Abstract
With a view to investigating the Peripheral Circulatory Insufficiency particularly in the field of surgical operations, the author has under-taken a circulatory analysis by means of modification of Wezler's methods which is among those used in connection with the physical methods for circulatory analysis. Two electric manometers, of the identical capacity, were attached to the carotic artery and the crural artery so as to record their pulse waves, from which were calculated the circulatory values by the Wezler formula. A total of 96 cases were subject to the investigation were examined before and after a surgical operation to observe the Circulatory Insufficiency throughout. The findings before the operations indicated 42% was accounted for the circulatory regulation of " Anspannungs " and in terms of diseases, the stomach cancer and cardia cancer cases claimed more than half in this category and those of the esophagus cancer nearly the half. The tachycardia cases at a resting period before the operation increased by 20%. In-stances of low cardiac output were noted in the patients of the cancer of digestive organs. The findings after the operations indicated that the majority of "Anspannungs" circulatory regulation took place right after the operations. A better circulatory condition after the operation was observed with a general anesthesia rather than with a spinal anesthesia. The fact that blood transfusion during the operation had a beneficial effect on the post operative low cardiac output behavior testified to the existence of a relationship between the two. Changes in the circulatory regulation owing to an operation were of the normal type but, depending on the nature of cases involved, there had appeared the patients who required the "Anspannungs " regulation immediately after their operations, only returning to the normal with the lapsing of time. It was also made clear that in such cases where the cardiac output was low both before and after the operations, the general tendency was to incur a circulatory insufficiency. In determining whether a case of low cardiac output occurred or not, indications were employed that before an operation the pulse pressure count was under 40 mmHg and after an operation the pulse pressure count was under 40 mmHg and the heart beat count was either over 100 or under 70. In the pre-operation study, 75% of the cases and post-operation study, 100 of the cases falling under the former category were diagnosed as being the low cardiac output. As the conclusions, it has been establised that though is a great deal of the "Anspannungs" circulatory regulation this is by no means a contraindication for any type of circulatory regulationin in surgical operation. A general anesthesia is preferred in a surgical operation, a blood transfusion during an operation had a beneficial effect on the subsequent low cardiac output, the use of some cardiotonic is recommended. On the determination of low cardiac output by means of the pulse pressure count is available especially immediately after the operation. Finally, it is considered that Wezler modification method is a useful tool in the precaution of the Peripheral Circulatory Insufficiency to be encountered in surgery.
