bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etidocaine in Intercostal Nerve Block for Pain Relief after Thoracotomy; a Comparison with Bupivacaine
Authors: Willdeck‐Lund Gunilla , Edström Håkan 
Published: January 2009

ABSTRACTFor pain relief after thoracotomy, intercostal nerve block with etidocaine 1 %, and bupivacaine 0.5 %, both containing adrenaline 5 μg/ml, was used. Duration of skin analgesia for sharp pain was around 11 hours for both solutions. Post‐operative pain was noted 6 and 5 hours after injection for etidocaine and bupivacaine respectively. No pathological changes in acid‐base balance or ventilation were observed.Peak expiratory flow decreased to 35–40 % of the pre‐operative values and remained at this level for about 12 hours. Arterial and venous blood levels of the local anaesthetics were low and no signs of toxicity were noted. All patients experienced a certain pain relief from the blocks. Because of shoulder pain in some patients intercostal nerve block alone does not seem to be a perfect post‐operative method for pain relief after thoracotomies.
Metabolic Changes in the Cerebral Cortex of the Rat Induced by Intravenous Pentothalsodium®
Authors: Carlsson Ghrister , Harp James R. , Siesjö Bo K. 
Published: January 2009

The effects of thiopental on cerebral metabolism were evaluated by means of measurements of cerebral metabolic rate for oxygen (CMRo2) and of tissue levels of organic phosphates, glycolytic substrates, citric acid cycle intermediates and selected amino acids. Shortly after the beginning of thiopental administration, CMRo2 was reduced to half the normal value, and there were signs of retardation of glycolytic flux at the phosphofructokinase step. Inhibition at this regulatory enzymatic step could be related to an increase in phosphocreatine and a fall in inorganic phosphate concentration. The rise in phosphocreatine, and the unchanged levels of ATP, ADP and AMP demonstrate that induction of anaesthesia with thiopental is unrelated to energy failure.Changes in citric acid intermediates included a fall in malate, and probably also in citrate, α‐ketoglutarate and fumarate, with a tendency towards reduction in the pool of citric acid cycle intermediates; and the amino acid changes were dominated by a progressive rise in aspartate. It is suggested that these changes are secondary to a reduced rate of pyruvate delivery, and to a decrease in malate/oxaloacetate ratio.
Tricyclic Antidepressive Poisoning with Special Reference to Cardiac Complications
Authors: Serafimovski N. , Thorball N. , Asmussen I. , Lunding M. 
Published: January 2009

Sixty‐eight cases of tricyclic antidepressive (TCA) poisoning are discussed. Cardiac arrest occurred in 8 patients, preceded by minor ECG‐abnormalities. Five patients died. All cardiac arrests arose within the first 24 h after TCA ingestion. Fifty‐seven patients developed ECG‐abnormalities, of which 84% began within the first 6 h after TCA ingestion. ECG‐abnormalities and other symptoms (respiratory arrest, coma, convulsion and hypotension) often occurred in the same patients. Treatment is described, and cardiac monitoring for at least the first 24 h is recommended. In cases of severe cardiac (ECG) abnormalities, monitoring is recommended until no ECG abnormalities are observed for at least 12 h.In conclusion, the unrestricted use of TCA is cautioned against, since TCA must be regarded as potentially cardiotoxic.
Treatment of Pre‐eclampsia and Eclampsia as a Hypoperfusion Syndrome
Authors: Söder G. , Grenroth C. , Norée L.‐O. , Wiklund P. E. 
Published: January 2009

A therapeutical program in pre‐eclampsia and eclampsia is presented. The results in 10 patients suggest that the same basic program as is used in the hypoperfusion syndrome can be used in pre‐eclampsia and eclampsia:Chlorpromazin to combat vasoconstriction and dilate the vascular bed. Plasma expanders, plasma, albumin and glucose with electrolytes to fill up the dilated vascular bed and restore the tissue perfusion.Buffers to combat acidosis, oxygen to combat hypoxemia, hypertonic Mannitol to mobilize edema.Furosemide to force diuresis.
The Effect of Anesthesia on Intraoperative and Postoperative Bleeding during Abdominal Prostatectomies: A Comparison of Neurolept Anesthesia, Halothane Anesthesia and Epidural Anesthesia
Authors: Thorud Thorolf , Lund Ivar , Holme Ingar 
Published: January 2009

Intraoperative blood loss was measured during abdominal prostatectomies in 213 patients anesthetized with neurolept anesthesia, halothane anesthesia and epidural anesthesia. In 55 of these patients, postoperative bleeding was also measured. The average intraoperative blood loss with neurolept anesthesia was 8.2 ± 5 ml/min, with halothane anesthesia 6.6 ± 6.3 ml/min and with epidural anesthesia 3.8 ± 2.3 ml/min. The difference of blood loss in the epidural group and in the groups receiving general anesthesia is highly significant.Average systolic and diastolic blood pressures were lower during operation in the epidural group than in the other two groups. Statistical analyses failed, however, to show a significant correlation between blood pressures and blood loss in the individual patient. Thus, the ultimate explanation for the diminished bleeding associated with epidural anesthesia is not definitely ascertained. The average postoperative bleeding was not significantly different among the three anesthetic groups.
Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions
Authors: Tølløfsrud S. , Noddeland H. 
Published: January 2009

Background: Extracorporeal circulation induces increased capillary permeability with fluid leakage into the interstitial space, resulting in positive fluid balance and intravascular hypovolaemia. Hypertonic saline 75 mg . ml‐1 in dextran 70, 60 mg . ml‐1 (HSD) seems to be of benefit in patients with impaired perfusion. The purpose of the study was to investigate the effects of HSD infusion on fluid balance and cardiorespiratory functions just after the end of cardiac surgery.Material and methods: Twenty patients with 3‐vessel coronary artery disease undergoing elective coronary artery bypass surgery were studied. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. The patients were allocated to receive just after the end of surgery either HSD or isotonic saline (4 ml . kg‐1 during 30 min) at random in a doubleblind single infusion. Ringer's acetate solution was added as needed to stabilise haemodynamics postoperatively.Results: HSD caused mobilisation of the retained intraoperative fluid excess, and increased diuresis. Despite reduced need for extra fluid and a decreased cumulative fluid balance, after HSD infusion patients had increased filling pressures of the heart and improved cardiac output. HSD infusion also induced reduced intrapulmonary venous admixture and improved PaO2 in the early postoperative period.Conclusions: The present study documents that infused hypertonic saline with dextran just after the end of cardiac surgery resulted in mobilisation of the intraoperative fluid excess with increased urine output in the early postoperative period and improved gas exchange. Despite reduced need for extra i.v. fluid and decreased cumulative fluid balance, after HSD infusion the patients had increased filling pressures of the heart with improved cardiac output.
Influence of arterial carbon dioxide tension on systemic vascular resistance in patients undergoing cardiopulmonary bypass
Authors: BuhreM.D W. , Weyland A. , Grüne F. , derVelde J. van , Schorn B. , Kazmaier S. , Sonntag H. 
Published: January 2009

Background: The effects of induced hypothermia in cardiac surgical patients are not yet fully understood. Despite numerous studies on the effects of acid‐base management on organ blood flow, only little information is available on the effects of α‐stat versus pH‐stat management on systemic haemodynamics. We therefore compared the effect of a‐stat and pH‐stat acid‐base management on systemic haemodynamics in a prospective, controlled, cross‐over study.Methods: Twenty patients undergoing coronary artery bypass surgery were included in the study. Cardiac output was measured by thermodilution. Cardiac index and systemic vascular resistance were calculated according to standard formulae. Measurements were performed under hypo‐ and hypercapnia after induction of anaesthesia. Measurements were repeated at the end of two 30‐min periods of pH‐stat and α‐stat acid‐base management, respectively.Results: Systemic vascular resistance at the lower PaCO2‐levels (hypocapnia and α‐stat, respectively) was significantly higher than those at the higher level (hypercania and pH‐stat, respectively). The periods of different PaCO2‐levels were comparable with respect to haematocrit, blood viscosity and temperature. Systemic vascular resistance was not significantly different from the control period.Conclusions: This study demonstrates that during hypothermic cardiopulmonary bypass, systemic vascular resistance underα‐stat acid‐base management is higher than under pH‐stat management. As obvious from measurements during the control period, this finding can be completely explained by the difference in PaCO2.
Central and mixed venous blood oxygen correlate well during acute normovolemic hemodilution in anesthetized pigs
Authors: Schou Dr.H. , DeSa V. Perez , Larsson A. 
Published: January 2009

Background: Central venous oxygen saturation (ScvO2) and oxygen tension (pcvO2), obtained from the superior vena cava, correlate well with mixed venous (pulmonary arterial) oxygen saturation (SvO2) and tension (pvO2) when the hematocrit is normal. The present study was undertaken to assess whether extreme hemodilution affects this relation.Methods: We compared mixed and central venous blood during graded arterial desaturation (inspired fraction of oxygen (FIO2) between 1.0 and 0.10) in 10 hemodiluted pigs, and in 10 pigs with normal hematocrit (control), during fentanyl‐ketamine‐pancuronium anesthesia and mechanical ventilation.Results: Arterial oxygen saturation decreased from 100% at FIO2=1.0 to 44 ± 12% at FIO2=0.10 (mean ± SD). Venous oxygen saturation ranged from 3.5% to 97.3%. The regression coefficient between SvO2 and ScvO2 was 0.97 (R2= 0.93, bias ‐2.4 ± 5.8%) in the hemodiluted and 0.99 (R2= 0.97, bias ‐3.0 ± 5.0%) in the control group. Venous oxygen tension values ranged from 0.5 kPa to 9.5 kPa, and the regression coefficient for oxygen tension was 0.94 (R2= 0.89, bias ‐0.20 ± 0.47 kPa) in the hemodiluted and 0.99 (R2= 0.97, bias ‐0.43 ± 0.48 kPa) in the control group. The regression coefficient for pH was 0.95 in the hemodiluted and 0.98 in the control animals.Conclusion: The findings indicate that also during hemodilution monitoring of central venous blood oxygen may be as useful as monitoring of mixed venous blood oxygen.
Transfusion policies in coronary artery bypass — a nationwide survey in Finland
Authors: Kytölä L. , Nuutinen L. , Myllylä G. 
Published: January 2009

Background: Since the discovery of HIV, minimizing the use of donor blood has become increasingly important in surgical activity. In Finland, however, the use of homologous red blood has grown considerably during the past years. Therefore, we found it necessary to conduct a nationwide survey of transfusion practices in elective surgery. This report deals with transfusions in coronary artery bypass (CABG) operations in all Finnish cardiac centres.Methods: The study group comprised 804 primary CABG patients operated during a 2‐year period. Two reviewers retrospectively examined the data concerning the use of and indications for homologous and autologous blood in the patient charts.Results: In all, 705 (88%) of patients received homologous blood. The proportions of patients receiving blood components differed between hospitals: from 53 to 99% for red cells, 2 to 22% for fresh frozen plasma and 5 to 49% for platelets. The variation was not caused by diverse patient populations: the mean number of blood component units transfused per patient differed from 1 to 6 between centres — even after adjustment for confounding variables. Multiple blood conservation methods were used in one centre. Nevertheless, homologous blood was administered to 88% of their patients.Conclusions: A considerable proportion of CABG patients are transfused with homologous blood in Finland compared to other countries. In addition, the transfusion practices proved highly variable between hospitals and were determined largely by local opinions. This study reveals a clear demand for prospective studies and constructive discussion among anaesthesiologists to establish uniform guidelines for blood use in cardiac surgery.
Effects of propofol vs isoflurane on respiratory gas exchange during laparoscopic cholecystectomy
Authors: Gehring Dr.H. , Kuhmann K. , Klotz K. F. , Ocklitz E. , RothIsigkeit A. , SedemundAdib B. , Schmucker P. 
Published: January 2009

Background: Respiratory function and pulmonary gas exchange are affected in laparoscopic procedures where a pneumoperitoneum is introduced using CO2. Previous studies have shown differing results concerning pulmonary gas exchange during laparoscopic procedures: Whereas in patients undergoing isoflurane anaesthesia decreases in PaO2 are demonstrated, this factor remains unchanged in patients undergoing propofol anaesthesia. In the present study, the effects of propofol on pulmonary gas exchange were compared with those of isoflurane in patients undergoing elective laparoscopic cholecystectomy in a prospective randomised manner.Methods: Twenty ASA patients with physical status I and II were divided randomly between isoflurane (IG) and propofol groups (PG). After induction of anaesthesia patients were moderately hyperventilated. Respirator settings remained unchanged during pneumoperitoneum (PP) until 10 min after deflation of the peritoneal cavity. Blood gas analyses were performed at 5 time points: 15 min after induction of anaesthesia (giving pre‐PP values), immediately before carbon dioxide insufflation (0 min PP), after both 30 and 60 min of PP and 10 min post PP. Inspiration plateau pressure (Pplat), compliance of the respiratory system, and both ins‐ and expiratory gas concentrations were continuously recorded by an Ultima V® monitor (Datex Corp., Helsinki, Finland). The difference between arterial and end‐tidal CO2 partial pressure (P(a‐et)CO2) was calculated so as to allow assessment of physiological dead space by the modified Bohr equation.Results: Pulmonary gas exchange differed significantly after 30 min of PP between the IG and the PG. At this time, PaO2 was 19.5 ± 2.9 kPa (mean ± SD) in the IG and 23.1 ± 1.8 kPa in the PG (P<0.01), whereas PaCO2 was 5.5 ± 0.37 kPa in the IG and 4.9 ± 0.27 kPa in the PG (P<0.01). These discrepancies remained until after carbon dioxide desufflation. At 10 min post PP, PaO2 was 18.3 ± 2.6 kPa in the isoflurane group and 21.9 ± 2.2 kPa in the propofol group (P<0.01), whereas PaCO2 was 5.4 ± 0.46 kPa in the IG and 4.8 ± 0.22 kPa in the PG (P<0.01). During carbon dioxide insufflation the P(a‐et)CO2 increased significantly in the IG from 0.47 ± 0.13 kPa to 0.76 ± 0.37 kPa (P<0.05), while the values in the PG remained constant.Conclusion: This study demonstrates that pulmonary gas exchange in patients with laparoscopic cholecystectomy is affected by the choice of anaesthetic procedure. During and after laparoscopic cholecystectomy using isoflurane as the anaesthetic, the PaCO2 is significantly higher and the PaO2 significantly lower than they are with propofol.
The palm print as a sensitive predictor of difficult laryngoscopy in diabetics
Authors: Nadal J. L. Y. , Fernandez B. G. , Escobar I. C. , Black M. , RosenblattM.D W. H. 
Published: January 2009

Background: Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom tracheal intubation may be difficult because of glycosylation of both metacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indices in a diabetic population.Method: 83 adult, diabetic patients scheduled for surgery under general anesthesia were evaluated preoperatively using 4 physical examination indices predictive of difficult laryngoscopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index was calculated.Results: The palm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies.Conclusion: We believe that in the diabetic population, the palm print index may be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have greater utility, in distinct populations as compared to when they are applied to all patients.
Prevention of nausea and vomiting in female patients undergoing breast surgery: A comparison with granisetron, droperidol, metoclopramide and placebo
Authors: Fujii Dr.Y. , Tanaka H. , Toyooka H. 
Published: January 2009

Background: Breast surgery is associated with a relatively high incidence of postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the efficacy of granisetron, droperidol and metoclopramide for preventing PONV after breast surgery.Methods: In a randomized, double‐blind, placebo‐controlled trial, 120 female patients received granisetron 40μg.kg‐1, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n=30 for each) intravenously immediately before the induction of anaesthesia. A standard general anaesthetic technique was employed throughout. Postoperatively, during the first 24 h after anaesthesia, the incidence of PONV and adverse events was recorded.Results: The incidence of PONV was 17% with granisetron, 37% with droperidol, 43% with metoclopramide and 50% with placebo (P<0.05; overall Fisher's exact probability test). The incidence of adverse events was not different among the groups.Conclusion: Granisetron is highly effective for reducing the incidence of PONV in female patients undergoing breast surgery. Droperidol and metoclopramide are ineffective in this population.
Effects of veratridine on mechanical responses of human malignant hyperthermic muscle fibers
Authors: Adnet P. J. , Etchrivi T. S. , Halle I. , Haudecoeur G. , Reyford H. G. , Krivosic‐Horber R. M. 
Published: January 2009

Background: To determine if alteration in the function of the sodium channel may in turn modify halothane‐induced changes in mechanical responses of muscle bundles from patients susceptible to malignant hyperthermia (MH).Methods: Mechanical responses of muscle bundles from 12 MH‐susceptible and 20 MH non‐susceptible patients were measured prior to and during administration of halothane alone and in the presence of 10μM veratridine, an inhibitor of sodium channel inactivation. Peak tension (PT), time to peak tension (TPT), positive peak of isometric tension derivative (+dP/dtmax) were used to characterize the inotropic state. Analysis of relaxation process was performed using half relaxation time (RT1/2) and the negative peak of isometric tension derivative (‐dP/dtmax). The ratio (R)=(+dP/dtmax)/(‐dP/dtmax) was used to measure the coupling between contraction and relaxation under isometric condition.Results: Veratridine significantly enhanced the 0.5, 1, 2 and 3 vol% halothane‐induced contracture and induced a negative inotropic effect in MH‐susceptible muscle bundles. R increased by nearly 90% indicating that the combined effects were more pronounced in the relaxation phase. In MH non‐susceptible muscle, veratridine did not significantly enhance the effects of halothane.Conclusions: These results on cut MH‐susceptible human muscle bundles support the hypothesis that halothane‐induced contracture in MH can be modified by the binding of an inhibitor of sodium channel inactivation.
Efficacy of EMLA® cream prior to dorsal penile nerve block for circumcision in children
Authors: SerourM.D F. , Mandelberg A. , Zabeeda D. , Mori J. , Ezra S. 
Published: January 2009

Background: While circumcision may be performed solely with dorsal penile nerve block (DPNB), some painful steps in its use are skin needle penetration and infiltration of the anesthetic product. The objective of this study was to evaluate the efficacy of EML® cream, prior to DPNB for circumcision in children.Methods: We conducted a prospective, randomized, double‐blinded, placebo‐controlled study with 42 children undergoing circumcision with DPNB alone, as an ambulatory procedure. Overall efficacy of EMLA® cream (Group A) during needle penetration and infiltration was assessed using a visual analog scale, compared with a placebo cream (Group B). Patients were asked to orally report any pain during skin needle penetration and infiltration of anesthetic, and were graded from 1 to 4 according to intensity of pain, as 1) none, 2) slight, 3) moderate, or 4) severe. The child graded the global discomfort of the entire procedure using the visual analog scale.Results: When assessing needle penetration, none from Group A suffered any pain, whereas all from Group B suffered at least mild pain. Considering infiltration of the anesthetic, all children suffered at least slight‐to‐moderate pain. Based on the children's visual analog scale scores, EMLA® cream has no beneficial effect for penile block.Conclusion: Since the dorsal penile nerves are located under the Buck's fascia, topical anesthesia may not reach them and other techniques may be necessary to anesthetize them. We found that although EMLA® cream is efficient as a topical anesthesia during needle penetration for DPNB, it has no beneficial effect during infiltration.
Pulmonary function in adult survivors of severe acute lung injury treated with inhaled nitric oxide
Authors: Luhr O. , Aardal S. , Nathorst‐Westfelt U. , Berggren L. , Johansson L.‐Å. , Wahlin L. , Frostell C. 
Published: January 2009

Background: Following an episode of acute respiratory distress syndrome (ARDS), some degree of measurable pulmonary impairment may be anticipated. ARDS is thought to be the more severe form of acute lung injury (ALI) and a recently proposed addition to conventional therapy in ALI/ARDS is inhaled nitric oxide (INO). We carried out a non‐randomised follow‐up study with pulmonary function tests on survivors of severe ALI/ARDS treated with INO.Methods: Sixteen previously healthy pulmonary patients, survivors of severe ALI/ARDS, were evaluated with pulmonary function tests >8 months after the acute event. The tests included static and dynamic spirometry, diffusion capacity for carbon monoxide (DLCO), blood gas analysis and evaluation of a chest radiograph.Results: The most common abnormality seen was a low DLCO in 69% of the patients. Abnormally low values were seen in forced vital capacity in 31%, in forced expiratory volume in 1 s in 13%, and in residual volume and total lung capacity in 6%. Blood gas data were within normal limits in 15/16 patients. All chest radiographs showed resolution of the interstitial and alveolar changes present during the acute event.Conclusion: In this non‐randomised follow‐up study we conclude that a degree of measurable pulmonary impairment after INO treatment in severe ALI/ARDS was common, but did not differ markedly from other published studies on pulmonary function in similar patient material. No late unexpected major abnormalities due to the inhaled nitric oxide treatment could be identified in these survivors.