ABSTRACT
The aim of this prospective non-interventional investigation was to study whether preoperative colonization of nasopharynx with potentially pathogenic airway bacteria carried an increased risk for the development of early postoperative bacterial airway infections after heart surgery in preschool children. Of the 91 patients studied, 62 (68%) were colonized preoperatively in the nasopharynx with Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae and/or Staphylococcus aureus. Nine children developed postoperative airway infections (four pneumonia, three bacterial bronchitis and two acute otitis media). Preoperative colonization was not significantly associated with increased risk for postoperative airway infection: 6/62 (10%) in colonized vs 3/29 (10%) in non-colonized children. Preoperative nasopharynx cultures in asymptomatic children should be avoided since it is unpleasant for the child, is not cost-effective, and may lead to unnecessary antibiotic treatment.
Subject(s)
Bacterial Infections/epidemiology , Nasopharynx/microbiology , Postoperative Complications/epidemiology , Respiratory Tract Infections/epidemiology , Thoracic Surgical Procedures , Bronchitis/epidemiology , Child, Preschool , Female , Humans , Infant , Male , Otitis Media/epidemiology , Pneumonia, Bacterial/epidemiology , Prospective Studies , Risk FactorsABSTRACT
Heart rate and systemic arterial blood pressure were recorded during induction of anaesthesia up to 9 min after endotracheal intubation in 92 patients scheduled for coronary artery bypass surgery, in order to study to what degree the circulatory response to induction of anaesthesia and intubation was modified by different relaxants. Pancuronium (pancuronium bromide) 0.1 mg X kg b.w.-1 and alcuronium (diallyl-nortoxiferine) 0.25 mg X kg b.w.-1 were randomly studied in 36 patients during induction with high-dose fentanyl and in 36 patients induced with thiopentone, diazepam, fentanyl and nitrous oxide. In patients given high-dose fentanyl anaesthesia, systolic blood pressure before, during and after intubation was significantly lower with alcuronium (P less than 0.01). The same difference between alcuronium and pancuronium was observed in balanced anaesthesia before endotracheal intubation. Induction of anaesthesia and intubation were followed by a moderate increase in heart rate, irrespective of the type of anaesthesia and relaxant. Subsequently, 20 patients (10 with high-dose fentanyl and 10 with balanced anaesthesia) were studied. They received pancuronium 0.05 mg X kg b.w.-1 + alcuronium 0.125 mg X kg b.w.-1. This mixture of relaxants produced an intermediate blood pressure response.
Subject(s)
Alcuronium/pharmacology , Anesthesia, General , Blood Pressure/drug effects , Coronary Artery Bypass , Heart Rate/drug effects , Pancuronium/pharmacology , Toxiferine/analogs & derivatives , Adjuvants, Anesthesia , Adult , Aged , Fentanyl , Humans , Intubation, Intratracheal , Middle Aged , Nitrous Oxide , Random Allocation , Thiopental , Time FactorsABSTRACT
The effects of intravenous injection of prenalterol, a selective beta 1-adrenoceptor agonist, on central haemodynamics and the distribution of ventilation-perfusion (VA/Q) were assessed in eight patients after aortic and/or mitral valve replacement. VA/Q distributions were determined by the multiple inert gas elimination technique. Administration of prenalterol resulted in a significant increase in cardiac output and heart rate with no changes in mean pulmonary arterial pressure and wedge pressure. There was an insignificant fall in arterial oxygen tension from 14.3 to 12.4 kPa, accompanied by a significant increase in the inert gas shunt from 6.4 to 11.3% of cardiac output, while the configuration of the distribution of perfusion and ventilation on VA/Q remained unchanged. The increase in shunt was probably more an effect of the increase in cardiac output than a direct effect of the drug on the pulmonary vascular bed.
