Cardiovascular and electroencephalographic effects of laudanosine in "nephrectomized" cats.

We studied a cat model simulating laudanosine accumulation in the "anephric" patient. Cardiovascular effects were seen only with the bolus doses of laudanosine 2 mg kg-1, and at plasma laudanosine concentrations unlikely to be achieved clinically. Similarly, EEG and power spectra analysis showed no evidence of epileptiform activity at all plasma laudanosine concentrations achieved.

Clinical pharmacokinetics of the newer intravenous anaesthetic agents.

In the last 15 years the role of opioids in anaesthesia management has undergone dramatic change. Initially used as premedicants, or adjuvants to inhalation anaesthetic agents or as analgesics for postoperative pain relief, narcotics have now evolved into primary anaesthetic agents, primarily because of their ability to maintain cardiovascular stability especially in patients with compromised myocardial function. Sufentanil, alfentanil, and lofentanil are 3 new synthetic congeners of fentanyl.

In vitro degradation of atracurium in human plasma.

The degradation of atracurium and the formation of laudanosine was examined in vitro in both Sorensen buffer and human plasma using sensitive, specific high pressure liquid chromatographic assays to determine drug concentrations. At normal physiological pH and temperature, the degradation of atracurium was threefold more rapid in plasma than in buffer. Laudanosine is the major end-product of atracurium degradation in buffer or in plasma; its production is more rapid in plasma than in buffer.

Craftsman versus professional: analysis of the controlled drinking controversy.

With the publication of the Pendery et al. follow-up of the Sobells' experimental studies of controlled drinking, serious questions about the relationship of paraprofessionals (i.e.

Cardiovascular and pharmacodynamic effects of high-dose fentanyl in newborn piglets.

To understand better the hemodynamic effects of fentanyl anesthesia on the developing newborn, the authors studied the changes in cardiac output and its four determinants (preload, afterload, heart rate, and contractility) and plasma fentanyl kinetics in newborn piglets following the administration of high-dose fentanyl with or without atropine premedication. Twenty-five healthy farm piglets were divided into four groups. Hemodynamic studies were conducted on five who received 50 micrograms/kg intravenous fentanyl, five controls who received only 0.

Enflurane, halothane and isoflurane do not inhibit angiotensin converting enzyme activity.

We studied the effect of halothane, enflurane and isoflurane on angiotensin converting enzyme (ACE) activity using [3H]-benzoyl-phenylalanyl-alanyl-proline (BPAP) as a substrate. Isolated rabbit lungs were perfused in a recirculating system in vitro with BPAP in Krebs-Ringer solution. The rate of metabolism and per cent metabolism were determined before and after treatment for 30 minutes with four MAC multiples of enflurane, halothane or isoflurane.

Atracurium infusion requirements in children during halothane, isoflurane, and narcotic anesthesia.

We were interested in determining the dose-response relationship of atracurium in children (2-10 yr) during nitrous oxide-isoflurane anesthesia (1%) and the atracurium infusion rate required to maintain about 95% neuromuscular blockade during nitrous oxide-halothane (0.8%), nitrous oxide-isoflurane (1%), or nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 sec at 10-sec intervals.

Anesthesia for pediatric orthotopic liver transplantation.

The anesthetic management of 68 liver transplantations in 50 pediatric patients is described. The surgical technique is briefly reviewed. The selection of an anesthetic technique was not as important as management of numerous intra-operative problems.

Hemodynamic effects of halothane in the newborn piglet.

In order to better understand the mechanism of hypotension and bradycardia in newborn infants under halothane anesthesia, we studied the changes in the four determinants of cardiac output in newborn piglets given 0.5 and 1% end tidal halothane. Cardiac index (CI) was measured by thermodilution.

Clinical pharmacology of atracurium in infants.

The neuromuscular effects of atracurium were studied in 25 infants anesthetized with 1.0% end-tidal halothane and N2O-O2. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 sec at 10-sec intervals.

Uptake and distribution of halothane in infants: in vivo measurements and computer simulations.

We measured uptake of halothane (the fraction of halothane in expired gas divided by the fraction of halothane in inspired gas, FE/FI) with a mass spectrometer over time in 7 infants less than 3 months of age. FE/FI for halothane in these infants increased more rapidly than has been described in adults by others. In addition, we developed a mathematical model for halothane uptake and distribution that incorporates age-dependent anatomic and physiologic parameters (alveolar ventilation, functional residual capacity, cardiac output, brain volume, etc).

Clinical pharmacology of atracurium in paediatric patients.

The potency of atracurium was determined in adolescents and children during nitrous oxide-halothane and nitrous oxide-thiopentone-fentanyl anaesthesia using single dose-response curves. Dose-response curves were parallel. The effective doses producing 95% twitch depression (ED95) (mg kg-1) during nitrous oxide-halothane were larger in younger children than in the adolescents.

Enflurane, halothane, and isoflurane inhibit removal of 5-hydroxytryptamine from the pulmonary circulation.

We were interested in determining the effect of enflurane, halothane, and isoflurane on the uptake and removal of 5-hydroxytryptamine (5-HT) and phenylethylamine (PEA) from the lung. Isolated rabbit lungs were perfused in a recirculating system in vitro with 0.1 microM [14C]5-HT or 0.

Xanthine oxidase-induced lung injury inhibits removal of 5-hydroxytryptamine from the pulmonary circulation.

We were interested in determining the effect of lung injury initiated by superoxide anions and hydroxyl radicals on removal of 5-hydroxytryptamine (5-HT) and phenylethylamine by the isolated perfused lung. The rate of removal and percentage of removal of these bioamines was determined before and after lung injury initiated by perfusion of the lung with hypoxanthine (HX) and xanthine oxidase (XO) or xanthine oxidase alone for 10 or 30 minutes; free radicals are generated by such treatment. Because of variation in removal of bioamines among lungs of different animals, the effects of lung injury on bioamine removal were determined by calculating the percentage of inhibition of removal using data from the control and test period for each lung.

Muscle relaxants in infants and children.

In the first 2 years of life there is physical and biochemical maturation of the neuromuscular junction of man. With this maturation there is an increase in the neuromuscular reserve (margin of safety) of the infant and a change in the contractile properties of skeletal muscle. On a weight basis neonates and young infants are resistant to both depolarizing and non-depolarizing muscle relaxants; when dosage is calculated on the basis of surface area neonates and young infants are not resistant to succinylcholine, but appear sensitive to non-depolarizing relaxants.

Intracranial pressure: monitoring and normalization therapy in children.

The clinical course of 42 children with intracranial pressure monitoring was reviewed. Intracranial hypertension was documented in a variety of diagnostic categories. Therapy was titrated to maintain a baseline intracranial pressure of less than 15 torr (mm Hg), and to decrease the frequency of spontaneous and reactive pressure waves.

Advantages of infant ventilators over adapted adult ventilators in pediatrics.

A lung simulator with variable compliance and resistance components was used to evaluate the dynamic compliance of the Bournes, Babybird, and Pediatric Emerson postoperative ventilators. With increase in airway pressure from combined changes in compliance and resistance, the internal compliance of the Bournes was lowest and the internal compliance of the Emerson was highest. With low constant airway resistance (50 cm/L/sec), the Babybird exhibited tidal volume losses similar to those of the Bournes in the face of decreased lung compliance.