Flunitrazepam versus diazepam for endoscopies.
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Biomedical subjects
Publications and source records attributed to H B Aronson.
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In 38 subjects, 24-h food-and-water deprivation during the Jewish fast day, Tisha b'Av, led to a 2.5-fold increase in plasma free fatty acids and to a doubling of the bilirubin concentration. There were also significant increases in serum sodium, chloride, total proteins, albumin, uric acid, phosphorus and alkaline phosphatase and aspartate aminotransferase activity. Serum glucose and triglycerides decreased in concentration. There were no changes in concentrations of urea, potassium, cholesterol or calcium. The marked increases in free fatty acids might constitute a hazard for those with impaired myocardial function.
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A forearm tourniquet for i.v. regional analgesia of the hand, using doses of bupivacaine smaller than in the conventional (upper arm) method, produced successful analgesia in 98 of 102 patients. In 63 patients bupivacaine 50 mg or less was adequate, while in 33 the dosage was between 60 and 75 mg. No toxic effect was noted. This technique permits surgery of the hand, wrist and distal forearm.
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A 12-hour overnight fast in 17 subjects did not result in a significant increase in blood viscosity, as occurs after a 24-hour fast. The usual preoperative fast does not therefore appear to have any adverse rheological effect. However, when it is necessary to prolong the fast, intravenous fluids should be given to prevent the expected increase in blood viscosity which then might have clinical effects as a result of decreased organ perfusion.
Impressions of two different regional anesthetic techniques used in the management of 670 cases in a hand surgery unit are described. For operations at or below the wrist, subcutaneous ring anesthesia for the forearm tourniquet, together with local nerve block or local infiltrative anesthesia using Lignocaine, is very satisfactory. It is effective, simple, and safe, and it permits patient cooperation with the surgeon, who can readily evaluate motor activity because the flexor and extensor extrinsic muscles of the hand are then not paralyzed. For more extensive upper limb surgery, intravenous regional anesthesia with Bupivacaine is very effective, though toxicity might result if the tourniquet is unreliable or is released too rapidly. These effects are minimized by the intravenous infection of diazepam (5 to 10 mg) immediately prior to release the tourniquet.
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This is a report of a case of inadvertent release of an arm tourniquet only 5 minutes after intravenous regional anaesthesia with 150 mg of bupivacaine without serious effect.
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As a result of abstaining from food and water for 24 h during the midsummer Tishah-b'Ab fast, blood viscosity increased by 16.5% in 27 subjects studied; plasma viscosity increased by 10.3% in nine; hematocrit, by 3.1% in 27; serum total protein, by 6.3% and albumin, by 7.7%, both in 29 subjects. These changes were statistically significant. Plasma fibrinogen did not increase significantly. Fasting-induced changes could impair blood supply to vital organs in patients with vascular insufficiency.
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