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Biomedical subjects

L Nuutinen

Publications and source records attributed to L Nuutinen.

At least 19 recordsLinked to original sources
PubMed1992

Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement.

Postoperative pain relief immediately after major surgery cannot be achieved with opioids alone in all patients without respiratory depression or other significant side effects. This investigation was conducted to determine whether the need for opioids and the incidence of side effects can be reduced while maintaining the quality of pain relief using a nonsteroidal antiinflammatory drug as an adjuvant to an opioid. The analgesic efficacy and safety of patient-controlled analgesia using fentanyl with and without intravenous diclofenac were compared after total hip replacement. Forty patients were randomly assigned to receive either diclofenac 75 mg as an initial intravenous loading dose followed by an infusion of 5 mg per hour or saline in a double-blind fashion. The amount of fentanyl administered was recorded. The patients assessed their pain intensity verbally and on a visual analogue scale at intervals of 4 h. The diclofenac group showed a significant reduction in the amount of fentanyl administered during the first 16 h postoperatively as compared to the placebo group (0.65 mg +/- 0.2 vs. 1.08 mg +/- 0.4 respectively, P less than 0.01), and also reported less pain at 16 h (median score on visual analogue scale 0.75 vs. 2.4 respectively, P less than 0.05)). There were no differences in side effects, postoperative blood loss, plasma activated partial thromboplastin time, or Ivy bleeding time between the groups. In conclusion, the addition of diclofenac led to a reduction in fentanyl requirement but did not have any other significant advantages in the treatment of pain following major orthopedic surgery.

Adult↗
PubMed1992

Comparison of intravenous diclofenac, indomethacin and oxycodone as post-operative analgesics in patients undergoing knee surgery.

The non-steroidal anti-inflammatory drugs diclofenac, indomethacin and oxycodone were compared in the treatment of pain after arthroscopy or arthrotomy of the knee in a double-blind, randomized trial. A single and, if needed, a repeated dose of one of the following six dose and drug alternatives was given intravenously for post-operative pain relief: diclofenac 37.5 mg or 75 mg, indomethacin 25 mg or 50 mg and oxycodone 5 mg or 10 mg. Oxycodone 5 mg i.v. was used as a rescue medication whenever the patient needed further pain relief after the two doses of the trial drugs. The observation period was 14 h. In the diclofenac group the patients needed significantly less trial and rescue analgesics than in the indomethacin (P less than 0.001) and oxycodone (P less than 0.05) groups, the latter groups being equal in this respect. Both the duration from the first trial drug infusion to the second trial medication and to the first rescue medication were significantly longer in the diclofenac group than in the indomethacin group (P less than 0.05 and less than 0.01, respectively).

Adult↗
PubMed1991

Behavioral and histopathologic effects following intrathecal administration of butorphanol, sufentanil, and nalbuphine in sheep.

A large number of opioids and nonopioids have been administered epidurally and intrathecally in the hope of providing segmental analgesia without serious adverse effects. However, neurotoxicity data are generally unavailable for many of these drugs. The present study evaluated the behavioral, motor, electroencephalographic, and histopathologic changes following intrathecal injection of large and small doses of butorphanol, sufentanil, and nalbuphine in sheep. Thirty-two sheep (20-32 kg) were anesthetized and catheters placed intrathecally after hemilaminectomy. The large doses of butorphanol, sufentanil and nalbuphine were 0.375 mg/kg (4.4-5.2 ml), 7.5 micrograms/kg (3.6-4.8 ml) and 0.75 mg/kg (1.5-2.4 ml), and the small doses were 0.075 mg/kg (0.9-1.1 ml), 1.5 micrograms/kg (0.7-0.9 ml) and 0.15 mg/kg (0.38-0.5 ml), respectively. The opioids were administered intrathecally every 6 h for 3 days and the above-mentioned parameters studied. Five sheep received intrathecal saline (1.1 or 5.2 ml) and served as controls. Histopathologic changes were evaluated by a neuropathologist blinded to the study protocol. Irrespective of dose, intrathecal injection of butorphanol was associated with severe behavioral responses such as agitation, rigidity, vocalization, and restlessness, as well as prolonged or irreversible hindlimb paralysis. Electroencephalography showed increased cortical activity or seizure activity. One sheep died because of severe respiratory depression that did not respond to naloxone. Spinal cord histologic changes consisted of suppurative meningitis and myelitis as well as neuronal changes such as spongiosis and chromatolysis. Large doses of intrathecal sufentanil were associated with similar though somewhat less severe responses. The behavioral and motor changes following the small dose of intrathecal sufentanil were of mild to moderate nature. Following intrathecal nalbuphine, the above-mentioned changes were similar to those seen in control animals. We conclude that butorphanol in doses of 0.075 and 0.375 mg/kg intrathecally and sufentanil 7.5 micrograms/kg intrathecally are neurotoxic in sheep.

Animals↗
PubMed1991

The role of nitrous oxide in postoperative nausea and recovery in patients undergoing upper abdominal surgery.

The effect of nitrous oxide on postoperative nausea/vomiting and alertness were studied in 50 patients undergoing elective upper abdominal surgery. The study period lasted 20 h. Patients were randomly assigned to receive thiopentone-fentanyl-isoflurane-pancuronium anaesthesia with either 70% nitrous oxide-oxygen (Group I) or air-oxygen (Group II). There were no differences between the groups regarding age, sex, weight or amount or per- and postoperative analgetics given. The mean inspiratory isoflurane concentrations were 0.6% and 1.15% in Groups I and II, respectively. The postoperative alertness was tested by a visual analogue scale (0-10) for 6 h postoperatively. Omitting nitrous oxide did not decrease the frequency of postoperative nausea, although the symptoms were milder in the air group. The patients without nitrous oxide were alert earlier, in spite of a higher isoflurane concentration: VAS from 5 to 8.7 vs from 2.8 to 6.9 during the first 6 postoperative hours.

Abdomen↗
PubMed1991

Failure of transcutaneous electrical nerve stimulation and indomethacin to reduce opiate requirement following cholecystectomy.

This randomized study examined the effect of transcutaneous electrical nerve stimulation (TENS) and indomethacin on postoperative opiate requirement in 60 patients after cholecystectomy. An open intravenous bolus of 25 mg of indomethacin followed by an infusion of 5 mg in 1 h, alone or combined with either low or high frequency TENS, was administered during the study period of 16 h. An intravenous bolus of either 5 mg of oxycodone or 0.15 mg of buprenorphine was administered double blindly for postoperative pain relief. The number of doses of buprenorphine given (3, 9) differed (P = 0.01) from the number of doses of oxycodone given (5, 4). Neither indomethacin nor TENS reduced the postoperative opiate requirement.

Buprenorphine↗
PubMed1979

Liver drug metabolism in patients undergoing open-heart surgery.

The effect of open-heart surgery on the drug metabolism of the liver was investigated in 17 patients by using the rate of antipyrine elimination as an index. A correlation was found between the pre-operative heart size and the antipyrine elimination rate. In patients with a markedly dilated heart, the plasma antipyrine half-life was prolonged and apparent clearance significantly impaired. Immediately postoperatively, antipyrine elimination was impaired in all patients. Later, the drug metabolism improved in patients with atrial septal defect, changed temporarily in patients with aortic valve replacement, and remained unchanged in patients with mitral valve replacement. The results indicate that adaptive changes in drug metabolizing capacity occur in patients undergoing cardiac surgery. The changes are related to the type of lesion corrected, the pre-operative functional capacity of the liver, and the time lapse after surgery.

Adolescent↗
PubMed1979

Are changes in serum immunoglobulin and complement levels following open heart surgery influenced by oxygenator type or postoperative parenteral nutrition?

The serum IgG and IgA concentrations significantly decreased through the seventh day and the serum IgM and complement (C3 and C4) concentrations through the second day after elective open heart surgery for heart valve disease in a series of 16 patients. A significant increase over the preoperative concentration was seen, however, in the serum IgA, IgM, C3 and C4 on day 14 postoperatively. The serum IgG and IgM concentrations declined significantly only in patients perfused by a bubble oxygenator, although the two small series of patients perfused by bubble and membrane oxygenator did not differ significantly from each other. Parenteral nutrition had no effect on postoperative changes in serum immunoglobulin and complement concentrations.

Adolescent↗
PubMed1978

Intraoperative changes in coronary resistance during aortic valve replacement.

Coronary vascular resistance was investigated in 10 patients undergoing aortic valve replacement using continuous constant-pressure coronary perfusion at 32 degrees C. After coronary flow was initiated, resistance was low but increased steadily until it reached a certain resting level. The plateau was attained faster after a short period of anoxia than after a longer period. The initial postischemic resistance was dependent on the duration preceding anoxia, being of the same magnitude after short and moderate periods of anoxia but significantly higher after a long period. This resistance difference between the groups lasted for the whole perfusion. The total coronary resistance and flow reached a plateau in 30 minutes, while resistance increased threefold but flow decreased to half of the initial postanoxia flow. Our results indicate the importance of initiating coronary perfusion soon after aortic cross-clamping to avoid increase in the initial vascular resistance and subsequent inadequate myocardial flow.

Adult↗
PubMed1978

Catecholamines and free fatty acids in plasma of patients undergoing cardiac operations with hypothermia and bypass.

Plasma concentrations of adrenaline, noradrenaline, and free fatty acids were measured at different stages of cardiac operations in which hypothermia and bypass were used. The rise of adrenaline, noradrenaline, and free fatty acid concentrations in plasma is consistent with the concept that these are important compounds in stress situations such as hypothermia and surgical operations. There is a more marked release of adrenaline and it may be a more specific hormone in response to hypothermia and bypass than is noradrenaline in man.

Cardiac Surgical Procedures↗
PubMed1978

[Blood sugar level in surgical patients].

Serum glucose levels of six different patient groups were investigated preoperatively, during operation, postoperatively and in the first postoperative days: Group A, 10 cholecystectomy patients with 5% glucose infusion 2000 ml/day at a constant infusion rate; group B, 10 cholecystectomy patients with 10% constant rate glucose infusion; group C, 20 cholecystectomy or hernia patients with saline infusion; group D, 34 patients with 5% free rate glucose infusion 2000 ml/day; group E, 15 atrial septal defect patients with 5% constant rate glucose infusion 1500 ml/day and group f, 14 valvular surgery patients with 5% constant rate glucose infusion. Serum glucose increased in all groups during the study, most in the group B and least in the group C. There were no significant differences between the groups A and D, so constant or "free" infusion rate are the same from this viewpoint. The differences between the saline group (C) and all other groups was per- and postoperatively and in the postoperative day significant (p less than 0.001). There were no significant differences between the open heart surgery groups (E and F) and general surgery groups (A and D).

Blood Glucose↗
PubMed1978

Myocardial reactive hyperemia caused by initial myocardial anoxia during aortic valve replacement.

Reactive hyperemic response of individual coronary arteries and of the whole heart to anoxia during coronary cannulation was investigated in 10 patients undergoing aortic valve replacement. Reactive hyperemic response in man is identical to that reported in experimental investigations. The duration of hyperemic response was dependent on the length of the preceding period of anoxia; the longer the period of anoxia, the more prolonged was the hyperemic response. No significant collateral circulation between the coronary arteries could be demonstrated during prolonged anoxia of an individual coronary artery. Blood flow debt was almost always overpaid, but the repayment percentage decreased with the lengthening of the anoxic period, being 460 percent after a short period of anoxia (less than or equal to 2 minutes), 230 percent after an anoxic period of moderate length (3 to 5 minutes), and only 160 percent after a long period of anoxia (greater than or equal to 7 minutes). The total mean repayment of blood flow debt of the whole heart was 195 percent.

Adult↗
PubMed1978

Total pancreatectomy for acute hemorrhagic pancreatitis. A case report.

A patient with acute hemorrhagic pancreatitis treated successfully with total pancreatectomy is reported. Total pancreatectomy is rarely indicated in acute hemorrhagic pancreatitis as suggested by only one surviving patient in the literature so far. Though near total pancreatectomy remains the best surgical treatment in patients with acute hemorrhagic pancreatitis dying from the disease because of failure of nonoperative treatment, total pancreatectomy may be considered as an alternative if circumstances so indicate.

Acute Disease↗
PubMed1978

Effect of initial myocardial anoxia on coronary flow during aortic valve replacement.

Flow to the right and left coronary arteries was recorded continuously during aortic valve replacement using continous constant-pressure coronary perfusion at 32 degrees C in 13 patients. The initially high coronary flow decreased gradually until a certain level, the so-called resting flow level, was reached and stabilized there as long as perfusion temperature remained unchanged. At 32 degrees C, resting flow was about 50% of the peak hyperaemic flow. The length of preceding anoxia had a significant effect on the duration of reactive hyperaemic response. After a short anoxic period, resting flow level was reached in about 3 min, after moderate period in 15 min and after long anoxia in 35 min, respectively.

Adolescent↗
PubMed1977

Intra-operative ascending aortic flowmetry.

Intra-operative flowmetry was carried out before and after cardiopulmonary bypass in 34 patients who underwent aortic root surgery. Most of the patients had either aortic or combined aortic and mitral valve replacement. Flowmetry performed before and after the procedure proved to be a very useful diagnostic tool, particularly in evaluating the immediate postoperative haemodynamic performance of the replaced aortic valve and the completeness of the correction.

Adolescent↗
PubMed1977

Myocardial protection by continuous coronary perfusion during aortic valve replacement.

The coronary perfusion system used at Oulu University Central Hospital is described and the importance of physiological coronary perfusion stressed. Our method of protecting the myocardium from ischemic injury during aortic valve replacement included the following: phasic constant-pressure coronary perfusion, maintenance of coronary perfusion pressure larger than or equal to 80 mmHg, maintenance of the heart in a beating, empty, oxygenated state, and the use of the largest possible coronary canula. Under these circumstances, autoregulation of the coronary vascular bed was maintained. When small coronary cannulae were used a significant pressure drop occured across the tubing system, especially at high flow rates. Flow measurements recorded by an on-line electromagnetic flowmeter proved reliable.

Adolescent↗
PubMed1977

Renal blood flow and intrarenal oxygen tension in haemorrhagic hypotension.

The changes occurring in renal cortical and medullary tissue oxygen tensions and in renal total blood flow (RBF) were studied during haemorrhagic hypotension in six dogs. The flow was measured with an electromagnetic flowmeter, and tissue oxygen tension with IBC (Ineternational Biophysics Corporation, USA) oxygen electrodes. Haemorrhagic hypotension led to a considerable decrease in cortical tissue oxygen tension. The decrease in the medullary tissue oxygen tension was smaller, while the renal total flow decreased considerably during haemorrhage. The role of perfusion pressure alone in the redistribution of renal blood flow during haemorrhagic hypotension is discussed.

Animals↗