bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of eltanolone and thiopental in anaesthesia for termination of pregnancy
Authors: Eriksson H. , Haasio J. , Korttila K. 
Published: January 2009

This study was presented in part at the 22nd meeting of the Scandinavian Society of Anaesthesiologists in Kuopio, Finland, in June, 1993.Eltanolone, a new steroid hypnotic, was compared to thiopental in short anaesthesia.Sixty unp re medicated, ASA 1—2 women were randomized to receive eltanolone 0.6 (group El) or 0.8 mg . kg‐1(group E2) or thiopental 4 mg . kg‐1(group T) for induction of anaesthesia. One minute before induction glyco‐pyrrolate 0.2 mg and alfentanil 15 μg . kg‐1i.v. were administered. If induction failed, additional boluses of the test drug were given. Anaesthesia was maintained with 67% nitrous oxide in oxygen, and additional bolus doses of the test drug were given in a standardized fashion, if needed. Recovery was assessed by a research nurse blinded to the agent used.Mean±s.d. induction doss were 0.7±0.1 mg . kg‐1(group E1), 0.8±0.1 mg . kg‐1(group E2) and 4.0±0.0 mg . kg‐1(group T). Induction time was prolonged in the group E1 compared to the other two groups (P<0.05). Side effects were few in all groups, but involuntary muscle movements or hypertonus occurred in 23% of the patients in the eltanolone and in 3% in the thiopental groups (n.s.). Early recovery (eye opening, orientation and sitting) was slower in both eltanolone groups compared to the thiopental group (P<0.01). No differences between the groups were found in toleration of oral fluids, walking, voiding, postoperative analgesic requirements or postoperative nausea and vomiting. Psychomotor recovery, as assessed by the Maddox Wing and the Digit Symbol Substitution tests was similar between the groups. Home readiness was achieved in 78 min (34–101 min), 90 min (29–181 min), and 84 min (36–111 min) in the groups E1, E2 and T, respectively [median (range)] (n.s.) Early recovery was faster after thiopental than eltanolone, but no differences between the groups regarding home readiness or the psychomotor tests were found.
Interactions between the lipophilic opioid sufentanil and clonidine in rats after spinal application
Authors: Meert T. F. , Kock M. De 
Published: January 2009

Background: Alpha2‐adrenoceptor agonists, such as clonidine, can potentiate the analgesic properties of spinal opioids. In order to further extend this observation to highly lipophilic and potent spinally acting opioids, we tested the interactions between clonidine and sufentanil after both epidural and intrathecal administration in rats.Methods: The rats were equipped with spinal catheters. Antinociceptive testing was performed with the Tail Withdrawal Reaction test. Dose‐response functions of sufentanil, clonidine and combinations of clonidine plus sufentanil were determined.Results: These indicated that 1) sufentanil, but not clonidine alone, results in a dose‐related antinociception after both the epidural and the intrathecal route of administration; 2) In combination with normally inactive doses of sufentanil, the addition of clonidine results in activity; 3) In a particular dose‐range of sufentanil, there is a direct relationship between the doses of sufentanil and clonidine needed to produce antinociception; 4) Even at very high doses of clonidine, a minimal amount of sufentanil is needed to produce antinociception and 5) At the conditions tested here, the contribution of clonidine is minimal at high, intrinsic active doses of sufentanil.
The metabolic effects of oral tizanidine in healthy volunteers
Authors: Taittonen M. , Räty H. , Kirvelä O. , Aantaa R. , Kanto J. 
Published: January 2009

This pilot study compared the metabolic effects of placebo and 6 mg and 12 mg of oral tizanidine in random double‐blind cross‐over fashion in five healthy volunteers.The metabolic measurements were made with a portable metabolic chart (Deltatrac, Datex/Instrumentarium, Helsinki, Finland). Heart rate (HR), systolic (BPS), mean (BPM) and diastolic (BPD) blood pressure were measured noninvasively. Subjective assessment of tiredness and dryness of mouth were measured by using visual analogue scales (VAS).There were no statistically significant differences in tiredness or dryness of mouth between the groups. BPD decreased significantly after both doses of tizanidine when compared to placebo (by an average of 12% after 6 mg of tizanidine and 15% after 12 mg of tizanidine from the baseline). Oxygen consumption and energy expenditure decreased significantly after 6 and 12 mg of tizanidine when compared to placebo. The average decrease in oxygen consumption was 3% after 6 mg of tizanidine and 8% after 12 mg of tizanidine, when compared to the baseline. Energy expenditure decreased by an average of 5% after 6 mg of tizanidine and 9% after 12 mg of tizanidine, when compared to the baseline. There were no other statistically significant differences between the groups.This study indicates that 6 and 12 mg of oral tizanidine can be useful for reducing energy expenditure and oxygen comsumption without prominent cardiovascular effects.
Peroperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery: The Gothenburg study of perioperative risk (PROPER). Part II
Authors: Ouchterlony J. , Arvidsson S. , Sjöstedt L. , Svärdsudd K. 
Published: January 2009

All anaesthetic and surgical procedures impose a certain risk of complications. However, reliable estimates of this risk from prospective studies are rare. This study is a prospective clinical epidemiological study of 1361 consecutive patients subjected to elective general and orthopaedic surgery.These patients were followed from an extensive preoperative assessment to three months after the operation. In this report the peroperative and early postoperative period in the postoperative care unit or intensive care unit is described.General anaesthesia was given to 59% and regional/local anaesthesia to 41%. Adverse peroperative events occurred in 19%. The most common were circulatory events (11%), respiratory (4%), and allergic events (1%). Most events were of minor severity. However, with the official registration system, only 1 out of 8 events was detected. In the postoperative unit one or more adverse event was noted in 47% of the cases. These were dominated by circulatory (18.4%) and respiratory events (5.0%). CNS depression was noted in 6.8% of the cases. Most per‐ and postoperative event variables were highly correlated to the degree of surgical stress. In conclusion, a new concept for preoperative assessment and the registration of events during and after surgery was used. In this way, a large number of events of importance, not least for quality assurance, were found that would be missed with the official coding system. In a previous report we could show that even minor events affected the cost of care substantially.
Nitrous oxide is a potent cerebrovasodilator in humans when added to isoflurane. A transcranial Doppler study
Authors: Strebel S. , Kaufmann M. , Anselmi L. , Schaefer H. G. 
Published: January 2009

Nitrous oxide during neurosurgical procedures is almost always given in combination with either volatile or intravenous anesthetics. The modifying influence of such interventions has been studied clinically and in experimental settings; the reported findings, however, are inconsistent.The present study compares the cerebrovascular effects of MAC equivalent concentrations of isoflurane alone and isoflurane plus nitrous oxide. Twenty lumbar laminectomy patients randomized either to receive isoflurane or isoflurane plus nitrous oxide were investigated over a dose range from 0.5 to 1.5 MAC. A transcranial Doppler (TCD) ultrasonography device was used to measure cerebral blood flow velocity (CBFV) in the right middle cerebral artery (MCA) as an index of anesthethic‐induced alterations in cerebral blood flow (CBF). A small but marginally significant decrease in CBFV at 1 MAC and no change at 1.5 MAC occurred in the isoflurane anesthetized patients. In contrast, a small but significant increase in CBFV at 1 MAC and a very significant increase at 1.5 MAC occurred in the isoflurane plus nitrous oxide anesthetized patients. Nitrous oxide added to an isoflurane anesthetic regimen is concluded to be a potent vasodilator. In addition, the vasodilating effects of nitrous oxide were not uniform; they progressively increased with an increasing isoflurane concentration.
Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin
Authors: Tølløfsrud S. , Svennevig J. L. , Breivik H. , Kongsgaard U. , ØZer M. , Hysing E. , Mohr B. , Seem E. , Geiran O. , Abdelnour M. , Frøysaker T. , Noddeland H. 
Published: January 2009

The effects on fluid balance, pulmonary tunctions and economics were evaluated in a randomized comparison of one colloid free and three colloid containing fluid regimens, for 48 hours during and after coronary artery‐bypass (CAB) surgery.A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. Only Ringer's acetate (RAc) was used as priming solution for extracorporeal circulation. Forty patients were randomized to receive either RAc, polygeline 35 mg‐ml‐1 (Haemaccel®), dextran 70 (Macrodex®) 60 mg ml‐14, or albumin 40 mg‐ml‐1 in saline whenever fluid volume was needed to stabilize haemodynamics.At the end of the operation, fluid retention was significantly lower in patients receiving polygeline and dextran 70, compared with patients receiving RAc. At 48 hours, however, there were no differences in cumulative fluid balance. Patients in the colloid groups postoperatively had a higher serum colloid osmotic pressure (s‐COP), bui a higher net lung capillary filtration pressure (AP) only on the second postoperative day than the RAc group. However, this did not adversely atfect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the colloid groups. The most expensive colloid fluid regimen (albumin) cost about 230 USS more per patient than the RAc fluid regimen.We conclude that Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid retention only during the intraoperative period, compared with dextran 70 or polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adversely. Thus, the RAc regimen is clinically fully acceptable and economically more favourable than the polygeline, dextran 70, and albumin‐containing fluid regimens.
Effects of heparin on the inhibitory action of protamine on endothelium‐mediated vasorelaxation
Authors: Akata T. , Kodama K. , Takahashi S. 
Published: January 2009

The precise mechamism(s) of inhibitory action of protamine on endothelium‐mediated vasorelaxation has not been fully elucidated. In addition, no information is available regarding the effects of a heparin‐protamine complex on the endothelium‐mediated relaxation.Employing isometric tension recording methods, we studied the effects of heparin, an anionic substance, on the protamine‐induced inhibition of acetylcholine (ACh)‐induced vasorelaxation in isolated rabbit small mesenteric artery.Protamine (≥50 μg/ml) inhibited ACh (0.03–10 μM)‐induced relaxation under a norepinephrine (10 μM)‐stimu‐lated condition (P<0.05). The ACh relaxation, even 20 min after washout of protamine (150 μg/ml), was still significantly inhibited as compared to the control (before protamine) ACh relaxation, and further, it was not significantly different from the ACh relaxation maximally inhibited in the presence of protamine. Preapplication of heparin (700 U/ml) almost abolished the protamine inhibition (50 & 150 μg/ml) of the ACh relaxation. However, heparin (700 U/ml), applied on washout of protamine (150 ug/ml), had no effect on the prolonged protamine inhibition.In conclusion, a heparin‐protamine complex had no direct effect on the endothelium‐mediated relaxation, and the inhibitory action of protamine on the endothelium‐mediated relaxation might be due to its polycationic property. The prolongation of protamine inhibition and the lack of effects of heparin on the prolonged protamine inhibition may suggest a toxic effect of protamine on the endothelium.
Adenosine increases the cutaneous heat pain threshold in healthy volunteers
Authors: Ekblom A. , Segerdahl M. , Sollevi A. 
Published: January 2009

Adenosine is an endogenously produced substance which in animal experiments exerts anti‐nociceptive effects. In humans, algcsic effects have been presented following exogenous adenosine administration. A recent study on anaesthetized patients, however, suggested an anti‐nociceptive effect during i.v. adenosine. We have studied the pain‐reducing effect in healthy volunteers using adenosine 50–80 μg · kg‐1· min‐1(n = 10), morphine 0.1 mg · kg‐1(n = 5), adenosine 50 μg · kg‐1· min‐1+ morphine 0.1 mg · kg‐1(n=6), and ketamine 0.1 mg · kg‐1(n=5); all drugs given i.v., single‐blind. Quantitative sensory tests (QST) revealed a significantly increased cutaneous heat pain threshold following adenosine. No effect was seen following ketamine or morphine. Suprathreshold heat pain perception was unchanged in all subjects. Furthermore, warm and cold perception thresholds were not influenced significantly by any drug. Adenosine, morphine and kctamine produced well‐known side‐effects but of a mild intensity not necessitating any treatment.The present results show that i.v. adenosine can provide a modest but selective increase of cutaneous heat pain thresholds, suggesting a pain‐reducing capacity of adenosine in humans.
Autotransfusion after open heart surgery: the oxygen delivery capacity of shed mediastinal blood is maintained
Authors: Schmidt H. , Kongsgaard U. , Kofstad J. , Geiran O. , Refsum H. E. 
Published: January 2009

Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient‐blood, during cardiopulmonary bypass and in the postoperative period.Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3‐diphosphoglycerate (2,3‐DPG) concentration.Autotransfusion volume ranged from 450–1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3‐DPG concentration in the patient‐blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3‐DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient‐blood.The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient‐blood is not influenced by autotransfusion.
Ketamine inhibits contractile responses of intestinal smooth muscle by decreasing the influx of calcium through the L‐type calcium channel
Authors: Hirota K. , Zsigmond E. K. , Matsuki A. , Rabito S. F. 
Published: January 2009

During the inflammatory response, tissues release histamine (H), substance P, serotonin (5‐HT), prostaglandins and kinins, agents that mediate manifestations of inflammation such as pain, vasodilatation, increased capillary permeability and smooth muscle contraction. In this study we investigated whether racemic (R[+]) ketaminc (K) and its isomers are spasmolytic on intestinal smooth muscle contracted by inflammatory mediators, and whether the spasmolytic effect of K is related to changes in calcium influx through the L‐type calcium channel or to an interaction of K with opioid receptors.We measured the contractions of guinea‐pig ileum mounted in an organ bath containing Tyrode's solution gassed with 95% O2/5% CO2 at 37d̀C. In the first protocol we determined the effect of K and its isomers on contractions induced by five mediators: 10 7 M H, 10‐8 M substance P, 10‐8 M ncurokinin A, 5X 10‐9 M bradykinin and 5X 10‐7 M 5‐HT. For each of these mediators, we plotted concentration‐response curves for the inhibitory effect of K, and from regression fitting of these curves, we calculated the IC50 (concentration of K that inhibited the contraction by 50%). In the second protocol we measured the contraction induced by the calcium ionophore A23187 (5.0X10‐6 M), both alone and after 1.8–7.2X 10‐4 M R(±)K. Then we examined how the inhibition caused by R(±)K was affected by increases in the concentration of extracellular calcium by adding calcium (1.8 7.2X10‐3 M). To study whether the L‐type calcium channel opener S(—)Bay K8644 or naloxone reverse the spasmolytic effect of K, we added 7.2X10‐1 M (R(±)K to the bath, followed by S(‐)Bay K8644 (2.5X 10‐8 2X 10‐7 M) or naloxonc (10 8‐3X 10‐6 Mi, and the response to H was elicited again.R(±)K and its isomers inhibited the contraction of the ileum induced by all of the agents tested. No significant differences in the inhibitory potency were found among the three forms of K. Naloxone, on the contrary, did not affect the relaxant effect of K. The calcium ionophore A23187 produced ileum contractions that were effectively blocked by K. The calculated IC50 of K on histamine‐induced contractions was 4.7±0.7×10‐1 M with 1.8×10‐3 M calcium; this 1G50 increased significantly to 6.8±0.8×10‐4 M when calcium rose to 7.2×10‐3 M, P<0.01. The L‐type calcium channel opener S (—)Bay K8644, given after K, effectively restored the response of the muscle to H again in a dose‐dependent manner.K and its isomers have equipotent inhibitory effect on ileum contraction induced by all the inflammatory mediators tested. This relaxant effect of K is related not to an interaction of K with opioid receptors but to changes in calcium influx through the L‐type calcium channel.
A double blind comparison of lidocaine 2% with or without glucose for spinal anesthesia
Authors: Harbers J. B. M. , Stienstra R. , Gielen M. J. M. , Cromheecke G. J. 
Published: January 2009

The aim of the study was to compare lidocaine 2% plain to lidocaine 2% with glucose 8% for spinal anesthesia. Forty male patients scheduled for urologic surgery participated. The patients were randomly divided into two groups: the plain (P) group received 4 ml of glucose‐free lidocaine 2%, the heavy (H) group received 4 ml of lidocaine 2% containing 8% glucose. After the injection, the patients remained in the sitting position for three minutes before they were placed supine.The onset and maximum level of sensory blockade were similar with both preparations (T7‐T8). In both groups there were respectively 3 (P) and 4 (H) patients who did not acquire a sensory level above T10. There was a tendency towards a longer duration of sensory blockade in the P group. The patients in both groups developed an almost complete motor blockade within approximately 10 minutes. Duration of complete motorblockade of the lower extremities was significantly shorter for the H group: 59.1 ±6.5 minutes (mean±SEM) than the P group: 89.5±6.4 minutes.We consider lidocaine 2% with or without glucose a suitable agent for subarachnoid anesthesia for short procedures. As hyperbaric lidocaine results in a more rapid recovery of motor blockade, it may have advantages for patients in day‐case settings.
Phenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations, acid base status and Apgar scores
Authors: LaPortaDr. R. F. , Arthur G. R. , Datta S. 
Published: January 2009

Maternal and neonatal catecholamine concentrations, following the use of either phenylephrine or ephedrine to treat a drop in maternal blood pressure after spinal anaesthesia for caesarean delivery, were compared. Patients were randomly assigned to one of two groups: Group 1 patients (n = 20) were treated with ephedrine given as 5 mg intravenous bolus injections; Group 2 patients (n = 20) were treated with phenylephrine given as 40 μg intravenous bolus injections, for decreases in maternal systolic blood pressure to maintain maternal systolic blood pressure above 100 mmHg. Maternal vein (MV), umbilical vein (UV), and umbilical artery (UA) blood samples were taken at the time of delivery. Samples were analyzed for catecholamine concentrations and blood gas values.Noradrenaline concentrations in UA, UV and MV (at delivery) samples were significantly higher in group 1 compared to group 2; they were 6858±3689 vs 1674±944‐pg · ml‐1 (P<0.0001), 1265±758 vs 395±470 pg · ml‐1 (P<0.001) and 239±165 vs 103±93 pg · ml‐1 (P<0.01), respectively. Comparing blood gas values between groups 1 and 2, statistically significant differences were observed in UA pH (7.28±0.01 and 7.32±0.01 pH units, P=0.01), UA pCO2 (7.32±0.24 and 6.68±0.21 kPa, P=0.03), UA base excess (2.2±0.4 and 0.9±0.4 mmol · l‐1, P=0.04) and UV base excess (2.0±0.3 and 0.7±0.3 mmol · l‐1, P=0.004). No significant differences in maternal characteristics, acid base values, incidence of nausea and vomiting, and Apgar scores were observed between groups.Phenylephrine appears to be as safe and effective as ephedrine in treatment of drop in blood pressure in healthy non‐labouring parturients undergoing caesearean delivery. The use of phenylephrine was also associated with significantly lower noradrenaline concentrations in both mother and neonate.
Resistance to atracurium in rats with experimental inflammation: role of protein binchng
Authors: GARCIA E. , CALVO R. , RODRIGUEZ‐SASIAIN J. M. , JIMLNEZ R. , TROCONIZ I. F. , SUAREZ E. 
Published: January 2009

The influence of altered protein binding on the neuromuscular effect of atracurium has been studied in rats with experimental inflammation induced by subcutaneous injection of turpentine oil.Doses of atracurium ranging from 0.45 to 1.5 mg·kg‐1 were administered to control (n = 30) and to experimental inflammation induced rats (n = 30). Neuromuscular transmission was monitored by recording the twitch tension of the tibialis‐anterior muscle elicited by stimulation of the sciatic nerve. Three effect parameters were recorded: (i) intensity of the effect, measured as percentage depression of baseline twitch tension, (ii) duration of drug action (min) and (iii) recovery time (min).The dose‐intensity of the effect relationship was modelled using a sigmoid Emax model. The ED50 (effective dose eliciting 50% of the maximum effect) was significantly increased (P<0.01) in the inflammation group as compared to the control group (0.94 vs. 0.68 mg·kg‐1). This change was reflected in a shift of the dose‐response curve to the right in the pretrcated rats. For equipotent doses ED95 (defined as the effective dose eliciting 95% of maximum effect), no differences were found in recovery time and duration of action between the two groups of rats. Mucoproteins levels (index of α1‐acid glycoprotein (AAG)) and protein binding were significantly increased in rats with experimental inflammation as compared to control rats.Based on these results, altered serum protein binding of atracurium appears to be responsible, at least in part, for the resistance to atracurium.