摘要:

Intrapulmonary gas distribution was studied in 10 extremely obese patients: (1) during spontaneous breathing awake; (2) during anaesthesia with controlled ventilation and zero end‐expiratory pressure (ZEEP), and (3) as under (2) but with a positive end‐expiratory pressure of approximately 15 cmH2O (PEEP). Gas distribution was assessed quantitatively by means of a multiple‐breath nitrogen wash‐out technique and subsequent fractional analysis, which permitted the calculation of nitrogen wash‐out delay (NWOD). Gas distribution was also analyzed by means of a single‐breath nitrogen wash‐out in order to determine the slope of the “alveolar plateau.” Gas distribution was within normal limits during spontaneous breathing, judged from multiple‐breath as well as single‐breath wash‐out. With anaesthesia and ZEEP, NWOD was higher, indicating less efficient gas mixing, and the slope of the “alveolar plateau” was twice as steep as during spontaneous breathing. With PEEP, distribution of inspired gas improved (lowered NWOD and flatter slope). Theoretical considerations and clinical experiments led to the conclusion that uneven distribution in the anaesthetized obese is caused both by regional differences in the pulmonary time constants (as in obstructive lung dis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01218.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Preoperative administration of gallamine was evaluated during inhalation anaesthesia with nitrous‐oxide and halothane with two administrations of suxamethonium 1 mg/kg body weight, 5 min apart.Sixty healthy patients were randomly divided into three groups, and pre‐anaesthetic gallamine, 0.3, 0.4 or 0.5 mg/kg body weight, respectively, was administered intravenously 3 min before induction, according to the allocation. Just before induction of anaesthesia the patients were examined for signs and symptoms of partial curarization. After induction of anaesthesia by nitrous‐oxide‐oxygen‐halothane, suxamethonium 1 mg/kg was given intravenously. Exactly 5 min later the same dose was repeated. EGG was monitored continuously and serum potassium, Pao2and Paco2were measured at appropriate intervals.It was found that none of the examined doses of gallamine gave any reliable protection against serious bradyarrhythmias after repeated doses of suxamethonium. Furthermore the higher doses of gallamine caused an unacceptably high frequency of patients with tachycardia and signs and symptoms of partial cur

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01219.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The effects of a 20 mg i.v. bolus of ephedrine sulphate on haemodynamics and plasma lidocaine concentrations were evaluated in eight volunteer subjects receiving a constant i.v. infusion of lidocaine HCI (2 or 4 mg min‐1). Injection of ephedrine caused a significant increase in mean arterial blood pressure, which preceded an elevation of heart rate by about 2 min. Cardiac output and hepatic blood flow, measured at 10 and 20 min after injection, were also increased significantly, while there was a decrease in total peripheral resistance and no change in splanchnic vascular resistance. There were no significant circulatory alterations over the same period in a control group of four subjects on receiving the lidocaine infusion. After ephedrine, the mean splanchnic extraction ratio of lidocaine fell from 0.76 to 0.66 at 10 min, then rose again to 0.71 at 20 min, and these changes were accompanied by a 9% increase in its splanchnic clearance. Extraction and clearance remained unchanged in the control group. The implications of these findings are considered in relation to the use of ephedrine to prevent or treat hypotension after peridural block with local anaesthetic agent

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01220.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Diazepam and flunitrazepam were compared in equipotent doses as induction agents for premedicated patients having cardiac surgery. Both drugs caused a significant fall in arterial blood pressure, a rise in Paco2and a fall in Pao2. There was no significant difference between the two drugs in onset time of anaesthesia, cardiovascular or respiratory depression, or quality of induction. There was also no significant difference from induction with thiopentone in these respects.Diazepam, over a 0.2 to 0.6 mg/kg range of doses, showed no difference in toxicity, although induction was clinically smoother with the higher dose.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01221.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Anaphylactic shock (AS) was induced in 15 monkeys, and their hemodynamics were studied in order to identify the mechanisms initiating the low cardiac output (CO) state. Further, in 16 monkeys various substances were used with the aim of mimicking or antagonizing the changes in AS. Initial peripheral collapse was indicated by lowering of the right atrial pressure (RAP). The subsequent development of pulmonary hypertension increased RAP and, by extending venous pooling, reduced filling of the left heart. The degree of pulmonary hypertension or arterial hypotension was a poor indicator of the fall in CO. Hypoxemia and dysrythmias occurred occasionally, but early hemoconcentration was not found. Light depression of CO (—42%), due to venous pooling and reduction in left heart filling, could be corrected by fluid administration. In contrast, severe depression of CO (—81%) associated with ST‐T depression and with decreased cardiac contractility responded less to the fluid load, suggesting that myocardial failure was partly responsible for the low output state.Inhibition of prostaglandin (PG) synthesis by indomethacin did not prevent the development of AS. Injections of PGE2and PGF2α, alone or together with histamine (Hi), did not mimic AS. PGE2induced hypotension accompanied by an increase in CO, and PGF2αinduced general vasoconstriction and a somewhat diminished CO. Hi induced hypotension and pulmonary hypertension; CO increased after low doses but decreased after sublethal doses. Compound 48/80, a liberator of Hi and slow‐reacting substance (SRS), imitated Hi effects initially, but later mimicked a minor state of AS. Infusion of FPL 55712, a selective antagonist of SRS, prevented AS, and general vasoconstriction occurred instead. In this model of AS, SRS is a more important mediator than

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01222.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

A machine has been constructed for mixing O2and N2O. It consists of: (a) a proportional pressure and thereby flow regulator at the inlets for O2and N2O; (b) a digital gas mixer which determines the gas mixture; and (c) a rotameter to measure the outlet flow.The contents of mixtures obtained from the machine were measured with a quadropole mass spectrometer (at 2 and 5 1 min‐1with downstream pressures of 500 and 3000 Pa). The mean numeric difference between desired and registered vol% O2varied between 0.3 and 0.5 vol% at the four conditions tested. The maximal deviation was 1.2 vol%. Five conventional machines in daily use at the hospital were also tested. The mean numeric difference for these machines varied between 1.1 and 2.7 vol% O2. The maximum deviation was 7.4 vol

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01223.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The mean CO2output during anaesthesia in paralyzed patients can be monitored by continuous capnographic analysis of the total exhaled gases, the latter being mechanically integrated by pumice canisters. The gas is evacuated from the Hafnia A circuit via an ejector flowmeter. The results are not influenced by the flow rates employed.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01224.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

An aberrant placement of a central venous catheter into the upper part of the thoracic duct with loop formation in the left innominate vein was observed on catheterizing via the left internal jugular vein. The misplacement, which did not have any deleterious effects, was caused by the atypical insertion site of the thoracic duct at the dorsocaudal wall of the left innominate vein and, possibly, by its incompetent closing valve. The stiffness of the nylon catheter used may also have been a contributory factor.The possible causes of this complication of central venous catheterization are discussed. The preferential use of the right internal jugular vein is stressed.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01225.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

A flexible, disposable intravenous catheter can be introduced into the neurovascular sheath in the axilla and used for injection of local anesthetic solution to block the axillary brachial plexus. The technique is described and the results of the first 137 consecutive catheter blocks are reported and compared to a similarly evaluated series of conventional axillary blocks.The catheter method constitutes an interesting alternative to needle techniques and offers the possibility of a continuous axillary block.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01226.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10‐S4–5(group II), general anesthesia + epidural analgesia extending from Th8‐S4–5(group III), general anesthesia + epidural analgesia extending from Th4–6‐S5(group IV) and epidural analgesia extending from Th4‐S5without general anesthesia (group V).The results showed that the Cortisol response was abolished in group V, inhibited in group IV and normal in groups II and III. The hyperglycemic response to surgery was inhibited in groups II, III and IV, and abolished in group V.Epidural analgesia from Th4to S5, preventing the adrenocortical and hyperglycemic responses to hysterectomy, and possibly also inhibiting other components of the endocrine‐metabolic response to surgery, may have important applications in further studies of the physiologic significance of the endocrine‐metabolic re

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01227.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY