[The effect of epidural analgesia during labour on the blood gases and acid-base balance (author's transl)]. / Beeinflussung blutgasanalytischer Parameter durch kontinuierliche Periduralanästhesie zur Dämpfung des Geburtsschmerzes.

The effect of epidural analgesia on the blood gases and acid-base balance was studied in 20 women during labour and in the newborn. The measurements were taken during the early first stage, the second and forth stage and in the newborns immediately post partum. 20 women in labour who had not been given epidural analgesia served as a control group. The values for the blood gases and the acid balance were less affected in women who had epidural analgesia, but the incidence of deliveries requiring vaginal operations was higher.

[Efficacy of low doses of heparin to postoperative changes of blood gases after abdominal surgery (author's transl)]. / Einfluss einer Low-Dose-Heparinisierung auf das postoperative Verhalten der Blutgase nach Oberbaucheingriffen.

Arterial hypoxaemia near critical values may occur during the postoperative period after surgery under general anaesthesia. Mainly alterations of ventilation/perfusion ratio seem to be the cause for this disorder. In this study we examined the effect of low-dose-heparin in improving pulmonary perfusion and consequently reduction of postoperative hypoxaemia. In 22 elderly patients both male and female we found no significant differences in oxygen tension compared to a control group of 19 patients. In both groups duration and degree of postoperative hypoxaemia were equal with minima on the first respectively second postoperative day. As in both groups there were no significant differences in other parameters further influencing oxygen supply--such as haemoglobin, haematocrit, pH and mean arterial blood pressure--we do not believe that disturbances of perfusion caused by microembolism are mainly responsible for postoperative hypoxaemia. Likewise low dose heparin seems to have no effect on postoperative hypoxaemia.

[Haemodynamic alterations after epidural anaesthesia in geriatric patients (author's transl)]. / Hämodynamische Veränderungen nach Peridural-anästhesie mit zwei kurzwirksamen Lokalanästhetika bei hochbetagten Menschen.

In 22 elderly patients haemodynamic alterations after epidural anaesthesia with Carticain 2% (Ultracain) with epinephrine (1:200 000) were compared to those after Lidocaine 2% with epinephrine. There were no differences to be found in these agents, and a less pronounced depressing effect of Carticain on circulation could not be confirmed. Unlike young people elderly patients only develop slight and short rises of heart rate and cardiac output after epidural anaesthesia, which are not sufficient to compensate for the distinct fall of mean arterial pressure up to the 15th minute. In our study mean arterial pressure decreased to critical values which might lead to cerebral and coronary ischemia in these patients. Adequate prophylactic and therapeutic measures are discussed.

[Postoperative changes of blood gases after uncomplicated abdominal surgery in geriatric patients (author's transl)]. / Die postoperativen Veränderungen der Blutgase nach unkomplizierten Oberbaucheingriffen bei hochbetagten Menschen.

In 34 elderly male and female patients undergoing upper abdominal surgery under general anaesthesia we investigated duration and degree of postoperative hypoxaemia. In this study only patients with no signs and symptoms of pulmonary or cardiac diseases, verified by normal lung function--vital capacity and FEV1, X-ray and electrocardiographic findings were considered. Postoperative development was free of complications and temperature rises in all cases. The investigations showed occurrence of arterial hypoxaemia during the postoperative period with values near the lower limit where the organism must fall back on cardio-circulatory reserve mechanisms in order to avoid general hypoxydosis. Regarding the restricted pulmonary and cardiac capacity for adaptation and compensation in geriatric patients, we recommend to prolong the practice of O2-application for two or three hours over a period of 24 to 48 hours, especially in patients with postoperative complications such as prolonged gastric atony, temperature, haemorrhage or cardiac and coronary insufficiency. This prolonged application of oxygen by mask or nasal tube should go parallel to other physiotherapeutic measures.

[Haemodynamic effects after rapid infusion of dextrane in geriatric patients (author's transl)]. / Auswirkungen der raschen Volumensubstitution auf hämodynamische Parameter bei geriatrischen Patienten.

In 85 geriatric premedicated patients haemodynamic effects were investigated following rapid infusion of 500 ml dextrane. The data measured one day preoperative revealed typical age-related changes of the cardiovascular system: decrease of cardiac output, stroke volume and heart rate; increase of peripheral vascular resistance and mean arterial pressure. After infusion of dextran central venous pressure rose by 4.9 mm Hg (mean), mean arterial pressure by 7.5 mm Hg (8.5%) and cardiac output by 1.04 1/min (24.3%). Heart rate alterations were insignificant, but total peripheral resistance decreased significantly by 12.5%. Pulmonary capillary pressure rose to 15.4 +/- 3.4 mm Hg. We conclude that it is possible to increase cardiopulmonary efficiency by extracardiac measures preoperatively even in aged patients. In no case critical left- or right ventricular filling pressure exceeded, so we cannot accept the often expressed warnings against induced hypervolaemia in patients with no cardiac failure except old age.