RESUMEN
We studied the effect of two new formulations of H2-receptor antagonists on gastric fluid pH and volume. Forty-five healthy, elective adult in-patients in three study groups, 15 in each, were premedicated using oral diazepam 10 mg with 100 ml of a dose of water soluble suspension of ranitidine 300 mg with sodium citrate/bicarbonate, or a resoriblette of famotidine 40 mg, or placebo. Gastric fluid samples were obtained by blind aspiration after anaesthesia induction, 50-70 min from premedication, and again 90 min from premedication. After a mean period of 60 min from ingestion the patients medicated with H2-antagonists had higher gastric juice pH than those in the control group (1.5 (1.1-6.3), median (range)) (P < 0.0001) for ranitidine (6.8 (4.1-7.8)), P < 0.01 for famotidine (3.9 (1.5-7.6)); P < 0.05 ranitidine vs famotidine). Recovered volumes were similar for the groups (median 3-4 ml, range 0-50 ml). None of the H2 patients had pH < 3.5 and volume > or = 0.3 ml.kg-1 (P < 0.05 vs placebo). In second aspirations, taken 90 min from premedication, the group differences from control in pH persisted. Famotidine patients had the lowest volumes (P < 0.05 vs controls); yet one famotidine patient had a pH < 2.5 and volume > or = 0.3 ml.kg-1. It is concluded that, at the moment of oral anxiolytic premedication, ranitidine-buffer suspension effectively reduced gastric juice acidity, whereas famotidine resoriblette failed to increase reliably gastric pH in 50-90 min.
Asunto(s)
Famotidina/administración & dosificación , Antagonistas de los Receptores H2 de la Histamina/administración & dosificación , Premedicación , Ranitidina/administración & dosificación , Estómago/efectos de los fármacos , Adolescente , Adulto , Femenino , Determinación de la Acidez Gástrica , Humanos , Masculino , Persona de Mediana Edad , Neumonía por Aspiración/prevención & control , SuspensionesRESUMEN
Urinary excretion of fluoride after enflurane anaesthesia has been found to correlate with urinary pH, while the correlation with urinary volume has remained unsettled. We therefore studied the effect of moderate doses of mannitol and furosemide on serum fluoride levels and urinary excretion of fluoride in surgical patients after controlled doses of enflurane (6+6+6 patients) or halothane (5+5+5 patients). The highest serum fluoride level was 31 mumol/1 in an enflurane patient (enflurane dose 1.26 end-tidal vol % x h) and 8 mumol/1 in a halothane patient (halothane dose 0.59 end-tidal vol. % x h). Mannitol caused th greatest mean excretion of fluoride (not significant (n.s)) in the enflurane patients without any marked rise in urinary pH or volume. Furosemide increased urinary output markedly but did not enhance urinary fluoride excretion or raise urinary pH. Compared with the control groups of both inhalation anaesthetic patients, the diuretics appeared to have no effect on the serum fluoride levels. In the enflurane patients there was a positive correlation between the change in fluoride clearance and the change in urinary pH, but no with the change in urinary volume during the first postoperative hours. On the other hand, in the halothane patients there was a positive correlation between the change in fluoride clearance and the change in urinary volume. A possible "fluoro-uretic" action of mannitol was also seen in the halothane patients, as in the later postoperative period fluoride excretion was greatest when mannitol had been given.
Asunto(s)
Enflurano , Fluoruros/orina , Furosemida/uso terapéutico , Halotano , Manitol/uso terapéutico , Adulto , Anciano , Anestesia General , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana EdadRESUMEN
The surgical complications in a series of 500 transplantations done by a single transplantation unit with over ten years' experience in the field are reported. The complications are divided into vascular, urological and gastrointestinal. In addition, renal rupture, primary wound infections and operative deaths are reported. Most of the losses of transplants caused by surgical complications are due to renal rupture and vascular complications, accounting for 3.6 and 2 percent of losses respectively out of the 500 kidney transplants. The urological complications caused a loss of the remaining 1.2% of a total of 6.8%. tthe overall mortality was highest in gastrointestinal complications with 6% of the total of 10% deaths following surgical complications. The mortality rate in the group of patients with gastrointestinal bleeding and perforations and with acute pancreatitis was extremely high. More accurate screening for potential candidates for gastroduodenal ulceration and better prophylactic treatment is needed. More active treatment of acute pancreatitis is suggested.