THE ANTIARRHYTHMIC PROPERTIES OF LIDOCAINE AND PROCAINE AMIDE. CLINICAL AND PHYSIOLOGIC STUDIES OF THEIR CARDIOVASCULAR EFFECTS IN MAN

The effects of lidocaine (Xylocaine) and procaine amide on arterial pressure, myocardial contractile force, and ventricular excitability were studied in 12 patients undergoing cardiac operations. Both compounds resulted in an increase in the stimulation threshold of the ventricle during diastole and neither caused a significant change in the duration of the absolute refractory period. Lidocaine, in doses of 1.0 to 2.0 mg./Kg., produced no significant circulatory depression but every patient given procaine amide (2.0 or 4.0 mg./Kg.) evidenced a fall in arterial pressure and a decrease in the contractile force of the right ventricle. These physiologic observations and clinical experiences with the use of lidocaine indicate that it is an effective antiarrhythmic agent and that it is preferable to procaine amide in the management of ventricular arrhythmias that occur during and following cardiac operations.

PSYCHOLOGICAL DISTURBANCES ASSOCIATED WITH OPEN HEART SURGERY

In our unit open heart surgery has provided sufficient stress to precipitate post-operative psychological disturbances in a high proportion of patients. In the year before this investigation was begun, 21 of 108 patients developed obvious mental abnormalities post-operatively. Blickenstorfer (1) reported post-operative psychosis in 3 per cent, of 300 patients subjected to open heart surgery, and the same incidence, 3 per cent., was reported by Bolton and Bailey (3) following closed and open heart surgery on 1,500 adult patients. The incidence of mental disturbance in our unit was so much higher that a detailed study of all patients (141) operated on in the unit during a 10-month period appeared to be indicated.

STEREOTACTIC TRACTOTOMY IN THE SURGICAL TREATMENT OF MENTAL ILLNESS

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