bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Ability and Enflurane Defluorination in Surgical Patients
Authors: Rosenberg P. H. , Oikkonen M. , Neuvonen P. J. , Leander P. 
Published: January 2009

Antipyrine clearance and half‐life, which are measures of the hepatic metabolic ability, were determined prior to anaesthesia in 14 surgical patients. The antipyrine results correlated neither with the highest serum fluoride concentrations nor with the fluoride excretion in urine followingadministration of enflurane. Enzyme induction may therefore have little influence on enflurane metabolism in man. Inorganic fluoride concentrations in serum and in excreted urine were determined following the exposure of a total of 21 surgical patients to measured doses of enflurane. In the group of 14 patients tested for metabolic ability, a mean dose of 0.4 end‐tidal vol. %X h enflurane resulted in a mean peak serum fluoride concentration of 6.8 μmol/1 (maximum 13.6 μmol/l) 2 h after enflurane exposure. In the material as a whole, the enflurane dose was positively correlated with both post‐anaesthetic highest serum fluoride concentrations and the 24‐h fluoride excretion in urine. Furthermore, there was a correlation between the 24‐h post‐anaesthetic urine pH (P<0.01) as well as urine volume and fluoride excretion in urine during that time. At a urinary pH below 5.0, the fluoride excretion was very low, while the highest excretions were associated with a urinary pH of about 7.0.Raising the patient's per‐ and post‐anaesthetic urine pH and maintaining a good urinary output (which also tends to increase urine pH) may be enough to prevent accumulation of inorganic fluoride in the body following enflurane anaesthesia.
Enflurane Anesthesia in Living Donor Renal Transplantation
Authors: Wickström I. 
Published: January 2009

Two groups of patients undergoing elective living donor renal transplantation were studied during enflurane or halothane supplemented anesthesia. The duration of anesthesia was similar in both groups. The mean administered enflurane dose was 243 vol% min; the corresponding halothane dose was 56 vol% min. In the enflurane group, the mean serum inorganic fluoride level peaked at 21.0 μmol/1 3 h after the end of anesthesia. The inorganic fluoride level in urine produced by the renal graft increased continuously, but did not peak, during the first 24 postanesthetic hours.The renal graft quickly started to function in all patients in both groups. The frequency of rejection reactions was higher in the enflurane group than in the halothane group. Serum creatinine levels decreased rapidly in both groups. Urine flow was high on the day of transplantation, but normalized on the first postanesthetic day. Renal sodium clearance decreased earlier in the enflurane group than in the halothane group. This difference was statistically significant on the first postanesthetic day. In the enflurane group, the required pancuronium dose was significantly lower than in the halothane group. In one patient in the enflurane group, the serum inorganic fluoride level increased to 37.5 μmol/1.In this patient renal tubular function may have been affected, but the change was not conclusive since a pronounced rejection of the graft became evident. Since increases in serum inorganic fluoride level approaching 75% of the threshold level for nephrotoxicity in normal kidneys may occur, enflurane should not be routinely used in anesthesia for renal transplantation.
Central Haemodynamics and Oxygen Transport During CPAP With and Without Mandatory Ventilations
Authors: Vuori A. , Klossner J. 
Published: January 2009

Ten patients, subjected 16 h earlier to open‐heart surgery (aortocoronary bypass and/or aortic valve replacement), were studied during the weaning period after postoperative mechanical ventilation. Central haemodynamics and oxygen transport were assessed along with total oxygen consumption during continuous positive airway pressure with four mandatory ventilations per minute (mode CPAP+IMV) and, subsequently, during CPAP alone.During the two modes of ventilation, airway pressure was adjusted to be equal during the spontaneous inspiratory phases. All parameters of haemodynamics, oxygenation and oxygen consumption were found to be essentially satisfactory and unchanged during both modes of ventilation. Our observations suggest that, as the parameters studied were unaltered with the change from CPAP+IMV to CPAP, the use of ventilatory support for these patients during the weaning period (in the form of four mandatory ventilations per minute) appears, in terms of central haemodynamics and oxygen transport, to be well tolerated in cases where adequate spontaneous ventilation is in doubt.
Invasive Analysis of Non‐invasive Indicators of Myocardial Work and Ischaemia During Anaesthesia Soon After Myocardial Infarction
Authors: Reiz S. , Häggmark S. , ÖStman M. 
Published: January 2009

Atrial pacing was used for preoperative evaluation of six patients with recent anterior myocardial infarction (MI) (e.g. within 6 weeks) scheduled for abdominal emergency surgery. Central and coronary haemodynamics were used to compare changes in myocardial work and oxygenation with alternations of the non‐invasive variables rate pressure product (RPP) (systolic blood pressure X heart rate), triple product (TP) (systolic blood pressure X heart rate X mean pulmonary arteriolar occlusion pressure) and ST‐T‐segments (lead V5).There was good correlation between myocardial oxygen consumption and rate pressure product and triple product during pacing to stable angina pectoris. ST‐T‐segment depressions were recorded already at moderate chest discomfort and correlated well with a decrease in coronary vascular resistance. Changes in myocardial oxygen consumption induced by combined thoracic epidural analgesia (T3–4 to L1–2) and light general anaesthesia with nitrous oxide and fentanyl were poorly correlated with changes in rate pressure product or triple product. ST‐T‐segment depressions were recorded on five occasions in four of the patients, all in association with intubation and/or extubation. Only on one of these occasions could RPP or TP have indicated that myocardial oxygen demand exceeded supply. On the other four occasions, it was probable that myocardial ischaemia was induced by transient arterial hypoxaemia. The V5 ST‐T‐segment was the most sensitive non‐invasive variable to monitor. The anaesthetic method was safe in all patients, asjudged by good intraoperative cardiovascular stability, low morbidity and absence of intra‐ or postoperative reinfarction.
Pentobarbital‐Anesthetized and Decerebrate Cats Reveal Different Neurophysiological Responses in Anesthetic‐Induced Analgesia
Authors: Mori K. , Komatsu T. , Tomemori N. , Shingu K. , Urabe N. , Seo N. , Hatano Y. 
Published: January 2009

Cats were used to assess the significance of differences in animal preparations in the study of anesthetic‐induced analgesia. Comparison was made between pentobarbital‐anesthetized and decerebrate non‐anesthetized cats. Bradykinin dissolved in normal saline was injected into the femoral artery as a noxious stimulus, and the neural response in the spinal cord lateral funiculus was recorded using the multi‐unit activity technique. The magnitude of the neural response and the changes in spontaneous firing were compared before and after cervical cord transection at C1. Before the transection, the response was greater in anesthetized than in decerebrate cats. The cord transection potentiated the response in both preparations, but the degree of potentiation was greater in decerebrate than in anesthetized cats.These studies confirmed the presence of a descending pain inhibition system acting tonically on the nociceptive neural mechanisms in the spinal cord, and indicated the susceptibility of this system to pentobarbital. We conclude that pretreatment with pentobarbital induces pharmacologically a state of partial spinal cord transection and reduces the effects of drugs acting through supraspinal CNS structures.
Complications of Central Venous Catheterization of the Subclavian Vein: The Influence of a Parenteral Nutrition Team
Authors: Jong P. C. M. De , Meyenfeldt M. R. Von , Rouflart M. , Wesdorp R. I. C. , Soeters P. B. 
Published: January 2009

Early and late complications of central venous catheterization were investigated in 488 consecutive catheters, 389 introduced in the subclavian vein by a percutaneous puncture technique, 84 by a cut down technique of the cephalic vein, and 15 by a peel away technique. Care and introduction of the catheters was controlled by the parenteral nutrition team in 239 cases.Immediate and late complications were found using both the puncture and venous cut down techniques, but immediate complications differed in the two groups due to the different methods of insertion.The rate of catheter related sepsis (CRS) did not differ significantly when the group under control of the nutrition team was compared with the group without nutritional control (5.9 vs. 6%). The rate of CRS was 1 CRS/220.7 days of therapy in the puncture group and 1 CRS/342.2 days of therapy in the venous cut down group. Catheter tips and blood were cultured from both CRS and non‐CRS patients, and the micro‐organisms identified.Catheters were withdrawn, under supervision of the nutrition team, for a number of reasons including death, thrombosis, and technical problems, but suspicion of CRS accounted for a high percentage of withdrawals (18% in the puncture group, 16.6% in the venous cut down group). It is suggested that, when CRS is suspected, removal of the catheter should be delayed until all other possibilities have been investigated.
Hospital Experience of Total Parenteral Nutrition with 3‐litre Containers (Big Bags)
Authors: MUTH LIISA 
Published: January 2009

A system for total parenteral nutrition (TPN) with a 3‐litre container (big bag) has been developed. The bag is filled by a pharmacist in the hospital pharmacy. One of four standard nutritional regimes can be chosen depending on the patients weight and estimated metabolic condition. The bags contain aminoacids, electrolytes, trace elements and energy in the form of glucose. Lipids with vitamins are given separately via a side port and not mixed into the bags.During one year 61 patients have been given a total of 846 bags. All patients, except for two, maintained or increased their body weight during TPN with the big bag system. However, almost all patients lost weight when TPN was exchanged for enteral or oral feeding. S‐phosphate was initially low but normalized within one week in all patients. S‐magnesium was low in 1/3 of the patients and remained low in 50% of those for the entire treatment period. S‐calcium increased beyond the normal upper limit in 25% of the cases. S‐albumin increased in all patients, except for those with metastasizing cancers. Fifteen positive cultures were obtained from big bags. Only in one patient, however, the same bacteria could be cultured from both the patient and the big bag. Some increase in infections related to central venous catheters was noticed. Better utilization due to increased amount of potassium, magnesium, phosphate and zinc compared to routine may be beneficial.
Continuous transcutaneous oxygen measurement: reproducibility and trace analysis in healthy adults
Authors: Swift A. C. , Downham D. Y. 
Published: January 2009

One hundred and fourteen transcutaneous oxygen traces were obtained from 46 adults using a mass spectrometer. Such traces usually rise to a plateau about which they fluctuate. To estimate the plateau level, here called the asymptote, two models are described ‐ a time‐series model and a growth model. If yt is the trace measurement at time t, for the time‐series modelyt+l = m + α(yt‐m)+ε1, and for the growth modeldyt/dt = β(m‐yt),where parameters α and β represent the rate of approach to the asymptote m. Least squares estimates of these parameters were determined for every trace. For every trace, the estimated asymptotes are similar for both models but the other parameters show less agreement. Considering the traces for each person in pairs, each trace pair is allocated to one of four groups according as the traces were recorded on the same or different sites and on the same or different days. The correlation coefficient (r) between the estimated asymptotes is greatest for traces recorded on the same site and day (r>0.94, P< 0.001) and least for traces from different sites and days (r>0.71, P<0.001). The time series estimates of the asymptotr arc more credible than the growth model.
Interactive cardiovascular effects between isoflurane and peroperative events
Authors: RANER C 
Published: January 2009

Abstract. The objective of this five–part (IV) study was to evaluate cardiovascular interactions between isoflurane and some pathophysiological and pharmacological interventions, likely to occur peroperatively. Specific aims were to investigate:

Interactive responses between hemorrhage–induced hypovolemia and isoflurane in the intestinal circulations.
Interactive response between regional hypothermia (28°C) and isoflurane in the intestinal circulation.
Interactive responses between amrinone and isoflurane in the intestinal and renal circulations.
Modulation by dopamine of the cardiovascular responses to isoflurane.
Modulation by dopamine of the cardiovascular responses to thoracic epidural blockade concurrent with isoflurane administration

Intestinal (I–III) and renal (III) blood circulations were studied by optic flowmetry in cat models, with regional perfusion pressures controlled either by an extracorporeal pumpassisted circuit (I, II) or by adjustable abdominal aortic occlusion (III). Central hemodynamics were assessed in cat and dog models (III–V).Isoflurane was found to depress cardiac function in a doserelated fashion. In the regional circulation, isoflurane dose dependently produced vasodilation in the small intestine and in the kidney. The net response from these cardiac and vascular effects of isoflurane was a decrease in arterial pressure. In the small intestine, reflex vasoconstriction, induced by hemorrhage, was overruled by the vasodilator effects of isoflurane. Regional hypothermia in the small intestine attenuated the local vasodilator effects of isoflurane. The phosphor diesterase III inhibitor amrinone induced intestinal and renal responses, which added to the vasodilations induced by a moderate dose of isoflurane. The depressor effect of isoflurane could effectively be controlled by exogenous dopamine through counter–directed actions on cardiac function and through increased systemic vascular tone. The combination of isoflurane and thoracic epidural blockade was associated with depressed cardiac function. Exogenous dopamine effectively countered such actions and, in this situation, increased vascular tone to a greater extent than in control situations.
Retracted: Influence of volume replacement with different HES–solutions on microcirculatory blood flow in cardiac surgery
Authors: BOLDT J. , ZICKMANN B. , RAPIN J. , HAMMERMANN H. , DAPPER F. , HEMPELMANN G. 
Published: January 2009

A variety of hydroxyethyl starch (HES) preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found.A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH–patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P<0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. + 18%). Group 3 (200/0.62) showed the highest decrease in forehead–LDF. During CPB, forehead–LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5). At the end of the operation, LDF was most reduced in groups 1 (– 32%) and 3 (– 33%). Forearm–LDF increased in all ANH–patients. Immediately after ANH this increase was lowest in group 3 (200/0.62). In the further course of the investigation, no more differences were seen in any HES patients. The different HES preparations showed a different microcirculatory response. 6% HES 200/0.5 seems to be overall most suitable for volume replacement in cardiac surgery patients undergoing acute normovolemic haemodilution (ANH) due to the best effects on microcirculatory skin perfusion assessed by laser Doppler flow. HES 6% 200/0.62 showed the overall least positive effects with regard to skin capillary blood flow in this situation.
High–frequency jet ventilation vs continuous positive airway pressure for differential lung ventilation in patients undergoing resection of thoracoabdominal aortic aneurysm
Authors: GODET G. , BERTRAND M. , ROUBY J. J. , CORIAT P. , HAG B. , KIEFFER E. , VIARS P. 
Published: January 2009

Twenty patients, scheduled for surgical resection of thoracoabdominal aortic aneurysm were divided into two groups according to the type of differential lung ventilation used during graft replacement of the descending thoracic aorta. In the high–frequency jet ventilation (HFJV) group of ten patients, HFJV was applied to the left lung once collapsed and retracted by the surgeon, the patient lying in the right lateral decubitus and being intubated by a Carlens' tube. In the continuous positive airway pressure (CPAP) group of ten patients, CPAP was applied to the left lung at the same mean airway pressure as HFJV (1 kPa). Before anaesthetic induction, an arterial and a Swan–Ganz catheter were inserted for cardiovascular monitoring. The same anaesthetic technique using fentanyl 6 μg·kg‐1, flunitrazepam 0.02 mg kg‐1 and pancuronium 0.1 mg kg‐1 was used for each patient. Haemodynamic and respiratory measurements were made: 15 min after positioning the patients in the right lateral decubitus using two–lung ventilation; 15 min after collapse and retraction of the left lung using one–lung ventilation and 15 min after using differential lung ventilation with CPAP or HFJV.Left lung collapse with conventional one–lung ventilation induced a dramatic decrease in arterial oxygenation: Pao2/Fio2 ratio decreased from 43 6 kPa to 20 8 kPa, alveolo–arterial oxygen difference increased from 24 7 kPa to 72 11 kPa and pulmonary shunt increased from 17 2% to 37 3%. Whereas differential lung ventilation with CPAP did not improve any of the respiratory parameters measured, differential lung ventilation with HFJV, significantly increased Pao2/Fio2 ratio to 41 14 kPa. Therefore, since HFJV improves gas exchange without altering the conditions of surgical comfort, different lung ventilation with HFJV appears to be superior to differential lung ventilation with CPAP.
Possible errors in diagnosis of bacterial sinusitis in tracheal intubated patients
Authors: WESTERGREN V. , FORSUM U. , LUNDGREN J. 
Published: January 2009

Bacterial sinusitis is recognized as a complication of prolonged nasotracheal intubation. Verification of the diagnosis, however, requires culture findings from a “true” sample from the maxillary antrum. A “true” antral sample can only be obtained after passing either the nasal or oral mucosae with their rich aerobic and anaerobic bacterial flora.No properly controlled study has been made into the problem of contaminated samples in bacterial sinusitis complicating prolonged nasotracheal intubation. The design of the study was a case series in an intensive care unit. The patients had either had endotracheal tube or tracheal cannula for seven days or were septic, having an endothracheal tube or a tracheal cannula and therefore due to an investigation of infection foci. Antral cultures obtained via the canine fossa were compared with oral cultures to exclude the contribution of oral bacterial contamination and thereby to improve the reliability of diagnosis based on culture results. The contamination rate was lowered significantly from 67% to 5% when an area of free bone was prepared in the canine fossa thus avoiding instrument contact with the oral mucosa.A high contamination risk can be dealt with by adjusting the technique of sampling thereby increasing the culture reliability.
Effects of five amino–amide local anaesthetic agents on human polymorphonuclear leukocytes measured by chemiluminescence
Authors: CEDERHOLM I. , BRIHEIM G. , RUTBERG H. , DAHLGREN C. 
Published: January 2009

The aim of this study was to assess the influence of five amino–amide local anaesthetic agents on the production of oxygen metabolites in the human polymorphonuclear leukocyte (PMNL), both intra– and extracellularly.Ropivacaine, a new long–acting amino–amide local anaesthetic agent, bupivacaine, lidocaine, mepivacaine and prilocaine in concentrations 1–5 μg–ml‐1up to 500–1000 μg–ml‐1were compared to an untreated control. PMNLs were isolated from heparinized blood (healthy adult volunteers). Cells were incubated with the various local anaesthetics (37C, 30 min), then placed in a Biolumat (luminol–amplified chemiluminescence) and stimulated by formyl–methionyl–leucyl–phenylalanine (FMLP), phorbol myristate acetate (PMA) or ionomycin. Horseradish peroxidase (HRP) was added to discriminate between an intra– or extracellular response.In general, a decrease in chemiluminescence–response was seen with higher concentrations (500–1000 μg–ml‐1) of the various local anaesthetics. Lidocaine showed a decrease even at lower concentrations. A marked increase in intracellular response for prilocaine 1000 μg–ml‐1(3894 μmol–1‐1) accompanied by a reduction in extracellular response, using FMLP HRP as a stimuli, was noted. Ropivacaine 1000 μg ml‐1(3216 umol–1‐1) showed a decrease both intra– and extracellularly that was similar to, and even somewhat more pronounced than lidocaine 1000 μg–ml‐1(3692 μmol'l‐1), when using PMA with or without HRP as the stimuli.
Intradermal anaesthesia: comparison of several compounds
Authors: PRIEN TH. 
Published: January 2009

Objective: To compare the efficacy of different local anaesthetics to produce intradermal anaesthesia for venous cannulation and the discomfort associated with skin infiltration.Measurements: A visual analog scale (VAS) for pain (0 = no pain/10 = most pain imaginable) was used to assess pain elicited by raising the skin wheal and inserting the cannula.Main results: With regard to analgesic potency all five local anaesthetics were comparable (mean VAS–score 1.7–2.09) and effective when compared to 0.9% saline (mean VAS–score 4.2; P < 0.001). Infiltration pain was least with mepivacaine–1 (mean VAS–score 1.0; P < 0.001) and highest with procaine (mean VAS score 2.7; P < 0.001).