bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice reaction time in patients with post‐operative cognitive dysfunction*
Authors: STEINMETZ J. , RASMUSSEN L. S. ,   THE ISPOCD GROUP
Published: August 2010

Background: Post‐operative cognitive dysfunction (POCD) is detected by administration of a neuropsychological test battery. Reaction time testing is at present not included as a standard test. Choice reaction time (CRT) data from the first International Study of Post‐operative Cognitive Dysfunction study were collected, but the association between POCD and reaction time has not been presented before. We hypothesized that CRT could be used as a screening tool for POCD.Methods: Patients aged 60 years or older scheduled for major surgery with general anaesthesia were recruited from 13 centres in nine countries. CRT was measured 52 times using the four boxes test. Patients performed the test before surgery (n=1083), at 1 week (n=926) and at 3 months (n=852) post‐operatively. CRT for the individual patient was determined as the median time of correct responses. The usefulness of the CRT as a screening tool for POCD was determined by the receiver–operator characteristic (ROC) curve.Results: Patients with POCD 1 week after surgery had a significantly longer reaction time compared with patients without POCD: 857 (221) vs. 762 (201) ms, respectively (P<0.0001). Also at 3 months, patients with POCD had a significantly longer CRT. ROC curves revealed that a reaction time of 813 ms was the most appropriate cut‐off at 1 week and 762 ms at 3 months but the positive predictive value for POCD was low: 34.4% and 14.7%, respectively.Conclusions: Post‐operative cognitive dysfunction is associated with impaired performance in the CRT test but the test is a poor predictor of POCD.
Bispectral index monitoring: appreciated but does not affect drug dosing and hypnotic levels*
Authors: LINDHOLM M.‐L. , BRUDIN L. , SANDIN R. H. 
Published: August 2010

Background: Bispectral index (BIS) has been associated with benefits from less‐deep anesthesia as well as preventing awareness, albeit not at the same time. We investigated how increasing experience from BIS in clinical practice affect the hypnotic level, drug consumption, as well as subjective opinions on this monitoring.Methods: Eight certified registered nurse anesthetists (CRNAs) with previous experience from 88 (46–121) BIS monitored cases anesthetized 80 cases with concealed BIS, followed by 80 cases with available BIS. Additional education and training was followed by yet another 160 patients randomized to open or blindly recorded BIS. BIS levels, anesthetic gas consumption, fentanyl use, and subjective opinions on utility and reliability were investigated.Results: After gaining initial experience from BIS monitoring, the fraction of time with BIS levels of 40–60 did not deteriorate in cases with concealed monitoring and no further improvement was found in subsequent cases with available data from the BIS monitoring, not even after additional training and encouragement to adhere to the 40–60 interval. Compared with the first experience from BIS monitoring the subjective opinions on utility had increased from 33 to 78 mm (100 mm visual analog scales) (P<0.0001).Conclusion: Although BIS became considerably appreciated, growing experience and repeated education had no impact on drug dosing and BIS levels.
Clinical practice and routines for day surgery in Sweden: results from a nation‐wide survey
Authors: SEGERDAHL M. , WARRÉN‐STOMBERG M. , RAWAL N. , BRATTWALL M. , JAKOBSSON J. 
Published: August 2010

Background: Day surgery has expanded considerably during the last decades. Routines and standards have developed but differ between and within countries.Methods: We studied the practice of day surgery in Sweden by an extensive questionnaire survey sent to all 92 hospitals.Results: The proportion of day surgery vs. in‐hospital procedures was overall 43%, with 43% in adults and 46% in children. Orthopaedic (33%), general (29%) and gynaecological (17%) surgery were the most common ambulatory procedures. Most patients (>90%) underwent pre‐operative assessment by an anaesthesiologist. Patient self‐assessment questionnaires were common (86%). Risk stratification for post‐operative nausea and vomiting was used by 70% of the departments. Anxiolytic pre‐medication was uncommon. Most anaesthesiologists (95%) used pre‐operative oral analgesics to initiate post‐operative analgesia, the most common being paracetamol (95%), NSAIDs (73%) and coxibs (15%). A balanced general anaesthesia technique was preferred. Post‐operatively, 93% of the units routinely assessed patients' pain. Analgesic combinations of paracetamol, NSAIDs and weak opioids were used by 94% of the units. Most hospitals (80%) had standardised discharge criteria based on clinical assessment, and many required a patient escort at home for 24 h post‐operatively. Assessments of unplanned admission, re‐admission and post‐operative complications were not performed routinely. Follow‐up telephone calls within 1–2 days were performed regularly in about 40% of the units, or in selected patients only (37%). Pain was the most frequent complaint on follow‐up.Conclusions: In Sweden, a high degree of standardised regime for day surgical practice was found. Post‐operative pain is the most common complaint after discharge.
Exposure to noise during continuous positive airway pressure: influence of interfaces and delivery systems
Authors: CAVALIERE F. , CONTI G. , COSTA R. , SPINAZZOLA G. , PROIETTI R. , SCIUTO A. , MASIERI S. 
Published: August 2010

Background: We measured noise intensity and perceived noisiness during continuous positive airway pressure (CPAP) performed with two interfaces (face‐mask, helmet) and four delivery systems.Methods: Eight healthy volunteers received CPAP in random order with: two systems provided with a flow generator using the Venturi effect and a mechanical expiratory valve (A: Venturi, Starmed; B: Whisperflow‐2, Caradyne Ltd); one ‘free‐flow’ system provided with high flow O2 and air flowmeters, an inspiratory gas reservoir, and a water valve (C: CF800, Drägerwerk, AG); and a standard mechanical ventilator (Servoventilator 300, Siemens‐Elema). Systems A, B, and C were tested with a face‐mask and a helmet at a CPAP value of 10 cm H2O; the mechanical ventilator was only tested with the face mask. Noise intensity was measured with a sound‐level meter. After each test, participants scored noisiness on a visual analog scale (VAS).Results: The noise levels measured ranged from 57±11 dBA (mechanical ventilator plus mask) to 93±1 and 94±2 dBA (systems A and B plus helmet) and were significantly affected by CPAP systems (A and B noisier than C and D) and interfaces (helmet CPAP noisier than mask CPAP). Subjective evaluation showed that systems A and B plus helmet were perceived as noisier than system C plus mask or helmet.Conclusions: Maximum noise levels observed in this study may potentially cause patient discomfort. Less noisy CPAP systems (not using Venturi effect) and interfaces (facial mask better than helmet) should be preferred, particularly for long or nocturnal treatments.
Prevalence of self‐reported neuropathic pain and impact on quality of life: a prospective representative survey
Authors: GUSTORFF B. , DORNER T. , LIKAR R. , GRISOLD W. , LAWRENCE K. , SCHWARZ F. , RIEDER A. 
Published: August 2010

Background: Data on the incidence of neuropathic pain (NeP) in Austria, its general characteristics and consequences for the quality of life (QOL) are still lacking. The prevalence in the United Kingdom is 8%.Methods: A representative survey (n=7707) was carried out. Patients with NeP were identified using previously validated criteria and subsequently asked to complete a questionnaire on QOL and detailed pain characteristics.Results: The prevalence of NeP was 3.3% (n=260). A higher prevalence was found in 41–50‐year‐olds (26%) and 51–60 year olds (24%). Pain was long lasting (>1 year: 66%; >5 years: 41%) and severe at onset (mean 6.8; numerical rating scale) as well as later (mean 4.7; 20% 8 or higher). Strong or predominant restriction of daily activities was reported in 65%, strong or predominant sleep disturbances in 60%, feelings of depression in 34% and anxiety in 25%.Conclusion: For the first time, data on the prevalence of NeP in Austria are available. Pain patterns in those affected are characteristic and impact on QOL as well as pain intensity are severe.
Detection of carbon dioxide in expired air after oesophageal intubation; the role of bystander mouth‐to‐mouth ventilation
Authors: KRAMER‐JOHANSEN J. , DORPH E. , STEEN P. A. 
Published: August 2010

Background: The identification of a correctly placed tube during anaesthesia routinely depends on the detection of carbon dioxide (CO2) in the expired air.Results: We describe a previously unreported cause of false‐positive prediction in two patients with high initial values of CO2 in expired air after oesophageal intubation. Both patients had received bystander cardiopulmonary resuscitation with mouth‐to‐mouth ventilation, and the CO2 from the rescuers' expired air was trapped and subsequently detected after oesophageal intubation.
Tryptase levels after suxamethonium administration and defibrillation
Authors: STORJORD E. , NIELSEN E. W. 
Published: August 2010

Background: A more than threefold increase in tryptase, when comparing with the control sample, strengthens the diagnosis of anaphylaxis. Trauma, coronary ischaemia and non‐IgE‐mediated reactions to several medications have been shown to cause more than threefold rise in tryptase levels. The aim of our study was to examine whether suxamethonium or defibrillation could lead to a more than threefold increase in tryptase in the absence of signs of anaphylaxis.Methods: S‐tryptase was measured in 50 patients who had general anaesthesia with either pentothal and suxamethonium before electro convulsive therapy (ECT) to treat depression (n=31) or propofol before electro conversion to treat atrial fibrillation (n=19). Blood samples were collected minutes before and 1 h after the procedures.Results: Tryptase values did not differ significantly before and after the procedures.Conclusion: Tryptase levels do not increase in patients undergoing elective defibrillation or ECT with the administration of suxamethonium, in absence of symptoms of anaphylaxis.
Low dose of lidocaine: comparison of 15 with 20 mg/ml with dextrose for spinal anesthesia in lithotomy position and ambulatory surgery
Authors: IMBELLONI L. E. , GOUVEIA M. A. , CORDEIRO J. A. 
Published: August 2010

Background: Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). Although TNS is not associated with either lidocaine concentration or dose, its incidence has never been examined with very small doses of hyperbaric spinal lidocaine in patients in the lithotomy position. We designed this study prospectively to compare the efficacy of low‐dose 15 mg/ml with low‐dose 20 mg/ml hyperbaric lidocaine in patients undergoing elective outpatient surgery in the lithotomy position.Methods: A total of 100 patients were randomized to receive either 30 mg of 15 mg/ml or the same dose of 20 mg/ml hyperbaric lidocaine. Lidocaine density at 37 °C is 1.0241 g/ml for the 15 mg/ml and 1.0260 g/ml for the 20 mg/ml solution. Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48 and 72 h and questioned about their perceptions of pain after the spinal anesthesia with specific questions designed to diagnose TNS.Results: The spread of analgesia was the same with both solutions of lidocaine. Motor block was incomplete in all patients in both groups. TNS were not observed when low doses of both solutions of lidocaine with dextrose were used in these ambulatory patients in the lithotomy position.Conclusion: Hyperbaric lidocaine results in rapid recovery from sensory block and motor blockade. It may have advantages for patients in a day‐case setting. No patients complained of TNS after discharge.
Pulse pressure variation and stroke volume variation during different loading conditions in a paediatric animal model
Authors: RENNER J. , CAVUS E. , MEYBOHM P. , GRUENEWALD M. , STEINFATH M. , SCHOLZ J. , BOENING A. , BEIN B. 
Published: August 2010

Background: Previous studies in adult patients and animal models have demonstrated that pulse pressure variation (PPV) and stroke volume variation (SVV) can be used to predict the response to fluid administration. Currently, little information is available on the performance of these variables in infants and neonates. The aim of our study was to assess whether PPV and SVV can predict fluid responsiveness in an animal model and to investigate the influence of different tidal volumes applied.Methods: PPV and SVV were monitored by pulse contour analysis in 19 anaesthetized and paralysed piglets during ventilation with tidal volumes (VT) of 5, 10 and 15 ml/kg both before and after fluid loading with 25 ml/kg of hydroxy‐ethyl starch 6% (HES). Cardiac output was measured by pulmonary artery thermodilution and a positive response to HES infusion was defined as ≥20% increase in the stroke volume index (SVI).Results: Before HES infusion, PPV and SVV were significantly greater during ventilation with a VT of 10 and 15 ml/kg than during ventilation with a VT of 5 ml/kg (P<0.05). After HES infusion, only ventilation with VT 15 ml/kg resulted in a significant increase in PPV and SVV. As assessed by receiver operating characteristic curve analysis, SVV during ventilation with VT 10 ml/kg was the best predictor of a positive response to fluid loading (AUC=0.87).Conclusions: In this paediatric animal model, we found that SVV during ventilation with 10 ml/kg was a sensitive and specific predictor of the response to fluid loading.
Usefulness of a central venous catheter during hepatic surgery
Authors: STÉPHAN F. , REZAIGUIA‐DELCLAUX S. 
Published: August 2010

Aim: Central venous catheter (CVC) is often inserted during liver resection because a low central venous pressure (CVP) reduces blood loss and the procedure may be associated with circulatory impairment. The aim of the study was to evaluate the usefulness of a CVC besides the measurements of CVP, and whether peripheral venous pressure (PVP) measurement could be used reliably in place of CVP.Methods: We conducted an observational study during a 16‐month period. Number of CVC inserted, expected surgical difficulties, and intraoperative complications which could lead to treatment involving a CVC were prospectively recorded and analysed. Measurements of CVP and PVP were simultaneously obtained at different times during surgery. Bias and limits of agreement with their 95% confidence interval (95% CI) were calculated.Results: Of the 101 patients included, 28 had expected surgical difficulties. Of the 75 CVCs inserted, only six (8%) were used for another purpose that CVP measurement in patients with expected surgical difficulties. A total of 124 measurements in 23 patients were recorded. Mean CVP was 4.8 ± 2.9 mmHg and mean PVP was 6.9 ± 3.1 mmHg (P<0.0001). The bias was −2.1 ± 1.1 mmHg (95% CI: −2.3 to −1.9). When adjusted by the average bias of −2 mmHg, PVP predicted a CVP≤5 mmHg with a sensitivity and a specificity of 93% and 87%, respectively.Conclusion: Routine insertion of a CVC should be discussed in patients without expected surgical difficulties. Thus, PVP monitoring may suffice to estimate CVP in uncomplicated cases.
Infusion of albumin attenuates changes in serum protein binding of drugs in surgical patients compared with volume replacement with HAES
Authors: REINE P. A. , KONGSGAARD U. E. , ANDERSEN A. , THØGERSEN A.‐K. , OLSEN H. 
Published: August 2010

Background:In vitrostudies have indicated that stabilizers present in pharmaceutical‐grade albumin influence albumin‐binding capacity for highly protein bound drugs.Methods:A randomized study including 40 surgical patients, treated with either albumin or starch solutions, was performed. Volumes of colloids were given based on clinical indication. Blood samples were obtained. The serum samples were analyzed to determine the concentrations of albumin, tryptophan,N‐acetyl‐dl‐tryptophan, caprylate and α‐1‐acid glycoprotein as well asin vitrodrug binding of naproxen, warfarin and digitoxin.Results:During surgery, the albumin concentration declined in the Starch group from 26.8 to 15.3 g/l. It remained unchanged in the Albumin group (29.2 g/l). The two groups were analyzed with the pre‐operative sample acting as the control. In the starch group, the percent free concentration of the drugs increased significantly (P<0.01): for naproxen from 0.2% to 0.6%, for warfarin from 1.2% to 1.8% and for digitoxin from 6.8% to 11.1%. In the Albumin group, the % free fraction of naproxen doubled from 0.1% to 0.2% (P<0.05), whereas the % free fraction of warfarin decreased from 1.1% to 1.0% (P<0.05). The free fraction of digitoxin remained unchanged.Conclusions:Infusion of albumin during surgery resulted in maintained albumin values and almost maintained binding parameters for the study drugs, although some statistically significant changes were found. The use of starch solutions, however, led to in a reduction in albumin values and a significant reduction in binding parameters.
Laparoscopic colon surgery: unreliability of end‐tidal CO2 monitoring
Authors: KLOPFENSTEIN C. E. , SCHIFFER E. , PASTOR C. M. , BEAUSSIER M. , FRANCIS K. , SORAVIA C. , HERRMANN F. R. 
Published: August 2010

Background: The relatively good haemodynamic and respiratory tolerance to abdominal CO2 insufflation has mostly been observed in healthy patients during short‐lasting laparoscopic procedures. End‐tidal CO2 pressure (PetCO2) has been shown to be a reliable method to assess arterial CO2 (PaCO2) in the absence of cardio‐respiratory disease in this setting. However, no study has investigated whether PetCO2 is accurately related to PaCO2 during laparoscopic colon surgery. Indeed, these procedures last longer, prolonging the pneumoperitoneum and requiring a Trendelenburg position. The aim of the present study was to measure the PaCO2–PetCO2 difference over time in patients undergoing laparoscopic colon surgery and to determine whether PaCO2 is reliably assessed by PetCO2.Methods: Forty consecutive patients (ASA I and II) scheduled for laparoscopic colon surgery were anaesthetized and ventilated to obtain a PetCO2 between 4.0 and 5.5 kPa. After initiation of CO2 insufflation, PaCO2 and PetCO2 were recorded every 30 min during surgery.Results: No complication was observed during anaesthesia. The mean arterial pressure increased significantly after CO2 insufflation and remained steady up to the end of pneumoperitoneum. The heart rate remained stable over time. The relation between PaCO2 and PetCO2 was not constant among patients and increased over time within the same patients. The R2 values fluctuated and did not show a constant correlation between PaCO2 and PetCO2.Conclusion: The correlation between PaCO2 and PetCO2 during laparoscopic colon surgery is inconsistent mainly due to inter‐ and intra‐individual variability.
Effects of pain stimulation on bispectral index, heart rate and blood pressure at different minimal alveolar concentration values of sevoflurane
Authors: SANDIN M. , THÖRN S.‐E. , DAHLQVIST A. , WATTWIL L. , AXELSSON K. , WATTWIL M. 
Published: August 2010

Background: The aim of the present study was to examine the level of unconsciousness measured with bispectral index (BIS) at different minimal alveolar concentration (MAC) levels of sevoflurane, and to study the hemodynamic and BIS reactions during noxious stimulation with transcutaneous electrical nerve stimulation (TENS) and an ice water pain test (IWP).Methods: This study was approved by the Ethics Committee and was performed on 10 healthy, young volunteers (six males and four females), ASA physical status I. Anesthesia was induced and maintained with sevoflurane in an oxygen/air mixture. The volunteers were spontaneously breathing, but if necessary, ventilation was mechanically supported. TENS and IWP were performed at 1.0, 1.5 and 2.0 MAC of sevoflurane.Results: At 1.0 MAC, there was a significant increase in BIS during pain stimulation both with IWP (P<0.03) and with TENS (P<0.005), but at 1.5 MAC there were no changes. A marked variation in BIS was seen at 2.0 MAC, with periods of burst suppression and periods of high BIS values despite clinical signs of deep anesthesia. These marked variations in BIS were seen before, during and after pain stimulation. One volunteer (# 8) had a short episode of convulsions at 2.0 MAC.Conclusion: BIS, heart rate and blood pressure increased during pain stimulation at 1.0 MAC but not at 1.5 MAC of sevoflurane. There was a remarkable variation in BIS at 2.0 MAC of sevoflurane, with BIS values indicating wakefulness despite clinical signs of deep anesthesia. This BIS variation is probably caused by epileptogenic activity due to sevoflurane.
Effects of the cannabinoid antagonist AM281 on systemic hemodynamics and mortality rate in streptozotocin‐induced diabetic rats with endotoxic shock: comparison between non‐diabetic and diabetic rats
Authors: KADOI Y. , HINOHARA H. , KUNIMOTO F. , SAITO S. 
Published: August 2010

Purpose:On the basis of previous findings that the anandamide antagonist AM281, an endogenous cannabinoid receptor antagonist, could restore the hemodynamic and cerebral blood flow changes and improve the mortality rate in non‐diabetic rats during sepsis, this study was conducted to examine whether AM281 could restore the hemodynamic variables and improve the mortality rate in streptozotocin‐induced diabetic rats during sepsis.Methods:The study was designed to include three sets of experiments, each set of experiment being conducted in both diabetic and non‐diabetic animals: (1) measurement of changes in systemic hemodynamics and carotid artery blood flow, (2) measurement of biochemical variables and (3) assessment of mortality rate. Systemic hemodynamics, carotid artery blood flow changes and biochemical variables were assessed at pre‐treatment and 1, 2 and 3 h after the treatment was performed.Results:In both non‐diabetic and diabetic rats, administration of lipopolysaccharide (LPS) induced a reduction in hemodynamic variables, these reductions being greater in diabetic than in non‐diabetic rats. In diabetic rats, administration of AM281 could only partially prevent these hemodynamic changes, these changes being insufficient to elevate these variables to control values. Significant differences were observed in mortality rates at 6 and 12 h between non‐diabetic and diabetic groups with the same treatment. At 12 h, only non‐diabetic AM281 group rats were still alive (mortality rate 50%).Conclusion:Administration of AM281 only partially prevented the hemodynamic, biochemical and carotid artery blood flow changes associated with LPS‐induced septicemia in diabetic rats, as compared with non‐diabetic rats in whom these changes were prevented to a greater extent.