bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of percutaneous dilation tracheotomy – value of preincisional ultrasonic examination?
Authors: Bonde J. , Nørgaard N. , Antonsen K. , Faber T. 
Published: March 2003

Background: In this observational study we have evaluated the implementation of percutaneous dilation tracheotomy (PDT), using the foreceps dilation technique (Portex) in a multidicsiplinary ICU.Methods: We included a preincisional ultrasonic evaluation of the neck in order to visualise the isthmus glandula thyroidea and major vessels. The observational period comprised one year. PDT was performed in 28 patients.Results: Implementation of PDT was uneventful. Duration of insertion was 10 min (4–40 min). Total time of tracheostomy was 8 days (1–65 days). In nine cases, the proximal end of the isthmus was overlying the space between the 1st and 2nd tracheal ring, which was considered the optimal insertion site. This resulted in seven cases of insertion between the cricoidea and the 1st tracheal ring and in two cases in a more distal insertion. Nineteen tracheotomies were performed in the interstice between the 1st and 2nd tracheal ring. In nine patients, major vessels were overlying the trachea. In none of the patients did this information result in an altered insertion site. Two cases of minor bleeding were observed; both stopped upon compression. In two patients the primary tube size (8.0) was too big and a smaller tube had to be inserted. In one patient the tube was maladapted to the stoma and had to be interchanged with an ordinary tracheostomial tube on the 5th day of tracheostomy.Conclusion: Based on the experience gathered in this study and information from the literature, we have abandoned the routine use of ultrasonic examination of the neck prior to PDT. In order to achieve and maintain routine, we suggest that the procedure is performed by a restricted number of doctors.
In‐hospital cardiopulmonary resuscitation
Authors: Skogvoll E. , Isern E. , Sangolt G. K. , Gisvold S. E. 
Published: March 2003

Background: Direct comparison of survival rates from in‐hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in‐hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material.Methods: The hospital (900 beds, 37 000 annual admissions) has no established do‐not‐resuscitate (DNR) order policy. CPR outside the Intensive‐ or Coronary Care Units (ICU/CCU) is performed by an emergency medical team consisting of an anaesthesiologist, a medical resident and a nurse anaesthetist. CPR attempts during 5 years (1990–1994) were analysed retrospectively. Patient survival, cerebral and overall performance category (CPC/OPC) score of the survivors was determined. The Utstein template was evaluated in terms of clinical relevance and data availability.Results: During 5 years, 4927 patients died as in‐patients. CPR outside the CCU/ICU was attempted 244 times. CPR was primarily successful on 83 occasions (34%), and 42 patients (17%) were finally discharged with CPC 1 or 2. Survival from primary ventricular fibrillation (VF) or ventricular tachycardia was 40%, pulseless electrical activity 3%, asystole 11% and of rhythm undetermined 6%. Age or sex effects were not observed.Conclusion: More than 90% of in‐hospital deaths in this hospital are handled without CPR being initiated. Overall survival was 17%, and almost all survivors made a favourable outcome. The Utstein template for in‐hospital cardiac arrest performed acceptably as a framework for reporting outcome in this retrospective study.
Postoperative nausea and vomiting in childrenusing patient‐controlled analgesia:the effect of prophylactic intravenous dixyrazine
Authors: Kokinsky E. , Thornberg E. , Nilsson K. , Larsson L. E. 
Published: March 2003

Background: Although patient‐controlled analgesia (PCA) with morphine provides a high degree of satisfactory postoperative analgesia in children, it is often associated with a high incidence of postoperative nausea and vomiting (PONV). Our aim in this study was to evaluate the prophylactic effect of dixyrazine, a phenothiazine with proven anti‐emetic properties.Methods: The incidence of nausea and vomiting was studied in 60 children using PCA after major surgery. The patients were randomised to receive either dixyrazine 0.25 mg kg−1 or placebo on the induction of anaesthesia in a double‐blind, placebo‐controlled design. The anaesthetic technique was standardised. The PCA pump was programmed to deliver bolus doses of morphine of 20 μg kg−1 with a continuous background infusion of 8–10 μg kg−1 h−1. Nausea, vomiting, sedation and pain scores were noted every 3 h for a period of 24 h.Results: The morphine consumption of morphine was the same in both groups. During the stay in the recovery room the incidence of vomiting was 3% in the dixyrazine group compared to 30% in the placebo group (P<0.05). On the ward, 57% versus 83% of the children vomited (P<0.05). Rescue antiemetics were significantly lower, 30%, in the dixyrazine group compared to 60% in the placebo group (P<0.05). Higher sedation scores were recorded for the dixyrazine group in the recovery room. No other adverse effects were found.Conclusion: A significant number of children using PCA with morphine after major surgery experience PONV. Although prophylactic dixyrazine reduces the incidence and severity of vomiting, the incidence still remains high.
Sepsis attenuates the intensity of the neuromuscular blocking effect of d‐tubocurarine and the antagonistic actions of neostigmine and edrophonium accompanying depression of muscle contractility of the diaphragm
Authors: Narimatsu E. , Nakayama Y. , Sumita S. , Iwasaki H. , Fujimura N. , Satoh K. , Namiki A. 
Published: March 2003

Background: Prolonged effects of non‐depolarizing muscle relaxants in septic patients have been reported, although the influence of sepsis on neuromuscular transmission has not yet been clarified satisfactorily. These studies were intended to elucidate the influence of sepsis on neuromuscular transmission and on the action of drugs being utilized for regulation of muscle tone (a neuromuscular blocker and anti‐cholinesterase (anti‐ChE) drugs).Methods: The effect of d‐tubocurarine (dTc) on neuromuscular transmission and the antagonistic action of anti‐ChE drugs (neostigmine and edrophonium) on dTc‐induced twitch depression were estimated using sham control and septic rat nerve‐hemidiaphragm preparations in vitro. Isometric twitch tension elicited by indirect (phrenic nerve) or direct (muscle) stimulation at 0.1 Hz was evaluated.Results: Sepsis induced by panperitonitis attenuated the twitch tension elicited by indirect or direct stimulation (P<0.01) without obvious morphological inflammatory damage to the diaphragm. dTc dose‐dependently decreased twitch tension elicited by indirect stimulation (P<0.01) less intensely in the septic group than in the sham group (P<0.01). The antagonistic actions of the anti‐ChE drugs on dTc (1 μM)‐induced twitch depression were less intense in the septic group (P<0.01 or 0.05).Conclusion: These results demonstrate that sepsis in the acute phase attenuates the effects of a neuromuscular blocker and anti‐ChE drugs and depresses muscle contractility simultaneously.
The effect of ketamine on clinical endpoints of hypnosis and EEG variables during propofol infusion
Authors: Sakai T. , Singh H. , Mi W. D. , Kudo T. , Matsuki A. 
Published: March 2003

Background: We studied the effect of variable doses of ketamine on the endpoints of hypnosis, e.g., unresponsiveness to verbal commands (UVC), loss of eyelash reflex (LER), and inhibition of body movement response with or without sneezing to nasal membrane stimulation (INBMR), and processed EEG variables, e.g., bispectral index (BIS), 95% spectral edge frequency (SEF) and median frequency (MF) during propofol infusion.Methods: Forty‐eight patients received either propofol infusion, 30 mg · kg−1 · h−1 (Group P; n=12) or ketamine bolus, 0.25, 0.5 or 0.75 mg i.v., followed by propofol infusion, 30 mg · kg−1 · h−1+variable dose ketamine infusion, 0.25, 0.5 or 0.75 mg · kg−1 · h−1 (Groups PK0.25, PK0.5 and PK0.75; n=12 each) until UVC, LER and INBMR. BIS, 95% SEF and MF values were monitored and recorded at the endpoints of hypnosis. Propofol and ketamine concentrations were measured at INBMR.Results: Propofol infusion, 30 mg · kg−1 · h−1, induced UVC, LER and INBMR at BIS: 65±2, 63±9 and 33±7; 95% SEF: 17±3, 17±4 and 14±3; and MF values of 5±2, 5±3 and 3±2, respectively. With adjunctive ketamine (Groups PK0.5 and PK0.75), the hypnotic endpoints were achieved at higher BIS and 95% SEF values and lower propofol doses and concentrations as compared to Groups P and PK0.25 (9.9±5.8 and 9.4±3.4 vs. 13.4±4.5 and 14±5.8 μg · ml−1).Conclusions: Our results suggest additive interaction between propofol and ketamine (Groups PK0.5 and PK0.75) for achieving the hypnotic endpoints; however, ketamine did not depress the EEG variables in proportion to its hypnotic effect. The paradoxically higher BIS and 95% SEF values at the hypnotic endpoints may be due to lower propofol concentrations and/or no effect of ketamine on the EEG variables.
Lack of pre‐emptive analgesic effect of (R)‐ketamine in laparoscopic cholecystectomy
Authors: Mathisen L. C. , Aasbø V. , Ræder J. 
Published: March 2003

Aim: This study evaluated the pre‐emptive analgesic effect of intravenous (i.v.) (R)‐ketamine in laparoscopic cholecystectomy. (R)‐ketamine was used due to the lower incidence of side‐effects.Methods: Sixty patients who underwent surgery under general anesthesia were randomly allocated to 3 groups and studied in a double‐blind manner. Two i.v. injections were administered: one after induction of anesthesia, approximately 3 min before surgery, and one after surgery. The placebo group (PLA, n=20) received saline in both injections. The preoperative group (PRE, n=20) received (R)‐ketamine 1 mg/kg and then saline. The postoperative group (POST, n=20) received saline and then (R)‐ketamine 1 mg/kg. Postoperatively, the patients used a patient‐controlled analgesia (PCA) pump. Pain was evaluated with a visual analog scale (VAS) at 30 min and every hour for 4 h and with a verbal rating scale (VRS) at 24 h and after 7 days.Results: There were no occurence of side‐effects from (R)‐ketamine. VAS and VRS at 1, 2, 3, and 4 h postoperatively showed no statistical differences. In the POST group, extubation was delayed and pain score (VAS) at 30 min postoperatively was significantly lower (P<0.05) than the two other groups. There were no statistical differences in meperidine consumption during the first 4 h postoperatively and no differences in consumption of analgesics at 24 h and 7 days.Conclusion: In this study a 1 mg/kg dose of (R)‐ketamine given at the end of surgery exerted a short‐lasting hypnotic and analgesic effect. The same dose given preoperatively did not show postoperative analgesic effect or pre‐emptive effect.
Paraplegia after thoracotomy – not caused by the epidural catheter
Authors: Løvstad R. Z. , Steen P. A. , Forsman M. 
Published: March 2003

Background: Paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used.Case report: A 56‐yr‐old woman, with Bechterev disease but otherwise healthy, was operated with left‐sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid‐thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 μg/ml fentanyl and 2 μg/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. Laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later.Conclusions: This case shows – once again – that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.
A simplified method for separate measurements of lung and chest wall mechanics in ventilator‐treated patients
Authors: Kárason S. , Karlsen K. L. , Lundin S. , Stenqvist O. 
Published: March 2003

Background: Airway pressure measurements above the endotracheal tube will be distorted because of endotracheal tube resistance. To separate lung and chest wall compliance, esophageal pressure is conventionally measured with an air‐filled balloon catheter, which is difficult to insert in unconscious patients. We have developed a methodology with fluid‐filled catheters for intratracheal and esophageal pressure measurements.Methods: Twelve anesthetized patients were studied. Tidal volumes were measured by side‐stream spirometry. Airway pressures were measured at the Y‐piece and in the trachea with fluid‐filled pressure lines. Esophageal pressure was measured via the narrow lumen in a fluid‐filled SalemTM double‐lumen stomach tube, which was slowly retracted from the stomach up through the esophagus until maximal respiratory pressure readings and minimal cardiac artifacts were obtained. Lung mechanics were measured at different tidal volumes (TV) and positive end‐expiratory pressure (PEEP).Results: There was a significant difference between airway pressures at the Y‐piece and in the trachea. Total compliance significantly increased with increasing TV and decreased with increasing PEEP. Chest wall compliance increased significantly with increasing TV, while lung compliance did not change significantly. Two patients showed repeatedly marked increase in lung compliance at one specific ventilatory setting, an increase the proportion of which was not reflected by changes in total compliance.Conclusions: Y‐piece pressures are not representative of intratracheal pressures, which can be measured by inserting a fluid‐filled pressure line through the tube. Esophageal pressure is easily recorded with a fluid‐filled SalemTM double‐lumen catheter. Large changes in lung compliance may pass unnoticed when only total compliance is monitored. Monitoring of lung compliance may offer an improved basis for decisions about ventilator settings.
The effect on intraocular pressure of endotracheal intubation or laryngeal mask use during TIVA withoutthe use of muscle relaxants
Authors: Kiliçkan L. , Baykara N. , Gürkan Y. , Toker K. 
Published: March 2003

Background: Depolarizing and non‐depolarizing muscle relaxants possess many untoward side effects. In most patients endotracheal intubation may be performed with a propofol and alfentanil combination. The purpose of this study was to compare the effect on intraocular pressure (IOP) and haemodynamics of endotracheal (ET) intubation or laryngeal mask (LMA) insertion during total intravenous anaesthesia (TIVA) without the use of muscle relaxants.Methods: In a randomised study, 20 patients scheduled for elective orthopaedic surgery were assigned to two groups of 10 patients. Anaesthesia was induced with i.v. alfentanil 40 μg/kg and propofol 2.5 mg/kg. LMA insertion or ET intubation was achieved by the same anaesthesiologist. Airway score, insertion score, patient response and haemodynamics were recorded. IOP measurements were recorded before and after induction, 1 and 2 min after ET intubation or LMA insertion, and 1 and 2 min after extubation.Results: Mean arterial pressure and heart rate after insertion of the airway management devices was significantly higher than induction values in the ET group (P<0.05), while during 2–3 min no significant changes were observed in LMA group. In all patients following propofol and alfentanil induction, IOP was significantly lower than preinduction values (P<0.001). IOP following extubation was significantly higher than preinduction values in the ET group, but not in the LMA group (P<0.001).Conclusion: During TIVA without the use of muscle relaxants neither LMA insertion nor ET intubation increased the IOP, but ET extubation did.
Effects of sevoflurane and isoflurane anesthesia on arterial ketone body ratio and liver function
Authors: Nishiyama T. , Yokoyama T. , Hanaoka K. 
Published: March 2003

Background: The purpose of this study was to compare the effect on arterial ketone body ratio (AKBR), which indicates hepatic mitochondrial energy charge in relation to hepatic blood flow, and liver function test (serum levels of liver enzymes) between sevoflurane and isoflurane anesthesia.Methods: Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alkaline phosphatase (ALP), γ‐glutamyl transpeptidase (GTP), and lactate dehydrogenase (LDH) were measured before and 1, 2, 3, 7, and 14 days after anesthesia in each of 60 patients receiving either sevoflurane or isoflurane anesthesia for neurosurgery (tumor resection). In 13 patients of both groups, arterial concentrations of acetoacetate and 3‐hydroxybutyrate were also measured before, during and after (up to 12 h) anesthesia and the AKBR was calculated.Results: AST, ALT and GTP increased, peaking 7 days after anesthesia, especially in the isoflurane group. There was a significantly greater number of patients with abnormal AST and ALT values in the isoflurane group than in the sevoflurane group. The increase of TBil had its peak 1 day after anesthesia in both groups. AKBR decreased after anesthesia induction and recovered to the control value 12 h after anesthesia in both groups. There was no difference between the two anesthetic groups in AKBR.Conclusion: Isoflurane induced an elevation of serum levels of liver enzymes more frequently than did sevoflurane 3 to 14 days after anesthesia, while AKBR until 12 h after anesthesia did not show any significant difference between sevoflurane and isoflurane anesthesia.
Focus on mobilisation after lower abdominal surgery. A double‐blind randomised comparison of epidural bupivacaine with morphine vs. lidocaine with morphine for postoperative analgesia
Authors: Rygnestad T. , Zahlsen K. , Bergslien O. , Dale O. 
Published: March 2003

Background: Epidural infusion of morphine, usually with bupivacaine, for postoperative pain relief has proved to be safe and effective. Lidocaine with its short duration of action and low toxicity may be an alternative to bupivacaine. The clinical importance of the choice of local anaesthetic drug on mobilisation after lower abdominal surgery has not been studied previously.Methods: A total of 52 patients was randomised to epidural infusion of morphine (1.6–4.4 μg  ·  kg−1  ·  h−1) with either lidocaine (0.44–0.98 mg  ·  kg−1  ·  h−1) or bupivacaine (0.10–0.28 mg  ·  kg−1  ·  h−1) in a double‐blind fashion. The time to mobilisation, degree of pain relief, blood pressure, respiration and motor function were recorded at regular intervals postoperatively for 40 h. Serum concentrations of lidocaine, its main metabolite monoethylglycinexylidide (MEGX) and bupivacaine were measured at 3, 15 and 40 h.Results: There were no significant differences in the clinical characteristics between the two patient groups. There were no significant differences in the time from the end of surgery to the time the patients were able to stand without support (bupivacaine: median 24 h (interquartile range (IQR): 22–31), lidocaine: median 28 h (IQR 23–40), P=0.15) or were able to walk without support (bupivacaine: median 46 h (IQR 28–62), lidocaine: median 48 h (IQR 35–54), P=0.78). No significant differences between the groups were recorded with respect to pain relief, blood pressure, respiration, sedation score and motor function. The plasma concentration of lidocaine and bupivacaine increased significantly during the treatment period (P<0.01 for both drugs), but not the concentration of MEGX. The highest venous lidocaine concentration was 17.5 μmol/l and the highest bupivacaine concentration was 18.8 μmol/l. There was a significant correlation between the concentration of both lidocaine and bupivacaine and the concentration of α1‐acid glycoprotein (AAG) (lidocaine: r=0.77, P<0.001, bupivacaine: r=0.60, P<0.001), suggesting that the free fraction of the drugs did not increase. No patients showed serious signs of toxicity. The epidural infusion rates remained stable in both groups during the study period.Conclusion: There were no clinically or statistically significant differences in the postoperative course after lower abdominal surgery in patients who received an epidural infusion of morphine combined with bupivacaine as compared to patients who received morphine with lidocaine. Further clinical studies to establish the place of lidocaine in postoperative epidural analgesia should be performed.
Lumbar versus thoracic epidural buprenorphine for postoperative analgesia following coronary artery bypass graft surgery
Authors: Mehta Y. , Juneja R. , Madhok H. , Trehan N. 
Published: March 2003

Background: Thoracic epidural analgesia (TEA) is reported to provide effective analgesia following cardiac surgery. We compared the effect of buprenorphine (BN) through the lumbar and thoracic epidural routes for postoperative analgesia following coronary artery bypass graft surgery (CABG).Methods: Forty patients with normal left ventricular ejection fraction scheduled for CABG were randomly divided into two groups, the TEA group (n=19) and the lumbar epidural analgesia (LEA) group (n=20). For postoperative pain relief they received epidural BN 0.15 mg at the first demand for pain relief following extubation. A top‐up dose of BN 0.15 mg was administered in cases where visual analogue scale (VAS) score was >3 at 1 h after first dose. Subsequent breakthrough pain was treated with 30 mg intramuscular ketorolac tromethamine (ketorolac). Pain assessed by VAS score on a 0–10 scale, respiratory rate, FEV1, FVC, mean arterial blood pressure, cardiac index, PaO2 and PaCO2 were measured at frequent intervals. Side effects of epidural opioids were noted.Results: Both groups were comparable in demographic characteristics, had similar VAS scores from 1 to 24 h postoperatively, required similar amounts of intramuscular ketorolac for breakthrough pain and had comparable pulmonary functions and side effects.Conclusion: This study shows that BN by the lumbar epidural route for analgesia after CABG compares favourably with the same drug through the thoracic route in terms of quality of analgesia and incidence of side effects.