Einfluß verschiedener niedriger Droperidol-Dosierungen auf postoperative Angst, innere Anspannung, allgemeine Befindlichkeit und PONV

Background: Droperidol even in low doses such as 0,5?mg to 1,25?mg can increase postoperative anxiety and state of tension. The aim of this study was to determine whether these side effects occur frequently following low-dose droperidol and to see whether these are dose related. Methods: 184 female in- and outpatients ASA grade 1 and 2 undergoing gynaecological laparoscopy were recruited to this prospective, double-blind study. General anaesthesia was standardized (induction with thiopentone, fentanyl 2?µg/kg and vecuronium 0,1?mg/kg, tracheal intubation, maintainance with enflurane in N₂O/O₂). Patients were randomly allocated to receive saline (n=45), 0,625?mg (n=46), 1,25?mg (n=47) or 2,5?mg (n=46) droperidol i.v. 10 minutes before the end of surgery. 1, 3, 6, and 24 hours postoperatively, the patients’ anxiety, state of tension and overall mood was evaluated using two psychological questionnaires which had been tested for the perioperative period (Erlanger anxiety and tension-scale / BSKE-EWL-test). Sedation was evaluated by the staff of the recovery room. In addition, postoperative nausea and vomiting (PONV) was assessed using a 100?mm visual analogue scale and by counting the episodes of retching or vomiting. PONV was then rated over the whole observation period as none, mild, moderate or severe using a fixed scoring algorithm. Statistical analysis was performed using the ANOVA and the chi²-test. Results: The patients did not differ with regard to biometric data, duration of surgery and anaesthesia. The postoperative scores for anxiety, state of tension and overall mood were not different between the groups at any observation time (Fig.?1: anxiety and tension: P=0,5687; figure 2: overall mood: P=0,0647). Quality of sleep in the first night after surgery was the same in all groups (Table?2 and 3). Sedation was not significantly different (Table?4; P=0,0704). Furthermore, duration of stay in the recovery room did not differ (P=0,4353). On the other hand, three patients from the 2,5?mg droperidol group had to stay unexpectedly on the ward overnight, because they had been too much sedated to be discharged at home. This was not the case with any patient from the other groups. Compared to placebo, PONV over the whole 24?h observation period was significantly reduced by droperidol (Fig.?3; P=0,0338): completely free from PONV: placebo: 41,3%, 0,625?mg droperidol: 67,4%, 1,25?mg droperidol: 53,2%, 2,5?mg droperidol: 71,7%. Also the severity of PONV was reduced. Conclusion: In gynaecological laparoscopy under general anaesthesia with tracheal intubation, we recommend droperidol 0,625?mg in the prevention of PONV, as it reduces PONV as well as 2,5?mg with no severe sedation in this dosage. Psychological side effects did not occur more frequently after droperidol compared to placebo in any of the investigated dosages.     

Industrial progress concerning latex allergy in surgery

Latex allergy has been well described in the literature, but it remains a constant worry for high-risk groups. We wish to show that the manufacturing industry has made real progress in response to this iatrogenic pathology. The high-risk groups are defined, in addition to the allergies with which they are associated: foodstuffs, ethylene oxide, airborneallergens. The criteria necessary to have available high-quality sterile surgical gloves are stated: they must be either hypo-allergenic or non-allergenic dependent upon the circumstances of use, they must guarantee protection against the transmission of infection and allow the medical practitioner complete freedom of movement. In the same way urinary catheters for intermittent probing, penile sheaths and condoms are mentioned. Powder must definitely be eliminated from any medical glove, because it can both be a vector for latex particles and can be the cause of granulomas in the abdominal cavity. The European Community standards (CE) and the recommendations of the American Associations of Allergology are explained. Sterilization by gamma irradiation is one sign of real progress, outperforming ethylene oxide which is too allergenic. The composition of the gloves must ensure an effective barrier against both allergens and infections. Pre-lubricated latex-free urinary catheters, penile sheaths and latex-free condoms represent substantial improvements for the population at risk. Since 1995 considerable progress has been made by the manufacturing industry in response to the needs of both allergologists and surgeons.     

Forebrain connections of the hamster intergeniculate leaflet: comparison with those of ventral lateral geniculate nucleus and retina

The hamster intergeniculate leaflet (IGL), part of the circadian rhythm regulatory system, has very extensive interconnections with subcortical visual nuclei. The present investigation describes IGL connections with the hamster diencephalon and telencephalon and compares them with ventral lateral geniculate nucleus (VLG) connections and retinal projections. Connections of the geniculate nuclei were evaluated using anterograde transport of iontophoretically injected Phaseolus vulgaris leucoagglutinin and by retrograde transport of cholera toxin beta fragment. The cholera fragment was also injected intraocularly to trace retinal efferents. The IGL has ipsilateral and contralateral projections to the anterior and posterior hypothalamic nuclei, the ventral preoptic, lateral and dorsal hypothalamic areas, but not to the core ventromedial nucleus and very sparsely to the paraventricular nucleus. There are also IGL projections to the medial and lateral zona incerta, anteroventral, anterodorsal, reuniens, parataenial, paraventricular, centrolateral, central medial, and laterodorsal thalamic nuclei. IGL projections to the telencephalon are found in the horizontal limb of the diagonal band, olfactory tubercle, nucleus of the lateral olfactory tract, posterior bed nucleus of the stria terminalis, ventral pallidum, and in nuclei of the medial amygdala. The only substantial VLG projections are to bed nucleus of the stria terminalis, IGL, medial zona incerta, central medial and laterodorsal thalamic nuclei. Several of the IGL targets, the bed nucleus of the stria terminalis and zona incerta in particular, send projections back to the IGL and VLG. In addition, cells are present in the caudal cingulate cortex that project to both nuclei. Retinal projections are found in many of the regions receiving IGL innervation, including nuclei of the medial basal telencephalon, the posteromedial bed nucleus of the stria terminalis, and nuclei of the hypothalamus. A retinal projection is also visible in the lateral olfactory tract from which it extends rostrally, then medially along the base of the rhinal fissure. Fibers also extend caudally, in a superficial location, to perirhinal cortex. The results further demonstrate the widespread connections of the IGL and support the idea that the IGL modulates olfactory, photic, and circadian rhythm regulation of regulatory physiology and behavior.     

Oxidative bioactivation of the lactol prodrug of a lactone cyclooxygenase-2 inhibitor.

The lactol derivative of a lactone cyclooxygenase-2 inhibitor (DFU) was evaluated in vivo and in vitro for its potential suitability as a prodrug. DFU-lactol was found to be 10 to 20 times more soluble than DFU in a variety of aqueous vehicles. After administration of DFU-lactol at 20 mg kg-1 p.o. in rats, a Cmax of 7.5 microM DFU was reached in the plasma. After oral administration, the ED50s of DFU-lactol in the carrageenan-induced paw edema and lipopolysaccharide-induced pyresis assays in rats are comparable with the ED50s observed when dosing with DFU. Incubations of DFU-lactol with rat and human hepatocytes demonstrated that the oxidation of DFU-lactol can be mediated by liver enzymes and that a competing pathway is direct glucuronidation of the DFU-lactol hydroxyl group. Assays with subcellular fractions from rat liver indicated that most of the oxidation of DFU-lactol occurs in the cytosolic fraction and requires NAD(P)+. Human liver cytosol can also support the oxidation of DFU-lactol to DFU when NAD(P)+ is added to the incubations. Fractionation of human liver cytosolic proteins showed that at least three enzymes are capable of efficiently effecting the oxidation of DFU-lactol to DFU. Incubations with commercially available dehydrogenases suggest that alcohol and hydroxysteroid dehydrogenases are involved in this oxidative process. These data together suggest that lactols may represent useful prodrugs for lactone-containing drugs.     

Academic preparation of athletic trainers as counselors

Athletic trainers have assumed several roles and responsibilities over the years, but perhaps there is no more important role than that of a counselor. Are they prepared to do so? One hundred and thirty-two modified Revised Wylie Inventories were mailed to college/university athletic trainers to examine their educational preparation and experiences with counseling in various areas. Most athletic trainers surveyed reported that they were predominantly counseling in the areas of injury prevention, injury rehabilitation, and nutrition, and felt academically prepared to do so. However, it was reported that preparation to counsel in other less common areas (eg, family matters, financial matters, etc) was not adequately addressed in academic programs. The athletic trainers surveyed sought continuing education in order to meet the other counseling needs of student-athletes. Although they used several psychological referral services, it was apparent that most athletic trainers frequently served as counselors on many nonorthopedic topics. We suggest that athletic training educators consider incorporating both academic knowledge and clinical experience in a wider variety of counseling areas into their curricula.     

Oligonucleotide-directed mutagenesis as a general and powerful method for studies of protein function.

We have used oligonucleotide-directed mutagenesis to make a specific change in the beta-lactamase (EC 3.5.2.6) (ampicillin resistance) gene of the plasmid pBR322. Evidence suggests that the active site for this enzyme may include a serine-threonine dyad (residues 70 and 71). By priming in vitro DNA synthesis with a chemically synthesized 16-base oligodeoxyribonucleotide, we have inverted the Ser-Thr dyad to Thr-Ser and thereby generated a mutant with an ampicillin-sensitive phenotype. This "double-mismatch" method is relatively simple and also very general because detection of mutants is at the level of DNA and involves only colony hybridization. Accordingly, the procedure can be applied to any DNA sequence and does not depend on the phenotype of the mutant.     

Klippel-Trénaunay syndrome. An unusual presentation of unilateral leg edema

Klippel-Trénaunay syndrome is a rare congenital condition that classically presents as a triad of varicosities, bone or soft-tissue hypertrophy, and cutaneous hemangiomas. The authors describe a case of this disease in an otherwise healthy patient with unilateral leg edema and intermittent bleeding from prominent ankle varicosities. The diagnosis was made on the basis of clinical presentation, diagnostic studies, and a comprehensive literature review. An overview of the pathology, treatment, and prognosis of this disease is provided.