Epidural analgesia for post-thoracotomy patients.

Fifty-three patients underwent 55 post-thoracotomy bupivacaine epidural analgesia experiences for pain control. Hospital records of all patients were analyzed for effectiveness of pain relief, changes in vital signs, and complications. In most instances, pain relief was adequate and patients were able to move, cough, and deep breathe unusually well in the postoperative period. Correlations were tested among changes in blood pressure, pulse, respiration, the actual value for low blood pressure, and subsequent elevation, age, sex, thoracotomy side, primary diagnoses, a secondary diagnoses, metastases, and complications. Systolic blood pressure reduction was greater in older patients who received epidural bupivacaine, with a correlation coefficient which attained significance (p less than 0.04). Patients who underwent thoracotomies for chronic pulmonary inflammation (p less than 0.04) or patients who had previous myocardial infarctions (p less than 0.05) also demonstrated significant reduction in systolic blood pressure. However, the number of patients in each group (six and four, respectively) makes their significance questionable. Although there were no serious complications or deaths attributable to this technique of pain control, possible morbidity is discussed. Removal of the epidural catheters was without incident. There was no evidence of irritation, pain, or infection at the catheter placement sites.

Gastric emptying. A comparison of the Heineke-Mikulicz and Finney pyloroplasties with the Ramstedt pyloromyotomy.

Roentgenographic complete gastric emptying times using dilute barium were measured in 31 conditioned mongrel dogs (1) under normal or basal conditions, (2) after subdiaphragmatic complete truncal vagotomy, and (3) after four different methods of gastric drainage. The drainage procedures in 24 dogs were divided into four groups of six dogs each: (1) Heineke-Mikulicz two-layer (HM1) pyloroplasty; (3) Finney pyloroplasty (FP); and (4) the Ramstedt pyloromyotomy (RP). Using the same protocol for measuring complete gastric emptying, a fifth group of seven dogs underwent two gastric drainage procedures each: RP followed by subsequent conversion to the HM1. The statistical comparison to these procedures for adequacy of gastric drainage demonstrated no significant differences or superiority of any procedure in the groups of animals tested.