No abstract

At a Base Hospital. 2151 patients of militancy trauma were managed from Jan 1990 to 31 May 1993. It involved military. paramilitary, ex-servicemen, civilians, foreigners and antinational elements. The nature of trauma was either gun shot wounds ( 1333) or blast injuries (818). Polytrauma (multiple injury to soft tissue, bone. parenchyma with shock or injury to more than one body region) was seen in 862 patients. Standard protocol was evolved for initial management in lCU/acute surgical ward. Time taken for initial evaluation of injury. resuscitation. respiratory care and oxygen therapy. analgesics. blood group cross matching, antibiotics and preparation of the part before surgery was usually 45 min. Anaesthesia was induced with ketamine 2 mgJkg or thiopentone 3 mgJkg based on haemodynaemic response and maintained with N20 : 02 (50 : 50 ratio). relaxant controlled ventilation. Mortality was 3.8% including 4 deaths on operation table.

While studying the organotoxicity of etomidate (an intravenous induction agent used principally in anaesthesia) in dogs and cats it was noted that all of them developed haemolysis. Haemolysis was confirmed visually and by the Benzidine test for free haemoglobin in urine. Flame photometric analysis detected elevated serum potassium levels (6-5 mmol/l). Varying doses of etomidate (0.6, 1.2 and 2.4 mg/kg) had similar effects. In a limited group of women undergoing tubectomy, etomidate was used in doses of 0.3 mg/kg for induction, with serial increments of 5 mg. A total dose of 40 mg was given in a 30 min period; a dose-dependent haemolysis occurred, which was confirmed by matching with standard haemolysed serum solutions and correlating with serum potassium levels.Perusal of the literature did not reveal any mention of haemolytic activity. The attention of anaesthetists and clinical pharmacologists should be drawn, through this forum, to this phenomenon, and we would like to exchange data on this untoward effect. We are interested to know of other specific tests, apart from spectrometric and colometric estimation, for detecting minor degrees of haemolysis.

Histamine releasing activity of chandonium iodide and -tubocurarine was studied in guinea pig ileum (in vitro), guinea pig peritoneum (in vivo) and in human volunteers (in vivo) by intradermal testing at dilutions of 1:1,000 and 1:10,000 of the clinical dosage of drugs.-tubocurarine revealed significant histamine releasing activity in in vivo animal experiments and high incidence of positive intradermal reaction, 53.5 per cent and 13.5 per cent, in human volunteers. Chandonium iodide neither showed histamine releasing activity in animals nor in man. In clinical terms, chandonium iodide appears to be a safe neuromuscular blocking agent.