Search PubMed⌕ Search

Biomedical subjects

K Korttila

Publications and source records attributed to K Korttila.

At least 109 records · Page 6Linked to original sources
PubMed1981

The influence of intramuscularly administered pethidine on the amnesic effects of intravenous diazepam during intravenous regional anaesthesia.

Patients undergoing surgery under regional anaesthesia often receive narcotic analgesics for premedication which may modify the sedative and amnesic effects of intravenously administered diazepam. Sixty-two patients scheduled for upper extremity surgery under intravenous regional anaesthesia received 0.15 mg/kg of diazepam intravenously to supplement the local anaesthesia. Thirty-two of the patients received 0.01 mg/kg of atropine plus 1 mg/kg of pethidine and 30 patients only atropine intramuscularly approximately 1 h before injection of diazepam. Another 30 patients received the same atropine-pethidine premedication and saline intravenously, and served as a reference group. Atropine-pethidine premedication followed by saline did not produce any amnesic effects. Sixty-nine and 38% of patients receiving atropine-pethidine premedication followed by diazepam did not remember a picture shown to them 15 min after diazepam injection or the performance of operation, respectively, the respective figures for patients given atropine premedication followed by diazepam being only 23% and 0% (P less than 0.01 - 0.001 between groups). The anti-recall of painful stimulus (exanguination) was significantly (P less than 0.01) more common when diazepam was given after pethidine premedication (31%) when compared to its injection after atropine alone (7%). The drowsiness produced by the drugs was greatest and the overall patient acceptability of the technique used most satisfactory when pethidine was used for premedication and diazepam for sedation. It is concluded that intramuscularly administered pethidine potentiates the amnesic action of intravenous diazepam for painful stimuli, prolongs the amnesic action of diazepam for visual stimuli and improves the patients' acceptability of intravenous regional anesthesia supplemented by intravenous diazepam.

Adult↗
PubMed1981

Recovery and driving after brief anaesthesia.

It seems clear that patients should always be escorted when leaving the hospital after brief anaesthesia. The length of hospital stay should be based on the patient's test performance as well as on the supposed effects of the drugs on psychomotor performance. Minimal requirements for safe discharge should, in addition to stable vital signs and the ability to maintain oral fluids, include that patients are able to dress themselves and able to walk out. Recommendations not to drive should be based on the extent of the impairment of performance when assessed at the hospital, as well as on documented objective knowledge of the residual effects of the drugs used. In most cases patients should refrain from driving for at least 24 hours after anaesthesia.

Anesthesia↗
PubMed1980

Tofisopam, a novel 3,4-benzodiazepine: multiple-dose effects on psychomotor skills and memory. Comparison with diazepam and interactions with ethanol.

Twelve healthy male volunteers were treated (double-blind crossover design) with tofisopam (a new 3,4-benzodiazepine), diazepam, or placebo, on 2 consecutive days each. Psychomotor skills were impaired after a single dose of diazepam (10 mg) given on day 1. Measurements on day 2 showed that some tolerance had developed to the diazepam-induced impairment of reactive and coordinative skills, but not to its effects on flicker fusion or on the extraocular muscle balance. Tofisopam failed to impair performance both as a single dose (100 mg) and after repeated doses (100 + 50 + 50 + 100 mg). The subjects felt more fatigue, dizziness, calmness, and passiveness after diazepam than after tofisopam. When either drug was given together with 0.8 g/kg ethanol on day 2, the breath ethanol concentrations were 0.7--1.0 mg/ml and all psychomotor skills were impaired. Diazepam + ethanol particularly impaired memory and learning as well. After this combination the subjects were classified (time anticipation test) as 'disqualified drivers' more often than after placebo. It is concluded that diazepam, as well as either benzodiazepine with ethanol, may reduce the ability to drive vehicles or operate machinery.

Administration, Oral↗
PubMed1980

Comparison of i.m. lysine acetylsalicylate and oxycodone in the treatment of pain after operation.

Lysine acetylsalicylate (LAS) is a soluble salt of acetylsalicylic acid and can be given parenterally. LAS 12.5 mg kg-1 and 25 mg kg-1 were compared with oxycodone 0.15 mg kg-1 in the treatment of pain after operation in 60 patients undergoing varicose vein surgery. Both treatments almost completely relieved moderate to severe pain for the 3-h observation period. The time until the peak of action was longer after LAS (60-90 min) than after oxycodone (30-60 min). No significant differences were found between the smaller and larger doses of LAS, suggesting a plateau effect. Further clinical experiments with LAS using i.v. mode of administration and other pain models are warranted.

Adult↗
PubMed1980

Reduction of the risk of acid pulmonary aspiration in anaesthetized patients after cimetidine premedication.

Forty-two patients undergoing elective general surgery received either placebo, cimetidine 300 mg, or cimetidine 600 mg orally 1.5-2 h before anaesthesia in a double-blind, randomized study. Another 13 subjects received no oral premedication and served as a control group. When compared to placebo or control patients, both doses of cimetidine significantly (P less than 0.01) decreased the acidity and volume of gastric contents. None of the subjects given cimetidine were in the risk range of acid pulmonary aspiration (pH under 2.5 plus volume over 25 ml), whereas 46% of the control patients and 40% of the patients given placebo (P less than 0.005 vs cimetidine in both groups) were in the risk range.

Administration, Oral↗
PubMed1980

The role of thiopental and fentanyl in the production of balanced anaesthesia.

In order to clarify the interactions between various doses of thiopental and fentanyl in producing "balanced anaesthesia", their effects on consciousness, superficial nociception, and respiration and circulation were studied during N2O+O2 inhalation in connection with the induction of anaesthesia. Altogether 60 patients were studied; the drug combinations used were thiopental 5 mg/kg (TP5), thipental 3 mg/kg (TP3), thiopental 3 mg/kg and fentanyl 0.5 micrograms/kg (TP3F0.5), thiopental 2 mg/kg and fentanyl 1 micrograms/kg (TP2F1), thiopental 1 mg/kg and fentanyl 2 micrograms/kg (TP1F2), and fentanyl 3 micrograms/kg (F3). Five minutes after the i.v. supplementation of N2O+O2 anaesthesia, the depth of anaesthesia and analgesia (antinociception) were evaluated from the eyelid reflex and by pinching an inguinal skin fold. Cardiorespiratory parameters were measured during this study period at 1-min intervals. The balance between antinociception and anaesthesia was closest to optimum in groups TP2F1 and TP2F0.5. In pure thiopental groups, the analgesia was poor; only four patients did not respond to the nociceptive stimulus, whereas in group F3 anaesthesia (disappearance of the eyelid reflex) was obtained in only two patients. The respiratory depression was most pronounced in groups receiving 3, 2 and 1 micrograms/kg fentanyl and weakest in groups where only thiopental was used. Blood pressure decreased in all groups but no statistically significant differences were noted. On the basis of the results it seems obvious that attempts to achieve what is called "balanced anaesthesia" by the supplementation of an N2O+O2 mixture with fentanyl only leads to an unnecessarily prnounced respiratory depression, whereas supplementation with thiopental alone does not offer adequate antinociception.

Adult↗
PubMed1980

The role of diazepam and fentanyl in the production of balanced anaesthesia.

The effects of diazepam-fentanyl combinations on consciousness, superficial nociception, respiration and circulation during N2O+O2 inhalation were studied in 40 premedicated patients during induction of anaesthesia. The balance between antinociception and anaesthesia was closest to the optimum in patients receiving 0.2 mg/kg of diazepam plus 1 micrograms/kg of fentanyl; the eyelid reflex was negative in all patients and only two out of ten patients reacted to abdominal pinching. When only 0.2 mg/kg of diazepam was given with N2O+O2, the eyelid reflex was negative in all patients, but half of them reacted to pinching. When the dose of diazepam was reduced to 0.1 mg/kg and patients received 1 or 2 micrograms/kg of fentanyl, the balance between anaesthesia and antinociception was good, but 30-50% of patients had a positive eyelid reflex and reacted to pinching. No distinct respiratory depression was observed in patients given 0.2 mg/kg of diazepam, whereas seven patients given 0.1mg/kg of diazepam plus 2 micrrograms/kg of fentanyl had apnoea lasting more than 60 s associated with a significant (P less than 0.05-0.001) increase in end-tidal CO2 and PCO2 in arterialised venous blood. No significant changes were observed in blood pressure or heart rate after any of the drug combinations studied. It appears that an optimal balance between anaesthesia and antinociception with minimal side-effects during balanced general anaesthesia requires reinforcement of N2O+O2 anaesthesia not only with fentanyl but also with hypnotics for sedatives.

Adult↗
PubMed1980

Venous complications after intravenous injection of diazepam, flunitrazepam, thiopentone and etomidate.

The occurrence of phlebitis, thrombosis, and thrombophlebitis after intravenous premedication with diazepam (0.15 mg/kg) dissolved in propylene glycol (Valium) or in polyethylene glycol (Diapam) or flunitrazepam (0.0125 mg/kg), and after intravenous induction of balanced general anaesthesia with thiopentone (4.0 mg/kg) or etomidate (0.3 mg/kg) was studied on the 7th and 14th postoperative days in 115 patients undergoing short-stay varicose vein surgery. Venous complications occurred most frequently after etomidate (43% at 14 days), thiopentone (23% at 14 days), and Valium (21% at 7 days). Diapam caused fewer venous sequelae (9% at 14 days) than Valium (18% at 14 days), but the smallest number of complications were noticed after flunitrazepam (8% at 7 days and none at 14 days). Venous sequelae were more severe and more extended after thiopentone and after etomidate than those after the diazepam preparations. It is concluded that venous complications after flunitrazepam premedication were mild and infrequent and that the incidence of such complications was unacceptably high after etomidate induction.

Adult↗
PubMed1980

Failure of intramuscularly administered lorazepam and scopolamine-morphine premedication to produce amnesic effects to supplement conduction anaesthesia.

Patients undergoing surgery under regional anaesthesia often prefer to be sedated and do not later want to recall the procedure. One hundred and twenty-one patients scheduled for various surgical procedures under epidural, spinal, sacral, or brachial plexus blockades received 1 mg/kg of pethidine, 0.007 mg/kg of scopolamine, plus 0.14 mg/kg of morphine, or 0.03 mg/kg or 0.06 mg/kg or lorazepam intramuscularly as preanaesthetic medication before the operation. The patients's self-assessments of degree of fatigue and apprehension were similar after each premedication when assessed before operation. Postoperative anxiety and confusion as well as need for postoperative care and supervision were greatest after 0.06mg/kg of lorazepam. Significantly (P smaller than 0.05 to P smaller than 0.01) fewer patients given 0.06 mg/kg or lorazepam remembered different events and procedures carried out on them before and after operation than those given other premedications, but no significant differences were noted in patients' ability to recall the performance of operation when asked on the following day. Seventy-seven, 63, and 57% of patients receiving 0.06 mg/kg of lorazepam remembered the start of blockade, performance of operation, and stay in recovery room, respectively. Intravenous sedation should be preferred to these intramuscularly administered premedications if drug-induced amnesia is sought to supplement local anaesthetic techniques.

Adult↗
PubMed1980

Comparison of lysine acetylsalicylate and oxycodone in postoperative pain following upper abdominal surgery.

Intravenous lysine acetylsalicylate (LAS) and oxycodone were compared under double-blind conditions for analgesia after upper abdominal surgery in sixty patients anaesthetized by N2O--O2--halothane--relaxant technique. Either 125 mg/10 kg or 250 mg/10 kg LAS or 0.4 mg/10 kg or 0.8 mg/10 kg oxycodone was randomly administered when the patients complained of moderate or severe postoperative pain. When 30 min had elapsed following the injection of the test drug, oxycodone was given in 4 mg increments on demand until adequate pain relief was achieved. At 15 min postdrug, the lower dose of LAS offered significantly less pain relief than all other test drugs. At 30 min, the effect of the higher dose of LAS reached almost the analgesic level of the higher dose of oxycodone but only the latter provided significantly (P less than 0.05) better analgesia than the low dose of LAS. About 50% less additional narcotic supplementation was demanded following higher doses of both drugs when compared to lower ones. LAS 250 mg/10 kg (c. 1.8 g/70 kg) was found approximately equipotent to oxycodone 0.8 mg/10 kg (c. 6 mg/70 kg). However, LAS had a slower onset of action. Sweating seemed to occur more frequently after LAS than oxycodone, but significant changes in respiratory rate or sedation following LAS-oxycodone combinations when compared to oxycodone alone were not noted. The results show that for analgesia after upper abdominal surgery, 1.8 g of LAS may be substituted for about 6 mg of oxycodone.

Abdomen↗
PubMed1979

Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia.

In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. No pain was experienced by patients receiving thiopentone. The frequency of involuntary movement was 15-35% with etomidate and 15% with thiopentone. The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.

Adult↗
PubMed1979

Importance of using proper techniques to teach cardiopulmonary resuscitation to laymen.

Immediate attempts to resuscitate patients with cardiac arrest by lay bystanders distinctly increase the chances of survival in such patients. In the present study we investigated possibilities of intensifying the cardiopulmonary resuscitation (CPR) training of laymen. A group of 46 young conscripts (test group) was given 2 hours of CPR instruction in what was considered the most efficient way. The procedures included showing a film on the theory and practice of CPR, a discussion of the film, and then 3 to 5 min instructed individual practice with a recording manikin. Another 56 conscripts participated in a 1-h illustrated lecture on CPR, which was followed by group training with a non-recording manikin; they served as a reference group. The performance of the subjects in CPR was measured with a recording manikin before and 2 months after the training. Before training, none of the subjects passed the surprise resuscitation test. After training, the skills of 62% of the subjects in the test group were acceptable according to original criteria for lay public, and 28% passed the test according to the strict criteria for medical personnel. The less intensive training given to the reference group did not improve the acceptability of resuscitation. It is concluded that CPR training for laymen may lead to failure to attain an adequate level of skill. Proper training techniques and equipment are important, but even their use does not guarantee that an adequate level of CPR performance will be attained by all laymen if their skills are not later refreshed.

Adult↗
PubMed1979

Increased serum concentrations of lactic, pyruvic and uric acid and bilibubin after postoperative xylitol infusion.

Xylitol has been suggested as a more advantageous calory source for intravenous administration than glucose in certain clinical situation, but the general suitability of intravenous xylitol infusion has not been confirmed. Thirty-middle-aged women were infused with 100 g of xylitol as postoperative fluid therapy after gynaecological laparotomy and general anaesthesia. Another 10 women received 50 g of glucose in a similar manner and served as a reference group. Infusion of xylitol both at the rate of 0.25 g/kg/h (1000 ml 10% xylitol in approx. 8 h) and 0.5 g/kg/h (1000 ml 10% xylitol in approx. 4 h) caused a distinct increase in the serum concentrations of lactic acid, pyruvic acid, and uric acid; such an increase was not seen with glucose infusion. The faster infusion of xylitol also distinctly increased serum bilirubin concentrations. Because of the possibility of lactic acidosis and urate deposits in kidneys, infusion of 100 g or more of xylitol at a rate of 0.25 g/kg/h or faster is not safe for postoperative fluid therapy in routine clinical work.

Anesthesia, General↗
PubMed1978

Effect of age on amnesia and sedation induced by flunitrazepam during local anaesthesia for bronchoscopy.

Bronchoscopy was undertaken in 79 outpatients using local anaesthesia plus an i.v. injection of flunitrazepam 0.01 mg kg-1. The co-operation of the patients and the ease of bronchoscopy were good regardless of the age of the patient. There was an increase in amnesia for the bronchoscopy with increasing age, but the most distinct difference between different age groups was that the amnesic action of flunitrazepam was evident earlier and persisted longer in patients of more than 60 yr. Eye co-ordination and ability to stand steadily and walk on a line returned to normal more slowly in patients more than 60 than in those less than 60 yr, but no differences in recovery were noted between patients less than 40 and those of 40--59 yr, or between those 60--69 and those more than 70 yr.

Adult↗
PubMed1978

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

Diazepam and flunitrazepam were compared as amnesic and sedative adjuncts to local anaesthesia for diagnostic bronchoscopy in 92 patients. After local anaesthesia of the pharynx, larynx and trachea with lignocaine, atropine plus diazepam of flunitrazepam was injected i.v. The co-operation of the patients and the technical circumstances under which the bronchoscopy was performed were good in each group. None of the treatments significantly modified arterial pressure or heart rate. Two hours after the injection, flunitrazepam 0.01 mg kg-1 more frequently caused amnesia for pictures shown to the patients during the first 15 min after injection (failure to recall 42--75%, and for bronchoscopy 67%), than did diazepam 0.125 mg kg-1 (failure to recall 21--67%; bronchoscopy 38%). Double doses of the drugs caused amnesic actions similar to those of flunitrazepam 0.01 mg kg-1. When failure to recall was assessed on the following day, 29% and 5% of the patients remembered bronchoscopy after flunitrazepam 0.01 and 0.02 mg kg-1 respectively; after diazepam 0.125 and 0.25 mg kg-1 the corresponding percentages was 59% and 30% (P less than 0.05% v. fluintrazepam). The ability to stand and walk on a stright line was similar after the smaller doses of both drugs, but after the larger doses recovery was slower after flunitrazepam. Psychomotor performance was still distinctly impaired 2 h after the injection of the larger doses.

Adult↗
PubMed1978

Operating room nurses' psychomotor and driving skills after occupational exposure to halothane and nitrous oxide.

Concentrations of halothane and nitrous oxide were assayed by gas chromatography throughout a working day in three operating theatres and in the end-tidal air of 19 nurses 15 and 60 min after leaving the theatres. Perceptual, psychomotor and driving skills were measured in these nurses and in 11 younger nurses working in the wards of the same hospital. A complicated psychomotor test battery and a driving simulator were used. End-tidal air concentrations of halothane and nitrous oxide were positively correlated with the exposure level of these gases in the operating theatres. Some of the operating room nurses had greater amounts of halothane in their end-tidal air (average 15 to 10 ppm) than student volunteers 4.5 h after 3.5 min of general anaesthesia with a combination of halothanenitrous-oxide oxygen (10 ppm halothane). These volunteers had worse psychomotor and driving performances when measured than controls who had not been anaesthetized. No correlations were found between the concentrations of halothane or nitrous oxide in end-tidal air and psychomotor or driving performance. Despite their higher age and exposure to the operating room environment, the driving skills of the operating room nurses were similar to those of the ward nurses. The results suggest that tolerance to anaesthetic gases develops among operating room personnel. No impairment of driving skills can be expected after daily exposure to halothan and nitrous oxide among long-term employees in operating theatres.

Air Pollutants↗
PubMed1978

Effect of pain on human psychomotor performance.

The effect of pain on human psychomotor performance was measured in seven healthy volunteers after an intramuscular injection of vitamin B or saline using a controlled cross-over method. Vitamin B, causing moderate to severe pain, or painless saline was injected into the buttock at a time when the subjects' performance was impaired after an intravenous injection of diazepam (0.3 mg/kg). The subjects' psychomotor performance was tested before and 2, 3, and 4 h after diazepam (before, 15 min, and 1 h 15 min after the vitamin B and saline injections). The effects of the vitamin B injection on the subjects' divided attention, reaction or co-ordination skills or their ability to discriminate the fusion of flickering light did not differ from the corresponding effects of the saline injection. The results suggest that pain as such does not have any major influence on human psychomotor performance.

Adult↗