Sequential cardiorespiratory patterns of anesthetic induction with ketamine in critically ill patients

Hemodynamic and O2 transport effects of ketamine anesthesia were evaluated in 22 critically ill patients. After placement of radial and pulmonary artery catheters, simultaneous measurement were made of cardiac output, intravascular pressures, arterial and mixed venous gases, saturations, pH, and Hct; cardiorespiratory values then were calculated for a preinduction control period and sequentially at frequent intervals over a 15-min observation period. In general, there was an early progressive increase in HR, cardiac index (CI), arterial and venous pressures, stroke work, and O2 delivery (DO2); O2 consumption (VO2) and O2 extraction (O2 Ext) decreased. In general, ketamine produced an inotropic cardiac response, but these responses were not uniform; a relatively small percentage had reduced pressures, flow, and reduced myocardial performance that were related to hypovolemia and associated medical conditions.     

A study of cumulative effects and recovery from anaesthesia with intermittent doses of althesin. A comparison with methohexitone

The cumulative effects and post-anaesthetic recovery of Althesin were studied by comparing the drug with methohexitone in a series of 60 patients undergoing surgery for varicose veins. Anaesthesia was maintained with each anaesthetic agent in 30 patients by administration of intermittent doses of the respective drugs in accordance with the surgical stimulus. When repeat doses were required at intervals of 2 to 5 minutes, the fall off in requirements was observed with both anaesthetics, more distinctly with Althesin than with methohexitone. No significant difference could be observed in the time required for immediate awakening after the two drugs. However, the majority of the patients anaesthetized with Althesin displayed a peculiar lack of mental clarity for a short period after recovering consciousness. The recovery from anaesthesia was studied by various tests and observations. Recovery after Althesin appeared to proceed slightly faster than after methohexitone. When Althesin was required in high total dosage (exceeding 150 mu1/kg), the immediate awakening was associated with emotional upset and confusion. Frequency of nausea and vomiting after anaesthesia was considerably higher in the Althesin group than in the methohexitone group. These symptoms might be toxic due to the excessive dosage given. Using the induction time as a basis for calculation of the potency ratio, Althesin and methohexiton were found to have the ratio of 1:33 (expressed in mu1/kg : mg/kg).     

A comparative study of intravenous anaesthesia with thiopental versus althesin in outpatient dental practice

Selective retrograde catheterisation of the left internal spermatic vein at its orifice in the renal vein was carried out in 25 patients suspected of varicocele. When contrast medium is injected, the patients with varicocele, standing in the erect position, present a retrograde filling of the varicose spermatic vein, in contrast to the absence of such reflux in normal men. The venography is indicated for diagnostic and therapeutic purposes and it is the only available, non-surgical technique to prove the existence of a disturbed venous flow in the testicular region.     

Comparison of detomidine/ketamine and guaiphenesin/thiopentone for induction of anaesthesia in horses maintained with halothane

This prospective clinical study compared the physiological effects of two commonly used anaesthetic induction techniques in horses maintained with halothane. One hundred horses admitted for elective surgery were randomly allocated to receive either guaiphenesin (to effect) and thiopentone (5 mg/kg), or detomidine (20 microg/kg) and ketamine (2 mg/kg) for the induction of anaesthesia after acepromazine premedication. Anaesthesia was maintained with halothane in oxygen. There were no significant differences in breed, age, sex, weight, type of surgery and duration of anaesthesia between the groups. Immediately after induction of anaesthesia heart rate was higher after guaiphenesin and thiopentone, and arterial blood pressure was higher after detomidine and ketamine. Thereafter hypotension, often necessitating an infusion of dobutamine, developed in both groups. Arterial blood gases and respiratory rates were similar in the two groups. There were no significant differences between the groups in the subjectively scored quality of induction and recovery, or in recovery time.     

Observations on the use of midazolam for sedation, and induction of anaesthesia with midazolam in combination with ketamine in the goat

Midazolam hydrochloride administered intramuscularly at a dosage of 0.4 mg/kg induced sedation and sternal recumbency in goats. Increasing the dosage to 1 mg/kg resulted in rapid onset of ataxia followed by lateral recumbency, and loss of consciousness. Light surgical anaesthesia lasted for a period of 7-15 min and was suitable for non-painful procedures. Heart rate was significantly increased (p < 0.05) at both dosage rates, while respiration rate was only increased after midazolam at 0.4 mg/kg. The combination of midazolam (0.4 mg/kg) and ketamine hydrochloride (4 mg/kg) increased heart and respiration rate significantly (p < 0.05). A light plane of surgical anaesthesia suitable for endotracheal intubation was induced, which lasted for a period of 16-39 min.     

Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium

Haemodynamic variables were measured following administration of rocuronium 0.6 mg.kg-1 or vecuronium 0.08 mg.kg-1 (approximately equivalent to 2 x ED95 doses) in patients anaesthetized with fentanyl 50 micrograms.kg-1 and scheduled to undergo elective coronary artery bypass grafting. There were increases in stroke volume index (+15%) and cardiac index (+11%), and a decrease in pulmonary capillary wedge pressure (-25%) following administration of rocuronium (P < 0.05). The changes in heart rate (+7%), mean arterial pressure (-5%), systemic vascular resistance (-12%) and other measured or derived indices were insignificant. In comparison the administration of vecuronium was associated with decreases in heart rate (-7%), mean pulmonary artery pressure (-17%), central venous pressure (-15%) and the rate-pressure product (-9%) (P < 0.05). The changes in mean arterial pressure (-7%), cardiac index (-6%) and systemic vascular resistance (-8%) following vecuronium were insignificant. There were no differences in any of the variables between rocuronium and vecuronium. The absolute values of all variables were, however, within acceptable clinical limits. There was no evidence of histamine release in any patient. The present study shows that rocuronium 0.6 mg.kg-1 is associated with changes of only small magnitude in haemodynamic variables.     

Anaesthesia for cardioversion: immediate haemodynamics in patients anaesthetized with thiopental or althesin

This case report describes successful lithium treatment in a patient with long-standing periodic catatonia. Various medical treatments had been tried with meager results. Since 1955, a number of phenothiazines had been tried, also with little improvement. The institution of lithium treatment in 1964 caused a dramatic improvement in the patient's condition. For 9 years the patient remained totally asymptomatic. Lithium treatment was terminated in 1975 because of lithium intoxication with a diabetes insipidus-like syndrome. The patient then became psychotic again and has since experienced periodic phases similar to the previous illness. The diagnostic validity of the case is discussed, and some possible explanations of the favourable response to lithium are mentioned briefly.     

The enhanced bioavailability of mebendazole in echinococcosis patients when used with Essentiale

We report a case of extremely severe hyponatraemia which led to the discovery of anterior hypophysis insufficiency associated with empty sella turcica in a dysimmune context. This type of hyponatraemia is consecutive to corticotropic and thyreo-tropic hormones deficiency and to inappropriate secretion of arginine vasopressin. These endocrine abnormalities are of suprapituitary origin. They can be explained by a hypothalamo-hypophyseal dysregulation of little known mechanism, or by a lesion of the hypothalamus.     

A comparison of 2% and 1% formulations of propofol for the induction and maintenance of anaesthesia in surgery of moderate duration

This study, conducted in 110 patients undergoing surgery of moderate duration, compared the pharmacodynamic equivalence, efficacy and safety of 1% and 2% formulations of propofol. Anaesthesia was induced with propofol 2 mg.kg-1 given over 40 s and supplementary bolus injections of propofol were given if needed. There were no significant differences between the groups in mean induction times, total induction doses of propofol, frequency and mean duration of apnoea, fentanyl requirements or mean recovery times (times to eyes opening and to orientation). Isolated statistically significant group differences in systolic and diastolic blood pressures and heart rates during induction were not considered clinically significant. Discomfort on injection occurred in 40% and 52% of those given 1% (n = 55) and 2% (n = 55) propofol, respectively; there was no statistically significant group difference in severity. No major adverse effects were reported. This study showed that the 2% formulation has a similar safety and pharmacodynamic profile to the 1% formulation.     

Iodixanol in cardioangiography in patients with coronary artery disease. Tolerability, cardiac and renal effects

PURPOSE: Complications following transvaginal ultrasound-directed follicle aspiration are rare, making it difficult to assess their true incidence. During a 4-year prospective study the complications arising from a series of 2670 consecutive procedures were monitored. RESULTS: Vaginal hemorrhage occurred in 229 (8.6%) of the cases, with a significant loss (> 100 ml) in 22 (0.8%). Postoperative pelvic infection occurred in 18 (0.6%) of the cases. Hemorrhage from the ovary with hemoperitoneum formation was seen on two occasions and necessitated emergency laparotomy in one instance. A single case of pelvic haematoma formation from a punctured iliac vessel was also recorded; this settled without intervention. Of the 18 cases with infection, 9 were severe with pelvic abscess formation; microbiological examination of the pus from these cases suggests that the most common route of infection in such cases is probably by direct inoculation of vaginal organisms into the peritoneal cavity by the collecting needle. CONCLUSION: The low incidence of pelvic infection questions the value of using prophylactic antibiotics. No increased risk of infection was demonstrated in cases with preexisting peritoneal damage.     

A comparison of eltanolone and propofol anaesthesia for minor gynaecological surgery

This paper reports a rare case of a 69-year-old man bearing a right parotid lump, measuring near 5 cm diameter, which diagnosis resulted a Warthin's tumor. The used procedure to reach the diagnosis was aspiration through a fine needle. Two months after the laboratory diagnosis--so within the preoperative term--we can corroborate the clinical and radiological missing of the growth. Review and analysis of etiologic and pathogenic mechanisms.     

A comparison of active-alert hypnotic induction with traditional relaxation induction.

Describes the testing of an active-alert induction procedure which sufficiently controlled conditions to permit a comparison between the alterations produced by that procedure and those produced by the traditional relaxation induction technique. Ss were 50 university students. In the active-alert induction the S rode a bicycle ergometer under load, keeping eyes open while exercising and receiving suggestions of alertness. The alternate form, used in random alternation with the same Ss, consisted of the standard eye-fixation and relaxation induction of the Stanford Hypnotic Susceptibility Scale, Form B (SHSS-B). Within each session on 2 days during which each S served, the induction procedure was followed by 8 tests of responses to suggestion, from the SHSS-A and SHSS-B. The mean measured hypnotic responsiveness was independent of the type of induction. The active-alert condition was characterized by an acceleration of the rate of pedaling for the more responsive Ss. Although the subjective alterations differed between the 2 kinds of induction, the highly susceptible reported that in both cases altered states were achieved. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical efficacy and safety of propofol or ketamine anaesthesia in dogs premedicated with medetomidine

Combinations of medetomidine with either propofol or ketamine were compared for the sedation and induction of anaesthesia in dogs undergoing a variety of surgical (60 per cent) and non-surgical (40 per cent) procedures. Eighty-four dogs were used at four sites. Medetomidine was administered intramuscularly at a dose of 1000 micrograms/m2 body surface area 10 to 15 minutes before the induction of anaesthesia by the administration of propofol (n = 44) or ketamine (n = 40) dosed to effect. The dogs became sedated by medetomidine after a mean (sd) time of 6.7 (5.4) minutes, and their heart rates and respiration rates decreased. Sixteen of the dogs suffered an adverse effect, 13 of them vomited. Anaesthesia was induced by the intravenous administration of propofol (2.1 [0.7] mg/kg) or ketamine (3.7 [1.9] mg/kg), and further doses of the anaesthetic were given, depending on the length of the operation, once in 17 per cent, twice in 11 per cent and three or more times in 24 per cent of the cases. The heart rate of the dogs anaesthetised with ketamine was significantly higher than that of the dogs anaesthetised with propofol, but there were no other significant physiological differences. There were 11 adverse side-effects in the ketamine group compared with five in the propofol group and they were generally more severe. The quality of the recovery from anaesthesia was considered to be smooth in 89 per cent of the propofol group but in only 63 per cent of the ketamine group.     

L-arginine--substrate for no synthesis--its beneficial effects in therapy of patients with peripheral arterial disease: comparison with placebo-preliminary results

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in three cases with a new technique called the "balloon push-out method." Instead of pulling the tumor, which is hard to grasp because of its delicate nature, we pushed it out of the esophageal wall with a balloon-mounted intraluminal endoscope in order to perform the operation faster and more safely. We found this technique to be very useful in this kind of operation.     

A comparison between medetomidine-ketamine and medetomidine-propofol anaesthesia in rabbits

Clinician-managers (CMs) are becoming increasingly responsible for resource allocation decisions, decisions that can spawn ethical issues when resources are scarce. The purpose of the study on which this article is based was to determine which factors would predict CMs' satisfaction with organizational practices that assist them with ethical issues arising from resource allocation decisions.     

Strategies used with intrusive thoughts: A comparison of OCD patients with anxious and community controls.

Models of intrusive thoughts attribute a key role to strategies used by people to cope with their unwanted cognitions. In an extension of previous work, the authors conducted structured interviews with 38 people with obsessive–compulsive disorder, 38 people with another anxiety disorder, and 19 healthy volunteers. The interview identified the repertoire of strategies used with the participant's most troubling thought. The 2 clinical groups reported significantly more strategies than the nonclinical group. The clinical groups also reported significantly greater intensity of the thought and their emotional response and lower efficacy for the strategies. People with OCD reported a significantly higher proportion of strategies that were specifically linked to the thought content (as distinct from nonspecific strategies that were only linked sequentially in time). The results identify both common and differential characteristics of intrusive cognition in anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of ketamine and the combination ketamine-xylazine for effective surgical anesthesia in the rabbit

Ketamine alone and the combination ketamine-xylazine were evaluated as surgical anesthetics in rabbits. It was found that ketamine alone provided inadequate analgesia for ventral abdominal incisions or exposure of the femur. The combination of xylazine with ketamine did provide adequate enalgesia for both surgical procedures.     

Anesthetic and cardiorespiratory effects of tiletamine-zolazepam-medetomidine in cheetahs

OBJECTIVE: To evaluate anesthetic and cardiorespiratory effects of an intramuscular injection of a tiletamine-zolazepam-medetomidine combination in cheetahs. DESIGN: Prospective study. ANIMALS: 17 adult captive cheetahs. PROCEDURE: The anesthetic combination was administered intramuscularly via a dart. Induction quality, duration of lateral recumbency, duration of recovery, and quality of anesthetic reversal with atipamezole were assessed. Cardiorespiratory variables (arterial blood gas partial pressures, arterial blood pressure, heart and respiratory rates, end-tidal CO2, oxygen saturation, and rectal temperature) were measured during anesthesia. RESULTS: Sedation and lateral recumbency developed within 1.9 +/- 1.0 (mean +/- SD) and 4.3 +/- 2.0 minutes of drug administration, respectively. Clinically acceptable cardiorespiratory and blood gas values were recorded for at least 87 minutes after drug administration in all but 1 cheetah. Hypoxemia and arrhythmias developed in 1 cheetah breathing room air but resolved after treatment with oxygen. Hypertension developed in all cheetahs. Significant differences in heart and respiratory rates, mean arterial blood pressure, arterial pH, partial pressure of oxygen, and hemoglobin saturation were found between cheetahs that did and did not receive oxygen supplementation. After administration of atipamezole, sternal recumbency and mobility returned within 6.9 +/- 5.8 and 47.5 +/- 102.2 minutes, respectively. Postreversal sedation, which lasted approximately 4 hours, developed in 4 cheetahs. CLINICAL IMPLICATIONS: Tiletamine-zolazepam-medetomidine delivered via a dart provided an alternative method for induction and maintenance of anesthesia in cheetahs. Atipamezole at the dose used was effective for reversal of this combination in the initial phase of anesthesia.     

Toxicity grading systems. A comparison between the WHO scoring system and the Common Toxicity Criteria when used for nausea and vomiting

Human neutrophil PLD activity stimulated with GTP-gamma-S was reconstituted with recombinant ARF1 in cytosol-depleted cells. PMA-pretreatment of intact cells greatly enhanced the subsequent reconstitution of the ARF1-regulated PLD activity. This enhancement was only observed provided that the intact cells were pretreated with PMA, suggesting the stable recruitment of a cytosolic component, presumably protein kinase C, to the membranes. rARF1-reconstituted PLD activity was not dependent on MgATP, but could be considerably enhanced by MgATP. Maximal effects of MgATP were seen at 1 mM. This enhancement by MgATP could not be attributed to protein kinase C. Neomycin was found to inhibit ARF1-regulated PLD activity suggesting the requirement for polyphosphoinositides. We conclude: (i) that many of the observed effects of PMA may be dependent on the presence of the small GTP-binding protein, ARF, and (ii) polyphosphoinositides are required for ARF1-stimulated PLD activity.