Masui. The Japanese journal of anesthesiology
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It is difficult to predict the occurrence of postoperative pulmonary complications. We analyzed correlation between postoperative pulmonary complications and pre-operative pulmonary functions in patients with severely disturbed respiratory functions; i.e. %VC of under 50% or FEV1% of under 50%, for the past 6 years. ⋯ Of the 29 patients with preoperative FEV1% under 50%, pulmonary complications developed in 8 patients (27.5%). We found that postoperative pulmonary complications correlate well with preoperative FEV1%.
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We studied whether prostaglandin E1 (PGE1) inhibits the granulocyte elastase increase, white blood cell increase and platelet decrease caused by surgical stimuli in 30 head-neck surgical patients. The patients were divided into a group of no PGE1 infusion (C group) and two groups of PGE1 infusion (infusion of 10 ng.kg-1.min-1 in P 10 group and infusion of 30 ng.kg-1.min-1 in P 30 group). PGE1 was infused intravenously using a syringe pump during operation. ⋯ Platelets decreased significantly in the first postoperative day in C and P 10 group. PGE1 has a tendency to inhibit dose-dependently the postoperative decrease in platelets. We conclude that 30 ng.kg-1.min-1 infusion of PGE1 did not inhibit granulocyte elastase release from white blood cells, but has a tendency to inhibit postoperative platelet decrease.
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Effects of highly decreased cardiac output on the development and recovery of diaphragmatic fatigue were studied in dogs. The fatigue was induced by supramaximal electrical stimulation (20 Hz) of phrenic nerves for 30 minutes. Cardiac output was reduced during this period to 30% of control value by mechanically obstructing inferior vena cava with a balloon in animals with lowered cardiac output group (lowered Qt group). ⋯ The standardized transdiaphragmatic pressure (Pdi/Pdi 100) and integrated electromyographic activity (Edi/Edi 100) elicited by electrical test stimuli (20, 100 Hz) were significantly lower in lowered Qt group (P less than 0.01) during entire fatigue and recovery period. The decrease of Pdi/Pdi 100 and Edi/Edi 100 at high frequency test stimuli (100 Hz) was observed only in lowered Qt group. These results suggest that when cardiac output is severely decreased the diaphragm is more susceptible to fatigue, and that this may be caused by a failure of neuromuscular junction as well as by an impaired excitation-contraction coupling.