Optimization of alarms: a study on alarm limits, alarm sounds, and false alarms, intended to reduce annoyance.

Alarms in the operating room remain a major source of annoyance and confusion. Nearly all alarms result from a transgression of certain alarm limits. We surveyed manufacturers at a major meeting of anesthesiologists for their default alarm limits.

Transfusion thresholds in common elective surgical procedures in Finland.

Background And Objectives: Transfusion practices and thresholds in common elective surgical procedures were investigated in a nationwide multicenter survey in Finland.

Materials And Methods: The records of 764 total hip replacement (THR), 397 total knee replacement (TKR) and 343 transurethral resection of the prostate (TURP) patients were reviewed by four anesthesiologists.

Results: The allogeneic red cell (RBC) transfusion rates in THR, TKR and TURP operations were 92, 84 and 18%, respectively.

The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy.

Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies, would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning, anesthesia, and increased intra-abdominal pressure.

Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane-fentanyl anesthesia during laparoscopic cholecystectomy.

Placental transfer of sulindac, sulindac sulfide, and indomethacin in a human placental perfusion model.

Objective: Evaluation of the transplacental transfer and placental metabolism of sulindac, its active sulfide metabolite, and indomethacin, drugs used as tocolytic agents, in dual recirculating human placental perfusion.

Study Design: Term placentas were obtained with maternal consent immediately after delivery. Drugs were added to the maternal reservoir, together with antipyrine as a reference compound, and disappearance from the maternal circulation and appearance in the fetal circulation were followed up for 2 hours in 4 experiments for each compound.

Ketorolac, diclofenac and ketoprofen are equally efficacious for pain relief after total hip replacement surgery.

We have compared the efficacy of ketorolac 30 mg i.v. followed by infusion at a rate of 90 mg/15.

Transfusion policies in coronary artery bypass--a nationwide survey in Finland.

Background: Since the discovery of HIV, minimizing the use of donor blood has become increasingly important in surgical activity. In Finland, however, the use of homologous red blood has grown considerably during the past years. Therefore, we found it necessary to conduct a nationwide survey of transfusion practices in elective surgery.

Comparison of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery.

This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, the patients received either tropisetron 5 mg, droperidol 1.

Hormonal responses and cardiac filling pressures in head-up or head-down position and pneumoperitoneum in patients undergoing operative laparoscopy.

In order to determine if there are differences in stress responses, as reflected in neuroendocrine activation, we have compared data from two groups of patients undergoing laparoscopic surgery either in the head-up position for cholecystectomy or in the head-down position for hysterectomy. Arterial blood samples were obtained for measurement of serum concentrations of cortisol, catecholamines, renin activity and atrial natriuretic peptide (measured as N-terminal peptide of proANP), and haemodynamic data (pulmonary capillary wedge pressure, PCWP) were collected at the following times: in awake patients, supine at rest (baseline); in awake patients in the position used during surgery; during laparoscopy; and 2 h after surgery. The same anaesthetic technique and normocapnic mechanical ventilation were used in both groups.

Is routine ipsilateral adrenalectomy during radical nephrectomy harmful for the patient?

To investigate the effects of unilateral adrenalectomy on the postoperative course and laboratory parameters, 40 patients with a renal tumour were randomized either to undergo (n = 20) or not to undergo (n = 20) ipsilateral adrenalectomy. Adrenal hormone (cortisol, epinephrine, norepinephrine and aldosterone), adrenocorticotropic hormone, electrolyte, creatinine, growth hormone, glucose, insulin and free fatty acid concentrations were measured preoperatively and postoperatively. Cortisol and epinephrine concentrations were elevated immediately after the operation but returned to preoperative levels within the first 2 postoperative days.

Introducing epidural fentanyl for on-ward pain relief after major surgery.

Background: Epidural opioids have been recommended for analgesia after major surgery. In this report we describe how we introduced a low-cost, on-ward, nurse-based acute pain service using epidural fentanyl after major surgery in the University Hospitals of Oulu and Kuopio.

Methods: In order to evaluate the feasibility of epidural fentanyl infusion administered by ward nurses, we prospectively assessed pain and side effects during fentanyl infusion (median duration 41 h) after major surgery in 305 consecutive patients in Kuopio.

Intravenous ketoprofen for pain relief after total hip or knee replacement.

Background: There are few studies in which ketoprofen, a propionic acid derivate NSAID, has been tested as an intravenous postoperative analgesic. The aim of this double-blind, randomized, placebo-controlled work was to study the tolerability and efficacy of intravenous ketoprofen in seventy-six patients undergoing hip or knee total endoprothesis surgery using three different doses.

Methods: The patients received either ketoprofen 50 mg, 100 mg or 150 mg, or placebo as an initial intravenous loading, followed by an infusion containing 50 mg, 100 mg or 150 mg or placebo, respectively, over the following eleven and a half hours.

Management of upper airway obstruction using a Seldinger minitracheotomy kit.

Two adult patients with upper airway obstruction due to epiglottitis and infectious mononucleosis requiring urgent airway management are presented. Successful establishment of an open airway was achieved by performing a minitracheotomy using the Seldinger technique followed finally with nasotracheal fibreoptic intubation.

Risk/benefit evaluation of NSAIDs in postoperative pain therapy.

NSAIDs are effective analgesics with a clear role in the management of postoperative pain. Following major surgery they are part of a balanced approach to analgesia using a combination of different drugs and techniques. Additional clinical benefits include less drowsiness and lack of respiratory side effects.

Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty?

Evidence of pre-emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain. Forty-one patients undergoing total knee arthroplasty were randomly allocated to four groups.

Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy.

More prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. The early reports of hemodynamic changes during gynecologic laparoscopy are conflicting, and the effects of anesthesia, head-down tilt and pneumoperitoneum have not been clearly separated. Invasive hemodynamic monitoring was carried out in 20 female ASA Class I-II patients who underwent laparoscopic hysterectomy.

Sublingual triazolam versus peroral diazepam as a premedication for general anaesthesia.

Sublingual triazolam 0.2 mg (T) was compared with peroral diazepam 10 mg (D) as a premedicant in a randomised, double-blind study. Eighty-one ASA I-III patients aged 18-70 yr, scheduled for elective surgery and general anaesthesia were studied.

0.1% bupivacaine does not reduce the requirement for epidural fentanyl infusion after major abdominal surgery.

Background And Objectives: Although local anesthesia has been demonstrated to potentiate spinal morphine analgesia in animal studies, results comparing epidural local anesthesia/opioid mixtures with opioid alone are contradictory in clinical studies. The hypothesis was that, although the concentration of bupivacaine (0.1%) was low to minimize its adverse effects, if the infusion rate of a fentanyl/bupivacaine solution was closely adjusted according to need, the presence bupivacaine would reduce the requirement for epidural fentanyl.

A clinical and pharmacokinetic comparison of ropivacaine and bupivacaine in axillary plexus block.

The clinical and pharmacokinetic properties of ropivacaine and bupivacaine, both 5 mg/mL, used in axillary plexus block were compared in 60 patients in this randomized, double-blind, parallel-group study. The axillary plexus was identified with a nerve stimulator and 30, 35, or 40 mL of drug, depending on body weight, was injected into the perivascular sheath. In 20 patients, venous blood samples for the pharmacokinetic measurement were obtained over 24 h.

Ventilatory effects, blood gas changes, and oxygen consumption during laparoscopic hysterectomy.

We evaluated the ventilatory effects and blood gas changes of prolonged CO2-pneumoperitoneum in nor-moventilated patients and examined the respiratory and gas exchange consequences of head-down positioning (25-30 degrees) and CO2 insufflation into the peritoneal cavity in 20 patients without major cardiorespiratory disorders in various phases of laparoscopic hysterectomy. The patients received general anesthesia with isoflurane, fentanyl, and vecuronium, and minute ventilation (MV) was adjusted to maintain the PETCO2 at 33-36 mm Hg throughout the entire procedure, either by increasing the tidal volume (TV) and keeping the respiratory rate (RR) at 12/min (10 patients) or by changing the RR and maintaining the TV at 8 mL/kg (10 patients). Arterial and mixed venous blood samples were collected simultaneously for blood gas analysis and for measurements of oxygen consumption, and respiratory mechanics and gases were recorded by an anesthetic gas analyzer and side stream spirometry device.