This study was designed to assess the stress response of acute hemodilution (AH) in patients subjected to radical cystectomy. Forty adult male patients were randomly allocated into a control group (n = 10) where homologous blood transfusion was used, a preinduction AH group (n = 20) where AH was performed before lumbar epidural block and induction of anesthesia, and into a postinduction group (n = 10) where AH was performed after induction of anesthesia. Monitored variables included hemodynamic, hematological and coagulation factors, liver function tests, and serum hormones. AH performed in awake or in anesthetized patients did not result in significant hemodynamic disruption, or result in detectable end-organ or stress-hormone changes when compared to control patient outcomes after radical cystectomy. Hemodilution can be performed by protocol for patients who are undergoing this procedure without major adverse effects.
Previous clinical reports have suggested that deep tendon reflexes of diabetic patients are delayed and experimental studies have reported differential sensitivity of motor endplates to neuromuscular blocking drugs. These observations prompted us to study the neuromuscular effect of tubocurarine in 25 diabetic and 15 non-diabetic patients during urological surgery. Anaesthesia was induced with thiopentone followed by suxamethonium and maintained with nitrous oxide in oxygen and increments of butorphanol. Muscle relaxation was provided with tubocurarine in an initial dose of 0.25 mg kg-1 and increments of 20% of the initial dose. At the end of surgery, residual neuromuscular block was antagonized with increments of neostigmine 0.5 mg and atropine 0.2 mg. There was a delay in the onset of action of tubocurarine in diabetic patients. A no-response state was obtained in some patients, and its duration correlated with post-tetanic count (PTC) in diabetic patients, and with post-tetanic twitch height percent (PTTH%) in the control group. We concluded that, in diabetic patients, the onset of action of tubocurarine was delayed compared with control patients, and the reliable predictor of the duration of the no-response time was PTC in diabetic patients and PTTH% in non-diabetic subjects.
Dopexamine hydrochloride, a dopamine analogue, has been reported, both experimentally and clinically, to increase renal blood flow (RBF) and improve renal function in normal kidneys. The availability of computer-enhanced radionuclide scintigraphy, which provides accurate non-invasive measurement of changes in RBF, enabled us to study the renographic effects of dopexamine hydrochloride in patients with chronic renal dysfunction (CRD). Ten patients suffering from CRD and ten normal kidney donors were the study population. Renography was performed, heart rate (HR) and blood pressure (BP) measured, and hematological and biochemical tests carried out before and after intravenous infusion of dopexamine 2 micrograms kg-1 min-1 for 60 min. The patient population displayed significant increases in total cortical and medullary RBF and renographic clearance rate (CR), while in kidney donors the RBF was increased in all kidney regions with no change in CR. HR increased in both groups, while BP showed no significant changes. The hematological and biochemical changes were transient and returned to preinfusion levels after 24 h. It is concluded that dopexamine hydrochloride 2 micrograms kg-1 min-1 increases RBF and CR in patients with CRD.
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