Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialMivacurium: dose-response relationship and administration by repeated injection or infusion.
The dose-response relationship and neuromuscular blockade after infusion or repeated injection of mivacurium were studied in 65 patients in nitrous oxide-narcotic anesthesia. The ED95 (twitch tension) was determined in 45 patients by intravenous injection of a single bolus of 30, 39, 47, 54, or 60 micrograms/kg (9 patients per dose). Another 20 patients received an initial bolus of 2 x ED95 followed either by an infusion started at 5% twitch recovery (i.e., 95% depression) and adjusted to sustain 95% twitch depression (n = 10) or by repeated injection of 0.6 x ED95 whenever twitch tension had recovered to 25% of control (n = 10). ⋯ A 6 +/- 2 min recovery index was found after up to 10 repeat injections given every 9 +/- 3 min. There was no significant effect of neostigmine in both groups. In conclusion, the recovery indices after the infusion or repeat injection of near-equal doses of mivacurium were identical.
-
Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Clinical TrialAlkalinization of mepivacaine for axillary block.
We examined the onset and distribution of sensory blockade, the onset of motor blockade, and venous mepivacaine concentrations after axillary block with 1.25% mepivacaine with and without bicarbonate. There were no statistically significant differences between the alkalinized and placebo groups with respect to distribution of analgesia or anesthesia, time to onset of analgesia, or time to onset of paresis. ⋯ Concentrations of mepivacaine in venous blood did not differ significantly. We conclude that alkalinized mepivacaine offers the advantage of quicker onset of more profound blockade in several terminal nerve distributions.
-
This study quantitated the force applied during tracheal intubation to determine (a) whether the force differed among novice and experienced intubators, and (b) whether the force required differed when intubating patients' tracheas versus intubating the trachea of a commonly used training mannequin. We studied 27 tracheal intubations performed by 17 experienced (greater than 100 prior intubations) and 10 novice (less than 10 prior intubations) intubators. Each intubation was performed with a No. 3 Macintosh blade instrumented with strain gauges to determine force applied in the sagittal plane. ⋯ The only difference was in the impulse (force x duration), which was more for the novice group largely because of the longer average duration of intubation (40 +/- 12 s vs 19 +/- 4 s, P = 0.06). Among experienced intubators, we found that applied force correlated with patient weight and Mallampati class. Intubation of the Laerdal Airway Management Trainer required mean forces comparable to those required in patients (26.6 +/- 2.5 N vs 22.3 +/- 2.9 N), although the maximum force applied during the intubation effort was greater (58.3 +/- 4.7 N vs 43.2 +/- 4.7 N, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)