ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The prevalence of hepatitis B viral markers is increased in some groups of medical workers who are exposed to blood from patients carrying the virus, but this has not been studied critically in physicians and others who administer anesthesia. Physician anesthesiologists (M.D.) and nurse anesthetists and anesthesia assistants (non-M.D.) at four university-affiliated hospitals were evaluated for hepatitis B markers as determined by seropositivity for hepatitis B surface antigen, antibody to the hepatitis B surface antigen, or antibody to the hepatitis B core antigen. In the 86 subjects (38 M.D., 48 non-M.D.) who represented 80.4% of possible participants, the overall prevalence of serologic markers of hepatitis B was 23.3%. The frequency did not differ between M.D. (23.7%) and non-M.D. (22.9%) groups or between men (20.3%) and women (26.9%). Of 81 subjects who had no clinical history of hepatitis, 16 (19.8%) had positive serologic markers. The frequency of seropositivity increased with time since graduation from medical school (M.D.) or nursing school or college (non-M.D.). The prevalence of serologic markers of hepatitis B virus in this study of anesthesia personnel is five to eight times that of the general population but is similar to that of other medical workers who frequently are exposed to blood.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Controversy persists about the cardiac toxicity of bupivacaine if accidentally administered intravenously during regional anesthesia. Using awake, unanesthetized sheep, we evaluated the cardiac effects of low and high equivalent does of lidocaine and bupivacaine given intravenously over 10 s. All animals convulsed within 30 s of injections. Although both drugs significantly increased heart rate and systemic and pulmonary arterial blood pressure for up to 10 min, cardiac output was affected variably. The magnitude of hemodynamic changes that each drug produced did not differ significantly from each other at either dose level. However, of the sheep receiving intravenous lidocaine, none developed arrhythmias other than mild sinus tachycardia and minimal ST-T wave changes (which occurred in 25% of the animals). After intravenous bupivacaine injection, all sheep had transient changes on the EKG and/or arrhythmias (e.g., supraventricular tachycardia; atrioventricular conduction blocks; ventricular tachycardia; multiform premature ventricular contractions; wide QRS complexes; ST-T wave changes; and in one animal, fatal ventricular fibrillation). Normal sinus rhythm usually returned within 8–10 min. Arterial blood gas and acid-base values stayed within the normal range during the studies, and serum potassium did not change significantly from control. In conclusion, in conscious adult sheep, equivalent doses of lidocaine or bupivacaine produced similar central nervous system (CNS) toxicity when rapidly injected intravenously. In the absence of marked hypoxia, respiratory or metabolic acidosis, hyperkalemia, or hypotension, serious cardiac arrhythmias occurred after bupivacaine but not lidocaine.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effects of increasing depths of anesthesia on the activities of the hypoglossal nerve (HN) and the phrenic nerve (PN) were investigated in artificially ventilated, vagotomized cats. An abrupt increase in inspired concentration of halothane from 1% to 4% immediately decreased both HN and PN activities, but HN activity decreased more and disappeared much earlier than did PN activity. Steady-state responses of HN and PN activities to changes in endtidal concentration of halothane showed that halothane depressed both HN and PN activities in a dose-related manner but at different rates, suggesting that respiratory control of the tongue muscles and the diaphragm are in part mediated by different neural pathways. Differential suppression of PN and HN activities also was observed following an acute increase in anesthetic depth with thiopental and diazepam. In contrast, no such differential suppression was observed following ketamine administration. Thus, differential suppression of PN and HN may be associated not only with depth of anesthesia but also with the type of anesthetic used.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Isolated rat sciatic nerves were used to study the interaction between 2-chloroprocaine (2-CP) and bupivacaine (BP). Five nerves studied as controls were treated with 5 × 10–4m BP and the amplitude of the compound action potential (CAP) evoked by suprathreshold stimulation was measured. This concentration of BP completely blocked nerve conduction; but, following washout with normal Krebs–Ringer solution, the CAP amplitude recovered to 50% of initial values in 50 (±4) min with a rate of recovery of 1.7 (±0.6) %/min. In another series of experiments, five nerves were blocked first with 5 × 10–4m 2-CP, allowed to fully recover, and then were blocked with BP under the same conditions as the controls. Under these conditions, the half time for the recovery of CAP amplitude following BP was shortened to 25 (±5) min, with a rate of recovery of 2.8 (±0.3) %/min. When five nerves were exposed to a 5 × 10–4m solution of a 2-CP metabolite, 4-amino-2-chlorobenzoic acid, no nerve blockade was produced. When these nerves subsequently were blocked with BP, recovery to 50% of initial values occurred in 22 (±5) min, with a rate of recovery of 2.0 (±0.2) %/min. Although pretreatment with either 2-CP or 4-amino-2-chlorobenzoic acid significantly shortened the duration of BP-induced nerve blockade, neither drug had a significant effect on the rate of recovery once the CAP amplitude returned to measurable values.These results suggest that the metabolite of 2-CP, 4-amino-2-chlorobenzoic acid, remains in the nerve following recovery from neural blockade and interferes with the subsequent action of BP upon this nerve.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Controversy still surrounds the differential susceptibility of nerve fibers to local anesthetic conduction block. In order to help resolve this controversy, we developed anin vivomodel of peripheral nerve blockade in the cat that closely reproduced the clinical state. Using this model, differential rate of nerve blockade of A-alpha, A-delta, and C fibers by 2-chloroprocaine, lidocaine, bupivacaine, and etidocaine was observed and quantitated. C fibers were blocked first by 2-chloroprocaine, lidocaine and bupivacaine. Etidocaine blocked A-delta fibers first. A-alpha fibers always were blocked last. Of the four local anesthetics tested, 2-chloroprocaine produced the greatest differential rate of block of the nerve fibers, and etidocaine produced the least.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Adaptations of the critical-incident technique were used to gather reports of anesthesia-related human error and equipment failure. A total of 139 anesthesiologists, residents, and nurse-anesthetists from four hospitals participated as subjects in directed or open-ended interviews, and 48 of them functioned as “trained observers.” A total of 1,089 descriptions of preventable “critical incidents” were collected. Of these, 70 represented errors or failures that had contributed in some way to a “substantive negative outcome.” From these incidents, ten potential strategies were developed for prevention or detection of incidents.Overall patterns observed in this wider study were similar to those of our earlier report. The incidents most frequently reported included breathing circuit disconnections, drug-syringe swaps, gasflow control errors and losses of gas supply. Only 4% of the incidents with substantive negative outcomes involved equipment failure, confirming the previous impression that human error is the dominant issue in anesthesia mishaps. Among the broad categories of key strategies for mishap prevention were additional technical training, improved supervision, improved organization, equipment human-factors improvements, and use of additional monitoring instrumentation. The data also suggest that less healthy patients are more likely to be affected adversely by errors. It is suggested that, in future studies of anesthesia mortality and morbidity, untoward events should be classified according to preventive strategy rather than outcome alone as an aid to those who wish to apply the experience of others to lessen the risk in their individual practice.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

One theory of narcosis postulates that inhaled anesthetics produce general anesthesia by causing the release of endogenous opioid peptides. In the present study, however, the concentration of immunoreactive beta-endorphin-like material (eight patients) or leuenkephalin (four patients) did not increase in cerebrospinal fluid of patients 5 min after induction of anesthesia with thiopental, 2–5 mg/kg and N2O 70%; after an additional 10 min, during which halothane was added; at 5, 15, and 60 min after surgical incision; or after 30 min in the recovery room. Therefore, any contribution of the endorphin system to the production of general anesthesia does not appear to require the release of beta-endorphin.

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1984

数据来源: OVID