Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.

The catecholamine and cardiovascular responses to laryngoscopy alone have been compared with those following laryngoscopy and intubation in 24 patients allocated randomly to each group. Following induction with fentanyl and thiopentone, atracurium was administered and artificial ventilation undertaken via a face mask for 2 min with 67% nitrous oxide in oxygen. Following laryngoscopy, the vocal cords were visualized for 10 s. In one group of patients, ventilation was then re-instituted via a face mask, while in the second group the trachea was intubated during the 10-s period and ventilation of the lungs maintained. Arterial pressure, heart rate and plasma noradrenaline and adrenaline concentrations were measured before and after induction and at 1, 3 and 5 min after laryngoscopy. There were significant and similar increases in arterial pressure and circulating catecholamine concentrations following laryngoscopy with or without intubation. Intubation, however, was associated with significant increases in heart rate which did not occur in the laryngoscopy-only group.

Effect of halothane on cardiovascular and plasma catecholamine responses to tracheal intubation.

The catecholamine and cardiovascular responses to intubation were investigated during halothane anaesthesia. Thirty patients were allocated randomly to two groups. Following induction of anaesthesia and muscle relaxation, group 1 was ventilated with 70% nitrous oxide in oxygen before intubation; group 2 received 1% halothane in addition. After intubation, both groups received 0.5% halothane. Arterial pressure and heart rate, and plasma noradrenaline and adrenaline concentrations were measured throughout the induction sequence. In group 1 intubation was associated with increases (from pre-induction values) in systolic arterial pressure of 13% and diastolic arterial pressure of 35%, although the plasma concentrations of noradrenaline did not alter significantly. In group 2, although there was a pressor response to intubation, no overall change in systolic arterial pressure and only a 13% increase in diastolic arterial pressure occurred when compared with pre-induction values. This response was associated with a 78% increase in the noradrenaline concentration; the adrenaline concentration did not alter significantly.

Hyperbaric bupivacaine and hyperbaric cinchocaine: a comparison of their use for spinal anaesthesia.

A new spinal analgesic formulation, 'heavy bupivacaine', was compared clinically with a commonly used agent. Sixty patients, who required spinal analgesia for transurethral prostatectomy, received either 1.5 ml of hyperbaric 0.5% cinchocaine (Nupercaine, Percaine, Dibucaine) in 6% dextrose or 2.5 ml of hyperbaric 0.5% bupivacaine (Marcain) in 8% dextrose. The onset, rate of rise, plateau height of the sensory block, reduction in blood pressure and peak expiratory flow rate, and the operative and post-operative blood loss did not differ significantly. Motor blockade was significantly less with bupivacaine. It is concluded that hyperbaric bupivacaine is an acceptable alternative to hyperbaric cinchocaine for spinal analgesia for transurethral prostatectomy.

Anaesthesia and severe skin disease.

A review of the anaesthetic management of severe skin disease is presented. Erythroderma, urticaria pigmentosa, hereditary angioedema, epidermolysis bullosa, pemphigus, pemphigoid, the Stevens-Johnson syndrome, Behcet's syndrome, scleroderma, Ehlers-Danlos syndrome and congenital anhidrotic ectodermal defect are discussed.