bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injection of morphine loco dolenti recommended as early as 1876
Authors: Tammisto T. , Tammisto CH. 
Published: March 2003

The peripheral site of action of opioids was proved some 20 years ago. The concept of the peripheral action of morphine, however, appears to be over 100 years older.We report on the contents of a paper, presented on 28 April 1876 at the meeting of the Finnish Medical Association (“Finska Läkarsällskapet”), on the use of morphine and its sites of action. The author was Professor Knut Felix von Willebrand, whose details are included.Prof. v. Willebrand starts by focusing on several unwanted side effects, often seen in connection with morphine administration, and advises how they can be avoided by using the pupils of the eye as a manometer for tolerance of morphine, as suggested by Vibert. After having presented four case reports which illustrate the use of morphine in his own practice, Prof. v. Willebrand explains his conception of the sites of action of morphine.The paper gives a lively picture of the use of morphine about 125 years ago. Furthermore, it indicates that Prof. v. Willebrand believed firmly in the peripheral site of action of morphine and recommended to inject morphine loco dolenti whenever possible.
Regional anaesthesia for outpatient knee arthroscopy: a randomized clinical comparison of two different anaesthetic techniques
Authors: Casati A. , Cappelleri G. , Fanelli G. , Borghi B. , Anelati D. , Berti M. , Torri G. 
Published: March 2003

Background: The purpose of this prospective, randomized study was to evaluate the time required to perform anaesthesia, achieve surgical block and fulfil standardized discharge criteria in outpatients receiving knee arthroscopy with either spinal anaesthesia or combined sciatic‐femoral nerve block.Methods: After a standard midazolam/ketoprofen premedication and baseline measurement of cardiovascular parameters, 50 ASA I–II patients scheduled for elective outpatient knee arthroscopy were randomized to receive spinal anaesthesia with 8 mg of 0.5% hyperbaric bupivacaine (group Spinal, n=25), or combined sciatic‐femoral nerve block with 25 ml of mepivacaine 20 mg ml−1 and a multiple injection technique (15 ml for femoral nerve block and 10 ml for sciatic nerve block). Times lasting from skin disinfection to the end of local anaesthetic injection (preparation time) and then to achieve surgical anaesthesia (readiness for surgery), as well as times required for block resolution, micturition, unassisted ambulation, and home discharge were recorded by a blinded observer. Occurrence of adverse events was also recorded.Results: Preparation time (mean±SD) was longer with sciatic‐femoral block (8±2.7 min) than spinal anaesthesia (5±2.1 min) (P=0.0002) while no differences were observed in the time required to achieve readiness for surgery (14±5 min and 15±6 min in the Spinal and Sciatic‐femoral groups, respectively). No differences in haemodynamic side effects and need for intraoperative additional analgesia were observed. Patients receiving spinal anaesthesia showed a faster resolution of nerve block and longer time to micturition (137±49 min and 231±101 min) than patients receiving peripheral nerve blockade (206±51 min and 145±36 min) (P<0.0005 and P=0.002, respectively); however, no differences were observed in the time required to fulfil standardized discharge criteria (241±101 min in group Spinal and 209±70 min in group Sciatic‐femoral; P=0.86).Conclusion: In patients receiving elective outpatient knee arthroscopy, using a combined sciatic‐femoral nerve block with 25 ml of mepivacaine 20 mg ml−1 and a multiple injection technique results in a slightly longer preoperative time but provides similarly effective anaesthesia with no differences in home discharge times as compared to spinal anaesthesia with 8 mg hyperbaric bupivacaine.
The effect of paracetamol (acetaminophen) on fentanyl metabolism in vitro
Authors: Feierman D. E. 
Published: March 2003

Background: Fentanyl is a synthetic opioid widely used in anesthesia and analgesia. In experimental animals and in humans it has been shown that most fentanyl biotransformation occurs in the liver, where this opioid is converted primarily to its N‐dealkylated derivative, norfentanyl. Recent studies have shown that fentanyl is metabolized to norfentanyl via cytochrome P‐450 3A4 (CYP3A4). CYP3A4 is responsible for the metabolism of numerous other therapeutic agents, including those administered concurrently with fentanyl (e.g., nifedipine, lidocaine, erythromycin and cyclosporine). Paracetamol is also metabolized by the CYP3A family, with a Km that is nearly equal to therapeutic blood concentrations. Since paracetamol is widely used, its potential interaction with fentanyl metabolism would be of great interest.Methods: In the present study, rat and human liver microsomes were used to assess the ability of paracetamol to inhibit fentanyl metabolism.Results: In both sets of microsomes, paracetamol produced a concentration‐dependent inhibition of fentanyl oxidation to norfentanyl. Kinetic analysis of the data showed that 0.5–5 mM paracetamol inhibited fentanyl metabolism in a noncompetitive fashion. A Dixon plot revealed that the Ki for paracetamol inhibition of fentanyl metabolism is approximately 3.2 mM and 2.8 mM for human and rat liver microsomes, respectively.Conclusions: Since these concentrations of paracetamol are approximately one order of magnitude greater than therapeutic concentrations, it would appear that potentially important and possibly harmful fentanyl–paracetamol drug interactions do not occur with therapeutic concentrations of paracetamol.
Accurate monitoring of blood loss: thoracic electrical impedance during hemorrhage in the pig
Authors: Krantz T. , Cai Y. , Lauritsen T. , Warberg J. , Secher N. H. 
Published: March 2003

Background: Cardiovascular variables are closely regulated in that they remain relatively stable during minor hemorrhage. We considered that such stability would make these variables less accurate for monitoring a blood loss. In contrast, thoracic electrical impedance would be unlikely to be a regulated variable and could serve as a non‐invasive monitor of a volume deficit.Methods: In 10 pigs bled (0–24 ml kg−1) and retransfused (to 28 ml kg−1) during halothane anesthesia, the magnitude of the electrical impedance, cardiovascular, blood gas and temperature variables, atrial natriuretic peptide and near infrared spectroscopy of the leg muscles were recorded.Results: During hemorrhage and retransfusion, the median correlations between changes in the magnitude of the thoracic impedance and the external blood loss ranged from 0.97 to 0.98 with an individual range from 0.80 to 1.0. These correlation coefficients were higher and their ranges were lower than correlations established for any other measured parameter.Conclusion: During hemorrhage and retransfusion in the halothane anesthetized pig, a change in the magnitude of thoracic electrical impedance appears to be an accurate and also non‐invasive monitor of a blood volume deficit.
Effect of intra‐aortic magnesium on renal function during and after abdominal aortic surgery: A pilot study
Authors: Bäcklund M. , Pere P. , Lepäntalo M. , Lehtola A. , Lindgren L. 
Published: March 2003

Background: Infrarenal aortic cross‐clamping causes renal vasoconstriction. Magnesium may protect against renal deterioration through its vasodilatory properties.Methods: Thirty patients with normal preoperative renal function undergoing infrarenal aortic cross‐clamping for elective aortic surgery received magnesium (4 mmol) or saline into the aorta immediately after aortic cross‐clamping and again just before unclamping in a double‐blind fashion. Pulmonary artery occlusion pressure was maintained ≥15 mmHg. Five patients with magnesium were excluded due to need for intravenous nitroglycerine because of myocardial ischaemia during the study.Results: Postoperative creatinine clearance remained unchanged in both groups. Urinary N‐acetyl‐β‐D‐glucosaminidase excretion increased before and decreased after aortic cross‐clamping in both groups. The concentrations of glutathione peroxidase in serum were identical between the two groups.Conclusions: These data indicate that intra‐aortic magnesium had no effect on renal function during or after aortic cross‐clamping.
Aerosolized surfactant in lung‐lavaged adult rats: factors influencing the therapeutic response
Authors: Bahlmann H. , Sun B. , Nilsson G. , Curstedt T. , Robertson B. 
Published: March 2003

Objective:To evaluate the effect of aerosolized modified natural surfactant in adult rats with respiratory failure.Methods: Lung‐lavaged adult rats were treated with aerosolized surfactant, aerosolized saline or a bolus of surfactant. Surfactant was labelled with dimyristoylphosphatidylcholine (DMPC) and human serum albumin was given intravenously for evaluation of lung protein leakage. Blood gases and dynamic compliance were measured intermittently. At the end of ventilation, the lungs were either fixed by vascular perfusion for histological examination or washed for determination of total phospholipids, DMPC and human albumin in the lavage fluid.Results: Treatment with bolus surfactant led to a quick and sustained restoration of pre‐lavage blood gas values in most animals. The response to aerosolized surfactant varied considerably, with an overall moderate improvement of gas exchange. The saline‐treated group failed to show any significant recovery of lung function. No histopathological differences were found between any of the groups. On average 0.46% of total administered aerosolized surfactant could be recovered. Vascular‐to‐alveolar leakage of human albumin averaged 11%, with no significant differences between the groups. Final values for PaO2 were significantly correlated with total phospholipids in the lavage fluid, and inversely related to the vascular‐to‐alveolar leakage of albumin.Conclusion: Neither bolus nor aerosolized surfactant influenced lung morphology. Nebulized surfactant improved lung function but the effect was inferior to that obtained with bolus surfactant, and the outcome depended on the balance between the combined pool size of exogenous and endogenous surfactant and the vascular‐to‐alveolar leakage of serum protein.
Dual mode antimony electrode for simultaneous measurements of PO2 and pH
Authors: Sjöberg F. , Nilsson G. 
Published: March 2003

Background: In biomedical research and clinical medicine there is a demand for potent sensors to measure the components that make up blood gas analyses. Today, as when the electrochemical PO2, PCO2 and pH electrodes were first introduced, these measurements are usually made with the same type of sensor technology. The aims of the present study were, firstly, to find out whether the platinum cathode in the Clark electrode can be replaced by antimony for oxygen measurements (amperometry (A)); secondly, whether, during oxygen measurements, the inherent corrosion potential of the antimony metal can be used for measurement of pH in the same measurement area (potentiometry (P)).Methods: An electrode of purified, crystallographically orientated monocrystalline antimony (COMA) connected to a reference electrode (silver‐silver chloride) was used for the P measurements. Measurements of A (at −900 mV) and P were made in an aqueous environment regulated for oxygen, pH, and temperature.Results: Reproducible oxygen sensitivities of 0.925 nA/% oxygen (2% CV (coefficient of variation)) (A), 10.7 mV/% (P), and 0.7mV/% (P) were found in the oxygen range: 0–21%, <5%, and above 5%, respectively. The pH sensitivity was 57 mV/pH unit (P). Oxygen and pH measurements were less accurate at oxygen concentrations close to 0%.Conclusions: Both the oxygen and pH part of the composite electrode signal can be identified by this dual mode technique (A and P). The sensor seems to be promising as it provides measurements of two separate variables (oxygen and pH) and also has the desirable characteristics of a solid state sensor.
The effects of clonidine on ropivacaine 0.75% in axillary perivascular brachial plexus block
Authors: Erlacher W. , Schuschnig C. , Orlicek F. , Marhofer P. , Koinig H. , Kapral S. 
Published: March 2003

Introduction:The new long‐acting local anesthetic ropivacaine is a chemical congener of bupivacaine and mepivacaine. The admixture of clonidine to local anesthetics in peripheral nerve block has been reported to result in a prolonged block. The aim of the present study was to evaluate the effects of clonidine added to ropivacaine on onset, duration and quality of brachial plexus block.Methods: Patients were randomly allocated into two groups. In group I brachial plexus was performed using 40 ml of ropivacaine 0.75% plus 1 ml of NaCL 0.9%, and in group II brachial plexus was performed using 40 ml of ropivacaine 0.75% plus 1 ml (0.150 mg) of clonidine. Onset of sensory and motor block of radial, ulnar, median and musculocutaneous nerve were recorded. Motor block was evaluated by quantification of muscle force, according to a rating scale from 6 (normal contraction force) to 0 (complete paralysis). Sensory block was evaluated by testing response to a pinprick in the associated innervation areas. Finally, the duration of the sensory block was registered. Data were expressed in mean±SD. For statistical analysis a Student t‐test was used. A P‐value of ≤0.05 was considered as statistically significant.Results: The duration of blockade was without significant difference between the groups. Group I: 718±90 min; Group II: 727±117 min. There was no intergroup difference in sensory and motor onset or in quality of blockade.Conclusion: The addition of clonidine to ropivacaine 0.75% does not lead to any advantage of block of the brachial plexus when compared with pure ropivacaine 0.75%.
Pre‐incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre‐emptive analgesia for upper abdominal surgery
Authors: Wu C. T. , Yeh C. C. , Yu J. C. , Lee M. M. S. , Tao P. L. , Ho S. T. , Wong C. S. 
Published: March 2003

Background: Previous studies have shown that N‐methyl‐D‐asparate (NMDA) receptor antagonists provide a pre‐emptive analgesic effect in humans. This study investigated the benefits of pre‐emptive analgesia for upper abdominal surgery, using pre‐incisional epidural ketamine + morphine + bupivacaine (K+M+B) treatment for achieving postoperative pain relief.Methods: Sixty ASA 1–2 patients scheduled for upper abdominal surgery were allocated to three groups in a randomized, single‐blinded study. Patients in the control group (I) received general anaesthesia followed by an infusion of normal saline. Group II and III patients received general anaesthesia with a continuous epidural infusion of 2% lidocaine. Thirty minutes after the incision in groups I and II, an epidural pain control regimen was administered using ketamine (10 mg) and morphine (1 mg) in 10 ml of 0.085% bupivacaine (K+M+B). Group III patients also received K+M+B, but it was administered 10 min after the 2% lidocaine injection and 30 min before skin incision. All patients received an epidural pain control regimen (q12 h) for 3 days after their first injection. Patient‐controlled analgesia (PCA) with morphine was used to control subsequent postoperative pain. During the 3‐day period following surgery, duration to PCA trigger (h), morphine consumption (mg), pain intensity at rest and when coughing/moving, and analgesic‐related adverse effects were recorded. The VAS scale (0–10) was used to assess pain intensity.Results: Median times to first PCA trigger were 1.2 (0.5–2.0) h, 3.0 (0.7–4.2) h, and 4.0 (2.5–7.5) h for groups I, II, and III, respectively. Both the incident and resting pain scores were consistently lower for group III patients than groups I and II. The number of PCA triggers (all attempts/successful triggers) during the day following surgery were 14.0 (3–30)/8.0 (3–24) times, 10.0 (3–23)/6.0 (2–20) times, and 7.0 (3–12)/4.5 (1–10) times for groups I, II, and III. Total morphine consumption for the 3‐day observation period was 12.5 (3–42) mg, 10.5 (2–29) mg, and 6.0 (1–20) for groups I, II, and III, respectively.Conclusion: Pre‐incisional epidural K+M+B treatment combined with continuous epidural anaesthesia and general anaesthesia provides an ideal pre‐emptive analgesic therapy, exhibiting better postoperative pain relief than general anaesthesia and post‐incisional K+M+B treatment.
Platelet dysfunction after intravenous ketorolac or propacetamol
Authors: Niemi T. T. , Backman J. T. , Syrjälä M. T. , Viinikka L. U. , Rosenberg P. H. 
Published: March 2003

Background: Paracetamol is a weak cyclo‐oxygenase inhibitor in vitro. A recent study in children has shown that high doses of paracetamol are effective and safe. We studied the effect of propacetamol on haemostasis in adult volunteers.Methods: Ten volunteers were investigated in a double‐blind, randomized, crossover study. They received propacetamol 60 mg kg−1 or ketorolac 0.4 mg kg−1 in saline i.v. (30 min) in two different sessions. Platelet function was evaluated before the test infusion (S‐0), two (S‐2) and 24 h (S‐24) after the start of the infusion. Coagulation parameters (PT, APTT, factor V and VII activities) were measured at S‐0, S‐24 and 48 h (S‐48).Results: One of the volunteers had no secondary platelet aggregation in S‐0 and was excluded from the final analysis. Two hours (S‐2) after propacetamol and ketorolac administration the adrenaline (0.9 μg ml−1 and 9.0 μg ml−1) induced maximal platelet aggregation was decreased compared with S‐0. At S‐2 platelet aggregation was inhibited more after ketorolac than after propacetamol. At 24 h after ketorolac, but not after propacetamol, there was still a decrease in the adrenaline‐induced maximal platelet aggregation. Propacetamol did not affect adenosine diphosphate (ADP)‐induced maximal platelet aggregation, whereas ketorolac decreased 3 and 6 μM ADP‐induced maximal platelet aggregation at S‐2 and S‐24. However, 2 h after both ketorolac and propacetamol, thromboxane B2 (TxB2) concentration decreased in platelet rich plasma after 5 min aggregation induced by 8 μM ADP. Coagulation was unaffected.Conclusion: Propacetamol 60 mg kg−1 i.v. causes reversible platelet dysfunction demonstrated by a decrease in maximal platelet aggregation and TxB2 concentration. After 0.4 mg kg−1 ketorolac i.v. platelet aggregation and TxB2 formation are inhibited more in comparison with propacetamol, and platelet dysfunction is still seen after 24 h.
Effects of conventional physiotherapy, continuous positive airway pressure and non‐invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting
Authors: Matte P. , Jacquet L. , Van Dyck M. , Goenen M. 
Published: March 2003

Background: Coronary artery bypass graft (CABG) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters. The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry (IS) with non‐invasive ventilation on continuous positive airway pressure (CPAP) and with non‐invasive ventilation on bilevel positive airway pressure (BiPAP or NIV‐2P).Methods: Ninety‐six patients were randomly assigned to 1 of 3 groups: NIV‐2P (1 h/3 h), CPAP (1 h/3 h) and IS (20/2 h). Pulmonary function tests and arterial blood gases analyses were obtained before surgery. On the 1st and 2nd postoperative days, these parameters were collected together with cardiac output and calculation of venous admixture.Results: For the 3 groups a severe restrictive pulmonary defect was observed during the 1st postoperative day. On the 2nd postoperative day, in opposition to IS, intensive use of CPAP and NIV‐2P reduced significantly the venous admixture (P<0.001) and improved VC, FEV1 and PaO2 (P<0.01).Conclusion: We conclude that preventive use of NIV can be considered as an effective means to decrease the negative effect of coronary surgery on pulmonary function.
Effect of pentaglobin and piperacillin on survival in a rat model of faecal peritonitis: importance of intervention timings
Authors: Jacobs S. , Sobki S. , Morais C. , Tariq M. 
Published: March 2003

Background: Faecal peritonitis is a progressive pathophysiological condition which may lead to multiple organ failure and death. The reason for the associated morbidity and mortality could be attributed to the fact that some of the subtle alterations in cellular function that occur during the early stage of peritonitis are unidentified and consequently missed, leading to inadequate or delayed intervention. Recent studies have shown that early treatment with antibiotic and antisera containing antibodies to lipopolysaccharide (immunoglobulin) improve the survival rate in these patients. The present investigation was undertaken to study the effect of pentaglobin and piperacillin with particular attention to time lag of drug intervention on animal survival following experimental peritonitis.Methods: Experimental peritonitis was produced by inoculating 1 ml/kg of faecal suspension (2:1 w/v in saline) into the peritoneal cavity. Two groups of animals were treated with pentaglobin (4 ml/kg) or piperacillin (1000 mg/kg) respectively, whereas rats in another group received both drugs simultaneously. The first dose of each drug was given at 4 h, 6 h, 8 h and 12 h after faecal inoculation followed by 3 additional doses at 8‐h intervals. For biochemical studies, separate groups of animals were used in which the treatment was started 4 h after faecal inoculation and the animals were killed at 12 h after the treatment.Results: Both piperacillin and pentaglobin prolonged survival time of animals which received the treatment within 6 h of faecal insult. The combination of pentaglobin plus piperacillin produced better results as compared to the individual effect. There was a significant decrease in serum superoxide dismutase (SOD) and glutathione peroxidase (GSH‐Px) and increase in catalase following faeces‐induced septicaemia, suggesting a significant increase in oxidative stress. The changes in enzyme levels were significantly attenuated by both the drugs.Conclusion: The findings suggest that intervention with a combination of pentaglobin and antibiotics within 6 h of peritonitis might significantly improve survival rate in rat.