bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time‐ and dose‐related regional fluxes of tissue‐type plasminogen activator in anesthetized endotoxemic pigs
Authors: NYBERG A. , JAKOB S. M. , SEEMAN‐LODDING H. , PORTA F. , BRACHT H. , BISCHOFBERGER H. , JERN C. , TAKALA J. , ÅNEMAN A. 
Published: August 2010

Background: Acute endotoxinemia elicits an early fibrinolytic response. This study analyzes the effects of the dose and duration of endotoxin infusion on arterial levels of tissue‐type plasminogen activator (tPA) and pulmonary, mesenteric and hepatic plasma tPA fluxes.Methods: Pigs were randomized to receive an acute, high‐dose (for 6 h, n=13, high ETX) or a prolonged, low‐dose (for 18 h, n=18, low ETX) infusion of endotoxin or saline vehicle alone (for 18 h, n=14, control). All animals were fluid resuscitated to maintain a normodynamic circulation. Systemic and regional blood flows were measured and arterial, pulmonary arterial, portal and hepatic venous blood samples were analyzed to calculate regional net fluxes of tPA. Plasma tumor necrosis factor (TNF‐α) levels were analyzed.Results: Mesenteric tPA release and hepatic uptake increased maximally at 1.5 h in ETX groups related to dose. Maximal mesenteric tPA release [high ETX 612 (138–1185) μg/min/kg, low ETX 72 (32–94) μg/min/kg, median±interquartile range] and hepatic tPA uptake [high ETX −1549 (−1134 to −2194) μg/min/kg, low ETX −153 (−105 to −307) μg/min/kg] correlated to TNF‐α levels. Regional tPA fluxes returned to baseline levels at 6 h in both ETX groups and also remained low during sustained low ETX. No changes were observed in control animals.Conclusions: Endotoxemia induces an early increase in mesenteric tPA release and hepatic tPA uptake related to the severity of endotoxemia. The time patterns of changes in mesenteric and hepatic tPA fluxes are similar in acute high‐dose endotoxemia and sustained low‐dose endotoxemia.
Laparoscopic vs. small incision cholecystectomy: Implications for pulmonary function and pain. A randomized clinical trial
Authors: KEUS F. , AHMED ALI U. , NOORDERGRAAF G. J. , ROUKEMA J. A. , GOOSZEN H. G. , VAN LAARHOVEN C. J. H. M. 
Published: August 2010

Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post‐operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. The small‐incision cholecystectomy (SIC), a procedure which does not require a pneumoperitoneum threatens to be lost to clinical practice even though there is evidence of equality. We hypothesized that the SIC technique should be equal and might even be superior to the LC when considering post‐operative pulmonary function due to the short incision length.Methods: A single‐centre, randomized clinical trial was performed including patients scheduled for elective cholecystectomy. Pulmonary flow–volume curves were measured pre‐operatively, post‐operatively, and at follow up. Blood gas analyses were measured pre‐operative, in the recovery phase and on post‐operative day 1. Anaesthesia, analgesics, and peri‐operative care were standardized by protocol. Post‐operatively, patients and caregivers were blinded to the procedure.Results: A total of 257 patients were analysed. There was one pulmonary complication (pneumonia) in the LC group. In both groups, similar reductions of approximately 20% in pulmonary function parameters occurred, with complete recovery to pre‐operative values. Patients in the SIC group consumed more analgesia when compared with the LC group without impact on blood gas analysis. Patients converted to a conventional open technique showed significant differences in six of the eight parameters in pulmonary function tests.Conclusion: When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC regarding pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation.
Adrenal function in different subgroups of septic shock patients
Authors: SALGADO D. R. , ROCCO J. R. , ROSSO VERDEAL J. C. 
Published: August 2010

Background: Relative adrenal insufficiency (RAI) is a common complication during septic shock and may be more frequent in specific subgroups. The main objectives of this study were to determine the adrenal function and the RAI incidence in different subgroups of septic shock patients considering: main admission categories (medical, elective or emergency surgery); source of infection; nosocomial or community‐acquired infections; gender, age <65 years or >65 years; and the presence or absence of neurological diseases, acute respiratory distress syndrome (ARDS) and bacteremia.Methods: Prospective study in a medical–surgical ICU, including adults with septic shock, from May 2002 to May 2005. All patients had total serum cortisol measured at baseline and 60 min after a high‐dose ACTH test within the first 96 h of shock onset. RAI was defined as a serum cortisol increment after ACTH test (Δmax249) <90 μg/l.Results: One hundred and two subjects were enrolled, and the overall RAI incidence was 22.5%. Patients with ARDS before ACTH test or bacteremia showed lower Δmax249 values than patients with ARDS after ACTH test (96 vs. 153 μg/l, P=0.02) or without bacteremia (140 vs. 175 μg/l, P=0.04). Multivariate regression analysis revealed that female gender, development of ARDS before ACTH test, and bacteremia were associated with greater RAI incidence. There was no difference in RAI incidence considering neurological diseases, age, type and source of infection and the main admission categories.Conclusions: Female gender, bacteremia and early‐onset ARDS were variables independently associated with greater RAI incidence in septic shock patients. There was no difference in the RAI incidence concerning other subgroups.
Sonoclot analysis in elderly compared with younger patients undergoing coronary surgery
Authors: PLEYM H. , WAHBA A. , BJELLA L. , STENSETH R. 
Published: August 2010

Background: The Sonoclot analyzer is a point‐of‐care method for assessment of the clotting mechanism in whole blood. The results are available within 20 min. The aim of the present study was to investigate whether repeated Sonoclot analyses could identify peri‐operative differences in hemostatic function between elderly and younger patients undergoing coronary artery bypass grafting (CABG). In addition, we investigated whether Sonoclot analyses could identify disturbances in hemostatic function leading to post‐operative bleeding.Methods: Twenty‐five elderly and 25 younger patients undergoing CABG were included. Blood samples for Sonoclot analyses were drawn pre‐operatively, during surgery, and during the first 20 post‐operative hours. The Sonoclot variables sonACT, clot rate, time‐to‐peak, amplitude of the peak, and R3 were analyzed, and the results were compared between the two groups. Post‐operative blood loss volumes were recorded and correlated to the Sonoclot variables. The Sonoclot variables were also correlated to previously reported results on various hemostatic variables measured in the same patient population.Results: There was a significant difference in sonACT between the two groups (P=0.018). There were no differences between the groups in any of the other Sonoclot variables. There were no significant correlations between any of the Sonoclot variables and post‐operative bleeding, or between the Sonoclot variables and other hemostatic variables.Conclusions: The difference in sonACT between the two groups indicates a reduced hemostatic function in the elderly patients. However, repeated Sonoclot analyses were not able to identify more specific disturbances in hemostatic function, and did not predict increased post‐operative bleeding.
Pain management of opioid‐treated cancer patients in hospital settings in Denmark
Authors: LUNDORFF L. , PEUCKMANN V. , SJØGREN P. 
Published: August 2010

Aim: To evaluate the performance and quality of cancer pain management in hospital settings.Methods: Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory.Results: In total, 59 cancer patients were included. In 49 (83%) patients pain aetiology was assessed by the physicians of the departments of oncology and surgery. In only 19 (32%) patients they assessed pain mechanisms. The median oral morphine dose was 120 mg/day (range: 10–720 mg/day). Seventy‐eight per cent of patients received opioids at adequate regular intervals according to the duration of action. In 88% of the patients supplemental short‐acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non‐neuropathic pain received adjuvant drugs. Regarding opioid side effects only constipation and nausea were treated in the majority of the patients. Average pain intensity in the last 24 h for the total number of patients (n=59) ≤5 cm was 88.1% (confidence interval 77.1–95.1).Conclusion: Cancer pain was prevalent in opioid‐treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most often adequate. However, opioid side effects were highly prevalent and most side effects were left untreated.
Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube
Authors: MOIED AHMED S. , RIZVI K. A. , KHAN R. M. , UZ ZAFAR M. , NADEEM A. 
Published: August 2010

