摘要:

At present there is a lack of information concerning haemodynamic changes related to the degree of sympathetic blockade during spinal analgesia. In this investigation, involving 36 patients, changes in haemodynamic parameters were studied in 30 patients receiving spinal analgesia and in six patients having “sham spinal” analgesia. Three local anaesthetic solutions were used: bupivacaine without and with glucose and tetracaine with glucose. Skin conductance responses were used to evaluate changes in provoked sympathetic activity. It was found, as in previous studies, that a complete block of sympathetic activity in the foot was seen in only 60% of patients with an average analgesic level of T4. A partial sympathetic blockade was registered up to and above the level of analgesia. In 25/30 cases only minor alterations in cardiac output, heart rate, stroke volume, mean arterial pressure and systemic vascular resistance were seen in spinal analgesia whose level reached on average T4–5. In five cases in whom analgesia reached T4‐3, mean arterial pressure fell≥30% with a well‐preserved cardiac output, but with complete sympathetic blockade up to T5, and in two cases also in the hand. Only minor differences were observed between the different anaestheti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02605.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

To discover the influence of age and body mass on spinal analgesia with hyperbaric tetracaine, 60 patients (17–82 years) were administered a subarachnoid injection of 15 mg tetracaine in 3 ml of 5% glucose. The patients were in the lateral position during the injection and in the supine position thereafter. The maximal spread of analgesia (mean T4, range T1‐T11) did not correlate with age or body mass. Any variable studied was not significantly different for the different age groups. In 29 patients (48%) the block required supplementation with fentanyl or general anaesthesia (five patients). Tourniquet‐induced pain occurred in eight patients (28% of patients with tourniquet). Decreases in systolic arterial blood pressure,>30% of the preanaesthetic value, correlated with the level of analgesia and were more frequent in patients over 50 years (P<0.01). Severe hypotension and bradycardia with transient serious changes in QRS‐complexes occurred in one patient (analgesia level, T3). In conclusion, 15 mg of hyperbaric tetracaine provided a relatively high sensory spinal blockade without correlating with age or body mass. Supplementation of analgesia during surgery was needed in almost half of the patient m

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02606.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Cardiac output, central haemodynamics and regional blood flows were studied in pigs. The microsphere technique was used for blood flow determinations. Measurements were made during spontaneous breathing (SB) and during intermittent positive pressure ventilation with 0.8 kPa (8 cmH2O) positive end‐expiratory pressure (8 PEEP) before and during thoracic epidural analgesia (TEA). TEA in the pig caused reduced cardiac output due to reduced heart rate with maintained stroke volume. During TEA there was also a reduction of mean arterial blood pressure which ran almost parallel to the decrease in cardiac output with maintained systemic vascular resistance during SB and at 8 PEEP. The distribution of cardiac output was basically the same during SB and at 8 PEEP as it was before TEA. However, myocardial blood flow and relative perfusion decreased during TEA, both during SB and at 8 PEEP. TEA also reduced spinal cord blood flow within the thoracic region during SB and at 8 PEE

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02607.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo2) were studied during hypotension induced with sodium nitroprusside (SNP) in 10 patients undergoing total hip replacement a.m. Charnley. Cerebral blood flow was measured using an injection ofxenon‐133 intoan arm vein. The decay curve was detected by five scintillation counters placed over each hemisphere and analysed with theNovo 10a cerebrograph.Blood samples were drawn from the radial artery and the jugular venous bulb to calculate the CMRo2. In the group as a whole, there were significant decreases in mean arterial pressure and in cerebrovascular resistance. There were no significant changes, in either CBF or CMRo2in the group as a whole, but there were substantial individual differences. In conclusion, the use of SNP‐induced hypotension for extracranial surgery should be used only in patients monitored clos

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02608.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The amount of reactive oxygen intermediates (ROI) generated by activated polymorphonuclear neutrophils (PMN), as well as the closeness of contact between PMN and vessel wall, may determine whether PMN activators will induce the adult respiratory distress syndrome. We examined the ROI‐generating and aggregating effects of zymosan activated plasma (ZAP), phorbol myristate acetate (PMA) and n‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP), on isolated human and rabbit PMN. PMA, after a short lag phase, induced a large and long‐lasting increase in ROI generation. The initial peak response was higher and more rapid in human than in rabbit cells. The reaction to FMLP occurred almost instantaneously, but was much weaker than that to PMA, and ROI generation returned to near baseline in less than 10 min. No species difference was seen. ZAP caused an FMLP‐like ROI response in human cells, whereas no response was observed in rabbit PMN. PMN aggregation was induced by all three activators, most markedly by PMA. No species difference was detected for PMA; FMLP gave a stronger aggregation of rabbit than of human PMN, however, while the opposite was true for ZAP. In conclusion, ZAP was a potent stimulus for PMN aggregation, but had modest (or no) effects on the production of ROI. Marked differences between human and rabbit PMN responses

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02609.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The effects of complement activation on pulmonary vascular permeability are disputed. In rabbit lungs perfused with autologous blood, zymosan activated plasma (ZAP) induced a moderate increase in pulmonary vascular resistance (PVR), but did not detectably change the vascular permeability within 2 h. The stronger neutrophil granulocyte (PMN) activator, phorbol myristate acetate (PMA), usually gave larger PVR increases and also increased pulmonary vascular permeability. Lungs from neutropenic animals, similarly perfused and given PMA, showed unchanged PVR reactions but had no apparent increase in vascular permeability. Lungs perfused with cell‐free medium and given PMA displayed modest PVR increases, and no measurable permeability change. The lung preparatory procedure itself markedly influenced leukocyte circulation. Exsanguination of lung donors decreased the concentration of circulating PMN significantly, and they virtually disappeared from the perfusate within minutes after start of lung perfusion. PMN‐mediated effects must therefore have been caused by cells already sequestered in the lungs. We conclude that ZAP docs not induce an increased pulmonary vascular permeability in isolated, perfused rabbit lungs, in contrast to PMA. The permeability effects of PMA appear to be PMN depend

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02610.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This report concerns three patients in whom continuous intravenous infusion of Diazemuls® (diazepam dissolved in soya bean oil and emulsified) diluted in 5.5% glucose was used for the controlling of epileptic‐seizures (status). Diazemuls infusion was effective in one patient with complex partial status epilepticus; in another patient with convulsion secondary to a brain stem infarct, the convulsions were abolished; while only reduced jerking was achieved in the third patient suffering from myoclonic jerks caused by anoxic brain damage. Infusion time ranged from 15 to 33 h. The serum concentrations of diazepam obtained during the infusions were higher than recommended in the literature for treatment of status epilepticus, but could not be correlated to either clinical efficacy or infusion ra

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02611.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Strong premedication may prolong recovery and cause side‐effects after short surgical procedures in general anaesthesia. To be operated without premedication may be unpleasant for the patient. Midazolam is a water‐soluble benzodiazepine with rapid onset and short half‐life. In a randomized study with 193 female patients, we compared the effects and side‐effects of three different premedicants i.m.: midazolam, morphine‐scopolamine (Mo‐Scop) and placebo. Midazolam and Mo‐Scop had an equal and significantly better effect than placebo on preoperative anxiety and alertness. Side‐effects like nausea, dry mouth and prolonged recovery occurred significantly more often in the Mo‐Scop than the midazolam or placebo groups. The midazolam‐premedicated patients had significantly more amnesia compared with the other two groups. Only 3% of the patients would prefer no medication before anaesthesia, whereas 80% would prefer a combination of an anxiolytic and hypnotic premedication. Sixty‐three percent of the patients would prefer a premedicant administered by injection. The results indicate that midazolam i.m. is an effective premedicant, with few side‐effects, for short procedures

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02612.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Twenty‐one patients who underwent elective cholecystectomy were studied with regard to the effect of intrapleural administration of bupivacaine‐adrenaline solution on postoperative pain and ventilatory capacity. Administration of 10 or 20 ml of 2.5 mg/ml or 5 mg/ml bupivacaine solution resulted in complete analgesia in 143 of 159 administrations. Most patients experienced the maximal pain‐relieving effect within 1–2 min and analgesia persisted as a rule for 3 5 h. Forced vital capacity and forced expiratory volume in 1 s increased after intrapleural analgesia on average by 56% and 46%, respectively, on the first postoperative day and by 35% and 51%, respectively, on the second day. There was no significant difference in the analgesic effect or in the effect on the ventilatory capacity between the 2.5 mg/ml or the 5 mg/ml solution, in either the 10 ml or the 20 ml dose. Placebo (NaCl) given intrapleurally had no effect on pain or on the ventilatory capacity. The plasma concentration of bupivacaine after intrapleural administration showed a wide interindividual variation, with considerably higher average values when the 5 mg/ml solution had been used than for the 2.5 mg/ml solution. Although no toxic effects were noted, a 2.5 mg/ml solution, which can be given in an initial dose of 20 ml and top‐up doses of 10 ml at 3–6 h intervals, is recommended. In four patients minor pneumothorax developed when the catheter was introduced. The pneumothorax was easily evacuated, but underlines the need for great care when introducing t

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02613.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Peroperative thermal losses were studied in 28 patients (mean age 64 years) operated for a total hip prosthesis under controlled hypotension. The patients were split into four groups according to the method of hypothermia prevention used: reflective blanket, heating humidifier of inhaled gases, combination of both techniques or no prevention at all. The thermal loss was quicker and more intense in the last group. The superiority of one prevention method over another could not be demonstrated, but the urgency of its implementation proved to be essential.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02614.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY