bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Different Respirator Adjustments on Central Haemodynamics in Open‐Heart Surgery Patients
Authors: Laaksonen V. O. , Arola M. K. , Inberg M. V. , Irjala J. K. , Kari A. V. 
Published: January 2009

Changes in cardiac index (CI), mean pulmonary artery pressure (PAP), mean pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and pulmonary artery vascular resistance (PVR), associated with spontaneous respiration (SR) and two different types of intermittent positive pressure ventilation (IPPPV and IPNPV) were studied in a total of 17 patients undergoing aortic valve replacement or myocardial revascularization.Swan‐Ganz thermodilution pulmonary artery cardiac output catheters were used and the aim was to determine: whether postoperative cardiac output may paradoxically be greater during IPPPV than during IPNPV or SR; whether the use of “negative” pressure in the expiratory phase during controlled ventilation may be responsible for bringing about the central haemodynamic conditions prevailing during spontaneous respiration; and whether, in weaning from postoperative IPPPV to SR, there is a risk of pulmonary congestion as a consequence of possible autotransfusion.IPPPV connected with anaesthesia induction caused a highly significant deterioration of central haemodynamics. The use of positive end‐expiratory pressure (PEEP) is not to be recommended for such patients at this stage.On the first postoperative day, the mean CI was lower during IPPPV than during IPNPV (P<0.1) or during SR (P<0.05). The changes observed in CI, were, however, so slight that the authors consider the routine use of PEEP to be beneficial during controlled ventilation following major open‐heart surgery. In some patients, the CI was paradoxically higher during IPPPV than during IPNPV or SR.The mean CI was nearly the same during IPNPV (3.32) as during SR (3.38). However, PAP, PCWP and PVR values were significantly higher during SR than during IPNPV. Thus, according to this study, the use of “negative” end‐expiratory pressure during controlled ventilation did not in these patients produce central pressure conditions corresponding to spontaneous respiration.The present study supports the finding that in weaning from controlled ventilation with PEEP to SR there is a danger of pulmonary congestion. This could be predicted by measurement of pulmonary wedge pressure, but not by measurement of central venous pressure.
Pulmonary Complications, Ventilation and Blood Gases after Upper Abdominal Surgery
Authors: Hansen G. , Drabløs P. A. , Steinert R. 
Published: January 2009

Forty patients who underwent elective cholecystectomy were examined preoperatively and during the first postoperative week by physical examination, measurement of FVC and FEV1, arterial pH and blood gas analyses, and chest x‐ray. Postoperative pulmonary complications (p.p.c.) were detected in 30 (75%) of the patients. Simple auscultation was the most sensitive tool in discovering p.p.c., but 18 of the 30 patients with complications also had a pathological chest x‐ray.Obesity, smoking, postoperative naso‐gastric tube and postoperative wound infection were predisposing factors for p.p.c. Six patients with preoperative pulmonary disease all had a progress in their lung pathology. There was no definite relationship of duration of anaesthesia or drainage of the abdominal wound to development of p.p.c.The patients with p.p.c. showed a deeper and more prolonged fall in Pao2 postoperatively than the normal group. None of the normals showed an arterial Po2 below 70 mmHg in the postoperative course, while 63% of the p.p.c. group did.FVC and FEV1 showed marked reductions from preoperative values on the first postoperative day, and then gradually increased to near preoperative values after 1 week. Arterial pH and Pco2, showed no definite changes during the postoperative course.
The Need for Fentanyl Supplementation of N2O‐O2Relaxant Anaesthesia in Chronic Alcoholics
Authors: Tammisto Tapani , Tigerstedt Irma 
Published: January 2009

In order to find out how the need for analgesic supplementation during N2O‐O2‐relaxant anaesthesia is affected by chronic alcohol consumption, 82 patients with various known alcohol habits were anaesthetized for gastric or biliary surgery. Muscular relaxation was kept constant with the aid of a peripheral neurostimulator, and fentanyl was given in increments of 0.05‐0.1 mg for nociceptive symptoms during the anaesthesia.For induction, alcoholics (annual consumption above 151 pure alcohol) needed significantly more thiopental/kg body weight than social drinkers (1–151 annually) or non‐alcoholics (< 11 annually), and excitative symptoms were more frequent in alcoholics. A positive correlation was found between fentanyl supplementation and alcohol consumption (r = 0.41), non‐alcoholics requiring on average 3.8 μ/kg/h of fentanyl, as compared with 6.4 μ/kg/h in alcoholics. This correlation was clearer than that found previously under similar conditions by the authors between halothane supplementation and alcohol consumption (r = 0.20). In both studies the correlation was partly due to the higher incidence of gastric surgery among alcoholics, since gastric surgery itself requires more supplementation. An analysis of the different symptoms pointing to the need for fentanyl supplementation revealed that the simultaneous occurrence of several symptoms and the prevalence of motor responses were more common in alcoholics. In one patient halothane had to be used as well. In other patients no special difficulties were observed, and none of the patients reported dreams or recollections. The results suggest that during N2O‐O2‐relaxant anaesthesia the demand for fentanyl supplementation is increased by about 70% in chronic alcoholics with a mean annual consumption of 31 1 pure alcohol.
Arrhythmias During Halothane Anaesthesia II: The Influence of Atropine
Authors: Eikard Bent , Andersen Jens Rikardt 
Published: January 2009

The effect of i.v. atropine premedication on cardiac rhythm was studied in healthy adult patients during thiopental‐N2O/O2‐halothane anesthesia without intubation. A higher incidence of arrhythmias was seen in younger patients in close relation to administration of atropine, but the overall incidence during anesthesia was identical in the atropine groups and the control groups. The most common arrhythmias were supraventricular ectopies. None of the ECG irregularities led to serious arrhythmias. No consistent changes in blood pressure were observed as the result of arrhythmias or changes in heart rate.It is concluded that atropine should be reserved for situations where severe bradycardia and hypotensionoccur, or can be expected to occur, and not given automatically, since cardioacceleration which is inherent in its action may be injurious to patients with limited cardiac reserve.
Halothane Anaesthesia and Suxamethonium II The Significance of Preoperative Gallamine Administration
Authors: Wisborg K. , Christensen V. , Viby‐Mogensen J. 
Published: January 2009

Preoperative administration of gallamine was evaluated during inhalation anaesthesia with nitrous‐oxide and halothane with two administrations of suxamethonium 1 mg/kg body weight, 5 min apart.Sixty healthy patients were randomly divided into three groups, and pre‐anaesthetic gallamine, 0.3, 0.4 or 0.5 mg/kg body weight, respectively, was administered intravenously 3 min before induction, according to the allocation. Just before induction of anaesthesia the patients were examined for signs and symptoms of partial curarization. After induction of anaesthesia by nitrous‐oxide‐oxygen‐halothane, suxamethonium 1 mg/kg was given intravenously. Exactly 5 min later the same dose was repeated. EGG was monitored continuously and serum potassium, Pao2 and Paco2 were measured at appropriate intervals.It was found that none of the examined doses of gallamine gave any reliable protection against serious bradyarrhythmias after repeated doses of suxamethonium. Furthermore the higher doses of gallamine caused an unacceptably high frequency of patients with tachycardia and signs and symptoms of partial curarization.
Diazepam and Flunitrazepam as Induction Agents for Cardiac Surgical Operations
Authors: Clarke R. S. J. , Lyons S. M. 
Published: January 2009

Diazepam and flunitrazepam were compared in equipotent doses as induction agents for premedicated patients having cardiac surgery. Both drugs caused a significant fall in arterial blood pressure, a rise in Paco2 and a fall in Pao2. There was no significant difference between the two drugs in onset time of anaesthesia, cardiovascular or respiratory depression, or quality of induction. There was also no significant difference from induction with thiopentone in these respects.Diazepam, over a 0.2 to 0.6 mg/kg range of doses, showed no difference in toxicity, although induction was clinically smoother with the higher dose.
Inadvertent Thoracic Duct Catheterization during Transjugular Central Venous Cannulation. A Case Report
Authors: Májek M. , Malatinsky J. , Kadlic T. 
Published: January 2009

An aberrant placement of a central venous catheter into the upper part of the thoracic duct with loop formation in the left innominate vein was observed on catheterizing via the left internal jugular vein. The misplacement, which did not have any deleterious effects, was caused by the atypical insertion site of the thoracic duct at the dorsocaudal wall of the left innominate vein and, possibly, by its incompetent closing valve. The stiffness of the nylon catheter used may also have been a contributory factor.The possible causes of this complication of central venous catheterization are discussed. The preferential use of the right internal jugular vein is stressed.
Evaluation of Impedance Cardiography during Anesthesia in Extremely Obese Patients
Authors: Rasmussen Jens Peter , Eriksen Jørgen , Andersen Jens 
Published: January 2009

In three anesthetized markedly obese patients, non‐invasive stroke volumes (the transthoracic electrical impedance method) were compared to simultaneously obtained invasively measured stroke volumes (dye‐dilution method). Close correlations were obtained (r = 0.90‐0.98) between the two methods, although constant lower impedance stroke volumes were found in these patients when the values usually employed for the electrical resistivity of the blood (ζ) were used for calculation of the impedance stroke volume. No statistically significant difference (P> 0.10) between the two methods was found when a ζ of 175 ohm ζ cm was used for the calculations, or when the percentage changes in stroke volumes were analyzed.The impedance method is safe and reliable; it also permits non‐invasive measurements of stroke volume during anesthesia in markedly obese patients.
Pulmonary Function in Obese Patients Scheduled for Jejuno‐Ileostomy
Authors: Andersen Jens , Rasmussen Jens Peter , Eriksen Jørgen 
Published: January 2009

Preoperative pulmonary parameters were evaluated in 37 extremely obese but otherwise healthy patients. They were on average 100.9% overweight. X‐ray of the chest, electrocardiograms, and residual volume, vital capacity, total lung capacity, maximum breathing capacity, forced expired volume in 1 second, and related ratios were all within the normal range. The alveolar‐arterial oxygen gradient and the arterial carbon dioxide tension were also within the normal range. The only abnormal finding was a substantially reduced arterial oxygen tension.It is suggested that the measurement of functional residual capacity, closing volume, and the slope of the alveolar plateau (phase III in the single breath nitrogen washout technique) might give more valuable information.
Measurement of Rapid Changes in Cardiac Stroke Volume. An Evaluation of the Impedance Cardiography Method
Authors: Secher N. J. , Thomsen A. , Arnsbo P. 
Published: January 2009

One hundred and twenty‐nine simultaneous measurements were carried out on seven patients, 67 at rest and 62 during the Valsalva manoeuvre, in order to compare impedance cardiography with the thermodilution method, during rapid changes in cardiac stroke volume and pulmonary blood volume.A coefficient of correlation of 0.86 was found following linear regression analysis of the whole material. Analysis of the individual patient showed that the mean coefficient of correlation was 0.94 (range 0.91–0.97), and that the slope of the regression lines was 0.41 to 1.82, and further that the mean intercept was 0.2 ml.It is concluded that impedance cardiography can be employed for measuring the relative intraindividual changes in cardiac stroke volume during the Valsalva manoeuvre, and it is suggested that it may be of use in other situations, such as during haemorrhage or continuous positive pressure ventilation.
Parenteral Use of Diazepam in an Emulsion Formulation. A Clinical Study
Authors: Thorn‐Alquist Anne‐Marie 
Published: January 2009

A recently described injection formulation for diazepam, consisting of an oil emulsion where the drug is dissolved in the oil phase, has been found to give a lessened degree of side reactions than commercially available preparations. This emulsion formulation was compared to Valium® inj. as premedication in patients undergoing operation for hernia or varices under epidural anaesthesia.The effects, measured as the degree of drowsiness according to an arbitrary scale, were found to be equal for the two formulations. Neither was there any difference in blood concentrations in the two application groups, respectively, between the preparations used. The propylene glycol content of Valium inj. is said to cause a delayed release of the drug from the injection site after i.m. application, and this is briefly discussed, as well as the possibility of administering the diazepam emulsion continuously, diluted with Intralipid, without the risk of precipitation.
A Danish Cholinesterase Research Unit
Authors: Viby‐Mogensen J. , Hanel H. K. 
Published: January 2009

The organisation and initial experiences of a Danish Cholinesterase Research Unit are presented.The primary aim of the research unit is to provide a service for determining genotypes and activity of serum cholinesterase (acylcholine‐acyl‐hydrolase E.C. 3.1.1.8.) in patients suspected of having abnormal serum cholinesterase. Centralization of these investigations and use of a standard methodology have permitted the setting up of a central card index of families in Denmark with inherited abnormal serum cholinesterase.During the first 3 years, a total of 967 individuals have been genotyped. Two hundred patients were referred to the centre following an episode of prolonged apnoea after suxamethonium. In addition, 723 relatives of these 200 patients have been investigated, and 513 warning cards have been issued. Forty‐four individuals were genotyped for reasons not related to prolonged apnoea.Genetic variations of serum cholinesterase were identified with differential inhibition techniques using dibucaine, sodium fluoride, sodium chloride, succinyldicholine, and urea as inhibitors. It was found that no single inhibitor was able to differentiate between all known genotypes of locus E1. Inhibition of serum cholinesterase by urea, used together with the conventional dibucaine inhibition, gave results which compared favourably with the results obtained with the classical combination of dibucaine and fluoride inhibition. The results indicated that, at least in differentiation of rarer genotypes, urea inhibition may give valuable information not obtainable using fluoride inhibition.The difficulties in deciding which patients should be issued with warning cards are discussed. It is pointed out that only through close cooperation with the local anaesthetists involved will it be possible to elucidate the connection between the rarer genotypes and suxamethonium sensitivity.
The 600 Gram CO2 Absorption Canister: An Experimental Study
Authors: Jørgensen B. , Jørgensen S. 
Published: January 2009

Model investigations were performed on a canister containing 600 g of Sodasorb indicator soda lime in a transparent lime compartment used in the Hafnia circle. The CO2 input was 300 ml per min. Carbon dioxide will be efficiently eliminated from the gas mixture conveyed to the patient connection in this system for at least 4 h, irrespective of the rate of fresh gas flow. There was proportionality between the fresh gas inflow and the duration of effective CO2 elimination. The relative efficacy of the CO2 absorption was investigated at different levels in the canister. The temperature in the axis of the lime compartment was 43–52° C, and the temperature of the gas mixture conveyed to the patient attachment 30–35° C.The colour shift in the lime charge was a reliable indicator of the efficiency of CO2 elimination. The canister should be replaced when the colour shift has progressed to 2/3 of the lime charge.The canister contains no disposable parts except for the lime charge. All the components of the circle system should be taken apart and cleaned after each anaesthesia.
The Effect on the Splanchnic Blood Flow and Cardiac Output of Various Carbon Dioxide Concentrations during Fluroxene (Fluoromar®) Anaesthesia An Animal Study
Authors: Juhl B. , Einer‐Jensen N. 
Published: January 2009

Seven dogs premedicated with pethidine 10 mg/kg body weight, were anaesthetized with mebumal natrium 25 mg/kg body weight i.v. and gallamoni jodidum 80 mg, together with O2‐N2O in a ratio of 1 to 1. Thereafter four dogs were constantly hyperventilated and three constantly hypoventilated under stepwise increasing anaesthesia with fluoromar® (= fluroxene), up to 6% inspiratory concentration. A change was made between the groups at this fluoromar concentration, from hyper‐ to hypoventilation and vice versa, after which the fluoromar concentration was reduced stepwise to 0% inspiratory. During the course of this anaesthesia, the related values for flow, pressure and resistance in the systemic and splanchnic circulations were measured at fluoromar concentrations: 0–1 1/2–3‐6‐6‐3‐1 1/2‐0%.The relative changes in the systemic circulation during increasing concentrations of fluoromar are independent of hypo‐ or hypercapnia, while the absolute magnitudes of the measured parameters are strongly dependent on the CO2 tensions. The hypercapnic dogs had the highest cardiac output, stroke volume and most rapid pulse, as well as the lowest peripheral resistance. The same group of dogs had the lowest liver blood flow and the greatest splanchnic resistance. The mean pressures in the aorta, right atrium and portal vein were not different between the groups.A straight line dependence at 6% fluoromar, was demonstrated between cardiac index and Paco2: cardiac index (1‐min‐1‐m‐2) = 1.22 + 0.23 ± Paco2 (kPa), ((cardiac index (1‐min‐1‐m‐2) = 1.22 + 0.03 ± Paco2 (mmHg)), and peripheral resistance and Pao2: peripheral resistance (kPa 1‐1 min) = 12.85—0.5 ± Paco2 (kPa), ((peripheral resistance (dyn‐sec‐cm‐5 ± 10‐3) = 7.72‐0.04 ± Paco2 (mmHg)). The pressure in the portal vein appears to rise and the liver flow to fall with rising carbon dioxide tension, but the relationship is not significant.In the latter half of the investigation only small changes were demonstrated which could be related to the falling concentration of fluoromar. These were slight rises in the mean pressure of the aorta and cardiac frequency, similar for both groups. In addition, a slight rise in the peripheral resistance and splanchnic resistance were observed in the hypocapnic group. No changes were seen in the cardiac output and liver flow in any of the groups during falling fluoromar concentrations. The absolute magnitude of the measured parameters in relation to the CO2 tension reflects the conditions in the first half of the investigation, but the difference between the groups is less pronounced. This was partly due to the smaller difference in Paco2 between the groups in this part of the investigation and partly due to the time and experimental course.
Antagonism of Fentanyl with Naloxone during N2O+O2+ Halothane Anaesthesia
Authors: Tigerstedt Irma 
Published: January 2009

To investigate the antagonistic effect of naloxone on fentanyl‐induced respiratory depression, 55 patients (randomly divided into various study and control groups) were studied during nitrous‐oxide‐oxygen‐halothane anaesthesia. Respiratory depression after 0.1 mg of fentanyl was totally reversed by 10 μg/kg of naloxone, measured as 100% restoration of spontaneous respiration, normal minute volumes and end‐tidal CO2, while 15 μg/kg of naloxone was needed to antagonize 0.2 mg of fentanyl. The respective control groups remained apnoeic. If no fentanyl had previously been administered, there was no difference in the respiratory behaviour of naloxone‐treated and control patients, which indicates that no unspecific analeptic effect of naloxone could be demonstrated. The circulatory changes after fentanyl were nearly reversed by naloxone, as has been found earlier with other narcotics.Recovery from anaesthesia was scored from 0 to 10 (using a modification of Apgar scores for newborns), and somewhat higher mean scores were obtained with the naloxone‐treated patients than with their controls. However, higher postoperative pain scores were recorded in these patients as well as a higher incidence of nausea and vomiting.The study demonstrates the dose‐relationships of fentanyl and naloxone for estimation of total antagonism; however, the use of naloxone for partial antagonism at the termination of anaesthesia cannot be based on these findings.
Naloxone as Narcotic Antagonist after Balanced Anaesthesia
Authors: Tigerstedt Irma 
Published: January 2009

Different modes of naloxone administration were studied in 100 patients following N2O‐O2‐relaxant anaesthesia, where fentanyl was administered for analgesia according to a standardized dose schedule (mean 4.3 μg/kg/h). After reversal of muscular relaxation, the patients were randomly given naloxone—either 1.0 or 2.5 μg/kg i.v. or 2.5 or 5.0 μg/kg i.m., or none (control). Each group consisted of 20 patients.Awakening was fastest after 2.5 μg/kg i.v. of naloxone (1.8 ± 0.1 min), the time being significantly shorter (P < 0.025) than in the control group (2.7 ± 0.4 min). After 15 min, the minute volume and frequency of respiration were significantly higher (P < 0.05) in all naloxone groups than in the control group. However, the arterialized venous Pco2 did not show significant differences during the recovery. It is therefore suggested that naloxone reversal may cause an increase in CO2 production. The immediate postoperative pain (score 0–3) was mildest in the control group (1.0 mean) and severest after 2.5 μg/kg i.v. of naloxone (1.8 mean); the difference was statistically significant (P < 0.05). The groups receiving 1.0 μg/kg i.v. and 2.5 μg/kg i.m. did not differ from each other (1.2 mean). Nausea and vomiting were reported more often after 5.0 μg/kg i.m. of naloxone than in the other groups. After moderate doses of fentanyl during balanced anaesthesia, routine use of naloxone does not seem to be necessary, but if rapid recovery is essential, 1.0 μg/kg i.v. or 2.5 μg/kg i.m. of naloxone may be recommended and these doses do not cause a higher incidence of side effects.
Epidural Block in Twin Labour and Delivery
Authors: Gullestad Signe , Sagen Norvald 
Published: January 2009

In a clinical study, 28 twin mothers were provided with epidural block during labour and delivery. This group was compared to 24 twin mothers who received conventional analgesics throughout labour. General anaesthesia was administered when operative delivery was indicated in the control group.In the epidural group, duration of labour was significantly prolonged. A delayed second stage of labour caused an increased number of operative vaginal deliveries.Intra‐uterine asphyxia was not more frequent in the epidural group. Judged by the Apgar score and the neonatal course, there was no difference between the newborn in the two groups. Neither clinical evaluation, nor acid‐base investigations showed any difference between the condition of Twin I and Twin II in the epidural group.