bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vomiting, retching, headache and restlessness after halothane‐, isoflurane‐ and enflurane‐based anaesthesia: An analysis of pooled data following ear, nose, throat and eye surgery
Authors: VAN DEN Berg A. A. , Honjol N. M. , Mphanza T. , Rozario C. J. , Joseph D. 
Published: January 2009

Background: Isoflurane has exceeded halothane and enflurane in usage. A literature search, however, revealed no data comparing the effects on emesis, headache and restlessness of these three agents.Methods: With hospital ethics committee approval and patient consent, a prospective, randomised, double‐blind study of 556 patients undergoing ENT and eye surgery was undertaken to evaluate the effects of halothane, isoflurane and enflurane on vomiting, retching, headache and restlessness until 24 h after anaesthesia. Balanced general anaesthesia was administered comprising benzodiazepine premedication, induction with thiopentone‐atracurium‐morphine (ENT patients) or fentanyl (eye patients), controlled ventilation and maintenance with either halothane 0.4–0.6 vol% (n = 186), isoflurane 0.6–0.8 vol% (n = 184) or enflurane 0.8–1 vol% (n=186) in nitrous oxide 67% and oxygen.Results: The three study groups were comparable, and comprised comparable subgroups having ear, nose, throat, intraocular and non‐intraocular surgery. During early recovery from anaesthesia, the respective requirements for halothane, isoflurane and enflurane for analgesia (7%, 9% and 10%), frequency of emesis (6%, 8% and 8%), antiemetic requirements (1%, 1% and 2%), restlessness‐pain scores and time spent in the recovery ward (27 SD 10, 31 SD 12 and 26 SD 9 min) were similar. During the ensuing 24‐h postoperative period, patients who had isoflurane experienced emesis less often than those who had halothane (36% vs 46%, P<0.025) but did so with similar frequency to those who had enflurane (46% vs 41%). Antiemetic requirements were least in those given isoflurane (isoflurane 12%, halothane and enflurane 23% each, P<0.005), but headache and analgesic requirements were similar.Conclusion: Isoflurane induces less postoperative emesis than halothane, but headache is similarly frequent after anaesthesia with any of these agents.
Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits
Authors: Ma D. , Sapsed‐Byrne S. M. , Chakrabarti M. K. , Whitwam J. G. 
Published: January 2009

Background:It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic.Methods:PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose‐response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg−1i. v. or midazolam 0.05 mg · kg−1i. v. on the effects of propofol and fentanyl respectively on PNA were studied.Results:Propofol and fentanyl caused a dose‐dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg−1i. v. and 32 μg · kg−1i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg−1reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg−1. The mean ED50s, calculated from dose‐response curves, were 5.4 mg · kg−1, 3.9 μg · kg−1and 0.4 mg · kg−1for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg−1i. v. or midazolam 0.05 mg · kg−1i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg−1and 8 μg · kg−1, respectively.Conclusion:Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.
Spinal cord blood flow after intrathecal injection of ropivacaine and bupivacaine with or without epinephrine in rats
Authors: Kristensen J. D. , Karlsten R. , Gordh T. 
Published: January 2009

Background: Ropivacaine is a new local anaesthetic available for spinal and epidural anaesthesia. When new drugs are being introduced for spinal application, their effect on spinal cord blood flow (SCBF) should be studied for safety and toxicological aspects. In the present study, SCBF was studied after intrathecal (i. t.) application of ropivacaine and bupivacaine with and without epinephrine.Method: SCBF was measured continuously in spontaneously breathing, enflurane/N2O anaesthetized rats, using laser‐Doppler flowmetry technique. The spinal cord was exposed by laminectomy at the L1‐L2 level, and a laser‐Doppler probe was placed over the dorsal horn, allowing on‐line registration of SCBF in a tissue hemisphere of 1–2 mm. Relative changes in SCBF were then measured on‐line after i. t. administration of increasing doses of ropivacaine, bupivacaine or bupivacaine with epinephrine.Results: Ropivacaine and bupivacaine decreased SCBF in a dose‐dependent manner. In contrast, the reduction in SCBF produced by bupivacaine + epinephrine (Bupi+Epi) was equal for all doses of bupivacaine. The order of magnitude of SCBF decreases was Bupi + Epi >ropivacaine>bupivacaine. The maximal decrease in SCBF at the highest concentration given (10 mg/ml) was 37±6% for ropivacaine, 27±7% for bupivacaine and 40 ±6% for bupivacaine + epinephrine.Conclusion: Ropivacaine and bupivacaine produce a dose‐related, transient decrease in SCBF following i. t. administration in anaesthetized rats. However, the decrease in SCBF produced by both ropivacaine and bupivacaine was less than that produced by bupivacaine, when epinephrine was added in a concentration of 5 μg/ml. These results suggest that ropivacaine, like bupivacaine, may be used for spinal anaesthesia without important effects on SCBF.
Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy
Authors: Rømsing J. , ØStergaard D. , Walther‐Larsen S. , Valentin N. 
Published: January 2009

Background: Tonsillectomy is a common procedure in childhood resulting in significant morbidity due to pain. The aim of this study was to evaluate the analgesic efficacy and safety of a single dose of ketorolac i.v. given before or after tonsillectomy, compared to placebo.Methods: A randomized, double‐blind, placebo‐controlled study was performed in 60 children, 5 to 15 years of age, admitted for tonsillectomy Patients were allocated to receive ketorolac 1 mg . kg‐1 i.v. or placebo. Postoperative pain was assessed by self‐report 1.5, 3, 5, and 24 h after surgery.Results: Pain scores were significantly lower for both ketorolac groups compared to the placebo group 1.5, 3, and 5 h after surgery (P<0.05). Pain scores were lowest in the preoperative ketorolac group 1.5 to 5 h after surgery, and significantly fewer children in this group had fentanyl 0 to 1.5 h after surgery. But no significant differences were found between pain scores of the preoperative and postoperative ketorolac groups in the first 24 h after surgery. Acetaminophen consumption during the first 5 h after surgery was significantly less in patients receiving ketorolac (P<0.05). Patients in the preoperative ketorolac group had a significantly lower incidence of postoperative vomiting (P<0.05). There were no significant differences in the incidence of postoperative bleeding between groups. Three children in the preoperative, 5 children in the postoperative ketorolac group, and 5 children in the placebo group experienced postoperative haemorrhage.Conclusion: This study indicates that a single dose of ketorolac 1 mg . kg‐1 i.v. administered either before or immediately after surgery improves postoperative analgesia in children after tonsillectomy without evidence of increased incidence of bleeding.
Stability of local anesthetics in heparinized blood, plasma and sulfuric acid
Authors: Adams H. A. , Pawlik D. , Bauer H. , Mautgreve W. 
Published: January 2009

Background: This study was undertaken to investigate the stability of local anesthetics in different media.Methods: 60 patients with axillary plexus block, using prilocaine, mepivacaine or lidocaine 1%, or with lumbar epidural catheter‐anesthesia, using bupivacaine 0.5%, were investigated. Stability was evaluated in heparinized whole blood for 24 h at +4°C, in plasma for 8 weeks at –25°C and in sulfuric acid for 6 months at –25°C.Results: Mean recovery rates were between 96.4% and 102.6% in all local anesthetics and media. No statistical significance became obvious for differences between recovery rates and initial values.Conclusion:Stability of prilocaine, mepivacaine, lidocaine and bupivacaine can be expected when samples are stored as heparinized whole blood for 24 h at +4°C, plasma for 8 weeks at –25°C, and after preparation into sulfuric acid for 6 months at –25°C.
Distribution, tolerability and tissue compatibility of intrathecal tizanidine in the sheep
Authors: Ochs G. , Loew M. , Tonn J. , Toyka K. 
Published: January 2009

Background: Tizanidine (TZD) is an alpha‐2‐adrenergic drug with potential spinal analgesic action and could be a substitute or additive for intrathecal (i.t.) opiates in chronic pain treatment. However, long‐term tolerability and tissue compatibility are not yet established.Methods: Three sheep were infused intrathecally with TZD up to 4000 μg/d over a time period of up to 440 d using implantable drug administration devices; one control animal was infused with vehicle only; standard values were collected from untreated sheep. CSF samples and blood samples were analyzed to determine pharmacokinetics and systemic redistribution. Behavioral effects were studied. The spinal cord tissue was investigated using standard laboratory histology.Results: Bolus kinetics after i.t. injection of TZD are best described by a two‐phase model. Elimination half‐lives of TZD in CSF were 15 min and 152 min, respectively. Clearance of TZD from lumbar CSF was 0.48 ml/min. Doses higher than 500 μg i.t. caused dose‐dependent motor inactivity and sleepiness. Continuous i.t. TZD up to 4 mg/d was well tolerated regarding behavior, physical activity, heart rate, muscle strength, and coordination. Minor elevations of CSF cell counts and total protein were detected both in saline and TZD‐treated animals, presumably due to local irritation by the catheter and repeated sampling procedures. Histological evaluation of the spinal cord and adjacent tissues showed no abnormalities.Conclusion: The long‐term intrathecal infusion of TZD is well tolerated and non‐toxic in the sheep. The data favor clinical trials in patients with chronic pain.
Retracted: Modified double burst stimulation at varying stimulating currents
Authors: Saitoh Y. , Fujii Y. , Makita K. , Tanaka H. , Amaha K. 
Published: January 2009

The above article, published on August 1998 in Wiley Online Library (http://wileyonlinelibrary.com) and in Volume 42, pp. 851‐857, has been retracted by agreement between the authors, the journal Editor‐in‐Chief, Professor Michael Haney and John Wiley and Sons Ltd. The retraction has been agreed due to the lead author's declaration that official permission from the Ethical Committee of the Faculty of Medicine, Tokyo Medical and Dental University was not sought and therefore was not granted for this study.
REFERENCE

Saitoh Y, Fujii Y, Makita K, Tanaka H, Amaha K. Modified double burst stimulation of varying stimulating currents. Acta Anaesthesiol Scand. 1998;42(7):851‐857.
Brachial plexus injury during cardiac catheterisation in children: Report of two cases
Authors: Neto E. P. Souza , Durand P. G. , Sassolas F. , Vial C. , Lehot J. J. 
Published: January 2009

The arm is particularly vulnerable to neurological injury, due to the intimate anatomical relationship between the brachial plexus and the traction zones. Severe injuries of the brachial plexus can be caused by compression, traction or laceration. Fortunately, many deficits are superfial and permanent neurovascular deficits are rare. Nevertheless, it is important to identify the probable cause of the injury since the prognosis for recovery directly depends on the underlying nature of the neurological deficit. Two anaesthetised children who suffered brachial plexus injury during cardiac catheterisation are reported. The first, with Ebstein's anomaly and significant pulmonary valve stenosis, presented, after the procedure, with a right arm motor deficit with proximal predominance. The second patient, with tetralogy of Fallot and pulmonary atresia, presented difficulty in left arm abduction and external rotation on awakening.The risk factors for brachial plexus lesions during anaesthesia are discussed. These include improper positioning, anaesthetic agents, extreme variations of body mass index and anatomical anomalies. Prevention, evolution and treatment of the brachial plexus injury are also considered. With proper care by the cardio‐radiologist and anaesthesiologist the frequency of this injury can be reduced.
Adrenaline markedly improves thoracic epidural analgesia produced by a low‐dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double‐blind, cross‐over study with and without adrenaline
Authors: Niemi G. , Breivik H. 
Published: January 2009

Background:Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture.Methods:A prospective, randomised, double‐blind, cross‐over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h−1of bupivacaine 1 mg · ml−1, fentanyl 2 μg · ml−1, and adrenaline 2 μg · ml−1were included. On the 1stand 2ndpostoperative days each patient was given a double‐blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score.Results:The number of hypaesthetic dermatomal segments decreased (P<0.001) and pain intensity at rest and when coughing increased (P<0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml−1(P<0.01), and there was more sedation during the period without adrenaline.Conclusions:Adrenaline increases sensory block and improves the pain‐relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.
Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: A randomized, double‐blind, placebo‐controlled trial
Authors: Fujii Y. , Tanaka H. , Toyooka H. 
Published: January 2009

Background: Nausea and vomiting during and after spinal anaesthesia for caesarean section are distressing to the patient. This study was undertaken to evaluate the efficacy and safety of granisetron, droperidol and metoclopramide for the prevention of nausea and vomiting in parturients undergoing caesarean section under spinal anaesthesia.Methods: In a randomized, double‐blind, placebo‐controlled trial, 120 patients received granisetron 3 mg, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n=30 of each) i. v. immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during and after spinal anaesthesia for caesarean section.Results: The incidence of intraoperative, post‐delivery nausea and vomiting was 13%, 17%, 20% and 63% after administration of granisetron, droperidol, metoclopramide and placebo, respectively; the corresponding incidence during 0–3 h after surgery was 7%, 27%, 27% and 43%; the corresponding incidence during 3–24 h after surgery was 7%, 20%, 23% and 37% (P<0.05; overall Fisher's exact probability test). No clinically important adverse events were observed in any of the groups.Conclusion: Granisetron is highly effective for preventing nausea and vomiting during and after spinal anaesthesia for caesarean section. Droperidol and metoclopramide are effective for the prevention of intraoperative, post‐delivery emesis, but are ineffective for the reduction of the incidence of postoperative emesis.
Slow injection of local anaesthetic will decrease pain during dorsal penile nerve block
Authors: Serour F. , Mandelberg A. , Mori J. 
Published: January 2009

Purpose: To evaluate whether a very slow injection of local anaesthetics during dorsal penile nerve block for circumcision causes less pain than a more rapid injection.Methods: In a prospective, double‐blind, randomized study, 75 patients aged 15 to 53 yr (mean±SD=22±8.4 yr) were randomized into two groups. A solution of 2% lidocaine, 1 mg . kg−1, and 0.5% bupivacaine, 0.5 mg . kg−1 without epinephrine to a maximum dose of 10 ml was injected using either a very slow rate (injection time 100 to 150 s, Group A) or a faster rate (injection time 40 to 80 s, Group B). Patients were questioned regarding pain by a physician who was blinded to the mode of therapy. Pain was rated as 1) mild (negligible), 2) moderate (non‐negligible, but easily endurable), 3) intense (but endurable) and 4) total refusal to continue.Results: A significant pain score difference was found between Groups A and B (median=l vs. 2, P=0.0006) as well as a significant correlation between pain score and the rate of infiltration (rs= –0.394, P<0.0001).Conclusions: Slow injection is an important factor in reducing pain during penile block.
Does lidocaine protect the heart during coronary revascularisation?
Authors: Rinne T. , Kaukinen S. 
Published: January 2009

Background: Lidocaine has been used as the primary antiarrhythmic agent for ventricular arrhythmias during acute myocardial infarction (MI) and open heart surgery. Its cardioprotective effects have been studied in experimental settings and also during angioplastic reperfusion and coronary revascularisation. The basic mechanism of action, probably also involved with cardioprotection, has been demonstrated to be blockade of cardiac sodium channels. In this open study we investigated the contribution of continuous lidocaine infusion to cardioprotection during coronary revascularisation with blood cardioplegia.Methods: During coronary revascularisation with cold blood cardioplegia, a study group of 50 patients received a prophylactic lidocaine infusion for 20 h started with a bolus dose before aortic clamping; another group of 50 patients without the infusion served as a control group. Serum troponin T concentration, serum creatine kinase MB activity and electrocardiography were the main parameters recorded.Results: Serial measurement of Troponin T (P=0.06) and CK‐MB values: (P=0.09) were slightly lower in the lidocaine group, but the differences were not statistically significant.Conclusion: Lacking statistically significant evidence of improved cardioprotection, lidocaine infusion cannot be recommended as a routine treatment during coronary revascularisation.
Retracted: Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery
Authors: Boldt J. , Papsdorf M. , Piper S. , Padberg W. , Hempelmann G. 
Published: January 2009

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties.Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro‐ and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg−1 · min−1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin‐1 (ET‐1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day.Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min−1 · m−2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET‐1: from 2.88±0.91 to 6.91±1.20 pg/ml).Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.