Two techniques for catheterization of the internal jugular vein are described in detail. In a group of 108 adults and 54 children, catheterization of the internal jugular vein was attempted 168 times. Failure to achieve catheterization occurred 12 times. The success rate for the first 50 patients was 86%, but it increased with experience, and was nearly 96% for the remaining patients. Almost 90% of catheterizations were achieved on the first or second attempt. The success rate was understandably lower in the children's group. Catheter malpositioning occurred infrequently (six times) and was most common in the children's group. There were few complications, although two were of a serious nature. The techniques described are straightforward, easy to master and perform, and are recommended as useful additions to the anaesthetist's clinical armamentarium.Address :
Changes in free and total thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum were measured before, during, and for nine days after uncomplicated abdominal surgery in eight patients. The results showed a pronounced fall in total as well as in free T3 levels, amounting to 50% in both variables on the first postoperative day, and returning towards preoperative levels on the seventh and ninth day. Apart from an increase during surgery, free T4 levels were constant in the whole period despite a slight postoperative decrease in total T4. The TSH level fell about 80% within the first 24 postoperative h, but returned to the preoperative level thereafter. These results suggest a suppression of both T3 and TSH production during the pre- and early postoperative period.
In a double-blind study, 57 patients were anaesthetized with either AlthesinB', thiopentone, or lentanyl combined with diazepam for cystoscopies. One and a half and four hours after the administration of anaesthesia, the patients were investigated with an objective neuropsychological method, Continuous Reaction Time, and with a subjective rating scale, Beecher's Mood Scale. One week later the patients answered a questionnaire about side-effects experienced during the days followinganaesthesia. At the 1% h investigation, the patients were cerebrally affected, both subjectively and objectively. The CNS-dysfunction was different for the three anaesthetics. After administration of thiopentone, the patients experienced the highest degree of subjective effects but had the smallest reaction time prolongation. Fentanyl-diazepam gave the least subjective effects, but the highest degree of cerebral affection in the reaction time measurements. The effects of Althesin were intermediate. Four hours after anaesthesia, the reaction time prolongations had disappeared, except for Althesin, and only patients who had thiopentone registered subjective effects. The number of side-effects was greatest and most prolonged following thiopentone. About 25% of the patients reported that side-effects had persisted more than 1 day after anaesthesia.
In eight patients undergoing cardiac surgery for aortic and/or mitral valvular disease, mean arterial blood pressure (MAP), central venous pressure (CVP), cardiac index (CI), stroke index (SI), pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure (PAMP) were measured after premedication with diazepam-scopolamine (I), after breathing 100% oxygen (II), and on controlled respiration (111) after induction of anaesthesia with enflurane-02, and endotracheal intubation facilitated by succinylcholine.All measurements were done prior to surgery. Enflurane anaesthesia was found not to affect cardiac index. The average SI decreased by 27%, but was compensated for by an average increase in heart rate (HR) of 33%. The average systemic vascular resistance (SVR) decreased by 14%. All other measured parameters were found to be unaffected by enflurane-02 anaesthesia. It is concluded that the cardiovascular stability observed in healthy young normals during enflurane anaesthesia is preserved in patients with moderate to severe heart failure, making enflurane an anaesthetic agent well suited for patients with cardiac disease.
We have studied the peripheral vascular effect in man of propanidid 6 mg/kg, administered as a bolus injection during cardiopulmonary by‐pass with the aorta cross‐clamped and at constant perfusion flow. Ten measurements in eight patients were performed. A decrease was found in systemic vascular resistance: from 150.7±16.3 to 99.5±10.1 k Pa × s/l. No venous pooling occurred. It is concluded that, in man, propanidid causes a vasodilation which must contribute to the hypotension it causes.
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