bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supraceliac aortic cross‐clamping and declamping. Effects of dopexamine and dopamine on systemic and mesenteric hemodynamics, metabolism and intestinal tonometry in a rat model
Authors: Studer W. , Wu X. 
Published: March 2003

Background: The effects of dopexamine and dopamine on mesenteric ischemia during reperfusion following aortic cross‐clamping are not known. We determined intramucosal tonometric PCO2 and PCO2 gap using a rat model of supraceliac aortic cross‐clamping and declamping.Methods: Under pentobarbital and fentanyl anesthesia, 24 rats were surgically instrumented with arterial, right atrial, and portal venous catheters, ultrasonic flowprobes for measurements of abdominal aortic, superior mesenteric and carotid artery blood flow, and a pediatric tonometer for intestinal mucosal PCO2 measurements. Rats were randomized to receive a continuous infusion of dopexamine (10  · μg · kg−1 · min−1, n=8), dopamine (10 μg · kg−1 · min−1, n=8 ), or physiologic saline (control, n=8), infused at a rate of 4 ml · kg−1 · h−1, administered throughout the experimental protocol. After 30 min of drug infusion, the aorta was cross‐clamped at the supraceliac level for 30 min. Reperfusion following declamping was observed for 180 min.Results: Intestinal tonometric PCO2 remained unchanged during drug treatment before aortic cross‐clamping, increased similarly in all groups following declamping during early reperfusion, and recovered to baseline within 30 min of reperfusion. Dopexamine treatment was associated with higher lactate levels and increased heart rate (P<0.05) during aortic cross‐clamping.Conclusions: 1) Mesenteric ischemia, determined by intestinal tonometric PCO2 and PCO2 gap, recovers within 30 min of reperfusion following 30 min of aortic cross‐clamping irrespective of drug treatment and, 2) dopexamine induced higher lactate levels and increased heart rate during aortic cross‐clamping and should be carefully analyzed for potentially adverse effects on cardiac function.
A comparison of coracoid and axillary approaches to the brachial plexus
Authors: Koscielniak‐Nielsen Z. J. , Rotbøll Nielsen P. , Risby Mortensen C. 
Published: March 2003

Background: Brachial plexus block by the coracoid approach does not require arm abduction and may be more effective than the axillary approach because of a more proximal injection of local anaesthetic. However, the clinical usefulness of the coracoid approach has not been tested in prospective controlled trials. The present randomized, observer‐blinded study compared success rates, time to obtain a complete block, frequency of adverse effects and block discomfort in two groups of 30 patients, anaesthetized for hand surgery using either the coracoid or the axillary approach to the brachial plexus.Methods: After subcutaneous infiltration with 5 ml of 1% mepivacaine/adrenaline the brachial plexus was located using a nerve stimulator and an insulated pencil‐point needle. Ropivacaine 0.75%, 20–40 ml, depending on body weight, was used for the initial block. In the coracoid (C) group two plexus cords, and in the axillary (A) group four terminal nerves were electrolocated and the volume of ropivacaine was divided equally between them. Spread of analgesia to the arm was assessed every 5 min, by an anaesthetist unaware of the block technique. The block was defined as effective (complete) when analgesia was present in all five sensory nerve areas distal to the elbow. Incomplete blocks were supplemented 30 min after the initial block.Results: In the C group a median 11 min was required for block performance as compared to 12 min in the A group (NS). Onset of block was shorter and the frequency of incomplete blocks lower in the A group (median 17 min and 17%) than in the C group (30 min and 47%, respectively). Lack of analgesia of the ulnar nerve was the main cause of incomplete initial blocks in the C group. All incomplete blocks were successfully supplemented. However, total time to obtain complete block was shorter in the A group than in the C group (29 min vs. 41 min, P<0.05). Accidental arterial puncture occurred in seven patients (five in C and two in A group), which resulted in two haematomas, both in the C group (NS). No permanent sequelae were observed.Conclusion: The axillary approach to the brachial plexus using four injections of ropivacaine results in a faster onset of block and a better spread of analgesia than the coracoid approach using two injections.
Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients
Authors: Rømsing J. , Østergaard D. , Drozdziewicz D. , Schultz P. , Ravn G. 
Published: March 2003

Background:In order to establish an effective drug regimen, we compared the analgesic efficacy of oral diclofenac and high‐dose acetaminophen on pain after tonsillectomy.Methods:In this randomised, double‐blind study 48 children, 5 to 15 years of age, following tonsillectomy were assigned to receive either diclofenac 2–3 mg kg−124 h−1(n=24) or acetaminophen 90 mg kg−124 h−1(n=24) for the first three days after surgery. Postoperative pain was assessed by self‐report each day before scheduled medication at 7 h, 12 h, 18 h and 23 h.Results:The number of children rating severe pain was high in both the diclofenac group, 5–50%, and in the acetaminophen group, 12–58%, during the three day study period. Pain scores in the diclofenac group were only significantly lower at 12 h on day 1–3 compared to pain scores in the acetaminophen group (P<0.05). None of the children in the diclofenac group experienced any episodes of nausea/vomiting compared to 9 children in the acetaminophen group on day 1. The incidences of nausea/vomiting increased with pain (P<0.05). None of the 48 children experienced any episodes of bleeding.Conclusions:This study indicates that diclofenac was no more effective than high‐dose acetaminophen (90 mg vs. 60 mg kg−124 h−1) for analgesia, but resulted in a lower incidence of nausea and vomiting in patients following tonsillectomy.
Postoperative pain control by epidural analgesia after transabdominal surgery
Authors: Andersen G. , Rasmussen H. , Rosenstock C. , Blemmer T. , Engbæk J. , Christensen M. , Ørding H. 
Published: March 2003

Background: The efficacy of postoperative epidural pain treatment has been well documented in controlled studies. However, the literature concerning results of daily routine use of this method often only emphasises certain aspects of it.Methods: A prospective study of 168 patients scheduled for major surgery with transabdominal access was performed in order to evaluate efficacy, side effects, complications and rate of acceptance of postoperative epidural pain treatment. The epidural catheter was placed before surgery and the patients received epidural analgesia by a bupivacaine/morphine mixture for 3 days postoperatively, continued by another 3 days with bolus injections of morphine only.Results: Only few complications followed the insertion of the epidural catheter, but in about 16% of the patients the epidural catheter or the drugs administered by it made reinsertion or change in the type of analgesia necessary during the first 3 postoperative days. Despite the possibility for individualising the treatment and p.r.n. analgesics, pain relief when coughing and moving during day 1–3 was insufficient in 30–50% of the patients. Serious side effects were rare, but pruritus was frequent, as were the symptoms of nausea and vomiting. The patients were generally satisfied with the treatment; however, a small group had unacceptable pain when the epidural catheter was inserted.Conclusion: Analgesia was insufficient when coughing and moving in an unacceptably large number of the patients. Also the number of epidural catheter related problems was high. In order to make early intervention possible, the patients and epidural catheters should be observed daily and systematically by members of the staff competent to detect possible problems.
Comparison between pentazocine, pethidine and placebo in the treatment of post‐anesthetic shivering Note
Authors: Terasako K. , Yamamoto M. 
Published: March 2003

Background: We have compared the effects of pethidine, pentazocine and placebo in the treatment of post‐anesthetic shivering.Methods: Forty‐five patients who shivered after routine surgery were allocated randomly to receive normal saline (n=15), pentazocine 7.5 mg (n=15) or pethidine 17.5 mg (n=15).Results: After 10 min, 13 patients had stopped shivering in the pethidine group, which was significantly more than the incidence in the two other groups (placebo=2; pentazocine=4) (P<0.01). Pentazocine was not significantly different from normal saline in affecting shivering.Conclusion: We conclude that pentazocine 7.5 mg was not effective in the treatment of post‐anesthetic shivering(
Note).
Midlatency median nerve evoked responses during recovery from propofol/sufentanil total intravenous anaesthesia Note
Authors: Rundshagen I. , Schnabel K. , Schulte Am Esch J. 
Published: March 2003

Background: Median nerve somatosensory evoked responses (MnSSER) are frequently used to monitor the integrity of the somatosensory pathway during surgery. We investigated MnSSER components during the wakeup phase from anaesthesia with propofol/sufentanil, because detailed information is lacking about the reversibility of anaesthetic induced changes of MnSSER. The aim of the study was to document precisely the MnSSER waves in relation to the clinical awakening. The hypothesis was that anaesthetic induced MnSSER changes are reversed when the patient becomes responsive after anaesthesia.Methods: In 20 gynaecological patients anaesthesia was maintained with propofol 8 mg kg−1 h−1 supplemented by bolus injections of sufentanil. MnSSER were recorded at C4′ (N20, P25, N35, P45, N50) following electrical median nerve stimulation on the day before surgery, after the end of surgery during anaesthesia and every 5 min during recovery, till the patients were responsive again and able to identify a shown object.Results: While the primary cortical MnSSER complex N20P25 regained baseline values, the cortical latencies ≥35 ms remained prolonged (P<0.001) and the amplitudes P45N50 were suppressed (P≤0.013), when the patients were responsive after 26±7 min following anaesthesia. However, the amplitudes P25N35 exceeded their corresponding baseline value (P<0.01).Conclusion: Persistent changes of MnSSER waves ≥35 ms reflect impaired signal processing along the somatosensory pathway following propofol/sufentanil anaesthesia when the patients are responsive again. Further studies combining MnSSER recording with distinct neuro‐psychological tests are needed to define the clinical relevance of these findings(
Note).
Halogenated volatile anesthetics inhibit carbon monoxide‐stimulated soluble guanylyl cyclase activity in rat brain
Authors: Masaki E. 
Published: March 2003

Background: Because of halogen contents, halogenated volatile anesthetics (HVA) have a similarity to nitric oxide (NO) in terms of great affinity for the ferrous ion. Interactions between HVA and NO at the ferrous ion of soluble guanylyl cyclase (sGC) have been reported in different tissues. Carbon monoxide (CO), a more stable gas than NO, activates sGC by the same mechanism as NO. This study was undertaken to examine the effect of HVA on CO‐stimulated sGC activity in rat brain.Methods: Sprague‐Dawley rat brain was homogenized and ultracentrifuged. The resulting supernatant was used as sGC fraction. The fraction was incubated with CO and HVA, and the activity of sGC was determined by measuring cyclic guanosine monophosphate (cGMP) production using an enzyme immunoassay in aliquots of the supernatant.Results: CO clearly increased cGMP production in a dose‐dependent manner. Sevoflurane and isoflurane produced significant and dose‐dependent inhibition of CO‐stimulated sGC activity. There was no difference in the inhibitory effect between the two anesthetics. GTP dose‐dependently increased CO‐stimulated cGMP production. Both anesthetics decreased GTP production, but the inhibition by the anesthetics was not significant at higher GTP concentrations.Conclusions: These results suggest that HVA can compete with CO at the ferrous ion of sGC and inhibit the activity of this enzyme.
Safety, efficacy, and long‐term results of a modified version of rapid opiate detoxification under general anaesthesia: A prospective study in methadone, heroin, codeine and morphine addicts
Authors: Hensel M. , Kox W. J. 
Published: March 2003

Background: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long‐term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine).Methods: Seventy‐two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long‐term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature.Results: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre‐existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow‐up. Six patients were lost during follow‐up.Conclusions: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.
Contractures in skeletal muscle of malignant hyperthermia susceptible patients after in vitro exposure to sevoflurane
Authors: Snoeck M. M. J. , Gielen M. J. M. , Tangerman A. , Van Egmond J. , Dirksen R. 
Published: March 2003

Background: Sevoflurane, a potent inhalational anaesthetic agent that is structurally similar to halothane, has some favourable characteristics, but may also be able to trigger malignant hyperthermia (MH) in susceptible patients. The diagnosis of malignant hyperthermia susceptibility relies on the in vitro contracture test on skeletal muscle. The present study was undertaken to investigate whether exposure to sevoflurane of muscles of malignant hyperthermia susceptible (MHS) patients would also cause an abnormal contracture.Methods: Muscle fascicles obtained from three MHS patients, one malignant hyperthermia non‐susceptible (MHN) patient, two control patients and one malignant hyperthermia equivocal (MHE) patient were exposed to sevoflurane instead of halothane in the in vitro contracture test, carried out according to the protocol of the European Malignant Hyperthermia Group. The muscle fascicles were surplus to diagnostic requirements. Sevoflurane concentrations in the testbath were measured using a headspace gas chromatographic technique.Results: The kinetics of sevoflurane concentration in the testbath were similar to those of halothane. An in vitro contracture response of 2 mN or more was seen in all four MHS/MHE patients with sevoflurane but not in the three control/MHN patients. The magnitude of muscle contracture in the sevoflurane test was less than in the conventional halothane test at comparable testbath concentrations.Conclusions: Sevoflurane can trigger an abnormal contracture in human muscle in vitro. This is indicative of malignant hyperthermia susceptibility. Exposure to sevoflurane should be avoided in patients thought to be susceptible to malignant hyperthermia.
Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia
Authors: Schwall B. , Jakob W. , Sessler D. I. , Taeger K. , Fröhlich D. 
Published: March 2003

Background: Previous studies reported that, contrary to local anesthesia, cataract surgery under inhalational anesthesia is associated with substantial adrenergic activation. We tested the hypothesis that total intravenous anesthesia (TIVA) with propofol and alfentanil produces less or comparable adrenergic activation during cataract surgery than local anesthesia.Methods: Patients were randomly assigned to peribulbar local block (n=10) or TIVA (n=10). The heart rate, blood pressure, plasma concentrations of catecholamines, cortisol, and glucose were assessed at seven pre‐, intra‐, and post‐operative time points.Results: In the patients given local anesthesia, plasma concentrations of epinephrine, norepinephrine and cortisol did not change significantly. In contrast, plasma epinephrine decreased by roughly 66% during TIVA: from 45±16 to 15±8 pg/ml. Plasma norepinephrine concentration decreased by roughly 50%, from 462±265 to a minimum value of 219±6 pg/ml and plasma cortisol concentrations decreased by roughly 61%, from 16.4 ng/ml to 6.4 ng/ml. Blood pressure and heart rates remained near baseline values during local anesthesia. In contrast, systolic blood pressure decreased by 30% and heart rate by 12 beats/min during TIVA.Conclusion: The presented study and available data clearly suggest that local anesthesia produces the best adrenergic and hemodynamic stability during cataract surgery. Contrary to previously reported results on inhalational anesthesia (thiopentone/enflurane), the TIVA regimen used effectively prevents the adrenergic and metabolic response during cataract surgery.
The effect of sedation on weaning following coronary artery bypass grafting: propofol versus oxycodone‐thiopental
Authors: Leino K. , Nunes S. , Valta P. , Pikänen O. , Vanakoski J. , Takala J. 
Published: March 2003

Background: Propofol has been advocated for sedation in intensive care because of superior recovery characteristics. We hypothesised that the use of two totally different sedation methods after coronary artery bypass grafting should result in differences not only in extubation time, but also in breathing pattern and gas exchange during weaning and after extubation.Methods: Thirty patients participated in this randomised and controlled study. We used propofol infusion and oxycodone‐thiopental bolus dosage, titrated to sedation level 4 or 5 according to Ramsey. Weaning was performed using protocol‐based pressure support trials.Results: Total (SD) fentanyl dose during operation was 33 (6) μg · kg−1 for propofol and 34 (6) μg · kg−1 for oxycodone‐thiopental (ns). The target sedation was achieved equally with both methods. The time from admission to intensive care unit to extubation was 494 (100) min for propofol and 521 (98) min for oxycodone‐thiopental (ns). Weaning times were 63 (24) min and 112 (63) min in the propofol and oxycodone‐thiopental groups, respectively (P<0.05). Breathing frequency increased and tidal volume decreased from weaning to 2 h postextubation.Conclusion: Propofol infusion and oxycodone‐thiopental bolus dosages, titrated to the same sedation end point, resulted in similar time from admission to extubation, although the weaning period was shorter in the propofol group. In terms of breathing pattern, gas exchange, blood gases and haemodynamics, the methods were similar. Propofol, despite its attractive pharmacological profile, may offer no clinical benefit in short‐term sedation after a moderate dose fentanyl anaesthesia in cardiac surgery.
Effect of PEEP and inhaled nitric oxide on pulmonary gas exchange during gaseous and partial liquid ventilation with small volumes of perfluorocarbon
Authors: Max M. , Kuhlen R. , Falter F. , Reyle‐Hahn M. , Dembinski R. , Rossaint R. 
Published: March 2003

Background: Partial liquid ventilation, positive end‐expiratory pressure (PEEP) and inhaled nitric oxide (NO) can improve ventilation/perfusion mismatch in acute lung injury (ALI). The aim of the present study was to compare gas exchange and hemodynamics in experimental ALI during gaseous and partial liquid ventilation at two different levels of PEEP, with and without the inhalation of nitric oxide.Methods: Seven pigs (24±2 kg BW) were surfactant‐depleted by repeated lung lavage with saline. Gas exchange and hemodynamic parameters were assessed in all animals during gaseous and subsequent partial liquid ventilation at two levels of PEEP (5 and 15 cmH2O) and intermittent inhalation of 10 ppm NO.Results: Arterial oxygenation increased significantly with a simultaneous decrease in cardiac output when PEEP 15 cmH2O was applied during gaseous and partial liquid ventilation. All other hemodynamic parameters revealed no relevant changes. Inhalation of NO and instillation of perfluorocarbon had no additive effects on pulmonary gas exchange when compared to PEEP 15 cmH2O alone.Conclusion: In experimental lung injury, improvements in gas exchange are most distinct during mechanical ventilation with PEEP 15 cmH2O without significantly impairing hemodynamics. Partial liquid ventilation and inhaled NO did not cause an additive increase of PaO2.
The risk of cardiac injury during laparoscopic fundoplication: cardiac troponin I and ECG study Note
Authors: Boccara G. , Pouzeratte Y. , Troncin R. , Bonardet A. , Boularan A.‐M. , Colson P. , Mann C. 
Published: March 2003

Background: Myocardial trauma has been described during gastroesophageal reflux laparoscopic surgery, in association with the proximity of cardiac structures. In addition, specific haemodynamic changes induced by CO2 pneumoperitoneum could exacerbate perioperative cardiac complication even in patients without cardiac risk factors. The aim of this study was to evaluate the influence of gastroesophageal reflux laparoscopic surgery on the perioperative ECG, cardiac troponin I and myocardial enzyme changes.Methods: Forty‐two ASA I–II patients without ischaemic heart disease or combined double‐risk factors were studied. Automated ST segment analysis was used intraoperatively. ECG, plasma myocardial enzyme and cardiac troponin I concentrations were reported on arrival in the recovery room (H0), 4 h (H4) and 24 h (H24) postoperatively.Results: Intraoperative ST segment changes occurred in two patients: the first during a hypotensive episode (MAP<55 mmHg; 3/42 patients) and the second during a hypertensive episode (MAP >110 mmHg; 3/42 patients). One case of intraoperative subcutaneous emphysema occurred without ST disturbance. One case of pneumothorax was observed at H0–H4 in another patient without clinical symptoms. Cardiac troponin I and CK‐MB were not increased postoperatively. Transaminase concentrations increased (2‐fold normal values) in 26/42 patients. In these 26 patients, 7 experienced 5‐fold isolated transaminase increase, associated with left hepatic artery section.Conclusion: According to perioperative ECG changes and/or specific cardiac troponin I measurements, we did not identify specific myocardial damage following gastroesophageal reflux laparoscopic surgery. Unexpectedly, the incidence of hepatic cytolysis was frequent (62%) and has not previously been reported in the literature.