bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol
Authors: Klemola U.‐M. , Mennander S. , Saarnivaara L. 
Published: March 2003

Background: Alfentanil‐propofol combination provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil, especially in ambulatory surgery. In this study intubating conditions after remifentanil‐propofol were compared to those after alfentanil‐propofol.Methods: In a randomized, double‐blind study 60 healthy patients were assigned to one of three groups (n=20). After intravenous atropine, remifentanil 3 or 4 μg kg−1 (Rem3 or Rem4) or alfentanil 30 μg kg−1 (Alf30) was injected over 30 s followed by propofol 2.5 mg kg−1. Sixty seconds after the administration of propofol, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.Results: Overall conditions at intubation were significantly (P<0.05) better, and the frequency of excellent conditions was significantly (P<0.05) higher in the Rem4 group compared with the Alf30 group. Intubation was judged to be impossible in 20%, 25% or 5% of the patients in the Alf30, Rem3 or Rem4 groups, respectively. No patient manifested signs of opioid‐induced muscular rigidity. In terms of arterial pressures or heart rate, there were no differences between the groups.Conclusion: The best method was the combination of remifentanil 4 μg kg−1 and propofol 2.5 mg kg−1. This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.
Assessment of postoperative nausea using a visual analogue scale
Authors: Boogaerts J. G. , Vanacker E. , Seidel L. , Albert A. , Bardiau F. M. 
Published: March 2003

Background: Assessment of postoperative nausea intensity is difficult because nausea is a subjective and unpleasant sensation. We propose using the Visual Analogue Scale (VAS) device to increase the efficiency and precision in the assessment of nausea. We carried out a pilot study on postoperative patients suffering from nausea to measure the degree of agreement between the VAS scores and those given on a 4‐point verbal descriptive scale (VDS).Methods: Postoperative nausea was evaluated by means of a classical VAS (0–10 cm) device and a 4‐point VDS (0=no nausea, 1=mild, 2=moderate, 3=severe) in 128 surgical spontaneously complaining patients. Evaluation was repeated 45 min after rescue medication given if nausea was intractable, lasted more than 10 min or at the request of the patient. Ordinal logistic regression was used to measure the association between VAS and VDS and to determine cut‐off points on the VAS.Results: The VAS device was easily understood and used by patients. VAS scores decreased significantly from 5.5±2.3 to 1.4±1.8 after rescue medication (P=0.002). Application of ordinal logistic regression to pre‐ and post‐medication data combined yielded an agreement of 86% between VAS and VDS and the cut‐off points on the VAS were estimated as follows: 0–1 (no nausea), 1+–4 (mild), 4+–7 (moderate) and 7+–10 (severe).Conclusion: The VAS method proved to be useful for assessing quantitative nausea intensity and for testing the efficacy of rescue medication. It was found that a cut‐off value of 4 on the VAS may be considered as a critical threshold triggering anaesthesiologists or nurses to administer rescue medication.
Anaesthesia, recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia
Authors: Lie Karlsen K. , Persson E. , Wennberg E. , Stenqvist O. 
Published: March 2003

Background: Whereas induction and recovery will occur more rapidly with the new low soluble anaesthetics than with isoflurane, the quality of anaesthesia and recovery with special emphasis on postoperative nausea and vomiting (PONV) is not well known.Methods: In an open (peroperatively), double‐blinded (postoperatively), randomised controlled study, we assessed anaesthesia characteristics, recovery and 24 h PONV after breast surgery comparing isoflurane, desflurane and sevoflurane.Results: There were no significant quality differences between the three agents during anaesthesia and recovery except for the incidence of PONV in the postanaesthesia care unit (PACU). The PONV rate (24 h in PACU and ward) was higher in the desflurane group (67%) than in the isoflurane group (22%), (P<0.01). The corresponding PONV rate for sevoflurane was 36%.Conclusion: The quality of anaesthesia, time to opening of eyes and influence on respiration was similar with all three anaesthetics. As the emergence from anaesthesia did not differ significantly between the three agents, the choice of agent could be based on PONV rate and price. Desflurane had a significantly higher 24 h PONV rate than isoflurane. Early PACU PONV rate was significantly (P<0.05) lower for the more soluble isoflurane (4%) than for the low soluble gases, desflurane and sevoflurane together (28%). The result of this study does not give a rationale for a transition to the new low soluble agents in breast cancer surgery.
Postural post‐dural puncture headache. A prospective randomised study and a meta‐analysis comparing two different 0.40 mm O.D. (27 g) spinal needles
Authors: Flaatten H. , Felthaus J. , Kuwelker M. , Wisborg T. 
Published: March 2003

Background: To compare the incidence of postural post‐dural puncture headache (PPDPH) after spinal anaesthesia using two different 0.40 mm O.D. (27 g) spinal needles: pencil‐point needle and Quincke needle. In addition, a meta‐analysis of studies comparing small bore spinal needles with regard to development of PPDPH was performed.Methods: Clinical study: A prospective randomised double‐blind study was set up to investigate PPDPH after using 0.40 mm pencil‐point (Pencan, B. Braun) or Quincke (Spinocan, B. Braun) spinal needle. Postoperatively on day 5 to 7 a telephone interview was conducted in order to reveal postoperative complications such as headache and backache. PPDPH was considered present when the headache was new to the patient, and demonstrated posture dependence. Meta‐analysis: Electronic database search and manual search of relevant literature were performed in order to find randomised control trials comparing equal sized (outer diameter, O.D.) spinal needles with different bevel shape. Only studies with a proper method and not merely presented as an abstract were included in addition to the present clinical study.Results: Out of 313 patients randomised, 301 were completely followed up, 153 in the pencil‐point group and 148 in the Quincke group. The two groups were comparable regarding surgical procedures and demographic data. Of 15 patients suffering from PPDPH, 12 were found in the Quincke group, and 3 in the pencil‐point group. The difference was 6.1% (95% CI from 1.2 to 12.5%). The meta‐analysis of 1131 patients gave a relative risk of developing PPDPH of 0.38 (95% CI from 0.19 to 0.75) in the pencil‐point group compared to the Quincke group.Conclusion: A pencil‐point‐shaped spinal needle will significantly reduce PPDPH compared with Quincke‐type spinal needles, also when small bore needles (0.40 mm O.D.) are used.
Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action
Authors: Rømsing J. , Møiniche S. , Østergaard D. , Dahl J. B. 
Published: March 2003

Background: In order to investigate the evidence for a peripheral analgesic effect of local infiltration with nonsteroidal anti‐inflammatory drugs (NSAIDs) in postoperative pain, we conducted a systematic review.Methods: Randomised controlled and double‐blind trials were evaluated. Outcome measures were pain scores, the use of supplementary analgesics, and time to first analgesic request. Efficacy was estimated by significant difference (P<0.05) as reported in the original reports and by calculation of the weighted mean difference of pain scores between treatment groups.Results: Sixteen studies with data from 844 patients were considered appropriate for analysis. The NSAIDs were administered as intra‐articular injections, as components of intravenous regional anaesthesia (IVRA), and by wound infiltration and were compared with systemic administration or placebo. In the four studies comparing intra‐articular NSAIDs with systemic administration a statistically significant effect in favour of intra‐articular NSAIDs was found. Only one study compared IVRA NSAID with systemic administration, showing a significant effect in favour of IVRA administration. No more than two of the five studies comparing intrawound NSAIDs with systemic administration showed significant effect after intrawound administration. Most of the studies comparing local infiltration with placebo showed significant effect in favour of local infiltration.Conclusion: There is evidence for a clinically relevant peripheral analgesic action of intra‐articular NSAIDs while results of IVRA and wound infiltration with NSAIDs in postoperative pain are inconclusive. Trials without a systemic control group were not considered to provide evidence for a local effect.
Suppression of surgical hyperaldosteronism by potassium canrenoate during gynecologic surgery under sevoflurane anesthesia
Authors: Watanabe T. , Ogawa R. 
Published: March 2003

Background: Surgical hyperaldosteronism leads to sodium and water retention during surgery and often causes postoperative edema. This study investigated the effect of potassium canrenoate (PC) on pituitary adrenocortical function in lower abdominal surgery under sevoflurane anesthesia.Methods: Twenty patients were randomized to receive 400 mg of PC (the PC group, n=10) or saline (the control group, n=10) intravenously. The following parameters were determined: plasma aldosterone, adrenocorticotropic hormone (ACTH), plasma renin activity (PRA), serum sodium and potassium, urinary sodium and potassium, and urine output.Results: The aldosterone and ACTH levels showed significant increases in the control group during surgery. Plasma ACTH also increased significantly in the PC group, but plasma aldosterone levels were unchanged during surgery. The urine Na/K ratio of the PC group was significantly higher than that of the control group.Conclusion: The present study suggested that PC suppresses the increase of plasma aldosterone caused by surgical stress. That may prevent sodium retention and potassium excretion during surgery.
The effect of two low‐dose propofol infusions on the relationship between six‐pulse transcranial electrical stimulation and the evoked lower extremity muscle response
Authors: Van Dongen E. P. , Ter Beek H. T. , Aarts L. P. , Schepens M. A. , Morshuis W. J. , Benning F. J. , De Boer A. , Boezeman E. H. 
Published: March 2003

Background: Transcranial stimulation of the motor cortex using high‐voltage electrical stimuli given in train is a method of monitoring the integrity of the motor pathways during thoracoabdominal aortic aneurysm surgery. The purpose of this study was to assess the relationship between the stimulus intensity and the corresponding amplitude of the myogenic motor evoked potential (tcMEP) in response to six‐pulse transcranial electrical stimulation during two levels of low‐dose propofol infusion and stable fentanyl/nitrous oxide anaesthesia.Methods: Nine patients (37–78 yr) scheduled to undergo surgery on the thoracoabdominal aorta were studied. After achieving a stable anaesthetic state the output voltage was decreased with 50 V intervals from 350 V to 200 V during a target propofol infusion aimed at a plasma steady‐state concentration of 0.7 μg · ml−1 and increased with 50 V intervals from 200 V to 450 V during a target propofol infusion aimed at a plasma steady‐state concentration of 1.4 μg · ml−1. TcMEPs were recorded from the right tibialis anterior muscle.Results: Doubling the target propofol infusion to 1.4 μg · ml−1 resulted in a 30–50% decrease in tcMEP amplitude. The largest tcMEP amplitude using the six‐pulse paradigm was found during a propofol infusion aimed at a plasma concentration of 0.7 μg · ml−1 and demanded a stimulus output of 350 V, corresponding to a charge density of 7.5 μC · cm−2 per phase.Conclusion: Doubling the target propofol infusion to 1.4 μg · ml−1 provides less robust, but still recordable tcMEPs in response to six‐pulse electrical stimulation. Safety guidelines are discussed.
Retracted: Changes in the impact factor of anesthesia/critical care journals within the past 10 years
Authors: Boldt J. , Haisch G. , Maleck W. H. 
Published: March 2003

Background: The impact factor (IF) is published by the Institute for Scientific Information (ISI). There is a tendency to assess quality of scientific journals with the help of the IF. An analysis of the changes in the IF over time in the different specialities may help to further enlighten the worth and problems of the IF.Methods: The IFs listed under the subheadings Anesthesiology and Emergency Medicine & Critical Care in the Science Citation Index – Journal Citation Report were descriptively analysed over the past 10 years. Additionally, IFs of some other important journals (subheadings Surgery, Cardiovascular, General Medicine) were analysed.Results: The IF of most of the journals showed a constant increase over the years (average in Anesthesiology: +65%; average in Emergency Medicine & Critical Care: +145%). IFs of the highest ranked journals of other specialities showed a similar increase over the years (average in surgical journals: +56%; average in cardiac journals: +59%; average in general journals: +40%). More Anesthesiology and Emergency Medicine & Critical Care journals originated from the USA show an IF >2.0 over the past 10 years than do European journals.Conclusion: Although the value of the IF is highly controversial, it is a frequently used tool to assess rating of a medical journal. Anesthesiology and Emergency Medicine & Critical Care journals showed a continuous increase in the IF over the past 10 years.
Gastro‐intestinal complement activation during human liver transplantation: Impact on postoperative liver function
Authors: Rønholm E. , Tomasdottir H. , Runeborg J. , Mattsby‐Baltzer I. , Olausson M. , Åneman A. , Bengtsson A. 
Published: March 2003

Background: Liver transplantation elicits a systemic inflammatory response and eventually a multiple organ failure syndrome. Gastro‐intestinal inflammatory activation with release of proinflammatory cytokines and complement activation may occur. This study evaluates gastro‐intestinal complement activation and the association with postoperative parenchymatous liver cell injury and liver dysfunction.Methods: In 17 patients undergoing liver transplantation, blood samples were collected from radial artery and portal vein for analysis of complement SC5b‐9 and endotoxin concentration. Portal venous‐arterial SC5b‐9 plasma concentration gradients at 30 min after reperfusion were calculated. Outcome parameters included postoperative organ failure and serum concentrations of aspartate aminotransferase, alanine aminotransferase, bilirubin and factor II‐VII‐X.Results: Patients with gastro‐intestinal SC5b‐9 release (n=7) had higher postoperative serum aspartate aminotransferase and alanine aminotransferase concentrations [49 (32–80) μkat/l vs 8 (6–14) μkat/l, P<0.01 and 33 (15–54) μkat/l vs 8 (4–23) μkat/l, P<0.04, respectively] and lower factor II‐VII‐X concentrations [46 (21–48)% vs 60 (47–69)%, P<0.02] compared to patients without gastro‐intestinal SC5b‐9 release (n=10). The ICU stay was prolonged in patients with gastro‐intestinal complement release. There was no difference in number of organ failures and serum bilirubin concentration between the groups. The endotoxin concentration in arterial and portal vein blood was low and the association between endotoxaemia and complement activation was poor.Conclusion: Gastro‐intestinal complement activation may contribute to postoperative parenchymatous liver cell injury and liver dysfunction in patients undergoing liver transplantation.
Effects of dopexamine and volume loading on hemodynamics and oxygenation parameters in patients undergoing pulmonary resection
Authors: Müller M. , Sticher J. , Schindler E. , Padberg W. , Jänich S. , Hempelmann G. 
Published: March 2003

Background: Pulmonary resection may result in a reduction in arterial oxygen pressure as well as in cardiac output. Since cardiac index, oxygen delivery, and oxygen consumption are considered as important determinants of patients’ outcome, we evaluated the effects of dopexamine and volume loading on cardiopulmonary variables in patients undergoing pulmonary resection.Methods: Forty adult patients undergoing pulmonary resection for lung or bronchial tumors were included in an open placebo‐controlled study. The patients were selected according to a randomized sequence to group A (n=20) or group B (n=20). Dopexamine (2 μg · kg−1 · min−1) was started when steady state conditions were achieved after induction of anesthesia in group A. Saline 0.9% was given as control (group B). Hemodynamic monitoring was performed using a pulmonary artery catheter.Results: Dopexamine increased heart rate, cardiac output and oxygen delivery compared with control without increasing oxygen consumption during anesthesia and surgery. Furthermore, dopexamine was found not to alter the course of PaO2/FiO2 values.Conclusion: In patients undergoing pulmonary resection, dopexamine can be used perioperatively to increase cardiac index without decreasing the PaO2/FiO2 ratio.
The effect of dextromethorphan, alone or in combination with ibuprofen, on postoperative pain after minor gynaecological surgery
Authors: Ilkjær S. , Nielsen P. A. , Bach L. F. , Wernberg M. , Dahl J. B. 
Published: March 2003

Background: Experimental studies have demonstrated that peripheral tissue injury may lead to hyperexcitability of nociceptive neurones in the dorsal horn, in part mediated by N‐methyl‐D‐aspartate (NMDA)‐receptor mechanisms. Sensitisation of dorsal horn neurones may be an important contributor to postoperative pain. The aim of the present study was to investigate the effect of the NMDA‐receptor antagonist dextromethorphan on pain after minor gynaecological surgery, and to evaluate a potential additive effect with ibuprofen.Methods: In a double‐blind, placebo‐controlled study, 100 patients scheduled for elective termination of pregnancy were randomised to receive placebo, oral ibuprofen 400 mg, oral dextromethorphan 120 mg, or a combination of ibuprofen 400 mg and dextromethorphan 120 mg, 1 h before surgery. Pain and analgesic requirements were assessed 0.5, 1 and 2 h after operation.Results: We observed no effect of dextromethorphan on visual analogue scale (VAS) pain scores or analgesic consumption, and no additive or synergistic analgesic effects between ibuprofen and dextromethorphan. Ibuprofen reduced pain scores compared with placebo, and analgesic consumption compared with both placebo and dextromethorphan. The combination of ibuprofen and dextromethorphan increased preoperative nausea compared with both placebo and ibuprofen, whereas no statistically significant side effects were observed with dextromethorphan alone.Conclusion: No analgesic effects of oral dextromethorphan 120 mg on pain after surgical termination of labour, and no additive analgesic effects when combined with ibuprofen 400 mg, were observed. Ibuprofen reduced both VAS pain scores and analgesic consumption compared with placebo.
Subcutaneous infiltration with ammonium sulphate 10% does not prolong the local anaesthetic duration of lidocaine in humans
Authors: Møiniche S. , Dahl A. , Dahl J. B. 
Published: March 2003

Background: The aim of the present study was to investigate whether a solution of ammonium sulphate and lidocaine had a prolonged duration of action compared with lidocaine alone after subcutaneous infiltration in human volunteers.Methods: In a double‐blind, randomised, controlled trial 12 male volunteers had either 4 ml lidocaine 1% (40 mg) or a solution of 4 ml ammonium sulphate 10% and lidocaine 1% (40 mg) subcutaneously infiltrated in corresponding skin areas on the right and left calf. The duration of the local anaesthetic action of the test medications was assessed 1–6 h after the infiltrations using thresholds to mechanical (von Frey hairs) and thermal stimulation (heat detection thresholds: HDT, and heat pain dectection thresholds: HPDT), and by calculation of areas under the curve (AUC) for electronic visual analogue scale (VAS) pain ratings (sampled at 2 Hz) during a heat stimulation on the test areas for 30 s with a 45°C warm thermode.Results: At no assessment were thresholds to mechanical or thermal stimulation increased in favour of ammonium sulphate treated legs compared with control legs. On the contrary, HPDT were significantly lower in ammonium sulphate treated legs than control legs at the 3 h and 4 h assessment after infiltration (P<0.02). Similarly, the AUC for the VAS ratings was significantly higher in treatment legs compared with control legs 2 h and 3 h after infiltration (P<0.05).Conclusion: No improvement in local anaesthetic duration of ammonium sulphate 10% plus lidocaine 1% compared with lidocaine 1% alone was demonstrated early after subcutaneous infiltration in human volunteers.
Low‐dose prostacyclin in treatment of severe brain trauma evaluated with microdialysis and jugular bulb oxygen measurements
Authors: Grände P.‐O. , Möller A. D. , Nordström C.‐H. , Ungerstedt U. 
Published: March 2003

Background: The endogenous substance prostacyclin is a substance with the potential to improve microcirculation and oxygenation around contusions in the brain following a head trauma by its vasodilatory, antiaggregatory and antiadhesive effects. Microdialysis measurements of local concentrations of selected interstitial substances in the brain, and measurements of venous jugular bulb oxygenation reflecting overall brain oxygenation, might be useful to evaluate possible therapeutic effects of a specific therapy, such as treatment with prostacyclin.Methods: This case report study on six patients, of whom five were given prostacyclin, includes cerebral microdialysis measurements of interstitial lactate (n=5), pyruvate (n=3), glycerol (n=5) and glucose (n=4), and is combined with measurements of venous jugular bulb oxygenation in three of the patients. One microdialysis catheter was placed adjacent to a contusion, and in four of the patients another catheter was also placed in the contralateral less injured side for comparison. Low‐dose prostacyclin infusion (0.5–1.0 ng kg−1 min−1) was started when lactate concentrations in the more injured side was raised at a constant level for more than 10 h. The study also includes one patient used as control to whom no prostacyclin was given.Results: Lactate was markedly lower in the less injured than in the more injured area of the brain. During the prostacyclin infusion elevated lactate and lactate/pyruvate ratio were reduced. Elevated glycerol decreased, a low glucose increased and jugular bulb blood oxygenation increased following start of prostacyclin. The control patient showed an increase in lactate and lactate/pyruvate ratio.Conclusion: The microdialysis data combined with the jugular bulb oxygenation data indicated that low‐dose prostacyclin exerts effects compatible with improved oxygenation and reduced cell damage in the severely traumatised brain.