European journal of anaesthesiology
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General anaesthesia and many types of acute respiratory failure are accompanied by a decrease in functional residual capacity (FRC). This reduction promotes closure of dependent airways and alveolar collapse, thus impeding ventilation of these regions. Perfusion, on the other hand, is forced towards dependent regions by lowered pulmonary vascular pressure and increased alveolar pressure. ⋯ Application of general positive end-expiratory pressure (PEEP) increases FRC and may improve gas exchange but cannot restore V/Q to normal. Differential ventilation, with equal distribution of ventilation between the lungs, and the application of PEEP solely to the dependent lung (selective PEEP) with the patient in the lateral position, improve V/Q matching and gas exchange with less impedance of cardiac output and less danger of barotrauma. This ventilation technique has proved successful in short-term experiments and in a small number of patients treated over several days.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Neuromuscular block: atracurium and vecuronium compared and combined.
The neuromuscular blocking action of atracurium and vecuronium acting separately and in combination have been compared using the evoked EMG of the adductor pollicis muscle. Dose response curves have been drawn for the drugs given separately and found to be nonparallel (P less than 0.05). ⋯ The effect on neuromuscular transmission of a combined medication using equipotent doses of atracurium and vecuronium, determined from the dose response plots, was found to be greater than would be expected by addition of their separate actions. The combination of small doses resulted in significant neuromuscular blockade.