Women and specialty choice: why not anesthesiology?

The number of women in all medical specialties increased during the 1970s and 1980s. Anesthesiology residency programs experienced unprecedented growth from 1980 to 1986. We reviewed statistics published by the American Medical Association to investigate the relationship between the increase in female residents in all specialties compared to that for individual specialties including anesthesiology, pathology, surgery, pediatrics, obstetrics/gynecology, radiology, internal medicine, and psychiatry. We found an above average rate of growth for female residents in gynecology, pediatrics, and internal medicine; pathology, radiology, psychiatry, surgery, and anesthesiology showed a below average rate of growth. Studies have shown a correlation between gender and choice of specialty. Factors influencing the differences in choice and the decrease in the percentage of women choosing anesthesiology are unknown.

Peripheral somatic sensory neuropathy and skin galvanic response in the feet of patients with diabetes.

The relationship between abnormality in the peripheral sympathetic nervous system (skin galvanic response) and in the peripheral somatic sensory nerve fibers was studied in the lower extremities of 51 patients with diabetes. Deficits in temperature and pain sensations (the small sensory nerve fibers) were related to abnormal sympathetic nervous function (temperature sensation, p less than 0.001; pain sensation, p less than 0.05). The deficits in temperature sensation, in particular, predicted abnormal sympathetic nervous function reliably and vice versa. There was no relationship between deficits in touch and vibration sensations (the large sensory nerve fibers) and abnormal sympathetic nervous function. There was a relationship between skin galvanic response and RR-variation (p less than 0.01). However, abnormality in RR-variation was not related to the deficits in any of the four sensory modalities.

Protection against cerebral hypoxia by local anesthetics: a study using brain slices.

The ability of the local anesthetics lidocaine, 2-chloroprocaine and cocaine to protect neuronal tissue against hypoxic damage was evaluated. Rat hippocampal slices were incubated with non-depressive doses of these agents 60 min prior to their exposure to 15 min hypoxia. The rate of recovery of synaptic function (evoked field potentials) following the hypoxic episode was used as an index of hypoxic damage. Slices treated with 0.1 mM of any of the three local anesthetics exhibited a significant increase in the recovery rate of synaptic function from hypoxia as compared to control, untreated slices. These results indicate that local anesthetics, by reducing neuronal sodium influx (and possibly its concomitant calcium influx) which occurs upon hypoxic depolarization, are able to prolong the hypoxic insult a cerebral tissue could tolerate.

Comparison of neuromuscular blockade in upper facial and hypothenar muscles.

Facial and hand muscles are used frequently for monitoring neuromuscular blockade. Therefore, we compared changes in electrically evoked muscle potential magnitude in upper facial and hypothenar muscles after fixed doses of neuromuscular blockers (succinylcholine, 750 micrograms/kg; pancuronium, 70 micrograms/kg; vecuronium, 50 micrograms/kg; and atracurium, 300 micrograms/kg). Face-hand comparisons were made in both anesthetized (nitrous oxide/narcotic, n = 51) and comatose (closed-head injuries, n = 5) patients. In 24 anesthetized patients, complete blockade of the hypothenar muscles prevented quantitative comparison. In the remaining 27 patients, the relaxant effect (as determined by the percentage change from prerelaxant baseline muscle potentials) was significantly smaller (P less than 0.0001) in the upper facial muscles (65 +/- 24% versus 92 +/- 8%, mean +/- SD). All four evoked muscle responses to train-of-four stimulation were detectable in upper facial muscles of the 19 patients receiving non-depolarizing neuromuscular blocking drugs; this pattern was seen in hand muscles of only 7 patients (P less than 0.001). The neuromuscular blockade in both the hand (49 +/- 54%) and the upper facial area (68 +/- 28%, P greater than 0.05) of comatose patients was smaller and more variable than that seen during anesthesia. These results illustrate the value of quantitative monitoring of neuromuscular function, especially during highly variable and unpredictable drug-induced blockade in the comatose state. We conclude that during narcotic-based anesthesia the upper facial and hand muscles are differentially sensitive to commonly used neuromuscular blockers.