bluuebunny/crossref_metadata_2025_split huggingface dataset:
The N‐methyl‐D‐aspartate‐receptor antagonist dextromethorphan lacks analgesic effect in a human experimental ischemic pain model
Authors: Plesan A. , Sollevi A. , Segerdahl M. 
Published: March 2003

Background: N‐methyl‐D‐aspartate‐receptor antagonists may be useful in pain management. The aim of this study was to evaluate dextromethorphan (DEX), a commonly used oral antitussive drug with NMDA‐receptor antagonistic properties, in respect of its analgesic properties as single drug and co‐administered with morphine (MO) on experimental ischemic pain. In addition, the analgesic effects of another clinically available NMDA‐receptor antagonist, ketamine (KET) as well as of morphine (MO) were tested as active controls.Methods: Nineteen healthy volunteers were included in the study. Experimental ischemic pain was induced using the forearm tourniquet test. Placebo (PLAC), oral DEX (30 and 90 mg, respectively), KET (9 μg kg−1 min−1 i.v.), MO (0.1 mg kg−1 i.v.) and the DEX+MO and KET+MO combinations were evaluated during eight separate experiments. Development of ischemic pain was rated by visual analog scale (VAS) every minute over 30 min and ratings were summed as sum of pain scores (SPS).Results: DEX by itself did not influence SPS compared to PLAC. The DEX+MO co‐administration did not enhance MO‐induced analgesia. MO and KET reduced pain ratings by 27% and 39%, respectively. The KET+MO combination showed no enhancement of the analgesic effect in comparison with the respective drugs in monotherapy.Conclusion: DEX in clinical doses has no effect on the present acute ischemic pain model and does not influence MO‐induced analgesia. Further studies on other pain modalities are needed in order to evaluate the potential use of DEX in pain treatment.
Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy
Authors: Elhakim M. , Amine H. , Kamel S. , Saad F. 
Published: March 2003

Background: Previous work has demonstrated that intraperitoneal (i.p.) lidocaine may provide analgesia after laparoscopic cholecystectomy. The aim of this prospective, randomized, double‐blind study was to compare pain relief, recovery variables, and side effects after i.p. instillation of lidocaine plus tenoxicam given either i.v. or i.p. after laparoscopic cholecystectomy.Methods: Ninety patients were randomly allocated to one of three groups to receive either 200 ml normal saline i.p. and 2 ml of normal saline i.v. (saline group), 200 ml lidocaine 0.1% i.p. and 2 ml tenoxicam 20 mg i.v. (tenoxicam i.v. group), or 200 ml lidocaine 0.1% with 20 mg tenoxicam i.p. and 2 ml of normal saline i.v. (tenoxicam i.p. group). The i.p. instillation was made under the right diaphragm and on the gall bladder bed. VAS pain scores at rest, on movement and during coughing, were measured 2, 4, 6, 12, and 24 h after operation. The time to first demand of analgesia, total analgesic requirement, recovery variables, and side effects were investigated.Results: In the tenoxicam i.p. group, pain scores were significantly lower both at rest and on movement and analgesic consumption was reduced compared with the saline group (P<0.05). In the tenoxicam i.v. group, pain scores at rest were significantly lower compared with the saline group. Although recovery of bowel function was significantly faster in the tenoxicam i.p. group (P<0.05), there were no differences in any other recovery characteristics or incidence of nausea between the groups.Conclusion: Combination of intraperitoneal lidocaine and tenoxicam provided better analgesia on movement, and faster return of bowel function compared with i.p. lidocaine and i.v. tenoxicam during the 24 h period after surgery.
The effect of the obstetrician group and epidural analgesia on the risk for cesarean delivery in nulliparous women
Authors: Beilin Y. , Friedman F. , Andres L. A. , Hossain S. , Bodian C. A. 
Published: March 2003

Background: The effects of regional anesthesia and of the obstetrician on the risk of cesarean delivery remain controversial. The purpose of this study was to determine whether epidural analgesia or the obstetrician group is associated with an increase in the risk for cesarean delivery in nulliparous women.Methods: Data were collected for a two‐year period from the medical records of all nulliparous women who had a private obstetrician who delivered >20 babies per year, and who presented with a singleton gestation in the vertex presentation for a trial of labor.Results: Data were collected for 3699 women of whom 1832 were nulliparous. Of the 1832 nulliparous women, data were analyzed for the 1278 women who met our study criteria, representing 14 separate obstetrician groups. Excluding the 50 women whose babies were delivered for fetal distress (leaving 1228 women for analysis), the epidural rate was 93%, range 81–98%, and the cesarean delivery rate was 14%, range 8–34%. Logistic regression analyses revealed that (odds ratio, 95% confidence interval) patient age (1.7, 1.2–2.4), birth weight (1.001, 1.001–1.002), induction of labor (1.9, 1.3–2.7), non‐Caucasian (1.9, 1.2–2.9) and the obstetrician group, (P=0.002), were independently associated with the risk of cesarean delivery, but epidural analgesia was not (1.6, 0.7–3.6).Conclusions: The obstetrician group is independently associated with the risk of cesarean delivery in nulliparous women, but we could not demonstrate this association with epidural analgesia. We suggest that in future studies regarding epidural analgesia and cesarean delivery, the obstetrician group should be included as a variable (
Note).
Helicopter emergency medical service in out‐of‐hospital cardiac arrest – a 10‐year population‐based study
Authors: Skogvoll E. , Bjelland E. , Thorarinsson B. 
Published: March 2003

Background: In 1988, Norway established a countrywide, physician staffed helicopter emergency medical service (HEMS). The medical benefit remains controversial. The aim of this study was to estimate the population incidence of HEMS involvement in out‐of‐hospital cardiac arrest, report the patient outcome and evaluate the contribution of HEMS to survival.Methods: We studied HEMS operations in central Norway (population 364 000) during a 10‐year period (1988–1997). Missions were classified according to type and quality of intervention done by the primary care providers. HEMS witnessed cardiac arrests were not considered. Patient outcome was determined as survival to hospital discharge with cerebral performance category (CPC) score. The contribution made by HEMS in each survivor was assessed from the timing of return of spontaneous circulation (ROSC) and from subsequent need for advanced medical intervention. The relation between survival and HEMS response time was investigated by ordinal correlation.Results: A total of 541 requests (14.9 per 100 000 inhabitants per year) were identified, of which 424 missions were completed. Overall survival to discharge was 36/541 (6.6%), yielding a population survival incidence of 1 per 100 000 per year. Ninety‐five percent of survivors made a favourable cerebral outcome (CPC 1 or 2). General practitioners/ambulance personnel resuscitated 29 out of 36 survivors. The remainder achieved ROSC after HEMS arrival. Case by case, HEMS assistance was considered possibly important in 17 survivors. We found no relation between survival and HEMS response time (P=0.77).Discussion:Survival following out‐of‐hospital cardiac arrest assisted by HEMS in this region is low, but not negligible. While primary care is most important, HEMS may possibly contribute to the additional survival of 0.19 to 0.46 patients per 100 000 per year. This benefit appears to be independent of HEMS response time ( Note).
Elastic pressure–volume curves indicate derecruitment after a single deep expiration in anaesthetised and muscle‐relaxed healthy man
Authors: Sigurdsson S. , Svantesson C. , Larsson A. , Jonson B. 
Published: March 2003

Background: In acute respiratory distress syndrome, lung volume is lost immediately after positive end‐expiratory pressure (PEEP) is removed and is not immediately regained when PEEP is restored to its original value. The aim of this study was to investigate whether the same phenomenon also occurs in cardiopulmonary healthy individuals during anaesthesia and muscle relaxation.Methods: In 13 anaesthetised and muscle‐relaxed patients, inspiratory elastic pressure–volume (Pel–V) curves were, after lung recruitment, obtained from zero end‐expiratory airway pressure (ZEEP) and from a PEEP of 5 cmH2O. The curves were aligned on a common volume axis. Differences in lung volumes and compliance (Crs) were calculated at the different airway pressures.Results: At comparable pressures the ZEEP curve showed significantly lower volumes up to an airway pressure of 25 cmH2O. Maximum Crs was similar on the curves obtained from ZEEP and PEEP. However, the lower segments of the curve recorded from PEEP showed lower Crs compared to the curve recorded from ZEEP.Conclusion: During anaesthesia and muscle paralysis, the Pel–V relations change immediately when 5 cmH2O of PEEP is removed. This phenomenon is probably mainly caused by closure of small airways and only in a minor part, if any, by formation of atelectasis. This study indicates that under these conditions lung volume might easily be normalised by a large breath producing an airway pressure of 20 cmH2O.
Intraperitoneal tonometry for detection of regional enteric ischaemia
Authors: Koga I. , Stiernstrom H. , Christiansson L. , Wiklund L. 
Published: March 2003

Background: The objective of this study was to test the hypothesis that intraperitoneal tonometry can be a specific monitor for ischaemia in the small intestine.Methods: Twelve pigs were anaesthetized and mechanically ventilated. The celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) were identified. Tonometry catheters were positioned intraperitoneally at three different locations where blood supply varied. One at a time of the mesenteric arteries was occluded, producing regional ischaemia in different splanchnic organs.Results: Regional PCO2 (Pr CO2) increased significantly in the intestinal region, in the small intestine, only during the SMA clamping. In the epigastric region, i.e. in the space between the liver and the stomach, PrCO2 increased significantly only during CA clamping.Conclusion: Intraperitoneal tonometry in the intestinal region can be a specific monitor of ischaemia in the small intestine.
Light‐guided intubation via the intubating laryngeal mask using a prototype illuminated flexible catheter
Authors: Dimitriou V. , Voyagis G. S. 
Published: March 2003

Background: The transillumination of the soft tissues of the neck using lighted stylets has been used as an aid for tracheal intubation. We evaluated the efficacy and safety of a prototype illuminated flexible catheter to facilitate light‐guided intubation through the intubating laryngeal mask.Methods: The illuminated flexible catheter consists of a completely flexible thin plastic catheter with a bulb attached to its distal end. The device was placed into a silicone tracheal tube in such a way that the bulb was adjusted at the distal end of the tracheal tube. The tracheal tube preloaded with the device was inserted through the intubating laryngeal mask and, by observing the glow on the neck, was advanced into the trachea. We report our experience with light‐guided intubation through the intubating laryngeal mask in 400 ASA grade 1–3 patients undergoing general anaesthesia.Results: The intubating laryngeal mask was inserted successfully in all patients. The overall intubating success rate was 99.8% (399/400); in 367 (91.8%) cases at the first attempt, in 28 (7%) at the second, in 4 (1%) at the third and in one case (0.2%) at the fifth attempt. There were 27 patients with potentially difficult airways. All these cases were intubated successfully; in 23 of 27 (85.2%) at the first attempt, in 3 of 27 (11.1%) at the second and one of 27 patients (3.7%) at the third attempt.Conclusion: We conclude that the use of the illuminated flexible catheter facilitates the intubation through the intubating laryngeal mask. The suggested light‐guided intubating method proved to be a simple, safe and effective technique.
Epidural abscess after epidural catheter for pain release during pancreatitis
Authors: Heller A. R. , Ragaller M. , Koch T. 
Published: March 2003

Background: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis.Case report:We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T‐helper cell counts were distinctively reduced in the absence of HIV serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin III in the peripheral blood.Conclusion: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.
Efficacy of intrathecal neostigmine for the relief of postinguinal herniorrhaphy pain
Authors: Tan P.‐H. , Kuo J.‐H. , Liu K. , Hung C.‐C. , Tsai T.‐C. , Deng T.‐Y. 
Published: March 2003

Background: Intrathecal administration of various doses of neostigmine has been reported to produce analgesia without neurotoxicity in both animal and human studies. The present study was undertaken to evaluate the efficacy and safety of intrathecal neostigmine for the relief of pain for patients having undergone inguinal herniorrhaphy surgery.Methods: Sixty men scheduled for elective inguinal herniorrhaphy with spinal anaesthesia were randomly allocated to three groups: group I (n=20) received intrathecal (IT) tetracaine 15 mg, group II (n=20) received IT tetracaine 15 mg+ neostigmine 50 μg, and group III (n=20) received IT tetracaine 15 mg+neostigmine 100 μg. The onset of anaesthesia, duration of analgesia, time to use of first rescue analgesics, the overall 24‐h VAS pain scores and the incidence of adverse effects were recorded for 24 h postdrug administration.Results: Onset of anaesthesia (time to T6 sensory block) was significantly faster for group II and III patients compared with group I patients. Motor block (time to lift leg) was greatly prolonged for group III patients, with an average of 6.4 h, compared with 4.1 h for group II patients. Group III patients also showed a later onset of postsurgical pain, lower overall 24‐h VAS pain score and prolonged time to first rescue analgesics than did group II patients. There was a significantly greater incidence of adverse effects associated with IT neostigmine, especially nausea and vomiting.Conclusion: Our study showed that intrathecal neostigmine at 50 μg or 100 μg enhanced the onset of tetracaine anaesthesia and provided analgesia lasting for 6–9 h, although increased incidences of prolonged motor blockade and nausea or vomiting were noted (Note).
Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture – a randomized controlled trial
Authors: Scheinin H. , Virtanen T. , Kentala E. , Uotila P. , Laitio T. , Hartiala J. , Heikkilä H. , Sariola‐Heinonen K. , Pullisaar O. , Yli‐Mäyry S. , Jalonen J. 
Published: March 2003

Background: Perioperative myocardial ischaemia is an important risk factor for cardiac morbidity and mortality after noncardiac surgery. The impact of analgesic management on the incidence and severity of cardiac ischemia was studied in 77 elderly patients undergoing surgical treatment of traumatic hip fracture.Methods: After hospital admission and written consent, patients were randomised to conventional analgesic regimen (intramuscular oxycodone, OPI group) or continuous epidural infusion of bupivacaine/fentanyl (EPI group). The analgesic regimens were started preoperatively. Patients were operated under spinal anaesthesia and the treatments were continued three days postoperatively. ECG was continuously recorded. ST segment depression of ≥0.1 mV or elevation of ≥0.2 mV lasting ≥1 min were considered as ischaemic episodes. Nocturnal arterial oxygen saturation (SaO2) was recorded perioperatively, and subjective pain was assessed every morning using a visual analogue scale (VAS).Results: Fifty‐nine (OPI 30, EPI 29) patients were evaluable for efficacy. Thirteen patients (43%) in the OPI and 12 patients (41%) in the EPI group had ischaemic episodes (NS). However, significantly more patients in the OPI group had ischaemic episodes during the surgery (8 vs. 0 in the EPI group, P=0.005). The median (quartal deviation) total ischaemic burden (i.e. integral of ST‐change vs. time) in patients with ischaemic episodes was ten times larger in the OPI group (340 [342] mm  ·  min) compared with the EPI group (30 [36] mm  ·  min) (P=0.002). There were no significant differences between the groups in average heart rates or in heart rates at the start of ischaemic episodes or in maximal heart rates during the attacks. Average nocturnal SaO2 was similar in the two groups and there were no differences in the number of hypoxaemic (SaO2<90%) episodes. Preoperatively there were no differences in subjective pain, but postoperative and average perioperative VAS scores for pain were almost 40% lower in the EPI group (P=0.006). Perioperative myocardial infarctions were not detected.Conclusions: Continuous epidural bupivacaine/fentanyl analgesic regimen, started preoperatively, reduces the amount of myocardial ischaemia in elderly patients with hip fracture.
Selective and segmentally restricted antinociception induced by MPV‐2426, a novel alpha‐2‐adrenoceptor agonist, following intrathecal administration in the rat
Authors: Onttonen T. , Kalmari J. , Pertovaara A. 
Published: March 2003

Background: MPV‐2426 (radolmidine) is a novel alpha‐2‐adrenoceptor agonist developed for spinal pain therapy. In the present study we determined the segmental distribution and selectivity of the antinociceptive effect induced by MPV‐2426 following i.t. administration in rats.Methods: The experiments were performed in lightly anesthetized rats with an i.t. catheter for administration of drugs into the lumbar spinal cord level. To determine segmental distribution of antinociception, the withdrawal latency of the tail and forepaw from a hot water bath was measured. To determine selectivity of reflex modulation, the effect of i.t. MPV‐2426 on the innocuous H‐reflex was determined.Results: In the hot water immersion test MPV‐2426 produced a dose‐dependent (0.3–3.0 μg) prolongation of tail withdrawal latency whereas the effect on forepaw withdrawal latency was short of significance. Dexmedetomidine, the reference alpha‐2‐adrenoceptor agonist, produced a significant dose‐related prolongation of both the tail and the forepaw withdrawal (0.3 and 1.0 μg). MPV‐2426 (1.0 and 3.0 μg) produced no significant change in the amplitude of the H‐reflex or M‐response induced by electrical stimulation of the tibial nerve, nor any change in the modulation of the H‐reflex amplitude induced by conditioning sural nerve stimulation. The antinociception induced by MPV‐2426 was completely reversed by atipamezole (1 mg/kg s.c.), an alpha‐2‐adrenoceptor antagonist.Conclusion: MPV‐2426 produces a selective and segmentally more restricted antinociceptive effect than dexmedetomidine following i.t. administration. The antinoception induced by MPV‐2426 is due to action on spinal alpha‐2‐adrenoceptors.
Effects of alpha adrenoreceptor antagonists, prazosin and yohimbine, on intrathecal lidocaine‐induced antinociception in mice
Authors: Uchihashi Y. , Kamei M. , Fukuda I. , Nakai T. , Karasawa F. , Satoh T. 
Published: March 2003

Background: The precise mechanisms involved in the spinal analgesic effect of lidocaine are not yet clear. We previously found that lidocaine releases noradrenaline, a modulator of nociception, in rat spinal cord. Here, we attempted to clarify whether or not the noradrenaline release contributes to spinal analgesia by lidocaine.Methods: The effects of intrathecal injections of the alpha adrenoreceptor antagonists, prazosin (0.01–0.3 nmol) and yohimbine (0.1–3 nmol), on intrathecal 2% lidocaine were assessed using the tail‐flick (TF) test in mice.Results: Lidocaine significantly increased the TF latency for 15 min. Prazosin (0.03, 0.1 or 0.3 nmol) and yohimbine (0.3, 1.0 or 3.0 nmol) significantly reduced the lidocaine‐induced increase of the TF latency 10 min after injection, although both drugs showed a ceiling effect.Conclusion: These results suggest that stimulation of the noradrenergic systems plays an important role in spinal analgesia by lidocaine.
Effects of oxygen and nitric oxide inhalation in a porcine model of recurrent microembolism
Authors: Weimann J. , Zink W. , Gebhard M. M. , Gries A. , Martin E. , Motsch J. 
Published: March 2003

Background: Inhalation of nitric oxide (iNO) has been proposed for the treatment of acute pulmonary embolism. The present study evaluates the effects of oxygen (O2) and nitric oxide inhalation in a porcine model of sustained pulmonary hypertension induced by recurrent pulmonary microembolism.Methods: Twelve pigs were embolized under general anesthesia with 300‐μm microspheres intravenously three times over a period of seven weeks. Five pigs served as untreated controls. Hemodynamic and gas exchange responses to 100% oxygen and 40 ppm NO inhalation, and their combination (O2+iNO) were measured seven days after the last embolization.Results: Recurrent microembolism caused sustained pulmonary hypertension (pulmonary vascular resistance index; PVRI 408±57 dyn · s · cm−5 · m−2) as compared to the control group (PVRI 143±20 dyn · s · cm−5 · m−2; P<0.05). PVRI was significantly reduced by O2, iNO, and O2+iNO inhalation by 29±3, 28±4, and 32±3%, respectively.Conclusion: We conclude that both O2 and iNO are selective pulmonary vasodilators in a porcine model of sustained pulmonary hypertension following recurrent pulmonary microembolism and, therefore, may be useful in the treatment not only in the acute phase of pulmonary embolism but also later in the time course of the disease.
Electrical stimulation of the vestibular system prevents postoperative nausea and vomiting
Authors: Pusch F. , Freitag H. , Goll V. , Wildling E. , Hoerauf K. , Obwegeser R. , Weinstabl C. 
Published: March 2003

Background: Electrical stimulation of the vestibular system may prevent nausea and vomiting. We studied the influence of transcutaneous impulse stimulation in prevention of postoperative nausea and vomiting (PONV) following gynaecological surgery.Methods: In this randomised study 70 women undergoing elective gynaecological surgery under general anaesthesia were assigned to receive either the activated (stimulation group) or the inactivated (non‐stimulation group) impulse stimulator. The stimulator comprises the stimulator itself, two negative electrodes on a headset applied over both mastoid processes and a nuchal positive electrode. The device yielded a pulse frequency of 5 Hz direct current, individually adjustable between 0.5 and 4 mA. A trapezoid stimulation of 50 ms was applied. Nausea, vomiting, dizziness and the amount of antiemetic drugs used were assessed during the first 4 h postoperatively.Results: Lower postoperative nausea scores with a lower incidence of vomiting and postoperative dizziness were found in the stimulation group. A lower amount of antiemetic drugs was needed in the stimulation group when compared to the non‐stimulation group (P<0.01 between groups).Conclusion: This study suggests that electrical stimulation of the vestibular system may be useful in prevention of PONV.