ABSTRACT
Health Care: The small-business lobby says Clinton's mandatory plan will kill off jobs. But Mom and Pop may end up breathing easier.
Subject(s)
Commerce/economics , Health Benefit Plans, Employee/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Employment/economics , Health Benefit Plans, Employee/economics , Health Policy/economics , Lobbying , United StatesABSTRACT
The in vitro fertilization business is taking off. But is it ripe for abuse?
Subject(s)
Fertilization in Vitro , Health Facilities, Proprietary/economics , Marketing of Health Services/standards , Women's Health Services/economics , Ambulatory Care Facilities/economics , Ambulatory Care Facilities/standards , Commerce/standards , Costs and Cost Analysis/statistics & numerical data , Female , Health Facilities, Proprietary/standards , Humans , Infant, Newborn , Pregnancy , United States , Women's Health Services/standardsSubject(s)
Chorionic Villi Sampling/adverse effects , Congenital Abnormalities/etiology , Obstetrics and Gynecology Department, Hospital/standards , Chorionic Villi Sampling/standards , Clinical Competence , Female , Fingers/abnormalities , Humans , Infant, Newborn , Informed Consent , Pregnancy , Toes/abnormalities , United StatesABSTRACT
Eight-five veterans underwent thoracic operations, mainly for carcinoma of the lung, with the aid of endobronchial anesthesia. Changes in arterial oxygenation (PaO2) and pulmonary shunt (Qs/Qt) were determined sequentially. Mean PaO2 after both lungs were ventilated for 20 minutes, supine, with 100% oxygen was 433 +/- 8 mm Hg. Selective ventilation of one bronchus dropped this value significantly (p less than 0.01) to 247 +/- 13 mm Hg. PaO2 did not change appreciably when the patient was turned to the lateral position; however, following pleurotomy there was a significant (p less than 0.01) decline in mean PaO2 to a nadir of 178 +/- 17 mm Hg at 90 minutes. Transient hypoxemia (PaO2 less than 60 mm Hg) occurred in 11 of 85 patients, most frequently (7/11) during positioning. Preoperative PaO2 PaCO2, forced expiratory volume in 1 second, forced vital capacity, or medical status did not predict hypoxemia. Qs/Qt increased significantly (p less than 0.01) at the onset of atelectasis from 18% +/- 0.9% to 25.4% +/- 0.9% but did not change with turning. The maximal mean Qs/Qt (30.3% +/- 1.1%) occurred immediately after opening the pleura and then decreased significantly (p less than 0.05), despite the fall in PaO2. Blood loss greater than 1,000 cc (n = 10), especially with hypotension, resulted in a significant increase (p less than 0.05) in Qs/Qt and a fall in PaO2. Thus pulmonary vascular adaptation to acute atelectasis has been demonstrated in man, and this, as in animal models, fails with hemorrhage.
Subject(s)
Anesthesia, Endotracheal/adverse effects , Thoracic Surgery , Humans , Lung Neoplasms/surgery , Middle Aged , Partial Pressure , Postoperative Complications , Pulmonary Atelectasis/etiology , Pulmonary Wedge PressureABSTRACT
Pulmonary functional veno-arterial shunt determinations were made breathing 100% oxygen in thirty consecutive patients during thoracotomy with one-lung anesthesia. Initially, with both lungs ventilated (FiO2 100%), the mean shunt value was 18.1 +/- 1.2% (S.D.). With the collapse of one lung by deflation and surgical pneumothorax, the shunt rose to 36.0 +/- 1.5%. With time the value fell: 36.0 +/- 1.5% at five minutes, 30.3 +/- 1.4% at fifteen minutes, 30.3 +/- 1.4% at thirty minutes, 28.1 +/- 1.4% at sixty minutes, and 24.6 +/- 2.8% after two hours. This trend was significant at a p value of less than 0.001. This study for the first time documents in man the phenomenon of pulmonary circulatory adaptation to acute atelectasis.
Subject(s)
Pulmonary Atelectasis/physiopathology , Pulmonary Circulation , Acute Disease , Arteriovenous Shunt, Surgical , Cardiac Output , Humans , Lung Neoplasms/complications , Lung Neoplasms/surgery , Oxygen/blood , Pneumothorax, Artificial , Pulmonary Atelectasis/complications , RespirationABSTRACT
For over a decade there has been concern about hepatitis related to halothane anesthesia. No dose relationship or other direct cause has ever been established, and jaundice has been found to occur after other anesthetics for surgical operations. Enflurane is a newer halogenated compound with a remarkable record of safety, yet a few cases of hepatitis are reported to be associated with its administration. We have compared effects on the liver of the two anesthetics by testing hepatic serum enzymes and sulfobromophthalein in 12 patients who received halothane and 12 who received enflurane. No significant differences between the two groups were found. Both had similar but minimal elevations of the hepatic serum enzymes and retention of sulfobromophthalein. More than half the patients had enzyme increases over normal levels but reasons for this were not obvious. Since hepatic change may take place in many postoperative patients, it is not surprising to have an occasional one develop hepatitis. The exact cause is unknown and therefore it is impossible to predict the patient who will develop the disease, regardless of the anesthetic.
Subject(s)
Anesthesia, General , Enflurane , Halothane , Liver/enzymology , Methyl Ethers , Adult , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Chemical and Drug Induced Liver Injury/etiology , Enflurane/pharmacology , Halothane/pharmacology , Hepatitis/etiology , Humans , Liver/drug effects , Male , Methyl Ethers/pharmacology , Middle Aged , Ornithine Carbamoyltransferase/blood , Postoperative Complications , Pylorus/surgery , VagotomyABSTRACT
One hundred three men undergoing thoracotomy on a general thoracic surgery service received endobronchial anesthesia with 100% oxygen using the Robertshaw tube. Bronchial intubation was accomplished in all. However, cross-leak or difficulty with deflation necessitated discontinuance in 8, while Pao2 values of 41 and 45 mm Hg caused abandonment in 2. There were no operative deaths. Surprisingly, hypoxemia in these patients related more to insufficient alveolar ventilation than to the venoarterial shunt.
