RESUMEN
Porphyromonas gulae, Tannerella forsythia and Campylobacter rectus are considered dominant periodontal pathogens in dogs. Recently, quantitative real-time PCR (qRT-PCR) methods have been used for absolute quantitative determination of oral bacterial counts. The purpose of the present study was to establish a standardized qRT-PCR procedure to quantify bacterial counts of the three target periodontal bacteria (P. gulae, T. forsythia and C. rectus). Copy numbers of the three target periodontal bacteria were evaluated in 26 healthy dogs. Then, changes in bacterial counts of the three target periodontal bacteria were evaluated for 24 weeks in 7 healthy dogs after periodontal scaling. Analytical evaluation of each self-designed primer indicated acceptable analytical imprecision. All 26 healthy dogs were found to be positive for P. gulae, T. forsythia and C. rectus. Median total bacterial counts (copies/ng) of each target genes were 385.612 for P. gulae, 25.109 for T. forsythia and 5.771 for C. rectus. Significant differences were observed between the copy numbers of the three target periodontal bacteria. Periodontal scaling reduced median copy numbers of the three target periodontal bacteria in 7 healthy dogs. However, after periodontal scaling, copy numbers of all three periodontal bacteria significantly increased over time (p<0.05, Kruskal-Wallis test) (24 weeks). In conclusion, our results demonstrated that qRT-PCR can accurately measure periodontal bacteria in dogs. Furthermore, the present study has revealed that qRT-PCR method can be considered as a new objective evaluation system for canine periodontal disease.
Asunto(s)
Bacterias/clasificación , Bacterias/aislamiento & purificación , Perros/microbiología , Boca/microbiología , AnimalesRESUMEN
Reduced expression in immortalized cells (REIC/Dkk-3), a member of the human Dickkopf (Dkk) family, is a growth suppressor in human and canine mammary tumours. Mammary gland tumours are common neoplasms with high malignancy in female cats. The purpose of this study was to clone the feline REIC/Dkk-3 homolog, investigate its expression in cell lines established from feline mammary gland tumours, and test its tumour suppressor function. Western blot analysis revealed that expression of the REIC/Dkk-3 protein was reduced in feline mammary carcinoma cell lines. Forced expression of REIC/Dkk-3 induced apoptosis in feline mammary tumour cell lines. These results demonstrate that REIC/Dkk-3 expression, which is downregulated in feline mammary tumour cell lines, results in the induction of apoptosis in these cells. Our findings suggest that feline REIC/Dkk-3 represents a potential molecular target for the development of therapies against feline mammary cancers.
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Péptidos y Proteínas de Señalización Intercelular/metabolismo , Proteínas Supresoras de Tumor/metabolismo , Animales , Apoptosis , Enfermedades de los Gatos/metabolismo , Gatos , Línea Celular Tumoral/metabolismo , Clonación Molecular , Femenino , Neoplasias Mamarias Animales/metabolismoRESUMEN
AIMS: The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function. PATIENTS AND METHODS: A total of 41 patients (four males, 37 females) with main thoracic (MT) adolescent idiopathic scoliosis (AIS) treated with ASF were included. Mean age at surgery was 15.2 years (11 to 27). Mean follow-up period was 13.5 years (10 to 18). RESULTS: For the TL/L curve, the mean curve flexibility evaluated with supine pre-operative bending radiographs was 78.6% (standard deviation 16.5%), with no significant loss of correction observed. On comparing patients with an increase of the TL/L curve increase (> 4º, n = 9, 22%) to those without, significant differences were observed in the correction rate of the MT curve at the final follow-up (p = 0.011), correction loss of the MT curve (p = 0.003) and the proportion of patients who had semi-rigid instrumentation (p = 0.003). Pre-operative percentage predicted forced vital capacity (%FVC) was 80%, dropping to 72% at final follow-up (p < 0.001). The Scoliosis Research Society questionnaire score was not significantly different between patients with and without a TL/L curve increase (p = 0.606). Spontaneous lumbar curve correction (SLCC) was maintained up to 18 years following selective ASF in most patients and demonstrated significant correlation with maintenance of MT curve correction. CONCLUSION: Maintenance of MT curve correction using rigid instrumentation provided stable SLCC over time. An observed 8% decrease in %FVC indicates that ASF should be reserved for patients with no or only mild pulmonary impairment. Cite this article: Bone Joint J 2016;98-B:997-1002.
