bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of indomethacin to treat acute rises of intracranial pressure and improve global cerebral perfusion in a child with head trauma
Authors: IMBERTI R. , BELLINZONA G. , ILARDI M. , BRUZZONE P. , PRICCA P. 
Published: January 2009

Background: The use of vasoconstrictors (e.g. dihydroergotamine, indomethacin) for the treatment of increased intracranial pressure (ICP) secondary to brain trauma is controversial. In particular, it has been suggested that vasoconstrictors be employed only for intracranial hypertension secondary to hyperemia, when venous jugular bulb saturation (SjO2) is >75%. Method We administered indomethacin as a bolus i.v. (5–10 mg) on 18 occasions to a multiple‐injured 3‐year‐old child with acute rises of ICP secondary to severe brain trauma (GCS score 7) determining a large hypodensity area in and swelling of the right hemisphere.Results: Before indomethacin administration the average of mean ICP was 68.1 ± 10.8 (SD) mm Hg (range 47–84) and the cerebral perfusion pressure (CCP) was 38.4±10.4 mm Hg (range 30–65). In response to indomethacin, ICP dropped in a few seconds to 22.7±5.6 and CCP increased to 82.4±6.1 mm Hg (P <0.001), while the mean arterial pressure remained unchanged. On 6 occasions SjO2 was also evaluated immediately before and 5 and 10 min after indomethacin administration. Before indomethacin administration, SjO2 values were within the normal range on 2 occasions and abnormally low on four. SjO2 increased from the mean value of 45.6215.7 to 59.828.9 (after 5 min) and 60.6212.4% (after 10 min) (P< 0.01 versus pre‐indomethacin). At the same time the cerebral venous pH increased from 7.4320.01 to 7.4550.01 (P=0.01). These findinge suggest that the global cerebral perfusion was improved. Eighteen days after injury the child was awake and was discharged from the ICU.Conclusion: To our knowledge, increase of SjO, in response to indomethacin has not been previously reported. Although great caution is necessary in the use of indomethacin for the treatment of ICE these findings suggest that indomethacin can be useful for the treatment of acute rises of ICP compromising severely the CCP, even if SjO, is normal or abnormally low. Under these circumstances, indomethacin can improve the global cerebral perfusion.
National survey on the anaesthetist's beliefs, opinions, behaviour and techniques in postoperative pain control in Italy
Authors: NOLLI M. , APOLONE G. , NICOSIA F. 
Published: January 2009

Background: Using a personal, anonymous questionnaire developed ad hoc, we tried to document the role, the problems and the activities of Italian anaesthetists in postoperative pain control.Methods: A random selection ‐ stratified by region ‐ was made from a list of 971 hospitals. The final sample was made up of 395 departments of anaesthesia and intensive care from 369 hospitals. The completeness and consistency of each questionnaire were assessed.Results: The response rate achieved was 78.9% (312 centres in 293 hospitals) with 2435 evaluable questionnaires corresponding to 30% of all Italian anaesthesia departments and 25% of Italian anaesthetists. Only 15.2% of anaesthetists are completely responsible for the postoperative analgesia (POA) (prescriptions and evaluations) and an established attitude for POA (protocols/guidelines) exists in 18 departments only. 60% of anaesthetists use routinely the intramuscular route, 55.2% the intravenous route (infusion plus bolus), and 23.7% the spinal/epi‐dural route. Only 6.2% of the anaesthetists use the patient‐controlled analgesia system. Nonsteroidal anti‐inflammatory drugs (NSAIDs) are the most commonly used agents (47% NSAID vs 37.9“/0 opioids; NSAID‐opioid association 14.7%). A local anesthetics‐opioids association is preferred for the spinal/ epidural route (15.1%) only (local anaesthetic 4.9% only; opioids alone 2.7%). Lack of time, work organization, technique knowledge/training, trust in nursing‐ward staff, difficulty in monitoring the patient on the ward, concern about opioid use leading to ventilatory depression, and administration errors are reported to be the main factors that limit an appropriate approach to postoperative pain (POP), the correct use of analgesics and a free choice of POA technique.Conclusion: This survey shows that Italian anaesthetists do not consider the postoperative period to be their own personal work area and that POA is to be considered as a matter of individual choice.
Elastic work of breathing during continuous positive airway pressure in intubated patients with chronic obstructive pulmonary disease (theoretical analysis and experimental validation)
Authors: AERTS J. G. J. V. , BERG B. VAN DEN , VERBRAAK A. F. M. , BOGAARD J. M. 
Published: January 2009

Background: Continuous positive airway pressure (CPAP) is known to decrease inspiratory work of breathing in patients with chronic obstructive pulmonary disease (COPD). This effect is primarily attributed to a reduction in inspiratory elastic work of breathing (Wi,el) related to a decrease in intrinsic positive end‐expiratory pressure (PEEP).Methods: The aim of this study is to design a model for computation of Wi,el on the basis of respiratory mechanics in patients with COPD, at various intrinsic PEEP‐ and CPAP‐levels. The model was used to estimate the optimal CPAP‐level with respect to the intrinsic PEEP‐level in terms of reduction of Wi,el. Calculations of the decrease in Wi,el due to CPAP obtained with the model were compared to changes in Wi,el and total work of breathing (Wi,tot) determined from respiratory measurements in patients with COPD.Results: Model calculations revealed that Wi,el was minimal whenever a CPAP‐level equal to the intrinsic PEEP‐level was applied. When a CPAP‐level exceeding the intrinsic PEEP‐level was applied, the reduction in Wi,el was less. Comparing these results to the respiratory measurements, a similar pattern in reduction of Wi,el and Wi,tot was established, although absolute values of the differences were smaller in the experimental data.Conclusion: This study indicates that in order to reduce Wi, el in patients with COPD, intrinsic PEEP should be measured and the CPAP‐level adjusted to the intrinsic PEEP‐level.
Effect of temperature variation (22˚C‐ 44˚C) on halothane and caffeine contracture testing in normal humans
Authors: ANTOGNINI J. F. , GRONERT G. A. 
Published: January 2009

Background:Malignant hyperthermia (MH) susceptibility is diagnosed using halothane‐caffeine contracture testing of a muscle sample maintained at 37˚C. However, there has not been a systematic study that examines the effect of different temperatures on the response of normal muscle to halothane and caffeine. We hypothesized that altering bath temperature would modify the contracture responses.Methods:We obtained muscle samples from 20 patients undergoing surgical procedures of the lower extremities. The samples were dissected into 245 bundles and the bundles were exposed to halothane 3% or incremental caffeine, according to the North American MH group protocol. Several bundles from each patient were simultaneously studied at four different temperatures (22˚C, 30˚C, 37˚C and 44˚C). Each bundle was studied at only one temperature, the muscle samples of 3 patients were simultaneously studied at all four temperatures for halothane and caffeine.Results:Maximum contracture to caffeine (32 mM) was highest at 37˚C; however, at lower caffeine concentrations (2–4 mM), there was no consistent effect of temperature on contracture response. Likewise, temperature did not alter contracture responses to halothane. The extremes of temperature (22˚C and 44˚C) were associated with lack of twitch in response to electrical stimulation. For the bundles exposed to halothane at 22“C, the absence of a twitch was associated with the presence of a contracture, although these were never above the diagnostic threshold.Conclusions:We conclude that temperature has little effect on responses of normal muscle to halothane and caffeine.
Delayed derecruitment after removal of PEEP in patients with acute lung injury
Authors: LICHTWARCK‐ASCHOFF M. , GUTTMANN J. , EBERHARD L. , FABRY B. , BIRLE J. , ADOLPH M. 
Published: January 2009

Background:A step decrease in positive end‐expiratory airway pressure (PEEP) is not followed by an instantaneous loss of the PEEP‐induced increase in end‐expiratory lung volume (EELV). Rather, the reduction of EELV is delayed, while adverse PEEP effects on hemodynamics are immediately attenuated upon the drop in airway pressure. Step PEEP increments were applied to the lungs of patients with acute lung injury. It was investigated retrospectively whether enlargement of end‐expiratory lung volume and changes in lung mechanics persist 45 min after removal of the PEEP increment.Methods: In 14 patients with acute lung injury (LIS score 2.7) EELV and volume‐dependent dynamic compliance of the respiratory system (Cdyn,rs) were determined 45 min after removal of an additional PEEP increment (0.64 kPa added to baseline PEEP of 1.0 kPa).Results: Nine patients kept an EELV gain of 13% (SD 7) and showed improved Cdyn,rs. In 5 patients, EELV was reduced (by 9% (SD 6)) and Cdyn,rs unchanged after removal of the PEEP increment compared to baseline.Conclusion: A subgroup of patients with acute lung injury, the characteristics of which remain to be defined, benefit from prolonged recruitment effects up to 45 min after removal of a PEEP increment, while sequelae of continuously increased airway pressures are minimised.
Beneficial effects of the prone position on the incidence of barotrauma in oleic acid‐induced lung injury under continuous positive pressure ventilation
Authors: Du H. L. , YAMADA Y. , ORII R. , SUZUKI S. , SAWAMURA S. , SUWA K. , HANAOKA K. 
Published: January 2009

Background: Factors that contribute to ventilator‐induced barotrauma are not well defined. This study investigates the effects of posture on ventilator‐induced barotrauma, as well as arterial oxygenation.Methods: Twelve dogs with oleic acid lung injury, lying in the prone position (n=6) and right lateral position (n=6), were mechanically ventilated with continuous positive pressure ventilation for 24 hours. The incidence of pneumothorax and arterial oxygenation were investigated in each position. Results: All animals lying in the lateral position developed pneumothorax in the nondependent thorax, while only one animal in the prone position developed pneumothorax in the left thorax (P < 0.05). Postmortem examination revealed that in the lateral group, the nondependent lung consisted of large areas of emphysematous regions and neutrophil infiltration regions, while the dependent lung was composed of extensive atelectasis and neutrophil infiltration. Lung ruptures occurred in the non‐dependent lung at the regions of either emphysematous change or severe neutrophil infiltration. In the prone group, in contrast, both lungs were inflated fairly homogeneously with only small areas of atelectatic and emphysematous changes. In the dog in whom pneumothorax developed, lung ruptures were limited to the regions of severe neutrophil infiltration in the left lung. No animal in either group had a peak airway pressure more than 20 cmH2O. The peak airway pressures were 17.5 ±1.3 cmH2O in the lateral group and 16.6±2.1 cmH2O in the prone group (P>0.05). Tidal volume was comparable between the lateral group (13±2 ml/kg) and the prone group (12±1 ml/kg) before pneumothorax occurred (P>0.05). Arterial oxygenation was much better in the prone group than in the lateral group during the experiment (P < 0.05).Conclusion:It was concluded that in lung injury dogs, the prone position has beneficial effects on the incidence of ventilator‐induced barotrauma and arterial oxygenation when compared with the lateral position. Ventilator‐induced barotrauma may occur at lower airway pressure.
Results of in vitro contracture tests for the diagnosis of malignant hyperthermia susceptibility in monozygote twins
Authors: ISLANDER G. , TWETMAN E. RANKLEV 
Published: January 2009

Background:Malignant hyperthermia susceptibility is a pharmacogenetic disorder in which susceptible individuals may develop a potentially life‐threatening hypermetabolism when exposed to certain anaesthetic agents. The most common diagnostic method is the in vitro contracture test (IVCT) of skeletal muscle biopsies. There is a wide variation in the size of contractures between susceptible individuals and the reproducibility of the test in humans has not been evaluated.Methods: We have performed the IVCT in 4 monozygote pairs of twins, which gave us on opportunity to study the reproducibility. Results: The clinical diagnoses were consistent in all twin pairs, although slight differences in contractures and thresholds were seen.Conclusion: In this material the reproducibility of the IVCT was found to be satisfactory.
Grading of severity of postdural puncture headache after 27‐gauge Quincke and Whitacre needles
Authors: CORBEY M. P. , BACH A. B. , LECH K. , FRØRUP A. M. 
Published: January 2009

Background: Small‐gauge needles are reported to have a low incidence of complications. Pencil‐point needles are associated with a lower frequency of postdural puncture headache (PDPH), but a higher failure rate than Quincke needles.Methods: The incidence of PDPH was investigated in 200 patients under the age of 45, undergoing day‐care surgery, after spinal anaesthesia with either 27‐gauge Quincke or Whitacre needle. The severity of headache was graded as I (mild), II (moderate) or III (severe) using a grading system based on the visual analogue scale (VAS) associated with a functional rating (FG).Results: The frequency of PDPH following the Whitacre needle was 0% and 5.6% after the Quincke needle (P = 0.05). Two PDPHs were assessed as grade III, and three as grade II. All PDPHs occurred when the Quincke needle bevel was withdrawn perpendicular to the dural fibres following parallel insertion. No PDPH occurred when the bevel was inserted and removed parallel to the dural fibres (P < 0.05). There was no statistical difference (P>0.8) in the incidence of PDPH and postdural puncture‐related headaches (PDPR‐H) in patients with recurrent headaches or migraine compared to patients with no previous history of headaches.Conclusions: We conclude that the 27‐gauge Whitacre needle is the ‘needle of choice’ in patients with normal body stature. The incidence of PDPH following Quincke needles may not only be affected by the direction of the bevel during insertion but also during removal. Statistically, there was no gender variation in PDPH in this study (P=0.5). A previous history of recurrent headache or migraine does not predispose to PDPH.
Calculated versus measured oxygen consumption during and after cardiac surgery. Is it possible to estimate lung oxygen consumption?
Authors: KEINÄNEN O. , TAKALA J. 
Published: January 2009

Background: Lung tissue is metabolically active and consumes oxygen. The oxygen content difference between arterial and mixed venous blood does not include the effect of pulmonary tissue oxygen uptake. Thus, oxygen consumption (VO2) of the lung should be reflected as a difference between VO2 measured by gas exchange and VO2 derived by the Fick principle. The purpose of this study was to measure in clinical conditions this difference (taken to represent the VO2 of the lung), and to evaluate the sources of error in lung VO2 estimation.Methods: Nine patients undergoing coronary artery bypass grafting were studied. VO2 was measured by indirect calorimetry (VO2gasex) and compared to Fick‐derived VO2 (VO2Fick) after induction of anaesthesia, after closure of the chest, at admission to intensive care, after stabilization of haemodynamics and during weaning from mechanical ventilation. The Fick‐derived VO2 was calculated from blood samples taken at the beginning and at the end of each 20 min measurement period, and the mean of 12 consecutive thermodilution cardiac output measurements taken during each 20 min measurement period.Results: VO2gasex was higher than VO2Fick (P <0.01; in all except 4 of 45 measurements). The difference between the measured and the calculated VO2 was 33 ±25 ml/min (mean±SD, range ‐16–100 ml/min). This difference represented 14±3% (range 11–18%) of the whole body VO2. The VO2‐difference was highest after the induction of anaesthesia (50±19 ml/min; range 20–81 ml/min, P < 0.03) and lowest on arrival at the intensive care unit (10±16 ml/min; range ‐16–39 ml/min). Core temperature did not correlate with the oxygen consumption difference.Conclusions: A constant difference between measured and calculated VO2 can be detected in carefully controlled clinical conditions. The difference between the two methods is due to both lung oxygen consumption and errors in the measurement of VO2, thermodilution cardiac output, haemoglobin and blood oxygen contents. We suggest that the perioperative changes of the VO2‐difference are due not only to variation of the measurements but also to changes in lung metabolic activity.
Relationship between intra‐ and postoperative oxygen transport and prolonged intensive care after cardiac surgery: a prospective study
Authors: PÖLÖNEN P. , HIPPELÄINEN M. , TAKALA R. , RUOKONEN E. , TAKALA J. 
Published: January 2009

Background: Prolonged intensive care is a rare but serious complication of cardiac surgery. It is required in less than 10% of operated patients but they use more than 30% of all the intensive care resources needed for cardiac surgery. The aim of our study was to describe the clinical course of the patients who need prolonged intensive care following cardiac surgery and to assess whether the intra‐ and postoperative oxygen transport variables are different in these patients as compared to patients with an uncomplicated course.Methods: The study patients were divided into two groups according to the length of stay in the intensive care unit (ICU) after the operation: Group I, n=241, ICU‐stay 5 days and Group II, n=20, ICU‐stay≥5 days. Hemodynamic and oxygen transport data were prospectively obtained intra‐ and postoperatively and postoperative organ dysfunctions were recorded.Results: The patients in the prolonged intensive care group tended to be older, have lower ejection fraction and longer cardiopulmonary bypass time. Postoperatively, this group had significantly increased oxygen extraction rate (P=0.035, repeated measures for ANOVA). In the logistic regression analysis, in creased oxygen extraction (31% in Group I vs. 36% in Group II, P < 0.005) at 6 hours after arrival at the intensive care unit had the strongest independent association with the need for prolonged intensive care.Conclusions: There was no significant relationship between the factors conventionally assumed to be risk factors for prolonged intensive care. Instead, an increase in whole body oygen extraction, reflecting a mismatch between the whole body oxygen demand and supply, was associated with the need for prolonged intensive care. Oxygen extraction increased to compensate for the reduced oxygen delivery, which in turn was caused by a lower arterial oxygen content.
Hemodynamic and coronary vascular effects of dexmedetomidine in the anesthetized goat
Authors: LAWRENCE C. J. , PRINZEN F. W. , LANGE S. DE 
Published: January 2009

Background:In phase III trials, the hemodynamic stabilising effect of the α2‐adrenergic agonist dexmedetomidine (DEX) is being investigated in patients with coronary artery disease. Coronary vascular effects of α2‐agonists have been studied in dogs and pigs, but both species have a different hemodynamic response to DEX than man. The aim of this study was to investigate the hemodynamic and coronary vascular effects in goats.Methods:In 6 open‐chest goats anesthetized with halothane, central and coronary hemodynamics and oxygen supply and demand were measured before and following IV bolus infusion of DEX in doses ranging from 0.1 to 10 μg/kg.Results:With DEX doses of 1 μg/kg or higher, mean arterial pressure (MAP), systemic vascular resistance, coronary vascular resistance and arterio‐mixed venous oxygen content increased within 2 min, but returned to baseline within 15 min. In contrast, there was a progressive and cumulative decrease in cardiac output (CO), heart rate, and dP/dtmax. Regional coronary venous oxygen extraction (C(a‐cv)O2) transiently increased after 3 μg/kg DEX and decreased 15 min after 10 μg/kg DEX. LVEDP transiently increased after 3 and 10 μg/kg DEX. The changes after DEX 10 μg/kg differed from those after lower doses: MAP (35%), CO (50%), stroke volume (33%), C(a‐cv)O2(15%) and myocardial oxygen extraction (33%) were all decreased. Myocardial oxygen supply and demand decreased in parallel.Conclusions:1) The cardiovascular response to IV DEX in goats is similar to man. 2) In goats after DEX, systemic and coronary vasoconstriction are short‐lived, and 3) the balance between myocardial oxygen supply and demand is maintained.
Role of zatebradine and propranolol in attenuation of tachycardia produced by dobutamine in pigs
Authors: NEUSTEIN S. M. , DIMICH I. , SHIANG H. , MEZROW C. 
Published: January 2009

Background:Zatebradine is a new specific bradycardic agent that selectively slows the depolarization in the pacemaker cells of the sinoatrial node. The purpose of our investigation was to determine whether the tachycardia induced by dobutamine can be attenuated by the administration of zatebradine. The results were compared with those produced by propranolol, which is used in the treatment of sinus tachycardia.Methods:Twelve pigs were anesthetized with sodium pentobarbital, intubated, and ventilated. After baseline hemodynamic measurements were obtained, dobutamine was administered until the heart rate reached 25% above baseline. Animals were randomized to one of two groups. Group I received zatebradine, 0.5 mg/kg IV, and Group II received propranolol, 0.5 mg/kg IV.Results:Dobutamine 10 μg kg‐1min‐1increased the heart rate (HR) by 25%, and increased mean arterial blood pressure (MAP), left ventricular (LV) dP/dt, and cardiac output (CO) (P< 0.05). Zatebradine decreased the HR to baseline (P< 0.05) without affecting left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), LV dP/dt, or CO. Stroke volume (SV) increased significantly (P< 0.05). Propranolol also reduced HR to baseline, but decreased LV dP/dt, LVSP, CO, and SV (P< 0.05).Conclusion:Zatebradine effectively attenuates the tachycardia caused by dobutamine in anesthetized pigs, without reducing cardiac performance.
Analgesic and psychomotor effects of thiopental at subanesthetic concentrations in human volunteers
Authors: YOUNG C. J. , COALSON D. , KLOCK P. A. , KLAFTA J. M. , GOLDSHER G. , APFELBAUM J. L. , ZACNY J. P. 
Published: January 2009

Background:Studies of the effects of barbiturates on the modulation of pain have produced mixed results. In a prospective, double‐blind, randomized, placebo‐controlled trial, we studied the effects of thiopental at presumed steady‐state, “conscious sedation” levels on cold‐pressor‐induced pain in 12 healthy volunteers.Methods:Five drug conditions were used, each condition consisting of an injection (either drug or placebo) with a 20‐min infusion and a 160‐min recovery period. The conditions were placebo (saline), thiopental targeted to three effect‐site concentrations, and fentanyl (1.4 μg/kg), as a positive control to verify test sensitivity to analgesic drugs. The three thiopental concentrations were modeled (STANPUMP) to achieve effect‐site concentrations of 5, 7.5, and 10 μg/ml using a bolus and a three‐step continuous infusion. Five minutes into the infusion period and 115 min after the infusion period was terminated, subjects immersed their forearms in ice cold water for 3 min while pain and behavioral assessments were recorded.Results:Thiopental at the highest dose produced a significant reduction (P< 0.05) in self‐reported pain intensity both at 5 min into the infusion period and at 115 min after termination of the infusion. Fentanyl reduced pain intensity during the first immersion only. Thiopental changed subjects' moods and psychomotor performance in a dose‐related fashion.Conclusions:Our laboratory results do not support the long‐held belief that barbiturates are “antanalgesic” or hyperalgesic, at least for cold‐pressor‐induced pain.