摘要:

Complement activation was studied in 45 patients undergoing total hip arthroplasty under epidural anesthesia. The patients were randomly allocated to three groups. In Group I blood loss was replaced with microaggregate‐poor erythrocyte concentrate (SAGM‐ERC) plus 3% dextran‐60 as plasma substitute, and postoperative analgesia was maintained with intramuscular ketobemidone. In Group II blood loss was replaced as in Group I, but epidural anesthesia was prolonged 12 h postoperatively and kept at a level of T4 with 0.5% bupivacaine. In Group III blood loss was replaced with non‐frozen stored plasma plus SAGM‐ERC, and postoperative analgesia was maintained with ketobemidone as in Group I. All groups received pre‐ and postoperative thrombo‐prophylaxis with dextran. The plasma concentration of C3a‐des‐argininc (C3a‐desArg) was measured by radioimmunoassay preoperatively, immediately after operation and 3, 6 and 18 h postoperatively. No significant differences in plasma C3 and C4 were found between the groups. G3a‐dcsArg was significantly (P<0.01) increased up to 6 h postoperatively in Group III compared with both the preoperative value and Groups I and II. It is demonstrated that infusion of plasma can enhance or initiate endogenous complement activation. Blood component therapy with SAGM‐ERC and 3% dextran‐60, on the other hand, did not significantly increase the plasma level of C3a‐desArg irrespective of the type

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02621.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Thirty‐two ASA I or II women undergoing abdominal hysterectomy were randomly allocated to four groups to determine what type, if any, of recorded intraoperative message they would receive. Groups I and II heard a neutral recording with no verbal content. Group III heard an experimental recording with a positive suggestion for a rapid recovery. Group IV had a self‐prepared message. The tapes were played during general anesthesia when anesthetic depth was judged to be stable and adequate by vital signs, end‐tidal anesthetic concentration and EEG compressed spectral array. No patient reported any recall of intraoperative messages when interviewed on the day after surgery. Chart review showed no difference in days of hospitalization, dose of analgesics required, time to beginning oral intake, or the amount of wound drainage (P<0.05). We conclude that no awareness can be observed directly by recall or indirectly by response to suggestion given under stable and adequate general anest

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02622.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A method for estimation of blood volume changes during transurethral prostatic surgery is presented (haemoglobin dilution method (HDM)). It is based on a calculation of the patient's preoperative total haemoglobin content, from which losses are subtracted. The haemoglobin concentration of the blood is used as an indicator of dilution. The HDM was compared to the131I‐RISA technique in 10 patients undergoing transurethral resection of the prostate (TUR). The difference between the HDM and RISA in estimating the total operative procedure blood volume change was 0.03 ±0.12l (ns) with a linearity of 0.90. The blood volume changes were also predicted by a fluid balance formula. With RISA as reference, the formula had a lower precision (0.24 l) and a poorer linearity (0.65) than the HDM. The HDM did not lose in accuracy if repeated several times during the TURs or if a theoretical formula for estimation of the preoperative blood volume was us

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02623.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Eighty‐one patients admitted for minor surgery were followed with questionnaires and self‐rating scales in the pre‐ and post‐anesthetic period to evaluate the effect of giving either routine or detailed information. The patients were randomly allocated to two groups and received either routinely given information by the anesthetist for about 5 min or more detailed information for at least 20 min. The patients' experience of the effect of the preanesthetic visit was tranquillizing and adequate in both groups. The most significant difference with detailed information was a smaller number of side‐effects like slow cerebration, nausea and a general feeling of discomfort compared to the routinely informed patients. Repetitive ratings on Spielberger's State of Anxiety Scale showed that the patients who had had previous anesthetic experience were less influenced by the degree of information given. In view of the considerable numbers of parameters investigated, there were relatively few significant differences between the groups, and it was concluded that there was no convincing benefit from expanding routine to detailed in

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02624.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Seventy‐four patients admitted for elective surgery completed identical questionnaires and rating scales pre‐and postoperatively. The course of anxiety was compared between patients who were either routinely informed or had contact with an anesthetic nurse available for support during the 30‐min anesthesia and surgery preparation. Comparing the results with our three other studies, it is concluded that emotional support given by a “contact‐person” is more effective than either detailed information or a tr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02625.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The effect of atropine (0.001–10 μmol ·1‐1) on neuromuscular transmission in the rat hemidiaphragm preparation was investigated by analysing its effects on directly and indirectly‐elicited twitch, tetanic post‐tetanic twitch responses and on the phenomenon of post‐tetanic twitch potentiation. The effect of atropine on contractions produced by endogenous acetylcholine (ACh) or exogenous ACh (added directly into organ bath containing muscle) was studied in rat ileum. The results showed that atropine in low concentrations (1 μmol·1‐1or less), enhanced the indirectly‐elicited twitch, tetanic and post‐tetanic twitch responses in the rat diaphragm preparation. The mean EC50value of atropine‐induced increase in twitch tension was 0.08 ± 0.01 μmol·l‐1(mean ± s. e. mean, n = 6). Atropine had little effect on directly‐elicited twitch tension, but in high concentrations (10 μmol·1‐1or more), it reduced the directly, and indirectly‐elicited twitch contractions and produced a neuromuscular block in the rat diaphragm preparation. Atropine increased the contraction produced, in rat ileum, by endogenous ACh, i.e. ACh released from the phrenic nerve stimulated at 50 Hz for 20 s duration (control contraction: 1.3 ± 0.1 g, contraction in atropine: 1.7 ± 0.2 g). In contrast, atropine significantly reduced the contraction produced by exogenous ACh in the same preparation (control contraction: 3.0 ± 0.5 g, atropine: 2.0 ± 0.1 g), suggesting that a different mechanism may be involved in the latter effect of atropine. It was concluded that atropine, in low concentration, enhanced neuromuscular transmission, possibly via a presynaptic mechanism. In high concentration, atropine may reduce and then block transmission, possib

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02626.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The correlation between degree of peripheral neuromuscular blockade and response to carinal stimulation was evaluated in two groups of 25 patients: one group was anaesthetized with thiopental, N2O and halothane, and the other group received thiopental, N2O and fentanyl. The degree of peripheral blockade was evaluated using train‐of‐four (TOF) and posttetanic twitch (PTC) stimulation of the ulnar nerve. The degree of diaphragmatic paralysis was evaluated indirectly by stimulating the carina and observing the corresponding muscular response, which was graded as severe, mild or absent. During halothane anaesthesia a PTC of 0 always indicated that no response to carinal stimulation could be elicited. On the appearance of the first response to posttetanic twitch stimulation (PTC= 1), 2% of the patients showed a mild response to carinal stimulation. At the first response to TOF stimulation, 48% of the patients reacted with a mild response. During thiopental, N2O, fentanyl anaesthesia one of 25 patients showed a mild response to carinal stimulation at a PTC of 0. When PTC was 1, 20% of the patients reacted mildly to the stimulation. At the first response to TOF stimulation, 92% showed a response to carinal stimulation; 24% of these responses were severe, necessitating intervention. It is concluded that the TOF response elicited peripherally is a late sign of neuromuscular recovery of the diaphragm, and that the method of counting posttetanic twitches is superior to the TOF response in evaluating early recovery of this muscle. Further, to ensure total diaphragmatic paralysis, the neuromuscular blockade of the peripheral muscles should be so intense that no response to posttetanic twitch stimulation (PTC = 0) can be elici

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02627.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

One emergency ambulance serving an urban part of the greater Stockholm area was equipped with a semiautomatic defibrillator Life Pack 200 Physio Control during an 8‐month study period. The equipment advises the user whether defibrillation is required or not, and in cases of detected ventricular fibrillation, defibrillation is advised. The user then has to press a button to defibrillate through the same electrodes that record the electrocardiogram. A built‐in tape recorder was used for documentation of the underlying rhythm disturbance. In all, advice was requested 332 times. Accuracy in interpretation of ventricular fibrillation was found to be high. The sensitivity and specificity in interpretation of ventricular fibrillation were 93% and 100%, respectively. No defibrillations were performed in patients without ventricular fibrillation. All instances of ventricular fibrillation were converted to another rhythm or asystole. Seven percent of the patients with cardiac arrest caused by ventricular fibrillation survi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02628.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Twenty patients undergoing transurethral resection of the prostate (TUR) were followed every 10 min intraoperatively as well as 1 and 2 h postoperatively with measurements of blood haemoglobin concentration (B‐Hb), serum sodium (S‐Na), serum potassium (S‐K), serum osmolality (S‐osmol), blood loss, central venous pressure and volumetric determination of the irrigating fluid absorption. Changes in B‐Hb correlated well with the sum of acetated Ringer solution given and intravascular irrigating fluid absorption. A transient decrease in S‐Na of 1–4 mmol/l followed absorptions<300 ml. With larger intravascular absorptions, three stages of dilutive changes in S‐Na and B‐Hb are described. Extravascular absorptions resulted in mild blood parameter changes at various times after their occurrence. Absorption of irrigating fluid was associated with an increase in S‐K. S‐osmol decreased in conjunction with some absorptions, although the irrigating fluid was isotonic. Postoperative analyses of blood parameters gave only limited information about intraoperative complications. The only consistent pattern was associated with intravascular irriga

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02629.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

One hundred and twenty‐nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v. nicomorphine during surgery and epidural nicomorphine post‐operatively (epidural group, n = 58) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation and with post‐operative intramuscular nicomorphine (intramuscular group, n = 71). Post‐operative nicomorphine was only given at the request of the patients, and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group were given nicomorphine exclusively by epidural injection. Post‐operatively, both groups (i.m. and epidural) obtained effective and rapid onset of analgesia, but the pain assessments by the patient and the medical team favoured the epidural group. The requirements of nicomorphine over a period of 3 days were significantly lower in the epidural group 42 mg (s.d.= 18) versus 92 mg (s.d. = 33) in the intramuscular group.Significantly fewer pulmonary complications were observed in the epidural group: 7 atelectases compared to 27 in the intramuscular group. The epidural group showed no signs of ventilatory depression in spite of a catheter inserted at the T3

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02630.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY