bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of high‐dose ketamine on the vascular reactivity of human and porcine isolated coronary artery segments
Authors: KLOCKGETHER‐RADKE A. , HAGEMANN I. , FRERICHS A. , MAJOWSKI K. , HELLIGE G.
Published: January 2009

The influence of ketamine on the vasomotor effect of histamine and serotonin was studied in isolated human and porcine coronary artery rings. Ketamine (10‐‐3 mol L‐1) attenuated the contractile response to both mediators significantly (P < 0.05 for histamine concentrations of 310‐‐5 mol L‐1 and above as well as for serotonin concentrations of 310‐‐8 mol L‐1 and above). This effect of ketamine was observed in intact and endothelial denuded porcine rings (difference ns.) as well as in coronary arteries from explanted human hearts of patients undergoing heart transplantation. It is concluded that this reduction of the contractile response to histamine and serotonin caused by ketamine is not dependent on the endothelial function (e.g. endotheliumderived relaxing factor).
A positron emission tomography study of cerebral blood flow and oxygen metabolism in healthy male volunteers anaesthetized with eltanolone
Authors: WESSÉAN A. , WIDMAN M. , ANDERSSON J. , HARTVIG P. , VALIND S. , HETTA J. , LÅNGSTRÖM B.
Published: January 2009

Background: The effects of eltanolone anaesthesia in humans on regional cerebral blood flow, regional cerebral metabolic rate of oxygen and oxygen extraction ratio were to be evaluated using positron emission tomography (PET).

Methods: Six healthy male volunteers were studied. Series of PET‐measurements with 15O and H215O were carried out in the awake state (baseline) (n=6), during eltanolone anaesthesia (n= 5) and during early recovery (n=5), when the subjects were oriented with respect to person, place and time. Eltanolone was given as a programmed infusion.

Results: Cerebral blood flow (rCBF) was reduced in almost all cortex regions studied by 31216% (meanSD, P < 0.01). During recovery KBF increased to 10926% of pre‐anaesthetic baseline levels (P < 0.01). Eltanolone in the doses administered lowered oxygen metabolism (rCMRO2) by 528% (P < 0.01) in cortex regions. During recovery rCMRO2 increased to 9013% of baseline (P < 0.01). The oxygen extraction (OER) in cortical regions decreased by 32223% (P < 0.01) during anaesthesia and returned to 82210% of baseline (P < 0.01) during recovery. Less reduction in cortical blood flow during eltanolone anaesthesia was seen in the uncus (P < 0.01), though no differences in the depression of oxygen metabolism were seen. Oxygen extraction remained homogeneous throughout the brain.

Conclusion: Eltanolone anaesthesia was shown to reduce cerebral oxygen metabolism and cerebral blood flow in healthy volunteers. There were no signs of ischaemic effects.
Rupture of the left main‐stem bronchus by the tracheal portion of a double‐lumen endobronchial tube
Authors: SAKURAGI T. , KUMANO K. , YASUMOTO M. , DAN K.
Published: January 2009

We report a rupture of the left main‐stem bronchus following the insertion of a left‐sided double‐lumen endobronchial tube in a 76‐yr‐old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double‐lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.
Hemidiaphragmatic paralysis following subclavian vein catheterization
Authors: AKATA T. , NODA Y. , NAGATA T. , NODA E. , KANDABASHI T.
Published: January 2009

The right subclavian artery was inadvertently punctured during attempted preoperative insertion of a right subclavian venous catheter in a 59‐yr‐old woman undergoing radical hysterectomy. Large supraclavicular swelling became apparent soon after the arterial puncture. The postoperative chest X‐ray obtained approximately 24 h after the catheterization revealed significant elevation of the right hemidiaphragm, which was further augmented on the 2nd to 4th postoperative days; oxygenation was concurrently impaired during these days. It was clinically judged that the hemidiaphragmatic paralysis was responsible for the elevated diaphragm. Both chest roentogenogram and arterial blood gas analyses started to improve on the 5th day, finally returning to normal on the 6th day. It is unlikely that the surgical procedure caused the paralysis, because it dealt only with the lower abdomen. Rather, the attempts at the subclavian venous catheterization probably caused the phrenic nerve paralysis, because the phrenic nerve travels very close to the subclavian vessels. Both the large haematoma formation following the arterial puncture and the time course of the paralysis suggest that compression of the right phrenic nerve by the haematoma, rather than needle trauma, was responsible for the paralysis.
Obstetric outcome following epidural analgesia with bupivacaine‐adrenaline 0.25% or bupivacaine 0.125% with sufentanil ‐ a prospective randomized controlled study in 1000 parturients
Authors: Olofsson Ch. , Ekblom A. , Ekman‐Ordeberg G. , Irestedt L.
Published: January 2009

Background: Epidural analgesia (EDA) is the most efficient method for pain relief during labour, but there is still a debate as to whether it interferes with the normal process of delivery. Some authors argue that the incidence of instrumental deliveries, Caesarean section, malrotation and protracted labour is increased in parturients receiving EDA.

Methods: 1000 parturients were prospectively randomized to receive EDA either with a high dose of local anaesthetic (0.25% bupivacaine with adrenaline=HD) or with a low dose (0.125% bupivacaine with sufentanil 10 μg=LD).

Results: The incidence of instrumental delivery and Caesarean section and the need for oxytocin was reduced in the LD compared to HD group. The delivery time was similar with HD and LD among primiparous, but decreased significantly among multiparous in the LD group. The incidence of malrotation was low in both groups. The quality of analgesia was equal during the first stage in the 2 groups, but was lower in the LD group during the second stage. More parturients in the LD group ambulated, but this did not affect the incidence of instrumental delivery.

Conclusion: It is concluded that a lower dosage of bupivacaine combined with sufentanil in epidural analgesia significantly improves the obstetric outcome as compared to a higher dosage of bupivacaine with adrenaline using intermittent bolus technique.
Efficacy of propacetamol in the treatment of postoperative pain Morphine‐sparing effect in orthopedic surgery
Authors: Peduto V. A. , Ballabio M. , Stefanini S.
Published: January 2009

Background: Combined analgesic regimens have been suggested to improve the treatment of postoperative pain. The aim of our study was to evaluate the analgesic efficacy and tolerability of propacetamol, in combination with morphine.

Methods: Four i.v. infusions of propacetamol 2 g or placebo were administered, in a double‐blind fashion, after orthopedic surgery (n=97). Morphine was administered by a patient‐controlled analgesia (PCA) device. The total dose of morphine, pain intensity and global efficacy of treatment were evaluated. Tolerability was assessed by monitoring blood pressure, heart and respiratory rate, sedation scores, adverse events, and renal and hepatic parameters.

Results: The total dose of morphine was significantly decreased in the propacetamol group compared to placebo (9.4±8.5 mg vs 17.6±12 mg; P< 0.001), arriving at a sparing effect of 46%. The evolution of pain intensity showed a similar pattern in the two groups. Global efficacy of treatment was rated significantly better by patients receiving the combination propacetamol+ PCA morphine (87% of “good”/“excellent” ratings vs 65%; P=0.01). Tolerability was comparable in the two groups. Eight patients in the propacetamol and 4 patients in the placebo group reported adverse events, of mild/moderate intensity, most commonly nausea/vomiting. Renal and hepatic parameters were also seen to be comparable.

Conclusions: These results confirm a significant morphine‐sparing effect, significantly better scores in the final assessment by patients, and a good tolerability of propacetamol after orthopedic surgery. The drug may, therefore, represent a useful alternative to NSAIDs, as complementary drug to opioids, in the management of moderate/severe postoperative pain.
Plasma levels of clonidine following epidural bolus injection in children
Authors: Ivani G. , Bergendahl H. T. G. , Lampugnani E. , Eksborg S. , Jasonni V. , Palm C. , Mattioli G. , Podesta E. , Famularo A. , Lönnqvist P. A.
Published: January 2009

Background:The use of clonidine as an adjunct to epidural administration of local anesthetics in children has been reported to substantially improve the duration and quality of postoperative analgesia. The aims of the present study were to determine the pharmacokinetic profile and to investigate the interaction between postoperative sedation and analgesia after epidurally administered clonidine in children.

Methods:Plasma levels of clonidine (0–10 h postop) and assessment of postoperative analgesia and sedation (0–24 h postop) were performed at predetermined intervals following lumbar epidural administration of bupivacaine 2.0 mg/kg and clonidine 2 mg/kg in 8 children undergoing ureteral re‐implantation surgery using general anesthesia (age range: 1–9 yr, weight range: 9–11 kg). Plasma levels of clonidine were analyzed by radioimmunoassay, and sedation and analgesia were assessed by previously described scoring systems.Results: The venous plasma pharmacokinetics of clonidine following epidural administration showed a considerable interindividual variation. Cmaxand Tmaxvalues of clonidine were found to be within the 0.45–0.77 ng/mL and 48–193 min range, respectively. The time to absorb 95% of the clonidine dose from the epidural space into plasma varied between 36 min and 7.6 h. In 6 of the 8 patients postoperative analgesia substantially outlasted the duration of sedation (≥2 h). Sedation could not be detected in any patients at plasma concentrations below 0.3 ng/mL.

Conclusions:The pharmacokinetic profile associated with epidural clonidine administration in children (1–9 y) was similar to that previously reported in adults. The postoperative analgesia seen after administration of epidural bupivacaine‐clonidine during general anesthesia in children cannot only be explained by residual postoperative sedation.
Granisetron prevents nausea and vomiting during spinal anaesthesia for caesarean section
Authors: Fujii Y. , Tanaka H. , Toyooka H.
Published: January 2009

Background: Nausea and vomiting during spinal anaesthesia for caesarean section are common and unpleasant complications. This study was undertaken to evaluate the efficacy of granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, for prophylactic treatment of nausea and vomiting in parturients undergoing nonemergent caesarean section under spinal anaesthesia.

Methods: In a randomized, double‐blind, placebo‐controlled trial, 100 patients, 21–38 years, received either placebo (saline) or granisetron at 3 different doses (20 μg · kg‐1, 40 μg · kg‐1 or 80 μg · kg‐1) (n=25 for each) intravenously immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during spinal anaesthesia for caesarean section.

Results: The treatment groups were similar with regard to maternal characteristics and operative management. The incidence of nausea and vomiting was 64%, 52%, 14% and 12% after administration of placebo and granisetron in a dose of 20 μg · kg‐1, 40 μg · kg‐1 and 80 μg · kg‐1, respectively (P<0.05; overall Fisher's exact probability test). No clinically important adverse effects were observed in any group.

