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R Larsen

Publications and source records attributed to R Larsen.

At least 37 records · Page 2Linked to original sources
PubMed2001

Precise measurement of the positive muon anomalous magnetic moment.

A precise measurement of the anomalous g value, a(mu) = (g-2)/2, for the positive muon has been made at the Brookhaven Alternating Gradient Synchrotron. The result a(mu+) = 11 659 202(14) (6) x 10(-10) (1.3 ppm) is in good agreement with previous measurements and has an error one third that of the combined previous data. The current theoretical value from the standard model is a(mu)(SM) = 11 659 159.6(6.7) x 10(-10) (0.57 ppm) and a(mu)(exp) - a(mu)(SM) = 43(16) x 10(-10) in which a(mu)(exp) is the world average experimental value.

Journal Article↗
PubMed2001

[Patient surgical masks during regional anesthesia. Hygenic necessity or dispensable ritual?].

OBJECTIVE: The use of surgical face masks (SFM) is believed to minimize the transmission of oro- and nasopharyngeal bacteria to wounds and surgical instruments. However, there are disadvantages for patients undergoing regional anaesthesia and wearing masks: deficient assessment of lip cyanosis, anxiety, retention of CO2, costs. Up to now no studies have been published investigating whether or not SFMs, worn by patients during regional anaesthesia, will reduce bacterial convection. METHODS: We investigated 72 patients during aseptic operations: 24 individuals with regional anaesthesia and SFMs, 22 individuals with regional anaesthesia without SFMs and 26 patients undergoing general anaesthesia. Using an air sampler (volumetric impaction method) 100 L air were collected on blood agar over 2 min. After incubation at 37 degrees C over 60 h the colony forming units (CFU) were counted and differentiated. Airborne culturable bacteria were sampled over the operation field, on the anaesthetic side of the surgical curtain, as well as 10 cm before and to the side of the patients mouth. RESULTS: At all 4 locations there were no significant differences in the number of CFUs between patients wearing a SFM or not (e.g. over the operation field: patient with SFM 5.5 +/- 1.1; no SFM 4.8 +/- 1.2; mean +/- SEM). Significantly more CFUs were detected in patients undergoing general anaesthesia (p < or = 0.05). The extent of the operation did not correlate with the number of CFUs; however, we observed a trend that more CFUs were detected with an increasing number of persons working in the operating room. CONCLUSION: Surgical face masks worn by patients during regional anaesthesia, did not reduce the concentration of airborne bacteria over the operation field in our study. Thus they are dispensable. A higher airborne germ concentration has been detected in patients during general anaesthesia. The reasons for this finding are unknown, but it may be discussed as being a result of a higher activity and number of staff involved during general anaesthesia causing more air turbulence.

Adult↗
PubMed2001

[Less pain on injection by a new formulation of propofol? A comparison with propofol LCT].

BACKGROUND: Pain on injection is a major disadvantage of propofol, experienced by the vast majority of patients. Since the traditional formulation has almost normal osmolality and pH, it is hypothesised that the concentration of free propofol in the aqueous phase of the emulsion is responsible for the pain and that reducing the amount of free propofol would also reduce the frequency and intensity of pain on injection. This study was designed to investigate whether pain on injection can be reduced in frequency and intensity by a new formulation of propofol. METHODS: We performed a monocentre, controlled, randomised, double-blind study to compare the pain produced by intravenous injection of a new propofol preparation (propofol-MCT/LCT) with standard propofol in patients undergoing elective surgical procedures. A total of 184 non-premedicated patients received either 1% propofol prepared in a mixture of medium and long chain triglycerides (Propofol-MCT/LCT, Propofol- Lipuro, B. Braum Melsungen AG) or standard 1% propofol prepared exclusively in long chain triglycerides (Propofol-LCT; Disoprivan, AstraZeneca) into a vein of the dorsal hand for induction of anaesthesia. Anaesthesia was maintained by TIVA with propofol and remifentanil. Pain on injection was recorded and graded as none, mild, moderate or severe. RESULTS: Patients receiving propofol-MCT/LCT had a significantly lower incidence of pain on injection compared to the standard propofol group (37% vs 64%) with the intensity of pain also being less severe. There were no differences between both groups in propofol dosage for induction (3.2 +/- 0.8 mg/kg vs 3.3 +/- 0.9 mg/kg) and maintenance of anaesthesia (3.4 +/- 0.6 mg/kg/h vs 3.2 +/- 0.5 mg/kg/h), remifentanil dosage (25 +/- 6 micrograms/kg/h vs. 24 +/- 6 micrograms/kg/h), intraoperative hemodynamics, recovery parameters and postoperative patient satisfaction. Postoperative thrombophlebitis at the injection site for propofol was not observed in any of the patients. CONCLUSIONS: Propofol-MCT/LCT produced significantly less pain on injection when compared to standard propofol in ASA I and II patients undergoing elective surgery. Pain was also significantly less severe, with both effects presumably being due to the lower concentration of free propofol in the MCT/LCT-preparation. With regard to injection pain propofol-MCT/LCT offers significant a advantage over standard propofol.

Anesthesia, Intravenous↗
PubMed2001

The Narcotrend--a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia.

INTRODUCTION: The Narcotrend is a new EEG monitor designed to measure the depth of anaesthesia based on a 6-letter classification from A (awake) to F (general anaesthesia with increasing burst suppression) and divided into 14 substages (A, B0-2, C0-2, D0-2, E0,1, F0,1). This study was designed to investigate the assessment of the depth of anaesthesia as measured by the Narcotrend in comparison with bispectral index monitoring (BIS). METHODS: Both BIS and Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturers. All patients were premedicated with diazepam 0.15 mg/kg orally in the evening and on the morning before surgery. Induction of anaesthesia was started with a remifentanil infusion at 0.4 microgram/kg/min; 5 min later propofol was given for hypnosis using a target-controlled infusion initially started at 3.5 micrograms/ml. After loss of consciousness patients received 1.2 mg/kg of suxamethonium. Immediately after intubation, remifentanil was reduced to 0.2 microgram/kg/min, and the depth of anaesthesia was adjusted according to clinical needs by regulating the propofol target-controlled-infusion. BIS values and Narcotrend stages were recorded as data pairs in intervals of 1 min during anaesthetic induction and emergence, and in intervals of 5 min during maintenance of anaesthesia. RESULTS: Fifty patients undergoing orthopaedic surgery were studied and 2031 data pairs were obtained. An increasing depth of anaesthesia as indicated by the Narcotrend was associated with significantly lower mean BIS values. With BIS values between 100 and 85 (representing awake patients), 95.5% of all data pairs indicated a Narcotrend stage A or B. In case the BIS was found to be 65-40 (representing general anaesthesia) the corresponding Narcotrend stages were measured as D (52.4%) or E (41.1%). No patient complained of intraoperative recall when interviewed on the 1st and 3rd postoperative day. CONCLUSIONS: We could demonstrate that an increase of the hypnotic component of anaesthesia as indicated by BIS is accompanied by corresponding effects as displayed by the Narcotrend during propofol-remifentanil anaesthesia. The Narcotrend stages D or E are assumed equivalent to BIS values between 64 and 40 indicating general anaesthesia.

Anesthesia, General↗
PubMed2001

[Injection pain from propofol-MCT-LCT in children. A comparison with propofol-LCT].

OBJECTIVES: This prospective, randomised, double-blind study was designed to compare the incidence and intensity of pain on injection of propofol formulated in a mixture of medium- and long-chain triglycerides, Propofol-MCT/LCT 1% (Propofol-Lipuro, B. Braun, Germany) with propofol in a commonly used emulsion of long-chain triglycerides, Propofol-LCT 1% (Disoprivan, Zeneca) in children undergoing elective surgical procedures. METHODS: After approval of the local ethics committee 40 children, aged 7-14 years, were enrolled in the study. Premedication was with 5-10 mg diazepam orally one hour before induction of anesthesia. In the beginning 20% of the calculated dose of Propofol for induction was injected into a separate venous cannula in a dorsal vein of the hand; patients were observed for expressing pain spontaneously during injection patients or were asked to describe the sensations after 10 s. Withdrawal of the arm during injection was also noted. RESULTS: Significantly more children reported pain on injection of propofol-LCT compared to Propofol-MCT/LCT (25% vs, 10%) and significantly more children retracted their arm during injection of propofol-LCT (40% vs. 10%). IMPLICATIONS: Propofol-MCT/LCT 1% (Propofol-Lipuro) for induction of anesthesia produced significantly less pain on injection and significantly less drawing back of the arm when compared to Propofol-LCT (Disoprivan). Thus, with respect to pain on injection Propofol-MCT/LCT appears to be superior to Propofol-LCT in children aged 7-14 years.

