Inhalation of nebulized minute lidocaine droplets has been suggested to be a very safe and pleasant method to produce topical anaesthesia for bronchoscopy. We produced topical anaesthesia of the respiratory tract either by laryngotracheal spraying (LS) of lidocaine (439 +/- 85mg) or ultrasonic nebulizer administration (UNA) of lidocaine (462 +/- 81 mg) in 40 patients undergoing bronchoscopy. All patients also received an average of 15 mg of diazepam intravenously. Both modes of lidocaine administration produced adequate anaesthesia and were safe, but when rated on the visual analogue scale, both the efficacy of local anaesthesia and the cooperation of patients during bronchoscopy were better (P less than 0.05) after LS than those after UNA. The peak plasma concentrations of lidocaine (means +/- s.d.) were lower and occurred earlier after UNA (0.53 +/- 0.34 micrograms/ml at 5-15 min after administration) than those after LS (0.89 +/- 0.63 micrograms/ml at 15-25 min after spraying). The highest individual values measured (2.54 micrograms/ml after LS and 1.17 micrograms/ml after UNA) were much less than those reported toxic lidocaine plasma concentrations. It is concluded that bronchoscopy can be conducted under local anaesthesia as successfully and safely using inhalation of lidocaine droplets from an ultrasonic nebulizer as when using laryngotracheal spraying of lidocaine.
The blood levels of monomeric methylmethacrylate were measured in 20 patients with fracture of the femoral neck, treated with a Thompson prosthesis under spinal anesthesia. Monomeric methylmethacrylate was detected in the blood stream in all patients; the maximum levels (mean 6.44 micrograms/ml, range 0.05-31.89 micrograms/ml) were measured 30 s after insertion of the Thompson prosthesis. A moderate drop in systolic blood pressure and a marked reduction of arterial oxygen tension was noted after cementation and insertion of the prosthesis; the mean maximum drops were 10.1 mm Hg (range 0-32 mm Hg) and 6.1 mm Hg (range 0-13.5 mm Hg) No dose-dependent correlation could be established between the levels of monomeric methylmethacrylate and the drop in arterial blood pressure or arterial oxygen tension.
View related articles Citing articles: 28 View citing articles I'ro1n the Cliiiir for 0rtllop:irtlics and l'raiimattrlogg, llrncl : Profcssor I<. 15. I(allio, and the Chilclrrii's Clinic, Hrad : IBrofrssor Niilo Hallmaii, of tlic lliiivrrsity Crntral Hospital, Hclsiiilti.
The effects of cementation on arterial blood pressure, arterial oxygen tension and plasma levels of cortisol were studied in 30 patients with femoral neck fracture treated with the Thompson prosthesis in spinal (n = 15) or general (n = 15) anaesthesia. In spinal anaesthesia hypotension of clinical importance was observed coincidentally with the use of methylmethacrylate, while the levels of plasma cortisol remained unchanged. A significant rise was noted in arterial blood pressure and plasma levels of cortisol after cementation in general anaesthesia. Arterial oxygen tension fell in both groups. These findings indicate that the hypotension frequently reported in connection with cementation is triggered by a complex mechanism which can be modified by the anaesthetic technique.
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