The anti-cardiolipin antibody syndrome (or anti-phospholipid antibody syndrome) is characterized by the presence of autoantibodies to phospholipids. Its major association is with systemic lupus erythematosus. It is characterized further by in vitro prolongation of phospholipid-dependent coagulation tests. However, in vivo it is associated with a markedly increased incidence of thrombosis, both arterial and venous. We describe the case of a 36-yr-old female patient with the anti-cardiolipin antibody syndrome who presented initially for diagnostic laparoscopy and later for exploratory laparotomy. Her postoperative course after the first general anaesthetic was complicated by disseminated intravascular coagulation and adult respiratory distress syndrome. After the second operation, she deteriorated further with worsening cardiac, renal and respiratory function and eventually died. As far as we are aware, this is the first reported case of the anti-cardiolipin antibody syndrome in anaesthetic literature. Further aspects of this puzzling condition and its anaesthetic implications are discussed.
A cumulative dose response curve for loss of consciousness was obtained using 48 unselected premedicated patients presenting for elective surgery. Dosage was administered on the basis of lean tissue mass (LTM) using a simple nomogram. The end point for loss of consciousness was the failure of the patient to grasp a light object. Using probit analysis an ED50 for thiopentone in premedicated patients was found to be 2.63 mg/kg LTM. The sequential up-and-down technique was then used to determine ED50 values for thiopentone (2.70 mg/kg LTM), methohexitone (1.1 mg/kg LTM), propanidid (3.66 mg/kg LTM) and Alfathesin (0.014 ml/kg LTM). The experimental methods and, in particular, the administration of doses to patients on the basis of LTM, would appear to be responsible for a high level of predictability of response in an apparently heterogeneous patient population. The ED50 values compared favourably with clinically recommended doses for induction of anaesthesia, except the ED50 for Alfathesin which was approximately one quarter of that recommended. An appendix provides some of the mathematical background of the up-and-down sequential technique together with a table of maximum likelihood solutions for different sequences and an example of the calculation of an ED50 and its confidence limits
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