Metoclopramide increases plasma but not cerebrospinal fluid vasopressin levels in man: study in hydrocephalic patients

Arginine vasopressin (AVP) concentrations were determined in plasma and in cerebrospinal fluid (CSF) in 8 adult male patients suffering from hydrocephalus of various etiologies, before and after intravenous administration of 10 mg metoclopramide. Metoclopramide was able to increase the plasma (2.6 +/- 0.2 ng/l in basal conditions and 6.1 +/- 0.6 ng/l at 30 min) but not the CSF AVP levels. The results suggest that the neurons which secrete AVP into the CSF may be functionally different from those secreting into the peripheral circulation.

[Evaluation of 2 modalities of use of propofol in cerebral angiography]

Fifty eight adult patients suffering from different intracranial lesions and scheduled for cerebral angiography were given propofol. In the first group (38 patients) brief periods of anaesthesia were induced and reinduced by means of 1.5 mg/kg of propofol iv and sometimes extended with boluses of 25-50 mg of this anesthetic. The patients were premedicated with 0.5 mg atropine im 30-40 min before the induction. Fentanyl, droperidol and diazepam in various combinations and doses were injected, im together with the atropine and iv 1-2 min before the induction, to obtain long-lasting sedations. In the second group (20 patients) the induction of the anaesthesia started 20-35 min after 0.5 mg of atropine im and 1 min after 0.1 mg of fentanyl iv. The induction was based on a bolus of 2.5 mg/kg of propofol and it was followed by suxamethonium, tracheal intubation and mechanical ventilation with N2O 70% in O2. An adequate depth of anaesthesia was maintained with supplemental doses of 50 mg of propofol, frequently associated with 25 mg of suxamethonium. Both methods proved to be reliable and safe. Nevertheless, the second method provided a better stability as far as a number of physiologic variables is concerned.

Diurnal changes of plasma and cerebrospinal fluid somatostatin and 24-h growth hormone secretory pattern in man. A study in hydrocephalic patients

Somatostatin concentration was determined in plasma and in cerebrospinal fluid during a 24-h period in 7 male patients suffering from hydrocephalus of differing aetiologies. Blood and ventricular cerebrospinal fluid samples were taken every 2 h during the day (08.00-22.00 h) and every hour during the night (24.00-07.00 h). Simultaneously, plasma growth hormone levels were also evaluated. Plasma SRIH levels showed significant circadian variations with highest values in the daytime and lowest values during the night. Cerebrospinal fluid SRIH did not show any significant time-related circadian changes. Plasma GH levels showed the well-known circadian pattern in the majority of patients. No significant correlation was found between the plasma GH and plasma or cerebrospinal fluid SRIH values recorded during the 24-h period. Results suggest that peripheral SRIH does not play any major role in the control of the 24-h GH secretory pattern in man.

Diurnal pattern of plasma and cerebrospinal-fluid vasopressin levels in hydrocephalic patients: absence of a circadian rhythm and of a correlation between plasma and cerebrospinal-fluid variations

The arginine vasopressin (AVP) concentrations were determined in plasma and in cerebrospinal fluid (CSF) during a 24-hour period in 7 male patients suffering from hydrocephalus of differing etiologies. Blood and ventricular CSF samples were simultaneously collected every 2 h during the day (08.00-22.00) and every hour during the night (24.00-07.00). In both plasma and CSF, the AVP levels did not show significant time-related circadian variations. No significant correlation was found between the plasma and CSF AVP values during the 24-hour period. The data obtained indicate the absence of the plasma and CSF AVP circadian rhythm in hydrocephalic patients and suggest that in these patients, and possibly in healthy humans, physiological stimuli which are able to induce variations in the plasma AVP concentration during daily life do not alter the CSF AVP content.

Diurnal beta-endorphin changes in human cerebrospinal fluid

Plasma and cerebrospinal fluid (CSF) beta-endorphin levels were determined by a RIA method in seven hydrocephalic male patients. The samples were simultaneously collected every two hours from 8 AM to 12 midnight and every hour from 1 AM to 7 AM. In both plasma and CSF beta-endorphin levels showed significant time-related variations during the 24 hour period. These results suggest the existence of diurnal CSF beta-endorphin variations analogous to those observed in plasma.

Variations of prolactin content in human cerebrospinal fluid after metoclopramide and morphine

Serum and cerebrospinal fluid (CSF) prolactin (PRL) concentrations were determined in fourteen patients of both sexes suffering from hydrocephalus, in basal conditions and after i.m. administration of 10 mg metoclopramide or 10 mg morphine. A significant increase in both serum and CSF hormone values was found after administration of both drugs. Serum and CSF PRL values after metoclopramide administration increased earlier and to a greater extent than after morphine. Furthermore, the metoclopramide induced CSF PRL increase immediately followed the serum peak, whereas after morphine administration an evident delay in the CSF hormone peak with respect to the serum increase was found. These data suggest that PRL entry in the CSF compartment is subject to a controlling mechanism which acts at the blood/brain barrier.

Diurnal prolactin changes in human cerebrospinal fluid

Eight adult male patients suffering from hydrocephalus of differing aetiologies were investigated in order to detect the existence of diurnal variations of prolactin (PRL) concentration in human cerebrospinal fluid (CSF). Blood and ventricular CSF samples were taken every 2 h during the day (0800-2200 h) and every hour during the night (2300-0700 h). CSF mean PRL levels showed significant nyctohemeral variations with low levels (2.1 +/- 0.3 ng/ml) during day-time and higher levels at night (3.3 +/- 0.1 ng/ml), similar to that observed in serum (PRL values: 16.4 +/- 5.2 and 24.8 +/- 4.3 ng/ml during day and night periods respectively). The presence of a 24 h CSF PRL secretory profile similar to that in serum was shown in six patients with normal 24 h mean PRL values and normal diurnal changes in serum. In two patients with an altered serum 24 h secretory pattern no significant nyctohemeral variations in CSF PRL levels were found. Present data show the existence in man of nyctohemeral variations in CSF PRL content related to the 24 h changes of PRL levels in serum.

Changes of CSF prolactin induced by metoclopramide in man

A sharp increase in serum and CSF prolactin (PRL) values after acute metoclopramide (10 mg i.m.) administration was found in six male patients without endocrine diseases. Peak values occurred simultaneously in serum and in CSF. This finding suggests the possibility that CSF PRL content depends also on the retrograde transport from pituitary gland.

Electromanometric confirmation of needle position in haemopericardium with severe tamponade

Simultaneous recording of the electrocardiogram and of the pressure transmitted through the drainage needle in patients with haemopericardium provided confirmation that the needle tip was in the pericardial cavity. Proper position was indicated by a positive pressure wave beginning before the QRS complex, reaching its maximum value in the first part of the ST segment and ending with the T wave. In contrast, ventricular penetration was signalled by a positive pressure wave beginning in the first part of the QRS complex, reaching its maximum during the T wave and ending between the T and P waves.

[Analysis of EEG frequency in althesin anesthesia]

Twelve subjects were given Althesin until the EEG level of burst suppression was reached. The cerebral electrical activity was continuously monitored by the conventional EEG-tracing method and by a tracing compression technique (BFA), based on the time to-frequency domain conversion and the display of the spectra in prospectical array. The BFA computed in real time the power spectra of 64 frequencies (0,25-16 Hz) by means of the Fourier's transform. The depth of Althesin anesthesia proved to correlate with the EEG spectra.

[Effects of the intravenous infusion of althesin on intracranial pressure and related functions]

30-60 min after the i.m. administration of 0.5 mg atropine sulphate, 9 adult conscious neurosurgical patients on spontaneous ventilation were given a total of 12 i.v. infusions of Althesin at a rate of 0,25-0,60 ml/kg/h able to induce stable clinical and EEG levels of anaesthesia. PICm, PAm and PVCm respectively decreased in all, in ten and in six administrations. The PAm decreased below 60 mmHg in only one case, in another there was no change and in another still it increased in a stable manner. In all cases PICm, PAm and PVCm decreased by a mean of 3.88 +/- 1.22 (P < 0,05), 20,76 +/- 17,44 (P < 0,05) and 0,90 +/- 1,50 mmHg. The paCO2 generally increased and, in only one case, did it induce an intracranial hypertensive reaction; the paO2 was frequently reduced. The interruption in the infusion was followed by the regression of all effects. This appened for the PICm and PAm without dangerous rebound effects. The clinical use of Althesin in neurosurgical patients is discussed with regards to problems of anaesthesia and intensive care.

[Effects of an intravenous bolus of althesin on intracranial pressure and related functions]

30-40 min after i.m. administration of 0.5 mg atropine sulphate, 8 adult conscious neurosurgical patients on spontaneous ventilation were given a total of 10 rapid i.v. injections of Althesin at a dosage of 40-50 (45.5 +/- 4.33 as a mean) microliter/kg. Method was able to induce clinical and EEG signs of deep anaesthesia. PICm and PAm decreased in all cases by 6.82 +/- 3.91 (P < 0,05) and 20.18 +/- 9.30 mmHg respectively; PVCm decreased in only half of the cases. The intracranial hypotensive effect was positively correlated to the basal PICm (P < 0.05) and resulted proportionately more marked in cases with greater signs of EEG depression. The PAm never decreased below 60 mmHg. The paCO2 was generally increased and the paO2 was always decreased. The intracranial hypotensive effects regressed 12-23 min after the injection without dangerous rebound effects; recovery of the PAm was slower. The use of Althesin in the anaesthesia and in the intensive care of neurosurgical patients is discussed.

Propranolol in neurosurgical patients with sinus tachycardia. Cardiovascular effects and mode of use

Cardiac rate (CR) and systolic arterial blood pressure (ABP) response to the intravenous injection of one, two, or three mg propranolol were recorded in 77 patients with traumatic, neoplastic, or haemorrhagic intracranial lesions and sinus tachycardia. In most patients tachycardia occurred with no cause except the intracranial lesion; in the other patients induction of general anaesthesia or surgical procedures on the brain appeared to have an initiating role. A central imbalance, with increased sympathetic cardiotropic influences is suggested and discussed. (I) First administrations of propranolol always reduced CR but had different effects on ABP from case to case; in all the patients 2.05 +/- 0.84 mg of drug lowered CR by 28 +/- 14/min (P less than 0.01), and ABP by 4.7 +/- 11 torr. CR decrease and ABP changes were without relation to the injected dose. Previous digitalization (desacetyllanatoside C) did not modify CR response to propranolol but reduced (P less than 0.05) its arterial hypotensive action. Positive correlations were found between basal CR and CR decrease (P less than 0.01), basal CR and ABP changes (P less than 0.01), CR decrease and ABP changes (P less than 0.05). Halothane appeared to potentiate CR response (P less than 0.01). (II) CR effect was less when the same dose of propranolol was repeated within 90 min (P less than or equal to 0.05). Usefulness and the mode of use of propranolol were critically evaluated.