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Vértebras Lumbares/diagnóstico por imagen , Escoliosis/cirugía , Fusión Vertebral , Vértebras Torácicas/cirugía , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Capacidad Vital , Adulto JovenRESUMEN
This study evaluated the accuracy and reproducibility of a human portable blood glucose meter (PBGM) for canine and feline whole blood. Reference plasma glucose values (RPGV) were concurrently measured using glucose oxidation methods. Fifteen healthy dogs and 6 healthy cats were used for blood sampling. Blood glucose concentrations and hematocrits were adjusted using pooled blood samples for our targeted values. A positive correlation between the PBGM and RPGV was found for both dogs (y = 0.877, x = -24.38, r = 0.9982, n = 73) and cats (y = 1.048, x = -27.06, r = 0.9984, n = 69). Acceptable results were obtained in error grid analysis between PBGM and RPGV in both dogs and cats; 100% of these results were within zones A and B. Following ISO recommendations, a PBGM is considered accurate if 95% of the measurements are within ± 15 mg/dl of the RPGV when the glucose concentration is <100 mg/dl and within ±15% when it is ≥100 mg/dl; however, small numbers of samples were observed inside the acceptable limits for both dogs (11%, 8 of 73 dogs) and cats (39%, 27 of 69 cats). Blood samples with high hematocrits induced lower whole blood glucose values measured by the PBGM than RPGV under hypoglycemic, normoglycemic, and hyperglycemic conditions in both dogs and cats. Therefore, this device is not clinically useful in dogs and cats. New PBGMs which automatically compensate for the hematocrit should be developed in veterinary practice.
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Automonitorización de la Glucosa Sanguínea/veterinaria , Glucemia/química , Animales , Automonitorización de la Glucosa Sanguínea/instrumentación , Gatos , Perros , Femenino , Masculino , Sistemas de Atención de Punto , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: We developed a fibrinogen γ-chain (dodecapeptide HHLGGAKQAGDV [H12])-coated, ADP-encapsulated liposome (H12-[ADP]-liposome) that accumulates at bleeding sites via interaction with activated platelets via glycoprotein IIb-IIIa and augments platelet aggregation by releasing ADP. OBJECTIVE: To evaluate the efficacy of H12-(ADP)-liposomes for treating liver hemorrhage in rabbits with acute thrombocytopenia. METHODS: Thrombocytopenia (platelets < 50 000 µL(-1)) was induced in rabbits by repeated blood withdrawal (100 mL kg(-1) in total) and isovolemic transfusion of autologous washed red blood cells. H12-(ADP)-liposomes with platelet-poor plasma (PPP), platelet-rich plasma (PRP), PPP, ADP liposomes with PPP or H12-(PBS)-liposomes/PPP, were administered to the thrombocytopenic rabbits, and liver hemorrhage was induced by penetrating liver injury. RESULTS: Administration of H12-(ADP)-liposomes and of PRP rescued all thrombocytopenic rabbits from liver hemorrhage as a result of potent hemostasis at the liver bleeding site, although rabbits receiving PPP or ADP liposomes showed 20% survival in the first 24 h. Administration of H12-(ADP)-liposomes and of PRP suppressed both bleeding volume and time from the site of liver injury. H12-(phosphate-buffered saline)-liposomes lacking ADP also improved rabbit survival after liver hemorrhage, although their hemostatic effect was weaker. In rabbits with severe thrombocytopenia (25 000 platelets µL(-1)), the hemostatic effects of H12-(ADP)-liposomes tended to be attenuated as compared with those of PRP treatment. Histologic examination revealed that H12-(ADP)-liposomes accumulated at the bleeding site in the liver. Notably, neither macrothombi nor microthrombi were detected in the lung, kidney or liver in rabbits treated with H12-(ADP)-liposomes. CONCLUSIONS: H12-(ADP)-liposomes appear to be a safe and effective therapeutic tool for acute thrombocytopenic trauma patients with massive bleeding.
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Adenosina Difosfato/administración & dosificación , Fibrinógeno/administración & dosificación , Hemorragia/tratamiento farmacológico , Hemostáticos/administración & dosificación , Hepatopatías/tratamiento farmacológico , Oligopéptidos/administración & dosificación , Trombocitopenia/tratamiento farmacológico , Heridas Penetrantes/tratamiento farmacológico , Enfermedad Aguda , Animales , Pruebas de Coagulación Sanguínea , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Modelos Animales de Enfermedad , Estudios de Factibilidad , Hemorragia/sangre , Hemorragia/etiología , Hemorragia/patología , Hemostasis/efectos de los fármacos , Liposomas , Hepatopatías/sangre , Hepatopatías/etiología , Hepatopatías/patología , Masculino , Microscopía Inmunoelectrónica , Agregación Plaquetaria/efectos de los fármacos , Recuento de Plaquetas , Conejos , Trombocitopenia/sangre , Trombocitopenia/complicaciones , Trombocitopenia/patología , Factores de Tiempo , Heridas Penetrantes/sangre , Heridas Penetrantes/complicaciones , Heridas Penetrantes/patologíaRESUMEN
This randomized trial investigated whether 5% sevoflurane potentiated neuromuscular blockade by vecuronium. General anaesthesia was induced with 5% sevoflurane in oxygen in 16 patients or with propofol in 16 patients. After loss of consciousness, vecuronium was administered to all participants at randomly assigned doses of 25, 30, 35 or 40 µg/kg. Neuromuscular blockade was assessed by use of acceleromyography to measure responses to train-of-four stimuli in the adductor pollicis and corrugator supercilii muscles. Maximum blockade was significantly more intense in the adductor pollicis among patients in the sevoflurane group than in the propofol group, whereas there was no significant between-group difference at the corrugator supercilii muscles. In both groups, maximum blockade at the corrugator supercilii was significantly less intense than that achieved at the adductor pollicis. In the dose-response analysis, the 50% and 95% effective doses were lower for sevoflurane than for propofol in both muscles, although this did not reach statistical significance. It is concluded that induction of general anaesthesia with sevoflurane might provide improved conditions for intubation and reduce airway problems.
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Anestesia , Anestésicos por Inhalación/farmacología , Éteres Metílicos/farmacología , Bloqueo Neuromuscular/métodos , Fármacos Neuromusculares no Despolarizantes/farmacología , Propofol/farmacología , Bromuro de Vecuronio/farmacología , Adulto , Anestésicos Intravenosos/farmacología , Demografía , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , SevofluranoRESUMEN
BACKGROUND: Little information is available regarding the neuromuscular effects of sevoflurane in patients with myasthenia gravis (MG). We evaluated the neuromuscular effects of sevoflurane alone in patients with MG and in those with normal neuromuscular transmission. METHODS: Sixteen patients with generalized type MG (MG group) and 12 otherwise healthy patients (control group) entered into this study. Anaesthesia was induced with propofol, fentanyl, and midazolam followed by nitrous oxide in oxygen. Neuromuscular monitoring was recorded from the adductor pollicis muscle using electromyography with train-of-four stimulation of the ulnar nerve. After a stabilization period, and before sevoflurane administration, baseline T4/T1 was obtained and MG patients were classified as non-fade MG group (baseline T4/T1 > or = 0.90) (n = 10) and fade MG group (baseline T4/T1 < 0.90) (n = 6). End-tidal sevoflurane concentration was kept constant at 1.7% for 30 min and doubled thereafter to 3.4% and maintained for a further 30 min. RESULTS: Sevoflurane produced a concentration-dependent decrease in T1 and T4/T1 values. At 3.4% sevoflurane, T1 and T4/T1 decreased significantly from baseline values in all three groups. From baseline until the patient woke up from anaesthesia, the T4/T1 of the fade MG group was significantly lower than the other groups. At the end of anaesthesia, T4/T1 returned to values similar to the baseline in all three groups. CONCLUSIONS: During sevoflurane anaesthesia, concentration-dependent inhibition of neuromuscular transmission was observed in MG and control patients. The inhibitory effects of sevoflurane were more prominent in MG patients with baseline T4/T1 <0.90.
Asunto(s)
Anestésicos por Inhalación/farmacología , Éteres Metílicos/farmacología , Miastenia Gravis/fisiopatología , Unión Neuromuscular/efectos de los fármacos , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Estimulación Eléctrica , Electromiografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Unión Neuromuscular/fisiopatología , SevofluranoRESUMEN
BACKGROUND AND OBJECTIVE: Postoperative nausea and vomiting (PONV) after ophthalmic surgery under general anaesthesia remains a complex and perturbing complication associated with several factors. Little information is available regarding the risk factors for nausea and vomiting after vitrectomy in adults. In this study, we evaluated the potential risk factors for PONV after vitrectomy in adult patients. METHODS: Univariate and multivariate analyses of clinical factors associated with PONV were undertaken in a retrospective case-control series of 247 adult patients undergoing vitrectomy under general anaesthesia. We examined PONV for the first 48 h. Factors examined were age, body mass index (BMI), smoking status, H2-blocker as premedication, type of general anaesthesia (sevoflurane and fentanyl or total intravenous (i.v.) anaesthesia with propofol and fentanyl), duration of surgery, and intraoperative fentanyl dose. RESULTS: Fifty-nine patients (24%) reported one or more episodes of PONV during the study period. Female gender (P < 0.01), lower BMI (P < 0.01) and general anaesthesia with inhalational anaesthetics (P < 0.01) were significantly related to nausea during the first 2 h postoperatively. Female gender (P < 0.01) was significantly related to nausea and vomiting throughout the study period. Other factors, including smoking status, did not alter the risk for nausea and/or vomiting. CONCLUSIONS: We conclude that female gender, lower BMI and inhalation anaesthesia are the main risk factors for PONV after vitrectomy in adults. Smoking status did not reduce the incidence of PONV in our patients.
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Anestesia General/efectos adversos , Anestésicos por Inhalación/efectos adversos , Náusea y Vómito Posoperatorios/inducido químicamente , Vitrectomía/métodos , Adolescente , Adulto , Factores de Edad , Anciano , Anestesia General/métodos , Anestésicos Intravenosos/efectos adversos , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Fentanilo/efectos adversos , Antagonistas de los Receptores H2 de la Histamina/administración & dosificación , Humanos , Incidencia , Japón/epidemiología , Masculino , Éteres Metílicos/efectos adversos , Persona de Mediana Edad , Náusea y Vómito Posoperatorios/epidemiología , Propofol/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Sevoflurano , Factores Sexuales , Fumar , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVE: The optimal depth of insertion of left-sided double-lumen endobronchial tubes is strongly correlated with body height in average-sized adults. However, this relationship has not been studied in below average-sized adult patients. We investigated whether or not there is a clinically useful relationship in below average-sized adult patients. METHODS: One hundred and ninety six consecutive adult patients undergoing thoracic surgery under one-lung anaesthesia (body height < or = 155 cm) were included in this study. Left-sided double-lumen tubes were inserted under the guidance of a fibre-optic bronchoscope. Optimal depth was defined as the proximal surface of the bronchial cuff positioned just below the carina. RESULTS: There was a statistically significant positive correlation between body height and the optimal depth of insertion (r = 0.61, P < 0.0001); however, the correlation coefficient was low. The actual optimal depth of insertion of one patient was even 4.5 cm shorter than that obtained from the equation. CONCLUSION: Although there was a statistically significant correlation between body height and the optimal depth of insertion of left sided double lumen tubes in adult patients of short stature (< or = 155 cm), clinical application of the equation is not warranted and these tubes should be inserted under direct vision with a fibre-optic bronchoscope.
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Estatura/fisiología , Bronquios/anatomía & histología , Intubación Intratraqueal/métodos , Anciano , Anestesia General , Bronquios/fisiología , Broncoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Valor Predictivo de las PruebasRESUMEN
A 36-year-old man was admitted to our hospital because of impalement injury due to a downwards fall upon some reinforced steel rods. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). The steel rods were taken out in the operating room. The heart, great vessels, vertebrae, and spinal cord were not involved in the impalement wounds. We performed a bronchoplasty of the torn and separated right main bronchus, and repaired the impaled left lung without any pulmonary resection. He recuperated without sequelae.
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Materiales de Construcción/efectos adversos , Recuperación de la Función , Acero/efectos adversos , Traumatismos Torácicos/etiología , Traumatismos Torácicos/cirugía , Accidentes de Trabajo , Adulto , Puente Cardiopulmonar , Humanos , Masculino , Traumatismo Múltiple/etiología , Traumatismo Múltiple/cirugía , Heridas Penetrantes/etiología , Heridas Penetrantes/cirugíaRESUMEN
We managed a patient with a huge ovarian tumor (15 kg). The patient was a 50-year-old woman and could not take the supine position because of the tumor causing respiratory embarrassment. An epidural catheter was inserted 3 cm cephalad via the Th 11-12 interspace in the right lateral position. Three milliliters of 1% mepivacaine was injected epidurally for test dose and produced hypesthesia of Th 9-12 five min after the injection. Additional 3 ml of 1% mepivacaine was injected epidurally, which widened the hypesthesia to Th 5-L 2. Intra-arterial pressure was monitored continuously. Under epidural anesthesia without sedation, 11,000 ml of fluid was suctioned slowly from the cyst in 20 min, during which time remarkable hemodynamic derangement did not occur. The patient was turned into the supine position and the trachea was intubated. Laparotomy was performed under general anesthesia. During the surgery, respiratory and hemodynamic conditions were stable. On the following day, chest radiography demonstrated an abnormal shadow in the lower lobe of the right lung. It disappeared the next day without any treatment. Anesthetic management of patients with huge abdominal tumor is also discussed.
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Adenocarcinoma de Células Claras/cirugía , Anestesia Epidural , Anestesia General , Neoplasias Ováricas/cirugía , Femenino , Humanos , Laparotomía , Mepivacaína , Persona de Mediana Edad , Posición SupinaRESUMEN
A 37-year-old man with exophthalmos underwent resection of the left apical peridontal cyst under general anesthesia. Eye patches (Opticlude) without adherence to epibulbar area were used during anesthesia and surgery. At the end of the surgery, his left eyelid was noted to be incompletely closed. His left bulbar conjunctiva showed marked conjestion with severe pain. Staining with fluorescein dye demonstrated corneal abrasion in the lower third of the left eye. The corneal abrasion healed in two days after topical treatment.
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Anestesia General , Lesiones de la Cornea , Dispositivos de Protección de los Ojos , Adulto , Quistes/cirugía , Humanos , Masculino , Enfermedades Dentales/cirugía , Raíz del DienteRESUMEN
BACKGROUND AND OBJECTIVES: Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. CASE REPORT: We managed a 60-year-old man with bronchial asthma and active wheezing under continuous epidural anesthesia using plain lidocaine. The wheezing gradually diminished 20 minutes after the epidural injection of 13 mL 2% lidocaine and completely disappeared over 155 minutes during continuous epidural injection of 2% lidocaine (6 mL/h). The plasma concentrations of lidocaine in arterial blood during the epidural anesthesia ranged from 2.5 to 3.9 microg/mL. Wheezing reappeared 55 minutes after termination of the continuous epidural injection of lidocaine. The plasma concentration of lidocaine at this time was 1.9 microg/mL. CONCLUSIONS: At clinically relevant concentrations, lidocaine in the blood absorbed from the epidural space may improve bronchospasm in patients with bronchial asthma.
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Anestesia Epidural , Anestésicos Locales , Asma/fisiopatología , Lidocaína , Ruidos Respiratorios/efectos de los fármacos , Anestésicos Locales/sangre , Aneurisma/complicaciones , Aneurisma/cirugía , Asma/complicaciones , Espasmo Bronquial/complicaciones , Espasmo Bronquial/fisiopatología , Arteria Femoral , Humanos , Lidocaína/sangre , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Hypohidrotic ectodermal dysplasia (HED) is a rare congenital anomaly complex characterized by hypodontia, hypotricosis and hypohidrosis. There have been only a few reports of anesthetic management of patients with HED. We managed a 20-year-old man with HED, who underwent debridement and skin grafting under epidural anesthesia, without untoward events. Potential problems in anesthetic management of patients with HED are also discussed.
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Anestesia Epidural , Procedimientos Quirúrgicos Dermatologicos , Displasia Ectodérmica/cirugía , Adulto , Nalgas , Desbridamiento , Humanos , MasculinoRESUMEN
Holt-Oram syndrome (HOS) is a rare disorder characterized by congenital anomalies of the upper limbs and heart. Cardiac arrhythmias are common in patients with HOS. We successfully managed a 24-yr-old woman with HOS who underwent laparoscopic ovarian cystectomy. Potential problems in the anaesthetic management of patients with HOS are discussed.
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Anestesia General/métodos , Cardiopatías Congénitas , Quistes Ováricos/cirugía , Adulto , Brazo/anomalías , Femenino , Humanos , Laparoscopía , SíndromeRESUMEN
Familial amyloid polyneuropathy (FAP) type I is a rare disease characterized by sensorimotor polyneuropathy, and autonomic nervous system and cardiac conduction system dysfunction. Severe bradyarrhythmia and hypotension may occur during anaesthesia and surgery in patients with the FAP type I. Only one report has been published of a patient with FAP type I who was managed with epidural anaesthesia. The present authors report a 38-year-old Japanese man with a permanent pacemaker because of advanced FAP type I who underwent rotation flap of the gluteus maximus muscle to cover a trophic ulcer in the sacral region under lumbar epidural anaesthesia. Ten millilitres of adrenaline (1:200,000) was injected around the ulcer prior to surgical manipulation. Neither bradycardia nor hypotension developed during the procedures. The haemodynamic changes under lumbar epidural anaesthesia in FAP type I are discussed.
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Neuropatías Amiloides/complicaciones , Anestesia Epidural , Adulto , Neuropatías Amiloides/fisiopatología , Epinefrina/farmacología , Hemodinámica/fisiología , Humanos , Masculino , Monitoreo Intraoperatorio , Úlcera Cutánea/cirugía , Vasoconstrictores/farmacologíaRESUMEN
An 8-year-old asthmatic child on theophylline was anesthetized with enflurane in nitrous oxide and oxygen. He developed a generalized muscle rigidity after intravenous succinylcholine. Although the maximum rectal temperature was 37.9 degrees C, a marked elevation in muscle-derived enzymes and myoglobinuria were observed. The relations among theophylline which is a derivative of xanthines, inhalation anesthetics, and myoglobinuria are discussed.
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Anestesia por Inhalación/efectos adversos , Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Enflurano , Mioglobinuria/etiología , Fármacos Neuromusculares Despolarizantes/efectos adversos , Succinilcolina/efectos adversos , Teofilina/uso terapéutico , Niño , Humanos , Masculino , Rigidez Muscular/etiología , Óxido Nitroso , OxígenoRESUMEN
We describe a patient in whom possible coronary artery spasm occurred during the infusion of trimetaphan. A 55-year-old man with a meningioma was scheduled for surgical excision of the tumour. He denied any previous history of chest pain. Anaesthesia was maintained with nitrous oxide (67%) in oxygen. The blood pressure before commencement of the surgery was 114/70 mmHg, and the pulse rate was 60 beats min-1. The blood pressure rose to 152/94 mmHg (the pulse rate to 62 beats min-1) during incision of the scalp, and intravenous infusion of trimetaphan was initiated. The blood pressure gradually decreased to 113/58 mmHg (the pulse rate 64 beats min-1) 10 min after start of this infusion, and premature ventricular contractions were evident on the electrocardiogram. Trimetaphan was withheld, and lignocaine was given intravenously. The premature ventricular contractions disappeared but ST segments were elevated. Glyceryl trinitrate was then infused intravenously. The ST segments remained elevated for 5 min, were depressed for 2 min and finally became isoelectric. There were no wide swings in blood pressure or pulse rate during the event. Post-operative laboratory examination revealed no evidence of myocardial infarction. Recovery of the patient was uneventful.