Koerner Sk

Respiratory and circulatory effects of intravenous butorphanol and morphine

The respiratory and circulatory effects and other side effect liability of intravenous doses of 30 and 60 μg/kg butorphanol, 150 to 300 μg/kg norphine, and a placebo were investigated in a crossover double‐blind study.

Diagnosis and Reversal of Rejection in Experimental and Clinical Lung Allografts

Abstract Experience in our patients and dogs with lung transplants has provided reliable criteria for diagnosing rejection and distinguishing it from other pathological processes such as pneumonia and ischemic injury. These criteria include fever; dyspnea; malaise; increased sputum production; decreased arterial oxygen tension; and, most importantly, the rapid development (often within hours) of a roentgenographic alveolar infiltrate without any change in the sputum bacteriology. Using these criteria we have identified multiple rejection episodes in 2 patients and in comparably immunosuppressed dogs. In almost every instance all acute manifestations of rejection, including the roentgenographic infiltrates, have been completely reversed by three to seven large intravenous doses of methylprednisolone given at 12- to 24-hour intervals. In the dogs, reversal of rejection has also been confirmed by gross and microscopical examination of the allograft. These findings show that acute rejection in lung allografts can be reliably identified by noninvasive criteria and successfully reversed.

Oxygen in ischemic heart disease

0 xygen has been used for years in patients with ischemic heart disease without attention to its indication or effects, both beneficial and detrimental. It has been assumed that an increase in arterial PO, would result in increased delivery of oxygen to hypoxic areas of the myocardium followed by improvement in cardiac function and, hopefully, prevention of fatal arrhythmias. Such clear-cut benefits have not been demonstrated as yet and, furthermore, adverse effects of oxygen therapy on cardiac function have been reported as well as many toxic. effects on other organs, the lungs in particuIar. This report will attempt to review some aspects of pulmonary oxygen toxicity, the physiology of oxygen transport, and its metabolic and hemodynamic effects on the ischemic heart.

Fiberoptic evaluation of bronchial anatomy prior to canine bronchospirometry

Abstract Tracheobronchial anatomy was studied in 35 unselected dogs by fiberoptic bronchoscopy to evaluate their suitability for bronchospirometry with Benfield, Carlens, or Kottmeier tubes. Measurements of the distance of the upper lobe bronchi from the main carina were made in vivo to evaluate potential lobar obstruction. When the tubes were correctly positioned, the location of the right upper lobe orifce determined the feasibility of accurate bronchospirometry with the Benfield and Kottmeier tubes. On this basis the Benfield tube was potentially suitable for use in 21 of 35 animals and the Kottmeier in only 3 of 35 animals. The Carlens tube was unsuitable for use in all the dogs studied because in each animal the left limb of the tube bypassed the left upper lobe orifice. Bronchoscopy prior to bronchospirometry will allow selection of animals with bronchial anatomy suitable for use with available tracheal dividers.

Clinical pharmacological studies with 6-azidomorphine

The intravenous (i.v.) administration of 4 mug/kg 6-deoxy-6-dihydroazido-isomorphine (6-AM) base to healthy, young adult male volunteers caused no circulatory and relatively little, short-lasting respiratory depression. Of the ten volunteers all felt lightheaded, two became euphoric and when they became ambulatory at the end of the experiment, three vomited and two other became nauseated. The intramuscular (i.m.) administration of the same dose of 6-AM had considerable analgesic effect against various types of experimental pain. It was more effective against ischemic pain, than against pain induced by electrical stimulation of the earlobe or the tooth pulp and it effected severe pain more than mild or moderate pain. In the six subjects investigated, 6-AM produced significant myosis. Of the 16 subjects who received 4 mug/kg 6-AM i.m. five experienced mild euphoria, two felt lightheaded, six became pale and sweaty in the course of the experiments carried out in the sitting position. When they becam ambulatory after the completion of the experiments, two subjects vomited and six others became nauseated. The findings of this study indicate that 6-AM causes less circulatory and respiratory depression than is to be expected from equianalgetic doses of morphine. Its other side effects (e.g., nausea, vomiting) are also less frequent and severe than those encountered after the administration of comparable doses of morphine to ambulating volunteers.