Comparison of bretylium and lidocaine in the prevention of ventricular fibrillation after aortic cross-clamp release in coronary artery bypass surgery.

The authors compared bretylium and lidocaine for reducing the incidence and persistence of ventricular fibrillation following aortic cross-clamp release performed during coronary artery bypass surgery. Thirty-three adult patients scheduled for elective bypass surgery were randomly assigned in a double-blind fashion to receive a bolus of bretylium, 10 mg/kg, lidocaine, 2 mg/kg, or saline, in equal volumes prior to the release of the aortic cross-clamp. Coronary artery bypass surgery was conducted using standard cardiopulmonary bypass (CPB) procedures with systemic cooling to 24 degrees to 28 degrees C.

Nifedipine-induced hypotension and mesenteric ischemia.

We have presented a case in which nifedipine-induced hypotension in a patient receiving beta blocker and nitrate therapy precipitated mesenteric angina, leading to emergency exploratory celiotomy. Although paradoxic angina is an unusual complication of this antianginal therapy, it should be considered in any patient who has acute abdominal pain and hypotension while receiving this therapeutic regimen.

Continuous thoracic epidural analgesia for the control of pain associated with pleural sclerosis.

Successful use of nonnarcotic, thoracic epidural analgesia for the control of pain associated with pleural sclerosis was accomplished in three gynecologic oncology patients with severe respiratory compromise due to malignant pleural effusions. Excellent analgesia was obtained with no observed anesthetic complications.