bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neostigmine 50 μg kg−1 with glycopyrrolate increases postoperative nausea in women after laparoscopic gynaecological surgery
Authors: Løvstad R. Z. , Thagaard K. S. , Berner N. S. , Raeder J. C. 
Published: March 2003

Background: Neostigmine, used for reversal of neuromuscular block, has been implicated in the development of postoperative nausea and vomiting (PONV). The use of mivacurium, which does not require neostigmine reversal due to its metabolism by plasma cholinesterase, has made it possible to study the effect of neostigmine on PONV in a randomised, double‐blind, placebo‐controlled manner.Methods: Ninety healthy women scheduled for laparoscopic gynaecological surgery were randomly allocated to two groups in a double‐blind manner. One group was given neostigmine (50 μg kg−1) and glycopyrrolate (10 μg kg−1) (group NG), the other NaCl i.v. as placebo (group P) at the end of surgery when all the patients were spontaneously reversed to at least 75% of full muscle power. The risk of PONV was reduced by using low doses of opioids and ondansetron prophylaxis. All the patients were monitored and assessed for 24 h with regard to pain, nausea, vomiting and overall satisfaction.Results: There was a statistically significant difference (P=0.03) in the occurrence of nausea during the first 6 h postoperatively between NG group (30%) and P group (11%), resulting in the more extensive use of antiemetic drugs in the NG group (28%) than in P group (7%) (P=0.01) in this period. There was no difference between the groups in the frequency of vomiting; seven nauseated patients had vomiting, four in group NG, three in group P. Total number of patients with PONV during the observation period of 24 h, usage of antiemetic rescue medication and overall patient satisfaction did not differ significantly between the groups.Conclusion: The results suggest that antagonism of neuromuscular block with a high dose of neostigmine increases postoperative nausea and the use of antiemetic drugs during the first 6 h after administration.
Haemodynamic changes and vasopressin release are not consistently associated with carbon dioxide pneumoperitoneum in humans
Authors: Lentschener C. , Axler O. , Fernandez H. , Megarbane B. , Billard V. , Fouqueray B. , Landault C. , Benhamou D. 
Published: March 2003

Background: Conflicting haemodynamic changes, suggested to be caused by vasopressin release, have been reported during carbon dioxide (CO2) pneumoperitoneum. However, peritoneal stimulations including open surgery cause both a systemic vasopressor response and a vasopressin release, which are suppressed by opiate administration. Also, a decreased venous return of blood to the heart causes vasopressin release. Furthermore, previous haemodynamic assessments of laparoscopic surgery have been conducted using various anaesthetic regimens, which are likely to have caused various haemodynamic effects. We hypothesised that intraoperative haemodynamic and/or humoral changes would not be observed in association with laparoscopic surgery provided that, (a) normovolaemia is continuously maintained using transoesophageal echocardiographic (TEE) assessment, and (b) adequate depth of general anaesthesia is continuously maintained by bispectral index (BIS) monitoring and high plasma Ievel opiate administration.Methods: Twenty ASA 1 women undergoing laparoscopic surgery received 10 ml  ·  kg−1 lactated Ringer’s solution and thereafter were randomly allocated to receive intraoperatively either 8 ng  ·  ml−1 or 4 ng  ·  ml−1 plasma remifentanil concentrations while BIS was maintained at 50±5 by isoflurane alteration. The group receiving 4 ng  ·  ml−1 remifentanil was used as control. Expired CO2 was maintained within a 32–38 kPa range throughout the investigation. Complete TEE haemodynamic investigation was performed before pneumoperitoneum (PP) (T1), and during PP horizontal (T2), with a head‐up tilt (T3), with a head‐down tilt (T4), horizontal (T5), and PP released (T6). Plasma vasopressin, epinephrine and norepinephrine levels were measured at T1, T3, and T6. ANOVA, Student’s t‐test and Mann‐Whitney U‐test were used for statistical analysis.Results: Haemodynamic indices and humoral values did not change significantly within and between remifentanil groups throughout the investigation (all P<0.05).Conclusion: Continuous adequate depth of anaesthesia and normovolaemia may have prevented both a humoral and a haemodynamic response, initiated in the peritoneum by the contact with CO2 in previous investigations.
Risk factors associated with new onset tachyarrhythmias after cardiac surgery – a retrospective analysis
Authors: Mayr A. , Knotzer H. , Pajk W. , Luckner G. , Ritsch N. , Dünser M. , Ulmer H. , Schobersberger W. , Hasibeder W. 
Published: March 2003

Background: Tachyarrhythmias (TA) represent a frequent and serious problem after cardiac surgery. We retrospectively analyzed 987 cardiac surgery patients admitted to a surgical intensive care unit between 1996 and 1999 to assess incidence and risk factors associated with development of postoperative TA in the intensive care unit.Methods: TA (n=149) were defined as non‐sinus rhythm with a heart rate (HR) ≥100 bpm in patients with preoperative sinus rhythm or as heart rate ≥130 bpm in patients with preoperative atrial fibrillation. A total of 787 patients served as controls (C). Demographic, premorbidity and perioperative data, admission SAPS and MODS‐score, presence of clinical syndromes systemic inflammatory response syndrome (SIRS) and sepsis were univariately compared between groups. For prediction of independent risk factors for TA‐development two multiple logistic regression models were finally established.Results: Concerning TA, atrial fibrillation and flutter (76%) were observed most frequently, followed by paroxysmal supraventricular tachycardia (15%) and ventricular tachycardia/fibrillation (11%). Age, a history or presence of congestive heart failure, development of SIRS and sepsis, severity of multiple organ dysfunction syndrome and in particular severity of cardiovascular failure proved to be independent risk factors for development of TA.Conclusion: In cardiac surgery patients, age, a history or presence of congestive heart failure, postoperative development of a systemic inflammatory response syndrome or sepsis and the severity of multiple organ function syndrome were independent predictors for development of TA in the intensive care unit. The association of severity of cardiovascular dysfunction with TA strongly suggests a causal relationship between catecholamine therapy and TA‐development.
Evaluation of two methods to calculate p50 from a single blood sample
Authors: Ekeloef N. P. , Eriksen J. , Kancir C. B. 
Published: March 2003

Background: The hemoglobin‐oxygen affinity is conveniently described as the oxygen tension at which the hemoglobin is 50% saturated (p50). We compared two methods of single‐point analysis for p50 calculation, using clinical data.Methods: From patients submitted to anesthesia for major surgery, 114 arterial or venous blood samples were analyzed by using the Sigaard‐Andersen oxygen status algorithm (p50OSA) and Doyle’s method (p50Doyle) based on Hill’s equation.Results: The oxygen saturation and tension varied respectively between 0.64–0.96 and 3.8 kPa–11.0 kPa. A Bland‐Altman analysis showed a mean difference of 0.04 kPa (SD 0.12 kPa). The limits of agreement were −0.20 kPa and +0.28 kPa.Conclusions: The Siggaard‐Andersen oxygen status algorithm is presently the most clinically useful single‐point method of p50 calculation.
Inhibitory effects of S‐(−) and R‐(+) bupivacaine on neutrophil function
Authors: Welters I. D. , Menzebach A. , Langefeld T. W. , Menzebach M. , Hempelmann G. 
Published: March 2003

Background: Local anesthetics inhibit migration, enzyme release and superoxide anion generation of polymorphonuclear leukocytes (PMN). Due to their ability to phagocytose and kill bacteria PMN represent a major defense mechanism in the circulating blood. In this study we determined the influence of racemic bupivacaine and its enantiomers on neutrophil phagocytic activity, oxidative burst as well as surface expression of complement and Fcγ receptors.Methods: Venous blood was pre‐incubated with different concentrations of either racemic bupivacaine, R‐(+) or S‐(−) bupivacaine. Fluoresceine isothiocyanate (FITC)‐labeled antibodies against Fcγ receptor III (CD16), complement receptor 1 (CD35) and complement receptor 3 (CD11b) were used to determine surface receptor expression. Phagocytic activity was measured by ingestion of FITC‐labeled vital Staphylococcus aureus. Oxidative burst was determined by conversion of nonfluorescent dihydrorhodamine 123 into fluorescent rhodamine 123. Fluorescent intensity of each sample was determined by flow cytometry.Results: Racemic bupivacaine inhibited surface receptor expression, phagocytosis, and oxidative burst in a time‐ and concentration‐dependent manner. Although the S‐(−) enantiomer exerted significantly less inhibitory action on neutrophil function compared to R‐(+) and racemic bupivacaine, these effects were small compared to the overall changes.Conclusion: These findings suggest that bupivacaine impairs surface receptor expression and may thereby contribute to reduced phagocytic activity and oxidative burst. Enantiomer‐specific effects of bupivacaine may play a minor role in the inhibition of these leukocyte functions.
A bilateral clinical model for the study of acute and chronic pain after breast‐reduction surgery
Authors: Bell R. F. , Sivertsen Å. , Mowinkel P. , Vindenes H. 
Published: March 2003

