1 Efficacy of and tolerance to brotizolam when used as a preoperative hypnotic were studied in two double-blind, randomised parallel group studies. 2 Brotizolam (0.25 and 0.50 mg) was superior to placebo. Efficacy was assessed as good-tosatisfactory in 73.0% of patients with 0.25 mg and in 88.0% with 0.5 mg. A similar assessment was reached in 40.0% of patients with placebo. Brotizolam 0.5 mg was superior to 0.25 mg, and with the higher dose subjective assessments of anxiety were reduced. 3 Efficacy of tolerance to 0.5 mg brotizolam and 2.0 mg flunitrazepam were compared, and both drugs were found to be effective and well tolerated. Brotizolam maintained sleep throughout the night more effectively than flunitrazepam. 4 A dose range of 0.25-0.5 mg brotizolam is recommended as a pre-operative hypnotic.

Postoperative parenteral nutrition can only be optimally effective if the characteristics of post-traumatic metabolism are taken into account. Two main possibilities are discussed for the carbohydrate component of parenteral nutrition during this phase: glucose with high doses of insulin or non-glucose carbohydrates (sugar substitutes) possibly in a suitable combination with glucose. The risks as well as the technical and organisational problems involved in the use of them are discussed and the authors prefer the second of the two alternatives. Possible side effects of non-glucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of frucose : glucose : xylitol in a ratio of 2 : 1 :1 with a total dose of 0.50 g/kg/hour has been studied most thoroughly. This combination normalises the fat metabolism and improves glucose tolerance without requiring exogenous insulin. Experiences with this combination as well as individual non-glucose carbohydrates on operated patients have been given continuously for up to 7 days and in some cases even for several weeks. No side effects, no deviations from a steady state and no abnormal changes of the laboratory values occurred. The authors are of the opinion that non glucose carbohydrates are necessary if the facilities for frequent blood sugar controls are not available.

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Bei 9 Patienten mit posttraumatischer Katabolie wurde ein Abfall des Linolsäuregehaltes im Serum innerhalb von 7 Tagen bis um 80% des Ausgangswertes gemessen. Die höchste Abfallrate fand sich zwischen dem ersten und fünften Tag. Analoges Verhalten ergab sich für das Stoffwechselfolgeprodukt der Linolsäure, die Arachi-donsäure. Als weiterer Ausdruck der Fettstoffwechselentgleisung muβ das Auftreten einer anomalen Eikosatriensäure gewertet werden. Der Linolsäuremangel im Postaggressionsstoffwechsel ist durch han-delsübliche Fettemulsionen oder gezielter durch Konzentrate essenti-eller Fettsäuren zu beheben.

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