bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of hypertonic 75 mg/ml (7.5%) saline on extracellular water volume when used for preloading before spinal anaesthesia
Authors: Järvelä K. , Kööbi T. , Kauppinen P. , Kaukinen S. 
Published: March 2003

Background: Prevention of hypotension during spinal anaesthesia is commonly achieved using fluid preloading. This may result in a substantial amount of excess free water retained in the body after spinal anaesthesia. We aimed to evaluate the effects of 7.5% hypertonic saline on extracellular water volume and haemodynamics when used for fluid preloading before spinal anaesthesia.Methods: This randomised double‐blind study evaluated the effects of 75 mg/ml (7.5%) hypertonic saline (HS) on extracellular water volume and haematocrit in patients undergoing arthroscopy or other lower limb surgery under spinal anaesthesia. Amounts of 1.6 ml/kg of HS (20 patients) or 13 ml/kg of 9 mg/ml normal saline (20 patients) were administered for preloading before spinal anaesthesia with a 10 mg dose of 0.5% hyperbaric bupivacaine. Etilefrine was administered in order to maintain mean arterial pressure (MAP) at 80% of its baseline value. Whole‐body impedance cardiography‐derived cardiac index (CI) and extracellular water (ECW) were measured.Results: There were no significant differences in demographic data or in the number of blocked segments. ECW remained similar in both groups despite the much smaller amount of infused free water in the HS group. There were no significant differences between the groups in CI values during the study. The amount of etilefrine administered was similar in the treatment groups. Dilution of haematocrit was also similar in both groups.Conclusion: Hypertonic 75 mg/ml (7.5%) saline is an alternative for preloading before spinal anaesthesia in situations where excess free water administration is not desired. It is effective in small doses of 1.6 ml/kg, which increase the extracellular water, plasma volume and cardiac output, and thus maintain haemodynamic stability during spinal anaesthesia.
Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children
Authors: Vakkuri A. , Yli‐Hankala A. , Särkelä M. , Lindgren L. , Mennander S. , Korttila K. , Saarnivaara L. , Jäntti V. 
Published: March 2003

Background: Sevoflurane inhalation induction of anaesthesia is widely used in paediatric anaesthesia. We have found that this method is frequently associated with epileptiform electroencephalogram (EEG) in adults, especially if controlled hyperventilation is used.Methods: We assessed EEG during sevoflurane inhalation induction in 31 children, aged 2–12 yr. Anaesthesia was induced with 8% sevoflurane in O2 in N2O 1:2. The patients were randomized to undergo controlled ventilation (CV group), or to breathe spontaneously (SB group) for 5 min. EEG was recorded as were noninvasive blood pressure and heart rate (HR). EEG recordings were classified by a clinical neurophysiologist.Results: Three different types of interictal epileptiform discharge were detected. Suppression with spikes (SSP) was found in 25% and 0% in the CV and SB groups, rhythmic polyspikes (PSR) in 44% and 20%, and periodic epileptiform discharges (PED) in 44% and 0% (P<0.01), respectively. The incidence of all different types of interictal epileptiform discharge (SSP+PSR+PED) was 88% and 20% (P<0.001), respectively. Epileptiform EEG was associated with increased heart rate and blood pressure during anaesthetic induction.Conclusion: Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.
Thiopental directly depresses lumbar dorsal horn neuronal responses to noxious mechanical stimulation in goats
Authors: Sudo M. , Sudo S. , Chen X. G. , Piercy M. , Carstens E. , Antognini J. F. 
Published: March 2003

Background: Thiopental has hypnotic actions in the brain, but it also depresses nociceptive transmission. In this study we examined whether thiopental had direct (spinal) and/or indirect (supraspinal) effects on the responses of single lumbar dorsal horn neurons to noxious mechanical stimulation, using a method to deliver thiopental differentially to either the torso or cranial circulation in goats.Methods: Goats (n=10) were anesthetized with isoflurane and neck dissections performed to permit cranial bypass. A lumbar laminectomy was made to permit single‐unit recording of lumbar dorsal horn neuronal activity (1–2 neurons/animal). Isoflurane was maintained at 0.8±0.1% to both head and torso throughout the study. During cranial bypass, thiopental was separately administered to the torso (low dose, 1.5±0.5 mg/kg; high dose, 3.7±0.5 mg/kg) or cranial (low dose, 0.12±0.03 mg/kg; high dose, 0.2 mg/kg) circulation.Results: Thiopental administered to the torso significantly depressed dorsal horn neuronal responses to noxious stimulation at the high dose: 757±471 to 392±305 impulses/min at 1 min post‐injection, P<0.006 (n=14); evoked responses recovered at 5 min post‐injection. At the low dose, there was a similar numerical decrease, but this did not reach significance: 876±780 to 407±499 impulses/min at 1 min post‐injection, P>0.05 (n=6). No significant change was observed when thiopental was administered to the cranial circulation: low dose, 1061±1167 to 965±874 impulses/min at 1 min post‐injection, P>0.05 (n=10); high dose, 864±331 to 917±525 impulses/min at 1 min post‐injection, P>0.05 (n=8).Conclusion: Thiopental has a direct (spinal) depressant effect on dorsal neuronal responses to noxious stimulus, but no significant supraspinal effect.
Controlled hypercapnia during one‐lung ventilation in patients undergoing pulmonary resection
Authors: Sticher J. , Müller M. , Scholz S. , Schindler E. , Hempelmann G. 
Published: March 2003

Background: In a pilot study, the haemodynamic and gas exchange effects of acute hypercapoia during one‐lung ventilation in thoracotomy patients were investigated. The effects of normocapnic one‐lung ventilation (OLV‐N) on haemodynamics and pulmonary gas exchange were compared with those of hypercapnic one‐lung ventilation (OLV‐H) in 14 patients undergoing pulmonary lobectomy.Methods: Hypercapnia was induced by decreasing tidal volume until PaCO2 increased to 8–9 kPa. During OLV, minute ventilation was reduced from 8.8±1.7 to 4.2±0.7 l min−1.Results: Cardiac index (from 3.3±0.6 to 3.9±0.6 l min−1, P<0.01) and pulmonary vascular resistance index (from 245±96 to 347±125 dyn s cm−5 m−2, P<0.05) increased during OLV‐H, whereas systemic vascular resistance index decreased from 1952±403 to 1636±361 dyn s cm−5 m−2 (P<0.01). Pulmonary oxygenation remained unchanged.Conclusions: All patients had an uneventful course during OLV‐H. The determinants of pulmonary oxygenation during hypercapnic one‐lung ventilation remain to be further elucidated.
High‐dose flumazenil potentiates the hypnotic activity of propofol, but not that of thiopental, in ddY mice
Authors: Adachi Y. U. , Watanabe K. , Higuchi H. , Satoh T. 
Published: March 2003

Background: Flumazenil is a specific benzodiazepine agonist, which is reported to have a partial benzodiazepine agonist‐like effect at a high dose. This study investigated the effects of flumazenil and midazolam on the hypnotic dose of propofol and thiopental in ddY mice, using a behavioral model.Methods: Mice were given either propofol or thiopental intravenously to induce hypnosis, which was defined as a loss of the righting reflex. The mice were pre‐treated with flumazenil (0.05, 0.1, or 0.2 mg kg−1) or midazolam (0.1 or 0.2 mg kg−1), and given propofol or thiopental after a 30‐s delay.Results: Pre‐treatment with flumazenil (0.1 or 0.2 mg kg−1) significantly decreased the hypnotic dose of propofol compared to the control group (9.3±0.39 [8.5–10.0] or 9.0±0.28 [8.5–9.6] vs. 10.8±0.42 [9.9–11.6] mg kg−1 (ED50±SEM and [95% confidence interval]) P<0.05), but not that of thiopental (9.1±0.30 [8.5–9.7] with 0.2 mg kg−1 flumazenil vs. 9.3±0.42 [8.4–10.1] mg kg−1 with saline). Midazolam reduced the hypnotic dose of both propofol and thiopental. Flumazenil antagonized the potentiating effect of midazolam (0.2 mg kg−1) on the hypnotic activity of propofol.Conclusions: These results suggest that the hypnotic activity of propofol is potentiated by the partial agonist activity of flumazenil in ddY mice.
Determinants of ICU mortality in necrotizing pancreatitis: the influence of Staphylococcus epidermidis
Authors: Ala‐Kokko T. I. , Tieranta N. , Laurila J. , Syrjälä H. 
Published: March 2003

Background: The severity of acute necrotizing pancreatitis ranges from self‐limited to rapidly progressive illness leading to multiple organ failure. Several scoring systems and clinical parameters have been used to predict the course of the disease. The aim of this study was to evaluate the clinical and microbiological determinants of poor outcome in necrotizing acute pancreatitis.Methods: Medical records of 67 consecutive patients admitted to the intensive care unit (ICU) of Oulu University Hospital due to acute necrotizing pancreatitis were retrospectively analyzed. All patients received standard surgical intensive care.Results: Patients who died (n=14) had significantly higher APACHE II, SAPS II and Ranson scores at admission to the ICU and maximum SOFA score achieved during ICU stay than did the survivors. The non‐survivors were hospitalized later from the time the symptoms were first manifest (5.3 vs. 2.4 days, P=0.051). Mechanical ventilation (P=0.002), surgical management (P=0.028), open packing surgical management (P=0.03), renal replacement therapy (P<0.001), use of inotropic drugs (P=0.012) and Staphylococcus epidermidis growth (P=0.029) in infected pancreatic tissue were all associated with mortality.Conclusions: In this study the time to hospitalization, severity of illness, intensity of care, and surgical management were associated with poor outcome. In addition, Staphylococcus epidermidis in pancreatic necrosis was associated with increased mortality.
Analysis of left ventricular systolic function during elevated external cardiac pressures: an examination of measured transmural left ventricular pressure during pressure–volume analysis
Authors: Haney M. F. , Johansson G. , Häggmark S. , Biber B. 
Published: March 2003

Background: Variations or disturbances in intrathoracic and extracardiac pressures (ECP) occur in critically ill and anaesthetised patients. There are uncertainties concerning the analysis of left ventricular pressure–volume relationship (LVPVR) and the calculation of systolic function parameters when conducted without reference to transmural left ventricular pressure (LVPtm) in the setting of elevated ECP.Methods: In 7 anaesthetised adult pigs, we measured LVPVR using conductance volumetry and tip manometry along with measurement of pericardial and other intrathoracic pressures. Experimental pericardial infusion and pleural insufflation were performed. Transient controlled preload reductions were accomplished using balloon occlusion of the inferior vena cava. Preload recruitable stroke work (PRSW) was calculated using both intracavitary left ventricular pressure (LVPic) and LVPtm, and differences were tested for using a paired t‐test.Results: The pericardial and pleural interventions produced significant elevations in ECP. No difference in PRSW calculated using LVPic and LVPtm was detected.Conclusion: These results suggest that LVPtm need not be measured and included in LVPVR analysis of systolic function when there is significant external cardiac pressure. To be able to employ LVPVR analysis of systolic function without reference to LVPtm is important for simplified application in the clinical setting, particularly when elevated extracardiac pressures are suspected, or have been therapeutically induced, as with continuous positive pressure ventilation.
Effects of positive end‐expiratory pressure on intestinal circulation during graded mesenteric artery occlusion
Authors: Lehtipalo S. , Biber B. , Fröjse R. , Arnerlöv C. , Johansson G. , Winsö O. 
Published: March 2003

Background: Reduced gut perfusion is associated with multiple organ failure. Positive end‐expiratory pressure (PEEP) reduces cardiac output (CO) and portal blood flow, and might be detrimental in a situation of already compromised intestinal circulation. The aim of this study was to investigate regional circulatory and metabolic effects of PEEP during graded regional hypoperfusion.Methods: In 12 barbiturate‐anesthetized pigs, we measured systemic and regional blood flows (superior mesenteric arterial, QSMA and portal venous, QPORT), jejunal mucosal perfusion (LDF), tissue oxygenation (PO2TISSUE) and metabolic parameters at PEEP (0, 4, 8 and 12 cm H2O) in a randomized order. Measurements were performed at unrestricted intestinal perfusion pressures (IPP) and at IPP levels of 50 and 30 mmHg.Results: During unrestricted IPP, PEEP decreased MAP, CO, QSMA and QPORT, while systemic, and preportal (RPORT) vascular resistances and jejunal mucosal perfusion were not significantly changed. Preportal tissue oxygen delivery and PO2TISSUE decreased, while preportal tissue oxygen uptake was unaltered. During restricted IPP, PEEP produced the same pattern of hemodynamic alterations as when IPP was not restricted. QPORT and QSMA were lowered by the reductions in IPP, and QPORT was further reduced during PEEP. At an IPP of 30 mmHg, this reduction in QPORT decreased preportal tissue oxygen uptake. Consequently, intestinal ischemia, as indicated by increased net lactate production, occurred. Simultaneously, jejunal mucosal perfusion and PO2TISSUE declined.Conclusion: At IPP levels below 50 mmHg, even moderate levels of PEEP impaired local blood flow enough to cause intestinal ischemia. Our data underscore the importance of considering regional circulatory adaptations during PEEP ventilation.
High concentrations of adrenergic antagonists prolong sciatic nerve blockade by tetrodotoxin
Authors: Kohane D. S. , Lu N. T. , Crosa G. A. , Kuang Y. , Berde C. B. 
Published: March 2003

Background: Millimolar‐range concentrations of some adrenergic antagonists have been shown to have local anesthetic‐like properties, and to stimulate GTPase activity in vitro. In this report, we investigate whether these agents can potentiate the effect of tetrodotoxin (TTX) and bupivacaine, a conventional local anesthetic, and whether GTPase activation plays a role.Methods: Rats received sciatic nerve blockade with tetrodotoxin or bupivacaine co‐injected with adrenergic antagonists and/or agonists, or pertussis toxin. Thermal nociceptive blockade was quantified with modified hotplate testing.Results: Nerve block from TTX alone lasted 153 (99–223) min (median and 25th and 75th percentiles). Co‐injection with 20 mM phentolamine, propranolol, and yohimbine prolonged TTX block to 856 (765–862), 486 (444–510), and 465 (413–495) min respectively (P<0.005 in all cases, compared to TTX alone). Micromolar concentrations of adrenergic antagonists (which inhibited the prolongation of TTX block by epinephrine) did not prolong TTX block. Injection of adrenergic antagonists alone did not produce specific nerve block. They did not prolong TTX block when injected at a remote subcutaneous site. Prolongation of TTX block by phentolamine was not inhibited by co‐injection with pertussis toxin. Adrenergic antagonists did not prolong bupivacaine block.Conclusions: High concentrations of adrenergic antagonists markedly prolonged TTX block, but not bupivacaine block. This locally mediated action does not appear to be adrenergic‐receptor‐specific, or mediated by GTPase activation.
Treatment with paracetamol in infants
Authors: Arana A. , Morton N. S. , Hansen T. G. 
Published: March 2003

Background: Paracetamol (N‐acetyl‐p‐amino‐phenol) or acetaminophen has become the most widely used analgesic and antipyretic in children. However, there is a wide discrepancy between the extent to which paracetamol is used and the limited available pharmacological data in small infants. The purpose of this article is to present a review of the current literature regarding the use of paracetamol in neonates and infants with a particular emphasis on pharmacological issues.Methods: A MEDLINE search (up to March 2000) was conducted to identify relevant English‐language publications using paracetamol, children, infants and neonates as search terms. Additional studies were identified from bibliographies of the reviewed literature.Results: Pharmacological studies on paracetamol in infants are few. Most studies have focused on the administration of one single paracetamol dose, and the problem of cumulative toxicity with repeated dosing has not been addressed. Plasma paracetamol concentration should be 10–20 mg ml−1 to achieve antipyretic and analgesic effects. The bioavailability of the different formulations and routes of administration vary with age. Rectal absorption is slower and more erratic than the oral; however, in the very young, rectal bioavailability is higher than in older patients. Volume of distribution seems to be age‐independent, whereas clearance is reduced in neonates and particularly in preterm babies. Neonates and infants are capable of forming the reactive intermediate metabolite that causes hepatocellular damage, particularly after multiple doses. They have an immature glucuronide conjugation system, but the rate constant for the sulphation metabolic pathway is larger than in older children, and this is the most important route of metabolism.Conclusions: The pharmacokinetics and pharmacodynamics of paracetamol differ substantially in neonates and infants from those in older children and adults; hence, dosing should be adjusted accordingly.
A single‐injection, multi‐segmental paravertebral block – extension of somatosensory and sympathetic block in volunteers (Note)
Authors: Saito T. , Den S. , Cheema S. P. S. , Tanuma K. , Carney E. , Carlsson C. , Richardson J. 
Published: March 2003

Background: It is our experience that a deposition of an anesthetic solution in the ventral area of the paravertebral space near the parietal pleura and the sympathetic trunk produces extended unilateral block. Because sympathetic block effects in this extended paravertebral block are not reported yet, we undertook this singly blinded, controlled study on the sympathetic change in volunteers.Methods: A total of 22 ml 1% lidocaine was injected at the T11 level into the ventral area of the right‐sided paravertebral space in 16 volunteers. The distribution of analgesia, heart rate, blood pressure and body temperature (measured by 12 skin sensors) was monitored. On a later occasion the volunteers underwent a control injection of saline.Results: Unilateral analgesia (with no contralateral element) was induced in every subject injected with lidocaine, contrasted with no block induction with saline. Loss of pin‐prick sensation was observed within 10 min after injection and involved a mean of 12 (range 8–13) dermatomes. A sympathetic block was indicated by cutaneous temperature increase within at least 6 dermatomes. Increase of arterial blood pressure was obtained in all volunteers with no change in pulse rate. No side effects or complications occurred. Epidural spread of the local anesthetic was unlikely because of the absence of contralateral cutaneous analgesia and temperature increase.Conclusion: One‐sided extended analgesia (sensory loss) follows the paravertebral injection of lidocaine. A large ipsilateral sympathetic block is observed without change in pulse rate and with no hypotension. These are all characteristics of an optimal regional block.
Measuring patient satisfaction with anaesthesia: perioperative questionnaire versus standardised face‐to‐face interview
Authors: Bauer M. , Böhrer H. , Aichele G. , Bach A. , Martin E. 
Published: March 2003

Background: Patient satisfaction represents an essential part of quality management. Measuring the degree of patient satisfaction can be achieved with a variety of tools such as postoperative visits and patient questionnaires. The primary aim of this study was to quantify the degree of patient satisfaction with anaesthesia. A secondary aim was to compare the questionnaire technique with standardised face‐to‐face interviewing.Methods: The authors prospectively studied 700 patients on the second postoperative day. Patients were randomised and allocated to complete either a written questionnaire or to answer the same questions during a standardised face‐to‐face interview. The questionnaire was subdivided into a set of questions on anaesthesia‐related discomfort and another set on satisfaction with anaesthesia care in general. The questions on discomfort were assessed on a 3‐point scale, and those on patient satisfaction on a 4‐point scale.Results: Response rate was 84% (589 of 700 patients). Internal consistency, as measured by Cronbach’s α, was 0.84. When evaluating the questions on anaesthesia‐related discomfort, the most frequent sensations were “drowsiness” (>75%), “pain at the surgical site” (>55%), and “thirst” (>50%). The data on patient satisfaction showed a high degree of satisfaction (>90%). The responses to questions on anaesthesia‐related discomfort revealed only minor differences between the questionnaire and the face‐to‐face interview. The questions on satisfaction with anaesthesia, however, were answered consistently in a more critical manner during the interview (P<0.0001).Conclusions: The standardised interview may be more suited to determine patient satisfaction than a questionnaire. Quality improvements are possible for emergence from anaesthesia, postoperative pain therapy, and the treatment of postoperative nausea and vomiting.
The influence of halothane, isoflurane and sevoflurane on rocuronium infusion in children
Authors: Woloszczuk‐Gebicka B. , Lapczynski T. , Wierzejski W. 
Published: March 2003

Background: Rocuronium is a non‐depolarizing neuromuscular blocking agent with intermediate duration of action and without significant cumulative properties, suitable for continuous infusion. This study was designed to determine the infusion requirements in children under nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane anaesthesia.Methods: Forty children, 3–11 years old, ASA physical status group I or II were studied. They were randomly allocated to receive fentanyl‐nitrous oxide, 1 MAC halothane‐nitrous oxide, 1 MAC isoflurane‐nitrous oxide or 1 MAC sevoflurane‐nitrous oxide anaesthesia. Rocuronium, 0.6 mg−1 was used to facilitate endotracheal intubation. Electromyographic response of adductor pollicis to train‐of‐four (TOF) stimulation, 2 Hz for 2 s, applied to the ulnar nerve at 10‐s intervals was recorded using Relaxograph (Datex, Helsinki, Finland). Once the first twitch response (T1) returned to 5%, muscle relaxation was maintained by continuous infusion of rocuronium, adjusted automatically in a closed‐loop system to maintain a stable 90–99% T1 depression. The block was considered stable if it changed by no more than 2% over a 10‐min observation period.Results: Halothane, isoflurane and sevoflurane groups had lower infusion requirements than the fentanyl‐nitrous oxide group (P<0.00075). Rocuronium requirement (mean ± SD) at one hour from the commencement of anaesthesia was 16.7±2.3, 13.6±3.7, 13.1±5.1 and 8.4±1.6 μg · kg−1 · min−1 for children receiving fentanyl‐nitrous oxide, halothane, isoflurane and sevoflurane anaesthesia, respectively.Conclusions: The rocuronium infusion rate required to maintain stable 90–99% T1 depression was reduced by approximately 20% with halothane and isoflurane anaesthesia, and by 50% with sevoflurane anaesthesia when compared to fentanyl‐nitrous oxide anaesthesia. Significant patient‐to‐patient variability of infusion rate makes monitoring of neuromuscular transmission necessary.