bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrathecal low‐dose hyperbaric bupivacaine–clonidine combination in outpatient knee arthroscopy: a randomized controlled trial
Authors: VAN TUIJL I. , GIEZEMAN M. J. M. M. , BRAITHWAITE S. A. , HENNIS P. J. , KALKMAN C. J. , VAN KLEI W. A. 
Published: August 2010

Background: Spinal anesthesia for knee arthroscopy can be produced with a low dose of bupivacaine, but additional intrathecal drugs are often required to lower the risk of failed blocks. We investigated the effect of the addition of clonidine (0, 15 or 30 μg) to 5 mg hyperbaric bupivacaine on the duration of the motor block, analgesic quality and ability to void after the surgery in a randomized controlled trial.Methods: Seventy‐five patients received spinal anesthesia using either 5 mg hyperbaric bupivacaine (B5C0), 5 mg hyperbaric bupivacaine with 15 μg clonidine (B5C15) or 5 mg hyperbaric bupivacaine with 30 μg clonidine (B5C30). The primary outcome was the duration of the motor block. Secondary outcomes included the time until spontaneous voiding, and the need for additional analgesia or general anesthesia.Results: The mean time to complete regression of motor block was 70 (±43) min in group B5C0. Adding 15 and 30 μg of clonidine increased the motor block duration by 25 [95% confidence interval (CI): 2–48] and 34 (95% CI: 11–57) min, respectively, but resulted in better analgesic quality. The mean time until spontaneous voiding was 177 min in the B5C0 group. This time increased with 18 (95% CI −13 to 49) and 44 (95% CI 15–74) min in group B5C15 and group B5C30, respectively.Conclusion: The addition of 15 μg clonidine to 5 mg of intrathecal hyperbaric bupivacaine prolongs the duration of motor block and improves the quality of the block.
Fluoroscopic guidance of Arndt endobronchial blocker placement for single‐lung ventilation in small children
Authors: MARCINIAK B. , FAYOUX P. , HÉBRARD A. , ENGELHARDT T. , WEINACHTER C. , HORBER R. K. 
Published: August 2010

Background: Thoracoscopic surgery may require single‐lung ventilation (SLV) in infants and small children. A variety of balloon‐tipped endobronchial blockers exist but the placement is technically challenging if the size of the tracheal tube does not allow the simultaneous passage of the fibreoptic scope and the endobronchial blocker. This report describes a technique for endobronchial blocker insertion using fluoroscopic guidance in children undergoing SLV.Methods: After approval from the local Medical Ethics Committee and parental consent, 18 patients aged 2 years or younger scheduled for thoracic surgery requiring SLV were prospectively included. Following induction of anesthesia, a 5 Fr endobronchial blocker (Cook® Arndt endobronchial blocker) was inserted first into the trachea under direct laryngoscopy. Correct placement in the main bronchus was assessed by fluoroscopy and tracheal intubation next to the endobronchial blocker. Optimal position and balloon inflation was verified using a fibreoptic scope. The duration and number of insertion attempts as well as age, weight and size of the tracheal tube were recorded.Results: Eighteen patients were studied. Median (range) age and weight were 12 (0.2–24) months and 11.2 (4–15) kg, respectively. SLV was successfully achieved in all patients using a 5 Fr endobronchial blocker outside a 3.5–4.5 mm ID tracheal tube within 11.2 (±2.2) min. No side effects were observed during the procedure.Conclusion: Fluoroscopic‐guided insertion of extraluminal endobronchial blocker is an effective and reliable tool to place Arndt endobronchial blockers in small children.
Isoflurane attenuates myoglobin release during ischemic and/or reperfusion periods
Authors: KITAGAWA H. , YAMAZAKI T. , AKIYAMA T. , NOSAKA S. , MORI H. 
Published: August 2010

