bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative ropivacaine infiltration in breast surgery
Authors: Johansson A. , Axelson J. , Ingvar C. , Luttropp H.‐H. , Lundberg J. 
Published: March 2003

Purpose:The aim of the study was to investigate whether preoperative infiltration with ropivacaine in conjunction with breast surgery improves postoperative pain management and attenuates postoperative nausea and vomiting.Method:Prospective, randomised, double‐blind study, including 60 healthy women (ASA 1–2) allocated to one of two groups. Thirty patients were given 0.3 ml/kg saline in the operating field before surgery. Another 30 patients received a similar volume of ropivacaine 3.75 mg/ml. A visual analogue scale (0–100 mm) was used for evaluation of postoperative pain, nausea and vomiting. If the score was more than 30 mm at rest, the patients were given ketobemidone i.v. as treatment for postoperative pain, and dixyrazine i.v. against nausea and vomiting. The intra‐ and postoperative analgesic requirements and postoperative nausea and vomiting were registered.Results: The intraoperative fentanyl consumption was similar in the saline group 81±22 μg vs 76±28 μg; (ns) in the ropivacaine group. The postoperative 24‐h ketobemidone consumption was also similar to those treated with ropivacaine (4.2±2.6 mg vs 4.2±4.3 mg; ns). Postoperative nausea and vomiting (PONV) occurred with similar frequencies in both groups. The 24‐h dixyrazine consumption was the same in the two groups (2.1±2.7 mg in the saline group compared to 2.4±2.8 mg in the ropivacaine group; ns). After 6 h recovery, 41% of all patients had experienced nausea and 20% vomiting.Conclusion: We found no differences in postoperative pain management between 3.75 mg/ml ropivacaine and saline wound infiltration before breast surgery. The data show similar postoperative needs of analgesics and antiemetics with a similar frequency of PONV.
Pharmacokinetics of 0.2% ropivacaine and 0.2% bupivacaine following caudal blocks in children
Authors: Ala‐Kokko T. I. , Partanen A. , Karinen J. , Kiviluoma K. , Alahuhta S. 
Published: March 2003

Background: Ropivacaine is the first S‐enantiomer aminoamide local anaesthetic in clinical use, and has been found to be less toxic than bupivacaine. Caudal ropivacine has been shown to cause less motor blockade and longer duration of analgesia in the postoperative period than bupivacaine in children. Plasma levels of ropivacaine and bupivacaine have not been previously compared in children. This study was undertaken to compare the total venous plasma concentrations of similar doses of ropivacaine and bupivacaine following caudal administration.Methods: Blood samples were obtained to determine the total venous plasma levels of the used local anaesthetic in 30 children, aged 2.3–8.7 years, ASA I, given 1 ml · kg−1 of either 0.2% ropivacaine or 0.2% bupivacaine in a prospective, randomised manner.Results: There were no differences in the individual peak plasma concentrations achieved. Time to the measured peak plasma concentration was significantly shorter in the bupivacaine group. The plasma concentrations of bupivacaine were significantly lower than for ropivacaine at 60, 90 and 120 min after the block.Conclusion: Absorption and tissue distribution of ropivacaine is slower than for bupivacaine following caudal administration in children.
Coagulation effects of a recently developed hydroxyethyl starch (HES 130/0.4) compared to hydroxyethyl starches with higher molecular weight
Authors: Entholzner E. K. , Mielke L. L. , Calatzis A. N. , Feyh J. , Hipp R. , Hargasser S. R. 
Published: March 2003

Background: Hydroxyethyl starches (HES) are known to interfere with blood coagulation according to molecular weight, the degree of substitution and the C2/C6 ratio. A recently developed low molecular hydroxyethyl starch (HES 130/0.4) was designed to reduce the blood compromising potency.Methods: In this study, effects of a 30% in vitro haemodilution with the new HES preparation (HES 130/0.4) in comparison to HES 200/0.5, HES 450/0.7 and sodium chloride solution were investigated using intrinsic and extrinsic activated thrombelastography (TEG) and plasmatic coagulation tests.Results: Whereas plasmatic tests revealed no prolongation of coagulation by HES in comparison to sodium chloride, the TEG variables clotting time, clot formation time and maximal clot firmness showed a significant (P<0.05) inhibition by all the HES preparations. The inhibition was most pronounced in HES 450 (P<0.05 vs HES 130) while HES 130 did not show a statistically significant difference in extrinsic activated maximal clot firmness when compared to sodium chloride.Conclusion: These in vitro results demonstrate that hydroxythyl starches especially compromise clot polymerisation. The new preparation HES 130/0.4 seems to inhibit platelet function to a lesser extent than hydroxyethyl starch preparations with a higher molecular weight and degree of substitution.
Influence of opioids on the vascular tone of isolated porcine coronary artery segments
Authors: Klockgether‐Radke A. P. , Gravemann J. , Kettler D. , Hellige G. 
Published: March 2003

Background: It was the aim of this study to elucidate the influence of opioids on coronary vascular tone using the model of isolated porcine coronary artery segments.Methods: We studied the effects of fentanyl (0.01, 0.1, 1.0 μg ml−1), alfentanil (0.1, 1.0, 10 μg ml−1), and sufentanil (0.01, 0.1, 1.0 μg ml−1) on the contractile response to three vasoconstrictors, acetylcholine, histamine and serotonin.Results: Fentanyl (0.1, 1.0 μg ml−1) dose‐dependently attenuated the contractile response to acetylcholine, but not to histamine and serotonin. There were no differences in fentanyl's vasorelaxing potency between rings with intact and denuded endothelium. Alfentanil and sufentanil did not exert any significant influence on any of the vasoconstrictors tested.Conclusion: It is concluded that, in isolated porcine coronary artery rings, fentanyl at high concentrations has an attenuating effect on acetylcholine‐induced contractions, which is independent of endothelial function, whereas alfentanil and sufentanil do not influence coronary vascular tone.
Endogenous morphine is produced in response to cardiopulmonary bypass in neonatal pigs
Authors: Brix‐Christensen V. , Goumon Y. , TØnnesen E. , Chew M. , Bilfinger T. , Stefano G. B. 
Published: March 2003

Background: Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Endogenous morphine production has previously been demonstrated in humans after cardiac surgery with CPB. It has been hypothesized that morphine plays a role as an anti‐inflammatory mediator in the systemic inflammatory response. The aim of this study was to investigate if the CPB procedure in itself elicits an endogenous morphine production in neonatal pigs.Methods: Endogenous morphine production was measured in arterial blood in piglets exposed to sternotomy alone (sham group, n=10) or sternotomy and CPB (n=10). Blood samples were obtained immediately after the induction of anaesthesia, at the end of CPB and 4 h later. Morphine in arterial blood was detected by radioimmunoassay and confirmed by gas chromatography mass spectrometry.Results: Animals undergoing CPB showed detectable endogenous morphine concentrations immediately after CPB, with increased concentrations postoperatively. There was no measurable morphine production in the sham operated pigs.Conclusion: The CPB procedures elicits an endogenous morphine production in neonatal pigs. This morphine response is analogous to the previously demonstrated response in patients subjected to cardiac surgery and CPB.
Surgical stress induces acute coronary release of tissue‐type plasminogen activator in the pig
Authors: Österlund B. , Holmgren A. , HÄggmark S. , Jern C. , Johansson G. , Seeman‐Lodding H. , Biber B. 
Published: March 2003

Background: Tissue‐type plasminogen activator (t‐PA) is an endothelium derived key enzyme in the initiation of endogenous fibrinolysis. Acute regulated release of active t‐PA occurs within minutes in response to threatening thrombotic vessel occlusion. The aim of this study was to investigate the impact of surgical stimulation on the kinetics of t‐PA release in the coronary vascular bed in the pig.Methods: In anaesthetised pigs (n=16), arterio‐venous concentration gradients of t‐PA, and plasma flows (retrograde thermodilution) were obtained across the coronary vascular bed before (control) and at 1, 3, 5 and 10 min after sternotomy.Results: At control, no significant coronary net flux (release or uptake) of t‐PA was observed, while sternotomy induced a rapid net release of total t‐PA (132.6 ng · min−1), with an associated increase in active t‐PA (93.6 ng · min−1). This response, evident already after 1 min, showed a peak at 5 min and returned towards baseline levels within 10 min. No concurrent alterations in aortic levels of active t‐PA were found and haemodynamic variables were unaltered.Conclusion: The rapidly increasing and transient net coronary release of t‐PA after sternotomy suggests that the endothelium actively promotes local endogenous fibrinolysis during surgery. Such events could reflect a dynamic responsiveness to protect the coronary circulation during stress.
Risk factors for preoperative anxiety in adults
Authors: Caumo W. , Schmidt A. P. , Schneider C. N. , Bergmann J. , Iwamoto C. W. , Bandeira D. , Ferreira M. B. C. 
Published: March 2003

Background: Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults.Methods: A cross‐sectional study was performed with 592 inpatients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I–III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State‐Trait Anxiety Inventory, the Montgomery‐&Auml;sberg Depression Rating Scale, the WHO Self‐Reporting Questionnaire‐20, and the future self‐perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors.Results: High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR=2.30), moderate to intense depressive symptoms (3.22), high trait‐anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR=0.61) was associated with lower risk for preoperative state‐anxiety.Conclusions: History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait‐anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state‐anxiety. Previous surgery reduced the risk for preoperative anxiety.
Recovery profile and side effects of remifentanil‐based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy
Authors: Grundmann U. , Silomon M. , Bach F. , Becker S. , Bauer M. , Larsen B. , Kleinschmidt S. 
Published: March 2003

Background: Nitrous oxide (N2O) has been suggested to contribute to bowel distension, resulting in worsened operating conditions for laparoscopic surgery, and to increase incidence of postoperative nausea and vomiting. Therefore, our objective was to assess the feasibility of two remifentanil‐based anaesthetic regimens free from N2O with special regard to recovery profile, postoperative analgesic demand and side effects in patients undergoing laparoscopic cholecystectomy.Methods: Fifty patients (ASA I–II, 23–65 yr) were randomly assigned to receive remifentanil‐based anaesthesia in conjunction with propofol (group R/P) or desflurane (group R/D). After standardised induction of anaesthesia, analgesia was continued with remifentanil in all patients. For maintenance of hypnosis, propofol or desflurane were used in concentrations to ensure loss of consciousness, lack of awareness, and maintenance of heart rate and blood pressure within ±25% of initial values. At the end of surgery all anaesthetics were discontinued without tapering and early emergence and recovery were recorded. Pain scores were assessed by using a visual analogue scale. Patient‐controlled analgesia with i.v. piritramide was used for treatment of postoperative pain and recorded for 90 min in the postanaesthesia care unit (PACU). In addition, side effects were noted.Results: Early emergence from anaesthesia did not differ between the groups. In group R/P, time to eye opening, spontaneous respiration and extubation was 4.4±2.9 min, 5.2±3.4 min and 5.5±3.3 min respectively, compared with 4.7±2.7 min, 5.3±2.4 min and 5.7±2.5 min in group R/D. While pain scores did not differ between both groups on admission to the PACU, patients receiving desflurane required more i.v. piritramide as compared to those receiving propofol, 22.0±6.5 mg and 17.9±7.0 mg, respectively (P<0.05). Nausea was less frequent after propofol (16% vs. 48%, P<0.05).Conclusion: In patients undergoing laparoscopic cholecystectomy, remifentanil‐based anaesthetic regimens in conjunction with propofol or desflurane are suitable and allow for rapid recovery from anaesthesia. However, the use of propofol results in less postoperative analgesic consumption and nausea as compared to desflurane.
Early detection of increased tumour necrosis factor alpha (TNFα) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course
Authors: Spielmann S. , Kerner T. , Ahlers O. , Keh D. , Gerlach M. , Gerlach H. 
Published: March 2003

Background: The inflammatory response after trauma includes tumour necrosis factor alpha (TNFα) as pro‐inflammatory cytokine. Furthermore, both soluble TNF receptor proteins (sTNF‐R1 and sTNF‐R2) were described to influence the post‐traumatic inflammatory response and organ dysfunction.Method:From 47 trauma patients, blood samples were obtained at the scene of accident, at hospital admission, after 4 h, 12 h, and 24 h, and daily until day 6. Plasma levels of TNFα, sTNF‐R1 and sTNF‐R2 were measured by enzyme immunoassay (EIA) and analysed comparing clinical parameters such as injury scores (ISS, AIS), development of multiple organ dysfunction syndrome (MODS) and/or systemic inflammatory response syndrome (SIRS), and outcome.Results: Significant changes were observed in a time‐dependent manner: TNFα and soluble TNF receptor levels were elevated compared to values of healthy persons. At 4 h after trauma, TNFα and sTNF‐R2 showed an increase from initial values, which continued during the entire observation period. Severe trauma led to enhanced sTNF‐R1 levels on scene and on hospital admission. Development of SIRS along with elevated sTNFR1 began on scene and was present on admission, with increased sTNF‐R2 from day 1 to day 4. MODS (until day 6) was preceded by increased sTNF‐R2 levels on admission and up to 4 h after trauma. Outcome was associated neither with TNFα nor with soluble TNF receptor levels.Conclusion: Thus, in trauma patients, early post‐traumatic MODS and SIRS coincide with increased levels of TNFα and TNF receptor proteins, revealing different, time‐dependent changes. Hence, detection of TNFα and soluble TNF receptor proteins after trauma should pay regard to the time point of sampling.
Blood viscosity, hemodynamics and vascular hindrance in a rat model of acute controlled bleeding and volume restitution with blood or Haemaccel
Authors: Hilzenrat N. , Arish A. , Yaari A. , Almog Y. , Sikuler E. 
Published: March 2003

Background:Hemorrhage and volume restitution with commercially available solutions is followed by reduced blood viscosity. Consequent hemodynamic changes may arise not only from the reduced viscosity itself but also from changes in vascular geometry induced by autoregulation processes. Vascular hindrance reflects the contribution of vascular geometry to flow. Our aim was to explore the possible effects of blood volume restitution with Haemaccel or blood, on regional blood flow and vascular geometry.Methods: Under ketamine anesthesia, blood was withdrawn at a rate of 0.3 ml/min for 15 min followed by 15 min of stabilization. The shed blood or Haemaccel was infused at the same rate and volume as used for withdrawal. Hemodynamic measurements were performed using radioactive microspheres. Blood viscosity was measured with an Ostwald viscometer. Vascular hindrance was calculated as the resistance/viscosity ratio.Results: Volume replacement with Haemaccel (n=10), compared to blood (n=10), was followed by increased cardiac output and portal venous inflow (37.1±9.0 and 3.1±0.5 vs 25.9±6.8 and 2.2±0.9 ml · min−1 · 100 g bw−1, respectively; P<0.05), decreased viscosity (2.8±1.3 vs 3.7±1.3, respectively; P<0.01) and decreased peripheral and splanchnic arteriolar resistance (3.8±1.1 and 40.9±7.6 vs 5.2±1.7 and 61.1±29.5 mmHg · ml−1 · min · 100 g bw, respectively; P<0.05). No significant differences between the groups were observed in vascular hindrance and cardiac output distribution.Conclusion: Volume replacement with Haemaccel, compared to blood, induced increase in systemic and splanchnic blood flows, reflecting mainly changes in viscosity and not in blood vessel geometry. These results suggest no significant difference in overall activation of autoregulation process between volume restitution with blood or Haemaccel.
The effect of chronic cocaine administration on hemodynamic stability and neurohumoral mediators during isoflurane anesthesia and shock in rats
Authors: Mets B. , Pantuck C. B. , Diaz J. , Soo E. 
Published: March 2003

Background: The aim of this investigation was to determine whether chronic cocaine administration altered endogenous vasoconstrictor secretion in response to hypotension from isoflurane anesthesia and blood loss in rats.Methods: Rats received continuous intravenous infusions of saline (n=11), or cocaine 6 mg kg−1 d−1 (n=13) or 18 mg kg−1 d−1 (n=12) for 13 days. On day 14, rats were anesthetized with intraperitoneal ketamine and xylazine and a femoral artery catheter and a tracheotomy performed to allow lung ventilation (PaCO2, 30–40 mmHg). After baseline parameters were noted, isoflurane was introduced to end‐tidal concentrations of 0.7% for 10 min (1/2 MAC), 1.4% for 10 min (MAC) and again 0.7% for 10 min (1/2 MAC‐2) when 5 ml of blood was withdrawn (SHOCK). Blood samples were drawn to assess arterial blood gas indices at various time points as well as plasma epinephrine, angiotensin II and vasopressin at MAC, 1/2 MAC‐2 and SHOCK.Results: Rats administered cocaine had higher oxygen extraction, required higher minute ventilation and had lower PaO2 values than rats administered saline despite similar body temperatures and hematocrits. Isoflurane administration resulted in significant dose dependent but similar blood pressure decreases in all study groups. Plasma epinephrine, angiotensin II and vasopressin concentrations were not different in saline or cocaine treated animals at any time point.Conclusion: These data suggest that chronic cocaine treatment in rats does not impair endogenous vasoconstrictor secretion nor alter the heart rate and blood pressure response to isoflurane and blood loss.
Management of postoperative pain in Spain
Authors: Puig M. M. , Montes A. , Marrugat J. 
Published: March 2003

Background: The management of postoperative pain is suboptimal world‐wide. This survey was carried out to determine current management in Spanish hospitals.Methods: Spanish hospitals were divided into two groups: <200 beds (n=346) and >200 beds (n=186). A structured questionnaire was mailed to the heads of the anaesthesiology services of a random sample of 150 of hospitals of <200 beds, and all larger hospitals.Results: Only 19% of hospitals with <200 beds responded and further analysis of this group was not possible; 53% of hospitals with >200 beds responded. In this sample (>200 beds), 45% of patients receive information on postoperative pain, given by the anaesthesiologist in 78% of cases. Over 70% of the hospitals do not have an acute pain unit and responsibility for postoperative pain lies with the anaesthesiology team in 71%, with the surgical team in 40% and with nursing in 33%, with an overlap of pain caretakers. Pain is measured on the surgical wards in 36% and recorded with the vital signs in 34%. On post‐anaesthetic recovery wards, analgesia is most frequently given by intravenous (83%), epidural (78%) and continuous intravenous (66%) administration. On surgical wards, the most frequent routes that are available are epidural (72%), intravenous (69%) and intramuscular (58%). Only 28% of the anaesthesiology services are satisfied with the pain treatment carried out in their hospitals. No significant differences on postoperative pain management were observed between teaching and non‐teaching institutions.Conclusion: The survey shows that the management of postoperative pain in hospitals with >200 beds in Spain is suboptimal and this is associated with dissatisfaction among many anaesthesiologists.
Postoperative epidural analgesia in children after major orthopaedic surgery
Authors: Løvstad R. Z. , Støen R. 
Published: March 2003

Background: The study was performed in order to improve postoperative pain management in children after major orthopaedic surgery. Two different anaesthetic techniques (sevoflurane‐low fentanyl and propofol‐higher fentanyl) and two different epidural mixtures (bupivacaine 1.5 mg ml−1 and adrenaline 2 μg ml−1 compared with bupivacaine 1 mg ml−1, adrenaline 2 μg ml−1 and fentanyl 2 μg ml−1) were investigated with regard to postoperative analgesia and side effects, primarily postoperative nausea and vomiting (PONV).Methods: Forty‐two children were randomised into one of three groups: sevoflurane anaesthesia and epidural solution with fentanyl (SBAF); sevoflurane anaesthesia and epidural solution without fentanyl (SBA); propofol anaesthesia and epidural solution without fentanyl (PBA).Results: Including fentanyl in the epidural mixture resulted in excellent postoperative analgesia without any need of i.v. opioids. However, 7 out of 16 children were nauseated and needed antiemetic drugs. On average, a 55–75% higher dose of bupivacaine was necessary to assure adequate analgesia when an epidural mixture without fentanyl was used. In addition, significantly more children needed i.v. opioids. Under these conditions there was no significant difference in pain scoring between the groups. There was significantly less nausea and less use of antiemetic drugs in children having epidurals without fentanyl in the sevoflurane groups. The same tendency, although not significant, was observed in the whole material. Sevoflurane anaesthesia resulted in less PONV than propofol anaesthesia, probably due to the higher amount of intravenous fentanyl used with the latter. This difference was not significant due to the small number of children included. Incidence of pruritus related significantly to epidural fentanyl.Conclusion: A satisfactory postoperative analgesia can be achieved with both epidural mixtures used in the study. Epidural fentanyl results in better analgesia, but significantly more PONV and greater use of antiemetic drugs. Omitting epidural fentanyl results in less PONV, but significantly less profound analgesia and a need for additional treatment with i.v. opioids, in addition to a 55–75% higher epidural bupivacaine infusion. Both epidural treatments result in high and similar patient satisfaction and no serious complications. The study could not show any significant difference between the effect of sevoflurane and propofol anaesthesia on PONV.