Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1987
Randomized Controlled Trial Comparative Study Clinical TrialA clinical comparison of atracurium and vecuronium in women undergoing laparoscopy.
In a double-blind, prospective, randomised trial in 30 women undergoing laparoscopy, atracurium and vecuronium were compared in equipotent (2 X ED95) doses. In the atracurium group, first twitch depression was significantly greater at one minute, and degree of fade significantly greater at one and two minutes, but thereafter neuromuscular monitoring showed no significant difference between the groups. Clinically there was no significant difference between the drugs. ⋯ Reversal and recovery were comparable in the two groups. Neostigmine was required in all patients and in three (one atracurium, two vecuronium) a second dose was required in all patients and in three (one atracurium, two vecuronium) a second dose was administered on clinical grounds. Antagonism of the neuromuscular block is required with surgery of this duration despite the intermediate duration of action of the relaxant drugs.
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A review of the Accident Compensation Corporation (ACC) files on dental damage following anaesthesia or surgery was undertaken along with a survey of New Zealand anaesthetists asking about their practice with respect to protection of teeth during anaesthesia. These results confirm that damage is relatively common and that the majority of damaged teeth (62%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. The anaesthetists surveyed thought that dental damage was even more common than shown from the ACC records, and yet the vast majority of them did not routinely use specific protective guards and 45% of them did not ever use protective guards of any type.
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Six disposable heat and moisture exchangers were tested on patients undergoing anaesthesia requiring mechanical ventilation. Inspiratory humidity and temperature were monitored to find the steady-state values reached with each device together with the times taken for these to be achieved. The exchangers were tested in a non-rebreathing T-piece circuit and in a conventional circle system with a fresh gas flow of 6 l/min: the Siemens 150 provided 28 and 32 mg of water/litre of inspired gas (at about 30 degrees C) in 10 and 5 min respectively, but is rather heavy and bulky. ⋯ The Pall is also a very effective bacterial filter and has been found to be satisfactory in the intensive care setting. The Terumo appeared to perform no better than a circle system with catheter mount (13 mg/l at 27 degrees C). It would seem that more complex humidification equipment is not necessary during anaesthesia if an efficient heat and moisture exchanger is used.