摘要:

Intubating conditions have been assessed at 60 s following administration of vecuronium 0.1 mg kg‐1or atracurium 0.5 mg kg‐1given either as a single dose after induction of anaesthesia with thiopentone or in divided doses; vecuronium 0.015 mg kg‐lfollowed 4 or 6 min later by 0.085 mg kg‐1, or atracurium 0.075 mg kg‐1followed 4 or 6 min later by 0.425 mg kg‐1. In the divided dose groups the smaller initial (priming) dose was given prior to induction of anaesthesia. Onset and duration of clinical relaxation were assessed using a peripheral nerve stimulator. The intubating conditions at 60 s improved significantly. with the use of relaxants in divided doses being acceptable in 80 and 70% of patients, respectively, with vecuronium and atracurium, but the conditions are not as good as those commonly found using suxamethvniuin. Priming at 6 min has no advantage over priming at 4 min. The onset of complete block was accelerated with priming. but the difference was not significant. The duration of clinical relaxation of vecuronium was significantly prolonged by giving it in divided doses. Unpleasant awareness of muscle weakness was observed in 15 patients, requiring early induction of anaesthesia in f

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02428.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A study was undertaken to evaluate the cardiovascular effects of sufentanil, in combination with three different muscle relaxants, used as sole anesthetic with 100% O2in 30 patients undergoing elective coronary artery vein graft surgery. Patients were randomly allocated to receive pancuronium (P), vecuronium [V) or atracurium (A) for muscle relaxation. All patients received 15 μg/kg sufentanil at induction followed by 5–10 μg/kg sufentanil prior to sternotomy. At the 95% level of significance no statistical difference was found for any of the measured and derived cardiovascular parameters between groups P, V and A, except for a decreased systolic blood pressure in the atracurium group after induction. Sufentanil in combination with pancuronium or vecuronium provided stable hemodynamic conditions throughout anesthesia. Atrarurium was less satisfactory. We conclude that there is no advantage to be gained, in the presence of beta blockade, from the use of the new generation muscle relaxants as compared to pancuronium during high‐dose sufentanil anesthesia for coronary artery vein gra

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02429.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Continuous endobronchial insumation of air in paralyzed animals (continuous flow apneic ventilation ‐CFAV) has been shown to maintain adequate oxygenation and carbon dioxide removal. CFAV in patients using oxygen resulted in adequate oxygenation but a mean rise in Paco2of 0.6 mmHg/min (0.08 kPa/min). This experiment compared carbon dioxide removal in dogs with air and oxygen. Ten dogs were anesthetized and paralyzed, and CFAV was used for 1 h with either air or oxygen in a randomized fashion. Adequate oxygenation was obtained with air and oxygen. Normal Pacos levels were obtained with air; however, in the animals where oxygen was used, Paco2levels rose to a mean of 6.45 ± s.e.mean 0.4 kPa (48.5 ± s.e.mean 3.2 mm

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02430.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Blood loss has previously been shown to be more detrimental for spontaneously hypertensive (SHR) than for normotensive Wistar‐Kyoto (WKY) rats. To evaluate whether this decreased tolerance to blood loss is due to disturbances in circulatory control or to alterations in cellular function caused by the hypertensive disease, SHR and WKY were subjected to complete liver ischaemia. During a 45‐min period of ischaemia as well as after 4 h of reflow, the liver content of ATP, glycogen, glucose and lactate was determined. Liver ATP decreased to 15% and liver glycogen to 30% of initial levels, while liver glucose increased 6‐fold and liver lactate 13‐fold during the ischaemic period in both SHR and WKY. Following 4 h of reflow, KIP was restored to 11.5± 1.7 μmol × g protein‐1(56% of initial level) in SHR and to 15.2 ± 1.3 (76%) in WRY. The levels of lactate and glucose returned to control levels after the reflow period while the glycogen stores were further depleted in SHR as well as WKY. No difference between SHR and WKY in cellular metabolic function during the ischaemic period could thus he demonstrated, and the postischaemic recovery was not significantly different. It is concluded that hypertensive disease does not seem to change the ischacmic tolerance of liver cells to any consid

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02431.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Two groups of patients intubated for long periods were examined post mortein. In Group A (22 patients) the mean duration of intubation was 4.0 days and in Group B (19 patients) 5.7 days. The mean for the two groups was 4.8 days. In Group A a conventional endotracheal tube was used, and in Group B an anatomically shaped tube. Both tubes had cuffs of the intermediate‐volume, low‐pressure type. The larynx and trachea, from the epiglottis to the bifurcation, were removed in one piece at autopsy and the inner surfare was photographed. The photographs were magnified and from these the size and estimated depth of any lesions were recorded. In the arytenoid and tracheal regions no significant difference was found between the two groups. In the cricoid region, on the other hand, the outcome was significantly more favourable following use of the anatomically shaped t

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02432.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A clinical trial of the combination of naloxone in alow dose (1–1.5 μg·kg‐1body weight) with physostigmine (0.5–1.0 mg i.v.) was made to elucidate whether this combination could reverse postanaesthetic oversedation in neurosurgical patients without increasing postoperative pain. The investigation was made following previous findings that physostigmine has analgesic properties in addition to its systemic antisedative and anticholinergic effects as well as a stimulatory effect on morphine‐depressed ventilation. Altogether 198 neurosurgical patients were investigated. The results showed that postanaesthetic oversedation can be safely treated by a combination of naloxone and physostigmine in the dosages named above, resulting in the rapid reversal of sedation, where opiates, neuroleptics and benzodiazepines have been used. In contrast, this combination has very little effect on sedation following the administration of agents such as halothane and isoflurane. In the great majority of patients (95%), the treatment resulted in excellent analgesia during the first postoperative hour. The incidence of nausea and vomiting was increased somewhat by this treatment, but these side‐effects could be minimized by decreasing the rate of drug administration. Physostigmine is contra‐indicated in patients having symptoms and signs similar to those of Parkinson's disease, and the dose of physostigmine should also be reduced to 0.5 mg i.v. in all patients over

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02433.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Brainstem auditory evoked potentials (BAEP) were determined in 12 volunteers. The effect of isoflurane anaesthesia on BAEP was determined in six patients. Body temperature and end‐tidal CO2% were controlled. Increasing end‐tidal isoflurane concentration from 0.6–2.4% increased BAEP wave I, III and V latencies. The amplitude of wave V decreased with increasing isoflurane concentration. Thus a dose‐related change was demonstrated between end‐tidal concentration of isoflurane and BAEP

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02434.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Application of self‐administered postoperative prophylactic positive expiratory pressure (S‐PEP) treatment in addition to conventional physiotherapy was investigated in 75 patients undergoing thoracotomy. Twenty‐nine patients used a face‐mask set supplied with an expiratory resistance (S‐PEP group) arid 27 patients used a face‐mask set without resistance (control group). The observation period and postoperative treatment with the face‐mask was 3 days. In the S‐PEP group 13 patients developed radiographic atelectasis during the 3 postoperative days compared to eight patients in the control group (P>0.05). The postoperative Pao2: in the S‐PEP group was 0.36 kPa lower than in the control group (P>0.05). We conclude that application of S‐PEP postoperatively after thoracotomy in addition to conventional physiotherapy including early mobilization had no beneficial effect in preventing atelectasis, as evaluated by changes in blood gas tensions and c

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02435.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

During 1983 and 1984, 1305 patients underwent 1400 pulmonary artery (PA) catheterizations. Successful placement was achieved in 1397 (99.6%) of 1403 attempts. The catheters were inserted via the right internal jugular vein on 1364 occasions. The median duration of monitoring was 28 h with a range from 3 to 220 h. Central venous puncture complications included carotid artery puncture in 67 instances (4.8%) and pneumothorax in one patient. Insertion of the catheters was associated with supraventricular arrhythmias on 11 occasions, ventricular arrhythmias on 930 (66.4%), right bundle branch block on two and a total heart block on one occasion. Eighteen (2.3%) of the 794 cultured catheter tips were positive. Anin situtime of more than 72 h was associated with a significantly higher percentage (7.2%) of positive tip cultures compared with anin situtime of less than 72 h (P<0.01). Repeated PA catheterization was not associated with significantly more complications than the initial catheterization. The results show that monitoring with a PA catheter in cardiac surgical patients is associated with a low incidence of morbidity.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02436.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Intrathecal and epidural catheters and an intravenous cannula were inserted in 10 goats. After administration of either morphine 4 mg, intravenously, 1 mg intrathecally or 4 and 8 mg epidurally. or fentanyl 0.1 mg intravenously, 0.05 mg intrathecally or 0.1 and 0.2 mg epidurally, venous blood and CSP were sampled at 2, 5, 10. 15, 30 min and 1, 2, 4, 6, 8 and 24 h. The concentrations of the drugs were measured by radioimmunoassay. After administration of intravenous morphine the plasma concentrarion‐time curve fitted a 3‐compartment model (body clearance = 84 ±23 ml/min/kg, mean ± s.d., N = 5), while after fentanyl the plasma concentration‐time curve was best described by a 2‐compartment model (body clearance = 3.9–5.8 ml/min/kg, N = 3)). After intrathecal injection the elimination rates of the opioids from CSF were 0.3 to 2.0 and 0.6 to 2.4 ml/h/kg for morphine and fentanyl, respectively (N = 3). The time to reach maximum CSF concentration after epidural administration was 0.22 ±0.14 h for morphine (N = 6) and 0.22 ±0.13 11 for fentanyl (N = 8). In the same goat the CSF availability was 2.3 and 11.3% for morphine and 0.8 and 3.3%, for fentanyl following epidural administration of the low and high doses, respectively. After cpidural administration, morphine and fentanyl are absorbed into CSF at the same rate but the relative amount of drug absorbed may be higher for morphine than fentanyl. Bulk flow is supposed to be the principal mechanism of opioid elimina

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02437.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY