Bilateral tension pneumothorax associated with mediastinoscopy.
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Biomedical subjects
Publications and source records attributed to L J Saidman.
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The deliberate reduction of blood pressure in an attempt to reduce intraoperative blood loss has generated significant controversy in the 30 years since its clinical introduction. Numerous series have been reported, but few have met generally accepted, current criteria for controlled studies. In this article, the effect of blood pressure reduction on organ perfusion will be presented together with a review of techniques of achieving hypotension. A summary of results is included and, based on this data, recommendations are offered regarding the application and limits of deliberate hypotension.
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A difference between potassium concentrations in arterial plasma and venous serum was evaluated. The difference was 0.5 mM/litre, with a range of 0.1 to 1.1 mM/liter. Multiple factors operating primarily upon the venous sample are responsible for this difference. The value for arterial plasma potassium is stable and preferable, but a revised normal for arterial plasma K+ is necessary.
Time-compressed Fourier analysis of the electroencephalogram has proven to be a useful analytical procedure during anesthesia and surgery which simplifies data interpretation by presenting the EEG in a time-compressed frequency domain rather than the conventional time domain. This method of data analysis graphically accentuates the electroencephalographic correlates of ischemia-induced cerebral dysfunction and other cerebral oxygen consumption abnormalities. The ability to accentuate trends in frequency and power is derived from sequential plotting of spectra to produce a graph with three dimensional axes of frequency, time, and power. In carotid endarterectomies the system has proven more useful than the conventional EEG in assessing the need for a vascular shunt to maintain internal carotid flow during endarterectomy. In open-heart surgery time-compressed EEG spectral analysis has allowed early recognition of cerebral ischemia resulting from arterial hypotension and venous hypertension. Five cases are presented which demonstrate the ability of our system to reflect developing cerebral ischemia.
Arterial blood-gas changes were studied in 21 healthy women undergoing laparoscopic sterilization with local anesthesia and supplemental IV sedation, employing CO2 as the inflating gas. No significant hypercarbia was noted. Two patients became transiently apneic following IV medication and 2 became extremely agitated during the procedure. This constituted a major nonsurgical complication rate of 19 percent. Safety requirements for patients undergoing this procedure is suggested.
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