bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital management of diabetic emergencies – a population‐based intervention study
Authors: Holstein A. , Plaschke A. , Vogel M.‐Y. , Egberts E.‐H. 
Published: December 2004

Background: Diabetes‐related emergencies are frequent and potentially life‐threatening. A study was performed to obtain reliable data about the prevalence of diabetic emergencies and to improve the quality of prehospital care of patients with diabetes‐related emergencies.Methods: A prospective population‐based study in a German emergency medical service district in the period from 1997 to 2000 was conducted. After initial diabetes training for the entire emergency team, a standardized protocol was introduced for prehospital emergency therapy of severe hypoglycaemia (SH) and severe hyperglycaemic disorders. A rapid blood glucose test was performed on all emergency patients with the exception of resuscitations and deaths. Indicators of treatment quality before and after these interventions were compared.Results: A rapid blood glucose test was performed in 6631 (85%) of the 7804 emergencies that occurred during the period investigated. The prevalence of acute diabetic complications was 3.1%, and 213 cases of SH and 29 severe hyperglycaemic disorders were recorded. Education of the emergency team led to a significant improvement in the quality of treatment. Larger volumes of iv 40% glucose solution (50 ± 20 ml (1997–2000) vs. 25 ± 17 ml (1993–96); P < 0.0001) were administered to patients with SH. Insulin‐treated patients who were well educated about their diabetes were more often treated only at the emergency scene, after SH (25% vs. 8%; P = 0.007), and without complications. In 50 patients who experienced sulfonylurea‐induced SH, the mandatory additional glucose infusions and hospitalization for further observation reduced mortality from 4.9% to 0% (P = 0.2).Conclusion: Training of the emergency team is an effective and efficient intervention to improve quality of treatment and prognosis outcome for patients with diabetic emergencies. Treatment of SH at the emergency scene only was demonstrated to be safe in type 1 diabetic patients who had previously received structured patient education.
Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 µg for outpatient knee arthroscopy with tourniquet
Authors: Korhonen A‐M. , Valanne J. V. , Jokela R. M. , Ravaska P. , Korttila K. 
Published: December 2004

Background:  Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 µg of fentanyl permits fast‐tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine.Methods:  In this double‐blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 µg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2‐min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast‐tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs.Results:  One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 (P = 0.002). The PACU‐time was shorter: 36 (10–103) vs. 55 (10–140) min, respectively (P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus.Conclusion:  Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU‐time was shorter in the bupivacaine‐fentanyl group, but both groups reached home‐readiness equally.
Rocuronium and cisatracurium‐positive skin tests in non‐allergic volunteers: determination of drug concentration thresholds using a dilution titration technique*
Authors: Berg C. M. , Heier T. , Wilhelmsen V. , Florvaag E. 
Published: December 2004

Background: Muscle relaxants are believed to be responsible for 2/3 of the cases of anaphylactic reactions during anesthesia. This assumption is based mainly on positive skin tests obtained in individuals that have experienced anesthesia‐related anaphylaxis. A positive skin test is supposed to be associated with mast cell degranulation of vasoactive amines. In the present study we tested the frequency of positive skin tests with two commonly used muscle relaxants, rocuronium and cisatracurium, in a selected group of volunteers with low potential for allergic reactions.Methods: Thirty healthy volunteers without known allergy or previous exposure to muscle relaxants were studied. Low potential for allergic reactions was determined prior to inclusion in the study, using various allergy tests. Each individual was tested with intradermal and skin prick tests, and molar drug concentration thresholds for positive skin reactions were determined using a dilution titration technique. The presence or absence of mast cell degranulation was tested by electron microscopic investigation of skin biopsies obtained from positive and negative skin reactions.Results: None of the volunteers had a positive skin prick test. More than 90% of the volunteers had a positive intradermal test with both rocuronium and cisatracurium. The highest molar drug concentration that was not associated with a positive intradermal test was 10−6 M (rocuronium) and 10−7 M (cisatracurium), equivalent to vial dilution 1 : 1000 for both drugs. In none of the volunteers was mast cell degranulation detected.Conclusion: Non‐mast‐cell‐mediated positive intradermal skin reactions are frequently occurring with rocuronium and cisatracurium, even at vial dilution 1 : 1000. A clinically applicable test technique is needed that is able to separate positive skin tests associated with mast cell degranulation from non‐mast‐cell‐mediated reactions.
Warming of infusion syringes caused by electronic syringe pumps
Authors: Cornelius A. , Frey B. , Neff T. A. , Gerber A. C. , Weiss M. 
Published: December 2004

Purpose: To evaluate inadvertent warming of the infusion syringe in four different types of electronic syringe pumps.Methods: Ambient temperature and syringe surface temperature were simultaneously measured by two electronic temperature probes in four different models of commercially available syringe pumps. Experiments were performed at an infusion rate of 1 ml h−1 using both battery‐operated and main power‐operated pumps. Measurements were repeated four times with two pumps from each of the four syringe pump types at a room temperature of approximately 23°C. Differences among the four syringe pump brands regarding ambient to syringe temperature gradient were compared using ANOVA. A P‐value of less than 0.05 was considered statistically significant.Results: Syringe warming differed significantly between the four syringe brands for both the battery‐operated and main power‐operated mode (ANOVA, P< 0.001 for both modes). Individual differences between syringe surface and ambient temperature ranged from 0.3 to 1.9°C for battery operation and from 0.5 to 11.2°C during main‐power operation.Conclusion: Infusion solutions can be significantly warmed by syringe pumps. This has potential impact on bacterial growth and the stability of drug solutions and blood products infused, as well as on the susceptibility to hydrostatic pressure changes within the infusion syringe.
Benefit of using a triple‐lumen catheter to monitor left atrial pressure
Authors: Ceyran H. , Akçalý Y. , Asgun F. , Tezcaner T. , Tasdemir K. , Emirogullarý O. N. , Ersepciler M. 
Published: December 2004

Background: Left atrial pressure (LAP) monitoring provides a useful option for management of hemodynamic status in pediatric open‐heart surgical patients during the postoperative period.Patients and method: We used a triple‐lumen catheter placed into the left atrium transseptally to measure left atrial pressure. Twenty children that were operated on in our clinic are included in this study: 11 males and nine females. A 5‐Fr. triple‐lumen radio‐opaque polyethylene catheter was used for the procedure. After the repair of the primary cardiac defect, the distal end of the catheter was repositioned transseptally and advanced into the left atrium. The proximal and middle line's distal orifices were left in the right atrium. Distal line was used as a left atrial pressure line, the middle line as a central venous pressure line, and the proximal line as a route for fluid infusion or drug administration.Results: No mortality and no catheter‐related complication were observed. No failure or complication occurred during withdrawal of the catheter.Conclusion: We conclude that this preliminary technique can be a useful and easy way of monitoring LAP, as well as providing central venous access.
The vasoconstriction threshold is increased in obese patients during general anaesthesia
Authors: Kasai T. , Hirose M. , Matsukawa T. , Takamata A. , Tanaka Y. 
Published: December 2004

Background: In anaesthetized patients, body temperature decreases often, but overweight patients become less hypothermic. Obesity in itself protects body heat, and thermoregulatory reflexes may maintain normothermia in obese patients. We tested the hypothesis that even slight obesity increases the vasoconstriction threshold.Methods: Twenty male patients aged 30–65 years scheduled for open abdominal surgery were allocated to two groups: body fat ≥25% (obese group, n = 10), or <25% (normal weight group, n = 10). Anaesthesia was maintained with 0.4% isoflurane and opioid. The thermoregulatory vasoconstriction threshold was defined by the tympanic membrane temperature at which the skin temperature gradient equalled 0°C. Plasma adrenaline, noradrenaline and leptin were measured.Results: Age, height, heart rate and blood pressure did not differ between the two groups of patients. In the obese group the vasoconstriction threshold was higher than that in the normal weight group: 36.0 ± 0.1 vs. 35.5 ± 0.2°C. Consequently, after 4 h of anaesthesia, the core temperature was highest in the obese patients: 36.4 ± 0.1 vs. 35.5 ± 0.2°C.Conclusions: These results suggest that core temperature is maintained in obese patients because their vasoconstriction threshold to a low environmental temperature is high.
Electromyographic assessment of blink and corneal reflexes during midazolam administration: useful methods for assessing depth of anesthesia?
Authors: Mourisse J. , Gerrits W. , Lerou J. , Van Egmond J. , Zwarts M. J. , Booij L. 
Published: December 2004

Background: There are at least three components of the anesthetic state: loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. To investigate the third component, we used a standard electrical stimulus to evoke a blink reflex, which was electromyographically recorded. These data may give information on the anesthetic state.Methods: The relation between the electrically evoked blink and corneal reflexes and the depth of sedation and anesthesia induced with intravenous midazolam was investigated. Ten patients received i.v. increments of midazolam (1 mg, 2 mg, 3 mg, 3 mg, 3 mg, etc., until a 21‐mg total dose) to create a step‐wise deepening of sedation and anesthesia. Depth of anesthesia was assessed by the Observer's Assessment of Alertness/Sedation (OAAS) scale, ranging from 5 ( =  awake and alert) to 0 ( =  no motor response to tetanic stimulation).Results: Latency of the first (R1) and second (R2) blink components and the corneal (C) reflex component increased, whereas duration and area decreased with increasing depth of sedation and anesthesia. R1 was last seen at an OAAS score [mean (SD)] of 1.8 (0.8), R2 at a score of 3.1 (1.1), C at a score of 3.8 (0.8), and R3 at 4.8 (0.5). These end‐points were all statistically different from each other, except R2 vs. C.Conclusions: Our results suggest that the differential sensitivity of the components of the blink reflex could be useful to monitor depth of sedation and light levels of anesthesia during the administration of midazolam.
Hemodynamic and oxygenation profiles in the early period after hyperbaric oxygen therapy: an observational study of intensive‐care patients
Authors: Ratzenhofer‐Komenda B. , Offner A. , Quehenberger F. , Klemen H. , Berger J. , Fadai J. H. , Spernbauer P. , Prause G. , Smolle‐Jüttner F. M. 
Published: December 2004

Background: We studied whether hemodynamic and oxygenation profiles are altered in critically ill patients after exposure to hyperbaric oxygen (HBO).Methods: Ten intensive‐care patients (two females, eight males) undergoing HBO treatment after major abdominal surgery, after burn injury and after CO poisoning were included. All subjects were put on mechanical ventilation and received continuous sedation, and had HBO treatment at 2.2 absolute atmospheres for 50 min.Design: Observational prospective study, and repeated measure design.Results: Hemodynamic and oxygen transport patterns were determined before (C0), 1 h (C1) and 2 h (C2) after HBO therapy with continuous cardiac output dual oximetry pulmonary arterial catheter, a central venous and radial arterial line. Data were analyzed with non‐parametric repeated measure analysis. Key results are expressed as a percentage of baseline (C0 values correspond to 100%) at C1 and C2 (median values, lower and upper limit of confidence interval): cardiac index [C1: 105% (98–135), C2: 99% (91–117), P = 0.19], systemic (P = 0.62) and pulmonary vascular (P = 0.76) resistance indices were unchanged, but pulmonary venous admixture (Qs/Qt) increased [C1: 173% (112–298), C2: 140% (92–241), P = 0.00002)] and arterial oxygen tension decreased [C1: 76% (67–94), C2: 82% (72–112), P = 0.010].Conclusion: The hemodynamic profile remained unaffected. The increase in Qs/Qt and the decrease in PaO2 may be attributed to the inhalation of HBO, and both are reversible.
Fluid extravasation during cardiopulmonary bypass in piglets – effects of hypothermia and different cooling protocols
Authors: Farstad M. , Heltne J. K. , Rynning S. E. , Lund T. , Mongstad A. , Eliassen F. , Husby P. 
Published: December 2004

Background: Hypothermic cardiopulmonary bypass (CPB) is associated with capillary fluid leak and edema generation which may be secondary to hemodilution, inflammation and hypothermia. We evaluated how hypothermia and different cooling strategies influenced the fluid extravasation rate during CPB.Methods: Fourteen piglets were given 60 min normothermic CPB, followed by randomization to two groups: 1: rapid cooling (RC‐group) (∼15 min to 28°C); 2: slow cooling (SC‐group) (∼60 min to 28°C). Ringer's solution was used as CPB prime and for fluid supplementation. Fluid input/losses, plasma volume, colloid osmotic pressures (plasma, interstitial fluid), hematocrit, serum‐proteins and total tissue water (TTW) were measured and fluid extravasation rates calculated.Results: Start of normothermic CPB resulted in a 25% hemodilution. During the first 5–10 min the fluid level of the reservoir fell markedly due to an intravascular volume loss necessitating fluid supplementation. Thereafter a steady state was reached with a constant fluid need of 0.14 ± 0.04 ml kg−1 min−1. After start of cooling the fluid needs increased in the following 30 min to 0.91 ± 0.11 ml kg−1 min−1 in the RC group (P < 0.001) and 0.63 ± 0.10 ml kg−1 min−1 in the SC‐group (P < 0.001) with no statistical between‐group differences.Fluid extravasation rates after start of hypothermic CPB increased from 0.20 ± 0.08 ml kg−1 min−1 to 0.71 ± 0.13 (P < 0.01) and 0.62 ± 0.13 ml kg−1 min−1 (P < 0.05) in the RC‐ and SC‐groups, respectively, without any changes in degree of hemodilution. TTW increased in most tissues, whereas the intravascular albumin and protein masses remained constant with no between group differences.Conclusion: Hypothermia increased fluid extravasation during CPB independent of cooling strategy. Intravascular albumin and protein masses remained constant. Since inflammatory fluid leakage usually results in protein rich exudates, our data with no net protein leakage may indicate that mechanisms other than inflammation could contribute to fluid extravasation during hypothermic CPB.
Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients
Authors: Flisberg P. , Rudin Å. , Linnér R. , Lundberg C. J. F. 
Published: December 2004

Background:  Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side‐effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population.Methods:  During a five‐year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0–10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/nightmares/confusion, nausea/vomiting, pruritus, orthostatism/leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest.Results:  Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements.Conclusion:  In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low. Patients with epidural analgesia experienced overall less pain, while opioid related side‐effects were more common with intravenous morphine analgesia.
International publishing in anaesthesia – how do different countries contribute?
Authors: Figueredo E. , Sánchez Perales G. , Muñoz Blanco F. 
Published: December 2004

Background: The evaluation of the international distribution in biomedicine research is a subject that creates expectations. This study assesses the recent evolution of world‐wide distribution of research in the anaesthesiology field and discusses some of the possible factors which could give rise to changes in the interpretation of absolute results.Methods: A search on Medline was run to obtain the source country of the journal articles (with abstract) from 10 important anaesthesia journals in the 1997–2001 period. The data were analysed and standardized to journal impact factor values of each publication and population size. Annual evolution in the number of publications in the countries with the largest scientific production was analysed. Furthermore, the distribution of articles by country of origin was studied for each journal.Results: The 9724 publications came from 65 countries. In absolute numbers, the USA leads research in anaesthesiology (24.4%). The evaluation of the contribution of the more productive countries revealed a progressive increase in the German contribution (from 5.1% to 9.4%) and a decrease in the American contribution (from 28.6% to 21.8%) over the 5 years analysed. In relative terms, Finland, Sweden and Denmark were the most productive countries per million inhabitants (8.8, 7.2 and 6 publications/year, respectively).Conclusion: The geographic distribution of the publications on anaesthesiology must not only be analysed in absolute numbers, where the USA is the most productive. The North‐European countries show the largest production/number of inhabitants ratio; whereas the largest percentage increase during the period is found in Germany.
Neck haematoma and airway obstruction in a patient with goitre: complication of internal jugular vein cannulation
Authors: Silva F. S. 
Published: December 2004

Attempted jugular vein cannulation in a patient with a discrete goitre resulted in a rapid growing haematoma and airway obstruction. This life‐threatening complication is rare, and is usually related to two conditions: pre‐existing coagulopathy and/or arterial puncture by a large bore cannula or vessel dilator. None of these was present in this patient.Investigations revealed a retrosternal goitre causing tracheal compression and major changes in the calibre and the anatomical relationships of neck vessels. Possible origin and mechanism for the sudden haematoma are discussed, as well as the airway management.This case clearly illustrates how internal jugular vein cannulation using the traditional blind technique, guided by external landmarks, can be extremely hazardous in patients with distorted anatomy of the neck.
Effect of isoflurane on monocyte adhesion molecule expression in human whole blood*
Authors: De Rossi L. W. , Horn N. A. , Weingartz E. , Buhre W. , Rossaint R. 
Published: December 2004

Background: Recruitment of monocytes to inflamed tissue is a crucial step in the acute inflammatory reaction. Adherence of monocytes to endothelial cells followed by transmigration depends on monocyte surface adhesion molecules, inflammatory cytokines and chemoattractant chemokines. In the present study, we determined the effect of isoflurane on monocyte adhesion receptor expression in vitro.Methods: Citrated whole blood was incubated for 60 min with either 0.5 or 1 MAC isoflurane. In unstimulated blood samples and after stimulation with N‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP) monocyte cell‐surface expression of the selectins PSGL‐1 and L‐selectin, and the β2‐integrins CD11a and CD11b were evaluated by flow cytometry.Results: Isoflurane reduced significantly the expression of PSGL‐1 on unstimulated monocytes, whereas the remaining selectins and β2‐integrins were not affected. At both concentrations, the FMLP‐induced removal of PSGL‐1 from the monocyte surface was increased. Furthermore, at 1 MAC isoflurane the FMLP‐induced increase in CD11a expression was significantly inhibited. The surface expression of L‐selectin and CD11b was not affected following exposure to isoflurane.Conclusion: Isoflurane increases the removal of the selectin PSGL‐1 from the monocyte surface. Since PSGL‐1 is important during the initial step of monocyte adhesion to endothelial P‐selectin, the decrease in monocyte surface PSGL‐1 may have profound effects on monocyte–endothelial interactions. Furthermore, the effects of isoflurane on monocyte adhesion molecule expression are different from those reported for neutrophils.