Cerebral complications of induced hypotension.
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Biomedical subjects
Publications and source records attributed to G E Enderby.
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A patient with an intracardiac conduction defect characterised by first degree atrioventricular block due to slowed transmission through the atrioventricular node with increased refractoriness of the node, is described. Asymptomatic first degree block, rarely progressing to transient Wenckebach (type 1 second degree) block had been present for a period of 32 years until general anaesthesia was required, when profound bradycardia attributable to complete atrioventricular block developed abruptly. Subsequent investigations located delayed intracardiac conduction through the atrioventricular node, and indicated excess vagal activity rather than structural disease as the cause. The significance of first degree heart block is discussed in relation to other forms of atrioventricular conduction defect and the current recommendations for temporary pacing for elective general anaesthesia.
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The incidence of postoperative deep vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.
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