General anaesthesia in the early stages of pregnancy may carry an increased risk of embryotoxicity. One hundred and six women scheduled for non-emerency surgery were interviewed preoperatively and their menstrual history taken. Forty-three (41 per cent) were considered to be using adequate contraceptive therapy. Thirty-one (29 per cent) of the patients could have been in the early stages of pregnancy, and of these women, 19 (61 per cent) were undergoing surgery of a minor nature. Simple history taking identified the women 'at risk' and it is suggested that surgery could have been delayed without detriment in many cases.

Abnormalities, Drug-Induced↗

PubMed1975

Althesin and pancuronium in chronic liver disease.

In 32 patients with chronic liver disease, undergoing major abdominal surgery, anaesthesia was induced with either Althesin (alphaxalone and alphadolone acetate) or thiopentone, and maintained with nitrous oxide, oxygen and increments of either pethidine or fentanyl. The patients were ventilated artificially to maintain PaCO, values in the normal range. Pancuronium bromide was used as the muscle relaxant. Liver function tests at 24 hr and 5 day after surgery showed only minor changes compared with findings before operation. There was no significant difference between the Althesin and thiopentone groups. In two patients with severe obstructive jaundice there was difficulty in reversing the effects of pancuronium, but "pancuronium resistance" was observed in all patients. It is concluded that the anaesthetic sequence described, with either Althesin or thiopentone induction, is satisfactory with respect to changes in liver function in patients with chronic liver disease undergoing major surgery.

Adolescent↗

PubMed1975

Cardiovascular changes in labour associated with extradural analgesia using bupivacaine.

Cardiovascular changes were monitored continuously in 13 women during stimulated labour conducted under extradural analgesia with bupivacaine. Three solutions of bupivacaine (0.5% plain, 0.25% with adrenaline and 0.5% with adrenaline) were administered in a random fashion. The results show that the plain solution of bupivacaine was associated with a decrease in central venous pressure and an increase in maternal heart rate which approached statistical significance 40-45 min after administration. These changes did not occur when solutions containing adrenaline were used. The small number of patients and the random administration of the bupivacaine solutions make it difficult to establish the exact significance of the cardiovascular changes observed and a further within-patient study is required.

Adolescent↗

PubMed1975

Cardiovascular effects of extradural analgesia in labour: comparison of bupivacaine with lignocaine.

Two groups of patients who requested extradural analgesia were studied in a within-patient controlled trial and received either 0.5% bupivacaine with adrenaline 5 mug/ml or 0.5% bupivacaine plain as the analgesic agent (first group) or 0.5% bupivacaine or 2% lignocaine both with adrenaline 5 mug/ml (second group). Arterial pressure, central venous pressure (CVP), maternal and foetal heart rate and uterine contractions were monitored continuously. There was no significant difference in any of the cardiovascular measurements when solutions of 0.5% bupivacaine (with or without adrenaline 5 mug/ml) were used. The second group had a statistically significant increase in CVP during the study period in which 2% lignocaine was used. The position of the patient did not affect the cardiovascular measurements in either group. Since the addition of adrenaline 5 mug/ml to bupivacaine solutions did not confer any apparent advantages, it is concluded that plain solutions of 0.5% bupivacaine should be used except in the longest labours.

Anesthesia, Epidural↗

PubMed1975

Organ perfusion during controlled hypotension.

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Blood Pressure↗

PubMed1975

Assessment of the Von Recklinghausen oscillotonometer.

The Von Recklinghausen Scala Alternans Altera oscillotonometer was assessed in order to establish whether any of the disputed points over its use made a significant difference to the readings obtained. Inversion of a new cuff gave significantly higher systolic readings, but a worn cuff gave consistent results whatever its position. Measurements of systolic and diastolic pressures were not significantly affected by the use of the sustained leak lever provided the leak was small. Maintenance and cleaning of the instrument are essential for its proper working.

Air Pressure↗

PubMed1975