bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inclusion of pethidine in lidocaine for infiltration improves analgesia following tonsillectomy in children
Authors: ELHAKIM M. , SALAM A. Y. ABDUL , EID A. , KASCHEF N. , MOSTAFA B. E. 
Published: January 2009

Background:Previous work has demonstrated that pethidine exerts local anaesthetic effects on peripheral nervesin vivo.We examined the effects of infiltration anaesthesia by a combination of pethidine and lidocaine on post‐tonsillectomy pain and restlessness in children.Methods:Eighty children were randomly allocated to receive peritonsillar infiltration postoperatively with 3 ml of lidocaine 2% (1.5 ml on each side) combined with either 0.1 ml pethidine, 10 mg · ml‐1, (pethidine group) or 0.1 ml normal saline (control group). Pain and behaviour were assessed at 1, 3, 6 and 12 h postoperatively and on the following morning by the patients and by a nurse blinded to previous treatment.Results:Patients in the pethidine group had lower pain scores than those in the control group at rest as well as swallowing during the whole observation period (P< 0.05). Paracetamol was given to 34/40 children in the control group and to 6/40 children in the pethidine group. The corresponding figures for pethidine administration were 6/40 and 0/40, respectively. Patients in the pethidine group displayed a more rapid return to calm wakefulness than those in the control group (P<0.01).Conclusions:Inclusion of a low dose of pethidine in lidocaine for tonsillar infiltration improves pain relief after tonsillectomy in children.
Hemodilution significantly decreases tolerance to isoflurane‐induced cardiovascular depression
Authors: SCHOU H. , PEREZ DE V. , LARSSON A. , ROSCHER R. , KONGSTAD L. , WERNER O. 
Published: January 2009

Background:Hemodilution is used to reduce the need for allogenic blood transfusion. The aim of this study was to evaluate to what extent acute extreme normovolemic hemodilution affects the circulatory response to isoflurane.Methods:Ten midazolam‐fentanyl‐pancuronium anesthetized pigs were exposed to isoflurane at end‐tidal concentrations of 0,0.5,1.0,1.5 and 2%, before and after extreme normovolemic hemodilution (hematocrit 33±3% and 11±1%, respectively). Systemic and myocardial hemodynamics and oxygen delivery and consumption were measured.Results:At zero end‐tidal isoflurane concentration, hemodilution caused an increase in cardiac output (from 157±12 to 227±39 ml kg min‐1, P <0.01) a decrease in systemic vascular resistance (from 39±7 to 18±5 mmHg · L‐1 · min‐1, P <0.01) a decrease in mean arterial blood pressure (MAP) (from 130±13 to 91±13 mmHg, P <0.01) and a decrease in systemic oxygen delivery (from 23.1±2.7 to 11.8±1.7 ml · kg‐1 min‐1, P <0.01). When the end‐tidal isoflurane concentration was increased from 0 to 2% after hemodilution, cardiac output decreased by 86±37 ml · kg‐1 · min‐1, as compared with 36±20 ml · kg‐1 · min‐1 (P <0.01) before hemodilution. Likewise, systemic vascular resistance decreased with increasing isoflurane concentrations; at 2%, the decrease was 7±4 mmHg·L‐1· min‐1 after hemodilution and 18±5 mmHg.L‐1 mid before hemodilution (P < 0.01). At an end‐tidal isoflurane concentration of 2%, MAP had decreased to 43±6 mmHg after hemodilution, and to 61±15 mmHg before hemodilution (kO.01). After hemodilution, isoflurane concentrations above 1% decreased systemic oxygen delivery enough to cause delivery‐dependent oxygen consumption and hyperlactemia; and at 2% isoflurane, myocardial blood flow became insufficient, as indicated by myocardial lactate production.Conclusions:isoflurane‐induced cardiovascular depression had adverse effects on cardiac output and oxygen delivery during extreme hemodilution because: 1) The vasodilatory effect of isoflurane was insufficient to compensate for the myocardial depression, and also contributed to a critically low arterial blood pressure; 2) A decrease in cardiac output produced delivery‐dependent oxygen consumption and hyperlactemia; and 3) A decrease in myocardial blood flow caused myocardial ischemia which may have exacerbated the myocardial depression.
Differences in hormonal responses to preoperative emotional stress between preschool and school children
Authors: AONO J. , UEDA W. , KATAOKA Y. , MANABE M. 
Published: January 2009

Background:The behavior of children under emotional stress differs according to whether they are of preschool or school age.Methods:To examine the effect of age on hormonal responses to preoperative emotional stress, we measured the concentrations of catecholamines (adrenaline and noradrenaline) and cortisol in 56 healthy boys before surgery.Results:Among preschool boys (3–5 years old), those showing anxious behavior showed significantly higher cortisol, adrenaline, and noradrenaline concentrations in the blood circulation than those not showing such behavior (P <0.0001, P <0.0001 and P <0.005, respectively). However, among the schoolboys (6–11 years old), anxiety was associated only with the cortisol concentration (P <0.01)Conclusions: Hormonal responses to preoperative emotional stress in preschool boys differ from those in schoolboys.
Low cardiac output abolishes cardiovascular responses to infra‐renal aortic cross‐clamping in the pig
Authors: SEEMAN‐LODDINC H. , BIBER B. , PONTÉN J. , SUNDEMAN H. , WINSÖ O. 
Published: January 2009

Background:Previous data suggest that preoperative myo‐cardial dysfunction is associated with an altered cardiac response to infra‐renal aortic cross‐clamping (AXC). This study was designed to further explore how acute reductions in stroke volume and cardiac output influence the systemic, preportal and renal circulatory responses to AXC.Methods:In chloralose‐anesthetized normoventilated pigs, graded increases in pericardial pressure (PPERICARD) were obtained by local infusions of dextran. Measurements included cardiac output (CO, thermodilution), mean blood pressure proximal to the aortic clamping site (MAPROX) and ultrasonic flowmetry for portal (QPORT) and renal (QREN) blood flows. In all animals, measurements were made a) prior to AXC, b) at the end of a 5 min AXC period and, c) 5 min following dec‐lamping. These recordings were repeated during control (PPERICARD 0 cmH2O) and during stages with increased PPERICARD (4 and 8 mH2O, respectively).Results:Pericardial infusions of dextran produced hemody‐namic responses that in magnitude were proportional to PPERICARD levels. Stroke volume, CO and mean arterial pressure decreased, while systemic vascular resistance (SVR) increased.Conclusions:AXC‐induced systemic, preportal and renal circulatory responses are inhibited during a condition of acutely lowered cardiac output.
Fibreoptic laryngotracheoscopy via the laryngeal mask airway in children
Authors: HOLMSTRÖM A. , ÅKESON J. 
Published: January 2009

Background:Fibreoptic laryngotracheoscopy via the laryngeal mask airway ‐ previously reported in adults but not in children ‐ gives a better endoscopic view of the upper airway than does endoscopy via an endotracheal tube.Results:The laryngeal mask was found to enable laryngotracheoscopy with a flexible 5.0‐mm fibreoptic endoscope with no technical difficulties. Spontaneous ventilation could be readily preserved throughout the endoscopic procedure.Conclusions:In children anaesthetized with halothane, flexible fibreoptic laryngotracheoscopy via a laryngeal mask is a useful method ‐ offering technical advantages not achieved otherwise ‐ provided that generally approved restrictions to the use of a laryngeal mask airway are taken into account.
The influence of the duration of isoflurane anaesthesia on neuromuscular effects of mivacurium
Authors: JALKANEN L. , MERETOJA O. A. 
Published: January 2009

Background:The pharmacodynamic profile of muscle relax‐ants is usually changed by volatile anaesthetics. These changes seem to be time‐dependent, even though few data are available to substantiate this.Methods:We studied neuromuscular effects of a single dose of mivacurium (0.2 mg·kg‐1) during short and intermediate duration of isoflurane anaesthesia. Forty‐five children 1–10 years of age were randomized to receive 1.5% end‐tidal concentration of isoflurane in N2O/O2 for 10 or 30 min (groups Iso‐10 and Iso‐30, respectively) or to receive nitrous oxide in oxygen for 10 min (Group N2O) before 0.2 mg · kg‐1 of mivacurium was given. Neuromuscular response was recorded by adductor pollicis electromyogram.Results:The onset time of mivacurium was shorter in Group Iso‐30, 1.7 (1.0–2.3) min than in Group Iso‐10, 2.3 (1.7‐3.3) rnin or Group N2O, 2.3 (1.7‐3.3) min (median with 10–90% percen‐tiles) (P <0.05). In Group Iso‐30 the recovery time of the first EMG response was significantly longer than in groups Iso‐10 and N2O (P <0.0001). Groups Iso‐10 and N2O did not differ from each other.Conclusions:Our results indicate that the duration of a constant concentration of isoflurane anaesthesia influences significantly the pharmacodynamics of mivacurium. The duration of a volatile anaesthesia is critical when potentiation of NMB is evaluated or compared in neuromuscular studies.
Paediatric cardiac arrest and resuscitation provided by physician‐staffed emergency care units
Authors: SUOMINEN P. , KORPELA R. , KUISMA M. , SILFVAST T. , OLKKOLA K. T. 
Published: January 2009

Background:Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We wanted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergency care units.Methods:We analysed retrospectively the files of 100 prehospital cardiac arrest patients from Southern Finland during a 10‐year study period. The patients were less than 16 years of age.Results:Fifty patients were declared dead on the scene (DOS) without attempted resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the most common cause of arrest in the DOS patients (68%) as well as in those receiving CPR (36%). Asystole was the initial cardiac rhythm in 70% of the patients in whom CPR was attempted. Resuscitation was successful in 13 patients, 8 of whom were ultimately discharged. Six of the patients survived with mild or no disability and 4 of them had near‐drowning aetiology. In multivariate analysis, the short duration of CPR (≤15 min) was the only factor significantly associated with better survival.Conclusions: Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference between physician‐ and paramedic‐staffed emergency care units is the ability of physicians to refrain from resuscitation already on the scene when prognosis is poor.
Nitric oxide administration after the ventilator: evaluation of mixing conditions
Authors: WESTFELT U. NATHORST , LUNDIN S. , STENQVIST O. 
Published: January 2009

Background:Because of the potential toxicity of nitric oxide (NO) and its oxidising product nitrogen dioxide (NO2), any system for the delivery of inhaled NO must aim at stable and predictable levels of NO and as low concentrations as possible of NO2.Methods:In a laboratory set‐up, we have evaluated mixing conditions in a system where NO is added after the ventilator with continuous flow. Mixing was studied by using carbon dioxide (CO2) as a tracer gas since capnography has a short response time (360 ms) in comparison with measurements of NO with electrochemical fuel cells (response time of 18s). CO2 (in volumes corresponding to an ideal mixture of 1,3 and 6%) was fed, after the ventilator, either into plain breathing tubing, into one or two soda lime absorbers, or into an empty and a soda lime‐filled canister, at different ventilatory rates and different I: E ratios. Samples were drawn from the inspiratory limb close to the Y‐piece. NO was added in the same way and in the same volume as the highest concentration of CO2.Results:CO2 added to plain tubing resulted in peak levels up to five times the set levels, while addition to a mixing box with an empty and a soda lime‐filled canister resulted in even mixing with gas concentrations close to the ideal. When NO was fed into plain tubing, low levels were measured at the Y‐piece, indicating poor mixing. Gas supply to a mixing chamber resulted in even concentrations.Conclusions: Even and predictable levels of NO can be obtained with continuous flow of NO to the inspiratory limb, after the ventilator, if a mixing chamber is used. To obtain adequate mixing, the volume of the mixing box should be greater than the tidal volume.
The detection of carbon dioxide embolism during laparoscopy in pigs: a comparison of transesophageal Doppler and end‐tidal carbon dioxide monitoring
Authors: MANN C. , BOCCARA G. , FABRE J. M. , GREW V. , COLSON P. 
Published: January 2009

