Haemodynamic and plasma vasopressin responses during high-dose fentanyl or sufentanil anaesthesia.

This study compared the haemodynamic and arginine vasopressin responses of patients to fentanyl or sufentanil anaesthesia for coronary artery bypass surgery. Fourteen normotensive patients with normal left ventricular function were studied. Patients were induced with fentanyl (N = 7) 37.5 micrograms X kg-1 or sufentanil (N = 7) 7.5 micrograms X kg-1 by intravenous infusion over three minutes. Clinically important chest wall rigidity, bradycardia and recall of intraoperative events did not occur. All of the fentanyl patients became hypertensive after induction and five required vasodilator therapy since they did not respond to boluses of fentanyl (12.5 micrograms X kg-1). Two of these five patients had S-T depression greater than 1 mm. Five patients in the sufentanil group became hypertensive after induction. Four of these patients responded to additional sufentanil (3.75 micrograms X kg-1) while one required vasodilator therapy for concomitant S-T depression. Sufentanil attenuated the increase of arginine vasopressin during cardiopulmonary bypass. Levels of arginine vasopressin in the fentanyl group were significantly higher than those of the sufentanil group during bypass. Levels of AVP after bypass were higher in the sufentanil group. The incidence of hypertension was similar in both groups. The hypertension was more easily treated with sufentanil but concomitant vasodilators (nitroglycerine) were required in both patient groups. Neither fentanyl in doses up to 128 +/- 8.7 micrograms X kg-1 nor sufentanil in doses up to 23 +/- 1.4 micrograms X kg-1 can be used as sole agents for anaesthesia in adult coronary artery bypass patients with good ventricular function when induction times are three minutes and bolus top-up doses are used.

Prevalence of hepatitis B in anaesthesia personnel.

Hepatitis B virus (HBV) infection, an occupational risk to anaesthetists, varies widely in incidence throughout the world. This study was undertaken to define the prevalence of previous HBV infection in anaesthesia personnel in the teaching hospitals of metropolitan Vancouver. Participants donated a blood sample and completed a questionnaire. Overall participation rate was 90.4 per cent. No participants were HBV carriers. Ten of 83 anaesthetists (12 per cent) had antibodies to HBV while all anaesthesia residents were seronegative. Anaesthetists with HBV antibodies tended to be either older or foreign born. Standard precautions taken by anaesthetists such as use of preoperative questioning of a patient's hepatitis status or the use of gloves when handling body fluids of a suspected or proven HBV carrier could not be shown to affect this seropositivity rate. This study, consistent with others, suggests that anaesthetists are at risk for acquiring HBV infection from occupational exposure. This risk appears to be somewhat less than that for surgeons, dentists, and staff of dialysis and urban emergency units.

Arteriography in catheter-induced rupture of the pulmonary artery.

Rupture of the pulmonary artery is a potential complication of the use of a Swan-Ganz catheter. We report a single case in which the site of rupture was visualized on a postmortem arteriogram, but was not apparent on a contrast radiograph performed prior to death, presumably due to inadequate filling of the arterial tree with contrast. Awareness of the value of a properly performed arteriogram may allow a lifesaving lobectomy or pneumonectomy.

Haemodynamic and plasma vasopressin responses with high-dose fentanyl anaesthesia during aorto-coronary bypass operations.

Twelve male patients were given high dose fentanyl (75-100 microgram.kg-1) anaesthesia with oxygen during elective aorto-coronary bypass operations, and their haemodynamic and vasopressin responses were determined during induction, sternotomy, cardiopulmonary bypass, post-bypass and recovery periods. For comparison, a group of 12 male patients were anaesthetized with morphine, halothane 0.5 per cent, nitrous oxide and oxygen, and were similarly studied. Significant alterations in haemodynamics included increased mean arterial pressure after sternotomy in the fentanyl group, increased heart rate in both groups, increased systemic vascular resistance after sternotomy only in the halothane group, and decreased left ventricular stroke work index in both groups following induction, bypass, and during the recovery periods. Plasma vasopressin levels increased significantly in both groups during the bypass period, but returned to baseline levels following bypass. Serum sodium and osmolality did not change significantly, and urinary sodium and potassium excretion rose with the progress of the operation in both groups. A positive correlation was found between mean arterial pressure and vasopressin only in the halothane group. Systemic vascular resistance was correlated to vasopressin levels in both groups. Vasopressin response in both groups was similar, with significant but relatively low increases in levels during cardiopulmonary bypass. Fentanyl-oxygen anaesthesia did not provide haemodynamic stability in eight of 12 patients.

Continuous monitoring of mixed venous oxygen saturation in cardiac surgery.

Serial measurement of mixed venous oxygen saturation is useful in the care of critically ill patients. It is an index of cardiac output and overall tissue perfusion. Previously, lack of refinement of the technology for continuous monitoring of mixed venous oxygen saturation deterred its clinical application. The authors evaluated the Oximetrix ShawTM catheter oximeter system between May 1980 and April 1981 in 84 high-risk and moderately high-risk patients. Fifty-four had undergone only myocardial revascularization while 30 had undergone valvular or combined procedures. In 20 patients with compromised left ventricular function (mean ejection fraction of less than 40%) continuous mixed venous oxygen saturation was compared to hemodynamic parameters in an intraoperative and early postoperative study. The results indicated that satisfactory mixed venous oxygen saturation (more than 65%) correlated with normal hemodynamic measurements including cardiac output and cardiac index. In general, a fall in mixed venous oxygen saturation of more than 10% was noted before the mean blood pressure, heart rate or pulmonary capillary wedge pressure changed. Cardiac output, cardiac index, systemic vascular resistance and left ventricular stroke work index were found to change in association with a change in mixed venous oxygen saturation. A fall (mixed venous oxygen saturation less than 65%) can be related to: (a) abnormal hemodynamic status--reduced cardiac output, hypotension, elevated systemic vascular resistance and arrhythmias, (b) abnormal oxygen demand--shivering, suctioning, positioning and pyrexia and (c) abnormal oxygen supply--anemia, airway obstruction and altered diffusion of oxygen at the alveolar capillary membrane. The Oximetrix system proved reliable. Mixed venous oxygen saturation is a nonspecific indicator of hemodynamic status. Continuous monitoring of the mixed venous oxygen saturation facilitates optimal patient management by immediately alerting intensive care personnel to the development of inadequate tissue perfusion.

On the actions of compounds related to dopamine at a neurosecretory synapse.

1 The effects of a number of substances related to dopamine, including all its methylated derivatives, were investigated on the membrane potential and response to nerve stimulation of cockroach salivary gland cells. 2 Only N-methyldopamine (epinine), N,N-dimethyldopamine and N,N-dimethylnoradrenaline, all with unsubstituted hydroxyl groups, directly resembled dopamine in producing a hyperpolarization which could be as large as that caused by maximal nerve stimulation. During the continued presence of these substances the hyperpolarization waned and responses to nerve stimulation declined. 3 Many of the compounds caused one or both of two other effects, namely an increase in the rate of 'spontaneous miniature hyperpolarizations' and an enhancement of the submaximal responses to single nerve stimuli. There were no obvious structural requirements for these effects.