bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sentinel node mapping affects intraoperative pulse oximetric recordings during breast cancer surgery
Authors: Koivusalo A.‐M. , Von Smitten K. , Lindgren L. 
Published: March 2003

Background:  In invasive breast cancer lymphatic mapping with patent blue vital dye (PBV) is used intraoperatively to identify the sentinel lymph nodes: the first axillary node draining the mammary lymphatic basin and first involved by the metastatic growth in breast cancer. Patent blue vital dye spreads to tissues giving a bluish tinge to patients. We have noted the possibility that intraoperative peripheral pulse oximetric (SpO2) values are artificially low when intradermal PBV is used.Methods:  Twenty patients with normal pulmonary function undergoing breast cancer surgery in standardized anesthesia either did or did not receive intradermal PBV sentinel node marking. The radial artery was cannulated for blood‐gas‐analysis; arterial oxygen tension (PaO2); and arterial oxygen saturation (SaO2). Peripheral oxygen saturation was measured using the light absorption technique. Red and infrared light (660 and 900 nm), used by pulseoxymetry, is partially absorbed when passing through the tissue. The amount of light absorbed is sensored and saturation calculated. The color of the skin was evaluated.Results:  Peripheral oxygen saturation decreased only immediately after the injection of PBV, and remained at a significantly lower level (P<0.001) throughout the operation and up to 90 min postoperatively. Arterial oxygen tension and SaO2 values did not decrease after intradermal PBV. Patent blue vital dye made patients' skin more bluish (P<0.001). No changes in SpO2, PaO2 and SaO2 were found in control patients.Conclusion:  The spectrum of PBV has a peak absorption at 640 nm, thus making the SpO2 values incorrect. Peripheral oxygen saturation values are falsely low and true arterial oxygenation is not impaired when PBV is used during sentinel node mapping.
Rectally administered diclofenac (Voltaren) reduces vomiting compared with opioid (morphine) after strabismus surgery in children
Authors: Wennström B. , Reinsfelt B. 
Published: March 2003

Background: Nausea, vomiting and pain are common complications after strabismus surgery in children. Diclofenac, a non‐steroid anti‐inflammatory drug, is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery. This open randomised study was designed to investigate the analgesic and anti‐emetic properties of rectally administered diclofenac compared with opioid (morphine) given i.v. in connection with strabismus surgery in children.Methods: After obtaining approval from the local ethics committee and written informed consent from the parents, 50 ASA class I–II children, 4–16 years of age, were randomised to receive either rectally administered diclofenac (Voltaren) 1 mg/kg or i.v. opioid (morphine) 0.05 mg/kg perioperatively. The children were consecutively operated upon from May 1999 to January 2001. Anaesthesia was induced with fentanyl and propofol and maintained with propofol. Nitrous oxide was omitted. The postoperative pain was assessed after arrival at the post anaesthesia care unit (PACU) by using the validated Wong and Baker scale (FACES) Pain Rating Scale. Postoperative nausea and vomiting (PONV) was assessed by measuring the frequency of vomiting and the degree of nausea.Results: In the diclofenac group the incidence of PONV during the first 24 h was 12% (of which one child had severe vomiting). The incidence of PONV was much higher, 72% (P = 0.0000), in the morphine group, where 56% of the children also had severe vomiting. There were no difference in pain score between the two groups. Recovery time at the PACU was longer (P < 0.002) and the postoperative analgesic requirement higher in the morphine group (10 vs. 5 children). No children needed overnight admission to the hospital.Conclusion: Diclofenac given rectally is an effective analgesic for this kind of surgery and gives less postoperative nausea than i.v. morphine. No serious adverse events were observed.
Rapid detection of oesophageal intubation: take care when using colorimetric capnometry
Authors: Puntervoll S. A. , Søreide E. , Jacewicz W. , Bjelland E. 
Published: March 2003

Background: Rapid detection of a misplaced endotracheal tube in the esophagus is crucial, especially in emergency situations. Hence, we have compared the ability of a colorimetric CO2 indicator (Colibri technology, CO2ntrol 1) and a capnography to differentiate oesophageal and tracheal intubation, with and without CO2 air in the esophagus.Methods: Fourteen otherwise healthy patients were intubated with an endotracheal tube in the trachea under general anesthesia. After a positive verification of this endotracheal tube and established mechanical ventilation a second endotracheal tube was placed in the esophagus. Both were initially ventilated four times, and expired CO2 was measured with a mainstream capnograph and a colorimetric indicator. In the remaining five patients CO2 containing air was inserted into the esophagus first and then ventilated four times.Results: Both the colorimetric indicator and mainstream capnograph verified correct placement of the endotracheal tube from the first ventilation.When the tube was placed in the esophagus, both methods correctly showed that no CO2 was present. However, in patients (n=5) with CO2 installed in their esophagus, the colorimetric indicator, but not the capnograph, had readings showing that CO2 was present. This may cause a misinterpretation of correct tracheal placement.Conclusions: We found that in emergency situations where CO2 containing air may be present in the esophagus, capnography should be the preferred method of verifying endotracheal and not oesophageal intubation. The tested colorimetric CO2 indicator (Colibri technology, CO2ntrol 1) is very sensitive to low CO2 values. It may therefore falsely indicate correct endotracheal intubation, even when the tube is in the oesophageus.
Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: a retrospective study
Authors: Anderson S. , Høgskilde P. D. , Wetterslev J. , Bredgaard M. ,   Sørensen, Møller J. T. , Dahl J. B. 
Published: March 2003

Background:  Hypoglycemic patients treated by the emergency medical service (EMS) system are commonly left home. The criteria for leaving hypoglycemic patients at home and the appropriateness of the procedure remains, however, unvalidated. The present retrospective article addresses these questions.Methods:  The Copenhagen physician‐based mobile intensive care unit (MICU) responds to emergency calls in a two‐tier rendezvous system. Its prehospital data from 1995 to 1998 were retrospectively incorporated into a clinical database and cross‐referenced with clinical information from three Danish national registries, enabling identification of criteria for transportation of the patients to the hospital, and a detailed 72‐h follow up on patients left at home.Results:  The MICU treated 1148 hypoglycemic patients within the period, of which 84% were released at home. Treatment or no treatment before arrival of the MICU and level of consciousness following MICU treatment, were found to be strong predictors of a need for transportation to hospital; although other factors were implicated. Within the 72‐h following MICU treatment less than 8% of the patients left at home needed secondary MICU or hospital treatment because of glucose regulatory problems, and less than 5% experienced secondary hypoglycemia. Less than 1% was admitted to hospital beds with recurrent hypoglycemia within 24 h. Poor compliance with the diabetic treatment instructions often appeared to be involved in cases of recurrent hypoglycemia. A delay in admission was not to blame for a serious secondary patient course in any of the cases.Conclusion:  The majority of patients with prehospital hypoglycemia may safely be treated and released at home in a physician‐based EMS area.
The sevoflurane saving capacity of a new anaesthetic agent conserving device compared with a low flow circle system
Authors: Enlund M. , Lambert H. , Wiklund L. 
Published: March 2003

Background: An anaesthetic agent conserving device (ACD) has been added to a Bain system to approach the agent‐saving capacity of a low flow circle system.Methods: Randomly selected ASA physical status I patients received a standardized anaesthetic with sevoflurane in air/O2 through either a circle system with 1.5 l/min fresh gas flow (n = 8), or through a Bain system with an added ACD with fresh gas flow 4.4–6.4 l/min (n = 8). A target controlled infusion of remifentanil was used for analgesia.Results: The median sevoflurane consumption was 19.7 and 22.0 ml/MAC/h with the low flow circle system and the Bain system + ACD, respectively (P=0.10, Mann–Whitney U‐test), or when adjusted for weight 0.25 and 0.28 ml/MAC/h/kg (P=0.26, Mann–Whitney U‐test).Conclusion: The expenditure of sevoflurane with a Bain system + ACD was close to that in a circle system with 1.5 l/min fresh gas flow. It is thereby possible to use sevoflurane to all its potential, performing for example rapid alterations in end‐tidal concentration using high fresh gas flows by combining a Bain system with an ACD. Although the price is not decided for this not yet commercially available device, a potential for a lower cost exists. Additionally, there will be no concerns of toxic compounds produced in the absorber.
Impact of laryngeal mask airway and tracheal tube on pulmonary function during the early postoperative period
Authors: Natalini G. , Franceschetti M. E. , Pletti C. , Recupero D. , Lanza G. , Bernardini A. 
Published: March 2003

Background: The tracheal tube (TT) produces reversible bronchoconstriction and increases pulmonary airway resistance compared to the laryngeal mask airway (LMA). The possible persistence of this effect in the postoperative period has not been studied. The aim of this study was to compare the early postoperative pulmonary function in healthy patients undergoing minor surgical procedures with the LMA or with the TT.Methods: Sixty patients scheduled for saphenous vein stripping under general anaesthesia were randomised to receive the LMA or the TT. Before anaesthesia and 20 min after LMA or TT removal, pulse oxymetry values (SpO2) were recorded and patients performed forced spirometry in the supine position.Results: Preoperative pulmonary function was normal in both groups. There were no differences between groups in the preoperative respiratory function test and SpO2. Following surgery SpO2, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) decreased in both groups. The FEV1/FVC did not change in either of the groups. In the TT group, compared to patients using the LMA, there was a greater relative decrease of SpO2 (2.7 ± 2.7% vs. 1.3 ± 2.2%, P=0.017), FEV1 (17.6 ± 12.2% vs. 8 ± 17.4%, P=0.008), FVC (15.8 ± 12.4% vs. 9 ± 13.4%, P=0.023) and PEF (20.6% ± 15.3% vs. 8.1 ± 33.3%, P=0.033).Conclusions: This study demonstrates greater early postoperative respiratory restrictive syndrome and lower arterial oxygen saturation following tracheal intubation compared to LMA use in patients without respiratory disease.
Monitoring arterial blood pressure during whole body hyperthermia
Authors: Kerner T. , Deja M. , Ahlers O. , Hildebrandt B. , Dieing A. , Riess H. , Wust P. , Gerlach H. 
Published: March 2003

Background: For monitoring of arterial blood pressure (ABP) during whole body hyperthermia (WBH) different methods have been recommended. This investigation was performed to evaluate the agreement of invasive measurements at various sites, and to compare invasive and non‐invasive methods of ABP monitoring under conditions of a heat‐induced extreme vasodilation.Methods: In 19 patients, 48 treatments with WBH were performed. Measurements of ABP in the radial and femoral artery by oscillometry and by sphygmomanometry were taken at four temperature levels during WBH (37, 40, 41.8 and 39°C).Results: Significant differences were observed between invasive and non‐invasive methods for systolic ABP, with higher values for non‐invasive measurements. When compared with both invasive measurements for diastolic blood pressures, sphygmomanometry gave higher values and oscillometry gave lower values. Sphygmomanometry also showed higher values for mean ABP compared with all other techniques, while measurements in radial and femoral artery and by oscillometry only differed by approximately 5 mmHg.Conclusion: The mean arterial pressure and not the systolic and/or diastolic pressure should guide hemodynamic management during WBH. The sphygmomanometric technique is not recommended for use during hyperthermia.
Use of cerebral oximetry to detect and manage cerebral desaturation with a rapidly expanding neck hematoma
Authors: Akça O. , Sessler D. I. 
Published: March 2003

Background: We report a case in which cerebral oximetry was used to successfully demonstrate when cerebral oxygen saturation is dangerously low.Methods: In a 60‐year‐old‐man with end‐stage multiple myeloma and hyperviscosity syndrome, a rapidly expanding hematoma developed after insertion of an internal jugular central venous catheter. As the hematoma expanded, the patient became lethargic and disoriented (Glasgow Coma Score of E2/M4‐5/V2‐ETT). His platelet count was 17,000.mm−3, hemoglobin was 4.5 g/dl, partial thromboplastin time was 51 s, and his international ratio was 1.7. Although carotid pulses became unpalpable, blood pressure and heart rate remained stable. Cerebral oximeter probes positioned on the patient's forehead showed that cerebral oxygen saturation was 22–26% bilaterally. The surgery team was advised to surgically evacuate the hematoma.Results: The hematoma was evacuated and a small needle hole in the right internal jugular vein adjacent to the central‐venous catheter was found and repaired. Cerebral oxygen saturation increased to 56–58% within 1 h and stabilized near 60%. The patient awoke with normal cognitive function.Conclusion: This case demonstrates how cerebral oximetry can be used to give quantitative evidence of cerebral hypoxia, thus showing that immediate surgical intervention is necessary.
Small‐volume resuscitation: from experimental evidence to clinical routine. Advantages and disadvantages of hypertonic solutions
Authors: Kreimeier U. , Messmer K. 
Published: March 2003

Background: The concept of small‐volume resuscitatioin (SVR) using hypertonic solutions encompasses the rapid infusion of a small dose (4 ml per kg body weight, i.e. approximately 250 ml in an adult patient) of 7.2–7.5% NaCl/colloid solution. Originally, SVR was aimed for initial therapy of severe hypovolemia and shock associated with trauma.Methods: The present review focusses on the findings concerning the working mechanisms responsible for the rapid onset of the circulatory effect, the impact of the colloid component on microcirculatory resuscitation, and describes the indications for its application in the preclinical scenario as well as perioperatively and in intensive care medicine.Results: With respect to the actual data base of clinical trials SVR seems to be superior to conventional volume therapy with regard to faster normalization of microvascular perfusion during shock phases and early resumption of organ function. Particularly patients with head trauma in association with systemic hypotension appear to benefit. Besides, potential indications for this concept include cardiac and cardiovascular surgery (attenuation of reperfusion injury during declamping phase) and burn injury. The review also describes disadvantaages and potential adverse effects of SVR:Conclusion: Small‐volume resuscitation by means of hypertonic NaCl/colloid solutions stands for one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Today the spectrum of potential indications envolves not only prehospital trauma care, but also perioperative and intensive care therapy.
Comparison of epidural pain treatment with sufentanil‐ropivacaine infusion with and without epinephrine in children
Authors: Kokki H. , Ruuskanen A. , Karvinen M. 
Published: March 2003

Background:  Epidural analgesia provides outstanding pain relief after surgery, but it is also associated with numerous adverse effects. In order to improve postoperative pain management in children we determined whether the use of epinephrine added to epidural sufentanil‐ropivacaine infusion reduced drug requirements, the intensity and duration of postoperative pain and the incidence and severity of adverse effects.Methods:  A prospective, randomized, double blind, parallel group study design was used in 61 children. The children were given continuous epidural sufentanil‐ropivacaine infusion either with (n=32) or without (n=29) epinephrine for postoperative analgesia. Intravenous ketoprofen, a non‐steroid anti‐inflammatory drug, was used for all children, and epidural ropivacaine was used for rescue analgesia. The drug consumption, intensity of pain at rest and during activity, and all adverse effects were recorded.Results:  The need for sufentanil (P=0.001) and ropivacaine (P=0.006) was significantly lower in the with‐epinephrine group than in the without‐epinephrine group. The mean duration of epidural infusion (62 h) was similar in both groups. Four children in the without‐epinephrine group were noticed to have a low oxygen saturation (SpO2<90%), and in one child a low respiratory rate (8 breaths min−1). The incidence of pruritus was higher in the without‐epinephrine group (P=0.026).Conclusion:  Both infusions provided effective pain relief, and epinephrine as an adjuvant to continuous epidural sufentanil‐ropivacaine infusion seems to be useful in children.
Retrospective evaluation of continuous epidural infusion for postoperative pain in children
Authors: Jylli L. , Lundeberg S. , Olsson G. L. 
Published: March 2003

Background: The safety and efficacy of postoperative epidural analgesia (EDA) in children are not well documented in larger series of patients given routine postoperative care. The aims of this study were to evaluate the efficacy of pain relief, determine the incidence and type of complications during the entire period of epidural pain treatment in children, and assess the factors affecting efficacy Methods: Children treated postoperatively with an EDA infusion during the period 18 September 1994 to 1 January 1999 were studied. Data regarding the age, gender, efficacy of analgesia, duration of epidural infusion, types of side‐effects and complications, reasons for discontinuation, and types and duration of surgery were collected daily by the Acute Pain Treatment Service. The sensory dermatomal level of the surgical incision site was included retrospectively. Results: Five hundred and eighteen epidural infusions were given to 476 children. Pain relief was rated as ‘good’ at 76% of visits. There were no major complications or sequelae. Thirty‐seven per cent of the epidural infusions were prematurely discontinued, and 21% were discontinued because of unsatisfactory analgesia. Factors related to a higher percentage of unsatisfactory function were surgical incision site located above the umbilicus, gastrenterologic surgery, protracted surgery and age. Age and duration of surgery were significantly related to unsatisfactory function. Conclusion: This study shows that continuous epidural infusion for postoperative pain was satisfactory in most cases, and that no major side‐effects or complications occurred in children nursed on regular wards. The early recognition of unsatisfactory function of an EDA is important for a child's well being.
Mutation screening in the ryanodine receptor 1 gene (RYR1) in patients susceptible to malignant hyperthermia who show definite IVCT results: identification of three novel mutations
Authors: Rueffert H. , Olthoff D. , Deutrich C. , Meinecke C. D. , Froster U. G. 
Published: March 2003

Background: The ryanodine receptor of the skeletal muscle (RYR1) seems to be of outstanding importance in the pathogenesis of malignant hyperthermia (MH). It has been shown that point mutations in the RYR1 gene are strongly associated with the MH phenotype. A correctly determined phenotype is the basic prerequisite for adequate genetic MH screening. In this study we examined only those MH susceptible patients for the presence of potential RYR1 mutations who showed strong pathological muscle responses in the in vitro contracture test (IVCT).Methods: A total of 56 MHS index patients who complied with the following IVCT criteria were included in the molecular genetic investigation: Contracture forces ≥4 mN at a caffeine concentration of 2.0 mmol/l and ≥8 mN at a halothane concentration of 0.44 mmol/l. DNA sequences of exons 2, 6, 9, 11, 12, 14, 15, 17, 39, 40, 45, 46, 102 of the RYR1 gene were analysed by the direct sequencing technique. Furthermore, if an MH mutation was identified in an index patient, all relatives were screened for their family specific RYR1 defect.Results: In 39 index patients an RYR1 mutation was detected: Arg163Cys (n = 2), Asp166Asn (n = 1), Gly341Arg (n = 2), Arg401His (n = 2), Arg614Cys (n = 12), Asp2129Glu (n = 1),Vol2168Met (n = 1), Thr2206Met (n = 9), Ala2428Thr (n = 1), Gly2434Arg (n = 2), Arg2435His (n = 1), Arg2452Trp (n = 1), Arg2454His (n = 4). Three new RYR1 mutations were identified. We found a potential MH mutation in a further 130 relatives of the 39 index patients. Thirty‐seven individuals were classified as MHS exclusively by molecular genetic techniques and did not have to undergo the IVCT.Conclusions: The ascertained high rate of successful MH mutation screening (69.64%) is obviously associated with the more clearly defined MHS diagnosis in the IVCT. According to the EMHG guidelines for the molecular genetic detection of MH susceptibility, a positive MH disposition could be determined in numerous persons by a less invasive technique.
Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation
Authors: Söderström S. , Sellgren J. , Åneman A. , Pontén J. 
Published: March 2003

Background:  Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo‐vascular coupling during anesthesia.Methods:  We observed the differences between aortic systolic pressure (AoSAP, tipmanometry) and radial systolic pressure in 15 patients, (including two women) aged 53–78 years, before coronary artery bypass surgery. We studied the induction of anesthesia with fentanyl (20 µg kg−1), moderate volume loading, and thereafter the addition of 70% nitrous oxide. The circulatory effects of mechanical ventilation were studied by doubling the tidal volumes. Pulse wave contours were assessed by calculation of radical and aortic augmentation indices (AI), which measure the second systolic pressure peak.Results:  Radial systolic pressure was higher than AoSAP in the control situation (8±2 mmHg), and this SAP gradient increased further with fentanyl (12±2 mmHg). The gradient persisted throughout the study, but was partially reduced by volume loading and nitrous oxide, respectively. Radial augmentation index was the only parameter remaining in a stepwise multivariate model to explain the variance in the SAP gradient (r2=0.48). Radial augmentation index also correlated with aortic pulse pressure (r2=0.71). Mechanical ventilation had significant and similar effects on pulse wave augmentation both in the aorta and in the radial artery, and did not affect the radial to aortic SAP gradient.Conclusion:  These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery.