bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of patient‐controlled opioid analgesia for acute postoperative pain
Authors: Walder B. , Schafer M. , Henzi I. , Tramèr M. R. 
Published: March 2003

Background: The usefulness of intravenous patient‐controlled analgesia (PCA) with opioids for postoperative analgesia is not well defined.Methods: We systematically searched (MEDLINE, EMBASE, Cochrane Library, bibliographies, any language, to January 2000) for randomised trials comparing opioid‐based PCA with the same opioid given intramuscularly, intravenously, or subcutaneously. Weighted mean differences (WMD) for continuous data, relative risks (RR) and numbers‐needed‐to‐treat (NNT) for dichotomous data were calculated with 95% confidence intervals (CI) using fixed and random effects models.Results: Data from 32 trials were analysed: 22 (1139 patients) were with morphine, five (682) with pethidine, three (184) with piritramide, one (47) with nalbuphine and one (20) with tramadol. In three morphine and one pethidine trial (352 patients), more patients preferred PCA (89.7% vs 65.8%, RR 1.41 (95%CI 1.11 to 1.80), NNT 4.2). Combined dichotomous data on pain intensity and relief, and the need for rescue analgesics from eight morphine, one pethidine, one piritramide, and one nalbuphine trial (691 patients), were in favour of PCA (RR 1.22 (1.00 to 1.50), NNT 8). In two morphine trials (152), pulmonary complications were more frequently prevented with PCA (100% vs 93.3%, RR 1.07 (1.01 to 1.14), NNT 15). There was equivalence for cumulative opioid consumption, pain scores, duration of hospital stay, and opioid‐related adverse effects.Conclusion: These trials provide some evidence that in the postoperative pain setting, PCA with opioids, compared with conventional opioid treatment, improve analgesia and decrease the risk of pulmonary complications, and that patients prefer them.
Improved recovery after music and therapeutic suggestions during general anaesthesia: a double‐blind randomised controlled trial
Authors: Nilsson U. , Rawal N. , Uneståhl L. E. , Zetterberg C. , Unosson M. 
Published: March 2003

Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra‐operative period under general anaesthesia could improve the recovery of hysterectomy patients.Methods: In a double‐blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra‐operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient‐controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well‐being and duration of hospital stay were studied as outcome variables.Results: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well‐being or length of hospital stay between the groups.Conclusion: This double‐blind study has demonstrated that intra‐operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
Tracheal intubation through the intubating laryngeal mask in patients with unstable necks
Authors: Asai T. , Shingu K. 
Published: March 2003

Background: In patients with unstable necks, the neck should be stabilized during induction of anaesthesia, but this may make tracheal intubation difficult. Awake intubation may produce straining, which could be detrimental to the unstable neck.Methods: We studied 20 patients with unstable necks to examine the efficacy of insertion of the intubating laryngeal mask under conscious sedation (to minimize the possibility of losing a patent airway and to facilitate fibrescope‐aided intubation) followed by tracheal intubation through the laryngeal mask after induction of anaesthesia (to reduce stress response to intubation). After the patient had been sedated with midazolam (up to 5 mg) and fentanyl (up to 100 μg), the intubating laryngeal mask was inserted. General anaesthesia was then induced with sevoflurane and tracheal intubation attempted.Results: In all patients, tracheal intubation through the laryngeal mask succeeded without airway obstruction. Neither insertion of the mask under conscious sedation nor tracheal intubation after induction of anaesthesia caused straining, and only two patients moved upper extremities at intubation. Insertion of the laryngeal mask did not significantly alter blood pressure or heart rate. Tracheal intubation significantly increased blood pressure and heart rate, but the increase was considered to be small.Conclusions: In the patient with an unstable neck with a low risk of pulmonary aspiration, insertion of the intubating laryngeal mask while the patient is sedated may minimize difficulty in obtaining a patent airway before tracheal intubation and may facilitate a fibrescope‐aided tracheal intubation; subsequent induction of anaesthesia before tracheal intubation may minimize stress response to intubation.
Effects of combined methohexitone‐remifentanil anaesthesia in electroconvulsive therapy
Authors: Andersen F. A. , Årsland D. , Holst‐Larsen H. 
Published: March 2003

