bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic oral ibuprofen or ibuprofen‐codeine versus placebo for postoperative pain after primary hip arthroplasty
Authors: Dahl V. , Raeder J. C. , Drøsdal S. , Wathne O. , Brynildsrud J. 
Published: January 2009

The postoperative analgesic effect of ibuprofen was compared with a combination of ibuprofen and codeine versus placebo. The study was prospective, randomized, double blind with 123 consecutive hip arthroplasly operations. All the patients received oral diazepam as premedication and spinal anaesthesia with bupivacaine 5 mg/ml 3–4 ml.Postoperatively, when the spinal anaesthesia started to wear off, the patients were randomly assigned to one of three groups; the ibuprofen group (n=48) received 800 mg of ibuprofen orally. The ibuprofen/codeine group (IC, n=48) received 800 mg of ibuprofen combined with 60 mg of codeine. The placebo group (P, n=25), received oral placebo medication. The patients were observed for the need of additional opioid (e.g. ketobemidone), pain score (verbal and VAS), bleeding and side effects for five hours. The patients in the placebo group (P) had significantly higher pain scores (P >0.05) compared with the two other groups after 2 and 4 hours, with no significant differences after 1, 3 and 5 hours. The P group also received 45% more opioids (P<0.001) compared with the two other groups during the same period. No significant differences in bleeding or side‐effects were observed between the groups. There were no significant differences between the ibuprofen group and the ibuprofen/codeine group.We conclude that a prophylactic dose of 800 mg ibuprofen orally has an opioid sparing effect with a tendency of less pain experience during the first hours after hip arthroplasty.
Contribution from upper and lower airways to exhaled endogenous nitric oxide in humans
Authors: Schedin U. , Frostell C. , Persson M. G. , Jakobsson J. , Andersson G. , Gustafsson L. E. 
Published: January 2009

Endogenous nitric oxide (NO) is thought to regulate many biological functions, including pulmonary circulation and bronchomotion, and it has been found in exhaled air. Our aim was to study the excretion of NO in different parts of the respiratory system.Exhaled concentrations of NO were measured by chemiluminescence in chronic tracheostomy outpatients (group 1), in patients admitted for minor abdominal surgery (group 2), and in patients with acute respiratory failure (ARF) during mechanical ventilation (group 3). In awake volunteers (group 4), 0.57 L/min gas was aspirated through the nasal cavity into the chemiluminescence device.In group 1 (tracheostomy, n=5) we detected 16±2 (mean±s.c. mean) parts per billion (ppb) NO when exhaling through the mouth, and a lower (P<0.05) value of 4.6±0.8 ppb NO when exhaling through the tracheostomy. Before anaesthesia, group 2 (n=11) exhibited 13±2.4 ppb NO in orally exhaled gas, increasing considerably during exhalation through the nose. Upon endotracheal intubation exhaled NO concentration dropped to 1.3±0.2 ppb (P<0.05). In group 3 (ARF, n=7) tracheal NO concentrations were 0.8±0.2 ppb. In group 4 (volunteers, n=6) 394±23 ppb NO was recorded in air from the nasal cavity.In both healthy subjects and patients with respiratory failure a significant NO excretion occurs in the lower airways and lungs. The upper airways, expecially the nose, contribute the largest amount of NO (>90%) to exhaled air. The physiological implications of an upper airway source of NO remain to be defined.
Long‐term local corticosteroid application does not influence nerve transmission or structure
Authors: Johansson A. , Dahlin L. , Kerns J. M. 
Published: January 2009

The long‐term effects of a locally applied depot form of a corticosteroid on the electrical properties and structure of nerves were investigated in an animal experimental model.The conduction in electrically stimulated A‐fibres of the plantar nerve was monitored by a bipolar volley recording of the sciatic nerve whereas the conduction in C‐fibres of the plantar nerve was measured through a C‐fibre evoked segmental flexion reflex in the anaesthetized rat. Droplets of either methylprednisolone acetate or vehicle were placed under direct observation on the plantar nerve. Saline was used as a control on the contralateral side. One to two weeks after the application both the A‐fibre volley of the sciatic nerve and the C‐fibre evoked reflex discharge of flexor motoneurons were recorded.No difference was found between the nerves treated with corticosteroid, constituent vehicle or saline. Light and electron microscopic analysis of the nerves showed no changes in the nerve fibres or in the intraneural connective tissue in either the corticosteroid treated or the control nerves.It is concluded that locally applied corticosteroids in limited amounts have no long‐term effects on the electrical and structural properties of peripheral nerves.
Anesthetic modulation of the cardiovascular response to microlaryngoscopy
Authors: Sellgren J. , Ejnell H. , Pontén J. , Sonander H. G. 
Published: January 2009

The modulating effects of propoiol versus methohexital on the cardiovascular response to microlaryngoscopy were studied in 35 patients divided into four equal groups (one patient participated twice). Heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO; impedance cardiography), leg blood flow (LBF; occlusion plethysmography) and concentrations of arterial catecholamines were measured. After administration of atropine and fentanyl (2 μg·kg‐1), anesthesia was induced by either an injection of propofol (2.0 mg·kg‐1) followed by a low (6 mg·kg‐1·h‐1; n=91 or a high (12 mg·kg‐1·h‐1; n = 9) dose propofol infusion or an injection of methohexital (1.5 mg·kg‐1) followed by a low (5 mg·kg‐1·h‐1; n=9) or a high (10 mg·kg‐1·h‐1; n—9) dose methohexital infusion.The low methohexital infusion dose was insufficient to control MAP, which increased 41% during microlaryngoscopy compared to the awake state. The HR increased in all groups but the increase was most prominent in the low dose methohexital group. There were no statistically significant changes in CO in any group, whereas LBF increased consistently in all groups except in patients anesthetized with the low dose of methohexital. The increases of LBF in the propofol groups were intermediate and not dose dependent. The methohexital low dose group showed increases in norepinephrine levels compared to awake values and in epinephrine levels compared to the other groups.Propofol seems to differ from methohexital in modulation of peripheral vascular tone. The insufficient control of the cardiovascular response to microlaryngoscopy by the low methohexital dose in addition to longer recovery after the high methohexital dose favors the use of propofol.
Train‐of‐Four recovery after pharmacologic antagonism of pancuronium‐, pipecuronium‐, and doxacurium‐induced neuromuscular block in anaesthetized humans
Authors: Stinson L. W. , Lanier W. L. , Lennon R. L. 
Published: January 2009

Previous studies have suggested that the increased duration of action of long‐acting neuromuscular relaxants may make their pharmacologic antagonism more difficult and, thus, increase the likelihood of residual block. This hypothesis was tested in healthy, adult humans who received a background of isoflurane/N2O/fentanyl anaesthesia.Study subjects were paralyzed with either pancuronium (N=8), pipecuronium (N=8), or the longer‐acting relaxant, doxacurium (N=8). Neuromuscular function was monitored, and, using a blinded, randomized study design, the relaxants were titrated to identify the ED95 dose in each patient. Thereafter, spontaneous recovery was observed until there was 25% ofbaseline response to the first supramaximal twitch (Tl) in a train‐of‐four (TOF). At this time, the block was antagonized with neostigmine 0.07 mg/kg and glycopyrrolate 0.014 mg/kg i.v., and recovery of TOF was recorded.Spontaneous recovery to 25% of the baseline Tl response occurred at 52± 14 min (mean±SD) following administration of either pancuronium and pipecuronium, and 85 ±33 min following doxacurium (P<0.05 for doxacurium versus pancuronium and pipecuronium). In doxacurium‐rreated patients, reversal of block with neostigmine was less predictable and less complete than with the other two relaxants. For example, the ratio of the fourth to first twitch (T4/T1) of the TOF at 10 and 15 min after reversal was significantly less with doxacurium (59 ±14% and 61±16%, respectively) than with either pancuronium (75±6% and 75±10%) or pipecuronium (76±9% for both). At 30 min post‐neostigmine, the incidence of residual block (i.e. T4/T1 <0.70) was: pancuronium 2 patients, pipecuronium 1 patient, and doxacurium 5 patients.These studies support the hypothesis that incomplete reversal of neuromuscular block is more likely with longer‐acting neuromuscular relaxants.
High dose spinal anaesthesia with glucose free 0.5% bupivacaine 25 and 30 mg
Authors: Povey H. M. , Olsen P. Albrecht , Pihl H. , Jacobsen J. 
Published: January 2009

