MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Acta Anaesthesiologica Scandinavica' source. Sat, 20 Mar 2010 13:42:26 +0100 http://www.medworm.com/index.php?rid=3366876&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02232.x There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture ([ge]65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patie... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3366876 Tue, 16 Mar 2010 00:00:00 +0100 3366876 http://www.medworm.com/index.php?rid=3366877&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02231.x Subarachnoid (SA) morphine, highly effective for the management of pain after a cesarean delivery, is associated with a significant incidence of pruritus in up to 80% of patients. No previous study has compared the effectiveness of ondansetron (5-HT3 antagonist) vs. diphenhydramine (H1 receptor blocker) for the treatment of this side effect. In this randomized, double-blind study, 113 patients with a pruritus score 3 or 4 (1=absent; 2=mild, no treatment required; 3=moderate pruritus, treatment required; and 4=severe pruritus) after SA morphine 0.2 mg were assigned to group ondansetron, which received 4 mg intravenously (i.v.) ondansetron, and group diphenhydramine, which received 25 mg i.v. diphenhydramine. Patients who continued to have pruritus [ge]3 30 min after the study drug were cons... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3366877 Mon, 15 Mar 2010 00:00:00 +0100 3366877 http://www.medworm.com/index.php?rid=3351418&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02230.x Critically ill patients often spend time in the intensive care unit (ICU) either unconscious or sedated. On recovery, they are often in a state of confusion with memory loss that may be associated with a longstanding reduction in health-related quality of life (QoL). We hypothesised that the ICU-diary concept could improve their QoL by filling in their memory gaps. A non-randomised, prospective study in a non-academic eight-bedded general ICU. A group of patients (n=38) were selected to receive the ICU-diary concept (keeping a diary with photos while on the ICU plus a follow-up meeting) when a long and complicated course was expected. Health-related QoL at 6, 12, 24 and 36 months was compared with a group that did not receive the ICU-diary (n=224). The Medical Outcomes Study 36-Item Short-... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351418 Thu, 11 Mar 2010 00:00:00 +0100 3351418 http://www.medworm.com/index.php?rid=3351425&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02219.x In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health-related quality of life (HRQOL). We included 26 patients 13[ndash]28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini-Mental State Examination (MMSE). Twenty-five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive t... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351425 Wed, 10 Mar 2010 00:00:00 +0100 3351425 http://www.medworm.com/index.php?rid=3351424&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02222.x To compare isoflurane anesthesia in patients with or without hyperbilirubinemia undergoing hepatobiliary surgery. Forty-two patients with obstructive jaundice and 40 control patients with normal liver function scheduled for hepatobiliary surgery under isoflurane anesthesia were studied. Anesthesia was induced with propofol (1.5[ndash]2 mg/kg) and remifentanil (2 [mu]g/kg). After tracheal intubation, anesthesia was titrated using isoflurane in oxygen-enriched air, adjusted to maintain a bispectral index (BIS) value of 46[ndash]54. Ephedrine, atropine and remifentanil were used to maintain hemodynamic parameters within 30% of the baseline. The mean arterial blood pressure (MAP), heart rate (HR), drug doses and the time taken to recover from anesthesia were recorded. Demographic data, duratio... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351424 Wed, 10 Mar 2010 00:00:00 +0100 3351424 http://www.medworm.com/index.php?rid=3351423&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02224.x This study was designed to define how many spinal segments would be covered by the weight-based dosage of caudally administered 0.2% ropivacaine in children using the fluoroscopic method. After an approval from the institutional human research review board, in 83 ASA I boys undergoing day-case urological surgery, the distribution of ropivacaine mixed with a radioactive dye in relation to the volume injected caudally was studied. Three groups were studied: for perineal surgery 0.5 ml/kg (group C0.5), for inguinal hernia repair 1 ml/kg (group C1.0), and for orchiopexy 1.25 ml/kg (group C1.25). The dose of 0.2% ropivacaine containing radiopaque dye at a ratio of 1 : 4 was injected at a rate of 1 ml 3 s[minus]1. Fluoroscopic examination was performed immediately to define the level of the drug... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351423 Wed, 10 Mar 2010 00:00:00 +0100 3351423 http://www.medworm.com/index.php?rid=3351421&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02225.x The pleth variability index (PVI) is a new algorithm used for automatic estimation of respiratory variations in pulse oximeter waveform amplitude, which might predict fluid responsiveness. Because anesthesia-induced hypotension may be partly related to patient volume status, we speculated that pre-anesthesia PVI would be able to identify high-risk patients for significant blood pressure decrease during anesthesia induction. We measured the PVI, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in 76 adult healthy patients under light sedation with fentanyl to obtain pre-anesthesia control values. Anesthesia was induced with bolus administrations of 1.8 mg/kg propofol and 0.6 mg/kg rocuronium. During the 3-min period from the st... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351421 Wed, 10 Mar 2010 00:00:00 +0100 3351421 http://www.medworm.com/index.php?rid=3351420&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02226.x Ilioinguinal nerve (IIN) and iliohypogastric nerve (IHN) blocks provide good perioperative pain relief for children undergoing inguinal procedures such as inguinal hernia repair, orchiopexy, and hydrocelectomy. The aim of this ultrasound imaging study is to compare the relative anatomical positions of IIN and IHN in different age groups of pediatrics. Two-hundred children (aged 1[ndash]82 months, ASA I or II) undergoing day-case surgery were consecutively included in this study. Following the induction of general anesthesia, an ultrasonographic exam was performed using a high-frequency linear probe that was placed on an imaginary line connecting the anterior superior iliac spine (ASIS) to the umbilicus. There were significant differences in ASIS[ndash]IIN (distance from ASIS to IIN), ASIS[... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351420 Wed, 10 Mar 2010 00:00:00 +0100 3351420 http://www.medworm.com/index.php?rid=3351419&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02228.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3351419 Wed, 10 Mar 2010 00:00:00 +0100 3351419 http://www.medworm.com/index.php?rid=3295385&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02221.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3295385 Tue, 23 Feb 2010 00:00:00 +0100 3295385 http://www.medworm.com/index.php?rid=3295386&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02220.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3295386 Mon, 22 Feb 2010 00:00:00 +0100 3295386 http://www.medworm.com/index.php?rid=3280891&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02215.x The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the 'oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain,... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3280891 Thu, 18 Feb 2010 00:00:00 +0100 3280891 http://www.medworm.com/index.php?rid=3280892&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02213.x This study investigates the relationships among burnout, physical health and job satisfaction among Dutch NAs. Two thousand NAs working in Dutch hospitals were invited to participate in this online questionnaire. We tested the relationships among burnout, psychosomatic symptoms, sickness absence, perceived general health and job satisfaction. Nine hundred and twenty-three questionnaires were completed and analysed (46% response rate). Burnout and psychosomatic symptoms were negatively associated with job satisfaction, and predicted 27% of job satisfaction. Perceived general health was positively and sickness absence was negatively related to job satisfaction. Older NAs had a higher incidence of burnout than their younger counterparts. The results confirmed the importance of a healthy psych... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3280892 Wed, 17 Feb 2010 00:00:00 +0100 3280892 http://www.medworm.com/index.php?rid=3260195&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02214.x We describe a 41-year-old previously healthy man who was admitted to hospital on several occasions with rapidly developing hypovolemic shock accompanied by extreme hemoconcentration and hypoalbuminemia. Our case is similar to other reports describing patients with SCLS where the initial suspicions have been pointing towards septic shock. He received a combination of prophylactic treatment with theophylline, [beta]-agonists, immunoglobulins and statins but eventually died after a severe episode of SCLS that ended with recurrent cardiac arrest. Clinical autopsy revealed pulmonary edema and acute and chronical organic fluid overload. SCLS should be kept in mind when treating patients suffering from attacks of severe idiopathic edema and mimics recurrent septic shock where no pathogen is found... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3260195 Thu, 11 Feb 2010 00:00:00 +0100 3260195 http://www.medworm.com/index.php?rid=3255716&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02212.x This study was performed to evaluate the effect of entropy monitoring on end-tidal sevoflurane concentration and recovery characteristics in pediatric patients undergoing sevoflurane anesthesia. Seventy-eight children (aged 3[ndash]12 years) scheduled for a tonsillectomy and/or an adenoidectomy were randomly divided into one of two groups: standard practice (Standard) or entropy-guided (Entropy). In the Standard group, sevoflurane was adjusted to maintain the heart rate and systolic blood pressure (BP) within 20% of the baseline values. In the Entropy group, sevoflurane was adjusted to achieve a state entropy of 40[ndash]50. We compared the entropy values, end-tidal sevoflurane concentration and recovery times between groups. During maintenance of anesthesia, the entropy and BP values were... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3255716 Wed, 10 Feb 2010 00:00:00 +0100 3255716 http://www.medworm.com/index.php?rid=3255715&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02218.x Major cancer surgery is a high-risk situation for sepsis in the post-operative period. The aim of this study was to assess the relation between the monocyte production of IL-12 and the development of post-operative sepsis in patients undergoing major cancer surgery. In 19 patients undergoing major cancer surgery, the production of cytokines by basal and lipolysaccharide (LPS)-stimulated monocytes was measured before and after (from day 1 to day 3 and day 7) surgery. Seven of them developed a post-operative sepsis. Ten healthy volunteers were used as controls for the assessment of pre-operative values. Before surgery, the production of interleukin (IL)-12 p40 by LPS-stimulated monocytes was similar in the patients and the healthy volunteers. The production of IL-12 p40 by unstimulated monoc... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3255715 Wed, 10 Feb 2010 00:00:00 +0100 3255715 http://www.medworm.com/index.php?rid=3190329&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02186.x Direct puncture by a needle is a risk factor for nerve damage. This investigation used scanning electron microscopy (SEM) to attempt to visualize the damage caused by different needles. A 15 cm section of the tibial nerve was removed from the ankle of a patient undergoing below-the-knee amputation. The nerve specimen was punctured perpendicular to the fibers once by each of four needles: an insulated 22 G short-beveled (30°), a 25 G long-beveled Quincke spinal needle, an 18 G Tuohy, and a 25 G Whitacre pencil point. The distal and proximal ends on either side of the needles were marked and the nerve was sectioned into 0.5 cm pieces. Each sample was preserved and then prepared for SEM. The needle tract was observed for evidence of mechanical damage at magnifications between × 47 and × 10... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3190329 Thu, 21 Jan 2010 00:00:00 +0100 3190329 http://www.medworm.com/index.php?rid=3190328&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02201.x Caffeine is a natural alkaloid methylxanthine that is found in various plants such as coffee or tea. Symptoms of a severe overdose may present with hypokalemia, hyponatremia, ventricular arrhythmias, hypertension followed by hypotension, respiratory failure, seizures, rhabdomyolysis, ventricular fibrillation and finally circulatory collapse. A 21-year-old woman called for the ambulance herself soon after the ingestion of about 10,000 mg of caffeine. At the arrival of the ambulance, the patient went into cardiac arrest almost immediately. After a total resuscitation period of 34 min including seven counter-shocks and 2 mg epinephrine, the patient was stable enough to be transferred to the hospital. The patient soon went into VF again and received two more counter-shocks and 1 mg epinephrine... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3190328 Thu, 21 Jan 2010 00:00:00 +0100 3190328 http://www.medworm.com/index.php?rid=3182808&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2010.02208.x The precise mechanism by which sevoflurane exerts its effects in the human brain remains unknown. In the present study, we quantified the effects of sevoflurane on regional cerebral glucose metabolism (rGMR) in the human brain measured with positron emission tomography. Eight volunteers underwent two dynamic 18F-fluorodeoxyglucose positron emission tomography (PET) scans. One scan assessed conscious-baseline metabolism and the other scan assessed metabolism during 1 minimum alveolar concentration (MAC) sevoflurane anaesthesia. Cardiovascular and respiratory parameters were monitored and bispectral index responses were registered. Statistical parametric maps and conventional regions of interest analysis were used to determine rGMR differences. All subjects were unconsciousness at 1.0 MAC se... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182808 Tue, 19 Jan 2010 00:00:00 +0100 3182808 http://www.medworm.com/index.php?rid=3182816&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02195.x Because poor echogenicity of the needle remains a safety issue, we decided to analyze the learning process of the hydrolocalization technique (Hloc) performed to continuously identify needle-tip anatomical position during many ultrasound-guided regional anesthesia procedures. Ten senior anesthesiologists naïve to the Hloc agreed to participate in the study. They were requested to perform 40 out-of-plane (OOP) approach ultrasound-guided axillary blocks (AB) each using the Hloc. The Hloc, which is a needle-tip localization principle, was performed by means of repetitive injections of a small amount of a local anesthetic solution (0.5[ndash]1 ml) under an ultrasound beam. Details of the learning process and skill acquisition of the Hloc were derived from the following parameters: the duratio... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182816 Mon, 18 Jan 2010 00:00:00 +0100 3182816 http://www.medworm.com/index.php?rid=3182815&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02199.x During combined general and regional anaesthesia, it is difficult to use autonomic signs to assess whether wakefulness is suppressed adequately. We compared the effects of a dexmedetomidine[ndash]bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with superficial isoflurane anaesthesia ( (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182815 Mon, 18 Jan 2010 00:00:00 +0100 3182815 http://www.medworm.com/index.php?rid=3182814&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02200.x Our aim was to evaluate analgesia, motor block and pharmacokinetics of ropivacaine 0.2% and 0.75% in a femoral nerve block (FNB) in day case patients for anterior crucial ligament (ACL)-reconstruction compared with bupivacaine 0.25% and placebo. Following ethics committee approval and informed consent, 280 patients were randomly allocated to four groups for single-shot FNB [30 ml ropivacaine 0.2% (group RO2.0), 0.75% (RO7.5), bupivacaine 0.25% (BU2.5) and NaCl 0.9% (NaCl)]. Analgesia (pain scores, primary outcome) and motor block were assessed at 4 h (dismissal) and up to 24 h. Plasma concentration was determined up to 240 min thereafter. Pain scores at 4 h were significantly higher for NaCl 4 (0[ndash]8) (median, range) (vs.) BU2.5 2 (0[ndash]8), RO2.0 3 (0[ndash]9) and RO7.5 2 (0[ndash]8... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182814 Mon, 18 Jan 2010 00:00:00 +0100 3182814 http://www.medworm.com/index.php?rid=3182813&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02202.x Volumetric monitoring with right ventricular end-diastolic volume indexed (RVEDVi) and global end-diastolic volume indexed (GEDVi) is increasingly being suggested as a superior preload indicator compared with the filling pressures central venous pressure (CVP) or the pulmonary capillary wedge pressure (PCWP). However, static monitoring of these volumetric parameters has not consistently been shown to be able to predict changes in cardiac index (CI). The aim of this study was to evaluate whether a correction of RVEDVi and GEDVi with a measure of the individual contractile reserve, assessed by right ventricular ejection fraction (RVEF) and global ejection fraction, improves the ability of RVEDVi and GEDVi to monitor changes in preload over time in critically ill patients. Hemodynamic measure... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182813 Mon, 18 Jan 2010 00:00:00 +0100 3182813 http://www.medworm.com/index.php?rid=3182812&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02203.x This study examined the incidence and severity of cough after a bolus of alfentanil and remifentanil. Four hundred and sixty-five patients, aged 18[ndash]70 years, were allocated randomly to three groups to receive alfentanil 10 [mu]g/kg, remifentanil 1 [mu]g/kg or an equal volume of 0.9% saline intravenously over 10 s. Any episode of cough was classified as coughing and graded as mild (1[ndash]2), moderate (3[ndash]4) or severe (5 or more). The overall incidence of cough was higher in the opioid groups than in the saline group. The remifentanil group [39/150 patients; 26.0% (95% CI, 19.6[ndash]33.6%)] showed a higher incidence than the alfentanil group [11/152 patients; 7.2% (95% CI, 0.4[ndash]12.6%)] (P (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182812 Mon, 18 Jan 2010 00:00:00 +0100 3182812 http://www.medworm.com/index.php?rid=3182811&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02205.x Adequate monitoring of the hemodynamic state is essential after cardiac surgery and is vital for medical decision making, particularly concerning hemodynamic management. Unfortunately, commonly used methods to assess the hemodynamic state are not well documented with regard to outcome. Mixed venous oxygen saturation (SvO2) was therefore investigated after cardiac surgery. Detailed data regarding mortality were available on all patients undergoing aortic valve replacement for isolated aortic stenosis during a 5-year period in the southeast region of Sweden (n=396). SvO2 was routinely measured on admission to the intensive care unit (ICU) and registered in a database. A receiver operating characteristics (ROC) analysis of SvO2 in relation to post-operative mortality related to cardiac failur... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182811 Mon, 18 Jan 2010 00:00:00 +0100 3182811 http://www.medworm.com/index.php?rid=3182810&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02206.x The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a 'U'-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in bo... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182810 Mon, 18 Jan 2010 00:00:00 +0100 3182810 http://www.medworm.com/index.php?rid=3182809&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02207.x Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an [alpha]2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3182809 Mon, 18 Jan 2010 00:00:00 +0100 3182809 http://www.medworm.com/index.php?rid=3146928&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02197.x Ultrasound (US)-guided infraclavicular (IC) and axillary (AX) blocks have similar effectiveness. Therefore, limiting procedural pain may help to choose a standard approach. The primary aims of this randomized study were to assess patient's pain during the block and to recognize its cause. Eighty patients were randomly allocated to the IC or the AX group. A blinded investigator asked the patients to quantify block pain on a Visual Analogue Scale (VAS 0[ndash]100) and to indicate the most unpleasant component (needle passes, paraesthesie or local anaesthetics injection). Sensory block was assessed every 10 min. After 30 min, the unblocked nerves were supplemented. Patients were ready for surgery when they had analgesia or anaesthesia of the five nerves distal to the elbow. Preliminary scan t... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3146928 Thu, 07 Jan 2010 00:00:00 +0100 3146928 http://www.medworm.com/index.php?rid=3146932&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02192.x Ventilation with high positive end-expiratory pressure (PEEP) can lead to liver dysfunction. We hypothesized that an open lung concept (OLC) using high PEEP impairs liver function and integrity dependent on the stabilization of cardiac output. Juvenile female Pietrain pigs instrumented with flow probes around the common hepatic artery and portal vein, pulmonary and hepatic vein catheters underwent a lavage-induced lung injury. Ventilation was continued with a conventional approach (CON) using pre-defined combinations of PEEP and inspiratory oxygen fraction or with an OLC using PEEP set above the lower inflection point of the lung. Volume replacement with colloids was guided to maintain cardiac output in the CON(V+) and OLC(V+) groups or acceptable blood pressure and heart rate in the OLC(V... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3146932 Wed, 06 Jan 2010 00:00:00 +0100 3146932 http://www.medworm.com/index.php?rid=3146931&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02193.x Local anaesthetics (LA) are generally considered safe with respect to allergy. However, various clinical reactions steadily occur. Even though most reactions are manifestations of reflexes to perceptive stimuli, uncertainty often remains regarding a possible allergic mechanism. This uncertainty later leads to an avoidance of local anaesthesia and unnecessarily painful interventions, resource-consuming general anaesthesia or even the risk of re-exposure to other yet unidentified allergens. In the present study, follow-up procedures at an allergy clinic were analysed to examine the frequency of identified causative agents and pathogenetic mechanisms and evaluate the strength of the diagnostic conclusions. The medical records of 135 cases with alleged allergic reactions to LA were reviewed. D... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3146931 Wed, 06 Jan 2010 00:00:00 +0100 3146931 http://www.medworm.com/index.php?rid=3146930&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02194.x To prospectively investigate the performance, sealing capacity and operating room (OR) staff exposure to waste anaesthetic gases during the use of the Cobra perilaryngeal airway (CobraPLA) compared with the laryngeal mask airway classic (LMA). Sixty patients were randomly assigned to the CobraPLA or the LMA group. Insertion time, number of insertion attempts and airway leak pressures were assessed after induction of anaesthesia. Occupational exposure to nitrous oxide (N2O) and Sevoflurane (SEV) was measured at the anaesthetists' breathing zone and the patients' mouth using a photoacoustic infrared spectrometer. N2O waste gas concentrations differed significantly in the anaesthetist's breathing zone (11.7±7.2 p.p.m. in CobraPLA vs. 4.1±4.3 p.p.m. in LMA, P=0.03), whereas no difference cou... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3146930 Wed, 06 Jan 2010 00:00:00 +0100 3146930 http://www.medworm.com/index.php?rid=3146929&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02196.x High-volume wound local infiltration analgesia is effective in knee arthroplasty, but the analgesic efficacy of subcutaneous wound infiltration has not been evaluated. In a randomised, double-blind, placebo-controlled trial in 16 patients undergoing bilateral knee arthroplasty with high-volume local infiltration analgesia in the deeper layers, saline or ropivacaine 2 mg/ml was infiltrated into the subcutaneous part of the wound in each knee along with the placement of multi-fenestrated catheters in the subcutaneous wound layers in both knees. Pain was assessed for 6 h post-operatively and for 3 h after a bolus injection given through the catheter 24 h post-operatively. Visual analogue scale (VAS) pain scores were significantly lower from the knee infiltrated with ropivacaine compared with ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3146929 Wed, 06 Jan 2010 00:00:00 +0100 3146929 http://www.medworm.com/index.php?rid=3107319&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02189.x When using epidural anaesthesia (EDA) for pain relief after major surgery, a failure rate of 10% is common. A crucial step in improving the care of patients with EDA is to define the position of the epidural catheter. The aim of this study was to investigate how much time it takes to determine whether the block is sufficient by assessing the extent of loss of cold sensation before induction of anaesthesia. One hundred patients listed for abdominal surgery were included in the study. After an epidural catheter had been inserted and an intrathecal or an intravenous position had been made unlikely by the use of a test dose, the patient was given a bolus dose of local anaesthetic plus an opioid in the epidural catheter. The epidural block was tested every 2 min, starting at 5 min and ending at... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3107319 Mon, 21 Dec 2009 00:00:00 +0100 3107319 http://www.medworm.com/index.php?rid=3107318&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02190.x This study was undertaken to evaluate the effect of exposure time to sevoflurane on wound healing. Male Sprague[ndash]Dawley rats were used. Two circular full-thickness skin defects 8 mm in diameter were made on the dorsum of the rats. The animals were divided into six groups according to exposed gas type and time: S1 (sevoflurane, 1 h), S4 (sevoflurane, 4 h), S8 (sevoflurane, 8 h), O1 (oxygen, 1 h), O4 (oxygen, 4 h), and O8 (oxygen, 8 h). The surface area of the wounds was measured 0, 1, 3, and 7 days after surgery. Separately, the mean blood pressures (MBP) and arterial oxygen pressures (PaO2) were monitored during the sevoflurane exposure. Collagen type I production and transforming growth factor-[beta]1 (TGF-[beta]1) and basic fibroblast growth factor (bFGF) expression on the wound sur... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3107318 Mon, 21 Dec 2009 00:00:00 +0100 3107318 http://www.medworm.com/index.php?rid=3107317&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02191.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3107317 Mon, 21 Dec 2009 00:00:00 +0100 3107317 http://www.medworm.com/index.php?rid=3107316&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02184.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3107316 Mon, 21 Dec 2009 00:00:00 +0100 3107316 http://www.medworm.com/index.php?rid=3085465&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02183.x This study compares the predictive ability of three effect[ndash]site pharmacokinetic models during fast and slow infusion rates, utilizing the cerebral state index (CSI) as a monitor of consciousness. Sixteen healthy volunteers, 21[ndash]45 years of age, were randomly assigned to receive either a bolus dose of propofol 1.8 mg/kg at a rate of 1200 ml/h or an infusion of 12 mg/kg/h until 3[ndash]5 min after loss of consciousness (LOC). After spontaneous recovery of the CSI, the bolus was administered to patients who had first received the infusion and vice versa. The study was completed after spontaneous recovery of CSI following the second dose scheme. LOC was assessed and recorded when it occurred. Adequacies of model predictions during both administration schemes were assessed by compari... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3085465 Tue, 15 Dec 2009 00:00:00 +0100 3085465 http://www.medworm.com/index.php?rid=3085468&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02177.x Recent evidence has demonstrated the anti-apoptotic of dexmedetomidine in different brain injury models. Herein, we investigated whether dexmedetomidine could directly protect against cortical injury in vitro and in vivo. Apoptosis was induced by staurosporine or wortmannin treatment in cortical neuronal cultures in vitro or by 6 h of isoflurane (0.75%) administration to post-natal day 7 rat pups in vivo. Dexmedetomidine was then applied in escalating doses to assess the neuroprotective potential of this agent. Cell survival was quantified using an MTT assay in vitro and in vivo apoptosis was assessed using cleaved caspase-3 immunohistochemistry. Cortical Western blots were conducted for the cellular survival proteins Bcl-2 and phosphorylated extracellular signal-regulated protein kinase (... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3085468 Mon, 14 Dec 2009 00:00:00 +0100 3085468 http://www.medworm.com/index.php?rid=3085467&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02181.x This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3085467 Mon, 14 Dec 2009 00:00:00 +0100 3085467 http://www.medworm.com/index.php?rid=3085466&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02182.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3085466 Mon, 14 Dec 2009 00:00:00 +0100 3085466 http://www.medworm.com/index.php?rid=3064022&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02175.x Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a [ge]10% increment in SV estimated by oesophageal Doppler was estab... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3064022 Tue, 08 Dec 2009 00:00:00 +0100 3064022 http://www.medworm.com/index.php?rid=3064024&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02173.x This study indicates that the Swedish version of the RASS is applicable with good inter-rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3064024 Mon, 07 Dec 2009 00:00:00 +0100 3064024 http://www.medworm.com/index.php?rid=3064023&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02174.x After using propofol for a decade, pain on injection had been considered routine by patients and medical personnel. When given propofol from a different manufacturer, patients did not complain. Two preparations of propofol were compared. A comparative, double-blind, randomized study was conducted in 22 adult patients undergoing pain relief procedures; they received sedation by an intravenous injection of 1.7 mg/kg of propofol and then were treated with paravertebral injections. Pain on injection was assessed by verbal complaint, movement of the extremity, of the whole body and recollection of pain at induction, when discharged. Propofol from Baxter Laboratories, mixed with either 5 ml of 2% lidocaine or 5 ml of NaCl 0.9%, was compared with propofol Laboratorios Gray, which was similarly mi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3064023 Mon, 07 Dec 2009 00:00:00 +0100 3064023 http://www.medworm.com/index.php?rid=3019794&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02171.x Whether and how chronic advanced aortic regurgitation (AR) impacts the perioperative outcome of noncardiac surgery remains unclear. From November 1999 to December 2006, all patients undergoing noncardiac operations and ever examined by echocardiography within the last 6 months were screened. Those with chronic moderate[ndash]severe or severe AR were enrolled, provided they were not already trachea-intubated or aortic valve operated, and the surgery was not performed under local anesthesia. Case-matched subjects without significant AR served as controls. The perioperative outcomes of these patients were analyzed, and independent prognostic correlates were investigated by multivariate logistic regression analysis. A total of 167 patients (male 131, mean age of 75 years) complying with the en... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3019794 Tue, 24 Nov 2009 00:00:00 +0100 3019794 http://www.medworm.com/index.php?rid=3019797&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02166.x This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1[ndash]2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. After 1[ndash]2 h post-operatively, there were a higher proportion of patients with ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3019797 Mon, 23 Nov 2009 00:00:00 +0100 3019797 http://www.medworm.com/index.php?rid=3019796&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02169.x Propofol is the popular intravenous (i.v.) anaesthetic for paediatric sedation because of its rapid onset and recovery. We compared the efficacy and safety of a single dose and conventional infusion of propofol for sedation in children who underwent magnetic resonance imaging (MRI). This was a double-blind, randomized-controlled study. One hundred and sixty children were assigned to group I (single dose) or II (infusion). Sedation was induced with i.v. propofol 2 mg/kg, and supplemental doses of propofol 0.5 mg/kg were administered until adequate sedation was achieved. After the induction of sedation, we treated patients with a continuous infusion of normal saline at a rate of 0.3 ml/kg/h in group I and the same volume of propofol in group II. In case of inadequate sedation, additional pro... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3019796 Mon, 23 Nov 2009 00:00:00 +0100 3019796 http://www.medworm.com/index.php?rid=3019795&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02170.x A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present-day society and, consequently, the demand for health-care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025. Data collected by the Norwegian intensive care registry (NIR), showing the age distribution in Norwegian intensive care units (ICU) during the years 2006 and 2007, were used with three different Norwegian prognostic models of population growth for the years 2008[ndash]2025 to compute the expected increase in intensive c... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=3019795 Mon, 23 Nov 2009 00:00:00 +0100 3019795 http://www.medworm.com/index.php?rid=2996624&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02168.x Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of 'walking' caudal block compared with an intrarectal lidocaine gel for this procedure. One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 [mu]g fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated. The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1[n... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996624 Tue, 17 Nov 2009 00:00:00 +0100 2996624 http://www.medworm.com/index.php?rid=2996629&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02160.x A previously published study suggested that pre-treatment with magnesium sulphate (MgSO4) had no impact on the speed of onset of rocuronium-induced neuromuscular block. We set out to verify this assumption. Eighty patients (18[ndash]60 years) were randomly allocated to MgSO4 60 mg/kg or placebo (saline). Study drugs were given intravenously for 15 min before induction of anaesthesia with propofol, sufentanil and rocuronium 0.6 mg/kg. Anaesthesia was maintained with a target-controlled propofol infusion. Neuromuscular transmission was measured using train-of-four (TOF)-Watch SX® acceleromyography. Onset was analysed in 37 MgSO4 and 38 saline patients, and recovery in 35 MgSO4 and 37 saline patients. Onset time (to 95% depression of T1) was on average 77 [SD=18] s with MgSO4 and 120 [48] s ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996629 Mon, 16 Nov 2009 00:00:00 +0100 2996629 http://www.medworm.com/index.php?rid=2996628&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02162.x NT-proXNP, a new natriuretic peptide analyte, incorporates information about the concentrations of both N-terminal pro-atrial and pro-brain natriuretic peptides (NT-proANP, NT-proBNP). We aimed to investigate whether NT-proXNP is a reliable indicator of the cardiac index (CI) and the hemodynamic state in neonates and infants undergoing an open heart surgery. We enrolled 26 children under the age of 1 year into this prospective study. All patients underwent an elective cardiac operation with cardiopulmonary bypass (CPB) to achieve complete biventricular repair. Peri-operative hemodynamic parameters were assessed by transpulmonary thermodilution and natriuretic peptide levels were recorded. The NT-proXNP level correlated significantly with the simultaneously measured NT-proANP level (r=0.60,... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996628 Mon, 16 Nov 2009 00:00:00 +0100 2996628 http://www.medworm.com/index.php?rid=2996627&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02163.x This article aims to highlight the legal, ethical and professional aspects that might be relevant to anaesthesiologists in the case of a high-lethality infectious disease such as a severe pandemic influenza. The epidemiology, the role of anaesthesiologists and possible threats to the profession and colleagueship within medical specialties relevant to anaesthesiologists are reviewed. During historical plague epidemics, some doctors have behaved like 'deserters'. However, during the Spanish influenza, physicians remained at their jobs, although many perished. In surveys, more than half of the health-care workers have reported their willingness to work in the case of severe pandemics. Physicians have the same human rights as all citizens: they have to be effectively protected against infectio... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996627 Mon, 16 Nov 2009 00:00:00 +0100 2996627 http://www.medworm.com/index.php?rid=2996626&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02164.x Brief treatments for chronic non-malignant pain patients with problematic opioid use are warranted. The aims of the present study were to investigate (1) whether it is possible to withdraw codeine use in such patients with a brief cognitive-behavioural therapy (CBT), (2) whether this could be done without pain escalation and reduction in quality of life and (3) to explore the effects of codeine reduction on neurocognitive functioning. Eleven patients using codeine daily corresponding to 40[ndash]100 mg morphine were included. Two specifically trained physicians treated the patients with six CBT sessions, tapering codeine gradually within 8 weeks. Codeine use, pain intensity, quality of life and neuropsychological functioning were assessed at pre-treatment to the 3-month follow-up. Codeine ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996626 Mon, 16 Nov 2009 00:00:00 +0100 2996626 http://www.medworm.com/index.php?rid=2996625&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02165.x This double-blinded study aimed at evaluating and comparing the effects of magnesium and lidocaine on pain, analgesic requirements, bowel function, and quality of sleep in patients undergoing a laparoscopic cholecystectomy (LC). Patients were randomized into three groups (n=40 each). Group M received magnesium sulfate 50 mg/kg intravenously (i.v.), followed by 25 mg/kg/h i.v., group L received lidocaine 2 mg/kg i.v., followed by 2 mg/kg/h i.v., and group P received saline i.v. Bolus doses were given over 15 min before induction of anesthesia, followed by an i.v. infusion through the end of surgery. Intraoperative fentanyl consumption and averaged end-tidal sevoflurane concentration were recorded. Abdominal and shoulder pain were evaluated up to 24 h using a visual analog scale (VAS). Morph... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2996625 Mon, 16 Nov 2009 00:00:00 +0100 2996625 http://www.medworm.com/index.php?rid=2986051&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02158.x The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Using high-resolution solid-state manometry, we studied 17 patients (27[ndash]63 years) with a BMI[ge]35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position ([minus]20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2986051 Fri, 13 Nov 2009 00:00:00 +0100 2986051 http://www.medworm.com/index.php?rid=2986053&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02157.x Intranasal balloon catheters circulated with cold saline have previously been used for the induction and maintenance of selective brain cooling in pigs with normal circulation. In the present study, we investigated the feasibility of therapeutic hypothermia initiation, maintenance and rewarming using such intranasal balloon catheters with or without addition of intravenous ice-cold fluids during and after cardiac arrest treatment in pigs. Cardiac arrest was induced in 20 anaesthetised pigs. Following 8 min of cardiac arrest and 1 min of cardiopulmonary resuscitation (CPR), cooling was initiated after randomisation with either intranasal cooling (N) or combined with intravenous ice-cold fluids (N+S). Hypothermia was maintained for 180 min, followed by 180 min of rewarming. Brain and oesopha... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2986053 Thu, 12 Nov 2009 00:00:00 +0100 2986053 http://www.medworm.com/index.php?rid=2986052&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02161.x The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to co... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2986052 Thu, 12 Nov 2009 00:00:00 +0100 2986052 http://www.medworm.com/index.php?rid=2940658&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02156.x This study aimed to confirm an improvement of cardiopulmonary function by reducing fluid loading during an open-heart surgery. Forty-nine elective CABG patients were randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl starch (HSH group) or Ringer's solution (CT group). Both groups received 1 ml/kg/h of the study solution for 4 h after baseline values were obtained (PICCO® transpulmonary thermodilution technique). Net fluid balance (NFB), hemodynamic and laboratory parameters were measured. NFB was four times higher in the CT group compared with the HSH group during the first 6 h post-operatively. The total fluid gain until the next morning was lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group, 4298.7 (1059.3) ml (P (Source: Acta Anaesthesiologica... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940658 Fri, 30 Oct 2009 00:00:00 +0100 2940658 http://www.medworm.com/index.php?rid=2940663&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02090.x (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940663 Thu, 29 Oct 2009 00:00:00 +0100 2940663 http://www.medworm.com/index.php?rid=2940662&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02142.x In vitro and in vivo studies have indicated that stabilizers present in pharmaceutical-grade albumin influence the albumin-binding capacity for highly protein-bound drugs. However, the half-life of the stabilizers and the quantitative effect have been difficult to determine. A randomized crossover study including six healthy volunteers was performed. The study subjects received 750 mg of oral naproxen 2 h before the study. They were randomized to receive either 100 ml of 20% albumin or 100 ml of Ringer's acetate solution intravenously. Frequent blood samples were obtained. The experiment was repeated 4 weeks later with the alternate solution. The serum samples were analysed to determine the concentrations of albumin, N-acetyl-dl-tryptophan, caprylate, and naproxen. The free fraction of nap... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940662 Thu, 29 Oct 2009 00:00:00 +0100 2940662 http://www.medworm.com/index.php?rid=2940661&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02143.x A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanic... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940661 Thu, 29 Oct 2009 00:00:00 +0100 2940661 http://www.medworm.com/index.php?rid=2940660&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02144.x A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumulation; abdominal X-Ray showed air filled bile ducts. Central access was obtained, a pulmonary artery catheter floated, and 30 ml of air aspirated from the RV. Within 5 minutes pulses returned; the patient was transferred to the ICU. MRI revealed two watershed infarcts in the right frontal lobe. The patient fully recovered and returned a month later for an uneventful ERCP. (Source: Acta Anaesthesiologi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940660 Thu, 29 Oct 2009 00:00:00 +0100 2940660 http://www.medworm.com/index.php?rid=2940659&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02145.x This study investigates whether remifentanil post-conditioning is also cardioprotective. Remifentanil post-conditioning (5-min infusion at 1, 5, 10 or 20 [mu]g/kg/min) or ischemic post-conditioning (three cycles of a 10 s reperfusion interspersed with a 10 s ischemia) was induced in an open-chest rat heart model of ischemia and reperfusion injury, in the presence or absence of nor-binaltorphimine, naltrindole or CTOP, specific [kappa], [delta] and [mu] opioid receptor antagonists, respectively. The same sequence of experiments was repeated in the isolated heart model using the maximal protective dose of remifentanil from the dose[ndash]response studies. Both ischemic and remifentanil post-conditioning reduced the myocardial infarct size relative to the control group in both models. This ca... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2940659 Thu, 29 Oct 2009 00:00:00 +0100 2940659 http://www.medworm.com/index.php?rid=2928201&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02141.x Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine. Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor bloc... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2928201 Tue, 27 Oct 2009 00:00:00 +0100 2928201 http://www.medworm.com/index.php?rid=2928204&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02132.x We report a case of severe blunt abdominal trauma, successfully treated with antifibrinolytic medication and fibrinogen concentrate. Rotational thromboelastometry (ROTEM) was used to identify hyperfibrinolysis and afibrinogenaemia. In order to achieve haemostasis, over a 3-h period, the patient received a total of 1 g of tranexamic acid, 7 U of packed red blood cells, 16 g of fibrinogen concentrate (Haemocomplettan P), 3500 ml of colloids and 5500 ml of lactated Ringer's solution. Together with surgical measures, this treatment stopped the bleeding and stabilised the patient. There was no transfusion of either fresh-frozen plasma or platelets. The limited need for allogeneic blood products is of particular interest, and clinical studies of the approach used here appear to be warranted. (So... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2928204 Mon, 26 Oct 2009 00:00:00 +0100 2928204 http://www.medworm.com/index.php?rid=2928203&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02139.x We examined whether a combination of dexmedetomidine and hypothermia reduces brain injury after transient forebrain ischemia in rats to a greater extent than either treatment alone. Thirty-eight male Sprague[ndash]Dawley rats were anesthetized with fentanyl and nitrous oxide in oxygen. Four groups were tested: group C (saline 1 ml/kg, temporal muscle temperature 37.5 °C); group H (saline 1 ml/kg, 35.0 °C); group D (dexmedetomidine 100 [mu]g/kg, 37.5 °C); and group DH (dexmedetomidine 100 [mu]g/kg, 35.0 °C). Dexmedetomidine or saline was administered intraperitoneally 30 min before ischemia. Cerebral ischemia was produced by right carotid artery ligation with hemorrhagic hypotension (mean arterial pressure 40 mmHg) for 20 min. Neurologic outcome was evaluated at 24, 48, and 72 h after i... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2928203 Mon, 26 Oct 2009 00:00:00 +0100 2928203 http://www.medworm.com/index.php?rid=2928202&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02140.x The aim was to study the effects of different tobacco administration routes on pain and post-operative nausea and vomiting (PONV), following three common day surgical procedures: cosmetic breast augmentation (CBA), inguinal hernia repair (IHR) and arthroscopic procedures (AS). We have prospectively investigated the effects of regular tobacco use in ambulatory surgery. The 355 allocated patients were followed during recovery and the first day at home. Thirty-two percent of the patients used tobacco regularly, 33% of CBA, 27% of IHR and 34% of AS. Pain was well controlled in the post-anesthesia care unit at rest; during ambulation, 37% of all patients reported VAS>3. Tobacco use had no impact on early post-operative pain. Post-operative nausea was experienced by 30% of patients during recove... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2928202 Mon, 26 Oct 2009 00:00:00 +0100 2928202 http://www.medworm.com/index.php?rid=2903462&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02089.x Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia an... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2903462 Sun, 18 Oct 2009 23:00:00 +0100 2903462 http://www.medworm.com/index.php?rid=2891974&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02107.x This study validated the algorithm in a pediatric lung model and investigated the stability and feasibility in a pediatric peri-operative and intensive care setting. The lung model was ventilated in combinations of ventilatory modes, CO2 production, model FRC and respiratory rates. Sixteen children from 10 days to 5 years were studied peri-operatively with controlled ventilation using a Mapleson D system and in the intensive care unit using a Servo-i ventilator in a supported spontaneous mode. FRC was measured during stable metabolic, respiratory and circulatory periods at positive end expiratory pressure of 3[ndash]4 and 7[ndash]8 cmH2O. In the model and in the clinical setting, we found an excellent agreement between washout and washin measurements of FRC as well as acceptable coefficien... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891974 Wed, 14 Oct 2009 23:00:00 +0100 2891974 http://www.medworm.com/index.php?rid=2891973&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02112.x We describe two patients with an abnormal spinal anatomy in whom ultrasound-assisted spinal anesthesia was unsuccessful. Successful dural puncture was subsequently achieved using a technique of real-time ultrasound-guided spinal anesthesia. This may be a useful option in patients in whom landmark-guided and ultrasound-assisted techniques have failed. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891973 Wed, 14 Oct 2009 23:00:00 +0100 2891973 http://www.medworm.com/index.php?rid=2891972&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02116.x Although anesthetics have some cardioprotective properties, these benefits are often counterbalanced by their negative inotropic effects. Xenon, on the other hand, does not influence myocardial contractility. Thus, xenon may be a superior treatment for the maintenance of global hemodynamics, especially during right ventricular ischemia, which is generally characterized by a high acute complication rate. The effects of 70 vol% xenon and 0.9 vol% isoflurane on biventricular function were assessed in a porcine model (n=36) using the conductance catheter technique, and the expression of the type B natriuretic peptide (BNP) gene was measured. The animals underwent 90 min of right ventricular ischemia followed by 120 min of reperfusion. A barbiturate-anesthetized group was included as a control.... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891972 Wed, 14 Oct 2009 23:00:00 +0100 2891972 http://www.medworm.com/index.php?rid=2891971&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02128.x Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery. We compared unilateral lumbar PVB with conventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18[ndash]65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P (n=30) or S (n=30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intravenous infusion of propofol titrated to light sedation. The time to first post-operative analgesic re... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891971 Wed, 14 Oct 2009 23:00:00 +0100 2891971 http://www.medworm.com/index.php?rid=2891970&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02130.x In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5[ndash]10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the t... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891970 Wed, 14 Oct 2009 23:00:00 +0100 2891970 http://www.medworm.com/index.php?rid=2891969&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02131.x The use of neuromuscular blocking agents (NMBAs) is widespread in anesthetic practice; little is known about the current use of these drugs in Italy. This survey was conducted to obtain information about the most commonly used clinical tests and the train-of-four (TOF) ratios that are considered as being reliable for assessing recovery from neuromuscular blockade at the end of anesthesia and the estimated occurrence rates of post-operative paralysis in Italian hospitals. The questionnaire was given to Italian anesthesiologists attending the 62nd National Congress of the Italian Society of Anesthesia, Analgesia and Intensive Therapy. Collected data were stratified by age and the total number of surgical procedures performed in the hospitals concerned. Seven hundred and fifty-four correctly ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891969 Wed, 14 Oct 2009 23:00:00 +0100 2891969 http://www.medworm.com/index.php?rid=2891968&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02135.x Ketobemidone is often used as an alternative to morphine in children in the Scandinavian countries. The aim of this clinical trial was to explore the pharmacokinetics of ketobemidone in children because these properties have not been reported previously. Thirty children, newborn to 10 years, scheduled for elective surgery were included in the trial. Ketobemidone hydrochloride was administered as a single intravenous bolus dose and ketobemidone and norketobemidone concentrations were measured by LC-MS over 8 h. Pharmacokinetic parameters were determined using compartmental methods. Six children were excluded from pharmacokinetic analysis because of incomplete blood sampling. The values of ketobemidone clearance (l/h/kg) given as median (range) were 0.84 (0.29[ndash]3.0) in Group A (0[ndash]... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891968 Wed, 14 Oct 2009 23:00:00 +0100 2891968 http://www.medworm.com/index.php?rid=2891967&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02137.x Persistent post-herniotomy pain may be a neuropathic pain state based on the finding of a persistent sensory dysfunction. However, detailed information on the normal distribution of sensory function in pain-free post-herniotomy patients hinders identification of exact pathogenic mechanisms. Therefore, we aimed to establish normative data on sensory function in pain-free patients >1 year after a groin herniotomy. Sensory thresholds were assessed in 40 pain-free patients by a standardized quantitative sensory testing (QST). Secondary endpoints included comparison of sensory function between the operated and the naïve side, and correlation between sensory function modalities. QST showed that on the operated side, thermal data were normally distributed, but mechanical pressure and pinch thres... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891967 Wed, 14 Oct 2009 23:00:00 +0100 2891967 http://www.medworm.com/index.php?rid=2891966&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02138.x The bispectral index (BIS) and spectral entropy enable monitoring the depth of anaesthesia. Mild hypothermia has been shown to affect the ability of electroencephalography monitors to reflect the anaesthetic drug effect. The purpose of this study was to investigate the effect of hypothermia during a cardio-pulmonary bypass on the correlation and agreement between the BIS and entropy variables compared with normothermic conditions. This prospective clinical study included coronary artery bypass grafting patients (n=25) evaluating correlation and agreement (Bland[ndash]Altman analysis) between the BIS and both spectral and response entropy during a hypothermic cardio-pulmonary bypass (31[ndash]34 °C) compared with nomothermic conditions (34[ndash]37.5 °C). Anaesthesia was maintained with p... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2891966 Wed, 14 Oct 2009 23:00:00 +0100 2891966 http://www.medworm.com/index.php?rid=2880478&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02129.x The aim of this study was to investigate whether sevoflurane-induced post-conditioning has a neuroprotective effect against incomplete cerebral ischemia in rats. After cerebral ischemia by right common carotid artery occlusion in combination with hemorrhagic hypotension (35 mmHg) for 30 min, 1.0 minimum alveolar concentration of sevoflurane was administered for 15 min (Post-C 15, n=8), 30 min (Post-C 30, n=8), or 60 min (Post-C 60, n=8) in rats. Sevoflurane was not administered in control (n=8) and sham control rats (n=8). Neurologic evaluations were performed at 24, 48, and 72 h after ischemia. Degrees of neuronal damage in ischemic hippocampal CA1 and the cortex were assessed by counting eosinophilic neurons, and detection of DNA fragmentation was performed by terminal deoxynucleotidyl t... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2880478 Sat, 10 Oct 2009 23:00:00 +0100 2880478 http://www.medworm.com/index.php?rid=2880481&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02075.x Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2880481 Fri, 09 Oct 2009 23:00:00 +0100 2880481 http://www.medworm.com/index.php?rid=2880480&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02115.x In animal models of vomiting, [mu]-opioid (MOP, OP3) receptors mediate both emesis and anti-emesis. [mu]-receptors within the blood[ndash]brain barrier, mediating anti-emesis, are more rapidly accessible to lipid-soluble [mu]-opioid receptor agonists such as fentanyl than to morphine, and fentanyl has broad-spectrum anti-emetic effects in a number of species. Whether a similar situation exists in humans is not known. A search was performed for clinical studies comparing the emetic side effects of opioids administered peri-operatively in an attempt to identify differences between morphine and more lipid-soluble [mu]-receptor-selective agonists such as fentanyl. Overall, the evidence appears to suggest that fentanyl and other phenylpiperidines are associated with less nausea and vomiting tha... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2880480 Fri, 09 Oct 2009 23:00:00 +0100 2880480 http://www.medworm.com/index.php?rid=2880479&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02126.x Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone do... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2880479 Fri, 09 Oct 2009 23:00:00 +0100 2880479 http://www.medworm.com/index.php?rid=2801820&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02080.x We conducted a prospective observational survey of pregnant women with cardiac disease. The aim was to analyse and present the mode of delivery, outcome, and haemodynamic changes during a caesarean section under regional anaesthesia in women with cardiac disease. All pregnant women with a cardiovascular diagnosis, except hypertension, were included in the registry. Based on the cardiac diagnoses, and on the New York Heart Association classification, a multidisciplinary group made recommendations for each patient and decided on the mode of delivery. The data from continuous, invasive haemodynamic monitoring in intermediate- and high-risk patients under regional anaesthesia for a caesarean section were analysed and presented. The hospital had approximately 9000 deliveries in the period from ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801820 Wed, 16 Sep 2009 23:00:00 +0100 2801820 http://www.medworm.com/index.php?rid=2801819&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02098.x A deep level of anaesthesia measured by the bispectral index has been found to improve processing speed as one aspect of cognitive function after surgery. The purpose of the present study was to assess the possible effect of the level of anaesthesia on post-operative cognitive dysfunction (POCD) 1 week after surgery, as assessed by a neuropsychological test battery. We included 70 patients >60 years of age scheduled for elective non-cardiac surgery with general anaesthesia. The depth of anaesthesia was monitored using the cerebral state monitor, which provided a cerebral state index (CSI) value. Cognitive function was assessed by the ISPOCD neuropsychological test battery before and at 1 week (or hospital discharge) after surgery and POCD was defined as a Z score above 1.96. Five patients ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801819 Wed, 16 Sep 2009 23:00:00 +0100 2801819 http://www.medworm.com/index.php?rid=2801818&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02114.x The respiratory variation in the pre-ejection period ([Delta]PEP) has been used to predict fluid responsiveness in mechanically ventilated patients. Recently, we modified this parameter (PEPV) and showed that it was a reliable predictor for post-cardiac surgery, mainly paced, patients when moderately low tidal volumes were used. One of the modifications involved tidal volume indexation, which had not been proposed before for dynamic parameters. The aim of the present animal study was to investigate whether indexation to tidal volume should be part of a new definition of dynamic parameters such as the case for our newly proposed PEPV. Eight prone, anesthetized piglets (23[ndash]27 kg) were subjected to a sequence of 25% hypovolemia, normovolemia, and 25% and 50% hypervolemia. At each volemi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801818 Wed, 16 Sep 2009 23:00:00 +0100 2801818 http://www.medworm.com/index.php?rid=2801817&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02119.x Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. We studied 40 MO patients (body mass index >35 kg/m2) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation w... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801817 Wed, 16 Sep 2009 23:00:00 +0100 2801817 http://www.medworm.com/index.php?rid=2801816&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02121.x Imbalance of the renal medullary oxygen supply/demand relationship can cause ischaemic acute renal failure (ARF). The use of dopamine for prevention/treatment of ischaemic ARF has been questioned. It has been suggested that dopamine may increase renal oxygen consumption (RVO2) due to increased solute delivery to tubular cells, which may jeopardise renal oxygenation. Information on the effects of dopamine on renal perfusion, filtration and oxygenation in man is, however, lacking. We evaluated the effects of dopamine on renal blood flow (RBF), glomerular filtration rate (GFR), RVO2 and renal O2 demand/supply relationship, i.e. renal oxygen extraction (RO2Ex). Twelve uncomplicated, mechanically ventilated and sedated post-cardiac surgery patients with pre-operatively normal renal function wer... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801816 Wed, 16 Sep 2009 23:00:00 +0100 2801816 http://www.medworm.com/index.php?rid=2801815&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02123.x Shorter pre-operative fasting improves clinical outcome without an increased risk. Since October 2004, German Anaesthesiology Societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery. We conducted a nationwide survey to evaluate the current clinical practice in Germany. Between July 2006 and January 2007, standardized questionnaires were mailed to 3751 Anaesthesiology Society members in leading positions requesting anonymous response. The overall response rate was 66% (n=2418). Of those, 2148 (92%) claimed familiarity with the new guidelines. About a third (n=806, 34%) reported full adherence to the new recommendations, whereas 1043 (45%) reported an eased fasting practice. Traditional Nil per os after midnight was still recommende... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801815 Wed, 16 Sep 2009 23:00:00 +0100 2801815 http://www.medworm.com/index.php?rid=2801814&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02124.x Overdistension of the lung causes ventilator-induced lung injury (VILI) accompanied by surfactant abnormalities and inflammatory changes. We investigated the effects of surfactant replacement on overdistension of the terminal airspaces and plasma cytokine levels in VILI. VILI was induced by high-pressure ventilation (HPV) in rats anesthetized with pentobarbital, followed by ventilation for 2 h in the maintenance mode (tidal volume=10 ml/kg, positive end-expiratory pressure=7.5 cmH2O) with or without surfactant replacement. The sizes of the terminal airspaces were determined after fixing the lungs at an airway pressure of 10 cmH2O on deflation. Cytokine levels were assessed by enzyme-linked immunosorbent assay. The mean ratio of the largest terminal airspace size class ([ge]64,000 [mu]m2) w... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801814 Wed, 16 Sep 2009 23:00:00 +0100 2801814 http://www.medworm.com/index.php?rid=2801813&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02125.x Experimental studies of haemorrhagic shock have documented a superior haemodynamic response and a better outcome in female animals as compared with male controls. Such sexual dimorphism has, nevertheless, not been reported after circulatory arrest that follows exsanguination and shock. We aimed to study differences in cerebral injury markers after exsanguination cardiac arrest in pre-pubertal piglets. The hypothesis was that cerebral injury is less extensive in female animals, and that this difference is independent of sexual hormones or choice of resuscitative fluid. Thirty-two sexually immature piglets (14 males and 18 females) were subjected to 5 min of haemorrhagic shock followed by 2 min of ventricular fibrillation and 8 min of cardiopulmonary resuscitation, using three resuscitation ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801813 Wed, 16 Sep 2009 23:00:00 +0100 2801813 http://www.medworm.com/index.php?rid=2801812&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02127.x We investigated whether lipopolysaccharide (LPS) induced inflammation in alveolar epithelial type II (ATII) cells is through cluster of differentiation 14 (CD14) and Toll-like receptor 4 (TLR4) and the effect of different dosages of propofol on the inflammation in primary cultured rat ATII cells. Cultured ATII cells were randomly assigned to one of the following five groups: Group C: untreated group (control) cultured in the absence of propofol and LPS; Group LPS: treated with 1 [mu]g/ml LPS; Group P1: treated with 1 [mu]g/ml LPS and 25 [mu]M propofol; Group P2: treated with 1 [mu]g/ml LPS and 50 [mu]M propofol; Group P3: treated with 1 [mu]g/ml LPS and 100 [mu]M propofol. ATII cells in all groups were cultured at 37 °C for 3 h. CD14 and TLR4 mRNA was detected using real-time polymerase c... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2801812 Wed, 16 Sep 2009 23:00:00 +0100 2801812 http://www.medworm.com/index.php?rid=2773218&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02113.x To investigate the feasibility and efficacy of earlier induction of hypothermia already during the 'no-flow' period of cardiac arrest with non-invasive surface cooling or invasive aortic flush cooling. This was a prospective randomized experimental study that included 14 pigs, Large White breed (30[ndash]38 kg), with ventricular fibrillation cardiac arrest plus blanket surface and an invasive cold saline flush cooling. The endpoint was a decline in brain temperature (Tbr) at 35 min after cardiac arrest. With surface cooling, Tbr decreased from 38.7±0.2 °C to 37.4±0.8 °C (P=0.02) and with invasive cooling Tbr decreased from 38.8±0.13 °C to 19.0±2.8 °C within 216±23 s (P=0.02) and increased back to 33.0±0.6 °C at 35 min of cardiac arrest (P=0.02 vs. Tbr at 15 min, P=0.002 vs. Tbr ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2773218 Mon, 07 Sep 2009 23:00:00 +0100 2773218 http://www.medworm.com/index.php?rid=2773221&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02086.x Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO2) for detecting low cardiac output in patients with septic shock. We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CITD). Paired measurements of CITD and central venous oximetry values were obtained when the clinician first measured CITD. We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3[ndash]20). Baseline CITD was 3.5 l/min/m2 (1.... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2773221 Sun, 06 Sep 2009 23:00:00 +0100 2773221 http://www.medworm.com/index.php?rid=2773220&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02110.x Both multiple injection and single posterior cord injection techniques are associated with extensive anesthesia of the upper limb after an infraclavicular coracoid block (ICB). The main objective of this study was to directly compare the efficacy of both techniques in terms of the rates of completely anesthetizing cutaneous nerves below the elbow. Seventy patients undergoing surgery at or below the elbow were randomly assigned to receive an ICB after the elicitation of either a single radial nerve-type response (Radial group) or of two different main nerve-type responses of the upper limb, except for the radial nerve (Dual group). Forty milliliters of 1.5% mepivacaine was given in a single or a dual dose, according to group assignment. The sensory block was assessed in each of the cutaneou... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2773220 Sun, 06 Sep 2009 23:00:00 +0100 2773220 http://www.medworm.com/index.php?rid=2773219&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02111.x Xenon has been shown to reduce cellular injury after cerebral ischemia. However, the neuroprotective effects of xenon on ischemic spinal cord are unknown. The authors compared the effects of xenon and propofol on spinal cord injury following spinal cord ischemia in rabbits. Thirty-two male New Zealand white rabbits were randomly assigned to one of three groups. In the xenon and propofol group, 70% of xenon and 0.8 mg/kg/min of propofol were administered 30 min before an aortic occlusion and maintained until the end of the procedure. The aortic occlusion was performed for 15 min. In the sham group, the aorta was not occluded. After an assessment of the hind limb motor function using the Tarlov score (0=paraplegia, 4=normal) at 48 h after reperfusion, gray and white matter injuries were eval... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2773219 Sun, 06 Sep 2009 23:00:00 +0100 2773219 http://www.medworm.com/index.php?rid=2746163&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02082.x Rotational thrombelastometry/thrombelastography with ROTEM® and TEG® is becoming available bedside in an increasing number of intensive care units, where many patients with heparin-induced thrombocytopenia (HIT) are treated. The study has been performed in an effort to find out whether ROTEM® could be an alternative to activated partial thromboplastin time (aPTT) when argatroban is used for anticoagulation. Argatroban was added in vitro to a series of citrated whole-blood samples from 10 healthy volunteers to obtain whole-blood concentrations of 0, 0.125, 0.25, 0.5, 1.0, 2.0, 4.0 and 8.0 mg/l. ROTEM® and whole-blood aPTT analyses were performed at each argatroban concentration. Correlation analyses were performed using the Spearman correlation analysis. There was a significant and stro... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746163 Sun, 30 Aug 2009 23:00:00 +0100 2746163 http://www.medworm.com/index.php?rid=2746162&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02087.x The purpose of this study was to determine whether the application of high stimulation current thresholds (SCT) leads to a distant needle to nerve proximity (NNP) compared with low SCT during nerve localization for regional anaesthesia in pigs. A minimal motor response to the stimulation of femoral or brachial plexus nerves in 16 anaesthetized pigs was triggered either by a minimal SCT of a low (0.01[ndash]0.3 mA) or a high (0.8[ndash]1.0 mA) current in a random order. After eliciting a motor response with a predetermined SCT, synthetic resin was injected via the needle. After postmortem dissection of the injection site, the localization of the resin deposition was determined verifying the final position of the needle tip. Depending on the proximity of resin deposition to the nerve epineur... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746162 Sun, 30 Aug 2009 23:00:00 +0100 2746162 http://www.medworm.com/index.php?rid=2746161&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02093.x Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. Patients scheduled for extracorporeal shock wave lithotripsy were randomly assigned to one of four groups. Two groups received a combination of fentanyl/midazolam with either modafinil or placebo. The remaining groups received remifentanil/propofol with either modafinil or placebo. Modafinil 200 mg was administered to the treatment group patients 1 h before sedation/analgesia. Groups were compared using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of sedation and analgesia (OAA/S) and Aldrete score. Verbal... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746161 Sun, 30 Aug 2009 23:00:00 +0100 2746161 http://www.medworm.com/index.php?rid=2746160&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02101.x In general, there is a response time between actual arterial hypoxemia and its detection by pulse oximeters. We compared the desaturation and resaturation response times between two types of pulse oximeters, transmission and reflectance pulse oximeters, to find out which oximeter has a more rapid response time. Thirty-three ASA 1 or 2 patients were enrolled in this study. A transmission pulse oximeter was placed on the index finger and a reflectance pulse oximeter was placed on the forehead and monitored simultaneously. After the induction of general anesthesia without pre-oxygenation, we waited until the oxygen saturation value of any of two pulse oximeters declined to 90%, and then mask ventilation was started with 100% oxygen. Oxygen saturation was recorded at an interval of 2 s during ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746160 Sun, 30 Aug 2009 23:00:00 +0100 2746160 http://www.medworm.com/index.php?rid=2746159&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02102.x Incidence reports on acute lung injury (ALI) vary widely. An insight into the diagnostic preferences of critical care physicians when diagnosing ALI may improve identification of the ALI patient population. Critical care physicians in the Netherlands were surveyed using vignettes involving hypothetical patients and a questionnaire. The vignettes varied in seven diagnostic determinants based on the North American European Consensus Conference and the lung injury score. Preferences were analyzed using a mixed-effects logistic regression model and presented as an odds ratio (OR) with a 95% confidence interval. From 243 surveys sent to 30 hospitals, 101 were returned (42%). ORs were as follows: chest X-ray consistent with ALI: OR 1.7 (1.3[ndash]2.3), high positive end-expiratory pressure (PEEP... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746159 Sun, 30 Aug 2009 23:00:00 +0100 2746159 http://www.medworm.com/index.php?rid=2746158&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02103.x This study investigated the feasibility of electrical impedance tomography (EIT) to assess the V/Q distribution and matching during an endotoxinaemic ALI in pigs. Mechanically ventilated, anaesthetised pigs (n=11, weight 30[ndash]36 kg) were studied during an infusion of endotoxin for 150 min. Impedance changes related to ventilation (ZV) and perfusion (ZQ) were monitored globally and bilaterally in four regions of interest (ROIs) of the EIT image. The distribution and ratio of ZV and ZQ were assessed. The alveolar[ndash]arterial oxygen difference, venous admixture, fractional alveolar dead space and functional residual capacity (FRC) were recorded, together with global and regional lung compliances and haemodynamic parameters. Values are mean±standard deviation (SD) and regression coeffi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746158 Sun, 30 Aug 2009 23:00:00 +0100 2746158 http://www.medworm.com/index.php?rid=2746157&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02104.x Oxycodone is a semi-synthetic opioid with a [mu]-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O-demethylation via the polymorphic CYP2D6. The aim of this study was to investigate whether CYP2D6 poor metabolizers (PMs) yield the same analgesia post-operatively from intravenous oxycodone as extensive metabolizers (EMs). Two hundred and seventy patients undergoing primarily thyroid surgery or hysterectomy were included and followed for 24 h post-operatively. The CYP2D6 genotype was blinded until study procedures had been completed for all patients. All patients received intravenous oxycodone as pain treatment for 24 h post-operatively and morphine 5 mg was used as escape medication.... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746157 Sun, 30 Aug 2009 23:00:00 +0100 2746157 http://www.medworm.com/index.php?rid=2746156&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02108.x In clinical practice, we noticed a greater than expected spread of sensory spinal block in patients with rheumatoid arthritis. We decided to test this impression and compared the spread of standard spinal anaesthesia in rheumatoid and non-rheumatoid control patients. Spinal anaesthesia with 3.4 ml (17 mg) of plain bupivacaine was administered to 50 patients with seropositive rheumatioid arthritis and to 50 non-rheumatoid control patients. The protocol was standardised for all patients. All the patients were undergoing lower limb surgery and the rheumatoid patients were operated on due to their rheumatoid disease. The spread of sensory block was recorded 30 min from the dural puncture using a pin prick test and a cold ice-filled container. The impact of body mass index (BMI), height and age... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746156 Sun, 30 Aug 2009 23:00:00 +0100 2746156 http://www.medworm.com/index.php?rid=2746155&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02109.x The operating room is a complex work environment with a high potential for adverse events. Protocols for perioperative verification processes have increasingly been recommended by professional organizations during the last few years. We assessed personnel attitudes to a pre-operative checklist ('time out') immediately before start of the operative procedure. 'Time out' was implemented in December 2007 as an additional safety barrier in two Swedish hospitals. One year later, in order to assess how the checklist was perceived, a questionnaire was sent by e-mail to 704 persons in the operating departments, including surgeons, anesthesiologists, operation and anesthetic nurses and nurse assistants. In order to identify differences in response between professions, each alternative in the questi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2746155 Sun, 30 Aug 2009 23:00:00 +0100 2746155 http://www.medworm.com/index.php?rid=2721360&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02054.x Challenges have emerged following the revival of nitric oxide (NO) from 'something old', a simple gas derived from nitrogen and oxygen with a role in the early stages of evolution, into 'something new', an endogenously formed biological mediator regulating a wide variety of physiological functions. Although pain is a common sensation, it encompasses multiple neurobiologic components, of which NO is only one. In pain research, the study of NO is complicated by convoluted problems related mostly to the effects of NO, which are pro- or anti-nociceptive depending on the circumstances. This dual function reflects the multi-faceted roles of the NO molecule described in physiology. This review covers current information about NO and its implications in pain mechanisms. In addition, it follows the... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2721360 Fri, 21 Aug 2009 23:00:00 +0100 2721360 http://www.medworm.com/index.php?rid=2696995&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02097.x In conclusion, we observed a lower prevalence of chronic pain after cardiac surgery than in previous studies. Still, more than one out of 10 patients reported chronic pain after cardiac surgery. Chronic pain appears to affect HRQOL. Thus, given the large number of patients subjected to cardiac surgery, this study confirms that chronic pain after cardiac surgery is an important health care issue. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2696995 Thu, 13 Aug 2009 23:00:00 +0100 2696995 http://www.medworm.com/index.php?rid=2697010&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02061.x The respiratory variation in the pre-ejection period ([Delta]PEP) has been used to predict fluid responsiveness in mechanically ventilated patients. Recently, we automated this parameter and indexed it to tidal volume (PEPV) and showed that it was a reliable predictor for post-cardiac surgery, mainly paced, patients ventilated with low tidal volumes. The aims of the present animal study were to investigate PEPV's ability to predict fluid responsiveness under different fluid loading conditions and natural heart rates during low tidal volume ventilation (6 ml/kg) and to compare the performance of PEPV with other markers of fluid responsiveness. Eight prone, anesthetized piglets (23[ndash]27 kg) ventilated with tidal volumes of 6 ml/kg were subjected to a sequence of 25% hypovolemia, normovol... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697010 Wed, 12 Aug 2009 23:00:00 +0100 2697010 http://www.medworm.com/index.php?rid=2697009&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02064.x The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697009 Wed, 12 Aug 2009 23:00:00 +0100 2697009 http://www.medworm.com/index.php?rid=2697008&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02068.x Intense capsaicin-induced C-fiber stimulation results in reversible lysis of the nerve soma, thereby making capsaicin wound instillation of potential interest for the treatment of post-operative pain. Clinical histological and short-term sensory studies suggest that the C-fiber function is partly re-established after skin injection of capsaicin. However, no study has evaluated the long-term effects of wound instillation of purified capsaicin on sensory functions. Patients included in a double-blind placebo-controlled randomized study of the analgesic effect of capsaicin after groin hernia repair were examined by quantitative sensory testing before, 1 week and 2 years post-operatively. The primary endpoint was occurrence of hyperalgesia/allodynia. The secondary endpoints were acute and late... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697008 Wed, 12 Aug 2009 23:00:00 +0100 2697008 http://www.medworm.com/index.php?rid=2697007&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02069.x In the acute respiratory distress syndrome potentially recruitable lung volume is currently discussed. 3He-magnetic resonance imaging (3He-MRI) offers the possibility to visualize alveolar recruitment directly. With the approval of the state animal care committee, unilateral lung damage was induced in seven anesthetized pigs by saline lavage of the right lungs. The left lung served as an intraindividual control (healthy lung). Unilateral lung damage was confirmed by conventional proton MRI and spiral-CT scanning. The total aerated lung volume was determined both at a positive end-expiratory pressure (PEEP) of 0 and 10 mbar from three-dimensionally reconstructed 3He images, both for healthy and damaged lungs. The fractional increase of aerated volume in damaged and healthy lungs, followed b... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697007 Wed, 12 Aug 2009 23:00:00 +0100 2697007 http://www.medworm.com/index.php?rid=2697006&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02070.x Levosimendan and volatile anesthetics have myocardial pre-conditioning effects. [beta]-1 adrenergic receptor antagonists may inhibit the protective effect of volatile anesthetics. No information exists as to whether this also applies to the pre-conditioning effect of levosimendan. We therefore investigated whether levosimendan added to metoprolol would demonstrate a cardioprotective effect. Three groups of anesthetized open chest pigs underwent 30 min of myocardial ischemia and 90 min of reperfusion by temporary occlusion of the largest side branch from the circumflex artery or the left anterior descending artery. One group (CTRL) served as a control, in another group (BETA), a metoprolol-loading dose was intravenously injected 30 min before ischemia, and in a third group (BETA+L), a levos... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697006 Wed, 12 Aug 2009 23:00:00 +0100 2697006 http://www.medworm.com/index.php?rid=2697005&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02072.x Centralized trauma care has been shown to be associated with improved patient outcome. We compared the outcomes of trauma patients in relation to the size of the intensive care unit (ICU) using a large Finnish database. A national prospectively collected ICU data registry was used for analysis. All adult trauma admissions excluding isolated head trauma and burns registered from July 1999 to December 2006 were analyzed. Data from 22 ICUs were available. The non-university-affiliated units were categorized according to the number of beds and referral population as small, mid size and large. Acute physiology and chronic health evaluation (APACHE II)- and sequential organ failure assessment (SOFA)-adjusted mortalities were compared between the units. There were 2067 trauma admissions that fulf... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697005 Wed, 12 Aug 2009 23:00:00 +0100 2697005 http://www.medworm.com/index.php?rid=2697004&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02074.x Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modif... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697004 Wed, 12 Aug 2009 23:00:00 +0100 2697004 http://www.medworm.com/index.php?rid=2697003&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02076.x Direct measurement of lung volume, i.e. functional residual capacity (FRC) has been recommended for monitoring during mechanical ventilation. Mostly due to technical reasons, FRC measurements have not become a routine monitoring tool, but promising techniques have been presented. We performed a literature search of studies with the key words 'functional residual capacity' or 'end expiratory lung volume' and summarize the physiology and patho-physiology of FRC measurements in ventilated patients, describe the existing techniques for bedside measurement, and provide an overview of the clinical questions that can be addressed using an FRC assessment. The wash-in or wash-out of a tracer gas in a multiple breath maneuver seems to be best applicable at bedside, and promising techniques for nitro... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697003 Wed, 12 Aug 2009 23:00:00 +0100 2697003 http://www.medworm.com/index.php?rid=2697002&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02079.x Some studies suggest that certain clinical symptoms of cholestasis, such as fatigue and pruritus, result from altered neurotransmission. Patients with obstructive jaundice also have labile blood pressure and heart rate. In the present study, the authors investigated whether obstructive jaundice affects a patient's sensitivity to hypnotics and the haemodynamic profile of propofol. Thirty-six ASA physical status I/II/III patients with serum total bilirubin (TBL) from 7.8 to 362.7 [mu]mol/l scheduled for bile duct surgery were recruited. A computer-controlled propofol infusion programmed for effect site target was used to rapidly attain and maintain sequential increase of the compartment concentration (from 1 to 3 [mu]g/ml). Each target-controlled concentration was maintained for about 12 min... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697002 Wed, 12 Aug 2009 23:00:00 +0100 2697002 http://www.medworm.com/index.php?rid=2697001&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02081.x Non-pharmacologic techniques such as electrical acustimulation may mitigate post-operative nausea and vomiting (PONV). The primary purpose of this study was to investigate the effectiveness of acustimulation on attenuating PONV. Moreover, we tested whether a pre- or a post-induction application of acustimulation results in differences in PONV reduction. In this prospective, double-blind, randomized, controlled trial, we studied 200 patients undergoing a laparoscopic cholecystectomy during propofol (induction) fentanyl/isoflurane/atracurium (maintenance) anaesthesia. In the acustimulation group (n=101), subdivided into groups with pre-induction (n=57) and post-induction (n=44) acustimulation, an active ReliefBand® device was placed at the P6 acupoint. In the sham group (n=99), also subdivi... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697001 Wed, 12 Aug 2009 23:00:00 +0100 2697001 http://www.medworm.com/index.php?rid=2697000&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02083.x A 24-year-old man was bit on the tongue by a European common adder. Within 15 min following envenomation, he experienced tongue swelling, hypotension and impaired consciousness. Antihistamine, corticosteroid and crystalloids were administered. Within 105 min of envenomation, increasing oral, pharyngeal and facial oedema compromised the airway, leading to respiratory failure, concomitant with circulatory failure related to hypoxaemia and systemic toxic effects. Acute tracheotomy secured the airway, and two doses of antivenom successfully treated the systemic, toxic effects. The reaction was severe due to rapid and suspected high-dose uptake of venom, underlining the need for early advanced symptomatic treatment with airway control and early and eventually repeated dosing of antivenom. (Sour... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2697000 Wed, 12 Aug 2009 23:00:00 +0100 2697000 http://www.medworm.com/index.php?rid=2696999&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02084.x Cardiac surgery with an extracorporeal circulation cardiopulmonary bypass (CPB) is characterized by an oxidative stress response. Glutathione (GSH) belongs to the major antioxidative defense. In metabolic stress, glutamine (GLN) may be the rate-limiting factor of GSH synthesis. Decreased GLN plasma levels were observed after various critical states. We evaluated, in patients undergoing open heart surgery with CPB, the effects of a peri-operative GLN supplementation on GSH in whole blood and assessed their influence on the Sequential Organ Failure Assessment score and the intensive care unit length of stay. In this prospective, randomized, double-blinded study, we included 60 patients (age older than 70 years, ejection fraction (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2696999 Wed, 12 Aug 2009 23:00:00 +0100 2696999 http://www.medworm.com/index.php?rid=2696998&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02085.x The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset. In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 [mu]g/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was inject... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2696998 Wed, 12 Aug 2009 23:00:00 +0100 2696998 http://www.medworm.com/index.php?rid=2696997&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02094.x This study suggests that the Glidescope Ranger® may be merited in situations requiring endotracheal intubation by an experienced intubator in patient entrapment. Further studies are required to clarify whether performance in patients mimics that in a manikin. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2696997 Wed, 12 Aug 2009 23:00:00 +0100 2696997 http://www.medworm.com/index.php?rid=2696996&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02095.x We designed a prospective randomized single-blind study to compare efficiency and post-operative upper airway morbidity when the laryngeal mask airway (LMA) Supreme[trade] is used as an alternative to the endotracheal tube (ETT). One hundred and thirty-eight elective pelvic laparoscopic ASA I[ndash]II female patients were assigned to receive either the LMA Supreme® or the ETT for airway management. Balanced anesthesia and ventilation techniques were standardized to control end-tidal CO2 and BIS value in the range 4.5[ndash]5 kPa and 40[ndash]50, respectively, and to maintain adequate hemodynamic stability. A single surgeon blinded to the airway management technique performed all surgical procedures. The ventilation efficiency of each airway was evaluated. Anesthesia- and surgery-related t... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2696996 Wed, 12 Aug 2009 23:00:00 +0100 2696996 http://www.medworm.com/index.php?rid=2650852&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02030.x Infiltration of a long-lasting anaesthetic is helpful during the post-operative period. The recently developed local drug delivery system, biodegradable nanoparticles in a thermo-sensitive hydrogel (nanogel system), may possibly provide an extended duration of drugs. Therefore, we evaluated whether prolonged infiltration anaesthesia could be achieved by loading lidocaine into this delivery system. Thirty male rats were randomized into five groups of six rats each: saline; 2% hydrochloride lidocaine solution; lidocaine-loaded nanogel system and its compositing formulations, namely lido[ndash]nano gel; lido[ndash]nano; and lidogel. Durations of local anaesthesia with subcutaneously injected agents were measured by tail flick latency tests in a randomized, blind fashion. Lido[ndash]nano gel p... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2650852 Wed, 29 Jul 2009 23:00:00 +0100 2650852 http://www.medworm.com/index.php?rid=2635525&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02073.x The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0[ndash]1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635525 Fri, 24 Jul 2009 23:00:00 +0100 2635525 http://www.medworm.com/index.php?rid=2635537&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02018.x Previous studies have shown that ventilation[ndash]perfusion matching is improved in the prone as compared with that in the supine position. Regional differences in the regulation of vascular tone may explain this. We have recently demonstrated higher production of nitric oxide in dorsal compared with ventral human lung tissue. The purpose of the present study was to investigate regional differences in actions by another vasoactive mediator, namely prostacyclin. The effects on gas exchange and regional pulmonary perfusion in different body positions were investigated at increased prostacyclin levels by inhalation of a synthetic prostacyclin analogue and decreased prostacyclin levels by unselective cyclooxygenase (COX) inhibition. In 19 volunteers, regional pulmonary perfusion in the prone ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635537 Thu, 23 Jul 2009 23:00:00 +0100 2635537 http://www.medworm.com/index.php?rid=2635536&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02024.x Neuroprotection is a major therapeutic approach for ischemic brain injury. We investigated the neuroprotective effects induced by transplantation of human embryonic neural stem cells (NSCs) into the cortical penumbra 24 h after focal cerebral ischemia. NSCs were prepared from human embryonic brains obtained at 8 weeks of gestation. Focal cerebral ischemia was induced in adult rats by permanent occlusion of the middle cerebral artery. Animals were randomly divided into two groups: NSCs-grafted group and medium-grafted group (control). Infarct size was assessed 28 days after transplantation by hematoxylin and eosin staining. Neurological severity scores were evaluated before ischemia and at 1, 7, 14, and 28 days after transplantation. The terminal deoxynucleotidyl transferase-mediated dUTP n... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635536 Thu, 23 Jul 2009 23:00:00 +0100 2635536 http://www.medworm.com/index.php?rid=2635535&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02031.x The aim of this study is to assess the efficacy and clinical safety of regional anticoagulation (heparin pre-filter plus post-filter protamine) plus antiaggregation (pre-filter prostacyclin) [Group 1 (G1)] vs. only systemic heparin anticoagulation without antiaggregation [Group 2 (G2)] in critically ill patients with acute renal failure undergoing continuous veno-venous haemofiltration (CVVH). One hundred and ten patients were randomized in a prospective, controlled pilot study. G1 patients received 1000 U/h pre-filter heparin, 10 mg/h post-filter protamine sulphate and 4 ng/kg/min pre-filter prostacyclin, while G2 patients received 1000 U/h pre-filter heparin. The haemofilter transmembrane pressure (TMP) and lifespan, as well as the platelet count were observed 1 h before, and at 6, 12, 1... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635535 Thu, 23 Jul 2009 23:00:00 +0100 2635535 http://www.medworm.com/index.php?rid=2635534&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02033.x We carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics. One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S). Each received 3 ml of the study solution intrathecally as part of a combined spinal/epidural technique. The initial dose was 12 mg for Groups L and L+S, and 15 mg for Groups R and R+S. The test solution was required to achieve a visual analogue pain score (VAPS) of 30 mm or less to... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635534 Thu, 23 Jul 2009 23:00:00 +0100 2635534 http://www.medworm.com/index.php?rid=2635533&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02034.x According to this study, and previous ones, it seems worthwhile treating DNI patients with NIV. Twenty-five to 35% leave the hospital alive, every 6th patient lives for at least 1 year, and this paper shows that 10% may survive for 5 years or more. However, only chronic obstructive pulmonary disease and chronic heart failure patients (both with a concomitant low APACHE score) seem to have a reasonable outcome, and patients should be informed about this. So far, no study has investigated the quality of life of these survivors. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635533 Thu, 23 Jul 2009 23:00:00 +0100 2635533 http://www.medworm.com/index.php?rid=2635532&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02047.x The mitochondrial membrane potential drives the main functions of the mitochondria. Sevoflurane depolarizes neural mitochondria. There is still, however, limited information concerning the effect of anaesthetics on neural mitochondria in humans. The effect of sevoflurane and propofol on the intracellular Ca2+ concentration [Ca2+]i and the mitochondrial membrane potential ([Delta][Psi]m) was therefore compared in rat and human synaptosomes, and the changes were related to interventions in the electron transport chain. Synaptosomes from rat and human cerebral cortex were loaded with the fluorescent probes fura-2 ([Ca2+]i) and JC-1 ([Delta][Psi]m) before exposure to sevoflurane 1 and 2 minimum alveolar concentration (MAC), and propofol 30 and 100 [mu]M. The effect on the electron transport ch... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635532 Thu, 23 Jul 2009 23:00:00 +0100 2635532 http://www.medworm.com/index.php?rid=2635531&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02051.x The addition of opioid to local anaesthetics has become a well-accepted practice of spinal anaesthesia for caesarean delivery. Successful caesarean delivery anaesthesia has been reported with the use of a low dose of intrathecal hyperbaric ropivacaine coadministered with sufentanil. This prospective, double-blinded study determined the median effective dose (ED50) of intrathecal hyperbaric ropivacaine with and without sufentanil for caesarean delivery, to quantify the sparing effect of sufentanil on the ED50 of intrathecal hyperbaric ropivacaine. Sixty-four parturients undergoing elective caesarean delivery with combined spinal[ndash]epidural anaesthesia were randomized into two groups: Group R (ropivacaine) and Group RS (ropivacaine plus sufentanil 5 [mu]g). The initial dose of ropivacain... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635531 Thu, 23 Jul 2009 23:00:00 +0100 2635531 http://www.medworm.com/index.php?rid=2635530&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02052.x In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 [mu]g/kg, followed by a continuous infusion of alfentanil 0.25 [mu]g/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual a... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635530 Thu, 23 Jul 2009 23:00:00 +0100 2635530 http://www.medworm.com/index.php?rid=2635529&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02056.x We report a case of fatal post-operative pneumoperitoneum in a patient who had undergone urgent mitral valve surgery. In the absence of a proven cause of the pneumoperitoneum (refusal by the family of an autopsy), we can only propose a hypothesis for its origin. The most probable one is that forceful or sustained retrograde flexion of the transoesophageal echocardiographic probe created a lower oesophagus or gastric rupture and that oxygen flow administered by the nasal cannula went straight to the abdominal cavity, leading to tension pneumoperitoneum. (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635529 Thu, 23 Jul 2009 23:00:00 +0100 2635529 http://www.medworm.com/index.php?rid=2635528&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02060.x Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two diffe... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635528 Thu, 23 Jul 2009 23:00:00 +0100 2635528 http://www.medworm.com/index.php?rid=2635527&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02062.x Cardiac function curves are widely accepted to apply to humans but are not established for the entire range of filling of the heart that can be elicited during head-up (HUT) and head-down tilt (HDT), taken to represent minimal and maximal physiological filling of the heart, respectively. With the supine resting position as a reference, we assessed stroke volume (SV), cardiac output (CO) and filling of the heart during graded tilt to evaluate whether SV and CO are maintained during an assumed maximal physiological filling of the heart elicited by 90° HDT in healthy resting humans. In 26 subjects, central blood volume was manipulated with graded tilt from 60° HUT to 90° HDT. We measured SV, CO (Finometer®) and cardiac filling by echocardiography of the left ventricular end-diastolic volu... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635527 Thu, 23 Jul 2009 23:00:00 +0100 2635527 http://www.medworm.com/index.php?rid=2635526&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02071.x On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty. The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550). The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2635526 Thu, 23 Jul 2009 23:00:00 +0100 2635526 http://www.medworm.com/index.php?rid=2577904&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02048.x We evaluated the weekly progress of anesthesiology residents performing an interscalene block with ultrasound guidance (UG) for block success rates and for the specific time intervals: (i) time to image the brachial plexus and (ii) time from insertion of the block needle until motor stimulation occurred. Our primary objective was to characterize the influence of experience over the course of the regional anesthesia rotation on the performance of a UG interscalene block by anesthesiology residents. Residents conducted an interscalene block with UG under the supervision of attending anesthesiologists experienced in this technique. Block efficacy, time intervals required to perform the block, and acute complications were recorded. We compared success rates over the course of the rotation, and... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2577904 Tue, 07 Jul 2009 23:00:00 +0100 2577904 http://www.medworm.com/index.php?rid=2557376&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02046.x Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children. One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivac... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557376 Tue, 30 Jun 2009 23:00:00 +0100 2557376 http://www.medworm.com/index.php?rid=2557387&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02014.x Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians. A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%. One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8[ndash]33.0), low social support (10.5, 4.0[ndash]27.9), and family problems (6.5, 3.4[ndash]12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3[ndash]7.1) and superiors (2.1, 1.2[ndash]3.6), on-call-related... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557387 Mon, 29 Jun 2009 23:00:00 +0100 2557387 http://www.medworm.com/index.php?rid=2557386&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02023.x In a shock state, naloxone generates the cardiovascular pressor effect by displacing the endogenous opiate-like peptide [beta]-endorphin, resulting in restoration of the normal response to catecholamines. In addition to this opioid antagonistic effect, the non-opiate receptor-mediated effect has also been proposed. The aim of this study was to define the mechanism of non-opiate receptor-mediated action of naloxone. In guinea-pig ventricular tissues, cumulative concentration[ndash]response curves for isoproterenol as well as for forskolin and 3-isobutylmethylxanthine (IBMX) were obtained by increasing the concentration stepwise. To assess the effect on the phosphodiesterase (PDE), the effects of naloxone on contractile forces induced by isoproterenol (0.05 [mu]M) in the presence of IBMX, ci... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557386 Mon, 29 Jun 2009 23:00:00 +0100 2557386 http://www.medworm.com/index.php?rid=2557385&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02026.x Photoplethysmography (PPG), i.e. pulse oximetric wave, is a non-invasive technique that is used in anaesthesia monitoring primarily to monitor blood oxygenation. The PPG waveform resembles that of the arterial blood pressure but instead of pressure it is related to the volume changes in the measurement site and hence contains information related to the peripheral blood circulation, including skin vasomotion, which is controlled by the sympathetic nervous system. Because of this link, skin vasomotor response and PPG amplitude response have been associated with nociception under general anaesthesia. Recently, there has been interest in monitoring nociception during general anaesthesia. In many of the published studies, PPG waveform information has been included. The focus of this topical rev... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557385 Mon, 29 Jun 2009 23:00:00 +0100 2557385 http://www.medworm.com/index.php?rid=2557384&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02032.x Hypotension, a common intra-operative incident, bears an important potential for morbidity. It is most often manageable and sometimes preventable, which renders its study important. Therefore, we aimed at examining hospital variations in the occurrence of intra-operative hypotension and its predictors. As secondary endpoints, we determined to what extent hypotension relates to the risk of post-operative incidents and death. We used the Anaesthesia Databank Switzerland, built on routinely and prospectively collected data on all anaesthesias in 21 hospitals. The three outcomes were assessed using multi-level logistic regression models. Among 147,573 anaesthesias, hypotension ranged from 0.6% to 5.2% in participating hospitals, and from 0.3% up to 12% in different surgical specialties. Most (... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557384 Mon, 29 Jun 2009 23:00:00 +0100 2557384 http://www.medworm.com/index.php?rid=2557383&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02035.x We have evaluated whether co-administration of intravenous (i.v.) paracetamol could enhance the analgesic efficacy of ketoprofen (a non-steroidal anti-inflammatory drug or NSAID) in patients undergoing a tonsillectomy. This prospective, randomized, double-blinded and placebo-controlled add-on study with three parallel groups included 114 patients, aged 16[ndash]50 years, and scheduled for elective tonsillectomy. All patients were given ketoprofen 1 mg/kg i.v. after surgery, followed 5 min later by paracetamol 1 or 2 g i.v., or normal saline as a placebo. The primary outcome measure was the proportion of patients requiring oxycodone for rescue analgesia over the first 6 h (pain score >30/100 mm at rest or >50/100 mm during swallowing) after surgery. No difference was detected in the proport... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557383 Mon, 29 Jun 2009 23:00:00 +0100 2557383 http://www.medworm.com/index.php?rid=2557382&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02036.x The aim of this study was to determine the effect of a single exposure of carcinoma cells (Caco-2 and HEp-2) to an anaesthetic gas mixture containing sevoflurane 3%, applied for a period of either 1 or 2 h, on the induction of apoptosis, propapototic gene expression and sphingomyelinase activity. Apoptosis was determined by flow cytometry. p53, caspase 3 and CYP2E1 gene expression was determined using reverse transcriptase polymerase chain reaction. Activities of acid (aSMase) and neutral sphingomyelinases (nSMase) were measured using methyl-14C sphingomyeline, and for de novo ceramide and lipid synthesis [3H] palmitic acid was used. All results were compared with controls and analysed by Mann[ndash]Whitney and Kruskal[ndash]Wallis tests. In the treated Caco-2 cells, the apoptotic ratio in... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557382 Mon, 29 Jun 2009 23:00:00 +0100 2557382 http://www.medworm.com/index.php?rid=2557381&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02037.x The objective of this pharmacodynamic study was to evaluate the effects of low to moderate doses of vasopressin on renal blood flow (RBF), glomerular filtration rate (GFR), renal oxygen consumption (RVO2) and renal oxygen extraction (RO2Ex) in post-cardiac surgery patients. Twelve patients were studied during sedation and mechanical ventilation after cardiac surgery. Vasopressin was sequentially infused at 1.2, 2.4 and 4.8 U/h. At each infusion rate, systemic haemodynamics were evaluated by a pulmonary artery catheter, and RBF and GFR were measured by the renal vein thermodilution technique and by renal extraction of 51chromium[ndash]ethylenediaminetetraacetic acid, respectively. RVO2 and RO2Ex were calculated by arterial and renal vein blood samples. The mean arterial pressure was not aff... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557381 Mon, 29 Jun 2009 23:00:00 +0100 2557381 http://www.medworm.com/index.php?rid=2557380&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02038.x Caffeine is likely the most widely used psychoactive substance in the world. It is also an analgesic adjuvant and has individual analgesic properties. The latter effect has been attributed to adenosine receptor antagonism, but the site of action is unknown. The aim of this study was to investigate the analgesic properties of caffeine on experimentally induced ischemic pain and to attempt to elucidate whether the site of action is central or peripheral. Seventeen healthy subjects received intravenous (i.v.) regional and systemic infusions of caffeine at 10 mg/kg or placebo in a double-blind, crossover fashion to investigate the site of action for caffeine-induced analgesia. Subjects underwent a sub-maximum effort tourniquet test. Pain scores [visual analogue scale (VAS), 0[ndash]100] were a... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557380 Mon, 29 Jun 2009 23:00:00 +0100 2557380 http://www.medworm.com/index.php?rid=2557379&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02039.x Gabapentin (GPN) is effective in reducing post-operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre-operative administration of gabapentin is more effective than post-operative administration. After REB approval and informed consent, 126 patients were enrolled in a double-blinded, randomized-controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1[ndash]2 h pre-operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557379 Mon, 29 Jun 2009 23:00:00 +0100 2557379 http://www.medworm.com/index.php?rid=2557378&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02040.x This study attempts to assess the safety of low-flow anaesthesia (LFA) at fixed flow rates with particular reference to the incidence of a decline in FiO2 below safe levels of 0.3 and to determine whether LFA can be used safely in the absence of an FiO2 monitor. A total of 100 patients undergoing procedures under general anaesthesia at fresh gas flows of 300 ml/min of O2 and 300 ml/min of N2O were monitored while maintaining the dial setting of isoflurane at 1.5% for 2 h. The changes in gas composition were analysed and even a single recording of FiO2 of (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557378 Mon, 29 Jun 2009 23:00:00 +0100 2557378 http://www.medworm.com/index.php?rid=2557377&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02044.x The aim of this study was to ascertain whether anaesthetic induction-related anaphylactic bronchospasm could be distinguished from other types of bronchospasm by clinical features and response to treatment. Such features could then be used to identify a group of patients in whom skin testing is indicated. We retrospectively studied data from 183 patients referred to an anaesthetic allergy clinic because of bronchospasm during induction. For the analysis, the patients were divided into two groups depending on whether there was evidence suggesting immunological anaphylaxis. When the patients in whom intradermal tests were positive were compared with those in whom intradermal tests were negative, the skin test-positive patients had significantly more severe reactions, and they were more commo... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2557377 Mon, 29 Jun 2009 23:00:00 +0100 2557377 http://www.medworm.com/index.php?rid=2486028&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02021.x Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH. Data on out-of-hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long-term outcome (6[ndash]12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1[ndash]2 representing a good outcome and 3[ndash]5 a bad outcome. From October 2004 to October 2008, 986 TH-treated OHCA patients of all causes were included in the registry. Long-term outcome was reported in 975 patients. The median time from arrest to initiation of TH was 90 min (interquartile range, 60[ndash]165 min) and time to... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2486028 Wed, 24 Jun 2009 23:00:00 +0100 2486028 http://www.medworm.com/index.php?rid=2474953&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02029.x Several studies have assessed the effect of a 'liberal' vs. a 'restrictive' perioperative fluid regimen on post-operative outcome. The literature was reviewed in order to provide recommendations regarding perioperative fluid regimens. A PubMed search identified randomized clinical trials and cited studies, comparing two different fixed fluid volumes on post-operative clinical outcome in major surgery. Studies were assessed for the type of surgery, primary and secondary outcome endpoints, the type and volume of administered fluid and the definition of the perioperative period. Also, information regarding perioperative care and type of anaesthesia was assessed. In the seven randomized studies identified, the range of the liberal intraoperative fluid regimen was from 2750 to 5388 ml compared ... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2474953 Sun, 14 Jun 2009 04:00:00 +0100 2474953 http://www.medworm.com/index.php?rid=2474955&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02019.x The aim of this study was to compare the anti-inflammatory response of methylprednisolone and the [alpha]2-agonist dexmedetomidine in spinal cord injury (SCI). Twenty-four male adult Wistar albino rats, weight 200[ndash]250 g, were included in the study. The rats were divided into four groups as follows: the control group (n: 6) received only laminectomy; the SCI group (n: 6) with trauma alone; the SCI+methylprednisolone group (n: 6) with trauma and 30 mg/kg methylprednisolone, followed by a maintenance dose of 5.4 mg/kg/h; and the SCI+dexmedetomidine group (n: 6) with trauma and 10 [mu]g/kg dexmedetomidine treatment intraperitoneally. Twenty-four hours after the trauma, spinal cord samples were taken for histopathological examination and serum samples were collected for interleukin-6 (IL-... Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2474955 Wed, 10 Jun 2009 04:00:00 +0100 2474955 http://www.medworm.com/index.php?rid=2474954&cid=s_28810_5_f&fid=28810&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1399-6576.2009.02025.x This study looks at the effect of supplementary intravenous magnesium sulfate on acute pain when administered in patients undergoing lower limb orthopedic surgery using spinal anesthesia with bupivacaine. In this double-blind, randomized, placebo-controlled clinical trial, 60 patients were selected and randomly divided into two groups. Efforts were made to place both groups under the same method of anesthesia. One group received 8 mg/kg intravenous magnesium sulfate, started before the incision and continued up to the end of the surgical procedure, using a 50 ml syringe, via a peripheral large bore catheter; the second group received the same volume of placebos using the same method. To present the results, mean (± SD) was used; a P value of (Source: Acta Anaesthesiologica Scandinavica) Acta Anaesthesiologica Scandinavica journals http://www.medworm.com/rss/comments.php?id=2474954 Wed, 10 Jun 2009 04:00:00 +0100 2474954