This study of 40 healthy adults undergoing elective gynecologic procedures was undertaken to evaluate the microdrip technic of administering ketamine or Innovar slowly to induce anesthesia and to supplement N2O anesthesia. All patients were managed by the same anesthetist and surgeons and received 10 mg of diazepam and 0.4 mg of atropine IM for premedication. After injection of 10 mg of diazepam, anesthesia was induced by infusions containing either ketamine (2 mg/ml) or Innovar (0.1 ml/ml), at an average rate of 10 ml/min. The infusions were assigned to the patients randomly and their nature was disguised from the staff. After tracheal intubation, ventilation was mechanically supported and anesthesia maintained with N2O-O2 (2:1), by drip at a rate adjusted to the patient's vital signs, and by intermitten injections of 3 to 6 mg of d-tubocurarine. Special forms coded to suit computer use were used to collect data during induction, maintenance, and recovery, and standard mathematical tests were used for analysis. Results showed that (a) ketamine effects could not be differentiated clinically from those of Innovar; (b) ketamine dosage could be reduced to 0.3 to 0.5 the recommended bolus dosage; (c) pulse rates and incidence of mental aberrations during induction or recovery were equal in both groups; (d) blood pressure showed a modest but significant increase (10% from basal values) until 20 minutes of tracheal intubation only in the ketamine group; (e) mean Pao2 determined 30 minutes after tracheal intubation was significantly higher in the ketamine group; (f) ketamine administration by the slow (20 mg/min) microdrip technic reduces the incidence of side effects.

Anesthesia, Intravenous↗

PubMedDate not supplied

Asthma deaths: are they preventable?

Asthma deaths have increased 11% between 1979 and 1982. Asthma is not a terminal condition; therefore, by definition, many of these deaths are preventable. A literature survey indicates the major causes of death from asthma to be four: 1) delays in getting/receiving appropriate care, 2) medication misuse, underuse, overuse, interaction and toxic effects, 3) receiving inappropriate care: sedation, insufficient corticosteroids, and 4) other risk factors: nocturnal asthma/morning dippers, labile and hyperresponsive airways, and infection among others. Several possible preventive measures are discussed.

Asthma↗

PubMedDate not supplied

Fatal varicella in a corticosteroid-dependent asthmatic receiving troleandomycin.

Long-term use of corticosteroids (CSs) may result in an increased risk of disseminated varicella. Concurrent administration of troleandomycin (Tao) to treat CS-dependent asthmatics can potentiate steroid effects. We present the first case of fatal varicella in a patient concurrently receiving methylprednisolone and Tao therapy. At the time of her death she had been receiving CSs for 2 years and Tao for 1 year. She had a 2-day history of fever, lower back and abdominal pain, dysuria, and constipation. Later, when pox lesions were evident, it was learned she had been exposed to varicella 2 weeks previously. While hospitalized she developed hepatitis, gastrointestinal hemorrhage, disseminated intravascular coagulopathy, and pneumonitis, resulting in respiratory failure. She succumbed despite treatment with stress doses of steroids, intravenous acyclovir, fresh frozen plasma, and ventilatory support. Autopsy findings revealed evidence consistent with disseminated varicella. This case suggests that concurrent therapy with CSs and Tao may increase the risk for disseminated varicella, possibly by enhancing CS-induced immunosuppressive effects. We suggest that other immunologic parameters in addition to serum varicella titers might be helpful in identifying those CS-dependent patients at risk. Any CS-dependent asthmatic, whether or not receiving Tao, should receive varicella-zoster immune globulin within 96 hours of exposure and acyclovir once varicella is clinically apparent. Varicella vaccine should be considered for those not yet exposed.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Clinical and biochemical correlations in asthma.

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Asthma↗