bluuebunny/crossref_metadata_2025_split huggingface dataset:
Airway Closure and Closing Pressure During Mechanical Ventilation
Authors: Hedenstierna G. , McCarthy G. S. 
Published: January 2009

Six subjects without clinical evidence of lung disease were investigated for airway closure and airway closing pressure before and during fentanyl‐thiopentone anesthesia with mechanical ventilation. Airway closure was measured by single breath and FRC by multiple breath nitrogen washout. Airway closing pressure was taken to be the transpulmonary pressure at which airway closure commenced.Airway closure occurred within a normal breath in two out of six subjects breathing spontaneously, but in all during mechanical ventilation. Closing capacity was the same in both the awake and anesthetized states while FRC was reduced by 0.4 1 when anesthesia was instituted. Transpulmonary pressure at FRC was on average 1.5 cmH2O (0.15 kPa) and airway closing pressure 4.5 cmH2O (0.44 kPa) greater during anesthesia than in the awake state. Compliance of the lung, calculated both during a vital capacity maneuver and during a tidal breath, was lower with anesthesia. The results of this study suggest that the airways are less stable during mechanical ventilation. But, since lung compliance is lower during anesthesia, a higher transpulmonary pressure is required to maintain a given lung volume. Hence, airway closure occurs at the same lung volume in the anesthetized compared to the non‐anesthetized subject.
Intradermal Histamine Releasing Effect Caused by Org‐NC 45 A Comparison with Pancuronium, Metocurine and d‐Tubocurarine
Authors: Boorj L. H. D. J. , Erieg N. , Crul J. F. 
Published: January 2009

Hiatamine release caused by Org‐NC 45, pancuronium, metocurine and d‐tubocurarine was determined by measuring the diameter of the redness and skin induration following the intradermal injection of these drugs. d‐Tubocurarine and metocurine caused the largest diameter of redness and induration, followed by pancuronium.Org‐NC 45 caused the smallest reaction. We conclude that Org‐NC 45 may be the drug of choice in patients with asthma and allergic reactions.
The Use of Dioxonium as a Neuromuscular Blocking Agent
Authors: Salmenperå M. , Tammisto T. 
Published: January 2009

The feasibility of using dioxonium (Dx) as a neuromuscular blocking agent was evaluated in 66 patients anaesthetized for various surgical operations. To facilitate endotracheal intubation, initial bolus doses of 30,45 or 60 pg/kg were used. The onset and duration of block, as revealed by suppression of evoked twitch (thumb adduction) were measured in 30 patients with a force tranducer. Ten patients received 75pg/kgofpancuronium for comparison. Spontaneous and neostigmine‐supported recovery were compared after the three Dx doses. In 36 patients submitted for longer procedures, relaxation was maintained with additional 0.5 mg increments of Dx when needed.Increasing the initial bolus dosage of Dx from 30 μg/kg to 0 μg/kg accelerated the onset of a 90% block from 3.3 to 2.4 min and prolonged its duration from 23.1 to 32.9 min. The onset of block after 60 pg/kg of Dx was aignilicantly faster than obtained after 75 pg/kg Pc, which produced a 90% block of a comparable duration. The fade observed in the train of four stimulation at the same level of twitch suppression increased with the total dose of Dx used. This and the significant reversing effect of neostigmine after 45 and 60μg/kg, but not after 30 μg/kg of Dx indicated the dosage‐dependent change in the nature of the block from depolarizing to nondepolarizing. Side effects related to ciepolarization seemed to be minimal, hardly visible faxiculations occurring in 5 out of 12 patients after 60 pg/kg and in one out of 12 after 30 and 45 pg/kg of Dx. Residual muscle weakness incompatible with airusay maintenance and adequate spontaneous ventilation was encountered in 3 out of 66 patients, in spite of neostigrnine up to 4 mg. These patients had received over 100 μg/kg of Dx for procedures requiring maintenance of relaxation for over 2 hours, The dose‐dependent change in the nature of the block, the associated tachyphylaxis, and the unpredictable reversal with neostigmine after higher doses emphasize the need for careful monitoring of the neuromuscular junctions when Dx is used.
Simultaneous Computer‐Calculated Carbon Dioxide and Oxygen Direct Fick and Dye Dilution Measurements of Cardiac Output in Dogs
Authors: Noe F. E. , Whitty A. J. , Davies K. R. 
Published: January 2009

Cardiac output was measured by both indocyanine green dye dilution and the direct Fick method using computer‐calculated values for oxygen consumption and carbon dioxide excretion in eight mechanically ventilated dogs anesthetized with pentobarbital, with either tubocurarine or succinylcholine intravenous drip for neuromuscular relaxation. Sequential measurements were made during the anesthesia and in response to pharmacologically induced increased cardiac output using doxapram hydrochloride (1.5 mg/kg) given intravenously.The purpose of this project was to investigate the accuracy and reliability of the direct Fick measurements during anesthesia using computer‐calculated measurements of pulmonary gas exchange and, since these measurements have not been reported in detail previously, to establish tentative control values for future projects. The correlation of dye and direct Fick measurements of cardiac output during the first hour after induction of anesthesia was very good (r = 0.85 for all dye‐carbon dioxide Fick values; r = 0.83 for all dye‐oxygen 7 values).
Effects of Renal Function on Serum Fluoride Level in Dogs During and After Enflurane Anesthesia
Authors: Wickström I. , Stefansson T. , Sundström E. 
Published: January 2009

To study the effect of renal function on the increased serum inorganic fluoride level produced by the metabolism of enflurane, three groups of beagle dogs were exposed to prolonged enflurane anesthesia, 1.25 MAC for 8 h. One group was studied both with and without renal function, one group only without renal function, and one group on two different occasions with renal function intact. Serum inorganic fluoride levels were determined every hour during the enflurane anesthesia and on termination for a further 4 h. In dogs with no renal function, the increase rate and the peak of serum inorganic fluoride level were significantly higher than in dogs with renal function. The average peak level in dogs with renal function was 21.4 μmol/1 and in dogs with no renal function 38.4 μmol/1.Renal function was found to have the same capacity to increase the inorganic fluoride elimination from serum as other routes of elimination. At corresponding serum levels, the rate of decrease after terminating enflurane anesthesia was 3.5–4.0 μmol/1/h lower without renal function. Reanesthesia after 3 weeks did not significantly change the serum inorganic fluoride levels compared to the first anesthesia.
Comparison of Physostigmine and Neostigmine for Antagonism of Neuromuscular Block
Authors: Salmenperä M. , Nilsson E. 
Published: January 2009

The ability of physostigmine alone and in combination with neostigmine to reverse d‐tubocurarine‐induced neuromuscular block was evaluated in surgical patients. The relaxation was maintained at a level of90 % twitch suppression during balanced anaesthesia, and antagonism was attempted with physostigmine 1.5 mgX3; neostigmine 0.5 mgX3; neostigmine 1.0 mgX3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg × 3.The measured parameters included the twitch force or EMG amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 Hz stimulation and fading of these responses after repetitive 2 and 50 Hz stimuli. Although the restitution rate of twitch height and EMG amplitude were essentially the same with both antagonists, there was a considerable time‐lag in regeneration of the fades after repetitive stimuli with physostigmine as compared with the neostigmine group. The addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. The clinical antagonism was satisfactory in all patients receiving physostigmine. The divergence of relaxation‐indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of the two antagonists at the neuromuscular junction.
Midazolam for Induction of Anaesthesia in Outpatients: A Comparison with Thiopentone
Authors: Berggren L. , Eriksson I. 
Published: January 2009

Midazolam, a new water‐soluble benzodiazepine, with an elimination half‐life of approximately 2 h, was compared with thiopentone for induction of general Anaesthesia in a randomized, single‐blind study. The patients were 60 healthy women undergoing legal abortion as outpatients. Midazolam provided smooth and reliable induction of Anaesthesia with few side‐effects. However, the induction time was considerably longer in the midazolam group (82.3 + 6.1) than in the thiopentone group (45.9 ±1.7 s). The dose of midazolam required for induction was 0.36±0.01 mg/kg, while that of thiopentone was 6.43 ±0.21 mg/kg. Apnoea occurred with a frequency of 10 % in the midazolam group and 55 % in the thiopentone group, but was of equal duration in both groups. Circulatory conditions were more stable during induction with midazolam, with a slower fall in blood pressure and no change in heart rate. The patients were breathing O2/N2O in proportions of 1:2.To ensure adequate surgical anaesthesia, it was necessary to add halothane for short periods for all patients in the midazolam group and for 79% of the thiopentone group. Postoperatively, all patients who had received midazolam, but none induced with thiopentone, had anterograde amnesia; this lasted for more than 1 h. All patients in both groups could leave the hospital after routine postoperative observation for 3–4 h. Venous tolerance was good for both drugs.
Influence of Epidural Morphine on Postoperative Pain, Endocrine‐Metabolic, and Renal Responses to Surgery. A Controlled Study
Authors: Jørgensen B. C. , Andersen H. B. , Engquist A. 
Published: January 2009

In order to assess the analgesic properties of epidural low‐dose morphine and its possible influence on thr adrenocortical, hyperglycemic, renal, electrolyte and leukocyte responses to surgery and nitrogen excretion, a double‐blind randomized study was undertaken in 14 otherwise healthy patients admitted lor hysterectomy under halothane, N2O/O2 anesthesia. Before induction of anesthesia, an epidural catheter was introduced into the lumbar epidural space. After induction of anesthesia, either morphine 4 mg in 10 ml saline or 10 ml saline was injected into the epidural space, according to the allocation. Postoperatively, the degree of pain was evaluated by means of a visual analogue scale (0–10). When pain score exceeded 5 points during the 24‐h trial, either 4 mg morphine in saline or saline was given epidurally. If the pain score did not decrease more than 2 points after an epidural injection, morphine was given parenterally (5 mg i.v. f 5 mg i.m.). The results showed that pain scores, duration of pain relief and doses of morphine differed significantly between groups (P<0.05). Plasma concentrations of cortisol and glucose, plasma‐ and urine electrolytes, 24‐h creatinine and free‐water clearances, diuresis, fluid balance, leukocyte count and nitrogen excretion differed insignificantly between groups.In conclusion, epidural low‐dose morphine is a superior alternative to conventional postoperative pain treatment because of greater and longer lasting pain relief, without apparent side‐effects. The measured endocrine‐metabolic and renal responses did not differ between groups, indicating that low‐dose epidural morphine does not inhibit afferent neurogenic stimuli from the site of surgical trauma.
Addition of Drugs to Infusion Fluids Pharmaceutical Considerations on Preparation and Use
Authors: MYHR KIRSTEN 
Published: January 2009

In most hospitals, the addition of drugs to infusion fluids is carried out by nurses. The preparation involves certain hazards both microbiologically and pharmaceutically. Incompatibilities between drug and fluid or between drugs may result in admixtures which have reduced therapeutic activity or which are even hazardous to the patient.The all‐in‐one total parenteral nutrition mixtures represent a new way of administering nutrition and has achieved increased popularity both for in‐ and outpatients. During preparation, which takes place in the pharmacy, several precautions have to be taken to assure a product with acceptable stability. Some of the important incompatibilities are mentioned.
Long‐term Parenteral Nutrition Using a Mixture of Fat, Amino Acids and Carbohydrates in a Single Three‐Litre Bag
Authors: FLAATTEN H. 
Published: January 2009

Long‐term parenteral nutrition is today an established therapy, both in hospitals and at home. A variety of patients with chronic intestinal dysfunction, leading to malnutrition, are candidates for this treatment.There are however several problems related to this therapy, some of which can be attributed to the infusion system. In Scandinavia most patients receiving parenteral nutrition are given separate bottles of aminoacids, fat‐emulsions and carbohydrates. This method has several disadvantages. A new system which includes premixing of all nutrients in a single bag is discussed. Nutrients are mixed in three litre bags in the hospital pharmacy, under optimal conditions, and can be stored refrigerated for several days.
The Benzodiazepines: A pharmacological overview
Authors: Oreland Lars 
Published: January 2009

Benzodiazepines exert their effects by facilitating neurotransmission in GABAergic synapses, probably by increasing the affinity of the GABA receptor to GABA. Stimulation of GABA receptors (at least of the A type) opens chloride ion channels which inhibits the ability of the cell (e.g. monoaminergic or cholinergic) to conduct nerve impulses. The endogenous ligand for the benzodiazepine receptor is probably a peptide, which is able to induce “anxiety” in rats. Thus, if the benzodiazepines are receptor agonists, the endogenous ligand would be an antagonist.The clinical effects resulting from the above mechanism of action (anticonvulsant, muscle relaxant, anxiolytic, sedative‐hypnotic and amnesic) are discussed with special attention to preoperative sedation in dental practice.
Immunologic transfusion reactions
Authors: Högman Claes F. 
Published: January 2009

ABO blood group incompatibility is of major concern because the antibodies frequently cause intravascular destruction leading to the most clinically severe complications.Irregular erythrocyte antibodies seldom cause intravascular destruction. However, when the antibodies bind complement and are present in high concentration the extravascular destruction occurs predominantly in the liver and may cause a clinically severe reaction with hemoglobinemia, shock and DIC. Those IgG class antibodies which do not bind complement cause a spleen‐mediated, more or less drastically shortened life span of the red cells with unpleasant but usually not life threatening consequences for the patient. The transfusion reaction may occur with a delay of several days.Compatibility testing may consist of either a cross‐match performed in such a way that both ABO incompatibility and irregular antibodies are detected, or a type‐and‐screen procedure. In the latter a computerized delivery control checking the patient's previous serological history and the donor/recipient compatibility is a recent improvement and rationalization.In an acute situation a reduction of the normal security measures may be necessary. The clinician responsible for the patient must know the time needed for carrying out an acute blood group determination and compatibility test in the hospital and must give instructions about what normal security measures that should be refrained from.Blood group incompatible transfusions have nowadays a much better prognosis than earlier, provided a rapid diagnosis can be made and appropriate treatment can be started promptly.Formation of antibodies against leukocyte/thrombocyte antigens is a frequent consequence of transfusion which, however, can be prevented by modern blood component therapy. Such antibodies are a frequent cause of refractoriness to platelet transfusions in bone marrow aplasia patients.Plasma may cause transfusion reactions in two ways: (1) by transfer of plasma proteins which react with antibodies in the recipient, (2) by transfer of antibodies which react with cellular elements or plasma proteins in the recipient. Clinically mild reactions with urticaria and a failing plasma volume expansion are common, severe reactions with anaphylactoid shock, pulmonary complications and cellular destruction are rare.
Safety of blood and blood products in Scandinavia today
Authors: Lindholm Annika 
Published: January 2009

The safety of blood and blood products in Scandinavia today is high. An absolutely safe blood supply is, however, an unattainable goal. The dominating risk is transmission of non‐A, non‐B virus (NANBV). The calculated per blood unit risk is 1:200. The incidence of cirrhosis due to post‐transfusion hepatitis NANB is calculated to at most 0.1 % among recipients of blood components from about 5 donors. Other risk factors are transmission of hepatitis B virus (HBV), human immunodeficiency virus (HIV‐1) and cytomegalovirus (CMV). The prevalence of HBsAg among first time donors is about 0.05% (Sweden). In Scandinavia, anti‐HIV‐1 has been found in 0.001% of donations from start of screening in 1985 to December 1987. The prevalence was higher in Denmark, lower in Finland (and perhaps Iceland). The prevalence has declined during the last years. As of June 1988, 117 patients in the Scandinavian countries have been infected by blood components, all but 2 before screening was introduced. Besides these, 226 haemophiliacs have been infected by, in almost all cases, imported clotting factor concentrates before heat treatment was introduced. Most of the infected patients are still asymptomatic.About 70% of blood donors have anti‐CMV, a few percent of which will transmit CMV‐infection, with severe symptoms, to immunosuppressed patients without anti‐CMV.
Predeposit autologous blood donation
Authors: Stehling Linda 
Published: January 2009

Predeposit autologous donation for elective surgical procedures during which there is a potential requirement for transfusion is medically proven as safe and efficacious but significantly underutilized. The primary advantages are avoidance of transfusion‐transmitted disease and alloimmunization. Appropriate donor selection is essential. In general, there are no age or weight limits for donors. The incidence of adverse reactions is no greater in properly selected autologous donors than in homologous donors. Administration of oral ferrous sulfate allows many patients to meet all of their perioperative transfusion requirements. The blood is usually stored in the liquid state, but can be frozen.The mere availability of autologous blood is not an indication for its reinfusion. The criteria for transfusion are similar to those for homologous blood. However, a more liberal interpretation may be appropriate in some clinical situations. The issue of disposition of predonated blood which is not transfused to donor‐patients remains unresolved. In some areas all units are discarded. In others, the blood can be administered to other patients if the donor met all the criteria for homologous donors and the blood tested negative for infectious disease markers.
Postoperative pain treatment on wards – USA experience
Authors: Ready LB 
Published: January 2009

A large variety of treatment options are now available to experienced pain therapists. Effective doses of opioids can be administered by the oral, rectal, transdermal, or sublingual route, or by subcutaneous, intramuscular, or intravenous injection or infusion. Patient–controlled analgesia (PCA) is now familiar and commonly available. Most PCA pumps also offer the option to add a continuous background infusion to the basic patinet–controlled mode with the possibility of therapeutic benefits and new problems. Alternative delivery routes and PCA drugs have been reported.A variety of neural blockade techniques can provide effective and safe analgesia. These include topical application, local infiltration of incicions, and blockade of peripheral nerves or plexuses. Intrathecal and epidural opioids are now commonly used to control pain following a wide variety of surgical procedures, but many questions remain to be answered.The concept of postoperative pain management by anesthesiologists is growing in popularity in North America. It is not surprising that such a revolutionaryidea involving basic changes in long–established practices is receiving attention not only from clinicians, but also from economists and politicians. One manifestation of this attention in the United States is a clinical practice guideline entitled Acute Pain Management: Operative or Medical Procedures and Trauma. Important elements of the guideline include recognition of historic inadequacies in postoperative pain management and acknowledgement of the importance of effective pain control.
Anaesthetic depth and auditory evoked potentials
Authors: Thornton C. , Creagh–Barry P. , Jordan C. , Newton DEF 
Published: January 2009

We have investigated the auditory evoked response (AER) in a series of experimental and clinical studies to assess its usefulness as a measure of depth of anaesthesia. Three questions were posed. Does the AER show: –l) graded changes with increasing concentrations of general anaesthetics which are similar for different anaesthetic drugs 2) appropriate changes with surgical stimulation 3) changes with loss of consciousness?The AER was found to satisfy these criteria in that six general anaesthetics, belonging to different chemical groups, showed similar graded reductions in the amplitudes and increases in the latencies of the AER waves originating from the primary cortical section of the auditory nerve pathway. These changes were reversed by surgical stimulation indicating that the AER does not simply act as a concentration monitor but reflects true depth of anaesthesia. In addition there were changes in these early cortical AER waves which indicate potential awareness.The clinical investigations also suggested that the AER is a valid measure of depth of anaesthesia. A numerical index derived from the AER decreased when the anaesthetic blood concentration increased and increased when surgical stimulation increased in severity. The numerical index gave the same value at the same depth of anaesthesia in different patients. This means that a monitoring device based on the AER would not have to be calibrated separately for each patient and further that it could be attached to the patient when they are already anaesthetised. Further work is in progress on the display of information for the anaesthetist and in reducing the time taken to produce a reliable response.