European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium.
In order to compare the neuromuscular effects following rocuronium 0.6 mg kg-1 and atracurium 0.5 mg kg-1 30 children aged from 18 to 67 months were studied under the same anaesthetic conditions. After induction of anaesthesia with etomidate and fentanyl, neuromuscular blockade was monitored by recording the electromyographic response of the adductor pollicis muscle to a supramaximal train-of-four (TOF) stimulation of the ulnar nerve at 2 Hz for 2 s at 20-s intervals. Intubation was performed when more than 90% muscle relaxation was achieved, thereafter anaesthesia was maintained with 70% nitrous oxide in oxygen and isoflurane 0.5% end-tidal. ⋯ A statistically significant difference between rocuronium and atracurium also had been found for recovery of T1 to 50%, 75% and 90% as well as for the time taken to a TOF ratio of 70%. The recovery index for rocuronium and atracurium was not significantly different with 9.2 +/- 3.43 min and 10.9 +/- 2.65 min, respectively. Thus, rocuronium may be more advantageous than atracurium for short-lasting surgical procedures in young children.
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Randomized Controlled Trial Clinical Trial
Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy.
This study was undertaken to determine whether epidural analgesia has any benefit for post-operative pain relief in patients undergoing laparoscopic cholecystectomy. Patients were randomly assigned to receive post-operative epidural analgesia with a morphine-bupivacaine combination (Group A, n = 22) or placebo (saline) (Group B, n = 22). The same standard general anaesthetic technique, which consists of nitrous oxide and isoflurane in oxygen was used. ⋯ At 24 h after anaesthesia, pain scores in Group A (2.3 +/- 1.2) were lower than those in Group B (4.4 +/- 1.5) (P < 0.05). However, at 48 h post-operatively, no difference in scores was observed between the two groups. In conclusion, epidural analgesia with a morphine-bupivacaine combination improves pain relief during the first 24 h following laparoscopic cholecystectomy.
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Randomized Controlled Trial Clinical Trial
Effect of diluent volume on post-operative analgesia and sedation produced by epidurally administered midazolam.
We have studied the optimal diluent volume for post-operative analgesia and sedation produced by epidurally administered midazolam after upper abdominal surgery. Sixty patients were randomly allocated to four groups of 15 patients. When patients complained of pain after surgery, epidural midazolam 0.05 mg kg-1 in 3 mL saline (Group A), in 5 mL saline (Group B), in 10 mL saline (Group C) or in 15 mL saline (Group D) were injected as a bolus. ⋯ The interval to the second request for an analgesic was significantly shorter in Group D than in the other three groups. Memory retention of the pin-prick examination was reported by four patients in Group A. The present results indicate that 5-10 mL saline is the optimal volume for epidural injection when using midazolam 0.05 mg kg-1 for post-operative analgesia following upper abdominal surgery.
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Review Case Reports
Fatal air embolism: a complication of manipulation of a cavitating metastatic lesion of the liver.
A patient undergoing emergency laparotomy for an acute abdomen developed fatal air embolism as a result of surgical manipulation of a cavitating metastatic lesion of the liver. The diagnosis was made at postmortem examination. ⋯ The causes and management of air embolism are briefly reviewed. It is concluded that in exceptional circumstances when intubated patients are sent to a recovery area, the continuation of CO2 monitoring into the post-operative period should be considered.
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Comparative Study
Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients.
The prediction of difficult intubation in obese patients was investigated by co-estimating the degree of visibility of oropharyngeal structures in conjunction with the respective body mass index. Data were collected prospectively in a series of 1833 consecutive adult patients. Body mass index (BMI) in kg m-2 was used as a measure of obesity (morbid: > 40, moderate: 30-40, no obesity: < 30). ⋯ Statistical analysis revealed an increased risk of difficult laryngoscopy among obese patients compared with subjects with normal body mass index (20.2% vs. 7.6%, P < 0.001). When obesity is estimated with respect to oropharyngeal class the positive predictive value is greatly improved (66.7% vs. 20.2%, P < 0.001). We conclude that obesity which is associated with a disproportionately large base of the tongue, is a predisposing factor for difficult laryngoscopy.