bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of post‐herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone
Authors: Pasqualucci A. , Pasqualucci V. , Galla F. , De Angelis V. , Marzocchi V. , Colussi R. , Paoletti F. , Girardis M. , Lugano M. , Del Sindaco F. 
Published: March 2003

Background: Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post‐herpetic neuralgia (PHN).Methods: Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6–12 ml bupivacaine (0.25%) every 6–8 or 12 h+methylprednisolone 40 mg every 3–4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and “abnormal sensations” (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent‐to‐treat population.Results: In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir + steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B.Conclusions: Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone.
Randomised, placebo‐controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery
Authors: Aubrun F. , Langeron O. , Heitz D. , Coriat P. , Riou B. 
Published: March 2003

Background: The additive effect of non‐steroidal anti‐inflammatory drugs administered with propacetamol after major orthopaedic surgery has not been studied. Thus, we performed a prospective, placebo‐controlled study to assess the analgesic effects of ketoprofen in patients undergoing spinal fusion surgery and receiving propacetamol.Methods: Fifty patients undergoing spinal fusion surgery received either 100 mg of ketoprofen every 8 h or a placebo, postoperatively. All patients received propacetamol and morphine (intravenous titration followed by patient‐controlled analgesia (PCA) over 24 h). Pain was assessed using a visual analogue pain scale (VASpi). Data are mean±SD.Results: During morphine titration, ketoprofen did not significantly reduce the dose of morphine (8±6 vs 11±4 mg, NS) whereas it significantly decreased VASpi (P<0.001). During PCA, ketoprofen significantly reduced morphine consumption (25±17 vs 38±20 mg, P=0.04) and VASpi (P=0.002). The total postoperative morphine consumption was significantly (33%) reduced with ketoprofen.Conclusion: Ketoprofen reduced morphine requirements and improved postoperative analgesia in patients undergoing major spinal surgery and receiving propacetamol.
Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement
Authors: Fournier R. , Van Gessel E. , Macksay M. , Gamulin Z. 
Published: March 2003

Background: We designed this study to compare the postoperative analgesic effects of intrathecal morphine and nalbuphine, the endpoints being onset and offset of action.Methods: Geriatric patients scheduled for elective total hip replacement under continuous spinal anaesthesia were randomized to two double‐blinded groups in the recovery room as soon as they experienced a pain score higher than 3 cm on the visual analogue scale (VAS, 0–10 cm). Either 160 μg morphine or 400 μg nalbuphine in 4 ml normal saline were administered intrathecally. Pain scores on VAS, rescue analgesia (diclofenac and morphine, not allowed during the first 60 min), and the adverse effects (respiratory depression, postoperative nausea and vomiting, itching) were recorded for 24 h after surgery.Results: The study was stopped after inclusion of 2×12 patients due to slow onset of analgesia in the morphine patients. In the nalbuphine group, when compared to the morphine group, the time to a pain score <3 cm (8±6 vs. 31±32 min, P<0.001), the time to the lowest pain score (18±11 vs. 66±75 min, P<0.001) and the time to the first systemic analgesic intervention for a pain score >3 cm (218±256 vs. 1076±440 min, P<0.05) were significantly shorter. The analgesic requirements during the first 24 h were significantly lower in the morphine group (P<0.001).Conclusion: We conclude that after total hip replacement, administration of intrathecal nalbuphine resulted in a significantly faster onset of pain relief and shorter duration of analgesia than intrathecal morphine (
Note).
Total and prolonged filling of the lungs with Ringer’s solution under extracorporeal lung assist (ECLA) in dogs
Authors: Sakanashi Y. , Tanimoto H. , Okamoto T. , Tashiro M. , Ao H. , Terasaki H. 
Published: March 2003

Background: Massive alveolar lavage has been used clinically to remove materials accumulated in the alveoli. Recently, filling the lungs with oxygenated perfluorochemical (total liquid ventilation) has been investigated. However, effects of complete and prolonged filling of bilateral lungs with aqueous fluid, such as saline or Ringer’s solution, has not been evaluated, although it is possible to sustain gas exchange without the natural lung by using extracorporeal circulation and an artificial lung (extracorporeal lung assist: ECLA). It is also not known whether the lung can recover gas exchange ability after prolonged fluid filling.Methods: Normal mongrel dogs were endotracheally intubated under general anesthesia and mechanically ventilated. After initiation of venoarterial ECLA, warmed lactated Ringer’s solution was instilled into the lungs through the endotracheal tube, and the lungs were completely filled at a hydrostatic pressure of 15 cmH2O (fluid‐filled group: group F). After the lungs were filled for 4 h, the fluid was drained and ventilation was re‐instituted. ECLA, then mechanical ventilation was gradually weaned within 24 h after fluid drainage. In control group (group C), dogs were kept apneic for 4 h with their lungs inflated at an airway pressure of 15 cmH2O with air.Results: Transient hypoxemia occurred during fluid filling but every dog could be weaned from ECLA and mechanical ventilation to spontaneous respiration. The average rate of fluid absorption from the lung during fluid filling was 4.2±1.8 ml kg−1 h−1. After fluid drainage and restart of mechanical ventilation, bilateral lungs were expanded and well aerated. Total static respiratory system compliance (static compliance) remained unchanged even after fluid filling, and the weight of the lung water did not increase significantly compared to that in group C. Total urine volume was significantly increased in group F. Histologically, alveolar structures were preserved and no interstitial edema or bleeding was seen in either group.Conclusion: Complete filling of the bilateral lungs for 4 h with lactated Ringer’s solution under ECLA causes no deterioration in gas exchange or static compliance in normal dogs, although transient hypoxemia occurs during fluid filling.
Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery
Authors: Tenling A. , Joachimsson P.‐O. , Tydén H. , Hedenstierna G. 
Published: March 2003

Background: A lasting impairment of pulmonary function is common after cardiac surgery. Pain from the sternotomy may contribute to the impairment. Thoracic epidural analgesia (TEA) can efficiently relieve pain in the postoperative phase, but may also affect respiratory muscle function if local anaesthetics are used. We examined the effects of TEA on pulmonary function and ventilation at rest, before and after coronary artery bypass graft surgery (CABG).Methods: Thirty patients scheduled for CABG were randomized to receive either general anaesthesia alone or general anaesthesia with TEA. Before and after the operation the patients were examined by respiratory inductive plethysmography and spirometric tests.Results: Before the operation, TEA caused significant reductions in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), maximal inspiratory (PImax) and expiratory (PEmax) pressure. The rib cage contribution to tidal volume decreased significantly but the co‐ordination of the thoracic and abdominal movements remained essentially unaffected. Minute volume and respiratory frequency did not change significantly. On the first postoperative day a decrease in maximal breathing efforts was found in both groups. No differences between the groups in FVC, FEV1 and PImax were found, but PEmax was significantly greater in the TEA group. Despite the impairment, breathing at rest was largely normal in both groups.Conclusions: A better pain‐relief from TEA after CABG may improve the ability to cough by a greater expiratory muscle strength. FVC, FEV1, PImax and breathing at rest are not affected by TEA after cardiac surgery.
Thoracic epidural anaesthesia and analgesia: United Kingdom practice
Authors: O'Higgins F. , Tuckey J. P. 
Published: March 2003

Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists.Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom.Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non‐steroidal anti‐inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid‐based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy‐eight percent of hospitals provided an acute pain team to review epidural analgesia.Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid‐based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow‐up.
Mixed venous oxygen saturation during mobilization after cardiac surgery: are reflectance oximetry catheters reliable?
Authors: Kirkeby‐Garstad I. , Skogvoll E. , Sellevold O. F. M. 
Published: March 2003

Background: Oximetry catheters immediately reflect changes in mixed venous oxygen saturation (Sv¯O2). We have used the Baxter 2‐SAT system to register changes in Sv¯O2 during early mobilizations after cardiac surgery. To assess catheter reliability, readings were compared to blood gases.Methods: A total of 352 paired catheter and bench haemoximetry measurements were obtained at the expected highest and lowest levels of Sv¯O2 during the mobilization procedures. The agreement between methods was explored by a Bland‐Altman plot. The influence of haemoglobin (Hgb), pH, cardiac output (CO), posture, catheter identity and catheter calibration on agreement was assessed through analysis of covariance.Results: Data included a substantial number of low Sv¯O2 values, 95 paired means of Sv¯O2≤50% and 37 paired means ≤40%. Mean oxygen saturation difference between catheter and haemoximeter readings was −1.6±5.7% (SD). Agreement between the methods depended upon the level of Sv¯O2. At Sv¯O2 of 65%, the two methods were virtually identical. Below 65%, the catheters increasingly underestimated the corresponding haemoximetric values by 1.5% for every 10% reduction in Sv¯O2. Agreement was to some degree dependent on individual calibrations and catheter identity, but to a lesser extent on Hgb, CO and posture.Conclusion: The two methods are interchangeable for most clinical purposes. Catheter readings are, however, substantially lower than the corresponding haemoximetric measurements at low Sv¯O2 values. Careful interpretation of the absolute values resulting from catheter measurements is recommended, especially when Sv¯O2 readings are low.
Interaction of isoflurane and cromakalim, a KATP channel opener, on coronary and systemic haemodynamics in chronically instrumented dogs
Authors: Sakai K. , Zhang S. , Ureshino H. , Tomiyasu S. , Sumikawa K. 
Published: March 2003

Background: Although isoflurane has been shown to cause coronary and systemic vasodilation through KATP channel activation, the interaction of KATP channel openers and isoflurane has not been fully investigated. The present study was carried out to determine the haemodynamic actions of cromakalim, a KATP channel opener, under the conscious state and during isoflurane anaesthesia in chronically instrumented dogs.Methods: Fourteen dogs were chronically instrumented to measure systemic and coronary haemodynamics. Each dog was randomly assigned to receive doses of either cromakalim, 4 and 10 μg · kg−1 i.v., or isoflurane, 2.1% end‐tidal (1.5 MAC), plus cromakalim, 4 and 10 μg · kg−1 i.v.Results: Cromakalim dose‐relatedly decreased mean arterial pressure and systemic vascular resistance and increased coronary blood flow in both conscious and anaesthetized states. With isoflurane, the duration of effects of cromakalim were prolonged. Isoflurane exerted an additive effect on the increase in coronary blood flow induced by a low‐dose cromakalim, whereas it did not influence the effect of a high‐dose cromakalim. The maximum rate of increase in left ventricular pressure and segment shortening were increased by cromakalim in the conscious state but unchanged during isoflurane anaesthesia.Conclusion: The results suggest that the coronary vasodilating effects of isoflurane and cromakalim are basically additive until cromakalim exerts the maximal effect, and that the action of cromakalim on the coronary vasculature is prolonged by isoflurane.
Comparison of the effects of amrinone, milrinone and olprinone in reversing bupivacaine‐induced cardiovascular depression
Authors: Hirabayashi Y. , Igarashi T. , Saitoh K. , Fukuda H. , Suzuki H. , Shimizu R. 
Published: March 2003

Background: Increasing evidence indicates that amrinone, a phosphodiesterase fraction III (PDE‐III) inhibitor, has relative efficacy as an initial treatment for cardiovascular depression after bupivacaine in an experimental setting. This study was performed to compare the cardiovascular effects of the other new PDE‐III inhibitors, milrinone and olprinone, with those of amrinone in reversing bupivacaine‐induced cardiovascular depression.Methods: In sevoflurane‐anaesthetized dogs, bupivacaine was infused intravenously at 1 mg · kg−1 · min−1 until mean arterial pressure fell to 60 mmHg or less. The dogs received either amrinone (2 mg · kg−1), milrinone (0.2 mg · kg−1), olprinone (0.12 mg · kg−1) or 0.9% saline (0.5 ml · kg−1).Results: Amrinone, milrinone and olprinone improved left ventricular systolic and diastolic function, resulting in an increase in cardiac index. The most significant difference observed among the three drugs was the change in heart rate (HR) after treatment. Milrinone significantly increased HR, but olprinone did not.Conclusion: Milrinone and olprinone are as effective as amrinone in reversing bupivacaine‐induced cardiovascular depression.
Bispectral index, predicted and measured drug levels of target‐controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergence
Authors: Høymork S. C. , Ræder J. , Grimsmo B. , Steen P. A. 
Published: March 2003

Background: Target‐controlled infusions (TCI) have been launched as simple, accurate and reliable delivery systems of intravenous drugs. Bispectral index of EEG (BIS) seems promising in measuring hypnotic effect of anaesthetic drugs. The aims of this study were to evaluate the accuracy of TCI systems in patients undergoing laparoscopic cholecystectomy and to correlate measured drug levels to BIS values. Data were analysed for possible gender differences during emergence.Methods: After written informed consent, 20 patients were enrolled in an open study. Remifentanil was set at 7.5 ng/ml as target throughout the whole procedure, and propofol at 5 μg/ml at induction and 3 μg/ml after intubation. Values in blood samples of remifentanil and propofol were correlated to the estimated values and to systolic blood pressure and BIS. BIS values and measured drug levels during emergence and emergence time were compared for the two sexes.Results: Measured drug values varied considerably from the set target with a prediction error of −22% for remifentanil and 49% for propofol. The anaesthesia level was regarded as quite deep with a mean BIS during stable surgery of 42±7, and at this level we found no correlation between measured values of either of the two drugs and BIS. The emergence time was significantly shorter for women (12.6±2.5 min) than for men (19.0±4.2 min) (P=0.001), with no significant differences in measured levels of propofol or remifentanil or BIS during the emergence period.Conclusion: Present systems for TCI of remifentanil and propofol result in large intra‐ and interindividual variations in measured drug levels, and measured levels differ from target. There may be possible interaction between the two anaesthetics at a pharmacokinetic level. Within the level of anaesthesia studied here, BIS was not an indicator of the actual drug levels. Women woke up significantly faster than men.
Dynamic evaluation of fluid shifts during normothermic and hypothermic cardiopulmonary bypass in piglets
Authors: Heltne J. K. , Koller M.‐E. , Lund T. , Bert J. , Rynning S. E. , Stangeland L. , Husby P. 
Published: March 2003

