ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03872.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Small changes in core temperature profoundly alter cutaneous blood flow, a major factor influencing resistance to wound infection. Furthermore, when measuredin vitro, various immune functions are temperature dependent in the physiological range. Accordingly, we tested the hypothesis that mild hypothermia impairs and mild hyperthermia improves resistance to dermal infections. Thirty–two guinea pigs were anesthetized for 6 h using 1.5% (1.25 MAC) inspired isoflurane. Their core temperatures were maintained at either 39˚C (normal for guinea pigs, n= 11), 36˚C (n = 12), or 41˚C (n = 9). One h after induction of anesthesia, 2times108E.coliwere injected intradermally with a 26–g needle at eight sites on each animal's back. Core temperatures were not controlled after recovery from anesthesia, and animals in each group were maintained in the same environment. Twenty–four h after injection, the area of induration surrounding each injection site was measured. This is a standard test of resistance to wound infection. Values were compared using one–way ANOVA and Scheffe's S tests. Results are presented as means ± standard deviations; differences were considered significant whenP<0.05. Areas of inflammation on the hypothermic animals were significantly larger (48± 10 mm2) than those on normothermic (36± 10 mm2) or hyperthermic (37 ± 6 mm2) animals. These data suggest that mild hypothermia during anesthesia significantly impairs resistance to dermal infection. In contrast, mild hyperthermia does not appear to

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03873.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Short latency somatosensory evoked potentials (SEPs) to median nerve stimulation during isoflurane anaesthesia were recorded in 12 elective–surgery patients. The effect of isoflurane on the shape, amplitude and latency of SEPs was evaluated. SEPs were recorded at awake, 1 MAC, 1.5 MAC, at electroencephalogram (EEG) burst suppression and at continuous suppression levels. Finally, SEPs were recorded when anaesthesia was lightened back to 1 MAC. The peak latency and amplitude of the first cortical N20wave were measured. The latencies increased with increasing isoflurane concentrations. At high concentrations only an almost monophasic N20wave was recorded, reduced in shape and amplitude. No specific changes could be correlated with the burst suppression or suppression patterns. This suggests that EEG and SEP generators are differently affected with increasing isoflurane concentration. The results indicate that SEPs can also be recorded in drug–induced EEG suppress

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03874.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Given as a peroral premedicant for geriatric patients having cataract surgery under regional block, a butyrophenone neuroleptic melperon (15–30 mg, n = 50) ranked equally with diazepam (4–10 mg, n = 50), assessed using a qualitative subjective estimation of the patients' anxiety. The patients treated with melperon needed significantly fewer supplementations with intravenous drugs, to withstand the surgery, compared to those medicated with diazepam. Melperon is a compatible alternative, but its possible propensity to cause occasional arterial hypotension must be noti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03875.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Peroral dixyrazine (15–30 mg, n = 50) and diazepam (4–10 mg, n = 50) were used as premedicants for geriatric patients having cataract surgery under regional block. Compared to the diazepam patients, a larger number of the dixyrazine medicated patients appeared anxious, and there was a statistically significant difference between the groups, when summing up changes in anxiety throughout the study period. The dixyrazine patients needed more frequent supplementation with intravenous sedative drugs, compared with their diazepam counterparts. Peroral dixyrazine is an applicable choice for calm patients, when only slight sedation, or avoidance of somnolence are requi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03876.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The difference in analgesic activity following lumbar (group I) or thoracic (group II) epidural administration of 50 ug sufentanil was studied after cholecystectomy. Fifteen patients in each group were evaluated for pain relief using a linear analog scale (LAS), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume (FEV,) and arterial CO2tension (Paco2). In five additional patients in each group 75 μg sufentanil was injected for determination of serum levels. Pain scores were lower than three in both groups after 10 min, while mean pain scores remained below one from 20 min until 2 h following injection in both groups. Satisfactory pain relief lasted for 4 h. RR was significantly decreased from two until 360 min. in the lumbar group and from five until 120 min in the thoracic group. Paco2was raised in both groups only during the first hour. PEF and FVC were significantly improved compared to control 1, 2 and 4 h following injection. Serum sufentanil levels reached a maximum of 0.299 ±0.052 ng.ml‐1in the lumbar group and 0.377 ± 0.076 ng–ml‐1in the thoracic group after 5 min. There were no significant differences between the two groups in the variables

