bluuebunny/crossref_metadata_2025_split huggingface dataset:
Halothane decreases bacterial adherence in vitro
Authors: Batai I. , Kerenyi M. 
Published: March 2003

Background: Adherence of pathogenic bacteria to host epithelial cells is thought to be the initial step in infection, while the presence of the commensal flora is an important host defence mechanism. Anything altering bacterial adherence to human epithelial cells may contribute to bacterial infections. The impact of anaesthesia on this first step to infection is not known. In this study the effect of halothane on bacterial adherence was investigated.Methods: Human epithelial cells (HEp‐2) and two strains of Escherichia coli were exposed to halothane 2% for 2 h. Then HEp‐2 cells were coincubated with bacteria for 3 h. Bacteria attached to the epithelial cells were evaluated by light microscopy.Results: Compared to the control, bacterial adherence was reduced by 37% to 56% with the different strains when HEp‐2 cells were exposed to halothane. No significant difference was found when only bacteria were treated with halothane.Conclusion: Our results show that halothane reduces bacterial adherence to human epithelial cells in vitro. Reduced number or function of epithelial cell surface receptors may be responsible for the reduced adherence as no changes were observed when only the bacteria were exposed to halothane.
Caffeine‐ or halothane‐induced contractures of masseter muscle are similar to those of vastus muscle in normal humans
Authors: Melton A. T. , Antognini J. F. , Gronert G. A. 
Published: March 2003

Background: Skinned fibers from normal human masseter muscle have greater caffeine and calcium sensitivity than skinned fibers from vastus muscle. We examined sensitivity to caffeine and halothane in fresh, cut muscle bundles (non‐skinned) from human masseter muscle.Methods: Masseter bundles (caffeine, n=25, halothane, n=19) excised from 10 humans under general anesthesia had tension measured in 37°C baths during the addition of caffeine (0.5, 1, 2, 4, 8, 32 mM) or 3% halothane. Results were compared to those of our previous studies (1989, 1997, 25 patients) of vastus bundles (caffeine, n=71, halothane, n=63) using the same protocol, technicians, and equipment.Results: Baseline force in the caffeine test was 2.10±1.57 for masseter, and 2.02±1.68 and 1.82±1.29 respectively for vastus muscle. Force at 32 mM caffeine concentration was 11.2±9.9 g for masseter, 11.0±5.4 and 13.5±7.5 g for vastus. Concentration‐response curves were virtually identical. In the halothane group, neither baseline values (masseter 1.47±1.30, vastus 1.91±1.32 and 2.15±1.71) nor contractures in response to 3% halothane were different. Most bundles had no contracture in response to 3% halothane; 3 masseter bundles and 2 vastus bundles (1989) developed contractures of less than 0.05 g. Three vastus bundles (1997) developed contractures >0.2 g.Conclusion: Contracture responses of intact cut masseter and vastus bundles (non‐skinned) do not differ with respect to caffeine and halothane. Responses of skinned fibers might demonstrate greater sensitivity under certain conditions, but they do not reflect those of intact cut bundles.
Surveillance of antibiotic resistance in ICUs in southeastern Sweden
Authors: Erlandsson C.‐M. , Hanberger H. , Eliasson I. , Hoffmann M. , Isaksson B. , Lindgren S. , Nilsson L. E. , Sörén L. , Walther S. M. ,   the ICU Study Group of the South East of Sweden
Published: March 2003

