bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nasal mucosa inflammation induced by oxygen administration in humans
Authors: CAPELLIER G. , ZHANG Z. , MAHEU M. F. , POINTET H. , RACADOT E. , KANTELIP B. , REGNARD J. , BARALE F. 
Published: January 2009

Background: The effect of oxygen toxicity in human airways is still poorly documented. We prospectively evaluated the inflammatory reaction induced by nasal oxygen exposure in an experimental setting.Methods: Healthy subjects without nasal symptoms were exposed to high FIO2 during 5 h. Oxygen was delivered from a tank at a flow of 41/min to one nostril of each subject and both nostrils were studied. Mucociliary clearance was measured as saccharine nasal transit time (SNTT). Nasal lavage was performed with 5 ml normal saline and the fluid recovered was processed for cytology and measurements of cytokines concentrations: TNFα, IL‐6, IL‐8 and soluble ICAM‐1. Under local anaesthesia, biopsies were performed for immunochemistry and electron microscopy.Results: After oxygen exposure mucociliary clearance decreased and SNTT increased from 16 [9–21] to 20.5 [14–32] min (median and extremes; P < 0.1). In the lavage fluid, concentration of IL‐6 was higher in the oxygen‐exposed nostril (40.5 [11–128] pg/ml) than in the non‐exposed one (7 [0–34] pg/ml; P < 0.05). There was also a trend for a higher IL‐8 in the exposed than in the non‐exposed nostril, (respectively 501 [214–587] pg/ml and 214 [122–616] pg/ml, P < 0.08), and for a higher number of polymorphonuclear cells in exposed nostril. In the mucosal biopsies substance P was not found, but ICAM‐1 expression was higher in the mucosa and submucosa of the exposed nostrils where mast cells were also more abundant and showed piecemeal degranulation.Conclusion: In summary, we found clinical, functional and biological evidence of ongoing nasal inflammation following high FIO2 inhalation for 5 h. Since the histology and behaviour of nasal and bronchi mucosa are very similar, the same inflammatory events are likely to be occurring in the bronchi upon high concentrations of inhaled oxygen.
Survey of postoperative analgesia following ambulatory surgery
Authors: RAWAL N. , HYLANDER J. , NYDAHL R‐A. , OLOFSSON I. , GUPTA A. 
Published: January 2009

Background: The quality of pain relief during the first 48 hours following ambulatory surgery has been poorly documented. This questionnaire study was performed to evaluate the nature and severity of pain after the patient leaves the hospital.Methods: 1100 patients in the age group 5–88 years who underwent ambulatory surgery during a period of 6months were asked to complete a questionnaire 48 h after the end of the operation. In thecase of children, parents were asked to complete a similar questionnaire. The questions were related to pain experienced during the first 48 h after surgery and to the nature andseverity of postoperative complications.Results: A total of 1035 out of the 1100 patients returned the questionnaire, 94.1%. Overall the majority (65%) of patients had only mild pain at home; however, patients undergoing certain types of surgery had moderate‐to‐severe pain: inguinal hernia surgery (62% patients), orthopaedic surgery (41%), hand surgery (37%) and varicose vein surgery (36%). In these patients the severity of pain did not decrease during the 2‐day study period. About 10% patients had more severe pain than they had anticipated, and 20% had difficulty in sleeping at night due to severe pain. Despite this, over 95% of patients were satisfied with man‐agement of postoperative pain. Nausea (20%), tiredness (20%) and vomiting (8%) were the commonest complications reported during the first 48 h. A significant association was found between the administration of a general anaesthetic and the incidence of nausea postoperatively. A large number of patients were alone at home after the operation (28.4%); some (3.8%) had no access to a relative or friend in case of need.Conclusion: Our results show that about 35% of day‐surgery patients experience moderate‐to‐severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow‐up routines need to be improved.
Perioperative magnesium infusion and postoperative pain
Authors: WILDER‐SMITH C. H. , KNØPFLI R. , WILDER‐SMITH O. H. G. 
Published: January 2009

Background: NMDA receptor activation is considered one of the mechanisms involved in postoperative pain and hypersensitivity. Magnesium is the physiological blocker of the NMDA‐receptor‐complex‐associated calcium ionophore. The aim of this study was to determine if a pre‐, intra‐ and postoperative infusion of magnesium would reduce postoperative pain.Methods: In a prospective, randomised, double‐blinded and placebo‐controlled study, 24 patients undergoing elective hysterectomy in standardised general anaesthesia received a 5 h infusion of either placebo or magnesium laevulinate (initial bolus 8 mmol: then 8 mmol/h) starting with induction of anaesthesia. Postoperative analgesia was by PCA morphine for the first 48 h and patients were followed for 5 d with regular assessments of pain and side‐effect scores.Results: Overall, pain scores were similar with magnesium and placebo infusion, although patients in the magnesium group experienced more episodes of severe or unbearable pain (pla‐cebo=6%, magnesium=16%, P=0.02). Median pain scores were higher in the magnesium group only at 3 h postoperatively (P= 0.04): afterwards there were no significant differences. Except for the first postoperative hour (placebo=12.8±4.7 mg, mag‐nesium=9.3±3.2 mg, P=0.04), cumulative morphine consumption was similar. Gastrointestinal complication rates and patient satisfaction were similar in both groups.Conclusions: Perioperative magnesium infusion does not improve postoperative analgesia. At the doses used in this study, the use of magnesium is associated with short‐term decreases in postoperative analgesia.
Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts
Authors: ENQVIST B. , BJÖRKLUND C. , ENGMAN M. , JAKOBSSON J. 
Published: January 2009

Background:Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature.Methods:Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4–6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized.Results:Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively.Conclusions:Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements.
Topographical analysis of the EEG effects of a subconvulsive dose of lidocaine in healthy volunteers
Authors: DETSCH O. , ERKENS U. , JACOFSKY U. , THIEL A. , KOCHS E. , HEMPELMANN G. 
Published: January 2009

Background:The purpose of the present study was to assess the effects of intravenous lidocaine on spatial changes of electroen‐cephalographic power and on psychomotoric status in conscious volunteers.Methods:In 11 healthy volunteers lidocaine (2‐min bolus, 100 mg; 15‐min infusion, 40 μg kg‐1min‐1) or placebo were given intravenously in a randomized, single‐blinded, two‐way crossover study. Haemodynamics and lidocaine plasma concentrations were measured at baseline and within a period of 30 min following bolus injection. Vigilance and emotional status were tested using visual analogue scales (VAS). Toxic CNS effects were evaluated by a questionnaire. The raw EEG (17 leads, reference Cz) and computed power spectra were continuously recorded.Results:The chosen lidocaine dosage led to nearly constant plasma concentrations (unbound lidocaine 2.5 min and 15 min after bolus 0.36±0.14 μg/ml and 0.30±0.06 μg/ml, respectively [mean±SD]). The placebo caused no symptoms, changes in VAS‐scores or EEG‐parameters. Lidocaine induced pronounced subjective symptoms and significant increases in delta activity for 15 min, most dominant at the frontotemporal and occipital leads (max. +219% O1). Frontal and occipital beta1 and beta2 power (max. +131% and +124% at O1, respectively) was immediately increased after the bolus injection. No EEG changes occurred at central region Cz, and no interhemispheric EEG differences were noted. Theta, alphal, and alpha2 power remained unchanged.Conclusion:The current data demonstrate simultaneous changes in psychomotoric status as well as delta and beta spectral power during lidocaine infusion. These data could be an indication that the pronounced frontotemporal and occipital EEG changes are the electroencephalographic expression of subjective sensations.
Intravenous versus intraperitoneal morphine before surgery to provide postoperative pain relief
Authors: KALMAN S. H. , JENSEN A. G. , NYSTRÖM P. O. , EINTREI C. 
Published: January 2009

Background:Opioid receptors have been demonstrated on peripheral afferent nerves throughout the body. The aim of the present study was to compare the effects of intravenous and intraperitoneal administration of morphine with regard to pain, postoperative morphinerequirement, and recovery after major abdominal surgery, and to describe the pharmacokinetics of intraperitoneal morphine in humans.Methods:In a double‐blind manner, 30 patientsscheduled for major abdominal surgery were randomized to either 50 mg of morphine intravenously (IV) or 50 mg of morphine intraperitoneally (IP) before operation. Pain was measured on a visual analogue scale and morphine requirements were registered for 3 days. Recovery was measured as time to oral intake of food, time to flatulence and days in hospital. Plasma morphine, mor‐phine‐3‐glucuronide, and morphine‐6‐glucuronide concentrations were determined during the first 4 h after morphine administration.Results:During the first postoperative hours there was less pain at rest (P=0.02) and on coughing (P=0.004) in the intravenous group. The requirementof additional morphine (P=0.016) was lower in the intravenous group during the first postoperative day. No major differences in recovery were seen. The plasma concentrations of morphine measured as area under the curve (AUC) during the first 4 h were similar, but the intravenous group showed significantly higher concentrations of the active metabolite morphine‐6‐glucuronide, (P=0.016), indicating a difference in pharmacokinetics after intraperitoneal compared to intravenous administration of morphine.Conclusion:Intraperitoneal administration of 50 mg of morphine before major abdominal surgery is less efficient in reducing pain and postoperative morphine requirements than thesame amount of morphine given intravenously.
Can training improve the results with infrared tympanic thermometers?
Authors: PETERSEN M. H. , HAUGE H. N. 
Published: January 2009

Background: Infrared tympanic thermometry (ITT) is a method for body temperature measurement. Correct measuring technique is said to be important to achieve good results with this method. The objective of this study was to investigate the accuracy and effect of training in the use of infrared tympanic therm‐omtry (ITT) on the measurement results.Method: Nurses trained in the use of ITT, and nurses not trained performed measurement sequences on 65 patients: one rectal and two ITT measurements in each sequence.Results: Mean rectal temperatures were significantly (P < 0.01) higher than with ITT (0.44±0.42 (SD)˚C for trained, 0.56±0.4 (SD)˚C for untrained). Coefficient of repeatability for ITT measurements was ±0.54˚C for trained nurses, and ±0.48˚C for untrained. With ITT temperatures adjusted upwards of 0.5˚C, the sensitivity of ITT for detecting fever as defined by rectal measurements would be 70% for trained, and 54% for untrained nurses. Repeatability and sensitivity for trained and untrained nuses were not significantly (P > 0.05) different.Conclusion: Training had little effect on the accuracy of the measurements. According to our results, ITT is often unreliable and should be used with caution.
Management of the difficult airway A case of failed fiberoptic intubation
Authors: WULF H. , BRINKMANN G. , RAUTENBERG M. 
Published: January 2009

Background: Fiberoptic intubation is the current gold standard for the management of difficult intubation. Nevertheless, in rare circumstances even fiberoptic intubation fails.Methods: We describe the case of a female patient suffering from neurofibromatosis Recklinghausen and a giant malignant schwannoma on the neck obstructing the pharynx and compromizing respiration. Based on the clinical presentation and the MRI findings, difficulties in airway management were anticipated and fiberoptic intubation of the awake patient was planned.Results: After localizing the vocal cords it was not possible to advance the tube into the trachea due to the severe deviation of the glottis. A decision was made to cancel any further fiberoptic intubation attempts and a conventional tracheotomy was performed under local anaesthesia without problems.Conclusion: This case illustrates that even awake fiberoptic intubation has its failure rate, due to inability to visualize the larynx, inability to advance the tube over the fiberscope (as in the present case), or inability to direct the tube towards the larynx. Due to the extreme deviation of the larynx other established techniques for difficult intubation were not deemed appropriate in this case. Therefore, weighing the risks and benefits, a decision was made to perfom a tracheotomy under local anaesthesia.
A rare case of a somatosensory evoked potentials recording during cardiopulmonary resuscitation
Authors: YANG L.‐C. , TAO‐CHEN L. , GALIK J. 
Published: January 2009

Background: Neuronal damage is a possible complication of cardiac surgery. To reduce the potential risk of postoperative neurological deficit, the functional state of affectedcentral nervous system pathways is monitored intraoperatively by recording evoked potentials (EPs). Apart from animal research, there is little clinical evidence of EPs recordingduring cardiac arrest and cardio‐pulmonary resuscitation (CPR).Methods: Both scalp (SCEPs) and spinal (SSEPs) short‐latency somatosensory EPs were recorded as the response to theelectrical stimulation of the right median nerve during mitral valve replacement surgery. Evoked potentials were recorded before, during, and after sudden ventricular fibrillationfollowed by CPR.Results: Preoperative control recordings of both SCEPs and SSEPs were in the normal ranges. During the first 4 min of cardiac arrest and resuscitation, all SCEPs waves disappeared, while the spinal component of the SSEPs was still recognizable. After CPR, all waves of both EPs recordings recovered completely. The patient woke from anesthesia without neurological deficits.Conclusions: As expected, scalp‐recorded EPs are more sensitive to the cardiac arrest than spinal EPs. Rapid and almost complete recovery of postoperative EPs, namely SCEPs, correlated well with normal neurological recovery.
Residual neuromuscular block is a risk factor for postoperative pulmonary complications A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium
Authors: BERG H. , VIBY‐MOGENSEN J. , ROED J. , MORTENSEN C. R. , ENGBÆK J. , SKOVGAARD L. T. , KRINTEL J. J. 
Published: January 2009

Background: After anaesthesia involving pancuronium a high incidence of both residual neuromuscular block and postoperative pulmonary complications (POPC) has been reported. The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, and vecuronium, and to examine the effect of residual neuromuscular block on the incidence of POPC.Methods: A total of 691 adult patients undergoing abdominal, gynaecological, or orthopaedic surgery under general anaesthesia were randomised to receive either pancuronium, atracurium, or vecuronium. Perioperatively, the response to train‐of‐four (TOF) nerve stimulation was evaluated manually. Post‐operatively, the TOF ratios were measured mechanomyograph‐ically, and through a 6‐day follow‐up the patients were examined for pulmonary complications.Results: The incidence of residual block, defined as a TOF ratio <0.7, was significantly higher in the pancuronium group (59/226: 26%) than in the atracurium/vecuronium groups (24/450: 5.3%). In the pancuronium group, significantly more patients with residual block developed POPC (10/59: 16.9%) as compared to patients without residual block (8/167 4.8%). In the atracurium/vecuronium groups, the incidence of POPC was not significantly different in patients with (1/24: 4.2%) or without (23/426: 5.4%) residual block. Multiple regression analysis indicated that abdominal surgery, age, long‐lasting surgery, and a TOF ratio<0.7 following the use of pancuronium were potential risk factors for the development of POPC.Conclusion: Postoperative residual block caused by pancuronium is a significant risk factor for development of POPC.
Aortic cross‐clamping influences regional net release and uptake rates of tissue‐type plasminogen activator in pigs
Authors: SEEMAN‐LODDING H. , HAGGMARK S. , JERN C. , TERN S. , JOHANSSON G. , WINSO O. , BIBER B. 
Published: January 2009

Background: The key regulator of intravascular fibrinolysis, tissue‐type plasminogen activator (t‐PA), is released from a dynamic endothelial storage pool. The aim of the study was to investigate regional t‐PA net release and uptake rates in response to infra‐renal aortic cross‐clamping (AXC) and declamping (DC).Results: Prior to AXC, we found a high net release rate of total t‐PA across the preportal vascular bed (1700 ng.min‐1, P < 0.001), and a high hepatic net uptake (4900 ng.min‐1, P < 0.001), while coronary and pulmonary t‐PA net fluxes were small and variable. AXC per se did not induce significant alterations in net fluxes of t‐PA. Following DC, preportal and coronary net releases of total t‐PA increased (to 2900 ng · min‐1 and 60 ngemin‐1, respectively). Despite an increase in hepatic net uptake of total t‐PA (to 6100 ng.min‐1) after DC, a significant increase in hepatic venous total t‐PA occurred.Methods: Anesthetized pigs were studied during 5 min of AXC, followed by a 35‐min declamping (DC) period. Arterio‐venous concentration gradients of total and active t‐PA, as well as respective plasma flows, were simultaneously obtained across the preportal, hepatic, coronary and pulmonary vascular beds. Plasma levels of total t‐PA (ELISA with purified porcine t‐PA as standard), and active t‐PA (spectrophotometric functional assay) were determined.Conclusions: The release and uptake of t‐PA is indicated to be dynamic and organ‐specific. DC induces an acute profibrinolytic reaction in preportal organs. The high hepatic t‐PA uptake capacity restricts preportal profibrinolytic events to affect the systemic circulation.
Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery
Authors: STUBHAUG A. , BREIVIK H. , EIDE P. K. , KREUNEN M. , Foss A. 
Published: January 2009

Background:Tissue injury induces central sensitization in the spinal cord dorsal horn neurons via mechanisms involving N‐methyl‐D‐aspartate (NMDA) receptors, leading to secondary hyperalgesia. Using punctuate mechanical hyperalgesia as a measure of central sensitization, we examined whether induction and maintenance of central sensitization after surgery could be prevented by a low‐dose infusion of the NMDA‐receptor antagonist ketamine.Results:The area of punctuate mechanical hyperalgesia was significantly reduced in the ketamine group 1, 3 and 7 d after the operation (P< 0.01–0. 001). “Wind‐up pain” was also reduced by ketamine (P< 0.05). PCA morphine consumption and pain intensity (visual analogue scale) differed between groups only during the first hours after surgery, in favour of ketamine. The ketamine patients scored significantly higher on a global satisfaction score. Side‐effects were most frequent in the placebo group.Conclusion:Low‐dose i.v. infusion of ketamine during and after surgery reduces mechanical punctuate hyperalgesia surrounding the surgical incision. These results indicate that blockade of NMDA receptors prevents the central sensitization caused by nociceptive input during and after surgery.Methods:Twenty living kidney donors were included in a randomized, double‐blind, parallel, two‐group study. Before start of surgery 10 patients received an i.v. bolus of racemic ketamine 0.5 mg · kg‐1, followed by a continuous i.v. infusion of ketamine 2 μg‐kg‐1‐min‐1for 24 h, thereafter 1 μg.kg‐1min‐1for another 48 h. The control group received placebo bolus and infusion. A standard general anaesthesia including fentanyl was used. Patient‐controlled (PCA) i.v. morphine was used for postoperative analgesia. Punctuate mechanical hyperalgesia and temporal summation of mechanical stimuli causing “wind‐up pain” were measured using von Frey filaments.
Endogenous nitric oxide in the airways of different animal species
Authors: KHEDIN U. , RÖKEN B. O. , NYMAN G. , FROSTELL C. , GUSTAFSSON L. E. 
Published: January 2009

Background: High amounts of endogenous nitric oxide (NO) have been demonstrated in the human upper airway, but the role of nasal NO is still unclear. The present study aims to describe nasal NO excretion in different animal species with special living conditions or anatomy.Methods: Domestic animals (horse, cow, pig, sheep, dog, cat) and zoo‐animals (Rhesus monkey, chimpanzee, gorilla, elephant, fur seal, alpaca, yak, dolphin, camel, capybara, bear, tiger, wolf, giraffe, alligator, Harris' hawk, kangaroo) were studied awake, resting or anaesthetised. NO concentrations were measured by chemiluminescence using different analysers and techniques, including measurements on mixed exhaled air, during continuous or intermittent gas sampling, and on single breaths.Results: Rhesus monkeys (number of individuals N=5) and pigs (N=2) were compared and displayed quite different excretion patterns. Allowing NO to accumulate in the nose during timed occlusions yielded peak concentrations in monkeys of 0.46‐CO.07 parts per million (ppm, meanzSEM), 0.590.08 ppm, 0.700.08 ppm and 1.020.05 pprn NO after 15, 30, 60 and 120 s of occlusion. In pigs, 0.012–0.021 ppm NO were recorded, independent of occlusion time. The chimpanzee was similar to the Rhesus monkey and the highest NO value, 2.9 ppm, was recorded after 4–5 min of occlusion. In single breaths from 3 elephants 0.031–0.082 ppm, from 1 gorilla 0.029 ppm, and from 1 chimpanzee 0.0690.003 pprn NO (8 observations) were recorded.Conclusions: We found considerable species difference in nasal NO excretion with pronounced amounts only in primates and elephants. The physiological implications of these findings remain to be defined.