bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluid therapy in burns
Authors: Onarheim H 
Published: January 2009

Abstract: The dissertation evaluates changes in transcapillary fluid and protein balance in the initial phase after extensive burns, comparing the effects of different regimens for post‐burn fluid resuscitation.Studies were performed in anaesthetized rats and sheep. Within 15 min after major thermal injury, cardiac output (CO) was reduced by 40–50%, mainly due to a reduced stroke volume. Mean arterial pressure (MAP) also dropped by 30–40 mmHg. Both lactated Ringer's and plasma improved this postburn circulatory impairment.Rapid bolus infusions of small volumes of very hypertonic saline, 7.5% NaCl (2 400 mosmol/1), have rapidly corrected the circulatory impairment in haemorrhagic shock. Following a rapid bolus infusion of 7.5% NaCl in 6% Dextran 70, CO and MAP were completely restored, but the effect only lasted 30–60 min. When administered by a slow infusion, 7.5% NaCl gave no circulatory improvement.The transcapillary colloid‐osmotic gradient was maintained in injured skin following infusion of plasma, whereas it was almost annihilated by infusion of lactated Ringer's. Plasma infusion thus induced a protein‐rich edema in injured skin, whereas lactated Ringer's resulted in a generalized edema.Increased interstitial fluid flux can mobilize the interstitial matrix protcoglycan hyaluronan. Following burn injury, plasma concentrations of hyaluronan increased up to ten times above baseline. This observation suggests that at least some of the degradation of structural connective tissue components in thermally injured skin is by lymphatic removal (and subsequent degradation in liver). Increased plasma concentrations of interstitial components have not previously been observed after thermal injury.
Performance characteristics of a novel reusable intermediate–volume low–pressure cuffed endotracheal tube
Authors: HÄHNEL J. , TREIBER H. , KONRAD F. , MUTZBAUER T. , STEFFEN P. , GEORGIEFF M. 
Published: January 2009

Study objective: To evaluate the performance of the reusable intermediate–volume low–pressure cuffed “Super Safety Yellow” (Willy Rüsch AG, P. O. Box 1620, D–71332 Waiblingen, Germany) endotracheal tube with regard to cuff seal, tube tip position, and incidence of postoperative throat complaints. The “Super Safety Yellow” was compared with the “Super Safety Clear” (W. Rusch AG), the “lo–pro” (Mallinckrodt Laboratories, Cornamady, Athlone County, Ireland), and the “red rubber” (W. Rüsch AG) tubes.Methods: Two hundred adult patients scheduled for minor surgery under standardized general anaesthesia were allocated to one of these tubes. Past–cuff leakage (indicator: orally instilled 0.2% indigocarmine) as well as intratracheal tube tip position (degree of being centred) were assessed by fibre–optic tracheoscopy. The semi–standardized interviews for the recording of postoperative sore throat were performed in double–blind fashion once a day, starting on the day of operation till p.o. day 3. Statistics: x 2–test; significance: P < 0.05.Main Results: A past–cuff leakage was found in three “red rubber” tubes. There were significant differences in tube tip position with the “Super Safety Clear” being best, and the “Super Safety Yellow” being worst centred (P = 0.010). The incidence of postoperative throat complaints showed a nonsignificant tendency in favour of the PVC–tubes. A significant number of such complaints were observed in women (P = 0.0004) and in obese patients (P = 0.011). By contrast, this incidence did not significantly differ with age, tracheal cross–sectional shape, tube tip position, use of atropine, and duration of intubation.Conclusion: Although resembling the “red rubber” tube in the incidence of postoperative throat complaints, the “Super Safety Yellow” may be an alternative to the currently used disposable tubes in anaesthesia. Its performance is comparable with regard to cuff seal and intra–cuff pressure. Additionally, it helps in reducing PVC waste and may lessen costs.
Central–to–peripheral arterial pressure gradient during cardiopulmonary bypass: relation to preand intra–operative data and effects of vasoactive agents
Authors: HERT S. G. DE , VERMEYEN K. M. , MOENS M. M. , HOFFMANN V. L. , BATAILLIE K.J. 
Published: January 2009

A significant central–to–peripheral arterial pressure gradient may exist during and after cardiopulmonary bypass (CPB). The etiology and mechanisms of this phenomenon remain controversial. We studied the pressure gradient between aorta, brachial artery and radial artery in 68 patients, scheduled for elective coronary artery bypass surgery. We evaluated whether choice of cardioprotection during CPB (use of cold cardioplegic solution or use of intermittent crossclamping under protection with lidoflazine), and choice of pulsatile or nonpulsatile flow during the course of CPB, affected the magnitude and duration of the systolic pressure gradient. We also studied whether central–to–peripheral pressure gradient was influenced by administration on CPB of different vasoactive drugs with different mode of action: sodium nitroprusside (direct action on the vessels), droperidol (alpha–adrenergic blocking action), ketanserin (5–hydroxytryptamine antagonist) and phenylephrine (selective alpha,–agonist).It appeared that central–to–peripheral gradient occurred early during CPB and remained constant throughout the course of CPB. The gradient disappeared within 60 min after weaning from CPB. We found the main pressure gradient to occur between the brachial and the radial artery. There was no relation between magnitude of the gradient and sex, weight, length or age of the patient. There was also no relation between magnitude of the pressure gradient and type of cardioprotection, choice of pulsatile vs nonpulsatile flow on CPB and duration of CPB. We also found no relation between pressure gradients and changes in temperature, haematocrit and systemic vascular resistance. The pressure gradient was not affected by any of the vasoactive drugs.
Depolarizing neuromuscular block – a presynaptic mechanism?
Authors: FELDMAN S. , HOOD J. 
Published: January 2009

It has been known since 1951 that drugs such as decamethonium and suxamethonium produced an acetylcholine like (agonist) effect on the postsynaptic membrane of the neuromuscular junction causing depolarization. Inspite of evidence of action of these drugs on the motor nerve terminals, it has been widely assumed that the neuromuscular block they produced is the result of depolarization followed by desensitization of the postsynaptic membrane.Evidence questioning the view that these drugs produce their clinical effects as a consequence of depolarization of the postsynaptic membrane or desensitization is presented together with the results of recent experiments which are more readily explained by proposing a presynaptic action of these drugs, initially stimulating then depressing acetylcholine release.
Effects of fentanyl or alfentanil as supplement to propofol anaesthesia for termination of pregnancy
Authors: LINDHOLM P. , HELBO–HANSEN H. S. , JENSEN B. , BÜLOW K. , NIELSEN T. G. 
Published: January 2009

One hundred and twenty patients undergoing early legal termination of pregnancy by dilatation and suction curettage before 12 weeks of pregnancy were randomly allocated to receive total intravenous propofol anaesthesia either alone or supplemented with fentanyl 1.5 μg·kg‐1 or alfentanil 15 μg kg‐1. Supplementation with fentanyl or alfentanil improved operating conditions (P<0.01), reduced total propofol requirements (P < 0.01) and reduced postoperative pain intensity (P < 0.05). Immediate recovery, assessed by the time patients took to open the eyes, to give correct date of birth and by co–operation score, was more rapid in the alfentanil group compared to the control group (P < 0.05), whereas there was no significant difference between the alfentanil and fentanyl groups. The three anaesthetic techniques did not differ with regard to side effects.In conclusion, total intravenous propofol anaesthesia in patients undergoing early termination of pregnancy was improved by supplementation with either fentanyl 1.5 μg kg‐1 or alfentanil 15 μg–kg‐1. The benefit was slightly greater with alfentanil than with fentanyl.
Splanchnic ischaemia and its role in multiple organ failure
Authors: LANDOW L. , ANDERSEN L. W. 
Published: January 2009

Multiple organ failure remains the leading cause of death in the intensive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis of this syndrome. Their data indicate that inadequate gut perfusion leads to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration impairs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypothesized that production of tumor necrosis factor α, and other biologic mediators by endotoxin–stimulated macrophages, triggers a generalized and uncontrolled inflammatory response that ultimately leads to multiple organ failure.Preliminary evidence suggests that survival can be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future studies are needed to determine whether additional treatment modalities can improve outcome once the inflammatory response has fully developed.
Inhaled nitric oxide lowers pulmonary capillary pressure and changes longitudinal distribution of pulmonary vascular resistance in patients with acute lung injury
Authors: BENZING A. , GEIGER K. 
Published: January 2009

In acute lung injury (ALI), where pulmonary microvascular permeability is increased, transvascular fluid filtration depends mainly on the hydrostatic capillary pressure. In the presence of intrapulmonary vasoconstriction pulmonary capillary pressure (PCP) may increase thereby promoting transvascular fluid filtration and lung oedema formation. We studied the effect of 40 ppm inhaled nitric oxide (NO) on PCP and longitudinal distribution of pulmonary vascular resistance (PVR) in 18 patients with ALI.PCP was estimated by visual analysis of the pressure decay profile following pulmonary artery balloon inflation. Contribution of venous pulmonary resistance to total PVR was calculated as the percentage of the pressure gradient in the pulmonary venous system to the total pressure gradient across the lung.Inhalation of 40 ppm NO produced a prompt decrease in mean pulmonary artery pressure (PAP) from 34.1 6.8 to 29.65.7 (s.d.) mmHg; (P < 0.0001). PCP declined from 24.86.2 to 21.65.2 mmHg; (P < 0.0001) while pulmonary artery wedge pressure (PAWP) did not change. PVR decreased from 16673 to 12850 dyn sec cm‐5; (P < 0.0001). Pulmonary venous resistance (PVRven) decreased to a greater extent (from 7641 to 5028 dyn. sec. cm‐5; (P < 0.001) than pulmonary arterial resistance (PVRart) (from 9036 to 7929 dyn sec cm‐5; (P < 0.01). The contribution of PVRven to PVR feU from 44.310.8 to 37.811.9%; (P < 0.01). Cardiac output (CO) remained constant. The findings demonstrate that NO has a predominant vasodilating effect on pulmonary venous vasculature thereby lowering PCP in patients with ALI.
Renal effects of human atrial natriuretic peptide in patients after major vascular surgery
Authors: BERGMAN A. , ODAR–CEDERLOF I. , THEODORSSON E. , WESTMAN L. 
Published: January 2009

The effects were studied postoperatively of an infusion of atrial natriuretic peptide (ANP) 7.5 pMol–kg‐1 –min‐1 on renal function and haemodynamics in seven patients who had been operated with insertion of an abdominal aortic graft. Urine flow, glomerular filtration rate (GFR), renal plasma flow (RPF) and excretion of electrolytes and osmoles were measured for three periods of 20 minutes during infusion of ANP, in the morning of the day after surgery. Haemodynamic studies were conducted, and serum levels of ANP, catecholamines and plasma renin activity were measured.ANP levels increased from 52 to approximately 250 pMol–L‐1 during ANP infusion and decreased after infusion to a level equal to baseline. GFR increased from 92 mL–min“1 by 58, 20 and 21%, respectively. RPF was unchanged. Urine flow rate increased from 1.99 mL–min”‘ by 81, 151 and 173%, respectively. Fractional clearances of sodium, chloride and osmoles were increased during the second and third ANP periods whereas fractional potassium clearance did not change during the study. There were no changes in catecholamine levels or plasma renin activity during the study. Heart rate, mean arterial pressure and calculated systemic and pulmonary vascular resistance did not change whereas reductions occurred in cardiac index, mean pulmonary artery pressure, pulmonary artery wedge pressure and mean right atrial pressure. We conclude that infusion of ANP also in the postoperative situation increases GFR, diuresis and sodium excretion.
Neurologic symptoms after epidural anaesthesia. Report of three cases
Authors: GEMMA M. , BRICCHI M. , GRISOLI M. , VISINTINI S. , PAREYSON D. , SGHIRLANZONI A. 
Published: January 2009

We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space–occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post–epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms.Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.
Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), part I: isoflurane produces dose–dependent coronary vasodilation
Authors: HOHNER P. , NANCARROW C. , BACKMAN C. , HÄGGMARK S. , JOHANSSON G. , FRIDÉN H. , DIAMOND G. , FRIEDMAN A. , REIZ S. 
Published: January 2009

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double–blinded protocol. After induction with fentanyl (3 μg–kg‐1) and thiopentone (2–4 mg kg‐1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15–20 μg kg‐1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12–lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, iv phenylephrine and nitroglycerine were adminstered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision.Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose–dependent (P< 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose–dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities.The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P= 0.008 andP= 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.
Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, part II: effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia
Authors: HOHNER PER , BACKMAN CHRISTER , DIAMOND GEORGE , FRIEDMAN ARNOLD , HÄGGMARK SÖREN , JOHANSSON GÖRAN , KARP KJELL , REIZ SEBASTIAN 
Published: January 2009

This study examines the effects of nitrous oxide on haemodynamics, anterior left ventricular (LV) function and incidence of myocardial ischaemia in abdominal vascular surgical patients with coronary artery disease. Forty–seven patients were randomly assigned to isoflurane–fentanyl anaesthesia with nitrous oxide–oxygen vs airoxygen (control). Systemic and coronary haemodynamics, 12–lead ECG, LV anterior wall modon by cardiokymography (CKG) and myocardial lactate balance were recorded at four intervals: before and during anaesthesia and 10 and 30 minutes into surgery. Systemic haemodynamics were controlled by anaesthetic dose, and, when insufficient, by iv nitroglycerine (NG) in case of LV failure (PCWP > 18 mmHg) and by phenylephrine during hypotension.We found that nitrous oxide was associated with greater need for iv nitroglycerin (patients:P= 0.031, episodesP= 0.005) and more myocardial ischaemia (patientsP= 0.012, episodesP= 0.00l) despite systemic and coronary haemodynamics comparable to the control group. We conclude that nitrous oxide, known to have both sympathomimetic and cardiodepressive actions, produced cardiodepression in the face of sympathetic stimulation. Our study design did not allow us to conclude if myocardial ischaemia was the consequence of increased wall stress or a reason for the observed LV dysfunction. The higher incidence of introperative myocardial ischaemia and need for NG did not cause increased cardiac morbidity.
Thoracic epidural analgesia in aortocoronary bypass surgery I: haemodynamic effects
Authors: STENSETH R. , BJELLA L. , BERG E. M. , CHRISTENSEN O. , LEVANG O. W. , GISVOLD S. E. 
Published: January 2009

Tachycardia and hypertension may cause myocardial ischaemia in patients with coronary heart disease going through major surgery. Thoracic epidural analgesia (TEA) has been reported to be beneficial in this situation.The haemodynamic effects of TEA in aortocoronary bypass surgery were investigated in 30 male patients < 65 years old and with ejection fraction > 0.5. They were randomized into 3 groups: the high dose fentanyl (HF) group receiving high–dose fentanyl (55 μg kg‐1) anaesthesia, the HF + TEA group receiving the same fentanyl dose + TEA with 10 ml bupivacaine 5 mg ml‐1 followed by 4 ml every hour, and the low dose fentanyl (LF) + TEA group receiving low–dose fentanyl (15 μg kg‐1) anaesthesia + TEA. Haemodynamic parameters, the use of vasoactive and inotropic drugs and fluid balance were followed during the operation and for 20 h postoperatively.Before bypass the only significant difference between groups was a higher mean pulmonary arterial pressure in the HF + TEA group and a lower systemic vascular resistance (SVR) in the LF + TEA group, both compared to the HF group. 89% of epidural group patients needed small doses of ephedrine whereas more HF group patients were given nitroglycerine. During bypass SVR and mean arterial pressure (MAP) were significantly higher and pump flow lower in the HF group compared to the LF + TEA group. More ketanserin to HF group patients and methoxamine to epidural group patients were given. After bypass heart rate increased in all groups. Lower MAP 0.5 h after bypass and higher filling pressures in the early post bypass period in the epidural groups, most pronounced in the HF + TEA group, were noted. More propranolol, nitroglycerine and sodium nitroprusside were given to patients in the HF group. No difference in intraoperative fluid balance between groups was seen.Our results suggest more easy control of perioperative hypertension and tachycardia with TEA. This was achieved without haemodynamic side effects of clinical importance.
Thoracic epidural analgesia in aortocoronary bypass surgery II: effects on the endocrine metabolic response
Authors: STENSETH R. , BJELLA L. , BERG E. M. , CHRISTENSEN O. , LEVANG O. W. , GISVOLD S. E. 
Published: January 2009

Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may – in part – be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS).Thirty male patients (age < 65 years, ejection fraction > 0.5) were randomized into 3 groups; the HF group receiving a high dose fentanyl (55 μg–kg‐1) anaesthesia, the HF + TEA group with the same fentanyl dose + TEA with 10 ml bupivacain 5 mg ml‐1, followed by 4 ml every hour, and the LF + TEA group receiving fentanyl 15 μg kg‐1 + TEA. Adrenalin, noradrenalin, systemic vascular resistance (SVR), glucose, Cortisol, lactate and free fatty acids were followed during the operation and for 20 h postoperatively.A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and Cortisol was noticed in all groups, but the increase was delayed in the epidural groups.Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone.
Effects of propofol and thiopentone on polymorphonuclear leukocyte functions in vitro
Authors: SKOUTELIS A. , LIANOU P. , PAPAGEORGIOU E. , KOKKINIS K. , ALEXOPOULOS K. , BASSARIS H. 
Published: January 2009

Anaesthetic agents may impair host defense mechanisms including polymorphonuclear leukocyte (PMNL) function.We have studied the effects of thiopentone and propofol in low (thiopentone 10 mg/L, propofol 2 mg/1) and high (thiopentone 40 mg/L, propofol 6 mg/L) clinically relevant concentrations on PMNL adherence, chemotaxis, phagocytosis and killing in vitro.The results demonstrated that thiopentone in both concentrations significantly decreases all PMNL functions tested and had a direct influence on the PMNLs in terms of their chemotactic response. In contrast, propofol decreases significantly only PMNL chemotaxis but not adherence, phagocytosis and killing. The effect of propofol was not attributable to the lipid carrier vehicle, as Intralipid with same formulation had no effect on PMNL function.