William J. Murray

Defluorination of Methoxyflurane during Anesthesia: Comparison of Man with Other Species

Human plasma and urinary inorganic fluoride concentrations were elevated within 30 minutes after initiation of methoxyflurane administration and increased progressively during anesthesia. To define an animal model for studies of the effect of such rapid methoxyflurane catabolism to fluoride ion, defluorination was evaluated in calves, monkeys, dogs, rabbits, guinea pigs, rats, and mice. All animals defluorinated methoxyflurane.

NITROUS OXIDE DOES NOT IMPAIR HEPATIC FUNCTION IN YOUNG OR OLD SURGICAL PATIENTS

We investigated whether anesthesia including nitrous oxide (N2O) caused hepatic injury, and whether any adverse effect of N2O was affected by patient age. One hundred patients having total hip replacements were randomly assigned to a regimen that included or excluded N2O (50%-60%) during regional anesthesia supplemented with isoflurane and intravenous adjuvants. Using postoperative plasma levels of alanine aminotransferase, bilirubin, and alkaline phosphatase 1 and 3 days after surgery as indicators of hepatic impairment, we found no evidence that N2O causes hepatic injury in either young or old patients.

Development of a Service Clinical Anesthesia Laboratory

Routine laboratory monitoring of patients in operating and recovery rooms is practically unknown, in spite of the probability that here may occur some of the most rapid and significant physiological changes encountered during a patients hospitalization. Can these alterations secondary to the pharmacological challenges of anesthesia and the traumatic stresses of surgery be detected by existing measurement techniques? And more important, could such laboratory data contribute toward an improvement in patient care by decreasing the risks of a surgical procedure? Establishment of Facility These questions were first subjected to testing a little over a year ago by the Anesthesia Service of the North Carolina Memorial Hospital. An electronic monitoring program which made a continuous electrocardiogram, peripheral pulsimeter tracings, and measurements of end expiratory carbon dioxide and direct arterial blood pressure had previously been put into routine use. This clearly facilitated closer control of the operating-room patient, and it was questioned