Rapid tracheal intubation with vecuronium: the priming principle.

Following the administration of a single 0.1 mg/kg dose of vecuronium bromide, satisfactory conditions for tracheal intubation developed in 156 +/- 12 s (mean +/- SEM), and the clinical duration of the initial dose was 36 +/- 2 min. When the initial dose of vecuronium was administered in two increments, a 0.015 mg/kg "priming" dose, followed 6 min later by a 0.050 mg/kg "intubating" dose, intubation time decreased to 61 +/- 3 s and clinical duration to 21 +/- 1 min. The priming dose that had no unpleasant effect on premedicated, awake patients could be administered 3-4 min before, and the intubating dose 2 to 3 min after induction of anesthesia. With the described technique, comparable intubating conditions could be obtained just as rapidly with vecuronium as with succinylcholine chloride, without subjecting the patients to the side effects of and the complications occasionally encountered with succinylcholine. An added advantage of the use of a priming dose is that it will reveal undiagnosed, pathologic, or idiopathic increase of sensitivity to nondepolarizing muscle relaxants.

An unusual procedure in performing brachial plexus block.

A new surgical treatment of pseudarthrosis humeri needed specific anesthesiological management. The relevant problems for the anesthesiologist were the following: one year prior to the present admission the patient suffered from a polytrauma with contusio cerebri and had, as a result of prolonged intubation during the following period of intensive therapy, an excessive tracheal stenosis in the subglottic area, however without any clinical signs. For these reasons, general anesthesia did not seem to be practicable and the conventional way of blocking the brachial plexus appeared to be somewhat problematic owing to the postoperative scar tissue in the previously surgically treated region. For these reasons an unusual anesthetic management was chosen: the brachial plexus was anesthetized in the subaxillar region by surgical exposure of the neurovascular bundle. We feel, that the surgical exposure of the brachial plexus as described here is a practicable alternative to the common techniques of blocking the brachial plexus in very special situations.

[Cardiac and peripheral vascular effects of the volatile inhalational anaesthetic enflurane in chronically instrumented dogs (author's transl)]. / Kardiale und peripher vaskuläre Effekte des volatilen Inhalationsanästhetikums Enfluran bei chronisch instrumentierten Hunden.

While enflurane is generally held to induce arterial hypotension, its overall effects on left ventricular (LV) performance are less clear. Accordingly, mongrel dogs were chronically instrumented with miniature LV pressure transducers, with aortic and left atrial catheters and with electromagnetic flow probes and hydraulic cuff occluders on a common iliac artery. A pair of ultrasonic transducers was implanted on opposing endocardial surfaces to measure LV internal minor axis diameter. Experiments were performed 2 to 9 weeks after surgery when the animals were resting quietly without premedication. Enflurane (2 and 4 vol.-%) decreased mean arterial pressure by 27% and 36% and led to a progressive, dose-dependent decrease in myocardial contractility and induced striking peripheral vasodilatation, i.e. LV-dP/dtmax was reduced by 32% and 54% and iliac conductance rose by 101% and 163%. However, the decrease in contractility was not associated with an increase in LV preload, i.e. LV-end-diastolic diameter was decreased by 2 vol.-%, while it was not significantly different from control values with 4 vol.-%. Thus, in intact chronically instrumented dogs the direct negative inotropic effect of enflurane is modified by a synchronous decrease in myocardial loading conditions.

[Clinical and experimental results with acupuncture-analgesia (author's transl)]. / Klinische und experimentelle Ergebnisse mit der Akupunktur-Analgesie

Operations under acupuncture analgesia have been performed in Vienna since March 1972. A total of 102 procedures has been performed with "classical" Chinese acupuncture analgesia. Additionally given analgesics, psychodynamic factors and neurophysiological components are of joint importance. Our success rate in these cases was 64 p.c. Since October 1972 we call "two-phase-acupuncture-analgesia". Up to June 1975 72 operations were performed under some modifications of this method. In a neurophysiological study 17 volunteers and in 2 patients undergoing stereothalamotomies depression or even disappearance of evoked potentials was be observed during acupuncture with alectrical stimulation. Thus an interaction between pain stimuli and acupuncture stimuli in the thalamus could for the first time be demonstrated in man.

The role of the anaesthesiologist in the intra- and post-operative management of kidney transplant patients.

Based on experiences with 256 kidney transplant operations in 239 patients over a period of ten years (18.6. 1965 to 15.4. 1975) the role of the anaesthesiologist as it had developed in our institution has been described. Some problems with regard to the anaesthetic management of living donors were discussed. The care of patients who, due to their deteriorating cerebral function, are potential donors was also described. An outline of the own anaesthetic management of the recipient has been given and alternative methods were mentioned. Some special points were specifically stressed like the choice of relaxants, fluid replacement, blood transfusion, diuretic treatment starting already intraoperatively. Good intensive care of the potential donor is of great importance for the function of the transplanted organ. Very important is also the postoperative treatment of the recipient, which in our institution is performed in a teamwork between anaesthesiologist, surgeon and nephrologist. Finally, the functional results of our series are briefly demonstrated.

Urinary catecholamine excretion and thyroid hormone blood level in the course of severe acute brain damage.

Urinary catecholamine excretion and thyroid hormone blood level were studied in 16 patients following severe cerebral trauma. Increased excretion rates of epinephrine and norepinephrine were found. There was no significant difference in the catecholamine excretion when compared with generally traumatized patients. The relationships between catecholamine excretion, increased metabolic rates, and negative nitrogen balance indicate that in patients with a midbrain syndrome there exists an additional diencephalic metabolic factor, which leads to a rise in fat oxidation and perpetuation of catabolism. Early high caloric parenteral nutrition seems to inhibit the initial increase of catecholamine excretion and thus protects the body from an unnecessary breakdown of its own reserves. If the course is classified according to neurological stages, it can be shown that patients with a traumatic apallic syndrome in poor condition have a high increase of catecholamine excretion. Secretion of thyroid hormones is not influenced significantly by cerebral trauma.

Telemetric ECG data (biorhythms) in operations with acupuncture analgesia in the People's Republic of China.

During seven operations with acupuncture analgesia in the People's Republic of China, recordings were made with a self-developed device for telemetric transmittance of the ECG. Among others, the amplitude of the QRS complex as well as the period of time between two cardiac cycles were electronically measured and registered for evaluation. Through comparison of the values from China with our own material, the following statements can be made: (1) All patients were in conditions ranging from restlessness and slight excitation to weariness and drowsiness. A condition similar to narcosis must be excluded. (2) In a large number of cases a preoperatively performed strong psychological sedation through pharmacological agents can be excluded with certainty. (3) The massive reaction to events such as the cleansing of the operative field refutes-at least partly-our concept of "Asiatic indifference". (4) Acupuncture cannot depress reflexes. (5) Finally, the hypothesis that acupuncture has a stabilizing effect on the circulation is invalid.

[Telemetric ECG data (biorhythms) during operations under acupuncture analgesia in the People's Republic of China (author's transl)]. / Telemetrische EKG-Daten (Biorhythmen) bei Oerationen in Acupunctur-Analgesie in der Volksrepublik China

On an educational journey to China, we were able to record and accumulate electrocardiograms during operations under acupuncture analgesia with the aid of a self-developed apparatus. To elaborate this among others the amplitude of the QRS-complex as well as the time period between two cardiac cycles were electronically measrued and registered. With examples from the comprehensive material it is possible to draw the following conclusions: 1. The patients were in conditions ranging from restlessness and irritation to weariness and drowsiness. A condition similar to that resulting from narcosis must be excluded. 2. A pre-operatively undertaken strong psychological sedation by means of drugs can be excluded with certainty. 3. The massive reaction to events such as the washing out of the operative field refutes, at least partly, our concept of "Asiatic indifference". 4. Acupuncture is not able to depress reflexes. 5. Finally, the hypothesis that acupuncture has a stabilizing effect on the circulation is not valid.