In a double-blind trial of tranexamic acid in massive upper gastrointestinal haemorrhage, 76 patients were treated with the active drug and 73 patients with placebo. The doses were 1 g intravenously six times daily for a maximum of 3 days, followed by 1.5 g orally four times daily for a maximum of 4 days. The treatment group and the placebo group were comparable with respect to mean age, diagnoses and laboratory tests but differed slightly with respect to sex and alcohol consumption. The transfusion requirement in the treatment group was less than in the placebo group during the first days after admission, the difference being significant on the second day after admission. Ten patients in the treatment group and 18 patients in the placebo group were operated on. Eleven patients in the treatment group and 12 patients in the placebo group died. In the tranexamic-acid-treated group fewer operations were performed and significantly less blood was needed. It therefore seems highly likely that tranexamic acid has a beneficial effect, although small.
SUMMARY
The intraspinal pressure was investigated in 15 patients under anaesthesia after intravenous injection of succinylcholine. In all, 23 experiments were carried out.
The pressure began to rise within 1 minute after the intravenous injection, and the rise in pressure varied between 5 and 320 mm H2O above the initial pressure.
At the end of the apnoea period the pressure began to fall and, after an average of 7 min. 25 sec. following the injection, reached a minimum value between ‐115 and +55 mm H2O in relation to the initial pressure. The pressure subsequently rose again after resumption of spontaneous respiration, but later once more declined.
The effect of hyperventilation on the intraspinal fluid pressure was studied on five anaesthetized patients in a control group.
The relation between the variation of the intraspinal pressure and of the cerebral blood flow is discussed.
A model experiment was performed for studying nitrous-oxide levels in the breathing zones of the different members of an ambulance team, viz. the anesthetist, the accompanying person in the ambulance coupé, and the ambulance driver. Without a functioning local exhaust coupled to the exhalation valve, the integrated average level of nitrous oxide in the breathing zone of the anesthetist was 650-1,700 ppm, with top concentrations up to 7,500 ppm. Under the same conditions, the accompanying person in the ambulance coupé was exposed to average concentrations of 58-280 ppm, with top concentrations up to 660 ppm. The mean exposure of the driver was 9-45 ppm (max. 81 ppm). However, the exposure to nitrous oxide was considerably decreased in all parts of the ambulance by an effective local exhaust system. A prerequisite for nitrous-oxide analgesia in ambulances is an effective local exhaust coupled to the exhalation valve or face mask. The ambulance coupé ought to be equipped with a motor-driven exhaust fan in the roof, the ordinary inlet fan of the ambulance should be switched on at maximum speed, and any additional heater or fan in the ambulance coupé should be placed inside the coupé and not behind the driver's seat.
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