Charles R. Allen

Evaluation of CL-1848C: a new dissociative anesthetic in normal human volunteers.

o MAKE the initial investigation of any T new drug in the human subject is always a serious decision for the clinical pharmacologist. When the drug is a parenteral anesthetic with pharmacology disparate from that of commonly used drugs and with potential neuropharmacologic properties, the problem is compounded. Preliminary animal testing, regardless of the extent or species utilized, including the subhuman primate, gives valuable infonnation, but the moment must always come when the first human is subjected to the investigational drug. Some of us have previously been active in studying a dissociative anesthetic, CI581, now ketamine,l-3 but were not the first to use it on humans.4 From our observations and personal experience, we felt that the investigation of a new drug, CL-1848C (fig. l), from Cutter Laboratories, must be approached as a multidisciplinary problem.5

RECOVERY SCORING REVISITED

The authors offer a system of scoring in the recovery room to evaluate the patient in the postanesthetic period. They hope this system can circumvent the numerous systems developed which, however, do not permit of easy comparisons.

Continuous cuff inflation during long-term intubation and ventilation: evaluation of technic.

DVERSE effects from the use of cuffed A endotracheal or cuffed tracheostomy tubes have been reported over the past 3 decades. -3 In 1969, the characteristics of cuff materials and tracheal pressure due to inflation were detailed as they affected the trachea in animals.4 The following year, a method of intermittent cuff inflation and its effects were described,S and in 1970 and 1971, at least three article#-8 enumerated most of the causes of tracheostenosis following prolonged tracheal intubation and tracheostomy .

MALIGNANT HYPERPYREXIA: A REEXAMINATION

Such hyperpyrexia is an uncommon but clear-cut and serious entity. Prognosis is gloomy. It is an unpredictable entity occurring generally in healthy patients and attempted prophylactic management has been unsuccessful. The authors explain this reaction in clinical and animal studies.

An evaluation of the cidematic decontamination system for anesthesia equipment.

N STUDIES on the reduction of cross-infecI tion by the disinfection of anesthesia equipment, Snow and Anderson,l as well as others,2 have indicated that heat sterilization, though optimal from cost, effectiveness, speed, and safety standpoints, is injurious to rubber goods and to certain other material used in anesthesia, while methods using cold antiseptic solutions and disinfectants have been found unreliable.3~4 Gross5 reported that gram-negative bacilli from anesthesia apparatus proliferate in cold sterilization solutions, and Plotkin and Austrians describe such contamination as responsible for 40 instances of bacteremia and at least one death. Thomas’ refuted experiments supposedly showing that patients do not infect anesthesia breathing circuits, “in the light of laboratory evidence that aerosols of organisms are able to traverse 3-foot lengths of corrugated tubing and soda lime canisters, and that the interiors of breathing circuits become contaminated when volunteers cough or sneeze into them.” Knights pointed out that humid environments such as exist in anesthesia equipment provide a potentially favorable habitat for gram-negative organisms. Still other observersg have suggested that the anesthetic agents are themselves bactericidal, and a recent articlelo urges wider use of cold sterilization methods.