Background: The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube™ (ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication.Methods: Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups (n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra‐operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post‐operative discomfort were recorded.Results: The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more (P<0.01) as compared with Group B (17%). The incidence significantly increased (P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post‐operative period in three patients in Group A and resolved spontaneously in <15 min in each case.Conclusion: Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak‐proof oropharyngeal cavity.
Rotational thrombelastometry for the bedside monitoring of recombinant hirudin
Authors: SUCKER C. , ZOTZ R. B. , GÖRLINGER K. , HARTMANN M. 
Published: August 2010

Background: Recombinant hirudin is used as an alternative anticoagulant, particularly in patients with heparin‐induced thrombocytopenia type II. However, bedside monitoring for hirudin is not available. The present study aims to evaluate rotational thrombelastometry regarding its suitability to detect the effects of recombinant hirudin on whole blood coagulation. Hirudin was added to whole blood samples from healthy donors (n=5) and thrombelastometry variables resulting from activation of samples with tissue factor, ellagic acid, and ecarin were determined.Methods: Hirudin (0.1–10 μg/ml) was added to citrated blood. Thereafter, rotational thrombelastometry was performed by initiating coagulation via recalcification and addition of tissue factor, ellagic acid, and ecarin, respectively, using the commercially available assays.Results: In the absence of hirudin, clotting times (CT) induced by ellagic acid, tissue factor, and ecarin, respectively, were 141.7±18.0, 54.0±7.6, and 64.5±4.1 s. Increasing concentrations of hirudin led to dose‐dependent prolongation of the clotting time with the three activators. All assays were capable to detect hirudin concentrations in the range of 0.5–5 μg/ml. At a final hirudin concentration of 1 μg/ml, clotting time increased to 268.0±25.1, 84.0±9.3, and 107.5±9.9 s, respectively, with the above‐mentioned activators. The other thrombelastographic variables, including clot formation time, angle α, and maximum clot firmness, were not altered by hirudin at concentrations up to 5 μg/ml.Conclusions: Our study demonstrates the suitability of rotational thrombelastometry to detect anticoagulant effects of recombinant hirudin.
Chronic pain after hysterectomy
Authors: BRANDSBORG B. , NIKOLAJSEN L. , KEHLET H. , JENSEN T. S. 
Published: August 2010

Background: Chronic pain is a well‐known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established.Method: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic post‐hysterectomy pain are discussed.Results and conclusion: Chronic pain is reported by 5–32% of women after hysterectomy. A guideline is proposed for future prospective studies.
Administration of milrinone before ischemia, in the presence of β‐blockade, to treat metabolic impairment and myocardial stunning in pigs
Authors: SIDI A. , MUEHLSCHLEGEL J. D. , KIRBY D. S. , LOBATO E. B. 
Published: August 2010

Background: We examined effects of phosphodiesterase type III inhibition on regional myocardial metabolism and global left ventricular function, during ischemia, in the presence of β‐blockade.Methods: Twenty‐three pigs were randomized and studied to completion in four groups: C, did not receive drugs; M, received 50 μg/kg milrinone; E, received esmolol (150 μg/kg/min); E+M, received both. The left anterior descending artery (LADa) was then occluded for 15 min, followed by a 60‐min reperfusion. Left ventricular (LV) function data obtained included LV pressures, cardiac output (CO), slope of end‐systolic pressure–volume relationship (Emax), and dP/dT. Blood lactate concentrations were obtained from the aorta, LADa, and vein at baseline, end of occlusion, and during early (5 min) and late (1 h) reperfusion.Results: During ischemia, occlusion produced significant depression in LV dP/dT, Emax and concomitant elevation of LVEDP that persisted over early reperfusion in groups not treated with milrinone. After ischemia, measurements of CO were higher, with lower LVEDP and SVR; LV dP/dT and the Emax were higher, with lower LVEDP in the E+M group vs. the E group. Ischemic region lactate extraction during ischemia was better with E group vs. C group. Esmolol without or with milrinone was associated with nonsignificant lactate ischemic production during early reperfusion from baseline values.Conclusion: We demonstrated that the pre‐emptive administration of milrinone before ischemia was associated with less ischemic hemodynamic effects, without worsening the ischemic metabolic process. The combination E+M diminished ischemic metabolic impairment, and preserved left ventricular function and baseline hemodynamics.
Propofol–fentanyl anaesthesia at high altitude: anaesthetic requirements and haemodynamic variations when compared with anaesthesia at low altitude
Authors: PURI G. D. , JAYANT A. , DORJE M. , TASHI M. 
Published: August 2010

Background: There are few published accounts of anaesthesia delivery at high altitude. Natives at high altitude are known to have altered cardiorespiratory reserve. This study seeks to demonstrate the safety of propofol–fentanyl anaesthesia at high altitude titrated to the bispectral index (BIS) (3505 metres above sea level) in native highlanders. It also shows the differential effects of anaesthesia and surgery on the haemodynamics of such individuals as compared with individuals living at low altitude.Methods: Fifteen consenting adults scheduled to undergo general surgical/orthopaedic procedures under general anaesthesia using fentanyl, and propofol infusions titrated to the BIS along with nitrous oxide in oxygen after intubation, were recruited in the high‐altitude arm. Their anaesthesia record was compared with retrospective data from low altitude with respect to anaesthetic requirements, recovery after anaesthesia and the haemodynamic responses to surgical stress.Results: The high‐altitude dwellers required significantly larger doses of propofol at anaesthetic induction (2.31±0.64 vs. 1.41±0.24 mg/kg, P<0.0001) and thereafter to maintain designated BIS than their low‐altitude counterparts (6.22±1.14 vs. 4.61±1.29 mg/kg/h, P<0.01). They, however, had uneventful and short recovery times. The high‐altitude population also had significantly lower baseline heart rates (72±9.83 vs. 88±12.1, P<0.04) as also the heart rate responses to noxious stimulation such as direct laryngoscopy or skin incision (P<0.04, P<0.005, respectively).Conclusions: High‐altitude dwellers require significantly larger amounts of intravenous anaesthetic propofol. Heart rate at rest as also the heart rate responses to surgical stress were significantly attenuated at high altitude.
Use of ultrasound guidance and contrast enhancement: a study of continuous infraclavicular brachial plexus approach*
Authors: DHIR S. , GANAPATHY S. 
Published: August 2010

Purpose: We describe our experience of combining the use of ultrasound (US) guidance with contrast enhancement and peripheral nerve stimulation for the insertion of infraclavicular brachial plexus catheters.Methods: Thirty patients scheduled to have upper limb surgery under regional block were studied. Under US guidance and peripheral nerve stimulation assistance, continuous peripheral nerve block needle and stimulating catheter were placed in the infraclavicular area. Needle and catheter tip location was confirmed with agitated 5% dextrose and seen under colour Doppler with US before injecting local anaesthetic (LA). Patients were evaluated in terms of onset times and efficacy of block. Post‐operatively, on block recession a catheter was stimulated and visualization of spread of LA during injection through the catheter was done. Secondary block (subsequent to re‐injection of LA) was assessed. Patients were followed‐up for a week.Results: Mean time to onset of block was 19.7 (± 4.9) min. There were no incomplete blocks and all components of the plexus were blocked completely. Post‐operatively, in 95.7% of patients, the spread of hand‐agitated LA via the catheter could be seen by color Doppler with ultrasonography. All patients had excellent post‐operative analgesia and high degree of satisfaction. There were no complications.Conclusion: Contrast enhancement with US guidance during infraclavicular brachial plexus block enables direct visualization of needle and catheter tip location. Our early experience suggests that this leads to successful initial and subsequent post‐operative block. Further controlled studies are needed to compare this technique with more prevalent and conventional techniques of catheter insertion.
Antinociceptive efficacy of levetiracetam in a mice model for painful diabetic neuropathy
Authors: OZCAN M. , AYAR A. , CANPOLAT S. , KUTLU S. 
Published: August 2010

Background and Objective: Despite important advances in available knowledge, management of neuropathic pain remains incomplete, and results from experimental and clinical studies indicate that some anticonvulsants show promise for treating neuropathic pain. The aim of this study was to assess the antinociceptive efficacy of levetiracetam (LEV, ucb L059) in a mice model for painful diabetic neuropathy using the in vivo nociceptive behavioral ‘hot‐plate test.’Methods: The hot‐plate test consisted of placing individual mice (adult male Balb/C) on the hot plate at 50±0.1 °C and timing the delay for the first hind paw lift (nociceptive threshold). After obtaining control values, diabetes was induced by injection of streptozotocin [200 mg/kg intraperitoneally (i.p.)] and 2 weeks after induction of diabetes (serum glucose ≥400 mg/dL) LEV was administered i.p. and hot‐plate tests were repeated. Pain threshold values were determined and analyzed by Kruskal–Wallis one‐way analysis of variance (ANOVA) followed by a pairwise comparison using a Dunnett's t‐test on the ranked data.Results: LEV (60, 300 and 900 mg/kg) had no significant effect on the nociceptive threshold in normal mice (n=8 for each dose, P>0.05). There were significant decreases in pain threshold latency in diabetic mice compared with the normal healthy group and these were significantly and dose‐dependently restored by much lower doses of LEV (20, 100 and 200 mg/kg) in a reversible manner.Conclusion: Results obtained from the in vivo behavioral test lend support to the validation of the promising therapeutic potential of the novel antiepileptic agent LEV in the treatment of neuropathic pain.
Pre‐operative carbohydrate loading may be used in type 2 diabetes patients
Authors: GUSTAFSSON U. O. , NYGREN J. , THORELL A. , SOOP M. , HELLSTRÖM P. M , LJUNGQVIST O. , HAGSTRÖM‐TOFT E. 
Published: August 2010

Background: Post‐operative insulin resistance and hyperglycaemia are associated with an impaired outcome after surgery. Pre‐operative oral carbohydrate loading (CHO) reduces post‐operative insulin resistance with a reduced risk of hyperglycaemia during post‐operative nutrition. Insulin‐resistant diabetic patients have not been given CHO because the effects on pre‐operative glycaemia and gastric emptying are unknown.Methods: Twenty‐five patients (45–73 years) with type 2 diabetes [glycated haemoglobin (HbA1c) 6.2 ± 0.2%, mean ± SEM] and 10 healthy control subjects (45–72 years) were studied. A carbohydrate‐rich drink (400 ml, 12.5%) was given with paracetamol 1.5 g for determination of gastric emptying.Results: Peak glucose was higher in diabetic patients than in healthy subjects (13.4 ± 0.5 vs. 7.6 ± 0.5 mM; P<0.01) and occurred later after intake (60 vs. 30 min; P<0.01). Glucose concentrations were back to baseline at 180 vs. 120 min in diabetic patients and healthy subjects, respectively (P<0.01). At 120 min, 10.9 ± 0.7% and 13.3 ± 1.2% of paracetamol remained in the stomach in diabetic patients and healthy, subjects respectively. Gastric half‐emptying time (T50) occurred at 49.8 ± 2.2 min in diabetics and at 58.6 ± 3.7 min in healthy subjects (P<0.05). Neither peak glucose, glucose at 180 min, gastric T50, nor retention at 120 min differed between insulin (HbA1c 6.8 ± 0.7%)‐ and non‐insulin‐treated (HbA1c 5.6 ± 0.4%) patients.Conclusions: Type 2 diabetic patients showed no signs of delayed gastric emptying, suggesting that a carbohydrate‐rich drink may be safely administrated 180 min before anaesthesia without risk of hyperglycaemia or aspiration pre‐operatively.