Is administration time of oral non-steroid anti-inflammatory drugs important? A clinical study in patients undergoing arthroscopic subacromial decompression.
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Administration, Oral↗
Biomedical subjects
R E Anderson
Publications and source records attributed to R E Anderson.
Cerebral state index: comparison between pairwise registrations from the left and the right sides of the brain.
BACKGROUND: Lateralization of cerebral blood flow and EEG activity is known to vary during cognition, sleep and waking. In spite of this, electrode placement for the cerebral state index (CSI) monitor is not specified to a particular side of the brain. This study is designed to determine if pairwise registrations differ for CSI measured simultaneously from the left or right sides of the brain. METHODS: In total, 25 ASA I-II patients undergoing elective day surgery under general anaesthesia were recruited. Pairwise recordings were made every minute from two CSI monitors (Cerebral State Monitor, Danmeter A/S; Odense, Denmark) connected to the left and the right side of the head. Sedation was graded according to the observer's assessment of alertness/sedation rating scale and correlated with CSI. RESULTS: A large overlap of indices, of similar magnitude, for each side of the brain was seen between different levels of sedation. The agreement between pairwise registrations was high, correlation between the 584 CSI pairs of recordings left/right was r(2)=0.92. CONCLUSIONS: Despite known lateralization of the EEC, this study found a very high correlation in CSI derived simultaneously from the left and right sides of the brain by two independent monitors.
Adult↗
Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery.
BACKGROUND AND OBJECTIVE: The cerebral state index (CSI) derived from a new small handheld electroencephalogram monitor was studied during routine day surgical anaesthesia titrated according to the bispectral index (BIS). The objective was to determine the degree of agreement between the two monitors. METHODS: Anaesthesia was induced with propofol and fentanyl (0.1 mg) in 38 patients undergoing general anaesthesia for routine day-surgery. Maintenance anaesthesia (sevoflurane (20/38), desflurane (10/38) or propofol (8/38)) titrated by BIS XP (Aspect Medical, Natwick, MA, USA) and BIS and CSI (cerebral State Monitor, Danmeter; Odense, Denmark) index values were recorded every minute. No patient received muscle relaxation. Observer's Assessment of Alertness/Sedation rating scale was used to assess level of sedation. RESULTS: Pair-wise recordings (914) of CSI and BIS were collected. The indices showed similar pattern and decreased with increasing level of sedation, however with large ranges for each level of sedation. Median indices were similar during surgery (BIS: 50 (14-89); CSI: 51 (7-88)) and both indices increased (P 20% from BIS-index in 24% of readings, and on rare occasions CSI indices deviated >100% from the BIS reading. When BIS < 40, CSI decreased slower than BIS and with wider spreading. CONCLUSIONS: When used for day-surgery anaesthesia without muscle relaxation, CSI and BIS show similar patterns and numerical values but with the incidence of occasionally large discrepancies between pair-wise readings. Which monitor is the more dependable remains to be established and cannot be implied from this initial explorative study.
Adult↗
Desflurane vs. sevoflurane as the main inhaled anaesthetic for spontaneous breathing via a laryngeal mask for varicose vein day surgery: a prospective randomized study.
BACKGROUND: Sevoflurane has become widely used in day surgery; however, desflurane may be a valuable alternative even in this setting. This study compares emergence from anaesthesia for day surgery with spontaneous breathing using either desflurane or sevoflurane. METHODS: This prospective, randomized, single-blinded study examined 70 ASA III patients undergoing elective ambulatory varicose vein surgery. Primary endpoint was emergence time (cessation of anaesthetic gas to communicating). Secondary endpoints included post-operative pain, nausea, time to discharge, and patient satisfaction. Patients were anaesthetized according to a standardized protocol including multimodal analgesia and antiemetic therapy and were randomized to receive sevoflurane or desflurane as the main anaesthetic while breathing spontaneously through a laryngeal mask airway. Fresh gas flow was oxygen in air 1 : 2 l/min. RESULTS: Intra-operative anaesthesia was uneventful apart from airway irritation observed in 5/35 desflurane and 1/35 sevoflurane patients. Emergence was 25-40% faster in patients anaesthetized with desflurane. Pain and post-operative nausea and vomiting (PONV) were equally infrequent in both groups. Overall, patient satisfaction was high with no difference between the groups. CONCLUSION: Desflurane is associated with a faster emergence with no differences during the post-operative course except a somewhat higher incidence of airway irritation.
Adult↗
Cerebral state index response to incision: a clinical study in day-surgical patients.
BACKGROUND: Inadequate anaesthesia, with somatic/autonomic response or awareness, is often revealed at intubation and surgical incision. Anaesthetic depth monitors should be able to prevent this risk. This explorative study examined the ability of the cerebral state monitor to predict autonomic/somatic responses to incision. METHODS: Forty-two ASA I-II day-surgical patients [19 men and 23 females; mean age 52 (29-79) years, mean weight 77 (50-118) kg] were induced clinically with fentanyl/propofol with sevoflurane after placement of the laryngeal mask airway. The cerebral state index (CSI) was blindly recorded 4 min prior to and 4 min after incision. RESULTS: During the 4 min prior to incision, the mean CSI was 45 (16-62) and increased by 9 (-13-40) when the mean value for the first 4 min after incision was subtracted from the value prior to incision, corresponding to a relative change of 21% (-21-118). The change in CSI did not show any consistent relation to the value before incision. Five patients showed minor movements after incision and six patients had > 25% increase in blood pressure. Neither CSI nor the change in index differed between patients who did or did not respond somatically or autonomically to incision. The last CSI value just prior to incision was 44 for non-responders and 40 and 42 for somatic and autonomic responders, respectively. CONCLUSION: The CSI in the majority of patients was within acceptable ranges during clinically adjusted anaesthesia prior to incision but seems not to be able to reliably predict an autonomic or somatic response to incision.
Adult↗
Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery?
AIMS: Impaired fasting glucose (IFG) below the diagnostic threshold for diabetes mellitus (DM) is associated with macrovascular pathology and increased mortality after percutaneous coronary interventions. The study goal was to determine whether pre-operative fasting blood glucose (fB-glu) is associated with an increased mortality after coronary artery bypass grafting (CABG). METHODS AND RESULTS: During 2001-03, 1895 patients underwent primary CABG [clinical DM (CDM) in 440/1895; complete data on fB-glu for n=1375/1455]. Using pre-operative fB-glu, non-diabetics were categorized as having normal fB-glu (<5.6 mmol/L), IFG (5.6< or =fB-glu<6.1 mmol/L), or suspected DM (SDM) (> or =6.1 mmol/L). fB-glu was normal in 59%. The relative risks of 30 day and 1 year mortality compared with patients with normal fB-glu was 1.7 [95% confidence interval (CI): 0.5-5.5] and 2.9 (CI: 0.8-11.2) with IFG, 2.8 (CI: 1.1-7.2) and 1.9 (CI: 0.5-6.3) with SDM vs. 1.8 (CI: 0.8-4.0) and 1.6 (CI: 0.6-4.3) if CDM, respectively. The receiver operator characteristic area for the continuous variable fB-glu and 1 year mortality was 0.65 (P=0.002). CONCLUSION: The elevated risk of death after CABG surgery known previously to be associated with CDM seems also to be shared by a group of similar size that includes patients with IFG and undiagnosed DM.
Aged↗
Effects of thoracic epidural analgesia on glucose homeostasis after cardiac surgery in patients with and without diabetes mellitus.
BACKGROUND AND OBJECTIVE: Even moderate hyperglycaemia increases mortality/morbidity after coronary artery bypass grafting, stroke and myocardial infarction. The goal of this prospective study was to determine if using thoracic epidural analgesia from start of surgery until the end of the third postoperative day would blunt postoperative hyperglycaemia. METHODS: Forty-four patients had diabetes mellitus, 60 did not; half of each group had an epidural with continuous local anaesthetics. All patients received continuous insulin infusions during the initial 24 h period beginning with surgery. Blood glucose was measured four times daily (fasting or 2-3 h post-prandial) until end of the third postoperative day. RESULTS: For patients without diabetes, the epidural group had lower mean blood glucose and insulin requirements (P < 0.02) than controls during the initial 24 h period beginning with surgery. For patients with diabetes mellitus, thoracic epidural analgesia reduced mean blood glucose (P = 0.017) with unchanged insulin requirements. Epidural did not diminish the increase (vs. preoperative) in fasting blood glucose on the third postoperative day (32% vs. 22%, P < 0.001) for non-diabetics. Epidural analgesia was not able to attenuate hyperglycaemia during the first 3 postoperative days. CONCLUSIONS: Epidural analgesia improved glucose homeostasis minimally during the initial 24 postoperative hours but did not attenuate hyperglycaemia during the subsequent 3 postoperative days.
Aged↗
Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass.
The lack of a gold standard complicates the evaluation and comparison of anaesthetic depth monitors. This randomised study compares three different depth-of-anaesthesia monitors during cardiopulmonary bypass (CPB) at 34 degrees C with fentanyl/propofol anaesthesia adjusted clinically and blinded to the monitors. Coronary artery bypass grafting patients (n = 21) were randomly assigned to all three possible paired combinations of three monitors: Bispectral Index (Aspect Medical), AAI auditory evoked potential (Danmeter), Entropy (Datex-Ohmeda). Indices were manually recorded every 5 min during CPB. Agreement between paired indices was classified as good, non-, or disagreement. Anaesthesia was classed as adequate, inadequate, or excessive according to recommended index values. Of the 255 paired indices recorded, 62% showed good agreement, 33% showed non-agreement, and 5% showed disagreement. Using good agreement between two monitors as a gold standard, a quarter of the measurements indicate inappropriate anaesthetic depth monitoring during CPB with clinically titrated anaesthetic depth.
Adult↗
Cerebral state index during anaesthetic induction: a comparative study with propofol or nitrous oxide.
BACKGROUND: Confidently predicting the depth of anaesthesia for the individual patient and independently of drug(s) type using EEG-based monitors has proven difficult. This open, randomized, explorative study of day surgical patients evaluates the ability of the Cerebral State Monitor (Danmeter AB, Odense, Denmark) of anaesthetic depth to identify loss of response (LOR) using either propofol or N(2)0 for induction. METHODS: In this open, randomized study, day surgical patients (n=10 in each group) were studied using the Cerebral State Index Monitor. After baseline measurements, induction to LOR was achieved with either repeated 30-mg boluses of propofol every second minute or with N(2)0 (after premedication 5 min before with 30 mg propofol) increased every other minute in 15% increments (max. 75%). Sedation level was evaluated every other minute using the Observer's Assessment of Alertness/Sedation scale. RESULTS: Baseline values were 91 (82-98) and 94 (82-100) for N(2)0 and propofol patients, respectively. During induction CSI decreased with increasing sedation in patients given propofol (P<0.001) but not in patients given nitrous oxide. Median value at LOR was 56 (40-76) and 95 (87-100) for the propofol and nitrous oxide group of patients, respectively. CONCLUSION: The Cerebral State Index(trade mark) behaves as other depth of anaesthesia monitors with a progressive decrease during propofol induction but loss of consciousness with N(2)0 results in no change in CSI.
Adolescent↗
Entropy of EEG during anaesthetic induction: a comparative study with propofol or nitrous oxide as sole agent.
BACKGROUND: The search continues for an anaesthetic monitor that can define the level of anaesthesia in an individual patient irrespective of anaesthetic agent(s) used. Studies of available monitors based on bispectral analysis or evoked auditory potentials show the complexity of the problem. We assessed a new monitor, based on the entropy of the EEG, during induction of anaesthesia with either propofol or nitrous oxide. METHODS: In an open, randomized study (two groups; n=10) of day surgical patients, we induced loss of response with incremental boluses of propofol. The other group was given propofol 30 mg and then increasing concentrations of nitrous oxide until loss of response. We measured entropy with the M-Entropy Module S/5 (Datex-Ohmeda) using forehead electrodes and recorded response entropy (RE; including frontal electromyogram) and state entropy (SE; only the cortical EEG). Values are median (range). RESULTS: Baseline values were RE 98 (96-100), SE 89 (87-91) and RE 98 (96-99), SE 89 (87-91) for the propofol and nitrous oxide patients, respectively. During propofol induction, both entropy indices decreased with increasing sedation, with RE 40 (23-76) and SE 34 (17-70) at loss of response. Neither RE nor SE decreased during nitrous oxide inhalation, and at loss of response using nitrous oxide, RE and SE were unchanged at 98 (96-100) and 88 (85-91) respectively. CONCLUSIONS: The entropy monitor of anaesthetic depth shows a successive decrease with propofol but loss of consciousness with nitrous oxide is not associated with change in entropy indices.
