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Biomedical subjects

J Modig

Publications and source records attributed to J Modig.

89 records · Page 5Linked to original sources
PubMed1976

Respiration and circulation after total hip replacement surgery. A comparison between parenteral analgesics and continuous lumbar epidural block.

The cardiopulmonary effects of two different types of postoperative analgesic regimes were compared in 31 cardiorespiratorily healthy patients subjected to total hip replacement surgery. The investigation was performed preoperatively on the morning of the day of surgery and during the first 3 days postoperatively. All patients received continuous lumbar epidural analgesia preoperatively, during surgery and up to the end of the first measurement period, which started 2.5 h after surgery. Ten patients were subseuqently given pentazocine (Fortalgesic) intramuscularly on demand for pain relief throughout the investigation, while 14 patients received 0.4% plain lidocaine (Xylocain), and seven patients 0.4% lidocaine with adrenaline (1/400,000) as a continuous lumbar epidural drip for analgesia thorughout the investigation. It was confirmed that the operative procedure itself did not significantly influence the postoperative arterial oxygenation, while the type of postoperative analgesic regimen was of considerable importance in this respect. Thus, patients given pentazocine showed a significant increase in pulmonary venous admixture, due both to an increase in true shunt and to an increase in ventilation/perfusion disturbances. This pattern of poor pulmonary function still persisted on the third postoperatively. In patients given an epidural block no significant changes in pulmonary venous admixture were noted postoperatively, and thus there was no reduction in PaO2. All patients, irrespective of the type of analgesic regimen used, had a significantly increased cardiac index and oxygen uptake postoperatively, although patients given an epidural block showed a greater increase in cardiac index, and thus a tendency towards a more hyperkinetic circulation than those given pentazocine.

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PubMed1975

Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers.

Thirteen patients submitted to total hip replacement surgery by the Charnley technique were studied. Operations were performed under epidural analgesia with the patients awake and breathing air. During the surgical procedure, the magnitude of tissue-thromboplastic activity, the amount of fat globules, the presence of bone marrow cells and the concentrations of acrylic monomers were determined in the pulmonary arterial blood. Simultaneously, arterial blood gases and blood pressure were monitored. Marked reductions of the arterial blood pressure and arterial oxygen tension occurred after impaction of the femoral prosthesis, and minor depressions appeared after insertion of the acetabular prosthesis. A significant correlation was found between the release of tissue-thromboplastic products into the pulmonary circulation, i.e., products that initiate intravascular coagulation and the circulatory and respiratory reactions. The pulmonary fat droplets, per se, seem to be of minor importance, and the release of acrylic monomers is probably of no importance for these reactions.

Acrylates↗
PubMed1975

Pulmonary and circulatory reactions during total hip replacement surgery.

The pulmonary and circulatory reactions to insertion of the acetabular and of the femoral prosthesis were studied during total hip replacement surgery in 22 patients with osteoarthrosis. The patients were given lumbar epidural analgesia and were divided into two groups. One group of 15 awake patients breathed air spontaneously (group A). The other group of seven patinets received additional anaesthesia with controlled ventilation with air (group B). This permitted an evaluation of the influence of the ventilatory pattern on the pulmonary and circulatory reactions to the surgical events. The greatest alterations were observed following impaction of the femoral prosthesis. This event caused the following statistically significant changes in both groups: An increase in total pulmonary venous admixture (from a mean value of 6.8 to 12.2% in group A and from 8.2 to 10.5% in group B) and a decrease in arterial oxygen tension (group A: 80.3 to 71.5 mmHg; group B: 82.6 to 76.9 mmHg); an increase in pulmonary vascular resistance (group A: 122 to 155 dyn -s- cm-5; group B: 129 to 164 dyn -s- cm-5) and an increase in mean pulmonary arterial pressure (group A: 17.3 to 19.0 mmHg; group B: 21.8 to 24.4 mmHg). Furtheremore, within the first 2 min after impaction a distinct transient rise in mean pulmonary arterial pressure by 2-4 mmHg was noted in a few patients, and in many patients the mean systemic arterial pressure decreased by 5 mmHg or more. No significant changes were found in cardiac output, pulmonary capillary wedge pressure, oxygen uptake, mixed venous oxygen tension, acid-base values, ratio of total dead space to tidal volume, or total airway resistance. The above findings indicate a tendency to pulmonary vascular and peripheral airway constriction leading to transient ventilation/perfusion disturbances and a decrease in arterial oxygen tension, and peripheral vasodilatation leading to a transient decrease in systemic arterial pressure.

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PubMed1975

The use of 125I-labelled fibrinogen for determination of fibrin trapping in the lungs in patients developing the microembolism syndrome.

The microembolism syndrome occurred in four patients out of a series of 15 patients with multiple injuries who were considered to run a risk of developing this syndrome. These four patients showed signs of fibrin trapping in the lungs, as demonstrated by the use of 125I-labelled fibrinogen and external detection over the lungs. It is, therefore, considered that this method can be used for diagnosing the microembolism syndrome. The fibrin trapping occurred at the onset of the progressive respiratory insufficiency. The time relation between the uptake of fibrin and the onset of the progressive respiratory insufficiency supports the theory of a causal connection between fibrin and pulmonary damage. Measurements of different coagulation and fibrinolysis factors in the blood were not able to discriminate between patients who developed the microembolism syndrome and those who did not.

Adolescent↗
PubMed1975

The role of regional block versus parenteral analgesics in patient management with special emphasis on the treatment of postoperative pain.

Based upon a series of clinico-physiological investigations, the usefulness of regional anaesthetic techniques such as extradural, intercostal and splanchnic blocks are stressed. Main emphasis is put on the relief of postoperative pain after some common types of operations such as prostatectomies, total hip replacements and cholecystectomies. Compared with parenteral analgesics, regional anaesthetic techniques offer several advantages such as a more favourable situation of oxygen transport and a more effective treatment of pain without depressing the sensorium.

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PubMedDate not supplied

Effects of graded infusions of monomethylmethacrylate on coagulation, blood lipids, respiration and circulation. An experimental study in dogs.

In 4 dogs injected intravenously (i.v.) with 125I labeled fibrinogen, 51Cr labeled platelets and 99mTc labeled albumin, and subjected to successively increasing amounts of i.v. infused monomethylmethacrylate, doses corresponding to the amounts released into the blood stream following implantation of acrylic cement during total hip replacements did not affect the clotting mechanism, did not cause trapping of platelets and fibrin in the lungs, did not generate fat emboli, and did not cause depression of the arterial oxygen tension or blood pressure. Monomethylmethacrylate in whole blood was associated with both blood cells and plasma.

Animals↗
PubMedDate not supplied

Early recognition and treatment of post-traumatic pulmonary microembolism.

There is a special form of pulmonary dysfunction which most often occurs following massive tissue damage, such as major fractures accompanied by hypovolemia. This syndrome may be appropriately called post-traumatic pulmonary microembolism to distinguish it from other causes of respiratory failure. We believe that pathophysiology is initiated at the time of trauma and consists of platelet aggregation and fibrin deposition in the pulmonary microcirculation caused by release of tissue-thromboplastin products. Whether this acute traumatic pulmonary microembolism will progress to a fully developed post-traumatic pulmonary microembolism with respiratory symptoms depends upon the magnitude and duration of tissue-thromboplastin release and the efficiency of the fibrinolytic system to clear the lungs. The early microembolic effects on the lungs consist mainly of ventilatory derangements with a low ventilation/perfusion ratio; not until a later stage does true shunting of mixed venous blood across fluid-filled alveoli and small airways occur. Frequently determinations of Pao2 and AaDO2 during air breathing ("air-test") to reveal a low ventilation/perfusion ratio is, therefore, preferable to true shunt determinations in patients who may develop this syndrome; caution must be exercised in giving room air to critically ill patients. These ventilatory variables, combined with frequent platelet counts, allow early recognition of post-traumatic pulmonary microembolism.

Adult↗
PubMedDate not supplied

Determinants of early adult respiratory distress syndrome with special reference to chest radiography. A retrospective analysis of 220 patients with major skeletal injuries.

The medical records of 220 consecutive patients with traumatic injuries admitted to the intensive care unit in the years 1974-1982 were scrutinised in an attempt to find radiographic signs and clinical determinants of early adult respiratory distress syndrome (ARDS). All patients included in this study were considered to run a risk of developing ARDS and had 'pure' major fractures in the sense that there were no accompanying severe brain, chest or abdominal injuries. There were no deaths in this series of patients. ARDS developed in 27 patients (12.3%), on an average on the second day of trauma. Chest radiographs of 21 of these patients showed features indicative of ARDS, whereas those of the other 6 patients were normal despite hypoxaemia. In most of the 27 patients the only radiographic manifestation of ARDS was interstitial oedema; only a minority presented with alveolar oedema in addition. In 6 patients no radiographic changes ever occurred. Ventilator treatment with positive end expiratory pressure may have prevented the pulmonary insufficiency from becoming radiographically manifest. The clinical determinants of post-traumatic ARDS were a high fracture index, based on the number and severity of fractures, implying severe trauma, and shock on admission. Fluid overload was not found to be the cause of ARDS.

Adolescent↗
PubMedDate not supplied

Videodensitometry and chest radiography in the evaluation of pulmonary blood flow and pulmonary oedema in a porcine model of early adult respiratory distress syndrome.

The adult respiratory distress syndrome was induced in pigs (n = 11) by a continuous infusion of E. coli endotoxin in order to evaluate the use of radiographic videodensitometry and chest radiography for assessment of pulmonary circulation and pulmonary oedema. A further aim was to determine the effect of an ionic contrast medium, Urografin 60%, on extravascular lung water (EVLW). The infusion resulted in a decline in arterial oxygen tension. Mean pulmonary arterial pressure increased, and cardiac output decreased, resulting in a marked rise in pulmonary vascular resistance. EVLW increased moderately. The corresponding variables in control animals (saline infusion; n = 5) changed very little. Good correlations were found (r = 0.87-1.0) between absolute flows as measured by the thermodilution technique and relative flows as determined by videodensitometry in animals with pulmonary damage. In the endotoxin group there was a significant correlation (r = 0.75) between the change in EVLW from baseline to the final measurement (at 6 hours) and the corresponding change in radiographic density. Radiographic signs of pulmonary damage were sparse. Only 3 of 11 animals displayed increased radiographic density of the lung parenchyma indicative of pulmonary oedema. Pleural effusion developed in 4 animals. Injection of Urografin 60%, 1 ml X kg-1, caused a slight but significant decrease in EVLW. We propose that at this concentration and dosage the contrast medium acts mainly as an osmotic diuretic.

Absorptiometry, Photon↗
PubMedDate not supplied

Cardiac risk in abdominal aortic surgery.

Seventy-eight patients were included in a prospective study of the cardiac risk in abdominal aortic surgery. The Goldman risk score and the American Society of Anesthesiologists (ASA) classification system were applied besides several individual clinical risk factors. Thirty-three patients developed some kind of cardiac event, 13 of which were myocardial infarctions leading to death in six patients. Computer aided stepwise logistic procedure was used to determine risk factors independently correlated with these complications. This study showed that the Goldman risk score, angina, hypertension and renal insufficiency were significantly correlated with postoperative cardiac complications while no correlations were demonstrated with history of myocardial infarction, chronic heart failure or the ASA score system. A high incidence of cardiac complications (32%) was also found in the low-risk category in the Goldman score system, which indicates the need for cardiac function tests before abdominal aortic surgery.

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