Search

MANY FAVORABLE reports on the use of Efocaine 1 as a long-acting local anesthetic drug have been published in the past two years. 2 Studies of histological changes following the injection of this drug in various animals have been reported previously by us. 3 These changes may be summarized as follows: necrosis of muscle followed by regeneration and connective tissue proliferation; nerve destruction of varying degrees of severity, the repair of which may be associated with neuroma formation. It is not unexpected, therefore, to see reports of complications associated with the use of this drug appear in the medical literature. Bonica 4 noted 6 cases of postinjection neuritis in 100 cases in which this drug was used. Eastwood and Bartlett 5 recently stated that they have discontinued the clinical use of Efocaine because of similar complications. Shapiro and Norman 6 reported three serious complications following the injection of this drug

With the introduction of the blood bank in this country in 1937,1the administrative responsibilities of blood replacement in patients have become centralized and organized. Placing the onus of adequate cross matching in the hands of a few has reduced the technical hazards of transfusion almost to an irreducible minimum. The value of transfusion therapy has been accorded increasing recognition through these years, being established without doubt by the experiences of World War II. Today it is recognized universally that no satisfactory substitute exists for blood when the need for it is indicated in a patient. Although the indications and necessity for blood transfusions are well established, hazards associated with its use are existent that may loom large enough in the minds of some physicians to cause hesitation in recommending it prophylactically or even at critical moments. The more common dangers or complications are (1) hemolytic transfusion reactions, (2)

THE INTRODUCTION of a new drug into the field of anesthesiology is frequently received either with marked enthusiasm or marked disapproval. Trichloroethylene is one such drug. In England and Canada, since the report of Hewer, in 1942,1trichloroethylene has had wide application for the production of analgesia and light-plane anesthesia, particularly in the obstetrical field. In the United States, its use was somewhat discouraged by the report of Waters, Orth, and Gillespie, in 1943,2in which adverse effects on cardiac rhythm were noted. Other controversial reports continued to appear in the literature. Hamilton3reported 26 deaths in 284 cases of industrial poisoning by trichloroethylene in German industry. However, Taylor4tested trichloroethylene in experimental animals and found no adverse toxicological effects. McAuley,5in 1943, reported three instances of postoperative bilateral trigeminal anesthesia in cases in which trichloroethylene had been used by the carbon-dioxide absorption technique. Later

It is especially necessary to guard against the development of hypercapnia and hypoxia in the patient during thoracic surgery because so many factors may combine to interfere with pulmonary ventilation. It is especially difficult to judge the depth of anesthesia and adequacy of gas exchange when spontaneous respiration is replaced by controlled respiration. The possible advantages of deliberate hyperventilation were explored in 128 patients undergoing thoracic surgery. In most of them ventilation was achieved by manual compression of the reservoir bag, but in about 20 patients mechanical respirators were used. Samples of arterial blood were obtained for determinations of pH, pCO 2 , and oxygen saturation. Four case histories are given showing the possibility of maintaining normal acidbase balance or producing an alkalosis in this way, and illustrating the inadequacy of spontaneous respiration in some cases. There was no evidence that the methods of artificial respiration used hindered the return of venous blood to the heart. Excessive depth of anesthesia was avoided by using concentrations and quantities of anesthetics such that it was virtually impossible for deep planes of anesthesia to be attained. No ill-effects attributable to alkalosis were seen even in patients maintained in that state for several hours. The results indicate that an extensive evaluation of the relative merits of respiratory acidosis and alkalosis is desirable.

Within the past 20 years emphasis has been placed on the importance of maintaining normal acid-base balance in the postoperative period; it has become recognized that an adequate "stir-up" regimen, 1 coupled with proper ventilation, assisted by mechanical ventilators if necessary, provides the key in this respect. Owing to recent technical developments, attention at present is being focused on the degree to which oxygenation is being maintained during and after surgery. Reports have indicated that hypoxemia, according to accepted values, may be present more often than believed. 2 Arterial blood gas values were determined in surgical patients preoperatively, during surgery, and in the immediate postoperative period. In this way, "control values" may be compared with those found during and after the altered conditions imposed by surgery and anesthesia. Methods In all patients, arterial blood samples were obtained from an indwelling needle in the radial, ulnar, or brachial artery. Samples were

The differential spinal examination has been used at Duke University Medical Center for approximately 15 years in the evaluation of low-back and lower extremity pain. This is a technique of using increasing concentrations of procaine hydrochloride to block nerves of various sizes and degrees of myelinization. With the ever increasing number of compensation and liability cases, there is a corresponding need for this type of diagnostic and prognostic test. It is an attempt to give the physician an objective estimate of the pain. It must be stressed that this is just another test for diagnostic and prognostic evaluation. However, initial results seem to indicate that much weight can be placed on the findings in an attempt to objectively categorize the pain as being either organic or functional and whether it is medicated by sensory or sympathetic pathways.