bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recovery characteristics of sevoflurane or halothane for day‐case anaesthesia in children aged 1–3 years
Authors: Viitanen H. , Baer G. , Annila P. 
Published: March 2003

Background: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day‐case anaesthesia in a specifically limited age group of children 1–3 yr.Methods: Eighty unpremedicated children undergoing day‐case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within ±20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end‐points. A postoperative questionnaire was used to determine the well‐being of the child at home until 24 h after discharge.Results: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side‐effects in the two groups were otherwise similar in the recovery room and at home.Conclusions: In children 1–3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30‐min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics.
Intramuscular ephedrine reduces emesis during the first three hours after abdominal hysterectomy
Authors: Hagemann E. , Halvorsen A. , Holgersen Ø. , Tveit T. , Ræder J. C. 
Published: March 2003

Background: We tested the hypothesis that intramuscularly administered ephedrine prevents postoperative nausea and vomiting. Ephedrine is cheap, and for this indication poorly documented.Methods: One hundred and nine patients undergoing elective abdominal hysterectomy under general anaesthesia were studied in a randomized, double‐blind placebo‐controlled study. Ten minutes before the end of the procedure patients received either ephedrine 0.5 mg/kg i.m. or placebo. The patients were closely observed for 24 h for postoperative nausea or vomiting (PONV) and received a standardized two‐step antiemetic treatment of i.v. metoclopramide 10 mg, supplemented with ondansetron 4 mg i.v. if needed.Results: The ephedrine treated patients had significantly less nausea, retching and vomiting, and need of antiemetic rescue during the first 3 h postoperatively compared with the placebo patients. No difference between the groups was evident in the 3–24 h postoperative observation period. All the patients with PONV during 0–3 h experienced PONV in the 3–24 h period. Treatment or prophylaxis with one drug was less efficient than two or more drugs combined. No significant differences in hypotension, tachycardia or other side‐effects between the groups were noted.Conclusion: Ephedrine 0.5 mg/kg i.m. administered at the end of abdominal hysterectomy has a significant antiemetic effect during the first 3 h after administration with no evident side‐effects.
Intermittent atrial level right‐to‐left shunt with temporary hypoxemia in a patient during support with a left ventricular assist device
Authors: Kilger E. , Strom C. , Frey L. , Felbinger T.W. , Pichler B. , Tichy M. , Rank N. , Wheeldon D. , Kesel K. , Schmitz C. , Reichenspurner H. , Polasek J. , Weis F. , Goetz A. E. 
Published: March 2003

We report a 56‐year‐old male patient developing hypoxemia after surgical replacement of infected valves of a left ventricular assist device (LVAD, NovacorTM) which had supported him during the previous 15 months. Contrast transesophageal echocardiography (TEE) revealed an atrial septal defect with intermittent right‐to‐left shunt across a patent foramen ovale.We postulate that the shunt detected in this patient occurred as a consequence of reduced pulmonary vascular compliance due to positive end‐expiratory pressure (PEEP) and an increase of mean intrathoracic pressure. Furthermore, we hypothesize that synchronized LVAD operation exacerbates any potential right‐to‐left shunt due to the profound left ventricular unloading which occurs during LVAD support.In this first report of a right‐to‐left shunt from a previously unrecognized patent foramen ovale in a NovacorTM patient, the subsequent transient hypoxemia could be managed by avoiding PEEP of more than 3 mmHg, and mean airway pressure of more than 11 mmHg and by careful volume replacement in order to prevent the pump from completely emptying the left ventricle (LV) and the left atrium (LA). Thus, prior to every LVAD implantation a transesophageal contrast echocardiography with Valsalva maneuver should be performed to identify intracardiac right‐to‐left shunt.
Cardiac output measurements during cross‐clamping of the descending thoracic aorta in pigs
Authors: Aadahl P. , Aakhus S. , Sæther O. D. , Stømholm T. , Myhre H. O. 
Published: March 2003

Background: Cross‐clamping of the descending thoracic aorta (XC) induces an increase in cardiac output (CO). The intention of this study was to evaluate the high CO during XC by the use of clinically available methods (thermodilution and pulsed Doppler ultrasound) compared to transit‐time ultrasound flowmetry of the ascending aorta as the gold standard.Method:Ten pigs were anaesthetised with ketamine and fentanyl. The descending thoracic aorta was cross‐clamped for 30 min, and cardiac output was measured with pulmonary artery thermodilution technique, pulsed Doppler ultrasound on the aortic annulus and transit‐time ultrasound flowmetry of the ascending aorta.Results: At 15 min following XC, CO increased from 1.7 l/min to 4.6 l/min measured with transit‐time ultrasound (P<0.05). With thermodilution technique, CO increased from 2.6 l/min to 5.7 l/min (P<0.05), and from 2.4 l/min to 6.0 l/min measured with Doppler ultrasound (P<0.05). There was an increase in mean arterial pressure of 81% and heart rate increased 76% (P<0.05).Conclusion: XC of the descending thoracic aorta induces an increase in CO of 171%. Thermodilution and pulsed Doppler ultrasound are reliable methods for detecting high cardiac output during thoracic aortic surgery.
Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children
Authors: Kokki H. , Heikkinen M. , Turunen M. , Vanamo K. , Hendolin H. 
Published: March 2003

Background: In adults, pencil‐point spinal needles are believed to be less traumatic and therefore to be superior compared to cutting‐point needles with respect to success rate and postpuncture complications. The aim of this randomised, parallel groups and prospective study was to record the success rate and to evaluate the incidence of complications following spinal anaesthesia with the two types of needles in children.Methods: We studied 215 children aged 1 to 18 years. A 25‐gauge needle was used in children up to 7 years (n=96) and a 27‐gauge needle in older children (n=119). During lumbar puncture with either a cutting‐point (n=109) or a pencil‐point (n=106) spinal needle, we recorded puncture characteristics and the success of cerebrospinal fluid (CSF) aspiration. Hyperbaric bupivacaine 5 mg ml−1 at a dose of 0.3–0.4 mg kg−1 was used for the spinal anaesthesia. The incidence of postdural puncture complications was recorded from diaries completed by the children and parents one week after the lumbar puncture.Results: The success rate of the spinal anaesthesia was 97% without difference between the needles. The success rate was higher when the aspiration of CSF was easy compared to if it was difficult (98% vs. 88%, P=0.02). Two hundred and seven diaries were returned (97%). Twenty‐four children developed a headache, 8 of which were classified as a postdural puncture headache (PDPH), 6 with the cutting‐point needle and 2 with the pencil‐point needle (n.s.). Nine children developed signs of transient radicular irritation with no difference between the needles.Conclusion: Both types of spinal needles can be used in children, and a free aspiration of CSF results in a high success rate of the spinal block. Postpuncture complications are as common in children as in adults.
Comparison of combined spinal epidural anesthesia and epidural anesthesia for cesarean section
Authors: Choi D. H. , Kim J. A. , Chung I. S. 
Published: March 2003

Background: Epidural anesthesia (EA) is popular for cesarean section, but has some drawbacks such as incomplete block, inadequate muscle relaxation and delayed onset. Combined spinal epidural anesthesia (CSEA) has gained increasing interest as it combines the reliability of a spinal block and the flexibility of an epidural block. We investigated the efficacy of CSEA that combines the main spinal and the supporting epidural anesthesia, comparing with pH‐adjusted EA, for cesarean section.Methods: Sixty‐four pregnant women at full term were divided into two groups. Patients in the CSEA group (n=32) were given 1.5–1.6 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by 10 ml of 0.25% plain bupivacaine through the epidural catheter 10 min later. Patients in the EA group (n=32) received 20–25 ml of 2% lidocaine which was already mixed with 0.1 ml of 0.1% epinephrine, 100 g of fentanyl and 1.5 ml of 8.4% sodium bicarbonate. The quality and side effects of surgical anesthesia, neonatal state, and postoperative course were compared between the two groups.Results: In the EA group, 22% (7 cases) complained of intraoperative pain but none in the CSEA group (P=0.011). Muscle relaxation and motor block were much better in the CSEA group (P<0.001 and P=0.011 each). Significantly more women in the EA group had shivering (P=0.001). They also had more nausea and vomiting but the differences were not significant. Not only the time to T4 block (9.7 vs. 18.3 min, mean, P<0.001) but also the stay in the postanesthesia care unit, recovery of sensory and motor block and start of postoperative pain were all significantly shorter in the CSEA group. No one in either group had post‐dural puncture headache (PDPH).Conclusion: We can conclude that, when combining the main spinal and the supporting epidural anesthesia, CSEA has greater efficacy and fewer side effects than the pH‐adjusted EA in cesarean sections.
Quality of recovery in children: sevoflurane versus propofol
Authors: Picard V. , Dumont L. , Pellegrini M. 
Published: March 2003

Background: Sevoflurane, with its low pungency and low blood and tissue solubility, is an attractive anaesthetic in paediatric outpatient surgery. Propofol‐anaesthesia is recognised for its rapid and clear‐headed emergence. This study was designed to compare emergence and recovery characteristics of sevoflurane and propofol anaesthesia for tonsillectomy in children.Methods: Children aged 3–10 years, undergoing elective tonsillectomy, were randomly assigned to receive propofol (n=25, induction with 3 mg · kg−1, maintenance with 100–250 μg · kg−1 · min−1) or sevoflurane anaesthesia (n=25, induction 7 vol.%, maintenance 2–3 vol.%). Tracheal intubation was performed with alfentanil 20 μg · kg−1 and atracurium 0.5 mg · kg−1. Ventilation was controlled to maintain normocapnia and all patients received N2O/O2 (60:40 vol.%) for induction and maintenance of anaesthesia. At the end of surgery infiltration of the operative sites with bupivacaine 2 mg · kg−1 was provided for postoperative analgesia. Emergence, recovery, discharge times, and incidence of side effects were compared between the two groups.Results: Time to extubation (14 vs 15 min), time to response to simple verbal command (21 vs 21 min) and time to discharge from the recovery room (45 vs 50 min) were similar in the sevoflurane and propofol groups, respectively. There was a significantly greater incidence of postoperative agitation in the sevoflurane group (46%) compared with the propofol group (9%) (P=0.008). This did not, however, delay discharge from the recovery room. The incidence of nausea and vomiting was not significantly different (8% vs 0%; P=0.49).Conclusion: In children, recovery from anaesthesia with sevoflurane results in a higher incidence of agitation compared with propofol.
The impact of 4‐chloro‐m‐cresol in heparin formulas on malignant hyperthermia: in vitro and in vivo
Authors: Anetseder M. , Ritter L. , Horbaschek H. , Hartung E. , Roewer N. 
Published: March 2003

Background: The preservative 4‐chloro‐m‐cresol (4CmC) is a specific activator of sarcoplasmic Ca2+ release and induces contractures in skeletal muscles of malignant hyperthermia susceptible (MHS) patients in vitro. Clinical formulas of heparin contain 4CmC. We studied whether (a) these heparin formulas induce contractures in isolated MHS and normal (MHN) human skeletal muscles and whether (b) significant serum levels of 4CmC are reached after heparinization in cardiopulmonary bypass patients.Methods: (a) In vitro, muscle bundles of 16 MHS and 22 MHN patients were exposed to the heparin formula Liquemin® (containing 4CmC 0.08 mg/500 IU), to chlorocresol and to preservative‐free heparin in the in vitro contracture test. (b) In vivo, serum 4CmC levels of 12 patients receiving Liquemin® 500 IU/kg before cardiopulmonary bypass were determined at 1, 5 and 60 min by high‐pressure liquid chromatography.Results: (a) For Liquemin® and 4CmC, significant contractures were measured with MHS muscles compared to MHN muscles at 61.4 μM 4CmC. (b) In control sera, the detection threshold for 4CmC was 4 μM. Concentrations of 4CmC in all patients’ serum samples were below this threshold.Conclusion: Heparin formulas, containing 4CmC, induce dose‐dependent contractures in vitro in MHS human skeletal muscle at about 60 μM 4CmC. However, in vivo, 4CmC serum concentrations with therapeutic heparinization are less than 1/15 of the in vitro concentration. The lipophilicity of 4CmC with a high volume of distribution may account for these findings. MHS patients seem not to be at risk from clinical heparin formulas containing chlorocresol.
Peroperative cardiovascular stability during brainstem surgery. The use of high‐dose methylprednisolone compared to dexamethasone
Authors: Mursch K. , Buhre W. , Behnke‐Mursch J. , Markakis E. 
Published: March 2003

Background: In neurosurgical procedures within brainstem structures, corticosteroids are routinely administered to prevent oedema and to reduce intraoperative trauma. After replacing the routine administration of dexamethasone (DX) by high‐dose methylprednisolone (MP) during surgery for tumours within brainstem structures, a decreased incidence of intraoperative haemodynamic instability events was observed. To test this hypothesis, a retrospective analysis was performed.Methods: Peroperative data of 62 surgical procedures of brainstem tumours were retrospectively analysed with respect to haemodynamic instability requiring changes in surgical strategy and/or emergence medication with vasoactive drugs. Severe changes in haemodynamic parameters were defined as a significant increase or decrease in heart rate and/or mean arterial blood pressure greater than 30% compared to baseline values. From 1988 to 1994, intravenous dexamethasone was given peroperatively in 33 patients. After a bolus of 1 mg kg−1 body weight (BW) 30 min preoperatively, 0.2 mg kg−1 were given every 4 h. From 1994 until now, methylprednisolone was administered instead of dexamethasone in 29 patients. After an initial bolus of 30 mg kg−1 BW immediately before surgery, 5.4 mg kg−1 h−1 were given 23 h postoperatively.Results: The results of this retrospective analysis suggest that the number of operations with episodes of bradycardia, arterial hypotension (P<0.05), tachycardia and arterial hypertension (P<0.005) was significantly decreased in the group of patients treated with high‐dose methylprednisolone.Conclusion: The retrospective analysis of the clinical data showed that the routine use of high‐dose methylprednisolone was associated with a decreased incidence of haemodynamic instability in a selected group of patients undergoing brainstem surgery. This finding has to be proven in prospective double‐blind controlled studies.
Low‐dose dopexamine in patients undergoing hemihepatectomy: an evaluation of effects on reduction of hepatic dysfunction and ischaemic liver injury
Authors: Marx G. , Leuwer M. , Höltje M. , Bornscheuer A. , Herrmann H. , Mahr K. H. , Vangerow B. , Heine J. , Piepenbrock S. , Rueckoldt H. 
Published: March 2003

Background: Hepatic dysfunction is a common problem in patients after hemihepatectomy. Treatment with low‐dose dopamine has been shown to be beneficial in hemihepatectomy patients. We hypothesized that dopexamine, a synthetic vasoactive catecholamine, due to its specific pharmocodynamic profile may be more effective in reducing hidden ischaemic episodes in the hepato‐splanchnic region during and after temporary total cross‐clamping of hepatic inflow in these patients.Methods: The effects of low‐dose dopexamine on hepatic venous haemoglobin oxygen saturation (Shv¯O2), hepatic venous lactate level, monoethylglycinxylid (MEGX) formation, hepatic synthetic function and indicators for hepatic cell damage were studied during hemihepatectomy and for 16 h postoperatively in hemihepatectomy patients and compared to those of low‐dose dopamine. In a prospective, double‐blind clinical study 20 patients received randomly either dopexamine (DPX) 0.5 μg kg−1 min−1 (n=10) or dopamine (DO) 2.5 μg kg−1 min−1 (n=10). Infusions were started after induction of anaesthesia and continued 16 h postoperatively. Hepatic vein, radial and pulmonary artery were catheterized. Measurements were carried out after induction of anaesthesia, after total cross‐clamping of hepatic inflow, and at 2 h and 16 h postoperatively.Results: There were no differences in systemic haemodynamics, oxygenation, Shv¯O2, serum aminotransferases or MEGX levels between the groups. At 16 h postoperatively prothrombin and antithrombin III levels were significantly lower while hepatic venous lactate was significantly higher in the DPX group compared to the DO group.Conclusion: In patients undergoing hemihepatectomy, we could not reveal superior hepatoprotective effects of low‐dose dopexamine compared to low‐dose dopamine.
Does halothane or isoflurane affect hypoxic and post‐hypoxic vascular response in rabbit aorta?
Authors: Haddad E. , Lebuffe G. , Boillot A. , Imbenotte M. , Vallet B. 
Published: March 2003

Background: Halothane and isoflurane affect differently endothelium‐dependent and ‐independent vasorelaxation at 95% O2. In addition, hypoxic vascular response might involve endothelium‐dependent and ‐independent mechanisms. Therefore, we investigated, in rabbit aortic rings, 1) the influence of halothane and isoflurane on vasodilation at 95% O2 and on hypoxic‐induced vasorelaxation at 0% O2 and 2) the influence of halothane and isoflurane on endothelium‐dependent and ‐independent post‐hypoxic vascular response.Methods: Endothelium‐intact and endothelium‐denuded rabbit aortic rings were used. Phenylephrine precontracted rings were exposed, at 95% O2, to acetylcholine (ACh, 10−9 to 10−4 M) or sodium nitroprusside (SNP, 10−9 to 10−4 M) in the presence or absence of anaesthetic at 1 or 2 MAC. Precontracted rings were also exposed to an acute reduction in O2 from 95% to 0% followed by an acute reoxygenation with 95% O2 in the absence or presence of anaesthetic at 1 or 2 MAC.Results: At 95% O2, halothane decreased endothelium‐dependent relaxation to ACh, while endothelium‐independent relaxation to SNP was decreased only at 2 MAC. Isoflurane did not modify ACh‐ or SNP‐induced relaxation. At 0% O2, neither halothane nor isoflurane altered the hypoxic vascular relaxation. Post‐hypoxic response was not changed either.Conclusion: Our results indicate that halothane and isoflurane do not alter vascular hypoxic response in conductance arteries.
Effects of etomidate on free intracellular amino acid concentrations in polymorphonuclear leucocytes in vitro
Authors: Mühling J. , Weiss S. , Knülle V. , Sablotzki A. , Dehne M. G. , Hempelmann G. 
Published: March 2003

Background: Previous studies have shown the inhibitory effects of etomidate on polymorphonuclear leucocyte (PMN) function. No reports exist, however, regarding free intracellular amino acid metabolism, although physiological cell metabolism and basic cell functions rely upon a balanced intracellular amino acid content and the cell membrane‐mediated separation of cellular amino acids from the extracellular plasma amino acid pool. Thus, in the current study, we evaluated the effects of etomidate on free intracellular amino acid metabolism in PMN.Methods: With ethics committee approval, blood was withdrawn from 35 healthy volunteers and incubated (1 h) either with 0 μg/ml, 0.0156 μg/ml, 0.0625 μg/ml or 0.5 μg/ml of etomidate as well as with its additives (propylene glycol and Lipofundin MCT® 10%). The PMN were separated using standardized Percoll®‐gradient and centrifugation procedure before deep‐freezing and lyophilization techniques were employed. All PMN samples were dissolved in methanol/H2O, and the concentrations of free intracellular amino acids were monitored using both novel advanced PMN‐separation and high‐performance liquid chromatography techniques.Results: Etomidate influenced important free amino acid profiles in PMN in a dose‐dependent manner, indicating complex changes of cellular amino acid turnover. Neither propylene glycol nor Lipofundin MCT® 10% changed free amino acid concentrations in PMN.Conclusions: For the first time, the effects of etomidate on free intracellular amino acid metabolism in PMN have been investigated. Our results draw attention to the biochemical pathways which may be involved in etomidate‐induced alterations in PMN function and cellular immunocompetence.
Ropivacaine‐clonidine combination for caudal blockade in children
Authors: Ivani G. , De Negri P. , Conio A. , Amati M. , Roero S. , Giannone S. , Lönnqvist P. A. 
Published: March 2003

Background: Adding clonidine to weak ropivacaine solutions (<0.2%) could potentially enhance analgesia as well as further reduce the risk for unwanted motor blockade. The aim of the present study was to compare the postoperative pain‐relieving quality of a ropivacaine 0.1%‐clonidine mixture to that of plain ropivacaine 0.2% following caudal administration in children.Methods: In a prospective, observer‐blinded fashion, 40 ASA 1 paediatric patients undergoing subumbilical surgery were randomly allocated to receive a caudal injection of either plain ropivacaine 0.2% (1 ml/kg) (R0.2) or a mixture of ropivacaine 0.1% with clonidine 2 μg/kg (1 ml/kg) (R0.1C). Objective pain scale score and need for supplemental analgesia were used to evaluate analgesia during the first 24 h postoperatively. Residual postoperative sedation was also assessed.Results: A significantly higher number of patients in the R0.1C group (18/20) could be managed without supplemental analgesia during the first 24 h postoperatively compared to the R0.2 group (11/20) (P=0.034). Both the degree and the duration of postoperative sedation was similar in both groups. No signs of postoperative motor blockade were observed.Conclusions: The combination of clonidine (2 μg/kg) and ropivacaine 0.1% is associated with an improved quality of postoperative analgesia compared to plain 0.2% ropivacaine. The improved analgesic quality of the clonidine‐ropivacaine mixture is achieved without causing any significant degree of postoperative sedation.