The effect of propanidid on systemic vascular resistance in man.

We have studied the peripheral vascular effect in man of propanidid 6 mg/kg, administered as a bolus injection during cardiopulmonary by-pass with the aorta cross-clamped and at constant perfusion flow. Ten measurements in eight patients were performed. A decrease was found in systemic vascular resistance: from 150.7 +/- 16.3 to 99.5 +/- 10.1 kPa x s/1. No venous pooling occurred. It is concluded that, in man, propanidid causes a vasodilation which must contribute to the hypotension it causes.

Percutaneous catheterization of the internal jugular vein.

Two techniques for catheterization of the internal jugular vein are described in detail. In a group of 108 adults and 54 children, catheterization of the internal jugular vein was attempted 168 times. Failure to achieve catheterization occurred 12 times. The success rate for the first 50 patients was 86%, but it increased with experience, and was nearly 96% for the remaining patients. Almost 90% of catherizations were achieved on the first or second attempt. The success rate was understandably lower in the children's group. Catheter malpositioning occurred infrequently (six times) and was most common in the children's group. There were few complications, although two were of a serious nature. The techniques described are straightforward, easy to master and perform, and are recommended as useful additions to the anaesthetist's clinical armamentarium.

The cardiovascular effects of pancuronium during halothane and cyclopropane anaesthesia.

The effect of pancuronium 0.1 mg/kg i.v. on heart rate (HR) and mean arterial blood pressure were investigated in two groups of eight patients, each receiving inhalational anaesthesia with either halothane or cyclopropane. A more pronounced effect on HR in the cyclopropane group with a mean increase of 104% occurred. The mean increase in the halothane group was 54%. There was a statistically significant difference (P less than 0.05) between the HR increases The vagolytic effect of pancuronium and the influence of halothane and cyclopropane on the autonomic nervous system are discussed.

The cardiovascular effects of ketamine used for induction of anaesthesia in patients with valvular heart disease.

The effects of induction of anaesthesia by ketamine 2 mg.kg-1 were studied in six patients with valvular heart disease before tracheal intubation and operation. Cardiac index was unaffected because a mean decrease in stroke index was compensated for a mean increase in heart rate. A significant increase was found in mean arterial pressure, pulmonary arterial mean pressure, pulmonary capillary wedge pressure and central venous pressure. Systemic vascular resistance increased, but not significantly, whereas pulmonary vascular resistance increased significantly by more than 150 per cent. Right ventricular minute work index increased in all patients, and the increase was as much as 400 per cent. Left ventricular minute work index increased in four of the six patients, but the magnitude of the increase was not so marked. It is therefore concluded that ketamine causes pronounced pulmonary vasoconstriction and an undesirable strain on the myocardium. Such effects could prove deleterious in patients with limited functional reserve of the right ventricle.

Cardiovascular haemodynamics after induction of anaesthesia with althesin in patients with valvular heart disease.

The haemodynamic effects of the induction of anaesthesia with Althesin 0.1 ml.kg-1 were studied in eight patients with valvular heart disease before tracheal intubation and surgery. A 20 per cent reduction in stroke index was compensated for by an increase in heart rate of similar magnitude. Cardiac index, mean arterial, pulmonary arterial, central venous and pulmonary capillary wedge pressures and systemic vascular resistance were unaffected. Pulmonary vascular resistance declined by nearly 30 per cent. It is therefore conclude that Althesin causes only minimal cardiovascular depression in patients with valvular heart disease.

The use of epidural analgesia for delivery in a patient with pulmonary hypertension.

In a patients with severe pulmonary hypertension, haemodynamic observations, including cardiac output and pressure measurement in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9 to L1 combined with bilateral pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100 g girl with an Apgar score of 9 at 1 min was delivered by vacuum extraction. The patient died 9 days after the delivery because of intractable cardiac failure.

Influence of morphine anaesthesia on the endocrine-metabolic response to open-heart surgery.

Twelve patients scheduled for aortic valve replacement during extracorporal circulation were randomly allocated to either morphine anaesthesia or fluroxene anaesthesia. Morphine in a total dose of 4 mg/kg was administered before skin incision. At the start of extracorporal circulation all patients received 25 g glucose intravascularly. The endocrine-metabolic response to surgery, as expressed by changes in plasma ACTH, cortisol, insulin, growth hormone, cyclic adenosine-3',-5'-monophosphate (cyclic AMP), glucose, free fatty acids, blood b-hydroxybutyrate and cumulative nitrogen balance was measured before and during anaesthesia and surgery, and on the first five post-operative days. It was found that morphine anaesthesia blocked the increase in ACTH, cortisol, growth hormone, cyclic AMP, and glucose during surgery. However, after initiation of extracorporal circulation only ACTH, cortisol, and, to a lesser degree, the glucose and insulin response to glucose were lowered by morphine anaesthesia. From the first to the fifth days after operation no differences between the two groups could be demonstrated in any parameter. Cumulative nitrogen balance was similar in the two groups. It is concluded that morphine in large doses administered before skin incision inhibits the initial endocrine-metabolic response to open-heart surgery, but that the effect is short-lasting and without effect on overall postoperative protein catabolism.