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Biomedical subjects

K Korttila

Publications and source records attributed to K Korttila.

At least 73 records · Page 4Linked to original sources
PubMed1990

Metabolites of methohexitone do not contribute to its prolonged action on the central nervous system.

Methohexitone has been reported to have a prolonged action on the central nervous system (CNS) despite its relatively short elimination half-life. A hydroxy metabolite of methohexitone was identified, purified and isolated from the urine collected from eight surgical patients and five mongrel dogs anaesthetized with methohexitone. Using a rotarod device, the CNS-activity of the human and canine metabolites was tested in mice and compared to that of methohexitone. In this test, the metabolites showed CNS-depressant activity, but the ED50 (dose needed to affect 50% of the animals) of the metabolites was ten times higher than the ED50 of the parent drug. Because in patients, no traces of the hydroxy metabolite could be found in blood, and in dogs the plasma concentration of the metabolite was about two-thirds of that of the parent compound, it is unlikely that the residual CNS-effects of methohexitone are due to its major metabolite, hydroxymethohexitone.

Animals↗
PubMed1990

The experience of the person ventilating the lungs does influence postoperative nausea and vomiting.

One hundred and ninety-eight patients undergoing elective abdominal hysterectomy were anaesthetized with isoflurane in nitrous oxide and oxygen. Ventilation before endotracheal intubation was carried out either by an experienced senior or by an inexperienced junior member of the anaesthetic team. The incidence and severity of emesis (none, nausea, retching or vomiting) were assessed five times during the first 24 h after operation. Patients whose lungs had been ventilated by experienced members of staff had significantly less (P less than 0.05 to 0.01) postoperative emesis in the recovery room (incidence of emesis 35%) and 2-6 h after operation (incidence 27%) when compared to patients whose lungs had been ventilated by inexperienced members of staff (incidence of emesis 54% and 40% in the recovery room and after 2 to 6 h, respectively). The results suggest that the experience of the person ventilating the lungs is associated with postoperative nausea and vomiting.

Adult↗
PubMed1990

Randomized comparison of recovery after propofol-nitrous oxide versus thiopentone-isoflurane-nitrous oxide anaesthesia in patients undergoing ambulatory surgery.

A randomized, prospective study was performed to compare recovery characteristics in 41 ASA physical status I-II patients scheduled for ambulatory surgery with either propofol or thiopentone-isoflurane anaesthesia. Particular attention was focused on the recovery time needed to meet discharge criteria. The propofol group received propofol 2 mg.kg-1 for induction followed by propofol infusion (6-9 mg.kg-1.h-1) 1 min after intubation. The thiopentone-isoflurane group received thiopentone 4 mg.kg-1 for induction followed by isoflurane (0.5-2%) 1 min after endotracheal intubation. Other drugs administered during or after anaesthesia were similar between the groups. The propofol group had significantly (P less than 0.05) faster clinical recovery than the isoflurane group with respect to times to response to commands, eye opening, orientation, ability to stand and void, tolerance to oral fluids, "home-readiness", and recovery of perceptual speed. Patients in the propofol group had significantly less (P less than or equal to 0.05) emesis than the patients given isoflurane. We conclude that in patients undergoing ambulatory surgery propofol infusion is preferable to thiopentone-isoflurane anaesthesia, because it may allow faster discharge home.

Adult↗
PubMed1990

Gastric aspiration at the end of anaesthesia does not decrease postoperative nausea and vomiting.

Two hundred and one women undergoing elective abdominal hysterectomy were anaesthetised with isoflurane in nitrous oxide and oxygen. At the end of anaesthesia the stomach was aspirated in half of the patients, selected in random order. In the other half no aspiration was performed. Incidence and severity of emesis (none, nausea, retching or vomiting) was assessed during the first 24 hours after operation. Emesis was similar after the operation regardless of aspiration of the stomach (overall emesis, 79% and 70% for those whose stomach had and had not been aspirated, respectively). The incidence at all times during the 24 hours was similar in both groups. The results suggest that gastric aspiration at the end of anaesthesia has no major effect on the incidence or severity of postoperative emesis in patients undergoing abdominal hysterectomy.

Adult↗
PubMed1989

Randomized comparison of outcome after propofol-nitrous oxide or enflurane-nitrous oxide anaesthesia in operations of long duration.

A randomized, prospective, comparative study was performed to evaluate induction characteristics, haemodynamic changes and recovery in 60 ASA I-II patients undergoing mainly gynaecological laparotomies with either propofol or thiopentone-enflurane anaesthesia. The propofol group (n = 30) received 2 mg.kg-1 propofol for induction of anaesthesia followed by propofol infusion. The thiopentone-enflurane group (n = 30) received thiopentone 4 mg.kg-1 for induction followed by enflurane (0.5-2 per cent). All patients received nitrous oxide (66 per cent] in oxygen begun one minute after tracheal intubation, and fentanyl (1.5 micrograms.kg-1) four minutes prior to induction. Other drugs administered during or after anaesthesia were similar among the groups. Haemodynamic measurements were similar between propofol and enflurane groups except after tracheal intubation when the mean arterial pressure was lower in the propofol group (P less than 0.05). The propofol group had significantly less (P less than 0.01) emesis in the recovery room than the enflurane group. The propofol group experienced significantly less (P less than 0.05) dizziness, depression/sadness and hunger than the enflurane group in the postoperative period as assessed with a visual analogue questionnaire. We conclude that propofol provided better outcome than enflurane in terms of these nonvital but annoying outcome measures after relatively long intra-abdominal operations.

Adult↗
PubMed1989

Nitrous oxide does not increase nausea and vomiting following gynaecological laparoscopy.

The effect of three different anaesthetic techniques on the incidence and severity of postoperative emesis (nausea, retching and vomiting) was studied in 150 patients undergoing gynaecological laparoscopy. Patients were anaesthetized with isoflurane in nitrous oxide and oxygen (Group A), enflurane in nitrous oxide and oxygen (Group B) or with isoflurane in air and oxygen (Group C). Groups had been predetermined by date of birth. During the first 24 hours after the operation no difference was found at any time in the incidence or severity of emesis among the groups. The overall incidence of emesis during the first 24 hours postoperatively was 54, 48 and 52 per cent, in groups A, B and C, respectively. It is concluded that nitrous oxide does not increase the incidence of emesis after isoflurane anaesthesia and that isoflurane and enflurane anaesthesia are associated with similar incidences of nausea and vomiting after gynaecological laparoscopy.

Adult↗
PubMed1989

Effects of intravenous diazepam and thiopental on the vestibulo-ocular reflex in man.

The effects of i.v. injection of diazepam 0.3 mg/kg and thiopental 6.0 mg/kg on vestibulo-ocular reflex (VOR) were studied in 9 healthy volunteers. One hour after injection of both diazepam and thiopental VOR gain was reduced and time constant shortened. Four hours after intravenous injection of diazepam the VOR gain was still significantly reduced and had not yet returned to control 8 h after injection. Although both drugs were detected in blood still 8 h after the injection, there were no longer significant effects on VOR. Moreover, individual values of VOR gain and time constant did not correlate with the blood concentrations of the drugs. Decrease of VOR gain and shortening of time constant after i.v. given diazepam and thiopental in man are interpreted as resulting from both specific effects on VOR and non-specific reduction of alertness.

Adult↗
PubMed1988

Nitrous oxide and human state-dependent memory.

State-dependent effects of nitrous oxide on human memory were examined by administering serial and paired-associate learning tasks to subjects receiving 20 and 30% nitrous oxide or placebo. Nitrous oxide in 30% concentration impaired learning of both tasks. In addition, it produced an atypical form of asymmetric state-dependent memory; subjects who learned while receiving placebo and recalled while receiving nitrous oxide displayed the worst recall.

Adult↗
PubMed1988

Nausea and vomiting after general anaesthesia with isoflurane, enflurane or fentanyl in combination with nitrous oxide and oxygen.

One-hundred and eighty patients undergoing elective abdominal hysterectomy were anaesthetized in random order with isoflurane, enflurane or fentanyl in combination with nitrous oxide and oxygen. Incidence and severity of emetic sequelae (none, nausea, retching or vomiting) were studied during the first 24 h after the operation. Patients who received isoflurane had significantly (P less than 0.01) less emetic sequelae (27%) during the first 2 h in the recovery room compared with patients who received enflurane (45%) or fentanyl (48%). There was no difference between the groups in the overall incidence of emetic sequelae during the time period of 2-24 h post-operatively (isoflurane 65%, enflurane 77% and fentanyl 77%). Significantly (P less than 0.02) more patients had emetic sequelae if they had experienced nausea or had vomited after previous anaesthetics.

Adult↗
PubMed1987

Buprenorphine as premedication and as analgesic during and after light isoflurane-N2O-O2 anaesthesia. A comparison with oxycodone plus fentanyl.

Sixty patients undergoing gynaecological laparotomies under isoflurane anaesthesia received 0.4 mg of buprenorphine sublingually or 0.12 mg/kg of oxycodone intramuscularly in random order for preanaesthetic medication. Patients premedicated with buprenorphine were given buprenorphine before, during and after anaesthesia and patients premedicated with oxycodone received fentanyl before and during anaesthesia and oxycodone after anaesthesia. Buprenorphine premedication produced less drowsiness and sedation and alleviated patients' apprehension significantly (P less than 0.05) less than oxycodone. Systolic and diastolic blood pressure and heart rate were significantly (P less than 0.05 to P less than 0.01) higher after intubation in the buprenorphine group when compared with the oxycodone plus fentanyl group. After anaesthesia, spontaneous respiration started rapidly; the return of consciousness and immediate recovery occurred at the same rate in both groups. In the recovery room moderate to severe pain was more common (P less than 0.05) in the oxycodone plus fentanyl group than in the buprenorphine group. The respiratory rate in the recovery room was lower among patients given buprenorphine, and two patients given buprenorphine developed severe respiratory depression. In the ward (2 to 24 h after operation) sublingual buprenorphine provided pain relief as good as intramuscularly administered oxycodone. No differences were noted in the incidence or severity of emetic symptoms between the groups. It is concluded that buprenorphine can provide good postoperative pain relief for gynaecological laparotomies performed under light isoflurane anaesthesia, but patients need to be monitored carefully after operation because of the possibility of respiratory depression.

Adult↗
PubMed1987

Intravenous diclofenac sodium decreases prostaglandin synthesis and postoperative symptoms after general anaesthesia in outpatients undergoing dental surgery.

One hundred unpremedicated patients scheduled for outpatient restorative dentistry and/or oral surgery were given either 75 mg diclofenac sodium (prostaglandin synthesis inhibitor) or a saline placebo i.v. in a double-blind random fashion before induction of anaesthesia with methohexitone (2 mg/kg). Intubation was facilitated with suxamethonium (1.2 mg/kg) and anaesthesia was maintained with isoflurane in 50% nitrous oxide and oxygen using spontaneous respiration. Cuff pressure was continuously monitored and maintained at 10-25 mmHg. The mean duration of anaesthesia was 141 +/- 75 min in the diclofenac group and 150 +/- 73 min in the saline group. Diclofenac inhibited prostaglandin synthesis, as evident from serum thromboxane B2 and urinary 6-keto-prostaglandin F1 alpha data. There was no difference in recovery as assessed from the orientation time (14.2 +/- 5.7 min and 14.5 +/- 6.3 min for diclofenac and saline patients, respectively), perceptual speed and ability to walk along a straight line 30 and 60 min after anaesthesia. Emetic symptoms were equally common in both groups: an overall incidence of 32.6% and 36.7% for the diclofenac and saline patients, respectively. In the whole patient series women became nauseated and vomited more than men (P less than 0.01). Diclofenac reduced the incidence of pain in the throat or oral region 1 h after anaesthesia (P less than 0.05) and other symptoms 1-24 h postoperatively (P less than 0.01). Thus, preoperative intravenous diclofenac appears useful in ambulatory patients undergoing restorative dentistry and oral surgery under isoflurane anaesthesia.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Nitrous oxide does not increase the incidence of nausea and vomiting after isoflurane anesthesia.

A total of 110 patients undergoing elective abdominal hysterectomy were anesthetized in random order with either isoflurane in nitrous oxide and oxygen or isoflurane in air and oxygen. Fentanyl was used as an adjunct to isoflurane in all patients, 0.05 mg every 45 min. No difference was found between the two anesthetic techniques in the incidence of nausea, vomiting, or both during the first 24 hr after operation. The overall incidence was 62 and 67% for air-O2 and N2O-O2 groups, respectively. Patients who had had nausea or vomiting after previous anesthetics had nausea or vomiting significantly more frequently than patients who did not. It is concluded that nitrous oxide does not contribute to the occurrence of nausea or vomiting after isoflurane anesthesia for gynecologic laparotomies.

Adult↗
PubMed1986

Droperidol, alizapride and metoclopramide in the prevention and treatment of post-operative emetic sequelae.

Women (182) undergoing elective orthopaedic surgery under general anaesthesia received 100 or 200 mg alizapride, 1.25 mg droperidol, 20 mg metoclopramide or a saline placebo intravenously 5-10 min before the end of anaesthesia in a double-blind random fashion to prevent post-operative nausea and vomiting. Administration of the same anti-emetic was repeated during 24 h post-operatively if the patient complained of nausea or retched or vomited. Significantly fewer patients given any of the anti-emetics prophylactically were nauseated or vomited in comparison with patients given saline. The incidence of nausea and vomiting in the saline group was 83%, while in those patients who received an anti-emetic it was as follows: droperidol 35% (P less than 0.001 vs. saline), alizapride, 100 mg 46% (P less than 0.01), alizapride 200 mg 53% (P less than 0.05) and metoclopramide 58% (P less than 0.05). The number of patients needing an additional dose of the same substance in the post-operative period was significantly higher in the saline group (67%) than in the groups which had received droperidol (32%, P less than 0.01) and alizapride 100 mg (37%, P less than 0.05) or 200 mg (33%, P less than 0.05). The patients who received metoclopramide, however, did not differ statistically from the saline group in the treatment of nausea and vomiting. It is concluded that droperidol was the most effective, and metoclopramide the least effective, anti-emetic in this study.

Adolescent↗
PubMed1985

Comparison of diazepam and midazolam for sedation during local anaesthesia for bronchoscopy.

Bronchoscopy was performed in 76 outpatients using local anaesthesia plus diazepam 0.2 mg kg-1 i.v. or midazolam 0.05 or 0.1 mg kg-1 i.v. Patient co-operation and ease of bronchoscopy were good in all patients. Two hours after injection, 67% (diazepam 0.2 mg kg-1), 36% (midazolam 0.05 mg kg-1) and 75% (midazolam 0.1 mg kg-1) of the patients failed to recall the insertion of the bronchoscope. Similarly, when asked on the following day, only 22%, 52% and 8%, respectively, of the patients remembered bronchoscopy. Two hours after sedation, the patients' performances in three psychomotor tests were similar to those measured before sedation in each group, but the patients' ability to stand steadily and walk along a straight line reverted to normal significantly (P less than 0.05) more slowly in patients receiving midazolam 0.1 mg kg-1 than in the patients given diazepam. The results suggest that midazolam offers no advantage over diazepam in terms of speed of recovery of psychomotor function, when doses of similar potency are given for bronchoscopy.

Aged↗
PubMed1985

Comparison of alfentanil and fentanyl as supplements to induction of anaesthesia with thiopentone.

In 120 premedicated patients undergoing general surgery, anaesthesia was induced with thiopentone 3 mg kg-1, preceded by alfentanil 4.5, 9.0 or 13.5 micrograms kg-1 or fentanyl 1.5 micrograms kg-1. The largest alfentanil dose attenuated the arterial blood pressure response to laryngoscopy and intubation better than the smaller doses of alfentanil. Changes in frontal muscle electromyogram or plasma cortisol and prolactin levels were not dependent on the adjuvant used. After thiopentone, 30, 7 and 17% of the patients given alfentanil 9.0 and 13.5 micrograms kg-1 and fentanyl 1.5 micrograms kg-1, respectively, reacted to pinching of the lower abdomen. Patients given alfentanil 4.5 micrograms kg-1 did not tolerate the endotracheal tube after recovery from suxamethonium block and their heart rate was increased 12 min after alfentanil administration. We conclude that the antinociceptive effect of alfentanil is distinctly shorter than that of fentanyl. The analgesic potency of alfentanil is between one sixth and one ninth of that of fentanyl.

Adult↗
PubMed1985

Effect of a small dose of droperidol on nausea, vomiting and recovery after outpatient enflurane anaesthesia.

Young, healthy outpatients (100) undergoing restorative dentistry and/or oral surgery under enfluranenitrous oxide-oxygen anaesthesia were given 0.014 mg/kg of droperidol or a saline placebo i.v. in a double-blind random fashion 5 min after induction of anaesthesia to prevent postoperative nausea and vomiting. Overall, less patients given droperidol were nauseated (18%) or vomited (7%) in comparison with patients given saline (27% and 11%, respectively). During the first postoperative hour, 4% of patients given droperidol were nauseated and 2% vomited, whereas 16% of patients given saline were nauseated and 6% vomited. Four patients given saline were not discharged from the clinic 1 h after anaesthesia owing to prolonged nausea and vomiting. The time elapsed until the patients were oriented as to time and place after cessation of enflurane and nitrous oxide administration was similar in both groups (mean +/- s.d., 13.5 +/- 4.7 min). Thirty minutes after anaesthesia, the ability to walk on a straight line was significantly (P less than 0.001) worse in patients given droperidol as compared to patients given saline. After 60 min, only one patient given droperidol and four patients who received saline and vomited took side steps or were unable to walk. Psychomotor performance was significantly (P less than 0.05) better in a perceptual speed test both 30 and 60 min after anaesthesia in patients receiving saline as compared to those given droperidol. It is concluded that although droperidol is a less effective antiemetic after outpatient than after inpatient enflurane anaesthesia, small doses of droperidol may be used for outpatients prone to vomiting to prevent delayed discharge from the clinic due to prolonged vomiting.

Adult↗