EMLA anaesthetic cream for debridement of burns: a study of plasma concentrations of lidocaine and prilocaine and a review of the literature.

The lidocaine-prilocaine cream (EMLA) effectively reduces the pain from debridement of chronic leg ulcers. Studies have demonstrated that when applied to leg ulcers, plasma concentrations of the local anaesthetics are well below the threshold for CNS toxicity. However, there are minimal pharmacokinetic data available from EMLA application to burn wounds.

Quality of life--the effect of hyperbaric oxygen treatment on radiation injury.

The purpose of the present study was to assess changes in health-related quality of life (HRQL) among patients with radiation injury one year after hyperbaric oxygen (HBO2 therapy). HBO2 therapy was given once daily, five times a week in monoplace hyperbaric chambers for at least 19 days. HRQL was measured by SF-36 (Short Form with 36 questions).

Risk of misclassification of decompression sickness.

Decompression sickness (DCS) is classified on the basis of which organ system is affected, and neurological DCS is considered more severe than DCS in joints and skin with respect to response to recompression treatment and risk of long-term sequelae. Gas bubble formation interstitially in the tissues or in the circulation is considered to be the mechanism for all types of DCS. Ten patients diagnosed as having DCS in joints or skin, by doctors experienced in diving medicine, underwent clinical examination by a neurologist and had an electroencephalogram.

Hypermetropia-succeeded myopia after hyperbaric oxygen therapy.

A 58-year-old man presented with a change in vision during hyperbaric oxygen (HBO) therapy. Subsequent follow-up visits showed a hypermetropic shift, which succeeded the myopic shift after each of two series of HBO treatments. The maximal refractive amplitude was 3.

Electroencephalography and magnetic resonance imaging in neurological decompression sickness.

The purpose of this study was to evaluate the use of electroencephalography (EEG) and magnetic resonance imaging (MRI) in the clinical evaluation of acute decompression sickness (DCS) in the central nervous system (CNS). Twenty-one patients treated because of acute DCS in the CNS during 1999-2001 were included, 15 patients with clinical cerebral DCS and five with clinical spinal cord DCS. Seven patients had abnormalities in their EEG, five with cerebral DCS and two with spinal cord DCS.

Time and temperature effects on body fluid loss during dives with the open hot-water suit.

Background: Bodyweight (BW) losses up to 5 kg have been observed during diving with the open hot-water suit (HWS). The objective of these dives was to study the hormonal, hematological, and renal effects of dehydration during shallow HWS diving.

Methods: In series 1, four divers dove for 3.

Venous gas embolism in chamber attendants after hyperbaric exposure.

An initial occupational survey (OS) was initiated to investigate the prevalence of venous gas embolism (VGE) in chamber attendants assisting hyperbaric oxygen (HBO2) treatments. Nine female subjects were exposed for three consecutive days to the routine hospital procedure of compressed air exposure to 240 kPa for approximately 115 min with 12 min of terminal oxygen (O2) breathing. VGE was monitored with ultrasound Doppler in 15 min intervals for 2h after the first and third exposure.

Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood.

Purpose: The aim of this study was to quantify ocular refractive changes after a standard hyperbaric oxygen (HBO) treatment protocol and to characterize the time period of recovery.

Patients And Methods: Hyperbaric oxygen therapy was given for 90 min daily at a pressure of 240 kPa for 21 days. Oxygen was administered to 20 patients using an oronasal mask and to 12 patients using a hood.

[Neurologic decompression sickness in sports divers].

Background: Sports diving is a popular recreational activity. Sports divers presenting with acute decompression sickness may exhibit residual neurologic and neuropsychological symptoms during follow-up, in spite of appropriate treatment.

Material And Methods: A retrospective review of medical records was carried out for sports divers admitted to the department of neurology at Haukeland University Hospital during 1997.

Dehydration and body fluid-regulating hormones during sweating in warm (38 degrees C) fresh- and seawater immersion.

Body weight (BW) reductions of more than 4 kg have been observed during diving with the open hot water suit, a technique in which heated seawater (SW) continuously floods the skin surface. To test the hypothesis that osmotic effects may be involved in these fluid-loss processes, head-out immersion experiments in 38 degrees C freshwater (FW) and SW for 4 h were performed. Average BW reduction was 2.

[Hyperbaric oxygen treatment for radiation reactions].

Background: A national hyperbaric centre was established in 1994 at Haukeland Hospital with responsibility for all hyperbaric oxygen (HBO) treatment in Norway. In hypoxic tissues with symptomatic radiation reactions, hyperbaric oxygen induces the formation of collagen and angiogenesis resulting in permanently improved local microcirculation.

Material And Methods: 234 patients received elective HBO treatment at Haukeland Hospital in 1997 with a total of 4,048 treatments.

Effects of a standard hyperbaric oxygen treatment protocol on pulmonary function.

The prescription of hyperbaric oxygen (HBO) therapy for disorders not related to diving is increasing. Pulmonary oxygen toxicity is well known, but the effect of the cumulative oxygen exposure corresponding to a standard HBO treatment protocol has not been quantified before. Twenty patients (10 male) had 21 HBO treatments at a partial pressure of oxygen of 240 kPa for 90 min daily.

[Hyperbaric oxygen therapy. Now an established treatment in Norway].

Hyperbaric oxygen therapy can be a life-saving form of treatment for certain acute medical conditions, e.g. cerebral gas embolism, clostridial infections, and smoke/carbon monoxide inhalation.

[Insulin pumps and drop in pressure].

Do insulin pumps deliver more insulin at lower environmental pressures and, if so, is this due to pump dysfunction or to formation of bubbles in the insulin solutions? H-TRON V-100 (Hoechst Infusor V-100), MRS-1 (Disetronic), Nordic Infusor MK II (Novo Nordisk) and Minimed 504-S (Minimed Technology) insulin pumps were studied at 0.9 ATA and 0.8 ATA with constant infusion 2.

[Intensive care of patients with burns].

We discuss the fluid requirements of burn patients and present the most common formulas for fluid resuscitation. The most commonly used formula is the Parkland formula containing 4 ml/kg/% Ringer acetate, which we still recommend for general use. Hypertonic Ringer acetate containing 240 mmol Na/l may reduce fluid requirement and edema generation.

Respiratory depression by analgesics at 41 bar.

The effects of morphine and fentanyl on respiration and tissue CO2 measured transcutaneously were studied at surface and at 41 bar ambient pressure in conscious, trained rats. Morphine and fentanyl were given in equianalgesic doses i.v.

EEG power spectra in rats during compression and during pentobarbital infusion at pressure.

The EEG of rats was studied with power spectrum analysis under compression to 71 ATA with He-O2 and during constant rate infusion of pentobarbital at 71 ATA and at surface. During compression the 1-4 Hz delta activity was increased, and 8-11 Hz alpha, 12-14 Hz spindle, and 16-10 Hz low beta activities were reduced compared to control animal recordings. During the course of pentobarbital infusion at 71 ATA, this picture changed: the delta activity was reduced while alpha and spindle activities (barbiturate spindles) increased, considerably more than in the rats studied at surface pressure.

Transcutaneous measurement of PCO2 at high ambient pressure (41 bar).

The accuracy of transcutaneous CO2 monitoring with the Kontron CO2 sensor was studied during compression to 41 bar and subsequent decompression. The PCO2 was stable and accurate during the test of the sensor in the pressure chamber, although an increase of 0.1-0.

Pharmacokinetics and tissue concentrations of ceftazidime in burn patients.

The pharmacokinetics and tissue concentrations of ceftazidime have been investigated in 8 patients with severe burns (20-80% of body surface area) undergoing skin transplantation 2 to 21 days after injury. Two prophylactic doses of ceftazidime were administered as 1 g i.v.

Transcapillary colloid osmotic pressures in injured and non-injured skin of seriously burned patients.

Thermal skin injury is accompanied by rapid and excessive oedema formation implicating a dramatic increase in the transcapillary fluid transport. In order to clarify the pressure changes occurring across the microvasculature after a thermal skin injury we have measured colloid osmotic pressures (COP) in interstitial fluid (COPi) of injured and non-injured skin as well as in plasma (COPp) from patients suffering major cutaneous burns. Interstitial fluid was collected with a wick-technique and analysed for COP.

Anesthetic effect and distribution of infused pentobarbital in the rat at 71 ATA.

The anesthetic dose requirement and distribution of 14C-labeled pentobarbital were studied in rats at 1 ATA air and at 71 ATA He-O2. Pentobarbital was infused intravenously at a rate of 5 mg X kg-1 X min-1. The depth of anesthesia was assessed by EEG using the burst suppression of 1-s duration (silent second) as the biological end point.

The effect of high pressure on the kinetics of monoamine transmitters in the rat brain.

The effects of 71 ATA pressure on the turnover of serotonin (5-HT), noradrenaline (NA), and dopamine (DA) were studied. High pressure increased the concentration of the 5-HT metabolite 5-hydroxyindoleacetic acid (5-HIAA) by 40%. A concomitant increase in 5-HT synthesis (measured by the accumulation of 5-hydroxytryptophan after inhibition of the decarboxylase) of 25% was found.