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Scienetific
Abstracts
Pentazocine-induced
fibrous
myopathy
Syrin
loong
Oh,
James
L.
Rollins
and
Irwin
Lewis
J.
Am.
Med.
Assoc.
231:271-3
(Jan.
20)
1975
Clinical,
electromyographic,
and
histo-
pathological
findings
are
reported
in
3
pa-
tients
with
fibrous
myopathy,
induced
by
intramuscular
injection
of
pentazocine
over
several
years.
Characteristic
clinical
fea-
tures
include
fibrotic
induration
in
the
quad-
riceps
and
deltoid
muscles
(the
common
sites
of
injection),
considerable
limitation
of
motion
because
of
fibrotic
muscle
con-
tracture,
and
the
minimal
weakness
of
the
involved
muscles.
Animal
experiments
con-
firmed
the
close
relationship
between
myo-
pathy
and
pentazocine.
When
widespread
atrophy
occurs,
it
is
probably
the
result
of
secondary
disuse
of
the
fibrotic
deltoid
mus-
cle
rather
than
the
pentazocine
injection.
Judicious
use
of
this
drug
is
recommended.
Anesthetic
management
of
the
patient
with
hyperthyroidism
Linda
C.
Stehling
Anesthesiology
41
(6)
585-95
Dec.,
1974
The
pathophysiology
(.including
thryo-
adrenal
relationships)
and
manifestations
of
hyperthyroidism
are
discussed.
In
the
anesthetic
management
of
the
hyperthy-
roid
patient,
antithyroid
drugs,
adrenergic
blocking
agents,
iodine,
and
corticosteroids
are
essential
therapeutic
agents.
Various
drugs
which
are
contraindicated
are
men-
tioned.
Careful
monitoring
of
the
patient
should
continue
postoperatively
in
case
of
thyroid
storm,
which
is
characterized
by
hyperexia,
tachycardia,
and
susceptibility
to
severe
hypotension.
Drugs
and
equip-
ment
necessary
for
treatment
should
be
readily
available.
Other
possible
surgical
complications
are
described.
Malignant
hyperthermia
Harry
C.
Schwartz
and
Robert
M.
Garcia
1.
Oral
Surg.
33
(1)
57-60
Jan.,
1975
Malignant
hyperthermia,
a
genetic
dis-
ease,
occurs
most
frequently
in
apparently
healthy
children
and
young
adults
(1/
14,000).
It
may
develop
after
exposure
to
various
inhalation
anesthetic
agents
(e.g.,
halothane,
cyclopropane,
methoxyflurane,
or
diethyl
ether)
or
skeletal
muscle
relax-
ants
(e.g.,
succinylcholine
chloride,
d-
tubocurarine).
Clinical
features
include
fever
(an
average
of
1070
F),
rigidity
of
the
skeletal
muscles,
drop
in
arterial
oxygen
pressure,
and
later,
acute
failure
of
the
left
ventricle,
renal
shutdown,
consumptive
coagulation,
and
signs
of
decerebration.
Mortality
is
approximately
64%o.
The
patho-
physiology
of
the
condition
is
explained.
The
dentist
should
obtain
an
adequate
his-
tory
of
the
patient
before
administration
of
general
anesthetics.
Determination
of
serum
creatine
phosphokinase
can
aid
diag-
nosis
in
doubtful
instances.
If
any
suscepti-
ble
patient
filters
through
this
screening,
anesthesia
must
be
terminated
and
initial
treatment
given
promptly,
before
the
pa-
tient's
removal
to
hospital
facilities
neces-
sary
for
full
management.
The
biochemical
pharmacology
of
abused
drugs
II.
Alcohol
and
barbiturates
John
Caldwell
and
Peter
S.
Sever
Clin.
Pharm.
Ther.
16
(5)
737-49
Nov.,
1974
The
metabolism
of
the
lower
alcohols
is
reviewed
briefly
in
parallel
with
the
pharm-
acological
effects
of
these
substrates
and
their
metabolites.
The
barbiturate
series
are
discussed
in
terms
of
their
chemistry,
metabolism,
and
modes
of
action.
Aspects
of
tolerance
common
to
central
depressant
drugs
are
discussed.
ANESTHESIA
PROGRESS
96
Evaluation
of
cardiovascular
and
pulmonary
changes
during
meperidine-diazepam
anesthesia
Arlet
R.
Dunsworth,
William
E.
Thornton,
D.
Lamar
Byrd
and
John
W.
Allen
1.
Oral
Surg.
33
(
1)
18-22
Jan.,
1975
The
effect
of
meperidine-diazepam
anes-
thesia
on
the
cardiovascular
and
pulmonary
system
was
investigated
in
189
patients
undergoing
oral
surgery,
of
whom
147
re-
ceived
meperidine
hydrochloride-diazepam
intravenously
and
42
served
as
controls,
receiving
no
drugs.
Blood
pressure,
pulse,
respiratory
rate,
and
electrocardiogram
were
checked
preoperatively
in
all
patients
and
were
monitored
closely
throughout
the
surgical
procedures.
Neither
ventricular
cardiac
arrhythmias
nor
clinically
signifi-
cant
respiratory
depression
occurred
in
the
patients
sedated
with
average
doses
of
meperidine-diazepam.
[Editor's
Note:
Caution
is
advised
in
the
interpreta-
tion
of
the
date
in
this
study.
Findings
did
indicate
a
significant
decrease
in
the
pOQ
which
cannot
be
explained
away
by
citing
little
change
in
percent
oxygen
saturation.
The
pO2
is
a
more
meaningful
parameter
of
tissue
oxygenation.
See
Greenfield,
W.
&
Granada,
M.
G.
The
Use
of
Narcotic
An-
tagonist
in
the
Anesthetic
Management
of
The
Ambulatory
Oral
Surgery
Patient.
Anes.
Prog.
XXII:2,
38-44,
1975.]
Lidocaine
in
the
prevention
of
primary
ventricular
fibrillation
K.
I.
Lie,
Hein
J.
Wellens,
Frans
J.
van
Capelle
and
Dirk
Durrer
NE
J.
Med.
291
(25):
1324-6
Dec.
19,
1974
Lidocaine
has
been
reported
previously
as
ineffective
in
preventing
primary
ventri-
cular
fibrillation
in
acute
myocardial
in-
farction.
However,
in
a
double-blind
study,
a
higher
dose
(an
intravenous
bolus
in-
jection
of
100
mg
followed
by
3
mg/min)
than
previously,
was
administered
to
107
myocardial
infarction
patients
(group
1),
while
a
control
group
of
105
such
patients
received
5%v
glucose
and
water
(group
2).
This
dosage
was
effective
in
preventing
primary
ventricular
fibrillation
(no
instan-
ces
in
group
1,
9
in
group
2)
but
side
ef-
fects,
drowsiness,
numbness,
speech
distur-
bance,
and
dizziness,
were
experienced
by
15%o
of
the
patients
(in
the
older
age
group),
in
whom
the
infusion
rates
had
to
be
controlled.
Anesthesia-electrical
inhibition
of
pain
Anonymous
Amer.
1.
Med.
53:208,
1974
The
"gate
control"
theory
of
pain,
postu-
lating
that
an
inhibitory
sensory
gate
lo-
cated
in
the
posterior
spinal
horns
could
be
closed
by
stimulation
of
large
diameter
cutaneous
afferent
fibers,
apparently
has
become
an
accepted
neurophysiological
principle
and
has
led
to
renewed
interest
in
pain
therapy
and
anesthesia.
Medtronic,
Inc.
recently
has
produced
the
"Neuromod"
transcutaneous
nerve
stimulator,
which
is
designed
to
permit
stimulation
of
these
fibers
with
a
minimum
of
nociceptor
response.
No
claims
are
made
in
the
present
review
for
the
anesthetic
potential
of
the
trans-
cutaneous
nerve
stimulator,
but
such
equip-
ment
may
well
prove
to
be
a
useful
adjunct
in
anesthesia
for
plastic
surgery
in
the
future.
Some
comparisons
are
made
with
acupuncture.
Duration
of
amnesia
during
sedation
with
diazepam
afid
pentazocine:
preliminary
report
Frederick
1.
Flinn,
Paul
Wineland
and
Larry
I.
Peterson
J.
Oral
Surg.
33
(1)
:23-6
Jan.,
1975
The
duration
of
amnesia
during
sedation
with
diazepam
and
pentazocine
was
in-
vestigated.
Fifteen
volunteers
were
as-
signed
to
3
experimental
groups;
each
sub-
ject
was
tested
for
amnesia
first
after
a
saline
injection,
thus
providing
control
values,
then
again
after
receiving
pentazo-
cine
(group
1),
diazepam
(group
2),
or
a
combination
of
the
two
drugs
(group
3).
Group
1
experienced
only
slight
sedation
and
no
amnesia.
In
group
2
the
degree
of
sedation
and
the
incidence
and
duration
of
amnesia
varied
greatly
between
individ-
uals,
but
when
amnesia
occurred,
it
lasted
an
average
of
24
minutes.
Group
3
were
consistently
well
sedated
and
all
experi-
enced
amnesia
which
lasted
on
average
25
minutes.
May-June,
1975
97
