bluuebunny/crossref_metadata_2025_split huggingface dataset:
The end‐systolic pressure‐volume relationship and ventriculoarterial coupling in patients undergoing coronary artery bypass graft surgery
Authors: Kadoi Y. , Kawahara H. , Fujita N. 
Published: January 2009

Background: The end‐systolic pressure‐volume relationship and analysis of ventriculoarterial coupling have been established as a useful tool to determine the left ventricular performance and arterial loading conditions. The purpose of this study was to evaluate the end‐systolic pressure‐volume relationship and ventriculoarterial coupling in anesthetized patients with either a normal heart or coronary artery disease (CAD) using a transeso‐phageal echocardiography (TEE) monitor.Methods: Sixteen patients with CAD and 4 patients without ischemic disease were studied. The end‐systolic volume of the left ventricle was obtained by TEE, and the end‐systolic pressure was obtained from the brachial arterial dicrotic pressure. In order to obtain the end‐systolic pressure‐volume relationship, we plotted 7 different left ventricular end‐systolic pressures against the corresponding left ventricular end‐systolic volumes during the pressure manipulation. The linear regression obtained by this method was designated as the end‐systolic elastance (Ees). Furthermore, we calculated the effective arterial elastance (Ea) using the pressure‐volume framework.Results: We divided the patients with CAD into 3 groups: Group A: left ventricular ejection fraction (LVEF)>50%, Group B: LVEF 35–50%, Group C: LVEF<35%. We also studied a control group (Group D) who did not suffer from an ischemic heart condition. Ees in group C (1.4±0.2) was lower than in the other 3 groups (P<0.05). Ea/Ees in group C (1.9±0.1) was greater than in group A (0.7±0.1), group B (1.0±0.06) and group D (0.6±0.1)(P<0.05). There were no significant differences in Ees and Ea/Ees between group A and group D.Conclusions: We found that patients with CAD and a normal LVEF had a physiological Ea/Ees identical to the control subjects. We also demonstrated that patients with CAD and a reduced LVEF showed a deterioration in Ea/Ees.
In vitro study on antioxidant potential of various drugs used in the perioperative period
Authors: Kang M.‐Y. , Tsuchiya M. , Packer L. , Manabe M. 
Published: January 2009

Background:Since surgical trauma not only intensifies the oxidative stress by generating reactive oxygen species (ROS), but also weakens the biological defense system against ROS attack, the antioxidant activity of drugs used during the perioperative period, which possibly normalizes the impaired redox state in the patient, is of fundamental importance and great clinical interest.Methods: We have applied the phycoerythrin fluorescence‐based assay, in which 2,2′‐azobis (2‐amidinopropane) dihydro‐chloride (AAPH)‐generated peroxyl radical attacks B‐phycoerythrin (B‐PE) to lead to a sensitive decrease in its fluorescence intensity linearly, to evaluate the antioxidant activity of major drugs in anesthetic practice.Results: By the protective effect on B‐PE fluorescence decay, the antioxidant activities of the drugs were classified into three groups: Group I drugs, which only slowed B‐PE fluorescence decay (nicardipne, verapamil, diltiazem, ephedrine, aminophyl‐line, vecuronium, lidocaine, mepivacaine, midazolam, thiamylal, droperidol, ***etamine, hydroxyzine, butorphanol, prednisolone, hydrocortisone, betamethasone, dexamethasone, methylprednisolone, and furosemide); Group II drugs, which protected B‐PE oxidation completely and stopped fluorescence decay in a certain duration (dopamine, epinephrine, norepine‐phrine, dobutamine, isoproterenol, and buprenorphine); and Group III drugs, which had no protective effect on B‐PE oxidation (nitroglycerin, prostaglandin E1, neostigmine, pancuronium, suxamethonium, atropine, bupivacaine, pentazocine, and heparin).Conclusion: These results indicate that Group I and II drugs exert some antioxidant activity in vitro, as measured by their protection of fluorescence decay of B‐PE. Careful consideration of these properties might, then, serve to facilitate more efficient drug application.
Pituitary‐adrenal, hormonal changes during induced hypotension with labetalol or isoflurane for middle‐ear surgery
Authors: Matson A. M. , Shaw M. , Loughnan B. A. , Burrin J. M. , Hall G. M. 
Published: January 2009

Background: Pituitary‐adrenal secretion during induced hypotension for middle‐ear surgery has received little attention. Previous work failed to differentiate the effects of induced hypotension from surgical stimulation. We have undertaken a preliminary study examining the effects of hypotension, achieved with labetalol or isoflurane, on pituitary‐adrenal secretion before, during and after middle‐ear surgery.Methods: Twenty‐four patients were allocated randomly to 3 groups. The control group were anaesthetised with isoflurane, and normotension maintained for 30 min before hypotension was induced with isoflurane and surgery started. In the labetalol group, this drug was given i.v. to obtain a mean arterial pressure (MAP) of 60 mm Hg for 30 min before surgery and hypotension maintained with labetalol during the operation. In the isoflurane group, hypotension was induced to a MAP of 60 mm Hg for 30 min before surgery and continued throughout the procedure. All 3 groups received metoprolol i.v. before hypotension was established. Blood samples were collected before induction of anaesthesia, during anaesthesia alone (normotensive or hypotensive), surgery with hypotension, and recovery. They were analysed for adrencorticotropic hormone (ACTH), arginine vasopressin (AVP), cortisol and aldosterone.Results: Induced hypotension before surgery failed to stimulate release of ACTH, AVP and cortisol. No significant increase in these hormones occurred until the postoperative period. Aldosterone concentrations increased significantly during anaesthesia and hypotension in the labetalol and isoflurane groups (P <0.05) and continued to rise significantly in all 3 groups during surgery. However, there was no significant difference in aldosterone concentration before surgery between the control and the 2 hypotensive groups.Conclusion: ACTH, AVP and cortisol secretion were not stimulated by induced hypotension to MAP of 60 mm Hg before surgery. Increased aldosterone secretion occurred and a further study with a larger sample size is needed.
Parasympathetic activity in brain death: effect of apnea on heart rate variability
Authors: Kawamoto M. , Sera A. , Kaneko K. , Yuge O. , Ohtani M. 
Published: January 2009

Background: Power spectral analysis of heart rate variability is a useful monitoring of brain‐damaged patients. However, the effect of artificial ventilation is not clearly demonstrated in assessing vagal activity because the locus of its activity is originated close to the respiratory center in the brain stem. We studied heart rate variability during artificial ventilation and apnea test as part of an assessment of brain death.Methods: Ten adult patients with severe brain damage were studied. Power spectral analysis of heart rate variability from electrocardiographic R‐R intervals was integrated to compare spectral components before, during and after the apnea test. Before the test, circulatory and blood gas variables and electrocar‐diographic recording were obtained under controlled mechanical ventilation at a rate of 12 and 18 (/min), each for 5 min. Measurements were made for 10 min during the apnea test, and repeated thereafter as before the test. Power spectral analysis based on fast Fourier transformation was made by integrating each low‐ (LF: 0.04‐0.15 Hz) and high‐ (HF: 0.15‐0.40 Hz) frequency band areas. LF was assessed as sympathetic and para‐sympathetic nervous activity, and HF as respiratory‐related parasympathetic vagal activity. The HF/LF ratio showed sym‐pathovagal balance.Results: All patients were assessed as brain dead. During apnea, PaCo2 (P<0.05) and LF (P<0.05) increased, and pH (P<0.01) and HF/LF ratio (P<0.05) decreased. Heart rate, mean arterial pressure, PaO2 and HF remained consistent throughout.Conclusion: It was shown that sympathovagal balance was inclined to be sympathotonic during apnea, and that there were no changes in the respiratory‐related vagal activity in spite of stopping artificial ventilation.
Haemolysis following rapid experimental red blood cell transfusion
Authors: Hansen T. G. , Sprogøe‐Jakobsen U. , Pedersen C. M. , Olsen K. Skovgaard , Kristensen S. Risom 
Published: January 2009

Background: The vast majority of infusion pumps used for rapid transfusion of large amounts of blood have never been properly examined regarding their influence on the quality of the red blood cells (RBCs) infused. In this study, we evaluated the effect of two different infusion pumps on the degree of RBC destruction following rapid experimental blood transfusion.Methods: Divided into 2 groups according to age, 30 u of SAGM RBCs were infused through an experimental transfusion model by either a manual roller pump (MRP) or a pressure infusor pump (PIP). Fresh (i.e stored for 8–11 d) RBCs, 20 u, and 10 u of older (i.e. stored for 25–33 d) RBCs were randomly allocated to infusion with either of the two pumps. The rate of infusion was as fast as possible with the MRP, and with the PIP adjusted with an external applied pressure of 300 mm Hg. RBC samples collected before and after infusion were analyzed for total haemoglobin, free haemoglobin, haematocrit, total free potassium, lactate dehydrogenase (LDH) and the percentage of haemolysis. The time spent for each transfusion was measured by a stop watch.Results: Following infusion, a marginal increase (i.e. considerably below 0.8%) in the percentage of haemolysis and LDH content was seen with both pumps. This increase was only statistically significant when RBCs stored for 8–11 d were used (P= 0.002 for both parameters). Irrespective of the age of the RBCs, no differences between the two pumps could be detected. Compared to the PIP, infusion with the MRP could be accomplished significantly faster, i.e. median 5.9 ml/s (5.2–6.4 ml/s) versus 2.9 ml/s (2.5‐3.2 ml/s), (P<0.0001).Conclusions: Both the pumps used in this study are safe alternatives for rapid transfusion of RBCs; however, with MRP this can be accomplished approximately twice as fast as with the PIP.
Comparing analgesic efficacy of non‐steroidal anti‐inflammatory drugs given by different routes in acute and chronic pain: A qualitative systematic review
Authors: Tramŕr Dr.M. R. , Williams J. E. , Carroll D. , Wiffen P. J. , Moore R. A. , McQuay H. J. 
Published: January 2009

Aim: To test the evidence for a difference in analgesic efficacy and adverse effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) given by different routes.Methods: Systematic review of published randomised controlled trials. Relevant trials were comparisons of the same drug given by different routes. Presence of internal sensitivity was sought as a validity criterion. Analgesic and adverse effect outcomes were summarised, and synthesised qualitatively.Results: In 26 trials (2225 analysed patients), 8 different NSAIDs were tested in 58 comparisons. Fifteen trials (58%) compared the same drug by different routes. Drugs were given by intravenous, intramuscular, intrawound, rectal and oral routes in postoperative pain (14 trials), renal colic (4), acute musculo‐skeletal pain (1), dysmenorrhoea (1), and rheumatoid arthritis (6). Five of the 15 direct comparisons were invalid because they reported no difference between routes but without evidence of internal sensitivity. In all 3 direct comparisons in renal colic, intravenous NSAID had a faster onset of action than intramuscular or rectal. In 1 direct comparison in dysmenorrhoea, oral NSAID was better than rectal. In the 5 direct comparisons in postoperative pain, results were inconsistent. In 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Injected and rectal administration had some specific adverse effects.Conclusion: In renal colic there is evidence that NSAIDs act quickest when given intravenously. This may be clinically relevant. In all other pain conditions there is a lack of evidence of any difference between routes. In pain conditions other than renal colic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow.
Preoperative anxiolysis with minimal sedation in elderly patients: bromazepam or clorazepate‐dipotassium?
Authors: Erb Dr.T. , Sluga M. , Hampl K. F. , Ummenhofer W. , Schneider M. C. 
Published: January 2009

Background: In elderly patients undergoing ophthalmic surgery the loss of co‐operation due to over‐sedation, induced by drugs given preoperatively, may jeopardise the success of microsurgery performed under regional anaesthesia. The aim of this study was to compare the psychotropic effects of bromazepam and clorazepate‐dipotassium, two benzodiazepines with predominantly anxiolytic and only weak sedative action.Methods: A randomised, placebo‐controlled, double‐blind study was designed to include 60 patients, ASA physical status II‐III, older than 60 years scheduled for ophthalmic surgery under regional anaesthesia. The patients were randomised to receive either bromazepam (3 mg) or clorazepate‐dipotassium (20 mg) or placebo. The study drugs were given at 10 p.m. the night before surgery and 90 min before surgery. Using the State‐Trait Anxiety Inventory (STAI), the patient's anxiety was assessed at the end of the preoperative visit, on the next morning before the study drug was given and on arrival at the operating theatre.Results: Bromazepam induced a marked anxiolytic effect as documented by a significant reduction in the STAI State values after both applications (P0.01). Clorazepate did not differ from placebo at any evaluation time with regard to the STAI and haemodynamic values. Sedative effects and oxygen saturation (SpOz) were comparable in all groups.Conclusion: Bromazepam is superior to clorazepate in its anxiolytic action and suitable as preoperative medication in the elderly patient because of lack of overt sedative effects.
Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy
Authors: RederPh.D J. C. , Mjaland O. , Aasbø V. , Grøgaard B. , Buanes T. 
Published: January 2009

Background: The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy.Methods: All 60 patients received ketamine 0.2 mg kg‐1, fentanyl 2 μg kg‐1 and propofol 2 mg kg‐1 for induction. Ketorolac 0.4 mg kg‐1 and ondansetron 0.05 mg kg‐1 +droperidol 20 μg Kg‐1 was given as prophylaxis for postoperative pain and emesis, respectively. The patients were randomly assigned into Group P with propofol maintenance and opioid supplements, or Group D with desflurane in a low‐flow circuit system.Results: All the patients were successfully discharged within 8 h without any serious complications. Emergence from anaesthesia was more rapid after desflurane; they opened their eyes and stated date of birth at mean 6.4 and 8.4 min respectively, compared with 9.6 and 12 min in the propofol group (P<0.05). Nausea and pain were more frequent in Group D, 40% and 80% respectively; versus 17% and 50% in Group P (P<0.05). By telephone interview at 24 h and 7 d after the procedure, there was no major difference between the groups. With desflurane, drug costs per case were 10 $ lower than with propofol.Conclusion: We conclude that desflurane is cheaper and has a more rapid emergence than propofol for outpatient cholecystectomy. However, propofol results in less pain and nausea in the recovery unit. Despite ondansetron and droperidol prophylaxis, there was still a substantial amount of nausea and vomiting after desflurane.
Midazolam‐flumazenil versus propofol anaesthesia for scoliosis surgery with wake‐up tests
Authors: Koscielniak‐Nielsen Z. J. , Stens pedersen H. L. , Hesselbjerg L. 
Published: January 2009

Background: Wake‐up tests may be necessary during scoliosis surgery to ensure that spinal function remains intact.Methods: Intra‐ and postoperative wake‐up tests were performed together with somatosensory cortical evoked potentials (SCEPs) monitoring in 40 patients randomized to either midazolam (M) or propofol (P) infusions for scoliosis surgery. Other anaesthetic medication was similar in both groups. At the surgeon's request, N2O was turned off and midazolam or propofol infusions were discontinued. In the M group, flumazenil was given in refracted doses. Patients were asked to move hands and feet. The test was repeated immediately after the end of surgery.Results: The median intraoperative wake‐up times were 2.9 min in the M group and 16.0 min in the P group. The respective postoperative wake‐up times were 1.8 and 13.9 min. The quality of both intra‐ and postoperative arousals was significantly better in the M group. Twelve patients in the P group could not be awakened intraoperatively within 15 min and were given nalox‐one. One of these patients woke up violently and dislodged the endotracheal tube. Another patient in the P group had explicit recall of the test, but no pain. Five patients in the M group became resedated in the recovery room. Cost of anaesthetic drugs was similar in both groups. Satisfactory intraoperative SCEPs were recorded from 17 patients in each group. There were no neurological sequelae.Conclusions: Wake‐up tests can be conducted faster and better with midazolam‐flumazenil sequence compared with propofol.
Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques
Authors: Tramer Dr.M. R. , Sansonetti A. , Fuchs‐Buder T. , Rifat K. 
Published: January 2009

Background: Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.Methods: Children (3–16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg · m‐2iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg · kg‐1iv. All children received prophylactic atropine 0.02 mg · kg‐1and alfentanil. Nitrous oxide was omitted.Results: Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thio‐pentone‐isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number‐needed‐to‐treat was 5.5 (95% CI 2.9–46). Propofol was not different from thiopentone‐isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number‐needed‐to‐harm was 3.9 (95% CI 2.6–8).Conclusions: Thiopental‐isoflurane‐air/O2‐alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol‐lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high‐dose prophylactic atropine.
Nausea and vomiting after major arthroplasty with spinal anaesthesia including morphine: a randomised trial of subhypnotic propofol infusion as prophylaxis
Authors: Grattidge P. 
Published: January 2009

Background: Postoperative nausea and vomiting (PONV) following major arthroplasty with spinal anaesthesia and intrathecal morphine is reported in 45–74% of patients. This randomised, double‐blind, placebo‐controlled trial was undertaken to determine whether a subhypnotic infusion of propofol has a prophylactic antiemetic effect in this patient population.Methods: 82 patients undergoing hip or knee replacement under subarachnoid bupivacaine anaesthesia plus morphine 0.25 mg were randomised at the end of surgery to receive either propofol 30 mg · h‐1 or fat emulsion (Intralipid®) 3 ml · h‐1 for 20 h postoperatively. Blinded observers recorded episodes of nausea, vorniting and pruritus.Results: PONV in the intervention group was 40% vs 59% in the controls (P=0.1, not significant). Pruritus occurred in 34%, with a similar rate in both groups.Conclusion: These results suggest that routine use of postoperative, subhypnotic propofol infusion as PONV prophylaxis is not justified in this patient population.
In vivo spasmolytic effect of ketamine and adrenaline on histamine‐induced airway constriction
Authors: Hirota K. , Hashimoto Y. , Sakai T. , Sato T. , Ishihara H. , Matsuki A. 
Published: January 2009

Background: Ketamine (K) has been reported to produce bronchodilation in patients suffering from asthma. Although most researchers have used indirect measurements to study the effect of K in vivo, the reliability of these indirect methods are controversial. We have developed a new technique to measure the bronchial cross‐sectional area (BCA) in vivo with a superfine fibreoptic bronchoscope (SFB). Employing this method, we evaluated in vivo spasmolytic effect of K and adrenaline (A).Methods: Twenty‐one mongrel dogs were anaesthetized with pentobarbitone (30 mg . kg‐1) and paralyzed with pancuronium (200μg . kg‐1 . h‐1). The trachea was intubated with an endotracheal tube that has a second lumen for insertion of a SFB (OD: 2.2 mm) to measure the BCA continuously. The tip of the SFB was placed between the 2nd and 3rd bronchial bifurcation of the right lung. A videoprinter printed the BCA, which was then measured with NIH Image. Bronchoconstriction was produced with histamine (H: 10μg . kg‐1+500μg . kg‐1 . h‐1) which was administered until the end of the experiment. The BCA was assessed before and 30 min after the start of H infusion. The dogs were randomly allocated to 3 groups of 7 dogs each. In group K, K (0–10 mg . kg‐1) was given i.v., and the BCA was measured 5 min after each K dose. In group A, A (0‐0.4μg . kg‐1) was given i.v., and the BCA was measured 1 min after each A dose. In group A+K, K (1 mg . kg‐1 i.v. +1 mg . kg‐1 . h‐1 i.v.) was given followed, 30 min after, by A i.v. in the same doses as in group A. The BCA was assessed 30 min after the start of K and again 1 min after each A dose.Results: K 10 mg . kg‐1 reversed H‐induced bronchoconstriction. A subthreshold dose of K significantly potentiated the effect of A, reversing the decrease in BCA by H.Conclusion: We have found that K could reverse the H‐induced bronchoconstriction and potentiate the A‐induced bronchial relaxation.