IN A PREVIOUS STUDY it was found that buprenorphine hydrochloride is a potent analgesic and that severe post-operative pain is relieved appreciably for at least six hours by 0.4 mg or less. 1 This confirmed impressions gained from studies on animals and man currently in progress abroad. 2'3The purpose of this study was to compare the analgesic activity of buprenorphine hydrochloride 0.2 mg and 0.4 mg against each other and also against the usual standard, morphine sulphate 5 mg and 10 mg, each of which was given as a single intramuscular injection following selected major surgical procedures associated with severe post-operative pain. METHODA double-blind randomly assigned comparison was done of four groups of 40 patients, each of whom gave written informed consent agreeing to participate in the evaluation by accepting one intramuscular dose of either buprenorphine (0.2 or 0.4 mg) or morphine (5 or 10 mg) from identical serially numbered vials, if moderate to severe pain occurred in the recovery room after awakening from anaesthesia following abdominal surgery. A patient was admitted to this comparative study provided pre-operative laboratory studies were within normal limits, the investigator agreed that the patient was having severe pain post-operatively and the patient requested medication for the pain. Exclusions were specified to eliminate women of childbearing age, patients undergoing narcotic maintenance treatment or who had a history of tolerance or addiction to analgesic drugs, neurosurgery, cardiac surgery and any patient who had severe disease of vital organs, endocrine disease or haematologic disease. Those who had limited mental competence or difficulty in answering questions at the initial interview were also excluded. Patients excluded from the study received medication for pain according to standard procedures in the recovery room.No other analgesic medication was given to a patient once medicated in the test, unless severe pain was not relieved or unless severe pain recurred within two hours.Pain intensity was scored as 0 = none; 1 = mild; 2 = moderate; 3 = severe; and 4 = very severe. Pain relief was scored as 0 = no relief; 1 = slight relief; 2 = moderate relief; 3 = good relief; and 4 = complete relief. 4-r Scoring was done routinely at 30 minutes and then hourly for six hours. If no additional medication was required, the patient was kept under direct surveillance for 12 hours. Patients From:
Cognizant of the confusion existing inl this basic physiologic measurement, we undertook the following investigation to compile data seeking to define the relative accuracy of the three indirect methods over a wide blood pressure range, and to identify some of the factors contributing to the current enigma. METHODSIndirect Measurement of Blood Pressure. Two to four trained observers participated sequentially in determining auscultatory systolic and diastolic levels, and oscillometric and palpatory systolic levels, on each patient, using a mercury manometer. Care was taken to insure that these observers did not see the intra-arterial pressure recordings. Another assistant entered each observer's indirect blood pressure findings on the tracings at the appropriate points.In the dletermination of auscultatory systolic and diastolic pressure, the standards recommended by Bordlev and his co-workers8 were followed. Oscillometric systolic pressure was recorded as the point on the manometer scale at which the meniscus of the pulsating mercury column became convex. Palpatory systolic pressures were determined by the perception of a pulse in the radial artery. I)iastolic
PANCURONIUM BROMIDE IS AN amino steroid muscle relaxant (Figure 1) which was synthesized in 1964 by Hewett and Savage and has been studied and evaluated clinically in Europe during the past four years2 -5 It is an odourless, white, crystalline powder with a bitter astringent taste, melts at 215~ with decomposition, and is soluble in 50 parts of chloroform and one part water at 20~ The co]ourless solution is stable while sealed, but breaks down in a few hours after exposure to air. In Europe it is available in 2-ml ampoules containing 4 mg pancuronium bromide, 18 nag sodium chloride B.P. and water for injection B.P. to 2 mls. The preparation which was used in this study contains preservatives (acetic acid and sodium acetate) to buffer the solution to pH 4.0. Pharmacological studies have shown that it has no hormonal action but is a potent non-depolarizing skeletal muscle relaxant like'tubocurarine and gallamine. It has a more rapid onset of action than tubocurarine with a similar duration of action. It has a somewhat longer action than gallamine. It has no significant effect on the blood pressure or the tracheobronchial tree due to the very. slight ganglionblocking action and the claim is that no histamine is released, a It does not affect OOC. CH
Vision is as necessary an element in scientific achievement as is the carefully controlled experiment.-Ernest Gellhorn, 1953 SOME OF TIIE NEUROENDOCRINE SUBSTANCES that play a prominent role in the central nervous system are found in the peripheral circulation. Their exact functions are not entirely clear, but it appears evident that alterations in their concentration in the circulating blood are associated with profound overt mental and physical changes, TM as well as possibly initiating sudden serious disturbances of pulmonary ventilation, myocardial contractility, microcireulatory homeostasis, gastrointestinal and renal function, and carbohydrate metabolism. ~-9 These in turn may lead to the development of a shock-like state and death. The purpose of this study was to make a precise systematic inquh T into the effects of general anaesthetics as administered in clinical practice on the circulating blood level of four biogenic amines and to attempt to interrelate these with any changes that might appear in the mean arterial blood pressure, urine output , haematocrit, blood water, blood sugar, serum potassium, serum inorganic phosphorus, pyruvate, lactate, oxygen tension, acid-base balance, and serum transaminases (SGOT and SGPT). MATERIALS ANn METHODS Serial crossover tests were carried out in four consecutive sets of experiments in 10 to 15 trained, large (20 to 30 kg.) male dogs. Each animal received a general anaesthetic at one-to two-week intervals without prior administration of premedicant drugs or antisialogogues. After an overnight fast, a dog was weighed, then an intravenous infusion of 0.9 per cent saline was started in a forepaw vein after drawing a blood sample for estimation of blood sugar, serum potassium, serum inorganic phosphorus, SCOT, SGPT, whole blood histamine, and serotonin and plasma catecholamines (epinephrine and norepinephrine). Anaesthesia was then induced with 20 mg./kg, thiopenta] (2.S$ solution), and the dog was intubated with a large cuffed tube that was attached to a gas machine which delivered NsO ~ O~ (except with cyclopropane, when N20 was not used). A gas flow was used sufllcient to provide a minute ventilation of 350 to 400 ml./kg.
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