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Biomedical subjects

K Korttila

Publications and source records attributed to K Korttila.

At least 19 recordsLinked to original sources
PubMed2005

Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anesthesia for ambulatory knee arthroscopy.

BACKGROUND: We tested the hypothesis that selective spinal anesthesia for ambulatory knee arthroscopy can be accomplished with a small dose of bupivacaine at the L3/4 interspace with or without a head-down tilt of 5 degrees when the patients were in the lateral decubitus position. METHODS: In this double-blind study, 123 patients were randomly allocated to receive spinal anesthesia with 4 mg of hyperbaric bupivacaine inserted at either the L2/3 interspace, while the vertebral column was kept horizontal (L2/3 group), or the L3/4 level, with the vertebral column horizontal (L3/4H) or tilted 5 degrees head-down (L3/4T). At 7 min, an additional head down tilt was used in all groups if the sensory block was inadequate. RESULTS: In the L3/4T group the sensory block (Th8) reached a significantly higher level 30 min after spinal injection, compared with both the L2/3 (Th10) and L3/4H (Th11) groups. In the L3/4H group, 39% of the patients needed an additional tilt for 3 min at 7 min, compared with 10% (P=0.004) in the L3/4T group. Sacral block developed later and recovered faster (P<0.05) in the L3/4T group compared to the L3/4H group. Home-readiness was achieved equally fast in all groups. CONCLUSION: When producing selective spinal anesthesia, the posture of the vertebral column is a major determinant of both sensory and motor segments to be blocked. A 4-mg dose of hyperbaric bupivacaine at the L3/4 interspace with a 5 degrees head-down tilt of the vertebral column for 6 min is recommended for knee arthroscopy.

Adult↗
PubMed2005

Factorial design provides evidence to guide practice of anaesthesia.

Many scientific articles are written merely to get something published, neglecting the clinician who would like the medical literature to guide their practice. Evidence-based medicine is expected to help in clinical decision-making. Systematic reviews of the literature followed by a meta-analysis of randomized, controlled trials (RCT) have claimed to represent the highest strength of evidence. However, the results published in meta-analyses have not always been confirmed in subsequent large RCTs. An analysis of 12 large RCTs and 19 meta-analyses addressing the same questions found that the outcomes of these large RCTs were not predicted accurately 35% of the time by previously published meta-analyses. Therefore, meta-analyses of several small RCTs do not obviate the need for large, multicentre RCTs, which can still be considered as a gold standard for the development of clinical guidelines or practice plans. Moreover, large RCTs using a factorial design can be highly efficient because they can answer several clinical questions at the same time and offer the only systematic approach to investigate an interaction of combinations in multimodal approaches.

Anesthesia↗
PubMed2004

Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique.

BACKGROUND: We tested the hypothesis that patient-controlled epidural analgesia for labor (PCEA) provides better analgesia and satisfaction than the intermittent bolus technique (bolus) without affecting the mode of delivery. METHODS: We randomized 187 parturients to receive labor analgesia using either the PCEA or bolus technique. The PCEA group received a starting bolus of 14 mg of bupivacaine and 60 micro g of fentanyl in a 15-ml volume, followed by a background infusion (bupivacaine 0.08% and fentanyl 2 microg ml(-1)) 5 ml h(-1) with a 5-ml bolus and 15-min lock-out interval. The bolus group received boluses of 20 mg of bupivacaine and 75 micro g of fentanyl in a 15-ml volume. RESULTS: Parturients in the PCEA group had significantly (P < 0.05-0.01) less pain during the first and second stages of labor. There was no difference in the spontaneous delivery rate between the groups, but the cesarean delivery rate was significantly (P < 0.05) higher (16.3% vs. 6.7%) in the PCEA group than in the bolus group. Bupivacaine consumption was significantly (P < 0.01) higher (11.2 mg h(-1) vs. 9.6 mg h(-1)) and the second stage of labor was significantly (P < 0.01) longer (70 min vs. 54 min) in the PCEA group than in the bolus group. Patient satisfaction was equally good in both groups. CONCLUSION: The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section.

Adolescent↗
PubMed2003

Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non-cardiac surgery with general anaesthesia in the elderly. We hypothesized that the incidence of POCD would be less with regional anaesthesia rather than general. METHODS: We included patients aged over 60 years undergoing major non-cardiac surgery. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. Cognitive function was assessed using four neuropsychological tests undertaken preoperatively and at 7 days and 3 months postoperatively. POCD was defined as a combined Z score >1.96 or a Z score >1.96 in two or more test parameters. RESULTS: At 7 days, POCD was found in 37/188 patients (19.7%, [14.3-26.1%]) after general anaesthesia and in 22/176 (12.5%, [8.0-18.3%]) after regional anaesthesia, P = 0.06. After 3 months, POCD was present in 25/175 patients (14.3%, [9.5-20.4%]) after general anaesthesia vs. 23/165 (13.9%, [9.0-20.2%]) after regional anaesthesia, P = 0.93. The incidence of POCD after 1 week was significantly greater after general anaesthesia when we excluded patients who did not receive the allocated anaesthetic: 33/156 (21.2%[15.0-28.4%]) vs. 20/158 (12.7%[7.9-18.9%]) (P = 0.04). Mortality was significantly greater after general anaesthesia (4/217 vs. 0/211 (P < 0.05)). CONCLUSION: No significant difference was found in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia in elderly patients. Thus, there seems to be no causative relationship between general anaesthesia and long-term POCD. Regional anaesthesia may decrease mortality and the incidence of POCD early after surgery.

Activities of Daily Living↗
PubMed2003

Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet.

BACKGROUND: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 microg of fentanyl permits fast-tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine. METHODS: In this double-blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 microg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2-min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast-tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs. RESULTS: One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 (P = 0.002). The PACU-time was shorter: 36 (10-103) vs. 55 (10-140) min, respectively (P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus. CONCLUSION: Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU-time was shorter in the bupivacaine-fentanyl group, but both groups reached home-readiness equally.

Adult↗
PubMed2003

Ondansetron does not prevent pruritus induced by low-dose intrathecal fentanyl.

BACKGROUND: Addition of an opioid to low-dose spinal anesthesia with bupivacaine improves the quality and success of anesthesia. However, the intrathecal fentanyl-induced pruritus is as high as 75%. We hypothesized that after administration of 4 or 8 mg of prophylactic IV ondansetron, the incidence of pruritus induced by low-dose intrathecal fentanyl would be significantly lower than after placebo. METHODS: In this double-blind study, 90 outpatients undergoing knee arthroscopy received 3 mg of bupivacaine + 10 micro g fentanyl intrathecally. Before spinal puncture, the patients received randomly either saline (P) or ondansetron 4 mg (O4) or 8 mg (O8) IV. They were asked about pruritus frequently, and they estimated its severity on a scale of 0-10. RESULTS: There was no difference in the incidence of pruritus between the three groups: pruritus occurred in 17 (57%), in 21 (75%) and in 19 patients (70%) in P, O4 and O8 groups, respectively. The pruritus was mostly mild. Four patients in the placebo group, three in the O4 and four patients in the O8 groups considered it severe. One patient in each group requested treatment for pruritus; after IV naloxone their pruritus was relieved. Neither time to pruritus nor duration of pruritus differed between the groups. One patient in each group developed a long-lasting (>10 h) pruritus. CONCLUSIONS: After prophylactic administration of 4 or 8 mg of ondansetron IV, the incidence, duration and severity of pruritus were similar to placebo. Ondansetron does not prevent pruritus induced by low-dose intrathecal fentanyl.

Ambulatory Surgical Procedures↗
PubMed2003

Cognitive dysfunction after minor surgery in the elderly.

BACKGROUND: Major surgery is frequently associated with postoperative cognitive dysfunction (POCD) in elderly patients. Type of surgery and hospitalization may be important prognostic factors. The aims of the study were to find the incidence and risk factors for POCD in elderly patients undergoing minor surgery. METHODS: We enrolled 372 patients aged greater than 60 years scheduled for minor surgery under general anesthesia. According to local practice, patients were allocated to either in- (199) or out-patient (173) care. Cognitive function was assessed using neuropsychological testing preoperatively and 7 days and 3 months postoperatively. Postoperative cognitive dysfunction was defined using Z-score analysis. RESULTS: At 7 days, the incidence (confidence interval) of POCD in patients undergoing minor surgery was 6.8% (4.3-10.1). At 3 months the incidence of POCD was 6.6% (4.1-10.0). Logistic regression analysis identified the following significant risk factors: age greater than 70 years (odds ratio [OR]: 3.8 [1.7-8.7], P = 0.01) and in- vs. out-patient surgery (OR: 2.8 [1.2-6.3], P = 0.04). CONCLUSIONS: Our finding of less cognitive dysfunction in the first postoperative week in elderly patients undergoing minor surgery on an out-patient basis supports a strategy of avoiding hospitalization of older patients when possible.

Aged↗
PubMed2002

How to study postoperative nausea and vomiting.

Anesthesiological journals are flooded by innumerable studies of postoperative nausea and vomiting (PONV). Nevertheless, PONV remains a continuing problem with an average incidence of 20-30%. This paper should provide essential information for the design, conduct, and presentation of these studies. It should also increase comparability among future studies and help clinicians in assessing and reading the literature on PONV. First, future studies should address new and relevant questions instead of repeatedly investigating prophylactically given antiemetics whose main results are predictable (e.g. already proven by meta-analysis). Second, group comparability should be based on well-proven risk factors and a simplified risk score for predicting PONV. Endless listings of doubtful risk factors should be avoided. Third, a realistic sample size estimation should be performed, i.e. in most cases at least 100 patients per group are necessary. Fourth, nausea, vomiting and rescue medication should be recorded and reported separately with the corresponding incidences (and number of patients with these separate symptoms), and the main end-point should be PONV. The entire observation period should cover 24 h. Additional reporting of the early (0-2 h) and delayed (2-24 h) postoperative period is desirable and should consider single and cumulative incidences. Lastly, interpretation of results should take into account the study hypothesis, sources of potential bias or imprecision, and the difficulties associated with multiplicity of analysis and outcomes.

Clinical Trials as Topic↗
PubMed2002

A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery.

UNLABELLED: We randomized 150 parturients into a double-blinded trial to receive intrathecal (IT) 100 microg (IT 100 group) or 200 microg (IT 200 group) or epidural 3 mg (Epidural group) of morphine for elective cesarean delivery with a combined spinal/epidural technique. The patients additionally received ketoprofen 300 mg/d. Postoperative pain relief and side effects were registered every 3 h up to 24 h, and all patients were interviewed on the first postoperative day. Pain control was equally good, but the parturients in the IT 100 group requested rescue analgesics more often compared with the other groups (P < 0.05). Itching was a common complaint and was reported by 74% of the parturients in the Epidural group and 65% and 91% in the IT 100 and IT 200 groups, respectively (P < 0.01). Medication for itching was requested by 44%, 24%, and 45% of the patients, respectively (P < 0.05). There was no difference in postoperative nausea or vomiting. The pain relief was perceived as good by >90% of the patients in all groups. In conclusion, because of the decreased incidence of and lesser requirements of medication for itching, IT morphine 100 microg with ketoprofen is recommended in cesarean deliveries. Rescue analgesics nevertheless need to be prescribed. IMPLICATIONS: Spinal morphine is an effective analgesic after cesarean delivery, but it has several side effects. The purpose of this study was to compare the prevalence of side effects and the level of analgesia of epidural morphine with two different doses of spinal morphine after elective cesarean delivery. Although rescue analgesics may be required, intrathecal morphine 100 microg is suggested for postoperative analgesia after cesarean delivery.

Adult↗
PubMed2001

Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children.

BACKGROUND: Sevoflurane inhalation induction of anaesthesia is widely used in paediatric anaesthesia. We have found that this method is frequently associated with epileptiform electroencephalogram (EEG) in adults, especially if controlled hyperventilation is used. METHODS: We assessed EEG during sevoflurane inhalation induction in 31 children, aged 2-12 yr. Anaesthesia was induced with 8% sevoflurane in O2 in N2O 1:2. The patients were randomized to undergo controlled ventilation (CV group), or to breathe spontaneously (SB group) for 5 min. EEG was recorded as were noninvasive blood pressure and heart rate (HR). EEG recordings were classified by a clinical neurophysiologist. RESULTS: Three different types of interictal epileptiform discharge were detected. Suppression with spikes (SSP) was found in 25% and 0% in the CV and SB groups, rhythmic polyspikes (PSR) in 44% and 20%, and periodic epileptiform discharges (PED) in 44% and 0% (P<0.01), respectively. The incidence of all different types of interictal epileptiform discharge (SSP+PSR+PED) was 88% and 20% (P<0.001), respectively. Epileptiform EEG was associated with increased heart rate and blood pressure during anaesthetic induction. CONCLUSION: Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.

Anesthetics, Inhalation↗
PubMed2000

Epileptiform EEG during sevoflurane mask induction: effect of delaying the onset of hyperventilation.

BACKGROUND: Hyperventilation during sevoflurane-N2O-O2 mask induction in adults is associated with a hyperdynamic circulatory response and epileptiform electroencephalogram (EEG). We tested the hypothesis that delaying onset of hyperventilation will prevent severe (periodic) epileptiform EEG and hyperdynamic response. METHODS: Thirty patients were randomized to receive either delayed (group D, n=15) or immediate (group I, n=15) onset of hyperventilation during sevoflurane (8% in N2O 50%) mask inhalation induction with single-breath method for unconsciousness. Fifteen patients were allowed to breathe spontaneously for 2 min after loss of consciousness and controlled hyperventilation (ETCO2 <4%) was started thereafter. In 15 patients controlled hyperventilation was started immediately after loss of consciousness. EEG was recorded, and mean arterial pressure (MAP) and heart rate (HR) registered. RESULTS: Epileptiform EEG patterns were seen in 13 patients in group I and in 9 patients in group D (n.s.). Periodic epileptiform discharges (PED) tended to occur more often in group I (P=0.07). Heart rate and MAP were higher in group I than in group D from 2 min to 3 min (P < 0.05), and both HR and MAP rose significantly from the baseline in group I. In group D, HR but not MAP rose significantly from baseline. CONCLUSION: Regardless of its timing, hyperventilation at a high sevoflurane concentration produced severe epileptiform EEG with a hyperdynamic response. PED tended to occur more often with immediate onset of hyperventilation.

Adult↗
PubMed2000

Are electrocardiogram electrodes acceptable for electroencephalogram bispectral index monitoring?

BACKGROUND: The monitoring of electroencephalogram bispectral index (EEG-BIS) during anaesthesia reduces anaesthetic use and improves recovery. However, it also increases the direct costs of anaesthesia due to the need for special EEG electrodes. In the present study we tested the feasibility of less expensive electrocardiogram (ECG) electrodes for EEG-BIS monitoring. METHODS: In the first part of the study we compared skin-electrode impedances when EEG electrodes were used after alcohol swab pretreatment of skin to impedances when ECG electrodes were used after alcohol swab pretreatment with or without skin abrasion paste. In the second part of the study we evaluated the difference in parallel BIS values collected with two BIS monitors, using either ECG electrodes or EEG electrodes. In the third part of the study we compared parallel BIS values collected with two sets of EEG electrodes. RESULTS: Skin pretreatment with abrasion paste led to lower impedances with ECG electrodes than did alcohol swab pretreatment of skin with EEG electrodes. When the skin was pretreated with alcohol swab, higher impedances were measured with ECG electrodes than with EEG electrodes. In most patients, BIS values collected with ECG electrodes were also higher than those collected with adhesive EEG electrodes. The difference between parallel BIS values collected with two sets of adhesive EEG electrodes was smaller than the difference between BIS values collected with ECG and EEG electrode sets. CONCLUSION: Low skin-electrode impedances indicating reliable skin-electrode contact can be ensured with inexpensive pregelled ECG electrodes only if the skin is carefully prepared with both abrasion paste and alcohol. When only alcohol pretreatment of skin is used, the BIS values collected with EEG electrodes and ECG electrodes are not equal. EEG-BIS monitoring with pregelled ECG electrodes is recommended only if skin is prepared with abrasion paste before attaching the electrodes.

Adult↗
PubMed1999

EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery.

BACKGROUND: Recent studies have suggested that electroencephalogram (EEG) bispectral index (BIS) monitoring can improve recovery after anaesthesia and save money by shortening patients' postoperative stay. We wanted to evaluate the direct costs of BIS monitoring and to measure immediate recovery after anaesthesia in patients with or without BIS monitoring. METHODS: Eighty patients undergoing gynaecological surgery were studied. At first, 40 patients were randomized to receive either propofol or sevoflurane anaesthesia. In these patients, BIS was collected but the information was not displayed. Thereafter, the anaesthesiologists were trained to follow and understand the BIS information, and 40 patients were anaesthetized with aid of the monitoring. Recovery times were measured by a study coordinator. Drug consumption was calculated. RESULTS: BIS monitoring improved the immediate recovery after propofol anaesthesia, while no differences were seen in patients receiving sevoflurane. The consumption of both propofol and sevoflurane decreased significantly (29% and 40%, respectively). BIS monitoring increased direct costs in these patients; the break-even times (704 min for propofol and 282 min for sevoflurane) were not reached. CONCLUSION: BIS monitoring decreased the consumption of both propofol and sevoflurane and hastened the immediate recovery after propofol anaesthesia. Detailed cost analysis showed that the monitoring increased direct costs of anaesthesia treatment in these patients, mainly due to the price of special EEG electrodes used for relatively short anaesthesias.

Adult↗
PubMed1999

Warming of insufflation gas during laparoscopic hysterectomy: effect on body temperature and the autonomic nervous system.

BACKGROUND: Hypothermia is a known side effect of laparoscopic operations. It may increase the sympathetic activity of the autonomic nervous system (ANS), which can be evaluated noninvasively by heart rate variability (HRV). We tested the hypothesis that warming of the delivered CO2 insufflation gas helps to maintain the normal body temperature. METHODS: Thirty-seven healthy women undergoing laparoscopic hysterectomy were randomized into heated (37 degrees C, n=18) or unheated (24 degrees C, n = 19) gas insufflation groups. Anesthesia was induced with propofol and maintained with sevoflurane in O2-air. Tympanic (ttymp) temperature was recorded before, during and after the operation. Nasopharyngeal (tnaso) temperature was recorded only during operation. Electrocardiograms were recorded and stored to evaluate changes in HRV. The individual changes in HRV were compared after decibel (dB) transformation. RESULTS: A median decrease in tympanic temperatures during the operation was 0.7 degrees C in the heated and 0.3 degrees C in the unheated group (P = 0.01 between groups), and in nasopharyngeal 0.3 degrees C and 0.1 degrees C (P = 0.03), respectively. Preanesthetic tympanic values were reached within 90 min after anesthesia. After dB transformation, HRV high frequency power differed between the groups. It was better preserved in the patients receiving unheated gas. CONCLUSION: The heating of insufflation gas does not prevent a decrease in body temperature and is thus unnecessary during laparoscopic hysterectomy.

Adult↗
PubMed1999

Sevoflurane requirement for laparoscopic tubal ligation: an electroencephalographic bispectral study.

It has been shown in healthy volunteers that a concentration of volatile anaesthetic lower than 1 minimum alveolar concentration provides unconsciousness. We tested the hypothesis that, using the electroencephalogram bispectral index, less than 1 minimum alveolar concentration of sevoflurane can produce unconsciousness in patients. Anaesthesia was induced and maintained with sevoflurane in N2O and O2 (33%) in 32 ASA I-II women undergoing laparoscopic tubal ligation. For the first patient, the sevoflurane concentration was adjusted to 1 minimum alveolar concentration with an end-tidal concentration of 0.7%. The electroencephalogram bispectral index values were used to determine the concentration to be used for the next patient. The ED50 (effective dose) measured using end tidal concentrations of sevoflurane for laparoscopic tubal ligation in a 40-year-old patient was 0.70% (CI 95%: 0.63-0.77) and ED95 0.83% (CI 95%: 0.75-0.90). None of the patients had any operation-associated recall. It is concluded that the sevoflurane concentration needed for laparoscopic tubal ligation is not lower than 1 minimum alveolar concentration.

Adult↗
PubMed1999

Comparison of sevoflurane-nitrous oxide and propofol-alfentanil-nitrous oxide anaesthesia for minor gynaecological surgery.

We studied 44 patients undergoing minor gynaecological surgery, anaesthetized in random order with sevoflurane-nitrous oxide or propofol-alfentanil-nitrous oxide. Operating conditions, recovery and postoperative nausea and vomiting (PONV) were assessed. For postoperative analgesia, all patients were given ketoprofen 100 mg rectally at the end of anaesthesia. Patients and gynaecologists were equally satisfied with both anaesthetic techniques. Patients given propofol woke up (3.5 vs 6.5 min), became orientated (5.0 vs 7.5 min) and were able to walk (57 vs 69 min) significantly (P < 0.05) earlier than those given sevoflurane, but there were no differences in times to achieve home readiness (166 vs 149 min) or in psychomotor recovery between the two groups. Intrauterine bleeding and PONV were more common with sevoflurane (incidence of PONV 64%) than with propofol anaesthesia (incidence of PONV 5%). We conclude that propofol-alfentanil is preferable to sevoflurane in ultra-short anaesthesia for minor gynaecological surgery.

Adult↗