bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of desflurane on liver function markers in infants and children
Authors: Wissing H. , Kuhn I. 
Published: March 2003

Background: In an open‐labelled clinical trial, the effect of desflurane anaesthesia on liver function markers in paediatric patients was monitored.Methods: Fifty infants and children, 37 male, scheduled for elective cleft plate surgery were included in the study. Median age was 0.57 (0.25–5.45) years (range), mean desflurane exposure was 2.29±0.75 MAC‐h. Function markers were determined within 24 h prior to and within 24–48 h after anaesthesia. Complete data sets were available for total bilirubin 29, aspartate aminotransferase (ASAT) 36, alanine aminotransferase (ALAT) 35, and for alkaline phosphatase (AP) 28. Pre‐ and postanaesthetic function tests were compared by means of Wilcoxon's matched‐pairs test.Results: Only for AP could a statistically significant reduction of the postanaesthetic values be observed, while the other parameters showed no significant changes. Postanaesthetic ASAT and ALAT were clearly reduced in three children who had unspecific highly elevated preanaesthetic values. After the study, this observation could be repeated in at least one child, who received a further anaesthesia with desflurane within 3 months.Conclusion: The data suggest that desflurane does not affect excretory or structural liver integrity in infants and children.
Improved cerebral blood supply and oxygenation by aortic balloon occlusion combined with intra‐aortic vasopressin administration during experimental cardiopulmonary resuscitation
Authors: Nozari A. , Rubertsson S. , Wiklund L. 
Published: March 2003

Background: Intravenous administration of vasopressin during cardiopulmonary resuscitation (CPR) has been shown to improve myocardial and cerebral blood flow. Aortic balloon occlusion during CPR may also augment myocardial and cerebral blood flow and can be used as a central route for the administration of resuscitative drugs. We hypothesized that, as compared with intravenously administered vasopressin, the administration of this drug above the site of an aortic balloon occlusion would result in a greater increase in cerebral perfusion and oxygenation during CPR and after restoration of spontaneous circulation (ROSC).Methods: Twenty piglets were subjected to 5 min of ventricular fibrillation followed by 8 min of closed‐chest CPR and were treated with 0.4 U kg−1 boluses of vasopressin intravenously (the IV‐vasopressin group with sham aortic balloon) or above the site for an aortic balloon occlusion (the balloon‐vasopressin group). The aortic balloon catheter was inflated in the latter group 1 min after commencement of CPR and was deflated within 1 min after ROSC. Systemic blood pressures, cerebral cortical blood flow, cerebral tissue pH and PCO2 were monitored continuously and the cerebral oxygen extraction ratio was calculated.Results: During CPR, arterial blood pressure and cerebral perfusion pressure were greater in the balloon‐vasopressin group, as compared with the IV‐vasopressin group. These pressures did not differ between the groups after ROSC. Cerebral cortical blood flow was not significantly greater in the balloon‐vasopressin group during CPR, whereas significantly higher cortical blood flow levels were recorded after ROSC. Cerebral tissue pH decreased in the IV‐vasopressin group during the post‐resuscitation hypoperfusion period. In contrast, decreasing pressures during the hypoperfusion period did not result in increasing tissue acidosis in the balloon‐vasopressin group.Conclusions: During CPR, intra‐aortic vasopressin combined with aortic balloon occlusion resulted in significantly greater perfusion pressures but not in greater cerebral cortical blood flow. After ROSC, however, a greater increase in cortical blood flow was recorded in the balloon‐vasopressin group, even though the aortic balloon was deflated and perfusion pressures did not differ between the groups. This suggests that vasopressin predominantly gives vasoconstrictive effects on cerebral cortical vessels during CPR, but results in cerebral cortical vasodilatation after ROSC.
Effects of remifentanil on neutrophil adhesion, transmigration, and intercellular adhesion molecule expression
Authors: Hofbauer R. , Frass M. , Gmeiner B. , Sandor N. , Schumann R. , Wagner O. , Kaye A. D. 
Published: March 2003

Background: Anaesthetic drugs are used for pain therapy and anaesthesia. Neutrophils play a significant role during the process of inflammation. The aim of the current study was to investigate the effects of remifentanil and fentanyl on neutrophil migration through endothelial cell monolayers, and on adhesion molecule expression.Methods: After isolation of polymorphonuclear neutrophils (PMNL) we used a currently described migration assay. PMNL and/or endothelial cell monolayers (ECM) were pre‐treated with remifentanil using clinically relevant, as well as higher and lower concentrations or relevant concentrations of fentanyl.Results: Concentrations of remifentanil (50 ng/mL) similar to the relevant plasma concentration were able to inhibit PMNL migration through ECM significantly (migration compared to the control 82±7% SD; P<0.05), when both cell types were treated with the synthetic narcotic remifentanil. Fentanyl (30 ng/mL) showed a stronger inhibitory effect (migration compared to the control 67±9.2%; P<0.05). Endothelial cell adhesion molecule expression was reduced after either remifentanil or fentanyl.Conclusion: The results of the present investigation indicate that remifentanil influences interaction of ECM against human neutrophils. Compared to fentanyl, remifentanil seems to exhibit minor inhibitory effects on neutrophil migration.
Angiotensin II mesenteric and renal vasoregulation: Dissimilar modulatory effects with nitroprusside
Authors: BroomÉ M. , Åneman A. , Haney M. , HÄggmark S. , Johansson G. , Biber B. 
Published: March 2003

Background: The role of systemic arterial pressure for the vascular effects of angiotensin II (Ang II) and the interactions between Ang II and perfusion pressure‐dependent local vascular control mechanisms are not well understood. This study addresses these aspects of exogenous Ang II in the mesenteric and renal regional circulations.Methods: Ang II was infused in incremental doses (0–200 μg/h) in anesthetized instrumented pigs (n=10). Renal and portal blood flows were measured by perivascular ultrasound. In the second part of the study, sodium nitroprusside (SNP) was infused at doses titrated to keep mean arterial pressure constant, in spite of concurrent Ang II administration.Results: Powerful dose‐dependent vasoconstrictions by Ang II were found in renal and mesenteric vascular beds (at highest Ang II doses vascular resistances increased by 109% and 88% respectively). Ang II‐induced vasoconstriction was fully inhibited in the mesenteric, but not in the renal circulation, during conditions of constant mean arterial pressures achieved by SNP infusion.Conclusions: Mesenteric, but not renal, vasoconstriction by Ang II was inhibited by pharmacological maintenance of perfusion pressure. This could reflect differences between these vascular beds as regards the importance of co‐acting myogenic pressure‐dependent vasoconstriction. Alternatively, as the drug chosen for pressure control, sodium nitroprusside, serves as a nitric oxide donor, the relative balance between nitric oxide‐mediated vasodilation and Ang II‐induced vasoconstriction could have regional differences.
Cognitive dysfunction 1–2 years after non‐cardiac surgery in the elderly
Authors: Abildstrom H. , Rasmussen L. S. , Rentowl P. , Hanning C. D. , Rasmussen H. , Kristensen P. A. , Moller J. T. ,   the ISPOCD group
Published: March 2003

Background: Postoperative cognitive dysfunction (POCD) is a well‐recognised complication of cardiac surgery, but evidence of POCD after general surgery has been lacking. We recently showed that POCD was present in 9.9% of elderly patients 3 months after major non‐cardiac surgery. The aim of the present study was to investigate whether POCD persists for 1–2 years after operation.Methods: A total of 336 elderly patients (median age 69 years, range 60–86) was studied after major surgery under general anesthesia. Psychometric testing was performed before surgery and at a median of 7, 98 and 532 days postoperatively using a neuropsychological test battery with 7 subtests. A control group of 47 non‐hospitalised volunteers of similar age were tested with the test battery at the same intervals.Results: 1–2 years after surgery, 35 out of 336 patients (10.4%, CI: 7.2–13.7%) had cognitive dysfunction. Three patients had POCD at all three postoperative test sessions (0.9%). From our definition of POCD, there is only a 1:64 000 likelihood that a single subject would have POCD at all three test points by chance. Logistic regression analysis identified age, early POCD, and infection within the first three postoperative months as significant risk factors for long‐term cognitive dysfunction. Five of 47 normal controls fulfilled the criteria for cognitive dysfunction 1–2 years after initial testing (10.6%, CI: 1.8–19.4%), i.e. a similar incidence of age‐related cognitive impairment as among patients.Conclusion: POCD is a reversible condition in the majority of cases but may persist in approximately 1% of patients.
Does efficacy of seal and fibreoptic view change during anaesthesia with the laryngeal mask airway: A comparison of oxygen and oxygen‐nitrous oxide gas mixtures
Authors: Brimacombe J. , Keller C. 
Published: March 2003

Background: We test the hypothesis that oropharyngeal leak pressure (OLP) and fibreoptic position (FP) are stable for the laryngeal mask airway (LMA) during anaesthesia with and without nitrous oxide.Methods: Forty paralysed anaesthetised patients (ASA 1–2, aged 18–80) were randomly allocated to receive 100% oxygen (O2 group) or 33% oxygen in nitrous oxide (O2‐N2O group) for maintenance. In vivo intracuff pressure (CP) using a size 5 LMA was adjusted to 60 cm H2O. OLP, FP and CP were measured every 5 min for 30 min.Results: CP was higher in the O2‐N2O group than the O2 group, other than at time zero (all: P<0.0001). CP increased every 5 min in the O2‐N2O group (all: P<0.0001), but not in the O2 group. There were no differences in OLP and FP between groups at any time. There were no significant changes in OLP or FP with time within each group. There were no changes in OLP greater than 1.5 cm H2O and no change in FP for any patient.Conclusion: We conclude that OLP and FP are stable for the LMA during anaesthesia lasting 30 min with or without nitrous oxide.
No genotoxic effect of propofol in Chinese hamster ovary cells: Analysis by sister chromatid exchanges
Authors: Tomioka S. , Nakajo N. 
Published: March 2003

Background: In spite of its high placental transfer, propofol is frequently used in general anesthesia and sedation during obstetric and gynecological surgery such as in vitro fertilization. This study investigated whether or not propofol has a genotoxic potential by the sister chromatid exchange assay in vitro.Methods: Sister chromatid exchanges induced after exposure to propofol were measured in Chinese hamster ovary cells with and without metabolic activation. After propofol (0.2–20 μg ml−1) diluted dimethyl sulfoxide was applied for 2 h with or without S9 mix, the cells having been incubated for two metaphases (34 h) in the presence of 5′‐bromo‐2‐deoxyuridine. N‐nitrosodimethylamine and mitomycin C were used as positive controls with and without metabolic activation. The chromosomes were stained with the fluorescence plus Giemsa method, and then sister chromatid exchanges in 50 cells were counted for each concentration.Results: Although increasing concentrations of propofol inhibited cell proliferation, no concentrations of propofol used in this study increased the sister chromatid exchange values, with and without metabolic activation.Conclusion: It was concluded that there was no indication, from the sister chromatid exchange assay in mammalian cells, of a genotoxic effect of propofol and its metabolites.
Are electrocardiogram electrodes acceptable for electroencephalogram bispectral index monitoring?
Authors: Seitsonen E. , Yli‐Hankala A. , Korttila K. 
Published: March 2003

Background: The monitoring of electroencephalogram bispectral index (EEG‐BIS) during anaesthesia reduces anaesthetic use and improves recovery. However, it also increases the direct costs of anaesthesia due to the need for special EEG electrodes. In the present study we tested the feasibility of less expensive electrocardiogram (ECG) electrodes for EEG‐BIS monitoring.Methods: In the first part of the study we compared skin‐electrode impedances when EEG electrodes were used after alcohol swab pretreatment of skin to impedances when ECG electrodes were used after alcohol swab pretreatment with or without skin abrasion paste. In the second part of the study we evaluated the difference in parallel BIS values collected with two BIS monitors, using either ECG electrodes or EEG electrodes. In the third part of the study we compared parallel BIS values collected with two sets of EEG electrodes.Results: Skin pretreatment with abrasion paste led to lower impedances with ECG electrodes than did alcohol swab pretreatment of skin with EEG electrodes. When the skin was pretreated with alcohol swab, higher impedances were measured with ECG electrodes than with EEG electrodes. In most patients, BIS values collected with ECG electrodes were also higher than those collected with adhesive EEG electrodes. The difference between parallel BIS values collected with two sets of adhesive EEG electrodes was smaller than the difference between BIS values collected with ECG and EEG electrode sets.Conclusion: Low skin‐electrode impedances indicating reliable skin‐electrode contact can be ensured with inexpensive pregelled ECG electrodes only if the skin is carefully prepared with both abrasion paste and alcohol. When only alcohol pretreatment of skin is used, the BIS values collected with EEG electrodes and ECG electrodes are not equal. EEG‐BIS monitoring with pregelled ECG electrodes is recommended only if skin is prepared with abrasion paste before attaching the electrodes.
A survey of tracheal intubation difficulty in the operating room: a prospective observational study
Authors: Adnet F. , Racine S. X. , Borron S. W. , Clemessy J. L. , Fournier J. L. , Lapostolle F. , Cupa M. 
Published: March 2003

Background: The purpose of this study is to describe all degrees of endotracheal intubation difficulty among patients attended by eight anesthesiologists during routine surgery over a six‐month period. Airway characteristics were routinely assessed preoperatively, according to the anesthesiologists’ usual practice.Methods: Difficult tracheal intubation was evaluated by the Intubation Difficulty Scale (IDS), a quantitative score based on seven variables. An IDS value of 0 is consistent with a procedure without difficulty, and an IDS > 5 with a procedure involving moderate to major difficulty.Results: For 1171 patients undergoing tracheal intubation, IDS was 0 in 55%, and greater than 5 in 8% of cases. External laryngeal pressure, repositioning the patient and added use of a stylet were the most frequent methods chosen to facilitate tracheal intubation.Conclusion: There was a high incidence (37%) of minor difficulties encountered during routine surgery.
Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome
Authors: Varpula T. , Pettilä V. , Nieminen H. , Takkunen O. 
Published: March 2003

Background: Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be associated with improved outcome. To fulfil this approach, sedation, neuromuscular blocking agents and full mechanical ventilatory support are often used in critical failure of gas exchange.Case report:We present a patient who developed multiple organ failure, including severe ARDS, after severe skin injuries and septic shock. Ventilatory strategy consisted of lung protective approach, permissive hypercapnia and prone positioning. Airway pressure release ventilation (APRV) with the patient’s superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after application of combined use of APRV and prone positioning.Conclusion: APRV and maintenance of patients’ spontaneous ventilation is feasible during prone positioning, and this approach may have beneficial synergistic effects on gas exhange in patients with severe acute lung injury.
End‐tidal to arterial oxygen tension difference as an oxygenation index
Authors: Bengtsson J. , Bake B. , Johansson Å. , Bengtson J. P. 
Published: March 2003

Background: “Ideal” alveolar oxygen tension (PAO2) is a calculated entity and the alveolar‐arterial oxygen tension difference (PA‐aO2) is used to evaluate gas exchange function of the lungs. Accurate calculations of PAO2 necessitate measurements of the respiratory exchange ratio (RER), which is less frequently done, and most often approximations are made. The measured end‐tidal oxygen tension (PETO2) is a reflection of the alveolar oxygen tension. The aim was to study the relationship between PAO2 and PETO2, and to see whether the end‐tidal to arterial oxygen tension difference (PET‐aO2) could give the same information about lung function as PA‐aO2.Methods: Twenty patients admitted for cardio‐pulmonary exercise tests were studied. They bicycled for 4 min at each work load until maximum work load was reached. Arterial blood gases were analysed before, after 4 min at each work load, at maximum work load and after 2 min of recovery. A metabolic computer measured mixed expired gas concentrations. End‐tidal gas concentrations were measured with a side stream gas analyser.Results: We measured major increases in oxygen uptake, carbon dioxide elimination and RER. PAO2 and PETO2 increased at maximum exercise and during recovery. PAO2 and PETO2 were closely correlated during the study, through great changes in oxygen uptake and RER (r=0.88). When correction was made for wet gas the median difference was 0.12 kPa.Conclusions: At ambient air (FIO2=0.21), PET‐aO2 as a respiratory index may give equivalent information to PA‐aO2, without the need for measurements of mixed expired gas tensions or the hazard of an assumed RER.
Effects of olprinone, a new phosphodiesterase inhibitor, on gastric intramucosal acidosis and systemic inflammatory responses following hypothermic cardiopulmonary bypass
Authors: Yamaura K. , Akiyoshi K. , Irita K. , Taniyama T. , Takahashi S. 
Published: March 2003

Background: Phosphodiesterase (PDE) III inhibitors have both an inotropic and a peripheral vasodilatory effect, and also inhibit the activation of macrophages. Thus a newly developed PDE III inhibitor, olprinone, could modify gastric intramucosal pH (pHi), systemic oxygen consumption, and systemic inflammatory responses in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods: We studied 23 patients. In 15 patients, olprinone (0.1 or 0.2 μg · kg−1 · min−1) was administered from the commencement of CPB until their admission to the ICU. The other 8 patients received placebo. The pHi and regional CO2 tension (PrCO2) were assessed by a capnometric air tonometry. Systemic inflammatory responses were evaluated by serum interleukin‐6 (IL‐6), IL‐10, and leucocyte counts.Results: The pHi and PCO2‐gap, the difference between PrCO2 and arterial CO2 tension (PaCO2), showed a transient decrease and an increase after CPB, respectively. Although olprinone did not affect pHi, olprinone at 0.2 μg · kg−1 · min−1 significantly lessened post‐CPB increase in PCO2‐gap. Olprinone at 0.2 μg · kg−1 · min−1 significantly increased IL‐10 and reduced the extent of leucocytosis, while it did not affect IL‐6 levels. At the same dosage, olprinone also lessened the surge in systemic oxygen uptake index (V˙O2) and augmented the increase in mixed oxygen saturation (Sv¯O2) both of which occurred after CPB. At 0.1 μg · kg−1 · min−1, however, olprinone did not show any significant effect.Conclusion: Our results suggest that olprinone at 0.2 μg · kg−1 · min−1 suppresses gastric intramucosal acidosis and systemic inflammation following CPB.
Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block
Authors: Mcnamee D. A. , Convery P. N. , Milligan K. R. 
Published: March 2003

Background: Femoral and sciatic nerve block may improve post‐operative analgesia following total knee replacement.Objectives:To compare the post‐operative analgesia following primary total knee replacement provided by spinal anaesthesia alone or in combination with femoral and sciatic nerve block with bupivacaine or ropivacaine.Methods: Seventy‐five patients were randomised into one of three groups: spinal anaesthesia only; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg · kg−1 bupivacaine 7.5 mg · ml−1 to each nerve; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg · kg−1 ropivacaine 7.5 mg · ml−1 to each nerve.Results: The mean (SD) time to first morphine request was significantly prolonged for both groups receiving combined femoral and sciatic block, 912 (489) min for the bupivacaine group and 781 (394) min for the ropivacaine group (P<0.001) compared with 413 (208) min for the group receiving spinal anaesthesia alone. Morphine consumption was significantly reduced in both groups receiving combined femoral and sciatic block. There were no systemic or neurological sequelae in any of the groups.Conclusions: Femoral and sciatic blockade following intrathecal bupivacaine/diamorphine provided superior analgesia when compared with intrathecal bupivacaine/diamorphine alone. There were no significant clinical differences between the group receiving bupivacaine 7.5 mg · ml−1 and the group receiving ropivacaine 7.5 mg · ml−1.
Computer control versus manual control of systemic hypertension during cardiac surgery
Authors: Hoeksel S. A. A. P. , Blom J. A. , Jansen J. R. C. , Maessen J. G. , Schreuder J. J. 
Published: March 2003

Background: We recently demonstrated the feasibility of computer controlled infusion of vasoactive drugs for the control of systemic hypertension during cardiac surgery. The objective of the current study was to investigate the effects of computer controlled blood pressures on hemodynamic stability when compared to conventional manual control.Method:Systemic artery blood pressures were managed either by computer (80 patients) or by a well‐trained anesthesiologist (80 patients). The vasodilator drugs sodium nitroprusside and nitroglycerin were used. Hemodynamic stability was determined from the standard deviation of the mean arterial pressure samples and from the percentages of time that arterial pressure was hypertensive or hypotensive.Results: The average standard deviation of the mean arterial pressure samples was smaller for the computer controlled than for the manually controlled group: 7.5±2.2 (mean±SD) versus 8.9±2.3 mmHg (P<0.0001). The systemic artery pressure was less hypertensive and less hypotensive in the computer controlled than in the manually controlled group: 9.4±5.7 versus 13.1±6.0% (P<0.0001) and 8.0±5.9 versus 11.8±7.4% (P<0.0001), respectively.Conclusion: We conclude that, compared with manual control, computer control of systemic hypertension significantly improved hemodynamic stability during cardiac surgery.