The anaphylatoxins C3a and C5a are vasodilators in the canine coronary vasculature in vitro and in vivo.

The effect of complement fragments on coronary blood flow in vivo and the contraction of coronary arteries in vitro was determined. In pentobarbital anesthetized dogs, intraarterial bolus injection of C3a and C5a, zymosan-activated serum and methylcholine in the coronary vascular bed caused transient and dose-dependent increases in coronary blood flow. Similar increases were obtained with 25 micrograms of C3a (104 +/- 13%, n = 5) and 0.1 microgram of methylcholine (102 +/- 4%, n = 3). Smaller increases in blood flow were elicited by 25 micrograms of C5a (41 +/- 18%, n = 4) and 0.2 ml of zymosan-activated serum (48 +/- 5%, n = 4). None of these responses were associated with significant changes in left ventricular contractile force measured with a strain gauge, arterial blood pressure, and heart rate. C3a dilated the coronary vascular bed in conscious dogs with an activity equal to or greater than that observed in anesthetized dogs. Isolated canine coronary arteries that were precontracted with serotonin relaxed in response to C3a, whether or not the endothelium was intact. Overall these data suggest that physiologically high doses of anaphylactic complement fragments vasodilate the canine coronary circulation.

Plasma glucose concentrations during liver transplantation.

We reviewed the intraoperative plasma glucose concentrations in 100 consecutive patients who underwent orthotopic liver transplantation. The plasma glucose concentration increased significantly (P less than 0.05) from 110 +/- 46 mg/dl (mean +/- SD) to 204 +/- 60 mg/dl during the preanhepatic phase of transplantation (phase I). No significant change in plasma glucose concentrations occurred during the anhepatic phase (phase II). During the reperfusion phase (phase III), the mean plasma glucose concentration increased significantly (P less than 0.05) from 201 +/- 56 mg/dl to 384 +/- 72 mg/dl. The only glucose administered was that contained in the blood products. No correlation was found between the amount of glucose administered with the blood products and the changes in plasma glucose concentrations in these patients. None of the patients became hypoglycemic during any phase of the transplant procedure. All patients demonstrated a tendency toward hyperglycemia.

The effects of age, epinephrine, and operative site on duration of caudal analgesia in pediatric patients.

The effects of age, operative site (penoscrotal or inguinal), and the addition of epinephrine 1:200,000 to bupivacaine on duration of postoperative analgesia after caudal block were prospectively and blindly evaluated in 341 children aged 13 months to 17 yrs. At the conclusion of the surgical procedures under halothane/N2O/O2 anesthetics (n = 419), caudal blocks were performed with 0.5 ml/kg of either 0.25% bupivacaine or 0.25% bupivacaine with 1:200,000 epinephrine injected at a rate of 0.5 ml/sec. The duration of analgesia was noted by parents or nurses who had been instructed how to identify, in a standard manner, the onset of postoperative pain. The mean duration of analgesia was significantly longer in young children (P less than 0.001), in children having penoscrotal operations (P less than 0.001), and when epinephrine was added to bupivacaine (P less than 0.001). There were no major complications. The authors conclude that duration of analgesia is significantly influenced by age, operative site, and the addition of epinephrine 1:200,000 to bupivacaine.

Role of nitrous oxide and other factors in postoperative nausea and vomiting: a randomized and blinded prospective study.

Postoperative nausea and vomiting have been reported to be associated with the use of nitrous oxide. To further investigate this possibility, 780 patients undergoing anesthesia and surgery were randomly divided into four groups: group I: enflurane/nitrous oxide/oxygen; group II: enflurane/air/oxygen; group III: isoflurane/nitrous oxide/oxygen; and group IV: isoflurane/air/oxygen. The frequency of postoperative nausea and vomiting was ascertained in the recovery room and at 24-h follow-up by blinded observers. Other data collected included gender, age, body mass index, previous history of postoperative nausea and vomiting, and postoperative narcotic use. The authors found no association between the use of nitrous oxide and subsequent development of postoperative nausea and vomiting. Use of the 95% confidence interval allowed the authors to project a maximum potential increase in the frequency of postoperative nausea and vomiting associated with nitrous oxide to be 5.4% with enflurane and 9.7% with isoflurane in the immediate postoperative period. Female gender, younger age, and a previous history of postoperative nausea and vomiting, but not body mass index, were found to be associated with postoperative nausea and vomiting (P less than 0.05). It is concluded that there is no association between the use of nitrous oxide and the development of postoperative nausea and vomiting.

Human T-cell lymphotropic virus type III (HTLV-III) infection: how it can affect you, your patients, and your anesthesia practice.

The effects of the current HTLV-III epidemic are of considerable significance to the general public and health care system. It is a new disease with diverse ramifications . . . not all of which are understood. Many drugs are being evaluated in clinical trials, but at present, they are not expected to be able to rid an infected individual of HTLV-III. There is hope for an effective vaccine, but its development is not anticipated in the near future. For now, prevention of exposure is our only means of decreasing HTLV-III transmission. We will be caring for increasing numbers of patients with HTLV-III infection. Some of these patients will have AIDS or ARC. However, a much larger pool of patients will have asymptomatic, unrecognized HTLV-III infections. Therefore, all of our patients should be treated with good hygienic practices. Appropriate guidelines can help insure our safety as well as that of our patients. The evidence is overwhelming that HTLV-III is spread sexually, by injection of contaminated blood, and from mother to fetus. Our highest personal risk for becoming infected with HTLV-III is by parenteral introduction via contaminated needles or other sharp objects. We must realize that despite the routine close contact with blood and body secretions of patients inherent to our profession, we are at little risk for becoming infected. Furthermore, with care and vigilance, we can protect our patients from risk of infection with not only HTLV-III, but a wide variety of other infectious agents as well.