Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1990
Does suxamethonium influence the subsequent dose requirements of alcuronium and its reversibility in children?
Suxamethonium is often used for intubation prior to the use of a nondepolarizing muscle relaxant. This study was performed to determine whether suxamethonium altered the dose of alcuronium required to produce neuromuscular block. ⋯ Reversal with neostigmine was more rapid following 50 micrograms/kg than after 25 micrograms/kg. If recovery from neuromuscular block was greater than 25 per cent, the lower dose produced satisfactory reversal, whether or not suxamethonium had been given previously.
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Anaesth Intensive Care · Nov 1990
Rate-controlled analgesia: a laboratory evaluation of a new infusion device.
We report an evaluation of the Bard Harvard Mini Infuser, one of a new generation of agent-specific intraoperative infusion pumps which are designed for use by the anaesthetist. This pump permits potent intravenous anaesthetic agents to be used in pharmacokinetically designed dosage regimens. The controls are calibrated directly in kg body weight and micrograms per minute rather than the usual settings of ml of solution per hour. ⋯ Two points to note are that it must be purged every time before it is connected to the intravenous infusion and if an occlusion is suddenly relieved, the patient can receive an 'accidental bolus' of up to 1.18 ml of drug. The main advantage of this pump is that it uses undiluted drug direct from the ampoule and does not require any calculations or dilutions prior to use. However, this restricts its use to drugs with a concentration of 500 mcg/ml and in effect means that it is suitable mainly for infusion of alfentanil.
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This paper reports the results of a prospective survey of 266 attempted central venous catheterisations by various routes, evaluating their success rate and incidence of immediate complications and attempts to demonstrate a relationship between patient height in centimetres (H) and ideal catheter length. The overall rate of intrathoracic placement was 230 from 239 catheterisations (96%) after 266 attempts (86%). Of these 230 catheters, 54 terminated in the right atrium (24%). To avoid right atrial placement with its well documented risk of cardiac tamponade, it is recommended that right infraclavicular subclavian catheters are inserted to H/10-2 cm, right internal or external jugular catheters to H/10 cm and left external jugular catheters to H/10 + 4 cm.