bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high‐risk patients undergoing thyroid or parathyroid surgery
Authors: Jokela R. , Koivuranta M. , Kangas‐Saarela T. , Purhonen S. , Alahuhta S. 
Published: March 2003

Background: Oral antiemetic prophylaxis may be a practical alternative to intravenous administration. Intravenous ondansetron and tropisetron prevent postoperative nausea and vomiting (PONV) at least as efficiently as traditional antiemetics, droperidol and metoclopramide. We tested the hypothesis that the incidence of PONV after oral ondansetron or tropisetron prophylaxis is lower compared with metoclopramide among high‐risk patients.Methods: In a prospective, double‐blind study we studied 179 high‐risk patients who received either ondansetron 16 mg, tropisetron 5 mg, or metoclopramide 10 mg orally 1 h before the operation. A standard general anesthetic technique and postoperative analgesia were used. The incidence of PONV and the need for rescue antiemetic medication was recorded for 24 h.Results: In the postanesthesia care unit, the incidence of PONV was lower after premedication with tropisetron compared with ondansetron and metoclopramide (15%, 32% and 39%, respectively). The incidence of PONV during 0–24 h was the same in each group (68%, 58% and 75% in the ondansetron, tropisetron and metoclopramide group, respectively), but the incidence of vomiting was significantly lower after ondansetron (34%) and tropisetron (22%) prophylaxis compared with metoclopramide (53%). The need for additional antiemetics was significantly lower after tropisetron prophylaxis compared with metoclopramide. Patient satisfaction was significantly higher after tropisetron than after metoclopramide.Conclusions: In the initial period, the incidence of PONV was lower after premedication with oral tropisetron than after ondansetron or metoclopramide. Considering the entire 24‐h postoperative period, the incidence of PONV was the same after all three premedications, but the incidence of vomiting was lower after oral ondansetron and tropisetron than after metoclopramide.
Airway closure in anesthetized infants and children: influence of inspiratory pressures and volumes
Authors: Thorsteinsson A. , Werner O. , Jonmarker C. , Larsson A. 
Published: March 2003

Background: Cyclic opening and closing of lung units during tidal breathing may be an important cause of iatrogenic lung injury. We hypothesized that airway closure is uncommon in children with healthy lungs when inspiratory pressures are kept low, but paradoxically may occur when inspiratory pressures are increased.Methods: Elastic equilibrium volume (EEV) and closing capacity (CC) were measured with a tracer gas (SF6) technique in 11 anesthetized, muscle‐relaxed, endotracheally intubated and artificially ventilated healthy children, aged 0.6–13 years. Airway closing was studied in a randomized order at two inflation pressures, +20 or +30 cmH2O, and CC and CC/EEV were calculated from the plots obtained when the lungs were exsufflated to −20 cmH2O. (CC/EEV >1 indicates that airway closure might occur during tidal breathing). Furthermore, a measure of uneven ventilation, multiple breath alveolar mixing efficiency (MBAME), was obtained.Results: Airway closure within the tidal volume (CC/EEV >1) was observed in four and eight children (not significant, NS) after 20 and 30 cmH2O inflation, respectively. However, CC30/EEV was >CC20/EEV in all children (P≤0.001). The MBAME was 75±7% (normal) and did not correlate with CC/EEV.Conclusion: Airway closure within tidal volumes may occur in artificially ventilated healthy children during ventilation with low inspiratory pressure. However, the risk of airway closure and thus opening within the tidal volume increases when the inspiratory pressures are increased.
Neurological outcome after experimental cardiopulmonary resuscitation: a result of delayed and potentially treatable neuronal injury?
Authors: Liu X. L. , Nozari A. , Basu S. , Ronquist G. , Rubertsson S. , Wiklund L. 
Published: March 2003

Background: In experimental cardiopulmonary resuscitation (CPR) aortic balloon occlusion, vasopressin, and hypertonic saline dextran administration improve cerebral blood flow. Free radical scavenger α‐phenyl‐N‐tert‐butyl‐nitrone (PBN) and cyclosporine‐A (CsA) alleviate neuronal damage after global ischemia. Combining these treatments, we investigated neurological outcome after experimental cardiac arrest.Methods: Thirty anesthetized piglets, randomly allocated into three groups, were subjected to 8 min of ventricular fibrillation followed by 5 min of closed‐chest CPR. The combined treatment (CT) group received all the above‐mentioned modalities; group B was treated with balloon occlusion and epinephrine; and group C had sham balloon occlusion with epinephrine. Indicators of oxidative stress (8‐iso‐PGF2α), inflammation (15‐keto‐dihydro‐PGF2α), energy crisis (hypoxanthine and xanthine), and anoxia/hypoxia (lactate) were monitored in jugular bulb venous blood. Neurological outcome was evaluated 24 h after CPR.Results: Restoration of spontaneous circulation (ROSC) was more rapidly achieved and neurological outcome was significantly better in the CT group, although there was no difference in coronary perfusion pressure between groups. The jugular venous PCO2 and cerebral oxygen extraction ratio were lower in the CT group at 5–15 min after ROSC. Jugular venous 8‐iso‐PGF2α and hypoxanthine after ROSC were correlated to 24 h neurological outcomeConclusions: A combination of cerebral blood flow promoting measures and administration of α‐phenyl‐N‐tert‐butyl‐nitrone and cyclosporine‐A improved 24 h neurological outcome after 8 min of experimental normothermic cardiac arrest, indicating an ongoing neuronal injury in the reperfusion phase.
Biochemical markers for brain damage after cardiac surgery – time profile and correlation with cognitive dysfunction
Authors: Rasmussen L. S. , Christiansen M. , Eliasen K. , Sander‐Jensen K. , Moller J. T. 
Published: March 2003

Background: Cerebral dysfunction is common after cardiac surgery and may be reflected in increasing blood concentrations of neuron specific enolase (NSE) and S‐100β protein. The aim of the study was to determine the optimal timing of blood sampling.Methods: We studied 15 patients undergoing coronary artery bypass grafting. Serum concentrations of NSE and S‐100β protein were measured before surgery and after 12, 18, 24, 30, and 36 h. Neuropsychological testing was performed before surgery, at discharge from hospital and after 3 months.Results: Serum concentrations of both NSE and S‐100β protein increased significantly. At the first postoperative test, seven patients had cognitive dysfunction and a significant correlation was found between the composite z‐score and the increase in the NSE level after 36 h (R = 0.76, P=0.001). The median increase in NSE after 36 h was 4.1 µg/l in patients having cognitive dysfunction and 0.9 µg/l in the remaining patients (P<0.05). No significant correlation was found between cognitive dysfunction and the increase in S‐100β protein. After 3 months, no statistically significant correlation was found between either NSE or S‐100β protein and cognitive dysfunction.Conclusion: NSE seems to be a useful blood marker for early cognitive dysfunction after coronary artery bypass grafting, optimal timing of blood sampling being at approximately 36 h postoperatively.
Cerebral blood flow, oxidative metabolism and cerebrovascular carbon dioxide reactivity in patients with acute bacterial meningitis
Authors: Møller K. , Strauss G. I. , Thomsen G. , Larsen F. S. , Holm S. , Sperling B. K. , Skinhøj P. , Knudsen G. M. 
Published: March 2003

Background: The optimal arterial carbon dioxide tension (PaCO2) in patients with acute bacterial meningitis (ABM) is unknown and controversial. The objective of this study was to measure global cerebral blood flow (CBF), cerebrovascular CO2 reactivity (CO2R), and cerebral metabolic rates (CMR) of oxygen (O2), glucose (glu), and lactate (lac), in patients with ABM and compare the results to those obtained in healthy volunteers.Methods: We studied 19 patients (17 of whom were sedated) with ABM and eight healthy volunteers (controls). CBF was measured during baseline ventilation and hyperventilation with single‐photon emission computed tomography (SPECT) (14 patients) and/or the Kety‐Schmidt technique (KS) (11 patients and all controls). In KS studies, CMR was measured by multiplying the arterial to jugular venous concentration difference (a‐v D) by CBF.Results: CBF did not differ significantly among groups, although a larger variation was seen in patients than in controls. CO2R was not significantly different among groups. At baseline, patients had significantly lower a‐v DO2, CMR(O2), CMR(glu), and CMR(lac) than controls. CMR(O2) did not change between hyperventilation compared to baseline ventilation, whereas CMR(glu) increased.Conclusion: In patients with acute bacterial meningitis, we found variable levels of CBF and cerebrovascular CO2 reactivity, a low a‐v DO2, low cerebral metabolic rates of oxygen and glucose, and a cerebral lactate efflux. In these patients, a ventilation strategy guided by jugular bulb oximetry and/or repeated CBF measurements may be more optimal in terms of cerebral oxygenation than a strategy aiming at identical levels of PaCO2 for all patients.
Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia
Authors: Ederoth P. , Flisberg P. , Ungerstedt U. , Nordström C.‐H. , Lundberg J. 
Published: March 2003

Background: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol.Methods: Fourteen patients who underwent major abdominal or thoraco‐abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI‐group, n=6) or a continuous i.v. infusion of morphine (MO‐group, n=8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique.Results: The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI‐group, glycerol concentrations started to increase on Day 2, and reached significantly higher levels on Day 3 compared with the MO‐group. The glucose and lactate levels showed no differences between groups in the two regions.Conclusion: The uniform glycerol levels in abdominal subcutaneous adipose tissue in conjunction with the difference in glycerol levels in the deltoid area indicate that the local lipolysis is different in the two study groups. This might be explained by a regional metabolic influence of thoracic epidural analgesia, possibly via the sympathetic nervous system.
Heart rate to arterial pressure impulse response during one lung ventilation
Authors: Kawamoto M. , Hidaka S. , Kurita S. , Yuge O. , Kawamoto N. 
Published: March 2003

Background: Although one lung ventilation (OLV) is commonly used, little is known about the modulation of the autonomic nervous system with OLV while under general anesthesia. As the frequency domain and time domain analyses are powerful analytic tools, we investigated their modulation during OLV.Methods: Patients undergoing thoracic surgery were classified into two groups: those who did (group A, n=8) and those who did not (group N, n=8) receive atropine. After a double lumen tube was placed endotracheally, mechanical ventilation of both lungs (BLV) was established at 18 min−1 while under isoflurane anesthesia. Electrocardiogram, systolic arterial pressure (SAP), and inspiratory flow (Finsp) were digitally recorded as follows: awake before anesthesia; BLV after anesthesia; BLV after intravenous 10 µg kg−1 of atropine (group A) or not (group N); left OLV; and right OLV. Power spectral analyses of heart rate (HR) and SAP were computed by determining low‐(LF, 0.04–0.15 Hz) and high‐frequency (HF, 0.15–0.40 Hz) components, and impulse response analysis was executed among HR, SAP, and Finsp. Impulse responses were assessed by the maximum values in the time domain.Results: In frequency domain analysis, atropine depressed LF and LF/HF but not HF in HR variability, while no difference was observed between right OLV and left OLV. The heart rate to SAP impulse response was maintained at a significantly higher level in group A than in group N (905±360 vs. 425±375 mmHg beats−1min−1) at right OLV. A significant difference was also observed between left and right OLV within group N.Conclusion: Impulse response analysis demonstrated that there is a greater effect on autonomic nervous system modulation during right OLV than in left OLV, which mainly results from a parasympathetic neural linkage origin.
Catheter‐related epidural abscesses – Don't wait for neurological deficits
Authors: Royakkers A. A. N. M. , Willigers H. , Van Der Ven A. J. , Wilmink J. , Durieux M. , Van Kleef M. 
Published: March 2003

Epidural abscess is a rare but serious complication of epidural anesthesia for peri‐ and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and symptoms. When neurologic signs or symptoms develop, MRI scanning is the diagnostic procedure of choice. The therapy of choice is intravenous antibiotics for more than 4 weeks with or without a laminectomy or drainage.In the present paper we describe three patients with epidural abscesses presented during a time period of 1 year in our hospital. In each case, patients developed local signs of infection and systemic signs, but no neurological symptoms.Based on these cases and a review of the literature, we propose that MRI scanning should be strongly considered when patients present with systemic and local signs, even in the absence of neurological deficits.
Post spinal meningitis and asepsis
Authors: Videira R. L. R. , Ruiz‐Neto P. P. , Brandao Neto M. 
Published: March 2003

Background:  Post spinal meningitis (PSM) is a complication still currently being reported. After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department.Methods:  Cases defined as PSM comprised meningitis within a week after spinal anesthesia. Anesthesia records, anesthesia complication files and the records of the Hospital Commission for Infection Control from 1997 to 2000 were reviewed. Asepsis techniques applied were surveyed by a questionnaire answered by all our department's anesthesiologists. The equipment and procedures for spinal anesthesia were listed. Current anesthesia textbooks were reviewed for recommendations regarding asepsis techniques in conjunction with spinal anesthesia.Results:  Three cases of PSM were identified following 38,128 spinal anesthesias whereas none was observed in 12,822 patients subjected to other types of regional or general anesthesia (P>0.05). Culture of cerebrospinal fluid yielded Streptococcus in two patients and was negative in the other patient. The asepsis technique applied by the anesthesiologists varied considerably. The literature review showed that aspects on asepsis for spinal anesthesia are poorly covered.Conclusion:  The incidence of meningitis was similar in patients subjected to spinal anesthesia and in those subjected to other anesthetic techniques. Asepsis techniques were found to differ considerably among our staff members, reflecting the lack of well‐defined published standards for this procedure. We recommend that asepsis for spinal anesthesia should not be less rigorous than for surgical asepsis.
Electrophysiologic cardiac effects of the new local anesthetic IQB‐9302 and of bupivacaine in the anesthetised dog
Authors: Gomez De Segura I. A. , Vazquez I. ,   Moreno‐Planas, Benito J. , Galiano A. , De Miguel E. 
Published: March 2003

Background:  Local anesthetics are not free from potentially fatal complications. Therefore every new local anesthetic should be tested to demonstrate a lower, or at least similar, degree of toxicity over clinically used analogs. Most toxic effects from local anesthetics affect the cardiac electrophysiologic function, so the aim of this study was to characterize the electrophysiologic effects of a new long‐acting local anesthetic (IQB‐9302, Ciprocaine), and compare them with those of bupivacaine in the anesthetized dog.Methods:  Eight Beagle dogs received three increasing infusion doses of either IQB‐9302 or bupivacaine. Under isoflurane anesthesia, dogs were instrumented to monitor cardiovascular (cardiac output, arterial and venous blood pressures) and cardiac electrophysiologic data (sinus and atrioventricular (AV) node function, atrial, nodal and ventricular conduction times, and refractoriness).Results:  Only the highest dose of both drugs induced hemodynamic or electrophysiologic alterations: cardiac output and heart rate were reduced while blood pressures remained unchanged. Atrial and intranodal conduction times and atrial refractoriness increased similarly with both anesthetics, but to a slightly lesser extent with IQB‐9302. Significant increases in His‐Purkinje and intraventricular conduction times were the most severe noxious effects and occurred only with large doses of either drug. IQB‐9302 was slightly less toxic than bupivacaine and, unlike this latter drug, potentially fatal arrhythmias were not induced.Conclusion:  IQB‐9302 has hemodynamic and cardiac electrophysiologic effects similar to those caused by bupivacaine. Nevertheless, slightly less toxic effects were derived from IQB‐9302 administration than with bupivacaine, and, unlike the latter, the former might be less proarrhytmogenic. The new long‐acting local anesthetic IQB‐9302 may offer clinical advantages compared with bupivacaine.
Pharmacokinetics and pharmacodynamics of mivacurium in young adult and elderly patients
Authors: Østergaard D. , Viby‐Mogensen J. , Pedersen N. A. , Holm H. , Skovgaard L. T. 
Published: March 2003

Background:  Mivacurium is hydrolyzed by plasma cholinesterase, and is therefore less dependent on liver metabolism and renal elimination than other neuromuscular blocking drugs. This might favor the use of mivacurium in elderly patients. The purpose of this study was to compare the pharmacodynamics and the pharmacokinetics of the three isomers of mivacurium and their metabolites in young adult and elderly patients.Methods:  Sixty‐four patients were included in a dose–response study, in which 32 young adults and 32 elderly patients received one of four doses of mivacurium. An additional bolus dose of mivacurium to a total of 0.1 mg/kg was given followed by a continuous infusion adjusted to maintain a 91–99% neuromuscular block. The times to maximum block and different levels of recovery were measured using mechanomyography and train‐of‐four (TOF) nerve stimulation. Thirty‐two patients were randomly selected for the pharmacokinetic study. Venous samples were taken for determination of the three mivacurium isomers and the metabolites.Results:  The estimated ED95 were 0.053 and 0.061 mg/kg in young adults and elderly patients, respectively (NS). The median infusion rate did not differ, but duration to a TOF ratio of 0.7 was significantly longer in elderly patients than in young adult patients (21.0 vs. 16.5 min). No statistically significant difference between the age groups in clearance and elimination half‐life of the isomers was seen. The half‐lives of the metabolites were significantly prolonged in the elderly patients.Conclusion:  There were no significant differences in the potency or infusion requirements between the adult and elderly patients, but the rate of recovery was significantly, though only moderately prolonged, in the elderly patients. No significant difference in clearance was seen but the elimination half‐lives of the metabolites was longer in the elderly patients.
Myocardial tissue oxygen during coronary artery constriction and hypotension in dogs
Authors: Hoffman W. E. , Albrecht R. F. , Jonjev Z. S. 
Published: March 2003

Background: Sodium nitroprusside (SNP) may decrease myocardial tissue oxygenation in dogs with normal coronary arteries. We compared SNP‐ with desflurane‐induced hypotension on myocardial tissue oxygen and pH in dogs with left anterior descending artery constriction.Methods: Twenty‐four dogs were anesthetized with 8% desflurane for baseline anesthesia. Catheters were inserted into the femoral artery and vein and the coronary sinus. A flow probe and flow restriction device was placed on the left anterior descending (LAD) artery. A probe that measured myocardial oxygen pressure was inserted into the middle myocardium in the LAD region. Baseline measures were made of LAD artery flow, arterial and coronary sinus blood gases, and myocardial tissue gases. A 30% decrease in blood pressure was induced with SNP with unrestricted LAD flow (n=6) or when LAD artery flow was restricted by 30% from baseline (n=6). In separate dogs, a 30% decrease in blood pressure was produced with 14 ± 1% desflurane with unrestricted LAD flow (n=6) or with baseline LAD artery flow restricted by 30% (n=6).Results: During SNP‐induced hypotension with no LAD constriction, LAD artery flow and coronary sinus oxygen tension increased but myocardial tissue oxygen tension (PmO2) decreased by 40%. When baseline artery flow was decreased by 30% by LAD constriction, SNP‐induced hypotension decreased tissue oxygen pressure by 80%, and ischemic acidosis was produced. During unrestricted LAD artery flow or with a 30% flow restriction, desflurane‐induced hypotension produced no significant change from baseline myocardial tissue oxygen tension or pH.Conclusion: During coronary artery constriction, desflurane‐induced hypotension maintained myocardial tissue oxygenation and pH better than did SNP‐induced hypotension. The divergence between tissue and coronary sinus oxygen tension during SNP suggests that arteriovenous shunting may occur.
Hepatic function during xenon anesthesia in pigs
Authors: Reinelt H. , Marx T. , Kotzerke J. , Topalidis P. , Luederwald S. , Armbruster S. , Schirmer U. , Schmidt M. 
Published: March 2003

Background: Inhalation anesthetics decrease liver perfusion and oxygen consumption by changing the distribution pattern of perfusion between the hepatic artery and the portal vein and by direct effects on liver cells. The effects of xenon on liver perfusion and function have been not investigated until now.Methods: Fourteen pigs were randomly assigned to two groups to receive either 73–78% xenon or 75% nitrogen in oxygen with additional supplementation of pentobarbital and buprenorphine. Microspheres were used to determine the arterial perfusion of the liver and splanchnic organs. Oxygen contents were measured by catheterization of the portal and a liver vein. Lactate and glucose plasma concentrations were measured in hepatic, mixed venous and arterial blood. Alanine aminotransferase (ALT) and lactate dehydrogenase (LOH) plasma concentrations were measured in arterial blood. Urea production rates were calculated to assess hepatic metabolic function.Results: Significant higher oxygen contents were found in the liver venous blood during xenon anesthesia. No differences were found in any other investigated parameters.Conclusion: Higher oxygen content in liver venous blood observed during xenon anesthesia was not induced by changes in hepatic perfusion distribution or by an impairment of liver metabolic capacity. However, it can be explained by similar results known from inhalation anesthesia. Additionally, the effect can be caused by the reduction of plasma catecholamine concentrations during xenon anesthesia.