Roger L. Klein

Controlled Substance Dispensing and Accountability in United States Anesthesiology Residency Programs

Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiology training programs was conducted in the summer of 1990 to determine the level of CS dispensing and accountability within their programs. The survey demonstrated that CS dispensing and accountability varied considerably among programs, among hospitals associated with individual programs, and within geographically distinct anesthesia delivery areas within the separate hospitals. Nevertheless, most institutions were moving toward improved methods of CS dispensing and providing more and better CS accountability. The presence of significant CSD, particularly among anesthesiology residents, was reconfirmed. We were unable to correlate the level of accountability of CS with the incidence of CSD. It remains to be seen to what extent CS accountability will continue to develop and whether CSD prevalence will then be changed.

The influence of chlorpromazine, diazepam, and droperidol on emergence from ketamine.

N SPITE of an extensive pretesting proI gram, ketamine has not settled comfortably in the daily practice of anesthesia. After an early phase of enthusiasm, caution regarding its use has been voiced in recent literature.1-3 Moderate and rather favorable cardiovascular and respiratory effects, no apparent organ damage, ease of administration, and a wide margin of safety constitute sufficient advantages to assure it a place in clinical practice. Undesirable side effects have been recognized but are diminishing with increasing refinement in its use.

Intravenous fluid administration as therapy for hypotension secondary to spinal anesthesia.

YPOTENSION is the most common comH plication of subarachnoid anesthesia. The incidence is said to vary from 30 to 60 percent, depending on such factors as the level of analgesia, site and type of operation, and patient age, condition, and blood volume. Since blood pressure can be described as the product of cardiac output and total peripheral resistance, the usual management of spinal hypotension has been directed toward one or the other of these two factors: the use of peripheral vasoconstrictors to increase the total peripheral resistance or the use of drugs with an inotropic or chronotropic cardiac action to augment the output of the heart.