Background: Recently, we have developed cardiac microdialysis for detection of protein leakage from the injured myocardium. We examined whether the exposures to isoflurane would exert a beneficial effect on myocardial injury caused by ischemia or reperfusion.Methods: A dialysis probe was implanted into the left ventricle free wall in the rabbits. The dialysate myoglobin level served as an index of myocardial interstitial myoglobin levels. Rabbits were randomly assigned to one of three groups: (1) without exposure to isoflurane (vehicle, n=6), (2) inhale 1 MAC isoflurane once for 30 min (ISO30‐1, n=6), and (3) twice for 30 min (ISO30‐2, n=6). All rabbits underwent 30 min of coronary occlusion and 60 min of reperfusion. To determine whether the isoflurane induced myocardial protection against chemical hypoxia, sodium cyanide (30 mM) was administered and dialysate myoglobin levels were measured with (n=6) and without pre‐exposure to isoflurane twice for 30 min (n=6).Results: In all three groups dialysate myoglobin levels were increased by coronary occlusion and furthermore augmented by reperfusion. In comparison with the vehicle group, the ISO30‐1 group suppressed only the increase in the dialysate myoglobin level during reperfusion. The ISO30‐2 group suppressed during both the ischemic and reperfusion periods. Cyanide induced increases in dialysate myoglobin levels. These increments in dialysate myoglobin levels were suppressed by repeated exposure to isoflurane.Conclusion: Repeated exposure to isoflurane suppressed myocardial myoglobin release caused by both ischemia and reperfusion injury. Isoflurane may provide protection against myocardial ischemia/reperfusion and hypoxic injuries.
Insulin alters cytokine content in two pivotal organs after brain death: a porcine model
Authors: BARKLIN A. , LARSSON A. , VESTERGAARD C. , KJAERGAARD A. , WOGENSEN L. , SCHMITZ O. , TØNNESEN E. 
Published: August 2010

Background:To optimize the quantity and quality of organs available for transplantation, it is crucial to gain further insight into the treatment of brain dead organ donors. In the current study we hypothesized that insulin treatment after brain death alters cytokine content in the heart, liver, and kidney.Methods:Sixteen brain dead pigs (35–40 kg) were treated with either (1) no insulin [brain dead without insulin treatment treatment (BD)], or (2) insulin infusion intravenously (i.v.) at a constant rate of 0.6 mU/kg/min during 360 min [brain dead with insulin treatment (BD+I)]. Blood glucose was clamped at 4.5 mmol/l by infusion of 20% glucose. Blood samples for insulin, glucose, catecholamines, free fatty acids, and glucagon were obtained during the experimental period. Six hours after brain death biopsies were taken from the heart, liver, and kidney. These were analyzed for cytokine mRNA and proteins [tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐6, and IL‐10].Results:The BD+I compared with the BD animals had lower IL‐6 concentrations in the right ventricle of the heart (P=0.001), in the renal cortex (P=0.04) and in the renal medulla (P=0.05), and lower IL‐6 mRNA in the renal medulla (P=0.0002). Furthermore, the BD+I animals had lower concentrations in the renal medulla of IL‐10 (P=0.01), and tended to have lower TNF‐α in the renal cortex (P=0.06) than the BD animals. In the right ventricle of the heart TNF‐α mRNA and IL‐10 mRNA were higher in the BD+I than in the BD group (P=0.002 and 0.004).Conclusion:Insulin has anti‐inflammatory effects on cytokine concentration in the heart and kidney after brain death.
A controlled comparison between single doses of intravenous and intramuscular morphine with respect to analgesic effects and patient safety
Authors: TVEITA T. , THONER J. , KLEPSTAD P. , DALE O. , JYSTAD Å. , BORCHGREVINK P. C. 
Published: August 2010

Background and aim of investigation:Intramuscular (IM) administration has been considered to be safer than intravenous (IV) for opioids on wards, but a comparative knowledge of patient safety and analgesic potency following a single dose of IV and IM administration is lacking. This study was carried out to compare patient safety and analgesic efficacy of a single and high dose of morphine given IM or IV for post‐operative pain management.Materials and methods:Thirty‐eight patients with post‐operative pain following hip replacement surgery were given IM or IV morphine 10 mg at a specified pain level. The study was randomized and double blinded. Time to onset of analgesic effect (11‐point numeric rating scale), respiratory function (paCO2, paO2, and respiratory rate), level of sedation (5‐point verbal rating scale), and hemodynamic function were recorded.Results:In the IV group there was a slight but significant increase in paCO2after 5, 10, and 15 min compared with the IM group (5.2 vs. 4.8, 5.4, vs. 5.0 and 5.5 vs. 5.1 kPa, respectively). The IV group had a significantly faster onset of analgesic effect than the IM group (5 vs. 20 min). Between 5 and 25 min after morphine administration, pain status in the IV group was significantly improved compared with the IM group. Patients in the IV group were slightly more sedated than the IM group 5 and 10 min after morphine.Conclusion:A 10 mg bolus dose of IV morphine given to patients with moderate pain after surgery does not cause severe respiratory depression, but provides more rapid and better initial analgesia than 10 mg given IM. IV morphine even at a dose as high as 10 mg IV is well tolerated if there is a certain level of pain at its administration. The safety of IV morphine on the general ward needs to be further explored in adequately controlled studies.
Erythropoietin measurements in severely traumatized patients
Authors: VIALET R. , VENTRÉ C. , LEONE M. , CONFORTO C. , MARTIN C. 
Published: August 2010

