Biomedical subjects

M Oikkonen

Publications and source records attributed to M Oikkonen.

At least 19 recordsLinked to original sources

PubMed2001

Convalescence in the first week after laparoscopic cholecystectomy: results from a detailed questionnaire on morbidity and recovery of daily activities.

BACKGROUND: The aim of this study was to evaluate postoperative morbidity and return to daily activities after laparoscopic cholecystectomy. METHODS: Thirty-five patients were asked to keep daily detailed structured diaries for 1 week. RESULTS: Half of the patients were discharged from hospital on the 1st postoperative day (POD1); another third were released on POD2. Distressing pain subsided on POD2, but disturbing pain occurred in 10% of the patients on POD5-7. On POD7, mild pain at rest appeared in 30% of the patients and when moving in 60% of them. Although pain was the most common complaint, the mean consumption of analgesics was low. Even though one-fifth of the patients felt nauseated on POD2-3, and one-seventh again as late as POD7, drinking and eating did not pose problems. At the end of the week, one-third of the subjects experienced slight disorders in night rest and vigilance. Moving and walking were disturbed in one-third of the patients, and bending over and lifting objects were relatively difficult for 60% of the patients on POD7. Thirty percent of the 21 patients who were employed reported that they were capable of returning to work on POD7. CONCLUSION: To account for the variability in the rate of convalescence, the length of sick leave after laparoscopic cholecystectomy should be individualized.

Adult↗

PubMed2000

Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA.

BACKGROUND: Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations. METHODS: One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home. RESULTS: The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home. CONCLUSION: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.

Adenoidectomy↗

PubMed1998

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children.

We studied the effect of anticholinergics on the incidence of cardiac arrhythmias during paediatric anaesthesia. ASA I-II children (n = 77) undergoing adenoidectomy were randomly allocated to three groups. Intravenous atropine 0.02 mg kg-1 was given in group A (n = 25), glycopyrrolate 0.004 mg kg-1 in group G (n = 27) and physiological saline in group P (n = 25) 3 min before the induction of anaesthesia. The children breathed spontaneously under halothane anaesthesia with 66% nitrous oxide in oxygen after induction with thiopentone and succinylcholine. Perioperative monitoring of the ECG (Holter recordings) and oxygen saturation was carried out. Ventricular tachycardia occurred in 16.0%, 18.5% and 12.0% of the children in groups A, G and P respectively (ns). The incidence of ventricular arrhythmias (ventricular tachycardia, ventricular bigeminy, ventricular premature beats > 10) was 20.0% in group A, 44.4% in group G and 36.0% in group P (ns). Bradycardia (< 70 beats min-1) was observed in 0.0%, 14.8% and 24.0% of patients in groups A, G and P respectively (A vs P, P < 0.05). The use of anticholinergics did not influence the incidence of ventricular arrhythmias during halothane anaesthesia in children. Bradycardia was more common in the placebo group than in the atropine group.

Adenoidectomy↗

PubMed1997

Leakage of fluid around low-pressure tracheal tube cuffs.

The aim of the study was to evaluate leakage of liquid past the low-pressure cuffs of tracheal tubes. Ten samples of each of nine different types of tubes were tested in a PVC mock trachea, using intracuff pressures of 20, 30, 40 and 50 cmH2O. In five types of tubes, 6-10 cuffs allowed profuse leakage (> 20 ml water in 5 min) even at the highest intracuff pressure, i.e. 50 cmH2O. In the most efficient tube, all the cuffs were leak-proof (leakage < 5 ml in 5 min) at 40 cmH2O and in the second best type the cuffs were leak-proof at 50 cmH2O. The leakage of fluid past the tracheal tube remains an unresolved problem with low-pressure cuffs.

Equipment Failure↗

PubMed1995

CSF concentrations and clinical effects following intravenous dixyrazine premedication.

Single concurrent plasma and lumbar spinal fluid samples were collected from twenty-two patients given IV dixyrazine 0.15 mg/kg, 10-106 min earlier in an open study. Dixyrazine penetrated rapidly into the spinal fluid; the CSF/P ratio was 0.3 by 10 min after drug administration and persisted at that level during the study period. The uncontrolled sedative and anxiolytic effects assessed by the patients were slight, and were correlated with the CSF drug concentrations only during the first 30 min after medication.

Adolescent↗

PubMed1995

Ranitidine suspension or famotidine resoriblette and gastric fluid volume and pH.

We studied the effect of two new formulations of H2-receptor antagonists on gastric fluid pH and volume. Forty-five healthy, elective adult in-patients in three study groups, 15 in each, were premedicated using oral diazepam 10 mg with 100 ml of a dose of water soluble suspension of ranitidine 300 mg with sodium citrate/bicarbonate, or a resoriblette of famotidine 40 mg, or placebo. Gastric fluid samples were obtained by blind aspiration after anaesthesia induction, 50-70 min from premedication, and again 90 min from premedication. After a mean period of 60 min from ingestion the patients medicated with H2-antagonists had higher gastric juice pH than those in the control group (1.5 (1.1-6.3), median (range)) (P < 0.0001) for ranitidine (6.8 (4.1-7.8)), P < 0.01 for famotidine (3.9 (1.5-7.6)); P < 0.05 ranitidine vs famotidine). Recovered volumes were similar for the groups (median 3-4 ml, range 0-50 ml). None of the H2 patients had pH < 3.5 and volume > or = 0.3 ml.kg-1 (P < 0.05 vs placebo). In second aspirations, taken 90 min from premedication, the group differences from control in pH persisted. Famotidine patients had the lowest volumes (P < 0.05 vs controls); yet one famotidine patient had a pH < 2.5 and volume > or = 0.3 ml.kg-1. It is concluded that, at the moment of oral anxiolytic premedication, ranitidine-buffer suspension effectively reduced gastric juice acidity, whereas famotidine resoriblette failed to increase reliably gastric pH in 50-90 min.

Adolescent↗

PubMed1995

Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry.

In order to quantify changes in total respiratory compliance (Crs) effected by peritoneal pressurization we measured, under standardized anaesthetic conditions and using side stream spirometry Crs in 32 patients scheduled for abdominal surgery through laparoscopic techniques. To qualify the changes in Crs as to the type (duration and patient's position) of surgery, 20 patients having cholecystectomy, eight having gastric fundoplication, and four having inguinal hernia repair were studied. At CO2 insufflation to a mean intraabdominal pressure of 11 cmH2O in the horizontal position, Crs decreased abruptly by 20% in each of the surgical sub-groups (P < 0.05-0.01). During the insufflation period a further deterioration was observed, most pronounced in inguinal hernia patients operated upon in a head-down tilt position (P < 0.05). In the cholecystectomy and fundoplication patients, operated upon in a head-up tilt, the recovery of Crs was immediate at deflation, whereas an incomplete recovery (P < 0.05 vs initial values) was seen in the hernia patients. In evaluating all patients none of the demographic factors, age, sex, body-mass-index, intraabdominal pressure, or duration of pressurization, were associated with the detected changes.

Adult↗

PubMed1995

Diabetic autonomic neuropathy and the haemodynamic actions of vecuronium and pancuronium during vitrectomy.

In order to clarify whether autonomic neuropathy modifies the haemodynamic effects of alfentanil, vecuronium and pancuronium, twenty-seven patients with diabetes mellitus were studied at thiopentone induction, and during nitrous oxide anaesthesia for ophthalmic vitreous surgery. Heart rate was lower in the diabetic patients receiving vecuronium compared with those receiving pancuronium, but no difference was seen in arterial pressure. During and after anaesthesia induction, the profiles of heart rate and arterial pressure resembled those found in healthy controls. Even in patients with advanced autonomic neuropathy, anaesthetics may exert their inherent vagotonic or sympathicotonic actions.

Adult↗

PubMed1994

Propofol vs isoflurane for gynaecological laparoscopy.

Propofol (n = 15) and isoflurane (n = 15), both administered by clinical and haemodynamic criteria, proved to be equally feasible as sole maintenance anaesthetics (combined with 0.5 mg alfentanil and suxamethonium) for gynaecologic laparoscopies. Two min postextubation, the number of patients awake and responsive to commands was higher in the group given propofol. Later recovery till 2 h postanaesthesia was similar for the groups, except that the propofol patients more frequently required oxycodone for pain relief, and that three of them (NS) were bradycardic. Emesis was rare in both groups. The rapid recovery without emesis qualifies these two anaesthetics for gynaecologic laparoscopies.

Adult↗

PubMed1994

Dixyrazine premedication for cataract surgery. A comparison with diazepam.

Peroral dixyrazine (15-30 mg, n = 50) and diazepam (4-10 mg, n = 50) were used as premedicants for geriatric patients having cataract surgery under regional block. Compared to the diazepam patients, a larger number of the dixyrazine medicated patients appeared anxious, and there was a statistically significant difference between the groups, when summing up changes in anxiety throughout the study period. The dixyrazine patients needed more frequent supplementation with intravenous sedative drugs, compared with their diazepam counterparts. Peroral dixyrazine is an applicable choice for calm patients, when only slight sedation, or avoidance of somnolence are required.

Administration, Oral↗

PubMed1994

Circulatory drugs modify the hemodynamic actions of alfentanil combined with vecuronium or pancuronium.

To verify, whether drugs used to treat hypertension, coronary disease, and heart insufficiency modify the hemodynamic effects of the combinations alfentanil-vecuronium and alfentanil-pancuronium, 36 patients taking these drugs (most often beta-adrenergic antagonists) were randomized to receive either vecuronium or pancuronium in connection with ophthalmic surgery. In comparison with healthy patients, the heart rate and arterial pressure changes during induction, intubation and surgery appeared to be smoothed. Heart rate and arterial pressure equaled between the study groups, indicating a block of the sympathomimetic actions of pancuronium. One third of the patients receiving vecuronium exhibited nodal rhythm and some of them showed slow heart rates during intense surgical stimulation. Pancuronium offered protection against bradyarrhythmias.

Aged↗

PubMed1994

Melperon premedication for cataract surgery. A comparison with diazepam.

Given as a peroral premedicant for geriatric patients having cataract surgery under regional block, a butyrophenone neuroleptic melperon (15-30 mg, n = 50) ranked equally with diazepam (4-10 mg, n = 50), assessed using a qualitative subjective estimation of the patients' anxiety. The patients treated with melperon needed significantly fewer supplementations with intravenous drugs, to withstand the surgery, compared to those medicated with diazepam. Melperon is a compatible alternative, but its possible propensity to cause occasional arterial hypotension must be noticed.

Administration, Oral↗

PubMed1993

QT interval, heart rate and arterial pressures using propofol, thiopentone or methohexitone for induction of anaesthesia in children.

The effects on corrected QT interval (QTc), heart rate and arterial pressure were studied after induction with propofol 1.5, 2 or 2.5 mg.kg-1, thiopentone 5 mg.kg-1 or methohexitone 2 mg.kg-1 in 123 ASA class I or II children undergoing outpatient otolaryngological surgery. Premedication consisted of oral midazolam and atropine. The children were randomly allocated to one of the three propofol groups or to the thiopentone or methohexitone group. After injection of the intravenous anaesthetic, the QTc interval was significantly prolonged after propofol 2.5 mg.kg-1. Thirty seconds after suxamethonium 1.5 mg.kg-1, a significant prolongation of the QTc interval occurred in the thiopentone and propofol 1.5 and 2 mg.kg-1 groups. After intubation, no further prolongation of the QTc interval occurred in any of the groups. Heart rate increased significantly after the barbiturates but not after propofol. Systolic arterial pressure decreased significantly after propofol 1.5 and 2.5 mg.kg-1. In all groups a cardiovascular intubation response occurred. Bradycardia and junctional rhythm occurred in 4% of the children in both barbiturate groups and in 19-29% in the propofol groups. It is concluded that propofol causes prolongation of the QT interval and results in a higher incidence of bradycardia and junctional rhythm than the barbiturates.

Anesthesia, Intravenous↗

PubMed1992

Anaesthesia for geriatric oesophagoscopy: isoflurane vs. alfentanil-methohexitone vs. propofol.

Twenty-one geriatric patients (68-86 years) undergoing 30 oesophagoscopic surgical procedures received either isoflurane (mean duration 40 min), alfentanil (-methohexitone) (30 min), or propofol (30 min) anaesthesia supplemented with nitrous oxide. Each of the three study groups comprised ten patients. The times elapsing from the end of anaesthesia until the patients became irritated by the endotracheal tube, and until their tracheas were extubated, appeared similar for the groups, as did the rapidity of awakening and the ensuing grade of consciousness. During anaesthesia, spontaneous ventilation prevailed in the isoflurane group, but at recovery no inter-group differences in respiratory rate were found. There were few statistically significant differences between the groups in arterial pressure or heart rate. Only propofol prevented temporary increases in heart rate and arterial pressure.

Aged↗

PubMed1992

Alfentanil combined with vecuronium or pancuronium: haemodynamic implications.

Forty-two fit, anticholinergized patients, induced with thiopentone, received either vecuronium (V) or pancuronium (P) 0.1 mg/kg, followed by alfentanil 15 micrograms/kg. The mean heart rate in the Group V was significantly lower than that in the Group P. The difference, 10-15 bpm, appeared after alfentanil administration, and lasted for 5 min postintubation, when under N2O anaesthesia. The Group P patients maintained their arterial pressure closer to the preinduction level than did the Group V patients, but a statistically significant inter-group difference appeared only at two recording stages. Four Group V patients, contrasted to none of the Group P patients (P less than 0.05), were put in head-down tilt, or were given atropine, and/or etilephrine for an undue decrease in arterial pressure. Compared to vecuronium, pancuronium increased heart rate, and protected from arterial hypotension, when combined with low-dose alfentanil.

Adult↗

PubMed1991

Oral atropine enhances the risk for acid aspiration in children.

Two modes of administration of an anticholinergic drug were compared in 58 healthy children undergoing adenoidectomy. The study was double-blind and randomized. All children were premedicated with oral midazolam 0.5 mg/kg. Twenty-nine children received oral atropine 0.03 mg/kg (Group A) and the rest were given i.v. glycopyrrolate 0.005 mg/kg at the induction of anaesthesia (Group G). In Group A, of 29 children, the stomach was empty in 2, pH was less than 2.5 in 23, the gastric volume was greater than 0.4 ml/kg in 19, and both these risk factors were present in 17 children. The same figures in Group G were 5 (NS), 14 (P less than 0.05), 10 (P less than 0.05) and 9 (P less than 0.05) children, respectively. The antisialagogue effect was similar in both groups.

Administration, Oral↗

PubMed1991

Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft.

Fifty-two patients were randomized to receive either incentive spirometry (IS) or intermittent positive pressure breathing (IPPB) in addition to conventional chest physical therapy following coronary artery bypass grafting. Slow vital capacity and peak expiratory flow readings decreased rapidly and to an equal extent in both groups after surgery, and partly recovered by the sixth postoperative day (POP). Arterial PO2 values were similar for the groups on the first three POPs. On the POPs 2, 3, and 6, the number of chest films showing atelectases as well as the number of individual patients having atelectases revealed no statistically significant differences between the two groups. Based on the three variables studied, we consider both devices equal in efficiency after coronary surgery.

Blood Gas Analysis↗

PubMed1991

Effects of deliberate hypotension induced by labetalol on renal function.

The effect of deliberate hypotension induced by labetalol on renal function, was studied in 25 patients undergoing middle-ear surgery. The patients were randomized into three groups, one enflurane (E) group and two isoflurane (I and F) groups. Group F received frusemide 0.5 mg kg-1 at the onset of hypotension. The mean arterial pressure was 50 mmHg (6.7 kPa) in Groups E and I, and 49 mmHg (6.5 kPa) in Group F during hypotension. During hypotension, urine flow rate, effective renal blood flow, endogenous creatinine clearance, and osmolar clearance decreased. Free-water clearance and fractional electrolyte excretions also indicated deterioration of renal function during hypotension, but it returned to normal after anaesthesia. The effects of frusemide appeared mainly after anaesthesia. Frusemide reduced the amount of labetalol and isoflurane needed to maintain hypotension. Serum fluoride concentration did not increase to a potentially nephrotoxic level.

Acid-Base Equilibrium↗