Adel R. Abadir

EFFECTS OF ISOFLURANE AND OXYTOCIN ON GRAVID HUMAN UTERUS IN VITRO

Introduction. Isoflurane (1-chloro-2,2,2triflurroethyl ether) is a well accepted inhalation anesthetic agent used in everyday clinical practice. The agent is relatively insoluble in blood, usually produces minimal hemodynamic.changes, facilitates neuromuscular blockade, and depresses cerebral activity. There are a limited number of publications reporting the depression of contractibility of human uterine muscle by isoflurane in vitro and in vivo (1,2). Blood loss during dilation and evacuation or during delivery was related to isoflurane effect (3). Oxytocin, a synthetic polypeptide, is used to elicit uterine contractions or to control uterine bleeding. The information regarding the isoflurane and oxytocin combined effect on human uterus is limited. In this study we examined the effect of isoflurane on isolated gravid human myometrium and demonstrated the reversibility of this effect.

Anesthesia for Plastic and Reconstructive Surgery

This book consists of 20 chapters written by anesthesiologists familiar with plastic and reconstructive surgery and covers everything from anesthesia equipment and monitoring to ophthalmic reconstructive surgery. Who is this book written for? Some chapters present unnecessary, superficial information suggesting that perhaps the book was intended for surgeons or others interested in a casual explanation of anesthesia for plastic and reconstructive surgery. Examples include: (a) the advice “Auscultation of the chest will reveal whether the endotracheal tube is in the correct position.” is incomplete and outdated in the age of capnography; (b) the chapter on anesthesia equipment quotes the American National Standards Institute’s requirements published in 1979 instead of the improved standards of the American Society of Testing and Materials; and (c) the technique described for cannulation of the right internal jugular vein provides no measures to differentiate arterial versus venous puncture. This book contains other, more disturbing deficiencies. It states ”evaluation of bleeding profile (PTPTT) is necessary when patients are taking aspirin regularly”; the appropriate test would be a bleeding time. The chapter on anesthesia monitoring reprints the minimal monitoring standards practiced by Harvard Medical School in 1986, which were a milestone in patient safety at the time. However, further advances have been made. Considering that plastic surgery is frequently performed under heavy intravenous sedation in a nonhospital surgicenter or office setting, the latest standards approved by the American Society of Anesthesiologists in 1989 and 1990 should have been the cornerstone of the monitoring chapter. These newer standards are mentioned in another chapter on cosmetic surgery. Other chapters are of textbook caliber for practicing anesthesiologists and residents. The chapters on maxillofacia1 trauma and craniofacial surgery are brief, easily read, well-illustrated discussions of complicated areas. Far more complete and accurate information on anesthesia equipment, monitoring, various anesthetic techniques, and regional blocks can be found in a variety of standard anesthesia textbooks. This book is a convenient collection of information on anesthestic concerns for plastic and reconstructive surgery if the reader understands that the book is superficial, incomplete, and somewhat outdated,