Background: There is a need for new clinical models to investigate effectively the development of pain after surgery and the effect, if any, of pre‐emptive treatment. Bilateral models are of special interest, since the patient serves as his/her own control. The objective of this preliminary study was to test a clinical model for the study of acute and chronic pain after bilateral reduction mammoplasty.Methods: Eight patients participated in the study where the breasts were randomized to test and control groups. In each patient, one breast was preoperatively infiltrated with lidocaine and adrenaline and the other breast infiltrated with saline and adrenaline. Assessment included visual analogue scale (VAS) pain intensity, thermal thresholds, mapping for punctate hyperalgesia and tactile sensation. Assessments were made preoperatively, postoperatively and at 6 months after surgery.Results: With regard to acute postoperative pain intensity, the model demonstrated a clear difference between lidocaine and placebo treated breasts. There was no difference between lidocaine and placebo treated breasts with regard to chronic pain, but these results are inconclusive due to small number of patients.Conclusion: The model is sensitive and may be useful in studies of mechanisms of development and prevention of chronic pain after surgery.
Inclusion of lignocaine base into a polar lipid formulation –in vitro release, duration of peripheral nerve block and arterial blood concentrations in the rat
Authors: Dyhre H. , Wallin R. , Björkman S. , Engström S. , Renck H. 
Published: March 2003

Background: Slow‐release formulations of local anaesthetics may produce nerve blocks of long duration. The present study aimed at investigating the in vitro and in vivo properties of a polar lipid formulation for slow release of lignocaine and the effects on nerve block duration by inclusion of dexamethasone into the system.Methods: In vitro release of lignocaine from the lipid formulation was studied in a US Pharmacopoeia rotating apparatus. Sciatic nerve blocks were induced in rats by 0.1 ml of test formulations containing lignocaine HCl 20 mg  ·  ml−1 in aqueous solution, lignocaine base 20, 100 or 200 mg  ·  ml−1 in lipid formulation or the last formulation with dexamethasone 0.05, 0.5 or 5 mg  ·  ml−1. The durations of sensory and motor block and the arterial blood concentrations of lignocaine were investigated.Results: In vitro there was a sustained release of lignocaine from the lipid formulation, with 50% release at around 48 h. In vivo lignocaine base 20 mg  ·  ml−1 in lipid formulation produced sciatic nerve blocks of significantly shorter duration than lignocaine HCl 20 mg  ·  ml−1 in aqueous solution, while lignocaine base 100 and 200 mg  ·  ml−1 in lipid formulation produced blocks lasting two and three times longer, respectively, than the lignocaine HCl solution. Addition of dexamethasone did not affect the duration of nerve block. Following administration of lignocaine base 200 mg  ·  ml−1 in lipid formulation, as compared to lignocaine HCl 20 mg  ·  ml−1 in aqueous solution, the maximal blood concentration of lignocaine was only three times higher in spite of the ten‐fold difference in dose, and the mean terminal half‐life was three times longer, reflecting the slow release from the formulation.Conclusions: Our findings indicate that lignocaine base in polar lipids acts as a slow‐release preparation of local anaesthetic both in vitro and in vivo.
Fentanyl does not improve the nerve block characteristics of axillary brachial plexus anaesthesia performed with ropivacaine
Authors: Fanelli G. , Casati A. , Magistris L. , Berti M. , Albertin A. , Scarioni M. , Torri G. 
Published: March 2003

Background: The aim of this prospective, randomized, double‐blind study was to evaluate the effects of adding 1 μg · kg−1 fentanyl to ropivacaine 7.5 mg · ml−1 for axillary brachial plexus anaesthesia.Methods: With Ethics Committee approval and written consent, 30 ASA physical status I–II in‐patients, scheduled for orthopaedic hand procedures were randomly allocated to receive axillary brachial plexus block with 20 ml of either ropivacaine 7.5 mg · ml−1 (n=15) or ropivacaine 7.5 mg · ml−1+1 μg · ml−1 fentanyl (n=15). Nerve blocks were placed using a nerve stimulator with the multiple injection technique. A blinded observer recorded the time to onset of surgical block (loss of pinprick sensation in the innervation areas of the hand (C6–C8) with concomitant inability to flex the wrist against gravity and move the fingers when squeezing the hand) and first request for pain medication after surgery.Results: No differences in demography, degree of sedation or peripheral oxygen saturation were observed between the two groups. Median (range) time required to achieve readiness for surgery was 15 min (5–36 min) with ropivacaine alone and 15 min (5–40 min) with the ropivacaine‐fentanyl mixture. No differences in the intraoperative quality of nerve block were reported between the two groups. Four patients receiving ropivacaine plain and two patients receiving the ropivacaine‐fentanyl mixture did not require analgesics during the first 24 h after surgery (P=0.62). The degree of pain experienced at first analgesic request in those patients asking for pain medication, as well as median consumption of postoperative analgesics, were similar in the two groups. First postoperative analgesic request was made at 11 h (25th–75th percentiles: 9.1–14 h) in patients receiving ropivacaine alone and at 11.8 h (25th–75th percentiles: 9.8–15 h) in patients receiving the ropivacaine‐fentanyl mixture (P=0.99).Conclusion: The addition of fentanyl 1 μg · ml−1 to ropivacaine 7.5 mg · ml−1 does not improve the nerve block characteristics of axillary brachial plexus anaesthesia for orthopaedic procedures involving the hand.
Onset and duration of action of rocuronium – from tracheal intubation, through intense block to complete recovery
Authors: Schultz P. , Ibsen M. , Østergaard D. , Skovgaard L. T. 
Published: March 2003

Background: The primary objective of this study was to establish the relation between the post tetanic count (PTC) and the time to reappearance of the first response (T1) in train‐of‐four (TOF) nerve stimulation following rocuronium 0.6 mg/kg, 0.9 mg/kg, and 1.2 mg/kg. The secondary objective was to evaluate the intubation conditions after 1 min.Methods: One hundred and eight patients were randomised to one of three doses of rocuronium: 0.6, 0.9 or 1.2 mg/kg. Tracheal intubation was performed at 60 s by a blinded investigator. During propofol, fentanyl, midazolam anaesthesia the neuromuscular block was monitored by mechanography using TOF stimulation every 12 s. At 6 min intervals, a tetanic stimulation (50 Hz) was applied for 5 s preceded and followed by a 30 s period of 1 Hz stimulation until the reappearance of T1.Results: There was a significant difference in recovery following the high dose and the two lower doses. The relation between time (min) to reappearance of T1 (t) and PTC can be expressed as follows: and . T1 was seen at a mean PTC level of 8 or 9 in all three groups. The intubation conditions were graded as excellent or good in all patients except in two patients following the 0.6 mg/kg dose of rocuronium.Conclusion: The PTC method can be used to predict the time to first response to TOF nerve stimulation during intense rocuronium induced neuromuscular blockade. The relation between PTC and the time to T1 was prolonged after 1.2 mg/kg compared with 0.6 mg/kg and 0.9 mg/kg. No further improvement in intubation conditions at 60 s was evident by increasing the rocuronium dose from 0.9 mg/kg to 1.2 mg/kg.
Does discontinuation of desflurane at the time of neostigmine administration speed recovery from cisatracurium block compared to that with a propofol‐based technique?
Authors: Kirkegaard‐Nielsen H. , Caldwell J. E. , Abengochea A. , Berry P. D. , Heier T. 
Published: March 2003

Background: Volatile anaesthetics are known to influence the effect of neostigmine as an antagonist of neuromuscular block. The aim of the present study was to investigate whether discontinuation of desflurane at the time of neostigmine administration shortens reversal time from cisatracurium block, compared to that with a propofol‐based anaesthesia.Methods: Ten volunteers were studied twice. For one study, anaesthesia was induced with alfentanil and propofol and maintained with nitrous oxide 70% and propofol 150 μg · kg−1 · min−1. For the other study, experimental conditions were replicated except that desflurane 6% was administered and the dose of propofol was only 50 μg · kg−1 · min−1. The evoked mechanical response of the adductor pollicis to train‐of‐four (TOF) stimulation was recorded. Neuromuscular block was induced with cisatracurium 0.2 mg · kg−1. When the magnitude of the first TOF response (T1) had recovered to 10%, the block was antagonized with neostigmine 70 μg · kg−1. At this time, propofol was decreased to 50 μg · kg−1 · min−1, or the desflurane was discontinued.Results: There were no significant differences between the two techniques of anaesthesia in the rate of neostigmine‐induced recovery of the TOF ratio. The times (mean±SD) to achieve TOF ratios of 0.7, 0.8, and 0.9 were (propofol first, desflurane second) 6.1±2.2 and 6.5±1.6 min; 10.4±4.2 and 9.6±2.7 min; 17.1±6.9 and 21.0±13.0 min, respectively.Conclusion: Discontinuing desflurane does not speed neostigmine‐induced recovery from cisatracurium neuromuscular block, when compared to that during propofol‐based anaesthesia.
Similar haemodynamic, respiratory and metabolic changes with the use of sevoflurane or halothane in children breathing spontaneously via a laryngeal mask airway
Authors: Erb T. , Christen P. , Kern C. , Frei F. J. 
Published: March 2003

Background: In preschool children, short‐lasting surgical procedures are often performed under combined inhalational and regional anaesthesia with the child breathing spontaneously via a laryngeal mask airway (LMA). Despite widespread use, only limited data are available on haemodynamic, respiratory and metabolic effects of sevoflurane and halothane during LMA anaesthesia.Methods: In an open‐label, randomised, controlled study, 49 children (aged 3–8 years) were allocated to receive either sevoflurane or halothane in 60% nitrous oxide. After insertion of the LMA, end‐tidal concentrations of sevoflurane or halothane were maintained at 1 MAC with the child ventilating spontaneously throughout the entire procedure. Analgesia was provided by caudal block. Haemodynamic and respiratory parameters were recorded, and capillary blood‐gas samples were obtained repeatedly.Results: Changes in heart rate (HR) and systolic blood pressure were similar in both groups during all observed periods, apart from a significantly higher increase in HR during inhalational induction with sevoflurane (P<0.05). Regression slope analysis during anaesthesia revealed a decrease of the respiratory rate of 5 breaths h−1 (P<0.001) and an increase of end‐tidal PCO2 and capillary PCO2 of about 0.25 kPa h−1 (P<0.001), with no significant difference between the two groups. Base excess, calculated in capillary blood gas samples, did not change over time (P>0.5) in either group.Conclusions: The use of approximately 1 MAC sevoflurane or halothane in 60% N2O in children breathing spontaneously via LMA resulted in comparable haemodynamic, respiratory and metabolic changes, and clinically relevant deteriorations did not occur during the 65‐min study period.
Lack of agreement between thermodilution and carbon dioxide‐rebreathing cardiac output
Authors: Nilsson L. B. , Eldrup N. , Berthelsen P. G. 
Published: March 2003

Background: A continuous, accurate, non‐invasive monitor of cardiac output would represent a major step forward in patient management. A cardiac output computer, NICO2, based on the Fick principle and an automatic partial carbon dioxide (CO2)‐rebreathing technique has just become available. We compared the performance of this monitor with the standard thermodilution method.Methods: Thirty patients were investigated after cardiac surgery. Replicate measurements were performed simultaneously with the thermodilution and NICO2 techniques. An Altman‐Bland analysis was used to assess repeatability of each of the two methods and to determine the agreement between the two techniques.Results: The repeatabilities of thermodilution and CO2‐rebreathing cardiac output were excellent, with coefficients of repeatability of 0.35 l/min and 0.60 l/min. Mean thermodilution and NICO2 cardiac output were 4.4 l/min (SD 0.9, range 2.7–6.1) and 4.6 l/min (SD 1.3, range 1.6–6.9). A comparison of the methods, however, revealed excessive limits of agreement (±1.80 l/min).Conclusion: The agreement between the NICO2 derived cardiac output and the de facto standard – thermodilution cardiac output – is poor. The methods are not interchangeable with the present version of the NICO2. The repeatability of the partial CO2‐rebreathing technique holds promise that a sufficient accuracy may be obtained by suitable modifications of the monitor’s algorithms.
High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions
Authors: Kimme P. , Jannsen B. , Ledin T. , Gupta A. , Vegfors M. 
Published: March 2003

Background: There are several studies indicating a correlation between treatment with hydroxyethyl starch (HES) and pruritus. In order to see whether there is a possible dose–response relationship between HES and pruritus, we retrospectively studied 50 patients who had received HES in varying doses (cumulative dose 500–19500 ml) as hemodilution therapy after subarachnoid hemorrhage.Methods: Of 50 consecutive patients, 6 were excluded due to severe neurological sequelae. A questionnaire was sent to the remaining 44 patients at 6 months (5–12 months) median (range) after the end of HES treatment.Results: We received answers from 37 patients, of whom 54% reported pruritus. On average pruritus lasted for 15 weeks. There was significantly more pruritus in patients who received more than 5000 ml of HES versus those who received less than 5000 ml (P=0.023). Pruritus had a delayed onset and appeared as pruritic crises lasting for 2–30 min. It had a patchy distribution in most patients and no predilected locations. In 4 patients (20%) the pruritus lasted longer than 21 weeks.Conclusion: Our study indicates that there is a dose‐dependency for the incidence of HES‐induced pruritus, and that in some cases the pruritus may be severe and long‐lasting.