摘要:

Twelve patients, subjected 20 h earlier to coronary artery bypass surgery, were studied on discontinuation of the postoperative mechanical ventilation employing PEEP+5 cmH2O (CMV + PEEP). Compared to the values obtained during CMV + PEEP, cardiac index and mixed venous blood oxygen tension increased with the change to spontaneous ventilation at ambient pressure, employing a 28% O2Ventimask® for the intubated patient. There was a slight decrease in both the arterial oxygen content and oxygen tension, but the increase in cardiac output compensated well for the lowering in the arterial oxygen content, and consequently the systemic oxygen transport was statistically unaltered. Oxygen consumption, pulmonary shunt fraction and arteriovenous oxygen content difference also remained unaltered. The observations suggest that after open‐heart surgery, CMV using a PEEP as low as+ 5 cmH2O may exert, in comparison to controlled oxygen therapy during spontaneous breathing, a significant lowering effect on the already compromised cardiac performance. This necessitates continuous weighing of the beneficial effects obtained by employing postoperative CMV + PEEP, against the adverse haemodynamic effects, although the alterations in cardiac output may partly ensue from the changes in metabolism, muscular effort and oxygen consumption during the two modes of ventilation, although there was no significant increase in oxygen consumpti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01611.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

In a prospective clinical study including 100 patients, the consequences of using the interscalene approach to block the brachial plexus were investigated according to the area of analgesia, complications and blood concentrations of local anesthetics. Sufficient analgesia of the shoulder and the upper part of the arm was obtained in 98–99% of the cases, whilst the area of analgesia in the forearm and the hand was more variable. In two groups, with 10 patients in each group, the blood concentration was measured during the first 50 mill after injection in the neurovascular sheath by either the interscalene or the axillary approach. The peak values were at the same level in the two groups, but there was a much more rapid rise in concentration in the interscalene group. No toxic reactions were seen. The complications were in accordance with those reported in other publication

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01612.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The placental transfer and pharmacokinetics of atropine were studied in 44 healthy parturients undergoing caesarean section. The concentrations in the plasma were determined by a new radioimmunoassay after intravenous (n = 32) or after intramuscular (n = 12) administration of 0.01 mg/kg of atropine. A fast placental transfer with apparent foetal uptake of the drug was found after intravenous injection. There was also a difference in the umbilical vein and artery concentrations after intramuscular administration. The maternal pharmacokinetics of i.v. atropine obeyed a two‐compartment open model with a fast distribution phase (mean tα1/2= 1.02 min) and quite fast elimination (t1/2= 2.56 h). The total apparent volume of distribution was 1.0 1/kg and the total plasma clearance 6.36 ml/min/kg. The mean peak maternal plasma levels after i.m. atropine administration were found at 1.59 h and the mean calculated half‐life of elimination was then 2.1 h. No atropine was found in the amniotic f

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01613.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The development of intracuff pressure in a Shiley tube with a high‐residual‐volume, low‐pressure cuff was studied in 61 patients during nitrous oxide‐oxygen anaesthesia and after replacement of nitrous oxide with nitrogen in the anaesthesia system. The mean minimal occluding pressure of the cuff filled with air was 18 cmH2O (1.8 kPa). In the 27 Group I patients, the intracuff pressure was always adjusted to its initial value after reaching the value of 25 cmH2O (2.5 kPa). In the 34 Group II patients, the intracuff pressure was allowed to increase freely. In Group I, the intracuff pressure reached the value of 25 cmH2O (2.5 kPa) in about 34 min. In Group II, the intracuff pressure increased linearly up to 120 min, reaching the value of 38 cmH2O (3.7 kPa). Thereafter, the increase in the intracuff pressure slowed to about 40 cmH2O (3.9 kPa) at 150 min. During 60 min after the replacement of nitrous oxide with nitrogen, the intracuff pressure in Group I decreased from 22 cmH2O (2.2 kPa) to 15 cmH2O (1.5 kPa) and in Group II from 36 cmH2O (3.5 kPa) to 24cmH2O(2.4kPa). During 240 min after extubation, the incidence of hoarseness ranged from 12 to 25% in Group I and from 19 to 28% in Group II. During 60 min after extubation, sore throat did not occur in Group I, whereas in Group II, its incidence was 13% (P<0.05). No other side‐effects possibly associated with intubation were noticed. Eighty percent of the patients who developed side effects were women, whereas 60% of all patients were women. The present results suggest that even during a relatively short period of intubation of 120 to 140 min, the intracuff pressure should be controlled and kept below the value of 25 cmH2O

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01614.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The adsorption of diazepam to infusion sets and plastic syringes was studied. Infusion solutions consisting of diazepam injection (Valium®) in glucose 5.5%, diazepam emulsion (Diazemuls®) in glucose 5.5%, or diazepam emulsion in a lipid emulsion (Intralipid® 10%) were infused through two different infusion sets (Transcodan L‐74 and Cutter IL). It was found that, when an infusion solution with a low diazepam concentration (0.04 mg/ml) was infused slowly (4 ml/h), the diazepam adsorption was more than 80%. At a higher diazepam concentration (0.1 mg/ml) and increased infusion rate (20 ml/h) the adsorption decreased. Diazepam injection in glucose 5.5% was adsorbed to a higher degree (40–75%) than diazepam emulsion in glucose 5.5% (15–35%). When diazepam emulsion was diluted with the lipid emulsion, no diazepam adsorption to the infusion set occurred at this concentration and infusion rate. No significant difference between the two infusion sets could be found. The miscibility of diazepam emulsion with glucose 5.5%, glucose 10%, or sodium chloride 0.9% was examined. Diazepam emulsion proved to be miscible with glucose 5.5% and glucose 10%, but sodium chloride should not be used to dilute diazepam emulsion. The effect on the diazepam concentration of storing diazepam injection and diazepam emulsion in plastic syringes for up to 4h was also studied. It was found that the diazepam concentration remained unchanged during t

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01615.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The potential mutagenicity of inhalation anaesthetics was investigated by the sister chromatid exchange (SCE) test system applied to lymphocytes in peripheral blood drawn from patients before and after anaesthesia. Twenty‐one women, aged 39–82 years (median 57.7 years) received halothane for 75–180 min (median 125 min). Fourteen other patients, aged 45–90 years (median 67.5 years) received enflurane for 90–180 min (median 130 min). In both groups the numbers of SCEs were unchanged immediately following anaesthesia and 5 days after. It was concluded that, by this method, comprising human cells exposedin vivo, there was no indication of a mutagenic effect of short‐term exposure to halothane or enflurane in anaesthetic con

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01616.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The effects of i.v, buprenorphine (0.3 mg) and oxycodone (10 mg) on intracholedochal passage pressure were studied in 20 patients who had undergone surgery of the common biliary tract, prior to the extraction of an indwelling T tube. Informed consent was obtained from all patients, each of whom was given buprenorphine or oxycodone in random order. The intracholedochal passage pressure was measured from the T tube perfused with continuous saline infusion (55 ml/h). Both analgesics significantly (P<0.01) increased the intracholedochal passage pressure after 5 min, with an equal peak increase of about 1.5 kPa at about 7 min. The pressure decline was rapid and similar in both groups: 20 min after administration of the test drug only about 40% of the maximum elevation caused by either drug remained. Thereafter, a slower fall towards the baseline was recorded after both drugs during the remaining 45 min of the study period. The results indicate that buprenorphine can be used with the same indications and precautions as other narcotics for postoperative pain relief in patients who have undergone surgery of the biliary tract.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01617.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

Thiopentone was administered as induction agent for general anesthesia to eight patients with stable ischemic heart disease; 6 mg/kg of the drug induced decrease in arterial blood pressure (— 27%), systematic vascular resistance (— 20 %), stroke volume index (—14%), mean pulmonary arteriolar occlusion pressure (— 15%) and left ventricular stroke work index (— 38%), while heart rate increased by 10% and cardiac output remained unchanged. Total body oxygen consumption decreased by 30%. Myocardial oxygen consumption decreased by 39% with unchanged or decreased myocardial oxygen extraction and myocardial lactate uptake decreased by 40%. Arterial and coronary sinus hypoxanthine levels were unchanged and no ST‐T‐segment changes or dysrhythmias were recorded. In the present experimental setting, the results indicate that thiopentone substantially decreased myocardial oxygen requirements. In spite of the marked reduction in coronary perfusion, myocardial oxygen demand was matched by supply, myocardial dysoxia was not induced and cardiodepression was clinically negligible. Rate pressure product was a poor indicator of changes in myocardial oxygen consumption after thiopentone a

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01618.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

Thirty‐three patients were randomly assigned to two groups to study the analgesic potency, duration of action and side effects of epidural and intramuscular morphine after hip surgery. Two milligrams of preservative‐free morphine chloride in 10 ml of normal saline in the epidural space was compared to 10 mg of intramuscularly administered morphine. There was a more rapid onset of action after intramuscular morphine. However, the quality of pain relief was substantially higher and the duration of action markedly longer after epidural morphine. The total dose required in the epidural group was 3.6 mg and in the intramuscular group 41 mg during the 15‐h observation period. The side effects of epidural morphine were few and mild, the most embarrassing being urinary retention (20 %). Nausea and/or vomiting was less common after epidural morphine (20% versus 55%). Pruritus or respiratory depression which have been reported previously were not encountered. However, it is recommended that preservative‐free solutions are used to avoid itching and that the patients are monitored, as respiratory depression may occur long after administration of epidural

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01619.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

Leakage of cerebrospinal fluid following dural puncture and subsequent downward sagging of the brain have been suggested as a cause of the rare subdural haematomas occurring after spinal or attempted epidural anaesthesia which have been reported in the literature. We report a case where this mechanism probably produced a fatal brain lesion, due to the herniation of the uncus against the tentorium cerebelli 15 days after spinal anaesthesia. The patients complained of severe headache and nausea after the procedure. The reported case shows that postdural‐puncture headache may be a sign of more serious sequelae and should be treated by the means availabl

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1981.tb01620.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY