bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects
Authors: Alho O.‐P. , Karttunen T. J. , Karttunen R. , Tuokko H. , Koskela M. , Suramo I. , Uhari M. 
Published: July 2003

Background:  Viral cold is thought to be the major contributing factor in the pathogenesis of sinusitis, as it causes ostiomeatal obstruction. The aim was to evaluate whether paranasal sinus functioning during viral colds is similar in subjects with and without allergic rhinitis.Methods:  Forty‐eight volunteers were examined during an early (2–4 days) natural cold and again 3 weeks later. The examinations included computed tomography (CT) scans, nasal mucosal biopsies, and viral and bacterial specimens. Subjects with positive skin prick tests and persistent or intermittent rhinitis were considered to have allergic immunoglobulin E (IgE)‐mediated rhinitis. In addition, specific IgE antibodies to staphylococcal enterotoxin B (SEB) were measured.Results:  Nine subjects (19%) had allergic rhinitis. The allergic subjects were significantly more often IgE sensitized to SEB than the nonallergic subjects (33%vs 3%, P = 0.02). Viral etiology of the cold was identified in 32 (67%) subjects. The subjects with allergic rhinitis had significantly higher CT scores compared with nonallergic subjects during the colds (median (range) scores 16 (6–22) vs 6 (0–17), P = 0.004). In both groups, the median scores declined markedly during convalescence, but the difference remained significant (P = 0.009). Among the allergic subjects, those who were IgE sensitized to SEB tended to have the highest CT scores [median (range) 16 (16–22)]. Total serum IgE and the nasal subepithelial eosinophil counts correlated with the CT scores during the cold (rs = 0.38, P = 0.008 and rs = 0.46, P = 0.001, respectively).Conclusions:  Subjects with allergic IgE‐mediated rhinitis had more severe paranasal sinus changes in CT scans than nonallergic subjects during viral colds. These changes indicate impaired sinus functioning and may increase the risk of bacterial sinusitis.
Low utilisation of unactivated protein C in a patient with meningococcal septic shock and disseminated intravascular coagulation
Authors: Lignell A. , Siegbahn A. , Stridsberg M. , Pauksen K. , Gedeborg R. , Sjölin J. 
Published: July 2003

Background:  Activated protein C has recently been shown in a multicentre trial to significantly reduce mortality in patients with septic shock. There are also some case reports and minor studies demonstrating promising results with the unactivated form of protein C. However, in children with severe meningococcal infection, skin biopsies have demonstrated low expression of endothelial thrombomodulin and protein C receptors, suggesting low protein C activation capacity in severe meningococcal sepsis.Methods:  A patient with meningococcal septic shock was treated with two doses of the unactivated form of protein C, the first during intense activation of the coagulation system and the second during a phase of low grade or no activation. Repeated plasma samples were analysed for protein C concentration, which made it possible to compare pharmacokinetics and half‐lives of the two administrations. A shorter half‐life during intense coagulation was expected if there was an activation and consumption of the protein C administered.Results:  The calculated half‐lives of protein C during intense and low grade activation were 32 h and 19 h, respectively, a magnitude similar to that reported in protein C‐deficient patients without infection.Conclusion:  The result indicates that whole body utilisation of the unactivated protein C was low. Endothelial impairment of protein C activation does not seem to be restricted to the skin vessels only.
Pneumoperitoneum versus abdominal wall lift: effects on central haemodynamics and intrathoracic pressure during laparoscopic cholecystectomy
Authors: Andersson L. , Lindberg G. , Bringman S. , Ramel S. , Anderberg B. , Odeberg‐Wernerman S. 
Published: July 2003

Background:  It has been shown repeatedly that laparoscopic cholecystectomy using pneumoperitoneum (CO2 insufflation) may be associated with increased cardiac filling pressures and an increase in blood pressure and systemic vascular resistance. In the present study, the effects on the central circulation during abdominal wall lift (a gasless method of laparoscopic cholecystectomy) were compared with those during pneumoperitoneum. The study was also aimed at elucidating the relationships between the central filling pressures and the intrathoracic pressure.Methods:  Twenty patients (ASA I), scheduled for laparoscopic cholecystectomy, were randomised into two groups, pneumoperitoneum or abdominal wall lift. Measurements were made by arterial and pulmonary arterial catheterization before and during pneumoperitoneum or abdominal wall lift with the patient in the horizontal position. Measurements were repeated after head‐up tilting the patients as well as after 30 min head‐up tilt. The intrathoracic pressure was monitored in the horizontal position before and during intervention using an intraesophageal balloon.Results:  After pneumoperitoneum or abdominal wall lifting there were significant differences between the two groups regarding MAP, SVR, CVP, CI, and SV. Analogous to previous studies, in the pneumoperitoneum group CVP, PCWP, MPAP, and MAP as well as SVR were increased after CO2 insufflation (P < 0.01), while CI and SV were not affected. In contrast, in the abdominal wall lift group, CI and SV were significantly increased (P < 0.01), as was MAP (P < 0.01), while CVP, PCWP, MPAP, and SVR were not significantly affected. There was a significant difference in intraesophageal pressure between the two groups. In the pneumoperitoneum group, the intraesophageal pressure was increased by insufflation (P < 0.01) while, in the abdominal wall lift group, it was unaffected. In the pneumoperitoneum group the mean increases in cardiac filling pressures were of the same magnitude as the mean increase in the intraesophageal pressure.Conclusions:  In healthy patients, abdominal wall lift increased cardiac index while pneumoperitoneum did not. Cardiac filling pressures and systemic vascular resistance were increased by pneumoperitoneum but unaffected by abdominal wall lift. The recorded elevated cardiac filling pressures during pneumoperitoneum may be only a reflection of the increased intra‐abdominal pressure.
Influence of the cortical electrical activity level during general anaesthesia on the severity of immediate postoperative pain in the morbidly obese
Authors: Gurman G. M. , Popescu M. , Weksler N. , Steiner O. , Avinoah E. , Porath A. 
Published: July 2003

Background:  The objective of anaesthesia is to provide hypnosis, analgesia and adequate conditions during surgery. It is difficult to establish the appropriate dose of general anaesthetic drugs in the morbidly obese patient. Moreover, there are conflicting data concerning adequate anaesthesia levels and the severity of postoperative pain.The aim of this study was to investigate the relationship between the spectral edge frequency (SEF) during general anaesthesia and the severity of immediate postoperative pain following gastric banding surgery in morbidly obese patients.Methods:  Seventy‐one ASA 2 morbidly obese patients (BMI > 35%) undergoing elective laparoscopic gastric banding procedure were recruited for this study.Anaesthesia consisted of midazolam, fentanyl and thiopental for induction, vecuronium for muscle relaxation, N2O and isoflurane with additional fentanyl administrations, according to the clinical judgement of the anaesthesiologist, for maintenance.Continuous SEF monitoring was added to the standard monitors (SpO2, ETCO2, ECG, NIBP, O2 and isoflurane concentration), but the EEG monitor screen was hidden from the anaesthesiologist's sight.SEF postoperative analysis divided the patients into two groups: group 1, SEF‐recommended target range of 8–12 Hz, more than 80% of the surgical time; and group 2, SEF‐recommended target range of 8–12 Hz, less than 80% of the surgery duration. Pain intensity was assessed in the post anaesthesia care unit using a standard visual analogue scale (VAS) of 10 cm, when patients were awake enough to correct a deliberately given wrong own telephone or ID number. Intravenous morphine was administered for postoperative analgesia in 2‐mg increments, every 3–4 min, until the patient felt comfortable.A recovery room nurse unaware of the SEF range recorded during surgery registered pain severity and morphine requirements.Results:  The end‐tidal isoflurane concentration was significantly higher in group 1 than in group 2 (0.83 vs. 0.7 P = 0.016). The intensity of pain at admission into the recovery room and at discharge was significantly lower in group 1 than in group 2 (VAS 6.1 vs. 6.9–P = 0.0049, and 3.9 vs. 4.2–P = 0.00478, respectively).Conclusions:  Keeping the SEF range between 8 and 12 Hz during anaesthesia for laparoscopic gastric banding for morbid obesity, both the immediate post operative pain intensity and morphine requirement, are significantly reduced.
What anaesthetists need to know about viral hepatitis
Authors: Lentschener C. , Ozier Y. 
Published: July 2003

Background:  Viral hepatitis is a major world‐wide public health issue. An increasing number of virus hepatitis carriers with acute or chronic hepatitis at all stages of the disease will be referred to anaesthetists. An update of what anaesthetists should know about viral hepatitis was believed to be warranted.Methods:  The present review focuses on (a) diagnosis criteria and main biological and clinical patterns of acute and chronic hepatitis, and (b) extrahepatic manifestations, and adverse effects resulting from specific drug therapy likely to influence anaesthetic care.Results:  Elective surgery should be postponed and any medications that could be harmful to the liver should be disregarded in patients suspected of having acute viral hepatitis. A prothrombin time decrease to less than 50% (INR > 1.75) is the first sign of acute severe liver failure. Extrahepatic manifestations resulting mainly from small‐ and medium‐sized vessel alteration, and adverse effects caused by specific drug therapy are associated with chronic viral hepatitis and are likely to alter anaesthetic care. A titrated anaesthesia should be provided and agents not eliminated by the liver should be favoured. Vasopressor therapy should be administered early to control a systemic intraoperative blood pressure decrease associated with a high cardiac output. Prophylactic antibiotics should take into consideration the risk of translocation of gut bacteria to the systemic circulation. Prophylactic guidelines of hepatitis nosocomial transmission should be respected.Conclusions:  Anaesthetists are likely to play a key role in immediate acute hepatitis and chronic hepatitis perioperative assessment and care.
Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia
Authors: Greif R. , Laciny S. , Rajek A. , Doufas A. G. , Sessler D. I. 
Published: July 2003

Background:  Mild perioperative hypothermia produces morbid cardiac outcomes that may result from sympathetically induced hypertension. However, volatile anesthetics produce vasodilatation that may reduce the hemodynamic response to hypothermia. We tested the hypothesis that the volatile anesthetics isoflurane and desflurane blunt the normal cold‐induced hypertensive response.Methods:  We analyzed prospective data from three analogous studies: 1) 10 volunteers given desflurane (2.6 Volume percentage) maintained in left‐lateral position; 2) nine volunteers without anesthesia or anesthetized with various doses of desflurane; and 3) eight volunteers given various concentrations of isoflurane. Mean skin temperature was reduced to 31 C, which decreased core body temperature and triggered thermoregulatory vasoconstriction. Mean arterial pressures were determined before and after hypothermia provoked intense thermoregulatory vasoconstriction.Results:  The hemodynamic responses to thermoregulatory vasoconstriction were similar without anesthesia and at all concentrations of desflurane and isoflurane. On average, mean arterial pressure increased 14 (SD = 5) mmHg with and without anesthesia.Conclusion:  We conclude that thermoregulatory vasoconstriction significantly increases arterial pressure with or without isoflurane or desflurane anesthesia.
Anesthesia‐related mortality and morbidity over a 5‐year period in 2,363,038 patients in Japan
Authors: Kawashima Y. , Takahashi S. , Suzuki M. , Morita K. , Irita K. , Iwao Y. , Seo N. , Tsuzaki K. , Dohi S. , Kobayashi T. , Goto Y. , Suzuki G. , Fujii A. , Suzuki H. , Yokoyama K. , Kugimiya T. 
Published: July 2003

Background:  Statistical data of mortality and morbidity related to anesthesia have not been reported in Japan since World War II. The need to comprehensively examine the events of cardiac arrest as well as mortality prompted the first national study in Japan.Methods:  Confidential questionnaires were sent to all Japan Society of Anesthesiologists Certified Training Hospitals every year from 1994 through 1998. Collected data were analyzed for incidence of cardiac arrest and other critical events during anesthesia and surgery, and their outcomes within 7 postoperative days. The principal causes of the critical incidents were also analyzed.Results:  With an average response rate of 39.9%, a total of 2,363,038 cases were documented over 5 years. The average incidence per year of cardiac arrest during surgery due to all etiologies and that totally attributable to anesthesia was 7.12 [95%CI: 6.30,7.94] and 1.00 [0.88, 1.12]) per 10,000 cases, respectively. The average mortality per year in the operating room or within 7 postoperative days due to all etiologies and that totally attributable to anesthesia was 7.18 [6.22, 8.13] and 0.21 [0.15, 0.27] per 10,000 cases, respectively. The two principal causes of cardiac arrest during anesthesia and surgery due to all etiologies were massive hemorrhage (31.9%) and surgery (30.2%), and those totally attributable to anesthesia were drug overdose or selection error (15.3%) and serious arrhythmia (13.9%). Preventable human errors caused 53.2% of cardiac arrest and 22.2% of deaths in the operating room totally attributable to anesthesia.Conclusions:  The rates in Japan of cardiac arrest and death during anesthesia and surgery due to all etiologies as well as those totally attributable to anesthesia are comparable to those of other developed countries.
Aerosolized surfactant and dextran for experimental acute respiratory distress syndrome caused by acidified milk in rats
Authors: Cui XG. , Tashiro K. , Matsumoto H. , Tsubokawa Y. , Kobayashi T. 
Published: July 2003

Background:  Inhibition of pulmonary surfactant by plasma‐derived proteins is an important pathogenetic factor of acute respiratory distress syndrome (ARDS). Inhalation of aerosolized surfactant may be suitable for early treatment of ARDS. However, requirement of a high dose is a drawback. Because dextran reverses surfactant inhibition, we examined whether dextran improves the therapeutic effects of aerosolized surfactant in rats with experimental ARDS.Methods:  Acidified milk (pH 1.8, 1.5 ml kg−1) was injected into the trachea of the rats ventilated with pure oxygen using 2.45 kPa peak inspiratory pressure and 0.74 kPa positive end‐expiratory pressure. When PaO2 decreased to <13 kPa, the rats were assigned to four groups: control group (n = 8), receiving no material; D‐only group (n = 6), receiving aerosolized dextran for 45 min; S‐only group (n = 8), receiving aerosolized modified natural surfactant (MNS) for 30 min; and S‐plus‐D group (n = 9), receiving aerosolized MNS for 30 min followed by aerosolized dextran for 15 min.Results:  In the control group and D‐only groups, the mean PaO2 remained at <10 kPa for 180 min. In the S‐only and S‐plus‐D groups, the PaO2 increased to 50 kPa (P < 0.01 vs. untreated). The PaO2 of the surfactant‐only group gradually decreased to <17 kPa at 180 min, whereas the PaO2 of the S‐plus‐D group was maintained at >38 kPa for 180 min (P < 0.01 vs. S‐only group).Conclusion:  Inhalation of aerosolized dextran potentiates the effects of aerosolized surfactant by prolonging the therapeutic response.
Comparison of transcutaneous and endtidal CO2‐monitoring for rigid bronchoscopy during high‐frequency jet ventilation
Authors: Simon M. , Gottschall R. , Gugel M. , Fritz H. , Mohr S. , Klein U. 
Published: July 2003

Objective:  To compare endtidal and transcutaneous respiratory monitoring of high‐frequency jet ventilation (HFJV) in rigid bronchoscopy. Both techniques provide a noninvasive measurement of pCO2.Methods:  High‐frequency jet ventilation was applied via a rigid bronchoscope. Driving pressure (DP) was initially adapted to ensure normal ventilation. It was then changed twice by ±30% from the initial value. Endtidal and transcutaneous data were compared with arterial blood gas monitoring (ABG).Results:  Results were analyzed separately for the time just after changing the driving pressure (10 min) and the remaining time until the next change of the driving pressure (4 min). The first part was called the dynamic phase, and the second part the steady‐state phase. Correlation coefficient between endtidal capnography and ABG was 0.96 for the steady state and 0.94 for the dynamic phase, respectively. Bland‐Altman analysis revealed a bias of −0.21 kPa with limits of agreement (LOA) 1.63 kPa for the steady state and −0.25 kPa, 2.08 kPa for the dynamic phase, respectively. Correlation coefficient between transcutaneous monitoring and ABG for the steady state phase was 0.83, and was 0.72 for the dynamic phase. Bland‐Altman analysis resulted in a bias of −0.89 kPa with LOA − 3.84 kPa during steady state and 0.92 kPa, 4.06 kPa for the dynamic phase, respectively.Conclusion:  Endtidal capnography offers accurate respiratory monitoring of HFJV. Transcutaneous monitoring showed a good correlation to ABG only during steady‐state conditions. For the dynamic phase the accuracy was significantly lower. Thus, we cannot recommend transcutaneous respiratory monitoring for the specific indication of rigid bronchoscopy using HFJV.
Acupuncture fails to reduce but increases anaesthetic gas required to prevent movement in response to surgical incision
Authors: Kvorning N. , Christiansson C. , Beskow A. , Bratt O. , Åkeson J. 
Published: July 2003

Background:  Acupuncture is used for clinical pain relief but has not been evaluated under clinical anaesthesia. This study was designed to compare movement in response to surgical incision in anaesthetized patients subjected to electro‐acupuncture (EA) or sham procedures. Our hypothesis was that EA stimulation would reduce the requirements for anaesthetic gas.Methods:  Forty‐six healthy women, scheduled for laparoscopic sterilization at a Swedish county hospital, were randomized to have either the electro‐acupuncture (n = 23) or sham (n = 23) procedure between the induction of general anaesthesia and the start of surgery. The minimal alveolar concentration (MAC) of sevoflurane required to prevent neck or major limb movements in response to surgical incision was determined in each group of patients.Results:  The MAC for sevoflurane was found to be higher in the group given acupuncture than in the control group (2.1 ± 0.3% vs. 1.8 ± 0.4%; P = 0.008).Conclusion:  Electro‐acupuncture given during general anaesthesia with sevoflurane failed to reduce but instead increased the clinical need for anaesthetic gas, possibly by reducing the anaesthetic effect of sevoflurane and/or by facilitating nociceptive transmission and/or reflex activity.
Dexamethasone is as effective as ondansetron for the prevention of postoperative nausea and vomiting following breast surgery
Authors: Wattwil M. , Thörn S‐E. , Lövqvist Å. , Wattwil L. , Gupta A. , Liljegren G. 
Published: July 2003

Introduction:  Postoperative nausea and vomiting remain a common problem following breast surgery. This study assesses whether dexamethasone is as effective as ondansetron in the control of postoperative nausea and vomiting (PONV).Methods:  Eighty ASA I–III patients undergoing breast surgery for carcinoma of the breast were included in the study. Following premedication with diazepam 5–10 mg, patients were induced with fentanyl 50 µg and propofol 2–2.5 mg kg−1. A larynx mask was inserted and anesthesia maintained with sevoflurane in oxygen and nitrous oxide. Patients were then randomly divided into two groups: Group D (dexamethasone) was given 4 mg dexamethasone i.v. after induction and Group O (ondansetron) was given 4 mg ondansetron at the same time point. Postoperatively, nausea, vomiting and pain were recorded at 1‐h intervals during 4 h, and thereafter every 4 h during 24 h.Results:  The incidence of PONV during 24 h was 37% and 33% in Group D and Group O, respectively (NS). No differences were found between the groups in the incidence of postoperative nausea, vomiting or pain at the different time intervals. No differences were found in the incidence of PONV in smokers vs. non‐smokers. No side‐effects of these drugs were observed.Conclusions:  Ondansetron 4 mg or dexamethasone 4 mg are equally effective in the prevention of postoperative nausea and vomiting following breast surgery. Other factors being similar, the difference in cost between these drugs would favor the use of dexamethasone instead of ondansetron when monotherapy against PONV is used.
ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia
Authors: Höhne C. , Meier L. , Boemke W. , Kaczmarczyk G. 
Published: July 2003

Background:  This study investigates whether long‐term treatment with an angiotensin converting enzyme inhibitor (ACEI) impairs the hemodynamic regulation during the early phase of spinal anaesthesia.Methods:  Forty‐two patients undergoing minor surgery were studied. Twenty‐one patients were long‐term treated (ACEI group), while the other patients served as controls (nonACEI group). All patients received a balanced electrolyte solution(6 ml kg−1) 20 min before spinal anaesthesia.Results:  Mean arterial blood pressure decreased 19% in both groups within 20 min after spinal anaesthesia. Heart rate did not change in either group. Plasma renin concentration increased from 7.3 ± 2.1 to 12.8 ± 4 pg ml−1 during spinal anaesthesia in nonACEI patients (P < 0.05), whereas an elevated plasma renin level remained unchanged in the nonACEI group. The angiotensin II concentration increased in both groups during spinal anaesthesia (P < 0.05). The vasopressin concentration did not change during spinal anaesthesia in the ACEI group, but increased from 1.2 ± 0.3 to 2.2 ± 0.5 pg ml−1 in patients with ACEI treatment (P < 0.05). The norepinephrine concentration increased transiently 5 min after spinal anaesthesia in both groups, and returned to baseline levels within 15 min.Conclusion:  Long‐term ACEI treatment does not further exaggerate the blood pressure decrease in the early phase of spinal anaesthesia. The increase in vasopressin concentrations in ACEI treated patients seems to be sufficient to compensate for the inhibited renin‐angiotensin system. In addition, the transient increase in plasma norepinephrine, which occurs independent of preoperative ACEI treatment, seems to be involved in blood pressure regulation during spinal anaesthesia.