The purpose of this study was to investigate if a more intense and/or prolonged blockade could be obtained safely when a high‐dose intrathecal plain bupivacaine was given.Thirty patients for elective surgery were included. Two groups of 15 patients, received 25 or 30 mg 0.5% bupivacaine (plain). The sensory and motor blockade was determinated. Heart rate and respiratory frequency was monitored continuously, arterial blood pressure every 5 minutes. Peak expiratory flow (PEF) was performed before, and 45 min after the spinal injection.In group 25 mg the maximal spread of analgesia was to T3.7±0.9 (mean±s.e.mean) after 45 minutes, in group 30 mg 13.1 ±0.4 also after 45 min (NS). The maximal extent of analgesia was retained for a significantly longer period and the initial decline in extent of analgesia was significantly slower in the 30 mg group. No significant difference as to duration of motor blockade was found. Peak expiratory flow diminished significantly 45 min after the spinal injection in both groups, but no significant difference was found between the groups. The total duration of analgesia did not differ significantly between the groups.A significantly longer duration of maximal cephalad spread, and a slower initial regression, was found in the 30 mg group. No severe uncontrolled haemodynamic or respiratory side effects occurred.
Effects of propranolol pretreatment on cerebral blood flow, oxygen uptake and catecholamines during metabolic acidosis following E. coli endotoxin in dogs
Authors: Westerlind A. , Larsson L. E. , Häggendal J. , Ekström‐Jodal B. 
Published: January 2009

After an intravenous injection of E. coli endotoxin in dogs a decrease in cerebral blood flow (CBF) and an increase in cerebral metabolic rate of oxygen (CMRo2) have been shown to occur. In metabolic acidosis following endotoxin CMRo2 increased with decreasing pH. A possible explanation for the increased CMRo2 after endotoxin and metabolic acidosis seems to be a damage of the blood‐brain barrier (BBB) by endotoxin. This gives possibilities for a leakage of hydrogen ions and circulating monoamines from the blood to the brain, thus affecting the cerebral blood flow and metabolism.The effects of an E. coli endotoxin injection on CBF and CMRo2 during metabolic acidosis and P‐adrenoceptor blockade were studied in eight anaesthetized dogs. All the dogs were pretreated with propranolol (PPL), per os 12.5 mg . kg‐1 twice a day for one week. Metabolic acidosis (pH 7.01–7.30) was achieved by an intravenous infusion of hydrochloric acid. Endotoxin E. coli lipopolysaccharide O 111:B 4 was given as an intravenous injection of 1 mg . kg‐1 bodyweight over a 5 min period. Another five animals, published earlier, with the same experimental protocol but without PPL, constituted a control group.After endotoxin no increase in CMRo2 or CBF was observed with increasing acidosis in the PPL‐group. In the control group, after endotoxin, both CBF and CMR02 increased with decreasing pH. This resulted in a significant difference in both CBF and CMRo2 between the groups in the pH range 7.01—7.15.The present results indicate that the increase in CMRo2 and CBF with metabolic acidodis in endotoxinaemia is mediated via P‐adrenoceptors.
Neurochemical evidence that [Ca2+]oantagonizes the effect of neomycin on acetylcholine release from mouse hemidiaphragm preparation: An attempt to assess the margin of safety
Authors: Chaudhry I. A. , Nitahara K. , Nagashima H. , Vizi E. S. 
Published: January 2009

Although the neuromuscular junction is the most thoroughly studied synapse of any type and has become the model of our understanding of synaptic transmission, some questions remain unanswered; e.g. there has been no direct assessment of the size of margin of safety.In this study the [Ca2+]o‐dependent, quantally released acetylcholine measured by a neurochemical method, and the contraction of the mouse hemidiaphragm in response to phrenic nerve stimulation were recorded, and the effect of neomycin was studied.It was found that a much higher concentration of neomycin was needed to depress contractions, than to reduce acetylcholine release to the same extent, and that there was an inverse correlation between [Ca2+]oand the inhibitory effect of neomycin on acetylcholine release. Ninety percent of the release of acetylcholine had to be reduced by neomycin before any reduction in muscle responses could be seen. This indicates that the margin of safety is about 10.In conclusion, at the neuromuscular junction any reduction in ACh release, whatever the mechanism, first produces a reduction in the margin of safety. The nondepolarizing neuromuscular blocking agents block primarily the nicotinic receptors located on the postjunctional site. Many receptors have to be blocked before a reduction of muscle response is observed. This is probably the reason why unexpected clinical problems (e.g. recurarization) have been described when a patient has been treated with antibiotics, even though the dose of muscle relaxant injected was relatively low.
A prospective survey of postoperative nausea and vomiting with special regard to incidence and relations to patient characteristics, anesthetic routines and surgical procedures
Authors: Larsson S. , Lundberg D. 
Published: January 2009

We performed a prospective study on 421 patients subjected to routine general‐, orthopaedic‐, urologic‐, gynecological and paediatric surgery to estimate the current incidences of nausea and vomiting during the first 24 hours after surgery.The overall incidences of postoperative nausea or vomiting were 17% and 28%, respectively. Postoperative emetic symptoms were not related to age in adults. Women had more often emetic symptoms than men (P<0.01). In general, opiate premedication was more frequently associated with postoperative nausea and vomiting than benzodiazepines (P<0.01), but in otherwise comparable subgroups of patients undergoing major surgery, this difference was not confirmed. Balanced general anaesthesia caused more nausea (23%) and vomiting (53%) than face‐mask anaesthesia (13% and 15%, respectively) or regional blocks (12% and 7%, respectively) (P<0.001). There was a positive correlation between the duration of anaesthesia and the incidence of postoperative emetic symptoms (P<0.001). The incidences of postoperative nausea and vomiting after abdominal surgery were 23% and 58% respectively. Corresponding figures for orthopaedic surgery were 25% and 34%, other kinds of extra‐abdominal surgery 18% and 32% and for laparoscopy 21% and 25%. After minor gynecological‐, urological‐and paediatric surgery the incidences were less than 20%.In conclusion female gender, balanced anaesthesia, lengthy duration of anaesthesia, and abdominal and orthopaedic operations appeared to be most frequently associated with postoperative emetic symptoms.
Sevoflurane for ENT‐surgery in children A comparison with halothane
Authors: Johannesson G. P. , Floren M. , Lindahl S. G. E. 
Published: January 2009

Sevoflurane, a new volatile anesthetic agent, is of great potential interest in pediatric anesthesia. Its use for ENT surgery in children was compared with halothane in this study.Altogether 40 children participated in the investigation. In 18 (median age 4.2 years), halothane was used. The remainder (median age 4.0 years) were anesthetized with sevoflurane. After rectal premedication with midazolam and atropine, anesthesia was induced by mask (the agent in O2/N2O, 40/60) using a Mapleson D system. The trachea was intubated without the use of muscle relaxants and the children were then allowed to breathe spontaneously at fresh gas flows set high enough to avoid rebreathing. Hemoglobine oxygen saturation (SpO2), inspired and expired gas concentrations, respiratory rate (RR), heart rate (HR), ECG and blood pressure were followed.Equianesthetic concentrations of the agents were used and induction characteristics were comparable between the two agents. RR and end‐tidal CO2 tensions were similar in the two groups. HR and systolic blood pressures were, however, higher with sevoflurane. Cardiac arrhythmias were seen more frequently with halothane (61%) than with sevoflurane (5%). During emergence, postoperative nausea/vomiting was more frequent after halothane anesthesia. Initially, postoperative excitement occurred more often after sevoflurane, when paracetamol was given during anesthesia, which was reduced (P<0.01) when paracetamol was given at the time for premedication. It is concluded that sevoflurane is an excellent induction agent, and maintains heart rate and systolic blood pressure better than when halothane is used. The incidence of cardiac arrhytmia is lower with sevoflurane than with halothane. Sevoflurane anesthesia does, however, result in a high rate of postoperative excitement after ENT surgery, a factor that must be addressed prior to anesthesia.
The effect of ketanserin upon postoperative blood pressure, cerebral blood flow and oxygen metabolism in patients subjected to craniotomy for cerebral tumours
Authors: Felding M. , Cold G. E. , Jagobsen C.‐J. , Stjernholm P. , Voss K. 
Published: January 2009

