Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane,enflurane, isoflurane and sevoflurane

Eleven male volunteers were studied to compare the airway irritation produced by the four anaesthetic agents: halothane, enflurane, isoflurane and sevoflurane at two concentrations, equivalent to one and two MAC. Tidal volume, respiratory frequency and functional residual capacity changes induced by 15 sec inhalation of the anaesthetics were measured using respiratory inductive plethysmograph. Appearance of the cough reflex was also observed. The order of subjective airway irritation was evaluated by the volunteers. Inhalation of the anaesthetic agents induced a decrease in tidal volume, increase in respiratory frequency and decrease in functional residual capacity. Significant changes were considered to have occurred if tidal volume and respiratory frequency changed by more than 30% from the resting values for at least ten seconds, or if functional residual capacity changed by more than 30% of the value at resting tidal volume, for at least ten seconds. Each change was induced most frequently by isoflurane followed by enflurane, halothane and, least frequently, by sevoflurane. The orders of appearance of the cough reflex and of subjective airway irritation were similar. Sevoflurane did not elicit a cough reflex. It is concluded that sevoflurane was the least irritant anaesthetic and is considered to be the most suitable for inhalational induction of anaesthesia. Sept volontaires du sexe masculin font partie dune étude visant à comparer les ejfets irritants de quatre agents anesthésiques sur les voies respiratoires: l’halothane, l’enflurane, l’ isoflurane et le sévoflurane, à deux concentration qui équivalent soit à MAC 1, soit à MAC 2. On mesure les changements de volume courant, de fréquence respiratoire et de capacité résiduelle fonctionnelle à l’aide d’un pléthysmographie à induction. On note l’apparition du réflexe de toux. De plus, on évalue le degré subjectif d’irritation éprouvé par les sujets. L’inhalation d’agents anesthésiques cause une baisse du volume courant, une augmentation de la fréquence respiratoire et une diminution de la capacité résiduelle fonctionnelle. On considère significatifs les changements de volume courant et de fréquence respiratoire de plus de 30% des valeurs de repos pour au moins dix secondes, les changements de capacité résiduelle fonctionnelle de plus de 30% de sa valeur au volume courant de repos pour au moins dix secondes. Les changements sont initiés principalement par l’isoflurane, suivi par l’enflurane, l’halothane et moins fréquemment par le sévoflurane. L’ordre d’apparition du réflexe de toux et de l’impression subjective d’irritation des voies aériennes est identique. Le sévoflurane ne provoque pas de réflexe de toux. On conclut que le sévoflurane est le moins irritant des anesthesiques et qu’on peut le considerer comme celui qui convient le mieux à l’induction de l’anesthésie par inhalation.     

A comparison of sevoflurane with halothane,enflurane, and isoflurane on bronchoconstriction caused by histamine

