| 1. |
- Zaric, D, et al.
(författare)
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The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers
- 1996
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 40:3, s. 9-342
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation.METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography.RESULTS: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P < 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables.CONCLUSION: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.
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| 6. |
- Dobrydnjov, Igor, et al.
(författare)
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Enhancement of intrathecal lidocaine by addition of local and systemic clonidine
- 1999
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 43:5, s. 556-562
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Tidskriftsartikel (refereegranskat)abstract
- Background: Enhancement of local anaesthetic-produced regional blocks by clonidine seems well established. There are insufficient data about dose-effect relationship of combinations of clonidine with individual agents, efficiency of local versus systemic administration of clonidine, and comparative evaluation of clonidine with vasoconstrictors. Because of unavailability of long-acting local anaesthetics at the time of study, our aim was to evaluate augmentation of lidocaine spinal block with local or systemic clonidine and to compare the results with the efficacy of intrathecal phenylephrine.Methods: Ninety pts of age 50–72 yrs with ASA 1–4 physical status, scheduled for open prostatectomies, hysterectomies or ostheosynthesis of fractured hip were randomized to one of 6 treatment groups, 15 pts in each. Patients received intrathecally (L3–L4) either 100 mg of plain lidocaine (group L100); or a mixture of lidocaine 40 and 80 mg with clonidine 100 μg (groups L40-C100 and L80-C100); or a combination of lidocaine 40 and 80 mg with clonidine 300 μg orally 60 min before spinal puncture (L40-C300 and L80-C300). Addition of intrathecal phenylephrine 5 mg to 80 mg of lidocaine was also investigated (L80-P5).Results: There were no significant intergroup differences concerning demographic data or type of surgery. All operations (duration up to 150 min) were completed without need for analgesic supplementation. The addition of clonidine resulted in a significant reduction of the onset time of spinal block and prolongation of the duration of sensory and motor blocks compared to plain lidocaine or lidocaine with phenylephrine. In spite of the well-known hypotensive action of α2-agonists, haemodynamic depression only in group L80-C300 was significantly more pronounced than in L100 and L80-P5 groups. The least decrease of BP and minimal need of rescue ephedrine among all patients studied were recorded in the group receiving low dosage of lidocaine with intrathecal clonidine (L40-C100). Sedation occurred in most patients receiving clonidine.Conclusion: Our results indicate that addition of clonidine to lidocaine, irrespective of the route of administration, prolongs the duration of spinal block and permits a reduction of the lidocaine dose needed for a given duration of block. Addition of phenylephrine results in a less pronounced statistically significant prolongation of anaesthesia. The regression of sensory block before restoration of motor function seems to be a specific (and unfortunate) effect of both clonidine and phenylephrine.
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| 7. |
- Eiken, Ola, et al.
(författare)
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Effect of nitrous oxide on human skeletal muscle function
- 1996
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 40:4, s. 486-488
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nitrous oxide (N2O) is commonly administered in conjunction with parturition, which requires the performance of repeated high-force voluntary muscle actions. Therefore, we examined the effect of a subanesthetic dose of N2O on the force-velocity relationship of the quadriceps femoris muscle. METHODS: Nine healthy subjects performed maximal voluntary muscle actions once while breathing air and once while breathing a normoxic gas mixture containing 35% (N2O). Peak torque of the knee extensors was measured during concentric muscle contractions at different angular velocities (30, 60, 90, 150 and 210 degrees s-1), and eccentric (30, 60, 90, and 150 degrees s-1) and isometric (knee-joint angle approximately equal to 60 degrees) muscle actions. Maximal angular velocity was determined during unloaded knee extensions. RESULTS: N2O decreased peak torque at any given angular velocity. The overall decrease in peak averaged 4.8 +/- 2.2% (P < 0.0001). Likewise, N2O decreased maximal angular velocity by 5.7 +/- 4.3% (P < 0.01). Thus, the impairment in muscle function induced by a 35% N2O is only minute and hence most likely of little significance in clinical practice.
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| 8. |
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| 9. |
- Ekbäck, Gustav, et al.
(författare)
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Perioperative autotransfusion and functional coagulation analysis in total hip replacement
- 1995
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 39:3, s. 390-395
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Tidskriftsartikel (refereegranskat)abstract
- Functional coagulation analyses like Sonoclot and thromboelastography have not been evaluated during perioperative autotransfusion. We have prospectively studied three different transfusion regimes in 45 patients undergoing total hip arthroplasty. Blood losses were replaced either with heterologous erythrocyte concentrate (group I), intra- and postoperative autotransfusion of blood salvaged with cellsaver technique (group II) or predonated autologous erythrocyte concentrates together with salvaged blood (group III). Routine and functional coagulation analyses with a Sonoclot were performed preoperatively, 6 hours postoperatively (6 h), day 1–5 and 10. An early postoperative hypo- and late postoperadve hypercoagulative phase could be detected with Sonoclot signs of platelet function and fibrin deposition in all groups. Sonoclot coagulation analyses better correlated to both blood loss and dextran dosage than APTT and platelet count in the routine coagulation analyses. Functional coagulation analysis has a potential use in individualizing plasmasubstitution and thromboprophylaxis regimes during autotransfusion in THR.
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| 10. |
- EKLUND, J
(författare)
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PROPER AND ACCURATE USE OF REFERENCES
- 1995
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Ingår i: ACTA ANAESTHESIOLOGICA SCANDINAVICA. - : Wiley. - 0001-5172 .- 1399-6576. ; 39:5, s. 575-576
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 13. |
- Eriksson, Mats, et al.
(författare)
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Increased platelet microvesicle formation is associated with mortality ina porcine model of endotoxemia
- 1998
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 42:5, s. 551-557
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Tidskriftsartikel (refereegranskat)abstract
- Background:Gram-negative sepsis in humans and endotoxemia in pigs induce the formation of platelet microvesicles. These microvesicles are active in homeostasis and may thus contribute to the outcome in patients with activated coagulation and fibrinolysis. We decided to prospectively evaluate the effects of endotoxemia on microvesicle formation and some common physiologic variables against survival in a porcine model.Methods:Nineteen included pigs were anesthetized, monitored and subjected to an infusion of E. coli endotoxin. Microvesicle formation was determined by flow cytometry.Results:The formation of microvesicles was significantly increased in the 6 pigs that died during endotoxin exposure. This increased formation became significant from the 3rd hour of endotoxemia. Microvesicle formation did not increase in surviving endotoxemic pigs. Cardiac index, mean arterial blood pressure, base excess and systemic vascular resistance index were distinctly reduced in the animals that died as compared to those surviving the endotoxemic period.Conclusion:The increased formation of platelet microvesicles seems to be associated with poor prognosis in porcine endotoxemia. Since microvesicles are active in coagulation, they may contribute to the derangement of the coagulation system caused by endotoxemia. Different degrees of microvesicle formation may reflect inter-individual responses to a given challenge.
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| 14. |
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| 15. |
- FROSTELL, CG
(författare)
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BACKGROUND OF NITRIC-OXIDE INHALATION
- 1995
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Ingår i: ACTA ANAESTHESIOLOGICA SCANDINAVICA. - : Wiley. - 0001-5172 .- 1399-6576. ; 39, s. 58-59
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 16. |
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| 17. |
- Gannedahl, Per E., et al.
(författare)
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Minimal influence of anaesthesia and abdominal surgery on computerized vectorcardiography recordings
- 1995
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Elsevier. - 0001-5172 .- 1399-6576. ; 39:1, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- Myocardial infarction still represents a major cause of morbidity and mortality following surgical procedures. Continuous computerized on‐line vector‐ECG has previously been shown to be useful in the detection of myocardial ischaemia, in acute myocardial infarction and unstable angina pectoris and for ischaemia monitoring after PTCA procedures. This method was presently tested for the possible influence of anaesthesia and surgery during cholecystectomy under general anaesthesia (n = 9), and during inguinal hernia repairs using a spinal block (n = 5). The patients had no history, symptoms or signs of ischaemic heart disease. Analyses of vectorcardiographic changes were made in relation to predefined standardized anaesthetic and surgical procedures, all of which potentially could influence the vector‐ECG. Three vectorcardiographic trend parameters were studied: QRS‐vector difference, ST‐vector magnitude and ST‐change vector magnitude. The overall vectorcardiographic changes were minimal and smaller than vectorcardiographic changes previously reported during myocardial ischaemia and infarction. Since anaesthetic and surgical procedures per se had only minor effects on the vector ECG recordings, it is concluded that continuous computerized on‐line vectorcardiography will not be skewed by these procedures. Hence, vectorcardiography has the potential of becoming a new monitor for the detection of perioperative myocardial ischaemia.
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| 18. |
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| 19. |
- Gannerdahl, Per E., et al.
(författare)
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Vectorcardiographic changes during laparoscopiccholecystectomy may mimic signs of myocardial ischaemia
- 1997
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Elsevier. - 0001-5172 .- 1399-6576. ; 41:9, s. 1187-1192
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic surgery involves the use of intra-abdominal carbon dioxide insufflation (pneumoperitoneum). The increased intra-abdominal pressure causes marked haemodynamic changes, which may influence electrocardiographic monitoring. The aim of the present study was to elucidate the influence of pneumoperitoneum on vectorcardiographic recordings.METHODS:Vectorcardiographic changes (QRS vector difference = QRS-VD, QRS loop area, QRS magnitude, ST vector magnitude, spatial ST vector change) were recorded continuously applying computerized vectorcardiography in 12 anaesthetised cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy. Measurements were made before and during pneumoperitoneum in three different body positions (supine, Trendelenburg and reversed Trendelenburg), also employing transesophageal echocardiography and invasive blood pressure monitoring.RESULTS:Pneumoperitoneum significantly increased QRS-VD, in parallel with an enlargement in loop area and magnitude. The magnitude was significantly increased in the transversal and frontal planes and there was a tendency to increase the magnitude in the sagittal plane. The increase in QRS-VD reached levels previously associated with the development of myocardial ischaemia in patients with coronary artery disease. The ST-variables were not changed by the pneumoperitoneum. The positional changes also influenced QRS-VD significantly.CONCLUSIONS:When computerized vectorcardiography is used for ischaemia monitoring during pneumoperitoneum, the ST-variables seem reliable. However, vectorcardiographicQRS-changes should be interpreted with caution, as the QRS alterations found during pneumoperitoneum mimic the changes seen during myocardial ischaemia.
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| 21. |
- Gordh, T
(författare)
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How anaesthesiology came to Sweden
- 1998
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Ingår i: Acta anaesthesiologica Scandinavica. Supplementum. - : Wiley. - 0515-2720 .- 0001-5172 .- 1399-6576. ; 42113, s. 34-38
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Tidskriftsartikel (refereegranskat)
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| 22. |
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| 24. |
- Hahn, RG
(författare)
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Adenosine and isoflurane concentrations
- 1997
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 41:9, s. 1226-1226
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 27. |
- Hahn, RG
(författare)
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Is glycine a safe irrigating fluid?
- 1997
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 41:4, s. 545-545
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 36. |
- Lehtipalo, Stefan, et al.
(författare)
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Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery
- 1999
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 43:3, s. 258-264
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe postoperative pain is a well-known problem following shoulder surgery. This study evaluates the clinical efficacy of continuous interscalene brachial plexus block, patient-controlled analgesia, and morphine (i.v. and i.m.) for postoperative analgesia in this setting.METHODS: Thirty patients, scheduled for acromioplasty during general anesthesia, were randomly allocated to one of three different postoperative pain management groups. Group MO received morphine (5 mg i.m. and 2 mg i.v.) when visual analogue pain score (VAS) > 3, group PL received a continuous interscalene brachial plexus block with bupivacaine (1.25 mg kg-1 + 0.25 mg kg-1 h-1) and group PCA received patient-controlled analgesia with morphine (bolus 1 mg). Postoperative pain relief was assessed (24 h) by VAS, circulatory and respiratory stress parameters (heart rate, systemic arterial pressure and respiratory rate) and stress metabolites (glucose, lactate, glycerol by abdominal subcutaneous microdialysis).RESULTS: Pain relief in the PL group was effective (VAS < 3) and significantly more potent than in groups MO and PCA, except at 16 and 20 h. Lactate was significantly increased in the PL group, glucose was significantly increased in all groups, while glycerol showed a variable pattern. There were no significant stress metabolite differences among groups. VAS showed no statistical correlation with microdialysate, respiratory or circulatory data.CONCLUSION: Successful continuous interscalene brachial plexus block provides very good pain relief following shoulder surgery and is superior to the other methods studied. However, we were unable to demonstrate a correlation between VAS pain scores and stress indicators in metabolic, circulatory and respiratory parameters.
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| 38. |
- Lindahl, S
(författare)
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A salute for Torsten Gordh, 90
- 1998
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Ingår i: ACTA ANAESTHESIOLOGICA SCANDINAVICA. - : Wiley. - 0001-5172 .- 1399-6576. ; 42, s. 1-1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 39. |
- Lindahl, SGE
(författare)
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The Radiometer Prize for priceless achievements
- 1997
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 41:9, s. 1093-1094
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 40. |
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| 41. |
- Luhr, O., et al.
(författare)
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A retrospective analysis of nitric oxide inhalation in patients with severe acute lung injury in Sweden and Norway 1991-1994
- 1997
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 41:10, s. 1238-46
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with severe acute lung injury (ALI) have been treated compassionately on doctors' initiative with inhaled nitric oxide (INO) in Sweden and Norway since 1991. In 1994 the previously used technical grade nitric oxide was replaced by medical grade nitric oxide. METHODS: We have carried out a retrospective data collection on all identified adult patients treated with INO for >4 h during the period 1991-1994 focusing on safety aspects and patient outcome. We used the following exclusion criteria (1) Age <18 years, (2) Simultaneous treatment with extracorporeal removal of CO2 (3) NO inhalation period <4 h, (4) Incomplete or missing patient charts, (5) Use of INO in order to treat pulmonary hypertension following cardiac surgery, with little or no acute lung injury. RESULTS: Inclusion criteria were met by 56 out of 73 identified patients. Mean age was 48+/-19 years and the median duration of INO treatment was 102 h. PaO2/FIO2 ratio at start of treatment was 85 +/- 33 mm Hg with a lung injury score (LIS) of 3.2+/-0.8. The aetiology of the lung injury was pneumonia (n= 27), sepsis (n=12) and trauma (n=8). Survival to hospital discharge was 41% and survival after 180 d was 38%. Three serious adverse events were identified, two from technical failures of the INO delivery device and one withdrawal reaction necessitating slow weaning from INO. No methaemoglobin values >5% were reported during treatment. CONCLUSION: The overall mortality did not differ dramatically from historical controls with high mortality. Only a randomised study may determine whether INO as an adjunct to treatment alters the outcome in severe ALI. One cannot at present advocate the routine use of INO in patients with ALI outside such studies.
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| 45. |
- Metcalf, Kerstin, et al.
(författare)
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Intravenous endotoxin does not increase tissue extravasation of albumin in rats
- 1998
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 42:8, s. 966-973
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.Methods: Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.Main Results: LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).Conclusion: After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.
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