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What an intriguing anecdote. Makes me wonder whether this lipophilic tenacity is
a component of post surgical acuity decrements.
Dale Bikin, Pharm D
Banner Good Samaritan Pharmacy
1111 E McDowell, Phoenix, AZ 85006
> May I add another anecdote from anaesthetics to illustrate your point about
> different clearance from different compartments? Back in the 1970's Professor
> Prys-Roberts of Bristol UK was working on the cardiovascular effects of the
> volatile anaesthetic halothane in pigs. The animals had a good life for several
> months after the experiment but eventually the time came for slaughter, but what
> to do with the corpse? The meat could not go on the usual market so it was
> decided to keep it for a departmental lunch to which I was invited. To
> everyone's horror the only taste from the meat was halothane, one of the most
> unpleasant culinary surprises I have ever had.
> I guess it was a tribute to the lipophilicity of that molecule since the pigs
> had ben given their last halothane many months before their end. That and the
> extraordinary sensitivity of human taste buds
> Andrew Sutton
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It's something I have often wondered about, whether anaesthesia is a kind of
chemical assault that takes time to recover from. A factor against slow
clearance is that modern anaesthetics have much more rapid clearances yet many
patients still seem to get into a depressed state that I assume includes acuity
decrements. It also occurs when they have only had a local anaesthetic.
Perhaps all the tension before the op uses up some kind of energy that it takes
time to replace.
The beauty of a steriodal IV anaesthetic called Althesin that I worked on in the
1980s was the brilliant recoveries. Most patients woke up in a distinctly bright
and alert mood and I thought it was no coincidence that it was a steroid. Most
people don't know that progesterone will put people to sleep if infused IV and
that may be a useful sedative phenomenon during pregnancy when the placenta is
producing quite a lot of it. A sleepy foetus is a good idea in my, (and I
imagine most mothers') view but a hangover would not be appropriate for the
mother. Unfortunately Althesin was solubilized in cremophor and that caused
anaphylactic reactions. Propofol now seems to have cornered the market so it
will never be revived in a better solvent or as an emulsion.
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