摘要:

In 39 patients undergoing aorto‐coronary‐bypass grafting, spectral analysis of the EEG (compressed spectral array: CSA) and calculation of spectral edge frequency (SEF) were performed. The effects of different temperatures and of perfusion pressure (PP) were analyzed. Predictable patterns were observed. During cooling on cardiopulmonary bypass (CPB). linear regression analysis revealed a close correlation between SEF and tympanic membrane (Tty) or nasopharyngeal temperature (Tnp). During rewarming, a nonlincar correlation between SEF and Ttyor Tnpwas found. Rectal temperature as well as blood temperature in the arterial or venous line of the oxygenator seemed to be less useful. The independence of SEF and PP was demonstrated during the whole procedure. At the onset of CPB, after correction of the aortic clamp for performance of the aortic anastomosis and after removal of the aortic clamp, bilateral EEG slowing of varying duration occurred in 20 patients. Comparison of mean SEF before and after CPB revealed a difference of about 5 Hz. In no patient were major neurological abnormalities observed postoperativ

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02531.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Changes in the haemodynamics of the lower extremities, big toe temperature, blood pressure and heart rate were studied in 20 patients undergoing spinal or epidural anaesthesia for transurethral surgery. Calf blood flow was determined by strain gauge plethysmography (SGP) and Doppler ultrasound. Bupivacaine 0.5% was injected at the L3‐L4 interspace, the dose being 3–4 ml (mean 3.6) in the spinal and 17–20 ml (mean 18.6) in the epidural group. The number of sensory blocked segments 30 min after anaesthesia was 12.7 ± 0.7 (mean ± s. e. mean) and 14.4 ± 0.7. respectively. Only minor decreases in blood pressure were noted following the blocks. Heart rate remained virtually unchanged. The increase in skin temperature was more pronounced (P<0.01) following epidural (mean 8°C) than spinal anaesthesia (mean 4°C). In addition, the arterial blood flow was significantly higher (P<0.05) following epidural than spinal block (means 3.5 and 2.2 ml/100 ml/ min, respectively). The venous capacity and maximum venous outflow remained pr unchanged in both groups. Obviously, epidural anaesthesia with bupivacaine causes a more intensive sympathetic block than does spinal anaesthesia. As probably no venous pooling occurred, when examined by SGP and Doppler ultrasound, neither of the blocks is likely to contribute to the initiation of deep vein

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02532.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Measurements of body temperature, respiratory gas exchange, sweat evaporation rate and circulating level of catecholamines, lactate, pyruvate, free fatty acids and glucose were made in seven patients susceptible to malignant hyperpyrexia (MHS) and in seven control subjects during 2 h of treadmill walking at 40% of maximum oxygen consumption. These studies took place in an ambient temperature or 22°C. The MHS patients displayed the same thermoregulatory, plasma catecholamine and metabolic responses as the control subjects. The results or the present study suggest that non‐competitive. low‐intensity, steady‐state exercise need not be contraindicated for MHS pa

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02533.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Humidification and heating of anaesthetic gases are desirable to prevent respiratory tract damage and a fall in body temperature during operative procedures. Numerous studies on the humidity and temperature of inspiratory gases in different breathing systems for anaesthesia have been carried out, but comparisons arc difficult since different methods have been used. In this laboratory set‐up we studied a non‐rebreathing system with and without humidifiers and a circle absorber system with low (0.5 l/min) or medium (5 l/min) fresh gas flows regarding their ability to heat and humidify anaesthetic gases. The humidity of inspired g was acceptable in the non‐rebreathing system using either a Bennett Cascade humidifier or disposable humidifiers and in the circle absorber system using a fresh gas flow of 5 l/min or less. The temperature of the inspired gases was highest with the Bennett Cascade humidifier, followed by the low‐flow circle system. The circle absorber system used with low fresh gas flow gave higher inspiratory gas temperature and humidity than the non‐rebreathing system with a good disposable h

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02534.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Graded increases of intracranial pressure (ICP) in anaesthetized pigs induced elevations of plasma levels of neuropeptide Y (NPY)‐like immunoreactivity (LI) and catecholamines, simultaneously with hypertension and tachycardia. Plasma adrenaline (ADR) increased at a lower ICP‐level than did the plasma levels of noradrenaline (NA) and NPY‐LI. At the maximal ICP elevation, 22.9 kPa (172 mmHg), plasma NPY‐LI was increased about 10‐fold, from 48±8 pmol/l in the basal state, while NA and ADR concentration increased more than 100‐fold. At this maximal ICP‐level the plasma levels of NPY‐LI were correlated to the concentrations of both NA (r = 0.87, P<0.01) and ADR (r = 0.92, P<0.001). Plasma NPY‐LI continued to increase to about 1000 pmol/l, 10 min after the maximal elevation of ICP was discontinued, while the catecholamines then had declined considerably. A slight cardiac release of NPY‐LI was observed at the maximal elevation of ICI. The half‐life of NPY‐LI in plasma was about 6 min upon systemic infusion. At plasma levels similar to those obtained upon maximal ICP elevation, exogenous NPY caused slight vasoconstriction in the spleen and skeletal muscle, but had no effects on coronary blood flow or systemic blood pressure. This suggests that NPY mainly exerts local actions after release from nerve endings, while levels of circulating NPY in plasma must be very high to influence blood flow in some organs. It is concluded that elevation of ICP results in hypertension and tachycardia related to elevated plasma levels of NPY‐LI and catecholamines. The markedly increased plasma levels of NPY‐LI suggest that this peptide is co‐released with NA from sympathetic nerve terminals. NPY may therefore contribute to the cardiovascula

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02535.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In ten elderly patients subjected to extensive thoracolumbar epidural anaesthesia, circulatory changes were studied before and during sympathetic stimulation. Induced hypercapnia was used as a sympathetic stimulus. After establishment of the epidural anaesthesia, which extended from TI to L2, there were decreases in heart rate, mean arterial blood pressure, cardiac output and systemic vascular resistance. Hypercapnia before the epidural block increased heart rate, arterial blood pressure and cardiac output, while hypercapnia after established epidural block induced only a slight increase in arterial blood pressure. The results indicate that in spite of an extensive epidural block, there are some “escaped” sympathetic nerve fibres that can be mobilized during sympathetic stimulat

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02536.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Administration of small doses of bupivacaine epidurally at the upper thoracic level will partially block the cardiac sympathetic nerves hut not the sympathetic outflow via the adrenals. Local anaesthetics have direct systemic effects on the myocardium and the systemic circulation. The present study aimed to examine the effect of high thoracic epidural anaesthesia (TEA) in elderly patients, and to examine the effect (if raising plasma bupivacaine concentrations in these patients, who had earlier had the sympathetic innervation of the heart blocked by thoracic epidural anaesthesia. Fifteen elderly patients scheduled for thoracotomy took part in the study. All received high thoracic epidural anaesthesia including the upper five thoracic dermatomes. When epidural block WBS established, ten patients received bupivacaine 3 mg/min intravenously for 20 min, while five patients received a corresponding volume of normal saline solution. After TEA was established, heart rate, mean arterial blood pressure and cardiac output decreased. When bupivacaine was given to these patients intravenously during the block, mean arterial blood pressure increased, while cardiac output decreased still more. The mechanisms behind these effects seem to be a direct constriction of the systemic blood vessels and a depressive effect on the myocardium, which was blocked from the influence of the cardiac sympathetic nerves by the high thoracic epidural block.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02537.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The effects of Live different local anaesthetics: lignocaine, prilocaine, etidocaine, mepivacaine, bupivacaine, on tone, contractility, and on cholinergic and non‐cholinergic responses of chick tracheal smooth mu were studied and comparedin vitro.The cholinergic and non‐cholinergic contractions of the tracheal smooth muscle were elicited by electrical field stimulation, at a maximal voltage with 0.2 Hz and 0.2 ms square pulse duration, in the presence of adrenergic blockers, guanethidine, propranolol, and other drugs, e.g. indomethacin. Atropine was used to reduce the cholinergic responses due to electrical field stimulation arid to applied acetylcholine (ACh). Lignocaine, in low concentrations, reduced these responses and also those produced by electrical field stimulation in the presence of atropine. In high concentration (>100 times clinical concentrations), lignocaine abolished all the responses and produced a sustained contracture in the muscle. Among the local anaesthetics studied, bupivacaine and lignocaine were found to be more effective than mepivacaine, prilocaine and etidocaine, in reducing the cholinergic contractions produced by electrical field stimulation and by exogenous ACh. It was suggested that lignocaine, and other local anaesthetic drugs, may have anti‐ spasmic effect on the tracheal smooth muscle, in that they inhibited the contractions induced by electrical field stimulation and by depolarizing a

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02538.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This study compares the recovery from sufentanil and isoflurane anaesthesia in patients undergoing outpatient arthroscopy of the knee under general anaesthesia. In 40 unpremedicated patients, divided at random into two groups, anaesthesia was induced with methohexitone and vecuronium bromide and, after intubation, maintained with nitrous oxide 66% in oxygen supplemented with sufentanil or isoflurane. Patients in Group A received sufentanil (I μg/kg) at induction and if necessary an incremental dose of 10 μg. Patients in Group B received 3%, isoflurane prior to intubation and 0.9% during maintenance. Awakening from anaesthesia was more rapid with sufentanil than isoflurane. Recovery was assessed from the time patients took to open their eyes, to give correct answers to five questions and to recover from ocular imbalance (Maddox wing test), and by comparing pre‐ and postoperative performance of a paper and pencil test (the p‐deletion test). After 2 h, there was no difference between the two groups. Both anaesthetic techniques provided satisfactory operating conditions, but the sufentanil group showed a higher incidence of nausea and vomiting (45%) than the isoflurane group

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02539.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Results of arterial blood gas and acid‐base balance analyses were analyzed in 50 patients suffering from dextran‐induced anaphylactic reactions. Metabolic acidosis was always present in severe cases, leading to cardiac arrest, and also frequently found in those with less severe reactions with only slightly impaired circulation. Bronchospastic respiratory signs were frequently encountered but acidosis was noted to develop even without these symptoms. The severity of the acidosis was generally underestimated during treatment. Arterial Po2and PCO2were not significantly affected during these reacti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02540.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY