bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bedside troponin T testing is not useful for early out‐of‐hospital diagnosis of myocardial infarction
Authors: Gust R. , Gust A. , Böttiger B. W. , Böhrer H. , Martin E. 
Published: January 2009

Background: A new commercially available rapid qualitative bedside immunoassay for cardiac troponin T has been developed. The aim of the study was to investigate whether this new rapid bedside cardiac troponin T assay facilitates diagnosing myocardial infarction in a pre‐hospital setting.Methods: We evaluated the sensitivity and specificity of the new rapid bedside troponin T assay for myocardial infarction. In 68 patients with acute, central, crushing chest pain, who were strongly suspected of having myocardial infarction, the emergency doctor performed preclinically a bedside cardiac troponin T test. The results were compared with the diagnosis after admission to hospital, using the criteria of the World Health Organization.Results: The diagnosis of myocardial infarction was confirmed in 16/68 (24%) patients after admission to hospital, but only in 4/16 (25%) patients with myocardial infarction was a positive result observed preclinically with this test. The result was false positive in 1/5 patients (20%).Conclusions: In contrast to an excellent specificity (0.98), sensitivity (0.25) of the rapid troponin T assay was poor. Thus, we conclude that this test cannot improve the distinction between myocardial infarction and angina pectoris in a pre‐hospital setting.
Transient radicular irritation (TRI) after spinal anaesthesia in day‐care surgery
Authors: Corbey M. P. , Bach A. B. 
Published: January 2009

Background: A high incidence of backache with radiating pains to the lower extremities, termed transient radicular irritation (TRI), has been reported following the use of 5% hyperbaric lidocaine. This has been attributed to a neurotoxic reaction.Methods: A retrospective audit has been carried out in our hospital on the postoperative anaesthetic records of all patients from the 1st of January 1993 to the 1st of September 1996, who received spinal anaesthesia with either hyperbaric lidocaine or hyperbaric bupivacaine for day‐care surgery.Results: Backache was reported in 1.9% of patients (6/322) receiving hyperbaric lidocaine and in 2.4% of patients (1/41) receiving hyperbaric bupivacaine. This was not associated with any sensory, motor or sphincter disturbances. One patient complained of backache with bilateral pain referred to the gluteal area (TRI), which was assessed as acute facet joint syndrome. Unilateral accidental block of the femoral nerve was observed in 3 patients, sensory disturbances in the L2/3 dermatome was reported in a further 3 patients at 24 h, following wound infiltration with local anaesthetic during hernia repair.Conclusions: The low incidence of backache at 24 h and the absence of associated symptoms of neurogenic pain, sensory and motor disturbances, does not support the hypothesis that TRI is a neurotoxic reaction, subsequent to the use of hyperbaric lidocaine.
Anaesthesia for videoarthroscopy of the knee
Authors: Naidu‐Sjösvärd K. , SJöberg F. , Gupta A. 
Published: January 2009

Background: The newer inhalational agents desflurane and sevoflurane have a low blood‐gas partition coefficient and are not very fat soluble, and consequently recovery is rapid and smooth. Very few studies have been published concerning adults where a direct comparison has been made between sevoflurane and desflurane in the ambulatory setting.Methods: This study was done to assess aspects of recovery following minor ambulatory videoarthroscopic knee surgery in 50 ASA I‐II patients. Baseline values were obtained on the following psychomotor tests: digit symbol substitution test (DSST), perceptive accuracy test (PAT) and simple reaction time (SRT). The patients were then randomly allocated to one of two groups according to an open (unblinded) study design: Group D (Desflurane) were maintained on desflurane while Group S (Desflurane) were maintained on sevoflurane. Propofol was used as the induction agent in all patients and the larynx mask was used to maintain a free airway. Oxygen and air (FiO2 0.33) were used as the carrier gases. The concentration of desflurane or sevoflurane was adjusted in order to maintain adequate anaesthesia and stable haemodynamics. Alfentanil was given at induction and every 15 min as an analgesic. At the end of the operation, the gases were turned off abruptly and 100% oxygen was delivered at 6 L/min until eye‐opening. Early recovery was measured by the time to eye‐opening, giving name and date of birth. Intermediate recovery was measured by psychomotor testing every 30 min, and the time to sitting up in bed, drinking fluids and discharge home by a nurse who was blinded to the anaesthetic technique.Results: Early recovery was quicker in the desflurane compared to the sevoflurane group (P<0.001). Psychomotor recovery as measured by the PAT occurred significantly earlier in the desflurane compared to the sevoflurane group at 15 and 45 min (P<0.001) and as measured by the DSST at 30 min (P<0.05). The number of patients who could not perform the SRT test at 15 min was greater in the sevoflurane compared to the desflurane group (13 vs 0) (P<0.01). No differences were found in other recovery parameters, including home discharge, between the groups. The incidence of pain and other minor postoperative complications was similar between the groups except for sore throat which was higher in the desflurane group.Conclusion: Early and intermediate (psychomotor) recovery is quicker in the desflurane compared to the sevoflurane group, but there is no difference in discharge times between the groups.
A risk score to predict the probability of postoperative vomiting in adults
Authors: Apfel C. C. , Greim C. A. , Haubitz I. , Goepfert C. , Usadel J. , Sefrin P. , Roewer N. 
Published: January 2009

