Acta anaesth. scand. 1975, 19, 55-59
Prostaglandin
F 2 alfa
Infusion and Halothane Anaesthesia
H. VEJLSTED and E. B. OBEL Department of Anaesthesiology and Department of Gynaecology and Obstetrics, Rigshospitalet (University Hospital), Copenhagen, Denmark
The cardiovascular reaction to infusion of prostaglandin F2 i l l f a was examined in seven patients during N20-halothane anaesthesia. As in the non-anaesthetized individual, no changes in blood pressure, pulse rate, CVP or ECG occurred during anaesthesia, but a great reflux of enteric juice to the ventricle was noticed only 2-3 min after the beginning of the hormone infusion. I t is concluded that prostaglandin F, may be safely given to patients who are going to be anaesthetized, but the patients must be considered as having a full stomach and therefore treated as such.
Received 9 April, accepted,fir publication
With the increasing use of the prostaglandins as potent labour inducing agents, the number of patients under treatment with or just finishing treatment with the hormone who may have to be anaesthetized is likewise increasing. The prostaglandins (PG) are unsaturated fatty acids possessing vasodepressor and smooth muscle stimulating activity (GOLDBLATT 1933). The work of BERGSTROM (1966) has shown that the factor PG consists of a family of related compounds named El-,, F, and F, a , f a , A and B. The physiological role of the hormone is still unknown, but as surveyed by HORTON(1972), many reports have elucidated some of its biological effects. Studies over the cardiovascular reactions to PG have shown that the A and E series can produce peripheral vasodilatation (BERGSTROM 1966). A vasoconstriction induced by stimulation of the sympatic nervous system or by injection of norepinephrine in dogs is antagonized by PGE, (KADOWITZet al. 1968). The PG of the F series has not been shown to possess any cardiovascular effects (KARIMet al. 1969, CARLSON et al. 1970). The human bronchial muscles are relaxed by PGE, and constricted by PGF, a l f a
53uh 1974
(SWEATMAN & COLLIER 1968). Increased peak flow is measured in asthma patients during & ROETtreatment with PGE (HERXHEIMER SCHER 1971). I n agreement with the finding that PG causes bile reflux to the ventricle in humans (HORTON et al. 1968), BENNET& FLESI~LER (1970) have demonstrated that PGE, relaxes the circular muscles of the gastrointestinal canal, whereas the longitudinal muscles are caused to contract. Furthermore, both the basal and the pentagastrin induced H + secretion in the ventricle is diminished by PGE (WADA& ISHIZAWA 1970). Introduced into clinical application by KARIMet al. in 1968 as a labour inducing agent, the use of PG has so far been confined to obstetrics. I t may be necessary to anaesthetize patients for evacuation of the uterus immediately after PG treatment. We therefore found it of interest to investigate whether the addition of an anaesthetic would alter patient response to already administered PG. U p until now, only PGF, a , f a has been used in the obstetrical department of this hospital and the main anaesthetic agent is halothane. The aim of the present study is to examine the possible interaction between thcse two agents.
56
H. VEJLSTED AND E. B. OBEL
MATERIAL AND METHODS
PGFZ
infusion and anaesthesia
alfa
M'hile the patient was still awake, an infusion of PGFZ a l f a at a rate of 62 ,ug/min was itarted using a Deccadripcounter (Type460),and the abovementioned parameters were registered for a 10-minute period Induction of anaesthesia was carried out using atropine 0.5 mg and enibomal 250 mg intravcnously Tracheal intubation was facilitated by suxamcthonium 50 mg. The patients were connected to a Bird respirator (Mark 7) and serial blood gas analysis assurcd an arterial Pco2 within normal limits. During anothcr 10-minute pcriod of PGFz a I f a infusion (62 ,ug/min), measurements were carried out with the patients under 0 2 - N 2 0 anaesthesia aided by gallaminc, average 100 mg. After this period, the patients werc anaesthctized with OZ-NZO and halothane in various conceritrations from 0.5 to 4% - but constant for every paticnt and another 10-minute period of mrasurements took place under the infusion of PGFz
Patients Seven female patients, otbrrwise healthy as judged by history and routine laboratory tests, who were admitted to the hospital for various gynaecological diseases were included in the investigation. The paticnts were from 20 to 60 ycars of age.
?'remedication Diazepam 10 mg or meperidinc 50 mg and atropine 0.5 mg was given intramusculary 1 h before the investigatory procedures.
.Weasurement procedure5 With the patients in a supine position on the operating table, an i.v. drip with glucose 5% was started. A central venous pressure (CVP) catheter was introduced via an antecubital vein. ECG was monitored, and blood pressure. pulse rate and skin temperature were measured every second minute. After the induction of anaesthesia, a Levin tube was passed into the stomach. The gastric contents were aspirated every 10 minutes and checked for volume, pH and bilr. After every aspiration the tube was flushed with air.
~
All measurements were performed brforc thc surgical intervention. As control material to tlir findings regarding the aspirate, we refer to tht. work of CIIRISTENSEN & SKOVSTED (1975).
140
BP
I3O
mmHg 120 I10 I00 90
PULSE RATE 80 70
CVP
cm H20
36 S K I N 35 TEMP. *C 34 I
l
l
l
l
l
l
l
3 3 ' p I I ' I I I I 3 5 7 9 I I 13 TIME,min. AWAKE i
I
PG F2Q
l
l
I
I
l
I
l
I
l
l
I
I
l
I
l
I
3 5 7 9 I I 13 02-
1
N20 PG F2a
l
I
I
l
I
l
I I
I I
I I
l
I
l
I
3 5 7 9 II 13 HALOT H A N E
1
PGF2Q
l
PROSTAGLANDIN F a
Period
NzO+PGFz
RESULTS Fig. 1 shows the parameters of one patient. I n this case as with the other subjects who were examined, there was no alteration in blood pressure, pulse rate, CVP or skin temperature with the addition of prostaglandin, neither with the patient awake nor under the two types of anaesthesia. The ECG’s examined after the procedure did not show any arrhythmias or changes in ventricular complexes. I n Table 1, the findings concerning the gastric contents are presented. During the 10-minute period of N,O and PGF, alfa an average of 51 ml was aspirated with a pH of 3. During the 10-minute period of halothane anaesthesia, the volume was 125 ml; p H had increased to 5, and the aspirate showed a positive reaction for bile.
INFUSION AND HALOTHANE
Halothane+PGF,
alfa
57
Control
BAILLIE (1 959) monitored 100 patients who, under general anaesthesia, were given methyl-ergometrine intravenously. He found that about 50% of them developed some arrhythmia, all of which were remedied by atropine given intravenously.
PGF2 alfa Our study confirms the finding of K A R I M et al. (1969) and CARL SO^ et a1 (1970) that the infusion of PGF, a , f a to the awake individual has no effect upon the cardiovascular system. We may conclude that the drug may also be given safely in therapeutic doses to patients under general anaesthesia with N,O-halothane since the addition of this anaesthetic, as demonstrated in our report, does not create any alteration in blood pressure, pulse rate, CVP or ECG. The limitations of our investigation are obvious. Only one of the prostaglandins DISCUSSION has been studied in connection with anaesSynthetics thesia. When and if the more potent members The two drugs generally used for uterine of this hormone family, e.g., PGE and PGA contraction in connection with anaesthesia become available for clinical use, they will in obstetric clinics are the synthetics, oxy- have to be separately studied as these hortocine (Syntocinonm) and methyl-ergometrine mones seem to have a place in antihyper(Methergina). As to the compatibility of these tensive treatment (LEE et al. 1971), in the drugs and anaesthesia, several investigations treatment of peripheral vascular diseases & MORRIS (CARLSON & ERIKSSON 1973) and in the have been carried out. ICHIYANAGI (1959) found that oxytocine may be used treatment of peptic ulcers (Robert et al. et al. (1962), 1971). safely with cyclopropane. LIPTON using other anaesthetics, have come to the same conclusion, especially when oxytocine is Increased gastric contents given in a dilute solution. If given as a The observation of the increased gastric conbolus, it creates a transient increase in tents during the administration of PGF, a,fa is cardiac output, a fall in blood pressure and of importance. The Report on Confidential S T changes in the EGG. Enquiries into Maternal Deaths (19723
~
58
H. VEJLSTED AND E. B. OBEL
points to the fact that more than 50% REFERENCES of the deaths due to complications of anaesBAILLIE,T. 1%’. (1959) Influence of ergometrinc on thr thesia were due to aspiration. Even at a pH initiation of the cardiac impulse. 3. Obstet. Gynarc. above 2.5, the aspiration of semi-solid gastric B r i t . Cwlth. 76, 34. B. (1970) Prostaglandins contents may produce chemical pneumonitis BENNET,A. & FLESHLER, and the gastrointestinal tract. Gastroenterology 59, 730. (TEABEAUT 1952). BERGSTROM, S. (1966) The prostaglandins. Recent CHRISTENSEN & SKOVSTED (1 975) examined Progr. Hormone Res. 22, 153. the influence of anaesthesia upon changes CARLSON, L. A,, EKELUND, L. C. & ORO I,. (1970) in gastric contents and pH, using in portions Clinical, metabolic and cardio-vascular cffects of different prostaglandins in man. Acta nzed. scand. 188, of their investigation the same anaesthetic 553. agents and aspiration procedure as we did in CARLSON, L. A. & ERIKSSON, J . (1973) Femoral artery the present work. infusion of PGE, in severe pcriplieral vascular CHRISTENSEN & SKOVSTED (1975) showed diseases. Lancet i, 155. that after 1 h of halothane anaesthesia the CHRISTENSEN, V. & SKOVSTED, P. (1975) Effects of general anaesthetics on the p H of gastric contents i n pH of the gastric contents was 5.1, and the man during surgery: A survey of halothanr, fluroxvolume aspirated in the same period was ene and cyclopropane anarsthesia. Acta anarsth. only 4.7 ml. Under PG infusion, we found a scand. 19, 49. much higher, bile admixed volume after only GOLDBLATT, M. W. (1933) A depressor substdncc in 10 min of halothane anaesthesia. The increase seminal fluid. 3. Soc. Chem. Znd. (Lond.) 152, 1056. H. & ROETSCHER, I. (1971) Effccts of in volume in the present series as compared to HERXHEIMER, & SKOVSTED PGEl on lung function in bronchial asthma. the series from CHRISTENSEN Europ. J . d i n . Pharmacol. 3, 123. (1975) may be due to PGF, HORTON, E. W., MAIN,I. H. M., TIIOMPSON, C..J. & The practical consequences of this obserWRIGHT,P. M. (1968) Effects of orally adminisvation are that every patient who is under tered PGEl on gastric secretion and gastrointestinal motility in man. Gut 9, 655. treatment with or who has just been treated E. W. (1972) Prostaglandins. M o u o g r a f h 011 with PG and who is going to be anaesthetized HORTON, Endocrinology, 7. Springer-Verlag, Berlin, Heidrlberg, must be considered at risk like the “full New York. stomach” patient and treated accordingly. ICHIYANAGI, K. & MORRIS,L. E. (1959) Effcct of
ACKNOWLEDGEMENT The prostaglandin F, Co., Denmark.
was supplied by Upjohn,
ZUSAMMENFASSUNG Bei 7 Patienten wurde wahrend einer NZO-HalothanNarkose die kardiovaskulare Reaktion auf eine Infusion von Prostaglandin-Fz untersucht. Wie bei wachen Personen kommt es zu keinen Veranderungen von Blutdruck, Pulsfrequrnz, zentralem Venendruck oder EKG, aber ein starker Reflux von Darmsaft in den Magen wurde schon 2-3 Minuten nach der Hormonbehandlung beobachtet. Es wird der SchluB gezogen, daB ProstaglandinF, gefahrlos auch Patienten gegeben werden kann, die gelegentlich operiert werden sollen, doch miissen diese als Patienten mit vollem Magen betrachtet und endotracheal intubiert werden.
cyclopropane and various oxytocics on cardiac rhythm in the parturient woman. Anesthesiology 20, 669. KADOWITZ, P. J., SWEET,C . S. & BROIjY, M.J. (1968) Differential effects of PGEx, EZ,F 1 and E12 a ~ f r on adrenergic vasoconstriction in the dog hindpaw. J . Pharmacol. exp. Ther. 177, 641. KARIM,S. M. M., SOMERS, K. & HILILEK, K. (1969) Cardiovascular actions of prostaglandin Iiz a t f a i n man. Europ. 3. Pharmacol. 5, 117. R. R., PATEL,R . C. & KARIM,S. M. M. TRUSSELL HILLIER, K. (1968) The response of the pregnant human uterus to PGF, .II,-induction in labour. B r i t . med. 3. 4, 62 1. LEE,J . B., MCGRIFF, J. (2. KANNEOIESSEK, Il.,AYKEN 1’. Y . Y . , MUDD,J. G. & FRAWLEY.T. F. (1971) Prostaglandin A , : Antihypertcnsive and rrnal effects. Ann. intern. M e d . 74, 703. LIPTON,B., HERSHEY, S. G. & BAIZ,S. (1962) Conipatability of oxytocics with anaesthctic agents. 3. h e r . med. ‘4~s.. 179, 410. Report on Confidential Enquiries into Matcrnal Deaths in England and \Tales 1967-1969. (1972) H.M.S.O., London. ROBERT,A,, STOWE,D. F. & NEZAKKIS, ,J. E. (1971)
PROSTAGLANDIK F 2
Prevention of duodenal ulcers by administration of prostaglandin E2. Scand. 3. Gastroent. 6, 303. SWEATMAN, \.V. J. F. & COLLIER, H. 0. .J. (1968) Effccts of prostaglandins on human bronchial musclc. h’dure (Lond.) 217, 69. TEABEAUT, J. R. (1952) Aspiration of gastric contents. Experimental study. Amer. 3. Path. 28, 51. WADA.T. & ISHIZAWA, M. (1970) Effects of prostaglandins on the function of gastric srcretion. 3 a p . 3. clin. ex$. Med. 28, 2465.
INFUSION AND HALOTHAKE
Address :
Hans t’ejlsted. M.D. Department Rigshospitalrt ’legdarnsvej Copcnhagen 2100 C3
59
Prostaglandin
F 2 alfa
Infusion and Halothane Anaesthesia
H. VEJLSTED and E. B. OBEL Department of Anaesthesiology and Department of Gynaecology and Obstetrics, Rigshospitalet (University Hospital), Copenhagen, Denmark
The cardiovascular reaction to infusion of prostaglandin F2 i l l f a was examined in seven patients during N20-halothane anaesthesia. As in the non-anaesthetized individual, no changes in blood pressure, pulse rate, CVP or ECG occurred during anaesthesia, but a great reflux of enteric juice to the ventricle was noticed only 2-3 min after the beginning of the hormone infusion. I t is concluded that prostaglandin F, may be safely given to patients who are going to be anaesthetized, but the patients must be considered as having a full stomach and therefore treated as such.
Received 9 April, accepted,fir publication
With the increasing use of the prostaglandins as potent labour inducing agents, the number of patients under treatment with or just finishing treatment with the hormone who may have to be anaesthetized is likewise increasing. The prostaglandins (PG) are unsaturated fatty acids possessing vasodepressor and smooth muscle stimulating activity (GOLDBLATT 1933). The work of BERGSTROM (1966) has shown that the factor PG consists of a family of related compounds named El-,, F, and F, a , f a , A and B. The physiological role of the hormone is still unknown, but as surveyed by HORTON(1972), many reports have elucidated some of its biological effects. Studies over the cardiovascular reactions to PG have shown that the A and E series can produce peripheral vasodilatation (BERGSTROM 1966). A vasoconstriction induced by stimulation of the sympatic nervous system or by injection of norepinephrine in dogs is antagonized by PGE, (KADOWITZet al. 1968). The PG of the F series has not been shown to possess any cardiovascular effects (KARIMet al. 1969, CARLSON et al. 1970). The human bronchial muscles are relaxed by PGE, and constricted by PGF, a l f a
53uh 1974
(SWEATMAN & COLLIER 1968). Increased peak flow is measured in asthma patients during & ROETtreatment with PGE (HERXHEIMER SCHER 1971). I n agreement with the finding that PG causes bile reflux to the ventricle in humans (HORTON et al. 1968), BENNET& FLESI~LER (1970) have demonstrated that PGE, relaxes the circular muscles of the gastrointestinal canal, whereas the longitudinal muscles are caused to contract. Furthermore, both the basal and the pentagastrin induced H + secretion in the ventricle is diminished by PGE (WADA& ISHIZAWA 1970). Introduced into clinical application by KARIMet al. in 1968 as a labour inducing agent, the use of PG has so far been confined to obstetrics. I t may be necessary to anaesthetize patients for evacuation of the uterus immediately after PG treatment. We therefore found it of interest to investigate whether the addition of an anaesthetic would alter patient response to already administered PG. U p until now, only PGF, a , f a has been used in the obstetrical department of this hospital and the main anaesthetic agent is halothane. The aim of the present study is to examine the possible interaction between thcse two agents.
56
H. VEJLSTED AND E. B. OBEL
MATERIAL AND METHODS
PGFZ
infusion and anaesthesia
alfa
M'hile the patient was still awake, an infusion of PGFZ a l f a at a rate of 62 ,ug/min was itarted using a Deccadripcounter (Type460),and the abovementioned parameters were registered for a 10-minute period Induction of anaesthesia was carried out using atropine 0.5 mg and enibomal 250 mg intravcnously Tracheal intubation was facilitated by suxamcthonium 50 mg. The patients were connected to a Bird respirator (Mark 7) and serial blood gas analysis assurcd an arterial Pco2 within normal limits. During anothcr 10-minute pcriod of PGFz a I f a infusion (62 ,ug/min), measurements were carried out with the patients under 0 2 - N 2 0 anaesthesia aided by gallaminc, average 100 mg. After this period, the patients werc anaesthctized with OZ-NZO and halothane in various conceritrations from 0.5 to 4% - but constant for every paticnt and another 10-minute period of mrasurements took place under the infusion of PGFz
Patients Seven female patients, otbrrwise healthy as judged by history and routine laboratory tests, who were admitted to the hospital for various gynaecological diseases were included in the investigation. The paticnts were from 20 to 60 ycars of age.
?'remedication Diazepam 10 mg or meperidinc 50 mg and atropine 0.5 mg was given intramusculary 1 h before the investigatory procedures.
.Weasurement procedure5 With the patients in a supine position on the operating table, an i.v. drip with glucose 5% was started. A central venous pressure (CVP) catheter was introduced via an antecubital vein. ECG was monitored, and blood pressure. pulse rate and skin temperature were measured every second minute. After the induction of anaesthesia, a Levin tube was passed into the stomach. The gastric contents were aspirated every 10 minutes and checked for volume, pH and bilr. After every aspiration the tube was flushed with air.
~
All measurements were performed brforc thc surgical intervention. As control material to tlir findings regarding the aspirate, we refer to tht. work of CIIRISTENSEN & SKOVSTED (1975).
140
BP
I3O
mmHg 120 I10 I00 90
PULSE RATE 80 70
CVP
cm H20
36 S K I N 35 TEMP. *C 34 I
l
l
l
l
l
l
l
3 3 ' p I I ' I I I I 3 5 7 9 I I 13 TIME,min. AWAKE i
I
PG F2Q
l
l
I
I
l
I
l
I
l
l
I
I
l
I
l
I
3 5 7 9 I I 13 02-
1
N20 PG F2a
l
I
I
l
I
l
I I
I I
I I
l
I
l
I
3 5 7 9 II 13 HALOT H A N E
1
PGF2Q
l
PROSTAGLANDIN F a
Period
NzO+PGFz
RESULTS Fig. 1 shows the parameters of one patient. I n this case as with the other subjects who were examined, there was no alteration in blood pressure, pulse rate, CVP or skin temperature with the addition of prostaglandin, neither with the patient awake nor under the two types of anaesthesia. The ECG’s examined after the procedure did not show any arrhythmias or changes in ventricular complexes. I n Table 1, the findings concerning the gastric contents are presented. During the 10-minute period of N,O and PGF, alfa an average of 51 ml was aspirated with a pH of 3. During the 10-minute period of halothane anaesthesia, the volume was 125 ml; p H had increased to 5, and the aspirate showed a positive reaction for bile.
INFUSION AND HALOTHANE
Halothane+PGF,
alfa
57
Control
BAILLIE (1 959) monitored 100 patients who, under general anaesthesia, were given methyl-ergometrine intravenously. He found that about 50% of them developed some arrhythmia, all of which were remedied by atropine given intravenously.
PGF2 alfa Our study confirms the finding of K A R I M et al. (1969) and CARL SO^ et a1 (1970) that the infusion of PGF, a , f a to the awake individual has no effect upon the cardiovascular system. We may conclude that the drug may also be given safely in therapeutic doses to patients under general anaesthesia with N,O-halothane since the addition of this anaesthetic, as demonstrated in our report, does not create any alteration in blood pressure, pulse rate, CVP or ECG. The limitations of our investigation are obvious. Only one of the prostaglandins DISCUSSION has been studied in connection with anaesSynthetics thesia. When and if the more potent members The two drugs generally used for uterine of this hormone family, e.g., PGE and PGA contraction in connection with anaesthesia become available for clinical use, they will in obstetric clinics are the synthetics, oxy- have to be separately studied as these hortocine (Syntocinonm) and methyl-ergometrine mones seem to have a place in antihyper(Methergina). As to the compatibility of these tensive treatment (LEE et al. 1971), in the drugs and anaesthesia, several investigations treatment of peripheral vascular diseases & MORRIS (CARLSON & ERIKSSON 1973) and in the have been carried out. ICHIYANAGI (1959) found that oxytocine may be used treatment of peptic ulcers (Robert et al. et al. (1962), 1971). safely with cyclopropane. LIPTON using other anaesthetics, have come to the same conclusion, especially when oxytocine is Increased gastric contents given in a dilute solution. If given as a The observation of the increased gastric conbolus, it creates a transient increase in tents during the administration of PGF, a,fa is cardiac output, a fall in blood pressure and of importance. The Report on Confidential S T changes in the EGG. Enquiries into Maternal Deaths (19723
~
58
H. VEJLSTED AND E. B. OBEL
points to the fact that more than 50% REFERENCES of the deaths due to complications of anaesBAILLIE,T. 1%’. (1959) Influence of ergometrinc on thr thesia were due to aspiration. Even at a pH initiation of the cardiac impulse. 3. Obstet. Gynarc. above 2.5, the aspiration of semi-solid gastric B r i t . Cwlth. 76, 34. B. (1970) Prostaglandins contents may produce chemical pneumonitis BENNET,A. & FLESHLER, and the gastrointestinal tract. Gastroenterology 59, 730. (TEABEAUT 1952). BERGSTROM, S. (1966) The prostaglandins. Recent CHRISTENSEN & SKOVSTED (1 975) examined Progr. Hormone Res. 22, 153. the influence of anaesthesia upon changes CARLSON, L. A,, EKELUND, L. C. & ORO I,. (1970) in gastric contents and pH, using in portions Clinical, metabolic and cardio-vascular cffects of different prostaglandins in man. Acta nzed. scand. 188, of their investigation the same anaesthetic 553. agents and aspiration procedure as we did in CARLSON, L. A. & ERIKSSON, J . (1973) Femoral artery the present work. infusion of PGE, in severe pcriplieral vascular CHRISTENSEN & SKOVSTED (1975) showed diseases. Lancet i, 155. that after 1 h of halothane anaesthesia the CHRISTENSEN, V. & SKOVSTED, P. (1975) Effects of general anaesthetics on the p H of gastric contents i n pH of the gastric contents was 5.1, and the man during surgery: A survey of halothanr, fluroxvolume aspirated in the same period was ene and cyclopropane anarsthesia. Acta anarsth. only 4.7 ml. Under PG infusion, we found a scand. 19, 49. much higher, bile admixed volume after only GOLDBLATT, M. W. (1933) A depressor substdncc in 10 min of halothane anaesthesia. The increase seminal fluid. 3. Soc. Chem. Znd. (Lond.) 152, 1056. H. & ROETSCHER, I. (1971) Effccts of in volume in the present series as compared to HERXHEIMER, & SKOVSTED PGEl on lung function in bronchial asthma. the series from CHRISTENSEN Europ. J . d i n . Pharmacol. 3, 123. (1975) may be due to PGF, HORTON, E. W., MAIN,I. H. M., TIIOMPSON, C..J. & The practical consequences of this obserWRIGHT,P. M. (1968) Effects of orally adminisvation are that every patient who is under tered PGEl on gastric secretion and gastrointestinal motility in man. Gut 9, 655. treatment with or who has just been treated E. W. (1972) Prostaglandins. M o u o g r a f h 011 with PG and who is going to be anaesthetized HORTON, Endocrinology, 7. Springer-Verlag, Berlin, Heidrlberg, must be considered at risk like the “full New York. stomach” patient and treated accordingly. ICHIYANAGI, K. & MORRIS,L. E. (1959) Effcct of
ACKNOWLEDGEMENT The prostaglandin F, Co., Denmark.
was supplied by Upjohn,
ZUSAMMENFASSUNG Bei 7 Patienten wurde wahrend einer NZO-HalothanNarkose die kardiovaskulare Reaktion auf eine Infusion von Prostaglandin-Fz untersucht. Wie bei wachen Personen kommt es zu keinen Veranderungen von Blutdruck, Pulsfrequrnz, zentralem Venendruck oder EKG, aber ein starker Reflux von Darmsaft in den Magen wurde schon 2-3 Minuten nach der Hormonbehandlung beobachtet. Es wird der SchluB gezogen, daB ProstaglandinF, gefahrlos auch Patienten gegeben werden kann, die gelegentlich operiert werden sollen, doch miissen diese als Patienten mit vollem Magen betrachtet und endotracheal intubiert werden.
cyclopropane and various oxytocics on cardiac rhythm in the parturient woman. Anesthesiology 20, 669. KADOWITZ, P. J., SWEET,C . S. & BROIjY, M.J. (1968) Differential effects of PGEx, EZ,F 1 and E12 a ~ f r on adrenergic vasoconstriction in the dog hindpaw. J . Pharmacol. exp. Ther. 177, 641. KARIM,S. M. M., SOMERS, K. & HILILEK, K. (1969) Cardiovascular actions of prostaglandin Iiz a t f a i n man. Europ. 3. Pharmacol. 5, 117. R. R., PATEL,R . C. & KARIM,S. M. M. TRUSSELL HILLIER, K. (1968) The response of the pregnant human uterus to PGF, .II,-induction in labour. B r i t . med. 3. 4, 62 1. LEE,J . B., MCGRIFF, J. (2. KANNEOIESSEK, Il.,AYKEN 1’. Y . Y . , MUDD,J. G. & FRAWLEY.T. F. (1971) Prostaglandin A , : Antihypertcnsive and rrnal effects. Ann. intern. M e d . 74, 703. LIPTON,B., HERSHEY, S. G. & BAIZ,S. (1962) Conipatability of oxytocics with anaesthctic agents. 3. h e r . med. ‘4~s.. 179, 410. Report on Confidential Enquiries into Matcrnal Deaths in England and \Tales 1967-1969. (1972) H.M.S.O., London. ROBERT,A,, STOWE,D. F. & NEZAKKIS, ,J. E. (1971)
PROSTAGLANDIK F 2
Prevention of duodenal ulcers by administration of prostaglandin E2. Scand. 3. Gastroent. 6, 303. SWEATMAN, \.V. J. F. & COLLIER, H. 0. .J. (1968) Effccts of prostaglandins on human bronchial musclc. h’dure (Lond.) 217, 69. TEABEAUT, J. R. (1952) Aspiration of gastric contents. Experimental study. Amer. 3. Path. 28, 51. WADA.T. & ISHIZAWA, M. (1970) Effects of prostaglandins on the function of gastric srcretion. 3 a p . 3. clin. ex$. Med. 28, 2465.
INFUSION AND HALOTHAKE
Address :
Hans t’ejlsted. M.D. Department Rigshospitalrt ’legdarnsvej Copcnhagen 2100 C3
59
