RESUMO
It is recognised that prolonged anaesthesia with nitrous oxide (N2O) induces megaloblastic anaemia by oxidising vitamin B12. To determine whether sepsis aggravates the effect of N2O on haemopoiesis 5 patients with severe sepsis, who required surgery and were exposed to short-term (45-105 minutes) N2O anaesthesia, were studied. None had evidence of pre-operative vitamin B12 or folate deficiency. The effect of the combination of N2O anaesthesia and sepsis on DNA synthesis in bone marrow cells was assessed morphologically, and by the deoxyuridine suppression test. In 3 patients exposed to the longest duration (75-105 minutes) of N2O, addition of folinic acid and vitamin B12 partially improved the utilisation of deoxyuridine in vitro. No patient had evidence of megaloblastic haemopoiesis as judged by bone marrow morphology. It is concluded that prolonged N2O anaesthesia in patients with severe sepsis may adversely affect DNA synthesis. Although this effect did not manifest as overt megaloblastic erythropoiesis, it may be prudent to avoid N2O in such patients.
Assuntos
Infecções Bacterianas/complicações , Medula Óssea/efeitos dos fármacos , Ácido Fólico/metabolismo , Óxido Nitroso/efeitos adversos , Vitamina B 12/metabolismo , Adolescente , Adulto , Feminino , Humanos , Masculino , Fatores de TempoRESUMO
An adult male injured in a landmine explosion presented with the classic triad of primary, secondary and tertiary blast injuries. The anaesthetic management and postoperative treatment of blast injury to the lung is discussed.
Assuntos
Anestesia/métodos , Traumatismos por Explosões/terapia , Lesão Pulmonar , Adulto , Humanos , Masculino , Cuidados Pós-OperatóriosRESUMO
Twelve cases of paracetamol overdose are reported. Nine patients ingested antimuscarinic agents and/or codeine concomitantly. Our findings indicate that 'mixed' overdose of this type gives rise to marked attenuation of the rate of paracetamol absorption and, apparently, reduced morbidity associated with paracetamol poisoning. It is speculated that suitable antimuscarinic agents may be incorporated into paracetamol formulations to achieve inhibition of gastric emptying and to confer a degree of protection in case of overdose.