The rates of DNA single-strand breaks in peripheral lymphocytes of 41 persons administering anesthesia daily and 44 control persons were determined by nucleoid sedimentation. There is a significantly higher rate of DNA single-strand breaks in nonsmoking anesthesia persons than in nonsmoking control persons (P < 0.01). Smoking anesthesia persons and smoking control persons presented increased rates of DNA single-strand breaks. Nonsmoking nurse anesthetists showed an insignificantly higher rate of damage than nonsmoking anesthesiologists. DNA single-strand breaks indicate damage before the start of DNA repair. Therefore, detected DNA single-strand breaks may be reversible. As not every DNA repair is perfect, increased rates of DNA single-strand breaks may possibly lead to irreversible DNA damage.

Halothane (CAS 151-67-7) induced DNA strand breaks in isolated lymphocytes of two patients with a deficient DNA repair (xeroderma pigmentosum). In lymphocytes (resting cells) of healthy human donors and in L 5178 Y cells (proliferating cells) of mouse lymphoma, halothane did not induce demonstrable DNA strand breaks. The cells were exposed to 1.0 vol/% halothane for 60 min, and the DNA strand breaks were demonstrated by alkaline elution. The results suggest a possible genotoxic side effect of halothane in patients with deficiency in DNA repair.

DNA was exposed to halothane (CAS 151-67-7) in a cell-free system. After exposure the DNA was used as substrate for DNase I from bovine pancreas. The DNase I activity increased after halothane exposure of the substrate depending on time and doses. Drugs are able to influence the DNA conformation. Conformational changes in the DNA can enhance the DNase I cleavage rate. Therefore, it is possible that halothane exposure induces changes in DNA conformation demonstrable by an increased DNase I activity. The results suggest a mechanism by which halothane may contribute to chromosomal defects and disturbances of DNA metabolism in cells.

DNA single strand breaks were determined in peripheral lymphocytes of neurosurgical patients before and after 180 min of general anesthesia with isoflurane (CAS 26675-46-7)-nitrous oxide-oxygen. Immediately after anesthesia, the frequency of DNA single strand-breaks appeared to be significantly enhanced. In the majority of patients the DNA single strand breaks induced was equivalent to the effect of 0.2-0.5 Gray following x-ray radiation of lymphocytes in vitro. In a part of the examined patients these investigations were repeated on the first postoperative day. Then an increase of the frequency of DNA single strand breaks could not be demonstrated any more. The DNA single strand breaks were repaired by cellular repair systems. As DNA repair is regulated genetically, isoflurane-nitrous oxide-oxygen could induce DNA damage in patients with DNA repair defects.

Das Erleben chronischer Schmerzen ist ein komplizierter Vorgang, der unter Umständen das Leben eines Patienten völlig verändert. Die Verständigung zwischen Arzt und Patient über ein solch komplexes Geschehen ist nicht immer leicht, da die Kommunikation ihrerseits durch zahlreiche Faktoren beeinflu\t wird. Wie Patienten mit chronischen Schmerzen zwischen der Angabe ihrer Schmerzintensität und der Beurteilung ihrer Stimmung differenzieren, sollte in unserer Studie mit einer neuen Meßmethode—Dolormeter—an 200 Probanden überprüft werden. Unsere Ergebnisse zeigen, daß unsere neue Methode geeignet ist, um bei Patienten mit chronischen Schmerzen die Schmerzintensität zu beurteilen, nicht aber, um die Psyche der Patienten zu explorieren. Das Urteil der Patienten zeigt klar, daß sie ihre Schmerzintensität und ihre psychische Verfassung getrennt beurteilen. Zur Angabe ihrer Schmerzintensität wählen sie den Dolormeter, zur Beurteilung ihrer Stimmung bevorzugen sie den Profile of Mood States.

The aim of this study was to evaluate a new modified visual analog scale, called the dolorimeter, together with a verbal rating scale (VRS) and a linear visual scale (VAS), in the measurement of acute postoperative pain. The scales were evaluated with reference to their sensitivity, reliability and validity, and correlation. During the study 200 patients 11-70 years of age (125 men, 75 women) were interviewed after orthopedic surgery to ascertain the intensity of the pain. We had the patients judge the intensity of pain before and 1 h after giving analgesics by using the dolorimeter, VRS, and VAS. At the end of the examination, we asked the patients whether the pain had decreased or not which method they preferred, and why they preferred this method. The results of this interrogation proved that the sensitivity of the VRS is low; its parameters overlap greatly on the analog, scale, and it is therefore too rough to be a sufficient measurement of pain. On the other hand, the high sensitivity of the two analog scales which patients can use to determine their individual pain intensity proved to be much more sensitive. All three methods correlated statistically; the highest correlation coefficients were found between the analog scales VAS and the dolorimeter. Because the dolorimeter is clearly preferred to the other methods, especially by elderly patients, we came to the conclusion that the dolorimeter is less abstract than the VAS and more practical to handle.

In a double-blind, randomized study of 29 patients who underwent orthopedic procedures we studied the additional effect of intrathecal buprenorphine on isobaricpinal anesthesia and postoperative analgesia. The injections were 20 mg tetracaine (19 patients) or 20 mg tetracaine plus 0.15 mg buprenorphine (10 patients). In both groups the drugs were contained within a total volume of 4 ml cerebrospinal fluid. Progression and regression of the sensory blockade of spinal anesthesia were estimated with pinprick; the motor blockade was judged by the Bromage scheme. Postoperative pain was evaluated by the patients using an analogue scale after Scott and Huskisson. Arterial blood gases, respiratory rate, blood pressure, and heart rate were measured and other side-effects determined. Both groups were comparable in age, body weight, height and duration of operation (Table 1). The addition of buprenorphine elevated the sensory blockade by three segments both during spread and regression of anesthesia (Figs. 1, 2). Postoperative analgesia was better up to 8 h after injection (p less than 0.05), after 8 h pain levels were equal in test and control groups (Fig. 3). After buprenorphine patients became aware of pain sensation 13 h after injection; in the control group the pain-free interval lasted only 9 h (p greater than 0.05). There were no differences in the need for postoperative analgesics between both groups. The respiratory rate was lower during the whole period of observation (p less than 0.05). The mean values for PaCO2, pH and BE were similar in both groups (Fig. 4). PaO2 was elevated in the buprenorphine group. There was no essential alteration of blood pressure after buprenorphine. The pulse rate, however, was slightly diminished.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to better understand the effects and side effects of intraspinal administration of morphine we studied the rostral spread of a comparable substance within the cerebrospinal fluid (CSF). This study was performed in connection with nuclear medical diagnostics ruling out possible rhinorrhoea or disturbances of CSF-circulation in 14 patients: Following lumbar intrathecal injection of the tracer 111-Indium-DTPA, the radioactivity over the medulla oblongata was measured continuously for 2 1/2 hours with a single probe scintillation counter; thereafter the distribution of activity over the total spinal canal was determined; finally the spread of activity was registered with the gamma scintillation camera in the 3rd, 24th and 48th hour. The diffusion of the tracer was followed in a model of the subarachnoid space. A few minutes after injection, activity over the medulla oblongata could be detected; initially it increased markedly, later less so; at the end of the 2 1/2 h observation time, approximately 8% of the total activity had reached this level. The timing of activity increase and the peak activity over the medulla oblongata varied between the individuals. Up to 48 hours the activity continued to shift from the spinal canal to the endocranium. Diffusion played a secondary role. These results are further evidence that morphine is transported cephalad within the CSF rather quickly and may act on cervical spinal cord and brainstem.

The purpose of this randomized double-blind study was to determine the optimal dose of epidural morphine by establishing a dose-effect relationship. The 139 patients, who had orthopedic operations on the lower extremities, received continuous lumbar epidural anesthesia with bupivacaine, 0.75%, with or without the addition of 1, 2, 3, 4, or 5 mg of morphine hydrochloride. Analgesia and side effects were determined during the first 24 hr postoperatively. In the 12-hr period after epidural anesthesia, arterial blood gas tensions were compared between those patients who received 5 mg morphine (n = 13) and those who received no morphine (n = 14). Patients who received 2 or more mg of morphine were less likely to require the administration of postoperative systemic analgesics (P less than 0.05). The addition of 2 or more mg of morphine to bupivacaine, 0.75%, reduced postoperative pain intensity (P less than 0.05); 5 mg of morphine reduced pain intensity for the longest time. Frequency of catheterization and pruritus increased dose-dependently. The mean PaCO2 after 5 mg of epidural morphine averaged 5 mm Hg higher than in the control group, indicating minor respiratory depression, better analgesia, or both. The dose of 3 mg of epidural morphine added to the local anesthetic is recommended for postoperative analgesia after surgery of the lower extremity; it is a compromise that provides adequate analgesia with an acceptably low frequency and intensity of side effects.

This study was designed to investigate under controlled conditions sensory and motor blockade provided by epidural anaesthesia following two concentrations of bupivacaine without adrenaline. Twenty four patients received for extracorporeal shock wave lithotripsy a lumbar continuous epidural anaesthesia randomized with bupivacaine 0.75% (n = 12) or 0.5% (n = 12). During development and regression, sensory blockade was determined by the pinprick method, motor blockade by the Bromage score. All differences between the two concentrations--even though not all statistically significant--spoke in favour of bupivacaine 0.75%: shorter time of onset, more cephalad spread, higher intensity and longer duration of sensory and motor blockade. The higher concentration should be injected more slowly due to the increased risk if intravascular injection should occur; it should not be used for cesarean section.