Background: The aim of this study was to identify factors most relevant for postoperative vomiting (PV) and to develop a risk score to predict the probability of PV.Methods: Adult inpatients scheduled for elective ear, nose and throat (ENT) surgery under general anaesthesia were offered to participate in a prospective study for PV over 24 h. No prophylactic antiemetics were used. The data of 1137 patients were randomized and split into an evaluation set (n=553) and a validation set (n=584). The evaluation set was subjected to logistic regression analysis to quantify the relative impact of anaesthetic, surgical and individual factors and to develop a risk score. The score was then tested by applying it to the validation set. The area under a receiver operation characteristic (ROC) curve was calculated and the predicted and actual incidences of patients were correlated.Results: In the evaluation set, patient‐related factors (female gender, young age, non‐smoking, history of PV or motion sickness) and a high duration of anaesthesia were independent risk factors for PV. The probability of PV could be estimated from the equation: PV = 1/(1 + exp(‐z)) where z=1.28 · (gender)‐0.029· (age)‐0.74·(smoking)+0.63·(history of PV or motion sickness)+0.26 · (duration)‐0.92. In the validation set this score achieved an area under the ROC‐curve of 0.78 and the actual incidence correlated strongly with the predicted risks (R2=0.93, P<0.001).Conclusion: The data suggest that the probability of PV following ENT surgery under inhalational anaesthesia with low‐dose opioids can be predicted by a score mainly based upon patient‐related risk factors.
Effects of intravenous anesthetics on bacterial elimination in human blood in vitro
Authors: Heller A. , Heller S. , Blecken S. , Urbaschek R. , Koch T. 
Published: January 2009

Backround: Since anesthetics are widely used in critically ill patients, this study investigates anesthetic effects on neutrophil and monocyte function concerning bacterial elimination in human whole blood.Methods: The effects of thiopental (20 and 200 μg/ml), propofol (5 and 50 μg/ml), midazolam (0.15 and 1.5 μg/ml) and ketamine (3 and 30 μg/ml) on elimination of Escherichia (E.) coli from whole blood were investigated in vitro after incubation for 1 h in both clinical (1) (n=10) and 10‐fold higher (h) (n=11) concentrations. These data were compared to neutrophil and monocyte phagocytosis (1; n=6) and burst activity (1; n=10, h; n=11), measured by flow cytometry. To enable quantification of the clearance process, a defined number of 105 colony forming units of E. coli were added to the blood assays and bacterial growth was determined.Results: All anesthetics delayed bacterial clearance from the blood in the 10‐fold concentration (P<0.05). Thiopental (1+h) and propofol (h) suppressed neutrophil (59±3% and 38±6%) and monocytic (45±6% and 30±11%) oxidative burst (P<0.01). Phagocytosis was reduced even after propofol (1) in polymorphonuclear leukocytes (PMN) (34±9%; P<0.05) and monocytes (35±11%). Ketamine (h) prolonged bacterial elimination (P<0.01), which did correlate with inhibition of monocytic phagocytosis, by 26±14%. Midazolam application (h) resulted in an inhibition of PMN‐respiratory burst by 19±6% (P<0.05) and impaired bacterial clearance (P<0.05).Conclusion: Thiopental, propofol, midazolam and ketamine affect E. coli clearance and neutrophil and monocyte oxidative burst and phagocytosis in vitro only in high concentrations, while thiopental inhibited monocytic burst and propofol impaired PMN phagocytosis even in clinically used concentrations. These data suggest that i.v. anesthetics in concentrations recommended for general anesthesia seem to have minor influence on the investigated host defense mechanisms.
Prognostic importance of automated ST‐segment monitoring after coronary artery bypass graft surgery
Authors: Yazigi A. , Richa F. , Gebara S. , Haddad F. , Hayek G. , Antakly M.‐C. 
Published: January 2009

Background: Automated ST‐segment monitors are widely used in cardiac surgery units. The purpose of this study was to determine if cardiac morbidity and mortality, after CABG surgery, are predicted by ECG ST‐segment changes on automated monitors.Method: One hundred patients, who underwent CABG, were included in this prospective study. ST‐segment deviations were recorded by an automated ST monitor, in the ICU, for 24 h after surgery. A reversible ST depression of more than 0.1 mV or a ST elevation of more than 0.2 mV and for at least 1 min were considered as significant episodes. Adverse cardiac outcomes were defined as: myocardial infarction (MI), severe left ventricular failure, ventricular fibrillation (VF) and cardiac‐related death.Results: Sixty patients (group 1) presented significant episodes of ST deviation (6δ5 episodes per patient). Forty patients (group 2) were free from ST changes. Eight patients from group 1 had postoperative adverse cardiac outcomes: 5 MI, 2 VF and 1 cardiac‐related death. Patients from group 2 were all free from adverse cardiac outcomes. Automated ST‐segment analysis during the first 24 h had a positive predictive value of 13% and a negative predictive value of 100%.Conclusion: Automated ST analysis is a non‐invasive, sensitive and very easy‐to‐use monitoring system to screen patients who may develop myocardial ischemia and cardiac complications after CABG surgery.
The effects of nitric oxide inhalation on respiratory mechanics and gas exchange during endotoxaemia in the pig
Authors: Dahm P. L. , Jonson B. , De Robertis E. , Myhre E. , Svantesson C. , Thörne J. , Blomquist S. 
Published: January 2009

Background: In the adult respiratory distress syndrome, nitric oxide (NO) inhalation improves oxygenation through reducing ventilation‐perfusion mismatching, but detailed information on the pulmonary effects of NO inhalation in septic shock is scarce. The present study investigated the effects of inhaled NO on alveolar dead space (Vdalv) and venous admixture as well as on respiratory system compliance (Crs) and respiratory system resistance (Rrs) in a porcine model of septic shock. Protective effects of NO are discussed.Methods: Thirteen anaesthetised and ventilated pigs were given an infusion of endotoxin for an observation time of 220 min to induce acute lung injury (ALI). In the NO‐early group (n=6), an inhalation of 60 ppm NO was started simultaneously with the endotoxin infusion and continued for 190 min. In 7 control/NO‐late animals, 60 ppm NO was administered for 30 min following 190 min of endotoxin infusion. Haemodynamics, single‐breath CO2‐, pressure‐, and flow signals were recorded.Results: Endotoxin induced haemoconcentration, pulmonary vasoconstriction, and a decrease in Crs, while venous admixture, Vdalv, and Rrs increased. In the NO‐early group, the pulmonary vasoconstriction was attenuated, no increase in pulmonary venous admixture or in Vdalv was seen before cessation of NO, and the improvements in oxygenation outlasted the NO inhalation. In the control/NO‐late group, the NO inhalation reversed the changes in dead space and venous admixture. NO had no effect on the changes in respiratory mechanics.Conclusion: In porcine ALI, 60 ppm NO diminishes pulmonary vasoconstriction and improves gas exchange by reducing pulmonary venous admixture and alveolar dead space, but does not prevent a fall in Crs. NO inhalation may help prevent longlasting pulmonary failure.
Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy
Authors: Holdgaard H. O. , Pedersen J. , Jensen R. H. , Outzen K. E. , Midtgaard T. , Johansen L. V. , Møller J. , Paaske P. B. 
Published: January 2009

Background: As no clinical randomised studies have previously been performed comparing complications with the Ciaglia Percutaneous Dilatational Tracheostomy Introducer Set (PDT) and conventional surgical tracheostomy (TR), we designed a study with the aim of comparing the efficacy and safety of the two techniques.Methods: Sixty patients selected for elective tracheostomy were randomised for either PDT (30 patients) or TR (30 patients). All patients had general anaesthesia and were ventilated with 100% oxygen. Furthermore, lidocaine with epinephrine 1% (3–5 ml) was used for local analgesia and to minimise bleeding during the procedure.Results: The median time for insertion of the tracheostomy tube was 11.5 min (range 7–24 min) in the PDT group and 15 min (range 5–47 min) in the TR group (P<0.01). Complications during the procedure were cuff puncture of the endotracheal tube in 5 cases in the PDT group. Minor bleeding was encountered in 6 cases in the PDT group as opposed to 24 cases in the TR group (P<0.01), major bleeding in none versus 2 cases, respectively. In 8 cases in the PDT group, increased resistance to insertion of the tracheostomy tube was met by further dilatation. During the post‐tracheostomy period, complications occurred with minor bleeding in 2 cases in the PDT group as opposed to 9 cases in the TR group (P<0.05), and major bleeding was encountered in 1 case in each group. Minor infections were encountered in 3 cases in the PDT group as opposed to 11 cases in the TR group (P<0.01). Major infection was encountered in none versus 8 cases, respectively (P<0.01).Conclusion: Our results indicate that the percutaneous dilatational tracheostomy technique performed with the Ciaglia Introducer Set is effective, safe and superior to conventional surgical tracheostomy as immediate complications as well as complications with the tracheostomy tube in situ are fewer and of less severity.
Increased platelet microvesicle formation is associated with mortality in a porcine model of endotoxemia
Authors: Eriksson M. , Nelson D. , Nordgren A. , Larsson A. 
Published: January 2009

Background: Gram‐negative sepsis in humans and endotoxemia in pigs induce the formation of platelet microvesicles. These microvesicles are active in homeostasis and may thus contribute to the outcome in patients with activated coagulation and fibrinolysis. We decided to prospectively evaluate the effects of endotoxemia on microvesicle formation and some common physiologic variables against survival in a porcine model.Methods: Nineteen included pigs were anesthetized, monitored and subjected to an infusion of E. coli endotoxin. Microvesicle formation was determined by flow cytometry.Results: The formation of microvesicles was significantly increased in the 6 pigs that died during endotoxin exposure. This increased formation became significant from the 3rd hour of endotoxemia. Microvesicle formation did not increase in surviving endotoxemic pigs. Cardiac index, mean arterial blood pressure, base excess and systemic vascular resistance index were distinctly reduced in the animals that died as compared to those surviving the endotoxemic period.Conclusion: The increased formation of platelet microvesicles seems to be associated with poor prognosis in porcine endotoxemia. Since microvesicles are active in coagulation, they may contribute to the derangement of the coagulation system caused by endotoxemia. Different degrees of microvesicle formation may reflect inter‐individual responses to a given challenge.
Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient‐controlled analgesia
Authors: Silvasti M. , Rosenberg P. , Seppälä T. , Svartling N. , Pitkänen M. 
Published: January 2009

Background: Morphine has been the standard opioid in patient‐controlled analgesia (PCA). Oxycodone, the analgesic potency of which in i.v. administration has been suggested to be slightly greater than that of morphine, has not yet been studied for its efficacy in PCA.Methods: Fifty patients, undergoing a plastic reconstruction of the breast or a major operation of the vertebrae, such as lumbar spinal fusion, used PCA for postoperative pain. Patients were randomized to receive either morphine 45 μg/kg or oxycodone 30 μg/kg as i.v. bolus doses. Patients were assessed for pain with a visual analogue scale (VAS) and side effects at 3, 9 and 24 h. Venous blood samples for the measurement of plasma concentration of oxycodone and that of morphine and its metabolites were taken.Results: In this study patients needed, on average, the same amount of oxycodone and morphine in the recovery room and on the ward. There was no difference in the quality of analgesia (VAS) or incidence of side effects, such as nausea, vomiting, pruritus and urinary retention. The plasma concentrations of morphine‐6‐glucuronide showed that this metabolite might contribute to the analgesia resulting from morphine administration.Conclusions: The same dose of intravenous oxycodone and morphine administered by PCA pump was needed for immediate postoperative analgesia. The two drugs appear to be equipotent.
Postoperative nausea and vomiting with special reference to risk factors and prevention in laparoscopic surgery
Authors: Koivuranta M. 
Published: January 2009

The current incidence, risk factors and prevention of postoperative nausea and vomiting (PONV) were prospectively evaluated in 1703 inpatients. The objectives of the study were: 1) to create a predictive model based on patient characteristics in order to enable the estimation of the risk for PONV, 2) to ascertain the antiemetic efficacy of prophylactic intravenous ondansetron in comparison with droperidol and placebo against PONV following laparoscopic surgery, and 3) to evaluate the antiemetic effectiveness of combining ondansetron with a low dose of droperidol in high‐risk inpatients.The incidence of nausea and vomiting after common surgical procedures was high. In the recovery room, the overall incidence of nausea and vomiting was 18% and 5%, respectively, and over the whole 24‐h observation period the respective figures were 52% and 25%. The most significant predictive factors associated with an increased risk for the symptoms were female sex, a previous history of postoperative nausea and vomiting, a history of motion sickness, a longer duration of surgery and non‐smoking. Based on these five items, a risk score predicting nausea and vomiting was constructed with a moderately good discriminating power, as judged from the area under the receiver operating characteristic curve.Intravenous ondansetron 4 mg was ineffective in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. A higher dose of prophylactic ondansetron 8 mg effectively reduced the incidence and alleviated the intensity of PONV in women scheduled to have laparoscopy for gynaecological and general surgical procedures, as compared with placebo. The antiemetic efficacy of prophylactic ondansetron 8 mg and droperidol 1.25 mg was similar as for overall nausea during the 24‐h observation period, but ondansetron seemed to be slightly more efficacious in preventing vomiting. Both ondansetron and droperidol were well‐tolerated with only minor side‐effects.In a high‐risk, female, inpatient laparoscopic population, with a mean estimated risk of 65% for PONV, prophylactically administered ondansetron 8 mg in combination with either a 0.75 mg or 1.25 mg dose of droperidol reduced the incidence of post‐operative nausea to 35% and that of vomiting to 15% during the first 24 h after surgery. Of these drug combinations, the smaller dose of droperidol resulted in less postoperative sedation than the higher dose; both combinations being otherwise equally well‐tolerated without serious adverse events.These results indicate that postoperative nausea and vomiting can, to some extent, be predicted by a few patient characteristics, and in laparoscopic surgery ‐ which is associated with an increased risk for PONV ‐ the incidence can be reduced with either a single dose of ondansetron or droperidol or a combination of these drugs.
Epidural abscess complicating epidural anesthesia and analgesia: An analysis of the literature
Authors: Kindler C. H. , Seeberger M. D. , Staender S. E. 
Published: January 2009

Background: Epidural abscess is a serious complication of epidural block. Because of its low incidence, the risk factors and the symptoms and cause of epidural abscess related to epidural anesthesia and analgesia are not well known by anesthesiologists.Methods: A computer‐assisted search of the literature on epidural catheter‐related abscess was performed to describe the clinical course and bacteriology of this complication, to determine possible risk factors, and to assess the index of suspicion among physicians.Results: Forty‐two patients with a catheter‐related epidural abscess were identified. Only in 15 patients was the correct diagnosis considered initially. The time from insertion of the epidural catheter to symptoms varied between 1 and 60 d. Initial symptoms included back pain, fever, and leukocytosis. The time from symptoms to treatment was a few hours to 108 d. Interval from first symptoms to treatment was significantly longer in patients with persistent neurologic deficits compared with patients who completely recovered. Staphylococcus aureus was the most common etiologic agent. Outcome was reported in 39 patients, but only 19 made a full recovery.Conclusion: The index of suspicion among anesthesiologists, other physicians and nurses taking care of patients with epidural catheters must be increased for this complication; this should shorten the interval from symptoms to treatment and lower the incidence of neurological sequelae.