bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia
Authors: SCHWILK B. , BOTHNER U. , SCHRAAC S. , GEORGIEFF M. 
Published: January 2009

Background: The prevalence of respiratory diseases in smokers and nonsmokers and the incidence of perioperative respiratory events (PREs) were investigated for patients undergoing general anaesthesia. The aim was to quantify well‐known problems and to identify possible new associations between smoking and PREs.Methods: From July 1992 to December 1994, risk factors, demographic data, and PREs were documented by an automatically readable anaesthetic record (ARAR). PREs were used as defined by the German Society of Anaesthesiology and Intensive Care.Results: Of 26 961 subsequent anaesthesias in adults, 7122 (26.4%) were performed in smokers with a prevalence of chronic bronchitis of 23.3% (4.8% in nonsmokers). 1573 PREs occurred in 1397 (5.2%) of all anaesthetics. 459 events concerned intubation problems and problems in technical airway management. 1114 specific respiratory events (SPREs) like re‐intubation, laryngospasm, bronchospasm, aspiration, hy‐poventilation/hypoxaemia and others had a total incidence of 5.5% in smokers and 3.1% in nonsmokers. The relative risk (RR) of SPREs was 1.8 in all smokers, 2.3 in young (16–39 years) smokers, and 6.3 in obese young smokers. The RR of perioperative bronchospasm was 25.7 in young smokers with chronic bronchitis.Conclusion: The impact of smoking on perioperative respiratory problems should make anaesthetists take this widespread preoperative condition seriously, particularly in young adults. The presented method of incident reporting (based on a national classification) could contribute to future research in anaesthetic epidemiology.
The claims of compensation for awareness with recall during general anaesthesia in Finland
Authors: RANTA S. , RANTA V. , AROMAA U. 
Published: January 2009

Background: Awareness during anaesthesia has been estimated to occur in 0.2%‐0.4% of patients undergoing general surgery. In Finland, according to the Patient Injury Act, compensation is paid for an injury caused by medical treatment. We have analysed the claims for compensation involving awareness under anaesthesia filed between May, 1987 and December, 1993.Methods: Original claims, hospital notes, and expert advisor's comments as well as the comments of the anaesthesiologist in charge of the anaesthesia, and decisions of the Patient Injury Association, were reviewed.Results: A total of 23 363 claims of patient injury were made during the study period. Of these, 391 considered anaesthetic treatments, and there were four cases of awareness with recall.Conclusion: Claims of compensation for awareness during anaesthesia were surprisingly few, possible reasons of which are discussed. Compensations paid were low in comparison with some other countries.
Effect of esmolol on the heart rate, arterial pressure and electrocardiographic changes during laryngomicroscopy
Authors: KORPINEN R. , SIMOLA M. , SAARNIVAARA L. 
Published: January 2009

Background: Laryngomicroscopy causes considerable haemo‐dynamic and ECG changes and therefore requires high doses of anaesthetic agents, which prolong recovery. In this double‐blind randomized work, we studied the effect of esmolol, a short‐acting beta‐adrenergic receptor‐blocking agent, on haemodyn‐amic and ECG changes during laryngomicroscopy under thio‐pental‐alfentanil‐isoflurane‐suxamethonium anaesthesia.Methods: Forty ASA class I‐II patients (mean age 43±11 yr) were allocated to receive either esmolol 1 mg·kg‐1+200 μg·kg‐1· min‐1 (the esmolol group) or saline (the control group). Heart rate and arterial pressure were measured non‐invasively and ECG was analyzed with the aid of a microcomputer. Comparisons between the groups were performed using two‐way analysis of variance with repeated measures and the Student's t‐test.Results: In the presence of esmolol, neither the heart rate nor the QTc interval of the ECG increased significantly when com pared with the baseline values, with the exception that the QTc interval was increased after intubation. The increase in arterial pressure after insertion of the operating laryngoscope was not prevented in esmolol‐treated patients. No cardiac arrhythmias occurred in either of the groups.Conclusions: On the basis of the present study, esmolol‐bolus +infusion during alfentanil‐isoflurane anaesthesia in healthy, middle‐aged patients is a useful treatment in circumstances where an increase of the heart rate, prolongation of the QTc interval and cardiac arrhythmias should be avoided.
Different effects of halothane, isoflurane and sevoflurane on sarcoplasmic reticulum of vascular smooth muscle in dog mesenteric artery
Authors: YAMAMOTO M. , HATANO Y. , KAKUYAMA M. , NAKAMURA K. , TACHIBANA T. , MAEDA H. , MORI K. 
Published: January 2009

Background:The direct effect of halothane on vascular smooth muscle is mediated in part via its effects on the sarcoplasmic reticulum (SR). Little information is available concerning the effects of other volatile anesthetics including isoflurane and sevoflurane, whose vascular effects differ from those of halothane. The aim of the present study was to compare the effects of halothane, isoflurane and sevoflurane on the SR by testing the contraction induced by caffeine in vascular smooth muscle.Methods:Rings without endothelium from isolated canine mesenteric artery were mounted in physiological saline solution (PSS) for isometric tension recording. After complete depletion of Ca2+from the SR by adding 35 mM caffeine, the rings were exposed to normal Ca2+containing PSS (Ca2+loading), to Ca2+‐free PSS for 10 min, and then to 15 mM caffeine to induce contraction. Anesthetics were administered during Ca2+loading, the Ca2+‐free phase and simultaneously with caffeine administration.Results:Halothane (0.5‐2%) attenuated the caffeine‐induced contraction of canine mesenteric artery when administered during Ca2+loading in the SR (P<0.001), whereas isoflurane and sevoflurane (1–4%) failed to affect the contraction. When given simultaneously with caffeine, halothane (1–2%) potentiated the caffeine‐induced contraction (P<0.05), but isoflurane and sevoflurane had no effect. When given before caffeine administration, halothane (0.5‐2%), isoflurane (24%) and sevoflurane (4%) all potentiated the caffeine‐induced contraction (P<0.05).Conclusion:It has been shown that halothane not only potentiates caffeine‐ induced Ca2+release from the SR, but also induces contraction by releasing Ca2+from the SR. We conclude that halothane decreases Ca2+accumulation in the SR while exerting facilitative and additive effects on caffeine‐induced Ca2+release from the SR when applied before caffeine administration and simultaneously with caffeine, respectively, whereas isoflurane and sevoflurane lack both the ability to decrease Ca2+accumulation and an additive effect on caffeine‐induced Ca2+release from the SR, but are able to facilitate Ca2+release by caffeine.
Preoperative glutamine loading does not prevent endotoxemia in cardiac surgery
Authors: SUOJARANTA‐YLINEN R. , RUOKONEN E. , PULKKI K. , MERTSOLA J. , TAKALA J. 
Published: January 2009

Background: The presence of endotoxemia is relatively common in cardiac surgery patients and it may modify the metabolic and hemodynamic responses peri‐ and postoperatively. Impaired gut fuel metabolism may contribute to the disturbed function and deterioration of the intestinal mucosal barrier and the development of bacterial translocation and endotoxemia. Glutamine may protect the gut mucosal barrier during marginal or insufficient perfusion.Methods: We studied the effects of glutamine supplementation on endotoxemia and blood levels of tumor necrosis factor (TNF) during and after extracorporeal circulation (ECC) and the effects of endotoxemia on systemic and regional (splanchnic and leg) hemodynamics and metabolism after cardiac surgery. Nineteen elective coronary bypass patients were randomly assigned to receive preoperatively for 12 h either an infusion of glucose and a balanced amino acid solution (AA‐group) or a solution containing 1/5 of total nitrogen as alanyl‐glutamine (ALAGLN‐group).Results: Glutamine and amino acid loading before ECC did not protect from peri‐ or postoperative endotoxemia. Endotoxemia was detected in 5 vs. 7 of patients during ECC and 6 vs. 5 of patients postoperatively in the ALAGLN‐group vs. AA‐group, respectively. More than half of the patients at every measurement had an increased level of TNF. There was no consistent difference between the arterial and hepatic vein endotoxin‐ or TNF‐concentrations. Endotoxemia did not modify systemic or regional hemodynamics and metabolism after cardiac operationConclusion: Glutamine did not prevent endotoxemia during or after cardiac surgery. An increased level of TNF was common and observed also in some patients without endotoxemia. Endotoxemia did not mode regional or whole‐body metabolic patterns or hemodynamics.
Effects of dopamine, dopexamine and dobutamine on renal excretory function during experimental sepsis in conscious rats
Authors: PALSSON J. , RICKSTEN S.‐E. , HOULTZ E. , LUNDIN S. 
Published: January 2009

Background:Acute renal failure is a frequent complication in human sepsis. Various inotropic drugs are often used to improve central haemodynamics and renal function. The differential preservative role of the most commonly used inotropic drugs on renal function, in this condition, has previously not been extensively studied. The aim of this experimental animal study was therefore to compare the preserving effects of dopamine, dopexamine, dobutamine and saline on renal excretory function, after induction of sepsis in conscious rats.Method:The effects of dopamine (DA) (2.5 μg · kg‐1· min‐1; n= 11), dopexamine (DX) (1 μg·kg‐1· min‐1; n=10), dobutamine (DB) (5 μg·kg‐1· min‐1; n=10) and saline (n=13) on the glom‐erular filtration rate (GFR), urine flow (UF), sodium excretion (SE) and fractional urinary excretion of sodium (FUENa) were studied and compared in conscious rats subjected to a 1‐h infusion of live E.colibacteria (109/h).Results:In the saline‐treated control group, bacteria infusion decreased GFR, UF, SE and FUENaby 31%, 53%, 51% and 36% respectively, associated with a 16% decrease in mean arterial pressure (MAP), and a 10% increase in heart rate (HR). In the post‐E. colitreatment period, the fall in MAP was less pronounced with DX compared to both DB and control, while there was no difference between DX and DA. The increase in HR was most pronounced with DB. GFR decreased to a lesser extent with DX compared to DA, DB and control. UF and SE were better maintained with DX compared to DB and control, while there was no difference in FUENabetween the groups.Conclusion:We conclude that dopexamine, to a greater extent than dopamine and dobutamine, improves renal excretory function in experimental septic shock.
Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients
Authors: DUMONT L. , MATTYS M. , MARDIROSOFF C. , VERVLOESEM N. , ALLÉ J. L. , MASSAUT J. 
Published: January 2009

Background: Obesity is an important respiratory risk factor after abdominal surgery. Laparoscopic surgical techniques seem beneficial in obese patients in terms of respiratory morbidity, with a faster return to normal respiratory function. However, there is little information about intraoperative respiratory mechanics and about patient tolerance to abdominal insufflation in the morbidly obese.Methods: We studied respiratory mechanics and arterial blood gases in 15 morbidly obese patients (mean BMI=45) undergoing laparoscopic gastroplasty under general anaesthesia and controlled ventilation. Respiratory mechanics were analysed using side‐stream spirometry.Results:When compared to preinsufflation values, servocon‐trolled abdominal insufflation to 2.26 kPa caused a significant decrease in respiratory system compliance (31%), a significant increase in peak (17%) and plateau (32%) airway pressures at constant tidal volume with a significant hypercapnia but no change in arterial O2 saturation. Respiratory system compliance and pulmonary insufflation pressures returned to baseline values after abdominal deflation.Conclusion: These alterations in pulmonary mechanics are less than those observed with comparable degrees of abdominal inflation in non‐obese patients, and were well tolerated. From the point of view of intraoperative respiratory mechanics, laparoscopic surgery is safe in morbidly obese patients.
Oral ketamine therapy in the treatment of postamputation stump pain
Authors: NIKOLAJSEN L. , HANSEN P. O. , JENSEN T. S. 
Published: January 2009

Background: Hyperacti vity of N‐methy l‐D‐aspartate (NMD A) receptors may be one of the factors in the maintenance of post‐amputation stump pain.Conclusion: NMDA receptor antagonists may have a potential in the treatment of neuropathic pain, including stump pain.
Severe complications associated with epidural and spinal anaesthesias in Finland 1987–1993 A study based on patient insurance claims
Authors: AROMAA U. , LAHDENSUU M. , COZANITIS D. A. 
Published: January 2009

Background: The Patient Injury Act has been in effect in Finland since 1 May 1987. This legislation is a no‐fault compensation scheme and implies that if a patient during the course of medical treatment suffers any injury as a result of that treatment he or she may file a claim to the Patient Insurance Association (HA). From 1 May 1987to 31 December 1993, 23 500claims for compensation were made.Methods:All claims made to PIA involving spinal and epidural anaesthesias during the above period were collected and reviewed and a data base was prepared. The total number of anaesthetics given during this period was estimated by sending questionnaires to every hospitalin the country.Results: Eighty‐six claims were associated with spinal and/or epidural anaesthesia. Respectively, the total the number of spinal and epidural anaesthesias administered was 550 000 and 170 000. There were 25 serious complications associated with spinal anaesthesia: cardiac arrests (2), paraplegia (5), permanent cauda equina syndrome (l), peroneal nerve paresis (6), neurological deficits (7), and bacterial infections (4). The 9 serious complications which were associated with epidural anaesthesia were: paraparesis (l), permanent cauda equina syndrome (I), peroneal nerve paresis (l), neurological deficit (I), bacterial infections (2), acute toxic reactions related to the anaesthetic solution (2), and overdose of epidural opioid (1).Cxxonclusions:According to this material the incidence of serious complications was 0.45:lO 000 following spinal and 0.52:lO 000 following epidural anaesthesia.
Preoperative infiltration of bupivacaine ‐ effects on pain relief and trauma response (cortisol and interleukin‐6)
Authors: ERIKSSON‐MJOBERG M. , KRISTIANSSON M. , CARLSTROM K. , EKLUND J. , GUSTAFSSON L. L. , ÖLUND A. 
Published: January 2009

Hypothesis: Subcutaneous infiltration of bupivacaine before skin incision can reduce postoperative pain and modulate the stress response.Methods: In a randomized study on pain relief after hysterectomy 29 patients were referred into one of three groups, receiving 30 ml of bupivacaine 0.25% with adrenaline, 30 ml of saline or no infiltration along the line of the proposed incision 10 min before start of surgery. A Visual Analogue Scale was used for repeated pain ratings. Postoperative pain relief was provided with patient‐controlled analgesia with intravenous morphine 0.04 mg/kg. Lockout time was 10 min. The immuno‐logical and endocrine stress response to trauma was reflected by blood interleukin‐6 (IL‐6) and cortisol concentrations measured during 72 h following skin incision.Results: There were large individual variations in the accumulated postoperative consumption of morphine at 20 h after start of surgery. It was significantly reduced in patients receiving infiltration of bupivacaine. They used 39 mg (9–62) median (range) of intravenous morphine whereas the patients in the saline group used 65 mg (47–120) and patients in the control group used 54 mg (36–130) (P <0.05). Significant elevation of plasma IL‐6 and serum cortisol levels appeared in all groups with peak values at 3 h. There were no differences between the groups. There was a correlation between cortisol and IL‐6. Six of the 29 patients had a postoperative infection which was reflected in increased IL‐6 levels.Conclusion: Preoperative subcutaneous infiltration of bupivacaine significantly reduced the postoperative consumption of intravenous morphine.
Antinociceptive effect of perioperative adenosine infusion in abdominal hysterectomy
Authors: SEGERDAHL M. , IRESTEDT L. , SOLLEVI A. 
Published: January 2009

Background:Adenosine (ADO), and stable analogs thereof, have been shown to exert antinociceptive action in cutaneous and deep somatic pain under experimental and clinical conditions in animals and in humans. The aims of this randomized double‐blind placebo‐controlled study were to evaluate if a low dose of intravenous (i.v.) ADO could reduce the requirements of volatile anesthetic and postoperative opioid in connection to hysterectomy, where visceral nociception significantly contributes to pain.Methods:Forty‐three women, age 32–65 years, ASA I and 11, scheduled for abdominal hysterectomy, were assigned to receive an i.v. infusion of either adenosine, 80 μg. kg‐1min‐1, or placebo during surgery. Anesthesia was maintained with isoflurane (ISO)/N2O/ O2inhalation. Postoperatively, a reduced dose of 40 μg. kg‐1. min‐1was continued for 3 h.Results:The end‐tidal (ET‐) IS0 was equal between groups before surgery. During surgery, the IS0 requirement was increased, compared to the preoperative level, in the placebo group, while the requirement declined in the ADO group. The overall IS0 requirement in the ADO group was reduced by 36% (P<0.002). The first 24 h postoperative opioid requirement, with equal resting pain in both groups, was 18% (P< 0.05)lower in the ADO group.Conclusion:A low dose of perioperative adenosine infusion in abdominal hysterectomy reduces the requirements of volatile anesthetic and postoperative opioid analgesic.
Analysis of anaesthesia in patients suspected to be susceptible to malignant hyperthermia before diagnostic in vitro contracture test
Authors: BENDIXEN D. , SKOVGAARD L. T. , ØRDING H. 
Published: January 2009

Background: It is well known that patients susceptible to malignant hyperthermia (MH) do not always develop clinical signs of MH at their first anaesthetic. Large material concerning this epidemiological problem do not exist. Therefore, we undertook the present investigation at the Danish Malignant Hyperthermia Register.Methods: Retrospective analysis of anaesthetics given to 371 patients before in vitro contracture test (IVCT) for susceptibility to MH or before death of MH. Patients (or relatives in the case of a dead patient) gave information about previous anaesthetics and anaesthetic charts were collected and reviewed.Results: Fifteen patients died of clinical MH, 112 patients survived an episode of suspected MH, and 244 patients were relatives of the above. Of the 127 patients with clinical signs of MH, 37% had received anaesthesia before, and trigger agents (potent inhalational agents and /or suxamethonium) were used in 98% of patients with no statistical difference between MH‐susceptible (MHS) and non‐susceptible (MHN) patients. Emergency anaesthesia was more frequent in patients with fulminant MH compared to those with abortive forms of MH (P< 0.01). Of the 244 relatives, 48% had received anaesthesia before MH was suspected in the family and trigger agents were used in 44% of the anaesthetics without statistical difference between MHS and MHN relatives. In 17 cases, trigger agents were used for anaesthesia after MH was suspected in the family, but before IVCT.Conclusion: The clinical expressivity of the MHS phenotype was found to be 34%‐54%.
Can final EMG baseline be used as a reference to calculate neuromuscular recoverv?
Authors: MERETOJA O. A. , THEROUX M. 
Published: January 2009

Background: Investigations recording recovery times of muscle relaxants have used initial or final baseline of a neuromuscular trace, or both, as a reference for data analysis. We evaluated the use of final baseline of EMG traces as a reliable reference to calculate recovery times.Methods: We analyzed EMG traces from 82 children who had full spontaneous neuromuscular recovery following a single dose of mivacurium. Times from administration of mivacurium to 25, 50, 75, and 90% EMG recoveries were measured using both initial and final baselines as a reference. EMG traces with final baseline of 100±10% of the initial baseline were regarded as optimal. Recovery times from all other traces were compared to the times obtained from these optimal traces. Poor final baseline was defined as that of<80% of initial baseline. Inter‐group comparisons were made using Kruskal‐Wallis test followed by Mann‐Whitney U tests.Results: EMG recovery times were similar for optimal traces whether the reference was the initial or the final baseline of the EMG trace. If the final baseline was used as the reference, then traces with poor final EMG baseline also showed similar neuromuscular recovery times. If the initial baseline was used as the reference for EMG traces with poor final baseline, then neuromuscular recovery times became 2655% longer (P<0.05).Conclusions: We conclude that the final baseline of an EMG trace can be used as a reference for calculations of neuromuscular recovery times following a bolus injection of mivacurium.
Nitrous oxide has different effects on the EEG and somatosensory evoked potentials during isoflurane anaesthesia in patients
Authors: PORKKALA T. , JANIT V. , KAUKINEN S. , HAKKINEN V. 
Published: January 2009

Background: Electroencephalogram (EEG) and somatosensory evoked potentials (SEPs) are altered by inhalation anaesthesia. Nitrous oxide is commonly used in combination with volatile anaesthetics. We have studied the effects of nitrous oxide on both EEG and SEPs simultaneously during isoflurane burst‐suppression anaesthesia.Methods: Twelve ASA I‐II patients undergoing abdominal or orthopaedic surgery were anaesthetized with isoflurane by mask. After intubation and relaxation the isoflurane concentration was increased to a level at which an EEG burst‐suppression pattern occurred (mean isoflurane end‐tidal concentration 1.9 (SD 0.2) %. With a stable isoflurane concentration, the patients received isoflurane‐air‐oxygen and isoflurane‐nitrous oxide‐oxygen (FiO2 0.4) in a randomized cross‐over manner. EEG and SEPs were simultaneously recorded before, and after wash‐out or wash‐in periods for nitrous oxide. The proportion of EEG suppressions as well as SEP amplitudes for cortical N20 were calculated.Results: The proportion of EEG suppressions decreased from 53.5% to 34% (P< 0.05) when air was replaced by nitrous oxide. At the same time, the cortical N20 amplitude was reduced by 69% (P < 0.01).Conclusion: The results suggest that during isoflurane anaesthesia, nitrous oxide has a different effect on EEG and cortical SEP at the same time. The effects of nitrous oxide may be mediated by cortical and subcortical generators.