[Tracheal tube obstruction caused by local anesthetic gel]. / Trakealtubestop forårsaget af lokalanalgesi-gel.

A case report of tracheal tube obstruction caused by a thin, almost invisible, membrane is presented. It was found probable that the membrane consisted of dried local anaesthetic gel. An experimental study showed that inadvertent application of 0.3 ml of lignocaine or prilocaine gel at the orifice of the tube may result in the formation of such a membrane. After 48 hours, the membrane resisted any pressure that might be generated in a resuscitation bag.

Respiratory flow characteristics during isoflurane/nitrous oxide anaesthesia.

Ventilatory characteristics during isoflurane anaesthesia and spontaneous breathing were studied in ten adults during surgery. After premedication with diazepam and induction with thiopental sodium and suxamethonium, 1.2% isoflurane in a 50% mixture of nitrous oxide in oxygen was introduced via a non-rebreathing circuit. Respiratory flow was measured by means of a pneumotachograph, arterial gases were sampled and carbon dioxide elimination and dead-space to tidal volume ratios (VD/VT) calculated. The time axis of one respiratory cycle was divided into 20 equidistant sections and the flow at the end of each section was expressed as a percentage of the maximum flow rate during inspiration and expiration, respectively. In this manner, a relative respiratory flow pattern was constructed. The total ventilation was 5.8 +/- 0.5 1.min-1 (mean +/- s.d.) with a tidal volume of 191 +/- 45 ml and a respiratory rate of 31 +/- 6.min-1. The PaCO2 was 7.2 +/- 0.6 kPa, the carbon dioxide elimination 151 +/- 38 ml (STPD) and VD/VT 0.53 +/- 0.12. The respiratory flow pattern showed early peak flows during both inspiration and expiration. The expiratory flow rate after 90% of the total respiratory cycle time was on average 43% of the maximum expiratory flow rate. The conclusion was that isoflurane seems to have a similar respiratory flow pattern to halothane. The significant hypercarbia that resulted is still acceptable but a lighter anaesthetic level is recommended for routine surgery.

Influence of extradural and general anaesthesia on natural killer cell activity and lymphocyte subpopulations in patients undergoing hysterectomy.

The effect of hysterectomy was studied on natural killer (NK) cell activity, the distribution of lymphocyte subpopulations, and the endocrine stress response in 16 patients allocated to receive extradural analgesia S5-T4 (group I) or neuroleptanaesthesia (NLA) (group II). In group II a significant decrease in NK cell activity was found after operation for at least 3 days, while surgery during extradural analgesia did not induce significant changes. The impaired NK cell activity was accompanied by leucocytosis and lymphopenia affecting the T-lymphocytes (OKT3+ and OKT4+), the B-lymphocytes (B1+) and NK cells (Leu 11+). Compared with group II, extradural analgesia significantly reduced the cortisol and noradrenaline response to surgery, while the adrenaline response in both groups was abolished. The results suggest that the decrease in NK cell activity and alterations in lymphocyte subsets induced by surgery and general anaesthesia can be prevented to a certain degree by extradural analgesia.

Fosfomycin-ampicillin versus gentamicin-ampicillin in the treatment of critically ill patients with pneumonia.

Thirty-two patients with severe pneumonia (22 on assisted ventilation) were entered into a prospective randomised trial, in which fosfomycin plus ampicillin (17 patients) was compared with gentamicin plus ampicillin (15 patients). Treatment was either 4 g fosfomycin or 80 mg gentamicin every 8 h and 1 g ampicillin every 6 h. Complete or partial clinical success was attained in 94% (16/17) in the fosfomycin group and in 80% (12/15) in the gentamicin group. Bacteriological success was 87.5% with fosfomycin-ampicillin and 90% with gentamicin-ampicillin. An intermediary sensitive Klebsiella pneumoniae strain developed complete resistance in the fosfomycin group, and an in vitro sensitive Pseudomonas aeruginosa strain was resistant in vivo in the gentamicin group. Two of three patients in the fosfomycin group receiving the infusion through a peripheral vein developed thrombophlebitis. No other side-effects were observed. We conclude that fosfomycin is at least as effective as gentamicin. Since fosfomycin is widely atoxic and may be given in large doses, irrespective of kidney function, it is considered to have advantages over gentamicin in the combined therapy of pneumonia.