bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of heat and moisture exchanger on humidity and body temperature in a low‐flow anaesthesia system
Authors: Johansson A. , Lundberg D. , Luttropp H. H. 
Published: December 2004

Background: Artificial humidification of dry inspired gases seems to reduce the drop in body temperature during surgery. The aim of this study was to evaluate the humidity and temperature of anaesthetic gases with heat and moisture exchangers (HMEs). The secondary aim was to evaluate if HMEs in combination with low‐flow anaesthesia could prevent a decrease in the body temperature during general anaesthesia.Methods: Ninety patients scheduled for general surgery were randomised to receive a fresh gas flow of 1.0, 3.0 or 6.0 l min−1 with or without HMEs in a circle anaesthesia system. Relative humidity, absolute humidity, temperature of inspired gases and body temperatures were measured during 120 min of anaesthesia.Results: The inspiratory absolute humidity levels with HMEs were 32.7 ± 3.1, 32.1 ± 1.1 and 29.2 ± 1.9 mg H2O l−1 and 26.6 ± 2.3, 22.6 ± 3.0 and 13.0 ± 2.6 mg H2O l−1 without HMEs after 120 min of anaesthesia with 1.0, 3.0, or 6.0 l min−1 fresh gas flows (P < 0.05, between with and without HME). The relative humidity levels with HMEs were 93.8 ± 3.3, 92.7 ± 2.2 and 90.7 ± 3.5%, and without the HMEs 95.2 ± 4.5, 86.8 ± 8.0 and 52.8 ± 9.8% (P < 0.05, between with and without HMEs in the 3.0 and 6.0 l min−1 groups). The inspiratory gas temperatures with HMEs were 32.5 ± 2.0, 32.4 ± 0.5 and 31.0 ± 1.9°C, and 28.4 ± 1.5, 27.1 ± 0.8 and 26.1 ± 0.6°C without HMEs after 120 min of anaesthesia (P < 0.05, between with and without HME). The tympanic membrane temperatures at 120 min of anaesthesia were 35.8 ± 0.6, 35.5 ± 0.6 and 35.4 ± 0.8°C in the groups with HMEs, and 35.8 ± 0.6, 35.3 ± 0.7 and 35.3 ± 0.9°C in the groups without the HMEs (NS).Conclusions: The HMEs improved the inspiratory absolute humidity, relative humidity and temperature of the anaesthetic gases during different fresh gas flows. However, the HMEs were not able to prevent a body temperature drop during low‐flow anaesthesia.
A randomised double‐blind evaluation of adenosine as adjunct to sufentanil in spinal labour analgesia
Authors: Rane K. , Sollevi A. , Segerdahl M. 
Published: December 2004

Background: Intrathecal injection of sufentanil offers labour pain relief of short duration. This double‐blind randomised study evaluates if the combination of adenosine to sufentanil could give relevant prolongation (40%) of the duration of sufentanil spinal analgesia.Methods: Twenty‐five healthy parturients requesting labour analgesia were included. Patients received 10 µg of sufentanil + 500 µg of adenosine or 10 µg of sufentanil intrathecally. Pain intensity and duration of pain relief were assessed.Results: Pain relief was equal between groups. Duration of analgesia was not increased by adenosine + sufentanil, 99 ± 54 min, vs. sufentanil, 89 ± 56 min.Conclusion: Adding 500 µg of adenosine to 10 µg of sufentanil could not provide any prolongation of labour pain relief.
Ketamine reduces swallowing‐evoked pain after paediatric tonsillectomy
Authors: Elhakim M. , Khalafallah Z. , El‐fattah H. A. , Farouk S. , Khattab A. 
Published: December 2004

Background: Ketamine efficacy as an analgesic adjuvant has been studied in several clinical settings with conflicting results. The aim of this study was to investigate the effect of ketamine on spontaneous and swallowing‐evoked pain after tonsillectomy.Methods: Fifty children were randomized to receive premedication with either ketamine 0.1 mg kg−1 i.m. or placebo given 20 min before induction of a standard general anaesthesia. All children received rectal diclofenac 2 mg kg−1 and fentanyl 1 µg kg−1 i.v. before surgery.Results: The ketamine group showed significantly lower pain scores both at rest and on swallowing, with less total paracetamol consumption (P < 0.05) during the 24 h after surgery. Significantly more patients required postoperative morphine titration in the control group (P < 0.05). The time to the first oral intake, and duration of i.v. hydration, were significantly shorter and the quality of oral intake was significantly better in the ketamine group (P < 0.05). There were no differences in the incidence of vomiting or dreaming between the groups.Conclusion: Premedication with a small dose of ketamine reduces swallowing‐evoked pain after tonsillectomy in children who received an analgesic regimen combining an opioid and a NSAID.
Plasma cytokines do not reflect expression of pro‐ and anti‐inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs*
Authors: Brix‐Christensen V. , Vestergaard C. , Chew M. , Johnsen C. K. , Andersen S. K. , Dreyer K. , Hjortdal V. E. , Ravn H. B. , TØnnesen E. 
Published: December 2004

Background: Plasma concentrations of inflammatory markers are increased in response to the trauma of cardiac surgery and cardiopulmonary bypass (CPB). It is, however, unknown whether the plasma cytokine levels and cytokine mRNA expression at organ level reflect each other.Methods: Twenty‐six piglets (17–19 days) were allocated to the sham‐group (sternotomy only, n = 13) or to the CPB‐group (sternotomy, 120 min CPB procedure with 60‐min aortic cross‐clamp, n = 13). The pigs were observed for 0.5 h or 4 h post‐CPB. Plasma levels of IL‐1β, IL‐6, IL‐8 and IL‐10 and mRNA expression of TNF‐α, IL‐1β, IL‐6, IL‐8, IL‐10 and iNOS in organs were registered with concomitant changes in oxygenation index (OI) and expiratory nitric oxide (NO).Results: In pigs killed 0.5 h post‐CPB there was a significant increase in IL‐10 mRNA in the lungs and kidneys compared with the sham‐group. IL‐1β mRNA was detectable in the kidneys and lungs of the CPB‐pigs, while IL‐6 mRNA was up regulated only in lungs. In pigs killed 4 h post‐CPB a significantly higher IL‐6 mRNA was found in heart tissue and a lower IL‐10 mRNA was found in lungs of CPB pigs compared with the sham‐group. There was a concomitant significant increase in OI and increased plasma IL‐8 and IL‐10 concentrations in the CPB‐pigs compared with the sham‐pigs.Conclusion: The cytokine mRNA expression pattern was very different for the pigs killed already 0.5 h after the CPB procedure compared with the pigs killed 4 h post‐CPB. The plasma cytokine levels poorly reflected mRNA expression of the pro‐ and anti‐inflammatory cytokines.
Circulatory effects of angiotensin II during anaesthesia, evaluated by real‐time spectral analysis
Authors: Ullman J. , Härgestam R. , Lindahl S. , Chan S. H. H. , Eriksson S. , Rundgren M. 
Published: December 2004

Background: General anaesthesia may stimulate the renin‐angiotensin system. Exogenous administration of angiotensin II elevates blood pressure mainly via increased total peripheral resistance caused by direct vasoconstrictor actions. It is also well established that the hypertensive effect of angiotensin II involves a cerebrally mediated component. The hypertensive effect of an intravascular infusion of angiotensin II is substantially reduced by isoflurane anaesthesia. A likely mechanism is that isoflurane anaesthesia reduces the cerebral component of the angiotensin II effect on blood pressure, which involves influences on autonomic nervous activity. In an experimental study in sheep we used real‐time spectral analysis of arterial blood pressure signals to obtain information on parasympathetic, respectively, sympathetic autonomic nervous activity in response to angiotensin II administration during isoflurane anaesthesia.Methods: The study was performed on conscious and isoflurane‐anaesthetized sheep that were subjected to an intracarotid infusion of angiotensin II (85 ng kg−1 min−1) during 20 min followed by a recovery period of 30 min and thereafter an injection of the angiotensin II, AT1‐receptor antagonist losartan (10 mg kg−1) i.v. Systemic and regional (renal and femoral) circulation was monitored in parallel to real‐time spectral analysis of the arterial blood pressure signal.Results: Isoflurane anaesthesia reduced both magnitude and duration of the hypertensive response to angiotensin II infusion. The power spectral density in the frequency band that represents sympathetic activation, correlated to the changes in mean arterial pressure in conscious animals, but not during isoflurane anaesthesia.Conclusion: We conclude that the cerebrally mediated component of the hypertensive effect of circulating angiotensin II is largely eliminated by isoflurane anaesthesia. Spectral power analysis of the blood pressure signal indicates that the cerebral angiotensin II effect involves activation of sympathetic nervous activity.
Respiratory burst activity of polymorphonuclear cells is dependent on the cell preparation technique
Authors: Zhao J. , Juettner B. , Scheinichen D. , Jaeger K. , Heine J. , Piepenbrock S. 
Published: December 2004

Background: Controversial results have been reported regarding the effect of anaesthetics on superoxide anion production during the respiratory burst (RB) of polymorphonuclear cells (PMN). The differences could be caused by the cell preparation methods and the aim of this study was to compare two techniques.Methods: RB activity was measured in cell suspensions isolated with the single‐step Ficoll procedure and in unfractionated whole blood. Two concentrations of propofol (therapeutic and 10‐fold of this, 6 µg ml−1 or 60 µg ml−1) were investigated after cell preparation with both methods. RB was stimulated with Escherichia coli (E. coli), phorbol 12‐myristate 13‐acetate (PMA) or N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP) and measured by means of fluorescence intensity in a flow cytometer.Results: The percentage of PMNs in whole blood which generate superoxide anions in response to fMLP was significantly lower (2.5 ± 0.7%; mean ± SEM) than that in Ficoll isolated cell suspensions (15.1 ± 1.7%). Incubation with propofol led to a concentration‐related decrease of RB activity in Ficoll separated PMNs after both PMA and fMLP stimulation. No significant effect of propofol was observed on the RB in PMA stimulated whole blood samples.Conclusion: The results suggest that the influence of cell preparation methods should be considered when the in vitro effects of anaesthetics on PMN functions are studied with flow cytometric methods.
Fatal lipoid pneumonia due to bronco‐aspiration of isoparaffin after ingestion of an organophosphate insecticide
Authors: Nogué S. , Sanz P. , Borondo J. C. , Picón M. , De La Red G. , Mestre G. 
Published: December 2004

A 66‐year‐old‐male patient with a history of depression voluntarily ingested around 400 ml of an insecticide composed of 5% methylparathion, 75% isoparaffin, 8% etoxylated oleic acid, 4% 1,2,4‐trimethylbenzene, 6% naphtha, 1% 1,3,5‐ trimethylbenzene, 0.4% propylbenzene and 0.3% xylene.The patient was conscious and alert at admission. Gastric lavage was performed and activated charcoal administered. There were no clinical symptoms of organophospate ingestion despite reduced concentrations of erythrocyte and plasma cholinesterase. Chest X‐ray showed pulmonary infiltrate compatible with bronco‐aspiration. The patient evolved to respiratory failure refractory to treatment and died from multiorganic failure 23 days after ingesting the insecticide.The pathological findings included a pulmonary fibrosis in the alveolar spaces which caused enlargement of the intra‐alveolar septa. Abundant lipin‐laden macrophages were observed within the alveolar spaces.We review the most relevant aspects of cases of fatal lipoid pneumonia and point out that on occasion severe or fatal intoxication is due to the substances accompanying the active ingredients.
Fentanyl decreases propofol requirement for laryngeal mask airway insertion
Authors: Goyagi T. , Tanaka M. , Nishikawa T. 
Published: December 2004

Background:  Since fentanyl is a potent depressant of the upper airway reflex, preadministration of fentanyl may facilitate insertion of the laryngeal mask airway (LMATM) using propofol. Accordingly, we tested the hypothesis that fentanyl pretreatment would reduce the dose of propofol required for the LMA insertion.Methods:  Forty‐one healthy patients without sedative premedication were randomly assigned to either fentanyl group, receiving fentanyl 2 µg kg−1 intravenously, or control group, receiving equal volumes of normal saline. Then, 3 ml of 2% lidocaine was given intravenously to alleviate pain associated with propofol administration. Thirty s after the fentanyl or saline injection, a predetermined dose of 1% propofol was given at a rate of 100 mg min−1. Insertion of the LMA was attempted 90 s after the completion of the propofol injection. The dose of propofol given to a particular patient was determined by the response of the preceding patient in that group to a higher or lower dose, using the up‐and‐down method. The first patient in each group received 2.5 mg kg−1 of propofol, while the step‐size was 0.25 mg kg−1.Patients responses were assessed by a blinded observer.Results:  ED50 and ED95 of propofol requirements were significantly less in the fentanyl group (0.82, 1.17 mg kg−1, respectively) than those in the control group (2.39, 2.62 mg kg−1, P < 0.001).Conclusion:  Our results indicate that preadministration of fentanyl 2 µg kg−1 decreases the propofol requirement for the LMA insertion.
Milrinone improves lung compliance in patients receiving mechanical ventilation for cardiogenic pulmonary edema
Authors: Takeda S. , Matsumura J. , Ikezaki H. , Kim C. , Sato N. , Nakanishi K. , Sakamoto A. , Ogawa R. , Tanaka K. 
Published: December 2004

Background:  Cardiogenic pulmonary edema is a frequent cause of respiratory failure. We investigated whether milrinone improved lung compliance.Methods:  We selected 10 patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection of milrinone (50 µg kg−1) over 10 min, followed by continuous intravenous infusion (0.5 µg kg−1 min−1). Lung compliance, blood gas values, hemodynamic parameters, and sample plasma milrinone levels were assessed over 120 min after the onset of the continuous infusion of milrinone.Results:  Ten min following milrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 37 ± 12 to 42 ± 12 ml cmH2O−1 and from 40 ± 13 to 45 ± 12 ml cmH2O−1, respectively (P < 0.01). Plasma milrinone levels reached a therapeutic level for vasodilator and positive inotropic effect at 10 min after milrinone infusion. A significant decrease in mean pulmonary artery pressure and pulmonary artery wedge pressure occurred simultaneously with an increase in respiratory system compliance. However, an increase in cardiac index was observed later than these changes. There were significant correlations between the mean pulmonary artery pressure and Cdyn (r = −0.39, P < 0.01) and Cst (r = −0.38, P < 0.01).Conclusions:  Milrinone‐induced improvement in lung compliance along with an improvement of hemodynamics was found together with an inverse relationship between compliance and mean pulmonary artery pressure.
EMLA® does not permit pain‐free retrobulbar injection*
Authors: Kuvaki̇ B. , Gökmen N. , Günenç F. , Ceyhan Kara H. , Üzümlü H. , Özden G. , Söylev M. , Gökel E. 
Published: December 2004

Background:  Retrobulbar injection can be associated with significant pain, due to both needle insertion and deposition of the local anaesthetic solution. The local anaesthetic cream EMLA® (eutectic mixture of local anaesthetics) which contains a mixture of lignocaine and prilocaine has been shown to reduce the pain associated with skin puncture. The efficacy of EMLA® in alleviating the pain of retrobulbar injection for cataract surgery was assessed in this study.Methods:  In this, randomised double‐blind study, EMLA® (n = 53) or lignocaine 5% ointment (n = 50) was administered to the inferior orbital margin at least 45 min before retrobulbar block in 103 patients. Pain assessed during retrobulbar block was marked subjectively by the patient on a 10‐point numerical rating scale.Results:  Median verbal pain scores were 3.0 with an interquartile range of 1.5–6.5 in the control group and 3.50 with an interquartile range of 2.0–6.0 in the EMLA® group (P = 0.67).There was no significant difference between the EMLA® group and the lignocaine ointment group according to this pain assessment.Conclusion:  EMLA® does not permit pain‐free retrobulbar injection.
Concordance between trifluoroacetic acid and hepatic protein trifluoroacetylation after disulfiram inhibition of halothane metabolism in rats
Authors: Spracklin D. K. , Emery M. E. , Thummel K. E. , Kharasch E. D. 
Published: December 2004

Background:  Cytochrome P4502E1(CYP2E1)‐mediated oxidation of halothane to a reactive intermediate (trifluoroacyl chloride) that covalently binds to hepatic proteins forming trifluoroacetylated neoantigens is believed to be the initiating event in a complex immunologic cascade culminating in antibody formation and severe hepatic necrosis (‘halothane hepatitis’) in susceptible patients. Trifluoroacyl chloride may also hydrolyze to the stable metabolite trifluoroacetic acid (TFA). CYP2E1 inactivation by disulfiram or its primary metabolite, diethyldithiocarbamate, inhibits human halothane oxidation to TFA in vitro and in vivo. Nevertheless, disulfiram effects on hepatic protein trifluoroacetylation by halothane in vivo are unknown. This investigation tested the hypotheses that disulfiram prevents halothane‐dependent protein trifluoroacetylation in vivo, and that TFA represents a biomarker for hepatic protein trifluoroacetylation.Methods:  Rats were pretreated with isoniazid (CYP2E1 induction), isoniazid followed by disulfiram (CYP2E1 inhibition), or nothing (controls), then anesthetized with halothane or nothing (controls). Plasma and urine TFA were quantified by ion HPLC; hepatic microsomal TFA‐proteins were analyzed by Western blot.Results:  CYP2E1 induction increased both TFA and TFA‐protein formation compared with uninduced halothane‐treated rats. Disulfiram, even after CYP2E1 induction, nearly abolished both TFA and TFA‐protein formation. Pretreatments similarly affected both TFA and TFA‐protein formation across all groups.Conclusions:  Disulfiram inhibition of CYP2E1‐mediated halothane oxidation prevents hepatic protein trifluoroacetylation. Based on the concordance between TFA and TFA‐protein formation, TFA appears to be a valid biomarker for TFA‐protein formation. Disulfiram inhibition of human halothane oxidation in vivo, previously assessed by diminished TFA formation, probably also confers inhibition of hepatic TFA‐protein formation.
Withdrawal of medical treatment in the ICU. A cohort study of 318 cases during 1994–2000*
Authors: Nolin T. , Andersson R. 
Published: December 2004

Background:Many deaths in intensive care occur after life support has been withdrawn or withheld. In Sweden there are no guidelines for the withholding or withdrawal of life‐sustaining treatments, and information on the frequency of such decisions is scarce. Open and conscious accounts of crucial standpoints in theses decisions are important. The aim of this study was to determine the incidence of decisions to withdraw medical therapy in a Swedish, general intensive care unit (ICU), the underlying reasons and outcomes.Methods:In this historical cohort study in a 10 bed ICU, we studied the records of the 3904 patients admitted during the period 1994–2000.Results:Medical therapy was withdrawn in 318 (8.1%) patients. During the study period, 466 patients died in the ICU, of which 191 (41.0%) had had a withdrawal decision. Of the 318 patients with a withdrawal decision followed up, 191 (60.1%) died in the ICU, 104 (32.7%) later on a general ward, and 23 (7.2%) were discharged alive from the hospital. The main reasons for withdrawing therapy were failure to respond to treatment in 119 (37%), poor prognosis of the acute disease in 119 (37%), poor prognosis of coexisting chronic disease in 62 (20%) and the patient's own request in 18 (6%) of the cases. The median time from ICU‐admission to a withdrawal decision was 2.8 days. The median time from a withdrawal decision to death was 0.6 days (191 patients) in the ICU, 2.4 days (104 patients) in the general ward and 1.4 months (19 patients) for those dying after hospital discharge. In five cases a renewed evaluation was performed.Conclusion:Medical therapy was withdrawn in the ICU in 8.1% of patients and the chief reasons were failure to respond to therapy or poor prognosis of the acute disease. Four patients were still alive five years later. The time interval from admission to a withdrawal decision was short.
A practice survey on vasopressor and inotropic drug therapy in Scandinavian intensive care units
Authors: Oldner A. , Rossi P. , Karason S. , Åneman A. ,   for the Scandinavian Critical Care Trials Group
Published: December 2004

Background: This practice survey was performed to analyse the indications for use of vasopressor/inotropic drugs, preferred drugs and doses as well as concomitant monitoring and desired haemodynamic target values in Scandinavian ICUs. An internet‐based reporting system was implemented.Methods: A total of 223 ICUs were identified in the Scandinavian countries and invited to participate in a one‐day point‐prevalence study. An internet‐based database was constructed and a practice survey protocol designed to identify haemodynamic monitoring, indications for vasopressor/inotropic drug‐therapy, fluids used for volume loading, pretreatment circulatory state, actual and targeted haemodynamic variables. Patients were eligible for the study if on vasopressor/inotropic drug‐therapy for more than 4 h.Results: A total of 114 ICUs participated. A total of 114 adult patients matched the inclusion criteria. Sixty‐seven per cent of the patients had received vasopressor/inotropic drug‐treatment for >24 h and 32% received more than one drug. Arterial hypotension (92%) and oliguria (50%) were most common indications. Fluid loading prior to therapy was reported in 87% of patients. Dopamine (47%) and noradrenaline (44%) were the most commonly used drugs followed by dobutamine (24%). No other drug exceeded 6%. Non‐catecholamine drugs were rarely used even in cardiac failure patients. Invasive arterial pressure was monitored in 95% of patients, pulmonary artery catheters were used in 19%. Other cardiac output monitoring techniques were used in 8.5% of the patients.Conclusion: Dopamine and noradrenaline seem to be the most commonly used inotropic/vasopressor drugs in Scandinavia. Traditional indications for inotropic/vasopressor support as hypotension and oliguria seem to be most common. Invasive monitoring was used in almost all patients, whereas a limited use of pulmonary artery catheters was noted. The internet‐based reporting system proved to be an efficient tool for data collection.