Conclusions: Prophylactic use of granisetron in a minimum dose of 40 μg · kg‐1 is effective for preventing nausea and vomiting during spinal anaesthesia for caesarean section.

© Acta Anaesthesiologiat Scandinavica 42 (1998)
Operations on patients deemed “unfit for operation and anaesthesia”: What are the consequences?
Authors: Prause G. , Ratzenhofer‐Komenda B. , Smolle‐Juettner F. , Krenn H. , Pojer H. , Toller W. , Voit H. , Offner A. , Smolle J.
Published: January 2009

Background: The decision “patient unfit for anaesthesia and operation” is likely to cause a delay of the scheduled operation. This retrospective evaluation was done: 1) to determine the correctness of preoperative tentative diagnoses of coexisting diseases making anaesthesia and operation excessively risky in relation to the physician's training status; 2) to examine the question of whether preoperative medical management modified according to the anaesthesiologist's suggestions had a positive impact on the perioperative course.

Methods: The medical records of patients scheduled for elective non‐cardiac surgery who were rated “unfit for operation and anaesthesia” were evaluated. The accuracy of the tentative diagnoses was examined for relation to the training status of the anaesthesiologists. The preoperative management was tested for its impact on postoperative outcome.

Results: During the observation period 16 122 patients underwent preoperative anaesthesiological assessment; 1021(6.3%) were initially considered to be unfit for operation and anaesthesia. The records of 807 patients were available for review. The accuracy of the tentative diagnoses was 70%, and was not significantly affected by the training status of the physicians (P= 0.022). Four hundred and seventeen patients were excluded from the second part of the investigation (discharged without operation, underwent operation using local anaesthesia or tentative diagnosis not confirmed). Three hundred and ninety patients were operated under general anaesthesia. Group I (n= 216) was managed according to the anaesthesiologist's suggestions and was found to have a significantly lower complication rate (18.1%) than group II (n=174) in which the suggestions from the preoperative assessment were ignored (32.2%; P<0.05). The perioperative mortality rate in group I was 2.3% compared with 5.2% in group II (n.s.; P>0.05).

Conclusions: We conclude that the anaesthesiology decision “patient unfit for operation and anaesthesia” has a high accuracy, independent of the anaesthesiologist's training status, and that preoperative medical management significantly reduces complications.
Pharmacokinetics and clinical effects of intramuscular scopolamine plus morphine A comparison of two injection sites
Authors: Kentala E. , Scheinin H. , Kaila T. , Seppälä T. , Kanto J.
Published: January 2009

Background: Intramuscular scopolamine plus morphine pre‐medication is traditionally used when prominent sedative or antisialogogue effect is needed. Knowledge of the pharmacokinetics of scopolamine is limited due to low plasma concentrations found after therapeutic doses. This investigation compares the pharmacokinetics and the clinical responses of this drug combination injected into two commonly used injection sites.

Methods: Twelve ASA class 1 patients scheduled for minor surgery under spinal anaesthesia received scopolamine 6 μg/kg plus morphine 200 μg/kg injected in either deltoid (group D, n=6) or gluteal (group G, n=6) muscle.

Results: The peak plasma concentrations of scopolamine after deltoid or gluteal injection (2.2 vs 1.6 μg/1) and the time they were reached (17 vs 19 min) were comparable. The absorption of morphine was similar in both groups (Tmax 16 min), but the peak plasma concentrations were higher after deltoid injection (71 vs 49 μg/1). The individual variation in the elimination half‐lives of both scopolamine and morphine was smaller after deltoid injection (T½ scopolamine 1.9±0.7 vs 2.1±1.1 h, morphine 1.3±0.7 vs 2.3±1.5 h). Moderate slowing (25%) of heart rate was found in both groups. A heavy sedation and antisialogogue effect (VAS) was found in both groups with faster occurrence of maximal effect in group D (60 vs 120–180 min).

Conclusion: More predictable pharmacokinetics and clinical effects of intramuscular scopolamine plus morphine premedication can be achieved after an injection into deltoid muscle.
Forced‐air surface warming versus oesophageal heat exchanger in the prevention of peroperative hypothermia
Authors: Hovmann Rasmussen Y. , Leikersfeldt G. , Drenck N.‐E.
Published: January 2009

Background: In a prospective, randomized, placebo‐controlled study we investigated the efficacy of 2 different heating methods in 24 patients undergoing abdominal surgery of at least 2 h expected duration.

Methods: Group I: control, no active warming. Group II: forced‐air surface warming on upper extremities and upper thorax. Group III: warming with oesophageal heat exchanger. All patients had a standardized, combined general and epidural anaesthesia. Core and skin temperatures were measured at induction of general anaesthesia, and subsequently every 30 min, and changes in total body temperature were calculated.

Results: There were no statistically significant differences between the 3 groups regarding demographic data. Patients in groups I and III developed hypothermia, while this was not the case with patients in group II. When using analysis of variance with repeated measurements, there was no significant difference in core temperature, comparing group I and group III (P=0.299) or the interaction between time and treatment of these groups (P=0.373). As a consequence, data from groups I and III were pooled and regarded as an internal group on the one hand, and group II as an external group on the other hand. Core temperature, the mean skin temperature and total body temperature were significantly different comparing the internal group and the external group. The interaction between time and treatment was likewise found to be significantly different.

Conclusions: We conclude that in major abdominal procedures lasting 2 h or more, serious hypothermia develops unless effective measures to prevent hypothermia are used. Forced‐air warming of the upper part of the body is effective in maintaining normothermia in these patients, while central heating with an oesophageal heat exchanger, at least in its present form, does not suffice to prevent hypothermia.
Effects of inhaled nitric oxide on platelet‐activating factor‐induced pulmonary hypertension in dogs
Authors: Yamada T. , Yukioka H. , Hayashi M. , Asada A. , Inoue M.
Published: January 2009

Background:Platelet‐activating factor (PAF), a lipid mediator released during endotoxin shock, induces pulmonary hypertension, systemic hypotension and cardiac dysfunction. In this study, we compared the effect of inhaled nitric oxide (NO) on PAF‐induced pulmonary hypertension and NO metabolism with that on pulmonary hypertension induced by a stable thromboxane A2mimetic, U46619. Since PAF‐induced hypotension might be mediated by NO, the effect of inhaled NO combined with an intravenously administered NO synthase inhibitor, NG‐nitro‐L‐arginine (L‐NNA), on PAF‐induced hemodynamic change was also investigated.

Methods:In a total of 28 beagles anesthetized with pentobarbital the following substances were intravenously administered: PAF 0.56±0.30 μg·kg‐1·min‐1(group PAF), L‐NNA 10 mg·kg‐1+ PAF 0.04±0.03 μg·kg‐1· min‐1(group L‐NNA+ PAF), U46619 0.60±0.11 μg·kg‐1·min‐1(group U46619) or L‐NNA 10 mg·kg‐1+ U46619 0.61±0.23 μg·kg‐1· min‐1(group L‐NNA+U46619) to obtain a mean pulmonary arterial pressure (MPAP) of 25 mmHg. Nitric oxide was then inhaled at 5, 10, 20 and 40 ppm for 15 min at 15‐min intervals in the order of increasing concentration. An additional 7 dogs (control group) inhaled NO at normal MPAP (17 mmHg). Hemodynamic and respiratory parameters, NOHb, NO2‐+NO3‐, and MetHb levels in blood were measured before and during NO administration.

Results:In the control group, hemodynamic and respiratory values did not change significantly during NO administration. In group PAF, NO significantly reversed the PAF‐induced pulmonary hypertension. PAF induced a marked systemic hypotension and cardiac output reduction, but these changes were not affected by inhalation of NO. L‐NNA pretreatment markedly decreased the dose of PAF required to maintain a MPAP of 25 mmHg, and abolished the PAF‐induced hypotension. In group L‐NNA+PAF, the diminishing effect of inhaled NO on pulmonary vascular resistance (PVR) was significantly greater than that in group PAF. U46619 induced pulmonary hypertension and increases in blood pressure, intrapulmonary shunt and peak airway pressure. L‐NNA pretreatment did not change the dose of U46619 required to maintain a MPAP of 25 mmHg. The effects of inhaled NO on PVR decrease were similar in groups U46619 and L‐NNA+U46619. No NOHb was detected in any group. NO2‐+NO3‐concentration increased during NO administrations. There were no significant differences in NO2‐+NO3‐concentration among groups.

Conclusions:Inhaled NO at the dose of 5–40 ppm effectively reversed PAF‐induced pulmonary hypertension, especially following pretreatment with L‐NNA. Inhaled NO did not affect PAF‐induced hypotension or cardiac dysfunction. These findings indicate that low concentrations of inhaled NO may be useful in reversing pulmonary hypertension in the endotoxemia where PAF may be one mediator.
The end‐systolic pressure‐volume relationship and ventriculoarterial coupling in patients undergoing coronary artery bypass graft surgery
Authors: Kadoi Y. , Kawahara H. , Fujita N.
Published: January 2009

Background: The end‐systolic pressure‐volume relationship and analysis of ventriculoarterial coupling have been established as a useful tool to determine the left ventricular performance and arterial loading conditions. The purpose of this study was to evaluate the end‐systolic pressure‐volume relationship and ventriculoarterial coupling in anesthetized patients with either a normal heart or coronary artery disease (CAD) using a transeso‐phageal echocardiography (TEE) monitor.

Methods: Sixteen patients with CAD and 4 patients without ischemic disease were studied. The end‐systolic volume of the left ventricle was obtained by TEE, and the end‐systolic pressure was obtained from the brachial arterial dicrotic pressure. In order to obtain the end‐systolic pressure‐volume relationship, we plotted 7 different left ventricular end‐systolic pressures against the corresponding left ventricular end‐systolic volumes during the pressure manipulation. The linear regression obtained by this method was designated as the end‐systolic elastance (Ees). Furthermore, we calculated the effective arterial elastance (Ea) using the pressure‐volume framework.

Results: We divided the patients with CAD into 3 groups: Group A: left ventricular ejection fraction (LVEF)>50%, Group B: LVEF 35–50%, Group C: LVEF<35%. We also studied a control group (Group D) who did not suffer from an ischemic heart condition. Ees in group C (1.4±0.2) was lower than in the other 3 groups (P<0.05). Ea/Ees in group C (1.9±0.1) was greater than in group A (0.7±0.1), group B (1.0±0.06) and group D (0.6±0.1)(P<0.05). There were no significant differences in Ees and Ea/Ees between group A and group D.

Conclusions: We found that patients with CAD and a normal LVEF had a physiological Ea/Ees identical to the control subjects. We also demonstrated that patients with CAD and a reduced LVEF showed a deterioration in Ea/Ees.
Combined overdose with verapamil and atenolol: treatment with high doses of adrenergic agonists
Authors: Kalman S. , Berg S. , Lisander B.
Published: January 2009

A 55‐year‐old man was admitted following an overdose of sustained‐release verapamil (calcium channel blocker) and ordinary‐release atenolol (β‐l blocker). At admission, there was extreme bradycardia (20–25 beats min‐1) and hypotension (systolic arterial pressure 40–50 mm Hg). To counteract the cardiovascular depression, prenalterol, dopamine, dobutamine, isoprenaline, adrenaline and noradrenaline were used. A satisfactory state was obtained with adrenaline, noradrenaline and dopamine infused at high rates. Cardiac output was then more than 10 1 min‐1, with a very low total peripheral resistance. The infusion of the adrenergic agonists could be interrupted on day 3. Prolonged ventilator treatment was necessary but the patient recovered without sequelae. Treatment options for similar cases are outlined.
Reflections on lidocaine for spinal anesthesia
Authors: SEVERINGHAUS JOHN W.
Published: January 2009

This paper was presented in September 1997 during a Round Table Discussion on lidocaine toxicity, held at the Nobel Forum, Karolinska Institute, Stockholm, Sweden. The occasion was in honor of Professor emeritus Torsten Gordh, who in August 1997 celebrated his 90th birthday. Torsten Gordh, also present at the Round Table Discussion, was the first anesthesiologist who used lidocaine clinically. Today, when some clinical problems with the intrathecal use of lidocaine are discussed, we are indeed fortunate to have Torsten Gordh still most vital and active in our midst.
The role of nitric oxide in neuropathic pain and neurodegeneration
Authors: JR TORSTEN GORDH
Published: January 2009

To Torsten Gordh senior: I was asked to participate in this celebration day arranged because of your 90 years birthday and I am really glad to do so, in order to honor my father. In my lecture I will connect to Torsten Gordh senior's deep and well known interest for the spinal cord and anaesthesia/analgesia, and today discuss the role of nitric oxide (NO) in the spinal cord, and its importance for neuropathic pain and neurodegeneration.
In vitro study on antioxidant potential of various drugs used in the perioperative period
Authors: Kang M.‐Y. , Tsuchiya M. , Packer L. , Manabe M.
Published: January 2009

Background:Since surgical trauma not only intensifies the oxidative stress by generating reactive oxygen species (ROS), but also weakens the biological defense system against ROS attack, the antioxidant activity of drugs used during the perioperative period, which possibly normalizes the impaired redox state in the patient, is of fundamental importance and great clinical interest.

Methods: We have applied the phycoerythrin fluorescence‐based assay, in which 2,2′‐azobis (2‐amidinopropane) dihydro‐chloride (AAPH)‐generated peroxyl radical attacks B‐phycoerythrin (B‐PE) to lead to a sensitive decrease in its fluorescence intensity linearly, to evaluate the antioxidant activity of major drugs in anesthetic practice.

Results: By the protective effect on B‐PE fluorescence decay, the antioxidant activities of the drugs were classified into three groups: Group I drugs, which only slowed B‐PE fluorescence decay (nicardipne, verapamil, diltiazem, ephedrine, aminophyl‐line, vecuronium, lidocaine, mepivacaine, midazolam, thiamylal, droperidol, ***etamine, hydroxyzine, butorphanol, prednisolone, hydrocortisone, betamethasone, dexamethasone, methylprednisolone, and furosemide); Group II drugs, which protected B‐PE oxidation completely and stopped fluorescence decay in a certain duration (dopamine, epinephrine, norepine‐phrine, dobutamine, isoproterenol, and buprenorphine); and Group III drugs, which had no protective effect on B‐PE oxidation (nitroglycerin, prostaglandin E1, neostigmine, pancuronium, suxamethonium, atropine, bupivacaine, pentazocine, and heparin).

Conclusion: These results indicate that Group I and II drugs exert some antioxidant activity in vitro, as measured by their protection of fluorescence decay of B‐PE. Careful consideration of these properties might, then, serve to facilitate more efficient drug application.
Pituitary‐adrenal, hormonal changes during induced hypotension with labetalol or isoflurane for middle‐ear surgery
Authors: Matson A. M. , Shaw M. , Loughnan B. A. , Burrin J. M. , Hall G. M.
Published: January 2009

Background: Pituitary‐adrenal secretion during induced hypotension for middle‐ear surgery has received little attention. Previous work failed to differentiate the effects of induced hypotension from surgical stimulation. We have undertaken a preliminary study examining the effects of hypotension, achieved with labetalol or isoflurane, on pituitary‐adrenal secretion before, during and after middle‐ear surgery.

Methods: Twenty‐four patients were allocated randomly to 3 groups. The control group were anaesthetised with isoflurane, and normotension maintained for 30 min before hypotension was induced with isoflurane and surgery started. In the labetalol group, this drug was given i.v. to obtain a mean arterial pressure (MAP) of 60 mm Hg for 30 min before surgery and hypotension maintained with labetalol during the operation. In the isoflurane group, hypotension was induced to a MAP of 60 mm Hg for 30 min before surgery and continued throughout the procedure. All 3 groups received metoprolol i.v. before hypotension was established. Blood samples were collected before induction of anaesthesia, during anaesthesia alone (normotensive or hypotensive), surgery with hypotension, and recovery. They were analysed for adrencorticotropic hormone (ACTH), arginine vasopressin (AVP), cortisol and aldosterone.

Results: Induced hypotension before surgery failed to stimulate release of ACTH, AVP and cortisol. No significant increase in these hormones occurred until the postoperative period. Aldosterone concentrations increased significantly during anaesthesia and hypotension in the labetalol and isoflurane groups (P <0.05) and continued to rise significantly in all 3 groups during surgery. However, there was no significant difference in aldosterone concentration before surgery between the control and the 2 hypotensive groups.

Conclusion: ACTH, AVP and cortisol secretion were not stimulated by induced hypotension to MAP of 60 mm Hg before surgery. Increased aldosterone secretion occurred and a further study with a larger sample size is needed.
Parasympathetic activity in brain death: effect of apnea on heart rate variability
Authors: Kawamoto M. , Sera A. , Kaneko K. , Yuge O. , Ohtani M.
Published: January 2009

Background: Power spectral analysis of heart rate variability is a useful monitoring of brain‐damaged patients. However, the effect of artificial ventilation is not clearly demonstrated in assessing vagal activity because the locus of its activity is originated close to the respiratory center in the brain stem. We studied heart rate variability during artificial ventilation and apnea test as part of an assessment of brain death.

Methods: Ten adult patients with severe brain damage were studied. Power spectral analysis of heart rate variability from electrocardiographic R‐R intervals was integrated to compare spectral components before, during and after the apnea test. Before the test, circulatory and blood gas variables and electrocar‐diographic recording were obtained under controlled mechanical ventilation at a rate of 12 and 18 (/min), each for 5 min. Measurements were made for 10 min during the apnea test, and repeated thereafter as before the test. Power spectral analysis based on fast Fourier transformation was made by integrating each low‐ (LF: 0.04‐0.15 Hz) and high‐ (HF: 0.15‐0.40 Hz) frequency band areas. LF was assessed as sympathetic and para‐sympathetic nervous activity, and HF as respiratory‐related parasympathetic vagal activity. The HF/LF ratio showed sym‐pathovagal balance.

Results: All patients were assessed as brain dead. During apnea, PaCo2 (P<0.05) and LF (P<0.05) increased, and pH (P<0.01) and HF/LF ratio (P<0.05) decreased. Heart rate, mean arterial pressure, PaO2 and HF remained consistent throughout.

Conclusion: It was shown that sympathovagal balance was inclined to be sympathotonic during apnea, and that there were no changes in the respiratory‐related vagal activity in spite of stopping artificial ventilation.
Haemolysis following rapid experimental red blood cell transfusion
Authors: Hansen T. G. , Sprogøe‐Jakobsen U. , Pedersen C. M. , Olsen K. Skovgaard , Kristensen S. Risom
Published: January 2009

Background: The vast majority of infusion pumps used for rapid transfusion of large amounts of blood have never been properly examined regarding their influence on the quality of the red blood cells (RBCs) infused. In this study, we evaluated the effect of two different infusion pumps on the degree of RBC destruction following rapid experimental blood transfusion.

Methods: Divided into 2 groups according to age, 30 u of SAGM RBCs were infused through an experimental transfusion model by either a manual roller pump (MRP) or a pressure infusor pump (PIP). Fresh (i.e stored for 8–11 d) RBCs, 20 u, and 10 u of older (i.e. stored for 25–33 d) RBCs were randomly allocated to infusion with either of the two pumps. The rate of infusion was as fast as possible with the MRP, and with the PIP adjusted with an external applied pressure of 300 mm Hg. RBC samples collected before and after infusion were analyzed for total haemoglobin, free haemoglobin, haematocrit, total free potassium, lactate dehydrogenase (LDH) and the percentage of haemolysis. The time spent for each transfusion was measured by a stop watch.

Results: Following infusion, a marginal increase (i.e. considerably below 0.8%) in the percentage of haemolysis and LDH content was seen with both pumps. This increase was only statistically significant when RBCs stored for 8–11 d were used (P= 0.002 for both parameters). Irrespective of the age of the RBCs, no differences between the two pumps could be detected. Compared to the PIP, infusion with the MRP could be accomplished significantly faster, i.e. median 5.9 ml/s (5.2–6.4 ml/s) versus 2.9 ml/s (2.5‐3.2 ml/s), (P<0.0001).

Conclusions: Both the pumps used in this study are safe alternatives for rapid transfusion of RBCs; however, with MRP this can be accomplished approximately twice as fast as with the PIP.
Comparing analgesic efficacy of non‐steroidal anti‐inflammatory drugs given by different routes in acute and chronic pain: A qualitative systematic review
Authors: Tramŕr Dr.M. R. , Williams J. E. , Carroll D. , Wiffen P. J. , Moore R. A. , McQuay H. J.
Published: January 2009

Aim: To test the evidence for a difference in analgesic efficacy and adverse effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) given by different routes.

Methods: Systematic review of published randomised controlled trials. Relevant trials were comparisons of the same drug given by different routes. Presence of internal sensitivity was sought as a validity criterion. Analgesic and adverse effect outcomes were summarised, and synthesised qualitatively.

Results: In 26 trials (2225 analysed patients), 8 different NSAIDs were tested in 58 comparisons. Fifteen trials (58%) compared the same drug by different routes. Drugs were given by intravenous, intramuscular, intrawound, rectal and oral routes in postoperative pain (14 trials), renal colic (4), acute musculo‐skeletal pain (1), dysmenorrhoea (1), and rheumatoid arthritis (6). Five of the 15 direct comparisons were invalid because they reported no difference between routes but without evidence of internal sensitivity. In all 3 direct comparisons in renal colic, intravenous NSAID had a faster onset of action than intramuscular or rectal. In 1 direct comparison in dysmenorrhoea, oral NSAID was better than rectal. In the 5 direct comparisons in postoperative pain, results were inconsistent. In 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Injected and rectal administration had some specific adverse effects.

Conclusion: In renal colic there is evidence that NSAIDs act quickest when given intravenously. This may be clinically relevant. In all other pain conditions there is a lack of evidence of any difference between routes. In pain conditions other than renal colic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow.
Preoperative anxiolysis with minimal sedation in elderly patients: bromazepam or clorazepate‐dipotassium?
Authors: Erb Dr.T. , Sluga M. , Hampl K. F. , Ummenhofer W. , Schneider M. C.
Published: January 2009

Background: In elderly patients undergoing ophthalmic surgery the loss of co‐operation due to over‐sedation, induced by drugs given preoperatively, may jeopardise the success of microsurgery performed under regional anaesthesia. The aim of this study was to compare the psychotropic effects of bromazepam and clorazepate‐dipotassium, two benzodiazepines with predominantly anxiolytic and only weak sedative action.

Methods: A randomised, placebo‐controlled, double‐blind study was designed to include 60 patients, ASA physical status II‐III, older than 60 years scheduled for ophthalmic surgery under regional anaesthesia. The patients were randomised to receive either bromazepam (3 mg) or clorazepate‐dipotassium (20 mg) or placebo. The study drugs were given at 10 p.m. the night before surgery and 90 min before surgery. Using the State‐Trait Anxiety Inventory (STAI), the patient's anxiety was assessed at the end of the preoperative visit, on the next morning before the study drug was given and on arrival at the operating theatre.

Results: Bromazepam induced a marked anxiolytic effect as documented by a significant reduction in the STAI State values after both applications (P0.01). Clorazepate did not differ from placebo at any evaluation time with regard to the STAI and haemodynamic values. Sedative effects and oxygen saturation (SpOz) were comparable in all groups.

Conclusion: Bromazepam is superior to clorazepate in its anxiolytic action and suitable as preoperative medication in the elderly patient because of lack of overt sedative effects.
Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy
Authors: RederPh.D J. C. , Mjaland O. , Aasbø V. , Grøgaard B. , Buanes T.
Published: January 2009

Background: The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy.

Methods: All 60 patients received ketamine 0.2 mg kg‐1, fentanyl 2 μg kg‐1 and propofol 2 mg kg‐1 for induction. Ketorolac 0.4 mg kg‐1 and ondansetron 0.05 mg kg‐1 +droperidol 20 μg Kg‐1 was given as prophylaxis for postoperative pain and emesis, respectively. The patients were randomly assigned into Group P with propofol maintenance and opioid supplements, or Group D with desflurane in a low‐flow circuit system.

Results: All the patients were successfully discharged within 8 h without any serious complications. Emergence from anaesthesia was more rapid after desflurane; they opened their eyes and stated date of birth at mean 6.4 and 8.4 min respectively, compared with 9.6 and 12 min in the propofol group (P<0.05). Nausea and pain were more frequent in Group D, 40% and 80% respectively; versus 17% and 50% in Group P (P<0.05). By telephone interview at 24 h and 7 d after the procedure, there was no major difference between the groups. With desflurane, drug costs per case were 10 $ lower than with propofol.

Conclusion: We conclude that desflurane is cheaper and has a more rapid emergence than propofol for outpatient cholecystectomy. However, propofol results in less pain and nausea in the recovery unit. Despite ondansetron and droperidol prophylaxis, there was still a substantial amount of nausea and vomiting after desflurane.
Midazolam‐flumazenil versus propofol anaesthesia for scoliosis surgery with wake‐up tests
Authors: Koscielniak‐Nielsen Z. J. , Stens pedersen H. L. , Hesselbjerg L.
Published: January 2009

Background: Wake‐up tests may be necessary during scoliosis surgery to ensure that spinal function remains intact.

Methods: Intra‐ and postoperative wake‐up tests were performed together with somatosensory cortical evoked potentials (SCEPs) monitoring in 40 patients randomized to either midazolam (M) or propofol (P) infusions for scoliosis surgery. Other anaesthetic medication was similar in both groups. At the surgeon's request, N2O was turned off and midazolam or propofol infusions were discontinued. In the M group, flumazenil was given in refracted doses. Patients were asked to move hands and feet. The test was repeated immediately after the end of surgery.

Results: The median intraoperative wake‐up times were 2.9 min in the M group and 16.0 min in the P group. The respective postoperative wake‐up times were 1.8 and 13.9 min. The quality of both intra‐ and postoperative arousals was significantly better in the M group. Twelve patients in the P group could not be awakened intraoperatively within 15 min and were given nalox‐one. One of these patients woke up violently and dislodged the endotracheal tube. Another patient in the P group had explicit recall of the test, but no pain. Five patients in the M group became resedated in the recovery room. Cost of anaesthetic drugs was similar in both groups. Satisfactory intraoperative SCEPs were recorded from 17 patients in each group. There were no neurological sequelae.

