Teflurane: a new halogenated gaseous anesthetic--first clinical experience.
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Biomedical subjects
Publications and source records attributed to G Corssen.
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A series of 110 children, ranging in age from 2 days to 4 years and in weight from 2.4 to 12.9 kg, underwent total surgical correction of complicated heart defects with the aid of profound hypothermia and total circulatory arrest. Combined surface and core cooling, in conjunction with light general anesthesia, proved to be a safe and effective method to provide optimal working conditions for the surgeon. The technic of cooling and rewarmining, as well as hemodynamic and metabolic parameters monitored, are important, and factors such as type of heart defect, age, weight should be considered in relation to postoperative morbidity and mortality.
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Clinical evaluation of etomidate, an ultrashortacting nonbarbiturate hypnotic agent, shows it to be useful for anesthetic induction in adults. It produces sleep in 1 arm-brain circulation time, metabolites apparently peaking at 7 minutes postinjection. Cardiovascular and respiratory systems appear minimally affected and there is no indication of organ toxicity or other biochemical or hematologic drug-induced disturbances. Moderate pain on injection at some sites and transient myoclonia were the principal disadvantages observed.
The analgesic effects of butorphanol tartrate and morphine sulfate were compared in 127 patients judged to have moderate to severe pain following major operations. The study was double-blind, and the drugs were given IM at several dosage levels. Scores for pain intensity and relief, as well as pain-intensity difference, were determined at 30, 60 and 120 minutes after medication, then were analyzed by a parallel-line assay method in a modified computer program. The analysis indicated butorphanol tartrate to be 7 times as potent as morphine sulfate. Peak analgesic effects were obtained at 60 minutes with both drugs. Side effects were minimal in degree and incidence. Neither butorphanol nor morphine induced any changes in blood pressure, pulse rate, or respiratory rate. These data, along with those from studies elsewhere, suggest that butorphanol is a safe, potent, and effective analgesic agents, with probably a low potential for inducing drug dependence.
In exploring new modalities to control or ameliorate unbearable intractable pain associated with invasive cancer, the authors studied the effectiveness and safety of a new method involving the destruction of the pituitary by injection of absolute alcohol into the gland. Of a series of 24 patients undergoing pituitary adenolysis for control of cancer pain, 13 patients experienced complete and lasting relief and 10 showed significant improvement. The authors hope that the encouraging results obtained in this preliminary study will stimulate other investigators also to employ the transnasal, transphenoidal approach to alcohol-induced hypophysectomy for the control of intractable pain due to advanced cancer.
Following intravenous injection of 0.3 mg/kg of etomidate, the only noteworthy change in measured cardiovascular parameters was a 10 percent increase in heart rate. This suggests relatively stable cardiovascular response associated with administration of this new nonbarbiturate anesthesia induction agent.
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