bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retracted: Price development in important anesthesia and critical care medicine journals in comparison to journals of other disciplines
Authors: Boldt J. , Maleck W. H. , Fent T. 
Published: March 2003

Background: In today’s climate of financial restrictions, libraries and individual subscribers complain about the price increase of scientific journals. The development in prices of anesthesia/critical care journals was analysed over the past 6 years and compared to prices of some journals of other disciplines.Methods: Important journals in the categories Anesthesiology, Emergency Medicine & Critical Care, Surgery, Medicine (General), and Cardiac & Cardiovascular Systems listed in the 1999 Science Citation Index of Journal Citation Report were included and prices for the years 1995 to 2000 were analysed.Results: Increase in prices ranged from +13% to +199%. The mean increase in journal prices was lowest in the category Anesthesiology (+61%), higher in the category Critical Care (+73%), and highest in the category Medicine, General (+101%). Changes in the impact factor (IF) varied widely, ranging from a decrease (Lancet: −43%; J Neurosurg Anesth: −44%) to a tremendous increase (e.g. Reg Anesth +165%; Ann Emerg Med +149%). The journals’ size (number of articles or pages) did not increase proportionally with the increase in prices.Conclusion: A disproportionate rise in journal prices was seen over the past 6 years. The large increase in cost may have multiple reasons. The rapidly increasing cost of research journals may affect research quality because economic pressure may result in reduction in availibility of information due to cancellation of subscriptions to journals.
Patient‐controlled epidural analgesia versus continuous epidural analgesia after total knee arthroplasty
Authors: Silvasti M. , Pitkänen M. 
Published: March 2003

Background: Patient‐controlled epidural analgesia (PCEA) has been found to be an effective method for pain relief during labour and after surgery. The goal of this study was to compare the efficacy of bupivacaine–fentanyl PCEA and continuous epidural infusion with the same mixture for treatment of pain after total knee arthroplasty.Methods: Fifty‐four patients under spinal anaesthesia were allocated to two groups in this randomized, double‐blind study: the PCEA group could demand a bolus of 0.05 ml/kg of the bupivacaine 1.1 mg/ml and fentanyl 5 μg/ml solution, with a lockout interval of 10 min and total dose limit of three bolus doses per hour. The EPI group received a continuous infusion of 0.1 ml kg−1 h−1 of the same bupivacaine–fentanyl solution, and only a minimal extra bolus dose of 0.2 ml with the same lockout interval. All the patients received also paracetamol 1 g, orally, three times a day. In addition to pain scores at rest and during leg lifting, the 20‐h analgesic consumption and the incidence of side effects were recorded.Results: Forty‐nine patients completed the study. The bupivacaine and fentanyl consumption during 20 h was smaller in the PCEA group (P<0.001). Analgesia and the need for rescue‐opioid medication were similar in both groups. There were no differences between the PCEA and EPI groups regarding the incidence of side effects. Five patients were confused about how to operate the PCEA apparatus.Conclusion: The amount of bupivacaine–fentanyl solution consumed was significantly less with PCEA than with continuous infusion of bupivacaine–fentanyl solution without affecting the quality of postoperative analgesia after total knee arthroplasty. Several of the elderly patients had difficulties in operating the PCEA apparatus.
Ropivacaine 1 mg  ·  ml−1 does not decrease the need for epidural fentanyl after hip replacement surgery
Authors: Kostamovaara P. A. , Laurila J. J. , Alahuhta S. , Salomäki T. E. 
Published: March 2003

Background: Ropivacaine is a new long‐acting local anesthetic. Laboratory trials have demonstrated a synergistic analgesic effect between intrathecal opioids and local anesthetics. We tested the hypothesis that addition of ropivacaine 1 mg  ·  ml−1 to epidural fentanyl (10 μg  ·  ml−1) postoperatively decreases the need for fentanyl, improves the quality of analgesia and decreases the side‐effects of fentanyl.Methods: Forty patients were enrolled in this double‐blind, randomized study to receive either fentanyl 10 μg  ·  ml−1 (group F) alone or fentanyl combined with ropivacaine 1 mg  ·  ml−1 (group R) for 20 h as an epidural infusion at TH12–L1 or L1–L2 for analgesia after hip replacement surgery. The patients were free to use a patient‐controlled epidural analgesia device, which was programmed to infuse 3 ml of the study medication hourly and to allow a 3‐ml bolus when needed (maximal hourly dose of fentanyl was 150 μg). The consumption of medication, visual pain scores at rest and on movement, hemodynamic and respiratory parameters, motor and sensory block, nausea, pruritus and sedation were recorded.Results: There were no significant differences between the groups in the total mean fentanyl consumption (1.10±0.18 mg in group F, 1.08±0.31 mg in group R, 95% CI: −0.14 to 0.19, P=0.774). The pain scores were similar at rest (median scores ≤1) and on movement (median scores ≤3). The adverse effects were similar and of a minor nature, consisting mostly of pruritus and nausea.Conclusion: Addition of ropivacaine 1 mg  ·  ml−1 to epidural fentanyl 10 μg  ·  ml−1 did not significantly decrease the requirement for fentanyl administered for pain relief after hip replacement surgery.
A small dose of droperidol decreases postoperative nausea and vomiting in adults but cannot improve an already excellent patient satisfaction
Authors: Hechler A. , Neumann S. , Jehmlich M. , Lange U. , Hopf H.‐B. 
Published: March 2003

Background: We evaluated whether or not 1) a routine prophylaxis with 20 μg  ·  kg−1 body weight of droperidol would efficiently prevent postoperative nausea and vomiting (PONV) after elective surgery in adults and 2) an efficient prophylaxis would improve patient satisfaction.Methods: With approval of the local ethics committe and after having obtained informed written consent, 1334 patients in a randomised, single‐blinded fashion either received droperidol (group 1, n=665) or saline intravenously (group 2, n=669) 20 min before the end of a standard O2/N2O/fentanyl/isoflurane anaesthesia of at least 30 min duration. End points: incidence of PONV during the first 24 h; individual episodes of nausea or vomiting, overall patient satisfaction with the procedure.Results: Compared to saline, intravenous injection of droperidol substantially and significantly reduced the incidence of PONV from 30% to 20% (P<0.0001). Women suffered three times more frequently from PONV (10.5% vs. 30%, P<0.0001). Droperidol significantly reduced the incidence of PONV from 35.4% to 24.4% in women (relative risk reduction: 31%, P=0.0002), but not in men (13.1% vs. 8.2%, relative risk reduction: 37%, P=0.159) – without impact on overall patient satisfaction (98.8% vs. 97.1%, P=0.439). Distribution of surgical procedures, sex, age, height, weight and anaesthetic duration were not different between groups. To prevent one woman from suffering PONV, nine had to be treated prophylactically at an individual drug cost (German prices) of about  0.80 per woman.Conclusion: Routine PONV prophylaxis with 20 μg  ·  kg−1 body weight of droperidol is cost‐efficient and appropriate in women but not in men.
Long‐term infusion of atrial natriuretic peptide (ANP) improves renal blood flow and glomerular filtration rate in clinical acute renal failure
Authors: Swärd K. , Valson F. , Ricksten S.‐E. 
Published: March 2003

Background: Short‐term infusion of atrial natriuretic peptide (ANP) increases renal blood flow (RBF) and glomerular filtration rate (GFR) in patients with acute renal dysfunction. In the present study we evaluated the effects of long‐term infusion (>48 h) of ANP on (RBF) and (GFR) in 11 postcardiac surgical patients requiring pharmacological circulatory support and with acute renal impairment.Methods: Urinary clearance of Cr‐EDTA and PAH as well as central hemodynamic measurements were performed for 2–3 consecutive 30‐min periods during ANP infusion (50 ng · kg−1 · min−1), one hour after abrupt discontinuation of ANP and again immediately after reinstitution of ANP infusion.Results: During ANP infusion, urine flow (UF), GFR, RBF and renal vascular resistance (RVR) were 6.4±1.1 ml · min−1, 19.9±3.1 ml · min−1, 408±108 ml · min−1 and 0.286±0.054 mmHg · min · ml−1, respectively. UF, GFR and RBF decreased significantly by 28% (P<0.001), 32% (P<0.01) and 31% (P<0.05), respectively when ANP infusion was discontinued. RVR increased by 93% (P<0.05) while there was no change in filtration fraction. After reinstitution of ANP infusion, all measured renal variables returned to baseline. There was no significant correlation between the number of ANP treatment days and the percentage decrease in GFR (r=0.18) or RBF (r=0.22) during ANP withdrawal. Central hemodynamic variables were not affected by ANP withdrawal.Conclusions: ANP infusion improves RBF and GFR in patients with acute renal impairment after cardiac surgery. This renal vasodilatory effect is maintained during a long‐term infusion and seems to be hemodynamically safe.
No impact of a leucocyte depleting arterial line filter on patient recovery after cardiopulmonary bypass
Authors: Sahlman A. , Ahonen J. , Salo J. A. , Rämö O. J. 
Published: March 2003

Backround:Contact of blood with foreign surfaces in the cardiopulmonary bypass (CPB) circuit induces an inflammatory response and immunosuppression which are associated with several organ dysfunctions following cardiac surgery. The aim of the present study was to evaluate clinical patient recovery after coronary artery bypass surgery (CABG) using CPB with leucocyte filtration or no arterial line filter.Methods: Sixty patients scheduled for CABG were randomly assigned to undergo CPB with a leucocyte depleting arterial line filter (Pall LG6®) or no filter. Total leucocyte count and platelet count were determined before and after CPB. Values for blood urea nitrogen, serum creatine, serum sodium and potassium, serum osmolality, urine creatine, urine sodium and potassium, and urine osmolality were recorded at baseline, at 6 h and 24 h after CPB, and on the 5th postoperative day. Complement status was evaluated by measuring the levels of C3 and C4 before surgery and 24 h after CPB. Need for postoperative inotropic support was recorded, as was oxygen index prior to and after tracheal extubation. Times to awakening and tracheal extubation were noted, as were length of stay at the intensive care unit (ICU) and the hospital. Amount of chest drainage until 24 h and need for red blood cell transfusions were recorded.Results: The level of C3 at 24 h was significantly lower in LG6®‐patients, but no further differences were detected between the groups in any of the laboratory or clinical parameters except for greater chest drainage in LG6®‐patients. However, need for red blood cell transfusions was similar in both groups.Conclusion: Leucocyte filtration in our elective CABG patients did not have any impact on pulmonary gas exchange, need for postoperative inotropic support, length of postoperative mechanical ventilation, or length of ICU or hospital stay.
Impact of enteral feeding on gastric tonometry in healthy volunteers and critically ill patients
Authors: Rokyta Jr R. , Novák I. , Matějovič M. , Hora P. , Nalos M. , Šrámek V. 
Published: March 2003

Background: Enteral feeding may interfere with gastric tonometry measurement. The effect of enteral nutrition on gastric tonometry has not been fully documented.Methods: Seven healthy volunteers and nine stable intensive care unit (ICU) patients with poor tolerance of gastric feeding were investigated. Consecutive continuous postpyloric and gastric feeding, both at two different rates (40 and 100 ml  ·  h−1, respectively), and an intragastric 200 ml nutrition bolus were studied. Gastric intramucosal PCO2 (PiCO2) was measured by air tonometry and in patients a gastric intramucosal‐arterial PCO2 difference (PCO2 gap) was calculated. Hemodynamics and blood gases were also measured.Results: In volunteers, PiCO2 remained stable during the postpyloric phase. During continuous gastric feeding PiCO2 did not change significantly, although in 4 volunteers PiCO2 increased >0.5 kPa. PiCO2 decreased significantly after gastric bolus from 6.9±0.4 to 6.1±0.5 kPa (P<0.05). Eight patients had an increased PCO2 gap (>1 kPa) at baseline (1.8±0.6 kPa). PCO2 gap changes during the whole study were not statistically significant. However, during the postpyloric phase (or immediately afterwards), the PCO2 gap increased by more than 0.5 kPa in 5 patients. After gastric bolus, a decrease in PCO2 gap >0.5 kPa was seen in 5 patients.Conclusion: In volunteers, postpyloric feeding does not interfere with gastric tonometry measurement and gastric bolus leads to a PiCO2 decrease. The impact of postpyloric and gastric feeding on gastric tonometry in ICU patients with compromised gut is variable.
Ropivacaine 1 mg/ml, plus fentanyl 2 μg/ml for epidural analgesia during labour. Is mode of administration important?
Authors: Smedvig J. P. , Soreide E. , Gjessing L. 
Published: March 2003

Background: Patient‐controlled epidural analgesia (PCEA) with a moderate to high concentration of bupivacaine in obstetrics has been shown to give comparable analgesia and even higher level of satisfaction compared to continuous epidural infusion. We hypothesised that the use of a very low concentration technique (ropivacaine/fentanyl) might result in excessive dosing in the PCEA group, more motor blockade and a negative impact on spontaneous delivery rate.Methods: We conducted a randomised, double‐blind study of 60 nulliparous women at term comparing low concentration ropivacaine/fentanyl administered in either patient‐controlled or fixed continuous infusion mode. Parturients with known predictors of painful deliveries, i.e. breech presentation, primary induction of labour, were not included. Deliveries within 90 min from the start of epidural analgesia were omitted from the evaluation.Results: We found that both groups required a mean of 12 ml/h low concentration mixture (loading and midwife rescue boluses included). There was no difference between groups with respect to spontaneous delivery rate (71%). This low concentration technique resulted in haemodynamic stability without crystalloid preloading, infusion or vasopressor use. Motor blockade of clinical importance was not detected in any patient.Conclusion: We conclude that epidural use of ropivacaine 1 mg/ml+fentanyl 2 μg/ml provides effective analgesia with equal volume requirements irrespective of administration mode, with a high spontaneous delivery rate. Choice of PCEA or CEI (continuous epidural infusion) should be directed by other considerations, most importantly compliance of midwife and possible reduction in workload for anaesthesiology staff.
Coagulation assessment in healthy pigs undergoing single xenon anaesthesia and combinations with isoflurane and sevoflurane
Authors: Horn N. A. , Hecker K. E. , Bongers B. , Baumert H. J. , Reyle‐Hahn S. M. , Rossaint R. 
Published: March 2003

Background: With the introduction of new anaesthetics into clinical practice possible side effects of these novel anaesthetics have to be evaluated. This study was performed to clarify whether xenon or combinations of xenon with isoflurane or sevoflurane modify blood coagulation.Methods: The study was performed in 20 healthy pigs which first underwent xenon anaesthesia (65 Vol%) and were then randomly assigned to combinations of xenon and isoflurane or sevoflurane at varying concentrations. During anaesthesia the following parameters were controlled: aPTT, PT, fibrinogen concentrations and thrombelastographic measurements.Results: Xenon monoanaesthesia did not alter significantly any coagulation parameter. When isoflurane was introduced the aPTT showed a significant increase while fibrinogen concentration decreased. The introduction of sevoflurane led also to a decrease in fibrinogen concentration, while the aPTT was unchanged. These decreases in fibrinogen concentration were not accompanied by reduced maximal clot strength or elevated fibrinolysis evaluated by thrombelastography. Although the above‐described changes were statistically significant, none of the parameters throughout the experiment exceeded the limits of normal values.Conclusion: In our study, xenon monoanaesthesia and combinations of xenon with isoflurane and sevoflurane did not lead to pathologic alterations in the measured coagulation parameters.
Heart–lung interactions during positive pressure ventilation: left ventricular pressure–volume momentary response to airway pressure elevation
Authors: Haney M. F. , Johansson G. , Häggmark S. , Biber B. 
Published: March 2003

Background: Left ventricular (LV) pressure and volume changes are known to occur in response to positive airway pressure (PAP). We aimed to further describe the immediate LV response to increased PAP as demonstrated in successive heart cycles with LV pressure and volume alterations. We postulated that these acute systematic LV events during institution of PAP can follow a distinct pattern that would allow calculation of parameters of systolic function, including end‐systolic elastance (Ees) and preload recruitable stroke work (PRSW). We also aimed to examine the relationship of PAP‐derived Ees and PRSW to the same parameters derived from vascular occlusion.Methods: Eight anesthetized adult pigs were studied with invasive circulatory measurements including LV pressure and volume (conductance). The PAP intervention was an airway pressure plateau of 15 cm H2O for 6 s (APP). Venous occlusion was performed by transient balloon inflation in the inferior vena cava (IVCO). Ees and PRSW were derived for each APP and IVCO intervention.Results: Central circulatory variables during APP and IVCO are reported. LV systolic function parameters could be derived from each of the heart–lung interactions during APP sequences. Ees and PRSW derived from APP showed a significant positive bias in relation to those derived from the IVCO sequence.Conclusions: We conclude that the heart–lung interactions during APP of the magnitude and duration shown here can allow derivation of Ees and PRSW. These parameters are not interchangeable with Ees and PRSW derived from IVCO.
Always flush the sampling port before flushing the arterial cannula in pediatric patients
Authors: Weiss M. , Fischer J. E. , Neff T. , Hug M. I. , Baenziger O. 
Published: March 2003

Background: Blood sampling from arterial lines is a frequent event in anesthesia and critical care. To avoid clot formation, both the stopcock outlet and the cannula must be flushed after sampling. We investigated in a bench experiment whether fluid flow through the cannula is affected by the sequence of flushing procedures.Methods: Continuity of fluid delivery from a vascular cannula was gravimetrically determined using two different flushing techniques with either a syringe pump flush system or a bag flush system. The procedures comprised first flushing the stopcock towards the cannula and then towards the stopcock sampling outlet or the reverse order. Experiments were repeated in triplicate and two sets for each flushing system at hydrostatic pressures of 37 mm Hg and 74 mm Hg.Results: The main finding of the study was that flushing the stopcock towards the outlet after flushing the cannula resulted in considerable retrograde aspiration volumes and zero flow times, in particular in combination with syringe pump flush systems. At a hydrostatic pressure of 74 mm Hg, the observed zero flow time at the cannula tip amounted to (mean±SD) 0.1±0.01 min with the bag flush system and 7.7±0.5 min with the syringe pump flush system. The related retrograde aspiration volumes were 2.2±0.7 μl with the bag system and 30.0±2.0 μl with the syringe pump system. No backflow was recorded when the stopcock was first flushed to ambient pressure and then afterwards towards the cannula.Conclusion: Opening a flush system to ambient pressure affects the continuity of fluid delivery, particularly when using syringe pump flush systems. After blood sampling, the stopcock outlet should be flushed first followed by cannula flushing.
Ultrasound control for presumed difficult epidural puncture
Authors: Grau T. , Leipold R. W. , Conradi R. , Martin E. 
Published: March 2003

Background: The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre‐puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia.Methods: We used digital ultrasound equipment with a 5‐MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance.Results: Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better.Conclusions: With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced.
Posture‐related distribution of hyperbaric bupivacaine in cerebro‐spinal fluid is influenced by spinal needle characteristics
Authors: Mardirosoff C. , Dumont L. , Deyaert M. , Leconte M. 
Published: March 2003

Background: No studies have evaluated the relationship between duration of time sitting and spinal needle type on the maximal spread of local anaesthetics. The few trials available have studied the influence of time spent sitting on the spread of anaesthesia without standardising spinal needle types, and have not found any effect.Methods: In this randomised, blinded study, 60 patients scheduled for elective orthopaedic surgery of the lower limbs were divided into 4 groups. With the patient sitting erect, 15 mg hyperbaric bupivacaine were injected in a standard manner through a 24G Sprotte or a 27G Whitacre needle and patients were placed supine after 1 min (24G/1 group and 27G/1 group) or 4 min (24G/4 group and 27G/4 group).Results: Time to achieve maximum block height after injection was similar in all groups. Block height levels were significantly lower at all time points for the 24G/4 group. Maximum block heights were Th4 in the 24G/1, 27G/1 and 27G/4 groups, and Th6 in the 24G/4 group (P<0.0001).Conclusion: In a standard spinal anaesthesia procedure, when different lengths of time spent sitting are compared, spinal needle characteristics influence the maximum spread of hyperbaric bupivacaine. However, within the limits of our study, a two‐segment difference in block height is too small to consider using spinal needles as valuable tools to control block height during spinal anaesthesia in our daily practice.