Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1996
Responses to nondepolarizing neuromuscular blockers and succinylcholine in von Recklinghausen neurofibromatosis.
Patients with type 1 neurofibromatosis (NF-1) have been reported to have prolonged responses to nondepolarizing (ND) neuromuscular blockers (NMBs). Responses to succinylcholine (SCh) have been described as increased, decreased, or normal. The purpose of this study was to assess responses to NMBs in NF-1 patients in order to determine the clinical significance of abnormal responses. ⋯ Standard milligram per kilogram doses of NMBs were used in all cases, and in none was there evidence of abnormal response. The risk of abnormal response to NMBs in individuals with NF-1 appears to be minimal. We recommend no alteration in dosing of either SCh or ND NMBs in patients with NF-1.
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Anesthesia and analgesia · Feb 1996
Displacement of the endotracheal tube caused by change of head position in pediatric anesthesia: evaluation by fiberoptic bronchoscopy.
Displacement of the endotracheal tube (ETT) caused by flexion and extension of the neck and the placement of a tongue depressor was investigated in 10 small children between the ages of 16 and 19 mo by means of a fiberoptic bronchoscope. The ETT tip moved a mean distance of 0.9 cm toward the carina with flexion and 1.7 cm toward the vocal cords with extension of the neck. After the placement of a tongue depressor, the ETT tip, which had once moved toward the vocal cords with neck extension, was displaced a mean distance of 1.2 cm toward the carina. Our results demonstrate that endobronchial intubation and accidental extubation could occur after significant changes of the head position and careless placement of a tongue depressor in small children.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Clinical TrialIntravenous lidocaine does not attenuate the cardiovascular and catecholamine response to a rapid increase in desflurane concentration.
This study was designed to investigate the effect of intravenous lidocaine on the sympathetic activity after a rapid increase in desflurane concentration. Twenty ASA grade I and II patients, were allocated randomly to a control group (C) and a lidocaine group (L). After induction of anesthesia with intravenous propofol 2 mg/kg and muscle relaxation with intravenous vecuronium 0.1 mg/kg, desflurane was given to achieve an end-tidal minimum alveolar anesthetic concentration (MAC) of 0.7 Group L received 1.5 mg/kg lidocaine intravenously, while Group C received an equal volume of 0.9% sodium chloride solution intravenously. ⋯ Plasma catecholamines were not significantly different between the groups. Intravenous lidocaine did not attenuate the sympathetic response to a rapid increase in desflurane concentration. It is unlikely that airway irritation is the cause of this phenomenon.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Comparative Study Clinical TrialCompound motor action potential recording distinguishes differential onset of motor block of the obturator nerve in response to etidocaine or bupivacaine.
The purpose of this investigation was to establish an objective (quantitative) method for determining onset time of motor block induced by different local anesthetics. Twenty-four consenting patients undergoing transurethral surgery during spinal anesthesia were randomized to receive direct obturator nerve block with 10 mL of plain bupivacaine 0.5% (n = 12) or 10 mL of plain etidocaine 1% (n = 12). Another 14 patients (control group) received obturator nerve "block" with saline. ⋯ While CMAP amplitudes in the control group returned to their initial (baseline) values after 3-6 min, the patients receiving etidocaine or bupivacaine achieved > or = 90% motor blockade after 6 and 13 min, respectively. In the present report, the time to > or = 90% block was significantly faster in patients given etidocaine compared with those given bupivacaine. We conclude that electromyographic recording of CMAPs can be used to compare the ability of different local anesthetics to induce motor block.