Adult↗
Entropy during propofol hypnosis, including an episode of wakefulness.
Depth of anaesthesia has proved to be a complex process to quantify. Monitors based on bispectral analysis of the electroencephalogram and auditory evoked potential have been available, but only recently has a monitor based on entropy become available. This study determined state entropy and response entropy in nine healthy volunteers during propofol hypnosis with a brief intervening period of wakefulness. Both the calculated entropy indices decreased with increasing levels of sedation (r2 = 0.58 and 0.61, respectively) and they showed a high correlation with each other (r2 = 0.94). However, an overlap was observed in real time indices between different stages of the Observer's Assessment of Alertness/Sedation Scale. Only three of the nine volunteers had explicit memories from the episode of wakefulness. Electroencephalographic entropy monitors seem to have potential for staging clinical hypnotic effects.
Adolescent↗
The AAI index, the BIS index and end-tidal concentration during wash in and wash out of sevoflurane.
The bispectral index (BIS), auditory evoked potential index (AAI) and the end-tidal sevoflurane concentration were studied during induction and emergence in 10 ASA I-II patients. Both during 'wash-in' and 'wash-out' of sevoflurane, the AAI and BIS indices show huge variability and an overlap of indices between awake and not responding to command. This was the most pronounced during induction and the range of values was larger for the AAI index as compared with the BIS index. Mean (range) BIS was 85 (73-98) and 48 (10-83) awake and unconscious, respectively, and mean AAI index was 71 (43-99) and 21 (4-85), respectively. This study demonstrates the difficulties of using processed EEG variables in real time in a clinical situation of non-steady state pharmacodynamics.
Anesthetics, Inhalation↗
Inhalation anaesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy.
BACKGROUND AND OBJECTIVE: Cost consciousness has become increasingly important in anaesthesia as elsewhere in healthcare. Cost-minimization with uncompromised patient safety and quality requires systematic comparisons of alternative techniques. Inhalation anaesthesia with desflurane or sevoflurane is compared in this study with propofol delivered by the target controlled infusion technique. Directly measured drug consumption and costs and emergence times are compared. METHODS: Consumed anaesthetics were measured during elective arthroscopy of the knee, and costs were calculated for ASA I-II patients (n = 102) randomized to 3 groups: one group received anaesthesia using propofol administered by target controlled infusion, the others inhalation anaesthesia with either desflurane or sevoflurane in combination with nitrous oxide. A partial rebreathing system was used with a laryngeal mask airway. Vaporizers were weighed before and after each anaesthetic. RESULTS: Anaesthetic duration, postoperative pain and emesis as well as discharge time did not differ between groups. Inhaled anaesthetic techniques with desflurane or sevoflurane were associated with 2-3 min shorter emergence times (P < 0.001) and approximately 45% lower cost for consumed anaesthetics as compared with a propofol technique based on target controlled infusion. The inclusion of waste costs improved the cost reduction to 55%. CONCLUSIONS: For this patient group, use of inhalation anaesthesia reduced drug costs by half and shortened emergence times compared to target controlled infusion with propofol with equal perioperative patient conditions.
Adult↗
Sevoflurane requirements during ambulatory surgery: a clinical study with and without AEP-index guidance.
BACKGROUND: Several monitors have been developed to measure anesthetic depth. The auditory evoked response uses an auditory signal to actively test the level of brain activity. The aim of the present study was to determine whether sevoflurane titration with A-line auditory guidance from the evoked potential monitor would reduce gas consumption and improve recovery times. METHODS: Patients (n=60, aged 18-65 years) undergoing elective knee arthroscopy were randomized to titrate the main anesthetic sevoflurane with O2:N2O (1:2), either clinically (30 patients) or in combination with a target auditory evoked potential index of 30+/-5 (30 patients) using the A-line monitor (version 1.4, Danmeter A/S; Odense, Denmark). Induction was supplemented with fentanyl, and randomized to 0.05, 0.10 and 0.15 mg immediately before propofol (10 in each group). Sevoflurane consumption and emergence times were the primary and secondary study end-points. RESULTS: Guidance from the A-line monitor did not reduce the sevoflurane consumption time or the emergence, regardless of the fentanyl dose. However, it did reduce the time from the recovery room to discharge eligibility (P<0.05). Sevoflurane consumption decreased inversely with the fentanyl dose (P<0.01), with no impact on emergence times. CONCLUSION: The auditory evoked potential index provided by the A-line monitor does not decrease sevoflurane consumption or emergence times for ambulatory knee arthroscopy.
Adult↗
No correlation between serum concentrations of S100B and cognitive function.
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Cardiopulmonary Bypass↗
Crystal structure of the bacterial cell division inhibitor MinC.
Bacterial cell division requires accurate selection of the middle of the cell, where the bacterial tubulin homologue FtsZ polymerizes into a ring structure. In Escherichia coli, site selection is dependent on MinC, MinD and MINE: MinC acts, with MinD, to inhibit division at sites other than the midcell by directly interacting with FTSZ: Here we report the crystal structure to 2.2 A of MinC from Thermotoga maritima. MinC consists of two domains separated by a short linker. The C-terminal domain is a right-handed beta-helix and is involved in dimer formation. The crystals contain two different MinC dimers, demonstrating flexibility in the linker region. The two-domain architecture and dimerization of MinC can be rationalized with a model of cell division inhibition. MinC does not act like SulA, which affects the GTPase activity of FtsZ, and the model can explain how MinC would select for the FtsZ polymer rather than the monomer.
Amino Acid Sequence↗
Membrane protein diffusion sets the speed of rod phototransduction.
Retinal rods signal the activation of a single receptor molecule by a photon. To ensure efficient photon capture, rods maintain about 109 copies of rhodopsin densely packed into membranous disks. But a high packing density of rhodopsin may impede other steps in phototransduction that take place on the disk membrane, by restricting the lateral movement of, and hence the rate of encounters between, the molecules involved. Although it has been suggested that lateral diffusion of proteins on the membrane sets the rate of onset of the photoresponse, it was later argued that the subsequent processing of the complexes was the main determinant of this rate. The effects of protein density on response shut-off have not been reported. Here we show that a roughly 50% reduction in protein crowding achieved by the hemizygous knockout of rhodopsin in transgenic mice accelerates the rising phases and recoveries of flash responses by about 1.7-fold in vivo. Thus, in rods the rates of both response onset and recovery are set by the diffusional encounter frequency between proteins on the disk membrane.
Animals↗
Regulation of type II phosphatidylinositol phosphate kinase by tyrosine phosphorylation in bovine rod outer segments.
Type II phosphatidylinositol phosphate kinase (PIPKII) is an enzyme responsible for the synthesis of phosphatidylinositol-4,5-bisphosphate (PI-4,5-P(2)) from phosphatidylinositol-5-phosphate (PI-5-P). In this study, we demonstrate the presence of PIPKII alpha in bovine photoreceptor rod outer segments (ROS) and the involvement of tyrosine phosphorylation in the regulation of its activity. PIPKII activity in bovine ROS was verified by the preferential conversion of synthetic dipalmitoyl PI-5-P to PI-4,5-P(2), lack of effect of phosphatidic acid, inhibition by heparin, immunoreaction with an anti-PIPKII alpha antibody on Western blots, and immunocytochemical localization in bovine and rat ROS by anti-PIPKII alpha. Immunoprecipitates of bovine ROS with the anti-PIPKII alpha antibody possessed PIPK enzymatic activity and preferentially used PI-5-P as substrate for PI-4,5-P(2) biosynthesis. The activity of PIPKII was greatly increased under conditions favoring tyrosine phosphorylation in ROS, and PIPKII activity was immunoprecipitated with anti-phosphotyrosine (anti-PY) antibodies from tyrosine phosphorylated ROS. Preincubation of ROS with tyrosine kinase inhibitors almost abolished the kinase activity in the anti-PY immunoprecipitates. Immunoblot analysis showed that PIPKII alpha was present in anti-PY immunoprecipitates from phosphorylated ROS but not from nonphosphorylated controls. We conclude that PIPKII alpha is present in ROS and that its activity is regulated by tyrosine phosphorylation.
Animals↗