The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10-S5 (group II), general anesthesia + epidural analgesia extending from Th8-S4--5 (group III), general anesthesia + epidural analgesia extending from Th4--6-S5 (group IV) and epidural analgesia extending from Th4-S5 without general anesthesia (group V). The results showed that the cortisol response was abolished in group V, inhibited in group IV and normal in groups II and III. The hyperglycemic response to surgery was inhibited in groups II, III and IV, and abolished in group V. Epidural analgesia from Th4 to S5, preventing the adrenocortical and hyperglycemic responses to hysterectomy, and possibly also inhibiting other components of the endocrine-metabolic response to surgery, may have important applications in further studies of the physiologic significance of the endocrine-metabolic response to surgery.

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We report a study of antimicrobial use in patients admitted to the Intensive Care Unit (ICU) in a Danish university hospital during the course of 1 year. Of 615 patients admitted, 434 (71%) received antibiotics, 220 (36%) for infections and 222 (36%) for prophylaxis. Therapy for suspected infection accounted for 67% of the total consumption of antibiotics and prophylaxis for 33%. Ampicillin was the drug most frequently used; 43% of the patients treated for infection received this drug. One hundred and thirty-one patients (60%) were treated for suspected lower respiratory tract infection. Relevant microbiological specimens were obtained from 120 (92%) of these patients and a possible pathogen was isolated in 92 patients (77%, 92/120). Staphylococcus aureus and Streptococcus pneumoniae were each isolated in almost a quarter of the patients, and Enterobacteriaceae in 53%. However, many of the pathogens isolated were of no clinical relevance and merely reflected a state of colonization. Most treatments were given during the first few days following admission. Of 220 patients receiving antibiotics for an infection, 87% were treated on day 1, but only 34% (14 of 41) on day 11. The frequent use of laboratory investigations combined with good communication between clinicians and microbiologists probably resulted in rapid cessation of unnecessary therapy. Fifty-two per cent of the antibiotics given for prophylaxis were administered later than the first postoperative day. This study emphasizes the need for consultation between surgeons and clinical microbiologists to supervise postoperative antibiotic use.

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Based on logistic regression analysis, our data indicate the following risk factors for postoperative complications: positive fluid balance exceeding 4000 mL during anaesthesia (pulmonary complications and mortality), body mass index < 17 or > 25 kg m(-2) (severe dysrhythmias), or history of chronic heart disease (pulmonary complications). Thirteen patients (12.4%) suffered from a fluid balance > 4000 mL during anaesthesia. Regression analysis indicated that fluid balance exceeding 4000 mL was associated with a higher risk of postoperative complications than blood loss exceeding 1000 mL and to be the strongest risk factor for postoperative pulmonary complications and in-hospital mortality. Further trials estimating the effect of restrictive fluid regimens and the use of vasopressors for blood pressure control during anaesthesia must be carried out.

The effects of neurogenic block on plasma concentrations of adrenaline, noradrenaline and cyclic AMP were studied. Eighteen patients were subjected to surgery of moderate or minor extent under enflurance anesthesia with or without epidural analgesia. The results show that adrenaline secretion during surgical stress is a response to neurogenic stimuli, since the increase found in patients subjected to hysterectomy under general anesthesia is blocked by the addition of epidural analgesia. Furthermore, plasma adrenaline after neurogenic block is comparable with adrenaline levels during minor surgical stress. The plasma noradrenaline concentration does not correlate with the extent of trauma. In contrast to adrenaline levels, noradrenaline concentrations varied insignificantly during and after surgery. However, the addition of epidural block induced a postoperative increase in noradrenaline apparently unrelated to changes in heart rate or blood pressure. Simultaneous measurements of the catecholamines and cyclic AMP indicate that adrenaline is of minor importance for plasma cyclic AMP in resting patients, whereas the increase in cyclic AMP elicited by surgery reflects adrenaline-stimulated beta-adrenergic activity.

Opinions differ on the use of isotonic sodium chloride and Ringer lactate solution for extracellular volume depletion. We have compared changes in serum electrolyte concentrations and acid-base and haemodynamic status after rapid infusion of 2 litre of either isotonic sodium chloride or Ringer lactate solution in healthy volunteers. Changes within groups were small and statistically insignificant. Central venous pressure changes were associated with secretion of atrial natriuretic peptide, but this response was delayed.

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