bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seizure duration with remifentanil/methohexital vs. methohexital alone in middle‐aged patients undergoing electroconvulsive therapy
Authors: Smith D. L. , Angst M. S. , Brock‐Utne J. G. , DeBattista C. 
Published: September 2003

Background:  The object of this study was to test whether substituting part of the methohexital dose with the short‐acting opioid remifentanil would prolong seizure duration in middle‐aged patients while providing a similar depth of anesthesia as with methohexital alone. This has been reported for the combined use of methohexital and remifentanil in elderly patients, but has not been investigated in middle‐aged patients likely to require a higher total dose of methohexital for inducing anesthesia.Method:  Seven patients (42±10 years; mean ±SD) receiving electroconvulsive therapy (ECT) were anesthetized with methohexital (1.25 mg kg−1) or with methohexital (0.625 mg kg−1) plus remifentanil (1 µg kg−1) in this randomized, double blind, crossover study. Additional methohexital was given as needed until loss of eyelash reflex was observed. Suxamethonium (1 mg kg−1) was used for muscular paralysis.Results:  Motor and EEG seizure durations were significantly longer after induction with methohexital plus remifentanil (45±14 and 58±15 s) than with methohexital alone (31±11 and 42±18 s). A methohexital dose of 1.2±0.3 and 1.9±0.3 mg was necessary to achieve loss of eyelash reflex if methohexital was used with and without remifentanil. Peak heart rate after ECT was significantly higher if remifentanil was coadministered with methohexital (148±12 vs. 126±24 b.p.m).Conclusion:  Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle‐aged patients requiring a 1.5‐fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.
Intrathecal midazolam added to bupivacaine improves the duration and quality of spinal anaesthesia
Authors: Bharti N. , Madan R. , Mohanty P. R. , Kaul H. L. 
Published: September 2003

Background:  The antinociceptive action of intrathecal midazolam is well documented. In this prospective study, we investigated the addition of midazolam to intrathecal bupivacaine on the duration and quality of spinal blockade.Methods:  Forty ASA I or II adult patients undergoing lower abdominal surgery were selected for the study. The patients were randomly allocated to receive 3 ml of 0.5% hyperbaric bupivacaine intrathecally either alone or with 1 mg of midazolam using a combined spinal epidural technique. The duration and quality of sensory and motor block, perioperative analgesia, haemodynamic changes, and sedation levels were assessed.Results:  The duration of sensory block (i.e. time to regression to the S2 segment) was significantly longer in the midazolam group than the control group (218 min vs. 165 min; P < 0.001). The duration of motor block was also prolonged in the midazolam group as compared with the control group (P < 0.01). In 90% of the patients in the midazolam group, the quality of block was adequate during the intra‐operative period as compared with only 65% of the patients in the control group (P < 0.05). The duration of effective analgesia was longer in the midazolam group than in the control group (199 vs. 103 min; P < 0.001). Blood pressure, heart rate, oxygen saturation and sedation scores were comparable in both groups. No neurological deficit or other significant adverse effects were recorded.Conclusion:  The addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without significant side‐effects.
Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double‐blind clinical trial
Authors: Debreceni G. , Molnár Z. , Szélig L. , Molnár T. F. 
Published: September 2003

Background:  Pain following thoracotomy is frequently associated with clinically important abnormalities of pulmonary function. The aim of the current study was to compare the efficacy of continuous thoracic epidural analgesia (EDA) to continuous intercostal (IC) block for postoperative pain and pulmonary function in a prospective, randomized, double‐blinded clinical trial.Methods:  Fifty patients undergoing lung lobectomy for malignancies were randomized into two groups (25/group). Respiratory function (forced vital capacity, forced expiratory volume per 1 s/forced vital capacity, maximum midexpiratory flow rate, peak expiratory flow rate) were evaluated preoperatively, within 4 h after the operation and on the first postoperative day. Visual analog scale (VAS: 0–10) scores were evaluated four‐hourly for 20 h.Results:  The VAS scores were significantly lower in the EDA versus IC group at the 4th, 8th, and 12th h of observation (mean ± SD) 5.5 ± 2.9 vs. 7.3 ± 2.2 P = 0.04; 4.1 ± 2.1 vs. 5.1 ± 2.9 P = 0.02; 3.6 ± 1.9 vs. 5.2 ± 2.4 P = 0.01, respectively. Respiratory function parameters deteriorated significantly in both groups (P < 0.001) with no significant difference between the groups. Only one major adverse effect was detected: one patient suffered from rib osteomyelitis after intercostal cannulation and healed following surgical repair.Conclusions:  The results of the present study show that following thoracotomy in the early postoperative period continuous EDA is a better pain relieving method than continuous IC block, as indicated by the VAS scores.
Pancuronium bromide, a non‐depolarizing muscle relaxant which promotes apoptosis of blood lymphocytes in vitro
Authors: Delogu G. , Moretti S. , Marcellini S. , Antonucci A. , Tellan G. , Marandola M. , Signore M. , Famularo G. 
Published: September 2003

Background:  Several compounds used in anesthesia practice have demonstrated to impair immune function and to influence the process of apoptotic death in T cell population following surgical trauma. We designed this study to test in vitro the impact of neuromuscular blocker, such as pancuronium, at clinically relevant concentration on lymphocyte apoptosis, death factor expression and mitochondrial function.Methods:  Following isolation, lymphocytes were incubated with pancuronium bromide at a clinically relevant concentration (0.136 µmol l−1) for 3 h at 37 C in a 5% carbon‐dioxide‐humidified atmosphere and the frequency of apoptotic lymphocytes was then measured. We also investigated crucial steps in the apoptotic process, including Fas/Fas ligand (FasL) phenotype, intracellular expression of the interleukin‐1β‐converting enzyme (ICE) p20, mitochondrial membrane potential (ΔΨm), generation of mitochondrial reactive oxygen species, and glutathione (GSH) levels. Control experiments were performed incubating cells in the complete culture medium added with the dilution medium of the drug without addition of the drug.Results:  Expression of Fas, FasL and ICEp20 was six‐fold, four‐fold, and five‐fold increased, respectively, among pancuronium‐treated lymphocytes with respect to control cultures (P = 0.0001). The percentage of cells exhibiting either dissipation of mitochondrial membrane potential or increased production of reactive oxygen species was seven‐fold increased following exposure to pancuronium compared with untreated lymphocytes (P = 0.0001). These findings were associated with a decrease in GSH level. In addition, the frequency of apoptotic cells was 10‐fold greater among lymphocytes cultured in the presence of the drug with respect to control cultures. (P = 0.0001).Conclusion:  Our data suggest an apoptogenic effect of pancuronium in vitro at clinically relevant concentration on peripheral blood lymphocytes. This could be implicated in the transient immune suppression following a surgical operation.
Epinephrine added to a lumbar epidural infusion of a small‐dose ropivacaine‐fentanyl mixture after arterial bypass surgery of the lower extremities
Authors: Förster J. G. , Niemi T. T. , Aromaa U. , Neuvonen P. J. , Seppälä T. A. , Rosenberg P. H. 
Published: September 2003

Background:  The addition of epinephrine (2 µg·ml−1) to a thoracic epidural infusion of an opioid‐local anesthetic mixture improves analgesia. Here, we studied whether epinephrine could improve analgesia also at lumbar level, when added to an epidural infusion of a low‐dose ropivacaine‐fentanyl mixture after arterial bypass surgery of the legs.Methods:  Patients in group RFE (n = 21) received a postoperative epidural infusion containing ropivacaine (1 mg·ml−1), fentanyl (2 µg·ml−1), and epinephrine (2 µg·ml−1). Patients in group RF (n = 25) received a similar infusion without epinephrine. The infusion speed was 1 ml·10 kg−1 · h−1. The infusion was scheduled for 48 h.Results:  Epinephrine did not reduce the need for rescue pain medication. Visual analog scale scores (VAS) for pain at rest were low and similar in the groups. Pain intensity was stronger during leg movement [mean VAS 1.5–2.6 (range 0–9)], but it was not affected by the coadministration of epinephrine. The groups did not differ concerning frequency and severity of side‐effects. Epinephrine did not reduce fentanyl plasma concentrations. Ropivacaine concentrations were slightly lower in group RFE only in the samples 6 h from the start of the infusion, but not anymore on the first and second postoperative day.Conclusion:  In the dosage used here, epinephrine did not improve epidural lumbar analgesia. Different distances from the epidural application site to the α2‐adrenergic receptors of the spinal cord, and differing epinephrine dose requirements may explain why epinephrine as an additive improves epidural analgesia at thoracic, but not at lumbar level.
Antinociception of intrathecal cholinesterase inhibitors and cholinergic receptors in rats
Authors: Yoon M. H. , Choi J. I. , Jeong S. W. 
Published: September 2003

Background:  Intrathecal cholinesterase inhibitors have been shown to have an antinociceptive effect which is mediated through the spinal cholinergic receptors, mainly muscarinic receptor. Spinal nicotinic receptor also has been involved in the control of nociception. Authors characterized the respective role of muscarinic or nicotinic receptor for the antinociception of cholinesterase inhibitors and further determined the antinociceptive potency of them.Methods:  Rats were prepared with intrathecal catheters. Formalin‐induced flinching response was regarded as a nociceptive behavior.Results:  Intrathecal neostigmine, physostigmine and edrophonium produced a dose‐dependent suppression of flinching in both phases. Atropine and the M1 selective antagonist attenuated the effect of them, while the M2 selective antagonist did not affect. M3, M4 selective, and nicotinic receptor antagonists reversed the antinociception induced by edrophonium, but by neither neostigmine nor physostigmine. The ordering of potency was neostigmine > physostigmine > > edrophonium.Conclusion:  These data indicate that the nicotinic receptor may be involved, at least in part, in the antinociceptive action of cholinesterase inhibitor at the spinal level, and M1 receptor subtype may be a common pharmacologic site of action. Moreover, neostigmine is more potent than physostigmine and edrophonium.
Neither vasopressin nor amiodarone improve CPR outcome in an animal model of hypothermic cardiac arrest
Authors: Schwarz B. , Mair P. , Wagner‐Berger H. , Stadlbauer K. H. , Girg S. , Wenzel V. , Lindner K. H. 
Published: September 2003

Background:  Aim of this experimental animal study was to investigate the influence of vasopressin and amiodarone on cardiopulmonary resuscitation (CPR) outcome in a pig model of hypothermic cardiac arrest.Methods:  After surface cooling to a core temperature of 26°C, ventricular fibrillation was induced in 14 12–16‐week‐old domestic pigs. After 15 min of untreated cardiac arrest, a manual closed chest CPR was started and pigs were randomly assigned to two treatment groups: Group 1 pigs (n = 7) received vasopressin 0.4 U kg−1 as initial drug therapy, followed by a combination vasopressin (0.4 U kg−1) and amiodarone (4 mg kg−1) as subsequent drug therapy. Subsequent drug therapy was administered in animals without permanent restoration of spontaneous circulation after a first series of electrical countershocks 10 min after drug administration. Group 2 pigs (n = 7) received saline placebo as initial drug therapy and saline placebo and amiodarone (4 mg kg−1) as subsequent drug therapy.Results:  Vasopressin significantly increased coronary perfusion pressure and defibrillation success (successful defibrillation in five of seven Group 1 vs. none of seven Group 2 pigs, P = 0.02). Due to refibrillation within 30–150 s, the 60‐min survival rate was not improved by vasopressin. Subsequent drug therapy with amiodarone had no further effect on defibrillation success or the refibrillation rate.Conclusions:  Data from this experimental animal model suggest that vasopressin and amiodarone may not be beneficial for treatment of ventricular fibrillation associated with severe hypothermia when concomitant measures at core rewarming are not applied.
Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol – the role of cardiac output
Authors: Ezri T. , Szmuk P. , Warters R. D. , Gebhard R. E. , Pivalizza E. G. , Katz J. 
Published: September 2003

Background:  We investigated the hypothesis that manipulation of cardiac output (CO) with esmolol (Es) or ephedrine (E) affects the onset time of rocuronium.Methods:  Following anesthesia induction, 33 patients received E (70 µg kg−1), Es (500 µg kg−1) or placebo (P) 30 s before rocuronium (0.6 mg kg−1) administration. Cardiac output was measured non‐invasively after intubation every 3 min. The interval from the end of rocuronium administration to the disappearance of all twitches was considered to be the onset time.Results:  Onset time was shorter after E (52.2 ± 16.5 s) and longer after Es (114.3 ± 11.1 s) compared with P (87.4 ± 7.3 s) (P < 0.0001). Cardiac output increased (P < 0.05) in group E for 15 min after rocuronium. In group Es, CO decreased (P < 0.05) at 3 and 6 min. Cardiac output was higher in group E vs. group Es, 3–6 min post administration of rocuronium (P=0.015).Conclusion:  Pretreatment with E or Es appears to affect the onset time of rocuronium by altering CO as measured with the NICOTM (Non‐Invasive Cardiac Output) monitor (Novametrix Medical Systems Inc., Willingford, CO).
Regionally differentiated fibrinolytic responses during volume‐resuscitated acute endotoxemia in pigs
Authors: Nyberg A. , Seeman‐Lodding H. , Ahlqvist M. , Fagerberg A. , Jern C. , Åneman A. 
Published: September 2003

Background:  Microcirculatory dysfunction and formation of microthrombi are common in sepsis as a result of a procoagulant state. A profibrinolytic change has however, been reported in early sepsis. This study investigates systemic and regional (pulmonary, preportal, hepatic, renal) fibrinolytic capacity as mirrored by fluxes of tissue‐type plasminogen activator (t‐PA) in response to acute endotoxemia and volume resuscitation.Methods:  Eight anaesthetized, ventilated pigs (24–29 kg) were instrumented for systemic and regional haemodynamic monitoring. Aortic, pulmonary arterial, portal, hepatic and renal venous blood samples were collected. Following baseline stabilisation, Escherichia coli endotoxin was infused for 120 min. During the last 30 min of infusion, volume resuscitation was initiated targeting baseline cardiac output, and animals were observed for 3 h. Total tPA was analyzed by ELISA calibrated for porcine tPA. Net organ tPA fluxes were calculated based on in/outflowing plasma concentrations and regional blood flows.Results:  Preportal release and hepatic extraction of tPA was observed at baseline. Pulmonary and renal net fluxes of tPA were not significantly different from zero. Endotoxemia increased plasma tPA levels in all investigated vascular beds. Preportal tPA release increased approximately 10‐fold and hepatic extraction increased approximately 12‐fold in non‐resuscitated acute endotoxemia. No significant changes in pulmonary or renal tPA fluxes were observed. Volume resuscitation restored net fluxes to baseline values while plasma levels remained elevated approximately twofold compared with baseline.Conclusion:  Acute endotoxemia induces a prompt, marked and regionally differentiated pro‐fibrinolytic response that cannot be discerned based on systemic levels of circulating tPA and that was normalized during volume resuscitation.
Equivalence of hydroxyethyl starch HES 130/0. 4 and HES 200/0. 5 for perioperative volume replacement in major gynaecological surgery
Authors: Sander O. , Reinhart K. , Meier‐Hellmann A. 
Published: September 2003

Background:  Hydroxyethyl starch solutions (HES) are increasingly used for the compensation of surgical blood loss. The objective of this clinical trial was to compare a novel 6% HES 130/0.4 solution with a favourable pharmacological profile and a standard 6% HES 200/0.5 solution for maintenance of haemodynamic stability in major gynaecological surgery.Methods:  Sixty female patients aged 18–80 years undergoing major gynaecological surgery with indication for perioperative colloidal volume replacement were enrolled in this prospective, randomized double‐blinded clinical study. The administration of study medication was dependent on individual requirements to maintain haemodynamic stability. The amount of study medication required from induction of anaesthesia until 6 h postoperatively served as the primary investigative parameter.Results:  The two one‐sided test procedure by Westlake demonstrated equivalence of mean infused volumes between HES 130/0.4 and HES 200/0.5 during the study period (1224 ± 544 ml and 1389 ± 610 ml, respectively, P < 0.05). Perioperatively, haemodynamics did not differ significantly between treatment groups. While none of the mean values of coagulation parameters shifted outside the normal range, the degree of haemodilution revealed reduced haematocrit values in HES 200/0.5 treated patients at 6 h postoperatively (P < 0.05). Moreover, prothrombin time (PT) was higher and consequently international normalized ratio (INR) was lower at the same time point for patients who received HES 130/0.4 (P < 0.05).Conclusion:  This clinical trial demonstrated therapeutic equivalence of this novel low‐substituted HES 130/0.4 solution and a standard HES 200/0.5 solution for perioperative volume replacement. Moreover, both HES preparations were equally well‐tolerated and safe.
Xenon incorporated in a lipid emulsion inhibits NMDA receptor channels
Authors: Weigt H. U. , Georgieff M. , Beyer C. , Wachter U. , Föhr K. J. 
Published: September 2003

Background:  Over the past decade hyperpolarized (129)xenon incorporated in lipid emulsions has been studied for the purpose of imaging enhancement in radiology. Xenon (Xe), a NMDA (N‐methyl‐D‐aspartate)‐receptor antagonist, has neuroprotective properties even at subanesthetic concentrations. Thus, its intravenous administration for this purpose deserves further evaluation. In this study, we investigated in an in vitro model the effect of Xe, incorporated in a lipid emulsion (Lipofundin MCT® 20%), on the NMDA receptor channel of cortical neurons of the mouse.Methods:  Pulses of 50 µM of NMDA solution were extracellularly applied to the cells for 10 s, and the elicited membrane currents (I) were recorded while the membrane potential (V) was clamped at −80 mV. Either Lipofundin MCT® 20% or aqueous solution was loaded with Xe and applied simultaneously with the NMDA pulses by means of a multibarreled pipette attached to a battery of infusion‐pumps.Results:  Xenon equilibrated in Lipofundin® caused a concentration‐dependent and reversible inhibition of NMDA‐induced currents (maximal Xe content [Xemax]: 190 µl ml−1). The inhibitory effect was equivalent compared with the effect of Xe dissolved in aqueous solution (Xemax: 89 µl ml−1) even though the Xe content of the lipid solution was almost doubled. Further enhancement of the Xe content by saturating both the lipid emulsion and the aqueous solutions with Xe (Xemax: 256 µl ml−1) did not increase the inhibitory action on NMDA‐receptors.Conclusion:  The data demonstrate that Xe dissolved in Lipofundin MCT® 20% inhibits NMDA‐receptors. Lipid emulsions enriched with Xe may serve as a carrier and a reservoir for Xe.
Differences among forced‐air warming systems with upper body blankets are small. A randomized trial for heat transfer in volunteers
Authors: Perl T. , Bräuer A. , Timmermann A. , Mielck F. , Weyland W. , Braun U. 
Published: September 2003

Background:  Forced‐air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Significant differences have been described between forced‐air warming systems in combination with full body blankets. We investigated four forced‐air warming systems in combination with upper body blankets for existing differences in heat transfer.Methods:  After approval of the local Ethics Committee and written informed consent, four forced‐air warming systems combined with upper body blankets were investigated in a randomized cross‐over trial on six healthy volunteers: (1) BairHugger™ 505 and Upper Body Blanket 520, Augustine Medical; (2) ThermaCare™ TC 3003, Gaymar™ and Optisan™ Upper Body Blanket, Brinkhaus; (3) WarmAir™ 134 and FilteredFlow™ Upper Body Blanket, CSZ; and (4) WarmTouch™ 5800 and CareDrape™ Upper Body Blanket, Mallinckrodt. Heat transfer from the blanket to the body surface was measured with 11 calibrated heat flux transducers (HFTs) with integrated thermistors on the upper body. Additionally, the blanket temperature was measured 1 cm above the HFT. After a preparation time of 60 min measurements were started for 20 min. Mean values were calculated over 20 min. The t‐test for matched pairs with Bonferroni‐Holm‐correcture for multiple testing was used for statistical evaluation at a P‐level of 0.05. The values are presented as mean±SD.Results:  The WarmTouch™ blower with the CareDrape™ blanket obtained the best heat flux (17.0±3.5 W). The BairHugger™ system gave the lowest heat transfer (8.1±1.1 W). The heat transfer of the ThermaCare™ system and WarmAir™ systems were intermediate with 14.3±2.1 W and 11.3±1.0 W.Conclusions:  Based on an estimated heat loss from the covered area of 38 W the heat balance is changed by 46.1 W to 55 W by forced‐air warming systems with upper body blankets. Although the differences in heat transfer are significant, the clinical relevance of this difference is small.