Endobronchial inflammatory polyp associated with a foreign body. Successful treatment with corticosteroids.

We describe a case of endobronchial polyp associated with a foreign body. To our knowledge, this is the first report of such an occurrence. The polyp was successfully treated with steroids. This is only the third report of steroid treatment of endobronchial polyps.

Absorption of bupivacaine after topical application to the oropharynx.

Bupivacaine in dosages of 20, 40, 60, or 80 mg was applied by spray to the oropharynx of 24 volunteers. Blood levels of bupivacaine were detectable at 10 minutes, peaked at 60-90 minutes, and were still measurable at 150 minutes after administration. The maximum bupivacaine plasma level recorded in any volunteer was 0.96 -g/mL (after 80 mg). Increase in pulse rate and decrease in systolic blood pressure were significantly correlated with increasing bupivacaine dosage. No clinical signs or symptoms of drug toxicity were observed in any subject.

Respiratory diseases in iron ore miners and millers.

Workers in iron mines are at risk of developing interstitial lung disease if the dust levels are above the threshold limit value. However, they more commonly develop the usual diseases that affect all workers. Some illnesses, such as chronic bronchitis, bronchial asthma, and the collagen vascular diseases that affect the lung, may be more severe because of the inhalation of dust. The most difficult problem is to differentiate asymptomatic sarcoidosis from pneumoconiosis. The family doctor who also acts as the company doctor must be aware of the potential conflict of interest.

Thoracic epidural analgesia -- a double blind study between etidocaine and bupivacaine.

In a double-blind study on 40 patients for elective upper abdominal surgery, measurements was made of onset time, duration and segmental spread of analgesia, systolic blood pressure, heart rate and peak expiratory flow during thoracic epidural analgesia with etidocaine 1% and bupivacaine 0.5%, both containing adrenaline 5 mug/ml. No major differences were found between the two agents. The results differ in many aspects from those obtained with these agents in lumbar epidural analgesia.

Thoracic epidural analgesia I-a double-blind study between bupivacaine and etidocaine.

A double-blind comparison was made in 40 patients undergoing thoracic epidural analgesia with either bupivacaine 0.5% or etidocaine 1.0%, both with adrenaline 5 mug/ml. All patients were undergoing elective upper abdominal surgery. They were studied both pre- and postoperatively. The parameters measured were: onset time, segmental spread and duration of analgesia; and also systolic blood pressure, heart rate and peak expiratory flow rate. In respect of these parameters, no major differences were found between the two solutions under the conditions of the study. The overall results, however, differ in many respects to those found when these agents are used in lumbar epidural analgesia.

Etidocaine in intercostal nerve block for pain relief after thoracotomy; a comparison with bupivacaine.

For pain relief after thoracotomy, intercostal nerve block with etidocaine 1% and bupivacaine 0.5%, both containing adrenaline 5 mug/ml, was used. Duration of skin analgesia for sharp pain was around 11 hours for both solutions. Post-operative pain was noted 6 and 5 hours after injection for etidocaine and bupivacaine respectively. No pathological changes in acid-base balance or ventilation were observed. Peak expiratory flow decreased to 35-40% of the pre-operative values and remained at this level for about 12 hours. Arterial and venous blood levels of the local anaesthetics were low and no signs of toxicity were noted. All patients experienced a certain pain relief from the blocks. Because of shoulder pain in some patients intercostal nerve block alone does not seem to be a perfect post-operative method for pain relief after thoracotomies.

"Labrador lung": an unusual mixed dust pneumoconiosis.

Forty-eight workers involved for various periods from 1962 in mining and milling iron-containing rock in the Carol Lake area of western Labrador were found in late 1974 and early 1975 to have pneumoconiosis. Their annual chest roentgenograms demonstrated irregular nodular densities, and several revealed mild hilar lymphadenopathy or pleural thickening. All 48 workers were asymptomatic and had normal pulmonary function; their average age was 38 years. At work they had been exposed to high levels of dust containing iron, silica and anthophyllite, a type of asbestos. Lung biopsy specimens from 13 of them showed widespread focal fibrosis, large amounts of hemosiderin and silica and many ferruginous bodies; one ferruginous body was identified as having a core of anthophyllite. A granulomatous reaction was seen in two biopsy specimens and typical silicotic nodules were found in two others. The relatively brief exposure, especially in ones case (11 months), and the short latent interval before the development of the pneumoconiosis are reasons for concern for the health of iron ore workers.

[Effect of glucose concentration on spinal anesthesia with bupivacaine 0.5%]. / Effekt der Glukosekonzentration auf Spinalanaesthesien mit Bupivacain 0.5%.

Until recently isobaric agents were relatively seldom employed to produce spinal anaesthesia. Experience with bupivacaine has shown in a prospective study on 60 patients, that complications, especially with high or total spinals, are uncommon with either using hyper- or isobaric agents. Also it has been shown that the height of blockade after using hyperbaric agents can only be crudely controlled by positioning of the patient. 3 ml (15 mg) of 0.5% bupivacaine produces adequate analgesia, and muscle relaxation, rapidly, in the vast majority of patients. The duration of blockade was adequate for longer surgical procedures, and was not affected by varying glucose concentrations in the solutions employed. Also there was no difference in the number of dermatomes blocked. No significant differences could be found between the solutions containing 5 or 8% glucose; however, with the 8% concentration smaller variations were found in regard to the extent of dermatomal blockade. The degree of motor block was identical in all 3 groups. The duration of motor block decreased when using higher concentrations of glucose. It is not clear whether the differing glucose concentrations have an effect on C.S.F. osmolarity, and whether this is clinically relevant. The results show that isobaric spinal anaesthesia is at least as reliable as hyperbaric spinal anaesthesia.

Effect of baricity on spinal anaesthesia with bupivacaine.

In a double-blind study of spinal anaesthesia with 0.5% bupivacaine 3 ml with no glucose, 5% glucose or 8% glucose all three solutions gave consistently good nerve blocks. The hyperbaric solutions (5% and 8% glucose) produced a greater cephalad spread and were suitable for lower abdominal surgery, whereas the plain solution (no glucose) seldom affected the thoracic nerves. Cardiovascular changes were more marked with the hyperbaric solutions but only necessitated treatment on two occasions. The duration of block was not affected by baricity and was in the range 140-160 min.

Effect of the trendelenberg position on spinal anaesthesia with hyperbaric bupivacaine.

In a double-blind study, the effect of the Trendelenberg position was compared with the supine, in 20 patients following intrathecal injection of 3 ml of 0.5% bupivacaine in 8% glucose. All patients had blocks suitable for abdominal surgery. Although the mean spread was greater in those patients titled head-down, this was not statistically significant. The variation of the spread around the mean was greater in the head-down group, and blocks extended into the cervical region in two patients. There were no differences in motor block, duration or cardiovascular changes between the groups. It is concluded that the trendelenberg position is not necessary to ensure spread of local anaesthetic solution into the mid thoracic region for abdominal surgery.

Comparison of 0.75% ropivacaine with epinephrine and 0.75% bupivacaine with epinephrine in lumbar epidural anesthesia.

Forty-three ASA physical status I and II patients, scheduled for elective urologic surgery, were randomly entered into a randomized double-blind study using 20 ml bupivacaine 0.75% or 20 ml ropivacaine 0.75%, both with 5 micrograms/ml epinephrine. Two patients were excluded from evaluation of efficacy due to technical failure. After a test dose of 3 ml bupivacaine 0.75% with epinephrine or ropivacaine 0.75% with epinephrine, 17 ml of either solution was given in incremental doses over 4 minutes (4, 4, 4, and 5 ml). Analgesia was satisfactory for surgery in all patients except for one in each group. The onset time of analgesia was short: after administration of ropivacaine and bupivacaine, the T12 dermatome was blocked within 6-8 minutes. Mean maximum upper level of analgesia was similar in the groups--T8 +/- 0.6 and T7 +/- 0.6 (mean +/- SEM)--for ropivacaine and bupivacaine, respectively. Duration of analgesia at the T10 level was 190 +/- 12 minutes in the ropivacaine group and 234 +/- 20 minutes in the bupivacaine group and was significantly shorter for ropivacaine at T10, L2, and S5 segments. Frequency of complete motor block was significantly lower in the ropivacaine group (7/21) than in the bupivacaine group (16/20). No differences were found in onset to various degrees of motor block, however, the duration of degree 1 motor block was significantly shorter in the ropivacaine group. Hypotension and bradycardia requiring treatment were experienced by seven and three patients, respectively, in the bupivacaine group, and by two and one patient, respectively, in the ropivacaine group. No postoperative adverse events related to anesthesia were observed. Ropivacaine 0.75% with epinephrine is an effective long-acting local anesthetic. Duration of sensory block is similar to that of bupivacaine 0.75% with epinephrine; however, the motor block is less profound and of shorter duration.

Thoracic epidural analgesia-II: prolongation in the early postoperative period by continuous injection of 1.0% bupivacaine.

Sixteen patients were given thoracic epidural analgesia at the T5-T6 level with 2 ml of 1.0% bupivacaine solution plain for pain relief after upper abdominal surgery. In 13 cases the analgesia was prolonged by continuous injection of 1.0% bupivacaine for 24 or 48 h. Onset time and segmental spread of the analgesia are presented as well as segmental spread, intensity of the blockade, and peak expiratory flow rates during prolongation. Signs of tachyphylaxis were noticed, and also signs of accumulation of bupivacaine in plasma. A high incidence of urinary retention occurred. The method is not considered to be ideal for pain relief after upper abdominal surgery.

Etidocaine in retrobulbar anaesthesia. A comparison with mepivacaine.

A new long-acting local anaesthetic, etidocaine (Duranest) has been compared to mepivacaine (Carbocaine) in retrobulbar anaesthesia in a double-blind trial including 45 patients. Solutions used were etidocaine 0.5% and 1% and mepivacaine 1%, all without adrenaline. The onset time was short and no difference was found between the solutions. The duration of analgesia and motor block was significantly longer with etidocaine 1% compared to mepivacaine 1%. In a following open study with etidocaine 1% and mepivacaine 1% about 80% of the the patients in the etidocaine group never experienced any post-operative pain compared to about 50% in the mepivacaine group. No signs of local or systemic toxicity were noted in the studies.

The effect of lung volume on the ventilatory response to CO2 during resistive loading in normal subjects.

The ventilatory response to CO2 during resistive loading was determined in normal subjects when the end-expiratory level was allowed to increase and when it was restored to that present in the unloaded state. Restoration of the end-expiratory level of that seen in the unloaded state, during the resistive loading, resulted in an increase in ventilatory response to CO2. The mechanism by which increases in lung volume affect the ventilatory response to CO2 is unknown; multiple factors are likely to be involved. It is suggested that an increase in end-expiratory level plays a major role in limiting the ventilatory response to CO2 during resistive loading and may also be an important factor in the reduced ventilatory response to CO2 that is seen clinically when there is obstruction to air flow.

Local anesthetic efficacy of ropivacaine (LEA 103) in ulnar nerve block.

Ropivacaine (LEA 103) is a new long-acting local anesthetic that in animal experiments has proved to be equally potent but less toxic than bupivacaine. In this controlled double-blind study in man, the dose-response relation of ropivacaine was examined in peripheral nerve block and its potency was compared to that of bupivacaine. Nerve functions during bilateral ulnar nerve block were monitored in 70 normal subjects by a computer-controlled method. Results indicate that plain ropivacaine is optimally effective at concentrations between 0.5% and 0.75%, where it reliably blocks nerve functions for about 8 hours. Its profile of action is uniform for the different fiber groups and resembles that of bupivacaine. Addition of epinephrine does not improve latency or duration of ropivacaine nerve block. Adverse effects attributable to ropivacaine have not been observed.

Spinal analgesia with glucose-free bupivacaine--effects of volume and concentration.

Spinal analgesia using 22.5 mg glucose-free bupivacaine, given either as 3.0 ml of 0.75% solution or 4.5 ml of 0.5% solution was studied in a double-blind fashion in 40 patients scheduled for transurethral surgery. No differences in onset, duration and regression of analgesia or motor blockade were noticed, indicating that dosage (in mg) is more important than either volume or concentration when glucose-free bupivacaine solutions are used for spinal analgesia. The cardiovascular effects were small and no side-effects attributable to the spinal anaesthetic were seen.

Spinal anaesthesia with glucose-free 0.5% bupivacaine: effects of different volumes.

The effects of different volumes (1.5, 2, 3, and 4 ml) of glucose-free 0.5% bupivacaine used for spinal anaesthesia were compared in 40 patients scheduled for urological surgery. The blocks were performed with the patients in the sitting position. The time to maximum cephalad spread of analgesia varied between 13 and 18.5 min. A significant difference was found in cephalad spread between the 1.5-and 2-ml groups and the 3-and 4-ml groups. The duration of analgesia increased, the time to complete motor blockade of the lower limbs decreased and the frequency of complete motor blockade increased with increasing volume. Spinal anaesthesia with 3-4 ml of glucose-free 0.5% bupivacaine proved satisfactory for transurethral resection of the prostate.

Subarachnoid anaesthesia with 0.5% bupivacaine: effects of density.

The effects of subarachnoid administration of 0.5% bupivacaine 4 ml in 8%, 5% or 0% glucose were investigated in a double-blind study in 30 women undergoing laparotomy through a lower abdominal incision. The onset time for maximum segmental spread of analgesia was 10-15 min for all solutions. Cephalad segmental spread of analgesia was three to four segments higher with the hyperbaric solutions (T4-5 v. T7-8). Time of onset of complete motor blockade of the lower limbs was 5-10 min for all solutions. The glucose-free solution did not produce sufficient surgical anaesthesia because of too low cephalad spread. Duration of motor blockade generally decreased with increasing glucose concentration, only the hyperbaric solutions providing useful for abdominal surgery, with a duration of 1-1.5 h. Anaesthesia (halothane) was required in seven of 10 patients in the glucose-free group and in five of 20 in the hyperbaric groups. No occurrence of "post-spinal headache" was recorded in the study.

Hyperbaric bupivacaine for spinal anesthesia in cesarean section.

The efficacy and safety of 0.5% hyperbaric bupivacaine (Sensorcaine, Astra) was evaluated in 22 patients undergoing elective cesarean section under spinal anesthesia. The dose varied from 7.5 to 10 mg, (depending on the patient's height) which was significantly lower than previously reported. Patients were placed in head-down tilt immediately after subarachnoid injection. The mean spread of analgesia was to T3, which was reached in 10-15 min. Regression was complete in 258 +/- 16 min. Complete motor paralysis of lower extremities occurred in only two patients. Complete recovery of motor function in all patients was evident in less than 2.5 h. All infants were vigorous at birth and there were no serious maternal complications. The incidence of hypotension was 4.5%, the lowest reported as a consequence of spinal anesthesia in this group of patients. A technique involving the use of reduced doses of hyperbaric bupivacaine (0.5%) in conjunction with head-down tilt appears to be useful for spinal anesthesia for cesarean section.