Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report.

BACKGROUND: Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors. CASE PRESENTATION: A 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomography (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approximately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well. CONCLUSIONS: It is paramount to correctly identify the underlying cause of emergence agitation in order to successfully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.

Individual and Contextual Factors Associated With Hazardous Drinking in Spain: Evidence From a National Population-Based Study.

BACKGROUND: Heavy drinking (HD) and binge drinking (BD) exhibit marked differences in their relationships with contextual-level factors imbedded in geographical areas of residence. The objective is to identify sociodemographic factors, both at the individual and at the contextual level, associated with these 2 main hazardous consumption patterns. METHODS: Cross-sectional study using data from the 2011 to 2012 National Health Survey in Spain. The sample included 21,007 individuals ≥15 years of age. HD was defined as an alcohol intake of ≥40 g/d in men and ≥24 g/d in women. BD was defined as the consumption in the previous month of ≥6 alcoholic drinks (men) or ≥5 drinks (women) within 4 to 6 hours. Individual-level variables included sociodemographic factors, urban/rural residence, smoking, and perceived social support. Contextual-level variables covered percentage of population with no schooling, unemployment rate, and hospitality industry-related economic activity, all at the census tract level. We analyzed data using multilevel logistic regression and calculated areas under the curve (AUC). RESULTS: Being male, smoking, high-income, and low perceived social support were associated with both hazardous drinking patterns. Younger individuals were at higher risk for BD but at lower risk for HD. BD was more common among rural than urban dwellers (odds ratios [OR] = 1.35; 95% CI: 1.05 to 1.72), whereas HD was less likely in participants residing in areas with high unemployment rates (OR = 0.62; 95% CI: 0.41 to 0.93). HD was more likely in census tracts with higher levels of hospitality industry activity (OR = 1.74; 95% CI: 1.20 to 2.54). The AUC increased substantially for both HD and BD when the census tract variable was entered in the respective models (reaching 89.5 and 93.3%, respectively). CONCLUSIONS: Except for age, both drinking patterns have similar associations with individual-level variables but disparate links to contextual-level indicators. In both cases, accounting for area of residence substantially increased the ability to discriminate between high-risk drinkers from nonhazardous alcohol consumers.

Sleeve gastrectomy surgery: when 2 alcoholic drinks are converted to 4.

BACKGROUND: While it is well established that Roux-en-Y gastric bypass (RYGB) causes a rapid and heightened peak blood alcohol concentration (BAC), results from previous studies on the effects of sleeve gastrectomy (SG) on alcohol pharmacokinetics are conflicting. Data from 2 studies found SG did not affect BAC, whereas another study found SG caused a heightened peak BAC after alcohol ingestion. Moreover, these 3 studies estimated BAC from breathalyzers, which might not reliably estimate peak BAC. OBJECTIVES: The aims of this study were to evaluate (1) the effect of SG, relative to RYGB and a presurgery group, on alcohol pharmacokinetics and subjective effects, and (2) whether breathalyzers are reliable in this population. SETTING: Single-center prospective nonrandomized trial. METHODS: We performed alcohol challenge tests in 11 women who had SG surgery 1.9 ± .1 years ago (body mass index = 35.1 ± 6.6 kg/m2), 8 women who had RYGB surgery 2.2 ± .4 years ago (body mass index = 30.0 ± 5.2 kg/m2), and 9 women who were scheduled for bariatric surgery (body mass index = 44.1 ± 4.0 kg/m2). BACs were estimated from breath samples and measured by gas chromatography at various times after consuming approximately 2 standard drinks. RESULTS: BAC increased faster, peak BAC was approximately 2-fold higher, and feelings of drunkenness were heightened in both SG and RYGB groups relative to the presurgery group (P values<.001). BAC estimated from breath samples underestimated BAC by 27% (standard deviation = 13%) and missed peak BACs postsurgery. CONCLUSIONS: SG, similar to RYGB, causes marked alterations in the response to alcohol ingestion manifested by a faster and higher peak BAC. The breathalyzer is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol.

Natural Products for the Prevention and Treatment of Hangover and Alcohol Use Disorder.

Alcoholic beverages such as beer, wine and spirits are widely consumed around the world. However, alcohol and its metabolite acetaldehyde are toxic and harmful to human beings. Chronic alcohol use disorder or occasional binge drinking can cause a wide range of health problems, such as hangover, liver damage and cancer. Some natural products such as traditional herbs, fruits, and vegetables might be potential dietary supplements or medicinal products for the prevention and treatment of the problems caused by excessive alcohol consumption. The aim of this review is to provide an overview of effective natural products for the prevention and treatment of hangover and alcohol use disorder, and special emphasis is paid to the possible functional component(s) and related mechanism(s) of action.

Alcohol and tobacco cue effects on craving in non-daily smokers.

Non-daily smokers commonly smoke cigarettes following the consumption of alcohol, yet the reason(s) for this remains poorly understood. The present study examined the impact of alcohol consumption on responses in tobacco salient cues 49 male and 50 female non-daily smokers. After the administration of an alcohol, placebo, or control beverage, participants were exposed to series neutral video clips and tobacco smoking salient video clips, and their subjective states and heart rates were monitored. The timing of the exposure to the tobacco smoking clips was randomly determined to coincide with the timing of either the ascending limb or the descending limb of the blood alcohol concentration (BAC) curve of the alcohol beverage condition. The tobacco smoking clips were found to increase cigarette craving regardless of beverage condition or timing of exposure (p = .002). Alcohol consumption was associated with increased ratings of intoxication (p < .001), increased heart rate across participants (p < .001), and increased cigarette craving in female participants specifically (p = .017). Alcohol did not influence responses to the smoking videos. These results suggest that smoking salient cues and alcohol may impact cigarette craving in non-daily smokers through independent processes.

Activation of adenosine A1 receptors reduces anxiety-like behavior during acute ethanol withdrawal (hangover) in mice.

Elevated signs of anxiety are observed in both humans and rodents during withdrawal from chronic as well as acute ethanol exposure, and it represents an important motivational factor for ethanol relapse. Several reports have suggested the involvement of brain adenosine receptors in different actions produced by ethanol such as motor incoordination and hypnotic effects. In addition, we have recently demonstrated that adenosine A1 receptors modulate the anxiolytic-like effect induced by ethanol in mice. In the present study, we evaluated the potential of adenosine A1 and A2A receptor agonists in reducing the anxiety-like behavior during acute ethanol withdrawal (hangover) in mice. Animals received a single intraperitoneal administration of saline or ethanol (4 g/kg) and were tested in the elevated plus maze after an interval of 0.5-24 h. The results indicated that hangover-induced anxiety was most pronounced between 12 and 18 h after ethanol administration, as indicated by a significant reduction in the exploration of the open arms of the maze. At this time interval, ethanol was completely cleared. The acute administration of 'nonanxiolytic' doses of adenosine and the selective adenosine A1 receptor agonist 2-chloro-N6-cyclopentyladenosine (CCPA), but not the adenosine A2A receptor agonist N6-[2-(3,5-dimethoxyphenyl)-2-(2-methylphenyl)ethyl]adenosine (DPMA), at the onset of peak withdrawal (18 h), reduced this anxiogenic-like response. In addition, the effect of CCPA on the anxiety-like behavior of ethanol hangover was reversed by pretreatment with the selective adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX). These results reinforce the notion of the involvement of adenosine receptors in the anxiety-like responses and indicate the potential of adenosine A1 receptor agonists to reduce the anxiogenic effects during ethanol withdrawal.

Estradiol protects against alteration of protein kinase C(epsilon) in a binge model of ethanol dependence and withdrawal.

This study tested the hypothesis that a binge type of ethanol intake and ethanol withdrawal disturbs protein kinase C (PKC) homeostasis in a manner protected by 17beta-estradiol. Ovariectomized rats implanted with 17beta-estradiol or oil pellets received ethanol (7.5% weight/volume, 7 days) or control solution by a gavage method. The cerebelli were collected during ethanol exposure or ethanol withdrawal to assess the activity, protein levels, and cellular distribution of PKC(epsilon) and total PKC, using an ATP phosphorylation and immunoblot assays. While both ethanol exposure and ethanol withdrawal increased membrane protein levels and membrane translocation, only ethanol withdrawal enhanced activity of PKC(epsilon). Ethanol withdrawal not ethanol exposure increased the three parameters of total PKC. 17beta-Estradiol treatment prevented these changes in PKC profiles. These data suggest that an excessive episodic intake of ethanol followed by ethanol withdrawal disturbs PKC homeostasis and cellular distribution of PKC, in particular PKC(epsilon), in a manner that is protected by estrogen. PKC(epsilon) appears more vulnerable during ethanol withdrawal than during ethanol exposure.

[Alcohol as medication is no good. More risks than benefits according to a survey of current knowledge]. / Alkohol som medicin fungerar dåligt. Riskerna överväger nyttan visar genomgång av kunskapsläget.

Moderate drinking has small effects on health. Alcohol-related risks are greatest for young people, and decrease with age. Women are more sensitive than men to the effects of alcohol. Protective effects of moderate drinking are reported for cardiovascular disease, diabetes type 2 and cognitive functioning. However, moderate drinking also involves risks, especially of injuries, violence, foetal damage, certain forms of cancer, liver disease and hypertension. Alcohol consumption should not be recommended for health reasons. Binge drinking, regardless of age, is a medical risk. Health professionals should discuss the pattern of drinking with patients, especially binge drinking, to a larger extent than is usually the case today.

Emerging techniques in biomedical research and their application to alcohol toxicity.

