Does paddle force applied during defibrillation meet advanced life support guidelines of the European Resuscitation Council?

OBJECTIVES: to determine whether paddle force applied during defibrillation meets the 12 kg (approximately 120 N) force recommended by the advanced life support (ALS) guidelines of the European Resuscitation Council (ERC). MATERIALS AND METHODS: an adult mannequin was "defibrillated" using standard defibrillation paddles instrumented to measure paddle force. Paddle force was recorded at the time the discharge buttons on the paddle handles were depressed. RESULTS: 54 doctors and nurses performed simulated defibrillation on a mannequin. Median sternal paddle force was 60.6 N (range 26.1-132.8 N) and median apical paddle force was 59.5 N (range 18.6-118.5 N). Only 3/54 operators (5.6%) applied sternal paddle force equal to or in excess of ERC recommendations. No operator applied apical paddle force equal to or in excess of ERC recommendations. CONCLUSIONS: force applied to defibrillation paddles does not meet guidelines of the European Resuscitation Council. Greater emphasis during advanced life support training should be placed on the importance of firm paddle force during defibrillation.

Naloxone and pentazocine given after morphine.

Morphine 0.3 mg kg-1 was i.m. given to 25 patients after upper abdominal operations, for analgesia purpose. One hour later, naloxone 0.01 mg was injected i.v. for every 1 mg morphine given. Ten minutes later, pentazocine 0.5 mg kg-1 was also injected i.v. in order to appreciate how it could counteract the reduction in analgesia level caused by naloxone. Complete analgesia could be found in all patients after the mentioned dose of morphine. The minute-ventilation and respiratory frequency were reduced from 7.74 +/- 0.66 to 6.88 +/- 0.77 l (decrease not significant J and from 22.76 +/- 0.98 to 17.44 +/- 0.88 (p less than 0.001). Naloxone partially restored their values, to 7.70 +/- 0.55 l and 18.96 +/- 0.88, but 17 patients out of 25 immediately complained of wound pain. Pentazocine improved analgesia again, in all patients, but also depressed the minute-ventilation to 6.43 +/- 0.48 l, without evident changes in respiratory frequency. If the respiratory changes after morphine and naloxone-pentazocine are compared, it is to emphasize that the distribution of the values was much less after the drug combination, 0.56 in comparison with 1.44, P (Fischer Snédécor test) less than 0.001, showing a more homogeneous improving of the minute-ventilation. In conclusion, if pentazocine is added to naloxone, while a respiratory depression caused by morphine has to be reversed, the analgesia level is maintained and the respiration is insignificantly reduced.

Pseudocholinesterase changes in anesthesia using pancuronium.

Pseudocholinesterase activity was investigated in three groups of unselected patients. A slight rise of the enzyme was found during surgery under local anesthesia with lidocaine. In general anesthesia with thiopentone and halothane, the pseudocholinesterase activity diminished. The inhibition was more pronounced when pancuronium had been injected. From these data one may conclude that pancuronium must be carefully given in patients with low level of pseudocholinesterase when other drugs inhibiting the enzyme activity, like succinylcholine, procaine and propanidid, are used.

Gastric lipoma and mucocele of appendix. Case history.

An interesting coexistence of two rare diseases in the same patient is presented. A 51 year old female was operated for a benign tumor of the stomach, a lipoma of about 5 cm of the gastric antrum. After the tumor removal, a mucocele of the appendix was surprisingly found, for which an appendectomy was necessary. The clinical course was uneventful and one year after the operation the patient is in a good state of health. A short review of the literature accompanies the description of the case.

Experimental preparation of deantigenized vascular heterografts and study of tolerance after transplantation.

A new technique in preparing a heterograft is presented. Deantigenized calf carotid arteries are obtained by papain digestion and formol tanning. The biochemical determinations show a pronounced reduction in total protein content after papain digestion. The formol tanning gives a good rigidity and elasticity in adapting to different blood volumes without aneurysmal dilatation. Eight dogs were grafted : two died after surgery, two were killed after 35 days and two others 60 days after transplantation, one died after 8 months and one is alive 30 months after transplantation. The good in vivo tolerability has been appreciated. There have been no haemodynamic troubles and no cell changes of rejection. An insignificant quantity of immunoglobulins G has been found in the sera of the animals with heterografts. These data draw attention on the possibility of the use, in clinical practice, of the deantigenized calf arteries.

Room air ventilation for total intravenous general anaesthesia.

The use of room air alone to ventilate patients who were anaesthetized with total intravenous anaesthesia, including morphine 2 mg.kg-1, was studied in ten patients. The were scheduled for gastrectomy for peptic ulcer or stomach carcinoma. The patient's minute-ventilation was measured the day previous to surgery; this, together with a frequency of 14 c.min-1, was used to preset the ventilator. Alveolar ventilation, end-expiratory CO2, arterial blood gases and acid-base balance were monitored throughout the procedure. The blood oxygen level was found to remain similar to the reference value; there was a moderate hypocapnia, a low end-expiratory CO2 and minimal changes in acid-base balance. No pulmonary complication was encountered in the postoperative course. These results showed that room air could be used in unusual circumstances for healthy patients for whom a total intravenous anaesthetic technique has been chosen.

[Unusual accidents in anesthesia practice]. / Accidente rare în practica de anestezie.

The extension of major manoeuvres in the practice of anesthesy and of intensive care lead to an increase in the frequency of iatrogenic accidents:--oesophageal perforation when a Porges type tube; --left oeso-pleural fistula following postoperative gastric aspiration;--direct trauma to the oesphagus occuring during tracheostomy.

Pancuronium requirements. With special reference to serum protein pattern.

Requirements of pancruonium were evaluated in 50 adult patients undergoing abdominal surgery in halothane anaesthesia. A significant negative correlation was found between gamma-globulin and the apnoeic dose of pancuronium (r = --0.335, P less than 0.02), on the one hand, and the apnoeic period after it (r = --0.311, P less than 0.05), on the other hand. beta-Globulin displayed a significant positive correlation with the apnoeic period after pancuronium (r = 0.344, P less than 0.02). The heavier patients necessitated less drug/kg bw. to obtain apnoea than the leaner ones did. Finally, the females showed a higher sensitivity to pancuronium in comparison to the males.

[Massive histamine liberation. Recovery]. / Eliberarea masiva de histamina. Recuperare.

The case of a patient is described, in whom the clinical aspect of massive liberation of histamine occured during general anesthesia, including bronchospasm, hypotension, generalized congestion of the skin. The changes could be reversed and the surgical intervention was continued. The course of the operation made necessary a prolongation of anesthesia, and re-administration of all the substances which had been included in the procedure. However, the following administration of these substances was not followed by a new liberation of histamine. Short comments are made in connection with the theoretical aspects of this evolution.

[Changes in the iridic circulation during shock treated with phenoxybenzamine (experimental and clinical)]. / Modificarile circulatiei iriene în cursul socului tratat cu fenoxibenzamina (experimental si clinic)

Irian circulation was studied in the course of shock and following injection of phenoxybenzamine. It is concluded that the drug induces an improvement of the irian vasculature, an increase in the number of open vessels and an increase in their diameter.

[Practical aspects of the treatment of Darrow's syndrome]. / Aspecte practice in tratamentul sindromului Darrow.

An analysis is made of a group of 30 patients who, in the course of the evolution of their basic disease,have also presented, at a certain time, lowered potassium concentrations in the blood and metabolic alkalosis. As etiological factors the frequency is stressed, of conditions in the course of which stasis gastric juice is lost, the chronical lack of potassium import, as well as corticoid therapy. Special attention is given to circumstances imposed by oedema of the anastomosis opening. Interpretation and monitoring of the treatment were carried out on the basis of sophisticated, as well as current laboratory methods, but the importance of the clinical signs is stressed, when a well-equiped laboratory department is not available.

[Extra-arachnoid subdural injection, an accident of peridural anesthesia]. / Injectarea subdurala extraarahnoidiana, accident de peridurala.

Two cases are presented, with accidents of peridural anesthesia, Anesthesia of the entire brain stem, paralysis of the intercostal muscles, and of the upper limbs, apnoea and miosis that developed later indicate an extension of the anesthetic effects far higher that it could have been expected considering the technical details of the procedure. On the other hand the absence of any durable coma, of extreme mydriasis, and of severe arterial hypotension, as well as the relatively rapid retrocession of the additional effects of the administration of an anesthetic exclude the possibility of total rachianesthesia, and it can be concluded that there was an accidental injection of anesthetic in the extra-arachnoid subdural space.

Inhibitory effect of disodium edetate on gastric secretion.

Disodium edetate (ethylenediaminetetraacetic acid, disodium salt; disodic EDTA), 3 g, was given, via an intravenous normal saline drip of 30 min, to 25 patients in order to assess a benefit for anaesthesia practice. A significant reduction of both volume and acidity of the gastric secretion was found in all the 10 patients with peptic ulcer having received the drug. The peak of the change was 1 h after administration. In other 10 non-ulcer patients undergoing orthopaedic surgeries under epidural anaesthesia with lidocaine 2%, 5 mg kg-1, pH of the gastric juice unanimously rose, from 2.24 +/- 0.28 to 4.10 +/- 0.21 1 h after EDTA with a P derived from paired difference analysis of less than 0.001. A similar group of patients receiving only normal saline showed no important changes in pH (from 2.37 +/- 0.24 to 2.34 +/- 0.19). The pH of the fundic surface, measured directly under fiberscopic control in further 5 patients suffering from peptic ulcer, was found also to rise from 1.84 +/- 0.21 to 4.62 +/- 0.34 1 h after EDTA, P less than 0.001. Total and ionized calcium changed unsignificantly. Disodic EDTA in the dose and manner used in this study showed no clinical side-effects. The constant and obvious effect of inhibition of the gastric secretion as well as the dynamics of such an action recommend disodic EDTA to be tried in reducing the aspiration pneumonia morbidity.

[Influence of extracorporeal circulation on renal function]. / Influenta circulatiei extracorporale asupra functiei renale.

The renal function was investigated comparatively in two lots of patients with cardiovascular diseases that had been operated with and without extra-corporeal circulation. It was shown that extra-corporeal perfusion alters the renal function in an increased number of cases (28% against 17.75%). Other parenchymatous tissues have also been involved, such as the liver and the pancreas. The humoral parameters and the clinical data are discussed, which demonstrate the organic involvement following such interventions. The good results obtained stress the necessity of an energetic treatment, which should include early dialysis.

[Muscular clearance after administration of phenoxybenzamine in shock]. / Clearance-ul muscular dupa administrarea de fenoxibenzamina în soc

The authors made an experimental investigation in the dog concerning the evolution of the muscular clearance of phenoxybenzamine in the course of de-shocking procedures. The animals were shocked by hemorrhage and were treated by perfusion of volemic mass and administration of phenoxybenzamine. This substance was flowed in paralell with the hemodynamic parameters and the rhythm of the diuresis. It was noted that the direction and the amplitude of changes concerning the half-life of Na131I do not depend on the blood pressure.

[Involvement of the thyroid gland in clinical shock (anti-shock action of propylthiouracil)]. / Implicatiile tiroidei în socul clinic (actiunea antisoc a propiltiouracilului)

Propylthyouracil, a synthetic anti-thyroid drug, was given intravenously in ten patients in a severe shock condition and its action was followed on the blood cathecholamines. This was assessed in venous blood according to a modified colorimetric method by Manuhin, before and 30 minutes after the substance was perfused. Although statistically non-significantly the two amines show a tendency to fall after the administration of the drug. In line with a series of previous studies carried out in various institutes of chemical and pharmaceutical research the drug was given for the first time in humans in shock conditions. Discussing the results obtained the administration of propylthyouracil is recommended, as an adjuvant therapy in severe shock.

[Serum acetylcholinesterase changes after pancuronium administration]. / Modificarile acetilcolinesterazei serice dupa pancuronium

The acetylcholinesterase activity was followed, as a variant of true cholinesterase, in three groups on non-selected patients: 10 of these were under local anesthesia with lidocaine, 12 were under general anesthesia with thiopenthal and halotane and 43 were under the same type of general anesthesia, that had also been given Pancuronium as a muscle relaxant. A slight inhibition was noted of the enzyme activities in the course of local anesthesia and a more significant one in the course of general anesthesia. The enzyme concentrations were lower in those patients that had also received Pancuronium, suggesting a cummulative inhibitory effect on serum acetylcholinesterase. The changes were not significant from the statistical viewpoint.

Effect of aspirin in coronary artery bypass grafting.

OBJECTIVES: To evaluate the effect of aspirin (ASA) therapy on postoperative blood loss, transfusion requirements, reoperation for bleeding, duration of stay in the intensive care unit and in the hospital in a selected population undergoing a first coronary artery bypass grafting (CABG) surgery. DESIGN: Prospective observational study in consecutive patients during a 3-month period. SETTING: A teaching cardiothoracic center. PARTICIPANTS: Two hundred forty consecutive patients undergoing elective coronary artery bypass grafting surgery for the first time. INTERVENTIONS: Two hundred forty consecutive patients admitted for a first CABG the day before surgery were visited. patients with an abnormal routine coagulation screen or taking drugs that might have affected their coagulation mechanisms were prospectively excluded (n = 96). The date of the last dose of ASA was recorded in the 144 remaining patients, and data were acquired prospectively. MEASUREMENTS AND MAIN RESULTS: Total mediastinal blood drainage, blood products usage, reopening, and duration of intensive care unit and hospital stay were recorded. Patients were grouped by days free of ASA. There were no significant differences detected between groups. CONCLUSIONS: In patients undergoing a first CABG and with no known factors affecting their coagulation, ASA therapy did not appear to increase blood loss, reopening for bleeding, or blood products usage requirements during the hospital stay. ASA therapy did not influence the duration of stay in intensive care or in the hospital.