bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhibitory effect of propofol on ketamine‐induced c‐Fos expression in the rat posterior cingulate and retrosplenial cortices is mediated by GABAA receptor activation
Authors: Nakao S. , Nagata A. , Miyamoto E. , Masuzawa M. , Murayama T. , Shingu K. 
Published: December 2004

Background:  Non‐competitive N‐methyl‐D‐aspartate (NMDA) receptor antagonists, including ketamine, have psychotomimetic activities and cause neuronal damage in the posterior cingulate and retrosplenial cortices (PC/RS), which are suggested to be the brain regions responsible for their psychotomimetic activities. We previously demonstrated that ketamine induced marked c‐Fos (c‐fos protein) expression in the rat PC/RS, which was inhibited by propofol, and the expression was closely related to ketamine‐induced abnormal behavior. In the present study, we investigated whether the inhibition by propofol was mediated by GABAA receptor receptor activation.Methods:  Using Wistar rats, propofol alone, propofol with bicuculline or propofol with flumazenil was injected intravenously and then continuously infused. Fifteen minutes later, 100 mg kg−1 of ketamine or normal saline was injected intraperitoneally. Two hours after the ketamine or saline injection, the brain was extracted and brain sections were prepared, and c‐Fos expression was detected using immunohistochemical methods.Results:  Ketamine induced marked c‐Fos expression in the PC/RS (171 ± 9/0.4 mm2), which was significantly inhibited by propofol (5 ± 5/0.4 mm2). The inhibition by propofol was disinhibited dose‐dependently by both bicuculline (0.5 and 1.0 mg kg−1 bicuculline groups: 46 ± 15 and 143 ± 16, respectively) and flumazenil (0.1 and 1.0 mg kg−1 flumazenil groups: 79 ± 6 and 130 ± 15, respectively).Conclusion:  These results demonstrate that the inhibitory effect of propofol on ketamine‐induced c‐Fos expression in the PC/RS is mediated by GABAA receptor activation, and suggests that ketamine‐induced psychoneuronal adverse effects may be suppressed by propofol via the activation of GABAA receptors.
Retrograde intubation with a Mini‐Trach II kit
Authors: Slots P. , Vegger P. B. , Bettger H. , Reinstrup P. 
Published: December 2004

Background:  Retrograde intubation has been accepted internationally as a viable alternative for managing the difficult airway. Various techniques have been described to perform this procedure, however, difficulties have arisen on account of problems with suboptimal materials. We therefore describe a retrograde intubation technique using the knife and stiff plastic introducer from a Mini‐Trach II set from Portex Ltd (Kent, UK).Methods:  The cricothyroid membrane was identified and using the knife from the mini‐trach set, incised longitudinally. The plastic introducer was inserted through the incision and maneuvered out through the mouth providing a guide over which the endotracheal tube was threaded. The technique was evaluated on 20 cadavers and thereafter used in four patients.Results:  Mean intubation time in the 20 cadavers was 6.7 s (range 3–10) from incision to removal of the guide. Also, the technique was used successfully in four patients in whom anterograde attempts failed. In one of these patients the retrograde intubation was life saving.Conclusion:  Retrograde intubation with a stiff curved plastic introducer was rapid and easy in cadavers and in four patients. In emergency situations where conventional intubation fails it may be life saving.
Nitric oxide increases dramatically in air exhaled from lung regions with occluded vessels
Authors: Fernández‐Mondéjar E. , Hambraeus‐Jonzon K. , Ronéus A. , Hedenstierna G. 
Published: December 2004

Background:  We observed dramatic changes in exhaled nitric oxide concentration (ΔNOE) during wedge measurements, and hypothesised that occlusion and redistribution of pulmonary blood flow affects NOE.Methods:  We inflated the balloon of the pulmonary artery catheter and measured NOE and central hemodynamics in closed chest anesthetised pigs (n = 11) ventilated with hyperoxic gas (fraction of inspired oxygen [FIO2] = 0.5), before and during lung injury, and in open chest anesthetised pigs (n = 17) before and during left lower lobar (LLL) hypoxia (FIO2 0.05), and during hyperoxic (FIO2 0.8) ventilation of the other lung regions (HL).Results:  In the closed chest pigs NOE increased from 2.0 (0.9) to 3.4 (2.0) p.p.b. (P < 0.001) during wedge, and returned to 2.0 (1.0) p.p.b. when the balloon was deflated. The increase in mean pulmonary artery pressure (MPaP) during wedge was small and insignificant (P > 0.07). When the balloon was inflated in the right pulmonary artery in the open chest pigs, the perfusion of the HL decreased from 2.57 (0.58) to 2.34 (0.55) l min−1 (P < 0.001), and NOEHL increased from 2.5 (0.9) to 6.2 (3.2) p.p.b. (P < 0.001). The perfusion of the LLL increased from 0.33 (0.26) to 0.54 (0.34) l min−1 (P < 0.001), and NOELLL decreased from 1.7 (0.6) to 1.5 (0.5) p.p.b. (P < 0.001). Neither lung injury nor LLL hypoxia had any influence on ΔNOE (P > 0.07) during wedge. The correlation coefficient (R2) was 0.66 between changes in regional blood flow and ΔNOE, and 0.37 between changes in MPaP and ΔNOE.Conclusions:  Nitric oxide concentration increases dramatically from lung regions with occluded vessels, whereas changes in MPaP have minor effects on NOE. This is an important fact to consider when comparing NOE within or between studies, and indicates a possible marker of diseases with occluded lung vessels.
Post‐thoracotomy pain after thoracic epidural analgesia: a prospective follow‐up study
Authors: Tiippana E. , Nilsson E. , Kalso E. 
Published: December 2004

Background: Pain becomes chronic in 22–67% of patients who undergo a thoracotomy. Thoracic epidural analgesia (TEA) has replaced less invasive methods to manage postoperative pain. We wanted to find out if active use of TEA, combined with extended pain management at home, reduces the incidence of chronic post‐thoracotomy pain.Methods: All consecutive thoracotomy patients during a 16‐month period were included. On the ward, pain was measured daily by VAS during rest and coughing and the consumption of analgesics was registered. The patients were interviewed one week after discharge by telephone and by a questionnaire after 3 and 6 months to find out how much pain they had.Results: A total of 114 patients were recruited. The data were analysed from 89 patients who had had TEA and 22 who had had other methods. TEA was effective in alleviating pain at rest and during coughing. In the TEA patients the incidence of chronic pain of at least moderate severity was 11% and 12% at 3 and 6 months, respectively. One week after discharge 92% of all patients needed daily pain medication.Conclusions: TEA seems effective in controlling evoked postoperative pain, but technical problems occurred in 24% of the epidural catheters. The incidence of chronic pain was lower compared with previous studies where TEA was not used. The patients had significant pain and needed regular pain medication and instructions during the first week after discharge. Extended postoperative analgesia up to the first week at home is warranted.
Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients
Authors: Rasmussen L. S. , Johnson T. , Kuipers H. M. , Kristensen D. , Siersma V. D. , Vila P. , Jolles J. , Papaioannou A. , Abildstrom H. , Silverstein J. H. , Bonal J. A. , Raeder J. , Nielsen I. K. , Korttila K. , Munoz L. , Dodds C. , Hanning C. D. , Moller J. T. 
Published: December 2004

