Our aim was to study the attenuation of the hemodynamic response to microlaryngeal surgery by beta-blocking agents used as support drugs to the anesthetic technique. The study was carried out in 30 patients randomly allocated to one of three groups. The control group received only anesthetic drugs. The second group received labetalol hydrochloride 0.3 mg/kg 3 minutes before induction and 0.15 mg/ kg 2 minutes prior to the start of suspension of the larynx. The third group received esmolol hydrochloride 500 micrograms/kg 3 minutes prior to induction and a continuous infusion of 300 micrograms/kg during the surgical procedure. Hemodynamic data in the three groups were compared by analysis of variance. A statistically significant difference (p < .05) was found in hemodynamic data among the two groups treated with blocking agents and the control group. The addition of beta-blocking agents to the anesthetic technique attenuates the hemodynamic response to suspension laryngoscopy.

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Perforation of a colonic interposition for oesophageal stenosis has not been previously reported after ingestion of aspirin. We present a patient in whom conservative management was successful. Case reportA 33-year-old man with a long-standing history of oesophageal stenosis due to gastroesophageal reflux and four previously unsuccessful operations, underwent resection of the oesophageal stenosis with a left isoperistaltic coloplasty in 1979. In June 1988 the patient was involved in an accident while manipulating a fire-work rocket. As a result, he developed a painful lesion in the left hand and started taking analgesics (24g/day acetylsalicylic acid). In August he noticed the acute onset of epigastric discomfort and pain in the right posterior hemithorax; 7 days before admission he passed black-tarry stools.On admission the patient was haemodynamically stable, with epigastric pain. Rectal examination confirmed black-tarry stools. The haemoglobin was 9.5 g/dl and the white blood count 9.5 x 103/dl. The electrocardiogram showed a sinus tachycardia of 160 beats/min. The chest X-ray showed surgical changes in the right hemithorax, while the plain abdominal films were normal. Twelve hours later severe respiratory distress developed with a fever of 39.5"C. He was admitted to the intensive care unit. Chest X-ray revealed an infiltration in the right lung, and a rise in the white cell count (12.2 x 103/dl) was noted. Seventy-two hours later there was evidence of progressive lung consolidation with cavitary lesions in the pleural space and mediastinum that were confirmed by computed tomographic (CT) scan. A barium swallow showed a leak in the lower third of the intrathoracic colon, with free barium above the right hemidiaphragm ( Figure 1 ). An upper gastrointestinal endoscopy showed abundant pus and mucus in the colonic mucosa but the perforation could not be visualized.Antibiotic therapy was started with clindamycin and tobramycin, and parenteral nutrition was initiated. A large chest tube was placed under CT scan guidance in the largest cavity, but the fever persisted and a repeat CT scan revealed another large posterior cavity; this was also drained percutaneously. His clinical condition improved subsequently, and a further GastrographinB (Schering, Berlin, GDR) swallow showed no evidence of leakage. On day 45 the chest tubes were removed and oral feeding was started. DiscussionThe development of fistulae in oesophageal surgery is a common complication in the postoperative period' but the late presentation in this case is a rare finding2. The most probable cause was the development of an ulcerative lesion in the colonic mucosa, Figure 1 above the right hemidiaphragm (arrow)Barium extratiasation from coloplasty with contrast medium secondary to the massive intake of aspirin. The ulcer was not seen on endoscopy but it seems reasonable to assume that the erosive effect of salicylates3, potentiated by the stasis that frequently occurs after a coloplasty4, triggered perforation in the colonic mucosa. The clinical picture ...