Biomedical subjects
Publications and source records attributed to J P Alexander.
Two hundred and four patients were monitored during oral surgery using three surface e.c.g. leads simultaneously. In nine patients, sustained supraventricular tachycardia was observed during surgical stimulation. The role of sympathetic stimulation and halothane anaesthesia in producing arrhythmia is discussed.
A prospective study on 227 patients undergoing arthroplasty of the hip was carried out with reference to the effects on the cardiovascular and respiratory systems. Investigations revealed that the placing of acrylic bone cement and the prosthesis in the femoral shaft produced clinical and biochemical disturbances which were consistent with pulmonary microembolism. A fall in arterial oxygen tension during the procedure and hypoxaemia extending into the postoperative period with elevation of serum lipase and a fall in triglycerides supported the idea that embolisation with marrow fat occurred. The method of venting (by catheter or proximal hole) did not influence the biochemical disturbances. The implications of these findings are discussed.
Experiences with the anaesthetic management of 248 patients undergoing total hip replacement are presented. Blood loss does not appear to be influenced by hypertension, the method of venting or the type of anaesthetic, with the exception of neurolept-analgesia. The importance of oxygen therapy in the treatment of the pulmonary embolic syndrome is stressed and the prevention of deep venous thrombosis is discussed. Mortality and morbidity figures are given.
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Cardiac rhythm was monitored in 219 patients who had ocular operations under general anaesthesia and in 15 patients who had cataract surgery under local analgesia. Of these, 140 were children having squint surgery. The high incidence of the oculo-cardiac reflex and the adequate protective effect of atropine 0-01 mg/kg given intravenously was confirmed. Isolated extrasystoles were common, particularly in older patients, and sustained ectopic cardiac arrhythmias were observed in 4-6 per cent of patients of all ages. The significance of these arrhythmias in relation to surgical stimulation and the anaesthetic drugs used is discussed.
Three cases of hypersensitivity to an anaesthetic induction with fazadinium and thiopentone are described. One reaction was fatal. Two patients had documented and the third presumptive previous exposure to thiopentone, and all had a history of allergy (skin rash) to penicillin. None of the patients had received fazadinium before. The possibility that fazadinium contributed to the severity of the reactions is conjectural.