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Canadian Journal of Anesthesia, Vol 12, 107-120, Copyright © 1965 by Canadian Anesthesiologists' Society

The Unfavourable Effects of Prolonged Anaesthesia

LEROY D VANDAM MD1

1 Director of Anaesthesia, Peter Bent Brigham Hospital, and Clinical Professor of Anaesthesia, Harvard Medical School, Boston, Mass

In the light of recent investigations I have undertaken to re-examine the thesis that prolonged anaesthesia may be shocking. Discussion was confined to the pharmacological properties and manner of administration of anaesthetics, although it is recognized that many effects cannot be distinguished from those produced by operation. Not only may anaesthetics alter physiology intra-operatively, but their physical properties suggest that retention in the body can extend untoward effects into the postoperative period. As an example of postanaesthetic shock the instance was cited of postoperative hypotension refractory to vasopressor drugs Some of the common abnormalities underlying this condition were enumerated, and each subsequently examined for possible anaesthetic complicity.

Through several mechanisms, anaesthetics may contribute to postoperative diminution in plasma volume. Anaesthetic respiratory depression and the pattern of intermittent positive pressure breathing applied induce significant hypoxia. The influence of anaesthetics on renal function leads to water and salt retention. Disturbances in intermediary carbohydrate metabolism wrought by anaesthetics may aid in the development of metabolic acidosis. Finally under some circumstances anaesthetic administration may introduce infection and the prolonged use of nitrous oxide suppress the bone marrow.

Although the picture has been magnified, the total of the changes cited could add considerably to the burdens of an already chemically ill surgical patient. If this thesis is an acceptable one, and operations or other procedures requiring prolonged anaesthesia continue to be necessary, it is apparent that anaesthetics must be selected and given with a view to minimizing their supposed shocking properties.

Note:

The sixth Dr Harry Shields Lecture, The University of Toronto, November 13, 1964






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Copyright © 1965 by the Canadian Anesthesiologists' Society.