bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected?
Authors: HOFF R. G. , VAN DIJK G. W. , METTES S. , VERWEIJ B. H. , ALGRA A. , RINKEL G. J. E. , KALKMAN C. J. 
Published: August 2010

Background: Patients with aneurysmal subarachnoid haemorrhage (SAH) often have disturbed autoregulation of cerebral blood flow. A reduction in systemic blood pressure during surgery may therefore lead to delayed cerebral ischaemia (DCI). To assess the incidence and severity of intra‐operative hypotension, we performed a retrospective cohort study in 164 patients with recent SAH and surgical clipping of the aneurysm.Methods: Intra‐operative hypotension was defined in three levels of severity, as a decrease in mean arterial pressure (ΔMAP) of more than 30%, 40% or 50% compared with the pre‐operative pressure. For each patient the total amount of time with intra‐operative hypotension was retrieved. Logistic regression analysis was performed to study the relation between intra‐operative hypotension and the occurrence of DCI and poor outcome.Results: A period with ΔMAP>30% occurred in 128 patients (78%) with a median duration of this period of 105 min (25–75‰ 50–171 min). ΔMAP>40% occurred in 88 patients (54%) and ΔMAP>50% occurred in 22 patients (13%). In univariate analysis, ΔMAP>50% was associated with poor outcome. After adjusting for age and World Federation of Neurological Surgeons grade, the association with poor outcome was no longer statistically significant [odds ratio (OR) 1.018; 95% CI 0.996–1.041].Conclusion: Hypotension during surgical clipping of intracranial aneurysms occurred frequently. In our study population of patients mostly in good clinical condition, hypotension was not confirmed as an independent risk factor for DCI or poor outcome. Anaesthesia may have had a cerebral protective effect.
Racemic, S(+)‐ and R(−)‐ketamine do not increase elevated intracranial pressure
Authors: SCHMIDT A. , ØYE I. , ÅKESON J. 
Published: August 2010

Background: There is controversy regarding the influence of ketamine and its enantiomers on cerebral haemodynamics at increased intracranial pressure (ICP). This study was designed to compare cerebrovascular responses, with particular respect to ICP, to bolus injections of racemic, S(+)‐ and R(−)‐ketamine in an experimental model of intracranial hypertension.Methods: Nine pigs were anaesthetised with fentanyl and vecuronium during mechanical normoventilation. The ICP was raised with extradural balloon catheters to 23 mmHg. The intra‐arterial xenon clearance technique was used to determine cerebral blood flow (CBF). Three 60‐s bolus injections of racemic ketamine (10 mg/kg), S‐ketamine (5 mg/kg) and R‐ketamine (20 mg/kg) were given in a randomised sequence. Cerebral and systemic haemodynamic responses were evaluated before and at 1, 5, 10, 15, 30 and 45 min after each injection.Results: Racemic ketamine decreased ICP (P=0.026) by maximally 10.8%, whereas there was no effect on ICP of S‐ (P=0.178) or R‐ketamine (P=0.15). All study drugs had similar biphasic effects on CBF, with maximal initial decreases by 25–29%, followed by transient increases by 7–15%, and a reduction of mean arterial pressure by maximally 22–37%.Conclusions: A decrease or a lack of an increase in ICP in response to intravenous bolus injections of racemic, S‐ or R‐ketamine suggests that the administration of racemic or S‐ketamine might be safe in patients with intracranial hypertension due to a space‐occupying lesion. The ICP‐lowering effect indicates that racemic ketamine might offer a therapeutic advantage over S‐ketamine.
Nosocomial infections and infection control in regional anesthesia
Authors: SCHULZ‐STÜBNER S. , POTTINGER J. M. , COFFIN S. A. , HERWALDT L. A. 
Published: August 2010

Background: Although rare, infectious complications from regional anesthesia and analgesia can be devastating. The literature on this topic consists primarily of surveys, case reports, case series, and studies in which used supplies were cultured. We derived infection control recommendations from the existing literature and compared these recommendations with existing guidelines.Methods: Structured literature search of the Cochrane Central Register of Controlled Trials, MEDLINE, including old MEDLINE and EMBASE until 2005. Descriptive statistics were cited when applicable.Main results: Incidence rates for infectious complications vary substantially between studies and range from 3.7 to 7.2/100,000 for spinal anesthesia‐associated meningitis and from 0.2 to 83/100,000 for epidural anesthesia‐associated epidural abscesses. Few comprehensive prospective trials have been conducted and most case reports do not provide complete information about infection control practices.Conclusion: Studies using more robust methods are necessary to define the rates of infection after different regional anesthesia procedures and to identify risk factors for infections. Data on risk factors would allow anesthesiologists to develop evidence‐based guidelines for placement and care of catheters used for regional anesthesia. A multicenter surveillance system may help anesthesiologists address some of the unanswered questions and to develop evidence‐based infection control recommendations.
Effect of fentanyl on heart rate variability during spontaneous and paced breathing in healthy volunteers
Authors: VETTORELLO M. , COLOMBO R. , DE GRANDIS C. E. , COSTANTINI E. , RAIMONDI F. 
Published: August 2010

Background:Many studies have been conducted to assess the effects of fentanyl on the autonomic nervous system (ANS) by heart rate variability (HRV) analysis, but disagreement on the results is still present due to confounding influences introduced by concomitant administration of other drugs or opioid‐related transitory respiratory depression. We performed a single‐drug controlled‐breathing study on healthy volunteers to assess the impact of fentanyl on ANS.Methods:HRV as a measure of sympathovagal balance was prospectively analyzed with an autoregressive model in 11 subjects during spontaneous and paced breathing (PB) at 20 breaths/min both before and after fentanyl 1 mcg/kg administration. HRV total power, sympathovagal balance (low‐frequency/high‐frequency ratio) and normalized spectral powers were considered (LFnu, HFnu).Results:Fentanyl led to a reduction of LFnu (from 55.2±23.3 to 43.2±24.1,P<0.05) without HFnu increase during PB. A decrease inR–Rinterval variance (from 3345.6±3333.4 to 1806.9±1328.6 ms2,P<0.05) was shown after fentanyl administration during spontaneous but not PB. PB alone decreased the HRV total power andR–Rinterval variance.Conclusions:Low‐dose fentanyl administration in healthy volunteers leads to sympathetic and overall ANS modulation decrease, with a trend toward vagal activation.
Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?
Authors: BARTHA E. , RUDIN Å. , FLISBERG P. , LUNDBERG C. J. , CARLSSON P. , KALMAN S. 
Published: August 2010

Background: A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post‐operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high‐risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post‐operative costs of intensive care in patients receiving epidural or intravenous analgesia.Methods: Clinical data and rates of post‐operative complications were extracted from a previously reported trial following thoraco‐abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care.Results: Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros/patient, were outweighed by lower post‐operative costs of intensive care 5,571 vs. 7,921 Euros/patient (NS).Conclusion: Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post‐operative care following major surgery.
Comparative evaluation of ultrasound‐guided continuous infraclavicular brachial plexus block with stimulating catheter and traditional technique: a prospective‐randomized trial
Authors: DHIR S. , GANAPATHY S. 
Published: August 2010

Background: Secondary catheter failure has been reported in up to 40% of patients with continuous peripheral nerve blocks resulting in failure to provide pain relief after the initial block wears off. Introduction of stimulating catheters as well as ultrasound for regional anaesthesia has facilitated correct placement of catheter tip, closer to the plexus. This randomized study was conducted to compare the efficacy of continuous infraclavicular brachial plexus blocks using non‐stimulating catheter, stimulating catheter and ultrasound‐guided catheter placement with nerve stimulation assistance.Methods: Patients undergoing elective hand surgery were randomly allocated to receive continuous infraclavicular brachial plexus block using non‐stimulating catheter [group traditional nerve stimulation (TR)], stimulating catheter [group stimulating catheter (ST)] or ultrasound‐guided catheter placement with nerve stimulation assistance [group ultrasound guidance with nerve stimulation assistance (US)]. Motor and sensory blocks were assessed every 5 min and primary block success was determined at 30 min. After resolution of the primary block, threshold stimulating current and resulting response, spread of drug on re‐injection as seen ultrasonographically and the capacity to re‐establish block was documented. Complications and need for supplement was noted.Results: The primary block success was significantly higher in the US group [96% US, 58% ST, 59% TR (P=0.0005)]. Secondary catheter failure was significantly lower in the US group [9% US, 17% ST, 86% TR (P<0.0001)]. Axillary nerve was blocked more predictably in the US group (100% US, 79% ST, 50% TR (P=0.0003).Conclusion: In this study, ultrasound guidance with nerve stimulation assistance significantly improved primary success and reduced secondary catheter failure in continuous infraclavicular brachial plexus blocks.
Impaired myocardial t‐PA release in patients with coronary artery disease
Authors: ÖSTERLUND B. , JERN S. , JERN C. , SEEMAN‐LODDING H. , ÖSTMAN M. , JOHANSSON G. , BIBER B. 
Published: August 2010

Aims: Myocardial ischemia remains a significant perioperative complication in coronary artery disease (CAD) patients. We hypothesized that noxious stimuli during major surgery are associated with an acute release of tissue‐type plasminogen activator (t‐PA) into the coronary circulation, and that this response is reduced by CAD.Methods and results: Two patient groups, with (n=14) and without (n=8) CAD, were studied during the initial phase of heart surgery. After retrograde great cardiac vein catheterizations during closed‐chest conditions, coronary arterial–venous concentration gradients of t‐PA and plasminogen activator inhibitor type‐1 (PAI‐1) were measured together with coronary blood flow measurements, allowing derivation of coronary net release rates. Pre‐surgery atrial pacing, performed to evaluate the influence of increases in heart rate (+40 beats/min) and coronary blood flow (+80 ml/min), did not significantly alter coronary net release of t‐PA or PAI‐1 in either patient group. Sternotomy induced a prominent increase in coronary net release of both total and active t‐PA in the non‐CAD group. This response was considerably reduced in the CAD group.Conclusions: This study provides the first analysis of coronary t‐PA release during major surgery and demonstrates a deficient local endothelial t‐PA release in patients with CAD. This suggests a reduced local fibrinolytic capacity in CAD patients, which may explain the increased risk for coronary thrombosis in this patient group.
Effect of pulsed radiofrequency for postherpetic neuralgia
Authors: Kim Y. H. , Lee C. J. , Lee S. C. , Huh J. , Nahm F. S. , Kim H. Z. , Lee M. K. 
Published: August 2010

Background: Postherpetic neuralgia (PHN) is one of the most intractable pain disorders, particularly among elderly patients. Lesioning of dorsal root ganglion (DRG) using pulsed radiofrequency (PRF) has shown pain reduction for PHN. We assessed the efficacy of PRF lesioning of DRG for PHN via an open, nonrandomized study.Methods: Forty‐nine patients with PHN refractory to conservative therapy were involved. After impedance and sensory electrical nerve stimulation thresholds were assessed, PRF was performed three times adjacent to the DRG of corresponding levels at 42 °C for 120 s under the fluoroscopic guidance. Pain ratings were conducted on a visual analogue scale at 4‐, 8‐ and 12‐week follow‐up. The data were analyzed using the one‐way ANOVA test. P<0.05 was considered to be statistically significant.Results: There was excellent pain relief (about 55%) at 4 weeks after PRF lesioning adjacent to the DRG and the effectiveness was maintained at the subsequent 12‐week follow‐up. The pain duration, age and stimulation level did not influence the outcome. There were no procedure‐related complications.Conclusions: PRF lesioning of DRG showed significant pain relief compared with the conventional treatments in patients with intractable PHN. In order to elucidate the mode of action of PRF, further research is needed and the optimal electrical parameters of PRF have to be determined.
Early time course of altered leukocyte response to lipopolysaccharide and peptidoglycan in porcine gunshot injury
Authors: GUNDERSEN Y. , VAAGENES P. , THRANE I. , OS Ø. , PILLGRAM‐LARSEN J. , SUNDNES K. O. , AASEN A. O. , OPSTAD P. K. 
Published: August 2010

Background: Penetrating injuries are frequently combined with polybacterial soiling. Clearance of the microorganisms depends on the ability to activate immune responses, but post‐traumatic hyporeactivity of immune cells is almost universal. The aim of this study was to map the early time course of this altered leukocyte reactivity, and to compare the reactions to subsequent Gram‐positive or Gram‐negative challenges.Methods: Twelve juvenile pigs sustained two standardized rounds, one through the right femur and one through the left upper abdomen. First aid treatment and acute surgery were started immediately. Blood samples were drawn before trauma and after 10, 30, 60, and 90 min, and thereafter stimulated in ex vivo whole blood for 3 h with lipopolysaccharide (LPS, 10 ng/ml), peptidoglycan (PepG, 1 μg/ml), or an equivalent amount of normal saline. The leukocyte response was evaluated by measurement of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1 β, IL‐6, IL‐8, and IL‐10 in the supernatant.Results: In the post‐traumatic in vivo serum, the concentration of TNF‐α increased steadily (significant after 60 min). A reduced ex vivo reaction to LPS was evident after 10 min, and was statistically significant after 30 min. The lowest levels were reached after 90 min. The ex vivo synthesis of TNF‐α after stimulation with PepG remained unaltered. A similar development was seen for IL‐6. IL‐1 β levels did not change, while IL‐8 increased significantly only after 60 and 90 min.Conclusions: Trauma almost instantaneously reprogrammed circulating leukocytes. As measured with TNF‐α, a profound hyporeactivity to LPS, but not to PepG, was induced. In addition, no global down‐regulation of leukocyte function was found after stimulation with LPS.
Comparison of etoricoxib vs. ketorolac in postoperative pain relief
Authors: LENZ H. , RAEDER J. 
Published: August 2010

Background: COX‐2 inhibitors have been claimed to have equal analgesic efficacy as non‐selective nonsteroidal anti‐inflammatory drugs, but this has been disputed in animal experiments.Methods: One hundred thirty‐three women scheduled for ambulatory, laparoscopic gynaecological surgery were included in this randomised, double‐blind study. Group E received 120 mg etoricoxib orally as premedication. Group K received 30 mg ketorolac i.v. after induction of anaesthesia. General anaesthesia was induced and maintained with propofol and remifentanil. Fentanyl 0.5 μg/kg i.v. and local wound anaesthesia was administered at the end of surgery. Postoperatively, the patients received fentanyl 0.5 μg/kg i.v. if visual analogue scale (VAS) ≥30 mm. Before discharge, Group K received 30 mg ketorolac i.v. Twenty‐four hours postoperatively, Group E received 120 mg etoricoxib.Results: The first 4 h postoperatively, Group K required 83±65 μg and Group E required 123±91 μg fentanyl [mean (SD), P=0.004]. After 30 min VAS in Group K was 31.3±19.7 mm and 43.8±16.9 mm in Group E [mean (SD), P<0.001]. Discharge readiness was significantly shorter in Group K (222±40 min) compared with Group E (244±47 min) [mean (SD), P=0.004]. There were no differences in pain scores or rescue pain medication at 24 or 48 h postoperatively. Less nausea was observed in the 4–24‐h period in Group E.Conclusions: Thirty milligram ketorolac i.v. after induction of anaesthesia resulted in significantly less immediate pain and opioid consumption during the first 4 h postoperatively compared with 120 mg etoricoxib preoperatively.
Risk factors and outcome in ICU‐acquired infections
Authors: MAGNASON S. , KRISTINSSON K. G. , STEFANSSON T. , ERLENDSDOTTIR H. , JONSDOTTIR K. , KRISTJANSSON M. , JONMUNDSSON E. , BALDURSDOTTIR L. , SIGVALDASON H. , GUDMUNDSSON S. 
Published: August 2010

Background: Nosocomial infections are common in intensive care units (ICU). The objectives of this study were to determine risk factors of ICU‐acquired infections, and potential mortality attributable to such infections.Methods: An observational study was performed in a 10‐bed multidisciplinary ICU. For a period of 27 months, all patients admitted for ≥48 h were included. Infections were diagnosed according to Centers for Disease Control and Prevention definitions. Airway colonization was explored by molecular typing. Risk factors for infection were determined by multivariable logistic regression. Survival was analyzed with time‐varying proportional hazards regression.Results: Of 278 patients, 81 (29%) were infected: urinary tract infections in 39 patients (14%), primary bloodstream infections in 25 (9%), surgical site infections in 22 (8%) and pneumonia in 21 (8%). Of the total of 147 episodes, Gram‐negative bacilli were isolated in 90, Gram‐positive cocci in 49 and Candida sp. in 25. Risk factors for pneumonia were mechanical ventilation [odds ratio (OR=7.9, CI 1.8–35), lack of enteral nutriment (OR=8.0, CI 1.4–45) and length of time at risk (OR=1.8, CI 1.2–2.8), while gastric acid inhibitors did not affect the risk (OR=0.99, CI 0.32–3.0). Transmission of bacteria from the stomach to the airway was not confirmed. The risk of death was increased as patients were infected with pneumonia [hazard ratio (HR)=3.6; CI: 1.6–8.1], or primary bloodstream infection (HR=2.5; CI: 1.2–5.4), independent of age and disease severity.Conclusions: Mortality was increased by ICU‐acquired pneumonia and primary bloodstream infections. Our findings did not support the gastro‐pulmonary hypothesis of ICU‐acquired pneumonia. The proposition that blood transfusions increase the risk of ICU‐acquired nosocomial infections was not supported.
Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study
Authors: ARAKELIAN E. , GUNNINGBERG L. , LARSSON J. 
Published: August 2010

Background: How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency.Methods: Twenty‐one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people.Results: Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment.Conclusions: The concept ‘operating room efficiency’ is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.
Epidural sufentanil provides better analgesia from 24 h after surgery compared with epidural fentanyl in children
Authors: CHO J. E. , KIM J. Y. , KIM J. E. , CHUN D. H. , JUN N. H. , KIL H. K. 
Published: August 2010

Background: Studies comparing epidural fentanyl and sufentanil in adults reported a similar analgesic effect with variable side effects. We hypothesized that epidural fentanyl and sufentanil will have a similar analgesic effect in children undergoing urological surgery.Methods: Sixty‐four children undergoing urological surgery were randomized into two groups: fentanyl in ropivacaine (fentanyl group, n=32) and sufentanil in ropivacaine (sufentanil group, n=32). After anaesthesia, an epidural catheter was inserted at the L2–3, L3–4 or L4–5 interspace. For post‐operative pain relief, a solution consisting of fentanyl 0.1 mcg/kg/ml or sufentanil 0.015 mcg/kg/ml in 1.5 mg/ml ropivacaine was infused at a rate of 2 ml/h. To assess post‐operative pain, the faces pain scale and the face, legs, activity, cry, consolability score were recorded at 1, 6, 24, 48 and 72 h after surgery. The incidence of adverse effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was also evaluated.Results: Pain scores demonstrated no significant difference between the groups. The need for rescue analgesia during 24–72 h was higher in the fentanyl group than in the sufentanil group (6/32 vs. 0/32, P=0.012). The incidence of pruritus was higher in the sufentanil group compared with that in the fentanyl group (5/32 vs. 0/32).Conclusions: Epidural sufentanil provides better analgesia from 24 h after surgery compared with epidural fentanyl in infants and children undergoing urological surgery. The incidence of pruritus in the sufentanil group was higher than that in the fentanyl group.