Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1987
Comparative Study Clinical Trial Controlled Clinical TrialComparison of propofol and antagonised midazolam anaesthesia for day-case surgery.
A technique of midazolam/fentanyl/isoflurane/nitrous oxide anaesthesia, in which the benzodiazepine was antagonised by the specific antagonist, flumazenil, was compared with propofol/fentanyl/nitrous oxide anaesthesia for minor outpatient urological surgery. No significant difference was found in the overall ease of anaesthesia; however, using subjective (linear analogue sedation scales) and objective (letter deletion and simple reflex time) tests, recovery was found to be significantly slower for the antagonised midazolam group. ⋯ The midazolam group displayed the greatest degree of residual sedation at the 4-hour time of discharge and on arrival home a significantly larger number of patients in the midazolam group slept for a period. It is likely that the dose of flumazenil chosen (1 mg) was inadequate to completely antagonise the dose of midazolam (mean 17 mg) for the full duration of recovery.
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The efficacy of monitoring neuromuscular blockade during surgery based on visual assessment of the response to calf stimulation was determined in twenty-five patients. The calf stimulator was adjusted before the administration of any muscle relaxant to produce a brisk ankle jerk. Following an initial bolus dose of atracurium (0.5 mg/kg), further incremental doses (0.2 mg/kg) were administered when the response to calf stimulation was small and obvious. ⋯ The response to calf muscle stimulation often persisted after that resulting from ulnar nerve stimulation was abolished. The technique has only limited accuracy in assessing neuromuscular blockade. However, it may be useful in helping to avoid the wide fluctuations in blockade which are prone to occur with the intermediate duration competitive neuromuscular blocking agents.
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A survey was conducted to investigate the attitudes of anaesthetists and nurses to anaesthetic pollution. In order that the results could be viewed in context, attitudes to other possible occupational hazards, including radiation exposure and work-related stress, were also investigated. Four hundred (66%) completed questionnaires were returned. ⋯ Levels of concern were similar for radiation exposure; however, both occupational groups expressed higher levels of concern about work-related stress. Seventeen (21%) anaesthetists and 46 (14%) nurses reported having suffered adverse health effects which they thought were due to anaesthetic pollution. The most frequent complaints were headache and fatigue.