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Biomedical subjects

M Tuominen

Publications and source records attributed to M Tuominen.

At least 19 recordsLinked to original sources
PubMed1999

Factors associated with post-operative myocardial ischaemia in elderly patients undergoing major non-cardiac surgery.

Forty patients (> 65 years) undergoing hip arthroplasty or peripheral vascular surgery both associated with high risk for post-operative myocardial ischaemia were randomized to receive either spinal or general anaesthesia. Ambulatory ECG recording (Holter) until the third post-operative morning, a daily 12-lead ECG and serum creatine kinase and troponine concentraItions were obtained. The number of ischaemic episodes, total duration of ischaemia and ischaemic minutes per hour were noted for each patient peri-operatively. Sixteen of the patients (40%) had post-operative myocardial ischaemia. An intra-operative increase in the plasma concentration of norepinephrine but not epinephrine was detected in the patients who later developed post-operative myocardial ischaemia. The increase in plasma norepinIephrine concentrations correlated with the decrease in core temperature. The type of anaesthesia had no effect on the incidence of myocardial ischaemia during or after surgery. Our results suggests that intra-operatively decreased core temperature and the increase in plasma concentration of norepinephrine probably caused peripheral vasoconstriction leading to latent cardiac dysfunction. These events should be avoided in the patients at risk of post-operative cardiac ischaemia.

Aged↗
PubMed1999

Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery.

Tramadol, a weak opioid mu-receptor agonist, may have a favourable potency and side effect profile for intravenous patient-controlled analgesia (PCA). In a prospective, double-blind, randomized study involving 54 patients, tramadol was compared with oxycodone in PCA after maxillofacial surgery. All the patients were given diclofenac sodium 1 mg kg-1 intramuscularly and dexamethasone 8 mg twice a day. Post-operatively patients received tramadol or oxycodone by a PCA apparatus (lockout 5 min, tramadol 0.3 mg kg-1 bolus, oxycodone 0.03 mg kg-1 bolus). During the immediate recovery period, opioid was administered i.v. in a double-blind fashion, either tramadol 10 mg or oxycodone 1 mg increments until the pain control was judged to be satisfactory by the patient. Pain was assessed at rest and during activity (mouth opening) before and after loading, at 2 h after commencing the PCA, as well as at 21.00 and at 09.00 hours on the following morning. Side effects were recorded. The potency ratio of tramadol to oxycodone was found to be approximately 8:1. There was no significant difference between the groups in the VAS scores for pain. No respiratory depression was identified. Tramadol was found to provide adequate analgesia after maxillofacial surgery without risk of respiratory depression. However, the incidence of nausea was slightly greater in the tramadol group than in the oxycodone group (44% vs. 28%, NS).

Adolescent↗
PubMed1998

Comparison of intrathecal morphine and continuous femoral 3-in-1 block for pain after major knee surgery under spinal anaesthesia.

Major knee surgery is associated with moderate or severe post-operative pain. Intrathecal morphine and continuous femoral 3-in-1 block were compared prospectively in 40 patients for pain after major knee surgery under spinal anaesthesia, with 4 mL isobaric 0.5% bupivacaine. In a random order, 20 patients received preservative free morphine 0.3 mg mixed with spinal bupivacaine. In 20 patients, following spinal anaesthesia with only bupivacaine, femoral 3-in-1 block was performed post-operatively with 0.5% bupivacaine 2 mg kg-1. The block was continued via a catheter with 0.25% bupivacaine 0.1 mL h-1 kg-1 until the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. Three patients in the morphine group and one patient in the femoral group did not need any additional oxycodone. In the morphine group on average 2.8 (range 0-7) and in the femoral group 3.2 (0-5) additional doses of oxycodone were needed during the 24 h observation period. The mean pain scores were significantly lower in the morphine group at 9 and 12 h into the 24-h trial. Itching was seen only in the morphine group (40% of the patients). Other side effects were similar in the two groups. All patients were satisfied with their pain therapy. Both intrathecal morphine and femoral 3-in-1 block alone were insufficient for the treatment of severe pain after major knee surgery.

Aged↗
PubMed1998

Comparison of respiratory effects of tramadol and pethidine.

Tramadol is a centrally acting opioid with a low affinity for mu-opioid receptors, which has been claimed not to depress respiration as do the classic opioids. The respiratory effects of intravenous (i.v.) pethidine (0.6 mg kg-1) and tramadol (0.6 mg kg-1) were compared in 36 ASA Grade I-II patients in a placebo-controlled double-blind study. After induction of anaesthesia with propofol followed by suxamethonium-facilitated endotracheal intubation, the patients spontaneously breathed halothane in 70% nitrous oxide and oxygen via a non-rebreathing valve. Inspiratory and expiratory oxygen, and end-tidal carbon dioxide concentrations (PETCO2), tidal volume (VT), minute volume of ventilation (MV) and respiratory rate were monitored by a side-stream spirometry at an end-tidal halothane of 0.3%. The recordings were collected before surgery. Pethidine caused significant respiratory depression seen as an increase in fractional inspiratory-expiratory oxygen difference and PETCO2 and as a decrease in MV and respiratory rate. However, the effects of tramadol were similar to those of a placebo. Tidal volume was not affected by any study drug. In conclusion, tramadol 0.6 mg kg-1 was shown not to be associated with respiratory depression, unlike equipotent dose of pethidine in this setting.

Adult↗
PubMed1998

Satisfaction with dental care among elderly Finnish men.

To study satisfaction with dental care among elderly Finnish men and to estimate the role of different factors affecting it, a questionnaire was sent to a systematic sample of 2043 elderly Finnish men (mean age 73 years). Acceptably filled-out questionnaires were returned by 1561, a participation rate of 76.4%. The questionnaire included 44 questions concerning dental and denture services and a modified 14-item Dental Satisfaction Questionnaire. The subjects were asked to express how strongly they agreed or disagreed with each of the 14 statements. These were later transformed and recoded to indicate level of satisfaction from +2 (very satisfied) to -2 (very dissatisfied). Overall satisfaction was estimated by summing up all the 14 scores. Dentate subjects were significantly (P<0.01) more satisfied than the edentulous. Subjects were least satisfied with dental care fees and most satisfied with accessibility and availability of services. Dentate subjects viewed almost all 14 items significantly more favorably than did the edentulous. Economics was seen to have a strong influence on dissatisfaction with dental care fees, which was related to income level. Maintaining the remaining dentition and supporting the dentition with fixed or removable dentures seem to be the means to increase satisfaction among the dentate. The benefits of belonging to a clinic's recall system should be explained thoroughly to the elderly.

Age Factors↗
PubMed1997

Comparison of respiratory effects of tramadol and oxycodone.

STUDY OBJECTIVE: To compare the respiratory effects of tramadol and oxycodone. DESIGN: Placebo-controlled, double-blind randomized study. SETTING: IV Department of Surgery, Helsinki University Central Hospital. PATIENTS: 36 ASA physical status I and II patients undergoing minor surgery with general anesthesia. INTERVENTIONS: The respiratory effects of intravenous (i.v.) tramadol 0.6 mg/kg and oxycodone 0.04 mg/kg were compared after induction of anesthesia with propofol and succinylcholine-facilitated endotracheal intubation. Patients spontaneously breathed halothane in 70% nitrous oxide and oxygen via a nonrebreathing valve. The trial drugs or placebo were given after recovery from neuromuscular block. MEASUREMENTS AND MAIN RESULTS: Inspiratory and expiratory oxygen and end-tidal carbon dioxide concentrations (ETCO2), tidal volume (VT) minute volume of ventilation (VE), and respiratory rate (RR) were recorded by side-stream spirometry with end-tidal halothane of 0.3% for 30 minutes before surgery. Oxycodone caused a significant respiratory depression seen as an increase in the inspiratory-expiratory oxygen difference and ETCO2 and as a decrease in VE and RR. On the contrary, the effect of tramadol were similar to those of placebo. VT was not affected by any study drug. CONCLUSION: Tramadol was not associated with respiratory depression in the present setting.

Adult↗
PubMed1997

Home-readiness after spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine.

Fifty-four patients were studied prospectively to evaluate home-readiness after a small dose (1 or 2 ml) of subarachnoid hyperbaric 0.5% bupivacaine. The block regressed significantly earlier in the 1 ml group than in the 2 ml group (p < 0.05). The patients were also able to walk significantly earlier in the 1 ml group (median 161 min and 231 min in the 1 ml and 2 ml groups, respectively) (p < 0.05). However, there were no significant differences between the groups in time of ability to void. We conclude that adequate surgical anaesthesia can be achieved with small doses of hyperbaric bupivacaine used for spinal anaesthesia. Although the sensory and motor block after 1 or 2 ml hyperbaric bupivacaine recovered within a reasonable time for day-case surgery, in some patients recovery of the ability to void was delayed to an undesirable extent.

Adult↗
PubMed1996

Intravenous ketorolac vs diclofenac for analgesia after maxillofacial surgery.

PURPOSE: To compare the efficacy of the non-steroidal antiinflammatory drugs (NSAID), ketorolac and diclofenac in prevention of pain after maxillofacial surgery. METHODS: Sixty ASA I-II patients (30 in each group) received randomly, and double blindly either ketorolac 0.4 mg.kg-1 or diclofenac 1.0 mg.kg-1 iv after general anaesthesia induction, before surgical incision. In the ketorolac group, the same dose was repeated iv three times at six hour intervals. The diclofenac group patients received diclofenac 1.0 mg.kg-1 after 12 hr iv. Rescue analgesic medication consisting of oxycodone 0.03 mg.kg-1 iv, was administered by a patient controlled analgesia apparatus. RESULTS: Two patients in the ketorolac and three patients in the diclofenac group did not need oxycodone during the study period. On average, 12 and 11 doses of oxycodone were needed in the ketorolac and the diclofenac groups, respectively (NS). Side-effects were similar in both groups. All patients except one were satisfied with the pain therapy. CONCLUSION: Parenteral ketorolac (0.4 mg.kg-1 four times in 24 hr) and diclofenac (1 mg.kg-1 twice in 24 hr) were similar, but insufficient alone, for analgesia after maxillofacial surgery.

Adult↗
PubMed1996

Effect of reduced articular function on deposition of type I and type II collagens in the mandibular condylar cartilage of the rat.

A group of rats was fed a soft diet after weaning and the incisors shortened regularly to keep them out of occlusion. The controls were fed a hard diet. Immunohistochemical techniques and image analysis were employed to investigate deposition of pro-type I collagen and type II collagen, and the thickness of articular cartilage layers in the mandibular condyle. The immunostaining against pro-type I collagen was most intense intracellularly in the fibrous and upper chondroblast layers in 30- and 50-day-old rats fed a hard diet. In the rats fed a soft diet, marked intra- and extracellular staining against pro-type I collagen was visible in the upper chondroblast and upper hypertrophic layers but also in the lower hypertrophic layer. The intensity of staining against type II collagen was weak in animals on a soft diet, while in the animals fed a hard diet the staining was intense in the superior layers of mature chondroblasts. The total number of chondroblasts recorded was reduced by 35 percent at the age of 50 days in the soft-diet compared to the hard-diet animals. The results show that the deposition of type I and II collagens, the thickness of the cartilage cell layers and the number of chondrocytes are sensitive to alterations in loading.

Animals↗
PubMed1996

Growth and type-II collagen expression in the glenoid fossa of the temporomandibular joint during altered loading: a study in the rat.

The aim of this study was to measure changes in growth of the glenoid fossa and its articular eminence after decreased loading. A further aim was to evaluate the role of mechanical forces in relation to the existence of a cartilage layer, by determining type-II collagen secretion. A total of 99 Wistar rats were used: 48 animals were fed whole pellets and 51 were fed ground pellets. At age 21 days, after weaning, the upper and lower incisors of the soft-diet group were shortened by cutting them, twice a week. Ten animals fed whole pellets and 10 fed ground pellets were injected i. p. with Alizarin red (200 mg/kg) at ages 22, 30 and 40 days, and killed at ages 30, 40 and 50 days respectively. The heads were freed from the soft tissue and the zygomatic process cut sagittally at the deepest point of the greatest transversal concavity of the eminence. Bone apposition was measured. The other animals were used for studies involving collagen II immunostaining. Bone growth decreased in the group fed ground pellets except in the anterior-most part of the glenoid fossa at 50 days. Immunohistochemical analysis revealed larger areas of anti-collagen II staining in the group fed whole pellets, most markedly in the posterior part of the glenoid fossa. Growth of the articulationg surface of the temporal component of the temporomandibular joint appears to depend on mechanical factors, such as the condyle. The underlying mechanics seem likely to be different. The presence of type-II collagen is obviously not regulated only by compressive forces but probably also by tension loading.

Animals↗
PubMed1995

Auditory disturbance associated with interscalene brachial plexus block.

We performed an audiometric study in 20 patients who underwent surgery of the shoulder region under an interscalene brachial plexus block (IBPB). Bupivacaine 0.75% with adrenaline was given followed by a 24-hr continuous infusion of 0.25% bupivacaine. Three audiometric threshold measurements (0.25-18 kHz) were made: the first before IBPB, the second 2-6 h after surgery and the third on the first day after operation. In four patients hearing impairment on the side of the block was demonstrated after operation, in three measurements on the day of surgery and in one on the following day. The frequencies at which the impairment occurred varied between patients; in one only low frequencies (0.25-0.5 kHz) were involved. The maximum change in threshold was 35 dB at 6 kHz measured at the end of the continuous infusion of bupivacaine. This patient had hearing threshold changes (15-20 dB) at 6-10 kHz on the opposite side also. IBPB may cause transient auditory dysfunction in the ipsilateral ear, possibly via an effect on sympathetic innervation.

Adult↗
PubMed1995

Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine.

We have studied prospectively 600 patients who had spinal anaesthesia for minor surgery, to evaluate the incidence of transient radicular irritation after the block. The anaesthetic agent (hyperbaric 5% lignocaine, hyperbaric 0.5% bupivacaine or plain 0.5% bupivacaine) was chosen according to the anticipated duration of surgery. We obtained information after operation from 537 patients (282 by telephone, 255 by letter). Ten percent of patients anaesthetized with hyperbaric 5% lignocaine (27 patients) had transient bilateral radiating pain in the lower extremities, buttocks, or both. Typically the pain started within 24 h after spinal anaesthesia, lasted less than 2 days and was described as mild. Lignocaine was the only variable that correlated with this pain. Two patients complained of symptoms after hyperbaric 0.5% bupivacaine but these were atypical compared with pain after lignocaine. None of the patients anaesthetized with plain bupivacaine had similar complaints. We conclude that the use of 5% hyperbaric lignocaine for spinal anaesthesia should be reconsidered.

Adult↗
PubMed1995

Anaphylactoid skin reactions after intravenous regional anaesthesia using 0.5% prilocaine with or without preservative--a double-blind study.

Methylparaben, the preservative of various local anaesthetic solutions, is a potential allergen. In a double-blind study, 0.5% prilocaine with (Citanest, n = 100) or without (n = 100) methylparaben were compared for the occurrence of skin reactions after intravenous regional anaesthesia of the arm in surgical patients. Skin reactions were registered after the deflation of the tourniquet cuff, and intradermal tests were performed with 0.5% prilocaine, 0.1% methylparaben and saline in all patients. Seventeen patients in the Citanest group and four patients in the methylparaben-free prilocaine group developed erythematous skin reactions in the exposed arm after deflation of the tourniquet cuff (P < 0.05, between the groups). The skin symptoms disappeared within an hour and were always restricted to the region which had been anaesthetised. None of the affected patients had positive intradermal tests. The observed skin reactions are probably non-IgE-mediated anaphylactoid reactions in which the presence of methylparaben in the local anaesthetic solution plays a major role.

Adult↗
PubMed1995

Premedication with promethazine and transdermal scopolamine reduces the incidence of nausea and vomiting after intrathecal morphine.

Intrathecal morphine provides effective postoperative pain relief in major orthopaedic surgery. In use, however, is associated with unpleasant side effects like nausea and vomiting. The effect of different premedications on postoperative emetic sequelae induced by intrathecal morphine was studied in a prospective, double blind study. Sixty patients scheduled for arthroplasty surgery of the lower extremity were anaesthetized with spinal anaesthesia with a combination of isobaric bupivacaine 20 mg and morphine 0.3 mg. For premedication the patients were randomised to three groups of equal size. They received either oral diazepam (5-15 mg), oral promethazine (10 mg) or a combination of promethazine and transdermal scopolamine (1.5 mg). Sixty percent of the patients with both promethazine and transdermal scopolamine were totally free from postoperative nausea and vomiting (PONV) symptoms compared to those premedicated with diazepam (40%) or promethazine alone (30%). Promethazine together with transdermal scopolamine reduced significantly the number of patients with vomiting (to 25%) and also vomiting episodes. This combination was also more efficient in reducing the incidence of nausea (to 25%) and nausea episodes than promethazine along (P < 0.05). Combination also reduced the requests for additional pain relief (P < 0.05). PONV occurred in a majority of patients during the first 12 hours of the 24 hour study period and the need for additional analgesics thereafter. The incidence of itching (50-65%) and urinary catheterisation (55-70%) was similar in all groups. In conclusion, the combination of oral promethazine and transdermal scopolamine was most effective in reducing PONV symptoms and also reduced the need for postoperative pain treatment.

Administration, Cutaneous↗
PubMed1995

Comparison of parenteral diclofenac and ketoprofen for postoperative pain relief after maxillofacial surgery.

Non-steroidal anti-inflammatory drugs (NSAID) effectively reduce the need for opioid analgesia after various types of surgery. The efficacy of diclofenac and ketoprofen to relieve pain after maxillofacial surgery was compared in the present study. In a randomized and double-blind fashion, 90 ASA I-II patients (16-60 yrs) were studied, divided into three groups: Thirty patients received 1.0 mg.kg-1 diclofenac i.v. after general anaesthesia induction, before surgical incision, and four hours later the same dose was given i.m. Thirty patients received ketoprofen 1.35 mg.kg-1 i.v. and i.m., as above, and a third group of 30 patients received a comparable volume of saline i.v. and i.m. The patients received supplemental analgesia using a patient controlled analgesia apparatus; the rescue medication consisted of 0.03 mg.kg-1 oxycodone i.v. (four-hour maximum dose was 0.4 mg.kg-1) during the 24-hour follow-up. The three groups were comparable regarding the type of maxillofacial surgery (osteotomies vs. soft tissue surgery). Overall, there was a lower need for i.v. oxycodone during the 24-hour period in the diclofenac group (269 doses) than in the ketoprofen group and in the saline group (388 doses, each) (P < 0.01). The significantly lower number of oxycodone administrations in the diclofenac group was a result of a distinguishable difference, particularly during the first four hours after surgery. There was no statistically significant difference in the incidence of side effects of the analgesic therapy between the three groups.

Adolescent↗
PubMed1995

Effect of unilateral masticatory function on craniofacial growth in the rabbit.

In this study the main purpose was to investigate the effect of altered masticatory function on the shape and inclination of the articular surface of the glenoid fossa, and on the growth of the mandible in the rabbit. The maxillary and mandibular molars of 14, 10-d-old rabbits were ground down to the gingiva on the right side twice a week; 9 were controls. At age 50 d all rabbits were killed, soft tissue of the heads was removed, and the measurements were made. The inclination of the articular surface of the glenoid fossa was shallower on both sides in the experimental group than in the controls; the difference was greater on the right side. There were dimensional and angular differences between right and left sides of the mandible and maxilla in the experimental animals. In conclusion, unilateral masticatory function was found to cause an asymmetric craniofacial growth. Furthermore, function has an effect on the shape of the glenoid fossa, especially on the balancing side, in conjunction with asymmetric function.

Animals↗