摘要:

Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P<0.0001 andP<0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P<0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03412.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03578.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The endothelium‐derived relaxing factor (EDRF) is nitric oxide (NO) or a closely related nitrosothiol derivative. It is formed from the amino acid, L‐arginine. NO is rapidly inactivated locally and is instantly destroyed by haemoglobin when released into the blood stream. EDRF‐NO as well as NO generated from vasodilator nitrates act by activation of soluble guanylate cyclase, elevating cellular cyclic GMP levels, causing vasodilatation and inhibition of platelet aggregation. Endothelium‐dependent vasodilatation is attenuated in hypertension, atherosclerosis and diabetes. This is due to either loss of endothelium or deficient formation of EDRF‐NO. In these conditions, therapy with exogenous nitrates may substitute for a failing endogenous

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03579.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Upper abdominal surgery has a high incidence of postoperative respiratory complications. Although operations involving a thoracic as well as an upper abdominal incision as encountered in esophageal surgery are likely to be associated with an even higher complication rate and perhaps permanent alterations of respiratory function, only a few studies have addressed this problem. We evaluated the postoperative course of patients undergoing thoracoabdominal esophagectomy with esophagogastrostomy. Twenty patients were evaluated, of whom 10 (50%) developed respiratory complications as defined by our criteria, which were the simultaneous occurrence of rectal temperature over 38°C on the first postoperative day and radiographic evidence of pulmonary infiltration. Although there is no general consensus regarding the diagnostic criteria of a postoperative pulmonary complication, we were able to validate the clinical relevance of our definition by showing that these patients suffered from a more severe and more prolonged impairment of global oxygen exchange than those who did not fulfill the criteria. They also required a longer period of respiratory support (median duration of intubation 12 vs. 3 days,P<0.005). A comparison of the preoperative pulmonary function with that determined at least 6 months after the operation showed that only vital capacity (VC) and total lung capacity (TLC) were significantly (P<0.05) reduced following the operation, but not to a clinically relevant degree (VC ‐6%, TLC

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03414.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03580.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03581.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

To assess the hemodynamic effects of acute changes in extracellular ionized calcium concentration, [Ca2+], seven dogs were chronically instrumented to measure heart rate, aortic, left atrial, and left ventricular (LV) pressures, cardiac output, and coronary and renal blood flows. [Ca2+] was lowered 0.35 mmol ± l‐1by citrate infusion and then increased 0.35 mmol ± l‐1above control level by CaCl2infusions. This protocol was performed in the conscious dogs with and without ganglionic blockade (chlorisondamine 2 mg ± kg‐1). LV dP/dtmaxdecreased at low [Ca2+] and increased at high [Ca2+] during all conditions. The other hemodynamic variables measured were only slightly changed by changing [Ca2+] without ganglionic blockade and surprisingly even less with ganglionic blockade. Therefore, the lesser hemodynamic effects induced by acute changes in [Ca2+] in the conscious compared with anesthetized dogs cannot be explained by the depressant effects of the anesthetics upon the autonomic nervous system. We have suggested that the binding of Mg2+to citrate may be of importance for the minor hemodynamic effects in the consci

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03415.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The study was designed to measure the timing of the peak cardiovascular response following laryngoscopy and endotracheal intubation. Thirty patients ASA 1 or 2 were studied, with arterial pressure being continuously monitored using the Ohmeda 2300 Finapres. Patients were randomised to receive either propofol 2.5 mg ± kg‐1(Group A) or thiopentone 4.5 mg ± kg‐1(Group B). The mean time to complete laryngoscopy and intubation was 26 s in Group A and 20 s in Group B. The peak response occurred on average 31 s after the start of the stimulus in Group A and after 32 s in Group B. In 8 out of the 30 cases the peak response occurred during the period of stimulation. Systolic pressure fell on average by 2.6 kPa (20 mmHg) (range 0 to 5.9 (45 mmHg)) from its peak value to the value measured at the 1‐min time mark in the propofol group, and by 2.3 kPa (17 mmHg) (range 0.4 (3 mmHg) to 3.8 (29 mmHg)) in the thiopentone group. We conclude that the use of slow arm‐cuff‐based arterial pressure measurement techniques may miss important hypertensive episodes during laryngoscopy and endotracheal intubation. The effectiveness of agents in obtunding the pressor response may thus be mis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03416.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03582.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

31‐phosphorous magnetic resonance spectroscopy was used in a rat model of 10 min severe incomplete forebrain ischemia (two‐vessel occlusion with hypotension) to assess the effect of hyperglycemia on intracellular pH and high energy phosphates during ischemia and early reperfusion. One group (n = 8) with preischemic hyperglycemia (serum glucose 20 mmol ± l‐1) showed an increased intracellular acidosis (pH 6.35) during ischemia compared to 6.55 in the normoglycemic control group (n=7,P<0.001), but the recovery of phosphocreatine and ATP in early reperfusion was the same in the two groups. Another group (n = 7) was normoglycemic during ischemia, but received an i.v. bolus of glucose during the first minute of reperfusion. In this group the recovery of intracellular pH in early reperfusion was slower than in the control group (0.034 ± 0.006 pH units per minute compared to 0.052 ± 0.11 in the controls, ± s.d. a

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03417.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY