bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reversal of Fentanyl‐Induced Narcotic Depression with Naloxone Following General Anaesthesia
Authors: Tigerstedt Irma 
Published: January 2009

To study the need for and mode of naloxone reversal after liberal use of fentanyl during anaesthesia, a fixed‐dose schedule of fentanyl (mean 6.5 μg/kg/h) was applied intraoperatively to 60 patients, randomly divided into four treatment groups. After surgery and reversal of muscle relaxation, end‐tidal CO2 was allowed to rise to 8% by manually assisted ventilation. Thereafter, 0.04 mg increments of naloxone were given i.v. every 3 min until spontaneous respiration maintained ETco2 below 8% (group I) or below 6.5% (group II). After similar intravenous reversal to that in groups I or II, an additional intramuscular dose of naloxone, identical to that given i.v., was given to groups III and IV after awakening from nitrous oxide.If ETco2 remained above 6.5%, mean spontaneous minute ventilation was lower than before anaesthesia and significantly (P<0.05) less than if ETco2 had decreased below that value. This difference had disappeared 45 min postnal‐oxone. Arterialized venous Pco2 showed normocapnia (6.0 kPa) in patients with ETco2 <6.5%, hut slight hypercapnia (6.6 kPa) in patients with ETco2>6.5% after intravenous naloxone. After 15 min, the patients with additional intramuscular naloxone had significantly (P<0.05) lower values of Pco2 than those with intravenous naloxone only.Postoperatively, a positive correlation (R = 0.35) between the total dose of naloxone and pain intensity could be demonstrated (P<0.01). As acute postoperative pain could not be avoided after naloxone reversal to normoventilation, titration of naloxone after liberal use of analgesics is recommended with the help of capnography, until an acceptable ETco2 of about 7% is maintained.
A Circle System Without Carbon Dioxide Absorption
Authors: Ladegaard‐Pedersen H. J. 
Published: January 2009

An anaesthetic circle system without a carbon dioxide absorber is described. The efficiency of the circle, i.e. the fraction of alveolar gas in the outflow from the circle, was measured in 15 patients during halothane anaesthesia or neurolept analgesia. The fraction ranged from 0.88 to 0.95 (mean 0.91), while the ratio between the alveolar ventilation and the fresh gas inflow ranged from 0.97 to 1.71. The efficiency was not correlated to this ratio. There was no need for hyperventilation if the fresh gas inflow was 10% higher than the alveolar ventilation required to maintain normal Paco2.The circle was used in 50 patients manually ventilated by nurse anaesthetists. Mean fresh gas inflow was 60 ml/kg. Mean Paco2 was 5.47 kPa (41 mmHg). In a similar group of 50 other patients, in which the standard circle used in the department was employed, the mean Paco2 was 4.80 kPa (36 mmHg). The frequency of hypercapnia was equal in the two groups, but hypocapnia was not seen when the circle without absorber was used.
Hemodynamic Observation in Relation to Extensive Surgical Treatment of Patients with Increased Operative Risk
Authors: Sørensen M. Bredgaard , Bille‐Brahe N. E. , Engell H. C. 
Published: January 2009

In 25 patients, considered high surgical risks according to clinical criteria, systemic and pulmonary hemodynamic parameters were monitored using a flow‐directed pulmonary arterial thermodilution catheter before, during and after major vascular surgery. During and after the operation, hemodynamic complications were observed in 13 patients. The following conditions were dealt with: hypovolemia, increased systemic vascular resistance, and left ventricular failure in hypervolemia and in normovolemia. Tachy‐arrhythmias seen in six of the patients were associated with left ventricular failure, hypovolemia or normal hemodynamics.Operation for renovascular hypertension and thoracolaparotomy carried the highest risk. Two of the patients died from primarily surgical complications.
Haemodynamic Effects of Different Corticosteroids in Controlled Haemorrhagic Shock in the Dog
Authors: Hellman A. , Häggendal E. , Lindfors Maria , Lundberg D. 
Published: January 2009

The haemodynamic effects of massive doses of hydrocortisone (80–320 mg.kg‐1), methylprednisolone (4–32 mg.kg‐l), betamethasone (1.6–12.8 mg.kg‐1) and aldosterone (0.1–0.8 mg.kg‐1) and the interaction with phenoxybenzamine and propranolol have been studied during controlled haemorrhagic shock in the anaesthetized dog. Hydrocortisone was the only steroid which showed any significant vasodilating ability when given alone. The alpha‐receptor blocking agent phenoxybenzamine distinctly decreased the total peripheral resistance. The effect of the phenoxybenzamine was increased in combination with hydrocortisone or methylprednisolone, especially if the steroid was given as the first drug. The vasodilation found was efficiently abolished by the beta‐receptor blocking agent propranolol. The ability of hydrocortisone or methylprednisolone to potentiate phenoxybenzamine was not shared by betamethasone or aldosterone. Thus, the haemodynamic effect of the steroid does not seem to be correlated to either a glucocorticoid nor a mineralocorticoid effect.It is suggested that the steroid effect studied is related to the ability of hydrocortisone or methylprednisolone to block the extra neuronal amine uptake which decreases the rate of elimination of the sympathetic transmitter from the vicinity of the adrenergic receptor of the vascular smooth muscles.
Postanaesthetic Postural Stability Following Thiopental or Propanidid Anaesthesia
Authors: Eriksen Jørgen , Jansen Erik , Larsen Robert E. , Olesen Mogens B. 
Published: January 2009

Using a quantitative Romberg‐test performed on a computerized force‐plate‐system, postural stability was tested in 39 patients before and 3 hours after general anaesthesia with either thiopental (20 patients) or propanidid (19 patients).Sway‐tendencies in the sagittal and the transversal direction were recorded.Comparing pre‐ and postoperative test results, patients anaesthetized with thiopental had a decreased postural stability 3 hours after anaesthesia, indicated by a significantly (P < 0.05) increased sway‐tendency of 22.6% in the sagittal direction. No change occurred in sway‐tendency in the transversal direction in this group.In the propanidid group no significant differences were found between pre‐ and postoperative test results.
Effect of Respiratory Physiotherapy on Arterial Oxygen Tension
Authors: Hedstrand U. , Liw M. , Rooth G. , ÖGren C. H. 
Published: January 2009

The effect of deep breathing on arterial oxygen tension was investigated in 45 postoperative patients. Arterial oxygen tension was estimated by the transcutan‐eous oxygen tension method, which allows continuous non‐invasive measurement of the arterial oxygen tension changes. Three deep breaths in 1 min, assisted by three respiratory therapy devices, were compared to a standard physiotherapy programme. A peak increase in arterial oxygen tension of 3–4.5 mmHg occurred after 1 min, and significantly increased values were seen for 2–4 min following deep breathing with the three respiratory devices. From the various physiotherapeutic procedures, verbally and manually assisted deep breathing gave a 7 mmHg Po2 peak and significantly increased values for 6 min.The sigh mechanism is discussed in the light of the present knowledge of airway closure, which gives a satisfactory explanation of the short‐lasting increase in oxygen tension.
Prolonged Apnoea after Suxamethonium: An Analysis of the First 225 Cases Reported to the Danish Cholinesterase Research Unit
Authors: Viby‐Mogensen J. , Hanel H. K. 
Published: January 2009

During the last 4 years, 225 patients have been referred to the Danish Cholinesterase Research Unit following an episode of prolonged apnoea after suxaniethonium.Fourteen patients (6.2%) were found to have a low serum cholinesterase activity due to an acquired deficiency (for instance, liver disease, chronic debilitating disease or carcinoma).One hundred and forty‐eight patients (65.8%) had an inherited abnormal serum cholinesterase, and 105 of these patients (46.7%) were homozygous for the atypical enzyme (E1E1a). The mean period of apnoea in this latter group was 92 min (range: 25–240). Seventeen patients (7.6%) were heterozygous for the normal and the atypical enzyme (E1YE1a), with a mean apnoea period of 25 min (range: 7–60 min). Twelve patients were found to be heterozygous for the atypical and the silent gene (E1aE1s). The mean period of apnoea was 126 rnin (range: 45–210 min). Fourteen patients had other rare genotypes. The longest mean period of apnoea (170 min, range: 70–330) was found in patients homozygous for the silent gene (E1sE1s). The silent gene and the fluoride‐resistant gene were found in 8.9% and 2.7% of the patients, respectively.In 63 patients (28.1%) both the type and quantity of serum cholinesterase were normal. In 34 of these patients (15.2%), the prolonged apnoea was due to other causes; for example, suxamethonium overdose, hyperventilation and central as well as peripheral respiratory depression. However, in the other 29 patients (12.9%), the reason for the prolonged apnoea could not be established. The possibility therefore exists that these cases represent unknown genotypes.
Preoperative Hemodynamic Evaluation of Patients Submitted for Major Surgery
Authors: Sørensen M. Bredgaard , Engell H. C. 
Published: January 2009

Prior to major vascular surgery, hemodynamic studies were carried out in 63 patients by means of a flow‐directed pulmonary artery balloon catheter.The results were correlated to electrocardiographic and roentgenologic findings, as well as to pertinent clinical information. Of 15 patients with either atrial fibrillation or both left ventricular hypertrophy and an increased cardiac volume, six had pulmonary pressures elevated above normal values; none of 14 patients with only one of the two signs (left ventricular hypertrophy or increased cardiac volume) had elevated pulmonary pressures. Also, the 34 patients with normal roentgenologic and electrocardiographic findings had normal hemodynamics, irrespective of a history of previous AMI, present angina or dyspnea on exertion.It is concluded that hemodynamic studies by means of a balloon‐tipped catheter floating in the pulmonary artery are indicated before major surgery in patients with either atrial fibrillation or both electrocardiographic and roentgenologic signs of left ventricular hypertrophy. In such patients pulmonary pressures should be monitored during and after surgical operation.
Effects of Antihypertensive Medication on the Cardiovascular Response to Ketamine in Rats
Authors: Kaukinen S. 
Published: January 2009

The effects of hydralazine, clonidine, propranolol and methyldopa medications on the cardiovascular response to ketamine anaesthesia were studied in spontaneously hypertensive (SH) rats. Except in propranolol‐ and methyldopa‐treated animals, blood pressure was increased by ketamine in all groups. The heart rate was increased only in the normotensive control rats, whereas it was reduced in both the unmedicated and all of the medicated SH rats. Plasma renin activity under ketamine anaesthesia was markedly higher in normotensive control rats than in any of the SH groups. The pressor responses to dopamine and metaraminol were not altered by propranolol medication, but hydralazine suppressed these responses, while they were markedly intensified by clonidine and methyldopa treatment. Similarly, small additional doses of ketamine caused a pressor response only in clonidine‐ and methyldopa‐treated animals, whereas in the other groups the response was depressive. The tolerance to haemorrhagic shock during ketamine anaesthesia was notably improved by hydralazine and methyldopa medication, but impaired by propranolol treatment.The results suggest that, with special reference to shock tolerance, hydralazine and methyldopa, and to a lesser extent also clonidine, have a favourable effect on the circulation under ketamine anaesthesia, whereas the action of beta‐blockade may be harmful.
Effects on Muscarinic Receptors of Various Agents in Reversal of Neuro‐muscular Blockade: A Study Evaluating Atropine, Glycopyrron, Neostigmine and Pyridostigmine
Authors: Eriksen S. , Hansen E. Kjær , Hasselstrøm L. 
Published: January 2009

The effects were studied of various drug combinations, recommended for use in reversal of neuromuscular blockade, on heart rate and salivary secretions in 80 healthy patients anaesthetized with nitrous oxide‐oxygen‐halothane and relaxed with d‐tubocurarine. The drug combinations were mixtures of atropine 1 mg—neostigrnine 2.5 mg, atropine 1 mg—pyridostigmine 15 mg, glycopyrron 0.5 mg—neostigmine 2.5 mg, and glycopyrron 0.5 mg— pyridostigmine 15 mg, respectively.It was found that administration of the atropine‐containing mixtures induced more pronounced initial increases and delayed decreases in heart rate than the mixtures containing glycopyrron. Pyridostigmine‐containing mixtures elicited a somewhat more pronounced initial increase in heart rate than neostigmine‐containing mixtures, but a less pronounced and delayed decrease in heart rate. Supraventricular arrhythmias occurred less frequently in the pyridostigmine groups than in the neostigmine groups. No such difference was found between the atropine and glycopyrron groups. Glycopyrron caused a more intense dryness of the mouth than atropine.A differential attitude towards the use of drugs for reversal of neuromuscular blockade, based on the cardiovascular state of the particular patient, might be recommendable.
The Prognostic Value of EEG in Coma Survivors after Cardiac Arrest
Authors: Thomassen A. , Sørensen K. , Wernberg M. 
Published: January 2009

EEG was recorded in 64 patients while they were in a state of moderate coma after cardiac arrest. The clinical course of the patients was followed, and the prognosis was compared with the EEG findings.A total of 59 patients died within periods ranging from 1 to 287 days, 57 without having regained consciousness. Five patients survived, all with cerebral sequelae. The immediate causes of death were brain death in 18, pneumonia in 24, and cardiovascular complications in 17 cases. Autopsy was performed in 54 patients.The EEGs were visually graded and classified into five groups, in order of increasing abnormalities (Hockaday et al. 1965). Of the records, 17% were unclassifiable. An extremely abnormal EEG (grade V) was indicative of death after a few days, while other grades of EEG changes did not give any prognostic indications. Good correlation was disclosed by multiple regression analysis between the length of the survival time and the EEG changes estimated on the basis of 12 variables.A method is described by which it is possible to estimate the probable length of survival of a patient from his EEG records. There was a fair correlation between the estimated and observed survival times, except in the patients who died from cardiovascular complications after a few days. In these cases the prediction from the EEG was too optimistic.It is concluded that EEG is a useful supplement to the clinical evaluation of patients in coma after cardiac arrest. The EEG must be assessed in a special way, as simple visual grading is of only limited prognostic value.
Maternal, Foetal and Neonatal Blood Creatine‐Phosphokinase‐Activities and Creatine‐Phosphokinase‐Isoenzymes after Labour with and without Epidural Analgesia and after Caesarean Section
Authors: Jouppila R. , Jouppila P. , Koivisto M. , Virkkunen L. , Wendt L. von , Pakarinen A. 
Published: January 2009

Maternal, cord and neonatal blood creatine‐phosphokinase (CK) activities and CK‐isoenzymes were determined in connection with 24 labours after normal pregnancies. In eight cases there was a normal vaginal delivery; in another eight cases there was a normal vaginal delivery with segmental epidural analgesia; and In the remaining eight cases there was an elective caesarean section under general anaesthesia.The lowest maternal blood CK‐activities were seen in connection with caesarean section. There was a statistically significant difference in the maternal CK levels after delivery between cases with caesarean section and normal labour (P<0.05) and between cases with caesarean section and labour with segmental epidural analgesia (P<0.001). Most of the maternal CK‐activity was of muscular type, and there were no statistically significant differences in isoenzyme fractions between the different groups.The neonatal blood CK‐activities were at their peak at the age of 1 day in all groups. Between the groups there were no statistically significant differences in cord or neonatal blood CK‐activities at any time. Most of the cord and neonatal blood CK‐activity was also of muscular type, and there were no significant differences in the CK‐isoenzyme fractions between the groups.
The Effect of Acute Respiratory Acidosis on the Proportion: Total Splanchnic Perfusion/Cardiac Output, and the Alteration in this Proportion by Two Anaesthetics
Authors: Juhl B. , Einer‐Jensen N. 
Published: January 2009

Eight dogs were anaesthetized and ventilated. Respiratory acidosis with variations in the pH (range: 7.49 to 7.05) were brought about by changes in the dead space of the apparatus. The pH‐related changes in cardiac output (Q), and total splanchnic perfusion (Qsp1) were studied during anaesthesia with mebumal natrium (NFN) N2O‐O2‐gallamoni jodidum (NFN) (“basic anaesthesia”), and after the addition of 1 % halothane (inspiratory). Similar relationships were demonstrated in the systemic circulation between pH changes and changes in the cardiac output, pulse pressure, and total peripheral resistance during both types of anaesthesia; whereas the pulse frequency and the mean aorti cpressure were not significantly correlated to changes in pH.Qsp1 was different during the two types of anaesthesia. Under “basic anaesthesia,” the pH‐related changes in Q and Qsp1 were opposite and of varying magnitude. Their mutual relation: the fraction of cardiac output perfusing the splanchnic area, was Qsp1/Q= ‐2.28 + 0.34×pH (r = 0.69, N = 28, P<0.001). After the addition of halothane, no correlation could be demonstrated between Qsp1/Q and changes in pH. The changes in Q and Qsp1 were in the same direction and of the same relative magnitude, with an average of Qsp1/Q = 0.21. In agreement with this, no changes could be demonstrated in the total splanchnie resistance (Rsp1) during halothane anaesthesia in relation to the provoked pH changes, while Rsp1 under “basic anaesthesia” showed a slight rise with falling pH in the majority of dogs (six out of eight). The pressure in the portal vein (Pvp) appeared to rise with a falling pH. For both types of anaesthesia, the APvp (kPa) = ‐0.97 × δpH (r = 0.79, N = 34, P<0.001).
Plasma Free Norepinephrine and Epinephrine Concentrations Following Diazepam‐Ketamine Induction in Patients Undergoing Cardiac Surgery
Authors: Kumar S. M. , Kothary S. P. , Zsigmond E. K. 
Published: January 2009

Ketamine causes cardiovascular stimulation, presumably, by increasing central sympathetic activity. This study was undertaken to find out if diazepam in appropriate doses could abolish or moderate the central sympathetic and cardiovascular stimulation following ketamine in patients undergoing cardiac surgery.Twelve patients, scheduled for valvular replacement (8) and direct aortocoronary bypass graft operations (4) were studied. After premedication with diazepam 0.15 mg/kg orally and morphine sulphate 0.15 mg/kg i.m., they were induced with diazepam 0.3 mg/kg i.v., followed 10 min later by ketamine 2 mg/kg i.v. Direct arterial pressure by a strain gauge from the radial artery and heart rate by EKG were continuously recorded. Plasma free norepinephrine, measured by Vendsalu's method, in the arterial blood was 0.39±0.03 ng/ml prior to induction, 0.39±0.03 ng/ml 10 min after diazepam and 0.42±0.05 ng/ml (P>0.05) 5 min after ketamine administration. Plasma free epinephrine concentrations were 0.10±0.04 ng/ml prior to induction, 0.06±0.03 ng/ml (P>0.05) 10 min after diazepam and 0.01±0.003 ng/ml (P<0.05) 5 min after ketamine. Heart rate and systolic pressure did not change significantly throughout the study period. Diastolic pressures were elevated significantly (P<0.05) 5 min after ketamine administration, amounting to a 12% increase over baseline.Diazepam‐ketamine induction in cardiac surgical patients did not result in clinically significant central sympathetic or cardiovascular stimulation.
Systemic Reactions to Tourniquet Ischaemia
Authors: Modig J. , Kolstad K. , Wigren A. 
Published: January 2009

In 15 patients, mean age 60 years, undergoing knee arthroplasty under lumbar epidural analgesia, changes in EGG, blood pressure, blood gases, serum potassium, acid‐base status and serum creatine‐phosphokinase were studied following release of a tourniquet applied for 70–135 min. During and after the ischaemia, the skin temperature of the leg operated on was monitored.Although dextran‐70 was rapidly infused following tourniquet release, the blood pressure decreased significantly, due to a reduction in peripheral resistance. There were no signs of myocardial or pulmonary disturbances. Serum potassium in arterial blood increased significantly and reached a peak 3 min after tourniquet release. There was a tendency to metabolic acidosis, most pronounced after 3 min and caused by local lactate production. The skin temperature of the ischaemic leg fell progressively, which, combined with muscular relaxation, indicates a low metabolic rate. There was no evidence of local ischaemic muscular injury. It is concluded that the systemic changes after interruption of up to 2 h of tourniquet ischaemia are moderate and reversible, even in the elderly.
Cardiac Function During Induction and Early Anesthesia with Methoxyflurane. An Evaluation Using Systolic Time Intervals and Pressure Time Indices
Authors: Sørensen B. , Rasmussen J. P. , Dauchot P. J. , Regula G. 
Published: January 2009

In addition to the standard monitoring of heart rate and blood pressure, the Systolic Time Intervals were used to evaluate cardiac performance, and the Pressure Time Indices (tension time index = TTI; diastolic pressure time index = DPTI) were used to estimate myocardial oxygen balance. Twelve patients with known heart disease were studied during induction with thiopental, intubation, and early anesthesia with methoxyflurane.Cardiac performance diminished after thiopental; and during methoxyflurane it was reflected in increases in pre‐ejection period (PEP) and the ratio PEP/LVET. Intubation resulted in a hyperactive state of the heart, as shown by maximal decreases in PEP and PEP/LVET.Myocardial oxygen balance ‐ estimated from the supply/demand ratio (DPTI/ TTI) ‐ was impaired after thiopental. After intubation, DPTI/TTI decreased to its lowest value due to an excess of myocardial oxygen demand (TTI) over myocardial oxygen supply (DPTI), signifying a transitory underperfusion of the subendocardium. During methoxyflurane the oxygen balance was gradually restored towards control value.The Systolic Time Intervals and the Pressure Time Indices provided valuable information on cardiac function not available from standard monitoring alone.