The prevalence of visible and/or occult blood on anesthesia and monitoring equipment.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have attempted to stop the spread of blood-borne pathogens by issuing several recommendations and regulations. However, unless healthcare workers comply with these standards, they are not effective. In the anesthesia care environment, the anesthetist is responsible for ensuring that the equipment is clean, and disinfected, before use. We studied the prevalence of visible and occult blood on 6 types of anesthesia and monitoring equipment identified as ready for use in 28 operating suites, in 2 facilities. The sample consisted of 336 observations of the 6 types of equipment. The equipment was inspected for visible blood and then tested for occult blood using a 3-stage phenolphthalein test. Of the 336 observations, 110 (32.7%), were positive for occult blood with only 6 showing visible blood. The presence of blood on this equipment may be in direct violation of the OSHA Blood-borne Pathogen Standard and the infection control guidelines of the American Association of Nurse Anesthetists. Furthermore, the presence of blood on this equipment may increase the risk for nosocomial and occupational exposure to viral and bacterial pathogens. Recommendations were made to decrease the risks from this contamination by redesigning equipment, increasing the use of disposable equipment, and ensuring compliance with effective infection control practices.

Characteristics of women-only and mixed-gender drug abuse treatment programs.

Specialized substance abuse treatment programs have been developed for women within the past two decades. This article presents the results of a secondary analysis of a regional database of drug abuse treatment programs that compared the characteristics of women-only (WO) and mixed-gender (MG) programs across three treatment modalities. In general, WO programs differed from MG programs in their policies regarding fees, sources of payment, special populations served, services offered, and treatment capacity, process, and duration. The differences in program characteristics reflect broader societal gender differences, including women's generally lower economic status and primary responsibility for child-rearing.

Lesbian alcohol and marijuana use: correlates of HIV risk behaviors and abusive relationships.

One hundred fifty-two self-identified lesbian and bisexual women participated in an exploratory study of lesbian health and high-risk sexual behaviors. These women were primarily White, middle class, and college educated. The relationship of alcohol and marijuana use to high-risk sexual behaviors and involvement in past or current abusive experiences was investigated. Having been involved in coercive sexual activities was related to some high-risk sexual activities and alcohol and marijuana use. The women in this sample were engaging in high-risk sexual activities, perhaps because of a lack of HIV-risk perception among lesbians in general, and in this sample in particular. These results demonstrate the need for HIV and safer-sex education even among highly educated women and awareness of the interrelationship between drug use and unsafe sexual activities.

Levo-alpha-acetylmethadol (LAAM): clinical, research, and policy issues of a new pharmacotherapy for opioid addiction.

A number of issues are relevant to the development and use of levo-alpha-acetylmethadol (LAAM) as a treatment alternative to methadone. A brief history of methadone maintenance treatment is provided and variants of standard methadone treatment are discussed. The history and current status of LAAm are discussed, as well as its advantages over methadone. In addition, relevant clinical, research, and policy issues are addressed. LAAm has advantages over methadone specifically with regard to thrice-weekly dosing, potential to reduce HIV/AIDS risk, possible cost savings, and possible improved clinic-community relations. The effective and cost-effective implementation of LAAM as a new treatment for opioid addiction requires attention to a number of issues: (1) LAAM as an HIV prevention measure through its potential risk-reduction effects, (2) the sue of LAAM with specific high-risk subgroups, (3) causes of differential rates of treatment dropout and their amenability to intervention, (4) the role fo patient choice in long-term maintenance treatment, (5) the impact of LAAM on clinic operations, (6) the potential for LAAM as a take-home medication, and (7) the costs of implementing and sustaining LAAM maintenance services.

Effect of i.v. anaesthesia with propofol on drug distribution and metabolism in the dog.

We have studied the effect of i.v. anaesthesia with propofol in the emulsion (Intralipid) formulation on drug distribution and metabolism in six dogs using dual-route administration of propranolol as a model compound. Each dog was studied on two consecutive days: day 1 awake and day 2 during propofol anaesthesia (6 mg kg-1 followed by an infusion of 0.8 mg kg-1 min-1). Propofol anaesthesia was associated with reduced intrinsic clearance by 40% (P less than 0.05) but no significant difference in systemic clearance or hepatic plasma flow. Propofol produced marked changes in drug distribution; volume of distribution (Vss) of propranolol increased 54% from 82.5 (SEM 7.3) litre awake to 127.3 (27) litre during propofol anaesthesia (P less than 0.05). This change was accompanied by an increase (P less than 0.05) in the free fraction of propranolol from 8.5 (0.7) % in awake to 14.0 (0.7) % in propofol-anaesthetized dogs. The combination of the effects of both drug clearance and protein binding resulted in a 65% decrease in the intrinsic clearance of unbound drug (P less than 0.05). In contrast with the effects of propofol on drug distribution, infusion of Intralipid alone in another group of six dogs had no significant effects on drug distribution, protein binding or drug metabolism. We conclude that propofol is a modest inhibitor of drug metabolism, but has major effects on propranolol distribution, possibly by changing plasma protein binding.

Adrenergic response to nicardipine in the management of postoperative hypertension.

Nicardipine, a new dihydropyridine calcium channel blocking agent, has been shown to be effective in the management of hypertension. The adrenergic response to intravenous nicardipine as measured by changes in plasma catecholamine concentrations in seven patients undergoing treatment of postoperative hypertension is reported. Postoperative hypertension was defined as a systolic blood pressure (SBP) greater than 140 mm Hg. Nicardipine or placebo was administered in doses of 10 mg/h, 12.5 mg/h, and 15.0 mg/h for 5 minutes, 5 minutes, and 15 minutes, respectively, to achieve a therapeutic response defined as a reduction of SBP of 15% or more. Once a therapeutic response occurred, patients entered a maintenance period when the study drug infusion rate was reduced to the equivalent of 3.0 mg/h, and the dose was adjusted by 1.0 to 2.5 mg/h every 15 minutes as needed to maintain blood pressure control. Patients who did not respond to the study drug had their treatment code broken and, if on placebo, received open-label nicardipine. Blood samples were taken for the measurement of plasma norepinephrine (NE) concentrations at baseline prior to nicardipine infusion, at the time of therapeutic response, during maintenance, and after discontinuation of nicardipine. There were no significant differences between the baseline heart rate prior to nicardipine infusion and at the time of therapeutic response, during maintenance, or after discontinuation of the infusion. Mean NE concentrations at baseline prior to nicardipine infusion were 589.3 +/- 140.1 pg/mL (normal range, 75 to 480 pg/mL). Thus, hypertensive patients in the recovery room have a high degree of background sympathetic stimulation. Nicardipine did not further increase plasma NE levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of Anglo- and Mexican-Americans on the 16PF administered in Spanish or English.

The 16PF was administered in either Spanish or English to 546 Anglo- or Mexican-Americans separated into three ethnicity/test language groups: Anglos tested in English, Mexican-Americans tested in Spanish, and Mexican-Americans tested in English. Multivariate and univariate statistics revealed significant differences among the three groups. The largest number of scale differences was between Anglos and Mexican-Americans tested in Spanish. The second largest number of differences was found between the two Mexican-American groups, and the smallest number of differences was found between Anglos and Hispanics tested in English.

Cardiomyopathy in a patient undergoing laparoscopy for oocyte retrieval during in vitro fertilization/embryo transfer. A case report.

Most patients undergoing laparoscopic procedures experience no complications; however, a major complication rate of approximately 0.3% has been documented. Cardiomyopathy is also rare. A patient who underwent laparoscopy for oocyte retrieval during in vitro fertilization/embryo transfer developed congestive heart failure and pulmonary edema. A cardiomyopathy was diagnosed subsequently.

The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation.

The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of magnesium on plasma cholinesterase activity.

Plasma cholinesterase activity levels were studied in 15 pregnant patients with preeclampsia before and after the administration of therapeutic doses of magnesium sulfate. Plasma cholinesterase activity was also studied in 15 healthy nonpregnant and 15 healthy pregnant women. The mean plasma cholinesterase activity level in pregnant patients with preeclampsia before and after the administration of magnesium sulfate was 179 +/- 26 and 176 +/- 39 units/ml, respectively. The healthy nonpregnant patients and healthy pregnant patients had a plasma cholinesterase activity level of 426 +/- 85 and 264 +/- 24 units/ml, respectively. Our data demonstrated that magnesium has no significant effect on plasma cholinesterase activity. Our data also confirm that there is a significant reduction in plasma cholinesterase activity in pregnant patients with preeclampsia compared with either healthy nonpregnant or healthy pregnant patients. We conclude that the low level of plasma cholinesterase activity is probably responsible for the prolonged action of succinylcholine in pregnant patients with preeclampsia receiving magnesium sulfate.

Comparison of propofol and thiopental for the induction of anesthesia.

We compared the safety, efficacy, and side effects of induction of anesthesia with propofol (2.5 mg/kg), a new intravenous agent, and thiopental (4.0 mg/kg) in 62 patients in American Society of Anesthesiologists class I or II. There was no significant difference between induction times for the propofol (40.0 +/- 2.0 sec) and thiopental (44.0 +/- 4.0 sec) groups. Propofol administration produced a significant fall (P less than .05) in systolic blood pressure (SBP), from 134.1 +/- 2.6 mm Hg before injection to 128.3 +/- 2.4, 118.2 +/- 2.7, and 114.4 +/- 2.8 mm Hg one, two, and three minutes after injection, respectively. Diastolic blood pressure (DBP) fell significantly (P less than .05) during the three postinjection periods. Heart rate (HR) rose significantly (P less than .05), from 78.6 +/- 3.1 beats per minute before injection to 89.4 +/- 3.4 beats per minute one minute after injection. In patients given thiopental, SBP fell significantly (P less than .05), from 131.7 +/- 2.7 mm Hg before induction to 126.4 +/- 3.4 and 126.9 +/- 4.0 mm Hg two and three minutes after injection, respectively. The DBP did not change significantly in the thiopental group, but the HR rose significantly (P less than .05), from 73.3 +/- 2.8 beats per minute before injection to 83.9 +/- 3.0, 90.1 +/- 2.3, and 84.2 +/- 2.4 beats per minute one, two, and three minutes after injection, respectively. In 94% of patients given propofol, there were apneic periods of more than 60 seconds, compared to 50% in the thiopental group (P less than .05). There was a significant difference (P less than .05) between groups for the incidence of pain on injection; 31% of the patients receiving propofol had pain, compared to 3% of those receiving thiopental.

Terminal transferase in human bone-marrow lymphocytes.

Activity of the enzyme terminal transferase (TdT) has been localised in normal human bone-marrow lymphocytes. These cells may represent a prothymocyte population, which, on malignant transformation, may give rise to acute lymphoblastic leukaemia, and to some cases of chronic granulocytic leukaemia in the blastic phase.