bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial Hypotension and Hypoxaemia During Total Hip Replacement: The Importance of Thromboplastic Products, Fat Embolism and Acrylic Monomers
Authors: Modig J. , Busch C. , Olerud S. , Saldeen T. , Waernbaum G.
Published: January 2009

Thirteen patients submitted to total hip replacement surgery by the Charnley technique were studied. Operations were performed under epidural analgesia with the patients awake and breathing air. During the surgical procedure, the magnitude of tissue‐thromboplastic activity, the amount of fat globules, the presence of bone marrow cells and the concentrations of acrylic monomers were determined in the pulmonary arterial blood. Simultaneously, arterial blood gases and blood pressure were monitored.

Marked reductions of the arterial blood pressure and arterial oxygen tension occurred after impaction of the femoral prosthesis, and minor depressions appeared after insertion of the acetabular prosthesis. A significant correlation was found between the release of tissue‐thromboplastic products into the pulmonary circulation, i.e., products that initiate intravascular coagulation and the circulatory and respiratory reactions. The pulmonary fat droplets, per se, seem to be of minor importance, and the release of acrylic monomers is probably of no importance for these reactions.

13 Patienten, bei denen ein totaler Hüftgelenksersatz nach Charnley durchgeführt wurde, dienten als Grundlage dieser Stuide. Die Operationen erfolgten in Epiduralanaesthesie, die Patienten waren wach und atmeten Luft. Während des Eingriffes wurden das Ausmaß der thromboplastischen Gewebsaktivität, die Menge der Fett‐tröfchen, das Vorhandensein von Knochenmarkszellen und die Konzentration der Akrylmonomeren kontinuierlich im Pulmonalarterienblut bestimmt. Gleichzeitig wurden arterielle Blutgase und Blutdruck registrert.

Nach dem Einzementieren der Femoralprothese kam er reglmäßig zu ausgeprägter Atem‐ und Kreislauf‐depression, nach Einsetzen der Azetabularprothese traten geringere Dämpfungen afu. Als Resultat unserer Untersuchungen steht fest, daß die zirkulatorischen und respiratorischen Phänomene hauptsächlich durch die Freisetzung gewebsthrombopulasticher Produkte in dne Kreislauf verursacht werden, nämlich Produkte, die zu intravaskulärer Koagulation (Aggregation von Thrombozyten und Fibrin) führen. Die Fett‐tröfchen an sich sind von geringer Bedeutung, die Freisetzung von Akrylmonomeren wahrscheinlich irrelevant.
The Effect of the Short‐Acting Barbiturate Enibomal (Narcodorm®) on Systolic Time Intervals
Authors: Ibler M. , Dalsgaard M.
Published: January 2009

The systolic time intervals were studied in 16 surgical patients without heart disease between 29 and 75 years of age by a non‐invasive technique before and after an induction dose of enibomal (Narcodorm®).

The pre‐injection period/left ventricular ejection time‐ratio (PEP/LVET‐ratio) increased between 8 and 60% and (1/PEP2) decreased between 3 and 50%, indicating a reduction of myocardial contractility under the influence of enibomal.

Factors responsible for circulatory depression during barbiturate anaesthesia are discussed.

Mit Hilfe einer nicht‐invasiven Methode wurder bei 16 herzgesunden chirurgischen Patenten im Alter zwischen 29 und 75 Jahren die Systolen‐Intervalle vor und nach einer Einleitungsdosis von Enibomal (Narcodorm™) untersucht.

Das PEP/LVET‐Verhältnis erhöhte sich um 8 bis 60% und 1/PEP2 fiel um 3 bis50%, was auf eine Verminderung der Kontraktilität des Herzmuskels unter dem Einfluß von Enibomal hinweist.

Die Faktoren, die für eine Kreislafudepression während Narkosen mit Barbituraten verantwortlich sind, werden diskutiert.
Prostaglandin F2 aifaInfusion and Halothane Anaesthesia
Authors: Vejlsted H. , Obel E. B.
Published: January 2009

The cardiovascular reaction to infusion of prostaglandin F2 alfawas examined in seven patients during N2O‐halothane anaesthesia.

As in the non‐anaesthetized individual, no changes in blood pressure, pulse rate, CVP or ECG occurred during anaesthesia, but a great reflux of enteric juice to the ventricle was noticed only 2–3 min after the beginning of the hormone infusion.

It is concluded that prostaglandin F2 alfamay be safely given to patients who are going to be anaesthetized, but the patients must be considered as having a full stomach and therefore treated as such.

Bei 7 Patienten wurde währendeiner N2O‐Halothan‐Narkose die kardiovaskuläreReaktion auf eine Infusion von Prostaglandin‐F2alfa untersucht.

Wie bei wachen Personen kommt es zu keinen Veränderungen von Blutdruck, Plusfrequenz, zentralem Venendruck oder EKG, aber ein starker Reflux von Darmsaft in den Magen wurde schon 2‐3 Minuten nach der Hormonbehandlung beobachtet.

Es wird der Schluß gezogen, daß Prostaglandin F2alfa gefahrlos auch Patienten gegeben werden kann, die gelegentlich operiert werden sollen, doch müssen dieseals Patienten mit vollem Magen betrachtet und endotracheal intubiert werden.
Central and Peripheral Circulation Immediately After Pulmonary Surgery as Related to Sympathoadrenal Activity
Authors: Delius W. , Johansson L. , Nyström S.‐O. , Westerholm C. J. , Wranne B.
Published: January 2009

Catecholamine output and circulation were observed in connection with pulmonary surgery in one group of ten patients who were anaesthetized with halo‐thane‐N2O‐O2‐d‐tubocurarine and who breathed spontaneously after operation. In another group of four patients who received a modified neurolept anaesthesia with phenoperidine‐N2O‐O2‐d‐tubocurarine and who were mechanically ventilated also after operation, catecholamine output and temperature were observed.

In both patient groups, catecholamine output was normal during operation. Adrenaline output increased by 400% the first postoperative hours, while noradrenaline output remained normal. Thereafter, noradrenaline output increased, while adrenaline output started to decrease. A subnormal body temperature was seen at the end of the operation. In two patients from the neurolept group, adrenaline output and temperature were recorded hour by hour; maximal adrenaline output coincided with maximal temperature rise. In the patients from the halo‐thane group, the postoperative change in foot, calf and forearm blood flow correlated well with the change in catecholamine output. The central circulatory response to the sympathoadrenal stimulation was, however, found to be less pronounced than is ordinarily seen.

Bei einer Gruppe von 10 Patienten, die für Lungen‐operationen mit Halothan‐N.2O‐O2‐d‐Tubocurarin narkotisiert worden waren und postoperativ spontan atmeten, wurden die KKKatecholaminausscheidung und der Kreislauf untersucht. Bei einer anderen Gruppe von 4 Patienten, die eine modifizierte NLA mit Phenoperidin‐N2‐O2‐d‐Tobocurarin erhielten und auch postoperative beatmet wurden, wurden die Katecholaminausscheidung und die Temperatur beobachtet.

Während der Operation war die Katecholaminausscheidung in beiden Gruppen normal. In den ersten postoperativen Stunden steig die Adrenalinausscheidung um 400%, während die Noradrenalinausscheidung normal blieb. Danach steight die Noradrenalinausscheidung an, während die Adrenalinausscheidung abzufallen beginnnt. Zu Operationsende wurde eine subnormale Körpertemperatur festgestellt. Bei zwei Patienten der NLA‐Gruppe wurden Adrenalinausscheidung und Temperatur Stunde für Adrenalinausscheidung mit dem des Temperaturanstiegesüberein. Bei den Patienten der Halothangruppe stimmten die postoperativen Veränderungenim Fuß‐, Waden‐ und Unterarmblutstrom gut mit den Katecholaminausscheidungsveränderungen überein. Die zentrale Kreislaufreaktion auf die sympathoadrenale Stimulation war allerdings weniger ausgepräget als dies für gewöhnlich gesehen wird.
Effects of Thiopental (Trapanal®) on Coronary Blood Flow and Myocardial Metabolism in Man
Authors: Sonntag H. , Hellberg K. , Schenk H. D. , Donath U. , Regensburger D. , Kettler D. , Duchanova H. , Larsen R.
Published: January 2009

The influence of thiopental (Trapanal®) on coronary blood flow (MBF), myocardial oxygen consumption (MVO2), and general haemodynamics was investigated in seven patients without heart disease. Besides measurement of MBF, the amount of substrates (glucose, lactate, pyruvate and free fatty acids (FFA)) was also determined in arterial and coronary sinus blood samples. Thiopental was given intravenously in a mean dose of 4 mg/kg b.w. MBF was measured by means of the argon method. After injection of thiopental, all seven patients showed a significant increase of MBF and MVO2, a fact which can essentially be explained by the increase of heart rate.

The effects of thiopental on arterial concentrations, arterio‐coronary substrate differences, myocardial uptake, and O2‐extraction ratio of the different substrates are discussed.

Die Veränderungen der Koronardurchbluting, des myokardialen O2‐Verbrauches, der allgemeinen Hämodynamik sowie der wichtigsten Substrate des Herzstoffwechsels unter dem Einfluß von Thiopental wurden an insgesamt 7 herzgesunden Patienten untersucht. Die verabreichte i.v., Dosis von Thiopental betrug 4 mg/kg Körpergewicht. Die Koronardurchblutng wurde mittles der Argon‐Fremdgasmethode bestimmt. Nach Injektion von Thiopental in der angegebenen Dosierung kam es bei allen Patienten zu einem signifikanten Anstieg desMBF und des MVO2, eine Tatsache, die im wesentlichen mit der Herzfrequenzsteigerung erklärt werden kann.

Der Einfluss von Thiopental auf die arteriellen Substratkonzentrationen, auf die Substrataufnahme und Sauerstoffextraktionsquotienten werden diskutiert.
Effects of Different Inspiratory Gas Flow Patterns on Thoracic Compliance During Respirator Treatment
Authors: Johansson H.
Published: January 2009

Nine patients under general anaesthesia and 26 intensive care patients undergoing respirator treatment were investigated with special reference to changes in compliance under the influence of different inspiratory gas flow patterns during intermittent positive pressure ventilation (IPPV). Pressure recordings were performed in the respirator tubings, in the trachea and in the oesophagus. Flow rate was measured with pneumotachograph.

Total compliance showed an increase with a decelerating flow compared to an accelerating flow in the anaesthetized group as well as in patients with low compliance and high resistance, and also in patients with chronic respiratory disease. These findings were explained by an improved evenness in the distribution of gas in the greater airways during the inspiratory phase. A separation of total compliance into lung and chest wall compliance did not reveal any significant variations correlated to flow pattern. The change in compliance occurred within minutes and remained during a 30‐minute setting period.

An neun narkotisierten und 26 in Respiratorbehandlung befindlichen Patienten wurden während der künstlichen Beatmung Untersuchungen angestellt, um eventuelle Veränderungen der Compliance durch verschiedene Charakteristiken des inspiratorischcn Gasflows festzustellen. Es wurden Druckmessungen in den Respiratorschläuchen, der Trachea und dem Ösophagus vorgenommen. Die Gasströmung wurde mit einem Pneumotachographen gemessen.

Die totale Compliance stieg bei dezelerierender Strömung im Vergleich mit akzelerierender an, und zwar sowohl in der Gruppe der narkotisierten Patienten als auch bei Patienten mit niedriger Compliance und holier Resistance und endlich auch bei Patienten mit chronischen Atembeschwerden. Diese Befunde erklären sich aus einer gleichmässigeren Gasverteilung in den zuleitenden Atemwegen walirend der Inspirationsphase. Eine Unterteilung der Compliance in Lungen‐ und Brustwandcompliance ergab keine signifikanten Änderungen unter Einfluss der Flowcharakteristik. Die Änderung der Compliance fand im Laufe einiger Minuten statt und hielt während der halbstündigen Beobachtungsperiode an.
Cardiac Function During Halothane and Fluroxene Anesthesia Expressed by Systolic Time Intervals
Authors: Rasmussen J. P. , Sørensen B.
Published: January 2009

A non‐invasive method of measuring the systolic time intervals (STI) during anesthesia is described. Using the ratio between the pre‐ejection period and the left ventricular ejection time (PEP/LVET‐ratio) as an expression of cardiac function, it is shown in 39 patients that thiopentone exerted a marked depression on the heart (increase in PEP/LVET‐ratio). This depression was further aggravated by halothane, while fluroxene caused an improvement of PEP/LVET‐ratio. In the immediate post‐anesthetic period PEP/LVET‐ratio almost reached control value after discontinuation of fluroxene in contrast to halothane, where an increased PEP/LVET‐ratio (25%) still persisted. The changes were mainly due to a prolongation of PEP without any specific change in LVET. During the study, PEP/LVET‐ratio showed a close correlation to the reciprocal value of the square of the pre‐ejection period (1/PEP2).

STI from 27 volunteers were measured and compared to the values from the patients before anesthesia was induced. PEP and PEP/LVET‐ratio were significantly shorter in the patient group.

Es wird eine nicht‐invasive Methode zur Messung des Systolen‐Zeitintervals (STI) während der Narkose beschrieben. Unter Verwendung der Relation zwischen der Vor‐Auswurfperiode (PEP) und der Auswurfzeit des linken Ventrikels (LVET) als Ausdruck der Herzleistung konnte an 39 Patienten gezeig werden, daB Thiopental eine deutliche Depression des Myocards hervorruft (= Anstieg der PEP/LVET‐Relation). Diese Depression wird weiter verstärkt durch Halothan, während Fluroxene eine Verbesserung der PEP/LVETRelation bewirkt. In der unmittelbar postnarkotischen Periode kehrt die PEP/LVET‐Relation nach dem Absetzen von Fluroxene sehr rasch zu den Ausgangswerten zurück, während im Gegensatz dazu nach Halothan noch eine um ca. 25% erhöte PEP/LVET‐Relation bestehen bleibt. Verantwortlich dafür war vor allem eine PEP‐Verlängerung ohne spezifische Änderung des LVET. Im Verlauf der Untersuchung zeigte die PEP/LVET‐Relation eine nahe Korrelation zum reziproken Wert des Quadrats der Vor‐Auswurfperiode (1/PEP2).

Bei 27 freiwilligen Versuchspersonen wurde das STI gemessen und mit den Werten von Patienten vor der Narkoseeinleitung verglichen. PEP und die PEP/LVET‐Relation waren in der Patentengruppe signifikant kürzer.
High‐Frequency Positive‐Pressure Ventilation (HFPPV) During Transthoracic Resection of Tracheal Stenosis and During Peroperative Bronchoscopic Examination
Authors: Eriksson I. , Nilsson L.‐G. , Nordström S. , Sjöstrand U.
Published: January 2009

Operation of a patient with intrathoracic tracheal stenosis using a new ventilation technique (HFPPV) is described. The technique permits tracheoscopy during ventilation and operation, thus enabling exact location of the stenosis to be obtained. Further, peroperative tracheoscopic checking of the anastomosis can be carried out. Resection and anastomosis can be performed without interference of a bulky endotracheal tube.

Es wird die Operation eines Patienten mit intrathorakaler Trachealstenose beschrieben, bei der eine neue Beatmungstechnik (HFPPV = hochfrequente Überdruck‐Ventilation) angewandt wurde. Die Methode ermöglicht unter gleichzeitiger Beatmung eine tracheoskopische genaue Lokalisation der Stenose. Ferner kann während der Operation die Anastomose tracheoskopisch kontrolliert werden. Resektion und Anastomose können ohne Beeinträchtigung durch einen dicken Endotrachealtubus vorgenommen werden.
Effects of Respiratory Acidosis on the Arrhythmia Threshold During Fluroxene and Halothane Anesthesia
Authors: Eikard B. , Skovsted P.
Published: January 2009

Hypercarbia was induced in 12 patients anesthetized with either halothane or fluroxene in an inspired concentration of approximately 1.3 MAG (1% halothane and 4–5% fluroxene). The six patients receiving halothane anesthesia responded to hypercarbia with a pronounced tachycardia, an increased arterial pressure and an electrocardiographically monitored threshold level for ventricular arrhythmias at a Paco2 level averaging 98 mmHg. The six patients receiving fluroxene anesthesia responded to hypercarbia with both tachycardia and hypertension, but in spite of an average Paco2 level of 109 mmHg, no ventricular arrhythmias could be provoked. It is therefore suggested that within the non‐narcotic level of hypercarbia a threshold level for cardiac arrhythmias does not exist under fluroxene anesthesia.

Bei 12 Patienten, die mit einer Einatmungskonzentration von etwa 1,3 MAC Halothan (1%) bzw. Fluroxen (4‐5%) narkotisiert wurden, wurde eine Hypercarbie eingeleitet. Die 6 Halothan‐Patienten reagierten auf die Hypercarbie mit einer ausgeprägten Tachycardie, einem erhöhten arteriellen Blutdruck sowie einem elektrokardiographisch überwachten Schwellenanstieg für ventrikuläre Arrhythmien bei einem arteriellen Paco2‐Spiegel von ca 98 mmHg. Die 6 Patienten, die Fluroxen erhalten hatten, reagierten auf die Hypercarbie ebenfals sowohl mit Tachycardie als auch mit Hypertonie, aber trotz eines mittleren arteriellen Paco2,‐Spiegels von 109 mmHg war es nicht möglich, ventrikuläre Arrythmien zu provozieren. Man kann daher annehmen, daB es innerhalb nichtnarkotischer Hypercarbiebereiche keinen Schwellenspiegel für kardiale Arrythmien unter Fluroxennarkose gibt.
The Influence of Arterial Carbon Dioxide Tension on the Cerebrovascular Response to Arterial Hypoxia and to Haemodilution
Authors: Häggendal E. , Winsö I.
Published: January 2009

Cerebral blood flow (CBF) measurements and blood gas analyses were performed on anaesthetized and artifically ventilated dogs during arterial hypoxia or haemodilution in different ranges of arterial carbon dioxide tension. Arterial hypoxia as well as haemodilution produced a flow increase in all ranges of ventilation. However, this flow increase was elicited at a cerebrovenous oxygen tension which rose with the arterial carbon dioxide tension, but which tended to be maintained by the flow increase during continued decrease of the arterial oxygen content. On the assumption that the cerebrovenous oxygen tension reflects the oxygen tension of the brain tissue, it is suggested that the arterial carbon dioxide tension influences the ability of the brain tissue to maintain the aerobic metabolism during reduced tissue oxygen tension. This means that tissue hypoxia, in the sense of utilisation of anaerobic metabolism, occurs at a tissue oxygen tension which is lower the lower the arterial carbon dioxide tension is.

Zerebrale Durchblutungsmessungen und Blutgasanalysen wurden an anaesthesierten und beatmeten Hunden bei arterieller Hypoxie und Haemodilution unter verschiedener arterieller Kohlensäurespannung durchgeführt. Sowohl arterielle Hypoxie als auch Haemodilution ergaben in allen Bereichen der Ventilation eine Durchblutungssteigerung, welche jedoch bei einer zerebralvenösen Sauerstoffspannung, welche mit der arteriellen Kohlensäurespannung wuchs, hervorgerufen wurde, aber durch Erhöhung der Durchblutung während fortschreitender Abnahme des arteriellen Sauerstoffgehaltes aufrechterhalten wurde. Unter der Annahme, daB die zerebralvenöse Sauerstoffspannung die Sauerstoffspannung im Hirngewebe wiederspiegelt, wird angenommen, daB die arterielle Kohlensäurespannung die Fähigkeit des Hirngewebes aeroben Stoffwechsel bei reduzierter Gewebssauerstoffspannung zu erhalten, so daB Gewebshypoxie im Sinne der Utilisation von auch anaeroben Stoffwechsel bei einer Gewebssauerstoffspannung auftreten würde, welche um so niedriger ist, je geringer die arterielle Kohlensaurespannung ist.
Effect of Controlled Halothane Anaesthesia on Splanchnic Blood Flow and Cardiac Output in the Dog
Authors: Thulin L. , Andreen M. , Irestedt L.
Published: January 2009

Effects of halothane anaesthesia on splanchnic blood flow and cardiac output were studied in six dogs. Blood flows in the hepatic artery, the superior mesenteric artery and the portal vein were measured electromagnetically. Cardiac output was measured by thermodilution. Depth of anaesthesia, ventilation, acid–base state and body temperature were controlled.

Cardiac output and blood flows in the hepatic artery, the superior mesenteric artery and the portal vein decreased significantly to 73%, 54%, 59% and 60% of control values, respectively. Total peripheral vascular resistance decreased significantly, while mesenteric and portal resistance remained essentially unchanged and hepatic arterial resistance showed a significant increase.

It is suggested that the difference between the various vascular responses may be caused by a differentiated release from baroreceptor inhibition in various parts of the bulbar vasomotor center.

Die Auswirkung von Halothannarkose auf die Splanchnikusdurchblutung und den Cardiac Output wurden bei 6 Hunden untersucht. Die Durchblutung der Arteria Hepatica, der Mesenterica Superior und der Pfortader wurden elektromagnetisch gemessen. Cardiac output wurde mittels Thermodilution registriert. Narkosetiefe, Atmung, Säure‐Basen‐Verhältnis und Körpertemperatur wurden überwacht.

Cardiac output und die Durchblutung der Arteria Hepatica, der Mesenterica Superior und der Pfortader waren signifikant auf 73%, 54%, 59% und 60% der Kontrollwerte herab gesetzt. Totaler peripherer GefäBwiderstand nahm ebenfalls signifikant ab. Während mesenterialer und portaler Widerstand im Wesentlichen unverändert blieben und der Widerstand der Arteria Hepatica einen signifikanten Anstieg zeigte.

Es wird angenommen, daB die Unterschiede zwischen den verschiedenen Reaktionen der GefäBgebiete durch differenzierte Freisetzung von Barorezeptoreninhibition in den verschiedenen Teilen des bulbären Vasomotorenzen trums bewirkt werden.
Maternal and Fetal Responses to Halothane in Pregnant Monkeys
Authors: Eng M. , Bonica J. J. , Akamatsu T. J. , Berges P. U. , der Yuen D. , Ueland K.
Published: January 2009

Maternal cardiac output, blood pressure, heart rate, fetal blood pressure, heart rate and respiratory blood gases, and uterine blood flow were measured in six pregnant monkeys during halothane–nitrous oxide and oxygen anesthesia and compared to these same parameters observed during nitrous oxide and oxygen anesthesia. Halothane 1.5% was associated with a decrease in maternal arterial pressure (54%), heart rate (10%), cardiac output (17%), total peripheral resistance (40%), and uterine blood flow (28%). Mean fetal heart rate decreased 18% and mean fetal blood pressure 22%. These changes in fetal hemodynamics were probably related to a direct depression of the fetal cardiovascular system and its usual compensatory mechanism as well as the fetal asphyxia secondary to the decrease in uterine blood flow.

Mütterliches Herz‐Minuten‐Volumen, Blutdruck, Pulsfrequenz, fetaler Blutdruck, Herzfrequenz und respiratorische Blutgase und uterine Durchblutung wurden bei 6 schwangeren Affen unter Halothan‐Lachgas und Sauerstoffnarkose gemessen und mit Lachgas‐Sauerstoff anaesthesierten Tieren vergleichen. Halothan 1,5%ig war begleitet von einer Abnahme des mütterlichen arteriellen Druckes (54%) der Pulsfrequenz (10%) des Herz‐Minuten‐Volumen (17%) des peripheren Gesamtwiderstandes (40%) und der uterinen Durchblutung (28%). Die mittlere fetale Herzfrequenz nahm um 18% ab und der fetale Blutdruck um 22%. Diese Veränderungen der fetalen Haemodynamik entsprechen wahrscheinlich einer direkten Depression des fetalen Herz‐Kreislaufsystems und seines normalen Kompensationsmechanismus sowie der fetalen Asphyxie bedingt durch die Reduktion der uterinen Durch blutung.
Mechanical Ventilators as Vehicles of Infection
Authors: Perea E. J. , Criado A. , Moreno M. , Avello F.
Published: January 2009

Twenty–five patients from the intensive care unit who had been subjected to tracheostomy and required mechanical respiration were studied. Data are presented concerning the bacteriological controls performed on the tracheal exudates, various parts of the ventilators (Engström Model 200 and Bennett PR–2), and the Wright spirometer.

The germs found were mainly pseudomonas, enterobacteriaceae germs and bacteria from the acinetobacter group. There was a high incidence of infections in the tracheostomies of these patients.

We found a cause and effect relationship between the contaminating bacteria isolated from the cannula and the bacteria isolated from the tracheal exudates in the case of pseudomonas aeruginosa. However, this was not found to be the case where enterobacteriaceae were concerned. Acinetobacter calcoaceticus were isolated almost exclusively in the ventilators.

The study calls attention to the need for rigorous disinfection of ventilators to prevent hospital cross infections.

25 Patienten unserer Intensivbehandlungsstation, die tracheotomiert waren und mechanische Ventilation benötigten, waren die Grundlage dieser Untersuchung. Es werden die Ergebnisse bakteriologischer Kontrollen aus dem Trachealsekret, aus verschiedenen Teilen der Respiratoren (Engström Modell 200 und Bennett PR‐2) und aus dem Wright‐Spirometcr vorgelegt.

Die gefundenen Keime waren vorwiegend Pseudomonas, Enterobakterien und Bakterien der Acinetobaktergruppe. Die Tracheostomata dieser Patienten waren zu einem hohen Prozentsatz infiziert.

Im Falle der Pseudomonas aeroginosa fanden wir eine Ursache‐Wirkungs‐Relation zwischen den von der Kanüle isolierten kontaminierenden Bakterien und den aus den Trachealexsudaten isolierten Keimen. Im Falle der Enterobakterien fand sich diese Beziehung jedoch nicht. Die oxydierenden gram‐negativen Keime, Acinetobakter, wurden fast ausschließlich aus den Ventilatoren isoliert.

Diese Untersuchung unterstreicht die Notwendigkeit rigorosester Sterilisation der Respiratoren zur Vermeidung von Krankenhaus‐Kreuzinfektion.
The Effect of Controlled Halothane Anaesthesia on Splanchnic Oxygen Consumption in the Dog
Authors: Andreen M. , Irestedt L. , Thulin L.
Published: January 2009

The influence of halothane anaesthesia on splanchnic oxygen flow and oxygen uptake was studied in seven dogs. Mean oxygen supply to the liver and the portally‐drained tissues decreased significantly to 44% and 53% of control values, respectively, while mean oxygen consumption diminished insignificantly to 68% and 82% of control values, respectively. There was a fall in the oxygen flow/oxygen consumption ratio in all animals following halothane. The relatively unimpaired oxygen uptake, in spite of a diminished oxygen supply, led to an increased extraction of oxygen by the tissues. Some factors affecting oxygen utilisation during halothane anaesthesia are discussed.

An 7 Hunden wurde der Einfluß einer Halothannarkose auf den Sauerstoff‐Flow und die Saurrstoffaufnahme im Splanchicusbereich untersucht. Die Mittelwerte der Sauerstoffversorgung der Lebcr und der durch die Pfortader drainierten Gewebe ficl signifikant auf 44% bzw. 53% der Kontrollwertr, während der mittlere Saucrstoffverbrauch nicht‐signifikant auf 68% bzw. 82% der Kontrollwerte absank. Unter Halothan kam es bci allen Tieren zu einem Absinken der Relation Saucrstoffzufuhr/Sauerstoffverbrauch. Die relativ ungestorte Sauerstoffaufnahme bei gleichzeitig verminderter Sauerstoffzufuhr fübrte zu einer erhöhten Sauerstoffextraktion durch die Gewebe. Einige Faktoren, die Sauerstoffausnutzung während der Halothannarkose betreffend, werden diskutiert.
Electroencephalographic Study of Children During Ketamine Anesthesia
Authors: Rosén I. , Hägerdal M.
Published: January 2009

EEG was recorded on nine occasions of ketamine anesthesia in eight children. Two of the patients were neurologically normal and six were under investigation for various neurological disorders. The EEG during the catatonic phase of ketamine anesthesia is characterized by alternating high amplitude delta complexes and periods of fast activity.

The two cases which in the routine EEG showed focal paroxysmal activity did not show any electroencephalographic aggravation or clinical seizure during ketamine influence. One case exhibiting a subcortical type of epileptiform activity showed a marked potentiation of this activity with ketamine. On routine neurological examination during the catatonic phase of ketamine anesthesia the pharyngeal reflex was generally weak and failed altogether in two cases and corneal reflexes were absent in three cases.
The Postanesthetic Antiemetic Effect of Premedication with Dehydrobenzperidol Before Ether Anesthesia
Authors: Alsner T. , Brandt M. R. , Sørensen B.
Published: January 2009

A study was performed to evaluate the antiemetic effects after ether anesthesia when dehydrobenzperidol (DHB) and pentobarbital were used for premedication and to compare these effects with halothane anesthesia when pentobarbital was used as premedication. Eighty‐four patients undergoing minor surgical operations were randomly divided into three groups. The patients received ether and either DHB 0.2 mg/kg or pentobarbital 2 mg/kg for premedication, or halothane and pentobarbital 2 mg/kg for premedication. The complaints of nausea and vomiting were recorded 24 h after anesthesia. We found that DHB compared to pentobarbital had a greater antiemetic effect after ether anesthesia, but the difference was not significant (P > 0.05). However, if only persistent nausea and vomiting were considered, the difference was significant (P < 0.05). The incidence of nauseal/vomiting after ether anesthesia with DHB as premedication was a little higher compared to halothane anesthesia with pentobarbital as premedication, but the difference was not significant (P > 0.05). However, if only persistent nausea/vomiting was considered, the incidence of complaints was equal in the two groups.

It is concluded that when used for premedication to ether anesthesia DHB seems to lead to less postanesthetic nauseal/vomiting than pentobarbital. Further DHB seems able to reduce the incidence of nausea/vomiting after ether anesthesia roughly to the level of that seen after pentobarbital premedication for halothane anesthesia.
Anesthesia for Cesarean Section III: Effects of Epidural Analgesia on the Respiratory Adaptation of the Newborn in Elective Cesarean Section
Authors: Magno R. , Kjellmer I. , Karlsson K.
Published: January 2009

A rise in fetal Paco2 was observed after elective cesarean section in patients anesthetized both with a barbiturate and with nitrous oxide/oxygen. Epidural analgesia seemed to be a good alternative in order to attain better blood gas values in the newborn infant.

Fourteen healthy mothers and their infants were studied in connection with elective cesarean section. Epidural analgesia with plain bupivacaine 0.75% was used. Doses varied between 90 and 120 mg. The time between the epidural injection and delivery was around 50 min. In six cases the fetal heart rate was registered continuously. Most of the mothers were sedated with diazepam intravenously or fully anesthetized, after delivery. The mothers were interviewed later. The respiratory adaptation of the infants was studied by blood gas and acid‐base measurements in repeated arterial samples during the first 3 hours of life. A comparison was made with a group previously studied, where general anesthesia with a barbiturate, nitrous oxide/oxygen was the method used. The present material showed no differences concerning Pao2 and Paco2 but clearly indicated a tendency towards an earlier normalization of the initial metabolic acidosis. Mothers showed a respiratory alkalosis which was overcompensated by the metabolic component. Maternal blood pressure falls were observed in four cases, and fetal effects could be detected.

Although epidural analgesia has a more favorable effect upon the newborn's metabolic component, both the compared methods allow good respiratory adaptation provided they are used correctly. Mothers can be given the opportunity to choose between being conscious or asleep when their child is delivered.
The Effect of Halothane Anaesthesia upon Cerebral Oxygen Consumption in the Rat
Authors: Harp J. R. , Nilsson L. , Siesjö B. K.
Published: January 2009

The influence of halothane (0.6 and 2%) upon cerebral (cortical) blood flow (CBF) and cerebral metabolic rate for oxygen (CMRo2) was studied in artificially ventilated rats, using a modified technique of Kety & Schmidt (1948). The values obtained in halothane anaesthesia were compared to those recorded in nitrous oxide anaesthesia, or to those measured in unanaesthetized animals given an analgesic drug (fentanyl citrate).

Although it could be confirmed that halothane induces vasodilatation in the brain, there were relatively small differences in CBF between the groups. The results demonstrate that, in the rat, halothane depresses CMRo2 in a dose‐dependent way. With 0.6% halothane, CMRo2 was reduced by 20–30% and, with 2% halothane, CMRo2 was reduced by about 50%. Thus, in the rat the effect of 2% halothane upon metabolic rate is comparable to that observed in barbiturate anaesthesia.
The Effect of Nitrous Oxide on Oxygen Consumption and Blood Flow in the Cerebral Cortex of the Rat
Authors: Carlsson C. , Hägerdal M. , Siesjö B. K.
Published: January 2009

The effect of 70% nitrous oxide upon cerebral oxygen consumption (CMRo2) and cerebral blood flow (CBF) was studied in artificially ventilated rats. The control groups consisted of unanaesthetized animals in which a stress‐induced increase in CMRo2 and CBF was prevented by previous adrenalectomy, or by administration of a beta blocker (propranolol). There were no significant differences in CMRo2 between animals ventilated with either N2O or N2. It is concluded that if nitrous oxide depresses cerebral metabolism the depression cannot exceed 10%.
Reduction of Psychotomimetic Side Effects of Ketalar® (Ketamine) by Rohypnol®(Flunitrazepam) A Randomized, Double‐Blind Trial
Authors: Freuchen I. , øSjstergaard J. , Kuhl J. B. , Mikkelsen B. O.
Published: January 2009

A double‐blind controlled trial based on 140 women undergoing abortus provocatus was employed to study whether the frequency of side effects after administration of the anaesthetic Ketalar®(ketamine) could be reduced by a concurrent dose of Rohypnol® (flunitrazepam). The control group was given ketamine alone. The dosage of ketamine was 2 mg/kg body weight, supplemented if necessary by 1 mg/kg, in combination with either 2 mg flunitrazepam or placebo. No other anaesthetics were used. On several counts, the combination of ketamine and flunitrazepam was proved to reduce the adverse reactions seen with ketamine alone. Motor restlessness and confusion in the awakening state occurred with significantly less severity and frequency. Amnesia for dreams was significantly more frequent. Memory of dreams was often unpleasant after ketamine alone. The influence on pulse rate was significantly smaller and no significant changes in systolic blood pressure were seen, whereas a significant increase occurred with ketamine alone. Less pronounced fluctuations in diastolic blood pressure occurred with the combination ketamine‐flunitrazepam. Respiratory rate increased significantly with both treatments, but respiratory minute volume was lower with the ketamine‐flunitrazepam combination.
Thoracic Epidural Analgesia III—Prolongation in the Early Postoperative Period by Intermittent Injections of Etidocaine with Adrenaline
Authors: Renck H. , Edström H.
Published: January 2009

In 38 patients who had undergone elective upper abdominal surgery, postoperative analgesia was obtained by thoracic epidural analgesia, prolonged by intermittent injections of 3.0, 4.0 and 5.0 ml, respectively, of 1.0% etidocaine with adrenaline 1:200,000. The spread of analgesia after repeated doses is given, as are also the incidences of incomplete analgesia and urinary retention. Signs of tachyphylaxis were noticed. Decreases in the systolic blood pressure were evident, especially after the first injections in the three groups investigated. The falls in blood pressure in the 5 ml group were so pronounced that this part of the study had to be terminated. Accumulation of etidocaine in plasma was noticed in all groups. The clinical implications of the method are discussed.
Halothane Anaesthesia and Suxamethonium I: The Significance of Preoperative Atropine Administration
Authors: Viby‐Mogensen J. , Wisborg K. , Gabrielsen J. , Spotoft H.
Published: January 2009

Preoperative administration of atropine was evaluated during induction of halothane anaesthesia with two administrations of suxamethonium 1 mg/kg body weight, 5 min apart.

Sixty‐eight healthy, adult patients were studied. They were divided into five groups according to dose and route of administration of atropine. EGG was continuously monitored. Serum potassium, pH, Paco2, Pao2 and standard bicarbonate were measured at appropriate intervals.

It was found that neither atropine 0.01 mg/kg body weight given intramuscularly 1 h before the anaesthesia nor atropine 0.01 mg/kg body weight given intravenously 5 min prior to induction protected against serious bradycardias (defined as heart rate below 20 beats per minute) following the second dose of suxamethonium.

No serious brady‐arrhythmias were seen in patients given either a combination of intramuscular and intravenous atropine in the above‐mentioned doses or in patients given atropine 0.015 mg/kg body weight intravenously 5 minutes prior to induction. However, a decrease in heart rate to around 40–50 beats per minute occurred in some of these patients. Furthermore, these large doses of atropine caused an increase in heart rate during induction to more than 120 beats per minute in about 50% of the patients and to more than 140 beats per minute in about 25% of the patients.

Our results suggest that preoperative administration of atropine does not protect against serious brady‐arrhythmias following a second dose of suxamethonium, unless doses of atropine are used which cause tachycardia of considerable degree.
Anesthesia for Cesarean Section V
Authors: Magno R. , Karlsson K. , Selstam U. , Wickström I.
Published: January 2009

The new anesthetic inhalation agent, enflurane, is supposed to allow rapid induction and recovery. Experience with this agent in obstetrics is limited. Enflurane was therefore studied in 14 pregnant women undergoing elective cesarean section. Its effects upon the respiratory adaptation of the newborn infants were followed during the first 3 hours, as judged by oxygen tensions and acid‐base balance measurements in serial neonatal arterial samples. Results were compared with those from a previously studied group of women anesthetized with a barbiturate and nitrous oxide‐oxygen. There were no differences with respect to oxygen tension. Carbon dioxide values in the enflurane group were higher than those in the barbiturate group. In comparison with the barbiturate group the enflurane group of babies had lower BD values, which is a sign of a better metabolic state post‐partum. Mothers anesthetized with enflurane were satisfied with the method, especially for the post‐operative period.
Amnesic Action of and Skills related to Driving after Intravenous Flunitrazepam
Authors: Korttila K. , Linnoila M.
Published: January 2009

Amnesic action, skills related to driving and the ability to discriminate the fusion of flickering light were measured double‐blind in 29 healthy volunteers before and after three doses of intravenous flunitrazepam. Every subject experienced amnesia for the pinching of the abdomen after being injected with flunitrazepam. Even the smallest dose of flunitrazepam(0.01 mg/kg) caused the amnesia without affecting the level of consciousness. The late effects of flunitrazepam were the most harmful to coordination. With 0.01 mg/kg eye‐hand coordination was slightly impaired for as long as 6 h after the injection, and after 0.02 and 0.03 mg/kg the impairment was still significant (P < 0.05) at the last observation period 10 h after the injection. It was concluded that, because the amnesic action of flunitrazepam is more effective than that of clinically comparable doses of diazepam, further clinical experiments with flunitrazepam are warranted. Its longer and more harmful effects on psychomotor performance than those of equipotent doses of diazepam suggest that doses of 0.02 mg/kg or more of flunitrazepam should be avoided in outpatient anaesthesia or sedation.
Comparison of the Effect of Anileridine and Pethidine on the Intracholedochal Pressure during Constant Fluid Perfusion
Authors: Tuominen Marjatta
Published: January 2009

Anileridine and pethidine have a spasmolytic action on animal intestine. Pethidine is known to have a spasmogenic effect at the choledocho‐duodenal junction of man, but there is no study of the effect of anileridine on the biliary tract. In the present study the effects of anileridine and pethidine on the intracholedochal pressure during constant fluid perfusion in man were compared. The maximal elevation of the choledochal passage pressure was significantly greater after anileridine than after pethidine. However, the difference between anileridine and pethidine seemed to be less than that reported previously between morphine and pethidine. The effect of anileridine was of shorter duration than that of pethidine. Anileridine and pethidine are not ideal analgesics when the normal activity of the biliary ductal system has to be maintained in pain or during cholangiography.
A Comparison of the Effects of the Inhalation of 4% and 8% Fluroxene in the Pregnant Primate
Authors: Eng Marlene , Berges Peter U. , Der Yuen Douglas , Bonica J. J. , Ueland Kent
Published: January 2009

A comparison was made of the effects of inhalation of 4% fluroxene (n = 5) and 8% fluroxene (n = 5) in pregnant monkeys. Measurements of maternal arterial blood pressure, heart rate, cardiac output, total peripheral resistance, uterine blood flow, fetal heart rate and arterial blood pressure, and maternal and fetal blood gas levels were made. Inhalation of 4% fluroxene for 20 minutes produced little change in maternal hemodynamics and was well tolerated by the fetus. Fluroxene 8% inhaled for a similar 20‐minute‐period produced a significant decrease in maternal blood pressure (‐27%), total peripheral resistance (‐32%), and uterine blood flow (‐27%) and lowered the level of maternal fetal exchange.
Halothane Anaesthesia in Caesarean Section
Authors: Kangas L. , Erkkola R. , Kanto J. , Mansikka M.
Published: January 2009

The safety and efficacy of halothane anaesthesia were investigated in 97 caesarean sections using 0.4–0.6% halothane added to a mixture of 6 1 N2O/3–4 1 O2. The administration of halothane was initiated before intubation and terminated immediately prior to delivery. Only one patient reported memories from the operation. The mean Apgar score 1 min after delivery (8.5) was significantly better than that (8.2) in 100 caesarean sections in which a mixture of 7 1 N2O/3 1 O2 was used.

In 17 caesarean sections, the halothane concentrations were examined after 0.9% halothane had been given for exactly 1 min after intubation. It was found that halothane reached and passed the placenta after only 1 min. The levels in the maternal artery and umbilical vein were comparable. The levels in the maternal artery, maternal vein and umbilical vein were markedly higher than in the umbilical artery, which indicated an accumulation of halothane in the foetal tissues. However, due to the vigour of the newborn, halothane concentrations 10 min after birth were very low. The half‐life of halothane in the maternal circulation was approximately 1 min with the described method of administration.

Blood gas determinations, which were made in seven newborns, proved satisfactory.
The Haemodynamic Effects of Unsupplemented Nitrous Oxide‐Oxygen‐Relaxant Anaesthesia in Cardiac Patients
Authors: Dottori O. , Korsgren M. , Ax:sonLöf B. , Wilhelmsen L.
Published: January 2009

The effect on the systemic and pulmonary circulation of unsupplemented nitrous oxide in about 30% oxygen, with and without IPPV, was investigated in five cardiac patients and compared with control periods at rest with air breathing. The results of this investigation show that nitrous oxide in conventional oxygen concentration does not cause any great haemodynamic changes. During tracheal intubation, however, significant increases in both systemic and pulmonary blood pressures were registered. However, these pressures reverted to the control values immediately after the tracheal intubation. The results of this study support many earlier clinically good experiences obtained when using this conventional nitrous oxide‐oxygen mixture in cardiac patients.
The Antagonist Effect of Naloxone Hydrochloride after Neuroleptanaesthesia during Neurosurgery
Authors: Arnér Staffan , Gordon Emeric
Published: January 2009

The effects of naloxone were studied in 82 patients undergoing intracranial surgery under general anaesthesia with fentanyl or phenoperidine. After the operation was finished the patients' alertness, sensitivity to pain, blood pressure, pulse rate, respiratory rate, tidal and minute volume were recorded parallel with arterial blood gas analyses prior to and immediately after the administration of varying amounts of naloxone i.v. in a single dose. These parameters were also repeatedly controlled for several hours in the postoperative period.

The results show that a single i.v. naloxone dose of 1 μg/kg b.w. is effective in the rapid and definite reversal of the respiratory depression caused by the analgesics. This dose was neither correlated to the total amount of analgesics given, nor to the time period which elapsed between the last dose of the analgesic drug and the administration of naloxone. No side effects or complications were encountered when the indicated doses of naloxone were given. It is concluded that, even in a small single dose, naloxone effectively antagonises the respiratory depression caused by fentanyl and phenoperidine without totally eliminating the immediate postoperative analgesic effects of these agents.
Hemodynamic Drug Interaction: Peridural Lidocaine and Intravenous Ephedrine
Authors: Mather L. E. , Tucker G. T. , Murphy T. M. , Stanton‐Hicks M. d'A. , Bonica J. J.
Published: January 2009

Hypotension following peridural anesthesia with lidocaine was treated by intravenous injection of ephedrine. The ephedrine relieved the cardiovascular depression, but was associated with a concomitant increase in plasma lidocaine concentrations. This increase may push the plasma lidocaine concentration into the toxic region.
Suxamethonium Apnoea Terminated with Commercial Serumcholinesterase
Authors: Stovner J. , Stadskleiv K.
Published: January 2009

A case of prolonged suxamethonium apnoea successfully terminated by the infusion of a commercial preparation of serumcholinesterase is reported. The patient appeared to be homozygous for the dibucaine resistant gene, having only 15% of normal activity in his serum. His dibucaine number was 21, and the Michaelis constant was 5.5 times that of normal sera. One and a half hours after receiving 110 mg suxamethonium for oesophagoscopy, the patient was still apnoeic with no response to ulnar nerve stimulation. Intravenous administration of 90 mg commercial serumcholinesterase, the equivalent to 1000 ml fresh human plasma, restored twitch and tetanic responses and the patient could lift his head 15 min after the beginning of the enzyme injection. The serumcholinesterase activity of the patient's serum increased by 55% (from 15% to 70%) following the injection. This rise was halved over the next 8 days.