bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recombinant human erythropoietin in preoperative autologous blood donation did not influence the haemoglobin recovery after surgery
Authors: Åvall A. , Hyllner M. , Bengtson J. P. , Carlsson L. , Bengtsson A. 
Published: December 2004

Background: Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment.Methods: Thirty‐eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery.Results: No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL−1 in all but four patients.Conclusions: In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels.
Resistive load of laryngeal mask airway and proseal laryngeal mask airway in mechanically ventilated patients
Authors: Natalini G. , Rosano A. , Lanza G. , Martinelli E. , Pletti C. , Bernardini A. 
Published: December 2004

Background:  The ProSeal Laryngeal Mask Airway (PLMA) ventilation tube is narrower and shorter than the standard Laryngeal Mask Airway (LMA) and is without the vertical bars at the end of the tube. In this randomized, crossover study, PLMA and LMA resistances were compared.Methods:  Respiratory mechanics was calculated in 26 anesthetized, mechanically ventilated patients with both LMA and PLMA. The laryngeal mask positioning was fiberoptically evaluated. Differences in the respiratory mechanics of the LMA and the PLMA were attributed to the differences between the laryngeal masks.Results:  In the total study population the airway resistance was 1.5  ±  2.6 hPa.l−1.s−1 (P = 0.005) higher with the PLMA than with the LMA. During the PLMA use, the peak expiratory flow reduced by 0.02 ± 0.05 l min−1 (P = 0.046), the expiratory resistance increased by 0.6 ± 1.3 hPa.l−1.s−1 (P = 0.022), and the time constant of respiratory system lengthened by 0.09 ± 0.18 s (P = 0.023). These differences doubled when the LMA was better positioned than the PLMA, whereas they disappeared when the PLMA was positioned better than the LMA.Conclusions:  The standard LMA offers a lower resistive load than the PLMA. Moreover, the fitting between the laryngeal masks and the larynx, as fiberoptically evaluated, plays a major role in determining the resistive properties of these devices.
Detection of organ ischemia during hemorrhagic shock
Authors: Kvarstein G. , Mirtaheri P. , Tønnessen T. I. 
Published: December 2004

Background:  In a porcine hemorrhagic shock model we aimed to determine: (a) whether blood flow to the intestine and kidney was more reduced than cardiac output; (b) whether parameters of anaerobic metabolism correlated with regional blood flow; and (c) whether metabolic parameters in intestine, kidney and skeletal muscles detected a compromized metabolic state at an earlier stage than did systemic parameters.Methods:  In an animal research laboratory at a university hospital six domestic pigs were subjected to volume‐controlled hemorrhage. Every 30 min samples of blood were withdrawn. Systemic and regional hemodynamic parameters and tissue levels of PCO2 were monitored. Whole body and organ‐specific oxygen consumption (VO2) and veno‐arterial (VA) differences of lactate, glucose, potassium (K+), PCO2, H+ and base excess (BE) were calculated every 30 min.Results:  With progressive hemorrhage, intestinal blood flow decreased to the same extent as cardiac output, whereas the reduction in renal blood flow was more pronounced. We found a concomitant reduction in VO2 (onset of supply dependent metabolism) in intestine, kidney and skeletal muscles. In muscular tissue PCO2 increased to levels three times higher than baseline, while renal and intestinal PCO2 increased eightfold.Supply dependency was associated with a concomitant increase in VA CO2 and VA H+. Also, VA lactate increased, mostly in intestine and least in skeletal muscle. Intestinal and renal VA K+ increased, while muscular VA K+ decreased. Arterial lactate and H+ increased considerably, whereas arterial BE decreased.Conclusion:  With progressive hemorrhage, renal blood flow, but not intestinal and skeletal muscle blood flow, was reduced more than cardiac output. Supply dependent oxygen metabolism (VO2) and organ acidosis occurred simultaneously in the three organs, despite differences in blood flow reductions. Organ ischemia coincided with a pronounced change in arterial lactate and systemic acid base parameters.
Effects of intra‐abdominal CO2‐insufflation on normal and impaired myocardial function: an experimental study
Authors: Greim C. A. , Broscheit J. , Kortländer J. , Roewer N. , Schulte am Esch J. 
Published: December 2004

Background:  Intra‐abdominal pressure (IAP) elevation during CO2‐pneumoperitoneum increases cardiac afterload and may enhance dysfunction of the already compromized heart. This study focused on the effects of acute IAP increases on left and right ventricular loadings and contractility in the heart with impaired global function.Methods:  Impairment of myocardial function (IMF) was pharmacologically induced in 16 pigs by administration of halothane and propranolol, while baseline arterial pressure was maintained by intravenous phenylephrine. Intra‐abdominal pressure was gradually increased by 10 mmHg up to 30 mmHg in the supine position (IMF group 1, n = 8) or in a head‐down tilted position (IMF group 2, n = 8). In two control groups with normal myocardial function, IAP was also increased in the supine position or the head‐down tilted position. Cardiac function in all groups was assessed by epicardial echocardiography, intraventricular pressure measurements and pulmonary artery catheterization.Results:  The increase in IAP was accompanied by a transient rise in LV end‐systolic wall stress and reduced cardiac output significantly by 16–24% in all groups. In the IMF groups, LV end‐diastolic transmural pressure increased by 34–60% to peak values of 24 mmHg, while cross‐sectional LV end‐diastolic areas remained unchanged. Increases in right ventricular end‐diastolic volume and decreases in right ventricular ejection fraction as well as in cardiac output were most pronounced at IAP 20 mmHg and significantly stronger in both IMF groups than in the control groups (P < 0.001).Conclusion:  Following the acute elevation of IAP, the right ventricular volume load shifted more extensively in the IMF groups than in the animals with normal myocardial function. Myocardial function in the impaired heart may worsen during IAP elevation due to right ventricular load alterations rather than a LV afterload increase.
Citation classics in anaesthesia and pain journals: a literature review in the era of the internet
Authors: Terajima K. , Åneman A. 
Published: December 2004

Background: The number of citations an article receives reflects its scientific impact. The introduction of internet‐based resources to search and access articles has made it possible to review even whole scientific areas. This study identifies the top 50 most‐cited articles over the last 25 years in speciality journals dedicated to anaesthesia and pain, respectively.Methods: Twenty‐two journals listed in The Science Citation Index Expanded™ in the field of anaesthesiology and nine major medical journals were screened using the cited reference option to identify articles cited more than 100 times between 1986 and 2002. The top 50 articles in speciality journals and the top 10 articles in major medical journals concerning anaesthesia and pain were retrieved for further analysis.Results:  The most‐cited articles in speciality journals were published from 1986 to 1997 and received a mean of 222 (anaesthesia) and 279 (pain) citations. Sixty‐seven institutions produced the most‐cited articles and of those 28 were located outside North America. The articles were published in six journals led by the Journal of Pain (50 articles) and Journal of Anaesthesiology (39 articles). Forty‐seven articles were classified as related to clinical experience, 33 were review articles, and 20 discussed basic science.Conclusion:  To make an article a possible ‘citation classic’ in anaesthesiology, it should be published in one of six leading journals and originate from an established institute in North America. Internet resources to publish and cite the literature have to date not advanced any article published in the last 5 years to the top 100 list.
Influences on serum concentrations of morphine, M6G and M3G during routine clinical drug monitoring: A prospective survey in 300 adult cancer patients
Authors: Klepstad P. , Dale O. , Kaasa S. , Zahlsen K. , Aamo T. , Fayers P. , Borchgrevink P. C. 
Published: December 2004

