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Biomedical subjects

S N Piper

Publications and source records attributed to S N Piper.

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

Does age affect liver function and the hepatic acute phase response after major abdominal surgery?

OBJECTIVE: The liver plays a key role in the inflammatory response during major surgery or infection. The influence of age on liver function and hepatic acute phase protein (APP) synthesis should be serially studied in elderly patients undergoing major abdominal surgery. DESIGN AND SETTING: Prospective and descriptive study over 3 days. Clinical investigation in the operating room and surgical intensive care unit (ICU) of a tertiary care hospital. PATIENTS AND INTERVENTIONS: 42 consecutive patients were grouped according to age: less than 60 years ("adult") or over 65 years ("elderly") and prospectively studied. All patients received standardized general anesthesia and were treated afterwards according to the standard protocols of our ICU. Intensivists caring for the patients were not involved in the study and were blinded to data analysis. MEASUREMENTS AND RESULTS: Concentrations of interleukin (IL)-6, serum amyloid A (SAA), C-reactive protein (CRP), alpha1-antitrypsin (alpha1-AT), and haptoglobin were measured to assess the APP response. Liver function was evaluated by the monoethylglycinexylidide (MEGX) test and by measuring alpha-glutathione S-transferase (alpha-GST). All measurements were performed at induction of anesthesia (T0), at the end of surgery (T1), and 2 h (T2), 24 h (T3), and 48 h (T4) postoperatively. There was no difference in the incidence of postoperative septic complications between the two groups. Baseline values of IL-6 and the four APPs were normal in all patients and did not differ between the groups. IL-6 levels increased significantly in all patients at T1 and T2, with a significantly higher increase in the older patients (elderly: from 7.4+/-3.4 pg/ml to 220.6+/-49.5 pg/ml; adult: from 6.2+/-2.5 pg/ml to 189.9+/-36.8 pg/ml). A return to baseline values was seen at T3 in both groups. Concentrations of all APPs, except for haptoglobin, started to increase at T3. Peak concentrations were significantly lower in the elderly patients (elderly: SAA 358+/-133 microg/l, CRP 5.1+/-2.3 mg/dl, alpha1-AT 160+/-96 mg/dl; adult: SAA 444+/-100 microg/l, CRP 8.5+/-3.2 mg/dl, alpha1-AT 223+/-85 mg/dl). Baseline alpha-GST and MEGX concentrations were normal in all patients. Alpha-GST concentrations increased in both groups at T1 and T2, with a significantly higher increase in the older patients (elderly: 3.7+/-1.4 microg/l to 10.2+/-2.9 microg/l; adult 4.5+/-2.1 microg/l to 8.5+/-1.7 microg/l). A return to baseline values was seen at T3 in both groups. MEGX concentrations were significantly lower and abnormal (<50 ng/ml) in the older patients at T3 and T4. CONCLUSIONS: Our observations suggest that the postoperative hepatic acute phase response is reduced in elderly patients undergoing major abdominal surgery. The decreased release of liver-synthesized APPs was associated with an impaired hepatocyte function and a disturbance of hepatocellular integrity. Further work needs to be done to determine whether these findings might have an impact on the incidence of postoperative septic complications or prognostic significance for survival in aged patients.

Abdomen↗
PubMed2001

[Change in kidney function in elderly patients in the perioperative phase].

BACKGROUND: Reduction in organ function is a common problem in the perioperative period of the elderly patient. Especially renal function is often decreased in this situation. PATIENTS AND METHODS: In a prospective study, we assessed the perioperative changes of renal function in elderly (> 65 years, n = 30) and younger (< 65 years, n = 30) patients without preoperative renal dysfunction who were scheduled for major abdominal surgery. After induction of anesthesia (t0), at the end of surgery (t1), 4 h after surgery (t2), and on the first (t3), second (t4) and third postoperative day (t5), alpha-1-microglobulin, beta-N-acetyl-glucosaminidase, fractional sodium clearance, and creatinine clearance were measured. RESULTS: The creatinine clearance was significantly higher at all time points in the elderly than in the younger patients (p < 0.05). Fractional sodium clearance showed no significant differences between the two groups. At t4 and t5, alpha-1-microglobulin had increased significantly from the baseline value only in the elderly patients. Beta-N-acetyl-glucosaminidase was significantly elevated compared with the baseline value in the elderly patients and also differed significantly from younger patients during the study period. CONCLUSION: In elderly patients undergoing major abdominal surgery, short-term alternations in the renal system were observed in the perioperative period. With adequate volume replacement, no relevant disturbances in renal function are to be expected in the elderly surgical patient.

Adult↗
PubMed2001

Urapidil does not prevent postanesthetic shivering: a dose-ranging study.

PURPOSE: To investigate the effect of 0.2 mg x kg(-1), 0.3 mg x kg(-1) and 0.4 mg x kg(-1) urapidil on the incidence and severity of postanesthetic shivering. METHODS: One hundred and fifty patients (ASA I-III) scheduled for elective abdominal, urologic or orthopedic surgery under standardized general anesthesia were randomly allocated to one of five groups (each group n=30) using a double-blind protocol: group A received 0.2 mg x kg(-1) urapidil, group B: 0.3 mg x kg(-1) urapidil, group C: 0.4 mg x kg(-1) urapidil, group D: 3 microg x kg(-1) clonidine (positive control group), and group E: saline 0.9% as placebo (negative control group). Postanesthetic shivering was scored using a five-point scale. RESULTS: Twelve patients of group A, 11 of group B, nine of group C, three of group D and 14 of group E showed signs of postanesthetic shivering. Postanesthetic shivering was significantly decreased in the clonidine group compared to the three urapidil groups and the placebo group. Significantly less patients treated with clonidine needed anti-shivering therapy. There were no significant differences between the urapidil and placebo groups. Therapeutic interventions for hemodynamic effects were not required in any group. Time to extubation, but not time to discharge, was prolonged in the clonidine group. CONCLUSION: Urapidil showed no beneficial effect on shivering in any of the doses evaluated, whereas prophylactic administration of clonidine was effective in preventing postanesthetic shivering.

Adult↗
PubMed2001

Placebo-controlled comparison of dolasetron and metoclopramide in preventing postoperative nausea and vomiting in patients undergoing hysterectomy.

BACKGROUND AND OBJECTIVE: In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of dolasetron and metoclopramide in preventing postoperative nausea and vomiting in women undergoing hysterectomy. METHODS: Patients were allocated randomly to one of three groups: group A (n = 50) received 50 mg dolasetron orally, group B (n = 50) received 20 mg metoclopramide intravenously and placebo orally, group C (n = 50) received placebo orally. If patients complained of retching or vomiting, or if patients demanded an antiemetic, 1.25 mg droperidol was administrated intravenously. To quantify postoperative nausea and vomiting the following score was used: 0 = no nausea, 1 = nausea, 2 = retching, 3 = single vomiting, 4 = multiple vomiting. The Raatz test was used to analyse postoperative nausea and vomiting (PONV) scores. RESULTS: Dolasetron reduced the postoperative nausea and vomiting score significantly (P < 0.02 vs. metoclopramide; P < 0.0001 vs. placebo). Metoclopramide also reduced the postoperative nausea and vomiting score (P < 0.02 vs. placebo). Fisher's exact test showed a significant reduction of vomiting in the dolasetron group compared with metoclopramide-treated patients (P < 0.007) and placebo-treated patients (P < 0.000006) and a significantly lower rate of nausea in comparison to the placebo group (P < 0.009). There were no significant differences between the metoclopramide and the placebo groups (in Fisher's exact test). The use of postoperative droperidol per patient was significantly lower in the dolasetron group (P < 0.04 vs. metoclopramide; P < 0.0001 vs. placebo) than in the metoclopramide (P < 0.02 vs. placebo) and in the placebo groups. CONCLUSIONS: Oral dolasetron is more effective than either metoclopramide given intravenously or placebo for preventing vomiting after hysterectomy. It also was significantly superior to either metoclopramide or placebo concerning the PONV score and the need for droperidol rescue.

Antiemetics↗
PubMed2001

Effects of postoperative sedation with propofol and midazolam on pancreatic function assessed by pancreatitis-associated protein.

This prospective randomised controlled study evaluated the effects of postoperative sedation with propofol and midazolam on pancreatic function. We studied 42 intensive care unit patients undergoing elective major surgery who were expected to be sedated postoperatively. Patients were randomly assigned to a propofol group (n = 21) or a midazolam group (n = 21). To assess pancreatic function, the following parameters were measured: pancreatitis-associated protein, amylase, lipase, cholesterol and triglyceride prior to start of sedation on the intensive care unit, 4 h after the sedation was started and at the first postoperative day. Patients in the propofol group received on average (SD) 1292 (430) mg propofol and were sedated for 9.03 (4.26) h. The midazolam group received 92 (36) mg midazolam and were sedated for 8.81 (4.68) h. Plasma cholesterol concentrations did not differ significantly between groups. Triglyceride plasma levels 4 h after the start of infusion were significantly higher in the propofol group (140 (54) mg.dl(-1)) than the midazolam-treated patients (81 (29) mg.dl(-1)), but were within normal limits. There were no significant differences between the two groups regarding amylase, lipase and pancreatitis-associated protein plasma concentrations at any time. No markers of pancreatic dysfunction were outside the normal range. We conclude that postoperative sedation with propofol induced a significant increase of serum triglyceride levels but that pancreatic function is unchanged with standard doses of propofol.

Acute-Phase Proteins↗
PubMed2001

Changes of haemostasis in patients undergoing major abdominal surgery--is there a difference between elderly and younger patients?

Many physiological functions are altered in the elderly. It is not clear whether this applies to haemostatic mechanisms in patients undergoing major surgery. Twenty-five consecutive patients <60 yr and 25 consecutive patients >70 yr scheduled for abdominal surgery for malignancies were included in our study. Various standard coagulation variables and specific markers of coagulation were serially measured before surgery (baseline), at arrival on the intensive care unit (ICU), 4 h after arrival on ICU, and on the morning of the first postoperative day. Platelet function was assessed using the Platelet Function Analyser PFA-100 with adenosine diphosphate (ADP) as an inductor. Anaesthesia and surgery were similar between the elderly (76(3) years) and younger (53(5) years) groups. Baseline plasma levels of prothrombin fragments F1+2, thrombin-antithrombin III (TAT) complex, and D-dimers were significantly different between the two groups, indicating thrombin activation and fibrin formation in the elderly. Postoperatively, only F1+2 plasma levels were significantly higher in the elderly (4.0(0.8) nmol/l) than in the younger patients (2.2(0.9) nmol/l), whereas the course of D-dimer and TAT did not differ significantly between the two groups. Endothelial-derived markers of coagulation (von Willebrand factor, collagen-binding activity of von Willebrand factor) were not different between the groups throughout the study period. Platelet function was impaired in the elderly compared with the younger patients. It is concluded that elderly patients showed more prothrombin activation/thrombin generation and increased fibrinolytic activity prior to surgery than younger patients. However, perioperative changes of coagulation in the elderly were similar to those seen in younger patients.

Abdominal Neoplasms↗
PubMed2001

Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution.

The combined reduction of oxygen-carrying capacity and perfusion pressure during the combination of acute normovolaemic haemodilution (ANH) and controlled hypotension (CH) raises concerns of hypoperfusion and ischaemic injury to the brain. Forty-two patients undergoing radical prostatectomy were prospectively allocated to receive CH induced by sodium nitroprusside (mean arterial pressure (MAP) 50 mm Hg), a combination of CH+ANH (post-ANH haematocrit 29%; intraoperative MAP 50 mm Hg), or standard anaesthesia (control). Serum levels of the brain-originated proteins neuron-specific enolase (NSE) and protein S-100, blood loss, transfusion requirements, adverse effects, and postoperative recovery profile were compared among the three groups. Intraoperative blood loss in the CH group (mean (SD)) (788 (193) ml) and CH+ANH group (861 (184) ml) was significantly less than in the control group (1335 (460) ml). Significantly fewer total units of allogeneic packed red blood cells (PRBC) were transfused in the patients receiving hypotensive anaesthesia (CH, 3 units; CH+ANH, 2 units; control, 17 units). There was no difference in immediate postoperative recovery profile among the three groups as determined by the emergence from anaesthesia and time to discharge from the postanaesthesia care unit. Serum S-100 protein concentrations increased significantly in all groups from baseline to peak concentrations 2 h postoperatively (CH 0.25 (0.11) microg litre(-1); CH+ANH 0.31 (0.12) microg litre(-1); control 0.31 (0.10) microg litre(-1)). A return to baseline values was seen within 24 h postoperatively in all patients. No changes in NSE concentrations were seen. Our observations suggest that CH and CH+ANH were effective in reducing blood loss and transfusion requirements in patients undergoing radical prostatectomy. Increased serum S-100 protein concentrations imply a disturbance in astroglial cell membrane integrity and an increased endothelial permeability of the blood-brain barrier. There were no associations between serum S-100 protein or NSE and adverse cognitive effects. Further work needs to be done to determine the prognostic importance of S-100 protein and NSE as surrogate variables of postoperative cerebral complications.

Aged↗
PubMed2001

Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients.

OBJECTIVE: To study the effects of pretreatment with pentoxifylline before cardiac surgery on postoperative organ function in elderly patients (>80 yrs) undergoing cardiac surgery. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Two-day clinical investigation in an intensive care unit of a university-affiliated hospital. PATIENTS: Forty elderly patients (age >80 yrs) undergoing first-time elective aortocoronary bypass grafting. INTERVENTIONS: In 20 patients, pentoxifylline (loading bolus of 300 mg followed by a continuous infusion of 1.5 mg.kg-1.hr-1 until the second postoperative day) was given after induction of anesthesia; another 20 patients received saline solution as placebo. MEASUREMENTS AND MAIN RESULTS: Concentrations of soluble adhesion molecules (soluble E-selectin, soluble vascular cell adhesion molecule-1, and soluble intercellular adhesion molecules) were measured to assess endothelial function. Liver function was evaluated by monoethylglycinexylidide test and by measuring alpha-glutathione S-transferase plasma concentrations. Renal function was assessed by measuring serum creatinine and urine concentrations of alpha-1-microglobulin. Splanchnic perfusion was assessed by monitoring intramucosal pH by using continuous tonometry. All measurements were performed before pentoxifylline infusion (T0), at the end of surgery (T1), 5 hrs after surgery (T2), and at the morning of the first (T3) and second (T4) postoperative day. Postoperative concentrations of all measured soluble adhesion molecules were significantly higher in the nontreated controls than in the pentoxifylline-treated patients. Monoethylglycinexylidide serum concentrations were significantly lower and abnormal (<50 ng/mL) postoperatively only in the untreated control patients. alpha-Glutathione S-transferase increased in both groups with a significantly higher increase in the control group (from 3.2 +/- 1.2 to 24.1 +/- 4.2 ng/mL) than in the pentoxifylline-treated patients (from 3.8 +/- 1.9 to 11.5 +/- 2.1 ng/mL). Serum creatinine was unchanged in both groups, whereas alpha-1-microglobulin increased significantly more in the control group than in the pentoxifylline-treated group. Intramucosal pH remained almost unchanged in the pentoxifylline patients (>7.35) but decreased significantly in the control group (5 hrs after surgery, intramucosal pH 7.29 +/- 0.13). CONCLUSIONS: Pretreatment of patients aged >80 yrs undergoing cardiac surgery with pentoxifylline attenuated deterioration of endothelial, renal, and liver function as seen in an untreated control group. Splanchnic perfusion also appears to be improved in the pentoxifylline-treated group. Whether pretreatment with pentoxifylline will improve outcome in this patient population remains to be elucidated.

Aged↗
PubMed2000

Hemodynamics, intramucosal pH and regulators of circulation during perioperative epidural analgesia.

PURPOSE: To evaluate the effects of perioperative epidural analgesia on hemodynamics, splanchnic perfusion and regulators of circulation. METHODS: Twenty patients undergoing aortic surgery were randomised into two groups: epidural analgesia group (EAG): epidural analgesia with bupivacaine (15 ml, 0.125%) was started before surgery. Eight and 16 hr postoperatively 10 ml bupivacaine 0.125% and 1 mg morphine were given. Control group (COG): patients received no epidural catheter. Monitoring included pulmonary artery catheter and gastric tonometer. Norepinephrine, epinephrine, renin, ADH, ANP and endothelin were measured: before epidural analgesia (T0), before aortic clamping (T1), 20 min after aortic clamping (T2), after declamping the first leg (T3), at end of surgery (T4), one hour (T5) and 24 hr postoperatively (T6). RESULTS: At T5 mean arterial blood pressure decreased in EAG compared with baseline (86 +/- 16 to 75 +/- 8 mmHg) and compared with COG (75 +/- 8 vs 84 +/- 11 mmHg). At T2 pulmonary capillary wedge pressure and cardiac index increased and at T6 decreased in both groups. Systemic vascular resistance decreased at T I and at T3-T5 in EAG compared with COG and at T1 and T3-T6 to baseline (1472 +/- 448 to 1027 +/- 184 dyn x sec x cm(-5) x m(-2)). In EAG and in COG, pHi decreased compared with baseline but without group differences. In both groups, epinephrine, norepinephrine, renin, and ADH levels increased from baseline. Endothelin and ANP levels showed no changes. CONCLUSIONS: Perioperatively administrated epidural bupivacaine has no beneficially effects on hemodynamics, pHi or release of regulators of circulation.

Analgesia, Epidural↗
PubMed2000

Massive postoperative swelling of the tongue: manual decompression and tactile intubation as a life-saving measure.

Massive swelling of the tongue due to haemorrhage is a rare but potentially fatal complication secondary to trauma, surgery, tumour invasion or uncontrolled anticoagulant therapy. This article presents a report of bleeding from the left lingual artery secondary to elective excision of a lipoma of the floor of the mouth and subsequent life-threatening upper airway obstruction. In this case, the upper airway obstruction was managed by manual decompression of the tongue and tactile nasal intubation. To our knowledge this case provides the first description of using this method in life-threatening upper airway obstruction caused by massive haemorrhagic swelling of the tongue.

Airway Obstruction↗
PubMed2000

Acute phase response to nitroprusside-induced controlled hypotension in patients undergoing radical prostatectomy.

This study evaluated the effects of sodium nitroprusside-induced controlled hypotension on the acute phase response in patients undergoing radical prostatectomy. Thirty patients were randomly allocated to two groups, a hypotension group (mean arterial blood pressure was adjusted to 50 mmHg) and a control group (mean arterial blood pressure > 70 mmHg). C-reactive protein increased significantly in the hypotension group from 0.13 (0.23) to 9.85 (2.84) microg x ml-1 and in the control group from 0.15 (0.27) to 7.38 (3.02) microg x ml-1. In both groups, serum amyloid A increased significantly, but levels were higher in the hypotension group [585 (125) microg x l-1] than in the control group [460 (187) microg x l-1]. Interleukin-6 increased significantly in both groups, but was higher in the hypotension group [139 (124) pg x ml-1] than the control group [56 (27) pg x ml-1]. Elastase showed no significant changes in the control group but in the hypotension group there was a significant increase from 65 (51) to 122 (75) ng x ml-1. Sodium nitroprusside-induced hypotension was associated with a more pronounced acute phase reaction.

Acute-Phase Proteins↗
PubMed2000

Economic aspects of different muscle relaxant regimens.

OBJECTIVE: At a time of cost reduction in medical care efforts to manage the ever-increasing costs of new pharmaceutical drugs become increasingly important. Costs of four different muscle relaxant regimens including the new intermediate-acting neuromuscular blocking drugs (NMBD) cisatracurium and rocuronium will be analyzed. METHODS: Eighty patients undergoing laparoscopic cholecystectomy were prospectively studied. All patients received standardized general anaesthesia with desflurane/fentanyl. Muscle relaxation was achieved with atracurium, cisatracurium, vecuronium, or rocuronium with 20 patients in each group. Intraoperatively muscle relaxants were added to maintain two twitches of the train-of-four (TOF) assessment. RESULTS: There were no differences among the four groups regarding biometric data, duration of surgery and anesthesia, number of patients with reversal of neuromuscular blockade, and time of extubation. Length of stay in the postanesthesia care unit (PACU) and the incidence of side effects were similar in all groups. Total costs of used drugs were significantly lowest in the atracurium-treated patients (per patient: 18.27 Euro) and significantly highest in the cisatracurium group (26.71 Euro) compared with the other groups (vecuronium: 22.61 Euro; rocuronium: 22.63 Euro). CONCLUSION: It is summarized that the use of cisatracurium was associated with higher costs compared to a standard muscle relaxant regimen using atracurium, whereas patient outcome was the same in all study groups. The routine use of the newer NMBDs can only be justified economically, if considerable improvements to clinical practice can be demonstrated.

Adult↗
PubMed2000

A comparison of urapidil, clonidine, meperidine and placebo in preventing postanesthetic shivering.

UNLABELLED: This placebo-controlled study was performed to evaluate the efficacy of urapidil compared with clonidine and meperidine in preventing postanesthetic shivering, which is common after anesthesia administration and may be very distressing. We studied 120 patients undergoing elective abdominal or orthopedic surgery under standardized general anesthesia. After surgery, patients were randomly assigned to one of four groups (each group n = 30) using a double-blinded protocol: Group A received 0.2 mg/kg urapidil; Group B, 3 microg/kg clonidine; Group C, 0.4 mg/kg meperidine; and Group D, saline 0.9% as placebo. Postanesthetic shivering was scored by using a five-point scale. Clonidine and meperidine significantly reduced the incidence and the severity of shivering in comparison with placebo, whereas there were no significant differences between the urapidil and placebo groups. Both clonidine and meperidine caused a significantly prolonged emergence time (13.4 +/- 5.8 and 13. 3 +/- 5.0 min, respectively) compared with placebo (10.4 +/- 5.3 min) and urapidil (11.4 +/- 2.9 min). We confirmed that both clonidine and meperidine are effective in preventing postanesthetic shivering, whereas urapidil, in our setting and dosage, was not effective. Patients who received clonidine or meperidine had a prolonged emergence time. In the dosage used, urapidil seems to be unable to prevent postanesthetic shivering. IMPLICATIONS: Shivering (irregular muscle activity) is common after surgery and anesthesia. This study compared urapidil (an antihypertensive drug) as a prophylaxis with two established antishivering drugs (meperidine and clonidine) and placebo. In the dosage used, we were unable to show a significant benefit of urapidil.

Adult↗
PubMed2000

Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients.

UNLABELLED: Hepatic blood flow is reduced in a dose-related manner by all inhaled anesthetics now in use. We assessed hepatic function in elderly patients anesthetized with desflurane or sevoflurane. We measured the cytosolic liver enzyme alpha glutathione S-transferase (alpha GST), the formation of the lidocaine metabolite monoethylglycinexylidide (MEGX), and gastric mucosal tonometry-derived variables as sensitive markers of hepatic function and splanchnic perfusion. Thirty patients, 70 to 90 yr old, were allocated randomly to receive desflurane or sevoflurane anesthesia. Anesthetic exposure ranged from 2.1-4.5 minimum alveolar concentration hours. No significant changes in standard liver enzyme markers were seen throughout the study. In both anesthetic groups, tonometric measurements showed a significant decrease from baseline in regional PCO(2), regional to arterial difference in PCO(2), and intramucosal pH at 90 min after skin incision. alpha GST concentrations increased significantly in both groups (desflurane: median peak concentrations 5.8 microg/L [25th, 75th percentile 5.3 microg/L, 7.2 microg/L]; sevoflurane: 7.0 microg/L [5.8 microg/L, 7.3 microg/L]) without showing differences between both anesthetic groups. A return to baseline values in tonometric values and alpha GST levels was seen 24 h postoperatively. MEGX formation did not change significantly after surgery. Median MEGX concentrations postoperatively were 70.0 ng/mL (56.2 ng/mL, 102.0 ng/mL) and 70.0 ng/mL (60.0 ng/mL, 94.2 ng/mL) in the desflurane and sevoflurane groups, respectively. We conclude that, overall, liver function in elderly patients is well preserved during desflurane and sevoflurane anesthesia. Increased serum levels of alpha GST and changes of gastric tonometry-derived variables imply a reduction in splanchnic perfusion, leading to a temporary impairment of hepatocyte oxygenation. IMPLICATIONS: We measured the lidocaine metabolite monoethylglycinexylidide, the cytosolic liver enzyme, alpha glutathione S-transferase, and gastric mucosal tonometry-derived variables to evaluate the effects of desflurane and sevoflurane on hepatic function in elderly patients. Liver function was well preserved, whereas increased alpha glutathione S-transferase levels and changes in tonometry-derived variables indicated a reduction in splanchnic blood flow and a temporary impairment of hepatocyte oxygenation for both anesthetics.

Aged↗
PubMed2000

Influence of dopexamine on hemodynamics, intramucosal pH, and regulators of the macrocirculation and microcirculation in patients undergoing abdominal aortic surgery.

OBJECTIVE: To investigate whether dopexamine hydrochloride beneficially influences splanchnic perfusion and regulators of the macrocirculation and microcirculation in patients undergoing surgery of the abdominal aorta. DESIGN: Prospective, blinded, and randomized study. SETTING: University-affiliated hospital. PARTICIPANTS: Twenty patients undergoing elective abdominal aortic surgery. INTERVENTIONS: The patients were randomized to one of two groups. In the dopexamine group (DOP, n = 10), dopexamine, 1 microg/kg/min, was started before surgery and continued for 24 hours. In the control group (COG, n = 10), patients received saline solution as placebo. Extensive hemodynamic monitoring was carried out using a pulmonary artery catheter, and intramucosal pH was measured using a gastric tonometer. From arterial blood samples, important regulators of the circulation were measured before dopexamine was administered (T0), before aortic clamping (T1), 20 minutes after aortic clamping (T2), after declamping the first leg (T3), at the end of surgery (T4), 1 hour postoperatively (T5), and 24 hours postoperatively (T6). MEASUREMENTS AND MAIN RESULTS: Heart rate increased significantly in DOP (63+/-16 to 84+/-18 beats/min). At T5, mean pulmonary artery pressure was significantly lower in DOP (15+/-6 mmHg) than in COG (22+/-6 mmHg). During aortic clamping, pulmonary capillary wedge pressure increased significantly in both groups. Cardiac index increased significantly from baseline only in the dopexamine patients. No significant differences between the groups were seen with regard to oxygenation parameters and intramucosal pH. Renin plasma levels increased significantly only in COG (46+/-32 to 99+/-55 microU/mL). Endothelin and atrial natriuretic peptide plasma levels showed no significant differences between the two groups. Atrial natriuretic peptide increased significantly only in DOP (366+/-171 pg/mL; COG, 159+/-71 pg/mL). Antidiuretic hormone, norepinephrine, and epinephrine plasma levels increased significantly from baseline in both groups, without showing significant differences between the groups. CONCLUSIONS: In patients undergoing abdominal aortic surgery, prophylactic perioperative administration of dopexamine hydrochloride produced effects on hemodynamics but without improving oxygenation and intramucosal pH. From the measured regulators of the circulation, only renin was beneficially affected.

Adult↗
PubMed1999

A randomised comparison of three laryngoscopes with the Macintosh.

The Macintosh laryngoscope blade was compared with three modified blades--the Bizzarri-Giuffrida, the 'Improved Vision' Macintosh, and the Wiemers blade. Before and after a training session 24 participants intubated a Laerdal Airway Management Trainer with the four blades in random order. Intubation time was measured, oesophageal malpositions and 'clicks' indicating possible teeth damage, were counted. Each participant scored the handling of each blade on a 6-point scale (1 = very good, 6 = very poor). Intubation times before training were 10.6 +/- 5.3 s for the Macintosh, 16.7 +/- 9.2 s for the Bizzarri-Giuffrida, 13.3 +/- 9.0 s for the 'Improved Vision' Macintosh and 11.7 +/- 6.1 s for the Wiemers. Intubation times after training were 7.1 +/- 2.5 s for the Macintosh, 10.6 +/- 5.4 s for the Bizzarri-Giuffrida, 8.1 +/- 3.4 s for the 'Improved Vision' Macintosh and 7.6 +/- 2.5 s for the Wiemers. The handling scores were: 2.0 +/- 0.8 for the Macintosh, 3.9 +/- 1.2 for the Bizzarri-Giuffrida, 2.1 +/- 0.8 for the 'Improved Vision' and 2.3 +/- 0.8 for the Wiemers. In regard to the intubation time before training (P < 0.02), the intubation time after training (P < 0.003), and handling (P < 0.0005), the Bizzarri-Giuffrida was significantly inferior to the Macintosh. The 'Improved Vision' Macintosh and the Wiemers were not significantly different to the Macintosh. No significant difference was seen for oesophageal malpositioning and 'clicks' between any of the blades.

Equipment Design↗
PubMed1999

Nefopam and clonidine in the prevention of postanaesthetic shivering.

Postanaesthetic shivering affects up to 70% of patients after general anaesthesia, and may be very distressing. Various drugs have been used to treat or prevent postanaesthetic shivering, but the ideal one has not yet been found. Sixty patients undergoing elective abdominal or orthopaedic surgery under general anaesthesia were included in a randomised, double-blind study. Patients received clonidine (3 microgram.kg-1), nefopam (0.15 mg.kg-1) or saline 0.9% as a placebo at the end of surgery, prior to extubation. Nefopam and clonidine significantly reduced the incidence and severity of shivering in comparison with the placebo. The recovery time, between the end of anaesthesia and extubation, was significantly longer in the clonidine-treated patients [13.6 (5.2) min] than in either the nefopam [9.6 (2.8) min] or the placebo [10.0 (5.4) min] groups. Mean arterial blood pressure and heart rate were significantly lower in the clonidine group compared with both other groups. Our results suggest that nefopam and clonidine are effective in the prevention of postanaesthetic shivering. However, following clonidine administration the recovery time was prolonged and hypotension was significantly greater than after nefopam.

Adult↗