This article represents the proceedings of a symposium at the 2002 RSA-ISBRA Meeting in San Francisco. The chairs were Vinood B. Patel and Victor R. Preedy. The presentations were (1) Macromolecular structural analysis, by Vinood B. Patel; (2) Profiling and imaging of proteins in tissue sections using mass spectrometry as a discovery tool in biological research, by Pierre Chaurand and Richard M. Caprioli; (3) The use of SELDI ProteinChip trade mark arrays, by Brian M. Austen, Emma R. Frears, Francesca Manca, and Huw Davies; (4) DNA hybridization array technologies, by Kent E. Vrana; and (5) Adeno- and adeno-associated viral mediated gene transfer approaches for alcoholic liver disease, by Michael Wheeler. Concluding remarks were by Victor R. Preedy.

Effect of alcoholic intoxication on water content and activity of Na,K-ATPase and Ca-ATPase in rat brain.

We studied the effect of 2-week alcohol intoxication on water exchange and activity of Na,K-ATPase and Ca-ATPase in rat brain. Alcohol intoxication increased water content in the brain due to cell hyperhydration. It is assumed that hyperhydration results from increased Na+ content in cells due to inhibition Na,K-ATPase activity, which in turn is caused by activation of lipid peroxidation under the effect of ethanol. A possible mechanism of Na,K-ATPase inhibition.

Smoking and intoxication after alcohol challenge in women and men: genetic influences.

In an earlier analysis, men and women who were current or former smokers were found to report feeling less intoxicated on average than nonsmokers after ingestion of a challenge dose of alcohol. Here, we examine whether differences in subjective response to alcohol and a tendency to smoke cigarettes are transmitted together in families; and, if so, whether this association might be entirely explained by the same heritable factors that influence alcohol intake (as we might expect if both smoking and subjective intoxication are influenced by some general susceptibility for substance use). Alcohol challenge data on 388 Australian male and female twins (194 complete pairs) were reanalyzed using multivariate genetic analysis to evaluate the association between cigarette smoking and self-report intoxication after a standard dose of alcohol. In women, we could not reject the hypothesis of complete genetic overlap between effects on intoxication rating and history of smoking, and a significant residual genetic correlation between smoking and postalcohol intoxication persisted even when genetic influences on alcohol consumption were controlled for. In men, the familial association seemed to be largely environmentally mediated and associated with differences in drinking history. These findings prompt the question of whether, in some individuals, cigarette smoking may contribute to the development of tolerance to the effects of alcohol.

[Acute alcoholism after ethanol fixation for ovarian chocolate cyst].

We experienced a case of acute alcoholism after ethanol fixation for ovarian chocolate cyst. A 46 year old female was scheduled for ethanol fixation for ovarian chocolate cyst. Ethanol fixation was performed with 110 ml of 99% ethanol under general anesthesia. Ethanol 70 ml was not removed. After the operation, patient did not emerge from anesthesia within 30 min. Blood alcohol concentration was 232 mg.dl-1. It is important to remove total ethanol used for ethanol fixation in anesthetic management for ethanol fixation for ovarian chocolate cyst.

Consumption, behaviour and knowledge with respect to alcoholic drinks in student nurses in the province of Bologna, Italy.

A study was carried out on alcohol intake among the students of the Schools for Trained Nurses in the province of Bologna by means of an anonymous especially prepared questionnaire. The series consisted of 1077 subjects: 753 females and 324 males aged between 16 and 40. 68.2% of males and 56.8% of females drank wine, l'81.3% of males and 61.8% of females drank beer and 65.3% of males and 46.2% of females drank spirits. While beer was the most popular drink, wine was on average drank in greater quantity. Alcohol intake was significantly related to sex (higher among males), area of origin (South) and cigarette smoking. The risk attributable to alcohol abuse are well known to almost all of the sample, above all those in the 2nd and 3rd years of their course. Nevertheless their alcohol consumption was not particularly different from that of students attending other High Schools. Regarding the sources, of their information about the risks, the 'mass media' was more quoted by the oldest students while 'family' was given by the younger students; the Nursing School was more often mentioned by both sexes in the 2nd and 3rd year of course. No relation however was found between the students knowledge of risks and actual consumption.

Ethanol induced oxidative stress and membrane injury in rat erythrocytes.

The aim of this study was to observe membrane injury and to investigate the mechanism of antioxidant defence systems against acute ethanol toxicity. Erythrocyte superoxide dismutase and Na+, K(+)-ATPase activities were significantly decreased and catalase levels were significantly increased one hour after ethanol intoxication of male swiss albino rats. These data demonstrated that superoxide dismutase and catalase are susceptible to lipid peroxidation and that these enzymes protect tissues from free radicals. The possible mechanism involved in Na+, K(+)-ATPase and Ca(2+)-ATPase inhibition are discussed in relation to the development of ethanol toxicity and the role of lipid peroxidative processes.

Uso do metanol como combustível / Use of methanol as fuel

mm funçäo da polêmica nacional envolvendo o uso do metanol como combustível, professores da Universidade de Säo Paulo envolvidos com a Saúde do Trabalhador, em sua reuniäo de 13 de março de 1990 discutiram o assunto e têm a esclarecer alguns aspectos do ponto de vista técnico. O uso do metanol como combustível de motores de combustäo interna näo é uma idéia recente, tendo sido considerado e testado como tal, antes mesmo da gasolina ter-se tornado economicamente viável