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
Sevoflurane anaesthesia in paediatric patients: better than halothane?
Forty-two children (aged 2-16 years) were randomly assigned to receive either sevoflurane (n = 21) or halothane (n = 21) in nitrous oxide/oxygen. After pre-medication with midazolam, anaesthesia was induced by facemask and the anaesthetic concentration was increased until loss of eyelash reflex (sevoflurane, 6%; halothane, 2.5%). Thereafter, 1-1.5 MAC of the inhalational agents were maintained until skin closure. ⋯ Emergence time with sevoflurane was 12.9 min vs. 16.3 min with halothane, but this difference was not statistically significant. It is concluded that sevoflurane is as suitable for paediatric patients as halothane. The slightly faster emergence time offered by sevoflurane over halothane was of no clinical significance in the present study.
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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.
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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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A 17-nation survey was undertaken with the aim of studying the availability of acute pain services (APS) and the use of newer analgesic techniques, such as epidural and patient-controlled analgesia (PCA). A questionnaire was mailed to selected anaesthesiologists in 105 European hospitals from 17 countries. Depending on the population, between five and ten representative hospitals from each country were selected by a country coordinator. ⋯ This survey of 105 hospitals from 17 European countries showed that over 50% of anaesthesiologists were dissatisfied with post-operative pain management on surgical wards. Only 34% of hospitals had an organized APS, and very few hospitals used quality assurance measures such as frequent pain assessment and documentation. There is a need to establish organized APS in most hospitals and also a need for clearer definition of the role of anaesthesiologists in such APS.