[Anxiety as a anesthesiological problem]. / Lek--jako problem anestezjologiczny.

Fear is a feeling which always accompanies people. It is a compound phenomenon, which has different components as psychologic, motor, somatic-vegetative and metabolic. The operation and anesthesia increase the feeling of anxiety. The dimension of the fear has the inconvenient influence on the time of recovery, quantity of complications and the discomfort felt by patients. The dimension of the fear can be measured in many ways. The questionnaires are one of the methods of taking an objective measurement. The STAI is one of the most often used between them. It enables the estimation of the efficacy of the preoperative preparing methods and the dynamics of the fear during the hospitalization. Monitoring of the anxiety can be very useful in the decreasing the fear.

[Comparison of anxiety in patients before surgery for varicose veins and laparoscopic cholecystectomy]. / Porównanie leku u chorych przed operacja zylaków konczyn dolnych i przed cholecystektomia laparoskopowa.

The trial of estimation of the fear degree before operation and its dependence on the patient's sex, type of operation and anaesthesia was performed. 76 patients before the operation were examined: group I--38 patients, including 27 women and 11 men waiting for the repair of lower extremities varicose veins under local anaesthesia, and group II--also 38 patients, including 27 women and 11 men before the laparoscopic cholecystectomy due to cholecystolithiasis. The Polish version of the Spilberg's State--Trait Anxiety Inventory was used in the estimation of the fear. The statistically significant difference of the preoperative fear degree between examined groups was not found. There were also no significant differences between men and women in the same group. Women in both groups displayed a significantly higher values of the fear as a trait. Probably laparoscopic operations are considered by the patients as more safe than traditional ones, and maybe the trust in doctors causes the fact that the operation under general anaesthesia is connected with low fear as well as the operation under local anaesthesia.

Effect of enflurane on selected neuropeptides and marker enzymes in rabbit brain.

The aim of this study was to evaluate the effect of 5-, 15-, and 60-min enflurane anesthesia on the levels of Met-enkephalin, Leu-enkephalin and neuropeptide Y in discrete areas of the rabbit brain. We also evaluated the effect of enflurane anesthesia on energetic, transport and catabolic processes by measuring the activities of succinate dehydrogenase, magnesium-dependent adenosine triphosphatase and acid phosphatase in the rabbit striatum and hypothalamus. Induction of anesthesia (5 min) decreased Met-enkephalin levels in the hypothalamus and striatum, and increased them in the hippocampus and mesencephalon. Induction of anesthesia increased Leu-enkephalin levels in all brain areas studied, except for the striatum, and increased neuropeptide Y content in the hippocampus. 15- and 60-min enflurane anesthesia increased Met-enkephalin content in the hypothalamus and hippocampus. After 15- and 60-min anesthesia, and after cessation of anesthesia, Leu-enkephalin levels were increased in the hypothalamus and mesencephalon, and were decreased in the striatum and hippocampus. In the striatum, neuropeptide Y content was significantly decreased during anesthesia and after cessation of anesthesia. Histochemical analysis revealed that enflurane enhanced ATP production, catabolic processes, and the rates of exchange and transport of energetic substrates in the striatum and hypothalamus. In conclusion, enflurane affects the levels of Met, Leu-enkephalins and NPY in a manner depending on the duration of anesthesia and the brain structure. Compared with isoflurane , which was studied in our previous study enflurane produces stronger alterations in the activities of enzymatic marker in the rabbit brain. This suggests that enflurane may be less safe than isoflurane.

Influence of isoflurane on enkephalin levels and on some indicatory enzymes in the central nervous system of rabbits.

The objective of this study was to analyse the effects of isoflurane anesthesia (lasting for 15 or 60 min) and isoflurane anesthesia termination (after 1 or 24 h) on met-enkephalin (MENK) and leu-enkephalin (LENK) levels in discrete brain areas and spinal cord segments in rabbits. Moreover histochemical analysis of activities of succinate dehydrogenase, magnesium-dependent adenosine triphosphatase (Mg++ATP-ase) and acid phosphatase in the striatum and hypothalamus were carried out to evaluate the effects of isoflurane anesthesia on energetic, transport and catabolic processes. Throughout anesthesia (15 and 60 min) and after its termination (1 h) the LENK contents were increased in hypothalamus, hippocampus, mesencephalon and lumbar segment of spinal cord. Moreover, during isoflurane anesthesia and after its termination (1 h) MENK and LENK levels decreased in cervical segment and MENK content dropped in thoracic segment of spinal cord. Histochemical data indicated, that isoflurane enhanced energetic processes as well as exchange processes in neurocytes, glial cells, capillary walls and ependymal cells of the third ventricle. Measurements of acid phosphatase activity provided evidence of no signs of toxicity of isoflurane in the examined areas. The changes in enkephalin levels observed during the isoflurane anesthesia and after its termination depended on the type of examined neuropeptides, as well as on parts of the brain and spinal cord studied. The changes observed after isoflurane administration in enkephalinergic system are discussed with regard to our earlier experiments with halothane and enflurane.

Influence of halothane on the level of enkephalins in discrete brain areas of rabbits.

With regard to the fact, that theory of anesthesia, based on the endogenous opioid peptides requires further investigations the aim of this paper was to measure the concentration of leucine- (LENK) or methionine-enkephalin (MENK) in discrete brain areas of rabbits during and after 1 h halothane (2% v/v) anesthesia. The level of LENK and MENK was measured in discrete brain areas using the radioimmunoassay. Animals were divided into the following groups, depending upon the duration of anesthesia: I-15 min; II-60 min; III-1 h after anesthesia termination; IV-control group of non-anesthetized animals. After halothane anesthesia evident decrease in the concentration of leu-enkephalins in hypothalamus (HT) and the opposite effect in hippocampus (H) were observed. The MENK level significantly increased after halothane (for 60 min) in hypothalamus, hippocampus and mesencephalon (M). The change in the level of LENK in the thalamus (Th), hippocampus and mesencephalon and in the level of MENK in the hypothalamus and mesencephalon persisted after withdrawal of anesthesia. It was found that the alterations in the level of enkephalins in discrete areas of rabbit's brain is a feature of halothane anesthesia. The explanation of this phenomenon is possibly important for the understanding of the mechanism of halothane anesthesia and requires further investigations.

[Effect of CO2 insufflation into the peritoneal cavity on selected indices of respiratory system function during laparoscopic cholecystectomy]. / Wplyw insuflacji CO2 do jamy otrzewnej na wybrane wskazniki czynnosci ukladu oddechowego podczas laparoskopowej cholecystektomii.

An attempt was undertaken at evaluation of the influence of CO2 insufflation in patients subjected to laparoscopic cholecystectomy on pulmonary dynamic compliance, pulmonary resistance, pressures in the airways, CO2 pressure in expired air, and arterialized blood gas analysis. The studies were carried out in a group of 33 patients, including 26 women and 7 men, evaluated according to ASA scale as I/II degrees. The means of the values obtained before CO2 insufflation into the peritoneal cavity were compared with the means from the period of pneumoperitoneum maintenance. Statistically significant decrease of pulmonary compliance, increase of the mean pressure in the airways and increase of CO2 pressure both in expired air and arterialized blood were demonstrated. Pulmonary resistance and oxygen pressure in blood remained without statistically significant changes. The attention was paid to the rationale of including capnometry to the standard monitoring equipment during laparoscopic operations.

[Effect of age on dynamics of fear in patients undergoing cholecystectomy]. / Wplyw wieku na dynamike leku chorych poddanych operacji usuniecia pecherzyka zólciowego.

Forty patients, hospitalized in order to undergo the planned cholecystectomy were investigated with the help of self-evaluation questionnaire after Spielberger et al. The patients were divided according to the age, into two groups, each of them including 20 persons: Group I-13 women and 7 men above 60 (61-84) Group II-15 women and 5 men below 60 (19-57) The patients filled the questionnaire two days before the operation as well as the day before going home. Preoperational examination did not show any significant differences in fear intensification between two groups. Fear did not also depend upon the sex of the patients. Significantly higher (p < 0.001) level of fear was noticed in Group I at the time of medical examination before going home. The reason is most probably the elderly people's uncertainty concerning their physical efficiency with in many cases is necessary for them to survive. The seniors are also afraid of both compulsory dieting and limiting their life activities.

[Nalbuphine--properties and clinical use]. / Nalbufina--wlasciwosci i zastosowanie kliniczne.

Nalbuphine--a new opioid drug with agonistic-antagonistic action is presented. The action of the drug is discussed in the light of present theory of opioid receptors. On the basis of literature reports the experiences are analyzed of the clinical use of nalbuphine.