Haemodilution induces a hypercoagulable state.

It has been suggested that haemodilution with saline may increase whole blood coagulation. This study was conducted in two parts. First, we investigated the effect of in vitro dilution of blood with saline on whole blood coagulation as measured by the thrombelastogram (TEG). Blood (4 ml) was diluted with 0.9% saline 1 ml and coagulation compared with that of an undiluted control specimen obtained concurrently from the same subject. In the second part, the study was repeated using a modified gelatin colloidal solution (Haemaccel) as the diluent. The r time, k time and r + k time were decreased relative to control in both diluent groups. The alpha angles were increased compared with control in both groups while maximum amplitude was unchanged in the Haemaccel diluted group. We conclude that haemodilution per se increases the coagulability of whole blood in vitro, but that saline haemodilution has a more marked effect on final clot strength.

Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe.

The ability of a new continuous-wave Doppler esophageal probe to measure cardiac output noninvasively during surgery under general anesthesia was tested and compared with simultaneously measured thermodilution cardiac output. A Doppler computer, calibrated for the aortic diameter and the transcutaneously measured cardiac output from the suprasternal notch, computed the Doppler cardiac output from the descending aortic blood flow velocity signal. A total of 246 paired Doppler cardiac output and thermodilution cardiac output measurements were made in 14 patients during surgery. The average thermodilution cardiac output was 5.90 +/- 3.27 (standard deviation) liters/min (range 1.20 to 19.18); the average Doppler cardiac output was 6.21 +/- 4.0 liters/min (range 2.30 to 28.20). The difference between the cardiac output measured by the 2 techniques was 1.38 +/- 2.2 liters/min (range 0.04 to 16.8). Two to 5 cardiac output measurements were averaged and arranged into "time periods." The average standard deviations for thermodilution and Doppler cardiac outputs within each time period were 0.64 and 0.47 liters/min, respectively. There was a correlation between the 2 measurements over a range of cardiac output values (r = 0.76, Doppler cardiac output = 0.93 x thermodilution cardiac output +0.7, standard error of the estimate = 1.76). Reproducible measurements of Doppler cardiac output were obtained during intraobserver (mean difference 0.64 +/- 0.52 liter/min) and interobserver (mean difference 0.41 +/- 0.36 liter/min) studies (n = 8). Cardiac output measurement by the Doppler esophageal probe could be used for hemodynamic monitoring during surgery in selected patients with cardiopulmonary disease.

Intravenous papaverine in constructing continent urinary reservoir.

The use of intravenous papaverine as an adjunct in the construction of a continent urinary reservoir is a safe and effective method to facilitate an important but sometimes restrictive portion of this procedure. Additionally, it does not seem unreasonable to extend this technique to other procedures which involve the use of small bowel.

Atrioventricular block secondary to straining.

Cardiac arrest while straining during a bowel movement is not unusual in elderly patients. Sinus bradycardia caused by increased vagal tone can lead to severe myocardial and cerebral hypoperfusion with cardiac arrest. We describe a female postoperative patient who, while straining on a bedside commode, developed varying degrees of atrioventricular heart block, necessitating placement of a permanent pacemaker.

Prinzmetal's variant angina during extradural anaesthesia.

A 55-yr-old male undergoing varicose vein surgery with an extradural block complained of chest pain. E.c.g. changes and subsequent examination of the heart including coronary angiography suggested the diagnosis of Prinzmetal's variant angina. The therapeutic implications of this condition in patients undergoing anaesthesia and surgery are discussed.

Right stellate ganglion block for treatment of hypertension after cardiopulmonary bypass.

Right stellate ganglion block was performed on 24 patients in whom hypertension developed after cardiopulmonary bypass. Changes in blood pressure, central venous pressure, cardiac output, and heart rate were evaluated. Most patients evidenced a decrease in systolic blood pressure (average, 40 mm Hg) and diastolic blood pressure (average, 19 mm Hg). Systemic vascular resistance was measured in 8 patients, and 7 demonstrated a decrease (average reduction, 6.7 resistance units). Changes in cardiac output were variable. Although stellate ganglion block can be safely performed and, in most patients, markedly reduces systolic blood pressure, the results suggest that other hypotensive agents may be more advantageous in the treatment of hypertension subsequent to coronary artery operation.

Haemoptysis following insertion of a Swan-Ganz catheter.

Haemoptysis occurred in a patient in whom a Swan-Ganz catheter was inserted for the induction of anaesthesia for hemicolectomy. It is suggested that acute pulmonary hypertension, superimposed on existing chronic pulmonary hypertension, superimposed on existing chronic pulmonary hypertension associated with mitral stenosis, was an important aetiological factor in the haemoptysis.

Acute hypertension immediately after coronary artery surgery.

Hypertension immediately after coronary surgery is a problem in about one third of the patients so treated. This report discusses the possible causes of postoperative hypertension and describes several means of controlling the complication.

Diagnosis of pneumothorax complicating mechanical ventilation.

Pneumothorax developed in 4 patients as a complication of mechanical ventilation and the manifestations were different in each case. The first patient had had a previous pneumomediastinum with symptoms of chest pain and rise in blood pressure. The second became restless and "fought" the ventilator. The third had pneumothorax previously and developed tachycardia and arrhythmias, and the level of end-expiratory pressure in the manometer of the ventilator rose above the present level. In the fourth patient, subcutaneous and submucous emphysema were apparent before pneumothorax was diagnosed. Pneumothorax was diagnosed promptly in all these patients, permitting adequate management without additional complications.