The effects of droperidol and fentanyl on the intracranial pressure (i.c.p.) and cerebral perfusion pressure (c.p.p.) were studied in eight anaesthetized normocapnic patients with intracranial space-occupying lesions. The infection of droperidol resulted in a small and not significant increase in i.c.p. from 24.0 to 27.2 mm Hg, while c.p.p. decreased from 75.9 mm Hg to 57.8 mm Hg, as a result of a decrease in systemic arterial pressure. The addition of fentanyl produced no change in i.c.p., but a further decrease in arterial pressure decreased c.p.p. from 60.4 mm Hg to 47.8 mm Hg. In four patients values of c.p.p. less than 40 mm Hg were obtained. C.p.p. was was increased by hyperventilation in all but one of these patients. It is concluded that droperidol and fentanyl should be used in patients with intracranial hypertension only if hypocapnia has been established and when the arterial pressure is normal or increased.
Seven patients with intracranial disorders were studied during recovery from anaesthesia with nitrous oxide and halothane. Arterial, intracranial, and central venous pressure, and arterial carbon dioxide tension were measured and compared with the patient's clinical state. No patient had evidence of increased brain volume when the dura was closed. All had been hyperventilated during the surgical procedure. Cessation of hyperventilation and the continued administration of anaesthetics was followed by a moderate increase in intracranial pressure and a reduction in cerebral perfusion pressure, but critically low values were not seen. Spontaneous respiration returned when the PaCO2 was in the range of 33-51 mm Hg. When spontaneous respiration was judged to be normal, anaesthesia was interrupted and the endotracheal tube was removed. In the following minutes, until the patients were awake, the intracranial pressure decreased to normal or near normal values, with minimal change in PaCO2. In these seven patients in whom there were no signs of brain swelling, the skull was closed, the patients were allowed to resume spontaneous respiration, and anaesthesia was terminated without major changes in intracranial pressure or cerebral perfusion pressure. However, hyperventilation is advocated after operation in patients with marked brain swelling.
In nine patients with severe intracranial disease causing increased intracranial pressure (ICP), the effects on ICP and cerebral perfusion pressure (CPP) of the following manoeuvres were studied: (1) endotracheal intubation, (2) addition of 50% nitrous oxide to the inspired gas after hyperventilation with oxygen and thereafter (3) addition of halothane to the nitrous oxide/oxygen mixture. The mean "peak" increase in ICP during endotracheal intubation was 16.6 mm Hg. Critically small CPP values were prevented by an increase in arterial pressure. Nitrous oxide caused only a minor increase in ICP. Halothane caused a mean increase in ICP of 7.6 mm Hg and critically small CPP values in three patients.
Blood loss was measured in 100 women undergoing caesarean section under a basic anesthetic technique of a short-acting barbiturate, 63 96 nitrous oxide and gallamine, with either one of the following three agents, halothane (0.5-1.0 4/0 inspired), fentanyl 0.1 mg and droperidol 5 mg, or meperidine (pethidine) 50-1 25 mg given intravenously for additional analgesia after delivery of the baby.For the post-delivery period, operative blood loss averaged 505 ml and 399 ml in the two groups of 25 patients each receiving halothane "analgesia".The operative blood losses with fentanyl-droperidol analgesia (25 patients) or meperidine analgesia (25 patients) averaged 489 ml and 498 ml. Similar results were found for the amount of postoperative bleeding, where halothane averaged 218 ml and 130 ml, whereas fentanyl-droperidol and meperidine averaged 185 ml and 125 ml. No significant difference could be detected in blood loss associated with caesarean section, whether halothane, fentanyl-droperidol or meperidine was used for post-delivery analgesia.
I n nine patients undergoing cardiac surgery for aortic valvular disease, mean arterial blood pressure (MABP), central venous pressure (CVP), cardiac index ( C I ) , stroke volume (SV) and central blood volume index (CBVI) were measured ( I ) after premedication with diazepam-scopolamine and breathing 100 % 0 2 , (11) after induction of anaesthesia with fluroxene-02, endotracheal intubation facilitated by succinyl-choline with spontaneous respiration, and (111) with controlled respiration after relaxation with gallamine (Relaxan@) 120 mg. All measurements were done prior to surgery. Fluroxene was found not to affect the MABP, whereas the CVP temporarily rose, but fell to preanaesthetic values in the third measurement. The average CI decreased 21 % after induction, but the decrease did not prove significant, whereas the SV did fall significantly by a total of 43 %, in part secondary to the increased pulse rate caused by gallamine. CBVI was unaffected by induction of anaesthesia, but decreased 12 % in the third examination. It is concluded that the cardiovascular stability observed in healthy young normals during fluroxene anaesthesia (CULLEN et al. 1970) is preserved in patients with moderate to severe heart failure, making fluroxene the anaesthetic agent best suited for patients with cardiac disease.
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