Tapani Tammisto

Myoglobinuria after intermittent administration of succinylcholine during halothane anesthesia.

After the intermittent administration of succinylcholine to 24 ophthalmic patients during halothane anesthesia, 2 certain (immunochemically verified) and 5 probable cases of myoglobinuria were found. In all these patients the serum activity of creatine kinase was also elevated. These findings are interpreted as signs of probable museular injury. It is recommended that intermittent administration of succinylcholine during halothane anesthesia should be abandoned.

The Need for Fentanyl Supplementation of N2O‐O2 Relaxant Anaesthesia in Chronic Alcoholics

The demand for intermittent halothane supplementation during N2O‐O2‐relaxant anaesthesia was studied in 25 alcoholics (annual consumption over 15 1 pure alcohol) scheduled for biliary or gastric surgery. The controls were 45 nonalcoholics and 43 patients with an annual consumption of between 1 to 15 1. Thiopental (3 mg/kg/min) was given for induction. After intubation, halothane supplementation was given in 0.5% concentration for 10‐min periods. Standardized criteria for halothane supplementation were various motor and autonomic responses to painful stimuli. Muscular relaxation was kept fairly constant (roughly 90%), as assessed visually with the aid of a peripheral nerve stimulator. The total time for which halothane supplementation was given, expressed as a percentage of the total anaesthesia time, was used as an indication of the need for halothane supplementation. The need for thiopental for induction was not increased to a statistically significant extent in alcoholics, but signs of excitation did occur in 40% as compared with 11% in non‐alcoholics (P < 0.01). The demand for halothane supplementation was higher in alcoholics (47±4.8%, s.e. mean) than in non‐alcoholics (33±2.3%). This difference, however, was partly due to the higher incidence of gastric surgery, which required more supplementation than biliary surgery. Analysis of the different criteria indicating the need for halothane supplementation revealed that an increase in blood pressure or heart rate was more common in non‐alcoholics, whereas motor irritability, sweating and lacrimation were more frequent in alcoholics. Management of the anaesthetic posed no special difficulties in the alcoholics with an estimated mean annual consumption of 32 ± 4 (s.e. mean) litres of absolute alcohol. Three patients (5% of the alcohol consumers) reported dreams or recollections, suggesting that this mode of halothane supplementation does not guarantee an adequate anaesthetic depth. The difficulties and biases associated with this type of analysis are discussed.

Halothane‐Induged Heat Loss and Shivering in Rats

Factors which might affect halothane‐induced heat loss and shivering have been studied in rats. Hypothermia and shivering were correlated to the depth of anaesthesia, and the duration of shivering corresponded to the length of the rewarming phase. Prevention of hypothermia by anaesthetizing the rats in an ambient temperature of 32° C inhibited shivering. Local heat application to the head partly counteracted shivering. Cold‐adapted rats seemed to regain normothermia more quickly. Shivering was intensified by noise and handling. Hypercarbia, hyperventilation and hypoxia all intensified die hypothermia. Hypercarbia increased the duration of shivering during anaesthesia, whereas hyperventilation and hypoxia rather counteracted it. Shivering after anaesthesia and the return of normothermia were not affected by these measures. Potentiation of anaesthesia with d‐tubocurarine or pethidine prolonged the rewarming phase and reduced die intensity of shivering. Copper, which potentiates experimental extrapyramidal tremor, reduced die intensity of shivering and prolonged hypothermia without potentiation of anaesthesia. Medioxyflurane‐induced hypothermia was comparable to that occurring during halothane anaesthesia, but of longer duration. The shivering was less violent, but lasted longer.

The Need for Fentanyl Supplementation of N2O-O2Relaxant Anaesthesia in Chronic Alcoholics

In order to find out how the need for analgesic supplementation during N2O‐O2‐relaxant anaesthesia is affected by chronic alcohol consumption, 82 patients with various known alcohol habits were anaesthetized for gastric or biliary surgery. Muscular relaxation was kept constant with the aid of a peripheral neurostimulator, and fentanyl was given in increments of 0.05‐0.1 mg for nociceptive symptoms during the anaesthesia.

THE EFFECT OF 5-HYDROXYTRYPTAMINE (SEROTONIN) ON RETINAL VESSELS OF THE RAT.

5-hydroxytryptamine (5-HT), a biologicallly active hormone with marked vasoactive properties was first isolated and identified by Rapport et al. (1948), Rapport (1949) from serum and named serotonin. In 1952 Erspamer and Asero identified serotonin as the active principle of enteramine; a substance isolated by them from the chromaffin cells of the intestine. The connection between 5-HT and carcinoid syndrome has been established (Thorson et al., 1954). Since then a great deal of work has been done in this field. However the physiologic significance of 5-HT is still unknown. Despite the extensive work regarding specially the vasoconstrictor properties of 5-HT the actions on retinal circulation have scarcely been studied. In 1959 Morlunghi & Volpi observed that single intravenous doses of 4 mg/kg of 5-HT produced a transient spasm of the retinal arteries in rabbits and that repeated doses also caused morphological changes. Since the dosage of 5-HT used in their work was very high and since no other papers on this subject were found in the literature, it was thought worth while to study the effects of 5-HT on the retinal vessels of rats.

INTRAMUSCULARLY ADMINISTERED ATROPINE AND THE EYE

I t is a common procedure to give operative patients also other than eye patients as premedication among other drugs intramuscularly administered atropine primarily to reduce secretion and to prevent the vagotropic reflexes. There seems to be a considerable amount of uncertainty about what effect the atropine injection may have on the eyes of a patient with glaucoma. Leopold and Comroe (1948) showed, using 8 persons with normai eyes as subjects, that intramuscularly administered atropine caused clearly less dilation of the pupil and weakening of the accommodation than scopolamine when used in equivalent doses. Schwartz and al. (1957) had a niaterial of 14 glaucoma simplexpatients. In lhis material the intramuscularly administered atropint: (0.4-1.0 ma.) caused a slight increase in the intraocular tension in only five eyes. On the other hand the pupil was dilated in 11 of 15 eyes. However the diameter of the pupil did not in a single case increase more than one mm. The treatment of the glaucoma had been interrupted 48 hours before the experiment in these patients. De Torres (1947) used moderately large intravenous doses of atrupine and notified in a material of 62 glaucoma patients that the intraocular tension was lowered in 38 and increased in as many a s 51 per cent. In only three patients the pupil did not dilate in all others i t did. When BQrBny (1962) studied the mechanism of the pilocarpine effect in the eye he injected atropine in apes both intravenously and also directly into the anterior chamber after administration of pilocarpine We refer to these studies in the discussion.

Respiratory Depressant Action of Tilidine during N2O+O2, Anaesthesia

The respiratory depressant actions of pethidine and tilidine during anaesthesia were compared in 18 surgical patients anaesthetized with N2O + O2 after thiopental induction. Five minutes after thiopental, 0.5 mg/kg pethidine or 1.5 mg/kg tilidine were each given intravenously to six patients, the remaining six patients serving as controls.

A CLINICAL EVALUATION OF A NEW LOCAL ANAESTHETIC (MARCAIN®-ADRENALIN) IN OCULAR SURGERY

During the last two or three decades, several new local anaesthetics have been introduced. It has been especially tried to develop anaesthetics with prolonged action, but they have been associated with the disadvantage of toxicity, especially nervous and tissue toxicity. It would, however, be most important in ocular surgery and particularly following intraocular procedures that patients remain, without any pain, calm for as long as possible. In 1962 we started to use mepivacaine in our hospital. It could be demonstrated (CastrCn, 1963) that post-operative pain following ocular surgery occurred, when this agent was employed, about one-half hour and vomiting only over 1.5 hours later than when lidocaine was used. During the last couple of years, investigations have been published (Telivuo, 1963; Widman, 1964; AlbCrt & Lofstrom, 1965) according to which a new homologue of mepivacaine, (1 -n-butyl-DL-2-piperidinecarbon)-2,6-dimethylanilide hydrochloride (Marain@-Adrenalin, Firma Ab Bofors, Nobelkrut, Sweden), would possess even twice as prolonged action as mepivacaine. These investigations were performed in connection with intercostal blocks, regional anaesthesias of fingers and blocks of the ulnar nerve. According to studies performed by Henn (1964), however, this new substance is about four times more toxic than mepivacaine and approximately equally toxic than tetracaine. The structure of Marcain differs from that of mepivacaine only in the way that a butyl group has been substituted for one of the methyl groups of the latter:

Injection of morphine loco dolenti recommended as early as 1876

The peripheral site of action of opioids was proved some 20 years ago. The concept of the peripheral action of morphine, however, appears to be over 100 years older.

Finland's first anaesthesia revealed by newspapers

Background: According to the literature on the history of anaesthesia, Finland’s first anaesthesia was given on March 8, 1847 for a ligature of an aneurysm of the subclavian artery. It has, however, not been possible to verify the date with certainty. We therefore wanted to find out whether newspapers might give additional information and how this exceptionally important medical invention had been received by the Finnish newspapers.