ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03373.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Five numerical descriptors were derived from the electroencephalogram (EEG), recorded, and processed (Tracor Nomad®) during emergence from isoflurane‐nitrous oxide anesthesia. The five descriptors (median frequency, spectral edge frequency‐90%, total power, a frequency band power ratio, and the ratio of frontal to occipital power) were compared for their ability to predict imminent arousal. Arousal was defined as spontaneous movement, coughing or eye opening. All of the descriptors except the frontal‐occipital power ratio underwent significant (P<0.05) changes between the initial recordings made intraoperatively during surgical stimulus under anesthesia and later recordings in the 40 s preceding arousal. Apost hocanalysis was performed to identify the threshold value for each parameter that best served to predict imminent arousal. For median frequency, spectral edge frequency‐90%, total power, and the frequency band power ratio, thresholds that predicted imminent arousal with sensitivities of 90% and specificities of 82–90% could be identified. The data indicate that, even in the favorable circumstances of the present study (uniform anesthetic technique,post hocidentification of thresholds), none of several previously popularized EEG descriptors (median frequency, spectral edge frequency‐90%, total power, a frequency band power ratio) can serve as a completely reliable sole predictor of imminent arousal. As presently derived, these EEG descriptors at best provide trend information to be used in concert with other clinical signs of depth o

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03374.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This randomized study examined the effect of transcutaneous electrical nerve stimulation (TENS) and indomethacin on postoperative opiate requirement in 60 patients after cholecystectomy. An open intravenous bolus of 25 mg of indomethacin followed by an infusion of 5 mg in 1 h, alone or combined with either low or high frequency TENS, was administered during the study period of 16 h. An intravenous bolus of either 5 mg of oxycodone or 0.15 mg of buprenorphine was administered double blindly for postoperative pain relief. The number of doses of buprenorphine given (3, 9) differed (P= 0.01) from the number of doses of oxycodone given (5, 4). Neither indomethacin nor TENS reduced the postoperative opiate requirement.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03375.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The degree of histamine release induced by three different anesthetic drugs was studiedin vitrousing basophil leukocytes from atopic patients (n = 11) and controls (n = 14). In all, eight dilutions (1/2 to 10‐5) of Diprivan* and its solvent Intralipid*, thiopental and chlormethiazole in aqueous solution, were used. Histamine was released in four controls with weak dilutions (1/2 to 102) of Diprivan (n = 2) and thiopental (n = 2). The reaction with thiopental was greater than that with Diprivan. Five of the atopic subjects released histamine with one or more drug: thiopental and Diprivan four times each, Intralipid twice, and chlormethiazole once. Histamine release was greater in these patients than in controls, and occurred with dilutions ranging from 1/2 to 10‐2, except for one case. It is concluded that atopic patients release histamine with hypnotic anesthetic drugs more easily than normal subjects. In the clinical setting, where blood concentration of the drugs studied is equivalent to a dilution of less than 103, they do not release much histamine. They may be used in atopic patients if the drugs are injected slo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03376.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A questionnaire was sent to the first 371 patients investigated for MH susceptibility at the Danish MH Register, in order to assess sequelae from the muscle biopsy and possible subsequent anaesthetic complications. The purpose was to evaluate both the safety of anaesthetizing MH‐susceptible (MHS) patients without the use of trigger agents, and the safety of giving trigger agents to non‐susceptible (MHN) patients. Eighty‐eight per cent of patients alive replied to the questionnaire. Of these, 22% complained about discomfort at the site of the biopsy, 2% had experienced problems when needing a subsequent anaesthetic, and 0.9% had had trouble when applying for life or accident insurance. The median observation period for all patients following the muscle biopsy was 5.5 years (range 27 months–11 years). During this period, 36 MHS patients had been anaesthetized 52 times (28 general and 23 regional anaesthetics, data missing in one case) without any MH‐related complications. None of the patients had received prophylactic dantrolene. Three MHE patients had received non‐trigger anaesthetic agents on three occasions without development of MH. Thirty‐five MHN patients had been anaesthetized 64 times, and 13 of these MHN patients had received trigger agents 26 times without any signs of MH. An estimate of the probability of clinical MH developing in MHN patients subsequently anaesthetized with trigger agents was found to be 0–24.7% (95% confidence limits), whereas the probability of clinical MH developing in MHS patients anaesthetized with non‐trigger agents was 0–9.7% (95%

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03377.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

To investigate the influence of changes in thorax and lung compliance on ventilation during distal High Frequency Jet Ventilation (HFJV), similar ventilator settings were compared before and after changing the compliance in two groups of anaesthetized mongrel dogs. Each period of distal HFJV was preceded by adequate Intermittent Positive Pressure Ventilation (IPPV) to assure a start with baseline values. In Group 1 (n = 7), thorax compliance was changed by chest strapping, while in Group 2 (n = 7) lung compliance was changed by inducing acute lung injury by injection of oleic acid into the right atrium. Gas flow distribution in the ventilatory circuit during distal HFJV was determined before and after the changes in compliance were induced. Comparing similar ventilator settings during distal HFJV in the same dog, a decrease in lung or thorax compliance led to changes in gas flow distribution in the ventilatory circuit. Entrainment was decreased and bypass increased with a negative effect on the gas volume entering the lungs and on gas exchange. The results indicate that distal HFJV should be regarded as pressure‐limited ventilatio

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03378.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Ten male patients scheduled for transurethral prostatic resection (aged 57–79) were given irrigating fluid by intravenous infusion at 50 ml·min‐1over 20 min. Each patient was subjected to two infusions: 1.5% glycine in water on one occasion, and the same solution but with 1% ethanol added on the other. Urine and blood samples were collected at regular intervals for up to 2 h after infusion, and the changes in the distribution of water and electrolytes between fluid compartments were calculated. Transient prickling skin sensations were frequently reported effects of the infusions. Two patients experienced visual disturbances. There were no changes in the blood ammonia and plasma vasopressin levels. During the infusions, the estimated blood volume and the total plasma sodium and potassium content increased. The solutions produced osmotic diuresis with increased urinary excretion of water and electrolytes. After ending the fluid administration, blood volume was rapidly restored. Over the following 120 min the irrigant water was redistributed intracellularly or removed by urinary excretion. The addition of ethanol did not alter the overall effects of glycine solution on the fluid bal

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03379.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Acute supraventricular tachycardia is known to increase the plasma level of atrial natriuretic factor (ANF). The purpose of these experiments was to investigate if such an increase in plasma‐ANF could be ascribed to changes in atrial pressure and atrial dimensions. Eight anaesthetized dogs were instrumented with atrial pressure catheters and sonomicrometers to measure left and right auricular and atrial free wall dimensions. An acute increase in atrial rate from 150 to 200 min‐1for 10 min did not change plasma‐ANF or atrial haemodynamic variables. A further increase in atrial rate to 250 or 300 min‐1increased right and left atrial intracavitary pressures (P<0.01), both auricular diameters and right atrial free wall segment length (P<0.05). Left atrial free wall segment length remained unchanged. Plasma‐ANF increased in all dogs (P<0.01). The change in plasma‐ANF correlated well with changes in atrial pressures as well as with changes in atrial dimensions. These results support the hypothesis that release of ANF during acute atrial tachycardia may in part be attributed to atrial

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03380.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The fatal anaesthetic ratio (FAR) has been determined for halothane‐diethyl‐ether (HE) in pigs, and the central circulation during hypovolaemia has been investigated using a well‐documented agent such as isoflurane as a standard. The fatal anaesthetic ratio for HE in pigs was (3.21/1.03) = 3.12. This is high compared to the FAR for halothane of 1.7. The central circulation was investigated in 12 pigs which were randomly allocated to either HE or isoflurane anaesthesia, respectively. Baseline values were recorded when they were stable at 1.3 MAC of the volatile anaesthetic used. The pigs were bled 30% of their blood volume, and measurements were made at 5 and 30 min. There was one significant difference between these groups in central circulation: the blood pressure was higher at baseline measurement in the HE group. At 5 min and 30 min, there were no significant differences between these groups. There was a general depression of central circulation without any sign of decreased contractility. HE anaesthesia is well tolerated during hypovolaemia in

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03381.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

We studied 21 patients undergoing lumbar spinal surgery under halothane anesthesia on a convex saddle frame, in order to determine the hemodynamic effect of the prone position. A thermodilution pulmonary arterial catheter was placed in 14 patients (Group PA‐1: n = 8; and Group PA‐2: n = 6), and an inferior vena caval catheter in the remaining seven patients (Group IVC). Group PA‐1 and Group IVC patients were placed in the prone position on a convex saddle frame. In the prone position, the cardiac index (CI) decreased significantly from 3.1 ± 0.5 to 2.5 ± 0.3 (1·min‐1·m‐2mean ± s.d.,P<0.01) without accompanying significant changes in the other hemodynamic variables in Group PA‐1. The postural change in Group IVC did not exert a significant effect on the inferior vena caval pressure. Group PA‐2 were initially placed in the flat prone position on a flat saddle frame, which produced no significant changes in the hemodynamic variables. Then the convex curvature of the frame was adjusted to the grade appropriate for surgery, which produced a significant reduction in CI (from 2.9 ± 0.3 to 2.4 ± 0.4,P<0.05). We conclude that the prone position itself may not interfere with the circulatory function. The prone position using a convex saddle frame causes significant reductions in CI, but little change in the other h

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03382.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY