Showing papers in "BJA: British Journal of Anaesthesia in 1984"
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TL;DR: Tips for managing nausea and vomiting: Eat small meals or snacks every 2-3 hours throughout the day instead of three large meals, and keep small portions of your favorite foods on hand.
393 citations
TL;DR: Using the single breath test for carbon dioxide (SBT-CO2), the components of physiological deadspace were investigated during anaesthesia with IPPV in 58 patients, finding improvements with increasing VT can be attributed to beneficial effects on gas distribution and diffusion time.
Abstract: Using the single breath test for carbon dioxide (SBT-CO2) the component of physiological deadspace were investigated during anaesthesia with IPPV in 58 patients. A square-wave inspiratory flow and an end-inspiratory pause (25% and 10% of cycle time, respectively) were used. At tidal volumes of 0.45 litre (f = 17 b.p.m.),and 0.75 litre (f = 9 b.p.m.), median values for VDphys/VT were 0.44 and 0.31. Increasing VT and decreasing f did not change airway deadspace (VDRW) so that the fraction VDRW/VT was decreased (P
235 citations
TL;DR: Studies with an emulsion formulation of ICI 35 868 indicate that this new formulation has anaesthetic properties in rats and mice, and haemodynamic effects in the mini-pig which are similar to those of the previously available Cremophor formulation.
Abstract: Studies with an emulsion formulation of ICI 35 868 (2,6-diisopropylphenol) indicate that this new formulation has anaesthetic properties in rats and mice, and haemodynamic effects in the mini-pig which are similar to those of the previously available Cremophor formulation. Administration of the emulsion formulation to dogs produced no untoward effect, whereas the Cremophor formulation produced a marked increase in plasma histamine concentration. In the mini-pig, no adverse response was produced by the repeated administration of the emulsion formulation of ICI 35 868, whereas the Cremophor formulation produced anaphylactoid responses when a second injection was given 1 week after an uneventful first exposure to this formulation. Behavioural responses in the rat suggest that the emulsion formulation may produce less discomfort on i.v. injection
193 citations
TL;DR: The disadvantages associated with administration of drugs rectally include: interruption of absorption by defaccation, which may occur particularly with irritant drugs; the surface area of the rectum is far smaller for absorption than that of the duodenum, and this may produce problems with dissolution of some drugs.
Abstract: Rectal administration of drugs has been used since Ancient times to produce local effects. In addition, the rectal route may be used for systemic administration of drugs for the following reasons (De Boer ct al., 1982): (a) the presence of nausea and vomiting, or when the patient is unconscious; (b) the presence of disease of the upper gastrointestinal tract which affects absorption of drugs given orally; (c) an objectionable taste (a factor which may be particularly important in children); (d) the achievement of a rapid systemic effect by giving a drug in a suitable solution (as an alternative to parenteral administration); (e) drug absorption may be easily discontinued in the event of an accidental overdose; (f) the rate of drug absorption is not influenced by ingestion of food or the rate of gastric emptying; (g) first-pass elimination of high clearance drugs may be partly avoided; (h) contact with digestive fluids of the upper gastrointestinal tract is avoided, thereby preventing breakdown of some drugs. The disadvantages associated with administration of drugs rectally include: (a) interruption of absorption by defaccation, which may occur particularly with irritant drugs; (b) the surface area of the rectum is far smaller for absorption than that of the duodenum; (c) the fluid contents of the rectum are much smaller than those of the duodenum and this may produce problems with dissolution of some drugs; (d) degradation of some drugs by micro-organisms may occur in the rectum; (e) patient acceptability may be a problem, at least in some countries.
179 citations
TL;DR: The results indicate that extradural analgesia with a local anaesthetic drug can suppress the increases in the plasma concentrations of the catecholamines and cortisol after surgery, thus indicating that postoperative pain is a factor involved in the stress response following surgery.
Abstract: The influence of thoracic extradural local anaesthetics (0.5% bupivacaine) or extradural morphine on the metabolic response to upper abdominal surgery was compared with the administration of morphine i.v. in the period after operation. The extradural local anaesthetic group had significantly lower blood glucose and plasma FFA concentrations and consistently, but not significantly, lower blood glycerol and lactate concentrations than both the other groups. At 4 h both extradural groups had significantly lower plasma FFA and blood 3-hydroxybutyrate concentrations than the control group. Blood alanine concentration decreased in all three groups with a minimum at 24 h. There were no differences in serum insulin concentrations between the groups. It is concluded that thoracic extradural morphine differs from thoracic extradural local anaesthetics in being much less able to suppress the metabolic response associated with upper abdominal surgery.
173 citations
Journal Article•
TL;DR: Isoflurane has the largest circulatory margin of safety of all potent halogenated agents; it produces the least myocardial depression at a given multiple of MAC.
Abstract: The physical and pharmacological properties of the structural isomers isoflurane and enflurane differ from each other and from those of other potent inhaled anaesthetics. The minimum alveolar concentration (MAC) for isoflurane (1.15%) is one-and-one-half times that for halothane (0.75%) and two-thirds that for enflurane (1.7%). The blood/gas partition coefficient (1.4) for isoflurane is lower than the coefficients for all other potent inhaled agents. Despite this lower blood solubility, induction of anaesthesia is slightly faster with halothane because of isoflurane's mild pungency. Enflurane depresses ventilation more than isoflurane, which in turn is slightly more depressant than halothane. All these agents dilate constricted bronchi, and thus are useful in the anaesthetic management of patients who have asthma or chronic obstructive pulmonary disease. Isoflurane has the largest circulatory margin of safety of all potent halogenated agents; it produces the least myocardial depression at a given multiple of MAC. Isoflurane may increase heart rate, particularly in younger patients, and occasionally is associated with tachycardia. It decreases total peripheral resistance, thereby decreasing systemic arterial pressure. Although results from one study suggest that isoflurane may produce a "steal" or coronary blood flow in patients with coronary artery disease, results from other studies suggest that, even in the presence of coronary artery disease, coronary blood flow to all parts of the heart remains as adequate with isoflurane as with other anaesthetics. Greater concentrations of isoflurane (1.6 MAC) increase cerebral blood flow less than does halothane. Isoflurane does not produce convulsive activity, but can produce profound muscle relaxation. It enhances the action of tubocurarine or pancuronium, and (to a lesser extent) vecuronium or atracurium. The enhancement is comparable to that produced by enflurane. Less enhancement is produced by halothane or nitrous oxide-narcotic. Only 0.17% of isoflurane taken up in man appears as urinary metabolites. This resistance to biodegradation may explain the minimal or absent hepatotoxicity and nephrotoxicity of isoflurane.
165 citations
TL;DR: Measurements of heart rate, arterial pressure and skin resistance have been used as indirect indices of the level of sympathetic activity to assess both the efficacy of premedication and depth of anaesthesia.
Abstract: Nociceptive surgical stimulation is accompanied by increased hypothalamopituitary activity which is generally referred to as the stress response to injury. This is manifest by a release of trophic hormones from the hypothalamus which in turn stimulate release of ACTH, TSH, GH, FSH, luteinizing hormone and prolactin in addition to ADH from the pituitary. Consequently, there is increased secretion of cortisol and thyroxine with suppression of insulin and increase in blood sugar concentrations. These responses may be partly attenuated by large doses of opioid analgesic drugs and some local anaesthetic techniques used during general anaesthesia. These endocrine changes have recently been reviewed elsewhere (Kaufman 1982, 1984; Weatherill and Spence, 1984). In addition, increased hypothalamic activity induced by nociceptive stimulation is accompanied by increased traffic in sympathetic efferent tracts. This is manifest by the well known signs which are conventionally used to diagnose unduly light levels of anaesthesia — notably dilatation of the pupils, sweating, tachycardia and hypertension. Thus measurements of heart rate, arterial pressure and skin resistance have been used as indirect indices of the level of sympathetic activity to assess both the efficacy of premedication and depth of anaesthesia. Increased sympathetic tone involves augmented release of noradrenaline by presynaptic sympathetic fibres and also increased secretion of catecholamines from the adrenal medulla. Thus attempts have been made for a number of years to assess sympathetic activity \"directly\" by measurement of plasma catecholamine concentrations. Until recently, assays were not available with sufficient sensitivity to measure resting concentrations of plasma catecholamines. However, with the advent of radioenzymatic assay (REA) and, over the past 5-6 years, high pressure liquid chromatography (HPLC) techniques for measurement of catecholamines in plasma, there has been a large
156 citations
TL;DR: The results show that halothane and enflurane delay neural transmission along the brainstem and cortical sections of the auditory pathway and that the effects of these agents are approximately related to their known anaesthetic potencies.
Abstract: The effects of increasing concentrations of halothane and enflurane on selected components of the auditory evoked response were studied in 12 patients; six received halothane and six enflurane. After the induction of anaesthesia with thiopentone, anaesthesia was maintained with 70% nitrous oxide in oxygen. Ventilation was controlled. The inspired concentration of the inhalation agent was increased incrementally, halothane in steps of 0.5% up to 2.5%, and enflurane in steps of 1% up to 5%. With both agents, linear dose-related increases were seen in the latencies of waves III, V, Pa and Nb and the interpeak intervals I-V and III-V, with decreases in the amplitudes of Pa and Nb. In five of the patients the inhalation agent was discontinued at the end of the test period, resulting in reversal of the changes in some or all of these waves. End-tidal carbon dioxide tension was controlled and variations of temperature and arterial pressure were insufficient to produce the observed changes. The results show that halothane and enflurane delay neural transmission along the brainstem and cortical sections of the auditory pathway and that the effects of these agents are approximately related to their known anaesthetic potencies
151 citations
TL;DR: It was shown in 1970 that the frequency of regurgitation had decreased to 7.8% and of this number, 8.6% of patients had aspirated, so it is of vital importance that anaesthetists are aware of the effect of the drugs which they use on the LOS.
Abstract: Since Fyke, Code and Schlegel (1956) first demonstrated the existence of a high pressure zone at the lower end of the oesophagus, there has been increasing interest shown in this structure by anaesthetists. This area is termed the lower oesophageal sphincter (LOS) and is the major barrier preventing regurgitation of acid gastric contents into the oesophagus. This is of considerable concern to anaesthetists, as any regurgitated material may be aspirated into the lungs and produce the acid aspiration (Mendelson's) syndrome. It is of vital importance, therefore, that anaesthetists are aware of the effect of the drugs which they use on the LOS. Regurgitation and subsequent aspiration of gastric contents remains a major cause of morbidity and mortality in clinical anaesthesia. The overall mortality from aspiration has changed little over the past 20 years in the U.K. (Edwards et al., 1956; Lunn and Mushin, 1982). In every published study on deaths attributable to anaesthesia, there have been reports of fatalities resulting from vomiting or regurgitation and subsequent aspiration (Harrison, 1978; HoviViander, 1980). The occurrence of regurgitation has been estimated at 14-26% using older techniques of anaesthesia with ether, cyclopropane and uncuffed endotracheal tubes (Culver, Makel and Beecher, 1951; Berson and Adriani, 1954). Of these 7-16% had evidence of aspiration as judged by the appearance of tracer dye in the trachea at laryngoscopy and bronchoscopy. Using contemporary anaesthetic techniques and the same methodology it was shown in 1970 that the frequency of regurgitation had decreased to 7.8% and of this number, 8.6% of patients had aspirated (Blitt et al., 1970).
130 citations
TL;DR: Recent reports describing anaesthetic management of patients for elective removal of phaeochromocytoma have shown that perioperatdve mortality may be almost completely eliminated, the result of the increased knowledge of the pathophysiology of the tumours.
Abstract: The presence of a phaeochromocytoma is a hazardous and dramatic cause of arterial hypertension accounting for approximately fewer than 0.1% of all cases of hypertension (Manger and Gifford, 1977). Phaeochromocytomas are functionally active, catecholamine-containing tumours of chromaffin tissue, found usually in the adrenal medulla, but they may occur at any site where chromaffin tissue is located. Although the frequency of phaeochromocytoma is low, its diagnosis is important. Whereas the hypertension is usually cured by surgical removal of the tumour, undetected phaeochromocytoma is usually fatal. Although anaesthesia in patients with unsuspected phaeochromocytoma is associated with a high mortality rate, recent reports describing anaesthetic management of patients for elective removal of phaeochromocytoma have shown that perioperatdve mortality may be almost completely eliminated (Remine et al., 1974; Desmonts et al., 1977; Roizen et al., 1982). This reduction in operative mortality is the result of our increased knowledge of the pathophysiology of the tumours. This review summarizes the data from the literature regarding the diagnosis of phaeochromocytoma and the anaesthetic management of patients with these tumours.
128 citations
TL;DR: Possible correlations between age and certain characteristics of spinal blockade with plain bupivacaine were investigated in 124 patients, ages ranging from 15 to 92 yr, and the maximum spread of analgesia increased with age, although the correlation was poor.
Abstract: Possible correlations between age and certain characteristics of spinal blockade with plain bupivacaine were investigated in 124 patients, ages ranging from 15 to 92 yr. Three millilitre of 0.5°solution (sp. gr. 1.000 at 37°C) was injected at the L3-L4 interspace. There were great individual variations in all age groups, but the maximum spread of analgesia increased with age, although the correlation was poor (P 70 yr) was about twice as fast as that in the youngest ( 80 yr; mean 11 min), while in patients younger than 50 yr the mean time to complete motor block was approximately doubled. The mean sensory recovery of the two uppermost segments and the mean sensory recovery of the S1 segment did not correlate significantly with age. The decrease of systolic arterial pressure was correlated with the height of the sensory block only in the oldest (>80 yr) patients. Post-spinal headache was encountered in two patients (1.6%)
TL;DR: To what extent does failure of pressure regulation play a role in the development of hypertension, and to what extent is perturbation of arterial pressure well above the normal range deemed to be hypertensive.
Abstract: The sympathetic nervous system plays an important role in the regulation of arterial pressure in normal man (Korner, 1979). Figure 1 shows a schema for how perturbation of arterial pressure in everyday arterial pressures well above the normal range, and are therefore deemed to be hypertensive. To what extent does failure of pressure regulation play a role in the development of hypertension, and to what
TL;DR: The effects of 10%, 30% and 50% nitrous oxide on visual, auditory and somatosensory evoked potentials were studied in healthy volunteers, confirming that the changes are dose related.
Abstract: The effects of 10%, 30% and 50% nitrous oxide on visual, auditory and somatosensory evoked potentials were studied in seven healthy volunteers. The evoked potentials were averaged from the electroencephalogram following repeated peripheral sensory stimulation of the appropriate modality. Latencies and amplitudes of the resulting potentials were measured and compared with control values. In five subjects, increasing concentrations of nitrous oxide were associated with a graded reduction in amplitude of the visual (P
TL;DR: It was concluded that ketamine decreases synaptic transmission at terminals of excitatory interneurones, whereas the other three anaesthetics enhance synaptic inhibitions mediated by gamma-aminobutyric acid.
Abstract: The effects of ketamine, alphaxalone/alphadolone, methohexitone and di-isopropylphenol have been compared on synaptic excitations and inhibitions in the spinal cord of decerebrate or pentobarbitone-anaesthetized cats. Ketamine selectively and reversibly decreased polysynaptic reflexes over a wide dose range. With the other three anaesthetic drugs decreases in reflex activity were accompanied by increases in the prolonged inhibition of reflexes, and in the amplitude and time course of dorsal root potentials. It was concluded that ketamine decreases synaptic transmission at terminals of excitatory interneurones, whereas the other three anaesthetics enhance synaptic inhibitions mediated by γ-aminobutyric acid. Such specific effects of anaesthetics on particular synaptic processes do not support a unitary hypotheses of anaesthesia.
TL;DR: An animal preparation has been developed to test therapeutic agents in the extradural and intradural spaces of male Wistar rats and the method of cannulation allowed free rostral spread of drugs.
Abstract: An animal preparation has been developed to test therapeutic agents in the extradural and intradural spaces. Under anaesthesia a hole was drilled in the penultimate lumbar vertebra of male Wistar rats and the appropriate space cannulated. The catheter was tunnelled subcutaneously to emerge at the neck. There was no spinal cord or meningeal reaction after 1 month. Catheters remained patent for 3 months. The method of cannulation allowed free rostral spread of drugs. Using plain 2% lignocaine, paralysis and anaesthesia of the hind limbs required an intradural volume of 32±3 μlitre: the required volume on extradural injection was 46±2μlitre (P
TL;DR: Patients requesting extradural analgesia for the relief of pain in labour underwent an ultrasound scan to measure the depth to the extradural space and there was a high degree of correlation between these measurements and the subsequent depth of insertion of the Tuohy needle.
Abstract: Seventy-five patients requesting extradural analgesia for the relief of pain in labour underwent an ultrasound scan to measure the depth to the extradural space. There was a high degree of correlation between these measurements and the subsequent depth of insertion of the Tuohy needle. The advantages of the technique in clinical practice and as an aid to teaching, are discussed
TL;DR: Arterial oxygenation in patients was measured with an ear oximeter to assess factors that were associated with hypoxaemia at the induction of anaesthesia and to assess the efficacy of different methods of oxygen administration.
Abstract: Arterial oxygenation in patients was measured with an ear oximeter to assess factors that were associated with hypoxaemia at the induction of anaesthesia. Twenty patients breathed air during the induction of anaesthesia with thiopentone and following neuromuscular blockade with suxamethonium. Mean SaO2 decreased from 95.7% before induction to 85.5% 1 min after induction. The SaO2 at 1 min was less in those patients whose weight was more than expected (SaO2 80.5%), than in those patients whose weight was as expected or less than expected (SaO2 88.8%). Other factors such as haemoglobin concentration, FEV1, FVC, age, or smoking habits, were not related to the degree of arterial desaturation. To assess the efficacy of different methods of oxygen administration, four groups of 10 patients, were given oxygen in different ways using a Magill anaesthetic system with a supply of 10 litre min-1. Measurements were made for up to 3 min after the induction of anaesthesia and maintenance of apnoea. Group I breathed normally from the system for 1 min before anaesthesia was induced. Group II were treated similarly, but the mask had a standardized "leak", a 9.5-mm diameter hole. Group III took three vital capacity breaths from the system before anaesthesia, and group IV breathed air before anaesthesia, but their lungs were given three maximal manual inflations after the induction of anaesthesia. Mean SaO2 values after 3 min apnoea were: 96.8% (group I), 93.6% (group II), and 98.0% (group III). In group IV, measurements were stopped at 2 min when mean SaO2 was 92.9%.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Satisfactory postoperative analgesia, lasting for 22 h or longer, was obtained in over 60% of the patients in each group and respiratory depression occurred in six of the first group, and three in the second.
Abstract: Intrathecal morphine was given to 56 children undergoing open-heart surgery. The first 27 patients received 0.03 mg kg-1 and the other 29 received 0.02 mg kg-1. Satisfactory postoperative analgesia, lasting for 22 h or longer, was obtained in over 60% of the patients in each group. Respiratory depression occurred in six of the first group (0.03 mg kg-1), and three in the second (0.02 mgkg-1), most frequently between 3.5 and 4.5 h after the administration of the intrathecal morphine.
TL;DR: The results suggest that morphine 0.5 mg or 1 mg, administered intrathecally, effectively decreases the pain of labour, and that i.v. administration of naloxone can alleviate the common side effects.
Abstract: Thirty healthy women in active labour received an intrathecal injection of morphine 0.5 mg (n=12) or 1 mg (n=18) in 7.5% dextrose. Both doses provided excellent analgesia for labour, 93% of patients obtaining at least 50% pain relief. Analgesia began 15–60min after injection and did not decrease until 6–8 h after injection. Analgesia was satisfactory until distension of the perineum, either by forceps or the infant's head. The intrathecal injection of morphine did not adversely affect the condition of the infant. Eighty per cent of patients developed pruritus; 53%, nausea or vomiting, or both; 43%, urinary retention; and 43%, drowsiness. These side effects were decreased by naloxone, which did not affect the degree of analgesia. There was no significant depression of ventilation in any patient. These results suggest that morphine 0.5 mg or 1 mg, administered intrathecally, effectively decreases the pain of labour, and that i.v. administration of naloxone can alleviate the common side effects
TL;DR: It was concluded that elimination of unchanged morphine is not impaired significantly in patients with chronic renal failure, although accumulation of morphine-3-glucuronide probably occurs.
Abstract: Morphine 0.125 mg kg-1 was administered i.v. to 11 normal subjects and nine patients with chronic renal failure requiring regular haemodialysis. Plasma morphine concentrations were measured using high pressure liquid chromatography (HPLC). Although there was considerable individual variation in both groups, mean plasma concentrations of morphine were significantly higher in the patients with renal failure for 15 min after administration. The decay of plasma concentration fitted a three-compartment mamillary pharmacokinetic model in all subjects. Derived values (mean +/- SEM) of T 1/2 alpha, volume of distribution of the second compartment (V2), total volume of distribution at steady state (Vss) and transfer rate constant from the first to the second compartment (k12), were significantly different between groups. Mean values of terminal elimination half-life (T 1/2 gamma) and total body clearance were similar in the two groups. It was concluded that elimination of unchanged morphine is not impaired significantly in patients with chronic renal failure, although accumulation of morphine-3-glucuronide probably occurs. Although the pharmacological effect of morphine is not related temporally to plasma morphine concentrations, the higher values in patients with renal failure may be implicated in their increased sensitivity to the drug.
TL;DR: Cardiac index and stroke volume index increased and SVR, pulmonary vascular resistance, LVSWI and RPP decreased significantly, and nicardipine 0.5 mg significantly decreased systemic arterial pressure, systemic vascular resistance and rate-pressure product.
Abstract: Fourteen patients with vascular disease were studied to evaluate the efficacy of niordipine hydrochloride as a hypotensive agent in the treatment of acute hypertension occurring during anaesthesia. Five patients received a bolus injection of nicardipine hydrochloride 0.5 mg. Another nine patients received bolus injections of nicardipine 1 and 2 mg. Nicardipine 0.5 mg significantly decreased systemic arterial pressure (by about 24%), systemic vascular resistance (SVR), left ventricular stroke work index (LVSWI) and rate-pressure product (RPP). Nicardipine 1 or 2 mg had twice the effect in decreasing arterial pressure as did 0.5 mg, without significant change in heart rate or right and left ventricular filling pressures. Cardiac index and stroke volume index increased and SVR, pulmonary vascular resistance, LVSWI and RPP decreased significantly
TL;DR: It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk in carefully selected patients.
Abstract: The results of carry extubation after open heart surgery for congenital heart disease in 209 consecutive patients have been reviewed. No patient younger than 3 months of age, 52% of those between 3 and 12 months, and 88% of those older than 12 months had the tracneal tube removed in the operating theatre. Four patients required reintubation of the trachea, three because of respiratory difficulty and one because of cerebral oedema. There were two deaths in the eztubated group. Twelve patients had Pao2 values less than 8.0 kPa after operation, despite adequate oxygen therapy. In four of these, this was related to persistent intracardiac shunting. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk in carefully selected patients.
TL;DR: There was a significantly lower mortality in the subarachnoid anaesthetic group by 14 days after surgery, and it is conceivable that the difference in the distribution of deaths between the groups was a result of thrombo-embolism.
Abstract: One hundred and forty-eight patients undergoing "pin-and-plate" repair of fractured neck of femur received either subarachnoid blockade or general anaesthesia. The patients were followed up for 1 year after surgery. At the end of the year, 34% had died and 50% had returned home. Twelve per cent were either in hospital or in institutional care; 4% were lost to follow up. The mean duration of acute plus convalescent hospital bed occupancy was 54.4 days. There was a significantly lower mortality in the subarachnoid anaesthetic group by 14 days after surgery. The majority of the deaths in the general anaesthetic group were clustered between 6 and 16 days. However, at the end of 2 months the mortality rates were similar in both groups.lt is conceivable that the difference in the distribution of deaths between the groups was a result of thrombo-embolism.
TL;DR: Despite the presence of fetal distress, subarachnoid blockade was a most suitable method of anaesthesia in experienced hands.
Abstract: Fetal biochemical and neonatal clinical data were compiled in 126 emergency Caesarean sections performed for fetal distress. The choice of anaesthetic technique was determined by the wishes of the mother. General anaesthesia was administered to 71 parturients and regional analgesia to 55 (subarachnoid block 33, extension of extradural block 22). The aetiologies of fetal distress and the skin incision-delivery and uterine incision–delivery intervals were not significantly different between the two anaesthesia groups. Umbilical artery blood pH values were higher than the last scalp capillary blood pH values in 63% of the general anaesthesia and in 80% of the regional analgesia cases. Umbilical vein and artery blood-gas and pH data were similar in the two anaesthesia groups, but 1-min Apgar scores were significantly better following regional analgesia. Despite the presence of fetal distress, subarachnoid blockade was a most suitable method of anaesthesia in experienced hands
TL;DR: In normal patients the initial dose of vecuronium was slower in onset of action than was atracurium 0.5 mg kg-1, but the duration of action of increments over-all was not greatly different, and in anephric patients, except in the resistant patients, the behaviour of ve Curcuronium was similar to that of atraconium.
Abstract: Vecuronium (initial dose 0.1 mg kg−1; incremental doses 0.04 mg kg−1) was given to 21 normal and 21 anephric patients. There were no gross difference between the two groups in the effect or in the duration of action of either initial or incremental doses, except in two anephric patients who were resistant to the agent. Reversal with neostigmine was satisfactory. In normal patients the initial dose of vecuronium was slower in onset of action than was atracurium 0.5 mg kg−1 (26 patients): the first two incremental doses of vecuronium were administered significantly earlier than the corresponding increments of atracurium (0.2 mg kg−1), but the duration of action of increments over-all was not greatly different. However, in anephric patients, except in the resistant patients, the behaviour of vecuronium was similar to that of atracurium (26 patients). A comparison with an initial dose of rubocurarine 0.5mg kg−1 given to 20 anephric patients and tubocurarine 0.6 mg kg−1 given to 21 normal and 20 anephric patients showed tubocurarine to be longer acting and considerably less predictable. This was particularly so in the anephric group, in which its action sometimes persisted after neostigmine had been given
TL;DR: Depressed immune functions occurred after open-heart surgery, but not in association with anaesthesia alone before surgery, and the decreases were not mediated by hydrocortisone-sensitive suppressor cells.
Abstract: B lymphocyte function in vitro was measured in patients undergoing open-heart surgery. Conventional balanced anaesthesia, or high-dose fentanyl anaesthesia was used. Pokeweed mitogen (PWM) induced lymphocyte transformation was depressed at the end of the operation, but the response to formalinized Stapkylococcus aureus Cowan I (StaCw) was not. The numbers of immunoglobulin producing and secreting cells measured by an indirect protein A plaque-forming cell assay decreased after PWM-stimulation, but remained unchanged after StaCw stimulation at the end of the operation. IgG, IgM and IgA secretion by PWM- and StaCw-stimulated lymphocytes, into the culture medium, was depressed in the period after operation. Depressed immune functions occurred after open-heart surgery, but not in association with anaesthesia alone before surgery. The decreases were not mediated by hydrocortisone-sensitive suppressor cells. Minor differences between the two anaesthetic techniques were found in lymphocyte proliferative responses
TL;DR: The effects of subarachnoid administration of 0.5% bupivacaine 4 ml in 8%, 5% or 0% glucose were investigated in 30 women undergoing laparotomy through a lower abdominal incision in a double-blind study.
Abstract: The effects of subarachnoid administration of 0.5% bupivacaine 4 ml in 8%, 5% or 0% glucose were investigated in a double-blind study in 30 women undergoing laparotomy through a lower abdominal incision. The onset time for itntimiim segmental spread of analgesia was 10–15 min for all solutions. Cephalad segmental spread of analgesia was three to four segments higher with the hyperbaric solutions (T4-5 υ. T7-8). Time of onset of complete motor blockade of the lower limbs was 5–10 min for all solutions. The glucose-free solution did not produce sufficient surgical anaesthesia because of too low cephalad spread. Duration of motor blockade generally decreased with increasing glucose concentration, only the hyperbaric solutions proving useful for abdominal surgery, with a duration of 1–1.5h. Anaesthesia (halothane) was required in seven of 10 patients in the glucose-free group and in five of 20 in the hyperbaric groups. No occurrence of "post-spinal headache" was recorded in the study.
TL;DR: It is proposed that physiological models for studying drug disposition based on data from awake, unrestrained animals may provide insight into some mechanisms of changes in drug disposition that cannot be obtained using the traditional compartmental method.
Abstract: A sheep preparation hai been developed which allows repeated measurements of regional blood flow, oxygen consumption and drug disposition in awake, unrestrained animals. This allows systematic studies of both acute changes, such as haemodynamic disturbances, and of chronic changes, such as enzyme induction, to be carried out. Good agreement was shown between the values for cardiac output and regional blood flow obtained by the Fick and indicator dilution methods, and those obtained by others using microspheres. Significant day-to-day fluctuations in haemodynamic indices were shown to occur; assumptions that hepatic or renal blood flows are constant fractions of cardiac output, or that renal or hepatic flow indicator extraction ratios remain unchanged from day-to-day, will lead to significant errors. Thus, control measurements for each experiment are necessary. It is proposed that physiological models for studying drug disposition based on data from awake, unrestrained animal may provide insight into some mechanisms of changes in drug disposition that cannot be obtained using thf traditional compartmental method