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Biomedical subjects

L Saarnivaara

Publications and source records attributed to L Saarnivaara.

At least 55 records · Page 3Linked to original sources
PubMed1985

Cardiovascular responses to tracheal intubation in small children. Effects of the induction of anaesthesia with halothane.

Cardiovascular changes in 27 children (mean age 1.5 yr) were studied during the induction of anaesthesia with 2.5% halothane and 70% nitrous oxide in oxygen. The eyelash reflex disappeared in a mean of 62 +/- 3.6 (SEM)s and tracheal intubation could be performed 4.9 +/- 0.2 min after the start of halothane anaesthesia. Intubating conditions were satisfactory in 85% of the children. Systolic arterial pressure increased by 10.8 +/- 1.9 mm Hg and diastolic pressures by 6.0 +/- 1.4 (SEM) mm Hg after intubation of the trachea. Heart rate decreased significantly after induction. No cardiac arrhythmias were noted. There were no significant changes in Q-T interval after induction, after intubation or during the later course of the anaesthetic.

Anesthesia, Inhalation↗
PubMed1985

Comparison of pharmacokinetic and pharmacodynamic parameters following oral or intramuscular atropine in children. Atropine overdose in two small children.

Pharmacokinetic and pharmacodynamic parameters of atropine 0.03 mg/kg p.o. or 0.02 mg/kg i.m. were compared in a double-blind study in 20 children with a mean age of 5.1 years undergoing otolaryngological surgery, mostly adenotomy. Outside the study protocol, two small children accidentally received an overdose of atropine 0.3 mg/kg p.o. In addition to atropine, all children received triclofos 70 mg/kg p.o. Following p.o. administration of atropine, the mean maximum serum concentration of 6.7 nmol/l occurred at 2 h. The corresponding result after i.m. administration was 5.7 nmol/l at 0.5 h. Serum concentrations of atropine were 3.5 and 1.3 nmol/l 8 h after p.o. and i.m. administration, respectively. At 70 min the anti-sialogogue effect was clinically satisfactory after both modes of administration. The heart rate increased statistically significantly only after i.m. administration. The mean maximum rise in the rectal temperature before the start of anaesthesia occurred at 1 h and was 0.5 degrees C in the p.o. group and 0.7 degrees C in the i.m. group. The flush phenomenon, mostly on the face and sometimes also on the chest, occurred in both groups, being more intense in the i.m. group than in the p.o. group. The children who developed flush had a statistically significantly higher rise in rectal temperature than the children without flush. There was a positive but weak correlation between the serum concentration of atropine and the heart rate, whereas the correlation between the serum concentration after i.m. atropine and the rectal temperature was weakly negative. On the basis of the present study, there were no decisive differences between the effects and side-effects of the two modes of administration of atropine.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1985

Comparison of adrenaline and phenylephrine in out-of-hospital cardiopulmonary resuscitation. A double-blind study.

Phenylephrine, a strong alpha-adrenergic receptor-stimulating agent, was compared with adrenaline in 65 patients with out-of-hospital cardiac arrest, in a double-blind study. The resuscitation was performed by the physician-staffed Prehospital Emergency Care Unit of Helsinki University Central Hospital. The patients received either 1.0 mg of phenylephrine or 0.5 mg of adrenaline i.v. in the treatment of fine ventricular fibrillation, asystole or electromechanical dissociation. If two doses of either drug did not restore circulation, 0.5 mg of known 0.01% adrenaline was given i.v., maximally twice. In the adrenaline group, which consisted of 36 patients with a mean age of 61 years, 10 patients (28%) were successfully resuscitated. The phenylephrine group consisted of 29 patients with a mean age of 62 years. In this group nine patients (31%) were successfully resuscitated. The two groups were comparable regarding their apnoea-times, and there was no difference in the need for extra adrenaline between the groups. No adverse effects, such as hypertension or bradycardia, were noted in the patients treated with either adrenaline or phenylephrine, nor did the overall rate of successful resuscitation fall during the test period. It is concluded that phenylephrine seems as effective as adrenaline in the treatment of cardiac arrest, but further studies seem warranted.

Adult↗
PubMed1985

Comparison of paracetamol and aminophenazone plus diazepam suppositories for anxiety and pain relief after tonsillectomy in children.

The anxiety and pain-relieving effect of paracetamol 10 mg/kg or a combination of aminophenazone 4 mg/kg and diazepam 0.2 mg/kg suppositories was studied in 82 children after tonsillectomy in a double-blind study. Both suppositories were studied after halothane or enflurane anaesthesia. At 30 min after administration of coded suppositories, 88-90% of the children in various groups needed extra analgesics, and received pethidine 0.5 mg/kg i.v. Thereafter, the anxiety and pain relief was satisfactory in all groups. There was no significant difference between the effects caused by the drugs. No bleeding occurred from the operation site in any of the study groups. The results suggest that both paracetamol and a combination of aminophenazone and diazepam in the doses used here were weak analgesics for throat pain after tonsillectomy in children during the early postoperative period.

Acetaminophen↗
PubMed1984

Comparison of paracetamol and pentazocine suppositories for pain relief after tonsillectomy in adults.

The pain-relieving effect of paracetamol 500 mg or pentazocine 50 mg suppositories was studied in 91 voluntary adult patients after tonsillectomy in halothane or enflurane anaesthesia. Both suppositories were studied after both anaesthetics. Thus the patients were randomly allocated to four study groups. At 60 min after administration of coded suppositories, 46-50% of the patients in various groups needed extra analgesic and received pethidine 1 mg/kg i.m. Thereafter, the pain relief was satisfactory in all groups until the end of the observation period (120 min). The incidence of vomiting, the most common side effect, ranged from 5 to 14% in the groups. Bleeding from the operation site was most common (14%) in the patients treated with pentazocine after enflurane anaesthesia and did not occur in the patients treated with pentazocine after halothane anaesthesia. The incidence of bleeding in both paracetamol groups was 9%. In all cases, bleeding stopped without any special treatment. The results suggest that both paracetamol 500 mg and pentazocine 50 mg suppositories in the doses used were weak analgesics for throat pain after tonsillectomy in adults in the early postoperative period. The incidence of side effects was relatively low.

Acetaminophen↗
PubMed1984

Comparison of halothane and enflurane anaesthesia for tonsillectomy in adults.

Halothane and enflurane in combination with N2O/O2 were compared in 103 adults undergoing tonsillectomy. Anaesthesia was induced with thiopental, and intubation was facilitated with suxamethonium. During halothane anaesthesia the mean heart rate ranged from 91 to 106 beats/min and the mean systolic arterial pressure from 111 to 127 mmHg. The values did not differ significantly from the corresponding values during enflurane anaesthesia. Electrocardiographic changes occurred in 56% and 31% of the patients anaesthetized with halothane or enflurane, respectively. the incidence of junctional rhythm, the most common ECG change, was 46% in the halothane group and 29% in the enflurane group. 19% of the patients in the halothane group and 31% in the enflurane group responded to surgical stimulus by swallowing or coughing. The responses were mostly short-lasting and did not much disturb the surgeon. The incidence of laryngospasm was 6% after halothane and 2% after enflurane anaesthesia. The mean total recovery score (0-10) was 6.1 after halothane and 6.3 after enflurane at arrival in the recovery room and 9.8 in both groups 30 min later. After halothane, nausea and vomiting occurred in 8 and 12% of the patients, respectively. The corresponding figures after enflurane were 2 and 8%. It is concluded that both halothane and enflurane are suitable anaesthetics for tonsillectomy in adults. The most striking difference between the anaesthetics was the significantly more common occurrence of ECG changes during halothane than enflurane anaesthesia.

Adult↗
PubMed1984

Comparison of three hypotensive anaesthetic methods for middle ear microsurgery.

Three hypotensive anaesthetic methods were compared in 123 patients undergoing middle ear microsurgery. Hypotension was induced with halothane (1 vol.%), nitroprusside (4.4 micrograms/kg/min) or the combination of halothane (0.5 vol.%) and nitroprusside (1.2 micrograms/kg/min). The compensatory rise in the heart rate was controlled with a beta-adrenergic receptor blocking agent, practolol, the mean need for which was 0.03 mg/kg in the halothane group and 0.1 mg/kg in the other groups. The mean duration of the hypotensive period ranged from 79 to 107 min in the groups. During the hypotension, the average mean arterial pressure ranged from 55 to 60 mmHg (7.33 to 8.00 kPa) and the mean heart rate from 67 to 79 beats/min in the groups. The PaO2 value in the nitroprusside and halothane + nitroprusside groups, but not in the halothane group, decreased statistically and in some cases clinically significantly. The only peroperative side effects were ECG changes (mostly junctional rhythm), the incidence of which ranged from 16 to 24% in the groups. The mean values for the degree of haemostasis rated by the otologist on a visual analogue scale between poor (0 mm) and excellent (100 mm) were 90, 73 and 89 mm in the halothane, nitroprusside and halothane + nitroprusside groups, respectively. Recovery in the halothane group was statistically highly significantly longer than in the other groups. No rebound hypertension occurred in any of the groups after discontinuation of the hypotension. The most common side effect was nausea + vomiting, the incidence of which ranged from 15 to 26% in the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1984

Effects of practolol and metoprolol on QT interval, heart rate and arterial pressure during induction of anaesthesia.

The effects of the selective beta 1-adrenergic receptor blocking agents, practolol with intrinsic sympathetic activity (ISA) and metoprolol without ISA, were studied on QT interval, heart rate, arterial pressure and cardiac arrhythmias during the induction of anaesthesia in 142 adults. In the control group, the QT interval was statistically significantly prolonged after thiopental, and the most marked prolongation occurred after suxamethonium. Neither practolol nor metoprolol alone affected the QT interval. Practolol 100 micrograms/kg i.v., but not 40 or 150 micrograms/kg i.v., almost completely reduced the prolongation of the QT interval after suxamethonium. In all doses of 20, 30 and 40 micrograms/kg i.v. metoprolol statistically significantly and dose-dependently reduced the prolongation of the QT interval after thiopental, suxamethonium and laryngoscopy, but the prolongation of the QT interval after intubation still occurred. Practolol and metoprolol alone statistically significantly reduced heart rate, but did not prevent the increase of heart rate after thiopental. The effects on arterial pressure were minimal. Neither practolol nor metoprolol prevented the cardiovascular intubation response. Ventricular ectopic beats after intubation occurred in 20% of the patients in the control group and their incidence ranged from 20 to 27% in the groups pretreated with practolol or metoprolol 20 micrograms/kg. In the groups pretreated with metoprolol 30 or 40 micrograms/kg, ventricular ectopic beats occurred in 5% and 8%, respectively. It is concluded that the selective beta 1-adrenergic receptor blocking agents practolol with ISA, and especially metoprolol without ISA, reduced the prolongation of the QT interval after suxamethonium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Cardiovascular responses to enflurane induction followed by suxamethonium in children.

Induction of anaesthesia with enflurane 5 vol% plus 70% nitrous oxide in oxygen was followed by suxamethonium 1, 1.5 or 2 mg kg-1 i.v. and the cardiovascular changes studied in 58 children. The eyelash reflex disappeared in 44 +/- 1.2 (SEM)s and the venepuncture could be performed 1.8 +/- 0.05 (SEM) min after the start of enflurane anaesthesia. The increase in systolic arterial pressure after tracheal intubation was less marked after enflurane than after thiopentone (taken from an earlier study). Heart rate increased significantly after all doses of suxamethonium, but no cardiac arrhythmias were seen. The QT interval was significantly prolonged by enflurane (P less than 0.001), but remained unchanged after suxamethonium.

Anesthesia, Inhalation↗
PubMed1983

Effect of competitive myoneural blockade and fentanyl on muscle fasciculation caused by suxamethonium in children.

The effects of tubocurarine 0.06 mg kg-1, alcuronium 0.03 mg kg-1, pancuronium 0.01 mg kg-1, and fentanyl 1 or 2 micrograms kg-1 on the muscle fasciculations associated with suxamethonium were studied in 171 children undergoing otolaryngological surgery. The mean fasciculation index in all pretreatment groups was significantly smaller than in the control group. The most effective pretreatment was fentanyl 2 micrograms kg-1 followed, in order, by alcuronium, fentanyl 1 microgram kg-1, tubocurarine and pancuronium. The rate of the onset of the fasciculations after the injection of suxamethonium ranged from 8 s after pancuronium to 20 s after tubocurarine. There was evidence of respiratory depression in the children receiving fentanyl 2 micrograms kg-1 if the duration of anaesthesia was less than 30 min.

Child↗
PubMed1983

Ketamine anaesthesia for a patient with the Shy-Dräger syndrome.

A 58-year-old man with the Shy-Dräger syndrome underwent laryngo- and tracheoscopies in general anaesthesia for evaluation of the larynx after tracheostomy following bilateral vocal cord paralysis. A profound fall in arterial pressure during anaesthesia induced with thiopentone has been demonstrated in previously reported patients with the Shy-Dräger syndrome. In the present patient, anaesthesia induced with ketamine, maintained with nitrous oxide in oxygen and supplemented with fentanyl, diazepam and suxamethonium did not cause a fall in arterial pressure.

Anesthesia, General↗
PubMed1983

Prolongation of QT interval during induction of anaesthesia.

QT interval was studied in 156 adults and in 127 children during the induction of anaesthesia. Both in adults and in children, QT interval was prolonged statistically significantly after thiopentone 5 mg/kg and the most marked prolongation occurred after suxamethonium 1 to 1.5 mg/kg. In adults, d-tubocurarine 0.06 mg/kg, but not alcuronium 0.03 mg/kg or pancuronium 0.01 mg/kg, prevented statistically significantly the prolongation of the QT interval after suxamethonium 1.5 mg/kg. In children, all three muscle relaxants prevented statistically significantly the effect of suxamethonium 2 mg/kg and pancuronium also prevented the effect of thiopentone. The most common ECG changes were ventricular ectopic beats (VEB) which occurred in 26% of the adults and in 22% of the children who were not pretreated with the muscle relaxants. After pretreatment with d-tubocurarine, the incidence of VEB was 3% in both groups. In adults, alcuronium was as effective as d-tubocurarine in the prevention of VEB but in the alcuronium group supraventricular ectopic beats and junctional rhythm occurred in 6% and 9% of the patients, respectively. Pancuronium did not significantly prevent the incidence of VEB. On the basis of the present results, d-tubocurarine is the relaxant of choice for the prevention of the prolongation of QT interval as well as ECG changes during the induction of anaesthesia.

Adult↗
PubMed1983

The effect of instrumentation with a telescope during bronchoscopy on arterial oxygen tension and acid-base balance.

The effect of instrumentation with a telescope during bronchoscopy on the arterial oxygen tension and acid-base status was studied in 17 unselected, anaesthetized patients using a ventilating technique based on Sanders' method (1). After ventilating the patients with a bronchoscope and a telescope in the trachea, in the left main bronchus or in the right main bronchus, the PaO2 value was always statistically significantly higher than after ventilating only with a bronchoscope. During the course of the bronchoscopy as well as after 1 h in the recovery room, the arterial acid-base status was within normal limits and the mean PaO2 value during bronchoscopy ranged from 175 to 240 mmHg (23.3-31.9 kPa) and was 138 mmHg (18.4 kPa) in the recovery room when the patients breathed about 35% oxygen in air. The present results suggest that instrumentation with a telescope during bronchoscopy ameliorates rather than impairs the ventilation and oxygenation of the patients.

Acid-Base Equilibrium↗
PubMed1983

Attenuation of the cardiovascular intubation response with N2O, halothane or enflurane.

The circulatory intubation response was studied in 75 normotensive, otolaryngological patients after a thiopentone-suxamethonium induction followed by 2 min artificial ventilation with 100% oxygen (control), 70% nitrous oxide in oxygen (N2O), halothane 2% with N2O, enflurane 3% with N2O or enflurane 5% in oxygen. The above study groups (n = 15) were chosen after preliminary experiments performed in 25 different patients with halothane 2% (n = 8) or enflurane 3% (n = 6) in oxygen, which did not prevent the increase of arterial pressure after intubation, or with halothane 3% (n = 11) which attenuated the pressor response but caused cardiac arrhythmias in 55% of patients. Enflurane 5% in oxygen attenuated the increase of systolic arterial pressure by 53%, enflurane 3% with N2O by 34% and halothane 2% with N2O by 31%. The increase in heart rate after intubation was lowest in the halothane 2% with N2O group, but there were no statistically significant differences between the groups. Cardiac arrhythmias were commonest in the enflurane 3% with N2O group (20%) and they did not occur in the halothane 2% with N2O group. Considering the total effect on arterial pressure, heart rate and rate-pressure product, we recommend the combination of halothane 2% with N2O.

Adolescent↗
PubMed1980

Comparison of oral triclofos, diazepam and flunitrazepam as premedicants in children undergoing otolaryngological surgery.

Triclofos 70 mg kg-1, diazepam 0.25 mg kg-1 and flunitrazepam 0.02 mg kg-1 all in combination with atropine 0.03 mg kg-1 were compared as oral premedicants in 128 children undergoing otolaryngological surgery in a double-blind study. All drugs provided good anxiolysis in children 5 yr and older. In children less than 5 yr, the effects of triclofos were superior to those of diazepam and flunitrazepam. There was a positive correlation between anxiolysis and the ease of induction of anaesthesia. In both age groups, flunitrazepam prevented the fasciculations caused by suxamethonium more effectively than did diazepam or triclofos. The preinduction heart rate after triclofos was greater than after the other drugs and its antisialagogue effect was superior. The mean volume of gastric contents was 0.4 ml kg-1 for all the patients with no statistically significant difference between the groups. The mean pH of gastric contents was 4.5 after triclofos and 2.2 after other drugs. The serum concentration of both benzodiazepines in the older age group was greater than in the younger age group.

Administration, Oral↗