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Caudal analgesia for prostate biopsyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - November 17, 2009 Category: Anesthesiology Authors: M. CESUR, T. YAPANOGLU, A. F. ERDEM, I. OZBEY, H. A. ALICI, Y. AKSOY Source Type: journals

Time course of rocuronium-induced neuromuscular block after pre-treatment with magnesium sulphate: a randomised studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - November 16, 2009 Category: Anesthesiology Authors: C. CZARNETZKI, C. LYSAKOWSKI, N. ELIA, M. R. TRAMÈR Source Type: journals

Strong relationship between NT-proXNP levels and cardiac output following cardiac surgery in neonates and infantsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 transpul...
Source: Acta Anaesthesiologica Scandinavica - November 16, 2009 Category: Anesthesiology Authors: T. BREUER, R. SKOUMAL, F. HORKAY, B. MERKELY, M. ALA-KOPSALA, J. LEPPÄLUOTO, O. VUOLTEENAHO, H. RUSKOAHO, M. TÓTH, A. SZÉKELY Source Type: journals

Pandemic influenza: human rights, ethics and duty to treatEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 reporte...
Source: Acta Anaesthesiologica Scandinavica - November 16, 2009 Category: Anesthesiology Authors: I. PAHLMAN, H. TOHMO, H. GYLLING Source Type: journals

Patients with problematic opioid use can be weaned from codeine without pain escalationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 g...
Source: Acta Anaesthesiologica Scandinavica - November 16, 2009 Category: Anesthesiology Authors: H. K. NILSEN, T. C. STILES, N. I. LANDRØ, E. A. FORS, S. KAASA, P. C. BORCHGREVINK Source Type: journals

Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - November 16, 2009 Category: Anesthesiology Authors: I. M. SAADAWY, A. M. KAKI, A. A. ABD EL LATIF, A. M. ABD-ELMAKSOUD, O. M. TOLBA Source Type: journals

Body positions and esophageal sphincter pressures in obese patients during anesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - November 13, 2009 Category: Anesthesiology Authors: A. DE LEON, S.-E. THÖRN, J. OTTOSSON, M. WATTWIL Source Type: journals

Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 eit...
Source: Acta Anaesthesiologica Scandinavica - November 12, 2009 Category: Anesthesiology Authors: L. COVACIU, M. ALLERS, A. LUNDERQUIST, S. RUBERTSSON Source Type: journals

Room for improvement: nurses' and physicians' views of a post-operative pain management programEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-poi...
Source: Acta Anaesthesiologica Scandinavica - November 12, 2009 Category: Anesthesiology Authors: C. S. HARTOG, J. ROTHAUG, A. GOETTERMANN, A. ZIMMER, W. MEISSNER Source Type: journals

Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac functionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Th...
Source: Acta Anaesthesiologica Scandinavica - October 30, 2009 Category: Anesthesiology Authors: V. L. KVALHEIM, M. FARSTAD, E. STEIEN, A. MONGSTAD, B. A. BORGE, P. M. KVITTING, P. HUSBY Source Type: journals

Evidence-based medicine for lung-protective ventilation: the emperors new clothes for doubtful recommendations?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Acta Anaesthesiologica Scandinavica)
Source: Acta Anaesthesiologica Scandinavica - October 29, 2009 Category: Anesthesiology Authors: J. SAMARÜTEL Source Type: journals

Infusions of albumin increase free fraction of naproxen in healthy volunteers: a randomized crossover studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - October 29, 2009 Category: Anesthesiology Authors: P. A. REINE, U. E. KONGSGAARD, A. ANDERSEN, A.-K. THØGERSEN, H. OLSEN Source Type: journals

Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 systemati...
Source: Acta Anaesthesiologica Scandinavica - October 29, 2009 Category: Anesthesiology Authors: J. ÖRMAN, E. WESTERDAHL Source Type: journals

Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatographyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. M...
Source: Acta Anaesthesiologica Scandinavica - October 29, 2009 Category: Anesthesiology Authors: K. M. GOINS, J. M. MAY, C. HUCKLENBRUCH, K. E. LITTLEWOOD, D. S. GROVES Source Type: journals

Remifentanil post-conditioning attenuates cardiac ischemia–reperfusion injury via κ or δ opioid receptor activationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: Acta Anaesthesiologica Scandinavica - October 29, 2009 Category: Anesthesiology Authors: G. T. C. WONG, R. LI, L. L. JIANG, M. G. IRWIN Source Type: journals

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/mlEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ra...
Source: Acta Anaesthesiologica Scandinavica - October 27, 2009 Category: Anesthesiology Authors: M. GOZDEMIR, B. MUSLU, H. SERT, B. USTA, R. I. DEMIRCIOGLU, O. F. KARATAS, O. SURGIT Source Type: journals

Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - October 26, 2009 Category: Anesthesiology Authors: M. BRENNI, M. WORN, M. BRÜESCH, D. R. SPAHN, M. T. GANTER Source Type: journals

Neuroprotective effects of a combination of dexmedetomidine and hypothermia after incomplete cerebral ischemia in ratsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 produc...
Source: Acta Anaesthesiologica Scandinavica - October 26, 2009 Category: Anesthesiology Authors: K. SATO, T. KIMURA, T. NISHIKAWA, Y. TOBE, Y. MASAKI Source Type: journals

Postoperative impact of regular tobacco use, smoking or snuffing, a prospective multi-center studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ambu...
Source: Acta Anaesthesiologica Scandinavica - October 26, 2009 Category: Anesthesiology Authors: M. BRATTWALL, M. WARRÉN STOMBERG, N. RAWAL, M. SEGERDAHL, E. HOULTZ, J. JAKOBSSON Source Type: journals

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 wit...
Source: Acta Anaesthesiologica Scandinavica - October 18, 2009 Category: Anesthesiology Authors: H. BREIVIK, U. BANG, J. JALONEN, G. VIGFÚSSON, S. ALAHUHTA, M. LAGERKRANSER Source Type: journals

Validation and clinical feasibility of nitrogen washin/washout functional residual capacity measurements in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: C. OLEGÅRD, S. SØNDERGAARD, J. PÅLSSON, S. LUNDIN, O. STENQVIST Source Type: journals

Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reportsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: K. J. CHIN, V. W. S. CHAN, R. RAMLOGAN, A. PERLAS Source Type: journals

Xenon and isoflurane improved biventricular function during right ventricular ischemia and reperfusionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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) gen...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: M. HEIN, A. B. ROEHL, J. H. BAUMERT, C. BLEILEVENS, S. FISCHER, P. STEENDIJK, R. ROSSAINT Source Type: journals

Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repairEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: P. BHATTACHARYA, M. C. MANDAL, S. MUKHOPADHYAY, S. DAS, P. P. PAL, S. R. BASU Source Type: journals

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: T. AKKAYA, E. UNLU, A. ALPTEKIN, H. I. GUMUS, E. UMAY, A. CAKCI Source Type: journals

Knowledge of residual curarization: an Italian surveyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Intensiv...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: P. DI MARCO, G. DELLA ROCCA, F. IANNUCCELLI, L. POMPEI, C. REALE, P. PIETROPAOLI Source Type: journals

Pharmacokinetics after an intravenous single dose of the opioid ketobemidone in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pharmacoki...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: S. LUNDEBERG, N. STEPHANSON, P. LAFOLIE, G. L. OLSSON, C.-O. STILLER, S. EKSBORG Source Type: journals

Persistent sensory dysfunction in pain-free herniotomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, ...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: E. K. AASVANG, H. KEHLET Source Type: journals

Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypassEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 r...
Source: Acta Anaesthesiologica Scandinavica - October 14, 2009 Category: Anesthesiology Authors: P. MEYBOHM, M. GRUENEWALD, J. HÖCKER, J. RENNER, J.-T. GRAESNER, C. ILIES, J. SCHOLZ, B. BEIN Source Type: journals

Sevoflurane-induced post-conditioning has no beneficial effects on neuroprotection after incomplete cerebral ischemia in ratsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - October 10, 2009 Category: Anesthesiology Authors: H.-M. LEE, D.-H. LEE, J.-H. CHOI, S.-R. LEE, Y.-W. KIM, D.-L. JEE, H.-S. DO, H.-M. LEE, S.-J. PARK Source Type: journals

Triage and mortality in 2875 consecutive trauma patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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=...
Source: Acta Anaesthesiologica Scandinavica - October 9, 2009 Category: Anesthesiology Authors: R. MEISLER, A. B. THOMSEN, H. ABILDSTRØM, N. GULDSTAD, P. BORGE, S. W. RASMUSSEN, L. S. RASMUSSEN Source Type: journals

The potential for μ-opioid receptor agonists to be anti-emetic in humans: a review of clinical dataEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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]-recepto...
Source: Acta Anaesthesiologica Scandinavica - October 9, 2009 Category: Anesthesiology Authors: KEVIN D. JOHNSTON Source Type: journals

Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-opera...
Source: Acta Anaesthesiologica Scandinavica - October 9, 2009 Category: Anesthesiology Authors: K. MATTILA, V. K. KONTINEN, E. KALSO, M. J. HYNYNEN Source Type: journals

Regional anaesthesia for a Caesarean section in women with cardiac disease: a prospective studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: E. LANGESÆTER, M. DRAGSUND, L. A. ROSSELAND Source Type: journals

Depth of anaesthesia and post-operative cognitive dysfunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 asse...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: J. STEINMETZ, K. S. FUNDER, B. T. DAHL, L. S. RASMUSSEN Source Type: journals

Should dynamic parameters for prediction of fluid responsiveness be indexed to the tidal volume?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pro...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: S. T. VISTISEN, J. KOEFOED-NIELSEN, A. LARSSON Source Type: journals

Evaluation of the Video Intubation Unit in morbid obese patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ran...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: I. BATHORY, J.-C. GRANGES, P. FRASCAROLO, L. MAGNUSSON Source Type: journals

Dopamine increases renal oxygenation: a clinical study in post-cardiac surgery patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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....
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: BENGT REDFORS, GUDRUN BRAGADOTTIR, JOHAN SELLGREN, KRISTINA SWÄRD, SVEN-ERIK RICKSTEN Source Type: journals

Pre-operative fasting: a nationwide survey of German anaesthesia departmentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, ...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: J.-P. BREUER, G. BOSSE, S. SEIFERT, L. PROCHNOW, J. MARTIN, A. SCHLEPPERS, G. GELDNER, E. SOREIDE, C. SPIES Source Type: journals

Effects of surfactant replacement on alveolar overdistension and plasma cytokines in ventilator-induced lung injuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 1...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: H. WU, T. KOBAYASHI, Q. WAN, W. SHI, H. QIAN, X. CUI, W. LI Source Type: journals

Sex differences in cerebral injury after severe haemorrhage and ventricular fibrillation in pigsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 f...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: E. SEMENAS, A. NOZARI, H. S. SHARMA, S. BASU, S. RUBERTSSON, L. WIKLUND Source Type: journals

Propofol has anti-inflammatory effects on alveolar type II epithelial cellsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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: ...
Source: Acta Anaesthesiologica Scandinavica - September 16, 2009 Category: Anesthesiology Authors: L. MA, X. WU, W. CHEN, Y. FUJINO Source Type: journals

Surface vs. aortic flush cooling during cardiac arrest in pigsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - September 7, 2009 Category: Anesthesiology Authors: A. SCHRATTER, W. WEIHS, A. JANATA, K. BAYEGAN, M. HOLZER, F. STERZ, W. BEHRINGER Source Type: journals

Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Acta Anaesthesiologica Scandinavica - September 6, 2009 Category: Anesthesiology Authors: A. PERNER, N. HAASE, J. WIIS, J. O. WHITE, A. DELANEY Source Type: journals

Single stimulation of the posterior cord is superior to dual nerve stimulation in a coracoid blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - September 6, 2009 Category: Anesthesiology Authors: J. RODRÍGUEZ, M. TABOADA, J. OLIVEIRA, B. ULLOA, M. BÁRCENA, J. ÁLVAREZ Source Type: journals

Effects of xenon on ischemic spinal cord injury in rabbits: a comparison with propofolEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 occlude...
Source: Acta Anaesthesiologica Scandinavica - September 6, 2009 Category: Anesthesiology Authors: Y. YAMAMOTO, M. KAWAGUCHI, N. KURITA, M. KAKIMOTO, S. INOUE, H. FURUYA Source Type: journals

An evaluation of monitoring possibilities of argatroban using rotational thromboelastometry and activated partial thromboplastin timeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 aP...
Source: Acta Anaesthesiologica Scandinavica - August 30, 2009 Category: Anesthesiology Authors: M. ENGSTRÖM, M. RUNDGREN, U. SCHÖTT Source Type: journals

High or low current threshold for nerve stimulation for regional anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, t...
Source: Acta Anaesthesiologica Scandinavica - August 30, 2009 Category: Anesthesiology Authors: T. STEINFELDT, J. GRAF, T. VASSILIOU, A. MORIN, K. FELDMANN, W. NIMPHIUS, J. DE ANDRES, H. WULF Source Type: journals

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skillsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. G...
Source: Acta Anaesthesiologica Scandinavica - August 30, 2009 Category: Anesthesiology Authors: E. GALVIN, H. BOESJES, J. HOL, J. F. UBBEN, J. KLEIN, S. J. C. VERBRUGGE Source Type: journals

Comparison of desaturation and resaturation response times between transmission and reflectance pulse oximetersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Acta Anaesthesiologica Scandinavica - August 30, 2009 Category: Anesthesiology Authors: S. J. CHOI, H. J. AHN, M. K. YANG, C. S. KIM, W. S. SIM, J. A. KIM, J. G. KANG, J. K. KIM, J. Y. KANG Source Type: journals