In order to better understand the pathophysiologic changes in the immediate postoperative period after total hip replacement surgery and to distinguish alterations due to the surgical operation from those due to bed rest, we examined rheologic parameters and red cell metabolism of patients before, 1 day after, and 5 to 6 days after total hip replacement and compared the results to those obtained from normal volunteers placed at bed rest for 5 days. Bed rest in the control group led to increases in hematocrit, mean corpuscular hemoglobin concentration, red cell DPG and ATP levels, and plasma concentrations of total proteins, globulins, and fibrinogen, with attendant increases in whole blood viscosity, plasma viscosity, blood viscosity, relative blood viscosity with hematocrit adjusted to 45 %, and viscometric aggregation index, and the viscosity of red cell suspensions in Ringer's solution at 45% hematocrit decreased at low shear rate. The patient group, despite the postoperative lowering of their hematocrit, mean corpuscular hemoglobin concentration, and total plasma proteins and a consequent decrease of whole blood viscosity, revealed disproportionate increases in blood viscosity, relative blood viscosity, and viscometric aggregation index. These rheologic changes, which reflect an enhanced red cell aggregability, may contribute to complications of thrombophlebitis. Enforced inactivity, when superimposed on the effects of trauma, blood loss, transfusion with bank blood, and the lowflow state, would exaggerate these rheologic problems. The results suggest that management of total hip replacement patients should include hemorrheologic considerations (e.g., preoperative intentional hemodilution) and early postoperative activity.
1. Nine male and six female healthy subjects were studied during supine bicycle exercise at workloads of 12 and 37 W; pedalling rates varied between 30 and 50 cycles/min at each workload. Measurements were made of oxygen consumption (Vo2), carbon dioxide production (Vco2), minute ventilation (VE), tidal volume (VT), respiratory frequency (fR), inspiratory and expiratory time (TI, TE) and mean inspiratory flow (VT/TI) using a non-invasive canopy–computer–spirometer system. 2. At rest, males had greater values of VE, VT, TI, inspiratory duty cycle (TI/TTOT), Vco2 and Vo2, and a lower fR, than females. 3. At the lower workload, Vo2, Vco2, VE, VT and VT/TI increased linearly with increasing pedalling rate, whereas at the higher workload there was a decrease in Vo2 and little or no change in ventilatory parameters from 30 to 50 cycles/min except for an increase in fR in females. 4. While performing supine exercise, there was an effect of pedalling rate on ventilatory and metabolic parameters at the low workload (12 W) which diminished at the higher workload (37 W). An increase in pedalling rate appears to enhance efficiency at these low workloads. 5. Differences between the sexes during exercise generally include: (a) a higher breathing frequency, (b) a greater mechanical efficiency, and (c) lower ventilatory equivalents of O2 and CO2 (VE/Vo2 and VE/Vco2) during the higher workload in females than males.
Lipolysis was studied by measuring glycerol turnover (GTO) in injured and infected patients. GTO was elevated two to three times the normal values in five injured and four infected patients during D5W infusion. No correlation was found between GTO and plasma glycerol concentration in the two patient groups. GTO showed similar levels when measured during TPN in five injured and three infected patients. During TPN, plasma FFA levels remained unchanged in injured but decreased by 48% in septic patients. B-OH butyrate concentrations were high during D5W and dropped in both groups during TPN. Norepinephrine urinary output was high in both groups during D5W and TPN. Conclusions: 1) GTO was elevated two to three times the normal range in injury and infection; plasma glycerol concentration was not related to GTO. 2) In face of high catecholamine output, the insulin response to TPN did not inhibit TG breakdown but did decrease plasma ketone body concentrations.
This study was done to examine the criteria for determining the adequacy of preoperative total parenteral nutrition (TPN). We hypothesized that an important criterion for adequate preoperative nutrition should be a contraction of the expanded extracellular fluid compartment known to occur in malnourished patients undergoing surgical treatment. Clinical evidence of this included a rise in the serum albumin level and weight loss. Fifty-nine patients requiring preoperative nutritional support for at least five days were admitted to the study. The patients were divided into three groups (group 1, group 2a and group 2b) based upon the response of the patients to TPN. Group 1 consisted of 23 patients who demonstrated a rise in serum albumin value, loss in body weight and diuresis after seven days of TPN. Group 2 was made up of 36 patients who failed to demonstrate a rise in the albumin level in response to nutritional support for one week. Of these patients, 20 underwent operation at the end of a week of nutritional support (group 2a) while 16 patients received four to six weeks of nutritional support preoperatively (group 2b). The complication rate in the three groups was 4.3 per cent for those in group 1; 45 per cent for those in group 2a and 12.5 per cent for those in group 2b (p less than 0.05), group 2a versus group 2b). The results of this study demonstrate a high mortality and morbidity in patients who fail to increase the serum albumin level after one week of TPN. The data suggest that a prolonged period of parenteral nutrition results in a substantial decrease in perioperative complications in this group of patients.
1. Low level exercise is frequently used to assess cardiac and pulmonary function. This study examines the differences in both metabolic and respiratory patterns between the sitting and supine position. 2. Six normal male subjects were studied in both positions during four levels of exercise (12.5, 25, 37.5 and 50 W). Oxygen consumption (Vo2), carbon dioxide production (Vco2) and minute ventilation (Ve2) were greater when sitting as were the ventilatory equivalents to O2 (Ve2/ Vo2) and CO2 (Ve2/ Vco2). 3. Respiration was compared at equivalent workloads; the greater minute ventilation observed during sitting was due to greater tidal volumes (Vt) and mean inspiratory flows (Vt/Vi,). Expiratory time (Te) was longer and inspiratory duration shorter under most conditions when sitting. 4. When breathing patterns were compared at similar degrees of minute ventilation, Vt, Te and Vt/Ti were greater when sitting, while respiratory frequency (fr) was slower.
