bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single‐injection paravertebral block compared to general anaesthesia in breast surgery
Authors: Pusch F. , Freitag H. , Weinstabl C. , Obwegeser R. , Huber E. , Wildling E. 
Published: March 2003

Background: Breast surgery is frequently associated with postoperative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anaesthesia for this type of surgery. We studied the single‐injection paravertebral block at the level of T4 and report a comparison of single‐injection paravertebral block to general anaesthesia for breast surgery.Methods: After written informed consent was obtained, 86 patients were enrolled in this prospective study. Forty‐four women were randomly allocated to receive a single‐injection paravertebral block at the level of T4, while 42 women received general anaesthesia. The surgical procedures varied from lumpectomy (wide local excision of a tumour) to modified radical mastectomy with axillary dissection. The block was performed according to the guidelines described by Eason and Wyatt using 0.3 ml  ·  kg−1 (maximum dose 150 mg) of bupivacaine 0.5%. The skin and the underlying tissues were infiltrated with local anaesthetic solution two fingers (about 3 cm) from the anatomical midline and level with the cephalad end of the vertebral spine.Results: Time for performance of blocks lasted from 4 to 9 min. Recovery from anaesthesia or sedation was shortened, while postoperative pain scores (VAS), the incidence of vomiting and the requirement for analgesics were lower in the paravertebral group. Less painful restricted movement was observed in the paravertebral block group. Paravertebral block was inadequate in 6.8% of patients. Epidural spread with paraparaesis and Horner triad was assumed in one patient.Conclusion: Single‐injection paravertebral block at the level of T4 represents a suitable alternative to general anaesthesia in women undergoing breast surgery.
Intravenous ketoprofen and epidural sufentanil analgesia in children after combined spinal‐epidural anaesthesia
Authors: Kokki H. , Tuovinen K. , Hendolin H. 
Published: March 2003

Background: Epidural opioid analgesia has become more popular for postoperative pain treatment in children. Epidural opioids are associated with adverse effects such as respiratory depression, excessive sedation, protracted vomiting, urinary retention and pruritus. Following minor surgery, ketoprofen has a synergistic effect with opioids, resulting in an improved analgesia without increase in incidence of adverse effects. To see whether this is also true following major surgery, we compared the effect of i.v. ketoprofen and placebo as an adjuvant to epidural sufentanil analgesia.Methods: A prospective, randomised, double‐blind, placebo‐controlled, parallel‐group study design was used in 58 children, aged 1–15 years, receiving a standardised combined spinal‐epidural anaesthesia. Intravenous ketoprofen or saline was provided as a bolus and a continuous infusion in addition to epidural sufentanil infusion, which was adjusted as clinically required. Epidural bupivacaine was used for rescue analgesia. The study drug infusion was discontinued when pain scores were <3 on a 0–10 scale for 6 h with an epidural sufentanil infusion rate of 0.03 μg kg−1 h−1.Results: Children in the ketoprofen group received less rescue analgesia (none/29 vs. 8/29 children in the placebo group). In the ketoprofen group, criteria to discontinue epidural sufentanil were achieved more often (14 vs. 6 children) before the end of the 72 h study period. Less children in the ketoprofen group suffered pruritus (13 vs. 4). The incidence of nausea/retching and vomiting was similar (11 vs. 12) in both groups.Conclusion: In this study, ketoprofen as a background analgesic to epidural sufentanil provided improved postoperative analgesia and reduced incidence of adverse effects of the epidural opioid.
Combination of intra‐articular tenoxicam, lidocaine, and pethidine for outpatient knee arthroscopy
Authors: Elhakim M. , Nafie M. , Eid A. , Hassin M. 
Published: March 2003

Background: Studies of intra‐articular non‐steroidal anti‐inflammatory drugs have revealed an analgesic effect equivalent to that of intra‐articular local anaesthetic agents and morphine. The aim of this study was to evaluate the analgesic effect of intra‐articular lidocaine, pethidine and tenoxicam compared with that of lidocaine and pethidine on postoperative pain after arthroscopy.Methods: After day‐case knee arthroscopy, 60 patients were randomly allocated to one of three groups to receive 20 ml of a solution containing 0.9% saline (group S), 2% lidocaine and 10 mg preservative‐free pethidine (group LP) and 2% lidocaine, 10 mg preservative‐free pethidine and 20 mg tenoxicam (group LPT). Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements.Results: Pain scores were significantly lower in the LP group than in the S group at 1 and 2 h after surgery. From 4 h until the end of the first postoperative day, pain scores were significantly lower in the LPT group of patients at rest and on knee flexion than in the other two groups; these patients also used less oral analgesics (P<0.05).Conclusion: The combination of 20 ml lidocaine 2%, 10 mg pethidine and 20 mg tenoxicam given intra‐articularly provided superior analgesia and reduced oral analgesic requirement during the first day after arthroscopy compared with lidocaine and pethidine alone.
Pneumoperitoneum in healthy humans does not affect central blood volume or cardiac output
Authors: Andersson L. , Wallin C‐J. , Sollevi A. , Odeberg‐Wernerman S. 
Published: March 2003

Background: This study addresses the question of whether the elevation of the mean arterial pressure and central venous pressure in response to pneumoperitoneum for laparoscopic surgery is caused by increases in central blood volume and/or cardiac output.Methods: Eleven patients in good cardiopulmonary health and scheduled for laparoscopic cholecystectomy, with a mean age of 42 years, were included. After induction of anaesthesia with fentanyl and propofol, radial arterial and central venous lines were introduced. The central blood volume and cardiac output were determined by the indicator‐dilution technique, using in‐line densitometric measurements of indocyanine green (ICG). The measurements were made before and after the establishment of pneumoperitoneum by insufflation of carbon dioxide to an intra‐abdominal pressure level of 11–13 mmHg.Results: The mean arterial pressure (62±6 mmHg) increased after induction of pneumoperitoneum by 40±26% (P<0.05) and the central venous pressure increased from 6±4 mmHg to 8±6 mmHg (P<0.05). The cardiac output (4.3±0.9 L/min) and central blood volume (1.5±0.5 L) were not affected by the induction of pneumoperitoneum.Conclusions: In healthy anaesthetized subjects, the elevation of mean arterial pressure and central venous pressure in response to pneumoperitoneum was not caused by enhancement in cardiac output or central blood volume.
Modified natural and synthetically reconstituted surfactant therapies for acute lung injury caused by endotoxin in rats
Authors: Tashiro K. , Nishizuka K. , Matsumoto Y. , Ohta K. , Suzuki Y , Kobayashi T. 
Published: March 2003

Background: Impairment of surfactant is involved in development of acute respiratory distress syndrome. To develop artificial surfactant substitute for clinical use, we prepared synthetically reconstituted surfactant (SRS) by adding porcine surfactant‐associated protein B and C (SP‐B and SP‐C) to synthetic phospholipids, and compared its effect with that of modified natural surfactant (MNS) in rats with acute lung injury caused by endotoxin.Methods: Escherichia coli endotoxin (71±18 mg · kg−1, mean±SD) was injected into the tracheas of 27 anesthetized and mechanically ventilated rats (FIO2 of 1.0). When the PaO2 had decreased to below 26.7 kPa, the rats were randomly assigned to three groups. The MNS and SRS groups (n=9, each) were given 100 mg · kg−1 of MNS and SRS through the airway, respectively. The control group (n=9) was given air in the same volume.Results: The PaO2 of the control group remained below 13.3 kPa until the end of the experiment (6 h after the assignment). The PaO2 of the MNS group increased to 45.3±9.5 kPa and that of the SRS group to 45.5±3.7 kPa 0.5 h after the assignment (P<0.05 vs. control group). The PaO2 of both groups remained above 40 kPa throughout the experiment.Conclusion: In this acute lung injury model, the effects of replacement therapy with surfactant consisting of synthetic phospholipids, SP‐B and SP‐C, were the same as those observed with MNS. These results warrant development of surfactant substitutes based on natural SP‐B and SP‐C, and synthetic phospholipids.
Hepatolobectomy‐induced depression of hepatic circulation and metabolism in the dog is counteracted by isoflurane, but not by halothane
Authors: Matsumoto N. , Koizumi M. , Sugai M. 
Published: March 2003

Background: The effects of isoflurane and halothane anesthesia on hepatic circulation and oxygen metabolism during hepatolobectomy were investigated in the dog, in an attempt to assess which of the anesthetics was the better one for hepatic resection.Methods: Mongrel dogs (n=24) were divided into two groups and accordingly anesthetized with isoflurane (n=12) or halothane (n=12). Each test anesthetic was administered in air. Electromagnetic flowmeters were used to measure hepatic arterial and portal venous blood flows 1) before the inhalation of each anesthetic (baseline); 2) 1 h inhalation of 1.5 MAC (minimum alveolar concentration) of each anesthetic; and 3) 1 h after hepatolobectomy with each anesthesia. Measurements of systemic hemodynamics, blood gas tensions, and the arterial ketone body ratio were made at the same time.Results: Isoflurane maintained portal venous, hepatic arterial and total hepatic blood flows better than halothane anesthesia before and after hepatolobectomy. With halothane anesthesia, hepatolobectomy decreased prominently hepatic arterial blood flow. Hepatic arterial and mesenteric vascular resistance increased in the halothane group, but remained constant in the isoflurane group after hepatolobectomy. Hepatic oxygen delivery was significantly suppressed in the halothane group, but did not change in the isoflurane group. No significant difference was found in hepatic oxygen consumption between the two groups, but the arterial ketone body ratio decreased significantly only in the halothane group before and after hepatolobectomy.Conclusion: The present data indicate that isoflurane has less adverse effect than halothane anesthesia on hepatic circulation, oxygen delivery and energy charge in hepatolobectomy cases.
The interaction of temperature with thiopental and etomidate on extracellular dopamine and glutamate levels in Wistar‐Kyoto rats subjected to forebrain ischemia
Authors: Lesser J. B. , Koorn R. , Vloka J. D. , Kuroda M. M. , Thys D. M. 
Published: March 2003

Background: Many studies demonstrate an association between brain damage and the extracellular release of catecholamines and amino acids during cerebral ischemia. While the clinical value of hypothermia during periods of compromised cerebral blood flow and oxygen delivery is well established, the role of anesthetic agents is less clear. Furthermore, the interaction between these agents and hypothermia remains to be elucidated. The purpose of this study was to examine the interactive effects of temperature, sodium thiopental (STP) and etomidate (ETOM) on extracellular neurotransmitter accumulation in the rat corpus striatum during cerebral ischemia.Methods: Animals were randomly assigned to one of six subgroups: normal saline (NS‐norm, pericranial t≈37°C, and NS‐hypo, t=30°C), etomidate (ETOM‐norm and ETOM‐hypo), and sodium thiopental (STP‐norm and STP‐hypo). Microdialysis probes were inserted into the corpus striatum. Dopamine (DA), glutamate, 3,4‐dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels were measured. At zero minutes, animals received a 10‐min infusion of STP (3 mg · kg−1 · min−1), ETOM (0.6 mg · kg−1 · min−1), or NS. Prior to ischemia, animals were given either intravenous STP (10 mg · kg−1), ETOM (3 mg · kg−1), or NS in bolus form. Each animal was then subjected to 10 min of forebrain ischemia (Is1) followed by a reperfusion interval (Rep1). The entire sequence was then repeated.Results: There were significant interactions between temperature and drug for DA (Is1, P=0.006, Is2, P=0.032) and its metabolites (DOPAC, Is1P=0.01, HVA, Is1P=0.03), and for glutamate (Is1, P=0.03, Is2P=0.06). The nature of this interaction differed for DA and glutamate. The reduction in DA accumulation seen during hypothermia was offset by the addition of either STP or ETOM, whereas the addition of these drugs did not affect the reduced glutamate levels seen with hypothermia. During normothermia, STP and ETOM resulted in diminished DA accumulation compared to controls, yet they increased the accumulation of extracellular glutamate.Conclusions:: Consistent with other studies, hypothermia was associated with diminished extracellular DA concentrations during forebrain ischemia. However, depending on the temperature condition, the addition of STP or ETOM in our forebrain ischemia model led to unexpected findings. The administration of these agents during normothermia diminished ischemia‐induced DA accumulation yet resulted in significantly higher concentrations of extracellular glutamate. In contrast, STP and ETOM during hypothermia were noted to significantly offset the DA‐reducing effects of hypothermia.
Effects of intrathecal morphine, clonidine and baclofen on allodynia after partial sciatic nerve injury in the rat
Authors: Hao J.‐X. , Xu I. S. , Xu X.‐J. , Wiesenfeld‐Hallin Z. 
Published: March 2003

Background: Increased response to mechanical or cold stimulation of hind paws was observed in rats with partial sciatic nerve injury as a result of photochemically induced ischemia. The present study examined the effects of intrathecal morphine, clonidine and baclofen on the allodynia‐like responses.Methods: The left sciatic nerves of rats were irradiated for 2 min with an argon ion laser under chloral hydrate anesthesia. The threshold of paw withdrawal to mechanical stimulation was determined with a series of monofilaments (von Frey hairs). The response to cold stimulation was tested by spraying ethyl chloride on the plantar surface of the paw. When rats were exhibiting stable mechanical and cold allodynia‐like behaviors after nerve injury, the effects of i.t. morphine (1, 2, 7 μg), clonidine (1, 2, 7 μg) and baclofen (0.1, 0.2, 0.7, 9 μg) in a cumulative dose regime were investigated.Results: Intrathecal morphine dose‐dependently alleviated the mechanical and cold allodynia without inducing motor impairment or sedation. Intrathecal clonidine did not alter the response of hind paws to mechanical stimulation, but reduced the cold allodynia. Intrathecal baclofen reduced the responses of rats to mechanical stimulation only at doses that also induced profound motor deficits.Conclusions: The present data suggest that intrathecal morphine, and to some extent clonidine, but not baclofen, alleviated the abnormal pain‐related behaviors in this new rat model of partial peripheral nerve injury. Differences in the pharmacological profile between the present model and other models of peripheral nerve injury are discussed.
Spinal cord morphology after chronic intrathecal administration of adenosine in the rat
Authors: Rane K. , Karlsten R. , Sollevi A. , Gordh Jr T. , Svensson B. A. 
Published: March 2003

Background: The endogenous compound adenosine is known to have various modulatory effects both in the peripheral and central nervous system. Adenosine and its analogues induce anti?no?ci?ception in animal models when administrated systemically and intrathecally (IT), both in acute and chronic models of pain. Before a new drug is introduced for spinal pain treatment in humans, experimental studies of neurotoxicity must be undertaken.Methods: This study was performed in rats in order to reveal morphological or morphometric signs of spinal cord damage after chronic (two weeks) administration of adenosine. After insertion of IT catheters, the animals were injected twice a day during two weeks with adenosine (100 μg) or saline (controls). Potential spinal neurotoxicity was evaluated morphologically by light and electron microscopy supplemented by a morphometric analysis.Results: There were no signs of histologic changes indicating neurotoxic effects by any of the methods of analysis. The morphological findings in the adenosine treated rats did not differ in any case from those of the saline treated animals.Conclusion: The results suggest that chronic IT administration of a high dose of adenosine is not associated with neurotoxicity in the rat spinal cord.
Day‐case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia
Authors: Salman M. A. , Ercan Yücebaş M. , Coşkun F. , Aypar Ü. 
Published: March 2003

Background: The study was aimed to evaluate the analgesic efficacy, postoperative comfort, recovery characteristics and side effects of three different analgesic agents administered prophylactically.Methods: Eighty patients undergoing day‐case minor operative laparoscopy were randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Group T), fentanyl 100 μg i.v. (Group F), 5 ml of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision respectively. Bupivacaine, 35 ml, 2.5 mg/ml was also administered into the pelvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pressures, SpO2 and respiration rates were recorded in the PACU. Postoperative pain was evaluated by verbal rating scale. Pain scores, analgesic requirements and side effects were evaluated by telephone calls until the 48th postoperative hour.Results: Postoperative pain scores were lower and time to requirement of rescue analgesics was longer in groups F and B compared to Group P. In the PACU, analgesic requirements were lower in Group B, compared to Group P. Nausea and vomiting were increased in Group F.Conclusion: Tenoxicam 20 mg i.v. was found to be ineffective whereas bupivacaine was superior to other groups in reducing pain and analgesic requirements. Bupivacaine also increased time to first analgesics and obtained better recovery characteristics, underlining its value in prophylactic pain management compared to the other two agents.
No difference between bupivacaine in 0.9% and 8% glucose for spinal anaesthesia in small children
Authors: Kokki H. , Hendolin H. 
Published: March 2003

Background: Baricity is one of the most important factors to influence the characteristics of distribution of the local anaesthetic and hence success and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated.Methods: Two hyperbaric bupivacaine solutions, in 0.9% and in 8% glucose, for spinal anaesthesia were investigated in 60 children, aged 1–7 years, in a double‐blind, randomised, parallel group, prospective study. The children were premedicated with diazepam orally. Bupivacaine 5 mg ml−1 in either 0.9% or 8% glucose was injected in a dose of 0.4 mg kg−1. Maximum cephalad extent and regression of sensory block were tested by transcutaneous electrical stimulation.Results: Success rate, spread and duration of sensory block were similar in both groups. Only one child required a single dose of fentanyl during surgery. The highest median level of sensory block was T3 (T2–T7) (median (10th/90th percentiles)) in both groups. Time to reach T10 did not differ between the groups. The incidence of adverse effects was similar. Atropine was administered to one child in each group to treat bradycardia and 6 children (10%) experienced shivering. One child in each group vomited once.Conclusion: These results demonstrate that bupivacaine in 0.9% glucose and in 8% glucose solutions are equally suitable for spinal anaesthesia in small children. Similar success rate, spread and duration of the sensory and motor block are achieved with both baricities of bupivacaine.
Effect of i.v. tenoxicam during caesarean delivery on platelet activity
Authors: Elhakim M. , Fathy A. , Amine H. , Saeed A. , Mekawy M. 
Published: March 2003

Background: Non‐steroidal anti‐inflammatory drugs inhibit platelet aggregation and prolong bleeding time in healthy subjects. We have studied the effect of i.v. tenoxicam during caesarean delivery on skin bleeding time, operative, and postoperative blood loss, and beta‐thromboglobulin and platelet factor 4 as specific molecular markers for platelet activity.Methods: Fifty women were studied. Twenty‐five were given tenoxicam 20 mg i.v. 10 min before induction of general anaesthesia, and 25 formed a control group. Skin bleeding time and platelet markers were determined the day before and 1 h after induction of anaesthesia.Results: In the tenoxicam group, there was an slight increase in skin bleeding time with no statistically significant changes in platelet marker levels. In the control group, platelet markers increased 1 h after surgery. The surgeon's assessment of uterine relaxation, using a visual analogue score, operating theatre blood loss, and the frequency of bleeding over 24 h after operation, showed no significant difference between the two groups.Conclusion: During caesarean delivery i.v. tenoxicam causes a slight increase in bleeding time with no significant changes in platelet marker levels.
The effect of dopexamine on regional tissue oxygenation, systemic inflammation and amino acid exchange in major abdominal surgery
Authors: Suojaranta‐Ylinen R. T. , Ruokonen E. T. , Takala J. A. 
Published: March 2003

Background: Beta‐adrenergic agents are frequently used to improve cardiac performance in surgical and intensive care patients. Beta‐adrenergic agents have metabolic and anti‐inflammatory effects in addition to their cardiovascular effects. Splanchnic metabolic activity increases in response to surgery and inflammation. Dopexamine is believed to favor blood flow distribution to the splanchnic region.Methods: We investigated the effect of dopexamine, started before major abdominal surgery, on postoperative patterns of systemic and regional blood flow, metabolic response, and markers of inflammation. Twenty‐one patients undergoing major abdominal surgery were studied. All patients were stabilized preoperatively to predefined hemodynamic endpoints with fluids. After preoperative measurement of systemic and splanchnic oxygen transport and splanchnic lactate, glutamine and alanine exchange and blood levels of tumor necrosis factor (TNF) and interleukin‐6 (IL‐6), the patients were randomized to receive an infusion of dopexamine at 0.5 μg kg−1 min−1 (group 1) or 2.0 μg kg−1 min−1 (group 2) or placebo. Measurements were repeated at 6 h and 24 h after the end of the operation and the blood levels of cytokines also at 36 h postoperatively.Results: Dopexamine evoked an increase in cardiac index preoperatively. Postoperatively, there was no difference between the groups in systemic and regional hemodynamics or oxygen transport: cardiac index, splanchnic blood flow and oxygen delivery increased similarly in each group. Accordingly, systemic oxygen extraction decreased. Glutamine, alanine and lactate exchange did not differ between the groups. The only metabolic change was an increased splanchnic uptake of alanine, which also was unaffected by dopexamine. There was no difference between the groups in TNF and IL‐6 levels; TNF level did not change, while IL‐6 level increased in response to surgery.Conclusions: Dopexamine, when added to a preoperative stabilization protocol with fluids, did not augment the postoperative hemodynamic response, and had no effect on postoperative metabolic and inflammatory responses.