bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes of Swedish physicians and nurses towards the use of life‐sustaining treatment
Authors: Sjokvist P. , Berggren L. , Cook D. J. 
Published: March 2003

Background: Withdrawal or withholding of life‐sustaining treatment have become accepted clinical practice within the intensive care unit (ICU). One important factor influencing these decisions is the attitudes of physicians and nurses.Method: Questionnaire survey of physicians and nurses in ICUs in 12 Swedish university‐affiliated and/or tertiary referral hospitals.Results: The response rate was 850 of 1081 (79%) potentially eligible health care workers. Respondents first rated the importance of 16 factors considered in the decision to withdraw life support. The most important factors were the patient’s likelihood of surviving the current episode, patient advance directives, patient age and likelihood of long‐time survival. Respondents also chose between five levels of care, ranging from comfort measures to full intensive care, in two of 12 different scenarios. Respondent characteristics affecting the level of care chosen were the number of years of ICU experience and the particular ICU in which the respondent worked.Conclusion: Advance directives are believed by Swedish intensive care personnel to be very important in the decision to withdraw life support, contrary to several descriptive studies suggesting modest patient and family influence on these decisions. Attitudes towards the intensity of care vary between different centers, raising the possibility that levels of care for similar patients may differ across the country.
A review of recovery from sevoflurane anaesthesia: Comparisons with isoflurane and propofol includingmeta‐analysis
Authors: Robinson B. J. , Uhrich T. D. , Ebert T. J. 
Published: March 2003

Background: Sevoflurane has a lower blood:gas partition coefficient than isoflurane and thus should be associated with a more rapid recovery from anaesthesia.Methods: A review and meta‐analysis were employed to examine the recovery profiles of adult patients following anaesthesia, comparing sevoflurane to isoflurane and sevoflurane to propofol.Results: There were significant differences in times to several recovery events that favoured sevoflurane to isoflurane anaesthesia, including time to emergence, response to commands, extubation, and orientation. Likewise, there were significant differences in times to the same recovery events following anaesthesia with sevoflurane versus propofol. There were no differences in time to recovery room discharge when comparing sevoflurane to isoflurane or propofol.Conclusion: The observed differences between sevoflurane and isoflurane or propofol anaesthesia support the postulate that the use of sevoflurane is associated with a more rapid recovery from anaesthesia than either isoflurane or propofol.
Cost consciousness among anaesthetic staff
Authors: Schlünzen L. , Simonsen M. S. , Spangsberg N. L. M. , Carlsson P. 
Published: March 2003

Background: Anaesthetists, like all other specialists, need to be aware of the costs of drugs, fluids and disposables commonly used in their clinical practice so that excessive costs and waste can be minimized without compromising patient care or safety. The present study describes cost consciousness among 120 anaesthetic staff members in two Danish anaesthetic departments.Method: A prospective study questioning 120 anaesthetic staff members (69 anaesthetic nurses, 35 senior anaesthetists and 16 junior anaesthetists) about the costs of 29 drugs, fluids and disposable used in routine anaesthetic practice.Results: After the study period 107 questionnaires (90%) were available for analysis. Thirty‐eight percent of all estimated costs were within 50% of the actual costs and 85% were within 100%. The costs of relatively expensive items such as isoflurane, enflurane, sevoflurane and hydroxyethyl starch were consistently underestimated, whereas cheaper items such as narcotic drugs, endotracheal tubes, intravenous tubing, plastic syringes and Quincke spinal needle were consistently overestimated. In general, the anaesthetic staff overestimated the costs by 69% (range −24% to 270%). The anaesthetic nursing group overestimated the costs by 49% (range −24% to 270%), junior anaesthetists by 94% (range 25% to 226%) and senior anaesthetists by 72% (range −14% to 135%).Conclusion: This study shows that the overall consciousness of the costs of anaesthetic drugs, fluids and disposables has to be improved in order to permit the staff to optimize resources.
Prolonged dysequilibrium between blood and brain concentrations of propofol during infusions in sheep
Authors: Ludbrook G. L. , Upton R. N. , Grant C. , Martinez A. 
Published: March 2003