Background: Methohexitone is widely used to provide anaesthesia for patients undergoing electroconvulstive therapy (ECT). Short seizure duration, high blood pressures (BP) and heart rates (HR) are usual in elderly patients. In this study, elderly patients undergoing ECT received low dose methohexitone with remifentanil or methohexitone alone and motor seizure duration, haemodynamic response and recovery time were compared.Methods: Ten patients, of mean age 74.3 years, were enrolled in this double‐blind, randomised crossover trial, receiving a total of 38 ECTs. Each patient was given the following two i.v. regimens in random order: A) methohexitone 0.5 mg kg−1 combined with remifentanil 1.0 μg kg−1 and B) methohexitone 0.75 mg kg−1. Additional methohexitone was given, if needed, until loss of consciousness, and then suxamethonium 1.0 mg kg−1 for muscular paralysis.Results: Mean motor seizure duration was significantly longer with methohexitone‐remifentanil (37.6 s (SD 12.0)) than with methohexitone alone (27.1 (SD11.5)) (P=0.0009). Recovery time, time to spontaneous breathing, peak postictal changes in BP and HR were similar with both regimens.Conclusion: A reduced dose of methohexitone combined with remifentanil allows prolonged duration of motor seizures in ECT. We conclude that low dose methohexitone combined with a short‐acting opioid is a reasonable alternative for elderly patients undergoing ECT, and for other patients with short seizure duration.
Being awake intermittently during propofol‐induced hypnosis: A study of BIS, explicit and implicit memory
Authors: Barr G. , Anderson R. E. , Öwall A. , Jakobsson J. G. 
Published: March 2003

Background: Being awake during anaesthesia is a serious complication. An anaesthetic depth monitor must discriminate in real time between wakefulness and unconsciousness. The present study created a period of wakefulness during propofol‐induced hypnosis. Bispectral index (BIS), explicit and implicit memories of the awake period were investigated.Methods: Ten volunteers were studied. The calculated brain concentration of a target controlled infusion of propofol was increased until loss of response (LOR) to verbal command and then propofol was stopped. When fully awake, volunteers were presented with a picture, sound and smell. Propofol infusion was restarted until LOR and then ceased. BIS and the calculated brain concentration of propofol were recorded every minute. A structured interview was conducted for explicit memories after awakening and for explicit as well as implicit memories the day after.Results: Median BIS‐index for the transition between awake and asleep and vice versa differed significantly. It was not possible, however, to establish any threshold value or zone for discriminating between wakefulness and LOR due to the large inter‐individual variations in BIS‐index. No volunteer could explicitly recall any of the stimuli presented during the period of wakefulness.Conclusion: The BIS‐index decreases with increasing sedation but because of the large individual variations, the real‐time BIS‐index for the individual subject cannot reliably discriminate wakefulness from unconsciousness during propofol infusion. Propofol causes such profound amnesia that lack of postoperative recall does not assure that episodes of awareness have not occurred during propofol‐induced hypnosis.
Time course of changes in jugular venous oxygen saturation during hypothermic or normothermic cardiopulmonary bypass in patients with diabetes mellitus
Authors: Kadoi Y. , Saito S. , Goto F. , Someya T. , Kamiyashiki S. , Fujita N. 
Published: March 2003

Background: Preexisting diabetic mellitus is a risk factor determining postoperative neurological disorders. The present study assesses the effects of normothermic and hypothermic cardiopulmonary bypass (CPB) on jugular venous oxygen saturation (SjvO2)in patients with preexisting diabetic mellitus.Methods: Sixteen diabetic patients who underwent elective coronary artery bypass grafting surgery were randomly divided into two groups: Group DN (n=8, diabetic patients) underwent normothermic CPB (>35°C), and group DH (n=8, diabetic patients) underwent hypothermic CPB (32°C). Controls were 16 age‐matched non‐diabetic patients (normothemic group, CN: n=8; hypothemic group, CH: n=8). A 4.0 F fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to continuously monitor SjvO2 values. Hemodynamic parameters and arterial and jugular venous blood gases were measured seven times.Results: Cerebral desaturation, which was defined as SjvO2 values below 50%, was observed during normothermic CPB in diabetic patients (at the onset of CPB: 46±3%, at 20 min after onset of CPB: 49±3%, means±SD, respectively). No cerebral desaturation occurred in diabetic and control patients during hypothermic CPB.Conclusions: Patients with preexisting diabetes mellitus experienced cerebral desaturation during normothermic CPB.
Neurologic sequelae after caesarean section
Authors: Rorarius M. , Suominen P. , HaanpÄÄ M. , Puura A. , Baer G. , Pajunen P. , Tuimala R. 
Published: March 2003

Background: Because pregnancy increases the sensitivity of nervous tissue to local anaesthetics, pregnant patients may be at higher risk of developing neurologic deficits after spinal block than non‐pregnant patients. Therefore, we evaluated prospectively the incidence and type of neurologic symptoms after spinal anaesthesia with hyperbaric bupivacaine for caesarean section.Methods: In this prospective follow‐up study we recorded neurologic complications during anaesthesia and postoperatively until discharge from the hospital of 219 patients, who underwent caesarean section under spinal anaesthesia with hyperbaric bupivacaine (5 mg/ml, mean 13 mg). The patients filled in a questionnaire on the first and fifth postoperative days. In the case of complaints typical of neurologic symptoms they were checked first by the anaesthesiologist and, in the case of persistent symptoms, afterwards additionally by a neurologist.Results: Twenty‐six of 219 patients were not included in the further evaluation because of incomplete return of their questionnaires. Seventeen mothers (8.8%) complained of transient neurologic symptoms (TNSs), lasting mostly 1–2 days, in the buttocks and/or legs during the first three postoperative days. Eleven patients (5.7%) complained of postdural puncture headache. Two patients (emergency caesarean section because of protracted labour in one and elective caesarean section because of previous caesarean section in the other) complained of persisting pain or sensory abnormalities. Neither of them felt paraesthesia during lumbar puncture.Conclusion: Women after caesarean section under a spinal block seem to suffer more often from TNSs than non‐pregnant women. The conclusions are, however, uncertain since we had no control group operated on under other than spinal anaesthesia. The persisting neurologic symptoms in two patients might also be due to the obstetric procedure itself. To find out about the validity and possible underlying causes of our results, we need randomised studies with control groups receiving epidural or general anaesthesia.
Preoperative rectal diclofenac versus paracetamol for tonsillectomy: effects on pain and blood loss
Authors: Schmidt A. , Björkman S. , Åkeson J. 
Published: March 2003

Background:Diclofenac is widely used for postoperative analgesia but the perioperative safety of this drug is controversial because of its effect on platelet aggregation, which might increase blood loss. In a prospective investigator‐blinded study the effects of diclofenac and paracetamol on pain and blood loss were compared in patients undergoing tonsillectomy.Method:Ninety patients were randomised to receive rectal diclofenac 0.65–1.0 mg · kg−1or paracetamol 13–20 mg · kg−1preoperatively. Ten patients were excluded after randomisation. Pain was evaluated postoperatively by means of the visual analogue scale and by recording the use of pethidine for rescue analgesia. Perioperative blood loss was estimated from measured intraoperative blood loss; use of drugs to achieve haemostasis, and the incidence of reoperations.Results:Anaesthetic or surgical managements did not differ between the groups, but a significantly longer period of surgery was found in the diclofenac group, 32±16 vs. 25±11 min (P=0.024). Pain scores or pethidine consumption were not significantly different between the groups. Intraoperative blood loss was significantly larger in the diclofenac group, 1.9 (1.1–3.1) vs. 1.1 (0.7–2.0) ml · kg−1(P=0.007).Conclusion:Preoperative rectal diclofenac offers no advantage over paracetamol with respect to postoperative analgesia in tonsillectomy patients but increases intraoperative blood loss.
Ventilation–perfusion distributions in different porcine lung injury models
Authors: Neumann P. , Hedenstierna G. 
Published: March 2003

Background: Acute lung injury is characterized by hypoxemia which may be caused by hypoventilation, ventilation–perfusion (V˙A/Q˙) mismatch, intrapulmonary shunting and oxygen diffusion impairment. The multiple inert gas elimination technique (MIGET) allows analysis of these four causes of hypoxemia and is therefore the most comprehensive approach to investigate blood gas abnormalities. Using MIGET, we studied whether specific patterns of gas exchange abnormalities occur in different lung injury models and whether gas exchange abnormalities can be related to pathogenic aspects of lung injury.Methods: Lung injury was induced with oleic acid injection, endotoxin infusion or repeated lung lavage in groups of 6 mechanically ventilated pigs.Results: PaO2 decreased and PaCO2 increased significantly in all three lung injury models, but gas exchange was more impaired in the oleic acid and lavage, as compared to the endotoxin group. Shunt was the major cause of hypoxemia in our lung injury models, whereas V˙A/Q˙ mismatch contributed to venous admixture only after oleic acid injection and lung lavage. Oxygen diffusion limitation was not observed. Although alveolar ventilation was maintained after induction of lung injury, hypercapnia developed due to an increase of the ventilatory mean towards higher V˙A/Q˙ ratios, increased shunt and increased carbon dioxide production.Conclusions: Shunt and ventilation–perfusion mismatch fully explain the gas exchange disturbances observed in our lung injury models. Although V˙A/Q˙ distributions can be related to pathogenic aspects of the three study groups, we did not observe specific V˙A/Q˙ patterns which allow diagnosis of the type of lung injury from a recovered V˙A/Q˙ distribution.
Circulating neutrophils exhibit enhanced apoptosis associated with mitochondrial dysfunctions after surgery under general anaesthesia
Authors: Delogu G. , Moretti S. , Famularo G. , Antonucci A. , Signore L. , Marcellini S. , Lo Bosco L. , De Simone C. 
Published: March 2003

Background: Evidence suggests that apoptosis plays a main role in the postoperative changes detected in the polymorphonuclear neutrophil (PMN) population. Furthermore, recent studies have demonstrated that mitochondrial alterations constitute critical events of the apoptotic cascade. In this study we investigated whether apoptosis among neutrophils taken from patients undergoing surgical trauma could be associated with perturbation of mitochondrial transmembrane potential (ΔΨm) and/or exaggerated production of mitochondrial reactive oxygen species (ROS).Methods: Twenty‐seven patients undergoing elective surgery under general anaesthesia were enrolled in the study. Peripheral blood samples were drawn one day before the operation and at 12 and 24 h after surgery. Apoptosis rate was assessed by staining neutrophils with 7‐amino‐actinomycin D (7‐AAD) and by analysis by a FACScan flow cytometer. In order to evaluate ΔΨm, cells were exposed to 3,3‐dihexyloxacarbocyanine iodide [DiOC6(3)]; intracellular ROS was measured by means of hydroethidine (HE) and 2,7‐diclorofluorescein diacetate (DCFH‐DA), followed by analysis on a cytofluorometer.Results: At 12 h following surgery we observed a significantly (P<0.05) increased frequency of apoptotic PMNs compared to that preoperatively (30.79±3.68% vs 7.40±0.69%). At this same time‐point, the rate of neutrophils stained with HE, DCFH‐DA and [DiOC6(3)] were significantly (P<0.05) higher compared to baseline (51.05±5.44%, 50.58±5.84% and 55.31±4.33% vs 20.17±2.38%, 19.59±2.03 and 25.43±2.71% respectively). Overall measurements returned to the preoperative values 24 h after surgery.Conclusion: These data suggest that surgery under general anaesthesia triggers in the immediate postoperative period pathways of PMN accelerated apoptosis associated with significant alterations in mitochondrial function.
Monitoring of end‐tidal carbon dioxide partial pressure changes during infrarenal aortic cross‐clamping: a non‐invasive method to predict unclamping hypotension
Authors: Boccara G. , Jaber S. , Eliet J. , Mann C. , Colson P. 
Published: March 2003

Background: To assess the variations in end‐tidal CO2 in response to aortic cross‐clamping and the relationship with systolic arterial pressure (SAP) changes induced by unclamping.Methods: Thirty‐three patients undergoing infrarenal aortic abdominal aneurysm repair by aorto‐aortic prothetic bypass were prospectively studied. All patients were anesthetized with iv midazolam (0.05 mg · kg−1), thiopentone (3–5 mg · kg−1), fentanyl (5 μg · kg−1), pancuronium (0.1 mg · kg−1) and the maintainance of anesthesia used was 1–1.5% end‐tidal isoflurane and iv fentanyl. The perioperative management was standardized. End‐tidal CO2 and SAP were measured 5 min before (Pre‐XAA), 15 min after infrarenal aortic cross‐clamping (XAA), 5 min before (Pre‐UXAA) and immediately after unclamping (UXAA).Results: A total of 16 (48.5%) from 33 patients presented decrease in SAP following aortic unclamping, and 13 out of these patients had arterial hypotension defined as SAP <90 mmHg. End‐tidal CO2 variation (PreXAA–PreUXAA) induced by aortic clamping was correlated with SAP variation (PreUXAA–UXAA) induced by unclamping (r=0.763; P=0.0001). An end‐tidal CO2 reduction above 15% after aortic cross‐clamping was found to have a 100% sensitivity to detect a SAP decrease greater than 20% after unclamping, with a 100% specificity and a negative predictive value of 1.0. Complete aortic occlusion duration was not correlated to SAP unclamping variation (ΔSAP). Intraoperative characteristics (fluid loading, hematocrits, urinary output) were comparable, although blood loss was higher in patients experiencing ΔSAP>20%.Conclusions: End‐tidal CO2 variation monitoring during aortic cross‐clamping may provide a reliable and non‐invasive method to predict unclamping hypotension. When the aortic clamp was released, systolic hypotension (>20%) occurred in those subjects who had a decrease in end‐tidal CO2 greater than 15% during aortic cross‐clamping.
Perioperative response of leptin and the tumor necrosis factor alpha system in morbidly obese patients. Influence of cortisol inhibition by etomidate
Authors: Montalbán C. , Del Moral I. , García‐Unzueta M. T. , Villanueva M. A. , Amado J. A. 
Published: March 2003

Background: Leptin, tumor necrosis factor alpha (TNFα) and soluble TNFα receptors are secreted by the adipose tissue. Surgery induces a complex cytokine and neurohormonal response. The aim of our study was to investigate the perioperative response of leptin and the TNFα system in morbidly obese patients submitted to gastroplasty, and the possible involvement of cortisol in their responses.Methods: Serum cortisol, adrenocorticotropic hormone (ACTH), leptin, TNFα and soluble TNFα receptor I were measured in 22 morbidly obese women (11 anesthetized with thiopental and 11 with etomidate, a well known inhibitor of cortisol synthesis). Samples were collected before anesthesia induction, just before surgical incision, and 2, 4, 6, 12, 24 and 48 h after the start of surgery.Results: Baseline serum leptin correlated with body mass index (r=0.567, P=0.007). Baseline serum leptin and TNFα were higher than normal. Cortisol release was inhibited in the etomidate group with a subsequent higher stimulation of ACTH release. A statistically significant decrease in serum leptin levels was observed in both groups at 2, 4, 6 and 48 h, compared with basal values. A similar decrease in serum TNFα levels was observed in both groups, but the decrease reached significance only in the etomidate group. Serum soluble TNFα receptor I did not decrease. No differences were found between the two groups in leptin, TNFα or soluble TNFα receptor I concentrations at any time.Conclusion: Serum leptin and TNFα levels decrease in obese patients during gastroplasty. Transitory inhibition of cortisol release does not alter this response.