Human adrenomedullin (hAM), a potent vasodilatory peptide originally identified in pheochromocytoma, has been shown to be present in various human tissues and circulate in human plasma. We measured plasma concentrations of immunoreactive hAM in patients with sepsis who had been admitted to intensive care unit (ICU). Plasma hAM concentrations in 12 septic patients upon entering the ICU were extremely elevated (107 +/- 139 fmol/ml: mean +/- SD) compared to those of 16 age-matched normal subjects (7.9 +/- 3 fmol/mL). Among 10 patients with normal renal function, plasma hAM levels either decreased or increased during the hospital course; the former group survived and the latter group succumbed. Two patients with acute renal failure had markedly elevated plasma hAM levels during the early course, which declined rapidly during the recovery course. High performance liquid chromatography of plasma extracts from one patient with acute renal failure revealed a single major component of immunoreactive hAM coeluting with authentic hAM (1-52) during acute and recovery phase. Plasma hAM concentration showed positive correlations with heart rate, right atrial pressure, and serum creatinine concentration, but not with other hemodynamic variables. These data suggest that a marked increase in circulating hAM in sepsis may be caused by its decreased clearance and/or its enhanced synthesis by multiple organ dysfunction, and that increased endogenous hAM may be involved in the mechanism of cardiovascular abnormalities associated with sepsis.

The intubating laryngeal mask airway was used in 31 adult patients in whom tracheal intubation was known or suspected to be difficult. The intubating laryngeal mask airway was successfully inserted in 30 patients and provided a clinically patent airway. In the remaining one patient it was impossible to insert the device correctly. Tracheal intubation through the device was successful in 28 of 30 patients (93%). These results suggest that the intubating laryngeal mask airway has a potential role for tracheal intubation in adult patients with difficult airways.

Changes in skeletal muscle of a patient with malignant hyperthermia (MH) were examined in skinned fibers. In the patient's muscle, the Ca-induced Ca release mechanism showed a significantly higher sensitivity to Ca than that in normal muscles and the maximum rate of Ca release at a sufficiently high concentration of Ca was also significantly higher. Halothane accelerated Ca-induced Ca release to a similar extent both in the patient's and normal muscles. No difference was observed in the properties of Ca uptake by the sarcoplasmic reticulum (SR) and of the contractile protein system between the patient's and normal muscles. The changes observed in the Ca-induced Ca release mechanism were considered to be sufficient to explain the disease.

We have studied recovery of post-tetanic twitch (PTT) and train-of-four (TOF) responses after administration of vecuronium in 100 patients under different inhalation anaesthetics and neuroleptanaesthesia. Patients were allocated randomly to five groups of 20 patients each to receive: neuroleptanaesthesia (droperidol and fentanyl), halothane, isoflurane, enflurane or sevoflurane (1 MAC in nitrous oxide and oxygen). The times from initial administration of vecuronium 0.2 mg kg-1 to the first appearances of T1, T2, T3 and T4 differed significantly between groups. However, the intervals to the first appearance of PTT1, PTT10 and PTT20 did not differ significantly between groups.