Anesthesia in repeat mediastinoscopy: a retrospective study of 101 patients.

In most medical textbooks, a mediastinoscopy is considered an absolute contraindication for a repeat mediastinoscopy. Retrospectively, perioperative data from 101 patients were evaluated in whom repeat mediastinoscopy was performed. The complication rate was 23% in 18 patients; 10% of these were directly related to the surgery. The surgical complications observed were hemorrhage, biopsy of the esophagus, paresis of a recurrent laryngeal nerve, and pneumothorax, which were all treated successfully. The patients receiving a nondepolarizing relaxant had fewer complications than patients given only a single dose of succinylcholine. In this patient population, the mortality rate was zero. This review concludes that an earlier mediastinoscopy is not necessarily an absolute contraindication for repeat mediastinoscopy.

Cardiopulmonary bypass and host defense functions in human beings: I. Serum levels and role of immunoglobulins and complement in phagocytosis.

In patients undergoing open-heart surgical procedures, the serum levels of immunoglobulins and complement were determined as well as the functional capacity of these defense proteins as opsonins to facilitate phagocytosis by polymorphonuclear leukocytes. A considerable decrease in serum levels of the proteins studied was found after cardiopulmonary bypass (CPB). As a result, the opsonic capacity of post-CPB plasma was diminished. After correction for hemodilution, however, no difference between pre- and post-CPB plasma, as measured by the activity of thermolabile (e.g., complement C3) and thermostabile (e.g., immunoglobulin IgG) opsonins, could be demonstrated. It is concluded that CPB causes a quantitative but no functional decrease in levels of IgG and C3.

Cardiopulmonary bypass and host defense functions in human beings: II. Lymphocyte function.

In 47 patients undergoing open-heart surgical procedures, the influence of cardiopulmonary bypass (CPB) on lymphocyte function was investigated by studying in vitro the mitogen responses of lymphocytes in whole blood cultures. Subnormal mitogen responses before operation that likely resulted from dexamethasone medication were found in half of the patients studied. During operation, changes in phytohemagglutinin responses were uniform in a group of 23 patients. No significant effect of anesthesia and operation was observed until the patients were heparinized (i.e., before CPB). At the end of operation, the phytohemagglutinin response was below normal. In a group of 24 other patients, postoperative mitogen responses were studied. A tendency toward restoration of mitogen responses was observed in most patients the first morning after operation. However, no uniform pattern of normalization of mitogen responses was found. In an attempt to relate postoperative mitogen responses to trauma resulting from CPB, we observed that perioperative (in comparison with postoperative) administration of blood coincided with a significantly higher incidence of subnormal phytohemagglutinin and pokeweed mitogen responses on postoperative day 1. No correlation between laboratory data and clinical findings could be established.

The Central Anesthesiology Course in Noordwijkerhout. A joint project of the Boerhaave Committee in Leiden, the Netherlands Association for Anesthesiology, and teachers of anesthesiology in The Netherlands and Flanders (Belgium).

The evolution of a training and postgraduate course in Anesthesiology to serve two Dutch-speaking regions of Europe is described. Since the program was started in 1978, 520 persons have participated and accounted for 1,267 registrations.