Background: Previous work had shown dysequilibrium between the arterial blood and brain concentrations of the intravenous anaesthetic agent propofol following its rapid administration over 2 min to sheep. The extent of dysequilibrium was examined following slower administration as a constant rate 45‐min infusion (10 mg/min).Methods: Six sheep were prepared with arterial and sagittal sinus (effluent from the brain) blood sampling catheters and a Doppler flow probe for measuring an index of cerebral blood flow. Propofol concentrations in arterial and sagittal sinus blood during and after the infusions were measured using high‐performance liquid chromatography with fluorescence detection. Brain concentrations were calculated from these concentrations and cerebral blood flow using direct mass balance methods.Results: There was dysequilibrium between the arterial blood and brain concentrations until approximately 30 min after the start of the infusion, with marked hysteresis between the arterial blood and brain concentrations for the duration of the study. The equilibrium half‐life between the blood and the brain was 3.5 min, which is comparable to the value of 4.3 min derived from the earlier rapid administration data, suggesting there was no time dependency in the kinetics of cerebral uptake. The mass of propofol entering the brain via arterial blood was the same as the mass leaving the brain via sagittal sinus blood, suggesting minimal metabolism of propofol in the brain of sheep.Conclusion: It is clear that pharmacokinetic analysis based on arterial blood concentrations alone cannot accurately account for the concentrations of propofol at its site of action in the brain.
Topical wound anaesthesia in children – a temporary postoperative pain relief
Authors: Kokinsky E. , Cassuto J. , Sinclair R. , Rubensson A. , Nilsson K. , Larsson L. E. 
Published: March 2003

Background: Administration of local anaesthetics into the surgical wound may modulate pain at the peripheral level. A previous study in adults has shown good analgesic effects of topical lidocaine in wounds after herniorraphy.Methods: Postoperative pain relief after topical administration of 10% lidocaine aerosol in the surgical wound was investigated in a randomised, double‐blind study in children undergoing inguinal hernia repair. Forty‐four patients aged between 9 months and 11 years were randomised into three groups. One group received active treatment with a lidocaine aerosol 2.5–4.7 mg kg −1, one group received a placebo aerosol and one control group was untreated. Postoperative pain was evaluated by nurse assessment, self‐assessment and wound palpation 0, 1, 4 and 12 h after arrival in the recovery room.Results: After 1 h the incidence of pain, as estimated by behavioural assessment and self‐assessment, was significantly reduced in the lidocaine group in comparison to the placebo group, but not in comparison to the control group. The reaction on wound palpation was significantly reduced in the lidocaine group compared to both the placebo and control groups. At 0, 4 and 12 h no significant differences between the groups were observed. Plasma lidocaine concentrations were measured in six patients. Maximum individual concentrations were low, ranging from 0.17 to 0.86 μg ml−1.Conclusion: A very short and clinically insignificant pain relief is obtained following the administration of a lidocaine aerosol in the surgical wound. A low pain level in this model may limit the possibility to detect an effect of lidocaine.
Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery
Authors: Lehtipalo S. , Koskinen L‐O. D. , Johansson G. , Kolmodin J. , Biber B. 
Published: March 2003

Background: Severe postoperative pain is a well‐known problem following shoulder surgery. This study evaluates the clinical efficacy of continuous interscalene brachial plexus block, patient‐controlled analgesia, and morphine (i.v. and i.m.) for postoperative analgesia in this setting.Methods: Thirty patients, scheduled for acromioplasty during general anesthesia, were randomly allocated to one of three different postoperative pain management groups. Group MO received morphine (5 mg i.m. and 2 mg i.v.) when visual analogue pain score (VAS) >3, group PL received a continuous interscalene brachial plexus block with bupivacaine (1.25 mg kg−1+0.25 mg kg−1 h−1) and group PCA received patient‐controlled analgesia with morphine (bolus 1 mg). Postoperative pain relief was assessed (24 h) by VAS, circulatory and respiratory stress parameters (heart rate, systemic arterial pressure and respiratory rate) and stress metabolites (glucose, lactate, glycerol by abdominal subcutaneous microdialysis).Results: Pain relief in the PL group was effective (VAS <3) and significantly more potent than in groups MO and PCA, except at 16 and 20 h. Lactate was significantly increased in the PL group, glucose was significantly increased in all groups, while glycerol showed a variable pattern. There were no significant stress metabolite differences among groups. VAS showed no statistical correlation with microdialysate, respiratory or circulatory data.Conclusion: Successful continuous interscalene brachial plexus block provides very good pain relief following shoulder surgery and is superior to the other methods studied. However, we were unable to demonstrate a correlation between VAS pain scores and stress indicators in metabolic, circulatory and respiratory parameters.
Comparative effects of intravenous ketorolac and pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for paediatric strabismus surgery
Authors: Shende D. , Das K. 
Published: March 2003

Background: Corrective strabismus surgery is associated with moderate pain and a very high incidence of postoperative nausea and vomiting (PONV). Ketorolac tromethamine, a non‐steroidal anti‐inflammatory drug, is a popular analgesic in adults. There are only limited published data on the use of intravenous ketorolac for paediatric analgesia perioperatively. This study evaluated and compared the emetic and analgesic effect of ketorolac with pethidine and its suitability for this kind of surgery.Methods: Following institutional ethics committee approval and parental consent, 52 ASA class I children of age 2.5 to 15 yr were randomised to receive either ketorolac 0.9 mg kg−1 or pethidine 0.5 mg kg−1 given intravenously (IV). A blinded observer assessed recovery by Steward’s method immediately after arrival at the post anaesthesia care unit (PACU), pain by validated Objective Pain Score (OPS) at 0 h, 1/2 h and 1 h after arrival at the PACU and PONV by Numeric Rank Score at specified time intervals.Results: There were no differences in demographic data, anaesthesia time or surgery duration. Recovery scores, OPS and postoperative analgesic requirement were similar in both groups. PONV at various time intervals for the first 24 h, occurred more frequently in the pethidine group as compared to the ketorolac group (P<0.001) There were no side effects observed with either drug.Conclusion: Ketorolac in a dose of 0.9 mg kg−1 IV at the induction of anaesthesia is as effective as pethidine 0.5 mg kg−1 IV as an analgesic and is associated with significantly less PONV.
Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery
Authors: Alkaissi A. , Stålnert M. , Kalman S. 
Published: March 2003

Background: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the “true” and placebo effect of acupressure in prevention of postoperative nausea and vomiting (PONV).Patients and methods: Sixty women undergoing outpatient minor gynaecological surgery were entered into a double‐blind and randomised study. One group received acupressure with bilateral stimulation of P6 (A), a second group received bilateral placebo stimulation (P) and a third group received no acupressure wrist band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. In addition, the need for rescue antiemetic medication and nausea after 24 h was registered.Results: Complete response was obtained in 11, 11 and 9 patients in groups, A, P and R, respectively. Nine, 7 and 6 patients had nausea before discharge home, and 1, 1 and 8 patients were nauseated (8 vs 1 patient: P<0.05 ) 24 h after operation in A, P and R groups, respectively. When compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly (P<0.05) fewer needed rescue antiemetic medication after acupressure at P6 (no vomiting or rescue medication). When compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited after acupressure (P<0.05)Conclusion: In patients undergoing brief gynaecological surgery, placebo effect of acupressure decreased nausea after 24 h but vomiting and need of resuce antiemetics was reduced only by acupressure with the correct P6 point stimulation.
Production of nitrogen dioxide during nitric oxide therapy using the Servo Ventilator 300 during volume‐controlled ventilation
Authors: Lindberg L. , Rydgren G. 
Published: March 2003

Background: Inhaled nitric oxide may be useful in the treatment of pulmonary hypertension and hypoxaemia. Nitric oxide is rapidly oxidized to nitrogen dioxide, which is toxic and may adversely affect the airways of the patient. The aim of the present investigation was to examine factors that may affect the concentration of nitrogen dioxide, using the Servo Ventilator 300 nitric oxide delivery system, where nitric oxide is flow‐proportionally mixed with the main ventilatory flow in the proximal part of the inspiratory limb.Methods: In this experimental study nitric oxide and nitrogen dioxide levels were measured at the inspiratory site of a Y‐piece with a chemiluminescence analyzer and electrochemical fuel cells. The effects of different concentrations of nitric oxide and oxygen, minute volume, different tube lengths, a soda lime absorber, and a humidifier placed in the inspiratory limb were evaluated.Results: The concentration of nitrogen dioxide was dependent on the concentrations and residence time of nitric oxide with oxygen and the minute volume ventilation used. A soda lime absorber reduced concentrations of nitrogen dioxide at the expense of almost corresponding reductions in inhaled concentrations of nitric oxide. A humidifier increased the concentration of nitrogen dioxide, to an extent depending on the water volume and temperature used.Conclusion: Concentrations of nitric oxide and oxygen, minute volume ventilation, and residence time in the inspiratory part of the ventilatory circuit were factors that affected the generation of nitrogen dioxide. A soda lime absorber in this system is not recommended.
Positive end‐expiratory pressure prevents atelectasisduring general anaesthesia even in the presence of a high inspired oxygen concentration
Authors: Neumann P. , Rothen H. U. , Berglund J. E. , Valtysson J. , Magnusson A. , Hedenstierna G. 
Published: March 2003

Background: General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86–90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end‐expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2=1.0.Methods: Atelectasis was evaluated by computed tomography (CT) in 13 ASA I–II patients undergoing elective surgery. CT scans were obtained before and 15 min after induction of anaesthesia. Then, recruitment of collapsed lung tissue was performed as a “vital capacity manoeuvre” (VCM, inspiration with Paw=40 cmH2O for 15 s), and a CT scan was obtained at the end of the VCM. Thereafter, PEEP=0 cmH2O was applied in group 1, and PEEP=10 cmH2O in group 2. Additional CT scans were obtained after the VCM. Oxygenation was measured before and after the VCM.Results: Atelectasis (>1 cm2) was present in 12 of the 13 patients after induction of anaesthesia. At 5 and 10 min after the VCM, atelectasis was significantly smaller in group 2 than group 1 (P<0.005). A significant inverse correlation was found between PaO2 and atelectasis.Conclusions: PEEP=10 cmH2O reduced atelectasis formation after a VCM, when FiO2=1.0 was used. Thus, a VCM followed by PEEP=10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.
Intraoperative glucose administration influences respiratory quotient during paediatric anaesthesia
Authors: Sandström K. , Larsson L. E. , Nilsson K. , Stenqvist O. 
Published: March 2003

Background: Oxidation of carbohydrates and fat yields respiratory quotients (RQ) of 1.0 and 0.7 respectively. Maintained or increased blood glucose concentrations are usually seen during paediatric anaesthesia and surgery even without glucose administration. The aim of the present study was to evaluate whether an intraoperative glucose infusion influences the RQ as an indication of a different metabolic preference in comparison to a glucose‐free fluid regime.Methods: Eighteen children between 0.5 and 24 months of age were studied during anaesthesia with controlled ventilation, oxygen in air, isoflurane, thiopentone, atracurium and fentanyl. Oxygen consumption and carbon dioxide production were measured using indirect calorimetry All children received Ringer acetate as needed; in addition, nine children were given glucose 10%, 3 ml  ·  kg−1  ·  h−1, corresponding to 300 mg  ·  kg−1  ·  h−1. Blood samples for analyses of glucose, lactate, free fatty acids and ketones were taken before and during surgery.Results: RQ was significantly higher in the children given glucose 0.92±0.08, compared to 0.81±0.06 in the children without glucose (P<0.01). Oxygen consumption tended to be higher, although not significantly so, in patients without glucose infusion. Energy expenditure was 1.70±0.29 kcal  ·  kg−1  ·  h−1, without significant group differences. Higher blood glucose concentrations during surgery were found in the children given glucose.Conclusions: Our results indicate a higher glucose oxidation rate in patients given glucose during surgery.
Single‐dose spinal anaesthesia versus incremental dosing for lower limb vascular surgery
Authors: Lundorff L. , Dich‐Nielsen J. O. , Laugesen H. , Jensen M. M. 
Published: March 2003

