[Ways to decrease blood loss during total hip joint endoprosthesis]. / Puti umen'sheniia krovopoteri pri total'nom éndoprotezirovanii tazobedrennogo sustava.

Total replacement (endoprosthesis) of the hip joint was carried out in 93 patients aged 18-60 years. Sixteen operations were performed under prolonged epidural blockade, 66 under neuroleptanalgesia, and 16 under ataralgesia. A deficiency of circulating blood volume was detected in all patients before surgery. The lowest mean arterial pressure was recorded in the prolonged epidural block group, while in the neuroleptanalgesia and ataralgesia groups the mean arterial pressure was virtually the same. Isovolemic hemodilution in patients with preoperative deficit of circulating blood volume decreased blood loss during long traumatic operations. Prolonged epidural blockade in combination with isovolemic hemodilution and spontaneous respiration led to a notable (70%) decrease of the true blood loss in comparison with the traditional neuroleptanalgesia.

Flumazenil como antagonista benzodiazepinico en neuroleptoanestesia para intervenciones quirúrgicas cortas / Flumazenil as benzodiazepines antagonist in neuroleptoanesthesia for surgical interventions

El objetivo de este estudio fue evaluar la eficacia del flumazenil para revertir los efectos hipnóticos sedantes del diazepam en pacientes femeninas después de una anestesia general. Se estudió la eficacia y tolerancia del flumazenil como un antagonista específico de las benzodiazepinas con el fin de revenir los efectos de las altas dosis de diazepam. El estudio fue realizado con 20 pacientes (ASA I y II) las cuales fueron ubicadas en dos grupos de 10 pacientes cada uno, el grupo A recibió diazepam y flumazenil a dosis de (0,44 ñ 0,17 mg), el grupo B solamente diazepam. a todas las pacientes les fue monitorizada la tensión arterial sistólica, diastólica, frecuencia cardíaca, frecuencia respiratoria a los 0',5',15',30' y 120' en el período post-anestésico. El análisis de nuestros resultados demuestra que las dosis de flumazenil utilizados revirtieron los efectos hipnóticos sedantes del diazepam en los pacientes del grupo A, también se encontró que no hubo diferencias significativas en los valores hemodinámicos ni frecuencia respiratoria entre los grupos. El estudio también mostró que el tiempo de despertar en el grupo A 4,55 minutos ñ 0,23) fue menor que el del grupo B. Finalmente esta investigación confirma la eficiencia del flumazenil como un antagonista de las benzodiazepinas

Anaesthesia for non-cardiac surgery in heart-transplanted patients.

This review documents the anaesthetic management, haemodynamic function and outcome in 18 of 86 heart-transplanted recipients, who returned for 32 non-cardiac surgical procedures at the Toronto Hospital from 1985 to 1990. General anaesthesia was administered in eight of the 27 elective operations and four of the five emergency operations. Induction medications included thiopentone (2-4 mg.kg-1), fentanyl (1-7 micrograms.kg-1) and succinylcholine (1-1.5 mg.kg-1). Anaesthesia was maintained with a combination of oxygen/nitrous oxide and isoflurane or enflurane. Muscle relaxation was maintained with vecuronium or pancuronium. No delayed awakening or unplanned postoperative ventilation was observed. Neurolept-anaesthesia was administered to 63.0% and 20.0% of the elective and emergency operations, respectively. The anaesthetics included fentanyl (25-100 micrograms) and midazolam (0.5-1.5 mg) or diazemuls (2.5-5.0 mg). Spinal anaesthesia (75 mg lidocaine) was administered to only two of the 27 elective operations. No important haemodynamic changes were observed in any anaesthetic group, but lower systolic BP was found after induction and during maintenance periods in the patients who received general anaesthesia than in those who received neurolept-anaesthesia. However, no anaesthesia-related morbidity or mortality was noted. This suggests that general, neurolept- and spinal anaesthesia do not affect haemodynamic function or postoperative outcome in heart-transplanted recipients undergoing subsequent non-cardiac surgery.