Background:The aim of the study was to compare the value of transesophageal Doppler and end‐tidal carbon dioxide monitoring to detect venous carbon dioxide embolism in pigs during laparoscopic cholecystectomy.Method:Ten pigs were anesthetized under constant ventilation, and instrumented for laparoscopic cholecystectomy. CO2 pneumoperitoneum was performed at 15 mmHg and then, successive increased intravenous gas boluses of 0.1 to 4 ml/ kg injectedthrough the femoral vein using a 55‐mm long catheter. The responses indicative of embolism were defined as: 1) a change in Doppler tone placed facing the junction of the right atrium and inferior vena cava; 2)Results:Doppler was more sensitive in detecting 0.1, 0.2 and 0.4 ml/mg of CO2 embolism than end‐tidal CO2 (P <0.05). Over 0.4 ml/mg no differences in sensitivity were found but the Doppler signal modifications occurred earlier than the changes in end‐tidal CO2. Moreover, these changes always consisted of a reduction of the value.Conclusions: During laparoscopic cholecystectomy in pigs, transesophageal Doppler was a highly sensitive monitor which provided an earlier detection of CO2 embolism and at lower doses than end‐tidal CO2 monitoring.
Pulmonary clearance of 99m Tc‐DTPA in experimental surfactant dysfunction treated with surfactant instillation
Authors: NILSSON K. , JOHN J. , LACHMANN B. , ROBERTSON B. , WOLLMER P. 
Published: January 2009

Background: Breakdown of the alveolo‐capillary barrier is a characteristic feature of respiratory distress syndrome. Restoration of alveolo‐capillary barrier function may be an important aspect of surfactant raplacement therapy. We examined the effect of surfactant instillation on alveolo‐capillary barrier function in an experimental model of surfactant dysfunction by measuring pulmonary clearance of 99mTc‐DTPA.Methods: Nineteen rabbits were tracheotomized and mechanically ventilated. Surfactant dysfunction was induced by administration of a synthetic detergent in aerosol form. Detergent was given to 13 rabbits; seven rabbits were then treated with instillation of natural surfactant, whereas six rabbits received saline. Six rabbits were used as untreated controls. An aerosol of 99mTc‐DTPA was administered to all animals and the pulmonary clearance was measured with a gamma camera.Results: 99mTc‐DTPA cleared from the lungs with a half‐life of 71±22 min in the control animals, 21.4±7.4 min in the sur factant‐treated animals and 5.8±1.5 min in the saline‐treated animals. The difference in half‐life between groups was highly significant (P <0.001). There was no change in arterial oxygen‐ation or compliance in controls or in animals treated with saline. In animals treated with surfactant, a small transient reduction in arterial oxygen tension and a more long‐standing reduction in compliance were observed.Conclusions: Surfactant treatment thus significantly attenuated the effect of detergent treatment but did not restore alveolo‐capillary transfer of 99mTc‐DTPAto normal.
The effect of cortisol suppression on interleukin‐6 and white blood cell responses to surgery
Authors: JAMESON P. , DESBOROUGH J. P. , BRYANT A. E. , HALL G. M. 
Published: January 2009

Background:The endocrine and immune changes associated with surgery are well documented, but the interaction between them has not been fully evaluated. Cortisol production during surgery can be suppressed by etomidate and we have used this to investigate the relationshp between the cortisol response and immune changes in the perioperative period.Methods: We have measured the cortisol, interleukin‐6 and white cell responses to elective abdominal hysterectomy in 8 healthy female patients, who received etomidate 0.3 mg kg‐1 for induction of anaesthesia. A control group of 8 subjects received thiopentone. Both groups of patients received vecuro‐nium and fentanyl 2 yg kg‐1 and anaesthesia was maintained with nitrous oxide in oxygen and isoflurane 0.5‐1.0%. Venous blood samples were collected before and during surgery and up to 24 h in the postoperative period.Results: Serum interleukin‐6 values were significantly greater at 6 and 12 h (P <0.05) in those patients who received etomidate. Inhibition of the serum cortisol response to surgery in the etomidate group was also associated with less marked lymphopenia at 4 h (P <0.05). There was no significant difference in neutrophil granulocyte counts between the two groups.Conclusions: In conclusion, endogenous corticosteroids modulate the interleukin‐6 response to surgery.
Pharmacokinetic comparison of intravenous and intranasal administration of oxycodone
Authors: TAKALA A. , KAASALAINEN V. , SEPPÄLÄ T. , KALSO E. , OLKKOLA K. T. 
Published: January 2009

Background:For patients with chronic pain, treatment with oral analgesics is considered most convenient and feasible. Sometimes, however, the oral route cannot be used because of difficulties with swallowing, nausea, vomiting and gastrointestinal obstruction. To investigate the applicability of the nasal route for the administration of oxycodone, we studied the intravenous and intranasal pharmacokinetics of oxycodone in healthy volunteers.Methods: Ten healthy volunteers (3 males and 7 females) were given either an intravenous bolus of oxycodone hydro‐chloride 0.05mg/kg or nasal sprays of oxycodone hydrochlo‐ride 0.lmg/kg in a cross‐over manner. Blood was sampled and subjective effects and side effects were recorded for 10 h.Results: After intravenous administration of oxycodone, the plasma clearance of oxycodone was 0.83±0.33 l/min (mean ±SD) and the volume of distribution at steady‐state 2.02±1.47 1/kg and the terminal elimination half‐life 157±47 min. After intranasal administration, peak plasma concentration of oxycodone was 13±6ng/ ml and it was reached in the median time of 25 min. The intranasal bioavailability of oxycodone was 0.46±l.34. No clinically significant changes in blood pressure or heart rate were observed but all subjects experienced somnolence after both modes of administration.Conclusions: The results of this study show that oxycodone is rapidly and rather effectively absorbed from the nasal mucosa but the interindividual differences are large. The intranasal route may in some cases be an attractive alternative to oral or parenteral administration of opioid analgesics. However, because of large interindividual differences, it is prudent to titrate the dose of intranasal oxycodone individually.
Anesthetic quality during cesarean section following subarachnoid or epidural administration of bupivacaine with or without fentanyl
Authors: OLOFSSON Ch. , EKBLOM A. , SKÖLDEFORS E. , WÅGLUND B. , IRESTEDT L. 
Published: January 2009

Background: It is often assumed that subarachnoid administration of local anesthetics produces a more profound blockade than epidural anesthesia. Furthermore, the addition of fentanyl has been reported to increase preferentially intraoperative analgesia. In the present study we set out to study these two issues in a randomized and controlled study with respect to perceived pain and discomfort during surgery and postoperative pain.Methods: In the present study, 100 parturients subjected to elective cesarean section, 34 nullipara and 66 multipara, received one out of four combinations of the local anesthetic bupivacaine and the opioid fentanyl; group A ‐ bupivacaine 12.5 mg+10 μg fentanyl subarachnoidally, group B ‐ bupivacaine 12.5 mg+saline subarachnoidally, group C ‐ bupivacaine 100 mg+100 μg fentanyl epidurally, group D ‐ bupivacaine 100 mg+saline epidurally; N=25 in each group. Pain intensity and discomfort during surgery was assessed with a visual analogue scale (VAS). Postoperative pain intensity and need for analgesics postoperatively, ketobemidone, was registered for 24 h following surgery.Results: Intraoperative pain intensity and discomfort did not differ significantly between parturients in any of the four groups. Postoperative pain was significantly more intense in parturients receiving local anesthetics subarachnoidally as compared to the epidural groups during the first 6‐h period. This difference was also reflected in a significantly increased consumption of analgesics during this period. No significant differences between the groups were observed with regard to hemo‐dynamics (blood pressure), respiration (oxygen saturation) or other effects such as nausea or itching. All neonates had normal Apgar and neonatal adaptive capacity scores (NACS).Conclusion: We conclude that subarachnoidal (12.5 mg) and epidural (100 mg) injections with bupivacaine both produced adequate anesthetic quality in women undergoing elective cesarean section. The addition of fentanyl (10 μg subarachnoidally or 100 μg epidurally) did not significantly improve the quality of these already profound blockades.
Assessment of postoperative pain: impact of clinical experience and professional role
Authors: SJÖTRÖM B. , HALJAMÄE H. , DAHLGREN L.‐O. , LINDSTRÖM B. 
Published: January 2009

Background: Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings.Methods: Data collection was based on repeated interviews with nurses (n=30) and physicians (n=30) in connection with clinical pain assessments (n=180) including VASscoringResults: Commonly used strategies in the pain assessment were: ‐ how the patient looks, ‐ what the patient says, ‐ the manner of talking, and ‐ past experience of similar circumstances. The mean VAS‐score given by the patients (6.1±21.1) was significantly (P<0.001) higher than that rated by the staff members (4.9±21.2). Nurses as well as physicians overestimated low and underestimated high levels of pain indicated by the patients. The accuracy of the ratings by nurses, especially by more experienced ones (≤10 years in nursing), was found to be less precise than that of physicians. The pain assessment of these very experienced nurses was characterized by a systematic underestimation.Conclusions: The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients