In order to study the adjustment of central circulation to postural changes and the mechanism of orthostatic fainting, the pressure in the brachial artery, the pulmonary artery, the right ventricle and heart rate (HR) were recorded in sixteen healthy young men, both supine and after tilting to 45 degrees and 90 degrees head up, before (normovolaemic, NV) as well as after (hypovolaemic, HV) withdrawal and reinfusion of (mostly) 950 g blood (about 15% of blood volume, BV). Two subjects fainted in supine HV, two in 90 degrees NV, four disclosed impending symptoms of fainting, and two fainted in 90 degrees HV. 'Fainters' differed from the others by smaller BV in relation to body height, higher HR in 90 degrees NV and lower arterial mean pressure in HV. In the three fainting situations, right ventricular enddiastolic pressure (PRveD) was markedly lowered to or below 0 mmHg. Arterial diastolic pressure (PaD) was not correlated with PRveD, but the pulse pressure decreased with the fall in PRveD. In 90 degrees HV, PaD fell in the six subjects who fainted or disclosed impending symptoms. Irrespective of the situation, the fainting attack involved a sudden decrease of HR and arterial pressure, concomitantly with a first unchanged then increased PRveD and/or pulmonary artery diastolic pressure. A reflex control of the filling volume/pressure of the heart is assumed to precipitate fainting by counteracting the arterial blood pressure regulation.

Postoperative pain control after RRP with oral oxycodone hydrochloride, paracetamol and extra morphine on demand is preferable to EDA when pain control as well as mobilization and costs are taken into account.

No abstract

In eight healthy men 950 g of blood (12.2 17.6% of the blood volume) was withdrawn and reinfused after about half an hour. Respiration and circulation were studied by analyses of expiratory gas, blood gases and data from right heart catheterization. On hemorrhage oxygen uptake and cardiac output decreased by 10 and 28%, repectively; both varied indirectly with the blood loss. The pressures in the right ventricle, pulmonary and systemic arteries fell without relation to the cardiac output. Mean heart rate did not change significantly, but a moderate positive covariation (P less than 0.05) between heart rate and arterial blood pressure was found during bleeding. This result was confirmed by the relative bradycardia noted in the period prior to reinfusion. On refilling of the bood the oxygen uptake and the pulmonary arterial pressures increased above the initial value. The heart rate varied directly with the arterial pressure also during reinfusion. The observations demonstrate a depression of the metabolism and circulation on moderate hemorrhage. Part of these effects is tentatively referred to a lowered set point of the arterial baroreflexes.