COMPARISON OF 1.5% ENFLURANE WITH 1.25% ISOFLURANE IN OXYGEN FOR CAESAREAN SECTION: AVOIDANCE OF AWARENESS WITHOUT NITROUS OXIDE

We examined the feasibility of administering nearly 100% oxygenthroughout the induction-delivery period of general anaesthesiafor 113 Caesarean sections. Isoflurane 1.25% was compared with1.5% enflurane for maintenance of anaesthesia. The level ofanaesthesia was monitored by use of the isolated forearm technique.There was a greater amount of isolated forearm movement whenenflurane was used. The three main criteria for a satisfactorygeneral anaesthetic technique for Caesarean section were fulfilled,namely no maternal awareness, no undue depression of the fetusand no adverse effect on uterine contractility. Isoflurane andenflurane appear to be suitable anaesthetic agents for facilitatinghyper-oxygenation during Caesarean section.     

Hair Loss Associated with Moclobemide Use

A case is reported of a 34-year-old woman who developed diffuse hair loss after taking moclobemide 300 mg bd for 1 week, having previously taken 150 mg bd for 4 weeks without hair loss. Although the hair loss ceased 2 weeks after stopping moclobemide, her hair had not recovered at 6 months after stopping treatment. Other reports of hair loss on antidepressants are reviewed. © 1997 John Wiley & Sons, Ltd.     

Stent Fracture in the Coronary and Peripheral Arteries

Inherent risks of stenting include restenosis and thrombosis. Recently, stent fractures have been recognized as a complication that may result in thrombosis, perforation, restenosis, and migration of the stent resulting in morbidity and mortality. Stent fractures were originally seen in the superficial femoral arteries but have since then been reported in almost all vascular sites including the coronary, renal, carotid, iliac, and femoropopliteal arteries. Fractures are the result of the complex interplay between stent manufacturing, the stented segment, pulsatile and nonpulsatile biomechanical forces, and plaque morphology at a particular vascular site. The presentation of a patient with a fracture is highly variable, ranging from asymptomatic in nature, detected on routine screening without any sequelae, to sudden cardiac death related to a thrombosed coronary artery. Despite being recognized as an important complication, consensus on routine surveillance and diagnostic methods to detect fractures continues to be lacking. Fortunately, most cases are relatively benign and can be managed conservatively if detected. In the setting of recurrent symptoms, further intervention is usually sought. In review of the literature most cases are managed with placement of a stent over the fractured area, the stent‐in‐stent technique, but several other alternatives may be available. As the knowledge of the variables that make stents prone to fracture are identified, better technologies and techniques can be employed to minimize the risk of this complication. This article reviews the available literature on stent fractures and complications using data found on PubMed, MEDLINE, the Manufacturer and User Facility Device Experience (MAUDE) database, and the Cochrane databases. (J Interven Cardiol 2010;23:411–419)     

Cardiovascular and endocrine responses to haemorrhage in the pig

Heart rate (HR), mean arterial pressure (MAP), indices of sympathetic and parasympathetic activity (plasma concentrations of adrenaline, noradrenaline and pancreatic polypeptide, PP), vasopressin (VP) and aldosterone (ALDO) were measured in six pigs during continuous bleeding resulting in hypovolaemic shock, from which five survived. Three stages of haemorrhage could be defined. Stage I. Resting MAP was 85 ± 6 mmHg and increased to 96 ± 5 mmHg with a blood loss of 275 (range 250–300) (10 (9–12)% of the estimated blood volume) concomitant with an increase in HR from 105 ± 5 to 113 ± 6 beats min^-1 (P < 0.05). Stage II. After a blood loss of 375 (300–500) ml (15 (13–16)%) MAP fell to 62 ± 9 mmHg and HR to 95 ± 5 beats min^-1 (P < 0.05). Stage III. A blood loss of 1113 (825–1450) ml (44 (30–52)%) resulted in a MAP of 50 ± 4 mmHg and an increase in HR to 206 ± 3 beats min^-1 (P < 0.05). Adrenaline increased from 0.3 ± 0.1 to 0.8 ± 0.3 (stage II) and 3.6 ± 1.1 nmol l^-1 (stage III) (P < 0.05); noradrenaline from 0.4 ± 0.1 to 1.5 ± 0.4 (stage II) and 5.9 ± 1.7 nmol l^-1 (stage III) (P < 0.05); PP from 6.2 ± 1.6 to 13.3 ± 2.3 (stage II) and 20.9 ± 7.8 pmol l^-1 (stage III) (P < 0.05). VP changed only marginally, but ALDO increased from 496 ± 54 to 623 ± 76 pmol l^-1 (stage III) (P < 0.05). The results suggest that a high HR and intense sympathetic activity is seen during severe haemorrhage in the pig while vagal slowing of the heart and moderate hypotension are prominent when bleeding amounts to approximately 15% of the estimated blood volume.