Neuroleftanalgesics: 2. Laboratory evaluation of combination of analgesics and neuroleptics with nitrous oxideDobkin, Alien; Lee, Peter; Byles, Peter
doi: 10.1007/BF03004077pmid: 14298360
Mixtures of several analgesic and neuroleptic drugs were devised and used in sufficient dosage to provide smooth anaesthesia in dogs. The response of the cardiorespiratory system, metabolic reactions, and postanaesthetic recovery were compared from recordings of the vital signs, blood analyses, and direct observation. These data show that the mixtures of anileridine-thiopental (1:10), fentanyl-droperidol (1:50), fentanyl-thiopental (1:1000), meperidine-thiopental (1:4), pentazocine-thiopental (1:33), and methotrimeprazine-thiopental (1:40) provide satisfactory anaesthetic conditions when used along with the inhalation of nitrous oxide and oxygen, and pulmonary ventilation is controlled during the period of anaesthesia. The thiopental-d’tubocurarine mixture would have been included if it had not caused severe post-anaesthetic respiratory depression. It is suggested that similar conditions may be reproduced clinically with all of these mixtures, but there are two major disadvantages to using such an anaesthetic technique: controllability is difficult to maintain and delayed reactions may be highly undesirable.
Neuroleptanalgesics: 1. Effect of droperidol, fentanyl, innovar, benzquinamide, and pentazocine on the duration of thiopental-induced sleep in dogsDobkin, Allen; Lee, Peter
doi: 10.1007/BF03004076pmid: 14298359
A standardized crossover experiment was employed to determine the effect of combining some new neuroleptic and analgesic drugs with thiopental on the duration of thiopental-induced sleep in dogs. The dose selected for each of the drugs was within the therapeutic effective dose range of their primary action, and was unlikely to produce severe cardiorespiratory depression. Droperidol prolonged thiopental-induced sleep and delayed full recovery by more than twice the time for thiopental alone. Fentanyl and pentazocine had approximately the same effect, causing a 50 per cent to 75 per cent delay in recovery. The effect with Innovar was less than that of droperidol, but was much more than that with fentanyl, indicating a dominant action of droperidol in the mixture with respect to the hypnotic effect. Benzquinamide had virtually no effect on the duration of thiopental-induced sleep.
A new ventilator designed to meet the present-day needs of mechanical aid to ventilation in the treatment of respiratory failureAuchincloss, J.
doi: 10.1007/BF03004074pmid: 14298356
A description is presented of an internal ventilator which has the following features: (1) patient-triggering with guaranteed minimum frequency; (2) constant volume or constant ventilation as determined by the physician; (3) continuous, automatic monitoring of expired air tidal volume; (4) optional negative phase when ventilation is maintained at constant levels; (5) control over inspiratory flow rate and air-oxygen ratios. The ventilator has been tested under laboratory conditions and in separate series of short-term and long-term applications, and has been found useful because it provides the responsiveness and flexibility of patient-triggered apparatus, the basic security of constant ventilation or guaranteed minimum ventilation, and an automated system for monitoring ventilation. The rationale for design of a ventilator with these refinements is discussed and relates to the present population of patients requiring mechanical aid to ventilation.
Clinical, biochemical, and haemodynamic studies in man during refractory hypotensionJenkins, Leonard; Dodds, W.; Graves, H.
doi: 10.1007/BF03004073pmid: 14298357
1.
There appear to be four main clinical postoperative presentations in which patients most commonly have refractory hypotension: (i) thos4 with unrecognized, persisting blood-volume deficit, (ii) those with severe sepsis, (iii) those with complicating myocardial failure, (iv) those who have had extensive surgical procedures with local complications.
2.
These patients commonly present with a coexisting metabolic acidosis and/or hyponatraemia.
3.
In view of these observations, it is suggested that in the treatment of these patients with refractory hypotension blood and fluid loss be fully replaced. A persisting, unrecognized blood-volume deficit often in fact still exists in these patients. Central venous pressure (CVP) can be a useful guide to this replacement therapy. If during volume replacement the arterial bloodl pressure rises, before the CVP, then in all likelihood volume deficit hypotension shock existed. If, however, CVP increases steadily and before the arterial blood pressure rises, then the transfusion rate must be decreased and chemical therapy with cardiotonic agents used, in the form of a digitjalis preparation, isopropyl norepinephrine, or calcium chloride or gluconate. In either case concurrent correction of the acid-base defect is carried out. Metabolic acidosis and hyponatraemia can be treated effectively with NaHCO3. Appropriate antibacterial therapy is given where indicated.
4.
Patients considered to be in a potentially “irreversible” or irefractory hypotensive status may, in fact, show surprising reversibility and suirvivability, once the pathophysiologic defect is recognized and repaired.