X-Message-Number: 7451
Date: 08 Jan 97 02:59:24 EST
From: "Steven B. Harris" <>
Subject: Cryopreservation Premedication, pt 3

The following is a BioPreservation, Inc. (BPI)
technical briefing on premedication of human
cryopreservation patients to mitigate the injury 
associated with antemortem and post mortem 

Contents copyright 1997 by BioPreservation, Inc. 
All rights reserved. 

Premedication of the Human Cryopreservation Patient 
Part III 
by Michael Darwin 

Psychosocial Considerations 
	As the above discussion should make clear, premedication  
carries with it risks which are determined to a large degree by  
the patient's medical condition, and psychological and social  
situation. Determining the most beneficial (or lowest risk)  
approach can only be done after the patient is carefully assessed  
in all these areas. 
	Psychosocial evaluation and intervention are covered in  
considerable detail elsewhere in this text. However, a few words  
specific to premedication are in order. Patients who have family  
and/or primary caregivers who are hostile to cryonics are  
generally not candidates for premedication. The same is true of  
patients who have diminished capacity, diagnosed psychiatric  
problems or who are obviously not fully capable of giving  
informed consent. The only exceptions to this rule are situations  
* Patients who are no longer competent have left an advanced  
directive or have a Durable Power of Attorney for Health Care  
(DPAHC) which specifies premedication.  
* The patient's medical surrogate (as appointed in their DPAHC)  
is aggressively supportive of premedication.   
* The spouse or parent(s) or guardian of the patient are  
cryonicists and are aggressively supportive of premedication. 
	Situations where unresolved hostility, paranoia and mistrust  
exist on the part of any of the key players in the patient's  
personal, social or medical milieu, whether directed at cryonics  
or not, are absolute contraindications to premedication. 
	Ideal situations are ones where the patient and family are  
long-time cryonicists, or where the patient has been pursuing  
alternative treatments that involve self administration of  
unapproved parenteral or category 6 medications. The latter  
situation, such as is often the case in HIV patients and younger  
patients with cancer or other unexpected degenerative diseases,  
almost invariably implies a person and caregiver(s) who have  
become knowledgeable about the mechanics of administering  
parenteral drugs, are willing to take risks, and are generally  
(but not always) capable of independent judgment and the ability  
to absorb and draw conclusions from the primary biomedical  
literature. Such a patient and caregiver(s) will be able to use  
the Internet and access biomedical databases and illness-specific  
special interest groups (SIGS) and thus get a wide range of  
independent information. The ability to critically evaluate the  
peer-reviewed scientific literature supporting premedication for  
ischemia-reperfusion injury is a strong plus in favor of  
providing the patient with information on premedication. 
Medical Considerations 
	In addition to the psychosocial situation, the patient's  
medical condition and treatment will determine whether  
premedication is appropriate and if it is, what its  
specifications will be. Clearly a patient who is dying in a  
hospital will not be a candidate for intervention with category  
4, 5 or 6 drugs. Similarly, a patient with gut failure, GI  
obstruction, or other contraindications to p.o. medication will  
not be able to benefit from many of the drugs likely to be of use  
in premedication. Beyond these logistical considerations come  
more subtle and potentially dangerous ones.   
	An exhaustive medical evaluation of the patient by his  
personal physician and by a physician knowledgeable about  
premedication (including the pharmacology of the drugs to be  
used) is absolutely essential. The purposes of such an evaluation  
are to: 
1) Rule out the possibility that the patient has a potentially  
treatable illness and is not terminally ill in the first place. 
2) Rule out underlying medical conditions which may  
contraindicate premedication in general or the use of specific  
3) Provide medicolegal documentation of the appropriateness  
(i.e., anticipated benefits and lack of contraindication) of a  
given premedication protocol for the patient. 
4) Provide a sound basis for determining the appropriate  
medications as well as their dose and route of administration. 
	The medical evaluation of the patient prior to premedication  
should include the following elements without exception: 
1) A comprehensive gathering, duplication (and retention) by the  
Cryonics Organization's Medical Director (COMD) of all of the  
patient's available medical records. 
2) A thorough medical review of the records gathered by the  
attending physician and the COMD with specialist consultation as  
3) Evaluation by a clinical laboratory (which the COMD has  
confidence in) of the patient's CBC, clotting status, TSH level  
and serum chemistries, at a minimum. 
4) Evaluation of current and projected nutritional status,  
caloric intake, assessment of macronutrient intake (with special  
attention to fat intake), and assessment of dietary micronutrient  
5) Determination of baseline serum antioxidant levels and redox  
status (Pantox Profile). 
6) Infectious disease screen including testing for HCV, HBV, HIV,  
TB and other etiologic agents as circumstances may indicate. 
Pantox Panel 
	Determining the patient's antioxidant status is a crucial  
first step in formulating a plan for premedication. In some  
cases, patients may already be supplementing with vitamins or  
trace minerals which are central to the basic premedication  
protocol discussed below. In all cases it is desirable to titrate  
the dose to the desired levels. This will be especially important  
in cases of compromise to the gut, malabsorbtion syndrome,  
noncompliance, and poor nutritional status. Poor nutritional  
status will mean low intake of macronutrients including fats,  
which act as facilitators of absorption for lipid soluble  
Pantox Profile 
	The patient's serum antioxidant profile will serve several  
functions in addition to establishing a baseline for  
premedication. It serves as a marker for overall nutritional  
status and it provides easy to understand visual feedback for the  
patient, showing him graphically where he is now versus where he  
needs to be. Response to premedication as evaluated by serum  
antioxidant levels also contributes to our understanding of the  
effectiveness of premedication both in acutely raising blood  
levels of these drugs and in moderating ischemic injury. 
Below is a table giving the normal range of serum antioxidants  
and pro-oxidants (such as serum ferritin) evaluated by Pantox  
testing. [Pantox Laboratories, San Diego CA (619) 272-3885]. 
Lipid Soluble Antioxidants	Normal Range	Units 
Coenzyme Q10 (Ubiquinol)	0.33 - 4.37	*M 
Alpha-tocopherol (Vitamin E)	23.0 - 78.0	*M 
Gamma-Tocopherol 	1.50 - 7.50	*M 
Lycopene	0.07 - 0.66	*M 
Beta-Carotene	0.25 - 4.20	*M 
Alpha-Carotene	0.04 - 0.50	*M 
Vitamin A	1.60 - 3.51	uM 
Lipid Protection Ratio	4.70 - 15.8	 
Water-Soluble Antioxidants 
Vitamin C	22.0 - 137	*M 
Uric Acid	246 - 569	*M 
Total Bilirubin	1.71 - 20.5	*M 
Direct Bilirubin	0.00 - 5.13	*M 
Iron Status 
Serum Iron	7.17 - 26.8	*M 
Iron Binding Capacity	44.8 - 71.6	*M 
Percent Saturation	11.2 - 51.7	% 
Available Binding Capacity	32.9 - 75.0	*M 
Serum Ferritin	27.0 - 450	ng/ml 
Table 7-1: Normal limits for serum antioxidants and pro-oxidants. 
	The results of an individual's Pantox panel are displayed  
graphically so that the patient can meaningfully evaluate where  
s/he stands and see progress towards reaching predetermined  
goals. Below are graphic examples of a Pantox profile on a  
typical 51 year-old smoker with end-stage primary adenocarcinoma  
of the lungs. The "ideal" levels shown on the graphics for  
antioxidants are the lower limits considered desirable for  
premedication for cerebroprotection. 

End of Part III 
To be continued. 
BioPreservation, Inc. 
10743 Civic Center Drive 
Rancho Cucamonga, California 91730 

(N.B.: For those following Usenet's sci.cryonics, it will 
be noted that the partitioning of this article is not the same
on Cryonet and Usenet.  On Cryonet, due to space limitations,
this article will eventually be presented in 7 parts, whereas 
on sci.cryonics it has already been posted in 4 parts.)

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=7451