European journal of anaesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
Spontaneous EMG activity for detection of arousal during general anaesthesia--comparison between recordings from frontal and neck musculature.
Monitoring of the spontaneous electromyographic activity of the frontal muscles (FEMG) is used for detection of impending arousal during general anaesthesia. Since the irritation caused by an endotracheal tube in situ might enhance the sensitivity of neck muscles in detecting arousal, EMG recordings from sternocleidomastoid muscles (NEMG) were compared to FEMG recordings under five different clinical conditions with 10 patients in each group. ⋯ The results thus support our initial hypothesis and favour the use of neck muscles for monitoring. This, however, does not allow simultaneous recording of EEG through the same electrodes.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrapleural bupivacaine analgesia after thoraco-abdominal incision for oesophagectomy.
Intrapleural bupivacaine administration is said to produce good analgesia for the pain induced by a subcostal incision. However, reports of its efficacy after thoracotomy are conflicting. The goal of this study was to compare the analgesia produced by intrapleural administration of bupivacaine after oesophagectomy using a thoraco-abdominal incision with that obtained from intrapleural saline. ⋯ Plasma bupivacaine concentrations on Day 1 after the first intrapleural bupivacaine injection were less than 350 ng ml-1; on Day 4 after the last injection they were less than 1300 ng ml-1. In conclusion, intrapleural administration of bupivacaine produces effective analgesia after oesophagectomy performed with a thoracoabdominal incision. The technique is easy to perform and is safe.
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It has been shown that an epidural test dose with adrenaline does not always detect an intravascular injection in halothane-anaesthetized children. To ascertain whether test dosing with other agents might be more useful, we sought to determine if and at what dose levels three different intravenous drugs (adrenaline, isoprenaline and 1% lignocaine with 1/200,000 adrenaline) produced an increase in heart rate (HR) in halothane-anaesthetized lambs. Eight 2-week-old lambs were anaesthetized with 1% halothane in oxygen. ⋯ This increase did not occur in all lambs, and dysrhythmias were manifest in some. Isoprenaline always produced a significant increase in HR without dysrhythmias whether atropine was given or not. We conclude that in halothane-anaesthetized lambs, isoprenaline is a more reliable indicator of intravascular injection than adrenaline.
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Comparative Study Clinical Trial Controlled Clinical Trial
Neuromuscular effects of pipecuronium bromide.
The neuromuscular effects of pipecuronium bromide have been evaluated in 90 adult patients anaesthetized with thiopentone, nitrous oxide in oxygen and intravenous fentanyl with or without halothane. Eighty patients received pipecuronium 45 micrograms kg-1 and the remaining ten 70 micrograms kg-1. A separate group of 10 patients received pancuronium in a dose of 60 micrograms kg-1 (equipotent to pipecuronium 45 micrograms kg-1). ⋯ The time to onset of complete block with 70 micrograms kg-1 of pipecuronium averaged 2.5 min and the duration to 25% recovery 95 min. There were no significant changes in heart rate and arterial pressure with the use of pipecuronium. The results show pipecuronium to be a drug resembling pancuronium in its neuromuscular effects when used in equipotent doses.