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03877.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The effects of propofol on right ventricular function were studied in 11 ICU patients who needed sedation for acute respiratory failure or neurological diseases. Right ventricular function was studied using a thermodilution method at patients' bedside. Right ventricular ejection fraction (RVEF), cardiac output (CO), right ventricular end–diastolic volume (RVEDV), right ventricular end–systolic volume (RVESV), right ventricular end–systolic pressure (RVESP) and pulmonary capillary wedge pressure (PCWP) were obtained from a modified Swan–Ganz catheter. Calculation of right ventricular end–systolic pressure–volume relation (ESPVR) allowed to assess changes in right ventricular inotropic state. A baseline ESPVR was obtained before propofol infusion: RVESP = 0.21 RVESV + 2.4, r = 0.83,P<0.0001. Then, patients were given an induction dose of 1 to 2.5 mg kg‐1propofol over 1 min followed by a continuous infusion of 3 mg kg‐1h‐1. During propofol infusion heart rate, mean arterial pressure, PCWP, CO, systemic vascular resistance and RVEF significantly decreased. No change in RVEDV and RVESV was observed. ESPVR was significantly altered with a dramatic decrease in the slope of the relation: RVESP = 0.12 RVESV + 6.9 (P<0.001 from baseline). Dobutamine was used in five patients with clinically significantly cardiac dysfunction and restored the slope of the ESPVR to the baseline value: RVESP = 0.22 RVESV + 6.3 (NS from baseline). In the study patients, propofol altered the inotropic state of th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03878.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Internal jugular vein (IJV) cannulation is a popular approach for central venous access as it has few complications, of which failure to locate the vein and carotid artery puncture are the most common. A variety of manoeuvres and body positioning has been used to maximise IJV size and thereby increase cannulation success rate and decrease complications. Realtime 2D ultrasound can be used to view neck vascular anatomyin vivoand allow IJV size to be measured. Thirty–five volunteers had the lateral diameter of their IJV measured using the SiteRite ultrasound machine to discover the most effective methods of increasing its diameter. No correlation was found between the IJV lateral diameter and subject height, weight, age or neck circumference. Carotid artery palpation and full neck extension reduced its diameter considerably. Increasing Trendelenberg increased diameter. Abdominal binder and the Valsalva manoeuvre were the most efficient methods of increasing its siz

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03879.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A prospective study was conducted to evaluate a new compact portable coagulation monitor (Ciba–Corning Biotrack 512 Monitor), which enables the clinician to perform instantaneous activated partial thromboplastin time (APTT) and prothrombin time (PT). 126 patients scheduled for heparinized and nonheparinized vascular surgery, and gynaecological surgery, were included. A drop of capillary or venous whole blood was applied in disposable cartridges to successively perform APTT and PT, and the results of the tests were compared with conventional laboratory methods, performed in two different laboratories (Lab. A and B). Comparisons between Lab. A. and Lab. B. enables determination of the bias, precision, and percent of outliers (patients whose values differed more than 20%) in conventional methods. The reference value was defined as the mean of Lab. A. and Lab. B. values. For PT, there were no statistical differences between the capillary and venous samples performed with the portable monitor, and the reference value, for the bias, the precision and the proportion of outliers. For APTT, there were no statistical differences between the capillary and venous samples performed with the portable monitor, and the reference value, for the bias and the precision. The percent of outliers, however, was significantly greater with the venous sample of the compact monitor than with the reference (48 versus 22%), and even if it did not reach the statistical significance (P= 0.07) it was also higher with the capillary sample performed with the Ciba Monitor than with the reference (33%). In conclusion the assessment of blood coagulation using this new compact monitor could be of major interest during the intraoperative period when immediate results are mandatory, even if PT is more accurate than APTT with this new metho

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03880.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Sedation, anxiolysis, intubation responses and fentanyl anaesthetic requirements were investigated in a double‐blind, randomized study in twenty ASA I‐II elective hysterectomy patients. Ten patients received dexmedetomidine 2.5 μg kg‐1i.m. 60 min before induction and saline placebo i.v. 2 min prior to induction (= DP group). Ten patients received midazolam 0.08 mg kg‐1i.m. 60 min and fentanyl 1.5 μg kg‐1i.v. (= MF group) 2 min before induction of anaesthesia with thiopentone 4 mg kg‐1. Anaesthesia was maintained with 70% nitrous oxide in oxygen and with fentanyl 2 μg kg‐1i.v. increments according to predetermined criteria. Both premedications induced sedation (P<0.01 in both groups) and anxiolysis (P<0.01 in DP vs<0.05 in MF group) without any differences between the groups. Haemodynamic changes following tracheal intubation did not significantly differ between the groups. Intraoperatively systolic and diastolic arterial pressure were 15% and 13% lower in DP group (P<0.01 andP<0.05 for drug effect), the mean heart rate was approximately 9 beats min‐1lower in DP group (n.s.). Fentanyl was required more often in MF group: median 3.5 (QD 1.5) vs. 2.5 (QD 0.5) times in DP group (P<0.05), the total amount being 57% smaller in DP group: 0.03 (QD 0.01) vs. 0.07 (QD 0.02) μg kg‐1min‐1(P<0.05). Postoperative course and analgesic requirements were similar in both groups. Dexmedetomidine premedication may offer an alternative to current anaesthesia practice i

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03881.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY