Charles E. Hope

Anaesthesia for the Patient with a Coincidental Giant Lung Bulla: A Case Report

The anaesthetic management of a patient with a coincidental giant lung bulla who underwent lumbar discectomy and laminectomy is described. The specific problems associated with anaesthesia in patients wih bullae, such as acute enlargement or rupture of the bullae, are discussed. Precautionary measures which may be taken during anaesthesia include the avoidance of nitrous oxide, the prophylactic use of a double-lumen tube, and the immediate availability of chest drains in the anaesthetizing area. Monitoring during operation may involve bilateral chest auscultation and arterial blood gas analysis.

Comparison of Effects of Balanced Anaesthesia and Neuroloptanalgesia on Postoperative Cardiovascular Function in Patients with Coronary Artery Disease

Patients with chronic ischaemic heart disease and a history of myocardial infarction or who present with exertional or spontaneous angina suffer a decrease in left ventricular pump function during recovery from anaesthesia and in the period immediately after operation. This decrease is reflected in an increase in pulmonary capillary wedge pressure and in a decrease in stroke volume and cardiac output. Two groups of 10 such patients, clinically and haemodynamically comparable in the preoperative period, were studied: 10 patients received balanced anaesthesia, and 10 neuroleptanalgesia. The disturbance in left ventricular function was less pronounced with neuroleptanalgesia. A significant difference was noted between the groups with regard to pulmonary capillary wedge pressure during recovery from anaesthesia (balanced anaesthesia 15.8 +/- 4.4 mm Hg; neuroleptanalgesia 10.7 +/- 4.4 mm Hg; P less than 0.02). There was a relationship between type of anaesthesia and pulmonary capillary wedge pressure variations (P less than 0.01).

Risk of Bacteremia after Endotracheal Intubation for General Anesthesia

Blood cultures were obtained before and after endotracheal intubation to assess the risk of bacteremia associated with this procedure and to evaluate the need for prophylactic antibiotics to prevent bacterial endocarditis in patients with structural heart disease requiring general anesthesia. Blood cultures were obtained immediately before intubation and two and ten minutes after intubation in 50 individuals without evidence of structural heart disease who required general anesthesia for elective surgery. Of 32 who had orotracheal intubation, only one demonstrated postintubation bacteremia; of 18 individuals who had nasotracheal intubation, none had evidence of bacteremia. These data suggest that in healthy individuals undergoing endotracheal intubation under direct vision the risk of bacteremia is quite small (about 2%).