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P H Rosenberg

Publications and source records attributed to P H Rosenberg.

At least 19 recordsLinked to original sources
PubMed2006

Etoricoxib pre-medication combined with intra-operative subacromial block for pain after arthroscopic acromioplasty.

BACKGROUND: Arthroscopic shoulder surgery under general anaesthesia is often associated with severe post-operative pain which may delay discharge and the start of rehabilitation. Etoricoxib is a new cyclo-oxygenase-2 inhibitor with a long duration of action and a lack of a deteriorating effect on platelet function. Therefore, the effect of pre-operative etoricoxib combined with local anaesthesia on post-operative pain and the discharge profile was studied in day-surgery patients undergoing arthroscopic shoulder surgery under general anaesthesia. METHODS: Thirty ASA I-II adult patients scheduled for arthroscopic shoulder surgery were enrolled in this randomized prospective study. Half of the patients received etoricoxib 120 mg orally (group E) and the other half received placebo tablet orally (group C) 1 h before surgery. All patients received 20 ml of bupivacaine 2.5 mg/ml solution with epinephrine at the start of surgery and 20 ml of bupivacaine 5.0 mg/ml solution with epinephrine at the end of surgery into the subacromial space. All patients received general anaesthesia with spontaneous breathing via a laryngeal mask. In the post-anaesthesia care unit, pain was assessed on a scale from 0 to 10 (visual analogue scale, VAS) and intravenous fentanyl 25 microg was administered as scheduled (VAS > or = 3). In the day-surgery unit and at home, the analgesic was a tablet containing paracetamol 500 mg + codeine 30 mg (VAS > or = 3), as needed. RESULTS: Patients in group E reported lower post-operative pain scores at 30, 60, 120 (P < 0.01) and 180 min (P < 0.05) after surgery, and longer time to first analgesic use (P < 0.05). Patients in group E required less fentanyl (P < 0.05) and were discharged more quickly (P < 0.05) than patients in group C. Patients in group E had a lower cumulative consumption of paracetamol + codeine tablets (P < 0.05) and lower pain scores (P < 0.05) during 7 days at home than patients in group C. Adverse events were rare in both groups. CONCLUSION: In patients having arthroscopic shoulder surgery under general anaesthesia combined with intra-operative subacromial regional analgesia, etoricoxib 120 mg reduced immediate and late post-operative pain, and facilitated early post-operative discharge.

Adult↗
PubMed2006

Hyperbaric articaine for day-case spinal anaesthesia.

BACKGROUND: Articaine and lidocaine are clinically very similar suggesting that articaine could be suitable for day-case spinal anaesthesia. A dose-response study with articaine in ambulatory spinal anaesthesia was therefore performed. METHODS: In this randomized double-blind study, 90 day-case surgery patients received spinal anaesthesia with 60 mg (A60), 84 mg (A84) or 108 mg (A108) of hyperbaric articaine hydrochloride. Sensory block was tested with pinprick and motor block on a modified Bromage scale. A structured interview was performed on the first and seventh postoperative days. RESULTS: Sensory block reached the T10 dermatome in a median (range) of 5 (5-10) and was maintained at this level for 70 (35-145), 70 (15-115) and 85 (20-115) min in the A60, A84 and A108 groups, respectively. Six patients in the A108 group, two in the A84 group and one in the A60 group had maximum spread of analgesia to T(1) or higher (NS). Patients in the A108 group needed more medication for hypotension (P=0.018), had more often nausea and vomiting (P=0.027), took oral fluids later (P=0.031) and both sensory block recovery [median (range)] [2.5 (2-4.5) h] (P=0.017) and motor block recovery [2 (1.3-4) h] (P=0.009) were delayed. No patients in the A108 group needed opioid intraoperatively while fentanyl was needed in 5 (17%) and 2 (7%) patients in the A60 and A84 groups, respectively. Discharge criteria were attained in approximately 4.5 h after articaine injection (NS) and no drug-related sequelae were observed. CONCLUSIONS: Hyperbaric articaine 60 and 84 mg resulted in spinal anaesthesia allowing surgery of the lower extremities for about 1 h. Recovery was rapid. Use of 108 mg of articaine is not recommended because of frequent extensive cephalad spread of the block, accompanied by arterial hypotension and nausea.

Adult↗
PubMed2006

Continuous spinal microcatheter (28 gauge) technique for arterial bypass surgery of the lower extremities and comparison of ropivacaine with or without morphine for postoperative analgesia.

BACKGROUND: The aim of this study was to evaluate a microcatheter technique for continuous spinal anaesthesia (CSA) and continuous spinal postoperative analgesia (CSPA) in vascular surgery. METHODS: A total of 47 patients (range 51-95 yr, ASA II-IV) undergoing peripheral bypass surgery of the lower extremities received a spinal microcatheter (28 gauge) at L3-L4 or L2-L3. For CSA, ropivacaine 7.5 mg ml(-1) was given in small increments. Central venous pressure was maintained >or=3 mm Hg. Of 47 patients, 44 received CSPA, either using ropivacaine alone 2 mg h(-1) (group R, n=22) or ropivacaine 1 mg h(-1) with morphine 8 microg h(-1) (group RM, n=22) for 24 h after surgery (randomized, double-blinded). RESULTS: Intraoperative haemodynamic control was good; during the initial 60 min only four patients received phenylephrine i.v. for hypotension. Up to 30% of the patients felt mild pain at incision but surgery [mean duration 173 min (range 66-327)] was successfully completed under CSA in 45 patients. In four instances of acute revision surgery, a new block was administered utilizing the spinal catheter in place. Postoperative pain relief was comparably adequate in both groups with no difference in rescue pain medication. Four patients (three in R, one in RM) had weak motor blockade in the first postoperative morning. CONCLUSIONS: The described CSA technique offered good haemodynamic control, ease of maintaining spinal anaesthesia, and ease of providing a new spinal block for revision. The combination of low-dose ropivacaine and morphine for CSPA did not offer any benefit compared with the higher ropivacaine dose alone.

Aged↗
PubMed2006

Influence on platelet aggregation of i.v. parecoxib and acetaminophen in healthy volunteers.

BACKGROUND: Acetaminophen (paracetamol) alone or in combination with other analgesics is widely used for postoperative analgesia. While acetaminophen and non-steroidal anti-inflammatory drugs inhibit platelet function, the cyclooxygenase-2 (COX-2) selectively inhibiting coxibs show no interference with platelet function. The authors studied the effect of a combination of i.v. parecoxib and acetaminophen on platelet function in healthy volunteers. METHODS: Eighteen healthy, male volunteers (22-33 yr) received i.v. acetaminophen 1 g, parecoxib 40 mg+acetaminophen 1 g or placebo in a double-blind, crossover study. Platelet function was assessed by photometric aggregometry and by measuring the release of thromboxane B(2). Plasma acetaminophen concentrations were measured by high-performance liquid chromatography. RESULTS: Platelet aggregation (median area under the curve) triggered with arachidonic acid 500 microM was 24.6, 3.9 and 4.2x10(3) area units (P=0.02, all groups) after placebo, acetaminophen and parecoxib+acetaminophen, respectively. Inhibition of platelet aggregation showed no difference between acetaminophen alone and the combination (P=0.82). Aggregation triggered with arachidonic acid 750 or 1000 microM, adenosine diphosphate (ADP) 1.5 or 3 microM, or epinephrine 5 microM showed no differences between the groups. Release of thromboxane B(2) in response to ADP was inhibited similarly by both acetaminophen and the combination. Plasma acetaminophen concentrations were similar after acetaminophen and the combination. CONCLUSIONS: Acetaminophen and parecoxib showed no interaction in inhibiting platelet function. In combination they cause a mild degree of COX-1 inhibition corresponding to that of acetaminophen alone.

Acetaminophen↗
PubMed2006

Comparison of ropivacaine 2 mg ml(-1) and prilocaine 5 mg ml(-1) for i.v. regional anaesthesia in outpatient surgery.

BACKGROUND: Ropivacaine 2 mg ml(-1) (0.2%) provides longer-lasting analgesia after deflation of the tourniquet cuff, with fewer side-effects, than lidocaine 5 mg ml(-1) (0.5%) after i.v. regional anaesthesia (IVRA). Whether ropivacaine 2 mg ml(-1) also exerts this advantage over prilocaine 5 mg ml(-1), the local anaesthetic of choice in IVRA in most European countries was investigated in this study. METHODS: Sixty outpatients scheduled for forearm or hand surgery received IVRA with 40 ml of ropivacaine 2 mg ml(-1) (Ropi) or prilocaine 5 mg ml(-1) (Prilo) in a randomized, double-blinded fashion. The development and recovery of pin-prick analgesia and motor power of the hand, as well as ropivacaine and prilocaine plasma concentrations (n=30), were assessed during and after operation. RESULTS: Anaesthesia for surgery was adequate in both groups. Pin-prick analgesia was achieved at a similar rate, except in the radial nerve distribution area where at 10 min 60% of Ropi and 90% of Prilo patients had analgesia (P=0.017). At 10 min 100 and 97% had motor block of the hand in the Ropi and Prilo groups, respectively. Recovery of the sensory block in all innervation areas was already observed 2 min after the tourniquet cuff release. At 10 min after releasing the tourniquet cuff 31% of the Ropi patients and none of the Prilo patients still had analgesia in the median nerve distribution (P=0.004). At 12 min, 42% in the Ropi group and none in the Prilo group had decreased grip strength. After the release of the tourniquet, mean plasma concentrations of ropivacaine were higher than those of prilocaine. The highest individual concentration of ropivacaine was 1.65 microg ml(-1) and that of prilocaine 0.6 microg ml(-1). None of the Ropi patients experienced any symptoms of local anaesthetic toxicity. CONCLUSIONS: Compared with prilocaine 5 mg ml(-1), analgesia in IVRA with ropivacaine 2 mg ml(-1) developed slightly more slowly, while motor block developed at a similar rate. After the release of the tourniquet, sensation recovered quickly and at a similar rate in the two groups, except for a slightly slower recovery after ropivacaine in the innervation area of the median nerve, but no surgically useful extended analgesia after the cuff deflation was observed. Despite a 60% lower milligram-dose, ropivacaine plasma concentrations were markedly higher than those of prilocaine.

Adult↗
PubMed2006

Combination of hyperbaric lidocaine and ropivacaine in spinal anaesthesia for day surgery.

BACKGROUND AND OBJECTIVE: Motor function recovers rapidly but the extended duration of sensory block after spinal anaesthesia with hyperbaric ropivacaine may delay patients' ambulation after surgery. We tested whether compensating a reduction of the ropivacaine dose with a small dose of lidocaine would be adequate for surgery and shorten recovery from spinal anaesthesia. METHODS: Fifty-six consecutive outpatients, who were scheduled for lower extremity surgery under spinal anaesthesia, were randomized into two groups to receive either a hyperbaric solution of lidocaine 20 mg and ropivacaine 5 mg (Group LR) or hyperbaric ropivacaine 10 mg (Group R). Sensory block was tested with pinprick and motor block on the Bromage scale at 5-min intervals until 30 min, then at 15-min intervals until 90 min, and thereafter at 30-min intervals until full bilateral recovery. Blinded interviews were performed on the first and seventh postoperative day. RESULTS: The groups did not differ significantly regarding success of sensory block reaching T10 dermatome on the operative side, 24 (86%) in Group LR and 23 (82%) in Group R, median (range) onset time 5 (5-20) vs. 10 (5-25) min or median duration of T10 sensory block 68 (5-115) vs. 50 (20-115) min, respectively. Two patients in each group required general anaesthesia. Recovery did not differ between the groups, median time of full motor recovery was 75 min in both groups, sensory recovery of S2 2.5 h vs. 2.8 h, first voluntary micturition 4.2 (2.2-6.1) vs. 4.5 (2.4-6.6) h in the LR vs. R Group, respectively. Transient neurological symptoms did not appear. CONCLUSION: It is concluded that spinal anaesthesia with hyperbaric lidocaine 20 mg+ropivacaine 5 mg and hyperbaric ropivacaine 10 mg was quite similar regarding frequency, onset, duration of T10 dermatome sensory block and recovery. The patients would have been ready for discharge after voluntary micturition, 4.2-4.5 h from the subarachnoid injection of local anaesthetics.

Amides↗
PubMed2006

Outcome after anaesthesia and emergency surgery in patients over 100 years old.

BACKGROUND: Deteriorated organ function and reduced stress response in very old patients may cause post-operative morbidity and mortality. We wanted to identify immediate and longer-term outcome after anaesthesia and surgery in the oldest of the old patients. METHODS: We analysed retrospectively anaesthesia and hospital records of patients who were over 100 years old when undergoing major emergency surgery in our hospital during 1990-2004. RESULTS: Altogether, 12 patients (median age 101 years) underwent 14 operations (nine for hip fracture, four for lower extremity circulatory problems and one for peritonitis). During anaesthesia, invasive arterial pressure was monitored in eight patients while central venous pressure (CVP) was monitored in only one patient. Spinal anaesthesia with bupivacaine was given as a continuous technique in six and as single-shot spinal anaesthesia in five cases. Both spinal (11) and general (3) anaesthesias were characterized by marked drops in arterial pressure. Haemodynamics was managed with intravenous (i.v.) fluids and vasopressors. Five patients had post-operative delirium. Mortality at 30 days, 6 months and 1 year was 25%, 42% and 50%, respectively. Within 15 days of the operation, three patients had died (pneumonia, cerebral infarction and myocardial infarction). Nine patients returned home and six of them lived in their pre-operative mental and physical state for at least a year. CONCLUSION: Independently of the anaesthetic method, marked drops in blood pressure occurred, requiring pharmacological intervention. We assume that in most of the patients, hypovolaemia explains the intra-operative haemodynamic instability. A 25%, 30-day mortality may be regarded as acceptable and, overall, these very old patients tolerated emergency surgery quite well.

Aged↗
PubMed2006

Cardiovascular changes after naloxone administration in propofol-sedated piglets during opioid overdose.

BACKGROUND: Naloxone is an opioid receptor antagonist. Even when used in modest doses, it has been associated with serious cardiopulmonary side-effects. In this experimental porcine study, we examined the cardiac effects of naloxone during an opioid overdose. METHODS: Cardiac parameters, changes in the left ventricular compliance and the magnitude of catecholamine release were evaluated in eight spontaneously breathing piglets under propofol sedation. Cardiac parameters were recorded every 30 s and transthoracic echocardiography was used for the continuous assessment of cardiac performance. Respiratory arrest was induced by morphine (8 mg/kg). Ten minutes after morphine administration, naloxone (80 microg/kg) was injected intravenously. Every 5 min, arterial blood gases were measured and, every 10 min, a sample for the analysis of plasma catecholamines was drawn. RESULTS: There were no statistically significant changes in left ventricular ejection fraction and no signs of pulmonary hypertension. There was a statistically significant increase in the mean arterial pressure immediately after naloxone administration and in norepinephrine concentration before naloxone administration. After naloxone administration, the plasma catecholamine levels decreased in all but one animal. Two animals developed cardiac arrest (pulseless electrical activity and ventricular fibrillation) shortly after receiving naloxone. Although they were both administered naloxone prematurely due to hypoxic bradycardia, naloxone could have contributed to the development of ventricular fibrillation. CONCLUSION: Naloxone did not cause changes in ejection fraction or mean pulmonary artery pressure in hypoxic and hypercarbic conditions. After naloxone administration, the plasma catecholamine levels returned to baseline in all but one animal, and two animals developed cardiac arrest.

Analgesics, Opioid↗
PubMed2005

Advances in ophthalmic regional anaesthesia.

Although retrobulbar and peribulbar regional anaesthetic techniques are used (by both anaesthesiologists and ophthalmologists) in various types of eye surgery, topical anaesthesia of the conjunctiva and cornea, followed--as needed--by sub-Tenon's block, is now common in routine cataract surgery. Intracameral administration of local anaesthetic by the ophthalmologist is also performed. Sedation during ophthalmic surgery is distinctly lighter than for other surgery because it is essential that the patient remains alert and can cooperate with the surgeon. Continuous insufflation of oxygen-enriched air is needed to ascertain that CO2 has been flushed away. With a catheter placed into the nostril, the patient (whose head is draped and 'hidden') can have the end-tidal CO2 monitored. Finger index (FI), a palpation method that assesses the ease of performing retrobulbar block, is introduced. Because of the risk of life-threatening complications in ophthalmic regional anaesthesia, the services of an anaesthesiologist must be available and training of anaesthesia residents in ophthalmic regional anaesthesia is highly recommended.

Anesthesia, Conduction↗
PubMed2005

Characterization of inhibition of platelet function by paracetamol and its interaction with diclofenac in vitro.

BACKGROUND: Paracetamol (acetaminophen) is an effective analgesic and a weak inhibitor of cyclo-oxygenase (COX). Clinically paracetamol is often used together with traditional NSAIDs, which are strong inhibitors of COX. We studied binding of paracetamol to COX and its action on platelet function together with diclofenac. METHODS: Blood was collected from healthy donors and platelet function was assessed by photometric aggregometry, a platelet function analyser (PFA-100, Dade Behring, Deerfield, IL) and by measuring the release of thromboxane B(2) (TxB(2)), the stable metabolite of thromboxane A(2), after addition of paracetamol (10-80 microg ml(-1)). A concentration-inhibition relationship was established and the inhibition coefficient (K(i)) demonstrating 50% binding to COX was determined using a Schild-plot. Interaction of paracetamol (5-20 microg ml(-1)) and diclofenac (0.1-0.8 microg ml(-1)) was determined and an isobolographic analysis was performed. RESULTS: Paracetamol added to platelet-rich plasma (PRP) caused a concentration-dependent inhibition of platelet function. Photometric aggregometry and TxB(2) release was significantly inhibited by paracetamol from 10 microg ml(-1) onwards. The PFA-100 closure time was significantly prolonged by paracetamol at a high concentration only. K(i) was 15.2 microg ml(-1) with a 95% confidence interval of 11.8-18.6 microg ml(-1). Inhibition of aggregation by diclofenac was augmented by paracetamol. Isobolographic analysis showed synergism. CONCLUSIONS: The 95% confidence interval of K(i) equals the antipyretic plasma concentration of paracetamol, i.e. 10-20 microg ml(-1). High doses of paracetamol and a combination of diclofenac and paracetamol cause platelet inhibition and thus may increase risk of surgical bleeding.

Acetaminophen↗
PubMed2005

Future of regional anaesthesia.

The development and refinement of regional anaesthetic techniques for various types of surgery, mainly obstetric, ophthalmic and orthopaedic surgery, and of continuous regional analgesia continues. Suitable analgesic drug mixtures, and concentrations, will be further tested in order to find the ideal analgesic regimen for each type of surgery and for the individual patient. No new local anaesthetics or equipment for clinical use are expected in the near future. Improvement therefore depends much on how the anaesthesiologists use the present drugs, needles, nerve detection devices, catheters and pumps. During training in regional anaesthesia for the speciality of anaesthesiology and intensive care medicine, it may suffice to concentrate only on certain common techniques such as epidural block, spinal block, axillary brachial plexus block, intravenous regional anaesthesia and femoral nerve block. Rare regional anaesthetic blocks and invasive techniques should be mastered and taught by specially trained regional anaesthesiology experts. In chronic pain, regional anaesthetic blocks with local anesthetics are not expected to play any major therapeutic role. However, nerve blocks can be useful for diagnostic purposes and in order to facilitate rehabilitation in chronic pain syndromes.

Analgesia, Epidural↗
PubMed2005

Albumin induced hypercoagulability does not reduce blood loss in patients undergoing total hip arthroplasty.

BACKGROUND AND AIMS: Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients. MATERIAL AND METHODS: 101 patients undergoing primary hip arthroplasty received in random order 4% albumin (n = 48) or HES (average Mw 120 kDa/molar substitution ratio 0.7, n = 53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6-8%, 12-16%, 60% and 100% blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis. RESULTS AND CONCLUSIONS: Administration of albumin or HES 1200 ml (500-2000 and 500-1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.

Adult↗
PubMed2004

Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty.

BACKGROUND: We studied whether a small dose of clonidine added to a ropivacaine-fentanyl mixture improves epidural analgesia without provoking side effects typically related to larger amounts of epidural clonidine. METHODS: In this randomized, double-blinded study, patients (< or =85 yr, ASA I-III) underwent total knee arthroplasty (TKA) performed under spinal anaesthesia. After the operation, patients received an epidural infusion consisting of ropivacaine 2 mg ml(-1) and fentanyl 5 microg ml(-1) either without (Group RF, n=33) or with clonidine 2 microg ml(-1) (Group RFC, n=36). The infusion rate was adjusted within the range 3-7 ml h(-1). RESULTS: Average rate of infusion was slightly smaller in Group RFC than in Group RF (mean (sd) 4.7 (0.72) vs 5.2 (0.8) ml h(-1), P=0.004). Compared with the RF group, patients in the RFC group required significantly less rescue pain medication, that is i.m. oxycodone (median (25th, 75th percentile) 0 (0, 7) vs 7 (0, 12) mg, P=0.027). Arterial pressure and heart rate were slightly lower in Group RFC throughout the study period (mean difference between the groups 5 mm Hg (P<0.002) and 3 min(-1) (P=0.12), respectively). The groups did not differ statistically with respect to nausea, motor block, and sedation. CONCLUSIONS: The small amount of clonidine added to the low-dose ropivacaine-fentanyl mixture reduced the need for opioid rescue pain medication after TKA. Clonidine slightly decreased arterial pressure and heart rate without jeopardizing haemodynamics. Otherwise, the side effect profiles were comparable in both groups.

Adult↗
PubMed2004

Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery.

BACKGROUND: Previously, plain ropivacaine 15 mg given intrathecally has been shown to be feasible for ambulatory surgery of lower-extremities. Hypothetically, hyperbaric solution could improve and shorten the block. METHODS: This prospective, randomized, double-blind study included 56 patients undergoing surgery of lower extremities. They received intrathecally either 1.5 ml of ropivacaine 10 mg ml(-1) and 0.5 ml of glucose 300 mg ml(-1) (HYP) or 2 ml of ropivacaine 7.5 mg ml(-1) (PL). RESULTS: All patients in Group HYP achieved T(10) dermatome analgesia but only 64% (18/28) of Group PL. T(10) analgesia was reached in 5 min (median, range 5-20 min) in the HYP group vs 10 min (5-45 min) in the PL group (P=0.022), and full motor block in 10 min (5-45 min) vs 20 min (5-60 min) (P=0.003), respectively. Group HYP had a longer duration of analgesia at T(10); 83 min (5-145 min) vs 33 min (0-140 min) (P=0.004). Duration of sensory block from injection of the anesthetic to complete recovery was shorter in Group HYP than in Group PL, 210 min (120-270 min) vs 270 min (210-360 min) (P<0.001), as was duration of motor block, 120 min (5-150 min) vs 210 min (120-330 min) (P<0.001). Patients of Group HYP attained discharge criteria earlier than those of Group PL (P=0.009). CONCLUSION: In comparison with the plain solution, 15 mg of intrathecal hyperbaric ropivacaine produced a faster onset, greater success rate of analgesia at the level of T(10) dermatome, and faster recovery of the block.

Adult↗
PubMed2004

The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest.

INTRODUCTION: The Resuscitation 2000 Guidelines recommends amiodarone as the antiarrhythmic drug of choice in treatment of resistant ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Amiodarone has been associated with side-effects and difficulty of administration, due to recommended dilution, rendering it suboptimal for out-of-hospital cardiac arrest (CA) management. In the present study we report experiences and side-effects of the use of undiluted amiodarone in CA management in Helsinki Emergency Medical Service (EMS) during a 2-year period. METHODS: On October 1, the Resuscitation 2000 Guidelines were put into practice in Helsinki EMS. Thus, in the cardiac arrest treatment protocol, after three ineffective shocks and 1 mg of adrenaline (epinephrine), a bolus of 300 mg of undiluted amiodarone (Cordarone 50 mg ml(-1), Sanofi-Synthelabo, Helsinki, Finland) was administered into a vein located as centrally as possible. The Helsinki EMS performs systematic data collection according to the Utstein Guidelines. The blood pressure levels, heart rates and the need for vasopressors, of the patients with sustained return of spontaneous circulation (ROSC), were collected from the ambulance charts. RESULTS: During October 1, 2000 and September 30, 2002, 712 patients were considered for resuscitation and 566 were resuscitated. The initial rhythms were as follows: 32% had VF/VT, 36% had asystole and 32% had pulseless electrical activity (PEA). Of the 180 patients with VF/VT, 75 (42%) received undiluted amiodarone in addition to other resuscitative measures. Of the patients with asystole or PEA, 12 (6%) and 18 (10%), respectively, received amiodarone. The blood pressure levels and the need vasopressors after ROSC and during transportation to the hospital were similar among the patients who received and those who did not receive amiodarone. CONCLUSIONS: The present study suggests that amiodarone can be administered undiluted without unmanageable haemodynamical side-effects in the treatment of out-of-hospital cardiac arrest. This is likely to save time and simplifies the treatment protocol in the prehospital setting.

Aged↗