摘要:

The effects of graded elevations of intracranial pressure (ICP) on cardiac metabolism, blood flow and electrophysiology, and plasma catecholamines were studied in eight open‐chest pigs. ICP was consecutively elevated from 15 ± 3 mmHg in the control state to 40 ± 4, 84 ± 4 and 152 ± 11 mmHg. Mean arterial blood pressure and heart rate were significantly increased at the two highest ICP levels. Cardiac oxygen uptake was also increased from 2.9 ± 0.4 ml × min‐1to a maximum of 7.1 ± 2.0 ml × mir‐1, and coronary sinus blood flow increased from 49 ± 7 to 131 ± 35 ml × min‐1at the highest ICP level. The transmyocardial blood flow distribution was unchanged, as determined by the microspheres technique. Arterial plasma catecholamine concentrations were significantly elevated at the two highest ICP levels, but noradrenaline overflow from the heart did not increase. The high arterial adrenaline concentrations (51 ± 25 nmol × l‐1at the highest ICP level) may he responsible for the cardiac stimulation seen in these experiments. No signs of ischaemia, as judged by myocardial lactate production or the relative flow distribution to the endocardium were observed. Changes in the T‐wave morphology appeared in the subendocardial ECG at all ICP levels, the changes being more prominent with increasing ICP levels. It is concluded that the increase in circulating catecholamine levels, adrenaline in particular, together with an elevation of afterload cause an increase of myocardial work, which may explain the T‐wave changes in the ECG which are observed upon rapid elevatio

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02563.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Carbon dioxide tensions (PCO2) in arterialized capillary blood samples were measured in 39 infants anaesthetized for minor paediatric surgery. Anaesthesia was induced and maintained with oxygen, nitrous oxide and halothane, using a Mapleson‐D system with spontaneous ventilation and a Rendell‐Baker face mask. The duration of anaesthesia was between 15 and 95 min. Two capillary blood samples were obtained during stable anaesthesia before and after surgery. The Pco2values varied between 3.7 and 8.0 kPa. The highest values were found in infants aged 15–30 days, 6.6 ± 0.7 kPa (mean ± s.d.), compared to 5.9 ± 0.7 in infants aged 31–60 days, 5.6 ± 0.8 in infants aged 61–180 days and 5.5 ± 0.7 in infants aged 181–300 days. Comparison between measurements before and after surgery did not in any group indicate a progressive hypoventilation or a correlation between the length of the anaesthesia and the Pco2. It is concluded that anaesthesia with oxygen, nitrous oxide and halothane with spontaneous mask ventilation is a satisfactory method for minor procedures in infants over 1 month or age, while in younger infants controlled ventilation with intubation may be a safer

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02564.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Interscalene brachial plexus block was performed on 40 patients for prophylactic pain relief after shoulder surgery. A dose of 1.25 mg/kg of 0.5%, bupivacaine was injected for the block (Group 1) and continued with an infusion of 0.25%, bupivacaine 0.25 mg/kg/h (Group 2). If the postoperative analgesia was insufficient, the patients received i.m. oxycodone 0.15 mg/kg. In Group 1, one patient managed without oxycodone supplementation during the 24‐h observation period compared with eight patients in Group 2 [P<0.01). The rest of the patients received 3.8 ± 1.6 doses (Group 1) and 2.5 ± 1.2 doses (Group 2) of oxycodone (P<0.05). At 30 min, the mean bupivacaine plasma concentration was 1.0 pg/ml in Group 1 and 0.9 pg/ ml in Group 2. The mean plasma level of bupivacaine increased from 0.7 μg/ml after 180 min to 1.1 μg/ml (P<0.01) after 24 h of infusion, providing some evidence of accumulation during infusion. The dizziness and confusion experienced by three patients could be associated with the local anaesthetic, as they obtained relief after the infusion was st

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02565.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A hypertensive patient with left cardiac enlargement developed marked hypertension under general anaesthesia, during which time a tourniquet was applied around his thigh. When the tourniquet was released, severe hypotension ensued which responded to therapy. The patient, however, died 16 h later of a myocardial infarction. Because of this incident, the anaesthetic and haemodynamic data of 699 patients who underwent limb surgery with a pneumatic tourniquet inflated for at least an hour were retrospectively examined using multivariate analysis. A 30% increase in systolic and/or diastolic arterial blood pressure occurred in 27% of the total patient material and in 67%, of those who had had a general anaesthetic. There was a higher frequency of the occurrence of “tourniquet hypertension” with older age, longer operations and the operation site being the lower rather than the upper limb. Tourniquet hypertension rarely occurred in patients with spinal anaesthesia (2.7%) and brachial plexus blockade (2.5%), while those with intravenous regional anaesthesia had a higher incidence (19%) of hypertens

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02566.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Twenty‐seven patients admitted for cholecystectomy were matched for age and sex in three groups for different perioperative fluid therapies over a period of 3 days. Group I was given an acetated half‐isotone “balanced” saline solution with the addition of 2.5% glucose, Group II an acetated Ringer solution and Group III an isotonic glucose solution. Percutaneous muscle biopsies were performed before and on the third day after surgery for the determination of water content and the concentration of sodium, potassium, magnesium and chloride in skeletal muscle. The cumulative balance of sodium and potassium was measured daily during the study. In all three groups a significant increase in the total muscle water content was demonstrated. The concentration of sodium and chloride in skeletal muscle increased significantly in Groups II and III, whereas the concentration of potassium decreased in all groups. The cumulative sodium balance was positive in Groups I and II; the potassium balance was negative in all groups. In conclusion, the patients given the balanced saline solution showed the least change in water content and electrolyte concentrations in skeletal

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02567.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The anticonvulsive activity (ED50), acute toxicity (LD50), and minimal neurotoxicity (TD50) of diazepam in an emulsion form (Diazemuls®) were compared with two different water‐based diazepam solutions (Valium® and Stesolid®). The diazepam preparations were administered intravenously to male mice. After determination of time of peak drug activity, the ED50's were established against pentetrazol‐induced convulsions, at peak drug activity. The most important difference between the three diazepam preparations was a significantly higher LD50 of diazemuls (275 mg/kg) compared to Valium (49 mg/kg) and stesolid (51 mg/kg). ED50 was: diazemuls 0.24 mg/kg, Valium 0.14 mg/kg and stesolid 0.10 mg/kg. The therapeutic indices (LD50/ED50) were thus calculated to he 1146 for diazemuls, 350 for Valium and 510 for stesolid. Time of peak drug activity and TD50 were equal for all three drugs. No signs of pain on injection or necrosis were observed following diazemuls, whereas this was common after Valium and st

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02568.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3‐uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4‐S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous‐oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma‐TSH, compared to the other group, which had a significant (P<0.05) increase peroperatively. The patients receiving epidural analgesia were pain‐free and the normal stress‐induced increase in plasma‐glucose was abolished. Concerning T3we found a significant decrease in both groups and a steady level of T4‐ and T3‐uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma‐TSH concentration are markedly similiar to the effects of other anterior pituritary hormones, i.e. HGH,

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02569.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Oxazepam 25 mg, flunitrazepam 1 mg and placebo were compared as oral premedication in 602 gynecological patients in a double‐blind randomised parallel study. In 251 patients undergoing major surgery the same drug was also given as a hypnotic the night before the operation. Both active drugs shortened the sleep‐onset time, decreased the number of spontaneous awakenings at night and improved the quality of sleep when compared to placebo. The active drugs were significantly better than placebo as premeditation when assessed by both the patients and the anesthesiologist. In 351 patients admitted for day‐case minor surgery with no previous night medication, flunitrazepam was significantly better than placebo as premedication when assessed by both the patients and the anesthesiologist, while oxazepam was only better than placebo when judged by the anesthesiologist, not by the pat

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02570.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Changes in blood flow in the tracheal mucosa of the dog caused by the pressure exerted by high‐volume, low‐pressure cuffs were measured with the hydrogen clearance method. Before inflating the cuffs, the blood flow of the tracheal mucosa was measured as a control for 12 h in order to confirm that the procedures of the hydrogen clearance method itself had little or no influence on the blood flow in the tracheal mucosa. After inflating the cuffs to create a tracheal wall pressure (TWP) of 1.3 kPa (10 mmHg), 2.6 kPa (20 mmHg), 3.9 kPa (30 mmHg) or 6.0 kPa (45 mmHg), local blood flows of tracheal mucosa (TBF) corresponding to each TWP were measured every hour for 12 h. No significant changes in blood flow were observed in the tracheal mucosa with the hydrogen clearance method before inflating the cuffs. In the groups with TWP of 1.3 and 2.6 kPa, the TBF rose 1 h after inflation of the cuffs, and then returned to the baseline values. In the group with TWP of 6.0 kPa, the TBF decreased markedly already 1 h after inflation of the cuffs, and continued to decrease severely thereafter. In the group with TWP of 3.9 kPa, the TBF followed an intermediate course between the groups with TWP of 2.6 kPa and 6.0 kPa. From the results of the present study, it was found that TBF was significantly impaired by a TWP of more than 3.9 kPa. Therefore, in prolonged intubation, TWP should be kept at or below 2.6

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02571.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A double‐blind study was performed in 41 patients (ASA I) to compare 0.5% bupivacaine with and without 8%, glucose in epidural analgesia. There was no difference in the onset, spread, duration or intensity of the epidural anaesthesias. The absorption of bupivacaine to circulation was similar in both groups. No major complications were noted and the anaesthesias were satisfactory for surgery in all patient

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02572.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY