[EEG-effects of halothane. Studies on 50 patients (author's transl)]

Induction of anaesthesia with 1 vol% halothane N2O/O2 3:1 was electroencephalographically registrated in 50 patients between 20 and 80 years. Blood pressure - and pulse rate - measurements were taken at regular intervals. The clinical course of anaesthesia and changes in EEG corresponded. 4-5 min after the beginning of inhalation the first clinical and encephalographic signs were seen: The base-line-electroencephalogram changed characteristically. Weak rhythms disappeared; fast frequencies of 10-32 Hz developed accompanied by clinical excitation, and at the same time low waves of 2-4 (6) Hz increased and became dominant. Distinguishing EEG-features of deep anaesthesia: 15 min after the beginning of halothane inhalation. Here was flattening with high delta (theta) activity. Anaesthesia was lowered by intubation. EEG showed signs of alpha theta or increasing fast activity. In good correlation the blood pressure and pulse rate increased. Deviations from this general behaviour were recorded in patients in poor condition and with blood pressure levels below the need of cerebral blood flow demands.

Inhibition of the hypotensive effect of plasma protein solutions by C1 esterase inhibitor

The hypotensive effect of stable plasma protein solution (SPPS) is a well-known phenomenon, causing serious problems in surgical patients and patients supported by cardiopulmonary bypass. Kinins are believed to be responsible. A study was made to prevent this hypotension by adding C1 esterase inhibitor to the SPPS and comparing this with 5% human albumin. The results shows a significant difference between the effects of SPPS and SPPS plus C1 esterase inhibitor infusion on bypass. Five percent human albumin did not cause hypotension. Possible sequelae are discussed.

Bradykinin, plasma protein fraction, and hypotension

A directive from the Food and Drug Administration indicates that the use of plasma protein fraction (PPF) is contraindicated during cardiopulmonary bypass because of possible hypotension. Bradykinin has been implicated as the cause of this hypotension. Bradykinin levels were measured by radioimmunoassay in PPF and in 5% albumin and were found to be consistently elevated in the former and occasionally in the latter. The addition of PPF to pump primes resulted in significantly elevated levels of bradykinin, which rapidly cleared, indicating that extrapulmonary sites of bradykinin inactivation were efficient. The potential hypotensive effect of PPF was observed by determining the change in mean perfusion pressure in two groups of patients: one group with a 3,000 ml crystalloid prime and the other with a prime of 2,000 ml of crystalloid and 1,000 ml of PPF. There was no significant difference in the perfusion pressure between the two groups at any point, and the hypotensive effects seen in both groups were readily treated, suggesting that the directive against the use of PPF during cardiopulmonary bypass may be unnecessarily restrictive.

Balanced intraintestinal nutrition: digestion, absorption and biological value of selected preparations of milk proteins

The absorption of an enzymatic hydrolysate of whey proteins, hydrolysates of milk proteins and casein, 7% hydrolysate of bovine blood produced by Polfa under the trade name "Aminokwasy", and a standard mixture of amino acids from isolated small intestine loop of dogs and rats was compared. The composition of amino acids of the initial proteins and hydrolysates obtained from these proteins was determined. The biological value of selected proteins and hydrolysates was assessed determining the mean weight gain, nitrogen content of the body, urinary excretion of urea and creatinine, blood urea level and NPU. No significant differences were found in the absorption of nitrogen from the hydrolysate of milk and whey proteins. The nutritional value of whey protein hydrolysate was, however, slightly higher than that of an analogous hydrolysate of milk proteins. It seems that of all tested proteins whey hydrolysate (free of lactose) is the most suitable source for obtaining preparations for no-residue intraintestinal feeding.

Systemic anaphylaxis secondary to the use of 5 per cent plasma protein fractions

A severe anaphylactic reaction developed in a twenty-six year old female after the administration of only 40 ml of 5 per cent plasma protein fractions (Plasmanate). The reaction was characterized by generalized tingling, chest pain, sudden severe hypotension, and urticaria. The patient responded to intravenous fluid, epinephrine, diphenylhydramine, and steroid administration.

[Improvement of parenteral feeding through the additional administration of a serum protein solution]

On 7 days - 5 postoperative - patients undergoing Billroth I or Billroth II were continuously infused apparatively witn an amino acid mixture of 100% and a glucose-xylitol-solution of 25% (group I). One group (group II) additionally received a serum protein solution. From the first preoperative day to the fifth day of the postoperative period we determined individual parameters in blood and urine. A decrease of serum phosphate level beginning on the first day after starting parenteral nutrition was observed. In the nitrogen balances, in total protein and albumin concentration there were no differences, but serum gamma-globulin concentration of group II was very low at the end of the parenteral nutrition period, a point which at present cannot be explained.

Plasma exchange with plasma protein fraction and lactated Ringer's solution using the continuous flow cell separator

Ten patients underwent 50-70 percent plasma exchanges using the continuous flow cell separator. The exchange material consisted of Plasma Protein Fraction (PPF) and Lactated Ringer's Solution (LRS) instead of fresh frozen, modified or lyophilized plasma. No bleeding or other complications were encountered. The coagulation factor activity after exchange was above that required for hemostasis. The procedure is safe, expeditious and efficient.