摘要:

Cerebral blood flow (CBF), cerebral oxygen uptake (CMRo2) and central haemodynamics in anaesthetized dogs with controlled ventilation were studied at intervals for 2 h following an intravenous injection ofE. coliendotoxin, 1.0–1.5 mg/kg. CBF showed a 30% decrease within 15 min after the endotoxin administration, while the arterial blood pressure was still not markedly depressed. Autoregulation to arterial blood pressure changes was maintained during endotoxinaemia and the cerebrovascular reaction to changes in arterial carbon dioxide tension (Paco2) depressed. Normocapnic animals (PacO2≥ 4.0 kPa) showed an increase in CMRO2of over 40%, that was obvious 1 h after the administration of endotoxin. The intracranial pressure was decreased within 5 min of the administration of endotoxin irrespective of the prevailing arterial blood pressure. Thereafter, it was raised above the control level. Two hours after endotoxin increased protein concentrations in cerebrospinal fluid were seen, results compatible with blood‐brain barrier damage and penetration of other substances; e.g. monoamines released during endotoxinaemia could thus be expected to have a direct influence on both cerebral blood flow and metab

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01746.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

In an earlier study in dogs we found a reduced cerebral blood flow measured intermittently during the first holm after an intravenous injection ofE. coliendotoxin. Within 5 rnin after the endotoxin injection, a temporarily reduced cerebrospinal fluid pressure was seen irrespective of changes in arterial blood pressure. One possible explanation for this could be an early reduction of the blood flow in the brain. To test this hypothesis, the initial flow reaction was evaluated by measurement of the blood flow in the superior sagittal sinus using an electromagnetic probe around the intact sinus. In five animals followingE. coliendotoxin 1.0–1.5 mg/kg intravenously, the superior sagittal sinus blood flow decreased within 2 min, followed by increasing flows within 15 min and thereafter continuously decreasing values up to 60 min, thus giving a two‐phase vascular reaction. In all animals there was a marked initial increase in cerebrovascular resistance and the Fall in blood flow was thus not a mere consequence of blood pressure changes. In three other animals pretreated with methysergide. a serotonin antagonist, no increase in cerebrovascular resistance was seen during the initial phase. Later, the reaction was similar in all eight anim

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01747.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

E. coliendotoxin has been shown to decrease cerebral blood flow (CBF) and increase cerebral metabolic late of oxygen (CMRO2) in normocapnic dogs. The aim of this study was to investigate the effects of different clinical treatments on the cerebral and central circulation already under the influence of endotoxin. Thus the animals were treated with either methylprednisolone or a lactated Ringer's solution. CBF, CMRO2and intracranial pressure were followed. Central haemodynamic parameters, i.e. cardiac output, aortic pressure and pulmonary artery pressure, were also measured. Five dogs were given methylprednisolone (Solu‐Medrol®) 30 mg/kg 90 min after the endotoxin injection. Following this drug there were no significant changes in CBF when compared to controls. The primarily increased CMRO2did, however, show a transient decrease. Five animals were treated with a lactated Ringer's solution (Ringerdex®), 30 ml/kg, given intravenously over 20 min starting 90 min after the endotoxin injection. In these animals, the cardiac output as well as CMRO2returned to the values before endotoxin. CBF did not increase significan

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01748.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

In a patient with severe pulmonary hypertension, haemodynamic observations, including cardiac output and pressure measurements in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9to L1combined with Idatera1 pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100 g girl with an Apgar score of 9 at 1 rnin was delivered by vacuuni extraction. The patient died 9 days after the delivery because of intractable cardiac failure.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01749.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

The haemodynamic efferts of flunitrazepam (FLU) 1.25 mg × m‐2administered intravenously were studied in 18 anaesthetized cardiac patients suffering from isolated mitral (MIT, n = 6), aortic (AOR, n = 6) orcoronary (COR, n = 6) lesions. A placebo group of 18 clinically similar patients was used to asses the stability of the cardiovascular parameters under the conditions of the study. Heart rate. systemic arterial pressure, cardiac output and central venous pressure changes were measured 2, 5, 8 and 12 min after FLU or saline injection and compared with reference values collected before the start of the haemodynamic test. In the FLU group, the cardiovascular state of all the patients developed following the same pattern and the greatest differences were observed at 12 min post‐injection. These differences, expressed as a percentage 01 the initial values were (*P<0.05;**P<0.01;***P<0.001; ns = non‐significant):mean systemic arterial pressure:COR, ‐18% (**); MTT, ‐13% (*); AOR, ‐23% (**);heart rale:COR, 0% (ns); MIT, ‐10% (*); AOR, ‐12% (*);cardiac output:COR, ‐15% (**); MIT, ‐13% (*): AOR, ‐16% (**);.stroke volume:COR, ‐12% (*); MIT, 0% (ns); AOR, ‐3% (ns). This shows some differences concerning the SV and heart rate changes in the valvular and COR patients. As compared to the data from the literature, most of the haemodynamic effects of FLU seem relatively independent of the init

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01750.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Blood loss during total hip arthroplasty and the relation of different anesthetic techniques to surgical bleeding was explored in a consecutive, prospective study involving 157 patients with no previous history of hip surgery. Intraoperative blood loss was significantly reduced in patients operated under sodium nitroprusside induced hypotensive anesthesia as compared to halothane, NLA or epidural block. It might be suspected that postoperative blood loss is increased when the lowered blood pressure is raised towards normotension, but this was not the case. However, regression analysis between mean arterial pressure and intraoperative blood loss in patients anesthetized with hypotensive as well as “normotensive” techniques showed a poor correlation. Blood loss was greater with NLA and halothane anesthesia than with epidural block. The authors consider controlled hypotension a useful adjuvant in anesthesia for total hip arthroplasty in selected patients. Epidural block, on the other hand, is a suitable anesthetic technique for most patients and has the additional advantage of reduced surgical bleeding as compared to general anesthe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01751.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

A large and important group of acid‐base disturbances are the metabolic acidosrs. In grneral. every type of nietabolir acidosis can be treated with infusion of base when the underlying cause of the disturbances is removed. In our medical centers, the use of tris and bicarbonate is common. For a long time they were competitive agents and until now it was not possible to decide by available clinical methods which of these substances was more suitable for correction of metabolic acidosis. The intracellular pH of the whole rat (mean Icf‐pH) was determined from the distribution of14C labelled DMO (5,5‐dimethyl‐2,4‐oxazolidinedione) and monitored for 6 h following intravenous application of tris or sodiumbicarbonate in a dose of 10 mmol per kq body mass. Arterial plasma pH and PCO2were also measured. To determine and compare the effectiveness of the two buffer substances, intra‐and extracellular bicarbonate were calculated from the Henderson‐Hasselbalch equation. It was found that the buffering following bicarbonate infusion is more effective in both body compartments. Sodiumbicarbonate should be preferred in d

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01752.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

The autoregulation of myocardial blood flow was studied under: (a) haemorrhagic hypotension (mean pressure decrease 40% from baseline); (b) drug‐induced hypotension with sodium nitroprusside or trimetaphan (40% pressure decrease); (c) drug‐induced hypotension (40% pressure decrease) after moderate blood loss of 20%. Dogs were used in experiments under general anaesthesia with sodium thiopentone and artificially ventilated with N2O/O2(70%, 30%) and pancuronium. Under haemorrhagic hypotension, the flow was pressure‐dependent from the beginning. During nitroprusside hypotension, there was autoregulation of coronary flow to the level of mean pressure decrease 30% from control. Under trimetaphan, a constant flow persisted to the level of mean pressure decrease 20% from the baseline. Identical changes were seen during drug‐induced hypotension after moderate blood loss (20%). Central venous pressure, cardiac output, left ventricular stroke work and minute work changes are demonstrated. Blood gas data pH, Po2, Pco2in the aortic and coronary sinus under drug‐induced hypotension are compared with control groups. There is a level of autoregulation of myocardial blood flow under hypotension. This level can be unfavourably changed in cases with hypertension and coronary obstructive

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01753.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

The effects of induction of anaesthesia by etomidate 3 mg·kg‐‐1followed by continuous infusion of etomidate 2 mg·min‐1, fentanyl 0.01 mg·kg‐1and pancuronium 0.1 mg·kg‐1were studied in ten patients with valvular heart disease. No haemodynamic changes were seen after injection of etomidate, but after fentanyl was given thew was a significant decline in cardiac index (10%), in mean arterial systemic pressure (20%), in systemic vascular resistance (14%), in left ventricular minute work index (27%) and in right ventricular minute work index (21%) compared to the control values. After supplementing with pancuronium, no further significant changes were seen. There was no significant change in the pulmonary vascular resistance during the whole study. In conclusion, it appears that etomidate is a safe intravenous agent, and is worth further study, in particular in patients with minimal cardiac reserve requiring high inspired o

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01754.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

The validity of the transcutaneous oxygen tension (Ptco2) method as opposed to measurement of arterial oxygen tension (Pao2) and mixed venous oxygen saturation (SV̄O2), for monitoring optimal oxygen transport, was studied in six mechanically ventilated pigs with an oleic acid lung injury. With stepwise increments in positive end‐expiratory pressure (PEEP) from zero to 20 cmH2O, maximum oxygen flux was found at a PEEP of 8 cmH2O and named “optimal PEEP”. With increasing PEEP, cardiac output (CO) was maintained up to a PEEP of 8 cmH2O, when it began to decline, while venous admixture decreased at all respiratory settings up to a PEEP of 16, when it was about one‐fourth of the value (38.7%) at a PEEP of zero. Pao2increased with rising PEEP and reached a steady level at a PEEP of 16 cmH2O. Ptco2and Sv̄O2parallelled each other and rose steeply up to a PEEP of 8 cmH2O. They showed a further slight increase up to a PEEP of 12 and alter that a tendency to decrease. It is concluded that Ptco2and Sv̄o2both seem to distinguish the optimal PEEP and give more adequate information than does Pao2. The Ptco2method has the advantage of being no

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01755.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY