摘要:

Changes in central and coronary haemodynamics and myocardial oxygenation during anaesthesia induction, intubation, skin incision and sternotomy were studied in 24 patients undergoing a coronary artery bypass grafting operation under either high‐dose fentanyl or enflurane anaesthesia. The anaesthesia induction caused no changes in the coronary haemodynamics in either group, in spite of a marked decrease in the coronary perfusion pressure during enflurane induction. In both groups a decrease in the coronary sinus blood flow and an increase in the coronary vascular resistance was observed after the intubation. At this stage, two patients in both groups had a low level of myocardial lactate extraction, indicating possible myocardial ischaemia; mean myocardial lactate extraction had decreased significantly from the awake level in both groups. A circulatory response to surgical stimulation was seen in both groups, although it could be somewhat better controlled during enflurane anaesthesia. In the enflurane patients the increase in myocardial oxygen demand was accompanied by increased coronary flow, while in the fentanyl group the increase in coronary flow was not in proportion to the increased oxygen demand, and an increase in myocardial oxygen extraction was also seen. During surgery, three fentanyl patients and one enflurane patient had a low level of myocardial lactate extractio

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02234.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A comparison of haemodynamic stability with respect to arterial pressure, heart rate and cardiac output between six commonly used anaesthetic techniques: fentanyl (FE), halothane (HAL), morphine (MO), fentanyl/droperidol (NLA), and thiopentone (two dose levels: PE 3 and PE 6), all supplemented with nitrous oxide, was performed during induction of anaesthesia and sternotomy in 47 patients with good left ventricular function and maintained β‐blockers undergoing coronary bypass surgery. Interventions were kept to a minimum in order to characterize each anaesthesia group. Statistically, the material fell into two parts. The MO, PE 3 and PE 6 groups showed good stability under steady‐state anaesthesia, but variable and often extensive hyperdynamic responses were seen to endotracheal intubation and surgical stimulation. The FE, HAL and NLA groups were characterized by a good stability during the induction‐intubation phase but were unstable when combined with nitrous oxide in the absence of noxious s

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02235.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Phaeochromocytomas appear as frequently as one in 1000–2000 patients. Release of catecholamines may be triggered by events in the perioperative period. Patients whose phaeochromocytomas are diagnosed in this period, have a mortality of about 80%. Three patients with perioperative debut of symptoms of a phaeochromocytoma are presented. A possible drug‐induced release of catecholamines from the tumour is suggested for two of the patients. The first symptoms of a phaeochromocytoma may be arrhythmias and shock, which favours the use of adrenergic blockade prior to elective removal of phaechromocytomas. Therapeutic approaches to the treatment of catecholamine‐induced heart failure may be potassium and magnesium supplements and possibly drugs reducing circulating angiotensin II activities. Caution is advised in the use of digi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02236.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The pharmacokinetics of methohexital were investigated in ten young adult volunteers and in seven young and seven elderly patients. The latter two groups underwent enflurane and nitrous oxide anesthesia and surgery. Each subject received a bolus dose of 2 mg/kg of methohexital intravenously. Plasma levels of the drug were measured for 8 h after injection by gas chromatography using a nitrogen detector. Anesthesia (combined with surgery) and increase in age did not separately affect the kinetics of the drug; however, the elimination half‐life was longer in the elderly patients group than in the young non‐anesthetized volunte

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02237.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The adrenocortical response to a short tetracosactrin (Synacthen®) test was studied in 11 patients receiving either etomidate infusion or thiopentone infusion used to maintain anaesthesia for abdominal hysterectomy. Pethidine was used as the narcotic component. The results showed that etomidate infusion (median 28.5 μg/kg/min) completely blocked the adrenocortical response to corticotropin stimulation for at least 24 h after surgery. No suppression was found in patients receiving thiopentone infusion. It is concluded that etomidate cannot be recommended for routine induction and maintenance of anaesthesi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02238.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Plasma cortisol was measured in 18 patients undergoing gynecological procedures under etomidate or methohexital and nitrous oxide anesthesia. Plasma ACTH was also measured in three patients in each group. The mean plasma cortisol concentration before anesthesia was comparable in both groups. Plasma cortisol increased in patients anesthetized with methohexital, while none of the patients anesthetized with etomidate had an increase in plasma cortisol. The increase in plasma ACTH was equivalent in the two groups. Therefore, etomidate is a potent inhibitor of the adrenal response to surgery. The absence of clinical consequences associated with the blunted response suggests that a major increase in adrenal hormone production may not be necessary during surgery.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02239.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In 14 patients with supratentorial cerebral tumours with midline shift below 10 mm, CBF and CMRo2were measured (Kety&Schmidt) during craniotomy. The anaesthesia was continuous etomidate infusion supplemented with nitrous oxide and fentanyl. The patients were divided into two groups. In Group 1 etomidate infusion of 30 μg kg‐1min‐1was used throughout the anaesthesia, and CBF and CMRo2were measured twice. In this group CMRo2(± s. d.) averaged 2.31±0.43 ml O2100 g‐1min‐170 min after induction and 2.21 ± 0.38 ml O2100 g‐1min‐1130 min after induction. In Group 2 the etomidate infusion was increased from 30 to 60 μg kg‐1min‐1after the first study and a significant fall in CMRo2from 2.52 ± 0.56 to 1.76 ± 0.40 ml O2100 g‐1min‐1was found. Simultaneously, a significant fall in CBF was observed. The CO2reactivity was pr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02240.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

“Enflurane hepatitis” has only recently been accepted as a disease entity. As far as the authors know, this paper is the first report on enflurane hepatitis in a patient with a previous history of halothane hepatitis. Our conclusion is that a potent halogenated inhalation agent should never be given to a patient if a prior administration of another such agent has led to the development of hepatic inj

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02241.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

We examined HLA‐A, B, C and DR locus antigens in 38 Japanese patients who had recovered from halothane hepatitis. The patients were divided into two subgroups, i. e. jaundice and non‐jaundice groups, because the clinical features were quite different in each. DR2 was positive in 14 (58.3%) of 24 patients with jaundice, compared with 281 (33.6%) of the 837 Japanese healthy controls (chi‐square with Yates' correction = 5.30, relative risk = 2.77,P<0.025). Conversely, Bw44 was increased in non‐jaundice patients (50.0%), compared with 157 (12.7%) of the 1234 Japanese healthy controls (chi‐square with Yates' correction = 13.75, relative risk = 6.86,P<0.001). The haplotype frequency (Hf) of Aw24‐Bw52‐DR2 was high in the patients with jaundice (Hf=0.2362), while it was zero in the patients without jaundice (P<0.0042). These data suggest that the two groups of halothane hepatitis have different geneti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02242.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The haemodynamic changes induced by acute moderate blood loss were investigated in rats during normotensive halothane anaesthesia and during sodium‐nitroprusside‐induced hypotensive anaesthesia, respectively. Following haemorrhage in the normotensive group, mean arterial blood pressure, heart rate and left cardiac work decreased. Cardiac output was reduced non‐significantly. Blood flow was redistributed to favour cerebral, coronary, renal and hepatic circulation, mainly at the expense of blood flow to the carcass. Following haemorrhage in the hypotensive group, cardiac output increased significantly. Mean arterial pressure, heart rate and left cardiac work were unchanged. Absolute values for cerebral, coronary, renal and hepatic blood flow were maintained or even increased, while blood flow to the carcass was unch

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1985.tb02243.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY