Five healthy subjects were each given fluoride 3.0 mg (F) as sodium fluoride tablets on two occasions - during production of acid urine, induced by giving NH4Cl, and during production of alkaline urine obtained by giving NaHCO3. Frequent plasma and urine samples were taken up to 12 h and were analyzed with a F- sensitive electrode. Control experiments without F administrations were also performed to permit calculation of net F concentration in plasma and urine. The urine F excretion was lower during acid than alkaline diuresis. Pharmacokinetic analysis of the net plasma F concentrations showed that the apparent plasma half-life of F was longer when urine was acid (4.3 +/- 0.6h: SD; n = 5) than when it was alkaline (2.4 +/- 0.4h). This could be explained by changes in the renal clearance of F, which was always lower with an acid (61.5 +/- 8.1 ml/min) than an alkaline (97.8 +/- 10.4 ml/min) urine. The apparent extra-renal clearance, which mainly represents clearance to the bone-pool, was also significantly higher during production of alkaline (109.2 +/- 20.2 ml/min) than of acid (86.3 +/- 21.3 ml/min) urine. It is suggested, that increased reabsorption of non-ionic hydrogen fluoride (HF) is responsible for the decreased renal clearance during acidic conditions.

The haemodynamic and renal effects of ephedrine were studied in 11 mechanically ventilated patients on the first day after major vascular surgery. Ephedrine, a sympathomimetic agent with alpha-1, beta-1, and beta-2 agonistic activity, was infused into 11 patients to achieve a 20% rise in systolic blood pressure. The doses used were 2-6 micrograms/kg/min, and in six of these 11 patients the dose was then doubled, 4-12 micrograms/kg/min for another renal function test. Blood pressure, heart rate, and cardiac output increased at both dose-ranges. Systolic pulmonary arterial pressure increased by 10% at the first dose-range. Systemic vascular resistance was unchanged and plasma catecholamine levels were unaltered in the present study. Plasma renin activity diminished by 18% and 6%, respectively. Clearance of para-aminohippuric acid increased by 20% and 6%, at the two dose-ranges, while clearance of inulin and urine flow rate increased by 24% and 29%, respectively, at the first dose-range, without further increase during the second dose-range. Fractional chloride excretion, and fractional osmolar clearance were unaltered. Fractional Na+ clearance rose by 30% and 36%, respectively. Fractional free water clearance diminished by 8% at the second dose-range. When comparing the two dose-ranges, HR, systolic and mean BP rose by 8%, 13% and 11%, respectively. Fractional K+ excretion diminished by 30%. We conclude that ephedrine given as a continuous infusion seems to have beneficial effects on renal function in patients after elective major vascular surgery.

Surgical trauma induces a hormonal metabolic response which is partly responsible for postoperative catabolism. In this study 12 patients underwent cholecystectomy during isoflurane anaesthesia, six with a paravertebral block (PVB) in addition. Plasma concentrations of glucose, cortisol and adrenaline, and heart rate and arterial pressure were compared between the two groups. The patients with PVB showed a significantly diminished response to noxious stimuli.

The cardiovascular and neuroendocrine effects of a high-dose fentanyl anaesthesia (100 micrograms/kg body weight) were compared with those of a balanced type of fentanyl anaesthesia (5 micrograms kg-1) during upper abdominal surgery. High-dose fentanyl anaesthesia prevented the increase in catecholamine concentrations and attenuated the circulatory response to surgical stress seen in the group anaesthetized with the balanced technique of anaesthesia.

We have compared two groups of patients given low- or high-dose fentanyl anaesthesia. Arterial blood samples were collected for measurement of glucose, free fatty acids (FFA), glycerol, beta-hydroxy-butyrate, insulin, c-peptide, glucagon, human growth hormone (HGH), cortisol and adrenaline concentrations. After induction of anaesthesia, blood concentrations of most of these substances decreased. After the start of surgery the concentrations of cortisol, glucose, HGH, FFA and beta-hydroxy-butyrate increased significantly in the group anaesthetized with the lower dose of fentanyl. In the group that received high-dose fentanyl anaesthesia the plasma concentrations of almost all the hormones and substances measured remained relatively low. The differences between the two groups during surgery were significant for adrenaline (P less than 0.001) and cortisol (P less than 0.001). High-dose fentanyl appears to block the trauma-induced stress response seen in patients anaesthetized with low dose fentanyl.