Diltiazem cold cardioplegia in coronary artery surgery: effects on myocardial function and ischemia.

This study was undertaken to evaluate the myocardial preservation obtained by adding a calcium channel blocker, diltiazem (200 mcg/kg of body weight) to cold potassium cardioplegia in 24 patients with coronary artery disease who underwent myocardial revascularization, and were randomly divided into a treated Group D and a Control Group C. No significant differences were noted between the groups in cardiac electrical arrest and recovery time, recovery rhythm, mechanical function recovery, inotropic support, stroke index, or cardiac index. After cardiopulmonary bypass, the stroke index decreased by 13.1% in Group D and by 20.7% in Group C; cardiac index increased in both--18.6% and 14.0%, respectively--but the results were possibly from compensatory heart rate increases. Peripheral deltaP/deltat and endocardial viability ratios decreased in both groups. Coronary sinus enzymes and serum CK were slightly lower in the treated group. Serum CK-MB, however, was significantly higher in the Control Group. Electrocardiographic ischemic changes occurred in four patients, all in Group C (p =.046). Hyperkinetic arrhythmias occurred in five of the controls, but in none of the treated patients (p =.018). One perioperative myocardial infarction was diagnosed in the Control Group. These data suggest that diltiazem has no negative side effects on hemodynamics or cardiac rhythm and does not reduce impairment of myocardial function due to ischemia, but it does decrease the incidence of ischemic lesions in patients undergoing coronary artery bypass procedures.

[Can anesthesia be employed for male or female sterilization with impunity?]. / Si possono impunemente eseguire anestesie per interventi di sterilità maschile o femminile?

PIP: There are many questions regarding the legality or illegality of permanent sterilization in the Italian legal system. Many conflicting laws and articles in the Italian constitution lead to unclear conclusions which cause problems. Law number 194 states that it is no longer a crime to practice voluntary sterilization. However, the legislature did not take into accout that some jurists believe that loss of the capacity to procreate is a permanent affliction prohibited by article 5 of the Civil Code. Therefore, the patient's authorization of the sterilization will not hold up in court. These jurists conclude that even though voluntary sterilization is no longer a crime, it still remains punishable because it does great bodily harm. However, many such sterilizations take place in Italy. Rarely do the judicial authorities attempt to prosecute the subjects (actively or passively) except in a few cases where the law is carried out to its fullest extent and someone is jailed for a long period. The fact is that this is no longer a crime according to law 194 and a few innocent people are having to suffer for a crime which they did not really commit. Legal clarifications must be made so this does not continue to happen. For the time being, voluntary sterilizations should not be performed.^ieng

[Prevention of myalgias caused by succinylcholine with a small dose of a non-depolarizing muscle relaxant]. / La prevenzione delle mialgie da succinilcolina con una piccola dosse di miorilassante non depolarizzante.

Precurarisation with 1 mg/15 kg d-tubocurarine was given before 1.5 mg/kg succinylcholine to obtain muscle relaxation for tracheal intubation in 100 patients, whereas 1 mg/kg succinylcholine only was administered to 100 controls. Serious postoperative myalgia fell from 8% to 0%, and forms of average intensity from 21% to 8% in the curarised group. Muscle resolution was regarded as satisfactory in 96% (98% in the controls). The effectiveness and degree of safety of this combination are discussed, together with the indications and contraindications for the employment of the technique in the prevention of myalgia induced by succinylcholine.

[Changes in 2,3-diphosphoglycerate in polytransfused patients during neurosurgery]. / Le modificazioni del 2-3 difosfoglicerato in pazienti politrasfusi durante intervento neurochirurgico.

2,3-DPG values following administration of fructose 1,6-diphosphate were followed neurosurgery in 28 polytransfused patients. Intraerythrocyte 2,3-DPG values were already significantly over the baseline 8 hr after administration of the organic phosphate.

[Intravenous ethyl alcohol in metabolic resuscitation]. / L'alcool etilico per via venosa nella rianimazione metabolica.

Intravenously administered ethyl alcohol may be effective as analgesic and hypotensive peripheric vasoactive drug. In the Intensive Care Departments parenteral ethanol administration is infrequent because no "sure dosage" can be suggested in adults and children. Liver, kidney and C.N.S. diseases can worsen; foetopathy can follow. Drug-ethanol interaction may be particularly important for some patients admitted in Intensive Care Departments. Often the potential caloric support cannot be fully utilized ("empty" calories) and seldom hyperventilation, hyperlactacidemia and impaired protein synthesis can follow.

[Anesthesia problems of the multiply-injured patient]. / Problemi di anestesia nel politraumatizzato.

Anaesthesia in the case of subjects with multiple injuries is commonly a short-term emergency measure, in which a certain time is available for the implementation of intensive antishock therapy, or else anaesthesia for deferred emergency situations. Since the introduction of ketamine and althesin, the anaesthesiological risk has greatly reduced. Althesin has the best therapeutic index of all anaesthetics and the least myocardial toxicity. It also reduces intracranial pressure. Ketamine offers considerable neurovegetative protection. A personal technique, in which althesin with without althesin, is the drug of choice, is described.

[Althesin in anesthesia for neuroradiologic arteriographic studies]. / L'althesin nella anestesia delle indagini arteriografiche neuroradiologiche.

Following mention of problems of cerebral haemodynamics and the action of various anaesthetics on endocranial pressure, a personal anaesthesiological technique based on the use of althesin in drip form is reported and its advantages listed.