Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The potency of vecuronium was reported to be greater in Montréal than in Paris. This study was designed to determine whether there were differences in onset, duration, and reversibility with neostigmine between both centres. Twenty ASA I or II adults (ten men, ten women), aged 18-65 yr were studied in each of the two cities, during a standard thiopentone-fentanyl-nitrous oxide (60-70%) - isoflurane 0.5% end-tidal anaesthetic. ⋯ Duration from injection to 25% first twitch recovery was shorter (28.5 +/- 6.8 min) in Paris than in Montréal (39.1 +/- 7.3 min) (P < 0.0001). Time from injection of neostigmine to a train-of-four ratio of 70% was not different in Paris (6.3 +/- 2.2 min) from Montréal (5.6 +/- 1.9 min). It is concluded that the duration of an "intubating" dose of vecuronium is longer in Montréal, but, when given at 25% first twitch recovery, neostigmine has the same efficacy in Montréal as in Paris.
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Comparative Study
Evaluation of cost minimization strategies of anaesthetic drugs in a tertiary care hospital.
A survey was undertaken to compare anaesthetic drug expenditures over a three-year period, to evaluate the impact of strategies offered to curtain continuously rising drug costs. Suggestions to control rising expenditures were based primarily on education of staff and residents regarding drug costs, emphasizing rational use of the more expensive drugs, and minimizing drug wastage. To assess the impact of these measures, a review of annual hospital budgets, global pharmacy expenditures, and anaesthetic drug expenditures was conducted for the period 1991 to 1993. ⋯ For the entire survey period, the mean cumulative anaesthetic drug cost was 4.6% of the pharmacy budget, or 0.24% of the hospital budget. Analysis by drug class revealed a $51K decrease in expenditures on OA. due to decreased utilization of fentanyl and alfentanil, and a decrease in the price of fentanyl. The increased expenditure on INH drugs was primarily due to an increase in acquisition costs.(ABSTRACT TRUNCATED AT 250 WORDS)
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A combination of the lumbar plexus and sciatic nerve blocks using 2-chloroprocaine (2-CP) for unilateral lower extremity anaesthesia was studied. The purpose of this work was to evaluate the efficacy of 2-CP for ambulatory surgery of short duration with this combination of blocks. Twenty-five patients ASA 1 and 2 were studied. ⋯ The mean duration of the sensory block was 88.7 +/- 20.9 min, 83.3 +/- 16.4, 79.7 +/- 17.8 min and 93.7 +/- 22 min for the sciatic, femoral, obturator and lateral femoral cutaneous nerves respectively. Success rate was 92% and no major complication occurred. We conclude that a combination of the lumbar plexus and the sciatic nerve blocks with 2-CP is a useful technique for ambulatory surgery of short duration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Omeprazole reduces preoperative gastric fluid acidity and volume in children.
To explore the effects of oral omeprazole on preoperative gastric fluid pH and volume in children, 104 healthy in-patients aged 4-9 yr were randomly allocated to four groups (n = 26). Subjects in the Omeprazole-Omeprazole Group received two doses of omeprazole (20 mg per dose), those in the Placebo-Placebo Group, two doses of placebo, those in the Placebo-Omeprazole and Omeprazole-Placebo Groups, one dose each of the two preparations by mouth. For each treatment regimen, the first medication was administered at 9:00 p.m. on the night before surgery and the second at 5:30 a.m. on the morning of the day of surgery (three hours preoperatively). ⋯ The administration of omeprazole at bedtime before surgery increased gastric pH (3.3 +/- 1.3 vs 2.0 +/- 0.6, P < 0.05) in comparison with placebo, as did two doses of omeprazole (pH = 4.8 +/- 1.6, P < 0.05). A single dose of omeprazole administration on the morning of the day of surgery failed to increase gastric pH. There was a reduction in the number of children with a pH < 2.5 and a volume > 0.4 ml.kg-1 in the Omeprazole-Omeprazole and Omeprazole-Placebo Groups, compared with the Placebo-Placebo or Placebo-Omeprazole Groups.(ABSTRACT TRUNCATED AT 250 WORDS)