Background:Despite numerous studies in critically ill patients, physiological adaptation to acute anaemia and the pattern of erythropoietin (EPO) secretion has not been well described in severely injured patients. The aim of this study was to describe EPO secretion and its relationship with haemoglobin (Hb) levels in severely injured patients.Methods:We performed an observational, prospective clinical study in our intensive care unit (ICU). For all patients with severe trauma (Injury Severity Score>15), EPO measurement was obtained on admission, during the first 3 days and then when Hb level was measured. Maximal EPO level (EPOmax) and minimal Hb level (Hbmin) during the ICU stay was determined for all patients.Results:One hundred and seventy‐one consecutives patients were included (440 EPO measurements). Seventy‐nine patients (46.2%) showed an increased value (≥25 UI/l) EPOmax value. Most EPOmax values were observed early after the trauma [within 4 days for 63 patients (82.8%)].Plotting EPOmax to Hbmin values show that a threshold Hbmin value of 105 g/l best discriminated patients with and without an elevated EPO secretion. Less than 10% of the patients with Hbmin<105 g/l did not increase their EPO secretion.Conclusion:In severely traumatized patients a marked response to acute anaemia is observed in most patients. In our study, Hb threshold for a significant EPO secretion following post‐traumatic acute anaemia was 105 g/l. The peak level was achieved early in the course of the anaemia.
Influence of acute normovolaemic haemodilution on bispectral index monitoring and propofol dose requirements
Authors: DAHABA A. A. , RINNHOFER S. , WANG G. , XU X. , LIU X. Y. , WU X. M. , REHAK P. H. , METZLER H. 
Published: August 2010

Background: Numerous medical and physiological conditions that might alter electroencephalography (EEG), such as hypoglycaemia, hypothermia or hypovolaemia, were shown to result in the bispectral Index (BIS) indicating an incorrect hypnotic state. Recently, acute normovolaemic haemodilution (ANH) was shown to be associated with significant impairment of cognitive functions that could alter EEG and consequently BIS monitoring, an EEG derived parameter.Methods: In a randomised clinical study, we assessed the effect of ANH on BIS monitoring before induction and after propofol target controlled infusion (TCI) anaesthesia in 45 unmedicated patients randomly allocated to ANH with oxygen insufflation (oxygen group), ANH with air insufflation (air group), or control group.Results: With ANH, mean BIS values briefly declined in the oxygen group (82±4) and air group (84±3) before returning to baseline values. The loss of consciousness time was significantly shorter, with fewer propofol TCI dose requirements, and BIS was significantly higher in the oxygen group (1.3±0.5 min, 2.41±0.15 μg/ml, 73±7) and air group (1.2±0.6 min, 2.44±0.17 μg/ml, 75±5), compared with the control group (1.7±0.4 min, 2.75±0.17 μg/ml, 61±5), respectively. Whereas, there was no significant difference in BIS values between the oxygen group (38±7), air group (36±5) and control group (40±6) at propofol TCI 4 μg/ml anaesthesia maintenance.Conclusions: BIS values briefly declined with ANH before returning to baseline values before anaesthesia induction. Despite transient ANH enhancement of propofol effect during induction, there was no significant difference in BIS values with or without ANH during propofol maintenance of anaesthesia.
Process of foregoing life‐sustaining treatment: a survey among Scandinavian intensivists
Authors: Hynninen M. , Klepstad P. , Petersson J. , Skram U. , Tallgren M. 
Published: August 2010

Background: How ethical issues are dealt with varies considerably depending on the geographic and religious background of individuals. The views of Scandinavian physicians on end‐of‐life care were studied using a survey. The aim of this study was to clarify the actual processes of foregoing life‐sustaining treatment in Scandinavia.Methods:A questionnaire was developed and sent to 78 intensive care physicians working in Denmark, Finland, Norway and Sweden.Results: Forty‐four responses were obtained (13 from Denmark, eight from Finland, 12 from Norway and 11 from Sweden); 89% of the respondents were from University Hospitals. Withholding and withdrawing of treatment were practiced in all intensive care units (ICUs) concerned, but written guidelines on end‐of‐life care existed in only one ICU. End‐of‐life care is usually arranged in the ICU. Religious support is available in most hospitals during office hours, but lacking in 26% of ICUs outside office hours. Vasoactive medication, renal replacement therapy, and artificial nutrition are among the therapies most likely to be discontinued during withdrawal of life support. Certain types of monitoring and organ support are still continued in many centers during end‐of‐life care.Conclusion: Local written guidelines on end‐of‐life care are scarce in Scandinavian ICUs, which may explain the observed variability in the practices. Development of guidelines and monitoring how these instructions are carried out may help to improve the quality of care of dying ICU patients.
Increased plasma glutamate, glycine, and arginine levels in complex regional pain syndrome type 1
Authors: WESSELDIJK F. , FEKKES D. , HUYGEN F. J. P. M. , VAN DE HEIDE‐MULDER M. , ZIJLSTRA F. J. 
Published: August 2010

Background: Various inflammatory mediators have been identified as potential contributors to complex regional pain syndrome type 1 (CRPS1), but these mediators do not entirely explain certain manifestations of the syndrome, such as pain. The objective of this study was to investigate the role of amino acids in the pathogenesis of CRPS1.Methods: We used HPLC to determine plasma concentrations of 16 amino acids, especially those related to the NMDA receptor (e.g., glutamate and glycine) and nitric oxide (NO) synthesis (e.g., arginine and citrulline) in patients with CRPS1 (n=64) and age‐ and sex‐matched healthy controls (n=51). Patients rated pain intensity (visual analog scale) and the subjective experience of pain intensity (McGill Pain Questionnaire). Psychological dysfunction was assessed using the SCL‐90.Results: Relative to controls, in CRPS1 patients, plasma levels of glutamate, arginine, taurine, and glycine were increased, and plasma levels of glutamine and the ratio of citrulline to arginine were decreased. Remarkably, in CRPS1 patients there was a highly significant inverse correlation between glutamine and glutamate, although the sum of molar concentrations of glutamate and glutamine remains unchanged. Subjective measures of pain and indicators of psychoneuroticism and emotional instability did not correlate with amino acid levels.Conclusion: This study shows for the first time a pronounced increase in amino acid levels in this chronic pain syndrome. The marked differences in glutamate, glutamine, glycine, taurine and arginine levels between patients and controls suggest the involvement of both the NDMA receptor and the endothelium‐dependent arginine‐NO system in CRPS1.
Physiological effects of a lung‐recruiting strategy applied during one‐lung ventilation
Authors: CINNELLA G. , GRASSO S. , NATALE C. , SOLLITTO F. , CACCIAPAGLIA M. , ANGIOLILLO M. , PAVONE G. , MIRABELLA L. , DAMBROSIO M. 
Published: August 2010

Background: One‐lung ventilation (OLV) affects respiratory mechanics and ventilation/perfusion matching, reducing functional residual capacity of the ventilated lung. While the application of a lung‐recruiting manoeuvre (RM) on the ventilated lung has been shown to improve oxygenation, data regarding the impact of RM on respiratory mechanics are not available.Methods: Thirteen patients undergoing lung resection in lateral decubitus were studied. During OLV, a lung‐recruiting strategy consisting in a RM lasting 1 min followed by the application of positive end‐expiratory pressure 5 cmH2O was applied to the ventilated lung. Haemodynamics, gas exchange and respiratory mechanics parameters were recorded on two‐lung ventilation (TLVbaseline), OLV before and 20 min after the RM (OLVpre‐RM, OLVpost‐RM, respectively) and TLVend. Haemodynamics parameters were also recorded during the RM.Results: The PaO2/FiO2 ratio was 358±126 on TLVbaseline; it decreased to 235±113 on OLVpre‐RM (P<0.01) increased to 351±120 on OLVpost‐RM (P<0.01 vs. OLVpre‐RM), and remain stable thereafter. During the RM, CI decreased from 3.04±0.7 l/m2 OLVpre‐RM to 2.4±0.6 l/m2 (P<0.05), and returned to baseline on OLVpost‐RM (3.1±0.7 l/m2, NS vs. OLVpre‐RM). The RM resulted in alveolar recruitment and caused a significant decrease in static elastance of the dependent lung (16.6±8.9 cmH2O/ml OLVpost‐RM vs. 22.3±8.1 cmH2O/ml OLVpre‐RM) (P<0.01).Conclusions: During OLV in lateral decubitus for thoracic surgery, application to the dependent lung a recruiting strategy significantly recruits the dependent lung, improving arterial oxygenation and respiratory mechanics until the end of surgery. However, the transient haemodynamic derangement occurring during the RM should be taken into account.
Comparison of nerve stimulation vs. ultrasound‐guided lateral sagittal infraclavicular block
Authors: GÜRKAN Y. , ACAR S. , SOLAK M. , TOKER K. 
Published: August 2010

