bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrathecal adenosine increases spinal cord blood flow in the rat: measurements with the laser‐Doppler flowmetry technique
Authors: Rane K. , Segerdahl M. , Karlsten R. 
Published: October 2004

Background:  Adenosine and adenosine analogues induce antinociception both after systemic and intrathecal (i.t.) administration in animal models. Further, patients with neuropathic pain have been treated successfully with i.t. adenosine. Prior to introducing new analgesic drugs for regular spinal use in humans, experimental studies must be undertaken to evaluate the risks of neurotoxicity. It is important to evaluate the possibility of cytotoxic effects and that antinociception may be due to decreased spinal cord blood flow (SCBF) and neural ischaemia. The present study evaluates whether adenosine or isotonic mannitol induces changes in SCBF as assessed by laser‐Doppler flowmetry (LDF).Methods:  After laminectomy and insertion of i.t. catheters, seven rats received adenosine 50 μg in isotonic mannitol 500 μg, six rats received isotonic mannitol 500 μg and eight rats received saline 0.9%. SCBF was registered by the LDF technique continuously for 3 h after injection. Arterial blood pressure was also assessed.Results:  In the adenosine in mannitol group, SCBF increased up to 230% of baseline levels for almost 40 min, P = 0.044 and then declined. In the mannitol group, SCBF increased up to 180% of baseline (P < 0.011) before declining. At 60 min, SCBF had returned to saline levels and remained stable during the rest of the experiment.Conclusion:  Intrathecal administration of adenosine in mannitol and of mannitol both increased SCBF in rats, compared with saline. It is unlikely that the effects on SCBF induced by adenosine and mannitol could result in neurotoxicity of the spinal cord.
Low‐dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients
Authors: Olofsson C. , Nygårds E‐B. , Bjersten A‐B. , Hessling A. 
Published: October 2004

Background:  Hip fracture is common in the geriatric population. Patients in this group are often at high risk for perioperative complications from concurrent diseases. Conventional spinal anesthesia can be associated with hypotension but has a better postoperative outcome compared to general anesthesia. We judged that a reduced dose of bupivacaine in combination with sufentanil could give reliable blocks with minimal hypotension.Methods:  Fifty elderly patients were randomized into two groups. The study group received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and sufentanil 5 µg while the control group received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared.Results:  All patients had adequate duration of reliable blocks. More control group patients than study group patients required ephedrine due to hypotension.Conclusion:  A reduced dose of hyperbaric bupivacaine (7.5 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for the repair of hip fracture in aged patients with few events of hypotension and little need for vasopressor support of blood pressure.
Effects of subanaesthetic and anaesthetic doses of sevoflurane on regional cerebral blood flow in healthy volunteers. A positron emission tomographic study
Authors: Schlünzen L. , Vafaee M. S. , Cold G. E. , Rasmussen M. , Nielsen J. F. , Gjedde A. 
Published: October 2004

Background:  We tested the hypothesis that escalating drug concentrations of sevoflurane are associated with a significant decline of cerebral blood flow in regions subserving conscious brain activity, including specifically the thalamus.Methods:  Nine healthy human volunteers received three escalating doses using 0.4%, 0.7% and 2.0% end‐tidal sevoflurane inhalation. During baseline and each of the three levels of anaesthesia one PET scan was performed after injection of . Cardiovascular and respiratory parameters were monitored and electroencephalography and bispectral index (BIS) were registered.Results:  Sevoflurane decreased the BIS values dose‐dependently. No significant change in global cerebral blood flow (CBF) was observed. Increased regional CBF (rCBF) in the anterior cingulate (17–21%) and decreased rCBF in the cerebellum (18–35%) were identified at all three levels of sedation compared to baseline. Comparison between adjacent levels sevoflurane initially (0 vs. 0.2 MAC) decreased rCBF significantly in the inferior temporal cortex and the lingual gyrus. At the next level (0.2 MAC vs. 0.4 MAC) rCBF was increased in the middle temporal cortex and in the lingual gyrus, and decreased in the thalamus. At the last level (0.4 MAC vs. 1 MAC) the rCBF was increased in the insula and decreased in the posterior cingulate, the lingual gyrus, precuneus and in the frontal cortex.Conclusion:  At sevoflurane concentrations at 0.7% and 2.0% a significant decrease in relative rCBF was detected in the thalamus. Interestingly, some of the most profound changes in rCBF were observed in structures related to pain processing (anterior cingulate and insula).
Women report more pain on injection of a precurarization dose of rocuronium: A randomized, prospective, placebo‐controlled trial
Authors: Mencke T. , Schreiber J. U. , Knoll H. , Stracke C. , Kleinschmidt S. , Rensing H. , Silomon M. 
Published: October 2004

Background:  The purpose of this study was to investigate whether gender influences the perception of pain on injection of rocuronium.Methods:  In this prospective, placebo‐controlled trial 120 patients were randomized into four groups to receive rocuronium 0.03 mg kg−1 (40 female and 40 male patients) or saline (20 female and 20 male patients). The incidence and severity of the injection pain after administration of the study drug was compared between female and male patients using a numerical rating scale (0–10). Signs of local irritation, i.e. erythema and thrombophlebitis, were assessed up to 48 h after surgery.Results:  In 26 (32.5%) of the 80 patients receiving rocuronium, pain on injection was observed. This occurred significantly more frequently in the female compared with male patients: 18 (45%) vs. eight (20%), respectively (P = 0.032). The severity was more pronounced in the women than in the men (P = 0.020). The incidence of the rocuronium‐associated pain was significantly increased compared with the Saline groups (P < 0.001). After surgery no patient complained of any residual pain and no local signs were observed in any patient during the study period.Conclusions:  Women experienced more pain on injection of rocuronium than men, moreover this is an additional evidence for gender‐related differences in pain perception. When rocuronium is used as a precurarization agent, an analgesic pretreatment (e.g. opioids) should be considered, especially for female patients.
Further commentary on Denmark's 1952–53 poliomyelitis epidemic, especially regarding mortality; with a correction
Authors: Trubuhovich R. V. 
Published: October 2004

Berthelsen and Cronqvist recently published an article in Acta Anaesthesiologica Scandinavica including aspects which could lead on to further discussion about the Danish 1952–53 poliomyelitis epidemic. This paper considers how Bjørn Ibsen's initial approach to treatment during the epidemic was successful, as well as how it could have failed; the roles played by ventilatory failure vs. gross neurologic destruction in causing deaths; and compilations from publications of statistics concerning mortality of the epidemic.The Blegdam Hospital concept of ‘life‐threatening poliomyelitis’ is revisited, along with its division into six anatomico‐clinical categories for the 345 patients so classified. Attention is drawn to the severity of assorted cerebral lesions demonstrated in 114 of the 115 autopsies conducted from the 144 fatal cases. Despite an overall mortality rate of 41.6% among the entire epidemic's sickest patients, a lowest mortality rate of 11% in the last 18 of such patients is identified. Note is made of the difficulty in reconciling various sources for certain features – for which the 1956 book on the epidemic, edited by H.C.A. Lassen, has been freely used. Some folklore about aspects of management is mentioned.In the light of other recent research by Dr Berthelsen an essential correction is needed in dating ‘Bjørn Ibsen's Day', amending 26 August 1952 to the 27th.
Thermodilution cardiac output – are three injections enough?
Authors: Nilsson L. B. , Nilsson J. C. , Skovgaard L. T. , Berthelsen P. G. 
Published: October 2004

Background:  Bolus thermodilution cardiac output measurements have been a mainstay in clinical monitoring of critically ill patients for more than 30 years. Usually the results of an arbitrarily chosen number (1–6) of thermal indicator injections are averaged to increase the reliability of the measurement. The number of injections needed to achieve a given level of precision has, however, not previously been systematically investigated.Methods and results:  In 80 hemodynamically stable patients cardiac output was determined as the average of eight injections of 10 ml of iced saline. From the 638 measurements we examined the relationship between the number of thermal indicator injections and the precision of the resulting cardiac output estimate. Furthermore, the association between the number of injections and the least detectable difference among two sets of measurements was established.Conclusion:  The current study shows that one needs to average the results of four injections to be 95% confident that the result is within 5% of the ‘true’ cardiac output and that two series of four measurements have to differ by at least 7% before one can be sure (95%) that a change in cardiac function has taken place.
The 118 A > G polymorphism in the human µ‐opioid receptor gene may increase morphine requirements in patients with pain caused by malignant disease
Authors: Klepstad P. , Rakvåg T. T. , Kaasa S. , Holthe M. , Dale O. , Borchgrevink P. C. , Baar C. , Vikan T. , Krokan H. E. , Skorpen F. 
Published: October 2004

Background:  Dispositions for genes encoding opioid receptors may explain some variability in morphine efficacy. Experimental studies show that morphine and morphine‐6‐glucuronide are less effective in individuals carrying variant alleles caused by the 118 A > G polymorphism in the µ‐opioid receptor gene (OPRM1). The purpose of the study was to investigate whether this and other genetic polymorphisms in OPRM1 influence the efficacy of morphine in cancer pain patients.Methods:  We screened 207 cancer pain patients on oral morphine treatment for four frequent OPRM1 gene polymorphisms. The polymorphisms were the −172 G > T polymorphism in the 5′untranslated region of exon 1, the 118 A > G polymorphism in exon 1, and the IVS2 + 31 G > A and IVS2 + 691 G > C polymorphisms, both in intron 2. Ninety‐nine patients with adequately controlled pain were included in an analysis comparing morphine doses and serum concentrations of morphine and morphine metabolites in the different genotypes for the OPRM1 polymorphisms.Results:  No differences related to the −172 G > T, the IVS2 + 31 G > A and the IVS2 + 691 G > C polymorphisms were observed. Patients homozygous for the variant G allele of the 118 A > G polymorphism (n = 4) needed more morphine to achieve pain control, compared to heterozygous (n = 17) and homozygous wild‐type (n = 78) individuals. This difference was not explained by other factors such as duration of morphine treatment, performance status, time since diagnosis, time until death, or adverse symptoms.Conclusion:  Patients homozygous for the 118 G allele of the µ‐opioid receptor need higher morphine doses to achieve pain control. Thus, genetic variation at the gene encoding the µ‐opioid receptor contributes to variability in patients' responses to morphine.
Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indices
Authors: Jensen E. W. , Litvan H. , Struys M. , Vazquez P. Martinez 
Published: October 2004

The objective of this article was to review the present methods used for validating the depth of hypnosis. We introduce three concepts, the real depth of hypnosis (DHreal), the observed depth of hypnosis (DHobs), and the electronic indices of depth of hypnosis (DHel‐ind). The DHreal is the real state of hypnosis that the patient has in a given moment during the general anaesthesia. The DHobs is the subjective assessment of the anaesthesiologist based on clinical signs. The DHel‐ind is any estimation of the depth of hypnosis given by an electronic device. The three entities DHreal, DHobs and DHel‐ind should in the ideal situation be identical. However, this is rarely the case. The correlation between the DHobs and the DHel‐ind can be affected by a number of factors such as the stimuli used for the assessment of the level of consciousness or the administration of analgesic agents or neuro muscular blocking agents. Opioids, for example, can block the response to tactile and noxious stimuli, and even the response to verbal command could vanish, hence deeming the patient in a lower depth of hypnosis than the real patient state. The DHel‐ind can be disturbed by the presence of facial muscular activity.In conclusion, although several monitors and clinical scoring scales are available to assess the depth of hypnosis during general anaesthesia, care should be taken when interpreting their results.
Adverse biochemical and physiological effects of prostacyclin in experimental brain oedema
Authors: Gärdenfors F. , Nilsson A. , Ungerstedt U. , Nordström C. H. 
Published: October 2004

Background:  Prostacyclin (PGI2) and its stable analogues are known to reduce capillary hydraulic permeability. This study explores the biochemical and physiological effects of i.v. infusion of low‐dose PGI2 in an experimental model of vasogenic brain oedema.Methods:  Twenty‐seven anaesthetized and mechanically ventilated piglets with brain oedema induced by intrathecal injection of lipopolysaccharide (LPS) were used. Five of the animals received a continuous infusion of PGI2 (1 ng kg−1 min−1) i.v. Four microdialysis catheters were placed in the brain to measure interstitial concentrations of glucose, lactate, and glycerol. Mean arterial pressure (MAP), intracranial pressure (ICP) and temperature were monitored continuously. Low‐dose infusion of PGI2 started 1 h before the LPS injection and was constant during the study period.Results:  Intracranial pressure increased significantly in animals treated with PGI2. The increase in ICP was associated with significant cerebral biochemical changes: decrease in glucose, increase in lactate, increase in lactate/glucose ratio and increase in glycerol.Conclusion:  In LPS‐induced brain oedema i.v. infusion of low‐dose PGI2 caused a further increase in ICP and a perturbation of energy metabolism, indicating cerebral ischemia and degradation of cellular membranes.
Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide
Authors: Karanovic N. , Jukic M. , Carev M. , Kardum G. , Dogas Z. 
Published: October 2004

Background:  The oculocardiac reflex (OCR) may be activated during squint surgery. The aim of this study was to test whether rocuronium 0.4 mg kg−1 could reduce the frequency of OCR, and also whether a single dose of succinylcholine 1 mg kg−1 could affect the frequency of OCR during anesthesia with halothane in a nitrous oxide/oxygen mixture.Methods:  A total of 161 ASA I children, 3–10 years old, undergoing elective surgery of the medial rectus muscle (MRM) were randomly assigned to three groups. Group R (n = 51), received 0.4 mg kg−1 of rocuronium intravenously before endotracheal intubation. Group S (n = 58) received 1 mg kg−1 of succinylcholine. Group C (controls, n = 52) received no relaxant. Oculocardiac reflex was defined as a reduction in heart rate (HR) >= 15% and/or the appearance of any other arrhythmias, during manipulation of the MRM. Analysis of variance (anova), chi‐squared, Kruskal–Wallis, and Student's t‐tests were used for statistical analysis; P< 0.05 was considered statistically significant.Results:  In group R, OCR occurred in 15/51 (29%) of children, in group S in 31/58 (53%), and in group C in 23/52 (44%) (χ2 = 6.46, P = 0.049). In group R, the incidence of arrhythmias such as nodal rhythms, supraventricular and ventricular premature beats was 6%, compared with 22% in group S and 19% in group C (χ2 = 6.01, P = 0.040). However, there was no reduction in the occurrence of bradycardia (χ2 = 0.16, P = 0.924).,Conclusion:  Rocuronium reduced the frequency of OCR, mainly by reducing the incidence of supraventricular and ventricular premature beats.
Comparison of the analgesic efficacy of ketobemidone and morphine for management of postoperative pain in children: a randomized, controlled study
Authors: Jylli L. , Lundeberg S. , Langius‐Eklöf A. , Olsson G. L. 
Published: October 2004

Background:  Ketobemidone has been used as an analgesic for postoperative pain in children, but to our knowledge the effect and occurrence of adverse effects of ketobemidone compared to morphine is not known. The aim was to determine if the analgesic potency and the occurrence of adverse effects of ketobemidone differ from morphine when administered to children, as measured by patient‐controlled analgesia consumption (PCA) for postoperative pain.Methods:  Sixty healthy children, aged 6 to 16 years, scheduled for elective surgery were randomized to receive either ketobemidone (Ke) 1 mg ml−1 or morphine (Mo) 1 mg ml−1 for postoperative pain through PCA. Drug consumption (µg kg−1 h−1), the number of PCA doses, pain intensity, and adverse effects were recorded at regular intervals.Results:  Data on total drug consumption were based on 26 children in the Ke group and 28 in the Mo group. A non‐statistically significant difference for total mean consumption of ketobemidone (18.6 µg kg−1h−1) and morphine (23.2 µg kg−1h−1) was obtained. The mean dose ratio (Mo/Ke) was 0.80 and the median was 0.94. Children's characteristics, loading dose, PCA doses, VAS scores, and adverse effects showed no significant differences between the groups.Conclusion:  The analgesic potency and adverse effects of ketobemidone are similar to morphine when used for postoperative pain management in children.
Dixyrazine for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy
Authors: Glaser C. , Sitzwohl C. , Wallner T. , Lerche A. , Marhofer P. , Schindler I. 
Published: October 2004

Background:  The study assessed the efficacy and safety of dixyrazine, an alternative neuroleptic drug to droperidol, in the prophylaxis of postoperative nausea and vomiting (PONV).Methods:  A total of 197 patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomized to receive either dixyrazine 10 mg or placebo double‐blinded at the end of surgery. Scores pertaining to PONV episodes, analgetic supply, rescue medication, adverse events and patient satisfaction were collected over the first 2 h in the PACU and the next 22 h in the ward.Results:  The incidence of PONV over the entire 24‐h period was reduced from 32% in the placebo group to 13% in the dixyrazine group (P≤0.004). The incidence of nausea in the first 2 h was reduced from 15% in the placebo group to 4% in the dixyrazine group (P≤0.02) and from 12% to 5% in the next 22 h. The incidence of emetic episodes was not different between the two groups. Postoperative shivering was significantly less prevalent in the dixyrazine than in the placebo group (2% vs. 13%; P≤0008), and opioid analgesics were required significantly less often (61% vs. 75%; P≤0,01). No significant adverse effects were observed. Patient satisfaction was similar in both groups.Conclusion:  Prophylactic dixyrazine is an effective, safe, and cheap antiemetic drug for laparoscopic cholecystectomy without involving any significant adverse events.
Betamethasone does not prevent nausea and vomiting induced by ipecacuanha
Authors: Axelsson P. , Thörn S. E. , Wattwil M. 
Published: October 2004

Background:  Corticosteroids reduce the incidence of PONV but the mode of action is not known. The purpose of this study was to evaluate if betamethasone has serotonin (5‐HT) antagonistic effects. Ipecacuanha is known to release serotonin and therefore it was used to induce nausea and vomiting. The 5‐HT3 antagonist ondansetron was used as a control substance.Methods:  In a randomized, double‐blind, cross‐over, placebo‐controlled study 10 healthy male and female volunteers (6 M/4F), mean age 19.5 (18–23) years, mean weight 69.7 (53–84) kg, were studied on three occasions separated by at least 1 week. They were randomly allocated to receive pretreatment with betamethasone 8 mg, ondansetron 8 mg, or normal saline 2 ml as placebo on each occasion, 15 min before oral ingestion of 30 ml of Ipecacuanha syrup. After ingestion of ipecacuanha, vomitings were recorded and the intensity of nausea was estimated with a visual analog scale during 2 h.Results:  During the first 2 h after ingestion of ipecacuanha nine of the 10 volunteers vomited both after betamethasone and placebo. No volunteer vomited after ondansetron (P < 0.01 vs. betamethasone and placebo). The max VAS for nausea was significantly higher after betamethasone and placebo compared to ondansetron (P < 0.01). There were no statistically significant differences of the max VAS for nausea between betamethasone and placebo.Conclusion:  This study in volunteers has shown that betamethasone does not prevent nausea and vomiting induced by oral intake of ipecacuanha syrup. As ipecacuanha releases 5‐hydroxytryptamin, it can be concluded that betamethasone does not have 5‐HT3 antagonistic effects.
Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication
Authors: Malmgren W. , Åkeson J. 
Published: October 2004

Background:  Sevoflurane is a rapid‐acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator‐blinded study was designed to evaluate whether premedication with an opioid might reduce non‐divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane.Methods:  Ninety‐two healthy two to six year‐old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg−1 together with either morphine 0.15 mg kg−1 or midazolam 0.30 mg kg−1 approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre‐ and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS.Results:  There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward.Conclusion:  In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia.