Download Controversies in Cardiovascular Anesthesia by Jan L. Kramer, David J. Wagner (auth.), Phillip N. Fyman PDF

By Jan L. Kramer, David J. Wagner (auth.), Phillip N. Fyman M.D., Alexander W. Gotta M.D. (eds.)

On sixteen October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic influence of diethyl ether in a public demonstration within the "ether dome" of the Bulfinch development of the Massachusetts common sanatorium in Boston. The sufferer, Gilbert Abbott, suffered no discomfort, and the medical professional, Dr. John C. Warren, used to be in a position to whole a suture ligature of a vas­ cular tumor of the jaw with out the hurry that till then used to be so priceless. The operation proved a failure, because the tumor recurred; however the demonstration of ether's anesthetic impression used to be an outstanding luck. Operative soreness used to be conquered, and surgical procedure may enhance from a crude and unscientific perform the place pace used to be paramount, and the main physique cavities couldn't be entered, into the original mixture of technology and paintings that it really is now. "Gentlemen, this is often no hum­ bug," supposedly muttered Warren, might be the final noncontroversial examine­ ment of anesthesiology to be made via a general practitioner. The screams of resisting sufferers in soreness have been stilled, and quiet entered the working room for the 1st time. however the new technological know-how of discomfort aid was once quick wrapped in controversy. a controversy instantly arose as to who may legitimately declare primacy for the invention. Morton's try and disguise the genuine nature of his anesthetic agent, coupled with an attempt to patent the invention, clouded his popularity and encouraged different claimants to push themselves forward.

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However, on critical analysis, the argu35 36 3. Blood gas values should be corrected ment in favor of correction can be supported and is accompanied by good clinical results. DEFINITIONS The clinical value of reducing the normal body temperature in patients during anesthesia to hypothermic levels is based on the associated decreased rate of cellular reactions and the attendant reduction in oxygen dependence of the affected organs. This is often the choice during cardiopulmonary bypass in order to protect the ischemic myocardium and with the scope of preserving function to other organs of the body, especially the brain, when perfusion may be limited.

Stanley et al. did not observe. ischemic electrocardiographic or heart rate changes despite the use of pancuronium during CABG with fentanyl anesthesia [31, 55, 59]. In these studies, however, succinylcholine was administered for tracheal intubation and pancuronium used for maintenance of neuromuscular blockade. Thus, the timing of pancuronium administration may play an important role in the development of hemodynamic and/ or ischemic changes during CABG with fentanyl anesthesia. As with all other agents used to supplement fentanyl anesthesia, neuromuscular blocking agents must be administered cautiously and carefully titrated to clinical effect [78].

76. Bennett GM, Loeser EA, Stanley TH: Cardiovascular effects of scopolamine during morphine-oxygen and morphine-nitrous oxide anesthesia in man. Anesthesiology 46:225-227, 1977. 77. Moffitt EA, Mcintyre Aj, Barker RA, Imrie DD, Murphy DA, Landymore RW, Kinley CE: Myocardial metabolism and hemodynamic responses with fentanyl-enflurane anesthesia for coronary arterial surgery. Anesth Analg 65:46- 52, 1986. 78. Savarese jj, Lowenstein E: Editorial: the name of the game-no anesthesia by cookbook. Anesthesiology 62:703- 705, 1985.

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