European journal of anaesthesiology
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Comparative Study
Blood volume at the onset of hypotension during TURP performed under epidural anaesthesia.
An analysis was made of the development of hypotension in the course of 60 transurethral resections of the prostate (TURP) performed under epidural anaesthesia. Hypotension was defined as a decrease in the systolic pressure down to 85 mmHg or less, or a total drop of 60 mmHg or more within 15 min. Indirect estimations of the blood volume according to the haemoglobin dilution method indicated that patients who developed hypotension from the epidural anaesthesia had a larger decrease in blood volume than other patients. ⋯ Low central venous pressures, which were measured in 30 of the patients, were also associated with hypotension during and after TURP. There was a significant linear relationship between the total changes in blood volume and CVP measured at the end of each 10-min period of TURP (P < 0.001). However, no correlation between heart rate and hypotension was found.
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The effects of lung surgery performed during one-lung ventilation and the associated endocrine stress response on natural killer (NK) cell activity and the distribution of white blood cells in peripheral blood were studied in 10 patients with malignant lung tumours. Patients were anaesthetized with general anaesthesia combined with thoracic epidural anaesthesia. The endocrine response was measured as changes in serum cortisol, plasma adrenaline and noradrenaline. ⋯ Plasma noradrenaline increased significantly during the whole post-operative course. In conclusion, lung surgery was accompanied by similar changes in NK cell activity, leucocyte and differential counts, serum cortisol and plasma adrenaline levels as demonstrated after other types of major surgery. The elevated noradrenaline level post-operatively is a new observation that may be specific for lung surgery.