摘要:

From 1968 to 1975, the Swedish Adverse Drug Reaction Committee received 113 reports on anaphylactoid reaction to dextran 70, and 20 reports on the same reaction to dextran 40. For 1975, this would equal areportedincidence of anaphylactoid reaction to dextran 70 of 1:2,500. The median age of patients reacting to dextran 70 was 63 years. Median age increased with increasing severity of the anaphylactoid reaction: from 48 years in patients with skin symptoms predominantly, to 79 years in the five patients who died. Symptoms were noticed within 10 min of the start of the infusion, or before 100 ml had been infused in 96 patients (85%) with an anaphylactoid reaction to dextran 70. There was a tendency for severe reactions to be observed earlier than milder ones. Symptoms also tended to be observed earlier in conscious than in unconscious patients. Reactions reported to have occurred in unconscious patients tended to be more severe than those in conscious patients.Patients with anaphylactoid reaction to dextran 40 did not differ from those with reactions to dextran 70 with regard to age, severity of the reaction or time before onset of symptoms. There was one death in this group.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01205.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Increases in pulmonary arterial pressure, tracheal insufflation pressure, and blood levels of the prostaglandin F2α metabolite, 15‐keto‐13, 14‐dihydro F2α, were observed after protamine chloride or thrombin‐induced platelet aggregation and release reaction in dogs. These effects were largely eliminated after administration of acetylsalicylic acid, an inhibitor of prostaglandin synthesis. The platelet aggregation was not noticeably affected.It is suggested that release of prostaglandin F2α from platelets is an important factor for the pulmonary changes during induced platelet aggregation. The necessity of measuring metabolite levels, rather than prostaglandin F2α levels, in blood duringin vivoconditions is d

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01206.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Segmental epidural analgesia (T10‐T12) was performed in 418 parturients, using a 4–6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing‐down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3–5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01207.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Nerve injury can arise as a complication of peripheral nerve block anesthesia. Of the various factors involved, the trauma caused by the injection needle may be of significance. In this experimental study the frequency of fascicular injury was investigated immediately after needling isolated rabbit sciatic nerve preparations, and after intraneural injection with the nervein situ.Two different injection needles were used, one with a bevel angle of 14° and the other with a 45° bevel angle. Fascicular injury was indicated by a fluorescence microscopy technique, tracing locally applied Evans Blue Albumin. The results show that a 45°‐beveled needle less frequently produces fascicular damage and should therefore be recommended for use in clinical anesthesia. It is also concluded that paresthesiae, when necessary, should be elicited gently, and that intraneural injections should be avo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01208.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Fifteen healthy young volunteers were studied before and during an intravenous infusion of a local anaesthetic agent. Seven received bupivacaine and eight etidocaine in a dose rate of 2 mg/min over a period of 150 min. Variables of the central systemic circulation and also the hepatic blood flow were measured repeatedly. The circulatory alterations during administration of the two drug s were compared. Comparisons with previous results concerning lidocaine and a placebo were also made. It was found that bupivacaine increased the heart rate, mean arterial blood pressure and cardiac output significantly more than did etidocaine in an equal plasma concentration. Lidocaine was intermediate between bupivacaine and etidocaine. In contrast, these three drugs had the same decreasing effect upon the splanchnic vascular resistance, which caused an almost identical increase in the estimated hepatic blood flow. The calculated vascular resistance in the systemic circulation, excluding the splanchnic, was unchanged during the infusion of etidocaine, while it decreased during the infusion of bupivacaine. Most of this discrepancy was due to the different plasma concentrations of the drugs.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01209.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Changes in cardiac index (CI), mean pulmonary artery pressure (PAP), mean pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and pulmonary artery vascular resistance (PVR), associated with spontaneous respiration (SR) and two different types of intermittent positive pressure ventilation (IPPPV and IPNPV) were studied in a total of 17 patients undergoing aortic valve replacement or myocardial revascularization.Swan‐Ganz thermodilution pulmonary artery cardiac output catheters were used and the aim was to determine: whether postoperative cardiac output may paradoxically be greater during IPPPV than during IPNPV or SR; whether the use of “negative” pressure in the expiratory phase during controlled ventilation may be responsible for bringing about the central haemodynamic conditions prevailing during spontaneous respiration; and whether, in weaning from postoperative IPPPV to SR, there is a risk of pulmonary congestion as a consequence of possible autotransfusion.IPPPV connected with anaesthesia induction caused a highly significant deterioration of central haemodynamics. The use of positive end‐expiratory pressure (PEEP) is not to be recommended for such patients at this stage.On the first postoperative day, the mean CI was lower during IPPPV than during IPNPV (P<0.1) or during SR (P<0.05). The changes observed in CI, were, however, so slight that the authors consider the routine use of PEEP to be beneficial during controlled ventilation following major open‐heart surgery. In some patients, the CI was paradoxically higher during IPPPV than during IPNPV or SR.The mean CI was nearly the same during IPNPV (3.32) as during SR (3.38). However, PAP, PCWP and PVR values were significantly higher during SR than during IPNPV. Thus, according to this study, the use of “negative” end‐expiratory pressure during controlled ventilation did not in these patients produce central pressure conditions corresponding to spontaneous respiration.The present study supports the finding that in weaning from controlled ventilation with PEEP to SR there is a danger of pulmonary congestion. This could be predicted by measurement of pulmonary wedge pressure, but not by measurement of central

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01210.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Forty patients who underwent elective cholecystectomy were examined preoperatively and during the first postoperative week by physical examination, measurement of FVC and FEV1, arterial pH and blood gas analyses, and chest x‐ray. Postoperative pulmonary complications (p.p.c.) were detected in 30 (75%) of the patients. Simple auscultation was the most sensitive tool in discovering p.p.c., but 18 of the 30 patients with complications also had a pathological chest x‐ray.Obesity, smoking, postoperative naso‐gastric tube and postoperative wound infection were predisposing factors for p.p.c. Six patients with preoperative pulmonary disease all had a progress in their lung pathology. There was no definite relationship of duration of anaesthesia or drainage of the abdominal wound to development of p.p.c.The patients with p.p.c. showed a deeper and more prolonged fall in Pao2postoperatively than the normal group. None of the normals showed an arterial Po2below 70 mmHg in the postoperative course, while 63% of the p.p.c. group did.FVC and FEV1showed marked reductions from preoperative values on the first postoperative day, and then gradually increased to near preoperative values after 1 week. Arterial pH and Pco2, showed no definite changes during the postoperative c

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01211.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

In order to find out how the need for analgesic supplementation during N2O‐O2‐relaxant anaesthesia is affected by chronic alcohol consumption, 82 patients with various known alcohol habits were anaesthetized for gastric or biliary surgery. Muscular relaxation was kept constant with the aid of a peripheral neurostimulator, and fentanyl was given in increments of 0.05‐0.1 mg for nociceptive symptoms during the anaesthesia.For induction, alcoholics (annual consumption above 151 pure alcohol) needed significantly more thiopental/kg body weight than social drinkers (1–151 annually) or non‐alcoholics (<11 annually), and excitative symptoms were more frequent in alcoholics. A positive correlation was found between fentanyl supplementation and alcohol consumption (r = 0.41), non‐alcoholics requiring on average 3.8 μ/kg/h of fentanyl, as compared with 6.4 μ/kg/h in alcoholics. This correlation was clearer than that found previously under similar conditions by the authors between halothane supplementation and alcohol consumption (r = 0.20). In both studies the correlation was partly due to the higher incidence of gastric surgery among alcoholics, since gastric surgery itself requires more supplementation. An analysis of the different symptoms pointing to the need for fentanyl supplementation revealed that the simultaneous occurrence of several symptoms and the prevalence of motor responses were more common in alcoholics. In one patient halothane had to be used as well. In other patients no special difficulties were observed, and none of the patients reported dreams or recollections. The results suggest that during N2O‐O2‐relaxant anaesthesia the demand for fentanyl supplementation is increased by about 70% in chronic alcoholics with a mean annual consumption of

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01212.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Using the intra‐arterial133xenon (133Xe) method, the cerebrovascular response to acute PaCo2reduction was studied in 26 unconscious, brain‐injured patients subjected to controlled ventilation. The CO2reactivity was calculated as δ In CBF/δ Paco2. The perfusion pressure was defined as the difference between mean arterial pressure and mean intraventricular pressure.Although the CO2reactivities did not differ significantly from that in awake, normocapnic subjects, it was low in the acute phase of injury, especially in those patients with severe outcome in whom the brain‐stem reflexes were often affected. An increase of the CO2reactivity with time was observed, indicating normal response after 1–2 weeks.Chronic hypocapnia in six unconscious patients resulted in sustained CSF pH adaptation. The question whether a delay in CSF pH adaptation exerts an influence on the CO2reactivity, and the influence of cerebral lactacidosis on the CO2response are

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01213.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Cerebral pressure‐flow relations were studied in anaesthetized dogs during acute arterial hypertension, induced by compression of the thoracic aorta. In one group of animals steady state measurements were made with the radioactive gas elimination method. In another group the immediate changes of blood flow at a blood pressure change, as indicated by variations in the cerebral venous oxygen saturation, were studied with continuous oximetric analyses of the superior sagittal sinus blood. The initial blood flow was varied by variations of the arterial carbon dioxide tension or injections of papaverine. At low or normal blood flows auto‐regulation was efficient up to pressures around 180–200 mmHg, while at higher flows the upper autoregulatory pressure limit was found at lower blood pressures. Above the autoregulatory limit ‐ irrespective of the control flow level ‐ there was a rise in blood flow and a decrease in cerebrovascular r

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01214.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY