摘要:

Bronchiolar epithelial lesions, similar to those in human hyaline membrane disease (HMD), can be induced by artificial ventilation of newborn rabbits, delivered on day 27 of gestation. As verified by electron microscopy, these epithelial lesions develop within only 1–5 min of artificial ventilation. Tracheal instillation of natural surfactant at birth improves lung‐thorax compliance in these animals, enhances the aeration of the alveolar compartment. and prevents the development of bronchiolar epithelial lesions. This prophylactic effect is obtained even when the compliant lungs of the surfactant‐treated animals are greatly overventilated, i.e. when the ventilator is set at standardized high insufflation pressure. The application of a low positive end‐expiratory pressure (5 cmH2O) also results in increased lung‐thorax compliance, and reduces the extent of bronchiolar epithelial lesions. These findings suggest that the epithelial lesions are secondary to an abnormal expansion pattern. In a premature neonate with surfactant deficiency, overdistension of airways and irregular aeration of the alveolar compartment might produce shear stress in the airway mucosa, leading to disruption of the epithelium and formation of hyaline membranes. The same mechanism is probably also involved in the pathogenesis of the epithelial lesions in human neo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01733.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

The smooth muscle effects on human umbilical arteries of four different local anaesthetic agents‐lidocaine. etidocaine, prilocaine and bupivacaine‐were studied. Lidocaine and etidocaine relaxed the arteries. etidocaine more profoundly than lidocaine. Prilocaine in the concentration range 10‐1,000 μg/ml caused pronounced contractions. Bupivacaine consistently evoked a contractile response in the concentration range 5–25 pg/ml. but at lower and higher concentrations the response to this drug was inconsistent. The concentrations of lidocaine were determined in six human umbilical arteries following maternal epidural block with this agent and were found to be 0.1‐1.7 μg/g tissue. The contractile actions of prilocaine and bupivacaine on the human umbilical arteries are undesirable and might be hazardous if high concentrations are attained, e.g. during paracer

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01734.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Levomepromazine 0.1 μg/kg or droperidol 0.15 mg/kg for induction of neurolept anaesthesia were compared in a double‐blind prospective study of 60 patients undergoing upper abdominal surgery. On the morning after surgery, eight of 30 patients (26.7%) who received droperidol remembered having had unpleasant anxiety, or nightmarish or panicky experiences during induction of anaesthesia, whereas only one of 30 patients (3.3%) receiving levomepromazine experienced such unpleasant adverse effects (P<0.0l). During anaesthesia, the patients induced with levomepromazine needed somewhat less fentanyl, had somewhat less pain intensity, during the first 3 h after surgery, and they required the first postoperative dose of morphine 1.5 h later than the patients receiving droperidol (p<0.02). There was no difference in the number of patients receiving naloxone at the end of anaesthesia in the two groups. However, 21 of 30 patients (70%) in the levomepromazine group and only seven of 30 patients (23.3%) in the droperidol group were given physostigmine for arousal at the end of anaesthesia (p<0.0l). There was no difference between the two groups in the occurrence of postoperative nausea, restlessness, hallucinations, or sedation in the recovery ward. This study shows that levomepromazine is superior to droperidol for induction of neurolept anaesthesia because it gives less psychic adverse effects. more analgesia, and a deeper sedation, which is easily reversed with physostigmine at the end of anaesthes

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01735.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

In order to evaluate a new method of heparinization, uncoated (22) and heparin‐coated (27) central venous polyethylene catheters were inserted in 49 patients via basilic and cephalic veins punctured at the fossa cubiti. The mean duration of catheterization was 5.7 (1–11) days. One‐third of the patients with heparin‐coated catheters, and one sixth with uncoated catheters developed clinical thrombophlebitis, with a maximum incidence between 4 and 8 days after catheterization. A higher risk of developing thrombophlebitia in the first 4 days after catheterization was found in the patients with heparin‐coated polyethylene catheters. After 8 days of catheterization, it seems that there is a lower risk of new cases of thrombophlebitis appearing both in patients with uncoated and those with heparin‐coated polyethylene catheters. Radiological thrombosis, regardless of duration of catheterization and heparin‐coating, was demonstrated in all 22 patients investigated by “pull‐out” phlebography. The heparin‐coating did not decrease the rate of thrombotic complications. Location of the catheter tip in subclavian veins was associated with a significantly higher incidence of large, parietal thrombi and catheter occlusion than when the tip was situated in anonymous veins, the superior vena cava, or the right atrium. Cannulation by heparin‐coated, polyethylene tubing did not reduce the rat

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01736.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

With the purpose of producing a lung damage model simulating post‐traumatic pulmonary insufficiency, oleic acid 0.1 ml‐1kg‐1body weight (b. w.) was infused intravenously into eight mechanically ventilated young pigs, and the effects were studied for 2 h. After the infusion, Pao2during air breathing decreased to a fairly low and stable level of about 7 kPa. Venous admixture during air breathing and Vd/Vtshowed a marked initial increase and then remained unchanged, while venous admixture during breathing of pure oxygen increased but less markedly. Haematocrit (EvF), arterial carbon dioxide tension (Paco2) and base excess (BE) were unchanged. Mean pulmonary arterial pressure more than doubled and cardiac output decreased by 1/3, which was considered to reflect an insuperable increase in the resistance of the pulmonary blood flow. The lung model was found to resemble post‐traumatic pulmonary insufficiency with respect both to the V/Q ratio displacement and to the macroscopic appearance of the lungs at

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01737.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Acute myocardial ischaemia was induced in five greyhounds by ligation of the anterior descending branch of the left main coronary artery. Changes in oxygen availability and consumption in the ischaemic area in response to thiopentone 10 mg kg‐1were compared with corresponding changes in non‐ischaemic myocardium supplied by the circumflex artery. Despite a 40% reduction in arterial pressure, there were no significant changes in the oxygen availability/consumption ratio in either normal or ischaemic ar

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01738.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Significant and clinically important bradycardia has been observed on spraying the larynx in children irrespective of routine intramuscular administration of anticholinergic drugs. Intravenously administered anticholinergics, particularly glycopyrrolate (7.5 μg kg‐1), are more effective. It is, however, suggested that spraying the larynx may be avoided altogether in childr

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01739.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Halothane was administered at an end‐tidal concentration of 1% to 10 patients with stable ischaemic heart disease and clinical and haemodynamic signs of moderate heart failure. Measurements of central haemodynamic variables, coronary sinus blood flow and oxygen, lactate and hypoxanthine balances over the myocardium were done before and at steady state during halothane anaesthesia. Halothane induced marked haemodynamic changes with decreases in mean arterial pressure; (‐43%), mean pulmonary arteriolar occlusion pressure (‐42%), systemic vascular resistance (‐31%), cardiac index (‐20%), stroke volume index (‐31%) and left and right stroke work indices (‐62% and ‐55%, respectively). Heart rate and pulmonary vascular resistance did not change. Coronary sinus blood flow decreased in parallel with perfusion pressure, and myocardial oxygen consumption decreased (‐40%), as did myocardial oxygen extraction. Rate pressure product and triple product correlated better with changes in myocardial oxygen consumption in the present subset of patients than in healthy volunteers during halothane anaesthesia. The findings suggest that halothane, through its systemic vasodilatory effect, unloads the failing left ventricle and that this peripheral action predominates over the direct cardiodepressant action of the agent. The combined findings of unchanged coronary vascular resistance, decreased myocardial oxygen extraction and absence of increasing or pathological levels of lactate and hypoxanthine in coronary sinus blood imply a direct dilatory effect of halothane on the cor

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01740.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

A series of 100 patients undergoing caesarean section was studied using ketamine 1.2 mg/kg as induction agent. Fifteen minutes prior to induction, atropine 0.25‐0.5 mg and diazepam 1 mg was given intravenously as premedication. Anaesthesia was maintained with N2O:O2, FIO20.4. Once the umbilical cord was clamped, 0.2 mg fentanyl and 9 mg diazepam was given intravenously. Except for nitrous oxide, no more anaesthetic intravenous or inhalational agent was needed. Despite the fact that patients with known intrauterine asphyxia before the induction were included in the material, we found excellent Apgar scores (mean 9.1 at 1 min and 9.9 at 5 min). None of the patients reported awareness during the operation. Eight patients experienced pleasant dreams and three unpleasant. There were no hallucinations in the recovery area. The mental condition of the mothers after the operation was acceptable. It is suggested that ketamine can be used not only on special indications but also as a routine method for induction of anaesthesia for caesarean sectio

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01741.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

In patients premedicated with scopolamine + morphine (+ 5 mg nitrazepam the evening before surgery), the sleep‐inducing effect of midazolam 0.15 mg/kg l. v. was clearly slower in onset than that of thiopentone 4.67 mg/kg‐1. v. Somewhat fewer cardiovascular and local sequelae were found in the midazolam group, but, although apnoea occurred less often in the midazolam group it lasted longer. On the whole, the differences between midazolam and thiopentone had no apparent clinical consequences. Midazolam is a new alternative agent for induction in combination anaesthe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01742.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY