Monitoring pulmonary artery pressures in critically ill patients.

A flow-directed Swan-Ganz catheter was used for the catheterisation of the pulmonary artery in critically ill patients. The monitoring of pulmonary artery pressures provided reliable information regarding left ventricular function and pulmonary vascular resistance. Moreover, the pulmonary artery catheter can be used for mixed venous blood sampling. Experiences with pulmonary pressure monitoring for the assessment of left ventricular performance in patients with myocardial infarction and left ventricular failure, for the estimation of lung function in patients with respiratory failure and for the selection of the optimal level of positive end-expiratory ventilation are presented. The advantages of pulmonary artery pressure monitoring for the assessment of the circulatory and respiratory status of critically ill patients are stressed, and technical problems and complications are discussed.

[A study on the action of naloxone (author's transl)]. / Eigene Untersuchungen zur Wirkung von Naloxon.

The action of naloxone was evaluated in two separate investigations. In the first study the action of naloxone, nalorphine and placebo was compared in 5 healthy volunteers using a double-blind, cross-over trial. After the administration of nalorphine changes in psychical state and respiratory depression were observed in all subjects, whereas naloxone caused no changes even after very high doses. It is concluded, that naloxone has no agonism or intrinsic narcotic activity as opposed to nalorphine. In the second investigation, the efficacy of naloxone in antagonising large doses of fentanyl was evaluated in 25 surgical patients. The administration of naloxone caused a significant increase of respiratory rate and minute volume, a decrease of arteriell pCO2 and an increase of pO2. The results obtained confirmed that naloxone has a fast and potent anti-narcotic action.

[Acute pulmonary edema at the intensive care unit]. / Das akute Lungenödem auf der Intensivstation.

760 patients suffering from acute pulmonary oedema were treated between 1980 and 1986 at the Institute of Anaesthesiology of the Medical Academy in Wroclaw. The radiological image of the pulmonary oedema was sub-divided into three forms (hilar, hilar and perihilar, and hilar with massive plane-shaped infiltrates). In the treatment of acute pulmonary oedema in the intensive-care ward a thorough diagnostic programme is mandatory after the immediately necessary measures have been taken.

[The use of dopamin in shock and heart failure (author's transl)]. / Die Anwendung von Dopamin bei schock und Herzinsuffizienz.

The action of dopamine was evaluated in 18 patients with cardiogenic shock after myocardial infarction, in 14 patients with heart failure and in 18 patients with low-output syndrome after cardiac surgery. In the patients with shock, dopamine increased significantly systolic arterial blood pressure, myocardial contractility, diuresis and sodium excretion. In patients with heart failure a great increase in diuresis and sodium excretion with decrease of CVP was observed. In patients after cardiac surgery dopamine produced a significant increase of arterial blood pressure and diuresis with decrease of CVP. The clinical application of dopamine and the advantages of the use of dopamine combined with other catecholamines were discussed.

Changes in the phases of left ventricular contraction during induction of general anaesthesia.

By means of polycardiographic tracings the authors assessed the effects of althesin, ketamine and fentanyl on the dynamics of left ventricular contraction when these agents were applied for induction of anaesthesia. A depressing action of althesin was found while fentanyl and ketamine were without effect on the dynamics of left ventricular contraction. Polycardiographic tracings are a useful method for the assessment of the action of pharmacological agents on the cardiovascular system during operations.

Comparative study of the action of naloxone (Narcan) and nalorphine in man.

The comparative study of 2 narcotic antagonists, naloxone and nalorphine, was performed in healthy volunteers. The influence of these drugs on the respiratory and cicularoty systems and on the psychical state was compared. The study was carried out in a double-blind, cross-over manner. Increasing doses of naloxone and placebo or nalorphine and placebo, were administered intravenously. Naloxone, even in very high doses, caused no changes in cardivascular system, acid-base balance, sensitivity of respiratory centre to carbon dioxide and psychical state of volunteers. After the administration of nalorphine, even in very small doses, changes in psychical state in all examined subjects were observed. Nalorphine caused the significant change in the ventilatory response to CO2. Based on their results, the authors conclude that naloxone has no agonist or intrinsic narcotic activity, as opposed to nalorphine possessing strong narcotic action.

Cardiovascular effects of Althesin. Changes in systolic time intervals and peripheral tissue blood flow.

Systolic time intervals were studied and peripheral blood flow measurements made in twelve healthy patients before and after intravenous induction of anaesthesia with Althesin 0.05 ml per kg. The changes in systolic time intervals observed were considered to reflect the cardio-depressive properties of the drug. The reduction in peripheral blood flow which occurs in Althesin anaesthesia was confirmed. Measurement of systolic time intervals and peripheral blood flow constitute a simple and sensitive method for the evaluation of the effects of drugs on the cardiovascular system.