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The Use of Curare in Anesthesia A Review of 100 Cases

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Good muscular relaxation is one of the requirements for efficient abdominal surgery, and in order to obtain this relaxation surgeons and anesthetists have sometimes used anesthetic drugs and methods which are toxic or hazardous. The introduction of curare into clinical medicine has made it possible for us to obtain complete muscular relaxation at any time during anesthesia with nontoxic controllable anesthetic agents. After more than two years of careful clinical observation I have come to the conclusion that curare is a safe drug to use in combination with certain anesthetic agents, provided it is administered under properly controlled conditions.

The story of the transformation of this South American Indian arrow poison into an anesthetist's tool may be told briefly as follows: Curare has been known to science since 1595, when Hakluyt referred to it in his description of Sir Walter Raleigh's voyage up the Orinoco. In 1840 Claude Bernard,

Additional Resource: Curare In Anesthesia

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The Urgent Case for Immediate Treatment of Propofol as a Controlled Substance in All Clinical Settings

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Propofol has been reported as a drug of abuse amongst anesthesia providers since 1992. As an uncontrolled substance, propofol is seldom kept in locked storage, nor is it inventoried or counted similar to other potential drugs of abuse found in most operating rooms. Ease of access has been shown to be a factor in the incidence of propofol abuse. Most concerning is the high rate of accidental fatal outcomes reported in individuals who abuse propofol. The Peer Assistance Advisors of the AANA urgently recommend that all institutions, anesthesia departments, out-patient surgery centers, office anesthesia locations, and each clinical setting in which propofol is administered, adopt and apply the inventory and control methods currently in use for Schedule III substances, despite the lack of scheduled status, to their handling of the drug propofol. Propofol has become the most widely used IV induction agent for general anesthesia (1) because of its attractive properties of quick recovery (2) and minimal side effects. (3) (4)As such, it is commonly...

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Comparison of Pattern of Breathing with other measures of Induction of Anaesthesia, using Propofol, Mehohxital, and Sevoflurance

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We assessed change of the pattern of breathing as a marker of induction of anaesthesia, using a method of maintaining spontaneous breathing throughout the induction period. We compared this index with a measure used clinically, the lash re¯ex, and measures used for drug investigations such as loss of grip of an object, cessation of ®nger tapping, and loss of arm tone. Ninety female patients (mean age 32 (17±63) yr, mean weight 63 (10) kg) were randomly allocated to induction of anaesthesia using propofol, methohexital, or sevo¯urane. The i.v. agents were given by slow injection estimated to give an induction dose (for weight drop end point) in 90 s.Sevo¯urane was given by progressively increasing the inhaled concentration to 8% so that induction should occur within 90±120 s. We measured time to change in breathing pattern, loss of voluntary ®nger tapping, loss of the lash re¯ex (tested at 15 s intervals), loss of postural tone in an...

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Propofol Sedation: Who Should Administer?

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PROBLEM: Using propofol (DIPRIVAN) to sedate patients during endoscopic and other diagnostic procedures is gaining momentum in a growing number of hospitals, outpatient surgery centers, and physician offices.1 In trained hands, propofol offers many advantages over other drugs used for sedation because it: Has a rapid onset (about 40 seconds) and a short duration of action Allows patients to wake up, recover, and return to baseline activities and diet sooner than some other sedation agents Reduces the need for opioids, thus resulting in less nausea and vomiting.2 Trained nurses in most critical care settings often administer propofol safely to patients who are intubated and ventilated. However, some practitioners have been lulled into a false sense of security, allowing the drug’s good safety profile to influence their beliefs that propofol is safer than it really is. In untrained hands, propofol can be dangerous, even deadly; administration to a nonventilated patient by a practitioner who is not trained in theuse of drugs that can cause deep sedation and...

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Effects of Propofol Analogs on Glucuronidation of Propofol, an Anesthetic Drug, by Human Liver Microsomes

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INTRODUCTION

UDP-glucuronosyltransferases (UGTs) catalyze the glucuronidation of a broad spectrum of endobiotic and xenobiotic substrates . In general, the resulting glucuronides are more hydrophilic, facilitating renal and biliary excretion. In addition to hepatic metabolism, high rates of gastrointestinal glucuronidation in rats and humans have been observed . Propofol (2,6-diisopropylphenol) is administered as a bolus for the induction of anesthesia and as an infusion for maintenance of anesthesia or for sedation. A rapid and complete recovery is a major advantage of this drug, which is attributable to extensive biotransformation of the parent compound. Propofol is suggested to be a substrate for one of the UGT isoforms, UGT1A9 [6,7]. There is a hypothesis that propofol could be orally used with a suitable inhibitor among analogs for preventing its rapid glucuronidation [8]. In order to seek for a suitable inhibitor of propofol biotransformation, we investigated the interactions between propofol and its analogs in the glucuronidation by recombinant human...

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Academic Anesthesia Faculty Salaries: Incentives, and Productivity

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In the United States, financial compensation for academic anesthesiologists has usually been based on rank and/or clinical time. Typically, faculty salaries would increase with seniority and the associated increases in rank (i.e., assistant professor associate professor full professor). Since most of the actual financial compensation is derived from clinical activity, a certain clinical expectation (i.e., usually number of days per week in the operating room plus call) would be expected. If a faculty member has research grants, money from the grant may be used to help pay a faculty member’s salary and increase his or her nonclinical time. These are the principles by which academic departments have for years compensated their faculty, although there have undoubtedly been many variations. Over the past 10 to 15 years, many American academic anesthesia departments have increasingly had problems with recruiting and retaining faculty (especially junior faculty), making it difficult to provide clinical coverage for all of the...

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Crisis Management During Anaesthesia: Pulmonary Oedema

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Abstract

Background: Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Diagnosis may be difficult during anaesthesia and consequently management may be delayed.

Objectives: To examine the role of a previously described core algorithm “COVER ABCD–A SWIFT CHECK”, supplemented by a specific sub-algorithm for pulmonary oedema, in its management occurring in association with anaesthesia.

Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.

Results: Pulmonary oedema was identified in 35 (<1%) of the first 4000 reports to AIMS. The most frequent presenting sign was hypoxia (46%) and the most specific sign was the presence of frothy sputum (23%). The core algorithm, although successful in the management of the initial physiological upset,...

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Pulmonary Edema And Hemorrhage As Complications Of Acute Airway Obstruction Following Anesthesia.

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Abstract

Airway obstruction is a quite common complication while its conditioned pulmonary edema--rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. This may cause pulmonary edema and in some cases pulmonary hemorrhage. Last-mentioned is extremely rare. Pulmonary edema may arise soon after airway obstruction as well as later, after some hours. Damage of bronchi is found seldom during bronchoscopy in case of pulmonary hemorrhage, while more often alveolar damage is observed due to alveolar membrane damage. Hemorrhage is conditioned by hydrostatic pressure level, level of hypoxia, damage to bronchi or alveoli (disruption of alveolar membrane). Early diagnosis of negative-pressure pulmonary edema or pulmonary hemorrhage is very important, because this affects postoperative morbidity and mortality of the patients. Two cases of pulmonary edema and hemorrhage after upper airway obstruction as well as literature overview are presented in this article. Pulmonary hemorrhage developed during anesthesia...

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