European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients.
Rocuronium administration may cause tachycardia and an increase in cardiac index. Pancuronium, another steroidal non-depolarizing muscle relaxant, augments release of, and blocks re-uptake of catecholamines at adrenergic nerve endings. This study compared the haemodynamic effects of, and changes in catecholamine concentrations following administration of vecuronium (0.12 mg kg-1) or rocuronium (0.9 mg kg-1) to elderly patients. ⋯ Plasma noradrenaline concentrations were similar in the vecuronium and rocuronium groups prior to muscle relaxant administration (589(SD240) and 444(SD213) pg mL-1, respectively), 1 min after muscle relaxant administration (602(SD220) and 520(SD392) pg mL-1, respectively) and 1 min after tracheal intubation (597(SD351) and 440(SD181) pg mL, respectively). There was no significant change in either plasma noradrenaline or adrenaline concentrations in either group following muscle relaxant administration or tracheal intubation. The use of rocuronium (0.9 mg kg-1) in elderly patients does not result in a clinically significant change in heart rate, blood pressure or plasma catecholamine concentration.
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Randomized Controlled Trial Clinical Trial
Clonidine prolongs fentanyl-induced ventilatory depression.
The aim of the present study was to investigate the effect of intravenously (i.v.) administered fentanyl and clonidine on ventilation in 12 healthy male volunteers (age 30.8 +/- 4.9 years) who either received fentanyl alone (1.5 > or = micrograms kg-1) or fentanyl (1.5 > or = micrograms kg-1) in combination with clonidine (3 > or = micrograms kg-1). The effect on ventilation was measured with a CO2 rebreathing system. The respiratory depression caused by fentanyl disappeared 120 min after injection. ⋯ An impaired ventilatory response was observed during CO2 rebreathing at t120 after the injection of fentanyl and clonidine. Before drug administration, the slope of the response curves was 7700 +/- 2800 mL kPa-1, which was reduced to 5480 +/- 2135 mL kPa-1 (P < 0.035) at t120. These data suggest a prolongation of a fentanyl-induced ventilatory depression when used in combination with clonidine.
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Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. ⋯ Several hours after surgery, there was no significant difference between the two groups. These results can be explained by a granulocyte and monocyte refractory response developing subsequent to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play a role in reperfusion injury.
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This case report describes the peri-operative management of a 48-year-old woman with three cerebral aneurysms and phaeochromocytoma. The pharmacological and anaesthetic management of such patients is complex, and needs to be managed carefully by titrating anaesthetic agents and vasoactive drugs. The primary concern is the maintenance of cerebral perfusion pressure and autoregulation throughout the procedure, although these states cannot be monitored directly. The patient survived the operation neurologically intact, and it is presumed that the course of management which was chosen helped to achieve this result.
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Morphine is recommended as the strong opioid of choice by the World Health Organization (WHO) for cancer pain management. It is associated with delay in gastro-intestinal transit; as a result, patients may experience marked constipation. We describe a case of intestinal pseudo-obstruction associated with the use of oral morphine in a terminally ill cancer patient.