ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01270.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Carticaine, a new local anesthetic of the amide type, differs from those previously known in that it contains a thiophene ring. The physico‐chemical properties of the compound, its pharmacology and its toxicology are reviewed from the literature. A controlled, double‐blind investigation in which carticaine was compared with lidocaine for the purpose of throwing light on the effect of the new local anesthetic in epidural analgesia is presented. Carticaine and lidocaine 2% with adrenaline 1:200 000 were used in the investigation. It was not possible to show any statistically significant difference as regards latency, spread, duration, or motor blockade obtained with the two substances. Marked differences in the type of side effects or their frequency were not noted. From this investigation and a scrutiny of the published clinical studies on the effect of carticaine, it is concluded that its clinical properties are comparable to those of lidoca

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01186.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

In 1967, a method of artificial positive‐pressure ventilation without circulatory effects synchronous with respiration was required for experimental studies and for this purpose high‐frequency positive‐pressure ventilation (HFPPV) was developed. The original rationale for the HFPPV technique was (a) by means of endotracheal insufflation a reduction in dead space should make it possible, with smaller tidal volumes and higher ventilatory frequencies, to provide adequate alveolar ventilation at lower maximal and lower mean airway pressures than those required in conventional IPPV; (b) under insufflation with a high frequency and a short insufflation period the inertia characteristics of the lungs should be able to achieve critical suppression of the circulatory effects of the ventilatory pattern.In order to compensate for the increased VdVtwith intermittent positive‐pressure ventilation of high frequency, a ventilator system whose compressible volume and internal compliance were negligible was required.In dog experiments the HFPPV technique was found to provide the anticipated circulatory conditions. In addition it was observed that when air was intermittently supplied by endotracheal insufflation at a frequency of 60–80 per min the spontaneous breathing ceased almost instantaneously. As arterial blood gas analyses verified that this suppression occurred even at normoventilation, it was assumed that it most probably resulted from a suppression of the reflexogenic spontaneous respiratory rhythm. In comparative experimental studies the original expectations were verified, i.e. in normal dogs under general anaesthesia HFPPV gave adequate ventilation with the aid of relatively low transpulmonary pressures and with only slight circulatory or other systemic effects. This HFPPV technique was therefore investigated clinically and in all patients adequate alveolar ventilation was achieved with insufflation frequencies of 60–100 per min and with only small airway pressure variations.A ventilator system for HFPPV in which the insufflation catheter is excluded from the patient circuit was considered. This requires a modified insufflation technique which essentially gives no increase in the compressible volume or internal compliance of the ventilator system, or in the physiological dead space of the patient. A pneumatic valve principle utilizing the Coanda effect was found to fulfil these requirements. The ventilator systems designed according to these principles comprised a gas‐conditioning unit and a patient circuit. The gas‐conditioning unit supplied gas pressures which remained constant regardless of the ventilatory phase and provided gas mixtures (C2/N2O or O2/air) of desired temperature and relative humidity. The conditioned gas was delivered under high pressure to the side‐arm of the pneumatic valve connector of the patient circuit.These new systems for HFPPV were studied in a lung model and dog experiments. They were then applied in clinical practice for bronchoscopy (broncho‐scopic HFPPV) and laryngoscopy (laryngoscopy HFPPV) under general anaesthesia and for paediatric anaesthesia and neonatal respiratory care. Owing to their “open” character these ventilator systems and techniques lacked the capacity to give a volume‐controlled ventilation. Further technical development was thus motivated, and is the subjec

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01259.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The demand for intermittent halothane supplementation during N2O‐O2‐relaxant anaesthesia was studied in 25 alcoholics (annual consumption over 15 1 pure alcohol) scheduled for biliary or gastric surgery. The controls were 45 nonalcoholics and 43 patients with an annual consumption of between 1 to 15 1. Thiopental (3 mg/kg/min) was given for induction. After intubation, halothane supplementation was given in 0.5% concentration for 10‐min periods. Standardized criteria for halothane supplementation were various motor and autonomic responses to painful stimuli. Muscular relaxation was kept fairly constant (roughly 90%), as assessed visually with the aid of a peripheral nerve stimulator. The total time for which halothane supplementation was given, expressed as a percentage of the total anaesthesia time, was used as an indication of the need for halothane supplementation. The need for thiopental for induction was not increased to a statistically significant extent in alcoholics, but signs of excitation did occur in 40% as compared with 11% in non‐alcoholics (P<0.01). The demand for halothane supplementation was higher in alcoholics (47±4.8%, s.e. mean) than in non‐alcoholics (33±2.3%). This difference, however, was partly due to the higher incidence of gastric surgery, which required more supplementation than biliary surgery. Analysis of the different criteria indicating the need for halothane supplementation revealed that an increase in blood pressure or heart rate was more common in non‐alcoholics, whereas motor irritability, sweating and lacrimation were more frequent in alcoholics. Management of the anaesthetic posed no special difficulties in the alcoholics with an estimated mean annual consumption of 32 ± 4 (s.e. mean) litres of absolute alcohol. Three patients (5% of the alcohol consumers) reported dreams or recollections, suggesting that this mode of halothane supplementation does not guarantee an adequate anaesthetic depth. The difficulties and biases associated with this type of analysis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01187.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The renal and hepatic elimination and biotransformation, as well as the relation between disposition and duration of action of pancuronium and two of its analogues, dacuronium and ORG.6368, have been investigated in the cat. In pharmacokinetic studies, appreciable amounts of the latter two compounds were found in the urine, bile and liver 8 h after their intravenous administration. Various proportions of the injected dose of the respective drugs were metabolized. In another series of experiments it was shown that the early hepatic uptake (during the first 3 min after the injection) of ORG.6368 was significantly greater than that of dacuronium and pancuronium. The intensity and duration of action of the neuromuscular blocking effect of the three compounds were studied after intravenous and “close” intraarterial injection. On the basis of these pharmacokinetic and neuromuscular studies, it was concluded that the short duration of action of ORG.6368 is due primarily to its early hepatic uptake. The possibility cannot be excluded, however, that differences in the kinetics of the drug action of ORG.6368 and the other two compounds also contributed significantly to the differences seen in the duration of action of these compou

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01188.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Afferent vagal nerve activity from stretch‐receptors in the lung and efferent phrenic nerve activity were recorded during spontaneous respiration and during positive‐pressure ventilation with three different types of ventilators. During spontaneous respiration the efferent phrenic nerve activity slightly preceded the afferent vagal nerve activity. Volume‐controlled ventilation did not alter the phrenic nerve activity when the ventilation was set at a rate equal to that during spontaneous respiration, but afferent vagal volleys increased in duration. At higher frequencies of insufflation spontaneous inspiration was inhibited.An increase in afferent vagal nerve activity and a concomitant slight decrease in efferent phrenic nerve activity were obtained during animal triggered pressure‐controlled ventilation.High‐frequency positive‐pressure ventilation (HFPPV) gave rise to basal, non‐grouped activity in vagal afferents, causing inhibition of inspiration. During HFPPV, spontaneous respiration can take place on activation of other afferents to the respiratory centre.Clinical aspects of respirator treatment from a neurophysiological standpoint

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01260.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

A saline placebo, 3 mg/kg of 2% plain prilocaine, and 3 mg/kg of 2% plain mepivacaine were injected into the deltoid muscles of 10 healthy subjects in a double‐blind, cross‐over trial.Before and at 0.5, 1.5 and 3 h after injection, psychomotor skills related to driving were measured. When compared to the saline placebo, neither prilocaine nor mepivacaine impaired the parameters of psychomotor function measured. Blood concentrations of prilocaine were significantly (P<0.001) lower than those of mepivacaine during the whole observation period.It was concluded that in comparison to lidocaine, bupivacaine, or etidocaine, which have been tested previously and found to impair psychomotor performance, mepivacaine and, especially, prilocaine are the anaesthetic agents to be preferred when effects on central nervous system should be avoided, e.g. in outpatient pract

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01189.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

In experiments in dogs the ventilatory and circulatory conditions prevailing with the ventilatory pattern in high‐frequency positive‐pressure ventilation (HFPPV) were investigated with use of a pneumatic valve principle and a ventilator system of an “open” character. Keeping the gas input constant the importance of insufflation frequency and insufflation time and the reactions to various levels of positive end‐expiratory pressure (PEEP) were investigated in terms of changes in arterial pH, Pco2and Po2.With the volumes of delivered gas kept constant, an increasing insufflation frequency from 60 to 100 per min gave a parallel decrease in tidal volume accompanied by lower maximum intratracheal pressures and a significant decrease in alveolar ventilation. Also taking into account the possibilities of inducing a suppression of the spontaneous respiration, higher ventilatory frequencies than 60 per min do not seem to introduce any further advantages.Including the associated effects on cardiac output and venous admixture, the cardiopulmonary and circulatory parameters studied did not show any substantial changes with PEEP levels below 7.5–10 cm H2O. Thus the level of PEEP, which often is part of the ventilatory pattern in HFPPV, does not seem to have any untoward influence on the circulation (stroke volume, cardiac output, total peripheral vascular resistance) and oxygen transport (arterial oxygen content and oxygen flux) in normovo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01261.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

This study was designed to measure how fast and at what concentrations ketamine would enter the foeto‐placental circulation, when administered intravenously to 10 healthy mothers immediately before forceps delivery, which was indicated by a delayed second stage of labour. It is shown that ketamine very rapidly passes the placenta, and that ketamine levels in cord blood exceed the levels in the maternal venous blood as early as 1 min 37 s after the injection. The ketamine levels in cord blood reach a maximum in the period 1 min 37 s to 2 min 5 s after the injection. Later they show a tendency to decline. A short‐lasting, marked elevation of blood pressure was produced by the ketamine anaesthesia. Two of the newborn showed low Apgar scores at 1 min. In one of them this was probably attributable to the anaesthe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01191.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The incidence of immediate complications on inserting central venous catheters into 475 patients is reported. The catheter positions were verified by X‐ray. Six different insertion routes were used. Central venous cannulation via the right internal jugular vein is recommended because of the high incidence of satisfactory catheter positions and the small number of puncture complications with this rout

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1977.tb01192.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY