European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
The effects of midazolam followed by administration of either vecuronium or atracurium on the QT interval in humans.
Prolongation of the QT interval may produce potentially hazardous dysrhythmias. The effects on the QT interval of midazolam followed by administration of either vecuronium or atracurium have been investigated. Thirty patients, ASA I or II, without cardiovascular problems, electrolyte abnormalities or receiving any medication were studied. ⋯ Midazolam followed by administration of either vecuronium or atracurium did not produce any significant change in QTc interval (QT interval corrected for heart rate). Statistically significant prolongation of QTc was observed in both groups after intubation, although the mean QTc values did not exceed the upper limits of normal. Heart rate and arterial pressure were also increased significantly in both groups after intubation.
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Randomized Controlled Trial Clinical Trial
Optimum time for neostigmine administration to antagonize vecuronium-induced neuromuscular blockade.
We followed the recovery time course in 46 patients antagonized by neostigmine (0.036 mg kg-1) at different levels of vecuronium-induced neuromuscular blockade ranging from post-tetanic count 1 to train-of-four ratio 0.4 and in 15 patients during spontaneous recovery. Non-linear regression curve fit analyses showed that the optimal time for neostigmine administration was when the first twitch in the train of four (T1) was between 1% and 10%. ⋯ To achieve the optimum effect, neostigmine must therefore be given 32.6 min plus the required time for peak effect of neostigmine (5.3-7.1 min), i.e. 37.9-39.7 min, before train-of-four ratio 0.7 is reached. During spontaneous recovery this corresponds to a T1 between 1% and 15%.
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Randomized Controlled Trial Clinical Trial
Pre-emptive versus post-surgical administration of ketorolac for hysterectomy.
Seventy-seven women who underwent routine vaginal or abdominal hysterectomy were randomly allocated to receive intravenous ketorolac 30 mg either 30 min before surgical incision (pre-emptive group, n = 37), or at the end of the surgical procedure (post-surgical group, n = 40). The patients received routine post-operative care, which included morphine by patient-controlled analgesia, 1 mg per demand with a lockout of 6 min and a background infusion of 1 mg h-1. In addition, pain was assessed at 12 and 24 h using a 100 mm visual analogue scale (VAS), both at rest and on coughing. ⋯ There were no significant differences on univariate testing. Subsidiary stepwise multiple regression modelling identified age, weight, type of hysterectomy, and the timing of ketorolac administration as significant explanators of post-operative morphine consumption. A statistically significant pre-emptive analgesic effect was therefore identifiable, but the clinical significance is uncertain in relation to the other influences on post-operative analgesic requirements.
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Comparative Study
Continuous non-invasive blood pressure monitoring by brachial artery displacement method in high-risk surgical patients.
Continuous non-invasive blood pressure (CNBP) measurements were compared to invasive radial artery pressure recordings in 26 patients with cardiac, vascular and/or pulmonary disease. Patients were studied during general anaesthesia (n = 6), regional anaesthesia (n = 10), or combined technique (n = 10) for abdominal or transurethral surgery. CNBP was obtained from a cuff placed around the upper arm and simultaneously compared to invasive pressure from the ipsilateral radial artery. ⋯ During anaesthesia induction (n = 672) the difference between consecutive measurements (trend of pressure changes) with invasive and CNBP method exceeded 20 mmHg in 90 (13.3%) instances for systolic, in 33 (4.9%) instances for diastolic, and in 45 (6.6%) instances for mean blood pressure. In conclusion, the CNBP method by brachial artery wall displacement failed to measure the blood pressure reliably and to display the trend of pressure changes correctly during anaesthesia induction. In its present form this CNBP method should not replace invasive blood pressure monitoring in high-risk patients neither for anaesthesia induction nor during non-thoracic surgical procedures.
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Venous admixture as a measure of pulmonary gas exchange was studied before and during laparascopic cholecystectomy in 12 patients with normal healthy cardio-pulmonary function. After induction of anaesthesia the patients were studied by radial and pulmonary arterial catheterization and simultaneous arterial and mixed venous blood gas sampling in the horizontal, 15-20 degrees head-down and 15-20 degrees head-up tilt positions. After establishing the pneumoperitoneum (PP) by insufflation of carbon dioxide to an intraabdominal pressure level of 11-12 mmHg, the measurements were repeated in the same positions. ⋯ These changes were maintained during pneumoperitoneum and were not influenced by posture. It is suggested that alterations in the distribution of ventilation and/or lung perfusion results in a reduced venous admixture during PP without surgery. In addition, there was no indication that venous admixture is elevated as a result of laparoscopic surgery in the reversed Trendelenburg position.