James E. Eckenhoff

The measurement of coronary blood flow, oxygen consumption, and efficiency of the left ventricle in man.

Abstract The left ventricular coronary blood flow and left ventricular oxygen consumption per unit weight have been determined in twenty-six patients by means of the nitrous oxide method in conjunction with catheterization of the coronary sinus. The studies were performed on normal individuals and on patients with various forms of cardiovascular disease. The technique of coronary sinus catheterization and of the nitrous oxide method as applied to the coronary circulation in man have been presented. In the normal subject the left ventricular coronary blood flow per 100 grams per minute and the left ventricular oxygen consumption per 100 grams per minute averaged 65 c.c. and 7.8 c.c, respectively. The average oxygen extraction was 12 volumes per cent. In acutely anemic patients the left ventricular coronary blood flow per 100 grams per minute was slightly increased, whereas the left ventricular oxygen consumption per 100 grams per minute and the left ventricular oxygen extraction were reduced. In patients with essential hypertension, left ventricular coronary blood flow per 100 grams per minute, left ventricular oxygen consumption per 100 grams per minute, and left ventricular oxygen extraction were normal. In patients with coarctation of the aorta, the average left ventricular coronary blood flow per 100 grams per minute, left ventricular oxygen consumption per 100 grams per minute, and left ventricular oxygen extraction were all increased. In congestive failure due to mitral stenosis and insufficiency and to arteriosclerotic heart disease the left ventricular coronary blood flow per 100 grams per minute, was normal. The oxygen extraction was slightly elevated. Despite clinical and radiological evidence of marked left ventricular enlargement, the oxygen consumption per 100 grams per minute was only slightly elevated. Left ventricular coronary blood flows per 100 grams per minute were increased in patients with aortic insufficiency, arteriovenous fistula, and hyperthyroidism. The left ventricular coronary blood flow was normal in the patient with aortic stenosis. The left ventricular oxygen consumption per 100 grams per minute was normal in patients with aortic stenosis, with arteriovenous fistula, and with hyperthyroidism. It was elevated in the patient with aortic insufficiency. In one patient with clinical and electrocardiographic evidence of coronary occlusion with myocardial damage, the left ventricular coronary flow per 100 grams per minute, the oxygen extraction, and the left ventricular oxygen consumption per 100 grams per minute were markedly reduced. The results indicate that chronic increase in the energy requirements of the heart were met, not by an increase in the oxygen consumption per unit weight, but by an increase in the total oxygen consumption due to hypertrophy. The efficiency of the failing heart was low as a result of markedly decreased work in conjunction with slightly increased oxygen consumption.

THE INCIDENCE AND ETIOLOGY OF POSTANESTHETIC EXCITEMENT A Clinical Survey

Summary The postanesthetic recovery room records of 14,436 patients given general anesthetics have been surveyed to obtain information on the incidence of and etiologic factors in the development of emergence excitement. The incidence of excitement was 5.3 per cent in the entire group. The highest incidences of excitement were correlated with the youth of the patient, the excellence of his health, barbiturate and scopolamine preanesthetic medication, cyclopropane or ether anesthesia, and operative procedures associated with pain or emotional stress. The addition of a narcotic to the preanesthetic medication reduced the occurrence of emergence excitement. The significance of the results of the survey and a suggested regimen of therapy are discussed.

Causes of death among anesthesiologists: a 20-year survey.

During the years 1947–1966, there were 441 deaths among junior, active and retired members of the American Society of Anesthesiologists living in the United States or Canada. A cause of death was found for each member and death rates calculated for this group. Comparisons of these rates with those for U. S. males and with male policyholders of the Metropolitan Life Insurance Company were made. Anesthesiologists appear to have a low incidence of lung cancer, a somewhat lower than average incidence of coronary artery disease in recent years, and a high death rate from suicide and malignancies of the lymphoid and reticuloendothelial tissues. These data only suggest trends and point to the need for a prospective study of this subject.

Introduction to anesthesia : the principles of safe practice

PART 1 SONOGRAPHIC PRINCIPLES CHAPTER 1 Introduction Sonography Doppler Ultrasound Review Exercises CHAPTER 2 Ultrasound Sound Pulsed Ultrasound Attenuation Echoes Review Exercises CHAPTER 3 Transducers Construction and Operation Beams and Focusing Automatic Scanning Detail Resolution Review Exercises CHAPTER 4 Imaging Instruments Beam Former Signal Processor Image Processor Display Review Exercises PART 2 DOPPLER PRINCIPLES CHAPTER 5 Doppler Effect Flow Stenoses Doppler Equation Doppler Angle Review Exercises CHAPTER 6 Color-Doppler Instruments Color-Doppler Principle Instruments Doppler-Shift Displays Doppler-Power Displays Review Exercises CHAPTER 7 Spectral-Doppler Instruments Continuous-Wave Instruments Pulsed-Wave Instruments Spectral Analysis Spectral Displays Review Exercises PART 3 MISCELLANEOUS TOPICS CHAPTER 8 Artifacts Propagation Attenuation Spectral Doppler Color Doppler Review Exercises CHAPTER 9 Performance and Safety Performance Measurements Output Measurements Bioeffects Safety Review Exercises CHAPTER 10 Review Comprehensive Exam Glossary Answers to Exercises Appendix A: Compilation of Key Points Appendix B: List of Symbols Appendix C: Compilation of Equations Appendix D: Compilation of Boxes and Tables Appendix E: Mathematics Review Appendix F: Physics Review Appendix G: Additional Material for Exam Preparation Appendix H: Compilation of Advanced Topics Appendix I: Doppler Principles (condensed) References Index

Changes in Respiratory Dead Space During Halothane, Cyclopropane, and Nitrous Oxide Anesthesia

The influence of halothane, cyclopropane and nitrous oxide anesthesia on respiratory dead space has been measured in 18 surgical patients. Dead space was found to increase progressively in each patient, with the anatomical dead space remaining relatively unchanged. The progressive increase was in alveolar dead space. Similar measurements in 5 normal awake volunteers failed to reveal appreciable changes. Arterial oxygen tensions did not fall in spite of rhythmical mechanical ventilation.

CHANGES IN PHYSIOLOGICAL DEAD SPACE DURING DELIBERATE HYPOTENSION.

Alterations in physiological dead space have been calculated in 7 patients undergoing surgical procedures and subjected to nitrous oxide-halo-thane anesthesia with deliberate hypotension produced by pentolinium and head-up tilt. Mean blood pressure was lowered from an average of 87 mm. of mercury to an average of 50 mm. of mercury. Physiological dead space increased in all patients. The increase resulted from enlargement of both anatomical and alveolar dead spaces, but more especially the latter. The increase was greater in this group of patients as compared with another group anesthetized with the same agents but whose blood pressure was within normal limits.

N-Allylnormorphine: An antagonist to neonatal narcosis produced by sedation of the parturient

Abstract 1. 1. The use of n-allylnormorphine in the prevention of asphyxia neonatorum due to opiates has been investigated in a series of 1,100 parturients. 2. 2. When 10 mg. of this drug was injected intravenously into mothers prior to delivery there was no depression of the infants in the control group. There was, however, a significant reduction in the need for resuscitation and times required to gasp and breathe in infants born of mothers who had opiate sedation. 3. 3. The efficacy of the drug was reduced when the mothers received nitrous oxide anesthesia, but there was still a significant shortening of time to gasp and to breathe as well as a decreased incidence of the need for resuscitation in infants born of mothers clinically classified as moderately or deeply depressed. 4. 4. The opiate antagonistic effects of normorphine are not apparent in infants born of mothers who had ether anesthesia. 5. 5. One-tenth to 0.2 mg. of the drug was injected into the umbilical cord vein of 12 infants apneic 5 to 10 minutes after delivery. The result in 11 was a prompt institution of respiration, improvement in color and muscular tone, followed by sustained crying.

Blocking Action of Tetraethylammonium on Lobelin-Induced Thoracic Pain:

Summary The hypothesis is offered that specialized pain receptors exist in the visceral or parietal pleura and that TEA relieves certain types of thoracic pain by blocking these receptors. Attempts to demonstrate these receptors in lightly narcotized animals have been unsuccessful. However, it has been demonstrated that lobeline injected intravenously into man will produce substernal burning and coughing, which can be blocked by the prior injection of TEA. The significance of these observations is discussed.

Coronary Sinus Catheterization Technique for Studying Coronary Blood Flow and Myocardial Metabolism in vivo.

Summary Coronary sinus catheterization technique has been developed in intact dogs in order to study coronary blood flow and myocardial metabolism, and to evaluate the safety and practicality of a similar procedure in man. The pathological findings, among 30 autopsies following the procedure, have been discussed. The authors are very much indebted to Drs. S. S. Kety, C. F. Schmidt, and E. J. Bing for their help and advice, and to W. P. McShane, E. C. Johnson, Miss Alice Willis, Miss Sarah Bederman, and Mrs. Pauline Wilson for skillful technical assistance.

The oxygen content of coronary venous blood as affected by anoxia and cytochrome c.

Abstract 1. 1. By means of the bubble flowmeter and the coronary sinus catheterization methods of investigating the coronary circulation of the dog, the “normal” values for the coronary venous oxygen content have been found to be 3 to 6 volumes per cent. 2. 2. When 8 to 10 per cent oxygen mixtures were breathed, the oxygen content of coronary venous blood was reduced to 2 volumes per cent or less. 3. 3. Increases in oxygen uptake by the heart were accomplished primarily by increases in the volume of coronary blood flow. 4. 4. Cytochrome C, when injected intravenously in amounts varying from 3.8 to 12.5 mg. per kilogram of body weight, did not increase the coronary arteriovenous oxygen difference or the oxygen uptake of the heart.