bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of infusion pumps for continuous spinal administration of local anesthetics in post‐operative pain therapy
Authors: WENK M. , PÖPPING D. M. 
Published: April 2009

Background and Objectives: For completion of perioperative care and for general ethical considerations, any intraoperatively used catheter technique should be utilizable for post‐operative pain therapy. Continuous spinal anesthesia (CSA) is an established form of local anesthetic application. However, for its use in post‐operative therapy, infusion pumps are required that are technically able to deliver low rates and are distinctive in design to avoid possible pump or medication swaps. Because of a lack of devices specifically designed for CSA, we investigated the potential deployability of infusion pumps for post‐operative pain therapy via CSA microcatheters, which were originally designed and approved for different applications.Methods: The accuracy of infusion rates of three different pumps was measured in a liquor model environment. Furthermore, we investigated safety and user‐friendliness by interviewing 30 anesthesiologists and 15 pain nurses.Results: Except for the first hour of infusion, all pumps provided comparable and adequate flow profiles. However, interviews revealed significant risk factors for all pumps in terms of swapping devices, lines or medications and misprogramming the units.Discussion: All pumps tested were technically able to deliver accurate flow rates; however, because the non‐CSA‐specific design involves the risk of medication overdosage and syringe swaps, none of the systems tested can be recommended for routine use in post‐operative CSA, irrespective of the fact that it was an off‐label application anyway. Therefore, to ensure patient safety, continuous spinal administration of local anesthetics via microcatheters is a questionable method of post‐operative pain therapy as long as non‐specific pumps are used.
Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy
Authors: MASSICOTTE L. , CHALAOUI K. D. , BEAULIEU D. , ROY J.‐D. , BISSONNETTE F. 
Published: April 2009

Purpose: The aim of this study was to compare morphine consumption with patient‐controlled analgesia (PCA) between spinal anesthesia (SA) (bupivacaine, morphine and fentanyl) and general anesthesia (GA) (sufentanil) after an abdominal hysterectomy.Methods: Forty women were randomly assigned to receive SA with bupivacaine 15 mg, 0.15 mg of intrathecal morphine and 15 μg of fentanyl or GA with sufentanil, both combined with PCA. The primary outcome was morphine consumption with the PCA device. The secondary outcomes were post‐operative pain at rest and under stress on a visual analog scale, nausea, pruritus and respiratory depression on a standardized scale. Outcome measures were recorded at 6, 12, 18, 24 and 48 h post‐anesthesia. The duration of post‐anesthesia care unit (PACU) and hospital stay were recorded.Results: Patients in the SA group consumed at least two times less morphine at each time interval than the GA group: at 48 h, they used 19 ± 17 vs. 81 ± 31 mg (P<0.0001). Post‐operative pain at rest was lower in the SA group until the 18th hour and under stress until the 48th. There was more sedation in the GA group until the 18th hour. Little difference was observed in the incidence of pruritus. Nausea was more intense at the 6th hour in the GA group. There was no difference in the respiratory rate. The duration of PACU stay was shorter for the SA group (52 ± 9 vs. 73 ± 11 min, P<0.0001) as was the duration of hospital stay (2.2 ± 0.4 vs. 3.3 ± 0.7 days, P=0.01).Conclusions: It is concluded that intrathecal morphine 0.15 mg with 15 μg of fentanyl decreases post‐operative pain and morphine consumption by PCA without increasing adverse reactions for women undergoing an abdominal hysterectomy.
Reactive oxygen species in rats with chronic post‐ischemia pain
Authors: KWAK K. H. , HAN C. G. , LEE S. H. , JEON Y. , PARK S. S. , KIM S. O. , BAEK W. Y. , HONG J. G. , LIM D. G. 
Published: April 2009

Background: An emerging theme in the study of the pathophysiology of persistent pain is the role of reactive oxygen species (ROS). In the present study, we examined the hypothesis that the exogenous supply of antioxidant drugs during peri‐reperfusion would attenuate pain induced by ischemia/reperfusion (IR) injury. We investigated the analgesic effects of three antioxidants administered during peri‐reperfusion using an animal model of complex regional pain syndrome‐type I consisting of chronic post‐ischemia pain (CPIP) of the hind paw.Methods: Application of a tight‐fitting tourniquet for a period of 3 h produced CPIP in male Sprague–Dawley rats. Low‐dose allopurinol (4 mg/kg), high‐dose allopurinol (40 mg/kg), superoxide dismutase (SOD, 4000 U/kg), N‐nitro‐l‐arginine methyl ester (l‐NAME, 10 mg/kg), or SOD (4000 U/kg)+l‐NAME (10 mg/kg) was administered intraperitoneally just after tourniquet application and at 1 and 2 days after reperfusion for 3 days. The effects of antioxidants in rats were investigated using mechanical and cold stimuli. Each group consisted of seven rats.Results: Allopurinol caused significant alleviation in mechanical and cold allodynia for a period of 4 weeks in rats with CPIP. Both SOD and l‐NAME, which were used to investigate the roles of superoxide (O2 ˙−) and nitric oxide (NO) in pain, also attenuated neuropathic‐like pain symptoms in rats for 4 weeks.Conclusions: Our findings suggest that O2 ˙− and NO mediate IR injury‐induced chronic pain, and that ROS scavengers administered during the peri‐reperfusion period have long‐term analgesic effects.
High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart
Authors: JAKOBSEN C.‐J. , NYGAARD E. , NORRILD K. , KIRKEGAARD H. , NIELSEN J. , TORP P. , SLOTH E. 
Published: April 2009

Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two‐dimensional (2D) echocardiography and TDI in patients with ischemic heart disease.Methods: The effect of a high epidural block (at least Th1–Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E″) and atrial (A″) peak velocities during diastole.Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 ± 1.53 to 6.86 ± 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E″/A″ ratio increased from 0.75 ± 0.27 to 1.09 ± 0.32 (P=0.0026), indicating improved relaxation.Conclusion: A 2D‐echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.
Walking reduces the post‐void residual volume in parturients with epidural analgesia for labor: a randomized‐controlled study
Authors: WEINIGER C. F. , YAGHMOUR H. , NADJARI M. , EINAV S. , ELCHALAL U. , GINOSAR Y. , MATOT I. 
Published: April 2009

Background: The post‐void residual volume is higher among parturients who received epidural analgesia than those who received no or alternative analgesia.Methods: This prospective, randomized, controlled, non‐blinded study was performed in a tertiary referral center labor suite. The post‐void residual volume was measured by a transabdominal ultrasound following a voiding attempt. Healthy parturients with low‐dose epidural analgesia in active labor were randomized either to walk to the toilet or to use a bedpan for voiding. The primary outcome measure (post‐void residual volume in labor) was compared between the study groups.Results: The toilet group (n=34) and the bedpan group (n=28) demonstrated similar post‐void residual volumes (212 ± 100 vs. 168 ± 93 ml, P=0.289). Twenty patients (59%) randomized to the toilet group were unable to walk and actually voided in a bedpan. A secondary analysis was performed analyzing the groups as treated. The post‐void residual volume was significantly lower in the actual toilet group (n=14, 63 ± 24 ml) vs. the bedpan group (n=48, 229 ± 200 ml), P=0.0052. Thirteen (93%) women who walked to the toilet managed to void before the ultrasound measurement vs. 20/48 (42%) using the bedpan, P=0.001. Fewer women who managed to walk to the toilet required urinary bladder catheterization during the labor than women who used the bedpan (6/14, 43% vs. 36/48, 75%) P=0.028.Conclusion: Women who were randomized to walk to the bathroom with epidural analgesia and were able to do so during labor had a significantly reduced post‐void residual volume and a reduced requirement for urinary catheterization.
Post‐induction alfentanil reduces sevoflurane‐associated emergence agitation in children undergoing an adenotonsillectomy
Authors: KIM J. Y. , CHANG Y. J. , LEE J. Y. , PARK H. Y. , KWAK H. J. 
Published: April 2009

Background: Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy.Methods: One hundred and five children, aged 3–10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 μg/kg (A10) or 20 μg/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed.Results: The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) (P=0.007, 0.006, respectively). PAED scales were significantly different between the three groups (P=0.008), and lower in the A10 and A20 groups than that in the control group (P=0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups.Conclusion: The administration of alfentanil 10 μg/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension.
Inefficacy of simulator‐based training on anaesthesiologists' non‐technical skills*
Authors: ZAUSIG Y. A. , GRUBE C. , BOEKER‐BLUM T. , BUSCH C. J. , BAYER Y. , SINNER B. , ZINK W. , SCHAPER N. , GRAF B. M. 
Published: April 2009

Background: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non‐technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training.Methods: Forty‐two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS+MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios.Results: NTS+MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (P<0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (P<0.01) in both groups.Conclusion: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance.
A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit population
Authors: STRAND K. , SØREIDE E. , AARDAL S. , FLAATTEN H. 
Published: April 2009

Background: Simplified Acute Physiology Score (SAPS II) is the most widely used general severity scoring system in European intensive care medicine. Because its performance has been questioned in several external validation studies, SAPS 3 was recently released. To our knowledge, there are no published validation studies of SAPS II or SAPS 3 in the Scandinavian countries. We aimed to evaluate and compare the performance of SAPS II and SAPS 3 in a Norwegian intensive care unit (ICU) population.Method: Prospectively collected data from adult patients admitted to two general ICUs at two different hospitals in Norway were used. Probability of mortality was calculated using the SAPS 3 global equation (SAPS 3 G), the SAPS 3 Northern European equation (SAPS 3 NE), and the original SAPS II equation. Performance was assessed by the standardized mortality ratio (SMR), area under receiving operating characteristic, and the Hosmer and Lemeshow goodness‐of‐fit Ĉ test.Results: One thousand eight hundred and sixty‐two patients were included after excluding readmissions, and patients who were admitted after coronary surgery or burns. The SMRs were SAPS 3 G 0.71 (0.65, 0.78), SAPS 3 NE 0.74 (0.68, 0.81), and SAPS II 0.82 (0.75, 0.91). Discrimination was good in all systems. Only the SAPS 3 equations displayed satisfactory calibration, as measured by the Hosmer–Lemeshow test.Conclusion: The performance of SAPS 3 was satisfactory, but not markedly better than SAPS II. Both systems considerably overestimated mortality and exhibited good discrimination, but only the SAPS 3 equations showed satisfactory calibration. Customization of these equations based on a larger cohort is recommended.
Hyper osmolality does not modulate natriuretic peptide concentration in patients after coronary artery surgery
Authors: HONKONEN E. L. , JÄRVELÄ K. , HUHTALA H. , HOLM P. , LINDGREN L. 
Published: April 2009

Background: The heart secretes natriuretic peptides (NPs) in response to myocardial stretch. Measuring NP concentrations is a helpful tool in guiding treatment. It has been suggested that sodium ion and hyperosmolality could affect NP excretion. If this is true, peri‐operative NP measurements could be inconsistent when hypertonic solutions are used. With different osmolalities but equal volumes of hydroxyethyl starch (HES) – and hypertonic saline (HS) – infusions, this double‐blinded study tested the hypothesis that osmolality modulates the excretion of NPs.Methods: Fifty coronary surgery patients were randomized to receive within 30 min 4 ml/kg either HS or HES post‐operatively. Samples for analysis of atrial NP (ANP), brain NP (BNP), plasma and urine sodium and osmolality and urine oxygen tension were obtained before and 60 min after starting the infusions and on the first post‐operative morning. The haemodynamic parameters were measured at the same time points.Results: Plasma osmolality and sodium increased only in the HS group. Changes in plasma BNP and ANP levels did not differ between the groups (P=0.212 and 0.356). There were no correlations between NP levels and osmolality or sodium at any time point. In the HS group, urine volume was higher (3295 vs. 2644 ml; P<0.05) and the need for furosemide treatment was less (0.4 vs. 3.8 mg; P<0.01) than in the HES group.Conclusions: The absence of effects of plasma sodium content or hyperosmolality on NP release validates the value of NPs as a biomarker in peri‐operative patients.
Perineural meperidine blocks nerve conduction in a dose‐related manner: a randomized double‐blind study
Authors: ÖZTÜRK E. , BEYAZOVA M. , KAYA K. , MERAY J. , ZINNUROGLU M. , TARHAN B. 
Published: April 2009

Background: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve.Materials and methods: The study was conducted in a double‐blind, placebo‐controlled fashion. Eighteen healthy volunteers were randomized into three groups (Saline, meperidine 1% and meperidine 2%). Three millilitre of the study solution was administered to the ulnar nerve perineurally at the level of the wrist by the guidance of a nerve stimulator. Sensory nerve action potential (SNAP) and compound motor action potential (CMAP) amplitudes were recorded. At least a 20% decrease in the initial response amplitude was accepted as a block.Results: The number of individuals with sensory and motor block with saline, meperidine 1% and meperidine 2% were 0/6, 6/6, 6/6 and 0/6, 5/6, 6/6, respectively (P<0.05). The maximum decrease in the median SNAP and CMAP amplitude values were 4.7% and 8.3% with saline; 38.5% and 46.4% with meperidine 1%; and 100% and 97.8% with meperidine 2%, respectively (P<0.05). Median values for the duration of sensory and motor block with meperidine 1% and meperidine 2% were 45, 52.5 and 30, 32.5 min, respectively.Conclusion: Meperidine blocks sensory and motor nerve conduction in a dose‐related manner.
Isoflurane enhances spontaneous Ca2+oscillations in developing rat hippocampal neuronsin vitro
Authors: XIANG Q. , TAN L. , ZHAO Y.‐L. , WANG J.‐T. , JIN X.‐G. , LUO A.‐L. 
Published: April 2009

Background:During the nervous system development, spontaneous synchronized Ca2+oscillations are thought to possess integrative properties because their amplitude and frequency can influence the patterning of neuronal connection, neuronal differentiation, axon outgrowth, and long‐distance wiring. Accumulating studies have confirmed that some drugs such as volatile anesthetic isoflurane produced histopathologic changes in the central nervous system in juvenile animal models. Because the hippocampus plays an important role in learning and memory, the present work was designed to characterize the Ca2+oscillations regulated by volatile anesthetic isoflurane in primary cultures of developing hippocampal neurons (5‐day‐cultured).Methods:Primary cultures of rat hippocampal neurons (5‐day‐cultured) were loaded with the Ca2+indicator Fluo‐4AM (4 μM) and were studied with a confocal laser microscope.Results:Approximately 22% of 5‐day‐cultured hippocampal neurons exhibited typical Ca2+oscillations. These oscillations were dose‐dependently enhanced by isoflurane (EC50 0.5 MAC, minimum alveolar concentration) and this effect could be reverted by bicuculline (50 μM), a specific γ‐aminobutyric acid (GABAA) receptor antagonist.Conclusion:Unlike its depressant effect on the Ca2+oscillations in adult neurons in previous researches, isoflurane dose‐dependently enhanced calcium oscillations in developing hippocampal neurons by activating GABAAreceptors, a major excitatory receptor in synergy withN‐methyl‐d‐aspartate receptors at the early stages of development. It may be involved in the mechanism of an isoflurane‐induced neurotoxic effect in the developing rodent brain.
Mortality in diabetic patients undergoing non‐cardiac surgery: a 7‐year follow‐up study
Authors: KROLIKOWSKA M. , KATAJA M. , PÖYHIÄ R. , DRZEWOSKI J. , HYNYNEN M. 
Published: April 2009

Background: The prognosis of diabetic patients after non‐cardiac surgery remains controversial. This study was designed to compare the long‐term mortality between diabetic and non‐diabetic control patients undergoing non‐cardiac surgery and to evaluate the possible risk factors.Methods: We investigated 274 consecutive diabetic patients and 282 non‐diabetic control patients who underwent non‐cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years.Results: Mortality both in the short‐term postoperatively (≤21 days) and in the long‐term (up to 87 ½ months) was significantly higher in the diabetic patients compared with the non‐diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non‐diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post‐operative mortality but a combination of variables had a significant effect on both short‐ and long‐term mortality.Conclusion: Diabetic patients undergoing non‐cardiac surgery had a significantly higher incidence of short‐term post‐operative and long‐term mortality compared with non‐diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non‐cardiac surgery within a 7‐year follow‐up. The majority of deaths were associated with cardiovascular diseases.
Predictors of cardiac events in high‐risk patients undergoing emergency surgery
Authors: OSCARSSON A. , FREDRIKSON M. , SÖRLIDEN M. , ANSKÄR S. , GUPTA A. , SWAHN E. , EINTREI C. 
Published: April 2009

Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high‐risk patients undergoing non‐elective surgery.Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included.Troponin I (TnI) was measured pre‐operatively, 12 and 48 h post‐operatively. Pre‐operative N‐terminal fragment of B‐type natriuretic peptide (NT‐proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI >0.06 μg/l and NT‐proBNP >1800 pg/ml, respectively. Post‐operative major adverse cardiac events (MACE), 30‐day and 3‐months mortality were recorded.Results: Elevated TnI levels were detected in 33% of the patients post‐operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P<0.001) and 30‐day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT‐proBNP were seen in 59% of the patients. Elevated NT‐proBNP was an independent predictor of myocardial damage post‐operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1–18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT‐proBNP ≤1800 pg/ml, P<0.001).Conclusion: Myocardial damage is common in a high‐risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post‐operative period and increased concentration of NT‐proBNP before surgery. The combinations of TnI and NT‐proBNP are reliable markers for monitoring patients at risk in the peri‐operative period as well as useful tools in our risk assessment pre‐operatively in emergency surgery.