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Total intravenous anaesthesia is a form of anaesthesia which is more often used in human medicine for high risk patients. The case reports of two cats with a severe dyspnoe are presented. Both patients received anaesthesia with the steroid anaesthetic agent Saffan for 19 and 25 hours, respectively. Saffan is a well-tolerated agent with little side effects. Dosage and monitoring results are presented.

The acute effect of Fentanyl and Althesin upon haemodynamics, inotropism of the heart and myocardial oxygen consumption has not been studied in man so far. Healthy premedicated pateints (n = 16) were lightly anaesthetized with nitrous oxide-oxygen (ratio 2:1), 0.3 Vol.-% forane and 0.3 Vol.-% halothane respectively. In order to avoid any interference with respiratory depression all subjects were normoventilated via an orotracheal tube. In a circulatory steady state a single dose of 0.01 mg/kg Fentanyl (n = 7) and 0.075 mg/kg Althesin (n = 9) respectively was injected intravenously within 20 sec. After the application of Fentanyl there was a delayed (5th min) fall in blood pressure by 23%, which was due to a reduction in total peripheral resistance (12%) and in cardiac output (thermodilution technique) by 13%. The decrease in cardiac output was the result of a bradycardia (18%). Considering heart rate, pre- and afterload simultaneously, the fall in max dp/dt (catheter-tip manometer) by 20% could not be explained as a decrease in myocardial contractility. The altered haemodynamics led to a decrease of the myocardial oxygen consumption (control 6.4 ml O2/min x 100 g) by 31%. The energy demand of the heart was quantitatively calculated using the formula of the complex haemodynamic parameter developed by Bretschneider. Immediately after the administration of Althesin the cardiac output rose on account of tachycardia slightly, while stroke volume (19%), total peripheral resistance (32%) and mean arterial pressure (24%) reacted reversely. Since heart rate increased (11%), preload remainded unchanged and afterload decreased, the fall in dp/dt max (20%) has to be understood as a moderate reduction in myocardial inotropism. The energy demand of the heart decreased only initially by 15%. The clinical implications of the results were discussed.

The influence of a combination of fentanyl (0.1 mg) and etomidate (0,15 mg/kg and 0.3 mg/kg) on haemodynamics, inotropic state, myocardial oxygen consumption and vascular reaction has been investigated in 60 patients with congenital or acquired heart diseases--mostly functional class III according to NYHAC. Because of minor changes in haemodynamics (decrease in mean arterial pressure, left ventricular pressure, peak dp/dt, cardiac index, stroke index) the combination of 0.15 mg/kg etomidate and 0.1 mg fentanyl seems to be of great value for induction of anaesthesia in patients with cardiac disease compared to other intravenous induction agents such as propanidid, thiopentone or althesin. In accordance with the changes in haemodynamics there was a 12% and 18% decrease in myocardial oxygen consumption, respectively.

31 Anaphylactoid reactions to Dextran, Propanidid, Althesin, Ampicillin and Mepivacaine are reported. By rapid infusion of Ringer lactate and colloid solutions to an amount of 2,000-3,000 ml circulation could be restored in 30 minutes. Prednisolone did not reveal positive effects. After administration of epinephrine in 3 of 4 cases more negative than positive effects were seen.

We investigated the cardiovascular effects of intravenous thiopentone (3.0 mg/kg), etomidate (0.3 mg/kg), althesin (0.07 ml/kg), ketamine (1.5 mg/kg), diazepam (0.15 mg/kg) and flunitrazepam (0.015 mg/kg) alone and after the addition of fentanyl (0.01 mg/kg) during induction of anaesthesia in 46 premedicated patients subjected to coronary artery bypass surgery. Thiopentone, etomidate or diazepam caused only small changes in the haemodynamic determinants of myocardial oxygen supply and demand (arterial pressure, heart rate, left and right ventricular filling pressure) in patients with coronary artery disease in whom global resting left ventricular function was normal. Althesin and flunitrazepam produced a significant fall in arterial pressure, cardiac index and stroke index; heart rate increased after the administration of althesin. Ketamine markedly elevated systemic and pulmonary pressure, heart rate, systemic and pulmonary vascular resistance, right and left ventricular filling pressure. The subsequent administration of fentanyl was associated with a further decrease in arterial pressure in the althesin and flunitrazepam group. The circulatory stimulating effects of ketamine were largely abolished by fentanyl. None of the induction procedures was associated with cardiovascular stimulation during laryngoscopy and tracheal intubation.

The effect of alphaxalon + alphadolon-acetate on cerebrospinal fluid pressure (CSFP), mean arterial blood pressure (MPA), heart rate (BMP) and blood gases was investigated in 18 patients. Cerebral perfusion pressure (CPP) was calculated from the difference MAP minus CSFP. Alphaxalon + alphadolon-acetate lowered the normal CSFP and normalized ketamin induced increase of CSFP. Premedication with alphaxalon + alphadolon-acetate delayed the ketamin induced increase of CSFP, which returned to norm after a second dose of alphaxalon + alphadolon-acetate. This effect was seen despite elevation of pCO2 in all patients breathing spontaneously.