bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraocular pressure and ropivacaine in peribulbar block: A comparative study with bupivacaine
Authors: Nociti J. R. , Serzedo P. S. M. , Zuccolotto E. B. , Nunes A. M. M. , Ferreira S. B. 
Published: March 2003

Background: The aim of this study was to compare the effects on intraocular pressure (IOP) of ropivacaine and bupivacaine in peribulbar block.Methods: The study involved 40 patients with ASA physical status I, II or III undergoing cataract surgery under peribulbar block. Patients were allocated to two groups according to the local anesthetic used: Group R (n=20), 1.0% ropivacaine and Group B (n=20) 0.75% bupivacaine, both associated with 50 IU · ml−1 hyaluronidase, in peribulbar double injection technique. IOP was measured at four time points: 0=before block (control); 1=1 min after block; 2=5 min after block; 3=15 min after block.Results: Mean values of IOP (mm Hg) after block were significantly lower in Group R in comparison to Group B: time point 1=13.4±3.2 vs 20.8±4.7; time point 2=10.9±3.7 vs 14.4±3.8; time point 3=7.7±4.0 vs 10.5±3.1. The variation of IOP was different in each group. In Group R, the mean values obtained at the three time points after block were significantly lower than the control; in Group B, the mean value of IOP rose significantly 1 min after block and was lower than control only at time point 3.Conclusions: Ropivacaine 1.0% associated with hyaluronidase in peribulbar block is better than 0.75% bupivacaine under the same standard conditions for lowering IOP in intraocular surgery. This effect is probably due to relaxation of the extraocular muscles after the block with both anesthetics, and possibly to a smaller intraocular blood volume due to vasoconstriction in the case of ropivacaine.
Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day‐surgery patients undergoing herniorrhaphy under spinal anaesthesia
Authors: Toivonen J. , Permi J. , Rosenberg P. H. 
Published: March 2003

Background: By choosing spinal anaesthesia instead of general anaesthesia, and by infiltrating the wound area with local anaesthetic the need for postoperative analgesics may be reduced. An ilioinguinal and iliohypogastric nerve block (IINB) in inguinal herniorrhaphy was, therefore, studied in a day surgery setting in combination with a spinal block.Methods: One hundred ASA I–II adult patients scheduled for inguinal herniorrhaphy were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized and blinded fashion half of them received an IINB 5 min before the surgical incision with 10 ml of 0.5% bupivacaine (B‐IINB) and the other half with saline (S‐IINB). All patients received ketoprofen 100 mg i.v. during surgery and another 100 mg 2–3 h postoperatively. The patients were observed for about 6 h in the day surgery unit before discharge.Results: The results showed that in comparison with the S‐IINB group, significantly fewer patients in the B‐IINB group needed analgesics (P<0.01) and the amount required was also significantly less postoperatively, before discharge (about 6 h postoperatively) (P<0.05). The latency to the need for the first postoperative analgesic was shorter in the S‐IINB patients (P<0.01). At home the VAS scores and the need for analgesics (oral ketoprofen 100 mg) were low with no differences between the groups. No complications occurred.Conclusion: It is concluded that no long‐term analgesia could be demonstrated by a preincisional IINB performed during spinal anaesthesia in day‐surgery inguinal herniorrhaphy patients. Thus, reduced analgesic requirement was seen only for about 6 h postoperatively.
Distribution of intrathecal catheter positions in rat
Authors: Asato F. , Butler M. , Blomberg H. , Gordh T. 
Published: March 2003

Background: Although drug administration through an intrathecal catheter is widely used in the study of spinal pharmacology, the catheter positions in transverse plane that may cause a limited spread of a solution remain unclear. In the first step to clarify this issue, the distribution of the intrathecal catheter position was investigated in rats.Methods: A polyethylene catheter (PE‐10) was inserted intrathecally 8.5 cm through the atlanto‐occipital membrane, aiming the tip of the catheter to the dorsal surface of the spinal cord. Three or four weeks after the implantation of the catheter, 83 rats were transcardiacally perfused with fixative solution. The catheter positions were investigated longitudinally and transversely by cutting the spinal cord segmentally through the intervertebral disk at different spinal levels.Results: Seventeen rats were excluded from further data analysis. Transversely, catheters were located in the left lateral subarachnoid space in 23 rats (35%), in the right lateral in 15 (23%), in the dorsal in 22 (33%), and in the ventral in 6 (9%). Longitudinally, catheter position was significantly higher in the ventral group (median, T9) than that in the dorsal group (T11/12) (P<0.01).Conclusion: Chronic intrathecal catheters were variously located in the rat spinal subarachnoid space in the transverse plane, and lateral subarachnoid placement of the catheter (58%) was frequently observed, whereas dorsal subarachnoid placement occurred in 33%.
Ease of laryngeal passage during fibreoptic intubation: a comparison of three endotracheal tubes
Authors: Barker K. F. , Bolton P. , Cole S. , Coe P. A. 
Published: March 2003

