Central nervous system symptoms after intravenous lignocaine: dose-response during pregnancy.

There is continuing controversy over what dose of what drug should be used to identify an accidental intravascular or subarachnoid catheter placement in obstetric epidural anaesthesia. The purpose of this randomized, double-blind study was to evaluate the dose-effect relationship for the production of central nervous system (CNS) symptoms by intravenous lignocaine. Sixty first-trimester, pregnant patients divided into groups of 10 received saline or one of five doses of lignocaine (0.

Enteral absorption of octreotide: absorption enhancement by polyoxyethylene-24-cholesterol ether.

1. The somatostatin octapeptide-analogue octreotide was absorbed as an intact peptide from the gastro-intestinal tract with an absolute bioavailability of about 0.3% in rats.

In vitro-in vivo correlation for modified-release formulations.

A correlation of in vitro dissolution rate measurements with in vivo pharmacokinetic results in a human study was obtained for a sustained-release formulation of bromocriptine. Different methods were applied to reach this correlation, and the various outcomes were compared.

Lumbovertebral syndrome after extradural blood patch.

We describe a patient who developed an immobilizing lumbovertebral syndrome after an extradural blood patch and who was hospitalized with a suspected extradural abscess. An infectious aetiology of the persistent backache could be excluded and the patient recovered with analgesics and physiotherapy. The probable aetiology is discussed.

Laryngospasm during transtracheal high frequency jet ventilation.

A 74-year-old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.

Dreaming and anaesthesia: total i.v. anaesthesia with propofol versus balanced volatile anaesthesia with enflurane.

Sixty consecutive ASA Grades I and II patients scheduled for elective ear, nose and throat surgery were randomly assigned to receive either total i.v. anaesthesia with propofol ('propofol group') or 'balanced technique' with thiopentone induction followed by N2O and enflurane.

Severe head injury: should expected outcome influence resuscitation and first-day decisions?

An early 'prognosis' based on initial findings can influence clinical decisions. To evaluate the quality of first-day outcome prediction based on either clinical or neuroradiological information, we prospectively examined 100 consecutive severely head-injured patients from the surgical intensive care unit. The prognoses were always made by the same experienced neurosurgeon and neuroradiologist according to a contracted Glasgow Outcome Scale (GOS).

Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?

To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). The DNR and mortality rates within the first 48 hours (13%, 10%, 10%, respectively) as well as for the entire stay in the surgical intensive care unit (SICU) were comparable for the three groups.

The absorption site of cyclosporin in the human gastrointestinal tract.

1. An emulsion preparation of cyclosporin was administered locally to different parts of the small and large intestine by gavage: to the duodenum (opposite to the papilla of Vater), jejunum (150 cm distal to the teeth), ileum (300 cm distal to the teeth), and to the colon descendens (30 cm proximal to the anus). 2.

Failure of continuous three-channel Holter monitoring to detect acute peri-operative myocardial infarction.

Continuous peri-operative three-channel Holter monitoring in a 70-year-old patient undergoing elective hip arthroplasty failed to show onset and progression of a lethal postoperative myocardial infarction, which was clearly visible in a 12-lead electrocardiogram. The modified bipolar leads used for Holter monitoring differed from the corresponding leads of the 12-lead electrocardiogram. The limitations of Holter monitoring applied to clinical management and research are highlighted.

Pharmacokinetics and pharmacodynamics of a new transdermal delivery system for bopindolol.

1. In two separate studies, each with 12 healthy male volunteers, the pharmacokinetic and dynamic properties of a transdermal delivery system for bopindolol were evaluated. 2.

Comparison of orthodox with fibreoptic orotracheal intubation under total i.v. anaesthesia.

Fibreoptic orotracheal intubation was compared with orthodox laryngoscopy and tracheal intubation using a total i.v. technique with propofol in 60 ASA I and II patients.

Is the end-tidal partial pressure of isoflurane a good predictor of its arterial partial pressure?

End-tidal partial pressure of isoflurane (PE'iso) may be used as a measure of anaesthetic depth. During uptake, an arterial partial pressure (Paiso) which is considerably less than PE'iso (Paiso/PE'iso much less than 1) leads to underestimation of depth of anaesthesia and, during elimination, PE'iso/Paiso much less than 1 will lead to an overestimation of anaesthetic depth. We measured Paiso/PE'iso during a 60-min uptake period of 1% isoflurane and PE'iso/Paiso during the subsequent 60-min elimination period in 26 patients (age 13-88 yr, ASA I-III) undergoing various surgical procedures.

Pulse oximetry in methaemoglobinaemia. Failure to detect low oxygen saturation.

The results of pulse oximetry saturation in a patient with a high level of methaemoglobinaemia, who subsequently underwent intravenous methylene blue treatment, are presented. The reasons for the erroneously low values after treatment are explained. Pulse oximeters currently available are not helpful in patients treated with methylene blue and should be used with caution in patients who present with cyanosis of unknown origin.

The measurement of expiratory oxygen as disconnection alarm.

The efficacy of an oxygen-monitoring alarm in the expiratory limb of an anesthetic circuit was evaluated as a method of detecting disconnections of the patient from the anesthetic machine. Oxygen concentrations were determined in the expiratory limb of a semiclosed anesthetic circuit with a ventilator and a 2-1 reservoir bag serving as a simple lung model. Adjustments of ventilation during the different measurements were a PEEP of 5 cmH2O, respiratory rates of 10/min and 5/min, and tidal volumes of 1,000 and 500 ml, respectively.

Isoflurane causes more severe regional myocardial dysfunction than halothane in dogs with a critical coronary artery stenosis.

The effects of 1) isoflurane (ISO)- and halothane (HAL)-induced hypotension to a mean aortic pressure (AoP) of 55 mmHg, and 2) of substituting ISO and HAL for each other at a mean AoP of 55 mmHg on global and regional left ventricular performance (ultrasonic dimension technique) and on coronary hemodynamics (electromagnetic flow probes) were studied in eight open-chest dogs (anesthetized and paralyzed by continuous infusions of fentanyl and pancuronium) with a critical coronary artery stenosis (micrometer-controlled snare) of the left anterior descending coronary artery (LAD). The stenosis reduced resting coronary blood flow by 5% (P less than 0.05) without affecting global or regional myocardial performance.

Cardiovascular effects of diltiazem in the dog.

The effects of two bolus injections (0.2 mg kg-1) and two infusion rates (0.2 mg min-1 and 0.

Anaesthetic uptake and elimination: is there a difference between halothane and isoflurane in the dog?

In two groups of dogs, the uptake and elimination of halothane and isoflurane were studied using a closed-loop anaesthetic system which automatically controlled end-tidal halothane and isoflurane partial pressures at equi-MAC concentrations. Haemodynamic and respiratory variables were recorded and the anaesthetic partial pressures were measured in the inspired and expired air, as well as in the arterial, cerebrovenous and mixed venous blood. The controller delivered a higher inspired partial pressure of halothane than of isoflurane to compensate for the higher blood/gas partition coefficient.

Influence of ventilatory and circulatory changes on the pharmacokinetics of halothane and isoflurane.

In two groups of dogs, uptake and elimination of halothane and isoflurane were studied using a closed-loop anesthesia system which automatically controlled end-tidal halothane or isoflurane partial pressure at minimal alveolar concentration (MAC) equivalent levels. Hemodynamic and respiratory variables were recorded and the anesthetic partial pressure was measured in the inspired and expired air, as well as in the arterial, cerebrovenous and mixed venous blood. Data were recorded during wash-in, hyperventilation, hypercirculation, hypotension and wash-out.

Value of a specific bradycardic agent in cardiac surgery compared to placebo.

The effects of alinidine on systemic and pulmonary haemodynamics and the ECG were studied in 8 patients early after open heart surgery as a double-blind cross-over comparison between alinidine and placebo. Placebo had no effect on any of the measured variables. Alinidine given as an i.

Anesthesia and the immune system.

While the direct effects of anesthesia on immunological competence have not yet been fully elucidated, it is clear that the use of certain anesthetics and anesthetic procedures contributes to reduced immune function, as demonstrated by such clinical markers as increased infection and tumor growth. This review evaluates evidence of the participation of anesthesia in suppression or activation of the immune system, and discusses the implications of these changes to patient care and outcome.