Adolescent↗
PubMed2001

Novel modified Ussing chamber for the study of absorption and secretion in human endoscopic biopsies.

The aim of this study was to design and evaluate a modified Ussing chamber, that makes use of constant air suction (modified Ussing air suction chamber, MUAS) for fixation of biopsy specimens. Standard size forceps biopsies were taken from the descending part of duodenum from patients undergoing endoscopy. Short circuit current (SCC) and conductance (G) were measured during basal conditions and after addition of different sugars and secretagogues. Histologic examination was performed to determine the degree of tissue damage after study in the chamber. Basal SCC was 54.7 +/- 4.3 microA x cm(-2) and G was 58.7 +/- 4.7 mS x cm(-2) (mean +/- SEM, n=48) and steady values of these parameters were observed for at least 2 h. Reproducible and steady responses in SCC were obtained with D-glucose (SCCmax=172 +/- 22.1 microA x cm(-2); EC50=6.9 +/- 0.7 mM, n=5) and D-galactose (SCCmax=233 +/- 55.7 microA x cm(-2); EC50=9.2 +/- 0.7 mM, n=3), and secretory responses with 5-hydroxytryptamine, 100 microM (DeltaSCC= 16.1 +/- 3.8 microA x cm(-2), n=10), histamine, 100 microM (DeltaSCC=24.0 +/- 4.1 microA x cm(-2), n=10) and prostaglandin E2, 1 microM (DeltaSCC=30.3 +/- 5.4 microA x cm(-2), n=6). Experimental biopsy specimens showed intact surface epithelium by histologic examination and did not differ from controls apart from minor indications of edge damage. No difference in basal electrical parameters and D-glucose fluxes were found between Helicobacter pylori positive and negative patients. Our data suggests that the MUAS chamber represents a promising alternative approach to measure transport processes in intestinal endoscopic biopsies.

Adult↗
PubMed2001

Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery.

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 microg kg(-1) min(-1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 microg kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response to simple neurological tests (digit symbol substitution test (DSST) and Trieger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emergence from remifentanil-desflurane anaesthesia was significantly quicker than that from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min, respectively; mean times for patients to state their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. Patients in the remifentanil-desflurane group successfully performed neurological tests significantly earlier than those in the fentanyl-desflurane group; for example, patients in the former group completed the arm holding test at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P < or = 0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an earlier opportunity for neurological examination suggest that remifentanil-desflurane is a suitable alternative to a standard fentanyl-based general anaesthetic technique in patients undergoing CEA.

Adult↗
PubMed2001

Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans.

Although both maternal obesity and diabetes mellitus increase the risk for neural tube defects, it is unknown whether they are independent risk factors or manifestations of an underlying prediabetic state such as hyperinsulinemia. We investigated whether hyperinsulinemia was a risk factor for neural tube defects independent of obesity and hyperglycemia in Mexican-American women. We identified case and control women from residents delivering or terminating pregnancies in hospitals or birthing centers in any of the 14 Texas-Mexico border counties during 1995-2000. Case women had a pregnancy affected by anencephaly, spina bifida, or encephalocele; randomly selected control women had normal births, frequency matched by year and birth facility. Questionnaire and laboratory values obtained 5-6 weeks postpartum were available for 149 case and 178 control women. Both hyperinsulinemia and obesity were related to increased neural tube defect risk [odds ratio (OR) = 1.91, 95% confidence interval (CI) = 1.21-3.01 and OR = 1.73, 95% CI = 1.03-2.92, respectively]. Adjustment for obesity only slightly reduced the effect of hyperinsulinemia (OR = 1.75, 95% CI = 1.09-2.82). Alternatively, a modest effect remained for obesity after adjustment for hyperinsulinemia (OR = 1.45, 95% CI = 0.84-2.51). Hyperinsulinemia is a strong risk factor for neural tube defects and may be the driving force for the observed risk in obese women.

Adult↗
PubMed2000

Investigation of folate pathway gene polymorphisms and the incidence of neural tube defects in a Texas hispanic population.

Neural tube defects (NTDs) are multifactorial in their etiology, having both genetic and environmental factors contributing to their development. Recent evidence demonstrates that periconceptional supplementation of the maternal diet with a multivitamin containing folic acid significantly reduces the occurrence and recurrence risk for having a pregnancy complicated by NTDs. Unfortunately, the mechanism underlying the beneficial effects of folic acid remains unknown. NTD surveillance data from the Texas-Mexico border show that the high NTD rate (28/10,000 live births) noted during the 1990-1991 Cameron county NTD cluster was superimposed on a background Cameron county NTD rate (16/10,000 live births) which is considerably higher than that generally noted in the United States (8-10/10,000 live births). These data suggest that genetic factors as well as transient environmental factors may contribute to the etiology of the NTDs. Furthermore, clinical and experimental evidence imply that allelic forms of genes involved with folate metabolism and/or transport may explain some of the observed variation in the NTD rates found across different populations. Two folate pathway genes were selected for evaluation in this study. The loci investigated included two known alleles of the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene, as well as the promoter region of the folate receptor-alpha (FR-alpha) gene. Odds ratios (ORs) for the C677T polymorphism in the MTHFR gene were 1.8 (CI 0.47-6.8) for heterozygosity and 1.8 (CI 0.35-9.4) for homozygosity for the mutant 677T allele, relative to wildtype homozygotes. The odds ratio for the heterozygosity for the A1298C polymorphism in the same gene was 1.1 (CI 0.09-14). No individuals homozygous for the 1298C allele were observed. The OR for heterozygosity of FR-alpha gene polymorphisms detected at nucleotide 762 and at nucleotides 610/631 was 1.4 and 0.7, respectively. Neither of the FR-alpha polymorphisms was observed in the homozygous condition. No statistically significant associations were observed for any of the polymorphisms examined, as the 95% confidence intervals for all of the ORs included one. However, the frequency of the MTHFR 677T allele in the largely Hispanic control group from Texas was significantly different from other populations (P < 0.005), and among the highest reported for any control populations examined.

Adult↗
PubMed2000

[Cognitive impairment in the early postoperative period after remifentanil-propofol and sevoflurane-fentanyl anesthesia].

OBJECTIVE: In ambulatory anaesthesia the time required to recover from cognitive impairment should be as short as possible. The aim of this study was to compare the early cognitive recovery after remifentanil/propofol (R/P) and sevoflurane/fentanyl (S/F) anaesthesia. METHODS: Sixty patients scheduled for elective gynaecological laparoscopy and 24 female volunteers tested for the assessment of learning effects were investigated. After praemedication with midazolam anaesthesia was induced with propofol, atracurium and either 1 microgram/kg fentanyl or 1 microgram/kg remifentanil. For maintenance 0.25 microgram/kg/min remifentanil and 0.6 mg/kg/min propofol (R/P) or 1.7 vol% sevoflurane (S/F) were given. Both groups were ventilated with 30% oxygen in air and received metamizol for postoperative analgesia. Verbal Learning Test, Stroop Colour and Word Interference Test, Digit Symbol Substitution Test and Four Boxes Test were performed the day before surgery and 30 min, 1 h, 2 h and 4 h after termination of anaesthesia. RESULTS: For remifentanil/propofol cognitive function was still impaired 2 h (Verbal Learning) and 4 h (Stroop, Digit Symbol Substitution and Four Boxes Test) after termination of anaesthesia. After sevoflurane/fentanyl anaesthesia cognitive impairment lasted the same duration in Four Boxes Test, but shorter in Stroop and Digit Symbol Substitution and could not be found in Verbal Learning Test. CONCLUSION: The duration of cognitive impairment in the early postoperative period differed by the test procedures and the anaesthetic procedures used in this investigation. Recovery appeared to be faster after sevoflurane/fentanyl than after remifentanil/propofol at least in aspects of cognitive function.

Adult↗
PubMed2000

[Time course of neuromuscular blockade after rocuronium. A comparison between women and men].

BACKGROUND: We studied 40 patients (20 female and 20 male) undergoing elective surgery under general anaesthesia to evaluate the effect of gender on the pharmacodynamics of rocuronium. METHODS: Using electromyography (EMG) we determined the maximal neuromuscular block and time course of action of 0.45 mg/kg rocuronium (1.5 x ED95). RESULTS: Age and body mass index were comparable between females and males (38 (+/- 8) vs. 37 (+/- 10) years and 24.2 (+/- 2.9) vs. 25.2 (+/- 1.7) kg/m2. However, significant differences in weight and height were found between females and males (65.7 +/- 9.3 kg vs. 77.5 +/- 5.5 kg; p < 0.01 and 178 +/- 6.8 cm vs. 164 +/- 6.7 cm; p < 0.01). Onset time was shorter in females (168 +/- 65 s vs. 211 +/- 56 s; p < 0.05). Maximal neuromuscular blockade after 0.45 mg/kg rocuronium was 94 (+/- 3) % in females and 89 (+/- 6) % in males; p < 0.01. Clinical duration was increased in females (23 +/- 5 min vs. 17 +/- 5 min; p < 0.05), while the recovery index was comparable between both groups (9 +/- 4 min in females and 9 +/- 3 min in males; n.s.). CONCLUSION: Compared to men neuromuscular blockade after 0.45 mg/kg rocuronium was more pronounced in women. The onset time was shortened and the clinical duration increased in female patients.

Adult↗
PubMed2000

Transcriptional activation of heme oxygenase-1 and its functional significance in acetaminophen-induced hepatitis and hepatocellular injury in the rat.

BACKGROUND/AIM: Glutathione depletion contributes to acetaminophen hepatotoxicity and is known to induce the oxidative stress reactant heme oxygenase-1. The metabolites of the heme oxygenase pathway, biliverdin, carbon monoxide, and iron may modulate acetaminophen toxicity. The aim of this study was to assess cell-type specific expression of heme oxygenase-1 and its impact on liver injury and microcirculatory disturbances in a model of acetaminophen-induced hepatitis. METHODS: Gene expression of heme oxygenase-1 was studied by Northern- and Western analysis as well as immunohistochemistry. The time course of heme oxygenase-1 and -2, cytokine-induced neutrophil chemoattractant-1, and intercellular adhesion molecule-1 was studied by Northern analysis. DNA-binding activity of nuclear factor-kappaB was determined by electrophoretic mobility shift assay. Sinusoidal perfusion and leukocyte-endothelial interactions were assessed by intravital microscopy. RESULTS: Acetaminophen caused a moderate sinusoidal perfusion failure (-15%) and infiltration of neutrophils along with activation of nuclear factor-kappaB and intercellular adhesion molecule-1 and cytokine-induced neutrophil chemoattractant-1 mRNAs. Induction of heme oxygenase-1 mRNA and protein (approximately 30-fold) in hepatocytes and non-parenchymal cells paralleled the inflammatory response. Blockade of heme oxygenase activity with tin-protoporphyrin-IX abrogated acetaminophen-induced hepatic neutrophil accumulation and nuclear factor-kappaB activation, but failed to affect sinusoidal perfusion and liver injury. CONCLUSIONS: The inflammatory response associated with acetaminophen hepatotoxicity is modulated by the parallel induction of the heme oxygenase-1 gene. However, heme oxygenase-1 has no permissive effect on sinusoidal perfusion and does not affect liver injury in this model. These data argue against a central role of nuclear factor-kappaB activation and neutrophil infiltration as perpetuating factors of liver injury in acetaminophen toxicity.

Acetaminophen↗
PubMed2000

A multicenter comparison of isoflurane and propofol as adjuncts to remifentanil-based anesthesia.

STUDY OBJECTIVE: To compare recovery, hemodynamics, and side effects of remifentanil-based anesthesia with hypnotic concentrations of isoflurane or propofol. DESIGN: Multicenter, prospective, randomized, two-group study. SETTING: 15 university and 5 municipal hospitals. PATIENTS: 249 ASA physical status I, II, and III adult patients scheduled for elective gynecological laparoscopy, varicose vein, or arthroscopic surgery of at least 30 minutes' duration. INTERVENTIONS: Anesthesia was induced in the same manner in both groups: remifentanil-bolus (1 microg/kg), start of remifentanil-infusion (0. 5 microg/kg/min), followed by propofol as needed for induction. Five minutes after intubation, remifentanil was reduced to 0.25 microg/kg/min, and it was combined with either a propofol-infusion (0.1 mg/kg/min) or with isoflurane (0.6 vol% end-tidal) in O(2)/air. Adverse hemodynamic responses of heart rate and systolic blood pressure were recorded and treated according to a predefined protocol. With termination of surgery, anesthetic delivery was discontinued simultaneously without tapering, and recovery times were recorded. MEASUREMENTS AND MAIN RESULTS: No significant differences were observed between the remifentanil-isoflurane or remifentanil-propofol treatment regimens. Recovery times (means +/- SD) were similar for spontaneous ventilation (5.8 +/- 3.2 min vs. 6. 3 +/- 3.7 min), extubation (7.6 +/- 3.5 vs. 8.5 +/- 4.2 min), eye opening (6.8 +/- 3.2 vs. 7.5 +/- 3.8 min), and arrival to the postanesthesia care unit (16.5 +/- 7.0 vs.18.0 +/- 7.2 min). There were no significant differences in adverse hemodynamic responses, postoperative shivering, nausea, or vomiting between the groups. CONCLUSIONS: Emergence after remifentanil-based anesthesia with 0.6 vol% of isoflurane is at least as rapid as with 0.1 mg/kg/min propofol. Both isoflurane and propofol are suitable adjuncts to remifentanil, and the applied dosages are clinically equivalent with respect to emergence and recovery. Therefore, both combinations should be appropriate, particularly in settings in which rapid recovery from anesthesia is desirable, such as fast tracking and/or ambulatory surgery.

Adult↗
PubMed2000

Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia.

UNLABELLED: We compared the recovery characteristics of remifentanil, desflurane, and sevoflurane when used for anesthesia in elective operative procedures. Sixty ASA physical status I and II patients, aged 18-65 yr, were randomly assigned to receive remifentanil-propofol, desflurane-N2O, or sevoflurane-N2O anesthesia. Before the induction of anesthesia, the patients of the desflurane and sevoflurane groups received fentanyl 2 microg/kg. In all groups, anesthesia was induced with propofol and maintained either with remifentanil 0.25 microg x kg(-1) x min(-1), desflurane, or sevoflurane 0.85 MAC with 65% nitrous oxide in oxygen. Anesthetics were titrated to achieve an adequate level of surgical anesthesia and to maintain mean arterial pressure within 20% of baseline values. Early recovery times and a modified Aldrete Recovery Score > 9 were recorded. Trieger Dot Test and Digit Substitution Test (DSST) were performed the day before surgery and in the postanesthesia care unit to evaluate intermediate recovery. The remifentanil-propofol group had a significantly faster emergence than desflurane or sevoflurane, with no difference between both inhaled anesthetics. Thirty min after anesthesia administration, patients in the remifentanil-propofol and in the desflurane groups gave significantly more correct responses in the DSST compared with sevoflurane (remifentanil 87%, desflurane 83%, sevoflurane 56%), the impairment in the sevoflurane patients corresponding to the effects of a blood alcohol level of approximately 0.1% and, thus, being of clinical importance. Ninety minutes after anesthesia administration, no significant difference could be demonstrated among the groups in the DSST scores. Emergence and return of cognitive function was significantly faster after remifentanil-propofol compared with desflurane and sevoflurane up to 60 min after anesthesia administration. IMPLICATIONS: We compared awakening and intermediate recovery times after remifentanil-propofol anesthesia to desflurane-N2O and sevoflurane-N2O anesthesia. Emergence and return of cognitive function was significantly faster after remifentanil-propofol compared with desflurane and sevoflurane up to 60 min after anesthesia administration.

Adult↗
PubMed2000

Interpleural analgesia does not influence postthoracotomy pain.

UNLABELLED: The management of postthoracotomy pain is a problem and may contribute to atelectasis, leading to hypoxemia, pulmonary infection, and permanent alveolar damage. We sought to determine the efficacy of interpleural analgesia for pain control and to evaluate independent predictors for postoperative pain intensity. Eighty-three patients undergoing elective anterolateral (n = 37) and posterolateral (n = 46) thoracotomy were included in a prospective, randomized, double-blinded trial. Patients were assigned to receive either 0.5% bupivacaine or saline solution interpleurally every 4 h for 10 doses postoperatively. All patients also received patient-controlled analgesics (PCA) with piritramide as the opioid for additional pain control. Pain was assessed on the basis of PCA requirements and by using a visual analog scale. Visual analog scale scores and PCA requirements were not different between groups. Both interpleural bupivacaine and saline significantly reduced pain scores 30 min after the administration. We concluded that pain reduction by interpleural instillation of bupivacaine reflects a placebo-like effect; however, interpleural analgesia is not effective in patients undergoing lateral thoracotomy. Sex and surgical approach were shown to influence postoperative pain intensity at rest, but not during coughing. The female patients, and those undergoing posterolateral thoracotomy, exhibited higher pain scores. This observation appears to be of only marginal clinical significance. The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study we demonstrated a lack of efficacy of interpleural analgesia. IMPLICATIONS: The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated a lack of efficacy of interpleural analgesia.

Analgesia↗