Background: A study was designed to assess a computer‐based program for continuous registration of antibiotic resistance, statistics concerning severity of illness, and consumption of antibacterial drugs.Methods: The frequency of antibiotic resistance among bacteria in eight ICUs in southeastern Sweden was investigated yearly from 1995 through 1997. The antibiotic consumption in the ICUs was registered as defined daily doses (DDD) and compared to severity of illness (APACHE‐II scores).Results: There was a statistically significant increase in ampicillin resistance among Enterococcus spp. between 1996 and 1997, which was due to a shift from Enterococcus faecalis to Enterococcus faecium. A high prevalence of resistance among coagulase‐negative staphylococci to oxacillin (≈ 70%), ciprofloxacin (≈ 50%), fucidic acid (≈ 50%) and netilmicin (≈ 30%) was seen in all ICUs during the whole study period. There was a statistically significant increase in ciprofloxacin resistance among Escherichia coli and Enterococcus spp. The resistance among Enterobacter spp. to cefotaxime decreased but this change was not statistically significant. Efforts were made to avoid betalactam antibiotics, except carbapenems, for treatment of infections caused by Enterobacter spp. and the consumption of cephalosporins decreased whereas the consumption of carbapenems increased. The total antibiotic consumption decreased by 2.5% during the study period. There was no correlation between APACHE II scores and antibiotic consumption.Conclusions: Each ICU within a hospital ought to have a program for “on‐line” antibiotic resistance surveillance of drugs used in that unit so that changes in empirical treatment can be made when there is an increase in antibiotic‐resistant isolates within that unit.
Permissive hypercapnia during thoracic anaesthesia
Authors: Morisaki H. , Serita R. , Innami Y. , Kotake Y. , Takeda J. 
Published: March 2003

Background: While permissive hypercapnia is commonly practised in critical care, it remains unclear if the comparable manoeuvres are clinically acceptable during anaesthesia. This retrospective study aimed at describing the anaesthetic implications of hypercapnia associated with deliberate hypoventilation during thoracic surgery in patients with severe emphysema.Methods: Thirteen patients with emphysema who required thoracic surgery under similar anaesthesia were reviewed: 3 patients were managed to maintain normocapnia (normocapnia group) whereas 10 patients developed hypercapnia (PaCO2 >70 mmHg) as a result of restricting peak airway pressures (hypercapnia group).Results: In the normocapnia group (PaCO2: 45±1 mmHg, mean±SD), no event which required therapeutic intervention during the surgery was seen, whereas 2 of 3 patients showed postoperative air leakage which persisted over 5 days. In the hypercapnia group, the maximum PaCO2 during anaesthesia ranged between 70 mmHg and 135 mmHg (98±21 mmHg). During anaesthesia, all 10 patients required inotropic support to prevent hypotension, 4 patients required tracheal gas insufflation of oxygen to the operated lung to avoid hypoxaemia and 3 patients required lidocaine to treat ventricular arrhythmia. However, the trachea was extubated in the operation theatre in 9 of 10 patients and no organ dysfunction was observed postoperatively. Four patients showed postoperative air leak on the first postoperative day, one of which persisted over 5 days.Conclusion: Although there are some limitations, this preliminary study indicates that hypercapnia around 100 mmHg during anaesthesia for thoracic surgery may not be associated with serious consequences.
Plasma paracetamol concentrations and pharmacokinetics following rectal administration in neonates and young infants
Authors: Hansen T. G. , O’Brien K. , Morton N. S. , Rasmussen S. N. 
Published: March 2003

Background: Despite widespread use in children pharmacokinetic data about paracetamol are relatively scarce, not the least in the youngest age groups. This study aimed to describe plasma paracetamol concentrations and pharmacokinetics of a single rectal paracetamol dose in neonates and young infants.Methods: Perioperatively, 17 neonates and infants ≤160 days of age received one rectal paracetamol dose (mean 23.9 mg/kg (±4.2 mg/kg)). Blood samples were drawn at 60, 120, 180, 240, 300 and 360 min, according to the infants’ weights. Plasma paracetamol concentrations were measured by a Colorometric Assay, Ectachem Clinical Chemistry Slides (Johnson & Johnson Clinical Diagsnostics).Results: The plasma paracetamol concentrations were mainly below the therapeutic (i.e. antipyretic) range of 66–132 μmol/l and did not exceed 160 μmol/l in any infant. The mean maximum plasma concentration (Cmax) was 72.4 μmol/l (±33.5 μmol/l) and the time to Cmax, i.e. the mean Tmax was 102.4 min (±59.1 min). The mean “apparent” terminal half‐life (n=10) was 243.6 min (±114.1 min).Conclusion: The absorption of rectal paracetamol (mean dose 23.9 mg/kg, ±4.2mg/kg) in young infants <160 days is variable and often prolonged and achieves mainly subtherapeutic plasma concentrations.
Vasopressin and angiotensin II in blood pressure control during isoflurane anesthesia in rats
Authors: Ullman J. 
Published: March 2003

Background: Hormonal systems such as vasopressin (AVP) and the renin‐angiotensin‐aldosterone system (RAS) have been reported to become activated during anesthesia and surgery. The purpose of this study was to examine the relative importance of AVP and angiotensin II (AII) in blood pressure control during isoflurane anesthesia in rats.Methods: Rats were given an AVP V1‐receptor antagonist (AVP‐a, 10 μg kg−1), the AII receptor antagonist saralasin (SAR, 20 μg kg−1 min−1) and hexamethonium (HEX, 10 mg kg−1) intravenously in random order, awake or anesthetized with isoflurane.Results: AVP‐a had no effect on mean arterial pressure (MAP) in awake or anesthetized animals, but reduced MAP by 20.0±2.2% in the anesthetized rats which previously had been treated with SAR and/or HEX. SAR infusion had no effect on MAP when administered to conscious rats, but decreased MAP by 12.0±4.4% during anesthesia. Ganglionic blockade with HEX consistently lowered MAP in the conscious and anesthetized animals.Conclusion: It is concluded that AVP contributes to the maintenance of blood pressure when the autonomic nervous system (ANS) and/or RAS are blocked during isoflurane anesthesia. SAR infusion leads to hypotension during anesthesia, but not in conscious rats. These findings indicate that AII is of importance for blood pressure maintenance during isoflurane anesthesia in rats, and that apparent pressor effects of AVP come into play when RAS and/or ANS are blocked.
The effects of two rewarming strategies on heat balance and metabolism after coronary artery bypass surgery with moderate hypothermia
Authors: Hanhela R. , Mustonen A. , Korhonen I. , Salomäki T. 
Published: March 2003

Background: Postoperative hypothermia is common in cardiac surgery with hypothermic cardiopulmonary bypass (CPB). This trial was designed to evaluate whether rewarming over the normal bladder temperature (over 37°C) at the end of hypothermic CPB combined with passive heating methods after CPB might result in a better heat balance, lower energy expenditure (EE) and decrease of disturbances in oxygen balance compared to only rewarming the patients to a bladder temperature of 35–37°C.Methods: A prospective, randomized controlled clinical study was performed in 38 patients scheduled for elective coronary artery bypass surgery. Twenty patients (group C) were rewarmed to a bladder temperature of 35–37°C at the end of hypothermic (28°C) CPB. Eighteen patients (group W) were rewarmed to a bladder temperature of 37–38.5°C.Results: At the end of CPB, the bladder temperature was 36.2±0.7°C (mean±SD) in group C and 37.9±0.5°C in group W. After half an hour’s stay in the ICU, the mean body temperature (MBT) was 35.1±0.6°C in group C and 36.6±0.7°C in group W. During the following five hours, MBT increased to 37.4±0.8°C in group C and to 38.0±0.6°C in the other group. The peak value of EE in the ICU was 1.73±0.44 (group C) vs 1.35±0.29 (W/kg) (group W) (P=0.003). EE was significantly (P=0.044 ) higher in group C than in the other group between 1.5 and 5.5 h in the ICU. The increased energy expenditure due to heat production was associated with an increase in O2 consumption (V˙O2) 61.6±30.4% vs 25.2±24.1%, (peak values) compared to the basal values of the two groups measured before anesthesia (between groups P<0.001). Between 1.5 and 5.5 h in the ICU, group C had significantly higher V˙O2 (P=0.026), CO2 production (P=0.017), venous pCO2 (P<0.001) and minute ventilation (p=0.014) than group W. Venous pH was lower (P<0.001) in group C. The peak value of oxygen extraction was also higher (P=0.045) in group C. On the other hand, the lowest value of venous oxygen saturation was higher (P=0.04) in group W.Conclusion: With rewarming the patients at the end of CPB to a bladder temperature of over 37°C combined with passive heating methods after CPB, it was possible to decrease EE and V˙O2 compared to the control group (rewarmed to bladder temperature of 35–37°C) after coronary artery bypass surgery with moderate hypothermia.
Stereoselective pharmacokinetics of ketorolac in children, adolescents and adults
Authors: Hamunen K. , Maunuksela E.‐L. , Sarvela J. , Bullingham R. E. S. , Olkkola K. T. 
Published: March 2003

