Evaluation of the efficacy of transcricoid lignocaine as adjunctive local anaesthesia for fiberoptic bronchoscopy.

INTRODUCTION: Optimisation of patient comfort during flexible bronchoscopy is achieved with the use of intravenous sedation and vocal anaesthesia. METHODS: The effect of transcricoid lignocaine injection was investigated with regards to ease of procedure and frequency of cough. A single-blinded study was carried out and two visual analogue scales were used as markers of efficacy. Treatment groups were matched for age, gender and total dose of lignocaine administered. RESULTS: The results highlighted a significant improvement in the perceived ease of procedure (p < 0.0001) and frequency of coughing during the procedure (p < 0.0001). CONCLUSION: The findings of the study demonstrate that the use of transcricoid injection of lignocaine provided a safe adjunct for anaesthesia in flexible bronchoscopy.

Pharmacokinetics and antipsychotic effect of remoxipride in chronic schizophrenic patients.

Single dose pharmacokinetics and the antipsychotic effect of 4 weeks treatment with three fixed dose levels of remoxipride (a selective D(2) receptor antagonist) were studied in chronic, stable schizophrenic inpatients. After a placebo washout of 1 month, 15 patients entered the study. Of these, 11 patients received a single 50 mg oral dose of remoxipride for pharmacokinetic evaluations. All 15 patients were randomly assigned to treatment with oral remoxipride either 25 mg t.i.d., 50 mg t.i.d. or 100 mg t.i.d. for 4 weeks. Blood samples for remoxipride and prolactin assays were taken at 0, 0.33, 0.5, 0.66, 1.0, 1.5, 2, 3, 4, 8, 12, 24, 28, 32 and 48 h after drug intake. The pharmacokinetic characteristics were similar to those previously found in normal healthy volunteers: the mean peak plasma concentration of remoxipride after 50 mg was 3.3 µmol/l, the mean time to reach this was 2.1 h; the mean area under the plasma concentration/time curve was 27.8 µmol/1.h.1( -1) and the mean elimination half-life of remoxipride was 5.5 h. A significant increase in prolactin levels was detected 2 h after administration of remoxipride but they had reverted to normal 8 h after drug intake in all but one patient. Antipsychotic effects were estimated using the brief psychiatric rating scale (BPRS) and the Krawiecka rating scale (KRS) at admission, baseline (end of the 4 week placebo washout period) and after 7, 14 and 28 days treatment. Following an increase in mean psychosis ratings for both positive and negative symptoms during the placebo washout period, these decreased during active treatment and at the end of the study were similar to the scores on admission. Thus the possible efficacy of remoxipride in chronic patients with negative symptoms should be further explored in placebo controlled studies. Remoxipride was well tolerated. Sleep disorders occurred in three patients, extrapyramidal symptoms were not aggravated and no clinically significant effects were observed on the cardiovascular system, in clinical chemistry or haematology.

A double-blind placebo controlled trial of a selective beta 2 adrenoceptor antagonist (ICI 118551) in chronic anxiety.

ICI 118551, a selective beta 2 adrenoceptor antagonist, was compared with placebo and propranolol in a double-blind cross-over trial in 11 chronically anxious patients, 8 of whom were continued on benzodiazepines. Each treatment was given for 1 week and there was a significant improvement in anxiety ratings (p less than 0.01) at the end of the 3-week trial. However there was no significant difference between the 3 treatments and no preference by either patients or doctor for any one treatment could be detected. Thus, under the conditions of this study, no beneficial effects of either selective or non-selective beta-blockade on chronic anxiety could be detected. Some previous studies with beta-blockers may have confused an effect on anxiety with an effect on benzodiazepine withdrawal.

Rapid normalization of the dexamethasone suppression test with mianserin.

Dexamethasone suppression tests (DSTs) were carried out in 6 depressed patients and 2 with schizophrenia before and 48 to 72 hours after starting treatment. All 8 were non-suppressors before treatment but the 5 patients treated with mianserin and 1 treated with chlorpromazine had normal suppression with the repeat DST, unrelated to clinical change. Non-suppression persisted in the 2 patients treated with ECT or haloperidol. Mianserin and chlorpromazine could, therefore, be associated with false negative DST results. Possible mechanisms for this are discussed.

Clinical pharmacology of sibutramine hydrochloride (BTS 54524), a new antidepressant, in healthy volunteers.

The cardiovascular, anticholinergic and central effects of single doses of 30, 45 and 60 mg of sibutramine hydrochloride (BTS 54524), a new potential antidepressant, were compared with amitriptyline (50 mg) and placebo given at weekly intervals in a randomised design to six healthy male volunteers. Sibutramine was associated with increases in both supine heart rate and systolic blood pressure at 1, 2 and 6 h after 60 mg (P less than 0.05). Amitriptyline caused a significant 50-60% decrease in salivation compared with placebo at 2 and 6 h but there were no changes with sibutramine. No significant changes in pupil size were detected with either drug. Visual analogue rating scales (VARS) revealed significant drowsiness with amitriptyline but neither sedative nor stimulant effects with sibutramine. Impairments of simple auditory and visual reaction times, visual two-choice reaction time, finger tapping and trail making, measured using an automated test battery, occurred with amitriptyline compared with sibutramine. If sibutramine proves to be an effective antidepressant it should be devoid of anticholinergic or central depressant effects. Chronic dosage studies are indicated to evaluate the clinical significance of its cardiovascular effects.