Background:  Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non‐cardiac surgery with general anaesthesia in the elderly. We hypothesized that the incidence of POCD would be less with regional anaesthesia rather than general.Methods:  We included patients aged over 60 years undergoing major non‐cardiac surgery. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. Cognitive function was assessed using four neuropsychological tests undertaken preoperatively and at 7 days and 3 months postoperatively. POCD was defined as a combined Z score >1.96 or a Z score >1.96 in two or more test parameters.Results:  At 7 days, POCD was found in 37/188 patients (19.7%, [14.3–26.1%]) after general anaesthesia and in 22/176 (12.5%, [8.0–18.3%]) after regional anaesthesia, P = 0.06. After 3 months, POCD was present in 25/175 patients (14.3%, [9.5–20.4%]) after general anaesthesia vs. 23/165 (13.9%, [9.0–20.2%]) after regional anaesthesia, P = 0.93.The incidence of POCD after 1 week was significantly greater after general anaesthesia when we excluded patients who did not receive the allocated anaesthetic: 33/156 (21.2%[15.0–28.4%]) vs. 20/158 (12.7%[7.9–18.9%]) (P = 0.04). Mortality was significantly greater after general anaesthesia (4/217 vs. 0/211 (P < 0.05)).Conclusion:  No significant difference was found in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia in elderly patients. Thus, there seems to be no causative relationship between general anaesthesia and long‐term POCD. Regional anaesthesia may decrease mortality and the incidence of POCD early after surgery.
Multiple organ failure and outcome of critically ill patients with haematological malignancy
Authors: Silfvast T. , Pettilä V. , Ihalainen A. , Elonen E. 
Published: December 2004

Background: The number of failing organs systems in ICU patients with haematological malignancy is associated with outcome. The objective of this study was to assess short and long‐term survival in these patients with special reference to multiple organ failure reflected by the SOFA (Sequential Organ Failure Assessment) score.Methods: Retrospective chart review of haematological patients admitted to the 10‐bed intensive care unit (ICU) of a tertiary level academic teaching hospital from 1994 to 1998. Of 31 admitted patients with the diagnosis of haematological malignancy, the charts of 30 were available for analysis.Results: Univariate logistic regression analysis of factors previously shown to influence survival revealed that only admission SOFA score and untreated status of haematological disease were significantly associated with survival (P < 0.05). ICU, 3‐month and one‐year survival rates were 57% (17/30), 23% (7/30) and 20% (6/30), respectively. If maximal SOFA score during the ICU stay was included in a multivariate model comprising treatment status and effect, admission day SOFA and APACHE II scores, mechanical ventilation, renal replacement therapy and neutropenia, the maximal SOFA score became the only independent variable. All patients with an admission SOFA score exceeding 11 died in hospital. Leave‐one‐out method revealed that admission SOFA scores and the status of haematological disease (untreated or not) correctly classified 83% (25 of 30) of patients to survivors or non‐survivors.Conclusions: Multiple organ failure assessed as SOFA score on admission and status of disease were associated with outcome in critically ill patients with haematological malignancy.
Differential release of matrix metalloproteinase‐9 and nitric oxide following infusion of endotoxin to human volunteers
Authors: Albert J. , Radomski A. , Soop A. , Sollevi A. , Frostell C. , Radomski M. W. 
Published: December 2004

Background: Roughly 400 000 cases of sepsis occur every year in the United States only and this is associated with a very high mortality. Bacterial lipopolysaccharide (LPS) triggers systemic inflammatory reactions in sepsis. However, down‐stream cellular cascade initiated by LPS is still being elucidated. Nitric oxide (NO) and matrix metalloproteinases‐2 and ‐9 (MMP‐2 and MMP‐9) are known to be induced by LPS. We have investigated the release of NO, MMP‐2 and MMP‐9 following infusion of LPS to volunteers.Methods: IPS (2 ng kg−1) was infused to 10 healthy volunteers. Before the experiments were started the subjects had an intravenous catheters placed. An electrocardiogram was also placed and monitored constantly. Body temperature was measured by ear thermometer every 10 min Venous blood was collected and cell‐free plasma assayed for the presence of MMP‐2 and MMP‐9 using zymography and NO using HPLC assay for NO metabolites, nitrite and nitrate.Results: The administration of LPS resulted in increased body temperature and tachycardia. Time‐dependent release of MMP‐9(30 fold increase from the baseline) peaking at 2 h following infusion of LPS was observed. LPS did not significantly modify the activity of MMP‐2 (P > 0.05). Infusion of LPS did not significantly change the levels of nitrite and nitrate (from 60 ± 11 to 67 ± 10 µm, P > 0.05).Conclusion: The release of MMP‐9, but not MMP‐2 or NO, is a sensitive index of endotoxaemia in humans. MMP‐9 release may contribute to the pathogenesis of sepsis via its pro‐inflammatory effects on the vasculature.
The effect of nitrous oxide on cerebral blood flow velocity in children anesthetized with propofol
Authors: Wilson‐Smith E. , Karsli C. , Luginbuehl I. A. , Bissonnette B. 
Published: December 2004

Background: Propofol for maintenance of anesthesia by continuous infusion is gaining popularity for use in pediatric patients. Nitrous oxide (N2O) has been shown to increase cerebral blood flow velocity (CBFV) in both children and adults. To determine the effects of N2O on middle cerebral artery blood flow velocity (Vmca) during propofol anesthesia in children, Vmca was measured with and without N2O using transcranial Doppler (TCD) sonography.Methods: Thirty ASA I or II children aged 18 months to 6 years undergoing elective urological surgery were enrolled. Anesthesia comprised propofol aimed at producing an estimated steady‐state serum concentration of 3 µg·ml−1 and a caudal epidural block. A transcranial Doppler probe was used to measure middle cerebral artery blood flow velocity. Each patient was randomized to receive a sequence of either Air/N2O/Air or N2O/Air/N2O in 35% oxygen. Fifteen min after each change in the N2O concentration, three measurements of cerebral blood flow velocity, blood pressure and heart rate were recorded. Ventilatory parameters and EtCO2 were kept constant throughout the study period.Results: CBFV increased by 12.4% when air was replaced by N2O, and returned to baseline when N2O was subsequently removed. There was a 14% decrease in CBFV when N2O was replaced with air, which increased to baseline when air was subsequently replaced with N2O. Mean heart rate and blood pressure remained constant throughout the study period.Conclusion: The effects of nitrous oxide on CBFV are preserved in children during propofol anesthesia.
Should patients undergoing a bronchoscopy be sedated?
Authors: Gonzalez R. , De‐La‐Rosa‐Ramirez I. , Maldonado‐Hernandez A. , Dominguez‐Cherit G. 
Published: December 2004

Background: The techniques, drugs and depth of sedation for flexible fiberoptic bronchoscopy is controversial, and several reports consider that the routine use of sedation is not a prerequisite. We evaluate whether the addition of sedation with propofol improves patient tolerance, compared to local anesthesic of the airway only.Methods: Eighteen patients with pneumonia undergoing flexible fiberoptic bronchoscopy were included in a randomized, single blind, prospective controlled study.The non‐sedation group received airway topical anesthesia, whereas the sedation group received topical anesthesia and intravenous sedation with propofol. The degree of pain, cough, sensation of asphyxiation, degree of amnesia, global tolerance and acceptance of another bronchoscopy in the future were noted. Changes in blood pressure, heart rate and saturation of oxygen by pulse oximetry were also evaluated.Results: The patients in sedation group had less cough (P < 0.05), pain (P < 0.01) and sensation of asphyxiation (P < 0.001). Global tolerance to the procedure was significantly better in the group under sedation (P < 0.01). These patients had total amnesia to the procedure (P < 0.0001), thus is more probable that will accept another bronchoscopy in the future (P < 0.01). There was a significant rise in heart rate and blood pressure in the patients without sedation. There were no differences in oxygen saturation (P = 0.75).Conclusions: Our results show that if we administer propofol for sedation, in addition to local anesthesia of the airway, the tolerance to the procedure is much better. Also it appears that sedation with propofol is safe if we carefully select and monitor the patient.
Environmental temperature stress on drugs in prehospital emergency medical service
Authors: Helm M. , Castner Th , Lampl L. 
Published: December 2004

Background: Drugs used in prehospital emergency medical service (EMS) in principle are subject to the same storage restrictions as hospital‐based medications. The prehospital emergency environment however, often exceeds these storage recommendations. Main stress factors are sunlight, vibration and extreme temperature, which may lead to alteration in chemical and physical stability of stored pharmaceuticals, as well as microbiological contamination and concentration enhancement of pharmacological inserts.Methods: The purpose of this study was to determine the environmental temperature stress upon drugs used in the prehospital EMS under real mission conditions within different types of rescue vehicles (rescue helicopter [HEMS], ambulance [AMB] and emergency physician transport vehicle [EPTV]) during a ‘summer’ and ‘winter’ monitoring period (2 months duration each/location: southern Germany).Results: Recorded temperatures varied from −13.2°C to +50.6°C. The recommended maximum storage temperature (+25°C) was exceeded in all rescue vehicles (33–45% of total exposure time), whereas the recommended minimum storage temperature (0°C) only fell short in the EPTV (19% of total exposure time). The daily maximum temperature variations ranged from 19.0°C (winter) to 32.9°C (summer).Conclusions: These results show that even in a moderate climatic zone, drugs used in prehospital EMS are significantly influenced by temperature stress; furthermore, these results recommend the usage of temperature‐controlled drug boxes.
Slow rewarming improves jugular venous oxygen saturation during rewarming
Authors: Kawahara F. , Kadoi Y. , Saito S. , Goto F. , Fujita N. 
Published: December 2004

Background: There have been many studies regarding the etiology of postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery. Although its etiology remains unresolved, one possible factor related to postoperative cognitive dysfunction is a reduced internal jugular venous oxygen hemoglobin saturation (SjvO2) during the rewarming period. The purpose of this study was to examine the effect of rewarming rates on SjvO2 during rewarming.Methods: One‐hundred patients scheduled for elective CABG surgery were randomly divided into two groups; control group (0.48 ± 0.09°C, n = 50), slow rewarming group (0.24 ± 0.09°C, n = 50). After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to monitor SjvO2 continuously. Hemodynamic parameters, arterial and jugular venous blood gases were measured at nine time‐points.Results: Cerebral desaturation (defined as a SjvO2 value below 50%) during rewarming was more frequent in the control group than in the slow group. Cerebral desaturation time (duration when SjvO2 was less than 50%) and the ratio of the cerebral desaturation time to the total CPB time in the control group differed significantly from those in the slow group (control group: 17 ± 11 min, 12 ± 4%, slow group: 10 ± 8 min, 7 ± 4%, respectively, P < 0.05). There was no significant difference in mini‐mental state examination on the day before the operation nor at 1 month after the surgery among four values (the day before the operation: control group; 48 ± 8, slow group; 48 ± 7, at one month after the surgery: control group; 46 ± 7, slow group; 45 ± 9).Conclusions: A slow rewarming rate could reduce the chance of a decrease in SjvO2 during rewarming.
Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial
Authors: Nilsson U. , Rawal N. , Enqvist B. , Unosson M. 
Published: December 2004

Background: This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperative in daycare surgery.Methods: One‐hundred and eighty‐two unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anaesthesia were randomly assigned to (a) listening to music (b) music in combination with therapeutic suggestions or (c) blank tape in the immediate postoperative period. The surgical technique, anaesthesia and postoperative analgesia were standardized. Analgesia, the total requirement of morphine, nausea, fatigue, well‐being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables.Results: Pain intensity (VAS) was significantly lower (P = 0.002) in the M (2.1), and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P < 0.001, were found. No differences were noted in the other outcome variables.Conclusion: This controlled study has demonstrated that music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients' experience of analgesia. Although statistically significant, the improvement in analgesia is modest in this group of patients with low overall pain levels.
Lidocaine versus ropivacaine for continuous interscalene brachial plexus block after open shoulder surgery
Authors: Casati A. , Vinciguerra F. , Scarioni M. , Cappelleri G. , Aldegheri G. , Manzoni P. , Fraschini G. , Chelly J. E. 
Published: December 2004

Background: This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery.Methods: Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient‐controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion.Results: Onset of the block occurred after 7.5 (5–40) min with lidocaine and 30 (10–60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13–0.7) with lidocaine and 0.7 (0.4–1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively).Conclusions: Although 1% lidocaine can be effectively used for postoperative patient‐controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.