| 1. |
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| 2. |
- Gardenfors, F, et al.
(författare)
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Adverse biochemical and physiological effects of prostacyclin in experimental brain oedema
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:10, s. 1316-1321
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prostacyclin (PGI(2)) and its stable analogues are known to reduce capillary hydraulic permeability. This study explores the biochemical and physiological effects of i.v. infusion of low-dose PGI(2) in an experimental model of vasogenic brain oedema. Methods: Twenty-seven anaesthetized and mechanically ventilated piglets with brain oedema induced by intrathecal injection of lipopolysaccharide (LPS) were used. Five of the animals received a continuous infusion of PGI(2) (1 ng kg(-1) min(-1)) i.v. Four microdialysis catheters were placed in the brain to measure interstitial concentrations of glucose, lactate, and glycerol. Mean arterial pressure (MAP), intracranial pressure (ICP) and temperature were monitored continuously. Low-dose infusion of PGI(2) started 1 h before the LPS injection and was constant during the study period. Results: Intracranial pressure increased significantly in animals treated with PGI(2). The increase in ICP was associated with significant cerebral biochemical changes: decrease in glucose, increase in lactate, increase in lactate/glucose ratio and increase in glycerol. Conclusion: In LPS-induced brain oedema i.v. infusion of low-dose PGI(2) caused a further increase in ICP and a perturbation of energy metabolism, indicating cerebral ischemia and degradation of cellular membranes.
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| 3. |
- Holmström, Anders, et al.
(författare)
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Desflurane results in higher cerebral blood flow than sevoflurane or isoflurane at hypocapnia in pigs.
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:4, s. 400-404
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Tidskriftsartikel (refereegranskat)abstract
- Background: In clinical neuroanaesthesia, the increase in cerebral blood flow (CBF) and intracranial pressure caused by the cerebral vasodilative effects of an inhalational anaesthetic agent is counteracted by the cerebral vasoconstriction induced by hypocapnia. Desflurane and sevoflurane may have advantages over the more traditionally used isoflurane in neuroanaesthesia but their dose-dependent vasodilative effects at hypocapnia have not been compared in the same model using truly equipotent minimal alveolar concentrations (MACs). Method: Desflurane, sevoflurane and isoflurane were administered in a randomized order to six pigs at 0.5 and 1.0 MAC. The intra-arterial xenon clearance technique was used to calculate CBF. Blood pressure was invasively monitored. Cerebral and systemic physiological variables were recorded first at normocapnia (PaCO2 5.6 kPa) and then at hypocapnia (PaCO2 3.5 kPa). Electroencephalographic (EEG) activity was continuously recorded. Results: None of the three agents abolished cerebrovascular reactivity to hyperventilation, and at 0.5 MAC all had similar effects on CBF at hypocapnia. Desflurane at 1.0 MAC was associated with 16% higher CBF (P = 0.027) at hypocapnia than isoflurane, and with 24% higher CBF (P = 0.020) than sevoflurane. There was no seizure activity in the EEG. Conclusion: More cerebral vasodilation at hypocapnia with high doses of desflurane than with sevoflurane or isoflurane indicates that desflurane might be less suitable for neuroanaesthesia than sevoflurane and isoflurane.
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| 4. |
- Malmgren, W, et al.
(författare)
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Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication.
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:10, s. 1277-1282
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. Methods: Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg-1 together with either morphine 0.15 mg kg-1 or midazolam 0.30 mg kg-1 approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. Results: There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. Conclusion: In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia.
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| 5. |
- Naredi, S., et al.
(författare)
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An outcome study of severe traumatic head injury using the "Lund therapy" with low-dose prostacyclin
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell. - 0001-5172 .- 1399-6576. ; 45:4, s. 402-406
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are two independent head injury outcome studies using the “Lund concept”, and both showed a mortality rate of about 10%, and a favourable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund concept aims at controlling intracranial pressure, and improving microcirculation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary pressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculation, which finds support from a microdialysis‐based clinical study and an experimental brain trauma study. The present clinical outcome study aims at evaluating whether the previously obtained good outcome with the Lund therapy can be reproduced, and whether the addition of prostacyclin has any adverse side‐effects.Methods: All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) ≤8, admitted to the University Hospital of Umeå during 1998 were included. The Lund therapy including prostacyclin infusion for the first three days at a dose of 0.5 ng kg−1 min−1. Outcome was evaluated according to the GOS >10 months after the injury.Results: One patient died, another suffered vegetative state and 7 severe disability. Of the 22 patients with favourable outcome, 19 showed good recovery and 3 moderate disability. No adverse side‐effects of prostacyclin were observed.Conclusion: The outcome results from previous studies using the Lund therapy were reproduced, and no adverse side‐effects of low‐dose prostacyclin were observed.
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| 6. |
- Olofsson, K, et al.
(författare)
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Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:6, s. 679-684
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sleep disturbance is common in intensive care patients. Aside from its unpleasantness, there is a correlation with intensive care unit (ICU) syndrome/delirium. Reasons for sleep deprivation appear to be multifactorial, including the underlying illness, an acute superimposed disturbance, medications, and the ICU environment itself. There are reasons to believe that alterations of the 'biological clock' might contribute. Melatonin secretion is one reflection of this internal sleep/wake mechanism. Melatonin levels are normally high during the night and low during daytime, being suppressed by bright light. Methods: Melatonin levels in blood and urine were studied over 3 consecutive days in eight critically ill patients during deep sedation and mechanical ventilation. Sedation was assessed with the sedation-agitation (SAS) scale and bispectral index (BIS) monitor. Results: The circadian rhythm of melatonin release was abolished in all but one patient, who recovered much more quickly than the others. There was no correlation between melatonin levels and levels of sedation. Conclusions: This study indicates that dyssynchronization of the melatonin secretion rhythm is common in critically ill and mechanically ventilated patients. It could be hypothesized that an impairment of the melatonin rhythm may play a role in the development of sleep disturbances and delirium in intensive care patients, and that melatonin supply could reduce the incidence of these phenomena.
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| 7. |
- Roscher, Roger, et al.
(författare)
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Effects of dopamine on porcine myocardial action potentials and contractions at 37 degrees C and 32 degrees C
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:4, s. 421-426
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little information exists on the effects of drugs with cardiovascular action in hypothermia, and some findings have indicated paradoxic effects of dopamine in this setting. As we have not found any data on the electrophysiologic and contractile effects of dopamine on the heart in hypothermia, we decided to study this in pig myocardium, since pigs have a cardiovascular system more similar to that of humans than other animals. METHODS: Excised muscle strips from pig ventricular septum were mounted in an organ bath. After 45 min of equilibration at 37 degrees C or 32 degrees C, resting and action potentials, time to peak contraction and contractile force were recorded during pacing with a frequency of 60/min. Dopamine at 4 microM or 8 microM was added and new recordings were made after 15 min. RESULTS: Cooling to 32 degrees C caused a prolongation of contraction by 48% and the contractile force increased by 39%. The membrane action potential duration at 50% and 90% repolarization levels increased at 32 degrees C by 28% and 16% respectively. Dopamine significantly (P<0.05) increased the contractile force and membrane action potential duration at 50% and 90% repolarization levels both in normothermia and in hypothermia, whereas the duration of the contraction was not significantly changed. CONCLUSION: Cooling to 32 degrees C significantly prolongs the myocardial action potential and the contraction duration. Dopamine increases the contractile force and prolongs the action potential both at 37 degrees C and at 32 degrees C.
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| 8. |
- Slots, P, et al.
(författare)
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One way to ventilate patients during fibreoptic intubation
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:4, s. 507-509
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Tidskriftsartikel (refereegranskat)abstract
- Occasionally anaesthesiologists find themselves in situations where ventilation during intubation with a fibreoptic bronchoscope (FOB) is desirable. In order to ventilate the patient during the FOB intubation, we used a 90 degree angle swivel connector, normally used for fibreoptic bronchoscopia in an intubated patient. After a nasotracheal tube is placed with the tip in the oropharynx, ventilation of the patient is possible via this tube by closing the mouth and other nostril. The fibrescopic procedure is done through the right-angle connector with suction port and the tube is used to guide the tip of the FOB to the aditus laryngis. The method has been used in 7 patients who were impossible to intubate with a conventional procedure. In all patients ventilation was possible and intubation was performed in 5 min (range 1-15).
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| 9. |
- Tunblad, K, et al.
(författare)
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Altered brain exposure of morphine in experimental meningitis studied with microdialysis
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:3, s. 294-301
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Tidskriftsartikel (refereegranskat)abstract
- Background: During pathologic conditions such as meningitis and traumatic brain injury the function of the blood-brain barrier (BBB) is disturbed. In the present study we examined the cerebral pharmacokinetic pattern of morphine in the intact brain and during experimentally induced meningitis using a pig model. Secondly, the use of intracerebral microdialysis as a potential tool for monitoring damage in the BBB by studying the pharmacokinetics of morphine is addressed. Methods: Six pigs were studied under general anaesthesia. One occipital and two frontal microdialysis probes and one pressure transducer were inserted into the brain tissue. Another probe was placed into the jugularis interna. Morphine 1 mg kg(-1) was administered as a 10-min infusion, and morphine concentrations were then measured for 3 h. Meningitis was subsequently induced by injecting lipopolysaccharide into the cisterna magna. When meningitis was established, the morphine experiment was repeated. Results: The unbound area under the concentration-time curve (AUC(u)) ratio of morphine in brain to blood was 0.47 (0.19) during the control period, and 0.95 (0.20) (P<0.001) during meningitis. The increase in the brain/blood AUC(u) ratio during meningitis implies decreased active efflux and increased passive diffusion of morphine over the BBB. The half-life of morphine in brain was longer than in blood during both periods, and was unaffected by meningitis. Conclusion: This study demonstrates that the morphine exposure to the brain is significantly increased during meningitis as compared with the control situation.
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| 10. |
- Åkeson, Jonas, et al.
(författare)
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Convulsions on anaesthetic induction with sevoflurane in young children.
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:4, s. 405-407
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Tidskriftsartikel (refereegranskat)abstract
- Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood-gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children. Case 1: during induction of anaesthesia with sevoflurane by facemask in a 3-year-old healthy boy, there were symmetrical clonic seizure-like movements of the upper extremities for 60 s. Case 2: on re-induction of anaesthesia with sevoflurane because of profuse bleeding following nasal adenoidectomy in a 4-year-old healthy girl with a family history of epilepsy, there were symmetrical tonic and clonic seizure-like movements for 30-40 s in the upper and lower extremities. Both episodes ceased spontaneously. Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.
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| 11. |
- Alkaissi, Aidah, et al.
(författare)
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Disturbing postoperative symptoms are not reduced by prophylactic antiemetric treatment in patients at high risk for post-operative nausea and vomiting
- 2004
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:6, s. 761-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To give prophylactics or timely treatment for post-operative nausea and vomiting (PONV) is the question. We compared the intensity and number of disturbing post-operative symptoms (i.e. pain, PONV, headache, fatigue, etc.) after prophylactic antiemetic treatment in a group of patients with >30% risk for post-operative vomiting. METHODS: Four hundred and ninety-five patients, from three hospitals, planned for gynaecological surgery were randomized double blind. They were given granisetron 3 mg, droperidol 1.25 mg or no prophylactic antiemetic. Post-operative symptoms were followed for 24 h using a questionnaire. Symptoms were analyzed both according to their intensity and in a dichotomous fashion. RESULTS: The intensity of different symptoms differed depending on whether droperidol, granisetron or no antiemetic had been given (P = 0.005) but the overall incidence of moderate to very severe symptoms was similar in all groups. No group fared better in general. The total number of symptoms was higher in the groups given prophylactic treatment (P < 0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis was 27%[95% confidence interval (CI) 8-43] and 22% (2-38), respectively. The NNT (number needed to treat) for granisetron (0-24 h) was 7 and for droperidol 8. The NNH (number needed to harm) (0-24 h) for headache and visual disturbances was 6 and 13 (NS) for granisteron and, 50 (NS) and 6 for droperidol. CONCLUSION: The intensity of symptoms or the total number of disturbing symptoms did not decrease after prophylactic antiemetic treatment in a group of patients, but the profile of disturbing symptoms changed. The relevance of post-operative symptoms in terms of patients' well-being needs to be addressed.
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| 12. |
- Andersson, L., et al.
(författare)
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Effect of CO2 pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:5, s. 552-560
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO2) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion ((V) over dot (A)/(Q) over dot) before and during pneumoperitoneum by using the multiple inert gas technique. Methods: Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The (V) over dot (A)/(Q) over dot relationships were evaluated by the multiple inert gas elimination technique before and during pneurnoperitoneum to obtain a direct measure of the pulmonary shunt. Results: Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO2 from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low (V) over dot (A)/(Q) over dot was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. Conclusions: In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg- causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.
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| 13. |
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| 14. |
- Axelsson, P, et al.
(författare)
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Betamethasone does not prevent nausea and vomiting induced by ipecacuanha
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:10, s. 1283-1286
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Tidskriftsartikel (refereegranskat)abstract
- Background: Corticosteroids reduce the incidence of PONV but the mode of action is not known. The purpose of this study was to evaluate if betamethasone has serotonin (5-HT) antagonistic effects. Ipecacuanha is known to release serotonin and therefore it was used to induce nausea and vomiting. The 5-HT3 antagonist ondansetron was used as a control substance. Methods: In a randomized, double-blind, cross-over, placebo-controlled study 10 healthy male and female volunteers (6 M/4F), mean age 19.5 (18-23) years, mean weight 69.7 (53-84) kg, were studied on three occasions separated by at least 1 week. They were randomly allocated to receive pretreatment with betamethasone 8 mg, ondansetron 8 mg, or normal saline 2 ml as placebo on each occasion, 15 min before oral ingestion of 30 ml of Ipecacuanha syrup. After ingestion of ipecacuanha, vomitings were recorded and the intensity of nausea was estimated with a visual analog scale during 2 h. Results: During the first 2 h after ingestion of ipecacuanha nine of the 10 volunteers vomited both after betamethasone and placebo. No volunteer vomited after ondansetron (P < 0.01 vs. betamethasone and placebo). The max VAS for nausea was significantly higher after betamethasone and placebo compared to ondansetron (P < 0.01). There were no statistically significant differences of the max VAS for nausea between betamethasone and placebo. Conclusion: This study in volunteers has shown that betamethasone does not prevent nausea and vomiting induced by oral intake of ipecacuanha syrup. As ipecacuanha releases 5-hydroxytryptamin, it can be concluded that betamethasone does not have 5-HT3 antagonistic effects.
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| 15. |
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| 16. |
- Basu, Samar, et al.
(författare)
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Lipid peroxidation induced by an early inflammatory response in endotoxaemia
- 2000
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 44:1, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endotoxaemic challenge promptly causes lipid peroxidation. Porcine endotoxaemia can be used to replicate severe human septic shock. This model was used to evaluate non-enzymatic [8-Iso-prostaglandin F2alpha (8-Iso-PGF2alpha)] and enzymatic [15-keto-13,14-dihydro-prostaglandin F2alpha (15-K-DH-PGF2alpha)] lipid peroxidation, respectively, in relation to survival. The aim of this study was to correlate, if possible, pathophysiologic events during endotoxaemia to the levels of these arachidonic acid metabolites. METHODS: Nineteen pigs were anaesthetised, monitored (circulatory and respiratory variables in relation to lipid peroxidation) and given a continuous 6 h E. coli endotoxin (10 microg x kg(-1) x h(-1)) infusion. All animals were mechanically ventilated at constant tidal volumes and the inspired oxygen fraction was kept constant during the experimental period. RESULTS: This endotoxin infusion caused expressed derangements in all pigs and death in 9 of them. The levels of 8-Iso-PGF2alpha, indicating oxidative injury, were different in time course, magnitude and fashion between survivors and non-survivors. The levels of 15-K-DH-PGF2alpha, indicating inflammatory response, showed a similar pattern. At 1 h the CO2 partial pressure in arterial blood was significantly higher in non-surviving pigs and correlated (r: 0.7; P<0.05) to the levels of 15-K-DH-PGF2alpha. Prostaglandin F2alpha is mainly metabolised in the lung. The lung weights were significantly (P<0.05) higher in non-surviving than in surviving animals. Both free radical and cyclooxygenase catalysed oxidative modification occurs during endotoxaemia. CONCLUSION: Increased metabolism and inflammation, as evaluated by 15-K-DH-PGF2alpha, in the group of non-survivors may mediate the increase in arterial CO2. Thus, increased lipid peroxidation seems to be associated with endotoxaemic organ dysfunction and increased mortality.
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| 17. |
- Berg, Sören, 1954-, et al.
(författare)
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Albumin extravasation and tissue washout of hyaluronan after plasma volume expansion with crystalloid or hypooncotic colloid solutions
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:2, s. 166-172
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intravascular volume expansion is followed by loss of fluid from the circulation. The extravasation of albumin in this readjustment is insufficiently known. Methods: Twelve male volunteers participated, each in three separate sessions, in a controlled, randomised, open fashion. They received one of the following: albumin 40g/L,(7.1mL/kg, i.e. 500mL per 70kg), Ringer's acetate (21.4mL/kg), or dextran 30g/L (7.1mL/kg). The fluids were infused during 30min and the subjects were followed for 180min. ECG, arterial oxygen saturation and non-invasive arterial pressure were recorded. Haemoglobin, haematocrit, serum albumin and osmolality, plasma colloid osmotic pressure and hyaluronan concentration were determined in venous samples. Results: The serum albumin concentration decreased (P < 0.05, ANOVA) following Ringer's acetate or dextran, whereas serum osmolality was unchanged in all groups. The colloid osmotic pressure decreased (P<0.05) after the Ringer solution. The blood volume increase was estimated from the decrease in haemoglobin concentration and did not differ between the three fluids. The cumulated extravasation of albumin was largest following albumin (10.4 ▒ 5.4g, mean ▒ SD), less following dextran (5.6 ▒ 5.0 g) and negligible in the Ringer group (0.5 ▒ 10.0 g, P < 0.05 against albumin). However, the Ringer solution increased the plasma concentration of hyaluronan drastically. Conclusions: Infusion of hypotonic colloidal solutions entails net loss of albumin from the vascular space. This is not the case after Ringer's acetate. Increased interstitial hydration from the latter fluid is followed by lymphatic wash out of hyaluronan. ⌐ Acta Anaesthesiologica Scandinavica.
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| 18. |
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| 19. |
- Björnström, Karin, 1971-, et al.
(författare)
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The difference between sleep and anaesthesia is in the intracellular signal : propofol and GABA use different subtypes of the GABAA receptor β subunit and vary in their interaction with actin
- 2003
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 47:2, s. 157-164
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Tidskriftsartikel (refereegranskat)abstract
- Background: Propofol is known to interact with the γ-aminobutyric acidA (GABAA) receptor, however, activating the receptor alone is not sufficient for producing anaesthesia.Methods: To compare propofol and GABA, their interaction with the GABAA receptor β subunit and actin were studied in three cellular fractions of cultured rat neurons using Western blot technique.Results: Propofol tyrosine phosphorylated the GABAA receptor β2 (MW 54 and 56 kDa) and β3 (MW 57 kDa) subtypes. The increase was shown in both the cytoskeleton (β2(54) and β2(56) subtypes) and the cell membrane (β2(54) and β3 subtypes). Concurrently the 56 kDa β2 subtype was reduced in the cytosol. Propofol, but not GABA, also tyrosine phosphorylated actin in the cell membrane and cytoskeletal fraction. Without extracellular calcium available, the amount of actin decreased in the cytoskeleton, but tyrosine phosphorylation was unchanged. GABA caused increased tyrosine phosphorylation of β2(56) and β3 subtypes in the membrane and both β2 subtypes in the cytoskeleton but no cytosolic tyrosine phosphorylation.Conclusion: The difference between propofol and GABA at the GABAA receptor was shown to take place in the membrane, where the β2(54) was increased by propofol and instead the β2(56) subtype was increased by GABA. Only propofol also tyrosine phosphorylated actin in the cell membrane and cytoskeletal fraction. This interaction between the GABAA receptor and actin might explain the difference between anaesthesia and physiological neuronal inhibition.
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| 20. |
- Broome, M., et al.
(författare)
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Acute effects of angiotensin II on myocardial performance
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:9, s. 1147-54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Specific angiotensin II (Ang II) receptors exist in many organs including peripheral blood vessels, cardiac myocytes and the central nervous system. This suggests multiple sites of actions for Ang II throughout the cardiovascular system. Cardiac effects of Ang II are not completely understood, though its prominent vasoconstrictor actions are well described. This study was designed to assess left ventricular function during administration of Ang II using relatively load-independent methods in a whole-animal model. METHODS: Ang II was infused in incremental doses (0-200 microg x h(-1)) in anaesthetised instrumented pigs (n=10). Cardiac systolic and diastolic function were evaluated by analysis of the left ventricular pressure-volume relationship. RESULTS: Heart rate (HR), mean arterial pressure (MAP) and systemic vascular resistance (SVR) increased dose-dependently with Ang II, while cardiac output (CO) remained unchanged. Systolic function indices, end-systolic elastance (Ees) and preload recruitable stroke work (PRSW), demonstrated dose-dependent increases. The diastolic function parameter tau (tau) did not change with increasing Ang II dose. CONCLUSION: Ang II infusion caused increases in contractility indices in anaesthetised pigs in the doses used in this study. The mechanisms for these systolic function effects may be a direct myocardial effect or modulated through changes in autonomic nervous system activity.
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| 21. |
- Broome, M., et al.
(författare)
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Angiotensin II mesenteric and renal vasoregulation : dissimilar modulatory effects with nitroprusside
- 2000
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 44:10, s. 1238-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of systemic arterial pressure for the vascular effects of angiotensin II (Ang II) and the interactions between Ang II and perfusion pressure-dependent local vascular control mechanisms are not well understood. This study addresses these aspects of exogenous Ang II in the mesenteric and renal regional circulations. METHODS: Ang II was infused in incremental doses (0-200 microg/h) in anesthetized instrumented pigs (n=10). Renal and portal blood flows were measured by perivascular ultrasound. In the second part of the study, sodium nitroprusside (SNP) was infused at doses titrated to keep mean arterial pressure constant, in spite of concurrent Ang II administration. RESULTS: Powerful dose-dependent vasoconstrictions by Ang II were found in renal and mesenteric vascular beds (at highest Ang II doses vascular resistances increased by 109% and 88% respectively). Ang II-induced vasoconstriction was fully inhibited in the mesenteric, but not in the renal circulation, during conditions of constant mean arterial pressures achieved by SNP infusion. CONCLUSIONS: Mesenteric, but not renal, vasoconstriction by Ang II was inhibited by pharmacological maintenance of perfusion pressure. This could reflect differences between these vascular beds as regards the importance of co-acting myogenic pressure-dependent vasoconstriction. Alternatively, as the drug chosen for pressure control, sodium nitroprusside, serves as a nitric oxide donor, the relative balance between nitric oxide-mediated vasodilation and Ang II-induced vasoconstriction could have regional differences.
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| 22. |
- Broome, Michael, et al.
(författare)
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Splanchnic vasoconstriction by angiotensin II is arterial pressure dependent
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:1, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Our hypothesis was that splanchnic vasoconstriction by exogenous angiotensin II (Ang II) is significantly potentiated by local mechanisms increasing vasomotor tone and that splanchnic tissue oxygenation during administration of Ang II is perfusion pressure dependent. The aim was to study local splanchnic circulatory effects and tissue oxygenation during intravenous infusion of Ang II at different levels of regional arterial driving pressure in a whole-body large animal model. METHODS: Ang II was infused in incremental doses (0-200 microg x h-1) in anaesthetised instrumented pigs (n=8). Mean superior mesenteric arterial pressure (PSMA) was adjusted by a local variable perivascular occluder. Perivascular ultrasound and laser-Doppler flowmetry were used for measurements of mesenteric venous blood flow and superficial intestinal blood flow, respectively. Intestinal oxygenation was evaluated by oxygen tissue tension (PtiO2) and lactate fluxes. RESULTS: Ang II produced prominent and dose-dependent increases in mesenteric vascular resistance (RSMA) when the intestine was exposed to systemic arterial pressure, but Ang II increased RSMA only minimally when PSMA was artificially kept constant at a lower level (50 mmHg) by the occluder. Although Ang II decreased PtiO2 at a PSMA of 50 mmHg, splanchnic lactate production was not observed. CONCLUSION: We demonstrate that splanchnic vasoconstriction by exogenous Ang II is dependent on arterial driving pressure, suggesting significant potentiation through autoregulatory increases in vasomotor tone. Intestinal hypoxaemia does not seem to occur during short-term infusion of Ang II in doses that significantly increases systemic arterial pressure.
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| 23. |
- Dobrydnjov, Igor, 1963-, et al.
(författare)
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Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:7, s. 806-814
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of the present study was to evaluate the postoperative analgesic and adverse effects of equal doses of oral or intrathecal clonidine in spinal anaesthesia with bupivacaine plain.Methods: Forty-five ASA I-III orthopaedic patients scheduled for osteosynthesis of a traumatic femur fracture were randomised in a double-blind fashion to one of 3 groups. Patients received 15 mg of plain bupivacaine intrathecally (group B) or an intrathecal mixture of bupivacaine 15 mg and clonidine 150 mg (group CIT). In group CPO oral clonidine 150 mg was administered 60 min before intrathecal injection of bupivacaine 15 mg.Results: Oral and intrathecal clonidine prolonged the time until the first request for analgesics, 313 ± 29 and 337 ± 29 min, respectively, vs. 236 ± 27 min in group B (P < 0.01). The total 24- h PCA morphine dose was significantly lower in group CIT(19.3 ± 1.3 mg) compared to groups B and CPO(33.4 ± 2.0 and 31.2 ± 3.1 mg). MAP was decreased significantly during the first hour after intrathecal clonidine(14%) and during the first 5 h after oral clonidine(14–19%). HR decreased in CIT during the 5th and 6th postoperative hours(7–9%) and during the first 2 h(9%) in CPO (P < 0.01). The degree of sedation was more pronounced in group CPO during the first 3 h. Four patients had pruritus in group B.Conclusions: Addition of intrathecal clonidine prolonged analgesia and decreased morphine consumption postoperatively more than oral clonidine. Hypotension was more pronounced after oral than after intrathecal clonidine. Intrathecal clonidine is therefore recommended.
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| 24. |
- Ekman, Andreas, et al.
(författare)
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Reduction in the incidence of awareness using BIS monitoring
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 48, s. 20-26
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Tidskriftsartikel (refereegranskat)abstract
- Reduction in the incidence of awareness using BISmonitoringA. EKMAN1,M-L.LINDHOLM1,C.LENNMARKEN2and R. SANDIN11Department of Anaesthesia and Intensive Care, Regional hospital, Kalmar, and The Karolinska Institute, Stockholm, and2Department ofAnaesthesia and Intensive Care, University Hospital, Linko¨ping, SwedenBackground: Explicit recall (ER) is evident i n a pproximat ely0.2% of patients given general anaesthesia including musclerelaxants. This prospective study was performed to evaluate ifcerebral monitoring using BIS to guide the conduction ofanaesthesia could reduce this incidence significantly.Patients and methods: A prospective cohort of 4945 consecutivesurgical patients requiring muscle relaxants and/or intubationwere monitored with BIS and subsequently interviewed for ERon three occasions. BIS values between 40 and 60 were recom-mended. The results from the BIS-monitored group of patientswas compared with a historical group of 7826 similar cases in aprevious study when no cerebral monitoring was used.Results: Two patients in th e BIS-monitored grou p, 0 .0 4% ,hadER as c ompared with 0.18% in the control group (P < 0.038).Both BIS-monitored patients with ER were aware during intub-ation when they had high BIS values (>60) for 4 min andmore than 10 min, respectively. However, periods with high BIS ¼ 4 min were al so eviden t in other patient s with no ER .Episodes with high BIS, 4 min or more, were found in 19% ofthe monitored patients during induction, and in 8% of casesduring maintenance.Conclusions: The use of BIS monitoring during general anaes-thesia requiring endotracheal intubation and/or muscle relax-ants was associated with a significantly reduced incidence ofawareness as compared with a historical control population.
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| 25. |
- Gradin, Maria
(författare)
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Need for a reliable pain evaluation scale in the newborn in Sweden
- 2000
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 44:5, s. 552-554
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Tidskriftsartikel (refereegranskat)abstract
- Background: A major problem in pain treatment in the newborn is the ability to assess the degree of experienced pain. Several different methods for estimating pain in the newborn have been introduced in recent years. The objectives of this study were to see whether pain scoring was used in Swedish neonatal units, and by which method, and furthermore to observe whether any changes had occurred between 1993 and 1998.Method: A questionnaire was distributed to all Swedish neonatal units in 1993 and 1998.Results: In both 1993 and 1998, 86% of all clinics answered the questionnaire. Two-thirds of these clinics used some method for estimating pain in the newborn at both times. Eight clinics used a structured method in the latter period compared to one in the earlier period. A higher proportion of units having full intensive care measured pain compared to other units.Conclusion: The study shows that an unchanging low proportion of neonatal units in Sweden attempt to assess pain. There is a minor increase in the number of departments that use a structured method for pain scoring. Documentation of pain intensity is still inadequate and should be improved.
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| 26. |
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| 27. |
- Haney, Michael, et al.
(författare)
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Heart-lung interactions during positive pressure ventilation : left ventricular pressure-volume momentary response to airway pressure elevation
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:6, s. 702-709
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Left ventricular (LV) pressure and volume changes are known to occur in response to positive airway pressure (PAP). We aimed to further describe the immediate LV response to increased PAP as demonstrated in successive heart cycles with LV pressure and volume alterations. We postulated that these acute systematic LV events during institution of PAP can follow a distinct pattern that would allow calculation of parameters of systolic function, including end-systolic elastance (Ees) and preload recruitable stroke work (PRSW). We also aimed to examine the relationship of PAP-derived Ees and PRSW to the same parameters derived from vascular occlusion. METHODS: Eight anesthetized adult pigs were studied with invasive circulatory measurements including LV pressure and volume (conductance). The PAP intervention was an airway pressure plateau of 15 cm H2O for 6 s (APP). Venous occlusion was performed by transient balloon inflation in the inferior vena cava (IVCO). Ees and PRSW were derived for each APP and IVCO intervention. RESULTS: Central circulatory variables during APP and IVCO are reported. LV systolic function parameters could be derived from each of the heart-lung interactions during APP sequences. Ees and PRSW derived from APP showed a significant positive bias in relation to those derived from the IVCO sequence. CONCLUSIONS: We conclude that the heart-lung interactions during APP of the magnitude and duration shown here can allow derivation of Ees and PRSW. These parameters are not interchangeable with Ees and PRSW derived from IVCO.
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| 28. |
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| 29. |
- Holmér Pettersson, Pia, et al.
(författare)
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Early bioavailability of paracetamol after oral or intravenous administration
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:7, s. 867-870
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Tidskriftsartikel (refereegranskat)abstract
- Background: Paracetamol is a peripherally acting analgesic commonly used in multimodal post-operative pain management to reduce the need for more potent analgesics with their unwanted side-effects. The dose and optimal galenical form for achieving analgesic concentrations is not well defined. The primary aim of this pilot project was to study the early bioavailability for two fixed doses of orally administrated paracetamol and one dose of intravenous propacetamol, all of which were given after minor surgery.Methods: Thirty-five patients undergoing day surgery were divided into five groups, seven patients each. Groups received either 1 g of an ordinary paracetamol tablet, 2 g of an ordinary paracetamol tablet, 1 g of a bicarbonate paracetamol tablet, 2 g of a bicarbonate paracetamol tablet or 2 g intravenously of prodrug propacetamol. We studied the plasma concentration of paracetamol during the first 80 min after administration.Results: Within 40 min, intravenous propacetamol gave a median plasma paracetamol concentration of 85 µmol/l (range 65–161) and decreased thereafter. After oral administration, median plasma paracetamol concentration increased with increasing dose and time, but there were huge inter-individual differences at all time points studied. At 80 min after oral paracetamol the median plasma concentrations were 36 and 129 µmol/l for the 1- and 2-g groups, respectively, with an overall range between 0 and 306 µmol/l.Conclusion: Oral administration of paracetamol as part of multimodal pain management immediately post-operatively resulted in a huge and unpredictable variation in plasma concentration compared with the intravenous administration.
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| 30. |
- Holmér Pettersson, Pia, et al.
(författare)
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Patient-controlled versus nurse-controlled pain treatment after coronary artery bypass surgery
- 2000
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 44:1, s. 43-47
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain after coronary artery bypass surgery persists for several days. A continuous intravenous infusion of an opioid adequately accomplishes good pain control in the intensive care unit, but it is often not suitable on the ordinary ward. Patient-controlled analgesia (PCA) with intermittent injections delivered by one of the new devices now available could be an alternative to conventional nurse-controlled analgesia (NCA) based on intermittent injections. The aim was to compare these two techniques with respect to efficacy and the amount of opioid used.Methods: Forty-eight patients randomly received PCA or NCA with ketobemidone following extubation after coronary artery bypass grafting. Drug consumption, pain assessment with the visual analogue score (VAS) and possible side effects were evaluated from extubation to the end of the second postoperative day.Results: On the day of surgery the VAS scores did not differ between the groups. From the afternoon of the first postoperative day the VAS scores were higher in the NCA group with mean values at 3–4 out of 10 as compared with mean values around 2 in the PCA group (P<0.01). During the study period the patients in the PCA group received more ketobemidone as compared with the NCA group, 61.9±24.0 mg and 36.3±20.2 mg, respectively (P<0.01). Additional oral analgesics were used in 12 of the patients in the NCA group compared with none in the PCA group. The few side effects reported were equally distributed between the two groups.Conclusion: PCA treatment after coronary artery bypass surgery resulted in better pain treatment and the use of more opioid without an increase in side effects compared with traditional NCA treatment.
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| 31. |
- Jacobson, Sofie, et al.
(författare)
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Primary sepsis in a university hospital in northern Sweden : a retrospective study
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 48:8, s. 960-967
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe sepsis and septic shock are associated with high mortality rates. Data on sepsis outcome from Scandinavian countries are sparse. The aim of this study was to examine the length of stay (LOS) in the ICU, ICU mortality and costs of care for adult patients with primary sepsis in a university hospital in northern Sweden.METHODS: We performed a retrospective data analysis of records of 92 patients admitted over a 3-year period, under the diagnosis of sepsis or urosepsis. Demographic data, admission category, APACHE II score, aetiology and severity of sepsis, ICU LOS, mortality and TISS were analyzed.RESULTS: Eighty-one adult patients were identified by standard definitions as suffering from sepsis. The median ICU length of stay was 4.2 days, 6 days for survivors and 2.1 days for non-survivors. Thirteen out of 20 deaths occurred within the first 3 days after admission. Overall ICU mortality rate was 24.7% while the ICU mortality for patients with septic shock was 57.7%. The mean costs of care for patients with sepsis were 3139 Euros day(-1) and the cost of care per patient surviving sepsis was 38,494 Euros.CONCLUSION: The incidence of primary sepsis in our ICU was low. Previous reports on high mortality in association with severe sepsis and septic shock are valid also at our hospital. The ICU-LOS was shorter than previously reported, while our costs of care were in the same range as stated by others. This retrospective analysis is valid for interpretation of the applicability of currently available sepsis therapies.
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| 32. |
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| 33. |
- Johansson, Jakob, et al.
(författare)
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Adrenaline administration during cardiopulmonary resuscitation : poor adherence to clinical guidelines
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:7, s. 909-913
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adrenaline does not appear to improve the outcome after cardiac arrest in clinical trials in spite of beneficial effects in experimental studies. The objective of this study was to determine whether adrenaline was administered in accordance with advanced cardiac life support (ACLS) guidelines during adult cardiopulmonary resuscitation (CPR). METHODS: From 15 January to 31 December 2000, all patients at Uppsala University Hospital in whom CPR was attempted were registered prospectively. The duration of CPR was documented in the register and the total dose of adrenaline was retrieved retrospectively from patient records. From these data the average interval between adrenaline doses was calculated. RESULTS: Data for evaluation of the between-dose interval of adrenaline was available in 53 of 107 registered cardiac arrests. In 68% (36/53) the average between-dose interval was longer than the 3-5 min recommended in the guidelines, and 8% (4/53) received no adrenaline. The median interval between adrenaline doses during CPR was 6.5 min (25th-75th percentile: 5.1-10.4). Adherence to guidelines was lower in out-of-hospital cardiac arrest than in in-hospital cardiac arrest (P = 0.01). CONCLUSIONS: In the majority of cases adrenaline did not appear to be administered according to current ACLS guidelines.
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| 34. |
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| 35. |
- Kimme, Peter, 1961-, et al.
(författare)
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High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:6, s. 686-689
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are several studies indicating a correlation between treatment with hydroxyethyl starch (HES) and pruritus. In order to see whether there is a possible dose–response relationship between HES and pruritus, we retrospectively studied 50 patients who had received HES in varying doses (cumulative dose 500–19500 ml) as hemodilution therapy after subarachnoid hemorrhage.Methods: Of 50 consecutive patients, 6 were excluded due to severe neurological sequelae. A questionnaire was sent to the remaining 44 patients at 6 months (5–12 months) median (range) after the end of HES treatment.Results: We received answers from 37 patients, of whom 54% reported pruritus. On average pruritus lasted for 15 weeks. There was significantly more pruritus in patients who received more than 5000 ml of HES versus those who received less than 5000 ml (P=0.023). Pruritus had a delayed onset and appeared as pruritic crises lasting for 2–30 min. It had a patchy distribution in most patients and no predilected locations. In 4 patients (20%) the pruritus lasted longer than 21 weeks.Conclusion: Our study indicates that there is a dose-dependency for the incidence of HES-induced pruritus, and that in some cases the pruritus may be severe and long-lasting.
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| 36. |
- Kvarnström, Ann, et al.
(författare)
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The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:4, s. 498-506
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain following spinal cord injury (SCI) is a therapeutic challenge. Only a few treatments have been assessed in randomized, controlled trials. The primary objective of the present study was to examine the analgesic effect of ketamine and lidocaine in a group of patients with neuropathic pain below the level of spinal cord injury. We also wanted to assess sensory abnormalities to see if this could help us to identify responders and if treatments resulted in changes of sensibility.Methods: Ten patients with spinal cord injury and neuropathic pain below the level of injury were included. The analgesic effect of ketamine 0.4 mg kg−1 and lidocaine 2.5 mg kg−1 was investigated. Saline was used as placebo. The drugs were infused over 40 min. A randomized, double-blind, three-period, three-treatment, cross-over design was used. Systemic plasma concentrations of ketamine and lidocaine were assessed. Pain rating was performed using a visual analogue scale (VAS). Sensory function was assessed with a combination of traditional sensory tests and quantitative measurement of temperature thresholds.Results: Response to treatment, defined as 50% reduction in VAS-score during infusion, was recorded in 5/10 in the ketamine, 1/10 in the lidocaine and 0/10 in the placebo groups. Neither ketamine nor lidocaine changed temperature thresholds or assessments of mechanical; dynamic and static sensibility. Nor could these sensory assessments predict response to treatment in this setting. Lidocaine and particularly ketamine were associated with frequent side-effects.Conclusion: Ketamine but not lidocaine showed a significant analgesic effect in patients with neuropathic pain after spinal cord injury. The pain relief was not associated with altered temperature thresholds or other changes of sensory function.
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| 37. |
- Lehtipalo, Stefan, et al.
(författare)
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Cutaneous sympathetic vasoconstrictor reflexes for the evaluation of interscalene brachial plexus block
- 2000
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 44:8, s. 946-952
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although signs of sympathetic blockade following interscalene brachial plexus block include Horner’s syndrome, increased skin temperature and vasodilatation, the degree of sympathetic blockade is not easily determined. The aim of this study was, therefore, to use activation of cutaneous finger pad vasoconstrictor reflexes for description and quantification of the degree of sympathetic blockade following unilateral interscalene brachial plexus block.Methods: Eight patients scheduled for acromioplasty under general anesthesia were studied. An interscalene plexus catheter was inserted preoperatively on the side to be operated upon and used postoperatively for administration of bupivacaine, given as a bolus (1.25 mg kg−1) followed by a continuous infusion (0.25 mg kg−1 h−1). Skin blood flow (SBF) in the pad of the index finger was assessed by the laser Doppler technique, and regional skin vascular resistance (RVR) was calculated. The inspiratory gasp test (apnea at end‐inspiration) or a local heat provocation were used as provocations of the cutaneous microcirculation.Results: Interscalene brachial plexus block increased SBF and decreased RVR at rest, and produced satisfactory sensory and motor block. The inspiratory gasp test decreased SBF and increased RVR in the unblocked arm, while the opposite, increased SBF and decreased RVR, were observed during local heat provocation. In the blocked arm, these gasp‐induced cutaneous vasoconstrictor and heat‐induced vasodilator responses were attenuated.Conclusions: Interscalene brachial plexus block reduces regional sympathetic nervous activity, illustrated by increases in skin blood flow, skin temperature and attenuated vasoconstrictor responses to an inspiratory gasp. The inspiratory gasp vasoconstrictive response is a powerful and sensitive indicator for monitoring the sympathetic blockade following interscalene brachial plexus block.
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| 38. |
- Lignell, Anders, et al.
(författare)
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Low utilisation of unactivated protein C in a patient with meningococcal septic shock and disseminated intravascular coagulation
- 2003
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 47:7, s. 897-900
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Activated protein C has recently been shown in a multicentre trial to significantly reduce mortality in patients with septic shock. There are also some case reports and minor studies demonstrating promising results with the unactivated form of protein C. However, in children with severe meningococcal infection, skin biopsies have demonstrated low expression of endothelial thrombomodulin and protein C receptors, suggesting low protein C activation capacity in severe meningococcal sepsis. METHODS: A patient with meningococcal septic shock was treated with two doses of the unactivated form of protein C, the first during intense activation of the coagulation system and the second during a phase of low grade or no activation. Repeated plasma samples were analysed for protein C concentration, which made it possible to compare pharmacokinetics and half-lives of the two administrations. A shorter half-life during intense coagulation was expected if there was an activation and consumption of the protein C administered. RESULTS: The calculated half-lives of protein C during intense and low grade activation were 32 h and 19 h, respectively, a magnitude similar to that reported in protein C-deficient patients without infection. CONCLUSION: The result indicates that whole body utilisation of the unactivated protein C was low. Endothelial impairment of protein C activation does not seem to be restricted to the skin vessels only.
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| 39. |
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| 40. |
- Liu, X. L., et al.
(författare)
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Differences in cerebral reperfusion and oxidative injury after cardiac arrest in pigs
- 2003
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 47:8, s. 958-967
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An investigation of the free radical scavenger sodium 2-sulfophenyl-N-tert-butyl nitrone (S-PBN) and the weak vasodilatator Tris buffer mixture (TBM) on cerebral cortical blood flow (CCBF) and the jugular bulb concentration of two eicosanoids, indicators of oxidative stress and inflammation, was undertaken in 30 anaesthetized piglets during cardiopulmonary resuscitation (CPR) and after restoration of spontaneous circulation (ROSC).METHODS: Thirty animals were subjected to 8 min of untreated circulatory arrest followed by 8 min of closed-chest CPR. During CPR, the animals were randomized to receive 60 mg/kg S-PBN, 1 mmol/kg TBM or 2 ml/kg normal saline (n = 10 in each group). Systemic haemodynamic variables, CCBF and jugular bulb plasma concentrations of 8-iso-PGF2alpha and 15-keto-dihydro-PGF2alpha were measured.RESULTS: The CCBF during reperfusion after ROSC was greater in the TBM group than in the S-PBN group, the regression coefficient between CCBF and mean arterial blood pressure being lower in the S-PBN group than in the TBM group. The jugular bulb plasma concentration of 8-iso-PGF2alpha during the first 30 min after ROSC was greater in the TBM group than in the S-PBN group. Administration of TBM after vasopressin did not attenuate the pressor effect of vasopressin.CONCLUSION: Administration of S-PBN during CPR results in less cerebral oxidative stress, possibly by promoting normal distribution of cerebral blood flow.
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| 41. |
- Liu, X. L., et al.
(författare)
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Neurological outcome after experimental cardiopulmonary resuscitation : a result of delayed and potentially treatable neuronal injury?
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:5, s. 537-546
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In experimental cardiopulmonary resuscitation (CPR) aortic balloon occlusion, vasopressin, and hypertonic saline dextran administration improve cerebral blood flow. Free radical scavenger alpha-phenyl-N-tert-butyl-nitrone (PBN) and cyclosporine-A (CsA) alleviate neuronal damage after global ischemia. Combining these treatments, we investigated neurological outcome after experimental cardiac arrest.METHODS: Thirty anesthetized piglets, randomly allocated into three groups, were subjected to 8 min of ventricular fibrillation followed by 5 min of closed-chest CPR. The combined treatment (CT) group received all the above-mentioned modalities; group B was treated with balloon occlusion and epinephrine; and group C had sham balloon occlusion with epinephrine. Indicators of oxidative stress (8-iso-PGF(2 alpha)), inflammation (15-keto-dihydro-PGF(2 alpha)), energy crisis (hypoxanthine and xanthine), and anoxia/hypoxia (lactate) were monitored in jugular bulb venous blood. Neurological outcome was evaluated 24 h after CPR.RESULTS: Restoration of spontaneous circulation (ROSC) was more rapidly achieved and neurological outcome was significantly better in the CT group, although there was no difference in coronary perfusion pressure between groups. The jugular venous PCO2 and cerebral oxygen extraction ratio were lower in the CT group at 5-15 min after ROSC. Jugular venous 8-iso-PGF(2 alpha) and hypoxanthine after ROSC were correlated to 24 h neurological outcomeCONCLUSIONS: A combination of cerebral blood flow promoting measures and administration of alpha-phenyl-N-tert-butyl-nitrone and cyclosporine-A improved 24 h neurological outcome after 8 min of experimental normothermic cardiac arrest, indicating an ongoing neuronal injury in the reperfusion phase.
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| 42. |
- Markström, Agneta, et al.
(författare)
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Effects of sustained pressure application on compliance and blood gases inhealthy porcine lungs
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:10, s. 1235-1240
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Short periods of sustained increase in airway pressures (Press(up)) are believed to re-open lung areas that collapsed upon induction of anaesthesia. Recruitment of alveolar surface is usually assessed in terms of changes in the pressure-volume (PV) curve. The purpose of this study was to analyse PV-curves before and after a Press(up) and to ascertain whether such changes are compatible with the concept of recruitment of lung volume.METHODS:During ketamine anaesthesia, 12 healthy piglets were subjected to a Press(up) with end-expiratory pressure (PEEP) of 12 cmH2O and end-inspiratory pressure of 40 cmH2O. Before and after Press(up), PV-curves were obtained from a slow insufflation of 630 ml at zero PEEP (ZEEP).RESULTS:Compliance was non-linear both before and after Press(up) increasing up to 300 ml and sharply decreasing thereafter. After Press(up), the entire compliance curve was shifted to a higher absolute level. Up to 100 ml and a pressure level corresponding to the lower inflection point on the PV-curve (LIP), compliance was higher before Press(up). No effects on blood gases could be observed.CONCLUSION:If the similar shape of the compliance curve corresponds to a similar chain of re-opening and overdistension events, this would imply that all volume gained by Press(up) is lost within 10 min, without explaining the higher absolute compliance following Press(up). We speculate that a) re-opening of rapidly collapsing small airways determines the initial compliance increase; b) the lower compliance after Press(up) until LIP indicates reduced intratidal re-opening of lung regions; and c) changes in bronchomotor tone induced by Press(up) raise the absolute compliance, with a similar scenario of alveolar and small airway recruitment now taking place but at different degrees of airway stiffness.
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| 43. |
- Metcalf, Kerstin, et al.
(författare)
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Aminoguanidine does not influence tissue extravasation of albumin in endotoxaemic rats
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:1, s. 112-118
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is generally maintained that protein and fluid are lost from the circulation under septic conditions. The role played by an increased production of nitric oxide, by the inducible nitric oxide synthase (iNOS), in this process is unclear.Methods: Chloralose anaesthetised male Wistar rats received E. coli lipopolysaccharide (LPS), 3 mg kg−1 i.v., and were studied for 5 h. Mean arterial pressure (MAP) and heart rate (HR) were monitored and haematocrit (Hct) was determined intermittently. Tissue plasma volume and tissue clearances of radiolabelled albumin over the last 2 h of the experiment were determined by a double-isotope method. In 8 rats, 2 h after LPS, aminoguanidine, an iNOS selective blocker, was given i.v. at a dose of 5 mg kg−1. This was followed by a continuous infusion for the duration of the experiment; altogether 20 mg kg−1 was administered. In the control group (n=8), a corresponding volume of saline was infused.Results: Aminoguanidine did not significantly influence Hct, MAP and HR, as evidenced by inter-group comparisons (Mann-Whitney test). Tissue plasma clearances of albumin and tissue plasma volume were similar in both groups.Conclusion: Aminoguanidine at 20 mg kg−1 did not reverse the haemodynamic changes induced by LPS. Neither did the drug affect the tissue plasma clearance of albumin or the tissue plasma volume.
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| 44. |
- Metcalf, Kerstin, et al.
(författare)
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Effective inhibition of nitric oxide production by aminoguanidine does not reverse hypotension in endotoxaemic rats
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:1, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Excess production of nitric oxide (NO) by the inducible NO synthase (iNOS) has been implicated in the pathophysiology of septic shock. Using methaemoglobin (metHb) and the stable NO metabolite nitrate as markers of NO formation, we assessed the effect of iNOS blockade by aminoguanidine (AG) on hypotension and NO formation in endotoxaemic rats.Methods: In 32 male Wistar rats under chloralose anaesthesia, MetHb (at 15 and 330 min, respectively) and plasma nitrate (at 330 min) were determined. Mean arterial pressure, heart rate and haematocrit were monitored. The LPS group (n=8) received bacterial endotoxin (LPS), 3 mg kg−1 i.v. and was subsequently monitored for 5 h. At 2 h after LPS, the LPS+AG20 group (n=8) received AG, 5 mg kg−1, and 5 mg kg−1 h−1 for the remaining 3 h. The LPS+AG100 group (n=8) instead received 25 mg kg−1, followed by 25 mg kg−1 h−1. The NaCl group (n=8) was given corresponding volumes of isotonic saline.Results: AG decreased the LPS-induced rise in plasma nitrate by about 50% in the LPS+AG20 group. MetHb levels, however, were not appreciably reduced by this dose. Both NO metabolites reached control levels after the higher dose of AG. LPS caused a progressive decrease in haematocrit. AG did not influence the LPS-induced hypotension, tachycardia or haemodilution.Conclusion: AG inhibited NO formation in a dose-dependent way. Yet, AG had no haemodynamic effects, suggesting a minor cardiovascular influence of iNOS in this endotoxin model, in parallel to what has been found in microbial sepsis.
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| 45. |
- Meyerson, J., et al.
(författare)
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The incidence of chronic post-sternotomy pain after cardiac surgery : a prospective study
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:8, s. 940-944
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Post-sternotomy pain is sometimes a sequela of cardiac surgery. The incidence, characteristics and clinical course of post-sternotomy pain are not well known. The aim of our study was to determine the incidence of chronic post-sternotomy pain in patients undergoing sternotomy for cardiac surgery in general and according to the specific surgical procedure. METHOD: In a prospective manner, a group of 349 consecutive patients were evaluated for chronic post-sternotomy pain one year after surgery. The patients were asked in a postal questionnaire to describe and score any persistent pain following the surgical procedure. The patients were classified into 3 sub-groups according to surgical procedure. The first group consisted of patients operated for coronary artery by-pass grafting (CABG) including internal thoracic artery grafting (ITAG). The second group included patients operated with CABG without ITAG and the third group of patients with valve replacement without CABG. RESULT: A total of 318 patients (91%) answered the questionnaire of whom 90 (28%) reported chest discomfort different from what they experienced before surgery. The scoring on the visual analogue scale (VAS, 0-100 mm) showed that 41 patients (13%) reported maximum pain intensity > or =30 mm (moderate pain), and 14 of these patients (4%) scored > or =54 mm (severe pain). There was no statistically significant difference in pain incidence and pain intensity when comparing the patients subjected to different surgical procedures. CONCLUSIONS: This prospective study shows that the overall incidence of non-cardiac pain after sternotomy for cardiac surgery is high (28%). Most patients experience a modest pain intensity but some (1%) report severe pain, never being lower than 54 mm on VAS. The study also indicates that the incidence of pain after sternotomy is not only associated with harvest of the ITA and additional aetiological factors must be sought.
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| 46. |
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| 47. |
- NIlsson, Ulrica, 1960-, et al.
(författare)
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Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery : a randomized controlled trial
- 2003
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 47:3, s. 278-283
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate post-operative in day care surgery.Method: One-hundred and eighty two unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anesthesia were randomly assigned toa) listening to music, b) music in combination with therapeutic suggestions or c) blank tape in the immediate post-operative period. The surgical technique, anesthesia and postoperative analgesia were standardised. Analgesia, the total requirement of morphine, nausea, fatigue, well-being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables.Results: Pain intensity (VAS) was significantly lower (P=0.002) in the M (2.1) and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P< 0.001, were found. No differences were noted in the other outcome variables.Conclusion: This controlled study has demonstrated that music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients’ experience of analgesia. Although statistically significant the improvement in analgesia is modest in this group of patients with low overall pain levels.
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| 48. |
- Nilsson, Ulrica, 1960-, et al.
(författare)
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Improved recovery after music and therapeutic suggestions during general anaesthesia : a double-blind randomised controlled trial
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:7, s. 812-817
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients.Methods: In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables.Results: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups.Conclusion: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
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| 49. |
- Nilsson, Ulrica, 1960-, et al.
(författare)
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Improved recovery after therapeutic suggestions and music during general anaesthesia
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:7, s. 812-817
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients. Methods: In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables. Results: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups. Conclusion: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
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| 50. |
- Nyberg, Annette, 1967, et al.
(författare)
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Pulmonary net release of tissue-type plasminogen activator during porcine primary and secondary acute lung injury.
- 2004
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:7, s. 845-50
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Tissue-type plasminogen activator (tPA) is a key mediator of fibrinolysis. Matching of pulmonary perfusion and ventilation is a critical denominator of oxygenation in acute lung injury (ALI). This study investigates pulmonary venoarterial plasma tPA gradients in association with acute ALI induced by bronchoalveolar lavage (BAL) and endotoxinemia (ETX). METHODS: Twenty-one anaesthetized, ventilated pigs were allocated to control (CTRL, n=5), bronchoalveolar saline lavage (BAL, n=8) or infusion of Escherichia coli endotoxin (ETX, n=8). Total tPA was analyzed in plasma (ELISA calibrated for porcine tPA). The inflammatory response was assessed by TNFa levels (ELISA). All variables were assessed at baseline and 2 h following ALI. RESULTS: Bronchoalveolar lavage and ETX induced similar increases in pulmonary shunt whereas pulmonary vascular resistance was significantly more increased in ETX animals. Cardiac output remained stable in BAL animals but decreased in ETX animals. The pulmonary venoarterial tPA plasma gradient increased in ETX animals, yielding a positive pulmonary net flux of tPA, which was absent in BAL animals. TNFalpha levels increased in ETX, but not in BAL, animals. A significant correlation was observed between TNFalpha and tPA plasma levels in ETX animals. All variables remained unchanged in CTRL animals. CONCLUSION: Plasma changes of tPA levels support a pulmonary release of tPA in early experimental ALI induced by acute ETX but not lavage, and are related to the inflammatory response. Despite increased vascular fibrinolytic capacity in ETX animals, pulmonary dysfunction was not different from BAL animals. The results demonstrate the close relation between inflammation and coagulation in early ALI.
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