bluuebunny/crossref_metadata_2025_split huggingface dataset:
Need for a reliable pain evaluation scale in the newborn in Sweden
Authors: Gradin M. 
Published: March 2003

Background: A major problem in pain treatment in the newborn is the ability to assess the degree of experienced pain. Several different methods for estimating pain in the newborn have been introduced in recent years. The objectives of this study were to see whether pain scoring was used in Swedish neonatal units, and by which method, and furthermore to observe whether any changes had occurred between 1993 and 1998.Method:A questionnaire was distributed to all Swedish neonatal units in 1993 and 1998.Results: In both 1993 and 1998, 86% of all clinics answered the questionnaire. Two‐thirds of these clinics used some method for estimating pain in the newborn at both times. Eight clinics used a structured method in the latter period compared to one in the earlier period. A higher proportion of units having full intensive care measured pain compared to other units.Conclusion: The study shows that an unchanging low proportion of neonatal units in Sweden attempt to assess pain. There is a minor increase in the number of departments that use a structured method for pain scoring. Documentation of pain intensity is still inadequate and should be improved.
Pulsatility does not change cerebral oxygenation during cardiopulmonary bypass
Authors: Grubhofer G. , Mares P. , Rajek A. , Müllner T. , Haisjackl M. , Dworschak M. , Lassnigg A. 
Published: March 2003

Background: To determine the effect of pulsatility during cardiopulmonary bypass (CPB) on cerebral oxygenation, we measured oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb) and oxidised cytochrome aa3 (CtO2) with near‐infrared spectroscopy (NIRS) in 14 patients electively scheduled for cardiac surgery.Methods: Cerebral oxygenation was measured during steady state CPB at a core temperature of 32°C. Non‐pulsatile flow and pulsatile flow were performed for 10 min each.Results: After 14 min of CPB, HbO2, Hb and CtO2 were significantly below prebypass values. HbO2 and CtO2 did not alter with changing flow patterns. Hb significantly increased both during the period of nonpulsatile (median: −0.7 vs. 0.25 μmol/l; P<0.05) and pulsatile flow (median: 0.25 vs. 0.5 μmol/l; P<0.001). This increase was independent of flow pattern.Conclusions: Neither oxygenated haemoglobin, nor intracellular oxygenation, represented by CtO2, indicated a beneficial effect of pulsatile perfusion during hypothermic CPB. These results, however, are only valid for short time effects within 10 min before rewarming from CPB and patients without flow‐limiting stenoses of the carotid artery.
PaO2 during anaesthesia and years of smoking predict late postoperative hypoxaemia and complications after upper abdominal surgery in patients without preoperative cardiopulmonary dysfunction
Authors: Wetterslev J. , Hansen E. G. , Kamp‐Jensen M. , Roikjær O. , Kanstrup I. L. 
Published: March 2003

Background: The incidence of late postoperative hypoxaemia and complications after upper abdominal surgery is 20–50% among cardiopulmonary healthy patients. Atelectasis development during anaesthesia and surgery is the main hypothesis to explain postoperative hypoxaemia. This study tested the predictive value of PaO2<19 kPa during combined general and thoracic epidural anaesthesia and the preoperative functional residual capacity (FRC) reduction in the 30° head tilt‐down position for the development of late prolonged postoperative hypoxaemia, PaO2<8.5 kPa for a minimum of 3 out of 4 days, and other complications.Methods: Forty patients without cardiopulmonary morbidity, assessed by ECG, spirometry, FRC and diffusion capacity preoperatively, underwent upper abdominal surgery. PaO2 during anaesthesia and preoperative FRC reduction were compared to known risk factors for the development of hypoxaemia and complications: age, pack‐years of smoking and duration of operation. The effect of optimizing pulmonary compliance with peroperative positive end‐expiratory pressure (PEEP) on postoperative hypoxaemia and complications was evaluated in a blinded and randomized manner.Results: Late prolonged postoperative hypoxaemia and other complications were found in 37% and 38% of the patients, respectively. Patients with PaO2>19 kPa during anaesthesia with FIO2=0.33 exhibited a risk, irrespective of PEEP status, of suffering late prolonged hypoxaemia of 0% (0;23) and patients with PaO2<19 kPa a risk of 52% (32;71), P<0.005. Having smoked more than 20 pack‐years was associated with a 47% (19;75) higher incidence of postoperative complications than having smoked less than 20 pack‐years, P<0.006.Conclusions: PaO2 during anaesthesia and smoked pack‐years provide new tools evaluating patients undergoing upper abdominal surgery in order to predict the patients who develop late postoperative hypoxaemia and complications.
Dysregulation of immune response following neurosurgical operations
Authors: Sablotzki A. , Ebel H. , Mühling J. , Dehne M. G. , Nopens H. , Giesselmann H. , Hempelmann G. 
Published: March 2003

Background: Postoperative infections are common and potentially fatal complications in neurosurgical intensive care medicine. An impairment of immune function has been described after central nervous system surgery and in patients harboring malignant brain tumors. The aim of our study was to investigate whether differences in cell‐mediated immunity can be found in patients undergoing craniotomy for surgery of glioblastoma or clipping of an intracerebral aneurysm.Methods: In order to determine the influence of the underlying disease on the immune system, we measured changes in cytokine concentrations (IL‐6, IL‐10, TGF‐beta1) and lymphocyte‐subsets (CD3+, CD3+HLA‐DR+, CD4+, CD8+, CD19+, and CD16+56+) in 8 patients with glioblastoma and in 8 patients with an intracerebral aneurysm before, during and after the neurosurgical procedure.Results: In the comparison of glioblastoma and aneurysm patients, we could show that IL‐6 plasma levels were pre‐ and intraoperatively higher in the aneurysm‐group (P<0.05), and the plasma concentrations of IL‐10 and TGF‐β were significantly elevated in the glioma‐group. The lymphocyte‐subsets showed a significantly lower percentage of NK‐cells and activated T‐cells in the glioma‐group.Conclusion: Our results document a significant dysregulation of immune response in glioma patients. This may be induced by elevated plasma concentrations of immunoinhibiting cytokines IL‐10 and transforming growth factor‐beta 1.
Age‐related modifications of effects of ketamine and propofol on rat hippocampal acetylcholine release studied by in vivo brain microdialysis
Authors: Wang Y. , Kikuchi T. , Sakai M. , Wu J. L. , Sato K. , Okumura F. 
Published: March 2003

Background: We sometimes encounter impairment of learning and memory after general anesthesia in elderly patients. The aim of this study was to examine age‐related modifications of the effects of ketamine and propofol on rat hippocampal acetylcholine (ACh) release because hippocampal cholinergic neurons are supposed to be involved in learning and memory.Methods: The experiments were performed on male Wistar young rats (2 months old) and old rats (18 months old), using in vivo brain microdialysis technique under freely moving condition. After initial sampling of three collections, test drugs were administered. The ACh release was determined by the HPLC‐ECD method.Results: In old rats, the hippocampal basal ACh release was significantly lower than in young rats. Ketamine (25 and 50 mg kg−1 i.p.) increased and propofol (25 and 50 mg kg−1 i.p.) decreased the hippocampal ACh release in both young and old rats. Furthermore, ketamine 50 mg kg−1 i.p. (anesthetic dose) produced facilitatory effects on the hippocampal ACh release in young rats (193% of the basal release), while in old rats the same dose of ketamine i.p. produced more pronounced facilitatory effects on the hippocampal ACh release (317% of the basal release). On the other hand, propofol 50 mg kg−1 i.p. (anesthetic dose) produced inhibitory effects on the hippocampal ACh release in young rats (56% of control) and in old rats (77% of control). Although the maximal inhibitory peak effects of propofol 50 mg kg−1 i.p. did not differ significantly between young rats and old rats, decrease of the hippocampal ACh release in old rats persisted longer than in young rats.Conclusion: Ketamine produced more pronounced facilitatory effects on the hippocampal ACh release in old rats, as compared with young rats. On the other hand, propofol has inhibitory effects on the hippocampal ACh release in young and old rats. The aging process may suppress the ability to recover from the inhibitory anesthetic state induced by propofol.
Efficacy and safety of premedication with oral ketamine for day‐case adenoidectomy compared with rectal diazepam/diclofenac and EMLA®
Authors: Filatov S. M. , Baer G. A. , Rorarius M. G. F. , Oikkonen M. 
Published: March 2003

Background: Because of its pain‐attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations.Methods: One hundred children between 10 and 15 kg of body weight scheduled for day‐case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA® cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 μg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1–9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well‐being at home.Results: The children of the K‐groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D‐groups; stridor scores ≥6 were seen in one child of the D‐groups (DS) and in six children of the K‐groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home.Conclusion: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.
Auditory evoked responses and learning and awareness during general anesthesia
Authors: Ghoneim M. M. , Block R. I. , Dhanaraj V. J. , Todd M. M. , Choi W. W. , Brown C. K. 
Published: March 2003

Background: There is a major distinction between conscious and unconscious learning. Monitoring the mid‐latency auditory evoked responses (AER) has been proposed as a measure to ascertain the adequacy of the hypnotic state during surgery. In the present study, we investigated the presence of explicit and implicit memories after anesthesia and examined the relationships of such memories to the AER.Methods: We studied 180 patients scheduled for elective surgical procedures. After a thiopental induction, one of four anesthetics were studied: Opioid bolus: 7.5 μg · kg−1 fentanyl, 70% N2O, with 2.5 μg · kg−1 supplements as needed (n=100); Opioid infusion: Alfentanil 50 μg · kg−1 bolus, 1–1.5 μg · kg−1 · min−1 infusion, 70% N2O (n=40); Isoflurane 0.3%: Fentanyl 1 μg · kg−1, 70% N2O, isoflurane 0.3% expired (n=16); Isoflurane 0.7%: Fentanyl 1 μg · kg−1, 70% N2O, isoflurane 0.7% expired (n=23). AER were recorded before anesthesia, 5 min after surgical incision and then every 30 min until the end of surgery. A tape of either the story of the “Three Little Pigs” or the “Wizard of Oz” was played continuously between the recordings. Explicit memory was assessed postoperatively by tests of recall and recognition, and implicit memory was assessed by the frequency of story‐related free associations to target words from the stories, which were solicited twice during a structured interview.Results: Six patients showed explicit recall of intraoperative events: All received the opioid bolus regimen. About 7% of patients reported dreaming during anesthesia. The incidence of picking the correct story that had been presented during anesthesia averaged 49%, i.e., very close to chance level. Overall, priming occurred only at the second association tests for the opioid bolus regimen, for which the frequency of an association to the presented story among those not giving an association to the control story was 26%, which was double the frequency (13%) of an association to the control story among those not giving an association to the presented story. This was significant by McNemar's test, P=0.02. There were significant associations between awareness, priming and AER, e.g., recall was associated with higher Nb amplitudes during anesthesia and priming was associated with shorter wave latencies.Conclusions: The incidence of awareness in patients anesthetized with nitrous oxide and bolus supplementation was 6%. Thus, this anesthetic technique did not reduce the risk of awareness compared with the use of nitrous oxide alone. Implicit memory occurred during nitrous oxide and bolus supplementation. Recording AER during anesthesia may help to predict awareness and implicit memory, particularly the former. The short contents of most of the dreams which were recalled could hamper future studies in this area.
Influence of acute normovolaemic haemodilution on the dose‐response and time‐course of action of atracuriumNote
Authors: Xue F. S. , Liao X. , Liu J. H. , Zhang Y. M. , An G. , Luo L. K. 
Published: March 2003

Background: Acute normovolaemic haemodilution is a common method to save and avoid homologous blood transfusion during surgery. The aim of this study was to evaluate the influence of acute isovolaemic haemodilution on the dose‐response and time‐course of action of atracurium.Methods: We studied 25 patients undergoing acute isovolaemic haemodilution during surgery and 25 patients not receiving haemodilution as a control group. All patients were ASA grade I and aged 18–54 yr. The haemodilution patients underwent major elective plastic surgery with an anticipated surgical blood loss of more than 600 ml, and the control patients underwent elective superficial plastic surgery with an anticipated surgical blood loss of less than 200 ml. Anaesthesia was induced with thiopental 4–6 mg/kg and fentanyl 2–4 μg/kg i.v., and maintained with 60% nitrous oxide in oxygen. After stabilization of anaesthesia, acute isovolaemic haemodilution in the haemodilution group was achieved by drainage of venous blood and an i.v. infusion of lactated Ringer's solution, and 6% dextran, during which haematocrit and haemoglobin decreased from 45.1% to 25.8% and from 147.2 g/l to 91.2 g/l, respectively. When anaesthesia was stable in the control group and haemodilution was completed in the haemodilution group, neuromuscular function was assessed by measuring with accelerography the response of the adductor pollicis muscle to supramaximal train‐of‐four (TOF) stimuli every 12 s to the ulnar nerve at the wrist via surface electrodes. The dose‐response relationships of atracurium in the two groups were determined by the cumulative dose‐response technique.Results: The results showed that during haemodilution, the dose‐response curve of atracurium was shifted to the left in a parallel fashion and the potency of atracurium was increased. In patients undergoing haemodilution, ED50, ED90 and ED95 of atracurium were decreased by 25–33%, and duration of action was increased by 21–48% following administration of the same dose (mg/kg), as compared with patients not undergoing haemodilution.Conclusion: We concluded that the patients undergoing acute isovolaemic haemodilution were about 30% more sensitive to neuromuscular blockade of atracurium and had a longer duration after administration of the same dose (μg/kg) than the control patients. Care must be taken with this problem when atracurium is used as a muscle relaxant during acute haemodilution.
Retracted: Composition of the editorial/advisory boards of major English‐language anesthesia/critical care journals
Authors: Boldt J. , Maleck W. 
Published: March 2003

Background: Publications represent a central part of the research process. An analysis of who is responsible for acceptance of publications in major English‐language anesthesia/critical care medicine journals was carried out.Methods: All English‐language journals listed in the SCI® Journal Citation Reports 1997 under the subheadings Anesthesiology (n=18) and Emergency Medicine & Critical Care (n=16) were analysed with regard to the editorship and the membership of advisory boards listed in the 1998 issues of the journals. The two groups were analysed separately with regard to their country of origin.Results: In the Anesthesiology section, 140 persons were listed as editors and 423 persons were identified as members of the advisory boards. Editors came from 14 different countries, with editors from the USA representing the majority (n=83; 59% of all editors, followed by the UK: n=24; 15% of all editors). Editors from other countries represent only a minority (n=33; 24% of all editors). The advisory boards came from 30 countries and were also dominated by the USA (n=220; 52% of all persons from the advisory boards). In the Emergency Medicine & Critical Care section 159 persons were listed as editors, of whom 119 originated from the USA (75% of all editors). Of the 835 persons listed in the advisory boards, 72% came from the USA, with 37 other countries sharing the remainder (second, UK: 8%; third, Canada: 2.5%).Conclusion: Most editors/editorial board members of important Anesthesiology, Emergency and Critical Care journals came from the USA. Other countries play a significantly less influential role even in journals which are characterised as ‘International Journals’.
Effect of dantrolene in an in vivo and in vitro model of myocardial reperfusion injury
Authors: Preckel B. , Schlack W. , Comfère T. , Thämer V. 
Published: March 2003

Background: In skeletal muscle, dantrolene reduces free cytosolic calcium by inhibiting calcium release from the sarcoplasmic reticulum. A similar effect in ischemic‐reperfused heart cells would protect myocardial tissue against reperfusion injury. We tested the hypothesis that dantrolene infusion during reperfusion protects the heart against reperfusion injury.Methods: Isovolumetric beating rat hearts were subjected to 30 min of ischemia followed by 60 min of reperfusion. Left ventricular (LV) developed pressure (LVDP) and creatine kinase release (CKR) were determined as indices of myocardial performance and cellular injury, respectively. In the treatment groups, dantrolene (25 (DAN25) or 100 (DAN100) μmol l−1) was infused during the first 15 min of reperfusion; control hearts received the respective concentration of the vehicle (mannitol (CON25, CON100), each group n=7). To investigate the effects of dantrolene on reperfusion injury in vivo, 18 chloralose‐anesthetized rabbits were subjected to 30 min occlusion and 180 min reperfusion of a major coronary artery. LV pressure (LVP), cardiac output (CO), and infarct size were determined. During the last 5 min of ischemia, nine rabbits received 10 mg kg−1 dantrolene intravenously (DAN). Another nine rabbits received the vehicle (dimethylsulfoxide) and served as controls (CON).Results: In isolated rat hearts, there was no recovery of LVDP in any group. Total CKR during 1 h of reperfusion was 845±76 (CON100) and 550±81 U g−1 dry mass (DAN100, P<0.05). In rabbits in vivo, hemodynamic baseline values were similar between groups (CON vs. DAN: LVP, 99±6 (mean±SEM) vs. 91±6mm Hg, P=0.29; CO, 252±26 vs. 275±23 ml min−1, P=0.53). During coronary artery occlusion, LVP and CO were reduced in both groups (CON: LVP, 89±3%; CO, 90±5% of baseline values) and LVP did not recover to baseline values during reperfusion (51±5% (CON) vs. 67±7% (DAN) of baseline, P=0.10). Infarct size was 41±4% of the area at risk in controls and 37±6% in dantrolene treated hearts (P=0.59).Conclusions: Dantrolene reduced CKR, indicating an attenuation of lethal cellular reperfusion injury in isolated rat hearts. However, in the rabbit in vivo, there was no effect on the extent of reperfusion injury after regional myocardial ischemia.
In vivo protein synthesis of circulating human T lymphocytes does not respond to a cortisol challenge within 24 h
Authors: Januszkiewicz A. , Essén P. , Mcnurlan M. A. , Ringdén O. , Wernerman J. , Garlick P. J. 
Published: March 2003

Background: Although immunocompetence is often measured by assessing responsiveness of lymphocytes to mitogenic stimulation in vitro, this approach may not reflect the in vivo situation. The aim of this investigation was to determine in vivo the protein synthesis rate (FSR) in isolated T lymphocytes and to study the effect of a short‐term cortisol infusion on FSR.Methods: Healthy volunteers (n=24) were randomised into 4 groups. A continuous cortisol infusion (6 μg kg−1 min−1) during 6 h was given to groups 1 and 2, whereas groups 3 and 4 served as control groups and received saline infusion. Protein synthesis was studied before and after 6 h of the cortisol/saline infusion (groups 1 and 3) or 24 h after the start of the infusion (groups 2 and 4). FSR was determined in vivo by the flooding method. The isotopic enrichment of phenylalanine in plasma and lymphocyte protein was determined with gas chromatography‐mass spectrometry.Results: The FSR in T lymphocytes was 13.6±0.9%/24 h as a mean value (±SD) of the first determination in 4 groups. There was no significant difference in FSR from the baseline value immediately after the cortisol infusion (group 1: 13.3±1.4%/24 h vs 13.5±2.8%/24 h) or 24 h after the start of the infusion (group 2: 13.6±0.7%/24 h vs 12.3±2.4%/24 h).Conclusion: The metabolic activity of circulating T lymphocytes, as reflected by a quantitative measurement of in vivo protein synthesis of human T lymphocytes, was not affected by the increased level of cortisol.
Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects
Authors: Mols G. , Rohr E. , Benzing A. , Haberthür C. , Geiger K. , Guttmann J. 
Published: March 2003

Background: Automatic tube compensation (ATC) is a new option to support spontaneously breathing tracheally intubated patients. We have previously demonstrated an increased respiratory comfort compared to pressure support ventilation (PSV) in volunteers. Here we characterized the breathing pattern during ATC associated with respiratory comfort in comparison to PSV. Furthermore, we studied whether ATC can be substituted by a simple modification of PSV.Methods: We exposed 10 volunteers breathing through a 7.5 mm endotracheal tube via mouthpiece to PSV with 1) immediate and 2) delayed pressure rise and to 3) ATC. Immediate changes of the respiratory pattern after mode shifts were analyzed in detail. Furthermore, the volunteers were instructed to indicate changes in comfort after transitions between these modes as increased, unchanged, or decreased.Results: Decreased comfort was associated with a substantial increase of tidal volume, minute ventilation, gas flow, and pressure. No differences in respiratory comfort were perceived between immediate and delayed pressure rise during PSV.Conclusion: PSV resulted in excessive tidal volumes and airflow, which was perceived as discomfort. This cannot be avoided by a delayed pressure rise but can be by the more comfortable ATC. ATC seems to adapt better to the ventilatory demand than PSV.