Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Although the recommended dose of rectal acetaminophen (25-30 mg.kg-1) is twice that for oral administration (10-15 mg.kg-1), the literature justifies the use of a higher dose when acetaminophen is administered via the rectal route. We measured venous plasma acetaminophen concentrations resulting from 45 mg.kg-1 of rectal acetaminophen in ten ASA 1, 15 kg paediatric patients undergoing minor surgery with a standardized anaesthetic. After induction of anaesthesia, a single 650 mg suppository (Abenol, SmithKline Beecham Pharma Inc.) was administered rectally. ⋯ A 45 mg.kg-1 rectal dose of acetaminophen resulted in peak plasma concentrations comparable with those resulting from 10-15 mg.kg-1 of oral acetaminophen at three hours after suppository insertion. It is concluded that the delayed and erratic absorption of acetaminophen after rectal administration leads to unpredictable plasma concentrations. Rectal acetaminophen will not be consistently effective for providing rapid onset of analgesia in children.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Edrophonium requirements for reversal of deep neuromuscular block following infusion of mivacurium.
Mivacurium is a new non-depolarizing muscle relaxant consisting of three stereoisomers. The two active isomers (cis-trans and trans-trans) undergo rapid metabolism by plasma cholinesterase (t1/2 beta < 2 min). Due to its rapid elimination, the need for reversal of mivacurium-induced neuromuscular block is controversial, and to date there have been no studies evaluating reversal of deep blocks. ⋯ Two patients (PLAC group), had dibucaine numbers and cholinesterase levels consistent with an EUEA genotype, whereas the two patients with delayed recovery in the EDR-1 group had characteristics of a normal genotype. We conclude that a very low dose of edrophonium (0.125 mg.kg-1) hastens reversal of deep mivacurium-induced neuromuscular block by approximately four minutes, and that edrophonium doses exceeding 0.125 mg.kg-1 provide no additional benefit. Heterozygous patients with atypical plasma cholinesterase levels, as well as certain individuals with normal dibucaine numbers and plasma cholinesterase activity, are at risk for prolonged neuromuscular block, but the block is easily reversed with edrophonium.
-
Randomized Controlled Trial Clinical Trial
Intrathecal fentanyl prolongs sensory bupivacaine spinal block.
The purpose of investigation was to study the effect of intrathecal fentanyl on the onset and duration of hyperbaric bupivacaine-induced spinal block in adult male patients. Forty-three patients undergoing lower extremity or genitourinary surgery were enrolled to receive either 13.5 mg hyperbaric bupivacaine 0.75% + 0.5 ml CSF it, (Group I) or 13.5 mg hyperbaric bupivacaine 0.75% + 25 micrograms fentanyl it, (Group II) according to a randomized assessor-blind protocol. The onset and duration of sensory block were assessed by pinching the skin with forceps in the midclavicular line bilaterally every two minutes for first twenty minutes and then every five to ten minutes. ⋯ Fewer patients demanded pain relief in the fentanyl-treated group than in the control group in the early postoperative period (19% vs 59%; P < 0.05). Episodes of hypotension were more frequent in the fentanyl-treated group than in the control group (43% vs 14%; P < 0.05). We conclude that fentanyl, 25 micrograms it, prolonged the duration of bupivacaine-induced sensory block (sensory regression to L1 dermatone) by 28% and reduced the analgesic requirement in the early postoperative period following bupivacaine spinal block.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The triple airway manoeuvre for insertion of the laryngeal mask airway in paralyzed patients.
The efficacy of the triple airway manoeuvre (mouth opening, head extension and jaw thrust) for insertion of the laryngeal mask airway (LMA) was compared with the standard insertion method. One hundred paralyzed patients were allocated randomly into two groups: in the control group (n = 50) the LMA was inserted by the standard method, and in the other (TAM group, n = 50) by the triple airway manoeuvre. In ten patients of each group, the position of the LMA and the epiglottis was assessed radiographically before insertion, after insertion but before cuff inflation, and after cuff inflation. ⋯ After cuff inflation the glottis was completely visible fibreoptically in 66% in the TAM group, compared with 14% in the control group (P < 0.001). Complete downfolding of the epiglottis was seen in 10% in the control group and none in the TAM group (P < 0.05). We conclude that in paralyzed patients LMA insertion with the triple airway manoeuvre provides wider pharyngeal space and decreases the incidence of epiglottic downfolding by the LMA compared with the standard method.