Sumitaka Haseba

Malignant hyperthermia and althesin

SummaryGeneral anaesthesia with Althesin was administered on two occasions to a patient who was identified as susceptible to malignant hyperthermia, in whom there was identified familial subclinical myopathy and once in another patient suffering from arthrogryposis multiplex congenita with a history of fever associated with two previous anaesthetics. In the first patient halothane was administered by accident in association with the Althesin, but no hyperpyrexia occurred. In the second instance nitrous oxide-oxygen and halothane were associated purposely with Althesin. In none of these cases was there any rise in temperature, muscle rigor or elevation of the serum CPK level. This experience corroborates the experimental evidence of Hall,et al.10 and Harrison,11 who reported that Althesin prevented the onset of hyperthermia, and the clinical reports of Page12 and Judelman.13 Althesin can be assumed to be an effective anaesthetic for malignant hyperthermia susceptible patients.RésuméĽAlthésin a été utilisé à deux reprises lors ľinterventions ophtalmologiques chez un enfant ayant présenté antérieurement un épisode ľhyperthermie maligne. A la suite de cet épisode, une étude familiale électromyographique avait démontré une susceptibilité à la maladie. Lors de la seconde anesthésie à ľAlthésin, de ľHalothane a été ajoutée accidentellement au protoxyde ľazote utilisé en maintien.Chez un second enfant, avec une histoire de température lors de deux anesthésies antérieures, ľAlthésin a également été utilisé avec du protoxyde ľazote et, cette fois-ci, on a ajouté volontairement de ľHalothane au protoxyde.Dans tous les cas, nous n’avons observé aucune élévation de température, aucune rigidité musculaire et aucune modification des CPK.Ceci confirme les énoncés de Hall et coll., ainsi que ceux de Harrison, à savoir ľAlthésin prévient ľhyperthermie et vient s’ajouter aux rapports cliniques de Page et Judelman sur la sécurité de cet agent pour les malades avec une susceptibilité connue à ľhyperthermie maligne.

Comparison of the effects of amrinone and dobutamine on hemodynamics and myocardial oxygen balance in dogs with experimental left ventricular failure

The purpose of the present study was to induce left ventricular failure in anesthetized dogs by repeated ventricular fibrillation and then to determine if amrinone is effective in circulatory support by comparing the effects of amrinone and dobutamine. After the repetitive ventricular fibrillation, mean arterial pressure and stroke volume index decreased, pulmonary capillary wedge pressure (PCWP) increased, and acute left ventricular failure occurred. Thereafter, dogs were divided into the following four groups. In Group C (n = 6), normal saline was administered; in Group D (n = 6), dobutamine was administered at 7 micrograms/kg/min; and in Groups A40 (n = 6) and A80 (n = 7), amrinone was administered at 40 micrograms/kg/min and 80 micrograms/kg/min, respectively. Stroke volume index increased by 78% in Group D and 46% in both Groups A40 and A80. Pulmonary capillary wedge pressure decreased by 44% in Group A40 and 38% in Group A80, but remained unchanged in Group D. Similarly, total peripheral resistance decreased by 32% in Group A40, 29% in Group A80, but remained unchanged in Group D. These results suggest that amrinone increased cardiac output and decreased both preload and afterload. In the coronary circulation, both drugs caused direct coronary vasodilation since they increased myocardial oxygen supply in excess of the increase in myocardial oxygen demand. Neither drug produced signs of myocardial ischemia, as indicated by myocardial lactate metabolism. Amrinone should be a useful drug after open heart surgery, especially in cases where significant adverse effects of catecholamines occur or where a low-output state with increased preload and afterload exists.

Microbiological Studies of Four Patients Extensively Burned by the Pyroclastic Flow of Mt. Fugen in Unzen, Japan

Serial microbiological tests were performed on 4 patients burned by the pyroclastic flow of Mt. Fugen in Unzen, Japan on June 3, 1991. The patients were young (average age, 30 years) and had extensive burns (average total burn surface area, 83%) and inhalation injury. All 4 patients died of multiple organ failure and septicemia. Methicillin-resistantStaphylococcus aureus (MRSA) andPseudomonas aeruginosa were persistently isolated from bronchial aspirates, burn wounds and the blood until death. There were no differences in isolates among the 3 specimen sites.S. aureus isolated from all patients became resistant to all antibiotics used, and the use of imipenem/cilastatin sodium, and ceftazidime transformedP. aeruginosa to a resistant strain within a short period of time. On the other hand, the sensitivity to gentamicin varied from one patient to another. From a study of the phenotypic character ofS. aureus strains, there was a suggestion of nosocomial infection in 2 patients. Our results demonstrate that extensive burns are usually associated with bacteremia and septicemia. In spite of prudent management with antibiotics, the control of resistant bacteria is difficult. We stress the need for the development of specific therapy for severe infections in burn patients, encompassing immunotherapy, antibiotic treatment, and wound treatment.