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Effect of sedatives on urinary volume of pregnant women
American Federation for Clinical Research (angiocardiography), utilizing an antecubital vein as the site of injection. Serial roentgenograms of the abdomen in the supine position are obtained with the aid of a rapid casette changer and a self-recocking bucky diaphragm. Thirty patients have been studied. Beginning opacification of the abdominal aorta and its branches was usually observed eight to twelve seconds following termination of the rapid intravenous injection. Four to six seconds later maximal opacification of the kidney parenchyma (nephrogram) occurred, permitting a clear differentiation of the kidney shadows from surrounding structures. In many instances, the renal cortex, medula and hilus were distinctly defined. The results obtained compare favorably with those obtained by direct injection of the aorta. Although visualization of the aorta and its branches as described here does not attain the degree of radiologic contrast observed following aortic injection, it has the following advantages: greater ease of injection, utilization of a cont.rast medium safer than the sodium iodide used for direct aortography and ability to perform the procedure without special apparatus or anesthesia. This method may be utilized not only in the study of renal circulation but also in the differential diagnosis of renal and extrarenal masses. INTRATHECAL EPHEDRINE SULFATE ANESTHESIA IN OBSTETRICS.
M.D., partment of
the
Medicine
Philadelphia,
W. Robert Penman, Pa. (From the De-
of Obstetrics Temple and
and
University
Gynecology School
of
Hospital.)
In the Department of Obstetrics and Gynecology ephedrine sulfate has been used to produce spinal anesthesia for delivery. When the patient is ready for delivery, she is placed on her side and the skin over the lumbar spine is prepared and sterile drapes applied. A spinal puncture is made with a spinal needle in the fourth lumbar interspace and when a free flow of spinal fluid is obtained, the anesthetic mixture is injected slowly during the intervals between uterine contractions. In this group of patients 2 ml. of a solution containing 50 mg. ephedrine sulfate and 5 per cent dextrose has been used. Following the injection, the patient is placed in the dorsal position without a pillow for a period of three to five minutes after which the AMERIeAN
JOURNAL
OF
MEDICINE
table is elevated 15 degrees to aid in low fixation of the anesthetic agent. With this technic, anesthesia adequate for delivery has been obtained in 95.4 per cent of twenty-two cases. The sensory anesthetic level rises to T-10 to T-11 and is maintained for at least sixty minutes. Motor function of the uterus and lower extremities is unaltered. No untoward maternal complications attributable to the ephedrine sulfate injection have been observed. Likewise, fetal physiology is apparently not disturbed as evidenced by the fact that there has been no change in the fetal heart rate between the time of injection and delivery nor is there any fetal respiratory depression after delivery. At this time it appears that intraspinal ephedrine sulfate is a satisfactory anesthetic agent for spontaneous or low forceps delivery of normal ‘patients and for the performance and repair of episiotomies. EFFECT OF SEDATIVES ON URINARY VOLUME OF PREC’NANT WOMEN.
Willis E. Brown, M.D., Otto F. Kraushaar, M.D. and (by invitation) J. T. Bradbury, Sc.D. and Y. K. Wang, M.D., Iowa City, Iowa. (From the IJ_nversity
of Iowa
College
of Medicine.)
In a previous communication before the Midwestern Section of this Society we have reported the effectiveness of diuretic agents in the mobilization and excretion of sodium and water. This study deals with the effect of sedatives and their antidiuretic effect. A series of patients were given a constant intravenous infusion for five hours and hourly urine specimens were obtained for eight hours. On test days these patients were given injections of a sedative and the effect on the urinary output and chloride excretion was measured. Morphine reduced the urinary output by 50 per cent without any significant alteration in urinary chlorides. When the patient was hydrated by oral administration of fluids, morphine, demerol, codeine and amytal caused a depression in urinary volume. Paraldehyde and avertin have not been found to have an antidiuretic effect. Additional studies were undertaken to determine the mechanism of the antidiuretic effect of morphine. By detailed studies on normal subjects and patients with diabetes insipidus it appears that this effect is not mediated by the posterior pituitary.
M.D., partment of
the
Medicine
Philadelphia,
W. Robert Penman, Pa. (From the De-
of Obstetrics Temple and
and
University
Gynecology School
of
Hospital.)
In the Department of Obstetrics and Gynecology ephedrine sulfate has been used to produce spinal anesthesia for delivery. When the patient is ready for delivery, she is placed on her side and the skin over the lumbar spine is prepared and sterile drapes applied. A spinal puncture is made with a spinal needle in the fourth lumbar interspace and when a free flow of spinal fluid is obtained, the anesthetic mixture is injected slowly during the intervals between uterine contractions. In this group of patients 2 ml. of a solution containing 50 mg. ephedrine sulfate and 5 per cent dextrose has been used. Following the injection, the patient is placed in the dorsal position without a pillow for a period of three to five minutes after which the AMERIeAN
JOURNAL
OF
MEDICINE
table is elevated 15 degrees to aid in low fixation of the anesthetic agent. With this technic, anesthesia adequate for delivery has been obtained in 95.4 per cent of twenty-two cases. The sensory anesthetic level rises to T-10 to T-11 and is maintained for at least sixty minutes. Motor function of the uterus and lower extremities is unaltered. No untoward maternal complications attributable to the ephedrine sulfate injection have been observed. Likewise, fetal physiology is apparently not disturbed as evidenced by the fact that there has been no change in the fetal heart rate between the time of injection and delivery nor is there any fetal respiratory depression after delivery. At this time it appears that intraspinal ephedrine sulfate is a satisfactory anesthetic agent for spontaneous or low forceps delivery of normal ‘patients and for the performance and repair of episiotomies. EFFECT OF SEDATIVES ON URINARY VOLUME OF PREC’NANT WOMEN.
Willis E. Brown, M.D., Otto F. Kraushaar, M.D. and (by invitation) J. T. Bradbury, Sc.D. and Y. K. Wang, M.D., Iowa City, Iowa. (From the IJ_nversity
of Iowa
College
of Medicine.)
In a previous communication before the Midwestern Section of this Society we have reported the effectiveness of diuretic agents in the mobilization and excretion of sodium and water. This study deals with the effect of sedatives and their antidiuretic effect. A series of patients were given a constant intravenous infusion for five hours and hourly urine specimens were obtained for eight hours. On test days these patients were given injections of a sedative and the effect on the urinary output and chloride excretion was measured. Morphine reduced the urinary output by 50 per cent without any significant alteration in urinary chlorides. When the patient was hydrated by oral administration of fluids, morphine, demerol, codeine and amytal caused a depression in urinary volume. Paraldehyde and avertin have not been found to have an antidiuretic effect. Additional studies were undertaken to determine the mechanism of the antidiuretic effect of morphine. By detailed studies on normal subjects and patients with diabetes insipidus it appears that this effect is not mediated by the posterior pituitary.