bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous non‐invasive monitoring of energy expenditure, oxygen consumption and alveolar ventilation during controlled ventilation: validation in an oxygen consuming lung model
Authors: Holk K. , Einarsson S. G. , Svensson K. L. , Bengtson J. P. , Stenqvist O. 
Published: January 2009

Background: We have developed a combined indirect calorimetric and breath‐by‐breath capnographic device (GEM) for respiratory monitoring: oxygen consumption (V̇O2), carbon dioxide excretion (V̇CO2), respiratory quotient (RQ), energy expenditure (EE), alveolar ventilation (V̇A) and dead space/total ventilation (VD/VT).Methods: The device was tested in a lung model in which V̇O2 was achieved by combustion of hydrogen. V̇CO2 was achieved by delivering CO2 into the single alveolus combustion chamber. V̇O2, V̇CO2, compliance, and anatomical dead space could be varied independently.Results: Measured V̇O2 was 101±3% (SD) of set value at a F1O2<0.6 and 101±7% at a F1O2>0.6 during 15 hours of testing. The corresponding V̇CO2 values were 99±2% and 102±7%. The GEM could with good accuracy measure accumulated energy expenditure (EE) during simulated unstable patient conditions up to a F1O2 of 0.8. At F1O2 above 0.8 V̇CO2 and V̇O2 could be estimated using a default RQ value of 0.85. On‐line estimated V̇A and VD/VT values could be obtained at any F1O2 up to 1.0. In a test sequence with stable V̇O2 and V̇CO2 the GEM adequately followed changes in V̇A, induced by changes in anatomical dead space, breathing frequency and compliance.Conclusion: The overall performance of the device is satisfactory and well comparable with any equipment tested. It allows near‐continuous non‐invasive monitoring of EE, V̇O2, V̇CO2, V̇A, VD/VT in ventilated, critically ill patients, providing a rationale for ventilator settings and nutritional support.
Beneficial effects of pre‐treatment with vitamin A on cardiac and pulmonary functions in endotoxaemic pigs
Authors: Eriksson M. , Lundkvist K. , Drott P. , Saldeen T. , Eriksson Ö. 
Published: January 2009

Background: Septic shock is associated with high mortality despite the development of new antibiotics. Since Vitamin A has an immunomodulating ability and is able to lower the concentrations of endotoxin and some cytokines, we decided to study whether supplementation with vitamin A may have a beneficial effect in experimental endotoxaemia.Methods: A porcine model was used, in which normally bred (i.e., not vitamin A depleted) animals were anaesthetised, monitored and injected intramuscularly with a non‐toxic dose of vitamin A (230IU·kg‐1) (n=9) or the corresponding volume of vehicle (n=9) 1 hour before an infusion of purified E. coli endotoxin was given in a dose of 10 μg· kg‐1·h‐1 over 6 hours. Another 3 pigs also injected with vitamin A, but not endotoxin, served as controls.Results: Vitamin A‐ and endotoxin‐injected pigs were significantly less affected in several circulatory and respiratory variables as compared to vehicle‐ and endotoxin‐injected animals (e.g., blood pressure; heart rate; cardiac index; pulmonary capillary wedge pressure; left and right ventricular stroke work indices; pH; base excess; oxygen delivery; and oxygen extraction). Vitamin A did not per se significantly affect these variables. Hb increased significantly in the vehicle group, indicating a more pronounced capillary permeability. Urinary output or fluid supply did not differ between the groups. Myocardial production of metabolites of prostacyclin or thromboxane A2 did not differ between the groups.Conclusion: Pre‐treatment with vitamin A had a beneficial effect on several variables, such as oxygen delivery and metabolic acidosis in the endotoxaemic pig. Improvement of these variables is associated with increased survival in septic shock and may indicate reduced tissue hypoxia. Thus, vitamin A may turn out to be useful as a prophylactic agent in conditions where septic shock is apt to occur.
Ventilatory effects of laparoscopic cholecystectomy
Authors: Bures E. , Fusciardi J. , Lanquetot H. , Dhoste K. , Richer J.‐P. , Lacoste L. 
Published: January 2009

Background: During laparoscopic cholecystectomy the arterial‐end‐tidal CO2 gradient (Fa‐ETCO2) has been variously shown to be unchanged, increased, decreased or even negative. The goal of this study was to evaluate Fa‐ETCO2, and to determine the proper contribution of V̇ECO2 and V̇A in regard to the increase of FETCO2.Methods: Ventilatory patterns were studied in 15 ASA 1–2 patients (mean age±SD: 48.5±15.0) undergoing laparoscopic cholecystectomy, with intraperitoneal CO2 insufflation limited to 12 mmHg, 15° head‐up position, during general anaesthesia and controlled ventilation. The following were studied before, during, and after the pneumoperitoneum: FaCO2, FETCO2, nasopharyngeal temperature; dead space ventilation, and expired volumes using the Single Breath Test for CO2. V̇A was calculated as the alveolar fraction of expired VT multiplied by the respiratory frequency.Results: During pneumoperitoneum it is shown that: 1) Fa‐ETCO2 either decreases and becomes even negative (n=8) (P<0.01), or stays unchanged (n=7), but never elevates; 2) V̇ECO2 increases (peak value: + 22.6%) (P<0.01); 3) V̇A is unchanged, and 4) dead space ventilation, determined in 7 patients, remains unchanged.Conclusion: We conclude that only exogenous CO2 loading, and not V̇A, can explain such increase in FETCO2 and FaCO:, in cases of limited CO2 insufflating pressure in ASA 1–2 patients.
Conditions to optimise the reversal action of neostigmine upon a vecuronium‐induced neuromuscular block
Authors: Baurain M. J. , Dernovoi B. S. , D'Hollander A. A. , Hennart D. A. , Cantraine F. R. 
Published: January 2009

Background: Since neostigmine was introduced for reversal of neuromuscular block, there has been controversy about the optimum dose for antagonizing neuromuscular block. The purpose of this study was to characterise recovery of neuromuscular transmission following a vecuronium‐induced block 15 min after neostigmine administration using different stimulation patterns, and to determine the effects of different doses of neostigmine given at various pre‐reversal twitch heights.Methods: Adductor pollicis (AP) mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation, was recorded 15 min after 20, 40 and 80 μg/kg neostigmine, given to reverse a vecuronium‐induced block at 10, 25 and 50% pre‐reversal twitch height (TH). Fifty four ASA class I and II anaesthetised (methohexital, fentanyl, N2O/O2) young adult patients were studied and randomly allocated into 9 groups of 6 patients each.Results: In contrast to twitch height (TH) and residual force after 50 Hz, 5 s tetanic stimulation (RF50Hz), the greater sensitivity of train‐of‐four (TOF) ratio and residual force after 100 Hz, 5 s tetanic stimulation (RF100Hz) points out the best reversal conditions (prereversal TH and the optimal neostigmine dose) (P<0.001, two‐way analysis of variance). The highest reversal scores (about 0.9 TOF ratio and RF100Hz) were obtained when 40 μg/ kg of neostigmine was given at 25 and 50% TH. A 0.9 TOF ratio was also observed when 40 μg/kg of neostigmine was given at 10% TH, but, under these conditions, RF100Hz was only 0.6 (P<0.05, Duncan test).Conclusion: To optimise the reversal action of neostigmine in order to obtain the highest neuromuscular transmission recovery (0.9 TOF ratio and RF100Hz) during a vecuronium‐induced neuromuscular block, the 40 μg/kg dose has to be given at 25 to 50% recovery of TH.
Results of in vitro contracture testing of both parents of malignant hyperthermia susceptible probands
Authors: Islander G. , Bendixen D. , Ranklev‐Twetman E. , ØRding H. 
Published: January 2009

Background: Malignant Hyperthermia (MH) is regarded as a dominantly inherited condition. Therefore, most investigators do not test the second parent if the first parent is found to be MH susceptible (MHS). The purpose of this study was to validate this policy.Methods: In vitro contracture tests (IVCT) have been performed in both parents of 101 MH susceptible probands. Diagnoses were made according to the European MH group protocol and include MH susceptible (MHS), MH equivocal (MHE) and MH negative (MHN). Our control material consists of 60 patients without any personal or family history of MH.Results: Thirty‐seven pairs of parents were MHS‐MHN, 20 were MHE‐MHN, 6 were MHS‐MHS, 20 were MHS‐MHE, 6 were MHE‐MHE, and 12 were MHN‐MHN. The frequency of MHE was greater in the parents than in the controls (26% versus 8%. P < 0.05). Several possible explanations exist: the IVCT produces false positive and/or false negative results; the MH genes may be more frequent in the population than previously expected; MH susceptibility may have more than one mode of inheritance; the mutation rate may not be negligible. Our test results in controls and fulminants point at a combination of these explanations.Conclusions: We conclude that both parents should be tested whenever possible. For genetic research it is important that labelling any parent “presumed normal” may give misleading results.
No additional analgesic effect of intra‐articular morphine or bupivacaine compared with placebo after elective knee arthroscopy
Authors: Aasbø V. , Ræeder J. C. , Grøgaard B. , Røise O. 
Published: January 2009

Background: Intra‐articular pain prophylaxis is a controversial measure, adding costs although the benefits are still disputed. We wanted to evaluate the effects of intra‐articular opioid or local anaesthesia or a combination of the two on postoperative analgesia and analgesic consumption after elective knee arthroscopy.Methods: 107 patients with little or no preoperative pain and a minor surgical procedure were studied in a prospective, randomized double‐blind design. The patients received midazolam 0.03 mg/kg intravenously before induction of general anaesthesia with fentanyl 1–2 μg/kg and propofol 2.0 mg/kg intravenously. Anaesthesia was maintained by a total intravenous technique with propofol infusion supplemented with alfentanil 10 μg/kg when needed. The patients breathed oxygen/air through a laryngeal mask. By the end of the surgery they received 20 ml of test drug into the knee‐joint: Group I (BM): 20 ml of bupivacaine 2.5 mg/ml with 3 mg of morphine; Group II (B): 20 ml of bupivacaine 2.5 mg/ml; Group III (M): 20 ml isotonic saline with 3 mg morphine; Group IV (P): 20 ml of isotonic saline (placebo).Results: There were no significant differences between the groups in: time to first analgesic administered, analgesic consumption during the pre‐or post‐discharge period, nausea, somnolence, side‐effects or postoperative pain perception during the first week.Conclusions: Intra‐articular administration of morphine or bupivacaine is not indicated after elective knee‐arthroscopy in patients with minor pre‐operative pain and a small surgical trauma.
Postoperative pain relief by topical lidocaine in the surgical wound of hysterectomized patients
Authors: Sinclair R. , Westlander G. , Cassuto J. , Hedner T. 
Published: January 2009

Background: To improve postoperative analgesia, local anesthetics have been administered perioperatively as infiltration or as aerosol in the surgical area. A previous study showed good analgesic effects by topical lidocaine in the wound in minor extraabdominal surgery (herniorraphy), while the same treatment in minor lower laparotomies did not improve postoperative analgesia. The present study investigated the effect of topical wound anesthesia using lidocaine aerosol on postoperative pain following major lower abdominal surgery.Methods: Postoperative pain and analgesic requirements were studied in a double‐blind randomized trial including 30 hysterectomized patients. Patients were randomized to receive single wound treatment either with lidocaine aerosol 500 mg (100 mg/ml; Xylocain® aerosol, ASTRA, Sweden) (n=15) or placebo aerosol (n=15). Postoperative pain was evaluated by visual analogue scale (VAS). Requirements of opiate analgesics (buprenorphine) after surgery were monitored.Results: Lidocaine aerosol induced a significantly (P<0.001) better analgesia at rest (VAS) and a significant (P<0.001) reduction in postoperative requirements of buprenorphine during the first 24 hours after surgery compared to placebo aerosol. Differences between the groups in pain scores (VAS) and buprenorphine requirements during the second postoperative day were not significant. Mean pain scores upon mobilization 24 h after surgery were significantly lower in the group receiving lidocaine aerosol (P<0.05). The plasma lidocaine concentration 4 h after the administration of lidocaine was well below toxic level and plasma lidocaine was detectable 48 h postoperatively. No drug‐related side effects were reported.Conclsuion: A single dose of lidocaine aerosol topically administered in the surgical wound of hysterectomy patients improved analgesia during the first postoperative day with minimal risk of side effects.
Methylprednisolone shortens the effects of bupivacaine on sensory nerve fibersin vivo
Authors: Johansson A. 
Published: January 2009

Perineural administration of corticosteroids is frequently applied in the treatment of a variety of chronic pain conditions. Methylprednisolone selectively inhibits the transmission of nerve impulses in C‐fibers whereas A‐fiber activity is unaffected.In the present study the effect of a mixture of 0.05 ml of methyprednisolone (40 mg/ml) and 0.05 ml of bupivacaine (5 mg/ml) was compared to that of 0.05 ml bupivacaine (5 mg/ml) using a plantar nerve block model in the rat. The conduction of impulses in electrically stimulated A‐fibers of the plantar nerve was monitored by a bipolar volley recording from the sciatic nerve. Impulse conduction in electrically stimulated C‐fibers was studied through a C‐fiber evoked segmental flexion reflex.The function of both the A‐fibers and the C‐fibers exposed to the methylprednisolone‐bupivacaine mixture showed a less profound block with signs of earlier recovery than those exposed to plain bupivacaine. The A‐fibers recovered somewhat faster than the C‐fibers.It is postulated that methylprednisolone adjuvant to bupivacaine affects the intra‐axonal uptake of bupivacaine in C‐fibers but not in A‐fibers by some unknown mechanism. The effect seems to be longer lasting in C‐fibers than in A‐fibers.
Patient‐controlled analgesia with morphine and droperidol following caesarean section under spinal anaesthesia
Authors: Russell D. , Duncan L. A. , Frame W. T. , Higgins S. P. J. , Asbury A. J. , Millar K. 
Published: January 2009

Background: The addition of droperidol to morphine for patient‐controlled analgesia reduces the incidence of nausea and vomiting, but may result in unwanted side effects.Method: We studied 40 women randomised to receive morphine sulphate with or without added droperidol (10mg droperidol/60mg morphine) by patient‐controlled analgesia following elective caesarean section under spinal anaesthesia.Results: Median morphine demand in the 20h after surgery was 74mg with morphine alone, and 53mg with added droperidol, the median consumption of which was 8.8mg. The incidence of nausea was reduced from 80% to 38.8% (P<0.01), and that of emesis from 55% to 16.7% (P<0.05) by the addition of droperidol. Psychomotor function was significantly impaired to a similar degree in both groups and there was no significant difference in sedation scores or pain scores. Subjective drowsiness which resulted in withdrawal from the study occurred in two patients, both of whom were receiving droperidol, and though all patients who completed the study were satisfied with their analgesia overall, significantly more of those receiving unsupplemented morphine (11/19 compared with 4/18, P<0.05) described it as excellent.Conclusion: The addition of droperidol 10mg to morphine 60mg for PCA following caesarean section under spinal anaesthesia reduces the incidence of nausea and emesis, but may result in drowsiness, limiting the usefulness of the technique.
Subcutaneous blood flow in man during sleep with continuous epidural anaesthesia
Authors: Sindrup J. H. , Petersen L. J. , Kastrup J. , Wroblewski H. , Secher N. H. 
Published: January 2009

Background: Subcutaneous blood flow increases during sleep and we evaluated if this increase is affected by epidural anaesthesia.Methods: Lower leg subcutaneous blood flow was determined by 133Xenon clearance in ten subjects during continuous epidural anaesthesia at L2‐L3 including eight hours of sleep, while the upper abdominal subcutaneous blood flow served as control.Results: Epidural anaesthesia to the level of the umbilicus was followed by an increase in the lower leg subcutaneous blood flow from 3.4 (1.8‐6.3) to 7.8 (3.6–16.9) ml min‐1 100 g‐1 (median and range; P<0.001) and returned to 3.5 (2.4–7.6) ml min‐1 100 g‐1 after 88 (45–123) min. In contrast, until the period of sleep the upper abdominal region blood flow remained at 5.2 (3.2–6.4) ml min‐1 100 g‐1. During sleep, lower leg subcutaneous blood flow did not change significantly, but the upper abdominal flow increased to 6.2 (5.2–7.2) ml min‐1 100 g‐1 after 34 (29–70) min (P<0.01), and it remained elevated for 125 (100–164) min.Conclusions: The results indicate that although epidural anaesthesia induced only a temporary increase in lower leg subcutaneous blood flow, it hindered the rise in subcutaneous blood flow normally manifest during early sleep.
Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract
Authors: Spies C. D. , Nordmann A. , Brummer G. , Marks C. , Conrad C. , Berger G. , Runkel N. , Neumann T. , Müller C. , Rommelspacher H. , Specht M. , Hannemann L. , Striebel H. W. , Schaffartzik W. 
Published: January 2009

Background: The prevalence of chronic alcohol misuse in patients with oral, pharyngeal, laryngeal or esophageal carcinomas exceeds 60%. No data is available, to our knowledge, on the morbidity and mortality of chronic alcoholics in surgical intensive care units (ICU) following tumor resection. We investigated whether the subsequent ICU stay in chronic alcoholics following tumor resection was prolonged and whether the incidence of pneumonia and sepsis was increased.Methods: 213 patients with carcinomas of the upper digestive tract were evaluated regarding their drinking habits. Chronic alcoholics met either the DSM‐III‐R criteria for alcohol abuse or dependence. Conventional laboratory markers and serum carbohydrate‐deficient transferrin were determined preoperatively. Major intercurrent complications during ICU stay such as an alcohol withdrawal syndrome, pneumonia and sepsis as well as the frequency of death were documented.Results: Patients did not differ significantly between groups regarding age or APACHE score on admission to the ICU. 121 patients were diagnosed as being chronic alcoholics, 39 as being social drinkers and 61 as being non‐alcoholics. In chronic alcoholics the frequency of death was significantly increased. Due to the increased incidence of pneumonia and sepsis the ICU stay was significantly prolonged in chronic alcoholics by approximately 8 days.Conclusions: The increased mortality and morbidity rate demonstrates that chronic alcoholics undergoing major tumor surgery have to be considered as high‐risk patients during their postoperative ICU stay. Further studies are required with respect to the immuno‐competence of chronic alcoholics and the prevention of alcohol withdrawal syndrome, pneumonia and sepsis in these patients.
Isovolaemic haemodilution with hydroxyethylstarch has no effect on somatosensory evoked potentials in healthy volunteers
Authors: Detsch O. , Heesen M. , Mühling J. , Thiel A. , Bachmann‐Mennenga B. , Hempelmann G. 
Published: January 2009

Background: An animal study in anaesthetized baboons demonstrated that somatosensory evoked potentials (SSEP) can be affected by extreme haemodilution. This might lead to misinterpretation and reduce the value of intraoperative SSEP monitoring when colloids are administered. In the present study the effect of haemodilution (HD) and subsequent retransfusion of autologous blood on SSEP was determined in healthy non‐premedicated volunteers.Method: Acute isovolaemic HD served as a model for blood loss immediately replaced with colloids. In 12 volunteers, 20 ml/kg·bw blood was withdrawn within 30 minutes and simultaneously replaced with 6% hydroxyethylstarch (HES). 30 minutes later, the autologous blood was retransfused within 30 minutes. Recording sites and parameters were: 1. Median nerve SSEP: cortical, cervical (C2), Erb's point; 2. Posterior tibial nerve SSEP: cortical, cervical (C2), lumbar (L1). In addition to SSEP latency and amplitude, median and tibial nerve central conduction times, spinal conduction time and nerve conduction velocity were determined. Serial SSEP measurements were made before, during and after HD and retransfusion every 15 minutes.Results: HD consisting of a withdrawal volume of 1550±155 ml (mean±SD) induced a decrease in haematocrit from 42.0±3.1% to 29.6±1.6% (P<0.001). Following retransfusion, haematocrit increased to 35.0±2.1% (P<0.001). Neither HD nor retransfusion influenced SSEP parameters.Conclusion: We conclude from our data that the therapy of blood loss up to 30% of estimated blood volume with HES does not affect SSEP monitoring as long as normovolaemia is maintained.
Renal function during intravenous infusion of urological irrigating fluids in the sheep
Authors: Hahn R. G. , Nilsson A. , Hjelmqvist H. , Zhang W. , Rundgren M. 
Published: January 2009

Background: Oliguria or anuria is an important sign of the transurethral resection syndrome, but the mechanism is not clear.Methods: We gave an intravenous infusion of 40 ml/kg of glycine 1.5%, sorbitol 2%‐mannitol 1%, and isotonic saline (control) in 6 conscious ewes and studied if irrigating fluids cause acute disturbances of kidney function.Results: Both the electrolyte‐free solutions induced an increase in urine flow and persistent hypo‐osmolality. The renal clearances of p‐aminohippuric acid and inulin as well as the unilateral renal blood flow, which was measured via ultrasonic flow probes, increased in response to infusion of glycine but not to sorbitol‐mannitol. After the infusions, the renal clearances decreased transiently to below baseline levels.Hypertonic saline was given after half of the infusions of electrolyte‐free irrigating fluid. This treatment redistributed water from the cells to the extracellular fluid, but had no effect on renal function.Conclusions: We conclude that 2500 ml of electrolyte‐free irrigating fluid had no detrimental effects on kidney function in sheep. The changes we observed were essentially the same as after infusion of isotonic saline.