Comparison of two methods of i.v. insulin administration in the diabetic patient during the perioperative period.

We have examined the effects of two types of insulin therapy (continuous i.v. infusion (group A: 1.25 u. h-1) and direct i.v. bolus administration of 10 u. every 2 h (group B: 10 u./2 h)) on the metabolic and endocrine responses to surgery in 60 adult diabetic patients undergoing general anaesthesia for elective procedures. Blood glucose concentrations were measured every 15 min from just before induction of anaesthesia until 2 h after surgery. Plasma ketone bodies, lactate, pyruvate, insulin, C-peptide and counter-regulatory hormone concentrations were measured also. Blood glucose concentrations were comparable in both groups, except at 60 min, because of fluctuating blood glucose concentrations in group B. In each group, one patient became hyperglycaemic. One case of hypoglycaemia occurred in group B. There were no statistically significant differences for the other data except for C-peptide. We conclude that, during the operative period, the administration of a direct i.v. bolus of insulin 10 u. every 2 h is a simple and effective method to control blood glucose concentrations; the method can be used when an insulin infusion pump is not available.

[Study of a new respiratory analeptic: injectable almatrine. Apropos of 22 cases of acute hypoventilation: respiratory activity and electroencephalographic control]. / Etude d'un nouvel analeptique respiratoire: l'almitrine injectable. A propos de 22 observations d'hypoventilation aigue: activité ventilatoire et contrôle électroencéphalographique.

2620 is a respiratory analeptic which acts by stimulation of peripheral chemoreceptors. It was administered intravenously in 22 patients in acute respiratory insufficiency. Doses during the first hour varied between 0.7 and 3 mg/kg. A careful study of the effects on respiration showed a significant increase in minute ventilation without any proportional increase in frequency for doses of between 1.7 and 3 mg/kg. Continuous recording of the electroencephalogram over a period of one hour revealed no convulsant effect even in particularly vulnerable patients. In seven patients, tracings showed a change in the sense of increased consciousness which corresponded with the clinical course of the diseases responsible for the state of hypoventilation.