bluuebunny/crossref_metadata_2025_split huggingface dataset:
The pre‐emptive analgesic effect of intra‐articular bupivacaine in arthroscopic knee surgery*
Authors: Tuncer B. , Babacan C. A. , Arslan M. 
Published: September 2005

Background:  The purpose of this study was to determine whether intra‐articular injection of bupivacaine prior to surgery provided better pain control after arthroscopic meniscectomy as compared with post‐operative administration of bupivacaine.Methods:  Forty patients of American Society of Anesthesiologists (ASA) class I or II undergoing arthroscopic meniscectomy were assigned in a randomized, double‐blinded manner into two groups: Group I received 20 ml of 2.5 mg/ml bupivacaine without epinephrine 30 min before skin incision and 20 ml of saline immediately after skin closure. Group II received identical injections in reverse order. All patients received total intravenous anesthesia. Post‐operative pain scores were evaluated at 1, 2, 4, 6, 8, 12 and 24 h at rest and movement of the knee, using a 10‐cm visual analog scale (VAS). The time to first analgesic use and 24‐h analgesic consumption were recorded.Results:  Pain scores were lower in Group I compared with Group II at 1, 2, 4 and 6 h at rest and on movement (P < 0.05). The time to first analgesic use was longer in Group I, but there was no statistically significant difference in 24‐h analgesic consumption.Conclusion:  Intra‐articular bupivacaine administered before surgery provided a statistically significant reduction in post‐operative pain scores compared with post‐operative bupivacaine administration.
Is peri‐operative cortisol secretion related to post‐operative cognitive dysfunction?
Authors: Rasmussen L. S. , O'Brien J. T. , Silverstein J. H. , Johnson T. W. , Siersma V. D. , Canet J. , Jolles J. , Hanning C. D. , Kuipers H. M. , Abildstrom H. , Papaioannou A. , Raeder J. , Yli‐Hankala A. , Sneyd J. R. , Munoz L. , Moller J. T. ,   (for the ISPOCD2 Investigators)
Published: September 2005

Background:  The pattern of cortisol secretion is influenced by surgery. As cortisol can adversely affect neuronal function, this may be an important factor in the development of post‐operative cognitive dysfunction (POCD). We hypothesized that the incidence of POCD would be related to changes in cortisol level.Methods:  We studied 187 patients aged over 60 years undergoing major non‐cardiac surgery with general or regional anaesthesia. Saliva cortisol levels were measured pre‐operatively and at 1 day, 7 days and 3 months post‐operatively in the morning (08.00 h) and in the afternoon (16.00 h) using salivettes. Cognitive function was assessed pre‐operatively, on day 7 and at 3 months using four neuropsychological tests. POCD was defined as a combined Z score of greater than 1.96.Results:  After surgery, salivary cortisol concentrations increased significantly. POCD was detected in 18.8% of subjects at 1 week and in 15.2% after 3 months. The pre‐operative ratios between the morning and afternoon cortisol concentrations (am/pm ratios) were 2.8 and 2.7 in patients with POCD at 1 week vs. those without POCD at 1 week, respectively. The am/pm ratios decreased significantly post‐operatively to 1.9 and 1.6 at 1 week, respectively (P = 0.02 for both). In an analysis considering all am/pm ratios, it was found that the persistent flattening in am/pm ratio was significantly related to POCD at 1 week.Conclusion:  The pattern of diurnal variation in cortisol level was significantly related to POCD. Thus, circadian rhythm disturbance or metabolic endocrine stress could be an important mechanism in the development of cognitive dysfunction after major surgery.
Inhibitory effects of desflurane and sevoflurane on oxytocin‐induced contractions of isolated pregnant human myometrium
Authors: Yildiz K. , Dogru K. , Dalgic H. , Serin I. S. , Sezer Z. , Madenoglu H. , Boyacı A. 
Published: September 2005

Background:  In this study, we investigated the inhibitory effects of desflurane and sevoflurane on oxytocin‐induced contractions of isolated human myometrium.Methods:  Following delivery of the infant and placenta, a small segment of myometrium was excised from the upper incisional surface of the lower uterine segment and 20 strips, randomly assigned into two groups (n = 10), were obtained from 20 non‐laboring term parturients. The study protocol consisted of a 60‐min period of spontaneous contractions, control recording with oxytocin 2 × 109 m (10‐min period), washout interval of 10 min, volatile administration (three times per 15‐min period) of 0.5, 1 and 2 minimum alveolar concentration (MAC), response to oxytocin (10‐min period), a further washout interval (10‐min period) and subsequent control recording with oxytocin without anesthetics.Results:  After oxytocin administration, the frequency and amplitude of contractions increased (P < 0.05) and the duration decreased (P < 0.05). The frequency and amplitude of contractions induced with oxytocin decreased significantly at 0.5, 1 and 2 MAC of desflurane and sevoflurane (P < 0.05). The amplitude of contractions was significantly different at 1 MAC between the two groups (P < 0.05). The duration of contractions at 2 MAC decreased in both groups (P < 0.05).Conclusions:  Desflurane and sevoflurane at 0.5, 1 and 2 MAC inhibit the frequency and amplitude of myometrial contractions induced with oxytocin in a dose‐dependent manner. However, desflurane inhibits the amplitude less than sevoflurane at 1 MAC. We suggest that 0.5 MAC of both agents and 1 MAC of desflurane may be safely used in the presence of oxytocin following delivery of the infant and placenta during Cesarean section without fear of uterine atony and hemorrhage.
Low arterial pressure during cardiopulmonary bypass in piglets does not decrease fluid leakage
Authors: Haugen O. , Farstad M. , Kvalheim V. , Rynning S. E. , Mongstad A. , Husby P. 
Published: September 2005

Background:  Cardiopulmonary bypass (CPB) is associated with increased fluid filtration occasionally leading to post‐operative organ dysfunction. One of the factors determining fluid filtration is the capillary hydrostatic pressure which depends on arterial pressure, venous pressure and pre‐ to post‐capillary resistance ratio. The purpose of this study was to assess whether lowering of the mean arterial pressure and/or the central venous pressure could reduce fluid extravasation during normothermic and hypothermic CPB.Methods:  Seven piglets were given nitroprusside to a mean arterial pressure of 35–40 mmHg during 60 min of normothermic and 90 min of hypothermic CPB (LP group). They were compared with a control group (C group, n = 7) without blood pressure interventions. Blood chemistry, net fluid balance, plasma volume, colloid osmotic pressure in plasma and interstitial fluid, intravascular protein masses, fluid extravasation rate and total tissue water content were measured or calculated.Results:  Mean arterial pressure was significantly lower in the LP group than in the C group during CPB. Plasma volume tended to increase in the LP group (P > 0.05), but remained essentially unchanged in the C group. Net fluid balance in the LP group was more positive than in the C group 30 min after CPB start [1.02 (0.15) vs. 0.56 (0.13) ml/kg/min (Mean (SEM) P < 0.05)]. Fluid extravasation rate tended to be higher in the LP group and total tissue water content of the gastrointestinal tract, left myocardium and skin was significantly elevated compared with the C group.Conclusion:  During CPB, lowering of the mean arterial pressure using nitroprusside did not reduce fluid extravasation. On the contrary, the data may implicate an increase in edema formation during low pressure CPB.
The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery
Authors: Kuitunen A. , Hiippala S. , Vahtera E. , Rasi V. , Salmenperä M. 
Published: September 2005

Background:  Thrombin formation during cardiac surgery could result in disordered hemostasis and thrombosis. The aim of the study was to examine the effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic activity in patients undergoing cardiac surgery.Methods:  Data were collected prospectively from 60 patients undergoing coronary artery bypass grafting using cardiopulmonary bypass (CPB). In a randomized sequence, 20 patients received aprotinin, 20 patients received tranexamic acid, and in 20 patients placebo was used.Results:  Significant thrombin activity was found in all the studied patients. Thrombin generation was less in the aprotinin group than in the tranexamic acid and the placebo group (thrombin/anti‐thrombin III complexes 33.7 ± 3.6, 53.6 ± 7.0 and 44.2 ± 5.3 µg/l 2 h after CPB and F1 + 2 fragment 1.50 ± 0.10, 2.37 ± 0.37 and 2.04 ± 0.20 nmol/l 6 h after surgery, respectively). The inhibition of fibrinolysis was significant with both anti‐fibrinolytic drugs (d‐dimers 0.427 ± 0.032, 0.394 ± 0.039 and 2.808 ± 0.037 mg/l 2 h after CPB, respectively). The generation of d‐dimers was inhibited until 16 h after CPB in the aprotinin group. The plasminogen activation was significantly less in the aprotinin group (plasmin/anti‐plasmin complexes 0.884 ± 0.095, 2.764 ± 0.254 and 1.574 ± 0.185 mg/l 2 h after CPB, respectively).Conclusion:  Thrombin formation is inevitable in coronary artery bypass surgery when CPB is used. The suppression of fibrinolytic activity, either with aprotinin or with tranexamic acid interferes with the hemostatic balance as evaluated by biochemical markers. Further investigations are needed to define the role of hemostatic activation in ischemic complications associated with cardiac surgery.
Effects of autotransfusion of mediastinal shed blood on biochemical markers of myocardial damage in coronary surgery
Authors: Pleym H. , Tjomsland O. , Åsberg A. , Lydersen S. , Wahba A. , Bjella L. , Dale O. , Stenseth R. 
Published: September 2005

Background:  Previous studies have shown conflicting results regarding the effect of autotransfusion of mediastinal shed blood after coronary artery bypass grafting (CABG) on the serum levels of myocardial band (MB) isoenzymes of creatine kinase (CK‐MB) and cardiac troponins. The effect of autotransfusion on serum levels of human heart fatty acid binding protein (H‐FABP), another marker of myocardial necrosis, has not been studied. The aim of the present study was to investigate the effects of autotransfusion of mediastinal shed blood on the serum levels of CK‐MB, cardiac troponin T (cTnT), and H‐FABP after uncomplicated primary CABG.Methods:  Fifty patients were randomized to post‐operative autotransfusion of mediastinal shed blood or no autotransfusion. Blood samples for the analysis of the biochemical markers of myocardial damage were drawn pre‐operatively and 1, 4, 12, 24, 48, and 72 h after the termination of cardiopulmonary bypass. Samples from the mediastinal shed blood were collected after 1 and 4 h.Results:  The levels of the biochemical markers of myocardial injury were all markedly elevated in mediastinal shed blood. Autotransfusion did not significantly affect the serum levels of cTnT or H‐FABP. However, during the early post‐operative hours, there was a trend towards a higher level of cTnT and H‐FABP in the autotransfusion group. During the first 24 h after surgery, the autotransfusion group had a significantly higher serum level of CK‐MB.Conclusion:  Post‐operative autotransfusion of mediastinal shed blood may contribute to elevated serum levels of biochemical markers of myocardial injury.
Analgesic efficacy of diclofenac in combination with morphine and paracetamol after mastectomy and immediate breast reconstruction
Authors: Legeby M. , Sandelin K. , Wickman M. , Olofsson C. 
Published: September 2005

Background:  Breast cancer treatment with mastectomy and immediate breast reconstruction (IBR) is associated with intense pain in the primary post‐operative period. The present prospective, placebo‐controlled and double‐blind study aimed to evaluate the analgesic efficacy of diclofenac, a non‐steroid anti‐inflammatory drug (NSAID), in combination with paracetamol and opioids. This was done by 64‐h assessment of post‐operative pain intensity, opioid consumption, blood loss, nausea and tiredness.Methods:  Fifty women selected for mastectomy and IBR with submuscular implants with or without axillary lymph node dissection (ALND) were randomized to receive diclofenac 50 mg × 3 or placebo rectally in addition to oral paracetamol and intravenous opioids delivered using a patient‐controlled analgesia (PCA) technique.Results:  During the first 20 h post‐surgery, patients who received diclofenac experienced significantly less pain when resting than those who received placebo. When moving, a non‐significant estimated difference in pain in favour of diclofenac was also noted. Opioid consumption during the first 6 h post‐operatively was 34% less with diclofenac than with placebo. Means (SD) were 16.9 (10.3) mg and 25.6 (10.2) mg, respectively (P = 0.007). After 64 h, the difference was no longer statistically significant. Post‐operative bleeding was significantly higher with diclofenac than with placebo (P < 0.01). Nausea and tiredness did not differ between the groups.Conclusions:  The addition of NSAID to paracetamol and opioid‐PCA reduced opioid consumption and improved pain relief during the first 20 h at rest but was not convincingly effective during mobilization. Post‐operative blood loss was higher with diclofenac.
Changes in the auditory evoked potentials index by induction doses of four different intravenous anesthetics
Authors: Nishiyama T. 
Published: September 2005

Background:  Many studies have investigated the electroencephalographic changes during the induction and maintenance of anesthesia. However, no comparative studies have been performed on the effects of intravenous anesthetics on the auditory evoked potentials index (AAI). The present study was performed to compare the changes in AAI caused by induction doses of thiopental, propofol, midazolam and ketamine.Methods:  Eighty females, aged 30–70 years, referred for mastectomy, had anesthesia induced with thiopental 4 mg/kg, propofol 2 mg/kg, midazolam 0.1 mg/kg or ketamine 1 mg/kg (each 20 patients). The response to verbal command and the AAI were measured every minute for 5 min.Results:  The AAI decreased to less than 40 within 1 min with thiopental and propofol. The AAI increased after 3 min with thiopental, but remained low with propofol. The AAI gradually decreased to less than 40 within 4 min with midazolam, but was higher than the AAI with propofol or thiopental. The AAI increased significantly with ketamine. The AAIs at the loss of verbal command were 19 ± 7 with thiopental, 21 ± 8 with propofol, 31 ± 10 with midazolam and 92 ± 2 with ketamine.Conclusion:  The AAI correlated with changes in hypnotic level, as measured by the response to verbal command, with induction doses of thiopental, propofol and midazolam, but not with ketamine. The AAI decreased to lower levels with propofol and thiopental than with midazolam at the induction of anesthesia.
Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema
Authors: Verheij J. , Van Lingen A. , Raijmakers P. G. H. M. , Spijkstra J.‐J. , Girbes A. R. J. , Jansen E. K. , Van Den Berg F. G. , Groeneveld A. B. J. 
Published: September 2005

Background:  Cardiac surgery can be complicated by pulmonary abnormalities, but it is unclear how various manifestations interrelate.Methods:  A prospective study in the intensive care unit was performed on 26 mechanically ventilated patients without cardiac failure within 3 h after elective cardiac surgery involving cardiopulmonary bypass. Oedema (extravascular lung water, EVLW) was measured by the thermal‐dye technique and permeability by a dual radionuclide technique, yielding a pulmonary leak index (PLI). Radiographic, mechanical and gas exchange features were used to calculate the lung injury score (LIS), ranging between 0 and 4. Evidence for left lower lobe atelectasis was obtained from plain radiographs. The plasma colloid osmotic pressure (COP) was measured by an oncometer.Results:  The EVLW (normal, <7 ml/kg) was elevated in 36% of patients and the PLI (normal, <14.1 × 10−3/min) in 44%, but the variables did not interrelate directly. Patients with a supranormal EVLW had a lower COP than patients with normal EVLW. The duration of mechanical ventilation was prolonged in patients (20%) with EVLW > 10 ml/kg. There was no difference in EVLW and PLI in patients with LIS < 1 and LIS > 1 (31% of patients). In patients with radiographic evidence for atelectasis (46%), the positive end‐expiratory pressure and inspiratory O2 fraction to maintain oxygenation were higher than in those without.Conclusions:  After cardiac surgery, mild pulmonary oedema is relatively common, even in the absence of high filling pressures, and is mainly attributable to a low COP, irrespective of increased permeability in about one‐half of patients. It may prolong mechanical ventilation at EVLW > 10 ml/kg. However, pulmonary radiographic and ventilatory abnormalities may result, at least in part, from atelectasis rather than increased permeability oedema.
Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation
Authors: Hofmann D. , Thuemer O. , Schelenz C. , Van Hout N. , Sakka S. G. 
Published: September 2005

Background:  Sufficient cardiac pre‐load for maintaining adequate cardiac output is a major goal in the treatment of critically ill patients. We studied the effects of increasing cardiac output by fluid loading on the indocyanine green plasma disappearance rate (ICG‐PDR) and gastric mucosal regional CO2 tension (PRco2) as an indicator of splanchnic microcirculation.Methods:  With approval by our ethics committee and written consent, we studied post‐operatively 12 patients (1 female, 11 males; 66 ± 13 years) with elective coronary artery bypass grafting (n = 10) or aortic valve replacement (n = 2). All patients had received pulmonary artery and left atrial catheterization previously for clinical indications. Cardiac output and filling pressures were measured immediately after intensive care unit (ICU) admission and 1 h after the beginning of fluid loading.Results:  Overall, 630 ± 130 ml of 6% hydroxyethylstarch (130 kDa) was infused with the splanchnic perfusion pressure remaining constant. Norepinephrine and epinephrine dosages were unchanged. The cardiac index increased significantly from 2.8 ± 0.7 to 3.5 ± 0.6 l/min/m2 and the stroke volume index from 30 ± 7 to 38 ± 8 ml/m2. ICG‐PDR showed no significant change, i.e. from 21.2 ± 6.5 to 21.6 ± 6.5%/min. Gastric mucosal PRco2 and the Pco2 gap (difference between regional and end‐tidal CO2 tension) were constant, i.e. changed from 5.1 ± 0.8 to 5.5 ± 1.1 kPa and from 0.9 ± 0.5 to 1.0 ± 0.7 kPa, respectively.Conclusion:  Increasing cardiac output to supranormal values by fluid loading is not associated with a significant change in ICG‐PDR or gastric mucosal PRco2.
The incidence of cognitive decline after (not) undergoing coronary artery bypass grafting: the impact of a controlled definition
Authors: Keizer A. M. A. , Hijman R. , Kalkman C. J. , Kahn R. S. , Van Dijk D. ,   (on behalf of the Octopus Study Group)
Published: September 2005

Background:  After coronary artery bypass grafting (CABG), 20–30% of patients are reported to suffer from cognitive decline. Studies reporting these high incidences, however, have not included an appropriate control group.Methods:  We repeatedly administered a series of neuropsychological tests to 112 healthy middle‐aged volunteers not undergoing surgery, and applied two widely used definitions of cognitive decline to their test results. In addition, we re‐analysed the neuropsychological test data of 281 CABG patients with a definition of cognitive decline that takes into account the natural variability of test performance that was found in the volunteers.Results:  Three months after their first assessment, 14–28% of the volunteers suffered from cognitive decline according to the definitions of cognitive decline after CABG. Using the controlled definition of cognitive decline that takes the natural variability in test performance into account, we found that only 7.7% of the CABG patients suffered from cognitive decline at 3 months after their operation.Conclusion:  These data suggest that the incidence of cognitive dysfunction after CABG has previously been greatly overestimated.
Stroke volume of the heart and thoracic fluid content during head‐up and head‐down tilt in humans
Authors: Van Lieshout J. J. , Harms M. P. M. , Pott F. , Jenstrup M. , Secher N. H. 
Published: September 2005

Background: The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart.Methods: This study evaluates the interdependence of SV and thoracic electrical admittance of thoracic fluid content (TA) vs. the central venous (CVP), mean pulmonary artery (MPAP) and pulmonary artery wedge (PAWP) pressures during head‐up (HUT) and head‐down (HDT) tilt in nine healthy humans.Results: From the supine position to 20° HDT, SV [112 ± 18 ml; mean ± standard deviation (SD)], TA (30.8 ± 7.1 mS) and CVP (3.6 ± 0.9 mmHg) did not change significantly, whereas MPAP (from 13.9 ± 2.7 to 16.1 ± 2.5 mmHg) and PAWP (from 8.8 ± 3.4 to 11.3 ± 2.5 mmHg;P < 0.05) increased. Conversely, during 70° HUT, SV (to 65 ± 24 ml) decreased, together with CVP (to 0.9 ± 1.4 mmHg;P < 0.001), MPAP (to 9.3 ± 3.8 mmHg;P < 0.01), PAWP (to 0.7 ± 3.3 mmHg;P < 0.001) and TA (to 26.7 ± 6.8 mS;P < 0.01). However, from 20 to 50 min of HUT, SV decreased further (to 48 ± 21 ml;P < 0.001), whereas the central pressures did not change significantly.Conclusions: During both HUT and HDT, SV of the heart changed with the thoracic fluid content rather than with the central vascular pressures. These findings confirm that the function of the heart relates to its volume rather than to its so‐called filling pressures.
Influence of hydroxyethyl starch on lipopolysaccharide‐induced tissue nuclear factor kappa B activation and systemic TNF‐α expression
Authors: Tian J. , Lin X. , Li Y. H. , Xu J. G. 
Published: September 2005

Background: Several studies have shown beneficial effects of hydroxyethyl starch (HES) on organ damage in the treatment of severe inflammatory situations, but the mechanisms remain unclear. Nuclear factor‐kappa B (NF‐κB) activation is known to contribute to many aspects of inflammatory injury and organ dysfunction in critical illness, and tumor necrosis factor‐alpha (TNF‐α) is considered the most important pro‐inflammatory cytokine. The present study was undertaken to test whether HES (200/0.5) has some effects on tissue NF‐κB activity and systemic TNF‐α expression induced by lipopolysaccharide in order to define a possible mechanism of the beneficial effects of HES.Methods: Male Wistar rats were randomly divided into seven groups treated with saline, lipopolysaccaride (LPS, 6 mg/kg), LPS plus HES (3.75, 7.5, 15, 30 ml/kg), or HES (30 ml/kg) alone. Two hours after LPS challenge, NF‐κB activation in the lungs, hearts, livers, and kidneys were examined with an electrophoretic mobility shift assay. Four hours after LPS challenge, plasma TNF‐α concentrations were measured using an enzyme‐linked immunosorbance assay.Results: 3.75 and 7.5 ml/kg HES suppressed LPS‐induced NF‐κB activation in the four tissues and decreased plasma TNF‐α elevation. The effects of 15 ml/kg HES was only significant in inhibiting NF‐κB activity in the lung and liver. No effect of 30 ml/kg HES was revealed in all the cases.Conclusion: Lower doses of HES may inhibit tissue NF‐κB activation and systemic TNF‐α elevation after LPS challenge, which might be helpful during sepsis.