Dola S. Thompson

Pharmacokinetics of intravenous procaine infusion in humans.

Pharmacokinetic data during and following the continuous intravenous infusion of procaine are lacking. We studied 12 women undergoing hysterectomy during N2O-O2 and narcotic anesthesia. A constant infusion of 2% procaine was administered at a rate of 1 mg/kg/min to six patients (group I) and at a rate of 1.5 mg/kg/min to the other six (group II). Procaine plasma levels were determined by flame ionization gas-liquid chromatography. Using a two-compartment pharmacokinetic model, disposition kinetics were studied. Steady-state plasma levels were achieved within 20 to 30 minutes after commencement of the infusion. Following termination of the infusion the drug disappeared with a distribution half-life (t½ α) of 2.49 ± 0.36 minutes and an elimination half-life (t½β) of 7.69 ± 0.99 minutes at both infusion rates. In group I, the fraction of drug in the central compartment was 65%, the volume of distribution at steady-state was 0.79 ± 0.14 L/kg, and total body clearance 0.08 ± 0.01 L/kg/min. In group II, the fraction of drug in the central compartment was 82%, the volume of distribution at steady-state 0.34 ± 0.07 L/kg, and the total body clearance 0.04 ± 0.01 L/kg/min. These data indicate that procaine is a drug of limited distribution and tissue uptake with a short duration of action.

Hypoxemia immediately after operation

Summary Postoperative hypoxemia was originally reported after chest surgery and has been regarded as a problem primarily related to such procedures. Recently low arterial oxygen tensien has been reported to occur after a variety of operations. This phenomenon takes place when the patient resumes breathing air and the high concentration of oxygen in the anesthesia mixture is discontinued. The arterial pH, PaCO 2 , and PaO 2 were determined after various types of surgery in ninety-eight veterans whose ages varied from forty-five to fifty-five years. Samples were drawn immediately upon entering the recovery room and thirty minutes later. Both showed low mean values, although some improvement was seen in the second sample. Hypoxemia was less marked in patients who received spinal than in those who had inhalation anesthetics. Hypoxemia varied with length of operation. A mean PaO 2 of 82 mm Hg was found in thirty-two healthy preoperative men at age fifty which is in line with the findings of others. A PaO 2 of 95 to 100 mm Hg is only expected in the young person and cannot be used as a figure in an evaluation of hypoxemia in older people. Hypoxemia characterizes the early postoperative period, making this a potentially dangerous time in which cardiac irregularities and even arrest may result.

An evaluation of the effect of halothane on liver function and disease

Abstract 1. 1. A retrospective study of 545 patients receiving halothane did not produce any evidence of liver disease attributable to anesthesia. 2. 2. Analysis of the data in the prospective study revealed no significant difference in values among the patients receiving halothane and those receiving nonhalothane anesthetics. 3. 3. The study seemed to implicate the fact of upper abdominal surgery rather than halothane as a mechanism leading to liver dysfunction after surgery.

Reappraisal of intravenous procaine as a short-acting anesthetic adjuvant

Our data in 74 patients demonstrate that procaine hydrochloride is a safe anesthetic adjuvant in doses of 1 mg/kg/min even when total doses are 5 to 7 g. Blood pressure, heart rate, electrocardiographic variables, and blood gases were not adversely affected. Patients had no nausea or untoward postanesthesia symptoms. Emergence from anesthesia was rapid, within less than 15 minutes in all patients, and most were fully awake before leaving the operating room. In two patients in whom blood levels were studied the drug disappeared within 40 minutes. Procaine is inexpensive,

Intravenous Procaine as a Supplement to General Anesthesia for Carbon Dioxide Laser Resection of Laryngeal Papillomas in Children

1.16 for 10 g, and it is not a known liver or kidney toxin. Until studies on cardiovascular dynamics and analgesic effects as in whom a low plasma cholinesterase activity is present or suspected. The clinical appraisal in 56 patients indicates its usefulness in suppressing premature venticular contractions and cough reflexes during endoscopic procedures in the respiratory tract. Procaine can be used to advantage in supplementing general anesthesia in outpatient surgery because of its brief action. For these reasons, the drug merits further study.

Prevention of Suctioning-Related Arterial Oxygen Desaturation. Comparison of Off-Ventilator and On-Ventilator Suctioning

Procaine suppresses the cough reflex, decreases laryngeal irritability, and has general anesthetic properties. For these reasons, 14 pediatric patients undergoing CO2 laser resection of laryngeal papillomas were studied in which an intravenous infusion of procaine (1 mg/kg/min) was added to N2O-O2 halothane/enflurane general anesthesia immediately following endotracheal intubation. These patients were compared to nine patients receiving the same anesthesia without procaine.The mean age of both groups was 11 years. There was no difference between the groups in duration of anesthesia or surgery. Emergence, however, averaged 15 minutes in study patients compared to 36 minutes in the control group (p<0.01). There was no difference in anesthetic concentrations required to maintain satisfactory operative conditions in the two groups. Muscle relaxants were required intraoperatively in seven control patients but in none of the study patients. The surgeon ranked the operative conditions excellent in all study patients but poor in seven of the nine control patients. Five of the latter required postoperative treatment of laryngeal complications, including reintubation in three. Only one of the study patients had postoperative stridor. No evidence of procaine toxicity was noted in the study patients with total doses ranging from 500–3600 mg. Intravenous procaine is useful in pediatric patients having endoscopic laryngeal operations.

Acute Cardiovascular Response to a Single Large Intravenous Dose of Methylprednisolone and Its Effects on the Responses to Norepinephrine and Isoproterenol

The purpose of this study was to determine the frequency and severity of arterial oxygen desaturation during and after endotracheal suctioning in a group of ventilator-dependent patients with acute respiratory failure (the majority of whom had underlying obstructive lung disease) and to evaluate the efficacy of several maneuvers designed to minimize desaturation. The adaptor method presented obviates both removal from and reconnection to the ventilator during suctioning, as well as the need to alter ventilator settings. It is concluded that on-ventilator adaptor suctioning is a simple and effective measure for minimizing suctioning-related arterial oxygen desaturation.

Droperidol as a Pre-medicant: A Multicenter Study

The cardiovascular actions of single 10-micrograms/kg iv doses of norepinephrine (NE) and isoproteronol (ISO), before and after the administration of a single 30-mg/kg iv dose of the glucocorticoid methylprednisolone (MP) (sodium succinate ester), were compared in adult cats. Methylprednisolone increased both systolic and diastolic pressures as well as the pulse pressure by approximately 50%. These steroid effects persisted unabated for the duration of the experiment (40 min). Heart rate was unaffected by MP. MP treatment significantly reduced the increase in systolic and diastolic pressures caused by NE. This MP effect was unrelated to the higher baselines for these two parameters caused by the steroid. The systolic blood pressure and positive chronotropic effects of ISO were also significantly blunted by MP. These observations suggest that a single large dose of MP may cause a depression of cardiovascular alpha- and beta-1-receptor sensitivity. The results are discussed in relation to the actions of massive dose glucocorticoid administration in certain shock states and central nervous system trauma and stroke.

Reversal of Fentanyl Induced Spasm of the Sphincter of Oddi

Etude sur 543 malades. Bonne a excellente efficacite dans 93% des cas en association avec la morphine ou la pethidine

Psychomimetic Reactions After Low-Dose Ketamine Infusion. Comparison with Neuroleptanaesthesia

We believe it is advisable to avoid narcotics, if possible, in patients with known or suspected gallbladder disease. Occasionally, however, this will not be possible, and narcotic induced spasm of the sphincter of Oddi may require treatment. Except for the stated contraindications of glucagon administration, it seems to be based upon this study and other available data that glucagon is just as effective as naloxone in reversing spasm of the sphincter of Oddi and may be associated with fewer undesirable effects, such as reversal of analgesia and adverse hemodynamic changes. Anticholingergic drugs in man have proved to be of minimal or no benefit in this regard.