[Clinical pharmacology aspects of althesin]. / Aspetti di farmacologia clinica dell'Althesin.

The main pharmacokinetic and pharmacodynamic features of althesin are described. Though relatively new, this steroid is now widely employed in anaesthesiological practice. From the pharmacological standpoint, the high therapeutic index of althesin, the fact that its metabolic fate is known, its rapid elimination, and the prompt, complete awakening of patients when it is used mean that it can be reliably employed in all forms of surgery and on all types of patient. The absolute contraindications coincide with those preventing the employment of general anaesthesia in any form, while the relative contraindications, i.e. those involving particular care in its administration, are linked to the presence of diseases interfering with its mechanism and elimination, the existence of allergy, or cardiovascular disorders of a fairly substantial nature. Althesin, in fact, while not responsible for frank cardiovascular changes, cannot be regarded as entirely innocuous. In other words, it is subject to the same limitations as the barbituric and non-barbituric drugs commonly employed in the i.v. induction of anaesthesia.

[Steroid anesthesia in microsurgery of the middle ear]. / L'anestesia steroidea nella micro-chirurgia dell'orecchio medio.

The essential requirements for correct anaesthesia in microsurgery of the middle ear are described and results obtained with an association of Althesin and NLA drugs in 52 stapedectomies, 27 tympanoplasties, and 14 myringoplasties are presented. Althesin was injected i.v. to induce anaesthesia. Maintenance was obtained by means of the continuous venous perfusion of a 10% solution. The usefulness of the association was apparent from the good cardiac stability noted throughout anaesthesia, during which adrenaline was routinely infiltrated via the external meatus. In addition, the manageability of Althesin enabled a modest degree of hypotension to be established during certain stages of the operation. This enabled the intraoperative bleeding that is one of the major snags in this type of surgery to be reduced in some cases. Other benefits related to the degree of postoperative sedation required and the low toxicity of the drugs employed.

The inhibitory action of ketamine on the rat's gastric secretion.

Ketamine exhibited effects on gastric acid secretion total acidity and acid output. Reduction of secretion by ketamine did not appe,r to be significantly different from values obtained with atropine or hexamethonium. In addition to atropine- and hexamethonium-like effects, ketamine also appeared to decrease gastric secretion through a potentiating activity on the sympathetic nervous system. When sympathetic activity was potentiated by cocaine, the antisecretory effect of ketamine appeared to be significantly reduced, compared with that of atropine. Furthermore, after alpha- or alpha- and beta-blockade, ketamine produced similar decreases in secretion, although maximum inhibitory effect was obtained after beta-blockade. Potentiation of adrenergic activity by ketamine seemed to be mediated through alpha-receptors. Histamine H2 receptors did not appear to be involved in the antisecretory action of ketamine.

[Anesthesiological problems in renal transplantation]. / Problemi anestesiologici nel trapianto renale

The physiopathological changes observed in uraemia are briefly described and an account is given pharmacological considerations relevant to the induction and maintenance of anaesthesia and muscle relaxation, The anaesthesiological management of 20 kidneys transplants (17 from living donors and 3 from cadavers) is explained. Steps taken for intra-operative care and protection of the transplanted organ to aid its function recovery are explained.