A total of 102 patients with phaeochromocytoma who underwent surgery by the same team between 1964 and 1976 were allocated to three groups according to the anaesthetic protocol used: (1) balanced anaesthesia and control of hypotension with noradrenaline; (2) anaesthesia with halothane and replacement of blood volume; (3) neuroleptanalgesia (droperidol and phenoperidine) and replacement of blood volume. None of the patients in any of the three groups received adrenergic inhibitors before anaesthesia. Comparison of the results in the three groups revealed that the major factor responsible for reduction of operative mortality to almost zero was control of hypotension by replacement of blood volume rather than by the use of noradrenaline following resection of the tumour, whereas the type of anaesthetic agent used was of secondary importance. PATIENTS AND METHODS Sixty female and 42 male patients with phaeochromocytoma, aged 12-78 yr (mean 42 ± 14 SD) underwent surgery between 1964 and 1976. In 86 patients the tumour was in the adrenal gland, in 11, it was extraadrenal and it was malignant in five. The character
Changes in abdominal (delta AB) and rib cage (delta RC) movements, and in vital capacity, were compared between 23 patients undergoing upper or lower abdominal surgery at 1, 3 and 7 days after surgery. Diaphragmatic index was obtained by measuring the relative abdominal motion (delta AB/delta AB + delta RC) using magnetometers. Electrical activity of abdominal muscles was assessed using needle electrodes after upper abdominal surgery in four additional patients. After upper abdominal surgery, the vital capacity and the diaphragmatic index were markedly reduced for 1 week. No abdominal muscle activity was observed at day 1. After lower abdominal surgery, the vital capacity returned to the normal range within 3 days of operation, without any diaphragmatic impairment. These findings substantiate the role of diaphragmatic dysfunction in postoperative reduction in vital capacity observed after upper abdominal surgery.
Diaphragmatic function was investigated in mechanically ventilated rats during endotoxic shock (group E, n = 18) and after saline solution injection (group C, n = 8). Endotoxic shock was produced by a 1-min injection of Escherichia coli endotoxin (10 mg/kg iv) suspended in saline. Diaphragmatic strength was assessed before (T0) and 15 (T15) and 60 (T60) min after injection by measuring transdiaphragmatic pressure (Pdi) generated during bilateral phrenic stimulation at 0.5, 10, 20, 30, 50, and 100 Hz. Diaphragmatic neuromuscular transmission was assessed by measuring the integrated electrical activity of the diaphragm. Diaphragmatic endurance was assessed 75 min after injection from the rate of Pdi decline after a 30-s continuous 10-Hz phrenic stimulation. In 16 additional animals, diaphragmatic glycogen content was determined 60 min after inoculation with endotoxin (n = 8) or 0.9% sodium chloride solution (n = 8). Diaphragmatic resting membrane potential (Em) was measured in 16 additional animals 60 min after endotoxin (n = 8) or saline injection (n = 8). Mean blood pressure decreased from 74 +/- 3 to 53 +/- 6 mmHg at T60 in group E, whereas it was maintained in group C. At T60 Pdi was decreased in group E for frequencies of 50 and 100 Hz and was associated with a decreased diaphragmatic electromyographic activity of 25.3 +/- 2.5 and 26.5 +/- 5.2% for 50- and 100-Hz stimulations, respectively, in comparison with T0 values.(ABSTRACT TRUNCATED AT 250 WORDS)
We conclude that in healthy elderly subjects undergoing THR, the flexibility of the analgesic regimen is more important than the route of administration with regard to efficacy, adverse effects and recovery of cognitive function.
The effects of deliberate hypotension and normovolaemic haemodilution on operative blood loss were studied in patients undergoing hip arthroplasty. Thirty patients were anaesthetized with halothane-nitrous oxide, and assigned to one of three groups. In group I, mean arterial pressure was decreased to 55 mm Hg by sodium nitroprusside. In group II, 23 +/- 2 ml/kg of blood was withdrawn just before the surgical procedure and replaced by twice volume with 4% albumin and Ringer lactate solution. The shed blood was reinfused at the end of the surgical procedure. In group III, the blood replacement was equal to blood loss and this group served as control. Intraoperative blood losses were 1050 +/- 185 ml and 900 +/- 130 ml in the autotransfused and control groups, respectively, and 320 +/- ml in the hypotensive group. However, the total red cell loss was significantly less in the hypotensive and autotransfused groups than in the control group. No complications occurred any of the three groups. Deliberate hypotension was the most effective means of reducing intraoperative bleeding and the time for this procedure was shorter than for normovolaemic haemodilution combined with autotransfusion.
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