norepinephrine plasma concentration increased in the S group after induction of anaesthesia. I group norepinephrine was increased 2 h after operation and showed no intergroup differences.

Conclusion: Sevoflurane, as well as isoflurane, does not prevent the metabolic endocrine responses to surgery.
Mathematical model of renal elimination of fluid and small ions during hyper‐ and hypovolemic conditions
Authors: Gyenge Christina C. , Bowen Bruce D. , Reed Rolf K. , Bert Joel L.
Published: March 2003

This study is concerned with the formulation of a ‘kidney module’ linked to the plasma compartment of a larger mathematical model previously developed. Combined, these models can be used to predict, amongst other things, fluid and small ion excretion rates by the kidney; information that should prove useful in evaluating values and trends related to whole‐body fluid balance for different clinical conditions to establish fluid administration protocols and for educational purposes. The renal module assumes first‐order, negative‐feedback responses of the kidney to changes in plasma volume and/or plasma sodium content from their normal physiological set points. Direct hormonal influences are not explicitly formulated in this empiric model. The model also considers that the renal excretion rates of small ions other than sodium are proportional to the excretion rate of sodium.

As part of the model development two aspects are emphasized (1): the estimation of parameters related to the renal elimination of fluid and small ions, and (2) model validation via comparisons between the model predictions and selected experimental data. For validation, model predictions of the renal dynamics are compared with new experimental data for two cases: plasma overload resulting from external fluid infusion (e.g. infusions of iso‐osmolar solutions and/or hypertonic/hyperoncotic saline solutions), and untreated hypo volemic conditions that result from the external loss of blood.

The present study demonstrates that the empiric kidney module presented above can provide good short‐term predictions with respect to all renal outputs considered here. Physiological implications of the model are also presented.
Glyburide decreases myocardial oxygen pressure in dogs
Authors: Hoffman W. E. , Albrecht R. F. , Jonjev Z. S.
Published: March 2003

Background: Reports show that glyburide, an adenosine triphosphate sensitive potassium (K+ATP) channel blocker, will reverse the myocardial protective effect of inhalational anesthesia. We evaluated the effect of glyburide on myocardial tissue oxygen pressure (PmO2) in dogs anesthetized with desflurane.

Methods: Twelve dogs were anesthetized with 8% end‐tidal desflurane for baseline anesthesia. A flow probe was placed on the left anterior descending (LAD) artery. A probe that measured PmO2 was inserted into the middle myocardium in the LAD region. After baseline measures, six dogs received i.v. 1 mg kg−1 of glyburide and six dogs received sham vehicle treatment. After the glyburide or sham treatment, each dog received an i.v. infusion of adenosine 0.1 µg kg−1·min−1, sodium nitroprusside (SNP) 2–4 µg kg−1·min−1 and 14% end‐tidal desflurane in random order.

Results: Glyburide decreased LAD artery flow from 59 ± 9 ml min−1 to 30 ± 6 ml min−1 (P < 0.05) and PmO2 from 44 ± 16 mmHg to 30 ± 9 mmHg (P < 0.05). Adenosine infusion increased LAD artery blood flow 180% in the sham‐treated dogs but produced no change in the glyburide‐treated dogs. Sodium nitroprusside infusion increased LAD artery flow and decreased PmO2 in both the glyburide‐ and sham‐treated dogs. Desflurane (14%) did not reverse the glyburide‐induced vasoconstriction but increased PmO2 to 38 ± 20 mmHg (P < 0.05).

Conclusion: Glyburide produced myocardial tissue hypoxia, which was not changed by adenosine, worsened by SNP and improved by 14% desflurane. The improvement in PmO2 with desflurane occurred without a change in myocardial blood flow.
Different benefit of bispectal index (BIS™) in desflurane and propofol anesthesia
Authors: Luginbühl M. , Wüthrich S. , Petersen‐Felix S. , Zbinden A. M. , Schnider T. W.
Published: March 2003

Background: Bispectal index (BIS™) monitoring may reduce drug usage and hasten recovery in propofol and inhalation anesthesia. The faster emergence profile of desflurane may reduce the effect of BIS monitoring on recovery from desflurane compared with propofol. This study compared hypnotic drug usage, recovery, patient satisfaction and incidence of inadequate sedation in BIS monitored and nonmonitored women anesthetized with desflurane or propofol.

Methods: One hundred and sixty patients scheduled for elective gynecological surgery were randomly assigned to desflurane or propofol anesthesia with and without BIS monitoring. Fentanyl, vecuronium and remifentanil were administered according to clinical criteria. The BIS monitor was used in all patients, but the monitor screen was covered in the controls. A BIS level between 45 and 55 was targeted in the BIS monitored patients whereas depth of anesthesia was assessed by clinical criteria in the controls.

Results: The mean (SD) desflurane MAC‐hours administered with and without BIS were 0.70 (0.15) and 0.76 (0.12), respectively, resulting in extubation times of 6.5 (4.1) and 8.3 (6.1) min. (NS). Bispectal index monitoring was associated with improved patient satisfaction, reduced postoperative nausea and antiemetic drug requirement, and fewer episodes with sustained BIS levels > 60. The mean (SD) propofol infusion rates were 6.0 (1.4) and 6.6 (0.9) mg kg−1h−1 with and without the BIS monitor (P = 0.023), resulting in mean (SD) extubation times of 6.8 (4.6) and 10.5 min (5.9), respectively (P < 0.05).

Conclusion: Bispectal index monitoring reduced propofol usage and hastened recovery after propofol anesthesia, whereas in desflurane anesthesia it was associated with improved patient satisfaction, probably because of decreased postoperative nausea and fewer episodes of inadequate hypnosis.
Diagnosis of malignant hyperthermia susceptibility during CABG surgery
Authors: Girard T. , Bally S. , Langer I. , Schürch M.
Published: March 2003

A 55‐year‐old man presented for coronary artery bypass graft (CABG) surgery. Malignant hyperthermia (MH) was suspected in his family. This case report describes a diagnostic approach to obtain a definite MH diagnosis by performing an in vitro contracture test at the time of CABG surgery in combination with molecular genetic investigations.
Analgesic effect of i.v. paracetamol: possible ceiling effect of paracetamol in postoperative pain
Authors: Hahn T. W. , Mogensen T. , Lund C. , Jacobsen L. S. , Hjortsoe N.‐C. , Rasmussen S. N. , Rasmussen M.
Published: March 2003

Background: Despite the widespread use of paracetamol for many years, the analgesic serum concentrations of paracetamol are unknown. Therefore the correlation between serum paracetamol concentrations and the analgesic effect was studied.

Methods: Sixty‐four women undergoing laparoscopic sterilization were included in a double‐blind, placebo‐controlled, randomized study. Patients were given i.v. propacetamol 40 mg kg−1 (group H), 20 mg kg−1 (group I), 10 mg kg−1 (group L) or placebo after surgery. Alfentanil was available via patient‐controlled analgesia (PCA) during the 4‐h postoperative study period. The patients' self‐reported pain was registered on the visual analog scale (VAS). A pharmacokinetic model was fitted to the paracetamol data.

Results: One to 3 h after injection of propacetamol the alfentanil consumption was significantly (P = 0.01–0.04) higher in the placebo group compared with groups H, I, and L receiving propacetamol. There were no significant differences between the amounts of alfentanil consumed in groups H, I, and L. Initial VAS‐scores were moderate (5.4–6.2), and declined significantly (P < 0.0001) over time, with no difference between groups. Paracetamol followed an open two‐compartment model with i.v. administration and first order elimination. The estimated concentrations immediately (t = 0) after injection were 56 mg l−1 (H), 28 mg l−1 (I) and 14 mg l−1 (L).

Conclusion: We showed a significant opioid‐sparing effect of paracetamol in the immediate postoperative period. Pharmacokinetic data were in accordance with other studies. Our results suggest that a ceiling effect of paracetamol may be present at i.v. doses of 5 mg kg−1, i.e. a serum concentration of 14 mg l−1, which is a lower dose than previously suggested.
Exotic snake bite: a challenge for the Scandinavian anesthesiologist?
Authors: Chew M. S. , Guttormsen A. B. , Metzsch C. , Jahr J.
Published: March 2003

Background: Venomous snake bites are uncommon in the Scandinavian countries. Envenomation from exotic snakes do however occur, mostly amongst snake handlers. This case report documents the effects and treatment for envenomation from Hoplocephalus bungaroides, or the Broad‐Headed snake, native to eastern and southern Australia. Snakes of the genus Hoplocephalus have previously been described as of ‘lesser medical importance’ because of their rarity.

Methods: This case report describes the signs, symptoms and management of systemic envenomation in a previously healthy man.

Results: The patient developed signs of severe coagulopathy less than an hour after envenomation. There was also biochemical evidence of rhabdomyolysis, and cardiotoxicity. At no time did the patient develop respiratory insufficiency, neurotoxicity or renal failure. The patient was initially managed with i.v. crystalloids, plasma, corticosteroids and antifibrinolytics and by observation in the intensive care unit (ICU). Coagulopathy resolved after causal treatment with monovalent Tiger snake antivenom.

Conclusion: The patient made good progress and was well on discharge from the ICU 26 h postenvenomation.
Neurologic deficits and arachnoiditis following neuroaxial anesthesia
Authors: Aldrete J. A.
Published: March 2003

Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil‐based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma.

Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal.

Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.
Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction
Authors: Dauri M. , Polzoni M. , Fabbi E. , Sidiropoulou T. , Servetti S. , Coniglione F. , Mariani P. , Sabato A. F.
Published: March 2003

Background: The purpose of this study was to compare three locoregional techniques of pain management after arthroscopic anterior cruciate ligament reconstruction (ACLR).

Methods: Sixty ASA I–II subjects were enrolled after obtaining written informed consent. Patients were randomly allocated to three groups of 20 subjects. The first group (EPI) received epidural ropivacaine 0.2% plus sufentanil 0.2 µg ml−1, at 5 ml h−1. Patients in the second group (CFB) were given a continuous infusion of the same analgesic mixture through a femoral catheter. The third group (IA) received a continuous intraarticular infusion of ropivacaine 0.2% plus sufentanil 0.2 µg ml−1, at 5 ml h−1. All subjects were allowed PCA boluses of 5 ml of local anesthetic. Analgesia was assessed for 36 h after the end of surgery by means of a visual analog scale (VAS) and a verbal scale (VS), as well as the number of PCA boluses administered and the amount of supplementary i.v. ketorolac, if given.

Results: The VAS and VS scores were significantly higher in group IA during the 24 h following surgery. Ketorolac requirement was higher in group IA throughout the postoperative observation. Adverse effects were similar in all groups except for urinary retention, which was significantly more frequent in group EPI.

Conclusions: We conclude that either epidural or continuous femoral nerve block provide adequate pain relief in patients who undergo ACLR, whereas intraarticular analgesia seems unable to cope satisfactorily with the analgesic requirements of this surgical procedure.
Preoperative emotional states in patients with breast cancer and postoperative pain
Authors: ÖZalp G. , Sarioglu R. , Tuncel G. , Aslan K. , Kadiogullari N.
Published: March 2003

Background: The present study examined the relationship between psychological variables, including anxiety, depression, and patient‐controlled analgesia (PCA) use in patients who underwent radical mastectomy.

Methods: Ninety‐nine ASA I–II women with breast cancer between 18 and 60 years scheduled for modified radical mastectomy completed the state scale of the state‐trait anxiety inventory and the Beck depression inventory before the day of surgery. Standard general anesthesia, surgery, and IV‐PCA therapy was conducted. Postoperative ratings of pain intensity, opioid consumption and satisfaction with PCA were recorded for the first 24 h on the ward. The degree of pain intensity was evaluated by a visual analog scale (VAS, 1–10). Satisfaction with pain control was reported using an five‐point scale from 1 (very dissatisfied) to 5 (very satisfied).

Results: The pain intensity, total analgesic consumption and dose/demand ratio were significantly related to preoperative anxiety and depression (P<0.05). Degree of dissatisfaction with PCA was significantly correlated with preoperative anxiety and depression (P<0.01).

Conclusion: Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.
Comparison of the catheter‐technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery
Authors: Türker G. , Uçkunkaya N. , Yavaşçaoğlu B. , Yilmazlar A. , ÖZçelik S.
Published: March 2003

Background: The aim of this study was to compare the intra‐ and postoperative analgesia provided by the catheter‐technique psoas compartment block and the epidural block in hip‐fractured patients. We also compared hemodynamic stability, motor blockade, ease of performing the technique, and complications.

Methods: Thirty patients who underwent partial hip replacement surgery were included in this prospective single‐blind study. Subjects were randomly assigned to Group E (n=15; general anesthesia plus epidural block with 15 ml of 0.5% bupivacaine) or Group P (n=15; general anesthesia plus psoas compartment block with 30 ml of 0.5% bupivacaine). Hemodynamic parameters were recorded at 10‐min intervals intraoperatively. Regional anesthesia procedure time, number of attempts at block, intraoperative blood loss, and need for supplemental fentanyl and/or ephedrine were noted. Postoperatively, a patient‐controlled analgesia device delivered an infusion and boluses of bupivacaine/fentanyl. Pain, motor blockade, ambulation time, patient satisfaction with analgesia, and complications were recorded postsurgery.

Results: The epidural required significantly more attempts than the psoas block, thus procedure time was longer in this group. Group E also showed significantly greater drops in mean arterial blood pressure from baseline at 30, 40 and 50 min after the start of general anesthesia. Significantly more Group E patients required epinephrine supplementation. The groups were similar regarding pain scores (at rest and on movement) and patient satisfaction, but Group E had higher motor blockade scores, longer ambulation time, and significantly more complications.

Conclusion: The continuous psoas compartment block provides excellent intraoperative and postoperative analgesia with a low incidence of complications for partial hip replacement surgery
Anti‐thrombotic effect of milrinone is caused by inhibition of calcium release from the dense tubular system in human platelets*
Authors: Hiramatsu N. , Kageyama K.
Published: March 2003

Aim: Milrinone, a phosphodiesterase III inhibitor, exerts positive inotropic effects which induce an increase in the intracellular calcium concentration by raising the cyclic adenosine monophosphate level in cardiac muscle. Milrinone was also reported to inhibit platelet aggregation, however, its mechanism remains unknown. Therefore, we investigated the effects of milrinone on intracellular calcium mobilization when platelets were activated.

Methods: Washed platelets, obtained from six healthy volunteers, were preincubated with milrinone (0.9 µM) for 1 min and then exposed to 0.015 iµ ml−1 thrombin for 5 min. The effect of milrinone on changes in the intracellular calcium level using a fluorescent dye, fura‐2, was also observed. Calcium mobilizations via plasma membrane calcium channels and the dense tubular system were assessed differentially.

Results: Milrinone (0.9 µM) significantly suppressed the aggregation ratios at 5 min compared with those in controls (86±5%) to 75±8%. The increase in the intracellular calcium concentration was also significantly suppressed (controls, 915±293 nM vs. 405±240 nM) when stimulated by thrombin. Milrinone also significantly inhibited the release of calcium from the dense tubular system (controls, 284±111 nM vs. 158±51 nM). Calcium influx through the plasma membrane was suppressed by milrinone 2.4 µM.

Conclusion: Milrinone (0.9 µM) inhibited thrombin‐induced platelet aggregation. This inhibitory effect was mainly mediated by suppressing calcium release from the dense tubular system.