bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurolytic thoracic paravertebral block in cancer pain
Authors: Antila H. , Kirvelä O. 
Published: January 2009

Background: Paravertebral block has successfully been used in the treatment of acute and chronic pain. The duration of paravertebral block could theoretically be prolonged by using neurolytic agents.Methods: We retrospectively analyzed the results of neurolytic paravertebral blocks performed in 7 patients suffering from intense cancer‐related thoracic pain. Thirty‐seven spinal nerve roots were blocked during 20 visits. Nerve roots were identified by eliciting paresthesia radiating to the painful area. Each root was blocked separately. After test block using 0.5% bupivacaine, the paravertebral blocks were performed with 1–4 ml of 7% phenol in aqua.Results: No technical failures or complications were recorded in the patient files. Pain relief lasted over 2 months after 4 visits (20%), from 1 week to 1 month after 5 visits (25%), and less than 1 week after a single visit (5%). After 9 visits (45%), the results were poor with no significant pain relief.Conclusion: Neurolytic paravertebral block with phenol doses used in our patients appears to have only limited use. Some patients with pain restricted to a small number of thoracic segments may benefit from its use. Because of complication risks, this technique should be limited to intractable pain in cancer patients with poor prognosis.
Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism: A dose‐response study in patients subjected to craniotomy for cerebral tumours
Authors: Bundgaard H. , VON Oettingen G. , Larsen K. M. , Landsfeldt U. , Jensen K. A. , Nielsen E. , Cold G. E. 
Published: January 2009

Background: Studies concerning the cerebrovascular effects of sevoflurane in patients with space‐occupying lesions are few. This study was carried out as a dose‐response study comparing the effects of increasing sevoflurane concentration (1.5% (0.7 MAC) to 2.5% (1.3 MAC)) on cerebral blood flow (CBF), intracranial pressure (ICP), cerebrovascular resistance (CVR), metabolic rate of oxygen (CMRO2) and CO2‐reactivity in patients subjected to craniotomy for supratentorial brain tumours.Methods: Anaesthesia was induced with propofol/fentanyl/atracurium and maintained with 1.5% sevoflurane in air/oxygen at normocapnia. Blood pressure was maintained constant by ephedrine. In group 1 (n=10), the patients received continuously 1.5% sevoflurane. Subdural ICP, CBF and CMRO2 were measured twice at 30‐min intervals. In group 2 (n=10), sevoflurane concentration was increased from 1.5% to 2.5% after CBF1. CBF2 was measured after 20 min during 2.5% sevoflurane. Finally, CO2‐reactivity was studied in both groups.Results: In group 1, no time‐dependent alterations in CBF, CVR, ICP and CMRO2 were found. In group 2, an increase in sevoflurane from 1.5% to 2.5% resulted in an increase in CBF from 29 ± 10 to 34±12 ml 100g−1 min−1 and a decrease in CVR from 2.7±0.9 to 2.3±1.2 mmHg ml−1 min 100g (P<0.05), while ICP and CMRO2 were unchanged. CO2‐reactivity was maintained at 1.5% and 2.5% sevoflurane.Conclusion: Sevoflurane is a cerebral vasodilator in patients with cerebral tumours. Sevoflurane increases CBF and decreases CVR in a dose‐dependent manner. CO2‐reactivity is preserved during 1.5% and 2.5% sevoflurane.
Comparison of spontaneous frontal EMG, EEG power spectrum and bispectral index to monitor propofol drug effect and emergence
Authors: Struys M. , Versichelen L. , Mortier E. , Ryckaert D. , Mey J. C. De , Deyne C. De , Rolly G. 
Published: January 2009

Background: The aim of this study was to investigate the accuracy of frontal spontaneous electromyography (SEMG) and EEG spectral edge frequency (SEF 95%), median frequency (MF), relative delta power (RDELTA) and bispectral index (BIS) in monitoring loss of and return of consciousness and hypnotic drug effect during propofol administration at different calculated plasma target concentrations.Methods: Propofol was administered by using a target‐controlled infusion at different propofol steady‐state concentrations. All variables were measured simultaneously at specific calculated concentrations and endpoints.Results: Loss of consciousness was accurately monitored by BIS, SEMG and SEF 95%, and propofol drug effect by BIS only. Return of consciousness was predicted by BIS, MF and SEF 95%. Due to the biphasic EEG pattern of propofol and the lack of reproducible data at specific propofol concentrations, the clinical usefulness of SEF 95%, MF and RDELTA was very limited. SEMG was useful to detect loss and return of consciousness, but without predictive value.Conclusions: The BIS might be an accurate measure to monitor depth of anaesthesia and hypnotic drug effect. Other neurophysiologic measures have limited value to monitor depth of anaesthesia and hypnotic drug effect.
Nausea and vomiting after dexamethasone versus droperidol following outpatient laparoscopy with a propofol‐based general anesthetic
Authors: Rothenberg D. M. , McCarthy R. J. , Peng C. C. , Normoyle D. A. 
Published: January 2009

Background: The purpose of this randomized, double‐blinded study was to compare the incidence and severity of postoperative nausea and vomiting (PONV) after dexamethasone versus droperidol following gynecologic laparoscopy, a group at high risk for developing PONV.Methods: Ninety‐five patients who underwent a propofol‐based general anesthetic received either dexamethasone 0.17 mg/kg IV, or droperidol 0.02 mg/kg IV, just prior to abdominal incision. Nausea, retching, vomiting, degree of sedation, and discharge times were assessed in the Post Anesthesia Care Unit (PACU), and the Ambulatory Care Unit (ACU). Following hospital discharge (24 h), the patients were contacted by telephone to assess any further complications.Results: PONV in the PACU (14.6% vs. 14.9%) and ACU (8.3% vs. 14.9%) was as common after dexamethasone as after droperidol. PONV following hospital discharge was, however, less common after dexamethasone than after droperidol (4.2% vs. 17.0%, P=0.041). Postoperatively, no complications of therapy were detected.Conclusions: We conclude that PONV is similar with dexamethasone and droperidol, but dexamethasone may have a longer duration of action in patients undergoing gynecologic laparoscopy.
Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: Detection by transesophageal echocardiography
Authors: Mammoto T. , Hayashi Y. , Ohnishi Y. , Kuro M. 
Published: January 2009

Background: Venous air embolism (VAE) and paradoxical air embolism (PAE) are serious complications associated with the sitting position for neurosurgery. Although PAE is the result of VAE, the incidence of PAE according to the severity of VAE has not been investigated systematically in humans.Methods: Twenty‐one patients scheduled for neurosurgery in the sitting position were investigated prospectively. VAE and PAE were continuously monitored by cardiac two‐dimensional 4‐chamber view using transesophageal echocardiography (TEE) and the severity of VAE and PAE was quantitatively graded from 0 to 3 by the microbubbles score. Haemodynamic parameters and end‐tidal CO2 concentration (PETCO2) during VAE and PAE were also recorded.Results: Microbubbles in the right atrium appeared in all patients and the number of patients involved in grades 0, 1, 2 and 3 of VAE was 0, 10, 3 and 8, respectively. PAE occurred in 3 patients and only followed grade 3 of VAE. PAE always appeared from 20 to 30 s after the most severe VAE. A reduction of PETCO2 and an increase of pulmonary artery pressure were noted during all episodes of grades 2 and 3 VAE. In contrast, a significant reduction of systemic blood pressure occurred in 1 case of grade 2 and 3 cases of grade 3.Conclusions: VAE detected by TEE appeared in all patients undergoing neurosurgery in the sitting position and PAE only occurred following the most severe grade of VAE. To prevent growth of VAE is an important prophylactic for PAE.
Effects of desflurane and propofol on arterial oxygenation during one‐lung ventilation in the pig
Authors: Karzai W. , Haberstroh J. , Priebe H.‐J. 
Published: January 2009

Background: Desflurane depresses hypoxic pulmonary vasoconstriction (HPV) in vitro. During one‐lung ventilation (OLV), HPV may reduce venous admixture and ameliorate the decrease in arterial O2 tension by diverting blood from the non‐ventilated to the ventilated lung. Accordingly, this study compares the effects of desflurane with those of propofol on oxygenation during two‐lung (TLV) and OLV in vivo.Methods: Ten pigs (25–30 kg) were premedicated (flunitrazepam 0.4 mg/kg im), anaesthetized (induction: propofol 2 mg/kg iv; maintenance: N2O/O2 50%/50%, desflurane 3%, propofol 50 μg kg−1 min−1, and vecuronium 0.2 mg kg−1 h−1 iv), orally intubated and mechanically ventilated. Femoral arterial and thermodilution pulmonary artery catheters were placed, and the orotracheal tube was replaced by a left‐sided 28‐Ch double‐lumen tube (DLT) via tracheotomy. After DLT placement, N2O and propofol were discontinued, FiO2 was increased to 0.85, and anaesthesia continued randomly with either desflurane (1 MAC) or propofol 200 μg kg−1 min−1. Using a cross‐over design, in each animal the effects of a), changing from TLV to OLV (left lung) during both desflurane and propofol and b), the effects of changing between the two anaesthetics during OLV were studied.Results: When changing from TLV to OLV, PaO2 decreased more (P<0.05) during desflurane (mean 75%) than during propofol (mean 60%). Changing between desflurane and propofol during OLV resulted in small but consistent (P<0.05) increases in PaO2 (mean 15%) during propofol.Conclusion: Consistent with in vitro results on HPV, 1 MAC desflurane impaired in vivo oxygenation during OLV more than did propofol.
No inhibition of gastro‐intestinal propulsion after propofol‐or propofol/ketamine‐N2O/O2 anaesthesia: A comparison of gastro‐caecal transit after isoflurane anaesthesia
Authors: Freye E. , Sundermann St. , Wilder‐Smith O. H. G. 
Published: January 2009

Background: Gastrointestinal motility may be considerably reduced by anaesthesia and or surgery resulting in postoperative ileus. Inhibition of propulsive gut motility is especially marked after an opioid‐based technique. Little, however, is known of the gastrointestinal effects of the hypnotic propofol when given continuously over a longer period of time, which is the case in total intravenous anaesthesia (TIVA) and in intensive care sedation. We therefore set out to study the effects of a propofol‐based nitrous oxide/oxygen anaesthesia (group PO) on gastro‐caecal transit time. The results were compared with a propofol‐ketamine technique (group PK) and an isoflurane‐based anaesthesia (group I; each group n=20).Methods: Gastro‐caecal transit was determined by measurement of endexpiratory hydrogen concentration (ppm). Following gastral installation of lactulose at the end of the operation, the disacchharide was degraded by bacteria in the caecum, resulting in the liberation of hydrogen which was expired. A 100% increase in endexpiratory hydrogen concentration compared to the preinduction period was considered the end‐point of gastrocaecal transit.Results: There was no significant difference with regard to gastro‐caecal transit in the three groups of patients. In the propofol group mean gastro‐caecal transit was 119 (±50.6 SD) min, in the propofol‐ketamine group it was 147 (±57.4 SD) min, and in the isoflurane group transit time was 122 (±48.6 SD) min.Conclusion: The data suggest that propofol, even when given as a continuous infusion, does not alter gastrointestinal tract motility more than a standard isoflurane anaesthesia. The data may be particularity relevant to patients who are likely to develop postoperative ileus. They also suggest that in an ICU setting propofol does not alter gut motility more than a sedation technique with the analgesic ketamine.
Anaesthesia for caesarean section — a German survey
Authors: Messerschmidt A. , Wulf H. , Stamer U. M. 
Published: January 2009

Background: Anaesthetic practice for caesarean section has changed during the last decades. There is a world‐wide shift in obstetric anaesthetic practice in favour of regional anaesthesia. Current data concerning anaesthetic practice in patients under‐going caesarean section from Germany are not available. A comparison with figures from the UK, USA, Norway and other European countries might be of general interest.Methods: Questionnaires on the practice of anaesthesia for caesarean section and anaesthetic coverage of the obstetric units were sent to 1178 university, tertiary care, district, community and private hospitals in Germany.Results: The 532 completed replies of this survey represent 46.9% of the German obstetric units. Most hospitals (42.3%) have delivery rates between 500 and 1000 per year. General anaesthesia is the most common anaesthetic technique for elective (61%), urgent (83%) and emergency caesarean section (98%). Epidural anaesthesia is performed in 23% of scheduled and 5% of non‐scheduled caesarean sections, and spinal anaesthesia in 14% and 10%, respectively. Acid aspiration prophylaxis before elective caesarean section is used in 68.7% of the departments. The majority of the departments provide a 24‐hour anaesthetic coverage; however, in only 6.2% of the units, this service is assigned to obstetric anaesthesia, exclusively.Conclusion: Compared to data from 1978, anaesthetic practice for caesarean section has changed with an increase in regional anaesthesia. However, German anaesthetists prefer general anaesthesia for caesarean section. In contrast, anaesthetists in other countries predominantly use regional techniques, and the difference to German practice is striking. International consensus discussion and recommendations as well as comparable European instruments of quality control in obstetric anaesthesia are desirable.
Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery
Authors: Westman L. , Valentin A. , Eriksson E. , Ekblom A. 
Published: January 2009

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.Method: A dose‐escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG‐changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side‐effects, the most frequent being mild pruritus (10/33).Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.
Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery
Authors: Lisander B. , Ivarsson I. , Jacobsson S. ‐A. 
Published: January 2009

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient‐related variables associated with allogeneic blood transfusion.Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r2=0.45). Only one‐third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood‐saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.
Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography
Authors: Frerichs I. , Hahn G. , Golisch W. , Kurpitz M. , Burchardi H. , Hellige G. 
Published: January 2009

Background: Electrical impedance tomography (EIT) is a noninvasive technique providing cross‐sectional images of the thorax. We have tested an extended evaluation procedure, the functional EIT (f‐EIT), to identify the local shifts of ventilation known to occur during the transition between spontaneous, controlled and assisted ventilation modes.Methods: Ten patients scheduled for elective laparotomy were studied in the surgical ward, operating theatre and ICU during spontaneous and different modes of mechanical ventilation. Sixteen ECG electrodes were placed on the circumference of the thorax and connected with an EIT device (APT System Mark I, IBEES, Sheffield, UK). Measurements lasting 180 s were performed and f‐EIT images of regional ventilation computed. The geometrical centre of ventilation was determined to quantify the regional distribution of lung ventilation during individual modes of ventilation.Results: F‐EIT confirmed the differences in the distribution of ventilation associated with various modes of artificial ventilation. Accentuated ventilation of the dependent lung regions was observed during spontaneous breathing, whereas a shift of the centre of ventilation to the nondependent regions was found during controlled ventilation. In the course of assisted ventilation a continuous displacement of the centre of ventilation back towards the dependent lung regions, consistent with an increased proportion of spontaneous breathing, was detected. Unassisted spontaneous breathing after weaning from mechanical ventilation resulted in a similar ventilation distribution as during tidal breathing prior to surgery.Conclusion: F‐EIT determined the redistribution of lung ventilation during different modes of mechanical ventilation. We expect that f‐EIT will become a useful noninvasive bedside monitoring technique for imaging regional ventilation in pulmonary diseased patients during mechanical ventilation.
The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans
Authors: Persson J. , Hasselström J. , Wiklund B. , Heller A. , Svensson J.‐O. , Gustafsson L. L. 
Published: January 2009

Background: Ketamine in sub‐dissociative doses has been shown to have analgesic and phantom‐Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain‐generating mechanisms are not well understood.Methods: Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub‐dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5‐min infusion on four separate days in a cross‐over, double‐blind, randomised protocol. Plasma levels of (S)‐ and (R)‐ketamine and their nor‐metabolites were analysed with an enantioselective high‐performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).Results: Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose‐dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side‐effects, mainly disturbed cognition and perception, were pronounced and dose‐dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.Conclusion: We have demonstrated a potent dose‐dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.
Postural post‐dural puncture headache after spinal and epidural anaesthesia. A randomised, double‐blind study
Authors: Flaatten H. , Felthaus J. , Larsen R. , Bernhardsen S. , Klausen H. 
Published: January 2009

Background: This study was conducted in order to investigate the effect of patient expectation in the developement of postural post‐dural puncture headache (PPDPH).Methods: 224 patients less than 55 years scheduled for minor non‐obstetric surgery were randomised to receive single‐injection spinal (SA) or epidural (EA) anaesthesia. A 27‐g Quinke needle was used for SA and a 18‐g Tuohy needle for EA. Patients, operating team and postoperative ward personnel were all blinded to the anaesthetic given and so was an independent observer responsible for follow‐up after 5–7 days. The occurrence of headache, backache and other complaints was recorded. Headache was classified as PPDPH or non‐PPDPH, and duration and intensity of the headache was registered. The quality of anaesthesia was directly evaluated by the surgeon using a VAS scale from 1(excellent) to 10 (very poor) and indirectly by the supplemental use of opioid analgesia and general anaesthesia in the two groups.Results: 212 patients, 103 SA and 109 EA, with a mean age of 36.7 years, could be fully evaluated. The groups were comparable with regards to age, sex and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 16 patients (15.5%) in the SA group and 2 (1.8%) in the EA group (P=0.0014). Non‐PPDPH occurred in 13 patients in each group. PPDPH had significantly greater mean intensity and duration than non‐PPDPH. More patients in the EA group had postoperative backache (31.2%) than in the SA group (22.3%), but this difference was not statistically significant. More patients in the EA received general anaesthesia and opioid analgesia than in the SA group, and the surgeon's rating was on average 1.3 in the SA group compared to 2.5 in the EA group (P=0.0003).Conclusions: SA gave more headache but superior quality of surgical anaesthesia compared with EA. Dural puncture, and not expectation, is the major cause of PPDPH.