Background: A nerve stimulation‐guided lateral sagittal infraclavicular block (LSIB) has been proven to be an effective block. The purpose of this study was to evaluate whether the use of ultrasound (US) guidance would further improve the block quality of LSIB.Methods: In a prospective manner, 80 adult patients scheduled for hand, wrist and forearm surgery were randomly allocated to US or nerve stimulation (NS) groups. A needle was inserted into a sagittal plane, 20° dorsally, until muscle twitches were observed in synchrony with the stimulation. In the US group, the block was performed using the same puncture site but under ultrasonic guidance. The final position of the needle was verified with the use of a nerve stimulator. A local anesthetic mixture of 20 ml of levobupivacaine, 5 mg/ml and 20 ml of lidocaine and 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups.Results: The block was successful in 37 patients in the NS group and 38 patients in the US group. Block efficacy was better in the US group than the group NS in radial nerve distribution at 20 min (P<0.05). In the US group, there was a slight tendency toward better block density in other nerve areas also but these differences were not significant. Vascular puncture was noted in three patients in the NS group and none in the US group.Conclusions: The block success rate was high and comparable in both groups. There was a trend toward improved block quality in the US group, although not significant.
Apolipoprotein E polymorphism and gender difference in outcome after severe traumatic brain injury
Authors: ÖST M. , NYLÉN K. , CSAJBOK L. , BLENNOW K. , ROSENGREN L. , NELLGÅRD B. 
Published: August 2010

Background: Traumatic brain injury (TBI) is one of the most common causes of death and dismal outcome among children and young adults. The morbidity and mortality differ but more aggressive monitoring and more designated neuro intensive care units have improved the results. Studies have demonstrated a connection between apolipoprotein E (APOE) genotype and outcome after TBI, but few are prospective and none is from northern Europe. APOE has three alleles: ɛ2, ɛ3 and ɛ4.Methods: A total of 96 patients with Glasgow coma score (GCS) ≤8 were prospectively and consecutively included. APOE genotypes were all analyzed at the same laboratory from blood samples by polymerase chain reaction‐restriction fragment length polymorphism.Results: All patients were assessed at 1 year with Glasgow outcome scale extended (GOSE), National Institute of Health Stroke Scale (NIHSS) and the Barthel daily living index. The genotype was available in all patients. Twenty‐six patients expressed APOE ɛ4 while 70 patients did not. Outcome demonstrated that patients with APOE ɛ4 had worse outcome vs. those lacking this allele. When subdividing patients into gender, males with APOE ɛ4 did worse, a difference not detected among female patients.Conclusions: APOE ɛ4 correlated to worse outcome in TBI patients. We also found that males with APOE ɛ4 had poor outcome while females did not. Thus, the results indicate that genetic polymorphism may influence outcome after TBI.
Cardiac surgery patients present considerable variation in pre‐operative hemodynamic variables
Authors: SLOTH E. , LINDSKOV C. , LORENTZEN A.‐G. , NYGAARD M. , KURE H. H. , JAKOBSEN C.‐J. 
Published: August 2010

Background: It is essential to control hemodynamics in cardiac surgery. Patients are often monitored extensively in order to optimize hemodynamic performance. However, pre‐operative values are normally unknown. Furthermore, hemodynamic goals may seem arbitrary and the lack of an evidence‐based consensus may lead to both under‐ and over‐treatment. The aim of this study was to evaluate the variables most commonly used for hemodynamic guidance in the post‐operative period.Methods: Ten patients scheduled for elective cardiac surgery were followed with invasive hemodynamic monitoring the night before surgery. All data were recorded automatically and electronically.Results: We found considerable inter‐patient differences and intra‐patient variation. The greatest intra‐patient variation was found in the cardiac index (CI), ranging from 1.9 to 5.3 l/min/m2. Four patients had periodic CI <2.4 l/min/m2. Eight patients showed SpO2 values ≤92, four of them in more than 15% of the observations. Six patients had an SvO2 <70% in more than 40% of the observations and two an SvO2<64% in more than 20% of the observations.Conclusions: This study is unique because hemodynamic reference data in cardiac surgery patients have not been published previously. The intra‐patient variations were unexpectedly high in most hemodynamic variables and demonstrate the difficulties of using hemodynamic parameters as a guidance for treatment and indicate that goal‐oriented therapy using currently accepted values may result in over‐treatment in some patients.