Anthony F. Kirkpatrick

Ultra-long-duration local anesthesia produced by injection of lecithin-coated methoxyflurane microdroplets.

This study was designed to evaluate a new drug delivery system. The authors undertook to determine if microdroplets prepared by encapsulating volatile anesthetics with a membrane of lecithin could be used for local anesthesia. Local anesthesia was determined by monitoring the response of the rat to tail clamping and electrical stimulation of the skin following the intradermal injection of the microdroplets. Microdroplets were prepared from isoflurane, enflurane, halothane, methoxyflurane, diethyl ether, chloroform, and heptane. Although all microdroplet preparations produced local anesthesia, only methoxyflurane microdroplets produced an ultra-long duration of local anesthesia (approximately 24 h). Further characterization of the methoxyflurane microdroplets revealed two important differences from conventional local anesthetics. First, the local anesthetic effect of methoxyflurane reached a plateau that did not change significantly for 20 h while the injection of lidocaine and bupivacaine resulted in a peak effect that returned to baseline within 1 and 3 h, respectively. Second, the anesthetic effect of methoxyflurane remained essentially localized to the site of injection, while the anesthetic effect of lidocaine and bupivacaine migrated 15 cm in less than 1 h. The toxicity and safety of methoxyflurane were evaluated. When administered over the dosage range 1–16% (v/v) intradermally, or by injections into muscle, or by repeat injections every 4 days for 16 days, all animals regained their pre-treatment response to painful stimulations, and there was no evidence of gross injury to tissue. Deliberate intravenous injection of 0.8 ml of 6.7% (v/v) methoxyflurane microdroplets had no apparent anesthetic or toxic effect. The present study demonstrates that methoxyflurane microdroplets produce an anesthetic effect that is highly localized, stable in intensity, ultra-long in duration, and reversible.

A protocol-contract for opioid use in patients with chronic pain not due to malignancy

The legal, psychosocial, and medical factors that we believe have contributed to the success of our protocol-contract in prescribing opioids to patients with chronic pain not due to malignancy are outlined. These factors may be applicable to the treatment of a variety of chronic nonmalignant pain syndromes such as postherpetic neuralgia or human immunodeficiency virus/acquired immunodeficiency syndrome. The intended target audience of this paper is the physician (primary care, chronic pain specialist) who is involved in prescribing opioids for the treatment of chronic, nonmalignant pain.

Infusion of large particles of thiopental sodium during anesthesia induction

STUDY OBJECTIVE To determine the potential clinical significance of admixtures of thiopental sodium and acidic drugs, which are used during induction of general anesthesia and can cause the formation of particles of thiopental. DESIGN Using an infusion setup similar to that used for a rapid-sequence induction of general anesthesia, injection of either pancuronium bromide or vecuronium bromide caused formation of particles of thiopental that were measured using a particle analyzer. The effects of delaying the injection of the muscle relaxant on particle formation and the effects of plasma on particle dissolution were studied. MEASUREMENTS AND MAIN RESULTS The thiopental particles had a diameter of 17 to 39 microns, with a concentration of 15,000 to 20,000 particles/ml. Particle formation was prevented when a 30-second delay preceded administration of pancuronium or vecuronium following injection of thiopental. No particle formation was detected when succinylcholine was injected. Human plasma was far more effective than a crystalloid solution in dissolving thiopental particles. CONCLUSIONS It is unlikely that clinically significant particles of thiopental will remain intact upon entering the bloodstream. However, mixing thiopental with pancuronium or vecuronium has the potential of disrupting intravenous access due to occlusion with particles.

Cuban President Fidel Castro's health-care system

Denying food and medicine to Cuba’s civilian population in an effort to effect political change represents a sad and shameful episode in the history of the USA. Theodore MacDonald’s A developmental analysis of Cuba’s health care system since 1959 focuses on the impact of the US Trade Embargo on Cuba’s health system under the leadership of Fidel Castro since the overthrow of the dictator Fulgencia Batista on Jan 1, 1959. Many of the statistics come from a little-known 300-page report published in March, 1997, by the American Association for World Health (AAWH), a US Committee that serves the WHO. MacDonald points out many examples from the AAWH report where the Cuban people were denied specific medical products because of the US embargo. However, his book does not reveal the US Government’s response to AAWH study. In a “Fact Sheet”, the US State Department gives direct quotes from a group of anonymous Cuban doctors who recently arrived in the USA. They were “mystified” by the AAWH report.These nameless doctors “categorically and authoritatively state that our people’s poor health care situation” is the fault of the political regime. The State Department loses all credibility when it uses anonymous quotes to refute scientific data. Furthermore, the State Department now contradicts itself on the health consequences of the Cuban embargo. On the same page of its new website that it asserts “the US embargo does not deny medical supplies to the Cuban people”, it also concedes that the USA denies some medical supplies. In the Jan 18, 2000, issue of the Annuals of Internal Medicine, Secretary of State Madeleine Albright again denies the health consequences of the embargo. Madame Secretary asserts that “food and medicine have always been exempt from sanctions” against Cuba. Yet Cuba’s health system (which is operated by the Cuban Government) is absolutely banned by the US embargo from purchasing basic foodstuffs and is severely restricted from purchasing medicines and medical equipment from US companies worldwide. By repeatedly carrying out such deception, the State Department has made a significant contribution to blocking legislation to restore shipments of food and medicine essential to the health of Cuba’s civilian population. Other falsehoods promulgated to this day on the internet by the State Department through its “Fact Sheet” about the Cuban embargo include false statements about how much Cuba spends on health care and the amount of medical sales to Cuba. One can only assume that the misrepresentations are deliberate, since they were brought to the attention of the State Department by me and other people with research data on several occasions in the past 2 years. In July, 1997, the State Department told the Los Angeles Times it would evaluate research data on the issue and if there was an error on its “Fact Sheet” it would correct it. No correction has been forthcoming. While a difference over what is the best foreign policy is one thing, deliberately misrepresenting the facts is quite another, especially when the consequence of the deception contributes to the denial of food and medicine to civilians. It is disappointing that the State Department has stooped to such tactics. Perhaps the most interesting portion of the book— notwithstanding the State Department’s claims to the contrary—is the description of the extraordinary impCuban President Fidel Castro’s health-care system