Preoperative timolol and ocular compression in cataract surgery.

The intraocular pressure (IOP) reducing effect of topical timolol with digital ocular compression for the prevention of vitreous loss in cataract surgery was compared with the effect of combined acetazolamide-mannitol pre-medication with digital compression. In the timolol group of 30 patients the mean IOP reduced from 11.4 mmHg before the compression to 8.2 mmHg after it. In the acetazolamide-mannitol group of 29 patients the mean IOPs were 10.9 and 5.6 mmHg, respectively. The reduction of IOP was statistically highly significant in both groups. There was no case of vitreous loss and the post-operative healing was uncomplicated in both groups of patients. The application of timolol was easy and time saving, but acetazolamide-mannitol pre-medication created deeper hypotony after ocular compression, which was probably due to the vitreous reducing effect of mannitol.

The levels of zinc, copper, calcium and magnesium in serum and urine after heart-valve replacement. Effects of oxygenator type and postoperative parenteral nutrition.

We studied the effects of mitral or aortic valve-replacement operations with cardiopulmonary bypass on the levels of zinc, copper, calcium, and magnesium in serum and urine in 23 patients. The specimens of blood and urine were taken preoperatively and on the second and fifth postoperative days. There were remarkable decreases in serum levels on the second postoperative day of all four bioelements in all patients compared to the preoperative levels. At the same time there were also clear decreases of calcium and magnesium in urinary excretions. The urine zinc and copper excretion showed no big variations during the three study periods. On the fifth postoperative day, serum magnesium levels increased in all patients in spite of increased urine excretion. Serum calcium levels decreased on the fifth day further and urine excretion increased again. Serum copper levels increased slightly on the fifth postoperative day compared to the second postoperative day. At the same time serum zinc concentrations increased only in the patients who had parenteral nutrition (approximately 40 kcal per kg of body weight per day) for 4 postoperative days. The effect on zinc levels was the only difference in parameters between patients given conventional fluid therapy with 5% glucose solution or parenteral nutrition with 30% glucose, amino acid, and fat emulsion regimen. There were no differences in the bioelements between patients perfused with bubble or membrane oxygenators.

Are changes in serum immunoglobulin and complement levels following open heart surgery influenced by oxygenator type or postoperative parenteral nutrition?

The serum IgG and IgA concentrations significantly decreased through the seventh day and the serum IgM and complement (C3 and C4) concentrations through the second day after elective open heart surgery for heart valve disease in a series of 16 patients. A significant increase over the preoperative concentration was seen, however, in the serum IgA, IgM, C3 and C4 on day 14 postoperatively. The serum IgG and IgM concentrations declined significantly only in patients perfused by a bubble oxygenator, although the two small series of patients perfused by bubble and membrane oxygenator did not differ significantly from each other. Parenteral nutrition had no effect on postoperative changes in serum immunoglobulin and complement concentrations.

Neurologic activity of infants following anesthesia for cesarean section.

Elective cesarean section was performed in a consecutive series of 30 patients with full-term pregnancies who were not in labor. Epidural (lidocaine, 1.5 per cent, with epinephrine, 1:200,000) and general anesthesia (thiopental, nitrous oxide-oxygen, succinylcholine infusion) was used alternately. Neonatal acid-base values and Apgar scores showed no significant difference between the two anesthetic groups, and most infants were vigorous at birth. The neurologic recoveries of the infants showed no significant difference between the two groups. In the group receiving epidural anesthesia, there was a significant correlation between maternal hypotension and weak rooting and sucking reflexes of the infants during the first two days. All infants of high-risk obstetric patients in the series, independent of anesthetic technique used, had abnormal neurologic activity, as evidenced by either depression of muscle tone and the reflexes or all the tested variables. Neurologic assessment as followed in this series is a sensitive indicator of the effects of fetal stress factors acting during cesarean section.

Segmental epidural analgesia and postpartum sequelae.

The incidence of the postpartum sequelae of headache, backache, pain in the legs and difficulties in micturiton, was studied in 219 normal vaginal deliveries. 135 of the parturients received continuous segmental epidural analgesia at the level of Th 10--12 for pain relief during the first stage of labour. The remaining 84 parturients served as controls. The results showed that segmental epidural analgesia did not increase the occurrence of postpartum sequelae either in primiparous or in multiparous parturients.

The effect of dipyridamole on the thrombocyte count and bleeding tendency in open-heart surgery.

The effect of dipyridamole (Persantine) on the thrombocyte count and bleeding tendency in connection with open-heart surgery and perfusion was studied in 22 patients. A control series of 21 patients undergoing open-heart surgery was available. The treatment group received dipyridamole, 0.5 mg. per kilogram of body weight, in the beginning of cardiopulmonary bypass into the heart-lung machine and thereafter 10 mg. intravenously three times daily for 2 days. From the third day dipyridamole was administered by mouth, 75 mg. three times a day, until the patient was discharged from hospital. We found that dipyridamole had the effect of maintaining the thrombocyte count during cardiopulmonary bypass and the first and second postoperative days. Thereafter no significant difference was seen between the dipyridamole and control groups. The use of dipyridamole did not increase the postoperative hemorrhagic tendency. There were no significant differences in per- and postoperative blood loss and in bleeding and activated partial thromboplastin times between the groups.

Selective lumbar epidural block in labour. A clinical analysis.

Segmental epidural analgesia (T10-T12) was performed in 418 parturients, using a 4-6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3-5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.

Peroperative arterial blood pressure control in ophthalmological anaesthesia.

The effects were studied of a standardised general anaesthesia on mean arterial blood pressure, central venous pressure, blood gas values and the course of cataract operations. The material consisted of 20 unselected senile cataract operations, the mean age of the patients being 71.3 years. The arterial blood pressure was continuously checked, using an intra-arterial cannula. In order to avoid vitreous loss, the blood pressure was successfully kept optimally low during the extraction of the lens. No vitreous problems were noted. The oxygenation and ventilation of the patients were sufficient during anaesthesia and immediately postoperatively.

Comparison of thiopentone versus althesin for caesarean section.

Thiopentone and Althesin were compared in 50 patients undergoing general anaesthesia for Caesarean section. The patients were divided into group A (24 mothers) were thiopentone (3.5 mg/kg) was used for induction and group B (26 mothers) where Althesin (80 mu1/kg) was employed. Blood samples for estimating the maternal and umbilical venous and arterial blood pH, pCO2, BD and pO2 were taken at the time of delivery. The clinical condition of the newborn were estimated by the Apgar score. Postoperatively the mothers were interviewed about thei subjective opinion concerning the anaesthesia. The interview showed equal acceptance of both induction agents. The umbilical venous and arterial pH, pCO2 and BD were well within the normal physiological range and there was no significant intergroup difference. The only significant differences were the lower umbilical venous and arterial pO2 values in the Althesin group. The clinical condition of the newborn (Apgar score) showed no significant difference between the two groups.