摘要:

The CSF distribution of opioids after subarachnoid administration is important in determining therapeutic and undesirable side‐effects. There are many factors which influence CSF distribution of opioids including the age, position, anatomy of the spinal column of the patient or animal, and the physico‐chemical properties of the opioid solution and of the CSF. Opioids are cleared from their site of administration in CSF by three mechanisms: 1) uptake into the spinal cord, 2) diffusion through the dura and uptake into the blood, and 3) rostral‐caudal CSF distribution. Physico‐chemical factors such as lipid solubility, degree of ionization in the CSF and the baricity of the opioid solution are important in determining the rate of clearance by these three routes. Opioids which are highly lipid soluble, have high affinity for delta and/or kappa opiate receptor subtypes, and are largely non‐ionized at physiologic CSF pH, would have optimal pharmacokinetic properties for subarachnoid administration. These properties would allow administration of a small dose of opioid which would be rapidly taken up into the spinal cord, thereby limiting CSF and vascular distribution to supraspinal brai

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02668.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In experiments on isolated rat heart‐lung preparation, the effects of halothane and enflurane on myocardial metabolism during postischaemic reperfusion were evaluated with intramyocardial high energy phosphates, lactate and glycogen. Hearts were perfused for 10 min initially and made globally ischacmic for 8 min. Afterwards, they were reperfused for 12 min. Halothane or enflurane was administered from 5 min after the start of perfusion to the end of reperfusion. There were no significant differences in contents of high energy phosphates between control (C), halothane (H) and enflurane (E) groups (ATP: 15.50 ± 0.87, 16.05 ± 1.99 and 15.16 ± 2.03 μmol/g dry wt, respectively). However, lactate levels in the hearts in Groups H and E were significantly higher than those in Group C (44.04 ± 10.54, 40.63 ± 10.34 vs 28.63 ± 5.98). Slight deterioration in the myocardial oxidation‐reduction state may be caused by inhalational anaesthetics when they are administered during the postischaemic reperfus

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02518.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow‐up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long‐term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side‐effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal mor

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02669.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The cardiovascular reactions to reaming of the medullary cavity of the femoral bones in dogs were studied. Intramedullary reaming caused marked reductions in systemic and pulmonary artery blood pressure. Cardiac‐output was maintained, while total peripheral resistance was reduced. The haemodynamic changes were transient, and it is suggested that they were caused by a neurally transmitted reflex mechanis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02519.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The hemodynamic and cardiometabolic effects of prenalterol were evaluated in propoxyphene‐induced circulatory shock in 10 pentobarbital‐anesthetized pigs. Circulatory shock (i.e. a systolic arterial blood pressure below 60 mmHg (8 kPa) and/or a cardiac index of less than 2.01·min‐1·m‐2) was induced by intravenous propoxyphene chloride 15 mg‐min‐1. Circulatory shock occurred after 26 ± 3 mg·kg‐1of propoxyphene. During continuous infusion of propoxyphene, consecutive doses of prenalterol 0.5, 1.0, 2.0 and 4.0 mg i.v. were injected with an interval between increments of 8 min. The maximum effect of prenalterol was seen following the 2 mg dose. Increases were observed in mean arterial blood pressure, cardiac index, stroke volume index, left ventricular stroke work index, right ventricular stroke work index, maximum rate of rise of ventricular pressure, and total body oxygen consumption. Decreases were observed in pulmonary artery occlusion pressure, mean right atrial pressure and systemic vascular resistance, whereas heart rate and pulmonary vascular resistance remained unchanged. The cardiometabolic parameters: coronary sinus now, coronary vascular resistance, myocardial oxygen consumption and extraction, remained low. Due to profound vasodilation, normal perfusion pressures were not reestablished. In conclusion, prenalterol improved cardiac performance by a significant positive inotropic action. However, pure inotropic stimulation was not sufficient to counteract the circulatory shock state during severe propoxyp

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02520.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02670.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The degree of hypoxic pulmonary vasoconstriction was studied in eight subjects during enflurane anaesthesia and was compared with that during intravenous pentobarbital anaesthesia in the same subjects. The lungs were ventilated separately with the aid of a double‐lumen endobronchial catheter. After preoxygenation of both lungs for 30 min, during intravenous anaesthesia, the right lung (test lung) was rendered hypoxic by ventilation with 6% O2in nitrogen. The left lung (control lung) was ventilated continuously with 100% oxygen. Cardiac output (Q̇T) was determined by thermodilution, and the distribution of blood flow between the lungs was assessed from the elimination of a continuously infused, poorly soluble inert gas (SF6). The hypoxic challenge resulted in a reduction of the distribution of perfusion to the test lung from 57% to 36% of Q̇T. Mean pulmonary arterial pressure increased by 37% and pulmonary vascular resistance of the test lung doubled. Arterial oxygen tension decreased from 45.9 to 9.5 kPa. Administration of enflurane to an end‐tidal concentration of 2% to both lungs caused no significant change in the distribution of the pulmonary blood flow, PVR, or any other circulatory variable. The arterial blood gases remained unaltered. When the hypoxic challenge was discontinued, all variables returned towards control values. The findings suggest that the inhalational anaesthetic enflurane does not reduce the hypoxic vasoconstrictor response in the human

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02521.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In 35 patients a subcutaneously implanted injection port/reservoir was used to provide intrathecal morphine to relieve pain due to cancer. The reservoir offers an alternative to rather expensive devices. It can be used for repeated injections or for infusion. It is easy to locate and facilitates ambulatory treatment. The injections were carried out by members of the patient's family after they had been taught how to do it. Initially, doses of 0.25–0.5 mg of morphine resulted in pain relief for 14 to 24 hours. After 5 weeks of treatment morphine requirements increased to 0.75–2 mg. Side‐effects were minimal, and three delayed CSF fistula, two of them confirmed by isotope tracking with Tc99m, closed spontane

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02671.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In a randomized open study, 120 healthy female patients were included. For short gynaecological procedures they were anaesthetized with either propofol 2.5 mg·kg‐1(n = 60) or thiopentone 5 mg·kg‐1(n = 60) in combination with nitrous oxide/oxygen (67%/33%). Supplementary doses of propofol (10–20 mg) or thiopentone (25–50 mg) were given when necessary during the procedure. Induction characteristics for propofol and thiopentone 1 min after start of induction were similar. Propofol seemed to have a more depressant effect than thiopentone on the circulatory response to anaesthesia. Recovery times from the end of the operative procedure until the patients opened their eyes on command and were orientated were shorter in the propofol patients compared to the thiopentone patients. In the propofol group, patients recalled discomfort on injection more often than patients anaesthetized with thiopentone. Otherwise, the side‐effects were similar in both groups. We conclude that propofol is similar to thiopentone in its anaesthetic qualities during induction and maintenance of short anaesthetic procedures. Propofol was associated with a more rapid emergence from anaesthesia than

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02522.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The effects of intermittent and continuous positive‐pressure ventilation (IPPV and CPPV) instituted prophylactically were evaluated in a porcine model of endotoxin‐induced pulmonary and cardiovascular failure. Pigs under ketamine anaesthesia were infused i.v. withE. coliendotoxin over 6 h. Twenty animals, breathing air spontaneously, received endotoxin without treatment. Fifteen animals were treated prophylactically with IPPV (normoventilation with air). Nine animals received prophylactic treatment with CPPV (positive end‐expiratory pressure 0.8 kPa (8 cmH2O)). Endotoxin infusion in spontaneously breathing animals caused profound deterioration of pulmonary gas exchange, a marked rise in pulmonary vascular resistance (PVR) and a moderate increase in extravascular lung water (EVLW). Cardiac output (Qt) and O2delivery decreased considerably. Metabolic acidosis indicated oxygen deficit. Eleven of 20 animals died during the observation period. IPPV improved arterial oxygenation during endotoxin infusion, and the increase in EVLW tended to be lower. The alterations in pulmonary haemodynamics, Qtand O2delivery, were of the same magnitude as in spontaneously breathing animals. Survival was improved. CPPV fully prevented the deterioration in pulmonary gas exchange and the development of pulmonary oedema. There was an accentuated increase in PVR. Qtand Os delivery decreased markedly and a severe metabolic acidosis developed. All animals treated with CPPV died during the observation period. These results indicate that prophylactic IPPV and CPPV may counteract the development of sepsis‐induced lung insufficiency in man. However, it must be emphasized that adequate cardiovascular support is essential in optimizing the tr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02523.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY