Intravenous Pentothal Sodium Research Articles

Gastro-oesophageal reflux in large-sized, deep-chested versus small-sized, barrel-chested dogs undergoing spinal surgery in sternal recumbency

ObjectiveThe aim of this study was to investigate whether an increased frequency of gastro-oesophageal reflux (GOR) is more common in large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency than in small-sized, barrelchested dogs. Study designProspective, cohort study. AnimalsNineteen small-sized, barrel-chested dogs (group B) and 26 large-sized, deep-chested dogs (group D). MethodsAll animals were premedicated with intramuscular (IM) acepromazine (0.05 mg kg−1) and pethidine (3 mg kg−1) IM. Anaesthesia was induced with intravenous sodium thiopental and maintained with halothane in oxygen. Lower oesophageal pH was monitored continuously after induction of anaesthesia. Gastro-oesophageal reflux was considered to have occurred whenever pH values > 7.5 or < 4 were recorded. If GOR was detected during anaesthesia, measures were taken to avoid aspiration of gastric contents into the lungs and to prevent the development of oesophagitis/oesophageal stricture. ResultsThe frequency of GOR during anaesthesia was significantly higher in group D (6/26 dogs; 23.07%) than in group B (0/19 dogs; 0%) (p = 0.032). Signs indicative of aspiration pneumonia, oesophagitis or oesophageal stricture were not reported in any of the GOR cases. Conclusions and clinical relevanceIn large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency, it would seem prudent to consider measures aimed at preventing GOR and its potentially devastating consequences (oesophagitis/oesophageal stricture, aspiration pneumonia).

Analysis of the temporal regression of the QRS widening induced by bupivacaine after intralipid administration. Study in an experimental porcine model

ObjectiveThe principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. Material and methodsTwelve pigs were anesthetized with intravenous sodium thiopental 5mgkg−1 and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4–6mgkg−1 was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5mLkg−1 of IL over 1min, followed by an infusion of 0.25mLkgmin−1. Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30min after Intralipid/saline administration. ResultsBupivacaine (4.33±0.81mg/kg in IL group and 4.66±1.15mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184±62% in IL group, and 230±56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After 10min of the administration of IL, the mean QRS interval decreased to 132±56% vs. 15±76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. ConclusionIntralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10min. While the phenomena of cardiac toxicity persist, resuscitation measures and adequate monitoring should be continued until adequate heart conduction parameters are restored.

Análisis de la regresión temporal en el ensanchamiento del intervalo QRS inducido por bupivacaína con la administración de Intralipid. Estudio en un modelo experimental porcino

ObjectiveThe principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. Material and methodsTwelve pigs were anesthetized with intravenous sodium thiopental 5mg kg−1 and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4-6mg kg−1 was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5mL kg−1of IL over oneminute, followed by an infusion of 0.25mL kg min−1. Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30minutes after Intralipid/saline administration. ResultsBupivacaine (4.33±0.81mg/kg in IL group and 4.66±1.15mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184±62% in IL group, and 230±56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After ten minutes of the administration of IL, the mean QRS interval decreased to 132±56% vs. 15±76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. ConclusionIntralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10minutes. While the phenomena of cardiac toxicity persist, resuscitation measures and adequate monitoring should be continued until adequate heart conduction parameters are restored.

The historical significance of anaesthesia events at Pearl Harbor.

Up to the end of World War II, less than 10% of the general anaesthetics administered was with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most 'sophisticated and complex' drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. This paper presents the significance of the anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.

Rapid Intravenous Induction of Anesthesia for Dilatation of Severe Post-Intubation Tracheal Stenosis with Rigid Bronchoscopy: Report of 100 Cases

Background : Rigid bronchoscopic dilatation is the lifesaving method for management of severe tracheal stenosis which is carried out under general anesthesia. However, this procedure is a challenging practice for both anesthesiologist and bronchoscopist because loss of airway control and sever hypoxemia can occur following induction of anesthesia. Inhalational induction with avoiding muscle relaxants and preservation of spontaneous breathing is commonly recommended in these patients. However, this technique needs a long time to reach the appropriate levels of anesthesia and may be associated with the risk of complete airway obstruction during airway manipulation. This paper describes our experience in using rapid intravenous induction of anesthesia for dilation of severe tracheal stenosis with rigid bronchoscopy. Materials and Methods : We conducted a retrospective chart review of one hundred patients with benign severe post intubation tracheal stenosis who underwent rigid bronchoscopy for dilation of stenosis using intravenous sodium thiopental and succinylcholine for induction of general anesthesia. Results : In 97 patients adequate airway was established immediately after induction of anesthesia with the first attempt of rigid bronchoscope. In one patient, because of local bleeding and mild hypoxemia the airway was managed by a 4 mm tracheal tube and following improvement of oxygenation, dilatation of stricture was successfully done with rigid bronchoscope. In second patient, after passing the first bronchoscope, due to risk of rupturing the trachea, a small transverse cervical incision was made on the trachea and a tracheal tube was inserted through it for patient’s ventilation and dilatation of stricture was managed safely with the rigid bronchoscopes. In the third patient, due to failure of passing the bronchoscope, the trachea was intubated with a 4 mm endotracheal tube and tracheal resection and anastomosis was done successfully. Conclusion : in patients with severe post intubation tracheal stenosis, rapid intravenous induction of anesthesia is a safe method for passage of rigid bronchoscope for dilatation of stricture. Careful planning and close cooperation of the anesthesia and surgical teams is critical for safe and successful conduction of this procedure.

Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

Effect of Sodium Oxybutyrate on Mesentery Microcirculation and Liver Metabolism in Hemorrhagic Stroke (Experimental Study)

Objective: to study the effect of sodium oxybutyrate on canine mesentery microcirculation and liver metabolism in hemorrhagic stroke. Materials and methods. The investigation was based on the examination of specimens taken from 72 dogs of both sexes, weight 15.5±1.5 kg. Hypovolemic hypotension was induced by free bloodletting via the femoral artery. Systolic blood pressure was lowered to 40 mm Hg and maintained at the same level during an hour by the Wiggers procedure. The magnitude of blood loss was 31—33 ml/kg. The dogs were divided into 4 groups: 1) intact (n=5); 2) one-hour hypovolemic hypotension (n=8); 3) control (n=31), in which physiological saline was intravenously injected at a concentration of 0.9—1.1 ml/kg an hour after hypovolemic hypotension; 4) experimental (n=28), in which 10% sodium oxybutyrate solution was intravenously injected at a concentration of 180—200 mg/kg an hour after hypovolemic hypotension. In Groups 1 and 2 dogs, as well as in the control and experimental groups, divided into 2 subgroups, in which laparotomy was carried out under local 0.25% novocaine solution in combination with intravenous sodium thiopental (15—20 mg/kg) an hour after the drug administration and an hour after blood reinfusion, then right liver lobe pieces were excised for histochemical and biochemical studies. In Groups 3 and 4, heparinized blood was reinfused an hour after administration of the agent. The animals were observed during an hour. In the dogs from the latter two groups, mesentery vascular microcirculation was evaluated at control time stages, by using biomicroscopy on a MBR-1 microscope-based unit. Results. Despite uncompensated blood loss, the use of sodium oxybutyrate in hemor-rhagic stroke improves microcirculation in the mesentery vessels. In the liver, it enhances the rate of reactions of oxida-tive phosphorylation and the pentose phosphate pathway, activates glucose uptake processes, prevents lactate accumulation, preserves glycogen stores, and elevates the content of high-energy phosphates. Conclusion. Administration of 10% sodium oxybutyrate solution at concentrations of 180-200 mg/kg an hour after hypovolemic hypotension prevents the progression of mesentery microcirculatory disorders and hepatic metabolic changes during the following hour of hemorrhagic stroke. Blood loss compensation during previous administration of sodium oxybutyrate promotes a fuller and more rapid recovery of mesentery microcirculation and hepatic metabolic processes in the early postresuscitative period. Key words: hemorrhagic stroke, sodium oxybutyrate, microcirculation, metabolism, liver.

PREVENTION OF BRADYCARDIA BY ATROPINE SULFATE DURING UROLOGICAL LAPAROSCOPIC SURGERY A RANDOMIZED CONTROLLED TRIAL

Cardiac arrhythmias are a well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery. Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P < .001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.2 mm Hg in group 1 and 23.5 +/- 9.8 mm Hg in group 2 (P < .001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 mm Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 (P = .001). This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery.

The interaction of temperature with thiopental and etomidate on extracellular dopamine and glutamate levels in Wistar-Kyoto rats subjected to forebrain ischemia.

Many studies demonstrate an association between brain damage and the extracellular release of catecholamines and amino acids during cerebral ischemia. While the clinical value of hypothermia during periods of compromised cerebral blood flow and oxygen delivery is well established, the role of anesthetic agents is less clear. Furthermore, the interaction between these agents and hypothermia remains to be elucidated. The purpose of this study was to examine the interactive effects of temperature, sodium thiopental (STP) and etomidate (ETOM) on extracellular neurotransmitter accumulation in the rat corpus striatum during cerebral ischemia. Animals were randomly assigned to one of six subgroups: normal saline (NS-norm, pericranial t approximately equal to 37 degrees C, and NS-hypo, t=30 degrees C), etomidate (ETOM-norm and ETOM-hypo), and sodium thiopental (STP-norm and STP-hypo). Microdialysis probes were inserted into the corpus striatum. Dopamine (DA), glutamate, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels were measured. At zero minutes, animals received a 10-min infusion of STP (3 mg x kg(-1) x min(-1)), ETOM (0.6 mg x kg(-1) x min(-1)), or NS. Prior to ischemia, animals were given either intravenous STP (10 mg x kg(-1)), ETOM (3 mg x kg(-1)), or NS in bolus form. Each animal was then subjected to 10 min of forebrain ischemia (Is1) followed by a reperfusion interval (Rep1). The entire sequence was then repeated. There were significant interactions between temperature and drug for DA (Is1, P=0.006, Is2, P=0.032) and its metabolites (DOPAC, Is1 P=0.01, HVA, Is1 P=0.03), and for glutamate (Is1, P=0.03, Is2 P=0.06). The nature of this interaction differed for DA and glutamate. The reduction in DA accumulation seen during hypothermia was offset by the addition of either STP or ETOM, whereas the addition of these drugs did not affect the reduced glutamate levels seen with hypothermia. During normothermia, STP and ETOM resulted in diminished DA accumulation compared to controls, yet they increased the accumulation of extracellular glutamate. Consistent with other studies, hypothermia was associated with diminished extracellular DA concentrations during forebrain ischemia. However, depending on the temperature condition, the addition of STP or ETOM in our forebrain ischemia model led to unexpected findings. The administration of these agents during normothermia diminished ischemia-induced DA accumulation yet resulted in significantly higher concentrations of extracellular glutamate. In contrast, STP and ETOM during hypothermia were noted to significantly offset the DA-reducing effects of hypothermia.

Airway Management for Adult Patients with Acute Epiglottitis

Airway Management for Adult Patients with Acute Epiglottitis

Unanticipated Difficult Intubation in Two Family Members

Janet N. Siler, M.D., Daniel B. Walter, M.D., Mary Finnerty, C.R.N.A., Michelle Byrnes, S.R.N.A., Nazareth Hospital, 2601 Holme Avenue, Philadelphia, Pennsylvania 19152.Idona Umali, M.D., Hazelton-St. Joseph's Medical Center, 667 North Church Street, Hazelton, Pennsylvania 18201.To the Editor:--A 47-yr-old woman and her 70-yr-old mother experienced difficult intubations within 2 months of each other while undergoing general endotracheal anesthesia.Preoperatively, the daughter's airway revealed a three-finger-breadth mouth opening with partial visualization of her uvula, three-finger-breadth thyroid-mental distance, adequate neck mobility, and full dentition. She stood 158 cm tall, weighed 80 kg, with the majority of her weight distributed to the lower portion of her body. No other significant medical history existed. After intravenous sodium thiopental and succinylcholine, one unsuccessful tracheal intubation attempt by the student nurse anesthetist, two attempts by the certified registered nurse anesthetist, and two attempts by the staff anesthesiologist included varying head position, cricoid cartilage pressure, and use of both Macintosh and Miller laryngoscope blades. Laryngoscopy in all attempts permitted visualization of the epiglottis but not the vocal cords. Adequate ventilation was possible via face mask between intubation attempts. A call for help and a request for the difficult airway cart occurred simultaneously with return of the patient's spontaneous respirations. A blind nasal tracheal intubation by a second staff anesthesiologist succeeded on the third attempt. The gynecologic surgical procedure progressed uneventfully. A second airway assessment postoperatively was similar to her preoperative airway evaluation. Postoperatively, the patient experienced hoarseness and soreness of her pharynx and larynx for 10 days. The patient registered with the Difficult Airway Medic Alert Registry and purchased a Medic Alert bracelet* **.Subsequently, her edentulous mother, at another hospital, after intravenous induction of general anesthesia and use of a combination of rocuronium and mivacurium for muscle relaxation, was found to require three attempts before successful tracheal intubation. Her height was approximately 153 cm, and she weighed approximately 68 kg, with most of her body weight in her abdomen, hips, and thighs. Again, visualization of the epiglottis but not the vocal cords occurred. The patient had previous laminectomy surgery many years ago, but these medical records were not available. Her orthopedic surgery progressed uneventfully, and postoperatively, she experienced a minimal sore throat. Postoperatively, no other existing medical conditions revealed a potential for a difficult intubation, and her previous medical records for her laminectomy could not be located. She also wears a Medic Alert bracelet.When assessing the surgical patient preoperatively, one includes a question about family problems with anesthesia. We suggest a heightened awareness when taking the preanesthetic history regarding possible difficult intubation in family members. As the registry of difficult intubations acquires data, the presence of genetically related patients might be addressed.Janet N. Siler, M.D., Daniel B. Walter, M.D., Mary Finnerty, C.R.N.A., Michelle Byrnes, S.R.N.A., Nazareth Hospital, 2601 Holme Avenue, Philadelphia, Pennsylvania 19152.Idona Umali, M.D., Hazelton-St. Joseph's Medical Center, 667 North Church Street, Hazelton, Pennsylvania 18201.(Accepted for publication April 10, 1995.)* Mark L: Medic Alert National Registry for Difficult Airway/Intubation, The Johns Hopkins University, Alert or Patient Enrollment, 1-410-955-0631 or fax 1-410-955-0994.** Medic Alert 1-800-432-5378, Medic Alert Foundation, Turlock, California 95381-1009.

Development of a protocol to provide prolonged general anesthesia to pregnant sows.

This study was designed to determine whether a pregnant sow could be maintained under conditions of prolonged general anesthesia in order to provide access to prematurely delivered piglets for purposes of acute experimentation. Fifteen time-dated pregnant (90% of gestation) sows were preanesthetized with intramuscular xylazine (Rompun Mobay Pharmaceutical, Shawnee, KS)/ketamine (Aveco Pharmaceutical, Fort Dodge, IA). After anesthesia was induced with intravenous sodium thiopental, the animals underwent tracheotomy and mechanical ventilation. The electrocardiogram was monitored externally; systemic arterial pressure was supervised by the insertion of a brachial artery cannula; and urine output was determined by inserting a cystostomy tube. A surgical plane of anesthesia was achieved by the "balanced" technique: an inhalant, isoflurane, supplemented by intravenous doses of sufentanil citrate, propofol (Stuart Pharmaceuticals, Wilmington, DE), and vecuronium. Sows were maintained under general anesthesia for an average of 12 h; piglets were delivered, one or two at a time, by a modified cesarean section technique. No sows or piglets were lost to anesthetic complications. It is concluded that, with appropriate precautions, pregnant sows can be anesthetized for a prolonged period of time, and provide viable premature neonates for acute experimentation.

Extraction of clinical information from electroencephalographic background activity: the combined use of brain electrical activity mapping and intravenous sodium thiopental.

Traditional visual inspection of electroencephalographic (EEG) tracings and computer-assisted topographic mapping were compared in their abilities to detect and locate supratentorial lesions following intravenous sodium thiopental administration. Of the 13 subjects, 8 had atrophic and 5 had mass lesions, all defined by computed tomographic scan and 11 confirmed at operation. EEGs made before and after thiopental administration were evaluated separately from topographic maps of statistical difference between EEGs at multiple frequency ranges made before and after thiopental injection. Topographic mapping of statistical difference accurately detected all thirteen lesions, whereas EEG detected eight. In addition to demonstrating reduced beta production overlying structural abnormalities, topographic mapping revealed regionally augmented beta, especially over irritative lesions. Moreover, localization was possible with the topographic method after the first thiopental injection, whereas a second injection was required for EEG localization by visual inspection. Changes in slow (delta) activity were also useful in delineation of atrophic lesions, in which delta was usually augmented but occasionally regionally reduced. Multielectrode studies with topographic mapping appear essential in delineating cerebral abnormalities, because both slow and fast activities may be increased or reduced over such areas. The relative response of EEG background activity to thiopental at different frequencies may assist lesion characterization as well as localization.

Relation between glucose tolerance and serum insulin levels in man before and after thiopental intravenous administration.

A glucose-tolerance test was performed in a number of healthy volunteers before and after a single dose of intravenous sodium thiopental. During this test, serum insulin levels were determined at similar intervals. A small but significant decrease in glucose tolerance, not related to serum insulin levels, was seen.

Metabolic Changes in the Cerebral Cortex of the Rat Induced by Intravenous Pentothalsodium®

The effects of thiopental on cerebral metabolism were evaluated by means of measurements of cerebral metabolic rate for oxygen (CMRO2) and of tissue levels of organic phosphates, glycolytic substrates, citric acid cycle intermediated and selected amino acids. Shortly after the beginning of thiopental administration, CMRO2 was reduced to half the normal value, and there were signs of retardation of glycolytic flux at the phosphofructokinase step. Inhibition at this regulatory enzymatic step could be related to an increase in phosphocreatine and a fall in inorganic phosphate concentration. The rise in phosphocreatine, and the unchanged levels of ATP, ADP and AMP demonstrate that induction of anaesthesia with thiopental is unrelated to energy failure. Changes in citric acid intermediated included a fall in malate, and probably also in citrate, alpha-ketoglutarate and fumarate, with a tendency towards reduction in the pool of citric acid cycle intermediates; and the amino acid changes were dominated by a progressive rise in aspartate. It is suggested that these changes are secondary to a reduced rate of pyruvate delivery, and to a decrease in malate/oxaloacetate ratio.

LOSS OF VISION AFTER DETACHMENT SURGERY

To the Editor: In reference to Jarrett and Brockhurst, Unexplained Blindness and Optic Atrophy Following Retinal Detachment Surgery,Arch Ophthal73: 782-791, 1965, I wish to add one of my cases to this series. The patient was a 60-year-old man with a mild degree of hypertension which was controlled before operation. Scleral buckling with encircling polyethylene tube was performed under general anesthesia, consisting of intravenous sodium pentothal maintained by nitrous oxide and oxygen through an intratracheal tube. The preoperative fundus picture and the surgical procedure adopted is shown in the accompanying diagram. Strepto-penicillin solution was employed for irrigation after closing the buckling sutures. Recovery was generally uneventful. On the fourth postoperative day a rough assessment of the visual acuity showed that the patient could not count fingers even at close range. Fundus examination revealed a mild degree of uniform vitreous haze, the retina was settled all around, and a prominent

Intravenous anesthesia in major obstetric and gynecologic surgery: Report of 1,301 cases

1. 1. A series of 1,301 major obstetric and gynecologic cases using intravenous sodium pentothal anesthesia is reported. 2. 2. The continuous method of intravenous administration of sodium pentothal is definitely advocated. 3. 3. The average dose of 1.5 gm. of sodium pentothal was used by this method. Occasionally 1.75 to 2 gm. were employed. 4. 4. No immediate or postoperative complications were encountered. 5. 5. The indications, contraindications, requisites, advantages and disadvantages have been discussed. 6. 6. Nitrous oxide and d-tubarine hydrochloride have been used to supplement intravenous sodium pentothal in abdominal cases when further relaxation was required.

Intravenous procaine-pentothal during labor: Preliminary report

It is only natural that in the search for an ideal analgesic for labor this drug should be considered. Allen2 studied its effects in a series of maternity cases and stated he obtained good results. The convulsions which occasionally occur with his technique are easily controlled with intravenous Pentothal Sodium. Johnson and Gilbert3 also reported good results with the use of procaine during labor. The studies of Frazer4 with a dilute mixture of procaine and Pentothal as an adjunct to surgical anesthesia seemed to us to point in the proper direction. He used this mixture in varying concentrations to produce anesthesia either alone or in combination with other anesthetic agents. We decided t.o study the value of this mixture of procaine and Pentothal Sodium as an analgesic agent during labor.

The effect of intravenous pentothal sodium with or without inhalation of oxygen on liver function.

The effect of intravenous pentothal sodium with or without inhalation of oxygen on liver function.

FERTILITY IN PARAPLEGIC MALES*: A PRELIMINARY REPORT OF ENDOCRINE STUDIES

INTRODUCTION THE natural desire of patients with spinal cord injuries to have children motivated this study on 34 paraplegic patients with various levels of spinal cord injury. Reproduction among male patients with a spinal cord injury is rare, although not impossible. Recently 2 such cases were reported (1), to which we add 8 of our own, only 1 of which is included in this study. Studies of the sex behavior of paraplegic patients reveal that ejaculations are relatively rare as compared with erections (2, 3, 4), and that the percentage of motile sperm is low in the massaged prostatic contents. PLAN OF INVERSTIGATION AND METHODS This investigation was planned to obtain data, relevant to the endocrine, genital and neurophysiologic status of the patients. Biopsy specimens were obtained from both testes of all patients reported here. Intravenous sodium pentothal was used for anesthesia in the patients with sensitive gonads.