Background: The use of a fibreoptic bronchoscope to facilitate endotracheal intubation is well established in modern anaesthetic practice. Difficulty may be encountered when inserting an endotracheal tube over the fibrescope as the bevelled tip can impinge on the vocal cords or epiglottis and impede advancement through the laryngeal inlet. Intavent have recently developed a tapered tip tube for use with their Intubating Laryngeal Mask Airway. A randomised, double‐blind study was performed to compare the ease of railroading three different tubes over a fibrescope placed in the trachea.Methods: We studied 54 patients presenting for elective dental surgery. General anaesthesia was induced with propofol 2–3 mg/kg, fentanyl 1–1.5 μg/kg, and atracurium 0.5 mg/kg and maintained with oxygen (5 l/min) and isoflurane 1–2%. Nasotracheal fibreoptic intubation was attempted in all patients. In each case the ease of tube advancement over the fibrescope and into the trachea was evaluated by the blinded observer, using the classification system (Grade 0–2) described by Jones et al.Results/Conclusion:The Intavent tube was found to be superior for nasotracheal fibreoptic intubation to either the Mallinckrodt reinforced tube (P<0.034) or the Portex Blue Line tube (P<0.004).
Clonidine decreases intraoperative bleeding in middle ear microsurgery
Authors: Marchal J. M. , Gómez‐Luque A. , Martos‐Crespo F. , Sánchez De La Cuesta F. , Martínez‐López M. C. , Delgado‐Martinez A. D. 
Published: March 2003

Background: The antihypertensive drug clonidine is a centrally acting α2 agonist useful as a premedicant because of its sedative, anxiolytic, and analgesic properties. We examined the effect of clonidine given as an oral preanesthetic medication in producing a bloodless surgical field in patients undergoing middle ear microsurgery. We also evaluated whether the administration of clonidine would alter the reflex cardiovascular response to laryngoscopy and endotracheal intubation, anesthetic requirement, postoperative pain intensity and consumption of analgesics, and pre‐ and postoperative sedation and anxiety.Methods: A prospective, randomized, double‐blind clinical trial was performed in 40 patients scheduled for elective middle ear surgery under general anesthesia. Twenty‐one patients received clonidine (300 μg p.o.) 90 min prior to arrival at the operating theater and 19 received placebo (control group). The hemodynamic endpoint of the anesthetic management was maintenance of hypotension for producing a bloodless surgical field. The desired control of the cardiovascular system was attained with isoflurane (inspired concentration increments of 0.25 vol% up to a maximum of 1.5 vol%)±fentanyl (bolus of 1 μg · kg−1)±urapidil (bolus of 0.3 mg · kg−1) as needed. Intraoperative bleeding was assessed on a four‐point scale from 0=no bleeding to 3=abundant bleeding.Results: There was less bleeding in the clonidine group (mean±SEM) than in the control group (0.75±0.3 vs 1.1±0.4, P<0.05). Patients given clonidine required a mean inspired isoflurane concentration of 0.63±0.1 vol% as compared with 1.01±0.2 vol% in controls (P<0.05). Fentanyl requirements were also significantly lower (57.10 vs 79.42 μg · kg−1, P<0.05). Four clonidine‐treated patients required urapidil to achieve satisfactory hypotension as compared with 11 controls (P<0.05). Clonidine attenuated the associated cardiovascular response following laryngoscopy and intubation, and was more effective than placebo in achieving a satisfactory preoperative sedation and decreasing intensity of postoperative pain. Preoperative anxiety and incidence of adverse events was similar in both groups.Conclusion: Premedication with clonidine reduced bleeding in middle ear microsurgery, attenuated hyperdynamic response to tracheal intubation, and reduced isoflurane, fentanyl, and urapidil requirements for controlled hypotension.
The influence of a dominating centre on a quantitative systematic review of granisetron for preventing postoperative nausea and vomiting
Authors: Kranke P. , Apfel C. C. , Eberhart L. H. , Georgieff M. , Roewer N. 
Published: March 2003

Background: We performed a meta‐analysis on granisetron in the prevention of postoperative nausea and vomiting (PONV) and further investigated whether total results and the dose–response characteristics may be significantly affected by a single centre.Methods: Systematically searched randomised controlled trials (RCT) using granisetron for the prevention of PONV after general anaesthesia were included in the analysis. The pooled relative risks (RR) and numbers needed to treat (NNT) with their corresponding 95%‐confidence intervals (CI) were calculated. For all centres, one dominating centre and other centres pooled, comparisons were performed according to all doses, low dose (≤20 μg/kg) and high dose (>20 μg/kg) granisetron.Results: A total of 27 RCT with 2938 patients were included in the analysis. RR (CI) to suffer from PONV with granisetron when all comparisons were considered was 0.46 (0.39–0.54), 0.7 (0.6–0.81) and 0.34 (0.28–0.41) for all doses, low and high dose, respectively. RR of the dominating centre (1867 patients) were significantly better compared to the remaining centres (1071 patients), with 0.41 (0.34–0.49) and 0.60 (0.49–0.73), respectively. In the dominating centre low dose granisetron was ineffective with a RR of 0.84 (0.68–1.04), while high dose granisetron led to a strong decrease with a RR of 0.30 (0.26–0.36). In contrast, the RR of other centres pooled for low and high dose granisetron were comparable with 0.62 (0.49–0.79) and 0.56 (0.42–0.75), respectively.Conclusions: Overall results and dose–response characteristics of meta‐analyses may be significantly altered by one dominating centre. Further, if data of a dominating centre do not appear to be valid for other centres, it may seem advisable to either exclude them from the analysis or to perform sub‐group analyses so that results without the data from the dominating centre are available.
The pressure at the lower inflexion point has no relation to airway collapse in surfactant‐treated premature lambs
Authors: Ingimarsson J. , Björklund L. J. , Larsson A. , Werner O. 
Published: March 2003

Background: The lower inflexion point (LIP) on the inspiratory part of the pressure–volume (PV) loop has been suggested to be related to the pressure at which air spaces collapse. Our hypothesis is that airway collapse might instead be assessed from the upper inflexion point on the expiratory part of the PV‐loop (UIPexp), where lung volume starts to decrease significantly. We therefore examined whether there was a relation between LIP and UIPexp in premature surfactant‐treated lambs.Methods: Ten lambs, at 119–141 days of gestational age, were delivered by cesarean section and given 200 mg/kg modified natural porcine surfactant before the first breath. The lambs were then connected to a ventilator and PV‐loops using airway pressures of 0–35–0 (ZEEP‐loop) and 5–35–5 cmH2O (PEEP‐loop) were obtained after lung recruitment at 15, 60 and 120 min after birth. From the loops, LIP, UIPexp, upper inflexion point of the inspiratory part of the loop (UIP insp), inspiratory capacity (IC) as well as inspiratory and expiratory maximal compliance of the respiratory system (Crsinsp and Crsexp) were calculated.Results: The ZEEP‐loop showed a substantial hysteresis with a distinct LIP at 19±2 cmH2O (mean±SD), which was different (P<0.001) from UIPexp (9±2 cmH2O). The pressures at LIP and UIPexp were unrelated (r2=0.06). UIPinsp was located at 28±2 cmH2O. Crsinsp was 2.1±0.6 ml · cmH2O−1 · kg−1, which was lower (P<0.001) than Crsexp (2.8±0.6 ml · cmH2O−1 · kg−1). IC was 26±6 ml/kg. The PEEP‐loop had a minimal hysteresis with an expiratory part coinciding with that of the ZEEP‐loop.Conclusion: In surfactant‐treated premature lambs the pressures at LIP and UIPexp are not related, showing that LIP does not indicate the pressure at which airways collapse.
Effects of prilocaine and articaine on human leucocytes and reactive oxygen species in vitro
Authors: Günaydin B. , Demi̇ryürek A. T. 
Published: March 2003

Background: The aim of this study was to investigate the ability of local anaesthetics to inhibit reactive oxygen and nitrogen species generated by either stimulated human leucocytes or cell‐free systems using luminol chemiluminescence (CL).Methods: Free radical generation was stimulated in leucocyte assay by formyl‐methionyl‐leucyl‐phenylalanine (FMLP, 2 μM). In cell‐free experiments, hydrogen peroxide (H2O2) 3.5 mM, sodium hypochloride 5 μM, ferrous sulphate (FeSO4) 40 nM, peroxynitrite 50 nM and xanthine 0.1 mmol l−1 plus xanthine oxidase 0.25 U ml−1 were used to produce H2O2, hypochlorous acid (HOCl), hydroxyl radical, peroxynitrite and superoxide‐induced CL, respectively.Results: Prilocaine inhibited FMLP‐induced CL in leucocytes (94±1%, at 1 mM), whereas articaine showed an activation (59±7%) at high concentration (1 mM) and inhibition (13±6%) at low concentration (0.1 mM). In cell‐free experiments, prilocaine (22±6%, at 1 mM) and articaine (85±1%, at 1 mM) caused concentration‐dependent inhibition in xanthine‐xanthine oxidase‐induced CL. Although articaine had no effect on H2O2‐induced CL, prilocaine significantly attenuated the H2O2 signal (97±0.3%, at 1 mM). Prilocaine (99±0.04%, 1 mM) and articaine (70±6%, 1 mM) markedly inhibited HOCl‐induced CL, whereas these drugs had no effect on FeSO4‐induced CL. Articaine inhibited peroxynitrite CL (63±6%, 1 mM), but prilocaine did not produce any depression on this signal.Conclusion: Prilocaine interacted with superoxide, HOCl and H2O2, whereas articaine reacted with superoxide, HOCl, and peroxynitrite. The direct scavenging properties of these drugs might be involved in the inhibition observed in leucocyte assay and could provide experimental support for investigating the potential benefit of using these local anaesthetics in patients presenting pathologies associated with free radical reactions.
Postoperative reading speed does not indicate implicit memory in elderly cardiac patients after propofol and remifentanyl anaesthesia
Authors: Münte S. , Münte T. F. , Mitzlaff B. , Walz R. , Leuwer M. , Piepenbrock S. 
Published: March 2003

Background: A recent study in young patients undergoing propofol‐alfentanil‐nitrous oxide anaesthesia demonstrated implicit memory for stories presented during operation using a postoperative reading speed task. In this study we investigated whether patients who tolerate only small amounts of anaesthetics are prone to develop implicit and explicit memories about intraoperative events.Methods: Thirty patients with poor physical status (ASA III–IV) undergoing cardioverter defibrillator implantation were included in the study. Patients were premedicated with intravenous midazolam and anaesthesia was maintained using propofol and remifentanil infusions. During surgery one of two audio‐tapes containing two short stories was played to the patients. Reading speed for the stories played during surgery and two similar stories from the other tape was tested 4 h later. Explicit memory was tested at 4 h and 24 h after audiotape presentation using a structured interview and a forced‐choice recognition test pertaining to the story content. Thirty additional awake subjects served as controls.Results: Although half of the patients seemed to be awake one or more times during the operation, no explicit memories of intraoperative events were reported. The forced‐choice recognition of the stories was at chance level. No effect on reading speed was found in either the patients or the control subjects.Conclusions: The possible reasons for reduced explicit and implicit memory performance in elderly patients are age and poor physical status of the patients and the modality change between study and test phases. A non‐anaesthetised control group of the same age and physical status should therefore be included in all studies of implicit memory.
Comparison of two video‐assisted techniques for the difficult intubation
Authors: Biro P. , Weiss M. 
Published: March 2003

Background: Two recently developed video‐optical intubation devices, the video‐optical intubation stylet (VOIS) and the angled video intubation laryngoscope (AVIL) were compared for intubation times and success rate in a simulated difficult tracheal intubation setting.Methods: Thirty anaesthetists were asked to perform 5 intubation attempts with both techniques. Intubation times were recorded and the subjective degree of difficulty and preference for each technique were requested.Results: Intubation time with the VOIS was shorter (17.4±6.8 s) than with the AVIL (22.8±13.4 s; P=0.0001). Four of the 150 intubation attempts with the AVIL were scored as unsuccessful, due to prolonged intubation time (>60 s). The estimated degree of difficulty was not significantly different.Conclusion: In conclusion, both video‐assisted intubation devices, the video‐optical intubation stylet and the angled video intubation laryngoscope, can be considered to be simple and effective tools which facilitate tracheal intubation and which require only brief instruction and training.
Postoperative analgesia by combined continuous infusion and patient‐controlled epidural analgesia (PCEA) following hip replacement: ropivacaine versus bupivacaine
Authors: Bertini L. , Mancini S. , Di Benedetto P. , Ciaschi A. , Martini O. , Nava S. , Tagariello V. 
Published: March 2003

Background: Ropivacaine is a new local anaesthetic, which compared to bupivacaine is less toxic and shows greater sensory and motor block dissociation. We hypothesised that treatment of postoperative pain with a combined regimen of continuous epidural infusion and Patient‐Controlled Epidural Analgesia (PCEA) using ropivacaine could have given better results compared with those we had obtained using bupivacaine.Methods: Patients undergoing total hip replacement were randomly assigned to two groups. They received epidural analgesia for postoperative pain treatment using ropivacaine, 2 mg  ·  ml−1 or bupivacaine 2 mg  ·  ml−1. Both drugs were administered as a constant infusion of 6 ml  ·  h−1 supplemented by PCEA bolus doses of 2 ml. Patients in both groups received morphine intravenously on demand from a patient‐controlled analgesia (PCA) device. An independent observer recorded pain scores, intensity of motor block and morphine consumption at regular intervals during the first 24 h after surgery.Results: Fifty‐one patients were evaluated. Ropivacaine and bupivacaine, in similar amounts, provided similar results assessed as adequate to very good postoperative analgesia, whereas motor block was significantly more intense in patients treated with bupivacaine.Conclusions: Despite similar analgesic effects, epidural infusion of ropivacaine combined with PCEA provides higher patient satisfaction than equal doses of bupivacaine due to lack of motor block.
Caudal bupivacaine‐tramadol combination for postoperative analgesia in pediatric herniorrhaphy
Authors: Senel A. C. , Akyol A. , Dohman D. , Solak M. 
Published: March 2003

Background: Administration of bupivacaine caudally has been used for postoperative analgesia after urogenital, rectal and lower abdominal surgery in children. Caudal opioids may offer analgesic advantages over bupivacaine alone but have been associated with side effects such as respiratory depression. Tramadol is an analgesic assumed to lack a respiratory depressant effect and has been shown to provide effective, long‐lasting analgesia after epidural administration in adults and children. The aim of this study was to determine whether the addition of tramadol to bupivacaine caudally prolongs the duration of analgesia compared with bupivacaine alone, with respect to side effects, and whether caudal tramadol alone provides satisfactory analgesia.Methods: Sixty boys, aged 12–84 months, undergoing unilateral herniorrhaphy, were allocated randomly to three groups. Children in group B received 0.25% plain bupivacaine 1 ml kg−1, group BT received an identical local anesthetic dose mixed with tramadol 1.5 mg kg−1 and group T received caudal tramadol 1.5 mg kg−1 in 0.9% sodium chloride in the same total volume (1 ml kg−1). Pain and demeanour assessments were made 1, 2, 3, 4, 6, 12 and 24 h after recovery from anesthesia with reference to a three‐point scale.Results: Analgesia time (time between caudal injection and first administration of analgesic) in group BT (13.5±2.2 h) was significantly longer than in the other two groups (P<0.05). In group T, more patients required additional analgesia after surgery than in the other two groups (P<0.05). Pain scores in the three groups were similar up to 4 h after operation but the mean score in group T was higher than groups B and BT 4 and 6 h after operation (P<0.05). Significantly more patients who had received caudal bupivacaine alone or with tramadol had lower pain and demeanour scores during the first 24 h after operation compared with those in the tramadol group.Conclusion: Caudal administration of bupivacaine with the addition of tramadol resulted in superior analgesia with a longer period without demand for additional analgesics compared with caudal bupivacaine and tramadol alone without an increase of side effects.