摘要:

The effect of 4 mg oral naloxone on preoperative gastric volume and pH of gastric aspirate was studied in a double‐blind, randomized study. Twenty patients received 10 ml of naloxone (4 mg) mixed with 10 ml of orange juice, and 20 patients received 10 ml of isotonic saline mixed with 10 ml of orange juice, 2 h before surgery. Gastric content was obtained immediately after intubation of the trachea. No significant difference in gastric volume and pH of gastric aspirate was found between the two groups. It is concluded that naloxone does not affect gastric emptying and gastric acid secretion to a degree great enough to protect against aspiration of gastric contents into the lung

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02378.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Rats were anaesthetized with halothane and artificially ventilated. After bilateral nephrectomy and implantation of arterial and venous catheters, arterial plasma pH (pHc) was adjusted by infusion of HC1 or sodium bicarbonate to 7.2, 7.4, or 7.5 and kept constant throughout the experiment. The distribution of tris between intra‐ and extracellular compartments was determined as a function of time up to 24 h after infusion of14C‐labelled tris and3H inulin in five skeletal muscle groups, heart, liver, spleen, and brain tissue. The following results were obtained: 1. Tris diffuses very slowly into the intracellular space of the investigated tissues. 2. For different arterial plasma pH, the intracellular tris concentration is quite different. It rises more rapidly and reaches higher levels in alkalemia. 3. Five different skeletal muscle groups showed the same rates of rise of intracellular tris at the same pHv. 4. Tris diffuses almost immediately into liver cells, the rates being slower in spleen, heart, skeletal muscle and brain, in that order. 5. Only in the liver did intracellular tris concentration reach a steady state, at levels higher than theoretically predicted, suggesting that ionic tris also is permeable. In other tissues, lack of steady states at the end precluded similar conclusions. It can be concluded that the clinical importance of tris therapy is in its elimination of H+ ions from the extracellular space and in the generation of bicarbonate that then penetrates the intracellular compartm

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02379.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The influence of non‐opioid (NO) and opioid (O) premedication on ventilation and ventilatory CO2response was studied in 18 spontaneously breathing children during halothane anaesthesia. Eight patients in Group NO and 10 in Group O were comparable in age, body weight and type of surgery performed. The sedative effect was evaluated and measurements by pneumotachography and in‐line capnography were made immediately after induction of sleep, just before the start of surgery, during surgery and after surgery both before and after 3 min of about 2% CO2inhalation. Immediately after induction the mean value (X s. e. mean) of end‐tidal CO2concentration (ETCO2) was 4.86 X 0.21% in Group NO and 5.28 X 0.22% in Group O. Before and during surgery, minute ventilation (VE) was higher in Group NO (P<0.05) mainly due to higher respiratory rates. ETCO2was similar in the two groups before, during and after surgery. The ratio of VE to CO2elimination (VCO2) and of dead space (VD) to tidal volume (VT) was higher in Group NO, but ventilatory response to CO2inhalation immediately before the postoperative period was similar in both groups. It was concluded that opioid premedication resulted in more efficient ventilation during anaesthesia and surgery, and that CO2response at the end of surgery was maintained in both g

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02380.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The effect of the addition of two different resistive loads (producing 23 and 36 cmH2O (2.26 and 3.53 kPa) 1‐1s‐1, respectively, at 71 min‐1) on minute volume, tidal volume, respiratory rate, duration of inspiration and inspiratory drive was studied in six intubated children during nitrous oxide, oxygen and halothane anaesthesia. With both resistive loads, tidal volume was initially reduced in all patients except one, the reduction being greater in older children. Tidal volume returned to baseline values within 3–5 min in most cases, and a transient increase was seen on removal of the load. Changes in inspiratory drive were also most marked in older children. End‐tidal carbon dioxide concentration rose by 0.5% when the higher resistance was used. Respiratory rate and duration of inspiration were unchanged, suggesting the absence of a respiratory off‐switch‐reflex mechanism directly mediated by stretch receptors within the airways or lungs. Ventilatory compensation occurring after 3–5 min may have resulted from chemical stimulation and/or from reflexes from joint receptors and respiratory

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02381.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Electrocardiographic (ECG) changes were studied in 82 adult patients with a mean age of 49 years undergoing microlaryngoscopy. The patients were pretreated with practolol 0.15 mg/kg i. v. 5 min before induction of anaesthesia with thiopental. Anaesthesia was maintained with nitrous oxide in oxygen, fentanyl and suxamethonium‐infusion. ECG changes occurred in 49% of the patients before anaesthesia and procedure. Pre‐existing ECG changes increased or new changes occurred in 39% of the patients during intubation and in 38% during the procedure. The most common preanaesthetic ECG changes were flat or negative T‐wave (18%), sinus tachycardia (13%), ischaemic S‐T segment depression (8.5%) and intraventricular conduction disturbance (8.5%). ECG changes during intubation were sinus tachycardia (16%), ventricular ectopic beats (12%), supraventricular ectopic beats (10%) and ischaemic S‐T segment depression (10%). The most common changes during microlaryngoscopy were supraventricular ectopic beats (16%), T‐wave flattening or inversion (15%), ischaemic S‐T segment depression (11%) and sinus bradycardia (10%). In all patients ECG changes disappeared without any special treatment. Unlike our earlier identical study without practolol pretreatment, neither sinus tachycardia nor junctional rhythm occurred during microlaryngoscopy in the present study. The results suggest that practolol pretreatment before microlaryngoscopy is especially useful when sinus tachycardia and junctional rhythm shou

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02382.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

It has been postulated that esophageal retention of diazepam tablets is a problem of clinical significance, and that rectal administration is an advantageous alternative. To test this hypothesis, 100 patients were randomly allocated to premedication with either 15 mg diazepam orally or 10 mg diazepam as a rectal solution. A double dummy technique was used. A sedative effect was seen in 23 (50%) of the patients premedicated by mouth (O‐group), but only in eight (20%) of those premedicated rectally (R‐group) (P<0.05). Four patients (9%) in the O‐group and seven (18%) in the R‐group were unacceptably anxious before induction (n. s.). The plasma concentrations in the tablet group were nearly twice the concentrations found in the rectal‐solution group, but no correlation between premedication effect and plasma concentration was found. Timing of premedication was very inaccurate, and this favored oral administration because of a more prolonged effect. No evidence of persistent esophageal retention

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02383.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The effect of blood transfusions on the electrolyte, metabolic and hemodynamic status of 31 patients undergoing major laparotomies was studied. Two groups were compared: Group I, II patients receiving continuous intraoperative blood transfusions exceeding 5 units at a rate over 0.3 ml/kg/min, and Group II, 20 patients receiving transfusions of 1–5 units at a rate below the limit. Transiently increased potassium values (5.2 0.3 mmol/1) were found in Group I during the rapid transfusion phase. The difference was statistically significant (P<0.05) when compared to Group II (4.3 0.2 mmol/1). There was also a significant correlation (r = 0.64;P<0.05) between the increase in serum potassium concentrations and the respective potassium load caused by the blood transfused. Most of the hyperpotassemic patients had surgery of the abdominal aorta. During the rapid transfusion, the patients in Group I had significantly lower concentrations of serum ionized calcium (P<0.05) and higher central venous pressures (P<0.05), but more periods of hypotension when compared to Group II. After the transfusion the massively transfused patients had slight metabolic alcalosis, the BE and pH differing significantly (P<0.05) from the values of Group II. It is concluded that hyperpotassemia may occur during rapid transfusions (over 0.4 ml/kg/min) of stored blood, especially in patients undergoing surgery of the abdominal aorta, even without simultaneous shock, acidosis or hypothermia. Calcium administration may be of benefit especially in situations where combined hyperpotassemia and hypocalcemia reduce the myocardial performanc

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02384.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Intravenous regional anaesthesia, confined to the distal lower limb and using bupivacaine 0.25%, was studied in 12 patients undergoing orthopaedic procedures to the feet. The technique was well accepted by both surgeons and patients and was free from serious toxicity. Bupivacaine was demonstrated in the systemic venous circulation in every case prior to surgery, whilst the tourniquet remained inflated. The plasma bupivacaine levels were less than that associated with toxicity, except in one case exhibiting signs of minor toxicity (bupivacaine plasma level 1.99 μg/ml‐1). Reasons for the leak in spite of a well‐conducted technique are discu

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02385.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A total of 1558 admissions to an ICU over 5 years because of severe self‐poisoning with drugs provides the basis for this study. Three drugs accounted for 60% of the admissions: overdose with barbiturates in 28%, with tricyclic antidepressants in 19% and with propoxyphene in 14%. The annual incidence of poisonings with barbiturates and tricyclic antidepressants was the same during the period, whereas the incidence of propoxyphene intoxication increased by 80%. Intensive supportive care was the main principle of treatment. All patients were artificially ventilated. The mortality rate was 6.1%, salicylate, propoxyphene and strong analgesics having the highest mortalities (11%, 9% and 9%, respectively). A mortality rate of 3% was found following overdose with tricyclic antidepressants. By 36 months after the overdose, 235 patients (18%) had died. The expected number of deaths was 39 (3%). The suicide rate in the follow‐up period was 10%, in the majority (75%) of whom death was caused by a new episode of self‐pois

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02386.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Transverse sections of lung tissue were studied in patients by computerized tomography during anaesthesia and in the postoperative period. Eight patients were studied during intravenous (thiopentone) and six during inhalational (halothane) anaesthesia. The latter patients were studied during both spontaneous and mechanical ventilation. Five of the patients who underwent surgery for inguinal hernia and five patients in whom laparotomy was performed were studied 1 h and 24 h postoperatively. No patient showed any lung changes while awake preoperatively, and all patients developed dependent, crest‐shaped lung densities within 5–10 min of anaesthesia. The densities comprised 3.4% of the lung volume in the caudal (basal) 5 cm of the lung tissue. No significant differences in the size and distribution of the densities were noted between spontaneous breathing and mechanical ventilation during anaesthesia, or between intravenous and inhalational anaesthesia. The densities remained in nine of ten patients 1 h postoperatively, and they remained in five of ten patients 24 h after anaesthesia. The densities are considered to be compression atelectases which may develop as a result of relaxation of the diaphragm. They may be important contributors to postoperative pulmonary complicati

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02387.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY