bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does brain death induce a pro‐inflammatory response at the organ level in a porcine model?
Authors: BARKLIN A. , LARSSON A. , VESTERGAARD C. , KOEFOED‐NIELSEN J. , BACH A. , NYBOE R. , WOGENSEN L. , TØNNESEN E. 
Published: August 2010

Background: Organs from brain‐dead donors have a poorer prognosis after transplantation than organs from living donors. A possible explanation for this is that brain death might initiate a systemic inflammatory response, elicited by a metabolic stress response or brain ischemia. The aim of this study was to investigate the effect of brain death on the cytokine content in the heart, liver, and kidney. In addition, the metabolic and hemodynamic response caused by brain death was carefully registered.Methods: Fourteen pigs (35–40 kg) were randomized into two groups (1) eight brain‐dead pigs and (2) six pigs only sham operated. Brain death was induced by inflation of an epidurally placed balloon. Blood samples for insulin, glucose, catecholamine, free fatty acids (FAA), and glucagon were obtained during the experimental period of 360 min. At the conclusion of the experiment, biopsies were taken from the heart, liver, and kidney and were analyzed for cytokine mRNA and proteins [tumor necrosis factor α (TNF‐α), interleukin (IL)‐6, and IL‐10).Results: We found a dramatic response to brain death on plasma levels of epinephrine (P=0.004), norepinephrine (P=0.02), FAA (P=0.0001), and glucagon (P=0.0003) compared with the sham group. There was no difference in cytokine content in any organ between the groups.Conclusion: In this porcine model, brain death induced a severe metabolic response in peripheral blood. At the organ level, however, there was no difference in the cytokine response between the groups.
Effects of fentanyl on gastric myoelectrical activity: a possible association with polymorphisms of the μ‐opioid receptor gene?
Authors: WALLDÉN J. , LINDBERG G. , SANDIN M. , THÖRN S.‐E. , WATTWIL M. 
Published: August 2010

Background: Opioids have inhibitory effects on gastric motility, but the mechanism is far from clear. Electrical slow waves in the stomach determine the frequency and the peristaltic nature of gastric contractions. The primary aim of this study was to investigate the effects of the opioid fentanyl on gastric myoelectric activity. As there were large variations between the subjects, we investigated whether the variation was correlated to single nucleotide polymorphisms (SNP) of the μ‐opioid receptor (MOR) gene.Methods: We used cutaneous multichannel electrogastrography (EGG) to study myoelectrical activity in 20 patients scheduled for elective surgery. Fasting EGG was recorded for 30 min, followed by intravenous administration of fentanyl 1 μg/kg and subsequent EGG recording for 30 min. Spectral analysis of the two recording periods was performed and the variables assessed were dominant frequency (DF) of the EGG and its power (DP). Genetic analysis of the SNP A118G and G691C of the MOR gene was performed with the polymerase chain reaction technique.Results: There was a significant reduction in DF and DP after intravenous fentanyl. However, there was a large variation between the patients. In eight subjects EGG was unaffected, five subjects had a slower DF (bradygastria) and in six subjects the slow waves disappeared. We found no correlation between the EGG outcome and the presence of A118G or G691C in the MOR gene.Conclusions: Fentanyl inhibited gastric myoelectrical activity in about half of the subjects. The variation could not be explained by SNP in the MOR gene. Because of small sample size, the results must be regarded as preliminary observations.
Renal cytokine profile in an endotoxemic porcine model
Authors: GRANFELDT A. , EBDRUP L. , TØNNESEN E. , WOGENSEN L. 
Published: August 2010

Introduction:In animals exposed to acute endotoxemia with lipopolysaccharide (LPS), high levels of cytokines are found in the kidney. The objective of this study is to determine whether the high renal content of TNF‐α, IL‐1β, IL‐10 and IL‐1 receptor antagonist (IL‐1ra) is due to glomerular filtration and reabsorption, or whether the cytokines are produced locally in the kidney.Methods:Eighteen anesthetized and mechanically ventilated pigs (35–43 kg) were randomized into two groups: Group 1 (n=12) LPS infusion for 360 min and Group 2 (n=6) control pigs, no treatment. At 360 min, the pigs were euthanized and tissue samples from the kidneys were obtained. Localization of the cytokines was determined by immunohistochemistry and double immunofluorescence (dIF).Results:Pigs exposed to endotoxemia showed increased accumulation of leukocytes and increased protein expression of TNF‐α and IL‐1β when compared with controls. dIF showed that TNF‐α‐positive cells co‐localized with both endothelial and mesangial cells in the glomeruli. Furthermore, the endothelial cells of the cortical arterioles were positive for IL‐1β. TNF‐α and IL‐1β staining were absent in renal tubular cells. A positive signal for IL‐10 was detected at the tubular brush border while IL‐1ra was detected in the glomerulus and in the tubular cells.Conclusion:LPS‐induced endotoxemia increased TNF‐α and IL‐1β protein expression and leukocyte accumulation in the kidneys. The results indicate that the increased levels of the pro‐inflammatory cytokines TNF‐α and IL‐1β are caused by a local production in the kidneys while the anti‐inflammatory cytokines IL‐10 and IL‐1ra are filtrated and reabsorbed in the tubuli.
Effect of oral gabapentin on the intraocular pressure and haemodynamic responses induced by tracheal intubation
Authors: Kaya F. N. , Yavascaoglu B. , Baykara M. , Altun G. T. , Gülhan N. , Ata F. 
Published: August 2010

Background: Laryngoscopy and tracheal intubation may cause undesirable increases in blood pressure, heart rate (HR) and intraocular pressure (IOP). Gabapentin has been used effectively to attenuate the pressor response to laryngoscopy and tracheal intubation. We investigated whether the pre‐treatment with gabapentin attenuates the IOP in addition to a haemodynamic response to tracheal intubation.Methods: Sixty ASA I–II patients were randomly allocated into two groups who received either gabapentin (800 mg) or placebo 2 h before surgery. IOP, mean arterial pressure (MAP) and HR were measured before and after the induction of anaesthesia as well as at 0, 1, 3, 5, 10 and 15 min following intubation.Results: IOP and MAP increased from baseline immediately after intubation in the placebo group (P=0.001 and 0.002, respectively). When compared with the placebo group, IOP values of the gabapentin group were significantly lower for the first 15 min after tracheal intubation (P=0.002 at 0 min, P=0.006 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min, P<0.001 at 10 min and P=0.003 at 15 min) while MAP was lower in the first 10 min (P=0.001 at 0 min, P=0.002 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min and P=0.028 at 10 min). These results showed that gabapentin effectively suppresses the increase in IOP secondary to endotracheal intubation and attenuates the increases in MAP.Conclusion: It is suggested that gabapentin is a useful adjuvant in order to prevent an increase in the IOP in response to laryngoscopy and tracheal intubation.
BIS does not predict dreams reported after anaesthesia
Authors: SAMUELSSON P. , BRUDIN L. , SANDIN R. H. 
Published: August 2010

Background: In earlier studies, between 1% and 57% of patients have been reported to dream during anaesthesia. Thus, dreaming is much more common than definite memories of real events. We wanted to examine whether dreaming during anaesthesia is related to insufficient hypnotic action, as indicated by BIS levels and, thus, may constitute a risk for awareness.Methods: After IRB approval, 2653 consecutive surgical patients were included. BIS registrations were recorded continuously during the anaesthetic procedure. The patients were interviewed on three occasions after anaesthesia. Standard questions, according to Brice, to evaluate awareness and dreaming during anaesthesia were asked. The dreams were categorized as either pleasant/neutral or unpleasant without any further evaluation of the dream content. Episodes with a mean BIS below 40, above 60 and above 70 were identified and subdivided according to duration (1, 2, 4 and 6 min, respectively). The total time as well as number and duration of episodes for the three BIS‐levels were used to analyze any relation to reported dreaming. The mean BIS was also analyzed.Results: Dreaming during anaesthesia was reported by 211 of patients (8.0%) on at least one of the post‐operative interviews. BIS data did not show any significant correlation with dreaming, and neither did any of the tested case‐specific parameters (gender, age, ASA group, BMI, use of relaxants, induction agent, maintenance agent, length of procedure, omitting N2O and concomitant regional anaesthesia).Conclusion: Dreaming during anaesthesia seems to be a separate phenomenon, not in general related to insufficient anaesthesia as indicated by high BIS levels.
Left molar approach improves laryngeal view in patients with simulated limitation of cervical movements
Authors: SAINI S. , BALA R. , SINGH R. 
Published: August 2010

Background: Immobilized cervical spine, because of either diseases or stabilizing devices, poses considerable difficulties with endotracheal intubation due to poor laryngoscopic view. The left molar (LM) approach has been shown to be useful in difficult sporadic intubation cases. We evaluated efficacy of this approach of laryngoscopy to improve laryngeal view in patients with simulated limitation of cervical movements.Methods: Thirty patients of American Society of Anesthesiologists grade I/II, who were scheduled to undergo routine surgical procedures under general anaesthesia and endotracheal intubation, were studied. A two‐piece semi‐rigid cervical collar was used to immobilize the cervical spine. Under standardized anaesthesia and neuromuscular blocking agent, conventional laryngoscopy using a curved Macintosh blade was performed and glottic view was recorded with and without optimal external laryngeal manipulation (OELM). Subsequently, in the same subjects the laryngoscope blade was withdrawn and re‐inserted through the LM approach and glottic view was recorded with and without OELM followed by tracheal intubation.Results: With the conventional approach, laryngeal view was recorded as grade II in five patients, grade III in 24 patients, and grade IV in one patient. However, with the LM approach, laryngeal view was grade I in 25 patients, grade II in five patients, and grade III or IV in none (P<0.001). Tracheal intubation with the LM approach required the use of a flexible stylet to guide the tube tip into the larynx.Conclusions: The laryngeal view is improved by the LM approach in patients with simulated limited cervical movements with a high success rate of tracheal intubation, but requires orientation for negotiation of the tube through the narrow oropharyngeal space available.
Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma
Authors: ROCCO M. , CARBONE I. , MORELLI A. , BERTOLETTI L. , ROSSI S. , VITALE M. , MONTINI L. , PASSARIELLO R. , PIETROPAOLI P. 
Published: August 2010

Background: Blunt thoracic trauma is a major concern in critically ill patients. Repeated lung diagnostic evaluations are needed in order to follow up the clinical situation and the results of the therapeutic strategies. The aim of this prospective clinical study was to evaluate the possible role of lung ultrasound (LU) compared with bedside radiography (CXR) and computed tomography (CT) used as the gold standard in the evaluation of trauma patients admitted to the intensive care unit with acute respiratory failure.Method: A total of 15 thoracic trauma patients were studied at intensive care unit (ICU) arrival (T1) and 48 h later (T2) with CT, CXR and LU. We evaluated the presence of pleural effusion (PE) and lung contusion (LC). For this purpose the lung parenchyma was divided into 12 regions so that we could compare 180 lung regions at T1 and T2, respectively.Results: Sensitivity of ultrasound was 0.94 for PE and 0.86 for LC while specificity 0.99 and 0.97, respectively. The likelihood ratio was 94 (ρ+) and 0.06 (ρ−) for PE and 28.6 (ρ+) and 0.14 (ρ−) for LC.Conclusions: Ultrasound provides a reliable noninvasive, bedside method for the assessment of chest trauma patients with acute respiratory failure in the ICU.
Intra‐operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia
Authors: ARAI Y.‐C. P. , SAKAKIBARA S. , ITO A. , OHSHIMA K. , SAKAKIBARA T. , NISHI T. , HIBINO S. , NIWA S. , KUNIYOSHI K. 
Published: August 2010

Background: The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity.Methods: Thirty‐two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure.Results: Intra‐operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group.Conclusion: Intra‐operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.
Improved survival after an out‐of‐hospital cardiac arrest using new guidelines
Authors: STEINMETZ J. , BARNUNG S. , NIELSEN S. L. , RISOM M. , RASMUSSEN L. S. 
Published: August 2010

Background: An out‐of‐hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30‐day survival after OHCA.Methods: We prospectively recorded data on all patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implementation), separated by a 4‐month period in which the above‐mentioned change took place.Results: We found that 30‐day survival increased after the implementation from 31/372 (8.3%) to 67/419 (16%), P=0.001. ROSC at hospital admission, as well as survival to hospital discharge, were obtained in a significantly higher proportion from 23.4% to 39.1%, P<0.0001, and from 7.9% to 16.3%, P=0.0004, respectively. Treatment after implementation was confirmed as a significant predictor of better 30‐day survival in a logistic regression analysis.Conclusion: The implementation of new resuscitation guidelines was associated with improved 30‐day survival after OHCA.
Effects of levosimendan on indocyanine green plasma disappearance rate and the gastric mucosal–arterial pCO2 gradient in abdominal aortic aneurysm surgery
Authors: LEPPIKANGAS H. , TENHUNEN J. J. , LINDGREN L. , SALENIUS J.‐P. , RUOKONEN E. 
Published: August 2010

Background: Levosimendan has a dual mechanism of action: it improves myocardial contractility and causes vasodilatation without increasing myocardial oxygen demand. In a laboratory setting, it selectively increases gastric mucosal oxygenation in particular and splanchnic perfusion in general. The aim of our study was to describe the effects of levosimendan on systemic and splanchnic circulation during and after abdominal aortic surgery.Methods: Twenty abdominal aortic aneurysm surgery patients were randomized to receive either levosimendan (n=10) or placebo (n=10) in a double‐blinded manner. Both the mode of anaesthesia and the surgical procedures were performed according to the local guidelines. Automatic gas tonometry was used to measure the gastric mucosal partial pressure of carbon dioxide. Systemic indocyanine green clearance plasma disappearance rate (ICG‐PDR) was used to estimate the total splanchnic blood flow.Results: The immediate post‐operative recovery was uneventful in the two groups with a comparable, overnight length of stay in the intensive care unit. Cumulative doses of additional vasoactive drugs were comparable between the groups, with a tendency towards a higher cumulative dose of noradrenaline in the levosimendan group. After aortic clamping, the cardiac index was higher [4(3.8–4.7) l/min/m2 vs. 2.6(2.3–3.6) l/min/m2; P<0.05] and the gastric mucosal–arterial pCO2 gradient was lower in levosimendan‐treated patients [0.9(0.6–1.2) kPa vs. 1.7(1.2–2.1) kPa; (P<0.05)]. However, the total splanchnic blood flow, estimated by ICG‐PDR, was comparable [29(21–29)% vs. 20(19–25)%; NS]. Organ dysfunction scores (sequential organ dysfunction assessment) were similar between the groups on the fifth post‐operative day.Conclusion: Levosimendan favours gastric perfusion but appears not to have a major effect on total splanchnic perfusion in patients undergoing an elective aortic aneurysm operation.
Pre‐operative oral carbohydrate treatment before coronary artery bypass surgery
Authors: JÄRVELÄ K. , MAARANEN P. , SISTO T. 
Published: August 2010

Background: Cardiac surgery is a stress that causes insulin resistance, which leads to an increase in insulin requirement. The aim of the present study was to evaluate the effect of a pre‐operative oral carbohydrate drink vs. overnight fasting on perioperative insulin requirements in non‐diabetic patients undergoing elective coronary artery bypass grafting (CABG) surgery.Methods: One hundred and one patients scheduled for CABG were enrolled in the study. After fasting overnight, the patients were randomised into two groups. In the control group (C), no drink was given in the morning. In the treatment group (T), the patients ingested 400 ml of carbohydrate fluid 2 h before induction of anaesthesia. Blood glucose and insulin requirement was recorded. Gastric drainage was measured. Post‐operative nausea and vomiting was recorded.Results: Neither the number of patients requiring insulin nor the amount of insulin required to maintain normoglycaemia differed between the study groups. More patients in the treatment group experienced nausea post‐operatively (26 vs. 16, P=0.044), but vomiting was equally common in the study groups (10 vs. 7). Intra‐operative gastric drainage was 26.8±57.9 ml in the treatment group vs. 16±37.9 ml in the control group (NS).Conclusion: In this study patient population, a pre‐operative oral carbohydrate drink did not reduce post‐operative insulin resistance or post‐operative nausea and vomiting. According to our findings, it is safe to allow cardiac surgery patients to drink clear fluids up to 2 h before induction of anaesthesia, because gastric emptying of the drink was almost total and no aspiration occurred.
Peripheral intravenous catheter use in Europe: towards the use of safety devices
Authors: STRAUSS K. W. , ONIA R. , VAN ZUNDERT A. A. J. 
Published: August 2010

Background: Peripheral intravenous catheters are among the most widely used medical devices in the world. European patients are increasingly aware of the risk of health care associated infections and the role catheters play in their facilitation.Aims: We intend to show that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by the needles from catheters and that the political will is building to take action to ensure safer devices are provided.Methods: We review the wide variety of peripheral intravenous catheters which are specially engineered to reduce these risks.Results: Available safety devices include spring‐loaded retractable needles, guards that shield the dangerous tips and closed, needle‐free access valves for intravenous sets.Conlusions: It is no longer necessary for patients and professionals to take risks to health and life when solutions which minimize these risks are at hand.
Lung injury following thoracic aortic occlusion: comparison of sevoflurane and propofol anaesthesia
Authors: ANNECKE T. , KUBITZ J. C. , LANGER K. , HILBERATH J. M. , KAHR S. , KROMBACH F. , BITTMANN I. , REHM M. , KEMMING G. I. , CONZEN P. F. 
Published: August 2010

Background: Halogenated anaesthetics have been shown to reduce ischaemia–reperfusion injuries in various organs due to pre‐ and post‐conditioning mechanisms. We compared volatile and total intravenous anaesthesia with regard to their effect on remote pulmonary injury after thoracic aortic occlusion and reperfusion.Methods: Eighteen pigs were randomized after sternotomy and laparotomy (fentanyl–midazolam anaesthesia) to receive either sevoflurane or propofol in an investigator‐blinded fashion. Ninety minutes of thoracic aortic occlusion was induced by a balloon catheter. During reperfusion, a goal‐directed resuscitation protocol was performed. After 120 min of reperfusion, the anaesthetic regimen was changed to fentanyl–midazolam again for another 180 min. The oxygenation index and intra‐pulmonary shunt fractions were calculated. After 5 h of reperfusion, a bronchoalveolar lavage was performed. The total protein content and lactate dehydrogenase activity were measured in epithelial lining fluid (ELF). Alveolar macrophage oxidative burst was analysed. The wet to dry ratio was calculated and tissue injury was graded using a semi‐quantitative score. Ten animals (n=5 for each anaesthetic) without aortic occlusion served as time controls.Results: The oxygenation index decreased and the intra‐pulmonary shunt fraction increased significantly in both occlusion groups. There were no significant differences between sevoflurane and propofol with respect to the oxygenation index, ELF composition, morphologic lung damage, wet to dry ratio and alveolar macrophage burst activity. Differences were, however, seen in terms of systemic haemodynamic stability, where catecholamine requirements were less pronounced with sevoflurane.Conclusion: We conclude that the severity of remote lung injury was not different between sevoflurane and propofol anaesthesia in this porcine model of severe lower‐body ischaemia and reperfusion injury.
Correlation between plasma milrinone concentration and renal function in patients with cardiac disease
Authors: HASEI M. , UCHIYAMA A. , NISHIMURA M. , MASHIMO T. , FUJINO Y. 
Published: August 2010

Background: The dose of milrinone should be reduced in patients with renal failure. However, there is little data examining the relationship between plasma concentration of milrinone (pCmil) and renal function in intravenous infusion.Methods: We evaluated the pCmil relative to renal function during intravenous infusion. We enrolled 10 heart failure patients. Milrinone was continuously infused at a rate of 0.2 μg/kg/min. Blood samples were collected at 6, 12, 24, and 48 h after the beginning of infusion. Urine was sampled during the first 24 h to calculate creatinine clearance (CLcr) and renal clearance of milrinone (rCLmil).Results: The pCmil exhibited stability over 6 h after the beginning of infusion. During the first 24 h, CLcr and rCLmil were 62.2±30.6 ml/min and 1.67±0.77 ml/kg/min (106.2±60.3 ml/min), respectively. The rCLmil was highly correlated with CLcr. Y=1.77X−3.89 (X, CLcr; Y, rCLmil; R2=0.809, P<0.0001). Significant correlations were observed between CLcr and the plasma concentration during the continuous infusion. This correlation was expressed as the equation Y=51.1 × (BW/X)+28.2 (X; CLcr, Y; plasma concentration; BW, body weight; R2=0.695, P<0.01).Conclusion: The pCmil exhibited stability 6 h or later after the continuous infusion of milrinone 0.2 μg/kg/min. The pCmil can be estimated by the value of CLcr and BW.