bluuebunny/crossref_metadata_2025_split huggingface dataset:
Irrigation fluid absorption during transurethral resection of the prostate: Spinal vs. general anaesthesia
Authors: Gehring H. , Nahm W. , Baerwald J. , Fornara P. , Schneeweiss A. , Roth‐Isigkeit A. , Schmucker P. 
Published: March 2003

Background: The absorption of irrigation fluid during transurethral resection of the prostate (TURP) is determined primarily by hydrostatic pressure in the bladder and prostatic venous pressure. In comparison to spontaneously breathing patients, patients undergoing mechanical ventilation with positive pressure have a raised central venous pressure and a reduced venous return, both of which can influence intravascular absorption. The purpose of the prospective study was to compare the effects of general (GA) and spinal anaesthetic (SA) techniques on the perioperative absorption of irrigating fluid in patients undergoing TURP.Methods: Forty patients undergoing TURP were randomised and assigned either to group GA or SA. Irrigating fluid absorption was traced by adding 1.5% (w/v) ethanol to the irrigating fluid. Perioperative blood ethanol concentration (BEC), haemoglobin concentration, haematocrit, serum sodium concentration and central venous pressure (CVP) were measured at 10‐min intervals during TURP and at 30‐min intervals while patients were recovering. Absorption routes were indexed by the BEC and changes in serum sodium concentrations. Where the BEC was greater than 0.05 mg · mL−1, absorption of irrigating fluid was assumed. For assessing the volume of irrigating fluid absorbed, the maximum BEC, the absorption rate, the area under the BEC curve (AUC), and the volumes calculated according to the Hahn nomogram (Volin) for each patient were taken into consideration.Results: There were 15 cases of irrigating fluid absorption in patients receiving GA (75%), and 11 in those receiving SA (55%). CVP was significantly lower in spontaneously breathing patients with SA as compared to those with GA (P<0.05). In patients with irrigating fluid absorption the maximum BEC (P<0.02), as well as the rate of irrigant fluid absorption (P<0.01), were significantly higher amongst patients receiving SA. In this group, the calculated area under the curve and the absorbed fluid volumes determined with the nomogram were significantly increased (P<0.05).Conclusion: The absorption of irrigation fluid during the TURP is significantly more marked amongst spontaneously breathing patients with regional anaesthesia in comparison to patients undergoing general anaesthesia with positive pressure ventilation. The markedly lower central venous pressure before the start of irrigation should be considered as a possible cause of this effect.
A comparison of the monitors INVOS 3100 and NIRO 500 in detecting changes in cerebral oxygenation
Authors: Grubhofer G. , Tonninger W. , Keznickl P. , Skyllouriotis P. , Ehrlich M. , Hiesmayr M. , Lassnigg A. 
Published: March 2003

Background: Measurements of cerebral haemoglobin oxygenation of 2 near‐infrared spectroscopy devices (INVOS 3100 and NIRO 500) were compared during and after hypocapnia.Methods: Fifteen awake, healthy volunteers, who hyperventilated to obtain end‐tidal CO2 (EtCO2) values of approximately 20 mmHg, were studied. During hyperventilation and 8 min thereafter, EtCO2, INVOS 3100 (RSO2=regional cerebral oxygenation) and NIRO 500 recordings (HbO2=oxyhaemoglobin, Hb=deoxyhaemoglobin, Hb‐diff=HbO2–Hb, CtO2=oxidised cytochrome oxidase aa3) were analysed.Results: Hyperventilation induced a significant decline in EtCO2 from 30.5 to 14.7 mmHg (P<0.001) and RSO2 from 67.1% to 62.7% (P=0.025). At hypocapnia, only Hb (+1.61±0.48 μmol/L; P<0.001) and Hb‐diff (−3.01±2.0 μmol/L; P<0.001) indicated a decline in cerebral haemoglobin oxygenation. Within 8 min after hyperventilation, both EtCO2 and RSO2 normalised to values insignificantly different from baseline. In contrast, Hb and Hb‐diff remained significantly different (Hb: +2.52±1.28 μmol/l; P<0.001, Hb‐diff: −4.31±4.0 μmol/L; P<0.001). A correlation with EtCO2 was found for RSO2 (R=0.35; P<0.001) and CtO2 (R=0.42; P<0.001). All volunteers were continuously awake and none presented clinical symptoms of cerebral hypoxia.Conclusion: Changes in cerebral haemoglobin oxygenation state were reflected more accurately by INVOS 3100 than NIRO 500. The cause may be the different technology of the monitors, since INVOS 3100 eliminates the contribution of extracranial oxygenation.
Effect of prostaglandin E1 and nitroglycerin on portal venous flow during hypothermic extracorporeal circulation: Assessment by transesophageal echography
Authors: Iribe G. , Ohnishi Y. , Hayashi Y. , Kuro M. 
Published: March 2003

Background: Although several vasodilators are used to control vascular resistance during cardiac surgery, their effects on splanchnic circulation during extracorporeal circulation are unknown. We designed the present noninvasive study to evaluate the effect of prostaglandin E1 and nitroglycerin on portal venous flow during extracorporeal circulation using transesophageal echography.Methods: We included 26 patients undergoing cardiac surgery with moderate hypothermic extracorporeal circulation in this study. After obtaining hemodynamic stability under extracorporeal circulation, we measured portal venous diameter, mean flow velocity and the velocity time integral using transesophageal echography and calculated portal venous flow. The patients were assigned to two groups where either prostaglandin E1 (N=13) or nitroglycerin (N=13) was administered intravenously to maintain perfusion pressure at the level of 70 mmHg. We measured the same parameters 20 and 40 min following administration of the drug.Results: Visualization of the portal vein was obtained by transesophageal echography in anesthetized patients. Calculated portal venous flow significantly increased in the prostaglandin E1 group, while it did not alter in the nitroglycerin group.Conclusion: The present results indicate that transesophageal echography may be a feasible tool to assess portal venous flow, and that prostaglandin E1 may improve the blood distribution to the splanchnic area and the liver during hypothermic extracorporeal circulation.
Sevoflurane causes more postoperative agitation in children than does halothane
Authors: Beskow A. , Westrin P. 
Published: March 2003

Background: An agitated recovery may occur after inhalation anesthesia. The aim of the present study was to assess the recovery quality after mask anesthesia with either halothane or sevoflurane in children.Methods: Sixty‐two children, 8 months to 18 years of age, scheduled for minor surgery, were randomly assigned to receive either halothane or sevoflurane. The patients were premedicated with midazolam and anesthesia was induced iv with propofol or by inhalation and maintained with halothane or sevoflurane in N2O/O2 via face mask. Recovery was assessed by a “blinded” observer using a postanesthetic recovery score. Agitation and pain were judged using a visual analog scale. The incidence of vomiting was noted. The day after anesthesia older children and parents of younger children were interviewed about their experience of the anesthesia and recovery period.Results: There were no differences between groups in respect of age, weight, length, or duration of surgery or inhalational gas exposure. Median time from end of administration of inhalational agent to spontaneous eye opening was less after sevoflurane (25 min) than after halothane (48 min), (P<0.01). Likewise, recovery was faster after sevoflurane anesthesia (P<0.05). Agitation, but not pain, occurred more frequently after sevoflurane than after halothane (P<0.05) and agitation was significantly more common in younger children. There was no difference in duration of hospital stay between day‐care patients in the two groups.Conclusion: Early postanesthetic agitation and recovery was faster after mask anesthesia with sevoflurane than after halothane. There was a higher incidence of agitation in younger children, without correlation to pain.
Continuous epidural administration of midazolam and bupivacaine for postoperative analgesia
Authors: Nishiyama T. , Matsukawa T. , Hanaoka K. 
Published: March 2003

Background: Midazolam has been reported to have a spinally mediated analgesic effect. Clinically, single‐shot epidural or spinal administration of midazolam has been shown to have an analgesic effect on perioperative pain. In this study, we investigated the analgesic effect of continuous epidural administration of midazolam with bupivacaine on postoperative pain.Methods: Four groups of 20 patients who underwent gastrectomy or cholecystectomy were studied. Continuous epidural infusion of bupivacaine 100 mg (Group C), bupivacaine 100 mg+midazolam 10 mg (Group M10), or bupivacaine 100 mg+midazolam 20 mg (Group M20) in 40 ml per 12 h was started after surgery using the balloon infuser. Group I received intermittent epidural bupivacaine (2.5 mg  ·  ml−1) 6 ml every 2 h. When necessary, an indomethacin suppository and then a single epidural shot of bupivacaine (2.5 mg  ·  ml−1) 6 ml was administered. Blood pressure, heart rate, respiratory rate, analgesic area, analgesia score, and sedation score were monitored for 12 h postoperatively. Memory and frequencies of supplemental analgesia (indomethacin suppositories and epidural bupivacaine) were also checked.Results: Group M20 showed a significantly wider area of pinprick analgesia and better analgesia scores than other groups. The need for rescue analgesics were significantly less in Group M20. Sedation and amnesia were more pronounced in Group M20 than the other groups.Conclusion: Adding midazolam (10 to 20 mg per 12 h) to continuous epidural infusion of bupivacaine for postoperative pain can provide a better analgesia, amnesia and sedation than bupivacaine alone.
Errors in the intensive care unit (ICU)
Authors: Flaatten H. , Hevrøy O. 
Published: March 2003

Background: In order to obtain information about the occurrence and severity of errors in an ICU, this investigation was conducted in a combined ICU and postoperative ward at a Norwegian University Hospital.Methods: An anonymous registration was conducted in order to reveal as many as possible of all errors in the unit. A separate registration form was used, recording the type of error, date and time, sex and age of the patient, patient condition (unstable/stable) and where the error occurred (on the ward or during transport). The registration started in October 1995, and reports until November 1996 are included (13 months). Consequences of the errors were graded using a 6‐point scale (0=no consequences and 5=fatal). Two experienced intensivists and two experienced ICU nurses independently evaluated the errors using a visual analogue scale (VAS) with 10 as the worst imaginable error. All four were blinded to consequences of the error.Results: A total of 87 errors was reported: 36 (41.3%) were medication errors, 17 (19.5%) related to intravenous infusions, 15 (17.2%) were due to technical equipment failure, and the rest (19 errors, 21.8%) miscellaneous. No consequences could be detected in 55 cases (63%) (grade 0). Six errors were graded as 1, and 22 (25%) as grade 2 (therapeutic intervention necessary, no damage recorded). Five errors had more serious consequences, and one was fatal. The scoring of errors varied a great deal. Mean VAS score was 4.2 (SD 1.7). The sum of VAS score (max. 40) on each error followed a normal distribution, and 12 errors had a score >25.Conclusion: Errors happen frequently in the ICU. Probably, our data do not represent the true incidence of errors in the period, which we believe was higher. Many errors are graded as serious or severe, but still have limited consequences for the patient.
Prophylactic ondansetron for postoperative emesis.Meta‐analysis of its effectiveness in patients with previous history of postoperative nausea and vomiting
Authors: Figueredo E. , Canosa L. 
Published: March 2003

Background: The objective of this study was to compare, by means of meta‐analysis, the postoperative antiemetic efficacy of ondansetron in patients with and without antecedents of postoperative nausea and vomiting.Methods: MEDLINE and EMBASE databases were searched for randomised placebo‐controlled trials which evaluated the antiemetic effectiveness of 4 mg and 8 mg intravenous doses of prophylactic ondansetron in adult patients. A further selection was with respect to those studies which noted the patient's previous history of postoperative nausea and vomiting (PH‐PONV) and, for the meta‐analysis, the patients were divided into two sub‐groups: those with (PH‐PONV +) and those without a previous history of postoperative nausea and vomiting (PH‐PONV −). Absence of vomiting was used as the index of effectiveness.Results: Twenty‐one trials involving 3984 patients (2446 in ondansetron groups and 1538 in placebo groups; 1163 PH‐PONV(+) patients and 2821 PH‐PONV(−) patients) met the selection criteria. The effectiveness of the 4 mg dose of ondansetron was: OR (95% CI)=2.40 (1.77–3.26) vs. 2.71 (2.23–3.30) for the patients of PH‐PONV(+) and PH‐PONV(−) sub‐groups, respectively. For the 8 mg dose, the effectiveness of ondansetron was: PH‐PONV(+)=4.21 (2.66–6.66) and PH‐PONV(−)=2.61 (1.81–3.59). For neither of the doses evaluated was there any significant statistical difference between the sub‐groups.Conclusions: The effectiveness of ondansetron in the prevention of postoperative vomiting is not affected by the patients’ PH‐PONV.
Pharmacology of G‐1–64, a new nondepolarizing neuromuscular blocking agent with rapid onset and short duration of action
Authors: Gyermek L. , Lee C. , Nguyen N. 
Published: March 2003

Background: Chances are slim that a clinically useful ultra‐short‐acting neuromuscular blocking agent of rapid onset will emerge from the benzylisoquinolinium or the aminosteroid series to which all currently popular relaxants belong. G‐1–64 is a promising prototype of a new series of bis‐quaternary ammonium salt of bistropinyl diester derivatives we have synthesized and studied in the laboratory.Methods: Neuromuscular block (NMB) and autonomic and cardiovascular side effects were studied on appropriate preparations of anesthetized rats, rabbits, cats, ferrets, pigs and monkeys. Neuromuscular blocking characteristics, cumulativeness, and pharmacological reversibility were determined. Cardiac vagal block was evaluated by the inhibition of the bradycardic response to stimulation of the vagus in the cat, rat, ferret, and pig. Sympathetic ganglion block was evaluated on the cat's superior cervical ganglion/nictitating membrane preparation. Arterial blood pressure and heart rate were determined in all species.Results: G‐1–64 produced nondepolarizing NMB with train‐of‐four (TOF) and tetanic fades, and reversible with anticholinesterases. Its ED50 ranged between 60 and 800 μg/kg in these species. It showed a significantly faster onset (0.9–2.1 min) and/or shorter duration of action (5–12 min) than either atracurium or mivacurium. It did not show cumulativeness on repeated doses or infusion. A varying degree of cardiac vagal block was present, dependent on the species at doses exceeding the ED80 for NMB. Cardiovascular changes, ganglion block or signs suggesting histamine release were absent.Conclusion: With favorable neuromuscular blocking characteristics and modest side effects, G‐1–64 and similar derivatives may have clinical potential.
Investigation of fading responses induced by non‐depolarising muscle relaxants in the evoked EMG of the gastrocnemius muscle of the cat
Authors: Suzuki T. , Nagai H. , Katsumata N. , Ogawa S. , Suzuki H. 
Published: March 2003

Background: During partial neuromuscular blockade indirect repetitive nerve stimulation causes fade in the response of the muscle. We studied the intensity of the fade induced by intravenous administration of three steroidal muscle relaxants, and investigated the mechanism of fade by comparing with results obtained during partial blockade with animal toxins and vesamicol.Methods: In 60 cats, we measured the fade in the compound action potentials of the gastrocnemius muscle evoked by repetitive sciatic nerve stimulation at 100 Hz during partial neuromuscular blockade with rocuronium, vecuronium, pancuronium, α‐bungarotoxin, μ‐conotoxin and vesamicol, respectively.Results: Profound fade was induced by all three non‐depolarising muscle relaxants (rocuronium=vecuronium<pancuronium) and by vesamicol, in contrast to α‐bungarotoxin and μ‐conotoxin which induced no fading.Conclusion: Our results suggest that non‐depolarising muscle relaxant‐induced fade is caused by an inhibitory effect on acetylcholine release. Pancuronium seems to have a higher potency of presynaptic inhibition of acetylcholine release than both rocuronium and vecuronium.
Postoperative respiratory arrhythmias: incidence and measurement
Authors: Sleigh J. W. 
Published: March 2003

Background: Postoperative respiratory disturbances may be the result either of depression of respiratory drive, or alteration of respiratory pattern.Methods: Using an inductance plethysmograph, we continuously recorded the breathing in 52 patients for 4 h after major thoracic, abdominal, and body surface surgery. The ventilatory response to hypercapnia was measured preoperatively, and at the start and end of the observation period.Results: From a variety of statistical measures of respiratory depression, it was found that the occurrence of apnoeas (breath times >10 s), did not correlate with measures of respiratory drive, or with dose or route of administration of opioid, site of surgery, pain, or drowsiness. Instead, the incidence of apnoeas correlated most closely with measures of respiratory pattern (standard deviation of breath times (r=0.72), the mean breath time (r=0.63), approximate entropy of the breath times (r=−0.32)). Twenty‐nine percent of patients had some breath times (Ttot) longer than 20 s.Conclusion: We would conclude that changes in respiratory pattern are not closely correlated with changes in traditional measures of respiratory drive.
Effects of dopamine in lung‐transplanted pigs at 32°C
Authors: Roscher R. , Ingemansson R. , Algotsson L. , Sjöberg T. , Steen S. 
Published: March 2003

Background: We have used hypothermia successfully in patients with acute respiratory failure after lung transplantation. However, we have observed that dopamine may cause a substantial decrease in mean arterial pressure (MAP) in hypothermic subjects. Furthermore, a dopamine‐induced increase in pulmonary vascular resistance (PVR) has been reported in the literature, and this could aggravate the increase in PVR which is often seen both in the early postoperative phase after lung transplantation, and during hypothermia. We thus hypothesized that dopamine would decrease MAP and increase PVR in hypothermic lung‐transplanted subjects.Methods: Left single lung transplantation combined with right pneumonectomy was performed in 6 pigs anesthetized with ketamine and midazolam and muscle relaxed with pancuronium. After an observation period of 24 h, the effect of dopamine infused at 5 and 12 μg · kg−1 · min−1 was studied in normothermia (38°C) and after cooling by cold‐water immersion to 32°C.Results: Systemic vascular resistance index (SVRI) increased and cardiac index (CI) decreased in hypothermia. Dopamine decreased SVRI and increased CI, both in normothermia and at 32°C. MAP decreased during infusion of dopamine in hypothermia. Dopamine had no effect on the pulmonary vascular resistance index (PVRI).Conclusion: The results suggest that dopamine may be used to increase cardiac output after lung transplantation in moderate hypothermia as well as in normothermia, but one should be aware that dopamine may cause a substantial decrease in blood pressure, depending on the prevailing hemodynamic conditions at the start of its administration.
Factors affecting gentamicin pharmacokinetics in septic patients
Authors: Tang G. J. , Tang J. J. , Lin B. S. , Kong C. W. , Lee T. Y. 
Published: March 2003

Background: This prospective, comparative study was designed to estimate the volume of distribution (Vd) and elimination rate constant (Ke) of gentamicin and to determine the clinical factors affecting the pharmacokinetics of gentamicin in different stages of sepsis.Method: Seventy‐seven critically ill patients treated with gentamicin for gram‐negative sepsis were included. These septic patients were divided into hyperdynamic septic and hypodynamic septic groups according to cardiac index. Twenty‐seven patients who received postoperative prophylactic gentamicin were recruited as controls.Results: Fifty‐two patients in the hyperdynamic septic group had a significantly larger Vd than those in the hypodynamic septic and control groups. The Vd was correlated significantly with both Acute Physiological Score (APS) (r=0.340, P<0.01) and cardiac index (r=0.394, P<0.01). The Ke of gentamicin correlated significantly with both blood urea nitrogen (BUN) (r=0.565, P<0.01) and serum creatinine level (r=0.563, P<0.01).Conclusion: The increased Vd in the septic patients was related to the severity of illness and magnitude of cardiac output. The Ke of gentamicin was correlated with the serum creatinine level.
Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?
Authors: Eyraud D. , Benmalek F. , Teugels K. , Bertrand M. , Mouren S. , Coriat P. 
Published: March 2003

Background: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension.Methods: In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 μg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (t0)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 3 l/min.Results: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end‐systolic wall‐stress (ESWS) and left‐ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post‐induction values with mean end‐tidal concentration of 5.1±0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end‐diastolic and end‐systolic cross‐sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure.Conclusion: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.