bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty Note
Authors: Niemi T. T. , Pitkänen M. , Syrjälä M. , Rosenberg P. H. 
Published: March 2003

Background: Hypotensive epidural anaesthesia (HEA) is a technique for reducing peroperative blood loss by significantly lowering mean arterial pressure (MAP).Methods: Thirty patients scheduled for primary total hip arthroplasty were given HEA (n=15) or spinal anaesthesia (SPA) (n=15) with bupivacaine in random order. The dose of bupivacaine was titrated to provide epidural blockade up to T1–T4 and spinal blockade at least to T10. Intravenous adrenaline infusion was adjusted to achieve a MAP of about 50–60 mmHg in the HEA group. During SPA MAP was maintained above 70 mmHg with ephedrine, as needed.Results: Intraoperative blood loss (median and 25th and 75th percentiles) was 400 ml (163–575) in the HEA group and 900 ml (663–1100) in the SPA group (P<0.05). At 3 h postoperatively cumulative blood loss was still smaller in the HEA group (600 ml versus 1100 ml, P<0.05). The cumulative number of transfused packed red cell concentrate (PRC) units was smaller in the HEA group than in the SPA group during surgery and postoperatively. Prothrombin time value was smaller in the SPA than in the HEA group (69% versus 79%, P<0.05) at 3 h postoperatively. D‐dimer concentrations increased more in the SPA group at the end of the surgery and 3 h postoperatively (P<0.05).Conclusions: HEA resulted in reduced blood loss due to hypotension and reduced number of transfused PRC units during total hip arthroplasty. Based on lower prothrombin time value and higher D‐dimer concentrations in the SPA group, the coagulation system might be better preserved during HEA than SPA.
Evaluation of three risk scores to predict postoperative nausea and vomiting
Authors: Eberhart L. H. J. , Högel J. , Seeling W. , Staack A. M. , Geldner G. , Georgieff M. 
Published: March 2003

Background: So far there are three different scores to predict postoperative vomiting (PV: Apfel et al., 1998) or postoperative nausea and vomiting (PONV: Koivuranta et al., 1997; Palazzo and Evans, 1993). All three scores used logistic regression analysis to identify and create weights for the risk factors for PV or PONV. In short, these were sex, age, history of previous PONV, motion sickness, duration of anaesthesia, and use of postoperative opioids. However, an external evaluation and a comparison of these scores has not been performed so far.Methods: Patients undergoing a variety of surgical procedures under general anaesthesia were studied prospectively. Preoperatively, they completed a questionnaire concerning potential risk factors for the occurrence of PV or PONV implemented in the three risk scores. Balanced anaesthesia (induction agent, non‐depolarising neuromuscular blocker, opioid, and inhalation agent in nitrous oxide/oxygen) was performed. No intravenous anaesthesia or any antiemetic prophylaxis was applied. Postoperatively, the patients were observed in the recovery room for the occurrence of PV and PONV and were visited twice on the ward within the 24‐h observation period. Both the patients and the nursing staff were asked whether PV or PONV was present. The severity of PONV was categorised using a standardised scoring algorithm. A total of 1444 patients was finally included into the analysis. Using information of the predicted risk for the individual patients and the actual occurrence of PV or PONV, Receiver Operator Characteristics (ROC‐curves) were drawn. The area under each ROC‐curve was calculated as a means of the predictive properties of each score and was compared for statistical differences.Results: For prediction of PONV (any severity) the AUC‐values (AUC=area under the curve) and the corresponding 95%‐confidence intervals were: Apfel: 0.70 (0.67–0.72); Koivuranta: 0.71 (0.69–0.73); Palazzo: 0.68 (0.65–0.70). For prediction of PV: Apfel: 0.73 (0.71–0.75); Koivuranta: 0.73 (0.70–0.75); Palazzo: 0.68 (0.65–0.70). Thus, all three scores appeared to have a moderate accuracy as measured by the AUC. The score of Koivuranta predicts PONV (P=0.007) and also PV (P=0.002) significantly better than Palazzo’s score. Furthermore, for predicting of PV the score of Apfel was also superior to Palazzo’s score (P=0.005). All three scores predict PV with the same accuracy as PONV.Conclusion: The occurrence of PV and PONV in patients undergoing surgery under balanced anaesthesia can be predicted with moderate but acceptable accuracy using one of the available risk scores, regardless of local surgical or anaesthesiological circumstances. For clinical practice, we recommend the score published by Koivuranta, since its calculation is very simple.
The dissociation of sedative from spinal antinociceptive effects following administration of a novel alpha‐2‐adrenoceptor agonist, MPV‐2426, in the locus coeruleus in the rat
Authors: Xu M. , Wei H. , Kontinen V. K. , Kalso E. , Pertovaara A. 
Published: March 2003

Background: MPV‐2426 is a novel alpha‐2‐adrenoceptor agonist developed for spinal pain therapy. In the present study we characterized its sedative and antinociceptive properties following microinjections into the brainstem and intrathecally at the lumbar spinal cord level.Methods: Sedative effects of MPV‐2426 were assessed in a locomotion measuring device following unilateral microinjection into the locus coeruleus (LC) of the brainstem or 1–2 mm rostral to the LC in rats. Antinociceptive effects induced by MPV‐2426 in the brainstem, and for comparison intrathecally at the lumbar spinal cord level, were determined with a tail‐flick test. Dexmedetomidine was used as the reference alpha‐2‐adrenoceptor agonist.Results: MPV‐2426 produced a dose‐related hypolocomotive/ sedative effect, which was significantly stronger following microinjection into the LC than 1–2 mm rostral to the LC. The sedation induced by MPV‐2426 was reversed by atipamezole (1 mg/kg s.c.), an alpha‐2‐adrenoceptor antagonist. The sedative potency of dexmedetomidine, the reference alpha‐2‐adrenoceptor agonist, was stronger and less dependent on the exact injection site in the brainstem. Following microinjections at sedative doses in the brainstem, only dexmedetomidine produced a significant antinociceptive effect in the tail‐flick test. When microinjected into the lumbar spinal cord, MPV‐2426 and dexmedetomidine had an equally strong antinociceptive effect in the tail‐flick test.Conclusion: The results indicate that the sedative potency of MPV‐2426 is considerably weaker than that of dexmedetomidine. Additionally, the spread of MPV‐2426 within the central nervous system is more limited than that of dexmedetomidine. This could explain why MPV‐2426 is sedative only when injected into the LC while antinociceptive effect is obtained when it is injected intrathecally at the lumbar spinal cord level.
Epileptiform EEG during sevoflurane mask induction: Effect of delaying the onset of hyperventilation
Authors: Vakkuri A. , Jäntti V. , Särkelä M. , Lindgren L. , Korttila K. , Yli‐Hankala A. 
Published: March 2003

Background: Hyperventilation during sevoflurane‐N2O‐O2 mask induction in adults is associated with a hyperdynamic circulatory response and epileptiform electroencephalogram (EEG). We tested the hypothesis that delaying onset of hyperventilation will prevent severe (periodic) epileptiform EEG and hyperdynamic response.Methods: Thirty patients were randomized to receive either delayed (group D, n=15) or immediate (group I, n=15) onset of hyperventilation during sevoflurane (8% in N2O 50%) mask inhalation induction with single‐breath method for unconsciousness. Fifteen patients were allowed to breathe spontaneously for 2 min after loss of consciousness and controlled hyperventilation (ETCO2 <4%) was started thereafter. In 15 patients controlled hyperventilation was started immediately after loss of consciousness. EEG was recorded, and mean arterial pressure (MAP) and heart rate (HR) registered.Results: Epileptiform EEG patterns were seen in 13 patients in group I and in 9 patients in group D (n.s.). Periodic epileptiform discharges (PED) tended to occur more often in group I (P=0.07). Heart rate and MAP were higher in group I than in group D from 2 min to 3 min (P<0.05), and both HR and MAP rose significantly from the baseline in group I. In group D, HR but not MAP rose significantly from baseline.Conclusion: Regardless of its timing, hyperventilation at a high sevoflurane concentration produced severe epileptiform EEG with a hyperdynamic response. PED tended to occur more often with immediate onset of hyperventilation (
Note).
Preoperative treatment with recombinant human erythropoietin or predeposit of autologous blood in women undergoing primary hip replacement
Authors: Gombotz H. , Gries M. , Sipurzynski S. , Fruhwald S. , Rehak P. 
Published: March 2003

Background: Controversy exists about the advantages of predeposit of autologous blood (PDAB), and whether more comfortable blood conservation regimens may yield comparable results. To test the hypothesis that preoperative treatment with recombinant human erythropoietin (rHuEPO) with or without acute concomitant normovolaemic haemodilution (ANHD) is as effective as PDAB in reducing allogeneic blood transfusions, we conducted a prospective randomised study in women undergoing primary hip replacement.Methods: Sixty consecutive female patients scheduled for primary hip replacement and suitable for PDAB were randomly assigned to one of 3 groups. Group I (EPO) and II (ANHD) received 600 U/kg rHuEPO s.c. and 100 mg iron saccharate i.v. on day 14 and, if needed, on day 7 before surgery. Additionally, in group II acute normovolaemic haemodilution (ANHD) was implemented after induction of anaesthesia. In group III (PDAB) conventional PDAB up to 3 U, without volume replacement but with concomitant oral iron therapy, was performed starting 4 weeks before surgery.Results: The blood conservation methods resulted in a comparable net gain of red cells in all 3 groups until the day of surgery. Because of the withdrawal of autologous blood, haemoglobin values before surgery were lower in the PDAB group than in the EPO and ANHD groups, and during surgery were lower in the PDAB and ANHD groups than in the rHuEPO‐only group. Applying moderate ANHD in conjunction with preoperative rHuEPO treatment did not yield an incremental decrease in allogeneic transfusions. There was no difference between the groups in the number of patients who received allogeneic transfusions or in the total number of allogeneic units transfused.Conclusions: Withdrawal of autologous blood is associated with lower pre‐ and intraoperative haemoglobin levels when compared to preoperative augmentation of red cell mass using rHuEPO. As a measure to reduce allogeneic transfusion requirements, preoperative treatment with rHuEPO may be as effective as standard predeposit of autologous blood in women undergoing primary hip replacement, but requires less preoperative time.
Total versus tube‐related additional work of breathing in ventilator‐dependent patients
Authors: Haberthür C. , Elsasser S. , Eberhard L. , Stocker R. , Guttmann J. 
Published: March 2003

Background: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient’s work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube‐related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation.Methods: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow‐adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation).Results: The percentage of the tube‐related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation.Conclusion: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.
A comparison of anaesthesia using remifentanil combined with either isoflurane, enflurane or propofol in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery
Authors: Chung F. , Mulier J.‐P. , Scholz J. , Breivik H. , Araujo M. , Hjelle K. , Upadhyaya B. , Haigh C. 
Published: March 2003

Background: Anaesthesia comprising remifentanil plus isoflurane, enflurane or propofol was randomly evaluated in 285, 285 and 284 patients, respectively, undergoing short‐procedure surgery.Methods: Anaesthesia was induced with propofol (0.5 mg · kg−1 and 10 mg · 10 s−1), and a remifentanil bolus (1 μg · kg−1) and infusion at 0.5 μg · g−1 · min−1. Five minutes after intubation, remifentanil infusion was halved and 0.5 MAC of isoflurane or enflurane, or propofol at 100 μg · kg−1 · min−1 were started and titrated for maintenance.Results: Patient demography and anaesthesia duration were similar between the groups. Surgery was performed as daycases (52%) or inpatients (48%). The median times (5–7 min) to extubation and postoperative recovery were similar between the groups. Responses to tracheal intubation (15% vs 8%) and skin incision (13% vs 7%) were significantly greater in the total intravenous anaesthesia (TIVA) group (P<0.05). Fewer patients given remifentanil and isoflurane (21%) or enflurane (19%) experienced ≥1 intraoperative stress response compared to the TIVA group (28%) (P<0.05). Median times to qualification for and actual recovery room discharge were 0.5–0.6 h and 1.1–1.2 h, respectively. The most common remifentanil‐related symptoms were muscle rigidity (6–7%) at induction, hypotension (3–5%) and bradycardia (1–4%) intraoperatively and, shivering (6–7%), nausea and vomiting postoperatively. Nausea (7%) and vomiting (3%) were significantly lower with TIVA compared with inhaled anaesthetic groups (14–15% and 6–8%, respectively; P<0.05).Conclusion:Anaesthesia combining remifentanil with volatile hypnotics or TIVA with propofol was effective and well tolerated. Times of extubation, postanaesthesia recovery and recovery room discharge were rapid, consistent and similar for all three regimens.
Effects on the bispectral index during medium‐high dose fentanyl induction with or without propofol supplement
Authors: Barr G. , Anderson R. E. , Öwall A. , Jakobsson J. G. 
Published: March 2003

Background: The search for a drug‐independent monitor to determine depth of anaesthesia and hypnosis continues. The bispectral analysis (BIS) of the EEG correlates well with the clinical dose–response of hypnotic drugs during induction, but the effect on BIS of an opiate induction, as for coronary bypass surgery, is not known.Methods: Fourteen patients scheduled for elective coronary bypass surgery were studied. BIS was recorded during induction in 7 patients receiving 10 μg/kg fentanyl without any hypnotic agent and in 7 patients receiving 0.5 mg/kg propofol before the fentanyl dose.Results: The effect of fentanyl was very variable both regarding BIS and clinical response. Five of the 7 patients that received only fentanyl lost their response to verbal command within 8 min. BIS values at loss of response varied between 45 and 94. One patient remained awake with BIS 43. All 7 patients receiving propofol before the fentanyl dose lost their response to verbal command within 5 min. BIS values at the time for loss of response varied between 78 and 98.Conclusion: Loss of response to verbal command when a medium‐high dose of fentanyl is used for induction cannot be distinguished from wakefulness with adequate sensitivity by BIS. The current BIS algorithm seems not to accurately reflect the hypnotic effects of fentanyl.
Stability of an epidural analgesic solution containing adrenaline, bupivacaine and fentanyl
Authors: Kjønniksen I. , Brustugun J. , Niemi G. , Breivik H. , Anderssen E. , Klem W. 
Published: March 2003

Background: A low dose solution of adrenaline 2 μg · ml−1, fentanyl 2 μg · ml−1 and bupivacaine 1 mg · ml−1 has been reported to give superior pain control when used for epidural analgesia after major surgery. The present paper describes the compounding and chemical stability of this triple‐component solution during storage and use.Methods: Sterile triple‐component concentrates (11X) were diluted by the use of gas isolator technology to give ready‐to‐use infusion solutions. Eight solutions were analysed by reverse phase high‐performance liquid chromatography (HPLC) methods, and assays were performed on 1, 45, 90 and 180 days after storage at 2–8°C. After 180 days the solutions were subsequently stored at 22°C for four days before they were reanalysed. HPLC quantification of adrenaline was also performed on samples from solutions given to 28 different patients.Results: The concentration of adrenaline and fentanyl decreased approximately 3.5% from 1 to 180 days at 4°C and four days at 22°C. The corresponding figure for bupivacaine was an apparent increase by 2.4% in concentration. No absorption to the polypropylene plastic bags of fentanyl and bupivacaine was detected. None of the 28 samples derived from used infusion bags contained less than 95% of the declared content of adrenaline.Conclusions: The triple‐component epidural analgesic solution remained stable during six months of cold storage, followed by four days of storage at room temperature. No significant degradation of adrenaline was observed in infusion solutions returned from the wards.
Cutaneous sympathetic vasoconstrictor reflexes for the evaluation of interscalene brachial plexus block
Authors: Lehtipalo S. , Winsö O. , Koskinen L‐O. D. , Johansson G. , Biber B. 
Published: March 2003

Background: Although signs of sympathetic blockade following interscalene brachial plexus block include Horner’s syndrome, increased skin temperature and vasodilatation, the degree of sympathetic blockade is not easily determined. The aim of this study was, therefore, to use activation of cutaneous finger pad vasoconstrictor reflexes for description and quantification of the degree of sympathetic blockade following unilateral interscalene brachial plexus block.Methods: Eight patients scheduled for acromioplasty under general anesthesia were studied. An interscalene plexus catheter was inserted preoperatively on the side to be operated upon and used postoperatively for administration of bupivacaine, given as a bolus (1.25 mg kg−1) followed by a continuous infusion (0.25 mg kg−1 h−1). Skin blood flow (SBF) in the pad of the index finger was assessed by the laser Doppler technique, and regional skin vascular resistance (RVR) was calculated. The inspiratory gasp test (apnea at end‐inspiration) or a local heat provocation were used as provocations of the cutaneous microcirculation.Results: Interscalene brachial plexus block increased SBF and decreased RVR at rest, and produced satisfactory sensory and motor block. The inspiratory gasp test decreased SBF and increased RVR in the unblocked arm, while the opposite, increased SBF and decreased RVR, were observed during local heat provocation. In the blocked arm, these gasp‐induced cutaneous vasoconstrictor and heat‐induced vasodilator responses were attenuated.Conclusions: Interscalene brachial plexus block reduces regional sympathetic nervous activity, illustrated by increases in skin blood flow, skin temperature and attenuated vasoconstrictor responses to an inspiratory gasp. The inspiratory gasp vasoconstrictive response is a powerful and sensitive indicator for monitoring the sympathetic blockade following interscalene brachial plexus block.
Effects of ketamine on formalin‐induced activity in the spinal dorsal horn of spinal cord‐transected cats: differences in response to intravenous ketamine administered before and after formalin
Authors: Nagasaka H. , Nakamura S. , Mizumoto Y. , Sato I. 
Published: March 2003

Background: Although formalin has been widely used as an algesic substance in rodent studies, the unique biphasic effect seen in rats is not present in humans. Humans, like cats, have a monophasic behavioral response to formalin injection. Electrophysiologically, spinal dorsal horn neurons in cats also have what could be considered a monophasic response after the initial burst of activity following formalin injection. Although several studies of the effects of ketamine on formalin responses have been carried out in rodents, we are unaware of similar studies in cats. We hypothesize that such species differences may explain observed differences in preemptive analgesic effects. Therefore, we examined the effects of ketamine on activity of spinal wide dynamic range (WDR) neurons evoked by formalin injection in cats.Methods: We investigated in cats the effect of ketamine on the activity of WDR neurons in the spinal dorsal horn that was evoked by formalin. In addition, we studied the effects of pre‐ and post‐administration of ketamine on the maintained phase of the formalin response. Each dose was a subanesthetic, anesthetic or high anesthetic dose (3.0 mg · kg−1, 10 mg · kg−1, and 30 mg · kg−1).Results: Intravenously administered ketamine produced a dose‐dependent depression of evoked activity that was significantly greater when the drug was administered before formalin.Conclusions: In spite of the species differences in responses to formalin, there still appears to be a clear preemptive effect of ketamine in the cat. Species differences may not explain apparent differences between human and animal preemptive analgesia.
Effects of propofol on desipramine‐sensitive [3H]‐noradrenaline uptake kinetics in rat femoral artery
Authors: Sandström K. , Wallerstedt S. M. , Törnebrandt K. , Bodelsson M. 
Published: March 2003

Background: The intravenous anaesthetic propofol inhibits the neuronal uptake of noradrenaline (uptake1) from the vascular sympathetic neuromuscular junction, resulting in an enhancement of the sympathetic neurotransmission. This could be important for maintenance of blood pressure during propofol anaesthesia. The aim of the present study was to determine how propofol influences the kinetics of uptake1.Methods: Isolated segments of rat femoral arteries were incubated with [3H]‐noradrenaline in the presence or absence of propofol and the radioactivity taken up was measured in a scintillation counter. The uptake1 inhibitor, desipramine, was used to delineate the specific neuronal uptake.Results: Desipramine and 10 μM propofol significantly reduced the uptake in segments incubated with 0.1 μM [3H]‐noradrenaline. Propofol at 1 μM and 100 μM did not affect the uptake. Non‐linear regression analysis of specific uptake yielded Km 0.50 μM, Vmax 1.6 pmol mg−1 15 min−1 and Hill coefficient 1.1. Propofol (1–10 μM) increased the Km value and propofol (10–100 μM) increased the Vmax value concentration‐dependently, while the Hill coefficient was not affected.Conclusion: Propofol seems to have a biphasic effect on the uptake of noradrenaline in the vascular sympathetic neuromuscular junction. At lower propofol concentrations there is a decrease in the affinity of the noradrenaline transporters. The resulting uptake inhibition is counteracted at higher propofol concentrations by an increase in the efficacy of the uptake.