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Smith, N.; EceR, Edmond; Gregory, George; Cullen, Bruce; Cullen, David
doi: 10.1007/BF03006906pmid: 5009450
Chez des jeunes sujets en bonne santé, on a étudié oe qui se produit si on ajoute à une anesthésie à 1’éther bien établie 70 pour cent de protoxyde d’azote ou d’azote. Le fait de changer la concentration d’oxygene en ajoutant de l’azote à 4.5 pour cent d’éther n’affecta que le rythme cardiaque, qui s’est légèrement accéléré. Le protoxyde d’azote ajouté à 3 pour cent d’éther ne produisit aucun effet, rnais ajouté à 4.5 pour cent d’ether, il augmenta la pression artérieUe moyenne, la résistance vasculaire systémique, le travail minute du ventricule gauche et l’index de tension. Les pupilles furent légèrement dilatées. Ainsi, le protoxyde d’azote avec l’éther a produit des signes de stimulation du récepteur alpha-adrénergique, semblables à ceux qu’on observe avec l’halothane, mais ne présenta pas les effets bêta qu’on observe avec le fluroxene-
Samulksa, Hanna; Ramaiah, Samala; Noble, William
doi: 10.1007/BF03006905pmid: 5009449
Qu’on change d’agent anesthésique ou qu’un appareil à anesthésie soit inutilisé durant quelques jours ne change rien au fait que l’halothane continue à être administré durant des heures d’un appareil qui a déja contenu cet anesthésique. La plupart des malades des salles d’operation doivent recevoir de lTialothane. Dans un système à circuit et le vaporisateur fermé, l’halothane a continué à être inhalé durant plus de neuf heures.
Rajagofalan, R.; Smith, Foster; Ramachandran, P.
doi: 10.1007/BF03006911pmid: 4550564
We have described what appears to us à most satisfactory anaesthetic technique for microlaryngoscopy and definitive surgery of the larynx. The method of ventilation employed was basically an extension of Sanders’ injector technique, using the Venturi principle. Blood gas determinations in à series of 16 patients showed oxygenation and ventilation to be satisfactory. From the endoscopist’s point of view, this technique offered several advantages: 1. The endoscopic procedure need not be interrupted to ventilate the patient. 2. Since the patient is adequately oxygenated and ventilated the time for the procedure is not limited. 3. There is no endotracheal tube to interfere with the free access and visualisation of the larynx.
doi: 10.1007/BF03006907pmid: 4550563
Respiratory alkalosis produced by ippb in patients undergoing cardiothoracic surgery may reduce cardiac output, facilitate the induction of cardiac arrhythmias, induce digitalis toxitity, decrease cerebral blood flow and shift the oxyhaemoglobin dissociation curve to the left. These effects are most threatening in patients undergoing cardiac surgery whose cardiac reserve is poor and whose myoeardial irritability is enhanced. This study was carried out in HO patients who underwent either open or closed heart surgery for acquired cardiac disease. Three groups of patients were each managed in a different way. Group a (48 patients) was ventilated with the carbon dioxide absorber in place and no carbon dioxide added to the breathing mixture; Group b (27 patients) had the carbon dioxide absorber eliminated from the circuit; and Group c (35 patients) had the carbon dioxide absorber eliminated from the circuit and 2.5 per cent carbon dioxide added to the breathing mixture. All patients were ventilated with tidal volumes which were 1,5 to 3.4 times greater than those recommended by Radford. All had satisfactory Pco2. The Paco2 and pH were significantly different for the three groups. The mean Paco2 for Groups a, b, and c were 30.6, 36.7, and 44.7 mm Hg respectively. An arterial pH greater than 7.44 was observed in 88 per cent of Group à and 33 per cent of Group b, but in only 6 per cent of Group c patients. A greater latitude in ventilatory volume was permissible in Group c subjects to attain à homogeneous result within à desired range of Paco2 levels. Severe acidaemia was not à problem. This study shows that respiratory alkalosis can be avoided while maintaining suitable oxygenation without risk of respiratory acidaemia in patients undergoing cardiac surgery. Empirically, this can be predictably obtained by the use of at least 6 liters of fresh gas, tidal volumes 2.0 to 2.5 times that calculated from the Radford nomogram, removal of the carbon dioxide absorber and addition of 2.5 per cent of carbon dioxide and 50 per cent of oxygen to the inspired mixture.
doi: 10.1007/BF03006912pmid: 5009452
The analgesic properties of methotrimeprazine 10 mgm and meperidine 50 mgms were compared in à blind study on 197 postoperative patients. Comparatively satisfactory pain relief was obtained with either active drug with the dosage schedule utilized. Hypotension was not à consistent or highly significant finding with methotrimeprazine except in the group over 42 years of age. Other factors have not been ruled out in the study. The incidence of nausea and vomiting was least with methotrimeprazine. On the other hand deep sedation associated with the use of methotrimeprazine (Nozinan) was significantly more than that seen with meperidine.
Zsigmond, Elemer; Robins, Gary
doi: 10.1007/BF03006910pmid: 4257896
Prolonged apnoea caused by succinylcholine in combination with anti-cancer drugs in patients suffering from malignant tumors has been reported in past. In order to determine the potential inhibitory eSect of anti-cancer agents on plasma cholinesterase in vivo in cancer patients, à systematic study was carried out to determine their in vitro inhibitory effect. Utilizing Kalow’s ultraviolet spec-trophotometric method the hydrolysis of benzoylcholine and procaine by purified human cholinesterase and pooled human plasma was determined both in the presence and in the absence of anti-cancer agents. Of those studied, only the alkylating agents possess significant anticholinesterase effects. These are in decreasing order of effectiveness: triethylene-melamine (tem), cyclophosphamide (Cytoxan), mechlorethamine (Nitrogen Mustard) and triethylene thiophosphoramide (Thio-tepa). The corresponding I50 values are 3.3 X 10-4 m, 4.0 x 10-4 m, 6.3 X 10-4 m, and 7.9 X 10-3 m concentrations with benzoylcholine as the substrate. In patients and especially in those treated with large intravenous doses of these anti-cancer drugs, the dose of succinylcholine should be reduced in proportion to the reduction of plasma cholinesterase activity to prevent prolonged apnoea and cardiac arrythmias which even may result in arrest. Therefore, patients who have more than 70 iper cent reduction in plasma cholinesterase activity should be protected by wearing an Identification Tag.
Wahba, W.; Craig, D.; Don, H.; Becklake, M.
doi: 10.1007/BF03006903pmid: 5009453
The cardio-respiratory effects of an epidural anaesthetic given to 13 subjects pre-operatively are reported. They were fasting, unpremedicated and supine. A sensory block up to the 4th thoracic segment was not followed by any significant change in frc, fev1, vc, A-aDo2, Qs/Qt or cardiac output.
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