Acta chirurgica Scandinavica
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Comparative Study
Leg haemodynamics during different forms of anaesthesia in patients undergoing reconstructive vascular surgery.
In the present study the effects of three different anaesthetics (halothane, n = 9, enflurane, n = 9, and neurolept, n = 11) on leg circulation were studied during vascular reconstruction with a reversed femoropopliteal saphenous vein bypass graft. Leg vascular resistance showed significant differences between the three anaesthetic groups. Thus, during the pretransfusion period, leg resistance in the neurolept group was significantly higher than in the halothane and enflurane groups, although the blood volume did not differ significantly between the groups. ⋯ Inducing pharmacological vasodilatation caused significant increases in common femoral arterial and bypass blood flows in all groups, but the increases were significantly more pronounced in the neurolept group. It is concluded that leg haemodynamics are influenced in different ways according to the anaesthetic agents used. This, in turn, might contribute to a better understanding and a more correct interpretation of the results of intraoperative flow and pressure measurements, and, consequently, to improvement of the reconstructive procedure.
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Comparative Study
Pharmacological vasodilation during reconstructive vascular surgery.
The effect on graft blood flow of two vasodilatory drugs, papaverine and bamethane (Vasculat), was infestigated by electromagnetic flowmetry intra-operatively in 31 patients following vascular reconstruction with a femoro-popliteal reversed saphenous vein bypass graft. With both drugs, graft flow augmentation was dose dependent (p less than 0.01) with increasing flow rates up to the injection into the popliteal artery of 40 mg of papaverine and 100 mg of bamethane respectively. ⋯ The interpretation of these findings is discussed, and the augmented graft flow values presented are compared to those previously reported. From the present results, it is recommended that, for 'maximal' intra-operative flow augmentation, papaverine should be used, the dose being 40 mg injected into the popliteal artery or into the graft, but not into the common femoral artery or elsewhere intra-arterially.
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The records of 82 patients with vascular trauma, treated at the Departments of General Surgery of the Sahlgren's Hospital, Göteborg, between 1969-1978 were revised. Nine patients were female and 73 male. The most common type of trauma was stab wounds. ⋯ In 28 patients some kind of reconstructive procedure was attempted, 23 of these patients survived. All reconstructive procedures in surviving patients were successful. In comparison with international experience, vascular trauma in Sweden seems to be very uncommon.
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Comparative Study
Penetrating abdominal trauma. A comparison of the development during 30 years between a rural and an urban area.
The development of penetrating abdominal injuries during 30 years has been compared between a rural and an urban area. There was an increase in number of injured patients but the causes of injury did not change. ⋯ There were minor but statistically insignificant differences in complications and mortality. Although the material is small exteriorization must be recommended as the method of choice in penetrating civilian colon injuries as it is in war injuries.
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In 14 patients with the respiratory distress syndrome it was demonstrated that this condition was caused by the administration of excessive volumes of fluid. In none of six patients examined post-mortem were any signs of thrombi or emboli observed in pulmonary vessels. Caution with the initial supply of fluids following major trauma and major surgery is recommended. By monitoring pulmonary arterial pressure, optimum volume replacement with 5% albumin solution for example can be achieved.