Influence of bolus doses of phenoperidine on intracranial pressure and systemic arterial pressure in traumatic coma.

The effects of bolus doses of phenoperidine 1-2 mg i.v. either alone, or combined with pancuronium 2-4 mg, were investigated in seven patients in traumatic coma. Phenoperidine alone significantly reduced mean arterial pressure (MAP) by a mean (+/- SEM) of 13.2 (+/- 2.8) mm Hg. Overall there was no significant change in intracranial pressure (ICP) despite the decreases in MAP and, consequently, cerebral perfusion pressure (CPP) decreased (14.0 +/- 2.4 mm Hg) on all but one occasion. In some instances these decreases were considerable (maximum 38 mm Hg). Similar results were obtained when phenoperidine was combined with pancuronium. These findings suggest that the bolus administration of phenoperidine and probably other opiates should be avoided in traumatic coma.

Double-blind comparison of the efficacy of extradural diamorphine, extradural phenoperidine and i.m. diamorphine following caesarean section.

A randomized, double-blind study of the efficacy, duration of action and side effects of three analgesic regimens following Caesarean section is described. Patients received i.m. diamorphine 5 mg, extradural phenoperidine 2 mg or extradural diamorphine 5 mg. Analgesia was of rapid onset in all groups, as judged by reductions in linear analogue pain scores and rank pain scores. Time to next analgesia was significantly greater after extradural phenoperidine (5.96 h) and extradural diamorphine (8.39 h) than after i.m. diamorphine (3.40 h) (P less than 0.001). Itching was reported on direct questioning by 50% of patients in the extradural groups. No serious side effects were reported. Factors affecting the disposition of extradurally administered diamorphine are discussed.

Effect of antacids on the plasma concentration of phenoperidine.

The effect of antacids on the plasma concentration of phenoperidine was studied in six volunteers. All subjects received the same dose of phenoperidine (15 micrograms kg-1) on different occasions in the presence, and absence of, an antacid preparation. In control studies, secondary peaks in the plasma concentration of phenoperidine were invariably observed; these were entirely eliminated, or modified substantially, by the concurrent administration of antacids. In the latter conditions, plasma concentrations of phenoperidine were greater during the first 20 min, and the area under the plasma concentration--time curve between 0 and 20 min was significantly greater than in control studies. In contrast, the plasma clearance of the drug was almost identical in control conditions and during treatment with antacids. After the oral administration of phenoperidine to two subjects, the systemic bioavailability of the drug was 9.9% and 13.9% respectively.

Neuroleptanesthesia for the guinea pig. An ideal anesthetic procedure for long-term physiological studies of the cochlea.

The guinea pig is notoriously difficult to anesthetize with conventional agents. Cardiorespiratory depression by general depressant anesthetic agents can render the cochlea abnormal. I report a technique that uses the specific neuroleptic and analgesia properties of the agents droperidol and phenoperidine, respectively, in combination with small doses of pentobarbital sodium, which is required only to produce unconsciousness. These agents can be given intraperitoneally, intramuscularly, or intravenously. The regimen allows performance of substantial surgery (including intracranial) and long-term (minimum, six to ten hours) physiological studies, such as those on the cochlea, with excellent cardiorespiratory stability. The method has been in continuous use in this laboratory since 1974 for single-fiber recordings from the cochlear nerve of normal and kanamycin-treated guinea pigs. This method has proved to be substantially more effective than use of pentobarbital, thiopental sodium, urethan, chloralose, or ketamine alone.

[Hemodynamic effects of equipotent doses of phenoperidine and fentanyl in man]. / Effets hémodynamiques de doses équipotentielles de phénopéridine et de fentanyl chez l'homme.

The haemodynamic effects of phenoperidine and fentanyl were studied in ten patients with craniocerebral trauma who presented no surgical indications. They were all mechanically ventilated with a constant tidal volume and rate and their cardiovascular state was stable. The patients were given 5 gamma/kg of fentanyl intravenously; the haemodynamic measurements were performed at two mn interval for 20 mn. Three hours later, the patients were given 30 gamma/kg of phenoperidine intravenously and the haemodynamic measurements were performed similarly. Phenoperidine and fentanyl had the same effects: a significant fall in heart rate, mean arterial pressure and cardiac index without any change in pulmonary wedge pressure. These changes do not dangerously alter the haemodynamic condition of the patients and thus are not a contra-indication to the general use of phenoperidine and fentanyl in anaesthetic practice and in intensive care.

Acute traumatic tetraplegia during pregnancy.

A case of acute traumatic tetraplegia during pregnancy resulting in maternal death is presented, and problems of management are discussed. Difficulties experienced by the mother were intractable urinary tract infection and respiratory insufficiency; those in the neonate were prematurity and the effects of drugs administered to the mother.

[Anesthesia with continuous infusion of alfatesine and phenoperidine. Uses in anesthesia of aged subjects in visceral surgery]. / Anesthésie à débit constant à l'alfatésine-phénopéridine. Applications à l'anesthésie du sujet agé en chirurgie viscérale.

Anaesthesia was administered to one hundred and fifty eight patients by continuous infusion of a mixture of Alfatesine and phenoperidine. The patients were divided on two groups: group A consisted in 96 patients undergoing abdominal surgery and group B of 62 cases of various types of surgery, mainly orthopedics. The average age was 63 years (range 16-96). The operative risk scored 6 or more in 71 cases. The length of operation averaged 151 minutes (S.D. +/- 15). The mixture made of alfadione 25 ml and phenoperidine 5 mg in a glucose 5 per cent 250 ml solution was administered by mechanical pump. The induction dose was 50 ml of the mixture for patients under 50 years (rate 10 ml per minute), 40 ml per patients from 50 to 70 years (5 ml per minute), and 30 ml for patients over 70 years (5 ml per minute). The maintenance dose was adjusted to weight and age and ranged from 0,11 to 0,15 ml/kg/h for alfadione and from 0,022 to 0,030 mg/kg/h for phenoperidine. Routine tracheal intubation and artificial ventilation were performed in group A. The results are studied in relation to the effectiveness of the anaesthesia mixture, its side effects and influence on recovery. Generally, the results are good and emphasize the value of the technic in abdominal surgery for elderly patients. The methods of application are discussed in terms of medical background.

Supplementation of general anaesthesia with narcotic analgesics.

Four analgesic drugs--fentanyl, phenoperidine, morphine and pethidine--were compared in a double-blind trial involving 113 patients paralysed and ventilated with nitrous oxide and oxygen. The differences between the drugs were relatively small. There were only slight differences in "duration of action", a term which is questioned in this context. Pethidine appeared to have a slightly longer duration of action than the other drugs. The problems inherent in studying analgesics in this manner are discussed.