Clinical and Experimental Investigation in Spinal Anesthesia.*

Bower, John O.; Wagoner, George; Clark, James H.

doi:10.1213/00000539-192601000-00048

Cited by 2 publications

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“…In explaining the hypotension of spinal anesthesia, it may be noted that Nowak (70) has argued in favor of a -toxic effect of the anesthetic after systemic absorption, but this explanation seems to have been excluded by the intravenous injection of large doses (27,9). We have observed no evidences of systemic toxicity or central respiratory depression in spite of relatively large doses of procaine intrathecally.…”

Section: The Evidence Bearing On the Autononmy Of The Peripheral Artementioning

confidence: 62%

“…But the denervated vessels of the ear in the rabbit, of the paws in dogs, etc., and of the hands and feet in man, ultimately recover their normal caliber, demonstrating that even in the skin, where tonic vasomotor activity 9 Neither Seevers and Waters (89) nor Bower et al (9) discuss the significance of venous pressure measurements relative to the atmosphere before and after paralysis of the thorax, nor consider the effect of position of the animal, which presumably was tied down upon its back. And neither Polano (74) nor Schuberth (86) question the validity of cardiac output measurements by indirect methods during thoracic paralysis.…”

Section: The Evidence Bearing On the Autononmy Of The Peripheral Artementioning

confidence: 99%

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The Effects of Spinal Anesthesia on the Circulation in Normal, Unoperated Man With Reference to the Autonomy of the Arterioles, and Especially Those of the Renal Circulation

Smith

Rovenstine²,

Goldring³

et al. 1939

J. Clin. Invest.

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The present study, comprising observations on 21 subjects given high spinal anesthesia, is an investigation of the effects of anesthetic denervation in normal man, uncomplicated by surgical intervention, on the circulation with particular reference to the vascular bed of the kidney. It is concluded that the renal arterioles are distinctly autonomous, in the sense that under basal conditions the renal vascular tone is not affected by anesthetic denervation. Our observations further suggest that the arteriolar bed generally (apart from the skin) possesses considerably more autonomy than is usually attributed to it-sufficient, in fact, in the normal supine individual at rest, to maintain an essentially normal arterial pressure. We find no evidence of significant arteriolar dilatation during high spinal anesthesia, such reduction in blood pressure as occurs being attributable, we believe, to diminished circulating blood volume in consequence of dilatation of the capillaries, venules, and veins.Part I deals with the following topics: (1) Methods; (2) the effects of spinal anesthesia on renal blood flow; (3) on the arterial pressure, and (4) on the reflex responses to posture, hypercapnia, and anoxemia. Part II consists of a review of the evidence on (5) the existence of tonic vasoconstrictor activity and on (6) the existence of autonomy in the peripheral arterioles generally, and (7) in the kidney in particular, and (8) the peripheral effects of hypercapnia and anoxemia. In (5) it is brought out that the notion of tonic vasoconstrictor activity in the sympathetic nervQus system, apart from the skin, is based largely upon animal experiments which are seriously complicated by general anesthesia, venous dilatation, etc., and that the information so obtained cannot be transferred with confidence to normal animals, and certainly not to man.PART I MethodsThe subjects were male convalescent patients ranging in age from 18 to 50 years who, with a single exception, presented no abnormal signs contraindicating selection for this study. They were examined in the morning in the basal, fasting condition, and were prepared for the measurement of renal blood flow and filtration rate by the clearance method, as described by Smith, Goldring, and Chasis (93). In the earlier observations the phenol red and inulin (35) clearances were followed, but after the introduction of the diodrast clearance (93), all three clearances were used. The phenol red clearance serves as a check on the diodrast clearance, the constancy of the phenol red/diodrast clearance ratio before and after anesthesia demonstrating that procaine per se has no effect upon the tubular excretory mechanism. The infusions corresponded to the typical infusion cited by Chasis, Ranges, Goldring, and Smith (18). Zero time was taken as the beginning of the priming infusion, which occupied about 10 minutes; the infusion was then changed to the sustaining infusion, the first urine collection period being started at about 30 minutes. The sustaining infusion was usually interrupted ...

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Section: The Evidence Bearing On the Autononmy Of The Peripheral Artementioning

confidence: 62%