Hypertensive and catecholamine response to tracheal intubation in patients with pregnancy-induced hypertension

The pressor and catecholamine responses to laryngoscopy and intubation were studied in nine patients with pregnancy-induced hypertension (PIH) and in eight normotensive controls. Five of the PIH patients had received oral labetalol as antihypertensive therapy. Mean arterial pressure (MAP) increased significantly from the pre-induction value in all groups 1 min after intubation, and also at 3 min in those with PIH who had not received labetalol. Arterial pressure was significantly greater in both PIH groups than in the control group at all times. However, the percentage increase in MAP on intubation was significantly less in the labetalol treated group than in either the untreated or the control groups. There were no significant differences between the groups in plasma concentrations of either noradrenaline or adrenaline; noradrenaline concentration increased significantly after intubation only in the control group. Labetalol appears to confer some protection against the pressor response to intubation in parturients with PIH.

Plasma concentrations of catecholamines following intraocular irrigation with adrenaline

Plasma concentrations of adrenaline and noradrenaline were measured in 13 patients undergoing cataract surgery after intraocular irrigation with an adrenaline-containing solution. Venous blood samples were withdrawn before, during and after intraocular irrigation with a solution of adrenaline 1:500,000. Plasma concentrations of both adrenaline and noradrenaline did not differ significantly from those noted before induction of anaesthesia.

Failure of rectal diclofenac to augment opioid analgesia after cholecystectomy

The analgesic efficacy of a single 100-mg suppository of diclofenac sodium given after elective cholecystectomy was studied in 30 healthy patients in a double-blind randomised controlled manner. The mean 24-hour postoperative morphine consumption of the placebo group and the diclofenac group was similar (45 mg). Analysis of the cumulative hourly morphine consumption from the patient-controlled analgesia system failed to show any statistically significant differences between the groups. Peak expiratory flow rate, forced expiratory volume at 1 second and forced vital capacity decreased 24 hours after operation to less than 50% of pre-operative values in both groups. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.

A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy

A controlled investigation was conducted to compare the effectiveness of diclofenac and papaveretum in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 3 and 13 years of age were randomly allocated to receive rectal diclofenac 2 mg/kg, intramuscular papaveretum 0.2 mg/kg or no medication immediately after induction of anaesthesia. Pain and appearance were assessed 1, 3 and 6 hours postoperatively, and the following morning. The assessments were double-blind and performed by the same observer. No significant differences in postoperative pain were found between the groups at any time. The use of diclofenac was associated with a significantly more rapid return to calm wakefulness and had significantly less effect upon respiratory rate. Consumption of paracetamol on the day of operation was significantly less in the diclofenac group. Diclofenac may offer advantages compared to papaveretum with regard to safety and convenience for use in the treatment of pain after tonsillectomy in children.

Paediatric postoperative analgesia. A comparison between caudal block and wound infiltration of local anaesthetic

Fifty children who underwent day case herniotomy received either a caudal injection of 1 ml/kg bupivacaine 0.25% or infiltration of the wound edges at the end of surgery with 0.5 ml/kg bupivacaine 0.25%, allocated at random. Postoperative pain and demeanour were assessed initially by an observer and later by use of a parental questionnaire. Wound infiltration of local anaesthetic solution provided analgesia which was comparable to that associated with caudal block, and the incidence of side effects was similar in the two groups. Wound infiltration of local anaesthetic offers a simple, safe alternative to caudal block for provision of postoperative analgesia in this group of patients.

Affinity chromatography of naturally occurring folate derivatives

In a previous report (1980, in Methods in Enzymology, Vol. 66, p. 686, Academic Press, New York) we described the preparation and use of purified milk folate-binding protein covalently linked to a Sepharose matrix. The present study was undertaken to test the capacity of this preparation to purify quantitatively folates from tissue extracts. In experiments that employed tissue extracts containing biologically synthesized [3H]folates, recovery of radioactivity from columns of the immobilized folate-binding protein (affinity columns) was consistently 90-95%. Folates eluted from the affinity column were practically pure. Anion-exchange chromatography of the purified fraction from rat liver extract yielded a number of uv-absorbing peaks which corresponded to the elution profile based on 3H counts, with respect to both the position and the area of the peaks. Treatment of the original extracts with folylpolyglutamate hydrolases resulted in the shift of these peaks to lower retention times, which corresponded to mono- or diglutamyl folate derivatives. Similar results were obtained with extracts from Lactobacillus casei. The purification of tissue folates by affinity chromatography allows determination of folate activity by direct physiochemical methods, which is particularly useful for analysis of folate composition in tissues.

Effects of alfentanil on the pressor and catecholamine responses to tracheal intubation

The effects of alfentanil (given during induction of anaesthesia) on the haemodynamic and catecholamine responses to tracheal intubation were studied in 44 adult patients who received alfentanil 10 micrograms kg-1 or 40 micrograms kg-1, or saline placebo. Alfentanil 10 micrograms kg-1 and 40 micrograms kg-1 prevented any increase in heart rate and arterial pressure after tracheal intubation. Alfentanil 40 micrograms kg-1 produced profound hypotension and bradycardia. The use of alfentanil in both doses was associated with a decrease in plasma adrenaline concentrations after tracheal intubation.

Modification of hepatic folate metabolism in rats fed excess retinol

Feeding rats a diet containing 1000 IU of retinol/g diet enhances the folate-dependent oxidation to CO2 of formate and histidine. The activity of hepatic methylenetetrahydrofolate reductase, which plays a critical role in the regulation of liver folate metabolism, is suppressed in these animals, resulting in decreased 5-methyltetrahydrofolate synthesis. This ensures a greater concentration of hepatic tetrahydrofolate, the coenzyme on which formate and histidine oxidation depend, but also compromises the level of S-adenosylmethionine in the liver.

Sudden sensorineural hearing loss following manipulation of the cervical spine

Review of the otolaryngologic literature reveals no reports of sudden sensorineural hearing loss resulting from manipulation of the cervical spine. Indeed, in previously reported cases of vertebrobasilar artery injury following spinal manipulation, hearing loss has received little attention. Two patients with sudden sensorineural hearing loss following cervical spine manipulation are presented. The audiologic findings and cerebral arteriograms are reviewed and treatment is discussed. A review of the anatomy and pathophysiology is also included, and a possible mechanism of injury to the vertebral artery is proposed.

A comparative study of diazepam with sustained-release diazepam as oral premedication in minor gynaecological surgery

Sixty patients undergoing elective minor gynaecological surgery received oral pre-operative medication with 10 mg diazepam in either conventional tablet form on the morning of operation or as the sustained-release tablet the night before. Subjective and objective assessments of the effectiveness of premedication were made. Patients receiving sustained-release diazepam on the night before surgery experienced fewer periods of wakefulness than those who received placebo. Patients who were given diazepam on the morning of surgery felt more drowsy pre-operatively than those who received sustained-release diazepam the night before.