[Change in the adhesiveness of polymorphonuclear neutrophilic granulocytes by the intravenous anesthetics midazolam and ketamine]. / Uber Veränderung der Adhärenz polymorphkerniger neutrophiler Granulozyten durch die intravenösen Anästhetika Midazolam und Ketamin.

The influence of midazolam and ketamine on polymorphonuclear neutrophil granulocyte (PMN) adherence was investigated in vitro by using nylon fiber columns. Both a concentration of 1.0 microgram midazolam/ml blood and 0.2 microgram/ml caused a reduction of adherence. This decrease was significant (p less than 0.05) in the case of the higher dosage. The two concentrations of ketamine used (1.3 micrograms/ml resp. 0.5 microgram/ml) produced a significant reduction of adherence too. Thus both anesthetic agents are able to impair PMN function in vitro dose-dependently. This feature is possibly related to increased risk of postoperative bacterial infection. Further studies concerning this problem should be conducted.

Cardiopulmonary parameters and prognosis after severe multiple trauma.

Comprehensive cardiopulmonary and metabolic monitoring of severely traumatized patients for 7 days from the time of injury has allowed us to determine parematers which correlate with survival and nonsurvival. The earliest and most persistent change is an increased pulmonary vascular resistance which results in right heart overload and failure. Left heart "failure" which has been previously described with acute respiratory failure and shock is shown to be a mathematical artifact caused by dilatation of the right heart and encroachment on left ventricular filling volume. Causes of death in most patients were not directly referable to right heart dysfunction but we postulate that hypercoagulability and microembolism could independently produce the observed pulmonary vascular changes as well as the multiple organ failure which usually was responsible for death. Resolution of this question will require more sophisticated hematologic evaluation.