Background: In patients scheduled for vascular surgery, atherosclerotic disease is highly prevalent. Haemodynamic reactions are often aggravated when spinal analgesia is used in this population. No randomized studies have been conducted comparing single shot (SS) with continuous spinal analgesia (CSA) for vascular patients. We did a prospective randomized study comparing haemodynamics when SS versus CSA was performed.Methods: Sixty patients were randomized to have SS or CSA. The power of the study was 0.90. Patients in the SS group received 17.5 mg bupivacaine and in the CSA group 5 mg was given initially and incremental doses of 2.5 mg were given until an analgesic level of T‐11 was reached. Mean arterial pressures (MAP) were measured invasively. ST‐analysis was done continuously. Postoperatively, the patients were interviewed using a standardized questionnaire. Back pain, neurologic sequelae and post‐dural puncture headache (PDPH) were investigated.Results: There was no significant difference between the analgesic levels (T‐7/T‐8), the decrease in MAP, the number of patients needing ephedrine and the total amount of ephedrine given in the two groups. The motor blockade was more pronounced in the SS group (P<0.001) and the total amount of bupivacaine used was 17.5 mg compared to 7.5 mg (5–17.5) in the CSA group (P<0.001). One patient suffered PDPH which was slight and responded to a nonsteroidal anti‐inflammatory drug. Two patients in each group had transient paraesthesias in the legs. There were technical problems with the spinal catheter in 4 patients, and these were excluded from the study.Conclusion: In this study we found no difference in the haemodynamic response to SS or CSA in patients scheduled for vascular surgery of the legs. SS is easier to apply and is recommended when the duration of surgery allows for it.
The sevoflurane‐sparing effect of nitrous oxide: a clinical study
Authors: Jakobsson J. , Heidvall M. , Davidson S. 
Published: March 2003

Background: We studied the sevoflurane‐sparing effect of nitrous oxide in a prospective randomised study.Methods: Forty‐two ASA I–II patients scheduled for elective knee arthroscopy under general anaesthesia were randomly assigned to a fresh gas flow consisting of oxygen in air or oxygen in nitrous oxide 1:2. All patients received a standardised anaesthesia consisting of induction with fentanyl and propofol and maintenance with sevoflurane adjusted according to clinical signs. The sevoflurane consumption was studied by means of weighing the vaporiser before and after every anaesthesia.Results: The mean sevoflurane consumption was reduced from 0.62 to 0.25 g/min, a 60% reduction, by the use of oxygen in nitrous oxide 1:2 in the fresh gas flow. The emergence was faster for the patients receiving nitrous oxide. No major differences were observed during recovery.Conclusion: Nitrous oxide was found to be cost‐effective for use during short ambulatory knee arthroscopy.
Local vascular response during organ elevation
Authors: Kongstad L. , Grände P.‐O. 
Published: March 2003

Background: Dural puncture can be followed by postural headache and, in patients with cerebral infections, by brain stem herniation. The present study evaluates whether these complications may be related to the changes in hydrostatic pressure generated by the spinal fluid column when the dural sac surrounding the cerebrospinal tissue has been punctured.Method: An isolated cat skeletal muscle enclosed in a plethysmograph connected to a tube served as a model imitating the brain, the cranium and the spinal canal. We investigated effects of organ elevation on tissue pressure, venous collapse (venous outflow resistance) and tissue volume with closed “spinal” tube (intact dural sac) and open “spinal” tube (dural puncture), and effects of compliance of the draining veins.Results: Organ elevation with closed “spinal” tube induced a decreased tissue pressure, whereas tissue pressure remained unchanged if arterial inflow pressure to the muscle was kept constant. Organ elevation with the “spinal” tube opened distally caused a significantly larger decrease in tissue pressure, venous dilation and disappearance of venous outflow resistance. Transcapillary filtration increased, and the filtration rate was higher with high than with low venous compliance.Conclusion: If our results are applicable to the brain, changing to an upright position following a lumbar dural puncture may generate a negative hydrostatic force and a negative interstitial cerebral pressure, causing an increased transvascular pressure and dilation of the cerebral outflow veins. The corresponding increase in cerebral blood volume may induce post‐spinal headache, and the increased transcapillary pressure may cause increased fluid filtration and brain oedema if the blood‐brain barrier is disrupted.