Changes in Blood and Interstitial Fluid Resulting From Surgical Operation and Ether Anesthesia 1

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Much consideration has been given to the changes which result in man and in experimental animals from administering by vein various quantities of fluids of different composition (1, 2, 3). Thus, the dislocation of body fluid and the urinary changes which follow rapid infusion of massive quantities of fluid in animals have been described (4,5,6). Shifts of water and salts between muscle and blood after infusion of isotonic fluids of varying pH have been studied in dogs by means of muscle biopsy and analysis (7). The circulatory effects of administering fluid by vein in various clinical conditions have been investigated, having in mind the primary importance of circulatory dynamics in determining response to intravenous fluid therapy (1,8). Such studies have served to emphasize the fundamental conclusions of Gamble (9, 10, 11), Peters (12, 13), and others.In the work on which the present report is based it seemed desirable to determine the results of large amounts of isotonic glucose and NaCl solutions administered by constant intravenous drip over a period of several days. The physiological responses to sustained submaximal infusions were under inquiry rather than the reaction to a large or small intravenous injection of brief duration, for it seemed possible that compensatory mechanisms of a different nature might be brought into play as the infusions were continued. MATERIAL AND METHODSPatients undergoing mild or moderately severe operations under ether anesthesia were studied just before operation, just after operation, at the end of the infusion period, and several days afterwards when the effects of the infusion had subsided. Determinations were made on a fasting basis, and the patients took water as desired during the infusion period but were allowed only small amounts of fruit juices in addition. The patients 'Aided by grants from the William F. Milton Fund, Harvard University, and the Josiah Macy, Jr. Foundation.were well-nourished women without cardiovascular or renal disease. During the study they were under constant observation by trained attendants and, if a patient objected, the infusion was discontinued. Urine was collected quantitatively by an indwelling catheter. Arm or leg veins were used for the infusion, the extremity being splinted, and except for slight redness about the needle in two or three instances no local reaction was noted. The patients were entirely afebrile, or nearly so, during the study. Intake of fluid by oral and intravenous routes and output of urine were totaled at 12-hour intervals. Four patients received 5 per cent glucose solution and six 0.9 per cent NaCl solution.

Section: Methodsmentioning

confidence: 65%

The Effects of Large Intravenous Infusions on Body Fluid 1

Stewart

Rourke²

1942

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“…28, 1939) Estimations of the volume of extracellular fluid in man have been made by calculating the volume of body fluid through which thiocyanate is distributed after the intravenous administration of sodium thiocyanate (1,2,3). In the method as proposed, a known amount of sodium thiocyanate in solution is administered intravenously and blood is drawn for the measurement of the concentration of thiocyanate in the serum 1 or 2 hours after the injection (1,2).…”

mentioning

confidence: 99%

The Rate of Attainment of Diffusion Equilibrium for Thiocyanate Between Plasma and Transudates Following the Intravenous Injection of Sodium Thiocyanate in Patients With Edema

Gilligan¹,

Altschule²

1939

Estimations of the volume of extracellular fluid in man have been made by calculating the volume of body fluid through which thiocyanate is distributed after the intravenous administration of sodium thiocyanate (1, 2, 3). In the method as proposed, a known amount of sodium thiocyanate in solution is administered intravenously and blood is drawn for the measurement of the concentration of thiocyanate in the serum 1 or 2 hours after the injection (1, 2). It has been demonstrated in normal man that the distribution of thiocyanate is rapid and that diffusion equilibrium is attained within 1 hour after injection (1, 2, 3).The time required for the attainment of equilibrium for CNS after intravenous injection of NaCNS in patients with edema has not been established; the present report affords information on this problem. Measurement of the CNS concentrations of serum and edema fluid has been made on samples drawn simultaneously at various times after intravenous injection of NaCNS.To establish the time required for attainment of equilibrium by analyses of transudate and serum it was necessary to know what the concentration of CNS in a transudate should be, in relation to the concentration in the serum, in a given system at equilibrium. Lavietes, Bourdillon, and Klinghoffer (2) observed in a few experiments in edematous patients that the concentration of CNS in the serum was from 5 to 21 per cent higher than in the transudate at equilibrium, when samples were drawn 12 to 64 hours after the administration of CNS. These authors suggest that CNS may combine in some manner with protein. Studies of the protein concentrations of serum and transudate have been made in each instance in the present study, and the difference in CNS concentration between serum and transudate in each case has been analyzed in respect to the difference in protein concentration.

“…Plasma volume studies were conducted on several of the cases immediately before and after operation by Dr. J. D. Stewart. His data appear in another communication (17).…”

Section: Clinical Detailsmentioning

confidence: 90%

The Cardiac Output and Oxygen Consumption of Nine Surgical Patients Before and After Operation 1

Snyder¹

1938

The effects of anesthesia and operation on the circulation and metabolic rate of man have not been accurately determined. A few studies of cardiac output and oxygen consumption have been reported in relation to surgical procedures, but the evidence is incomplete and inconclusive. Polano (1), using Broemser's method (2), has interpreted his data as indicating an increase in cardiac output in the immediate postoperative period. Rehn (3), with the same technic, has described a decrease in cardiac output postoperatively in those patients who show signs of shock and collapse. Broemser's method has been criticized on theoretical grounds (4). Altschule and Volk (5), using the ethyl iodide method, have described the changes in cardiac output and oxygen consumption which accompany total thyroidectomy, but they present no data for the immediate postoperative period. Blalock and his coworkers have found that trauma and hemorrhage (acute experiments) depress the cardiac output of dogs (6); that etherization produces an increase in cardiac output and a slight decrease in oxygen consumption; and that under very deep anesthesia the cardiac output returns to normal or is decreased (7).To determine more definitely the cardiac output and oxygen consumption of human subjects in relation to general surgical procedures, studies have been undertaken on hospital patients before operation, during recovery from anesthesia, and at suitable intervals thereafter. A. Ethyl iodide analysis in presence of ether vapor The effect of ether vapor on the analysis of ethyl iodide by Cool's method (10) was determined by the following experiments.A solution of ethyl iodide was prepared by breaking an ampule containing a known weight of redistilled ethyl iodide under the surface of the solute in a partly filled, calibrated liter flask. Fifty per cent ethyl alcohol was found to dissolve the ethyl iodide more rapidly than water and did not affect the results. This solution was pipetted directly into bromine water to compare the accuracy of this method for determining ethyl iodide with Cool's data. Differences between amounts of ethyl iodide expected and amounts obtained were 0.7, 0.1, and 0.1 per cent of the amount present. Double-ended glass sampling tubes, 500 cc. capacity, were charged with ether vapor, 6 to 8 volumes per cent. The solution of ethyl iodide was pipetted into these tubes which were subjected to Cool's procedure. The discrepancy between amounts expected and obtained was 0.6 and 0.4 per cent in two experiments. These differences are of the same order of magnitude as those described by Cool. Additional experiments conducted with titration bottles (see (9), Section II) and known concentrations of ethyl iodide vapor in the presence of ether gave similar results. Ether vapor was therefore considered to have no appreciable effect on the analysis of small amounts of ethyl iodide by the iodate method. (The presence of ether vapor causes a return of the blue color a few minutes after a titration has been completed, so that uniformity of procedur...