bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterial thermodilution in burn patients suggests a more rapid fluid administration during early resuscitation
Authors: CSONTOS C. , FOLDI V. , FISCHER T. , BOGAR L. 
Published: August 2010

Background: A number of target points have been used for fluid replacement in severely burned patients. The aim of our prospective randomized study was to compare the effect of two different types of fluid resuscitation regimes on the multiple organ dysfunction score (MODS) and central venous oxygen saturation (ScvO2) in the first 3 days after injury.Methods: Twenty‐four patients admitted to the critical care unit of a university hospital with the presence of burn injury affecting more than 15% of the body surface area and in‐hospital fluid resuscitation started within 3 h after burn injury were included. Patients were randomized into two groups. Fluid resuscitation was guided by the hourly urine output (HUO Group, n=12) or by the intrathoracic blood volume index (ITBVI Group, n=12). Invasive transpulmonary hemodynamic measurements utilizing pulse contour analysis with a single dilution technique and continuous ScvO2 measurements were performed in both groups.Results: The mean ScvO2 was significantly lower in the HUO Group than in the ITBVI Group (P=0.024) for the first 24 h. MODS was significantly higher in the HUO Group than in the ITBVI group 48 h (P=0.024) and 72 h after injury (P=0.014). The two main outcome parameters, i.e., MODS calculated at 48 and 72 h after injury and ScvO2 were negatively correlated on day 1 (r=−0.684, P=0.004, r=−0.677, P=0.003). There were no statistical differences in clinical outcome parameters.Conclusion: Our data suggest that ITBVI may be a better target parameter than HOU in the fluid resuscitation of severely burned patients after injury.
Effect of mivazerol, a α2‐agonist, on striatal norepinephrine concentration during transient forebrain ischemia in rats*
Authors: KIMURA T. , SATO K. , NISHIKAWA T. , TOBE Y. , MASAKI Y. 
Published: August 2010

Background: We have previously reported that mivazerol, a α2‐agonist, possibly provides neuroprotection against transient forebrain ischemia in rats. This study was designed to investigate the ability of mivazerol to attenuate ischemia‐induced increase in striatal norepinephrine concentration after transient forebrain ischemia in rats.Methods: Male Sprague–Dawley rats, anesthetized with halothane, were assigned to one of three groups (n=10 each); control (C, normal saline 1 ml/kg), mivazerol 20 μg/kg (M20), and 40 μg/kg (M40) groups. Monitored variables included temporal muscle temperature (maintained at 37.5±0.1 °C), electroencephalogram, systolic/diastolic blood pressure, heart rate, arterial blood gases, and blood glucose concentrations. Thirty minutes after subcutaneous drug administration, forebrain ischemia was induced with hemorrhagic hypotension (systolic arterial pressure: 40–50 mmHg) and bilateral carotid artery occlusion for 10 min, and then the brain was reperfused. Norepinephrine concentration in the interstitial fluids in the striatum was analyzed using in vivo microdialysis in combination with high‐performance liquid chromatography.Results: Ischemia resulted in a prompt increase in norepinephrine concentrations in the striatum in all groups. However, there were no significant differences in norepinephrine concentrations in the striatum between the three groups at any period.Conclusions: Our results indicate that mivazerol did not attenuate ischemia‐induced increase in striatal norepinephrine concentration. This suggests that the possible neuroprotective property of mivazerol is not related to inhibition of norepinephrine release in the brain.
Surgical stress index as a measure of nociception/antinociception balance during general anesthesia
Authors: WENNERVIRTA J. , HYNYNEN M. , KOIVUSALO A.‐M. , UUTELA K. , HUIKU M. , VAKKURI A. 
Published: August 2010

Background: No validated monitoring method is available for evaluating the nociception/antinociception balance. We assessed the surgical stress index (SSI), computed from finger photoplethysmographic waveform amplitudes and pulse‐to‐pulse intervals, in patients undergoing shoulder surgery under general anesthesia (GA) and interscalene plexus block and in patients with GA only.Methods: In this prospective, randomized study in 26 patients, increased blood pressure (BP) or heart rate, movement, and coughing were considered to be signs of intraoperative nociception and were treated with alfentanil. GA was maintained with desflurane aiming at a State Entropy level of 50. Photoplethysmographic waveforms were collected from the contra‐lateral arm to the surgery and SSI values from 0 (no surgical stress) to 100 (maximal surgical stress) were calculated off‐line.Results: Two minutes after skin incision, SSI had not increased in the plexus group and was lower in the plexus group (38 ± 13) compared with the controls (58 ± 13, P<0.005). Among the controls, 1 min before alfentanil administration, the SSI value was higher than during periods of adequate antinociception, 59 ± 11 vs. 39 ± 12 (P<0.01). The total cumulative need for alfentanil was higher in controls (2.7 ± 1.2 mg) compared with the plexus group (1.6 ± 0.5 mg; P=0.008). Tetanic stimulation to the ulnar region of the hand increased SSI significantly only among the patients with plexus block not covering the site of the stimulation.Conclusion: SSI values were lower in patients with plexus block covering the sites of nociceptive stimuli. In detecting nociceptive stimuli, SSI had better performance than heart rate, BP, or response entropy.
Does isoflurane enhance rhinovirus replication and virus‐induced cytokine secretion in airway epithelial cells?
Authors: Park H.‐W. , Wang J. H. , Kim J. U. , Koo S.‐W. , Kwon H. J. , Jang Y. J. 
Published: August 2010

Background: There have been no previous studies regarding the effect of volatile anesthetics on human rhinovirus (RV) infection in airway epithelial cells of patients with an upper respiratory infection (URI). We have therefore evaluated in vitro the effect of isoflurane on RV infection in airway epithelial cells.Methods: A549 cells and RV‐infected A549 cells were treated with isoflurane for 2 or 4 h. Surface expression of intercellular adhesion molecule‐1 (ICAM‐1) was assessed by flow cytometry, and effects on the secretion of interleukin (IL)‐6 and IL‐8 were measured by ELISA. The effect on RV replication in the cells was determined by viral titer.Results: Isoflurane treatment for 2 or 4 h had no significant effect on ICAM‐1 expression and secretion of IL‐6 and IL‐8 in control cells. Isoflurane also had no significant additional effect on RV‐induced ICAM‐1 expression and secretion of IL‐6 and IL‐8. Viral titers were not significantly influenced by isoflurane.Conclusion: Isoflurane treatment showed no additional effects with RV on ICAM‐1 expression, secretion of IL‐6 and IL‐8, and viral titer in A549 cells. These results suggest that isoflurane itself may not increase further RV infections, inflammations, and viral replication in patients with a viral URI.
Correlation between pre‐operative metabolic syndrome and persistent blood glucose elevation during cardiac surgery in non‐diabetic patients
Authors: DONATELLI F. , CAVAGNA P. , DI DEDDA G. , CATENACCI A. , DI NICOLA M. , LORINI L. , FUMAGALLI R. , CARLI F. 
Published: August 2010

Background: Cardiopulmonary‐bypass (CPB) induces hyperglycemia. There is growing evidence that perioperative maintenance of blood glucose within the physiological range improves patients' outcome. Nevertheless, perioperative normoglycemia is often difficult to achieve during surgery with CPB and the response to insulin infusion is characterized by a considerable variability. The aim of this study was to determine to what extent the presence of pre‐operative metabolic syndrome (MS) influences the blood glucose and insulin response during cardiac surgery.Methods: Forty‐five patients scheduled for elective cardiac surgery were screened for the presence of MS according to the International Diabetes Federation definition. Patients were then assigned to two groups: those with metabolic syndrome (MSP) and those without (control). During surgery, blood glucose levels were measured in all patients and hyperglycemia was treated with a standard protocol of continuous insulin infusion.Results: The mean blood glucose levels during CPB increased only in the MSP group (P<0.001). Mean blood glucose in control patients did not increase during CPB (P=0.4). Patients with MS received 13.3±8.4 IU of insulin during CPB, while the control group did not require insulin treatment (P<0.001). Forty percent of patients in the control group and 100% of those in the MSP group developed post‐operative insulin resistance. C‐reactive protein was higher in the MSP group before, during and at 48 h after surgery.Conclusions: The mean blood glucose levels during CPB increased only in patients with MS, while they remained unchanged in patients in the control group.
Meta‐analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery
Authors: VAN ZAANE B. , ZUITHOFF N. P. A. , REITSMA J. B. , BAX L. , NIERICH A. P. , MOONS K. G. M. 
Published: August 2010

Background: Stroke after cardiac surgery may be caused by emboli emerging from an atherosclerotic ascending aorta (AA). Epiaortic ultrasound scanning (EUS), the current ‘gold’ standard for detecting AA atherosclerosis, has not gained widespread use because there is a lack of optimized ultrasound devices, it lengthens the procedure, it endangers sterility, and there is a false belief by many surgeons that palpation is as sensitive as EUS. Furthermore there is no clear evidence proving that the use of epiaortic scanning changes outcome in cardiac surgery. Various researchers investigated the ability of transesophageal echocardiography (TEE) to discriminate between the presence and absence of AA atherosclerosis. It is acknowledged that TEE has limited value in this, but it has never been supported by a meta‐analysis estimating the true diagnostic accuracy of TEE based on all quantitative evidence. We aimed to do this using state‐of‐the‐art methodology of diagnostic meta‐analyses.Methods: We searched multiple databases for studies comparing TEE vs. EUS for detection of atherosclerosis. A random‐effects bivariate meta‐regression model was used to obtain summary estimates of sensitivity and specificity, incorporating the correlation between sensitivity and specificity as well as covariates to explore heterogeneity across studies.Results: We extracted six studies with a total of 346 patients, of whom 419 aortic segments were analyzed, including 100 segments with atherosclerosis [median prevalence 25% (range 17–62%)]. Summary estimates of sensitivity and specificity were 21% (95% CI 13–32%) and 99% (96–99%), respectively.Conclusions: Because of the low sensitivity of TEE for the detection of AA atherosclerosis, a negative test result requires verification by additional testing using epiaortic scanning. In case of a positive test result, AA atherosclerosis can be considered as present, and less manipulative strategies might be indicated.
Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography
Authors: BRUHN J. , VAN GEFFEN G.‐J. , GIELEN M. J. , SCHEFFER G. J. 
Published: August 2010

Background: The sciatic nerve block by the posterior approaches represents one of the more difficult ultrasound‐guided nerve blocks. Our clinical experiences with these blocks indicated a point slightly distal to the subgluteal fold as an advantageous position to allow good ultrasonic visibility. In this study, we systematically scanned the sciatic nerve from the subgluteal fold to the popliteal crease, to determine an optimal point for ultrasonographic visualization.Methods: After institutional approval and written informed consent, we recruited 15 volunteers to visualize the sciatic nerve from the subgluteal fold to the popliteal crease using a linear ultrasound probe in the range of 7–13 MHz. The ultrasonographic visibility of the sciatic nerve, nerve diameter (width and thickness), and skin‐to‐nerve distance at 20 equidistant points between the subgluteal fold and the popliteal crease were recorded.Results: The sciatic nerve could be successfully visualized in cross‐section as a hyperechoic structure on ultrasound in all volunteers. In the course from subgluteal to the popliteal area, the shape of the sciatic nerve changed from flat to round, while the skin–nerve distance varied with the smallest skin–nerve distances at the popliteal crease and at 5.4 cm (on average) distal to the subgluteal fold. The best ultrasonographic visibility scores were found between 7.2 and 10.8 cm (on average) distal to the gluteal fold.Conclusion: Between 5.4 and 10.8 cm from the subgluteal fold seems to be the best area to scan the sciatic nerve in terms of superficial nerve position and good ultrasonic visibility.
Skin conductance as a means to predict hypotension following spinal anaesthesia
Authors: LEDOWSKI T. , PREUSS J. , KAPILA R. , FORD A. 
Published: August 2010

Background and objective: Hypotension following spinal anaesthesia (SA) is common, especially in the elderly. Elevated sympathetic tone has been shown to correlate with severe hypotension after SA. The aim of this prospective trial was to investigate skin conductance (SC), as a measure of sympathetic tone, to predict hypotension after SA.Methods: After ethical approval and written informed consent, 30 patients undergoing SA were included. Baseline measurements of SC [number of fluctuations per second (reflecting the firing rate of skin sympathetic nerves), area under the curve (AUC) A and B (reflecting the magnitude of the sympathetic impulse)], blood pressure and heart rate were recorded. After administration of SA, all parameters were assessed every 2.5 min for a total of 15 min. Baseline readings of SC were compared with the lowest blood pressure within the study period.Results: Data from 30 subjects [73 (8) years] were analysed. After SA, the mean arterial blood pressure declined an average of 21.3 (11.3) mmHg. A cut‐off value of 0.35 μSs for baseline AUC B allowed prediction of more than mild hypotension (>15% from baseline) after SA with a sensitivity of 72.5% and a specificity of 77.5%.Conclusions: AUC B, as a parameter of SC, may predict severe arterial hypotension after SA in the elderly.
Three‐dimensional ultrasound‐assisted popliteal catheter placement revealing aberrant anatomy: implications for block failure
Authors: CLENDENEN S. R. , YORK J. E. , WANG R. D. , GREENGRASS R. A. 
Published: August 2010

Background: The current means of introducing continuous sciatic catheters include nerve stimulation, with or without catheter stimulation techniques. More recently, ultrasound has been utilized to facilitate catheter placement.Methods: This case represents a stimulating catheter‐guided continuous block facilitated by three‐dimensional ultrasound, which revealed aberrant anatomy with proximal and wide bifurcation of the sciatic nerve with implications for block failure.Results: Before ultrasound imaging secondary failures were attributed to catheter misplacement or dislodgement.Conclusion: Because of this case observation, our current practice is to use ultrasound confirmation of the bifurcation of the nerve of all popliteal catheter placements, particularly catheters placed in patients having ambulatory procedures to prevent secondary failure of catheters at home.
Fentanyl‐induced cough does not depend on injection speed: a randomized study
Authors: Schäpermeier U. , Hopf H.‐B. 
Published: August 2010

Background: The aim of the study was to investigate whether the incidence of cough after intravenous fentanyl depends on the speed of injection.Methods: With ethics committee approval, 476 ASA class I–III nonsmoking patients free of bronchial hyperreactivity and respiratory tract infection undergoing general anaesthesia for elective surgery were randomized to either 1.5 μg/kg fentanyl injected over 2, 5 or 10 s or placebo (saline) via a periphereal intravenous cannula. The primary endpoint was the incidence of cough within 5 min after completion of injection.Results: The study was terminated for futility after enrollment of 476 patients because an interim analysis yielded an incidence of cough of 3%, 3% and 6% in the three fentanyl groups, respectively, and of 2% in the placebo group, with no difference between groups (P=0.374, χ2 test for cough between fentanyl and placebo groups).Conclusions: Under the conditions of our study, the incidence of cough after 1.5 μg/kg fentanyl injected intravenously over 2, 5 or 10 s was between 3% and 6%, unrelated to the speed of injection and not different from placebo.
Sepsis‐related acute kidney injury: a protective effect of drotrecogin alfa (activated) treatment?
Authors: VAN DOORN K. J. , SPAPEN H. , GEERS C. , DILTOER M. , SHABANA W. 
Published: August 2010

Background: Drotrecogin alfa activated (DrotAA) is licensed for treatment of patients with severe sepsis and organ failure. Among the latter, acute kidney injury (AKI), defined as the persistence of oligo‐anuria following adequate resuscitation, is one of the most apprehended. We conducted a prospective, observational, and controlled study to test the hypothesis that DrotAA beneficially affected the evolution and outcome of AKI, complicating acute sepsis‐induced cardiopulmonary failure.Methods: Forty‐six patients were studied. Thirty subjects received standard treatment for sepsis without DrotAA. In the remaining 16 patients, DrotAA was added as a continuous infusion of 24 μg/kg/h for 96 h.Results: Mean age, causes of sepsis, and severity/organ failure scores were comparable between patients treated with or without DrotAA. Mortality at 28 days was high and comparable between both treatment groups (56% vs. 69%, DrotAA vs. no DrotAA; P=0.5). When oligo‐anuria was present at the start of the study, it persisted during treatment in all patients, with no significant difference between groups. Both treatment groups presented with baseline mean daily fractional excretion of sodium values >2% that remained high during the observation period, regardless of whether DrotAA was given or not. Kidney histology showed a preserved renal architecture with tubular necrosis in all specimens. Similar glomerular, tubulo‐interstitial, and vascular alterations were present in both treatment groups.Conclusion: In this small cohort of patients with severe sepsis who received adjuvant DrotAA treatment, no effect on urine output, tubular function, or mortality could be demonstrated.
Itraconazole, a potent inhibitor of P‐glycoprotein, moderately increases plasma concentrations of oral morphine
Authors: HEISKANEN T. , BACKMAN J. T. , NEUVONEN M. , KONTINEN V. K. , NEUVONEN P. J. , KALSO E. 
Published: August 2010

Background:Individual variation in opioid response is considerable, partly due to pharmacokinetic factors. Transporter proteins are becoming increasingly interesting also in the pharmacokinetics of opioids. The efflux transporter P‐glycoprotein can affect gastrointestinal absorption and tissue distribution, particularly brain access of many opioids. The aim of this study was to evaluate whether itraconazole, which is a potent inhibitor of P‐glycoprotein and CYP3A4, would change the pharmacokinetics or the pharmacodynamics of oral morphine.Methods:Twelve healthy male volunteers ingested, in a randomized crossover study, once daily 200 mg itraconazole or placebo for 4 days. On day 4, 1 h after the last pre‐treatment dose, the subjects ingested 0.3 mg/kg morphine. Blood samples for the determination of plasma morphine, morphine‐3‐glucuronide (M3G), morphine‐6‐glucuronide (M6G) and itraconazole concentrations were drawn up to 48 h after morphine ingestion. Pharmacodynamic effects were evaluated using a questionnaire, visual analogue scales, a reaction time test, the Digit Symbol Substitution Test and the Critical Flicker Fusion Test.Results:Itraconazole increased the mean area under the plasma concentration–time curve [AUC (0–9)] of morphine by 29% (P=0.002), its AUC (0–48) by 22% (P=0.013) and its peak plasma concentration by 28% (P=0.035). Itraconazole did not significantly affect the pharmacokinetic variables of M3G or M6G or the pharmacodynamic effects of morphine.Conclusions:Itraconazole moderately increases plasma concentrations of oral morphine, probably by enhancing its absorption by inhibiting intestinal wall P‐glycoprotein. A possible improvement of morphine penetration to the brain could not be observed.
Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery
Authors: CHUNG C. J. , LEE J. M. , CHOI S. R. , LEE S. C. , LEE J. H. 
Published: August 2010

Background: Rapidly acting narcotics enhance the degree of bradycardia due to the oculocardiac reflex (OCR) elicited by extraocular muscle (EOM) tension during strabismus surgery. We evaluated and compared the effects of remifentanil and sevoflurane on OCR during paediatric strabismus surgery.Methods: One hundred and twenty children, 1–9 years old, undergoing elective strabismus surgery, were randomly assigned to receive sevoflurane or remifentanil. No anticholinergic prophylaxis was administered. Anaesthesia was induced using ketamine 1.0 mg/kg or midazolam 0.15 mg/kg with 66% N2O in O2. Laryngeal mask airways were placed with rocuronium 0.5 mg/kg. Anaesthesia was maintained with sevoflurane 2.0–3.0 vol% with 66% N2O in O2 or remifentanil 0.75 μg/kg over 1 min and followed by the continuous infusion of remifentanil 0.5 μg/kg/min with 66% N2O in O2. Heart rate (HR) and blood pressure (BP) were measured and compared. OCR was defined as a reduction in HR of >20% induced by traction of an EOM.Results: During anaesthesia, HR and BP were maintained at a lower level in the remifentanil group than in the sevoflurane group (each, P<0.05). The mean percent change in HR (−23.3±17.0% vs. −11.2±13.0%; P<0.05) and the incidence of OCR (58.3% vs. 28.3%; P<0.05) following traction of an EOM were higher in the remifentanil group than in the sevoflurane group.Conclusions: Remifentanil enhanced the degree of bradycardia due to OCR as compared with sevoflurane during paediatric strabismus surgery.
Lactobacillus plantarum 299v reduces colonisation of Clostridium difficile in critically ill patients treated with antibiotics
Authors: KLARIN B. , WULLT M. , PALMQUIST I. , MOLIN G. , LARSSON A. , JEPPSSON B. 
Published: August 2010

Background: The incidence of Clostridium difficile‐associated disease (CDAD) in hospitalised patients is increasing. Critically ill patients are often treated with antibiotics and are at a high risk of developing CDAD. Lactobacillus plantarum 299v (Lp299v) has been found to reduce recurrence of CDAD. We investigated intensive care unit (ICU) patients with respect to the impact of Lp299v on C. difficile colonisation and on gut permeability and parameters of inflammation and infection in that context.Methods: Twenty‐two ICU patients were given a fermented oatmeal gruel containing Lp299v, and 22 received an equivalent product without the bacteria. Faecal samples for analyses of C. difficile and Lp299v were taken at inclusion and then twice a week during the ICU stay. Other cultures were performed on clinical indication. Infection and inflammation parameters were analysed daily. Gut permeability was assessed using a sugar probe technique.Results: Colonisation with C. difficile was detected in 19% (4/21) of controls but in none of the Lp299v‐treated patients (P<0.05).Conclusions: Enteral administration of the probiotic bacterium Lp299v to critically ill patients treated with antibiotics reduced colonisation with C. difficile.