bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic oxygen uptake during experimental closed‐chest cardiopulmonary resuscitation using air or pure oxygen ventilation
Authors: Rubertsson S. , Karlsson T. , Wiklund L. 
Published: January 2009

Background: Although clinical cardiopulmonary resuscitation always includes ventilation with pure oxygen, this kind of ventilation has been reported to be associated with worse neurological outcome than ventilation with air in experimental cardiopulmonary resuscitation (CPR). The aim of the present investigation was to compare the systemic oxygen uptake during experimental closed‐chest CPR including ventilation with pure oxygen or ambient air and, furthermore, to elucidate possible mechanisms of action in the regulation of pulmonary gas exchange.Methods: In 24 anesthetized piglets, 2 min of induced ventricular fibrillation and no ventilation was followed by 10 min of closed‐chest CPR including i.v. administration of 0.5 mg adrenaline (at 8 min), and in one of the experimental groups alkaline buffer (at 5 min). The piglets were randomly divided into 3 groups: air ventilation during the entire CPR period with saline administration (n=8), air ventilation during the entire CPR period plus tris buffer mixture (n=8), and air ventilation for 3 min followed by 100% oxygen with saline administration (n= 8).Results: In the group ventilated with air and treated with tris buffer mixture, cardiac output was significantly greater than in the group ventilated with pure oxygen. The arterial‐mixed venous oxygen content difference was approximately 25% greater with pure oxygen than with air ventilation; however, there was no difference in systemic oxygen uptake. Systemic oxygen uptake increased after administration of tris buffer mixture in the group ventilated with air.Conclusions: Pulmonary hypoxic vasoconstriction appeared to be abolished during CPR including pure oxygen ventilation. Blood flow, not ventilation or pulmonary gas exchange, is the limiting factor during experimental closed‐chest CPR.
Extra protein loss not caused by surgical bleeding in patients with ovarian cancer
Authors: Rehm M. , Haller M. , Brechtelsbauer H. , Akbulut C. , Finsterer U. 
Published: January 2009

Backround: Clinical experience in patients with ovarian cancer has shown special difficulties in maintaining cardiovascular stability during surgery.Methods: To evaluate the causes for this observation, 15 patients with benign ovarian tumours (group I) and 13 patients with ovarian cancer (group II) were investigated perioperatively. Plasma volume (indocyanine green‐dilution technique), hae‐matocrit, plasma protein concentration, mean arterial pressure, heart rate, and central venous pressure were measured immediately before and after cytoreductive surgery.Results: Normal values of blood‐, plasma‐, and red cell volume were determined preoperatively in both groups, and in relation to body surface area there were no intergroup differences of these parameters. In group I, the significant decrease in red cell volume of 313 ml postoperatively was compensated for by an increase in plasma volume of 371 ml (median values). In contrast to group I, the decrease in red cell volume of 328 ml in group II was not related to a significant increase in plasma volume, so that blood volume postoperatively was 483 ml lower than preoperatively, although the same standardized infusion regimen as in group I was applied. Patients of group II had a significantly higher loss of intravascular protein (49 g vs 13 g in group I), which left the intravascular space by another way than by surgical bleeding. This extra protein loss is termed Intraoperative Protein Shift (IPS).Conclusion: IPS could be an important quantity in perioperative fluid balance. We assume that different surgical procedures predispose to occurrence of differing amounts of IPS.
Catheter‐related infections following axillary vein catheterization
Authors: Martin C. , Bruder N. , Papazian L. , Saux P. , Gouin F. 
Published: January 2009

