[Anesthesia with propanidid in a liposomal preparation. An experimental study in swine]. / Anästhesie mit Propanidid in liposomaler Zubereitung. Eine experimentelle Studie am Schwein.

BACKGROUND: Propanidid was widely used as a short-acting i.v. anaesthetic until it was withdrawn due to severe haemodynamic side effects. It was presumed that anaphylactoid reactions with massive histamine release were caused by the solvent cremophor rather than by propanidid itself. A new liposomal preparation of propanidid was examined in this animal study and compared with propanidid in cremophor solution and with propofol. METHODS: Eighteen pigs were randomly assigned to one of the following groups: Group 1 (n = 6): Propanidid in liposomal preparation (PropaLip; Braun Melsungen, Germany). Anaesthesia was induced with 60 mg/kg, followed by continuous infusion of 400 mg/kg.h. Group 2 (n = 6): Propanidid in cremophor solution (PropaCrem; Sombrevin, Gedeon Richter, Budapest) 15 mg/kg, 100 mg/kg.h. Group 3 (n = 6): Propofol (Disoprivan, Zeneca, Plankstadt, Germany) 5 mg/kg, 20 mg/kg.h. After induction and tracheal intubation, the animals were ventilated with 50% oxygen in air. Basic monitoring included noninvasive blood pressure measurements, electrocardiographic monitoring, and capnography. In a short surgical procedure, arterial and pulmonary artery catheters were placed via the right carotid artery and right internal jugular vein, respectively. As soon as the animals responded to a pain stimulus a second anaesthetic induction was performed, followed by a 60-min continuous infusion of the agent studied with invasive haemodynamic monitoring including arterial and pulmonary arterial pressures and cardiac output. Blood samples were taken for the measurement of serum levels of adrenaline, noradrenaline, cortisol, aldosterone, adrenocorticotropic hormone, and histamine. RESULTS: Intubation conditions and quality of anaesthesia were best in propofol animals, followed by PropaCrem animals. In spite of the large dose of 410 mg/kg.h, resulting in a volume load of as much as 16.4 ml/kg.h, the PropaLip animals showed evidence of poor anaesthetic quality. In group 1 we recorded the highest increases in heart rate (91 vs. 115/min), cardiac output (5.4 vs. 7.7 l/min), plasma catecholamine levels, and histamine concentrations (124-268 ng/ml). CONCLUSIONS: In our animal study, propanidid in liposomal preparation failed to show promise as a new anaesthetic agent. Our results are discussed in view of a drug targeting the cells of the reticuloendothelial system, especially the liver, where liposomes are eliminated from the blood. This may result in the transport of propanidid to one of its major places of inactivation.

[Comparative evaluation of anesthesia with etomidate and propanidid in patients undergoing electric cardioversion]. / Porównawcza ocena anestezji etomidatem i propanididem u chorych poddanych kardiowersji elektrycznej.

Cardioversion is one of the most effective treatment in cardiac arrhythmias. However, this technique is painful it requires proper anaesthesia assuring stable circulatory and respiratory functions. The authors compared two anaesthetics: etomidate and propanidid. No significant difference in their effects on both circulation and respiration has been noted. Some differences between both drugs in the produced adverse reactions were however noted. Etomidate caused pain at the site of injection, propanidid allergic reactions in the form of skin rash.

[Clinico-physiologic characteristics of intravenous sombrevin anesthesia in treating inflammatory diseases of the maxillofacial area]. / Kliniko-fiziologicheskie osobennosti vnutrivennoi anestezii sombrevinom pri lechenii vospalitel'nykh zabolevanii cheliustno-litsevoi oblasti.

The authors analyze the clinical applications of intravenous propanidid anesthesia in outpatient oral surgery for maxillofacial inflammations. The quality of this type of anesthesia, its adequacy, side effects, and terms of restoration of the psychophysiologic function and speech are discussed.

[The isolation syndrome]. / Sindrom izoliatsii.

In a previously healthy woman aged 36 years with 16% of the skin surface burned, an injection of sombrevin elicited basilar artery thrombosis which manifested in isolation syndrome (IS) with temporary left sight paresis and vertical ocular divergence. Pathological investigation revealed the infarct involving right brain pedicle and pontine paramedian regions.

Immune reaction to propanidid.

An adverse reaction to the intravenous anaesthetic agent propanidid is described in which the main features were hypotension, facial erythema, and abdominal pain. Changes in serum complement levels and differential white cell counts indicate that this was an immune reaction mediated by the classical complement pathway. The immune reaction apparently involved antibodies other than those of the IgE (reagin) class, and circumstantial evidence suggests that it was specific to propanidid rather than to the entire formulation or to Cremophor EL.

[Dangerous complications of sombrevin anesthesia]. / Opasnye oslozhneniia sombrevinovogo narkoza.

The experience of using sombrevin anesthesia in 3644 cases and its 3 severe complications which resulted in the development of terminal states up to the clinical death (reanimation was successful) is analyzed. This anesthesia is shown to be necessary under conditions providing a possibility of immediate fulfillment of the complex of highly skilled reanimation measures, with early solution of problems of succession between the polyclinic link and the reanimation hospital. Special attention is called to strict observation of the principle of the preliminary (the day before operation) examination by an anesthesiologist of the patients who are to be subjected to planned short operative interventions, for the individual choice of the method of anesthesia and prevention of severe complications after narcosis.

[Experiences with 31 anaphylactoid reactions (author's transl)]. / Erfahrungen aus 31 anaphylaktoiden Reaktionen.

31 Anaphylactoid reactions to Dextran, Propanidid, Althesin, Ampicillin and Mepivacaine are reported. By rapid infusion of Ringer lactate and colloid solutions to an amount of 2,000-3,000 ml circulation could be restored in 30 minutes. Prednisolone did not reveal positive effects. After administration of epinephrine in 3 of 4 cases more negative than positive effects were seen.

[Resuscitation in acute allergic reactions to drugs]. / Reanimatsiia pri ostrykh allergicheskikh reaktsiiakh na lekarstvennye sredstva.

Under analysis were 40 cases of allergic reactions of the immediate type arising in 38 patients following the application of various pharmacological agents. Urticaria and Quincke's edema were observed in 21 cases and anaphylactic shock--in 19 cases. Rare cases of anaphylactic shock following injections of sombrevin, polyglucin and clinical observations of the recurring character of the course of allergic reactions are described.