Hypertension and cerebral hyperperfusion are often seen in the immediate postoperative period after craniotomy for supratentorial tunours. This study was performed to evaluate the effect of ketanserin, given at the end of the peroperative period, upon cerebral blood flow (CBF), and cerebral metabolic rate of oxygen (CMRO2) before extubation. Mean arterial blood pressure (MABP), cerebral arterio‐venous oxygen content difference (AVDO2), PaO2, and PaCO2 were repeatedly measured during the operation, and 180 minutes after extubation. Ten patients were included in this study. The results were compared to those from a recent study in which ten patients served as control. All patients were anaesthetized with thiopentone, fentanyl, nitrous oxide 67%, halo‐thane 0.5% anesthesia. Ten patients were given ketanserin 10–20 mg (mean 18,5 mg) before extubation. There was no significant difference in CBF‐ and CMRO2 values between the two groups. During the period between closure of the dura and 5 minutes after extubation, an increase in MABP was observed in the control group (P<0.05) but not in the ketanserin group. During the same period, a decrease in AVDO2 was observed in both groups (P<0.05) and during the next 10 minutes an increase was observed. However, no difference in AVDO2 values between the two groups was found.These findings suggest that peroperative treatment with ketanserin reduces postoperative hypertension without influencing the cerebral blood flow or metabolism.
Effect of dopexamine on calculated low gastric intramucosal pH following valve replacement
Authors: Gårdebäck M. , Settergren G. , ÖHquist G. , Tirén C. 
Published: January 2009

Gastric tonometry was used to study the possible effect of dopexamine infusion on a low calculated intramucosal pH (pHi) as a sign of splanchnic ischemia.Measurements were made during surgery and for approximately 18 hours postoperatively on 19 non‐selected adult patients undergoing valve replacement. Patients developing a postoperative pHi>7.30 were randomized to receive dopexamine (2 μg · kg‐1min‐1) or placebo in a double blind fashion. Eighteen patients wore randomized, 10 to receive dopexamine and 8 to placebo.The calculated pHiremained unchanged for the first 2 hours in both groups. After 4 hours a significant (P<0.05) decrease in pHiwas noted in the dopexamine group which remained significantly below the placebo group during the monitoring period. The dopexamine treated patients had a significantly longer period of low pHibut the pH‐gap i.e. the difference between arterial pH and pHidid not differ between the two groups. Patients with postoperative complications, defined as infections (2), myocardial infarction (1), single‐ (2) or multiple organ failure and death (1), did not have longer periods with pHibelow 7.30. In these patients, however, a pH‐gap >0.12 occurred more often than in those without complications, indicating that an increased incidence of complications was related to a pH‐gap >0.12.It is our opinion that true mucosal ischemia is best detected by estimating the difference in carbon dioxide tension between arterial blood and mucosa. This can be expressed either directly as PCO2‐gap (PtonCO2‐PaCO2) or indirectly as pH‐gap.
Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms: An analysis of 75 consecutive patients with PDPH
Authors: Lybecker H. , Djernes M. , Schmidt J. F. 
Published: January 2009

Among 873 consecutive patients who had undergone a total of 1021 spinal anaesthesias involving puncture of the lumbar dura, 75 (7.35%) complained of Postdural Puncture headache. (PDPH). The severity of each patient's PDPH was categorized, on a scale from mild to severe, on the basis of the onset, duration, severity of the heActa ches, and the degree to which they were accompained by auditory and vestibular symptoms. In the patients who developed PDPH, 65% developed symptoms within 24 hours of the lumbar punctures and 92% developed symptoms within 48 hours.For the patients who recovered spontaneously the mean duration of the PDPHs was 5 days, with a range of 1–12 days. PDPH was characterized by headachches that were influenced by the patient's posture and the severity of PDPH was categorized as follows:Mild PDPH resulted in a slight restriction of their physical activity. These patients were not confined to bed and had no associated symptoms.Moderate PDPH forced the patient to stay in bed for part of the day, and resulted in restricted physical activity. Associated symptoms were not necessarily present.Severe PDPH Patients were bedridden for the entire day and made no attempt to raise their head or to stand. Associated symptoms were always present.Fortyfive of the PDPH patients (60%) recovered spontaneously. Of these, 8 patients (11%) were categorized as mild cases of PDPH, 14 (19%) as moderate, and 23 (30%) patients as severe cases of PDPH. Thirty of the PDPH patients (40%) were treated with an autologous epidural bloodpatch (AEBP). Of these, 27 patients (36%) were classified as severe and 3 patients (4%) as moderate PDPH.ASSOCIATED SYMPTOMS were present in all patients who had severe PDPH and in 86 percent of the patients who had moderate degrees of PDPH. Of all the patients with PDPH, 60% complained of nausea, 24% of vomiting, 43% of stiffness of the neck, 13% of ocular symptoms, and 12% of auditive symptoms. The headches in the PDPH patients were localized to the frontal region, bilaterally, in 25% of the cases, occipitally in 27% of the cases and in both regions in the remaining 45% of the patients.