This study was conducted to assess the effect of sevoflurane on lung resistance and compliance, and its responsiveness to histamine. We studied eight dogs to compare the effect of sevoflurane, isoflurane, enflurane, and halothane on bronchoconstriction caused by histamine. Baseline values of pulmonary resistance (R_L) and dynamic pulmonary compliance (C_dyn) were measured prior to administration of histamine. Histamine (2, 4, and 8 μg · kg⁻¹) were administered iv, and the values of R_L and C_dyn at the time of peak effect were recorded. Under 1 or 2 MAC anaesthesia, sevoflurane as well as the other three anaesthetics had no bronchoactive effects. The four anaesthetics, including sevoflurane, demonstrated inhibitory effect on increases in R_L and decreases in C_dyn caused by histamine. At 1 MAC anaesthesia, % changes in R_L caused by 2, 4, or 8 μg · kg⁻¹ of histamine were 38 ± 11, 85 ± 21, or 132 ± 24% (mean ± SE) for halothane, and 65 ± 11, 132 ± 15, or 172 ± 19% for sevoflurane, respectively. Sevoflurane was less effective than halothane in preventing increases in R_L. In preventing decreases in C_dyn, sevoflurane was less effective than halothane only at 8 μg · kg⁻¹ of histamine under 1 and 2 MAC anaesthesia. There was no difference in attenuating effect on changes in R_L and C_dyn between sevoflurane and isoflurane or enflurane. We concluded that sevoflurane was less potent than halothane in attenuating changes in R_L and C_dyn in response to iv histamine. Cette étude a été réalisée dans le but d’évaluer les effets du sévoflurane sur la résistance et la compliance pulmonaires en réponse à l’histamine. Les effets du sévoflurane, de l’isoflurane, de l’enflurane et de l’halothane sur la bronchoconstriction induite par l’histamine sont comparés sur huit chiens. Avant l’administration d’histamine, on mesure les valeurs initiales de la résistance (R_L) et de la compliance dynamique (C_dyn) pulmonaires. L’histamine (2, 4, 8 μg · kg⁻¹) est administrée par la voie veineuse et les valeurs maximales de la R_L et de la C_dyn sont enregistrées. Les quatre anesthésiques, dont le sévoflurane inhibent l’augmentation de la R_L et la diminution de la C_dyn provoquées par l’histamine. A MAC 1 d’anesthésie, les pourcentages de changement de R_L produits par 2, 4, ou 8 μg · kg⁻¹ d’histamine sont respectivement de 38 ± 11, 85 ± 21, ou 132 ± 24% (moyenne + SD) pour l’halothane, et de 65 ± 11, 132 ± 15, ou 172 ± 19% pour le sévoflurane. Le sévoflurane est moins efficace que l’halothane pour prévenir les augmentations de R_L. Le sévoflurane est moins efficace pour prevenir la diminution de C_dyn mais seulement à 8 μg · kg⁻¹ d’histamine sous anesthésie à MAC 1 et 2. Le sévoflurane, l’halothane et l’isoflurane ne sont pas de différents pour amortir les changements de R_L et C_dyn. Nous concluons que le sévoflurane est moins puissant que l’halothane pour diminuer la réponse à l’histamine de la R_L et de la C_dyn.     

3D TOF turbo MR angiography for intracranial arteries: phantom and clinical studies

This work investigated whether turbo magnetic resonance angiography (MRA) can replace conventional MRA in screening examination of intracranial arteries. A phantom was used to evaluate the effect of the zero-filling interpolation (ZFI) technique on spatial resolution and partial volume effect. Thirty-one consecutive patients underwent both turbo MRA with a slice thickness of 0.7 mm (data were measured as 1.33 mm sections) and conventional MRA with 1.0 mm sections. In the phantom studies, ZFI did not improve the spatial resolution, but the partial volume effect was somewhat reduced. In the clinical evaluation, turbo MRA showed better signal-to-noise and contrast-to-noise ratios of the intracranial major vessels than conventional MRA. The lesions included cerebral aneurysms less than 3 mm in diameter, occlusive vascular disease, arteriovenous malformations, and arteriovenous fistulas. These were all depicted on both turbo MRA and conventional MRA. Turbo MRA is a useful screening procedure because of its capability of delineating lesions in approximately half the usual imaging time. J. Magn. Reson. Imaging 1999;10:939-944.     

Purification and Partial Characterization of an Indomethacin Hydrolyzing Enzyme from Pig Liver

Purpose. Indomethacin is well known to be metabolized via O-demethylation and N-deacylation. In this paper we found an enzyme involved in the hydrolysis of amide-linkage of indomethacin and partially characterized it as well as its substrate specificity. Methods. An indomethacin hydrolyzing enzyme was purified to homogeneity from pig liver microsomes using columns of Q-Sepharose, Red-Sepharose and Blue-Sepharose. The enzyme activity was assayed by measuring of -chlorobenzoic acid liberated from indomethacin by HPLC. Results. The purified enzyme effectively hydrolyzed the amide linkage in indomethacin but not those in -naphthylacetate and -nitrophenylacetate, which are typical substrates for carboxylesterase. The subunit molecular mass of the enzyme was 65 kDa according SDS-polyacrylamide gel electrophoresis. The Michaelis constant (Km) and maximum velocity (Vmax) values for indomethacin were 67.8 µM and 9.02 nmol/min/mg protein, respectively. The amino acid sequence analysis of the enzyme after cyanogen bromide cleavage showed high homology with a mouse carboxylesterase isozyme designated as ES-male. The activity of indomethacin hydrolysis was relatively high in the pig, rabbit and human liver homogenate, but not in those from rat and mouse. On the other hand, purified human liver carboxylesterases pl 5.3 and 4.5, and pig liver carboxylesterases have no catalytic activity for indomethacin. Conclusions. These results indicate that the hydrolysis of amide-linkage of indomethacin in humans would be associated with an enzyme similar to the indomethacin hydrolyzing enzyme from pig liver microsomes described here.     

Oxygen uptake and carbon dioxide elimination during epinephrine-induced arrhythmias in humans

Key words  cardiac arrhythmias - oxygen uptake - carbon dioxide elimination     

Comparative cardiovascular effects of SNP,ATP and phentolamine during norepinephrine-induced hypertension in dogs

There has been no study comparing the advantage and disadvantage of various antihypertensive agents during surgery for pheochromocytomas because the study is difficult in clinical setting. In the present experiments using dogs, after increasing the arterial blood pressure with norepinephrine, we decreased it to the baseline with sodium nitroprusside (SNP), adenosine triphosphate (ATP), or phentolamine (PE) and compared the hemodynamic changes. A hyperdynamic state was found with ATP and with PE, but not with SNP. The norepinephrine-induced pulmonary hypertension could be successfully treated with SNP, but not with ATP or PE. The reason for these differences are thought to be the different vasodilative properties on peripheral arteries and veins. We conclude that agents that dilates the arteries and veins should be used to regulate the arterial pressure during surgical removal of a pheochromocytoma.(Murata K, Takahashi H, Ikeda K: Comparative cardiovascular effects of SNP, ATP and phentolamine during norepinephrine-induced hypertension in dogs. J Anesth 5: 396–403, 1991)     

Lithium carbonate in prophylaxis of reappearing catatonic stupor: case report

The case of a patient with reappearing stupor, accompanied by auditory hallucinations and persecutory ideas during the periods and not with alternating excitement, is reported. After 24 years of neuroleptics medication with little effect, the lithium carbonate regimen was started, which showed a remarkable prophylactic effect. The implications of lithium carbonate treatment for recurrent psychosis are discussed.     

抗体夹心酶联免疫吸附法测定重组E.coli L-门冬酰胺酶研究

用重组E.coliL-门冬酰胺酶免疫家兔，DEAE-纤维素柱层析纯化IgG，采用二步戊二醛交联法将辣根过氧化物酶标记抗体，建立抗体夹心酶联免疫吸附法，测定大鼠血浆中重组E.coliL-门冬酰胺酶浓度。本测定方法的线性范围为1～64U/L，灵敏度为0.4U/L。建立的抗体夹心酶联免疫吸附法测定大鼠血浆中重组E.coliL-门冬酰胺酶具有良好的精密度、回收率、灵敏度和特异性。     

Radioresponse of Thymomas Verified with Histologic Response

Patterns of radiologic response of 10 thymomas treated by preoperative radiotherapy (RT) (18-20 Gy/2 weeks) were determined in conjunction with histologic response. Changes in tumor volume were evaluated with CT scans obtained 5 to 36 days before and 14 to 24 days after the initiation of RT and before surgery. The extent of tumor volume reduction (TR) varied widely (40-78%), while the mean daily volume decrement expressed as a percentage of the pre-RT tumor volume correlated significantly with the pre-RT tumor volume. Histologically, the tumors, all of which were resected 17 to 33 days after RT initiation, generally consisted of predominant fibrous tissues, rare necrotic foci, and few epithelial cells. The TR did not correlate with pre-RT tumor volume, observation period, histologic subtype, or quantity of remaining epithelial cells. The TR of thymomas does not predict RT impact on tumor cells but does reflect the quantity of inherent tumor stroma.