bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum Potassium during Regional Anaesthesia with special reference to the effects of adrenaline
Authors: LÖFGREN A 
Published: January 2009

Abstract: Hypokalaemia may occur in connection with regional anaesthesia. The main purpose of this thesis was to: (1) Evaluate the effect of some major forms of regional anaesthesia on the serum potassium (S–K) level. (2) Determine whether the response to adrenaline with regard to the S–K level is different during and after surgery compared to a plain experimental situation and, if so, decide if this can be explained by an altered responsiveness in the β–adrenoceptors. (3) Study ECG disturbances attributable to adrenaline and to hypokalaemia caused by the local anaesthesia. (4) Find out whether differences in health status and medication constitute risk factors in developing marked preoperative changes in the S–K level.Ninety–seven patients and 10 volunteers participated in the studies. Local anaesthetics with and without adrenaline were used. Epidural anaesthesia using mepivacaine or bupivacaine and field block for inguinal hernia surgery with prilocaine were studied in relation to surgery. Intercostal nerve block with bupivacaine or prilocaine for postoperative pain relief after cholecystectomy and in volunteers were also studied. Data from 150 other patients were collected to evaluate S–K changes in the preoperative period.Local anaesthetics with adrenaline caused hypokalaemia, but it was not possible to predict the hypokalemic effect from one type of nerve block to another. During surgery under local anaesthesia, surgical stress aggravated the hypokalaemia from exogenous adrenaline. The hypokalemic effect of marcaine–adrenaline was nearly abolished during intra–abdominal surgery under general anaesthesia, but it was intensified during recovery after cholecystectomy. No major arrthythmias were caused by the local anaesthetics with or without adrenaline. Preoperative S–K changes, with increases occurring as frequently as decreases, of 0.4 mmol/1 occurred in one third of the patients.It is concluded that local anaesthetics with adrenaline cause a decrease in the S–K concentration and minor ECG disturbances. The hypokalemic effect of local anaesthesia might be intensified during postoperative recovery but reduced during surgery under general anaesthesia. The intra–operative lack of a hypokalemic effect caused by adrenaline could partly be explained by a reduced responsiveness in the β2–adrenoceptors. The preoperative changes in S–K can be explained only to a minor extent by the health status and medication of the patients.
Plasma cholinesterase and abnormal reaction to succinylcholine: twenty years' experience with the Danish Cholinesterase Research Unit
Authors: Jensen F. S. , Viby‐Mogensen J. 
Published: January 2009

For more than 20 years, the Danish Cholinesterase Research Unit (DCRU) has collected information about patients showing an abnormal response to succinylcholine.The purpose of this study was, on the basis of the 20 years' experiences with the Unit, to evaluate our clinical findings in patients referred because of prolonged response following succinylcholine. Also, we wanted to evaluate the results of our prospective controlled studies of the effect of succinylcholine in patients with normal and abnormal plasma cholinesterase genotypes.An explanation for the apparent abnormal response to succinylcholine was found in 61.1% of the 1,247 patients referred to the Unit. Of the 1,247 patients, 28.5% were genotypically normal and 46.5% had an abnormal genotype. In the remaining 24.9% of the patients, the genotype could not be established. The time to sufficient recovery of neuromuscular function following succinylcholine 1.0–1.5 mg kg‐1was 15–30 min in patients heterozygous for one abnormal gene, 35–45 min in patients heterozygous for two abnormal genes and 90–180 min in patients homozygous for the atypical gene. Patients with two newly discovered genotypes (AK (5 patients) and AH (1 patient)) showed slightly prolonged (20 min) and markedly prolonged (90 min) duration of action of succinylcholine, respectively.Our results indicate that it is a problem for many anaesthetists to correctly diagnose a prolonged response to succinylcholine. We therefore urge the anaesthetist always to use a peripheral nerve stimulator when faced with a case of apparent abnormal response to succinylcholine.
Effect of dextran on plasma tissue plasminogen activator (t‐PA) and plasminogen activator inhibitor‐1(PAI‐1) during surgery
Authors: Eriksson M. , Saldeen T. 
Published: January 2009

Dextran is known to increase the plasminogen activation rate in vitro and to decrease the α2‐antiplasmin activity.We decided to explore the effect of dextran on plasma tissue plasminogen activator (t‐PA) and plasminogen activator inhibitor‐1(PAI‐1) during surgical trauma.Thirty‐one patients undergoing elective surgery were given 500 ml of 6% dextran 70. Another nine patients serving as controls were given 500 ml of a glucose‐electrolyte solution. The activities of t‐PA and PAI‐1during surgery were determined, as was the concentration of t‐PA antigen.PAI‐1activity was decreased by 19% after infusion of 250 ml of dextran. After 500 ml, the activity was reduced by 22% (both P<0.05). The activity of t‐PA was increased by 43% and 29% (both P<0.05) and the antigenic amount of t‐PA was increased by 18% and 15% (both P<0.05) after infusion of 250 ml and 500 ml of dextran, respectively. No changes in these variables were observed in the control patients.It is concluded that infusion of dextran promotes fibrinolysis by enhancing plasminogen activation in patients subjected to trauma. Since elevated levels of PAI‐1prior to surgery are known to predispose to deep vein thrombosis, which may form already during the operation, the effect of dextran on PAI‐1described here may explain its clot preventing properties.
Topical ketamine inhibits albumin extravasation in chemical peritonitis in rats
Authors: Hirota K. , Zsigmond E. K. , Rabito S. F. 
Published: January 2009

Background. As ketamine has local anaesthetic actions and local anaesthetics are known to have anti‐inflammatory effects, ketamine could be expected to be an anti‐inflammatory agent. Here we sought to determine whether ketamine is indeed anti‐inflammatory in chemical peritonitis induced by HC1 in rats.Methods. Peritonitis was elicited by applying 0.02 M HCI on the surface of the cecum or appendix and quantified by measuring the extravasation of intravenously injected Evan's Blue bound to albumin extracted from those tissues. Three experimental sets were performed. In the first set, four groups of 10 rats each received: 1%, 2%, and 4% ketamine and 1% lidocaine. In the same animal, before induction of peritonitis one area was topically pre‐treated with 0.9% saline (control site) and another area was topically pre‐treated with 1%, 2% or 4% ketamine or 1% lidocaine (experimental site). In the second set, two groups of 10 rats each received: 2% ketamine or 1% lidocaine. Ten min after the induction of peritonitis, the control site was topically treated with 0.9% saline, while the experimental site was treated with 2% ketamine or 1 % lidocaine. In the third set 20 rats, divided into two groups, were pre‐treated either with 2% S(+)ketamine or 2% R(‐)ketamine before the induction of peritonitis instead of the previously employed racemic version of the drug.Results. Treatment of the cecum or appendix areas with ketamine or lidocaine before the induction of peritonitis decreased the extravasation of Evan's Blue‐albumin from 5.7±0.7 μg/100 mg tissue to 4.5±0.8, N.S. with 1% ketamine; from 5.9±0.8 to 4.1 ±0.7,P<0.01 with 2% ketamine; from 4.8±0.7 to 3.5±0.6,P<0.05 with 4% ketamine and from 5.9±0.6 to 3.6±0.8,P<0.01 with 1% lidocaine. Treatment of the areas of peritonitis with 2% ketamine or 1% lidocaine decreased the extravasation of Evan's Blue‐albumin from 5.6±0.5 μg/100 mg tissue to 4.4±0.6,P<0.05 and from 6.0±0.8 to 5.0+0.7,P<0.01. Administration of the isomer S(+)ketamine to colonic areas before the induction of peritonitis reduced the extravasation of Evan's Blue‐albumin from 6.5±0.7 μg/100 mg tissue to 4.1±0.6,P<0.01; while the isomer R(‐)ketamine was inactive.Conclusions.These results indicate that topically applied ketamine inhibited the development of chemical peritonitis. This action of racemic ketamine was due to the isomer S(+)ketamine.
How are haemodynamic and metabolic responses to haemorrhage influenced by segmental thoracic and thoracolumbar epidural analgesia? An experimental study in dogs
Authors: Yoshikawa G. , Agune T. , Takasaki M. 
Published: January 2009

To determine the effects of the spread of sympathetic blockade administered prior to haemorrhage on haemodynamic and metabolic responses 10 haemorrhage, we compared these responses among dogs treated by segmental thoracic epidural analgesia, thoracolumbar epidural analgesia and general anaesthesia.Group 1 of six dogs received 0.2% halothane plus epidural analgesia ranging from C4 to T5, group 2 of seven 0.2% halothane plus epidural analgesia ranging from C5 to L7, and group 3 of eight 0.9% (1 MAC) halothane anaesthesia. A volume of 35 ml · kg‐1 was bled over 30 min. The haemodynamic, metabolic and catecholamine variables were measured repeatedly at 30‐min intervals for 2.5 h.The mean arterial pressure decreased significantly in all groups immediately after haemorrhage. It recovered to 80–90 mmHg at 2–2.5 h in groups 1 and 3 but remained at 20–30 mmHg in group 2. The cardiac output decreased significantly in all groups. The systemic vascular resistance increased significantly in group 1 but decreased significantly in group 2. In group 3 it decreased significantly but soon recovered. Arterial pH and base excess decreased significantly in all groups immediately after haemorrhage. After that, base excess recovered slowly in groups 1 and 3 but decreased further in group 2. The plasma epinephrine concentration increased immediately after haemorrhage and then decreased slowly in groups 1 and 3. In group 2 it remained unchanged at the lower level. The decreases in mean arterial pressure, systemic vascular resistance and base excess were significantly larger in group 2 than in groups 1 and 3.These results demonstrate that the haemodynamic and metabolic changes after haemorrhage are milder under segmental thoracic epidural analgesia or 1 MAC halothane anaesthesia than under thoracolumbar epidural analgesia. Widespread epidural analgesia would weaken haemodynamic and metabolic compensatory responses to haemorrhage.
Intramuscular ketorolac following total hip replacement with spinal anaesthesia and intrathecal morphine
Authors: Fogakty D. J. , O'Hanlon J. J. , Millioan K. R. 
Published: January 2009

We have studied the analgesic and morphine sparing effect of ketorolac tromethamine in 60 patients after total hip replacement under spinal anaesthesia.In this double blind study 30 patients received ketorolac 30 mg IM 6 hourly postoperatively and the control group received saline. Analgesia was assessed by visual analogue pain scores (VAS) and morphine consumption by patient controlled analgesia (PCA). There was a significantly (P<0.02) lower morphine consumption in the ketorolac group (7.1 ±8.6 mg; Mean±s.d.) when compared to the saline group (14.2±13.6 mg). Although there was a trend for lower VAS on the first postoperative night this was only significant at 10 hours postoperatively and the next morning at 08:00 hr. The incidence of side effects (emetic sequelae, pruritus and headache) were similar in both groups. It is concluded that ketorolac reduces the consumption of additional morphine in conjunction with intrathecal morphine but had no effects on the side effects.
Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy
Authors: Scheinin B. , Kellokumpu I. , Lindgren L. , Haglund C. , Rosenberg P. H. 
Published: January 2009

The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1–2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double‐blind fashion 100 ml of either plain 0.15% bupivacaine {150 mg · 100 ml‐1) or the same solution with adrenaline (1.5 μg ml‐l), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 μg ml‐1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine‐adrenaline group. During the follow‐up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30–45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen.It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.
Replacement of major surgical blood loss by hypo‐oncotic or conventional plasma substitutes
Authors: Hiippala S. , Linko K. , Myllylä G. , Lalla M. , Hekali R. , Mäkeläinen A. 
Published: January 2009

The purpose of the study was to examine the effects of hypooncotic 4% hydroxyethyl starch 120/0.7, 3% dextran 70, 5% albumin and hyperoncotic 6% hydroxyethyl starch 120/0.7 on the perioperative colloid osmotic pressure (COP), albumin and protein concentrations and fluid balance.The plasma substitutes were used with red cell concentrates to replace blood loss with equal volume in sixty major abdominal or urological surgeries. A special effort was made to keep replacements and losses at even volumes constantly and to avoid fluctuation of blood volume. The blood specimen were obtained before induction, after each 20% blood loss, at the end of the recovery room phase and on the three following postoperative mornings.There were significant differences in the peroperative and immediate postoperative COPs. However, these differences had vanished by the first postoperative morning. COP was preserved above 16 mmHg in all groups throughout the study. The identical peroperative albumin and protein concentrations of the synthetic colloid groups suggests that their volume effect was the same, regardless of the varying COP. During the observation period there were no significant differences among the groups concerning the diuresis and the fluid balances. We conclude, that the hypooncotic 4% HES 120 and 3% dextran 70 solutions provide the same clinical effect as 6% HES 120 solution. Consequently less colloid is needed, which allows the use of greater volumes of the dilute colloid solutions in replacement therapy.
Desflurane analgesia for vaginal delivery
Authors: Abboud T. K. , Swart F. , Zhu J. , Donovan M. M. , Silva E. Peres Da , Yakal K. 
Published: January 2009

The use of subanaesthetic concentration of inhalational anaesthetic for vaginal delivery offers many advantages to the mother and newborn‐ Desflurane, with the characteristics of rapid onset and minimal metabolism, may provide better analgesia and safety for labour pain control.Eighty healthy parturients were randomly assigned to receive either desflurane 1.0–4.5% and oxygen (n = 40) or nitrous oxide 30–60% in oxygen (n=40). Analgesia was assessed using a score from 0 (no relief) Lo 4+ (excellent analgesia), amnesia for the delivery, blood loss were recorded. Neonates were evaluated by Apgar scores and neurologic and adaptive capacity scores (NACS). Data were analyzed for statistical significance using Student's l‐test or Chi‐square when appropriate.Analgesia scores were similar for both groups with more amnesia in desflurane group (23% vs 0%P<0.05). Blood loss did not differ significantly, 364 ml for the desflurane group and 335 ml for the nitrous oxide group. There were no significant differences for neonatal Apgar score at 1 min or at 5 min or the NACS at 2 hr or 24 hr between the two groups.We conclude that desflurane in subanaesthetic doses is safe and effective inhalation agent for normal delivery but might be associated with amnesia.
Clinical and Laboratory Studies on Propofol
Authors: Jensen A G 
Published: January 2009

Abstract: The aims of this study were to assess the suitability during major surgery of an intravenous anaesthetic technique based on propofol and to study the influence of this technique on early and late recovery, on postoperative bowel and lung function, and on the incidence of complications. Further, the effects of propofol were evaluated on the migration ability of human leucocytes, and on the cytoskeletal organization and the intracellular calcium ion concentration of cultured cells.Patients undergoing major abdominal surgery were randomly given either total intravenous anaesthesia based on propofol and fentanyl, or anaesthesia based on propofol, fentanyl and nitrous oxide or anaesthesia based on isoflurane and fentanyl. Postoperative atelectasis demonstrated by computed tomography of the chest was found to a similar extent, and a similar decrease in arterial oxygen pressure was seen in the groups. No correlation was seen between the size of atelectasis and postoperative oxygen pressure. Cardiovascular stability was equally well maintained during surgery, but the patients anaesthetized with propofol needed more ephedrine and glycopyrrolate to achieve stability. In all groups the Acute Physiology Score was normal by day 1 (range 1–7). A similar impairment of bowel function after operation was found, with passage of gas day 3 (1–6) and tolerance of enteral intake day 5 (1–10). Hospital stay 11 (6–45) days and incidence of complications were unaffected by anaesthetic technique. Early recovery was similar in the three groups, but patients anaesthetized with propofol reported fewer symptoms, better subjective control and a higher degree of social orientation than patients anaesthetized with isoflurane.Clinically relevant concentrations of propofol decreased random and chemotactic locomotion of leucocytes in an agarose assay. Concentration dependent and reversible effects of propofol (concentrations between 0.3μg·ml‐1 and 50 μg·ml‐1(1.7 to 280μM) were found on the actin distribution of the cytoskeleton in cultured cells. The maximal effect was seen after 20 min. of incubation. An increase in cytosolic free calcium in rat neurons was seen immediately after the addition of propofol, lasting 128±39 seconds and thereafter returning to normal. This effect was dual, 60–75% of the increase came from the extracellular buffer and the remaining part from intracellular stores. A rise in intracellular calcium can lead to changes in the cytoskeleton and to hyperpolarization of neurons.
Lack of effect of flumazenil on the reversal of propofol anaesthesia
Authors: Fan S. Z. , Liu C. C. , Yu H. Y. , Chao C. C. , Lin S. M. 
Published: January 2009

Propofol, like the benzodiazepines, activates the GABAA receptor‐chloride ionophore complex; they potentiate one another. Since neither pharmacodynamic nor pharmacokinetic data concerning drug interaction between flumazenil and propofol is available, and especially considering the relationship of binding sites, flumazenil, the antagonist of benzodiazepines, was investigated to determine its effect upon recovery from propofol anaesthesia. Forty women receiving dilatation and curettage procedures were included in this double‐blind test. After 50 μg fentanyl, propofol 2 mg · kg‐1 was injected for induction and followed by infusion at the rate of 15 mg · kg‐1 · hr‐1. After the operation, patients were given normal saline (Group A) or flumazenil 10 μg · kg‐1 (Group B) randomly.Recovery time in Group A was 15.2±5.1 min and Group B 15.8±4.8 min. Propofol concentrations at the end of infusion were 4.17±1.33 μg ·ml‐1 (Group A) and 4.03±1.45 μg · ml‐1 (Group B); these then declined to 1.22±0.17 μg · ml‐1 (Group A) and 1.18±0.15 μg · ml‐1 (Group B) when patients were able to open their eyes on command. No significant differences were found between the groups based on propofol concentrations and recovery time, nor did haemodynamic changes differ between them after administration of reversal agents. It was concluded that flumazenil 10 μg · ml‐1 does not influence recovery from propofol anaesthesia.
Lung function after open versus laparoscopic cholecystectomy
Authors: Gunnarsson L. , Lindberg P. , Tokics L. , Thorstensson Ö. , Thörne A. 
Published: January 2009

Postoperative lung function and gas exchange were studied in 36 patients after cholecystectomy. Twenty‐four of the patients underwent laparoscopic cholecystectomy while the remaining twelve were operated with open technique. Before surgery all patients had normal ventilatory volumes (forced vital capacity, FVC and forced expired volume in 1 s, FEV1) and normal gas exchange. Two hours postoperativley FVC was reduced to 64±16% (P<0.05) of the preoperative level in the laparoscopic group and to 45±23% (P<0.05) after open cholecystecomy. On the first postoperative day FVC was virtually normal in the laparoscopic patients (77±17% of preoperative level, NS), whereas the open surgery patients still had a decreased FVC (56±13% of preoperative, P<0.05). FEV1 in the postoperative period followed the same course as FVC. Gas exchange was significantly impaired in the early postoperative period in all patients but no difference between the two groups was found. Two hours postoperatively Pao2 was reduced to 85% (P<0.05) of preoperative value and Paco2 had increased by 0.5 kPa (p<0.05). The alveolo‐arterial oxygen tension difference (PA‐ao2) had increased by approximately 45% to a mean of 3.7 kPa (P<0.05). On the first postoperative day gas exchange was still significantly impaired in the open surgery patients. Atelectasis detected by computed X‐ray tomography of the lungs were found in both groups. However, the amount of atelectasis tended to be smaller in the laparoscopic group than in the open surgery patients.In summary, cholecystectomy irrespective of whether it was performed by open or laparoscopic technique was followed by deterioration in ventilatory function and gas exchange. However, the magnitude of this impairment was less pronounced in laparoscopic cholecystectomy patients than in the open surgery patients which may suggest that this minimal invasive procedure is favourable with respect to postoperative lung function.
Clinical application of differential ventilation with selective positive end‐expiratory pressure in adult respiratory distress syndrome
Authors: Wickerts C.‐J. , Blomqvist H. , Baehrendtz S. , Klingstedt C. , Hedenstierna G. , Frostell C. 
Published: January 2009

Differential ventilation in the lateral position with positive end‐expiratory pressure (PEEP) selectively applied to the dependent lung (DVSP) has been shown to reduce venous admixture and improve oxygenation without compromizing cardiac output in short term studies of patients with acute respiratory failure. We have applied this ventilation technique as a long‐term treatment in severe adult respiratory distress syndrome (ARDS) in an open clinical trial. Eleven patients with ARDS of varying aetiology were treated with DVSP for a total of 34 days.Median duration of conventional ventilatory therapy before start of DVSP was 5 days (1 to 18 days), inspiratory oxygen fraction (F1***2) was 0.61 ±0.16 (mean±s.d.), resulting in a mean arterial oxygen tension (Pao2) of 7.1±2.1 kPa (Pao2/F1o2= 11 ± 4 kPa). A gradual improvement in gas exchange was seen during the first 24 h of DVSP such that Pao2 increased to 8.4±1.4 with a decreased F1o2 (0.52±0.14) resulting in an increased Pao2/F1o2 (16±5 kPa). Five out of the eleven patients survived. No major complication was noted using DVSP as a method. We found a steady improvement in gas exchange over the first 24 hours in most patients. However, mortality rate was no lower than expected. Drawbacks with DVSP were increased demand on staff and difficulties with adequate endo‐bronchial suctioning.