In only one of the publications cited6 were ill preterm babies studied; and that was in 1970 when babies in the neonatal intensive care unit were considerably more mature than they are today. We therefore felt that an up to date investigation of the association between arterial and capillary blood gas measurements was warranted.A questionnaire sent to 42 neonatal units showed that more than half relied on capillary samples for most of their blood gas estimations. One third of the
Objective-To compare haemodynamic performance during transurethral prostatectomy and nonendoscopic control procedures similar in duration and surgical trauma.Design-Controlled comparative study. Setting-London teaching hospital. Patients-33 men aged 50-85 years in American Society of Anesthesiologists risk groups I and II undergoing transurethral prostatectomy (20), herniorrhaphy (eight), or testicular exploration (five).Main outcome measures-Percentage change from baseline in mean arterial pressure, heart rate, Doppler indices ofstroke volume and cardiac output, and index of systemic vascular resistance, and change from baseline in core temperature.Results-In the control group mean arterial pressure fell to 11% (95% confidence interval -17% to -5%) below baseline at two minutes into surgery and remained below baseline; there were no other overall changes in haemodynamic variables and the core temperature was stable. During transurethral prostatectomy mean arterial pressure increased by 16% (5% to 27%) at the two minute recording and remained raised throughout. Bradycardia reached -7% (-14% to 1%) by the end of the procedure. Doppler indices of stroke volume fell progressively to 15% (-24% to -6%) below baseline at the end of the procedure, and the index of cardiac output fell to 21% (-32% to -10%) below baseline by the end of the procedure. The index of systemic vascular resistance was increased by 28% (17% to 38%) at two minutes, and by 46-8% (28% to 66%) at the end of the procedure. Core temperature fell by a mean of 0-8 (-1.0 to -0.6) 'C. Significant differences existed between the two groups in summary measures of mean arterial pressure (p<005), Doppler indices of stroke volume (p<0005) and cardiac output (p<0005), index of systemic vascular resistance (p<0-0005), and core temperature (p<0-0001).Conclusions-Important haemodynamic disturbances were identified during routine apparently uneventful transurethral prostatectomy but not during control procedures. These responses may be related to the rapid central cooling observed during transurethral prostatectomy and require further study.
IntroductionTransurethral prostatectomy is considered the best treatment for relieving obstruction of the bladder outflow.' The reported hospital mortality for transurethral prostatectomy ranges from 0-2% to 2 5%.2 Most specialist centres expect a hospital mortality of between 05% and 1%. Hospital mortality and morbidity tend to be higher in small or non-specialised units and are related to medical state, presence of infection or uraemia, acute retention, age, and size of resection.37 Most of the morbidity and mortality is associated with the cardiovascular system, with myocardial infarction, cardiac arrest, heart failure,
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