bluuebunny/crossref_metadata_2025_split huggingface dataset:
Additive analgesic effect of codeine and paracetamol can be detected in strong, but not moderate, pain after Caesarean section
Authors: Bjune K. , Stubhaug A. , Dodgson M. S. , Breivik H. 
Published: January 2009

Background: A randomized, double‐blind, placebo‐controlled single oral dose study was done in order to examine whether codeine has an additive analgesic effect to that of paracetamol for moderate and strong postoperative pain after abdominal surgery. The maximum recommended single dose of paracetamol 1000 mg (Paracet®) was compared with a combination of a submnximal dose of paracetamol 800 mg plus codeine 60 mg (Paralgin forte®) and placebo for pain relief after Caesarean section in 125 patients.Methods: Visual analogue pain intensity score (VAS 0–100 mm) and categorical pain relief score were recorded for 6 hours after the study drug intake. The main efficacy variables analyzed were: pain intensity difference and summed pain intensity differences during the first 3 and 6 h after study drug intake, total pain relief during the first 3 and 6 h, global evaluation score at the end of the observation period, and time to rescue analgesic.Results: Because of protocol violations, 17 patients were excluded from the analysis of effects. Among the 108 patients included in the analysis of analgesic effect, 49 patients had moderate baseline pain (VAS between 40 and 60 mm on a 100 mm scale), and 59 patients had strong baseline pain (VAS more than 60 mm). In patients with strong baseline pain, statistically highly significant differences were documented in efficacy variables between the active drugs and placebo and between the two active drugs. However, in patients with moderate baseline pain, no differences were found between the study drugs in any of the analgesic efficacy variables.Conclusion: This study thus confirms that codeine has additive analgesic effect to paracetamol in pain after surgery. Our results show the importance of initial pain intensity in postoperative assessment of analgesic drugs. Assay‐sensitivity and test power are increased by selecting patients with sufficiently high initial pain intensity and by comparing groups of patients with identical surgery and similar demographic variables.
Cardiovascular responses to experimental infra‐renal aortic cross‐clamping. Modulating effects of isoflurane, sodium nitroprusside and milrinone
Authors: Seeman‐Lodding H. , Biber B. , Martner J. , Pontén J. , Winsö O. 
Published: January 2009

Background: Pharmacological control of blood pressure is usually indicated during aortic cross‐clamping (AXC). The aim of this study was to analyze the modulation by isoflurane (ISO), sodium nitroprusside (SNP) and milrinone (MIL) of the systemic circulatory responses to a standardized infra‐renal AXC.Methods: Chloralose‐anaesthetized pigs were exposed to AXC at control (no vasoactive drugs) and during the administration of each of the drugs.Results: During control, AXC increased mean arterial pressure (MAP, 17±4%) and systemic vascular resistance (SVR, 27±7%), but induced no significant changes in cardiac output (CO), heart rate (HR), pulmonary arterial pressures, pulmonary vascular resistance or central venous pressure. Low‐dose ISO (0.7%) and investigated doses of SNP and MIL did not significantly alter this response. High‐dose ISO (1.4%] attenuated the AXC‐induced increase in SVR, but not in MAP. All drugs decreased non‐clamp MAP levels. Therefore, with low‐dose ISO and with SNP or MIL, peak MAP during AXC was not significantly different fromcontrolnon‐clamp levels (i.e. prior to pharmacological or surgical interventions). High‐dose ISO was associated with a MAP during AXC that was below control non‐clamp levels.Conclusions: The objective that during AXC MAP should not exceed control non‐clamp levels was achieveable by ISO, SNP or MIL. The modulating actions of the drugs on MAP during AXC were exerted mainly through reductions in non‐clamp levels. This systemic hypotension was associated with decreased CO and SVR during ISO, and with decreased SVR and increased HR during SNP and MIL. Attenuation of the AXC‐induced increase in SVR was produced only by 1.4% ISO.
A cost‐benefit evaluation of using propofol and alfentanil for a short gynecological procedure
Authors: Enlund M. , Kobosko P. , Rhodin A. 
Published: January 2009

It is well established that the immediate recovery after propofol or alfentanil anesthesia is short. Although the drugs themselves are more expensive than older drugs, a potential for saving costs arises. Concerning the benefits in terms of late recovery, less information is available. With vaginal termination of pregnancy (VTP), anesthesia is supposed to be the major cause of sick‐leave. Does propofol and alfentanil anesthesia for VTP reduce sick‐leave compared with thiopental and nitrous oxide anesthesia, and do the increased costs of the drugs outweigh the reduced costs of sick‐leave?Data were obtained from 39 of 40 patients in ASA class I accepted for VTP and allocated to either propofol and alfentanil anesthesia (PA) or thiopental and nitrous oxide anesthesia (TN). A questionnaire was filled in by the patients at home after regaining full fitness. The number of patients with a sick‐leave of 2 days or less in the groups was compared statistically with the number of patients with 3 days or more off work. The economic impact from the reported sick‐leave was calculated for each study group, using data from national statistics. The figures were compared with the calculated costs of the drugs. The median number of days of sick‐leave was 1 in the PA‐group and 2 in the TN‐group (range 0–3 and 0–5, respectively). Nineteen of the 20 patients in the PA‐group and 13 of the 19 patients in the TN‐group needed a short sick‐leave period of 2 days or less (one‐sided test of proportions, P<0.05). At the time of the study each patient was paid 210 SEK/day from the social insurance system and the mean cost of the drugs was 72 and 15 SEK/patient in the PA‐ and TN‐groups, respectively. Using the mean difference in sick‐leave between the groups of 0.8 days/patient (rather than the difference in median values of 1), a net gain of 111 SEK/patient was the result of changing from thiopental‐nitrous oxide anesthesia to propofol‐alfentanil anesthesia.Although the cost of drugs was higher, costs for the social insurance system and for the individuals themselves were reduced by almost 50%, when using the propofol and alfentanil combination, resulting in an overall benefit corresponding to almost twice the increase in the cost of anesthesia.
Comparison of intubating conditions after rocuronium and suxamethonium following “rapid‐sequence induction” with thiopentone in elective cases
Authors: Sparr H. J. , Luger T. J. , Heidegger T. , Putensen‐Himmer G. 
Published: January 2009

Background: Rocuronium (Org 9426) was shown to have the fastest onset of action of all currently available non‐depolarizing neuromuscular blocking drugs and to provide intubating conditions similar to those of suxamethonium 60 to 90 s after administration. We compared the intubating conditions after rocuronium and suxamethonium following rapid‐sequence induction of anaesthesia.Methods: Fifty unpremedicated patients of ASA physical status I or II, scheduled for elective surgery were studied. Anaesthesia was induced with thiopentone 6 mg kg‐1 followed randomly by suxamethonium 1 mg kg‐1 or rocuronium 0.6 mg kg‐1 and, 45 s later, intubation was commenced. Muscle fasciculations, intubating conditions and intubation time, haemodynamic variables and oxygenation were assessed.Results: Intubation time did not differ between suxamethonium (9.8±2.2 s) (mean±SD) and rocuronium (10.5±2.9 s), respectively. Intubating conditions were clinically acceptable (good or excellent) in all patients given suxamethonium and in 96% of the patients given rocuronium. However, the condition of the vocal cords was better (P<0.05) and diaphragmatic response to intubation was less pronounced with suxamethonium (P<0.05). Changes in heart rate and arterial blood pressure were similar in both groups.Conclusion: The authors conclude that rocuronium is a suitable alternative to suxamethonium for rapid tracheal intubation even under unsupplemented thiopentone anaesthesia, at least in elective, otherwise healthy patients. Its use for rapid‐sequence induction under emergency conditions, however, needs further investigation.
The effect of succinylcholine on energy metabolism studied by 31 P‐NMR spectroscopy in rat denervated skeletal muscle
Authors: Mizogami M. , Fujibayashi T. , Harada J. , Goto Y. 
Published: January 2009

Background: The goals of this study were: (1) to demonstrate the differences of metabolic changes induced by succinylcholine (SCh) administration between normal and denervated muscle by 31P‐NMR spectroscopy: (2) to determine whether three kinds of drugs (vecuronium, midazolam and magnesium sulfate) could prevent these metabolic changes.Methods: Following unilateral sciatic nerve section, 20 male Wistar rats were studied at three‐week intervals. After SCh 1 mg·kg‐1 was administered intravenously, the changes of the inorganic phosphate/phosphocreatine (Pi/PCr) ratio, the β ATP/(PCr+Pi) ratio, and intracellular pH were measured by 31P‐NMR both in normal and denervated hind limb muscles of 5 rats. The other 15 rats were allocated to the pretreatment groups by the following drugs: vecuronium 0.02 mg·kg‐1, midazolam 0.1 mg·kg‐1 and magnesium sulfate 60 mg·kg‐1. After pretreatment 3 min before SCh administration, we measured the same parameters by 31P‐NMR.Results: SCh administration did not change the Pi/PCr ratio in normal muscle, but significantly increased that in denervated muscle (P<0.05). This increase of the Pi/PCr ratio was also observed in all pretreated groups but was minimal as compared with that in non‐pretreatment denervated muscle.Conclusion: These data suggested that SCh administration decreased the level of “energy reserve” in denervated muscle, and that this metabolic change was not totally inhibited by vecuronium, midazolam, or magnesium sulfate.
Rectal administration of morphine in children
Authors: Lundeberg S. , Beck O. , Olsson G. L. , Boreus L. O. 
Published: January 2009

Background: There is limited knowledge about the pharmacokinetics of morphine and its metabolites after rectal administration in children. In this study the pharmacokinetics of two different rectal formulations of morphine were examined and compared with intravenous morphine.Methods: Children undergoing elective surgery received rectal morphine 0.2 mg/kg before start of surgery. Ten children (mean age 14 months) received morphine rectally in a hydro‐gel formulation and another 10 children (mean age 16 months) received morphine rectally in a parenteral formulation. For comparison, 6 children (mean age 21 months) were given the same dose intravenously. The plasma concentrations of morphine, morphine‐3‐glucuronide (M3G) and mor‐phine‐6‐glucuronide (M6G) were measured by HPLC over 6 h after drug administration.Results: The mean rectal bioavailability of morphine was 35% (range 18–59) after hydrogel administration and 27% (range 6–93) after the solution. Mean values of Cmax were 76 nmol/1 (25–129) and 56 nmol/1 (15–140), respectively. The results showed that morphine gel had a significantly higher bioavailability (P<0.02) than the solution. The ratios of plasma (M3G + M6G) to morphine were higher after rectal administration (mean 7.5–8.7) than after i.v. injection (mean 5.3), indicating the presence of first‐pass metabolism using the rectal route.Conclusions: The rectal morphine hydrogel has pharmacokinetic properties which makes it a useful formulation for premedication and pain alleviation in paediatric patients.
MAC for halothane and isoflurane during normothermia and hypothermia in the newborn piglet
Authors: Satas S. , Haaland K. , Thoresen M. , Steen P. A. 
Published: January 2009

Background: Halothane and isoflurane are frequently used in studies of perinatal hypoxia and ischemia. Little information exists on the minimum alveolar concentration (MAC) necessary to prevent movement to a painful stimulus in newborn pigs and no information on the effects of hypothermia on MAC in pigs. Hypothermia is currently investigated as a posthypoxic neuroprotective intervention.Methods: The MAC of halothane and isoflurane necessary to prevent movement when a 25 cm hemostatic clamp was applied to the tail were determined in six 20–48‐hour‐old piglets, and when the same stimulus was applied to the hoof. MAC for halothane was first determined at 39°C, then at 35°C, whereafter halothane was discontinued and MAC for isoflurane determined first at 35°C and then at 39°C.Results: In all six piglets MAC was lower at 35°C than at 39°C for both anesthetics with both tail and hoof determination, lower for halothane than isoflurane for both stimuli at both temperatures, and lower for tail than hoof determination for both anesthetics at both temperatures. For halothane at 39°C, mean (SD) MAC hoof was 0.82 (0.05)% vs tail 0.60 (0.12)%, and at 35°C, hoof 0.65 (0.06)% vs tail 0.42 (0.10)%. For isoflurane at 39°C, MAC hoof was 2.47 (0.28)% vs tail 1.83 (0.28)%, and at 35°C, hoof was 1.83 (0.18)% vs tail 0.85 (0.25)%.Conclusion: In the newborn piglet, MAC should be determined by hoof clamp, MAC of isoflurane is approximately three times that of halothane, and both are reduced during hypothermia.
Effect of inhaled nitric oxide on venous admixture depends on cardiac output in patients with acute lung injury and acute respiratory distress syndrome
Authors: Benzing A. , Loop T. , Mols G. , Geiger K. 
Published: January 2009

Background: It has been shown that inhaled nitric oxide (NO) reduces intrapulmonary venous admixture (QVA/QT) and improves oxygenation in patients suffering from acute respiratory distress syndrome (ARDS). The change in QVA/QT during NO inhalation varies individually. Factors known to influence the respiratory response to NO are the NO conceritration and the level of shunt before NO administration. Other factors that may modify the effect on gas‐exchange during NO breathing are unknown.Methods: We studied the effect of 40 ppm inhaled NO on pulmonary gas‐exchange and haemodynamics in 37 patients with acute lung injury (ALI) and ARDS, respectively, and factors that may influence the respiratory response to NO.Results: Inhalation of 40 ppm NO produced a decrease in mean pulmonary artery pressure (MPAP) from 33.1±7.2 to 30.2±6.8 (mean±SD) mmHg (P<0.0001) while pulmonary artery wedge pressure (PAWP), cardiac output and mean arterial pressure remained constant. Change in QVA/QT during NO inhalation depended on the preinhalation cardiac output and had no association with mixed venous oxygen tension, MPAP‐PAWP, and QVA/QT before NO delivery. QVA/QT decreased in 26 patients (group 1) and increased in 11 patients (group 2) during NO inhalation. In group 1, cardiac output was lower than in group 2 (8.6 vs. 12.2 1‐min‐1; P<0.0005).Conclusion: We conclude that the change in venous admixture during inhalation of 40 ppm NO depends on cardiac output. If preinhalation cardiac output is high, 40 ppm NO can adversely affect gas exchange in patients with ALI and ARDS.
Thermoregulatory response in female patients during lower abdominal surgery in the head‐down tilt position
Authors: Hirose M. , Hara Y. , Iwasa J. , Matsusaki M. 
Published: January 2009

Background: The head‐down tilt (HDT) position suppresses sympathetic nervous activity. We investigated the effect on thermoregulation of the HDT position during lower abdominal surgery under general anaesthesia.Methods: Tympanic membrane temperature was measured to assess core temperature, and forearm‐fingertip and calf‐toe temperature gradients were used to assess peripheral vasoconstriction in 30 female patients less than 60 years of age.Results: During surgery in the HDT position (n=10), the tympanic membrane temperature was similar to that of patients in the supine position (n = 10) (36.2°C and 36.2°C), but in patients operated in the HDT position and premedicated with an angiotensin converting enzyme inhibitor (5 mg of enalapril, n = 10) it was reduced (35.7°C, P<0.05). In both groups of patients operated in the HDT position, forearm and calf skin‐surface temperature gradients were lower by 2–3°C than those in patients operated in the supine position (P<0.05).Conclusions: During lower abdominal surgery the head‐down tilt position does not augment core hypothermia in spite of suppressed peripheral vasoconstriction, and the renin‐angiotensin system may be of importance for thermoregulation.
Propofol influences the electroretinogram to a lesser degree than thiopentone
Authors: Tanskanen P. , Kylmä T. , Kommonen B. , Karhunen U. 
Published: January 2009

Background: The Electroretinogram (ERG) is used clinically to assess the function of retina. Anaesthetic agents are known to affect ERG, and as anaesthesia is often needed in children and uncooperative patients, knowledge about its effects is of clinical importance. Barbiturates selectively depress ERG components, and we compared thiopentone with propofol to assess if the latter preserved retinal function better.Methods: Ten pigs, average weight 17 kg (SD ± 2 kg) were anaesthetized randomly with propofol 10 mg kg‐1 or thiopentone 30 mg kg‐1. Anaesthesia was maintained by 65% nitrous oxide in oxygen and continuous infusion of the induction agent, i.e. 10 mg kg‐1 h‐1 of propofol, or 10 mg kg‐1 h‐1 for the first hour, then 5 mg kg‐1 h‐1 of thiopentone, with doses being based on pilot studies. After an interval of one week the programme was repeated using the other agent. After 40 minutes dark‐adaptation, responses to single flashes of graded intensities from a xenon flashlamp were recorded at five‐minute intervals. The a‐ and b‐wave amplitudes and implicit times (time to peak), and a‐wave slopes were determined.Results: The b‐wave implicit time was significantly shorter during propofol anaesthesia than when using thiopentone. The effect was most pronounced at the lowest intensities (P < 0.01). No statistically significant differences were found in the amplitudes of the b‐waves. The a‐wave appeared at lower stimulus intensity (P < 0.05) and the a‐wave slopes were significantly steeper (P < 0.01) during propofol anaesthesia.Conclusion: Propofol accordingly appeared to preserve the photoreceptor response better than thiopentone, and may therefore be considered to be more suitable for ERG recordings than thiopentone.
Lung uptake of lidocaine during hyperoxia and hypoxia in the dog
Authors: Hasegawa K. , Yukioka H. , Hayashi M. , Tatekawa S. , Fujimori M. 
Published: January 2009

Background:Lidocaine has been shown to accumulate in the lung following its administration. This study was undertaken to determine effects of dose of lidocaine on lung uptake during hyperoxic and hypoxic ventilation.Methods:Using cross‐circulation consisting of ventilation and constant‐flow perfusion of the left lower lobe independently from all other lobes of the dog lung under nitrous oxide and halolhane anesthesia, lidocaine was infused into the inflow system, so that plasma lidocaine concentrations in the inflow blood were maintained at 5, 10, 20, 40 and 70 μg/ml respectively during ventilation with 50% O2or 3% O2. During 20 μg/ml lidocaine infusion, indocyanine green (ICG), an intravascular marker, was mixed with the lidocaine solution, in such a fashion that plasma ICG concentration in the inflow blood was maintained at 20 μg/ml. Actual plasma lidocaine and ICG concentrations in blood drawn from the inflow ([Lid]pa, |ICG]pa)and the outflow ([Lid]pv, [ICG]pv) systems were measured 1, 3, 5, 7 and 10 minutes after the beginning of lidocaine infusion. Percent lung uptake of perfused lidocaine was calculated as (1‐([Lid]pv/[Lid]pa)/([ICG]pv/[ICG]pa)| x100.Results:During ventilation hyperoxia, mean percent lung uptakes of lidocaine were 41–52% 1 minute after the beginning of lidocaine infusion, and decreased in time‐dependent fashion to 7–12% 10 minutes later. Curves of percent lung uptake of lidocaine over time were similar for the 5 predetermined lidocaine concentration groups (5–70 μg/ml). There were no significant differences in percent lung uptakes of lidocaine between the ventilation hyperoxia and hypoxia conditions.Conclusions:These findings suggest that percent lung uptake of lidocaine is unaffected by hypoxic ventilation and by varying the concentration of lidocaine in the perfusion through the recipient dog lung lobe.
Atelectasis and pulmonary shunting during induction of general anaesthesia ‐ can they be avoided?
Authors: Rothen H. U. , Sporre B. , Engberg G. , Wegenius G. , Reber A. , Hedenstierna G. 
Published: January 2009

Background: Gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. A major cause of this disorder appears to be atelectasis and consequently pulmonary shunt. After re‐expansion, atelectasis reappears very slowly if 30% oxygen in nitrogen is used, but much faster if 100% oxygen is used. The aim of the present study‐was to evaluate if early formation of atelectasis and pulmonary shunt may be avoided if the lungs are ventilated with 30% oxygen in nitrogen instead of 100% oxygen during the induction of general anaesthesia.Methods: Twenty‐four adult patients with healthy lungs scheduled for elective surgery were investigated. During induction of anaesthesia, the lungs were manually ventilated via a face mask, using either 30% oxygen in nitrogen (group 1, n=12) or 100% oxygen (group 2, n=12). Atelectasis was estimated by computed x‐ray tomography and ventilation‐per‐fusion distribution with the multiple inert gas elimination technique, both awake and during general anaesthesia with mechanical ventilation.Results: No atelectasis was present in the awake subjects. After induction of anaesthesia, the mean amount of atelectasis was minor (0.2±0.4 cm2) in group 1 and considerably greater (8.0±8.2 cm2) in group 2 (P<0.001). The pulmonary shunt was 0.3±0.7% of cardiac output in the awake subjects. This value increased to 2.1±3.8% in group 1 and to 6.5±5.2% in group 2 (P<0.05). The indices of VA/Q mismatch showed no difference between the two groups.Conclusion: During induction of general intravenous anaesthesia in patients with healthy lungs, gas composition plays an important role for atelectasis formation and the establishment of pulmonary shunt. By using a mixture containing 30% oxygen in nitrogen, the early formation of atelectasis and pulmonary shunt may, at least in part, be avoided.