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Intravenous doses of 30, 20 and 10 mg nicomorphine (Vilan) are extremely quickly metabolized into the metabolites 6-nicotinoylmorphine and morphine. The half-lives of elimination are respectively 3 min for nicomorphine, 3 and 15 min for 6-nicotinoylmorphine, and 135-190 min for morphine. The kinetics of the 30 and 20 mg dose are comparable, the 10 mg dose shows patient dependent variations in metabolism. The AUC of the parent drug and its metabolites is linearly related to the dose.

Intrathecal (i.t.) injection of somatostatin has been reported to depress nociceptive reflexes as well as to cause severe disturbance of somatomotor performance. The present study was designed to assess the dependence of these effects on the dose and the interval between implantation of the catheter and i.t. injection of somatostatin in rats. The effects produced by i.t. injection of somatostatin consisted of an increase in the response latencies of nociceptive responses to noxious heat, impairment of motor performance and grooming behavior, convulsions, and death. Except for grooming behavior, these were related in incidence and degree to the dose and the interval, the potency of somatostatin being highest at short intervals. Sham operations also affected the effectiveness of somatostatin.

During induction of anesthesia and intubation dangerously low heart rates sometimes occur. In this study the short term influence of various commonly used anesthetics on heart rate was investigated, before, during and immediately after intubation. Various combinations of the drugs Fentanyl, nicomorphine, etomidate, thiopentone, succinyldicholine and vecuronium were studied in patients of ASA class I and II. The drugs nicomorphine, thiopentone and vecuronium did induce only minimal and short term heart rate changes. They are therefore safer in this respect and should probably be preferred for anesthesia induction of patients with known small cardiovascular safety margin.

To the best of our knowledge no recent literature on pregnancy in patients with primary pulmonary hypertension is available. In this case report a patient is presented who possibly suffered from primary pulmonary hypertension. The clinical course is described and some data from the literature are presented. The patient died post partum probably due to this disease; however, the postmortem examination, which undoubtedly could have proven this, was refused.

The clinical effects of epidural anesthesia with bupivacaine 0.75% for elective caesarean section were investigated in 20 healthy pregnant women. The mean total dose of bupivacaine which offers sufficient sensory and motor block, provided the epidural catheter is properly placed, was 137.5 mg. Maternal hypotension occurred in 4 patients in spite of prehydratation and left uterine displacement. No maternal systemic toxicity or local neurotoxicity was found. The results of the Apgar scoring and the neonatal acid-base studies showed that there is no clinically important neonatal depression with this technique.

Eight physiological variables--tidal volume, breathing rate, end-tidal carbon dioxide fraction, oxygen fraction in the anesthetic circuit, oxygen saturation by pulse oximetry, systolic and diastolic blood pressure, and heart rate--recorded on-line by a commercially available automated system were compared with the same variables recorded on handwritten anesthesia records. We quantified the differences between the automated and handwritten records generated from the same 30 patients (2,412 minutes of general anesthesia for elective eye surgical procedures). Considering the design of the study, we claim that the differences between both records were caused by the incompleteness or inaccuracy of the handwritten records, except in two instances. The amounts of missing or erroneous data for these eight physiological variables were expressed as fraction ("error fractions") of the time being recorded, designated EFm and EFe, respectively. For the first five variables the EFm on the handwritten records ranged between 0.23 and 0.31, and the EFe ranged between 0.01 and 0.06. For the last three variables the EFm range was 0.08 to 0.13, and the EFe range was 0.05 to 0.11. Most of these missing or erroneous data occurred during the period of induction (first 15 minutes) and at the end of the case (last 10 minutes). The EFm and EFe during induction had increased to 0.62 and 0.26, respectively, and to 0.76 and 0.06, respectively, at the end of the case. Erroneous data were observed on the automated records for the tidal volume during induction (EFe = 0.0044) and for the oxygen fraction during maintenance (EFe = 0.0024). The effect of averaging by the recordkeeper is discussed. The results of this study indicate the clinical relevance of automated record keeping.

Rats chronically implanted with intrathecal catheters displayed a dose-dependent increase in the hot-place and tail-flick response latencies following the injection of morphine or nicomorphine into the subarachnoid space through the indwelling catheter. Naloxone inhibited the antinociceptive effect of both opiate drugs, but the inhibition of nicomorphine-induced antinociception was incomplete. To evaluate the importance of cholinergic mechanisms in opiate effectiveness, the interactions with atropine or physostigmine were evaluated. Atropine reduced the effects of morphine and abolished the effects of nicomorphine at the doses used. Physostigmine markedly potentiated morphine effectiveness, but had a negligible effect on nicomorphine effectiveness. It is proposed that these differences relate to a specific cholinergic mechanism involved in antinociception after intrathecal nicomorphine. The data indicate that at a spinal level cholinergic mechanisms are relevant to opiate effectiveness.