bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of acute renal failure on antioxidant status in multiple organ failure
Authors: Metnitz PH. G. H. , Fischer M. , Bartens C. , Steltzer H. , Lang TH. , Druml W. 
Published: March 2003

Background: Acute renal failure (ARF) can be triggered or aggravated by reactive oxygen species (ROS) but established ARF per se might also affect the antioxidant defence mechanisms of the organism. We evaluated a broad pattern of antioxidants in critically ill patients with multiple organ failure with (MOF‐ARF) and without acute renal failure (MOF) to identify any potential involvement of renal dysfunction in the depletion of the antioxidant system.Methods: Observational study; 13 patients with MOF were investigated (9 with and 4 without ARF), and 17 healthy subjects served as controls. Blood samples were drawn after establishment of MOF. Plasma levels of ascorbate, α‐tocopherol, retinol, β‐carotene, selenium and lipid peroxidation products (MDA) were determined and the activities of the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione‐peroxidase (GSH‐PX) in erythrocytes were measured. In addition, ROS production (superoxide anion and hydrogen peroxide) in activated neutrophils was assessed.Results: Plasma levels of ascorbate, β‐carotene and selenium were reduced in both patient groups, when compared to controls. Decrease in selenium was more pronounced in the MOF‐ARF group. MDA levels were increased in both groups, again being more pronounced in MOF‐ARF patients compared to MOF patients. Hydrogen peroxide production by neutrophils from both patient groups was lower than from controls.Conclusion: A depression of the antioxidative system is present in critically ill patients with MOF. In patients with associated ARF this was even more pronounced and plasma MDA levels were higher, suggesting an additional effect on the antioxidative potential in the presence of renal dysfunction and/or renal replacement therapy.
Core and thenar skin temperature variation during prolonged abdominal surgery: comparison of two sites of active forced air warming
Authors: Motamed C. , Labaille T. , Léon O. , Panzani J. P. , Duvaldestin PH. , Benhamou D. 
Published: March 2003

Background: This study was designed to compare the efficacy of two different sites of active forced air warming, upper body or lower body, to maintain normothermia; and their respective effect on thenar skin temperature in relation to the accelerographic monitoring of neuromuscular blockade during long‐lasting abdominal surgery.Methods: Twenty‐six patients were randomised into two groups: upper body, (n=13) and lower body, (n=13), for intraoperative forced air warming. General anaesthesia was induced with thiopentone, sufentanil, and maintained with a mixture of N2O/O2/isoflurane. Pancuronium, 0.1 mg · kg−1was used to facilitate tracheal intubation. Reinjection doses of 0.01 mg · kg−1 were administered once 25% recovery of first twitch height of train‐of‐four stimulation had occurred, or if surgical relaxation was estimated as inadequate by the surgeon. Thenar skin temperature and core temperature were monitored continuously.Results: A similar trend for core temperature profile was observed in both groups. After an initial mild hypothermia, normothermia was reached progressively. Normothermia was obtained faster with lower body forced air warming than with upper body (2 h versus 3 h), P<0.05. Thenar skin temperature significantly increased during the first 90 min of surgery. This rise was significantly higher in the upper body group at 40 min and 60 min, P=0.03 and P=0.01, respectively. Stabilisation of thenar skin temperature occurred after 2 h without any further significant difference between groups. Muscle relaxant requirements were not significantly different between the groups.Conclusion: This study suggests that during long‐lasting abdominal surgery, normothermia is maintained after 2–3 h by either upper or lower body active forced air warming. After an initial post‐induction mild hypothermia, normothermia was achieved faster with lower body surface warming. Thenar skin temperature trend showed that it remained above 32°C during most of the procedure in both groups.
Lung lymph response to overinfusion with hydroxyethyl starch in sheep
Authors: Koizumi T. , Kaneki T. , Yamamoto H. , Ri‐Li GE. , Drome Y. , Kubo K. , Shibamoto T. 
Published: March 2003

Background: Several hydroxyethyl starch (HES) solutions are available clinically. We performed comparative studies of low and high molecular weight HES to evaluate the effects on lung lymph flow in sheep, to see the difference in the types of HES.Methods: We prepared awake sheep with vascular monitorings and lung lymph fistulas. We measured systemic artery pressure (Psa), pulmonary artery pressure (Ppa), and left atrial pressure (Pla) continuously. Cardiac output (CO) was measured every 30 min. Lung lymph flow (Qlym) was collected every 15 min. After baseline measurements, two HES solutions were infused over 2 h, respectively. Experiment 1 (n=6): low molecular weight HES (MW 70 000, substitution ratio 0.5–0.55), Experiment 2 (n=5): high molecular weight HES (MW 450 000, substitution ratio 0.7).Results: Both low and high molecular HES behaved similarly as a volume expander, increasing Psa, CO, Pla and Ppa, and decreasing hematocrit. In addition, the actual oncotic pressure gradient (plasma – lymph) was widened after the start of either low or high molecular HES, but the value for high molecular HES was significantly higher than that for low molecular HES. Qlym of low molecular HES rose significantly from the baseline and the percent increase in Qlym for low molecular HES was significantly higher than that for high molecular HES.Conclusion: These data suggest that low molecular HES is as useful a plasma substitute as high molecular HES, but may increase lung fluid filtration in the overinfused state.
Intraperitoneal lidocaine for postoperative pain after laparoscopy
Authors: Elhakim M. , Elkott M. , Ali N. M. , Tahoun H. M. 
Published: March 2003

Background: A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating pain after laparoscopic cholecystectomy. The use of intraperitoneal lidocaine was evaluated in this study.Methods: At the end of surgery, 200 ml saline containing 200 mg lidocaine, or the same volume of saline, were randomly splashed under the right diaphragmatic surface in 50 patients in a double‐blind manner. Postoperative shoulder and abdominal pain intensity were recorded on a numeric grading scale and a visual analogue scale, respectively. Analgesic consumption was also recorded. Respiratory function tests were compared before and after surgery. Side effects and recovery variables were assessed by the nurses at 2‐h intervals.Results: The incidence, severity and duration of shoulder pain were reduced from 40% of patients scoring 3.9±0.2 for duration of 17.9±0.2 h in the control group to 12% scoring 2.5±0.5 for duration of 1.6±0.01 h in the lidocaine group. Lidocaine treated patients had significantly less abdominal postoperative pain immediately on return to the ward and during the first postoperative day (P<0.05). “No pain on deep inspiration” was reported by 72% of patients in the lidocaine group immediately on return to the ward compared to 8% of those in the control group. Analgesic consumption for 24 h after surgery was significantly less in the lidocaine group (P<0.05). There were no significant differences in respiratory function tests, recovery variables or incidence of side effects between the two groups.Conclusion: Intraperitoneal lidocaine is simple to use and results in a long‐lasting reduction of pain after a single administration.
The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%
Authors: Keld D. B. , Hein L. , Dalgaard M. , Krogh L. , Rodt S. Å. 
Published: March 2003

Background: The incidence of TNS after spinal anaesthesia is a problem. Especially the use of hyperbaric lidocaine in patients placed in the lithotomy position during surgery has been associated with a high incidence of TNS. The present study was performed to investigate whether TNS is present more frequently in patients undergoing surgery in the supine position with use of hyperbaric lidocaine compared with hyperbaric bupivacaine.Method:Seventy patients were included and randomised to receive either hyperbaric lidocaine or hyperbaric bupivacaine. All patients were contacted on the first and third postoperative days by an anaesthesiologist blinded to the local anaesthetic used. The patients were asked about symptoms of TNS, pain not associated with the operation area, and asked to grade the complaints after a verbal analogue score from 0 to 10.Results: We found a total of ten patients who showed signs of TNS. There were nine patients in the lidocaine group (26%) who showed signs of TNS compared to only one patient in the bupivacaine group (3%) (P<0.01). The average score of TNS complaints was 3.5. A total of 13 patients (19%) complained of back pain. There were no significant differences with regard to which local anaesthetic was used. The average score of back pain was 3.3.Conclusion: TNS is a significant problem in patients having spinal anaesthesia with hyperbaric lidocaine compared to hyperbaric bupivacaine, both in the supine position. For day‐case surgery, TNS would start after dismissal from hospital. The use of hyperbaric lidocaine is therefore questionable, even though these problems are of an order that the majority of patients would still choose spinal anaesthesia for future operations.
High‐dose rectal and oral acetaminophen in postoperative patients – serum and saliva concentrations
Authors: Hahn T. W. , Mogensen T. , Lund C. , Schouenborg L. , Rasmussen M. 
Published: March 2003

Background: The primary purpose of the study was to examine the absorption of acetaminophen by measuring serum and saliva concentrations produced by a standard postoperative acetaminophen dosing regimen and secondary to examine the correlation between saliva and serum concentrations of acetaminophen after rectal and oral dosing.Methods: Twenty‐four women, aged 18–60 years, scheduled for minor gynaecological laparoscopic surgery were studied. Patients received acetaminophen 2000 mg suppositories after surgery and oral doses of 1000 mg at 4 and 8 h postoperatively. Alfentanil was available via patient‐controlled analgesia. Saliva and blood samples were collected postoperatively.Results: At 1, 2, 3, and 4 h after rectal dosing the saliva concentrations (mean±SD) were 15.2±5.9 μmol/l, 33.7±12.5 μmol/l, 45.5±19.1 μmol/l, and 55.4±23.1 μmol/l, respectively. The serum concentrations at 2 and 4 h were 31.0±11.2 μmol/l and 54.8±23.8 μmol/l, respectively. Additional oral dosing resulted in saliva concentrations at 5, 8, and 9 h of 99.7±49.5 μmol/l, 106.9±31.7 μmol/l, and 139.3±55.4 μmol/l, respectively, with coincident serum concentrations of 100.1±50.2 μmol/l, 105.6±29.0 μmol/l, and 141.2±52.1 μmol/l. After rectal dosing the linear regression resulted in r2=0.96, P<0.001 and saliva/serum‐ratio=0.99. After additional oral dosing the outcome of linear regression was: r2=0.90, P<0.001 and saliva/serum‐ratio=1.00.Conclusion: The slow and ongoing absorption process resulting in no maximum concentration within 4 h after administration of 2000 mg acetaminophen suppositories makes this rectal regimen therapeutically irrational for treatment of postoperative pain. The significant ratio and linear correlation between saliva and serum concentrations of acetaminophen suggests that saliva could be used instead of blood to monitor acetaminophen administration in patients.
Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy
Authors: Frietsch T. , Krafft P. , Becker H. D. , Buelzebruck H. , Wiedemann K. 
Published: March 2003

Background: Gas exchange during high‐frequency jet ventilation (HFJV) for prolonged rigid bronchoscopy (RBS) is usually monitored by arterial blood gas analysis. Capnography of expired gases during brief HFJV discontinuation may be a reliable and noninvasive supplemental method. Capnography can be performed either for single breaths or with respiratory rate (RR) reduced to 10 · min−1. The aim of this study was to demonstrate that capnography during short periods of HFJV discontinuation represents a reliable measure of PaCO2 during prolonged RBS.Methods: We prospectively investigated 100 consecutive patients (75 male and 25 female) undergoing HFJV for RBS. HFJV was delivered through the rigid bronchoscope at the following settings: working pressure 1.2 bar, rate 100 · min−1, FIO2 0.99, ti/ttot0.6. The light guiding channel ending at the distal tip of the rigid bronchoscope was used for gas sampling. Capnograms were assessed at 5 min intervals and compared to PaCO2 from arterial blood samples drawn simultaneously. The accuracy of single breath CO2 sampling was compared with sampling at RR=10 · min−1.Results: Mean duration of RBS was 30±21 min. A significant correlation between capnography (PetCO2) and arterial blood gas analysis (PaCO2) was observed, being r=0.90 for the RR=10 · min−1 method and r=0.91 for the single breath method. Mean difference between PaCO2 and PetCO2 was 0.37±0.2 kPa throughout the entire study period. No significant differences between single breath sampling or sampling at RR=10 · min−1 were observed.Conclusion: Capnography performed during short periods of HFJV discontinuation reliably and noninvasively reflects PaCO2 during prolonged endoscopic procedures. Capnography during HFJV for RBS may reduce the frequency of arterial blood gas sampling, the duration of unmonitored intervals and costs.
Milrinone therapy in catecholamine‐dependent critically ill patients with heart failure
Authors: Siostrzonek P. , Koreny M. , Delle‐Karth G. , Haumer M. , Koller‐Strametz J. , Heinz G. 
Published: March 2003

Background: Treatment with the PDE‐III inhibitor milrinone improves hemodynamics in patients with heart failure. We examined whether therapy with milrinone is safe and effective in critically ill patients with catecholamine‐dependent heart failure and whether treatment with milrinone facilitates weaning from prolonged catecholamine therapy.Methods: Twenty adult patients with reduced left ventricular function and prolonged (7±4 days) catecholamine therapy in whom attempts at catecholamine weaning had failed were examined. Patients were prospectively randomised either to group A (addition of a fixed dose of 0.5 μg · kg−1 · min−1 milrinone to catecholamine therapy) or to group B (continued catecholamine therapy without milrinone). Dobutamine and norepinephrine treatment and fluid intake were titrated according to predefined hemodynamic goals. Hemodynamic parameters, fluid requirements and catecholamine dose were monitored.Results: After 24 h of study treatment goup A showed a significant increase in cardiac index (2.2±0.4 l min−1 · m−2 to 2.7±0.5 l min−1 · m−2; P<0.005), a decrease in systemic vascular resistance (1427±609 dyn · s · cm−5 to 951±184 dyn · s · cm−5; P<0.005), required lower doses of dobutamine (5.9±4.2 μg · kg−1 · min−1 to 2.2±3.3 μg · kg−1 · min−1; P<0.02), but showed a tendency for higher vasoconstrictor (0.14±0.16 μg · kg−1 · min−1 to 0.29±0.43 μg · kg−1 · min−1; P=n.s.) and fluid requirements (+1404±2257 ml/24 h to +2508±1873 ml/24 h; P=n.s.). No significant changes occurred in group B. Weaning from catecholamine therapy was more often achieved in group A and more milrinone treated patients were discharged alive from the ICU (80% vs. 30%; P<0.05).Conclusions: Milrinone improves central hemodynamics and may facilitate weaning from prolonged catecholamine support in critically ill patients with heart failure. Its administration in this subset of critically ill patients is safe, but eventually is associated with additional vasoconstrictor and fluid requirements.
Differential action of spasmolytic vasodilators on platelet aggregation and endothelial cell‐dependent anti‐aggregation
Authors: Az‐Ma T. , Saeki N. , Yuge O. 
Published: March 2003

Background: The perioperative use of spasmolytic vasodilators during reconstructive or vascular surgery is an important therapeutic procedure to prevent vascular spasm. Platelet aggregation at vascular endothelium injured by the surgical manipulation is thought to be associated with the persistency of spasm, although little is known about the effects of these drugs on platelet aggregation and on anti‐aggregation provoked by endothelial cells.Methods: (1) To test the direct effect of vasodilators against platelet aggregation, change in light transmission through platelet‐rich plasma (PRP) stimulated with 4 μg/ml collagen was measured in the absence or presence of pentobarbital, papaverine, prostaglandin E1 (PGE1), trinitroglycerin, nitroprusside, nicardipine, and diltiazem. (2) Effects of these drugs on endothelial cell‐dependent anti‐aggregation were then evaluated. Incubation buffer of cultured porcine aortic endothelial (PAE) cells, which were preincubated with vasodilators for 10 min prior to a 1‐min stimulation with 1 μM bradykinin, was transferred to collagen‐stimulated PRP.Results: (1) Papaverine and PGE1 directly inhibited platelet aggregation in a concentration‐dependent manner. All other drugs failed to inhibit aggregation. (2) Incubation buffer of PAE cells stimulated with bradykinin showed a potent anti‐aggregation. Pentobarbital concentration‐dependently inhibited the endothelial cell‐dependent anti‐aggregation. Every other drug did not inhibit the anti‐aggregation by PAE cells.Conclusion: Because of the direct anti‐aggregatory effect without inhibiting endothelial cell‐dependent anti‐aggregation, we suggested that papaverine and PGE1 were the most promising vasodilators of all drugs examined in this study while further evaluation is required for the clinical relevance of the present study.
A randomised study of lidocaine and prilocaine for spinal anaesthesia
Authors: Østgaard G. , Hallaråker O. , Ulveseth O. K. , Flaatten H. 
Published: March 2003

