Combined use of labetalol and nifedipine in controlling the cardiovascular response from ECT.

Serious cardiac complications have been reported to occur in elderly depressed patients during a course of electroconvulsive therapy (ECT). As a result, cardiac medications are being used more often to dampen the cardiovascular response that occurs during an ECT treatment. Specifically, labetalol (a mixed alpha- and beta-blocker) has been shown to effectively control the heart rate during ECT. However, on occasion, patients may still exhibit sustained elevations of blood pressure during ECT when receiving labetalol. The optimum clinical management of these patients is unclear. The authors report on the safety and efficacy of combining nifedipine with labetalol to control blood pressure during ECT in ten elderly patients whose blood pressures were not adequately controlled by labetalol alone. No adverse effects were noted, nor did nifedipine appear to shorten seizure duration.

The influence of anesthetic choice on carotid endarterectomy outcome.

This study compared the technique of general and regional cervical block anesthesia for carotid endarterectomy. Three hundred sixty-eight patients undergoing 399 carotid endarterectomies were administered one of these alternative anesthetics as selected preoperatively by each patient and his or her physician. In 242 cases general anesthesia was used. The other 157 cases were done under regional cervical block anesthesia. Perioperative mortality was 1.0%. Nonfatal strokes occurred in 1.25%. There were significantly more strokes in the general anesthesia group. Perioperative blood pressure was unstable for a significantly longer period of time after general anesthesia (mean, 24.6 hours) as compared with regional cervical block anesthesia (mean, 2.1 hours). Furthermore, vasoactive drugs were required for significantly longer periods of time in the general anesthesia group.

Perioperative hypertension in patients undergoing carotid endarterectomy: shorter duration under regional block anesthesia.

Two alternative anesthetic techniques for use during carotid endarterectomy were studied in a series of 424 procedures. A total of 248 were performed in patients under general anesthesia and 176 patients received regional block anesthesia. Perioperative instability of blood pressure was noted in 108 patients. Hypertension was noted in 17.7% of those under general anesthesia vs 20.5% of those under regional block anesthesia. Intravenous vasodilator agents were used for 19.62 hr (+/- 4.33) in the general anesthesia group vs 1.4 hr (+/- 0.44) in the regional block anesthesia group (p less than .02). Perioperative hypertension correlated best with uncontrolled preoperative hypertension. Under regional block anesthesia the incidence of shunting was 4.5%. The 1 month operative mortality for the entire carotid series was 1.2% (5/424). There were three stroke-related deaths. In addition, two nonfatal major strokes and two minor strokes occurred in patients who received general anesthesia vs one nonfatal major stroke in a patient who received regional block anesthesia.

Effects of intravenous high doses of ketoprofen on blood clotting, bleeding time and platelet aggregation in man.

The effect of ketoprofen (Orudis, Farmitalia) on ADP, epinephrine (EPI) and collagen (COLL) induced platelet aggregation (PlA), simplate bleeding time (SBT), partial thromboplastin time (PTT) and per cent prothrombin activity (PrA) was studied in eleven patients, four males and seven females (median age 59 years) with rheumatoid arthritis (six cases), cancer (four cases) and osteoarthrosis (one case). Tests were performed before and 1, 8 and 24 hours after a single intravenous dose (600 mg) of ketoprofen and on Days 4 and 8 during a 7-day treatment (200 mg i.v. every 8 hours) and 1 day after withdrawal of the drug. PTT and PrA were not affected by the drug. Bleeding time was not significantly modified by the acute treatment, but was prolonged during the subacute course, though it was not different from baseline values at the end of the trial. Significant reduction of platelet aggregation was seen in both acute and subacute conditions with complete or almost complete recovery 36 hours after the last dose. It is concluded that ketoprofen affects platelets with readily reversible inhibition of in vitro aggregation and a slight increase of bleeding time.

Use of bupivacaine hydrochloride in oral surgery-a clinical study.

A study was developed in an attempt to investigate the possible usefulness of the local anesthetic agent, bupivacaine hydrochloride, for oral surgery. The results show that bupivacaine hydrochloride is an effective local anesthetic agent. It has a rapid onset time, a high frequency of surgical anesthesia, a long duration, and a low incidence of side effects. In comparison to lidocaine, bupivacaine has a greater potency, a lower toxicity at equipotent doses a longer duration, a possible pain-free period after return of normal sensation, and it does not require a vasoconstrictor for consistent profoundness.