Sixty cases of midtrimester abortions with extraovular 0.1% ethacridine lactate alone were studied. Blood loss during and after abortion was calculated measuring alkaline haematin as reported by Shaw et al.7) Its success rate was compared with another study of 90 cases in which 0.1 % ethacridine lactate with spartein sulfate was used. Where ethacridine lactate alone was used 41.66% cases aborted in 24 hours and 83.3% in 48 hours with mean induction abortion interval of 27 hours 18 minutes. While in other group 44.4% aborted in 24 hours and 84.56% in 48 hours with mean induction abortion interval of 28 hours 30 minutes. Extraovular ethacridine lactate instillation was found to be a safe and efficient midtrimester abortifacient. Spartein sulfate has a minimal role in reducing the induction‐abortion interval.
hypertension (170/85 mm Hg), tachycardia (140 beats min 21), and rhinorrhoea. The sweating was so severe that the sheet under the patient was drenched, and his pupils were dilated mildly. His facial expression was agonized, despite being conscious and denying any pain or discomfort. The surgery finished shortly after this and remifentanil was stopped. Within 30 min, the patient had regained sufficient spontaneous ventilation and his vital signs had returned to normal (arterial pressure 122/75 mm Hg and heart rate 115 beats min 21), and he was transferred to the general ward. The butorphanol and midazolam administration were restarted and the withdrawal signs resolved without further treatment. At the postoperative visit the next day, the patient's appearance and vital signs were unremarkable. We diagnosed opioid withdrawal syndrome based on the modified Himmelbach's scale. 1 Withdrawal syndrome from midazolam was also considered. However, benzodiazepine withdrawal signs are characterized by hallucinations and restlessness and are quite different from what we observed in our patient; therefore, it was excluded from our diagnosis. Butorphanol is an opioid agonist-antagonist, which may cause withdrawal syndrome when given to patients in combination with high-efficacy opioids. 2 3 Its elimination half-life after bolus administration is 3-5 h. 4 However, the pharmacokinetics are different after longterm use, since this lipid soluble accumulates in tissue. Chronic administration has been reported to induce tolerance to its mu-agonist property and to antagonize other mu-agonists. 5 Our patient had daily administration for 2 weeks. No clinical signs or symptoms were observed before operation, thus we propose that was not due to stopping butorphanol but by its combination with remifentanil. Development of acute abstinence syndrome has been reported separately with the administration of either remifentanil or butorphanol. 2 6 However, in this case, the syndrome was precipitated by a combination of the two narcotics. Although the withdrawal symptoms precipitated by butorphanol were less potent compared with other mu-antagonists such as naloxone, 3 we should be aware that some combination of opioid agonist and antagonist may synergistically cause unexpected side-effects in patients.
In a multicentre trial, intramuscular 15(S)15 methyl PGF (Prostin 15M, Up-john) was tried at 2-hourly and 3-hourly intervals for induction of second trimester abortion. The time schedule was assigned randomly. Eighty-eight patients for 2-hourly schedule and 89 patients for 3-hourly schedule were recruited. Of 2-hourly 83% and of 3-hourly schedule 88.8% of the patients aborted with the treatment. The induction abortion interval was 15.9 hours in 2-hourly and 17.2 hours in 3-hourly schedule. The dose of Prostin 15M was 2.2 mg and 1.7 mg respectively. The incidence of incomplete abortion was 21.9% in 2-hourly and 27.8% in the 3-hourly. The incidence of vomiting was less in the 3-hourly schedule, however, there was no difference in the incidence of diarrhoea.
A multicentre trial was carried out to find out the safety and efficacy of 15(S)15 methyl PGF (Prostin 15M, Upjohn) for induction of menses in early pregnancy (up to 49 days). Two hundred and eighty-four cases were recruited for the study. All patients received two doses of 0.5 mg (2.0 ml) Prostin 15M by the intramuscular route and antiemetic and antidiarrhoeal medication prior to the administration of the prostaglandin analogue. The overall success rate (complete abortion) at two weeks evaluation visit was 87.7%. The success rate was 92% up to 42 days and 100% up to 35 days of the last menstrual period. The side effects were mainly gastrointestinal and majority of the patients had less than three episodes of vomiting or diarrhoea. The duration of bleeding was prolonged (up to 7 days) with Prostin 15M treatment. Intramuscular Prostin 15M seems to be effective in inducing menses in early pregnancy especially if the duration of amenorrhea is up to 35 days.
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