Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review.

Purpose Of The Review: We aim to review the methods, current research evidence, and future directions in body composition analysis (BCA) with CT imaging.

Recent Findings: CT images can be used to evaluate muscle tissue, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) compartments. Manual and semiautomatic segmentation methods are still the gold standards.

Cardiovascular changes after naloxone administration in propofol-sedated piglets during opioid overdose.

Background: Naloxone is an opioid receptor antagonist. Even when used in modest doses, it has been associated with serious cardiopulmonary side-effects. In this experimental porcine study, we examined the cardiac effects of naloxone during an opioid overdose.

Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage: The Helsinki experience.

Background: Aneurysmal subarachnoid hemorrhage is a devastating disease that is followed by a marked stress response affecting other organs besides the brain. The aim in the management of patients with aSAH is not only to prevent rebleedings by treating the aneurysm by either microneurosurgery or endovascular surgery, but also to evacuate acute space-occupying hematomas and to treat hydrocephalus.

Methods: This review is based on the experience of the authors in the management of more than 7500 patients with aSAH treated in the Department of Neurosurgery at Helsinki University Central Hospital, Finland.

Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study.

Background: Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia.

Methods: Fifty-four patients scheduled for elective surgery of supratentorial brain tumour were randomized to receive in a double-blind manner a continuous DEX infusion (plasma target concentration 0.

QT interval and QT dispersion during the induction of anaesthesia in patients with subarachnoid haemorrhage: a comparison of thiopental and propofol.

Background And Objective: Thiopental prolongs the QT interval more than propofol, and the two induction agents were compared in patients with subarachnoid haemorrhage predisposed to electrocardiographic abnormalities and cardiac dysrhythmias.

Methods: Twenty-nine patients were studied randomly. Anaesthesia was induced with either thiopental or propofol and fentanyl; vecuronium was used as a neuromuscular blocking agent.

Extracranial contribution to cerebral oximetry in brain dead patients: a report of six cases.

The near infrared spectroscopy offers a noninvasive method to monitor regional brain oxygenation. The problem with the technique appears to be possible extacranial contribution to the measurements. As a part of another study, we monitored regional saturation (rSO2) in six brain dead patients either during the test for spontaneous respiration or in those not eligible for organ donation, after discontinuation of mechanical ventilation.

QT dispersion after subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) causes a stress response with increased concentrations of plasma catecholamines and serious cardiac arrhythmias. Increased QT dispersion has been shown to predispose to cardiac arrhythmias. In SAH patients, QT dispersion has not been studied previously.

The relevance of clinical and radiological measurements in predicting difficulties in fibreoptic orotracheal intubation in adults.

Resistance to the passage of the tracheal tube has been reported to occur in up to 36% of patients subjected to orotracheal fibreoptic intubation. In this prospective study we assessed five radiological measurements of the upper airway in an attempt to find anatomical causes of obstruction to passage of the tube. Forty-nine patients undergoing fibreoptic orotracheal intubation under general anaesthesia were studied.

Patient-controlled analgesia with oxycodone in the treatment of postcraniotomy pain.

Background: Moderate to severe pain occurs after craniotomy in 60% of patients. We evaluated the feasibility and safety of patient-controlled analgesia (PCA) with oxycodone in neurosurgical patients, and compared the efficacy of paracetamol with ketoprofen.

Methods: In the study there were 45 patients, who received either paracetamol 1000 mg or ketoprofen 100 mg three times a day.

The best view at laryngoscopy using the McCoy laryngoscope with and without cricoid pressure.

The best view obtained by levering the tip of the McCoy laryngoscope blade with or without modified cricoid pressure was studied in 100 patients presenting for general surgery. The airway was assessed pre-operatively (Mallampati score, thyromental distance, mouth opening, protrusion of the jaw and weight) in an attempt to identify the patients who might benefit from the use of the McCoy laryngoscope. The vocal cords were visible at laryngoscopy with the blade in the neutral position in 32 cases.

Knee-chest vs horizontal side position during induction of spinal anaesthesia in patients undergoing lumbar disc surgery.

In the prone knee-chest position the spread of plain 0.5% bupivacaine in the cerebrospinal fluid and associated haemodynamic changes may be different compared with the horizontal position. A randomized comparison was performed in 40 ASA I-II patients, aged 24-61 yr, undergoing lumbar disc surgery.

The effect of patient positioning on dynamic lung compliance.

Background: Side-stream spirometry offers a non-invasive method to monitor continuously respiratory mechanics in intubated patients. We studied the effects of different positions on dynamic lung compliance during anaesthesia.

Methods: The study consisted of 56 patients, operated in supine, prone, kneeling or lateral park-bench position.

Monitoring lung compliance and end-tidal oxygen content for the detection of venous air embolism.

Venous air embolism (VAE) is a recognized complication of surgery performed with the patient in the sitting position, but it occurs also during other operations. We report two cases of VAE, associated with a notable decrease in dynamic lung compliance, detected by side-stream spirometry. Based on these cases, an experiment with 10 pigs was designed to evaluate the usefulness of side-stream spirometry in the diagnosis of VAE.

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.

Comparison of 2-chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study.

In a double-blind, randomised study of patients scheduled for minor hand surgery 0.5% 2-chloroprocaine (n = 30) and 0.5% prilocaine (n = 30) in a volume of 40 ml were compared for intravenous regional anaesthesia.

The effect of amrinone on recovery from severe bupivacaine intoxication in pigs.

Cardiovascular collapse following intravascular bupivacaine may be resistant to treatment. The effect of amrinone on recovery from bupivacaine-induced severe cardiovascular depression was evaluated in 20 pigs (13-26 kg) in a placebo-controlled randomized double-blind study. Under 0.

A rodent model for studying four well defined toxic endpoints during bupivacaine infusion.

An animal model with four well defined endpoints for studying the cardiotoxicity and neurotoxicity of bupivacaine is described. Five male Wistar rats (264-324 g) were anesthetized, tracheostomized and ventilated, and ECG and EEG leads were placed. Femoral arteries and veins were then cannulated.

Cardiovascular and central nervous system effects of co-administered lidocaine and bupivacaine in piglets.

The toxic profile of bupivacaine (1 mg/kg/minute) when administered intravenously alone or with lidocaine (1 mg/kg loading dose, then 1 mg/kg/minute) was examined in 12 2-day-old pigs anesthetized with 70% N2O/30% O2 and paralyzed with 0.15 mg/kg pancuronium. Bupivacaine doses producing arrhythmias, seizures, isoelectric EEG and asystole were about 24% lower in the lidocaine plus bupivacaine group (n = 6) than in the bupivacaine group (n = 6).

Bupivacaine toxicity in young pigs is age-dependent and is affected by volatile anesthetics.

The influence of age and volatile anesthetic agents on plasma concentrations and toxic effects of bupivacaine were studied in 2-day-old, 2-week-old, and 2-month-old pigs. Bupivacaine was infused at a constant rate while the pigs' ECGs and EEGs were recorded. Six pigs in each age group were lightly anesthetized with 70% N2O/30% O2 during the bupivacaine infusion, and twelve 2-day-old pigs were anesthetized with 70% N2O/30% O2 plus either 0.

Treatment of bupivacaine-induced cardiac arrhythmias in hypoxic and hypercarbic pigs with amiodarone or bretylium.

The treatment of bupivacaine-induced cardiovascular toxicity with amiodarone or bretylium was studied using anesthetized pigs (n = 30). The pigs were given ketamine, glycopyrrolate, enflurane, and pancuronium and made hypoxic (FiO2, 12%; N2O, 88%) and hypercarbic (end-tidal CO2, 7.3-8.

Interaction of lidocaine and hypothermia in Bier blocks in volunteers.

The present investigation was designed to study the interaction of temperature, lidocaine, and ischemia during intravenous regional anesthesia (IVRA) of the arm. Five volunteers were studied during exposure of one of their arms to four different experimental conditions: hypothermia and ischemia; hypothermia, ischemia, and lidocaine; normothermia and ischemia; normothermia, ischemia, and lidocaine. Each subject was tested on four different occasions with only one test condition imposed per occasion and with 3 or more days between experiments.

Results of a randomized trial of vancomycin prophylaxis in craniotomy.

A single prophylactic dose of vancomycin was given in 143 supratentorial craniotomies with a bone flap and 26 suboccipital craniotomies. No antimicrobial agents were given to two similar groups of patients: 172 with supratentorial craniotomy and 19 with suboccipital craniotomy. The infection rate in the vancomycin groups was significantly lower (p less than 0.

Comparison of propofol and methohexitone anaesthesia for thermocoagulation therapy of trigeminal neuralgia.

Propofol and methohexitone given in equipotent doses were compared for anaesthesia for thermocoagulation of trigeminal rootlets. Thirty-eight patients received two to six injections of the induction agents in one therapy session. The increase in arterial blood pressure during coagulation was significantly lower in the propofol group.

Stress/catecholamine-induced cardiac necrosis. Reduction by beta 1-selective blockade.

Catecholamine-induced cardiac necrosis is a well-described phenomenon. Patients with severe head injury are known to be in a marked hyperadrenergic state and can experience cardiac morbidity; this was confirmed in a pilot study. A further study was then undertaken to examine a possible relationship between plasma catecholamine concentration and cardiac morbidity in patients with severe head injury and to assess the effect of intervention with the beta 1-selective agent atenolol.