Læknablaðið - 15.09.1983, Blaðsíða 4

190
LÆKNABLAÐID
NÝR DOKTOR í LÆKNISFRÆÐI - GÍSLIH. SIGURÐSSON
Nýlega varði Gísli H. Sigurðsson doktorsrit-
gerð sína við háskólann í Lundi. Heiti hennar
er: Enflurance and Halothane Anaesthesia in
Children. Cardiac arrhythmias and stress re-
sponse during adenoidectomy. Útdráttur úr
ritgerðinni fer hér á eftir:
Cardiac arrhythmias are frequently observed
during surgical procedures in the mouth and
throat and serious complication occasionally
occur, even in healthy individuals. The present
investigation deals with differential diagnosis,
incidence, etiological factors and prevention
of ventricular arrhythmias occurring during
inhalation anaesthesia with enflurane and
halothane in children undergoing adenoidec-
tomy.
ECG (including oesophageal ECG), heart
rate, capillary pulsation, mean arterial blood
pressure, respiratory rate, thoracic impedance,
end-tidal C02 tension, blood gases, plasma con-
centrations of catecholamines, ACTH, cortisol
and 17- a-hydroxyprogesterone were follo-
wed during the study.
It was found that anomalously shaped QRS
complexes occurring during halothane anaes-
thesia usually are manifestations of ventricular
arrhytmias rather than aberrantly conducted
supraventricular beats.
The incidence of ventricular arrhythmias was
highest in non-intubated children anaestheti-
zed with halothane. It was markedly reduced
with endotracheal intubation and controlled
ventilation. During enflurane anaesthesia the
incidence of ventricular arrhythmias was low
irrespective of which anaesthetic technique
was used. The high incidence of arrhythmias
during halothane anaesthesia was correlated
with high plasma catecholamine levels, while
the low incidence with enflurane was correla-
ted with low catecholamine levels. A sedative
premedication containing morphine, diaze-
pam and hyoscine significantly decreased end-
ocrine and symphathetic stress response to
surgery during halothane anaesthesia and
almost eliminated the occurrence of ventricu-
lar arrhythmias with this agent.
When inhalational induction with enflurane
or halothane is used for adenoidectomy intu-
bation and controlled ventilation would be
preferred and for halothane an effective pre-
medication is also recommended.