Background:  In order to make treatment decisions physicians should have knowledge about the relations between patient characteristics and drug disposition. Dose, route of administration, gender, age and renal function are reported to influence the serum concentrations of morphine, morphine‐6‐glucurnide (M6G) and morphine‐3‐glucuronide (M3G) during chronic treatment of cancer pain. These factors, however, are not evaluated in studies with a sample size sufficient to explore predictive factors.Methods:  Three hundred consecutive morphine users admitted because of a malignant disease were recruited. The relations of serum concentrations of morphine, M6G and M3G to patient characteristics (gender, age, weight, renal function, liver function, dose, route of administration) were explored, and regression analysis performed to investigate whether these characteristics predicted serum concentrations obtained during routine clinical drug monitoring.Results:  Morphine dose was associated with serum concentrations of morphine (r = 0.69), M6G (r = 0.76) and M3G (r = 0.76). Oral morphine resulted in higher dose‐adjusted M6G and M3G serum concentrations compared with s.c. morphine. Creatinine serum concentrations correlated with serum concentrations of M6G and M3G. Dose and route of administration predicted morphine serum concentrations, while dose and renal function predicted M6G and M3G serum concentrations. Age was an additional factor predicting M3G concentrations. Dose was the only factor that explained a clinically significant part of the observed variability.Conclusion:  Patient characteristics predict only minor parts of the variability of morphine, M3G and M6G serum concentrations observed during routine clinical drug‐monitoring in cancer patients.
Effects of different steroid treatment on reperfusion‐associated production of reactive oxygen species and arrhythmias during coronary surgery
Authors: Volk T. , Schmutzler M. , Engelhardt L. , Pantke U. , Laule M. , Stangl K. , Grune T. , Wernecke K. ‐D. , Konertz W. , Kox W. J. 
Published: December 2004

Background:  During conventional cardiac surgery ischemia and reperfusion may cause excessive production of reactive oxygen species leading to tissue damage including early arrhythmias. We therefore assessed the kinetics of markers of radical stress including oxidized and reduced glutathione (GSSG/GSH), oxidized proteins (PCG) and malondialdehyde (MDA), and tested the hypothesis that different steroid treatments inhibit these markers and early reperfusion‐associated supraventricular and ventricular extrasystolic beats.Methods:   In a randomized, controlled, blinded, prospective trial 36 patients received a preoperative infusion of methylprednisolone (MP, 15 mg kg−1, n = 12), tirilazad mesylate (TM, 10 mg kg−1, n = 12) or placebo (PL, NaCl, n = 12). Coronary sinus and arterial blood was drawn at baseline and 2, 5, 15, 30, 60 and 240 min after aortic declamping. Holter‐ECG analysis was used to identify arrhythmias.Results:  Cardiac GSSG release occurred very early ( < 15 min) and was not significantly attenuated by either drug treatment. Cardiac PCG production showed biphasic increases, lasted > 4 h and was significantly reduced only by TM. Cardiac MDA release was short ( < 30 min) and significantly reduced by MP and TM. Neither treatment had a significant influence on the early occurrence of ventricular or supraventricular arrhythmias. The number of patients needing cardioversions or defibrillations also were not different.Conclusions:  The results indicate that cardiac production of reactive oxygen species occurs after reperfusion in humans and is not inhibited by steroid treatment. Steroid treatment effectively reduces lipid peroxidation during cardiac surgery but has no influence on arrhythmias.
Intraoperative changes in arterial oxygenation during volume‐controlled mechanical ventilation in modestly obese patients undergoing laparotomies with general anesthesia
Authors: Yoshino J. , Akata T. , Takahashi S. 
Published: December 2004

Background:   In obese patients, arterial oxygenation can be greatly impaired during general anesthesia. Both avoidance of denitrogenation and application of positive end‐expiratory pressure (PEEP) during mechanical ventilation may be effective in preventing such impairment of arterial oxygenation.Methods:  We studied 28 obese/overweight and seven non‐obese (BMI < 25 kg · m−2) patients who underwent laparotomies with general anesthesia (i.e. isoflurane with or without nitrous oxide). During anesthesia, their lungs were mechanically ventilated at a rate of 10 breaths · min−1 with a constant flow, inspiratory‐to‐expiratory ratio 1 : 2, and tidal volume ∼10 ml · kg−1. The obese/overweight patients were allocated to four different groups in terms of denitrogenation and application of PEEP (7 cm H2O) during the ventilation (n = 7 each). In the non‐obese patients, their denitogenated lungs were ventilated without application of PEEP. Arterial gas analyses were performed before induction of anesthesia, and 30, 90, 150 and 210 min after tracheal intubation. The ratio of PaO2 to FiO2 was calculated as an index of arterial oxygenation.Results:  No significant changes in the PaO2/FiO2 ratio were observed throughout the study in the non‐obese patients and in the obese/overweight patients whose non‐denitrogenated lungs were ventilated with PEEP. In the obese/overweight patients whose lungs were ventilated after denitrogenation or without application of PEEP, significant decreases in the PaO2/FiO2 ratio were observed 30 and 90 min after tracheal intubation.Conclusions:  In obese or overweight patients under general anesthesia, it may be advisable to avoid denitrogenation and apply PEEP during mechanical ventilation in order to minimize the impairment of arterial oxygenation.
Is there a risk of sensitization and allergy to chlorhexidine in health care workers?
Authors: Garvey L. H. , Roed‐Petersen J. , Husum B. 
Published: December 2004

Background:  In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure.Methods:  Two hundred and forty‐eight doctors, nurses and auxiliary staff were invited to participate in the study. One hundred and four individuals took part in the full study including skin tests and a questionnaire and a further 74 individuals filled in the questionnaire giving a total of 178 questionnaires (72%). Patch tests with chlorhexidine gluconate 1% and chlorhexidine acetate 1% were performed looking for type IV (delayed type) allergy. A prick test with chlorhexidine gluconate 0.5% and an intradermal test with chlorhexidine 0.0002% were performed looking for type I (immediate type) allergy.Results:  There were no positive tests in any of the 104 individuals tested (99% confidence interval 0–4.9%). There was a predominance of females in both groups and the overall median age was 42 years (28–63). No one in the group not tested reported to have a verified or suspected allergy to chlorhexidine.Conclusion:  In this first study to examine the risk of type I and type IV allergy to chlorhexidine in health care workers with daily exposure to chlorhexidine, we did not identify allergies to chlorhexidine in any of the 104 individuals tested or in the additional 74 individuals who completed the questionnaire. We conclude that an allergy to chlorhexidine in health care workers is likely to be rare.
The work, duties and prestige of Finnish anesthesiologists: patients’ view
Authors: Tohmo H. , Pälve H. , Illman H. 
Published: December 2004

Background:  Patients' awareness of the medical qualifications and duties of anesthesiologists outside the operating theatres may be limited. How are anesthesiologists ranked with regard to prestige and academic qualifications among other hospital employees?Methods:  One hundred and sixty operative patients were interviewed in one tertiary care center and another secondary care center in Finland.Results:  Nearly all (90%) of the patients knew that anesthesiologists are medical doctors and that they work in operation theatres (87%). Many patients thought that anesthesiologists do not work in pain clinics (41%), obstetric departments (36%) and in the departments of radiology (68%), in ambulances (58%) and in research work (46%). Anesthesiologists were ranked second after surgeons with regard to prestige among health service professionals.Conclusions:  Patients knew the medical qualification of anesthesiologists very well. The work of anesthesiologists was highly appreciated, but the duties outside the operation theatres were poorly known.
Low plasma glutamine after multiple trauma: relationship with intracellular glutamine in polymorphonuclear neutrophils during prolonged ICU stay
Authors: Engel J. M. , Mühling J. , Weiss S. , Löhr T. , Simonis Y. , Menges T. , Hempelmann G. 
Published: December 2004

Background: Aim of the study was to evaluate whether low plasma glutamine (GLN) is related to low intracellular GLN in stress‐affected cells such as polymorphonuclear neutrophil (PMN). We hypothesized, that because low plasma GLN is assumed to have an impact on clinical outcome, stress‐affected cells may also show low GLN contents.Methods: Thirty‐nine consecutive severely injured trauma patients staying at least 10 days at a surgical intensive care unit (ICU) of a university hospital were separated into two groups: group one (n = 16) with low plasma GLN (< 420 µmol/l in average during ICU stay), and group two (n = 23) with normal plasma GLN. Initial blood samples for GLN analyses were collected within 24 h of admission at ICU. Further blood samples were taken on days 5 and 10 at 08:00 hours.Results: Patients in both groups showed no differences regarding demographic data, surgical interventions or infections. Acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) score and mortality rate were also comparable. During the study period, intracellular PMN GLN contents and concentrations did not differ between both groups. On the first day, intracellular PMN GLN content in the low plasma GLN group peaked at 5.01 ± 3.06 × 10−16 mol and in normal plasma GLN group at 4.73 ± 2.57 × 10−16 mol above the level of healthy individuals. In both groups, content decreased significantly towards the end of the observation period (group one: 2.79 ± 1.59 × 10−16 mol and group two: 2.63 ± 1.71 × 10−16 mol). A correspondent course could be observed for cell volumes. In contrast, variation of intracellular GLN concentrations remained within the reference range throughout the observation period: group one 836 ± 510 µmol/l on day 1 and 582 ± 331 µmol/l on day 10, and group two 788 ± 428 µmol/l on day 1 and 548 ± 356 µmol/l on day 10. No correlation between plasma GLN and intracellular GLN was found in either group.Conclusion: No association between low plasma GLN and low intracellular GLN in PMN was found in a cohort of severely injured trauma patients with a minimum stay of 10 days at ICU.
Effective pain relief from intra‐articular saline with or without morphine 2 mg in patients with moderate‐to‐severe pain after knee arthroscopy: a randomized, double‐blind controlled clinical study
Authors: Rosseland L. A. , Stubhaug A. , Grevbo F. , Reikerås O. , Breivik H. 
Published: December 2004

Background: Intra‐articular (IA) morphine has given good and prolonged pain relief in some studies when given at the end of arthroscopic procedures in the knee joint. However, similar studies have not been able to document any local analgesic effect of morphine. A large number of the negative studies have not demonstrated any assay sensitivity. We have documented that around 40% of patients have only very mild or no pain after arthroscopic procedures in the knee joint. This obviously is a confounding factor, reducing assay sensitivity when all patients are included in IA morphine studies.Method: By leaving a soft catheter IA in 57 patients and including only patients who developed moderate‐to‐severe pain within 1 h after an arthroscopic procedure in the knee joint under general anaesthesia, we included 40 patients. These patients had a mean pre‐treatment baseline pain of about 50/100 on a 100‐mm visual analogue scale (VAS) for pain intensity. A randomized, double‐blind controlled comparison of saline 10 ml with or without morphine 2 mg followed. Test drugs were administered through the IA catheter. Pain intensity and pain relief, consumption of rescue analgesics and global evaluation of effect and adverse effects were measured up to 36 h thereafter.Results: Pain intensity decreased from about 50 to about 10–15/100 in both groups and the sum of pain intensity differences at 2 and 22 h was not significantly different between the two groups. Global evaluation of effects and adverse effects, as well as consumption of rescue analgesics during 36 h after arthroscopic procedures, were also similar in the two groups.Conclusions: Only 70% of 57 patients had pain of moderate‐to‐severe intensity within 1 h after an arthroscopic procedure of the knee joint under general anaesthesia. IA injection of saline 10 ml and saline 10 ml with morphine 2 mg were both associated with pain relief. These findings may have implications for interpretations of a majority of published studies on IA morphine.