J.Jpn. Surg. Soc.. 54(2): 126-133, 1953
Original article
CLINICAL AND EXPERIMENTAL STUDY ON THE ACTION CURRENT OF THE AUTONOMIC NERVOUS SYSTEM AND THE PULSE WAVE CURVE IN SURGERY
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Surgical Department, Tokyo University Branch Hospital (Directer: Assist. Prof. Takeo HAYASHIDA) TANAKA Taihei |
In this study the action current and arterial pulse wave was observed in animal giving evidence of hitherto so called "nervous reaction to stress". Further it was shown that there was close correlation between the tenseness of autonomic nerve and the pulsewave speed. In clinicial study change of tenseness of autonomic nerve was proved. Resultantly there was little doubt about the exsistence of "nervous shock,"
In 134 rabbits nearly a single nerve fiber was dissected from the right cervical sympathic and parasympathic nerve and its centrifugal action currents were recorded. At the same time pulse pressure waves were recorded from the left carotid artery and a femoral artery. Thus prepeared rabbits were exposed to trauma, electric shock, hemorrhage or anesthesia and were given adrenaline, acethylcholine or potassium phosphate solution. Thereby the proportion of the number of spikes from recordings of sympathic and parasympathic action currents was found to correlate most closely to pulse wave speed. In 37 patients volume pulse waves were taken from the left carotid and femoral artery before and after operation or anesthesia.
(I) Experimental Study
1) Beating at abdomen. Parasympathic spikes increased immediately after beating and decreased gradually. Sympathic spikes increased immediately after beating, (usually it was greater than parasympathic spikes) but recovered in a few minutes. Thereafter decreased to minimum in 10 or 30 minutes followed by recovery or increase beyond the pretraumatic number in 50 to 60 minutes.
2) Slight trauma. (a slap at abdomen or crushing of a testicle). Sympathic and parasympathic spikes showed the same change as above only in slight degree and of short duration. Therefore, so to speak shock is only a situation in which posttraumatic change is severe.
3) Electric shock. Electric shock produced clinical shock only when circulating current was enough or cardiovascular disturbances proceded electric stimulation. In these cases the same reaction appeared as traumatic shock, but as sympathic inhibition appeared immediately after the electric stimulation relative parasympathicotony appeared early.
If the current was passed through thorax the parasympathicotony appeared immediately and it shifted to the sympathicotony after several seconds, while, sympathicotony appeared immediately after the passage through head.
4) Hemorrhage, Anesthesia. Hemorrhage produced a few minutes of parasympathicotony followed by sympathicotony.
Anesthesia (urethane, scopolamine) decreased both the sympathic and parasympathic spikes, but as sympathic decreased was earlier relative parasympathicotony appeared.
5) Intrathecal injection of potassium phosphate. (This had been used for treatment of nervous shock by other authors) This increased both sympathic and parsympathic spikes, but sympathicotony appeared because of particular increase of sympathic spikes. Intramuscular adrenaline increased sympathic spikes and acethylcholine increased parasympathic spikes.
6) Pulse wave speed corresponded well with ratio of sympathic and parasympathic spikes, though blood pressure, pulse rate, cardiac output didn't.
7) Physical change of shock appeared at first in action current of autonomic nerve preceding the change of blood pressure, pulse rate, respiration, pulse wave speed or cardiac output.
8) Nervous shock related well with autonomic nerve, whereas secondary shock did less.
(II) Clinical Study
1) Pulse wave speed increased postoperatively in cases of poor state even if blood loss had been replaced or recovered from anesthesia. It recovered relatively in early period in the course of postoperative convalescence. It was dangerous sign if the pulse wave speed abruptly dropped in the period of increase.
2) Pulse wave speed dropped transiently after spinal anesthesia. Result was not constant when scopolamine and morphine was used.
3) It was shown that cilculation of cardiac output by equation of Broemser and Ranke was simple and corresponded well with postoperative condition of patients.
(author's abstract)
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