Anesthesiology
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The authors developed a new method of intrathecal local anesthetic injection in rabbits in order to study the relationship between anesthetic concentration and impaired neurologic function. They found that none of the local anesthetics studied produced persistent neurologic damage in concentrations used clinically. ⋯ Pure solutions of relatively insoluble local anesthetics (bupivacaine and 2-chloroprocaine) failed to produce comparable neurologic or neuropathologic changes when tested at concentrations up to their solubility limits. Extensive neurologic impairment was not necessarily accompanied by equally extensive lesions in the spinal cord and nerve roots.
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Comparative Study
Bicitra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitis.
To evaluate the effect of Bicitra (Willen Drug Company, Baltimore, Maryland), a commercial preparation of sodium citrate and metoclopramide, on gastric contents 150 elective outpatients allocated into six groups with 25 patients in each group were studied. Patients in Group 1 served as controls. Patients in Groups 2, 3, 5, and 6 received Bicitra, po, either 15 ml (Groups 2 and 5) or 30 ml (Groups 3 and 6). ⋯ The addition of metoclopramide 10 mg, iv, to Bicitra reduced the proportion of patients with a gastric volume greater than or equal to 25 ml in Groups 5 and 6 to 28 and 36%, respectively. Metoclopramide (Group 6) independently reduced mean gastric volume (15.6 ml vs. 32.7 ml) and the proportion of patients with a gastric volume greater than or equal to 25 ml (20% vs. 36%). Bicitra and metoclopramide combination significantly reduced the proportion of patients with gastric contents greater than or equal to 25 ml with pH less than or equal to 2.5.
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Comparative Study
Toxicity and resuscitation in lidocaine- or bupivacaine-infused cats.
Controversy persists surrounding the relative safety of bupivacaine compared with lidocaine especially with regard to its cardiovascular toxicity and the ability to resuscitate following such occurrences. The margin of safety between seizure onset and cardiovascular collapse was compared in lightly anesthetized and ventilated cats given an equipotent infusion of either lidocaine or bupivacaine (N = 10 for each group). The infusion rates were 4 mg X kg-1 X min-1 bupivacaine or 16 mg X kg-1 X min-1 lidocaine. ⋯ Despite very high plasma local anesthetic concentrations, all lidocaine-infused animals were quickly resuscitated (4.4 +/- 3.0 min; mean +/- SD). The resuscitation time for the bupivacaine group (5.4 +/- 2.4 min) was similar. Two cats in the bupivacaine group could not be brought to resuscitation criterion, a difference, however, that was not statistically significant.