Showing papers in "Canadian Journal of Anaesthesia-journal Canadien D Anesthesie in 1978"
TL;DR: Ro 21-3981 is a promising anaesthetic induction drug that merits further human study and to compare it with diazepam for induction of anaesthesia.
Abstract: Ro 21-3981 is a newly synthesized water soluble benzodiazepine derivative. Its pharmacological properties are similar to diazepam. This investigation was designed to establish the effective induction dosage of Ro 21-3981 and to compare it with diazepam for induction of anaesthesia. The ED50 for Ro 21-3981 induction is 0.15 mg/kg and ED100 is 0.2 mg/kg. Ro 21-3981 is one and one-half times as potent as diazepam (0.3 rng/kg) and more rapid in action. There is significantly less pain on injection with Ro 21-3981 as compared to diazepam. Cardiovascular stability and apnoea were observed with both drugs. Ro 21-3981 is a promising anaesthetic induction drug that merits further human study.
124 citations
TL;DR: The volume and pH of the gastric content of 21 out-patients and 21 in-pat patients under general anaesthesia and gastric fluids were withdrawn for pH determinations.
Abstract: We measured the volume and pH of the gastric content of 21 out-patients and 21 in-patients under general anaesthesia. Gastric tubes were inserted after induction of anaesthesia, and gastric fluids were withdrawn for pH determinations. Gastric volumes were measured by a dilution technique using polyethylene glycol as the indicator and also by measurement of the volume aspirated through a gastrict tube. Out-patients had a mean gastric volume of 69 +/- 17 ml while in-patients had a mean volume of 33 +/- 4 ml. The average gastric pH for the out-patients was 1.8 +/- 0.2 and for the in-patients 2.0 +/- 0.3. Four out-patients had more than 75 ml of gastric fluid of pH less than 2.0. Aspiration through a gastrict tube did not empty the stomach completely and the volume thus obtained gave a falsely low estimate of the gastric volume.
109 citations
TL;DR: It is indicated that pulmonary ventilation with warm humidified anaesthetic gases provides heat transfer by the lungs, preventing hypothermia during operation and post-anaesthesia shivering is prevented by maintaining the patient normothermic in both the operating room and the recovery room.
Abstract: This study involves ventilation of the lungs with warmed humidified anaesthetic gases during prolonged elective abdominal operations. Tympanic, oesophageal and toe temperatures were compared between twenty warmed and twenty un-warmed patients at various times during operation and recovery. Fifty per cent (10/20) unwarmed patients shivered in the recovery room, while none of the warmed patients shivered. Our data indicate that pulmonary ventilation with warm humidified anaesthetic gases provides heat transfer by the lungs, preventing hypothermia during operation and post-anaesthesia shivering is prevented by maintaining the patient normothermic in both the operating room and the recovery room.
56 citations
TL;DR: It is concluded that stabilometry might be a useful tool with which to measure and record the extent of recovery and that this might be especially useful for use after out-patient surgery.
Abstract: A stabilometer has been used to measure changes in the activity of postural muscles during the later stages of recovery from anaesthesia. It is concluded that stabilometry might be a useful tool with which to measure and record the extent of recovery andthat this might be especially useful for use after out-patient sugery.
54 citations
TL;DR: Results obtained indicate that the sequence of return of neurological activity following tetracaine subarachnoid block is sympathetic nervous system activity, pinprick sensation, somatic motor function followed by proprioception in the feet, which provides the basis for recommended criteria which indicate when it is safe for patients who have had subarachable block anaesthesia to become ambulatory.
Abstract: Twenty-three adult men were studied during and after subarachnoid block anaesthesia for elective surgery. Measurements were obtained of mean arterial pressure and pulse, both supine and after standing for five minutes, core body (tympanic) and peripheral skin (toe) temperatures and blood flow in the leg. Time of measurements included one hour after the injection of tetracaine and after regression of the block. Results obtained indicate that the sequence of return of neurological activity following tetracaine subarachnoid block is sympathetic nervous system activity, pinprick sensation, somatic motor function followed by proprioception in the feet. This progression provides the basis for recommended criteria which indicate when it is safe for patients who have been subarachnoid block anaesthesia to become ambulatory. These criteria include: (1) return of pinprick sensation in the peri-anal area (sacral 4--5); (2) plantar flexion of the foot (while supine) at pre-anaesthetic levels of strength; and (3) return of proprioception in the big toe, always provided that the patient is not hypovolaemic or sedated.
54 citations
TL;DR: The depression produced by anaesthetic agents and meperidine were additive and the highest scores on this scale were obtained in those babies delivered under chloroprocaine epidural anaesthesia without mePeridine.
Abstract: The Early Neonatal Neurobehavioural Scale (E.N.N.S.) tests, first described by Scanlon, et al.1 were administered to 920 neonates on the first and second days of life. Meperidine was not given to 389 mothers, 50 mg was given to 358 mothers and 75 to 150 mg to 173 mothers within four hours of delivery. The delivery was conducted under chloroprocaine epidural anaesthesia in 280, ketamine-nitrous oxide general anaesthesia in 180, thiopentone-nitrous oxide general anaesthesia in 180 and lidocaine pudendal block in 280. All babies were over 2500 grams in weight with an Apgar score of at least 8 at one minute and 10 at five minutes. All were delivered from healthy women 18 to 35 years of age following a normal labour. The evaluator was unaware of the anaesthetic management, the method of delivery or the perinatal risk factors. There was no significant difference between the mothers and babies in the three meperidine dosage groups for maternal parity, maternal age, birth weight, number of forceps deliveries or duration of labour. Administration of meperidine was associated with a broad spectrum depression of most items on the E.N.N.S. on both the first and second days of life. The depression was greatest with the highest dose of meperidine. The depression produced by anaesthetic agents and meperidine were additive and the highest scores on this scale were obtained in those babies delivered under chloroprocaine epidural anaesthesia without meperidine.
51 citations
TL;DR: It was demonstrated that the modified Mapleson D circuit (Bain) with low fresh gas flows determined according to body weight is a partial rebreathing system, which will produce potentially dangerous hypercarbia using a Bain circuit with a fresh gas flow of 100 ml/kg/minute.
Abstract: A lung model was used to simulate gas exchange for a 70 kg adult under anaesthesia. It was demonstrated that the modified Mapleson D circuit (Bain) with low fresh gas flows determined according to body weight is a partial rebreathing system. With controlled ventilation this can be compensated for by increasing minute ventilation above the predicted and the arterial carbon dioxide level can then be regulated by adjusting the fresh gas flow. During spontaneous ventilation this compensation is critically dependent on the patient's ability to increase minute ventilation. Therefore in any particular case the arterial carbon dioxide is unpredictable and totally dependent on carbon dioxide responsiveness, carbon dioxide production, physiological dead-space, respiratory wave form, and apparatus dead-space. Although normocarbia can be achieved by certain ideal patients despite low fresh gas flows it can be done only if minute ventilation is markedly increased. This enforced hyperpnoea will significantly encroach on the respiratory reserve of these patients and may well be unattainable in some. We conclude that any decrease in respiratory drive, increase in carbon dioxide production, increase in physiological or apparatus dead-space (i.e. a mask) will produce potentially dangerous hypercarbia using a Bain circuit with a fresh gas flow of 100 ml/kg/minute. This hazard is not easily recognized. The only way to minimize these factors during spontaneous ventilation is by the use of a non-rebreathing circuit. To do this with a T-piece or Bain circuit the fresh gas flow must be between 200 and 300 ml/kg/min for an average adult, with this requirement being highly dependent on all the variables outlined. One must decide whether the low economy and high level of operating room pollution with this wide range of flow outweigh the advantages of trying to make the Mapleson D a universal circuit.
50 citations
TL;DR: The magnitude of the problem, when associated with the minimal morbidity of treatment, justifies continuation of the program and possible extension to other types of brain injury.
Abstract: Near-drowning victims are admitted to tertiary care facilities within a few hours of submersion. Following initial improvements, many patients undergo progressive cerebral deterioration. A retrospective study (1970–1974) of 30 patients at The Hospital for Sick Children, Toronto, revealed a mortality of 3.3 per cent and permanent brain damage in 30 per cent. At the same time, excellent results were reported, using an aggressive treatment of closed-head injuries, following cold-water water drownings and in the use of profound hypothermia in cardiovascular surgery. In 1975 some specific therapeutic measures were instituted for near-drowning victims and have subsequently been revised and extended.
49 citations
TL;DR: A case is reported in which the cutting current of transurethral electrocaut ery deactivated an implanted pacemaker, while coagulating current did not alter pacemaker activity, therefore frequent short bursts of cutting current were used for successful resection of the prostate.
Abstract: Electromagnetic interference from diathermy apparatus can be a real hazard in a patient with a demand pacemaker. A case is reported in which the cutting current of transurethral electrocaut ery deactivated an implanted pacemaker, while coagulating current did not alter pacemaker activity. Therefore frequent short bursts of cutting current were used for successful resection of the prostate. This case emphasizes the need for vigilant care of patients with demand pacemakers requiring transurethral resection.
47 citations
TL;DR: The results would indicate that the anaesthetic agents investigated in the present study caused increases in plasma ADH levels, but that these antidiuretic effects of anaesthesia might be modified by the volume of fluid infused during anaesthesia and operation.
Abstract: Plasma levels of antidiuretic hormone (ADH) were evaluated in 40 adult patients during and after various types of anaesthesia and surgery. The plasma level of ADH increased significantly 30 minutes after the start of anaesthesia with diethyl-ether (3.7 times) and after thiopentone (1.5 times), but it increased insignificantly in neuroleptanaesthesia (2.4 times) and with halothane (1.3 times). The surgical stress evoked marked increases in plasma ADH levels especially at ten minutes after the skin incision. A slight increase in plasma ADH level still continued into the early post-operative days.
39 citations
TL;DR: Three patients with epiglottitis who developed pulmonary oedema during the course of treatment with nasotracheal intubation and antibiotics had a benign course and responded to mechanical ventilation and increased airway pressure.
Abstract: We have presented three patients with epiglottitis who developed pulmonary oedema during the course of treatment with nasotracheal intubation and antibiotics The exact mechanism for the development of pulmonary oedema in these patients is not known Possible mechnisms are changed in the physical factors controlling the movement of fluids across the capillary-alveolar membrane, transitory bacteraemia and endotoxinaemia, or myocardial depression by the antibiotics and the anaesthetic agent The pulmonary oedema had a benign course and responded to mechanical ventilation and increased airway pressure
TL;DR: Butorphanol was found to be as effective as meperidine in relieving pain in labour and neither analgesic caused severe depression of the infant except for one me peridine-treated case.
Abstract: Butorphanol tartrate 1 mg and 2 mg were compared in 80 normal mothers at term in a doubleblind study with meperidine hydrochloride 40 mg and 80 mg for the relief of pain in labour. Butorphanol was found to be as effective as meperidine in relieving pain in labour. The foetal condition, as measured by ECG monitoring, Apgar scores, time to sustained respiration, umbilical venous H+ (pH) and Pco2, and a general nursery survey were comparable for meperidine and butorphanol. No psychomimetic phenomena were seen. Assays indicated that both butorphanol and meperidine crossed the placenta. The mean concentration of butorphanol in neonatal serum was 0.84 times maternal serum at 1.5 to 3.5 hours after intramuscular administration of a single or two successive doses of butorphanol 1 mg or 2 mg to the mother. The mean concentrations for meperidine in neonatal serum was 0.89 times maternal serum at 0.85 to 3.6 hours after intramuscular administration of meperidine 40 mg or 80 mg to the mother. Neither analgesic caused severe depression of the infant except for one meperidine-treated case.
TL;DR: It is concluded that suitable patients, anaesthetized to retain an adequate CO2 response, can be allowed to breathe spontaneously with the Bain breathing circuit.
Abstract: Although the Mapleson A system (Magill attachment) is more efficient in spontaneously breathing patients under anaesthesia, our clinical experience has shown that the Mapleson D system (Bain circuit) can be used safely for spontaneous respiration under suitable conditions. In 113 craniotomies under general anaesthesia with spontaneous breathing a mean Paco 2 of 39 ± 6 mm Hg was obtained with a fresh gas flow (FGF) ranging from 90 to 160 ml/kg; there was no difference between 15 patients with FGF of 93 ±4 ml/kg/min and a Paco 2 of 40 ± 6 mm Hg and 15 patients maintained on the highest FGF of 143 ± 11 ml/kg/min with a Paco 2 of 39 ± 5 mm Hg. Comparing the Bain circuit with the Magill attachment and the circle absorber in 101 unpremedicated young adults undergoing oral surgery under endotracheal anaesthesia with nitrous oxide and halothane or enflurane, we found the Bain circuit with 100 ml/kg/min (RMV 20 per cent higher than circle absorber, Paco, 40 ± 4 mm Hg) equally efficient than the Magill attachment with a FGF of 70 ml/kg/min (RMV 17 per cent higher than the circle absorber, Paco 2 39 ± 6 mm Hg). In the Bain circuit greater rebreathing by a reduction of the FGF to 70 ml/kg/min produced a 57 per cent rise in RMV with a Paco, of 42 ± 4 mm Hg; a slower respiratory rate induced by substituting enflurane for halothane did not improve the efficiency of the Bain circuit. In all patients the surgical stimulation induced about a ten per cent increase in RMV, inducing mild hypocapnia with the circle absorber (Paco 2 35 ± 5 mm Hg) and the Bain circuit with FGF of 140 ml/kg/min (Paco, 36 ± 3 mm Hg). It is concluded that suitable patients, anaesthetized to retain an adequate CO2 response, can be allowed to breathe spontaneously with the Bain breathing circuit.
TL;DR: The data suggest that this manœuvre should be of advantage to patients with coronary artery disease who may not be able to tolerate the increased cardiac dynamics which usually accompany extubation.
Abstract: The results of this study demonstrate that 60 mg of lidocaine sprayed down the tracheal tube before extubation and 40 mg sprayed down during tracheal tube removal prevents increases in blood pressure and pulse rate during and after extubation. The data suggest that this manœuvre should be of advantage to patients with coronary artery disease who may not be able to tolerate the increased cardiac dynamics which usually accompany extubation.
TL;DR: It is concluded that children with acute epiglottitis should always have an artificial airway inserted and only inhalation anaesthetic agents are recommended and Nasotracheal intubation seems to be associated with less morbidity than tracheostomy in experienced hands.
Abstract: Forty-seven patients treated for acute epiglottitis by nasotracheal intubation under general anaesthesia following a preset protocol are presented. The results are compared with 61 cases treated by tracheostomy following induction of general anaesthesia and intubation in the same institution. Both groups were followed clinically, and 13 of the children treated by nasotracheal intubation alone had a follow-up endoscopic examination of the larynx. There was no mortality in either group, but the morbidity was significantly higher in the children who had tracheostomy. Details of the management protocol are presented. Only inhalation anaesthetic agents are recommended and it is concluded that children with acute epiglottitis should always have an artificial airway inserted. Nasotracheal intubation seems to be associated with less morbidity than tracheostomy in experienced hands.
TL;DR: The effects of intravenous glycopyrrolate 0.3 mg on the lower oesophageal sphincter tone was studied in normal human subjects and this finding is of clinical importance in the pre-operative preparation of patients presenting for emergency surgery.
Abstract: Regurgitation and inhalation of acid gastric content, with resultant chemical pneumonitis, remains a common cause of death during anaesthesia. The effects of intravenous glycopyrrolate 0.3 mg on the lower oesophageal sphincter tone was studied in normal human subjects. Glycopyrrolate decreased lower oesophageal sphincter pressure by 0.88 kPa (p less than 0.005). This finding is of clinical importance in the pre-operative preparation of patients presenting for emergency surgery. A drug which decreases lower oesophageal sphincter tone would presumably increase the hazard of gastro-oesophageal reflux and pulmonary aspiration of acid gastric content.
TL;DR: It has been shown that fentanyl causes an average decrease in oxygen consumption of 4.9, 8.4, and 5.2 per cent at 5, 10 and 15 minutes after its infusion.
Abstract: Changes in whole body oxygen consumption due to bolus infusions of fentanyl and thiopentone given during "balanced anaesthesia" have been examined in 17 patients. It has been shown that fentanyl causes an average decrease in oxygen consumption of 4.9, 8.4, and 5.2 per cent at 5, 10 and 15 minutes after its infusion. Thiopentone causes an average decrease of 7.0, 8.8, and 1.9 per cent at 5, 10 and 15 minutes after infusion. It is believed that the effects of fentanyl and thiopentone on oxygen consumption are caused mainly by decreases in cerebral and myocardial oxygen consumption.
TL;DR: It is concluded that, during emergence from halothane anaesthesia, patients may have a significant impairment of the ventilatory response to hypoxaemia, which persists for some time even after regaining consciousness.
Abstract: Ventilation and the ventilatory response to a steady-state of isocapnic hypoxaemia were measured in six healthy volunteers, both awake and while sedated with low doses of halothane (0.05 and 0.1 MAC). Halothane sedation markedly reduced ventilatory responses to sustained hypoxaemia, in a dose-related fashion. We estimated the length of time after anaesthesia that halothane 0.1 MAC would be present in patients in the recovery room. In five healthy patients who had halothane anaesthesia with a mean duration of one hour, halothane 0.1 MAC or more persisted for approximately one hour. We conclude that, during emergence from halothane anaesthesia, patients may have a significant impairment of the ventilatory response to hypoxaemia, which persists for some time even after regaining consciousness.
[...]
TL;DR: It is concluded that ephedrine is a safe and easy mode of treatment for intractable hiccup during anaesthesia and surgery.
Abstract: Twelve patients who developed hiccup during anaesthesia and surgery were treated with an intravenous injection of ephedrine 5 mg (eleven cases) or 10 mg (one case). In nine patients ephedrine was successful after traditional methods had been tried and failed, and in three patients ephedrine was the only agent given.
TL;DR: A case report is presented demonstrating the beneficial β2 stimulating effect of halothane in a patient with status asthmaticus unresponsive to adequate conventional therapy.
Abstract: A case report is presented demonstrating the beneficial beta2 stimulating effect of halothane in a patient with status asthmaticus unresponsive to adequate conventional therapy. Twenty-four hours after the commencement of therapy, 0.5 per cent of 1.0 per cent halothane was administered for one hour with sustained reductions in peak inspiratory airway pressure and increases in dynamic and static effective compliances.
TL;DR: It is concluded that, in contrast to halothane, thiopentone does not selectively reduce the ventilatory response to hypoxia and, during light thiopENTone anaesthesia, a reasonably brisk hypoxic response is present.
Abstract: We have assessed the impact of thiopentone on the hypoxic ventilatory reflex, and on the responses to carbon dioxide and doxapram. Thiopentone sedation did not detectably alter any of these aspects of ventilatory control. Thiopentone anaesthesia reduced ventilation and the ventilatory responses to hypoxia, carbon dioxide and doxapram, all approximately in parallel. We conclude that, in contrast to halothane, thiopentone does not selectively reduce the ventilatory response to hypoxia. During light thiopentone anaesthesia, a reasonably brisk hypoxic response is present.
TL;DR: Steroids, aprotonin and methotrimeprazine appear to be useful agents in the management of patients with the carcinoid syndrome and an anaesthetic technique employing thiopentone, pancuronium and nitrous oxide proved satisfactory.
Abstract: Anaesthesia for nine patients with the carcinoid syndrome is described. With the exception of one case in which severe bronchospasm and hypertension occurred, complications were minor. Steroids, aprotonin and methotrimeprazine appear to be useful agents in the management of such patients. An anaesthetic technique employing thiopentone, pancuronium and nitrous oxide proved satisfactory.
TL;DR: Mechanisms of protection from hypoxia of the brain were reviewed under the headings of prevention, hyperventilation, hypothermia and protection by barbiturates.
Abstract: A functional classification of hypoxia of the brain has been presented and some of its significant aspects have been discussed Mechanisms of protection from hypoxia of the brain were reviewed under the headings of prevention, hyperventilation, hypothermia and protection by barbiturates In prevention of hypoxia of the brain, avoidance of factors producing a fall in cerebral perfusing pressure was emphasized Hyperventilation is not advised unless one can readily measure regional cerebral blood flow In the operating room, normocarbia or slight hypocarbia is recommended Animal studies indicate a protective role of barbiturates in ischaemic hypoxia of the brain However, it should be emphasized that, at present, hypothermia is the only established means of protection against hypoxia of the brain in man, when it is induced prior to the hypoxic insult The evidence for protection by barbiturates has been found only in experimental animals If one can extrapolate the results of studies in animals to man, then potential benefits would be expected in clinical stroke, cardiac arrest, in operations on the carotid artery and in head injury
TL;DR: It is concluded that acceptable carbon dioxide levels during spontaneous breathing with the Bain circuit can only be maintained by considerable active hyperventilation when using flow rates of 150 ml/kg and less.
Abstract: The efficiency of the Bain system has been compared with that of the Magill system in ten conscious subjects breathing spontaneously. Air was supplied at fresh flow rates of 150 ml/kg and decreased stepwise at four-minute intervals until a flow of 50 ml/kg was attained. Expired minute volume and end-tidal carbon dioxide concentrations were measured.
TL;DR: It is concluded thattracheal tubes can be left in place for seven days and at this time direct laryngoscopy should be done and if no significant laryngeal pathology is seen at this examination, tracheal intubation may be continued.
Abstract: Questionnaires were sent to patients who had tracheal intubation for periods longer than three days in a large multidisciplinary Intensive Care Unit. The information sought was of complaints related to talking, breathing, coughing, swallowing and chest infection. Of patients who had been intubated for seven days or less, 63 per cent of the 52 patients responding had no complications while only one of the remainder had a major complication requiring surgical removal of a granuloma. Forty-eight per cent of patients intubated for more than seven days had no complaints and the rest of the patients had minor complaints which did not persist. Most complained of hoarseness. Of patients who had a tracheostomy following prolonged intubation, only 23 per cent were free of complications. From this it is concluded that tracheal tubes can be left in place for seven days and at this time direct laryngoscopy should be done. If no significant laryngeal pathology is seen at this examination, tracheal intubation may be continued.
TL;DR: Patients presenting with typical dorsal root pain of more than six months’ duration were given a series of three epidural injections of methylprednisolone acetate, grouped according to known aetiologic factors to improve symptoms.
Abstract: Twenty-eight patients presenting with typical dorsal root pain of more than six months’ duration were given a series of three epidural injections of methylprednisolone acetate. The patients were grouped according to known aetiologic factors. Improvement in symptoms was most marked in the post-herpetic group where 86 per cent were free of pain after six months. In the post-trauma/surgical group, 50 per cent of patients were free of pain after six months, while in the idiopathic group only minimal improvement occurred. The side-effects of steroid administration into the epidural space were in all cases minor.
TL;DR: The technique of caudal anaesthesia in children was used for relief of post-operative pain in 120 patients, and Relief of pain was complete, with no side effects.
Abstract: We have described our technique of caudal anaesthesia in children. This technique was used for relief of post-operative pain in 120 patients. Relief of pain was complete. Post-operative recovery was quiet and comfortable, with no side effects. The surgeons, the parents and recovery room personnel were satisfied. There were no surgical oranaesthetic complications.
TL;DR: The median as well as the ulnar nerve may be used effectively in the evaluation of neuromuscular blockade with the peripheral nerve stimulator and when it is used as an aid to peripheral nerve block.
Abstract: The median as well as the ulnar nerve may be used effectively in the evaluation of neuromuscular blockade with the peripheral nerve stimulator. Both ulnar and median nerve stimulation produce flexion of the fingers. For maximum neural stimulation either during the routine use of the peripheral nerve stimulator or when it is used as an aid to peripheral nerve block, the negative pole should be attached to the exploring needle or over the nerve to be stimulated.
TL;DR: It appears that propylene glycol may play a role in the pathogenesis of the intravascular injury observed and is responsible for some of the effets irritants vasculaires observed.
Abstract: A previously established rat model has been utilized to demonstrate that an acute inflammatory response occurs after high intravenous doses of lorazepam. This occurs only with high concentrations of drug equivalent to 20 times the normal clinical dosage in man. In contrast, water soluble RO 21-3981 produces no vascular pathology in any dosage evaluated. It appears that propylene glycol may play a role in the pathogenesis of the intravascular injury observed.
TL;DR: Findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.
Abstract: A comparison of the levels of serum epinephrine, norepinephrine and blood pressure was made in 25 patients undergoing aorta-coronary bypass or valve replacement who were anaesthetized with a nitrous oxide-narcotic technique. Serum epinephrine and norepinephrine were measured in arterial samples drawn pre-induction, post-induction, before cardiopulmonary bypass, two and eight minutes after initiation of cardiopulmonary bypass, 20 minutes before termination and after termination of cardiopulmonary bypass. In both patient groups significant increases in epinephrine and norepinephrine occurred before cardiopulmonary bypass, with accompanying increase of blood pressure in the valve replacement patients. During cardiopulmonary bypass an initial hypotensive response (p < 0.001) was recorded, followed by a significant increase in blood pressure and epinephrine in both groups. After cardiopulmonary bypass, aorta-coronary bypass patients had epinephrine, norepinephrine and blood pressure equal to levels before cardiopulmonary bypass. In contrast, serum epinephrine continued to rise in the valve replacement patients, with a gradual recovery of blood pressure to pre-bypass levels. These findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.