The effects of oral transmucosal fentanyl citrate premedication on preoperative behavioral responses and gastric volume and acidity in children.

The authors compared the safety, efficacy, and effects on gastric volume and pH of oral transmucosal fentanyl citrate (OTFC) premedication and of placebo lollipop and no premedication in 55 children undergoing elective operations. The patients were randomly assigned to receive no premedication (group A, N = 18); OTFC containing 15-20 micrograms/kg of fentanyl citrate (group B, N = 18); or a placebo lollipop (group C, N = 19). Activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures, heart and respiratory rates), and pulse oximetry determined oxygen saturation were measured before and at 10-min intervals after premedication until the patients were taken to the operating room.

Effects of inhalation anaesthetics on filtration of venous gas emboli by the pulmonary vasculature.

Venous gas emboli are prevented from reaching the systemic circulation by filtration in the pulmonary vasculature. This filtration can be overwhelmed by exceeding certain critical rates of venous air infusion. To characterize further these filtration phenomena, the effects of pentobarbitone, isoflurane and halothane anaesthesia on the incidence of spillover of venous bubbles into the arteries were studied in groups of nine dogs.

A comparison of different methods of lubrication of glass syringes used to identify the epidural space.

Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. The unpolished saline lubricated syringes had a mean (SD) static force of 53.

Effect of the Trendelenburg position on the distribution of arterial air emboli in dogs.

We examined the effects of buoyancy on the distribution of arterial gas bubbles using in vitro and in vivo techniques in dogs. A simulated carotid artery preparation was used to determine the effects of bubble size and vessel angle on the velocity and direction of bubble movement in flowing blood. Because buoyancy tends to float bubbles away from dependent areas, bubble velocity would be expected to decrease as the vessel angle increased.

Mechanisms of succinylcholine-induced arrhythmias in hypoxic or hypoxic:hypercarbic dogs.

To evaluate the effects of succinylcholine on cardiac arrhythmias and serum levels of potassium and catecholamines, dogs with hypoxia alone and with hypoxia and hypercarbia were studied during anesthesia with halothane or enflurane. After the injection of succinylcholine (0.3 mg/kg), cardiac arrhythmias occurred in all halothane:hypoxia dogs and in 70% of dogs given halothane during hypoxia:hypercarbia.

Arterial air embolism of venous origin in dogs: effect of nitrous oxide in combination with halothane and pentobarbitone.

The effects of using nitrous oxide (N2O) with halothane or pentobarbitone anaesthesia on the filtration of venous air emboli (VAE) by the pulmonary circulation were studied in dogs. Dogs anaesthetized with either pentobarbitone, pentobarbitone/N2O, halothane, or halothane/N2O were embolized with venous air into the right atrium at 0.25 to 0.

Removal of tracheal secretions in anesthetized dogs: balloon catheters versus suction.

Artificial secretions were removed by suction (using 12- or 18-French suction catheters) or by means of a balloon-tipped catheter (6-French Fogarty arterial embolectomy catheter) in 20 experiments performed on five dogs anesthetized with halothane. Each dog had 5 ml of mucin injected 10 cm down the endotracheal tube prior to a 30-sec period of intermittent positive pressure ventilation. After this procedure, the ventilator was disconnected and the secretions were removed by suction with the 12- or 18-French catheters or by the Fogarty catheter.

Anaesthesia for the achondroplastic dwarf.

Over the past three years, 36 anaesthetics were administered to 27 patients with achondroplastic dwarfism. Twenty-four patients underwent craniectomy for foramen magnum stenosis. Sixteen of the operations were undertaken in the sitting position with nine incidents of venous air embolism (VAE), all of which occurred in patients under 12 years of age.

Etomidate infusion for resection of phaeochromocytoma. A report of 2 cases.

Anaesthesia in patients undergoing resection of phaeochromocytomas is associated with fluctuations in blood pressure and cardiac dysrhythmias. Two patients in whom an etomidate (Hypnomidate; Janssen Pharmaceutica) infusion was used as a supplement to droperidol, fentanyl, pancuronium, air and oxygen anaesthesia are described. Cardiovascular stability was well maintained; the advantages of this technique are discussed.

Neurolept anaesthesia using etomidate as the hypnotic agent.

A technique of neurolept anaesthesia using etomidate (Hypnomidate; Janssen) instead of nitrous oxide is described in which a continuous infusion of 1 mg/kg/h is used to supplement droperidol, fentanyl and alcuronium. This totally intravenous technique eliminates theatre pollution, may offer haemodynamic stability and may be of use in patients with raised intracranial pressure. Pain on injection and muscle movements which occur with etomidate administration do not detract from the value of this technique.

Factors governing the effective remediation of negative affect and its cognitive and behavioral consequences.

The present experiment tested the hypothesis that the remediation of negative emotion will be most effective when the remedial procedure matches the experience or cognition that induced the negative state--process-specificity hypothesis. Other hypotheses examined were that negative states induced by cognitive reflection related to the self would be resistant to remediation, even by a same-process positive procedure, and that changes in emotional expressions may make it appear that a negative state has been effectively remediated when lingering effects on behavior and cognition indicate that it has not. Negative emotional states were induced in second-grade children by one of four processes, all of which involved social rejection content: cognition that focused on (a) the self (thinking about oneself being rejected by a peer) or (b) another person (thinking about a peer being rejected); or experience that related to (c) oneself (actually being socially rejected) or (d) observing another (vicarious: seeing a peer be socially rejected).

Etomidate infusion for neuro-anaesthesia. A case report.

The successful administration of an etomidate infusion as a supplement to droperidol, fentanyl, muscle relaxant, air and oxygen anaesthesia in an 8-hour neurosurgical procedure is described. The merits of this technique are discussed, with particular emphasis on the conduct of anaesthesia in a patient with raised intracranial pressure.

Awareness during total intravenous anaesthesia using etomidate. A case report.

Total anaesthesia using a combination of droperidol and fentanyl and an etomidate infusion was induced and maintained intravenously in a 29-year-old patient undergoing laparotomy for a colonic resection. Post-operatively the patient complained of awareness. Possible explanations for this are discussed.

The treatment of resistant hypotension with ornipressin. A case report.

A 50-year-old man underwent emergency aortic valve replacement. He had been treated with five antihypertensive agents before the procedure; this contributed to the development of profound hypotension after induction of anaesthesia. The hypotension did not respond to conventional treatment with an incremental intravenous infusion of phenylephrine HCl, probably due to the direct vasodilator action of the hydralazine group of drugs which renders the peripheral vascular smooth muscle unresponsive to sympathomimetic stimulation.

Hypnosis with etomidate during total intravenous anaesthesia.

Etomidate (Hypnomidate; Ethnor) in an alcoholic solution was used as the hypnotic component of a technique of total intravenous anaesthesia in an open pilot evaluation in 50 patients undergoing surgery. No anaesthetic gases were used. Despite cardiovascular stability, lack of respiratory depression and a short awakening time, unwanted movements by the patients made total intravenous anaesthesia with this technique unsatisfactory.