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Mechanical Artifical Ventilation
BRITISH JOURNAL OF ANAESTHESIA
1060 observe apres avoir administre 100 mg de morphine par voie intraveineuse dans une periode de 10 minutes, une chute caracteristique de la pression oxygenique arterielle, plus prononcee qu'apres fentanyl. Les reactions au niveau du gaz carbonique furent similaires. II n'y eut pas de consequences retardees chez les sujets ayant recu le fentanyl. On nota apres Fadministration de 100 mg de morphine une periode de latence sans effets secondaires cliniques qui dura 6 heures chez le premier patient et 95 minutes chez le second; ensuite un coma profond, persistant durant 72 heures, survint chez les deux malades.
ZUSAMMENFASSUNG
Drei Patienten mit chronischem Nierenversagen erhielten 0.5 mg Fentanyl und 40 mg Suxamethonium intravenos. Daraufhin konnten eine GefaBaktivitat, die Suxamethonium zugeschrieben wurde, und Bewufltseinsverlust festgestellt werden. Eine einmalige langsame Fentanylinjektion von 0.5 mg bei vier chronisch niereninsuffizienten Patienten fiihrte zu keinen signifikanten kardiorespiratorischen Effekten. Nach intravenoser Applikation von 100 mg Morphin iiber einen Zeitraum von 10 Minuten konnte ein charakteristischer Abfall der arteriellen Sauerstoffspannung beobachtet werden, der ausgepragter war als nach Fentanyl. Eine
EFECTOS CARDIORRESPIRATORIOS DE LA ANESTESIA CON MORFINA O FENTANIL EN LA INSUFICIENCIA RENAL CRONICA Y TOXICIDAD CEREBRAL DESPUES DE MORFINA RESUMEN
Tres pacientes con insuficiencia renal cronica recibieron 0,5 mg de fentanil y 40 mg de suxametonio por via intravenosa. Fueron observadas vasoactiyidad atribuida al suxametonio y perdida de conciencia. Los efectos cardiorrespiratorios de 0,5 mg de fantanil sin supplemento inyectado lentamente no fueron significativos en cuatro pacientes cronicamente azotemicos. Despues de administrar 100 mg de morfina intravenosamente durante un periodo de 10 minutos fue observado un descenso caracteristico en la tension de oxigeno arterial que fue mas pronunciado que despues de fentanil. Las respuestas del anhidrido carbonico fueron similares. No hubo secuelas retrasadas en los receptores de fentanil. Despues de 100 mg de morfina hubo un periodo latente libre de efectos secundarios clinicos durante 6 horas en el primer paciente y 95 minutos en el segundo, despues de lo cual se desarrollo en ambos un coma profundo que persistio 72 horas.
BOOK REVIEWS Principles and Practice of Spinal Anesthesia. By P. C. of other countries. Even as it stands, this book is a Lund, M.D., F.A.C.A. Published by Charles C. landmark in anaesthetic literature and will be warmly Thomas, U.S.A. Pp. 875; illustrated. Price $37.75. welcomed everywhere. It is thoroughly recommended. It is now 33 years since Maxson's classic book on spinal W. W. Mushin anaesthesia and 25 years since Pitkin's on regional anaesthesia. This book is in their line of descent in Mechanical Artificial Ventilation (2nd edition). By terms of content and quality. Dr Lund gives us a Terring W. Heironimus in, M.D., F.A.C.S., F.C.C.P. scholarly, readable, comprehensive monograph which Published by Charles C. Thomas, U.S.A. Pp. xiv is both a reference book with an extensive bibliography, T-160; illustrated. Price $8.50. and a practical manual of detailed methods. There is hardly any aspect of spinal anaesthesia which is omitted. This is essentially a short, practical and elementary From history to pharmacology, from clinical techniques book which will be helpful to junior anaesthetists and to complications, from indications to pros-and-cons— other clinicians who are not yet fully familiar with the all is here. The writing is concise, the print is clear, problems of IPPV. In this second edition, only three and the illustrations, while few in number, are efficient years after the first, the author has not only made some in transmitting their message. If there was any regret revision of the text, but has extended the number of in the reviewer's mind on reading this fine book, it was references and included a few more ventilators. The that, perhaps understandably, it is so American. author is less happy dealing with mechanical matters Methods, quotations from authors, drugs, discussion, than with physiological and clinical ones, and it is and the place of this technique, are all in relation to these latter sections, occupying the bulk of the book, the American scene. Monumental works of this nature that will be of interest. Naturally, coming from the are best without an imprint of geographical or national United States, both the instruments described and the boundaries. The second edition will undoubtedly soon clinical environmental factors, so important in the be called for, and there will be an opportunity to make medical and nursing care of patients on IPPV, are of this work truly international in character by drawing that country. Nevertheless, British readers will find on world literature more extensively. Its impact as a this a useful introductory volume. To them it is compractical technical book for American doctors may be mended as a guide to current thinking and standards slightly less, but it would be enormously more attractive of care, in regard to IPPV in the U.S.A. as a reference book for the researchers and clinicians W. W. Mushin
Downloaded from http://bja.oxfordjournals.org/ at University of Ulster on June 28, 2015
KARDIORESPIRATORISCHE WIRKUNGEN DER A N A S T H E S I E MIT MORPHIN ODER FENTANYL BEI CHRONISCHEM NIERENVERSAGEN UND CEREBRALE TOXIZITAT NACH APPLIKATION VON MORPHIN
entsprechende Reaktion zeigten die Kohlendioxidwerte. Spater auftretende Folgeerscheinungen waren bei den mit Fentanyl behandelten Patienten nicht feststellbar. Nach 100 mg Morphin kam es zu einer von klinischen Nebenwirkungen freien Latenzperiode, die bei dem ersten Patienten 6 Stunden und beim zweiten 95 Minuten dauerte, bis schliefilich bei beiden ein tiefes Koma auftrat, das 72 Stunden anhielt.
1060 observe apres avoir administre 100 mg de morphine par voie intraveineuse dans une periode de 10 minutes, une chute caracteristique de la pression oxygenique arterielle, plus prononcee qu'apres fentanyl. Les reactions au niveau du gaz carbonique furent similaires. II n'y eut pas de consequences retardees chez les sujets ayant recu le fentanyl. On nota apres Fadministration de 100 mg de morphine une periode de latence sans effets secondaires cliniques qui dura 6 heures chez le premier patient et 95 minutes chez le second; ensuite un coma profond, persistant durant 72 heures, survint chez les deux malades.
ZUSAMMENFASSUNG
Drei Patienten mit chronischem Nierenversagen erhielten 0.5 mg Fentanyl und 40 mg Suxamethonium intravenos. Daraufhin konnten eine GefaBaktivitat, die Suxamethonium zugeschrieben wurde, und Bewufltseinsverlust festgestellt werden. Eine einmalige langsame Fentanylinjektion von 0.5 mg bei vier chronisch niereninsuffizienten Patienten fiihrte zu keinen signifikanten kardiorespiratorischen Effekten. Nach intravenoser Applikation von 100 mg Morphin iiber einen Zeitraum von 10 Minuten konnte ein charakteristischer Abfall der arteriellen Sauerstoffspannung beobachtet werden, der ausgepragter war als nach Fentanyl. Eine
EFECTOS CARDIORRESPIRATORIOS DE LA ANESTESIA CON MORFINA O FENTANIL EN LA INSUFICIENCIA RENAL CRONICA Y TOXICIDAD CEREBRAL DESPUES DE MORFINA RESUMEN
Tres pacientes con insuficiencia renal cronica recibieron 0,5 mg de fentanil y 40 mg de suxametonio por via intravenosa. Fueron observadas vasoactiyidad atribuida al suxametonio y perdida de conciencia. Los efectos cardiorrespiratorios de 0,5 mg de fantanil sin supplemento inyectado lentamente no fueron significativos en cuatro pacientes cronicamente azotemicos. Despues de administrar 100 mg de morfina intravenosamente durante un periodo de 10 minutos fue observado un descenso caracteristico en la tension de oxigeno arterial que fue mas pronunciado que despues de fentanil. Las respuestas del anhidrido carbonico fueron similares. No hubo secuelas retrasadas en los receptores de fentanil. Despues de 100 mg de morfina hubo un periodo latente libre de efectos secundarios clinicos durante 6 horas en el primer paciente y 95 minutos en el segundo, despues de lo cual se desarrollo en ambos un coma profundo que persistio 72 horas.
BOOK REVIEWS Principles and Practice of Spinal Anesthesia. By P. C. of other countries. Even as it stands, this book is a Lund, M.D., F.A.C.A. Published by Charles C. landmark in anaesthetic literature and will be warmly Thomas, U.S.A. Pp. 875; illustrated. Price $37.75. welcomed everywhere. It is thoroughly recommended. It is now 33 years since Maxson's classic book on spinal W. W. Mushin anaesthesia and 25 years since Pitkin's on regional anaesthesia. This book is in their line of descent in Mechanical Artificial Ventilation (2nd edition). By terms of content and quality. Dr Lund gives us a Terring W. Heironimus in, M.D., F.A.C.S., F.C.C.P. scholarly, readable, comprehensive monograph which Published by Charles C. Thomas, U.S.A. Pp. xiv is both a reference book with an extensive bibliography, T-160; illustrated. Price $8.50. and a practical manual of detailed methods. There is hardly any aspect of spinal anaesthesia which is omitted. This is essentially a short, practical and elementary From history to pharmacology, from clinical techniques book which will be helpful to junior anaesthetists and to complications, from indications to pros-and-cons— other clinicians who are not yet fully familiar with the all is here. The writing is concise, the print is clear, problems of IPPV. In this second edition, only three and the illustrations, while few in number, are efficient years after the first, the author has not only made some in transmitting their message. If there was any regret revision of the text, but has extended the number of in the reviewer's mind on reading this fine book, it was references and included a few more ventilators. The that, perhaps understandably, it is so American. author is less happy dealing with mechanical matters Methods, quotations from authors, drugs, discussion, than with physiological and clinical ones, and it is and the place of this technique, are all in relation to these latter sections, occupying the bulk of the book, the American scene. Monumental works of this nature that will be of interest. Naturally, coming from the are best without an imprint of geographical or national United States, both the instruments described and the boundaries. The second edition will undoubtedly soon clinical environmental factors, so important in the be called for, and there will be an opportunity to make medical and nursing care of patients on IPPV, are of this work truly international in character by drawing that country. Nevertheless, British readers will find on world literature more extensively. Its impact as a this a useful introductory volume. To them it is compractical technical book for American doctors may be mended as a guide to current thinking and standards slightly less, but it would be enormously more attractive of care, in regard to IPPV in the U.S.A. as a reference book for the researchers and clinicians W. W. Mushin
Downloaded from http://bja.oxfordjournals.org/ at University of Ulster on June 28, 2015
KARDIORESPIRATORISCHE WIRKUNGEN DER A N A S T H E S I E MIT MORPHIN ODER FENTANYL BEI CHRONISCHEM NIERENVERSAGEN UND CEREBRALE TOXIZITAT NACH APPLIKATION VON MORPHIN
entsprechende Reaktion zeigten die Kohlendioxidwerte. Spater auftretende Folgeerscheinungen waren bei den mit Fentanyl behandelten Patienten nicht feststellbar. Nach 100 mg Morphin kam es zu einer von klinischen Nebenwirkungen freien Latenzperiode, die bei dem ersten Patienten 6 Stunden und beim zweiten 95 Minuten dauerte, bis schliefilich bei beiden ein tiefes Koma auftrat, das 72 Stunden anhielt.