bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid‐diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml
Authors: Salmela L. , Aromaa U. 
Published: January 2009

Background: Transient radicular irritation (TRI) is common after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml. The purpose of this study was to determine the incidence of TRI after spinal anesthesia with hyperbaric lidocaine 50 mg/ ml diluted with cerebrospinal fluid (CSF) 1:1 and hyperbaric mepivacaine 40 mg/ml and hyperbaric bupivacaine 5 mg/ml.Methods: Ninety ASA class I‐IV patients undergoing mostly brief urological procedures under spinal anesthesia were randomly allocated to receive either hyperbaric lidocaine 50 mg/ ml diluted with CSF 1:1 (Group L), hyperbaric mepivacaine 40 mg/ml (Group M) or hyperbaric bupivacaine 5 mg/ml (Group B). Characteristics of the patients and details of the surgical procedures and spinal anesthesias were similar in all groups except for the intensity of motor block. The patients were evaluated on the first postoperative day by an anesthesiologist who did not know which spinal anesthetic agent had been used.Results: Six patients (20%) in Group L, 11 patients (37%) in Group M and none (0%) in Group B experienced pain in the legs and /or back (TRI) after spinal anesthesia.Conclusion: TRI is frequent after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml diluted with CSF 1:1. The incidence of TRI after hyperbaric mepivacaine 40 mg/ml is of the same magnitude. TRI could not be observed after bupivacaine spinal anesthesia.
Intrathoracic and pulmonary blood volume during CO2‐pneumoperitoneum in humans
Authors: Hachenberg T. , Ebel C. , Czorny M. , Thomas H. , Wendt M. 
Published: January 2009

Background: Induction of CO2‐pneumoperitoneum may have significant effects on systemic and pulmonary haemodynamics. We hypothesized, that intrathoracic (ITBV) and pulmonary blood volume (PBV) are affected during intra‐abdominal CO2‐insufflation, which may be pronounced by positional changes of the patient.Methods: Sixteen anaesthetized patients were studied before, during and after CO2‐pneumoperitoneum for laparoscopic cholecystectomy. A dye indicator technique was used to assess ITBV and PBV. In addition, gas exchange and haemodynamics were recorded.Results: In the supine position, induction of CO2‐pneumoperitoneum had no effects on ITBV, PBV and cardiac output. Mean systemic arterial pressure increased from 10.9±1.5 kPa (82±11 mmHg) to 12.7±1.5 kPa (95±11 mmHg, P<0.01). In the reverse Trendelenburg position ITBV decreased from 19.8±5.1 ml . kg‐1 to 16.7±3.7 ml . kg1 (P<0.05) during CO2‐insufflation, but increased to control values after 20 min. PBV decreased from 4.2±1.2 ml . kg‐1 to 3.4±1.1 ml . kg‐1 (P<0.05) and remained decreased during CO2‐pneumoperitoneum. Calculated venous admixture was unchanged throughout the study. Deflation of CO2‐pneumoperitoneum increased ITBV (22.4±5.2 ml . kg‐1, P<0.05) and cardiac output above control values.Conclusions: In anaesthetized‐paralyzed patients in the reverse Trendelenburg position intra‐abdominal CO2‐insufflation is associated with significant alterations of ITBV and PBV. The release of CO2‐pneumoperitoneum is associated with a re‐distribution of blood into the thorax.
No release of cardiac troponin I during major orthopedic surgery after acute normovolemic hemodilution
Authors: Hobisch‐Hagen P. , Schobersberger W. , Falkensammer J. , Luz G. , Innerhofer P. , Frischhut B. , Puschendorf B. , Mair J. 
Published: January 2009

Background: Normovolemic hemodilution is a well‐accepted method for intraoperative blood salvage. However, some controversy exists concerning the possible risk of myocardial fiber injury as a consequence of the reduced oxygen content. Laboratory diagnosis of perioperative myocardial fiber injury is difficult, since biochemical markers are elevated postoperatively due to the surgical trauma. Cardiac troponin I (cTnI) is a new, highly sensitive and specific cardiac marker for the detection of myocardial injury. The aim of our study was to investigate whether normovolemic hemodilution in patients with major orthopedic surgery (13 hemodiluted patients, 15 controls) induces a release of cTnI.Methods: cTnI as a highly specific and sensitive cardiac parameter, as well as total creatine kinase (CK), creatine kinase isoenzyme MB mass (CKMB mass) and myoglobin were measured after induction of anesthesia, after normovolemic hemodilution, prior to retransfusion of blood components, 3 h after surgery, and on the first and third postoperative days. Results: Prior to retransfusion of blood components the hematocrit was decreased to 25.4±1.2% (mean±SEM; range: 18%–34%) in the control group and to 20.2±0.8% (mean±SEM; range: 17%‐24%) in the hemodilution group. Total CK, CKMB mass as well as myoglobin concentration increased significantly in both groups, reaching their maxima within the first day of surgery. In contrast, cTnI was below the detection limit of the assay (<0.5 μg/L) at any time.Conclusions: We suggest that pre‐ and intraoperative hemodilution to a hematocrit of approximately 20% by maintaining normovolemia does not induce myocardial fiber injury in patients without preexisting cardiac diseases.
Removal of activated complement from shed blood: comparison of high‐ and low‐dilutional haemofiltration
Authors: Arnestad J. P. , Hyllner M. , Bengtson J. P. , Tylman M. , Mollnes T. E. , Bengtsson A. 
Published: January 2009

Background: Perioperative blood salvage is associated with release of inflammatory mediators. Depending on type of processing, the complement system is activated to some extent in the final blood product. The aim of the present study was to evaluate a haemofiltration technique concerning complement system activation and whether the volume of added saline will have an influence on the elimination of activated complement during processing.Methods: Sixteen patients undergoing total hip arthroplasty received wound blood salvaged intraoperatively with a haemofiltration technique. Saline was added to the reservoir for washing in a ratio of 1:1 or 5:1 of estimated blood volume. Samples for determination of the anaphylatoxins C3a and C5a, and the terminal SC5b–9 complement complex (TCC) were drawn from the patients, the collected blood, the ultrafiltrate and the processed blood.Results: Increased concentrations of C3a, C5a and TCC were found in aspirated and processed blood. Haemofiltration did not reduce the concentrations of these factors, except that of C3a in the group where saline was added in a ratio of 5:1. There were no increased concentrations of C3a, C5a or TCC in the patient plasma after reinfusion. No differences in blood pressure, heart rate, pH, arterial oxygen tension, arterial carbon dioxide tension, or base excess were found in association with rein‐fusion of the blood.Conclusion: Collected shed blood washed through haemofiltration contained moderately elevated concentrations of C3a, C5a and TCC. Reinfusion of the blood neither led to increased systemic concentrations of complement activation products, nor to disturbances in haemodynamic or biochemical parameters.
Tissue perfusion in relation to cardiac output during continuous positive‐pressure ventilation and administration of propranolol or verapamil
Authors: Elowsson P. , Norlén K. , Jakobson S. 
Published: January 2009

Background: Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive‐pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).Methods: General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end‐expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1followed by 0.15 mg · kg−1· h−1, n=8) or verapamil (0.1 mg · kg−1followed by 0.3 mg · kg−1· h−1, n=8).Results: CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.Conclusions: The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.
A bolus dose of 1.5 mg/kg amrinone effectively improves low cardiac output state following separation from cardiopulmonary bypass in cardiac surgical patients
Authors: Kikura M. , Levy J. H. , Bailey J. M. , Shanewise J. S. , Michelsen L. G. , Sadel S. M. 
Published: January 2009

Background: The aim of this study was to evaluate the efficacy of 1.5 mg/kg bolus of amrinone on low cardiac output (CO) state following emergence from cardiopulmonary bypass (CPB) in cardiac surgical patients.Methods: Immediately after emergence from CPB, 14 patients with a cardiac index (CI) less than 2.2 l min‐1 m‐2 despite administration of inotropes and nitroglycerin, received 1.5 mg/ kg amrinone over 3 min without changing catecholamine infusion rates (amrinone group). Hemodynamics and left ventricular short axis views with transesophageal echocardiography were recorded at baseline, 3, 5, and 10 min following amrinone administration. Left ventricular filling volumes were maintained constant by volume reinfusion from the CPB reservoir. We matched the data of the amrinone group with the other 14 patients who did not receive amrinone (non‐amrinone group) to evaluate the efficacy of amrinone in low CO state.Results: At baseline, CI (1.8±0.1 1 min‐1 m‐2) in the amrinone group was significantly lower than CI (3.0±0.2) in the non‐amrinone group. Following amrinone administration, CI and velocity of circumferential fibershortening corrected for heart rate (Vcfc) significantly increased, and systemic vascular resistance index and pulmonary vascular resistance index significantly decreased from the baseline within 10 min without changes in heart rate, mean arterial blood pressure, or pulmonary artery occlusion pressure, and became equivalent with those of the non‐amrinone group.Conclusions: A 1.5 mg/kg amrinone loading dose to patients in a low CO state, despite catecholamine therapy immediately after emergence from CPB, effectively improves ventricular function when loading conditions are maintained constant.
DA1‐receptor stimulation by fenoldopam in the treatment of postcardiac surgical hypertension
Authors: Gombotz H. , Plaza J. , Mahla E. , Berger J. , Metzler H. 
Published: January 2009

Background: Besides adequate analgesia, sedation and ventilation, postcardiac surgical hypertension has to be treated frequently with vasoactive drugs to avoid possible complications. In this study the hemodynamic effects of the DA1‐receptor agonist fenoldopam (F) are compared to those of the Ca‐channel antagonist nifedipine (N).Methods: Postoperatively, 64 CABG‐patients with a mean arterial pressure (MAP) of more than 105 mmHg over 10 min were investigated. Patients with compromised ventricular function, insufficient surgical repair, arrhythmia or an ECG unable to detect myocardial ischemia were excluded. The study drugs (initial dosage: F: 0.8; N: 0.3 μg kg‐1min‐1) were given continuously via a central venous catheter to reduce and to maintain the MAP between 80 and 95 mmHg. Hemodynamic parameters were determined using thermodilution technique.Results:A significant reduction of the MAP (F: from 121 ±11 to 83±4, N: from 119±8 to 82±9 mmHg) and of the calculated systemic vascular resistance (SVR) (F: 2110±500 to 970±200, N: 1980±660 to 1020±300 dyn‐s‐cm‐5) were noted in both groups, whereby in the F group the therapeutic goal could be achieved more quickly with the dosage regimen chosen. As a result, a marked increase of heart rate, cardiac index and stroke volume index could be observed, which was more pronounced due to the initially stronger decrease of SVR with F. There was also a stronger decrease of pulmonary vascular resistance in the F group, but the indices of right ventricular function did not differ between the groups.Conclusion: Fenoldopam seems to be an efficient alternative to nifedipine, especially because of its more rapid onset of action.
Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane‐nitrous oxide inhalation anaesthesia
Authors: Grundmann U. , Uth M. , Eichner A. , Wilhelm W. , Larsen R. 
Published: January 2009

Background: Remifentanil is a new rapid‐acting and ultra‐short‐acting μ‐opioid receptor agonist with few reports from use in children. Therefore, we compared a propofol‐remifentanil‐anaesthesia (TIVA) with a desflurane‐N2O‐anaesthesia (DN) with particular regard to the recovery characteristics in children.Methods: 50 children (4–11 yr) scheduled for ENT surgery were randomly assigned to receive TIVA (n=25) or DN (n=25). After standardised i.v. induction of anaesthesia in both groups with remifentanil, propofol and cisatracurium, TIVA was maintained with infusions of propofol and remifentanil. Ventilation was with oxygen in air. DN was maintained with desflurane in 50% N2O. The administration of volatile and intravenous anaesthetics was adjusted to maintain a surgical plane of anaesthesia. At the end of surgery all anaesthetics were terminated without tapering and early emergence and recovery were assessed. In addition, side effects were noted.Results: Both anaesthesia methods resulted in stable haemodynamics but significantly higher heart rate with desflurane. Recovery did not differ between the groups except for delayed spontaneous respiration after TIVA. Spontaneous ventilation occurred after 11±3.7 min versus 7.2±2.8 min (mean±SD, TIVA versus DN), extubation after 11±3.7 min versus 9.4±2.9 min, eye opening after 11 ±3.9 min versus 14±7.6 min and Aldrete score ≥9 after 17±6.8 min versus 17±7.5 min. Postoperatively, there was a significant higher incidence of agitation in the DN‐group (80% vs. 44%) but a low incidence (<10%) of nausea and vomiting in both groups.Conclusion: In children, TIVA with remifentanil and propofol is a well‐tolerated anaesthesia method, with a lower peroperative heart rate and less postoperative agitation compared with a des‐flurane‐N2O based anaesthesia.
Pharmacokinetics and clinical effect during continuous epidural infusion with ropivacaine 2.5 mg/ml or bupivacaine 2.5 mg/ml for labour pain relief
Authors: Irestedt L. , Ekblom A. , Olofsson C. , Dahlstrom A.‐C. , Emanuelsson B.‐M. 
Published: January 2009

