Scribd Logo
Upload

Welcome to Scribd!

  • Intravenous IV Ethyl Alcohol Therapy (Cowley 1955)

    Uploaded by

    Al_Coda
    32 views4 pages
    From the American Journal of Nursing, March 1955. Vol. 55. No. 3

    Original Title

    Intravenous IV Ethyl Alcohol Therapy(Cowley 1955)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    From the American Journal of Nursing, March 1955. Vol. 55. No. 3

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    32 views4 pages

    Intravenous IV Ethyl Alcohol Therapy (Cowley 1955)

    Uploaded by

    Al_Coda
    From the American Journal of Nursing, March 1955. Vol. 55. No. 3

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 4
    Intravenous Ethyl Alcohol Therapy The addition of alcohol to parenteral solutions helps to control the patient's pain and improve his nutrition. 1. MEDICAL ASPECTS By Howard S. Cowley uconot and various aleoholic mixtures for Intravenous in- fusions have been used for centuries for thelr analgesic as well as ancs- thetic effects; they were used ex- tensively by’ the Russians - during World War 1 (1, 2, 3, 4). It has long. been recognized that ‘alcohol acts as a rapid depressant of the central nervous system, and when employed parenterally it raises the pain thresh~ ‘ld by Inhibitation of the same sys- tem. In addition to its analgesic property it also has sedative, hyp~ note, dluretic, vasodilator, and ant pyretie effects(5). Alcohol affects the cerebrum, spinal cord, and respir tory center in. that order, whereas morphine and similar narcotics simultaneously affect the ccrebrum and respiratory center and, to a lesser extent, the spinal cord re- fexes(6). Ethyl alcohol in doses sulicient to produce vasodilation and the symp~ toms of mild inebriation does not effect the cerebral blood flow, or cerebrovascular resistance, but the patient’: body temperature and blood Dresture are slightly reduced and the pulse and respiration rate are slightly Increased(7). ‘The nutritional nceds of patients who are unable to take sufficient food or fluids orally has stimulated a growing demand for parenteral solu- ins which can meet the normal calorie requirements but not increase the fluid volume. As a result, not only vitamins but alcohol have been added to various commercial preparations of saline, dextrose, and hydrolyzed pro- teins, to increase the calorie value of the solution. “Alcohol has a caloric value of ap- proximately 57 calories per gm. however, the debate regarding the ‘extent to which these calories are utilized for werk energy continues. Moore and Karp are of the opinion that alcohol intravenously increases the calorie intake and protects car~ bohydrates, proteins, and body fat MARCH 1955 © VOL. 53, NO. 3 because it is a readily available and vunstorable source of eneray(8) Coffey recommended it to prevent the depletion of reserve carbohy- Grates and proteins—especially the former; although itis not available as 1 food it will be burned in preference to sugar when both are taken simul~ taneously(9). He further points out that acidosis, headaches, nausea, and vomiting are not concomitant ‘with ethyl alcohol infusions as they are when comparable amounts are taken by mouth. ts analgesic ‘with a wide margin of safety between therapeutic, toxie, and lethal dosage. For analgesia and sedation the blood level range of alcohol varies from 07 to 3 ce. per kilogram of body weight, depending upon an_individ- vual’s tolerance. The toxic dosage is approximately 7 ce. per kilogram of body weight(4). Alcohol is not fatal until a concentration of 05 percent De. Cowley is chil of the neuro legal wir, the Meena Ad work, Kena fof the total blood volume is reached (10). According to Mueller a 30 per cent blood concentration Is necessary to hemolyze red blood cells and this could not occur with § percent ethyl alcohol solutions(11). Admininteat Various commercial solutions of § percent cthyl alcohol solutions for Intravenous use are now given routinely, not only for their analgesic effect, but also for temporary mai tenance of nutrition in both operative and nonoperative patients, on our neurosurgical service. We have ob- served 103 neurosurgical patients who have been given ethyl alcohol ine fusions rather than the usual nar- cotics for the relict of pain. Alcohot infusions were not given to patients who had a proved or suspected liver damage, epilepsy, or shock. ‘The solutions ‘are alwoys shaken prior to administration to prevent layering: they are kept at room tem- perature as cold solutions tend to cause pain and discomfort along the vein selected for infusion. ‘We have found that the most sat~ Isfactory results are obtained by a rapid infusion—within 15 or 20 min~ lutes—ef 200 ce. of one of the com- mercially prepared alcohol solutions and then usunlly setting the fow, depending upon the individual's toler= 100 drops per minute. This’ rate maintains 9 blood alcohol level varying from 0.7 to 16 ce. per Kilogram of body weight; it takes approximately four hours for the re maining solution to run In. A more rapid rate of infusion results in ex= cessive alcohol accumulating in the blood with resultant incbriation, rest lessness, nausea, and vomiting. Every patient must be closely observed, as the reaction of each individual's cen~ tral nervous system is unpredictable. Infusions begun in surgery are sven to keep the blocd alcohal level slightly above the metabolic rate However, it Is imperative that al- cohol-dextrose-protein hydrolysate solutions are not given in combination ‘with intravenous sodium pentothal fas precipitates are formed inthe blood. However, these solutions may be used prior to the administration ‘of sodium pentothal anesthesia. Analgesic and Sedative Effects When intravenous alcohol is given preoperatively, the patient Is not ap- prehensive: he is relaxed, drowsy, and cuphoric. The need for ther ‘pre ‘operative sedation is eliminated. ‘During surgery less sodium pento~ thal is needed to produce sleep and some of the disadvantages of sodium pentothal anesthesia—respiratory de pression, Inryngospasm, and past operative depression—are minimized when intravenous alcohol has been lven before surgery. ‘The effect of alcohol on respiratory minute valume tends to prevent post operative ntelectasis(12). ‘This Is probably due to the rapid oxidation of Intravenous alcohol into oxygen fand earbon dioxide; the latter acts as ‘respiratory stimulant(13). Some anesthetists feel that the risk of surgery for cardine patients is decreased because alcoho! has been considered an effective coronary artery vasodilator(14). According, to Russck and his coworkers, how ever, there is neither clinical nor ‘experimental evidence to support this a5). 303 Frequently patients have amnesia regarding procedures that were car ried out under local, regional, oF spinal anesthesia. ‘They feel better postoperatively, suffer much less pain and discomfort, ‘and their consumption of and desire for opiates and barbiturates is ma- terially decreased. The incidence of headache, nausea, and vomiting fol- lowing surgery is decreased and ‘catheterization is seldom necessary. During the first postoperative day the patient may require ane or two infusions depending upon the type of ‘surgery. which was. performed. and the individual's tolerance. Usually he will remain drowsy and sleep without discomfort for about six hours after the infusion is terminated When pain at the operative site dic~ tates, another 1000 ce. Infusion may be given, Since the analgesic and sedative effects take about 20 minutes the Infusion should be started before the pain is severe. ‘As a rule intravenous infusions are not used for more than 48. hours, either for pain control or nutrition: usually they are not necessary. Howe ever, we have used, preoperatively from two to three infusions dally fo six to cight days for patients who had lossopharyngeal neuralgia due to Dharyngeal carcinoma, and who were ‘elderly, emaciated, and uddicted to narcotics. The resuit from the stand point of both pain control and im- proved nutrition were gratifying in all Instances. Local reactions caused by displaced needles ‘with subsequent infiltration ‘of fluid into the subeutancous tissues have been few and trivial. Occasional complaints of mild burning can be promptly and easily alleviated by ap- plying warm, moist compresses t0 the patient's arm. We have not observed fany Instances of venous sclerosis re sulting from the 5 percent ethyl al oho! solutions. Nutritional: Effects Although the most effective mothod of nutritional therapy Is via the gas~ trolntestinal: tract, occasionally. the intravenous method is more practical, ccepecially for short periods of time, as patlents who are unable to eat may be fglven adequate amounts of assimilable fats, protein, and carbohydates. When ‘nutrition and pain contral can both be achieved by the same infusion it be~ comes more practical. ‘Adding 100 ce. of 95 percent ethy! alcohol to 2000 ce. of 5 percent dex- trose almast doubles the caloric value. We prefer to use solutions containing 5 percent hydrolyzed amino acids, 5 percent glucose, and 5 percent ethyl alcohol to which vitamins Band C hhave been added. 04 Accepting’ the fact that minimal daily caloric requirement for a healthy individual is 2000 ealories, we can assume that the basal metabolic requirements as well as. the dally fluid requirement for a patient at bed rest and unable to take oral feedings to be approximately 2000 cc. of Parenteral solutions containing per- cent dextrose and 5 percent ethyl alcohol (16). Basal calories not provided by food are obtained from all three of the ‘nutritional body clements fat, carbo- hydrate, and protein (in that order) ‘at the expense of the lssues contain- ing these elements. ‘Although body fat is the most readily available intrinsic source of calories a supply of glucose must be resent to prevent acidosis. Glucose Is essential for the metabolism of both {fat and protein. Postoperative starva- tion results in the rapid depletion of liver glycogen which must be re- synthesized from amino acids which hhave lost the nitrogen value necessary {or tissue growth and repair. Thus the addition of alcohol which is burned In preference to simultaneously in= jected glucose protects all three of the ‘nutritional body clements(&9). Vita- mins B and © are essential for pro tein metabolism and wound healing, and when added to solutions contain- ing ethyl aleohol they do not lose their potency. Best and Taylor set one gram of normal dietary: protein per kilogram of body weight. as. the requirement for a. healthy individual(16). This amount may need to be doubled o tripled for the sick patient. Elman and numerous other investigators hhave shown conclusively that most postoperative patients are in a nega- tive state of caloric and nitrogen balance (17). Amino acids from which protein is synthesized are the only source of the nitrogen required by ‘ll body tlasue for growth and repair. If nitrogen Is not provided by food or parenteral feeding it is removed from the protein-contalning body tissues and utllized in tissues which have an urgent need for it(18). This re- sults in loss of energy, loss of nutri= tional reserve, muscular atrophy, and degenerative liver changes. ice has shown that the combina- tion of glucose, alcohol, and amino acids in solution will establish strong, positive nitrogen balance (19). ‘Weinstein has proved that hydro- lyzed protein solutions are effective in maintaining a state of positive nitrogen _belance following surgery (20). Ellin and his colleagues have emphasized that the utilization of these hydrolyzed proteins ts depend- ‘ent upon the simultaneous Injection ‘of high concentrations of carbohy- drate, as the latter increases nitrogen retention and tissue synthesis; even though the nitrogen intake remains constant the nitrogen retention is increased (21). Rice and others fur- ther demonstrated this with similar solutions containing ethyl alcohol (22). Summary Ethyl alcohol infusions are effective analgesic and sedative agents and possess diuretic, antipyretic, and nu- tritive effects as well. They must be administered necording to the indi- vidual's tolerance, metabolism, and pain. We encountered few contrain- dications to its use on our neuro surgical service. In combination with dextrose, hy- drolyzed proteins, and vitamins, ethyl alcohol infusions alleviate pre- and postoperative starvation, favor a positive nitrogen balance, maintal hydration and nutritional ‘require- ments, promote wound healing, and help to decrease the period of acute ‘ines. Tn our experience the patients seem. to feel generally better, develop fewer postoperative sequelae, and require less opiates and barbiturates than the patients who did not receive alcohol Infusions. ‘id ed, Phila: fee Co. 1B, Bb. ores. Ellis 4 Some, Danze C, and Kas, Harecutiay oat ieee te ee eee se Ub mice 'S* Sint Nor Meee ph hy, 2 TE ce Pana oes 8, 2 Boies 2 meant eran Beaten fem Aleey Sa, « Extn, Sine A. Sina Heer Dig ‘Sitaders Sna'Go, Be gE THE AMERICAN JOURNAL OF NURSING SS Rog. Howe, an orm. Ala dia Sat katate

    You might also like