Pulmonary hypertension may be either primary of unknown aetiology or secondary to eXisting cardio-respiratory disease. As a single entity the prognosis is poor but superimposition of the physiological changes of pregnancy and labour produces a lethal condition. This paper sets out two clinical cases of primary pulmonary hypertension as background for discussion to highlight the issues involved. Whatever this discussion does, let it be clearly spelt out that prevention is better than any proposed cure.
The haemodynamic effects of oxytocin on the pulmonary and systemic circulation were studied in six awake, pregnant (> 140 days gestation) ewes. Bolus doses of oxytocin 0.2 units/kg and then 0.8 units/kg were administered. A dose of 0.2 units/kg resulted in small but significant increases in mean pulmonary artery pressure (14%, P< 0.05) and pulmonary vascular resistance (24%, P< 0.05. A bolus of 0.8 units/kg resulted in a significant increase in mean arterial pressure (20%, P < 0.05) and systemic vascular resistance (33%, P< 0.05). Acute pulmonary hypertension was then induced with glass bead microemboli (150-200 pm), with an increase in pulmonary artery pressure of 26 mmHg and pulmonary vascular resistance of 448 dyn. s. cm-5. Boluses of oxytocin 0.2 and 0.8 units/kg were then administered. There were no significant changes, except for a 30% increase in systemic vascular resistance at one minute after oxytocin, 0.8 units/kg (P< 0.05).
Nothing works in all cases; nothing succeeds with all men Dale Carnegie BROADLY speaking, British-trained surgeons prefer general anaesthesia on inpatients. European and American surgeons lean towards local anaesthesia on outpatients. As far as we can tell, this choice mostly rests on economicsand availabilityof acceptable facilities for cosmetic surgery. In Australia we have good access to both techniques, so we wanted to evaluate each on its clinical merits.Over the last ten years we have used both techniques on about 4,000 patients. It has proven the obvious. Both are adequate in themselves. However, a specific combination of local and general anaesthesia minimizes the surgical risks and enhances the tranquillity of the procedure.
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