摘要:

Intravenous fat tolerance was tested in two groups of patients given a continuous i.v. infusion of heparin for several days. One group of 11 patients with deep vein thrombosis (DVT) of the leg was given 25000 30000 IU heparin daily for 4–5 days. The other group comprised 10 patients who had central venous catheters (CVC) for total parenteral nutrition. These patients were given 20000 IU heparin daily for 6 days as prophylasix against CVC‐related thrombosis. In the DVT group heparinization was associated with a 44% decrease in plasma fat removal capacity (P0.05, NS). During heparinization activated partial thromboplastin time was more than three times the basal value in the DVT group but less than twice those in the CVC group. One week after the heparin therapy the serum triglyceride levels were higher in both groups compared with initial values (DVT group: 1.2 ± 0.2 s.c. mean vs. 1.7 ± 0.3 mmol/l;P<0.05. CVC group: 1.0 ± 0.1 vs. 1.4 ± 0.2 mmol/l; NS). The possibility that full‐dose heparinization reduces plasma fat removal capacity and that this may be due to a partial depletion of lipoprotein lipase stores is

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02547.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The ability of graduated compression elastic stockings to prevent hypotension during elective epidural caesarean section was evaluated. Twenty women were randomly assigned to two groups of ten, one group being fitted with the stockings. The incidence and degree of hypotension were the same in both groups. Graduated compression clastic stockings are of no benefit in reducing the incidence of maternal hypotension during caesarean section.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02548.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Labetalol, an α‐ and β‐adrenergic receptor‐blocking agent, was studied as a hypotensive agent during halothane (mostly 0.5 vol.%)‐N2O‐fentanyl‐d‐tuhocurarine anaesthesia with a head‐up tilt of 5 degrees in 41 patients undergoing middle ear microsurgery. After the mean initial dose of 0.3 mg/kg, the mean need for labetalol ranged from 0.05 to 0.07 mg/kg at 30 ± 5‐min intervals. The mean duration of the hypotensive period was 102 min. During the hypotension, the average mean arterial pressure ranged from 59 to 62 mmHg (7.9‐8.3 kPa) and the mean heart rate from 61 to 66 b.p.m. After labetalol the maximum cardiac output decrease was 7%. Before labetalol the mean Pao2value was 158 mmHg (21.1 kPa) and during hypotension it ranged from 145 to 149 mmHg (19.3–19.9 kPa) when Fio2was 40%. The only peroperative side effects were ECG changes (middle junctional rhythm and sinus bradycardia) which occurred in 10% of the patients. The mean value for the degree of haemostasis rated by the otologist on a visual analogue scale between poor (0 mm) and excellent (100 mm) was 91 mm. The patients were able to open their eyes and to give their names 8–9 min after the end of anaesthesia. After extubation the patients were normotensive and there were no clinically significant changes in the cardiovascular parameters during the 4‐h recovery room period. Acid‐base status showed slight metabolic acidosis. The most common postoperative side effects were nausea only and nausea + vomiting, which occurred in 39% and 20% of the patients, respectively. It is concluded that labetalol produced stable, easily controllable hypotension without a compensatory rise in the heart rate, with minimal effect on peroperative Pao2value or cardiac output, as well as good operating conditions. The postoperative course was uneventful with the exception of a high incidence of nausea and vomiting, most probably due to the operation

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02549.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Sex‐related changes in the pharmacokinetics and pharmacodynamics (heart rate) of atropine were studied in female (n = 9) and male (n = 9) elderly patients after a single 0.02 mg/kg i.v. injection of the drug at the beginning of a combination anaesthesia. No significant differences were found between the sexes, which indicates that there are no sex‐related alterations in the response to this anticholinergic ag

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02550.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The neuromuscular blocking effect of atracurium given as a bolus dose (0.5 mg·kg‐1) followed by a maintenance infusion was studied during two different anesthetic techniques. It has been reported that benzodiazepines interact with non‐depolarising neuromuscular blockers. In this study no difference was found in the effect of atracurium given with conventional fentanyl/nitrous oxide anesthesia when compared to total intravenous anesthesia using midazolam/alfentanil. More than 90% twitch depression was achieved after 123 and 137 s, respectively. Recovery time to 10% twitch height following the bolus dose was around 32 min. The dosage range for atracurium given by infusion (0.29‐0.44 mg·kg‐1·‐1) w

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02551.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The prognostic value of conventional renal and liver function tests was evaluated during surgical septicemia. Changes in renal function variables were associated with the development of septic shock. Creatinine clearance was the most sensitive variable in predicting the outcome of septic shock, but serum creatinine and urine output were also of some value in this respect. Significantly lower creatinine clearance and urine output values, as well as significantly higher serum creatinine concentration, were thus observed during septic shock with fatal outcome compared to non‐fatal septic shock. In septicemia not complicated with shock, the variables of renal function remained in the normal range irrespective of final outcome. Among the liver function tests, serum albumin and total protein concentration revealed significant differences in behaviour between survivors and patients dying with persistent septicemia. However, due to the small differences and considerable overlap observed between the two groups of patients during the first 2 weeks of septicemia, these two variables are of limited practical value as prognostic predictors. The other liver function tests gave no information as regards the outcome of septicemia in the present stud

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02552.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The purpose of this review is to assess the current knowledge of mucopolysaccharidosis (MPS), with reference to the serious complications which may arise in connection with anaesthesia and operation. MPS consists of a heterogeneous group of hereditary diseases which are characterized by an abnormal accumulation of mucopolysaccharides, especially in cartilaginous and bone tissue. Because of their progressive and disabling nature, frequent surgical intervention is common, and is associated with a high degree of per‐ and postoperative risk. The clinical manifestations of MPS are frequently dwarfism, scaphocephaly, grotesque facial features with snub nose, hypertelorism, macroglossia and dental anomalies. The chest is deformed by pectus carinatum or excavatum, club‐formed ribs and kyphosis with gibbus. Furthermore, cardiomegaly, abdomen pendens, hepatosplenomegaly, umbilical hernia, corneal clouding, conductive deafness and subnormal intelligence are common findings. Prior to operation, patients should be thoroughly evaluated through clinical examination and laboratory investigations. In particular, lung function should be optimized by lung physiotherapy and treatment of airway infections. When inducing general anaesthesia, spontaneous respiration is recommended until the patient has been intubated, as airway anomalies, bleeding and salivation may make intubation extremely difficult. Local or regional anaesthesia is often preferable, though age and mental status are relative contraindications. When used in combination with careful sedation, many problems may be overcome. Postoperatively, it is important to treat stagnation of secretions and airway infections with lung physiotherapy, positive end‐expiratory pressure, and antibiotics. In connection with anaesthesia, it is vital to monitor the patient carefully before, during and after anaes

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02553.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

To provide general anaes hesia with endotracheal intubation during regional blockades, three dose regimens of propofol emulsion were studied: induction 2 mg kg‐1, infusion rate 9 mg kg‐1h‐(Group I); induction 2.5 mg kg‐1, infusion rate I? mg kg‐1h‐1(Group 2); induction 2.5 mg kg‐1, infusion rate 9 mg kg‐1(Group 3). Each group comprised 10 healthy (ASA class 1 or 2) unpremedicated patients. The induction times measured from the start of injection until counting ceased (± 50 s) and until eye‐lash reflex disappeared (± 80 s) showed no statistical differences between groups. In five patients in Group 1 and one patient in each of Groups 2 and 3 the induction dose was too low for intubation. Pain on injection was seen in 13 cases (mild 6, moderate 6 and severe I). Cough accompanied by hypersalivation was the most important side‐effect. Recovery times varied widely and showed no statistical differences. Answering simple questions was possible after 14 min in Group 1, 23 min in Group 2 and 19 min in Group 3. Apart from a short period of euphoria, recovery was uneventful. There was no tendency to fall asleep again. None of the combinations of induction doses and infusion rates provided good anaesthesia conditions for an acceptab

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02554.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The interaction of vecuronium, a monoquaternary analogue of pancuronium, with the cardiac muscarinic receptors in canine hearts was investigatedin vitroby [3H] QNB binding assay and compared with that of pancuronium. Both pancuronium and vecuronium, which are nicotinic antagonists of competitive types, inhibited the binding of [3H] QNB to cardiac muscarinic receptors with values of IC50of 5.41 × 10‐7mol/l and 3.97 × 10‐6mol/l respectively. According to the Kd and Bmax values on the Scatchard plot, pancuronium, while not influencing the number of receptors, had a 3‐fold greater inhibitory effect than vecuronium on the affinity of the muscarinic receptors. The K1values of vecuronium and pancuronium showed that pancuronium had a 7.3‐fold greater affinity with the receptors than vecuronium. We concluded that vecuronium had a direct inhibitory action on the binding of [3H] QNR to the canine heart muscarinic receptors, but this action was much weaker than pa

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02555.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The influence of rectal administration of barbiturates on Pco2during mask anaesthesia with spontaneous ventilation was studied in 72 infants. The age of the patients ranged between 6 and 24 months and they were all subjected to minor paediatric surgery. The patients were divided into four equally large groups: a control group receiving no premedication, a group receiving rectal thiopentone 30 mg·kg‐1and two groups receiving methohexitone either 20 or 30 mg·kg‐1. In all patients Pco2was measured in an arterialized capillary blood sample obtained during stable anaesthesia with oxygen, nitrous oxide and halothane before and after surgery. After rectal induction with barbiturates, the mean Pco2was significantly higher in the different barbiturate groups than in the control group (P<0.05). The mean Pco2value ± s.d. in kPa for the control group was 5.6 ± 0.7, for the group receiving thiopentone 30 mg·kg‐16.5 ± 1.6, for the groups receiving methohexitone 20 or 30 mg·kg‐16.1 ± 1.2 and 6.3 ± 1.1, respectively. It is concluded that the combination of rectal induction with barbiturates and mask anaesthesia with oxygen, nitrous oxide and halothane carries an increased risk of hypoventilation in infants unde

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1987.tb02556.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY