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d-Tubocurarine in cesarean section
SELECTED
Volume 56 Number 1
ABSTRACTS
I !I7
The authors report $2 extraperitoneal cesareans from their own experience. There WLS no fetal or maternal mortality. With excellent illustrations, they describe in detail t,hcir technique in performing this lifesaving operation. Both authors reject c.esarean hysterectomy for infection, revealing a maternal mortality of 14.2 per cent in 119 such operations. Their rejection is due also to the loss of the reproductive organ, which the operation entails, besides the shock and additional blood loss at the time of the operation. They reserve a place for cesarcan hysterectomy, however, for those patients with multiple fibroids, atonic uterus, or other pathologic conditions of the uterus. They report the experience of Baird, a maternal mortality of 7 per cent in 147 cases necessitating craniotomy, only to condemn craniotomy on the living child. They conclude that the modern extraperitoneal cesarean section is not only the safest method for the infected or potentially infected parturirnt patient but also may be used to advantage for less imperative indications. JA~IES P. MARR.
Gray, T. Cecil:
cl-Tubocurarine
in Cesarean Section, Brit.
M. J. 1: 444,
April
5, 1947.
The technique employed in anesthetization of 30 patients for cesarean section is dewribrd. d-Tubocurarine (Tuharine, Bur0.65 mg. of atropine is given one hour before operation. roughs Wellcome &- Co.), 15 mg. is injected, with the patient on t,he table, followed by 0.3 Gm. Kemithal (cyclohesenyl-allyl-thiobarbiturate) in 5 per cent solution. (Technique not stated.) ‘ ’ Closed circuit” cyclopropane anesthesia is then commenced at once. The operation may be started as soon as the patient fails to respond to painful stimuli. An airway is not employed because of the light anesthesia. Vomiting is avoided by this means. No evidence of curarizaThe uterus contracted so firmly that the use of Pituitrin was tion was evident in the babies. abandoned. Because of the light anesthesia the patient usually ‘ ‘ awakens ’ ’ as the dressings are applied. Postoperative complications mere minimal. The author believes the results vrarrant the exploration of the possibilities of this form of anesthesia by others. R. G. Dot-GLAS.
Newborn Wiener, A. S., Wexler, I. B., and Grundfast, T. H.: Therapy of Erythr6blastosis With Exchange Transfusion, Bull. New York Acad. Med. 23: 207, 191i.
Fetalis
In 1925 Hart successfully treated a case of ict,erus gravis by exchange transfusion. These authors first employed exchange transfusions in I944 on an infant with mongolian idiocy. In this, and in a subsequently treated case of ieterus gravis, coagulation interfered seriously with withdrawal of blood. In 1946, following Wallerstein’s encouraging results in erythroblastosis, the authors again used exchange transfusions, after heparinization of the infant’s blood. Three 200 unit doses of heparin are used during the exchange. In sevent’een cases knovvn to the authors, heparin has proved innocuous, and does not magnify possible silent intracranial hemorrhages (which Wallerstein considered a dangerous possibility). The infusion enters the saphenous vein, while blood is draining from the radial artery. The total exchange is twice the total blood volume (or, about 500 c.c.), which results in 90 per cent substitution. Success depends on the fate of the remaining Rh-positive cells. If lysis occurs, no harm results. If clumping occurs, the circulation is obstructed, and the procedure has been a. failure. To avoid clumping (intravascular conglutination), the authors suggest that the conglutinin content of the donor blood be reduced by replacing one-half the plasma by saline. Polycythemia from overtransfusion should be avoided. IRVING 1~. FRA;\TIi.
Exsanguination-Transfusion
in Erythroblastosis
Fetalis,
Internat.
Med.
Digest
50:
246,
1947.
Exsanguination-transfusion, or the exchange of good blood for bad, was first proposed in 1921. At that time Robertson reported its use in the treatment of severe burns in infants and children, and later in treatment of erysipelas, septic scarlatina and acute intestinal intoxication. Subsequently others used it in the treatment of poisoning by resorcin, mercuric chloride and phenol, and in treatment of typhoid fever.
Volume 56 Number 1
ABSTRACTS
I !I7
The authors report $2 extraperitoneal cesareans from their own experience. There WLS no fetal or maternal mortality. With excellent illustrations, they describe in detail t,hcir technique in performing this lifesaving operation. Both authors reject c.esarean hysterectomy for infection, revealing a maternal mortality of 14.2 per cent in 119 such operations. Their rejection is due also to the loss of the reproductive organ, which the operation entails, besides the shock and additional blood loss at the time of the operation. They reserve a place for cesarcan hysterectomy, however, for those patients with multiple fibroids, atonic uterus, or other pathologic conditions of the uterus. They report the experience of Baird, a maternal mortality of 7 per cent in 147 cases necessitating craniotomy, only to condemn craniotomy on the living child. They conclude that the modern extraperitoneal cesarean section is not only the safest method for the infected or potentially infected parturirnt patient but also may be used to advantage for less imperative indications. JA~IES P. MARR.
Gray, T. Cecil:
cl-Tubocurarine
in Cesarean Section, Brit.
M. J. 1: 444,
April
5, 1947.
The technique employed in anesthetization of 30 patients for cesarean section is dewribrd. d-Tubocurarine (Tuharine, Bur0.65 mg. of atropine is given one hour before operation. roughs Wellcome &- Co.), 15 mg. is injected, with the patient on t,he table, followed by 0.3 Gm. Kemithal (cyclohesenyl-allyl-thiobarbiturate) in 5 per cent solution. (Technique not stated.) ‘ ’ Closed circuit” cyclopropane anesthesia is then commenced at once. The operation may be started as soon as the patient fails to respond to painful stimuli. An airway is not employed because of the light anesthesia. Vomiting is avoided by this means. No evidence of curarizaThe uterus contracted so firmly that the use of Pituitrin was tion was evident in the babies. abandoned. Because of the light anesthesia the patient usually ‘ ‘ awakens ’ ’ as the dressings are applied. Postoperative complications mere minimal. The author believes the results vrarrant the exploration of the possibilities of this form of anesthesia by others. R. G. Dot-GLAS.
Newborn Wiener, A. S., Wexler, I. B., and Grundfast, T. H.: Therapy of Erythr6blastosis With Exchange Transfusion, Bull. New York Acad. Med. 23: 207, 191i.
Fetalis
In 1925 Hart successfully treated a case of ict,erus gravis by exchange transfusion. These authors first employed exchange transfusions in I944 on an infant with mongolian idiocy. In this, and in a subsequently treated case of ieterus gravis, coagulation interfered seriously with withdrawal of blood. In 1946, following Wallerstein’s encouraging results in erythroblastosis, the authors again used exchange transfusions, after heparinization of the infant’s blood. Three 200 unit doses of heparin are used during the exchange. In sevent’een cases knovvn to the authors, heparin has proved innocuous, and does not magnify possible silent intracranial hemorrhages (which Wallerstein considered a dangerous possibility). The infusion enters the saphenous vein, while blood is draining from the radial artery. The total exchange is twice the total blood volume (or, about 500 c.c.), which results in 90 per cent substitution. Success depends on the fate of the remaining Rh-positive cells. If lysis occurs, no harm results. If clumping occurs, the circulation is obstructed, and the procedure has been a. failure. To avoid clumping (intravascular conglutination), the authors suggest that the conglutinin content of the donor blood be reduced by replacing one-half the plasma by saline. Polycythemia from overtransfusion should be avoided. IRVING 1~. FRA;\TIi.
Exsanguination-Transfusion
in Erythroblastosis
Fetalis,
Internat.
Med.
Digest
50:
246,
1947.
Exsanguination-transfusion, or the exchange of good blood for bad, was first proposed in 1921. At that time Robertson reported its use in the treatment of severe burns in infants and children, and later in treatment of erysipelas, septic scarlatina and acute intestinal intoxication. Subsequently others used it in the treatment of poisoning by resorcin, mercuric chloride and phenol, and in treatment of typhoid fever.