Background: Edema, generalized overhydration and organ dysfunction commonly occur in patients undergoing open‐heart surgery using cardiopulmonary bypass (CPB) and induced hypothermia. Activation of inflammatory reactions induced by contact between blood and foreign surfaces are commonly held responsible for the disturbances of fluid balance (“capillary leak syndrome”). We used an online technique to determine fluid shifts between the intravascular and the interstitial space during normothermic and hypothermic CPB.Methods: Piglets were placed on CPB (fixed pump flow) via thoracotomy in general anesthesia. In the normothermic group (n=7), the core temperature was kept at 38°C prior to and during 2 h on CPB, whereas in the hypothermic group (n=7) temperature was lowered to 28°C during bypass. The CPB circuit was primed with acetated Ringer’s solution. The blood level in the CPB circuit reservoir was held constant during bypass. Ringer’s solution was added when fluid substitution was needed (falling blood level in the reservoir). In addition to invasive hemodynamic monitoring, fluid input and losses were accurately recorded. Inflammatory mediators or markers were not measured in this study.Results: Cardiac output, s‐electrolytes and arterial blood gases were similar in the two groups in the pre‐bypass period. At start of CPB the blood level in the machine reservoir fell markedly in both groups, necessitating fluid supplementation and leading to a markedly reduced hematocrit. This extra fluid need was transient in the normothermic group, but persisted in the hypothermic animals. After 2 h of CPB the hypothermic animals had received 7 times more fluid as compared to the normothermic pigs.Conclusion: We found strong indications for a greater fluid extravasation during hypothermic CPB compared with normothermic CPB. The experimental model using the CPB‐circuit reservoir as a fluid gauge gives us the opportunity to study further fluid volume shifts, its causes and potential ways to optimize fluid therapy protocols.
Is transient lumbar pain after spinal anaesthesia with lidocaine influenced by early mobilisation?
Authors: Lindh A. , Andersson A.‐S. , Westman L. 
Published: March 2003

Background: The aetiology of transient lumbar pain (TLP) after spinal anaesthesia has generated much interest. Many theories have been discussed. Early ambulation has been suggested as one plausible theory for developing TLP.Methods: A total of 107 patients scheduled for inguinal hernial repair under spinal anaesthesia (20 mg/ml hyperbaric lidocaine) were randomised to either early or late ambulation: the early ambulation (group A), as early as possible after total regression of spinal block or the late mobilisation (group B) bedridden for more than 12 h. The clinical course and duration of operation were monitored. Assessments 4, 8 and 12 h after spinal anaesthesia were performed with respect to wound pain, nausea, tiredness and eventual symptoms of TLP were recorded. The patients also kept a diary about any symptoms once daily day 1–3 at home. A telephone follow‐up was performed at day 5–7.Results: Our results showed an incidence of TLP of 23% in all patients. No difference was recorded between early and late mobilisation patients, 12 and 13 patients, respectively.Conclusion: Early ambulation does not seem to increase the risk of developing TLP.
Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia
Authors: Enlund M. , Mentell O. , Krekmanov L. 
Published: March 2003

Background: A probable causal relationship between submucosal infiltration of lidocaine, with adrenaline 12.5 μg · mL1, and untoward arterial hypotension during general anaesthesia for orthognathic surgery was investigated in two parts.Methods: The first part of the study was open and non‐randomised. The patients served as their own controls, receiving 5.4 mL saline/adrenaline before mandibular or maxillary surgery on the first side of the jaw and 5.4 mL lidocaine (2%)/adrenaline on the other side a minimum of 40 min later. Nine patients received in total 11 pairs of injections of the study drugs. In Part Two, 50 mg or 100 mg of lidocaine with adrenaline was infiltrated in an observer‐blinded and randomised order in either side of the jaw in another 13 patients.Results: A significant and dose‐dependent blood pressure decrease was observed after infiltration of lidocaine/adrenaline, but not after saline/adrenaline. The heart rate increased significantly after both types of injections, most pronounced after saline/adrenaline. Mean arterial blood pressure decreased on average 11% and 23% with lidocaine 50 mg and 100 mg, respectively (P<0.05, ANOVA).Conclusion: Lidocaine induced dose‐dependent arterial hypotension when combined with a defined level of general anaesthesia. The causative mechanism is unclear.