ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02394.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In six patients undergoing neurosurgical operation, brain surface oxygen pressure was studied during an increase of the inspired oxygen fraction (Fio2). The eight‐channel oxygen surface electrode (MDO‐electrode) was placed directly on the brain cortex. Fio2was increased to four levels, from baseline level 0.21 to 0.3, 0.5, 0.7 and 1.0, respectively. During these four stages and Fio20.21, brain surface oxygen pressure (Pto2) was measured. The physiological variables such as blood pressure, Paco2, pH and temperature were stable throughout the study. The results are presented as mean values ± s.d. and a Pto2histogram for each Fio2‐level. Already at an Fio2of 0.3 (at a Pao2of 16.3 ± 3.4 kPa) scattered histograms were seen in five of six patients. A scattered histogram indicates disturbed microcirculation. At the Fio2levels of 0.5, 0.7 and 1.0, all histograms were scattered. The Pto2values did not increase proportionally to Pao2at Fio2levels 0.3, 0.5 or 0.7. But at Fio21.0 four patients had normal mean Pto2values and two patients very high mean Pto2values. It is possible that the four patients with normal Pto2values succeeded in regulating the cerebral microcirculation as a response to the high Fio2leading to a high Pao2(60.1 ± 6.4 kPa). The same study was initially done on six pigs in which the regional cerebral blood flow (rCBF) was also measured. MDO‐electrode measurements at different Fio2‐levels gave the same results as in the patients. rCBF decreased when Fio2w

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02395.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Forty otherwise healthy male patients, scheduled for elective inguinal herniotomy, were randomly allocated to spinal anaesthesia with 3 ml 0.5% hyperbaric tetracaine or bupivacaine under double‐blind conditions. The extent of blockade (pin‐prick and cold sensation), blood pressure and heart rate and plasma catecholamines were measured before and 5, 10, 15, 20 and 30 min after injection, before skin incision. Cephalad spread of sensory and temperature analgesia was insignificantly higher after tetracaine. The mean time taken to reach maximal spread of analgesia was 22 min in both groups. Mean arterial pressure showed a more pronounced decrease in the tetracaine group (22 vs 12%,P<0.009). Heart rate fell slightly and similarly in both groups, while rate‐pressure product was significantly lower in the tetracaine group. The correlation between the decrease in mean arterial pressure and the cephalad spread of sensory analgesia was similar in the two groups, suggesting that at identical levels of sensory analgesia changes in blood pressure were similar after tetracaine and bupivacaine. Plasma norepinephrine and epinephrine measurements before spinal puncture and at maximal decrease in mean arterial pressure showed a depressed response to fall in blood pressure in the tetracaine group. It is concluded that spinal anaesthesia with 3 ml hyperbaric 0.5% tetracaine is followed by a more pronounced fall in blood pressure compared to an identical dose of bupivaeaine. The more pronounced sympathetic blockade, confirmed by plasma catechoiamine measurements, following tetracainc is probably due to a higher cephalad spread of neurogenic blockade, rather than a differential effect on sympathetic nerve f

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02396.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Blood coagulation and fibrinolysis were studied in 20 premenopausal women undergoing abdominal hysterectomy under general anaesthesia (GA) or high epidural analgesia (EDA). As expected, the adrenocortical stress response was suppressed in the EDA group. The Factor VIII complex (F VIII:C, F VIII R:Ag = von Willebrand factor), known to be related to adrenocortical activity and/or vessel wall reactivity, was found to increase less in the EDA group. With regard to all the other variables analysed there were no significant differences between the groups. With both anaesthetic procedures activation of coagulation could be demonstrated by a decrease in prekallikrein, F X and antithrombin as well as by an increase in fibrinopeptide A levels, A decrease in plasminogen and alpha2‐antiplasmin suggested activation of the fibrinoiytic system and a decrease in prekallikrein and kallikrein inhibition activity (C‐1‐esterase inhibitor) an activation of the kallikrein system. In this study only the differences in F VIII complex could explain the previously reported higher thromboembolic frequency after GA as compared t

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02397.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Two cases of malignant hyperthermia (MH) are presented. One patient was treated symptomatically for the first 6 h until she was given dantrolene. Her clinical course was complicated and the catecholamine and cortisol concentrations were still elevated 24 h after start of treatment. In the second patient an early diagnosis was made and treatment promptly instituted. Only minor endocrine‐metabolic changes were seen in this patient. However, in spite of the early successful treatment with dantrolene the MH reaction recurred 12 h after the initial symptoms. These two cases demonstrate the importance of early treatment including dantrolene. Successful treatment with dantrolene does not, however, preclude a recurrence of MH, and thus subsequent doses of dantrolene should be give

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02398.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The respiratory effects of high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of spirometry, nitrogen single‐breath test and flow‐volume loop. After the baseline measurements an epidural catheter was inserted at T4 level, and 5 ml of 0.5% bupivacaine were injected. This volume led to sensory block within dermatomes T1‐T5. Total lung capacity, vital capacity and inspiratory capacity decreased slightly but significantly during TEA. Expiratory reserve volume was not affected. Maximal inspiratory flow at 50% VC decreased 24%. Maximal expiratory (low at 75% VC and peak expiratory flow were not changed. N2difference during a constant flow rate of 0.5 l/s and forced expiratory volume in l s were not changed, which indicates that there were no changes of bronchial tone. The respiratory effects of high TEA in this study were caused by the motor block of the intercostal mu

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02399.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The performances of an Oxford miniature vaporizer (OMV) and a Fluotec Mark III vaporizer filled with an azeotropic mixture of halothane and diethyl ether were studied. Gas concentrations were estimated using an EMMA gas analyser and a MIRAN spectrophotometer. Calibration tables for both vaporizers were derived. In a small clinical series with air as the carrier gas, to which a small amount of oxygen was added, the azeotrope was found to be a satisfactory anaesthetic agent, giving a short awakening time and an almost pain‐free postoperative cours

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02400.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The new benzodiazepine triazolam was given to six initially awake dogs maintained with spinal anaesthesia and mechanical ventilation. Both cerebral blood flow (CBF) and cerebral metabolic rate for O2(CMRo2) were significantly reduced after the initial dose of 0.1 mgx kg‐1triazolam, and the EEG changed from an awake to a sleep pattern in less than 20 s. CMRO2was gradually reduced with increasing doses of triazolam (0.3, 1.0, 10.0 and 30.0 mgx kg‐1) to 76% of control after the final 30 mgx kg‐1dose. CBF did not decrease further after the initial dose, and the addition of N2O after the final dose did not cause any significant change in CBF or CMRO2. The dogs were hemodynamically stable during the study. Small increases in brain lactate and pyruvate levels, but not in the L/P ratio were the only significant changes in brain metabolite levels. Triazolam appears to be a safe and rapidly acting induction agent in th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02401.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A prospective study of the arterial supply of the hand was carried out in 100 ICU patients after cannulation of the radial artery. Patency of the radial artery was checked using a reversed Allen's test and Doppler ultrasonic technique. Furthermore, radial artery angiography was carried out in 15 patients with suspect thrombosis, and the artery was examined by microscopy in four patients at autopsy. Signs of thrombosis, Allen's test and Doppler technique, were found in 33/100 patients. In 10/15 angiograms a thrombosis was visualized, and in 3/4 patients at autopsy a thrombosis was found. The incidence of thrombosis was not correlated to sex, age, size of artery (judged by wrist circumference), cannulation technique or the presence of hypotension. It did, however, correlate to the presence of haematoma at the puncture site. After removal of the cannula recanalisation occurred soon in the majority of cases.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02402.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Perivascular axillary blockade was performed on 233 patients with the aid of a catheter technique. All patients received a primary injection of 50 ml of mepivacaine 1% with adrenaline. Sensory blockade was evaluated 20, 30 and 40 min after injection, and a complete sensory blockade was found in 90 (39%), 131 (57%) and 146 (63%), respectively. The blockade effect of a supplementary perivascular injection of 20 ml of the same agent was investigated on the remaining 87 blockades, which could be divided into three categories: 1) blockades which at 20 min showed lack of analgesia in several cutaneous segments of the hand (34 patients); 2) blockades which at 30 min showed a total lack of sensory blockade within a limited area (29 patients); and 3) blockades which at 40 min showed signs of blockade of all cutaneous segments, but one or several segments were not blocked with an intensity compatible with surgery (24 patients). Blockades of categories 1 and 2 were at 20 and 30 min, respectively, randomly allocated to control or to perivascular supplementation groups, while blockades of category 3 all had supplementation at 40 min. Sensory blockade was reevaluated 10 and 20 min after group allocation, and it was found that perivascular supplementation had no significant effect on the sensory blockade in category 1 and 2, while 68% of the blockades in category 3 improved to a complete blockade. It was concluded that the effect of a supplementary perivascular dose of local anaesthetic could be judged as acceptable with regard to intensifying an insufficient sensory blockade, but that it was incapable of extending the blockade into areas which were totally unblocked after the primary injection. On the basis of a previous and the present investigation, we have suggested practical, simple guidelines which might help the anaesthetist in deciding on his course of action when faced with an inadequate axillary blockade.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02403.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY