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Biomedical subjects

L Fagraeus

Publications and source records attributed to L Fagraeus.

34 records · Page 2Linked to original sources
PubMed1982

The emerging role of epidural anesthesia in arteriography and in vascular operations.

Continuous epidural anesthesia offers special advantages for patients with vascular disease. In 193 patients who had this technique employed for aortofemoral arteriography, profound pain relief was provided and the accompanying vasodilation produced superior demonstration of collateral and small distal vessels. Eleven of these patients had epidural anesthesia for major vascular reconstruction operations. This caused minimal depression of pulmonary and myocardial performance during the procedure. Postoperative epidural analgesics improved the pulmonary performance by allowing normal pain-free breathing. No epidural complications were seen. Special precautions are described for the safe use of these techniques.

Analgesia↗
PubMed1981

Pulmonary mechanisms and work of breathing at maximal ventilation and raised air pressure.

Pulmonary ventilation (V) and the interrelationships of airflow, transpulmonary pressure, and lung volume during inspiration and expiration were studied in eight healthy subjects who performed maximal exercise (MEx; 140% VO2 max), 15-s maximal voluntary ventilation (MVV), and forced inspiratory and expiratory vital capacity (FVC) maneuvers at 1, 3, and 6 ATA. Maximal exercise ventilation and MVV amounted to 149 +/- 7 (mean +/- SE) and 193 +/- 9 l . min-1, respectively, at 1 ATA and were both reduced by approximately 37% at 3 ATA and by 50% at 6 ATA. Expiratory peak flows during MEx and MVV were equal to the maximal flows obtained during FVC at comparable lung volumes, whereas inspiratory peak flows during MEx were 20% less than the FVC flows. Despite a sixfold increase in gas density, the rate of mechanical work of breathing decreased when the pressure was raised to 6 ATA, during MEx from 8 +/- 1 to 6 +/- 1 W, and during MVV from 28 +/- 5 to 18 +/- 3 W. With increasing gas density there was a shift of lung volumes in the inspiratory direction with consequent reductions of inspiratory-to-expiratory flow ratios. We conclude that depletion of energy stores in the inspiratory muscles contributed to limiting V during MEx at raised air pressure.

Adult↗
PubMed1980

Epidural anesthesia in aortofemoral arteriography.

The experience with a well-established regional anesthetic technique i.e., epidural anesthesia for alleviating pain during aortofemoral arteriogrpahy is described. Of 59 patients, 51 experienced no subjective or objective evidence of pain, while eight patients subjectively reported mild burning pain during injection of contrast. Apart from patient satisfaction, important additional benefits of epidural anesthesia were excellent filling of both distal small arteries and collateral vessels around obstructing arterial lesions. Complications were few and insignificant. It is concluded that epidural anesthesia is a safe procedure that not only eliminates pain, but also gives better quality radiographs.

Adult↗
PubMed1978

Nitrogen-oxygen saturation therapy in serious cases of compressed-air decompression sickness.

Decompression sickness and arterial air embolism which follow exposure to raised environmental pressures of compressed air are usually adequately treated by accepted recompression procedures of relatively short durations. With serious cases, however, conventional treatment may not allow sufficient time at depth for the complete resolution of manifestations because of the need to avoid pulmonary oxygen toxicity which is associated with a prolonged period of breathing compressed air. Treatment by nitrogen-oxygen saturation at a pressure equivalent of 30 m (100 ft) sea water is proposed. Based upon the success of three refractory cases treated by this procedure, recommendation are made for the conversion of standard compressed-air chambers into an emergency saturation mode for therapy.

Adult↗
PubMed1978

Alterations in plasma norepinephrine concentration during surgical resection of pheochromocytoma.

Using a sensitive and specific radioenzymatic assay, the plasma norepinephrine (NE) concentration was measured in seven patients with pheochromocytoma, one patient with bilateral adrenal medullary hyperplasia, one patient with a retroperitoneal paraganglioma, and two patients undergoing bilateral adrenalectomies for palliation of metastatic breast carcinoma. Surgical manipulation of the pheochromocytomas resulted in striking increases in plasma NE concentration with concomitant increases in blood pressure. There were either small changes or no changes in the patients' plasma NE and blood pressure during resection of the normal adrenal glands, the adrenal glands with medullary hyperplasia, or the retroperitoneal paraganglioma. Plasma dopamine-beta-hydroxylase (DBH) was measured in one patient with pheochromocytomas and the patient with medullary hyperplasia. There was no change in plasma DBH in either patient, supporting the concept that exocytosis is not the primary mechanism for catecholamine secretion from pheochromocytomas. It was also noted that enflurane is an excellent general anesthetic for the resection of pheochromocytomas, and that sodium nitroprusside (rather than phentolamine) may be the agent of choice for the management of the hypertensive episodes that occur during surgical manipulation of pheochromocytomas.

Adolescent↗
PubMed1978

Roles of nitrogen, oxygen, and carbon dioxide in compressed-air narcosis.

In an attempt to determine the roles of nitrogen, oxygen, and carbon dioxide in compressed-air narcosis, the effects on performance (mental function and manual dexterity) of adding CO2 in various concentrations to the inspired gas under three different conditions were studied in eight healthy male volunteers. The three conditions were: (1) air breathing at 1.3 ATA; (2) oxygen breathing at 1.7 ATA; and (3) air breathing at 8.0 ATA (same inspired O2 pressure as in (2)). By relating performance to the changes induced in end-tidal (alveolar) gas pressures, and comparing the data from the three conditions, we arrived at the following results and conclusions. A rise in O2 pressure to 1.65 ATA, or in N2 pressure to 6.3 ATA at a constant high PO2 level, caused a significant decrement of 10% in mental function but no consistent effect on psychomotor function. A rise in end-tidal PCO2 of 10 mmHg caused an impairment of approximately 10% in both mental and psychomotor functions. The results suggest that, at raised partial pressures, all three gases have narcotic properties, and that the mechanism of CO2 narcosis differs fundamentally from that of N2 and O2 narcosis.

Adult↗
PubMed1976

Autonomic origin of heart rate fluctuations at the onset of muscular exercise.

The time courses of the heart rate (HR) changes were studied in six healthy male subjects who performed step changes from rest to light dynamic leg exercise (50 W) in the sitting position during a) control, b) parasympathetic blockade (atropine, 2-2.5 mg iv), c) beta-adrenergic blockade (propranolol, 10 mg iv), and d) during combined blockade with both drugs. During the control and beta-blockade experiments all subjects showed an immediate, rapid increase in HR, reaching a peak value after about 10 s, whereafter an equally rapid transient drop by 10-20 beats/min took place reaching the lowest values about 17 s after the onset of work. HR then again increased to reach a steady-state level within 60-90 s. In the atropine experiments this response pattern was not evident at all, whereas in the experiments with combined blockade it could be distinguished to a small, but significant degree. It is concluded that the observed fluctuations of HR at the onset of light dynamic exercise can be explained by a rapid vagal withdrawal, followed by a transient increase in vagal tone.

Adult↗