Biomedical subjects
Publications and source records attributed to C Constantinescu.
In 49.84% of the cases of duodenal ulcer operated in the clinic, the authors were confronted with one of the dangerous complications of this disease--the ulcerous penetration. This experience permitted to differentiate the surgical act according to the evolutive degree of this complication and to its morphological character. The literature related to this problem is reviewed.
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We report 250 rapid induction anesthesias performed for the purpose of preventing regurgitation and vomiting in patients with full stomach. The anesthetic technique includes administration of morphine 20 mg and droperidol 5 mg intravenously 10-15 minutes before induction, a voluntary air hyperventilation at the anesthetist's command, during which induction drugs are introduced and an induction with a mixture containing suxamethonium 2 mg/kg and thiopentone 1.4 mg/kg, administered within 1-2 seconds. Eighteen seconds after the onset of injection the loss of lid reflex is observed followed 7 seconds later by masseter muscle relaxation. Within the following 5-10 seconds intubation is carried out in full fasciculation process, before cardia relaxation. With this technique, a mean intubation time of 35 seconds is achieved. The interval of maximum regurgitation risk is lowered to 15 seconds, so that ventilation by mask and cricoid pressure are no more necessary. The technique is indicated in the young and vigorous adult and contraindicated in the old and tainted patient, in coronary patients, in those with low heart output and slowing of circulation.
The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.
The pulmonary complications in a group of more than 20 000 surgical patients between 1971 and 1980 were examined, as well as the pulmonary state of 100 surgical patients who died within 10 days of operation. The factors related to the patient's constitutions, nature of the surgical disease, operation and anaesthesia. Equal and homogeneous groups were considered in respect of each factor which were analyzed retrospectively from 1980 to 1971. The mean frequency of pulmonary complications in the Department of General Surgery was 12%. The main risk factors of pulmonary complications were: the duration beyond 4 h of the operation (59%), age over 70 years (48%), obesity (35%). They were followed in decreasing order by sepsis, hypovolemia and particular sites of operation. Severe pulmonary complications, bronchopneumonia, pneumonia and thromboembolism contribute to mortality.
The authors present their experience about spinal anesthesia with pethidine as the sole medication. 713 patients whose mean age was 56.5 years received 1 mg . kg-1 of pethidine in 50 p. 100 aqueous solution administered by subarachnoid route. Indications were surgical procedures involving upper and lower abdomen, perineum and lower limbs. The set up of anesthesia is quite similar to those obtained with local anesthetics. Sensitivity disappears during the first three minutes in the area below the puncture site and in the following two or three minutes areflexia and paralysis is noted. The duration of the motor and sensory block is 90 to 120 minutes. Recovery appears to be in a reverse order. Spinal anaesthesia with pethidine exhibit the following characteristics: --sensory and motor blockade with minimal adverse reactions giving good and very good results in more than 90 per cent of cases, when involving perineum and lower limbs; --the most frequent adverse effect is a syndrome including hypotension, bradycardia and hypoxemia, appearing 20 to 30 minutes after injection, reversal is easily obtained by administration of pressure drugs and artificial ventilation. Neither delayed respiratory depression nor neurologic damage were noted; --a long lasting post-operative analgesia. In conclusion, this work demonstrates that: --1 mg . kg-1 of pethidine administered by subdural route realize a complete spinal anesthesia including motor, sensory and sympathetic blockade allowing surgical procedures in good conditions of security; --increasing the dosage of pethidine over 1 mg . kg-1 is not wise in order to avoid the occurrence of adverse side effects such as hypotension, bradycardia and bradypnaea; --this technic is only indicated for surgery in perineum and lower limbs.
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