DDAVP and open heart surgery.
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Biomedical subjects
Publications and source records attributed to P M Spargo.
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Cross clamping of the descending thoracic aorta is performed in this hospital for graft replacement of suprarenal aneurysms or during endarterectomy for extensive aortic occlusive disease. The anaesthetic management of nine patients is described and the surgical results are presented. Proximal aortic clamping and declamping lead to profound haemodynamic changes. Myocardial infarction, ventricular failure and even death may result. Renal preservation during clamping and massive blood transfusion are also problems of this surgical approach. The measures taken to ameliorate the consequences of proximal aortic clamping are discussed in detail.
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Twenty-four mongrel dogs were anaesthetized with pentobarbitone and morphine sulphate. Neuromuscular blockade was achieved using pancuronium. Spinal cord blood flow was measured using the radionuclide microsphere and hydrogen washout methods before, during, and following nitroglycerine-induced hypotension. Heart rate, mean arterial pressure, cardiac output, pulmonary capillary wedge pressure, and acid-base balance were determined with each measurement. Mean arterial pressure was reduced by 50%. Spinal cord blood flow, as measured by the microsphere method, increased during the period of hypotension, whereas values obtained using the hydrogen washout method were not significantly different from those at normotension. No significant change in spinal cord blood flow was detected by either method after the application of spinal distraction. Nitroglycerine acts predominantly on venous capacitance vessels and it is postulated that perfusion pressure, and therefore flow, is maintained despite a reduction in arterial pressure.
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A study of the effects of sedation on arterial blood gases in patients undergoing cerebral angiography was performed. Twenty-one patients received pentazocine (30 mg) and midazolam (5-22.5 mg) and arterial carbon dioxide and oxygen tensions were measured from radial artery samples before and during the procedure. A statistically significant rise in arterial carbon dioxide tension was demonstrated. It is suggested that this may cause a rise in intracranial pressure by increasing cerebral blood flow in a group of patients in whom there is a high incidence of raised intracranial pressure. The clinical significance of this increase in arterial carbon dioxide tension is discussed.