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Biomedical subjects

M A Mattila

Publications and source records attributed to M A Mattila.

At least 19 recordsLinked to original sources
PubMed1993

Effect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy.

The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double-blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. Simultaneously the need for etilefrine hydrochloride was reduced. No significant changes in the pulsatile inflow of the leg or the outflow were detected. Deep vein thrombosis (DVT) was detected by fibrinogen uptake test in five patients (three in DHEH and two in the control group) and verified by ascending phlebography in four patients. Intraoperative characteristics in patients with postoperative DVT were tachycardia (P < 0.001), enhanced need for etilefrine (P < 0.01) and a more rapid increase in big toe temperature (P < 0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.

Aged↗
PubMed1993

Introduction of a new patient monitoring system during dental procedures: pulse oximetry.

This paper describes three cases of early detection of hypoxia with pulse oximeter during intravenous sedation. In the main study group over 40 patients were monitored by pulse oximetry during large dental operation under iv-sedation. Diatsepam with soybean oily solvent and midatsolam were used as intravenous sedative agents in this study. The first signs of hypoxia were seen by pulse oximetry. In three healthy patients some periods of remarkable hypoxia was detected and those cases are reported in this paper. Two of the patients were treated by a surgical operation and one patient underwent large conservative dental treatment under sedation because of dental care fobia. During the dental treatment period external oxygen was added for all these three patients to avoid more complications as a result of hypoxia. Two of the patients received an injection of bentsodiatsepine antagonist, too. One patient needed further follow up but non of these patients developed any additional complications. As a conclusion pulse oximetric monitoring was found to be extremely sensitive as a predictor for coming complications as well as allowing early intervention in ventilation problems.

Adult↗
PubMed1992

Ultrasound-facilitated central venous cannulation.

OBJECTIVE: To compare the conventional method for cannulation of the internal jugular vein with the ultrasound-aided technique. DESIGN: Prospective, randomized trial. SETTING: Medical and surgical patients requiring central cannulation in a university hospital. PATIENTS: Consecutive medical and surgical patients in whom central venous cannulation was indicated. INTERVENTIONS: Cannulation of the internal jugular vein was performed by one anesthesiologist. During the first 6 months, the ultrasound-aided technique (n = 29) was used, and during the second 6 months, the conventional technique (n = 27) was applied. MEASUREMENTS AND MAIN RESULTS: The venous lumen was reached with fewer punctures (1.2 +/- 0.5 vs. 3.3 +/- 3.0 punctures per patient) and the cannulation time was shorter (35 +/- 19 vs. 198 +/- 211 secs) while using the ultrasound-aided technique. The ultrasound-aided method showed that the large-bore (diameter greater than 2.0 mm) needles invariably perforated the medial wall of the internal jugular vein, increasing the risk of perforating the adjacent carotid artery. CONCLUSIONS: Ultrasound guidance reduces both the duration of time and the number of punctures required to cannulate the internal jugular vein. The Seldinger technique appears safer for catheterization of the internal jugular vein.

Catheterization, Central Venous↗
PubMed1990

Double blind comparison of transdermal hyoscine and placebo for the prevention of postoperative nausea.

Transdermal hyoscine (Scopoderm, Ciba-Geigy) has been compared with placebo in 283 female patients. The hyoscine patch had no significant effect on postoperative nausea or vomiting. In contrast with earlier studies, there was no correlation between previous experiences of nausea (motion, pregnancy or surgery related) and nausea caused by the surgery or anaesthetic in this study. No correlation was found between nausea or vomiting and the type of operation.

Administration, Cutaneous↗
PubMed1988

[Comparison of bupivacaine hydrochloride 0.5% and bupivacaine carbonate 0.5% in interscalene plexus anesthesia].

Carbonated local anesthetics are less acidic than the hydrochlorides and require less buffering by the tissues. Rapid buffering and diffusion of the carbon dioxide enables free base to be deposited in high concentrations on nerve fibres. Carbon dioxide increases the intracellular hydrogen ion concentration, thus increasing the amount of active cation at the receptor site. The interscalene approach to the brachial plexus was chosen for comparison of bupivacaine hydrochloride 0.5% and carbonated bupivacaine 0.5%. The interscalene route has many potential advantages, including anesthesia of the shoulder and reliable block of the musculocutaneous nerve, but large volumes of local anesthetic solutions are needed. The use of such volumes may exceed the limit of toxicity. Therefore, the plasma concentrations produced by 40 ml of local anesthetic solution were studied in 42 patients for whom brachial plexus block was considered a suitable technique. The latency of onset of sensory analgesia was shortest and with the least variability in the dermatomes C5-C7. The first analgesia was detected by pinprick 5.1 +/- 0.4 (SE) min and complete analgesia in 19 +/- 1 min after bupivacaine hydrochloride and 4.7 +/- 0.5 min and 15 +/- 1 min after bupivacaine carbonate. The more caudad nerves showed a significantly longer latency time than the more cephalad ones. The duration of sensory analgesia varied between 6 and 12 hours, the more caudad nerves showing the shortest duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Peridural anesthesia with bupivacaine-CO2 and bupivacaine-HCl. A comparative study].

Carbonated bupivacaine and bupivacaine hydrochloride were used for epidural anaesthesia in patients undergoing surgery of the lower extremities. Thirty patients received 20 ml 0.5% bupivacaine hydrochloride and 32 patients 20 ml 0.42% carbonated bupivacaine. Carbonated bupivacaine had a more rapid onset of action and spread of both sensory and motor blockade than its hydrochloride salt. The differences were statistically significant.

Adult↗
PubMed1985

Midazolam vs lorazepam and placebo as hypnotic premedication before surgery. A controlled, double-blind study.

The efficacy of midazolam vs lorazepam and placebo was studied in 60 patients in a comparative, double-blind study. Midazolam 15 mg and lorazepam 2.5 mg were given orally in a single dose the night before operation. Sleep latency was shortest on midazolam but the mean duration of sleep longest on lorazepam. Four patients on lorazepam complained of headache and one reported tinnitus. Three patients receiving midazolam complained of headache. Headache was observed also in one patient given placebo and another experienced tachycardia. Midazolam administered the night before surgery is a preferable hypnotic for transient insomnia caused by preoperative anxiety.

Adult↗
PubMed1985

Venous sequelae after intravenous propofol ('Diprivan')--a comparison with methohexitone in short anaesthesia.

Propofol, in emulsion formulation, was compared with methohexitone for short duration anaesthesia with the main emphasis on acute and long-term venous tolerance. Flunitrazepam and fentanyl were given to all the patients. Fifty-two female patients undergoing short gynaecological procedures were randomly allocated to two groups to receive propofol or methohexitone as the intravenous anaesthetic agent. The dose of propofol was 2.0 mg/kg at induction with an average total dose of 2.58 mg/kg and the dose of methohexitone was 1.5 mg/kg and 2.20 mg/kg, respectively. Propofol or methohexitone were given through a 1.0 mm Teflon indwelling cannula in a superficial vein of one hand. All other drugs were given through a similar cannula in the other hand. There were no significant differences in acute or late tolerance between the propofol and methohexitone or control (all other drugs) groups. Because there was no thrombophlebitis following either drug the venous tolerance of both drugs can be regarded as good. Moreover this type of short anaesthesia was characterized with fast recovery and high patient acceptance.

Adolescent↗
PubMed1984

Effect of hydroxyethyl starch and dextran on plasma volume and blood hemostasis and coagulation.

Six healthy male subjects were given in a crossover fashion medium molecular weight (HES 125) and low molecular weight (HES 40) hydroxyethyl starch, dextran, and balanced salt solution by intravenous infusion. The plasma volumes were determined using labeled albumin and plasma protein measurements. Three properties of factor VIII protein complex and indices of blood coagulation and hemostasis were measured before and after the infusions. Both the salt solution and HES 40 increased plasma volume, but their effect wore off within 3 hours. Dextran and HES 125 increased plasma volume significantly (P less than 0.001) more than the salt solution did, and the expansion was maintained for 24 hours. Plasma volume increases (dextran and HES 125) were associated with high nonglucose carbohydrate levels in plasma and low levels in urine. No or slight increases in plasma volumes (HES 40), on the other hand, were associated with low and high carbohydrate levels in plasma and urine, respectively. Serum alpha-amylase activity increased significantly after both HES preparations as compared to salt solution. Dextran and HES 125 decreased all the three values of factor VIII, these decreases being maximal 3 to 6 hours after administration and highest (about 25 per cent) for F VIII R:Ag and F VIII R:cof. It is concluded that HES 125 and dextran are equally effective plasma expanders.

Adult↗
PubMed1984

Intravenous premedication with diazepam. A comparison between two vehicles.

Two preparations of diazepam, Valium Roche mixed Micelles and Diazemuls, were compared as intravenous premedicants in 119 patients undergoing minor gynaecological surgery. There were no differences between the formulations with regard to anxiolytic effects and systemic tolerance. There were no symptoms typical of thrombophlebitis in the Valium Roche Mixed-Micelles group and only one case in the Diazemuls group. Acute local tolerance was similar with both trial drugs and superior to conventional diazepam preparations. Based on the favourable results of the present study it can be concluded that such vehicles should be considered for any injectable preparation with a known tendency to produce venous irritation.

Adult↗
PubMed1983

Midazolam and fat-emulsion diazepam as intramuscular premedication. A double-blind clinical trial.

Sixty female patients were given, in random order, under double-blind conditions, either midazolam or fat-emulsion diazepam, intramuscularly, as premedication, 1 h before general anaesthesia. The dose of midazolam used was 0.13 mg/kg and that of diazepam 0.17 mg/kg. The degree of sedation, mood of the patient, and time at which onset of effect was perceptible were assessed before induction of anaesthesia, together with skin temperature and concentrations of midazolam or diazepam in plasma. Patients were interviewed postoperatively to discover their subjective evaluation of the premedication and to assess its amnesic effects. Midazolam was significantly superior (P less than 0.05) to diazepam as regards sedation. There were no differences in effects on mood of the patients between the two groups. Sixteen patients in the diazepam group and four in the midazolam group had no perception of onset of effect. The difference is significant (P less than 0.01). The skin temperature was, on average, 2 degrees C higher in the midazolam group than in the diazepam group (P less than 0.005). The mean plasma concentration was 67.8 +/- 24.5 micrograms/l in the midazolam group and 44.8 +/- 25.7 micrograms/l in the diazepam group. In only two cases was the concentration of diazepam above 100 micrograms/l (arbitrarily defined as the minimum sedative concentration). Subjective evaluation of efficacy significantly (P less than 0.002) favoured midazolam. Local pain was evident in two patients in the diazepam group, and three patients experienced nausea immediately after administration of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1983

The efficacy and plasma concentrations of flunitrazepam after oral or intramuscular premedication.

Flunitrazepam premedication administered orally or intramuscularly was compared in 41 surgical patients. The effect of the premedication was assessed both subjectively and objectively. The plasma concentrations were determined just before induction. The mean (+/-SD) plasma concentration in the oral premedication group was 8.2 +/- 2.2 ng/ml and 7.9 +/- 4.6 ng/ml in the intramuscular premedication group. There was a highly significant correlation (p less than 0.001) between the sedative effect and plasma concentration of flunitrazepam in all patients. Oral flunitrazepam was equal to i. m. flunitrazepam as an anxiolytic and sedative with a rapid onset of action. However, the oral route of administration of flunitrazepam is preferable because it is painless and easy to administer.

Administration, Oral↗
PubMed1982

A double-blind clinical trial comparing alcuronium with pancuronium.

Alcuronium and pancuronium were compared as muscle relaxants in a randomized and double-blind trial in routine clinical circumstances during combined balanced anesthesia in 40 female patients. The course of endotracheal intubation at 2 min. was statistically significantly better (p less than 0.001) in the pancuronium group than in the alcuronium group. There were no differences between the two groups regarding relaxation, maintenance of anesthesia and postoperative recovery. In the pancuronium group the systolic blood pressure was significantly higher than in the alcuronium group at 2 minutes after induction (p less than 0.01), at 2 minutes after intubation (p less than 0.05) and before incision (p less than 0.05). Also the diastolic blood pressure was significantly higher in the pancuronium group at 2 minutes after induction (p less than 0.001), before incision (p less than 0.01) and at 2 minutes after incision (p less than 0.05) than in the alcuronium group. Thus alcuronium is preferable when hypertensive episodes are to be avoided whereas pancuronium would be more suitable when hypotension can be expected.

Adult↗
PubMed1981

Reduction of venous sequelae of i.v. diazepam with a fat emulsion as solvent.

Venous sequelae were studied in 93 female patients undergoing minor gynaecological procedures. They were premedicated with diazepam i. v. dissolved in a fat emulsion (Diazemuls) injected to a superficial vein of the right hand. The patients observed the site of injection for 14 days and recorded their findings. Twenty-eight per cent reported mild tenderness and 7.5% mild or moderate swelling of short duration. Signs of thrombophlebitis were found in 2.2%. Thrombophlebitis after injection can be prevented effectively and safely using fat emulsion as a solvent for diazepam.

Adolescent↗
PubMed1981

Diazepam in rectal solution as premedication in children, with special reference to serum concentrations.

The absorption of rectal diazepam solution was studied in 22 children aged 1-9 yr by measuring serum concentrations. The mean dose was 0.27 +/- 0.09 mgkg-1. The mean serum concentration was 98.5 +/- 53.5 ng ml-1 4 min after administration and 206.7 +/- 105.8 ng ml-1 at 11 min. The correlation between dose and serum concentration was statistically significant at both times. With a dose of 0.4-05 mgkg-1 an adequate serum concentration was achieved within 5-6 min. No side-effects were observed. A rectal solution provides a faster, more effective and reliable alternative to tablets and suppositories, and to the uncertain i.m. injection of diazepam. Meticulous nursing is important.

Child↗
PubMed1981

The effect of diazepam on methohexitone short anaesthesia: a clinical double-blind investigation.

A double-blind investigation was performed on 113 adult females, hospitalized for short gynaecological procedures, in order to establish the suitability of methohexitone for short procedures and whether or not the quality of methohexitone anaesthesia could be improved with a diazepam supplement. All patients were anaesthetized with methohexitone (2.0 mg/kg): 57 of the patients received a 10 mg diazepam intravenous supplement and 56 received intravenous placebo (solvent of diazepam only). Diazepam injected after induction with methohexitone clearly improved the quality of methohexitone anaesthesia (p less than 0.1 more than 0.05) and reduced the need for supplementary doses of methohexitone (p less than 0.1 more than 0.05). The incidences of both nausea and vomiting were minimized (p less than 0.01 more than 0.001). Patient acceptance was equally good in both groups. It is commented that patients may seem fully awake and oriented, notwithstanding the fact that the body still contains significant amounts of the anaesthetic agent. Ambulatory patients should never be allowed to leave the hospital unescorted, as they recover their 'street-orientation' only after 12 to 24 hours. Furthermore, the patients or their escorts should be given definite and written instructions to avoid absolutely the use of alcohol or hypnotics which could, even in small amounts, potentiate the effect of methohexitone still in the body, for at least 12 hours. It is recommended that patients should avoid driving a motor vehicle or using dangerous tools or machines for 12 to 24 hours following recovery from methohexitone anaesthesia.

Adult↗