Charles L. Burstein

Protecting Action of Procaine Against Ventricular Fibrillation Induced by Epinephrine During Cyclopropane Anesthesia

Conclusions The experiments presented support the contention that when procaine is administered to cyclopropanized dogs the incidence of ventricular fibrillation following epinephrine administration is reduced. Sixty percent of the animals developed ventricular fibrillation after injection of one test dose of epinephrine. When procaine was previously administered all animals were protected, and the introduction of 8 test doses of epinephrine were required to produce the fatal complication. The results also indicate that procaine may be efficient in the treatment of ventricular fibrillation induced in the dog by epinephrine during cyclopropane anesthesia. In every instance in which procaine was given intravenously at the time when ventricular tachycardia occurred following the administration of epinephrine, recovery was effected.

PEDIATEIC PREANESTHETIC PREPAEATION

Present concepts of pediatric preanesthetic preparation are described.Factors involved consist of a modified psychological preparation, a technique of preanesthetic hypnosis produced by a small dose of thiopental sodium administered rectally, procaine amide to diminish reflex hyperactivity, and the use of banthine® as a drying agent.

Protecting Action of Chemicals Related to Procaine on Ventricular Fibrillation During Cyclopropane Anesthesia

Conclusions The administration of p-amino benzoic acid, the calcium double salt of benzyl succinic and p-amino benzoic acids, or sodium p-amino benzoate prior to a test dose of epinephrine during cyclopropane anesthesia reduced the incidence of ventricular fibrillation. The intracardiac injection of procaine at the time when ventricular fibrillation developed effected a return to normal in a number of cases. Ventricular fibrillation was not ameliorated by the intracardiac injection of the other three p-amino benzoic acid derivatives. The authors wish to express their appreciation for the helpful suggestions of Dr. Arthur C. DeGraff.

Effect of Some Short-acting Barbituric Acid Derivatives on Intestinal Activity in vivo.

Conclusion The short-acting barbituric acid derivatives studied when injected intravenously cause an immediate depression of rhythmic intestinal contractions and tonus. This primary effect, however, is transient and is succeeded by a more prolonged phase characterized by increase in both intestinal contractions and tonus.

Effect of Spinal Anesthesia on Intestinal Activity

Conclusion Spinal anesthesia causes an increase of intestinal contractions in the normal, unmedicated, dog.

Toxicity of Intravenous Paraldehyde

Conclusions The intravenous administration of paraldehyde as recommended for clinical anesthesia is not without danger. In experimental animals there is a narrow margin of safety (Minimum Anesthetic Dose-Minimum Lethal Dose). Massive diffuse pulmonary hemorrhages and dilatation of the right heart occur when animals are killed with minimum lethal doses. Pulmonary hemorrhages are present in animals having recovered from anesthetic doses.

Apnea during anesthesia

Abstract 1. 1. Observations of clinical cases are presented which corroborate the experimental findings that when central respiratory depression and anoxemia are present the administration of oxygen may further depress respiration to the point of respiratory arrest. 2. 2. When the two conditions, depressed respiratory center and anoxemia, exist, respiration is carried on mainly by an “anoxemic stimulus” mediated through the carotid body. 3. 3. Morphine medication is a frequent factor in causing central respiratory depression with ensuing hypoxemia resulting in respiratory activity maintained by an “anoxemic stimulus.” Further addition of an anesthetic agent enhances the central depression so that the administration of high concentrations of oxygen may produce apnea by removal of the “anoxemic stimulus.” 4. 4. To avoid such apnea during anesthesia, it is recommended that preanesthetic morphine be reduced when a potent non-irritating anesthetic agent like cyclopropane and excess oxygen is to be used. 5. 5. When such apnea does occur it is suggested to maintain high oxygen concentration and employ artificial respiration until spontaneous respiration is resumed. During such apnea the use of carbon dioxide is not advised. A central respiratory stimulant, such as metrazol, may be useful in conjunction with oxygen therapy. 6. 6. When respiratory activity is maintained largely by an anoxemic stimulus by way of the carotid body, treatment with oxygen is indicated to prevent cerebral damage from oxygen want.

Effect of Divinyl Oxide on Intestinal Activity in vivo.

The knowledge of the effect of the newer inhalation anesthetic agents on intestinal contraction is far from adequate. In a previous report 1 it was indicated that during the first two planes of surgical anesthesia the effect of cyclopropane on intestinal activity in the intact animal consists of an increase of both intestinal contractions and tone followed by inhibition if narcosis is further deepened. These results agree with the in vitro effects observed by Peoples and Phatak 2 on isolated intestinal muscle. Divinyl oxide, another of the newer anesthetic agents, was shown by the same authors 3 likewise to increase the tonicity of the isolated intestinal segment. The present study is concerned with the effect of divinyl oxide on intestinal activity in vivo. Six dogs were prepared with Thiry-Vella loops of the upper jejunum. When healing had occurred, tracings of the intestinal movements were recorded after inserting a balloon, connected to a water manometer, into the lumen of the proximal end of the Thiry-Vella loop. Respiratory tracings by means of a pneumograph applied about the chest were simultaneously recorded in order to rule out the possibility that the tracings taken from the balloon were not due to respiratory movements. No preanesthetic medication was administered. All animals were anesthetized with divinyl oxide (Vinethene—Merck) and oxygen by means of a Foregger Metric machine using the closed carbon dioxide-absorption technic. 4 An endotracheal tube fitted with an inflatable cuff was introduced as soon as the state of surgical anesthesia was reached in order to assure a patent airway and thereby obviate the effect of respiratory obstruction and the ensuing anoxemia.

Effect of Cyclopropane on Intestinal Activity in Vivo

Conclusion Cyclopropane causes an increase of both intestinal contractions and tone in the first 2 planes of third stage anesthesia; in the lower planes of third stage contractions are inhibited but tone is maintained. Ether, on the other hand, causes an abolition of the contractions in all planes of surgical anesthesia.