Background: Ropivacaine has shown less systemic toxicity than bupivacaine, and comparatively low muscle‐blocking properties could constitute another advantage when used epidurally for obstetric pain relief. We aimed primarily to compare maternal and foetal drug disposition following continuous epidural infusion of ropivacaine or bupivacaine.Methods: Twenty‐four full‐term, nulliparous women were randomized to continuous epidural infusion (10 ml/h) of ropivacaine 2.5 mg/ml or bupivacaine 2.5 mg/ml for labour pain relief in a double‐blind, parallel‐group design. Maternal blood samples were collected up to 24 h after the end of infusion as well as taken from the umbilical cord at the time of delivery. Sensory and motor block as well as analgesia were assessed. All the women were monitored by cardiotocography and neonatal assessment was performed.Results: The sensory block was adequate for both drugs. Higher plasma levels (total and free) were seen with ropivacaine, although the infusion with bupivacaine continued on average for about 2 hours longer. However, the ratios between maternal and umbilical blood concentrations were similar for both drugs. Normal neonatal Apgar and neonatal adaptive capacity scores (NACS) were found in both groups.Conclusion: A continuous epidural infusion of 25 mg/h ropivacaine or bupivacaine both produced good labour pain relief. Higher total and free plasma concentrations were seen for ropivacaine. The ratios between maternal and umbilical plasma levels were similar for both drugs.
Epidural fentanyl, adrenaline and clonidine as adjuvants to local anaesthetics for surgical analgesia: meta‐analyses of analgesia and side‐effects
Authors: Curatolo M. , Petersen‐Felix S. , Scaramozzino P. , Zbinden A. M. 
Published: January 2009

Background: The risk/benefit ratio of adding fentanyl, adrenaline and clonidine to epidural local anaesthetics for improving intraoperative analgesia is unclear. This meta‐analysis was performed to clarify this issue.Methods: Trials retrieved by search were considered if they were prospective, controlled, epidural analgesia (without combining general anaesthesia) was planned and occurrence of pain during surgery or side‐effects were reported. Papers entered meta‐analysis if they reached a predefined minimum quality score. Pooled odds ratios (OR) and confidence intervals (CI) were computed. P<0.05 was considered as significant.Results: Eighteen trials were included in the analysis for fentanyl. Fentanyl decreased the likelihood of pain (OR=0.21, 95% CI=0.15–0.30, P<0.001) and increased the incidence of pruritus (OR=5.59, 95% CI=3.12–10.05, P<0.001) and sedation (OR= 1.88, 95% CI=1.19–2.98, P=0.003), compared to control (local anaesthetic without fentanyl). Fentanyl had no effect on respiratory depression, nausea, vomiting and Apgar score. One case of respiratory depression of a newborn was observed. Because of the very low number of trials selected, evaluation of adrenaline and clonidine was not feasible.Conclusion: The analysis of current literature shows that the addition of fentanyl to local anaesthetics for intraoperative epidural analgesia is safe and advantageous. The reduction in the incidence of pain during surgery is quantitatively high and therefore clinically significant. Side‐effects are mild. Randomized, controlled trials have to be performed in order to clarify the role of adrenaline and clonidine as epidural adjuvants for surgical analgesia.
The effect of i. v. enalaprilat in chronically treated hypertensive patients during cardiac surgery
Authors: Schuetz W. H. , Lindner K. H. , Georgieff M. , Mueller S. , Oertel F. , Radermacher P. , Gauss A. 
Published: January 2009

Background:Angiotensin‐converting enzyme (ACE) inhibitors are well established as long‐term antihypertensives and have also been proved useful in hypertensive emergencies. Therefore, we investigated whether intraoperative i. v. enalaprilat may reduce the incidence of perioperative hypertensive reactions in coronary artery bypass grafting (CABG).Methods:Thirty‐eight male patients chronically treated for arterial hypertension and scheduled for CABG randomly and double‐blindly received either enalaprilat 30 μg · kg−1or NaCl 0.9% at the time of skin incision. Intraoperatively increases of mean arterial pressure (MAP) >85 mmHg or >80 mmHg during cardiopulmonary bypass (CPB) were treated by an urapidil bolus. The total intraoperative amount of urapidil was documented for both groups. Systemic and pulmonary hemodynamics as well as the plasma levels of epinephrine, norepinephrine, arginine vasopressin and renin were measured intraoperatively and up to 2 h after admission to the intensive care unit.Results:Mean arterial pressure, cardiac index and systemic vascular resistance did not differ between the enalaprilat and the control group. Renin plasma levels significantly increased after infusion of enalaprilat and did not change in the placebo group. Catecholamine and arginine vasopressin plasma levels increased significantly during CPB and remained high in the postoperative period without any intergroup difference. The same amount of urapidil had to be given in the two groups to maintain MAP below the defined limit.Conclusion:We conclude that infusing 30 μg · kg−1enalaprilat in patients chronically treated for arterial hypertension does not prevent hypertensive reactions during CABG.
Vasopressor hormone response following mesenteric traction during major abdominal surgery
Authors: Brinkmann A. , Seeling W. , Wolf C. F. , Kneitinger E. , Schonberger C. , Vogt N. , Orend K. H. , Buchler M. , Radermacher P. , Georgieff M. 
Published: January 2009

Background: We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia.Methods: In a prospective, randomized, placebo‐controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4‐L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6‐keto‐PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high‐pressure liquid chromatography (HPLC) with electrochemical detection.Results: Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6‐keto‐PGF1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo‐treated patients.Conclusion: Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.