Alan J. Ominsky

A prospective random comparison of halothane and morphine for open-heart anesthesia: one year's experience.

In 128 consecutive operations, a prospective, randomized comparison of morphine and halothane as primary agents for cardiac valvular repair and/or replacement was made. During induction, average systolic and mean blood pressures were lower (9 torr and 6 torr, respectively) with halothane than with morphine. However, the incidences of serious hypotension with the two agents were similar. Six of 61 patients with halothane and seven of 67 patients with morphine reached systolic blood pressures of 70 torr or less before incision. Intraoperative hypertension was more frequent and more severe with morphine, necessitating frequent use of supplementary chlorpromazine. Cardiac output data suggest that the higher average blood pressure seen with morphine was related to increased peripheral vascular resistance rather than increased cardiac output. There appeared to be hemodynamic differences between the agents, but neither mortality rates nor durations of hospital stay or postoperative stay in the intensive care unit demonstrated a clear–cut advantage of either morphine or halothane for anesthesia during cardiac–valve operations.

A Departmental Policy Addressing Chemical Substance Abuse

Substance abuse is a major socioeconomic problem. However, the ready availability of potent narcotic and sedative drugs probably constitutes a unique risk for anesthesiologists. Until recently, few anesthesia departments were prepared to recognize or safely manage afflicted colleagues. Because we felt it important to educate our staff and residents and to have a response mechanism established prior to the advent of a substance abuse problem, a departmental committee was formed to develop a Substance Abuse Policy. The policy has served to increase our general awareness and to direct our actions effectively when dealing with physician impairment. It is presented here in the belief that other departments might find it useful in tailoring their approach to this problem.

Sodium bicarbonate and systemic hemodynamics in volunteers anesthetized with halothane.

The cardiovascular effects of acute metabolic alkalosis (NaHCO3) in normal male volunteers anesthetized with halothane were measured. Pure metabolic alkalosis was studied by maintaning the end-tidal carbon dioxide tension at 40 torr. In each subject, cardiac index increased and total peripheral resistance decreased after each dose of NaHCO3. The increased cardiac index was associated with increased central blood volume, left ventricular minute work index, stroke index, and heart rate. Systolic time intervals showed increased myocardial performance. NaHCO3 administered to volunteers whose hearts were depressed by halothane appeared to cause peripheral vasodilation, volume expansion, and myocardial stimulation. The authors conclude that NaHCO3 administered during halothane anesthesia decreases total peripheral resistance and may lead to severe hypotension.

A Simple Aid to Blind Tracheal Intubation

An aid to blind endotracheal intubation using a miniature condenser microphone with amplifier and stereo headphones to amplify breath sounds has been previously described (1). A simple and less expensive method of amplifying breath sounds uses a piece of 30-inch intravenous extension tubing (Abbott Hospitals, Inc., North Chicago, IL) with one end inserted 2-3 cm into the proximal end of an endotracheal tube (Fig. l), and the other connected to the end of an earpiece adapter or placed directly into the anesthetists ear. The connector can be cut from the extension tubing to facilitate placement in a smaller endotracheal tube, if necessary. Breath sounds are well amplified, even in the presence of a metal stylet, and the anesthetist can directly observe the patient while performing the intubation.