The burden of psychosocial problems, including substance abuse, is high among trauma patients. Use of illicit substances is often noted during urine toxicology screening on admission and can delay surgery because of concerns for an interaction with anesthesia. Methamphetamine theoretically has potential to increase perioperative anesthetic risks. However, the authors are unaware of any studies documenting increased rates of cardiovascular complications in the perioperative period among orthopedic trauma patients. This study sought to determine the rate of cardiovascular complications in these patients. The authors reviewed the medical records of all patients between 2013 and 2018 who underwent orthopedic trauma surgery at two level I trauma centers in the setting of a methamphetamine-positive urine toxicology screening prior to surgery. Information on demographics, injury, type of surgical intervention, and incidence of perioperative cardiovascular and overall medical complications prior to discharge was recorded. Ninety-four patients were included in the study (mean age, 44 years; range, 16–78 years). Twenty-six (28%) patients had multiple injuries. Thirteen (14%) patients had debridement and/or provisional stabilization of an open or unstable fracture, 18 (19%) had treatment for an infection, and 63 (67%) had definitive fracture surgery. The overall rates of perioperative cardiovascular complications and perioperative medical complications were 2.1% and 3.2%, respectively. This study provides both a baseline understanding of the complication rate for methamphetamine-positive orthopedic trauma patients during general anesthesia and justification for larger multicenter studies to further investigate this topic. [ Orthopedics . 2019; 42(4):192–196.]

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The present investigation brought out the facts that the pupil of the cat is little affected by instillation of adrenalin, but shows, nevertheless, a greater responsiveness to adrenalin when given intravenously than does that of the rabbit, and that the duration of the dilatation effected by intravenous injection is, on the contrary, longer in the rabbit. In regard to the vasoconstricting effect of adrenalin when administered intravenously, it was found that the intensity as well as the duration of the rise of blood pressure was greater in the rabbit than in the cat.

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Summary Different lots of venom of the same species agree in their proteolytic activity. The venoms of different species of pit viper show great differences, which are not correlated with other actions of the venoms. Antivenins are irregular and uncertain in their neutralizing action and show no evidence of specificity.