Biomedical subjects
Publications and source records attributed to T M Wolfe.
This article reviews selected procedures for which a particularly close working relationship between the surgeon and the anesthesiologist is essential for patient safety. Anesthetic considerations for upper and lower gastrointestinal endoscopies, bronchoscopy for aspirated foreign bodies, resection of mediastinal masses, thoracotomies for procedures requiring one-lung anesthesia, and surgery for burn patients are reviewed.
Many new diagnostic and surgical procedures rely on immobile equipment such as computed tomography or magnetic resonance scanners, biplanar fluoroscopes, or radiotherapy units. To facilitate these procedures in infants and children, anesthesiologists must provide services in a variety of unique environments. This article reviews the anesthetic equipment and techniques that have been adapted to provide anesthesia for children outside the operating room.
An 8-year-old boy developed severe systemic hypertension during resection of an intramedullary tumor. The histological, ultrastructural and immunocytochemical characteristics of the tumor are those of a gangliocytoma. Based on the demonstration of tyrosine hydroxylase in neuronal tumor cells, it is postulated that catecholamine secretion was responsible for the systemic hypertension.
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Pentobarbitone, 20 mg X kg-1 IV followed by infusion of 25 mg X kg-1 X hr-1, produced a progressive decrease in mean arterial pressure in dogs from 113 +/- 17 mmHg (SD) after one hour of infusion to 82 +/- 21 mmHg after 3.5 hours and to 49 +/- 22 mmHg after 5.5 hours. EEG silence occurred at 3.6 +/- 0.6 hours. In dogs similarly treated with pentobarbitone, a two hour infusion of dopamine 5 micrograms X kg-1 X min-1 beginning at the time of EEG silence prevented the further decrease in pressure and restored pressure to 87 +/- 18 mmHg. The mechanism for this effect of dopamine was an increase in cardiac output as systemic vascular resistance was unaffected by dopamine. The cardiac output increase was mainly the result of an increase in stroke volume as heart rate increased only slightly. Since reduced stroke volume was the main reason why pentobarbitone lowered blood pressure, the effect of dopamine on stroke volume and thus on blood pressure makes it an appropriate antagonist to the cardiovascular effects of toxic doses of pentobarbitone.
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