Plasma cortisol and glucose concentrations were measured repeatedly from before the induction of anaesthesia until 9 h after skin incision in 36 patients undergoing abdominal hysterectomy. Twelve patients received general anaesthesia (halothane), and systemic opiates for postoperative pain; a further 12 patients underwent continuous extradural analgesia with a local anaesthetic agent (bupivacaine) and in the remaining 12 patients general anaesthesia (halothane) plus extradural morphine (4mg before skin incision and an additional 4mg at skin closure) were used. Patients receiving extradural morphine or bupivacaine were free of pain. The physiological cortisol and glucose response to surgery was blocked by the extradural analgesia with bupivacaine. Extradural morphine did not modify the initial increase in plasma cortisol and glucose concentrations during surgery, but suppressed the hyperglycaemic and cortisol response following surgery when compared with the general anaesthesia group receiving systemic opiates. However, cortisol and glucose concentrations were greater after operation in patients receiving extradural morphine compared with extradural bupivacaine, suggesting that the endocrine metabolic response to surgery is predominantly released by neurogenic stimuli other than pain stimuli involving opiate receptor-dependent nociceptive pathways.

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No association was found between the CYP2D6 oxidation polymorphism and lung cancer risk when sample size bias was taken into account.

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The present study is a theoretical and experimental evaluation of a modification of the carbon monoxide method for estimation of the circulating blood volume (CBV) with respect to the precision of the method. The CBV was determined from measurements of the CO-saturation of hemoglobin before and after ventilation with a gas mixture containing 20-50 ml of CO for a period of 10-15 min. A special Water's to and fro system was designed in order to avoid any leakage when measuring during intermittent positive pressure ventilation (IPPV). Blood samples were taken before and immediately after ventilation with the CO gas mixture. The amount of CO administered during each determination of CBV resulted in an increase in the CO saturation of hemoglobin of 2.1%-3.9%. A theoretical noise propagation analysis was performed by means of the Monte Carlo method. The analysis showed that a CO dose corresponding to an increase of less than 2% will result in an unacceptable coefficient of variation of repeated estimates. In the experimental study the coefficient of variation of repeated estimates of CBV was determined from duplicate measurements of CBV in nine healthy subjects and in nine intensive care patients. The coefficients of variation were 6.2% and 4.7% in healthy and diseased subjects, respectively. Furthermore, the day-to-day variation of the method with respect to the total amount of circulating hemoglobin (nHb) and CBV was determined from duplicate estimates separated by 24-48 h. In conclusion, determination of CBV can be performed with an amount of CO that gives rise to a harmless increase in the carboxyhemoglobin concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

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During a 12-month period, infraclavicular subclavian catheterization, using a Seldinger technique, was attempted on 77 occasions in 54 children with a median age of 2 years (range newborn to 10 years). General anaesthesia was used in the majority of cases, and catheterization was successful in 74 cases (96%). The initial catheter tip position was satisfactory in 81% of the cases, and catheters remained in situ for a median period of 7 days (range 1-28 days). There were few complications. Providing extensive experience in subclavian venous cannulation is gained in the adult, there is in our experience no minimal age or size which should limit the use of a subclavian vein catheter.