bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective dose of granisetron in the reduction of nausea and vomiting after breast surgery
Authors: FLJJII Y. , TANAKA H. , TOYOOKA H. 
Published: January 2009

Background: Prophylactic use of granisetron, a selective Shydroxytryptamine type 3 receptor antagonist, reduces the incidence of nausea and vomiting after breast surgery. This study was undertaken to determine the minimum effective dose of granisetron in the reduction of postoperative nausea and vomiting (PONV) in patients undergoing general anaesthesia for breast surgery.Methods: In a randomized, double‐blind manner, 120 female patients aged 42–66 years were assigned to receive either placebo (saline) or granisetron in a dose of 20 μg · kg‐1, 40 μg · kg‐1 and 80 μg · kg‐1 i.v. immediately before the induction of anaesthesia. A standard general anaesthetic technique was employed throughout. The POW and safety assessments were performed continuously during the first 24 h after anaesthesia.Results: There were no significant differences among the groups with regard to patient demographics, surgical procedures, anaesthetics administered and analgesics given. The incidence of PONV was 47%, 43%, 17% and 17% after administration of placebo and granisetron 20 μg ‐kg‐1, 40 μg kg‐1 and 80 μg kg‐1, respectively. Granisetron 40 μg kg‐1 was as effective as 80 μg ‐ kg‐1 and both resulted in significant reductions of the incidence of PONV compared with placebo and granisetron 20 μg kg‐1 (P < 0.05). No differences in the incidence of adverse events were observed among the groups.Conclusion: Granisetron 40 μg · kg‐1 appears to be the minimum effective dose for reducing POW in patients undergoing general anaesthesia for breast surgery.
Eltanolone for induction of anaesthesia in the surgical patient A comparison of dose requirements in young and elderly patients
Authors: SEAR J. W. 
Published: January 2009

Background The relative potency of the steroid anaesthetic agent eltanolone has been compared with respect to induction of anaesthesia in ASA I and II young (1840: years) and elderly (>65 years) patients.Results: Anaesthesia was adequately induced in 12/40 elderly and 7/40 young patients. The lowest effective induction dose was 0.2 mg/kg in elderly and 0.3 mg/kg in young patients. This gave a relative potency of 0.28 (95% CI 0.12–52; P=0.0039). The cardiovascular effects associated with induction were small; other side‐effects included involuntary movement and hypertonus, and respiratory upsets (apnoea, hiccups and coughing).Conclusion: The effective induction dose of eltanolone was significantly lower in the elderly patients; but the drug safety profile was similar in both age groups of patients.Method:113 temazepam premedicated patients (60 elderly) were evaluated in an open randomised study. They were allocated to receive doses between 0.05 and 0.75 mg/kg given i.v. over 30 s. The first 33 patients formed a pilot phase; the formal study comprised 80 patients. The primary efficacy variable was loss of verbal contact within 120 s and an effect lasting more than 4 min. All patients breathed 100% oxygen throughout the study period. Safety data (heart rate, blood pressure, respiratory apnoea, involuntary movements, hypertonus and other adverse effects) were noted.
The effects of cardiac surgery on early and late pulmonary functions
Authors: SHENKMAN Z. , SHIR Y. , WEISS Y. G. , BLEIBERG B. , GROSS D. 
Published: January 2009

Background: Impaired pulmonary functions are common in cardiac patients. Early and late effects of cardiac surgery on pulmonary function tests (PFTs) are presented.Methods: Fifty patients undergoing cardiac surgery (coronary artery bypass grafting [CABG, 74%], valve replacement or val‐vuloplasty [20%] and combined procedures [6%]) were studied. Anginal and cardiac failure symptoms severity, and smoking history, were evaluated preoperatively. PETS were studied and compared pre‐, and 3 weeks and 3.5 months postoperatively.Results: Pre‐ and postoperative PFTs were inversely related to severity of preoperative symptoms. Forced vital capacity (FVC) dropped from 98% of predicted preoperatively, to 63% (P < 0.00001) and 75% (P < 0.0001) 3 weeks and 3.5 months postoperatively, respectively. Expiratory volume in the first 1 s of forced expiration (FEW.O) decreased from 95% to 61% (P < 0.00001) and 70% (P < 0.00001), respectively. Forced expiratory flow at 50% of vital capacity (FEF50) decreased from 85% to 56% (P < 0.00001) and 59% (P < 0.00001). Forced expiratory flow at 75% of vital capacity (FEF75) decreased from 77% to 47% and 47% (P < 0.00001). Peak expiratory flow rate (PEFR) declined from 101% to 66% (P < 0.00001) and 86% (P < 0.003). Maximal voluntary ventilation declined from 103% to 68% (P < 0.00001) and 77% (P < 0.00001). Only FVC (P < 0.0003), FEV1.0 (P < 0.02) and PEFR (P < 0.00001) partially recovered postoperatively. Smoking history did not affect perioperative PETS. Pre‐, but not postoperative FVC, FEV1.0, FEF50 and FEF75 were worse in valve than in CABG patients.Conclusions: Pulmonary functions deteriorate significantly for at least 3.5 months after cardiac surgery. Preoperative cardiac ischaemic and failure symptoms are inversely related to perioperative PETS.
A positron emission tomography study of cerebral blood flow and oxygen metabolism in healthy male volunteers anaesthetized with eltanolone
Authors: WESSÉAN A. , WIDMAN M. , ANDERSSON J. , HARTVIG P. , VALIND S. , HETTA J. , LÅNGSTRÖM B. 
Published: January 2009

Background: The effects of eltanolone anaesthesia in humans on regional cerebral blood flow, regional cerebral metabolic rate of oxygen and oxygen extraction ratio were to be evaluated using positron emission tomography (PET).Methods: Six healthy male volunteers were studied. Series of PET‐measurements with 15O and H215O were carried out in the awake state (baseline) (n=6), during eltanolone anaesthesia (n= 5) and during early recovery (n=5), when the subjects were oriented with respect to person, place and time. Eltanolone was given as a programmed infusion.Results: Cerebral blood flow (rCBF) was reduced in almost all cortex regions studied by 31216% (meanSD, P < 0.01). During recovery KBF increased to 10926% of pre‐anaesthetic baseline levels (P < 0.01). Eltanolone in the doses administered lowered oxygen metabolism (rCMRO2) by 528% (P < 0.01) in cortex regions. During recovery rCMRO2 increased to 9013% of baseline (P < 0.01). The oxygen extraction (OER) in cortical regions decreased by 32223% (P < 0.01) during anaesthesia and returned to 82210% of baseline (P < 0.01) during recovery. Less reduction in cortical blood flow during eltanolone anaesthesia was seen in the uncus (P < 0.01), though no differences in the depression of oxygen metabolism were seen. Oxygen extraction remained homogeneous throughout the brain.Conclusion: Eltanolone anaesthesia was shown to reduce cerebral oxygen metabolism and cerebral blood flow in healthy volunteers. There were no signs of ischaemic effects.
Obstetric outcome following epidural analgesia with bupivacaine‐adrenaline 0.25% or bupivacaine 0.125% with sufentanil ‐ a prospective randomized controlled study in 1000 parturients
Authors: Olofsson Ch. , Ekblom A. , Ekman‐Ordeberg G. , Irestedt L. 
Published: January 2009

Background: Epidural analgesia (EDA) is the most efficient method for pain relief during labour, but there is still a debate as to whether it interferes with the normal process of delivery. Some authors argue that the incidence of instrumental deliveries, Caesarean section, malrotation and protracted labour is increased in parturients receiving EDA.Methods: 1000 parturients were prospectively randomized to receive EDA either with a high dose of local anaesthetic (0.25% bupivacaine with adrenaline=HD) or with a low dose (0.125% bupivacaine with sufentanil 10 μg=LD).Results: The incidence of instrumental delivery and Caesarean section and the need for oxytocin was reduced in the LD compared to HD group. The delivery time was similar with HD and LD among primiparous, but decreased significantly among multiparous in the LD group. The incidence of malrotation was low in both groups. The quality of analgesia was equal during the first stage in the 2 groups, but was lower in the LD group during the second stage. More parturients in the LD group ambulated, but this did not affect the incidence of instrumental delivery.Conclusion: It is concluded that a lower dosage of bupivacaine combined with sufentanil in epidural analgesia significantly improves the obstetric outcome as compared to a higher dosage of bupivacaine with adrenaline using intermittent bolus technique.
Efficacy of propacetamol in the treatment of postoperative pain Morphine‐sparing effect in orthopedic surgery
Authors: Peduto V. A. , Ballabio M. , Stefanini S. 
Published: January 2009

Background: Combined analgesic regimens have been suggested to improve the treatment of postoperative pain. The aim of our study was to evaluate the analgesic efficacy and tolerability of propacetamol, in combination with morphine.Methods: Four i.v. infusions of propacetamol 2 g or placebo were administered, in a double‐blind fashion, after orthopedic surgery (n=97). Morphine was administered by a patient‐controlled analgesia (PCA) device. The total dose of morphine, pain intensity and global efficacy of treatment were evaluated. Tolerability was assessed by monitoring blood pressure, heart and respiratory rate, sedation scores, adverse events, and renal and hepatic parameters.Results: The total dose of morphine was significantly decreased in the propacetamol group compared to placebo (9.4±8.5 mg vs 17.6±12 mg; P< 0.001), arriving at a sparing effect of 46%. The evolution of pain intensity showed a similar pattern in the two groups. Global efficacy of treatment was rated significantly better by patients receiving the combination propacetamol+ PCA morphine (87% of “good”/“excellent” ratings vs 65%; P=0.01). Tolerability was comparable in the two groups. Eight patients in the propacetamol and 4 patients in the placebo group reported adverse events, of mild/moderate intensity, most commonly nausea/vomiting. Renal and hepatic parameters were also seen to be comparable.Conclusions: These results confirm a significant morphine‐sparing effect, significantly better scores in the final assessment by patients, and a good tolerability of propacetamol after orthopedic surgery. The drug may, therefore, represent a useful alternative to NSAIDs, as complementary drug to opioids, in the management of moderate/severe postoperative pain.
Plasma levels of clonidine following epidural bolus injection in children
Authors: Ivani G. , Bergendahl H. T. G. , Lampugnani E. , Eksborg S. , Jasonni V. , Palm C. , Mattioli G. , Podesta E. , Famularo A. , Lönnqvist P. A. 
Published: January 2009

Background:The use of clonidine as an adjunct to epidural administration of local anesthetics in children has been reported to substantially improve the duration and quality of postoperative analgesia. The aims of the present study were to determine the pharmacokinetic profile and to investigate the interaction between postoperative sedation and analgesia after epidurally administered clonidine in children.Methods:Plasma levels of clonidine (0–10 h postop) and assessment of postoperative analgesia and sedation (0–24 h postop) were performed at predetermined intervals following lumbar epidural administration of bupivacaine 2.0 mg/kg and clonidine 2 mg/kg in 8 children undergoing ureteral re‐implantation surgery using general anesthesia (age range: 1–9 yr, weight range: 9–11 kg). Plasma levels of clonidine were analyzed by radioimmunoassay, and sedation and analgesia were assessed by previously described scoring systems.Results: The venous plasma pharmacokinetics of clonidine following epidural administration showed a considerable interindividual variation. Cmaxand Tmaxvalues of clonidine were found to be within the 0.45–0.77 ng/mL and 48–193 min range, respectively. The time to absorb 95% of the clonidine dose from the epidural space into plasma varied between 36 min and 7.6 h. In 6 of the 8 patients postoperative analgesia substantially outlasted the duration of sedation (≥2 h). Sedation could not be detected in any patients at plasma concentrations below 0.3 ng/mL.Conclusions:The pharmacokinetic profile associated with epidural clonidine administration in children (1–9 y) was similar to that previously reported in adults. The postoperative analgesia seen after administration of epidural bupivacaine‐clonidine during general anesthesia in children cannot only be explained by residual postoperative sedation.
Granisetron prevents nausea and vomiting during spinal anaesthesia for caesarean section
Authors: Fujii Y. , Tanaka H. , Toyooka H. 
Published: January 2009

Background: Nausea and vomiting during spinal anaesthesia for caesarean section are common and unpleasant complications. This study was undertaken to evaluate the efficacy of granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, for prophylactic treatment of nausea and vomiting in parturients undergoing nonemergent caesarean section under spinal anaesthesia.Methods: In a randomized, double‐blind, placebo‐controlled trial, 100 patients, 21–38 years, received either placebo (saline) or granisetron at 3 different doses (20 μg · kg‐1, 40 μg · kg‐1 or 80 μg · kg‐1) (n=25 for each) intravenously immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during spinal anaesthesia for caesarean section.Results: The treatment groups were similar with regard to maternal characteristics and operative management. The incidence of nausea and vomiting was 64%, 52%, 14% and 12% after administration of placebo and granisetron in a dose of 20 μg · kg‐1, 40 μg · kg‐1 and 80 μg · kg‐1, respectively (P<0.05; overall Fisher's exact probability test). No clinically important adverse effects were observed in any group.Conclusions: Prophylactic use of granisetron in a minimum dose of 40 μg · kg‐1 is effective for preventing nausea and vomiting during spinal anaesthesia for caesarean section.© Acta Anaesthesiologiat Scandinavica 42 (1998)
Operations on patients deemed “unfit for operation and anaesthesia”: What are the consequences?
Authors: Prause G. , Ratzenhofer‐Komenda B. , Smolle‐Juettner F. , Krenn H. , Pojer H. , Toller W. , Voit H. , Offner A. , Smolle J. 
Published: January 2009

