Clinical Impressions on the Use of Largactil at Shaughnessy Hospital*

THE term "artificial hibernation" first aroused our interest in Largactfl. Huguenard (2) produces a state of "artifical hibernation," which has many of the characteristics of true hibernation, by means of a diffuse blockade c,f the whole autonomic nervous system, peripherally, at the synapses, and eentraUy. Thus the patient, his autonomic system unable to respond to injury, would be protected from shock produced by his own defenee reactions. This state is achieved by the use of the now well-known "Lyric cocktail," in which Huguenard combmes a dozen or more "lytic" chugs. 'Iqae Phenothiazine derivatives, Phenergan, Diparcol, and Largactil, however, are the main constituents of this cocktail. Their effects are essentially similar, but Huguenard considers Largactfl as the most important single agent in his technique. The chemical, physical, and pharmacological properties of Largaclal have been most adequately described in the literature so only a brief r~sum~ of its effects as related to anaesthesia will be considered. Largaetfl has depressant action on the central nervous sysl~em which has not yet been completely defined. This depressant activity produces in many subjects a state of disinterestedness, sometimes described as a pharmacodynamic lobotomy. Reduced metabolism, hypothermia, absence of central vomiting, ahtagomsm to central nervous system stimulant~, and enhancement os the action of general anaesthetics, hypnotics, and analgesics are also reflections of this central depression. Largactil not only produces muscle relaxation by a central action similar to that of myane~in, but also enhances the effect of Flaxedil, which acts peripherally. This drug is an active adrenergic blocking agent. Parasy-mpatheric functions, on the other hand, are inhibited only by larger doses of Larg~ctS~. Laboratory experiments show that, as well as exerting some protective action on haemorrhagic and traumatic shock, the compound has a definite stabilizing effect on adrenalin-induced cardiac arrhythmias. Finally it should be noted that the drug is very irritant to tissues. Apparently th~ property depends on the concentration of the drug and not its low pH (5.8--5.6), and it is recommended that the drug be given deeply intramuscularly or diluted when given intravenously Largaetil has now been used in Shaughnessy Hospital in a total of 880 male patients.