Background: Previous pharmacokinetic studies on racemic ketorolac using nonstereoselective analytical methods have indicated that the plasma clearance of ketorolac is higher and the volume of distribution greater in children than in adults. The aim of this study was to study the stereoselective pharmacokinetics of racemic ketorolac in children, adolescents and adults.Methods: 18 children (6–11 yrs), 18 adolescents (12–17 yrs) and 18 adults (18–44 yrs) participated in the study. At the end of eye surgery they were given intravenous racemic ketorolac tromethamine 0.5 mg/kg. Plasma samples were assayed for (R)‐ and (S)‐ketorolac with high‐pressure liquid chromatography. Clearance (CL), volume of distribution at steady state (Vss) and elimination (Vz) and elimination half‐life (t1/2,z) were calculated with standard methods. Incidence of side‐effects were recorded.Results: CL, Vss, Vz and t1/2,z were higher (P<0.05) for (S)‐ketorolac than for the (R)‐enantiomer. Vss of the active (S)‐enantiomer was higher in children than in adolescents (P<0.05) and adults (P<0.001) but the values for CL were similar. Due to the higher volume of distribution, t1/2,z was also higher in children than in adults. The pharmacokinetics of the (R)‐enantiomer were essentially unaffected by age.Conclusion: On a pharmacokinetic basis, the maintenance dose requirements of ketorolac are similar in children, adolescents and adults.
The pressor response after laryngeal mask or cuffed oropharyngeal airway insertion
Authors: Casati A. , Cappelleri G. , Fanelli G. , Magistris L. , Beccaria P. , Albertin A. , Torri G. 
Published: March 2003

Background: Since the cuffed oropharyngeal airway (COPA) has been suggested to cause less pharyngeal trauma than the laryngeal mask airway (LMA), we conducted a prospective, randomised study to compare haemodynamic changes after placing either the COPA or LMA in healthy anaesthetised adults.Methods: After standard midazolam premedication (0.05 mg kg−1 IV), general anaesthesia (IV propofol 2 mg kg−1) was induced in 60 ASA physical status I–II, 18–65‐yr‐old patients, who were randomly allocated to receive COPA (n=30) or LMA (n=30) placement and then mechanically ventilated using a 60% nitrous oxide and 1% isoflurane in oxygen mixture (TV=8 ml kg−1, RR=12 b.p.m., I/E=1/2). Haemodynamic variables were recorded 20 min after the midazolam premedication (baseline), and then every 1 min until 10 min after general anaesthesia induction.Results: Nine patients of group COPA (30%) required chin lift, jaw thrust or head tilt to maintain adequate ventilation, while no problems were observed in the LMA group (P<0.0005); however, in no case did the designed extratracheal airway have to be removed due to unsuccessful mechanical ventilation, and no signs of gastric insufflation or regurgitation were reported. The maximum mean changes in haemodynamic variables were more marked after LMA placement (SAP: 12%±13%; DAP: 11%±18%; HR: 13%±16%) than COPA placement (SAP: −3%±18%; DAP: −5%±16%; HR: 4%±13%) (P<0.005, P<0.005, and P<0.01 for SAP, DAP and HR, respectively). Group LMA showed higher SAP and DAP values than group COPA only during the first 3 min after airway insertion.Conclusion: In healthy, anaesthetised patients, placing a cuffed oropharyngeal airway is associated with smaller cardiovascular changes after airway insertion compared with the laryngeal mask airway.
A survey of current usage of anticholinergic drugs in paediatric anaesthesia in Finland
Authors: Rautakorpi P. , Manner T. , Kanto J. 
Published: March 2003

Background: The aim of this survey was to obtain information about the current use of anticholinergic preanaesthetic medication in children. It was carried out as a follow‐up study of the previous survey amongst Finnish anaesthesiologists in 1990.Methods: A questionnaire was send to all members of the Finnish Society of Anaesthesiologists. Data from anaesthesiologists taking care of at least three paediatric anaesthesias/week (n=183) were analyzed.Results: In 1998 only one‐third of the Finnish anaesthesiologists routinely used anticholinergics before paediatric anaesthesia. The main indications for routine anticholinergic premedication were ENT surgery (66%), eye surgery (71%) and endoscopic procedures (67%). Anticholinergic drugs were administered principally via the intravenous route (90%) briefly before induction of anaesthesia, and glycopyrrolate was the most frequently used (66%).Conclusion: During the last eight years in Finland the routine use of anticholinergic premedication has decreased. As in 1990 the anticholinergic prophylaxis is directed to ENT and eye surgery, endoscopic procedures and to children younger than 1 year. Use of glycopyrrolate has gained popularity at the expense of atropine and scopolamine.
Xenon inhalation increases airway pressure in ventilated patients
Authors: Rueckoldt H. , Vangerow B. , Marx G. , Haubitz B. , Cobas Meyer M. , Piepenbrock S. , Leuwer M. 
Published: March 2003

Background: The inert gas xenon, known as an anaesthetic for nearly 50 years, is also used as a contrast agent during computerised tomography (CT)‐scanning. As xenon has a higher density and viscosity than air, xenon inhalation may increase airway resistance.Methods: In a retrospective study we investigated the effects of 33% xenon/67% oxygen on airway pressure and cardio‐respiratory parameters in 37 long‐term mechanically ventilated patients undergoing cerebral blood flow (rCBF) measurements by means of stable xenon‐enhanced CT.Results: Xenon administration caused a significant increase in peak airway pressure from 31.6±8.0 cm H2O to 42.7±16.9 cm H2O. This effect was reproducible, did not occur after reduction of inspiratory flow rate by 50% from 0.56±0.15 L  ·  s−1 to 0.28±0.08 L  ·  s−1, and vanished immediately after termination of xenon delivery.Conclusion: Due to the higher density and viscosity of this gas mixture, ventilation with xenon/oxygen produces a higher Reynolds’ number than oxygen/air when given at the same flow rate. This means that during xenon ventilation the zone of transition from turbulent to laminar gas flow may be located more peripherally (in smaller airways) than during oxygen/air ventilation with a subsequent increase in airway resistance. Our results indicate that xenon inhalation may cause a clinically relevant increase of peak airway pressure in mechanically ventilated patients.
Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat
Authors: Michalek‐Sauberer A. , Gilly H. , Steinbereithner K. , Vizi E. S. 
Published: March 2003

Background: Adequate vocal cord paralysis and full recovery of laryngeal muscle function are important when muscle relaxants are used perioperatively. This study was designed to compare the effects of vecuronium and rocuronium at the vocal cord abductor and adductor muscles and the anterior tibial muscle in cats.Methods: Twelve adult cats were studied under pentobarbitone‐N2O/O2‐anesthesia. After supramaximal electrical stimulation of the peroneal nerve and the recurrent laryngeal nerve (0.1 Hz and intermittent train‐of‐four) evoked electromyographic responses were obtained from the anterior tibial muscle, the posterior cricoarytenoid muscle (vocal cord abductor) and two vocal cord adductor muscles, the lateral cricoarytenoid and the vocal muscle. Six cats received bolus doses of increasing size of vecuronium (ED90 22.5 μg  ·  kg−1) and six cats rocuronium (ED90 90 μg  ·  kg−1).Results: Equipotent doses of vecuronium and rocuronium caused a similar degree of paralysis in all muscles (vecuronium ED90: 70% blockade at the posterior cricoarytenoid, 83% at the lateral cricoarytenoid, 84% at the vocal muscle and 90% at the anterior tibial muscle; rocuronium ED90: 71% at the posterior cricoarytenoid, 67% at the lateral cricoarytenoid, 78% at the vocal muscle and 90% at the anterior tibial muscle; vecuronium 2×ED90: 93% blockade at the posterior cricoarytenoid, 95% at the lateral cricoarytenoid, 97% at the vocal muscle and 99% at the anterior tibial muscle; rocuronium 2×ED90: 89% blockade at the posterior and lateral cricoarytenoid, 93% at the vocal muscle and 100% at the anterior tibial muscle). Onset time was significantly shorter at the posterior cricoarytenoid muscle (290 s) compared to the lateral cricoarytenoid muscle (400 s) after vecuronium ED90 and to the vocal muscle (150 s versus 210 s) after rocuronium ED90. Compared to the anterior tibial muscle (interval 25–75%: 6.5 min after vecuronium 2×ED90 and 3.3 min after rocuronium 2×ED90) and to the posterior cricoarytenoid muscle (interval 25–75%: 7 min after vecuronium 2×ED90 and 4.3 min after rocuronium 2×ED90), recovery of laryngeal adductor muscle function was markedly delayed with both neuromuscular blocking drugs (interval 25–75% at the lateral cricoarytenoid and vocal muscle: 14 min and 15.8 min after vecuronium 2×ED90 and 10.3 min and 11.6 min after rocuronium 2×ED90 respectively).Conclusion: In cats, the time course of neuromuscular blockade after vecuronium and rocuronium differs in antagonistic laryngeal muscles. The protective laryngeal function of glottis closure recovers later than vocal cord abduction after both vecuronium and rocuronium.
Local anaesthesia for awake fibreoptic nasotracheal intubation
Authors: Kundra P. , Kutralam S. , Ravishankar M. 
Published: March 2003

Background: Awake fibreoptic nasotracheal intubation (FNI) is performed in potentially difficult airways under local anaesthesia. This observer‐blinded study was designed to evaluate the efficacy of upper airway anaesthesia produced by nebulized lignocaine against combined regional block (CRB) for awake FNI.Methods: Forty‐eight ASA 1 adults were randomly allocated to receive 4 ml of 4%‐nebulized lignocaine (nebulization group) or translaryngeal block, bilateral superior laryngeal nerve block and three 4% lignocaine‐soaked cotton swabs in the nose (CRB group). Facial grimace and patient comfort were assessed by grimace and airway reactivity scores. Patients reported their discomfort on a 4‐point score.Results: All patients underwent successful FNI without significant discomfort; 79% in the nebulization group and 83% of the patients in the CRB group reported the procedure to be comfortable. A higher grimace score was recorded on insertion of the endotracheal tube (ETT) through the nostril in the nebulization group when compared to the CRB group, P<0.005. Similarly, patients in the CRB group were more comfortable during passage of the ETT into the glottis, as compared to the nebulization group. A progressive increase in heart rate was observed in all patients from the beginning of the procedure, but the rise in the nebulization group was greater, (P<0.05) and also lasted longer than in the CRB group (P<0.05). Mean arterial pressure was higher in the nebulization group when compared to the CRB group (P<0.05), with patients belonging to the CRB group demonstrating considerable haemodynamic stability.Conclusions: Both nebulization and CRB produced satisfactory anaesthesia of the upper airway, but CRB provided better patient comfort and haemodynamic stability.