The anesthetic management of a patient with pemphigus vulgaris--a case report.

The anesthetic management of a patient with pemphigus vulgaris who required general anesthesia and endotracheal intubation for craniotomy operation is described. The anesthesia was assured with Diprivan. Vecuronium bromide/isoflurane/nitrous oxide in oxygen and fentanyl when necessary. No anesthetic and surgical complication occurred.

Prophylactic administration of ondansetron in emergency intraabdominal operations.

Efficiency of ondansetron, a selective 5- HT3 receptor antagonist, in prevention of postoperative nausea and vomiting in 40 ASA I-II patients to undergo emergency intraabdominal operations is studied in a randomized, double-blind and placebo controlled study. Patients of no premedication are administered 4 mg i.v. ondansetron or placebo (saline) before induction. Thiopental (4 mg/kg) was used for induction, succinylcholine (2 mg/kg) for muscular relaxation, and 50% nitrous oxide in oxygen and isoflurane (0.8-1.5%) for the maintenance, and fentanyl and norcuron were administered when necessary. Vital findings were closely monitored and recorded during anesthesia and during early postoperative period. Study was carried out during postoperative 0-Ih, 1-2h and 2-24 h periods. Nausea scores and emesis attacks of the patients were recorded during 0-1 and 1-2 h periods Ondansetron was found significantly more effective than placebo (p < 0.05 and p < 0.05). Although it was effective during 2-24 h period, the difference was not statistically significant (p > 0.05). No significant difference was observed between the groups in terms of vital findings, laboratory findings and side effects (p > 0.05). Therefore, it is concluded that administration of prophylactic i.v. ondansetron to patients undergoing emergency intraabdominal operations is effective in prevention of nausea and vomiting without any significant side effect.

Comparison of intubation conditions under propofol in children--alfentanil vs atracurium.

We have assessed tracheal intubating conditions in 45 ASA I-II children, aged 4-14 years, undergoing elective ear, nose and throat surgery. After the induction dose of propofol 2.5 mgkg-1, Group I received alfentanil 10 ugkg-1, Group II received alfentanil 20 ugkg-1 and Group III received atracurium 0.5 mgkg-1 for tracheal intubation. The mean arterial pressure (MAP), heart rate (HR), arterial oxygen saturation (SaO2), end tidal carbondioxide (ETCO2) and intubation conditions were investigated. The quality of tracheal intubation was graded according to ease of laryngoscopy, position of the vocal cords, coughing and jaw relaxation. There were no significant differences in the overall assessment of intubating conditions between the three groups. Intubations were accomplished in 94% of the patients in Group I and II, and 100% of the patients in Group III. We conclude that the combination of propofol and alfentanil conditions for treacheal intubation in children and attenuate the hemodynamic responses to layngoscopy and tracheal intubation.

Prophylactic administration of ondansetron in emergency intraabdominal operations.

Efficiency of ondansetron, a selective 5-HT3 receptor antagonist, in prevention of postoperative nausea and vomiting in 40 ASA I-II patients who will undergo emergency intraabdominal operations is studied in a randomized double-blind and placebo controlled study. Patients of no premedication are administered 4 mg i.v. ondansetron or placebo (saline) before induction. Thiopental (4 mg/kg) was used for induction, succinylcholine (2 mg/kg) for muscular relaxation, and 50% nitrous oxide in oxygen and isoflurance (0.8-1.5%) for the maintenance of anesthesia, and fentanyl and norcuron were administered when necessary. Vital signs were closely monitored and recorded during anesthesia and early postoperative period. Study is carried out during postoperative 0-1 h, 1-2 h and 2-24 h periods. Nausea scores and emesis were recorded during 0-1 and 1-2 h periods. Ondansetron was found significantly more effective than placebo (p < 0.05 and p < 0.05). Although is was effective during 2-24 h period, the difference was not statistically significant (p > 0.05). No significant difference was observed between the groups in terms of vital findings, laboratory findings and side effects (p > 0.05). Therefore it is concluded that administration of prophylactic i.v. ondansetron to patients undergoing emergency intraabdominal operations is effective in prevention of nausea and vomiting without any significant side effects.

The effect of edothelium on the response to propofol on bovine coronary artery rings.

In this study, the effect of propofol on isolated bovine coronary artery tone was studied in artery rings precontracted with PGF2a. Propofol, in concentrations of 10-6-10-5 M did not change vascular smooth muscle tone, but at high concentrations (10-4-10-1 M) produced relaxation in rings with intact endothelium. In rings denuded of endothelium or treated with methylene blue, propofol produced relaxation at 10-3-10-1 M concentrations, but there was a significant decrease in relaxation compared to endothelium intact rings. In the presence of a calcium agonist (Bay K 8644; 10-5 M), propofol produced constriction in rings denuded of endothelium. These results suggest that high concentrations of propofol may have vasorelaxant effect on bovine coronary artery and that these effects may be due to actions on the endothelium and mediated by calcium channels.

The choice of anaesthetic technique for caesarean section does not affect plasma beta-endorphin levels in the neonate.

Umbilical cord blood was collected immediately after parturition in full term neonates during Caesarean section under either general or epidural anaesthesia. Using a radioimmunoassay technique, beta-endorphin concentrations were measured in the plasma of neonates and Apgar scores were evaluated. The mean value of beta-endorphin was 56.80 +/- 14.35 (pg mL-1) in the general anaesthesia group, and 53.17 +/- 10.58 (pg mL-1) in the epidural anaesthesia group (N.S.).

Morphine/prilocaine combination for intravenous regional anesthesia.

In this study we aimed to investigate clinically whether morphine acts on the peripheral nervous system directly. Twenty adult patients, who were scheduled for upper extremity surgery under tourniquet, had intravenous regional anesthesia. They were divided into two groups: one group was given 30 ml of 1% prilocaine plus 10 ml of 0.9% sodium chloride (P group) and the other group was given 30 ml of 1% prilocaine plus 6 mg morphine sulfate in 10 ml of 0.9% sodium chloride (P/M group). The onset of analgesia and anesthesia and recovery from anesthesia and analgesia were investigated in both groups. In the P/M group, the onset of analgesia and anesthesia was statistically faster and the recovery from anesthesia and analgesia was statistically slower than in the P group (P < 0.05). We conclude that morphine is clinically effective in the peripheral nervous system at this dosage range.

Resistance to atracurium: Wegener's granulomatosis--a case report.

Few previous reports clarified that patients with an increased alpha 1 globulin fraction in their serum protein electrophoresis, will have resistance to the neuromuscular block of atracurium. Having a patient with diagnosis of Wegener's granulomatosis and a marked elevation of alpha 1 globulin fraction in her electrophoresis, we took this opportunity to monitor the neuromuscular block of atracurium. The data obtained, confirm previous studies showing that patients with a marked increase in alpha 1 globulin fraction may have a resistance to the action of atracurium.

The addition of sodium bicarbonate to prilocaine solution during i.v. regional anesthesia.

A comparison of plain prilocaine and bicarbonated prilocaine in intravenous regional anesthesia was studied in 30 patients undergoing upper extremity surgery. The patients were divided into two groups: one group was given anesthesia in the form of 1% prilocaine and the other group was given 1% prilocaine plus sodium bicarbonate. The onset of analgesia and anesthesia and recovery from analgesia and anesthesia were investigated in both groups. Bicarbonated prilocaine produced faster onset of analgesia when compared with plain prilocaine (P less than 0.01). The onset of anesthesia and recovery from analgesia and anesthesia were not statistically different between the two groups. Clinically, the intensity of anesthesia was better when bicarbonated prilocaine solution was used instead of plain prilocaine. We conclude that bicarbonated prilocaine is better than plain prilocaine during IVRA.

Medical treatment of acute spinal cord injuries.

The injury was performed with 600 g-cm/weight on the spinal cord of 40 cats with T8-9 laminectomy in this study. Ten cats were given 10 mg/kg naloxone i.v. 1 h after injury. Ten cats were given 2 mg/kg thyrotropin-releasing hormone (TRH) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. Intravenous lidocaine was begun 30 min after injury in ten cats, administered as 1.5 mg/kg over the initial 5 min, 3 mg/kg over the next 30 min and 1 mg/kg every 30 min for 4 h. The remaining ten cats were given only saline (control group). TRH-treated cats showed significantly better histopathological scores than either naloxone- or lidocaine-treated animals (KW:13.65, P less than 0.50).

Intracerebral myiasis from Hypoderma bovis larva in a child. Case report.

Cerebral myiasis with a 10-day history of convulsions due to an intracerebral hematoma caused by a Hypoderma bovis larva is reported in an 8-year-old child. Computerized tomography (CT) showed the hematoma in a right parieto-occipital location. The H. bovis larva and the extensive intracerebral hematoma were discovered during surgery. Among human parasitoses, cerebral myiasis is rare: a review of the literature revealed only two reports, one published in 1969 and one in 1980. This is the first case that has been diagnosed as cerebral myiasis with exact identification of the Hypoderma bovis larva both from the CT scans and at surgery in a patient during life.