. AFRICA, FRANK S. CARUSO AND rtOBEltT J. NOVECK BUTOI1PHANOL TAttTRATE has been shown to provide adequate relief of severe post-operative pain for at least four hours when administered to adults intramuscularly in a dose of 2 to 4 rag. Morphine sulphate 10 to 15 mg, meperidine 80 rag/70 kg and pentazocine 30 to 60 mg have a similar effect. 1-4 In normal volunteers, respiratory depression and the suppression of the respiratory stimulating response to carbon dioxide inhalation appears to be less with butorphanol tartrate than with morphine sulphate. ~ When butorphanol tartrate 3 nag or morphine sulphate 15 mg was given intravenously to consenting patients under double-blind conditions, there was no appreciable elevation in plasma histamine with either.6 Finally, in a single blind study of subjects undergoing diagnostic cardiac catheterization, the intravenous injection of butorphanol tart-rate 0.02 mg/kg, or morphine sulphate 0.10 mg/kg, directly through a catheter inserted into the heart of consenting patients with suspected coronary heart disease, revealed that morphine sulphate tended to decrease stroke index, lowered left ventricular systolic blood pressure, and lowered left ventricular volume, while butorphanol tartrate tended to augment these parameters slightly. This cardiovascular study indicated that the new compound is safe even in patients with severe ischaemie heart disease. 7 In addition, the multidose administration of butorphanol tartrate over a period of 12 to 18 hours for relief of severe pain had no appreciable effect on the eaa'diorespiratory system. 8The objective of the present study was to evaluate the safety and efficacy of repeated intravenous injections of butorphanol tartrate in combination with hypnotics and muscle relaxants for balanced anaesthesia in patients requiring major abdominal operations.
M'ETHODS
Clinical ManagementInformed written consent was obtained from adult patients the day before they underwent elective :major abdominal surgery. Then, a venous blood sample was drawn for baseline serum transaminases, bilirubin, alkaline phosphatase, creatinine and blood urea nitrogen, albumin and total protein, in addition to routine laboratory studies which included chest ,and abdominal X-rays and an electrocardiogram. An anaerobic arterial blood sample was also taken to determine pH, Paco2, Pao2, Sao2, haemoglobin and haematocrit. Fifty-three patients, free from severe renal, hepatic or cardiorespiratory disease, including 38 non-pregnant females, were selected for this study. Vital statistics for these patients are shown in ~From the