Background: Transient neurologic symptoms (TNS) are common after lidocaine‐induced spinal anaesthesia (SA). Recent data indicate that TNS may be less frequent after prilocaine‐induced spinal anaesthesia, for which reason the isobaric solution was compared with lidocaine.Methods: One hundred patients scheduled for short urologic procedures under spinal anaesthesia were randomised to receive 80 mg prilocaine or lidocaine, both 20 mg/ml. The clinical course and the duration of anaesthesia were monitored. The following day an anaesthesiologist unaware of the randomisation interviewed the patients using a structured questionnaire.Results: Following prilocaine spinal anaesthesia the mean time until 2‐segment regression was 123(SD 42) min and total sensory block lasted 221(49) min, compared to 106(26) and 181(48) min following lidocaine. TNS occurred in 7/49 patients in the lidocaine group and in 2/50 in the prilocaine group (ns).Conclusion: TNS occurred also after isobaric prilocaine SA. The frequency was not significantly different from that following lidocaine SA but larger studies are needed to establish the relative risk of TNS following SA induced by the two local anaesthetics. Isobaric prilocaine has a longer duration of action than an equal dose of lidocaine and may be an alternative drug for spinal anaesthesia of intermediate or short duration.
A comparison of the hemodynamic effects of paracervical block and epidural anesthesia for labor analgesia
Authors: Manninen T. , Aantaa R. , Salonen M. , Pirhonen J. , Palo P. 
Published: March 2003

Background: Both paracervical block (PCB) and epidural analgesia are sometimes associated with hemodynamic effects potentially harmful to the well‐being of the fetus. Our study was designed to test the hypothesis that PCB would have a more profound effect on maternal and fetal blood flow than epidural analgesia.Methods: Forty‐four healthy primiparous parturients were randomized to receive either PCB (n=21) or epidural analgesia (n=23) with 25 or 30 mg of bupivacaine, respectively, for labor analgesia. Maternal blood pressure and fetal heart rate were recorded. Blood flow was measured using a color Doppler device. The blood flow measurements consisted of assessment of the pulsatility indices (PI) of the right maternal femoral artery and the main branch of the uterine artery (placental side), the umbilical artery and the fetal middle cerebral artery. The measurements were performed before administration of analgesia and approximately 15–20 min later after the onset of analgesia.Results: Both methods provided in general good analgesia, but rescue medication was required more often after PCB. Epidural analgesia decreased maternal blood pressure more than PCB and the PI of maternal femoral artery decreased after onset of epidural analgesia, indicating epidural‐induced vasodilation. The PI of the uterine artery increased after the onset of PCB, indicating vasoconstriction of this artery. No significant adverse effects or differences in the well‐being of the newborn were observed, as indicated by similar Apgar scores and pH‐status.Conclusion: There were small differences in the effects of PCB and epidural analgesia on uteroplacental circulation as well as on maternal hemodynamics. PCB may have a vasoconstrictive effect on the uterine artery. This and the fact that the parturients required rescue analgesia more frequently after PCB than after epidural block speaks for the feasibility of the latter in obstetrics.
A catheter technique in ophthalmic regional anaesthesia
Authors: Gombos K. , László C. J. , Hatvani I. , Vimláti L. , Salacz G. 
Published: March 2003

Background: Usually general anaesthesia is chosen if ophthalmic surgery of longer duration is expected. Our goal was to introduce a flexible catheter preoperatively into the extra‐ or intraconal space and to provide sufficient anaesthesia by continuous administration of a local anaesthetic via the catheter.Methods: The continuous anaesthetic technique was applied in 28 patients undergoing vitreoretinal surgery. An indwelling catheter was introduced in 20 patients into the intraconal and in 8 patients into the extraconal space. In 6 patients, the position of the catheter was controlled by ultrasound examination prior to the injection of the local anaesthetic agent.Results: For all patients adequate anaesthesia could be achieved and maintained with continuous retrobulbar administration (CRA) of a local anaesthetic by catheter. There were two patients who experienced moderate pain intraoperatively during continuous peribulbar administration (CPA). No complications occurred with the placement of the catheters. The catheter did not disturb the surgeon or the process of the ophthalmic surgery.Conclusions: Continuous administration of a local anaesthetic agent via an indwelling catheter into the intraconal space allowed ophthalmic anaesthesia without time restriction. Thus, CRA is a good alternative to general anaesthesia for patients undergoing long‐lasting ophthalmic surgery.