bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous sedation for retrobulbar injection and eye surgery: Diazepam and/or propofol?
Authors: Hampl K. F. , Marsch S. C. U. , Erb T. , Drewe J. , Schneider M. C. 
Published: January 2009

Principle goals of sedation for eye surgery are to provide patient comfort and to allow the patient to stay calm during both retrobulbar injection and surgery. Insufficient sedation may not prevent the patient from moving during retrobulbar injection, whereas very deep sedation may result in respiratory complications during surgery. The aim of the present study was to evaluates the effectiveness and suitability of a combination of diazepam and propofol for sedation for both application of retrobulbar block and subsequent elective eye surgery.One‐hundred and fifty patients were randomly allocated to receive either diazepam, propofol or a combination of both drugs before retrobulbar injection. Tolerance of retrobulbar injection and comfort during the surgical procedure were assessed by comfort scores using a nominal analogue scale between 1 (worst possible condition) and 6 (best conceivable condition). Side effects related to sedation were recorded.The combination of diazepam and propofol resulted in the highest comfort scores for both retrobulbar block (5.3±0.3) and the surgical procedure (5.4±0.4). Diazepam alone did not produce adequate sedation for retrobulbar block (3.1±0.3), whereas comfort scores during surgery were significantly higher (5.3±0.3) compared to propofol alone (3.6±0.4). No severe side effects induced by sedation were noted in any of the study groups.The combination of diazepam and propofol proved able to provide a reliable degree of sedation with minimal side effects for both retrobulbar block and surgery. The combination was clearly superior to the sedation induced by propofol or diazepam alone.
Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty?
Authors: Hendolin H. , Nuutinen L. , Kokki H. , Tuomisto L. 
Published: January 2009

Evidence of pre‐emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain.Forty‐one patients undergoing total knee arthroplasty were randomly allocated to four groups. Two groups received epidural morphine, 4 mg immediately after operation and 3 mg ten hours later, and two groups the same volume of saline. All patients had access to intravenous PCA‐fentanyl. One epidural morphine and one epidural saline group (PreEpiMo and PreMo, respectively) received morphine, 0.14 mg/kg i.m. as premedication. Pain was measured with a visual analogue scale (VAS). Respiration was monitored by means of pulseoximetry, arterial blood gas analysis and rate of breathing.Morphine premedication reduced postoperative pain in the immediate postoperative period in patients with epidural placebo (PreMo), hut the effect was absent in patients with PreEpiMo. Epidural morphine (EpiMo) provided stable analgesia with reduced need of PCA‐fentanyl. Two patients (10%) (one in EpiMo and one in PreEpiMo) developed respiratory depression requiring naloxone treatment. The dosage of epidural morphine used in this study was a likely explanation of this depression. Nausea, vomiting, itching and urinary retention were the most frequent side effects without significant differences between the groups. In conclusion, morphine premedication had a temporary rest effect on the postoperative pain. Epidural morphine provides a better analgesia than intravenous PCA‐fentanyl.
Decrease in plasma volume from intra‐abdominal trauma in rats is prevented by H1 but not by H2 histaminergic blockade
Authors: Larmark M. , Lisander B. 
Published: January 2009

Intra‐abdominal surgery causes plasma extravasation which, in the rat, is prevented by combined histaminergic H1 and H2 blockade. We evaluated the relative importance of H1 and H2 blockade in this situation.Cloralose‐anaesthetized Wistar rats were subjected to a standardized abdominal trauma. Mean arterial pressure (MAP), heart rate (HR) and haematocrit (Hct) were monitored and plasma volume (PV) was determined before and 1 h after the trauma.Compared to non‐traumatized rats (n=8), the trauma decreased PV and increased Hct (n=8). MAP decreased during the actual trauma, whereas HR remained stable throughout. In animals given cimetidine 25 mg kg‐1 i.v. just prior to the trauma (n=8), PV, Hct and MAP changed, as in the non‐blocked rats. In contrast, pyrilamine, 10 mg kg‐1 completely prevented the decrease in PV and the increase in Hct (n=7), but not the decrease in MAP.The findings suggest that a histaminergic HI mechanism is of importance for the plasma loss elicited by intra‐abdominal trauma.
Rapidly progressive pulmonary artery hypertension and end‐stage liver disease
Authors: Mortier E. , Ongenae M. , Poelaert J. , Blauwen N. den , Decruyenaere J. , Aken J. van , Rolly G. 
Published: January 2009

Pulmonary hypertension is a recognized but unusual complication of liver disease. It can complicate the perioperative course of liver transplantation. Mild to moderate pulmonary hypertension is generally well tolerated during the procedure and does not appear to contribute to mortality.Since the pulmonary vascular disease may progress rapidly, it may have advanced to the point of irreversibility at the time of surgery. So, patients with known moderate pulmonary hypertension should have pulmonary arterial catheterisation immediately prior to transplantation. If pulmonary artery hypertension has become severe, then a preoperative trial of vasodilators is warranted. If this fails, the procedure should be cancelled.We present a patient with alcoholic liver cirrhosis in whom a rapidly progressive pulmonary hypertension made liver transplantation impossible.
High‐dose fentanyl does not suppress interleukin‐1β‐induced increases in plasma ACTH and corticosterone in rats
Authors: Numai T. , Inaba H. 
Published: January 2009

Background. High‐dose fentanyl anesthesia is reported to attenuate the metabolic and endocrinal responses to surgery. Interleu‐kin‐1 (II‐1) is one of the key mediators in the immunono‐neuroendocrine system, and may be involved in the stress responses to surgery. We studied whether high‐dose fentanyl may influence the II.‐1β‐induced alterations in plasma ACTH and corticosterone in rats.Methods. Plasma ACTH, corticosterone, blood pressure, heart rate and acid‐base status were determined in either awake or fentanyl‐anesthetized animals immediately before and after either phosphate buffered saline or IL‐1β administration. Fentanyl anesthesia was induced by bolus intravenous injections of fentanyl at 50 μg/kg and pancuronium bromide at 0.2 mg/kg, and maintained by continuous administrations of fentanyl at 100 or 200 μg·kg‐1·h‐1 and pancuronium bromide at 0.4 μg·k‐1·h‐1.Results. In awake rats, IL‐lβ at incremental doses of 0.25, 0.5 and 1 μg/kg increased plasma ACTH in a dose‐dependent manner, but heat‐inactivated IL‐1β at 4 μkg did not influence plasma ACTH. A noxious stimulus with tail clamping for 30 min did not significantly alter plasma ACTH in fentanyl‐anesthetized rats. Fentanyl reduced the basal plasma corticosterone, but it did not modulate the increases in plasma ACTH and corticosterone after the administration of IL‐1β at 1 μg/kg. Fentanyl moderately increased the basal blood pressure and heart rate, but it moderately attenuated the IL‐1β‐induced elevations of blood pressure and heart rate. IL‐1β moderately decreased PCO2 in awake animals.Conclusions. Fentanyl anesthesia, which is able to suppress the endocrine responses to noxious stimuli, does not attenuate the IL‐1β‐mediated activation of the pituitary‐adrenal axis in rats.
Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling
Authors: Gannedahl P. , Odeberg S. , Brodin L.‐Å. , Sollevi A. 
Published: January 2009

Background. Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may cause marked circulatory alterations.Methods. Eight anaesthetized cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy, were studied before and during pneumoperitoneum in three different postures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitoring.Results. PP significantly increased end‐diastolic area (EDA) and pulmonary capillary wedge pressure (PCWP) irrespective of posture. PCWP was significantly influenced by postural changes, whereas EDA was not. Further, changes in EDA and PCWP covaried during the investigation, but showed no linear correlation. Systolic function, measured as end‐systolic area (ESA) and fractional area shortening (FAS), was not altered. Diastolic function, as assessed by the velocity rate of the trans‐mitral flow during the early filling phase (E) and the atrial contraction (A), showed no change of the E/A ratio, whereas after the induction of PP there was a significant reduction of the E component.Conclusions. In cardiovascularly healthy patients, the left ventricular volume is increased during pneumoperitoneum. Further, changes in invasive pressure determinations (PCWP) do not correlate linearly with changes in volume indices of left ventricular filling (EDA).
Are neurologic events occurring during carotid artery surgery predictive of postoperative neurologic complications?
Authors: Walleck P. , Becquemin J. P. , Desgrances P. , Bonnet F. 
Published: January 2009

Background. Per‐ and postoperative neurologic complications occurring during carotid artery surgery may be related to different mechanisms. Nevertheless, recent studies suggest that they are related and that patients who develop reversible neurologic events peroperatively are at risk of postoperative neurologic complications. We, therefore, studied 265 patients operated under regional anaesthesia to assess the incidence and the pathogenesis of per‐ and postoperative neurologic disorders and their relationship.Method. Neurologic function was adequately assessed in 261 patients during surgery. The operation was uneventful in 234 patients, while 27 suffered from transient ischaemic neurologic deficit occurring mainly during carotid artery clamping.Results. Postoperative neurologic complications occurred in 6 (2.5%) of the patients who were symptom‐free during surgery and in 1 (3.7%) of the patients who experienced neurologic deficit during surgery (NS). In this group, two additional patients had peroperative neurologic deficit which lasted a few hours postoperatively so that the total incidence of postoperative neurologic deficit (11.1%) was significantly higher than in the other group (P < 0.05). Emboli (N=3) and carotid artery thrombosis (N=3) were the main causes of postoperative neurologic deficit.Conclusion. We conclude that patients who have suffered from a peroperative neurologic complication were more frequently in an unstable neurologic condition postoperatively. However, the incidence of “new” neurologic deficit, separated by a free interval from the one occurring peroperatively, was not significantly different in this group.
Control of body temperature during abdominal aortic surgery
Authors: Gregorini P. , Cangini D. 
Published: January 2009

Background. Careful control of body temperature during anesthesia aims to prevent cardiocirculatory complications during the phase of recovery from anesthesia. Numerous studies have examined methods for warming the gases breathed by the patient, but the question of whether low flow anesthesia or heat and moisture exchangers can also influence the pattern of body temperature remains unresolved.Methods. In this clinical trial we evaluated the mean body temperature profile measured at five points in 40 patients divided into two groups: Group I was ventilated with a non‐rebreathing circuit and Group II was ventilated with a circle system using low flow rates of fresh gases. All patients were treated with a hydrophobic heat moisture exchanger.Results. The results point out a significantly (P < 0.01) lower decrease in mean body temperature 40 min after the start of mechanical ventilation with the use of low flow rate anesthesia.Conclusions. This study shows that anesthesia carried out using low fresh gas flow rates and heat moisture exchanger is able to reduce the fall in mean body temperature, when compared with anesthesia carried out using high fresh gas flow rates and heat moisture exchanger.
Decreased coronary blood flow is not responsible for myocardial dysfunction during bupivacaine‐induced cardiotoxicity
Authors: Fujita Y. , Kimura K. , Mihira M. , Yasukawa T. 
Published: January 2009

Background. Although previous studies have shown that bupivacaine produces a dose‐dependent vasoconstriction, the possible effects of decreased coronary blood flow on myocardial dysfunction during bupivacaine‐induced cardiotoxicity have not been investigated.Methods. We carried out the present study using the in situ beating hearts of six beagles. An autoperfusion circuit was established from the left carotid artery to the anterior descending coronary artery (LAD). Its blood flow (QLAD) was measured with an electromagnetic flow meter, and myocardial oxygen consumption was calculated using Fick's principle. Regional myocardial function (systolic shortening: %SS, post‐systolic shortening: %PSS) of the LAD‐supplied region was evaluated by the sonomicrometric technique. While saline or bupivacaine (10 μg/ml) was continuously infused into the LAD in a crossover design, the effects of a vehicle (baseline), acetylcholine (1 and 3 μg/min), nitroglycerin (10 μg/min) and adenosine (10 μg/min) on coronary haemodynamics and regional myocardial function were evaluated.Results. Bupivacaine caused a decrease in QLAD and regional myocardial dysfunction (a decrease in %SS and an increase in %PSS) at the baseline. While acetylcholine and adenosine increased QLAD with intracoronary bupivacaine‐infusion, regional myocardial dysfunction was not reversed. There was a positive correlation between regional myocardial oxygen consumption and %SS in the whole study.Conclusions. The results of this study indicate that the decrease in QLAD during bupivacaine‐induced myocardial toxicity is not responsible for regional myocardial dysfunction, and, moreover, that it parallels a decrease in myocardial oxygen demand.
Postoperative complaints after spinal and thiopentone‐isoflurane anaesthesia in patients undergoing orthopaedic surgery Spinal versus general anaesthesia
Authors: Standl T. , Eckert S. , Esch J. Schulte AM 
Published: January 2009

Background. The present prospective study investigates the impact of a standardized technique of spinal and general anaesthesia on the incidence and consequences of postanaesthetic complaints dependent on age and sex of patients.Methods. 433 orthopaedic patients underwent lower limb surgery in spinal (group 1) or general (group 2) anaesthesia. Spinal anaesthesia was performed with 0.5% hyperbaric bupivacaine using a 26‐gauge Quincke needle. General anaesthesia was induced with i.v. injection of thiopentone, fentanyl and atracurium and maintained with 65% nitrous oxide and 1‐1.5 Vol% isoflurane in oxygen. On postoperative day 4, patients were interviewed for onset and duration of postoperative complaints.Results. The overall incidence of nausea/vomiting (P=0.025) and sore throat (P=0.001) was higher in group 2. In addition, nausea/vomiting was higher in patients between 20 and 60 years in group 2 compared with group 1. While the incidence of urinary dysfunction was higher in men after spinal (P=0.04), nausea/vomiting was more frequent in women after general anaesthesia (P=0.008). Analgetic requirements (P=0.013), time of postoperative surveillance (P=0.042) and frequency of treatment of postoperative complaints (P=0.0001) was higher in group 2.Conclusion. Spinal anaesthesia was associated with a lower incidence of postoperative complaints and treatments and a shorter surveillance compared to general anaesthesia. Specific complications related to spinal anaesthesia did not depend on age or sex and may allow for recommendation of this technique even in younger and female patients undergoing orthopaedic surgery.
Percutaneous chronic epidural catheterization in the rabbit
Authors: Taguchi H. , Murao K. , Nakamura K. , Uchida M. , Shingu K. 
Published: January 2009

Background. Although several epidural catheterizations in small animals have been reported, all of them were performed surgically and no percutaneous method has been reported. We have established a technique for percutaneous chronic epidural catheterization in rabbits.Methods. Following pentobarbital anesthesia, the animals (n=15) were fixed in a prone position using a fixing apparatus. A 19‐gauge Tuohy needle was inserted in the lumbar region at an angle of about 30° to the skin with the paramedian approach and advanced into the epidural space with the loss‐of‐resistance method. A 23‐gauge Nylon catheter was advanced cephalad in the epidural space and the distal tip was extruded from the neck following the subcutaneous tunnelling. The effects of 0.5 ml of 1% lidocaine injected through the catheter were observed for 10 days.Results. No behavioral or neurological abnormalities were observed after the catheterization except for one case of catheterization in the epidural vessel. Motor paralysis of hind‐limbs became manifest at 1–2 min after injection of 0.5 ml of 1% lidocaine through the catheter, and lasted 15–25 min. Autopsy revealed that the catheter was located in the lumbar epidural space in all animals and the distribution of methylene blue was consistent with that of lidocaine.Conclusion. This rabbit model can be used to investigate the effects of epidurally administered drugs.
Effects on complement activation and cytokine (TNF‐α and IL‐8) release of infusion of anti‐TNF‐antibodies or a xanthine derivative (HWA 138) in septic baboons
Authors: Bengtsson A. , Redl H. , Schlag G. , Mollnes T. E. , Högåsen K. 
Published: January 2009