Conclusions: Wake‐up tests can be conducted faster and better with midazolam‐flumazenil sequence compared with propofol.
Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques
Authors: Tramer Dr.M. R. , Sansonetti A. , Fuchs‐Buder T. , Rifat K.
Published: January 2009

Background: Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.

Methods: Children (3–16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg · m‐2iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg · kg‐1iv. All children received prophylactic atropine 0.02 mg · kg‐1and alfentanil. Nitrous oxide was omitted.

Results: Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thio‐pentone‐isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number‐needed‐to‐treat was 5.5 (95% CI 2.9–46). Propofol was not different from thiopentone‐isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number‐needed‐to‐harm was 3.9 (95% CI 2.6–8).

Conclusions: Thiopental‐isoflurane‐air/O2‐alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol‐lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high‐dose prophylactic atropine.
Nausea and vomiting after major arthroplasty with spinal anaesthesia including morphine: a randomised trial of subhypnotic propofol infusion as prophylaxis
Authors: Grattidge P.
Published: January 2009

Background: Postoperative nausea and vomiting (PONV) following major arthroplasty with spinal anaesthesia and intrathecal morphine is reported in 45–74% of patients. This randomised, double‐blind, placebo‐controlled trial was undertaken to determine whether a subhypnotic infusion of propofol has a prophylactic antiemetic effect in this patient population.

Methods: 82 patients undergoing hip or knee replacement under subarachnoid bupivacaine anaesthesia plus morphine 0.25 mg were randomised at the end of surgery to receive either propofol 30 mg · h‐1 or fat emulsion (Intralipid®) 3 ml · h‐1 for 20 h postoperatively. Blinded observers recorded episodes of nausea, vorniting and pruritus.

Results: PONV in the intervention group was 40% vs 59% in the controls (P=0.1, not significant). Pruritus occurred in 34%, with a similar rate in both groups.

Conclusion: These results suggest that routine use of postoperative, subhypnotic propofol infusion as PONV prophylaxis is not justified in this patient population.
Hemiballism‐hemichorea from marked hypotension during spinal anesthesia
Authors: ItohM.D H. , Shibata K. , Nitta E. , Takamori M.
Published: January 2009

Hemiballism and hemichorea following anesthesia‐induced hypotension has rarely been described, but a recent case suggests an association. After experiencing marked hypotension during spinal anesthesia, a 70‐year‐old woman developed hemiballism and hemichorea. Involuntary ballistic movements with writhing, consisting of repetitive rotation and flexion‐extension without apparent muscle weakness, affected her left limbs proximally. Low‐amplitude, involuntary, choreiform movements involved the distal portions of these limbs. Magnetic resonance imaging demonstrated an area of high signal intensity in the contralateral subthalamic nucleus, suggestive of a focal ischemic lesion. Although such occurrences are rare, anesthesiologists should be aware of the risk of subthalamic nucleus ischemia following marked hypotension.
In vivo spasmolytic effect of ketamine and adrenaline on histamine‐induced airway constriction
Authors: Hirota K. , Hashimoto Y. , Sakai T. , Sato T. , Ishihara H. , Matsuki A.
Published: January 2009

Background: Ketamine (K) has been reported to produce bronchodilation in patients suffering from asthma. Although most researchers have used indirect measurements to study the effect of K in vivo, the reliability of these indirect methods are controversial. We have developed a new technique to measure the bronchial cross‐sectional area (BCA) in vivo with a superfine fibreoptic bronchoscope (SFB). Employing this method, we evaluated in vivo spasmolytic effect of K and adrenaline (A).

Methods: Twenty‐one mongrel dogs were anaesthetized with pentobarbitone (30 mg . kg‐1) and paralyzed with pancuronium (200μg . kg‐1 . h‐1). The trachea was intubated with an endotracheal tube that has a second lumen for insertion of a SFB (OD: 2.2 mm) to measure the BCA continuously. The tip of the SFB was placed between the 2nd and 3rd bronchial bifurcation of the right lung. A videoprinter printed the BCA, which was then measured with NIH Image. Bronchoconstriction was produced with histamine (H: 10μg . kg‐1+500μg . kg‐1 . h‐1) which was administered until the end of the experiment. The BCA was assessed before and 30 min after the start of H infusion. The dogs were randomly allocated to 3 groups of 7 dogs each. In group K, K (0–10 mg . kg‐1) was given i.v., and the BCA was measured 5 min after each K dose. In group A, A (0‐0.4μg . kg‐1) was given i.v., and the BCA was measured 1 min after each A dose. In group A+K, K (1 mg . kg‐1 i.v. +1 mg . kg‐1 . h‐1 i.v.) was given followed, 30 min after, by A i.v. in the same doses as in group A. The BCA was assessed 30 min after the start of K and again 1 min after each A dose.

Results: K 10 mg . kg‐1 reversed H‐induced bronchoconstriction. A subthreshold dose of K significantly potentiated the effect of A, reversing the decrease in BCA by H.

Conclusion: We have found that K could reverse the H‐induced bronchoconstriction and potentiate the A‐induced bronchial relaxation.