PubMed · 9867903
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J Watts. 1999. Rapid sequence induction.. https://doi.org/10.1016/s0196-0644(99)70434-8
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In reptiles the influence of local vascular factors on blood flow regulation is vaguely understood. The aim of this study was to investigate the role of nitric oxide (NO) on vascular function in anesthetized Trachemys scripta. The experimental protocol consisted of serial injections of sodium nitroprusside (SNP; 25 microg. kg(-1)), L-arginine (185 mg. kg(-1)) and L-NAME (50 mg. kg(-1)). SNP induced a systemic vasodilation (0.05 to 0.02 kPa. min. kg. mL(-1), P = 0.015), with no change in pulmonary vascular resistance (0.07 versus 0.08 kPa. min. kg. mL(-1), P > 0.05). L-Arg had no effect on resistances but increased cardiac output by 17%. L-NAME increased systemic resistance (33% increase; P = 0.01) while pulmonary resistance was unchanged. These effects are consistent with in vivo and in vitro studies on the systemic vasculature of different reptilian species, suggesting that NO has an important role in maintaining systemic vascular tone. The pulmonary vasculature did not respond to NO due to either a lack of an endogenous NO tone or a relaxed state of the pulmonary vasculature. The importance of NO-based mechanisms versus other neuro-humoral modulators in the reptilian circulation remains uncertain. However, as established in prior studies, cholinergic control of the proximal pulmonary artery is the main regulator of pulmonary resistance while systemic resistance depends on a more complex suite of neural, humoral and local effectors that include NO.
OBJECTIVE: To study the relationship between the indication for caesarean section (CS) and the need for resuscitation of the infant. DESIGN: Prospective cohort study. METHODS: During one year the following information was collected for each CS in a secondary teaching hospital (Isala klinieken/Weezenlanden Hospital), Zwolle, the Netherlands: indication for the CS, Apgar scores after 1 and 5 min and measures taken by the attending paediatrician at birth. These measures were divided into two groups: resuscitation (bag and mask ventilation or endotracheal intubation and ventilation) or no resuscitation (stimulation, supplemental oxygen, or no action at all). RESULTS: During the study year 202 CS were carried out. In the 50 CS carried out because of a narrow pelvis or a previous CS and in the 61 CS carried out for non-progressive labour there was little need for resuscitation of the newborn (4 and 3.3%, respectively), similar to resuscitation requirements after vaginal birth. The need for resuscitation of the newborn was significantly greater in the other indication groups, namely in 6/37 (16%) of cases of foetal malposition, in 3/10 (30%) of placental dysfunction, and in 11/44 (25%) of foetal distress. One infant had to be intubated directly after birth. The 1-minute Apgar score was lower in infants born after CS under general anaesthesia than under spinal anaesthesia (p = 0.002), regardless of the indication for the CS. CONCLUSION: Based on the indication for a CS, a paediatrician or physician experienced in neonatal resuscitation is required for a high-risk CS (foetal malposition, placental dysfunction, foetal distress, and general anaesthesia).
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