bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulse contour analysis versus thermodilution in cardiac surgery patients
Authors: Rauch H. , Müller M. , Fleischer F. , Bauer H. , Martin E. , Böttiger B. W. 
Published: March 2003

Background:  Previous studies have demonstrated that there is a lack of agreement between intermittent cold bolus thermodilution (ICO) and a semicontinuous method with dilution of heat (CCO) in cardiac surgical patients following hypothermic extracorporeal circulation (HCPB). Therefore, the aim of the present study was to compare both ICO and CCO with continuous pulse contour analysis (PCCO): a method based on a fundamentally different principle of determining cardiac output (CO).Methods:  A prospective criterion standard study of 25 cardiac surgery patients undergoing HCPB. Cardiac output was determined using the three methods (ICO, CCO, and PCCO) before and after HCPB up to 12 h after arrival on the ICU. Bias and precision were evaluated.Results:  A total of 380 triple determinations of CO could be analyzed. During the entire study period bias PCCO‐ICO was −0.14 l*/min (precision 1.16 l*/min) and bias CCO‐ICO was −0.40 l*/min (precision 1.25 l*/min). Up to 45 min after bypass PCCO agreed with ICO (bias −0.21 l*/min, precision 1.37 l*/min), while bias CCO‐ICO was −1.30 l*/min (precision 1.45 l*/min).Conclusion:  The agreement between PCCO and ICO in contrast to CCO in the first 45 min after HCPB indicates that CCO underestimates CO during this period.
Interrater reliability of diagnosing complex regional pain syndrome type I
Authors: Perez R. S. G. M. , Burm P. E. T. , Zuurmond W. W. A. , Giezeman M. J. M. M. , Van Dasselaar N. T. , Vranken J. , De Lange J. J. 
Published: March 2003

Background:  Diagnosis of complex regional pain syndrome type I (CRPS I) is based on clinical observation of symptoms. As little information is available on the reliability of CRPS I diagnosis, we evaluated the agreement between therapists with regard to the presence and severity of CRPS I and its symptoms.Methods:  The interrater reliability was evaluated in 37 presumed CRPS I patients by three observers; one consultant anesthesiologist and two resident anesthesiologists. Patients were assessed on the basis of Veldman's CRPS criteria.Results:  The interrater reliability for diagnosing CRPS I was good for the majority of observer combinations. The percentage of agreement for the absence or presence of CRPS I was good (88%−100%). Cohen's Kappa's ranged from 0.60 to 0.86. The agreement for the mean symptom score ranged from 70.2% to 88.6%; Kappa's were lower and showed more variation. Interrater reliability for assessment of the severity of CRPS I and its symptoms was poor. Factors influencing the interrater reliability were symptom type, individual observers and sample population.Conclusion:  Diagnosing CRPS I can be performed on the basis of clinical observation. Further assessment of severity of CRPS I and its symptoms should be performed with reliable and valid measurement instruments.
The importance of tail temperature monitoring during tail‐flick test in evaluating the antinociceptive action of volatile anesthetics
Authors: Sawamura S. , Tomioka T. , Hanaoka K. 
Published: March 2003

Background:  Tail‐flick (TF) latency can be influenced by tail‐skin temperature (TT), and treatments that raise TT can mimic hyperalgesia on a TF test. As volatile anesthetics can raise TT via heat redistribution, their antinociceptive action can be hidden or obscured in a TF test. We tested the hypothesis that TT monitoring improves the efficiency of TF tests in evaluating the antinociceptive action of volatile anesthetics.Methods:  The relationship between TT and TF latency was first explored under varied TTs in 12 rats. Then, TT and TF latency were measured before and during isoflurane exposure (1.2%). In the low temperature group (n=6), rats were prewarmed mildly to increase TT during isoflurane exposure. In the high temperature group (n=6), rats were prewarmed enough to prevent a TT increase during isoflurane exposure.Results:  There was a highly significant correlation between TT and TF latency, that is, TF latency decreased as TT increased. In the low temperature group, there was a significant increase in TT during isoflurane exposure, while an increase in TF latency did not reach statistical significance. Tail‐flick latency corrected by a change in TT showed a significant increase. In the high temperature group, TF latency increased significantly during isoflurane exposure without an increase in TT.Conclusions:  Isoflurane inhalation can induce an increase in TT, which can obscure its antinociceptive action as evaluated by a TF test. Monitoring TT during a TF test is important to efficiently evaluate the antinociceptive action of volatile anesthetics.
In‐hospital cardiopulmonary resuscitation: organization, management and training in hospitals of different levels of care
Authors: Skrifvars M. B. , Castrén M. , Kurola J. , Rosenberg P. H. 
Published: March 2003

Background: During recent years in‐hospital cardiopulmonary resuscitation (CPR) management has received much attention. This can be attributed to the Utstein model for in‐hospital CPR developed in 1997. The present status of in‐hospital resuscitation management in Finnish hospitals is not known. Therefore, a study was designed to describe the organization of training and clinical management of CPR in Finnish hospitals of different levels of care.Methods: In the summer of 2000, we performed a cross‐sectional mail survey throughout Finland, including all district, central and university hospitals. The questionnaire outlined in detail in‐hospital resuscitation management and training. For analysis the hospitals were divided into primary, secondary and tertiary groups, depending on levels of care.Results: Most hospitals (72%) reported having a physician or a nurse in charge of resuscitation management and training. Training in advanced life support was more common among nurses (80%) than among physicians (53%). Suprisingly, a majority of respondents (75%) reported that they felt training in CPR was insufficient. On the general wards and on wards treating cardiac patients, defibrillation was in most cases performed by a physician (91% and 51%, respectively), and less often by a nurse (16% and 31%, respectively). In the secondary and tertiary hospitals cardiac arrest was managed by a cardiac arrest team (53% and 62%, respectively) and in the primary hospitals by the ward physician (56%), anesthesiologist or emergency physician on call (44%). Most hospitals used do‐not‐resuscitate orders (83%) but only 33% of the hospitals had a unified style of notation. Systematic data collection was practised in 55% of hospitals, predominantly by using a model of their own. Only a few hospitals (11%) used the in‐hospital Utstein model.Conclusion: Our study showed that more attention needs to be paid to CPR management in Finnish hospitals. At present, 25% of hospitals do not have an appointed physician or nurse in charge of organizing CPR management. The study also revealed a lack of regular organized training in resuscitation for physicians. Fiftyfive per cent of hospitals practise systematic data collection, but only 11% according to the Utstein template; and without which further quality assurance is difficult.
Microvascular changes during anesthesia: sevoflurane compared with propofol
Authors: Bruegger D. , Bauer A. , Finsterer U. , Bernasconi P. , Kreimeier U. , Christ F. 
Published: March 2003

Background: We have developed a non‐invasive computer‐assisted venous congestion plethysmograph to measure the microvascular parameters in the lower limbs. This enables the assessment of microvascular changes following the induction of standardized anesthesia with either sevoflurane or propofol.Methods: In a prospective randomized trial we measured the capillary filtration coefficient (CFC), isovolumetric venous pressure (Pvi), an index of the balance of Starling forces, and limb blood flow 24 h preoperatively, immediately after induction of anesthesia and on the 1st and 2nd postoperative day. Anesthesia was maintained with either 1.0% sevoflurane and 5 µg/kg/h remifentanil or propofol (3 mg/kg/h), and 5 µg/kg/h remifentanil in 20 female patients undergoing breast surgery.Results: Preoperatively we found no significant differences between the mean CFC values of the sevoflurane group (3.7±0.3 ml/min 100 ml tissue/mmHg × 10−3=CFCU) and the propofol group (3.5±0.3 CFCU). In the sevoflurane group CFC decreased significantly to 2.9±0.2 CFCU, whereas it was unchanged in the propofol group. Both groups revealed a significant reduction in Pvi during steady‐state anesthesia. Limb blood flow remained unchanged. There was an overall significant positive correlation between the perioperative fluid substitution and the difference between the preoperative and intraoperative CFC values (r = 0.64, P<0.01).Conclusion: The decreased CFC in response to sevoflurane may result in less extravasation of fluids into the interstitial space, thereby reducing intraoperative fluid requirements. These data suggest that sevoflurane may be the preferred anesthetic agent in subjects susceptible to large intraoperative fluid shifts.
Atracurium and vecuronium block nicotine‐induced carotid body chemoreceptor responses
Authors: Jonsson M. , Kim C. , Yamamoto Y. , Runold M. , Lindahl S. G. E. , Eriksson L. I. 
Published: March 2003

Background: Vecuronium depresses carotid body chemosensitivity during hypoxia. We hypothesized that this is caused by inhibition of cholinergic transmission of the carotid body.Methods: The carotid body with its sinus nerve was removed en bloc from thiopentone‐anaesthetized adult male New Zealand rabbits and perfused in vitro with modified Tyrodes buffer solution at constant perfusion pressure, temperature, a buffer pH of 7.4 and normocapnia. Chemoreceptor discharge and spike frequencies (fx) were recorded from the whole sinus nerve after administration of 500 µg nicotine, given as duplicated controls and thereafter following 30 min perfusion of equipotent concentrations of atracurium (28.1 µM) or vecuronium(10 µM), after 30 min of neostigmine perfusion (9.2 µM) and finally after 30 min wash‐out with buffer solution only. A short‐lasting hypoxic test was performed before and at the end of the experimental period to confirm the responsiveness and validity of the preparation.Results: Atracurium (n = 7) and vecuronium (n = 6) reduced chemoreceptor responses to nicotine by 70 ± 30% and 66 ± 19% (SEM) (P<0.05). Chemoreceptor discharges showed full recovery after neostigmine in the atracurium group and partial recovery in the vecuronium group (P<0.05). Finally, after wash‐out the chemoreceptor responses to nicotine had fully recovered in both groups.Conclusion: Atracurium and vecuronium in equipotent concentrations block nicotine‐induced chemoreceptor responses of the carotid body.
Effect of CO2 pneumoperitoneum on ventilation‐perfusion relationships during laparoscopic cholecystectomy
Authors: Andersson L. , Lagerstrand L. , Thörne A. , Sollevi A. , Brodin L‐Å. , Odeberg‐Wernerman S. 
Published: March 2003

Background: Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO2) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation‐perfusion (V˙A/Q˙) before and during pneumoperitoneum by using the multiple inert gas technique.Methods: Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The V˙A/Q˙ relationships were evaluated by the multiple inert gas elimination technique before and during pneumoperitoneum to obtain a direct measure of the pulmonary shunt.Results: Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO2 from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low V˙A/Q˙ was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation.Conclusions: In patients without heart or lung disease, pneumoperitoneum at an intra‐abdominal pressure level of 11–13 mmHg causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.
Bicarbonate attenuates intracellular acidosis
Authors: Nielsen H. B. , Hein L. , Svendsen L. B. , Secher N. H. , Quistorff B. 
Published: March 2003

Background: This study was prompted by concern that administration of bicarbonate for correction of lactate acidosis aggravates a low intracellular pH (pHi). In healthy subjects we evaluated skeletal muscle pHi using 31P‐magnetic resonance spectroscopy during 5‐minute rhythmic handgrip to provoke intracellular acidosis.Methods: Subjects were randomized to treatment with bicarbonate or saline infused intravenously in a cross‐over study design with 1 h between trials.Results: In response to rhythmic handgrip, muscle venous O2 hemoglobin saturation decreased from 51 ± 4% to 36 ± 2% and lactate increased from 1.0 ± 0.1 to 4.9 ± 0.5 mmol/l with a reduction in pH from 7.43 ± 0.01–7.23 ± 0.01 (P<0.05). pHi decreased from 7.06 ± 0.02–6.36 ± 0.08 (P<0.05). Infusion of bicarbonate increased the arterial blood concentration from 26 ± 1 to 39 ± 1 mmol/l (P<0.05). The arterial CO2 partial pressure decreased from 5.6 ± 0.2 to 5.2 ± 0.3 kPa during rhythmic handgrip, whereas it increased to 5.9 ± 0.2 kPa (P<0.05) during infusion of bicarbonate. Bicarbonate treatment also increased pH of arterial and venous blood (7.55 ± 0.01 vs. 7.44 ± 0.02 and 7.31 ± 0.01 vs. 7.23 ± 0.02, respectively; P<0.05). In the last min of rhythmic handgrip the decrease in pHi was attenuated by the administration of bicarbonate (6.60 ± 0.11 vs. 6.40 ± 0.12; P<0.05).Conclusion: During exercise‐induced metabolic acidosis, intravenous administration of bicarbonate increased the buffering capacity of blood and attenuated the decrease in intracellular muscle pH, although there was a small increase in the arterial carbon dioxide pressure.
Effect of alkalinization and/or hyaluronidase adjuvancy on a local anesthetic mixture for sub‐Tenon's ophthalmic block
Authors: Moharib M. M. , Mitra S. , Rizvi S. G. 
Published: March 2003

Background and objectives: pH adjustment and/or addition of hyaluronidase to local anesthetic drugs decrease the time to onset and prolong the duration of regional anesthetic techniques for ocular surgery. The objective of this study was to investigate whether these factors are effective also in sub‐Tenon's block.Methods: Sixty patients were randomly assigned to four groups in a double blind, prospective fashion, and received 5.125 ml mixtures as follows: 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5% and 0.125 ml isotonic saline (group LB); 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5%, 15 IU hyaluronidase/ml and 0.125 ml isotonic saline (group LBH); 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5% and 0.125 ml sodium bicarbonate 8.4% (group LBpH); and 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5%, 15 IU hyaluronidase/ml and 0.125 ml sodium bicarbonate 8.4% (group LBHpH). This measurement was based on one quadrant sub‐Tenon's block. Akinesia was assessed every 30 s.Results: No statistically significant differences were found between the groups regarding mean times to onset and to complete akinesia. Group LBH displayed a significantly lower frequency of patients experiencing pain and a lower need for rescue medication during surgery than the other groups.Conclusion: pH adjustment and/or addition of hyaluronidase to a mixture of lignocaine and bupivacaine did not shorten the time to onset of akinesia following sub‐Tenon's technique. However, the addition of hyaluronidase was associated with a lower fraction of patients experiencing pain during surgery.
Coiling of lumbar epidural catheters
Authors: Lim Y. J. , Bahk J. H. , Ahn W. S. , Lee S. C. 
Published: March 2003

Background: The difficulties in threading an epidural catheter to vertebral levels remote to the puncture level have been well documented. This study was undertaken to determine the length that a single orifice epidural catheter can be threaded into the lumbar space without coiling (coiling length), and whether this is affected by the direction of the epidural needle bevel.Methods: Forty‐five young male patients scheduled for surgery under epidural analgesia were enrolled. The epidural space was identified using a midline approach at the L2−3 or L3−4 interspace with the loss of resistance to air technique. A 19‐G single‐orifice epidural catheter (Flextip PlusTM, Arrow International, Inc, Reading, PA, USA) was inserted through a Tuohy needle oriented either cephalad (n=20) or caudad (n=25). During insertion, the path and the position of the catheter tip was determined by fluoroscopy using iohexol dye.Results: The median coiling length was 2.8 cm, ranging from 1.0 to 8.0 cm. Only 13% of epidural catheters could be threaded 4 cm beyond the tip of the needle without coiling. No significant difference was found in coiling length between the cephalad group (2.9 cm) and the caudad group (2.5 cm).Conclusion: This study demonstrates that coiling length is independent of whether the bevel of the Tuohy needle is directed cephalad or caudad. We recommend that an optimal insertion depth of an end‐hole single orifice catheter is 3 cm.
Epidural buprenorphine in management of pain in multiple rib fractures
Authors: Govindarajan R. , Bakalova T. , Michael R. , Abadir A. R. 
Published: March 2003

Background: Pain from multiple rib fractures may affect pulmonary function, morbidity, and length of stay in the intensive care units. This study describes some clinical characteristics of epidural buprenorphine, a lipophilic and partial opiate agonist with a higher µ receptor affinity than morphine, in combating the pain in multiple rib fractures.Methods: The study was conducted prospectively over a 15‐month period. A total of 27 patients admitted to the hospital with multiple rib fractures were studied. Buprenorphine at a concentration of 0.3 mg in 5–10 ml normal saline was administered epidurally, twice daily the first 24 h, thereafter once daily. Ventilatory function tests (including vital capacity, tidal volume, respiratory rate, and minute volume) and assessment of pain intensity using a simple, categorical, verbal rating scale were obtained before and after institution of analgesia. Any nausea, vomiting, hypotension, urinary retention, respiratory depression or pruritis were recorded.Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd day after epidural analgesia when compared with the preanalgesia levels (P < 0.001). Changes in the verbal rating scale demonstrated that epidural buprenorphine was associated with marked improvement in pain at rest and pain during coughing and deep breathing. None of our patients developed hypotension (<10% of the baseline), urinary retention or respiratory depression. Nausea, vomiting, and mild pruritis were the only reported complications.Conclusions: Epidurally introduced narcotic, like buprenorphine in saline, has been found to be effective in our study to achieve adequate analgesia in treatment of patients with multiple rib fractures. In addition, this methodology of pain relief eliminates the costly delivery system and early discharge, and allows walking epidurals and follow‐up on outpatient basis.
Improved long‐lasting postoperative analgesia, recovery function and patient satisfaction after inguinal hernia repair with inguinal field block compared with general anesthesia
Authors: Aasbø V. , Thuen A. , Ræder J. 
Published: March 2003

Background: Inguinal hernia repair is a common surgical procedure, and different types of anesthetic techniques are in use. We wanted to test if preoperative inguinal field block (IFB) with ropivacaine would provide benefits in the postoperative period compared with general anesthesia and wound infiltration.Methods: Sixty patients scheduled for inguinal hernia repair were randomized to receive general anesthesia with wound infiltration postoperatively, or inguinal field block (IFB) before surgery, with no or only light sedation intraoperatively. General anesthesia was induced with midazolam, fentanyl and propofol, maintained with propofol and alfentanil, and supplemented with nitrous oxide in oxygen through a laryngeal mask. The IFB was performed by an anesthesiologist, with 50–60 ml ropivacaine and 5 mg/ml with a dedicated technique.Results: All significant differences were in favor of the IFB group: less pain (visual analog scale, verbal pain score) postoperatively and until day 7, faster mobilization with less pain, lower analgesic consumption, and higher patient satisfaction.Conclusion: Preoperative inguinal field block for hernia repair provides benefits for patients in terms of faster recovery, less pain, better mobilization and higher satisfaction throughout the whole first postoperative week.
Plasma cholinesterase activity and duration of action of mivacurium in phenotypically normal patients
Authors: Østergaard D. , Ibsen M. , Skovgaard L. , Viby‐Mogensen J. 
Published: March 2003

Background: The short duration of action of mivacurium is due to its rapid hydrolysis by plasma cholinesterase (pChe). In patients with normal phenotype, low pChe activity because of, for instance, disease or intake of drugs may prolong the duration of action of mivacurium. The purpose of this study was to evaluate the relationship between pChe activity and the duration of action of mivacurium 0.2 mg/kg in phenotypically normal patients.Material: Forty‐three adult patients with normal pChe phenotype and low or normal pChe activity, undergoing a variety of surgical procedures were included in the study with their informed consent and Ethics Committee approval. The neuromuscular block was monitored using TOF stimulation every 12 s and mechanomyography. The time to reappearance of the first response to TOF stimulation was measured.Results: The patients pChe activities ranged from 45 to 1272 U/l (normal range 660–1620 U/l) and the time to first response to TOF from 8.1 to 62.7 min. An inverse relationship between enzyme activity and duration of action of mivacurium was found. The relationship was described by the equation: log10 (time) =α‐ β log10 (pChe), where α (SD) is 2.547 (0.186) and β (SD) 0.454 (0.069).Conclusion: In patients with phenotypically normal pChe, prediction of the duration of action of mivacurium is possible from the patients actual pChe activity. In patients with pChe activities below the normal range, the time to reappearance of the first response to TOF stimulation may vary from 10 to 180 min Only patients with pChe activities <220 U/l had a significantly prolonged duration of action of mivacurium.