Background: The decision “patient unfit for anaesthesia and operation” is likely to cause a delay of the scheduled operation. This retrospective evaluation was done: 1) to determine the correctness of preoperative tentative diagnoses of coexisting diseases making anaesthesia and operation excessively risky in relation to the physician's training status; 2) to examine the question of whether preoperative medical management modified according to the anaesthesiologist's suggestions had a positive impact on the perioperative course.Methods: The medical records of patients scheduled for elective non‐cardiac surgery who were rated “unfit for operation and anaesthesia” were evaluated. The accuracy of the tentative diagnoses was examined for relation to the training status of the anaesthesiologists. The preoperative management was tested for its impact on postoperative outcome.Results: During the observation period 16 122 patients underwent preoperative anaesthesiological assessment; 1021(6.3%) were initially considered to be unfit for operation and anaesthesia. The records of 807 patients were available for review. The accuracy of the tentative diagnoses was 70%, and was not significantly affected by the training status of the physicians (P= 0.022). Four hundred and seventeen patients were excluded from the second part of the investigation (discharged without operation, underwent operation using local anaesthesia or tentative diagnosis not confirmed). Three hundred and ninety patients were operated under general anaesthesia. Group I (n= 216) was managed according to the anaesthesiologist's suggestions and was found to have a significantly lower complication rate (18.1%) than group II (n=174) in which the suggestions from the preoperative assessment were ignored (32.2%; P<0.05). The perioperative mortality rate in group I was 2.3% compared with 5.2% in group II (n.s.; P>0.05).Conclusions: We conclude that the anaesthesiology decision “patient unfit for operation and anaesthesia” has a high accuracy, independent of the anaesthesiologist's training status, and that preoperative medical management significantly reduces complications.
Pharmacokinetics and clinical effects of intramuscular scopolamine plus morphine A comparison of two injection sites
Authors: Kentala E. , Scheinin H. , Kaila T. , Seppälä T. , Kanto J. 
Published: January 2009

Background: Intramuscular scopolamine plus morphine pre‐medication is traditionally used when prominent sedative or antisialogogue effect is needed. Knowledge of the pharmacokinetics of scopolamine is limited due to low plasma concentrations found after therapeutic doses. This investigation compares the pharmacokinetics and the clinical responses of this drug combination injected into two commonly used injection sites.Methods: Twelve ASA class 1 patients scheduled for minor surgery under spinal anaesthesia received scopolamine 6 μg/kg plus morphine 200 μg/kg injected in either deltoid (group D, n=6) or gluteal (group G, n=6) muscle.Results: The peak plasma concentrations of scopolamine after deltoid or gluteal injection (2.2 vs 1.6 μg/1) and the time they were reached (17 vs 19 min) were comparable. The absorption of morphine was similar in both groups (Tmax 16 min), but the peak plasma concentrations were higher after deltoid injection (71 vs 49 μg/1). The individual variation in the elimination half‐lives of both scopolamine and morphine was smaller after deltoid injection (T½ scopolamine 1.9±0.7 vs 2.1±1.1 h, morphine 1.3±0.7 vs 2.3±1.5 h). Moderate slowing (25%) of heart rate was found in both groups. A heavy sedation and antisialogogue effect (VAS) was found in both groups with faster occurrence of maximal effect in group D (60 vs 120–180 min).Conclusion: More predictable pharmacokinetics and clinical effects of intramuscular scopolamine plus morphine premedication can be achieved after an injection into deltoid muscle.
Forced‐air surface warming versus oesophageal heat exchanger in the prevention of peroperative hypothermia
Authors: Hovmann Rasmussen Y. , Leikersfeldt G. , Drenck N.‐E. 
Published: January 2009

Background: In a prospective, randomized, placebo‐controlled study we investigated the efficacy of 2 different heating methods in 24 patients undergoing abdominal surgery of at least 2 h expected duration.Methods: Group I: control, no active warming. Group II: forced‐air surface warming on upper extremities and upper thorax. Group III: warming with oesophageal heat exchanger. All patients had a standardized, combined general and epidural anaesthesia. Core and skin temperatures were measured at induction of general anaesthesia, and subsequently every 30 min, and changes in total body temperature were calculated.Results: There were no statistically significant differences between the 3 groups regarding demographic data. Patients in groups I and III developed hypothermia, while this was not the case with patients in group II. When using analysis of variance with repeated measurements, there was no significant difference in core temperature, comparing group I and group III (P=0.299) or the interaction between time and treatment of these groups (P=0.373). As a consequence, data from groups I and III were pooled and regarded as an internal group on the one hand, and group II as an external group on the other hand. Core temperature, the mean skin temperature and total body temperature were significantly different comparing the internal group and the external group. The interaction between time and treatment was likewise found to be significantly different.Conclusions: We conclude that in major abdominal procedures lasting 2 h or more, serious hypothermia develops unless effective measures to prevent hypothermia are used. Forced‐air warming of the upper part of the body is effective in maintaining normothermia in these patients, while central heating with an oesophageal heat exchanger, at least in its present form, does not suffice to prevent hypothermia.
Effects of inhaled nitric oxide on platelet‐activating factor‐induced pulmonary hypertension in dogs
Authors: Yamada T. , Yukioka H. , Hayashi M. , Asada A. , Inoue M. 
Published: January 2009

Background:Platelet‐activating factor (PAF), a lipid mediator released during endotoxin shock, induces pulmonary hypertension, systemic hypotension and cardiac dysfunction. In this study, we compared the effect of inhaled nitric oxide (NO) on PAF‐induced pulmonary hypertension and NO metabolism with that on pulmonary hypertension induced by a stable thromboxane A2mimetic, U46619. Since PAF‐induced hypotension might be mediated by NO, the effect of inhaled NO combined with an intravenously administered NO synthase inhibitor, NG‐nitro‐L‐arginine (L‐NNA), on PAF‐induced hemodynamic change was also investigated.Methods:In a total of 28 beagles anesthetized with pentobarbital the following substances were intravenously administered: PAF 0.56±0.30 μg·kg‐1·min‐1(group PAF), L‐NNA 10 mg·kg‐1+ PAF 0.04±0.03 μg·kg‐1· min‐1(group L‐NNA+ PAF), U46619 0.60±0.11 μg·kg‐1·min‐1(group U46619) or L‐NNA 10 mg·kg‐1+ U46619 0.61±0.23 μg·kg‐1· min‐1(group L‐NNA+U46619) to obtain a mean pulmonary arterial pressure (MPAP) of 25 mmHg. Nitric oxide was then inhaled at 5, 10, 20 and 40 ppm for 15 min at 15‐min intervals in the order of increasing concentration. An additional 7 dogs (control group) inhaled NO at normal MPAP (17 mmHg). Hemodynamic and respiratory parameters, NOHb, NO2‐+NO3‐, and MetHb levels in blood were measured before and during NO administration.Results:In the control group, hemodynamic and respiratory values did not change significantly during NO administration. In group PAF, NO significantly reversed the PAF‐induced pulmonary hypertension. PAF induced a marked systemic hypotension and cardiac output reduction, but these changes were not affected by inhalation of NO. L‐NNA pretreatment markedly decreased the dose of PAF required to maintain a MPAP of 25 mmHg, and abolished the PAF‐induced hypotension. In group L‐NNA+PAF, the diminishing effect of inhaled NO on pulmonary vascular resistance (PVR) was significantly greater than that in group PAF. U46619 induced pulmonary hypertension and increases in blood pressure, intrapulmonary shunt and peak airway pressure. L‐NNA pretreatment did not change the dose of U46619 required to maintain a MPAP of 25 mmHg. The effects of inhaled NO on PVR decrease were similar in groups U46619 and L‐NNA+U46619. No NOHb was detected in any group. NO2‐+NO3‐concentration increased during NO administrations. There were no significant differences in NO2‐+NO3‐concentration among groups.Conclusions:Inhaled NO at the dose of 5–40 ppm effectively reversed PAF‐induced pulmonary hypertension, especially following pretreatment with L‐NNA. Inhaled NO did not affect PAF‐induced hypotension or cardiac dysfunction. These findings indicate that low concentrations of inhaled NO may be useful in reversing pulmonary hypertension in the endotoxemia where PAF may be one mediator.