bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of pretreatment with ketorolac on propofol injection pain
Authors: Huang Y. W. , Buerkle H. , Lee T. H. , Lu C. Y. , Lin C. R. , Lin S. H. , Chou A. K. , Muhammad R. , Yang L. C. 
Published: March 2003

Background:  Pain on injection is still a major problem with propofol. We performed this study to compare different doses of intravenous (i.v.) ketorolac with and without venous occlusion and its effect on the incidence and the severity of the pain after propofol injection.Methods: We conducted a prospective, randomized and double‐blind study of 180 patients (20–60 years of age.) scheduled to undergo elective surgery. Six groups of patients were generated: group A received normal saline (NS) 2 ml i.v.; groups B, C, D received ketorolac 10 mg in 2 ml NS with venous occlusion (VO) and a subsequent propofol injection at either 30, 60 or 120 s; groups E and F received ketorolac 15 mg and 30 mg in 2 ml NS and propofol was injected after 60 s. The pain perception was assessed during injection of propofol in all patients.Result:  The incidence of propofol‐associated injection pain was for A: 46.7%; B: 43.4%; C: 23.3%; D:16.7%; E: 20%, and F: 10%. The incidence of pain following propofol injection was reduced by i.v. ketorolac 10 mg with venous occlusion for 120 s. Furthermore, i.v. ketorolac 15 mg and 30 mg but not 10 mg following propofol injection after 60 s without venous occlusion revealed significant pain reduction when compared to saline group. There was no difference in venous sequelae at 7 days postoperatively between the groups.Conclusion: Our results suggested that pretreatment with i.v. 15 and 30 mg ketorolac reduces pain following propofol injection. Moreover, pretreatment with i.v. ketorolac 10 mg with venous occlusion for 120 s achieves the same pain relief effect.
A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery
Authors: ÜNlügenç H. , Gündüz M. , ÖZalevli M. , Akman H. 
Published: March 2003

Background: We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient‐controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol.Methods: Sixty‐six patients were allocated randomly to receive a PCA with tramadol alone (T), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double‐blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side‐effects, were recorded for up to 24 h after the start of PCA.Results: Pain and discomfort scores were lower (P < 0.01) in groups TM and TK at 15, 30, 60 and 120 min than in group T. The addition of magnesium or ketamine significantly reduced the consumption of tramadol at 6, 12 and 24 h (P < 0.01). The incidence of nausea did not differ between the groups.Conclusion: Adding magnesium or ketamine to tramadol improved analgesia and patient comfort and decreased the amount of tramadol required for postoperative pain management after major abdominal surgery.
Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery
Authors: Laurila P. A. , Löppönen A. , Kangas‐Saarela T. , Flinkkilä T. , Salomäki T. E. 
Published: March 2003

Background: Arthroscopic shoulder surgery is often associated with severe postoperative pain. The results concerning subacromial bursa blockade (SUB) as a method of pain relief have been contradictory. We hypothesized that a SUB and interscalene brachial plexus block (ISB) would similarly reduce early postoperative pain and the need for oxycodone as compared to placebo (PLA).Methods: Forty‐five patients scheduled for arthroscopic shoulder surgery were enrolled in this randomised, prospective study. The ISB and SUB blockades were performed with 15 ml of ropivacaine (5 mg/ml). In the PLA group, 15 ml of 0.9% saline was injected into the subacromial bursa. All patients received general anaesthesia.Results: The mean intravenously patient‐controlled delivered oxycodone consumption during the first 6 h was significantly lower in the ISB group (6 mg) than in the SUB group (24.1 mg; P=0.001) or in the PLA group (27 mg; P<0.001). No significant differences were detected between the SUB and PLA groups (P=0.791). The postoperative pain scores during the first 4 h at rest and during the first 6 h on movement were significantly lower in the ISB group than in the SUB and PLA groups.Conclusion: After arthroscopic shoulder surgery SUB has a minor effect only on postoperative analgesia, whereas an ISB with low‐dose ropivacaine effectively relieves early postoperative pain and reduces the need for opioids.
Thoracic sympatholysis with epidural blockade assessed by quantitative measurement of cutaneous blood flow
Authors: Nygård E. , Sejrsen P. , Kofoed K. F. 
Published: March 2003

Background: Quantifying sympathetic activity is difficult. Direct measurement is possible and superior to indirect techniques, but nerves to internal organs are not accessible in humans. Recently, we validated a quantitative technique for measurement of cutaneous blood flow using heat as an indicator. The aim of the study was to investigate whether sympatholysis during thoracic epidural blockade (TEA) may be documented by changes in regional cutaneous blood flow. A secondary aim was to assess whether, during TEA, local heating itself enhances regional blood flow.Methods: Six patients scheduled for elective coronary artery bypass grafting (CABG) were studied. An epidural catheter was inserted at the T2–3 interspace. Measurements were performed with an electrode, which can measure the local temperature of the skin. The probe is covered with a thermostatically controlled cap to avoid a thermic gradient to air. As a result of the cap, a change in temperature of the central disc depends almost solely on the blood flow in the underlying tissue. Regional cutaneous blood flow rates were measured before and after epidural anesthesia with and without local heating.Results and comments: All patients had a sensory blockade covering at least T1–5. Cutaneous blood flow increased in all six patients after blockade (13.6 ml/min/100 g, range 10.6–14.6 vs. 18.4 ml/min/100 g, range 13.9–24.5; P<0.05). Local heating did not further enhance blood flow.Conclusion: High TEA is associated with a uniform increase in thoracic cutaneous blood flow, and is suggestive of regional sympatholysis. Quantitative measurements of skin blood flow appear promising for documenting regional sympatholysis during TEA.
Ventilator treatment in the Nordic countries.  A multicenter survey
Authors: Kárason S. , Antonsen K. , Åneman A. , GROUP The SSAI ICU‐II 
Published: March 2003

Background: A 1‐day point prevalence study was performed in the Nordic countries to identify ventilator‐treatment strategies in the region.Material and methods: On 30 May 30 2001 all mechanically ventilated patients in 27 intensive care units (ICUs) were registered via the internet. The results are shown as medians (25th, 75th percentile).Results:  One hundred and eight patients were included (69% male) with new simplified acute physiology score (SAPS) 48 (37,57) and 4.5 d (2,11) of ventilator treatment. The most frequent indication for ventilator treatment was acute respiratory failure (73%). Airway management was by endotracheal tube (64%), tracheostomy (32%) and facial mask (4%). Pressure regulated ventilator modes were used in 86% of the patients and spontaneous triggering was allowed in 75%. The tidal volume was 7 ml/kg (6,9), peak inspiratory pressure 22 cmH2O (18,26) and positive end‐expiratory pressure (PEEP) 6 cmH2O (6,9). FiO2 was 40% (35,50), SaO2 97% (95–98), PaO2 11 kPa (10,13), PaCO2 5.4 kPa (4.7,6.3), pH 7.43 (7.38,7.47) and BE 2.0 mmol/l (− 0.5,5). The PaO2/FiO2 ratio was 220 mmHg (166,283). The peak inspiratory pressure (r=0.37), mean airway pressure (r=0.36), PEEP (r=0.33), tidal volume (r=0.22) and SAPS score (r=0.19) were identified as independent variables in relation to the PaO2/FiO2 ratio.Conclusion: The vast majority of patients were ventilated with pressure‐regulated modes. Tidal volume was well below what has been considered conventional in recent large trials. Correlations between the parameters of gas exchange, respiratory mechanics, ventilator settings and physiological status of the patients was poor. It appears that blood gas values are the main tool used to steer ventilator treatment. These results may help to design future interventional studies of ventilator treatment.
The prognostic value of global haemostatic tests in the intensive care unit setting
Authors: Nilsson G. , Astermark J. , Lethagen S. , Vernersson E. , Berntorp E. 
Published: March 2003

Background: Global haemostatic tests are often abnormal in critically ill patients, secondary to activation or consumption of coagulation factors or inhibitors. Methods for analysing plasma levels of these factors are, however, not widely available, and the predictive value of global tests is not known. We examined the clinical applicability to predict the outcome of the global haemostatic tests used at most hospitals.Methods: Blood was collected from patients within 6 h of admission to an intensive care unit (ICU) and tested regarding platelet count, International Normalized Ratio (INR), and activated partial thromboplastin time (APTT). Ninety‐two patients with platelet counts <100 × 109 l−1, INR > 1.36 and/or APTT >45 s were included in a study group, and an additional 92 patients with a comparable age and sex distribution, but not fulfilling these laboratory criteria, constituted a control group. The following data were recorded for each patient: number of days in the ICU and hospital; alive or deceased when released from the ICU and hospital; survival at 30 days and 180 days.Results: Survival upon discharge from the ICU and hospital was significantly reduced in the study group. This was especially pronounced in patients with medical disorders, whereas the survival rate was slightly higher in surgery patients. Expressing the survival predicting ability of the screening tests as odds ratios for all patients (study and control groups together) indicated that prolonged APTT in particular foretold a lower survival rate at studied time‐points after admission to the ICU.Conclusions: The global haemostatic tests INR and APTT can predict survival in critically ill patients, and prolonged APTT in particular seems to be associated with a negative prognosis.
Induction and mechanism of apoptotic cell death by propofol in HL‐60 cells
Authors: Tsuchiya M. , Asada A. , Arita K. , Utsumi T. , Yoshida T. , Sato E. F. , Utsumi K. , Inoue M. 
Published: March 2003

Background: Apoptosis (programmed cell death) occurs in various physiological and pathological conditions, exhibits a characteristic mechanism of intracellular sequential reaction and may be involved in determining clinical outcome. The antioxidant activity of propofol (2,6‐diisopropylphenol) together with the stimulating effect of protein kinase C suggests that propofol might have the potential to modulate apoptosis. Thus, it is of both clinical interest and biomedical importance to investigate and clarify the effect and mechanism of propofol upon the intracellular reactions underlying apoptotic cell death.Methods: The effect of propofol on apoptosis was investigated using cultured human promyelocytic leukemia HL‐60 cells. This well‐characterized cell line is useful for the study of apoptosis because the various biochemical steps occurring during apoptosis have been well documented.Results: Treatment of HL‐60 cells with propofol resulted in growth inhibition with the formation of apoptotic bodies in a concentration‐dependent manner. DNA fragmentation and ladder formation was also observed in a concentration‐dependent manner. Propofol treatment resulted in activation of caspase‐3, ‐6, ‐8 and ‐9, thereby suggesting that cell surface death receptor activation of the caspase cascade mediates propofol‐induced apoptosis with consequent formation of the cleaved product of Bid (a pro‐apoptotic Bcl‐2 family member protein) and activation of the mitochondrial pathway with cytosolic release of cytochrome c.Conclusion: Propofol may induce apoptosis, which is dependent on the mechanism that activates both the cell surface death receptor pathway and the mitochondrial pathway.
High frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome – a retrospective study
Authors: Andersen F. A. , Guttormsen A. B. , Flaatten H. K. 
Published: March 2003

Background: At present there are limited data about the effects of high frequency oscillatory ventilation (HFOV) in adult patients with acute respiratory distress syndrome (ARDS). This study evaluates efficacy of HFOV in such patients.Methods:  Sixteen ARDS patients, mean age 38.2 years (range 18–76), that underwent HFOV between 1997 and 2001 were enrolled in the study and evaluated in retrospect. FIo2, arterial blood gases, mean airway pressure (mean Paw), blood pressure, heart rate and central venous pressure were recorded by 4, 8, 12, 24, 48 and 72 h of HFOV and compared to conventional mechanical ventilation (CMV) at baseline (4 h prior to HFOV).Results:  On admission to the ICU, mean Simplified Acute Physiology score (SAPS II) was 40.3 (SD 12.6). Main causes of ARDS were pneumonia (9/16) and burn injuries (4/16). At baseline the patients had severe ARDS as noted by a mean lung injury score (LIS) of 3.2 (SD 0.3) and Pao2/FIo2 ratio 12.2 (SD 3.2) kPa. Within 4 h of HFOV, Pao2/FIo2 increased to 17.3 (SD 5.9) kPa (P = 0.016). Throughout HFOV, Pao2/FIo2 was significantly higher than at baseline. There were no significant changes in haemodynamic parameters. Ending HFOV after 6.6 (SD 3.2) days, survivors (n = 11) significantly reduced their Sequential Organ Failure Assessment Score (SOFA) compared to baseline. Survival at 3 months was 68.8%.Conclusion:  HFOV effectively improves oxygenation without haemodynamic compromise. During HFOV, the SOFA score may predict outcome.
Compensatory fluid administration for preoperative dehydration – does it improve outcome?
Authors: Holte K. , Kehlet H. 
Published: March 2003

Background: Preoperative fasting may lead to a fluid deficit of about 1 litre, which may contribute to perioperative discomfort and morbidity. We therefore examined the association between perioperatively administered fluids aiming to correct dehydration and clinical outcome.Methods: Review of randomized, controlled, clinical trials evaluating clinical outcome, in which fluid versus no fluid was administered pre‐ or intraoperatively, attempting to correct preoperative fluid deficits. Data were obtained from a Medline search (1966–2001), and references cited in original papers. Seventeen trials met the inclusion criteria.Results: Based on the amount of fluid administered, we divided the studies into two groups. In nine studies, fluid administration was <1 litre, and in eight studies ≥1 litre of fluid was administered. Administration of low‐dose fluid reduced preoperative thirst, but the limited data do not allow conclusions on postoperative outcome such as nausea, vomiting, headache and pain. Administration of ≥1 litre fluid generally reduced postoperative drowsiness and dizziness, while the effects on postoperative nausea, vomiting and thirst has not been clarified.Conclusion: Fluid administration to compensate preoperative dehydration improves symptoms related to dehydration. Based on the available data, administration of about 1 litre fluid pre‐ or intraoperatively in patients having fasted for minor surgical procedures seems rational.
Thermodilution cardiac output
Authors: Berthelsen P. G. , Eldrup N. , Nilsson L. B. , Rasmussen J. P. 
Published: March 2003

Background: The feasibility of thermodilution cardiac output measurements with the more convenient room temperature thermal indicator instead of cold injectates has been repeatedly investigated. However, the issue has not been addressed with the appropriate statistical approach advocated by Altman and Bland. Furthermore, we wished to determine if the incorporation of a second thermistor in the thermodilution catheter, to measure the temperature of the thermal indicator where it is delivered into the right atrium/superior caval vein, would result in more precise cardiac output measurements.Methods: Fifty patients were randomized to receive a single or dual thermistor pulmonary artery thermodilution catheter. Cardiac output was calculated as the average of four injections of 10 ml of isotonic saline. Precision (2 × SD of differences in replicate measurements) for the two catheters and injectate temperatures, and bias and limits of agreement between measurements, with cold and room temperature injectates, were determined.Results: Precision was (0°C) 0.42 l/min and (20°C) 0.90 l/min, and bias and limits of agreement −0.83 l/min and −1.93–0.27 l/min for the single thermistor catheter. For the dual thermistor system precision was (0°C) 0.34 l/min and (20°C) 0.58 l/min. Bias and limits of agreement were −0.03 l/min and −0.61–0.55 l/min.Conclusion: The second thermistor is redundant if cold injectates are used. If one wishes to use room temperature injectates the single thermistor system is inadequate. A dual thermistor catheter is, on the other hand, acceptable.
Bactericidal/permeability‐increasing protein inhibits endotoxin‐induced vascular nitric oxide synthesis
Authors: Ciornei C. D. , Egesten A. , Engström M. , Törnebrandt K. , Bodelsson M. 
Published: March 2003

Background: Endotoxin (lipopolysaccharide, LPS) up‐regulates inducible nitric oxide synthase (iNOS) in blood vessels during septic shock. This promotes the production of nitric oxide (NO), leading to dilation of the vessels. The aim of the study was to investigate the effects of the LPS‐binding endogenous antibiotic bactericidal/permeability‐increasing protein (BPI) on the action of LPS on the blood vessels wall and to identify possible influence on underlying NO‐related mechanisms.Methods: Isolated segments of rat thoracic aorta and cultured primary smooth muscle cells were incubated for 5–48 h in the presence of the following combinations of compounds: (a) LPS; (b) interleukin‐1β (IL‐1β); (c) BPI; (d) BPI + LPS; (e) BPI + IL‐1β or (f) neither BPI, LPS nor IL‐1β (control). After incubation of intact segments, we measured smooth muscle contraction in response to phenylephrine and accumulation of the NO end products nitrate and nitrite in surrounding medium. Western blot was used to assess the levels of inducible nitric oxide synthase (iNOS) in cultured cells.Results: Both LPS and IL‐1β decreased contractility and increased NO production, as well as iNOS. Co‐incubation with BPI attenuated all the effects of LPS but only the effects of prolonged exposure to IL‐1β in cultured cells.Conclusion: We conclude that BPI attenuates the LPS‐induced changes in vascular reactivity by inhibiting the expression of iNOS resulting in decreased NO formation and restored responsiveness to vasoconstrictors. The data suggest that BPI can prevent circulatory disturbances during Gram‐negative sepsis.
Consultants' opinion on a new practice‐based assessment programme for first‐year residents in anaesthesiology
Authors: Ringsted C. , Østergaard D. , Scherpbier A. 
Published: March 2003

Background: Assessment in postgraduate education is moving towards using a broad spectrum of practice‐based assessment methods. This approach was recently introduced in first‐year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments.Methods: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five‐point scale, asking the consultants' opinions about representativeness, suitability and content of the programme.Results: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered adequate coverage of the competencies of a first‐year resident and was appropriate for making pass/fail decisions. There was strong agreement that the content of the 18 tests used for pass/fail decisions was relevant and sufficient for pass/fail decisions.Conclusion: Judging from the consultants' opinions, the assessment programme for first‐year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility and acceptability of the programme in practice.
Does dopexamine influence regional vascular tone and oxygenation during intestinal hypotension?
Authors: Lehtipalo S. , Biber B. , Fröjse R. , Arnerlöv C. , Johansson G. , Winsö O. 
Published: March 2003

Background: Local effects of dopexamine on intestinal vascular tone and oxygenation were investigated during intestinal hypotension. To this end, we employed an experimental model, in which the superior mesenteric arterial pressure (PSMA) was controlled by an adjustable perivascular clamp. This approach enabled us to keep the intestinal perfusion pressure (IPP) constant in the face of any systemic circulatory alterations.Methods: In 11 barbiturate‐anesthetized pigs, we instrumented the superior mesenteric circulation for assessments of vascular resistance (RMES), IPP, jejunal mucosal perfusion (Laser Doppler) and intestinal tissue oxygenation (microoximetry). Measurements were carried out before and during dopexamine infusions (0.5 and 1.0 µg·kg−1·min−1) at a freely variable PSMA (i.e. the perivascular clamp fully open) and at a PSMA of 50 mmHg and 30 mmHg.Results:  At a constant PSMA of 50 mmHg, dopexamine had no significant intestinal vascular effects. However, at a constant PSMA of 30 mmHg, both doses of dopexamine were associated with decreases in RMES. Effects of dopexamine on intestinal oxygen delivery and extraction were minimal during these procedures, while a minor decrease in intestinal tissue oxygen tension was observed during dopexamine administration at the lowest IPP level.Conclusion: At very low intestinal perfusion pressures (approximately 30 mmHg) dopexamine produces intestinal vasodilation in excess of what is produced by intrinsic autoregulation. This suggests that there is a vasodilatory reserve in the intestine under such conditions and that a pharmacological vasodilator like dopexamine may improve intestinal circulation during regional severe hypotension.