Anesthesiology
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Halothane-induced contractures in isolated muscle fibers from swine susceptible to malignant hyperthermia (MHS) were significantly less when fibers were incubated in KRB plus 6.2 x 10(-6) M dantrolene sodium prior to the administration of 4 per cent halothane. Administration of dantrolene sodium at the time of maximum contraction to NHS fibers in which contractures had been induced by halothane significantly increased the rate of relaxation of these fibers compared with similar fibers not treated with dantrolene sodium. This study indicates possible prophylactic and therapeutic value of dantrolene sodium in malignant hyperthermia and suggests that the previously reported effectiveness of dantrolene sodium in preventing and treating halothane-induced contractures may be due, at least in part, to its direct effect on muscles.
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Twenty patients requiring ventilation for acute respiratory failure were studied to determine whether intrapulmonary shunt fraction (Qs/Qt) measured at an inspired oxygen concentration (FIO2) of 1.0 differs from Qs/Qt measured at the clinically indicated FIO2 and, if so, the mechanism by which this occurs. Qs/Qt increased from 15.5 +/- 1.8 per cent (mean +/- SE) at the clinically indicated inspired oxygen fraction (FIO2 0.3-0.6) to 21.7 +/- 2.1 per cent after 20 minutes at FIO2 1.0. Functional residual capacity (FRC) decreased by 6 +/- 6 per cent and total compliance (CT) by 10 +/- 6 per cent. ⋯ Patients with increased PCWP showed smaller increases in Qs/Qt with 100 per cent oxygen. These findings suggest two mechanisms responsible for the increase in Qs/Qt: 1) redistribution of blood flow to nonventilated areas, resulting from the vasodilating effect of an increased oxygen tension in the vessels of hypoxic lung segments; 2) resorption atelectasis. Of the total change in Qs/Qt observed during ventilation with oxygen, 63 per cent was calculated to be due to factors other than a decrease in FRC. (Key words: Ventilation, positive end-expiratory pressure; Oxygen, pulmonary shunt and; Lung, compliance; Lung, shunts.)