Background: The aim of this study was to determine the rate of infectious complications following axillary vein cannulation and a compare to that observed after internal jugular vein cathterization.Methods: A prospective comparative open study was carried out to determine the rate of infectious complications related to the use of catheters inserted via the axillary vein or the internal jugular vein. During the study period all patients submitted to central venous catheterization were evaluated. A total of 141 patients entered and completed the study. Catheter insertion sites were either the axillary vein punctured in the axilla, or the internal jugular vein punctured using an anterior approach. Catheter tips were cultured using a quantitative technique. Clinical information pertaining to the analysis was prospectively collected.Results: A total of 141 catheters from 141 patients entered was studied. Clinical characteristics and risk factors for catheter infection were similar in both groups. The incidence of catheter‐related infection (including catheter‐related sepsis, and bacteremia) was not different between the two groups (axillary vein: 8.1%; internal jugular vein: 7.6%). Catheter‐related bacteremia were seen at a rate of 3.7% in the internal jugular vein group and a rate of 1.6% in the axillary vein group (NS). The incidence of catheter colonization was similar in both groups (axillary vein: 14.5%; internal jugular vein: 11.4%).Conclusion: Catheter‐related infection after axillary vein catheterization was similar to that observed after internal jugular vein catheterization. The chance of developing catheter‐related sepsis was less than 10% with either route when catheters were used for the treatment of severely ill patients.
Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute‐phase protein responses in patients undergoing cardiac surgery
Authors: Brix‐Christensen V. , Tønnesen E. , Sørensen I. J. , Bilfinger T. V. , Sanchez R. G. , Stefano G. B. 
Published: January 2009

Background: Cardiac surgery with cardiopulmonary bypass (CPB) evokes a systemic inflammatory response involving the proinflammatory cytokines tumor necrosis factor‐α (TNFα), interleukin (iL)‐1, IL‐6, IL‐8 and anti‐inflammatory cytokines such as IL‐10. Like IL‐10, opioids downregulate the immune responses in vivo and in vitro, including the activity of the cytokine‐producing monocytes and granulocytes. The proinflammatory cytokines are potent inducers of the hepatic acute‐phase protein synthesis. The aim of the present study was to investigate if choice of anaesthesia, based on high‐dose opioids (fentanyl) versus low‐dose opioids influenced the release of IL‐6, IL‐8, and IL‐10. Secondly, it was investigated whether serum amyloid P‐component (SAP) is an acute‐phase protein in man such as C‐reactive protein (CRP), with which it is physically and structurally related.Methods: Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either low‐dose opioid anaesthesia consisting of thoracic epidural analgesia combined with inhalational anaesthesia (group I) or high‐dose fentanyl anaesthesia (group II). From each patient 18 blood samples were taken perioperatively. Cytokine analyses were performed with ELISA, CRP and SAP mere measured with rocket immunoelectrophoresis (REI).Results: Surgery and CPB elicited a marked, transient and almost simultaneous proinflammatory and anti‐inflammatory cytokine response with no differences between the groups. The cytokine levels returned to preoperative levels 1–3 d after operation. Anaesthesia and surgery did not affect SAP plasma levels while patients showed a major increase in CRP concentrations preceding the cytokine responses.Conclusion: CABG performed during two different anaesthetic techniques, high‐dose fentanyl versus low‐dose opioid anaesthesia, elicited a well‐defined cytokine response with minor variation in the time course of each cytokine. The cytokine production was not modified by type of anaesthesia. Finally, SAP is not an acute‐phase protein in men.
Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery
Authors: Fanelli G. , Casati Dr.A. , Aldegheri G. , Beccaria P. , Berti M. , Leoni A. 
Published: January 2009

Background: Cardiovascular function was assessed in 20 ASA I‐II patients, scheduled for elective orthopaedic surgery with tourniquet in order to compare the haemodynamic changes induced by unilateral spinal anaesthesia and combined sciaticofemoral nerve block.Methods: After baseline measurement of cardiovascular parameters, patients were randomized to receive unilateral spinal anaesthesia or combined sciatico‐femoral nerve block. Spinal anaesthesia was obtained by 8 mg of hyperbaric bupivacaine 0.5% slowly injected (speed=0.02 ml s‐1) through a 25‐G Whitacre spinal needle with the bevel orientated towards the dependent side and patients lying on their operated side for 15 min (group S, n=10). Combined sciatico‐femoral nerve block was obtained by 7 mg kg‐1 of mepivacaine 2% (group NB, n = 10). Haemodynamic variables were recorded 5, 10, 15, and 30 min after anaesthetic injection before surgery was started.Results: Anthropometric data, duration of surgery and acceptability of anaesthetic techniques were similar in the 2 groups. In 8 patients of group S, spinal block was restricted to the operated side (pinprick test and Bromage scale), while the other 2 patients developed bilateral spinal block after being turned supine. NB patients showed no haemodynamic changes during the study, whereas patients in group S showed a small but significant decrease of mean arterial blood pressure (P<0.002 vs baseline and P<0.04 vs NB), cardiac index (P<0.01 vs baseline and P0.01 vs NB), and stroke volume index (P<0.01 vs baseline and P<0.01 vs NB).Conclusion: Both sciatico‐femoral and unilateral spinal blockade provide adequate anaesthesia for unilateral leg surgery with tourniquet. The former technique affects cardiovascular performance less than the latter one.
Effects of high thoracic epidural anaesthesia on the peripheral airway reactivity in dogs
Authors: Yuan H. B. , Tang G. J. , Kou Y. R. , Lee T. Y. 
Published: January 2009

Background: It has been speculated that epidural anaesthesia may induce bronchoconstriction via the mechanism of a sympathetic blockade. However, this hypothesis has not been confirmed by any experimental evidence. Therefore, we investigated the effects of high thoracic epidural anaesthesia with neural sympathetic blockade on basal airway resistance and airway reactivity in response to bronchoconstrictive stimuli in a canine periphery lung model.Methods: Acetylcholine (Ach, 8 μg kg‐1 i.v.) or histamine (His, 3 μg kg‐1 i.v.) was administered to 7 anaesthetized mongrel dogs before and after thoracic epidural anaesthesia. Successful neuronal sympathectomy was confirmed by nitroglycerin test. The changes of peripheral airway resistance (Rp), haemodynamics, cardiac output (CO), and the recovery time for Rp from peak returning to baseline in each challenge were studied.Results: Thoracic epidural anaesthesia altered neither the baseline Rp nor the peak Rp evoked by Ach or His. However, the recovery time of the Rp was prolonged significantly after epidural anaesthesia (P<0.01) and correlated inversely with the CO in response to Ach or His challenge (Ach, r=0.542; His, r=0.651).Conclusions: Our results suggest that epidural anaesthesia with neural sympatheticblockade has no influence on the basal peripheral airway resistance; however, it prolongs the airway reactivity to Ach or His challenge, probably by the mechanism of reducing CO.
Patients' desire for information about anaesthesia: Danish attitudes
Authors: Bugge K. , Bertelsen F. , Bendtsen A. 
Published: January 2009

Background: Patients' desire for information about anaesthesia has been examined in a number of Commonwealth countries but not in Scandinavia. A questionnaire was distributed to form a basis for giving Danish patients more appropriate preoperative information.Methods: 201 preoperative patients in Denmark were asked to complete a questionnaire. The patients were divided into subgroups according to: age, gender, residential origin, ASA group, educational level, type of anaesthesia planned and number of previous anaesthetics.Results: Patients from a city area required significantly more information than patients from a rural/urban area about pre‐medication drugs, drips/catheters, pain/pain relief and complications. Men more than women preferred to know about dangerous complications. Information about pain /pain relief, duration of anaesthesia, and influence of anaesthesia on daily activities such as eating, drinking, mobilisation was given the highest priority, while unpleasant information such as about complications and needles was given the lowest priority. Meeting the anaesthetist and information about alternative methods of anaesthesia and premedication drugs were given only moderate priority. Ranking information in Denmark was significantly correlated with Scotland, Canada and Australia, despite profound differences in priority. More often than Danish patients, Australian patients felt they had right to know, and especially about complications.Conclusion: Patients from a city area required more information than patients from a rural/urban area. Information about the influence on daily activities was preferred to unpleasant information. Ranking information in Denmark was correlated with a number of Commonwealth countries.
Propofol sedation and gastric emptying in volunteers
Authors: Hammas B. , Hvarfner A. , Thörn S.‐E. , Wattwil M. 
Published: January 2009

Background: The purpose of this study was to evaluate the effects of light propofol sedation on gastric emptying and orocecal transit time (OCT).Methods: Ten healthy male volunteers were studied on 2 occasions separated by at least 1 week and were randomly allocated to receive either propofol sedation or i.v. saline as a control. During propofol sedation the volunteers were sedated to grade 2–3 on a 5‐grade scale. This was achieved by a propofol infusion of 5 mg kg‐1 h‐1 initially, which was then titrated down to a dose of 2.4±0.7 mg kg‐1 h‐1 Paracetamol absorption was used as an indirect measure of the rate of gastric emptying and OCT was determined by use of the hydrogen breath test after ingestion of raffinose. Student's t‐test for paired samples was used and the results are presented as means± SD.Results:During propofol sedation the maximum concentration of paracetamol (Cmax) was 115±26.8μl/L, time to peak concentration (Tmax) 50±38.8 min, and the area under the curve during the first 60 min (AUC604793±1538 μmolXmin/L, versus Cmax 99±20.8, Tmax 69±41.9 and AUC60 3897±1310 during saline infusion. These differences were not statistically significant. OCT was significantly shorter during the control study, 180±32.4 min, than during propofol sedation, 217±64.9 min (P<0.05).Conclusion: This study in volunteers has shown that gastric emptying of liquids seems uninfluenced by light propofol sedation. OCT was slightly prolonged during light propofol sedation.
Inhibition by midazolam of the adrenergic function in the isolated canine mesenteric vein
Authors: Kobayashi Y. , Muldoon S. M. , Kiyose M. , Hagiwara T. , Kumasaka S. , Okabe E. 
Published: January 2009

Background:Midazolam has been reported to cause hypotension or to depress sympathetic activity following intravenous injection. However, little information is available concerning the mechanism of these effects. The aim of the present study was to determine the effects of midazolam on release of noradrenaline (NA) at nerve terminals and on receptors in the venous smooth muscle.Methods:The effect of midazolam at nerve terminals was examined by measuring the amount of NA release from superfused canine mesenteric vein helical strips during electrical stimulation (ES; 5 Hz, 2 ms, 9V). The NA was quantified by high‐performance liquid chromatography with electrochemical detection; tension development evoked by ES was also recorded simultaneously. In a separate series of experiments, ring preparations from the isolated vein were mounted in Krebs‐Ringer solution for isometric tension recording to assess the effect of midazolam on α‐adrenoceptors.Results:Application of tetrodotoxin (10−6M) or replacement of superfusate with Ca2+‐free solution decreased both the release of NA and the tension development evoked by ES. Yohimbine (5X10−8M) increased the ES‐evoked release of NA, whereas it decreased tension development in the vein strips. Midazolam (10−4M) did not affect either the basal release of NA or the basal tension, but inhibited both the NA release (P<0.01) and the tension development (P<0.01) during ES; midazolam at 10−5M inhibited the tension development (P<0.05) but had no effect on NA release. In the ring preparations, midazolam (10−5and 10−4M) attenuated responses to NA (a mixed α1‐and α2‐adrenoceptor agonist, 10−8to 10−3M), phenylephrine (the α1‐adrenoceptor agonist, 10−8to 10−3M) and 5‐bromo‐6‐[2‐imidazolin‐2yl‐amino]‐quinoxaline (UK14304; the α2‐adrenoceptor agonist, 10−7to 10−3M) in a dose‐dependent manner.Conclusion:The data obtained in the present study suggest that midazolam at 10−4M may reduce venous tone by inhibiting the release of NA from sympathetic nerve endings and both α2‐ and α2‐adrenoceptor mediated smooth muscle contractions. It is also postulated that a stage of the post‐receptor transduction mechanism linked to the venous smooth muscle contraction may be more sensitive to midazolam than the NA release mechanism at nerve terminals since midazolam at the low concentration tested inhibited ES‐evoked tension development with no effect on the release of NA.
Tactile evaluation of the response to double burst stimulation decreases, but does not eliminate, the problem of postoperative residual paralysis
Authors: Fruergaard K. , Viby‐Mogensen J. , Berg H. , El‐Mahdy A. M. 
Published: January 2009

Background: Routine perioperative monitoring with accelero‐myography might prevent residual block, whereas routine tactile evaluation of the response to train‐of‐four (TOF) nerve stimulation does not. The purpose of this prospective, randomised and blinded study was to evaluate the effect of manual evaluation of the response to double burst stimulation (DBS3.3) upon the incidence of residual block.Methods: Sixty adult patients scheduled for elective abdominal surgery were included in the study. Pancuronium 0.08 to 0.1 mg kg−1 was given for relaxation and tracheal intubation. For maintenance of neuromuscular block, pancuronium 1–2 mg was administered. The patients were randomly allocated into two groups. In group DBS (double burst stimulation) the degree of block during anaesthesia was assessed by manual evaluation of the response to TOF nerve stimulation. During reversal, when no fade was detectable in the TOF response, the stimulation pattern was changed to DBS3.3. The trachea was extubated when the anaesthetist judged the neuromuscular function to have recovered adequately and no fade in the DBS3.3 response could be felt. In group CC (clinical criteria) patients were managed without the use of a nerve stimulator, and the level of neuromuscular block and reversal were evaluated solely on the basis of clinical criteria. In both groups, the TOF ratio was measured by mechanomyography immediately after tracheal extubation. Also, the ability to sustain head lift for 5 s, to protrude the tongue, to open the eyes, and to lift one arm to the opposite shoulder were tested.Results: The TOF ratio, as measured immediately after tracheal extubation, was significantly lower in group CC than in group DBS (means: 0.68 and 0.78, respectively), and the incidence of residual neuromuscular block defined as a TOF ratio <0.7 was significantly higher in group CC than in group DBS (57 and 24%, respectively). The time from the first TOF measurement until the TOF ratio reached 0.8 was significantly longer in group CC than in group DBS (means: 11.5 and 6.2 min, respectively). No significant differences between the two groups of patients were found in duration of anaesthesia, in times from end of surgery to injection of neostigmine, tracheal extubation or TOF ratio 0.8, in dose of pancuronium, or in any other postoperative variable.Conclusion: Routine perioperative manual evaluation of the responses to TOF and DBS3.3 decreased the incidence and the degree of residual block following the use of pancuronium. It did not, however, exclude clinically significant residual paralysis, nor did it influence the amount of pancuronium used during the operation, the duration of anaesthesia or the time from end of surgery to tracheal extubation or to sufficient recovery of neuromuscular function (TOF=0.8).
Use of the laryngeal mask airway during ophthalmic surgery results in stable circulation and few complications: a prospective audit
Authors: Ates̨ Y. , Alanoĝlu Z. , Uysalel A. 
Published: January 2009

Background: This study was performed to investigate airway complications related to Laryngeal Mask Airway (LMA) use in a selected group of paediatric patients undergoing ophthalmic surgery.Methods: Ninety‐four paediatric patients were enrolled. LMA was inserted under deep general anaesthesia with the standard technique previously described by Brain. Complications during induction, insertion of the LMA, maintenance of anaesthesia, removal of the LMA, emergence and on the first postoperative day were recorded. Failure of insertion, desaturation, laryngospasm, bronchospasm, vomiting, bucking, dislocation of the LMA, breath‐holding, and coughing were noted.Results: There was no significant age‐related difference in successful insertion ratio of the LMA. In two patients (2%), the LMA could not be inserted with three attempts and tracheal intubation was performed. Laryngospasm was recorded in three patients (3%), leading to desaturation in two patients (SaO295%) during insertion of the LMA. During maintenance of anaesthesia bucking occurred in one patient (1%). After removal of the LMA, incidence of early desaturation following upper airway suctioning was higher in patients with a history of frequent upper respiratory tract infection (P<0.01). Five patients (5%) had laryngospasm following the LMA removal; breath‐holding and coughing were noted in 21 (22%) patients. Circulatory reactions to insertion and removal of the LMA were minimal. The incidence of sore throat on the first postoperative day was only 1%.Conclusion: LMA can be regarded as a safe product for airway maintenance during ophthalmic surgery with a stable circulation and few complications.
1 MAC‐incision sevoflurane prevents explicit awareness during surgical skin incision and tracheal intubation
Authors: Mollestad K. E. , Heier T. , Steen P. A. , Raeder J. C. 
Published: January 2009

Background: This study tested the hypothesis that 1 MAC‐incision anesthesia secures unconsciousness during surgical skin incision and tracheal intubation.Methods: Twenty patients scheduled for gynecological laparotomy were anesthetized with sevoflurane as the sole agent. At 1 MAC‐incision steady‐state conditions, the patients were observed for autonomic /movement responses and wakefulness (response to verbal commands) in the 1‐min period following surgical skin incision and tracheal intubation.Results: Blood pressure and heart rate increased significantly secondary to both stimuli, and significantly more after tracheal intubation than skin incision. Ten and 19 patients moved in response to skin incision and tracheal intubation, respectively. None of the patients showed wakefulness.Conclusion: It is concluded that 1 MAC‐incision sevoflurane secures unconsciousness during surgical skin incision and tracheal intubation.