bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: a manikin study
Authors: Miki T , Inagawa G. , Kikuchi T. , Koyama Y. , Goto T. 
Published: August 2010

Background and aim:  The Airway Scope (AWS) is a new video laryngoscope. The purpose of this study was to compare the AWS and Macintosh laryngoscopes with regard to their usefulness for beginners in tracheal intubation.Methods:  Thirty‐one nurses with no previous experience of tracheal intubation used each device 10 times to intubate the trachea of a manikin (Laerdal Airway Managemant Trainer, Laerdal, Stavanger, Norway). Intubation correctly completed within 30 s was regarded as successful. The intubation time, success rate, number of esophageal intubations and dental clicks, and subjective evaluation of difficulty of intubation [rated from 1 (extremely easy) to 5 (extremely difficult)] were recorded.Results:  The average intubation time was significantly shorter for AWS than for the Macintosh laryngoscope (16.7 ± 11.0 s vs. 23.2 ± 24.9 s; mean ± standard deviation; P = 0.0297), and the success rate with AWS was significantly greater (91.3% vs. 79.4%; P < 0.001). In the total of 310 intubation attempts for each device, the number of esophageal intubations (0/310 with AWS vs. 20/310 with the Macintosh laryngoscope) and dental clicks (0/310 with AWS vs. 40/310 with the Macintosh laryngoscope) differed significantly (P < 0.001). AWS was rated as easier to use than the Macintosh laryngoscope (P < 0.001).Conclusion:  AWS is more useful for beginners as it provides quicker and easier tracheal intubation.
Medical futility in asystolic out‐of‐hospital cardiac arrest
Authors: VÄYRYNEN T. , KUISMA M. , MÄÄTTÄ T. , BOYD J. 
Published: August 2010

Objectives: To study the factors associated with short‐ and long‐term survival after asystolic out‐of‐hospital cardiac arrest, with a reference to medical futility.Methods: This is a retrospective observational study conducted in Helsinki, Finland during 1 January 1997 to 31 December 2005. All out‐of‐hospital cardiac arrests were prospectively registered in the cardiac arrest database. Of 3291 arrests, 1455 had asystole as the first registered rhythm. These patients represent the study population.Results: A short time interval to the initiation of advanced life support (ALS) was associated with a long‐term benefit, but a short first responding unit (FRU) response time had only a short‐term benefit. Conversion of asystole into a shockable rhythm provided only a short‐term benefit. The prognosis was poor if the FRU response time was over 10 min or the ALS response time was over 11 min in bystander‐witnessed arrests, and if the duration of resuscitation was over 8 min in emergency medical services (EMS)‐witnessed arrests. Bystander‐CPR was associated with increased 30‐day mortality. The 30‐day survival rate after an unwitnessed arrest (n=548) was 0.5%. All survivors in this group were either hypothermic or were victims of near‐drowning.Conclusions: Resuscitation should be withheld in cases of unwitnessed asystole, excluding cases of hypothermia and near‐drowning. The prognosis is poor if the FRU response time is over 10 min or the ALS response time is over 10–15 min in bystander‐witnessed arrests. The decision of whether or not to attempt resuscitation should not be influenced by the presence of bystander‐CPR. Early initiation of ALS should be prioritised in the treatment of out‐of‐hospital asystole.
Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients
Authors: BURGOS E. , GÓMEZ‐ARNAU J. I. , DÍEZ R. , MUÑOZ L. , FERNÁNDEZ‐GUISASOLA J. , GARCIA DEL VALLE S. 
Published: August 2010

Background:Hip fracture surgery is associated with high post‐operative mortality and poor functional results: the excess mortality is 20% in the first year; of those patients who survive, only 50% recover their previous ability to walk. The purpose of this study was to assess the predictive value of six functional status and/or surgical risk scoring systems with regard to serious complications after hip fracture surgery in the elderly.Methods:We performed a prospective study of a consecutive series of 232 patients (aged 65 years or older) undergoing hip fracture surgery. We pre‐operatively applied: The American Society of Anesthesiologists classification, the Barthel index, the Goldman index, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system, the Charlson index and the Visual Analogue Scale for Risk (RISK‐VAS) scale. These scales were evaluated with respect to three variables: incidence of serious complications, the ability to walk after a 3‐month period and 90‐day survival. The predictive value of the different scales was assessed by the calculated area under a receiver operating characteristic curve.Results:The RISK‐VAS scale, the POSSUM scoring system and the Charlson index reached a sufficient predictive value with regard to serious post‐operative complications. The Barthel index and the RISK‐VAS scale were those most useful for predicting ambulation at 3 months. None of the scales proved to be capable of predicting 90‐day mortality.Conclusions:A simple index such as the RISK‐VAS scale was the best predictor of serious post‐operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.
Lidocaine abolishes the myocardial protective effect of sevoflurane post‐conditioning
Authors: YAN M. , CHEN C. , ZHANG F. , CHEN G. 
Published: August 2010

Background: Post‐ischemic administration of volatile anesthetics activates ischemia–reperfusion injury salvage process and decreases myocardial damage. However, the mechanisms underlying anesthetic post‐conditioning and effects of lidocaine on it remain unclear. Here we report the cardioprotection of sevoflurane‐induced post‐conditioning and the effects of lidocaine on it.Methods: Isolated perfused rat hearts were exposed to 40 min of ischemia followed by 1 h of reperfusion. Volatile anesthetic post‐conditioning was induced by 15 min of 3 vol% sevourane (1.5 minimum alveolar concentration) administered at the onset of reperfusion. In some experiments, lidocaine was coadministered with sevoflurane in different concentrations (2, 10 and 20 μg/ml). Infarct size was determined by dividing the total necrotic area of the left ventricle by the total left ventricular slice area (percent necrotic area).Results: Sevoflurane‐induced post‐conditioning signicantly improved post‐ischemia functional recovery and decreased infarct size (47.3±5.6% in unprotected hearts vs. 18.6±3.1% in anesthetic post‐conditioning, P<0.05). Sevourane‐mediated cardioprotection was abolished by 20 μg/ml lidocaine.Conclusions: Sevourane‐induced post‐conditioning effectively protected myocardium against reperfusion damage and its cytoprotection was reversed by 20 μg/ml lidocaine.
Echocardiographic features, mortality, and adrenal function in patients with cirrhosis and septic shock
Authors: THIERRY S. , GIROUX LEPRIEUR E. , LECUYER L. , BROCAS E. , VAN DE LOUW A. 
Published: August 2010

Objectives: Cirrhosis of the liver is associated with an increased susceptibility to bacterial infections capable of causing septic shock and with a basal hyperdynamic circulatory state. The primary objective of this study was to delineate the echocardiographic characteristics and outcomes of septic shock in patients with liver cirrhosis. The secondary objective was to determine whether adrenal insufficiency, which may contribute to hyperdynamic syndrome, was more marked in patients with cirrhosis than in other patients with septic shock.Design: Prospective single‐center cohort study.Patients and methods: Thirty‐four patients admitted to the intensive care unit (ICU) for septic shocks were included, 14 with and 20 without liver cirrhosis. Echocardiography was performed within the first 24 h to measure the cardiac index (CI), systolic index (SI), and left ventricular ejection fraction (LVEF). A Synacthen test was performed.Results: Patients with cirrhosis had higher values for the CI (3.69±1.0 vs. 2.86±0.8 l/min/m2; P=0.02), SI (37.5±8 vs. 32.4±7 ml/m2; P=0.04), and LVEF (67±7 vs. 55.9±12%; P=0.005). ICU mortality was 53% overall, 64% in patients with cirrhosis, and 45% in patients without cirrhosis (P=0.27). Serum cortisol levels under basal conditions (H0) and after stimulation (H1) showed no significant differences between patients with and without cirrhosis. The proportion of patients with no response to Synacthen was 77% among patients with cirrhosis and 50% among patients without cirrhosis (P=0.18).Conclusion: In a population with septic shock, left ventricular function was more hyperdynamic in the subset with cirrhosis. Relative adrenal insufficiency occurred in similar proportions of patients with and without cirrhosis.
Keeping the spirit high: why trauma team training is (sometimes) implemented
Authors: WISBORG T. , BRATTEBØ G. 
Published: August 2010

Background: Systematic and multiprofessional trauma team training using simulation was introduced in Norway in 1997. The concept was developed out of necessity in two district general hospitals and one university hospital but gradually spread to 45 of Norway's 50 acute‐care hospitals over the next decade. Implementation in the hospitals has varied from being a single training experience to becoming a regular training and part of quality improvement. The aim of this study was to better understand why only some hospitals achieved implementation of regular trauma team training, despite the intentions of all hospitals to do so.Methods: Focus group interviews were conducted with multiprofessional respondents in seven hospitals, including small and large hospitals and hospitals with and without regular team training. Interviews were transcribed and analyzed using a Grounded Theory approach.Results: ‘Keeping the spirit high’ appeared to be the way to achieve implementation. This was achieved through ‘enthusiasm,’‘strategies and alliances,’ and ‘using spin‐offs.’ It seems that the combination of enthusiasts, managerial support, and strategic planning are key factors for professionals trying to implement new activities.Conclusions: Committed health professionals planning to implement new methods for training and preparedness in hospitals should have one or more enthusiasts, secure support at the administrative level, and plan the implementation taking all stakeholders into consideration.
Pain and disability 1 year after knee arthroscopic procedures
Authors: ROSSELAND L. A. , SOLHEIM N. , STUBHAUG A. 
Published: August 2010

Background: Persistent chronic pain after surgery is a major health care problem. Its prevalence after knee arthroscopy is unknown. We conducted a follow‐up of knee arthroscopy patients. The aims were to estimate the prevalence of pain at rest and during activity 1 year after knee arthroscopy.Methods: One hundred patients with moderate or severe acute pain after knee arthroscopy were included in one of two randomized‐controlled pain trials. A questionnaire was mailed to all the patients 1 year after inclusion.Results: The prevalence of pain at rest 1 year after surgery [numeric rating scale (NRS) 0–10 grade ≥1] was 30% (95% CI 17–47) in women and 29% (95% CI 17–46) in men. Four of 33 female (10%) and three of 34 male patients (9%) experienced pain intensities at rest of NRS>4, and the number of patients who had experienced NRS>4 during activities were 7 (21%) and 4 (11%), respectively. Age above 50 years was positively correlated to persistent pain. The number of patients who reported a reduced activity of daily living (ADL) due to pain (NRS>4) was 14 of 33 (42%, 95% CI 28–56%) in female and five of 34 (15%, 95% CI 5–25%) in male patients (P=0.03). Age above 50 years was positively correlated to impaired ADL function due to knee pain.Conclusions: Persistent pain after knee arthroscopy may be a significant health care problem. Age and female gender are independent risk factors for pain and disability 1 year after surgery.
Propofol reduces nitric oxide‐induced apoptosis in testicular ischemia–reperfusion injury by downregulating the expression of inducible nitric oxide synthase
Authors: YAGMURDUR H. , AYYILDIZ A. , KARAGUZEL E. , AKGUL T. , USTUN H. , GERMIYANOGLU C. 
Published: August 2010

Background: The aim of the present study was to investigate the underlying mechanisms in the preventive effects of intravenous anesthetics on testicular ischemia–reperfusion injury.Methods: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) for 1 h and reperfusion (detorsion) for 24 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At 24 h of reperfusion, animals were killed and ipsilateral testes were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease‐activating factor 1 (APAF‐1).Results: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF‐1 expressions. iNOS and APAF‐1 expressions were markedly increased in group 2, but these parameters were at the mild to moderate level in group 4 at 24 h of reperfusion. Also, elevated expression of iNOS was accompanied by a high NO production in group 2 compared with group 4. Although eNOS expressions were increased in both the groups (groups 2 and 4), there were no significant differences between these groups.Conclusions: Propofol as an anesthetic agent may attenuate germ cell‐specific apoptosis and decrease NO biosynthases through downregulation of iNOS expression in an animal model of testicular torsion and detorsion.
Effect of propofol on pathologic time‐course and apoptosis after cerebral ischemia–reperfusion injury
Authors: CHEN L. , XUE Z. , JIANG HAO 
Published: August 2010

Background: Propofol has been demonstrated to ameliorate cerebral ischemic injury and attenuate changes in multiple links of molecular reaction included in the paths to apoptosis. The experiment was aimed to evaluate whether propofol neuroprotection was mediated through the ability to regulate pathologic time‐course of apoptosis.Methods: The effect of propofol given at a series of time points during ischemia–reperfusion period was determined using an intraluminal middle cerebral artery occlusion model in rats. The morphological changes of apoptosis under different duration of ischemia were detected by terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP‐biotin in situ nick labeling staining, and the effect of propofol on apoptosis was observed. The expression of anti‐apoptotic protein bcl‐2 in post‐ischemia neurons and the influence of propofol was analyzed by immunochemistry staining.Results: Propofol attenuated neurological deficit, reduced infarct volumes, when given prior the onset of ischemia, during ischemia or 3 h after reperfusion. Apoptosis obviously appeared at 6 h post‐reperfusion preceded by 90 min ischemia, rose to the maximum value at 24 h post‐reperfusion and gradually diminished after 3 days reperfusion. Propofol inhibited apoptotic morphological changes between 6 h and 3 days post‐reperfusion. Propofol enhanced the expression of anti‐apoptotic protein bcl‐2 in post‐reperfusion neurons.Conclusions: The pathologic outcome of focal cerebral ischemia–reperfusion injury was displayed by co‐existence of apoptosis and necrosis. A short duration of ischemia induced apoptosis. The therapeutic window for propofol initiated before the onset of ischemia and lasted until early stage of reperfusion. The neuroprotection of propofol might be attributed to the inhibition of apoptosis.
Ropivacaine and levobupivacaine for bilateral selective ankle block in patients undergoing hallux valgus repair
Authors: PALMISANI S. , ARCIONI R. , DI BENEDETTO P. , DE BLASI R. A. , MERCIERI M. , RONCONI P. 
Published: August 2010

Background: A selective ankle block, blocking the tibial, deep and superficial peroneal nerves, can be used successfully for great toe surgery. No comparative information is available on selective ankle block using ropivacaine and levobupivacaine.Methods: We compared the onset time and success rate of a selective ankle block using low volumes (12 ml) of ropivacaine 10 mg/ml and levobupivacaine 7.5 mg/ml in 40 patients undergoing elective repair of bilateral hallux valgus. Each patient received an ankle block induced in one foot with ropivacaine and in the contralateral foot with levobupivacaine.Results: The success rate was higher [90% vs. 75%, hazard ratio (95% CI) 0.39 (0.23–0.64)] and anesthesia onset time was shorter (median, 10 vs. 20 min) after ropivacaine than after levobupivacaine. In successful ankle blocks, post‐operative pain was similar in the two groups.Conclusion: In this study, ropivacaine 10 mg/ml had a shorter anesthesia onset time and a higher success rate than levobupivacaine 7.5 mg/ml for selective ankle block.
Effects of halothane, isoflurane, and sevoflurane on lipid peroxidation following experimental closed head trauma in rats
Authors: YURDAKOC A. , GUNDAY I. , MEMIŞ D. 
Published: August 2010

Background: In a rat closed head trauma model we examined both the time course of lipid peroxidation and the effects of halothane, isoflurane, and sevoflurane on it by analysis of malondialdehyde (MDA) formation.Methods: Animals were divided randomly into five groups: sham‐operated (SO), n=18; control‐closed head trauma to left frontal pole, n=18; closed head trauma model+halothane, n=18; closed head trauma model+isoflurane, n=18; and closed head trauma model+sevoflurane, n=18. Halothane, isoflurane, or sevoflurane were applied 15 min after trauma for 30 min. Rats were euthanized 1,3, and 5 h after the inhalation agents. Brain tissue samples were taken 5 mm from the left and right frontal poles. MDA was considered to reflect the degree of lipid peroxidation.Results: MDA concentrations were greater in the control, halothane, sevoflurane, and isoflurane groups than in SO animals (P<0.001). No statistical difference between the hemispheres was found between the halothane, isoflurane, or sevoflurane groups, but MDA levels were lower with isoflurane than in the halothane, sevoflurane, and control groups at 1, 3, and 5 h (P<0.001). MDA levels were higher as compared with the halothane and sevoflurane groups at 1 h but not at 3 or 5 h (P<0.001).Conclusion: MDA levels with the isoflurane group were lower than in the other trauma groups, which suggest that isoflurane, given after closed head trauma, might be protective against lipid peroxidation of cerebral injury.
Oxycodone vs. fentanyl in the treatment of early post‐operative pain after laparoscopic cholecystectomy: a randomised double‐blind study
Authors: KOCH S. , AHLBURG P. , SPANGSBERG N. , BROCK B. , TØNNESEN E. , NIKOLAJSEN L. 
Published: August 2010

Background:It has been suggested that oxycodone is superior to other opioids in the treatment of visceral pain. We therefore compared the effect of intravenous (i.v.) oxycodone and i.v. fentanyl on post‐operative abdominal (visceral) pain after outpatient laparoscopic cholecystectomy.Methods:Seventy‐eight patients were randomised to intra‐ and post‐operative pain treatment with either oxycodone (n=39) or fentanyl (n=39). The patients received 10 mg oxycodone/100 μg fentanyl at the end of anaesthesia. In the post‐anaesthetic care unit (PACU), 5 mg oxycodone/50 μg fentanyl was administered to patients with moderate pain [3–5 on a numeric rating scale (NRS)], and 10 mg oxycodone/100 μg fentanyl was administered to patients with severe pain (>5 on an NRS). The following measures were recorded: intensity of pain at arrival, after 30, 60 and 90 min and at discharge from the PACU; total consumption of oxycodone/fentanyl; nausea; vomiting; sedation and pressure tolerance thresholds.Results:The median intra‐ and post‐operative consumption of oxycodone was 15 mg (range: 10–40 mg) and the consumption of fentanyl was 200 μg (range: 100–500 μg). The intensity of abdominal pain was significantly lower in the oxycodone group at arrival (P<0.05), after 30, 60 and 90 min, and at discharge from the PACU (P<0.01). There was a strong tendency towards more side effects with oxycodone.Conclusions:Oxycodone provided better analgesia but also more side effects, suggesting that the doses used in the present study may not be equipotent.
Impaired erythropoiesis after haemorrhagic shock in mice is associated with erythroid progenitor apoptosis in vivo
Authors: ROBINSON Y. , MATENOV A. , TSCHÖKE S. K. , WEIMANN A. , OBERHOLZER A. , ERTEL W. , HOSTMANN A. 
Published: August 2010

Objective: Multiply traumatised patients often suffer from blood loss and from subsequent therapy‐resistant anaemia, possibly mediated by apoptosis, necrosis, or humoral factors. Therefore, the underlying mechanisms were investigated in bone marrow (BM) and peripheral blood in a murine resuscitated haemorrhagic shock (HS) model.Methods: In healthy male mice, pressure‐controlled HS was induced for 60 min. The BM was analysed for Annexin‐V, 7‐amino‐actinomycin D, apoptotic enzymes (caspases‐3/7, ‐8, and ‐9), expression of death receptors (CD120a, CD95), mitochondrial proteins (Bax, Bcl‐2, Bcl‐x), as well as erythropoietin (EPO) receptor (EPO‐R). Blood cell count, peripheral EPO, and tumour necrosis factor‐α response were additionally monitored.Results: Twenty‐four and 72 h after HS, EPO and EPO‐R were strongly up‐regulated in peripheral blood and BM, respectively. Decreasing numbers of erythroid progenitors in BM after HS correlated with significant apoptotic changes confirmed by increased caspases‐3/7, ‐8, ‐9 activity in total BM, death receptor CD95 and CD120a expression on erythroid progenitors, and down‐regulated mitochondrial Bcl‐2 expression in total BM. Erythroid progenitors in peripheral blood were found to be increased after 72 h.Conclusion: Despite the massive EPO response and up‐regulation of EPO‐R, BM erythroblasts (EBs) decreased. This could be due to deficient maturation of erythroid progenitors. Furthermore, the increased intrinsic and extrinsic apoptosis activation suggests programmed death of erythroid progenitors. We propose that both apoptosis and negatively regulated erythropoiesis contribute to BM dysfunction, while erythroid progenitor egress plays an additional role.