bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sodium nitroprusside after cardiac surgery: systemic and splanchnic blood flow and oxygen transport
Authors: Parviainen I. , Ruokonen E. , Takala J. 
Published: January 2009

Background:Vasoactive drugs may interfere with splanchnic blood flow and tissue oxygenation. Sodium nitroprusside (SNP) is widely used in the treatment of postoperative hypertension after cardiac surgery, but the effects of SNP and other vasodilators on splanchnic blood flow have not been well documented.Methods:The effects of SNP on systemic blood flow, oxygen transport and gastric intramucosal pH (pHi) were studied in 12 patients with arterial hypertension after coronary artery bypass grafting. In 9 of these patients, the effect on regional (splanchnic and leg) blood flow and oxygen transport was also measured. Hemodynamic and regional blood flow responses were measured before and during SNP infusion (mean 2.8±1.7 μg/kg/min, range 0.6‐6.3 μg/kg/min), when the goal of the vasodilator treatment, mean arterial pressure 70–80 mmHg, had been reached.Results:SNP increased splanchnic (0.65±0.22 vs. 0.87±0.37 L·min‐1·m‐2,P<0.01) and femoral blood flow (0.15±0.04 vs. 0.21±0.06 L·min‐1·m‐2,P<0.05) in parallel with cardiac index (2.6±0.6 vs. 3.3±0.7 L·min‐1·m‐2,P<0.01). Fractional regional blood flows did not change. Mean gastric intramucosal pH decreased slightly (7.40±0.07 vs. 7.37±0.06,P<0.05). Both systemic (420±85 vs. 495±90 mL·min‐1·m‐2,P<0.05) and femoral oxygen delivery (25±5 vs. 32±10 mL·min‐1·m‐2,P<0.05) increased, but neither systemic nor regional oxygen consumption changed.Conclusions:These results suggest that vasoregulation is well preserved during treatment of early postoperative hypertension with SNP, and that SNP has no adverse effects on splanchnic tissue oxygenation.
Sumatriptan‐induced cerebral vasoconstriction as treatment of experimental intracranial hypertension
Authors: Nilsson F. , Nilsson T. , Edvinsson L. , Rosén I. , Bjórkman S. , Messeter K. , Nordström C‐H. 
Published: January 2009

Background:Increased intracranial pressure (ICP) is a major cause of mortality in severe head injuries and pharmacologically induced cerebral vasoconstriction has been suggested as a possible treatment. In the present study a porcine model of increased ICP was utilized to study the changes in cerebral haemodynamics and energy metabolism induced by a selective 5‐hydroxytryptaminei agonist (sumatriptan).Methods:ICP was raised by inflation of two balloons covering both parieto‐occipital regions extradurally. The animals were randomized into four groups receiving sumatriptan: 0.01 mg·kg‐1(A), 0.03 mg·kg‐1(B), 0.1 mg·kg‐1(C), and 0.5 mg·kg‐1(D) intravenously over 10 min. Measurements of cerebral blood flow (CBF), arterio‐venous oxygen content difference (CavO2), and jugular venous pH (vpH) were performed 5, 20, 40, 60, and 75 min after start of the infusion. ICP, mean arterial pressure, and EEG were recorded continuously. Direct effects of sumatriptan were also compared in cortical arteries and veinsin vitro.Results:Significant decreases in ICP were obtained in groups A, B, and C while group D exhibited a progressive increase in ICP. Significant reductions in CBF, increase in CavO2, and slowing of EEG were observed in groups B, C, and D. Sumatriptan caused moderate constriction of the arteries and a more pronounced dilatation of veinsin vitro.Conclusion:The results indicate that a low dose of sumatriptan has the potential to reduce a raised ICP. High doses of sumatriptan cause a further increase of ICP possibly by dilatation of intracerebral veins.
Effect of inotropic stimulation on the synchrony of left ventricular wall motion in a dog model of myocardial stunning
Authors: Schlack W. , Ebel D. , Thämer V. 
Published: January 2009

Background: Reperfusion after short coronary occlusion induces regional myocardial dysfunction (“stunning”), including asynchrony of left ventricular (LV) wall motion. Contractile function of stunned myocardium can be increased by inotropic stimulation, but whether this has an influence on wall motion asynchrony is unknown.Methods: In six anaesthetized dogs, the effect of inotropic stimulation on regional myocardial function, and LV asynchrony was tested after the induction of regional stunning (by 15 min of left circumflex artery side branch occlusion). Regional myocardial function was assessed as mean systolic wall thickening velocity (υswt) by sonomicrometry in the stunned (posterobasal wall) and normal myocardium (anteroapical wall), and LV asynchrony by the phase difference (φ) of the first Fourier transform of the wall thickness signals.Results: In the stunned myocardium, υswt decreased from 8.6±1.0 to 1.7±1.4 mm s‐1 (mean±SEM), P<0.01, and simultaneously φ increased from 10.8±3.6 to 85.7±14.3°, P<0.01. Intra‐coronary noradrenaline (NADR, 0.25 μg) improved υswt (8.3±1.4 mm s‐1, P<0.01) in the stunned region and changed φ to ‐38.1±18.0°, P<0.05. Systemic NADR (5 μg) also increased υswt of the stunned region (to 3.8±2.1 mm s‐1, P<0.05), but left φ unchanged (82.9±19.8°).Conclusion: Regional function of stunned myocardium can be augmented by inotropic stimulation with noradrenaline, but this does not result in an improvement of LV wall motion asynchrony during systemic inotropic stimulation.
Platelet factor 4 release in patients undergoing cardiopulmonary resuscitation ‐ can reperfusion be impaired by platelet activation?
Authors: Böttiger B. W. , Böhrer H. , Böker T. , Motsch J. , Aulmann M. , Martin E. 
Published: January 2009

Background: Reperfusion following cardiac arrest is associated with a marked activation of blood coagulation. This seems to be associated with microcirculatory reperfusion disorders. The present study was designed to investigate the possible involvement of platelets in reperfusion injury following cardiac arrest. Plasma levels of platelet factor 4 (PF 4) were used as an indicator for in vivo platelet activation because PF 4 is known to be released from platelets during aggregation.Methods: Plasma PF 4 levels (normal range: < 5 IU/mL) were measured in 18 patients at predetermined time points during cardiopulmonary resuscitation (CPR). In the case of restoration of spontaneous circulation, additional blood samples were analyzed until seven days after stabilization. The PF 4 levels of four sex‐matched volunteers were used as controls.Results: The median of the maximum individual PF 4 levels measured during CPR was 27.5 IU/mL (range 1.2 to 90 IU/mL; P < 0.01 versus controls). Compared with PF 4 levels in control volunteers (median: 0.35 IU/mL; range 0.2 to 0.6 IU/mL), PF 4 levels were significantly elevated in patients during CPR and in the early phase until 24 hours after restoration of spontaneous circulation (P < 0.05).Conclusion: A marked increase in PF 4 levels was observed during CPR and in the early phase after cardiac arrest in man. This increase in PF 4 levels has to be viewed as an indicator of platelet activation, which may play a role in the etiology of reperfusion injury and microcirculatory reperfusion disorders occurring after cardiac arrest.
Transfusion‐related acute lung injury (TRALI) after fresh frozen plasma in a patient with coagulopathy
Authors: Lindgren L. , Yli‐Hankala A. , Halme L. , Koskimies S. , Orko R. 
Published: January 2009

Background: Transfusion‐related acute lung injury (TRALI) is due to specific antigen‐antibody reaction involving the donor's leucocyte or granulocyte antibodies towards the recipient's antigens. Aggregation in small pulmonary vessels occurs, leading to derangement of permeability.Case history: TRALI after transfusion of four units of fresh frozen plasma (FFP) for factor V deficiency prior to elective cholecystectomy is presented. Within a few minutes after the third unit of FFP a florid pulmonary oedema developed. Hypotension and hypoxia with SpO2 83–87% at FiO2 1.0 followed. Prompt monitoring of central haemodynamics revealed a normal cardiac index without pulmonary hypertension. The operation was then conducted as planned. The bilateral pulmonary oedema resolved after 72 hours with ventilatory support. The patient recovered without complications. When tested postoperatively, the second unit of FFP contained granulocyte antibodies and the third unit contained HLA antibodies. The crossmatch of the patient's granulocytes and lymphocytes towards the two donors of the two units of FFP was positive.Conclusion: When TRALI is suspected the donor blood has to be tested against the recipient. Ventilatory support of the patient is continued until adequate oxygenation is reached.
Reduction of ischemia‐reperfusion syndrome after abdominal aortic aneurysmectomy by N‐acetylcysteine but not mannito1,2
Authors: Kretzschmar M. , Klein U. , Palutke M. , Schirrmeister W. 
Published: January 2009

Background:Abdominal aortic aneurysmectomy results in a general ischemia‐reperfusion syndrome accompanied by an acute rise in mean pulmonary artery pressure (MPAP). Severe and sometimes fatal postoperative cardiopulmonary complications have been described.Methods:This pilot study examined whether N‐acetyl‐cysteine (NAC), a precursor of the most important physiological antioxidant glutathione (reduced form: GSH; oxidized form: GSSG), or the hydroxyl radical scavenger mannitol (MAN) modifies these events. The patients received 150 mg/kg b.m. NAC (n=9) 30 minutes before infrarenal aortic clamping or 500 mg/kg b.m. MAN (n=10) 10 minutes before declamping. 11 patients had no additional treatment (control).Results:In the control group, a significant increase in plasma levels of oxidized glutathione and lipid peroxides was observed after declamping. Additionally, a significant increase in plasma levels of the stable metabolites of thromboxane (TXB2) and prostacyclin (6‐keto‐PGF1α) was measurable after declamping. There was a transient increase in MPAP and pulmonary vascular resistance (PVR), both of which returned to normal values within 20 minutes. Six hours after surgery, pulmonary dysfunction was manifest by increase in the intrapulmonary shunt fraction. Relative to the control group, NAC pretreatment led to a complete lack of changes in plasma lipid peroxide, thromboxane and prostacyclin levels after declamping; there was a significant increase in plasma GSH concentration persisting over a period of 12 hours. MPAP, PVR and Qs/QTvalues were unchanged. MAN pretreatment showed similar effects on the parameters obtained in the acute phase after declamping like the control group.Conclusions:Pretreatment with NAC, but not mannitol, may help prevent ischemia‐reperfusion syndrome following aortic clamping.
High‐frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates and infants
Authors: Murthy B. V. S. , Petros A. J. 
Published: January 2009

We have evaluated the high‐frequency oscillatory ventilation (HFOV) combined with intermittent mandatory ventilation (IMV) in critically ill neonates and infants using the Babylog 8000 SW 4.0.We used HFOV combined with IMV as a rescue mode in 10 neonates and infants aged 1 day to 17 months, who were receiving maximal conventional ventilation for severe respiratory failure.There was a significant reduction in inspired oxygen requirement when starting HFOV combined with intermittent mandatory ventilation (IMV), from a baseline mean of 0.90 (CI95 0.79‐1.01) to 0.55 (CI95 0.40‐0.71) at 6h and 0.44 (CI95 0.37‐0.52) at 12h. There was also an overall improvement in gas exchange with complete haemodynamic stability.These data suggest that HFOV‐IMV mode offers significant improvement as a rescue mode for neonates and infants with severe respiratory failure.
Deformed spinal needle tips and associated dural perforations examined by scanning electron microscopy
Authors: Jokinen M. J. , Pitkänen M. T. , Lehtonen E. , Rosenberg P. H. 
Published: January 2009

Background: The tips of modern thin Quincke‐type spinal needles may be easily damaged by bone contact during the puncture. The purpose of this study was to find out the frequency of tip deformation in routine clinical work and the appearance of the dural perforations made by such damaged needles.Methods: Two hundred and ninety‐five Quincke‐type needles (22G‐29G) used in routine spinal anaesthesia were inspected by light microscopy. Scanning electron micrographs were taken of some of the damaged tips and of experimental dural perforations made by these.Results: Four per cent of the needle tips were clearly bent or hooked and 11% were slightly bent. When an introducer needle was used (19 cases), one needle was clearly bent and one slightly bent. A puncture with a bone contact was associated with clear tip damage in 7%; a puncture without bone contact resulted in an undamaged or slightly bent needle tip in 99% of the cases. The numbers of bent tips among the various sizes were: 22G‐2/21, 25G‐13/40, 27G‐28/231, 29G‐1/3. In scanning electron microscopy (SEM) images of four clearly bent needle tips the deviation of the tip was between 10 μm and 20 μm. In SEM of eleven dural perforations, the holes made by needles with clearly bent tips were almost closed and three of them exhibited an “open tin can” appearance. None of the dural perforations was badly torn.Conclusions: We verified that the tips of modern thin spinal needles are vulnerable to damage due to contact with bone. However, the holes made in dura by needles with bent tips do not appear to be excessively torn.
Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection
Authors: Scott N. B. , James K. , Murphy M. , Kehlet H. 
Published: January 2009

Background: The neuroendocrine response following major surgery has not been previously influenced by either regional anaesthetic techniques or opioid analgesia probably due to insufficient intraoperative afferent neural blockade. In this study we attempted to determine whether significant inhibition of these pathways could be achieved by combining preoperative high spinal anaesthesia with postoperative thoracic epidural anaesthesia. In theory too, there may be additional benefits over perioperative thoracic epidural anaesthesia on pain and pulmonary dysfunction.Methods: 20 ASA 1–3 patients undergoing elective colonic surgery were studied. Gp 1 (n=10) received a high spinal intraoperative block to T4 using 6mls of 0.5% bupivacaine plus continuous epidural 0.125% bupivacaine/0.0025% diamorphine. Gp 2 (n=10) patients received epidural 0.5% bupivacaine block to T4 plus continuous epidural infusion of 0.125% bupivacaine/0.0025% diamorphine. We measured a) plasma glucose and Cortisol at 0, 1, 2, 3, 4, 8 and 24 h; b) forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak flow rate (PFR) preoperatively, at 8 and 24 h; c) visual analogue pain scores (VAS 0–10) at rest, cough and mobilisation at 8 and 24 h; d) block height every hour for 12 hours then 3 hourly; e) 24‐hour urine volumes for dopamine, adrenaline and noradrenaline f) 24‐hour PCA morphine requirements.Results: The two groups did not differ in age, sex, height, weight, duration of surgery, blood loss or serum albumin. Pain relief was excellent and similar in both groups. The average 24 hour morphine consumption was 10 mg in both groups with no differences in the block height. All the patients had a 30–50% reduction in FEV1, FVC and PFR (P>0.05). Metabolically, there was no statistical difference between the 2 groups except a higher rise in glucose in Gpl at 2 and 3 h (P=0.0312 and 0.014). 24‐hour catecholamine studies showed no differences for noradrenaline (P=0.8), adrenaline (P=0.47) and dopamine (P=0.36).Conclusions: Thoracic epidural bupivacaine/diamorphine infusion provided excellent postoperative analgesia following colonic surgery. An intraoperative combined spinal/epidural technique conferred no additional benefit on analgesia, pulmonary function and the neuroendocrine response.
Dural puncture: the patients' perspective A patient survey of cases at a DGH maternity unit 1983–1993
Authors: Costigan S. N. , Sprigge J. S. 
Published: January 2009

Background: This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia.Methods: Sixty‐three patients who had suffered from accidental dural puncture during obstetric epidural analgesia over a ten‐year period were sent a questionnaire enquiring about their experiences. 68% responded.Results: Headache was the most severe symptom, occurring in 86% of this group; it lasted for a median of eight days and recurred after discharge in 47%. Backache occurred in 70% and 58% suffered with backache following discharge.Headache was considered to be the worst aspect by 49% of responders, backache by 19% and bedrest by 33%. Bed rest was frequently voluntary (as opposed to being enforced on medical orders) since many patients only gained relief from their headache when supine.Twenty patients (47%) received a blood patch, which was effective in relieving headache in 14 patients; however, the headache recurred after discharge in 10 of these 14 patients. Only 8 patients (19%) stated that they were aware of the risk of dural puncture prior to their epidural, three of whom were members of paramedical professions.Conclusions: Headache and backache are both common following dural puncture with a 16G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.
Local anaesthesia and propofol‐fentanyl sedation for carotid artery surgery
Authors: Nordström O. , Potemkowski A. , Johansson R. , Ridder B. de , Sternlo J. E. , Larsson L. , Sandin R. 
Published: January 2009

Background: In patients undergoing carotid artery surgery with local anaesthesia (LA), a sedative / analgesic pharmacological supplement is appropriate in most cases in order to provide comfort. This adjunct should not preclude continuous clinical neurological monitoring. The aim was to investigate if a combination of fentanyl and propofol to supplement LA would provide comfort for the patient, allow continuous clinical neurological monitoring and absence of difficulties for the anaesthetist, and good conditions for surgery, including insertion of a shunt if this should become necessary.Methods: During a 1‐year period low doses of propofol and fentanyl were used to supplement LA in 36 cases of carotid artery surgery in 34 consecutive patients. A shunt was only used if neurological dysfunction occurred. Data on haemodynamics, pulmonary gas exchange, clinical neurological monitoring, and subjective opinions from patients, surgeons and anaesthetists were obtained. Morbidity within 30 days was documented.Results: Conversion to general anaesthesia was undertaken in one patient, previously operated on the same artery, who became unconscious due to a stroke during manipulation of the artery before arteriotomy. No other adverse outcome was found within 30 days. In the remaining 35 cases the procedures were carried out under LA. Stump pressures below 50 mmHg were found in 17/35 cases. Intraoperative neurological dysfunction was detected in 10/35 cases (stump pressures between 23 and 60 mmHg). Shunting was easily performed, and rapidly relieved the neurologic symptoms in all these patients. Intraoperative respiratory and haemodynamic control was satisfactory. Ease of performance, including clinical neurological monitoring, was acknowledged by both anaesthetists and surgeons, and all 33 patients (35 operations) who were accessible for a postoperative interview stated that they would prefer the same regimen in the case of further surgery.Conclusion: The number of cases in this open, uncontrolled study does not permit an evaluation of this anaesthetic and sedative technique in terms of neurological and cardiac outcome. Thus, we simply want to inform about our positive experiences regarding patient acceptance and ease of performance in all relevant respects when fentanyl and propofol are used to supplement LA for carotid artery surgery.
Propofol reduces emesis after sufentanil supplemented anaesthesia in paediatric squint surgery
Authors: Standl T. , Wilhelm S. , Knobelsdorff G. von , Esch J. Schulte am 
Published: January 2009

Background. Squint surgery is associated with a high incidence of postoperative emesis. The purpose of this prospective study was to examine the influence of propofol and isoflurane anaesthesia on the incidence of postoperative nausea and vomiting in children.Methods. Ninety children aged 3–10 years were randomly allocated to one of 3 groups. In all groups, children received 2 mg/kg propofol, 0.5 μg/kg sufentanil and 0.5 mg/ kg atracurium for induction of anaesthesia. In group 1, anaesthesia was maintained with 15–20 mg/kg·h propofol and children were ventilated with 30% O2 in air. In group 2, anaesthesia was maintained with 10–15 mg/kg·h propofol and 30% O2 in N2O. In group 3, anaesthesia was maintained with 1.0–1.5 Vol% isoflurane and 30% O2 in N2O. The time of extubation, awakening and postoperative surveillance, the incidence and numbers of episodes of postoperative nausea and vomiting were registered as well as requirements of antiemetics. Statistics were made using ANO‐VA and Chi‐square test or Kruskal‐Wallis test with P<0.05 considered as significant.Results. The overall incidence of nausea (P=0.0001) and vomiting (P=0.002) was higher in group 3 (70%;73%) than in group 1 (13%; 23%) and 2 (20%;28%). Episodes of nausea (P=0.0001) and vomiting (P=0.0013) were more frequent in group 3 (74%;69%) than in group 1 (13%;15%) and 2 (13%;16%). Antiemetic requirements were higher and the time of postoperative sleep and surveillance was longer in group 3 than in group 1 and 2 (P=0.04).Conclusion. Propofol‐sufentanil anaesthesia results in less emesis and treatment during the early postoperative phase irrespective of N2O administration compared with propofol‐ induced isoflurane anaesthesia and may be recommended in children undergoing squint surgery.
Age‐dependent development of acute tolerance to propofol and its distribution in a pharmacokinetic compartment‐independent rat model
Authors: Larsson J. E. , Wahlström G. 
Published: January 2009

Background:Previous animal and clinical studies have shown a dose‐dependent increase in propofol concentrations in blood at wakening after propofol infusion. A development of an acute tolerance to propofol has been proposed. To elucidate this, brain concentrations of propofol at the time of an EEG end point was used as a measure of CNS sensitivity.Methods:Twenty young or 20 old rats were assigned to either induction of anaesthesia with propofol or induction followed by maintenance of anaesthesia with intermittent propofol infusions during 60 minutes. All rats were killed at the EEG end point and samples of cerebral cortex, hippocampus, striatum, brain stem, cerebellum, blood, muscle and fat tissue were submitted to HPLC analysis of propofol concentrations. A new model describing the infusion requirements is introduced.Results:The estimated infusion rate during maintenance declined exponentially with time at a slower rate in young compared with old rats. Old rats had higher propofol concentrations in blood, hippocampus, striatum, brain stem, cerebellum, muscle and fat after 60 minutes compared with induction. In contrast, young animals had no significant change in brain concentrations, but the propofol concentrations in muscle and fat were increased.Conclusion:It is concluded that maintenance of propofol anaesthesia may alter the CNS sensitivity to propofol in old animals, i.e. an acute tolerance may develop. Young animals do not seem to be capable of developing an acute tolerance to propofol. The results also support previous findings that a redistribution is important for the rapid clearance of propofol from blood.