Perioperative kinetics of the nitric oxide derivatives nitrite/nitrate during orthotopic liver transplantation.

Nitric oxide (NO) is an important mediator in ischemia-reperfusion injury during human orthotopic liver transplantation (OLT). The perioperative kinetics of nitrite/nitrate plasma levels in 25 patients undergoing uncomplicated OLT were studied. A uniform pattern with significant increases of nitrite/nitrate levels immediately after reperfusion was seen in all patients, followed by a decrease to pretransplant levels within 24h.

Intrathecal clonidine for postoperative analgesia in elderly patients: the influence of baricity on hemodynamic and analgesic effects.

Intrathecal (IT) clonidine is an effective analgesic, but it also produces hemodynamic depression and sedation which are likely to be related to IT clonidine's cephalad spread within the cerebrospinal fluid. We hypothesized that IT clonidine's side effects could be reduced without compromising the duration and quality of analgesia by injecting clonidine IT in a hyperbaric solution and elevating the patient's trunk. We prospectively randomized 30 elderly patients to receive IT 150 microg of either isobaric (ISO) or hyperbaric (HYPER) clonidine for postoperative analgesia after surgical repair of traumatic hip fracture.

High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers.

Background: Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv).

Methods: Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 microg x kg-1 x min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively.

Preoperative orthostatic dysfunction is associated with an increased incidence of postoperative nausea and vomiting.

Background: Postoperative nausea and vomiting (PONV) occurs frequently after gynecologic surgery. Because hemodynamic condition seems to be influential, women presenting with preoperative orthostatic dysregulation may have an increased risk for PONV. The aim of the present study was to assess the relationship between preoperative orthostatic dysregulation and the incidence of PONV.

The effects of systolic arterial blood pressure variations on postoperative nausea and vomiting.

Unlabelled: In this clinical study, we tested the hypothesis that a marked systolic blood pressure decrease >35% (DeltaSBP >35%) from preanesthetic baseline during the induction and maintenance of anesthesia is associated with more postoperative nausea and vomiting (PONV). In 300 ASA physical status I and II women undergoing elective gynecological surgery with general anesthesia, the maximum DeltaSBP during the induction as well as maintenance of general anesthesia were calculated. Observers blinded to hemodynamic variables assessed the incidence of PONV.

Sonographic measurement of needle insertion depth in paravertebral blocks in women.

Single-injection paravertebral block offers adequate unilateral analgesia for thoracic and upper abdominal surgery. This technique is easy to learn but there is a risk, albeit low, of pleural puncture. The aim of the study was to determine whether sonographic measurements of the distances from the skin to the transverse process and to the parietal pleura are useful for calculating the required depth of needle insertion.

Procalcitonin as a diagnostic marker in patients with aspiration after closed head injury.

Background: Aspiration of gastric content frequently induces early onset of pneumonia in patients with impaired consciousness after closed head injury and thus worsens the prognosis. Early detection of aspiration and appropriate therapy are essential. The purpose of the study was to assess the diagnostic value of procalcitonin (ProCT) in aspiration of gastric content and to evaluate its prognostic impact in patients with closed head injury.

Automated melanoma recognition.

A system for the computerized analysis of images obtained from ELM has been developed to enhance the early recognition of malignant melanoma. As an initial step, the binary mask of the skin lesion is determined by several basic segmentation algorithms together with a fusion strategy. A set of features containing shape and radiometric features as well as local and global parameters is calculated to describe the malignancy of a lesion.

A prospective randomized trial comparing the cuffed oropharyngeal airway (COPA) with the laryngeal mask for elective minor surgery in female patients.

Objective: The cuffed oropharyngeal airway (COPA), a modified Guedel-type airway with a cuff at the distal end, has recently been introduced into anesthetic practice. The aim of this study was to compare the COPA with the well established laryngeal mask airway (LMA). Special consideration was granted to the difficult airway.

Electrical stimulation of the vestibular system prevents postoperative nausea and vomiting.

Background: Electrical stimulation of the vestibular system may prevent nausea and vomiting. We studied the influence of transcutaneous impulse stimulation in prevention of postoperative nausea and vomiting (PONV) following gynaecological surgery.

Methods: In this randomised study 70 women undergoing elective gynaecological surgery under general anaesthesia were assigned to receive either the activated (stimulation group) or the inactivated (non-stimulation group) impulse stimulator.

Analgesic effects of caudal and intramuscular S(+)-ketamine in children.

Background: Previous studies suggest that caudal administration of ketamine cause effective analgesia. The purpose of the current study was to compare the clinical effectiveness and plasma concentrations of S(+)-ketamine after caudal or intramuscular administration in children to distinguish between local and systemic analgesia.

Methods: After induction of general anesthesia, 42 patients, aged 1 to 7 yr, scheduled to undergo inguinal hernia repair randomly received a caudal (caudal group) or intramuscular (intramuscular group) injection of 1 mg/kg S(+)-ketamine.

Single-injection paravertebral block compared to general anaesthesia in breast surgery.

Background: Breast surgery is frequently associated with post-operative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anaesthesia for this type of surgery. We studied the single-injection paravertebral block at the level of T4 and report a comparison of single-injection paravertebral block to general anaesthesia for breast surgery.

Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor: a dose-response study.

Background: Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. The authors evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects.

Methods: Thirty-six parturients requesting labor analgesia were included in this prospective, randomized, double-blind study.

The dose-response of caudal ropivacaine in children.

Background: Ropivacaine, a new local anesthetic, is less cardiotoxic in adults and is less likely to cause motor blockade than is bupivacaine. The authors evaluated the clinical effectiveness and hemodynamic effects of ropivacaine compared with bupivacaine and the pharmacokinetics of ropivacaine when given for caudal blocks in 56 children 4.1 +/- 1.

Autoclaving impairs the connector-tube bond of the laryngeal mask airway but not its airtightness.

The general-purpose laryngeal mask airway (LMA) is re-usable when undamaged, and cleaned and autoclaved correctly. We had found weakening of the silicone adhesive that bonds the connector of the LMA to the tube. We report that repeated autoclaving damaged the adhesive such that the connector could be rotated in the tube after the 12th autoclave cycle in almost all of the LMA tested.

Sevoflurane anaesthesia in paediatric patients: better than halothane?

Forty-two children (aged 2-16 years) were randomly assigned to receive either sevoflurane (n = 21) or halothane (n = 21) in nitrous oxide/oxygen. After pre-medication with midazolam, anaesthesia was induced by facemask and the anaesthetic concentration was increased until loss of eyelash reflex (sevoflurane, 6%; halothane, 2.5%).

Desflurane maintains intraocular pressure at an equivalent level to isoflurane and propofol during unstressed non-ophthalmic surgery.

We have investigated the effects of desflurane compared with isoflurane and propofol on intraocular pressure (IOP) in 48 ASA I-II patients undergoing elective non-ophthalmic surgery. Anaesthesia was induced with thiopental 3-5 mg kg-1, fentanyl 2-4 micrograms kg-1 and vecuronium 0.1 mg kg-1.

The efficacy and safety of a clonidine/bupivacaine combination in caudal blockade for pediatric hernia repair.

Unlabelled: We evaluated the analgesic efficacy and hemodynamic and respiratory safety of clonidine when added to bupivacaine for caudal blocks in 58 children aged 38 +/- 2 mo (mean +/- SEM). Patients scheduled for ambulatory hernia repair were randomly given a caudal injection (0.75 mL/kg) of either saline placebo (P group), bupivacaine, 0.

High plasma levels of nitrogen oxides are associated with severe disease and correlate with rapid parasitological and clinical cure in Plasmodium falciparum malaria.

Plasma levels of nitrogen oxide (NO), neopterin and C-reactive protein (CRP) were compared in 3 groups of Gabonese patients with Plasmodium falciparum malaria before and after therapy: adults with uncomplicated malaria, children with uncomplicated malaria, and children with severe malaria. Plasma levels of all 3 molecules were significantly higher in severe malaria than in uncomplicated malaria. High levels of neopterin and CRP during the acute phase of malaria significantly correlated with slow parasitological and clinical cure after therapy.

Prediction of accelerated cure in Plasmodium falciparum malaria by the elevated capacity of tumor necrosis factor production.

Cytokine regulation was compared in three groups of Gabonese patients with Plasmodium falciparum malaria before and after therapy; adults with uncomplicated malaria, children with uncomplicated malaria, and children with severe malaria. Plasma levels of tumor necrosis factor (TNF), interleukin-6 (IL-6), IL-8, TNF receptors (TNF R), and the TNF/TNF R ratios were significantly higher in severe malaria compared with uncomplicated malaria. High plasma levels of all immunoregulatory molecules were associated with slow cure after therapy.

Quinine plus clindamycin improves chemotherapy of severe malaria in children.

In a randomized trial, a 4-day quinine-clindamycin regimen was compared with the standard 7-day quinine regimen for 100 Gabonese children (50 children in each group) with severe Plasmodium falciparum malaria. In each group, only one patient died. Parasite clearance and fever clearance times were significantly shorter in the quinine-clindamycin group (P = 0.