Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1983
Twitch depression and train-of-four ratio after antagonism of pancuronium with edrophonium, neostigmine, or pyridostigmine.
During N2O-O2-halothane anesthesia pancuronium (3 mg/70 kg) was antagonized with neostigmine (2.5 or 5 mg/70 kg), pyridostigmine (10 or 20 mg/70 kg), or edrophonium (50 or 100 mg/70 kg) in 36 human subjects (6 in each group). Reversal was attempted at 10% spontaneous recovery of muscle twitch, which was measured using train-of-four stimulation. ⋯ It was concluded that the three antagonists have different mechanisms of action. In comparison with neostigmine, edrophonium is more and pyridostigmine is less effective at presynaptic (or fade) receptors.
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Laser surgery offers several advantages to the surgeon and patient: microscopic precision, a bloodless operative field, and complete sterility. While the majority of procedures pose few problems beyond protection of the eyes of operating room personnel and patients, microlaryngeal surgery with the CO2 laser requires very careful anesthetic management. A preoperative visit to determine the degree of existing airway obstruction is mandatory in deciding the safest anesthetic technique. ⋯ We have reviewed selected aspects of the management of the patient undergoing laser surgery, outlined the principles of laser technology, and listed the many surgical procedures employing lasers. Also, recommendations on anesthetic management of microlaryngeal surgery with the CO2 laser with emphasis on currently available measures to prevent problems were reviewed in light of our own experience with this technique along with a summary of the literature on laser surgery. An understanding of the fundamental principles and applications of lasers will hopefully lead to safer patient care.