bluuebunny/crossref_metadata_2025_split huggingface dataset:
A catheter technique in ophthalmic regional anaesthesia
Authors: László C. J. , Gombos K. , Vimláti L. , Salacz G. , Hatvani I. 
Published: March 2003

Background: Regional anaesthesia for ophthalmic surgery is generally accomplished by peri‐ or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri‐ or retrobulbar space continuously.Methods: Twenty‐five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra‐ or intraconal space. Methylene blue solution was injected through the catheter.Results: Using the same transcutaneous retro‐ and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra‐ or extraconally.Conclusion: Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra‐ or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.
Tubeless combined high‐frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesia
Authors: Ihra G. , Hieber C. , Adel S. , Kashanipour A. , Aloy A. 
Published: March 2003

Background: High‐frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children.Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low‐frequency (LF) and a high‐frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed.Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months–10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia.The mean duration of supralaryngeal HFJV was 46 min (range 15–75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4–1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7–1.0 bar and 0.9–1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively.Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea.
Pain intensity and side effects during titration of morphine to cancer patients using a fixed schedule dose escalation
Authors: Klepstad P. , Kaasa S. , Skauge M. , Borchgrevink P. C. 
Published: March 2003

Background: Considerable dose variations and frequent initial side effects have been postulated during start of morphine treatment to patients with pain caused by malignant disease. However, to our knowledge, only one previous study has reported effective doses in morphine naive cancer patients and no prospective evaluation has compared symptoms before with symptoms during morphine titration.Methods: We recruited 40 cancer patients with uncontrolled pain despite receiving codeine or dextropropoxyphen. Baseline data were obtained for two days before start of morphine titration using a fixed scheduled escalation of immediate‐release (IR) morphine. When a stable morphine dose was achieved, IR morphine was replaced with slow‐release (SR) morphine in equivalent doses. Intensity of pain and side effects were assessed daily. The daily consumption of morphine, rescue analgesics and rescue antiemetics were registered.Results: The mean titration time to achieve adequate analgesia was 2.3 days (range: 1–6) using a mean daily morphine dose of 97 mg (range: 60–180). Nausea was unaltered after start with morphine but an increased incidence of vomiting occurred (premorphine period 5%, IR morphine period 29%). Transient sedation delayed dose increment in 9 of the 40 patients but mean sedation scores were unaltered. Constipation scores increased while other side effect scores were unaltered. Eighty‐two percent of the patients were satisfied or very satisfied with the pain treatment during introduction of morphine.Conclusion: In cancer patients with uncontrolled pain on weak opioids, successful titration of morphine is achieved fast, with a three‐fold morphine dose variation and with little increase in side effects.
Marked enhancement of anti‐allodynic effect by combined intrathecal administration of the adenosine A1‐receptor agonist R‐phenylisopropyladenosine and morphine in a rat model of central pain
Authors: Von Heijne M. , Hao J.‐X. , Sollevi A. , Xu X.‐J. , Wiesenfeld‐Hallin Z. 
Published: March 2003

Background: There is often no satisfactory treatment for chronic pain after spinal cord injury. We have previously reported that intrathecal (i.t.) administration of the adenosine A1‐receptor agonist R‐phenylisopropyl‐adenosine (R‐PIA) or the opioid morphine has anti‐allodynic effects in a model of presumed chronic central pain after photochemically induced spinal cord injury in rats. In the present study, we set out to investigate the possible interaction between i.t. R‐PIA and morphine in spinally injured rats.Methods: Sprague‐Dawley rats displaying allodynia‐like behaviors to mechanical and cold stimuli after photochemically induced spinal cord injury with minor motor deficits were used. R‐PIA and morphine, either alone or in combination, were administered i.t. through an implanted catheter to lumbar spinal cord.Results: Cumulative doses of R‐PIA or morphine dose‐dependently reduced the mechanical allodynia‐like behavior, with a threshold of 1 nmol and 1.5 nmol, respectively. When co‐administrated, R‐PIA and morphine produced marked suppression of mechanical allodynia at doses of 5 pmol and 7.5 pmol, respectively. The effect of i.t. co‐administration of R‐PIA and morphine on cold allodynia was comparable to i.t. R‐PIA alone. The combination of R‐PIA and morphine did not increase adverse effects such as motor deficits in comparison to either drug alone.Conclusion: These results demonstrate a supra‐additive interaction between the adenosine A1‐receptor agonist R‐PIA and morphine to reduce mechanical allodynia‐like behavior in rats with chronic spinal cord injury. The combination of R‐PIA and morphine administered spinally may be superior to R‐PIA or morphine alone for treating such pain.
Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia
Authors: Schlaich N. , Mertzlufft F. , Soltész S. , Fuchs‐Buder T. 
Published: March 2003

Background: The use of muscle relaxants in outpatient anaesthesia is controversial; some authors recommend an induction regimen including propofol and opioids without muscle relaxants. This study evaluated the requirements for rocuronium after remifentanil/propofol.Methods: We examined in four groups of ASA I–II patients (n=30 for each) the intubating conditions three minutes after induction of anaesthesia with remifentanil 0.5 μg kg−1 min−1, propofol 2 mg kg−1 without muscle relaxants or with different doses of rocuronium (0.6 mg kg−1, 0.45 mg kg−1, 0.3 mg kg−1) applying the criteria proposed by the Copenhagen Consensus Conference. In the second part of the study the time course of neuromuscular block was determined by electromyography using train‐of‐four (TOF) stimulation. To this end, another 60 ASA I–II patients were randomly assigned to receive remifentanil 0.5 μg kg−1 min−1, propofol 2 mg kg−1 and either rocuronium 0.6 mg kg−1, 0.45 mg kg−1, 0.3 mg kg−1, or 0.3 mg kg−1 followed by neostigmine 40 μg kg−1 and atropine 20 μg kg−1 at a T1 recovery of 10% (n=15 for each).Results: Intubating conditions were good or excellent in 30 patients after rocuronium 0.6 mg kg−1 and in 18 patients when rocuronium was omitted (P<0.01). After 0.45 mg kg−1 and 0.3 mg kg−1 rocuronium the numbers were 29 and 30 patients, respectively. Reducing rocuronium from 0.6 mg kg−1 to 0.45 mg kg−1 or 0.3 mg kg−1 increased the onset time from 136 (35) s to 199 (34) s and 249 (52) s (mean (SD)), (P<0.01); the clinical duration decreased from 38 (10) min to 24 (8) min and 16 (5) min, respectively (P<0.01); and the duration to a TOF‐ratio of 0.8 decreased from 60 (11) min to 45 (9) min and 34 (7) min (P<0.01). After rocuronium 0.3 mg kg−1 this time interval further decreased to 22 (3) min when neostigmine was given at a T1 of 10% (P<0.01 compared with spontaneous recovery after rocuronium 0.3 mg kg−1).Conclusion: After remifentanil/propofol intubation conditions were poor in 40% of patients without muscle relaxants; adding reduced doses of rocuronium to this regimen improved the intubation conditions significantly. In addition, reducing the initial dose of rocuronium markedly shortened its time course of action.
Esmolol cardioplegia in unstable coronary revascularisation patients
Authors: Rinne T. , Harmoinen A. , Kaukinen S. 
Published: March 2003

Background: Esmolol has been studied and applied to control hypertension and tachycardia during open heart surgery. Esmolol has been used on a minor scale as a single cardioplegic agent. Little information is available on esmolol as a component of blood cardioplegia. In this prospective, randomised, double‐blind clinical study we investigated whether esmolol improves cardioprotection in patients scheduled for an urgent coronary operation.Methods: Forty patients with unstable angina were operated using cold blood cardioplegia as the basic cardioprotective method. Cardioplegia was infused intermittently, and esmolol was given into the cardioplegia line (15 mg/min) during cold infusions. Patients with ongoing myocardial infarction were excluded.Results: The arrest time during the cardioplegic induction or the rate of spontaneous resumption of the heart rhythm did not differ significantly between the groups. The serial measurements of plasma creatine kinase MB‐fraction activity (P=0.27), serum creatine kinase MB‐fraction mass assay (P=0.16), troponin I (P=0.41) and myoglobin (P=0.14) similarly did not differ between the groups, nor did myocardial lactate extraction (P=0.12).Conclusion: Esmolol addition to blood cardioplegia did not increase the efficacy of cardioprotection in the present study setting in unstable patients during urgent coronary revascularisation.
Topical tenoxicam from pharyngeal pack reduces postoperative sore throat
Authors: Elhakim M. , Siam A. , Rashed I. , Hamdy M. H. 
Published: March 2003

Background: One puff of beclomethasone inhaler has been shown to reduce the incidence of sore throat following endotracheal intubation. The aim of this study was to determine the effect of a pharyngeal pack on the incidence of sore throat and whether tenoxicam‐impregnated gauze pack significantly influenced the frequency of sore throat.Methods: Eighty patients undergoing general anaesthesia for elective surgery of the nasal septum were evaluated. The anaesthetist sprayed the upper airway towards the trachea with one puff of beclomethasone inhaler (50 μg) before orotracheal intubation. Patients were randomly assigned to have either a 0.2% tenoxicam‐ or a 0.9% saline‐impregnated gauze pack in the oropharynx during operation. They were evaluated for occurrence and severity of postoperative sore throat by direct questions 12–24 h after surgery.Results: Four patients who experienced any symptoms in the tenoxicam group scored mild sore throat compared to 16 patients in the control group scoring mild, gradually developing moderate or severe sore throat (P<0.01). No drug‐related side effects were observed.Conclusion: The intraoperative use of a tenoxicam‐impregnated gauze pack is effective in reducing moderate or severe postoperative sore throat following the use of throat pack.
Changes in rapidly extracted auditory evoked potentials during tracheal intubation
Authors: Urhonen E. , Jensen E. W. , Lund J. 
Published: March 2003

Background: One of the problems encountered in assessment of the hypnotic level during anesthesia is the extraction of a consistent and reliable measure online and close to real time. Hemodynamic parameters such as heart rate and blood pressure are not, at least with the traditional single parameter versus time presentation, adequate for ensuring an optimal level of anesthesia, especially when using neuromuscular blocking agents (NMBA). In the literature, it has been demonstrated that auditory evoked potentials (AEP) are able to provide two aspects relevant to determining level of anesthesia: firstly, they have identifiable anatomical significance and, secondly, their characteristics reflect the way the brain perceives a stimulus.Methods: The aim of this study was to evaluate the AEP index based on a system identification model, the autoregressive model with exogenous input (ARX‐model), and to compare it to the classical method, the moving time average (MTA). The ARX enables the extraction within 15–25 sweeps, depending on the signal‐to‐noise ratio (SNR), whereas MTA typically needs 250–500 sweeps. The hypothesis of the present study was that since the ARX‐model extracts the AEP faster than the MTA‐model, the former should be able to detect changes during the brief, intense stimulus of endotracheal intubation. Twelve female patients scheduled for gynecological surgery were included in the study. Anesthesia was initiated with thiopentone and maintained with isoflurane and alfentanil. The AEP was mapped into an index (AEP‐index) normalized to 100 when the individual was awake and decreasing to an average of 25 during thiopentone induced anaesthesia. The results were compared to those obtained by MTA‐extracted AEP.Results: During tracheal intubation 9 patients showed an increase in the ARX‐extracted AEP‐index larger than 15, and 6 of these patients showed an increase larger than 25 (mean increase=33, SD=18). The MTA‐extracted AEP‐index showed only one patient with an increase larger than 15. The ARX‐extracted AEP changed significantly faster than the MTA‐extracted AEP.Conclusion: The ARX‐extracted AEP‐index increases during tracheal intubation. There is a significant difference between the ARX‐extracted AEP and the traditional MTA‐extracted AEP, in terms of response time. In order to trace short‐lasting changes in the hypnotic level by AEP, the AEP should be extracted by a method with a fast response such as the ARX‐model.
Risk factors for postoperative anxiety in children
Authors: Caumo W. , Broenstrub J. C. , Fialho L. , Petry S. M. G. , Brathwait O. , Bandeira D. , Loguercio A. , Ferreira M. B. C. 
Published: March 2003

Background: Anxiety is defined as a set of behavioural manifestations that can be divided into state‐ and trait‐anxiety. State‐anxiety is a transitory emotional condition that varies in intensity and fluctuates over time. Trait‐anxiety is a personality trait which remains relatively stable over time. The objective of this study was to identify and quantify perioperative risk factors for immediate postoperative anxiety in children.Methods: A prospective cohort study was performed with 90 schoolchildren, ages ranging from 7 to 13 years old, ASA physical status I–II, submitted to elective surgery. The measuring instruments were verbal scale of pain, visual analogue scale (VAS), Trait‐State Anxiety Inventory for Children (STAIC), Trait‐State Anxiety Inventory (STAI) for parents, and structured questionnaire.Results: Patients not submitted to analgesic block and patients with moderate and intense pain presented an estimated risk 5‐ and 13‐fold greater for high levels of postoperative state‐anxiety, respectively. High levels of preoperative state‐anxiety and administration of doses of midazolam less than 0.056 mg · kg−1 constituted an estimated risk for postoperative state‐anxiety of 3‐ and 4‐fold, respectively. A positive history of previous surgery was associated with lower risk for postoperative anxiety.Conclusions: High levels of preoperative state‐anxiety, administration of less than 0.056 mg · kg−1 of midazolam, absence of analgesic block and presence of moderate and intense postoperative pain constituted risk factors for immediate postoperative state‐anxiety in children. Previous surgery reduced the risk for postoperative anxiety.
Occupational exposure to inhaled anaesthetics: A follow‐up study on anaesthetists of an eastern European university hospital
Authors: Wiesner G. , Harth M. , Hoerauf K. , Szulc R. , Jurczyk W. , Sobczynski P. , Hobbhahn J. , Taeger K. 
Published: March 2003

Background: Although no dose–response relationship for the health risks associated with the occupational exposure to inhaled anaesthetics exists, public health authorities recommend threshold values. The aim of the present study was to assess if and to what extent these threshold values are exceeded in an eastern European university hospital before and after measures had been taken to reduce occupational exposure.Methods: At nine workplaces occupational exposure of anaesthetists to nitrous oxide and halothane or isoflurane was measured by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces and an air‐conditioning system at one workplace.Results: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared to 1996. In 1997 most of the nitrous oxide values still exceeded the threshold value of 100 ppm, whereas most of the halothane and isoflurane values were already below the threshold values of 5 ppm and 10 ppm in 1996.Conclusion: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach western European standards. These efforts comprise structural measures such as active scavenging devices and air‐conditioning systems at all workplaces, the use of total intravenous anaesthesia, low‐flow anaesthesia and an appropriate working technique.
Intrathecal adenosine administration in abdominal hysterectomy lacks analgesic effect
Authors: Rane K. , Sollevi A. , Segerdahl M. 
Published: March 2003

Background: Adenosine (Ado) is known, from studies in both animals and humans, to produce antinociception when administered systemically or intrathecally (IT). The current aim was to evaluate, in a placebo‐controlled, randomised, double‐blind study, whether IT adenosine given before surgery could reduce anaesthetic requirement and the need of opioids during 48 h after visceral surgery.Method:Forty women (37–66 years, ASA I and II) scheduled for elective hysterectomy were included. Before inducing the standardised O2/N2O/isoflurane/fentanyl anaesthesia, the patients received an IT injection of either adenosine (500 μg in 1 ml volume) or placebo 1 ml (saline). Intraoperative anaesthetic drug doses and haemodynamics were recorded. Postoperative pain was assessed by visual analogue scale. For postoperative analgesia, cetobemidone was provided via intravenous patient‐controlled analgesia (PCA).Results: During surgery, there were no differences between groups in anaesthetic requirement or haemodynamic parameters. Postoperative cetobemidone requirements were similar in both groups (median 48 mg for adenosine/50 mg for saline) during the first 48 postoperative hours.Conclusion: IT adenosine did not influence the requirement of anaesthetic drug or postoperative analgesics after hysterectomy.
A comparison of three doses of sufentanil in combination with bupivacaine‐adrenaline in continuous epidural analgesia during labour
Authors: Eriksson S. Ledin , Frykholm P. , Stenlund P.‐M. , Olofsson CH. 
Published: March 2003

Background: Sufentanil is now frequently added to local anaesthetic in labour epidural analgesia. However, this opioid has some side effects such as pruritus, and in higher doses could harm the neonate. The purpose of this study was to compare three doses of sufentanil combined with low‐dose bupivacaine, to determine the lowest appropriate dose.Method:In a prospective, randomized, double‐blind study, 243 parturients were randomized, to receive A – 0.5 μg/ml, or B – 0.75 μg/ml or C – 1 μg/ml sufentanil, in addition to bupivacaine 0.625 mg/ml+adrenaline 1.25 μg/ml. All were given an 8 ml bolus of the study solution, followed by continuous infusion at 6 ml/h. The analgetic effect was scored on a visual analogue scale (VAS). Onset quality was measured as VAS after 20 min, the total effect as VAS maximum during the first stage of labour. Overall maternal satisfaction was recorded within two hours post partum. Side effects were noted.Results: There were no differences between groups in VAS assessments after 20 min or in maximum registered VAS. In group A, 83% had VAS 0–4 after 20 min, in group B 77% and in group C 71%. Maximum VAS during the first stage was 0–4 for 60% of group A, 68% of group B and 61% of group C . Maternal satisfaction was also the same in the three groups. In group A, 70% reported excellent effect and 22% good effect. The corresponding figures in group B were 68% and 24% respectively, and in group C 62% and 24% respectively. Group A received a mean total dose of 21 μg sufentanil, group B 30 μg and group C 44 μg. Pruritis occurred in 51% of group A, 53% of group B and 65% of group C.Conclusion: We found no difference in the analgesic effect between three different concentrations of sufentanil. We conclude that the lowest dose may be used. This should decrease the risk of adverse effects on mother and child.