We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. Group 1 (n = 25) received up to two intravenous (IV) boluses of 5 mg of morphine followed by IV morphine PCA, whereas those in Group 2 (n = 26) received up to two IV boluses of 30 mg ketorolac, then IV ketorolac PCA. Up to two rescue doses of morphine (5 mg per dose, subcutaneously) were given in either group when pain during deep inhalation exceeded 5/10 on VAS. Ten patients from Group 1 required rescue doses of morphine compared to 22 patients from Group 2 (P < 0.0011). Two and 16 patients from Groups 1 and 2, respectively, were withdrawn because of inadequate analgesia (P < 0.01). Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.

Twenty-six patients with left main coronary (LMC) stenosis were operated upon with preoperative intra aortic balloon pump (IABP) support. There was no mortality, and no morbidity attributable to the balloon catheter. The most delicate facet of revascularization surgery in this entity is the pre-cardiopulmonary bypass phase including anesthesia induction during which blood pressure fluctuation may further diminish severely compromised coronary flow. Although systolic pressure dropped to below 100 mm Hg in 50% of patients during induction, there were only two patients with electrocardiographic evidence of perioperative myocardial infarction, and only one who needed rantic institution of cardiopulmonary bypass just after induction. Perioperative logistics were quite trouble free in all 26 patients, in marked contrast to 5 LMC patients operated upon prior to our preoperative IABP concent; 3 of these deteriorated upon induction, with two deaths resulting. Preoperative IABP is a reasonable supportive adjunct in surgery for LMC stenosis.

A microporous membrane oxygenator has been used in 258 clinical perfusions for cardiac surgery. In 132 perfusions the oxygenator was ventilated with 100% O2, and in 126 perfusions 98% O2-2%CO2 was used. Patients' BSA was 0.4-2.3 M2. Bypass duration was up to 563 min. In the group ventilated with 100% O2, average PaCO2 was 30 mmHg, with arterial pH of 7.48. 98% O2-2% ventilation resulted in an average PaCO2 of 36 mmHg, with arterial pH of 7.41. CO2 transfer is influenced by gas flow rate, and data from selected cases demonstrate that increasing gas flow results in decreasing PaCO2, while decreasing gas flow increases PaCO2. The thickness of the blood film is decreased by increasing the "shim" pressure, so that increasing the "shim" presure results in higher PaO2. Oxygen saturation averaged 99% for the entire series. Addition of CO2 to the oxygen and appropriate changes in gas flow and "shim" pressure permit changes to be made in the ventilation of the device during perfusion to achieve desired levels of PaO2 and PaCO2 under widely disparate conditions of temperature and flow.