Intracardiac injection of T-61, a veterinary euthanasia drug.

CASE REPORT: We report a suicidal attempt by intracardiac injection of T-61, a veterinary euthanasia drug containing embutramide, mebezonium and tetracaine in dimethylformamide. The main complications were reversible acute renal failure and pericardial effusion. There was a delayed abnormality of the liver function tests possibly related to the dimethylformamide solvent. A liver biopsy on day 16 showed a normal hepatic architecture with lipid-containing lysosomes and prominent vesicular endoplasmic reticulum noted on electron microscopy.

[Effect of drugs used in anesthesia on endocardial viability ratio (EVR) in cardiac surgery]. / Effet de drogues utilisées en anesthésie sur l'index de viabilité de l'endocarde (E.V.R. ou "endocardial viability ratio") en chirurgie cardiaque.

Endocardial viability ratio, arterial blood pressure, heart rate, central venous pressure and left ventricular diastolic pressure were examined in 50 patients undergoing one or more aorto-coronary grafts. General anaesthesia was obtained by morphine, diazepam, pancuronium and a mixture of oxygen and nitrous oxide. Morphine anesthesia did not effect EVR. Only mean arterial pressure showed a significant increase at the time of surgical stimulation. During sternotomy, EVR fell progressively in patients with hypertension. Tachycardia alone did not modify it. This hypertension was better treated by sodium nitroprussiate than by halothane or enflurane with regard to protection of the sub-endocardial layer against ischaemia. Under the influence of sodium nitroprussiate EVR rapidly reached values greater than those obtained under halothane or enflurane. In the hour following extra-corporeal circulation, endocardial viability ratio improved without any significant variation in classical haemodynamic parameters.

Measurement of endocardial viability ratio (E.V.R.) during anesthesia for cardiac surgery.

Since sub-endocardial ischemia is the consequence of a discrepancy between the blood demand and supply of oxygen at this level, the study of the myocardial performance by the measurement of the endocardial viability ratio (E.V.R.) is both useful and possible during anesthesia. E.V.R. is the ratio between the oxygen supply and demand of the myocardium. It is equal to the diastolic pressure time index (D.P.T.I.) over the tension time index (T.T.I.). Measurements are made at different times, by means of the arterial pressure and the left atrial pressure, as well as with the Datascope-E.V.R. Computer. During gradual morphine administration (0.5-1-1.5 mg/kg) and if no major surgical stress occurs, E.V.R. remains excellent and stable (1.46 - 1.48 - 1.43). It deteriorates more or less (1.29 - 1.09) during tachycardia or hypertension. Within the hour following the end of extracorporeal circulation, E.V.R. significantly improves (1.04 - 1.06 - 1.09 - 1.23). Although E.V.R. measurement is easy during cardiac surgery, it is impossible to carry out in case of arrhythmia. While morphine anesthesia induces no variation in E.V.R., tachycardia or hypertension require the addition of therapeutic drug. Within one hour following the end of extra-corporeal circulation, E.V.R. measurement shows improved endocardial viability, although the hemodynamic parameters undergo no significant change.