Lingual haematoma leading to upper airway obstruction

A case is reported in which upper airway obstruction occurred in a patient following suturing of his lacerated tongue under local anaesthesia and the subsequent development of a large lingual haematoma.

Endoscopic injection of the vasoconstrictor ornithine-8-vasopressin in transurethral resection

A simple technique to inject the synthetic vasoconstrictor agent ornithine-8-vasopressin endoscopically into the prostate has been developed. The method has been assessed by two prospective randomised controlled trials on patients undergoing transurethral resection of the prostate. Results from the first trial, involving 56 patients who had general anaesthesia, were that the mean operative blood loss was 48% less in the treated group, a significant difference (P = 0.05). Results from the second trial, involving 57 patients who had spinal anaesthesia, were that the mean operative blood loss was 75% less in the treated group, a highly significant difference (P = 0.01). The pharmacology of the drug is reviewed, and it seems to be a safe agent which aids transurethral resection. It frequently causes a modest and transient elevation in blood pressure shortly after injection and, although not encountered by the author, it is possible that a more severe elevation necessitating treatment may rarely occur.

A comparative study of the haemostatic properties and cardiovascular effects of adrenaline and ornipressin in children using enflurane anaesthesia

In a randomized, double-blind trial, haemostatic and cardiovascular effects of ornipressin and adrenaline were compared in 30 children requiring surgery for "bat-ear" deformity. Mean total blood loss was 14.3 ml with ornipressin and 11.7 ml with adrenaline, this difference being insignificant. There was a significant and progressive reduction in mean heart rate in children who received ornipressin, from 134 to 116 bpm (P less than 0.05), and a significant rise from 127 to 134 bpm (P less than 0.05) with adrenaline. Mean systolic pressure was unaltered by ornipressin but was significantly increased from 97 to 105 mmHg (P less than 0.05) in children receiving adrenaline. Ornipressin is as effective a haemostatic agent as adrenaline and the rises in heart rate and systolic pressure associated with adrenaline, which are factors known to predispose to the onset of ventricular dysrhythmias, do not occur with ornipressin.

[Value of deliberate normovolemic hemodilution associated with a capillary vasoconstrictor, ornipressin, in surgery of the spine]

This study of sixty-seven children divided in two groups compared the blood loss and the amount of blood transfused during and after the operation. The operations were carried out without haemodilution nor the local injection of vasoconstrictor (twenty-four patients) and following haemodilution and the local injection of vasoconstrictor (forty-three patients). The blood loss during operation was 344 +/- 455 ml per vertebra in the first group, and 151 +/- 54 ml in the second. The blood loss in the post operative period did not seem to be modified by haemodilution, as the level of hemoglobulin was virtually the same in the two groups eleven days after the operation. A mean of seven units of blood were transfused to the first group, whilst only three in the second group. In the post-operative period, both groups received a mean of one unit each. Associating haemodilution and a vasoconstrictor, ornipressin, reduced very significantly the need for homologous blood.

Ornipressin (POR. 8) for haemostatic infiltration in neurosurgery

A double blind controlled trial was carried out on 100 neurosurgical patients. Ornipressin 0·2 IU/ml was compared with adrenaline 1:250,000. Ornipressin proved to be as effective as the control agent, and had little systemic effect. It is concluded that absence of arrhythmigenicity makes ornipressin preferable to adrenaline.