ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03847.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This review is an update on anaesthetic agents and their excretion into breast milk; it presents the reported effects on suckling infants, and discusses the precautions which should be considered. For most anaesthetic agents, there is very sparse information about breast milk excretion and even less published knowledge about the possible effects on the suckling infant. Generally, when an anaesthetic agent is given on a single–dose basis, there is no evidence that it is excreted in breast milk in clinically significant amounts, even if there are detectable concentrations of the drug in the milk. Most anaesthetics are rapidly cleared from the mother, and, consequently, it should be possible to allow suckling as soon as practically feasible after surgery. However, repeated administration of certain opiates and benzodiazepines has been reported to cause adverse effects in neonates, with premature neonates apparently being more susceptible. Thus, in long–term treatment with these drugs, the importance of uninterrupted breast feeding should be assessed against possible adverse drug effects in the neon

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03848.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Small volumes of hypertonic NaCl–solutions have been proven to restore haemodynamics in hypovolemic shock patients. Topic of this study was to investigate whether bolus application of 7.5% NaCl–6.5% starch–solution (HSS) apart from its relevance in shock might be an effective therapy in oedema. Considering differential therapeutic aspects, the volume effects of 7.2 ml HSS were tested in three types of oedema: hydrostatic oedema induced by venous congestion (n = 6), oedema caused by bradykinin injection (n = 6), and proteinase–induced oedema (n = 6). The arterial, venous pressure and weight changes indicating volume shifts between intra– and extravascular space were continuously monitored in 36 isolated perfused rabbit hindlimbs. Oedema formation was induced corresponding to a weight gain of 18–20 g. Subsequently 7.2 ml HSS were injected into the extracorporeal circulation system containing 200 ml cell free, isoosmotic perfusate. Six experiments of each oedema group without HSS–application served as controls. 75–100% of oedema formation could be remobilised via bolus application of HSS within 5 min in all types of oedema. A persisting weight reduction was detectable in the hydrostatic and bradykinin oedema, whereas in the elastase oedema the initial weight loss was followed by a regain of weight up to 180% of initial oedema formation at 120 min after HSS–application. The results show that, due to the osmotic gradient induced by bolus application of HSS, the hydrostatic and bradykinin oedema can be permanently remobilised, whereas the therapeutic effect during proteinase oedema is only short–lasting due to an irreversible damage

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03849.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Propofol (n= 15) and isoflurane (n= 15), both administered by clinical and haemodynamic criteria, proved to be equally feasible as sole maintenance anaesthetics (combined with 0.5 mg alfentanil and suxamethonium) for gynaecologic laparoscopics. Two min postextubation, the number of patients awake and responsive to commands was higher in the group given propofol. Later recovery till 2 h postanaesthesia was similar for the groups, except that the propofol patients more frequently required oxycodone for pain relief, and that three of them (NS) were bradycardic. Emesis was rare in both groups. The rapid recovery without emesis qualifies these two anaesthetics for gynaecologic laparoscopics.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03850.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

To study neural contributions to the alterations in intracardiac conduction induced by IV lidocaine, we measured cardiac sympathetic nerve activity (CSNA) simultaneously with sinus cycle length (SCL) and AV conduction time using His–bundle electrocardiography following IV lidocaine in cats. Sixteen cats were anesthetized with halothane in oxygen and mid–sternotomized. The His–bundle electrogram and CSNA were recorded from an electrode placed in the interatrial septum and from the left ventrolateral or ventromedial nerve, respectively. Atrium–His (A–H), His–Purkinje (H–V), and total intraventricular (H–S) conduction times were measured during atrial pacing conducted at a cycle length of 300 ms. In eight cats, 1 MAC, 2 MAC, and 3 MAC halothane were given during IV lidocaine (Groups H–l, H–2 and H–3). In the other eight cats, anesthesia was switched from halothane to IV alpha–chloralose (30–50 mg–kgBW‐1; Group C). A significant decrease in CSNA with IV lidocaine, 2 mg–kgBW‐1′ was recognized in Groups C and H–l, but not in Groups H–2 and H–3. Prolongations of SCL during the spontaneous cycle, A–H and H–V in the paced mode following IV lidocaine were significant in Groups C, H–l and H–2, but not significant in Group H–3. We conclude that IV lidocaine induces a significant decrease in CSNA during alpha–chloralose or 1 MAC halothane anesthesia which partly

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03851.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Xenon is a more potent anesthetic than nitrous oxide, and gives more profound analgesia. This investigation was performed to assess the potential of xenon for becoming an anesthetic inspite of its high manufacturing cost. Seven ASA I—‐II patients undergoing cholecystectomy (n = 4), hernia repair (n = 2), or mammoplasty (n=l) were studied. Denitrogenation by 15–20 min of oxygen breathing under propofol anesthesia was followed by fentanyl–supplemented xenon anesthesia administered via an automatic minimal flow system which held the oxygen concentration at 30%. Xenon anesthesia lasted 76–228 min and 8–14 1 of xenon (ATPD) was used, of which 5.6–8.1 1 was expended during the first 15 min. Anesthesia appeared to be satisfactory, and the patients woke up rapidly after xenon was discontinued. The automatic system made minimal flow xenon anesthesia easy to administer, but nitrogen accumulation is still a problem. Assuming a xenon price of 10 US $ per litre, the average cost for xenon was about 65 US $ for the first 15 min and then about 25 USS for each subsequent hour

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03852.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In a model lung, airways dead–space can be accurately measured using a forced inspired oscillating argon signal, which varies sinusoidally about a mean concentration of 6% v/v with an amplitude of ± 4% v/v. With sinusoid forcing periods longer than 120 seconds, and at a breathing rate of 13.4 breaths minute‐1, the mean airways dead–space can be measured with a standard error of less than 5%. Sinusoid forcing periods shorter than 120 s provided inaccurate estimates of dead–space and so should not be used with this t

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03853.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The aim of the present study was to investigate if metabolic pH–alterations have an influence on cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo2) after an injection ofE. coliendotoxin. Following endotoxin in dogs with normal pH a decreased CBF and an increased CMRo2have earlier been found. Thirteen anaesthetized dogs were subjected to metabolic pH–variations in blood by infusion of hydrochloric acid or sodium bicarbonate. Ten dogs receivedE. coliendotoxin in a dose of 1 mg kg“‘ bodyweight. CBF, CMRo2and noradrenaline and adrenaline concentrations in blood and cerebrospinal fluid were measured repeatedly during normoxia and normocarbia. Measurements before endotoxin served as controls, together with three additional animals, where endotoxin was never given. In control measurements pH showed no influence on the variables studied. After endotoxin CBF, CMRo2and noradrenaline in cerebrospinal fluid increased with decreasing arterial blood pH. The influence exerted by metabolic pH alterations in blood after endotoxin may be explained by hydrogen ions and monoamines passing over a blood–brain barrier (BBB), damaged by endotoxin, into the brain tissue causing vasodilation and neuronal a

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03854.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Interactive effects between exogenous dopamine (DA) and isoflurane (I) combined with thoracic epidural blockade (TEA) were studied in dogs during chloralose anesthesia. The I–TEA interventionper sedecreased heart rate (HR; 28%), mean arterial pressure (MAP; 63%), cardiac output (CO; 54%), left ventricular dP/ dt (LVdP/dt; 75%) and LVdP/dt/systolic arterial pressure (SAP; 42%).Prior to the I–TEA intervention, dopamine increased MAP, CO, LVdP/dt, LVdP/dt/SAP and stroke volume (SV) already at the dose 10 μg–kg‐1. min‐1and, additionally, increased mean pulmonary artery pressure (MPAP) at the dose 20 μg–kg‐1. min‐1.During the I–TEA intervention, the DA–induced increases in MAP and systemic vascular resistance (SVR) were significantly higher than prior to I–TEA, as indicated by significant ANOVA interactive effects. At the dose 10 μg–kg‐1min‐1, DA restored MAP, CO, LVdP/dt, LVdP/dt/SAP and SV to levels found before the I–TEA intervention, while HR was restored first at the dose 20 μg–kg‐1–min‐1. At the dose 20 μg–kg‐1–min‐1, DA also increased MAP (39%), LVdP/dt (119%), LVdP/dt/SAP (73%), SVR (28%) and MPAP (70%)abovelevels prior to I–TEA. To conclude, exogenous dopamine effectively and dose–dependently counters cardiovascular depression induced by the anesthetic technique of combining I and TEA. The pressor and systemic vasoconstrictor actions of dopamine a

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03855.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

During induction of anesthesia in 60 patients undergoing coronary artery bypass grafting (CABG), we measured the QT–interval (QTI) in the ECG, heart rate (HR) and mean arterial pressure (MAP). Based on the HR, we corrected the QT–interval (QTcI). Prior to induction, six patients(10%) already had abnormal prolongation of QTcI (≥440 ms). After injection of fentanyl and vecuronium, the QTcI increased significantly (P<0.01); to a far lesser extent after injection of hypnotics (i.e. etomidate, midazolam or propofol). Orotracheal intubation caused significant shortening of QTCI (P<0.01). HR decreased markedly after injection of fentanyl. MAP decreased, however, only after injection of hypnotics. In the immediate post intubation period, HR and MAP increased significantly. The various hypnotics produced no significant difference in HR and QTcI at any measurement point. MAP changed only after injection of hypnotics. The decrease of HR and MAP during induction of anesthesia is thought to result from a corresponding reduction of adrenosympathetic stimulation. We believe that QTcI is similarly influ

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03856.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY