Comparison of the haemodynamic effects of intermittent positive pressure ventilation with high frequency jet ventilation

The cardiorespiratory effects of intermittent positive pressure ventilation and high frequency jet ventilation with and without positive end expiratory pressure were compared in patients following valvular heart surgery (mitral and/or aortic). Twenty patients received intermittent positive pressure ventilation and high frequency jet ventilation with 0, 0.5 and 1.0 kPa positive end expiratory pressure. High frequency jet ventilation was well tolerated. The addition of 1.0 kPa positive end expiratory pressure was associated with preservation of the arterial oxygen tension without any increase in shunt or significant adverse haemodynamic effect. The results are discussed and compared with a previous study of high frequency jet ventilation following aortocoronary bypass graft surgery.     

Detection of a Retention Wire Fracture in An Asymptomatic Patient 18 Years after Implantation

An asymptomatic patient with a Teletronics Accufix atrial lead (Teletronics, Englewood, CO, USA) presented for an annual fluoroscopic examination. The examination revealed a retention wire fracture, which occurred 18 years after the initial implantation. Annual fluoroscopic examination of these leads should still be performed. (PACE 2010; 33:246–247)     

Propofol and fentanyl anaesthesia for patients with low cardiac output state undergoing cardiac surgery: comparison with high-dose fentanyl anaesthesia

We have compared the haemodynamic effects of an infusion ofpropofol 8mg kg^–1 h^–1 followed by 4mg kg^–1h–1 and fentanyl 15µg kg^–1 (group 1) withmidazolam 3–6mg and fentanyl 60 µg kg^–1 (group2) in patients with a low cardiac output state undergoing cardiacsurgery. Heart rate was lower in group 1 throughout the periodbefore cardiopulmonary bypass. There were no significant differencesbetween the groups in other measured variables. Arterial pressuredecreased in both groups after induction, by 21% in group 1and 18% in group 2. Thermodilution assessment of right ventricularejection fraction was unchanged. Myocardial contractility wasnot affected adversely. Patients in group 1 who received aninfusion of propofol and a smaller dose of fentanyl awakenedsooner and the trachea was extubated earlier.     

An evaluation of the SpuncritTM infra-red analyser for measurement of haematocrit

Summary An open, single centre study was carried out to evaluate the accuracy of the Spuncrit^TM (Micro Diagnostics, Bethlehem, PA, USA) infra-red analyser which can be used for near-patient testing to measure haematocrit and estimate haemoglobin concentration. The primary comparison was with the Sysmex NE1500 (Tao Medical) analyser situated in the main hospital laboratory. Secondary comparison was with the Ciba Corning 288 (Ciba Corning Diagnostics Ltd, Halstead, UK) blood gas analyser currently used for near-patient testing in the Northern General Hospital. A total of 217 samples from 50 patients was analysed. The Pearson's correlation coefficients for haematocrit and haemoglobin concentration between the Spuncrit^TM and Sysmex NE1500 and between the Spuncrit^TM and Ciba Corning 288 were all close, between 0.85 and 0.92. The method of Bland and Altman was used to asses agreement between the results of the Spuncrit^TM and the Sysmex NE1500. The agreement for haematocrit was good with 2 SD of the Spuncrit^TM results being between – 5.66 and +4.42% of the measurement from the Sysmex NE1500. In conclusion, the Spuncrit^TM haematocrit measurement agreed well with results from the central laboratory, but the estimated haemoglobin concentrations agreed less well and three reasons are discussed.     

COMPARISON OF THE HAEMODYNAMIC EFFECTS OF ENOXIMONE AND PIROXIMONE IN PATIENTS AFTER CARDIAC SURGERY

We have compared the haemodynamic effects of the imidazole derivativephosphodiesterase inhibitors enoximone and piroximone in patientswith low cardiac output after cardiac surgery. Ten patients(group E) received enoximone and 10 patients (group P) receivedpiroximone, both at a loading dose of 0.5 mg kg^–1 followedby an infusion of 5 µg kg^–1 min^–1. In bothgroups the main changes with time were increases in cardiacindex (maximum 24.5% in group E, 25.8% in group P) and decreasesin systemic vascular resistance (maxi mum 26.8% in group E and24.8% in group P). There were moderate increases in heart rate(maximum 11.3% in group E and 13% in group P) but a greaterpercentage decrease in mean arterial pressure in group E (maximum11.9% vs 7.9%) with time. One patient in group E developed hypertensionduring the loading dose. Two patients in group E and two ingroup P developed hypotension during the loading dose. One patientin group E developed ventricular extras ystoles which may havebeen related to the drug being studied. (Br. J. Anaesth. 1993;71: 869–872)     

The Menopause: How Much Soma and How Much Psyche?

The clinical and experimental literature on the menopause is comprehensively reviewed from 1930 to the present. The syndrome and its incidence are described, along with the diverse biological, psychological, and cultural views on etiology. Hormone therapy is deemed to be central. All these views are synthesized to help answer the question: How much soma and how much psyche? The menopausal syndrome is documented and shown to have historically different etiologies, culminating in a compromise theory.