bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remifentanil sedation compared with propofol during regional anaesthesia
Authors: Servin F. S. , Raeder J. C. , Merle J. C. , Wattwil M. , Hanson A. L. , Lauwers M. H. , Aitkenhead A. , Marty J. , Reite K. , Martisson S. , Wostyn L. 
Published: March 2003

Background:  The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side‐effects and rapid recovery. In this study remifentanil is compared with propofol for sedation during successful regional anaesthetic blocks.Methods:  After informed consent was given, 125 patients undergoing surgery under spinal or brachial plexus anaesthesia were randomized to receive, either propofol: bolus 500 µg/kg plus initial infusion 50 µgkg/min or remifentanil: bolus 0.5 µg/kg plus initial infusion 0.1 µgkg/min. Study drug infusion rate was titrated throughout the procedure according to level of sedation and side‐effects. Pain, discomfort, sedation level and side‐effects were recorded at regular intervals until discharge from the post operative care unit (PACU).Results:  Two patients in the remifentanil group versus ten in the propofol group were treated for discomfort or pain during surgery (P<0.02). Due to a significantly higher rate of respiratory depression (46% vs. 19% with propofol, P<0.01) the mean remifentanil infusion rate was decreased to 0.078 ± 0.028 µgkg/min, whereas it was kept stable with propofol. Propofol patients had significantly higher (P<0.05) sedation levels and experienced more frequent amnesia of the procedure. Eleven propofol patients experienced pain at injection site, versus two remifentanil patients (P<0.02). Nausea and vomiting were more frequent in the remifentanil patients during infusion (27% vs. 2% in the propofol group, P<0.001) but similar postoperatively. Time to discharge from PACU was similar in the two groups.Conclusion:  Propofol results in less respiratory depression and nausea when sedation is needed during a case with a successful regional block. Remifentanil may be considered as an alternative if pain during the procedure is a major concern or if amnesia is contraindicated.
Sevoflurane versus isoflurane – anaesthesia for lower abdominal surgery.  Effects on perioperative glucose metabolism
Authors: Geisser W. , Schreiber M. , Hofbauer H. , Lattermann R. , Füssel S. , Wachter U. , Georgieff M. , Schricker T. 
Published: March 2003

Background: The aim of this study was to determine the impact of sevoflurane anaesthesia on metabolic and endocrine responses to lower abdominal surgery.Methods: A prospective randomized controlled study in 20 patients undergoing abdominal hysterectomy. Patients were randomly assigned to receive either sevoflurane (S) or isoflurane anaesthesia (I). Using a stable isotope dilution technique, endogenous glucose production (EGP) and plasma glucose clearance (GC) were determined pre‐ and postoperatively (6,6‐2H2‐glucose). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured preoperatively, 5 min after induction of anaesthesia, during surgery and 2 h after the operation.Results: EGP increased in both groups with no intergroup differences (preop. S 12.2 ± 1.6, I 12.4 ± 1.6; postop. S 16.3 ± 1.9*, I 19.0 ± 3.1*µmol kg−1 min−1, all values are means ± SD, *P < 0.05 vs. preop.). Plasma glucose concentration increased and GC decreased in both groups. There were no differences between groups. (Glucose conc. mmol l−1 preop.: S 4.1 ± 0.3, I 3.9 ± 0.5; 5 AI S 5.1 ± 0.6*, I 5.1 ± 1.0*, postop. S 7.0 ± 1.0*, I 7.1 ± 1.4*; * = P < 0.05 vs. preop.; GC ml kg−1min−1 preop. S 3.0 ± 0.4, I 3.2 ± 0.4; postop. S 2.4 ± 0.3*, I 2.7 ± 0.3*; *=P < 0.05 vs. preop.) Insulin plasma concentrations were unchanged. Cortisol plasma concentrations increased intra‐ and postoperatively with no changes between the groups. Norepinephrine plasma concentration increased in the S group after induction of anaesthesia. I group norepinephrine was increased 2 h after operation and showed no intergroup differences.Conclusion: Sevoflurane, as well as isoflurane, does not prevent the metabolic endocrine responses to surgery.
Mathematical model of renal elimination of fluid and small ions during hyper‐ and hypovolemic conditions
Authors: Gyenge Christina C. , Bowen Bruce D. , Reed Rolf K. , Bert Joel L. 
Published: March 2003

This study is concerned with the formulation of a ‘kidney module’ linked to the plasma compartment of a larger mathematical model previously developed. Combined, these models can be used to predict, amongst other things, fluid and small ion excretion rates by the kidney; information that should prove useful in evaluating values and trends related to whole‐body fluid balance for different clinical conditions to establish fluid administration protocols and for educational purposes. The renal module assumes first‐order, negative‐feedback responses of the kidney to changes in plasma volume and/or plasma sodium content from their normal physiological set points. Direct hormonal influences are not explicitly formulated in this empiric model. The model also considers that the renal excretion rates of small ions other than sodium are proportional to the excretion rate of sodium.As part of the model development two aspects are emphasized (1): the estimation of parameters related to the renal elimination of fluid and small ions, and (2) model validation via comparisons between the model predictions and selected experimental data. For validation, model predictions of the renal dynamics are compared with new experimental data for two cases: plasma overload resulting from external fluid infusion (e.g. infusions of iso‐osmolar solutions and/or hypertonic/hyperoncotic saline solutions), and untreated hypo volemic conditions that result from the external loss of blood.The present study demonstrates that the empiric kidney module presented above can provide good short‐term predictions with respect to all renal outputs considered here. Physiological implications of the model are also presented.
Glyburide decreases myocardial oxygen pressure in dogs
Authors: Hoffman W. E. , Albrecht R. F. , Jonjev Z. S. 
Published: March 2003

Background: Reports show that glyburide, an adenosine triphosphate sensitive potassium (K+ATP) channel blocker, will reverse the myocardial protective effect of inhalational anesthesia. We evaluated the effect of glyburide on myocardial tissue oxygen pressure (PmO2) in dogs anesthetized with desflurane.Methods: Twelve dogs were anesthetized with 8% end‐tidal desflurane for baseline anesthesia. A flow probe was placed on the left anterior descending (LAD) artery. A probe that measured PmO2 was inserted into the middle myocardium in the LAD region. After baseline measures, six dogs received i.v. 1 mg kg−1 of glyburide and six dogs received sham vehicle treatment. After the glyburide or sham treatment, each dog received an i.v. infusion of adenosine 0.1 µg kg−1·min−1, sodium nitroprusside (SNP) 2–4 µg kg−1·min−1 and 14% end‐tidal desflurane in random order.Results: Glyburide decreased LAD artery flow from 59 ± 9 ml min−1 to 30 ± 6 ml min−1 (P < 0.05) and PmO2 from 44 ± 16 mmHg to 30 ± 9 mmHg (P < 0.05). Adenosine infusion increased LAD artery blood flow 180% in the sham‐treated dogs but produced no change in the glyburide‐treated dogs. Sodium nitroprusside infusion increased LAD artery flow and decreased PmO2 in both the glyburide‐ and sham‐treated dogs. Desflurane (14%) did not reverse the glyburide‐induced vasoconstriction but increased PmO2 to 38 ± 20 mmHg (P < 0.05).Conclusion: Glyburide produced myocardial tissue hypoxia, which was not changed by adenosine, worsened by SNP and improved by 14% desflurane. The improvement in PmO2 with desflurane occurred without a change in myocardial blood flow.
Different benefit of bispectal index (BIS™) in desflurane and propofol anesthesia
Authors: Luginbühl M. , Wüthrich S. , Petersen‐Felix S. , Zbinden A. M. , Schnider T. W. 
Published: March 2003

Background: Bispectal index (BIS™) monitoring may reduce drug usage and hasten recovery in propofol and inhalation anesthesia. The faster emergence profile of desflurane may reduce the effect of BIS monitoring on recovery from desflurane compared with propofol. This study compared hypnotic drug usage, recovery, patient satisfaction and incidence of inadequate sedation in BIS monitored and nonmonitored women anesthetized with desflurane or propofol.Methods: One hundred and sixty patients scheduled for elective gynecological surgery were randomly assigned to desflurane or propofol anesthesia with and without BIS monitoring. Fentanyl, vecuronium and remifentanil were administered according to clinical criteria. The BIS monitor was used in all patients, but the monitor screen was covered in the controls. A BIS level between 45 and 55 was targeted in the BIS monitored patients whereas depth of anesthesia was assessed by clinical criteria in the controls.Results: The mean (SD) desflurane MAC‐hours administered with and without BIS were 0.70 (0.15) and 0.76 (0.12), respectively, resulting in extubation times of 6.5 (4.1) and 8.3 (6.1) min. (NS). Bispectal index monitoring was associated with improved patient satisfaction, reduced postoperative nausea and antiemetic drug requirement, and fewer episodes with sustained BIS levels > 60. The mean (SD) propofol infusion rates were 6.0 (1.4) and 6.6 (0.9) mg kg−1h−1 with and without the BIS monitor (P = 0.023), resulting in mean (SD) extubation times of 6.8 (4.6) and 10.5 min (5.9), respectively (P < 0.05).Conclusion: Bispectal index monitoring reduced propofol usage and hastened recovery after propofol anesthesia, whereas in desflurane anesthesia it was associated with improved patient satisfaction, probably because of decreased postoperative nausea and fewer episodes of inadequate hypnosis.
Analgesic effect of i.v. paracetamol: possible ceiling effect of paracetamol in postoperative pain
Authors: Hahn T. W. , Mogensen T. , Lund C. , Jacobsen L. S. , Hjortsoe N.‐C. , Rasmussen S. N. , Rasmussen M. 
Published: March 2003

Background: Despite the widespread use of paracetamol for many years, the analgesic serum concentrations of paracetamol are unknown. Therefore the correlation between serum paracetamol concentrations and the analgesic effect was studied.Methods: Sixty‐four women undergoing laparoscopic sterilization were included in a double‐blind, placebo‐controlled, randomized study. Patients were given i.v. propacetamol 40 mg kg−1 (group H), 20 mg kg−1 (group I), 10 mg kg−1 (group L) or placebo after surgery. Alfentanil was available via patient‐controlled analgesia (PCA) during the 4‐h postoperative study period. The patients' self‐reported pain was registered on the visual analog scale (VAS). A pharmacokinetic model was fitted to the paracetamol data.Results: One to 3 h after injection of propacetamol the alfentanil consumption was significantly (P = 0.01–0.04) higher in the placebo group compared with groups H, I, and L receiving propacetamol. There were no significant differences between the amounts of alfentanil consumed in groups H, I, and L. Initial VAS‐scores were moderate (5.4–6.2), and declined significantly (P < 0.0001) over time, with no difference between groups. Paracetamol followed an open two‐compartment model with i.v. administration and first order elimination. The estimated concentrations immediately (t = 0) after injection were 56 mg l−1 (H), 28 mg l−1 (I) and 14 mg l−1 (L).Conclusion: We showed a significant opioid‐sparing effect of paracetamol in the immediate postoperative period. Pharmacokinetic data were in accordance with other studies. Our results suggest that a ceiling effect of paracetamol may be present at i.v. doses of 5 mg kg−1, i.e. a serum concentration of 14 mg l−1, which is a lower dose than previously suggested.
Exotic snake bite: a challenge for the Scandinavian anesthesiologist?
Authors: Chew M. S. , Guttormsen A. B. , Metzsch C. , Jahr J. 
Published: March 2003

Background: Venomous snake bites are uncommon in the Scandinavian countries. Envenomation from exotic snakes do however occur, mostly amongst snake handlers. This case report documents the effects and treatment for envenomation from Hoplocephalus bungaroides, or the Broad‐Headed snake, native to eastern and southern Australia. Snakes of the genus Hoplocephalus have previously been described as of ‘lesser medical importance’ because of their rarity.Methods: This case report describes the signs, symptoms and management of systemic envenomation in a previously healthy man.Results: The patient developed signs of severe coagulopathy less than an hour after envenomation. There was also biochemical evidence of rhabdomyolysis, and cardiotoxicity. At no time did the patient develop respiratory insufficiency, neurotoxicity or renal failure. The patient was initially managed with i.v. crystalloids, plasma, corticosteroids and antifibrinolytics and by observation in the intensive care unit (ICU). Coagulopathy resolved after causal treatment with monovalent Tiger snake antivenom.Conclusion: The patient made good progress and was well on discharge from the ICU 26 h postenvenomation.
Neurologic deficits and arachnoiditis following neuroaxial anesthesia
Authors: Aldrete J. A. 
Published: March 2003

Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil‐based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma.Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal.Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.
Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction
Authors: Dauri M. , Polzoni M. , Fabbi E. , Sidiropoulou T. , Servetti S. , Coniglione F. , Mariani P. , Sabato A. F. 
Published: March 2003

Background: The purpose of this study was to compare three locoregional techniques of pain management after arthroscopic anterior cruciate ligament reconstruction (ACLR).Methods: Sixty ASA I–II subjects were enrolled after obtaining written informed consent. Patients were randomly allocated to three groups of 20 subjects. The first group (EPI) received epidural ropivacaine 0.2% plus sufentanil 0.2 µg ml−1, at 5 ml h−1. Patients in the second group (CFB) were given a continuous infusion of the same analgesic mixture through a femoral catheter. The third group (IA) received a continuous intraarticular infusion of ropivacaine 0.2% plus sufentanil 0.2 µg ml−1, at 5 ml h−1. All subjects were allowed PCA boluses of 5 ml of local anesthetic. Analgesia was assessed for 36 h after the end of surgery by means of a visual analog scale (VAS) and a verbal scale (VS), as well as the number of PCA boluses administered and the amount of supplementary i.v. ketorolac, if given.Results: The VAS and VS scores were significantly higher in group IA during the 24 h following surgery. Ketorolac requirement was higher in group IA throughout the postoperative observation. Adverse effects were similar in all groups except for urinary retention, which was significantly more frequent in group EPI.Conclusions: We conclude that either epidural or continuous femoral nerve block provide adequate pain relief in patients who undergo ACLR, whereas intraarticular analgesia seems unable to cope satisfactorily with the analgesic requirements of this surgical procedure.
Preoperative emotional states in patients with breast cancer and postoperative pain
Authors: ÖZalp G. , Sarioglu R. , Tuncel G. , Aslan K. , Kadiogullari N. 
Published: March 2003

Background: The present study examined the relationship between psychological variables, including anxiety, depression, and patient‐controlled analgesia (PCA) use in patients who underwent radical mastectomy.Methods: Ninety‐nine ASA I–II women with breast cancer between 18 and 60 years scheduled for modified radical mastectomy completed the state scale of the state‐trait anxiety inventory and the Beck depression inventory before the day of surgery. Standard general anesthesia, surgery, and IV‐PCA therapy was conducted. Postoperative ratings of pain intensity, opioid consumption and satisfaction with PCA were recorded for the first 24 h on the ward. The degree of pain intensity was evaluated by a visual analog scale (VAS, 1–10). Satisfaction with pain control was reported using an five‐point scale from 1 (very dissatisfied) to 5 (very satisfied).Results: The pain intensity, total analgesic consumption and dose/demand ratio were significantly related to preoperative anxiety and depression (P<0.05). Degree of dissatisfaction with PCA was significantly correlated with preoperative anxiety and depression (P<0.01).Conclusion: Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.
Comparison of the catheter‐technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery
Authors: Türker G. , Uçkunkaya N. , Yavaşçaoğlu B. , Yilmazlar A. , ÖZçelik S. 
Published: March 2003

Background: The aim of this study was to compare the intra‐ and postoperative analgesia provided by the catheter‐technique psoas compartment block and the epidural block in hip‐fractured patients. We also compared hemodynamic stability, motor blockade, ease of performing the technique, and complications.Methods: Thirty patients who underwent partial hip replacement surgery were included in this prospective single‐blind study. Subjects were randomly assigned to Group E (n=15; general anesthesia plus epidural block with 15 ml of 0.5% bupivacaine) or Group P (n=15; general anesthesia plus psoas compartment block with 30 ml of 0.5% bupivacaine). Hemodynamic parameters were recorded at 10‐min intervals intraoperatively. Regional anesthesia procedure time, number of attempts at block, intraoperative blood loss, and need for supplemental fentanyl and/or ephedrine were noted. Postoperatively, a patient‐controlled analgesia device delivered an infusion and boluses of bupivacaine/fentanyl. Pain, motor blockade, ambulation time, patient satisfaction with analgesia, and complications were recorded postsurgery.Results: The epidural required significantly more attempts than the psoas block, thus procedure time was longer in this group. Group E also showed significantly greater drops in mean arterial blood pressure from baseline at 30, 40 and 50 min after the start of general anesthesia. Significantly more Group E patients required epinephrine supplementation. The groups were similar regarding pain scores (at rest and on movement) and patient satisfaction, but Group E had higher motor blockade scores, longer ambulation time, and significantly more complications.Conclusion: The continuous psoas compartment block provides excellent intraoperative and postoperative analgesia with a low incidence of complications for partial hip replacement surgery
Anti‐thrombotic effect of milrinone is caused by inhibition of calcium release from the dense tubular system in human platelets*
Authors: Hiramatsu N. , Kageyama K. 
Published: March 2003

Aim: Milrinone, a phosphodiesterase III inhibitor, exerts positive inotropic effects which induce an increase in the intracellular calcium concentration by raising the cyclic adenosine monophosphate level in cardiac muscle. Milrinone was also reported to inhibit platelet aggregation, however, its mechanism remains unknown. Therefore, we investigated the effects of milrinone on intracellular calcium mobilization when platelets were activated.Methods: Washed platelets, obtained from six healthy volunteers, were preincubated with milrinone (0.9 µM) for 1 min and then exposed to 0.015 iµ ml−1 thrombin for 5 min. The effect of milrinone on changes in the intracellular calcium level using a fluorescent dye, fura‐2, was also observed. Calcium mobilizations via plasma membrane calcium channels and the dense tubular system were assessed differentially.Results: Milrinone (0.9 µM) significantly suppressed the aggregation ratios at 5 min compared with those in controls (86±5%) to 75±8%. The increase in the intracellular calcium concentration was also significantly suppressed (controls, 915±293 nM vs. 405±240 nM) when stimulated by thrombin. Milrinone also significantly inhibited the release of calcium from the dense tubular system (controls, 284±111 nM vs. 158±51 nM). Calcium influx through the plasma membrane was suppressed by milrinone 2.4 µM.Conclusion: Milrinone (0.9 µM) inhibited thrombin‐induced platelet aggregation. This inhibitory effect was mainly mediated by suppressing calcium release from the dense tubular system.