Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The hypothesis that histamine H2 receptor blockade adversely affects neuromuscular function was tested, in vivo, in rats anaesthetised with urethane during mechanical pulmonary ventilation. Succinylcholine was administered as a bolus and constant-rate infusion to maintain 49.2% (+/- 1.5 SEM) twitch suppression in 19 rats. Cimetidine iv, 3.2, 7.5, 10, 17.8, 23.7, 31.6, or 56.2 mg.kg-1 was then administered in groups of two to three rats. ⋯ There was a good relationship between peak potentiation and serum cimetidine concentration with 50% potentiation occurring at 46.5 (+/- 4.6) micrograms.ml-1. Potentiation at steady-state was not correlated to serum cimetidine concentration but there was a weak relationship between reversal and serum cimetidine concentration. These results support reports from patients of an interaction between cimetidine and succinylcholine.
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Operative charts were reviewed in 86 patients with Charcot-Marie-Tooth disease, a condition characterized by chronic muscular denervation. A total of 161 surgical procedures was performed. ⋯ Succinylcholine and malignant hyperthermia triggering agents were used in 41 (48%) and 77 (90%) patients, respectively, without untoward effects. Contrary to previous reports, this survey supports the safe use of succinylcholine and MH triggering agents in this disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
Supplemental maternal oxygen therapy during caesarean section under epidural anaesthesia: a comparison of nasal prongs and facemask.
Forty healthy parturients at term, undergoing elective Caesarean section, were divided into two groups to receive supplemental oxygen by either simple facemask (Group FM, 8 L.min-1) or nasal prongs (Group NP, 4 L.min-1) during the procedure. Anaesthesia was provided by epidural block to equivalent dermatomal levels in all patients. Maternal oxygen saturation was measured continuously with pulse oximetry and supplemental oxygen was provided to the mother after administration of the epidural test dose and continued until the end of the procedure. ⋯ There was no difference in the clinical condition of the neonates, as assessed by Apgar scores, or in the acid-base and oxygenation status, as assessed by blood gas analyses between the two groups. Mean umbilical vein oxygen saturation, a measure of fetal oxygen delivery, was 46 +/- 18% (95% confidence interval 39% to 54%) for Group NP and 54 +/- 17% (95% confidence interval 46% to 62%) for Group FM, again not different. We conclude that when the clinical condition, acid-base and oxygenation status of neonates, delivered by elective Caesarean section to healthy, low-risk parturients with normal placental function under epidural anaesthesia, are evaluated, it makes no difference whether the mothers received supplemental oxygen by nasal prongs or simple facemask.
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Randomized Controlled Trial Clinical Trial
[Peridural anesthesia for surgery of the ankle and foot: effect of the sitting position].
The effects of the sitting position on the quality of both sensory and motor blockade of segments L5 and S1 and the haemodynamic consequences during epidural anaesthesia were studied on 39 patients undergoing ankle or foot surgery. After insertion of an epidural catheter with the patient in the lateral position, 19 patients were kept sitting for 15 min following the injection of the local anaesthetic and 20 remained supine for the duration of anaesthesia (control group). All patients received a dose of 20 ml of 1.73% carbonated lidocaine with epinephrine 1:200,000. ⋯ Fourteen patients of the sitting group achieved motor blockade of more than three of five myotomes compared with five patients in the supine group (P less than 0.001). The maximum decrease in mean arterial pressure occurred sooner in the sitting group (14 +/- 9 min) than in the control group (21 +/- 10 min; P less than 0.01) and was more severe (-24 +/- 10% vs -16 +/- 10% respectively; P less than 0.05). Our results indicate that placing the patient in the sitting position for 15 min after inducing epidural anaesthesia does not influence caudal sensory blockade but does increase the depth of motor blockade.