Background. Sepsis and septic shock lead to activation of the complement cascade and to the release of pro‐inflammatory cytokines.Methods. The effects of E coli infusion and of infusion of anti‐TNF antibodies and a xanthine derivative (HWA 138) on complement activation and cytokine release was evaluated in 17 baboons. All animals received 5×108 live bacteria per kg body weight. Five animals received only bacteria, five received in addition 0.5 mg per kg body weight of anti‐TNF‐antibody, and seven received an infusion of 6 mg per kg body weight of HWA 138 in addition to the bacteria.Results. In baboons receiving 5×108 live E coli per kg body weight increased plasma levels of TCC, TNF‐α and IL‐8 were found. The release of TNF‐α was lower in the group receiving HWA 138 at 2 h after the infusion. In baboons receiving an infusion of anti‐TNF antibody the concentration of IL‐8 was lower at 2 and 4 h than in animals receiving just E coli or HWA 138.Conclusion. Infusion of anti‐TNF‐antibody before E coli infusion will decrease the formation of IL‐8. Infusion of HWA 138 before the E coli infusion will also inhibit the formation of TNF‐α.
Neutrophil and macrophage activation and anaphylatoxin formation in orthotopic liver transplantation without the use of veno‐venous bypass
Authors: Tomasdottir H. , Bengtson J. P. , Bengtsson A. 
Published: January 2009

Background. Activation of neutrophils and activation of complement may be an aetiologic factor behind circulatory insufficiency in association with reperfusion of the grafted liver.Methods. Neutrophil and macrophage activation (determined as PMN elastase and neopterin release) and complement activation were evaluated in 15 consecutive patients undergoing orthotopic liver transplantation without the use of veno‐venous bypass.Results. The PMN elastase concentrations were increased at the end ot the anhepatic phase, 2, 5 and 30 min after start of reperfusion and 6 and 24 h postoperatively. There were significantly higher PMN elastase concentrations in patients with circulatory instability (postreperfusion syndrome) compared with those without postreperfusion syndrome. The neopterin concentration was increased 2 min after the start of reperfusion and remained elevated until 6 h postoperatively. The plasma complement C3a concentrations were increased at the end of the anhepatic phase and 2, 5 and 30 min after the start of reperfusion. The plasma C3a levels were higher in patients with postreperfusion syndrome compared to those without.Conclusions. Activation of neutrophils and macrophages and of the complement cascade with the formation of biologically active substances may be one explanation for the circulatory instability often seen in patients undergoing orthotopic liver transplantation.
In vivo effects of tumor necrosis factor‐a on capillary permeability and vascular tone in a skeletal muscle
Authors: Jahr J. , Grände P.‐O. 
Published: January 2009

Background. The present study aims at analysing short‐term effects of TNFα on capillary permeability, on transcapillary fluid fluxes, and on vascular tone in a whole organ cat skeletal muscle in vivo preparation.Methods. The denervated muscle was isolated from the body but with intact vascular supply. The experimental setup allowed continuous recording of vascular tone, of hydrostatic capillary pressure and tissue volume variations. The capillary filtration coefficient (CFC), which represents the net effect for transcapillary fluid exchange of capillary permeability and number of open capillaries, was calculated before and during intra‐arterial TNF infusion.Results. We found that TNF had a minor effect on vascular tone in terms of a small vasodilation, and that no effect on hydrostatic capillary pressure could be recorded. CFC increased by 64% during the TNF infusion and this increase must be attributed to an increase in capillary permeability rather than an increase in the number of capillaries available for fluid exchange since the TNF effect on vascular tone is small. This was also supported by TNF‐induced transcapillary filtration.Conclusions. TNF is a potent drug for increasing capillary permeability causing transcapillary filtration in vivo. Its release, e.g. during sepsis, may therefore contribute to the capillary leakage often seen in this clinical situation.