bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aspiration in transtracheal jet ventilation
Authors: Jawan B. , Lee J. H. 
Published: January 2009

Background: Transtracheal jet ventilation (TJV) has been used successfully for managing difficult airways. However, there are some controversies regarding pulmonary aspiration. It has been shown that TJV caused no aspiration as long as the frequency of ventilation was kept higher than 60/ min. On the other hand, it has been demonstrated that manual translaryngeal jet ventilation at 20 breaths per minute also provided good protection from aspiration even with 30‐degree head‐up position. The purpose of this study was to reevaluate this controversy with observation of the trachea and the lungs together during TJV.Methods: Eight mongrel dogs were anesthetized, paralyzed and ventilated transtracheally with jet ventilator at frequencies variying from 600 to 10/min. The airway pressures below and above the jetting port were measured. The mouth of the dog was then filled with barium and chest x‐rays were taken 5 minutes after each different jetting frequency.Results: No tracheal or pulmonary aspiration was observed on chest x‐rays as long as the frequencies were set above 80 per minute. With frequencies of 60 per minute, barium was seen in the trachea but at a level above the jetting port. Slowing down the frequency to 10/min did not affect the level of barium.Conclusion: No aspiration could be visualized on chest x‐rays. The mechanism for preventing pulmonary aspiration is thought to be due to forceful continuous gas outflow through the larynx. The epiglottis seems to play no role in this mechanism. The limited tracheal aspiration was probably due to the existence of a negative pressure in the upper airway. Cessation of the TJV will cause a drop in this pressure gradient and results in pulmonary aspiration. It is recommended that the airway above the jetting port be totally cleansed prior to discontinuation of the tanstracheal jet ventilation.
Intravenous ketoprofen for pain relief after total hip or knee replacement
Authors: Kostamovaara P. A. , Laitinen J. O. , Nuutinen L. S. , Koivuranta M. K. 
Published: January 2009

Background: There are few studies in which ketoprofen, a propionic acid derivate NSAID, has been tested as an intravenous postoperative analgesic. The aim of this double‐blind, randomized, placebo‐controlled work was to study the tolerability and efficacy of intravenous ketoprofen in seventy‐six patients undergoing hip or knee total endoprothesis surgery using three different doses.Methods: The patients received either ketoprofen 50 mg, 100 mg or 150 mg, or placebo as an initial intravenous loading, followed by an infusion containing 50 mg, 100 mg or 150 mg or placebo, respectively, over the following eleven and a half hours. The consumption of fentanyl was recorded and the patients assessed their pain intensity on a 10‐cm visual analogue scale (VAS) at 0, 2, 4 and 12 hours. Possible side‐effects were recorded at the same intervals.Results: Patients receiving ketoprofen showed significantly lower total fentanyl consumption and significantly better pain relief at 12 hours was achieved by a 300 mg dose of ketoprofen than by placebo. Side‐effects were minimal, with no differences between the groups.Conclusion: A bolus of ketoprofen following continuous infusion of ketoprofen, coupled with a PCA‐system, was an effective and safe approach for the relief of postoperative pain.
Introducing epidural fentanyl for on‐ward pain relief after major surgery
Authors: Salomäki T. E. , Kokki H. , Turunen M. , Havukainen U. , Nuutinen L. S. 
Published: January 2009

Background: Epidural opioids have been recommended for analgesia after major surgery. In this report we describe how we introduced a low‐cost, on‐ward, nurse‐based acute pain service using epidural fentanyl after major surgery in the University Hospitals of Oulu and Kuopio.Methods: In order to evaluate the feasibility of epidural fentanyl infusion administered by ward nurses, we prospectively assessed pain and side effects during fentanyl infusion (median duration 41 h) after major surgery in 305 consecutive patients in Kuopio.Results: 92% of the patients on the ward who had received epidural fentanyl infusion at 31–54 μg h‐1 reported at most three episodes of severe pain (/ Numerical Rating Scale > 3/10) during the initial postoperative days, but there were some patients (8%) who reported several episodes (>3) of more severe pain (Numerical Rating Scale > 3). Three patients (0.9%) showed a diminished respiratory rate (<10/min), but only one of them (0.3%) was somnolent. One other patient (0.3%) was not arousable until the cessation of infusion. Nausea and pruritus were minor problems in our patients, but a majority needed a urinary catheter.Conclusion: With well‐trained nurses, careful monitoring and appropriate protocols, epidural fentanyl infusion proved to be a feasible method for pain relief after major surgery on a surgical ward.
Preoperative application of piroxicam gel compared to a local anaesthetic field block for postoperative analgesia
Authors: O'Hanlon J. J. , McCleane G. , Muldoon T. 
Published: January 2009

The non‐steroidal anti‐inflammatory drugs inhibit prostaglandin synthesis and hence have an analgesic action. Following topical administration, the drug is concentrated in the tissues and so can have a local analgesic effect. This study investigated the effect of the preoperative application of topical piroxicam on postoperative analgesic requirement compared to a placebo group and a conventional local anaesthetic field block.Forty‐two patients presenting for in‐patient inguinal hernia repair were randomly allocated on a double‐blind basis to have either piroxicam gel 15gm applied preoperatively, or an inguinal field block with 20ml of 0.375% bupivacaine following induction of anaesthesia, or no treatment. Postoperative Visual Analogue Scores for pain on moving in group P, I or C on admission and at 1 h, 2 h, and 4 h following surgery were: 2 vs 1 vs 6.5; 3 vs 3 vs 5; 3 v 2 vs 4.5; 3 vs 2 vs 5.0, respectively (P<0.005). Median(range) time to first analgesia was 25.4(15–70) min in group 1,30.3(10–49) min in group P; this was not significantly different from group C 21.5(7–70) min. Over the first 24 hours the postoperative morphine requirement was significantly less in the two treatment groups 30(20)mg in group I and 34(17)mg in group P and 71(15) in group C, P<0.0001. There were no apparent NSAID‐induced side‐effects, or effects on wound healing.The preoperative administration of piroxicam (15gm) topically compared favourably with a preoperative local anaesthetic field block with respect to VAS scores, time to first analgesia and total morphine consumption. And both treatment groups provided significantly superior analgesia than the control group.
Response to double‐burst appears before response to train‐of‐four stimulation during recovery from non‐depolarizing neuromuscular blockade
Authors: Kirkegaard‐Nielsen H. , Helbo‐Hansen H. S. , Severinsen I. K. , Lindholm P. , Bülow K. 
Published: January 2009

Background: Double‐burst stimulation (DBS) it a relatively new nerve stimulation mode introduced for improved manual detection of residual neuromuscular blockade. Previous studies have shown that DBS3,3 50/50 (3 stimuli at 50 Hz followed 0.75 seconds later by 3 stimuli at 50 Hz) can detect deeper degrees of neuromuscular blockade than train‐of‐four (TOF) stimulation.Aim: The aim of the present study was to examine if DBS3,3 80/40 (3 stimuli at 80 Hz followed 0.750 s later by 3 stimuli at 40 Hz) can detect even deeper degrees of neuromuscular blockade than DBS3,3 50/50 and to determine the time lapse from reappearance of response to each of the two DBS modes until reappearance of response to the TOF mode of nerve stimulation.Methods: The study comprised 20 women undergoing gynaecological surgery and anaesthetised with fentanyl, thiopentone, halothane, and nitrous oxide. Neuromuscular transmission was monitored by using mechanomyography and stimulation of the ulnar nerve. Atracurium was used for neuromuscular blockade.Results: Elapsed time from reappearance of response to DBS3,3 80/40 and DBS3,3 50/50 to reappearance of response to TOF stimulation was 459±196 (mean±SD) and 360±150 seconds, respectively, (P<0.05).Conclusions: DBS3,3 80/40 is capable of detecting deeper degrees of blockade than DBS3,3 50/50 which again is capable of detecting deeper degrees of blockade than TOF.
The effect of topical lignocaine on intubating conditions after propofol‐alfentanil induction
Authors: Bolow K. , Nielsen T. G. , Lund J. 
Published: January 2009

Background: Recent studies have found satisfactory conditions for intubation of the trachea without using muscle relaxants using an intravenous technique combining propofol and alfentanil. In this study we evaluate intubating conditions with this method and either lignocaine applied topically in the larynx and trachea or placebo.Methods: Sixty adult patients of ASA class I were premedicated with diazepam 15–20 mg and randomly allocated to one of two groups. For induction of anaesthesia both groups were given propofol 2.5 mg/kg and alfentanil 30 μg/kg. One group received 4 ml of lignocaine 40 mg/ml (≤3 mg/kg) topically into the larynx and trachea (group L), the other group an equal amount of isotonic saline (group S) in a double‐blind design. Intubation conditions were assessed as excellent, good, moderately good, poor or impossible, scored on the basis of jaw relaxation, ease of insertion of the tube and coughing on intubation.Results: The total score for group L was significantly better than the score for group S (P<0.0001) with significant differences with respect to ease of intubation and coughing after intubation.Conclusions: Induction of anaesthesia with propofol 2.5 mg/kg and alfentanil 30 μg/kg combined with 4 ml of lignocaine‐spray 40 mg/ml into the larynx and trachea offered consistent and satisfactory intubation conditions. We thus recommend this method for tracheal intubation, where the use of muscle relaxants is not indicated.
Nebulized tetracaine attenuates the hemodynamic response to tracheal intubation
Authors: Stevens J. B. , Vories P. A. , Walker S. C. 
Published: January 2009

Background: Local anesthetics, principally lidocaine, are commonly administered in an attempt to blunt the hemodynamic response to tracheal intubation. There are no prior investigations evaluating the use of tetracaine in this setting.Methods: In the present study, 30 female patients (ASA HI) scheduled for elective surgery were randomized to receive inhaled nebulized tetracaine 0.5 mg/kg or nebulized saline. Subsequently, anesthesia was induced with thiopental 5mg/ kg and succinylcholine 1.0 mg/kg. Sixty seconds later, the trachea was intubated. Vital signs were recorded at intubation and at 1‐minute intervals for the next 5 minutes.Results: Patients treated with tetracaine had a significantly (P<0.05) lower mean heart rate at intubation and all subsequent times. Similarly, there were significant differences (P<0.05) in mean arterial pressure between tetracaine and control patients at all times post‐intubation except at 2 minutes. The inhalation of nebulized tetracaine produced no adverse side effects.Conclusion: We conclude that nebulized tetracaine significantly attenuates the hemodynamic response to tracheal intubation.
Respiratory compliance during orthotopic liver transplantation
Authors: Tallgren M. , Hockerstedt K. , Lindgren L. 
Published: January 2009

After liver transplantation, respiratory complications are frequent. The purpose of this study was to assess if intraoperative monitoring of respiratory compliance is of clinical value in predicting such complications.Respiratory compliance was continuously monitored with a side‐stream respiratory gas flow and pressure sensor (Datex, Helsinki, Finland) at the endotracheal tube in 18 adult patients undergoing orthotopic liver transplantation without veno‐venous bypass.Respiratory compliance decreased along with blood volume expansion under anaesthesia before the start of surgery (P<0.05). Compliance improved as ascites was removed at the beginning of laparotomy (P<0.001). The highest compliance values were seen during liver surgery. In the patients without ascites preoperatively, compliance was lower at the end of surgery than at anaesthesia induction (P<0.001). In the patients with ascites, compliance at the end of surgery was equally low as at anaesthesia induction. Compliance at the end of surgery was lower in the patients with bilateral than in those with right‐sided or no pleural effusions in the postoperative chest X‐rays (P<0.001).In conclusion, intraoperative monitoring of respiratory compliance is one useful method for clinical use in predicting postoperative bilateral pleural effusions.
Use of the Univent System tube® for difficult intubation and for achieving one‐lung anaesthesia
Authors: GarcíA‐Aguado R. , Mateo E. M. , Onrubia V. J. , Bolinches R. 
Published: January 2009

Background: One‐lung ventilation in major thoracic surgery is the most commonly accepted technique, not only for surgery on the lung but also in procedures involving the oesophagus, mediastinum and thoracic aorta. Conventional double‐lumen tubes may sometimes be difficult to place correctly in patients in whom intubation is difficult. In such cases, the Univent System tube® may be of help. It has a curved movable blocker of small calibre, and is designed to slide inside the bronchial tree and occlude all or part of the target lung.Case Report: We describe a new application of the Univent System tube® in three cases where intubation was presumed to be difficult, and in another with unexpected difficult intubation.The laryngeal approach was carried out with the distally displaced blocker, inserting it through the sub‐epiglottis or the posterior commissure visible orifice. The tube was firmly held and slid through the length of the blocker, rotating slowly until fully introduced. The advantages and criteria for its use are discussed.Conclusion: Although the double‐lumen tube is the first choice for one‐lung ventilation, the Univent tube is a good option for selective bronchial intubation and in patients in whom difficult intubation is predicted.
Myoelectric activity in the stomach and duodenum after epidural administration of morphine or bupivacaine
Authors: ThÖorn S.‐E. , Wickbom G. , Philipson L. , Leissner P. , Wattwil M. 
Published: January 2009

Background:Gastric emptying is delayed in patients receiving postoperative pain relief with epidural morphine compared to patients receiving epidural bupivacaine. The electrophysiological basis for this effect is unknown. The aim of this study was to compare the effects of epidural morphine with epidural bupivacaine on gastroduodenal myoelectric activity (EMG) in patients after surgery.Methods:Fourteen patients with epidural analgesia who underwent open cholecystectomy were randomly assigned to receive either epidural morphine (EM) or epidural bupivacaine (EB) for postoperative pain relief. During surgery EMG electrodes were placed in the subserosa in the antrum and duodenum and the EMG registration started 3.5 hours after the end of surgery. Gastric emptying measured with the acetaminophen test was studied in the morning the day after surgery.Results:The spike activity in the antrum was significantly lower 160–340 minutes after the administration of morphine in the EM‐group compared to the activity in the EB‐group (P<0.04). The incidence of regular slow wave rhythm in the antrum was significantly lower 160–520 minutes after the administration of morphine in the EM‐group compared to the EB‐group (P<0.03). Duodenal Phase III activity measured with EMG was significantly more frequent during 160–520 minutes after the morphine administration in the EM‐group compared to the EB‐group (P<0.02). The acetaminophen absorption was significantly delayed in the epidural morphine group compared to the epidural bupivacaine group.Conclusions:Gastroduodenal electromyographic activity was significantly changed during epidural morphine compared to epidural bupivacaine. The delayed gastric emptying during epidural morphine may be explained by decreased and uncoordinated contractile activity in the antrum, shown by decreased spike activity and irregular slow wave rhythm. The increased pressure activity in the duodenum, shown by increased Phase III activity, may also impair gastric emptying.
The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery
Authors: Camus Y. , Delva E. , Cohen S. , Lienhart A. 
Published: January 2009

Background: The infusion of several liters of crystalloid solution at room temperature may significantly contribute to intraoperative hypothermia because warming fluid to core temperature requires body heat. The aim of this study was to evaluate the effect of delivering warmed intravenous (IV) fluid to the patient on preventing intraoperative hypothermia.Methods: Intraoperative core and mean skin temperatures were measured during prolonged abdominal surgery in 18 patients randomly divided into two groups according to intraoperative IV fluid management. In 9 patients (control group) all IV fluids infused were at room temperature. In the other 9 patients (group receiving warmed fluids) all IV fluids were warmed using an active IV fluid tube‐warming system. In all 18 patients a warming blanket covered the skin surface available for cutaneous warming. Intraoperative changes in total body heat content (kJ) were calculated from core and mean skin temperatures.Results: At the end of surgery, core temperature was 36.7±0.2°C in the group receiving warmed fluids and 35.8±0.2°C in the control group (P<0.05). The estimated reduction in heat loss provided by warming IV fluid was 217 kJ, a value very close to the theoretical value expected from thermodynamic calculation. During recovery, one patient shivered in the group receiving warmed fluids and seven in the control group (P<0.05).Conclusion: In conclusion, infusion of warmed fluids, combined with skin‐surface warming, helps to prevent hypothermia and reduces the incidence of postoperative shivering.
Predicting postoperative adverse events. Clinical efficiency of four general classification systems The Project Perioperative Risk
Authors: Arvidsson S. , Ouchterlony J. , SjÖoUstedt L. , SvÄaUrdsudd K. 
Published: January 2009

Background: The Project Perioperative Risk in Gothenburg is a prospective clinical‐epidemiological study designed to elucidate factors affecting the perioperative risk in unselected adult patients undergoing elective general or orthopaedic surgery. In this report on postoperative adverse events of varying severity, the predictive ability of four simple classification systems, ASA physical status, patient age, surgical stress and a visual analogue scale for intuitively appreciated global risk (RISK‐VAS), is described.Methods: 1361 patients undergoing 1471 surgical procedures were subjected to a detailed and standardised preoperative assessment and classified according to ASA, age, procedure magnitude and RISK‐VAS. Postoperative adverse events were prospectively registered during the entire hospital stay.Results: The four classifications all correlated to postoperative adverse events. ASA physical status, RISK‐VAS and patient age all appear to be more efficient in predicting severe than mild events, while surgical stress predicted severe events and mild ones equally well.Conclusion: The most efficient predictor of severe events appeared to be RISK‐VAS, where a relative risk of 28.1 of acquiring a severe postoperative adverse event could be demonstrated for those who had a score of 4 or more compared with those who had scores less than 4.
Peroperative adenosine infusion reduces isoflurane concentrations during general anesthesia for shoulder surgery
Authors: Segerdahl M , Persson E. , Ekblom A. , Sollevi A. 
Published: January 2009

Background:Adenosine (ADO), and stable analogs thereof, have been shown to exert antinociceptive action under experimental conditions in animals and in humans. The aim of this randomized double‐blind placebo‐controlled study was to evaluate if a low dose of intravenous (i.v.) ADO could reduce isoflurane requirements during joint‐associated surgery, as an indication of antinociception in deep somatic pain.Methods:Thirty‐two patients, age 19–62 years, ASA I and II, scheduled for shoulder joint surgery, were assigned to receive an i.v. infusion of either adenosine, 80 μg kg‐1min‐1, or placebo, during the surgical procedure. Anesthesia was maintained with isoflurane/N2O/O2inhalation.Results:The peroperative isoflurane concentration was significantly reduced at 50 minutes of surgery in the group receiving adenosine infusion. Also, the systolic blood pressure level was peroperatively more stable during adenosine infusion than during placebo. Other clinical parameters, such as pain, postoperative analgesic requirements and nausea, were not different between groups.Conclusion:A peroperative infusion of a low dose of adenosine during shoulder joint surgery may reduce the peroperative isoflurane requirement.
Heart rate variability in diabetic and non‐diabetic renal transplant patients
Authors: Kirvela M. , Salmela K. , Toivonen L. , Koivusalo A.‐M. , Lindgren L. 
Published: January 2009

Backround: Heart rate variability (HRV) has been used to investigate the autonomic modulation of heart rate. Diminished HRV has been observed in diabetic autonomic neuropathy, a condition associated with increased mortality. Uraemia is associated with impaired autonomic function, but reports on the effects of uraemia on HRV are scarce.Methods: HRV and its circadian variation were studied in 12 diabetic and 11 non‐diabetic renal transplantation and in 12 control patients. HRV in time and frequency domains was determined from 24‐hour ECG recordings.Results: In the diabetic group, all time domain and frequency domain measures of HRV were markedly reduced (P<0.05), when compared with the control group, and the circadian variation of HRV was absent. The mean (SD) amplitudes (ms) in the frequency bands were: high frequency: 3 (1), 6 (3) and 15 (3); low frequency: 9 (7), 16 (10) and 25 (8); very low frequency: 14 (8), 23 (12) and 30 (11) in the diabetic and non‐diabetic uraemic and in the control patients, respectively. In non‐diabetic uraemic patients, a tendency to reduced HRV was observed, but no statistical differences in HRV measures were found when compared with the control group.Conclusion: The severe impairment of HRV in patients with end‐stage diabetic nephropathy is probably due to autonomic neuropathy and partly also to the co‐existing heart diseases. It may be a contributing risk factor for ventricular arrhythmias and sudden death in these patients. Uraemia alone causes similar but less severe changes in HRV.