Anesthesia and analgesia
-
Anesthesia and analgesia · Apr 1981
Correlation between anticurare activity of tetanic stimulation and neostigmine in anesthetized man.
Frequency and dose-dependent changes in neuromuscular transmission were examined in 70 patients undergoing elective surgical procedures requiring the use of muscle relaxants. Anesthesia was induced with sodium thiopental and maintained with N2O-O2 and fractional dose of meperidine or fentanyl. Neuromuscular block was produced and maintained at 80% level with incremental intravenous doses of d-tubocurarine. ⋯ At a frequency of 200 Hz tetanic fade was followed by complete but transient posttetanic decurarization. The original control twitch tension was not exceeded in posttetanic or postdrug responses. It is concluded that the transient after effects of tetanic stimulation are closely related to the anticurare effects of neostigmine.
-
Anesthesia and analgesia · Apr 1981
Characteristics of succinylcholine-produced phase II neuromuscular block during enflurane, halothane, and fentanyl anesthesia.
The characteristics of phase II neuromuscular block following repeated intravenous injections of succinylcholine (SCh) were determined in 15 adult patients during enflurane, halothane, or fentanyl-nitrous oxide anesthesia. The onset of phase II block (train-of-four ratio (T4) equal to 0.5) occurred following a cumulative SCh dose of 4.4 +/- 0.3 (SEM) mg/kg of enflurane, 5.1 +/- 0.5 mg/kg of halothane, or 6.4 +/- 0.5 mg/kg of fentanyl. The cumulative SCh dose producing phase II block during fentanyl-nitrous oxide anesthesia was significantly greater than during enflurane (p less than 0.01) or halothane (p less than 0.05) anesthesia. ⋯ The transition phase was delayed during fentanyl-nitrous oxide anesthesia, occurring after a cumulative SCh dose of 4 to 7 mg/kg. Following this transition, tachyphylaxis (decreased time between SCh injections) was observed in each study group. The T4 ratio in all three study groups stabilized at 0.15 to 0.25 after 7 to 8 mg/kg.
-
Sevoflurane, 3% and 4% in oxygen was administered to four dogs for 3 hours. Sevoflurane was metabolized to inorganic fluoride and hexafluoroisopropanol. Serum fluoride concentrations reached peak values during 2 to 3 hours into anesthesia and averaged 18.5 micrometer/L (n = 2) and 20.0 +/- 4.8 (mean +/- SD) micrometer/L (n = 4) following 3% and 4% sevoflurane exposure, respectively. ⋯ Immediately after anesthesia, observed mean (n = 6) serum fluoride concentrations were 2.9 +/- 0.5 micrometer/L and 2.5 +/- 0.6 micrometer/L, respectively. Hepatic microsomal enzyme induction produced by pretreatment with either phenobarbital or polychlorinated biphenyls (PCBs) resulted in an approximately 5-fold increase in serum fluoride concentrations following anesthesia with sevoflurane when compared to noninduced rats exposed to sevoflurane. A comparison of serum fluoride concentrations between the rat and dog indicates that the amount of sevoflurane metabolized is lower in the rat than in the dog, and the fluoride concentrations observed in both animal species during sevoflurane anesthesia are not expected to produce nephrotoxicity.