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1. Patients should be divided preoperatively into low- or high-risk categories, depending on their probability of developing postoperative pulmonary complications. The evaluation should include spirometry as well as an assessment of the previously defined risk factors. 2. Patients in a low-risk category need only instruction in deep breathing pre- and postoperatively. Routine use of supplemented oxygen postoperatively is reasonable until it can be demonstrated whether such is necessary. 3. High-risk patients should be as free as possible of respiratory secretions at the time of surgery. A regimen for this purpose includes cessation of smoking, and administration of inhaled bronchodilators followed by chest percussion and postural drainage. 4. High-risk patients should be carefully instructed in deep breathing and coughing preoperatively. A mechanical device such as an incentive spirometer may be beneficial in this regard. If it is not possible to achieve spontaneous deep breathing, an attempt to accomplish this by IPPB may be undertaken. The tidal volume desired should be ordered. If IPPB does not result in large tidal volumes, it should be discontinued. 5. The deep breathing procedure found to be most successful preoperativelly should be continued postoperatively. 6. The patient should be as mobile as possible while in bed and ambulated as soon as is feasible. 7. Patients with preoperative expiratory flows of less than 20% of predicted values or with chronic hypercapnia should be carefully observed for postoperative ventilatory failure.
Annu Rev Med 1977
PMID:Pulmonary complications of general surgery. 32 60

Pancuronium bromide is a nondepolarizing muscle relaxant approved to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation. The use of pancuronium bromide during surgery led to the appreciation that it has advantages over drugs previously used for muscle relaxation. Patients in whom pancuronium bromide is of value are (1) hypoxemic patients resisting mechanical ventilation and so cardiovascularly unstable that use of sedatives is precluded, (2) patients with bronchospasm unresponsive to conventional therapy, (3) patients with severe tetanus or poisoning where muscle spasm prohibits adequate ventilation, (4) patients with status epilepticus unable to maintain their own ventilation, (5) shivering patients in whom metabolic demands for oxygen should be reduced, and (6) patients requiring tracheal intubation in whom succinylcholine administration is contraindicated. Without concomitant sedation, use of pancuronium bromide is associated with psychological risks. Other risks are undetected ventilator disconnection, tachyarrythmias, prolonged paralysis and drug interactions.
Ann Intern Med 1978 Jan
PMID:Pancuronium bromide. 33 1

The extent of strand breakage and repair in irradiated E. coli B/r and Bs-1 was studied using a DNA-unwinding technique in denaturing conditions of weak alkali. Although these two strains show widely different responses to the lethal effects of ionizing radiation, they both have an equal capacity to repair radiation-induced breaks in DNA. Oxygen enhancement ratios for the killing of B/r and Bs-1 were respectively 4 and 2; but after repair in non-nutrient or nutrient post-irradiation conditions, the oxygen enhancement values for the residual strand breaks were always the same for the two strains. The equal abilities of E. coli B/r and E. coli Bs-1 to remove the strand breaks measured by this weak-alkali technique leads us to suggest that some other type of damage to either DNA or another macromolecule may play a major role in determining whether or not the cells survive to proliferate.
Int J Radiat Biol Relat Stud Phys Chem Med 1978 Oct
PMID:Extensive and equivalent repair in both radiation-resistant and radiation-sensitive E. coli determined by a DNA-unwinding technique. 36 33

Hemodynamic, pulmonary, and renal variables were measured in 24 patients scheduled for major abdominal aortic operations. Control values were obtained before preoperative medications were given. All patients received 5% dextrose in Lactated Ringer's solution intraoperatively. Postoperatively, group 1 patients received 5% dextrose in water plus albumin, group 2 received 5% dextrose in 0.45 sodium chloride solution, and group 3 received 5% dextrose in lactated Ringer's solution. There were significant increases in Qs/Qt and AaDO2, 48 hours after operation in group 3. Oxygen consumption and cardiac output increased in all groups 24 hours after operation. Twenty-four hours later, these two variables returned to control values in group 1 but continued to rise in the other two groups. Significant diuresis occurred in group 1, 48 hours postoperatively, whereas the other two groups continued to retain water. Use of albumin and 5% dextrose in water in the postoperative period seemed to produce less deviations from control values of most measured variables, than the other two groups.
Crit Care Med 1979 Jan
PMID:Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta. 36 9

Thirty patients were studied using NAB-365 (clenbuterol), an exogenous catecholamine with selective beta-2 action to determine various parameters of pulmonary physiopathology. They included: alveolar-arterial gradients in partial oxygen pressures, coefficient of respiratory inefficacy, alveolar ventilation, and intrapulmonary venoarterial short circuits. By studying these parameters before and after clinical administration of clenbuterol we were able to demonstrate a decrease in the alveolar-arterial oxygen gradients (p less than 0.001), decrease in the respiratory inefficacy coefficient (p less than 0.001), increase in alveolar ventilation (p less than 0.001), and a shunt decrease (p less than 0.0025). The drug improves diffusion and oxygenation without affecting the adrenergic cardiac receptors.
Med Clin (Barc) 1979 Jan 10
PMID:[A study of the alveolar-arterial oxygen gradients and intrapulmonary shunt under the action of NAB-365, a new exogenous catecholamine of selective beta-2 action (author's transl)]. 37 94

1. Under hemorrhagic-traumatic shock conditions the depression of the flow and the pressure in pulmonary arteria and of the pressure in the left atrium was significant. The elevation of the pulmonary vessel resistance was significant, the pulmonary circulation time was longer. The depression of the oxygen partial pressure in arterial and venous blood was significant. 2. In comparison to single re-transfusion of the taken blood, the re-transfusion and application of 6-Methylprednisolone (Urbason; 30 mg/kg) could raise the pulmonary pressure and the flow in the pulmonary arteria and the oxygen pressure in the arterial and venous blood over their basic level. 3. After re-transfusion and simultaneous addition of phenoxybenzamine a renewing shock took place caused by a relative hypovolemia. 4. The hemodynamic circulation in the pulmonary and peripherial vessels was restored by hemodilution. While a single infusion of Haemaccel intensified the hypoxemia in comparison to shock conditions, the infusion of albumin (4%) caused no change in measured values. The application of Urbason (30 mg/kg) combined with Haemaccel-infusions raised the arterial and venous oxygen pressure significantly, in comparison to the hypotonic-phase they exceeded the basic values.
Fortschr Med 1979 Apr 26
PMID:[Therapy of so-called shock lung. Experimental animal studies of the lung in shock]. 37 97

Most authors agree that physical training in a cool environment improves tolerance to exercise in the heat and the rate of heat acclimatization, but the extent or degree of improvement remains controversial. The best improvement in heat tolerance for men is associated with intensive interval or continuous training at a training intensity greater than 50% of maximal oxygen uptake (Vo2max) for 8-12 weeks; the Vo2max should be increased 15-20%. Far less is known about the appropriate type, intensity and duration of endurance training associated with improved exercise-heat tolerance in women. The major benefits of physical training appear to apply to both short term (less than 2 hrs) or long term (greater than 2 hrs) exercise-heat exposures for men. Generally, individuals with high Vo2max values (previously trained and endurance athletes) are at an advantage in the heat. Utilization of proper physical training appears to produce about 50% of the total adjustment resulting from heat acclimatization, while increased fitness is associated with greater retention of acclimatization in cool environments. Female athletes appear somewhat better able to tolerate exercise in hot environments than nonathletic females while differences between highly trained females and males do not appear as dramatic as once thought.
Med Sci Sports 1979
PMID:Effects of physical training and cardiorespiratory physical fitness on exercise-heat tolerance: recent observations. 38 34

The influence of a 4-weeks carbohydrate-reduced, fat-rich diet on 9 slightly overweighted men was investigated. Caloric and protein intake remained unchanged. 70% were fat, 20% carbohydrates. Glucose, cholesterol, triglycerids, serumproteins, urea, uric acid, sodium and potassium were measured in rest. At a 60 minutes bicycle ergometer test glucose, triglycerids, free fatty acids and glycerol were registrated before and after 20 and 60 minutes work. The intensity was 70% of the maximal oxygen uptake. These were the most important results: (1) Body weight decreased continuously. One of the causes is an elevated heat production. (2) Serum-protein and -glucose remained unchanged. Cholesterol and triglycerides were reduced. Serum-urea, -sodium and -potassium diminished continually. On the contrary, uric acid raised over the normal range. (3) Work performance was reduced for 20%. (4) Hypoglycemic values did not appear. The oxidation of fat by the working muscles, and fat mobilisation increased by a fat-rich diet.
Med Klin 1979 Sep 07
PMID:[Carbohydrate-reduced diet and metabolism: about the influence of a 4-weeks isocaloric fat-rich, carbohydrate-reduced diet on body weight and metabolism (author's transl)]. 38 65

37 canine kidneys were intermittently perfused with Collins- or Sacks-solution every 2--6 h. 32 of these kidneys were transplanted after 12--24 h storage time. Additionally, 24 kidneys were stored under hypothermia for 12--24 h and then transplanted (control group). During perfusion the oxygen consumption of the kidneys and the enzyme and lactate release were measured. It was impossible to improve the results of hypothermic storage preservation by intermittent perfusion of the kidneys, on the contrary kidney function deteriorated by the number of perfusion processes. The failure of intermittent perfusion is caused by the increase of renal vascular resistance during perfusion. From the oxygen consumption and lactate release measurement it was concluded, that the washout solutions for kidney preservation should contain more substrate which can be utilized under anaerobic conditions to improve the results of hypothermic storage preservation.
Res Exp Med (Berl) 1979 Oct
PMID:[Canine kidney preservation by intermittent perfusion with hypothermic Collins- or Sacks-solution (author's transl)]. 39 64

Enhancement of lethal damage to E. coli B/r by penicillin was observed after X-irradiation under aerobic conditions but not after exposure to X-rays under anoxia or after U.V. (260 nm). No enhancement of damage occurred when incubation with penicillin was delayed for 2 hours after aerobic X-irradiation. This enhancing effect was only detected in this strain and not in the filamentous strain E. coli B. It is concluded that an X-ray induced lesion, sensitive to the presence of oxygen at the time of irradiation and probably located in the cell envelope, initiates filamentation in E. coli B/r, which results in lethal damage in this strain.
Int J Radiat Biol Relat Stud Phys Chem Med 1979 Dec
PMID:An oxygen dependent X-ray lesion in Escherichia coli strain B/r detected by penicillin. 39 50


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