摘要:

In a prospective multi‐center study, 262 patients were given general intensive care therapy following cardiopulmonary resuscitation if they were still comatose and unresponsive to pain 10 min after restored spontaneous circulation. Mortality (mainly cardiac) was 53.4% over the first 10 days, and 49% of the remaining survivors died between 10 days and 6 months. In the subsequent 6 months few patients died. Presenting electrocardiograms (ECG) showed ventricular fibrillation (VF) in 54.2%, asystole in 29.8% and electromechanical dissociation (EMD) in 9.2% of the patients. One‐year survival, 14.1% for asystole, 4.2% for EMD and 26.0% for VF and VT (ventricular tachycardia), differed significantly (P<0.01). VF/VT patients were older and had more cardiovascular disease. Adjustments of these and other covariates increased the significance of difference between ECG groups. Successful resuscitations from asystole or EMD appeared to be more common than has previously been reported, but this group of patients experienced an extremely high cardiac mortality over the first 6 months following resuscitat

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02905.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Intraabdominal surgery tends to lower circulating blood volume by mechanisms unrelated to bleeding. This phenomenon was investigated in chloralose anesthetized rats. Plasma volume was determined with radiolabelled albumin. Animals were subjected to a standardized abdominal trauma, eliciting minimal bleeding and evaporation, and others served as controls. The trauma decreased plasma volume and increased hematocrit significantly, whereas the plasma concentration of labelled albumin followed a similar time course in traumatized animals and in controls. It is concluded that experimental abdominal trauma may decrease blood volume by a loss of fluid with virtually the same albumin concentration as that of plasma.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02906.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A marked hypertensive response is often seen when the Mayfield skull‐pin device is applied to stabilize the head of the anesthetized patient for neurosurgery. In a prospective, blinded and randomized trial, 10 patients received an infiltration block of 0.5% mepivacaine with epinephrine 5 μg/ml (3 ml at each pin site) 1 min before the Mayfield holder was applied. Ten patients received normal saline and served as controls. All patients were under general anesthesia induced with sodium pentothal, fentanyl and pancuronium, and maintained with isoflurane in nitrous oxide/oxygen and increments of fentanyl. In the control group, there were significant increases in mean arterial pressure (mean increase 43%,P<0.001) and heart rate (15%,P<0.01) at 0.5, 1 and 2 min after application. In the mepivacaine group, no significant changes occurred. Infiltration of local anesthetic with epinephrine can thus safely protect against potentially dangerous increases in arterial pressure when the Mayfield holder is us

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02907.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Reports of midazolam interaction with vecuronium in animals prompted us to compare midazolam (0.25 mg kg‐1) with thiopentone (5 mg kg‐1) for possible interactions with vecuronium in patients, when used for induction of anaesthesia. After the administration of either of the two induction agents, the patients received vecuronium 0.1 mg kg‐1. The onset time, duration of action and 25–75% recovery index of the neuromuscular blockade were recorded by measuring the force of thumb adduction evoked by ulnar nerve stimulation. We found no differences between patients receiving either midazolam or thiopentone in their response to vecuronium. In three of the ten patients receiving midazolam, the injection of this drug produced a 8–29% reduction of the initial twit

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02908.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The feasibility of using labetalol, an alpha‐ and beta‐adrenergic blocking agent, as a hypotensive agent in combination with inhalation anaesthetics (halothane, enflurane or isoflurane) was studied in 23 adult patients undergoing middle‐ear surgery. The mean arterial pressure was decreased from 86 ± 5 (s.e. mean) mmHg to 52 ± 1 mmHg (11.5 ± 0.7 to 6.9 ± 0.1 kPa) for 98 ± 10 min in the halothane (H) group, from 79 ± 5 to 53 ± 1 mmHg (10.5 ± 0.7 to 7.1 ± 0.1 kPa) for 129 ± 11 min in the enflurane (E) group, and from 80 ± 4 to 49 ± 11 mmHg (10.7 ± 0.5 to 6.5 ± 0.1 kPa) for 135 ± 15 min in the isoflurane (I) group. The mean H concentration during hypotension in the inspiratory gas was 0.7 ± 0.1 vol%, the mean E concentration 1.6 ± 0.2 vol%, and the mean I concentration 1.0 ± 0.1 vol%. In addition, the patients received fentanyl and d‐tubocurarine. The initial dose of labetalol for lowering blood pressure was similar, 0.52 – 0.59 mg/kg, in all the groups. During hypotension, the heart rate was stable without tachy‐ or bradycardia. The operating conditions regarding bleeding were estimated in a double‐blind manner, and did not differ significantly between the groups. During hypotension, the serum creatinine concentration rose significantly in all groups from the values before hypotension and returned postoperatively to the initial level in the other groups, except the isoflurane group. After hypotension there was no rebound phenomenon in either blood pressure or heart rate. These results indicate that labetalol induces easily adjustable hypotension without compensatory tachy

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02909.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

With atracurium and vecuronium, spontaneous recovery of residual neuromuscular blockade monitored electromyographically during 0.5% isoflurane anaesthesia was studied in 60 patients undergoing plastic surgery. After thiopentone, in random order, either atracurium 0.5 mg kg‐1or vecuronium 0.1 mg kg‐1was administered and isoflurane added to N2O and O2mixture. Following spontaneous recovery of both the single twitch amplitude (T1) to 75% of the control value and the train‐of‐four ratio (TOF ratio) to 75%, incremental doses of the relaxant were given to maintain the T1at less than 10%. Before the end of surgery, the blockade was again permitted to recover spontaneously. During the initial spontaneous recovery, the mean recovery time of T1from 25% to 75% (the recovery index) with atracurium was longer (P<0.001) than that with vecuronium (13.2 min and 10.1 min, respectively) but, during the second recovery, the mean recovery index was shorter (P<0.05) with atracurium than with vecuronium (16.1 min and 19.8 min, respectively). The recovery time from T175% to TOF ratio 75%, indicating the recovery rate of residual neuromuscular blockade, with atracurium was about 15 min after both the initial and the second recoveries. With vecuronium, the respective recovery times were significantly (P<0.001) longer (25.6 min and 38.5 min, respectively). It is concluded that with vecuronium there is slower spontaneous recovery of residual neuromuscular blockade than with atr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02910.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A prospective randomised study of the effect when the patient remained sitting for 2 (Group‐2) or 60 min (Group‐60) before being put in the supine horizontal position, was evaluated in 12 patients, aged 39–67 years and given a spinal anesthesia with 4 ml 0.5% bupivacaine in 8% glucose (hyperbaric). The maximal cephalad spread of analgesia was obtained after 12.5 min (median) in Group‐2 and 75 min in Group‐60 (P<0.01). The spread of sensory analgesia went to T‐6 (Group‐2) and L3 (Group‐60) after 60 min (P<0.01). After 90 min the spread went to T6.5 in Group‐60, the difference being statistically significant (P<0.001). Given as median and range the maximum cephalad spread in Group‐2 was T6(T3‐T10) and in G

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02911.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The effect on the cardiovascular haemodynamic status of five neuromuscular blocking drugs, RGH‐4201, vecuronium, atracurium, pancuronium and metocurine, was studied in five conditioned foxhounds anaesthetised with fentanyl. Changes in heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output were recorded at 2, 5, 10, 20 and 30 min after administration of the drugs. From these, stroke volume, systemic vascular resistance and pulmonary vascular resistance were calculated. Administration of RGH‐4201 was followed by a pronounced increase in heart rate, accompanied by an increase in cardiac output and a decrease in systemic and pulmonary vascular resistance. Metocurine and pancuronium resulted in a decrease of right and left filling pressures and systemic‐/pulmonary vascular resistance. Changes after atracurium, vecuronium and metocurine were minimal. It is concluded that RGH‐4201 causes major alterations in the cardiovascular haemodynamic status in dogs anaesthetised with fentanyl when compared to vecuronium, atracurium, metocurine and pancuronium. With respect to cardiovascular stability, atracurium and vecuronium offer adv

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02912.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The EEG of ten elective abdominal surgery patients was studied during halothane anaesthesia. The EEG was analysed by compressed spectral array. The total power and various power bands were analysed. Anaesthesia was induced by mask with halothane in air. EEG analysis was performed from the data collected before induction and during anaesthesia at steady states of 1 MAC, 1.5 MAC, and 2 MAC. The correlation between deepening anaesthesia and power values was strongest in the 10–14 Hz band power and in the 18–32 Hz band power. This study confirms the usefulness of high frequency power in estimating the effect of halothane in patie

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02913.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The influence of adding 0.5% isoflurane to a narcotic‐based anaesthesia on the duration of effect and recovery time after repetitive administration of vecuronium was studied in ten healthy patients. The twitch response in the adductor pollicis muscle was recorded after supramaximal train‐of‐four (TOF) stimulation of the ulnar nerve at the wrist. Prior to endotracheal intubation a bolus dose of vecuronium (0.08 mg/kg b.w.) was given. During surgery repeated injections of vecuronium (0.02 mg/kg b.w.) were administered at a TOF ratio of 0.25. Hand‐skin temperature, systolic blood pressure, end‐tidal CO2and isoflurane concentrations were continuously monitored. Before and after 90 min administration of isoflurane, the duration of effect was 21 ± 4 and 24 ± 5 min (mean ± s.d.,P<0.05) respectively. Corresponding recovery times were 270 ± 60 and 280 ± 70 s (n.s.). Skin temperature remained unchanged and systolic blood pressure showed only minor variations. The addition of 0.5% isoflurane to a narcotic‐based anaesthesia causes a moderate increase in duration of effect but no change in recovery time from a repetitive vecuronium‐induced neuromuscular bloc

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02914.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY