Canadian Anaesthetists' Society journal最新文献

{"title":"Left ventricular ejection fraction during anaesthetic induction: comparison of rapid-sequence and elective induction","authors":"B. Chraemmer-jørgensen, P. Høilund-Carlsen, J. Marving, V. Christensen","doi":"10.1097/00132586-198708000-00013","DOIUrl":"https://doi.org/10.1097/00132586-198708000-00013","url":null,"abstract":"A randomized clinical trial was conducted in 14 women, aged 24–60 years, to compare the effects of rapid-sequence induction of anaesthesia and elective induction on heart rate, blood pressure and left ventricular ejection fraction (LVEF). None of the patients sufferedfrom heart or lung diseases, and all were scheduled for hysterectomy. Cuff blood pressure was measured repeatedly by an automatic recording device, and heart rate and LVEF were monitored by a portable nonimaging nuclear probe. In seven patients, a rapid-sequence induction was performed following preoxygenation and with simultaneous injection of thiopentone (5mg.kg1) and succinylcholine, without starting manual ventilation until the airway was secured with the endotracheal tube. In another seven patients, elective induction was carried out by sequential administration of the same drugs.Forty seconds after laryngoscopy and intubation mean blood pressure had increased by 38 per cent and heart rate by 29 per cent from preintubalion values in the rapid-sequence induction group, compared to 30 and 12 per cent respectively, in the elective induction group (p < 0.05). Similar decreases in LVEF was observed in both groups, from 0.60 to 0.42 in the elective induction group, and from 0.60 to 0.41 in the rapid-sequence induction group. The equal depression of LVEF indicates that laryngoscopy and intubation produce, with both induction regimens, sudden impairment of cardiac function. The more pronounced hypertension and tachycardia observed during rapid-sequence induction suggests a higher myocardial oxygen consumption which may represent a serious additional burden for the poorly perfused heart.RésuméUne étude clinique randomisée a été faite chez 14 femmes âgées de 24 à 60 ans afin de comparer les effets de la séquence rapide d’induction de l’anesthésie et de l’induction élective sur la fréquence cardiaque, la pression artérielle, et la fraction d’éjection du ventricule gauche (LVEF). Aucune des patientes souffraient de maladie cardiaque ou pulmonaire et toutes étaient cédulées pour hystérectomie. La mesure de la tension artérielle par brassard était répétée par un appareil automatique et la fréquence cardiaque et le LVEF étaient surveillés par un probe portatif nucléaire non imagé. Chez sept patientes, une séquence rapide d’induction était faite après préoxygénation et injections simultanées de thiopentone (5 mg.kg-1) et succinylcholine sans ventilation manuelle jusqu’à l’intubation. Chez sept autres patientes, l’induction élective était faite par l’administration séquentielle des mêmes médicaments. Quarante secondes après laryngoscopie et intubation la pression artérielle moyenne augmenta de 38 pour cent et la fréquence cardiaque de 29 pour cent des valeurs préintubation pour le groupe à séquence d’induction rapide, comparativement à 30 et 12 pour cent respectivement pour le groupe à induction élective (p < 0.05). Une diminution similaire du LVEF a été observée dans les deux groupes de 0.60 à ","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"9 1","pages":"754-759"},"PeriodicalIF":0.0,"publicationDate":"1986-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73157429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fentanyl-oxygen versus fentanyl-N2O/oxygen anaesthesia in children undergoing cardiac surgery.","authors":"P. Crean, G. Koren, G. Goresky, J. Klein, S. Macleod","doi":"10.1097/00132586-198610000-00035","DOIUrl":"https://doi.org/10.1097/00132586-198610000-00035","url":null,"abstract":"Fentanyl-oxygen (fentanyl-O2) anaesthesia was compared to fentanyl-nitrous oxide/oxygen (fentanyl-N2O/O2) anaesthesia in 14 children undergoing cardiac surgery. Children were randomly assigned to one of the two techniques studied, with seven patients in each group. The mean age (mean +/- SE) was 3.9 +/- 0.75 years (0.5-8.25 years) and mean weight 14.7 +/- 2 kg (3.5-29.5 kg). Patients were premedicated with IM atropine 0.02 mg . kg-1 and morphine 0.2 mg . kg-1 1 hour preoperatively. They received a fentanyl bolus of 30 micrograms . kg-1 with a concomitant continuous infusion of 0.3 micrograms . kg-1 . min-1. Pancuronium 0.1 mg . kg-1 was administered immediately following the fentanyl bolus. Fifty per cent nitrous oxide was given with oxygen in one group and 100 per cent oxygen was administered to the other group. Fentanyl plasma concentrations were similar in the two groups at the various stages of surgery. There were no significant differences between the two treatment groups in systolic and diastolic blood pressure or in heart rate in response to induction, intubation, and incision. There was a significantly greater increase in systolic blood pressure after sternotomy in the fentanyl-O2 group. In addition, in six of seven patients receiving fentanyl-O2 there were events of sudden increase in blood pressure during various stages of surgery before the bypass, necessitating an additional fentanyl bolus or the addition of droperidol in four cases. Similar phenomena were not documented in the fentanyl-N2O/O2 group. Our studies suggest that fentanyl-O2 anaesthesia in the schedule described, in children undergoing elective cardiac surgery for Tetralogy of Fallot, A-V canal, and transposition of the great arteries, is not sufficient to prevent elevation in systolic blood pressure despite fentanyl plasma concentrations in excess of 20 ng X ml-1. The addition of nitrous oxide prevents this phenomenon.","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"439 1","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"1986-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87171561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentiation of atracurium by pancuronium and d-tubocurarine.","authors":"H R Gerber,&nbsp;J Romppainen,&nbsp;W Schwinn","doi":"10.1007/BF03014261","DOIUrl":"https://doi.org/10.1007/BF03014261","url":null,"abstract":"<p><p>In 60 adult patients undergoing general surgical procedures, the effect of pancuronium or d-tubocurarine \"pretreatment\" on the injection of a 0.1 mg X kg-1 bolus of atracurium was measured in two separate studies. In study 1, the patients received either 0.5 mg (approximately 0.007 mg X kg-1) or 1.0 mg (approximately 0.015 mg X kg-1) pancuronium, or placebo (saline) three minutes before the injection of atracurium 0.1 mg X kg-1. In study 2, the patients received 0.05 mg X kg-1 or 0.1 mg X kg-1 d-tubocurarine, or a placebo. The degree of neuromuscular blockade was assessed by evoked mechanogram (adductor pollicis muscle) using supramaximal train-of-four stimulation. Patients receiving pancuronium or d-tubocurarine pretreatment (equal to an ED5-ED15 dose) showed significantly greater inhibition of twitch (ED70-ED80) and train-of-four ratio compared with the placebo groups (ED35-ED40). Pretreatment with the larger dose of d-tubocurarine (0.1 mg X kg-1) was associated with significant neuromuscular blockade. It is concluded that pancuronium and d-tubocurarine pretreatments potentiate the clinical action of 0.1 mg X kg-1 atracurium in man by 35-100 per cent.</p>","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"563-70"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14656072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonidine prolongs canine tetracaine spinal anaesthesia.","authors":"M D Bedder,&nbsp;R Kozody,&nbsp;R J Palahniuk,&nbsp;M O Cumming,&nbsp;W R Pucci","doi":"10.1007/BF03014266","DOIUrl":"https://doi.org/10.1007/BF03014266","url":null,"abstract":"<p><p>Using a randomized blind cross-over design, the comparative efficacy of clonidine in prolonging tetracaine spinal anaesthesia was studied in six mongrel dogs. Lumbar subarachnoid injections (1 ml) of: tetracaine 4 mg with clonidine 150 micrograms, tetracaine 4 mg with epinephrine 200 micrograms, tetracaine 4 mg, clonidine 150 micrograms, epinephrine 200 micrograms, and five per cent dextrose in H2O (vehicle) were administered randomly to each animal at 5-7 day intervals. Subarachnoid tetracaine produced a motor blockade of 186 +/- 58 (mean +/- SEM) min. Both clonidine and epinephrine produced a similar prolongation of tetracaine motor blockade, 135 per cent (p less than 0.01) and 116 per cent (p less than 0.05) respectively, compared with tetracaine alone. No motor blockade was observed in dogs receiving clonidine, epinephrine or five per cent dextrose in H2O. The addition of clonidine to tetracaine spinal anaesthesia produced a significant increase in duration of sensory blockade, 56 per cent (p less than 0.01) and 107 per cent (p less than 0.01) respectively, when compared to tetracaine with and without epinephrine. Subarachnoid clonidine alone produced a sensory blockade of 76 +/- 17 minutes, while only one animal receiving subarachnoid epinephrine had a sensory blockade (40 minutes). No neurologic deficits were observed in any of the animals. The study concludes that during spinal anaesthesia with tetracaine in dogs, clonidine is as effective as epinephrine in prolonging motor blockade, but is more effective in prolonging sensory blockade.</p>","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"591-6"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14887126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical sign to predict difficult tracheal intubation: a prospective study.","authors":"S. R. Mallampati, S. Gatt, L. Gugino, S. Desai, B. Waraksa, D. Freiberger, P. Liu","doi":"10.1097/00132582-198609000-00017","DOIUrl":"https://doi.org/10.1097/00132582-198609000-00017","url":null,"abstract":"It has been suggested that the size of the base of the tongue is an important factor determining the degree of difficulty of direct laryngoscopy. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure. The system was evaluated in 210 patients. The degree of difficulty in visualizing these three structures was an accurate predictor of difficulty with direct laryngoscopy (p less than 0.001).","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"39 2","pages":"429-34"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72615692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow requirements for the Bain breathing circuit during anaesthesia for caesarean section.","authors":"H S Moseley,&nbsp;K B Shankar,&nbsp;A Krishnan","doi":"10.1007/BF03014264","DOIUrl":"https://doi.org/10.1007/BF03014264","url":null,"abstract":"<p><p>We studied the relationship between arterial carbon dioxide tension (PaCO2) and fresh gas flow (FGF) during use of the Bain breathing circuit for Caesarean section anaesthesia. Thirty-one patients undergoing Caesarean section were anaesthetised using the Bain circuit with intermittent positive pressure ventilation. The PaCO2 were measured at FGF of 70 ml X kg-1 X min-1, 80 ml X kg-1 X min-1, and 100 ml X kg-1 X min-1. The FGF requirement to maintain a given PaCO2 during Caesarean section anaesthesia is the same as the requirements for nonpregnant subjects, despite the increase in carbon dioxide production associated with pregnancy. This is probably because the total FGF determined by body weight and given during Caesarean section anaesthesia is 15-20 per cent higher than nonpregnant levels, due to the weight gain associated with pregnancy. A FGF of 100 ml X kg-1 of pregnant weight/min maintains PaCO2 of 4.44 kPa predelivery, which is in the desirable range of PaCO2 during Caesarean section.</p>","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"583-7"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14225978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine induction for a patient with hyperinsulinism treated with oral diazoxide.","authors":"M Yamashita,&nbsp;K Motokawa,&nbsp;T Hirano","doi":"10.1007/BF03014282","DOIUrl":"https://doi.org/10.1007/BF03014282","url":null,"abstract":"","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"685-6"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14886254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine.","authors":"P L Liu,&nbsp;S Gatt,&nbsp;L D Gugino,&nbsp;S R Mallampati,&nbsp;B G Covino","doi":"10.1007/BF03014260","DOIUrl":"https://doi.org/10.1007/BF03014260","url":null,"abstract":"<p><p>Esmolol, an ultra-short-acting cardioselective beta-adrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12-minute infusion of esmolol (500 micrograms X kg-1 X min-1 for four minutes, then 300 micrograms X kg-1 X min-1 for 8 minutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg X kg-1 thiopentone followed by succinylcholine for tracheal intubation. Prior to induction esmolol produced significant decreases in heart rate (HR) (9.3 +/- 1.8 per cent) and rate-pressure product (RPP) (13.1 +/- 1.8 per cent), systolic blood pressure (SAP) (4.3 +/- 1.5 per cent) and mean arterial blood pressure (MAP) (1.7 +/- 2.0 per cent). Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR (p less than 0.0001), and RPP (p less than 0.0005) and significant differences in SAP (p less than 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.</p>","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"556-62"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14887123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acidemia impairs autoregulation of cerebral blood flow in newborn lambs.","authors":"B. Ong, R. Greengrass, D. Bose, G. Gregory, R. Palahniuk","doi":"10.1097/00132582-198609000-00015","DOIUrl":"https://doi.org/10.1097/00132582-198609000-00015","url":null,"abstract":"Cerebral blood flow (CBF) and autoregulation of cerebral blood flow were assessed in newborn lambs before and after inducing metabolic acidemia. CBF was measured by xenon washout and autoregulation by the change in CBF after increasing mean arterial pressure (MAP) 30 per cent with 0.02 per cent phenylephrine hydrochloride. After surgical preparation, stabilization, and demonstration of the presence of autoregulation, six lambs received 10 mg X kg-1 of lactic acid intravenously over 30 minutes. Arterial pH decreased from 7.35 +/- 0.01 (mean +/- SEM) during the control period to 6.96 +/- 0.02 (p less than 0.01) at the end of the lactic acid infusion. Arterial blood gases, MAP's, and heart rates did not change. Prior to lactic acid infusion, CBF before and after raising MAP were 53 +/- 3 ml/100 g/min and 56 +/- 4 ml/100 g/min respectively. After lactic acid infusion, CBF increased from 54 +/- 2 ml/100 g/min to 62 +/- 3 ml/100 g/min (p less than 0.05) following phenylephrine induced rise in MAP. Five control lambs showed no significant change in any of these variables, including CBF, over the same time periods. These data indicate that metabolic acidosis per se does not alter CBF, but that metabolic acidosis impairs cerebral vascular autoregulation in hyperoxic lambs. Similar changes in human neonates might result in intracranial haemorrhage.","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"36 4 1","pages":"5-9"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76061970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onset of pancuronium and d-tubocurarine blockade with priming.","authors":"F Donati,&nbsp;J Lahoud,&nbsp;C M Walsh,&nbsp;P A Lavelle,&nbsp;D R Bevan","doi":"10.1007/BF03014262","DOIUrl":"https://doi.org/10.1007/BF03014262","url":null,"abstract":"<p><p>The synergistic effect of pancuronium bromide (PCB) and d-tubocurarine (DTC) on the onset time of neuromuscular blockade was tested in 108 ASA physical status I and II adults anaesthetized with thiopentone, nitrous oxide and halothane. Either saline or a small (priming) dose (DTC, 0.04 mg X kg-1, or PCB, 0.007 mg X kg-1) was administered 3 min before a paralyzing dose of either DTC or PCB. The total dose of relaxant was equivalent to DTC, 0.4 mg X kg-1, or PCB, 0.07 mg X kg-1. Neuromuscular activity was measured using train-of-four stimulation applied every 12 s. Time to 50 per cent first twitch blockade was 63 +/- 4.6 s (mean +/- SEM) with DTC and 88 +/- 5.2 s with PCB (p less than 0.002). Times to 90 per cent blockade were not different between the two drugs (161 +/- 20 s and 141 +/- 21 s respectively). Priming a DTC blockade with either DTC or PCB or priming a PCB blockade with PCB produced an acceleration of less than 10 s at all levels of blockade. Compared with PCB alone, priming PCB blockade with DTC reduced the time to 50 per cent blockade to 71 +/- 4.5 s (p less than 0.02) and to 90 per cent blockade to 111 +/- 8 s (p less than 0.05). Priming did not affect the duration of action significantly, except in the case of PCB priming of DTC, where duration was increased from 39 +/- 4.4 to 57 +/- 4 min (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":9371,"journal":{"name":"Canadian Anaesthetists' Society journal","volume":"33 5","pages":"571-7"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03014262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14153672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}