[Benefits of regional anesthesia. Anticoagulant treatment and regional anesthesia].
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Biomedical subjects
Publications and source records attributed to K Samii.
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1. The effects of a single oral dose (100 mg) of flosequinan on systemic and regional (forearm, splanchnic and renal) vascular responses to simulated orthostatic stress (lower body negative pressure, LBNP) were investigated in nine healthy male volunteers, in a double-blind, placebo-controlled crossover study. 2. Forty-five minutes after its administration and before LBNP, flosequinan induced a significant decrease in total peripheral and in forearm vascular resistances without any concomitant change in arterial pressure, in heart rate and in the investigated biological parameters (plasma catecholamines, arginine vasopressin and renin activity). 3. After flosequinan and placebo, LBNP induced similar decreases in central venous pressure at all levels of LBNP (-10, -20 and -40 mm Hg) and in pulse pressure at LBNP -40 mm Hg. LBNP-induced increase in forearm vascular resistance was significantly more marked after flosequinan than after placebo at all levels of LBNP, and this was also true for splanchnic vascular resistance but at LBNP -40 mm Hg only. However, inasmuch as the basal values of these two parameters before LBNP were lower after flosequinan than after placebo, their final values after LBNP -40 mm Hg were similar. Finally, LBNP-induced changes in renal vascular resistance, glomerular filtration rate and filtration fraction as well as in plasma catecholamines, arginine vasopressin and renin activity were similar after flosequinan and placebo at all levels of LBNP. 4. Flosequinan affected neither reflex control of heart rate (phenylephrine test) nor non-specific vasoconstrictor responses (cold pressor test). (ABSTRACT TRUNCATED AT 250 WORDS)
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Post-operative infection is often due to a combination of several factors. A decrease in immune defence processes represents the first factor. This is seen in situations such as malnutrition (undernourishment or obesity), alcoholism, diabetes, neoplasms, infections and old age. It may also be induced by therapy such as immunodepressants, antimitotic chemotherapy, corticosteroids and radiotherapy. Finally, certain antibiotics have been accused of reducing immune defences. The second factor responsible for infection is bacterial flora. Errors such as broad spectrum antibiotic therapy prescribed in the presence of unexplored fever, or changed repeatedly, are responsible for imbalance in the bacterial flora and the acquisition of resistance to antibiotics. These errors firstly increased the prevalence of infections and, secondly their severity and the difficulty of their treatment. The last factor responsible for infection is rupture of the natural barriers formed by the skin and mucosae. This is related on the one hand to surgery itself and, secondly, to the intensive care techniques surrounding the surgical act: venous catheterization above all, but also bladder catheterization, tracheal intubation, etc.
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Hemodynamic response to dopamine hydrochloride in septic shock with myocardial dysfunction was studied in ten patients with normal renal function (group 1) and in ten patients with acute renal failure (group 2). The control hemodynamic data were similar in the two groups. Dopamine in groups 1 and 2 induced significant (P less than .01) and similar increases in cardiac index and mean aortic pressure. Group 1 had a smaller increase in heart rate (+ 16%), than group 2 (+ 24%), but this difference was not significant. Stroke volume index had a significant increase in group 1 (+ 18%), whereas it did not increase significantly in group 2 (+ 4%); this difference of changes in stroke volume index between the two groups was significant (P less than .01). This phenomenon suggests an increased chronotropic effect and/or a reduced inotropic effect of dopamine in patients with septic shock and acute renal failure.
A study was performed in order to observe haemodynamic changes induced by haemodialysis in 14 patients with acute renal failure and severe sepsis. Left ventricular function, as assessed by changes in pulmonary wedge pressure and left ventricular stroke work index through plasma volume expansion, did not change during haemodialysis. Ultrafiltration-induced decreases in cardiac index provoked in 8 patients, with nearly normal initial systemic arteriolar resistance, had adequate and constant increase in their resistance (p less than 0.001), whereas 6 patients with low initial systemic arteriolar resistance did not increase their resistance and had a frequent (9/13 measurements) and significant (p less than 0.001) fall in mean aortic pressure. This abnormality of vascular tone is probably due to severe sepsis and explains why hypotension is a frequent occurrence during haemodialysis in such patients.
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To determine the reliability of central venous pressure (CVP) as a guide to fluid therapy during an operation, repeated and simultaneous CVP and pulmonary wedge pressure (PWP) measurements were made with a Swan-Ganz catheter in 13 relatively elderly patients without obvious cardiac or respiratory disease- Overall correlation between CVP and PWP was highly significant (P less than .001); there was, however, an important variation of the correlation for each patient. For values of CVP greater than or equal to 8 mm Hg, the correlation was not significant. The disparity between right and left ventricular filling pressures was confirmed by the relationship between serial changes in CVP and PWP. These data strongly suggest that in relatively elderly patients undergoing surgery without evidence of cardiac or respiratory disease, CVP may be misleading index for appreciating PWP.
1. A first sample of a cross-section of the Belgian population was studied. 2. The presence of hypertension or borderline hypertension was established on the basis of two examinations at 1-3 weeks intervals, during which the blood pressure was measured four times after 10 min rest. 3. The prevalence of both hypertension and borderline hypertension increased with age in the two sexes and, independently of age, with the relative weight. 4. The probable effect of arm circumference in overestimation of blood pressure in heavy subjects was analysed by multivariate correlations. It was concluded that if the influence of arm circumference is excluded, the effect of relative weight on blood pressure is less marked but still present.
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