bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mouth Opening
Authors: Calder Ian , Picard John , Chapman Martin , O'Sullivan Caoimhe , Crockard H. Alan 
Published: November 2003

Background
The authors hypothesized that craniocervical extension occurs during normal mouth opening.

Methods
Twenty volunteers were studied. Interdental distance was measured at four different degrees of craniocervical extension.

Results
Interdental distance increased from 28 mm (95% confidence interval, 25-30) in slight flexion to 46 mm (95% confidence interval, 42-49) at full extension. Nearly maximal mouth opening was obtained with 26 degrees (95% confidence interval, 22-30) of craniocervical extension from neutral.

Conclusion
Craniocervical extension is an integral part of complete mouth opening in conscious subjects. Fixation of the craniocervical junction by disease, an internal or external fixation device, or technique may restrict mouth opening, with consequences for airway management.
Participation of Children in Clinical Research
Authors: Tait Alan R. , Voepel-Lewis Terri , Malviya Shobha 
Published: November 2003

Background
Given the initiatives of the National Institutes of Health and other agencies to include children in research, it is important to understand the factors that influence their participation. This study was designed to identify factors that influence parents' decisions to consent to their child's participation in clinical research.

Methods
This survey study consisted of 505 parents who had been approached for permission to allow their child to participate in a clinical anesthesia or surgery study at a large tertiary care children's hospital. Regardless of whether the parents consented to (consenters, n = 411), or declined (nonconsenters, n = 94) their child's participation in a study, they were offered the opportunity to complete a questionnaire eliciting information regarding factors that had influenced their decision.

Results
Consenters exhibited less uncertainty in their decision making, were more trusting of the medical system, had greater understanding of the research, and believed that the environment in which consent was sought was less pressured than nonconsenters. Predictors of consent included low perceived risk, degree to which the parent read the consent document, characteristics of the consent document, parental understanding, perceived importance of the study, and perceived benefits.

Conclusions
Identification of factors that influence parents' decisions to allow their child to participate in a clinical research study will be important by way of developing strategies to improve the manner in which study information is disclosed and to ensure that parents are truly informed.
Cardiopulmonary Bypass Has Minimal Effects on the Pharmacokinetics of Fentanyl in Adults
Authors: Hudson Robert J. , Thomson Ian R. , Jassal Rajive , Peterson David J. , Brown Aaron D. , Freedman Jeffrey I. 
Published: November 2003

Background
Although fentanyl has been widely used in cardiac anesthesia, no complete pharmacokinetic model that has assessed the effect of cardiopulmonary bypass (CPB) and that has adequate predictive accuracy has been defined. The aims of this investigation were to determine whether CPB had a clinically significant impact on fentanyl pharmacokinetics and to determine the simplest model that accurately predicts fentanyl concentrations during cardiac surgery using CPB.

Methods
Population pharmacokinetic modeling was applied to concentration-versus-time data from 61 patients undergoing coronary artery bypass grafting using CPB. Predictive ability of models was assessed by calculating bias (prediction error), accuracy (absolute prediction error), and measured:predicted concentration ratios versus time. The predictive ability of a simple three-compartment model with no covariates was initially compared to models with premedication (lorazepam vs. clonidine), sex, or weight as covariates. This simple model was then compared to 18 CPB-adjusted models that allowed for step changes in pharmacokinetic parameters at the start and/or end of CPB. The predictive ability of the final model was assessed prospectively in a second group of 29 patients.

Results
None of the covariate (premedication, sex, weight) models nor any of the CPB-adjusted models significantly improved prediction error or absolute prediction error, compared to the simple three-compartment model. Thus, the simple three-compartment model was selected as the final model. Prospective assessment of this model yielded a median prediction error of +3.8%, with a median absolute prediction error of 15.8%. The model parameters were as follows: V1, 14.4 l; V2, 36.4 l; V3, 169 l; Cl1, 0.82 l. min-1; Cl2, 2.31 l x min-1; Cl3, 1.35 l x min-1.

Conclusions
Compared to other factors that cause pharmacokinetic variability, the effect of CPB on fentanyl kinetics is clinically insignificant. A simple three-compartment model accurately predicts fentanyl concentrations throughout surgery using CPB.
Effect of Nitroglycerin Inhalation on Patients with Pulmonary Hypertension Undergoing Mitral Valve Replacement Surgery
Authors: Yurtseven Nurgul , Karaca Pelin , Kaplan Mehmet , Ozkul Vedat , Tuygun Abdullah K. , Aksoy Tamer , Canik Sevim , Kopman Ercument 
Published: November 2003

Background
The aim of this study was to investigate the postoperative hemodynamic effects of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery.

Methods
Twenty patients who underwent mitral valve replacement surgery were included in the study. In the surgical intensive care unit, at T0 (before the inhalation of nitroglycerin), basal systemic and pulmonary hemodynamics were recorded. Then, 2.5 microg x kg-1 x min-1 nitroglycerin liquid nebulized by a 2-l gas flow of 40% oxygen and air mixture was administered to the patients who were diagnosed as having pulmonary hypertension (mean pulmonary arterial pressures > 25 mmHg). The same parameters were measured at the first (T1), third (T2), and fifth (T3) hours after the beginning of this treatment and 1 h after the end of nitroglycerin inhalation (T4).

Results
There were no statistically significant differences at T0, T1, T2, T3, or T4 with respect to heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, mixed venous oxygen saturation, arteriovenous oxygen content difference, or arterial carbon dioxide tension. However, mean pulmonary artery pressure, pulmonary vascular resistance, and intrapulmonary shunt fraction were significantly lower, and the arterial oxygen tension/fraction of inspired oxygen ratio was higher at T1, T2, and T3 when compared to that of T0 and T4.

Conclusion
The results suggest that nitroglycerin inhalation produces a significant reduction in both mean pulmonary artery pressure and pulmonary vascular resistance in patients after mitral valve operations without reducing mean arterial pressure and systemic vascular resistance. Therefore, it might be a safe and useful therapeutic intervention during the postoperative course.
Severe Bradycardia during Spinal and Epidural Anesthesia Recorded by an Anesthesia Information Management System
Authors: Lesser Jonathan B. , Sanborn Kevin V. , Valskys Rytis , Kuroda Max 
Published: November 2003

Background
Bradycardia and asystole can occur unexpectedly during neuraxial anesthesia. Risk factors may include low baseline heart rate, first-degree heart block, American Society of Anesthesiologists physical status 1, beta-blockers, male gender, and high sensory level. Anesthesia information management systems automatically record large numbers of physiologic variables that are combined with data input from the anesthesiologist to form the anesthesia record. Such large databases can be scanned for episodes of bradycardia.

Methods
To select spinal and epidural anesthetics that did not also involve general anesthesia, 57,240 automated anesthesia records were scanned. Obstetrical patients and patients younger than age 12 yr were excluded. The electronic records selected were then scanned for episodes of moderate (heart rate < 50 and >/= 40 beats/min) or severe (heart rate < 40 beats/min) bradycardia.

Results
A total of 6,663 cases (11.6%) met the inclusion criteria. Among the 677 cases of bradycardia (10.2%) were 46 cases of severe bradycardia (0.7%). In the final multivariate logistic regression analysis, baseline heart rate less than 60 beats/min (P </= 0.0001) and male gender (P </= 0.05) contributed significantly to risk for a severe bradycardia episode (odds ratio [OR]), 14.1 and 95% confidence interval [CI], 6.9-28.0, and OR, 2.1 and 95% CI, 1-4.3, respectively). For the 631 episodes of moderate bradycardia (9.5%), the final multivariate model included baseline heart rate less than 60 beats/min (OR, 16.2; 95% CI, 12.4-22.0), age younger than 37 yr (OR, 1.4; 95% CI, 1.1-1.7), male gender (OR, 1.4; 95% CI, 1.2-1.8), nonemergency status (OR, 1.7; 95% CI, 1.2-2.4), beta-blockers (OR, 1.6; 95% CI, 1.1-2.3), and case duration (OR, 2.0; 95% CI, 1.6-2.4) as significant risk factors. Time of occurrence of a bradycardia event was distributed widely across the entire duration of a case.

Conclusions
Moderate or severe bradycardia may occur at any time during neuraxial anesthesia, regardless of the duration of anesthesia. Low baseline heart rate increases the risk for bradycardia.
Calreticulin Mediates Anesthetic Sensitivity in Drosophila melanogaster
Authors: Gamo Sumiko , Tomida Junya , Dodo Katsuyuki , Keyakidani Dai , Matakatsu Hitoshi , Yamamoto Daisuke , Tanaka Yoshiharu 
Published: November 2003

Background
Various species, e.g., Caenorhabditis elegans, Drosophila melanogaster, and mice, have been used to explore the mechanisms of action of general anesthetics in vivo. The authors isolated a Drosophila mutant, ethas311, that was hypersensitive to diethylether and characterized the calreticulin (crc) gene as a candidate of altered anesthetic sensitivity.

Methods
Molecular analysis of crc included cloning and sequencing of the cDNA, Northern blotting, and in situ hybridization to accomplish the function of the gene and its mutation. For anesthetic phenotype assay, the 50% anesthetizing concentrations were determined for ethas311, revertants, and double-mutant strains (wild-type crc transgene plus ethas311).

Results
Expression of the crc 1.4-kb transcript was lower in the mutant ethas311 than in the wild type at all developmental stages. The highest expression at 19 h after pupation was observed in the brain of the wild type but was still low in the mutant at that stage. The mutant showed resistance to isoflurane as well as hypersensitivity to diethylether, whereas it showed the wild phenotype to halothane. Both mutant phenotypes were restored to the wild type in the revertants and double-mutant strains.

Conclusion
ethas311 is a mutation of low expression of the Drosophila calreticulin gene. The authors demonstrated that hypersensitivity to diethylether and resistance to isoflurane are associated with low expression of the gene. In Drosophila, calreticulin seems to mediate these anesthetic sensitivities, and it is a possible target for diethylether and isoflurane, although the predicted anesthetic targets based on many studies in vitro and in vivo are the membrane proteins, such as ion channels and receptors.
Isoflurane Reduction of Carbachol-evoked Cytoplasmic Calcium Transients Is Dependent on Caffeine-sensitive Calcium Stores
Authors: Corrales Alexandra , Xu Fang , Garavito-Aguilar Zayra , Blanck Thomas J. J. , Recio-Pinto Esperanza 
Published: November 2003

Background
Many muscarinic functions are relevant to anesthesia, and alterations in muscarinic activity affect the anesthetic/analgesic potency of various drugs. Volatile anesthetics have been shown to depress muscarinic receptor function, and inhibition of the muscarinic signaling pathway alters the minimal alveolar anesthetic concentration of inhaled anesthetics. The purpose of this investigation was to determine in a neuronal cell which source of Ca2+ underlying the carbachol-evoked transient increase in cytoplasmic Ca2+ was reduced by isoflurane.

Methods
Experiments were performed at 37 degrees C on continuously perfused monolayers of human neuroblastoma SH-SY5Y cells using Fura-2 as the cytoplasmic Ca2+ indicator. Carbachol (1 mm) was applied to evoke a transient increase in cytoplasmic Ca2+.

Results
Isoflurane (1 mm) reduces the carbachol-evoked transient increase in cytoplasmic Ca2+, and this isoflurane action is eliminated when the cells are continuously stimulated with 200 mm KCl or pretreated with 10 mm caffeine or 200 microm ryanodine.

Conclusions
Isoflurane reduction of the carbachol-evoked transient increase in cytoplasmic Ca2+ requires full caffeine-sensitive Ca2+ stores and Ca2+ release from the caffeine-sensitive stores through the ryanodine-sensitive Ca2+ release channels. The results indicate that isoflurane interferes with a muscarinic Ca2+ signaling through a mechanism downstream from the muscarinic receptors.
Acetazolamide Reduces Referred Postoperative Pain after Laparoscopic Surgery with Carbon Dioxide Insufflation
Authors: Woehlck Harvey J. , Otterson Mary , Yun Hyun , Connolly Lois A. , Eastwood Daniel , Colpaert Krista 
Published: November 2003

Background
Carbon dioxide is the preferred insufflating gas for laparoscopy because of greater safety in the event of intravenous embolism, but it causes abdominal and referred pain. Acidification of the peritoneum by carbonic acid may be the major cause of pain from carbon dioxide insufflation. Carbonic anhydrase is an enzyme that increases the rate of carbonic acid formation from carbon dioxide. Because acetazolamide inhibits carbonic anhydrase, the authors hypothesized that the pain caused by carbon dioxide insufflation may be decreased by the administration of acetazolamide.

Methods
A prospective, randomized, double-blind study of 38 patients undergoing laparoscopic surgery during general anesthesia was performed. Acetazolamide (5 mg/kg) or a saline placebo was administered intravenously during surgery. Pain was rated on a visual analog scale (0-10) at four times: when first awake, at discharge from the recovery room, when discharged from the hospital, and on the day after surgery. The site and quality of pain were recorded, as were medications and side effects.

Results
Initial referred pain scores were lower after acetazolamide (1.00 +/- 1.98; n = 18) than after placebo (3.40 +/- 3.48; n = 20; P = 0.014), and 78% of patients in the acetazolamide group had no referred pain; however, only 45% patients in the placebo group had no referred pain. Incisional pain scores were not statistically different, and referred pain scores were similar at later times.

Conclusions
Acetazolamide reduces referred but not incisional pain after laparoscopic surgical procedures. The duration of pain reduction is limited to the immediate postsurgical period.
Inhibition of Inflammatory Hyperalgesia by Activation of Peripheral CB2Cannabinoid Receptors
Authors: Quartilho Aline , Mata Heriberto P. , Ibrahim Mohab M. , Vanderah Todd W. , Porreca Frank , Makriyannis Alexandros , Malan T. Philip 
Published: November 2003

Background
Cannabinoid receptor agonists inhibit inflammatory hyperalgesia in animal models. Nonselective cannabinoid receptor agonists also produce central nervous system (CNS) side effects. Agonists selective for CB2 cannabinoid receptors, which are not found in the CNS, do not produce the CNS effects typical of nonselective cannabinoid receptor agonists but do inhibit acute nociception. The authors used the CB2 receptor-selective agonist AM1241 to test the hypothesis that selective activation of peripheral CB2 receptors inhibits inflammatory hyperalgesia.

Methods
Rats were injected in the hind paw with carrageenan or capsaicin. Paw withdrawal latencies were measured using a focused thermal stimulus. The effects of peripheral CB2 receptor activation were determined by using local injection of AM1241. CB2 receptor mediation of the actions of AM1241 was shown by using the CB2 receptor-selective antagonist AM630 and the CB1 receptor-selective antagonist AM251.

Results
AM1241 fully reversed carrageenan-induced inflammatory thermal hyperalgesia when injected into the inflamed paw. In contrast, AM1241 injected into the contralateral paw had no effect, showing that its effects were local. AM1241 also reversed the local edema produced by hind paw carrageenan injection. The effects of AM1241 were reversed by the CB2 receptor-selective antagonist AM630, but not by the CB1 receptor-selective antagonist AM251. AM1241 also inhibited flinching and thermal hyperalgesia produced by hind paw capsaicin injection.

Conclusions
Local, peripheral CB2 receptor activation inhibits inflammation and inflammatory hyperalgesia. These results suggest that peripheral CB2 receptors may be an appropriate target for eliciting relief of inflammatory pain without the CNS effects of nonselective cannabinoid receptor agonists.
Comparative Neurotoxicity of Intrathecal and Epidural Lidocaine in Rats
Authors: Kirihara Yumiko , Saito Yoji , Sakura Shinichi , Hashimoto Keishi , Kishimoto Tomomune , Yasui Yukihiko 
Published: November 2003

Background
Although there is a considerable difference in the number of clinical reports of neurologic injury between spinal anesthesia and other regional techniques, there are no animal data concerning a difference in the local anesthetic neurotoxicity between intrathecal and epidural administration. In the current study, the functional and morphologic effects of lidocaine administered intrathecally and epidurally were compared in rats.

Methods
Male rats were implanted with an intrathecal or epidural catheter through L4-L5 vertebra in the caudal direction. In experiment 1, to determine relative anesthetic potency, 16 rats received repetitive injections of 2.5% lidocaine into intrathecal or epidural space in different volumes and were examined for tail flick test for 90 min. In experiment 2, to ascertain whether the relative potency obtained in experiment 1 would apply to other concentrations of lidocaine, additional rats received saline, 1%, 2.5%, or 5% lidocaine in a volume of 20 or 100 microl through the intrathecal or epidural catheter, respectively. In experiment 3, additional rats that received saline, 2.5% lidocaine, or 10% lidocaine in a volume of 20 or 100 microl through the intrathecal or epidural catheter, respectively, were examined for persistent functional impairment and morphologic damage.

Results
In experiment 1, the two techniques produced parallel dose-effect curves that significantly differed from each other. The potency ratio calculated was approximately 4.72 (3.65-6.07):1 for intrathecal:epidural lidocaine. In experiment 2, every lidocaine solution produced a similar increase in tail flick latency for the two techniques. In experiment 3, five of eight rats given 10% intrathecal lidocaine incurred functional impairment 4 days after injection, whereas no rats in the other groups did. Significantly more morphologic damage was observed in rats given 10% intrathecal lidocaine than in those given 10% epidural lidocaine.

Conclusions
Persistent functional impairment occurred only after intrathecal lidocaine. Histologic damage in the nerve roots and the spinal cord was less severe after epidural lidocaine than after intrathecal lidocaine. The current results substantiate the clinical impression that neurologic complications are less frequent after epidural anesthesia than after spinal anesthesia.
Comparison of the LMA-Classic ™ with the New Disposable Soft Seal Laryngeal Mask in Spontaneously Breathing Adult Patients
Authors: van Zundert André A. J. , Fonck Kristine , Al-Shaikh Baha , Mortier Eric 
Published: November 2003

Background
The laryngeal mask airway LMA-Classic has been used widely in clinical practice. A new disposable supraglottic airway device, the Soft Seal LM, has been introduced recently. In a randomized study, the authors compared the LMA-Classic and the disposable Soft Seal LM in terms of their clinical performance, cuff pressures during nitrous oxide anesthesia, position of the laryngeal mask in situ by fiberoptic evaluation, and morbidity in a wide range of routine general surgery procedures.

Methods
A total of 200 adult patients were randomly assigned to a size 4 laryngeal mask in two equal-sized groups for airway management during surgery: (1) LMA-Classic (Intavent Orthofix Ltd., Maidenhead, Berkshire, United Kingdom); or (2) Soft Seal LM (Portex Ltd., Hythe, Kent, United Kingdom). Anesthesia was administered with fentanyl, propofol, nitrous oxide, oxygen, and sevoflurane. The variables studied were ease of insertion, fiberoptic view, time in situ, incidence of blood on the laryngeal mask at the time of removal, and the incidence of postoperative sore throat at 2 and 24 h. The laryngeal mask cuff pressures were measured continuously. Intracuff pressure limitation was not attempted.

Results
The LMA-Classic and the Soft Seal LM showed similar clinical performances, as shown by their insertion time (successful insertion at first attempt was achieved within 20 s in 97% with LMA-Classic trade mark vs. 95% with Soft Seal LM), fiberoptic evaluation of the anatomic position of the laryngeal mask, and satisfactory anesthesia conditions. Laryngeal mask cuff pressures increased from 45 to 100.3 mmHg in the LMA-Classic and from 45 to 46.8 mmHg in the Soft Seal LM (P < 0.001). Macroscopic blood was seen on only four occasions in the LMA-Classic group. The incidence of sore throat was significantly increased at 2 h postoperatively when using the LMA-Classic, although there was no difference at 24 h after surgery.

Conclusions
In spontaneously breathing adult patients requiring a size 4 laryngeal mask airway, the new disposable Soft Seal LM device is an acceptable alternative to the reusable LMA-Classic trade mark, resulting in a good laryngeal seal and offering similar clinical performance. Cuff pressures increase substantially when the LMA-Classic is used but not when using the Soft Seal LM. There was less trauma to patients using the Soft Seal LM, as assessed by the incidence of sore throat in the early postoperative period.